Skip to main content

Full text of "Medical record"

See other formats 


This  is  a  digital  copy  of  a  book  that  was  preserved  for  generations  on  library  shelves  before  it  was  carefully  scanned  by  Google  as  part  of  a  project 
to  make  the  world's  books  discoverable  online. 

It  has  survived  long  enough  for  the  copyright  to  expire  and  the  book  to  enter  the  public  domain.  A  public  domain  book  is  one  that  was  never  subject 
to  copyright  or  whose  legal  copyright  term  has  expired.  Whether  a  book  is  in  the  public  domain  may  vary  country  to  country.  Public  domain  books 
are  our  gateways  to  the  past,  representing  a  wealth  of  history,  culture  and  knowledge  that's  often  difficult  to  discover. 

Marks,  notations  and  other  marginalia  present  in  the  original  volume  will  appear  in  this  file  -  a  reminder  of  this  book's  long  journey  from  the 
publisher  to  a  library  and  finally  to  you. 

Usage  guidelines 

Google  is  proud  to  partner  with  libraries  to  digitize  public  domain  materials  and  make  them  widely  accessible.  Public  domain  books  belong  to  the 
public  and  we  are  merely  their  custodians.  Nevertheless,  this  work  is  expensive,  so  in  order  to  keep  providing  this  resource,  we  have  taken  steps  to 
prevent  abuse  by  commercial  parties,  including  placing  technical  restrictions  on  automated  querying. 

We  also  ask  that  you: 

+  Make  non-commercial  use  of  the  files  We  designed  Google  Book  Search  for  use  by  individuals,  and  we  request  that  you  use  these  files  for 
personal,  non-commercial  purposes. 

+  Refrain  from  automated  querying  Do  not  send  automated  queries  of  any  sort  to  Google's  system:  If  you  are  conducting  research  on  machine 
translation,  optical  character  recognition  or  other  areas  where  access  to  a  large  amount  of  text  is  helpful,  please  contact  us.  We  encourage  the 
use  of  public  domain  materials  for  these  purposes  and  may  be  able  to  help. 

+  Maintain  attribution  The  Google  "watermark"  you  see  on  each  file  is  essential  for  informing  people  about  this  project  and  helping  them  find 
additional  materials  through  Google  Book  Search.  Please  do  not  remove  it. 

+  Keep  it  legal  Whatever  your  use,  remember  that  you  are  responsible  for  ensuring  that  what  you  are  doing  is  legal.  Do  not  assume  that  just 
because  we  believe  a  book  is  in  the  public  domain  for  users  in  the  United  States,  that  the  work  is  also  in  the  public  domain  for  users  in  other 
countries.  Whether  a  book  is  still  in  copyright  varies  from  country  to  country,  and  we  can't  offer  guidance  on  whether  any  specific  use  of 
any  specific  book  is  allowed.  Please  do  not  assume  that  a  book's  appearance  in  Google  Book  Search  means  it  can  be  used  in  any  manner 
anywhere  in  the  world.  Copyright  infringement  liability  can  be  quite  severe. 

About  Google  Book  Search 

Google's  mission  is  to  organize  the  world's  information  and  to  make  it  universally  accessible  and  useful.  Google  Book  Search  helps  readers 
discover  the  world's  books  while  helping  authors  and  publishers  reach  new  audiences.  You  can  search  through  the  full  text  of  this  book  on  the  web 

at  http  :  //books  .  google  .  com/| 


Digitized  by 


Google 


Digitized  by 


Google 


in 


Digitized  by 


Google 


Digitized  by 


Google 


Digitized  by 


Google 


Digitized  by 


Google 


The  Medical  Record. 


^  Smi-S[t0nt^lj  lournal  of  ItAinne  ani  Surprj. 


EDITED    BY 


GEORGE  F.  SHRADY,  M.D. 


-•-•♦v- 


MARCH  1,  1867— FEBRUARY  15,  1868. 


«*H#»H 


NEW  YORK: 

WILLIAM   WOOD    &   COMPATSTY, 

61    WALKER    STREET. 

Digitized  by 


Google 


'fi 


THE  NEW  YORK  PRINTING  COMPANY, 
81,  8^,  and  Zs  Cmire  street. 
New  York. 


Digitized  by 


Google 


The  Medical  Record, 

2L  Sietni-iaantljlji  Jffutnol  of  itteVtcine  antr  Surgerg. 


Vol.  2. 


New  York,  March  1,  1867. 


No.  25. 


€)rigmal  Cownun'ttatiimg. 


THE  MEDICAL  USE  OF  ELECyTRICITY. 
Bt  a.  H.  BEABD,  M.D.,  akd  A.  D.  ROCKWELL,  M.D., 

or  R«V   TOCB. 

No.  IL 

It  was  onoe  remarked  by  a  distinguished  philosopher 
thai  ''we  may  be  sure  that  a  scieoce  is  in  its  infancy 
when  its  advocates  are  particularly  dogmatic  in  the 
expression  of  their  beliefe. 

Judffed  by  this  standard,  the  science  of  the  medical 
use  of  electricity  is  just  emerging  from  infancy  into 
childhood,  for  its  disciples  are  far  less  positive  in  the  de- 
claration of  their  views  in  regard  to  the  unsettled  points 
connected  with  it^  than  were  the  original  investigators 
fifteen  years  ago.  A  brief  survey  of  the  history  of  re- 
cent explorations  in  this  department  will 'fully  explain 
our  meaning.  In  1850,  Duchenne,  of  Boulogne,  published 
a  work  entitled,  *'  Exposition  d'une  Nouvelle  ^ethode 
de  Ghilvanization,  dite  Galvanization  Localised,"  in  which 
he  announced  the  leading  idea  of  his  system,  namely, 
that  "  one  can  localize  the  electric  stream  over  a  fixed 
point  under  the  skin,  if  the  end  of  a  conductor  be  cover- 
ed with  a  moist  sponge,  and  strongly  pressed  upon  Uie 
skin."  In  1855,  he  published  another  work,  an  epitome 
of  five  years  of  experience,  entitled,  "  De  I'Electrization 
LocaUse^  et  de  son  Application  ^  la  Physiologie,  4  la  Pa- 
thologie,  et  ^  la  Therapeutique.''  This  book  excited  not 
a  little  attention^  and  really  created  an  era  in  medical 
scienoe.  It  aroused  the  enthusiasm  of  the  author's 
countrymen,  who  had  the  opportunity  of  witnessing 
his  brilliant  demonstrations,  and  was  abridged  for  the 
Oerman  physicians,  by  Dr.  Erdmann.  But  the  number 
of  those  who  were  inspired  to  enter  the  list  as  investi- 
gators was  comparatively  small.  Like  all  the  original 
explorers  in  this  department,  Duchenne  laid  special  stress 
on  his  physiological  experiments.  At  no  era  of  medical 
fldence  had  there  been  found  any  considerable  number 
in  any  country  who  were  willing  and  able  to  devote 
Uieir  lives  to  purely  experimental  researches  that 
achieve  no  direct  practical  resulta  While  Duchenne 
had  astonished  both  himself  and  the  scientific  world 
by  the  novelty  of  his  experience,  neither  be  nor  his 
admirers  were  fully  alive  to  the  immense  therapeutical 
value  of  his  discoveries.  As  a  consequence,  the  cause  of 
electro-therapeutics  would  not  be  espoused  by  those 
who  felt  compelled  to  turn  all  their  endeavors  to  practi- 
cal account^  and  but  very  few  of  those  who  warmed  into 
enthusiasm  over  his  demonstrations  were  willing  to  occu- 
py themsesLves  exclusively  in  the  same  field.  But  Meyer 
dr  Beiiin,  Bfiderlacher  of  Numberg,  Althaus  of  London, 
made  a  specialty  of  this  department^  and  have  published 
works  in  which  the  method  of  Duchenne  is  adopted 
18  the  basis.  Bemak,  of  Berlin,  was  one  of  the  few 
who  were  sufficiently  alive  to  the  value  of  Duohenne's 
eiqteriments  to  pursue  the  subject  still  further,  and 
in  1866  h^  enAbodied  his  experience  in  a  work  entitled 


"  Ueber  Methodische  EUctrisirung  Oddhmter  MushdnJ' — 
"On  the  Methodical  Electrization  of  Paralysed  Mus- 
cles " — ^in  which  he  announced  a  system  entirely  differ- 
ent from  that  of  Duchenne,  and  became  the  leader  of 
an  opposite  school  The  leading  idea  of  his  work  was 
this:  "That  in  order  to  bring  a  muscle  to  complete 
contraction,  it  is  far  better  to  excite  its  motor  nerves 
than  to  allow  the  stream  to  operate  upon  the  muscular 
substance  itself." 

Moreover,  he  employed  the  galvanic  stream  almost 
entirely,  while  Duchenne  had  performed  his  experiments 
with  the  faradaic  current.  Remak  reported  astounding 
cures,  but  at  first  failed  in  enlisting  the  sympathy  of  the 
profession.  Subsequently,  however,  he  learned  wisdom 
by  experience,  and  became  more  wary  in  his  statements, 
and  cahner  in  his  manner  of  expression.  Graduidly  the 
profession  accorded  to  him  their  confidence,  and  some 
of  the  ablest  minds  of  Germany — among  whom  we  may 
name  Benedict,  Schulz,  Meyer,  Neumann,  BosenthaJ, 
Frommhold,  and  Eulenberg — are  numbered  among  his 
disciples.  For  some  time  a  fierce  and  unreasonable  con- 
troversy was  carried  on  between  Remak  and  Duchenne, 
which,  both  in  its  character  and  in  its  results,  singularly 
reminds  one  of  the  fabled  story  of  the  knights  who 
quarrelled  over  the  pictures  on  the  opposite  side  of  the 
pubUc  sign.  Eemaic  contended  for  the  appUcation  of 
the  galvanic  stream  on  the  motor  nerves,  while  Du- 
chenne persisted  that  the  best  results  were  obtained 
with  the  faradaic,  or  induced  current,  on  the  muscles 
themselves. 

At  a  public  trial  in  Paris  (as  we  are  informed  by  Qar- 
ratt),  Remak  demonstrated  on  a  living  subject  that  so  &r 
as  producing  contraction  of  a  muscle  goes,  the  induced 
current  applied  to  the  motor  nerves  is  far  less  painful 
than  whenappUed  to  the  muscular  substance,  ^ut  so 
far  as  the  general  remedial  effects  of  electricity  are  con- 
cerned, both  were  in  the  right,  as  is  now  tolerably  well 
established. 

So  far  as  is  yet  ascertained,  the  remedial  effects  of 
electricity,  whether  employed  in  the  form  of  galvanisa- 
tion or  Atradaization,  are  governed  by  no  fixed  laws. 
Experience  is  our  only  guide  in  tlieir  use.  All  the  in- 
vestigatioDS  of  scientific  men  have  thus  far  failed  in  re- 
duciag  to  any  system  the  different  therapeutical  effects 
of  the  galvanic  and  the  faradaic  or  induced  currents. 

Although  there  has  been  not  a  little  speculation  on 
this  very  theme,  and  although  numberless  experiments 
have  been  instituted  with  a  view  to  establishing  the 
superiority  of  the  one  or  th6  other,  yet  we  believe  that 
the  most  progressive  and  candid  of  the  investigators  of 
the  present  day  are  willing  to  admit  that  the  whole 
subject  is  yet  in  chaos.  It  has  been  found  that  the 
brilliant  results  that  Remak  obtained  by  the  galvanic 
stream  can  also  be  secured  by  the  use  of  the  secondary 
current,  and  it  has  also  been  found  that  they  are,  so  fiir 
as  we  can  judge,  very  capricious  in  their  effects,  setting 
at  defiance  all  the  attempts  of  inquiring  minos  to  re- 
duce their  employment  to  a  logical  system. 

Those  who  are  accustomed  to  use  the  various  kinds 
of  electricity,  namely,  the  galvanic  or  constant  stream 
from  a  large  number  of  elements,  and  the  primary  and 


THE  MEDICAL  RECORD. 


secondary  induced  current  of  the  electro-magnetic  ma- 
chine, testify  that  while  all  are  beneficial,  no  one  has 
been  found  to  be  so  superior  to  the  others  as  to  justify 
its  exclusive  use.  It  has  been  thought  that  the  galva- 
nic stream  was  more  serviceable  in  rheumatic  and  neu- 
ralgic a(rection!9,  and  in  paralysis  dependent  on  central 
nerve  derangements ;  but  this  is  very  for  from  being 
/established. 

There  are  cases  where  at  first  the  induced  current 
♦rCts  more  speedily  than  the  galvanic  stream,  which 
cases,  later  on,  seem  to  be  more  amenable  to  the  latter. 
On£  day  a  patient  may  present  himself  with  a  rheuma- 
tic disorder  that  is  at  once  relieved  by  faradaization,  and 
the  next  day  another  patient  with  precisely  the  same 
disease,  at  precisely  the  same  stage,  is  more  speedily 
aided  by  galvanization. 

More  ihan  that,  there  are  cases  which  at  the  beginning 
of  the  searice  are  benefited  by  galvanization,  and  before 
its  close  yield  to  faradaization.  Nay,  further,  there  are 
instances  where  one  form  of  electricity  seems  to  irritate 
for  tiie  time  being,  while  the  other  at  once  calms  and 
sootbas.  What,  then,  is  the  law  of  their  operation  ? 
There  is  none,  so  far  as  can  be  determined  in  the  pre- 
sent atate  of  our  pathological  knowledge,  and  there  is 
no  guide  to  their  use  except  experience.  The  German 
investigators  have  carefully  studied  the  effects  of  the 
different  forms  of  electricity  in  exciting  muscular  con- 
tractioB3,  and  they  have  refined  this  subject,  as  it  ap- 
pears to  us,  to  an  absura  ^n4  profitless  excess. 
Ziemssec  has  experimented  largely  on  the  dead  subject, 
snd  has  ascertained  the  particular  border  points  that 
are  mostisusceptible  to  the  electrical  influence. 

It  i^as  been  very  clearly  established  that  muscu^ 
lar  contraction  is  produced  more  completely  and  with 
less  pain  when  the  electrodes  are  placed  on  the  "  border 
points"  where  the  motor  nerve  enters  the  muscle,  than 
when  applied  to  the  bellies  of  the  muscles  themselves. 

With  these  views  of  Remak  and  Ziemssen  our  expe- 
rience fiilly  accords.  We  have  found  that  in  certain 
cases  of  atrophy  and  loss  of  power,  where  wo  fail  in 
producing  contractions  by  application  directly  over  the 
muscles,  we  do  succeed  very  unaccountably  by  pressing 
the  fingers  along  and  underneath  the  borders  of  the 
same  muscles. 

We  have  focnd  that  some  inveterate  cases  of  rheu- 
matism that  evinced  no  signs  of  yielding  when  the 
hand  was  applied  in  a  general  way,  at  once  took  a  fo- 
vorable  turn  when  the  fingers  were  pressed  along  and 
underneath  the  borders  of  the  muscles  concerned. 

But  important  as  is  this  fact,  it  is  hardly  worthy  of 
the  attention  it  has  received  at  the  hands  of  some  of  the 
German  investigators. 

Ziemssen  and  Rosenthal  seem  to  act  on  the  supposi- 
tion that  electricity  is  chiefly  usefidin  cases  of  paralysis, 
whereas  its  proudest  victories  have  been  gamed  over 
long-standing  dyspepsia,  constipation,  neuralgia,  ame- 
-nonhoea,  chorea,  hysteria,  and  other  disorders  connected 
with  enfeebled  vital  organs,  and  a  deranged  nervous 
system. 

On  the  other  hand,  we  have  found  that  the  different 
forms  of  paralysis  tnat  present  themselves  to  us  for 
treatment  give  far  less  speedy  and  satisfactory  results 
to  the  electrical  treatment  than  almost  any  other  form 
of  disease.  And  yet  physicians  and  the  laity  are  pos- 
sessed with  the  idea  tliat  paralysis  is,  par  excellence,  the 
disease  that  justifies  the  use  of  the  battery. — Our  pre- 
sent knowledge  of  the  therapeutical  value  of  the  differ- 
ent forms  of  electricity  may  be  thus  summed  up : 

1st.  Q-alvanization  and  faradaization  are  of  so  nearly 
equal  value  in  paralytic,  rheumatic,  and  neuralgic  affec- 
tions, that  we  are  hardly  justified  in  employing  one  to 
the  exclusion  of  the  other.    It  would  seem  that  the 


best  results  are  obtained  when  they  are  used  with  al- 
ternations and  variations,  according  to  the  indication  of 
their  effects. 

2d.  Muscular  contractions  are  excited  with  the  least 
pain  and  most  speedily  when  the  electrode  (either  a 
sponge,  a  metal,  or  the  hand)  is  applied  along  the  edge 
of  the  muscle,  and  especially  at  the  border  point  where 
the  motor  nerve  enters  the  muscular  substance. 

3d.  The  ascending  faradaic  current  has  a  great 
power  of  exciting  muscular  contractions,  and  stimulating 
the  nerves,  and  is  especially  indicated  in  local  paralysis, 
anchylosis,  and  plastic  effusions.  Applied  through  the 
body  with  the  positive  pftle  at  the  feet,  its  effects  are 
not  unfrequently  very  disagreeable. 

4th.  The  descending  faradaic  current,  thoroughly 
applied,  with  the  negative  pole  at  the  feet,  is  a  tonic  and 
corrective  of  far  greater  ejficaey  ihan  ar,y  other  remedy  or 
comhinxxtion  of  remedies  now  known  to  science.  Judi- 
ciously given,  it  can  never  work  harm,  save  in  cases  of 
pulmonary  tuberculosis,  and  in  such  cases  we  rarely 
employ  it 

5th.  The  hand  is  by  far  the  best  electrode,  and  for  the 
following  reasons: 

(a)  It  is  more  effective,  from  its  wondrous  power  of 
adaptation.  The  fingers,  better  than  sponge  or  metallic 
electrode,  can  feel  their  wav  along  the  border  of  the 
muscles  and  press  towards  the  deeper  tissues. 

(6)  By  no  other  instrument  can  the  patient  receive 
the  same  quantity  of  electricity  with  so  little  irritation, 
particularly  when  applied  on  the  head,  or  over  any  sen- 
sitive diseased  organ. 

6th.  Although  paralysis  in  its  differenX  forms  is 
usuaUy  more  benefited  hy  electricity  ihan  by  any  system 
of  internal  medication,  it  is  yet  among  the  least  tractable 
of  the  various  diseases  ihat  present  themselves  for  this 
method  of  treatment. 

Tth.  The  diseases  which  are  found  to  yield  most  readily 
and  surety  to  the  different  forms  of  electricity  in  the  various 
modes  of  application,  are  neurcdgia,  dyspepsia,  rheuma- 
tism of  the  mbacute  and  chronic  varieties,  chronic  bron^ 
chUis,  constipation,  amenorrhoea,  anoemiaj  hysteria^  and 
general  debility, 

.8th.  The  electric  streams  are  of  great  value  as  adju- 
vants in  the  diagnosis  of  disease,  inasmuch  as  any  devi- 
ation fi*om  its  normal  sensitiveness  of  any  part  to  their 
influence  is  readily  indicated.  In  this  way  we  learn 
where  the  disease  is  located,  although  we  may  not  be  able 
to  determine  its  precise  nature. — In  order  to  illustrate 
more  clearly  to  the  profession  the  method  and  result  of 
our  treatment  by  faradaization,  we  propose  to  give  in 
detail  some  of  the  more  interesting  cases  of  the  various 
forms  of  disease  in  which  we  haye  employed  it.  We  can 
hardly  expect  that  the  bare  statement  of  the  curative 
powers  of  electricity  will  receive  absolute  credence 
without  the  presentation  of  some  typical  examples. 

Even  Remak  himself  (as  stated  above)  at  first  expe- 
rienced not  a  little  difficulty  in  gaining  the  confidence 
of  scientific  men.  So  easy  is  it  to  represent  on  paper 
what  is  very  difficult  to  practically  achieve,  and  so  ready 
are  specialists  to  dignify  their  own  peculiar  method  of 
treatment  to  the  exclusion  of  all  others,  that  we  cannot 
hope  for  the  full  appreciation  of  the  wondrous  powers 
of  electricity,  except  bv  those  in  the  profession  who 
may  be  led  to  employ  tne  descending  foradaic  current 
as  faithfully  and  persistently  as  we  have  ourselves. 

Neuralgia. — This  horrible  affection,  which  so  often 
disheartens  both  physician  and  patient,  we  have  found 
to  yield  to  the  persistent  application  of  electricity,  as 
uniformly  perhaps  as  anyother  disease,  unless  it  may 
be  nervous  dyspepsia.  Whether  it  exists  either  in  the 
weakly  or  the  strong  it  is  always  greatly  alleviated  and 


THE  MEDICAL  RECORD. 


generally  cored,  sometimes  by  a  few  applications,  in 
other  cases  by  a  protracted  treatment 

Indeed  otir  unexpected  success  in  certain  cases  did 
mach  to  stimulate  us  to  make  special  investigation  on 
the  whole  subject  of  electricity. 

Case  First — ^In  the  latter  part  of  August  of  last  year, 

Mr.  B ^  a  broker  down  town,  came  to  our  oflBce 

complaining  of  a  severe  neuralgia  of  the  back  of  the 
head  and  neck,  that  bad  rendered  his  life  miserable  for 
one  year  and  a  half.  He  had  consulted  many  physi- 
cians and  had  taken  much  medicine,  but  had  iouna  little 
relief.  He  was  a  tall,  well  formed,  muscular  man,  with 
a  hard,  full  face,  that  suggested  great  native  vigor  of 
constitution. 

With  not  very  strong  assurance  of  hope,  either  on 
our  part  or  on  his,  the  treatment  by  the  descending 
feradiuc  current  was  recommended  and  commenced  on 
the  5th  of  September.  He  was  relieved  on  the  first 
application,  which  was  a  very  thorough  one,  and 
extended  oyer  all  the  vital  organs.  On  the  8th  of  Sep- 
tember he  again  came  for  treatment,  and  reported 
himself  as  much  improved.  On  the  10th  4ie  reported 
himself  as  being  entirely  free  from  pain.  Another  appli- 
cation was  l^en  made,  and  he  bade  us  good-by,  prepa- 
ratory to  going  into  the  country.  We  c6uld  hardly 
bdieve  that  the  cure  could  be  anything  more  than  tem- 
porary, and  were  not  surprised  wnen  he  again  presented 
oimself  on  his  return  and  informed  us  that  his  old  enemy 
had  made  him  another  gentle  visit 

We  gave  him  another  thorough  application.  A  short 
time  since  he  called  at  our  office,  and  informed  us  that 
up  to  that  time  he  had  been  perfectly  welL 

Case  Second. — Miss  H.  The  following  case  proves 
that  that  most  distressing  and  persisting  of  all  neuralgic 
troubles,  tic  douloureux,  may  be  cured  where  medication 
has  failed. 

This  patient  presented  herself  for  treatment  in  the 
early  part  of  September,  expressing  herself,  however,  as 
having  but  little  hope  of  experiencing  more  than  a 
Bhght  temporary  relie£ 

Previously  she  had  been  treated  by  electricity  with 
some  short-lived  benefit;  sufficient,  however,  at  that 
time  to  inspire  her  with  hope.  She  was  doomed  to 
diiappointment,  for  in  a  very  few  weeks  the  paroxysms  of 
intt  nse  pain,  which  before  had  made  her  life  miserable, 
returned  with  greater  severity  than  ever.  As  she  told 
her  story,  the  sudden,  sharp,  shooting  pains  in  her  &ce 
would  every  few  minutes  cause  her  in  agony  to  hold  her 
speech.  To  such  an  extent  had  this  mysterious  disease 
affected  her  that  occasionally  her  tongue  seemed 
almost  paralysed,  and  at  times  her  utterance  was 
thick  and  broken.  These  fi-equent  and  terrible  par- 
oxysms had  left  imprinted  on  her  pale  face  an  ex- 
pression of  constant  care  and  suffering.  Her  own  esti- 
mate of  the  value  of  life  was  that  death  waspreferable 
to  an  existence  of  such  constant  agony.  Her  physi- 
cian had  tried  almost  everything  in  the  materia  medica 
supposed  to  be  beneficial  in  such  cases ;  and  so  without 
delay,  doubting  yet  hoping,  we  commenced  treatment 
by  teradaization.  The  patient  came  every  other  dav, 
and  for  the  first  two  or  three  times  only  a  comparatively 
nuld  current  was  given. 

The  strength  was  gradually  increased,  but  no  improve- 
ment was  manifest.  After  the  seventh  or  eighth  appli- 
catioa,  however,  a  current,  as  strong  as  the  operator 
and  patient  oomd  well  bear,  was  given  for  fifteen  or 
twenty  minutes,  at  each  sitting,  and  in  addition  to  the 
external  application,  the  tongue  was  thoroughly  electri- 
fied by  means  of  a  metallic  spatula.  From  this  time  a 
rapid  in^rovement  was  noticed. 


The  paroxysms  occurred  less  frequently  and  with  less 
severity.  She  discontinued  treatment  on  the  20th  of 
October,  having  had  no  return  of  pain  for  three  weeks. 
Up  to  this  date,  January  2.  she  baa  had,  so  far  as  we  can 
learn,  no  return  of  her  trouble.  Whether  in  this  par- 
ticular case  the  cure  is  ahsoJiUtely  permanent  it  is  of 
course  impossible  to  say:  but  enough  is  known  to  con- 
vince the  patient  and  tnose  who  knew  her  that  the 
benefit  denved  was  great  and  incalculable. 

Tic  Douloureux,  as  is  well  known  by  any  who  may 
have  had  much  experience  in  the  application  of  elec- 
tricity for  the  disease,  b  the  most  difficult  to  cure  or 
benefit  of  all  neuralgic  affections. 

Of  the  neuralgias,  the  cervico-occipital,  intercostal, 
lumbo-abdominal,  and  cephalalgia,  are  all  in  the  vast 
majority  of  cases  speedily  cured;  and  although  some 
cases  of  fitcial  neuralgias,  which  have  resisted  all  treat- 
ment by  medication,  still  fail  to  be  benefited  by  electri- 
city, yet  it  is  our  experience  that  the  great  majority 
even  of  such  cases  are  permanently  cured  by  persistent 
treatment 

Case  Third. — The  power  of  electricity  over  neuralgia 
of  a  specific  character  was  very  well  illustrated  in  the 
caj?e  of  a  Mrs.  B.,  sent  to  us  by  Dr.  Oummings. 

When  she  first  consulted  us  she  represented  that  for 
years  she  had  been  suffering  from  a  terrible  neuralgia 
m  the  head,  and  which  at  times  attacked  other  parts  of 
the  body.  For  six  wee^s  the  pa'n  had  been  so  severe 
that  she  had  been  umible  to  pursue  her  usual  avocation, 
which  was  that  of  an  operator  on  a  sewing-machine. 
She  was  a  plump,  fleshy  individual,  with  full  round 
cheeks,  indicative  of  anything  but  delicate  health.  In- 
deed so  vigorous  did  she  seem  that  we  told  her  that 
only  local  applications  would  be  necessair  in  her  case, 
and  accordingly  directed  her  to  place  her  hands  on  the 
sheet  of  qppper  to  which  the  negative  pole  was  attach- 
ed, while  a  very  gentie  current  was  passed  over  the 
front  and  back  part  of  the  head.  The  appUcation  had 
not  been  continued  more  than  two  or  three  minutes, 
when  she  exclaimed,  "  Doctor  I  my  pain  is  all  gone ; 
this  is  the  first  quiet  moment  I  have  had  for  a  long 
time." 

The  sitting  lasted  about  ten  minutes,  and  at  its  close 
she  was  directed  to  come  again  on  the  following  day. 
The  next  morning  she  informed  us  that  she  had  experi- 
enced no  more  pain  in  her  head,  but  that  "  the  disease 
had  gone  to  her  breast  and  shoulders.''  This  fact,  taken 
in  connexion  with  some  other  statements  that  she  had 
iocidentiJly  made  the  day  before,  led  us  to  suspect  that 
syphilis  was  the  cause  of  her  sufferings.  In  reply  to 
questions,  she  confessed  to  every  symptom  of  secondary 
syphilis,  and  in  fact  had  been  aware  all  along  that  the 
disease  was  in  her  system.  According  to  our  habit  in 
such  cases,  we  made  the  applications  down  the  spine 
and  over  the  vital  organs.  The  relief  was  complete,  al- 
though not  as  instantaneous  as  the  day  previous.  Seve- 
ral times  the  applications  were  renewed  at  intervda 
of  two  or  three  days,  and  each  time  she  expressed  her- 
self as  very  enthusiastic  over  the  improvement  she-was 
making.  We  examined  her  throat  with  the  laryngo- 
scope, ai)d  found  a  slight  degree  of  inflammation,  which 
readily  yielded  to  the  nitrate  of  silver.  The  fiflh  time 
she  came  she  reported  that  she  had  returned  to  her 
work,  and  was  able  to  labor  nearly  as  hard  as  at  any 
time  in  her  life.  The  horrible  nocturnal  pains  had 
entirely  disappeared,  and  her  sleep,  which  before  had 
been  so  much  interrupted,  was  quiet  and  refreshing. 
There  remained,  however,  some  neuralgic  distresses  in 
the  eyes,  which  disappeared  after  a  few  more  local 
applications. 

914  Bboabwat. 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


LARYNGOSCOPY. 
By  J.  SOUS  COHEN,  M.D. 

OF  PHIULOXLPHU. 

No.  VI- 

DEIIOXSTKO-LARTNXOSCOPY. — THE     EXHIBITIOH    OF    A    PA- 
TIENt's  LABTMX  to  0THEB8. 
(CoDtliiued  from  page  640,  ToL  1.) 

When  the  epiglottis  is  well  raised  we  gain  a  view  of 
the  whole  circumference  of  the  superior  Gryngeal  aper- 
ture. This  is  triangular^  somewhat  cordiform,  wider  in 
front  than  behind,  sloping  down  obliquely  backwards, 
and  terminating  behind  in  the  vertical  inter-arytenoidal 
fissure.  Its  border  is  formed  in  firont  by  the  free  rim  of 
the  epig:lottis ;  then  on  either  side  by  the  ary-epiglottic 
fold,  wUch  arches  backwards  in  the  ^rm  of  a  bow  until 
it  reaches  its  arytenoidal  attachment  posteriorly,  where 
it  surrounds  a  i*ounded  eminence,  the  cartilage  of  Santo- 
rini;  .and  tlie  two  arytenoids,  with  their  connecting 
muscle  and  mucous  fold,  complete  the  border  behind. 
An  enlargement  on  each  side  in  front  of  the  cartilages 
of  Santormi,  and  breaking  the  arch  of  the  ary-epiglottic 
fold  into  two  unequal  festoons,  is  produced  bv  the  in- 
closed extremity  of  the  staff-like  cartilage  of  Wrisberg 
surrounded  with  glands  and  adipose  tissue. 

A  reflection  of  mucous  memlsrane  runs  from  one  ary- 
tenoid cartilage  to  the  other,  which,  during  ordinary  res- 
piration, can  be  distinctly  seen  forming  the  posterior 
boundary  of  this  superior  portion  of  l£e  larynx;  but 
during  vocalization  the  contraction  of  the  arytenoid 
muscle  approximates  the  cartilages,  and  the  band  of 
mucous  membrane  folds  up,  exposing  the  vertical  fissure. 
The  obliquity  of  this  border  renders  the  thyroidal  wall 
of  the  larynx  much  deeper  than  the  arytenoidaL  Dr. 
Elsberg,  of  New  York,  writes,  that  in  this  posterior  widl 
he  has  detected  the  presence  of  tubercles  long  before 
the  ordinary  physical  signs  of  phthisis  could  be  recog- 
nised, and  that  after  results  venfied  this  early  prognosis. 
Czermak,  Stork,  Lewin,  and  others,  have  recorded  simi- 
lar observations. 

If  we  look  down  along  the  inner  or  laryngeal  face  of 
the  quadrangular  membrane,  we  will  see  on  either  side, 
about  half  an  inch  below  its  superior  border,  the  red 
mucous  membrane  folding  under  on  itself,  forming  the 
false  vocal  cord^  a  broad  mucous  fold,  and  leaving  between 
it  and  the  horizontal  surface  of  the  true  vocal  cord,  seen 
immediately  below  as  a  white,  glistening  band  extend- 
ing from  before  backwards,  an  oblong  interval,  which  is 
the  ventricle  of  the  larynx,  and  which  lead?  up  into  the 
laryngeal  sac.  By  means  of  a  deep  inspiration,  espe- 
cially if  short,  sudden,  and  following  vocalization,  these 
ventricles  can  be  rendered  more  distinct,  and  a  separa- 
tion of  their  walls  be  observed  dilating  the  cavity.  The 
size  of  the  ventricles,  or  rather  the  space  constituting 
them,  varies.  It  is  contended  by  some  anatomists,  that 
these  false  vocal  cords  are  not  merely  duphcatures  of 
mucous,  or  of  mucous  and  elastic  membrane,  but  tliat 
they  are  composed  in  part  of  ligamentous  tissue  (supe- 
rior thyro-arytenoid  ligament)  and  some  muscular  fibre. 
It  is  generally  conceded  that  they  contain  a  delicate 
narrow  band  of  fibrous  tissue  continuous  with  the  fibrous 
capsule  of  the  laryngeal  sac,  but  destitute  of  muscular 
fibre.  In  the  mucous  membrane  of  this  sac  there  open, 
as  first  described  by  Hilton,  some  sixty  or  seventy  small 
follicular  glands,  situated  in  the  submucous  areolar  tissue. 
Its  laryngeal  surface  is  covered  by  the  inferior  portion 
of  the  aryteno-epiglottideus  muscle  (compressor  sacculi 
laryngis  of  Hilbon)  which  compresses  the  sac  and  dis- 
charges its  secretions  upon  the  true  voc&^  norda,  which, , 


being  themselves  improvided  with  glands,  are  thus  lubri- 
cated. 

The  floor  of  the  ventricle  is  formed  by  the  true  vocal 
cordj  which  is  easily  recognised  by  ita  semi-metalllo 
lustre—a  moiher-of-pearly  white  in  the  female,  with  a 
yellowish  dash  in  the  taale ;  a  strong,  thick,  fibrous  band 
(the  inferior  ihyro-arytenoid).  The  sharp  edge  of  this 
band  constitutes  the  vocal  cord  par  excellence.  This 
structure,  at  least  its  lower  surface,  is  an  extension  in- 
wards of  the  vocal  membrane,  or  the  middle  crico- thy- 
roid ligament.  Each  cord  consists  of  a  compact  band  of 
parallel  fibres  of  elastic  and  fibrous  tissue,  arranged  in 
prismatic  form,  the  base  being  outwards,  so  that  a  ver- 
tical section  shows  the  upper  surface  horizontal,  and  the 
lower  surface  taking  an  oblique  direction  downwards 
and  outwards  ^.  Firmly  imbedded  into  the  external 
portion  of  the  vocal  cords  are  some  short  penoated  fibres 
from  the  vocal  muscle,  the  thyro-arytenoid,  which  is  ad- 
herent and  parallel  to  it^  attached  in  front  to  the  reced- 
ing angle  of  the  thyroid,  and  behind  to  the  arytenoid. 
When  the  two  true  vocal  cords  are  approximated,  their 
horizontal  surface  forms  a  floor  to  the  upper  laryngeal 
cavity.  Thmy  form  with  the  space  between  their  free 
edges  ihe  glottis  ;  their  sharp  bi»rders  are  iht  lips  of  the 
ghttUj  and  the  chink  or  fissure  between  these  lips  is  the 
rima  glodidis.  These  terms  should  not  be  conlbunded. 
The  length  of  the  rima  in  the  male  varies  from  ten  to 
thirteen  lines;  in  the  female,  from  seven  to  ten  lines;  in 
children  it  is  much  less,  and  when  dilated  the  space 
across  will  vary  ordinarily  from  three  to  six  lines,  but 
when  widely  dilated  by  a  deep  inspiration,  it  may  be 
fi*om  six  to  ten  lines,  leaving  a  space  large  enough  oflen 
to  admit  a  good  sized  finger.  The  rima  of  the  glottis  is 
not  formed  by  the  vocal  cords  alone,  but  also  by  the  in- 
ner face  of  the  arytenoids  posterior  to  the  points  of 
attachment  of  the  cords ;  so  that  we  speak  of  an  inter- 
ligamentous  rima  corresponding  to  the  length  of  the 
cords,  say  eight  lines,  and  an  mter-cartilaginous  rima 
posteriorly,  about  three  lines.  Luschka  is  disposed  to 
decry  this  division,  which  is  due  in  appearance  to  the 
knuckUng  inwards  of  the  posterior  attachments  of  the 
cords  when  the  posterior  vocal  processes  converge  in- 
wards. 

27ie  form  of  the  rima  glottidis  varies. — During  ordinary 
respiration  it  is  a  narrow  interval  somewhat  enlarged 
and  rounded  behind,  looking  not  unlike  the  lozenge- 
shaped  space  formed  by  pressing  together  the  tips  of  the 
two  thumbs  and  the  tips  of  the  two  fore-fingers,  and 
then  extending  the  thumbs  rather  strongly  posteriorly 
and  the  fingers  anteriorly,  when  the  space  separating 
the  two  thumbs  will  represent*  the  inter-carti lag' nous 
rima,  and  the  remaining  space  the  intsr-ligamentons 
rima.  When  widely  diluted,  the  rima  acquires  the  form 
of  an  equiteteral  triangle,  the  base  being  behind.  The 
form  of  the  rima  varies  greatly  during  phonation,  and 
may  become  elliptical,  oval,  or  circular,  as  the  cords  are 
acted  upon  by  the  complex  thyro-arytenoid  musde. 
with  portions  of  which  their  structure  is  blended,  and 
by  the  contraction  of  other  muscles  attached  to  the  ary- 
tenoids^ 

When  the  epiglottis  is  well  raised  from  the  laryngeal 
aperture,  as  b^  the  emisdon  of  a  high  musical  note,  so 
that  the  anterior  portions  of  the  vocal  cords  can  be  dis- 
cerned, we  oflen  see  below  the  small  end  of  the  pad  of  the 
epiglottis,  immediately  beneath  the  junction  of  that  car- 
tilage to  the  thyroid,  and  separating  the  anterior  attach- 
ments of  the  false  vocal  cord:',  a  well  marked)  sharply- 
defined,  pinhead-like  pit  or  foramen  in  tlie  mucous 
membrane.  This  is  the  fovea  centralis  of  Merkel,  and 
communicates  directly  on  both  sides  with  the  anterior 
entrance  into  each  laryngeal  sac,  being  continuous  below 
with  a  shallow  groove  formed  by  a  ah^t^t  ibid  of  the 

digitized  by  LjOO^^_ 


THE  MEDICAL  RECORD. 


kryngeal  mucous  membrane  which  stretches  across  from 
the  aDterior  end  of  one  vocal  cord  to  the  other.  This 
fovea  centralis  is  one  of  the  chief  points  of  insertion  for 
the  elastic  membrane.  Though  very  small  in  the  human 
labject,  it  is  said  to  be  quite  large  in  many  lower  animals, 
B8  in  the  horse,  where  it  seems  to  constitute  a  middle 
ventricle  to  the  larynx. 

The  anterior  and  posterior  points  of  insertion  of  the 
vocal  cords  are  seen  upon  them  as  four  yellowish  freckles. 
the  tnaeuloe  flavcR,  which  mark  the  positions  of  the  vocal 
processes. 

The  mucous  membrane,  as  it  passes  from  one  arvte- 
noid  cartilage  to  the  othier,  is  thrown  into  loose  folds 
known  as  the  commissnre  of  the  arytenoids,  and  is  best 
wen  dtretching  across  when  the  arytenoids  are  separated. 
As  these  cartilages  approach  each  other,  this  commissure 
becomes  folded  up,  as  it  were,  within  the  vertical  cleft  or 
notch,  the  arytenoid  fissure,  often  termed  improperly 
the  posterior  glottis. 

The  accompanying  figure,  borrowed  from  the  mono- 
graph of  Semeleder,  presents  such  an  appearance  as 
would  be  obtained  during  deep  inspiration  with  the 
epiglottis  moderately  raised,  could  all  the  pwis  figured 
be  seen  in  a  single  view. 


The  parts  seen  in  the  mirror  from  o  to  ft  are,  the  base 
of  the  tongue  with  its  circumvallate  papillsB,  the  indented 
crest  of  the  epiglottic  a  portion  of  its  upper  laryngeal 
face,  and  part  of  its  belly  protruding  beneath  and  cutting 
off  the  view  of  the  anterior  extremities  of  the  vocal 
cords :  then  through  the  widely  opened  glottis  and  be- 
neath the  vocal  cords,  the  inferior  portion  of  the  interior 
face  of  the  angle  of  the  thyroid ;  beneath  this,  the  middle 
crico-thyroi  1  ligament ;  then  the  broad  cricoid  cartilage, 
and  immediately  below  it,  two  or  three  rings  of  the 
trachea;  below  this  we  see  the  posterior  border  of  the 
laryngeal  aperture,  formed  by  the  commissural  fold 
stretched  between  the  two  separated  arytenoids ;  below 
this,  the  posterior  external  wall  of  the  larynx  down  to 
the  transverse  groove  which  marks  the  commencement 
of  the  oBsophn^ia 

In  the  horizontal  direction  from  c  to  d,  commencing 
with  the  lateral  boundary  of  the  rima  glottidis  on  either 
mdcj  we  see  the  true  vocil  cord  disappearing  beneath  the 
belly  of  the  epiglottis,  which  conceals  from  view  its  an- 
terior attachment  and  proximity  to  its  fellow ;  then  di- 
rectly upon  it  the  entrance  into  the  ventricle  of  Morgagni 
represented  by  a  thick,  dark  line;  above,  and  to  the 
outer  side  of  this,  the  broad  fold  of  lining  mambrane 
constituting  the  false  vocd  cord ;  outside  of  this,  and 
above  it,  the  ary-epidottic  fold  arching  inwards  and 
downwards  towards  the  commissure  behind  to  meet  its 
fellow,  where  is  seen  a  swelling  directed  towards  the 
interior  and  formed  by  the  cartilage  of  S.mtorini ;  and 
farther  outwards  and  forwards,  a  second  swelling  in  the 
fold,  formed  by  the  extremity  of  the  cariilage  of  Wris- 
berg.    Below  this  fold,  and  outside,  we  see  a  portion  of 


the  exterior  wall  of  the  quadrangular  membrane ;  and 
outside  of  this,  the  triangular  pyramidal  sinus  leading 
down  to  the  entrance  into  the  oesophagus,  and  bounded 
on  its  outside  by  the  wing  of  the  thyroid  cartilage.  The 
bright  spot  depicted  in  this  space  corresponds  to  a  point 
on  the  inner  surface  of  the  thyroid  plate,  shining  through 
its  thin  mucous  membrane,  and  the  enlargement  above 
this  is  formed  by*the  greater  horn  of  the  hyoid  bone. 

Under  unfavorable  circumstances,  the  view  is  limited 
to  a  portion  of  the  base  of  the  tongue,  the  edge  of  the 
epiglotti?,  more  or  less  of  the  arytenoid  cartilages,  and 
some  portions  of  the  posterior  wall  of  the  pharynx. 

If  we  wish  to  examine  the  whole  laryngeal  face  of 
the  epiglottis  and  the  anterior  extremities  of  the  vocal 
cords,  we  d'rect  the  patient  to  sound  a  high  note  quickly 
and  with  a  little  force,  which  effort  raises  the  larynx,  closes 
the  glottis,  and  throws  the  epiglottis  up  with  a  jerk,  so 
that  the  horizontal  surface  of  the  vocal  cords  is  distinctly 
seen,  as  well  as  the  false  vocal  cords  and  the  ventriclea 
An  inspiration  accompanied  by  sound,  or  an  ironical 
laugh,  will  bring  the  same  structures  in  view.  If  this 
does  not  suffice,  some  of  the  instruments  described  (page 
349,  first  volume)  for  pulling  the  epiglottis  forward 
may  be  employed.  When  a  depressed  epiglottis  pre- 
vents a  view  of  the  cords,  we  may  judge  of  their  flexi- 
bility by  the  movements  of  the  arytenoids,  which  can 
almost  always  be  recognised. 

To  examine  the  posterior  extremities  of  the  vocal 
cords,  the  anterior  surfaces  of  the  arytenoids,  the  ary- 
tenoid commissure,  and  the  inner  posterior  wall  beneath, 
we  reflect  the  light  more  posteriorly  by  inclining  the 
mirror  towards  the  horizon  during  an  inspiration,  which 
opens  the  glottis  and  separates  the  arytenoids,  which 
look  upwards,  backwards,  and  outwards,  exposing  their 
anterior  faces. 

To  examine  the  posterior  walls  of  the  arytenoids 
down  to  the  cricoid,  and  obtain  a  good  view  into  the 
pyramidal  sinuses,  we  direct  the  emission  of  sound,  so 
as  to  close  the  glottis ;  in  doing  which,  the  arytenoids 
approach,  exposing  their  pharyngeal  surfac(»,  sei)arating 
more  widely  the  quadrangular  membranes  from  the 
plates  of  the  thyroid. 

To  obtain  a  view  further  down  the  trachea  than  is  re- 
presented in  the  figure,  we  place  the  mirror  more  per- 
pendicularly, and  direct  a  deep  inspiration,  so  as  to  open 
the  glottis  to  its  fullest  extent,  and  then,  by  a  little  mani- 
pulation, reflecting  the  light  more  anter  orly.  we  may 
see  several  tracheS  rings  a?  narrow  bands,  colored  like 
the  conjunctival  membrane  of  the  eyelid,  arching  across 
with  their  concavities  downward}*,  becoming  narrower 
and  closer  as  they  are  more  distant,  until  the  foreshort- 
ening is  such  that  they  cannot  be  distinctly  counted  ;  and 
sometimes  in  this  way,  when  the  circumstances  are 
favorable,  such  as  a  pood  mirror,  a  steady  hand,  a  well 
directed  light,  a  straight  tracheal  axis,  a  wide  glotti"^ 
&C.,  we  can  gain  a  view  clear  down  to  the  bifurcation 
of  the  tube.  Sometimes,  when  we  fail  to  obtain  such 
an  extended  view  with  the  light,  patient,  eye,  and  mirror 
in  the  ordinary  position,  we  can  succeed  by  elevating 
the  position  of  the  patient  so  that  the  eye  of  the  obser- 
ver shall  be  below  the  plane  of  the  patient's  mouth: 
then  throwing  the  light  from  below  upon  the  laryngeal 
mirror,  which  is  to  be  held  horizontally,  the  light  can 
be  reflected  clear  down  the  windpipe,  and  we  can  see 
most  distinctly  the  increasing  foreshortening  of  the 
tracheal  rings ;  and  if  the  bifurcation  be  visible,  we  see 
behind  the  last  ring  (below  in  the  mirror),  instead  of  the 
complete  arch  with  its  concavity  downward?,  a  bright 
triangular  space,  base  up,  and  on  either  side  of  thU  tri- 
angular space,  which  often  seems  to  project  up  into  the 
interior  of  the  tube,  dark,  circular  discs  marking  the 
commencement  of  the  bronchi®.    If  the  right  bronchoi 


6 


THE  MEDICAL  RECORD. 


is  very  straight,  sufficient  light  can  sometimes  be  thrown 
in  to  demonstrate  more  or  less  of  its  extent 

A  good  rule  by  which  to  hunt  for  the  view  of  the  bi- 
furcation is,  to  get  a  good  view  of  the  laryngeal  face  of 
the  epiglottis,  and  then,  with  this  as  a  guide,  to  continue 
inspection  along  tliis  plane  right  down  the  anterior  sur- 
face of  the  trachea,  gradually  lessening  the  obliquity  of 
the  mirror  as  we  gain  a  deeper  view. 

If,  when  a  view  of  the  trachea  has  been  obtained,  we 
turn  the  mirror  a  little  to  one  side,  we  obtain  a  lateral 
view  of  that  tube  resembling  the  turns  of  the  thread  in 
the  nut  of  a  screw. 

THE  ICUSCULAR  FORCES  PRODUCING  CHANGES  IN  THE  FORM 
OF  THE  GLOTTIS. 

Before  leaving  the  demonstrative  portion  of  our  sub- 
ject, it  will  be  necessary  to  allude  to  the  muscles  moving 
the  laryngeal  structures,  and  to  whose  contractions  are 
due  the  various  alterations  of  form  observed  during  the 
performance  of  the  physiological  functions  of  respiration 
and  vocaUzation. 

In  the  first  place,  there  are  several  muscles  outside  of 
the  laryngeal  tube. 

1.  Crico-arytenoideus  posticus^  one  on  each  side,  occu- 
pies the  lateral  half  of  the  posterior  face  of  the  cricoid, 
and  runs  upwards  and  outwards  to  be  inserted  into  the 
exterior  posterior  part  of  the  arytenoid  surmounting  ihe 
cricoid  on  that  side.  U»e^  to  rotate  the  arytenoid  out- 
wards and  backwards,  and  open  the  chink  of  the  glottis. 
This  muscle  may  be  viewed  as  the  extensor  muscle  of 
the  respiratory  glottis,  opening  the  jntercartilaginous 
rima,  antagonizing  the  arytenoideus. 

2.  Oruxh-arytenoidetu  lateraliSj  one  on  each  side,  runs 
from  along  the  superior  margin  of  the  sides  of  the  cri- 
coid, obliquely  upwards  and  backwards  to  the  outer 
angle  of  the  base  of  the  arytenoid,  just  in  front  of  the 
insertion  of  the  posterior  crico-ary  tenoid.  Use^  to  draw 
the  arytenoid  forwards  and  outwards,  turning  the  pos- 
terior vocal  processes  inwards,  and  thus  contracting  the 
chink  of  the  glottis  in  vocalization. 

3.  Crico-thyroidettSf  one  on  each  side;  a  triangular 
muscle  running  from  the  anterior  lateral  surface  or  the 
cricoi.l  upwards  and  backwards  to  the  inferior  edge  of 
the  thyroid  plate,  and  into  its  inferior  horn,  leaving  an 
interval  between  itself  and  fellow  occupied  by  that  por- 
tion of  the  vocal  membrane  called  middle  crico-thyroid 
ligament.  Use,  to  draw  the  thyroid  upon  the  cricoid 
with  a  forward  rotary  motion,  thus  stretching  the  vocal 
cords,  rendering  them  tense  and  contracting  the  chink 
of  the  glottis. 

Tiien  we  have  behind,  the  arytenoideus,  a  single  muscle, 
sometimes  described  as  three  distinct  muscles.  A  trans- 
verse portion,  the  deepest,  goes  posteriorly  from  the 
whole  length  of  one  arytenoid  to  the  other,  covering 
them  completely,  except  at  the  very  tip ;  over  this  por- 
tion, two  oblique  portions  cross  each  other,  running  res- 
pectively from  the  base  of  one  arytenoid  to  the  apex  of 
the  other.  Sometimes  portions  of  this  muscle  are  con- 
tinuous with  the  thy ro-ary  tenoid  and  the  aryteno-epi- 
gloitideus,  one  or  both,  seeming  to  act  in  consonance 
with  them  in  closing  the  larynx.  In  fact,  there  seems 
to  be  a  guttural  communication  right  over  this  muscle 
with  the  posterior  portion  of  the  ary-epiglottic  fold, 
leading  from  the  ventricle  of  Morgagni  up  the  inner  pos- 
terior wall  of  the  lamyx  and  out  into  the  phamyx  be- 
hind. This  gutter  or  drain  is  the  flltrum  veniricuU  of 
Merkel,  and  seems  intended  to  lead  off  into  the  pharynx 
any  accumulating  secretion  from  the  laryngeal  pouch. 

The  use  of  the  arytenoideus  is  to  bring  the  two  aryte- 
noid cartilages  in  close  apposition,  which  it  does  very 
completely  by  means  of  its  transverse  and  oblique  fibres, 
80  that  the  plane  surface  of  the  posterior  vocal  process- 


es touch  each  other  and  thus  close  the  posterior  por- 
tion of  the  glottis.  This  muscle  may  be  viewed  as  the 
flexor  of  the  respiratory  glottis.  So  much  for  the  exte- 
rior muscles  of  the  lamyx : 

In  the  interior  of  the  larynx  we  find  several  muscular 
structures  inclosed  within  the  quadrangular  membrane. 
These  are  on  each  side. 

1.  Thyro^iglottideus,  a  delicate  muscle  running  from 
the  posterior  inner  face  of  the  thyroid  near  its  rentrant 
angle,  just  outside  of  the  thyro  arytenoid,  into  the  side 
of  the  epiglottis.  Use. — To  pull  the  epiglottis  down. 
This  it  can  do  ordinarily  only  when  the  tongue  is  relaxed, 
and,  therefore,  the  dropping  of  the  epiglottis  is  usually 
attributed  to  backward  pressure  from  the  base  of  the 
tongue  relaxing  the  middle  glotto-epiglottic  ligament; 
but  it  has  been  shown  by  the  laryngoscope  that  some 
persons  can  acquire  such  control  over  their  organs  as  to 
drop  the  epiglottis  with  the  tongue  extended ;  and  this 
would  seem  to  confirm  the  ascribed  use  of  this  muscle 
as  a  true  depressor. 

2.  Aryteno^iglottideus,  a  still  more  delicate  muscle, 
running  from  the  superior  lateral  portion  Of  the  aryte- 
noid into  the  sida  of  the  epiglottis,  some  of  its  fibres 
being  lost  in  the  ary-epiglottic  fold.  This  muscle  is  in- 
distinctly defined  horizontally  into  what  is  sometimes 
described  as  a  superior  and  an  inferior  muscle,  the  in- 
ferior portion  of  which  (compressor  sacculi  laryngis, 
HiUon)  compresses  the  laryngeal  pouch  and  squeezes  its 
secretion  out  upon  the  vocal  cords.  The  superior  por- 
tion will  constringe  the  upper  portion  of  the  quadrangu- 
lar membrane,  and,  with  the  thyro- epiglottic  muscle, 
assists  to  close  the  superior  laryngeal  aperture. 

THE  VOCAL  MUSCLE. 

There  is  still  another  intrinsic  laryngeal  muscle  on  each 
side  meriting  a  more  detailed  mention  than  that  of  its 
mere  origi n  and  insertion.  This  is  the  ihyro-arytenoidetis, 
lying  external  to  the  vocal  cord  and  inseparably  attached 
to  it,  from  which  circumstance,  many  anatomists  have 
considered  the  vocal  cord  but  the  tendon  of  this  muscle. 
It  is  most  usually  described  as  parallel  to  the  outer  side 
of  the  cord,  arising  from  the  lower  half  of  the  rentrant 
angle  of  the  thyroid  cartilage  and  from  the  middle  crico- 
thyroid ligament,  and  passing  backwards  and  outwards 
to  be  inserted  into  the  anterior  and  outer  face  of  the 
arytenoid  and  into  its  base;  its  use  being  to  i-elax  the 
vocal  cords  and  shorten  them,  thus  lessening  the  length 
of  the  chink  of  the  glottis. 

The  thyro-arytenoid  muscle,  however,  is  quite  com- 
plex in  the  arrangement  of  its  fibres,  and  seems  to  be 
the  vocal  muscle  par  excellence,  to  whose  contractions 
are  mainly  due  the  various  changes  of  forms  produced 
in  the  glottis  during  vocalization,  cantation,  etc.  It  has 
been  most  thoroughly  described  by  Bataille,  who  has 
dissected  it  minutely,  as  consisting  of  three  distinct  por- 
tions, for  which  reason  he  has  proposed  for  it  the  name 
triceps'laryngea. 

These  three  portions  are  callrd  by  Bataille,  1,  fafsceau 
plan;  2,  faiseeau  median  ou  aro\form;  and  3,  faisceau 
paraboloid. 

The  three  heads  arise  in  close  propinquity  from  the 
rentrant  angle  of  the  thyroid.  The  first  or  plain  bundle 
runs  back  with  long,  flat,  horizontal  fibres,  t^  be  insert- 
ed into  the  inferior  border  of  the  arytenoid  cartila^a 
The  second  or  middle  portion  forms  a  triangular  pyramid, 
separable  into  two  flat  triangles,  the  base  being  inserted 
into  the  concave  face  of  the  arytenoid  cartilage,  its  in- 
ternal surface  being  adherent  nearly  throughout  to  the 
1st  or  flat  bundle ;  and  near  its  arytenoidal  attachment 
it  anastomoses  again  with  this  flat  bundle  by  shoi  t  pen- 
nate  fibres.  Its  superior  surface  is  concave,  and  forms 
the  floor  of  the  ventricle.  The  third  bundle  assumes  the 
'     Digitized  by ^ „       ^_ 


THE  MEDICAL  RECORD, 


form  of  an  irregular  parabola,  with  fibres  divisible  into 
saperior,  middle,  and  inferior  layers,  and  sends  out  fibres 
of  attachment  to  the  1st  and  2d  bundles^  and  also  to  the 
intemal  wall  of  the  ventricle.  The  upper  edge  of  the 
1st  bmidle  is  intimately  incorporated  into  the  tissue  of 
the  vocal  cords  by  short  pennated  fibres,  and  forms  a 
large  portion  of  the  constituent  structure  of  the  cord, 
especially  of  its  inferior  surface. 

The  above  resum^  is  but  an  outline  of  the  minute  an- 
atomy of  this  complex  muscle,  which  makes  still  further 
attachments  to  the  epiglottis  and  other  adjacent  parts ; 
bat  it  is  sufficiently  descriptive  to  show  its  intricate  ar- 
rangement and  intimate  relations  with  the  vocal  cord, 
so  that  it  does  not  seem  irrational  to  infer  that  it  has  no 
slight  participation  in  producing  the  various  changes  of 
form  and  tension  in  Uie  glottis,  by  means  of  wWch  a 
narrow  band  of  tissue,  scarce  eight  lines  in  length,  and 
barely  more  than  a  line  in  breadth,  and  with  but  a  single 
margin  free  to  vibrate,  is  rendered  adequate  in  response 
to  emotion,  or  mental  conception,  to  execute  the  im- 
mense variety  of  sound  and  modulation  of  which  the 
human  voice  is  capable.  There  is  but  little  doubt  that 
the  careful  study  of  the  mechanical  construction  of  this 
muscle,  coupled  with  a  sufficient  number  of  accurate 
laryngoscopal  observations  as  to  the  changes  of  form  in 
the  glottis,  and  consonant  action  of  other  parts  attend- 
ant upon  the  production  of  musical  tones  in  the  various 
registers,  will  in  time  disclose  to  physiology  many  of  the 
secret  mysteries  of  the  most  distinctive,  seductive,  and 
suggestive  characteristic  of  humanity. 

XUOOITB  MEMBRANE,   GLANDS,   BLOOD-VESSELS,  AND  NERVES 
OF  THE  LARYNX. 

The  contour  of  the  larynx,  externally  and  internally, 
is  covered  by  mucous  membrane  continued  firom  that  of 
the  mouth  and  pharynx.  It  differs  in  thickness  and  de- 
gree of  adhesion  to  subjacent  parts.  It  is  exceedingly 
thin  and  closely  adherent  on  the  free  borders  of  the  true 
Tocal  cords;  thm,  but  less  adherent  in  the  sac  of  Hilton ; 
loosely  adherent  to  the  false  vocal  cords ;  thicker  and 
closely  adherent  on  the  posterior  face  of  the  epiglottis, 
and  on  the  inner  faces  of  the  vocal  processes ;  less  ad- 
herent to  the  anterior  surface  of  the  epiglottis;  very 
loo^ly  attached  to  the  ary-epiglottic  folds  and  to  the 
arytenoidal  walls,  which  parts  are  thus  extremely  liable 
to  become  infiltrated,  so  that  the  inner  surfaces  almost 
touch,  producing  oedema  of  the  larynx,  or,  as  it  is  im- 
properly termed,  oedema  of  the  glottis. 

The  epithelium  is  the  ciliated  variety  found  covering 
the  whole  mucous  respiratory  tract,  except  a  narrow 
stripe  of  the  squamous  epithelmm  of  the  pharynx,  which 
mounts  the  larynx  posteriorly,  continues  down  the  in- 
ternal face  of  its  posterior  wail,  and  covers  the  free  por- 
tion of  the  true  vocal  cord  from  one  end  to  the  other. 
On  the  inferior  fiw3e  of  the  cords  the  ciliated  epithelium 
is  s^n  encountered. 

The  larjrnx  is  abundantly  supplied  with  glands.  We 
find  them  in  the  laryngeal  pouches,  the  pyramidal  sinus- 
es, in  the  posterior  wall,  in  the  ary-epiglottic  folds 
when  near  tneir  arytenoidal  attachments  they  are  accu- 
mulated in  the  form  of  an  L,  and  are  called  collectively 
the  arytenoid  glands ;  in  the  pad  of  the  epiglottis,  and 
isolated  elsewhere;  but  there  are  none  upon  the  true 
Tocal  cords.  They  are  sometimes  solitary,  sometimes 
in  dusters,  and  vary  from  the  size  of  a  poppy  seed  to 
that  of  a  lentiL 

The  larynx  is  supplied  with  blood  by  branches  from 
the  superior  and  inferior  laryngeal,  and  the  crico-thyroid 
arteries. 

The  veins  empty  into  the  superior,  middle,  and  inferior 
thyroid  reins. 


The  nerves  supplying  the  larynx  are  the  superior,  and 
inferior  or  recurrent  laryngeal  of  the  par  vagum,  with 
some  filaments  from  the  great  sympathetic.  The  in- 
ferior laryngeal  is  the  motor  nerve,  and  supplies  all  the 
muscles  except  the  crico-thyroid,  which,  with  the  rau- 
cous membrane,  is  supplied  by  the  superior  laryngeal, 
which  also  sends  some  fibres  to  the  arytenoideus. 


THE  SULPHATE  OF  BEBEERINE  IN  UTE- 
RINE  DISEASES. 

Br  A.  P.  MERRILL,  M.D. 

It  will  scarcely  be  doubted  that  most  of  the  uterine 
diseases  which  are  treated  by  surgical  remedies  with 
such  varying  success,  are  due  to,  or  ace-  mpanied  by,  en- 
gorgements of  the  diseased  organ,  arising  from  local  and 
constitutional  irritations,  inviting  into  its  tissues  an  un- 
due dt'termination  of  blood,  the  natural  consequences 
of  which  are  hypertrophy  and  derangement  of  function. 
According  to  the  degree  and  duration  of  this  diseased 
condition  of  the  uterus,  there  is  an  increase,  decrease, 
or  suspension  of  secretion,  swelling,  pain,  leucorrhoea, 
haemorrhage,  and  possibly  obstruction  of  the  cervix  uteri. 
Displacements  are  also  consequences  of  this  tumefaction, 
and  these  are  facilitated  by  vaginal  relaxation,  which  is 
a  constant  concomitant. 

These  are  the  diseases  which  have  of  late  years  so 
occupied  the  minds  of  uterine  pathologists,  and  led  to 
the  invention  of  mechanical  and  surgical  remedies  al- 
most without  number.  Besides  the  volumes  which 
have  been  published  on  this  subject,  the  m?dical  jour- 
nals are  laden  with  essays  and  discussions ;  but  the  dis- 
agreements among  able  and  distinguished  physicians 
are  such,  that  they  who  are  dependent  f  r  their  opinions 
upon  the  observations  of  others,  are  still  at  a  loss  to  un- 
derstand the  true  character  of  the  disease,  and  the  re- 
medial power  of  the  surgical  treatment  which  is  so 
confidently  recommended.  If,  therelbre,  these  morbid 
conditions  of  the  uterus  and  its  appendages  may  be  re- 
lieved in  any  degree  by  curative  measures  which  tend 
to  supersede  the  use  of  the  speculum,  pessary,  tent, 
cau-tic,  leech,  hysterotome,  cervical  dilator,  and  other 
surgical  appliances  revolting  to  female  delicacy,  it  be- 
hoves the  profession  to  inquire  into  their  remedial  vir- 
tues; and  the  object  of  this  brief  paper  is,  to  recom- 
mend the  sulphate  of  bebeerine  to  such  scrutiny. 

Hav  ng  occasion,  several  years  a^o,  to  treat  a  married 
woman  of  nervous  temperament  Tot  periodic  fever  and 
neuralgia,  and  finding  that  she  sufiered  considerable  in- 
convenience from  the  action  of  quinine,  I  was  induced 
to  try  the  effect  of  the  sulphate  of  bebeerine  as  a  sub- 
stitute for  it.  Relief  not  being  obtained,  I  proposed  to 
withdraw  the  remedy,  but  she  objected,  saying,  although 
it  was  of  little  service  to  her  neuralgic  pains,  it  had 
promptly  relieved  her  of  exces-^ive  menstruation,  and 
she  wished  to  keep  the  medicine  by  her  to  answer  that 
indication  as  occasion  might  require.  Several  years 
subsequently  this  intelligent  lady  expressed  to  me  her 
conviction  that  she  owed  to  the  use  of  this  one  remedy 
her  relief  from  painful  uterine  disease  jof  long  standing, 
and  also  from  the  reproach  of  sterility. 

The  sulphate  of  bebeerine  is  a  remedy  for  dysmenor- 
rhoea,  excessive  menstruation,  hemorrhage,  leucorrhoea, 
and  all  uterine  disorders  dependent,  in  v^hole  or  in  part, 
upon  hypertrophy  and  hyperaemia  of  the  uterus  and  its 
appendages.  It  exercises,  also,  a  tonic  power  over  the 
kidneys  and  bladder,  and  a  restraining  influence  over 
blennorrhceal  discharges.  I  prescribe  it  in  pills,  made 
up  with  syrup,  in  doses  of  five  to  twenty  grains,  and 
commonly  employ  aloes  as  an  adjuvant  remedy. 


Digitized  by 


Google 


THE   MEDICAL  RECORD. 


©riginal  itctntts* 


LECTURES  ON  PUERPERAL  CONVULSIONS. 

Deliverbd  in  Chioaoo  Medical  College, 

By  W.  H.  BYFORD,  A.M.,  M.D., 

nor,  or  obstetbios,  no. 

Lecture  HI. 

Uterine  symptoms  are  not  uniform ;  sometimes  there 
are  none;  for  s^o  far  as  we  can  judge  by  examination  of 
the  uterus,  and  obpervations  of  the  manner  of  the  pa- 
tient or  any  complaint,  labor  in  many  cases  does  not 
commence  before  the  convulsions.  Rarely  we  meet 
with  cases  that  recover  from  them  and  are  not  delivered 
for  several  weeks  afterwards.  The  first  case  I  ever  saw, 
the  patient,  after  having  convulsions  for  twenty-four 
hours,  and  ten  or  twelve  in  number,  recovered  perfect- 
ly, and  in  five  weeks  afterwards  was  delivered  of  a  foetus 
tiiat  probably  ceased  to  live  at  the  time  she  had  the  con- 
vulsions. Where  there  are  no  uterine  symptoms  at 
first,  labor  is  apt  to  commence  soon  after  the  convulsions 
become  severe,  and  proceed  slowly  to  a  termination,  or 
advance  so  tardily  as  not  to  be  complete  before  a  fatal 
termination  of  the  disease.  Again,  we  often  meet  with 
cases  where  labor  is  in  active  progress  before  the  con- 
vulsions Commence.  Where  this  last  is  the  condition  of 
things,  labor  is  not  generally  retarded,  although  occasion- 
ally it  is  brought  to  a  complete  stop.  The  symptoms 
may  show  tliemselves  in  the  second  or  third  stage  of 
labor,  or  even  after  the  whole  process  is  finished.  I 
knew  one  patient  seized  with  these  convulsions  on  the 
third  day  atler  delivery.  Attacks  after  labor  are  more 
likely  to  take  place  very  soon — ^in  a  few  minutes,  or  a 
very  few  hours  at  most. 

The  diagnosis  is  not  generally  difficult  after  the  affec- 
tion is  completely  formed-  Li  a  practical  point  of  view, 
it  is  quite  important  to  diagnosticate  the  predisposition 
to  this  form  of  disease,  and  proper  care  will  generally 
enable  us  to  perceive  the  tendency  in  this  direction  when 
well  marked.  With  the  nervous  and  gastric  derange- 
ment described  above,  there  is  oedema  of  the  v^per  por- 
tion of  the  body,  upper  extremities,  or  face.  While 
oedema  of  the  legs  and  feet  is  more  frequently  produced 
by  pressure  upon  the  veins  coming  from  the  lower  ex- 
tremities, this  symptom  occurring  m  the  last  months  or 
weeks  of  pregnancy  in  the  upper  part  of  the  body,  is 
almost  invariably  the  effect  of  albuminuria.  When  this 
form  of  cedema  shows  itself,  the  urine  should  be  subject- 
ed to  tests  for  albumen.  Whether  uraemia  is  always 
present  when  there  is  albuminuria,  and  whether  ui»mia 
does  not  sometimes  occur  without  albuminuria,  are 
questions  which  have  not  been  positively  decided,  so  far 
as  I  know;  but  we  can,  with  sufficient  assurance,  regard 
it  as  an  available  rule,  that  albuminuria  indicates  ursemia. 
If  albumen  is  found  in  the  urine,  we  should  prove  by 
tests  that  there  is  or  is  not  a  deficiency  of  urea  and  uric 
acid  in  the  secretion.  These  two  facts  would  show  a 
predisposition  to  puerperal  convulsions.  The  diagnosis, 
then,  of  the  precj^sposition  is  made  out  bv  the  presence 
of  celema  of  the  upper  part  of  the  body,  face,  and  limbs, 
albumen  in  the  urine,  and  a  deficiency  of  urea  and  uric 
acid.  After  the  attack  has  supervened,  the  diagnosis, 
for  the  most  part,  lies  between  epilepsy,  apoplexy,  hys- 
terical and  puerperal  convulsions.  There  may  be  other 
affections  with  which  there  is  a  possibility  of  confound- 
ing these  convulsions.  Epileptic  convulsions  very  rarely 
occur  under  puerperal  circumstances  in  epileptic  pa- 
tients, and  when  they  do,  the  convulsive  seizure  is  not 
repeated.    Apoplexy  is  ushered  in  sometimes  by  con- 


vulsions of  short  duration,  to  which  characteristic  pro- 
found and  prolonged  coma  succeed.  The  convulsions 
are  not  repeated,  the  patient  does  not  soon  become  con- 
scious as  afrer  tne  first  paroxysm  of  puerperal  convul- 
sions, and  there  is  almost  constantly  nausea  and  vomit- 
ing with  apoplexy.  When  coma  is  of  more  than  very  tem- 
porary duration,  there  is  congtstion  of  the  brain,  either 
as  the  result  of  the  convulsions  or  as  a  primary  condition ; 
hence,  we  have  a  combination  of  apoplexy  and  ur»mic 
convulsions  as  a  not  unfrequent  thing.  I  think,  however, 
that  apoplexy,  uncomplicated  with  uraemia,  is  quite  un- 
common in  the  puerperal  state.  I  remember  to  have 
seen  only  one  instance.  As  I  have  endeavored  to  show, 
in  speaking  of  symptoms,  the  supervention  of  this  com- 
plication is,  perhaps,  the  most  frequent  cause  of  death, 
and  it  is  what  must,  if  possible,  be  avoided.  Hysterical 
convulsions  are  distinguishable  from  the  ursemia  by 
symptoms  arising  from  an  opposite  state  than  those  of 
apoplexy,  constant  consciousness,  more  or  less  complete, 
and  want  of  coma  properly  speaking.  In  hysteric  con- 
vulsions, the  color  of  the  face  is  not  so  deep,  the  par- 
oxysm is  not  terminated  by  carbonic  ansesthesia,  which 
shows  the  existence  of  apnoea;  there  is,  in  fact,  almost 
no  embarrassment  to  the  function  of  respiration  in  hys- 
teria, while  there  constantly  is  in  puerperal  convulsions. 
In  hysteric  convulsions,  the  muscular  contractions  are 
not  completely  symmetrical,  but  one  arm  will  be  acting 
violently  and  the  other  firmly  fixed,  and  the  legs  do  not 
move  synchronously  like  shocks  that  succeed  the  first 
general  contraction  in  uraemic  cases  j  and  I  hope  I  may 
be  permitted  to  say,  that  in  hysteria  the  mental  mani- 
festations are  perveisities  of  disposition  instead  of  the 
real  inebriety  of  the  uraemic  disease.  We  must  remem- 
ber that  they  may  be  complicated,  so  that  in  the  begin- 
ning we  may  have  hysterical  symptoms,  but  these  are 
soon  obscured  by  those  arising  from  congestion  of  the 
brain.  Perhaps,  as  in  the  premonitory  condition,  the 
most  important  items  in  a  clear  diagnosis  are  albuminu- 
ria and  oedema.  Examinations  of  the  urine  should  be 
made  when  practicable. 

Prognosis. — This  has  reference,  1st,  to  the  safety  of 
the  mother,  and  2d,  that  of  the  child.  According  to 
Brann,  30  per  cent,  of  the  cases,  under  ordinary  circum- 
stances, prove  fatal  to  the  mother.  My  own  ob  ervation 
leads  me  to  a  more  favorable  prognosis,  and  in  the  prac- 
tice of  my  fi-iends  and  myself,  I  think  25  would  be  a 
large  estimate  of  the  mortality  of  uraemic  puetperal 
convulsions.  The  particular  circumstances  influencing 
the  prognosis  are  various.  One  of  the  most  important 
is  the  time  of  the  attack;  commencing  before  or  in  the 
early  steps  of  labor  makes  the  case  more  dangerous  than 
if  it  takes  place  later,  for,  according  to  Brann,  the  ac- 
complishment of  labor  causes  a  cessation  of  the  convul- 
sions in  37  per  cent  of  the  cases,  their  amelioration  in 
31  per  cent,  more,  and  that  about  32  per  cent,  continue 
without  change.  There  is  less  danger  in  post-partom 
cases  than  those  commencing  during  labor.  Cases  in 
which  the  inter-paroxysmal  coma  is  profound  and  per- 
sistent, or  the  breathing  and  pulse  are  very  much  ac- 
celerated, or  where  the  bronchia  seem  filled  with  mucus, 
and  sibilant  r41e  is  heard  over  a  large  part^  or,  as  is  often 
the  case,  the  whole  of  the  chest,  the  projjnosis  is  grave ; 
as  is  also  the  case,  should  the  convulsions  recur  fre- 
quently, less  than  every  hour,  or  continue  for  a  long 
time.  Cerebral,  pulmonary,  and  circulatory  deviations 
are  the  guides  to  the  prognosis.  The  nearer  the  breath- 
ing and  pulse  continue  to  the  natural  standard,  the  more 
favorable  the  prognosis;  the  greater  their  departure  from 
it,  in  any  respect,  the  greater  the  danger.  This  state- 
ment needs  but  very  little  qualification.  The  mortality 
to  the  ffxhUj  if  I  can  judge  from  the  cases  that  have 
come  under  my  own  observation,  is  greater  than  that  to 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


9 


the  mother.  I  think  at  least  half  of  the  children  born 
daring  puerperal  convulsions  were  dead.  The  cause  of 
this  great  mortality  among  the  children  is  not  clearly 
agreed  upon  by  the  profession.  Some  think  the  con- 
raslve  action  of  the  uterus  cramps  the  circulation, 
causing  asphyxia.  The  most  likely  cause,  I  think,  is 
the  ursemia.  I  have  known  two  well  marked  cases  of 
ursemia  where  convubions  did  not  take  place,  but  the 
fosti  in  both  cases  were  dead-bom.  In  most  cases,  so 
soon  as  the  labor  has  termioated,  and  the  convulsions 
cease,  the  albuminuria  passes  rapidly  away,  all  eviden- 
ces of  unemic  poison  aisappea*,  and  the  patient  unin- 
terruptedly convalesces.  At  other  times,  several  weeks 
elapse  before  the  excretion  returns  to  its  normal  state, 
when  the  convalescence  is  interrupted  by  the  occurrence 
of  drop6i(»l  accumulations,  causing  death  or  tedious  re- 
covery, or  there  may  be  waning  or  great  nervous  pros- 
tration and  fever.  Very  early  the  damage  done  to  the 
brain  is  so  great  as  to  leave  some  part  of  the  bodv  or 
Hmbs  partially  or  wholly  paralysed,  or  bronchial  or 
pneumonic  inflammation  may  be  established  sometimes, 
and  not  readily  subside. 


Htports  of  l|o«pitals. 


BELLEVUE  HOSPITAL. 

8KKDY  UKIOX  IN  A  FRACTURE   OF  THE  TIBIA  AKD  FIBULA* 
— DISLOCATION  OF  OS  MAGNUM. 

SEKVICB  OF  DR  FRANK  H.  HAMILTON. 

[Seport«d  by  D.  M.  Cobt,  M.D.,  Houe  Surgeon.] 

Mart  Antc  Barrett,  aet.  twenty-nine,  was  admitted  to 
Bellevue  Hospital,  November  12,  1866.  On  the  day  of 
her  admission  she  was  thrown  upon  the  sidewalk  by  a 
man,  who  violently  kicked  her  in  the  left  leg.  She  was 
immediately  brought  to  the  hospital  j  says  her  health  and 
habits  are  pretty  good,  except  that  occasionally  she 
indulges  in  a  little  strong  drink.  Condition  of  leg, 
swollen  and  painful ;  false  motion  laterally  near  junction 
of  middle  and  lower  thirds  of  leg,  with  projection 
anteriorly  of  end  of  upper  fragment  of  the  tibia.  The 
line  of  fracture  is  oblique,  extending,  as  is  usually  the 
case  in  fractures  of  this  bone  from  direct  violence,  from 
above  downwards,  and  from  behind  forwards.  The 
fibula  was  broken  in  its  upper  third,  but  the  exteiit  of 
displacement  could  not  be  ascertained  on  account  of  the 
thickness  of  the  tissues  at  this  point.  The  leg  was 
^ortened  about  half  an  inch ;  otherwise  little  deformity. 

TV'eaiment. — The  patient  having  been  placed  in  bed, 
the  fragments  were  replaced  as  accurately  as  possible  by 
extension  applied  to  the  foot  The  limb  was  then 
snugly  pUced  in  a  fracture-box,  well  padded  with 
oakum,  and  cold  evaporating  lotions  applied  to  keep 
down  the  swelling. 

November  IQth. — To-day  a  single  enveloping  splint 
was  cut  from  medium  sole-leather,  and  after  being 
soaked  in  hot  water,  was  carefully  moulded  to  the  limb, 
embracing  the  entire  foot  and  ankle.  This  was  padded 
with  cotton  batting,  inclosed  in  a  sack  of  muslin  of  the 
exact  shape  and  size  of  the  sphnt,  and  the  whole  was 
confined  by  rollers  applied  very  tightly. 

November  17th, — It  was  to-day  noticed,  as  the  fingers 
were  placed  upon  the  point  of  fracture  on  the  anterior 
aspect  of  the  leg,  that  as  the  patient  rose  up  in  bed,  the 
upper  frafjment  would  move  downwards,  and  would 
return  again  when  she  was  requested  to  He  down.  To 
obviate  this  motion,  the  limb  was  suspended  upon  a 
crib,  allowing  it  free  motion  in  any  direction.    As  the 


patient  was  in  the  habit  of  using  stimulants  occasionally, 
she  was  allowed  two  ounces  of  whiskey  daily. 

November  2Qth. — Since  the  last  report,  the  patient  has 
been  allowed  to  sit  up  in  bed.  The  rollers  nave  been 
reappUed  from  time  to  time,  so  that  firm  and  continual 
pressure  might  be  kept  upon  the  broken  bone.  To-day 
she  was  permitted  to  get  out  of  bed  and  to  go  about  the 
ward  upon  crutches.  The  apparatus  was  readjusted, 
and  union  was  found  to  have  taken  place  to  a  slight 
degree. 

December  12th. — To-day,  just  one  month  after  the 
injury,  the  splint  was  removed,  and  union  was  found  to 
be  firm.  No  motion  whatever  could  be  produced 
between  the  fragments.  The  swelling  has  almost 
entirely  subsided,  and  the  limb  presents  a  perfectly  sym- 
metrical appearance.  When  accurately  measured, 
shortening  of  only  three-eighths  of  an  inch  was  found  to 
exist.  To  prevent  any  accident  the  splint  was 
reapplied  loosely,  and  the  patient  allowed  to  go  about 
as  before. 

December  IQth, — All  dressings  were  removed.  The 
patient  can  bear  considerable  weight  upon  the  limb; 
and  as  a  little  stiffness  of  the  ankle-joint  remains,  8b# 
was  advised  to  use  it  as  much  as  possible. 

The  special  interest  attached  to  this  case  consists  in 
the  fact  that  speedy  union  can  occur  between  two  frag- 
ments of  this  bone,  in  which,  according  to  the  common 
experience  of  surgeons,  union  is  so  frequently  (^elayed, 
by  carefully  adjusting  the  broken  ends,  and  holding 
them  firmly  in  position  by  the  proper  apparatus. 
There  is  no  bone  in  the  human  body  in  which  union  is 
so  often  deferred  to  the  eighth,  tenth,  or  even  sixteenth 
week,  as  in  this  bone.  It  is  true,  however,  that  exam- 
ples of  non-union,  or  a  complete  and  final  refusal  to 
unite,  are  here  very  rare,  showing  that  there  is  no  natu- 
ral inherent  difficulty  in  the  union  of  thw  bone,  and  that 
cases  of  delayed  union  can  generally  be  referred  to  a 
defect  in  the  apparatus  used.  To  follow  out  the  proper 
indications,  it  is  necessary  in  the  first  place,  after  the 
side-splints  or  single  spUnt,  whichever  is  used,  have 
been  applied,  to  carefully  adjust  the  bandage  as  ofien  as 
it  is  in  the  least  loosened  either  by  the  diminution  of 
the  swelling,  or  by  other  causes,  so  that  firm  and  con- 
tinual pressure  may  be  kept  upon  the  fragments.  In  the 
second  plaoe^  the  leg  should  be  swung,  to  obviate  in  a 
great  measure  the  sliding  motion  produced  upon  the 
fragments  whenever  the  patient  moves  in  bed.  And  in 
the  ihirdplace,  the  splints  should  be  made  large  enough 
to  nearlv  meet  over  the  spine  of  the  tibia ;  for  unless 
this  is  done,  the  fragments  at  this  point  have  no  sup- 
port except  by  merely  the  roller  as  it  passes  around  the 
splints  to  hold  them  in  position ;  or  what  might  obviate 
the  difficulty  still  more,  would  be  to  apply  an  anterior 
and  posterior  leather  splint,  being  careful  in  moulding 
and  padding  them,  so  that  the  anterior  one  would  not 
excoriate  the  thin  layer  of  tissue  covering  the  bone,  and 
the  posterior  one  so  that  it  would  accurately  fit  the 
uneven  surfiice  upon  the  calf  of  the  leg. 

Bridget  Malar,  ast.  twenty-eight, was  adnoritted  into  the 
Bellevue  Hospital,  Nov.  1 9, 1866.  On  the  day  of  her  ad- 
mission she  fell  down  a  flight  of  stairs,  striking  upon  the 
dorsum  of  her  left  hand,  and  flexing  it  forcibly  upon  the 
forearm  ;  she  came  immediately  to  the'hospital  Con- 
dition of  hand  somewhat  swollen  and  contused,  and  she 
is  unable  to  close  it.  There  is  a  marked  prominence 
upon  the  dorsum  on  a  line  with  the  second  metacarpal 
bone.  At  first  it  was  supposed  that  this  was  the  bone 
that  was  dislocated ;  but  in  comparing  the  relative  posi- 
tion of  this  joint  with  the  articulation  of  the  first  meta- 
carpal bone  with  the  trapesium,  it  was  found  to  \% 
the  OS  magnum.  Reduction  was  accomplished  by 
extension  upon  the  first  and  middle  fingers,  at  the  same 


Digitized  by 


Google 


10 


TIIE,  MEDICAL  RECORD. 


time  preBsure  being  made  upon  the  bone  itself,  when 
suddenly  it  resumed  its  natural  position.  It  is  now  a 
month  afler  the  accident  She  still  has  some  stiffness 
of  the  hand,  and  finds  it  difficult  to  grasp  anything 
firmly  ;  but  she,  is  rapidly  regaining  the  use  of  it. 

Note. — Cases  of  tnis  kind  are  extremely  rare,  and 
none  appear  in  the  case-books  at  Bellevue  Hospital. 
Dr.  Hamilton  has  never  seen  one,  although  in  his  work 
on  "  Fractures  and  Dislocations  "  he  quotes  some  few 
cases  reported  by  English  and  French  surgeons. 


KXOISION  OF    SUPERIOR    MAXILLA — ^LIGATUBE  OF  COMMON 

CAROTID. 

[RAported  bj  Dr.  Chxitubs  H.  Luvlum,  Hoom  Snrgeon.] 

Catherine  McCann,  »t  31,  a  native  of  Ireland,  admit- 
ten  August  17th,  1866.  She  first  noticed  a  small  swell- 
ing on  the  upper  jaw  twelve  years  ago,  which  gave  her 
no  trouble  until  four  months  ago,  when  it  increased  in 
size  and  became  painful. 

She  entered  the  hospital  June  20th,  1866,  and  the 
tumor  was  removed  by  Dr.  Sayre  on  the  same  day.  In 
a  few  days  she  was  discharged,  but  the  pain  continued, 
and  another  tumor  appeared  at  the  site  of  the  former. 
This  increased  rapidly  in  size,  and  at  the  time  of  her 
second  admission  (August  17th),  the  disease  had  invaded 
the  whole  lefl  side  of  the  jaw,  and  appeared  at  the 
mouth  as  a  fungous,  bleeding  mass. 

Sept  bth, — Consultation  held,  and  left  common  caro- 
tid ligated,  and  the  left  half  of  the  upper  jaw  and  malar 
bone  removed  by  Dr.  Hamilton.  But  little  blood  was 
lost  during  the  operation ;  the  cavity  stuffed  with  lint. 

S^t  6^.— Semi-comatose ;  does  not  speak,  but 
swallows  regularly ;  catheterized  twice  to-day.  Hemi- 
plegia of  the  right  side,  and  paralysis  of  the  left  instead 
of  die  right  side  of  the  face. 

Sepi.  llth. — Slight  hsemorrhage  from  the  roof  of  the 
mouth,  which  recurred  occasi  nally  until  the  close  of 
the  month.    It  was  checked  by  persulphate  of  iron. 

(M.  3d— The  cavity  left  by  the  removal  of  the  bone 
filled  with  a  ftingous  mass,  which  bleeds  readily  when 
touched.  Glands  at  the  angle  of  the  jaw  are  swollen 
and  tender. 

She  contiDned  to  grow  weaker,  and  died  Nov.  6th, 
ate  A.  M. 

Poet-morkm  30  hours  afler  death — rigor  mortis  not 
marked,  body  emaciated. 

Brain — The  left  hemisphere  had  patches  of  white 
softening,  especially  towards  its  posterior  aspect  The 
substance  of  the  brain  had  a  purplish-white  color,  and, 
except  at  these  softened  points,  was  harder  than  nor- 
mal 

Thorax :  Lunj^s— The  right  lung  had  numerous  ab- 
scesses scattered  through  its  substance,  but  no  deposits 
of  cancer  were  detected.    The  left  lung  was  healthy. 

Abdomen — ^Liver  studded  with  numerous  deposits  of 
cancer,  varying  in  aze  from  a  pea  to  a  hazel-nut.  There 
were  one  or  two  deposits  of  the  same  character  in  the 
spleen. 

Kidneys  contracted,  having  evidently  undergone  gra- 
nular degeneration. 

Local  Anaesthesia  in  Veterinary  Surgery.— Dr.  A. 
Liautard,  V.  S.,  New  York  College  of  Veterinary  Sur- 
geons, reports  the  successful  use  of  local  anaesthesia  in 
operations  upon  the  horse.  Absolute  ether  was  em- 
ployed upon  two  subjects:  one  for  the  extirpation  of  a 
targe  fibrous  tumor  of  the  chest,  and  the  other  for  the 
opening  of  an  abscess,  while  upon  another  the  opera- 
tion of  neurotomy  was  performed  with  the  greatest 
.ease  by  Che  Thlgolene  spray. 


|)tO0tf«s  0f  MtVxcai  Science. 

New  Method  op  Employino  Heat  as  a  Resusoitatino 
Agent. — Dr.  Joseph  G.  Richardson,  of  Union  Springs, 
N.Y.,  details  (Am.  Jour.  Med.  iSb*.)  a  very  interesting  case 
of  resuscitation  of  a  still-bom  infant,  by  a  novel  appli- 
cation of  heat.  The  idea  of  emplo3ring  this  method  was 
suggested  to  him  by  a  paper  by  Dr.  B.  W.  Richardson, 
of  London,  on  the  uses  or  heat  as  an  iovigorator.  The 
infant  alluded  to  was  bom  on  the  morning  of  the  18th 
of  February,  and  at  the  time  made  no  effort  to  xespire, 
although  a  feeble  pulsation  was  perceptible  at  the  pr»« 
cordia.  The  usual  treatment  of  hot  bath,  cold  affusion, 
etc.,  was  of  little  if  any  avail,  and  finally  it  occurred  to 
Dr.  R.  to  try  warming  the  blood  in  the  peripheric  veins, 
and  afterwards  forcing  it  back  to  the  heart.  To  carry 
out  this  idea,  the  little  one  was  properly  protected 
in  blankets,  and  placed  upon  the  hearth  of  a  large 
cooking-stove.  "  The  effect  of  this  treatment."  says 
Dr.  R.,  '*  was  almost  miraculous;  the  heart's  pulsation, 
which,  in  spite  of  three  hours'  labor  with  artificial 
respiration  and  its  adjuncts,  had  continued  feeble  and 
uncertain,  grew  rapidly  full  and  energetic ;  the  respira- 
tion, which  had  commenced  again  lo  prolong  its  inter- 
vals, changed  its  gasping  character,  became  continuous, 
and  although  groaning,  otherwise  almost  normal ;  and 
to  crown  all,  the  limbs,  which  had  heretofore  dangled, 
relaxed,  from  the  apparently  lifeless  tmnk,  soon  exhi- 
bited signs  of  vitality,  winch,  beginning  first,  after 
some  ten  minutes*  roasting,  with  a  slight  tremulous 
movement  of  the  extensors  of  the  right  leg,  gradually 
traversed  the  entire  muscular  system,  until  the  whole 
tiny  fi'ame  shook  like  an  aspen  leaf,  quivering,  one 
might  almost  think,  with  too  rude  a  blast  of  the  breath 
of  life.  I  remained  with  the  infant  for  an  hour  or  so 
longer,  and  experienced  the  intense  satbfacticn  of 
observing  a  continued,  though  tardy  improvement,  the 
skin  gradually  losing  its  blue  color,  and  assuming  the 

Eink  tint  of  a  healthy  new-bora  babe's.  The  physician 
eing  unfortunately  compelled  to  leave  the  case  in 
charge  of  an  ignorant  nurse,  who,  contrary  to  direc- 
tions, had  insisted  upon  administering  some  molasses 
and  water,  death  took  place  in  the  effort  at  deglu- 
tition." The  success  attending  this  new  adaptation  of 
an  old  principle  should  claim  the  attention  of  every 
practitioner.  We  have  no  doubt  that  many  lives  may 
thereby  be  saved. 

Dislocation  of  the  Radius  and  Ulna  forwards  at 
THE  Elbow  without  Fracture. — A  case  of  this  very 
rare  dislocation  occurred  at  University  College  Hospital 
the  week  before  last,  during  the  fi-ost.  A  strong  young 
man,  of  twenty  years  of  age,  slipped  down  on  the  pave- 
ment, falling  on  his  left  elbow.  On  getting  up  he  lound 
he  could  scarcely  move  the  elbow,  which  was  so  pain- 
fiil  that  he  applied  immediately  at  the  hospital.  On 
examining  him  about  twenty  minutes  after  the  fall,  Mr. 
J.  W.  Langmore,  the  house-surgeon,  found  that  there 
was  some  swelling  and  a  sUght  bruise  over  the  promi- 
nence of  the  elbow,  with  but  little  swelling  elsewhere. 
The  arm  was  bent  at  an  angle  of  about  130'*,  but  could 
be  flexed  to  a  right  angle  and  straightened  to  about 
160°,  although  all  movement  gave  the  patient  great 
pain.  The  forearm  was  about  three-quarters  of  an  inch 
longer  than  its  fellow.  The  condyles  of  the  humerus 
were  nearly  on  a  level  with  the  olecranon,  which  was 
displaced  forwards,  the  tendon  of  the  triceps  muscle 
being  very  tightly  stretched  round  the  end  of  the  hume- 
ms.  The  sigmoid  notch  could  be  felt.  The  head  of 
the  radius  could  also  be  felt  in  fi'ont  of  the  lower  end  of 
the  humerus.    Mr.  Langmore  replaced  the  ulna  by  bend- 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


11 


ing  the  elbow  across  his  knee,  and  then,  as  the  radios 
-was  still  dislocated,  he  reduced  it  by  pressure  on  its 
head,  whilst  good  extension  was  made  by  assistants. 
The  arm  was  then  put  on  a  straight  splint  and  an  evapo- 
rating lotioD  applied.  A  certain  amount  of  heat  and 
Bweffing  ensued,  but  by  the  fourth  day  this  subsided, 
and  the  joint  was  quite  movable. — Lancet. 

SmBPATiOK  OF  THi  ToNSiLs. — ^Tho  NiuhviUe  Journal 
of  MocUcme  cmd  Surgery  quotes  G-uersant  as  follows : 
**  If  in  young  subjects  whose  throats  are  narrowed,  the 
hnmorratge  feUowing  excision  of  tonsils  is  not  likely  to 
be  troublesome,  it  is  not  the  same  in  patients  of  eighteen 
or  twenty  years  old.  H»m  )rrhage,  in  such  cases,  is 
frequently  to  be  feared,  because  the  hypertrophy  is  of 
longer  standing,  and  the  vessels  are  more  developed.  I 
have  operated  upon  more  than  a  thousand  children,  and 
I  can  scarcely  remember  three  who  had  sufficient 
haemorrhage  to  cause  me  any  anxiety.  On  the  contra- 
ry, I  have  operated  upon  twelve  or  fifteen  adults,  and  I 
must  say  that  at  least  four  or  five  of  them  caused  me 
great  uneasiness,  and  that  I  could  only  stop  the  hsemor- 
rhage  by  the  use  of  the  hot  iron  or  the  perchloride  of 
iron.  I  should  say,  then,  that  the  operation  is  benefi- 
cial in  proportion  to  the  youth  of  the  patient,  and  grave 
in  proportion  to  his  advance  in  age." 

Steam  to  the  Cavity  or  the  Ttmpanum. — Dr. 
Ha^n,  of  Leipsic,  recommends  the  use  of  steam, 
which  is  generated  in  a  glass  flask,  as  an  application  to 
the  cavity  of  the  tympanum,  though  the  eustachian 
tube,  by  means  of  Politzer's  method  of  inflating  the 
cavity  of  the  tympanum  (blowing  in  the  air  through  the 
noee,  while  the  patient  swallows,  with  the  mouth  closed). 
It  is  said  to  cause  no  pain,  and  to  be  useful  in  the  case  of 
children  suffering  from  acute  inflammation  of  the  middle 
ear.  The  manoeuvre  is  to  be  repeated  from  three  to  five 
dm^  every  two  or  three  days. —  Wiener  Med,  Presse. 

Pruritus  Pudendi. — Prof.  N.  S.  Davis,  of  Chicago, 
recommends  as  a  local  application  for  this  troublesome 
affection,  the  following  lotion,  which  may  also  be  inject- 
ed, in  small  quantity,  into  the  vapfina  each  n'ght  and 
morning : — A  solution  of  borate  of  soda  (borax]  3  iij., 
and  sulphate  of  morphia  20  grains  in  a  pint  of  water. 

PoBONtNO  FROM  NiooTiNE. — A  patient  was  .brought 
to  the  Oeoeral  Hospital  in  Vienna,  in  the  wards  under 
Profe83or  Oppolzer's  care,  in  what  seemed  to  be  a  tetanic 
condition,  having  been  found  so  on  his  bed,  when  he  had 
lain  down  to  rest  a  short  time.  He  was  sensele^'',  but 
after  the  injection  of  i  gr.  of  morphia  in  solution,  in 
about  an  hour  he  began  to  move  his  head  and  ^dually 
his  body,  without,  however,  coming  to  consciousness. 
An  enema  of  water  and  vinegar  was  then  administered, 
when  vomiting  ensued,  and  with  a  small  amount  of 
greenish  fluid,  eight  or  ten  small  pieces  of  tobacco 
leaves  were  ejected. 

The  patient  recovered,  and  said  that  he  had  been  in  the 
habit  of  chewing  an  ordinary  cigar,  and  had  lain  down 
with  some  of  the  leaves  in  his  mouth.  Albumen  was 
found  in  the  urine,  the  next  day  after  admission,  but 
none  subsequently.  The  patient  left  the  hospital  on  the 
seventh  day  after  admission. 

MoDincATiOK  or  the  Operation  for  Strabismus.  By 
Dr.  R.  Loibrioh,  or  Paris. — I  lift  up  a  fold  of  the  con- 
ianctiva,  in  tenotomy  of  the  sectus  intemus,  on  the 
lower  ends  of  the  insertion  of  the  muscle,  cut  it  with 
the  scissors,  pass  in  through  the  opening  between  the 
conjunctiva  and  the  capsule  of  tenon  ]  divide  these  two 


membranes  carefully  from  each  other,  up  to  the  plica 
semilunaris),  and  separate  these,  as  well  as  the  caruncle, 
from  the  parts  lying  behind.  After  the  entire  capsular 
portion,  which  is  so  important  in  the  setting  back  (sdck- 
lagering)  of  the  muscle,  is  completely  independent  of  the 
conjunctiva,  I  divide  the  insertion  of  the  muscle  from 
the  conjunctiva  in  the  usual  way,  and  lengthen  the 
incision  in  the  capsule  made  with  the  tenotome,  above 
and  below  the  more  extensively,  according  as  I  wish 
the  setting  back  of  the  muscle  to  be  great  or  little.  I 
then  close  tlie  conjunctival  wounds  with  a  suture. 

The  advantages  of  my  method  are  as  follows: — 1.  A 
greater  freedom  and  a  much  larger  space  for  the  regu- 
lation of  distribution  (of  the  effect)  of  the  operation  for 
squint  2.  The  avoidance  of  a  sinking  in  01  the  carun- 
cle, and  of  every  trace  of  cicatricial  formation,  which 
the  ordinary  tenotomy  sometimes  leaves.  3.  The 
avoidance  of  more  than  two  operations  on  the  same 
patient,  and  more  than  one  on  the  same  eye. — Archiv 
fur  Ophthalmologie, 

A  Case  or  Dislooation  of  the  Globe  or  toe  Ete, 

CAUSED  BT  the  HoRN  OF  A  OoW,  MISTAKEX  rOR  AN  ENU- 
CLEATION. By  Proeessor  Yon  JBeeker,  or  Helsinoeors. 
— The  peasant  wom  m  A  S.,  aat.  thirty- two,  consulted 
me  last  September,  on  account  of  her  left  eye.  Seeing 
the  sunken  eyehd  and  the  half-opened  palpebral  fissure, 
which  seemed  empty,  I  asked  how  sne  had  lost  her 
eye  ?  She  answered,  that  the  eye  had  not  been  removed 
or  los*^,  as  all  the  people  said  to  whom  she  had  shown  it, 
but  that  it  was  simply  driven  into  the  head. 

She  stated,  that  in  June  she  had  gone  out,  as  was  her 
habit,  to  get  the  cow.  The  cow  was  ugly,  and  hooked 
at  one  of  the  children  who  was  with  her.  The  mother 
ran  to  save  her  child,  but  as  she  bent  over  to  seize  it, 
the  cow  ran  her  horn  into  the  left  eye,  so  that  she  sank 
to  the  ground,  although  it  gave  her  great  pain.  She 
rose  up,  put  a  handkerchief  around  her  nead,  and 
walked  to  the  house,  about  one  hundred  steps  off;  only 
a  very  little  blood  ran  from  the  eve  and  nose.  Once 
there,  she  lost  her  strength.  She  began  to  vomit;  had 
severe  headache  and  vertigo,  and  soon  lost  her  con- 
sciousness, so  that  she  did  not  know  what  happened  for 
four  days.  When  her  senses  returned  the  wound  was 
cloied,  and  the  eye  itself  scarcely  pained  at  alL  While 
sick,  she  had  continuous  and  severe  headache,  and 
could  only  take  liquid  food.  The  left  cheek  wa'  very 
much  swollen — no  sensation,  or  scarcely  any,  in  it.  There 
was  toothache.  She  could  not  see  well  with  the  right 
eye,  especially  near  at  hand ;  straining  the  eye  caused 
headache.  In  three  weeks  she  was  able  to  go  about. 
Present  condition  of  left  eye :  Along  the  supra-orbital 
border  is  a  cicatrix  25  mm.  long ;  it  begins  at  a  point 
vertically  over  the  puncta  and  extends,  becoming  2-3 
mm.  broad,  to  the  outer  commissure  of  the  lids.  The 
cicatrix  is  movable,  not  adherent  to  the  bone  beneath. 
The  upper  lid  is  verv  much  sunken  in ;  levator  palpebrss 
still  lifts  it,  so  that  the  palpebral  fissure  can  be  opened 
about  5  mm.  The  lower  lid  is  stretched  tensely  in 
front  of  the  orbital  cavity,  but  is  relaxed  below,  towards 
the  cheeks.  The  conjunctiva  smooth,  only  slightly 
hypersBraic.  If  the  lower  lid  is  drawn  down,  when  the 
reflection  of  conjunctiva  is  generally  seen,  we  find  an 
external  and  internal  fold  of  conjunctiva  reclining 
against  the  mucous  membrane  coming  from  the  upper 
lid,  and  thereby  having  a  deceptive  similarity  to  the 
funnel-shaped  space  left  afier  enucleation.  The  point 
of  the  finger  may  be  introduced  into  the  open  pal- 
pebral fissure,  without  any  resistance,  almost  20  mm. 
The  lachrymal  apparatus  is  normal.  If  the  two  lower 
folds  of  conjunctiva  with  the  lid  are  drawn  down  as 
much  as  possible,  we  may  see  scarce|ygbwo  lines  pver 

Digitized  by  VjOO^  ^  _ 


18 


THE  MEDICAL  RECORD, 


the  gupra-orbital  border,  the  upper  border  of  the  cor- 
nea^ the  b'uish-grey  irL<»,  and  even  a  small  portion  of 
the  moderately  enlarged  pupil,  all  healthy  and  normal. 
In  the  upper  portion  of  the  visual  field  of  this  eye  the 
patient  counts  fingers  with  complete  certainty.  The 
ocular  conjunctiva  next  to  the  cornea  is  white  and  nor- 
mal No  movability  of  the  globe  to  be  detected.  In 
right  eye  the  acuteness  of  vision  is  one-half;  glasses  do 
not  improve  it.  Field  of  vision  defective  in  outer  por- 
tion. Tlie  ophthalmoscope  shows  the  media  to  be 
dear ;  the  retinal  blood-vessels  a  little  dilated.  Vision 
has  lately  improved.  Some  paralysis  of  the  muscles  of 
the  left  side  of  the  face.  The  teeth  are  said  to  be  sensi- 
tive. Sensation  exists  everywhere  in  the  integument: 
it  is  a  little  blunted  in  the  lefl  lower  lid.  Both  orbital 
cavities  are  at  the  same  height. 

The  patient  was  put  under  the  influence  of  chloroform, 
kk  order  to  effect  a  more  thorough  examination.  The 
finger  introduced  around  the  upper  half  of  the  equator 
of  the  globe  showed  that  no  foreign  body  was  pressing 
the  eye  down.  From  the  trochlea  of  the  obliquus 
•uperior  I  felt  the  belly  of  the  muscle ;  the  eye  was 
then  rotated  inwards  and  downwards ;  the  globe  was 
Tery  firmly  adherent  to  the  inner  and  lower  side  of  the 
orbit  After  removing  the  tendinous  adhesions  in  the 
neighborhood  of  the  lachrymal  sac,  I  was  able  to  examine 
t'ae  inner  portion  of  the  infi*a-orbital  border ;  there  was 
no  unevenness  in  the  bone.  I  did  not  attempt  to 
replace  the  globe,  on  account  of  the  time  which  had 
elapsed,  three  and  a  half  months,  which  had  caused 
firm  adhesions.  Besides,  with  reposition  we  could  not 
hope  for  congruous  movements  of  the  globes.  K I  had 
been  able  to  dissect  up  the  eye,  and  place  it  in  its 
former  position,  the  strabismus  would  have  probably 
produced  extremely  unpleasant  double  images.  *  *  ♦ 
The  concussion  or  tension  of  the  optic  nerve  was  con- 
tinued upon  the  right  rfde,  and  caused  the  defect  on 
the  outer  part  of  the  field  of  vision,  and  also  the  para- 
lysis of  accommodation.  As  to  the  third  pair,  the 
branch  going  to  the  levator  is  unharmed;  tne  other 
may  have  been  torn  by  the  horn,  since  there  is  no  mova- 
bility in  the  globe. — Archiv  fur  Ophthalmologies  xii. 
JSandj  AbiheUung  If. 

Action  of  Baetta  and  Oxalates. — A  pupil  of 
Hoppe-Seyler,  several  years  ago,  attributed  the  toxical 
action  of  baryta  and  its  soluble  compounds  to  the  accu- 
mulation of  insoluble  sulphate  in  the  capillaries  of  the 
lungs,  thus  causing  a  mecnanical  impediment  to  the  pro- 
cess of  respiration  {Am.  Drttg  Circ).  This  is  denied  by 
Dr.  Cyon,  who.  from  a  series  of  recent  experiments,  feels 
justified  to  call  the  effects  of  baryta  a  paralys's  of  the 
central   organs  of  the  nervous  system  of  the  heart, 

Srobably  by  means  of  its  nervous  appendages.  A  simi- 
\r  effect  can  be  traced  in  the  action  of  oxalic  acid  and 
its  oompounds.  The  matter  is  of  importance  in  so  far  as 
doubts  hal  arisen  as  to  how  far  sulphuric  acid  for  baryta, 
and  lime  for  oxalic  acid,  might  be  administered  with 
•afety  in  cases  of  poisoning. — Druggists^  CirciUar, 

Othatomata,  or  Hahatomata  op  the  Acricle. — At 
a  meeting  of  the  Greneral  Association  of  St.  Petersburg 
Physicians,  held  April  19,  1866,  Dr.  Gehewe  spoke  at 
•ome  length  on  Othatomata  of  insane  patients,  with  a 
demonstration  of  some  pathological  preparations  of  these 
tumors.  The  blood  tumor  of  the  ear  was  first  de- 
scribed by  F.  Bird,  of  Siegburg,  in  1833.  Leubuscher, 
of  Halle,  called  it  Erysipelas  of  the  Auricle.  Fischer, 
however,  gave  tiie  tumors  the  name  of  Othatomata  in 
1848.  There  are  still  synonyms  used,  Sbematomata  or 
OHth  in  the  Insane,  There  is  no  doubt  that  the  affec- 
tion occurs  also  in  the  sane,  although  cases  have  been 
mneh  more  frequently  observed  among  ^e  insane.    The 


symptoms  are  as  follows:  There  is  formed  in  the  fossa 
between  the  heiix  and  anti-helix^  or  in  the  condia^  never 
on  the  lobe  of  the  ear,  a  livid  reddish  tumor,  which  in 
its  beginning  is  generally  unobserved,  since  the  pa- 
tients do  not  complain  of  ir,  and  it  easily  escapes  the 
attention  of  the  physician.  It  develops  quite  rapidly 
to  the  size  of  a  bean,  a  walnut,  or  even  to  that  of  a 
pigeon's  eg^.  The  tumor  is  tense,  elastic  to  the  touch, 
nas  quite  a  distinct  contour,  and  on  severe  pressure  is 
generally  painful  To  thi?  latter  symptom,  as  in  gene- 
ral in  the  subjective  symptoms  of  the  insane,  too  much 
credence  cannot  be  given,  since  sensation  is  either  mor- 
bidly increased  or  diminished  in  their  cases. 

The  tumor  remains  in  this  condition  for  some  days  or 
weeks,  finallv  loses  its  redness  and  heat,  collapses,  be- 
comes doughy;  its  integument  becomes  wrinkled, 
and  it  either  passes  into  a  normal  condition,  or,  in  the 
greater  number  of  cases,  leading  to  deformity  of  the 
auricle,  either  by  shrinking  or  hypertrophy. 

Virchow's  recent  observations  have  decided  with 
certainty  that  the  haematoma  of  the  auricle  occurs  in 
exactly  the  same  way,  and  under  the  same  conditions, 
as  the  cephalatomata  of  the  newly  born — that  is,  from 
mechanical,  and  often  traumat'c  causes.  These  causes 
produce  a  separation  of  the  perichondrium  from  the  car- 
tilage similar  in  both  cases,  only  with  this  difference, 
says  Virchow,  that  in  the  othatomata  pieces  of  cartilage 
generally  remain  adherent  on  certain  spots  of  the  loos- 
ened perichondrium.  Through  the  investigations  of 
Meckel^  the  conclusion  was  formed  that  these  portions 
of  the  cartilage  were  new  formations,  which  still  further 
confirmed  the  analogy  with  Cephalatomaia. 

In  cephalatomata  the  so  called  bony  ring,  which  Mive 
to  the  finger  the  false  sensation  that  there  was  a  nole 
in  the  skull,  is  only  a  deposit  of  periosteum,  which  first 
begins  to  form  on  those  points  where  the  periosteum 
is  elevated  from  the  bone.  The  periosteum  continues 
to  make  this  bony  deposit  and  finally  forms  a  bony 
shell  over  the  Iwematoma.  This  shell  is  a  proliferation 
of  the  inner  layer  of  periosteum,  from  which  the  new 
bony  layers  proceed.  Then  the  function  of  periosteum — 
the  nourishment  of  bone — ceases  with  the  separation 
of  the  layers  by  an  extravasation  of  blood;  and  thus 
there  arises  a  connected  layer  of  flakes  or  scales  of  car- 
tilage and  bone.  Etiology. — The  older  authors  ascribed 
the  existence  of  the  othatomata  to  a  blood  dyscrasia,  or 
to  an  "especial  predisposition  to  an  erysipelatous  na- 
ture." GuDDEN  was  the  first  one  (in  1860)  to  give  the 
mechanico-traumatic  origin.  His  reference  to  the  de- 
formed ears  of  the  heads  of  the  old  Grecian  pugilists, 
seen  in  the  Munich  gallery,  and  the  literatuie  of  the 
subjec*,  is  interesting.  The  observation  has  been  made, 
that  in  the  insane  the  left  ear  is  more  apt  to  be  affected 
with  thi^  tumor  than  the  right — this  being  the  one  more 
liable  to  be  struck  by  the  right  hand.  Gudden,  how- 
ever, goes  too  far,  when  he  makes  the  attendants  alone 
responsible  for  the  appearance  of  othatomata.  It 
may  occur  from  injuries  done  to  the  ears  by  the  patients 
themselves.  His  idea  as  to  the  origin  of  these  tumors 
is  substantiated  bv  the  fact,  that  on  a  better  organiza- 
tion of  insane  asylums — that  is,  with  a  better  class  of 
attendants— othatomata  are  less  frequently  seen. 

The  treatment  is  expectant  -  On  opening  the  tumor, 
a  viscid  bloody  fluid  or  pure  blood  is  evacuated.  The 
wound  so  >n  henls. 

The  belief  that  othatomata  generally  occur  in  pa- 
rents who  are  hopelessly  insane,  is  not  confirmed  by 
the  author,  who  relates  several  cases,  which  lead  to  the 
opinion  that  the  appearance  of  the  tumors  has  nothing 
to  do  with  the  prognosis. — 8L  Pdersburger  Medkin-^ 
ische  ZeUschrift,  1866,  4-6  Heft. 

Digitized  by  VjOOQ  IC 


THE  MEDICAL  RECORD. 


13 


The  Medical  Record. 

^   j$tmi-9^^i8  Itntnml  of  Ptbidne  hi^  Sxixsers* 
George  F.  Shradt,  M.D.,  Editor. 


Published  on  the  Ist  and  15th  of  each  Month,  by 
WILLIillf  WOOD  &  CO.,  61  Walkbe  Stsxbt,  New  Yobk. 

FOBMIQIf  AGSKCIE3, 


LtnrooH— Tbobhbs  k  Go. 

PaBIB— BOMAXISB   BT  ClB. 


Lbipsio— B.  Hkrm AHir. 

Bio  Jakxibo— Stbpbxnr  t  Ca. 


ITew  York.   IMaroli  1.  1807. 


OUR  TflfERAPEDTICS. 
Omt  system  of  tberapsutics  is  getting  in  a  bad  way. 
Tbe  phyBician  of  the  present  day  has  coaxed  himself 
into  the  comfortable  belief  that  nature  is  such  a  thusty 
handmaid,  and  is  capable  of  doing  so  much  for  him,  that 
be  ifl  inclined  to  leave  almost  everything  that  refers  to 
the  treatment  of  disease  entirely  in  her  hands.  The 
opinion  that  the  vis  medicairix  ncUuroB  can,  under  almost 
all  circamstances,  be  implicitly  trusted,  has  become  so 
preTalent,  that  we  can  hardly  be  surprised  that  the 
important  department  of  therapeutics  is  almost  entirely 
thrust  out  in  the  cold. 

It  is  within  the  recollection  of  many  that  the  custom 
of  dosing  our  patients  almost  to  the  death  was  a  duly 
honored  one,  and  the  physician  who  would  not  order  a 
•core  of  remedies  in  a  single  prescription,  notwith- 
standing he  might  in  so  doing  openly  defy  all  laws  of 
compatibility,  was  behind  the  age ;  was  in  fact  an  unre- 
haUe,  if  not  unsafe  practitioner.  We  have  certainly 
learned  something  since  then,  but  in  our  zeal  to  correct 
the  mistakes  of  our  predecessors  we  have  invited  a 
dangerous  reaction.  We  say  dangerous  reaction,  be- 
cause we  believe  it  to  be  so  in  that  tendency  to  neglect, 
which  it  has  already  engendered,  and  may  still  further 
snooorage. 

Experience  and  observation  have  taught  us  to  believe 
that  many  of  the  diseases  which  heretofore  were  con- 
trollable by  certain  remedies,  have  been  found  self-lim- 
ited. This  fact,  in  the  face  of  it,  carries  the  conviction 
to  the  mind  of  every  medical  man  that  medicines  are 
useless  in  such  maladies,  except  so  far  as  they  may  be 
employed  against  any  complication  that  may  arise.  So 
fiu",  then,  we  have  learned  much  that  is  valuable,  and 
are  certainly  in  a  measure  on  our  guard  against  any 
meddlesome  interference. 

Bat  are  we  not^  on  the  other  hand,  in  danger  of  doing 
too  little  ?  Are  we  not  getting  into  the  habit  of  being 
indiiSerent  pilots,  caring  more  to  learn  the  characters 
lod  customs  of  the  port  to  which  we  are  allowing  onr 
desperate  case  to  drill,  than  to  study  the  course  of  some 
Dew  and  better  channel  ?  I^is  we  fear  is  the  case.  We 
aocostom  ourselves  to  believe  that  such  and  such  dis- 
re  incoraUe  or  uncontrollable,  and  almost  the 


whole  of  our  attention  is  given  to  the  pathology  of  the 
affection  and  to  conjectures  upon  the  correctness  of  a 
diagnosis. 

Pathology,  as  a  study,  is  perhaps  more  attractive  than 
any  other  department.  The  brilliant  discoveries  that 
have  been  made  through  its  agency  in  increasing  our 
knowledge  of  the  nature  of  different  diseases,  are  suf- 
ficient to  account  for  this.  But  despite  its  allurement^, 
there  is  no  reason  why  it  should  be  studied  to  the  ex- 
clusion of  other  equally  important  branches,  in  which 
that  of  therapeutics  should  hold  no  mean  rank. 

There  seems  to  be  such  a  lack  of  disposition  to  study 
this  particular  branch,  and  to  treat  it  with  that  de- 
tail, care,  and  conservatism,  which  it  most  assuredly 
claims,  that  we  are  in  danger  of  becoming,  if  not  hob- 
byists, certainly  routinists.  If  this  tendency  be  not 
checked,  we  shall  soon  shut  our  eyes  to  everything  but 
two  or  three  remedies,  and  be  ready  to  use  them  in  our 
treatment  of  all  diseases.  Indeed,  that  time  seems 
nearly  to  have  arrived.  The  medical  professor  will 
now  lecture  upon  a  particular  disease ;  he  will  give  its 
history,  characters,  the  method  of  diagnosticating  it  from 
others  which  iti  may  resemble ;  but  when  he  comes  to 
the  treatment  of  this  very  interesting  affection,  how 
common  is  it  for  him  to  dispose  of  it  in  the  most  cur- 
sory manner  as  if  in  fact  it  was  of  the  least  importance. 
The  student  who  has  faithfully  followed  this  lecture,  has 
filled  perhaps  pages  of  his  note-book  with  the  ac- 
count of  the  disease,  but  under  the  head  of  treatment^ 
a  simple  line  suffices  to  write  the  stereotyped  phrase, 
"  Whiskey  J  Quinine^  and  /ron." 

Therapeutics  is  not  at  present,  we  must  acknowledge, 
a  very  inviting  study.  It  is  so  much  behind  its  sister 
departments  that  a  great  amount  of  labor  is  required 
before  we  can  make  an  even  start.  But  this  should  not 
discourage  us.  Most  of  our  works  are  made  up  of 
much  that  is  useless ;  of  too  many  remedies  that  are 
obsolete,  and  which  have  qualities  assigned  them  of 
which  they  are  as  innocent  as  the  paper  upon  which 
they  are  printed;  but  neither  the  knowledge  of  this  fact, 
nor  the  appreciation  of  the  uncertainty  attending  the 
administration  of  vaunted  specifics,  nor  the  conflicting 
theories  regarding  the  actions  of  medicines,  should 
allow  the  science  of  therapeutics  to  remain  in  its  present 
ignominious  position. 

Far  from  improving  our  knowledge  of  therapeutics  as 
we  should,  we  are  virtually  going  further  from  our  des- 
tined goal.  We  have  not  only  reduced  our  agents  to 
the  smallest  possible  number,  but  we  do  not  seem  to  be 
disposed  to  study  well  even  these  few.  A  physician 
who  wishes  to  prescribe  iron,  or  quinine,  would  rather 
for  convenience*  sake  order  it  contained  in  some  pill 
compounded  in  a  foreign  country,  than  figure  out  the 
ingredients  in  such  respective  proportions  as  will  meet 
the  indications  of  an  individual  case.  It  may  be  pos- 
sible that  these  manufactured  pills  are  carefully  made 
up,  even  though  they  are  compounded  on  a  wholesalii 
scale ;  but  the  habit  of  using  them  in  the  indiscriminate 
^igitizad  by ^ ^_ 


14 


THE  MEDICAL  RECORD. 


manner  now  so  generally  indulged  in  is,  to  say  the  least, 
unscientific.  When  a  single  ingredient  is  used  in  a  pill 
or  other  menstrua,  it  is  not  so  bad,  for  then  if  the  manu- 
facturer is  reliable,  the  probability  is  that  the  physician 
will  not  be  working  so  much  in  the  dark,  as  he  must 
then  recollect  what  he  is  using;  but  when  several 
materials  are  compounded,  is  it  likely  that  one  not 
careful  enough  to  write  for  his  own  proportion  of  ingre- 
dients would  be  apt  to  keep  in  mind  those  of  another 
which  may  be  offered  him  ? 

All  this  thoughtlessness  in  prescribing  is,  we  are  con- 
vinced, the  result  of  a  want  of  a  proper  appreciation  of 
the  potency  of  medicines,  and  their  value,  when  properly 
used,  in  modifying  disease.  The  young  physician  has 
sneered  at  the  "  old  fogy ;  '*  but  the  question  seriously 
comes  up,  concerning  the  present  treatment  of  disease, 
whether  the  "  old  fogy,"  who  has  parted  with  his  idol 
calomel,  cannot  return  the  compliment.  In  our  zeal  to 
support  the  claims  of  the  advocates  of  non-medication, 
we  have  discarded  too  many  old  and  well  tried  reme- 
dies, and  our  only  excuse  is  a  flimsy  one  at  best,  that 
their  employment  heretofore  was  but  the  exponent  of 
hobbyism.  The  manifestation  of  that  same  spirit  is 
apparent  in  the  distrust  with  which  every  new  remedy 
is  viewed,  many  refusing  to  give  such  an  article  a  fair 
trial,  even  though  its  recommendations  for  favor  ema- 
nate from  a  most  responsible  source.  The  consequence 
is,  that  our  list  of  remedies  is  being  quite  rapidly  re- 
duced ;  and  if  we  continue  in  our  present  course  Mate- 
ria Medicas  will  be  looked  upon  as  cumberers  of  the 
shelf,  and  our  therapeutics  will  be  in  the  deplorable 
position  of  the  traditional  Job's  turkey  with  one  feather 
in  its  tail,  and  that  feather  will  be  cskHed—sHmrdation. 


Vitoxms. 


The  recent  death  by  chloroform,  at  Bellevue  Hospi- 
tal, has  added  another  to  the  list  of  the  victims  of  anaes- 
thesia. No  blame  can  be  attached  to  any  one  connect- 
ed with  the  case.  The  gentleman  who  administered 
the  anaesthetic ;  used  all  ordinary  care,  and  the  operator, 
when  the  patient  began  to  sink,  employed  every  means 
which  science  could  suggest,  or  skill  put  in  practice,  to 
ward  off  the  fatal  result.  All  this  goes  towards  esta- 
blishing the  fact  that  chloroform  is  a  dangerous  article, 
and  that  we  should  be  continually  on  our  guard  against 
the  constantly  recurring  accidents  which  are  due  to  its 
use. 

In  another  column  is  published  a  circular  letter  in 
reference  to  the  holding  of  a  convention  of  medical 
teachers.  The  different  subjects  which  are  to  be  brought 
up  for  discussion  are  of  immense  importance,  especially 
those  rererring  to  this  establishment  of  a  uniform  rate 
of  fees,  and  the  increased  of  the  lecture  term,  and  the 
number  of  professorships.  We  cannot  commend  them 
too  strongly  to  the  serious  consideration  of  the  different 
faculties  of  our  colleges,  and  hope  that  the  call  of  the 
committee  will  meet  with  a  very  hearty  and  general  re- 
sponse. 


''  CONSIDBRATIOVS  G^^RALBS  SUB  l'ENSBHBLE  DU  SBBTICS 

DES  Ali^n^s  nu  Depabtkment  de  la  Seine,  Soxtvekibs  X 

M.  LB  S^NATEUB,  PfiiFET  DE  LA  SEINE."     By  U.  GiRABD  DB 

Cailleux,  Inspector-General  of  Asylums  for  that  Depart- 
ment.   **  Rapport  bur  lbs  Ali^&  db  la  Seine  tbait^ 

DANS  lbs  ASILBS  DB  BlOBTRB  BT    DB    LA    SALPiTRlBBB." 

By  the  same  Author.     Alao,  the  "Rapport  bt  Procbs- 

YERBAUX  DB  LA  COMMISSION  POUR  L' AMELIORATION  BT  LBS 
R^FORMES    1    OPBRBR  DANS    LB   SBRVICB    DES    ALI^jftS,** 

Signed  M.  Girabd  db  GailleuXi   as  Secretary  of  the 
Commission. 

During  the  last  year,  a  special  inquiry  has  been  insti- 
tuted by  the  French  government  into  the  state  of  the 
great  hospitals  for  the  insane  in  Paris,  the  Bic^tre  and 
the  Salp^tri^re,  and  generally  into  the  condition  of  all  the 
limatics  belonging  to  the  populous  department  of  the 
Seine.  The  results  of  this  inquiry  are  of  special  inter- 
est to  us  at  the  present  time,  when  the  minds  of  the 
profession,  as  well  as  the  public  generally,  have  been 
turned  to  the  subject,  and  when  State  Legislation  is  in- 
voked for  better  provision  for  our  insane  poor.  It  will 
be  seen  that  this  inquiry  has  terminated  in  the  adoption 
of  reforms  of  the  greatest  magnitude,  involving  the  en- 
tire subversion  of  the  existing  establishments,  and  the 
construction  of  several  new  asyliuns  to  accommodate 
all  the  insane  of  the  department,  many  of  whom  have 
hitherto  been  distributed  in  the  asylums  of  other  de- 
partments, more  or  less  remote  from  the  one  to  which 
they  belonged. 

The  Commission  consisted  of  three  eminent  senators, 
the  Procureur-G^neral,  one  Councillor  of  State,  and 
Drs.  Paul  Dubois,  Dean  of  the  Faculty  of  Medicine, 
Husson,  and  M.  Girard  de  Cailleux.  The  Board^  at  its 
several  sittings,  examined  numerous  witnesses,  includ- 
ing severd  of  the  most  eminent  alienist  physicians  in 
France,  and  presented,  by  its  chairman,  M.  Ferdinand 
Barrot,  an  able  report  of  the  results  of  its  labors.  This 
report  furnishes  a  very  clear  insight  into  the  state  of 
lunacy  in  France  generally,  and  especially  in  the  De- 
partment of  the  Seine  ;  and,  at  the  same  time,  portrays 
strongly  the  aspects  of  the  great  lunatic  hospitals  of 
the  capital,  and  the  reforms  which  the  commissioners 

llie  report  embraces  a  wide  range  of  topics,  such  as 
the  **  State  of  Lunacy  in  France  generally;  "  "  Of  the 
BioHre  ;  "  "  Of  the  SaipHriire  ;  "  "  Medical  Service  ;  " 
"  Occupatuma;"'  "  Surveillance  and  Directions;*'  **  ReUr 
gious  Services  /  *'  "  Mechanical  Restraint ;  "  Mortality  ;  " 
"  State  of  the  Insane  in  Provincial  Asylums  ;  "  "  Reforms 
Proposed,*'  Sc* 

We  have  only  space  for  a  few  items.  Most  of  the  phy- 
sicians visit  their  patients  at  eight  or  half-past  eight  in 
the  morning,  some  few  at  six.  When  speaking  of  the 
medical  service,  generally,  the  commissioners  take  oc- 
casion to  insist  on  the  greater  amount  of  observation 
and  attention,  and  therefore  onthelonger  time  necessary 
in  treating  the  insane  than  in  prescribing  for  an  equal 
number  of  patients  in  a  general  hospital,  on  account  of 
the  additional  psychological  element,  which,  to  render 

•  In  1884  the  inMuie  In  Fnrnoe  were  reckoned,  by  M.  Ferries,  tt  about 
12,000,  Indading  8  890  in  hoepltalft,  and  8,600  vr anderlng  at  laive,  or  Hv 
Ing  with  their  llMnllle^  or  shot  up  In  prison.  Whilst,  In  1S18.  there 
were  only  eifrht  institutions  for  lunatics,  in  1886  their  number  bad  in- 
creased  to  thlrly-nlne,  viz. :  One  State  Asylum,  and  thirty  -eiriit  de- 
partmental Besides  these  there  were  twenty-one  hospitals  witii  loiia- 
tic  wards,  and  forty-flre  private  asylums.  In  thisjrear  (1886)  the  in- 
sane were  numbered  at  60,288 ;  of  whom  26,288  were  under  treatment 
in  Institutions^  The  proportion  of  thb  tota!  to  the  then  population  of 
France  was  as  1  to  1,870,  whilst  in  the  Department  of  the  Seine  the  pro- 
portlott  of  lunatiOB  under  treatment  to  the  population  was  as  I  to  487. 


igitized  by 


Google 


THE  MEDICAL  RECORD. 


15 


treatment  saccessful,  must  be  taken  into  especial  con- 
sideration, in  cases  of  insanity.  This  fact  has  long  been 
rec<^Qi3ed  both  in  Great  Britain  and  our  own  country, 
where  those  who  have  charge  of  the  insane  generally 
reride  in  the  buildings ;  but  with  the  exception  of  the 
intemes,  or  resident  pupiUjihe  attending  physicians  of 
all  the  insane  hospitals  of  raris  reside  without  the  es- 
tablishments. In  regard  to  food,  the  dietary  of  the  two 
hospitals,  Bic^tre  and  Salpetriere,  is  reported  to  be 
abundant  and  of  excellent  quality,  but  a  regret  is  ex- 
pressed that  meat  is  furnished  only  once  a  day ;  the 
dres$  of  tlie  patients,  it  is  stated,  leaves  much  to  be  de- 
sired, the  clothes  being  badly  made,  and  badly  fitted, 
and  a  source  of  vexation  and  annoyance  to  their  wear- 
era.  No  provision  is  made  for  keeping  separate  the 
dothes  of  indivi<lual  patients ;  hence  there  is  a  want 
of  interest  in  their  preservation,  of  a  feeling  of  satis- 
faction in  their  cleanliness,  and  of  a  useful  stimulus  to 
order  and  management  or  economy.  The  means  of 
repression  or  discipline  resorted  to  are  prolonged  baths, 
Uie  douche,  the  camisole,  temporary  seclusion,  close 
cells,  and  Uie  deprivation  of  tobacco. 

In  regard  to  occupation,  at  the  Bic^tre,  the  insane 
are  occupied  in  agricultural  work,  in  horticulture,  shoe- 
making,  carpentry^  cartwright's  work  and  building 
operations,  in  paintm^,  blacksmith's  work  and  wa-hing, 
in  brewing,  in  the  piggeries,  and  in  household  work. 
Of  980  male  lunatics,  205  of  them  are  employed.  At 
the  Salp^tridre.  the  women  are  employed  in  cutting  out 
and  making  clothes,  in  household  work,  and  in  lint- 
making.  Of  1,431,  827  were  employed  in  these  differ- 
ent ways.  Of  these,  as  many  as  126  were  engaged  in 
making  lint,  539  in  needle-work,  and  only  one  in  wash- 
ing. The  excess  of  sedentary  work  is  regretted,  and 
the  washing  of  clothes  is  recommended  as  a  "  suitable 
work  for  the  women,  and  favorable  for  treatment."  In 
regard  to  surveillance^  the  number  of  attendants  of  the 
Bic^tre  is  fixed  at  116  or  1  to  8.52 ;  at  the  Salpetriere 
at  146,  or  1  to  9.10.  About  180  men  and  230  women  at- 
tend service  on  Sundays  and  great  fast-days. 

In  regard  to  mechanical  restraint,  While  the  Commis- 
sion admit  that  there  are  now  and  then  cases  of  insani- 
ty which  demand  the  employment  of  the  camisole  or 
seclutton  as  exceptional  means  of  treatment,  yet  it  is 
stated  that  restraint  is  much  too  largely  employed  at 
the  Parisian  hospitals  for  the  insane.  At  the  Bic^tre 
27  patients  were  found  wearing  the  camisole,  a  propor- 
tion to  the  980  inmates  of  1  in  36.  But  besides  these 
coerced  by  the  camisole,  many  others  were  fastened  to 
their  beds.  At  the  Salpetriere  only  18  patients  were 
in  any  way  restrained;  which,  in  the  population  of 
1431,  was  1  in  79.  None  were  confined  in  iheir  rooms  dur- 
ing the  day.  With  reference  to  their  classification  in 
the  two  establishments,  there  were  at  the 

Bic^tre. 

Befiractory, 87 , 

Criminal  Lunatic?,  ....    31 

Semi-tranquil    and    tran- 
quil,   442 782 

Pilfchy, 92 419 

including  203  Epilep- 
328,       tics 38 


SalpAtiidre. 

188 


loftrmary, , 


980 


1,427 


The  mean  ratio  of  registered  r««wmM,  between  1839 
and  1858,  was  1  in  6.27  at  the  Bicfitre,  and  1  in  4.02  at 
the  Salpetriere.  However,  among  such  recoveries  are 
redconed  some  who  have  only  been  improved.  The 
mortality  has  amounted,  on  an  average,  between  1839 
and  1858,  at  the  Bic^tre,  to  1  in  3.66,  and  at  the  Salp^ 
tridre  to  1  in  3.29.    Several  reasons  are  assigned  for  t^is 


excessive  mortality,  but  the  most  important  would  seem 
to  be,  first :  the  confinement  of  the  insane  under  new 
and  unhealthy  conditions,  where  their  physical,  physio- 
logical,  and  moral  habits  are  suddenly  interrupted  and 
changed  j  and  second,  the  vicious  hygienic  condition  of 
the  localities  in  which  the  establishments  are  placed. 
The  seats  of  disease  causing  death  are,  in  the  order  of 
frequency,  the  head,  the  abdomen,  and  the  chest. 

The  cost  of  the  patients  is  thirty  cents  a  day,  for  the 
men,  and  twenty-five  cents  a  day  for  the  women,  but 
the  Commission  state  that  this  might  be  reduced  for 
both  sexes  to  twenty  cents  a  dav,  ii  the  patients  were 
placed  in  properly  organized  asylums. 

The  general  result  of  the  inquiry  is,  that  Ihe  Bic^tf  e  and 
Salpetriere  are  inadequate  to  their  purposes,  and  need 
to  be  radically  reformed.  Their  several  sections  are  de- 
fective, and  too  often  vicious  both  in  their  architectural 
and  medical  arrangements,  and  the  different  quarters 
deficient  in  unity  of  co-ordination.  Some  of  them  are 
neither  safe  nor  salubrious  for  their  inmates.  The  dor- 
mitories are  overcrowded,  and  classification  incomplete. 
The  refiiwjtory  are  not  under  adequate  control  and 
supervision,  the  use  of  restraint  is  much  in  excess,  the 
number  of  dirty  patients  far  U^o  great,  the  medical  ser- 
vice imperfect,  surveillance  difficult  and  badly  organized, 
the  means  of  occupation  insufficient,  the  clothing  leav- 
ing much  to  be  desired,  and  there  is  an  intermixing  of 
inmates  prejudicial  in  itself  and  contrary  to  law,  which 
demands  a  remedy  as  soon  as  possible. 

We  pass  over  many  interesting  details,  to  quote 
some  of  the  reforms  proposed.  The  following  is  a 
resuTnS  of  the  recommendations  and  conclusions  arrived 
at  by  tfie  Commission : 

I.  The  creation  of  special  asylums  for  the  insane  of 
the  department  of  the  Seine.  II.  The  administration  of 
these  asylums  directly  by  the  departmental  authorities. 
III.  The  construction  of  a  central  asylum  to  be  situated 
in  Paris,  for  the  reception  of  all  forms  of  insanity,  but 
especially  of  acute  and  recent  cases,  and  in  connexion 
with  it  a  system  of  cUnical  instruction.  IV.  The  insti- 
tution of  an  office  for  the  admission  of  patients,  to  be 
annexed  to  the  central  asylum,  where  reputed  lunatics 
may  be  examined  <ind  their  dislribution  be  determined. 
V.  The  erection  of  asylums  out  of  Paris,  and  at  such 
distances  that  the  relations  between  the  patients  and 
their  friends  may  be  easily  maintained.  Vl.  The  es- 
tablishment of  especial  asylums  for  insane  epileptics  and 
idiots.  VIL  The  new  asylums  to  be  so  constructed  as 
to  receive  lunatics  of  both  sexes,  yet  so  as  to  secure  an 
absolute  separation  between  the  two.  VIII.  The  erec- 
tion of  establishments,  in  connexion  with  the  asylums, 
for  the  reception  of  pensioners  at  fixed  charges ;  such 
buildings,  however,  to  be  thoroughly  detached.  IX. 
The  direction  of  the  asylums  to  be  intrusted,  if  prac- 
ticable, to  one  individual,  having  entire  control  both 
over  their  general  government  and  medical  superinten- 
dence. X.  TTie  employment  of  the  insane  in  various  use- 
frd  arts,  and  particularly  in  out-door  operations.  XL 
The  adoption  of  the  system  of  committing  such  cases  of 
mental  disorder  as  present  no  danger  to  puhUe  order  and 
security,  to  the  care  of  their  friends  m  thcM'  own  homes.^* 

Such  are  the  most  ii^portant  measures  of  reform 
agreed  on  by  the  commission,  after  many  sittings^  and 
calling  to  their  assistance  several  of  the  most  emment 
alienist  phvsicians  of  France.  The  actual  number  of 
insane  in  the  department  to  be  provided  for,  at  the  date 
of  the  commission,  was  4216 ;  but  taking  into  considera- 
tion the  rapid  increase  of  their  number  of  late  years,  it 
was  resolved  to  assume  6,000  as  the  sum-total  for  which 
accommodation  should  be  provided. 

As  to  the  dimensions  which  the  asylums  should  have, 
it  was  generally  agreed  that  the  maximum  number  to 


Digitized  by 


Google 


16 


THE  MEDICAL  RECORD. 


be  received  for  treatment  should  be  600,  and  that,  con- 
sequently, ten  new  asylums  would  be  needed  for  the 
department. 

In  the  case  of  the  Central  Asylum  in  Paris,  it  was 
considered  desirable  to  subdivide  it  into  four  sections 
of  150  each,  and  to  appoint  a  non-resident  physician 
to  each,  who  should  give  regular  clinical  instruction 
and  lectures  to  the  medical  students  of  Paris ;  a  resi- 
dent physician  is  also  to  superintend  it^  and  the  bureau 
of  admission?.  M.  Girard  de  Oailleaux  expressed  his 
opinion  that,  ia  a  scientific  point  of  view,  the  smaller  an 
cuylum  the  better  it  is  ;  for  that  the  indications  of  science 
are  to  restore  to  the  lunatic,  as  far  as  possible,  his  social 
position  and  relations  (the  vie  de  famiUe),  by  supply- 
mg  in  their  absence  the  conlact  with  him  of  persons  of 
sound  mind,  and  of  kind  and  benevolent  character;  and 
that,  moreover,  the  physician  can  devote  the  more  time 
to  hi3  patien ts  the  less  numerous  they  are.  The  strict  de- 
ductions from  scientific  grounds  must,  however,  yield 
to  a  certain  extent  to  economical  considerations ;  and 
he  was  convinced  that  not  more  than  600  or  600 
patients  should  be  placed  in  the  same  asylum,  inclusive 
of  100  pensioners  of  various  classes,  paying  respectively 
$146,  $240,  $360,  and  $4S0,  or  more  per  anntmi. 
With  such  an  organization,  an  asylum,  costing  in  con- 
struction not  more  than  $500  per  patient,  exclusive  of 
the  cost  of  site,  should  by  proper  management,  by 
agricultural  and  industrial  labor,  and  by  a  regulation  of 
%  the  admissions  in  accordance  with  the  views  of  the 
Legislature,  cover  the  interest  chargeable  on  the  capital 
expended  in  its  construction.  This  resuU  experimce  has 
shown  practicable.  At  the  Insane  Asylum  at  Auxerre,  it 
is  stated,  the  expenditure  would  have  been  covered  by 
the  receipts,  had  not  an  increased  number  of  imbecile 
gratuitous  patients  been  admitted,  and  the  daily  charge 
for  maintenance  been  reduced  in  the  case  of  the  poor, 
from  one  firanc  fifteen  centimes  to  one  franc  per  day.  The 
conmiission  dwell  with  much  emphasis  upon  the  impor- 
tance of  restoring  to  the  insane,  the  ustutl  ir^uences  and 
surroundings  of  domestic  family  life  (vie  de  famiUi)^  and 
in  order  to  effect  this,  of  placing  them  under  the  influence 
in  the  highest  degree  attainable,  of  persons  of  sound 
mind,  a  result,  as  is  stated  in  the  Report,  to  be  arrived  at 
only  by  division,  by  instituting  smaU  sections  or  quarters, 
ana  by  separating  the  various  classes  of  patients.  It  is  by 
such  means  that  the  moral  status  of  the  insane  can  be 
improved,  that  discipline  can  be  enforced,  however 
chronic  their  malady  may  be,  and  it  is  with  regard  to 
(hronic  lunatics  that  the  moralizing  ir^uence  is  die  most 
difficult  and  more  frequently  the  most  useful.  Moreover, 
every  chronic  case  is  liable  to  pass  through  the  succes- 
sive phases  of  excitement,  collapse,  filthy  habits,  tran- 
quillity, and  turbulence,  along  with  incidental  maladies. 
Hence  arises  the  necessity  of  establishing,  even  in 
asylums  that  receive  only  chronic  cases,  those  fivefanda- 
mental  classes,  or  categories,  which  are  recognised  by 
the  French  legal  enactments  relative  to  the  construction 
of  asylums. 

The  Commission  remark  that,  "  if  regard  be  had  to 
the  indications  of  science,  as  must  be  indeed,  since  it  is 
desired  to  carry  out  a  reform,  and  to  offer  to  the  intel- 
ligence of  Europe  an  exaniple  worthy  of  imitation, 
there  must  be  a  division  or  the  insane,  to  escape  the 
error  of  erecting  asylums  of  too  large  dimensions,  and  not 
tofbUow  the  example  of  (he  English,  who  constructed  for- 
tresses  for  their  unfortunate  people,  in  spite  of  the  impotent 
protestations  of  science  and  experience.  There  is  nothing, 
moreover,  to  be  gained  in  respect  to  economy  in  these 
mischievous  agglomerations,  if  the  principles  of  classi- 
fication enunciated  are  adopted.  Indeed,  m  such  great 
aeyjums,  the  error  now  seen  in  the  asylums  of  the 
Seme  becomes  repeated,  of  dividing  the  services  and 


of  multiplving  the  general  costs,  at  the  expense  <^ 
breaking  the  unity  of  direction  and  mnnajeraent  True 
progress  is  bound  up  with  the  multiplication  of  asvlums 
and  their  distribution  under  one  sole  control"  In  re- 
gard to  the  proportion  of  cells  (equivalent,  we  sup- 
pose, to  the  padded  rooms  of  the  English  asylums), 
one  to  forty  of  the  population  was  deemed  sufficient. 
We  read  of  no  instance  where  cribs,  so-called,  are  used 
or  recommended  for  the  purpose  of  confining  the  in- 
sane ;  nor  is  there  any  evidence  that  they  have  ever 
be^n  employed  for  this  purpose  except  in  some  Ameri- 
can asylums. 

The  asylum  of  Auxerre,  which  was  visited  by  the 
Commissioners,  is  to  be  adopted  as  the  model  in  the 
construction  of  the  new  institutions  projected.  With 
reference  to  their  medical  staff,  it  was  decided  that, 
in  the  case  of  the  asylums  without  Paris,  the  medical 
officer  should  be  also  the  superintendent  or  director, 
and  have  under  his  control  a  steward,  a  secretary ^  and  a 
receiver.  The  principles  recognised  in  the  management 
of  our  own  asylums  were  fully  adopted  by  the  Com- 
mission, namely,  that  unity  of  thought,  of  interest^  of 
responsibility,  of  power,  and  action,  is  an  essential  con- 
dition for  the  successful  treatment  of  the  insane,  and 
for  the  good  government  of  an  asylum.  The  compound 
nature  of  man,  of  soul  and  body,  demands,  for  the  most 
successful  treatment  of  insanity,  tlie  combination  of  phar- 
maceutical, hygienic,  and  moral  means.  To  act  men- 
tally on  the  insane,  the  physician  must  have  complete 
authority  over  the  attendants  and  others  about  his  pa- 
tients, and  there  is  noth'ng  to  prevent  him  engaging 
in  the  pursuit  of  the  science  of  his  profession,  inasmuch 
as  he  can  have  assistance  from  others  in  many  adminis- 
trative details,  in  the  preparation  of  prescriptions,  in  con- 
ducting correspondence,  etc. 

In  discussing  the  question  of  the  practicability  of  pro- 
viding separately  for  the  curable  and  incurable,  a  majority 
of  the  Commission  voted  in  the  affirmative.  It  was 
agreed  that  about  four-fiflhs  of  the  insane  belong  to  the 
class  of  chronic  or  incurable,  and  it  was  conceded  gene- 
rally that  those  who  had  not  recovered  at  the  end  of  two 
years,  were  not  likely  to  do  so.  That  some  few,  out  of 
a  considerable  number,  should  get  well  after  that  period, 
was  held  to  be  no  argument  against  the  attempt  to 
separate  recent  and  acute  cases  of  insanity  from  chronic 
and  probably  incurable,  particularly  as  in  asylums  occu- 
pied by  the  latter,  the  hope  need  not  be  ignored,  and 
the  means  of  cure  would  not  be  wanting.  On  the 
other  hand,  it  was  admitted,  that  the  separation  is  de- 
sirable on  economic  arounds,  and  the  cure  of  recent  cases 
could  more  thoroughly  be  cared  for  in  specially  adapted 
asylums  of  small  size,  and  vnth  afuR  complement  of  medi- 
cal aid.  Moreover,  it  would  be  a  simple  expedient  to 
remove  any  cases  from  an  asylum  for  chronic  patients 
to  that  for  recent,  or  vice  versd,  when  thought  desirable ; 
and  it  would  not  be  necessary  to  call  any  of  the  insti- 
tutions asylums  for  incurables.  No  diflerence  of  opi- 
nion {wevfliled  in  regard  to  the  expediency  of  separate 
ing  the  insane  ep'deptics  and  idiots  from  other  persons 
of  unsound  mind,  aiui  of  placing  them  in  a  spe<nal  asy- 
lum. 

The  above  resumi  of  the  reports  of  this  able  and 
learned  Commission,  will  convey  some  idea,  however 
imperfect,  of  the  magnificent  general  scheme  about 
to  be  carried  out  in  the  department  of  the  Seine  for 
the  management  of  this  most  unfortunate  class  of 
beings ;  and  it  will  not  be  long  before  we  shall  find  a 
series  of  asylums,  built  afler  the  most  approved  models, 
furnished  with  every  appliance  for  the  well-being,  the 
treatment,  and  recovery  of  their  suffering  inmates.  In 
comparison  with  this  well  developed  scheme  of  asyluma, 
construction,  and  management^  much  of  what  has  been 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


17 


dooe  in  England  and  in  ibis  country,  roust  be  looked' 
upon  as  ill-coDtrtyed  and  ill-ezecutec^  and  needing,  ere 
long,  the  reformer's  hand. 

Thb  FuNcnoNs  Ain>  Disokdbbs  op  thb  RBPRODuonrE  Oa- 

OAX8  IH    CmLDBOOD,    YoUTH.    AdULT    AoR  AND  AdTANORD 

Ltpc  Bj  William  Aoton,  M.B.C.S.,  late  Surgeoo  to  the  Is- 
liogton  Dispen.sary,  etc ,  etc.  2d  Amer.  from  4th  London 
ed.     PliLk :  Lindsaj  k  Blakiston.    1867.    8to.,  pp.  291. 

Tab  fourth  edition  of  Mr.  Acton's  most  excellent  work 
is  before  us.  The  author  treats  the  subject  in  reference 
to  four  important  periods  of  human  life,  viz.  child- 
hood^ youth,  adult  age,  and  advanced  life.  He  has 
very  carefully  incorporated  in  the  treatise  what  new 
matter  has  accumulated  since  the  last  edition,  besides 
iifedng  the  lights  of  collateral  sciences. 

As  an  instance  of  thoroughness  of  treatment,  we  may 
mention  that  he  does  not  nesitate  to  view  his  subject 
firom  a  rehgious  stand-point,  even  referring  to  sermons 
preached  by  Jeremy  Taylor  and  others,  ne  text  is  en- 
livened by  quotations,  one  of  which,  from  Lord  Bacon, 
regarding  continence,  from  its  aptness  as  well  as  sound 
morality,  we  cannot  refrain  from  transferring  to  our 
own  pages.  "He  that  preferred  Helena,  quitted  the 
gifts  of  J  uno  and  PuUas ;  for  whosoever  esteemeth  too 
mach  of  amorous  affection,  quitteth  both  riches  and  wis- 
dom. .  .  .  They  do  best,  who,  if  they  cannot  but 
admit  love,  yet  make  it  keep  quarter." 

Masturbation,  Continence,  Incontinence,  true  and 
&be  Impotence,  Satyriasis,  Spermatorrhoea,  etc  ,  are  ful- 
ly and  aWy  discussed.  The  author  inclines  to  the  belief 
that  absolute  continence  can  be  maintained  without  in- 
jury to  the  individual,  thus  rebuking  the  advocates  of 
•exual  congress  as  a  cure  for  sexual  torments.  He 
■hows  that  religion,  moraUty,  and  science  may,  without 
other  aid^,  succeed,  when  working  in  unison.  The 
painful  subject  of  masturbation  is  treated  with  the 
anther's  usual  firmne  s  and  dehcacy,  and  we  simply  dis- 
mias  it  with  the  remark  that  it  does  credit  alike  to  the 
author's  head  and  heart. 

We  are  glad  also  to  see  that  Mr.  Acton  pays  due  de- 
ference tD  the  opinion  that  spermatorrhoea,  long  the 
bugbear  of  the  nervous  and  bulwark  of  quackery,  is  ra- 
ther a  disease  of  the  mind  than  the  body,  and  that 
the  fears  of  the  patient  should  be  allayed  as  speedily  as 
possible,  strict  attention  at  the  same  time  being  paid  to 
ezerciae  and  diet  without  any  resort  to  medication,  ex- 
cept in  desperate  cases. 

Altogether,  the  work  is  to  be  deemed  a  classic  in  its 
line,  from  the  fact  that  the  only  lights  which  the  author 
baa  followed  in  investigation,  are  those  of  sound  phi- 
losophy and  science. 

MsTBOMAsnA;  A  Treatise  on  Alcoholic  Poisoning.  By 
Albbrt  Day.  MD..  Superintendent  and  Physician  of 
WasbiDgton  Home,  Boston ;  with  an  Appendix,  by  H.  R. 
Storer,  Prof,  eta  Boston:  James  Campbell.  1867. 
18ma  pp.  70. 

Tns  little  volume  b  a  treatise  on  those  ppisons  which 
first  stimulate,  then  narcotize.  The  author  has  had 
ample  means  to  thoroughly  investigate  hia  subject, 
hsvinp:  had  over  two  thousand  cases  under  his  care,  a 
mat  many  of  which  were  suiSering  under  one  of  the 
oiffereut  forms  of  mania  ^  potu.  These,  he  truly  says, 
vary  in  symptoms,  according  as  the  patient  may  have 
been  habitually  intoxicated  a  considerable  length  of 
time,  or  have  indulged  in  a  paroxysm  of  drunkenness. 
1^  symptoms  are  w  11  descnbed,  but  there  is  not  that 
amoont  of  newness  about  the  volume  which  we  could 
expect  from  a  treatise  more  strictly  scientific.  It  is 
rea&y  intended  as  a  warning  to  the  young  against  the 
vice  of  drunkenness,  and  its  attendant  crimes — a  form  of 
which  we  all  know  is  frightfully  prevalent^ 


Looking  at  the  work  from  a  humanitarian  point  of 
view,  we  cannot  but  hope  that  it  may  meet  with  dl 
the  suceess  it  deserves,  and  at  the  same  time  are  well 
satisfied  that  those  who  have  not  larger  and  more  ela- 
borate treatises  in  their  libraries  can  find  in  its  pages 
much  practical  information.  Perhaps  the  only  objec- 
tionable feature  about  the  work  is  the  appendix,  by  Dr. 
Storer,  wherein  he  warmly  praises  Dr.  Day  for  his 
unflagging  zeal  in  this  branch  of  medical  treatment,  as 
well  as  the  Legislature  of  Massachusetts  for  passing  a 
law  to  incorporate  an  asylum  for  inebriates,  all  of  which 
we  think  unnecessary  to  the  discussion  of  the  subject. 


Ee|T0rt«  of  SacUttes. 


N.  Y.  PATHOLOGICAL  SOCIETY. 

Stated  Meeting,  Nov.   28,  1866. 
Dr.  Frank  H.  Hamilton  in  the  Chair. 

RESECTION  or  FEMUR  FOR  MORBUS  COXARIUS. 

Dr.  Rogers  exhibited  the  head  and  neck  of  the  left 
femur  of  a  boy  eight  years  of  age.  Three  years  ago  the 
patient  began  to  complain  of  the  ordinary  symptoms 
of  morbus  coxarius,  for  which  he  was  treated  by  ex- 
tension, falling  in  the  mean  time  into  the  hands  of  various 
individuals.  Next  he  entered  the  Institution  lor  the 
Ruptured  and  Crippled,  where  he  remained  under  treat- 
ment for  the  greater  part  of  two  years.  The  case  came  to 
the  Demilt  Dispensary  a  year  ago  this  month.  The  boy 
at  that  time  was  very  much  emaciated,  there  being 
extensive  suppuration  from  a  row  of  sinuses  extending 
in  a  longitudinal  direction  f  )r  half  the  distance  down  th^ 
external  and  posterior  aspect  of  the  thigh.  He  had  hectio 
fever^  night  sweats,  and  his  strength  was  failing  so  fast 
that  it  was  not  thought  he  would  last  very  lon^.  On 
consultation  an  operation  for  the  removal  of  the  diseased 
bone  was  considered  advisable,  and  was  performed  by 
Dr.  Rogers. 

Not  only  were  the  head  and  neck  of  the  bone  removed, 
but  a  portion  of  the  shaft,  in  an  oblique  direction,  which 
bad  become  denuded  of  periosteum  by  the  track  which 
the  pus  had  taken  to  escape  from  the  cavity  of  the  joint. 
At  the  time  the  operation  was  performed  there  was 
scarcely  anything  of  the  limb  left  but  skin  and  bone,  but 
by  careful  treatment  the  muscles  acquired  a  considerable 
development,  and  the  patient  being  presented  to  the 
Society  along  with  the  specimen  {?ave  ample  evidence 
of  beinpr  able  to  move  the  limb  with  considjerable  free- 
dom. The  operation  had  been  performed  only  a  year 
since,  and  the  patient  had  been  g'>ing  to  school  for  the 
past  six  months,  and  was  able  with  the  help  of  a  cane 
to  walk  with  ease.  The  affected  limb  was  shoitened 
about  an  inch.  Slight  rotation  outwards  and  inwards 
had  been  preserved  to  him,  and  flexion  was  tolerably 
firee,  although  of  course  limited. 

Dr.  Post  called  attention  to  the  existence  of  a  small 
sequestrum  at  the  upper  part  of  the  shaft,  just  below  the 
neck  and  on  the  inner  side  of  the  bone,  which  was  na 
larger  than  robin's  shot.  He  also  remarked  that  there 
was  a  remarkable  degree  of  porosity  in  the  remnant  of 
the  neck. 

Dr.  Rogers,  in  answer  to  a  question,  remarked  that 
the  treatment  subsequent  to  his  operation  was  substan- 
tially the  same  as  that  for  hip  disease  by  extension.  At 
the  time  that  the  patient  was  allowed  to  bjar  his  weight 
upon  the  limb,  aided  by  crutches,  there  was  no  difference 
in  length  between  the  two  extremities,  but  as  he  began 
to  use  it  the  thigh-bone  shoved  up  a  Uttle.  Dr.  R  did  not 
think  that  the  difference  would  have  been  so  great,  had 
his  injunctions  with  reference  to  the  gradual  use  of  the 


Digitized  by 


Google 


18 


THE  MEDICAL  RECORD. 


limb  been  followed.  Passive  motion  of  the  limb  was 
earlj  resorted  to,  and  to  this  circumstance  was  doubt- 
less due  the  amount  of  mobility  already  referred  to.  He 
stated  that  the  sinuses  on  the  back  part  of  the  thigh  were 
Sirious  obstacles  to  recovery,  and  continued  to  exist 
long  after  the  wound  of  the  operation  had  granulated 
and  healed 

Dr.  Post  thought  that  the  specimen  gave  evidence  of 
more  absorption  of  the  neck  than  the  head. 

De.  Roqers  remarked  that  the  displacement  of  the 
capsular  hgament  first  described  by  Dr.  Greo.  K  Smith, 
of  Brooklyn^  as  belonging  to  these  cases,  was  found  in 
the  present  mstance. 

A  BULLET  IN  THE  HBART  FOB  TWENTY  TEARS. 

Dr.  Hamilton  presented,  on  behalf  of  Dr.  Balch,  a 
heart,  in  the  substance  of  which  a  rifle  ball  had  been 
imbedded  for  twentv  years  of  the  life  of  the  patient. 
The  following  is  the  history  of  the  case  as  furnished  by 
the  gentleman  owning  the  specimen : 

In  the  year  1840,  John  Kelley,  a  boy  fourteen  years  of 
age,  was  employed  at  Chatham  Four  Comers,  Columbia 
CO.,  N.  Y.,  in  driving  a  horse  cart  hauHng  gravel,  for  the 
oonstmction  of  the  railroad  from  Albany  to  Boston. 

One  night  while  in  bed  in  the  upper  part  of  a  shanty, 
which  was  constructed  for  the  workmen,  a  target  rifle 
was  fired  fi-om  a  hill  back  of  the  house ;  the  bullet  pass- 
ed through  two  roof  boards  and  a  board  partition,  and 
entered  Kelley's  right  shoulder  through  the  upper  border 
of  the  trapezius  muscle  about  two  inches  from  the  acro- 
mion process.  The  physicians  who  were  called  probed 
the  wound,  and  thought  they  felt  the  ball  about  four 
inches  from  the  point  of  entrance,  the  course  of  the 
missile  being  downwards  and  a  little  inwards.  They 
decided  to  let  the  bullet  remain,  as  they  thought  an  ope- 
ration was  more  dangerous  than  non-interference. 

There  was  a  little  haemorrhage  and  no  great  local  dis- 
turbance at  the  time.  In  about  six  weelffl  the  boy  was 
•ble  to  resume  his  work.  He  gradually  gained  his 
health,  and  to  all  appearances  was  perfectly  well.  He 
afterwards  removed  to  Clinton  co.,  N.  Y.,  married,  and 
became  the  father  of  several  children. 

In  1845,  he  was  attacked  with  pneumonia,  situated 
in  t^e  upper  lobe  of  the  right  lung.  Dr.  Orvill  Terry  of 
Redford,  Clinton  co.,  N.  T.  attended  him  during  this 
seizure  and  also  his  last.  During  the  illness  of  1845,  for 
the  first  time,  was  noticed  a  very  tumultuous  action  of 
the  hearty  which  remained  after  his  recovery  from  the 
pneumonia,  and  continued  to  increase  up  to  the  time 
of  his  death,  June  14th,  1860 ;  twenty  years  after 
being  shot^  and  fifteen  after  disease  of  the  heart  manifest- 
ed itAelf. 

Kelley's  last  illness  was  the  result  of  exposure  to  the 
cold  waters  of  a  mountain  brook,  he  having  gone  into 
them  for  the  purpose  of  washing  sheep  a  few  days  be- 
fore bis  death.  Congestion  of  the  right  lung  was  the 
result  of  the  exposure.  The  heart's  action  became 
exceedingly  violent,  and  four  or  dye  days  closed  the 
scene.  Two  days  before  his  death  his  right  arm  and 
hand  became  purple  and  cold. 

The  post-mortem  examination  was  conmienced  with 
the  view  of  finding  the  bullet  ftnd  of  examining  the 
diseased  condition  of  the  heart  and  lungs. 

I  dissected  the  neck :  found  the  right  internal  jugular 
vein  enlarged,  the  right  external  jugular  I  could  not 
find ;  I  found,  however,  something  that  I  took  to  be  the 
remains  of  tne  external  jugular  entering  the  internal 
jugular  (which  is  an  anonialy  of  that  vein).  In  the  right 
subclavian  artery,  pericardium,  and  other  places^  I  found 
atheromatous  deposits.  The  upper  lobe  of  the  nght  lung 
I  found  congested;  other  parts  of  the  lung  normal;  no 
tubercle*  anywhere.    The  heart  was  enlai^^  soft^  and 


flabby;  it  having  undergone  Quain's  fatty  degeneration. 
The  pericardium  was  very  adherent,  more  particularly 
on  the  right  side.  I  had  not  yet  found  the  ball  A  hard 
lump  was  felt  in  the  right  ventricle,  near  the  apex  of 
the  heart ;  on  introducing  my  finger  into  the  ventricle 
through  the  vena  cava  and  right  auricle,  I  ascertained 
that  the  lump  was  in  the  wall  of  the  right  ventricle  near 
the  septum,  at  the  most  pendent  part  of  the  ventricle. 
On  looking  carefully  at  the  outer  surface  of  the  organ, 
I  could  find  no  cicatrix.  I  then  cut  down  upon  the 
lump  and  found  it  to  be  a  leaden  bullet,  somewhat  flat- 
tened, and  (encysted  in  the  wall  of  the  heart 
Dr.  Hamilton  remarked  that  the  case  had  been  already 

Eublished  in  the  American  Journal  of  Medical  Sciences^ 
ut  he  was  not  aware  that  the  specimen  had  ever  been 
presented  to  any  medical  society.  He  stated  in  this 
connexion  that  Dr.  S.  S.  Purple,  of  this  citv.  in  a  paper 
on  wounds  of  the  heart,  published  in  the  May  number 
of  1855,  of  the  N,  T.  Medical  Monthly  I  reported  twelve 
examples  of  gunshot  wounds  of  this  organ,  in  which  the 
patients  survived  from  two  days  to  six  years.  In  the 
case  reported  bv  Fugi  the  patient  Uved  fourteen  days 
with  a  ball  in  the  pericardium.  Dr.  Hopkins,  of  Ohio, 
has  reported  a  case  in  which  the  patient  survived 
fifteen  davs  with  a  pistol  ball  in  the  wall  of  the  1-ft  ven- 
tricle. Cfamochan's  patient,  the  notorious  Poole,  lived 
eleven  days  with  a  pistol  ball  encysted  in  the  walls  of 
the  heart.  In  the  case  reported  by  Dr.  Randall  of  Ohio, 
the  patient  died  on  the  sixty-seventh  day,  and  three 
shots  were  found  in  the  right  ventricle  and  in  the 
right  auride;  the  wounds  having  cicatrized.  In  the 
Indian  Annah  of  Medical  Sciences  a  man  is  said  to  have 
survived  ten  weeks  with  a  musket  ball  in  the  cavity  of 
the  left  ventricle.  Fournie  records  the  history  of  a 
man,  who,  wounded  by  a  ball,  fell  as  if  he  were  dead. 
Three  months  after,  he  suffered  from  severe  palpitations, 
but  which  nearly  disappeared  afler  three  years.  He 
died  six  years  afier  the  receipt  of  the  injury,  from  some 
malady  unconnected  with  his  injury ;  and  the  ball  was 
found  lodged  in  the  right  ventricle,  near  the  tip,  and 
resting  on  the  septum  medium. 

Dr.  Peasleb  did  not  see  why  Dr.  Balch's  patient 
might  not  have  lived  much  longer  with  the  ball  in  his 
heart,  as  it  did  not  seem  as  if  death  was  the  direct  result 
of  its  presence  in  that  organ.  The  palpitation  which 
the  patient  suffered  was  in  his  opinion  probably  increas- 
ed by  the  extra  labor  thrown  upon  a  heart  already  crip- 
pled. Beyond  this  increase  of  the  heart's  action  to 
overcome  the  weight  of  the  ball,  and  the  effect  of  its 
presence  in  somewhat  embarrassing  the  action  of  the 
organ,  there  was  nothing  unusual  He  observed  that 
the  missile  in  this  instance  had  perforated  the  muscular 
wall,  and  was  lying  in  contact  with  the  attached  sur&ce 
of  the  endocardiuna. 

Dr.  Rogers  thought  that  inasmuch  as  there  were 
no  signs  of  a  cicatrix  upon  the  walls  of  the  ventricle, 
Uie  ball  might  have  found  its  way  to  that  situation 
by  entering  one  of  the  large  vessels,  dropping  down, 
and  passing  though  the  endocardium. 

Dr.  Hamiltox  confessed  that  he  had  formed  no  theory 
upon  the  subject,  but  stated  that  he  believed  Dr.  Balch 
was  of  the  opinion  that  the  missile  had  entered  the 
heart  from  within. 

Dr.  Jacobi  asked  how  such  a  circumstance  as  the 
wound  of  so  large  a  vessel  could  be  conceived  without 
the  occurrence  of  haemorrhage? 

Dr.  Hamilton,  in  this  connexion,  referred  to  a  case  on 
record  in  which  the  carotid  artery  was  wounded  by  a 
ball  which  plugged  up  the  proximal  side.  The  patient 
died  of  secondary  hemorrhage  firora  the  distal  extremity. 

Dr.  Post  remarked  that  he  had  reported  a  somewhat 
similar  case  of  wound  of  the  vertebral  artery,  death 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


10 


taldng  place  seyeral  days  after  from  secondary  haemor- 
riuge.  He  also  stated  it  as  a  well  established  fact  that 
wotmds  of  the  large  vessels  near  the  heart  were  much 
more  promptly  fatal  than  similar  wounds  of  the  walls  of 
the  heart  itself. 

Db.  Flint  was  of  the  opinion  tliat  a  ball  of  the  size  in 
the  specimen  presented  would,  if  it  entered  the  cavity 
<ji  the  ventricle,  be  driven  by  the  current  of  blood  into 
the  pulmonary  artery. 

DsL  Peaslbx  suggested  that,  suppo?ing  the  ball  enter- 
ed the  heart  from  within,  the  only  available  vessel  that 
could  be  wounded  for  such  a  purpose  would  be  the 
saporior  vena  cava. 

Dr.  Finkell  stated  that  in  Poole's  case  there  was  no 
sign  of  a  cicatrix  upon  the  external  surface  of  the  heart. 
A  careful  search  was  made  for  some  track  of  a  ball,  but 
nooe  being  found,  the  heart  was  placed  aside  and  the 
examination  continued.  At  length  one  of  the  gentle- 
men present  only  by  accident  discovered  the  ball  in  the 
•obrtance  of  the  heart 

Br.  Hamilton  remarked  that  an  interesting  point  in 
Dr.  Balch's  case  was  that  no  syncope  followed  the  re- 
ceipt of  the  injury  to  so  vital  an  organ.  In  Poole's  case, 
the  shock  was  so  violent  that  his  comrades  at  first 
thought  him  dead;  so  in. the  case  of  the  man  who  sur- 
vived six  years. 

STPmunO  NECROSIS  OF  SKULL. 

Dr.  Hamilton  presented  an  example  of  syphilitic  nec- 
rosis of  the  skulL  The  specimen  consisted  of  the  crown 
of  the  skuU,  and  was  made  up  principally  of  the  upper 
portions  of  the  two  parietal  bones.  It  was  removed  by 
op^^tion  on  the  Monday  preceding.  He  exhibited  the 
ipedmen  more  for  the  purpose  of  bringing  out  a  point 
«  some  interest^  which  was  in  effect  that  the  bone, 
although  extensively  necrosed  and  worm-eaten,  was 
really  not  dead  at  the  time  of  its  removal.  At  the  time 
of  the  operation  he  found  this  portion  of  bony  tissue 
firmly  adherent  by  extensive  granulations  to  healthy 
parts  beneath;  the  granulations  extending  into  the 
very  interior  of  the  diploic  tissue.  When  the  bone 
was  separated  from  these  connexions,  the  haemor- 
rhage was  very  profuse,  so  that  in  a  very  short  time  the 
patient  lost  nearly  a  pint  of  blood.  He  believed  that 
the  existence  of  these  granulations  explained  the  reason 
why  the  bone  was  absorbed;  in  fact,  he  considered  that 
tb^  vesseb  were  the  only  agents  by  which  absorption 
ooald  be  carried  on. 

The  specimen  also  showed  that  the  disease  was  con- 
fined to  the  periosteum.  A  considerable  portion  of 
bone,  which  though  dead  had  not  shown  any  signs  of 
separating,  still  remained.  The  patient  did  well  after 
the  operation,  and  at  the  time  of  reporting  the  case  was 
able  to  sit  up. 

PLEURISY  IN  AN  INFANT. 

Dr.  Lewis  Smith  exhibited  a  specimen  of  pleurisy 
ia  an  infant  The  patient  died  at  the  end  of  three 
otoliths  and  fifteen  days,  without  having  any  conspi- 
oooQS  symptoms,  and  without  the  usual  courtesy  of  a 
diagnosis.  On  post-mortem  examination  the  left  pleu- 
ral cavity  was  nearly  empty,  the  lung  occupying  only 
about  one-sixth  of  the  space  allotted  to  it.  This  organ 
was  firmlv  bound  down  by  fibrous  material,  which  also 
covered  the  costal  pleura.  On  attempting  to  inflate  the 
long,  the  air  escaped  though  a  small  opening  in  the  centre 
of  a  solidification  in  the  upper  lobe.  This  solidification 
was  not  due  to  pneumonia,  but  probably  to  pulmonary 
apoplexv. 

He  also  presented  a  second  specimen  of  pleurisy  in 
«n  infant  who  died  at  the  age  of  seven  months.  In 
this  instance  a  diagnosis  was  made  of  pleuro-pneumonia, 


which  was  confirmed  by  a  post-mortem  examination. 
The  left  lung  ^as  found  to  be  the  seat  of  the  pneumo- 
nia, and  the  overlying  pleura  was  not  only  inflamed,  but 
that  portion  of  the  membrane  extending  beyond  the 
margin  of  the  inflamed  lung. 
The  Society  then  adjourned* 

EAST  RIVER  MEDICAL  ASSOCIATION. 

AnjouRNED  Meeting,  January  4,  1867. 

Dr.  V.  Morse,  President,  in  the  Chair. 

nSREDITART  TENDENCY  TO  THE  HjBMORRHAQIO  DIATHESIS. 

Dr.  Thoms  read  a  paper  with  the  above  caption. 

Cullen  has  observed  that  children  are  most  subject  to 
the  diseases  of  the  parents  whom  they  most  resemble ; 
it  is  rational,  however,  to  suppose  that  the  mother  ex- 
erts the  more  powerful  influence  in  giving  an  impetus 
to  the  tendency.  In  support  of  this  latter  view,  it 
should  be  remembered  that  in  the  crossing  of  animals, 
the  relative  influence  of  the  two  sexes  is  quite  mani- 
fest ;  e.  g.  a  mule,  the  issue  of  the  mare  and  the  ass,  is 
incomparably  larger  and  stronger  than  the  product  oi  a 
pair  where  me  sexual  relations  are  reversed. 

The  laws  governing  the  transmission  of  diseases  are 
various,  and  it  is  only  by  aid  of  exact  and  numerous 
observations,  which  from  necessity  can  only  be  slowly 
accumulated,  that  we  are  enabled  to  appreciate  the  rela- 
tive frequency  of  a  particular  disease  in  individuals  ex- 
posed to  a  suspected  hereditary  taint,  and  in  those  who 
are  not  obnoxious  to  any  such  influence. 

In  consideration  of  hereditary  hesmorrhamc  diathesis, 
the  solution  of  the  problem  is  to  be  sought  for  rather  by 
carefully  studying  tne  course  of  the  lives  of  the  children 
themselves,  than  by  tracing  out  the  morbid  genealogical 
tendencies  of  ancestors. 

Dr.  T.  then  quoted  the  following  quaint  account  of 
a  family  predisposition  to  haemorrhage,  reported  by 
Drs.  William  and  Samuel  Bual,  and  which  was  pub- 
lished in  the  Physico-Medical  Transactions  in  1817. 

"  The  subjects  of  the  following  account  were  the  de- 
scendants of  the  Rev.  Timothy  Collins,  the  first  pastor 
of  the  town  of  Litchfield,  Conn.  So  far  as  we  have 
been  able  to  ascertain,  the  first  manifestation  of  hsemor- 
rhagic  predisposition  was  in  the  male  children  of  his  son 
Oliver.  We  cannot,  by  diligent  inquiry,  learn  that  there 
were  any  indications  of  this  disposition  in  any  of  their 
predecessors  on  either  the  male  or  female  side.  Oliver 
Collins  had  several  sisters  and  brothers  who  had  chil- 
dren to  the  second  and  third  generation,  in  none  of 
whom  do  we  find  that  there  has  been  any  manifestation 
of  the  hsemorrhagic  trait. 

"  Oliver  Collins  had  four  sons  and  two  daughters.  In 
all  of  the  sons  this  predisposition  discovered  itself  in  an 
extreme  degree,  from  early  infancy,  and  continued 
through  life.  Three  of  them  bled  to  death.  It  is  not 
known  where  the  fourth  is,  or  whether  he  is  alive. 
Two  of  ihem,  though  frequently  reduced  by  haemor- 
rhage to  a  state  of  exhaustion  threatening  the  extinc- 
tion of  life,  lived  to  adult  age.  One  of  them  eventually 
died  from  haemorrhage  induced  by  the  extraction  of  a 
tooth ;  the  other  from  haemorrhage  following  a  slight 
contusion  of  the  fore-finger.  The  one  which  died  in 
childhood,  bled  to  death  from  a  slight  laceration  of  the 
tongue  by  the  teeth,  occasioned  by  a  stroke  under  the 
chin.  It  is  related  of  these  persons,  that  after  expe- 
rience had  taught  them  their  liability  to  haemorrhage, 
they  acquired  an  extreme  sensibility  in  relation  to  their 
danger,  shuddering  at  the  sight  of  edge  tools,  and  avoid- 


ing with  the  utmost  caution  all  exposure  to  them. 
"  The  next  appearance  of  a  disposition  to  bleeduag  i 

digitized  by  ^ JIC 


gwas 


so 


THE  MEDICAL  RECORD. 


ia  the  son  of  Mrs.  Baldwin,  one  of  Oliver  Collinfi's 
daughters.  It  may  be  noticed  here  that  the  other 
daughter,  Mrs.  Gaity,  has  both  male  and  female  descend- 
ants, in  none  of  whom  has  this  hsemorrhagic  constitu- 
tion appeared;  Mrs.  Baldwin's  son  possessed  it  in  an 
equal  degree  with  his  uncles.  He  Uved,  we  believe, 
till  near  the  age  of  puberty,  when  he  bled  to  death  from 
a  slight  wound  caused  by  the  fall  of  a  pewter  plate  on 
his  foot. 

"  The  last  instances  in  which  this  family  characteristic 
has  discovered  itself  are  tlie  male  children  of  Mrs.  Kil- 
bum  (a  daughter  of  Mrs.  Baldwin).  She  had  four  sons, 
in  all  of  whom  a  tendency  to  bleeding  has  been  strongly 
marked  since  early  infancy.  In  her  daughter  it  has 
been  absent.  Tw.>  of  her  sons  have  already,  in  child- 
hood, fall  n  victims  to  hsemorrhage.  Another  son,  who 
was  drowned  at  the  age  of  eighteen  months,  had  exhi- 
bited the  Ijsemorrhagic  predisposition  as  strongly  as  did 
his  brothers;  and  once  bled  almost  to  death  from  a 
rupture  of  the  fnenum  of  the  upper  lip.  The  death  of 
one  of  the  boys  was  caused  by  a  haemorrhage  proceed- 
ing fi'om  a  wound  produced  by  a  stab  penetrating  the 
bottom  of  the  foot.  He  died  in  about  forty-eight  hours 
from  the  time  of  receiving  the  injury.  His  brother  died 
affcer  extreme  exhaustion  induced  by  nasal  bleeding. 
He  had  an  abscess  in  the  leg,  which  discharged  a  short 
time  previous  to  his  death,  and  which  may  have  co- 
operated with  the  loss  of  blood,  in  exhausting  the  pow- 
ers of  life.  The  only  surviving  son  has  been  frequently 
reduced  to  a  state  of  exhaustion  threatening  hfe,  by 
haemorrhage  from  the  nostrils,  small  lacerations  of  the 
frcenum  of  the  upper  lip,  and  slight  wounds  in  various 
parts  of  the  body. 

With  regard  to  the  Kilbum  branch  of  the  Collins 
fiunily,  but  Httle  remains  to  be  said.  Indeed,  a  number 
of  years  have  elapsed  since  the  deaths  of  the  other,  vic- 
tkns  of  this  remarkable  predisposition.  We  may,  how- 
ever, premise  the  general  remark  that  we  cannot  dis- 
cover that  there  has  been,  in  any  instance,  in  the  female 
connexions  of  the  Collins  family,  any  evidence  of 
haemorrhagic  trait. 

"It  may  be  remarked  of  the  Kilbum  boys,  that  there 
is  not  only  a  strong  disposition  to  haemorrhage  when 
the  blood-vessels  are  wounded,  but  that  there  is  also  a 
tendency  as  strongly  marked  to  plethora  and  spontane- 
ous haemorrhage.  They  have  all  of  them,  and  we  be- 
Keve  the  same  to  be  true  of  their  bleeding  predecessors, 
had  frequent  haemorrhage  from  the  nostrils,  gums,  and 
particularly  from  the  fraenum  of  the  upper  lip. 

"  In  all  instances  slight  contusions  are  followed  by  ex- 
tensive ecchymosis,  and  a  great  degree  of  tumefaction. 
From  a  slight  contusion  on  one  of  the  knees  of  Kilbum's 
surviving  v^on,  received  eighteen  months  since,  an  enor- 
mous tumefaction  ensued,  with  rigidity  of  the  joint,  from 
which  he  is  not  yet  perfectly  recovered.  The  boys, 
when  beginning  to  walk,  have  for  a  number  of  months 
perpetual  ecchymosis  about  the  nates,  from  the  contu- 
ttons  received  from  falling  on  them.  The  plethoric  state 
of  the  system  which  takes  place  when  any  considerable 
lime  elapses  without  haemorrhage,  is  evidenced  by  a 
flushing  of  the  face,  a  sense  of  fulness  about  the  head, 
indisposition  to  active  exertion,  and  all  the  usual  symp- 
toms of  plethora.  Their  countenances  have  always  a 
sallow  puffed  hue,  not  unlike  that  which  is  observable 
in  those  who  have  recently  had  fevers  from  the  opera- 
tions of  marsh  effluvia. 

"  This  sallowness  is  not  absent  when  the  blood-vessels 
have  a  plethoric  fulness-  the  face  is  flushed,  exhibiting 
a  complexion  strikingly  aifferent  from  the  red  and  white 
tints  of  health.  When  the  vessels  are  drwned  by  haemor- 
rhage the  countenance  is  sallow  and  pale  in  the  extreme. 


We  have  never  witnessod  in  the  male  part  of  the  Kil- 
bum branch,  any  wounds  of  sufficient  size  to  have 
the  current  of  blood,  in  case  it  was  arterial,  assume  the 
per  saltum  motion ;  but  the  strong  impetus  with  which 
the  blood  is  discharged,  and  the  powerful  resistance 
which  it  opposes  to  m  remedies,  whether  mechanical  or 
of  other  kinds,  in  whatever  manner  appUed,  would  seem 
to  be  strong  evidence  that  the  blood  is  arterial.  The 
blood  is  not  destitute  of  coagulability;  large  coagula 
are  frequently  formed  about  the  orifice  of  the  wounds, 
but  the  impetus  with  which  the  blood  flows  overcomes 
their  too  feeble  resistance.  When  by  any  means  the 
haemorrhage  is  suppressed,  the  part  above  usually  be- 
comes distended,  hvid,  and  intolerably  painful,  so  that 
relief  is  obtained  only  by  permitting  a  recurrence  of  the 
bleeding.  SHght  wounds  have,  m  some  instances, 
healed  by  adhesive  inflammation.  We  have  not  dis- 
covered any  malformation  or  unnatural  distribution  of 
the  blood-vessels  generally,  nor  in  the  valvular  construc- 
tion of  the  veins  particularly.  It  has  been  noticed  in 
the  Kilbum  boys,  and  it  may  exist  in  all,  that  they 
have  had  during  the  debility  existing  after  haemorrhage 
depraved  appetites ;  one  of  them  was  disposed  to  eat 
sand,  another  common  earth. 

"  It  will  be  observed  in  this  report,  that  all  the  cases 
which  have  occurred,  have  been  in  the  male  line,  and 
it  has  disclosed  itself  at  an  early  age,  and  abating  as  age 
advances.  This  state  seems  often  to  fluctuate  in  the 
same  patient ;  a  scratch  at  one  time  threatening  fatal 
loss  of  bloodj  at  another  scarcely  attracting  attention. 
In  some,  distmct  periods  of  remission  and  exacerbation 
may  be  observed.  At  the  latter  times  the  patient  is  subject 
to  frequent  attacks  of  pain  and  swelling,  with  ecchy- 
mosis of  the  wrist,  ankles,  and  knee  joint,  attended 
wi  h  fever.  These  symptoms  continue  about  a  fort- 
night, and  then  disappear,  with  subsidence  of  the  swell- 
ing and  removal  of  the  ecchymosis.'* 

This  diathesis,  then,  has  many  points  of  resemblance 
to  both  the  scrofulous  and  the  scorbutic.  The  most  pro- 
minent signs  are  an  obvious  delicacy  of  system ;  usually 
a  fair  complexion ;  a  thin  transparency  of  skin ;  inriUv- 
bility  of  circulation  at  all  times,  conjoined  with  occa- 
sional febrile  accessions;  a  tendency  to  ecchymosis 
from  the  slightest  cause,  as  alio  to  haemorrhagic  oozing 
from  mucous  surfaces. 

The  causes  would  seem  to  be  twofold ;  a  morbid  con- 
dition of  the  blood,  and  also  of  the  capillaries.  In  the 
cases  similar  to  these  under  consideration,  the  blood  is 
described  as  "  thin  and  ichorous,  deficient  in  the  due 
proportion  of  fibrin,  and  in  the  power  of  coagulation ; 
more  especially  it  is  incapable,  even  when  whoUy  at 
rest,  of  forming  a  dense  and  firm  coagnlum."  In 
consequence  of  such  change  in  the  fluid,  there  ensues 
an  undue  tendency  to  congestion  of  the  capillaries;  so 
that  these  vessels,  when  cut,  are  not  only  filled  with 
blood  incapable  of  affording  the  best  hemostatic  agent 
—coagulation,  but  also  contain  an  amount  of  that 
fluid  greater  than  normal.  The  blood  itself  is  probably 
altered  in  quality,  but  the  nature  of  the  change  is  not 
accurately  known.  Dissolution  of  the  corpuscles  or 
fibrin,  so  much  insisted  on  by  some  writers,  is  not 
really  present.  The  corpuscles  seem  to  be  deficient  in 
number,  and  the  liquor  sanguinis  is  in  excess;  but 
these  peculiarities  may  be  the  result  and  not  the  cause 
of  the  haemorrhage. 

The  capillaries  and  minute  arterial  twi^^s  are  also  at 
fault.  When  examined,  the  latter  seems  to  be  devoid 
of  the  middle  coat,  the  former  is  of  a  thin  and  feeblo 
appearance  and  unusually  capacious.  It  may  be  that 
the  middle  coat  is  deficients  as  some  suppose,  but  nK)re 
probably  it  exisfc^  though  m  a  defective  state,  and  cer- 
tainly impaired  in  contractilitv^nd  tone.    In  conse- 

Digitized  by  VjOOQIC 


/ 


THE  MEDKj^AL  RECORD. 


21 

qatocBy   the    other   component  parts  of   the  natursfl.    vessels.    Of  internal  remedie<>,  opium  is  likely  to  ezer- 
biBiDOstatics  are  equally  defective  as  to  the  power  of  coa- J  cise  a  beneficial  influence  indirectly.     In  mucous  sur- 


golation.  The  cut  vessel  contsacts  and  retracts  scarcely,' 
tf  at  all;  remaining  open  and  unshrunk,  passively  pour- 
ing oat  its  thin  contents.  Further,  the  vascular  coats  are 
fiial>le  and  easily  torn.  Slight  bruises  produce  serious 
eechymosisi,  coughing  may  induce  haemoptysis,  a  sneeze 
brings  on  epistasis,  and  extravasations  in  the  internal 
cavities  are  not  unlikely  to  follow  slight  causes. 

The  Ti'tatment  necessarily  becomes  prophylactic,  every 
precantion  being  taken  to  prevent  any  and  every  solution 
of  continuity.  Re5erabling,  as  it  does,  scrofula,  the 
usual  tonics  adopted  in  the  treatment  of  that  disease 
ttD  be  of  service;  but  perseverance  in  their  use  is 
f  <poctalIy  essential.  Not  being  unlike  scurvy,  in  certain 
of  its  symptom.^  citric  a'^id  naturally  suggests  itself  as  a 
remedy,  and  this  be  would  be  inclined  to  put  to  a 
p-etty  thorough  test  Occasionally,  brisk  purgative 
doees  of  sulphate  of  soda  will  prove  beneficial,  in  two 
ways;  as  a  hydrajj^oguf,  diminishing  the  amount  of 
lerum  in  the  blood,  and  as  a  chemical  salt,  exerting 
some  peculiar  power  over  the  blood,  compelling  its  coa- 
pilaiion. 

When  the  cri-is  of  haemorrhage  has  occurred,  atten- 
tion should  be  directed  to  the  improvement  of  the  state 
of  the  blood,  as  well  as  the  condition  of  the  capillaries, 
with  a  view  to  haemostatic  results.     We  should  if  possi- 
ble increase  the  proportion  of  fibrin,  and  a3  a  means 
tbe  induction  of  inflammation  may  be  attempted  at  a 
distance  from  the  bleeding  part.    Then  again  a  deriva- 
tive  effect  on  the  source  of  haemorrhage  is  effected  only 
ai  tbe  expense  of  time,  which  in  these  cases  is  of  course 
not  without  value.    But  the  induction  of  true  inflamma- 
tion, in  view  of  the  reaction  in  store,  may  be  seriously 
questioned   h?re.     Simple  irritants  and  dry  cupping, 
however,  are  not  open  to  such  objections :  and  therefore 
may  be  unhesitatingly  employed.     For  the  sake  of  pro- 
moting a  state  of  nausea  and  depression,  as  most  likely 
to  favor  the  desired  haemostatic  result,  abstinence  from 
f)od  and  drink  may  be  insisted  on.    But  should  our 
fiz8t  effort?  fail,  and  the  bleeding  continue,  we  may  be 
driven  to  the  use  of  non-stimulant  nutriments  in  small 
qaanti.ies,  as  soup,  animal  jelly,  &e.,  omitting  aqueous 
fla:d«,  as   tending   t%  bring  about  a  plethora  of  thin 
bkK>d.  Wine,  brandy,  and  ail  other  stimulants,  unless  at 
die  eleventh  hour,  are  not  likely  to  exercise  any  other 
than  a  baneful  influence.    But  possessed  as  we  are  of  so 
tittle  power  in  contributing  an  increase  to  the  amount 
of  fibrin,  we  may  endeavor  to  turn  that  which  is  already 
m   the  system   to  good  account.    Subacetate  of  lead 
aad  opiam  may  then  be  administered  in  full  and  sus- 
tained doses.    In  the  event  of  the  failure  of  these  last 
we  may  fall  back  upon  the  sulphate  of  alum  and  potass., 
in  doses  of  fifteen  to  twenty  grains,  upon  gallic  acid  in 
doses  of  twelve  grains  frequently  repeated,  or  upon 
matico  in  infusion,  as  the  stomach  may  tolerate.     For 
chemical  reasons,  the  sulphate  of  soda  cannot  be  given 
m  conjunction  with  the  acetate  of  lead. 

Naaseants  not  only  moderate  the  heart's  action,  but 
plainly  fiivor  coagulation  of  the  blood.  Ipecacuanha  or 
tartar  emetic,  in  doses  short  of  actual  emesis,  at  the  com- 
mencement of  the  case  are  therefore  expedient ;  for  it 
is  then  our  aim  to  artificially  induce  that  depression 
wfaidi  is  analogous  to  faintnes^  from  syncope  without 
the  concomitant  of  loss  of  blood,  which,  of  course,  be- 
eomes  alarming  in  an  exact  ratio  to  its  period  of  con- 
tinuance. 

A  capricious  shifting  from  one  remedy  to  another,  in 
hftste  and  confusion,  is  to  bo  avoided :  the  medical  at- 
tendant is  called  upon  in  these  cases  to  persevere  in  one 
weQ  selected  plan  until  results  have  begun  to  tell. 


faoes,  turpentine,  gallic  acid,  matico,  the  fluid  nitrate 
of  mercury,  and  the  sulphate  of  iron,  have  often  proved 
highly  advantageous,  and  may  be  employed  as  local 
adjuvants  to  the  general  means  of  arrest  For  general 
application,  some  prefer  nitrate  of  silver,  not  as  a  mer^ 
styptic  to  be  trusted  to  alone,  but  as  preliminary  and 
adjuvant  to  pressure,  which  is  to  be  considered  the 
principal  local  means  of  arrest.  The  nitrate  is  used  so 
as  to  restrain  the  flow,  and  permit  the  apex  of  a  gradu- 
ated compress  to  be  retained  in  position  by  a  bandage, 
etc,  to  be  laid  in  a  dry  bed.  A  great  amount  of  press- 
ure must  be  carefully  avoided,  for  both  part  an  1  system 
are  intolerant  of  this;  ecchymosis,  sloughing,  and  ulcera- 
tion, with  much  constitutional  disturbance  of  a  low  and 
irritable  type,  will  certainly  follow,  and  in  a  short  time 
blood  will  burst  forth,  from  a  wider  surface  and  with  a 
more  willing  flow  than  before. 

The  actual  cautery  has  naturally  been  much  employ- 
ed in  desperate  cases ;  but  the  result'ng  eschar  arrests 
the  flow  only  temporarily,  since  the  process  of  detach- 
ment is,  in  such  cases,  both  early  and  rapid,  and  the 
ulceration,  opening  up  parts  devoid  of  plastic  exudation, 
opens  up  a  larger  surface  for  a  new  and  more  aggravated 
hcemorrhage.  Besides  this,  the  pnrts  are  by  its  use  ren- 
dered incapable  of  bearing  subsequent  application  of 
pressure.  Deligation  of  the  principal  arterial  trunks 
fails  because  the  oozing  is  from  capillaries. 

The  operation  of  transfusion  as  a  last  resort  should 
not  be  delayed  until  the  patient  is  quite  in  extremis. 
The  making  of  an  additional  wound,  which  in  its  turn 
may  assume  an  indomitable  tendency  to  bleed,  is  a  risk 
to  be  appreciated,  although  experience  has  shown  that 
such  is  not  invariably  the  result. 

Dr.  a.  K.  Gardner  related  a  case  irustralive  of  tl  e 
hsemorrhagic  diathesis,  as  manifested  in  the  person  of 
a  German  lady,  who  had  consulted  him  about  five  or 
six  years  ago  for  a  deeply  jaundiced  complexion,  ac- 
companied with  an  almost  intolerable  itching  of  the 
whole  body.  She  had  fteely  availed  herself  of  the 
benefits  reputed  to  belong  to  the  German  Spiings,  and 
from  thence  had  repaired  to  London  to  test  the  virtues 
of  a  n&w  liver  specific,  Podophyllin  I  Slie  returned  to 
this  city  with  a  recovered  complexion,  but  with  little 
if  any  mitigation  of  the  itching.  It  was  then  noticed 
that  there  were  certain  layers  of  a  yellow  formation  in 
the  palmar  creases,  and  near  the  inner  canthus  of  both 
eye?,  which,  by  competent  authority,  were  thought  to 
be  due  to  the  presence  of  fat.  La^t  June  she  projected 
a  visit  to  the  White  Mountains,  and  in  the  course  of 
her  journey  was  seized  with  an  exhausting  diarrhoea, 
not  cholera.  In  obedience  to  a  telegram  Dr.  G.  found 
her  in  a  perfectly  powerless  condition,  coughing  out  a 
stringy  mucus,  with  an  aphthous  tongue,  a  relaxed 
uvula,  and  emaciated  to  the  last  degree.  In  a  word, 
she  was  suffering  from  spinal  meninfjitis  after  the  diar- 
rhoea, complicated  with  other  troublesome  symptoms. 
He  advised  stimulants,  a  chlorate  of  potash  gargle,  and 
left  her  in  charge  of  a  physician  who  had  come  up  for 
a  vacation. 

She  recovered  but  partially,  when  she  was,  not  long 
afterwards,  seized  with  a  haemorrhage  fiom  on  old,  de- 
fective tooth,  which  had  been  not  at  all  interfered  with. 
PercUoride  of  iron,  matico,  nitrate  of  silver,  and  collo- 
dion»  had  all  proved  unavailing.  He  was  not  aware, 
however,  that  it  was  an  instance  of  hereditary  tenden- 
cy. The  case  of  a  child  mi"ht  also  be  adduced  in  fur- 
ther illustration  of  this  diatnesis.  This  little  patient, 
not  many  hours  after  birth,  exhibited  upon  its  occiput 
distinct  ecchymoses  not  traceable  to  any  accident  or 


Our  second  indication  is  directed  to  the  state  of  the  |  anomaly  in  labor,  these  came  to  implicaj^  other  por- 

^igitized  by  VjOOQiC 


\ 


22 


THE  MEDICASL  RECORD. 


tione  of  the  surface ;  and  the  cl\ild,  who,  by  the  way. 
was  remarkable  for  an  extremely  pellucid  skin  ana 
resembled  a  wax-doll  very  much  in  appearance,  finally 
died  at  the  end  of  a  week. 

A  third  case  was  that  of  a  child  which  was  seen  in 
consultation,  where  almost  fatal  hasmorrhage  occurred 
from  lancing  the  gums.  This  was  arrested  by  applica- 
tions of  the  Liquor  Ferri  Persulphatl,  but  died  after 
four  days  from  purpura  ha^morrhagica,  which  appeared 
over  various  portions  of  the  trunk  and  limbs. 

Db.  Barrt,  without,  of  course,  attempting  to  cite 
the  cases  as  parallel  with  those  of  Purpura  H»mor- 
rhagica,  had  succeeded  in  arresting  the  troublesome 
bleeding  sometimes  consequent  upon  the  extraction  of 
a  tooth,  by  a  cork  plug  shaped  like'  a  cone  and  armed 
with  a  pledget  of  raw  cotton  saturated  with  an  astrin- 
gent solution.  He  forced  this  well  down  into  the  cav- 
ity and  had  the  satisfaction  of  seeing  an  effectual  arrest 
of  these  very  troublesome  haemorrhages,  after  the  usual 
remedies  had  failed. 

Dr.  Burke  was  of  the  opinion  that  somehow  or  other 
the  hemorrhagic  diathesis  was  associated  with  a  jaun- 
diced complexion.  The  intolerable  itching  which  ac- 
companies the  latter  condition  was  well  marked  in  a 
patient  now  under  his  chiftge. 

The  meeting  then  adjourned. 


Corregpontjence. 


EXTRA-UTERINE  FCETATION,  AND  THE  ME- 
THOD OF  ARRESTING  THE  ATTENDANT 
HEMORRHAGE. 

To  Tin  Editob  or  thi  Mbdical  Bkoobd. 

Sir — I  find  that  your  report  of  my  remarks  made  at 
the  Pathological,  on  the  occasion  of  presenting  some 
M)ecimens  of  extra-uterine  foctation,  as  published  in  the 
Record  of  the  1st  inst.,  has  led  some  of  my  obstetric 
friends  into  a  misapprehension  of  the  oWect  of  the 
treatment  there  proposed,  of  the  accident3  of  this  abnor- 
mal condition.  The  chirurgical  procedure  "advocated,** 
was  directed  exclusively  to  the  saving  of  the  life  of  the 
woman  from  the  destructive  haemorrhage  following  a 
rupture  of  the  foetal  cyst — an  accident  uniformly  fatal,  so 
far  as  I  know. 

It  would  appear,  however,  that  those  remarks,  and 
the  proposed  ti  eatment,  have  been  accepted  by  some  of 
your  readers  as  applicable  to  the  management  of  the 
extra-uterine  foetus  in  general — an  impression  that  I 
desire  to  correct,  by  distinctly  stating,  that  no  inter- 
ference with  an  extra-uterine  foetus  was  then,  nor  at 
any  other  time,  advocated  by  me ;  except  so  far  as  it 
might  become  necessary  in  tne  proposed  operation  for 
arresting  the  flow  of  blood  from  the  torn  edges  of  the 
ruptured  cyst,  and  in  the  removal  of  the  effused  blood, 
fluids,  etc ,  from  the  peritoneal  cavity.  As  I  contem- 
plate bringing  this  matter  before  tlie  profession  in  a 
detailed  manner  at  an  early  day,  I  will  simply  add  here, 
that  I  then  stated,  that  where  all  the  usual  signs  of 
pregnancy  have  been  present  during  a  period  of  some 
weeks  or  months,  and  are  suddenly  attended  by  all  the 
rational  signs  of  haemorrhage  into  the  peritoneal  cavity, 
it  is  more  than  probable  that  an  extra-uterine  foetal  cyst 
has  burst,  and  that  blood  to  a  fatal  amount  is  esci^ing 
from  the  torn  tissues  and  vessels.  To  remove  all  doubt 
as  to  the  locality  of  the  effused  blood,  I  further  pro- 
posed the  use  of  the  trocar;  and  if  by  its  aid  the  pre- 
sence of  blood  in  the  peritoneal  sac  be  demonstrated, 
to  open  freely  the  cavity  of  the  belly,  secure  the  bleed- 
ing pedicle  or  vessels  by  ligature,  clean  out  carefully 
the  peritoneal  cavity,  and  close  it  up. 


, '  This  operation  would  naturally  include  the  removal 

of  such  portions  of  the  foetal  c^sc  as  would  be  likely  to 

1^  Hough,  but  should  not^  in  my  opinion,  include  any  more. 

In  the  majority  of  cases,  like  those  I  presented  to  the 
Society  on  the  occasion  alluded  to,  the  ligature  would 
be  required  to  include  the  fallopian  tube  on  one  or  on 
both  sides  of  the  cyst,  and  often  the  ligament  of  the 
ovary ;  and  doubtless  adl  the  tissues  included  and  stran- 
gulated by  these  ligatures,  would  require  removal 

In  conclusion,  I  desire  to  say,  that  gastrotomy  for 
the  removal  of  an  extra-uterine  foetus  for  any  reason,  is 
a  subject  that  I  have  never  proposed  to  advocate;  but 
when  the  Ufe  of  the  woman  is  next  to  certain  to  be 
lost  by  reason  of  haemorrhage  from  a  torn  foetal  cyst,  I  do 
distinctly  propose  to  make  an  effort  to  save  it,  by  ligat- 
ing  the  whok  bleeding  pedicU^  be  it  great  or  small,  and 
at  all  periods  of  gestation. 

RespectfuUy, 

Stephen  Rooebs. 
No.  ttS  West  Tbirtj-foarth  street 

0A8E  OF 

STRYCHNINE  POISONING  TREATED  WITH 
CAMPUOR  AND  CHLOROFORM. 

To  THB  Editob  or  thb  Mbdical  Bscobo. 

Sir — I  beg  leave  to  report  the  follovnng  case,  which 
I  hope  may  be  found  of  some  little  interest. 

On  the  20th  of  November,  1866,  at  12  m.,  I  was 

requested  to  see  H.  F ,  a  young  man  residing  in  this 

village,  who,  it  was  said,  had,  an  hour  and  a  hw  preyi- 
ously,  taken  four  (4)  grains  of  crystals  of  strycnnine 
for  the  purpose  of  self-destruction. 

I  found  him  on  the  floor  of  the  salesroom  of  one  of 
our  drug-stores  lying  on  his  back,  and  suffering  intensely 
from  spasms  easily  excited  upon  the  lightest  touch  or 
motion  made  in  his  presence.  He  was  perfectly  con- 
scious, and  obstinately  persisted  in  refusing  to  take  any 
remedy  which  was  proposed  to  avert  a  fkt«a  termination. 
Doctors  Sweeney  and  Nichols,  who  had  arrived  a  few 
minutes  earlier,  had  made  every  exertion  to  induce  him 
to  take  an  emetic,  but  failed.  He  had,  however,  taken 
a  small  quantity  of  camphor  and  commenced  the  inhal»> 
tion  of  chloroform,  which  he  se^ed  very  willing  to 
continue  on  account  of  the  relief  it  gave  from  suffering. 
One  small  dose  of  camphor  was  by  great  exertion  taken, 
but  soon  the  muscles  of  deglutition  became  permanently 
rigid:  any  further  attempt  to  use  internal  remedies  was 
utterly  useless.  For  about  three  hours  the  chloroform 
was  continued,  the  spasms  for  the  last  half  hour  gradu- 
ally gaining  in  severity,  until  3  p.m.  One  general  con- 
vulsion came  up  which  seemed  likely  to  end  the  scene. 
By  dint  of  hard  work  he  was  again  rallied,  and  the  chlo- 
roform pushed  until  perfect  insensibility  was  produced, 
and  maintained  for  some  time.  On  rallying  from  Uiis, 
he  soon  commenced  vomiting,  and  ejected  from  the 
stomach  a  quantity  of  apple  he  had  eaten  directly  after 
taking  the  poison.  After  this,  he  began  to  exhibit  evi- 
dence of  improvement :  the  spasms  bemg  gradually  less- 
ened until  7  P.M.  We  were  able  to  discontinue  the 
medicine,  which  had  been  used  almost  wit' out  intermis- 
sion for  seven  hours,  consuming  1  lb.  of  chloroform.  At 
this  time  a  small  quantity  of  urine  was  passed,  the  first 
that  had  escaped  during  his  illness.  And  again  at  9 
P.M.,  he  had  another  evacuation,  which  was  reserved 
for  subseauent  analysis.  This,  subjected  to  the  usual 
process  of  analysis,  gave  unequivocal  evidence  of  the 
presence  of  strychnine.  In  regard  to  the  agent  to 
which  we  are  indebted  for  a  cure  in  this  case,  i  think 
that  while  great  relief  from  suffering  was  due,  and  also 
vomiting  was  indirecUy  due,  to  the  chloroform,  we 
should  have  failed  utterly  had  not  a  portion  of  the  poi- 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


23 


■on  been  ejected  from  the  stomachy  and  its  absorption 
into  the  general  circdUtion  prevented.  The  subset 
qn^it  treatment  of  the  case  consisted  in  the  use  of  ano- 
ayues  and  diuretics — the  latter  with  the  hope  of  hasten- 
mg  the  elimination  of  the  poison  from  the  system 
tlsrough  the  renal  secretion. 

Yours,  etc» 

L.  A.  Hamilton. 
Ckakdos,  Omo,  FeK  17, 18<S7. 

THE  OPHTHALMOSCOPE  AND  CEREBRAL 
DISEASR 

[To  THX  EOROB  or  THB  IfXDIOAl   BSOORD.] 

DzAR  Sir — ^I  am  happy  to  find  in  the  number  of  jour 
TaloAble  journal  of  Feb.  15,  page  565  (Report  of  the 
Meeting  of  the  Medical  Society  of  the  State  of  New 
York),  a  statement,  which  probably  comes  nearer  the 
truth  than  the  speaker  intended,  to  wit : — That  amau- 
rotic symptoms,  diagnostic  of  cerebral  disease,  depend 
in  wo  CASE,  in  reality,  upon  a  plug  in  a  defective  tooth. 

Famih&nty  with  the  use  of  the  ophthalmoscope  had 
convinced  some  persons  of  this  fact  before,  but  addi- 
tional testimony  is  always  of  value. 

Yours  truly, 

B. 

Bkw  Ton,  Feb.  90,  186T. 


MtWoi  Vime  antr  3tttns. 


Personal. 

Bush  Medical  College. — ^Prof  Gunn,  of  the  Michi- 
gan University,  has  been  appointed  to  the  chair  ren- 
dered vacant  in  the  Rush  Medical  College  by  the  death 
of  Pro£  Brainard. 

Habvaud  Medical  School. — ^Dr.  James  C.  White,  the 
talented  junior  editor  of  the  Boston  Medical  &  Surgical 
Jcmmaly  has  retired,  in  order  to  accept  an  adjunct  pro- 
fessorship of  Medical  Chemistry,  in  the  Harvard  Medi- 
cal School. 

Death  of  Dr.  Kslloo,  U.  S.  N. — Dr.  Kelloo  died 
nddenly  at  Montevideo  on  the  7th  instant. 

Death  of  Thomas  K.  Chandler,  U.  S.  Navy. — 
The  St-  Thomas  papers  announce  the  death,  on  the 
5th  in«tant,  of  Thomas  K.  Chandler,  Acting  Passed  Assist- 
ant Surgeon  of  the  United  States  Navy  on  duty  with 
the  steamer  Penobscot.  The  deceased  was  a  native  of 
New  York,  and  was  appointed  to  the  position  he  occu- 
pied at  the  time  of  his  death  on  the  9th  of  June,  1866, 
and  was  assigned  to  duty  with  the  Penobscot.  His 
deafh  was  caused  from  yellow  fever,  which  disease  has 
been  prevalent  at  St.  Thomas  for  several  weeks  past. — 
K  T.  Herald. 


Medical  Convention. — At  the  meeting  of  the  Ame- 
rican Medical  Association,  held  in  the  city  of  Baltimore. 
May  3,  1866,  the  following  resolution  was  adopted 
wiUi  much  unanimity,  and  tne  undersigned  appointed 
a  Committee  to  aid  in  canying  it  into  practical  efifect : 

B^ftolved^  That  this  Association  earnestly  requests 
the  Medical  Colleges  of  the  country  to  hold  a  conven- 
tion for  the  purpose  of  thoroughly  revising  the  present 
system  of  Medical  College  instruction,  and  that  a  Com- 
mittee be  appointed  to  aid  in  carrying  the  resolution 
inioefiect. 

In  fulfilling  the  duties  enjoined  on  them,  the  under- 
signed respectfully  and  earnestly  invite  the  Trustees 
and  Faculty  of  each  regular  Medical  College  in  the 


United  States,  to  send  representatives  to  a  Convention 
to  be  held  in  the  citv  of  Cincinnati,  Ohio,  on  Friday 
preceding  the  next  Annual  Meeting  of  the  American 
Medical  Association,  namely,  on  the  3d  day  of  May, 
1867.  We  would  also  respectfully  suggest  that  all  dele- 
gates to  such  Convention  be  prepared  to  consider  fully 
and  act  upon  the  following  subjects: 

Firat  The  adoption  of  a  more  uniform  and  just  rate 
of  Lecture  Fees  by  all  the  Colleges  in  this  country. 
Second,  The  propriety  of  increasing  the  length  of  the 
Annual  Lecture  Term,  and  the  number  of  Professor- 
ships. Third.  The  adoption  of  measures  for  securing 
more  thorough  attention  on  the  part  of  the  students  to 
the  more  elementary  branches  of  medical  science,  and 
a  more  progressive  or^er  of  medical  studies.  Fourlh, 
The  practicabilitv  of  requiring  three  Annual  Courses  of 
Lecture^,  instead  of  two,  as  a  condition  of  graduation ; 
and  of  making  Hospital  CUnical  Instruction  a  necessary 
part  of  the  Third  (5ourse.  Fifth.  The  practicability  of 
establishing  and  exacting  some  appropriate  standard  of 
preliminary  education  for  young  men  proposing  to  enter 
upon  the  study  of  medicine. 

Feeling  confident  that  a  free  interchange  of  views 
upon  these  and  such  other  topics  as  the  Convention 
might  deem  proper,  would  result  in  the  adoption  of 
measures  of  great  importance  to  the  interests,  honor,  and 
usefulness  of  our  profession,  we  again  cordially  and 
earnestly  invite  your  cooperation. 

N.  S.  Davis, 

S.  D.  Gross, 

WoRTHiNGTON  HooKER,  \  Committee. 

M.  B.  Wright, 

Geo.  C.  Shattuck, 

Uric  Acid  from  Peruvian  Guano. — ^Dr.  Lowe  heats 
one  part  by  weight  of  oil  of  vitriol  in  a  porcelain  dish 
placed  on  the  water-bath,  and  adds  gradually  the  same 
weight  of  previously  dried  and  powdered  guano,  con- 
stantly stirring  with  a  glass  rod.  Much  carbonic  and 
muriatic  gas  is  evolved,  which  must  be  guarded  against, 
the  dish  being  kept  on  the  bath  as  long  as  the  escape  of 
hydrochloric  acid  is  perceptible ;  the  mess  is  then  dilut- 
ed with  twelve  to  fifteen  times  its  bulk  of  distilled  water, 
and  af^er  settling,  decanted  from  the  insoluble  portion, 
and  this  is  once  or  twice  repeated,  the  liquor  being 
filtered,  and  the  sediment  collected  on  the  filter  and 
washea  until  nearly  free  from  sulphuric  acid;  after 
which,  it  is  boiled  in  a  porcelain  dish  with  dilutic  caus- 
tic soda,  the  solution  filtered,  and  precipitated  by  the 
addition  of  a  small  excess  oi  hydrochloric  acid.  The 
crystallized  acid  is  collected  on  a  filter  when  cold,  wash- 
ed with  water^  and  if  necessary,  decolorized  by  heating 
it  for  a  short  time  on  the  water-bath  in  a  porcelain  dish 
with  its  own  weight  of  oil  of  vitriol,  diluting  afterwards 
very  gradually  with  water,  and  washing  on  a  filter. — 
Druggists*  Circular. 

A  Medical  Governor. — ^By  the  election  of  Governor 
Swann,  of  Maryland,  to  the  United  States  Senate,  Dr. 
C.  C.  Cox,  the  Lieutenant-Governor,  succeeds  to  the 
office  thus  vacated. 

Spectrum  Analysis. — ^Prof  Henry  Draper  delivered 
a  lecture  on  the  evening  of  the  19th  ult,  at  the  Rut- 
gers Institute,  on  "Spectrum  Analysis,'*  which  was 
illustrated  by  images  thrown  on  a  camera,  and  illumi- 
nated by  the  magnesium  Ught 

The  Aquatic  Animals  op  the  Amazon,  was  the  sub- 
iect  of  an  interesting  lecture  delivered  the  same  evening, 
Dy  Prof.  Agassiz,  at  the  Cooper  Institute,  under  the 
auspices  of  the  Association  for  the  Advancement  of 
Science  and  Art  ><^  t 

-^  '   Digitized  by  VjOOQIC 


u 


THE  MEDICAL  RECORD. 


DlATH  FROM  CnLOROrORM  AT  BeLLEVUI  HoSPTPAU — 

A  death  from  chloroform  took  place  recently  at  Belle- 
vue  Hospital  on  the  occasion  of  the  performance  of  a 
rhinoplastic  operation  by  Professor  Hamilton.  The  pa- 
tient was  a  robust,  middle-aged  Irish  woman,  whose 
nose  had  been  bitten  oflf  in  an  encounter  with  a  negro. 
A  preliminary  operation  had  been  made  for  the  purpose  of 
forming  a  flap  for  the  new  member,  and  everything  had 
progressed  favorably.  The  second  operation  was  intend- 
ed to  complete  the  formation  of  the  nose,  but  before  it 
could  be  commenced,  the  patient  expired.  It  seems  that 
chloroform  had  been  first  administered  by  two  of  the  hos- 
pital internes  with  a  view  of  bringing  the  patient  rapid- 
ly under  the  influence  of  an  ansosthetic,  and  an  effort 
was  afterwards  made  to  employ  ether,  but  insensibility 
not  being  satisfactorily  induced,  chloroform  was  again 
employed  with  the  desired  result,  and  the  anasthesia  af- 
terwards kept  up  by  ether.  As  the  operator  was  about  to 
commence,  the  patient  was  noticed  to  grow  suddenly 
pale,  the  pulse  ceased  at  the  wrist,  and  despite  every 
exertion  to  resuscitate  her  by  means,  first,  of  artificial 
respiration,  then  of  the  galvanic  battery,  and  afterwards 
by  artificial  breathing  following  laryngotomy,  the  pa- 
tient expired.  The  materials  were  chemically  pure,  and 
the  usual  care  was  taken  in  their  administration.  Death 
took  place  as  the  result  of  paralysis  of  the  heart. 

Eulogy  on  Prof.  Joseph  M.  Smith. — ^Dr.  W.  C.  Ro- 
berts read  a  very  interesting  and  eloquent  eulogy  upon 
the  late  lamented  Profe?sor  Joseph  M.  Smith,  on  Wed- 
nesday evening,  Feb,  6,  before  the  New  York  Academy 
of  Medicine.  The  meeting  was  well  attended,  and  the 
audience  paid  the  orator  the  high  compliment  of  the 
strictest  attention. 

Legalizeu  Prostitution. — It  is  stated  on  reliable  au- 
thority, that  Assemblyman  Jacobs's  bill  for  the  regula- 
tion of  prostitution,  to  which  we  have  already  referred, 
has  a  fair  prospect  of  becoming  a  law. 

Quarantine. — The  Board  of  Health  have  adopted  a 
memorial  declaring  that  full  and  unrestricted  authority 
should  be  vested  in  the  Commissioners  of  Quarantine  to 
allow  them  to  obtain  a  site  for  quarantine  purposes  by 
the  power  of  eminent  domain,  if  it  cannot  be  secured  by 
purchase.  The  document  has  been  forwarded  to  the 
Legislature. 

Milk  consumed  in  New  York  and  Vicinity. — ^The 
milk  consumed  in  the  city  of  New  York  and  its  imme- 
diate vicinity,  is  estimated  at  an  average  of  three  hun- 
dred thousand  quarts  a  day. 

Death  of  Dr.  W.  Brinton. — Dr.  William  Biinton, 
F.R,S.,  the  distinguished  London  physician,  died  of 
ursemia  on  the  17th  of  January,  aged  43  years. 

St.  Luke's  Hospital.— Dr.  Charles  F.  Taylor  has 
been  appointed  Consulting  Orthopoedic  Surgeon  to  this 
institution. 

Ligature  op  the  Right  Subclavian  and  Carotid 
Arteries — Professor  Joseph  C.  Hutchison  recently 
L'gated  pimultaneously,  the  right  subclavian  in  the  third 
portion,  and  also  the  right  carotid,  for  aneurism  of  the 
arteria  innominata.  The  operation  was  performed  at 
the  Brooklyn  City  Hospital,  and  the  patient  promises 
to  recover.  A  detailed  history  of  the  case  will  shortly 
be  furnished  our  readers  by  the  operator. 

Prevalence  of  Cribunal  Abortion. — ^But  the  worst 
feature  of  this  matter  is  ita  increased  and  increasng 
prevalence.  Formerly  it  was  almost  exclusively  adopted 
to  get  rid  of  the  encumbrance  and  shame  of  illicit  inter- 
course ;  and  by  the  masses  of  society,  especially  the 
moralist,  it  was  considered  as  the  natural  result  of  such 
carnal  indulgence ;  and  only  susceptible  of  control  as 
the  higher  religious  sentiment  prevailed,  infltiencing 


men  to  self-restraint  Of  course,  taking  the  world  afl 
we  find  it,  there  was  little  hope  of  accomplishing  much 
towards  the  abatement  of  the  evU — and  it  could  only  be 
held  in  check  by  operating  upon  the  fears  of  men, 
through  law.  Now,  however,  the  exceeding  prevalence 
of  the  evil  is  found  to  be  among  an  entirely  difiorent 
class,  and  the  fruit  of  legitimate  wedlock  in  every  grade 
of  society,  hi^h  and  low,  but  especially  the  former,  is 
the  prey  of  this  destroying  Moloch.  There  is  reason  to 
fear  that  in  this  present  age,  but  few  of  either  sex  en- 
ter into  the  marital  relation,  without  full  information  as 
to  the  ways  and  means  of  avoiding  or  destroying  the 
legitimate  results  of  matrimony — in  the  one  case,  whe- 
ther by  injections,  imperfect  intercourse,  or  the  abomi- 
nable French  appliance,  conception  is  prevented ;  while 
in  the  other,  by  medicinal  or  mechanical  means,  they 
destroy  the  fruit  of  conception ;  for  they  are  often  eut- 
ficiently  instructed  to  be  quite  independent  of  outside 
helps.  Among  married  persons,  so  extensive  has  this 
practice  become,  that  people  of  hi^h  repute  not  only 
commit  this  crime,  but  do  not  even  shun  to  speak 
boastingly  among  their  intimates,  of  the  deed  and  the 
means  of  accomplbhing  it.  Is  there  a  physician  here 
present,  whose  experience  does  not  fully  confirm  the 
statement?  Gracious  Heavens  I  and  has  it  come  to 
this,  that  in  an  age  of  advanced  Christianity,  with  the 
advantage  and  refinement  which  education  is  supposed 
to  bring,  woman,  the  dearest,  best,  and  purest  of  God's 
creation,  can  descend  to  this  lowest  level,  and  become  a 
murderess,  and  that  too  of  her  own  offspring  I — D.  M. 
Stewart,  Detroit  Rev,  Med,  and  Surgery. 

Production  of  Sexes  at  Will. — Dr.  Thos.  Liscnmb 
(Nashville  Journal  of  Medicine  and  Surgery)^  with  refer- 
ence to  M.  Thuny's  theory  of  the  production  of  sexes 
at  will,  says :  "  We  believe  that  the  Creator,  in  infinite 
wisdom  and  with  that  beneficence  to  the  creature  man 
that  characterizes  all  of  his  dealings  with  him,  has 
reserved  this  secret  to  himself;  veiling  it  in  mystery  so 
profound  as  to  cause  it  to  remain  for  ever  hidden  from 
the  researches  of  man.  If  so,  it  is  doubtless  best  that  it 
should  so  remain.  Discover  this  secret  to  man,  and 
what  might  he  not  attempt?  He  might,  in  the  exer- 
cise of  h£  limited  capacity,  conclude  that  first  one  and 
then  another  animal  was  useless  in  the  world ;  and  then, 
with  an  amount  of  zeal  worthy  of  a  better  cause,  com- 
mence* his  work  of  destruction  of  that  particular  spe- 
cies, by  so  regulating  the  intercourse  of  the  sexes  as  to 
prevent  any  female  offspring  being  begotten,  thus 
severing  link  after  link  in  the  great  chain  of  animated 
nature.  And  the  wickedness  of  man  might  not  stop 
here,  but  a  serious  and  grave  interference  with  the  pro- 
pagation of  his  own  species  might  be  attempted  and 
accomplished;  as  we  all  know  that  there  is  a  foolish 
and  wide-spread  prejudice  with  many  parents  against 
having  daughters  born  to  them ;  an  overweening  anxie- 
ty for  boys,  as  foolish  as  it  is  wicked,  as  if  the  great 
God  who  regulates  these  things  was  not  the  best  judge 
of  what  was  best  for  us,  and  best  for  the  world.  And 
as  the  unerring  word  of  inspiration  has  declared  that 
man  is  desperately  wicked,  and  our  own  observation 
and  experience  abundantly  attest  the  truth  of  the  decla^ 
ration,  what  other  great  wickedness  might  he  not  at- 
attempt?" 

Prof.  Hosas  of  Vienna. — In  a  lecture  published  in 
the  Bugalo  Meduxd  and  Surgical  Journal,  relating  to 
medical  affairs  abroad,  among  other  interesting  facts,  it 
is  noted  that  "  Professor  Rosas"  has  an  eye  clinic  in 
the  General  Hospital  in  Vienna.  If  we  are  not  great'y 
in  error.  Professor  Rosas  has  been  dead  quite  a  num- 
ber of  years.  Profefsors  Arlt,  Stellwafjr,  and  Jaeger 
are  the  Uying  teachers  of  ophthalmology  in  VieoiUL 


THE  MEDICAL  RECORD. 


25 


€>rtgtnal  Contmumcations* 


AN  OPERATION  FOR  ABSCESS  OF  THE 

APPENDIX  VERMIPORMIS  CJECI. 

Br  WILLARD  PARKER,  M.D., 

noraMOB  cr  PsoromjB  ▲!n>  psaotios  or  8ini«BBT,  oolliob  or 

PHTUOIAXB  AMD  BCMBOlfS,  MMW  TOBK. 

Famtliar  as  we  are  with  the  diseases  to  which  the 
alimentary  canal  is  liable,  there  is  one  part  of  it — the 
appendix  rermiformis — the  pathology  of  which  is,  to  a 
great  extent^  involyed  in  obscority.  In  the  ancient  lite- 
rature of  the  profession  we  find  nothing  in  regard  to 
it ;  in  fact,  we  have  no  reason  to  suppose  that  attention 
was  ever  directed  to  it  as  a  part  which  might  be  the 
seat  of  special  disease.  And  this  neglect  is  not  to  be 
wondered  at^  when  we  reflect  that,  by  its  position,  the 
appendix  vermifonnis  is  insignificant;  and,  by  its  ana- 
tomical similitude  with  the  rest  of  the  intestinal  tube,  it 
is  impossible  for  disease  affecting  it  to  remain  for  more 
than  a  limited  period^  local  In  many  cases,  general 
•Trnptoms  too  rapidly  mtervene  to  allow  an  exact  diag- 
nosiB  to  be  made  out;  and,  frequently,  it  is  only  at  the 
autopsy  that  we  become  acquainted  with  the  precise 
nature  of  the  disease  which  hSu  terminated  the  life  of 
the  patient 

During  the  present  century,  however,  the  seal  of  the 
profession,  which  has  been  at  work,  uprooting  the  hid- 
den things  of  the  past,  has  not  suffered  investigation 
into  the  obscure  physiology  and  pathology  of  the  ap- 
pendix, to  remain  wholly  idle.  Various  papers,  by 
So^ish,  French,  and  Gkrman  authors,  have  appeared  f 
besides  occasional  cases,  which  firom  time  to  time  hav^ 
found  their  way  into  tiie  medical  journals.  But  although 
much  has  already  been  done,  much  still  remains  to  be 
accomplished,  before  the  ooscurity  surrounding  this 
saUect  win  hAve  been  entirely  removed. 

There  are,  however,  three  diseases  of  the  appendix 
vermiformis,  which  hare  been  classified  from  post-mor 
tern  appearances: 

1.  Gangrene. 

2.  Perforating  Ulcer. 

3.  Abscess. 

To  these,  Rokitanski  adds  a  catarrhal  affection  of  the 
appendix,  which  may  be  only  the  commencement  of  a 
Braver  condition,  or  which  may  exist  by  itself  as  a  distinct 
diaeai^e.  By  some,  these  diseases  have  all  been  jnrouped 
together  under  the  general  name.  Typhlitis,  t  They  all 
have  the  same  origin,  viz.  the  impaction  of  cfdcu- 
lo^is  masses  in  the  <»libre  of  the  tube,  or  the  presence 
of  foreign  substances,  such  as  the  seed  of  fruit,  shot, 
etc  These  may  become  causes  of  disease,  either  by 
obstructing  the  circulation  of  the  part,  or  by  their  pre- 
sence, simply,  they  may  give  rise  to  irritation  and  inflam- 
mation. 

Ghangrene,  and  perforating  ulcers  of  the  appendix  ver- 

•Hmmv  Mid  DuMi,  *8or  qiMlflOM  Engoivemaiitt  InfUmDuitoIrM 
i^M  d^^meat daat U Fowe  DlaqiM  Drolto.    JUptrtoire G«ii«i»L 

**  Do*  abete'd«  U  Fo«e  I1iaqii«  Droit    Lepou  Onlat  d«  Dapaxtrto. 


Bj  tbM0  obMmn,  absoMMt  of  tho  riclit  IIIm  Awm.  and  tho  STmp- 
toat  aMompaajliii;  them,  were  dMef1t>oa,  but  th«j  lUlod  to  ponelro 
^•Maii«ri«ii  whieli  thooe  bore  to  Inflammattoat  orlgiwitlDg  in  tho 
•MMdlx TvrvUbmla.  They  Uurafbi  thai  thoy  wore  aU  **DrlmMil7 
naaflMtSoM  of  tbo  oellolar  tlasao  In  tho  rlfht  fllae  fiMia,  vliloh  nuij 
ttmiBAlt  in  retolntlon,  rappontion.  or  nniTorsal  poritonitla.* 

U  WM  woorvmd  for  Dr.  Bnrao,  **  Modloo-CUmrgionl  Tranonatloni,*' 
vok  EX.  tad  uli.,  to  eetnbltah  tho  troo  raUttons  of  these  ibaeMna, 
■ad  tTMo  them  hMk  fktMn  eflbet  to  oaoae. 

t  PorchcIL  the  lint  Germaa  phjdeiea  who  oaTe  partieiUar  attentioii 
••  theae  eoAtfoMi  propoied  the  aame  perHjpUitiii 


miformis,  usuallv  occur  in  male  children,  and  prove  fiital 
in  from  two  to  five  or  six  days.  No  certain  diagnosis 
can  be  made  out  Violent  Sjrmptoms  of  general  perito- 
nitis set  in,  and  it  is  rare  l^at  medical  interference  is  of 
any  avail 

Abscess  of  the  appendix,  on  the  contrary,  generally 
attacks  those  past  adult  age ;  is  slower  in  its  progress, 
and  presents  symptoms  more  easy  to  recognise.  An 
attach  is  ui^ered  in  by  pain  in  the  bowels,  suddenly 
coming  on ;  loss  of  appetite ;  nausea,  vomiting,  and  per- 
haps some  febrile  action.  In  a  short  time  the  pain  cir- 
cumscribes itself  in  the  right  iliac  region ;  nausea  and 
vomiting  continue;  the  bowe's  are  constipated;  skin 
dry  and  feverish;  pulse  inflammatory;  tongue  thickly 
coated ;  abdomen  somewhat  tumid  and  resonant  on  per- 
cussion— also  sympathetic  tenderness  over  its  whole 
extent  After  the  htpse  of  a  few  days,  a  small  cir- 
cumscribed tumor  may  be  detected  in  the  neighborhood 
of  the  right  iliac  fossa. 

All  of  the  symptoms  may  not  be  present  in  every 
case,  and  some  oi  them  are  common  to  other  diseases. 
Unoertainty  may  exist  with  regard  to  the  diagnosis.  It 
may  be  difficult  to  determine  whether  a  case  is  internal 
hernia,  abscess  of  the  appendix,  or  intussusception.  The 
greatest  diagnostic  mark  to  be  remembered,  is  this:  In 
the  above-named  diseases  internal  hernia  and  intussus- 
ception) there  is  insuperable  obstruction  in  the  bowels, 
while  in  abscess  of  the  appendix  vermiformis  there  is 
no  such  obstruction.  The  administration  of  a  cathartic, 
then,  will  clear  up  all  obscurity.  And  it  is  to  be  remem- 
bered, also,  that  m  abscess  of  the  appendix,  the  action 
of  a  cathartic  produces,  at  first,  marked  relief  of  all  the 
symptoms ;  but  this  relief  is  only  temporary.  Accord- 
ingly, then,  as  a  cathartic  acts  efficiency  or  not  at  all, 
we  are  able,  by  exclusion,  to  arrive  at  a  tolerably  cer- 
tain diagnosis;  the  more  so,  as  we  are  aided  by  the 
symptoms  already  enumerated,  the  pain  and  circum- 
scribed tenderness  over  the  iliac  fossa. 

The  prognosis  is  bad.  The  end  is  generally  death. 
Dr.  Lewis  reports*  forty-seven  cases  of  diseased  appen- 
dix, all  of  which  terminated  fatally.  Death  occurs  in 
this  way :  When  tiie  pus  has  accumulated  in  sufficient 
quantity,  it  forces  its  way  into  the  cavity  of  the  perito- 
neum, a  violent  peritonitis  is  induced,  and  death  rapidly 
ensues.  AU,  however,  who  have  abscess  of  the  appen- 
dix vermiformis,  do  not  die.  In  a  few  cases,  adhesions, 
strong  enough  to  keep  the  contained  pus  from  invading 
the  peritoneil  cavity,  are  created  ai*ound  the  abscess, 
and  the  pus  finds  an  exit  by  ulceration,  either  into  some 
portion  of  intestine,  generally  the  cescum,  or  through 
the  abdominal  walL 

The  following  cases  are  illustrative : — 

In  1843, 1  was  called  in  consultation  to  visit  Dr.  T.,  of 
Brooklyn.  He  had  been  confined  to  bed  for  some 
weeks,  sufiering  from  pain  in  the  bowels,  constipation, 
disturbance  of  system,  fever,  tenderness  in  right  in^nal 
region,  etc.  On  examiuation,  I  found  a  swelling  m  the 
neighborhood  of  the  iliac  foasa^  in  which  questionable 
fluctuation  existed.  An  opening  of  exploration  was 
made,  which  justified  a  free  incision.  I  accordingly  cut 
down  into,  and  excavated  the  contents  of  the  abscess; 
with  the  pus,  a  little  concretion,  the  siee  of  a  raisin-seed, 
came  out.  In  a  ^ort  time  the  patient  recovered,  ana 
is  living  now,  in  good  health. 

I  saw  Mr.  D.,  »t  forty-five,  a  stronff,  healthy  former, 
on  the  20di  of  May,  1865.  He  had  been  sick  for  six 
days  with  pain  in  the  bowels,  tenderness  over  right 
iliac  fossa,  etc.  He  was  Iving  on  his  back,  his  legs 
drawn  up ;  his  bowels  had  been  fi*eely  moved.  I  pre- 
scribed a  blister,  opium,  and  nourishment    I  next  saw 


•  Few  Toife  Journal  of  Mfdtolae. 

Digitized  by 


Hatmher,  186S.  T 

y  Google 


26 


THE  MEDICAL  RECORD. 


him  on  the  17th  of  June.    He  was  weak  and  emaciated 
from  the  seyerity  and  continuance  of  the  attack.    A, 
t'imor  had  appeared  over  the  region  of  tenderness, 
which  two  days  previously  had  grown  consicierably 
smaller,  and  at  the  same  time  a  liquid,  supposed  to  be 

Purulent,  discharge  had  taktn  place  fom  the  bowels, 
he  tumor  was  soft  to  the  touch,  and  presented  a  point 
where  pus  was  near  the  surface :  this  I  laid  open  with 
a  bistoury,  and  considerable  purulent  matter,  with  gas, 
made  its  escape.  Following  this  was  improvement  and 
perfect  recovery.  In  this  case  the  abscess  had  broken, 
not  only  through  into  the  intestine,  as  waa  shown  by 
the  reduction  m  the  size  of  the  tumor,  simultaneously 
with  a  discharge  from  the  bowels,  but  ulceration  was 
already  commencing  to  form  a  track  for  the  escape  of 
the  p;is  through  the  abdominal  walls. 

C.  J.  0.,  set.  twenty-one,  robust,  had  suffered  for 
two  years  from  dyspepsia  and  chronic  diarrhoea.  He 
stated  that,  on  the  lOtn  of  June,  1865,  he  was  attacked 
with  peritonitis,  the  pain  being  intensified  over  the 
right  iliac  fossa.  On  the  16th,  the  general  inflamma- 
tion having  abated,  he  noticed  a  sweling,  hard  to  the 
touch,  and  very  painful,  above  the  right  groin.  This 
tumor  gradually  enlarged  until  the  20th  of  August, 
when,  I  first  saw  hinL  It  presented  a  circumscribed 
appearance,  had  a  doughy  feel,  and  sometimes  crepitated 
as  if  it  contained  gas.  Leeches  were  applied  and  poul- 
tices; the  bowels  were  made  to  act,  and  he  had  got 
60  far  well  as  to  be  able  to  attend  to  his  busnes^, 
though  the  tumor  and  hardness  had  never  entirely  dis- 
appeared ;  when,  in  the  latter  part  of  November,  he 
had  a  recurrence  of  his  difficulty.  On  the  4th  of  Decem- 
ber I  made  an  incision,  through  which  some  pus  and 
a  small  calculus  made  their  escape.  On  examination 
the  latter  was  found  to  consist  of  uric  acid,  biliary  mat- 
ter, and  some  d^ris  of  muscular  food.  On  the  16th  of 
January,  the  tumor  in  the  meantime  having  disappeared, 
leaving  only  an  indurated  hardness,  the  patient  was 
again  attacked  with  violent  pain,  vomiting,  etc.,  as  at 
the  first.  On  the  17th,  some  enlargement  was  noticed, 
and  on  the  20th  Qt  having  attained  the  size  of  a  man's 
fist,  and  fluctuation  being  discovered),  it  was  opened, 
and  pus  copiously  discharged  therefrom.  In  a  short 
time  the  flow  of  pus  had  ceased,  the  parts  resuming 
very  nearly  their  normal  condition.  He  soon  returned 
to  his  home  in  Connecticut,  where  he  now  i^.  In  a 
letter  dated  April  6,  1866,  he  says  that  his  general 
health  is  poor,  being  troubled  with  weak  bowels  and 
vomiting,  but  nis  side  has  given  him  no  inconvenience 
since  it  was  last  opened. 

A  fact,  which  bears  somewhat  upon  the  prognosis,  is 
discovered  in  lookin^^  at  the  anatomical  position  of  the 
appendix.  Its  origin  is  generally  from  the  interior, 
.  posterior,  and  inner  side  of  the  c®cum,  and  it  may  be 
of  varying  size,  and  occupy  various  positions.  It  may 
depend  into  the  pelvis  and  He  over  the  iliac  fossa :  it 
may  lie  curled  up  behind  the  caecum,  on  the  outer  edge 
of  the  psoas  magnus,  upon  the  &scia  iliaca :  or  it  may 
He  encircling  the  c»cum  and  extend  up  tdong  the  colon 
for  four  or  five  inches.  By  remembering  the  last  posi- 
tion our  diagnosis  will  be  aided,  rather  than  the  progno- 
sis, for  we  will  be  prepared  to  find  the  tenderness  and 
circumscribed  swelling  at  a  higher  point  upon  the  abdo- 
men, than  the  region  over  the  iliac  fossa.  When  the 
api>endix  lies  behind  the  c»cum  upoa  the  fascia  iliaca, 
its  inflammation  and  abscess  become  of  less  import- 
ance, for  the  peritoneum  in  this  case  is  not  involved, 
and  the  direction  of  the  abscess  is  towards  the  outer 
margin  of  the  quadratus  lumborum,  where  the  parietes 
offer  but  httle  resistance.  These  last  positions  of  the 
appeiadix,  however,  are  rare,  and  they  are  only  men- 
.Uoned  as  being  among  the  possibilities. 


The  duration  is  variable,  and  depends  upon  the  ab- 
sence or  presence  of  adhesions.  In  the  first  case  the 
patient  dies  in  from  two  to  four  or  five  days.  In  the 
second,  death  cannot  occur  so  long  as  the  adhesions 
keep  the  peritoneal  cavity  intact  These  are  in  danger 
of  being  broken  as  loug  as  the  formation  of  pus  is  on 
the  increase:  that  is,  until  its  maximum  is  reacher?, 
which,  in  all  probability,  will  be  by  the  twelflh  day. 
The  adhesions,  if  they  break  at  all,  will  have  broken 
by  this  day,  so  that  we  may  conclude,  if  the  patient 
survives  the  fifth  day.  Nature  is  putting  her  seal  of 
safety  upon  the  case.  Death  may  occur  afler  the 
twelfth  day,  but  the  chances  are  greatly  diminished. 

Of  the  general  treatment  I  have  little  to  say.  Abso- 
lute rest  on  the  back,  opium,  and  such  nourishment  as 
will  maintain  the  plastic  integrity  of  the  blood,  will  be 
sufficiently  indicated  to  every  practitioner. 

The  matter  of  local  treatment,  however,  has  attracted 
my  attention  for  many  years.-  These  questions  pre- 
sented themselves :  Are  the  efforts  of  nature  exerted  in 
behalf  of  a  cure,  and  if  so,  in  what  way?  Observation 
indicates  the  reply,  and  experience  verifies  its  truth. 
Nature  does  labor  in  behalf  of  life,  in  two  ways :  1st, 
by  means  of  the  wall  of  false  membrane,  which  she 
builds  up  around  the  abscess ;  and  2d,  by  the  ulcera- 
tion, which  gives  an  external  vent  to  the  escape  of  its 
contents.  This  being  settled,  it  became  a  question 
whether  surgery  might  be  able  to  render  assistance  to 
Nature  in  this  work ;  and  if  so,  at  what  period  would 
interference  best  come  in  ? 

In  what  has  gone  before,  it  would  seem  that  in  some 
cases  no  adhesions  are  formed,  and  general  peritonitis 
quickly  carries  the  patient  to  the  grave.  It  is  obvious, 
in  these  cases,  that  surgery  ean  be  of  no  avail 

It  has  likewise  been  seen  that  many  cases  are  pro- 
longed beyond  the  fifth  day.  In  these  we  have  evidence 
of  an  adhesive  inflammation,  and  we  know  that  the 
next  step  in  the  progress  of  the  case  will  be  ulceration. 
The  only  danger  now  to  be  feared  i&,  that  before  ijlcera- 
tion  can  fully  accomplish  its  purposes,,  the  pressure  of 
the  accumulating  pus  will  break  through  the  recently 
formed  adhesions,  and  the  event  will  be  the  same  as  if 
no  adhesive  inflammation  had  taken  place.  Just  here, 
if  at  all,  the  office  of  the  surgeon  becomes  necessary ; 
for  by  making  a  free  incision  down  to  the  point  where 
pus  is  collected,  we  have  a  method  by  which  we  may 
supersede  nature  in  its  slow  process  of  ulceration.  By 
this  meansr  the  pus  will  escape  as  soon  as  it  is  formed; 
consequently  there  will  be  no  pressure  upon  the  recent 
adhesions,  and  even  though  weak,  they  will  be  strong 
enough  to  answer  all  the  purposes  for  which  they  were 
created.  The  time  for  making  the  indsion  is  a  matter 
of  great  importance.  To  be  successful,  it  is  neces.sary 
that  it  should  be  made  neither  too  early  nor  too  late — 
not  before  adhesions  are  fully  formed,  nor  after  a  short 
period  before  the  maximum  formation  of  pus  has  been 
reached;  t^at  is,  the  incision  should  be  made  after  the 
fifth  day,  and  before  the  twelflh. 

Reasoning  thus,  I  had  convinced  myself  of  the  prac- 
ticability of  an  operation,  in  cases  of  abs:ess  or  the 
appendix  vermiformis.  Of  its  safety  there  could  be  no 
doubt,  for  there  was  no  danger  in  the  division  of  those 
structures  throuj^h  which  the  incision  would  pass. 
That  it  was  perfectly  justifiable,  I  had  no  doubt,  for, 
taking  into  consideration  the  two  possibilities  of  any 
case,  1  could  find  no  reason  why  the  operation  should 
not  be  performed.  The  first  of  these,  was  where  the 
diagnosis  had  been  clearly  made  out.  This  has  been 
sufficiently  dwelt  upon  in  the  foregoing  paragraphs.  The 
second,  was  in  those  cases  in  which  there  was  doubt  as 
to  the  diagnosis.  If  no  abscess  had  already  formed,  in 
case  one  should  be  in  process  of  forma^n,  an  external 


igitized  by  VjOO^- 


THE  MEDICAL  RECORD. 


27 


Gpemag  would  tend  to  make  it  point  in  a  safe  direction. 
And  even  if  no  abscess  should  form,  a  free  incision 
would  relieTe  tension,  thus  adding  to  the  comfort  of  the 
patient^  and  in  no  way  preiudicmg  his  safety.  One 
odier  question  remained.  Would  me  operation  be  suc- 
oe>'«fuI  in  bringing  about  a  cure  ?  Judging  fi*om  the  result 
of  the  three  cases  reported  above,  an  affirmative  answer 
leenied  certiun ;  for  these  recovered,  because  in  each  one 
nature  had  provided  for  an  external  discharge  of  the  con- 
tents of  the  abscess,  and  what  nature  had  provided  for 
in  these  three,  an  operation  would  provide  for  in  all 
cases.  These  theories  received  final  confirmation  in  the 
result  of  the  case,  the  report  of  which  follows : 

J.  D.,  »r.  40,  strong,  of  full  habit,  was  attacked  with 
pain  in  the  bowels  at  half-past  four  o'clock  in  the  morn- 
ing of  Friday,  January  12, 1866.  He  has  been  more  or 
les  subject  to  severe  attacks  in  the  bowels  for  some 
years.  The  night  preceding  the  present  attack,  he  had 
been  out  with  friends  and  had  eaten  a  late  supper.  At 
five  A.M.  he  vomited,  and  felt  some  pain  in  the  right 
iliac  fossa.  At  eight,  he  took  coffee  and  toast,  after 
which  he  went  down  town.  During  the  day  he  had 
no  appetite,  and  took  no  food  until  evening,  when  he 
ate  a  little  cold  chicken.  There  was  no  movement  from 
the  bowels  during  the  day.  In  the  night  he  had  nausea. 
On  the  13th  he  arose  early,  having  passed  a  restless 
night.  After  break&st  he  took  two  blue-pills.  During 
the  day  he  suffered  from  pain  in  the  right  side,  which 
was  relieved  by  bending  over  to  that  side.  On  the  14(h, 
there  being  as  yet  no  movement  from  the  bowels,  he 
took  a  glass  of  Saratoga  Empire  water.  Pain,  restless- 
ness, and  nausea  still  continued.  Mustard  was  applied 
OTcr  the  affected  side.  This  evening  he  had'  an  mef- 
fident  movement  from  the  bowels.  On  the  15th,  the 
above  svmptoms  increased  in  severity,  oon tinned,  and 
in  addition  he  was  troubled  with  eructations.  In  the 
evening  his  family  physician,  Dr.  Sabine,  saw  him,  and 
ordered  opium  and  a  blister  to  the  affected  side,  also 
leeches.  On  the  16th,  I  saw  the  patient  in  consultation 
with  Dr.  S.  We  found  him  with  a  thickly  coa*ed 
tongue;  no  i^petite;  nausea,  and  a  constipated  state 
cf  ^  bowek;  pulse  inflammatory,  ranging  over  100; 
skin  dry  and  feverish ;  abdomen  tumid  and  resonant  on 
percufisioD ;  pain  in  the  whole  abdomen,  but  more  de- 
cided in  the  right  iliac  fossa.  Over  this  was  a  circum- 
scribed tenderness,  the  boundaries  of  which  could  easily 
be  marked  out  by  the  fingers.  Micturition  painfiil; 
pain  also  extendeid  down  the  right  thigh,  and  to  the 
ri^ht  testicle,  which  was  drawn  up.  He  was  lying 
with  his  right  thigh  flexed  on  the  pelvis,  which  position 
gave  him  some  relief. 

The  case  was  diagnosed  as  probably  abscess  of  the 
npeodix  vermiformis.  To  render  it  certain,  however, 
that  there  was  no  internal  hernia,  intussusception,  or 
impaction  of  ffeces,  and  to  dear  up  the  diagnosis,  we 
ordered  calomel,  gr.  xv.,  and  opium,  gr.  iij.,  to  be  given 
in  three  doses.  On  the  morning  of  the  1y  th,  oL  ricini 
I  j,  with  tr.  opii  gtt  xx.,  were  administered,  and  ope- 
rated freely,  a  large  quantity  of  scybalous  fseces  coming 
away.  The  immediate  effect  was  an  amelioration  of 
all  the  symptoms.  The  pulse  became  soft^  and  fell  to 
80;  skin  moist;  tongue  less  coated;  some  return  of 
appetite;  abdomen  less  tumid,  and  the  pain  became 
definitelv  circamscribed  in  the  right  iliac  fossa.  On 
the  19th,  his  symptoms  indicated  a  return  of  his  for- 
mer condition.  During  this  day  he  was  kept  under  the 
influence  of  opium,  and  on  the  20th,  finding  his  symp- 
toms mnre  unfavorable,  his  exact  condition  was  ex- 
pbined  to  hhn  aqd  the  operation  proposed.  It  was, 
with  lu8  consent^  decided  that  if  on  the  next  day  there 
ahoold  be  no  improvement^  it  should  be  performed.  On 
the  2l8t,  there  being  no  diange  for  the  better,  but  if 


anything  for  the  worse,  and  it  now  being  the  ninth 
day  of  uie  attack,  it  was  decided  to  operate  as  soon  as 
practicable.  An  injection  of  catnip  tea  was  given,  to 
reheve  the  bowels  of  wind,  and  at  half-past  two  p.m., 
assisted  by  Drs.  Sabine,  Sands,  Thomas  Sabine,  and  my 
pupil,  Mr.  Wynkoop,  I  commenced  the  operation. 

An  incision  six  inches  in  length  was  made  through 
the  integument,  commencing  above,  and  about  one  inch 
from,  the  anterior  superior  spinous  process  of  the 
ilium,  running  towards  the  symphysis  pubis.  About 
one  inch  of  the  incision  was  above  an  imaginary  line 
drawn  from  one  ant.  sup.  spin.  proc.  to  the  other,  and 
five  inches  below.  The  incision  was  continued  careftilly 
down,  and  all  the  stmctures  found  to  be  healthy,  until 
the  fascia  transversahs  was  reached,  which  was  found 
to  be  thickened.  This  was  divided  over  a  director,  and 
right  beneath  a  tumor  was  felt,  which  was  about  two 
inches  long  and  an  inch  and  a  half  in  width.  An  ex- 
ploring needle  was  introduced,  when  immediately  there 
guided  up  some  thick,  bad-smelling  pus.  The  sac 
was  now  freely  opened,  and  about  four  ounces  of  pus, 
injwhich  there  may  have  been  a  little  fseces.  discharged. 
A  tent  was  introduced  into  the  cavity,  and  the  wound 
left  to  close  up  by  granulations.  The  patient  rallied 
well,  after  the  operation,  and  passed  a  good  night  The 
next  morning  he  was  in  a  quiet  condition ;  pulse  84, 
soft;  tongue  more  moist:  abdomen  soft;  but  tittle 
fever ;  wind  escaping  feeely  from  the  bowels ;  wound 
discharging  healthily.  The  after  treatment  consisted 
entirely  of  rest,  opium,  and  nourishment.  Perfect  re- 
covery took  place  in  three  weeks,  and  at  the  date  of 
writing  (December,  1866)  he  is  enjoying  perfect  health. 


P0LITZEB»8  METHOD  OF  TREATMENT 

WITH   TWO    CASES  OF    ACUTE    AURAL 

CATARRH. 

Bt  henry  L.  SHAW,  M.D., 

eVBOBOlf  TO  THB  BTB  AlTD  BAB  INFXUCABT,  BOfiTOIT. 

The  treatment  of  diseases  of  the  ear  by  the  apparatus 
of  Politzer,  in  connexion  with  Roosa*s  modification  of 
Buttle's  inhaler,  although  much  practised,  has  not  re- 
ceived the  attention,  from  the  profession  generally,  to 
which  it  is  entitled.  We  are  indebted  to  our  friend  Dr. 
Roosa  for  having  first  called  our  attention  to  the  good 
results  following  this  method  of  treatment,  which  have 
been  folly  confirmed  by  our  own  experience. 

The  treatment  can  hardly  be  said  to  take  the  place 
of  the  eustachian  catheter;  yet,  in  many  instances, 
it  will  be  found  an  efficient  substitute.  No  objec- 
tions of  importance  can  be  urged  against  its  use.  For 
in  itfi  operation  it  is  harmless  and  unattended  with 
pain;  the  sensation  produced  by  the  introduction  of 
a  foreign  body  into  the  nostril,  being  the  only  unpleas- 
ant sensation  accompanying  its  use.  The  epistaxis 
which  it  sometimes  causes,  is  a  trifling  matter,  and  is 
not  unfrequently  due  to  the  faulty  manipulation  of  the 
operator.  In  persons  of  a  hsemorrhagic  diathesis,  this 
is  liable  to  take  place,  even  when  the  utmost  care  is 
used.  Rupture  of  the  membrana  tympani  is  mentioned 
as  one  of  the  accidents  attributable  to  its  use.  We  can 
conceive  that  such  an  accident  might  occur.  But  by 
regulating  the  force  by  which  the  bag  is  compressed, 
we  believe  it  may  almost  invariably,  u  not  always,  be 
avoided.  In  a  large  number  of  casea  treated  by  us,  it 
has  never  occurred.  As  is  well  known,  the  amount  of 
force  necessary  to  inflate  the  ear,  varies  in  different  pa* 
tients.  This  is  also  the  case  with  the  same  patient  at 
different  times.  Sometimes  a  very  forcible  compression 
of  the  bag  will  be  required ;  and  pe^ps  it  may  be 

digitized  by  LjOO^^_ 


THE  MEDICAL  RECORD. 


necessirv  to  repeat  the  operation  several  times  before 
we  shall  be  able  to  perceive  with  the  otoscope  the 
audible  click  which  notes  the  entrance  of  air  into  the 
tympanic  cavity.  The  patient  may  be  deceived  with 
reference  to  the  click ;  and  until  he  becomes  accustomed 
to  the  sensation,  it  is  well  to  confirm  his  assertion  in 
the  manner  above  described.  Should  the  click  not  be 
heard,  we  think  it  is  safe  to  conclude  that  the  tube  is 
closed.  Gases  are  not  unfrequently  seen  where  it  is 
impossible  to  inflate  the  tympanum  early  in  the  treat- 
ment. This  impossibility  often  arises  from  the  inflamma- 
tion and  swelling  of  the  mucous  membrane  adjacent  to 
the  mouths  of  the  eustachian  tubes.  The  diagnosis  of 
this  trouble  is  now  very  much  facilitated  by  the  rhino- 
scope  ;  and  under  the  persistent  use  of  local  remedies 
the  tubes  can  oftentimes  be  rendered  inflatable. 

We  have  not  relied  upon  the  use  of  the  bag  alone : 
the  inhaler  has  been  used  in  connexion,  in  nearlv  all 
instancea  The  sponge  has  been  moistened  with  Tr.  of 
iodine,  a  weak  solution  of  nitrate  of  silver,  or  any  agent 
which  seemed  applicable  to  the  case.  The  introduction 
of  air  alone  m^r  be  of  great  service,  and  occasionally, 
it  is  sufficient  K>r  the  cure.  Yet  it  will  be  found  m 
many  instances,  that  the  cure  will  be  hastened  by  the 
use  of  some  medicated  vapor.  That  the  vi^r  passes 
into  the  tympanum  we  have  demonstrated  m  the  fol- 
lowing manner,  in  the  cases  of  patients  with  internal 
otitis,  and  of  those  having  perforations  of  the  mem- 
brana  tympani.  The  external  auditory  passage  having 
been  thoroughly  cleansed,  a  piece  of  sott  paper  or  cot- 
ton soaked  with  starch,  is  inserted  in  the  bottom.  Io- 
dized air  is  then  forced  through  the  inhaler^  when  the 
characteristic  iodide  of  starch  will  be  found. 

The  following  cases  are  typical  of  a  class  very  com- 
monly met  with.  In  each  instance  cited,  the  improve- 
ment of  the  hearing  was  rapid  and  permanent.  No 
more  so,  however,  than  is  often  the  case. 

Marck  27. — ^Miss  D.  T y  aged  24;  strumous  tem- 
perament. Fair  health.  During  childhood  had  enlarged 
tonsils,  which  were  removed.  Three  years  ago,  haS  a 
shght  discharge  frova  the  ears,  which  lasted  but  a  few 
days.  Since  that  time,  has  had  several  attacks  of  slight 
deafness  of  short  duration.  Present  trouble  came  on 
suddeiJy  seven  weeks  ago.  Now  hears  conversation, 
if  very  loud,  at  two  feet.  Hearing  point  with  watch, 
left  ear,  half  an  inch.  External  auditory  passage  and 
membrana  tympani  normal.  Eustachian '  tube  not  in- 
flatable, althou^  she  says  she  herself  has  been  able, 
until  quite  recently,  to  force  air  in  by  closing  the  mouth 
and  nostrils.  Bight  ear,  hearing  point  with  watch  in 
contact.  Eustachian  tube  not  inflatable.  Auditory 
passage  normal.  Handle  of  malleus  very  prominent. 
Its  connexion  with  the  membrana  tympani  unusually 
vascular.  Mucous  membrane  of  throat  inflamed,  but 
not  swollen.    Complains  of  dryness  of  the  feiuces. 

Traatmeot:  Solution  of  nitrate  of  silver,  ten  grains  to 
the  ounce  of  water,  was  applied  to  the  tonsils  and  abont 
the  mouths  of  the  eustachian  tube.  9  Tr.  iodini,  po- 
tass, iod.,  &a.  3  ii*)  Aq.  pur.  Oil  M.  As  a  gargle  four 
times  daily. 

April2. — Solution  of  nitrate  of  silver  applied  to  throat. 
Oargle  continued. 

April  7. — ^Throat  is  better;  says  her  mother^s  voice 
sounds  more  natural  Hearing  point  with  watch  as  at 
first  visit.  Sol  of  silver  applied  to  throat.  Gktrgle  con- 
tinued.   Ordered  Tr.  ferri  dtlor. 

AprU  17. — Within  past  few  days,  has  had  several 
marked  cracks  in  both  ears,  followed  by  improved  hear- 
ing, la8tin|f  for  several  hours ;  in  one  instance  neariy  all 
day.    Pohtzer's  bag,  with  the  inhaler  containing  iodine, 
-as  used  for  the  first  time.   The  result  was  an  improve- 
^  of  six  in.  in  the  right  ear,  and  four  in  the  left 


Conversational  hearing  power  but  slightly  improved. 
Treatment  continued. 

May  2. — The  bag  has  been  used  several  times  since 
last  record.  There  is  a  gradual  improvement  Throat 
touched.     Treatment  continued. 

May  10. — Hears  ordinary  conversation  at  fifteen  feet. 
The  watch  is  heard  at  twenty-four  in.  right  ear;  twenty- 
one  in.  left.  Is  able  to  perform  duties  which  her  defec- 
tive hearing  unfitted  her  for  before.  A  single  vessel 
noticed  at  the  connexion  of  the  malleus  with  the 
membrana  tympani.  The  former  is  less  prominent. 
Eustachian  tubes  normal  She  was  heard  from  eight 
months  afterwards,  and  had  no  return  of  the  trouble. 

November  22.— Mr.  T  0.  X ,  aged  30;  sanguine- 
ous temperament  Six  weeks  ago.  after  exposure,  was 
taken  with  a  severe  coryza,  whicn  in  a  few  days  im- 
proved, leaving  him  deaf.  The  function  of  the  olfac- 
tory nerves  is  seriously  affected ;  is  unable  to  distinguish 
the  most  pungent  odor.  Taste  is  also  afiected,  but  in 
a  less  deffree.  Hearing  point  with  watch,  left  ear,  con- 
tact; right,  not  heard.  Conversation,  to  be  understood, 
has  to  be  very  loud  and  distinct^  and  within  a  foot  of 
the  ears.  He  is  then  aided  by  watching  the  motions  of 
the  lips.  External  auditory  passages  normal  Mem- 
brana tympani,  right,  dull ;  lefl^  normal.  Several  larg» 
blood-vessels  at  the  connexion  with  the  malleus ;  mucous 
membrane  of  throat  and  nares  inflamed ;  that  portion 
over  the  vertebral  column,  granular.  The  marked 
character  of  the  symptoms,  together  with  the  impair- 
ment of  the  olfactory  and  gustatory  nerves,  led  me  to 
ask  the  attention  of  my  colTengues  before  aaopting  any 
treatment  Iodised  air  was  inflated  with  the  following 
result:  conversation  in  an  ordinary  tone,  addressed  to 
others,  he  heard  quite  well  Point  with  watch  one 
and  a  half  inches,  right  ear ;  h%  not  noted.  Ordered 
tr.  of  iodine  gargle  as  in  the  previous  case. 

Dec,  1. — Since  last  record,  iodine  air  has  been  used 
several  times.  Conversational  hearing  power  improved. 
Has  been  able  to  hear  the  watch  at  two  and  a  half 
inches  most  of  the  time.  Tympanum  inflated,  and 
throat  touched  with  the  solution  of  silver.  Treatment 
continued. 

Dec.  6.— After  inflation,  watch  is  heard  at  four  inches. 
Throat  touched  with  tr.  of  iodine.  Treatment  conti- 
nued. 

Dec,  31. — Converses  with  but  little  difficulty.  Hears 
watch  at  eight  inches,  both  ears.  Throat  improved. 
Ordered  gargle  of  red  pepper,  vinegar,  sugar,  and  water, 
as  a  substitute  for  iodine  gargle. 

Jan,  25. — Seen  twice  a  week  since  last  report  Hears 
ordmary  conversation  at  twenty  feet ;  point  with  watch, 
twenty-five  inches,  being  about  the  normal  average. 

Ikh,  15. — Considers  his  hearing  as  acute  as  ever.    He 
is  still  under  treatment  for  his  other  troubles,  which 
have  improved  but  slightly. 
41  Eauz  Stbsr,  Bosroir. 


Chimists*  Certifioates. — ^The  Bogton  Medieai  and 
Surgical  Jovmdlj  in  aUuding  to  the  practice  of  granting 
chemical  certificates  for  difierent  injurious  articles  of 
commerce,  says :  It  is  no  defence  for  the  chemist,  in 
this  and  other  instances  which  miffht  be  mentioned, 
where  certificates  are  given  for  su<3i  or  equally  inju- 
dicious purposes,  to  urge  that  he  is  not  accountable  for 
the  use  which  is  subsequently  made  of  them.  Such  a 
plea  of  irresponsibility  will  not  be  accepted  by  those 
who  respect  chemistry  and  who  fhUy  appreciate  the 
character  of  such  pseudo-scientific  labors,  and  of  the 
parties  who  use  them  for  such  nnworth^purposeSf 

Digitized  by  OOOQ IC 


THE  MEDICAL  RECORD. 


29 


LARYNGOSCOPY. 
Bt  J.  SOUS  COHEN,  M.D^ 

<Mr  PBILADXI.FHXA. 

No.  VII. 

BI8T0L00T  OF  THE  LARTKX. 

A(xx>RDD7Q  to  the  researches  of  Luschka,  whose  AnaUh- 
mie  des  Memcken  is  the  most  elaborate  and  instructiye 
on  this  subject  which  the  writer  has  consulted,  we  learn 
that  the  cartilages  of  the  larjnx  are  composed  of  true 
cartilage  straotnre — fibro-cartilage  and  reticular  carti- 
lage. The  thyroid,  cricoid,  and  the  greater  portion  of 
the  arytenoid  cartilages,  are  formed  of  ordinary  carti- 
lage, bluish  white  in  color.  This  form  has  considerable 
dmosition  during  the  course  of  time  to  undergo  patho- 
logical de^neration.  It  undergoes  earliest  the  fibrous 
d^ceneration,  by  which  it  becomes  fragile,  assumes  a 
yellow  color,  or  becomes  spotted  with  yellow,  and 
grates  under  the  knife.  In  the  so-railed  granular  de- 
l^eneration  it  assumes  a  turbid  color,  sometimes  yellow- 
ish, sometimes  the  color  of  asbestos.  The  intercellu- 
lar subiftance  is  filled  more  or  less  with  larger  and 
smaller  dark  molecules,  and  contains  distributed  through 
it,  isolated  larger  granular  bodies.  Sometimes  the  de- 
generation is  into  porous  osseous  substance,  richly  sup- 
plied with  adipose  matter,  and  this  occurs  so  frequently 
m  mature  age  that  R.  Columbus  {J.  B.  MorgagrUy  Ad- 
wenaria  Anal  1, 23)  does  not  hesitate  to  enumerate  the 
larynx  with  the  osseous  system.  The  ossification  oc- 
curs most  firequently  in  the  cricoid  and  thyroid  carti- 
lages, sometimes  occurring  earUer  in  one,  at  other  times 
in  the  other.  S^nd  says  that  the  muscular  process  is 
always  the  starting-point  of  the  ossification ;  and  that 
next  to  the  influence  of  age,  the  amount  of  exercise  in- 
flnenoes  its  degeneration.  And  he  contends  that  this 
occurs  earlier  and  in  greater  extent-,  among  professional 
▼ocaiists,  than  among  individuals  wno  do  not  make  ex- 
traordinary use  of  their  voices. 

Less  firequently  than  ossification,  we  meet  with  infil- 
tration of  carbonate  of  lime,  which  is  also  said  to  occur 
in  the  capsules  of  the  cartilage,  as  well  as  its  hyaline 
mbstaDce. 

The  epiglottis,  the  cartilages  of  Santorini,  of  Wrisberg, 
the  sesamoid  cartilages,  the  vocal  processes  and  points 
of  the  arytenoids,  the  colliculus  and  vocal  processes  of 
the  thyroid  cartilapre,  are  composed  of  yellow  or  reticu- 
lar cartilage.  These  are  liable  to  calcification  rather 
than  ossification. 

The  thyroid  cartilage  is  ordinarily  described  as  com- 
posed of  two  plates,  ake,  or  wings,  which  are  joined  at 
the  centre.  This  is  not  sufficiently  exact.  It  was  first 
pointed  out  by  Rambaud,  and  subsequently  by  J.  A. 
CaTasse,  Halberstma  (Luschka),  et  cd.,  that  there  is  an 
intermediate  or  centnu  cartilage  uniting  the  two  wings 
— ^the  lamina  intermedia.  This  has  much  the  form  of 
an  inverted  wine-glass  with  flaring  edges,  or  the  large 
extremity  of  a  trumpet ;  but  occasionally  it  is  rhomboi- 
dal  in  shape.  It  can  be  recognised  in  all  a^s  and  in 
both  sexes,  and  can  be  readily  separated  in  the  unossi- 
fied  larynx  after  the  perichondrium  has  been  fully  re- 
moved, which  can  be  best  done  in  those  which  have 
been  immersed  for  some  time  in  alcohol.  A  transverse 
or  vertical  section  will  show  its  existence,  and  it  can  be 
isolated  by  maceration  in  a  dilute  solution  of  potassa. 
It  is  composed  of  a  hyaline  cartilage  structure,  and  by 
its  more  ^yish  color  can  be  distinguished  from  the 
milky  white  of  the' al»  proper.  The  cartlage  of  this 
intermediate  portion  of  the  thyroid  on  its  inner  surface, 
reoeires  the  anterior  vocal  processes,  to  which  the  true 
vocal  oords  are  attached,    it  baa  been  shown  by  Ger- 


hardt  to  be  composed  of  reticular  cartilage,  but  it  de- 
parts from  the  usual  construction  of  reticuhir  cartilage, 
inasmuch  as  instead  of  the  usual  thickly  matted  small, 
dark,  short  elastic  fibre  arrangement,  here,  paler  fibrils, 
sometimes  plaited  in  bands,  cross  each  other,  sometimes 
horizontally,  sometimes  curvilinearly,  forming  inter- 
spaces in  which  large  cartilage  cells  are  here  and  there 
distributed.  This  fibrous  cartilaginous  structure  has 
been  found  unchanged  by  Luschka,  even  when  the 
lamina  intermedia  nad  become  completely  ossified, 
which  circumstance  would  seem  to  show  that  it  may 
maintain  some  important  physiological  relation  to  the 
true  vocal  cords. 

We  have  spoken  of  the  yellow  color  of  the  vocil  pro- 
cesses of  the  arytenoids.  It  is  demonstrable  by  the 
microscope,  as  was  first  pointed  out  by  Rheiner,  that 
through  the  fibrous  basement  structure  of  their  reticular 
cartilage,  these  processes  are  actually  continuous  with 
the  fibro-elastic  element  of  the  true  vocal  cords. 

The  sesamoid  cartilages  first  discovered  by  Luschks, 
are  only  occasionally  present.  They  have  been  observ- 
ed in  various  degrees  of  development  in  both  sexes,  at 
all  ages,  and  in  both  feebly  and  strongly  built  in- 
dividuals. 

The  vocal  cords  are  duplicatures  of  the  elastic  vocal 
membrane  of  the  larynx;  and. their  remarkable  sus- 
ceptibility of  vibration  is  due  to  a  peculiar  fibrous 
band  which  forms  their  basement  structure.  These 
cords  at  their  extremities  are  reinforced  with  reticular 
cartilage,  by  which  their  vibration  is  secured,  and  their 
ossification  prevented.  Their  anterior  and  posterior 
extremities  are  so  thoroughly  connected  with  the  an- 
terior and  posterior  vocal  processes,  that  their  fibrous 
structure  is  inextricably  blended  into  the  felt-like  elas- 
tic element  of  the  vocal  cords.  In  addition  to  this  a 
large  proportion  of  the  fibres  of  the  thyro-arytenoid 
muscle  is  s » intimately  bound  up  into  this  duplicatupe 
of  elastic  vocal  membrane,  and  so  incorporated  into  its 
siructure,  that  it  actually  forms  the  largest  moiety  of 
the-  body  of  the  cord. 

The  question  has  been  started  as  to  the  existence  of 
points  of  difference  between  the  larynx  of  tlie  negro 
and  that  of  the  Caucasian.  Dr.  Gibb,  calling  attention 
to  this  subject  before  the  Medical  Society  of  London 
(see  London  Lancet,  June,  1864),  after  alluding  to  the 
greater  constancy  and  size  of  the  cartilages  of  Wrisberg. 
in  the  negro,  remarked  that  also  in  the  negro  "  the  vocal 
cords,  in  place  of  being  flat  and  horizontal  as  in  the 
white  man.  were  more  or  less  oblique  from  within 
outwards,  their  free  border  being  elevated  at  a  higher 
angle  than  their  attachment,  thus  giving  them  a  shelv- 
ing or  slanting  direction  outwards ;  the  ventricles  tak- 
ing a  direction  downwards  and  outwards,  so  that  any 
small  body,  such  as  a  bead,  placed  upon  the  slanting 
vocal  cora,  would  roll  into  the  ventricle ;  while  in  tlie 
white  man  the  ventricle  is  situated  external  to,  but 
immediately  above  the  plane  of  the  true  vocal  cords." 
The  writer  has  had  bu^^^  a  single  opportunity  to  make 
the  post-mortem  examination  of  the  larynx  of  a  negro 
(he  means  a  hlaek  man,  not  a  mulatto),  and  the  appear- 
ances described  by  Dr.  Gibb  were  not  present, — he 
has  in  his  possession  the  specimen  with  a  little  piece  of 
the  black  skin  of  the  neck  attached ;  and  in  a  number 
of  examinations  made  in  the  dissecting  room  of  the 
Jefferson  Medical  College  of  Philadelphia,  by  Dr.  Tay- 
lor, one  of  the  demonstrators,  no  difference  of  this  kind 
could  be  detected.  In  several  laryngoscopic  examina- 
tions of  mulattoes,  he  could  not  detect  this  difference.  It 
may  be  that  his  own  observations  chanced  to  be  upon 
exceptional  cases,  or  it  may  be  that  those  of  the 
gentleman  quoted  were  exceptional  At  any  rate,  he 
is  convinced  that  the  difference  hereon  thejvocal 
Digitized  by  VjOOQIC 


so 


THE  MEDICAL  RECORD. 


cords  of  the  Degro  and  Caucasian,  if  it  does  exist,  is 
not  constant. 

There  are  found  in  the  reticular  cartila^  of  the  epi- 
glottis, irregular  pits  or  notches  containing  follicular 
and  racemose  glands.  This  inlaying  with  glandular 
structure  gives  it  a  great  disposition  to  ulceration,  which, 
when  it  occurs,  usually  results  in  ulcers  irregularly  ser- 
rated in  outline. 

The  bulging  belly  of  the  epiglottis  is  due  in  part  to 
an  increased  thickness  of  cartilage,  but  in  a  greater 
measure  to  an  accumulation  of  glandular  and  adipose 
tissue. 

The  perichondrium  of  the  cartilages  of  the  larynx  is 
composed  of  thick  areolar  tissue,  interspersed  with  a 
few  irregular  elastic  fibres.  It  contains  a  tolerably  rich 
network  of  blood-vessels.  But  few  nerves  can  be 
traced  in  it,  and,  according  to  Luschka,  only  as  primitive 
fibres.  According  to  J.  Engles,  who  has  minutely  inves- 
tigated the  struct'ire  of  this  perichondrium,  that  of  the 
epiglottis  is  most  richly  supplied  with  nerves,  and  upon 
both  its  surfaces. 


PHYSIOLOGY  OP  THE  LARYNX — ^AND  OP  VOICE. 

The  larynx  belongs  to  that  class  of  musical  instru- 
ments in  which  the  sounds  are  produced  by  the  vibra- 
tions of  reeds  and  tongues.  There  are  Instruments 
with  metallic  reeds,  which  are  tense  in  themselves,  and 
thus  are  readily  thrown  into  vibration  by  the  passage 
of  a  current  of  air ;  and  there  are  others  with  membran- 
ous tongues  (caoutchouc,  etc.)  which  are  rendered  tense 
by  stretching. 

The  jewsharp  is  an  instance  of  a  musical  instrument 
with  a  metallic  tongue.  In  some  instruments,  as  the  ao- 
cordeon  and  its  class,  the  reed  is  attached  by  one  border, 
and  the  air  compressed  in  its  passage  into  a  narrow 
column,  rushes  past  it  on  three  sides ;  while  in  another 
class,  as  the  organ-pipe,  etc.,  the  reed  covers  a  portion 
of  the  opening  at  one  end  of  the  instrument.  In  the 
class  of  which  the  accordeon  is  the  type,  the  tone  is  prp- 
duced  solely  by  the  vibration  of  the  tongue  started  by 
the  concussion  of  a  column  of  air,  and  it  w'dl  vary  in 
character  with  the  length  and  elasticity  of  the  reed.  In 
the  class  of  which  the  organ-pipe  is  tlie  tvpe,  the  pitch 
is  dependent,  in  addition^  upon  the  length  of  the  tube, 
and  the  coincident  vibration  of  the  reed,  and  of  thp  air 
within  the  tube. 

The  larynx,  therefore,  may  be  described  as  a  reed 
instrument,  with  two  parallel  membranous  tongues — 
the  true  vocal  cords ;  the  instrument  terminating  in  a 
forked  exit  tube — the  mouth  and  the  nares ;  while  for 
the  production  of  the  necessary  current  and  its  con- 
veyance into  the  instrument,  we  have  the  lungs  as  the 
bellows,  and  the  bronchial  tubes  and  the  trachea  as  the 
conduits. 

In  order  that  sound  may  be  produced,  it  is  necessary 
that  the  lips  of  the  glottis  should  be  parallel  and  closely 
approximated  at  right  angles  to  the  axis  of  tlie  tube^  so 
that  only  a  narrow  fissure  remains  between  them ;  and 
then  the  air  driven  against  these  lips  of  the  glottis 
during  expiration,  sets  them  in  vibration  as  it  rushes 
between  tnem,  and  is  itself  also  set  in  vibration,  just  as 
occurs  when  sound  is  produced  in  the  organ-pipe. 

The  mechanism  of  the  vocal  apparatus  has  been 
imitated  by  Mr.  Willets,  who  constructed  an  artificial 
larynx  by  stretching  a  piece  of  thin  gutta-percha  around 
one  end  of  a  lube,  allowing  a  portion  of  the  rubber  to 
extend  beyond  the  tube ;  and  then  st- etching  still 
further  the  free  portion  of  the  rubber  between  two 
fixed  points  or  prujections,  so  as  to  produce  a  narrow 
elliptical  fissure.  Then,  by  blowing  into  the  free  por- 
tion of  the  tube  a  sonorous  sound  is  produced,  the  pitch 
of  which  c^  be  rendered  higher  by  stretching  the  rub- 


ber so  as  to  increase  the  tension  and  narrow  the  fissure; 
while  the  free  lips  of  the  rubber  will  be  seen  to  vibrate 
during  the  production  of  the  sound. 

A  strong  current  of  air  forced  through  the  excised 
larynx  of  a  recent  subject  will  produce  the  vocal  tones 
if  the  arytenoids  are  tied  together,  and  the  vocal  cords 
forcibly  stretched  lengthwise ;  and  the  intensity  and  pitch 
of  the  vocal  tone  will  vary  with  the  degree  of  tension 
and  force  of  the  blast. 

That  the  true  vocal  cords  alone  are  concerned  in  the 
production  of  sound  is  proved  by  repeating  the  expe- 
riment of  Magendie,  of  cutting  away  the  epiglottis,  the 
false  vocal  corns,  and  the  arytenoid  cartilages  above  the 
points  of  attachment  of  the  true  vocal  cords,  which  can 
be  done  without  destroying  the  power  of  producing 
vocal  tone  as  long  as  the  true  vocal  cords  are  entire, 
and  kept  tense  so  as  to  narrow  sufficiently  the  chink  of 
the  glottis;  and  the  same  result  is  seen  in  disease, 
where,  by  cicatrization  or  ulceration,  the  epiglottis  and 
false  vocal  cords  have  been  destroyed  or  their  functions 
impaired,  as  can  now  be  demonstrated  durmg  life  by  the 
aid  of  the  laryngoscope. 

For  the  production  of  voice  several  conditions  are 
necessary. 

In  the  first  place,  the  true  vocal  cords  must  approach 
each  other  and  be  parallel  so  as  to  cross  the  current  of 
air  horizontally  ;  in  ordinary  respiration  their  edges  are 
inclined  from  each  other ; — and  secondly,  the  Bssure  be- 
tween them  must  not  exceed  about  a  line  in  breadth. 
This  opening  concerns  the  ligamentous  rima,  or  vocal 
glottis ;  the  cartilaginous  rima  must  remain  completely 
closed ;  if  the  ligamentous  rima  were  completely  clos- 
ed idso,  there  would  be  no  passs^  for  the  escape  of  the 
respiratory  current,  and,  or  course,  there  could  be  no 
production  of  sound.  If  the  cartilaginous  glottis  remain 
open,  and  the  vocal  glottis  be  properly  fissured,  the  air 
will  rush  through  behind,  and  there  will  be  no  vocal 
sound.  If,  however,  the  vocal  glottis  be  properly  fissur- 
ed, and  the  anterior  portion  of  the  cartilaginous  rima 
closed  at  the  points  of  attachment  of  the  vocal  cords, 
though  it  may  be  opeu  again  behind,  we  will  have 
vocal  tone  of  the  same  pitch  as  if  it  were  closed  behind 
also,  though  at  the  same  time  the  two  will  be  muffled 
on  account  of  the  escape  of  a  portion  of  the  expiratory 
current  through  tiie  cartilaginous  glottis.  These  condi- 
tions are  occasionally  beautifully  demonstrated  in  vari- 
ous varieties  of  paralysis  of  the  muscular  apparatus  of 
the  vocal  cords. 

Then  the  escaping  current  of  air  must  strike  the  glot- 
tis with  a  certain  am  >unt  of  force.  If  this  is  prevented 
by  a  fistule,  or  an  artificial  opening  below  the  position 
of  the  true  vocal  cords,  there  will  be  no  voice  as  long 
as  it  is  allowed  to  remain  open,  because  the  air  wifl 
escape  before  it  can  be  propelled  against  the  vocal 
cords;  but  as  soon  as  it  is  closed  by  the  finger,  or 
by  the  valvular  arrangement  of  a  tracheotomy  tube 
arranged  for  speaking,  the  voice  can  be  produced. 
The  amount  of  force  with  which  the  vocal  cords  are 
struck,  can  be  very  well  appreciated  in  an  individual  with 
such  a  fistule  below  the  level  of  the  cords,  by  placing 
the  finger  upon  the  opening  while  the  patient  is  speak- 
ing, when  some  of  the  air  will  escape  at  the  sides  of  the 
finger  with  a  peculiar  forcible  rush.  IfJ  however,  this 
fistule  exist  above  the  position  of  the  true  vocal  cords  so 
that  no  portion  of  t^e  air  escapes  until  after  it  has  set 
them  in  vibration,  the  vocal  tone  will  be  produced. 

Then  again,  if  the  chink  of  the  glottis  be  properly 
fissured,  simple  expiration  will  not  accomplish  tone; 
the  air  must  be  propelled  as  it  were  with  some  amount 
of  force  against  the  glotti'>,  meeting  with  a  certain  re- 
sistance to  its  passage  through. 

A  certain  amount  of  tension  musjU))e  maintained  in 

digitized  by  VjC  _      ^_ 


THE  MEDICAL  RECORD. 


81 


the  oords,  and  according  to  the  increase  of  tension  will 
be  the  rise  in  pitch.  If  the  cords  are  relaxed,  tone  can 
be  prodaced  only  when  the  length  of  the  glottis  is  very 
nrach  shortened. 

For  the  production  of  a  clear,  sonorous  tone,  there 
mast  be  no  impediment  to  the  vibration  of  the  true 
Tocal  cords ;  and  to  the  inserviance  of  this  purpose  the 
Tentricles  of  the  larynx  seem  adapted,  as  they  secure  a 
space  above  the  cords  for  their  free  vibration. 

During  the  production  of  a  proper  healthy  note,  the 
cords  are  not  alone  tense  by  elongation — they  seem 
stretched  in  width ;  at  any  rate  their  transverse  extent 
18  more  prominent  to  the  eye.  and  they  assume  a  some- 
what vaulted  form,  as  thougn  the  escaping  current  of 
dk  pressed  upwards  their  central  portions.  Any  patho- 
logical alteration  which  interferes  with  the  free  move- 
ment of  the  cords,  or  which,  by  affecting  their  struc- 
ture, compromises  their  integrity  of  function,  their 
elasticity  and  vibratility,  will  produce  an  alteration  in 
the  character  of  the  vocal  tone. 

Injury  or  division  of  the  laryngeal  nerves  supplying 
the  muscular  apparatus,  will  produce  alteration  and  de- 
stniction  of  voice. 

The  alterations  in  the  position  and  tension  of  the 
vocal  cords  are  the  principal  agents  in  the  alteration  of 
tbe  tone,  and  are  accomphshed  as  follows: — 

They  are  separated  by  the  action  of  the  posterior 
crico-arytenoid  muscles;  they  are  brought  in  contact 
by  the  action  of  the  transverse  and  oblique  fibres  of 
the  arytenoid  muscles;  they  are  rendered  tense,  and 
lengthened  by  the  action  of  the  crico-thyroid  muscles ; 
they  are  stretched  transversely  and  shortened  by  the 
action  of  the  thyro-arytenoid  muscles ;  they  are  slack- 
ened and  shortened  by  the  action  of  the  lateral  crico- 
arytenoid muscles.  These  movements  can  be  verified 
by  galvanism  upon  the  recent  larynx. 

During  vocalization  we  see  the  true  vocal  cords  vi- 
brate in  their  entire  length;  that  is,  from  one  vocal  pro- 
cess to  the  other;  and  we  know  from  anatomical 
arrangement  and  subject' ve  sensations,  that  the  thyro- 
arytenoid muscles  vibrate  with  them,  as  also  the  general 
elastic  membrane  of  the  larynx;  while  in  deep,  sono- 
rous resonant  tones,  the  trachea  and  sometimes  the 
entire  respiratory  apparatus  vibrate  also.  This  vibra- 
^n  of  trachea,  etc.,  is  probably  due  to  the  action  of  the 
glottis  impeding  the  escape  of  the  strong  current  of  air 
which  reverberates  or  reacts  upon  these  structures ;  for 
it  is  not  likely  that  these  parts  have  anything  to  do  in 
the  modification  of  sound. 

There  are  a  number  of  agents  which  assist  in  the 
modification  of  sound.  Thus,  drawing  the  larynx  down 
upon  the  sternum,  by  the  action  of  the  sterno-thyroid 
muscles,  will  deepen  the  tone ;  and  drawing  it  upwards 
under  the  tongue,  by  the  thyro-hyroid,  shortemng  the 
length  of  the  main  exit  tube,  will  render  it  higher. 
These  movements  can  be  felt  by  placing  the  finger  over 
the  larynx  externally,  and  running  the  scale. 

The  epiglottis,  by  depression  over  the  superior  aper- 
ture of  tiMj  larynx,  will  deepen  the  tone  and  render  it 
duller,  just  as  placing  any  covering  over  the  end  of  any 
other  tubular  music«d  instrument  will  deaden  the  sound. 
The  epiglottis  doubtless  conduces  to  the  production  of 
the  patl^tical  warning  tones  of  the  minister,  and  to  the 
rough,  menacing  tones  of  the  ruffian  ;  and  is  produced 
consentaneously  with  the  lowering  of  the  jaw  and  de- 
pression of  the  tongue  in  the  production  of  these  deep 
and  hollow  tones. 

The  arches  of  the  palate  and  the  uvula  contribute  to 
the  modification  of  tne  vocal  sound,  as  we  well  know 
fit>m  examples  of  congenital  or  pathological  deficiencies; 
and  too  extensive  an  amputation  of  the  uvula  for  hyper- 
trophy or  elongation  is  said  in  many  instances  to  have 


been  followed  by  deterioration  in  the  quality  of  the  musi- 
cal tone.  We  sometimes  see  the  arches  of  the  palate 
vibrate  powerfully  in  the  production  of  the  trill,  and  it 
would  appear  in  some  instances  to  be  the  chief  agent  in 
the  formation  of  the  trill,  instead  of  vibration  of  the 
glottis. 

In  Tobold's  latest  work.  Die  Chroniachen  Kehlkopfs- 
Krankheiterij  are  given  the  deductions  of  a  reliable 
profea^or  of  music,  as  to  the  modification  and  timbre 
of  the  vocal  tones.  These  are  to  the  effect  that  the 
chest-notes  are  characterized  essentially  as  reed-notes, 
and  the  falsetto  and  head-notes  as  flute  notes  •  thus 
confirming  the  opinion  of  Petrequin  and  Diday, 
arrived  at  long  before  Garcia's  introduction  of  the 
laryngeal  mirror  as  a  means  of  observation. 

In  the  flute  instrument,  tone  is  produced  by  the  cur- 
rent of  air  only,  and  is  modified  by  the  length  of  the 
instrument.  In  the  reed  instrument,  as  we  have  already 
seen,  the  tone  is  produced  by  the  vibration  of  metallic 
or  membranous  laminae. 

It  has  been  a  subject  of  a  good  deal  of  controversy, 
whether  the  prinntive  producer  of  tone  in  the  reed  in- 
strument is  the  tongue  itself  or  the  air  which  is  set  in 
vibration.  The  tongue  or  reed  does  not  seem  to  per- 
form a  secondary  part  in  the  formation  of  tone,  for  the 
strength  of  the  tone  will  depend  upon  the  nature  and 
continuity  of  the  impulse  by  which  the  reed  is  set  in 
vibraton. 

That  the  vocal  cords,  although  being  but  short  mem- 
branes, can  by  their  intrinsic  vibration  produce  such 
full  and  powerful  tones,  is  dependent  upon  the  extraor- 
dinary elasticity  of  their  structure,  which  it  is  impos- 
sible to  imitate  artificially. 

The  function  of  the  vocal  cords,  in  the  formation  of 
the  chest-notes,  can  be  well  likened  to  that  of  the  lips 
in  blowing  the  trumpet  The  lips  are  in  themselves  in- 
elastic; but  by  voluntary  muscular  contraction  they 
may  be  made  to  imitate  membranous  tongues.  Now, 
while  the  lips  are  thus  vibrating  voluntarily,  and  pro- 
ducing tone,  if  we  place  opposite  them  an  exit-tube  (a 
horn,  trumpet,  trombone,  etc.),  we  will  not  only  find  the 
tone  become  more  sonorous,  but  it  will  be  modified  in 
the  most  varied  manner,  according  to  the  mechanism 
of  the  exit-tube;  and  the  entire  character  of  tone 
heard  will  be  due,  not  only  to  the  mere  blowing  of  air 
into  it,  but  also  to  the  reed-like  oscillation  of  the  lips. 
In  this  case  the  oscillating  lips,  imitating  or  acting 
for  the  time  as  membranous  reeds,  are  the  primitive 
medium  of  the  tone;  and  not  the  current  of  air  vibrating 
in  the  tube,  as  in  the  case  of  the  flute. 

Consequently,  as  the  tongue  or  reed  in  the  reed-in- 
strument, and  the  lips  in  the  blowing-instrument,  we 
must  regard  the  vocal  cords  as  the  primary  educers  of 
the  tone,  in  the  production  of  the  chest-notes. 

In  the  chest-no* es  the  cords  vibrate  in  great  extent, 
and  along  their  entire  breadth.  In  the  faketto  and  head- 
notes,  we  see  the  glottis  only  as  a  more  or  less  open 
slit,  and  the  vibration  is  confined  to  the  inner  bbrders 
of  the  vocal  cords,  while  the  bodies  of  the  cords  re- 
main tensely  stretched,  and  do  not  vibrate  at  all — 
the  inter-cartilaginous  glotiis  remaining  always  closed. 
In  the  fjJsetto  notes,  the  vibration  or  the  cords,  too, 
-plays  but  a  secondary  part :  and  it  is  the  vibration  of 
the  air  that  strikes  them,  which  is  to  be  principally  re- 
garded as  the  primitive  element  of  tone. 

To  produce  a  normally  formed  tone,  the  cartilaginous 
glottis  must  remain  completely  closed,  and  the  expira- 
tory current  escape  through  the  ligamentous  glottis 
only.  In  this  way  the  entire  escaping  current  is  set  in 
phonal  vibration,  and  the  tone  will  ring  out  fresh  and 
powerful.  But  if  the  cartilaginous  glottis  be  not  closed, 
there  streams  out  a  second  current^^ich,  in  ite  exit^ 
digitized  by  VjOOQIC 


82 


THE  MEDICAL  RECORD. 


mixes  with  the  phonal  ourrent  and  renders  it  dull  and 
yelled,  instead  of  clear  and  decided,  while  at  the  same 
time  more  frequent  inspiration  becomes  necessary,  on 
account  of  the  increased  expiratory  volume. 

In  the  modification  of  the  character  of  the  vocal 
sound  (timbre),  the  pharynx  performs  an  important 
part,  as  by  its  lengthening,  shortening,  or  contracting, 
It  modifies  the  shape  and  length  of  the  exit-tube.  We 
distinguish  two  essential  timbres,  between  which  we 
have  any  quantity  of  gradation.  The  clear  timbre  is 
produced  when  the  sofc  palate  sinks  to  meet  the  mount- 
mg  larynx.  If  this  occurs  to  too  great  an  extent^  a 
disagreeable  squeak  is  produced  instead.  When,  on 
the  other  hand,  the  larynx  sinks,  thus  lengthening  the 
pharynx,  the  tone  loses  m  clearness,  but  gains  in  round- 
ness and  volume,  and  acquires  the  dull  timbre ;  and 
when  this  movement  is  pushed  to  excess,  the  tone  is 
dampened  and  rendered  rough. 

If  we  compare  the  two  registers,  chest-voice  and  fal- 
setto (the  head  register  being  only  a  higher  modification 
of  the  falsetto),  we  find,  in  the  chest-voice,  that  the  pho- 
nal glottis  appears  closed  linearly,  in  its  entire  breadth : 
the  true  vo^al  cords  present  a  strong  resistance  to  the 
expiratory  current^  are  set  in  fiill  vibration,  and  the 
modification  of  tone  takes  place  by  expansion  and  con- 
traction of  the  lungs.  In  the  falsetto  voice,  the  phonal 
glottis  is  lancetr-formed,  showing  an  elliptical  sht,  and 
Uie  escaping  air  meets  with  bat  a  moderate  resistance ; 
and  the  higher  falsetto  notes  occur  through  successive 
shortenings  of  the  opening  of  the  glottis  firom  behind 
forwards. 

The  soft  palate,  the  epiglottis,  the  ventricles  of  the 
larynx  and  tne  false  vocal  cords,  are  not  directly  neces- 
sary to  the  production  of  a  chest,  or  falsetto  note;  they 
merely  modify  the  tone  formed  in  the  glottis. 

It  is  therefore  clearly  demonstrable  why  a  very  slight 
afiection  of  the  vocal  apparatus  may  cause  an  important 
alteration  in  the  production  of  sound,  or  even  prevent 
it  Even  a  sli&^ht  congestion  and  swelling  of  the  trup 
vocal  cords  win  prevent  vibratii  n  as  perfect  as  that  pro- 
duced when  the  cords  were  sound.  Swelling  of  the 
faiae  vocal  cords,  especially  when  filling  up  the  space  of 
the  ventricles,  will  cause  them  to  act  upon  tne  true 
vocal  cords  as  the  dampers  upon  a  stringed  instrument, 
and  thus  prevent  the  full  vibration  of  the  true  vocal 
cords,  even  when  the  latter  are  perfectly  sound. 

The  limits  of  a  journal  article,  in  the  present  series, 
preclude  as  full  a  discussion  of  the  physiology  of  voice, 
with  reference  to  the  phenomena  of  musical  tone  ana 
mutism,  as  the  writer  would  have  liked  to  indulge  in ; 
and  therefore  he  has  but  selected  firom  the  material  at 
his  disposal,  such  as,  being  confirmed  or  suggested  by 
ocular  observation  upon  the  living  human  larynx,  most 
fully  expresses  the  views  of  recent  observers  (in  this 
department  of  physiology,  who  have  availed  themselves 
of  the  laryngoscopa  in  their  investigation!*^ ;  and  the 
greater  portion  of  the  present  article  has  oeen  taken 
bodily  from  the  work  of  Tobold,  previously  referred  to. 
It  is  necessary  to  have  a  distinct  idea  of  the  mechanism 
of  the  vocal  apparatus,  in  the  normal  performance  of  its 
functions,  to  be  able  to  recognise  and  apprecia'e  devia> 
tions  occurring  in  disease,  especially  if  the  attempt  is  to 
be  made  to  correct  them.  The  import  of  thb  observa- 
tion will  be  acknowledged  when  we  study  the  subjects 
of  aphonia  and  dysphonia. 

But  the  larynx  is  also  greatly  concerned  in  respira- 
tion. The  appearanoe  of  the  glotti?,  under  these  cir- 
cumstances, as  seen  mirrored  in  the  laryngoscope,  is  as 
follows:  During  ordinary  quiet  respiration,  the  glottis 
remains  moderately  opened,  lozenge-shaped,  gently  di- 
lating with  an  inclined  movement  at  each  inspiration, 
and  contracting  again  in  the  expiratory  movement;  ibe 


arytenoid  cartilages  being  separated.  When  a  forced 
inspiration  is  taken,  the  vocal  cords  and  the  arytenoids 
become  separated  to  their  widest  extent,  and  the  form 
of  the  glottis  is  changed  to  a  trapezoid;  at  the  same 
time,  the  epiglottis  becomes  more  erect  and  continuous 
with  the  anterior  wall  of  the  trachea,  a  position  which 
afiPurds  the  best  view  of  the  conoid  ligament  where  the 
subject  is  young  enough  for  it  to  be  recognised,  as 
well  as  a  more  extended  view  down  the  tube.  The 
extensive  motility  of  these  parts  can  best  be  observed 
by  taking  a  deep  inspiration,  when  the  view  above 
described  will  be  presented ;  then  following  it,  by  into- 
nation, the  glottis  closes  promptly,  the  true  vocal  cords 
stretch  towards  each  other,  and  the  arytenoids  become 
closely  pressed  against  each  other. 

The  whole  mechanism  of  closure  of  the  larynx,  in  the 
act  of  swallowing,  cannot  be  observed  in  the  laryngo- 
scope, fur  the  simple  reason  that  one  cannot  swallow 
with  his  mouth  wide  open ;  but  the  movements  can  be 
induced  artificially  by  going  through  the  preliminary 
motions  of  swallowing,  retching,  etc.  Of  course,  respi- 
ration is  stopped  by  complete  closure  of  the  glottis 
from  approxm[iation  of  the  true  vocal  cords ;  then,  as 
the  movement  is  continued,  the  false  vocal  cords  become 
closely  applied,  and  the  epiglottis  falls  promptly,  its 
belly  tightly  pressed  upon  the  false  vocal  cords,  its  free 
border  reaching  beyond  the  arytenoids,  and  its  liilgual 
surfiu)e  undergoing  a  linear  indentation  in  the  middle 
line,  giving  it  much  the  appearance  of  a  double  cap  to 
the  spout  of  a  molasses  jug.  Some  persons  have  the 
facility  of  controlling  these  movements,  so  as  to  demon- 
strate the  triple  action  in  distinct  succession :  the  closure 
of  the  glottis,  the  apposition  of  the  false  vocal  cords, 
and  the  depression  of  the  epiglottis. 

In  cases  of  aphonia  fi-om  paralysis,  the  sole  factors 
of  this  closure  are  the  false  vocal  cords  and  the  epiglot- 
tis; where  the  epiglottis  has  been  destroyed,  the  factors 
are  the  vocal  cords,  true  and  false.  In  these  cases,  the 
combination  of  muscles,  called  a  sphincter  of  the  larynx 
in  the  last  article,  conipresses  the  false  vocal  cords  and 
the  ary-epiglottic  folds,  puckering  up  the  laryngeal  en- 
trance. 


©rtfiinal  itttnxts. 


LECTURES  ON  PUERPERAL  CONVULSIONS. 

DKUVRRED  IN  CHICAGO  MEDICAL  COLLEGE, 

Br  W.  H.  BYFORD,  A.M.,  M.D., 

PBOF.  or  OB8TETHI08,  ETC. 

Lecture  iv. 

Treaimeni. — The  two  main  indications  in  treatment 
are  :  First,  the  removal  of  hyperesmia  of  the  brain  and 
spinal  nervous  centres ;  and,  second,  removal  of  the 
uraemia. 

To  overcome  both  these  morbid  conditions  is  very 
desirable  but  sometimes  impracticable,  yet  we  can  gene- 
rally entirely  get  rid  of  one  of  them  and  thus  avoid 
the  commencement  or  continuance  of  the  paroxysms. 

The  treatment  is  very  properly  and  naturally  divided 
into  the  medical  and  obstetrical 

Although  possibly  not  the  most  important,  it  is  most 
convenient  to  consider  the  medical  treatment  first  The 
application  of  treatment  is  mod  fied  by  the  time  when 
instituted ;  that  is,  either  as  preventive  or  curative.  As 
I  have  endeavored  to  show,  we  may  often  determino 
the  presence  of  a  predisposition  to  puerperal  convul- 
sions quite  conclusively  some  days,  and  even  weeks, 
before  the  supervention  of  an  attack;  and  not  unfre- 
quently,  by  proper  treatment^  entirely  avoid  the  deve- 
lopment of  them.  ^^  ^ 

Digitized  by  VjOOQ  IC 


THE  MEDICAL  RECORD. 


88 


We  will  oftea  be  able  to  accomplish  one  of  the  iadi- 
citi<»i8  of  a  core  by  preventive  measures^  viz.  to  re- 
move hjpenemia  of  the  nervous  centrea  The  raeaDS 
to  accomplish  this  end  are  bleeding,  the  administration 
of  cathartics,  diaphoretics  and  diuretics.  When  the 
patient  is  plethoric,  with  a  red  injected  face,  a  full  and 
slow  pulse,  blood-letting  should  be  resorted  to.  We 
maj  bleed  the  patient  until  these  conditions  are  re- 
moved or  very  much  reduced.  I  hope  I  may  be  allowed 
to  remark  that  when  the  predisposition  is  certainly  pre- 
sent^ we  are  justified  in  using,  nay  the  case  demands] 
enei^tic  measures,  and  that  we  ought  not  to  be  deterrea 
from  the  employment  of  them  For  fear  of  inducing 
premature  delivery,  fjr  really  this  would  add  to  the 
chances  of  both  the  patient  and  foetus.  And  for  fear  of 
being  misundjrstood  by  the  student,  I  will  repeat  the 
main  items  diagnostic  of  the  predisposition,  vis. 
OBdema  of  the  upper  part  of  the  body,  face,  or  limbs,  or 
all  together,  albumen  in  the  urine,  and  the  various 
nervous  svmptoms  I  have  mentionedl  When  to  these 
are  added  those  of  decided  plethoja,  an  active  anti- 
phl(^tic  medication  is  generally  very  beneficial.  One 
decided  venesection  in  the  sitting  posture,  until  ap- 
proaching syncope  ia  observed,  will  sometimes  do  much 
^ood  and  entirely  avert  the  attack.  But  active  catharsis 
IS  also  attended  With  very  satisfactory  results.  The 
compound  powder  of  jalap  ib  one  of  the  best  of  cathar- 
tics at  such  times.  Ic  should  be  administered  in  suffi- 
ciently large  doses  to  cause  copious  watery  evacuations. 
Should  the  patient  not  be  decidedly  plethoric,  we  may, 
with  proprietv,  omit  the  bleeding,  but  the  cathartic  should 
be  given.  This  should  in  either  case  be  succeeded  by 
tha  wine  of  colchicum  in  decided  doses  every  four  or 
six  hours,  and  at  least  once  a  day  the  patient  should 
have  a  steam  bath  to  cause  free  diaphoresis. 

At  any  stage  of  this  treatment  nervous  suffering 
should  be  promptly  relieved  by  opium.  The  Dover  pow- 
der is  a  good  form.  Very  ofxen  such  treatment  is  fol- 
k>wed  by  premature  labor,  and  when  such  is  the  case 
the  labor  is  much  less  apt  to  be  attended  by  this  dread- 
ful complication.  I  think  this  plan  is  very  much  more 
appropriate  than  an  immediate  resort  to  the  intentional 
inductioa  of  premature  labor  without  first  reducing  the 
cerebral  hypenemia.  This  cerebral  hypenemia  should 
be  held  up  to  us  as  affording  one  of  the  most  valuable 
indications  of  treatment ;  very  often  its  removal  is  suffi- 
cient to  render  a  verv  threatening  case  safe.  The  pre- 
ventive treatment  I  have  recommended  is  not  always 
followed  by  premature  labor,  as  tliis  process  may  not 
take  place  at  the  end  of  term.  Sponge  baths  of  acetic 
acid,  friction  with  acetic  acid,  and  acid  drinks  and 
medicines,  may  be  used  with  the  hope  that  they  may 
enter  the  blood  and  neutralize  the  ureal  accumulations 
in  that  fluid. 

During  a  ParocByem. — ^The  first  thing  that  should  be 
attended  to  during  the  paroxysms  is  to  prevent  the 
injury  which  so  fre(|uenUy  results  to  the  tongue.  A 
large  cork,  or  a  sofbpme  stick,  should  be  placed  between 
the  molar  teeth  on  one  side  while  the  jaws  are  separated, 
md  thns  retained,  until  the  convulsion  ceases.  We  ought 
not  to  be  betrayed  by  any  excitement  into  the  use  of  a 
qK)on-handle  or  other  metallic  substance,  lest  damage 
niay  be  done  to  the  teeth.  The  clothing  should  be 
kM>sened,  so  that  the  neck,  body,  or  limbs,  may  not  be 
constricted  by  it.  The  throat  must  be  made  entirely 
naked  when  practicable,  and  we  must  observe  that  the 
violent  and  irregular  movements  do  not  twist  the 
dothing  about  some  part  of  the  person  to  an  injurious 
degree.  The  attendants  ought  not  to  restrain  the  move- 
ments of  the  patient  too  greatly ;  indeed,  perfect  freedom 
to  the  whole  body  should  be  allowed  when  it  does  not 
become   dear  that  it  will  result    in   throwing   the 


patient  ofif  the  bed  or  bruising  her  person.  It  is 
very  harmful,  for  instance,  to  iSke  hold  of  the  limbs 
and  try  to  hold  them  stilL  The  bed  should  be  large 
and  firm  enough  to  bear  the  weight  of  the  attendants, 
if  necessary.  Plenty  of  air  should  be  admitted  into 
the  room,  and  the  latter  should  not  be  too  warm.  The 
face  may  be  sprinkled  or  washed  with  cold  water.  I 
have  tried  to  interrupt  the  convulsions  by  dashing  the 
face  suddenly  with  ice-water,  but  have  not  seen  any 
effect  firom  it  that  was  desirable. 

Inter-^aroxygmal  lyeaiment. — It  is  a  matter  of  the 
greatest  moment  to  prevent  a  recurrence  of  the  parox- 
ysms; if  this  can  be  done  we  are  almost  sure  of  suc- 
cess. The  fewer  the  convulsions  the  less  the  danger, 
should  be  an  ever  present  fact  with  us.  It  is  the  fre- 
quent repetition  of  them  that  produces  the  fatal  effects 
upon  the  brain.  By  the  judicious  use  of  chloroform  we 
may  prevent  them  from  returning  in  a  g^eat  many 
instances,  if  not  all  of  them.  Dr.  Braun,  of  Vienna, 
recommends  us  to  give  chloroform  as  soon  as  there  is 
any  sign  of  a  supervening  paroxysm,  and  continue  it 
until  sound  sleep  is  induced ;  but  I  am  sure  that  to  ad- 
minister in  this  way  we  shall  fail  to  get  all  the  good 
effects  from  its  use  that  are  practicable,  for  in  many  in- 
stances the  premonition  is  so  short  we  will  not  prevent 
the  convulsion.  The  only  safe  way,  and  the  one  1  now 
practice  and  would  strongly  recommend,  is  to  keep  the 
patient  under  its  influence  all  the  time  sufficient  to  pre- 
vent a  manifestation  of  the  premonitory  symptoms. 

This  direction  may  be  followed  by  sitting  by  her 
constantly,  and  administering  the  anflostbetic  about  every 
ten  minutes  generally,  but  sometimes  it  may  be  neces- 
sary to  have  a  small  amount  mixed  with  the  air  inhaled 
constantly.  The  intention  is  to  very  much  lessen,  if 
not  entirely  subdue,  all  reflex  excitability,  and  keep  it 
controlled  until  the  cause  of  the  trouble,  uterine  pres- 
sure, can  be  removed.  The  effect  of  the  chloroform  is 
to  remove,  or  rather  to  subdue,  the  explosive  excitabil- 
ity of  the  nervous  centres  caused  by  the  circulation 
through  them  of  the  urea,  carbonate  of  ammonia,  or . 
whatever  other  exciting  stimulant  has  resulted  from  the 
retention  of  substances  that  ought  to  have  been  ex- 
creted by  the  kidneys.  It  is  not  likely  that  the  chloro- 
form chemically  neutralizes  the  poison  in  the  blood,  but 
that  it  renders  it  inoperative  by  producing  a  more 
powerful  but  antagonistic  influence  upon  the  Drain  and 
medulla.  It  is  not  at  all  directly  curative,  it  only  sus- 
pends the  action  of  the  mischievous  agent  until  curative 
means  may  be  made  effective  in  removing  the  patho- 
logical conditions  upon  which  the  convulsions  depend. 
And  I  must  insist,  in  aU  cases  of  ursemic  puerperal  con- 
vulsions, where  there  is  enough  excitability  to  keep 
reproducing  the  paroxysms,  chloroform  is  applicable  and 
demanded,  whether  attended  with  a  nresmic,  paralytic, 
or  even  apoplectic  state  of  the  brain  and  spinal  cord  or 
not  It  is  precisely  to  control  this  morbid  excitability 
of  the  nervous  system  that  it  is  used  *  and  although  I 
have  been  governed  by  this  principle  for  several  years, 
I  have  never  seen  any  unpleasant  effects  from  its  use 
in  convulsions.  And  whenever  I  had  canse  to  regret 
anjrthing  of  my  management  of  this  most  excellent 
remedy,  it  was  that  I  had  been  too  snaring  with  it, 
that  I  had  not  kept  my  patient  sufficiently  under  its  in- 
fluence. It  would  hardly  seem  necessary  to  say  that  it 
is  entirely  useless  during  a  paroxysm,  except  in  very 
rare  instances,  in  which  respiration  continues,  because 
it  cannot  be  inhaled  as  respiration  is  suspended,  and 
that  it  is  injurious  immediately  after  the  paroxysms, 
while  the  face  is  livid  with  carbonated  blood.  We  wait 
nntU  the  face  loses  thi^  asphyxiated  appearance,  and 
the  blood  is  again  charged  with  its  usual  amount  of 
oxygen.    As  soon  as  this  state  it  broud^t^tbout  we  give 

digitized  by\jOO^^_ 


84 


THE  MEDICAL  RECORD. 


the  chloroform  oontiDoally.  and  maintain  an  ansesthetic 
condition  that  will  keep  tne  patient  entirely  free  from 
the  convulsions.  She  snould  never  be  allowed  to  come 
oat  of  this  state  until  delivered,  if  this  can  be  done  by 
any  allowable  means,  even  should  it  require  twenty-four, 
thirty-six,  or  forty-eight  hours.  After  she  is  delivered 
she  may  be  treated  generally  without  further  use  of 
chloroform,  but  if  the  convulsions  recur  we  should 
resort  to  it  at  once,  and  keep  it  up  until  renal  and  intes- 
tinal secretion  is  fairly  established.  Keeping  the  patient 
thus  constantly  anse^thetized  beyond  the  convulsion 
pointy  we  ought  to  institute  curative  measures  with  as 
much  energy  and  activity  as*possible. 

Blood-letting  is  one  of  the  tirst  things  to  be  thought  of. 
The  intention  in  using  it  is  to  reduce  or  remove  the  cere- 
bral hypersemia,  by  lessening  the  amount  of  blood  and 
reducing  the  arterial  and  cardiac  vis  a  tergo.  To  effect 
this  we  must  take  a  large  quantity  compared  to  the 
amount  lor  other  conditions  of  the  system.  From 
twenty  to  forty  ounces  will  be  required  in  one  or  two 
operations.  The  pulse  must  be  affected  by  it  Some- 
times a  convulsive  paroxysm  occurs  while  the  patient  is 
bleeding;  this  ought  to  be  prevented  by  chloroform. 
I  have  several  times  bled  patients  under  the  influence 
of  chloroform.  The  ans&stheeia  should  be  slight  during 
the  bleeding,  but  sufficient  to  prevent  the  paroxysms, 
and  the  paUent  must  be  more  closely  watched.  She 
should  be  supported  in  a  sitting  posture  while  the  blood 
is  running,  and  as  soon  as  the  pulse  becomes  de- 
cidedly quicker,  we  should  lay  her  down  and  stop  the 
blood,  and  if  necessary  repeat  it  when  reaction  has 
resulted.  One  copious  or  two  moderate  bleeding  is 
allowable  almost  always,  and  in  very  plethoric  patients 
two  or  more  copious  bleedings.  Those  old  worthies  in 
the  profession,  &ooch,  Armstrong,  and  others  of  like 
stamp,  cured  many  cases  of  puerperal  convulsions  by 
powerful  depletory  treatment  alone.  Gooch  thought 
bleeding  the  remedy.  As  I  have  endeavored  to  show, 
th^  apoplectic  congestion  of  the  brain  is  an  important 
item,  altnough  not,  as  was  supposed  by  the  older  autliors, 
the  only  item.  It  is  probably  of  secondary  importance, 
but  its  removal  goes  a  great  way  towards  a  cure.  I 
insist  that  bleedm^r  is  one  of  the  very  best  curative 
medsures,  and  should  be  considered  in  all  cases.  At  the 
same  time  that  we  bleed,  or  if  we  do  not  think  best  to 
institute  blood-letting,  we  may,  with  great  propriety, 
administer  an  active  cathartic.  And  in  doing  so  we  are 
to  remember  that  promptness  is  a  necessary  quality ; 
for  the  longer  the  bleeding  is  delayed,  and  the  longer 
the  cathartic  is  in  operating,  the  more  valuable  time  is 
lost 

If  we  can  procure  copious  and  early  catharsis  without 
pain,  we  make  a  very  favorable  impression.  The  medi- 
cine I  have  used  most,  and  still  continue  to  recommend, 
is  croton  oil.  I  usually  administer  one  drop  in  an  emul- 
sion every  hour  until  it  operates  thoroughly,  which,  if 
good,  it  will  do  afler  two  or  three  doses.  This  treatment 
will  seldom  fail  to  very  much  modify  the  severity  of  the 
symptoms,  and  in  very  many  instances  completely  arrest 
the  convulsions.  I  know  that  before  the  days  of  chloro- 
form, at  a  time  when  the  pathology  of  these  cases  was 
not  as  well  understood  as  now,  twenty-five  to  thirty 
years  ago,  many  were  cured  by  this  treatment ;  and  I 
am  cognizant  of  two  cases  in  which  the  convulsions 
were  arrested,  and  delivery  did  not  take  place  in  one 
until  three  and  the  other  ^ye  weeks  af^rwards,  each 
patient  carrying  a  dead  child  that  long,  and  being  de- 
livered without  interference  or  further  convulsions. 
We  then  bled  in  both  arms  in  a  full  stream  until  there 
was  a  close  approach  to  syncope,  and  sometimes  twice, 
and  even  thrice,  in  the  same  case,  and  gave  the  croton 
oil  cathartic  at  th«  time  we  bled.    And  with  all  defi^- 


ence  and  respect  tor  those  who  have  learned  to  do  bet- 
ter without  than  with  bleeding,  I  must  assure  the  pro- 
fession that  such  success  as  attended  our  efforts  then 
would  not  put  them  to  the  blush  now.  I  am  afraid 
that  the  tendency  now  is  to  magnify  to  an  undue 
extent  the  effects  of  urssmia,  aud  depreciate  the  impor- 
tance of  cerebral  hyperemia.  And  in  saying  this  I  feel 
assured  that  a  proper  estimate  of  uraemia  will  make  it  a 
very  dangerous  element  of  the  disease,  while  I  think  I 
but  express  the  conviction  o£  the  most  judicious  and 
thinking  portion  of  the  profession,  when  I  say  that  we 
have  no  remedy  for  it  that  acts  with  anything  like  the 
promptitude  that  t^ose  do  which  prove  effective  in  the 
cerebral  congestion.  That  we  may  very  much  modify 
if  not  relieve,  the  latter,  in  a  few  hours,  nay  minutes, 
while  the  urssmia  cannot  be  remedied  in  leas  than  one  or 
two  days.  Afler  proper  depletion,  or  with  it,  cold  to  the 
head,  ice  in  bladders,  or  india-rubber  bagg,  will  aid  in 
the  &tme  thing,  reducing  cerebral  congestion ;  and  opium 
admhiistered  in  sedative  doses  may  so  affect  the  nerv- 
ous centres  as  to  materially  lessen  their  violence,  it 
operates  somewhat  in  the  same  manner  that  chlorofonn 
doe^  by  diminishing  the  excitability  of  these  organs.  It 
does  not  exert  any  direct  curative  power,  it  only  holds 
the  convulsions  in  abeyance  until  the  ursemia  and  hy- 
peraemia  are  removed.  Acids  undoubtedly  act  bene- 
ficially by  attacking  the  irritating  compound  circulating 
in  the  blood.  We  must  not  expect  too  much  from 
them,  however.  Acetic  and  citric  acid  drinks,  vinegar 
baths,  acid  compresses  over  the  abdominal  surface,  back, 
etc.,  should  be  resorted  to  as  much  as  in  the  nature  of 
the  case  is  practicable.  Then  we  should  resort  to  diu- 
retics and  hydragogues  of  a  particular  character.  €k)l- 
chicum,  or  its  preparations,  is  a  powerful  diuretic,  and 
has  the  reputation  of  inciting  the  kidneys  to  the  secre- 
tion of  urea.  When  given  in  large  doses  it  proves  a 
hydragogue  cathartic  and  emetic.  A  teaspoonful  of 
the  vinous  tincture  every  hour,  until  perceptible  effects 
result,  and  tlien  continued  in  such  doses  as  the  patient 
can  bear  without  great  irritation  in  the  alimentary 
canal,  is  the  usual  mode  of  using  it  here.  Other  diu- 
retics would  probably  be  useful. 

A  very  important  part  of  tlie  treatment  is  obstetiical. 
If  the  views  above  expressed  are  true,  so  long  as  the 
uterus  maiutaios  its  extreme  size,  the  pressure  on  the 
large  vessels,  and  the  vessels  and  substance  of  the  kid- 
neys, is  continued,  the  evil  working  cause  is  kept  up* 
and  while  the  subsidence  of  that  organ  in  the  pelvis  ana 
the  consequent  relief  to  the  tension  of  the  ^domuial 
muscles,  takes  off  some  of  this  pressure,  and  sometimes 
this  extends  the  critical  period,  if  it  does  not  entirely 
arrest  it;  yet,  it  is  not  generally  sufficient  And  the 
patient  is  not  usually  safe  until  it  is  emptied. 

The  ohsUiricai  treatment  will  vary  somewhat,  owing 
to  the  time  when  the  convulsions  occur.  During  preg- 
nancy, any  time  before  term,  premature  labor  is  apt  to 
supervene  as  the  effect  of  the  convulsions  or  the  condi- 
tion of  the  system  upon  which  they  depend.  And 
should  this  bd  the  case  it  may  be  accelerated  by  means 
which  I  shall  presently  indicate ;  but  if  there  are  no 
signs  of  labor,  the  treatment  should  be  wholly  medical, 
and  may  be  conducted  as  I  have  directed  above.  If 
labor  hat  commenced  and  dilatation  is  slow  and  diffi- 
cult, we  should  dilate  the  os  by  artificial  means.  The 
(miy  one  I  have  ever  resorted  to  is  the  finger.  By  pla- 
cing one  or  two  fingers  in  the  mouth  of  the  uterus  and 
gently  but  constantly  keeping  up  pressure  upon  it  from 
within  outwards,  we  will  veiy  much  shf  rten  the  stage 
of  dilatation.  The  effort  to  dilate  should  not  be  abated 
during  pain,  nor  in  the  intervals,  but  a  constant  fatiga- 
iog  pressure  made.  So  soon  as  the  os  is  dilated  to  two 
inches  in  diameter,  we  ought  to  rupture  the  membranes 

digitized  by  ^ „      ^_ 


THE  MEDICAL  RECORD. 


85 


and  allow  the  liquor  amnii  tx)  flow  but.  This  will  gen- 
erallj  add  energy  to  the  contractions  and  somewhat 
lessen  the  size  of  the  uterus.  We  should  not  desist 
from  dilatation  until  the  head  has  emerged  from  the  cer- 
vix entirely.  If  the  head  is  not  readily  expelled,  we  must 
apply  the  forceps  and  assist  by  judicious  traction.  If 
lahor  proceeds,  however,  with  reasonable  activity,  and 
we  can  succeed  in  controlling  the  convulsions,  we  must 
abstain  from  operative  procedure  entirely.  An  indis- 
pensable condition  in  all  cases  where  it  is  necessary  to 
accelerate  delivery  by  any  means  whatever,  is  to  keep 
the  patient  deeply  under  the  influence  oF  chloroform,  so 
mucti  as  is  necessary  to  preclude  the  danger  of  addi- 
tional irritation  thus  caused,  bringing  convulsions.  To 
dilate,  rupture  the  membranes,  and  use  the  forceps, 
should  be  the  extent  of  our  interference,  unless  when 
the  feet,  knees,  or  breech  presents.  Where  either  of 
these  parts  can  be  seized,  we  may  aid  very  materially 
by  traction  upon  it.  Craniotomy  is  not  justifiable  until 
we  can  demonstrate  the  death  of  the  foetus,  unless  in- 
dicated by  circumstances  independent  of  the  ursemia, 
•Dch  as  disparity  of  size  between  the  head  and  pelvis, 
ineffectual  efforts  with  the  forceps,  etc.,  etc.  Neither 
are  we  to  tliink  of  turning.  In  fact,  we  must  do  no 
more  than  is  absolutely  necessary,  and  do  that  in  such 
a  way  as  to  cause  the  least  possible  irritation,  and  be 
sure  to  use  chloroform  liberally.  I  say  that  I  have 
never  used  anything  but  my  fingers  to  dilate  the  ute- 
ros,  but  there  is  a  variety  of  very  efficient  means  used 
for  this  purpose.  The  compressed  sponge  is  one  of  the 
means  very  efficient,  quite  handy  and  available.  Dr. 
Barnes's  dilators  are  i^o  ycij  eligible  and  efficient. 
These  consist  of  gum  elastic  air  bags  of  different  sizes. 
The  smallest  should  be  introduced  into  the  cervix  empty, 
by  means  of  the  probe,  and  then  inflated  through  a  tube 
attached  to  it;  in  an  hour  this  may  be  replaced  by  the 
next  larger,  and  so  on  until  the  mouth  is  fully  dilated. 
If  the  compressed  sponge  is  used,  a  piece  large  enough 
to  pass  easily  into  the  cavity  of  the  cervix  may  be  in- 
troduced, and  in  three  hours  a  larger  one  if  necessary, 
and  so  on  until  the  process  is  completed. 

Convulsions  commencing  after  labor  is  finished,  ne- 
cessitate an  examination  of  the  uterine  globe  externally 
and  internally,  by  introducing  the  finger  into  its  mouth 
to  see  that  the  oigan  is  well  contracted,  and  there  are 
no  imprisoned  clots  that  are  causing  irritation.  If  con- 
traction is  not  good  and  blood  coagula  accumulate,  we 
may  use  friction  above  the  pubes  and  give  ergot  enough 
to  secure  the  desired  effect.  Depletion,  cathartics, 
diuretics  and  opium,  with  chloroform,  are  to  constitute 
the  treatment,  as  in  the  other  condition  above  men- 
tioned. 


Pr00te33  0f  MtVitai  Science. 


Accidental  and  Congenital  Ateuisia  of  the  Vagina  ; 
THE  Mode  of  Operating  for  suooessfullt  Establishing 
THE  Canal. — Dr.  Thos.  Addis  Emmet,  Surgeon  of  Wo- 
man's Hospital,  New  York,  communicates  an  article  to 
the  Bichjnond  Medical  JowrruH^  from  which  we  extract 
the  following: — After  a  review  of  the  literature  on  this 
subject,  we  learn  that  the  result  of  surgical  interference 
for  the  permanent  relief  of  accidental  occlusion — a  con- 
sequence of  inflammatory  action — is  favorable  in  pro- 
portion to  the  extent  of  the  vaginal  tract  involved,  and 
that  the  risk  of  inflammation,  as  a  sequence,  is  gene- 
rally in  the  same  ratio.  We  find,  moreover,  but  few 
congenital  cases  recorded,  where  the  canal  has  remained 
pennanent  after  an  operation,  and  from  the  frequent 
occurrence  of  pelvic  infleimmation  or  peritonitis  result- 
ing; the  operation  for  an  artificial  vagina  is  now  uni- 


versally regarded  as  one  of  a  very  grave  character.  It 
is  my  belief  that,  could  we  learn  the  after  hi>tory  of  the 
cases  recorded,  success  would  prove  an  exception  to  the 
rule.  For  it  has  been  ray  experience,  without  an  ex- 
ception, that  the  operation  has  eventually  failed  where 
the  parts  have  been  divided  by  means  of  the  knife,  in 
spite  of  every  effort  to  keep  the  surfaces  separated  by 
bougies,  or  any  other  means  which  would  be  resorted 
to  for  the  purpose.  Unless  some  portion  of  the  mucous 
membrane  has  remained  intact  at  the  upper  part  of  the 
canal,  the  plug  will  be  gradually  expelled  by  adhesion 
of  the  surfaces  from  above  downwards,  until  the  ori^al 
condition  is  attained.  When  merely  a  section  of  the 
canal  has  been  divided,  the  required  diameter  can  be 
preserved  so  long  as  a  bougie  is  retained,  but  after  dis- 
continuing its  use,  the  incised  tissue  will  gradually 
contract,  until  the  false  passage  becomes  obliterated,  or 
reduced  to  a  mere  sinus.  As  a  result  of  a  large  expe- 
rience in  operating  for  vesico-  and  recto-vogin^  fistulce, 
I  became  impressed  with  the  fact  that  in  the  prepara- 
tory operations,  when  it  was  necessary  to  divide  exten- 
sive bands  of  adhesions  before  the  edges  could  be 
apprt^ximated,  inflammation  rarely  followed  a  division 
by  scissors,  or  laceration  by  means  of  the  fingers.  In 
addition,  it  was  observed,  that  witli  less  hsdmorrhage, 
the  vaginal  tissue,  when  divided  by  scissors  or  lacerated, 
had  not  the  same  tendency  to  contract  (luring  the  pro- 
cess of  healing  as  when  separated  by  means  of  a  clean 
cut.  I  became  so  fully  impressed  with  these  facts,  that 
I  have  for  several  years  entirely  discarded  the  use  of  the 
knife  in  all  operations  about  the  female  pelvis,  wherever 
it  is  possible  to  do  so.  I  am  aware  that  the  impression 
generally  received  is  in  opposition  to  this  experience, 
Siat  the  risk  of  inflammation,  and  I  may  add  of  pysemia, 
is  lessened  by  the  laceration  of  the  tissues :  but  a  large 
number  of  the  profession  have  witnessed  tne  practical 
results  in  the  hospital,  and  its  records  will  bear  me  out 
in  the  assertion. 

A  New  Apparatus  for  Making  Extension  at  the  - 
Ankle- Joint. — Dr.  Julien  S.  Sherman,  of  Chicago,  de- 
scribes an  improved  apparatus  for  making  extension  at 
the  ankle-joint  Tn  order  to  construct  it  properly,  a  ca^t 
of  the  patient's  leg,  from  the  knee  to  the  ankle,  should 
be  taken  in  plaster  of  Paris.  It  is  not  necessary  to  in- 
clude the  foot.  A  piece  of  sole  leather  should  then  be 
soaked  in  water,  until  perfectly  soft  and  pliable,  and 
then  moulded  and  firmly  tied  upon  the  cast.  It  should 
remain  in  this  condition  until  thoroughly  dry,  when  it 
will  be  found  to  form  a  strong  socket,  wac&y  corres- 
ponding to  the  shape  of  the  leg  from  which  the  cast 
was  taken.  A  steel  sole  is  then  cut,  the  shape  of  the 
bottom  of  the  foot  being  somewhat  narrower  beneath 
the  instep  and  heel.  From  this,  and  riveted  to  its 
under  surface,  rises,  on  either  side,  a  steel  rod,  bent  to  . 
the  shape  of  the  limb;  upon  its  upper  two-thirds  a 
screw  is  cut.  This  rod  is  received  into  a  tube,  which 
is  attached  to  the  socket.  The  screw  carries  a  nut,  by 
which  the  extension  is  regulated.  The  rod  is  braced  to 
the  sole  by  an  additional  strip  of  steel  on  either  side. 
The  socket  is  lined  with  buckskin  and  provided  wifh 
eyelet-j  and  lacers.  Padding  is  not  necessary,  as  it  cor- 
responds so  accurately  to  the  limb  that  the  pressure  is 
easily  tolerated.  A  layer  of  tpcmgt  rubber  is  placed 
upon  the  sole,  which  gives  an  elastic  surface  to  strap 
the  foot  upon,  and  one  which  will  not  pack  or  hecomt 
ha/rdj  as  is  the  case  with  most  substances  used  for  this 
purpose.  The  apparatus  is  applied  by  first  adjusting 
and  lacing  the  socket;  the  rods  are  next  inserted  in  the 
tubes,  and  the  steel  sole  brought  up  against  the  bottom 
of  the  foot;  adhesive  straps,  an  inch  in  width  and  suf- 
ficiently long  to  pass  around  the  foot  and  heel,  are  next 
digitized  by  ^ „      ^_ 


36 


THE  MEDICAL  RECORD. 


^>pli6dy  so  fts  to  bind  them  firmly  down  to  the  sole; 
extension  is  then  made,  bj  turning  the  nuts  upon  the 
rods.  Bjthis  means,  all  pressure  upon  the  mfiamed 
Mirfaces  will  be  overcome^  and  the  derormity  of  "  talipes 
equinus,''  so  firequent  in  diseases  of  this  joint,  prevented, 
and  the  best  possible  condition  for  recoveiy  obtained. 
In  walking,  the  patieut  bears  all  his  weight  in  the 
socket,  relieying  entirely  the  ankle-joint 

Singular  Parasite. — ^Dr.  Ernst  Schmidt  exhibited  to 
the  Chicago  Medical  Society  a  specimen  of  a  very  un- 
usual parasitic  worm,  with  the  following  history : — An 
Amencan  giil,  ten  years  of  age,  weakly,  and  of  scrofu- 
lous diathesis,  had  suffered  for  some  time  from  capri- 
cious appetite  and  pain  in  the  upper  portion  of  the 
abdomen.  Two  weeks  ago  she  complained  of  pain  on 
the  left  shoulder;  at  the  seat  of  pain  there  soon  appear- 
ed a  slight  elevation,  tender  to  the  touch,  slightly  red, 
from  wmch,  in  a  short  time^  a  small  worm  was  observed, 
endeavoring  to  escape.  If  disturbed,  the  worm  with- 
drew its  head  beneath  the  skin;  by  gentle  pressure, 
however,  it  was  forced  through  the  small  openine  it 
had  made.  A  similar  swelling  appeared  behind  the  left 
ear,  from  which  another  worm  made  its  escape.  Thus 
far,  eight  elevations  have  appeared  in  different  portions 
of  the  body,  from  which  five  worms  have  been  secured. 
Some  of  these  elevations  were  neither  red  nor  very 
tender  on  pressure.  Palpation  gave  the  sensation  of  a 
foreign  body  under  the  skin.  The  efforts  of  the  worms 
to  pass  through  the  skin  caused  no  pain  or  hsemorrhage. 
The  small  opening  closed  readilv,  and  the  elevation  soon 
subsided.  The  child,  during  this  time,  was  nervous  and 
irritable,  the  pulse  being,  at  times,  as  low  as  40  per 
minute.  The  application  of  mercurial  ointment  caused 
the  elevations  to  disappear.  In  all  cases  where  this 
was  applied,  the  worms  seemed  to  pass  upwards  from 
their  original  position  towards  the  head.  The  child  was 
not  in  the  habit  of  eating  either  raw  meat  or  vegetables. 
There  were  no  indications  of  other  parasitic  worms  in 
the  child  or  other  members  of  the  family.  The  worths 
were  about  five-eighths  of  an  inch  in  length,  quite  trans- 
parent, and  divided  into  eight  sections,  with  an  alimen- 
tary canal  running  nearly  straight  from  the  anterior  to 
the  posterior  extremity.  The  mouth,  as  examined 
with  the  microscope,  presented  no  evidences  of  appara- 
tus for  suction  or  boring. —  Chicago  Medical  Journal, 

Extirpation  of  the  Utxrus. — Dr.  T.  Wood,  Surgeon 
to  the  Commercial  Hospital  of  Cincinnati,  reports  in  the 
CvMinnaU  Lancet  and  Observer^  a  very  in  tore -ting  case 
of  extirpation  of  the  uterus.  The  patient  was  a  widow, 
23  years  of  age,  who  was  admitted  into  iba  Commer- 
cial Hospital  October  1,  1866.  Her  abdomen  was  en- 
larged about  the  size  of  the  sixth  month  of  pregnancy ; 
the  tumor  was  hard  and  smooth,  and  occupied  the 
median  position  of  the  body ;  was  only  slightly  movable ; 
she  had  a  constant  leneorrhoeal  discharge  from  vagina, 
and  freqient  attacks  of  pain  of  a  lancinating  character, 
with  painful  micturition  and  great  difficulty  in  procuring 
a  passage  from  the  bowels.  Had  always  been  a  healthy 
woman;  is  stated  to  have  aborted  at  seven  months, 
seven  years  ago;  three  years  a^o  she  had  a  severe 
attack  of  rheumatism,  and  immediately  upon  the  subsi- 
dence of  acute  symptoms  of  this  disease,  a  smaJl  tumor 
made  its  appearance  and  has  been  steadily  increasing  in 
magnitude  until  it  has  attained  its  present  siae.  The 
diagnosis  being  fibrous  tumor  of  the  uterus,  its  removal 
by  abdominal  section  was  resolved  upon,  and  she  was 
put  upon  tonics  and  a  regulated  diet 

On  the  31st  of  October,  she  being  in  food  general 
health,  the  operation  was  performed  in  Uie  following 
manner:  After  being  placed  under  the  influence  of 
chloroform,  an  incision  was  made  over  the  most  promi- 


nent portion  of  the  tumor,  and  directly  in  the  median 
Une  of  the  body — extenaing  from  the  umbilicus  to 
within  an  inch  of  the  pubes.  This  cut  was  i^idly 
deepened ;  the  fascia,  and  finally  the  peritoneum,  divided 
upon  the  director,  when  the  glistening  and  smooth 
surface  of  the  tumor  was  exposed;  it  was  entirely  firee 
from  adhesions,  and  after  some  slight  traction  escaped 
through  the  opening;  was  pyrimrm  in  shape,  and 
attached  in  the  median  line  by  a  comparatively  slender 
pedicle.  After  tying  an  artery  and  a  large  vein  which 
passed  up  at  the  posterior  portion  of  the  tumor,  and 
applying  ligatures  to  the  ovarian  arteries  of  each  side, 
two  double  ligatures  were  then  passed  through  the 
pedicle  by  means  of  needles,  and  firmly  tied ;  the  tumcHr 
was  then  removed  by  a  few  strokes  of  the  scalpel; 
haamorrhage  was  very  slight,  not  over  |  ii.  having  been 
lost  during  the  entire  operation ;  there  was  no  protm* 
sion  of  the  bowels,  they  being  easily  retained  in  position 
by  cloths  wrunff  out  of  warm  water.  After  the  removal 
of  the  tumor,  Uie  pedicle  was  returned  into  the  abdo- 
minal cavity,  the  hgatures  being  collected  and  brought 
out  at  the  lower  end  of  the  cut.  After  careful  spong- 
ing, the  oozing  of  blood  having  entirely  ceased,  the  lips 
of  the  wound  were  brought  together,  and  retained  by 
means  of  silver  pins  and  twisted  suture.  The  wound 
was  then  dressed  with  doliis  wrung  out  of  cold  water, 
and  she  was  removed  to  her  bed.  The  case  did  weU 
until  the  latter  part  of  January  (precise  date  not  given), 
when  death  took  place.  This,  to  the  best  of  our  belief, 
makes  the  twenty-sixth  fatal  case  out  of  thirty-three 
operations  performed. 

On  the  Use  of  Sulphite  or  Soda  ih  the  Treatment 
OF  Erysipelas. — Dr.  Addinell  Hewson  stated  that  he 
had  been  using  the  solution  of  sulphite  of  soda  as  a  lo- 
cal i^pUcation  in  erysipelas  since  Februanr,  1864  and 
had  obtained  results  from  it,  in  the  various  forms  of  that 
disease^  which  were  to  him  both  interesting  and  surpris- 
ing. He  had  been  induced  to  try  it  from  the  representa- 
tion made  by  Prof.  Polli  of  its  influence  in  destroying  all 
diseases  of  a  cry  ptogamic  or  animalcular  origin — a  source 
to  which  recent  researches  would  lead  us  to  suppose  ery- 
s  pelas  was  due.  At  first  he  administered  it  mternally, 
in  doses  of  ten  grains  every  two  hours,  as  well  as  ap- 
plied it  locally ;  but  the  effects  of  the  local  use  were  so 
prompt  and  decided  that  he  has  now  abandoned  its 
mternal  administration  altogether.  In  extensive  trials 
of  this  remedy,  both  in  hospital  and  private  prac- 
tice, he  has  never  seen  it  fail  when  thoroughly  applied 
before  the  deep  planes  of  cellular  tissue  had  been  invaded 
by  the  disease.  Under  the  latter  circumstance,  no  posi- 
tive* curative  results  were  of  course  to  be  expected  from 
its  mere  external  use.  But  before  such  parts  had  become 
affected,  a  solution  of  ten  grains  of  this  salt  to  the  ounce 
of  water,  when  thoroughly  applied  on  lint  all  over  the 
surface  affected,  and  to  a  considerable  distance  beyond 
it,  and  covered  with  oiled  silk  to  prevent  the  evapora- 
tion of  the  solution,  had  not  only  produced  a  decided 
bleaching  effect  on  the  discolored  surface  in  every  such 
instance  in  the  first  twenty-four  hours  of  its  use,  bat 
had  invariably  destroyed  all  traces  of  the  disease  in 
forty-eight  hours  from  its  first  appHcation.  The  result 
was  the  same,  whether  the  appl' cation  was  made  in  the 
traumatic  or  idiopathic  form  of  the  disease.  He  had 
thus  cured  twenty-seven  cases,  seven  of  which  were  of 
idiopathic  erysipelas.  Even  in  the  cases  where  the  deep 
planes  of  cellular  tissue  were  involved  as  well  atf  the 
surface,  the  disease  on  the  surface  was  always  app^ 
rently  affected  by  the  application.  It  was  most  posi- 
tively bleached  in  all  instances,  and  in  many  was  evi- 
dently destroyed,  within  the  period  above  stated,  even 
whilst  that  in  the  deeper  parts  proceeded  on  steadily  to 
suppuratioD,— rrofM.  Cm.  qf  Pkift,  ofJPhHadelphia. 

Digitized  by  VjC  _      ^_ 


THE  MEDICAL  RECORD. 


»7 


The  Medical  Recx)rd. 

Obobos  F.  Shbady,  M.D.,  Editob. 

FnbUclMd  <m  tii0  Ut  and  lath  of  Mofa  Month,  bf 
WILLIAM  WOOD  A  00^  61  Walksb  Stbbct,  Nbw  Tobk. 


FOBKIGJf  A0JSSOIS8. 
LowwNi— TBVBvn  A  Co.  I     Lnpsio— B.  HnufAVif. 


Pi  in  "Bo— Aaq«  xr  Cu. 


Bio  Jambbo— Stspubxa  t  Oa. 


29'ew  Yorl£«   M:a3X)li  IC,  1867. 


THE  SOCIAL  CRIME  AS  AFFECTING  CUB 
NATIVE  POPULATION. 
8o  prevalent  is  the  belief  that  criminal  abortion  is 
ezteoflively  practised,  that  arguments  are  nnnecessary 
to  farther  establish  it  Daring  many  years  past  the 
subject  has  claimed  the  attention  of  medical  men  in 
erery  ooontry;  resolutions  condemnatory  of  the  crime 
have  been  passed  by  medical  bodies  everywhere; 
papers  almost  without  number  have  been  written  upon 
it;  legislation,  religion,  morality,  and  physical  well- 
bung^  have  all  been  in  turn  appealed  to ;  but  all  efforts 
to  arrest  its  progress  have  not  only  been  fhtile,  but 
worse  than  this,  we  have  undeniable  assarances  that  it 
is  on  the  increase.  Formerly  the  crime  was  confined 
principally  to  those  who  were  the  victims  of  illicit 
intercoarse,  and  who,  maddened  by  the  fear  of  expo- 
iuie  and  its  consequences,  were  ready  to  resort  to  any 
measure,  however  desperate.  Now,  however,  wives 
and  mothers  are  added  to  the  list,  and  are  better  versed 
in  the  abominable  art  than  their  erring  but  certainly  not 
more  culpable  sisters.  We  do  not  propose  to  remark 
upon  the  general  subject  of  abortion,  as  it  has  long 
iiooe  been  worn  threadbare ;  in  fact,  we  should  consi- 
der ourselves  as  having  no  excuse  to  allude  to  its  gene- 
ral prevalence  and  increase,  were  it  not  that  some  new 
fittts  have  lately  transpired  which  invest  it  with  no 
little  interest  These  &cts  are  of  the  utmost  importance 
as  bearing  upon  the  question  of  increase  in  population, 
tnd  are  also  of  special  concern  to  ns  in  reference  per- 
haps to  the  propagation  of  our  native  stock.  We  shall 
not  pretend  to  show  the  direct  relation  between  the 
prevalence  and  increase  of  abortion,  and  the  effect  which 
it  his  upon  the  comparative  decrease  of  native-bom 
Americans,  but  shall  simply  present  the  &cts  of  the 
CISC,  and  give  our  readers  an  opportunity  to  judge  for 
themselves. 

We  are  thus  far  enabled  to  see  the  results  of  an  exa- 
minatioa  of  this  question  only  in  a  single  State,  that  of 
Kaanchuaetts  ;  but  judging  from  the  care  with  which 
the  several  condusions  have  been  arrived  at^  they 
dK>a]d  certainly  have  no  inconsiderable  weight.  The 
\  returns  of  that  State  prove  that  the  increase  for 


the  last  twenty  years  in  the  number  of  inhabitants  has 
been  in  accordance  with  a  given  ratio.  This  is  cer- 
tainly well  enough  as  fiir  as  it  goes;  but  the  investiga- 
tions of  Db.  Nathan  Allin,  of  Lowell,  tend  strongly, 
•  if  not  condusively,  to  prove  that  this  increase  is  made 
at  the  expense  of  a  natural  growth  of  our  native 
population.  This  gentleman  has  given  considerable 
attention  to  the  subject,  and  makes  some  rather 
startling  statements  bearing  upon  it  He  mountains 
that  the  increase  of  inhabitants  of  that  Commonwealth 
during  the  past  twenty  or  thirty  years,  has  been  con- 
fined principally  to  those  localities  where  mechanical, 
manufacturing,  and  commercial  business  has  been  car- 
ried on,  the  purely  agricultural  districts  being  more  or 
less  stationary  in  population.  But  this  increase  has 
been  found  to  be  made  up  largely  of  the  foreign  ele- 
ment, either  from  immigration  or  by  the  greater  number 
of  births.  "  It  is  a  feet,"  says  he,  "  that  the  foreign 
class  will  have  on  an  average  about  three  times  as 
many  children  as  the  American.  On  the  other  hand,  if 
we  take  the  counties  or  towns  where  there  has  been 
but  little  increase  of  population,  we  find  that  they  are 
made  up  mostly  of  American  stock.  In  feet,  a  careful 
analysis  of  the  census  reports  of  different  periods  shows 
that  this  increase  in  population  in  tiie  State  follows 
almost  invariably  in  the  same  line  and  in  the  same  pro- 
portion as  the  foreign  element  has  been  introduced  or 
increased."  That  this  would  seem  directly  traceable  to 
the  number  of  births  exceeding  those  of  deaths,  the 
majority  of  the  former  being  due  to  the  foreign  element^ 
he  asserts  as  the  result  of  a  careful  examination  of  the 
Begistration  report,  that  the  counties  containing  the 
least  foreign  population  now  return  more  deaths  than 
birUis ;  while  in  those  cities  and  towns  having  the  great- 
est foreign  population,  the  reverse  is  true. 

Acknowledging  the  difficulty  in  discriminating,  in 
the  Begistration  reports,  between  the  deaths  of  Ameri- 
cans and  foreigners,  since  all  those  born  in  this  country 
are  counted  as  natives,  he  believes  that  this  can  be  in  a 
great  measure  surmounted  by  a  careful  examination  of 
the  books  of  the  undertakers,  superintendents  of  burials, 
and  dty  clerks,  and  has  proved  this  to  be  so  by  such  a 
perusal  of  the  mortuary  documents  of  the  cities  of 
Lowell  and  Lawrence.  In  order  to  throw  out  all  objec- 
tions against  the  force  of  the  Begistration  reports  for 
1864-6,  which  were  made  during  the  period  of  the 
war,  he  goes  back  to  a  period  considerably  antecedent^ 
and  proves  that  for  a  long  time  there  has  been  a  rela- 
tive decrease  of  births  with  the  Americans.  This  is 
the  language  of  the  report : — "  In  the  colonial  census  of 
1765,  taken  one  hundred  years  ago,  when  the  population 
was  purely  American,  the  total  inhabitants  were  then 
two  hundred  and  twenty-two  thousand  five  hundred  and 
sixty-three,  and  the  number  under  sixteen  years  of  age 
returned  as  one  hundred  and  two  thousand  four  hundred 
and  eighty-nine — almost  one-half  of  the  whole  popula- 
tion. Now  it  is  eistimated  that  only  about  one-third  d 
our  population  is  under  fifteen  years  oT^ge.  Accord* 
digitized  by  LjOO^^_ 


38 


THE  MEDICAL  RECORD. 


ing  to  this  estimate,  a  careful  analysis  of  the  natural 
proportion  of  the  children  to  each  class  will  show  that 
scarcely  one-fifth  of  the  Americans  are  at  the  present 
time  under  sixteen  years  of  age.  This  makes  a  sor- 
prising  difference  in  the  relative  number  of  children  of 
the  same  people  at  the  two  periods,  1765  and  1865.'' 

For  the  purpose  of  showing  that  there  has  been  a 
progressive  decline  in  the  number  of  births  among  Ame- 
ricans during  successive  periods,  he  has  chosen  to  refer  to 
the  records  of  some  towns  which  have  been  kept  over 
a  period  of  two  hundred  years,  and  have  been  carefully 
examined  in  reference  to  determining  the  relative  num- 
bers of  children  of  the  different  generations.  "  It  was 
found,"  he  remarks,  "  that  the  families  comprising  the 
first  generation  had,  on  an  average,  between  eight  and 
ten  children  ;  the  next  three  generations  averaged 
between  seven  and  eight  to  each  family ;  the  fifth  gene- 
ration about  five,  and  the  sixth  less  than  three  to  each 
family."  This  is  a  most  striking  falling  off  of  births, 
which  cannot  reasonably  be  explained  on  the  score  of  a 
physical  degeneration  of  our  race.  There  are,  it  is  true, 
influences  at  work  which  did  not  exist  when  our  grand- 
mothers and  great-grandmothers  were  alive;  the  ad- 
vance of  civilization  and  the  consequent  thirst  for 
indulgence  in  luxuries  have  certainly  left  their  mark 
upon  the  female  race  of  the  present  day,  and  have  in 
the  aggregate  lowered  their  standard  of  vitality ;  but 
despite  all  this,  we  cannot  be  made  to  believe  that  this 
can  even  begin  to  account  for  the  discrepancy.  A 
candid  examination  of  the  circumstances  of  the  case 
will  not  leave  us  long  in  ignorance  of  the  primary 
cause.  The  one  cause  which  we  are  forced  to  acfeept, 
and  which,  alas  I  there  is  too  good  reason  to  believe  is 
the  only  true  one,  is  a  settled  determination  on  the 
part  of  large  numbers  of  the  married  to  have  no  chil- 
dren, or  at  least  a  very  limited  number.  When  we 
couple  this  conviction  with  the  feet  set  forth  by  the 
labors  of  Dr.  Allen,  that  the  native  stock  has  a  marked 
tendency  to  decrease,  at  whose  doors  can  the  blame  be 
for  the  most  part  laid  ?  We  hardly  know  which  to 
deplore  the  most— the  growing  tendency  to  lessen  the 
numbers  of  a  noble  race,  or  the  depravity  which  invites 
the  sacrifice!  "What  a  change,"  says  our  statisti- 
cian, "  as  to  the  families  since  those  olden  times  I  Then, 
large  families  were  common — now  the  exception ;  then 
it  was  rare  to  find  married  persons  having  only  one, 
two,  or  three  children ;  now  it  is  very  common  I  Then 
it  was  regarded  a  calamity  for  a  married  couple  to  have 
no  children ;  now  such  calamities  are  found  on  every 
side  of  us — ^in  fact  they  are  fashionable  I  " 

If  this  be  so  with  other  States,  and  we  seriously 
suspect  it,  a  very  melancholy  and  painful  fact  is  brought 
to  light.  We  have  no  means  at  present  of  determining 
the  relations  of  native  new-bom  with  those  of  foreign 
extraction  in  our  own  State ;  one  thing  at  least  is  cer- 
tain, and  that  is,  that  the  aggregate  number  of  births 
has,  by  the  census  of  1865,  been  shown  to  be  dispro- 
portionately small    Sixty-six  out  of  every  one  hundred 


families  in  the  City  and  State  of  New  York  have  either 
no  children  at  all,  or  but  one  or  two.  The  lesson  which 
we  have  thus  far  learned  is  one  that  is  of  immense 
importance,  and  should  stimulate  a  searching  inquiry 
into  the  condition  of  every  State  in  the  Union.  Such 
an  investigation  has  already  been  set  on  foot  by  Dr. 
Hough,  who  has  the  superintendence  of  the  census 
of  the  Empire  State,  and  there  is  a  good  promise  of 
something  substantial  being  done ;  others  in  like  posi- 
tions should  do  the  same,  and  the  results  of  their  com- 
mon labors  in  this  particular  direction  may  soon  settle 
a  point  of  the  greatest  moment  to  every  commonwealth 
in  our  land. 

The  sessions  of  the  Medical  Colleges  have  closed  for 
the  season ;  the  usual  number  of  addresses  and  benedic- 
tions have  been  pronounced ;  and  the  young  medical  man, 
with  diploma  in  hand,  has  been  politely  courtesied  out 
upon  the  cold  and  uncharitable  world.  He  has  been 
told  that  his  profession  is  an  honorable  one,  and  that 
nothing  but  success  awaits  him.  While  we  hope  he 
will  appreciate  the  true  force  of  the  former,  we  think  it 
our  duty  to  imdeceive  the  too  credulous  one  in  regard 
to  the  latter.  A  distinguished  professor  is  in  the  halnt 
of  advising  his  pupils  to  study  well  the  cases  which 
may  present  themselves  in  the  early  part  of  a  profes- 
sional career,  and  at  the  same  time  of  remarking  that 
they  wUl  have  an  abundance  of  time  so  to  do.  This 
gives  a  clue  to  the  real  chances  which  any  young  medi- 
cal man  has  of  at  once  getting  into  a  lucrative  practice. 
Between  him  and  success  lie  many  obstacles,  and  much 
time ;  and  in  order  to  get  over  them,  it  is  well  that  he 
should  understand  what  to  expect  Disappointment  at 
the  start  has  been  the  lot  of  the  most  bnlliant  men  we 
have  among  us,  and  no  extra  talent  which  the  young 
doctor  may  deem  himself  possessed  of,  is  likely  to 
change  the  rule.  Practice  will  always  come  after  a 
while,  but  only  afler  a  while ;  and  every  one  wiio  de- 
sires to  do  credit  to  himself,  to  his  calling,  and  to  his 
patrons,  should  at  the  very  outSct  of  his  career 

"'Lmth  to  labor  iBd  to  wait** 
He  who  does  otherwise,  and  starts  in  a  different  way, 
and  gets,  by  some  seemingly  lucky  chance,  into  a  busi- 
ness at  once,  not  only  does  not  deserve  it,  but  will 
never,  in  the  end,  be  a  really  8uoce,s5ful  practitioner. 
He  can  never  get  time  to  study  as  he  should ;  he  begets 
a  careless  habit  of  prescribing ;  his  knowledge  is  always 
deficient,  and  he  never  rises  above  mediocrity.  Let 
this  thought  comfort  the  young  physician  during  the 
first  year  or  two  of  his  practice. 

^  I  ^" 

Thi  appointment  of  Prof.  Bsnjamix  Pierce,  of  Har- 
vard University,  to  succeed  the  late  Prof.  Baohb  as 
Superintendent  of  tho  Coast  Survey,  is  a  good  one, 
and  win  be  hailed  with  satisfaction  by  the  majority  of 
the  scientific  men  of  the  country,  to  whom  his  superior 
attainments  and  his  fitness  for  tiie  position  are  well 
known.  — 

Digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


89 


Ws  are  greatly  pained  to  see  the  use  made  of  the 
name  of  one  of  our  esteemed  Brooklyn  physicians, 
which  we  find  in  the  ^^ Daily  Eagle"  of  that  city  of  a 
late  date.  There  is  an  aoc  mnt  of  more  than  two 
odomoa^  headed  *^  A  Medical  Phenomenon,  a  young 
lady  of  this  city  lives  eighteen  months  without  food ; 
wonderful  exercise  of  clairvoyant  power.  ♦  *  Ex- 
tract from  ihe  diary  of  her  physician."  The  reporter 
states  that  ^'  the  lengthened  prostration  of  the  patient, 
her  remarkable  functional  derangement  and  peculiar 
powers,  induces  the  medical  attendant  to  allow  the 
added  indorsement  of  his  medical  name  and  reputa- 
ti<m."  Then  follows  the  name  and  address  of  the 
physician,  who  is  said  to  be  ''  of  no  inconsiderable 
reputation.''  We  hope  that  the  reporter  has  prestmied 
too  much  in  publishing  this  qitasi  advertisement,  and 
that  the  medical  gentleman  in  question  will  promptly 
disavow  any  such  use  of  his  name  as  is  here  made. 
The  case  is  worthy  a  scientific  notice,  in  a  medical  jour- 
nal, where  it  would  do  some  good.  As  it  is,  now,  it 
can  only  satisfy  a  morbid  curiosity  and  give  an  unenvia- 
ble notoriety  to  the  physician  in  charge.  This  diagust- 
ing  system  of  advertising,  if  allowed  by  our  profession, 
will  soon  degrade  us  to  the  level  of  the  quacks,  who 
regularly  occupy  columns  of  our  daily  press. 


Vimme. 


Tee  Brain  and  Cranial  Nerves,  suowino  their  Ortoin 
AND  Arranoembkt.  A  Chart  By  Thomas  S.  Butmbr, 
Undergraduate  in  Medicine,  Toronto  University,  Canada. 
426  Wellington  Street,  Montreal,  Canada. 

The  compiler  of  this  chart,  whose  industry  we  com- 
mend, has  well  achieved  the  object  had  in  view  of 
speaking  to  the  eye^  and,  through  that  medium,  of  more 
profoundly  impressmg  the  memory.  It  will  constitute 
a  very  useful  piece  of  fturniture  for  the  lecture-room, 
ind  would  not  be  out  of  place  in  the  offices  of  those  de- 
sirous of  keeping  bright  their  anatomical  lore. 

Medical  Rroolleotions  of  the  Armt  or  the  Poroif ao. 

By  JoxATHAN  Lbttbrman,  M.D.,  late  Surgeon  U.  a  Army, 

and  Medical  Director  of  the  Army  of  the  Potomac.     New 

York:  D.  Appleton  <k Co.,  1866.    Pp.  194. 

ScsoBov  Letterman,  who  will  long  be  held  in  gratefhl 

remembrance  for  his  administrative  ability  as  medical 

director  of  the  "  dear  old  Army  of  the  Potomac,"  amid 

lUits  strangely  chequered  fortunes,  has  succeeded  in 

S'ring  a  very  interesting,  not  to  say  fascinating  book, 
e  writes  in  a  perspicuous,  elegant  style,  and  we  yen- 
tore  to  a&«ert  that  but  few  who  open  his  volume  of  me- 
dical annals,  pregnant  as  they  are  with  instruction,  will 
care  to  do  otherwise  than  finish  them  at  a  sitting.  To 
old  campaigners  the  tribute  will  be  indeed  welcome ; 
while  ^e  "  intelligent  people,"  to  whom  he  appeals  in 
his  pre^e,  cannot  fail  to  appreciate  the  labors  of  that 
most  necessary  adjunct  to  a  well  appointed  army — an 
intelligent,  and  therefore  efficient  medical  department. 

An  Iktroductiok  to  Practical  Chemistry,  tnoludino  An- 
alysis; by  John  R  Bowman,  F.C.S.,  late  ProC  of  Practical 
Chemistry  in  King's  College,  London.  Edited  by  Charles 
L.  Bloxam,  F.C.8.,  Prof,  of  Practical  Chemistry  in  King's 
College,  liondon,  eta,  etc.  With  one  hundred  and  seven 
nhutrations.  Fourth  American,  fh>m  fifth  Revised  London 
Edition.    Philadelphia:  H.  C.  Lea,  1866,  12mo.,  pp.  351. 


This  work  does  not  pretend  to  be  more  than  it  really  is, 
an  introduction  to  practical  chemistry.  It  is  concise,  m 
theoretical  questions  are  avoided,  and  is  just  what  is 
specially  needed  by  the  student  who  wishes  to  work 
satisfactorily  in  the  laboratory.  The  symbols  and  equa- 
tions which  were  given  in  Uie  previous  editions  have 
been  omitted,  the  editor  wisely  concluding  that  a  much 
better  plan  for  the  student  would  be  to  frame  them  for 
himself.  The  chapter  on  mouth  blow-pipe  analysis 
has  been  much  improved,  in  fact  rewritten,  which  is 
virtually  the  case  with  that  portion  treating  of  exami- 
nations of  unknown  substances  with  the  blow-pipe. 
Besides  this,  the  several  metallic  and  non-metaUic 
bodies  have,  for  convenience  of  consultation,  been  ar- 
ranged alpiiabetically,  and,  altogether,  give  us  a  very 
fair  dictionary  of  blow-pipe  tests.  The  reactions  of 
metals  have  been  rearranged,  and  are  much  more  con- 
venient for  study  than  in  the  former  editions,  their  claims 
being  considered  in  the  same  order  in  which  they  are 
separated  from  a  solution,  and  not  in  the  inverted  order 
as  heretofore.  Qualitative  analysis  receives  its  share  of 
consideration,  and  the  tables  introduced  into  the  appen- 
dix for  the  rapid  analysis  of  simple  substances,  wiU  bo 
found  of  great  value  to  the  beginner.  The  illustration^ 
are  good,  and  give  a  fair  insight  into  the  different 
methods  of  manipulation,  a  proper  understanding  of 
which  mi^es  the  study  of  chemistry  so  attractive,  in- 
telligible, and  fascinating.  It  is  an  invaluable  work  for 
the  student,  and  will  serve  to  form  for  him  the  bes^ 
groundwork  for  future  studies  in  this  particularly  useful 
department  of  science. 

The  Physioian's  Daily  Pocket  Record,  Comprising  a  Vis- 
rriNO  List,  Diary,  aot)  Day-Book  op  Accounts  ;  Records 
OF  Obstetric  Praotiob;  Vaccinations,  Deaths;  Spb- 
oiAL  Memoranda,  etc.,  etc.  AisoaList  of  New  Remedies; 
a  Classified  List  of  Medicines,  their  doses  and  marked  value. 
Poisons  and  their  Antidotes ;  Medicinal  Weights  and  Mea- 
sures. Fee-tables,  etc.,  etc.  By  8.  W.  Butler,  M.D. 
Philadelphia :  Published  at  the  office  of  the  Medical  and 
Surgical  Reporter ^  116  South  Seventh  street,  1867. 

The  aim  of  Dr.  ButJer  has  been  to  make  this  a  con- 
venient and  serviceable  record  for  his  professional  bre- 
thren, and  he  has,  in  our  opinion,  succeeded  in  so  doinff. 
The  work  is  small,  got  up  in  handsome  pocket-book 
style,  is  compact,  and  the  divisions  have  been  made  by 
one  who  has  had  ample  opportunity  for  learning  the 
wants  of  practitioners.  The  list  of  new  remedies  has 
evidently  been  prepared  with  great  cwre,  which  ma^ 
also  be  said  to  be  the  case  with  the  doses  of  those  medi- 
cines in  common  use.  The  poisons  and  their  antidotes 
are  treated  in  a  very  convenient  tabulated  form,  and 
can  be  consulted  siUisfactonly  in  almost  any  emergency. 
The  table  of  fees  which  he  has  introduced,  is  an  impor- 
tant and  interesting  feature,  and  will  no  doubt  com- 
mend itself  with  dight  exceptions,  to  general  adop- 
tion. Although  calcinated  for  thirty-five  patients  daily, 
it  can  be  made  to  serve  for  more  by  simply  turning  the 
leaf  and  writing  on  the  next  page,  the  writer  not  being 
hindered  from  so  doing  by  each  day  of  the  week  having 
a  date.  This  plan  is  a  wise  one,  as  the  physician  can 
commence  his  book  at  any  time  of  the  year,  and  write 
in  the  date  for  himself  as  occasion  may  require.  Facing 
each  visiting  list  is  a  page  for  daily  memoranda,  the  use 
of  which  every  physician  can  well  appreciate,  as  well 
as  the  index  in  t^e  latter  part  of  the  work.  The  ob- 
stetric record  is  the  most  complete  we  have  seen  in  a 
work  of  the  sort;  and  with  care  in  filling  out,  it  can  be 
made  to  serve  as  a  reliable  statistical  accotmt  of  that 
department  of  practice.  Altogether,  it  is  an  admirable 
little  work,  ana  reflects  credit  upon  the  enterprise  of  the 
author. 


Digitized  by 


Google 


40 


THE  MEDICAL  RECORD. 


Vitpovts  of  ^OClttXtS. 


NEW  YORK  MEDICAL  JOURNAL  ASSOCIA- 
TION. 

Stated  Rbunion,  Jan.  26,  1867. 

Db.  Isaao  E.  Tatlor,  in  the  Chair. 

THE  TALUB  OF  STMl's   AMPUTATIOIT   AT  THE  ANKLE-JOINT 
IN  THE  ADAPTATION  OF  AN  ABTIFICUL  FOOT. 

Db.  E.  D.  Hudson,  according  to  previous  arrangement, 
remarked  upon  the  above  subjecL  He  said :  No  ampu- 
tation of  the  inferior  extremity  can  ever  compare,  in 
its  value  to  the  subject,  with  that  of  the  ankle-joint 
originated  by  Mr.  Svme.  Twelve  years  of  experience 
witn  that  variety  of  operation  have  afforded  me  assur- 
ance that  it  is  *'  a  fact  complete,"  not  capable  of  being 
improved  in  its  general  character.  It  is  scientific, 
practically  of  the  utmost  use,  and  subservient  to  the 
best  interests  and  happiness  of  the  patient 

Mr.  Fergusson  avowed  that  he  "  knew  of  no  kind  or 
style  of  amputation  which  deserved  more  high  consi- 
deration ;  and  so  far  as  the  subject  is  concerned,  it  is 
one  of  the  greatest  improvements  in  modem  surgery." 
No  other  operation  has  resulted  so  benefici^ly  and  satis- 
factorily. The  subjects  of  such  an  amputation  scarcely 
realize  their  loss,  with  legitimate  appliance.  They  ap- 
pear every  way  whole.  The  sensations  of  the  stump 
are  normal ;  the  articular  surfoce  and  thickened  tissues 
are  accustomed  to  the  hardest  service,  and  to  bear  the 
heaviest  burdens,  which,  with  apparatus,  enables  the 
patient  to  engage  in  his  accustomed  walks  and  voca- 
tions with  unabated  naturalness  and  endurance.  One 
gentleman,  for  whom  he  had  applied  a  foot,  had  walked 
wiirty-five  miles  in  a  day,  on  a  hunting  excursion,  while 
his  companions  did  not  suspect  that  ne  was  otherwise 
than  whole.  So  beneficent  have  been  the  results  of 
this  operation,  as  to  have  induced  many  a  sufferer  'from 
congenital  malformations,  varieties  of  talipes,  and 
troublesome  Ohopart  operations,  to  demand  it  as  an 
**  amputation  of  convemence." 

He  claimed  that  as  an  operation  it  had  for  its  support 
the  soundest  principle  of  surgical  economy,  since  it  re- 
tains, in  addition  to  the  entire  length  of  leg,  nature's 
foundation, — the  articular  portion  of  the  shaft  of  a  long 
bone, — as  a  base  of  support 

Again,  its  accustomed  service  is  concurrent  and  coequal 
with  that  of  the  calcaneum,  to  sustam  the  weight  and 
forces  of  the  body  which  are  reflected  to  it  So  alao  to 
remove  the  calcaneum,  and  to  substitute  the  articular 
base  of  the  tibia,  is  merely  a  change  of  place,  not  of 
functions. 

A  cogent  reason  in  support  of  amputation  of  the  ankle- 
ioint  is,  that  to  the  compacted  hardened  tissue  of  the 
lower  termination  of  the  tibia  are  transferred  and  united, 
for  a  cushion,  the  thickened  tissues  which  have  effectu- 
ally served  to  protect  the  os  calcis. 

The  place  of  those  tissues  is  changed ;  their  accus- 
tomed function  is  unchanged  and  normal. 

When  the  change  of  base  and  healthy  union  of  the 
hard  and  soft  parts  are  suocessfuUv  perfected,  the  same 
condition  and  serviceableness  of  the  end  of  the  stump 
is  g^ned  as  that  of  the  natural  heel  After  a  very  short 
period  of  exercise  the  sensations  become  perfectly  natu- 
ral, and  the  end  of  the  stump  as  enduring  as  the  heel  of 
the  natural  foot. 

He  had  been  led  to  a  very  great  interest  and  persist- 
ent advocacy  of  Mr.  Syme's  method,  by  a  regard  for  the 
humane  principles  of  rational  conservatism,  and  by  the 
numerous  cases  of  ankle-joint  amputations  which  had 


demonstrated  to  him  the  superior  utility  of  that  opera- 
tion to  any  amputation  of  the  leg,  or  any  modification 
of  the  general  one  of  Mr.  Sjme.  Of  fifty  recent  cases 
which  had  come  to  his  hands  for  final  treatment  b^ 
mechanical  means,  not  one  had  failed  of  a  highly  grati- 
fying success.  Both  patients  and  surgeons  who  have 
witnessed  their  results,  have  been  every  way  pleased 
with  their  exceeding  benefit  Not  every  subject  is  in 
immediate  condition  for  the  adaptation  of  apparatus 
for  reasons  that  will  readily  be  apparent  to  every  sur- 
geon. 

Some  require  treatment  for  ulcerations,  thickened 
tissues,  sweuings,  and  tenderness ;  others  require  some 
inuring  treatment,  before  the  application  of  apparatus. 
In  no  instance  did  he  yenture  to  apply  apparatus  until 
the  patient  could  endure  the  end  of  the  stump  upon 
either  the  bare  floor  or  some  unyielding  support  with 


Those  leg-makers  who  have  only  stereotyped  appa- 
ratus to  apply  indiscriminately  for  amputations  in  the 
continuity  of  the  leg,  and  who  find  this  new  method 
incompatible  with  their  highest  ideas,  had,  to  his  per- 
sonal knowledge,  treated  such  cases  by  apparatus,  as  for 
amputation.  This  allows  no  weight  at  the  end  of  the 
stump,  but  distributes  it  upon  the  walls  of  the  leg, 
beneath  the  head  of  the  tibia,  and  up  around  the  thigh. 

Those  who  have  no  discriminating  knowledge  of  sur- 
gical operations,  nor  of  physiological,  anatomical,  and 
pathological  principles,  can  hardly  be  expected  to  appre- 
ciate and  sustain  an  amputation  of  the  ankle-joint;  nor 
can  they  treat  it  legitimately  with  apparatus  which  M- 
fils  the  design  of  such  an  operation. 

To  illustrate:  Cs^tain  — ,  who  had  suffered  an 
amputation  of  the  ankle-joint— -Syme  method — came  to 

this  city  and  applied  to ■        for  apparatus.    He 

was  informed  that,  because  of  a  slight  pnckling  sensa- 
tion when  he  rested  his  stump  on  the  floor,  it  should 
not  receive  any  weight  at  its  end.  An  artificial  leg  was 
applied,  as  in  ordinary  cases  of  leg  amputation,  to  take 
the  weight  of  the  body  upon  its  walls  and  the  thigh,  so 
as  to  suspend  and  relieve  the  end  of  the  stump.  The 
captain  entertained  the  plea  of  tenderness  as  yalid ;  but 
being  very  greatly  annoyed  by  the  weight  and  irritation 
of  the  apparatus,  he  sent  for  a  surgeon  of  this  city, 
who,  upon  examininc^  the  stump  ana  appliance,  imme- 
diately transferred  him  to  Dr.  H.  He  found  his  stump 
admirably  well  formed  and  healtliy,  except  a  little 
pnckling  sensation,  which  hard  pressure  induced 

After  ten  days  of  preliminary  treatment,  during  which 
a  casement  and  foot  were  fitted,  and  trials  made,  the 
prickling  had  entirely  subsided,  the  natural  sensation  of 
the  heel  was  restored,  and  the  patient  went  out  walk- 
ing without  inconvenience. 

The  sensation  of  prickling  is  no  unusual  complaint  for 
persons  to  make  who  have  suffered  an  injury  of  the  tis- 
sues of  the  heel  or  foot,  when  they  have  so  far  re- 
covered as  to  begin  to  exercise  the  part.  It  is  a 
mere  temporary  sensation,  which  exercise  soon  converts 
into  a  normal  one.  The  objections  to  Syme's  opera- 
tion, tenderness,  unsoundness,  and  unreUableness  as  a 
basis  of  support,  after  the  stump  has  become  well  healed, 
are  entirely  gratuitou& 

The  practice  of  Mr.  Syme  (original  method)  to  exsect 
the  indurated  tissue,  the  most  depending  and  moat  ser- 
viceable feature  of  the  tibia,  thereby  exposing  the  can- 
cellated structure,  and  also  to  remove  the  malleoli 
through  their  base  on  a  level  with  its  articular  surface, 
is  unpnilosonhical  and  inexpedient  The  increased  yas- 
culanty  of  tne  canoelli  must  necessarily  conduce  to  pro- 
tract the  tenderness  of  the  face  of  the  stump.  Some 
surgeons  strive  to  enlarge  the  base  of  support  afforded 
by  the  tibio-tarsal  surface,  by  sawing  the  malleoli  o% 


igitized  by  VjOO^- 


THE  MEDICAL  RBCX)RD. 


41 


at  a  fine  tranaTerBe  with  the  end  of  the  tibia ;  but  the 
practice  ia  entirely  gratuitous,  and  in  some  respects 
prmdidal. 

The  inter-malleolar  space  is  the  only  true  and  all- 
aoificient  base  of  support ;  any  additional  surface  is  su- 
perfluous and  increasing  the  periphery  of  tibe  end 
readers  it  unduly  large  for  the  adaptation  of  symme- 
trical apparatus.  The  articular  surfia^ce  should  not  be 
molested.  The  malleoli  should  be  exsected  with  the 
•aw,  at  a  beyeUiog  angle  of  some  forty  degrees.  The 
moat  serviceable  and  best  proportioued  stump  is  thus 
oompoaed.  With  the  dense  ivory  structure,  the  cancel- 
lated and  medullary  tissues  all  preserved,  other  matters 
being  equal,  we  may  rationally  anticipate  the  best  re- 
•olta.  The  modified  variety  of  Baudens,  the  dorsal  flap, 
or  that  of  Rouz,  lateral  flap,  will  never  be  chosen  vari- 
eties, but  adopted  as  a  dernier  resiori  only.  Even  when 
the  operation  ia  thus  modified,  the  stump  is  eminently 
superior  for  utility,  and  the  entire  pressure  upon  its 
&oe.  to  any  amputation  of  the  leg. 

He  had  had  two  cases  of  the  bilateral-flaps  yariety, 
made  for  want  of  plantar  tissue,  and  cicatrized  over  the 
end  of  the  stump,  and  one  of  the  dorsal  yariety,  upon 
each  of  which  the  patients  bore  their  entire  weight,  on 
an  artificial  foot,  with  the  utmost  comfort. 

The  compensative  apparatus^  he  had  been  the  first  to 
originate  and  ^plv  in  the  United  States;  nor  was  he 
aware  of  any  liice  legitimate  treatment  abroad. 

With  it  he  had  invariably  made  the  &ce  of  the  stump 
the  basis  of  entire  support,  and  with  no  interveniug 
eobatance,  other  than  one  or  two  thicknesses  of  so^ 
flannel  doth.  The  apparatus  is  composed  of  a  light 
semi-cylindrical  wooden  case  for  the  leg,  receiving  the 
bulbous  end  of  the  stump  in  a  concavity,  at  its  lower 
end.  fitted  snugly  to  the  posterior  half  of  the  parietes 
of  the  stump  and  leg  for  two-thirds  of  its  length,  while 
its  base  is  entirely  supported.  Wide  leather  bands  lace 
up  over  the  anterior  half  of  the  leg,  to  keep  it  in  situ. 

The  case  is  strengthened  with  strong  hickory  pins, 
so  dovetailed  as  to  prevent  its  spl  tting  or  yielding  to 
the  weight  of  the  body.  To  the  leg  and  stump-case  an 
artificial  foot,  of  natural  size  and  shape,  is  attached  by 
a  strong  ginglymus  ankle-joint,  on  a  line  nearly  parallel 
with  that  of  its  mate.  An  artificial  Tendo-AchiUis  passes 
up  fit>m  the  heel,  through  an  inclosed  groove  into  the 
calf  of  the  casement,  where  it  is  strongly  inserted.  It 
preserves  the  foot  at  a  right  angle  with  the  leg  part, 
when  the  weight  of  the  body  passes  over  and  forward 
upon  the  ball  and  toe-piece  of  the  foot.  The  latter  is 
Blade  to  hug  the  ground,  the  same  as  the  toes  of  the 
natural  foot,  by  a  strong  lever  and  rubber  spring.  When 
the  heel  strikes  the  ground,  the  anterior  part  of  the 
foot  is  depre;»6ed,  but  elevated  sufliriently  by  rubber 
flexor  rorings,  when  the  weight  is  ofl^  to  prevent  trip- 
ping. The  apparatus  is  covered  with  green  rawhide, 
dried  and  contracted  on,  and  coated  with  a  neat  flesh- 
colored  enamel  It  may  be  dressed  with  stocking,  shoe, 
or  boot,  at  pleasure^  the  same  as  its  fellow. 

With  its  mplication  the  patient  is,  to  all  appearance 
and  for  usefolness,  restored  to  a  normid  condition. 

The  great  and  important  feature  of  the  Syme  opera- 
tion at  the  ankle-point,  he  would  repeat,  is  the  natural, 
phibeophical  basis  of  support  which  the  method  re- 
tains, and  the  opportunity  it  affords,  by  a  suflttcient 
■hortiiess,  for  the  adaptation  of  a  compensating  artificial 
foot  and  a  ginglymus  ankle-joint  in  a  proper  place. 

The  main  and  defensive  feature  of  M.  Firiooff's  modi- 
fteition  is  the  increased  length  of  stump,  created  by 
the  ezdaion  of  the  tibia  and  calcaneum,  and  the  annox- 
atioo  of  a  greater  or  less  portion  of  the  latter  to  the 
former,  for  the  service  of  the  "poor  man**  with  the  ap- 
pGttation  of  a  "bucket"  or  "boot" 


Every  physiological  anatomist  must  readily  perceive 
that  the  increased  length  of  the  stump,  by  an  adventi- 
tious portion  of  the  os-calcis.  will,  in  the  ratio  of  its 
increased  length,  necessarily  impair  it  for  the  applica- 
tion of  legitimate  mechanical  appliance. 

Statistics  furnish  abundant  evidence  that  it  possesses 
no  superior  advantage  as  relates  to  mortality,  slough- 
ings,  necrosis,  or  other  tmtoward  events,  over  the  Syme 
method;  nor  even  as  a  reHiahU  haeie  of  support;  only 
to  secure  the  beneflts  of  an  os-peg-leg — the  similitude  of 
the  wooden  relic  of  barbarity. 

The  special  interests  of  the  subject,  of  an  amputation 
of  the  inferior  extremity,  are  the  matters  of  importance 
— "  and  how  the  patient  may  mostfiUy  use  tlie  rest  of 
his  life,  by  walking  on  an  artificial  leg."  No  artificial 
leg  has  been,  or  can  be  constructed  and  adapted  to  any 
stump  of  the  leg,  having  its  parietes  for  support,  with 
such  perfect  favor,  as  that  which  he  originated  and 
adapts  for  ankle-joint  amputations.  The  same  apparatus, 
modified,  may  be  applied  to  the  Pirigoff  modincation, 
but  the  result  is  far  less  satisfactory. 

There  is  one  condition  of  the  ankle-joint  in  which  the 
Pirigoff  method  may  be  adopted  to  the  very  great  bene- 
fit of  the  patient,  viz.  Where  caries,  necrosis,  or  inju- 
ry of  the 'tarsal  end  of  the  tibia,  precludes  the  possibility 
of  the  Syme  method,  and  would  render  the  Pirigoff 
method  a  valuable  alternative  to  an  amputation  of  the 
leg  at  its  lower  third.  In  any  such  event,  to  excise  the 
diseased  tibia,  and  a  sufficient  amount  of  the  culcane- 
um,  and  annex  to  the  tibia  to  compensate  its  loss  by 
excision,  would  be  an  additional  fact  to  surgical  improve- 
ment— a  worthy  expedient — ^but  only  as  an  alternative 
to  the  leg  amputation.  It  would  make  the  leg  of  nor- 
mal length,  and  alike  serviceable  as  a  Syme  case  for  the 
adaptation  of  a  befitting  apparatus. 

Dr.  H.  condemned  the  indifference  of  tbo<>e  surgeons 
who  operated  without  reference  to  the  adaptability  of  the 
stump  for  the  most  comfortable  contrivances,  and  gave 
the  instance  of  a  lady  now  wearing  a  clumsy  apparatus 
uponf  whom  the  surgeon  performed  an  amputation  at 
the  upper  instead  of  the  lower  third,  because  she  was 
then  a  poor  girl  and  could  afford  only  a  "peg-leg.** 

After  a  few  remarks  by  Dr.  Hamilton  in  continuation, 
the  Association  adjourned. 


NEW  YORK  ACADEMY  OF  MEDICINE. 

Stated  Mietino,  March  6,  1867. 

Db.  Alfred  G.  Post,  President,  in  the  Chair. 

Dr.  Amdirson  delivered  to  the  Academy  several 
volumes,  transmitted  to  him  as  its  late  President. 
Among  these  was  a  copy  of  the  Transactions  of  the 
Montpelier  (France)  Academy  of  Medicine. 

Dr.  Underbill  moved  that  the  latter  institution  be 
placed  upon  the  exchange  list  of  the  Academy,  and  that 
the  present  donation  be  accepted,  with  thanks. — (Car- 
ried.) 

Dr.  Anderson  also  reported,  that  in  accordance  with 
the  wish  of  the  Publication  Committee,  a  sufficient  num- 
ber of  Dr.  Post's  Eulogy  upon  the  late  Dr.  Valentine 
Mott  had  been  fiirnished  to  the  different  medical  schools 
of  the  city,  for  distribution  to  the  graduates  of  the  sea- 
son, of  which  courteous  acknowledgments  had  been 
returned. 

SPIOIMSNB  OF  AMERICAN    ANTIQCTITIBa. 

Dr.  John  C.  Draper  presented  to  the  notice  of  the 
Academy  a  q)ecimen  of  common  salt,  nearly  chemically 
pure,  which  was  discovered  by  the  insurgents  of  the 
late  war  upon  the  PeHt  Avm  island,  near  YermilioQ 
Bay,  Louisiana.    The  deposit  was  found  some  fifteen 


42 


THE  MEDICAL  RECORD. 


feet  below  the  surface,  and  appears  at  that  depth  to  be 
pretty  generally  distributed  over  the  fsland,  which  is 
some  five  thousand  acres  in  extent.  Upon  the  surface 
of  this  deposit  were  found  the  bones  of  the  American 
elephant,  and  beneath  both  was  discovered  a  neatly 
woven  mat,  composed  of  the  common  Southern  cane 
{Arundinaria  macrospermum).  The  original  of  the 
photograph  now  exhibited  by  him  was  presented  by 
J.  F.  Clues,  Esq^  to  the  Smithsonian  Institutioo,  Wash- 
ington, and  is  in  a  state  of  excellent  preservation, 
owin^  to  both  the  strongly  silicious  character  of  the 
cane  itself  and  to  the  properties  of  the  soil  from  which 
it  had  been  removed.         ' 

This  specimen  was  of  interest,  as  throwing  some  light 
upon  the  antiquity  of  man ;  it  at  least  proved  that  he 
existed  previous  to  the  period  to  which  the  skeleton  of 
the  elephant  in  question  belonged. 

The  Academy  then  adjourned. 

PHILADELPHIA  COUNTY  MEDICAL 
SOCIETY. 

Conversational  Mkbtino,  Jan.  9,  1867. 

\     President,  Dr.  Wm.  Matburby,  in  the  Chair. 

discussion  on  dystocia. 

Dr.  Wm.  B.  Atkinson  opened  the  discussion  by  read- 
ing a  paper,  of  which  we  give  the  following  abstract : 

Under  the  head  of  difficult  labor  may  properly  be 
considered  all  cases  where,  from  any  cause,  the  delivery 
is  retarded  or  rendered  dangerous.  These  may  be  of 
two  classes: — ^preventable  and  unavoidable.  The  pa- 
tient may  neglect  the  evacuations,  and  delay  ensue 
from  a  distended  bladder  or  rectum.  The  physician 
may  not  be  in  attendance  sufficiently  early  to  rectify  a 
malposition  which  could  have  been  corrected  if  detect- 
ed in  time.  External  manipulation  would  be  here  in- 
dicated and  valuable. 

The  unavoidable  cases  are  much  more  numerous  and 
varied.  The  os  uteri  may  delay  by  its  obstinacy,  or  the 
pelvic  outlet  be  almost  completely  excluded  by  a  variety 
ot  causes.  The  duty  of  the  accoucheur  is  to  be  vigi- 
lant and  neglect  no  precautions.  The  bladder  and  rec- 
tum should  be  emptied ;  neglect  in  this  particular  may 
induce  paralysis  or  rupture  of  these  organs,  fistula,  rup- 
ture of  the  uterus,  etc.  Cases  of  delay  were  cited  as 
illustrative  of  this  point. 

Where  the  os  uteri  does  not  yield  readily,  we  may 
bleed,  nauseate,  use  belladonna  to  the  parts,  but  above 
ell,  employ  anesthetics. 

Opiates,  etc.,  may  be  employed  when  the  labor  is  te- 
dious, thus  quieting  the  contractions  and  giving  time  for 
the  circular  fibres  to  dilate.  These  are  contra-indicated 
in  full  labor.  Perhaps  nothing  is  of  so  much  value  as 
ansesthesia  to  incomplete  insensibility.  Eutocia  by  this 
means  should  always  be  obtained  when  no  objective 
symptoms  are  present  Tincture  of  gelsemin  has  been 
recommended  to  procure  painless  and  speedy  dilatation 
of  the  uterine  mouth.  Great  benefit  may  be  derived 
from  the  aid  to  dilatation  affi>rded  by  the  finger  of  the 
obstetrician  hooked  in  the  anterior  lip,  with  gentle  and 
nrm  traction  made  forwards  and  downwards :  this  pre- 
vents the  cap  or  sling  forming  over  the  foetal  head,  thus 
acting  as  a  cause  of  delay,  and  also  rectifies  these  mal- 
positions of  the  OS  so  frequently  productive  of  tedious 
labor,  the  result  of  so-called  obliquity  of  the  uterus. 
On  this  point  much  might  be  said,  and  many  cases  were 
quoted  to  prove  the  vsSue  of  this  procedure. 

The  membranes  should  not  be  ruptured  too  early,  lest 
we  thus  produce  tedious  labor,  nor  should  they  be  al- 
lowed to  remain  too  long  intact    On  both  these  points 


the  speaker  descanted  at  some  length  to  enforce  his 
views,  and  show  the  importance  of  attention  to  these 
particulars. 

When,  after  the  evacuation  of  the  amniotic  fluid,  the 
pains  cease,  or  occur  at  long  intervals,  tliey  may  be  re- 
newed by  sweeping  the  finger  around  within  the  os  at 
frequent  intervals. 

The  decubitus  of  the  patient  often  causes  a  change  in 
the  pains  and  retM^s  or  accelerates  delivery.  A  change 
from  the  side  to  the  back,  or  the  opposite  side,  will  fre- 
quently improve  the  contractions,  and  cause  the  head  to 
come  down  more  rapidly. 

In  slow  dilatation  of  the  os  it  is  suggested  to  divide 
to  a  Hmited  extent  a  portion  of  the  circular  fibres,  and 
it  is  claimed  that  the  operation  is  very  frequently  suc- 
cessfiil  and  very  serviceable.  Objected  to  as  dangerous 
and  rendering  the  patient  liable  to  rupture  of  the 
uterus.  The  tome  has  been  done  with  the  peri- 
neum. Both  are  strongly  advocated  by  high  authority, 
but  are  of  doubtful  propriety.  These  points  ought  to 
elicit  free  discussion  as  important  if  safe,  highly  dan- 
gerous unless  experience  has  taught  Otherwise. 

When  are  ergot  or  the  forceps  to  be  employed  ?  The 
former  is  indicated  when  the  os  is  freely  dilated  or  easy 
of  dilation,  when  no  obstacles  but  want  of  pains  inter- 
fere to  delay  the  delivery.  If  the  patient  is  exhausted, 
combine  it  with  stimulants.  The  speaker  had  never 
met  with  any  bad  results  from  the  employment  of  this 
remedy.  He  preferred  the  fluid-extract  as  more  con- 
venient, and  more  suitable,  for  a  variety  of  reasons. 

Finally,  the  forceps  come  in  play  as  an  efficient  aid. 
Here,  the  physician  requires  judgment  tod  patience  to 
determine  how  early  they  should  be  employed.  They 
should  be  regarded  as  aids  for  the  benefit  of  ihe  mother 
or  child,  and  not  for  the  convenience  of  the  doctor. 
When  the  delivery  is  delayed  by  exhaustion,  inertia 
uterij  or  failure  of  the  pains  from  any  cause ;  when 
further  delay  is  dangerous,  and  there  are  fears  for  tho 
life  of  either  the  mother  or  child ;  for  these,  and  other 
or  similar  cogent  reasons,  we  may  employ  this  in- 
strument He  did  not  regard  their  use  as  fi^usrhfc  with 
the  danger  attributed  to  them  by  many.  He  rather 
felt  that  many  of  the  fistulse,  etc.,  attributed  to  their 
employment,  were  the  effects  of  pressure  from  the 
child's  head,  rather  than  pressure  or  other  action  of  the 
forceps. 

Some  remarks  followed  on  other  obstetric  operations. 
Craniotomy,  etc.,  the  gimlet  craniotome  of  Dr.  Harlow 
was  eulogized  as  the  most  perfect  and  safe  instrument 
for  the  purpose  yet  devised. 

In  conclusion,  allusion  was  made  to  the  general  con- 
duct of  the  obstetrician,  his  art  requiring  skill,  gentleness 
and  firmness ;  and  yielding  an  ample  reward  when  prop- 
erly followed. 

Db.  Hamilton  remarked  that  one  important  point 
in  reference  to  facilitating .  the  passage  of  the  cnild's 
head  had  not  been  alluded  to  in  the  paper  of  Dr.  At- 
kinson ;  that  18^  to  act  on  the  lower  portion  of  the  va- 
gina— introducmg  one  or  two  fingers  between  the  head 
of  the  child  and  the  wall  of  the  vasrina,  and,  at  the 
moment  of  a  pain  coming  on,  to  press  firmly,  letting  the 
fingers  perform  this  office  on  the  perineum  in  the  direc- 
tion of  the  anus.  It  seems  to  have  some  effect  on  the 
passage  of  the  child's  head,  as  it  descends  and  presses 
in  that  direction,  the  motion  takes  place  rapidly. 

With  regard  to  the  period  at  which  the  membranes 
should  be  broken,  he  was  undecided.  He  has  some- 
times ruptured  very  tough  membranes  when  the 
child's  head  followed  rapidly ;  under  other  circum- 
stances, this  interference  was  followed  by  no  advan- 
tage, and  sometimes  it  was  absolutely  disadvantageous 
from  loss  of  the  wedge-Kke  bag.^JU  to  forctp,  he  ae- 
digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


48 


koowledged  their  value,  but  feared  they  were  instru- 
meots  of  great  abuse. 

Dr.  Hatheld  requested  some  remarks  from  Dr.  Har- 
low MB  to  the  advantages  of  bis  instrument  to  which 
the  reader  of  the  paper  had  referred; 

And  Dr.  Harlow,  first  speaking  of  the  subject-matter 
of  the  ^MpeTy  beUeved  that  we  may  avoid  extremes  in 
using  the  lorceps.  His  rule  is,  to  be  governed  by  con- 
mderations  of  safety  to  the  mother  and  to  the  child,  re- 

rding  not  only  iheir  Uves,  but  their  well-being  also. 
by  delay  we  compromise  the  well-being  of  either 
in  any  way,  we  are  guilty  in  not  using  the  forceps ; 
if,  on  the  other  hand,  we  use  them  for  our  own  con- 
Tenieoce,  and  thus  compromise  either,  we  are  guilty ; 
it  most  not  be  used  as  a  time-saving  instrument. 

With  regard  to  his  instrument  for  entering  the  foetal 
bead,  he  believed  it  to  be  the  best  of  the  kind  which 
oui  be  used.  It  has  been  noticed  by  Profl  Hodge,  who 
says  that  it  may  be  used  for  breaking  up  the  face,  and 
the  base  of  the  skulL  It  is  also  mentioned  in  Braith- 
waite  that  it  may  be  used  where  the  ossification  is 
greater  than  usual  and  other  instruments  cannot  be 
employed  readily.  It  is  not  to  be  employed  except  when 
abeolutely  necessary.  He  was  led  to  its  invention  by 
having  a  case  of  contracted  pelvis  where  he  was  ob- 
liged to  operate  on  two  or  three  occasions ;  the  diameter 
of  the  superior  strait  was  not  more  than  two  inches 
md  a  h  ilf ;  he  had  introduced  Meigs'  perforator,  and 
found  that  afler  inserting  it  into  the  skull,  he  could 
not  insert  the  forceps  that  accompany  Meigs*  per- 
forator. On  his  way  home  he  contrived  this  instru- 
ment. It  cons's's  of  an  olive-shaped,  gimlet-like  screw, 
enlarging  rapidly  from  its  point  to  its  broad  base ;  the 
edges  of  the  screw  are  entirely  smooth,  and  on  entering 
the  parts,  there  is  no  probabiHty  of  wounding  the 
mother.  It  has  no  sharp  edge  as  has  Smellie's  scissors, 
and  other  instruments.  It  not  only  perforates  the 
akull,  but  enlarges  the  opening  sufficiently  for  all  the 
pnrpoees  that  are  desired  in  craniotomy.  After  turn- 
mg,  followed  by  inabihty  to  deUver,  it  can  be  readily 
naed  to  break  up  the  base  of  the  skull. 

Dr.  Washinoton  F.  Atlib,  alluding  to  the  like  and 
dislike  of  the  forceps,  etc.,  remarked  that  it  requires  a 
mechanical  mind  to  use  the  forceps  justly  for  the  bene- 
fit of  the  mother  and  the  child;  otherwise  it  may  be 
ii^jurious  in  the  hands  of  those  who  abuse  it.  In  a  great 
many  patients,  the  existence  of  the  axis  of  the  pelvis  is 
k>8t  sight  of  in  the  use  of  the  forceps,  and  therefore  the 
application  of  the  forceps  is  difficult  in  the  hands  of  such 
practitioners,  when  it  would  be  perfectly  easy  in  the 
bands  of  others.  He  prefers  Siebold*s  forceps  because 
be  has  long  been  accustomed  to  their  use,  and  in  an 
extensive  range  of  applications,  has  always  been  able 
to  employ  them.  Many  physicians  condemn  the  use 
of  the  forceps  from  want  of  mechanical  skill  in  their  ap- 
pUcatioQ.  They  don't  throw  the  handles  back.  There 
»  no  position  of  the  head  in  the  pelvis  in  which  the 
forceps  cannot  be  apphed ;  the  higher  the  head  of  the 
diild  is  in  the  pelvis,  the  further  back  must  you  press 
the  handles,  sometimes  even  to  pressing  the  perineum 
and  rectum  backwards  to  the  oe  coccyx.  Dr.  Atlee 
prefers  forceps  short  in  the  handles.  He  believes  com- 
pression to  a  certain  extent  will  not  injure — and  almost 
every  case  is  attended  with  some  compression — the 
very  pressure  on  the  handles  will  do  this;  but  with 
•hcct-nandled  foi-ceps,  with  the  pivot  in  front,  it  is  im- 
possible to  do  injury,  especially  with  long  blades,  by 
any  amount  of  compression  which  the  hands  can  make 
iq>OQ  the  bead. 

There  is  an  occlusion  sometimes  of  the  os  uteri, 
where  labor  will  continue  for  days  without  progress,  in 
which  by  pressing  the  sharpened  finger-nail  agsunst  the 


circular  fibres  and  scratching  through  at  the  time  the 
pain  is  on,  you  perforate  the  closed  tissues,  and  imme- 
diately there  is  a  sudden  expansion  of  the  whole  os 
uteri,  and  the  child  is  born  in  a  few  minutes. 

Another  cause  of  dystocia  is  an  excess  of  waters, 
where  the  head  of  the  child  blocks  up  the  pelvis  even 
after  the  parse  of  waters  has  been  broken  previously.  A 
large  amount  of  waters  will  have  the  same  effect  as  a 
second  child.  The  uterine  efforts  cannot  be  well  ex- 
pended on  the  body  of  the  child  if  a  large  body  of  wa- 
ters is  around  it,  even  though  the  purse  may  have  been 
broken  below  the  head ;  the  head  is  sometimes  so  im- 
pacted in  the  superior  strait  that  the  labor  is  delayed  by 
the  large  quantity  of  water  above  the  superior  strait ; 
then  pushing  up  forcibly  the  head  of  the  (mild  and  sus- 
tainin|r  it  in  this  position  until  the  waters  are  drawn 
off,  will  facilitate  the  labor.  A^in,  in  breech  presenta- 
tions, we  find  the  life  of  the  child  sacrificed,  especially 
in  first  labors,  by  the  head  being  retained  with  press- 
ure of  the  head  against  the  umbilical  cord,  pressing  it 
against  the  superior  strait  Traction  of  the  body,  and 
turning  up  the  bod  v  so  as  to  follow  the  curve  of  the 
pelvis,  sometimes  mils  in  deUvering  the  head ;  the  fin- 
ger in  the  mouth  sometimes  fails  to  deliver  in  time, 
particularly  in  first  children ;  in  such  cases  the  speaker 
strongly  recommended  and  always  practised,  pressure 
externsily ;  in  every  foot  or  breech  presentation  he  calls 
the  nurse  to  the  bedside  and  teUs  her  to  place  her  hands 
immediately  over  the  lower  part  of  the  abdomen,  and 
to  follow  his  motions  by  strong  pressure,  and  almost  in- 
stantaneously the  head  is  forced  right  out,  and  the  child 
saved.  This  is  not  a  procedure  recommended  by 
authors  generally,  but  is  a  practice  well  worth  follow- 
ing. 

With  regard  to  the  instrument  of  Dr.  Harlow,  he 
related  a  case  proving  its  value.  The  head  had  been 
perforated,  but  the  brain  had  not  been  discharged;  the 
operation  had  been  performed  with  the  ordinary  scis- 
sorsL  but  the  incision  was  a  linear  one,  and  the  pressure 
of  the  head  in  coming  through  the  superior  strait  forced 
the  bones  together  and  kept  the  brain  within.  By  mak- 
ing a  crucial  incision,  deHvery  was  effected.  The  in- 
strument of  Dr.  Harlow  would  obviate  this  difficulty. 

Dr.  Andrew  Nebingbr  mentioned  several  interest- 
ing cases  of  labor  where  manual  dexterity  assisted  me- 
chanically without  resort  to  instruments.  He  exhibited 
the  cranioclast  of  Prof  Simpson,  designed,  after  removal 
of  the  contents  of  the  cranium,  to  break  up  the  bones 
of  the  skull,  leaviuj?  them  in  contact  with  the  scalp.  The 
head  collapsing  is  forced  down  into  the  cavity  of  the 
pelvis  and  removed  by  traction,  with  the  same  instru- 
ment. He  referred  to  the  statements  of  Dr.  Tyler  Smith, 
who  says  that  there  is  no  necessity  for  craniotomy  un- 
der any  circumstances,  and  he  induces  premature  labor 
at  seven  or  eight  months. 

Dr.  Spooner  desired  to  add  his  testimony  to  that  of 
Dr.  Hamilton  to  the  assistance  often  given  after  the 
head  of  the  child  has  passed  down  within  the  cavity  of 
the  pelvis,  by  the  pressure  on  the  posterior  portion  of 
the  vagina  by  two  or  three  fingers  within  the  canal, 
which  would  also  often  stimulate  the  uterus  when  con- 
tractions were  apparently  failing. 

As  to  rupturing  the  membranes,  if  the  patient  has  the 
appearance  of  an  unusually  distended  uterus  indicating 
a  liirge  collection  of  the  Uquor  amnii,  it  is  often  to  be 
inferred  that  the  uterus  does  not  contract  regularly  and 
the  labor  does  not  progress  as  well  as  it  would  were  it 
not  for  tills  distension,  and  therefore  he  generally  rup- 
tured the  membranes;  in  general,  however,  and  in  primi- 
parous  cased  as  a  rule,  it  is  not  indicated;  in  primiparous 
cases,  because  we  expect  there  will  be  more  or  less  delay 
as  the  head  comes  to  distend  the  perineum,  and  there 
digitized  by  VjOOQ IC 


44 


THE  MEDICAL  RECORD. 


will  be  more  or  leas  heat  and  oongestion  resulting  from 
the  dryness  caused  bj  an  early  rupture. 

In  regard  to  the  application  of  the  forceps,  he  admit- 
ted the  fSMulity  with  which  the  instrument  can  be  ap- 
plied if  the  person  has  a  mechanical  mind  and  properly 
appreciates  the  canal  of  the  pelyis. 

In  craniotomy,  after  the  evacuation  of  the  head,  he 
takes  away  the  bones  without  the  soft  covering,  trying 
to  leave  the  soft  tissues  so  as  to  protect  the  mother 
from  the  irregular  portions  of  the  cranium  which  remain 
projecting  through  the  scalp  tissues. 


€atttsipm(bmct. 


OUR  KNOWLEDGE  OF  MEDICINES. 


To  THB  Editob  or  1 


I  Medical  Bboobd. 


Sib--- Four  remarks  upon  our  want  of  knowledge  in 
medicines  are  eminently  true,  and  they  admit  of  very 
general  appUcation.  There  is  one  pointy  which  I  think 
bears  upon  this  question,  which  you  have  not  alluded 
to.  Every  one  must  admit  that  our  appreciation  of  the 
value  of  medicine  is  at  a  very  low  ebb ;  but  there  is  a 
something  behind  which  too  many  of  us  are  apt  to  lose 
sight  of,  and  that  is  a  practical  knowledge  of  those 
iiemedies  which  are  really  useful  to  every  practitioner. 
The  student  only  learns  these  by  rote;  and  it  being  a 
mere  effort  of  memory,  their  physical  properties,  action, 
and  doses^  soon  pass  from  his  recollection.  He  is  not 
brought  into  practical  familiarity  with  them.  The 
teacher  of  this  branch  thinks  that  he  has  performed 
his  duty,  when  lecturing  upon  a  given  drug,  to  pass  the 
specimen  of  the  same  around  io  a  bottle,  and  tell  all 
about  it^  and  then  it  is  dropped ;  there  being  no  ac- 
count made  of  it,  except  a  few  lines  in  the  note-book. 
The  lecturer  on  the  practice  of  medicine,  unless,  as  you 
say,  he  dismisses  the  treatment  with  the  magic  words, 
"whiskey,  quinine,  and  iron,"  only  names  an*>eztra 
article  or  two  that  may  be  used ;  but  how  it  is  to  be 
employed,  and  in  what  doses,  he  does  not  generally 
care  to  state.  Even  if  he  did,  what  particular  practical 
utility  would  it  be  to  the  student,  if  it  is  not  stamped 
indehUy  upon  his  mind  by  some  other  means  ? 

Your  corr^ondent  believes  that  much  good  could 
be  done  in  this  connexion  by  vrriting  out  the  prescrip- 
tions which  each  patient  treated  in  the  clinics  is  to'  have. 
This  could  be  done  on  the  blackboard,  and  would  take  very 
little  time,  and  be  of  great  benefit  in  constantly  keep- 
ing before  the  mind  the  necessity  of  being  careful  and 
intelligent  prescribers.  In  order  to  render  such  an  ex- 
ercise more  impressive,  there  would  be  no  impropriety 
in  giving  the  reason  for  prescribint^  such  and  such  arti- 
cles, and  explaining  their  applicaMlity  to  the  particular 
case.  Every  young  practitioner  of  our  day  feels  that 
his  knowledge  of  materia  medica  is,  from  the  neglect  of 
his  teachers,  very  deficient;  and  when  he  is  called  upon 
to  prescribe  for  his  patient^,  he  is  naturally  difiktent 
about  writing  the  prescription  which  he  should.  His 
memory  merely  supplies  him  with  a  very  few  remedies 
to  select  from,  and  these  are  still  further  reduced  in  re- 
membrance, because  he  does  not  feel  sure  that  he  knows 
how  to  write  for  them.  The  oonsequenoe  is  very  easily 
seen;  and,  with  the  exception  of  a  few  that  he  baa 
selected  from  his  limited  list  and  combined  to  suit  him- 
self he  has  nothing  to  fall  back  on.  He  is  virtually 
discouraged  at  the  onset,  in  his  efforts  to  prescribe  ;  and 
not  wishing  to  be  counted  an  ignoramus  by  his  apothe- 
cary, he  makes  himself  believe  that,  after  all,  therapeu- 
tics is  a  good  deal  of  a  humbug,  all  medicines  act  pretty 
nearly  Jike,  there  is  no  certainty  in  any,  and  so  he  gets 
to  be  a  man  with  one  idea. 


But  a  mere  knowledge  of  the  names  and  uses  of 
medidties  cannot  make  accomplished  prescribers.  A 
physician  who  writes  a  prescription  should  know  how 
to  compound  it  himself.  Now,  how  is  it  possible  to 
possess  this  knowledge  in  the  present  system  of  instruc- 
tion in  materia  medica?  The  answer  is  a  very  nmple 
one.  He  should  at  first  get  behind  some  apothecary's 
counter,  and  should  learn  the  art  of  skilfully  and  intel- 
ligently "  putting  up  "  prescriptions.  No  such  instruction 
is  contemplated  in  omr  colleges^  and  I  am  sorry  to  say 
there  is  but  little  promise  that  it  will  be  done,  at  least 
for  along  time  to  come.  How  many  physicians  write 
for  articles  which  they  would  not  know  if  they  were 
shown  them  ?  Suppose  a  mistake  should  be  made  by 
the  apothecary,  would  it  be  likely  to  be  detected  by  the 
physician  who  might  have  the  mixture  presented  to 
nim  afterwards  ? 

In  conclusion,  I  submit  if  it  would  not  be  a  proper 
plan  to  recommend  the  different  teachers  to  write  their 
prescriptions  upon  the  blackboard  in  every  case  where 
a  prescription  is  given,  and  that  a  dispensing  depart- 
ment should  be  attached  to  each  college  sufficiently 
large  to  give  each  student  during  some  pa^  of  his  pupil- 
age a  sufficient  chance  to  compound  such  prescriptions. 
I  am,  sir,  truly  yours, 

G. 

Niv  TosK,  Febniaiy  •,  1887. 

ETHER  VERSUS  CHLOROFORM. 

To  TEE  BdROS  or  THB  MCDXOAL  BsOOBD. 

Sir— The  death  by  chloroform  which  recently  took 
place  at  Bellevue  Hospital,  gives  a  sad  interest  to  ihe 
question  of  surgical  ansssthesia.  The  repeated  accidents 
which  have  occurred  in  May,  1866,  in  Berlin ;  June, 
1866,  in  Philadelphia;  February,  1867,  in  New  York, 
have  naturally  enough  staggered  the  faith  of  many  sur- 
geons in  the  great  ansesthetic. 

Allow  me,  sir,  to  refresh  the  minds  of  your  readers 
with  reference  to  the  past  records  of  chloroform.  As 
early  as  1853,  Baudens  acknowledged  eighty  deaths, 
and  A.  Forze€  found  eighty-five.  In  1859,  Barrier  de 
Lyon  ascertained  that  there  had  been  above  two  hun- 
dred deaths.  Diday  collected  fi:om  that  date  to  1864, 
twenty-one  cases  registered  in  England,  leaving  at  least 
as  many  which  were  unrecorded.  K  there  was  another 
drug  instrumental  in  the  destruction  of  so  many  lives, 
would  it  not  be  ejected  fi^om  the  materia  medica  f  True, 
the  fault  has  been  put  on  the  impurity  of  the  article 
emploved ;  but  hOw  often  has  chloroform  been  used  in 
case  of  accident,  in  its  purity,  as  in  the  instance  at  Belle- 
vue ;  showing  tliat  it  need  not  borrow  its  toxic  proper- 
ties from  heterogeneous  substances.  Hence,  from  1847, 
the  date  of  the  beginning  of  the  use  of  ansdsthesia,  sur- 
eeons  have  been  divided  into  two  classes,  the  chloroform- 
ists  and  the  etherists ;  and  though  t^e  first-named  had,  at 
first,  the  advantage,  their  rivals  nave  steadily  persevered, 
patient  and  unrelenting,  in  their  efforts  to  demonstrate 
the  general  efficiency  and  the  absolute  safety  of  ether. 

In  1848,  Oantu  remarked  that  half  of  his  <mloroform- 
ized  fh>gB  died,  and  hardly  any  of  bis  etherized  one& 
Sedillor  admits,  at  the  same  date,  that  when  he  stope 
giving  ether,  anesthesia  may  continue,  but  in  no  case 
become  aggravated.  Not  so  with  chloroform;  when 
discontinued  after  insensibility  is  produced,  its  action  is 
continued,  its  symptoms  may  in  some  instances  cause 
death.  This  circumstance  constitutes  the  most  mvked 
difference  between  the  anassthetic  rivals. 

The  few  men  who  supported  this  view  ag^'nat  trium- 
phant chloroformists  found  an  early  and  eminent  repre- 
sentative in  T.  E.  Petrequin,  diief-surgeon  of  the 
Hotel  Dieu  de  Lyon,  For  nearlv^twenty  years  he  has 
Digitized  by  VjC  „       ^_ 


THE  MEDICAL  RECORD. 


45 


bttudied  chlorofonn  and  used  ether  in  that  hospital,  the 
largest  in  France,  where  from  fourteen  to  fifteen  tnou- 
saod  patients  are  treated  annuallj,  and  where  more 
operations  are  performed  than  in  any  other.  From  this 
tdling  experienoe,  Petrequin,  Didaj,  and  in  fact  TEcoIe 
de  Lyon,  assert  that  pure  ether  has  fur  years  accom- 
plished in  their  hands,  without  accident,  those  services 
that  chlorofonn  has  rendered  elsewhere  at  a  cost  of 
sereral  hundred  Urea  Is  not  this  quesiion  worthy  of 
farther  study  ?  Tours,  etc., 

E.  SBounr,M.D. 

BLEEDING  FROM  THE  TOOTH-SOCKETS. 

To  Tm  £drob  w  thb  Msdioaj.  Bwobd. 

Sa: — ^I  am  reminded  by  the  paper  and  discussion  at 
a  late  meeting  of  the  .East  River  Medical  Aeeodatian,  as 
rimorted  in  your  oolumns,  of  certain  foot-notes  in 
Okditu^  Syaiem  of  Sarger^^  by  the  translator,  Dr.  South, 
which  may  be  of  value  to  those  who  may  not  have 
aooess  to  the  work.  The  subject  of  "  haemorrhagic  dia- 
thesis "  is  rather  fully  alluded  to  under  the  heading  of 
''bleeding  from  the  tooth-sockets." 

A  case  is  there  related  of  a  person  in  whom  the  h»mor- 
fhagic  diathesis  was  very  strongly  developed,  who  bled 
to  &ath  after  the  extraction  of  a  second  molar  tooth  for 
caries  in  ^ite  of  the  apptication  of  the  following  remedies: 
lonar  caustic  to  the  bottom  of  the  socket,  a  sponfi;e-tent 
•oaked  in  a  solution  of  sulphate  of  copper,  followed  up  by 
atetoi  plugging  of  tlie  socket  Brodie,  who  had  been  con- 
soked,  after  three  applications  of  the  actual  oantery,  and 
carefol  plugging  as  before,  finally  resorted  on  the  fourth 
day  of  the  hssmorrhage,  which  had  been  subdued  only 
for  short  intermissions,  to  ligature  of  the  common  carotid 
artery.  The  wound  made  in  the  operation  bled  very 
fitUe  at  first,  but  in  the  course  of  a  few  minutes  after 
the  operation  it  began  to  bleed  profusely.  Ice  to  the 
wound,  and  ice  to  the  left  side  of  the  face,  appear  to  have 
had  some  effect ;  but  the  hsemorrhage  afterwards  return- 
ed and  carried  off  the  patient  (July  7,  1816),  a  week  from 
the  time  of  the  removal  of  the  tooth.  Another  case  is 
related  where  the  haemorrhage  succeeding  the  extraction 
of  two  teeth  at  different  periods,  was  checked  by  the 
t/hetuttl  application  of  the  actual  cautery,  after  failmre  of 
means  which  very  readily  suggested  themselves  under 
the  circumstances.  The  point  made  by  the  annotator  is 
that  the  heated  wire,  not  more  than  a  Une  in  thickness, 
sboold  be  made  to  descend  to  the  very  bottom  of  the 
socket,  and  thus  command  the  bleeding  vessel,  which  is 
the  proper  artery  of  the  tooth.  This,  Dr.  South  thinks, 
should  be  resorted  to  at  once  before  the  constitutional 
powere  are  disturbed,  and  before  a  latent  phthisical  ten- 
dency is  developed,  of  which  he  can  recall  an  instance. 
The  suggestion  I  think  a  valuable  one,  and  certainly 
BBore  rational  than  the  introduction  of  the  wax  model 
reeommended  by  Cortez,  or  the  internal  use  of  ergot 
by  Dr.  Byan,  whose  successes  are  to  be  regarded  rather 
it  coincidences  than  as  consequences. 

Tours,  etc., 

♦  ♦  ♦ 

AuAn^  H.  T.,  Martk  7,  ISST. 

^    »    WW 

A  COMMENT  UPON  AN  OBSCURE  PASSAGE 

To  nn  Svnoa  or  tn  Mmdkal  Bsoobd. 

8ib: — ^With  a  full  appreciation  of  the  sly  humor  of  your 
correspondent ''  B,'  who,  in  his  note  to  yon  of  the  20th 
fAf  ult.,  ffide  yd  iL,  p.  23,  has  taken  due  advantage 
of  a  typographical  error,  I  hasten  with  becoming 
iherity  to  do  a  simple  act  of  justice  to  the  gentleman 
who  bbss  thus  been  made  the  subject  of  mir&ful  com- 


ment. ''B,"  I  fear  after  the  manner  of  too  many  expound- 
ers, twists  his  text,  which  as  printed  reads :  *'  Amauro- 
tic symptoms  upon  which  a  diagnosis  of  cerebral  disease 
was  based,  according  to  Dr.  Watson,  were  in  no  case 
found  to  have  depended  in  reality  upon  a  plug  in  a 
defective  tooth." 

By  the  simple  substitution  of  one  for  ''no,"  the 
meaning  of  the  speaker  becomes  at  once  comprehensi- 
ble. So,  too,  the  reporter,  had  he  not  been  compelled 
to  write  against  time,  might  have  said,  had  been^  instead 
of  "  wa$  based ; "  and  even  besides  these  two  errors, 
might  never  have  allowed  a  rather  grave  one  of  construc- 
tion to  have  escaped  his  eye.  But  ^*  proofs  "  may  be  cor- 
rected ad  infinitum^  as  you  are  well  aware,  and  still  hare 
many  unaccountable  typographical  errors  left. 

Hoping,  in  common  with  aU  commentators,  for  a  cer- 
tain share  of  success  in  the  elucidation  of  darK  passages^ 
I  remain  truly  yours, 

N«wToM.Mwch«,18«T. 


©bituarg* 


PROFESSOR  HOWARD  TOWNSEND,  M.D., 
or  ALBurr. 

At  a  meeting  of  the  physicians  (^aduates  of  the 
Albany  Medical  College),  resident  in  Schoharie  and 
Delaware  counties,  held  at  Stamford,  Delaware  cocmty, 
February  2,  1867,  Dr.  C.  C.  Covil,  Chairman,  and  Dr. 
J.  D.  Havens,  Secretary,  the  following  preambles  and 
resolutions,  presented  by  Dr.  Havens,  were  adopted : — 

Whereas,  The  ways  of  Providence  are  not  as  our 
ways,  but  are  oft  mysterious  and  past  finding  out:  and, 

Whereas,  It  has  pleased  Divine  Providence  m  His 
inscrutable  wisdom  to  remove  from  us  in  the  full  rigor  of 
manhood,  in  the  midst  of  a  life  of  activity  and  useful- 
ness, our  beloved  friend,  associate,  and  medical  teacher. 
Dr.  Howard  Townsend,  who  recently  filled  the  chair  oi 
Materia  Medica  and  Physiology ;  therefore, 

Besohed,  That  we,  in  common  with  the  Faculty  and 
Alumni  of  the  Albany  College  Hospital,  and  other  in- 
stitutions, sadly  feel  Uie  loss  of  one  to  whom  we  feel 
deeply  indebted  for  much  of  our  knowledge  in  his 
special  department^  which  he  was  ever  rendy  and 
anxious  to  impart,  not  only  in,  but  out  of  the  lecture- 
roonL  We  shall  ever  feel  a  deep  sense  of  gratitude  fbr 
his  unwavering  solicitude  for  the  professional  advance- 
ment of  those  under  his  instructions. 

Besohed,  That  while  he  was  ever  careful  to  impart 
the  true  and  demonstrated  principles  of  science,  and 
reject  the  false  and  undemonstrtUed  (which  he  r^arded 
as  bursting  bubbles  on  the  great  ocean  of  knowfedge), 
he  kept  pace  with  its  onward  march,  and  ably  and 
honorably  filled  positions  of  trust  in  the  literary  and 
scientific  world.  JPro£  Townsend  was  not  only  the  true 
physician,  but  the  literary  man  and  scientist  By  his 
untiring;  energy  he  did  much  for  the  advancement  of 
true  prmciples,  true  science,  and  true  knowledge. 

Resolvedy  That  while  we  regret  with  heartfelt  sorrow 
his  early  death,  yet  we  bow  with  submission  to  the  will 
of  Him  "  who  doeth  all  things  weU."  That  we  wiU  ever 
cherish  a  lively  sense  of  trratitude  as  we  contemplate 
his  benevdent  qualities  of  heart,  his  urbanity  of  dispo- 
sition, hia  generous  impulses,  and  the  true  Christian 
eharader  which  marked  his  lue. 

Resolved,  That  we  extend  to  the  Faculty  of  the  Col- 
lege, and  to  the  literary,  scientific,  and  educational  socie- 
ties with  which  the  deceased  was  connected,  our  wonojf 
for  the  hreparaUe  loss  they  have  sustained ;  also,  our 


46 


THE  MEDICAL  RECOIID. 


heartfelt  eympathj  to  the  family  and^  friends  of  the 
deceased. 

Resolved^  That  a  copy  of  these  resolutions  be  present- 
ed to  the  family,  and  soso  be  published  in  the  Albany 
Argus  and  Bloomville  Mirror, 

C.  C.  Coville,  Preset,  Stamford,  Delaware  Co. 

J.  D.  Havens,  SeoV,  Jefferson.  Schoharie  Co. 

E.  W.  Gallup,  Jefferson,  Schoharie  Co. 

R  Gr.  Havens,  Jefferson,  Schoharie  Co. 

W.  S.  Layman,  Gilboa,  Schoharie  Co. 

Dr.  Norwood,  ConesviUe,  Sobohftrie  Co, 

H.  W.  Bell,  Croton,  Delaware  Ca 

O.  L.  Butts,  Bloomvil'e,  Delaware  Co. 

C.  S.  Grant,  Hobart,  Delaware  Co. 

J.  L.  AUabon,  Margaretville,  Delaware  Co, 

J.  B.  Van  Housen,  Stamford,  Delaware  Co. 

C.  A.  Gibson,  Bloomville,  Delaware  Co. 


ttetu  |Jubltcatt0n«* 


Annual  Report  of  ths  Dibbotobs  of  Mount  Sinai  Hos- 
pital.   Jan.  1867. 

Report  of  the  Sanitary  Relations  of  the  State  of  Kan* 
SAS;  by  C.  A.  Loqan,  H.D. 

Cases  of  (Esophagotomy  fob  the  Removal  of  PoRBmN 
Bodies,  with  a  history  of  the  operation ;  by  David  W. 
Chebver,  M.D.,  Assist  Prof,  of  Anat  in  Harvard  Univer- 
'  sity,  eta    Boston,  186t. 

Injuries  of  the  Spine,  with  an  Analysis  of  nearly  400 
Oases;  by  John  Ashhurst,  Jr.,  A.M.,  M.D.,  Fellow  of  tbe 
College  of  Pbjrsiciaos  of  Philadelphia.  Philadelphia:  J. 
B.  Lippincott  A  Co.    London:  Trilbner  <b  Co.,  18ttt. 

Contributions  to  the  Pathology,  Diagnosis,  and  Treat- 
ment OF  Angular  Ouryatubb  of  the  Spine  ;  by  Benja- 
min Lee,  M.D.    Philadelphia :  J.  B.  Lippincott  k  Co.,  1867. 

Report  of  the  State  Sanitary  Commission  to  thbOoyebp 
NOB  OF  New  Jersey. 

The  Indigestions  ;  or,  "  Diseases  of  the  Diobstite  Organs 
Functionally  Tbbated;"  byTnoiiAS  King  Chambers, 
Honorary  Physician  to  H.  R.  H.  Prince  of  Wales,  etc.  etc 
Philadelphia :  Henry  0.  Lea,  1897. 

Health  in  Oountby  and  OmB&  Pbizb  Essay,  Amebioan 
Medioal  Association.    W.  F.  Thoms,  M.D.,  N.  T. 

Gums  FOB  Using  Medical  Battebies,  etc.  ,  by  Alfbsd  C. 
Gabbatt,  M.D.,  Fellow  of  Mass.  Med.  Society,  and  Mem- 
ber of  American  Medical  Assodation.  Philadelphia :  Lind- 
say &  Blakiston,  1867. 

DiPHTHEBiA — A  Pbizb  Essay  ;  by  E.  S  Oaillakd,  M.D. 
Richmond,  Ya. 

Second  Annual  Rbpobt  of  the  Dibectors  of  the  Experi- 
mental School  fob  Idiots  and  Fbeble-Minded  Children. 
December,  1866. 

Communications  fbom  the  Gk)rBBN0B,  transmitting  the 
Report  of  the  Commissioners  appointed  to  locate  the 
Hudson  Riveb  Asylum  fob  the  Insanb  of  thx  Statb 
of  New  Yobk. 

Illustbatbd  Catalogub  of  Mathematical,  Optical,  and 
Philosophical  Inbtrumxnts.  By  J.  W.  Queen  k  Co., 
Philadelphia 

Watson's  Principlbs  and  Practice  of  Physic.  Abridgbd 
FROM  THE  Last  Edition.  jBy  J.  J.  Mbylob,  A.M.,  M.D. 
Philadelphia:  Published  by  the  Author.     1867.    Pp.  277. 

The  Science  and  Practice  of  Medicine.  By  Wiluam 
ArrKiN,  M.D.,  Edin.,  Professor  of  Pathology  in  the  Army 
Medical  School,  eta  In  two  volume&  Vol  IL  With 
Additions  by  Meredith  Clymer,  M.D.,  late  Professor  of 
the  Institutes  and  Practice  of  Medicine  in  tbe  University 
of  N.  Y.  Philadelphia :  Lindsay  &  Blakiston.  1866.  Pp. 
1,114. 

Inhalation  in  thb  Treatment  of  Disbasbs  or  thb  Rbs- 


piRATORY  Passages,  particularly  as  effected  by  the  use  of 
atomized^fluids.  By  J.  M.  DbCosta,  M.D.  Physician  to 
the  Pennsylvania  Hospital, eta  Philadelphia:  Lippincott 
A  Co.     1867.    Pp.  86. 


SSit^xttai  ttetu0  anlr  3tetn0« 


PEBSONAL. 

Medical  Department — ^U.  S.  A.  Appointmbnts. — To 
be  Chief  Medical  Purveyor,  with  the  rank  of  Lieute- 
nant-Colonel— Surgeon  Kichard  S.  Satterlee,  U.  S.  Army, 
to  date  from  July  23,  1866. 

To  be  Assistant  Medical  Purveyors,  with  the  rank  of 
Lieutenant-Colonel  all  to  date  from  July  23,  1866— 
Surgeon  Charles  McDougal,  IT.  S.  Army ;  Surgeon 
Eugene  H.  Abadie,  U.  S.  Army:  Surgeon  Robert 
Murray,  XT.  S.  Army ;  Surgeon  Charles  Sutherland, 
U.  S.  Aj-my. 

To  be  Surgeons,  all  to  date  fix)m  July  20,  1866— 
Assistant-Surgeon,  Clinton  Wagner,  U.  S.  Army ;  As- 
sistant Surgeon  Jos.  P.  Wright,  U.  S.  Army ;  Asdstant- 
Sur^n  Charles  C.  Gray,  U.  S.  A. ;  Assistant-Surgeon 
William  C.  Spencer  U.  S.  Army. 

To  be  Medical  Store-keepers,  all  to  date  from  July 
20,  1866— George  Wright,  of  Pennsylvania ;  George  T. 
Beall,  of  New  Mexico ;  Andrew  Victor  Cberbonier,  of 
Maryland. 

M.  Mabet. — The  celebrated  author  ai  the  Researches 
on  Ciretdation,  and  inventor  of  the  Sphygmograph, 
Marey.  has  iust  exchanged  his  position  of  Substitute  for 
that  or  Professor  Suppfiant  to  fiie  chair  of  Natural  His^ 
lory  of  Organic  Bodies,  in  the  College  of  France. 

De.  Wm.  H.  Thomson,  on  the  7th  instant,  delivered 
a  highly  interesting  lecture  on  Modem  Statistics  as  ap- 
plied to  Ancient  EGstory,  before  the  New  York  Histori- 
cal Society. 

Db.  Rcfus  E.  Bbowne,  on  the  sameeyening,  discoursed 
on  the  Nervous  System  of  Man  and  Animals,  before  the 
Association  for  the  Advancement  of  Science  and  Art 

Db.  Wm.  Manucb  Smith,  of  Manlius,  Onondaga  coun- 
ty, N.  T.,  desires  us  to  state  that  any  communications 
likely  to  add  to  our  knowledffe  of  the  properties,  etc.,  of 
Conium,  would  be  acceptable  to  tbe  above  address,  and 
that  due  credit  in  future  reports  will  be  given  to  the 
soarces  of  such  information. 

Db.  William  E.  Stillwell,  an  Alumnus  of  the  College 
of  Physicians  and  Su.-geons,  (class  1830),  and  memtSr 
of  the  Medical  Society  of  the  County  of  New  York, 
died  in  this  city,  February  6,  in  the  60th  year  of  bis 
age. 

Dr.  Samuel  Demabest,  of  the  Northern  Dispensary, 
died  February  10,  in  the  29th  year  of  his  age. 

Db.  Wm.  B.  Little,  American  Consul  at  Panama,  died 
of  yellow  fever,  January  29th  ult. 

Dbath  of  Db.  Henbt  Bbtant. — ^We  are  pained  to 
hear  of  the  death  of  Dr.  Henry  Bryant,  of  this  city, 
which  took  place  at  Porto  Rico  on  the  first  instant. 
Dr.  Bryant  was  passing  the  winter  in  the  West  Indies 
in  the  pursuit  of  nealth,  and  in  the  collection  of  objects 
of  natural  history.    He  was  an  entliusiastic  omltholo- 

g'st^  and  to  his  liberality  the  Boston  Society  of  Natural 
istory  is  indebted  for  the  recent  donation  of  the  mag- 
nificent La  Fresnaye  collection  of  birds.  No  particuLm 
concerning  his  death  have  been  as  yet  received. — Boskm 
Medical  and  SwrgiealJoumak      ^^  ^ 

Digitized  by  VjOOQ  IC 


THE  MEDICAL  RECORD. 


41 


AniRiCAir  Medioal  Absociatiok. — The  Eighteenth 
AoouaI  Meeting  of  the  American  Medical  Association 
wOI  be  held  in  Cincinnati,  on  Tuesday,  May  7,  1867, 
at  11  o'clock  AJL 

The  following  Committees  are  expected  to  report : — 

On  QuarantiDe,  Dr.  Wilson  Jewell,  Pa.,  Chairman ; 
On  Ligature  of  Subclavian  Artery,  Dr.  Willard  Parker, 
N.  Y.,  Chairman;  On  Progress  of  Medical  Science, 
Dr.  Jerome  C.  Smith,  N.  Y.,  Chairman;  On  the 
CcnnparatiYe  Value  of  Life  in  City  and  Country,  Dr. 
Edward  Jarvis,  Mass.,  Chairman:  On  Drainage  and 
Sewerage  of  Cities,  etc.,  Dr.  wrson  Jewell,  Pa., 
Chairman ;  On  the  Use  of  Plaster  of  Paris  in  Surgery, 
Dr.  Jas.  L.  Little,  N.  Y.,  Chairman ;  On  Prize  Essays, 
Dr.  F.  Donaldson,  Md,  Chairman ;  On  Medicad  Educfr- 
fon,  Dr.  S.  D.  Grojfl,  Pa.,  Chairman;  On  Medical 
Literature,  Dr.  A.  C.  Post,  N.  Y.,  Chairman ;  On  In- 
rtruction  in  Medical  Colleges,  Dr.  Nathan  S.  Davis,  III., 
Chairman ;  On  Eank  of  Medical  Men  in  the  Army,  Dr. 
D.  H.  Storer,  Mass.,  Chairman ;  On  Rank  of  Medical 
Men  in  the  Navy,  Dr.  W.  M.  Wood,  XJ.S.K,  Chair- 
maa;  On  Insanity,  Dr.  Isaac  Ray,  R.  I.,  Chairman; 
On  American  Medical  Necrology,  Dr.  C.  C.  Cox,  Md., 
Chairman  •  On  the  Causes  of  Epidemics,  Dr.  Thomas 
Ant^eell,  D.  C,  Chairman;  On  Compulsory  Vaccina- 
tion, Dr.  A.  N.  Bell,  N.  Y.,  Chairman ;  On  Leakage  of 
Gas-Pipej8,  Dr.  J.  C.  Draper  N.  Y.,  Chairman;  On 
Alcohol  and  its  Relations  to  Man,  Dr.  J.  R.  W.  Dunbar, 
Mi,  Chairman  ;  On  the  Various  Surgical  Operations 
for  the  Relief  of  Defective  Vision,  Dr.  M.  A.  Pallen, 
Mo ,  Chairman  ;  On  Local  Anaesthesia,  Dr.  E.  Kracko- 
wizer,  N.  Y.,  Chairman ;  On  the  Influence  upon  Vision 
of  the  Abnotmal  Conditions  of  the  Muscular  Apparatus 
of  the  Eye,  Dr.  H.  D.Noyes,  N.  Y.,  Chairman;  On  the 
Comparaiive  Merits  of  the  Different  Operations  for  the 
Extraction  of  Tesical  Calculi,  Dr.  B.  I.  Raphael,  N.  Y., 
Chairman ;  On  the  Therapeutics  of  Inhalation,  Dr.  J. 
Solifl  Cohen,  Pa.,  Chairman ;  On  the  Deleterious  Arti- 
cles used  in  Dentistry,  Dr.  Augustus  Mason,  Mass., 
Chairman  ;  On  Medical  Ethics,  Dr.  Worthington  Hook- 
er, Conn.,  Cliairman ;  On  the  Climatology  and  Epide- 
mics of  Maine,  Dr.  J.  C.  Weston ;  of  New  Hampshire, 
Dr.  P.  A.  Stackpole ;  of  Vermont,  Or.  J.  Henry  Janes ;  of 
Maasachasetts,  Dr.  Alfred  C.  Garratt;  of  Rhode  Island, 
Dr.  C.  W.  Parsons;  of  Connecticut,  B.  H.  Catlin ;  of  New 
York,  Dr.  R  M.  Chapman ;  of  New  Jersey,  Dr.  Ezra  M. 
Hunt;  of  Pennsylvania,  Dr.  D.  F.  Oondie;  of  Delaware, 

Dr. Wood;   of  Maryland,  Dr.  O.  a  Mahon;    of 

'Georeia,  Dr.  Juriah  HarriBs;  of  Missouri,  Dr.  Qeo, 
JEngdman ;  of  Alabama,  Dr.  R.  Miller ;  of  Texas,  Dr. 
Owensnlle  Dowell;  of  Illinois,  Dr.  R.  C.  Hamil;  of 
lodiana,  Dr.  J.  F.  Hibberd  •  of  the  District  of  Columbia, 
Dr.  T.  Antisell ;  of  Iowa,  Dr.  J.  W.  H  Baker ;  of  Michi- 
gan, Dr.  Abm.  Sager ;  of  Ohio,  Dr.  J.  W.  Russell. 

Secretaries  of  all  medical  organizations  are  requested 
to  forward  lists  of  their  Delegates  as  soon  as  elected,  to 
the  Permanent  Secretary, 

W.  B.  Atkinsok,  M.D, 
215  bpruce  st , 

Philadelphia,  Pa. 

HiDicAL  Education  of  Women  in  Europe  ano  Ameri- 
ca.—A  small  audience  gathered  on  the  evening  of  the 
SSdkult,  at  the  Hall  of  the  N.  Y.  Historical  Society,  to 
liat^  to  a  lecture  by  Dr.  Elizabeth  Blackwell,  entitled 
^The  Medical  Education  of  Women  in  Europe  and 
America." 

Prerions  to  the  commenoement  of  the  lecture  Rich- 
aid  H.  Bbownb,  Esq.,  made  a  few  remarks  with  refer- 
eooe  to  the  history  and  workings  of  the  New  York 
Infixmary  for  Women  and  Children  during  the  past  thir- 
teen years.    The  lecturer  of  the  erenuig,  he  added, 


would  speak  in  support  of  the  Hospital  College  for 
Women,  recently  chartered  by  the  State  Legislature, 
and  which  it  is  hoped  will  soon  be  in  successful  opera- 
tion in  this  city. 

Dr.  Elizabeth  Blackwbll  then  said,  substantially : 
While  travelling  in  Europe  last  summer,  she  had  ob- 
served, with  great  interest,  the  increasing  attention 
which  was  being  paid  to  the  subject  of  femde  medi- 
cal education.  She  found  that  tms  idea  of  giving  to 
women  a  wider  knowledge  of  medicine  than  has  ever 
been  attempted  before,  is  no  longer  an  entirely  new 
subject,  as  it  was  in  Europe  sixteen  years  ago.  It  is  a 
subject  of  ridicule  to  some,  of  doubt  to  more,  of  decided  . 
approbation  to  a  few;  but  whatever  tlie  leeling  with 
which  1%  is  regarded,  it  is  no  longer  ignored.  Full 
credit  or  blame  is  attached  to  America  for  having  ori- 
ginated this  bold  experiment  of  doctorshin,  and  the  lead- 
mg  medical  journals  of  England  uneasily  assure  their 
readers  from  time  to  time,  that  this  foolish  American 
humbug  is  quite  exploded.  Nevertheless,  the  lady-doc- 
tor is  taking  root  even  in  England.  The  interest  of  the 
work  there  clusters  around  Miss  Elizabeth  Garrett, 
who  has  won  a  legal  footmg  in  the  profession  as  Licen- 
tiate of  the  Apothecaries'  Hall,  and  who  has  been  for 
some  time  established  as  a  medical  practitioner  in  Lon- 
don. The  French  Medical  School  of  Algiers  has  adso 
admitted  a  lady  student  to  its  classes,  offering  her  the 
same  education  and  the  same  diploma  that  it  gives  to 
its  male  students.  Such  instances  of  the  admission  of 
women  into  medical  schools  have  never  occurred  be- 
fore ;  it  is  entirely  a  new  experiment,  directly  due  to 
the  influence  of  American  example.  Some  t  me  ago, 
the  Emperor  of  Russia  gave  a  distinct  commission  to 
Dr.  H  D«  Hawrowitz,  who  was  sent  over  to  inquire  into 
the  sanitary  condition  of  our  armies,  to  report  also 
upon  what  part  women  were  taking  in  medicine.  This 
special  commission  grew  out  of  the  application  of 
twenty-five  Russian  ladies  for  admission  into  the  medi- 
cal schools  of  St.  Petersburgh ;  and  as  Russia  did  not 
want  to  lead  in  an  innovation,  she  sent  to  see  what 
America  was  doing.  Last  year,  a  commission  from  the 
Swedish  government  visited  England  for  a  similar 
purpose,  fifteen  young  ladies  having  applied  for  the 
privilege  of  entering  the  medical  college  or  Stockholm. 
Thus,  in  the  most  enlightened  nations  of  Europe  atten- 
tion has  been  called  to  this  new  idea  of  giving  to  women 
the  complete  education  of  the  physician ;  and  though 
no  institution  has  yet  been  formed  for  providing  this 
higher  education  (the  old  schools  of  midwi ves  being  still 
the  only  system  of  instruction),  yet^  if  the  experiment 
succeed  in  this  country,  it  will  undoubtely  be  followed 
abroad.  The  speaker  then  urged,  at  great  length,  the 
necessity  of  united  effort  and  liberal  assistance  in  found- 
ing in  this^  the  Metropolis  of  the  New  World,  a  college 
worthy  of  our  people,  in  which  females  who  desired  to 
do  so  might  gain,  through  a  proper  course  of  study  and 
practice,  a  'thorough  knowledge  of  the  science  of  medi- 
cine. 

At  the  close  of  the  lecture,  which  was  listened  to  wiUi 
unbroken  interest,  the  financial  report  of  the  Hospital 
College,  in  prospect,  was  read  by  K  B.  Minturk,  Esq. 
The  paper  set  forth  that  the  College  had  received  it4 
charter  firom  the  State  Legislature,  but  that  in  order  to 
carry  out  its  provisions  $100,000  were  needed.  Of  this 
amount  $25,000  had  already  been  subscribed,  and  it 
was  hoped  that  the  deficiency,  though  lar^e,  would 
soon  be  made  good.  A  number  of  subscriptions  were 
then  offered  by  persons  in  the  hall,  after  which  the 
audience  dispersed. 

The  Third  Ankval  Rbukiov  of  ths  O.  M,  Sogistt, 
BsiJkYini  Hospital  Ukdicjj*  Coklsoe,  too^  place  on 

Digitized  by  VjOOQ IC 


48 


THE  BfEDICAL  RECORD, 


the  evening  of  February  25th,  in  the  leetore-room 
of  the  institution.  The  auditorium  was  filled  by  a  large 
assemblage  of  students  and  fHends,  male  and  female. 
Dr.  Gkorge  R  Kent  presided,  who^  in  a  neat  address, 
inaugurated  the  anniversary  exercises,  which  included 
an  essay,  *'  The  Healing  Art,"  by  J.  W .  Read,  of  New 
York;  a  poem,  by  J.  Russ  Evans,  of  Ohio;  an  address 
to  the  students  and  graduates,  by  Prof.  Geoi^T.  Elliott, 
M.D.,  and  responses  to  the  foUowine  reeular  toasts : — 
Bellevue  Hospital  Medical  College,  the  Faculty,  Alumni 
and  members  of  the  0.  M,  Society,  and  the  Ladies,  by 
Dr.  James  R.  Wood,  Dr.  Frank  H.  Hamilton,  Dr.  Charles 
A,  Lee,  and  Dr.  Louis  A,  Sayre.  The  intellectual  enter- 
tainment was  agreeably  interspersed  with  instrumental 
selections  from  standard  operas,  which  pleasingly  varied 
the  proceedings.  At  the  annual  election  of  the  Society 
the  following  gentlemen  were  chosen  as  oflScers  for  the 
ensuing  year : — ^Ed.  0.  Harwood  of  Vermont,  Presi- 
dept;  William  Sprague,  of  New  York,  Vice-President; 
C.  G.  Stedman,  of  Ohio,  Secretary,  and  J.  W.  Bowden, 
of  New  York,  Treasurer. 

The  Annual  Commenokxent  or  thb  Medical  Dipabt- 
lONT  or  THE  New  York  Univebsitt  came  off,  March  1, 
in  the  chapel  of  the  institution.  There  was  a  large 
attendance  on  the  occasion,  with  an  interesting  and 
handsomely  carried  oat  programme.  The  valedictory 
address,  which  was  short  and  suggestive,  was  delivered 
by  Professor  John  C.  Draper,  who  congratulated  the 
graduates  upon  the  completion  of  their  college  course, 
and  pictured  the  duties  that  devolved  upon  them,  and  the 
honor  that  perhaps  awaited  manv  of  them  in  the  exer- 
cise of  the  most  honorable  of  all  the  learned  professions. 
Eight  prizes  were  awarded  for  distinguished  progress  in 
their  studies  to  as  many  students.  A  social  supper  closed 
the  Commencement  exercises. 

Thb  Annual  Commenosmbnt  or  Bellevue  Hospftal 
MEnicAL  College  was  held  at  Steioway  HMl,  on  the 
28th  ult  Prof.  Isaac  E.  Taylor.  President  of  the  Col- 
We,  conferred  the  degree  of  M.D.  upon  140  graduates, 
or  whom  forty-four  were  from  New  York,  and  the  re- 
mainder containing  representatives  from  nearly  every 
State  in  the  Union,  including  Georgia,  Mississippi,  Lou- 
isiana, and  Virginia. 

Afber  the  degrees  had  been  conferred,  the  address  to  the 
graduates  was  delivered  by  John  G.SAXE,E8q.,  the  poet 
and  humorist.  Being  in  one  of  his  happiest  moods,  he 
sent  forth  a  vast  fund  of  common  sense,  concerning 
"doctors  and  patients,"  his  thoughts  at  times  being 
clothed  in  the  most  grotesque  garbs.  The  valedictory, 
by  F.  B.  MoNbal,  MJ).,  of  the  graduating  class,  and  a 
most  artistic  rendition  by  the  orchestra  of  Bosquet's 
''  Nightingale  Polka,"  closed  the  exercises  of  the  even- 
ing. 

Long  Island  College  Hospital. — The  regular  term 
of  lectures  in  the  Collegiate  Department  of  the  Long 
Island  College  Hospital,  was  commenced  March  2. 
Darwin  G.  Eaton,  M.D.,  Professor  of  Chemistry  and 
Toxicology,  was  introduced  by  Dr.  T.  L.  Mason,  rresi- 
dent  of  the  Collegiate  Department,  and  delivered  a 
very  interesting  lecture  on  motion,  heat^  etc.,  making 
several  experiments  in  the  way  of  illustration.  To  show 
the  force  of  gravitation  he  drew  a  five-pound  weight  to 
the  ceiling,  a  height  of  sixteen  feet,  letting  it  fall  to  the 
floor.  This  weight,  before  reaching  the  floor,  he  said, 
was  going  with  double  the  speed  it  was  when  it  start- 
ed, showing  that  it  was  at  the  rate  of  thirty-two 
feet  per  second.  This  was  precisely  the  rate  of  speed 
of  all  motion,  for  should  this  weight  continue  falling,  it 
would  not  fiill  faster  than  thirty-two  fbet  per  second. 
He  held  that  the  motion  was  not  destroyed  by  the  strik- 


ing of  the  weight  upon  the  ground.  If  he  had  a  deli- 
cate thermometer  he  would  show  that  the  weight  bad 
become  heated  by  the  motion.  Heat  was  therefore 
obtained  from  motion;  and  to  illustrate  this  he  struck  a 
copper  wire  several  times  with  a  hammer,  produdnff 
heat  enough  to  light  alcohol.  Fire  might  be  produced 
in  three  different  ways— by  percussion^  friction,  aod 
compression,  and  be  gave  illustrations  m  each.  He 
spoke  of  the  motion  ot  the  earth  and  said  that,  accord- 
ing to  the  calculation  of  Dr.  Meyer,  if  the  world  should 
come  in  contact  with  another  body,  the  concussion 
would  be  sufficient  to  set  fire  to  and  bum  fourteen 
such  worlds. 

The  First  Annual  Comicenoement  of  the  New  York 
College  of  Dentistry  was  held  at  Steinway  Hall,  March 
6.  The  Degree  of  D.D.S.  was  conferred  upon  nine 
graduates,  and  speeches  were  delivered  by  Dr.  Eleasar 
Parmly,  Pre  ident  Board  Trustees:  His  Hon.  Mayor 
Hoffman,  and  Professor  Frank  H.  Hamilton. 

Alumni  Association,  Universitt  Meuioal  College. 
— After  several  informal  meetings,  an  organization  of  a 
Society  of  the  Alumni  of  the  Medical  Department  of  the 
University  of  the  City  of  New  York,  was  completed  on 
Friday  evening,  March  6,  in  the  oonncil-room  of  the 
University.  The  following  officers  were  elected :  Dr. 
Samuel  S.  Purple,  of  N.  Y.,  President,  class  of  1844; 
Dr.  J.  B.  M*Cann,  of  Virginia,  class  of  1843 :  Dr.  Solo- 
mon Sachwell,  of  N.  C,  class  of  1845;  Dr.  Daniel 
Ayres,  of  Brook^,  class  of  1846 ;  Dr.  Henry  S.  Hewit> 
class  of  1847;  Dr.  James  R.  Learning,  of  N.  Y.,  class  of 
1849;  Dr.  Frederick  D.  Lente,  of  Cold  Spring,  class  of 
1849,  Vice-Presidents;  Dr.  H.  Mortimer  Brush,  1862, 
Secretary;  Dr.  Gkorge  K.  Smith,  of  Brooklyn,  1859, 
Treasurer  J  Dr.  H.  M.  Sprague,  of  West  Farms,  1861, 
College  Historian;  Dr.  Gkorge  T.  Elliot,  Orator.  Coun- 
cillorsw  compriung  one  from  each  class,  were  also  elected, 
as  well  as  a  Committee  of  Nominations  and  Arrange- 
ments. It  was  voted  that  a  meeting  be  held  in  Octo- 
ber, when  the  address  of  Dr.  Elliot  is  to  be  delivered, 
and  an  alumni  supper  given.  There  was  a  lar^  attend- 
ance of  the  dumni  residents  in  N.  Y.  and  vicmity. 

Bellevue  Medical  College — Alumni  Assoctation.-;- 
A  meeting  of  graduates  of  the  Bellevue  Hospital  Medi- 
cal College  was  held  at  the  college  lecture-room,  on 
the  28th  ult,  by  adjournment  from  a  similar  meeting 
on  the  26th,  for  the  purpose  of  taking  preliminary  steijs 
towards  the  organization  of  an  association  of  the  alumni ; 
Dr.  L.  M.  Yale  in  the  chair.  A  committee,  appointed  ' 
at  the  previous  meeting,  presented  a  partial  report  upon 
a  form  of  organization,  which  was  recommitted  with 
instructions  to  report  in  full  at  a  general  meeting  of  the 
alumni  of  the  college,  to  be  held  at  the  same  place 
on  the  evening  of  Thursday,  28th  March,  at  eight 
o'clock. 

PoST-PaRTUM      KfilfORRHAOE     ARRBSTEn     BT    EtHBR 

Sprat  Exterhallt.— Dr.  Braxton  Hicks  (Lancet)  re- 
ports a  case  of  the  successful  application  of  the  ether 
spray  to  post-partum  hssmorrhage.  •  The  usual  remedies 
were  at  nrst  resorted  to,  and  failed;  but  the  nebulizer 
caused  the  uterus  instantly  to  contract^  and  so  it  re- 
mained. 

Cbolbra  m  Durham. — The  townships  of  Cozhoe 
and  Quarrington  (near  Durham)  have  lately  been  visited 
with  cholera.  Both  tliese  villages  suffered  severely 
during  the  epidemic  in  1849.  The  sanitary  authorities 
are  exercising  eveiy  precaution  against  its  tpreMd, 


EtMAXJL.—Fagt  eUTMi,  flrtt  eolumii,  tUth  tin*  from  bottom  cf  JMS^ 
Ibr  Lo*briek  read  LUbrtichj  Ibr  Mcfort,  flfUi  line,  thA  r^ehu ;  *m^ 
Une,  for  0114/9  read  #fi<l.  SeooBd  eoHimii,  liMUth  lloo  tt«m  (of^  m 
•fl^toy^rto^  roikd  rScyWa^tm wf ;  alfhth  Uoo,  fcr  tmciom$  nU 

Digitized  by  VjOOQIC 


THE  MEDICAL  RECORD.  40 


Digitized  by 


Google 


50 


THE  MEDICAL  RECORD. 


FW.  B. 


Itg,  VI. — An  upright  supporting  a  pulley  wheel  o,  to 
be  fastened  to  the  ^ooi"  ^7  ^^^  screwa^  opposite  the 
foot  of  the  bed. 


F10.& 


MODI  or  APPLIOATIOll. 


The  bacdB  of  adhesive  plaster  are  first  to  be  ^)plied, 
ane  on  either  side  of  the  limb  from  a  point  above  the 


ankle  upwards  as  high  as  the  seat  of  fracture.  The  limb 
is  then  to  be  bandaged  in  the  usual  manner,  beginning 
at  the  toes  and  covering  the  plasters^  but  leaving  their 
lower  ends  free.  The  band  of  elastic  webbing  is  next 
passed  round  the  sole  of  the  foot  and  fastened  to  the 
buckle  on  the  other  side  of  the  foot.  The  block  of 
wood  should  then  be  interposed  between  the  loop  of 
webbing  and  the  foot  A  cord  fastened  to  the  block 
thus  adiusted  is  passed  oyer  the  pulley,  and  has  a  weight 
suspended  from  itw  This  arrangement  combines  elas- 
ticity with  the  extending  force,  keeps  the  bands  stretch- 
ed out  smooth,  and  prevents  pressure  upon  the  ankles. 
The  amount  or  weight  required  must  be  proportioned  to 
the  resistance  to  be  overcome,  and  the  toleration  of  the 
patient.  Sometimes  five  or  six  pounds  only  can  be 
borne  at  the  outset,  and  an  increased  weight  subee- 
quently. 

After  a  fi-acture  has  taken  place  the  sooner  the 
limb  is  put  up  and  subjected  to  treatment  the  bet- 
ter. Spasmodic  twitchings  of  the  muscles  are  con- 
trolled, and  the  patient  made  comfortable  from  the  out- 
set. To  permit  the  application  of  lotions  to  the  seat  of 
injury  during  the  first  few  days,  the  bandar  should 
not  be  carri^  above  the  knee,  and  the  ends  of  the  plas- 
ter should  be  rolled  up  and  kept  in  reserve.  At  the 
end  of  six  or  eight  days  the  plasters  may  be  extended 
up  on  the  thigh,  and  the  bandage  contined  over  them. 
TiiB  coaptation  splints  are  now  to  be  applied  around 
the  thigh  and  secured  by  the  three  elastic  bands.  To 
complete  the  apparatus  the  perineal  band  should  be  ad- 
justed and  its  ends  fastened  to  the  head  of  the  bedstead, 
so  as  to  be  in  a  line  with  the  axis  of  the  body  and  limb. 
The  limb  should  be  raised  on  a  hair  cu^on  sufficiently 
to  keep  the  heel  from  pressure. 

In  the  empk>yment  of  this  method  of  treatment,  ex- 
perience has  shown  that  in  a  large  majority  of  cases  the 
use  of  the  perineal  band  nukj  be  dispensed  with,  the 
weight  of  tne  body  being  sufficient  to  resist  the  extend- 
ing force.  This  resistance  may  be  further  increased 
by  raising  the  foot  of  the  bedstead  five  or  six  inches 
above  the  floor. 


jLDTAjrrJLQta  of  the  method. 

The  advantages  claimed  for  this  method  over  others 
heretofore  io  use,  are  its  great  simplicity  of  arrange- 
ment^ facility  of  management,  and  especially  the  com- 
fort it  affords  the  patient  during  a  long  confinement  in 
bed.  The  efficiency  with  which  uninterrupted  exten- 
sion of  the  limb  can  safely  be  kept  up,  secures,  it  is  be- 
lieved, better  results  than  have  been  obtained  by  any 
other  method.  The  sitting  posture  may  be  allowed 
without  disturbine  the  action  of  the  apparatus:  an  in- 
dulgence for  which  patients  are  always  very  grateful, 
ana  one  which  greatly  alleviates  the  irksomeness  of 
their  condition.  The  materials  required  for  employing 
thb  treatment  are  obtainable  under  almost  any  circum- 
stances, the  on?^  indispensable  article  being  adhesive 
plaster.  U  this  is  of  the  ordinary  description,  it  is  bet- 
ter to  use  it  of  double  thickness.  All  the  other  articles 
requisite  may  be  improvised.  The  elastic  band  may  be 
dispensed  with,  and  a  round  stick  properly  placed  across 
the  foot  of  the  bedstead  may  serve  instead  of  a  pulley. 


BBSULTS  or  TRIATMKMT. 

The  following  statement  shows  the  results  of  this 
method  of  treatment  in  the  New  York  Hospital  since 
September,  1860,  a  period  of  ax  zqm. 

Digitized  by  VjOOQ  IC 


THE  MEDICAL  RECORD. 


61 


T  TAL  VUlfBER  OF  SDCPLB  FRACTCTRES  OF  SHAFT  OF  08 
FEMOBIS  TREATED.  146  CA8IS,  AGED  FBOM  2  TSARS  TO 
63  TEARS. 


Under  15  years  of  age,  54  «?««,  of  which  45  moto,  9 
female. 


PrfmltiTe  8hort<»nlDg 
in  46  of  54  cues. 


)i  inch  to  2H  inches. 
Arerage  1  hi  iochesw 


Weight  employed  in 


S  pounds  to  90  ponnds. 

Average   not  quite  9 

poundi* 


Result  of  TrestmeDt 
in  the  54  CMOS. 


No   Shortening  In  88 


Ifaximnm  of  Shorten- 
ing, 1  inch  in  9  eases. 

Ayerege  of  total  54  es- 
ses, about  1-6  inches. 


Over  15  years  of  age,  92  cases,  of  which  79  male,  13 
female. 


frimftiTe  Shortening 
in88or»i 


H  Ineh  to  9)4  inches. 
ATerage  i}i  inches. 


Weight  employed    in 
T9 


8  pounds  to  98  pounds 
ATerage  li)i  pounds. 


Result  of  Treatment  in 
89  cases  reourded. 


No   Shortening  in    19 


Maximum  of  Shorten- 
ing. IX  inches  in  9 


Arerage     scarcely    X 
inch. 


In  all  cases  the  measurement  was  taken  with  a  gra- 
duated tape  from  the  anterior  superior  spinous  process 
of  the  ilium,  to  the  extremity  of  the  internal  malleolus. 

The  employment  of  a  weight  and  pulley,  for  the  pur- 
pose of  maintaining  constant  extension  of  the  limb  in 
the  treatment  of  morbus  coxariua,  was  first  brought  to 
the  notice  of  the  medical  profession  in  New  York  by 
Henry  G.  Davis,  M.D.,  and  to  this  source  the  author 
acknowledges  his  indebtedness  f  r  the  suggestion  of  its 
application  to  the  treatment  of  6*acture  of  the  thigh. 

APPLICATION  OF  THE  METHOD  TO  STUMPS. 

Another  important  application  of  the  weight  andpjul- 
ley  extension  has  been  made  by  A.  Herraance  Smith, 
M  D.,  Assistant  Surgeon  U.  S.  Army,  to  the  treatment 
of  stumps  of  the  lower  limb,  in  which  retraction  of  the 
soft  parts  leaves  the  end  of  the  bone  exposed,  and  some- 
times necessitates  re-amputation.  It  was  first  employed 
by  Dr.  Smith  in  the  U.  S.  Army  Gh?neral  Hospital  at 
Frederick,  Maryland,  in  September,  1862. 

Subsequently,  Assistant-Surgeon  Robt.  P.  Weir, 
M.D.,  in  charge  of  the  same  hospital,  extended  its  use  to 
the  treatment  of  stumps  immediately  afler  amputation 
to  prevent  painful  twitchings,  and  found  it  afforded 
great  comfort  to  the  patient,  and  that  without  interfer- 
ing with  the  application  of  the  requisite  dressings  to 
the  stump. 

It  has  since  been  extensively  employed  in  civil  as 
well  a8  military  practice,  and  its  superiority  established 
as  the  best  means  we  possess  of  preventing  retraction. 


Causb  or  Cholera. — ^Dr.  Klob  has,  with  the  use  of  a 
microscope  of  from  eight  hundred  to  a  thousand  magni- 
fying power,  discovered  in  the  rice-water  evacuations, 
milliona  of  microsoopic  fungi,  which,  in  appearance, 
differ  little  from  the  ordinary  European  forms;  ana 
that  they  form  the  basis  of  the  frightful  malady,  and 


The  Hiohist  Point  Inhabited. — The  highest  inha- 
bited place  upon  the  face  of  the  globe  is  a  farm-house 
situated  13,500  feet  above  the  level  of  the  sea,  or  about 
two  miles  and  a  half  above  the  level  This  lofty  and 
e'evated  habitation  is  situated  near  the  highest  peaks 
of  the  Andes  in  South  America.  ObimboraEO,  which 


that  cholera  is  easily  propagated  by  their  mean^,  can '  rises  to  21,449  feet  above  the  level  ofgthe  sea. — Ho- 
iCKcely  BDj  longer  be  doubted.  |  change.  ^.^^.^^^  ^^  (^^      ^ 


52 


THE   MEDICAL  RECORD. 


CASES  OF  SUB-MUCOUS  FIBROID  TUMORS 

OF  THE  UTERUS. 

By  WM.  warren  GREENE,  M.D., 

PBomsoB  or  subobt  nr  BraxsHrms  mbdioal  oollbob,  ahit  dt  thb 
xbdioAl  school  or  maikb. 

In  the  autumn  of  1864, 1  was  consulted  by  Mrs. of 

Hampden  co.,  aged  53.  She  was  not  married  until 
after  the  termination  of  her  menstrual  life,  which  ceased 
eleven  years  ago.  About  eight  years  ago,  she  began 
to  sufifer  from  pain  and  sensations  of  weakne.«8  and 
dragging  througn  the  pelvis,  accompanied  by  occasional 
slight  hemorrhages.  Within  the  last  three  years  there 
had  been  a  marked  aggravation  of  all  these  symptoms, 
especially  of  the  hiemorrhage,  which  for  the  year  past 
had  amounted  to  alarming  floodings.  several  of  which 
attacks  had  nearly  proved  fatal,  and  rrom  the  effects  of 
one  of  which  she  did  not  have  time  to  r^illy  before 
another  occurred. 

She  was  now  extremely  anaemic  and  debilitated,  and 
her  nodnd  anxious  and  depressed. 

She  had  been  under  the  care  of  several  physicians,  all 
of  whom  had  pronounced  her  disease  the  '*  turn  of  It/eJ' 
One  had  made  a  vaginal  examination  and  pronounced 
the  uterus  healthy. 

When  will  physicians  learn,  and  through  their  lady 
patients,  that  a  woman  with  heaUhy  utertu  and  ovaries 
passes  out  of  her  menstrual  life  as  safely  as  she  enters 
it?  It  is  a  burning  shame  that  this  term  should  be 
used  as  often  as  it  is,  to  cover  professional  ignorance  or 
carelessness,  and  thousands  of  poor,  suffering  women 
be  physically  ruined,  simply  from  tile  want  of  an  intel- 
ligent  exammation  of  the  reproductive  organs,  and  the 
proper  treatment  thereot 

Upon  examination,  I  found  the  uterus  considerably 
enlarged,  smooth  and  regular  in  outline,  and  the  neck 
obliterated.  There  was  no  dilatation  of  the  os.  The 
impression  everywhere  given  to  the  finger,  and  espe- 
cially in  the  posterior  cm-de^-aac  of  the  vagina^  and  per 
rectum,  was  that  of  a  firm  body  within  the  cavity  of  the 
womb.  A  sound  passed  five  and  a  half  inches  along 
the  anterior  wall  of  the  uterus,  but  if  curved,  it  could 
not  be  rotated  in  the  cavity.  The  impression  conveyed 
by  it  was  that  of  a  firm  mass  occupying  the  posterior 
and  upper  portion  of  the  cavity.  I  now  coounenced  the 
dilatation  of  the  os  with  sponge-tents.  I  was  obliged  to 
do  this  slowly,  as  the  process  caused  her  much  pain  and 
nausea.  At  the  end  of  a  week  it  was  completed,  and 
with  my  hand  in  the  vagina  I  could  examine  the  cavity 
of  the  uterus  digitally.  Just  within  the  os  on  the  poste- 
rior wall  was  felt  a  tumor,  regular  in  ouUine  and  impart- 
ing a  yielding  semi-elastic  feehng  to  the  finger.  It  was 
evident  that  there  was  something  more  above  this;  but 
its  size  and  location  prevented  a  satisfactory  exploration 
of  the  upper  portion  of  the  cavity. 

The  patient  was  now  etherized  and  placed  in  the 
ordinary  position  for  lithotomy.  With  the  assistance  of 
Drs.^  Smith,  Brewster,  and  Paddock,  I  operated  in  the 
following  manner :  Having  seized  the  posterior  lip  with 
Museux's  forceps  and  dragged  the  organ  downwutis  as 
far  as  practicable,  the  instrument  was  placed  in  the 
hands  of  an  assistant,  and  with  a  long-handled,  probe- 
pointed  bistourr  I  divided  the  mucous  membrane  over 
the  surface  of  the  tumor,  which  I  then  with  the  fingers 
and  lithotomyscope  enucleated  and  removed.  It  ap- 
peared to  be  a  soft  fibroid,  and  was  so  tender  as  to  break 
into  many  fragments  during  its  removal  A  firm  mass 
could  now  be  felt  above,  and  the  mucous  membrane 
was  incised  from  the  fimdus  downwards.  With  the 
scoop  and  handle  of  the  bistoury,  the  tumor  was  so  far 
uncovered  as  to  enable  me  to  seize  it  with  a  Itfge  pair 


of  lithotomy  forceps  and  turn  it  from  its  bed.  It  was 
too  large  to  pass  through  the  o«,  and  was,  therefore, 
divided  into  two  paits  and  removed.  It  was  a  firm 
fibrous  tumor,  presenting  the  lobulated  condition  which 
so  often  obtains  in  fibroids  of  the  parotid  region.  The 
hsemorrhage  during  the  operation  was  considerable, 
although  not  alarming.  Alter  the  uterine  cavity  was 
cleared,  it  soon  ceased  without  any  interference.  The 
shock  to  the  system  was  severe ;  tor  several  hours  the 
pulse  was  very  feeble,  surface  and  extremities  cold,  and 
the  respiration  sighing.  By  the  following  morning, 
however,  reaction  was  fairly  established ;  and  under  tiie 
influence  of  anodynes  pro  re  natdj  twenty-three  drops 
of  the  muriated  tincture  of  iron  every  four  hours,  a 
nourishing  diet,  and  frequent  vaginal  injections  of 
warm  chlorinated  solutions,  she  recovered  without  a 
bad  symptom.  In  three  weeks  she  was  able  to  return 
home.  In  the  following  spring  she  called  upon  me,  on 
her  way  to  Iowa  to  visit  some  friends,  a  strong,  healthy, 
happy  woman,  having  had  no  return  of  hemorrhage  or 
pain* 

Cask  II. — ^Mrs. ,  aged  fifty,  was  married  when 

twenty-eight;  never  was  pregnant;  ceased  menstruat- 
ing when  forty ;  always  enjoyed  good  health  until  the 
spring  of  1863,  when  she  began  to  suffer  from  pain 
through  the  lower  portion  of  the  abdomen  and  pelvis, 
associated  with  occasional  discharges  of  blood  firom  the 
vagina.  These  haemorrhages  gradually  increased  in 
amount  and  frequency,  as  did  the  pain  in  severity,  until 
she  became  anaemic  and  much  debilitated,  being  obliged 
to  assume  the  recumbent  posture  the  greater  part  of 
the  time.  It  was  during  an  attack  of  Hooding  that  I 
first  saw  her  with  her  physician.  Dr.  Brewster,  in 
September,  1865.  The  blood  flowed  from  the  os  uteri, 
wWch  to  the  eye  and  touch  presented  a  natural  appear- 
ance. The  body  of  the  organ  was  slightly  retronected, 
and  its  posterior  wall,  with  that  of  the  upper  portion  of 
the  cervix,  enlarged  and  firm,  and  unyieldmg  upon 
pressure.  At  first  I  was  inclined  to  think  this  inflam- 
matory hypertrophy  and  induration ;  but,  upon  intro- 
ducing the  sound,  the  cavity  of  the  uterus  seemed  to 
be  slightiy  encroached  upon  at  a  point  corresponding 
with  the  external  swelling.  I  was  now  satisfied  that 
we  had  to  deal  with  some  morbid  growth  in  the  walls 
of  the  uterus,  but  whether  benign  or  malignant  was 
not  clear.  To  control  the  haemorrhage,  and  at  the  same 
time  open  the  o$  for  further  examination,  a  sponge-tent 
was  inserted,  which  it  was  intended  to  follow  with 
larger  ones  of  graduated  sizes,  until  thorough  dilatation 
was  accompliMied.  The  process,  however,  was  so 
painful,  and  her  debility  so  extreme,  that  we  were 
obhged  to  wait  until  her  strength  was  built  up,  relying  in 
the  meantime  upon  injections  of  Monsel's  solution  into 
the  cavity  to  control  the  hsemorrhage.  This  in  full 
strength  controlled  the  bleeding  for  the  time  being,  and 
gave  very  little  pain.  If  diluted  to  any  extent,  how- 
ever, it  produced  severe  uterine  tormina,  Tr.  iodine 
imdiluted  was  used  sef  era!  times,  but  it  did  not  prove 
sufficiently  styptic,  although  it  gave  very  little  pain. 
In  about  three  months  we  were  enabled  to  dilate  the 
OS  satisfactorily.  The  patient  was  placed  upon  the  back 
exposed  to  a  good  light,  and  the  posterior  lip  seized 
with  tenaculum  forceps  and  the  organ  dragged  well 
down  into  the  vagina.  I  was  now  enabled  to  carry  the 
finger  within  the  womb  above  the  point  of  swelling, 
which,  from  this  examination  conjointiy  with  a  rectal 
exploration  with  the  forefinger  of  the  opposite  hand, 
evidently  arose  from  a  small  fibroid  imbedded  in  the 
uterine  tissue.  The  mucous  membrane  over  the  tumor 
was  abraded,  and  blood  oozed  fcovn  its  surface.  Having 
introduced  a  Sims  speculum,  I  incised  the  mucous  mon- 
brane  with  a  scalpel    The  tumor,  however,  was  covered 


THE  MEDICAL  RECORD. 


58 


hy  m  layer  of  uterine  fibres,  which  were  divided ;  and 
mer  a  tedious  dissection,  performed  principallj  with 
the  handle  of  the  scalpel,  a  scoop,  and  the  nngers,  tlie 
tomor,  about,  the  size  of  a  pullet  s  egf^j  was  removed. 

The  principal  difficulty  attending  the  operation  arose 
from  the  intimate  blending  of  the  growth  with  the 
sorroandin?  parts.  So  close  was  this  that,  of  necessity. 
some  shreds  of  the  normal  structure  were  removed 
dormg  the  operation,  and  fragments  of  the  tumor  left 
behind,  which  were  afterwards  thrown  off  as  sloughs. 
There  was  considerable  h»morrbage,  which  was  con- 
trolled by  persulphate  of  iron.  No  anesthetic  was  used, 
and  the  patient  bore  the  operation  very  well  She  was 
kept  qniet  in  bed;  anodynes  given  pro  re  natd;  tr. 
feiri  murias,  twenty  drops  every  four  hours,  and  a 
Uand  nutritious  diet  ordered;  va^na  to  be  washed 
twice  a  day  with  chlorinated  lotions.  For  several 
weeks  there  was  considerable  sanguineo- purulent  dis- 
duurge,  and  after  this  had  ceased  she  had  for  three  or 
foor  months  occasional  slight  hemorrhages,  giving  rise 
to  a  suspicion  that  other  growths  of  a  similar  nature 
mi^t  exist  higher  up  in  the  cavity.  A  careful  exami- 
nation, however,  revealed  nothing,  and  it  was  hoped 
that  the  bleeding  proceeded  from  the  site  of  the  ablated 
tomor,  xucatrization  not  being  complete.  Tr.  iodine 
was  injected  repeatedly,  and  eight  months  ago  she  had 
the  last  appearance  of  blood.  Three  weeks  since  she 
called  at  my  office  and  reported  herself  in  perfect  health, 
a  statement  which  her  general  appearance  ^Ily  corro- 
borated. 

In  this  connexion  I  would  say  that  I  have  repeatedly 
naed  injeetions  of  liq.  ferri  persulph.  and  tr.  iod. 
midilated  into  the  womb,  and  nave  never  encountered 
any  serious  result&  In  another  patient  of  Dr.  Brew- 
sto^s  from  whose  eervioi  vieri  we  removed  a  fibroid, 
aod  with  whom  I  had  much  to  do,  we  repeatedly  made 
these  injections  with  but  little  subsequent  disturbance, 
iHkile  a  solution  of  moderate  strength  of  iodine  gave 
exoesfflve  pain. 

Cass  ElI.— Oct.  Ist  1864,  was  called  to  see  Mrs.  T., 
of  Madison  oo.,  N.  i .,  in  consultation  with  the  late 
Pro£  Timothy  Ghilds,  M.D.  For  two  years  and  a  half 
die  had  been  suffering  from  pelvic  and  abdominal  pain, 
aooompanied  by  frequent  and  oftentimes  alarming  ute- 
rine hemorrhaffes.  Eighteen  months  before  she  noticed 
a  firm  tumor  or  considerable  size  in  the  hypogastrium, 
which  had  gradually  increased  until  now  she  was  as 
large  as  a  woman  seven  months  pregnant  The  diagno- 
sis of  several  physicians  who  had  previously  examined 
her,  was  ovarian  tumor.  The  fact,  however,  that  the 
tomor  was  hard,  a  recnlar  ovoid  in  shape,  occupying 
the  median  line,  resembling  precisely  a  gravid  uterus ; 
and  that,  per  vaginam^  the  reel  was  that  of  a  child's 
head  within  the  uterine  cavity,  and  also  that  Simpson's 
sound  was  not  long  enough,  even  when  the  handle  was 
carried  clear  to  the  of,  to  reach  the  fundus,  the  instru- 
ment hogging  closely  the  anterior  wall,  and  not  admit- 
ting of  rotation  of  curve ;  proved  that  we  had  an  intra- 
uerine  tumor  mtuated  upon  the  posterior  wall  of  the 
(Vgan«  That  it  was  sessile,  was  evident  from  the  fact 
that  at  no  point  could  a  sound  be  passed  behind  it. 

As  ProC  Ghilds  left  for  New  York  at  this  time,  the 
patieDt  came  into  my  hands  for  treatment  For  the 
porpose  of  a  more  thorough  examination,  I  dilated  the 
m  with  sponge-tents  sufficiently  to  enable  me  to  touch 
with  the  tip  of  the  finger  Uie  lower  portion  of  the  tumor. 
The  parts  -Were  very  rigid,  and  the  process  of  dilatation  a 
veiT  tedious  one.  The  sensation  imparted  to  the  finger 
and  Uurooffh  the  aound  was  that  of  a  soft  fibroid  growth, 
and  I  mwSe  a  crucial  indsion  in  the  lower  portion  and 
inserted  pledgets  of  lint  saturated  with  glycerole  of 
psfdiloride  of  iron,  with  the  hope  of  producing   a 


slough.  In  this,  however,  I  was  disappointed,  and  I 
repeated  the  tents,  determined,  if  possiUe,  to  produce 
more  complete  dilatation,  and  then  to  repeat  the  in- 
cision more  extensively.  For  this  purpose  I  had  some 
very  large  tents  made  of  thoroughly  compressed  sponge, 
changing  them  every  two  days,  until  tne  os  was  satis- 
factorily opened.  I  visited  her  one  morning  with  the 
intention  of  i^ain  incising  the  mass,  when,  on  removing 
the  tent,  I  u>und  attached  to  it  a  little  irregularly 
shaped  mass  as  large  as  a  filbert^  which  I  judged  to  be 
a  portion  of  the  tumor,  and  which  my  friend  and  part- 
ner. Dr.  Paddock,  found  on  microscopic  examination, 
to  possess  the  structure  of  a  soft  fibroid.  It  now 
occurred  to  me  that  possibly  with  tents  of  large  sise 
carried  &r  up  between  the  anterior  uterine  wall  and  the 
tumor,  a  sufficient  amount  of  pressure  might  be  pro- 
duced to  destroy  enough  of  tne  mass  to  insure  the 
sloughing  of  the  remainder ;  it  being  well  known  that 
the  vitality  of  these  growths  is  so  low,  that  if  any  con- 
siderable portion  be  destroyed,  destruction  of  the  bal- 
ance soon  follows.  Accordingly  I  selected  the  largest 
sponges  I  could  find,  from  which  Mr.  Geo.  Meade,  of 
this  place,  made  me  some  tents,  varying  in  length  from 
four  to  six  inches.  One  of  these  I  pushed  entirely 
wiihin  the  uterine  cavity,  a  loop  of  tape  to  which  it 
WBs  firmly  attached  hanging  from  the  os.  For  twelve 
hours  subsequently  she  experienced  very  severe  pain, 
like  the  throes  of  ordinary  labor;  the  tent  was  re- 
tained, however,  till  the  next  day,  when  it  was  removed 
and  a  larger  one  introduced.  Upon  the  removal  of  the 
sixth  tent,  it  was  followed  by  several  small  fragments 
of  the  tumor,  and  upon  thoroughly  rinsing  the  uterus 
with  warm  water,  the  discha^d  fluid  was  loaded  wi^ 
little  particles  of  the  same,  rroia  this  time  the  process 
of  destruction  went  on.  There  was  a  constant,  and 
of^ntimes  profuse,  offensive  discharge,  loaded  with  par- 
ticles, shreds,  and  lumps  of  the  tumor,  occasionally  a 
mass  as  large  as  a  hen's  egg  being  thrown  off,  for  the 
ready  expulsion  of  which  it  was  occasionaUy  necessary 
to  dilate  the  contracting  os;  and  sometimes  a  larger 
mass  detaching,  which  I  crushed  with  forceps  to  facili- 
tate its  exit  from  the  cavity.  This  process  occupied 
fully  four  months  for  its  completion,  during  which 
time,  it  is  hardly  necessary  to  say  that  the  patient's 
sufferin<;s  were  extreme,  and  her  situation  oftentimes 
very  critical  She  had  by  inheritance,  however,  a  fine, 
elastic  constitution,  and  in  addition  to  a  high  degree  of 
intelligence,  possessed  an  unusual  amount  of  moral 
courage. 

The  uterus  and  vagina  were  thoroughly  washed 
twice  a  day  with  warm  solutions  of  compound  solution 
of  bromine,  tr.  ferri  murias,  in  twenty  to  forty  drop 
doses  three  or  four  times  daily,  stimulants  and  anodynes 
pro  re  natdj  and  a  full  nutritious  diet  given.  She  has 
had  no  hssmorrhage  since  June,  1866.  The  following 
September  I  made  a  carefiil  examination  and  found  the 
process  of  uterine  involution  to  have  advanced  con- 
sideraUy.  No  discharges.  Had  regained  her  color,  and 
to  a  considerable  degree  her  flesh  and  strength.  Made 
another  examination  one  year  ago  to-day.  Uterus 
much  smaller  than  in  September.  Had  had  no  dis- 
charge, and  expressed  herself  as  feeling  perfectly  well. 
Last  April  she  moved  to  Illinois  with  her  £unilv,  where 
she  now  resides  in  perfect  health.  I  hear  u'om  her 
dmost  every  week  through  her  numerous  friends  who 
reside  here,  to  one  of  whom  she  wrote  a  fortnight  since, 
"  I  am  perfectly  well" 
PmsnxLDi,  T' 


Public  Urinals. — ^A  bill  is  to  be  introduced  into  the 
New  York  Legislature  establishing  public  urinals  in  the 
city  of  New  York. 


Digitized  by 


Google 


54 


THE  MEDICAL  RECORD. 


A  CASE  OF 
INTERNAL    ADMINISTRATION    OP    CHLORO- 
FORM FOR  SUICIDAL  PURPOSES. 

DEATH  ON  THE  BIQHTH  DAY  rROM  ACUTE  OABTBITIS;     POST- 
MOBTEM  BXAMINATION  ;    WITH  OTHER  OASES. 

Br  0.  D.  POMEROY,  M.D. 

Mbs.  D.,  aged  forty-five,  on  Sunday,  Dec.  19,  at  hklf 
past  one  p.  m.,  swallowed  from  five  to  nine  fluid 
drachms  of  chloroform,  in  an  undiluted  state,  for  the 
purpose  of  self-destruction.  At  the  time  she  was  just 
recovering  from  a  drunken  debauch,  to  which  she  was 
occasionaSy  subject.  Physicians  were  immei  liately  sent 
for,  but  none  could  be  obtained  until  half-past  four  p.  m., 
when  Dr.  Stout  came. 

He  found  the  patient  in  a  state  of  profound  coma, 
extremities  cold,  pube  about  70,  and  feeble.  Death 
•eemed  so  imminent  that  no  effort  was  made  to  coun- 
teract the  effects  of  the  poison. 

From  the  attendants  I  learned  that  the  chloroform 

f  reduced  sleep  in  a  very  few  minutes ;  the  exact  time 
could  not  determine. 

At  seven  p.ic.,  Dr.  S.  saw  the  patient  agiun ;  she  had 
somewhat  reacted^  but  it  was  still  impossible  to  arouse 
her.  The  extremities  were  now  warm,  pulse  about  80, 
and  pretty  full  At  ten  p.ir.  she  recovered  conscious- 
ness, would  speak  if  spoken  to,  but  seemed  disin- 
clined to  notice  things.  An  intense  burning  pain  at  the 
epigastrium  was  from  this  time  until  death  a  constant 
symptom. 

A  bowl  of  strong  coffee  was  administered,  which  pro- 
duced no  sensible  effect.  A  movement  of  the  bowels, 
somewhat  resembling  coflbe-grounds.  now  occurred. 
Vomiting  commenced  soon  after,  ana  continued  with 
varyinff  intervals  until  the  termination.  The  attend- 
ants left  her  at  twelve,  midnight,  and  did  not  see  her 
r'n  until  next  morning ;  she  then  said  she  had  not 
^  t  during  the  nighty  but  seemed  drowsjr,  and  occa- 
sionally would  sleep  for  a  few  minutes.  This  condition 
of  things,  however,  did  not  remain  long^  as  during  a 
greater  part  of  the  day  there  was  no  mclination  to 
fueep.  The  Doctor  saw  the  patient  again  on  Monday 
morning,  and  diagnosticated  the  case  as  acute  gastntis. 
The  principal  symptoms  now  were,  intense  pain  in  the 
epigastrium^  and  constant  vomiting.  The  liquor  calcis, 
flour  and  mdk  were  administered,  and  a  blister  on  the 
epigastrium.  < 

There  was  no  movement  of  the  bowels  afler  the  one 
just  alluded  to. 

The  patient  complained  of  a  hackine  cough;  re- 
spiration somewhat  unpeded — the  mind  clear. 

At  no  time  was  she  inclined  to  take  nourishment,  as 
she  had  never  relented  in  her  desire  and  determination 
to  die. 

On  Tueiday,  five  grains  of  calomel  were  laid  dry  on 
the  tongue,  but  were  returned  by  vomiting  as  soon  as 
swallowed  j  at  the  same  time  beef-tea  was  given  per 
anum,  which  was  passed  almost  immediately— condi- 
tion of  things  not  materially  changed. 

Wednesday,  as  the  result  of  a  consultation,  a  pill  con- 
taining two  grains  of  calomel  and  one-eighth  ol  a  grain 
of  morphine  was  given  once  in  four  hoxir^,  until  tliree 
were  taken;  milk  punch  was  also  administered,  but  was 
aoon  rejected  by  vomiting — ^respiration  a  little  worse, 
pain  in  the  stomach  less. 

On  Thursday f  the  vomiting  was  less  frequent ;  there 

was  no  sleep^  other  symptoms  remaining  as  before,  ex- 

ecfpt  a  jaundiced  condition  of  the  skin  and  eyes,  which 

gradually  increased  miUl  death. 

Friday ^  dosed  at  intervals^  although  was  easily  arous- 


ed ;  no  nourishment  was  taken,  as  it  would  be  retained 
by  neither  the  stomach  nor  bowels.  There  was  vom- 
iting of  blood,  evidently  from  the  stomach,  of  a  dark- 
colored  matter  and  partially  coagulated. 

On  Saturday,  Dr.  S.  saw  the  patient  with  another 
medical  gentleman,  when  an  enema  of  quinine,  brandy, 
morphine,  and  beer-tea,  was  given,  which  was  instantly 
rejected.  There  was  some  vomiting  of  blood,  but  less 
than  on  the  previous  day. 

Sunday^  she  drank  a  glass  of  milk,  and  eat  a  little 
bread  and  milk,  being  the  only  nourishment  retained 
fix)m  the  first  The  physician  in  attendance  did  noth- 
ing, as  the  case  seemed  hopeless.  There  was  no  vomit- 
ing, but  most  of  the  remaining  symptoms  were  intensi- 
fied, especially  the  tendency  to  coma,  and  the  dyspncea. 
She  gradually  sank  and  died  at  half-past  twelve  AJf. 
The  amount  of  blood  thrown  up  was  a  little  more  than 
half  a  pint  The  mucous  membrane  of  the  tono^e, 
mouth,  and  fauces,  was  eroded  by  the  action  of  the  chlo- 
roform. 

Post-mortem  examination  at  half-past  three  p.m^ 
Monday.  No  external  signs  of  disease;  rigor  mortis 
fairly  marked;  patient  very  fat,  weighing  nearly  two 
hundred  pounds ;  heart  containing  a  moderate  amount 
of  blood  and  somewhat  fatty;  left  lung  imperfectly  col- 
lapsed and  slightly  adherent  to  the  pleura,  but  other- 
wise healthy;  right  lung— lower  lobe — ^in  a  state  of 
grey  hepatization;  other  portions  healthy;  liver,  nor- 
mal size,  fatty,  and  presenting  signs  of  commencing 
cirrhosis  in  one  of  its  lobes;  kidneys,  about  normal  siae 
and  a  Uttle  granular;  oesophagus,  presented  nothing 
worthy  of  observation;  thcstomacn  exhibits  a  pretty 
decided  fulness  of  its  blood-vessels,  with  a  spot  of  extra- 
vasation on  the  inner  surface  of  its  wall  nearly  an  inch 
in  diameter;  its  mucous  membrane  at  tnis  point  seems 
to  be  destroyed,  and  undoubtedly,  had  the  disease  pro- 
gressed further,  a  perforation  of  the  entire  wall  of  the 
stomach  would  have  resulted.  The  vomited  blood,  and 
the  coffee-colored  passage  (undoubtedly  blood),  very 
probably  came  firom  the  stomach. 

It  seems  reasonable  to  suppose  that  gastritis  was  the 
cause  of  death,  of  course  superinduced  by  the  chloro- 
form, which  seems  to  have  acted  as  a  corrosive  poison ; 
the  narcotic  effect  of  the  drug  not  destroying  or  doing 
more  than  somewhat  endangering  life,  the  (quantity 
taken  being  insufficient,  as  cases  like  the  following  suffi- 
ciently prove. 

A  soldier,  aged  twenty-seven,  on  furlough  and  in  a 
state  of  dnmkenness  for  several  days  past^  seeing  a  bot- 
tle on  a  table,  which  he  thought  contained  alcohol,  drank 
off  its  contents,  which  consisted,  in  feet,  of  twelve  and  a 
half  drachms  of  chloroform. 

He  was  found  soon  after  vomiting,  and  soon  became 
insensible,  still  continuing  to  discharge  mucosities.  The 
pupils  were  enormously  dilated,  and  his  a'^pect  was 
cadaveric;  respiration  was  stertorous,  the  pulse  100  and 
feeble,  and  the  action  of  the  heart  oocasionally  tumultu- 
ous. There  were  present  utter  loss  of  consciousness, 
complete  resolution  of  the  limbs,  and  absolute  general 
ansestbesia. 

After  a  short  period  the  puh^  became  insensible,  the 
respiration  was  arrested  every  now  and  tlien,  and  there 
was  tracheal  rdle.  Stimuli  to  the  surface  and  artificial 
respiration  were  resorted  to,  and  strong  coffee  infusion 
injected.  The  alarming  condition  continued  three  hours, 
the  ansdsthesia  remaining  complete  and  the  pupils  dilat- 
ed, while  occasional  contraction  of  the  hrtbs  was  ob- 
served. 

An  hour  later,  however,  the  pulse  rallied  and  the  skin 
became  warmer,  but  anaesthesia  still  persisted.  At  the 
end  of  the  sixth  hour,  the  amehoration  was  very  mani- 
fest^ and  in  another  hour  he  was  carried  to  the  hospital 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


55 


He  retained  no  memory  of  what  had  passed,  and  nei- 
ther convulsions  nor  delirimn  ensaed,  and  next  day  he 
complained  of  little  but  what  might  be  due  to  his  excess 
in  drinking.  Reported  to  Medical  Society  of  the  Haut 
Rhin,  and  published  in  Union  Med.y  No.  127,  and  the 
Medical  Times  and  OaxeUe,  Nov.  5^  1864. 

H.  Pringle  reports  a  case  for  James  Spencer,  Esq., 
Edinburgh,  in  BraiGiwaxt^*  Retrospect^  part  34,  p.  295, 
in  which  two  ounces  of  chloroform  were  swallowed  by 
a  female  servant,  aged  twenty-one,  in  the  Royal  Infir- 
mary. Edinburgh,  without  causing  death.  It  is  due  to 
the  pnysidans,  however,  to  state  that  the  preservation 
of  life  was  undoubtedly  due  to  the  very  zealous  and 
effective  treatment  she  was  subjected  to. 

Her  symptoms  were  somewhat  as  follows,  viz.  per- 
fiect  miconaciousness  when  first  observed;  twenty  min- 
utes after  taking  the  drug,  there  was  no  smell  of  chlo- 
rafonn  in  the  breath ;  pupils  much  contracted ;  con- 
junctive quite  insensible ;  pulse  at  first  not  much  af- 
fected, but  eventually  entirely  disappeared  for  a  short 
period ;  respiration  at  first  little  to  be  noticed,  but  after- 
wards was  reduced  to  two  or  three  per  ndnute,  and  for 
two  minutes  ceased  altogether  and  tne  jaw  fell ;  half  an 
hour  aflerwards,  however,  there  were  signs  of  return- 
ing animation ;  the  pulse  gained  strength ;  the  breath- 
ing became  less  embarrassed.  Her  hreaih  now  smelted 
of  Moro/orm;  pupils  widely  dilated;  sensibility  of 
conjunctivae  retnmmg;  extremities  recovering  their 
warmth ;  consciousness  slowly  returning.  In  six  hours 
after  taking  the  chloroform  she  answer^  when  spoken 
to;  on  the  next  day  perfectly  sensible ;  pulse  100,  soft; 
respiration  unembarrassed;  pain  in  abdomen;  thirst 
and  great  nausea;  tongue  moist  and  considerably  swol- 
len and  painfuL 

For  the  next  three  or  four  days  had  pain  in  the  bow- 
els, and  tenderness  when  pressed  upon ;  some  vomiting 
and  purging  (blood  being  passed) ;  pulse  pretty  rapid, 
etc    On  the  25th^  returned  to  her  work. 

The  treatment  m  this  case  was  sinajHsms  to  the  ex- 
tremities and  to  the  epigastrium;  stomach-pump 
(emetics  could  not  be  swallowed),  mustard  introduced 
into  the  stomach  by  the  pump,  again  to  be  withdrawn ; 
aromatic  spirits  of  ammonia  and  brandy  introduced  by 
the  same  means;  stimulating  enemata;  tongue  held 
forwards  by  forceps  to  prevent  closure  of  the  glottis; 
enemata  of  beef-tea  and  brandy,  often  repeated;  gal- 
ranism  and  artificial  respiration. 

A  black  draught  was  administered  by  the  stomach- 
pump,  in  order  to  dislodge  the  chloroform  from  the 
bowete,  which  evidently  succeeded.  After  conscious- 
ness was  restored,  the  white  of  egg,  mucilage,  and  warm 
milk,  were  administered ;  hot  fomentations  to  bowels ; 

r'  kte ;  swallowing  pieces  of  ice  occasionally ;  leeching 
epigastrium  and  applying  sinapisms  to  the  spine; 
beef-tea  by  the  mouth,  etc. 

The  artificial  respiration,  assisted  by  the  galvanism, 
seems  to  have  done  the  most  towards  resuscitating  the 
patient  The  author  is  inclined  to  recommend  ammo- 
nia, instead  of  alcohol,  in  treatment,  as  the  latter  is 
prone  to  add  still  further  to  the  excess  of  carbon  in  the 
Mood,  the  efi*ect  of  chloroform  poisoning,  for  it  (the 
chloroform)  seems  to  resemble  extreme  drunkenness. 

The  smell  of  chloroform  in  the  respiration  not  being 
present,  forty  minutes  afVer  taking  it,  and  being  present 
when  the  patient  commenced  to  rally,  seems  to  look  to 
its  extreme  rapidity  of  absorption,  and  its  presence  in 
the  bowels ;  hence  the  propriety  of  the  black  draught 
to  operate  upon  them.  The  same  author  speaks  of  the 
only  case  of  the  kind  he  ever  saw,  in  wnich  a  man 
swallowed  nas  ounces  of  chloroform^  but  recovered  from 
the  immediate  effects  of  the  drug  by  galvanism  and 
artificial  respiration,  "  but  died  in  forty-eight  hours,  in 


great  agony,  with  symptoms  of  acute  gastritis."  The 
poison  from  chlorofcnrm  he  ooiopares  to  that  of  opium, 
but  remarks  that  "  the  diminution  of  the  firequency  of 
the  respiration  was  not  proportionate  to  the  amount  of 
stupor."  A  case  is  quoted  ftt)m  Mr.  Lowe,  from  the 
same  source,  in  which  a  patient  having  inhaled  chloro- 
form was  saved  by  artificial  respiration,  when  the  pulse 
and  respiration  had  been  arrested  for  /our  minutes! 
Mother  case  of  fatal  poisoning  by  chloroform,  with  the 
post-mortem,  is  so  interesting  I  am  induced  to  qnote ; 
it  is  from  Dr.  W.  P.  Bain,  Surgeon  to  the  Poplar  Hospi- 
tal, reported  in  the  London  Lancet  for  June,  1859,  p. 

The  Dr.  was  called  at  7  am,  on  27th  October,  to 
see  Mrs.  D. ;  found  her  insensible,  head  resting  on  her 
breast,  countenance  of  death-like  paleness ;  mouth  open, 
eyelids  half  closed,  eves  turned  up,  pupils  shghtly  con- 
tracted, and  scarcely  affected  by  light;  pulse  84, 
moderately  frill;  breathing  abdominal  without  stertor; 
surface  and  extremities  warm;  total  insensibility.  A 
bottle  labelled  ''  chloroform,'*  and  found  in  the  room, 
fumished  the  due  to  the  cause  of  the  symptoms.  Water 
injected  into  the  stomach  by  the  pump  was  soon  reject- 
ed, tinged  with  bile;  sinapisms  were  applied  to  the 
neck,  <£est,  and  feet;  continued  insensible  and  motion- 
less for  many  hours,  with  the  exception  of  periodic 
vomiting,  which  took  place  with  difficulty ;  respiration 
being  stopped  for  half  a  minute,  until  a  prolonged 
stertorous  inspiration  would  be  taken,  when  the  respira^ 
tion  woidd  be  resumed  with  its  former  regularity ;  these 
attacks  becoming  more  infrequent  until  1  p.m.,  when 
the  eyelids  would  move  upon  irritating  the  eye ;  pulse 
100.  At  3,  more  sensibleL  pulse  lOO;  forearm  and 
fingers  livid-looking,  and  inclined  to  be  cold ;  feet  warm ; 
vomited  a  large  quantity  of  bile.  Six  p.m.;  pulse 
120;  answers  questions;  great  tenderness  in  the  epi- 
gastrium ;  fffices  and  urine  passed  involuntarily ;  the  oaor 
of  chloroform  very  strong  in  the  hreath.  Half  past  10 
P.M.;  pulse  160;  skin  warm;  no  headache;  thirsty, 
and  stiU  inclined  to  sleep. 

Says — In  consequence  of  trouble,  she  arose  at  3  a.m. 
and  mixed  a  wine-glassful  of  chloroform  with  an  equal 
quantity  of  water  and  swallowed  it,  and  retired  to  bed. 

As  the  narcotic  effects  of  the  chloroform  had  passed 
off,  effort  was  made  to  subdue  the  acute  gastritis  set  up 
by  its  corrosive  action. 

Effervescing  and  acid  drinks  were  given,  counter- 
irritatiou,  anodynes,  etc.,  employed  for  a  week ;  she 
exhibiting  all  the  symptoms  of  acute  gastritis,  and 
dying  on  the  eighth  day. 

The  amount  of  chloroform  taken  was  undoubtedly, 
from  the  best  information  obtainable,  correctlv  stated. 
Thirty-six  hours  after  taking  the  chloroform,  the  smell 
was  perceptible  in  her  breath. 

Post-mortem,  forty  hours  after  death.  I  will  quote 
only  the  appearances  of  the  stomach. 

**  The  surface  of  stomach  much  congested,  and  it  was 
much  contracted  about  the  middle  portion,  forming  two 
distinct  pouches ;  when  opened,  an  escape  of  gas^  pos- 
sessing a  very  ammoniacal  smell,  took  place;  the  inter- 
nal coats  were  highly  inflamed;  the  rugae  of  the 
depending  portion  krger  than  usual,  and  very  pulpy ; 
the  mucous  and  musciuar  coats  for  about  a  circle  of  two 
inches  in  diameter  near  the  cardiac  orifice,  were  entirely 
eroded,  the  peritoneal  only  remaining  on  its  surface. 
The  surrounoing  parts,  on  the*  contrary,  were  deeply 
vascular:  perforation  had  also  taken  place  near  the 
pylorus.'^  "  The  chief  points  of  interest  in  this  case, 
are  the  large  quantity  of  chloroform  taken,  without 
causing  sp^y  death;  the  long  time  (about  twehrs 
hours)  of  total  insensibility ;  the  permanence  of  odor 
in  the  breath ;  and  the  entire  absence  of  head  symp- 


56 


THE  MEDICAL  RECOKD. 


toms  OQ  the  recovery  from  the  quasi-intoxicadon.  It 
18  not  improbable  but  that  she  would  haye  recovered 
had  the  chlordbrm  not  been  taken  on  an  empty  stomach 
undefended  from  its  erosive  action." 

Dr.  Corrigan  {Braithtoaite'8  Retrosped,  Pt  31,  p.  262) 
speaks  of  a  case  in  the  Dublin  Hospital  Oastdtej  Nov. 
15,  1854,  in  which  four  drachms  and  a  half  of  chloro- 
form were  taken  by  mistake,  by  a  man  just  recovering 
from  a  debauch,  and  having  delirium  tremens.  The 
result  was  a  perfect  cure  of  the  disease,  without  any 
pain  or  burning  at  the  stomach ;  the  sleeplessness,  which 
had  been  so  persistent  a  symptom,  being  entirely  re- 
moved by  the  do«e. 

Joliffe  Tufnell,  Esq.,  in  the  Dublin  Hospital  Gazette, 
February  15^  1855.  p.  19,  in  an  article  '^  On  the  Use  of 
Chloroform  m  Delirium  Tremens,"  says:  ''I  have  no 
fear  of  its  use  internally.  I  have  employed  it  to  a 
degree  that  may  startle  those  who  have  had  not  much 
experience  of  it.  I  have,  in  a  case  of  traumatic  tetanus 
in  the  City  of  Dublin  Hospital,  kept  a  young  man,  aged 
eighteen,  under  its  influence  for  nine  days  and  nme 
nights  successively,  during  which  time  he  took  a  quarter 
of  a  pint  by  the  mouth,  and  a  pint  and  a  quarter  were 
evaporated  closely  over  the  nostrils,  carrying  him  in  a 
state  of  unconsciousness  through  this  fearral  disease,  and 
restoring  him  to  perfect  health." — Braiih.  Eet.j  Pt.  21, 
t  p.  72. 

The  conclusion  of  all  this,  manifestly  is— chloroform 
may  be  taken,  eyen  for  medicinal  purposes,  in  very 
large  doses,  without  destroying  life  from  its  narcotic 
properties ;  and  if  care  be  taken  not  to  administer  it  on 
an  empty  stomach,  or  to  sufficiently  dilute  it  with  some 
bland  vehicle,  as  mucilage,  gruel,  etc,  all  risk  of  pro- 
ducing gastritis  by  such  administration  is  avoided.  I 
never  have  heard  of  a  case  in  which  chloroform,  taken 
internally,  has  destroyed  life  by  its  narcotic  proper- 
ties (vide  the  case  before  referred  to  in  which  six 
ounces  were  taken,  death  resulting  from  gastritis 
only). 

1  do  not  know  that  the  gastritis  requires  more  than 
general  principles  to  guide  us  in  its  treatment  The 
narcotic  efiect  of  the  chloroform  seems  to  be  managed 
best  by  artificial  respiration,  galvanism,  emptying  the 
stomadi  by  the  stomach-pump,  removine  the  contents 
of  the  bowels  (for  at  least  two  cases  I  have  reported 
seem  to  show  that  the  chloroform  may  pass  soon  to  the 
bowels  and  remain  there  until  absorbed,  as  evinced  by 
the  absence  of  smell  from  the  breath  a  few  minutes 
afler  taking  the  poison,  and  its  subsequent  appearance 
upon  unloading  the  bowek^).  Ammonia  seems  to  be 
preferred  to  alcohol  as  a  stimulant,  as  it  does  not  seem 
to  increase  the  amount  of  carbon  in  the  blood,  as  is  the 
case  with  the  latter;  which  is  especially  caused  by 
ehloroform  poisoning.  ' 

Coffee  has  been  used  in  some  of  the  cases  reported, 
but  I  do  not  know  that  it  can  be  regarded  as  an  efficient 
antidote  to  chloroform. 


A  New  Usi  fob  Pisnt  Wood. — ^Mr.  Pannewits,  of 
Breslau,  has  discovered  a  method  by  which  a  species  of 
flannel  is  made  firom  the  fibres  of  pine  leaves,  which  is 
now  exdusiyely  used  in  the  hospitals,  prisons,  and 
barracks  of  Breslau  and  Vienna  for  bed-coverings. 
The  flannel  thus  made  has  the  advantage  of  driving 
away  all  insects ;  it  serves  for  stuffing  as  well  as  horse- 
hair, and  costs  but  one-third  of  that  article :  it  will  mi^e 
all  kinds  of  garments,  which  are  of  great  durability  and 
•omfortable  warmth.  The  liquid  fi*om  the  manu&otory 
is  now  used  as  a  medicine,  and  the  refuse  of  the  works 
makes  the  gas  by  which  they  are  lighted.— i^wftcoZ  and 
'^Hrgioal  Exporter,  \ 


©riginol  CectuMss* 


SCROFULOSIS  AND  TUBERCULOSIS. 

BUNO  A  LECTTTRB  BEFORE  THE  CLASS  OF 

THE   JEFFERSON  MEDICAL   COLLEGE. 

Session  1866-7. 

Bt  S.  H.  DICKSON,  M.  D., 

FMRMOB  or  TSaOKT  AMD  FBJLOHCB  OT  MBDIOISa. 

Paet  L 

I  SHALL  treat  of  these  subjects  together;  for  although  I 
do  not  believe  them  to  be  identic^,  as  is  strongly  main- 
tained by  many  prominent  pathologists,  still  at  times  it 
is  almost  impossible,  even  by  alwtract  reasoning,  to 
separate  them.  The  majority  of  pathologists  regard 
tuberculosis  as  the  same  thing  as  scrofulosis,  under 
special  circumstances  and  in  ^cial  localities. 

I  think  we  are  bound  to  separate  them ;  and  I  think 
we  can  do  this  as  readily  as  we  can  separate  purpura 
from  scurvy,  or  the  various  forms  of  typhic  fever,  if  we 
fix  our  attention  upon  the  prominent  circumstances 
belonging  to  their  history.  Of  scrofula,  we  know  its 
mode  of  causation ;  we  understand  how  it  has  gradually 
become  so  extended.  Of  tubercle,  I  believe  with 
Williams  we  do  not  know  its  cause ;  it  comes  upon  us 
under  the  most  inexplicable  conditions,  under  contin- 
gencies which  give  us  no  explanation.  Scrofulosis  is 
of  self-development,  always,  necessarily;  no  one  be- 
comes scrofulous  suddenly,  no  more  than  one  becomes 
base  suddenly  (nemo  repente  JU  turpissimita).  Tuber- 
cles may  be  developed  in  any  one  of  us  durioe  the  pro- 
gress of  a  typhoid  fever,  as  reported  by  Bell  ot  Glasgow 
and  others ;  and  any  one  of  us  may  fall  into  consumption 
at  once,  without  any  preliminary  warning  of  changes  in 
condition  and  constitution,  as  far  as  we  kuow. 

So  elowly  is  scrofula  developed,  however,  that  I  do 
not  believe  that  it  is  ever  developed  in  one  generation : 
I  believe  that  prepai*ation  is  made  in  one  generation,  and 
the  development  is  completed  in  another;  the  fathers 
eat  the  sour  grapes^  and  the  teeth  of  their  children  are 
set  on  edge.  Agam,  tuberculosis  is  not  itself  without 
deposit;  we  know  nothing  of  it  any  more  than  we  do 
of  dropsy  before  we  have  the  exudation  or  deposit^  or 
cellular  metamorphosis ;  it  is  not  itself  without  the 
tubercle,  whose  presence  is' essential  Not  so  with 
struma;  there  is  nothing  special,  no  peculiar  deposit 
necessary,  in  a  scrofulous  case.  Therefore  I  warn  you 
against  adopting  too  readily  the  doctrine  of  the  identity 
ot  scrofula  and  tubercle.  Examine  the  subject  for  your- 
selves, and  decide  acoordingly.  In  the  admirable  work 
of  Prof.  Flint  of  New  York,  to  which  I  have  often 
referred  you  during  the  present  course  of  lectures,  the 
doctrine  of  identity  is  taupfht.  I  regret  it  very  much; 
but  I  have  to  difier  from  him  entirely  as  to  the  identity 
of  a  scrofulous  cervical  gland  and  a  tuberculous  deposit. 
He  speaks  of  the  oervical  gland  as  showing  you  the 
changes  which  go  on  in  tubercle;  but  there  is  no 
tuberculous  deposit  in  a  cervical  gland.  Lloyd  tells 
you  very  well  the  changes  that  occur;  there  is  hyper- 
emia of  the  gland ;  it  is  always  an  inflammatory  gland^ 
Prof.  Flint  himself  says  tubercle  is  oflen  deposited 
independently  of  inflammation.  Now,  no  cervical  gland 
ever  enlarges  wiUiout  inflammation ;  it  becomes  sore, 
it  becomes  red,  and  by  and  by  it  suppuratea 

Vogel  and  others  tell  you  that  scrofulosi^s  tuberculosia, 

and  typhosis,  are  deposits  of  matter,  of  an  exudation  or 

metamorphosis  of  cells,  whatever  they  may  be,  identical 

with  each  other.    Vogel  says  they  aU-^consist  of  what 

digitized  by  VjC  „      ^_ 


THE  MEDICAL  RECORD. 


67 


be  calls  an  amorphous  stnima,  with  earthy  salts,  a  certain 
amount  of  fat,  and  a  certain  amount  of  cholesterine. 
There  is  no  such  deposit  in  many  seats  of  inflammation 
in  scrofulous  disease.  That  sudi  a  deposit  takes  place 
in  the  lung,  and  wherever  you  find  tubercle,  I  do  not 
dodbt  In  the  vast  majority  of  cases  of  typhoid  fever, 
no  snch  deposit  is  clearly  seen :  and  when  it  occurs  the 
patient  may  die,  and  not  by  tubercle.  These  are  views 
thftt  are  new  to  myself^  views  I  suggest  for  your  consi- 
deration. Is  there  such  a  thing  as  separate  typhosis? 
I  once  believed  there  was,  but  I  am  now  inchned  to 
diange  my  belief,  as  Woodward  did  not  find  it  in  typho- 
maLuial  intestines.  You  will  not  find  it  unless  there  is 
taberculous  depdsit;  and  this  is  tuberculosis  itself  as 
much  so  as  tuberculosis  of  the  lun^. 

This  subject  is  open  for  inquiry,  and  will  enrich 
research.    There  is  no  appellate  jurisdiction  which  shall 
fiiroe  UB  to  settle  a  question ;  we  are  in  search  of  truth, 
and  every  new  fact  gives  us  a  little  more  light.    The 
discovery  of  the  stereoscopic  examination  of  objects  is 
an  important  one ;  we  see  two  sides  of  the  object  at 
once.    Now  we  are  beginning  to  look  at  all  subjects 
stereoscopically  as  well  as  microscopically,  and  see  two  or 
three  sides  of  the  object  at  once ;  we  have  made  a  great 
step  in  the  path  of  science.    We  have  the  opportunity 
of  reading  the  beliefs  of  men  of  science  always  opposed 
to  each  other;  thus  we  are  liable  to  learn  those  truths 
which  cannot  be  controverted.    In  investigating  this 
•object,  let  it  be  first  decided  what  tuberculosis  is? 
What  is  it  ?    There  is  the  greatest  difference  of  opinion 
on  this  subject    One  writer  says  that  it  is  a  nucleated, 
another  a  non-nucleated  corpuscle ;  another  says  it  con- 
tains molecular  granules,   another  says  it  has  none. 
Micro6coi>ists  of  equal  ability  differ  on  this  point ;  one 
teSs  you  it  cons' sts  first  of  grey  matter  which  gradually 
degenerates  into  the  yellow ;  on  the  other  hand  Bobin 
says  the  grev  matter  is  not  properly  tuberculous  at  all, 
but  a  cytoblast ;  while  Virchow  says  it  is  a  metamor- 
phosis of  a  cell,  and  not  a  new  growth  at  all  I     Scrofii- 
K>sis  is  identical  with  what  form  of  tubercle  ? — ^the  grey  ? 
the  miliary?    the  yellow?  the  fatty?  the  albuminous? 
I  make  these  observations  to  show  there  is  a  real  dif- 
ference between  the  two,  closely  as  thev  are  allied.    I 
have  no  question  that  tuberculous  deposit  is  a  little  more 
likely  to  take  place  in  the  strumous  constitution,  but 
not  a  great  deal  more.    Flint  himself  tells  you  that 
tubercular  consumption  is  not  of  more  frequent  occur- 
rence in  those  marked  by  the  inflammation  of  the 
oervical  glands,   who  have  suffered  from  scrofula  in 
their  youth,  than  in  those  who  have  not  suffered  in  this 
way.    This  cervical  inflammation  is  one  of  the  dearest 
marks  of  scrofulous  tendency,  diathesis,  constitution ; 
and  yet  he  teUs  you  that  tubercular  consumption  does 
noc  occur  more  fi*equent]y  in  them  than  in  others. 
Nay,  you  find  those  who  believe  it  occurs  less  in 
suljects  who  hare  suffered  fix>m  inflammation  of  the 
oervical  glands.    I  am  of  this  opinion.    The  late  Dr. 
Parri^  of  this  city  haOed  the  appearance  of  swelling 
of  the  oervical  glands  as  one  or  the  means  of  added 
security  in  such  subjects,  firom  tubercular  consumption ; 
given  the  disposition,  it  had  better  take  this  mode  of 
manifestation  than  the  internal     I  have  lived  long 
enough  and  have  had  |;enerations  enough  of  patients 
under  my  care,  to  be  satisfied  that  Dr.  Parrish  was  right, 
nose  who  have  suffered  from  inflammation  of  the 
cervical  glands  in  early  youth  are  rather  less  liable  than 
those  who  have  not,  eoeteris  paribus,    I  am  certain  that 
the  ordinary  marks  of  inflammation  about  the  neck,  as 
left  in  the  well  known  cicatrices,  are  far  less  frequent 
now  than  when  I  began  the  practice  of  my  profession. 
I  don*t  speak  of  light  degrees  of  the  disease.    I  have  in 
my  iiote>  books  records  of  many  cases,  and  in  my 


memoir  a  long  list  of  cases  of  inflammation  of  the 
cervical  jflands  of  great  intensity,  great  swelling  even- 
tuating m  suppuration,  and  which  I  had  to  open  fre- 
quently. How  few  of  you  are  thus  marked !  The  same 
number  of  individuals  could  not  have  been  collected 
forty  years  ago  without  a  considerable  portion  with 
manifestations  clearly  enough  of  having  had  these  in- 
flammations. Now,  while  these  cases  have  been  dimi- 
nishing in  frequency,  tubercular  consumption  has  in- 
creased in  frequency ;  and  the  records  I  have  examined 
show  that^  with  us  at  least  in  this  country,  it  is  a 
disease  of  progressive  mortality.  Look  at  uie  rates 
of  mortality  in  this  city.  In  Prof.  Wood's  book  on 
Practice,  in  one  of  the  earlier  editions,  he  alleges  the 
influence  of  cod-liver  oil,  and  states  that  there  had  been 
a  diminution  of  the  number  of  cases  of  tuberculous  con- 
sumption upon  the  bills  of  mortali^,  corresponding 
with  the  increase  in  the  use  of  that  oil.  He  spoke  the 
trutL  It  was  a  coincident  which  is  rather  remarkable, 
and  is  quoted  in  the  last  edition  of  Aitken  as  a  perma- 
nent fact.  I  have  taken  pains  to  collate  the  fiu)ts.  The 
use  of  ood-liver  oil  has  gone  on,  perhaps  increased ;  it  is 
now  used  as  largely  as  ever,  and  yet  the  number  of 
deaths  firom  consumption  has  gone  on  increasing 
steadily.  The  annual  mortality  stated  in  the  edition  of 
Prof  Wood's  Practice  referred  to,  was  rather  less  than  nine 
hundred ;  last  year  it  was  more  than  two  thousand ;  and 
thus  it  has  been  for  the  last  four  years.  Look  at  the 
bills  of  mortality  for  yourselves,  and  you  will  see  that 
there  has  been  a  steady  increase  of  the  disease.  I  think 
Bennet  and  others  maintain  that  it  has  decreased  in 
Great  Britain.  I  am  willing  to  allow  this,  and  am  glad 
that  it  has  so  happened ;  but  is  the  identity  in  question 
to  be  explained  bv  this  subsidence  of  consumption? 
Scrofula,  they  say,  baa  also  diminished.  Aitken  affirms 
that  tlus  is  due  to  the  influence  of  vaccination.  Small- 
pox was  a  great  developer  of  the  scrofulous  diathetis ; 
and  this  being  nearly  broken  down  by  vaccination, 
scrofula  has  become  less  prominent  in  a  corresponding 
degree  in  that  country.  If  this  be  true,  I  am  very  glad 
of  it;  and  it  does  4^pear  to  be  true.  It  also  appears  to 
be  true  that  in  the  meanwhile  there  has  not  been  a  very 
great  diminution,  but  still  some  diminution  in  the  cases 
of  consumption.  I  do  not  think  this  diminution  is 
really  greater  than  can  be  accounted  for  as  a  result  of 
the  nicer  discrimination  in  diagnosis  made  at  the  present 
day  with  the  use  of  the  stethoscope  and  other  careful 
means  of  physical  exploration.  Phthisis  is  now  put 
under  one  head,  bronchitis  under  another,  and  otner 
affections  of  the  lungs  under  their  appropriate  heads ; 
different  affections  all  classed  formerly  under  the  gene-, 
ral  head  of  consumption.  So  far  as  I  can  infer,  really 
looking  for  the  truth^  all  the  difference  in  favor  of  our 
brethren  in  Gkeat  Britain  may  be  accounted  for  in  this 
YTKf.  Nev^iheless,  what  I  am  saying  to  you  is  in- 
tended to  be  suggestive,  rather  than  dogmatic.  I  don't 
wish  to  instil  opinions  in  those  who  hear  me.  I  desire 
you  to  think  for  yourselves;  it  is  responsibility  enough 
for  me  to  bring  before  vou  what  I  think  is  true,  without 
endeavoring  to  indoctnnate  you  with  my  own  views. 

Tubercular  consumption  is  the  greatest  outlet  of 
human  life.  If  connected  with  scrofula  as  effect  of 
cause,  it  is  of  the  greatest  importance  to  remove  the 
cause,  to  remove  the  predisposition,  which  will  extend : 
and  among  the  causes  pathologists  generally  hold 
scrofula  to  be.  I  will  not  deny  that  degree  of  con- 
nexion, though  I  deny  their  identity. 

The  investigation  of  scrofula  affords  us  one  of  those 

remarkably  instructive  methods  of  study  in  which  we 

take  a  course  opposite  to  that  generally  pursued  in  exa- 

I  mining  disease ;   and  instead  of  denvinff  general  or 

I  constitutional  disease  firom  some  local  change  of  the 


Digitized  by 


Google 


58 


THE  MEDICAL  RECORD. 


Baine  kind  continuing,  we  are  obliged  to  refer  the  local 
changes  to  some  general  or  obscure  condition  of  consti- 
tution which  we  call  scrofulous  diathesis,  the  occult 
state  of  causation  we  call  struma ;  when  it  manifests 
itself  in  any  particular  way,  it  is  usually  with  some 
modification  of  inflammation,  and  we  call  this  scrofula. 

No  organ  seems  to  be  free  from  this  diathesis ;  whether 
it  is  in  the  blood  or  in  the  harder  tissues,  is  obscure.  I 
do  not  think  we  are  ready  for  this  question  as  yet;  it  is 
impossible  to  say  whether  the  existence  of  the  materies 
morbi  in  the  blood  has  been  proved  undoubtedly.  Cole- 
man transferred  scrofulous  blood  from  a  diseased  animal 
to  a  healthy  oue,  and  the  healthy  animal  became  scro- 
fulous. He  took  animals  of  different  orders — the  horse 
and  ass — and  found  the  disease  transmissible  by  the 
blood.  Tuberculosis  is  equally  inoculable.  Klenke, 
and  later  Lebert  of  Breslau,  and  Yillemin,  have  been 
successful  in  inoculating  with  the  tubercular  matter  from 
consumption  to  the  lower  animals,  and  from  one  animal 
to  another ;  the  disease  being  propagable  both  by  the 
blood  and  by  the  deposit.  In  au  these  cases  of  occult 
diathesis,  as  in  gout,  carcinoma  in  scrofula,  it  may  be  a 
very  important  matter  to  know,  and  we  shall  know  by 
and  by,  whether  the  original  germ  is  transferred  in  the 
solid  or  the  fluid  form ;  whether  it  is  the  blood  that  circu- 
lates which  conveys  the  disease,  or  whether  it  is  the 
solid  tissues  which  help  to  form  and  modify  the  blood. 
Probably  both  are  concerned. 

In  the  young  child  bom  of  parents  who  have  trans- 
mitted to  it  this  peculiarity,  we  find  that  the  very  first 
movement  of  life  will  be  marked  by  changes  of  condi- 
tion. We  have  in  Mr.  Lloyd's  Museum  in  London,  two 
foetuses  with  tuberdes  of  the  lungs.  If  this  be  proof 
of  scrofulous  deposition,  we  have  the  proof  of  develop- 
ment of  scrofula  in  that  form ;  but  we  find  that  t^ese 
children  are  horn  with  diseased  skin,  affections  of  the 
83alp.  Soon  the  eye  becomes  affected,  the  lid  espe- 
cally,  which  is  thickened  and  roughened.  This  we  call 
scrofulosis.  After  a  while  there  is  rachitis,  mollities 
ossium;  this  is  called  scrofulosis.  It  occurs  in  the 
children  of  parents  who  live  in  certain  circumstances 
unfavorable  to  the  proper  development  of  animal  life. 
As  you  go  on,  you  find  certain  other  affections :  the 
heads  of  the  bones  swell  and  inflame — white  swelling; 
the  joints  are  swollen  in  this  way.  The  child  early 
shows,  perhaps,  spina  bifida.  I  have  seen  a  child  un- 
der these  circumstances  with  cleft  palate,  hare-lip,  hy- 
drocephalus, spina  bifida,  hypospadias,  deformity  of  the 
^^nitals,  all  combined,  and  still  the  miserable  httle  in- 
fant continued  to  live.  The  parents  were  scrofulous, 
a  \d  probably  all  these  conditions  concurred  to  the  pro- 
duction of  this  universallv  morbid  development  of  the 
child.    This  we  call  scroralosis. 

Of  the  three  similar  cachexise,  tjrphosis.  tuberculosis, 
and  scrofulosis,  we  may  regard  typhosis  as  trie  most  acute, 
tuberculosis  as  intermediate,  and  scrofUlosis  as  the  most 
chronic. 

M.  Jean  Dollfus,  a  manufacturer  in  Paris,  observing 
that  the  children  of  his  workwomen  died  more  rapidly 
than  other  children  in  the  proportion  of  40  percent,  to  18 

Ser  cent,came  to  the  conclusion  that  itwas  due  to  compel- 
ng  the  attendance  of  the  mothers  at  the  manufactory 
too  soon  after  their  confinements;  that  thereby  they  were 
not  allowed  sufiicient  time  to  attend  properly  to  their 
children  during  their  early  existence.  He  therefore 
allowed  them  to  desist  from  labor  for  six  weeks  foHow- 
ing  confinement,  instead  of  four  weeks,  as  had  been  the 
rule  previously,  and  this  brought  the  proportionate  mor- 
taUtv  down  to  25  per  cent  His  example  has  been  imi- 
tated extensively  throughout  Prance,  and  the  result  has 
been  that  the  mortality  among  the  children  of  such  ope- 
ratives has  been  gre.tly  diminished;   stiU  it  has  not 


been  reduced  below  the  proportion  of  25  to  18  of  the 
general  mortality. 

We  know  that  manufacturing  communities  in  Eng- 
land suffer  variousljr  from  scrofula;  we  know  that  their 
children  grow  up  nckety,  scrofrdous,  deformed,  disabled 
in  many  ways.  Gk>od  says  there  is  no  difficulty  in  ex- 
plaining the  existence  of  scrofiila  under  these  condi- 
tions: They  are  not  particulaiiy  well  fed:  they  are  not 
very  well  sheltered,  they  are  not  very  well  clothed,  and 
they  are  set  at  labor  too  early.  It  is  not  long  since  the 
British  Pariiament  enacted  a  bill  preventing  the  em- 
ployment of  childien  at  too  tender  an  a^e.  Children 
of  six  years  of  age  were  employed  at  labor,  and  stifl 
are,  in  spite  of  the  bill,  in  certain  branches  of  industry. 
We  learn  this  state  of  things  from  many  sources,  for  it 
has  been  made  the  theme  of  poetry,  of  works  of  fiction, 
novels,  etc.,  as  well  as  all  medical  works ;  and,  indeed,  we 
can  often  learn  much  professionally  instructive  from  such 
works ;  we  learn  that  they  are  employed  even  when  in 
bad  health.  Read  the  sad  tale  of  *^  Simon's  Sickly 
Daughter,"  sad  enough  to  make  any  one's  eyes  weep ; 
poor  follow,  he  takes  his  sickly  daughter  on  his  shoulder 
and  carries  her  to  her  work,  lor  she,  too,  must  add  her 
little  mite  towards  her  own  support 

Under  such  circumstances  we  can  understand  how  a!I 
thepeople  shall  become  scrofulous. 

Young  says  the  whole  of  Great  Britain  is  scrofulous, 
and  he  attributes  it  to  climate ;  but  there  is  something 
in  race  too.  The  Chinese  suffer  as  much  from  ochlesis, 
and  in  many  parts  of  their  country,  as  much  from  imper- 
fect nutrition  as  the  English,  but  we  do  not  hear  of 
scroftda  as  prominent  among  them.  The  blacks  in 
Africa  sufier  variously  and  capriciously ;  sometimes  from 
famine  to  a  great  extent.  Famine,  we  know,  pervades 
all  India  at  the  present  moment,  thousanos  dying 
weekly  in  Hindostan.  They  also  suffer  under  all  the 
circumstances,  except  clhnate,  which  in  Great  Britain 
produce  universal  scrofula,  yet  they  are  not  so  subject 
to  it.  In  this  country  we  do  not  suffer  from  ochlesis 
except  in  the  cities;  we  do  not  suffer  fi-om  want  of 
clothing,  food,  or  rfielter;  our  children  are  not  over- 
worked in  manufactories ;  our  laborers  live  well,  and 
are  in  every  way  in  a  better  physical  condition  than  the 
laborers  of  Great  Britain ;  and  yet  scrofula  is  exten- 
sively met  with  among  us.  I  have  said  that  it  has 
diminished  much  within  my  own  knowled^ ;  it  goes 
on  diminishing  on  account  of  the  increased  comfbrts, 
the  better  hygienic  conditions  which  science  in  the  ser- 
vice of  health  is  providing  every  day ;  still  there  is 
scrofula  among  us. 

Knox  ascribes  it  to  our  remarkable  hybridism ;  and 
thus  we  are  led  to  consider  another  cause.  Unques- 
tionably hybrid  races  are  very  generally  an  improve- 
ment on  the  original  races,  but  it  must  be  congenial 
hybridism ;  there  is  a  congenial  and  an  uncongenial 
miscegenaiion,  and  ceriain  races  when  they  mix  dete- 
riorate as  much  as  other  races  improve.  We  improve 
our  breeds  of  cattle,  horses,  etc.,  by  prof  er  crossing, 
and  so  the  human  animal  in  its  various  tribes  can  be 
made  to  improve  by  an  appropriate  crossing;  but  there  is 
a  certain  deterioration  in  the  mixture  of  ceriain  races 
which  we  can  trace  with  ease.  The  Scotchman,  healthy 
and  hardy,  perhaps  the  hardiest  specimen  of  the  human 
species,  mixes  veiy  readify  with  the  Indian  on  our 
frontiers,  but  it  is  an  absolute  fact  that  their  offVptinc: 
are  all  scrofulotis  and  consumptive.  Osceola  died  of 
consumption.  He  was  the  product  of  a  healthy  Indian 
woman  and  a  Scotchman.  The  Ridge  family  had  mor^ 
bus  coxarius  and  other  s^rrofulous  disorders,  and  finally 
consumption ;  and  thus  I  could  trace  numerous  instan- 
ces which  have  come  within  my  own  immediate  know- 
ledge.   I  beheve  that  hybridism  between  the  Scotch 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


59 


i^od  lodian  produces  almost  always  a  scrofulous  race. 
Not  ao  with  the  Freqrhman  and  the  Indiao.  The  French, 
from  the  South  of  France  at  any  rate,  mingle  with  the 
Indian,  and  not  badly  with  some  of  tne  better  races  of 
Africans ;  hence  we  have  our  octoroons,  our  quadroons, 
as  comparatively  healthy ;  but  the  mulatto  is  always 
liable  to  scrofula.  As  Nott  says,  he  can  never  keep  up 
his  numbers;  he  will  deteriorate,  and  especially  by 
acrofaloos  degeneration.  I  speak  from,  large  observa- 
tion, and  say  it  deliberately,  tnat  I  am  ready  to  indorse 
all  that  he  has  written  on  this  subject.  The  Portuguese 
io  the  island  of  Madeira  mixed  with  the  Indian  or 
Malay,  and  the  negro '  the  result  has  been  a  most  mis- 
erable race,  wretchedly  degenerate  in  every  way,  and 
Eable  to  scrofula.  We  know  the  degeneracy  of  the 
mingled  races  in  Mexico,  but  whether  they  are  scrofu- 
lous or  not  I  am  unable  to  assert ;  but  we  know  as  a 
fiict  that  they  are  exceedingly  degenerate,  and  among 
the  common  degenerations  of  the  human  race  scrofula 
stands  fi>remo8t. 


progress  of  SSitVictd  Science* 


CAunoNs  nr  Rbgaro  to  Use  of  Sphtomoobaph. — 
Oat  of  the  facts  detailed,  as  to  the  changes  in  the 
puke-curve  which  are  produced  bv  physiological  influ- 
enoes  that  are  in  daily  operation,  the  fi^owing  cautions 
ariae  as  to  the  time  at  which  sphygmographic  observa- 
tioDS  should  be  taken : — 

1.  Sphygmographic  obeerrations  must  never  be  taken 
within  two  hours  after  a  solid  meal,  like  dinner;  one 
hour  afler  breakfast ;  or  fifteen  minutes  after  the  inges- 
tion of  any  alcoholic  drink.  The  traces  obtained  during 
the  tempoTwrj  disturbance  consequent  upon  either  of 
these  are  entirely  worthless  as  a  representation  of  the 
real  condition  of  the  organs  of  circulation.  2.  Observa- 
tions mu^t  never  be  taken  during  a  state  of  bodily 
frtigpae  from  exertion.  3.  Observations  must  not  be 
taken  when  the  patient  is  under  cardiac  excitement 
caused  by  muscular  exercise.  4  Observations  must 
not  be  taken  when  the  patient  is  flushed  with  heat  from 
external  sources.  5.  Observations  must  not  be  taken 
while  the  patient  is  under  the  influence  of  sudden  emo- 
tional shock. — Dr.  Anbtib. — (Lancet,  Feb.  9.) 

TEMPBBATimB  OF  BoDY  IN  Oanceb. — ^Dr.  Da  Co8ta>  of 
the  Philadelphia  American  Journal  of  Medical  Sdenot, 
recently  presented  to  the  Pathological  Society  of  that  city 
a  case  of  cancer  of  the  stomach  in  which  Uie  tempera- 
tnre  of  the  body  was  below  100^  F.,  notwithstanding 
progressive  and  rapid  wasting.  Believing  that  this  fact 
had  a  significance  beyond  this  individual  case,  he 
remarks:—'^  It  is  known  that  in  tubercular  disease  the 
thermometer  indicates  a  heat  much  higher — a  fever 
tttnperature.  Shall  we  find  it  the  rule,  that  cancerous 
affections  show  a  comparatively  k)W  temperature  ?  If 
•o,  many  a  doubtful  differential  diagnosis  between 
cancer  and  tubercle  of  internal  organs  will  cease  to  be 
doabtfuL  Dr.  Da  CosU  has  thus  far  four  observations 
bearing  on  this  point  In  a  case  of  cancer  of  the  liver 
under  his  charge  at  the  Pennsylvania  Hospital,  and 
which  tenninated  fatdly,  the  evening  heat  was  never 
bat  a  fraction  above  99"^ ;  in  a  case  of  cancer  of  the 
mesenteric  glands,  of  which  the  temperature  was  taken 
carefully  by  Dr.  iSdward  Smith,  it  did  not  exceed  98*^ ; 
in  another  case  of  internal  cancer,  it  did  not  reach 
10(h>F." 

The  LiOATims  of  Veins  (the  Internal  Jugular)  not 
IBB  Cause  of  Ptjqoa, — Dr.  S.  W.  Gross,  in  an  article 


on  Wounds  of  the  Internal  Jugular  Vein,  and  their 
Treatment  (Amer,  Jour,  Med.  Sci.),  thus  speaks  of  the 
safety  of  the  ligature : — 

"  Afler  a  very  careful  examination  of  the  whole  sub- 
ject, I  do  not  hesitate  to  state  that  the  occurreuce  of 
pysemia,  when  of  traumatic  origin,  is  due  to  the  wound 
of  the  vessel  itself  and  not  to  me  ligature ;  that  a  pre- 
dispoifition  to  the  disease,  or  rather  a  peculiar  morbid 
condition  of  the  blood,  is  necessary  for  its  development ; 
and  that  when  that  predisposition  exists,  the  infection 
may  show  itself  whether  the  vein  has  been  tied  or  not ; 
in  other  words,  when  the  coats  of  the  vessel  are  healthy, 
and  the  condition  of  the  blood  is  normal,  the  ligature  is 
never  the  starting-point  of  pyaemia." 

Injection  of  Acetic  Acids  in  Cancerous  Tumors. — 
The  novelty  of  the  past  two  months  is  the  injection  of 
acetic  adds  in  the  substance  of  cancers  in  order  to  secure 
their  removal  by  absorption.  The  plan  is  brought  fur- 
ward  by  Dr.  Broadbent,  a  physician  who  is  thought 
highly  of  in  London.  It  suggested  itself  to  his  mind  in 
consequence  of  the  known  solvent  powers  of  this  add 
upon  cancer  cells  as  seen  under  the  microscope.  Dr. 
Broadbent  recommends  that  about  foity  drops  of  a 
mixture  of  one  part  uf  acetic  acid  with  five  or  six  parts 
of  distilled  water  should  be  injected  into  the  cancer; 
the  p  tint  of  the  syringe  being  thrust  (subcutaneously) 
into  different  parts  of  its  substance  during  the  operation, 
80  that  the  agent  is  well  disseminated  through  it.  The 
injection  is  repeated  at  intervals,  varying  from  five  to 
ten  days  or  longer  according  to  its  effects.  The  method 
is  now  being  extensively  tried,  and  many  cases  are 
reported  in  which  large  cancers  have  been  completely 
and  almost  painlessly  removed.  Its  true  vdue  can  by 
no  means  be  pronounced  upon  at  present. — Foreign 
Correspond,  Southern  Journal  Medical  Science. 

Thi  Cause  of  Dental  Caries  in  Married  Womek- 
J — Dr.  J.  P.  H.  Brown,  Augusta.  Ghk,  remarks  {Denied 
Register)  upon  this  subject  as  follows :  '^  The  teeth  are 
governed,  m  proportion  to  their  vitality,  by  the  laws 
of  disintegration  and  reparation,  like  any  other  portion 
of  the  system.  This  explains  why  the  teeth  of  many 
females,  after  marriage,  decay  so  rapidly.  They  enter 
the  marriage  relation  with  so  little  life-power  that, 
when  they  become  pregnant,  they  have  not  suffident 
vitality  to  appropriate  to  the  tooth-germs  of  the  foetus 
enourn  of  the  inorganic  elements  from  the  food  to  form 
healthy  dental  tissue.  In  such  cases  the  demands  of 
the  foetus  upon  the  mother  for  phoitpbate  of  lime,  leave 
her  osseous  system  in  a  weak  condition.  The  teeth 
also  furnish  their  quota  of  lime,  but  as  their  power  of 
reparation  is  very  feeble  in  comparison  to  the  more  vi- 
talized structure  of  bone,  they  are  left  constitutionally 
depraved,  and  ill  prepared  to  resist  the  chemical  action 
of  the  vitiated  secretions  of  the  mouth.  Hence  it  is 
that  the  offspring  of  such  mothers  have  teeth  of  so  frail 
a  quality,  that  the  best  and  most  skilful  operations 
upon  them  can  prove  of  only  temporary  benefit" 

A  New  Food. — Mr.  Hullett  calls  attention  to  the 
value  of  Chinese  sugar-grass  (Sorghum  tartaricum)  as  a 
valuable  addition  to  our  cereal  crops :  it  bears  six  or 
eight  times  the  quantity  per  acre  tnat  wheat  doe8, 
makes  capital  bread,  whilst  the  leaves  and  shoots  are 
good  for  cattle. — Lancet 

Bronohocelb  treated  bt  Strychnia. — Dr.  C.  Mann 
{Cincinnati  Journal  of  Medicine)  reports  a  cure  of  this 
affection  by  the  administration,  internally,  of  strychnia. 
This  in  a  measure  confirms  the  practice  employed  some 
years  ago  by  Dr.  Mumer,  of  Dublin. 


Digitized  by 


Google 


60 


THE  MEDICAL  RECORD. 


To  MAKE  Beet-Tea  Nuthitious. — ^Let  the  cook  under- 
stand that  the  yirtue  of  beef-tea  is  to  contain  all  the 
contents  and  flavors  of  lean  beef  in  a  dilute  form ;  and 
its  vices  are  to  be  sticky  and  strong,  and  to  set  in  too 
hard  a  jelly  when  cold.  When  she  understands  this,  let 
her  take  half  a  pound  of  fresh-killed  beef  for  every  pint 
of  tea  she  wants,  and  carefully  remove  all  fat,  sinew, 
veins,  and  bone.  Let  it  be  cut  up  into  pieces  under  an 
inch  square,  and  set  to  soak  for  twelve  hours  in  one- 
third  of  the  water  required  to  be  made  into  tea.  Then 
let  it  be  taken  out  and  simmered  for  three  hours  in  the 
remainiug  two-thirds  of  the  water,  the  quantity  lost  by 
evaporation  being  replaced  from  time  to  time.  The 
boiling  liquor  is  then  to  be  poured  on  the  cold  liquor  in 
which  the  meat  was  soaked.  The  solid  meat  is  to  be 
dried,  pounded  in  a  mortar,  and  minced  so  as  to  out  up 
.  aU  strings  in  it^  and  mixed  with  the  liquid.  When  the 
btef-tea  is  made  daily,  it  is  conyenient  to  use  one  day's 
boiled  meat  for  the  next  day's  tea,  as  thus  it  has  time  to 
dry  and  is  easiest  poimded.  Some  persons  find  it  more 
palatable  for  a  clove  of  ^lic  being  rubbed  on  a  spoon 
with  which  the  whole  is  stirred.^  ^^  The  Indigeitiom,*' 
hy  Dr.  Thorruu  King  Chcmibtn, 

Novel  Method  of  dealing  with  Lioatubes  applied 
TO  Arteries. — ^Mr.  Campbell  de  Morean  has  been  adopt- 
ing of  late,  at  the  Middlesex  HoEpital,  a  plan  of  deahng 
with  liffatures  applied  to  vessels  during  a  cutting  opera- 
tion, vniich  merits  notice.  When  the  vessels  have  been 
tied,  instead  of  following  the  usual  custom  and  leaving 
the  ligatures  hanging  out  of  the  wound,  Mr.  de  Morgan, 
by  means  of  a  needle,  passes  them  through  the  skin 
close  to  where  they  are  tied.  They  remain  quite  quiet, 
and  come  away  without  the  [lightest  pain  or  trouble 
when  their  work  is  done.  The  wound  consequently 
has  nothing  to  irritate  it^  and  enjoys  every  opportunity 
of  healing  by  the  first  intention.    The  plan  leaves  the 

Cas  quiet  as  if  a  compressure  had  been  applied. 
9  is  now  in  the  hospital  a  case  in  which  Mr.  Moore 
tried  the  method  at  Mr.  de  Morgan's  suggestion,  on 
Wednesday  week,  after  removing  a  breast. — Lancd, 

Ybntilation  roB  Ltvauds. — Dr.  Thomas  Inman  {Lof^ 
don  Medical  Mirror)  thus  alludes  to  home  ventilation : 
'^  When  speaking  of  airiness,  I  do  not  mean  individuals 
to  encourage  draughts  of  cold  air  about  their  persons, 
nor  can  I  recommend  them  to  do  as  a  medical  friend  of 
mine  is  said  to  do,  viz.  open  the  windows  of  the  bed- 
room at  night  to  get  the  fresh  country  air,  which  the 
town  smoke  vitiates  during  the  daj,  so  as  to  make  it 
too  impure  for  use.  There  may  be  dififerences  of  opinion 
on  die  subject  amongst  those  who  observe  little;  but 
amongst  those  who  do,  the  belitf  is  entertained  that 
warm  air  moderately  impure  (as  in  a  closed  bed-room 
where  two  or  more  are  sleeping),  is  less  noxious  to  the 
invalid  and  those  whose  health  is  shaky,  than  is  cold  air 
and  absolute  purity.  The  pur.ty  does  not  counter- 
balance the  e£fect  of  the  chill." 

Postural  Treatment  nr  Prolapse  of  the  Funis. — 
This  method,  suggested  by  Dr.  T.  G.  Thomas,  of  this 
city,  has  been  favorably  reported  upon  in  England.  One 
writer,  however,  objected  to  it^  in  a  note  to  the  Medical 
Tvmti  and  Gazettej  as  being  applicable  only  to  cases 
occurring  among  the  poorer  classes  of  patients.  To 
this  objection  Dr.  Dyce  makes  a  very  sensible  answer, 
and  quotes  the  reply  of  Napoleon  the  Great  to  Dubois, 
when  the  life  of  the  Empress  Maria  Louisa  was  in 
danger:  "  Forget  the  empress's  station,  and  treat  her  as 
you  would  a  soldier's  wife."  Dr.  Dyce  also  ascribes 
the  want  of  success  of  the  previous  writer,  to  the  fact 
that  the  manipulations  were  made  during  a  pain, 
whereas  they  should  have  been  made  in  an  interval 
Two  other  successful  cases  are  then  alluded  to. 


PoST-MORTEM  ApPEARANOES  IN   THE   StPHILIS  OF  TBI 

Lungs  and  Intestines. — Man,  thirty-six.  Acquired  m 
chancre  about  four  years  before  death.  Was  especially 
afiected  with  eruptions  and  ulcers.  Had  been  treated 
with  various  anti-syphilitic  remedies ;  for  a  great  part 
of  the  time  in  a  hospital ;  fifly-four  ulcers  fi*om  two 
lines  to  two  inches  long  were  found  in  the  small  intes- 
tine. The  base  of  the  ulcers  contained  black  pigments. 
Some  of  them  were  granulated.  In  isolated  cases  radi- 
ated fibrous  cicatricial  formations  were  also  seen  on  the 
black  base  of  the  ulcer.  Small,  tough  fibrous  granules 
were  found  upon  the  surface  of  the  ulcer,  corresponding 
to  the  serous  membrane  of  the  intestine,  which,  as  weu 
as  the  muscular  coat,  was  found  hypertrophied.  The 
ulcers  were  exclusively  found  in  the  small  intestine,  and 
extended  downwards  to  the  vcUviUa  Baukini  f  ilio-(XBcal 
valve).  The  mucous  membrane  of  the  auodenum 
showed  the  marks  of  chronic  inflammation ;  great  vascu- 
lar injection,  and  hypertrophic  swelling.  The  mucous 
membrane  of  the  stomach  exhibited  enlargement  of  the 
vessels,  considerable  thickening  of  the  pylorus ;  there 
was  atrophy  of  the  mar^n  of  the  liver,  the  parenchyma 
was  pale.  The  constituent  granules  {fldm)  "were  pig- 
mented in  the  centre.  Spleen  softened.  Pleuritic  effu- 
sion on  the  right  side,  with  fibrinous  pseudo-mem- 
branous deposit.  Bight  lung ;  camificadon  of  the  lower 
lobe;  oedema  and  pneumonic  infiltration  of  the  two 
upp^  lobes.  A  few  soft  nodules,  about  the  size  of  a 
hazel-nut,  of  a  homogeneous  gelatinous  nature,  were 
found  in  both  the  cedematous  and  inflltrated  portions, 
which  seemed  analogous  to  gummy  tumors.— J/es^ade, 
Virchow*$  Archiv, — Med,  CefUral  Zeitung, 

Steer  Sprat  Process  as  an  Aid  to  Diagnosis. — 
Dr.  Edward  Hayward,  of  London,  recommends  the  use 
of  ether  spray  as  a  means  of  diagnosticating  tumors. 
The  recommendation  is  based  on  one  case  of  an  obscure 
affection  of  the  right  hand  and  forearm  of  a  married 
lady  of  forty.  The  symptoms  were  those  of  a  neural- 
gic affection  of  the  ulnar  nerve,  accompanied  by  the 
tingling  of  the  hand  and  forearm,  with  contraction  of 
the  fingers  supplied  by  that  nerve,  and  a  tenderness 
more  or  less  over  the  region.  A  peculiar  indefinite 
swelUng  was  observed  above  the  elbow-joint,  and 
where  the  ulnar  nerve  rests  on  the  inner  head  of  the 
triceps  mnsde,  and  before  it  reaches  the  groove  between 
the  internal  condyle  of  the  humerus  and  the  olecranon. 
There  was  pain  on  pressure,  accompanied  by  numbness 
of  the  hand  and  great  tingling  of  the  fingers.  It  was 
thought  that  the  symptoms  were  due  to  sequelae  of 
rheumatic  disease,  causing  pressure.  Ether  spray  was 
used  to  relieve  pain,  with  great  benefit;  it  softened  the 
skin,  the  whole  of  the  structure  came  under  the  fingers^ 
softened  like  kneaded  dough,  and  we  could  thus  take  up 
the  tissues,  inch  by  inch,  between  the  fingers,  and  say 
there  was  no  cyst  and  no  tumor.  Ether  spray  was  con- 
tinued, with  painting  the  surface  with  tinctui-e  of  iodine 
and  oil.    It  did  well. — Med.  J\me$  and  Gaaette, 

New  Form  of  Antiseptic  for  Looal  Use. — The 
liquor  carhonis  delergone  is  recommended.  It  is  an 
alcoholic  solution  of  coal-tar,  containing,  we  presume, 
the  carbolic,  phenic,  and  other  acids,  with  dark  tarry 
matter,  and  differing  from  carbolic  acid,  as  the  liquor 
oinchonsD  does  from  quinine.  It  readily  mixes  with 
water,  forming  a  permanent  emulsion,  and  in  various 
strengths  is  available  as  a  mouth  wash,  a  gargle,  an  in- 
jection for  fetid  uterine  discharges,  cancer,  retained 
placenta,  etc.,  gonorrhoea  in  the  female,  foul  ulcers, 
sloughing  sores,  and  all  maladies  dependent  in  or  compli- 
cated by  parasitic  beings,  lice  fungi,  etc.  It  is  also  used 
combined  .with  soi^. — Med,  Bmee  and  OoMeUe, 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


61 


The  Medical  Record. 

^tmx-l^ont^ll  Immml  of  Ptbidnt  snb  Snxgerg. 
Geobgb  F.  Shsady,  M.D.,  Editob. 


PnUiah«d  oa  th«  1st  and  lAth  of  eaoh  Month,  br 
WILLIAM  WOOD  Jk  00^  61  Wjllkbb  SruBt;  Nxw  Yobk. 


FOXJPIGJf  AOENOIES, 

Iftnoir— TBCBirxB  h  Go.  I     Lsifsio—B.  HsRMJLHy. 

Pass— BotSASOB  bt  Gib.  1     Bio  Jabbibo— Stxpubha  t  Oa. 


Ifew  York,  -A.prU  1,  1867. 

THE  MORTALITY  ATTENDING  WET- 
NURSING. 

Im  the  preTious  number  we  took  occasion  to  remark 
upon  the  effect  which  the  preralence  of  criminal  abor- 
tion had  upon  the  decrease  of  oar  own  people.  The  re- 
port upon  which  these  remarks  were  in  the  main 
founded,  was  sufELcIently  full  as  to  details  to  give  rise  to 
a  good  deal  of  concern  among  thoie  interested  in  the 
nitaral  growth  of  population.  Bat  there  is  another 
uX  to  this  grand  social  drama  which,  though  not  start- 
ling OS  with  the  appalling  enactment  of  premeditated 
nmrder,  is  not  on  that  account  the  less  worthy  of  con- 
sidention;  we  refer  to  the  prevalent  and  fashionable 
practice  of  nursing  by  proxy. 

When  we  undertake  to  deplore  the  comparative  pau- 
citj  of  children,  we  should  not  allow  ourselyes  to  stop 
here,  but  should  put  the  question — What  proportion  of 
even  these  few  little  ones  receive  that  careful  nursing 
which  they  are  entitled  to  ?  No  one  can  answer  this 
ezcq)t  approximately ;  but  allowing  for  all  extenuat- 
ing circumstances,  every  practising  physician  knows 
ioD  well  that  the  present  system  of  neglect  of  nurslings 
is  frightfully  prevalent  The  fashionable  mother  now 
finds  something  else  to  do  besides  tending  her  offspring, 
and  the  real  excuse  is  not  so  much  on  account  of  deli- 
eate  health  or  physical  incapacity,  as  want  of  time,  and  a 
diaposition  to  shun  that  care  and  anxiety  for  the  welfare 
of  her  infant  which  she  should  feel,  as  well  as  a  desire, 
Uodable  enough  in  the  abstract,  to  preserve  her  beauty 
of  form  and  youthful  &ce.  This  is  one  extreme. 
another  is  to  be  found  in  the  mother  less  favored  by 
TortBDe,  who,  nevertheless,  is  actuated  by  a  desire  no 
less  deplorable — ^that  of  gain — and  consents  to  hire  out 
the  nourishment  of  her  own  offspring  to  that  of  another. 
It  is  to  these  two  classes  principally — the  one  creating 
the  demand  and  the  other  ftimishing  the  supply — that 
the  i»evalence  of  wet-nursing  is  due. 

The  subject  of  wet-nursing,  in  its  direct  relations  to 
the  mortality  of  nurslings,  has  been  lately  attracting 
itteotion  in  the  Imperial  Academy  of  Medicine  of 
Paris;  and  the  discussions  which  have  grown  out  of 
ievefal  documents  presented  to  that  body,  as  well  as 


the  documents  themselves,  have  proved  of  value  in 
associating  the  two  in  the  light  of  cause  and  effect. 
The  first  paper  was  by  Dr.  Monot,  who,  in  a  report 
upon  the  great  mortality  among  the  new-bom  infants  of 
the  old  province,  Morbihan,  maintained  that  such  was  the 
consequence  of  its  young  women  leaving  their  homes 
and  infants,  to  sell  their  milk  in  Paris.  Dr.  Brochard, 
who  followed,  charged  the  great  mortahty  of  the  chil- 
dren of  Normandy  to  the  fect^  that  the  majority  were 
those  taken  from  Paris  to  nurse. 

Perhaps  the  paper  which  had  the  most  weight  and 
best  succeeded  in  presenting  the  naked  truth,  was  the 
one  read  before  that  learned  body,  on  the  23d  of  Oc- 
tober last^  by  the  Honorable  Armand  Husson.  This 
document,  by  the  kindness  of  Dr.  Seguin,  is  now  be- 
fore us,  and  invites  a  comment  or  two  in  respect  to  the 
bearing  it  may  have  upon  the  customs  of  our  own 
people. 

The  writer  begins  by  establishing  the  general  mor- 
tality of  French  children,  from  one  day  to  one  year  old, 
at  one-sixth. 


Birth. 

Demth. 

Per- 

eentftge 
of  dMth. 

city  Popalation 

94S,847 

eT2,85T 

4CJ6S 
121,045 

18.81 

Rnrftl  PopQlftUon ........  

17.96 

Total 

9Si,704 

166,811 

ISJO. 

This  table  shows  that  the  mortality  is  less  in  the 
country  at  large  than  in  towns,  but  only  in  the  propor- 
tion of  0.34  per  100,  owing,  likely,  to  the  number  of 
town  children  sent  out  into  the  country.  The  same 
cause  working  on  a  larger  scale,  and  conversely,  shows 
a  mortality  of  only  16.30  per  hundred  for  the  city  of 
Paris,  whereas  the  same  mortality  is  as  high  as  17.98 
per  hundred  in  the  surrounding  country.  The  reason 
for  this  difference  is  an  all-powerful  one,  when  we  learn 
that  out  of  an  annual  registration  of  53,335  births, 
Paris  sent  away  the  enormous  number  of  18,000  chil- 
dren to  be  nursed  by  strange  mothers,  these,  for  the 
most  part,  living  close  by  and  in  a  circumference  of  30 
miles.  Again;  in  the  arrondissement  of  Nogent  le 
Bartoux,  the  deaths  among  the  nurslings  from  Paris 
amoiint  to  35  per  100,  whereas  for  those  children  bom 
on  the  spot  it  is  only  22  per  100. 

In  order  to  show  that  this  mortality— due  to  indiffer- 
ent and  careless  nursing — ^is  on  the  increase,  he  ascer- 
tained that  from  1839  to  1858,  the  mean  death-rate  of 
the  same  children,  from  a  day  to  a  year  old,  was  29.71 
per  100;  then,  from  1858  to  1864,  it  went  up  to  33.93 
per  100 ;  in  1862  it  was  down  to  30.02  per  100,  and  iii 
1864  it  increased  to  40.07.  It  is  tme,  that  these  chil- 
dren, fumished  with  nurses  by  the  Govemment,  were 
not  bom  in  the  best  conditions  of  vitality,  but  the  con- 
ditions of  their  births  were  virtuaUy  alike  every  year 
from  1839  to  1864. 

On  the  other  hand,  for  the  foundlingao|  the  Citjr of 

Digitized  by  VjOOQIC 


62 


THE  MEDICAL  RECORD. 


Paris,  placed  and  cared  for  by  the  administration,  their 
mortality  has  been,  from  1830  to  1868,  65.88  per  IOO7 
and  was  reduced  gradually  in  1864  to  39.26  per  100. 
Remarkable  decrease  indeed,  showing  a  great  ameliora- 
tion; though  presenting  yet  a  mortality  more  than 
double  the  average  one  of  the  whole  empire. 

But  this  improvement,  at  this  centre,  does  not  hold 
good  for  the  departm?nts,  where  the  death-rate  among 
foundlings  has  been  fearful,  as  shown  in  the  following 
enumeration : 

The  mortality  per  hundred  of  the  foundlings  from  one 
day  to  one  year  old  in  the  departments  of  Loire  Inf^ 
rieure,  was  90.50 ;  Seine  InfiSrieure,  87.36 ;  Eure,  78.12 ; 
Calvados,  78.00;  Aube,  70.27 ;  Seine  et  Oise,  69.23 ;  C6te 
d'Or,  66.46;  Indre  et  Loire,  62.16;  Mauche,  58.66. 

The  departments  which  present  the  greatest  mortality 
are  shown  to  belong  to  old  Normandy,  a  country  neither 
poor  nor  ignorant ;  and  the  inference  is  a  fair  one,  that 
other  causes  than  poverty  and  stupidity  must  combine 
to  destroy  these  children.  The  three  departments 
where  forced  labor,  misery,  and  crime,  are  joined  hand 
in  hand;  the  Seine  with  Paris;  the  North  with  Lille, 
Boubaix,  and  Valenciennes ;  and  the  Rhone  with  Lyons ; 
present  only  a  mean  mortality  of  the  same  children  as 
38.17  per  100. 

In  Great  Britain  substantially  the  same  state  of 
things  exists,  as  has  been  shown  to  be  the  case  in  Paris ; 
in  fact^  it  is  acknowledged  by  statisticians  that  all  over 
Europe  wet-nursing  is  a  villanous  scourge. 

If  we,  in  the  contemplation  of  this  subject^  return  to 
our  own  country,  and  view  the  cause  of  infant  mortality 
in  the  same  light  and  in  the  same  manner  as  has  been  so 
ably  done  by  M.  Husson  and  others,  we  shall  find  that 
our  large  cities  are  not  behind  Paris  or  London  in  the 
extent  to  which  the  practice  of  wet-nursing  is  carried  on. 
We  doubt  not,  if  the  truth  were  told,  that  we  should 
find  that  New  York,  Boston,  Philadelphia,  and  other 
centres  would,  in  proportion  to  population,  excel  any 
transatlantic  city  in  the  number  of  innocent  victims 
sacrificed  on  this  dreadful  altar  of  expediency. 

But  it  is  one  thing  to  refer  to  the  existence  of  an 
evil,  and  quite  another  thing  to  suggest  a  remedy.  The 
physician,  however,  is  competent  to  treat  this  question, 
and  to  do  much  in  his  own  circle  of  practice  to  prevent, 
by  his  advice,  the  continuance  and  growth  of  the  vice. 
He  may  be  the  means  of  accomplishing  a  good  deal, 
and  he  may  not ;  but  that  is  no  reason  why  every  prac- 
titioner should  withhold  his  counsel  when  it  may  be,  as 
in  these  cases  it  almost  always  is,  called  for.  He  owes 
a  duty  to  the  rising  generation  which  no  consideration 
for  the  peculiar  views  of  his  patients  should  deter  him 
from  performing^ 

Aw  artificial  ivory  is  now  made  in  Prance  from  a 
paste  of  papier-mach^  and  gelatine,  and  to  which  the 
name  of  rarisian  marble  is  given.  Among  other  things, 
the  finest  and  most  complicattd  mouldings  for  ceilings 
can  be  made,  or  capitals  of  columns  can  }^  construct^ 
in  any  color.    It  is  said  to  be  hard,  durable,  and  elastic. 


KcoUt00* 


Guide  for  usitro  Medical  Battebies,  bt  A.  G.  Gasbatt, 
M.D.,  eta  Phil.:  Lindsay  ft  Blakiston. 

For  more  than  ten  years  the  subject  of  electro-thera^ 
pontics  has  been  commanding  the  attention  of  some  of 
the  ablest  minds  of  the  profession  in  France,  in  Eng- 
land, and  in  Germany.  In  this  country  this  important 
department  has  been  almost  exclusively  in  the  hands  of 
charlatans  or  outsiders,  and  Dr.  Qtmratt  is  one  of  the 
very  few  of  our  recognised  practitioners  who  have  ac- 
corded to  it  anything  of  the  attention  it  deserves.  For 
a  number  of  years  he  has  made  a  specialty  of  electro- 
therapeutics, and  has  gained  the  co-operation  of  the  pro- 
fession in  Boston  and  vicinity.  For  his  courage  and 
independence  in  the  face  of  doubt  and  ridicule,  for  the 
restless  zeal  with  which  he  has  prosecuted  his  investiga- 
tions in  the  treatment  of  a  great  variety  of  diseases,  lar 
his  tolerant  and  catholic  spirit  that  has  not  spurned  to 
receive  suggestions  from  any  and  from  every  souroe — 
for  all  this  he  ia  deserving  of  the  warmest  praise.  But 
here  our  commendation  must  cease.  Unfortunately  for 
the  profession,  unfortunately  for  the  cause  of  electro- 
therapeutics, and  very  unfortunately  for  himself,  Dr, 
G^u*ratt  has  written  a  book  that  has  already  reached  a 
third  edition,  of  which  this  work  before  us  professes  to 
be  a  "synopsis,"  or  "condensation."  The  original  vol- 
ume was  severely,  but  deservedly  criticised,  not  only 
for  its  inaccuracies  of  style  as  well  as  of  statement,  but 
more  especially  for  its  ponderousness.  This  "  condensa- 
tion" is  an  improvement  upon  the  former  work  in  only 
one  respect — it  is  shorter.  From  the  1100  p^ges  of  thbO 
larger  volume  he  has  simply  dropped  930,  leaving  most 
of  his  faults  as  a  writer  as  conspicuous  as  before.  If 
he  could  only  have  dropped  the  entire  1100  pages  the 
improvement  would  have  been  greater  stilL  Industry 
alone  can  never  make  a  writer.  There  must  needs  \>q 
at  least  some  regard  for  the  laws  of  grammar  and  rhe- 
toric.   But  all  these  Dr.  Garratt  ignores. 

In  this  volume  there  are  jumbled  together  a  great 
variety  of  descriptions  of  apparatus,  of  directions  for 
employing  them,  and  citations  from  learned  authors  on 
almost  every  department  of  human  thoueht ;  but  for  any 
broad,  compact  generalizations  in  regard  to  the  scien- 
tific employment  of  electricity,  or  tor  anv  intelligible 
rules  in  regard  to  the  applications,  we  look  in  vain. 
His  absurd  and  repeated  violations  of  the  simplest  Iawb 
of  composition,  his  turgid  and  meaningless  amplifica- 
tions, his  lucus  a  non  lucendo  suggestions  for  practition- 
ers, will  surely  cause  all  who  are  not  endowed  with 
more  than  usual  self-control,  to  throw  aside  the  volume 
in  disgust,  both  with  the  subject  and  the  author.  We 
speak  witn  deliberation  when  we  sav  that  the  writings 
of  Dr.  Garratt  have  retarded  more  than  they  have  ad- 
vanced the  cause  of  electro-therapeutics.  Those  who 
are  already  familiar  with  the  details  of  electrical  appli- 
cation may  find  in  his  larger  work  a  verbose  complica- 
tion of  what  has  thus  far  been  attempted  in  this  d^)art- 
ment,  and  may  derive  some  assistance  therefrom.  But 
those  inquiring  minds  who  either  in  the  original  work 
or  in  the  "Guide  for  using  Medical  Batteries,"  seek  for 
information  that  may  make  them  practical  electricians, 
will  be  guided  into  darkness  rather  than  into  light.  The 
subject  of  electro-therapeutics  demands  great  energy, 
zeal,  patience,  and  experience,  on  the  part  of  him  wno 
would  became  proficient  in  it,  but  it  is  far  from  being 
as  complicated  and  abstruse  as  Dr.  Garratt  would  make 
us  believe.  We  are  firmly  convinced  that  the  medical 
use  of  electricity  is  destined  to  assume  an  importance 
of  whi<^  its  warmest  advocates  have  at  present  no  con- 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


6) 


ception ;  but  it  will  be  in  spite  of,  and  not  hj  means  of 
such  works  as  these.  In  all  friendliness  and  sincerity 
we  urge  upon  Dr.  Garratt  to  write  no  more ;  but  if  he 
must  use  his  pen,  let  him  condense  this  '^  condensation." 
Far  better  that  there  should  be  "  silence  for  a  century  '* 
on  this  subject  than  that  there  should  by  any  multiplica- 
tion of  such  works  as  "  Medical  Eledricity — Nervous  Dis- 
eaaes^"  or  this  "Guide  for  using  Medical  Batteries,** 


Vitpoxtsi  0f  ^ocitXits. 


NEW  YORK  PATHOLOGICAL  SOCIETY. 

Stated  Mxetino,  January  9,  1867. 

Dr.  Frahk  H.  Hamilton,  Pbesibbnt,  in  thb  Chaib. 

Db.    Louis   Baubb    presented    the   following  speci- 


osrrns  of  lowbr  tbikd  of  thigh-bone,  and  pabtial 

DCTAGHMBirr  OF  SPIPHT8IS  8U00BEDINO  AMPUTATION  AT 
THE  KNEE. 

The  patient  is  a  lad  of  fourteen  years,  undersized,  and 
of  delicate  organization,  exhibiting  no  marks  of  puberty. 
On  ptepping  from  a  ferry-boat,  he  missed  his  footing, 
got  the  lower  part  of  his  leg,  the  ankle-joint^  and  the 
taiBal  portion  of  the  foot  jammed,  lacerated,  and  com- 
minuted. The  attendant  amputated  at  the  knee-joint, 
after  Sko.  inexplicable  delay  of  five  days,  gangrene  having 
mperrened.  The  integumenta  appropriated  for  the 
coTerii;ig  of  the  stump  sloughed  away  likewise,  thus 
leaving  the  epiphysis  fully  exposed.  Gradually,  the 
stamp  became  subject  to  a  most  intense  pain,  which 
had  iaated  eight  weeks  without  cessation,  when  the  pa- 
tient came  under  my  charge.  His  reduced  and  anaemic 
condition^  the  accelerated  pulse  and  hectic  symptoms 
generally,,  denoted  continued  and  severe  suffering.  The 
lower  portion  of  the  stump  was  excessively  tender  to 
both  touch  and  movement.  The  integuments  surround- 
ing the  projecting  bone  were  ragged,  discolored,  and 
cedematous ;  the  discharge  was  copious,  and  of  a  sani- 
ons  character ;  the  epiphysis  black,  corroded,  and  soft, 
with  but  fragments  of  articular  cartlla^,  l(}bsely  adher- 
ent The  epiphysis,  moreover,  was  evidently  loose,  and 
might  have  Deen  detached  without  much  effort  The 
rabcrurian  bursa  was  slightly  distended  by  fluid.  Occa- 
ftODally  the  stump  would  be  shaken  by  spasms  of  the 
most  painful  character. 

An  early  ampu'.ation  of  the  diseased  portion  of  the 
stump  was  deemed  advisable,  and  the  patient  desired 
It  most  urgently.  Whilst  he  was  under  the  influence 
of  chloroform,  and  being  prepared  for  the  opera- 
tion, the  stump  was  still  so  tender  that  a  gentle 
touch  produced  lively  reflex  tremor.  The  amputation 
pttsaed  off  without  any  remarkable  incident,  except  that 
there  was  copious  bleeding  from  the  medullary  cavity. 
The  periosteum  was  but  loosely  adherent  and  so  much 
dianged  in  texture  that  consecutive  troubles  of  the  bone 
were  apprehended.  Nevertheless,  the  wound  closed 
rapidly  by  first  intention,  and  the  patient  was  about  on 
the  fourteenth  day. 

In  viewing  the  specimen  soon  after  its  being  removed 
and  longitudinally  divided,  we  found  it  exhibiting  both 
itypersDmia,  intensified  by  hasmorrhi^c  depositions, 
and  hyperplasy  towards  the  epiphysis;  the  reticular 
mbstance  is  notably  densifled,  while  the  periosteum  is 
internally  covered  with  osseous  elements— the  creation 
of  new  lx>ne.  On  ihe  surface  of  the  bone,  similar  rudi- 
mentary attempts  are  observable.  The  cartilaginous 
ooimexlon  between  the  ^aft  and  its  epiphysis  was 


materially  changed  in  thickness  and  consistence,  being 
so  soft  as  to  almost  allow  a  free  antero-posterior  move- 
ment. Its  spontaneous  separation  was  efiected  by  a 
maceration  of  twenty-four  hours. 

The  case  may  attract  more  surgical  than  pathological 
interest  The  injury  having  been  limited  to  the  lower 
part  of  the  extremity,  left  the  thigh-bone  intact  Its 
diseased  condition  accrued  from  the  exposure  of  the 
epiphysis  to  the  action  of  atmospheric  air  and  purulent 
maceration,  and  thence  it  extended  to  the  shaft  It 
would  seem  as  if  the  amputation  at  the  preferred  pointy 
under  the  preceding  circumstances,  was  rather  ill-con- 
ceived, inasmuch  as  the  covering  of  the  stump  had  to 
be  taken  from  parts  in  close  proximity  to  tissues  already 
mortified,  and  themselves,  perhaps,  more  or  less  vitally 
depressed.  Irrespective  of  this  objection,  however,  a 
query  arises,  whether  an  amputation  at  the  knee-joint, 
before  puberty,  is  at  all  judicious?  Dr.  Markoe  has  the 
merit  of  having  prominently  urged  that  amputation  on 
account  of  its  statistical  superionty .  The  ca.ses  adduced 
in  its  fevor  include,  if  I  am  correctly  informed,  two 
children ;  the  closing  of  their  stumps  met  with  no  pro- 
traction. With  due  respect  for  the  accuracy  and  clini- 
cal skill  of  that  gentleman,  I  entertain  humble  doubts  as 
to  the  practicability  of  so  general  a  rule.  Prom  my 
own  experience,  I  am  justified  in  inferring  that  there 
can  be  no  direct  union  between  the  flaps  and  the  articu- 
lar cartilage;  the  latter  has  to  undergo  some  prior 
structural  changes  which  must  inevitably  protract  the 
cicatriEation.  Whilst  thus  suppuration  and  the  forma- 
tion of  granulation  tissue  is  going  on,  the  epiphysis  is 
exposed  to  the  corroding  or  macerating  influence  of  pus, 
irrespective  of  the  atmospheric  air,  and  may  eventually 
become  necrotic.  In  its  turn,  secondary  amputation 
would  seem  inevitable.  This  is  merely  speculative  on 
my  part,  as  indeed  I  have  had  but  limited  opportunities 
for  watching  the  healing  process  of  such  wounds.  But 
other  surgeons  must  have  had  clinical  experience  to 
that  effect ;  hence  they  have  suggested  the  abscission  of 
the  articular  face.  Though  I  may  not  feel  prepared  to 
cope  with  the  larger  experience  of  Dr.  Markoe,  I  may 
be  justified  in  suggesting  the  revision  of  his  arguments  . 
in  favor  of  this  operation. 

FUNGOID  DISEASE  OF  KNEE-JOINT.      CARIES  OF  THB  ABTIOU- 
LATION.       AMPUTATION. 

The  specimen,  comprising  the  right  knee-joint,  may 
not  be  of  great  interest^  as  its  pathological  features  are 
rather  of  ordinary  occurrence.  Nevertheless,  it  may 
serve  to  bring  the  term  "ftmgoid  disease,"  preferred 
by  German  surgeons,  to  a  clearer  comprehension  among 
ourselves.  The  history  of  the  cnse  is  of  the  usual  cha- 
racter. The  patient  is  twenty-seven  years  of  age,  slen- 
derly buUt,  delicately  constituted,  and  a  glass-blower 
by  trade.  Nevertheless,  his  health  has  been  tolerably 
good,  until  he  met  with  an  accident  to  his  articulation 
about  three  years  ago.  Ever  since,  the  joint  has  given 
him  trouble.  But  so  insidiously  did  the  <£sease  advance, 
that  during  a  part  of  the  time  he  has  been  able  to  per^ 
form  military  service  in  the  field,  and  in  the  Veteran 
Reserves,  alias  the  "  Diarrhoea  Corps."  Of  late,  how- 
ever, the  disease  has  made  rapid  progress,  become  so 
painfril  as  to  deprive  him  of  rest  and  appetite^  and  con- 
sequently the  patient  has  been  much  reduced  in  weight 
and  appearance.  About  six  weeks  ago  I  took  charge 
of  the  case.  I  found  the  joint  but  moderately  flexed, 
at  an  angle  of  120**,  without  much  rotation  of  the  leg, 
and  everaion  of  the  toes.  The  articulation  had  lost  aU 
its  contours  by  distension  and  tumefaction.  Above  it, 
and  in  front,  there  was  a  large  abscess,  extending  up- 
wards over  ike  lower  third  of  the  thigh.  On  the  outer 
aspect  there  was  a  fistulous  opening,  leading^to^^ 
Digitized  by  VjC 


.oogie 


64 


THE  MEDICAL  RECORD. 


articular  cavity.  There  was  no  other  obstacle  to  the 
mobility  of  the  joint  than  a  moderate  contraction  of  the 
biceps-muscle,and  the  excessive  painfulness.  On  moving 
the  joint,  grating  of  bony  surfaces  could  be  discerned. 

Although  the  case  seemed  to  demand  early  amputa- 
tion, nevertheless  I  resolved  on  freely  opening  the 
respective  abscesses,  on  dividing  the  retracted  biceps, 
and  on  placing  the  extremitv  in  a  proper,  straight  posi- 
tion, and  to  be  guided  by  future  exigencies.  My  rea- 
sons for  this  plan  were  to  give  the  patient  the  chance, 
however  remote,  bf  preserving  his  extremity,  and  to 
give  him  instantaneous  relief  ^om  pain,  however  tem- 
porary, so  as  to  recruit  his  enfeebled  condition,  and  thus 
prepare  him  for  the  eventuality  of  amputation.  More- 
over, the  execution  of  the  pbm  could  be  rendered,  by 
chloroform,  harmless,  inasmuch  as  no  material  loss  of 
blood  was  apprehended.  My  expectations  were  fully 
reaUsed  by  the  result  following  the  procedure.  The 
patient  was  indeed  rendered  comfortable,  and  enjoyed 
mil  immunity  from  pain  for  more  than  a  fortnight. 
The  discharge  from  the  abscesses  did,  however,  not  mi- 
prove  in  either  quality  or  quantity,  and  after  a  fair 
trial  I  was  impelled  to  resort  to  amputation,  on  the 
80th  ult.  The  patient  sustained  considerable  loss  of 
blood,  in  spite  of  the  most  rapid  ligation.  But  two  arte- 
ries required  to  be  tied,  whereas  some  thirtv  veins  had 
to  be  secured ;  and  besides  that,  the  parenchyma  oozed 
bloody  serum  freely.  At  one  time  during  the  opera- 
tion, the  patient  became  excessively  debilitated:  he 
rallied,  however,  bv  degrees,  and  is  at  present  doing 
moderately  well,  the  wound  healing  by  suppuration. 
The  periosteum  was  found  to  be  greatly  thickened,  evi- 
dently caused  by  the  extensive  abscess  along  its  course. 
This  is  probably  the  reason  why  the  free  incision  into 
the  joint  had  no  lasting  effect  upon  the  condition  of  the 
patient 

^  The  specimen  presents  but  the  ordinary  characteris- 
tics. The  articular  surfaces  are  corroded,  and  but  a  few 
vestiges  of  cartilage  remain  loosely  attached.  The 
semilunar  cartilages  are  changed  in  consistence  and 
color,  and  partly  destroyed  by  ulceration.  The  capsu- 
lar ligament  is  perforated  in  three  different  places.  The 
svnovial  membrane  presents  a  condition  described  as 
"fungoid  disease ; '*  that  is  to  say,  it  has  undergone  a 
transformation  into  cell-layers  and  g^nulation  tissue, 
which  project  into  the  cavity,  as  folds  and  appendages, 
greatly  infiltrated  with  serum.  The  peri-articular 
structure  is  much  thickened,  and  pervaded  with  soft  fat. 
The  terms  '* white-swelling,"  "tumor  albus,"  and 
"  fungus  articuli,"  were  formerly  in  use  as  synonvms. 
Of  late,  the  appellation  of  "  fungoid  disease  "  has  been 
adopted  by  CTerman  writers,  not  so  much  for  the 
purpose  of  qualifying  the  general  circumscribed  intumes- 
cence of  the  jomt  and  adjacent  tissues,  as  to  charac- 
terize the  luxuriant  growth  and  devebpment  of  granu- 
lations that  spring  up  from  all  sides,  and  overrun  the 
articular  surfaces  like  a  multiferously  ramified  vine. 
This  pathological  condition  is,  however,  not  confined  to 
the  so-called  chronic  affections  of  the  joints,  but  it  may 
be  observed^  likewise^  in  wounds,  fistulae,  and  more 
particularly  m  the  neighborhood  of  diseased  bone ;  in 
fiwt,  everywhere,  where  physical  obstacles  prevail 
against  permanent  cicatrization.  This  should  be  clearly 
understood,  otherwise  it  might  lead  to  the  impression 
that  the  fungoid  disease  of  joints  comprises  something 
pathological^  specific,  which  of  course  does  not  exist 
Jt  IB,  in  fine,  the  old  disease  with  a  new  "  trade-mark." 


JAlSm  AHORTLOSre  OF  KKll-JOIHT. 
TEMPTS  AT  FOROIBLB  KXTINglOir. 
TATIOH. 


mvsucoiflBruL  at- 

SUBSEQUENT  AMPU- 


The  third  specimen  is  of  more  than  ordinary  interest^ 


inasmuch  as  it  elucidates  a  variety  of  important  patho- 
logical and  clinical  points.  The  patient  is  a  girl,  eight 
years  of  age  A  twist  of  the  knee-joint  two  years  ago, 
is  alleged  as  tlie  cause  of  the  disease,  which  may  have 
been  aggravated  by  repeated  falls.  The  general  appear- 
ance of  the  patient  implies  constitutional  derangement 
of  nutrition,  prevalent  among  all  the  other  children  of 
the  family,  although  their  parents  are  of  indubitably 
good  health.  Fifteen  months  ago,  at  the  request  of  her 
uncle,  a  respectable  physician  of  Paterson,  N.  J.,  I 
took  charge  of  the  patient.  She  was  then,  as  she  is 
now,  anaemic  and  attenuated,and  had  just  passed  through 
a  very  acute  and  painful  attack  of  the  disease,  being 
still  feverish,  and  without  rest  and  appetite.  The  joint 
had  lost  its  contours  by  peri-articular  tumefaction.  At 
its  inner  aspect  there  were  two  fistulous  openings, 
leading  into  the  articular  cavity,  and  discharging  but 
moderately  serous  fluid.  The  leg  was  angularly  con- 
tracted, rotated,  and  the  toes  everted.  There  was  stiQ 
some  mobility  within  a  small  angle.  The  biceps-muscle 
resisted  further  extension.  Patella  firmly  adnerent  to 
the  external  condyle  of  the  femur. 

I  suggested  forcible  extension  of  the  limb,  to  be  follow- 
ed by  subse(juent  absolute  rest;  and,  eventually,  the  divi- 
sion of  the  biceps.  This  plan  being  accepted,  I  proceeded 
to  its  execution,  the  patient  being  under  the  full  influence 
of  chloroform.  Bearing  in  mind  the  firail  condition  of 
the  patient,  and  the  loose  connexion  of  epiphyses  under 
such  circumstances,  I  observed  more  than  orainary  pre- 
cautions to  obviate  accidents.  After  a  few  gentle  move- 
ments of  the  joint  in  both  directions,  I  became  aware 
of  a  diastasis  of  the  femoral  epiphysis.  This,  of  course, 
ended  the  procedure.  The  extremity  was  replaced  in 
its  previous  position,  and  retained  by  proper  means.  No 
reaction  followed,  and  the  epiphysis  eventually  aggluti- 
nated firmly.  The  joint,  itself  remained  in  statu  quo 
ante,  A  fortnight  agp  I  was  urged  to  repeat  the  former 
trial,  and  I  responded  with  still  greater  timidity.  In 
order  to  remove  the  muscular  resistance,  I  commenced 
the  operation  by  dividing  the  tendon  of  the  biceps-mus- 
cle not  far  from  its  insertion ;  and  thereupon  extended 
the  limb  by  careful  handling,  gradually  succeeding  in 
bringing  it  to  a  straight  position.  As  soon  as  I  relin- 
quished the  traction  of  the  leg,  the  joint  bent  agaui, 
as  it  were  impelled  by  elastic  tissue.  I  did  not  succeed 
in  rupturing  tne  inter-articular  structure ;  I  equally  failed 
in  returning  the  leg  to  its  proper  axis  with  the  femur, 
or  in  detaching  the  patella.  The  result  was,  therefore, 
in  the  main  unsatisfactory.  On  repeating  the  move- 
ments of  the  joint,  it  appeared  as  if  the  latter  did  not 
participate ;  and  as  if  there  was  undue  mobility  between 
the  shaft  and  epiphysis  of  the  tibia.  Whilst  the  extre- 
mity lay  almost  extended  on  the  mattress,  and  I  was 
preparing  to  adjust  the  retaining  plaster-bandage,  I  made 
a  last  attempt  to  overcome  the  still  existing  resistanoe 
by  a  sudden,  though  gentle  pressure,  with  the  lumd, 
upon  the  knee-joint ;  whereupon  I  noticed  a  crackling 
from  above  the  joint  whjch  I  did  not  stop  to  inveslA- 
gate  more  closely.  The  accident  induced  me  to  replace 
the  limb  in  its  original  position,  which  I  thought  soon 
to  alter.  Reaction  of  a  very  intense  and  painful  charao- 
ter  supervening,  however,  which  the  patient  was  not 
prepared  to  suffer,  impelled  amputation.  I  am  happy 
to  say  that  the  patient  is  since  doing  well,  promising  a 
safe  and  speedy  recovery. 

The  sp^imen  is  certamly  of  singular  pathological  in- 
terest We  notice,  first,  the  angular  position  of  the  join^ 
in  which  it  is  held  by  soft  and  very  elastic  inter-articular 
tissue.  In  extending  it,  the  tibia  shdes  backwards  on 
the  femur ;  it  subluxates,  as  it  were.  This  movement  of 
the  tibia  I  misconstrued  as  bending  upon  its  epiphysis. 
Had  I  left  and  secured  the  limb  in  the  straight  position, 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


65 


a  conuderable  pressure  upon  the  popliteal  nerves  and 
▼eaels  must  have  ensued,  and  prejudiced  the  recovery 
of  the  patient.  It  will  be  further  observed  that  a  rotiir 
tion  or  the  tibia  on  the  femur  is  inefifectual,  although 
the  peri-articular  structural  complements  are  removed. 
The  reasons  are  twofold.  First,  the  tibia  is  turned  by 
It  least  ninety  degrees  on  its  axis,  so  that  its  internal 
nrface  has  become  the  anterior  one,  and  its  internal 
omdyle  protrudes  considerably  before  that  of  the  femur. 
In  tlus  position,  the  tibia  is  firmly  retained  by  the  inter- 
articular  connexions.  This  is,  indeed,  the  ordinary  po- 
sition in  the  like  cases.  Various  theories  have  been 
proffered  in  explanation.  Let  us  look  at  the  clinical 
nets.  Eolation  and  eversion  supervene  in  affections  of 
the  knee-joint  of  some  duration,  and  make  their  appear- 
ance pari  jMis»tf  with  the  contraction  of  the  biceps-mus- 
da.  They  accompany  the  angular  malposition  of  the 
knee-joint.  In  this  condition,  most  patients  rest  their 
limb  on  the  outer  sur£Eice,  in  which  the  biceps  pulls 
diagonally.  By  this  traction,  not  only  flexion,  but  rota- 
tion of  the  leg  also,  is  inevitably  produced;  as  the 
members  of  the  Societjr  mav  notice  when  I  imitate  this 
action  upon  the  remaining  fragment  of  the  tendon.  It 
is  more  clearly  seen  in  giving,  first  to  the  joint,  an  ex- 
tended position,  as  far  as  it  is  susceptible,  and  then  pigl- 
ing at  the  tendon,  you  observe  that  the  tibia  follows  in 
the  direction  of  flexion  and  rotation.  If  this  is  correct, 
as  it  seems  to  ocular  inspection,  the  modus  operandi  is 
dear,  and  the  cause  transparent.  It  explains,  likewise, 
the  reason  why  the  patella  rides  on  and  agglutinates 
with  the  external  condvle  of  the  femur;  because, 
through  the  rotation  of  the  tibia,  the  anatomical  rela- 
tions are  so  changed,  that  the  insertion  of  the  ligamen- 
tom  pateQte  arrives  below  the  external  condyle  of  the 
lemur;  and  the  patella  has.  consequently,  to  yield,  and 
to  accommodate  itself  to  tne  altered  relation.  In  very 
aggravated  cases,  the  patella  may  even  sUde  over  the 
external  condyle  of  the  femur,  and  thus  give  rise  to 
knock-knee  of  the  highest  degree.  On  inspecting  the 
joint,  we  notice  that  the  articular  cavity  is  almost  entire- 
ly obliterated  by  inter-articular  fibrous  structure,  leav- 
ing but  a  small  space  free.  And  so  elastic  is  that  fibrous 
tissue,  that  it  prevents  the  contact  of  this  portion  of  the 
joint,  and,  therefore,  obviates  the  grating  of  the  bonv 
sorfaces  upon  each  other.  In  flexing  the  joint  as  much 
as  possible,  we  have  a  glance  at  the  condition  of  the 
correq>onding  two  internal  condyles.  The  tibia  is  sim- 
ply corroded  and  sofbened;  whereas,  at  the  surface  of 
the  femoral  condyle,  a  small  sequestrum  is  noticeable, 
which  is,  however,  not  entirely  detached.  This  space 
of  the  joint  communicates,  upwards,  with  the  subcru- 
rean  bursa  I  found  the  bursa  lined  with  fibrinous  ma- 
terial, partly  organized,  indicating  that  during  the  latter 
period  of  the  disease  inflammation  has  had  access  to  that 
sfimcture.  Without  destroying  the  instructiveness  of 
the  specimen,  I  cannot  expose  the  cruciated  ligaments. 
Below  the  internal  condyle  of  the  tibia,  and  luongside 
of  the  tuberosity  of  the  tibia,  the  periosteum  is  de- 
stroyed in  a  circumference  of  a  five  cent  piece,  and  to  a 
larger  extent  detached  from  the  bone.  Most  probably 
th^  is  a  firee  communication  with  the  joint  at  the  cor- 
responding place,  which  I  have  not,  however,  been  able 
to  discover.  In  comparing  the  tize  of  the  respective 
epiphyses  with  each  other,  and  that  of  the  femur  with  its 
shaft,  we  observe  considerable  disparity.  The  shaft  of 
the  femur  is  so  small  in  circumference,  and  its  lower 
epiphysis  so  disproportionately  large,  that  they  could 
not  be  considered  as  belonging  to  the  same  bone,  if  dis- 
connected. I  possess  a  female  skeleton,  which  repre- 
ienta,  in  its  size  and  structure,  the  period  of  puberty ; 
yet  its  femoral  epiphyses  are  noticeably  smaller  than  this 
^)ecimen.    The  same  disparity  of  size  exists  with  the 


epiphysis  of  the  tibia.  The  sequestrum,  at  the  internal 
condyle  of  the  femur,  may  have  had  something  to  do 
with  this  enlargement,  but  certainly  not  much,  because 
the  enlargement  is  general,  and  not  confined  to  the 
affected  spot ;  nor  is  there  any  evidence  of  an  extensive 
disease  of  that  portion  of  the  joint.  It  would  seem, 
therefore,  that  the  previous  diastasis  had  given  rise  to 
this  hyperostosis ;  and,  perhaps,  the  circumstance  that 
the  epiphysis  is  covered  with  cartilage  to  an  extent  not 
seen  by  me  before,  may  corroborate  the  view  which  I 
feel  disposed  to  take  ot  this  pathological  fact 

The  periosteum  of  the  femur  and  its  connective  cot^ 
ering  are  materially  thickened  and  readily  detached. 
About  two  inches  above  the  epiphysis  the  shaft  of  the 
femur  is  posteriorly  infarcted  to  the  extent  of  three- 
fourths  of  its  diameter,  which  mfarction  was  evidently 
caused  on  the  oocasion  I  have  mentioned. 

At  the  upper  part  of  the  popliteal  space  the  perios- 
teum is  perforated  by  ulceration  extending  along  a  sub- 
periosteal track  of  some  two  inches,  without  apparent 
connextion  with  the  Joint.  The  section  of  the  femoral 
shaft  seems  to  be  disproportionately  thin  when  com- 
pared with  the  diameter  of  the  medullary  cavity. 

In  viewing  the  specimen  in  its  total  aspect  it  mi^ht 
be  questioned  whether  the  exsection  of  the  knee-jomt 
may  not  have  been  iM^efer able  to  amputation,  or  whether 
the  latter  was  at  all  justifiable.  On  these  points  I  shall 
be  glad  to  hear  the  opinions  of  surgical  experts.  I  may, 
however,  at  the  same  time  offer  my  own  views  on  these 
questions.  As  a  ^neral  thing,  I  am  a^inst  all  exsec- 
tions  of  the  knee-joint  in  children,  aud  for  two  reasons. 
In  the  first  place,  if  parts  of  the  respective  epiphyses 
are  left,  suppuration  is  very  protracted,  and  in  some 
instances  the  rest  of  the  epiphyses  being  exposed  to 
purulent  maceration  become  detached,  and  are  eventu- 
ally thrown  off  as  sequestra.  Very  few  patients  are  in 
the  condition  to  sustain  the  drain.  But  on  removing 
the  entire  epiphyses  at  once,  the  limb  becomes  mu<m 
shortened  and  its  usefulness  questionable.  In  the  pre- 
sent instance  I  had  no  confidence  in  the  restorative  pow- 
ers of  the  enfeebled  patient,  and  had,  therefore,  no  pre- 
text for  risking  a  profuse  suppuration  inevitably  follow- 
ing exsection.  In  reference  to  the  amputation  referred, 
I  had  shown  my  disinclination  to  mutilate  by  the  re- 
puted unsuccessful  attempts  at  saving  the  extremity. 
When  violent  reaction  had  set  in  after  the  second  trial, 
nothing  but  the  amputation  could  save  the  patient. 

FIBROUS  TUMOR  OF  UTERUS  SURR0X7NDED  BY  EHCEPHA- 
LOID  NODULES — COLLOID  AND  CYSTIO  DISEASE  01*  OVA- 
RIES. 

Six  months  ago  I  was  called  in  consultation  by  Dr. 
Lord,  of  Brooklyn,  upon  an  aged  lady.  In  stepping 
down  firom  a  stage^he  fell  and  fractured  the  neck  of 
the  right  femur.  We  placed  her  upon  a  water-bed,  em- 
ployed extension  by  pulleys  and  weights,  and  rendered 
her  condition  comfortable  and  painless.  A  carcino- 
matous disease  of  the  womb,  previously  acquired,  led  to 
her  decease  a  few  days  ago.  The  post-mortem  exami- 
nation placed  me  in  possession  of  this  and  another  ege^ 
cimen. 

The  womb,  it  appeared,  had  been  infested  for  some 
considerable  time  with  a  fibrous  tumor  in  its  anterior 
wall,  of  the  size  of  a  small  orange,  which,  howeven 
does  not  encroach  upon  the  uterine  cavity.  Around 
the  tumor  there  are  several  white  nodules  imbedded, 
which  under  the  microscope  have  been  recognised  aa 
encephaloid  cancer  from  the  fact  of  a  very  scanty  stro- 
ma and  multifariou^y  shaped  nudeolated  celis.  On 
the  surface  of  the  womb  there  are  similar  nodules,  some 
of  them  pedunculated.  The  uterine  cavity  is  empty, 
and  extends  over  the  whole  length  of  we  growui. 

Digitized  by  VjOOQIC 


65 


THE  MEDICAL  RECORD. 


measuring  not  less  than  seven  inches.  The  right  ovary^, 
the  lesser  of  the  two,  has  undergone  the  so-called  colloid 
degeneration,  and  shows  the  honeycomb  arrangement 
in  a  very  instructive  manner.  The  left  one  seems  to 
be  of  similar  structure,  with  additional  cystic  forma- 
tion. 

FBAOTURS  OF  NECK  OF  FElfUB. 

This  specimen  of  the  same  patient  presents  all  the 
peculiarities  so  well  delineated  by  Dr.  G.  K  Smith,  of 
Brooklyn,  namely,  the  shortening  of  the  neck  of  thigh- 
bone and  the  characteristic  insertion  of  the  capsular 
ligament  It  is  from  these  facta  impossible  to  say 
whether  the  fracture  was  extra  or  intracystular,  or 
both.  There  is,  of  course,  no  attempt  at  forming  cal- 
lus. 

INTERNAL  STRANGULATION  OF  SMALL  INTE8TINB  THROUGH 
AN  OPENING  IN  THE  IC^ENTERT ;  DEATH  WITHIN  27 
HOTTRS. 

The  patient^  a  negro  man  of  37  years,  alleged  to  have 
been  well  up  to  his  late  illness,  was  suddenly  attacked 
with  intense  pain  in  the  abdomen  and  incessant  vomit- 
ing, proving  uncontrollable  by  the  eflforts  of  his  attend- 
ant From  the  fact  that  a  copious  alvine  discharge  was 
effected,  no  apprehension  seems  to  have  been  enter- 
tained of  internal  obstructions.  The  patient  rapidly 
sank  and  died,  at  the  27th  hour  from  the  commencement 
of  his  trouble.  Suspicions  of  poisoning  having  reached 
the  coroner,  I  was  sunmioned  to  make  the  post-mortem 
examination,  when  the  cause  of  death  was  ascertained 
as  "  internal  strangulation  of  small  intestine."  There  is 
a  perforation  in  the  mesentery  near  the  fastening  of  the 
gut  in  which  two  slings  of  the  small  intestine  have  be- 
come strangulated.  Below  the  strangulation  the  latter 
waa  distended  and  discolored  with  extravasated  ve- 
nous blood  partly  located  between  the  muscular  and 
mucous  coats,  partly  within  the  tube  itself.  There  is  no 
trace  of  inflammation.  In  the  abdominal  cavity  there 
was  but  little  bloody  serum. 

Dr.  Hamilton,  in  reference  to  Dr.  Bauer*s  recom- 
mendation in  the  first  case  not  to  amputate  at  the  knee- 
>  joint  of  children,  on  account  of  the  liability  to  separa- 
tion of  the  epiphysis,  asked  if  the  same  objection  would 
hold  good  in  regard  to  other  joints. 

Dr.  Bauer  stated  that  he  would  raise  the  same  ob- 
jection. 

Db.  Sands  did  not  think  that  experience  would  bear 
out  this  objection.  He  himself  had  performed  two 
amputations  at  the  knee-joint,  in  the  New  York  Hos- 
pital, in  children,  a^ed  respectively  six  and  ten  years. 
Both  did  well  notwithstanding  that  in  one  of  them  the 
soft  parta  used  for  the  flap  haS  been  injured,  and  had 
partly  sloughed,  while  there  was  besides  suppuration  in 
the  joint  cavity  and  exfoliation  of  the  articular  lamellfe. 

Dr.  Bauer  remarked  that  the  recommendation  to  re- 
move the  cartilaginous  surfaces  of  the  joint  in  these  cases 
had  been  made  oy  other  surgeons  before  him,  and  he 
was  inclined  to  ^d^P^  *^^^'  views  upon  the  question  for 
two  reasons.  L  That  the  cartilage  is  too  apt  to  become 
detached  and  give  rise  to  dangerous  inflammation  of 
the  joint ;  and  IL,  that  the  whde  epiphyseal  extremity 
might  be  detached  as  the  result  of  the  same  morbid 
process  and  death  ensue.  After  all,  he  considered  tiie 
question  an  open  one,  as  there  had  not  been  enough 
exjjerience  in  this  operation  to  warrant  the  forming  of  a 
positive  opinion  on  the  subject,  as  the  whole  number 
reported  did  not  exceed  fifty. 

Dr.  Hamilton  remarked  that  a  statement  concerning 
a  matter  of  so  much  importance  by  a  gentleman  of 
such  experience  as  Dr.  Bauer,  should  not  go  unchal- 
lenged, more  especially  as  Uie  opinion  of  most  other 


surgeons  on  this  very  question  leaned  in  the  opposite 
direction.  The  reason  why  these  surgeons  were  of 
this  opinion  was,  that  they  thought  it  less  dangerous  to 
leave  a  cartilaginous  suiface  than  to  run  the  risk  of 
inviting  an  attack  of  osteo-myelitis  by  invading  the 
tissne  of  the  bone  itself 

Dr.  Bauer  expected  to  meet  with  this  challenge.  He 
did  not  pretend  to  offer  any  results  of  experience,  but 
simply  to  state  such  convictions  as  his  reasoning  upon 
the  subject  had  led  him  to  adopt 

Dr.  Wood  remarked  that  the  first  case  of  amputation 
of  the  knee-joint  performed  in  this  country  was  by  an 
army  surgeon,  upon  the  person  of  a  soldier  who  had 
been  wounded  in  the  Florida  war.  The  case  was  after- 
wards brought  to  the  New  York  Hospital,  and  so  suc- 
cessftil  was  tJie  result  that  the  operation  became  quite 
fashionable.  He  agreed  with  Dr.  Hamilton  that  the 
dangers  attending  upon  osteo-myelitis  were  prevented 
by  leaving  the  cartilage ;  and  stated  that  he  had  been 
in  the  habit  of  doing  this  and  had  never  experienced 
any  trouble.  He  remarked,  as  long  as  there  was  such 
danger  from  osteo-myehtis.  that  we  should  prefer  the 
line  of  section  through  the  knee-joint 

Dr.  Wood,  in  conclusion,  stated  that  he  had  no  ex- 
perience in  amputation  at  the  knee-joint  in  children. 

Dr.  Sands  admitted  that  his  two  cases  could  by  no 
means  settle  this  question  as  far  as  children  were  con- 
cerned, but  that  they,  nevertheless,  were  entitled  to 
have  their  weight. 

Dr.  Bauer  stated  that  amputation  at  the  knee-joint 
upon  children  had  been  performed  but  a  very  few 
times,  and  Dr.  Markoe,  in  nis  paper  upon  the  subject| 
only  reports  two  or  three.  The  same  could  be  said  con- 
cerning other  articles  which  had  been  written  upon  the 
operation. 

Dr.  Sands  exhibited  two  specimens  of  fracture  of  the 
neck  of  the  femur  occurring  in  the  same  individuaL 

tn  both  instances  Dr.  8.  remarked  that  the  firac- 
ture  was  within  the  capsular  hgament  The  direction 
of  the  fracture  upon  the  left  side  was  from  before  back- 
wards and  from  within  outwards.  The  largest  piece  of 
bone  attached  to  the  head  was  posteriorly.  Upon  the 
other  side  the  appearances  of  the  fracture  were  some- 
what similar  to  those  of  the  specimen  shown  by  Dr. 
Bauer.  The  line  of  fracture  was  from  before  backwards, 
and  from  within  outwards.  The  union  seems  to  have 
taken  place  by  the  ligamentous  bands  which  pass  from 
the  arUcular  surface  of  the  head  of  the  bone  to  the  in- 
ter-trochanteric  line,  and  by  bands  from  the  capsular 
ligament  with  the  firacture  surface ;  so  that  there  was 
a  very  perfect  false  joint,  and  the  head  of  the  bone 
moved  partly  upon  the  capsular  ligamen^and  partly 
upon  the  inter-trochanteric  line. 

The  right  limb  was  thirty-two  inches  in  length  and 
the  left  twenty-nine  and  a  half  The  cause  of  death 
was  the  effusion  of  blood  upon  the  surface  of  the  brain. 

Dr.  Wood  stated  that  the  case  to  which  the  speci- 
mens belonged  was  treated  by  extension  the  same  as  in 
fracture  of  the  thigh,  and  a  fair  chance  was  given  for 
bony  union  in  case  there  was  any  disposition  for  the 
fractured  ends  so  to  do.  He  further  remarked  that  in 
both  instances  of  the  fracture  the  patient  fell  upon  the 
respective  trochanter.  His  opinion  was,  that  in  the 
case  of  the  1^  femur  the  fracture  was  partly  within 
and  partly  without  the  capsule. 

Dr.  Hamilton  called  attention  to  the  manner  In 
which  the  injury  was  inflicted  in  reference  to  the  ex- 
periments of  Rodet.  That  gentleman  states  that  when 
the  blow  was  directly  upon  the  trochanter  from  with- 
out, the  fracture  was  extra-capsular;  if  from  behind  or 
below,  intra-capsular  :  if  from  behind  and  without, 
partly  within  and  partly  without,  the  capsule.  He  be- 
^igitized  by ^: ^_ 


THE  MEDICAL  RECORD. 


67 


tieired  that  in  the  main  the  observations  were  correct, 
bat  the  conclusions  based  upon  them  were  altogether 
too  exdusive.  He  had  seen  many  cases  in  old  persons 
where  the  blow  upon  the  trochanter  from  without  had 
leauUed  in  intra-capsular  lesion. 

Db.  Bausr  asked  Dr.  H.  what  were  the  statistics  of 
the  treatment  of  those  cases  partly  within  and  partly 
without. 

Dr.  HjLMaTON  answered  by  saying  that  he  was  not 
possessed  of  any  means  to  de  ermine  when  this  con(ti- 
tion  of  lesion  existed.  He  did  not  think  that  there 
was  any  evidence  that  fractures  within  the  capsde 
ever  united  by  bone. 

Ds.  Bausb  coincided  in  this  opinion  and  had  been  in 
Cbe  habit  of  acting  accordingly,  by  allowing  the  patient 
to  walk  about  by  the  aid  of  his  splint  within  eight  or 
nine  days  after  Uie  accident  or  as  soon  as  the  swelling 
had  subsided. 

Da.  Hahiltoii  remarked  that  the  only  argument  in 
favor  of  treatment  was  the  difficulty  of  making  a  dia- 
gnosifl  as  to  whether  the  fracture  was  wholly  witliout 
the  capsule  or  not. 

Dr.  Wood  corroborated  this  statement,  but  ^^as  in- 
clined to  give  his  patients,  especially  those  not  far  ad- 
vanced in  years,  the  benefit  of  a  doubt^  by  placing  them 
for  a  certain  time  upon  a  double  inclined  pume. 

Dr.  Messimgkr  referred  to  a  case  of  nacture  of  the 
neck  of  the  thigh  bone  occurring  in  a  lady  ninety-four 
years  of  age,  whom  he  treated  in  conjunction  with  Dr. 
bock.  The  patient  recovered  sufficiently  to  get  about 
comfortably  until  she  was  a  hundred  years  old.  She 
was  treated  upon  a  double  inclined  piane,  although  it 
was  not  claimed  that  bony  union  had  taken  place. 

The  Society  then  adjourned. 


EAST  RIVER  MEDICAL  ASSOCIATION. 

Statxd  MESTma,  March  5,  1867. 

Dr.  Y.  Morsk,  President,  in  the  Chair. 

THE  KFrXOTS  OF  ALCOHOLIC  LIQUOR  ON  THE  FATALITY  OF 
CHOLERA. 

Dr.  Thoms  read  a  statistical  paper  upon  the  above  syijfh- 
ject,  which  was  thoroughly  and  ably  discussed.  In  sup- 
port of  his  view  he  remarKed,  that  the  diagram  accompa- 
nying his  paper  on  the  Effe:t8  of  Alcoholic  Liquors  upon 
ti$  Public  Healthy  indicated  the  fact  that  the  death-rate 
from  cholera  was  greatest  in  those  wards  where  the 
hospitals  were  established  during  the  prevalence  of  the 
epioemic.  The  summary  of  our  statistical  knowledge 
may  be  ^ven  in  the  following  figures : 

The  Firsts  Fourth,  Sixth,  Twelfth,  Fourteenth,  and 
Twenty-second  Wards  have  shown  a  death-rate  from 
this  disease  of  under  one  in  everv  thousand  of  the 
population,  while  the  Eleventh,  Fifteenth,  Eighteenth, 
and  Twenty-finst  foot  up  a  death-rate  of  over  1  in 
5,000. 

The  wards  where  the  predisposing  elements  of  cho- 
lera are  most  unmistakably  found  are  the  First,  where 
the  deaths  from  cholera  were  1  in  489,  against  1  in  22 
from  all  other  causes ;  in  the  Fourth,  where  the  ratio 
WM  from  cholera,  1  in  576  to  1  in  26  from  other  influ- 
ences; and  in  the  Sixth,  cholera  claimed  1  victim  out  of 
every  212  of  its  population,  while  1  out  of  24  perished 
from  diseases,  casualties,  etc. 

The  TwelfUi,  Fourteenth,  and  Twenty-second  Wards, 
where  the  malarial  influence  predisposing  to  an  attacK 
of  the  disease  was  most  rife,  presented  us  with  the  fol- 
lowiog  mortuary  record:  The  Twelfth,  a  death-rate 
frooi  cholera  of  I  in  760,  from  all  causes  1  in  52 ;  the 


Fourteenth,  from  cholera  1  in  756,  from  all  causes  1  in 
30 ;  the  Twenty-Second,  from  cholera  1  in  908,  from 
all  causes  1  in  43. 

Cholera  hospitals,  during  the  epidemic,  were  esta- 
blished in  the  First,  Twelfth,  and  Twenty-second  Wards, 
which,  owing  to  the  contagious  character  of  the  dis- 
ease, may  have  augmented  the  death-rate. 

THE  INUNOTION  OF  BELLADONNA  IN  STRANGULATED  HERNIA. 

Dr.  Weisse  reported  the  following  case:  He  had 
been  called  to  a  young  man,  who,  upon  the  day  pre- 
vious, felt  something  give  way  in  the  groin,  while  lifting 
a  barrel  of  "  lager  Wer."  A  tumor  appeared,  which  in- 
creased in  boih  size  and  hardness,  so  much  so,  that 
some  hours  after  the  accident,  when  he  first  saw  him, 
the  implicated  parts  were  as  hard  as  marble.  He  di- 
agnosticated a  strangulated  hernia,  and  resorted  to  taxis 
without  success.  After  having  become  thoroughly 
convinced  that  surgical  interference  was  necessary,  he 
left  the  case  for  the  purpose  of  procuring  the  necessary 
aid,  merely  diret;ting,  during  his  absence,  the  inunction 
of  the  Ung,  BeUadmnm  (  3  i  ad  |  i)  with  the  proper 
amount  of  gentle  but  continued  force.  He  retumeu  in 
an  hour  with  Dr.  Stein  and  prepared  to  operate,  but 
was  agreeably  surprised  to  find  that  the  tumor  had. 
meanwhile,  become  soft  and  capable  of  being  kneadea 
like  dough.  Taxis  again  failed,  when  the  idea  of 
throwing  the  patient  into  the  position  best  adapted  for 
bringing  the  weight  of  the  intestines  into  play,  oc- 
curred to  him.  This  he  did  not  claim  as  original,  since 
it  had  been  discussed  in  some  of  the  Briti^  journals, 
but  he  desired  to  go  a  step  further  and  avail  himself  of 
their  recoH  after  impingement  against  the  abdominal 
walls.  In  carrying  out  this  meSiod  of  treatment,  he 
was  ably  seconded  by  his  colleague,  who  made  the 
necessary  lunges  with  the  patient's  body  at  the  given 
signal  The  third  attempt  was  successful;  the  usual 
gurgling  sound  of  a  returning  intestine  relieving  them  of 
their  present  anxieties. 

He  had  got  the  hint  of  treatment  by  belladonna 
from  a  French  medical  journal,  in  which  it  was  related 
that  a  physician,  after  exhausting  all  the  recommended 
expedients,  had  concluded  upon  division  of  the  stricture 
as  the  last  resort.  But,  to  this,  the  patient,  having  a 
horror  of  the  knife,  most  strenuously  objected.  Bella- 
donniL  with  the  view  to  relieve  the  pain  only,  then  sug- 
gested itself,  when  the  parts  soon  became  so  relaxed 
that  taxis  accomplished  the  desired  reduction.  He  re- 
peated the  report  to  the  la*e  Prof.  V.  Mott,  who  was 
quite  favorably  impressed  with  its  feasibility,  and  de- 
sired him  to  put  it  to  the  test  upon  the  first  opportu- 
nity, which,  as  related,  had  just  presented  itself 

The  points  of  interest  in  the  case,  he  thought,  were 
(1.)  The  effect  of  the  belladonna;  and  (2.)  The  advan- 
tages gained  by  the  recoil  of  the  intestine, 

Witnout  wishing  to  extravagantly  praise  belladonna, 
he  certainly  thought  that  it  had  not  yet  attained  its 
proper  rank  in  the  materia  medica.  It  might  be  em- 
ployed^ in  his  opinion,  in  nearly  all  those  cases  where 
the  poison  of  the  disease  manifested  itself  through  the 
medium  of  a  contracted  or  insensible  pupil,  which,  in 
turn,  showed  some  profound  impression  upon  the  sym- 
pathetic nervous  system. 

Dr.  T.  Nichols  had  fallen  into  the  habit,  especially 
in  the  case  of  children,  of  examining  the  state  of  the 
pupil,  and  from  it  had  derived  some  very  valuable  the- 
rapeutical hints.  He  frequently  used  belladonna  in 
scarlatina,  and  was  disposed  to  look  upon  it  as  a  valqar 
ble  agent  destined  to  replace  opium,  which  seemed,  in 
the  minds  of  some  practitioners,  to  exclude  the  sug-^ 
gestion  of  every  other  anodyne. 

To  be  ooQtlnuecl, 


igitized  by 


Google 


ea 


THE  MEDICAL  RECORD. 


€otttavmltut. 


MEDICAL  MATTERS  IN  CHICAGO. 

To  TBI  EOROE  or  TEM  MSDIOAL  BlCOBO. 

Sir — Our  medical  colleges  have  at  length  completed 
their  winter  terms,  and  nave  gpraduated  a  large  number 
of  students.  The  concluding  exercises  at  the  Rush 
Medical  College  were  of  a  character  less  brilliant  than 
would  have  been  the  case,  had  the  much-lamented  Brain- 
ard  lived  to  honor  the  occasion  by  his  presence.  It  was, 
nevertheless,  a  goodly  class  of  young  men — seventy- 
two  in  number — who  were  mustered  to  receive  their 
diplomas  from  the  hands  of  their  President,  Professor 
Blaney,  who  is  now  the  sole  survivor  of  those  fomous 
pioneers  by  whom  the  college  was  founded.  These 
anniversary  exercises  received  additional  interest  from 
the  fiict  that  they  occurred  for  the  last  time  in  the  old 
college  halL  The  return  of  spring  will  introduce  a  new 
era  in  the  history  of  "  Old  Rush."  A  new  building  will 
be  commenced  upon  a  site  adjacent  to  the  one  now  oc- 
cupied. In  this,  when  completed,  will  be  the  lecture- 
rooms,  and  the  apartments  of  the  faculty,  while  the  old 
structure  will  be  renovated  and  adapted  for  the  recep- 
tion of  the  museum  and  the  school  of  practical  anatomy. 
To  occupy  the  vacant  chair  of  surgery  comes  Professor 
Moses  Q-unn,  late  of  Detroit  Abandoning  his  profes- 
sorship in  the  University  of  Michigan,  he  now  transfers 
his  residence  to  this  city.  Alresuly  well  known  as  a 
lecturer,  his  great  reputation  cannot  fail  to  be  of  service 
to  an  institution  which  has  owed  so  large  a  portion  of 
its  success  to  the  fame  of  its  teachings  in  the  matter  of 
surffery. 

The  graduating  exercises  of  the  Chicago  Medical 
College  occurred  yesterday  afternoon.  The  degree  of 
M.D.  was  conferred  upon  thirty-three  young  men — the 
largest  class  that  has  ever  graduated  from  uiat  institu- 
tion. The  number  of  students  in  attendance  upon  lec- 
tures during  the  past  winter  has  been  one  hundred  and 
eight.  The  increasing  popularity  of  this  excellent 
school  is  one  of  the  most  encouraging  signs  of  the 
times,  and  furnishes  a  sufficient  refutation  of  the  argu- 
ments urged  against  the  measures  which  are  now  bemg 
discussed  in  behalf  of  an  elevation  of  the  standard  of 
medical  education.  In  this  school  the  students  are 
classified  as  juniors  and  seniors.  The  course  of  lectures 
is  also  divided  in  like  manner,  so  that  while  one  class 
listens  to  the  professors,  the  other  is  engaged  in  the 
dissecting-room.  At  the  close  of  the  winter  term  the 
juniors  are  required  to  pass  a  searching  examination 
before  thev  can  be  advanced  to  the  senior  class.  The 
method  of  review  by  daily  recitation  is  also  enforced 
in  both  classes.  The  length  of  the  winter  term  is  five 
months,  and  to  this  is  added  a  spring  term  of  three 
months.  Thus  we  have  here  provided  a  system  of 
medical  instruction  which  is  not  excelled  by  any  other 
school  in  the  country ;  and  it  appears  self-evident  that 
if  this  method  of  instruction  has  been  so  far  successful, 
in  spite  of  the  rivalry  of  all  the  other  schools,  it  cannot 
fyi  to  give  universfd  satisfaction,  when  the  concerted 
action  of  our  college  faculties  snail  require  as  much 
fk'om  every  candidate  for  a  medical  degree.  It  is  im- 
possible to  refain  fi'om  expressing  the  hope  Uiat  the 
proposed  conference  of  delegates,  meeting  in  Cincin- 
nati next  summer,  may  result  in  the  ^andonment 
of  a  policy  for  whicn  only  the  poverty  of  our  ancestors 
oould  be  an  excuse.  Our  modem  sense  of  propriety 
should  instantly  decree  the  suppresdon  of  such  an  old- 
time  exhibition  as  still  finds  favor  with  too  many  of  our 
medical  school  faculties. 


The  medical  students  who  have  passed  the  winter  in 
our  city  have  enjoyed  such  opportunities  for  clinical 
study  as  have  never  before  been  furnished  in  the 
North-west.  Our  county  hospital,  located  in  this  city, 
has  now  been  open  for  one  year.  In  all  the  details  of 
its  management,  it  is  a  mimatnre  edition  of  Bellevue 
Hospital  Twice  a  week  during  the  winter,  it  has 
been  opened  to  the  students ;  and  they  have  literally 
thronged  the  building.  Never,  even  in  Bellevue,  have 
I  witnessed  such  eager  pursuit  of  the  clinical  lecturers ; 
such  desperate  strueghng  for  standing-room  in  the 
dead-house.  Though  obliged  to  come  a  distance  of 
three  miles  fi*om  the  college,  the  students  would  crowd 
the  amphitheatre  of  the  hospital,  every  Tuesday  and 
Friday,  to  a  degree  onlv  matched  in  New  York  by  the 
attendance  upon  one  of  Dr.  Wood's  especial  field-iiays. 
Our  western  students  are  a  working  class  of  young  men, 
and  none  of  them  are  willing  to  lose  a  single  one  of  the 
opportunities  afforded  during  their  brief  term  of  metro- 
politan study. 

The  Chicago  Medxecd  Journal  has  once  more  changed 
hands,  returning  again  to  the  care  of  a  former  editor, 
J.  Adams  Allen,  M.D.,  Professor  of  Theory  and  Prac- 
tice in  Rush  Medical  College,  The  Journal  will  con- 
tinue to  be,  as  heretofore,  the  organ  of  the  college;  and 
at  the  present  time  may  become  a  very  convenient 
means  of  advertising  the  alumni  of  the  changes  through 
which  theur  ahna  mater  is  passing. 

Our  State  Legislature  has  recently  passed  a  bill  for 
the  establishment  of  a  Health  Commission  for  this  city. 
The  special  provisions  of  the  act  have  not  yet  been  given 
to  the  public,  but  rumor  reports  a  general  conformity 
with  the  features  of  the  New  York  enactment 

The  past  winter  has  been  a  season  of  remarkable 
health.  Great  uniformity  of  temperature,  combined 
with  an  unusual  precipitation  of  snow,  has  reduced  the 
death-rate  to  a  very  low  figure.  The  variable  weather 
of  spring  will  soon  increase  the  tendency  to  disease, 
and  then  our  long  winter  vacation  will  be  over.  Dur- 
ing the  month  of  February  the  number  of  deaths  re- 
ported to  the  health  officer,  including  all  the  cases  o! 
stiU-birth,  were  only  two  hundred  and  fifty-five,  in  a 
population  of  two  hundred  thousand.  Excluding  still- 
births, the  mortality  in  January  was  two  hundred  and 
seventy-seven.  During  the  year  1866,  notwithstanding 
the  prevalence  of  cholera,  which  destroyed  nine  hundred 
and  eighty-seven  lives,  the  total  mortality  was  only 
5,926,  being  equivalent  to  a  death-rate  of  a  trifle  less 
than  30  to  the  1,000  living,  or,  excluding  the  victims  of 
cholera,  a  trifle  over  24  to  the  1,000  of  population. 
This  favorable  exhibit  is  by  no  means  due  to  the  superi- 
ority of  our  climate,  or  to  an  advanced  state  of  sanitary 
intelligence,  but  to  the  absence  of  tenement  houses,  and 
to  the  youth  of  the  mass  of  the  community.  When 
the  extreme  of  hoary  a^e  shall  begin  to  add  its  quota 
to  our  returns  of  mortahty,  the  annual  death-rates  will 
undoubtedly  exceed  their  present  figure.  M. 

COMMENCEMENTS  OF  THE  COLLEGES  OF 
PHILADELPHIA. 

TKULg  PHT8I0IAN8,  XTC. 

PHtLABSLPHIA,  Mtrdk  lt»  18C7. 
Ty>  TUB  BDrroB  or  na  Mbdioal  Rboobo. 
Sir — The  past  week  has  been  full  of  interest  to  the 
medical  profession  of  this  city.  Our  medical  colleges 
have  sent  forth  their  quota  of  graduates,  and  our  County 
Medical  Society  has  had  an  animated  discussion  as  to 
the  status  of  medical  practitioners  of  the  gentler  sex. 

At  the  public  commencement  of  the  Jefferson  Medi- 
cal College,  held  on  the  9th  of  March,  the  degree  of 

Digitized  by  VjOO^  ^  _ 


THE  MEDICAL  RECORD. 


Doctor  of  Medicine  was  conferred  bjr  the  Hon.  Edward 
King,  LL.D..  President  of  the  Institation,  upon  one  hun- 
dred mad  fifty  graduates,  afler  which  me  valedictory 
address  was  delivered  by  Pro&  Biddlb,  of  the  chair  of 
Materia  Medica.  Dr.  Biddle's  address  was  admirably 
adapted  to  the  occasion,  and  abounded  in  yaluable 
counsel,  not  least  of  which  was  the  advice  to  avoid  two 
great  impediments  to  success  in  practioe.  one  being  the 
maelstrom  of  politics,  and  the  other  the  fascinating  pur- 
suit of  q>ecial  departments  of  science ;  for  the  field  of 
medicine  is  itself  amply  sufficient  to  employ  the  entire 
talents  of  the  physician.  He  also  recommended  a  strict 
adherence  to  die  C!ode  of  Ethics  of  the  American  Medi- 
cal Assodation,  and  actiye  membership  in  a  medical 
society. 

On  the  14th  of  March  the  annual  commencement  of 
the  Medical  Department  of  the  University  of  Penn- 
sylrania  was  held  at  the  Philadelphia  Academy  of 
Music,  and  the  degree  of  M.D.  was  conferred  upon  156 
graduates.  An  excellent  and  affectionate  valedictory 
ad<bre88  was  given  by  Prof.  Oaksom,  who  also  ooun-< 
selled  strict  adherence  to  the  national  code  of  ethics, 
and  connexion  with  local  medical  organiaatiocs. 

The  number  of  graduates  from  Pennsylvania  was  in 
hrgd  proportion  in  both  institutions,  being  70  at  the 
Je&rson  Medical  College,  and  99  at  the  University. 
The  number  of  matriculants  during  the  course  was 
356  at  the  Jefferson,  168  of  whom  were  Pennsyl- 
vmnians:  and  464  at  the  Medical  Department  of  the 
University,  of  whom  307  belonged  to  Pennsylvania, 
living  188  fi*om  other  States  at  the  Jefferson,  and  157 
outside  of  our  own  State  at  the  University. 

On  the  evening  of  the  13th  there  was  assembled  at 
the  conversational  meeting  of  the  Philadelphia  County 
Medical  Society,  a  larger  number  of  members  than 
uiually  attend;  the  subject  for  discussion  being  the 
report  of  the  committee  on  Female  Physicians. 

At  the  meedng  of  the  Medical  Society  of  the  State 
of  Pennsylvania,  held  in  1866,  there  was  passed  a  reso- 
lution to  the  effect  that  it  was  considered  unprofessional 
to  consult  with  the  professors  and  graduates  of  female 
medical  colleges,  as  at  that  time  organized.  At  the 
meeting  held  Last  year  at  Wilkesbarre,  a  resolution  was 
introduced  to  repeal  the  former  resolution,  which  was 
lost  by  a  very  closely  contested  vote ;  and  another  reso- 
lution was  offered  to  the  effect  that  nothing  in  the  reso- 
lution of  1860  should  be  so  construed  as  to  prevent 
members  who  so  desired,  from  consulting  with  properly 
qualified  female  practitioners ;  and  for  this  was  substi- 
tuted and  passed  another  postponing  further  considera- 
tion for  a  year,  and  recommending  the  discussion  of  the 
subject  in  the  interim  by  the  various  county  medical 
iocietiesL  On  this  subject  see  my  letter  in  No.  9,  p. 
220,  ToL  Lj  of  Tea  Record. 

On  the  evening  in  question  the  report  of  the  Com- 
mittee, as  prepared  by  the  chairman.  Dr.  D.  Francis 
Condie,  was  read  by  that  gentleman.  This  admirable 
report^  covering  the  entire  ground,  I  hope  to  give  you 
in  fhll,  in  a  regular  report  of  the  proceedings  of  the 
Sodety.  The  report  acknowledged  the  capability  of  the 
female  mind  to  accomplish  anything  intellectually  that 
eui  be  acquired  by  the  male ;  at  the  same  time  it  was 
•tienuousiy  opposed  to  encouraging  females  to  devote 
themselves  to  this  sphere  of  usefumess,  unless  only  so 
£v  as  to  properly  fit  them  for  intelligent  nursing  of  akk, 
with  which  the  proper  mission  of  woman,  in  this  direc- 
tion, was  attained:  but^  inasmuch  as  certain  women 
would  undertake  the  study  and  practice  of  medicine, 
and  their  services  would  be  solicited  by  a  large  number 
of  invalida,  our  duty  to  the  community  at  large  de- 
manded that  the  profession  should  see  that  such  females 
eoold  have  access  to  proper  instruction,  and  that  if  such 


were  the  case,  it  would  be  improper  to  refuse  to  consult 
with  them.  The  report  suggested  their  attendance  at 
the  same  medical  institutions  as  the  male  student,  and 
under  the  same  discipline;  and  that  if  it  should  be 
deemed  inexpedient  to  permit  their  presence  in  the  lec- 
ture-room at  ^e  same  time  with  male  students,  the 
same  lectures  should  be  delivered  to  females  at  different 
hours.  The  report  concluded  with  a  resolution  adverse 
to  the  repeal  or  the  resolution  of  1860. 

An  animated  discussion  ensued,  which  was  partici- 
pated in  by  many  of  the  members,  and  a  resolution  to 
the  effect  that  the  matter  should  be  referred  to  the 
American  Medical  Association,  was  laid  over  for  action 
at  a  special  meeting,  at  which  it  is  hoped  a  larger  at- 
tendance will  eecure  an  action  fuUy  representing  the 
views  of  the  profession. 

The  lectures  of  the  Auxiliary  Faculty  of  Medicine  of 
the  University  of  Pennsylvania,  embracing  various 
branches  of  natural  history  with  special  reference  to 
their  medical  relations,  will  commeoce  in  April,  and  be 
on  the  same  subjects  and  by  the  same  professors  as  last 
vear.  The  Summer  Course  of  Lectures  inaugurated 
last  year  at  the  Jefferson  Medical  College,  will  be  re- 
sumed the  coming  summer,  but  the  scheme  has  under- 
gone some  modification  in  subjects  and  lecturers. 

This  course  will  be  as  follows : — 

Clinical  Surgery,  by  Prof  Gross. 

Clinic  of  Diseases  of  Women  and  Children,  by  Profl 
Wallace. 

Chemistry  ajjplied  to  Toxicology,  by  Prof.  Rand. 

Materia  Medica  and  Therapeutics,  by  Prof.  Biddle. 

Clinical  Medicine,  by  Dr.  Da  Costa. 

Visceral  and  Surgicial  Anatomy,  by  Dr.  W.  H.  Pan- 
coast. 

Operative  and  Minor  Surgery,  by  Dr.  J.  H.  Brinton. 

Ophthalmic  and  Aural  Surgery,  by  Dr.  R.  J.  Levia 

Venereal  Diseases,  by  Dr.  F.  F.  Maury. 

Pathological  Anatomy,  by  Dr.  W.  W.  Zeen,  Jr. 

It  is  gratifymg  to  be  able  to  chronicle  here  one  new 
and  valuable  movement  in  a  proper  direction,  and  that 
is  the  teaching  of  Pathological  Anatomy.  The  sooner 
that  this  branch  is  made  part  of  the  regular  winter  cur- 
riculum of  studies,  the  better.  I  believe  that  the  Har- 
vard School  is  the  only  one  at  which  it  has  heretofore 
been  regularly  introduced,  and  the  necessity  exists  for 
following  this  example  wherever  medicine  is  taught 
At  present  but  little  knowledge  of  pathological  anatomy 
is  conveyed  to  the  student,  and  that  little  is  taught  inci- 
dentally with  other  branches.  The  establishment  of  a 
separate  chair  of  Pathological  Anatomy  would  relieve 
the  churs  of  Practice  and  of  Surgeiy  to  a  great  extents 
so  that  the  professors  of  these  practical  branches  would 
have  time  to  teach  them  more  thoroughly.  As  it  is, 
in  more  than  one  instance  but  partial  courses  are  given 
in  these  practical  subjects,  and  the  study  of  many  im- 
portant diseases  is  entirely  neglected.  This  fact  cSiould 
be  borne  prominently  in  mind  when  the  representatives 
of  the  various  medical  faculties  meet  in  convention  at 
Cincinnati  in  May  next. 

In  this  connexion  you  will  be  glad  to  learn  that  Dr. 
Altrsd  Still^,  Profbssor  of  the  Practioe  of  Medicine  in 
the  University  of  Pennsylvania,  made  Morbid  Anatomt 
the  subject  of  a  lecture,  introductory  to  the  course  of 
clinical  instruction  at  the  Philadelphia  Hospital  for  the 
winter  session  of  1866-7 ;  and  he  has  been  sufficiently 
impressed  with  its  importance  to  have  his  lecture 
printed  in  pamphlet  form,  a  copy  of  which  should  be 
placed  in  the  possession  of  every  one  interested  in  pro- 
gressive medical  education.  One  or  two  extracts  from 
this  timely  and  admirable  lecture  will  be  in  place. 

*^  1  shall  endeavor  to  show  you  that  morbid  anatomy 


to 


THE  MEDICAL  RECORD. 


is  an  indispensable  element  of  medical  science,  Uiat  its 
position  is  a  fundamental  one,  and  that  it  is  indeed  the 
very  comer-stone  of  that  science.  Let  me  attract  your 
attention  towards  it  and  fix  your  interest  upon  it;  let 
me  move  you  to  share  the  wonder  which  1  feel,  and 
which  I  can  scarcely  find  words  to  expres^  that  in  nei- 
ther of  the  great  schools  of  this  city  does  there  exist  a 
professorship  devoted  exclusively  to  a  scientific  exposi- 
tion of  pathological  anatomy.  -^ 

"  A  description  of  disease  without  an  accurate  account 
of  the  lesions  which  accompany  it,  is  like  a  drama,  or  a 
tale,  or  a  history,  which  stops  short  before  the  catastro- 
phe that  explains  and  justifies,  and  gives  an  interest  to 
all  that  has  gone  before.  Morbid  anatomy  draws  the 
veil  aside  which  conceals  the  machinery  upon  whose 
movements  all  the  phenomena  of  disease  depend,  and 
it,  alone,  reUeves  us  from  the  superstition  which  once 
pervaded  the  medical  world,  that  every  disease  is  a 
diabolical  inhabitant  of  the  body  which  is  to  be  exor- 
cised by  charms  and  incantations. 

"Without  the  revelations  of  morbid  anatomy  we 
should  possess  as  little  knowledge  of  the  nature  and 
seat  of  diseases,  as  the  physician  of  an  oriental  harem, 
who  is  obliged  to  prescribe  for  his  fair  patients  without 
being  allowed  either  to  see  or  to  touch  them.  Symp- 
toms are  the  inarticulate  cries  for  relief  of  sufferinj^  or- 
gans. Woe  to  the  sick  if  we  have  not  learned  to  inter- 
pret their  language  1  The  keys  to  its  meaning  are  not 
only  interrogation,  but  abo  inspection  and  all  the  meth- 
ods of  physical  examination,  which,  after  all,  are  so 
many  lessons  in  morbid  anatomy ;  for  they  enable  us 
to  discover  the  seats  of  disease  and  the  changes  of  struc- 
ture which  it  involves." 

And  the  lecture  concludes:  "If  you  shall  become  du- 
ly impressed  with  the  extreme  interest  and  the  incalcu- 
lable value  of  morbid  anatomy  to  yourselves  and  to  all 
disciples  of  the  healing  art,  unite  your  voices  in  an  ap- 
peal to  those  who  regulate  the  studies  of  our  Medical 
Institutions,  and  solicit  them  to  put  an  end  to  the  great 
defect  of  medical  education  whicn  we  now  have  to  de- 
plore. Importune  them  to  create  in  every  Medical 
College  a  cnair  from  which  the  science  of  morbid  ana- 
tomy shall  be  adequately  taught  so  that  you  and  your 
successors  may  cease  to  lament  the  imperfect  and  un- 
scientific notions  of  disease  which  you  are  now  too 
often  compelled  to  accept,  and  which^  so  long  as  they 
continue  to  prevail,  will  obUge  American  Medical  Sci- 
ence to  walk  with  uncertain  steps  and  veiled  counte- 
nance behind  her  European  sister." 

The  above  quotations  need  no  commendatory  com- 
ment ;  they  have  been  introduced  here  in  the  hope  that 
the  views  of  one  of  our  most  eminent  teachers  of  medi- 
cine will  be  brought,  through  the  medium  of  your  ex- 
tensive circulation,  to  the  knowledge  of  many  precep- 
tors whom  the  pamphlet  will  not  reach,  in  order  that 
they,  too,  may  unite  their  voices  in  an  appeal  for  the 
removal  of  a  great  defect  in  medical  instruction. 
Yours  truly, 

C.J. 


OVARIOTOMY  PERFORMED  TWICE  SUCCESS- 
FULLY UPON  THE  SAME  PATrENT  BY  THE 
SAME  SURGEON. 

To  TBI  KoiToa  or  mi  ICksioal  RsooitiK 

Sra— Dr.  Spencer  Wells,  before  the  Baydl  Medioai  and 
Chirurgicat  Society  (London  Lancei,  Feb.  1867),  alludes 
to  three  cases  in  which  ovariotomy  has  been  twice  per- 
formed upon  the  same  patient.  The  author  refers  to  a 
fourth  case,  "  believed"  by  him  to  be  the  first^  irt  which 
ovariotomy  has  been  successfully  twice  performed  upon 


the  same  patient  by  the  same  surgeon.  In  this  case 
Dr.  Wells  removed  the  left  ovary  in  February,  1866. 
In  about  eighteen  months  and  one  half  afler  the  ^t 
operation,  the  right  ovary  was  also  *^  removed  with 
complete  success." 

I  submit  the  report  of  a  case  upon  which  I  have  sucoew- 
fviUy  operated  twice.  The  patient  was  Mrs.  Ellen  Sim- 
mons, of  South  Bristol,  Ontario  county,  N.  Y.  I  re- 
moved the  left  ovary  April  14,  1858.  The  case  is  re- 
ported in  detail  in  the  AmtriccM  Journal  of  Medioal 
ScienoUy  October,  1858.  The  tumor  weighed  thirty 
pounds:  the  patient  recovered;  the  right  ovary  was 
then  healthy. 

During  the  month  of  July.  1859,  the  patient  dis- 
covered the  second  tumor,  wnich  increased  so  rapidly 
that  on  the  eleventh  of  September,  1859, 1  wasc^ed 
to  visit  her. 

On  the  twelfth  I  drew  fi-om  the  tumor  about  twenty 
pounds  of  fluid,  and  on  the  thirteenth  she  menstruated. 

I  decided  to  operate,  which  I  did  on  the  twenty-first 
of  September,  1859 — seventeen  months  and  six  days 
from  the  first  operation.  Chloroform  having  been 
given,  an  incision  was  made  through  the  old  cicatrix. 
The  tumor,  weighing  thirty  pounds,  was  removed ;  the 
pedide  secured  hy  a  single  hgature ;  the  wound  united 
by  sutures,  dressed  with  a  compress  and  corset-bandage, 
and  the  patient  made  a  second  recovery. 

I  was  assisted  in  this  operation  by  Drs.  Jewitt  and 
Carson,  of  Canandai^ua;  Durgao,  of  South  Bristol; 
Parmely,  of  West  Bloomfield,  and  Peltier,  of  Buffalo. 
My  operations  were,  iherejbrej  performed  nearly  six  years 
before  those  by  Dr.  Wdls,  cmly  accordingly ,  my  case  i$ 
believed  to  be  the  first  vn  which  ovariotomy  was  ever  suo- 
cessfuUy  performed  twice  upon  the  same  patient  by  iht 
same  surgeon. 

Desiring  to  honor  American  Surgery  rather  than 
myself  in  this  intere'^ting  matter, 
I  am,  sir. 

Your  obedient  servant. 

Hazard  A.  Potteb,  M.D. 

0«K«YA,  IS.  T.,  March  IT,  18W. 

THE   INSTITUTION  FOR  RUPTURED  AND 
CRIPPLED. 

A  CASE  PRESENTED  TO  THE  PATHOLOGTOAL  SOOXETT. 

To  THB  EDiToa  or  thi  Midioal  Bsoord. 

Sir — I  have  just  read  your  published  report  in  the  first  of 
March  number,  of  the  transactions  of  the  Pathological 
Society  of  Nov.  28,  1866,  and  regret  to  see  myself  re- 
presented as  stating  what  I  never  had  any  grounds  for 
doingf  viz.  that  "next  he  entered  the  Institution  for  the 
ruptured  and  crippled,  where  he  remained  under  treat* 
ment  for  the  greater  part  of  two  years,"  alluding  to  the 
boy  whose  hip-joint  disease  had  fallen  to  my  care,  and 
.whose  history  was  related  on  that  occasion.  It  was 
never  my  understanding  of  his  history  that  this  boy  had 
been  treated  at  the  institution  named,  as  a  resident 

?atient,  and  I  therefore  never  intended  to  say  so. 
lease,  therefore,  to  allow,  in  the  interest  of  those  who 
may  be  concerned,  and  of  trulAi,  a  correction  of  that 
report.  I  intended  to  state,  what  I  Aen  knew,  and  still 
believe,  ^at  thispaHent  wa^  under  the  care  and  treatment 
of  said  institution  for  about  two  yean  before  I  saw  him. 
It  was,  however,  as  an  out-patient,  according  to  all  the 
information  I  ever  could  get  upon  the  matter.  Pleaee, 
give  this  an  early  place,  and  oblige  Uiose  whom  the 
report  may  afifect  unfavorably,  as  well  as 
Yours  very  truly, 

Stsfbxn  ROGIBS. 
,MMch  «.  1S«T.  C^r^r^i 

Digitized  by  VjUO V  ^  _ 


THE  MEDICAL  BECOBD. 


11 


Urn  fnb[\c&t\ons. 


Ok  twm  AcnoK  of  Msdioikb  oh  the  System.  By  Fbe- 
DBBiCK  WiLUAM  Hbaolakd,  M.D.,B.A^  F.L.S.,  Fellow of 
the  Royal  College  of  Physicians.  6th  American,  from  4th 
London  Edition,  Revised  and  Enlarged.  Phil :  Lindsay 
ABlaeistok.  1867. 

TtABBACnOXS  OF  THE  MbMCAL  SOOXSTT  OF  THE  STATE  OF 
NOBTH  Oabouna.  1867. 


Mn^xcai  Vimsi  axdi  Uttmsi. 


GuTomiDECToifY. — Mr.  Baker  Brown  and  Mr.  Philip 
Harper^  in  deference  to  the  opinion  of  the  medical  press 
on  the  subject  of  ditoridectomy,  have  determined  not  to 
perform  the  operation  in  the  London  Surgical  Home, 
pending  professional  inquiry  into  its  validity  as  a  scien- 
tific and  justifiable  operation.  What  now  wiU  be  the 
cbsQoe  of  recovery  for  the  poor  epileptic  female  with  a 
ditorisf 

Small-Pox  in  London. — Small-pox  is  prevailing  to 
a  frightful  extent  in  London.  Altogether  there 
have  been  four  hundred  and  sixty-two  lives  lost 
by  this  one  disease  in  the  space  of  thirteen  weeks— 
an  aggr^te  which  may  without  exaggeration  be 
irooken  of  as  really  alarming.  It  is  most  sad  to  re- 
flect on  the  ignorant  carelessness  or  the  reckless 
feAIy  of  those  who  not  only  endanger  the  lives  of 
tfaenr  children  and  of  themselves,  but  also  jeopardize 
the  lires  of  their  neighbors  and  of  the  public  generally, 
by  neglect  of  the  simple  means  available  for  reducing 
the  baneful, power  of  smaU-pox  to  a  nullity.  It  is 
important  that  it  should  be  known,  moreover,  that 
throughout  the  country — in  large  towns  and  rural  dis- 
tricts alike— -this  loathsome  and  deadly  malady  is  spread- 
ing, as  wdl  as  in  London. — Lancet 

WaBKIHO  AOAIHST    THE    SofULTAEEOUS    PRESCRIPTION 

C9  Chlorate  of  Potass  and  Iodide  of  Potassiuh. — 
fhii  has  great  importance;  since  in  syphilitic  and 
other  afieciions  these  drugs  are  often  combined.  Bat 
IL  Yee  has  demonstrated  the  danger  of  such  practice 
by  showing  that  the  chlorate  of  potass  gives  up  its  oxy- 
gen, which  forms  with  the  iodide  of  potassium  an 
wdatdj  whose  toxic  properties  have  been  recently  de- 
monstrated by  Melsen. — Gazette  Midicale, 

Fersum  Bxdactum. — Metallic  iron  with  a  variable 
amoont  of  magnetic  oxide  of  iron,  prepared  by  reduc- 
ing peroxide  of  iron  to  the  metallic  state,  by  heating  it 
b  a  gun-barrel  in  a  furnace  and  passing  through  it  dry 
hydrogen  gas.  A  powerful  hasmatinic  and  tonia  .  .  .  . 
I^Me,  gr.  ij. — gr.  yj. —  Waring'e  PraeUocd  TherapetUiei, 

To  Detect  Sulpsurio  Acid  in  Yineoar. — ^A  German 
JoQcnal  publishes  a  neat  process,  which  may  be  thus 
briefly  stated.  Into  the  vinegar  to  be  tested,  put  a 
amall  quantity  of  starch,  boil  the  solution  down  to  half 
its  original  measure,  then  drop  into  it  a  very  minute 
portion  of  iodine.  If  the  vinegar  Is  pure  the  usual  blue 
tint  will  be  shown,  bnt  if  it  be  adulterated  with  sulphuric 
acid  no  such  coloration  will  take  place,  because  the 
action  of  this  acid  upon  starch  converts  it  into  glucose 
or  grape  sugar. 

t  OsMono  Process  for  Separating  Sugar. — ^In  France 
iogar  has  been  lately  separated  fi*om  beet  molasses  by 
applying  the  osmoseprtnciple.  The  membrane  used  is 
paper-parchment  Water  is  passed  upwards  and  molas- 
ses downwards  on  the  opposite  side  of  the  membrane. 


Anecdote  of  the  late  Prof.  David  S.  Conant. — ^An 
instance  illustrative  of  his  coolness  and  boldness  may  be 
briefly  adverted  to.  On  one  of  his  visits  to  his- home  he 
found  his  ^Either  suffering  from  a  cervical  tumor.  The 
disease  had  already  developed  to  such  an  extent  as  to 
threaten  suffocation  by  pressure  on  the  trachea^  and  was 
manifestly  malignant.  Satisfied  that  the  danger  of 
sudden  death  was  imminent,  he  detennined  to  remove 
as  much  of  the  mass  as  practicable  to  relieve  the  pressure. 
In  the  course  of  the  operation,  he  came  upon  the  carotid 
artery.  Without  any  hesitation  he  applied  a  ligature, 
and  then  extirpated  all  of  the  mass  that  could  be  safely 
removed.  This  operation  gave  ^reat  relief,  and  un- 
doubtedly prolonged  the  father's  life  some  months.  It 
is  not  every  surgeon,  however,  who  could  use  the  knife 
on  his  own'parent,  for  at  best  only  a  palliative  operation. 
— Memorial  AddresSj  Prof.  A,  B.  Crotky,  Univ.  Vermont 
Medical  Department 

Charitable  Bequests. — ^Paschal  P.  Pope,  of  Boston, 
recently  deceased,  bequeathed  $190,000,  as  follows: — 
To  Harvard  College,  $50,000,  for  a  Professorship  of 
Latin  Language  and  Literature ;  Home  for  Aged  Men, 
$30,000:  Saaors'  Snug  Harbor,  $30,000;  Boston  Di?- 
pensary,  $20,000;  Harvard  Benevolent  Society,  $20,000; 
Boston  Society  of  Natural  History,  $20,000;  the  Tem- 
porary Home  for  the  Destitute,  $10,000;  Boston  Provi- 
dent Association,  $10,000. 

Tbe  Therapeutics  of  Inhalation. — ^To  the  Profes- 
sion.— ^Dr.  J.  Sohs  Cohen,  of  Philadelphia,  is  engaged  in 
preparing  for  publication  a  work  upon  "  The  Value  of 
Ihhalaiums  in  the  Treatment  o^  Diseasej**  and  he  requests 
the  assistance  of  his  professional  brethren  in  supplying 
clinical  material  Contributions  will  be  duly  acknow- 
ledged, and  attention  drawn  to  every  source  from  which 
instruction  may  be  derived.  Negative  results,  and 
results  apparently  or  actually  unfavorable,  will  be  of 
peculiar  value.  Even  isolated  observations  will  be  of 
service.  Information  is  more  particularly  desired  as  to 
results  firom  inhalations  in  sore  throat  in  all  its  varieties, 
croup,  diphtheria^  oedema  of  the  glottis,  asthma,  and 
phthisis.  Where  other  treatment  has  been  conjoined 
with  inhalation^  mention  should  be  made  of  at  least  its 
general  character,  and  an  estimate  be  formed  of  its 
value.  Where  favorable  results  are  reported,  an  opinion 
is  requested  as  to  the  probability  of  equally  favorable 
results,  had  inhalation  not  been  resorted  to.  Any 
general  information  on  the  subject  in  the  possession  of 
the  writer  will  be  placed  at  the  disposal  of  correspondents 
intending  to  contribute  their  own  observations.  For 
the  past  few  years  this  subject  has  attracted  a  great  deal 
of  attention  abroad  and  at  home,  and  a  series  of  statistics 
of  its  therapeutic  results,  collated  from  the  experience  of 
American  physicians  in  different  sections  of  our  country, 
cannot  fail  to  prove  of  great  professional  value.  We 
invite  our  readers  to  cooperate  with  him.  Address. 
Dr..  J.  Solis  Cohen,  1106  Wahiut  street,  Philadelphia. 

Death  of  Dr.  Wiluah  Johnson  of  White  House,  N.  J. 
— At  White  House,  Hunterdon  co.,  N.  J.,  January  13, 
1867,  Dr.  William  Johnson  died  in  the  78th  year  of  his  age. 
He  was  bom  at  Princeton,  N.  J.,  on  the  18th  of  Pebruary, 
1789.  His  father,  Thomas  P.  Johnson,  was  a  lawyer  of 
distinguished  ability,  and  was  one  among  few  in  this 
State  upon  whom  was  conferred  the  honorary  degree  of 
Ser^nt-at-Law.  His  mother  was  a  member  of  the 
distinguished  Stockton  family,  many  of  whom  have  held 
important  offices  in  State  and  National  trust.  At  the 
eany  age  of  twelve  years  death  deprived  him  of  tbe  sym- 
pathy and  guidance  of  his  mother,  and  he  was  left  to  the 
guidance,  the  wisdom  of  his  distinguished  father.  After 
is  graduation  from  the  University  of  Pepnsylvania  he 

digitized  by  VjC  „      ^_ 


12 


THE  MEDICAL  RECORD, 


settted  at  Wliite  House,  N.  J.,  in  July,  1811.  He  goon 
feU  into  a  wide  and  laborious  practice,  to  which  he  de- 
voted himself  with  singular  fidelity  and  zeal  With  a 
Tigorous  and  active  mind,  he  was  a  most  laborious 
student,  and  constantly  brought  to  his  practice  the  re- 
sults or  patient  research  and  study ;  added  to  this,  he 
wrote  with  much  clearness,  elegance,  and  force.  He 
fiirnished  articles  for  different  medical  periodicals  until 
blindness  compelled  him  to  abandon  both  his  pen  and 
practice.  As  might  be  expected,  he  was  a  skilful  prac- 
titioner, and  enjoyed  a  wide  reputation.  Many  also 
sought  his  presence  that  they  might  sit  at  his  feet  as 
pupils  of  Galen. 

Changes  in  the  Faoultt  of  Pari& — The  vacant 
chairs  in  the  Faculty  of  Medicine  of  Paris  have  been 
filled  as  follows : — ^Professor  of  General  Pathologv  and 
Therapeutics,  Lassaigne;  Professor  of  Pathologic^  Ana- 
tomy, Vulpian;  Professor  of  Therapeutics  and  Materia 
Medica,  See  •  Professor  of  External  Pathology,  Broca ; 
Professor  of  Internal  Pathology,  Oxenfeld ;  Professor  of 
Internal  Pathology,  Hardy-  Adjunct-Professor  to  the 
same  (^air,  Raynaud.  The  resignation  of  Nelaton  is 
spoken  of. 

A  HosprrAL  for  Nervous  Diskases. — ^An  institution 
for  the  treatment  of  paralysis,  epilepsy,  and  other 
nervous  diseases,  will  be  opened  at  Lake  Mahopac, 
Putnam  co.,  N.  Y.,  in  the  early  part  of  this  spring.  It 
will  be  strictly  private,  and  under  the  direction  of  Dr. 
M.  Gonzalez  Echeverriai  who  u  so  fitvorably  known  in 
connexion  with  the  practice  of  the  specialty.  In  addi- 
tion to  tlie  best  comfort  and  to  the  natural  advantages  of 
the  location,  ever^  means  of  special  treatment  beneficial 
for  this  dass  of  diseases  will  be  afforded  to  the  patients. 
The  institution  will  be  provided  with  a  room  for  light 
gymnastics,  the  proper  apparatus  for  the  exercise  of 
paralytics,  and  the  conveniences  to  administer  the  dif- 
ferent kinds  of  hatha 

Annual  Cobocenoeiceht  of  the  Gollboe  of  Physicians 
AND  SuROBONS. — The  seventieth  annual  commencement 
of  the  College  of  Physicians  and  Surgeons  took  place  at 
Steinway  Hall  March  14th,  a  lara^  and  fashionable  au- 
dience honoring  the  occasion  with  their  presence  The 
President  of  the  College,  Edward  Delafield,  M.  D.,  the 
members  of  the  faculty,  the  Trustees  of  the  College  of 
Physicians  and  Surgeons  and  of  Columbia  Collep^,  as  also 
severed  prominent  physicians  of  this  and  the  neighboring 
cities,  occupied  seats  on  the  platform.  The  proceedings 
were  opened  with  prayer  by  the  Bight  Rev.  H.  A. 
Neely,  D.  D.,  Episcopal  Bishop  of  Maine.  The  Degree 
of  Doctor  of  M!edicine  was  then  oonferred  on  ninety- 
nine  young  gentlemen. 

Upon  t£e  condusion  of  this  ceremony^  Professors 
Clark  and  Dalton  announced  the  prizes  as  follows : — 
first  Harsen  prize  to  J.  Aokerman  Coles,  A.  R,  of  New 
Jersey ;  second  to  D.  Valentine  Ljrnch,  of  New  York 
city.  The  two  feculty  prizes  were  awarded,  first  to 
Albert  H.  Buck,  A-  B.,  of  New  York  city  for  a  thesis  on 
"  IHMna  SpirdliBj  *'  and  the  second  to  Ira  Remsen,  of 
New  York  citv,  for  a  thesis  on  **  The  Patty  Degeneration 
of  ti^e  Liver.  In  connection  with  these  latter  prizes, 
honorable  mention  was  made  of  the  theses  presented  by 
t^e  following  graduates:  Jonathan  Edwards,  Jr.,  of 
Renssalaer  county,  N.  Y.,  Henry  E.  Handerson,  A.  M. 
of  New  York  city ;  Roger  S.  Tracy,  A.  B.,  of  New  York 
city. 

The  address  to  the  graduates  was  then  pronounced  by 
the  Rev.  Henry  W.  Bellows,  D.  D.  It  was  a  well-oon- 
cetved  tribute  to  the  medical  profession,  and  was  well 
received  by  the  audience.  The  valedictory  address  was 
delivered  by  William  H.  Palmer,  A.  B.,  M.  D..  after 
which  the  exercises  were  d«sed  with  the  beneaiction. 


Alumni  Assocution  of  the  Colleob  of  Physicians 
AND  Surgeons  n.  t. — The  ninth  annual  meeting  was  held 
at  the  College  buildin|f  comer  Twenty-lhird  Street  and 
Fourth  Avenue  on  Friday  March  15th  ult  The  Presi- 
dent, Pro£  Alfred  C.  Post  delivered  the  inaugural  ad- 
dress in  which  he  reviewed  in  epitome  the  progress 
made  in  the  healing  and  kindred  Arts  for  the  past  60 
years. 

The  Committee  on  award  of  the  "Ddafield  Prize,  '* 
reported  that  but  one  essay  had  been  offered  in  compe- 
tition which,  notwithstanding  the  industry  and  care 
manifested  in  the  preparation,  was,  under  the  circum- 
stances, scarcely  entitled  to  the  prize,  The  Committee 
recommended  that  the  fund  be  increased  to  $3,000, 
the  interest  of  which  should  be  devoted  to  the  further- 
ance of  the  object  intended.  The  designation  of  the  Prize, 
at  the  urgent  request  of  Dr.  Delafield,  was  changed  to 
that  of  the  ** Alumni  Association  ;"  and  a  subsequent  mo- 
tion that  the  fund  be  increased  to  the  desired  amount  by 
voluntary  subscriptions  among  the  graduates  prevailed. 
A  Committee  was  then  appointed  to  make  the  neces- 
sary appeids.  After  an  animated  debate,  in  which  Drs. 
Parker,  Eliot,  Draper,  Watts  and  Calkins  participated, 
the  subject  of  the  Essav  was  led  as  during  the  past  year 
"  to  the  option  of  the  Competitor  "  and  under  the  same 
restrictions.  Much  interest  was  manifested  in  the  "  ne- 
crological  record  "  which  was  read  by  the  Secretary,  Dr. 
Eliot.  This  custom,  according  to  the  Eistoridlogical  and 
Gfeneahgioal  Register  for  1860,  from  which  the  Secretary 
quoted,  appears  to  have  been  originated  by  the  late  ProC 
J.  L.  Kingsley  at  Tale  College  in  1842,  and  was  after- 
wards adopted  at  "Harvard"  in  1851,  at  the  suggestion 
of  the  late  Hon.  Edward  Everett  j  Joseph  Palmer, 
M.D.,  being  the  necrologist' in  the  latter  seat  of  learning 
for  that  and  several  succeeding  years.  The  report  was 
received  with  thanks,  and  the  Secretary  instructed  to 
prepare  from  materials  in  hand  a  record  of  all  deceased 
alumni  for  future  reference.  The  following  officers 
were  elected  for  the  ensuing  year :  President^  Dr.  Gur- 
don ;  Vice  President^  Dr.  Ghlen  Carter  •  Recording  Secre- 
tary, Dr.  Ellswordi  Eliot;  Corresponding  Secretary ,  Dr. 
John  Shrady ;  Treasurer,  Dr.  Henry  B.  Sands. 

The  Committee  on  Prize  Essays  consisting  of  Drs. 
William  H.  Draper  and  William  E.  Roberts  was  oombin- 
ed.  The  Councillors  re-elected,  the  only  change  being 
the  substitution  of  the  name  of  Ezra  M.  Hunt  of  New 
Jersey,  for  that  of  Surgeon  Charles  S.  Tripler,  IT.  S.  A., 
deceased.  The  numerous  assemblage  then  adjourned  to 
the  Ashland  House,  where  a  liberal  collation  prepared  by 
the  faculty  of  the  College  awaited  them. 

The  SntniaFisLD  Soonrr  fob  Medioal  Im pBovmsKT, 
is  the  name  of  the  society  which  has  recently  been 
organized  in  Illinois,  hi  aooordance  with  the  genenJ 
statutes  made  and  provided,  and  which,  in  the  main, 
patterns  after  a  similar  society  in  Boston.  Its  organi- 
zation^ objects,  etc.,  are  in  brief  as  follows :— Secretary 
and  Treasurer,  G.  S.  Stebbins,  M.D. ;  Cabinet-keeper 
and  Librarian,  W.  W.  Qurdner,  M.D. ;  Presidential 
Committee,  V.  L.  Crsen,  M.D.,  M.  Calkins,  M.D.,  S.  F. 
Pomeroy,  M.D.,  A.  R.  Rice,  M.D.  The  objects  of  the 
society  are,  the  cultivation  of  confidence  and  good-will 
between  the  members  of  the  profession,  and  the  eliciting 
and  imparting  information  upon  the  different  branches 
of  medical  scienoe,  and  the  establishment  of  a  museum 
and  library  of  pathological  anatomy. 

Dr.  Triquet,  the  distiDguished  writer  on  aural  sur- 
gery, in  Paris,  died  in  January  of  this  year,  in  the  forty- 
third  year  of  his  age. 

Db.  Wm,  M.  Nickkrso!!,  Dei,  has  been  confirmed 
by  the  United  States  Senate  as  Assistant-Surgeon, 
TJ nited  States  Navy. 


Digitized  by 


Google 


THE  MEDICAL  RECOEIX 


19 


Chtiginol  Commumcati0na» 


SOME  POINTS  IN  THB 

ANATOMY  AND  PHYSIOLOGY  OP  THE  SKIN, 

A!fD   IN   THC  80-OALLKD  STMPATHUBj    BEING  THE   SUB- 

ariANCB  or  two  lectures  deltvered  befobb  the 

NEW  YORK  IfEDICAL  JOURNAL  ASSOCIATION. 

Br  CHARLES  B  MORGAN,  A.B.,  M.D. 
WBrmcuM  mm  »WiiWB  of  tbi  mkuk  at  to  NOBjnnir  DispntABT, 

VBW  TOBK   CITT. 

The  skin  consists  of-— 1.  The  external,  non-yasoular 
eptderm,  or  cutide  (eoderon  of  Huxley). — %  The  papil' 
imiedy  neuro-yascular  coriumj  or  true  skin  (enderon  of 
HuxJey^ ;  and  3.  The  subcutaneous  areolo-fatty  tissue 
containing  ^e  sweat  and  sebaceous  glands  and  the  hair 
folliole&  The  epiderm  consbts  again  of  two  layers,  an 
extaroal  or  homy  layer  (stratum  comeum),  formed  of 
flat,  polygonal,  usually  nucleated  epitheUal  scales  ad- 
benng  strongly  together  by  their  margins  and  surfaces, 
M>  as  to  give  rise  to  neany  parallel  strata  or  laminsB. 
2.  An  internal  layer  separating  this  from  the  next  one 
(the  rete  Malpighi),  and  perhaps  really  the  oldest  cells 
of  the  latter,  though  running  parallel  with  the  former, 
ia  made  up  of  flat  but  nucleated  cells.  Here  it  is  where 
the  homy  stratum  is  regenerated  and  where  patholo- 
gical prooe^ses  usually  b^n. 

The  rete  Malpighi,  at  its  upper  part,  consists  of  large 
distinctly  nucleated  cells  studded  over  with  points  like 
a  chMtnut-burr,  and  hence  their  name  of  spinous  or  den- 
tated  cells,  or  from  their  discoverer,  cells  of  Schron. 
As  we  go  further  down,  the  cell- walls  become  less  and 
leas  dii^inct,  until  finally  we  may  get  only  very  small 
nuclei,  haYing  a  more  or  lees  regular  arrangement,  and 
imbcKided  in  a  finely  gruiular  substaoce — the  mtermediar 
mtmbrane  of  Henle.  Between  this  membrane  and  the 
flohitanee  of  the  papiUss  is  a  structureless  band  called 
by  Todd  and  Bowman,  from  its  situation,  the  basement 
memhranef  but  cousidered  hj  Krause  to  be  simply  the 
optical  expression  of  the  dehoate  crenation  of  the  sur- 
isMDe  of  the  papillaa. 

The  papiUtBy  or  oonical  bodies,  constituting  the  exter- 
nal anriaoe  q[  the  derm  or  corinm,  are,  like  the  latter, 
formed  essentially  of  connective  and  elastic  tissue^  and 
are  divisiUe  inu> :  1.  The  iHMctcJar,  containing  a  capillary 
loop  and  generally  a  terminal  lymphatic  blind  cul-de- 
sao;  and  2.  The  nervom.  containing  a  peculiar  sefuitive 
nerve  termination  callea  from  its  position  axils  body, 
its  soppoced  fimction  taetUe  hody^  and  its  discoverer 
body  of  Meissner:  only  exceptionally  does  the  same 
paptUa  contain  a  capillary  loop  and  a  tactile  body ;  and 
everywhere  the  vascular  p^iUfl^  rise  above  the  less 
DBmerons  nervous  paplile.  The  tactile  bodv  is  oval  in 
flbapsL  with  irregularly  indented  outlines,  and  formed  of 
a  Uuck,  firm,  and  resistant  cell-wall  of  connective  taasne, 
with  elongated  nuclei  arranged  transversely  as  a  rale, 
and  so^er  cell-contents  of  a  clear,  finely-ffranular  amor- 
phous matter.  In  some  cases,  however,  I  have  detected 
aooUier  tonic  with  nudei  arranged  longitudinally,  thai 
ia,  panUel  to  the  axis  of  the  body,  and  most  internally 
a  stroctnreUas  membrane  c<«ii^ting  the  resemblance 
to  an  aborted  hair-foHide,  as  Kammler  first  surmised  it 
to  be.    One  or  more  double-contoured  nerve-fibres  rise 

Xto  the  bottom  of  the  body  and  there  pierce  it,  or 
t  do  so  at  the  top  after  having  wound  spirally  around 
the  body  to  this  pomt,  and  leaving  the  nucleated  neuri- 
lemma behind,  terminate  in  the  wo^git  Ov'U-oontents  in 
<iie  or  more  pale  axis  cylinders.  In  the.papillsd  (^  the 
eomunetivis,  the  lips^  glans  prais,  we  have  the  so-cillad 
cMsftflpatf  Ii0d»ef   of  KrMise,  oonsbtinf  of  a  thin, 


nucleated  ceU-wall,  containing  a  transparent,  finely 
granular  mass,  in  which  a  sensitive  nerve-fibre  losing 
its  douUe  contour  ends  in  a  single  pale  axii  cylinder,  or 
in  a  convoluted  mass.  In  the  subcutaneous  areolo-fatty 
tissue  along  the  sides  of  the  fingers  and  in  the  palm  of 
the  hand,  Sie  sensitive  nerves  often  terminate  in  tbe 
bodies  of  Vater  or  Paccini  Each  such  body  consists 
essentially  of  a  ^raussian  body  situated  axially  and  sur- 
rounded by  numerous  concentric  layers  of  nucleated 
connective  tissue,  making  a  kind  of  capsule  for  it. 

Thetti^ea^  gland  is  divisible  into  trie  glomerulus  or 
glandular  coi^  and  the  excretory  duct.  The  glandular 
canals  consist  of  an  external  tunic— K)f  indistinctly 
fibrous  connected  tissue  with  scattered  donated  nuclei 
— ^hned  internally  by  a  finely  granular  tunica  propria, 
covered  internally  by  a  single  or  multiple  layer  of  poly- 
gonal epithelial  cells.  The  large  glands  of  the  axilla 
possess,  in  addition,  a  middle  coat  of  smooth  muscular 
fibres  running  parallel  with  the  axis  of  the  tube.  The 
coils  of  the  glomerulus  are  bound  together  by  areolo- 
fatty  connective  tissue  in  which  ramify  numerous  capil- 
laries. The  excretory  duct,  whose  diameter  is  always 
inferior  to  that  of  the  glandular  canal,  though  consisting 
essentially  of  the  same  elements,  pursues  a  slightly 
wavy  course  from  the  upper  part  of  the  glomerulus  up 
to  the  rete  Malpighi,  where,  reduced  to  its  epithelial 
lining,  it  dilates  to  twice  its  previous  size,  and  after 
making  two  to  sixteen  spiral  twists  terminates  on  the 
surfiM^  of  the  epiderm  in  the  small,  round,  often  funnel* 
shaped  opening  called  the  sweat-pore.  According  to 
Sappey  there  are  700,000  to  800,000  sweat-glands ;  b«t 
Erasmus  Wilson  makes  out  7,000,000  in  the  adult  man^ 
and  estimates  the  total  extension  of  sweat  tube  at 
nearly  twenty-eight  miles. 

The  Asa/%  9weoX  is  a  thin,  cdoriess  liquid,,  some- 
what troubled  bv  the  particles  of  epithelium  suspended 
in  it ;  of  son^ewhat  saline  taste  and  acid  reaction,  except 
where  large  quantities  have  been  given  ofl^  and  in  the 
case  of  that  of  the  axillae,  the  sole  of  the  foot  and 
between  the  toes,  the  inguino-aorotal  and  vulvar  regions, 
etc.,  where  it  is  alkaline.  The  human  sweat  contains 
water,  ameisenic,  acetic,  butyric,  propionic,  and  occa- 
sionally baldrianic  (v.  valeric)  acids,  the  ohlorides  of 
sodium  and  potassium,  the  alkaline  sulphates  and  phos- 
phates, the  earthy  phoq[>hatet  and  oxide  of  ir(Hi,  the 
usual  ^ts  of  the  blood.  Occasional  ingredients  are  am- 
monia, tbe  hydrotio  or  sudoric  acid  of  Favr^,  alkalire 
lactates,  and  various  pigments  not  thoroughly  studied, 
Ih  loeSpsrta. 


• 

Urine. 

(J.  TogeL) 

Bweel 

Water 

W0.0 

40.0 

28.0 

0.5 

11.0 

S.S 

0.8 
&0 

40 

In  man  qoan- 
tftiee; 

996578 

Sottdnfttten.  .. 

i.4S7 

UfMk.  . 

Uric  add 

Ohiortd*  of  Sodlam 

srso 

»       *"  PirtMitain 

0.  48 

\  traee. 
0.fll 

AlkaUiM  Bvlphakff 

o((a 

Ammonia , 

AlkaHiM  liMtatofl 

OJIT 

"     BadoralM 

fat^matten 

156S 
O.01S 

Creatine,  Oreatialne         \ 
OxalateofUme                  

On  comparing  Favr^s  analvsis  of  the  sweat  with  J. 
Yogd's  of  the  urine,  we  find  that  in  both  excretions 
the  cpiatflity  of  water  is  large,  but  in  the  urine  there 

Digitized  by ' „       ^_ 


M 


THE  MEDICAL  RECORD. 


are  more  solid  mstters  than  in  the  sweat,  more'  urea, 
sulphateB,  and  phosphates,  but  relatively  leas  ohloride  of 
sooium ;  and  while  haying  exdasive  possession  of  tlie 
urio  acid,  creatine,  creatinine,  oxalate  of  lime  and  nro- 
hsematine,  it  has  no  lactates,  or  sudorates,  no  ameisemc, 
acetic,  propioDic,  butyric,  and  baldrianio  acids.  In  ane- 
mia, especially  that  dne  to  Bright^s  disease  or  cholera^ 
Urea  is  largely  present  in  the  sweats  In  diabetes  this 
excretion  contains  sugar ;  in  rheumatio  gout  uric  acid  as 
urate  of  soda,  but  never  albumen ;  and  the  stickiness  of 
ciertain  sweats  occurring  as  a  grave  sjrmptom  in  phthisis, 
cholera,  typhoid  and  puerperal  fevers,  is  due  to  no 
known  substance.  In  icterus  the  bile-pigment  ecdors 
tiie  sweat,  tears,  and  urine  daric  yellow,'  and  in  rare 
instances  blue,  green,  red,  black,  and  even  r^Mwphores- 
cent  sweats  have  been  observed.  Bensoic,  hippuric 
and  tartaric  adds,  when  taken  mtemally,  pass  rapidly 
into  the  sweat,  whereas  salicine  and  quinine  do  not  at 
all,  and  iodide  of  potassium  requires  some  five  days  to.  do 
so.  The  coloring  matter  of  rhubarb ;  owtain  odoroua 
principles  like  asafostida,  musk,  gariio,  onion,  leek,  etc, 
when  taken  freely,  taint  the  sweaty  and  so,  too,  do  cer- 
tain medicines  such  as  cantharid^.  valerian,  camphor, 
iodine,  sulphur,  phosphorus^  tellurium,  etc. 

The  kidneys  are  as  it  were  closely  compacted  bundles 
of  sweat-glands  placed  along  the  course  of  one  oi  the 
largest  arterial  streams  of  the  economy,  and  secrete 
continually,  whilst  the  sweat-glands  are  minute  kidneys 
scattered  irregularly  over  the  surface  of  the  body  on 
the  terminal  divisions  of  the  aorta,  and  only  secrete 
occasionally.  To  complete  the  parallel  both  these  ap- 
paratuses are  subjected  to  the  induenoe  of  the  nervous 
^stem.  Thus,  while  fear  causes  the  breaking  out  of  a 
profuse  sweat)  hysteria  gives  rite  to  an  abunduit  flow 
of  tk  ttale  urine  of  low  specific  gravity.  Again,  when 
the  kidneys  act  without  energy,  as  during  active  exer- 
tton  in  the  summer  of  dry«  warm  climates,  during  the 
existence  of  a  low  barometric  pressure,  the  sweat  ^ands 
instead  of  discharging,  as  is  usual,  but  500  grammes  a 
day,  may  pour  out  2,650  grammes  in  an  hour  and  a  ha]£ 
Lastly,  diaphoretics  may  act  as  diuretics  or  vice  ver»d 
according  to  the  manner  in  which  they  are  used.   . 

The  skin  is  also  an  organ  of  respiration  absorbing 
oxygen  and  exhaling  carbonic  acid ;  the  proportion  to 
that  escaping  from  the  lungs  being,  according  to  Scharl- 
inff,  as  0.0088  to  0.012. 

f)  The  sebaceous  glands  are  not  follicles  but  simply 
grouped  glands,  occurring  generally  in  connexion  with 
tke  hairs,  though  largest  where  these  are  smallest,  as  on 
the  nose.  Tiiese  ^ands  consist  of  a  homo^^neous^ 
transparent,  finely  granular  tunica  propria^  hned  by 
polyhedric  epitheliid  cell^  never  normally  nucleated, 
and  filled  with  minute  oil  drops  which,  escaping  on  the 
rupture  of  the  cell,  help  to  form  the  sebaceous  matter. 
The  latter,  examined  microscopically,  is  seen  to  re- 


InlMpwti. 

' 

Mlk. 
(Vemolf  and 

Smegma  pr»- 

Water 

88.90 
11.10 
8.9S 

4.86 

188 
8.06 

SottdmatCer 

CamIb 

1100 

.9 

LftfiOM....  .  .'. ...           ,    !         ^  *.....    ... 

OelaUne 

8.T 

Ohloride  PotMiliim 

Batter 

fktty  matter 

40.6 

semble  milk  very  closely ;  indeed  their  chemical  com- 
positions are  nearly,  if  not  quite,  identical  as  here  seen, 


and  many  facts  tend  to  prove  that  the  sebaceous  glands 
are  really  rudimentary  milk  glands  scattered  over  the  sur- 
face of  the  body ;  and  that  the  ceruminous  glands  in  the 
external  auditory  meatus  are  a  ^rther  transition  than 
the  sweat  glands  of  the  axilla  into  the  sebaceous 
glands,  just  as  the  mucous  glands  of  the  mouth,  etc.,  are 
the  connecting  link  between  the  sebaceous  and  the 
sweat  glands  in  the  other  direction. 

The  sense  of  touch,  in  its  widest  acceptation,  implies 
our  consciousness  of  all  the  sensorial  impressions  which 
are  neither  visud,  auditory,  olfactive,  nor  ^tator^; 
whereas  in  its  limited  application  it  signifies  me  modifi- 
cation of  the  general  sensibility  restricted  to  the  skin 
and  enabling  us  to  form  definite  ideas  of  the  size,  num- 
ber, weight,  temperature,  and  consistency  of  the  bodies 
we  are  brought  m  contact  with.  Evidently,  then,  even 
in  this  limit^  sense  toudi  is  a  complex  phenomenon, 
and  hence  it  was  that  S.  H.  Weber  subdivided  the 
tactile  impressions  according  to  their  causation  into : 

The  sense  of  iacHle  di§crimination  or  locaOzationn^ 
that  is^  the  power  enabling  us  to  distinguish  between 
two  similar  sensations  excited  simultaneously  in  two 
different  points  of  the  skin,  and  to  ascertain  m  a  mea- 
sure, not  only  their  distance  apart,  but  also  their  relative 
situations.  In  1829,  Weber  disoovered  that  when  the 
points  of  a  pair  of  dividers  or  compasses,  guarded  by  bits 
of  sealing-wax,  were  applied  to  the  skin,  the  eyes  being 
dosed,  tney  were  not  felt  as  distinct  separate  points 
unless  the  inter-compass  point  distance  (Dt.  Graves's  limit 
c^  confusion)  had  a  certain  value  which  varied  in  differ^ 
ent  regions  of  the  body.  Thus,  on  the  tip  of  the  tongue 
it  was  only  one-half  Paris  line  or  one  twenty-fourth 
of  an  ineh ;  on  the  finger-tip  one  line,  and  on  the  trunk, 
forearm,  and  thigh^  thirty  lines.  This  delicacy  of  per- 
ception is  greatest  m  the  direction  of  the  distribution  of 
the  nerves.  Thus,  on  the  middle  of  the  forearm  the 
points  are  felt  as  separate  when  two  inches  apart  if 
placed  transversely,  but  scarcely  so  at  three  inches  if  in 
a  line  parallel  to  the  long  axis  of  the  limb.  When  two 
points,  appUed  simultaneously  to  the  skin,  are  clearly 
distinguished,  the  separating  distance  seems  to  increase 
with  toe  aouteness  of  the  tactility  in  the  front  of  the 
surface  under  examination.  Hence,  if  the  points  of  the 
compass,  whfle  separated  by  two  or  three  lines,  are  ap- 
plied to  the  che€«  just  in  fix>nt  of  the  ear,  and  then 
moved  gradually  towards  the  angle  of  the  mouth,  the 
points  seem  to  recede  fixnn  one  another  in  consequence 
of  the  increase  in  tactile  aouteness.  When  the  two 
points  are  u^plied,  not  simultaneously,  but  in  succession, 
they  seem  further  apart^  and,  up  to  a  certain  limit,  all 
the  more  bo  the  longer  the  interval  between  their  suc- 
cessive M>plications.  The  same  seeming  increase  is  ob- 
served when  the  points  are  applied  simultaneously  to 
diflTerent  sides  of  the  median  line ;  or  on  parts  like  the 
two  lips  or  eyelids,  whose  relative  position  is  not  con- 
s'ant;  or,  as  is  the  case  with  the  palmar  and  dorsal 
sur&ce  of  the  fingers,  whose  structure  and  function  are 
difierent.  Yalentin  found  furthermore,  that  while  the 
absolute  delicacy  of  touch  varied  in  different  persons, 
the  relative  dehcac^  was  constant  in  the  (*ame  parts  of 
the  same  person.  Children,  owing  to  the  greater  crowd- 
ing together  of  the  sentient  points;  women,  on  account 
of  the  softness,  smoothnessy  and  greater  vasculiuity  of 
their  skin ;  and  the  blind,  in  consequence  of  great  prac- 
tice and  fix>m  concentrated  attention,  have  a  very  deli- 
cate sense  of  touch.  R.  Lichtenfels  discovered  that  the 
use  of  atropine,  daturine,  morphine,  strychnine,  and  al- 
cohol^ blunted  this  power,  enlarging  the  circles  of  per- 
esption  or  arms  of  oon^ymonj  mapping  off  the  surface  of 
the  body  into  .an  irregular  mosaic^  and  Wundt  and 
Bertheau  finding  this  to  be  so  dunng  the  progress  of 
certain  oases  of  paralysis,  proposed  to  use  Webers  oom- 

Digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


n 


passes  as  an  assthesiometer.  Volckmann  remarked  next 
tbAt  by  incessant  practice  the  limit  of  confusion  could  be 
reduced  to  one-hau  or  one-(}uarter  of  its  primitive  value, 
and,  as  Weber  observed,  this  increased  delicacy  actually 
extends  to  the  part  which,  though  actually  unexercised, 
is  situated  symmetrically,  e.  g.  &om  the  left  to  the  right 
thumb. 

1.  The  Sense  qf  Temperature  arises  when  the  acting 
body  is  hotter  than  the  normal  heat  of  the  human  body  ; 
beyond  a  certain  limit  in  either  direction,  a  burning 
pam  is  produced,  as  is  the  case  when  a  very  cold  or  a 
Tery  hot  metallic  body  is  handled.  Our  discrimination 
of  temperature  is  affected  by  the  rapidity  of  the  changes, 
the  extent  of  skin  surface  involved,  its  thinness  and 
richnesa  in  nerve-terminations  and  vessels.  In  the  fol- 
lowing aeries  established  by  Weber,  the  most  sensitive 
parts  come  first:  the  tip  of  the  tongue,  the  eyelids, 
cheeks,  lips,  neck,  trunk,  etc.  Owing  to  the  thinner 
epiderm  and  more  extended  surface,  water,  which  feels 
quite  hot  to  the  legs,  is  readily  supported  by  one  finger 
unless  it  is  moved  about.  For  cold  water  seems  colder, 
and  warm  warmer,  when  the  hands  are  moved  in  it, 
Uum  when  they  are  kept  motionless,  in  the  latter  the 
water  acquiring  the  heat  of,  in  the  former  case  communi- 
cating its  own  temperature  to  the  skin.  As  in  the 
similar  case  of  tactile  discrimination,  the  left  band  and 
dde,  having  a  thinner  epiderm  generally,  have  a  more 
acute  power  of  appreciating  temperature  toan  the  right, 
and  in  either  case  practice  and  concentrated  attention  re- 
fine the  sende  very  much  According  to  A.  Fick  and 
Wunderli  very  feeble  tactile  and  temperature  excitations 
may  very  readily  be  confounded  with  one  another. 
Bitter  discovered  under  certain  circumstances  the  action 
of  very  strong  galvanic  currents  on  the  skin  excited 
during  their  continuance,  or  at  the  instaiit  the  circuit 
was  completed  or  interrupted,  a  sensation  of  either  heat 
or  cold  as  the  case  might  be. 

2,  The  Sense  of  Weight,  or  Pressure^  is  the  power  to 
estimate  the  amount  of  a  force  compressing  or  stretch- 
ing the  skin  duiing  the  total  absence  of  any  muscular 
action,  L  e.  of  what  is  termed  the  museidcur  sense,  Weber 
found  that  he  could  distinguish  between  two  weights 
bearing  to  each  other  the  ratio  of  19.2  to  20,  or  even 
29  to  30,  when  laid  on  the  finger-tips,  whereas  on  the 
middle  of  the  forearm  the  ratio  had  to  be  18.2  to  20, 
and  on  the  brow  18.7  to  20.  The  delicacy  of'  this  esti- 
mation is  much  greater  when  the  impressions  are  suc- 
cessive than  when  they  occur  simultaneously,  provided 
that  the  separating  interval  does  not  amount  to  forty 
seconds,  though  it  may  to  twenty.  According  to  Kamm- 
ler  the  least  weight  perceptible  on  the  finger-tip  is  0.005 
to  0.015  gramme ;  but  on  the  finger-nail  one  gramme, 
that  is  fifteen  grains.  There  is  a  certain  relation  be- 
tween the  sense  of  temperature  and  that  of  weight 
Thus,  Weber  found  that  cold  bodies  seemed  heavier  than 
warm  ones  of  actually  the  same  weight  The  JfuseuJar 
Sense,  in  conjunction  with  the  sense  of  pressure,  enables 
us  to  form  accurate  conclusions  as  to  the  weight,  con- 
sistency, resistance  to  rupture  or  overturning,  etc., 
offered  by  the  bodies  we  are  handling.  Thus,  a  trun- 
cated cone  set  with  its  small  end  on  the  hand  laid  pas- 
sively on  a  cushion,  feels  heavier  than  when  its  large 
extremity  is  thus  placed,  whereas  on  poising  it  in  the 
hand  no  such  error  is  committed. 

In  the  general  use  of  an  anaDsthetic  at  first  there  is 
increased  cutaneous  irritability,  succeeded  by  analgesia; 
the  patient  sees  and  feels  the  cutting  of  the  knife,  but 
suffers  no  pun,  and  his  muscular  sense  is  still  active. 
Later  voluntary  and  reflex  action  cease  and  organic 
etherism  eomes  on^  marked  in  the  beginning  by  the 
lowering  of  the  animal  heat,  then  by  stoppage  of  re- 
paration and  h»matosis,  and  lastly  by  deaUi  super- 


vening on  paralysis  of  the  heart    The  return  to  the 
normal  state  obtains  in  the  same  order,  but  reversedly. 

Eraue,  while  agreeing  with  Weber  that  the  supera- 
cially  seated  bodies  of  Meissner  are  for  the  perception 
of  temperature,  chiefly  though  not  exclusively,  affirms 
in  addition  that  the  more  deeply  situated  bodies  of 
Pacdni  are  for  the  sense  of  weight,  and  the  hairs  for 
that  of  localization  and  the  detection  of  mere  contact 
Thus  Aubert  and  Kanmiler  remarked  that  pressure,  t^ 
be  perceived,  must  be  greater  on  a  part  that  has  been 
shaved  than  on  one  that  has  not,  and  in  fact  they  con- 
sidered the  tactile  bodies  to  be  aborted  hairs.  Mr. 
Brou^hton  found  that  while  a  kitten  could  readily 
thread  blindfold  its  way  out  of  a  maze,  in  which  he 
had  designedly  placed  it,  as  long  as  its  whiskers  were 
intact,  it  utterly  failed  to  do  so  when  these  were 
shaved  oS.  Spiess,  Aubert,  Kammler,  Scbiff,  &c., 
believe  that  the  muscular  sense  is  really  situated  in  the 
skin,  and  Erause  that  the  bodies  of  Paccini  are  the 
organs  mainly  concerned  in  it.  Brown-S^quard,  how- 
ever, has  shown  that  while  the  sensitive  nerve  fibres, 
giving  rise  to  the  other  senses,  cross  in  the  spinal  cord, 
those  regulating  the  muscular  sense  cross  in  the  medulla 
oblongata  like  the  other  motor  nerve-fibres.  Calmeil, 
BouilEiud,  Qerdy,  Flourens,  and  Longet,  have  shown 
that  the  removal  of  the  two  cerebral-lobes  does  not  im- 
pair the  general  sensibility :  while  Flourens  and  Brown- 
S^uard,  in  opposition  to  Gerdy,  Bouillaud,  and  Longet, 
assert  that  in  this  case,  the  power  to  perceive  impres- 
sions is  aboli^ed,  so  that  tne  spinal  cord  is  not  a  true 
sensorium. 

In  foot-sleea  the  touching  of  the  limb  causes  an  un- 
pleasant prickling  and  quivering,  like  a  feeble  induction 
shock,  and  the  same  occurring  in  hemiplegia  we  see 
why  the  rubbing  in  of  ointxaents  is  here  so  disagree- 
able. As  Leyden  remarks,  Weber's  method  was  in- 
tended to  measure  the  deticacy  of  tactile  discrimination 
and  not  the  degrees  of  alteration  of  the  sense  of  touch, 
which  consists  of  two  elements — the  locality  feeling 
and  absolute  sensibility — ^having  no  definite  and  con- 
stant relation  to  one  another.  Thus,  when  disease  ad- 
vances slowly,  the  locaUty  feeling,  being  so  largely  a 
thing  of  practice  and  attention,  may  remain  intact, 
though  the  psychological  impression  it  excites  may, 
from  want  of  absolute  certainty,  be  only  a  more  or  less 
clever  guess.  Hence,  in  patholo^cal  cases  we  must 
measure  not  only  the  locality  feehng,  but  also  the  de- 
cree of  absolute  sensibility,  Puchelt  was  the  first  to 
describe  what  is  styled  partial  sensitive  paralysis.  He 
found  cases  in  which  the  temperature  sense  was  intact, 
while  that  of  tactile  discrimination  was  much  impaired. 
Eigenbrodt  remarked  that  patients  sufferit^g  from  me- 
chanical or  pathological  alterations  of  the  spinal  cord, 
had  lost  the  sense  of  weight  Lastly,  Leyden  discovered 
that  in  grey  degeneration  of  the  posterior  columns  of 
the  spinal  cord,  while  the  muscular  sense,  owing  to  the 
integrity  of  all  the  motor  apparatus,  was  intact,  and 
the  sense  of  temperature  nearly  if  not  completely  so, 
the  absolute  sensibility  was  much  impaired. 

Bvperoesthesia^  then,  is  the  peculiar  state  in  which  the 
absolute  sensibUity  is  increased — ^the  minimum  of  stimu- 
lation needed  to  excite  perception  being  less  than  nor<- 
mal.  ffyperdl^esia  is  where  stimuU  which  normally 
cause  only  a  slight  sensation,  give  rise  to  pain  in  conse- 
quence 01  the  lowering  of  the  pain  minimum.  Some- 
times the  minima  of  perception  and  pain  coincide 
together,  in  which  event  the  first  is  lowered,  while  the 
second  remains  normal.  This  relative  hyperalgesia  is 
quite  common  in  disease  of  the  spinal  cord.  Positive 
hyperalgesia  also  i)robably  occurs  in  neuralgia,  hysteria, 
iijuries  of  the  spinal  cord,  etc.  Retardea  nerve  con- 
duction also  obtains  in  grey  degeneration  of  the  spinal 


76 


THE  MEDICAL  RECORD. 


cord,  but  has  yet  to  be  studied.  Lastly,  we  have  what 
may  be  termed  the  seme  of  direction.  The  tactile  sense, 
when  operatine  by  itself,  and  not  corrected  by  the 
sense  of  mosciuar  effort  called  forth  to  antagonise  it, 
always  suggests  the  idea  that  pressure  is  made  vertical 
to  the  suiidce.  Thus  it  is  that  when  the  hair  of  the 
head  is  pulled,  we  know  the  direction  of  the  traction. 
But  if  we  bold  the  head  of  the  person  operated  on 
steadily  between  our  knees,  and  prevent  tne  traction 
from  calling  forth  the  muscular  action  of  the  scalp,  by 
pressing  firmly  with  the  fingers  around  the  point  from 
which  the  hair  is  pulL  d^  the  patient  cannot  tell  from 
what  direction  you  pull  his  hair. 

The  interpretation  put  by  onr  minds  on  tactile  im- 
pressions, is  in  part  the  result  of  intuition  and  in  part 
that  of  practice.  Thus,  intuitively  we  refer  the  impres- 
sion made  on  any  part  of  a  sensitive  nerve,  to  its  peri- 
pherical  expansions,  or  (as  in  the  case  of  amputated 
limbs,  etc.)  to  the  regions  in  which  these  should  nor- 
mally be  situated. 

Leaving  our  present  topic,  we  next  pass  on  to  the 
consideration  of  the  so-called  gympathies. 

One  of  the  most  important  attnbutes  of  the  nervous 
system,  is  thit  of— 1.  Linking  together  the  different 
tissues  endowed  with  the  properties  of  animal  life, 
through  the  interposition  oi  the  nerve-centres — the 
impression  carried  thither  by  the  periphericcdj  incident^ 
or  eisodic  nerves  beinff  handed  over  in  a  new  physiolo- 
gical or  psychological  form,  to  the  excentric  or  exodic 
nerves — the  whole  constitutmg  Marshall  HalVs  diastaUie 
are — the  summit  of  which  is  the  nerve  centre.  2.  That 
of  linking  together  the  organs  of  vegetative  life  by 
themselves,  or  else  with  those  of  animal  life ;  ^e  spinal 
cord  being  the  centre  and  the  great  sympathetic  the 
branches  of  the  diastaltic  arc  The  transference  in  the 
grey  matter  of  the  spinal  cord  through  the  intervention 
of  the  nerve-cells,  of  the  irritation  brought  there  by  one 
sensitive  nerve-fibre  to  another  of  the  same  kind,  is 
called  oo-aensaUon  or  irradiation;  while  that  passing 
from  a  sensitive  to  a  motor  nerve-fibre,  or  viot  versd^  is 
termed  reflex  CKtion  (motion  or  sensation,  as  the  case 
may  be),  and  fi*om  a  motor  to  a  motor  nerve  €u$oeiaiion 
of  motion.  Reflex  (tctiont  (of  Procha^ka  and  exdUh- 
fnatory  of  Marshall  Hall)  are  (^visible  into:  I.  Ihie  reflex 
or  diaetaUie  actions,  or  those  belonging  in  particular  to 
the  organs  of  animal  life:  2.  Organic  or  sympathetic 
reflex  actions^  or  those  appertaining  to  the  organs  of 
vegetable  life  (nutrition  and  reproduction). 

Sympathies  are  then  reflex  actions  in  which  an  incon- 
Bcient  impression,  transmitted  in  general  b^  the  branch- 
es of  the  great  sympathetic  to  the  spinal  cord,  gives 
rise  there  to  an  involuntary  motor  action,  carried  to 
other  regions  by  motor  nerve-fibres  generally  divided 
ftowt  the  sympathetic,  though  sometimes  also  from  the 
nerves  of  animal  life.  This  motor  incitation  transmit- 
ted to  the  smooth  muscular  fibres  of  the  blood-vessels 
of  the  part,  or  to  those  of  the  excretory  ducts  of  glands, 
or  to  those  of  the  walls  of  the  intest  nal  tube  or  of  the 
heart,  gives  ri^e  to  diverse  interesting  phenomena. 

All  Uie  organs  and  living  tissues  have  a  mutual  and 
regular  coordination,  so  that  one  part  is  weakened  bv 
the  increased  action  of  another,  L  e.  normally,  equili- 
brium of  action  obtains.  In  addition,  each  of  these 
organs  or  tissues  exerts  on  one  or  more  other  parts,  a 
special  influence  more  marked  and  freouent  than  that 
connnon  to  the  rest  of  the  economy.  This  is  what  is 
termed  the  doctrine  of  territorial  i^fluence^  or  of  the  fMU- 
ro-vascvkir  areas.  If  this  reaction  of  one  organ  or  tissue 
on  another  obtains  by  the  exercise,  and  for  the  accom- 
plishment of  their  respective  funclians,  it  is  termed 
energy  or  cooperation^  as  in  the  case  of  the  glans  penis 
^d  Xhe  testide  during  coition  ]  whereas,  if  this  occurs 


between  two  organs  not  having  any  direct  physiological 
relation,  it  is  styled  sympathy ,  as  is  seen  when  sneezing 
results  nrom  a  strong  irritation  of  the  retina.  Now  we 
have  sympathy: 

1.  ^tween  the  diffbrent  parts  of  an  organ  or  tisine, 
and  this  expluns  the  spresding  of  an  erysipelas  from 
one  part  of  the  skin  to  another:  and  the  changing  of 
a  coryza  into  a  pulmonaiy  catarrn,  or  a  diarrhoea,  etc 

2.  between  paired  oreans.  Thus,  when  one  eye  is 
diseased,  the  other,  though  not  directly  acted  on,  is  soon 
involved  by  sympathy,  and  the  same  is  true  of  the  two 
ears,  lungs,  kidneys,  etc. 

3.  Sympathy  between  one  organ  and  another  of  the 
same  apparatus.  When  the  uterus,  as  in  pregnancy,  takes 
on  increased  activitv  and  development^  this  reacts  on 
the  mammas  and  sebaceous  glands.  In  fact,  the  secre- 
tion of  milk  is  the  effect  of  the  normal  or  pathological 
excitation  of  the  genital  apparatus.  Thus,  in  man  it 
occurs  when  there  is  sarcocele,  or  other  diseases  of  the 
testis.  Again,  acne,  which  is  a  disease  of  the  rudimen- 
tary milk-glands,  the  sebaceous  follicl^  obtains  mainly 
during  the  period  of  areat  genital  activity.  The  Frendi 
term  them  hovlons  de  sagesse,  or  pimples  of  chastity ; 
and  they  generally  disappear  after  marriage  Accord- 
ing to  J.  Frank,  though  the  skin  of  eunuchs  soon 
acquires  the  wrinkles  and  sallowness  of  old  age,  they 
enjoy  a  remarkable  immunity  against  cutaneous  affec- 
tions. 

The  nerves  of  mucous  membranes  are  generally  de- 
rived (rom  the  sympathetic,  except  where  skin  passes 
insensibly  into  mucous  membrane :  and  here  alone  is  it 
that  ordmary  sensibility  exists.  Thus,  the  nrethra,  ex- 
cept in  disease,  is  not  very  sensitive  beyond  the  gUns 
penis,  and  the  rectum  beyond  the  anua  The  greater 
sensitiveness  of  the  orifice  as  compared  with  tne  rest 
of  the  mucous  membrane  with  which  it  is  in  such  dose 
sympathy,  is  very  available  for  counter-irritation  in  the 
treatment  of  various  affbctions  of  the  mucous  mem- 
branes and  their  annexes.  Thus  it  waa  that  Bichat 
proposed  to  treat  ophthalmia  rather  by  producing  an  ar- 
tificial coryza  than  by  blisters  or  setons  to  the  neck  or 
temple.  Similarly,  we  have  the  treatment  of  cutaneous 
diseases  by  purgation,  excessive  costiveness  being  bo 
often  a  prominent  feature  in  them ;  and  the  relief  of 
toothache  by  placing  an  irritant  in  the  external  audi- 
tory meatus.  Again,  Brown-S^uard  has  shown  that 
the  sudden  introduction  of  cM  water  into  the  external 
ear  excites  an  epileptiform  convulsion ;  and  we  know 
how  that  sometimes  epilepsy  is  associated  with  dental 
caries,  and  that  certain  shrill  sounds  excite  the  sensa- 
tion called  setting  the  teeth  on  edge, 

4.  Sympathy  between  an  organ  of  one  apparatus  and 
that  of  another.  Thus  during  digestion,  wMle  the  gas- 
tric and  intestinal  glands  are  most  active,  the  sweat* 
glands,  aocordiog  to  oanctorius,  are  nearly  inert  Again, 
when  a  cold  bony  enters  the  stomach  at  a  time  when 
the  skin  is  bathed  in  sweat,  the  sweating  soon  ceases ; 
whereas  warm  teas  &vor  sweating.  Tickling  the  soles 
of  the  feet  sometimes  causes  nausea,  and  even  syncope ; 
and  Bkhat  thought  that  in  hemiplegia,  or  hypochon- 
driasis, etc,  it  was  possible,  by  ^repeating  the  tickling 
several  times  a  day,  to  get  a  stronger  and  more  endur- 
ing effcKit  than  the  merely  temporary  one  following  the 
use  of  blisters,  especially  as,  unlike  the  latter,  it  acts 
exclusively  on  the  nervous  system.  Now^  as  the  action 
of  the  surfkce  is  diminished  when  there  is  internal  in- 
flammation, by  increasing  the  action  of  the  former,  we 
remove  or  lessen  that  of  the  latter,  and  hence  the  use 
of  counter-irritation.  However,  issues  do  no  ffood  unless 
somewhat  painful  or  in  the  condition  of  healthy  ulcers. 
Nevertheless,  the  issues  should  not  be  too  pamfuL  nor 
kept  active  too  long ;  for  after  they  have  removed  the 


THE  MEDICAL  RECORD. 


11 


inflammatory  action  below,  they  still  combine  to  act  on 
t^  part*)  lessening  their  action ;  and  thus  stop  or  im- 
pede the  proper  operation  of  the  healing  process. 

Lastly,  It  has  long  been  known  that  when  any  parti- 
eolar  action  disappears  suddenly  from  a  part,  it  will 
often  quickly  affect  that  organ  which  is  most  in  sympa- 
thy with  the  part  or  organ  originally  diseased.  Henoe 
it  IS,  why  the  spontaneous  appearance  of  an  extensive 
ecsema  often  comcides  with  a  favorable  change  in  phthi- 
98,  and  its  disappearanee  (so  ^led  reiro-ceanon^  or  re- 
jMrntfitPA,  or  driving  in)  with  an  unfavorable  one."^ 

These  hiCts  show  now  it  is  that  the  knowledge  of  the 
special  sympathies  between  different  organs  and  tissues 
explains  the  causation  and  location  of  disease,  and 
shows  where  remedies  are  best  applied. 


NTTROUS^XIDE   AS    AN  AN^^ESTHETIC, 

WITH  REPORT  OF  SEVEN  OASES. 

By  CHARLES  F,  TAYLOR,  M.D., 


Thx  recent  death^  at  Bellevue  Hospital,  of  a  patient 
while  under  the  influence  of  chloroform,  occurring,  as 
it  did,  without  the  omission  of  any  precautions,  ana  in 
spite  of  the  most  intelligent  and  persistent  efforts  to 
sustain  animation,  will  no  donbt  have  a  tendency  to 
deter  a  still  larger  number  of  practitioners  from  the  use 
of  chloroform  as  an  anaesthetic.  But  an  ansesthetic  we 
must  have.  The  ability  to  annihilate  pain  and  prevent 
'muscular  action  during  surgical  operations  is  an  incalcn- 
bfaie  blessing  to  the  worid,  and  it  were  eren  better  to 
nm  aU  the  ritk  there  may  be  in  the  use  of  chloroform 
than  to  attempt  to  get  along  without  anssstheda.  Ether 
has  some  serious  o^ections.  It  is  very  unpleasant,  es- 
pecially to  children ;  is  frequently  slow  to  act,  and  some- 
timea  is  impotent  altogether  to  produce  insensibility 
without  carrying  it  to  an  impru<&nt  degree.  Besides 
these  objections,  though  considered  entirely  safe,  it 
oflen  leaves  the  patient  in  a  state  of  great  prostration. 

Under  these  circumstances,  I  have  thought  that  my 
experience  in  the  use  of  nitrous-oxide  as  an  anaesthetic 
mtfht  be  of  some  interest  at  this  time. 

WMe  L — This  was  an  operation  for  anchylosis  of  the 
lup-joint.  Tenotomy  and  very  strong  efforts  to  extend 
the  thi^h  were  made,  occupying  about  five  minutes^ 
the  patient^  a  girl  of  thirteen  years,  being  in  complete 
anesthesia,  and  in  as  favorable  condition  as  could  be 
asked.  She  was  brought  under  the  influence  in  about 
006  minute,  and  passed  out  of  it  in  about  the  same 
length  of  time.    No  ill  effects  followed, 

uam  2. — This  was  a  simple  operation  to  extend  the 
knee  by  dividing  the  tendons  ofthe  hamstring  muscles. 
It  was  chiefly  remarkable  for  the  rapidity  of  the  whole 
qMration,  the  little  patient,  a  bo^  seven  yean  old,  not 
being  quite  two  minutes  unconscious. 

date  3. — This  was  an  operation  for  deformity  of  the 
hip-joint,  in  a  lady  of  twenty-two.  In  this  case  our  at- 
tempts to  produce  unconsciousness  b^  the  use  of  ether 
--carefyiy  administered  by  Dr.  Vermilye — were  unsuc- 
eestful  The  most  persistent  efforts  K>r  over  one  hour 
faUed  to  produce  the  desired  effect  We  found  after- 
wards that  the  ether  used  was  not  good,  but  the 
quantity  gi^en  was  veij  great  Again  we  resorted  to 
the  nitrous-oxide,  and  m  about  forty  seconds  there  was 
complete  anaesthesia.  The  operation,  which  was  divi- 
sioo  of  the  aartorius,  occupied  one  minute,  and  in 
thirtv  seconds  more  the  patient  was  as  well  as  if  nothing 
had  happened. 

Com  4. — ^Thk  was  a  very  interesting  case  of  so-called 
'' hysterical  joist^''  affKting  the  ahoulder,  in  a  very 


ceptible  lady,  followed  by  partial  anchylosis.  Three 
years  before,  I  had  operated  on  the  right  shoulder,  as- 
sisted (as  in  the  case  first  related)  by  Dr.  Peaslee,  but 
there  was  such  complete  prostration  afterwards  from  the 
ether,  that  she  was  confined  to  the  bed  for  more  than  a 
month,  and  it  was  folly  two  months  before  she  reco- 
vered from  the  shock.  Three  years  afterwards  I  was 
sent  for  to  perform  another  operation  for  the  same 
trouble,  which  had  returned  this  time  in  the  le/i  shoul- 
der. The  dread  of  the  operation,  or  rather  of  the  effect 
of  the  ether,  was  so  g^eat,  that  it  had  been  put  off  till 
all  motion  at  this  joint  had  ceased,  though  the  adhesions 
were  readily  broken  up.  But  the  prostrating  effects  of 
the  anaesthetic  were  even  greater  than  t  efore,  and  she 
was  not  able  to  get  up  from  her  bed  till  nearly  all  the 
benefits  of  the  operation  had  been  neutralized  by  the 
long  confinement  When,  at  last,  she  did  get  up,  she 
was  so  pale  and  feeble  that  I  abandoned  the  idea  of 
employing  ether,  and  again  resorted — after  unsuccess- 
fiiUy  endeavoring  to  get  along  without  further  opera- 
tion— to  the  nitrous-oxide.  The  success  was  all  that 
could  be  desired.  There  was  no  prostration  whatever 
following  the  operation^  and  the  next  morning  she  came 
down  to  breakfast,  feehng  as  well  as  ever. 

Oaae  5.^About  a  week  afterwards  I  again  operated 
on  the  same  case,  with  the  same  happy  escape  from  the 
prolonged  prostration  which  bad  mvariably  attended 
the  use  of  ether. 

Oa$e  6. — This  was  a  case  of  deformity,  requiring  di- 
vision ofthe  flexors  of  the  thigh,  in  a  feeble  girl  of  nine 
years  of  age.  It  was  rapid,  and  not  attended  or  follow- 
ed by  the  lightest  shock  or  unpleasant  symptoms. 

Cose  7.— This  was  an  operation  for  club-foot,  and 
like  the  previous  case,  was  characterized  by  the  com- 
pleteness of  the  anaesthesia  and  the  absence  of  all  ill 
effects  following  it 

In  the  first  five  cases  the  gas  was  administered  by  G. 
R.  Ck>lton,  by  means  of  a  large  rubber  bag,  with  a  single 
mouthpiece,  the  expired  breath  being  thrown  into  and 
mixed  with  the  gas  in  the  bag,  which  formed  the  next 
inspiration.  Althoufi^h  the  achntmstration  of  the  gas 
was  successful  as  above  related,  yet  I  was  always 
anxious  about  the  venous,  partially  asphyxiated  ap- 
pearance of  the  patient,  which  made  us  cautious  about 
using  it  in  operations  requiring  much  time.  This  ap- 
pearance I  beheve  to  be  due  more  to  the  imperfect 
method  of  administering  the  gas  than  as  inseparable 
from  th\M  method  of  producing  anaesthesia.  Accord- 
ingly I  embrace  an  early  opportunity  of  employing  a 
method  devised  by  Mr.  Blakeney,  a  physician  in  Twenty- 
second  street,  near  Sixth  avenue,  which  entirely  avoid- 
ei  breathing  over  any  of  the  expired  gases.  His 
method  consists  of  forcing  the  gas  forward  under  pres- 
sure through  a  tube,  with  a  valve  which  opens  on 
inspiration  and  doses  on  expiration,  and  the  breath 
passes  out  through  another  tube  in  the  open  air.  In 
fact,  the  patient  breathes  pure  gas  all  the  time.  Al- 
though there  seems  to  be  uo  dimger  from  the  former, 
yet  I  greatly  prefer  the  latter  method,  and  shaH  hence- 
fOTth  employ  it  It  will  be  seen  that  I  have  no  expe- 
rience as  yet  in  nitrous-oxide  as  an  anaesthetic  in 
operations  requiring  more  than  Gre  minutes  to  perform. 

To  sum  up,  I  would  enumerate  the  following  advanU- 
ges  of  nitrous-oxide  over  ether,  viz.  1st.  The  rapidity 
of  its  action,  causing  the  saving  of  time  to  physician  and 
patient;  2d.  Its  agreeableness;  3d.  The  speedy  passing 
off  of  its  effect ;  and  4th.  The  absence  of  all  afier  effects 
of  sickness  at  the  stomach,  vomiting,  headache,  etc. 
Kot  one  of  idl  those  cases  complained  of  any  unpleasant 
symptom  whatever.  Its  disadvantages  are— Ist  The 
inconvenience  of  not  always  having  it  at  hand  when 
wanted ;  2.  The  cost  ($5.00)  of  havipg  it  brought  to 


igitized  by  LjOO^- 


rs 


THE   JiEDICAL  BECORD. 


you;  and  3d.  Its  possible  insufficiency  or  danger  in 
prolonged  operations.  But  for  all  short  operations  I 
believe  nitrous  oxide  to  be  the  best  ausBsthetic  we  have. 
For  all  superficial  operations,  such  as  the  opening  of 
abscesses,  etc.,  I  have  found  Richardson^s  vaporizer  to 
be  amply  sufficient. 

^  I  ^    

AN  ILLUSTRATION  OF  THE  BENEFICIAL  EFFECTS  OF 

ATOMIZED  LIME-WATER  IN  MEMBRANOUS 
CROUP. 

By  H.  ERNEST  SCHMID,  M.D., 
WHin  PLAnre,  ■.  t. 

Oi?  the  22d  of  last  November,  I  was  called  some  three 
miles  from  mv  residence  to  see  a  little  child,  about  20 
months  old,  wno  had  been  suffering  with  croupal  svmp- 
toms  for  five  or  six  days.  Very  slowly  and  graaually 
had  they  come  on,  so  as  not  to  give  the  mother  any 
uneasiness;  but  had  increased  in  intensity,  day  by  day, 
in  spite  of  the  various  remedies  applied,  until  the  child 
presented  the  alarming  spectacle  which  had  induced  the 
parents  to  call  me  in,  and  which  at  once  indicated  a 
case  of  membranous  croup,  of  the  gravest  aspect. 

I  ordered  immediately  tne  constant  inhalation  of  the 
vapor  of  hot  water  and  Dr.  Learning's  mixture  of 
chlorate  of  potassa,  muriate  of  ammonia,  senega^  etc. 

When  I  paid  my  second  visit,  on  the  following  day, 
the  little  boy  was  evidently  more  comfortable.  He 
had  coughed  up  a  large  piece  of  false  membrane,  and 
the  shrill,  brassy  inspiration  was  materially  softened. 

Becoming  engaged  in  an  obstetrical  case  of  uncom- 
mon severity,  I  was  unable  to  see  my  little  patient 
again  until  forty-eight  hours  later.  I  found  him  then 
in  an  almost  hopeless  condition.  His  labored  breath- 
ing could  be  heard  outside  the  house.  He  had  grown 
so  unruly  that  his  nurses  had  ceased  to  appTv  the 
steam,  and  were  awaiting  with  resignation  his  death, 
which  seemed  speedily  approachine.  He  lay  with  his 
head  thrown  far  back,  his  lips  deeply  cyanotic — ^in  feet, 
his  Entire  surface  showing  in  its  dusky  hue  the  fearfiil 
extent  of  the  deficiency  of  arterial  blood,  his  pulse 
small,  and  beyond  counting. 

I  had  seen  the  piece  of  membrane,  coughed  up  by 
the  child  on  the  second  day  of  my  attendance,  dissolve 
in  lime-water  as  readily  as  any  diphtheritic  deposit; 
and  I  determined  now  to  give  the  little  sufferer,  as  a 
last  chance,  the  inhalation  or  atomized  lime-water.  In 
fifteen  minutes  from  the  time  I  had  begun  to  let  the  spray 
play  over  the  mouth  and  nose  of  the  child  I  perceived, 
with  heartfelt  satisfaction,  that  my  efforts  were  begin- 
ning to  be  crowned  with  success.  The  harsh,  metallic 
breathing  grew  softer,  and  at  last  melted  down  as  if 
hushed  by  a  magical  power,  the  (nranotic  hue  gradu- 
,  ally  disappeared  from  the  fkce,  ana  befbre  I  left  the 
house  a  moribund  condition  was  exchanged  for  one  of 
hopeful  expectation.  A  relay  of  nurses  kept  up  the 
lime-w/tler  spray,  without  ceasing,  the  rest  of  the  day 
and  the  following  night,  so  that,  to  my  extreme  gratifi- 
cation, I  found  my  Tittle  patient,  on  my  visit  early  the 
next  morning,  sitting  up  in  his  cradle,  quite  contented 
with  the  supply  of  air  drawn  in  through  his  nostrils. 
It  was  now  more  difficult  to  make  him  breathe  the 
spray.  I  exhorted  the  attendants,  however,  to  the 
utmost  perseverance,  and  left,  delighted  with  my  suc- 
cess thus  far.  But,  on  the  following  day,  I  found  almost 
as  bad  a  state  of  things  as  at  my  first  visit.  The  glass 
tubes  (of  the  spray-producer)  had  become  choked  up 
by  the  deposit  of  lime  fi^m  the  lime-water,  and  would 
work  no  more ;  the  child  had  thus  been  without  the 
spray  for  at  least  eighteen  hours,  the  parents  not  tak- 
ing the  trouble  to  inform  me  at  once  of  the  hcL    1 1 


hastened  back  to  my  office,substituted  india-rubber  tubes 
for  the  glass, — ^the  former  having  a  much  larger  bore, — 
returned  to  my  little  charge,  and  again  had  the  satisfac- 
tion of  procuring  him  speedy  amelioration  of  his  urgent 
symptoms.  From  this  time  he  steadily  improved,  and, 
after  the  persevering  use  of  the  atomizer  for  three  more 
days,  I  dismissed  him  firom  my  \Ui  perfectly  cured. 
Vkbkvaxt,  1867. 


ADVENTITIOTJS  GROWTHS  OF  THE  UTERUS. 

NEW  FORMATIONS  OF  OOmTBOTIVB  TISSUE. 

(Belnf  a  TranaUtion  from  the  German  of  **  Klob  on  the  Pathologic*! 
Anatomy  of  the  Female  Sexual  Orfans.^*) 

By  JOSEPH  KAMMERER,  M.D., 
B.  F.  DAWSON,  M.D. 

KMW  TOBX. 

Thb  new  formations  of  connective  tissue  which  take 
place  in  the  substance  of  the  uterus  are  developed  from 
its  interstitial  tissue,  and  in  their  growth  affect  either  the 
whole  extent  of  the  latter,  or  iso&ted  portions  of  it^  in  a 
diffiise  manner ;  or  these  new  formations,  becoming  in- 
dependent are  situated  under  various  circumstances  in 
circumscribed  portions  of  the  uterine  substance;  or^ 
lastly,  they  are  considerably  separated  from  the  rest  or 
the  tissue  of  the  organ.  According  to  these  different 
relations  to  the  parent  tissue,  these  varieties  of  new  for- 
mation of  connective  tissue  must  severally  be  considered. 

DIFFtrSB  OROWTH  OF  COVlTlOTrVB  TIBSUB  Uf  THB  UTBKUB, 
BNQORGSIOBNT,     OHROBIO    HTFABCTUS     OF     THS    UTXBUB 

(Kiwiach), 

In  consequence  of  formative  irritation,  especially 
when  it  has  existed  for  a  long  time,  the  whole  uterine 
connective  tissue  sometimes  proliferates  either  without 
accompanying  increase  of  the  muscular  substance,  or,  if 
this  does  occur,  the  connective  tissue  predominates  to 
such  an  extent  that  the  muscular  substance  is  compara- 
tively of  not  much  account.  By  this  proceBS,  an  inerease 
of  the  substance  of  the  uterus  is  produced  by  a  portion 
of  its  tissue  which,  as  regards  function,  cannot  be  consi- 
dered as  the  most  essential  to  the  organ.  I  therefere  do 
not  hesitate  to  classify  this  affection  with  the  qualita- 
tive al' orations  of  formative  irritation,  ina^muoh  as  the 
natural  proportion  of  the  normal  tissues  oonstitutifig  the 
uterus  is  thereby  considerably  altered. 

In  this  disease  the  uterus  is  uniformly  increased  in  its 
diameters,  though  not  always  in  all  of  them ;  its  body 
and  fundus  generally  assume  a  splierical  shape,  and  fre- 

?uently  attain  to  the  sise  of  a  man's  fist,  and  even  kr^r. 
its  walla  are  sometimes  considerably  increased  m  thick- 
ness, up  to  twelve  or  fideen  inches,  especially  the  pos- 
terior one  and  the  fundua  The  cavity  of  the  uterus  is 
absolutely  enlarged,  chiefly  elongated ;  but  the  uterine 
walls  lie  close  together,  and  an  increase  of  its  eavity,  in 
the  general  meaning  of  the  term,  is  only  met  with  in 
rare  instances ;  I  should  rather  say  that  the  cavity  ©f 
such  an  hypcrfdastic  uterus  was  relatively  smaller  than 
that  of  a  normal  one.  Exteriorly  the  fundus  uteri  ap- 
pears rounder  and  broader,  the  anterior  and  srill  more 
the  posterior  walls  thickened,  the  latter  even  vaulted  or 
of  the  shape  of  a  boat's  keel,  the  oervix  more  ample  and 
increased  in  substance,  and  the  vaginal  portion  broader 
and  thicker. 

The  condition  of  the  parenchyma  of  the  uterus  varies 
according  to  the  duration  of  the  disease.  In  the  first 
stages  it  is  more  succulent  and  turgid,  owing  to  the  im- 
matured  condition  of  the  newly  formed  oonnective  tis- 
sue. The  longer  the  dnration  of  the  disease,  the  more 
Digitized  by  ^ ^_ 


THE  MEDICAL  KBCORD. 


19 


is  Ifae  mucous  oonnectiTe  tissue  transformed  into  the 
fibrillary  variety,  accompanied  with  contraction  of  tis- 
sue; the  parenchyma  on  section  appears  white,  or  of  a 
whhish-red  color,  deficient  in  blood-vessels  from  com- 
pression of  the  capillaries  by  the  contraction  of  the 
newly-formed  connective  tissue,  or  from  partial  destruc- 
tion or  obliteration  of  vessels  during  the  growth  of  tis- 
ane ;  the  firmness  of  the  nterine  substance  is  increased, 
simulating  the  hardness  of  cartilage,  and  creaking  under 
the  knife.  Thenewly-formed  tissue  is  chiefly  composed 
of  thin  fibrils,  deficient  in  nudei,  which  cross  the 
uterus  in  lines  of  various  breaddis  in  all  directions, 
lirming  a  complicated  felt-like  network,  and  constitut* 
mg  the  greater  substance  of  the  uterus.  In  the  first 
stages  of  the  disease  the  muscular  fibres  are  broader  and 
hjTpertrophied,  but  at  a  later  period  may  be  complete- 
ty  loetin  the  proliferation  of  connective  tissue. 

The  causes  of  this  difiuse  growth  of  the  connective 
tissue  must  be  sought  for  in  luibitual  hypersomia,  and  I 
cannot  concur  in  that  explanation  which  interprets  the 
process  described  as  chronic  inflammation.  It  is  true 
that  inflammatory  derangement  of  nutriticm  is  often 
fofiowed  by  proliferation  of  connective  tissue,  bnt  it  is 
impossible  to  conclude  that  firom  the  continuance  of  this 
fimnative  irritation,  derangements  of  nutrition  are  pro- 
<boed,  the  essential  diaraoteristics  of  which  are  destruc- 
ttve. 

DMise  growth  of  connteUve  Hsiue  coruUtutes  the  so- 
coBm  induration  hitherto  considered  a$  a  rmtUt  o/paren^ 
simo/otw  inflammaiion  of  Ihe  ni$rus> 
^  Frequently,  however,  this  proliferation  of  connective 
tiasoe  is  developed  after  repeated  deliveries  in  rapid 
soocession,  without  any  previous  or  existing  inflamma- 
tkm ;  it  abo  occurs  in  many  displacements  of  the  uterus, 
espeeiaUy  those  in  which  venous  reflux  is  hindered,  in 
eonaequenoe  of  traction  of  the  uterine  appendages. 
When  tumors  exists  especially  fibrous,  proliferation  of 
cennectire  tissue  almost  always  coexists  in  the  rest  of 
the  uteris.  When  the  uterine  cavity  is  distended  by 
secumulated  mucus  or  menstrual  blood,  this  prolifera- 
tion generally  exists  in  the  form  of  eccentric  hypertro- 
phy. Finally,  it  is  often  combined  with  the  various 
triotioiis  to  whidi  the  uterus  is  subject,  and  sometimes 
is  developed  in  consequence  of  the  puerperal  condition. 

From  the  description  of  this  affection,  it  is  evident 
that  the  term  "  infarctus,"  used  by  some  gynecologists, 
is  absolutely  improper.  For  reasons  mentioned,  1  would 
also  advise  the  dbuse  of  the  term  "  chronic  inflamma- 
tion." 

Id  most  cases,  the  mucous  membrane  of  the  vagina 
partKipatee  in  the  chronic  irritation ;  we  frequently  find 
ti  in  a  state  of  epithelial  desquamation,  and  even  of 
eaUrrfa  and  blennorrhcsa.  The  peritoneal  covering  of 
iIm  uterus  is  generally  thickened  and  covered  with 
Tirisas-shaped  felse  memlnranee.  The  pampiniform  and 
vtero-vagpnal  plexuses  are  often  in  a  varicose  condition, 
and  this  is  not  only  caused  by  the  contraction  of  the 
Mwly-ft>rmed  conneotive  tissue,  and  consequent  ocdu- 
Ma  of  tlie  blood'^vessels,  but  is  also  frequently  the  con- 
saquence  of  the  same  cause  which  produced  the  diffuse 
growth  of  the  above  tissue. 

Besides  local  hyperssmia,  we  must  take  into  consi- 
ienfion  the  general  eauses  of  this  affection ;  thus  it  is 
often  fousd  complicated  with  diseases  of  the  heart 
Snmsoni  calls  pamoular  attention  to  the  fact  that  pro- 
Unation  of  connective  tissue  repeatedly  occurs  after 
saeeesdve  miscarriages,  and  is  also  stud  to  occur  in 
prostitutes. 

When  difEu?e  growth  of  the  above  tissue  does  not 
take  place  unifermly  in  aH  parts  of  the  literus,  hyper- 
iww  dtstension  of  its  blood- vessds  is  apparent  in  those 
portions  not  at  all  or  only  slightly  afiected,  and  in  these 


parts  extravasations  may  occur,  especially  in  the  exter- 
nal or  internal  layers  of  uterine  tissue  (Scanzoni). 

The  consequences  of  the  above-mentioned  pathologi- 
cal conditions  are  derangements  of  menstruation  and 
sterility.  As  regards  their  termination,  it  must  be  noted 
that  in  the  majority  of  cases  the  proliferation  gradually 
ceases  after  attaining  a  certain  degree,  and  no  further 
alterations  of  tissue  take  place.  In  otiier  cases,  at  the 
climacteric  period,  involution  occurs,  commencing 
generally  by  distension  of  the  uterine  cavity,  with  an^ 
accumulation  of  mucus.  What  has  been  said  by  various 
authors  on  the  relations  of  difiuse  growth  of  connective 
tissue  to  the  development  of  carcinoma,  must  be  con- 
sidered as  a  mere  hypothesis;  this  same  question  has 
been  raised  in  regard  to  other  organs  in  which  carci- 
noma is  developed  from  an  hypertrophy  of  tissue,  and 
in  a  great  many  cases  it  must  be  left  to  the  discretion 
of  observers  whether  they  will  classify  certain  cases  with 
carcinonuL 

In  the  preceding  description  I  have  only  spoken  of 
that  proliferation  which  uniformly  afiects  the  entire  in*^ 
terstltial  connective  tissue  of  the  uterus;  we  shall  next 
consider  the  equally  important  analogous  conditiona 
which  only  afiect  portions  or  layers  of  the  uterus. 


©riglnal  €tctutts. 


SCROFULOSIS  AND  TUBERCULOSIS. 

BEINO  A  LEOTITRS  BEFORE  THE  CLASS  OF 

THE  JEFFERSON  MEDICAL  COLLBaE, 

Session  1866-7. 

Bt  S.  H.  DICKSON*,  M.D., 

PBOFIS80B  or  THBOKT  AlTD  FBAOTIOI  OV  MXDlOtlia. 

PARf  IL 

From  what  has  ahready  heen  said,  we  can  account  for 
scrofula  very  extensively ;  hut  th^re  is  a  certain  preva- 
lence of  scrofula  difficult  to  account  for.  It  is  stated  by 
Doran,  that  there  are  thirty-nine  families  in  Europe  out 
of  which  crowned  heads  are  chosen ;  you  may  remember 
it  as  the  number  of  stripes  jriven  the  Israelites — ^fort^ 
save  one ;  of  these,  twenty-nve  are  affirmed  to  be  posi- 
tivdy  scrofulous.  Why  should  they  be  scrofulous? 
They  feed  sumptuously,  they  are  clothed  in  purple  snd 
fine  linen,  they  are  magnificently  sheltered,  and  live 
under  as  good  hygienic  rules  as  are  practicable ;  their 
children  are  not  badly  reared;  royal  females  bring 
up  their  children  well;  they  are  taught  gymnastics^ 
nding,  shooting;  care  is  taken  to  bring  them  up 
with  a  view  to  their  physical  development — ^yet 
they  are  scrofulous.  We  must  go  far  back  to  the 
original  stock,  when  they  were  not  in  this  condition. 
The  house  of  Hapeburg  is  famous  for  its  thick  lip — and 
a  thick  lip  is  said  to  be  one  of  the  characterisiic  marks 
of  scrofula.  The  house  of  Brunswick,  which  occupies 
the  throne  of  G-reat  Britain,  is  known  for  many  years  to 
have  been  sul^t  to  scrofula.  We  owe  the  fashion 
of  wearing  high  stocks  to  a  Duke  of  York,  who  en- 
deavored in  this  wslj  to  hide  the  glands  of  his  neck  and 
the  results  of  ulceration.  There  is  nothing  in  the  habits 
of  these  &milies  which  produces  scrofula,  nor  has  there 
been  for  a  generation  or  two  back.  Some  even  go  so 
far  as  to  allow  but  a  sin^  healthy  family  to  exist  on  a 
European  throne,  and  this  is  the  superior  race  in  power, 
the  house  of  HohenzoUern^qpj^^^ijne^oLJPruflsia. 


^ 


THB  MBDKIAL  RECOHD. 


As  a  general  rule  the  crowned  heads,  the  rojal  fiRmlie«» 
are  at  one  end  of  the  scale  of  humanity,  the  poor  arti- 
sans in  the  manufactories  at  the  other ;  and  thus  we 
have  an  exemplification  of  the  old  proverb  that  extremes 
meet  Something  must  be  owing  to  climate.  Almost 
all  ttie  crowned  heads  of  Europe  are  derived  from 
Germany ;  it  were  easy  to  suppose,  then,  that  there  is 
something  in  temperament  and  individual  constitutkni, 
for  the  individual  constitutions  of  that  race  present  cer- 
tain peculiarities ;  Uiey  arg  fiiir-haired,  with  blonde  com- 
plexion and  blue  eyes ;  and  thus  we  have  imbibed  the 
idea  almost  universally  acknowledged,  passing  from 
book  to  book,  with  very  little  doubt  or  hesitation,  ex- 
pressed with  great  stress,  meeting  with  no  denial,  that 
scrofula  especially  attaches  itself  to  the  light-haired, 
the  blue-eyed,  the  blonde  complexion.  Certainly  the 
rule  is  not  absolute ;  a  crowd  of  instances  to  the  con- 
trary present  themselTes  to  my  recollection.  Whether 
from  crossing,  or  otherwise,  Holmes  observed  in  this 
country,  and  it  has  been  observed,  too,  m  Europe,  that 
this  fair  race  is  decreasing  in  numbers,  and  the  dark 
complexion,  the  black-bearded  races,  are  predominating 
over  the  entire  world.  In  the  various  miscegenations 
taking  place,  this  seems  to  be  the  prominent  type, 
which  will  prevail  ultimately  everywhere ;  the  other 
type  dying  out,  perhaps  from  weakness  originally,  and 
therefore  the  more  readily  deteriorated.  Hybridism,  or 
crossing,  has  been  supposed  to  be  the  cause  of  many 
evils ;  but  on  the  other  hand,  we  are  warned  that  the 
marrying  in  and  in  is  productive  of  great  evils.  Several 
writeiY  on  both  ddes  of  the  Atlantic,  on  this  side  Pro£ 
Bennis,  now  of  New  Orleans,  ascribe  much  of  tuber- 
culosis and  scrofulosis  to  the  marrying  of  relatives — ^phy- 
sical ineeBt,  as  it  is  called.  I  think  Uie  truth  ca^  be  put 
in  a  nutsheU.  I  suggest  it  to  you ;  there  is  a  great 
deal  of  exaggeration  on  this  subject,  yet  there  is  mudi 
reason  for  the  beb'ef  that  the  intermarriage  of  relat  ves 
is  dangerous  to  the  offspring,  not  on  account  of  their 
mere  co.nsanguinity,  but  because  they  are  likely  to  have 
the  same  predisposition  to  scrofula  if  that  predisposition 
exist  in  that  f  .mUy.  The  healthiest  and  hardiest  race 
in  the  world,  and  one  of  the  best  intellectuallv,  D'Israeli 
says  ihe  best  intellectually,  are  the  Jews.  Hrace  says, 
they  are  divided  into  two  races,  the  light  clear-corn- 
plexioned,  and  the  dark  race.  They  have  kept  these 
peculiarities  separate  from  the  earliest  times;  they 
marry  in  and  in,  as  we  know ;  breed  continually  toge- 
ther. Jews  seldom  intermarry  with  the  races  among 
whi<^  they  live.  GTentiles  seldom  marry  with  the 
Jewish  race.  *  There  are  such  exceptions  and  the  inter- 
marriage does  not  seem  to  be  uncongenial ;  they  form  a 
good  race,  g  nerally  mingle  well  together.  Here  then, 
we  have  an  instance  of  long  continued  intermarriage,  of 
marriage  of  relativef*,  and  without  any  deterioration. 
With  regard  to  degeneracy  in  them,  scrofulosis  and 
tuberculosis  are  certainly  not  necessary  reiults  uf  th^r 
intermarriage. 

Burton  says,  it  is  the  same  with  the  Arabs,  and  the 
Arabs  are  Ukewise  divided.  The  Arabs  are  Ishmaelites. 
and  they  are  divisible  into  two  daises,  the  blue-eyed 
and  the  dark-eyed.  Abd-el-Eader  is  blue-eyed  and  a 
bloiuie ;  yet  some  of  his  race  are  dark,  even  blacker 
than  the  Hindoo.  These  are  closely  intermarried — in- 
termarried even  among  tribes,  as  we  learn.  Among  the 
smaller  tribes  of  Bedouins,  all  marry  their  own  cousins — 
there  are  no  others  to  marry — yet  physically  they  are  a 
fine  race,  athletic,  energetic,  active.  What  can  vou 
desire  in  physical  health  and  development  more  than 
they  pos'jcss  ?  Oonsanguinity  is  not  therefore  among 
them  necessarily  follow^  by  degeneracy.  We  are  told 
the  same  thing  of  the  inhabitants  of  a  certain  part  of 
France.    The  Basques  and  Bretons  marry  their  cousins 


andldndred  habitually,  and  there  are  no  degeneraeietof 
any  kind,  physical  or  mental,  among  them. 

Therefore  we  come  to  the  conclusion  that  it  is  not 
an  essential  result  of  marriage  of  consanguiDity,  thai 
there  should  be  sorofolous  or  other  degeneiacy.  Whj 
then  does  it  often  happen,  for  there  is  no  doubt  that  it 
does  often  happen,  tbut  marriafles  of  consanguinity  are 
followed  by  physioal  or  mental  degeneracy  ?  Becanse, 
if  there  is  any  predispouticm  to  disease  in  a  family^  the 
female  will  have  it  as  well  aa  the  male ;  if  then,  under 
such  oircnmstanees^  two  coosins  cf  similar  scrofulous 
predii^Misition  many  each  other,  it  is  certain  the 
ofG^ring  of  these  cousins  will  be  more  scrofulous  than 
theu:  parents ;  but  it  is  not  so  by  the  law  of  consan* 
guinity.  For  suppose  two  persons  scrofulously  predis- 
posed|  of  the  most  distant  and  diverse  race,  marry,  the 
result  will  be  just  the  same  without  the  slightest  con- 
sanguinity. It  is  due  to  the  predispositicxi  and  not  to 
the  blood.  It  is,  for  tliis  reason,  more  apt  to  be  encoun- 
tered among  married  relatives;  but  it  is  not  essential,  it 
is  not  a  law.  If  two  cousins  are  healthy  and  see  fit  to 
marry,  there  is  as  much  reason  to  believe  that  their 
childreii  would  be  healthy,  as  if  they  were  not  connected 
by  coQsindiip  or  consanguinity  at  all  If  the  tempera- 
ments be  opposite,  it  wifi  be  ae  fiaivorable  a  conjunction 
as  if  they  were  not  cjinected.  If  we  could  manage 
these  things  as  the  stock-breeder  does  with  the  lower 
animals,  undoubtedly  we  oonld  in^rove  die  human 
breed  to  a  great  degree. 

As  the  scrofulous  diathesia  disoloses  Itself,  we  find  a 
universal  predisposition  to  various  phenomena,  various 
morbid  manifestations  of  the  skin,  the  eye;  the  bones 
themselves  becoming  soft  Bickets  we  scarcdy  know 
in  this  countiy,  though  frequent  in  many  other  parts  of 
the  world.  Softness  of  the  bones  of  various  kinds^ 
spina  bifida,  etc.,  the  child  behig  bom  with  the  defect. 
This  has  led  to  another  suggestion.  We  cannot  readily 
cure  this  terrible  form  of  disease  in  a  given  individual, 
but  we  can  prevent  it  in  the  c^pring  by  removing  the 
cause.  The  defect  of  lime  is  said  to  be  the  cause.- 
Mouries  discovered  that  the  milk  of  women  in  the  city 
of  Paris  contained  less  of  earthy  salts  than  the  proper 
proportion.  Now  in  defects  of  the  kind  we  are  speaking 
of  tne  earthy  salts  are  wanting;  too,  and  acting  on  the 
suggestion  resulting  from  this  investigation  he  found 
that  by  sending  the  children  out  of  Paris,  and  by  pro- 
curing for  then  the  milk  of  country  women,  this  diffi- 
culty was  abated ;  and  the  result  lias  been^  that  at  the 
present  day  very  few  children  in  Paris  are  nursed  by 
their  mothers.  We  learn  that  this  is  really  so  finom 
works  of  fiction,  from  poetry,  in  sadder  numbers  than 
are  recorded  in  our  medical  books,  for  it  has  produced 
a  sad  state  of  morals  ki  that  city.  Stone,  of  New  Or- 
leans, believes  tlMit  in  all  acrofoloos  and  tuberculous 
oases,  the  phoajjtate  of  lime  is  an  excellent  remedy. 
Many  others  have  maintained  the  same  thing.  lime  saUa 
are  neoeisary  to  remedy  this  defoct,  and  the  want  of 
the  lime  salts  in  the  maternal  parent  is  one  of  the  modes 
of  accounting  for  the  presence  of  the  disease  here'* 
(fitarily. 

Have  we  any  mode  of  treatment  for  sorofhlosis?  Are 
there  any  means  of  eure?  Any  artidee  of  diet  that 
will  prevent  it? — How  shall  we  tieat  scrofula?  Take 
any  of  its  manifestatioiis.  One  of  the  most  interesting 
is  the  affiBCtion  of  the  cervical  glands.  You  find  a  child 
beginning  to  diow  a  roidy  swelling  of  the  lymphatic 
glands  anywhere,  no  matter  where ;  you  find  children 
very  liable  to  enhunS^d  tonsils,  to  irregular  irritative 
dSarrhosa,  to  sore  throat,  to  riandular  swellings  exter- 
nally, to  swelling  of  &e  Ivm^iatic  ^nds  evervwhere, 
umfer  the  arm  in  the  axiUa,  akmg  the  bend  of  the  arm ; 
you  wUl  be  able  sometime  to  .^aoe  fl^m  a  digbt  J^w, 


THE  MEDICAL  RECORD. 


81 


A  swelliogr  of  the  duoi  along  the  whole  arm  up  to  the 
MiUa,  inflamed,  mieasy,  sore  to  the  tonch.  All  this 
Ikhtlity  depends  on  a  certain  hereditary  predisposition. 
Iodine  is  proposed  for  these  conditions,  and  the  yarious 
mo  Jes  of  administering  iodine  are  now  among  the  fa- 
vorite remedies.  I  do  not  believe  it  to  be  so  generally 
and  oniTersally  i^plicable  as  has  been  sappo^.  For 
instaacei  to  a  true  development  of  scrofulous  degene- 
racy it  does  not  seem  to  me  to  be  very  applicable.  Ma- 
rasmufl  I  hold  to  be  one  of  these  maniipestations.  A 
diild  thus  affected  will  begin  to  swell  with  a  sort  of  gen- 
eral, irregular,  knotty  hardness  of  the  belly,  and  at  last 
yon  will  find  the  mesenteric  glands  quite  enlarged.  This 
goes  on  to  an  enormous  extent.  I  have  seen  in  one 
child  an  enlargement^  a  mere  tumor,  an  immense  mass 
of  theae  glands,  agglutinated  together  as  large  nearly  as 
bis  head;  you  frec^uenUy  find  them  as  large  as  the  fist. 
It  is  a  common  thing  to  say  there  is  tuberculous  depo- 
sit in  the^e  cases;  I  have  never  seen  it  Lloyd  de- 
scribes the  manner  in  which  the  glands  of  the  neck  are 
thus  changed;  hyperssmia  first  shows  itself;  the  glands 
aie  in  a  state  of  determination,  a  stagnation  of  blood  soon 
followed  by  inflammation,  then  there  is  exudation,  but 
not  of  the  kind  to  be  described  as  tubercular;  it  is  a 
thin  curdy  fluid  which  will  sometimes  form  a  cavity — 
like  an  abscess;  but  sometimes  the  inflammation  is  of 
ordinary  character.  I  have  repeatedly  opened  these 
glands  m  the  neck,  when  I  found  pus  as  laudable  in 
appearance  as  any  surgeon  would  find  in  a  common 
phlegmon.  At  other  times  it  does  present  a  curd  or 
whey-like  separation  of  a  floid,  thin  stripes  of  pseudo- 
plasm,  with  a  turbid  senun. 

Iodine  seems  very  readily  to  affect  the  external  glands. 
I  don't  think  it  relieves  the  tonsilitis,  or  the  hardness, 
rednes!^  and  induration  of  the  tonsil,  which  by  and  by 
causes  neoesaity  for  extirpation ;  nor  does  it  seem  to 
benefit  the  su^ect  of  mesenteric  glandular  swelling, 
which  is  entirely  out  of  the  reach  of  iodine. 

Mercurials,  which  I  ol^ect  to,  and  dislike  to  use 
ander  all  other  conditions  of  scrofula,  which  I  think 
rather  tend  to  irritate  and  disturb  a  scrofulous  constitu- 
tion otherwise  affected,  seem  to  be  essentially  neces- 
sary ;  and  yet  you  must  avoid  with  great  care  the  local 
mitation  and  inflammation,  the  buo^  and  parotid  in- 
flammaUon  likely  to  be  produced.  Mercury  must  be 
osed  in  small  quantities.  Without  it  I  do  not  think  you 
will  relieve  a  child  from  this  sort  of  irritation ;  maras- 
mus^ as  it  has  been  called,  a  wasting  away,  a  very  rapid 
atrophy  of  the  whole  body,  shows  itself^  and  the  child 
emaciates  in  propordon  to  tlie  enlargement  of  the  glands, 
from  the  injury  done  in  the  general  disturbance  of  the 
assimilative  powers  of  the  constitution,  which  is  coinci- 
dent with  the  mesenteric  swelling.  I  have  opened  these 
swellin£8  after  death  and  found  them  in  the  state  which 
Lbyd  Mseribes  as  existing  in  the  glands  of  the  neck. 
I  have  never  seen  the  yeuow  tubercle  in  any  of  these 
dands;  I  have  seen  the  white  curdy  matter  which  may 
be,  I  don't  think  that  it  is,  identical  with  the  grey  mat- 
ter of  taberole.  These  two  subjects,  scrofula  and  tu- 
bercle, run  together  inextricably  at  certain  points,  but 
they  are  not  identically  the  same  conditiona  I  would 
rather  let  akme  even  inordinately  swollen  cervical 
glands  in  a  scroliilons  subject  I  do  believe  there  is 
something  fiivorable,  on  the  whole,  in  their  appearance, 
whether  it  be  meta^tical,  as  Parnsh  believed,  by  sav- 
ing other  parts;  or  whether  it  shows  a  not  quite  so 
giiat  degeneracy  of  oonstitution,  attacking  external 
l^ands  uistead  of  internal  glands,  I  am  not  pe- 
pared   to    say.     It  is  a  better   condition    of  thm^ 


internal  maniisstattons;  frequently  they  remam 
indolent  at  a  eertun  point  for  a  long  time.  Let 
thsoi  abne;   foflow  the  practice  of  one  of  our  late 


physicians  who  advises  you  "  if  it  lets  you  alone,  let  it 
alone."  They  frequently  disappear  of  themselves,  sub- 
side readily :  and  thus  is  accounted  for,  the  value  of  the 
"  roval  toucn,"  which  is  one  of  the  earliest  superstitions 
we  know  of.  If  we  trace  its  history  closely  we  find 
that  it  was  employed  among  barbarous  nations.  ^Ves- 
pasian was  supp<»ed  to  have  this  power  of  gracious 
touch,  by  whicn  he  also  relieved  blindness  and  paralysis, 
etc.  "Siatim  converaa  ad  usum  mantu  ac  cceco  dies  reUmi" 
says  Tacitus :  "  the  hand  recovered  its  power  and  the 
day  returned  to  the  blind."  Laird  teUs  us  that  Knig 
CMaf)  one  of  the  eariiest  Norwegian  kings,  had  this  sin- 
gular power.  He  took  a  piece  of  bread,  rolled  ir,  made 
me  form  of  the  cross,  put  it  in  the  mouth  of  the  patient; 
he  then  stroked  the  neck  and  the  glands  disappeared, 
and  thus  he  showed  the  royal  poww  he  derived  firom 
heaven.  We  know  that  the  kings  of  England  em- 
ployed the  royal  touch,  and  the  queen  down  as  late  as 
the  time  of  Dr.  Johnson.  We  know  of  other  persons 
who  have  enjoyed  this  power.  Valentine  Greatrakes 
has  left  a  name  in  history  on  account  of  the  number  of 
cases  that  occurred  under  hi^  hands. 

Scrofulous  persons,  therefore,  now  up  Yetj  often  in 
good  health,  get  rid  of  the  soroiulous  affection  of  the 
eye,  of  the  skin,  and  of  the  glands. 

Internal  scrofola  is  not  so  readily  got  rid  of;  nor 
are  the  scrofulous  affections  oi  the  bones.  Toynbee 
says  that  the  general  deafiiess  met  with  in  cities,  espe- 
cially where  ochlesis  prevails,  is  also  a  scrofolous  affec- 
tion. Iodine  is  used  m  all  these,  and  in  all  the  external 
manifestations  it  seems  to  be  singuUrly  i^plicable. 
Whether  ^itre  is  one  of  these  or  not  is  much  diluted. 
I  think  it  is,  for  it  is  much  under  the  influence  of  iodine. 
How  shall  the  iodine  be  administered?  There  are 
many  modes.  I  prefer  Lugol's  solution,  very  weak ;  a 
grain  to  the  quart  of  water,  and  administered  in  doses 
of  a  wine-glass  fuU  two  or  three  times  a  day.  Thus 
you  avoid  the  irritative  absorption  of  healthy  glandular 
structure  which  sometimes  follows  the  administration 
of  iodine.  The  deutiodide  of  mercury  and  potash  is  one 
of  the  best  preparations  and  very  effective.  All  the 
salts  ofpotash  are  serviceable,  upon  a  particular  view 
which  Qarrod  gives  us.  He  says  all  the  alkaline  salts 
tend  to  promote  the  natural  metamorphosis  of  tissue 
going  on  in  the  system ;  that  under  the  influence  of  the 
alkadies  there  is  a  more  ready  metamorphosis  of  the  less 
vital  tissues,  less  vital  deposits,  lees  vital  plasma,  and  of 
course  the  deposition  forming  the  glandular  and  other 
swellings  of  scrofiila.  I  have  no  doubt  he  is  right  A 
combination  of  salts,  such  as  we  have  in  sea- water,  I 
have  found  excellent  Recent  sea-water,  every  day,  in 
small  quantities,  will  imi»t>ve  the  health.  All  the  na- 
tural impregnations  of  mineral  waters  which  go  to  assist 
the  metamorphosis  of  tissue  are  beneficial,  and  upon 
that  general  principle.  I  know  no  other  to  guide  us ; 
there  is  no  specific  unless  iodine  is  a  specific ;  but  it  acts, 
I  think,  on  tnis  general  principle  ai  Garrod. 

With  reeard  (o  the  diet  much  may  be  done.  Bennet 
suggested  long  since  that  such  depositions  are  chiefly 
albuminotis;  many  books  call  them  fibrinous ;  but  there 
is  very  little  diffiirence  between  the  two  in  our  view. 
In  either  c-ise  it  will  be  of  great  consequence  to  avoid 
albuminous  food.  Bruce  also  says  that  they  contain 
too  much  caseine  among  the  proteine  compounds. 
Bencke  confines  his  patients  to  a  diet  of  whey ;  sub- 
tracting from  Uie  milk  the  whole  of  the  albumen,  leav- 
ing the  sugar  and  oUier  ingredientiL  getting  out  the 
ciml,  he  gives  the  whey.  It  is  said  tnat  the  cures  un- 
der his  hands  have  been  marvellous.  Very  little  bread 
is  allowed,  great  quantities  of  whey  being  drunk.  Even 
the  manifestation  of  tubercle  is  said  to  disappear  under 
this  regimen.  -^ ^ ~0'~ 


82 


THE  MEDICAL  RECORD. 


Utpovisi  of  ^Od|iital0. 


JEFFERSON  MEDICAL  COLLEGE 

I  or  PHILADELPBIA. 
SVRGIOAL  OUKIOS  Or  PBOFBSSOR  GB088. 

Wkdnbsdat,  Dec  19,  1866, 

Enlarged  ProHate,-^A.  G.  M e,  »t  61,  pre- 
sents himself  for  ezamiQation.  He  has  had  vesical 
trouble  for  ux  years ;  passes  urine  several  times  during 
the  night,  and  two  or  three  times  in  the  day-time ;  this 
is  not  accompanied  by  a  scalding  or  burning  sensation. 
Introducing  the  sound  into  the  bladder,  it  passes  very 
high  up,  and  over  a  very  rough  surface ,'  the  finger  in 
the  rectum  discovers  an  enlarged  prostate,  which  con- 
dition was  sufficiently  diagnosed  by  the  j&sciculated  con- 
dition of  the  bladder.  The  bladder  is  much  thickened. 
There  is  a  partial  paralysis  of  this  viscus  most  probably, 
and  its  interior  is  very  much  enlarged,  admitting  the 
exploring  instrument  even  to  its  revj  handle.  The 
unne  should  foe  examined  as  to  its  quantity  and  quality ; 
as  to  whether  it  is  unnaturally  aoid  or  allatline,  or  con- 
tains an  unusual  amount  of  mucus,  or  contains  any  phos- 
phates, urates,  or  any  other  deposit  ^  whether  it  contains 
any  pus,  etc.  A  great  deal  of  information  is  to  be  ob- 
tained in  this  way  before  we  can  reach  an  accurate 
diagnosis ;  but  the  cause  of  the  entire  difficulty  is  en- 
largement of  the  prostate  gland,  leading  to  mechanical 
obHmction  to  the  egress  of  the  urine,  and  to  hypertro- 
phy of  the  waUs  of  me  bladder. 

buch  a  disease  is  incurable.  All  that  can  be  done  is 
to  palliate  the  symptoms  and  relieve  the  suffering  of  the 
patient  to  the  extent  to  which  that  can  be  done.  We 
cannot  remove  this  hypertrophy,  Hydrochlbrate  of 
ammonia^  iodide  of  potas^m,  bromide  of  potassium, 
and  similar  articles,  have  been  employed  internally  with 
this  view.  Of  these  remedies  the  hydrochlorate  of  am- 
monia is  preferable.  Sometimes  suppositories  may  be 
introduced  with  advantage,  but  this  is  about  all  that 
can  be  done  towards  relidl  The  apf^cation  of  leeches 
to  the  rectum  and  vicinity,  the  application  locally  of 
iodine,  etc.,  all  prove  inefficient;  and  whatever  we  maj 
try,  we  find  at  last  that  nothing  can  be  done  to  dimi- 
nish permanently  the  size  of  the  organ;  and  as  long  as 
the  obstacle  to  the  egress  of  the  urine  remain^  just  so 
long  must  the  difficulty  in  the  bladder  remain. 

In  the  pesent  case  (the  patient  has  never  had  reten- 
tion of  unne)  there  is  paralysis ;  the  bladder  is  not  able 
to  contract  well  upon  its  contents.  He  will  be  directed 
to  take  one  draohm  of  Tr.  secale  comntum,  with  twenty 
drops  of  the  Tr.  ferri  chloridi  four  times  daily,  adding 
ten  drops  of  the  Tr.  cantharidis — ^another  excellent  rem- 
edy in  these  cases  of  ineontinenoe  of  urine  where  there 
is  paralysis  of  the  Uadder.  Secale  promotes  muscular 
contraction  of  the  musoular  fibres  of  the  urinary  blad- 
der; cantfaarides  acts  specifically  on  the  urinary  pas- 
sages ;  atid  the  tincture  of  the  chloride  of  iron  also  acts 
on  these  oi>];»n8,  and  is  an  excellent  tonic  besides;  and 
therefore,  the  combination  is  a  proper  one  under  the 
oiroumstancea 

The  bowels  are  to  belcept  in  a  soluble  condition,  with 
an  efficient  pur^fative  occasionally.  The  diet  is  to  be 
simple  and  nutritious. 

Ano4hm'  Cam  qfJBntmroed  ProBkOe. — ^Tfais  is  in  a  deaf 
and  (himb  gentleman,  who  presents  himself  for  relief 
from  incontinence  of  urine.  Bfe  is  wearing  an  ordinary 
urinal,  in  whl^  the  urine  is  received  as  it  flows,  and 
from  which  it  is  emptied  at  convenient  periods  by  turn- 
ing a  stop. 


There  is  another  contrivance  much  supmor  to  the 
ordinary  urinal,  whidi  was  originally  worn  by  Mr. 
Head,  a  man  with  a  congenital  extroj^y  of  the  blad* 
der.  In  these  cases  of  extrophy^  the  anterior  wall  of 
the  bladder  is  deficient  and  tne  posterior  wall  protrudes 
so  that  the  openings  or  the  ureters  can  be  distinguished. 
Afi^r  wearing,  a  great  variety  of  instruments  for  the 
purpose  of  ooUecting  the  urine,  he  finally  had  an  ap- 
paratus constructed  which  runs  along  the  inner  side  of 
the  thigh,  and  the  reservoir  is  long  and  lender,  and  is 
attach^  above  to  the  pubes,  while  the  tender  tumor  is 
covered  by  a  protector,  and  the  urine,  as  fast  as  it  passes 
off  from  the  ureters,  is  received  in  the  reservoir,  and 
conveyed  along  the  instrument^  where  it  is  retained, 
and  evacuated  by  means  of  a  screw,  several  times  a  day. 

This  patient  was  examined  with  the  sound  without 
finding  a  stone,  and  as  in  the  previous  case,  giving  evi- 
dence of  an  enlarged  prostate  eland.  Tnere  is  pre- 
cisely the  same  condition  of  the  bladder  as  in  the  other 
case ;  it  has  become  fasciculated  from  irritability.  The 
probability  in  the  present  instance  is  that  the  middle 
lobe  of  the  prostate  forms  some  mechanical  obstruc- 
tion to  the  evacuation  of  the  fluid,  leading  to  paralysis 
of  the  bladder,  and  incontinence  as  a  result.  Very  fi-e- 
quently  the  enlargement  exists  both  on  the  part  of  the 
lateral  lobes,  and  of  the  middle  lobe ;  at  other  times  it 
exists  in  one  or  in  both  lateral  lobes;  and  occasionally, 
exclusively,  or  nearly  so,  on  the  part  of  the  middle 
lobe.  When  the  middle  lobe  is  enlai^ed,  then  a  pro- 
jection resembling  much  the  uvula  is  formed,  which 
serves  as  a  meclumical  obstruction  to  the  evacuation  of 
the  urine,  and  there  is  no  particular  remedy  unless  we 
cut  it  off,  or  seize  hold  of  it  with  a  loop  of  wire,  and 
get  rid  of  it  in  that  manner.  A  good  mode  would  be 
to  get  in  to  the  bladder  in  a  manner  similar  to  the  late- 
ral or  median  operation  of  lithotomy,  and  ^en  to  snip 
off  this  middle  lobe;  there  might  be  a  little  bleed- 
ing, but  not  to  a  serious  exten^  and  thus  we  might 
dispose  of  this  body  whidh  we  cannot  get  rid  of  by  any 
medication.  This  operation  would  l^  safer  than  to 
seize  it  with  the  ^raseur. 

When  there  is  enlargement  of  the  lateral  lobes,  one 
or  both,  equally  or  unequally,  then  the  passage  is  very 
much  narrowed,  and  we  oan  literdly  do  nothing — ^be- 
cause we  have  no  remedy  to  relieve  hypertrophy  of 
that  organ. 

In  the  present  instance,  various  remedies  have  been 
employed,  none  very  persistently,  and  the  consequence 
has  been  that  the  patient  has  not  experienced  much  re- 
lief The  excoriated  condition  of  the  penis  in  this  case 
would  lead  to  the  inference  that  the  urine  is  acid,  and 
the  prescription  will  consist  of  tr.  ergot  f  3  j.  three 
times  daily  with  soda  bicarb,  grs.  xv.  to  each  dose; 
with  the  introduction  every  ni^t  at  bed-time  of  a  sup- 
pository containing  one-half  gr.  of  morphine  rubbed  up 
with  3  j  cocoa-butter.  This  treatment  wiB  be  conti- 
nued for  ten  or  twelve  days,  in  the  hope  of  affi^rding 
considerable  relie£ 

Ocdusum  of  the  Ure&irdl  Or^e, — John  M— — y, 
80t  11,  has  had  great  difficulty  in  passing  water  for 
about  a  year.  The  orifice  oi  his  urethra  is  barely  dis- 
tinguishable. The  prepuce  has  become  firmly  adherent 
to  the  head  of  the  penis,  from  inflammation  produced 
by  irritation  of  the  prepuce,  due  to  a  want  or  cleanli- 
ness. When  the  sebaoeons  matter  in  this  situation  is 
allowed  to  accumulate  it  is  very  apt  to  excite  inflamma- 
tion, and  if  the  patient  is  too  young  to  know  the  im- 
portance (^ablutions,  it  may  lead  to  the  present  state 
of  things. 

In  operating  fbr  the  removal  of  this  difficulty,  enlarg- 
ing the  ori£k)6  and  separating  the  prepuce  from  the 
glans,  a  strong  membrane,  apparently  fibrous^«s  found 


THE  MEDICAL  RECORD. 


83 


fitretched  over  the  meatus  urinariua,  and  the  adhesions 
were  yerr  finn.  An  affection  of  this  kind  will  lead  to 
disease  of  the  bladder  and  ureters;  it  may  lead  to  oal* 
eulos,  from  collection  of  the  salts  of  the  urine  as  a  re- 
sult of  the  difficulty  in  micturition.  Hypertrophy  of 
the  Uadder  is  a  common  consequence  of  this  condition. 


ptogctae  of  lEclrical  Stience • 


Diphtheria. — Dr.  E.  S.  Ghullard,  Richmond,  Va.,  in  a 
Priie  Essay  on  Diphtheria,  comes  to  the  following 
oooclusions: — **That  diphtheria  is  a  zymotic  disease; 
peculiar,  separate,  and  specific.  That  its  pathology 
proves  it  to  be  a  distinct  disease.  That  its  anatomical 
and  physiological  relations  appertain  to  no  other  dis- 
ease. That  it  is  both  epidemic  and  sporadic,  in  its 
preTalence.  That  its  etiology  is  obscure  and  in  no  re- 
spect understood.  That  its  symptoms  and  curse  render 
its  diagnosis  and  differential  diagnosis  simple.  That  it 
is  often  contagious ;  but  not  so  always.  That  its  dura- 
tion, in  the  acute  stage,  is  from  three  days  to  three 
weeks,  and  when  its  peculiar  sequelss  ensue,  that  the 
disease  may  persist  for  many  months.  That  hygienic 
bfluences  seem  not  to  affect  the  cause  of  the  disease ; 
but  that  they  do  affect  its  course  and  re^t.  That  its 
relation  to  age  is  marked  and  direct;  that  children  are 
its  most  frequent  subjects  and  its  most  frequent  victims. 
That  its  complications  are  numerous  and  most  of  them 
dangerousL  That  there  is  ng  direct  relation  between 
the  throat  lesions  and  the  result.  That  it  is  peculiarly 
apt  to  recur ;  and  that  convalescence  from  its  attacks 
is  slow,  tedious,  treacherous,  relapsing,  and  interrupted. 
That  there  seem  to  be  diseases  coincidently  occurring 
in  the  lower  animals,  during  its  prevalence.  That  its 
•equelse  are  peculiar  and  such  as  are  not  seen  afler  any 
other  disease.  That  its  mortality,  when  uncomplicated, 
is  not  serious  *  but  that  its  frequent  complications  ren- 
der the  mortality  severe.  That  the  chief  cause  of  death 
is  laryngeal  implication,  and  next  to  this  asthenia.  That 
the  proraoeis  can  seldom  be  satisfactorily  made.  That, 
in  DO  duease,  does  treatment  more  generally  influence 
the  results  That  the  autopsies  prove  (what  is  indicated 
by  the  patholoey,  the  anatomical  peculiarities,  the 
symptoms,  and  the  sequelae)  that  diphtheria  is  a  zymotic, 
dtstinct,  and  specific  disease.  After  a  careful  analysis 
and  patient  tillage  of  this  field;  after  freely  consulting 
an  fiuniliar  with  its  cultivation,  we  now  offer  to  our  fel- 
k>w-laborer8  the  results  of  the  harvest:  ^  Com  from  the 
sheaves  of  science,'  with  the  stubble,  produced  to  sus- 
tain it" 

MsiiBntUATioN  nr  the  Malb. — Dr.  V.  0.  Bling  reports 
{Somikem  Journal  Medical  Science)  a  very  eurioufl  case 
of  simulated  menstruation  in  a  maJe.  The  subject  was 
a  feUow  student  at  the  UntversitY  of  Louisiana  whose 
iottmate  acquaintance  he  first  made  during  the  month 
of  December,  1855.  He  then  learned  that  the  gentle- 
man had  been  the  victim  of  this  vicarious  function  for 
a  period  of  three  years,  eliminating  an  apparent  cata- 
menial  secretion,  with  the  same  regularity  and  attended 
with  the  same  indications  by  which  it  is  characterized 
in  the  human  female.  The  fluid  exuded  flowed  from 
the  sebaceous  glands  of  the  deep  fossa  behind  the  corona 
f^aodis,  and  was  of  a  sanguineous  appearance,  homo- 
geoeoua,  and  thick.  The  quantity  of  this  exudation  varied 
nom  one  to  two  ounees  during  each  heemorrhagic  period, 
and  the  duration  of  the  periods  firom  three  to  six  days. 
The  subject  was  then  twenty-two  years  of  age,  of  a 
lyiaphatic  temperament,  and  had  never  been  contami- 
nied  with  venereal  diseaae.    Though  not  prone  to  the 


indulgence  of  lustfrd  passions  he  was  not  innocent  of 
having  sometimes  yielded  to  their  prompting  which 
were  especially  potent  immediately  preceding  his  period- 
ical purifications. 

Incontinenob  or  Urine  Sucoessfullt  Treated  wcth 
Extract  of  Belladonna. — ^A  healthy  looking  country 
girl,  fourteen  years  old,  was  brought  by  her  mother  to 
the  Metropolitan  Free  Eospital  on  the  11th  of  January 
last  She  had  suffered  from  nocturnal  incontinence  of 
urine  for  the  last  two  years.  Not  a  night  passed  without 
her  wetting  the  bed,  and  to  such  an  extent  that  she  had 
been  compelled  to  lie  upon  straw  covered  with  a  sheet 
in  order  to  change  her  beddine  daUy.  She  had  been 
taken  out  of  bed  at  night,  scoldeo,  and  ridiculed,  without 
anv  effect  in  making  her  abandon  the  habit.  Dr.  Drys- 
dafe  ordered  her  a  quarter  of  a  grain  of  extract  of  bel- 
ladonna as  a  pill,  to  be  taken  at  bedtime  every  night. 
On  the  16th  of  January  her  mother  came  to  say  that  she 
had  not  wetted  her  bed  since  taking  the  mediciue.  Up 
to  the  18th  of  January  there  was  no  return  of  inconti- 
nence of  urine.  Dr.  Drysdale  remarked  that  he  had  in 
many  cases  seen  similar  results  from  the  use  of  bella- 
donna in  this  disease,  and  supposed  that  the  drug  acted 
by  paralysing  the  detrusor  urinss  muscle. — Lancei, 

Detection  of  Strychnine. — ^It  frequently  occurs  that 
when  strychnine  is  mixed  with  organic  matters — as 
usually  happens  in  medico-legal  cases — though  the  ordi- 
nary tests  may  be  applied  without  much  difficulty,  it  is 
by  no  means  easy  to  detect  the  crystaUine  form  of  the 
alkaloid.  A  suggestion  lately  made  in  the  Chemical 
News,  by  Mr.  Blunt,  appears  of  some  value.  He  says 
that  the  granular  masses  of  the  alkaloid  which  are  seen 
in  organic  mixtures  containing  strychnine  may  be  con- 
verted into  exquisite  stars  of  crystals  by  the  addition 
of  a  drop  of  sulphuric  acid,  if  consisting  of  one  drop  of 
strong  acid  in  five  of  water. — Lancet. 

Trichinosis. — ^A  committee  appointed  by  the  Medical 
Society  of  Vienna,  and  composed  of  Professors  Klob, 
MuHer,  and  Wedl,  has  just  pubhshed  a  long  report  on 
trichinosis,  in  which  the  startling  fact  is  asserted  that 
the  real  source  of  infection  lies  entirely  in  the  rat,-  in 
which  the  malady  is  n>ontaneously  developed,  and  whidi 
communicates  it  to  the  pig.  In  Moravii^  eighteen  out 
of  forty-nine  rats  examined  were  trichinized,  a  propor- 
tion of  nearly  thirty-seven  per  cent.  In  Lower  Aus- 
tria the  proportion  was  not  more  than  four  per  cent., 
and  in  the  environs  of  Vienna  abott  ten  per  eent  The 
report  confirms  the  fact  that  tridiiaosis  may  be  trans- 
mitted by  food,  from  die  rat  to  the  rabbit,  from  the 
rabbit  to  the  fox  and  hedgehog,  from  the  rat  to  the  pig, 
and  from  the  pig  to  the  rat.  Even  die  calf  may  be  in- 
fected by  being  fed  with  the  flesh  of  trichinized  rabbit. 
What  it  worse  still,  the  larvss  of  flies  feeding  on  infected 
meat  will  transmit  trichinosis  to  rabbits,  provided  the 
larvse  come  fresh  from  the  infocted  substance ;  for  if  a 
certain  time  be  allowed  to  pass,  the  trichines  soon  die 
in  the  digestive  tube  of  the  larvae.  It  is  important  to 
notice  that  the  report  distinctly  confirms  the  mnocuous- 
ness  of  trichinized  meat  when  thoroughly  salted,  smoked, 
or  boiled,  the  latter  process  being  by  far  the  most  effica- 
cious. Meat  roasted  for  three-ouartors  of  an  hour  is 
safe  food ;  boiling  requires  a  whole  hour.  And  yet  the 
report  mentions  cases  of  infection  recently  observed  in 
Austria,  so  that  means  diould  be  taken  there  to  protect 
the  public  from  tliis  disastrous  malady.  The  first  mea- 
sure proposed  it  the  extermination  of  all  rats  and  mice, 
but  not  without  previously  examining  them,  in  order 
to  ascertain  die  existence  of  trichinosis  among  them. 
If  this  examination  should  lead  to  affirmative  results, 
then  particular  care  should  be  taken  in  the  locality  to 


84 


THE  MEDICAL  RECDBD. 


keep  pigs  away  from  tU  sewers,  hei^  of  manure,  and 
other  such  j^aoes  frequented  by  rate.  The  flesh  of  the 
pig  should  be  exaxained  either  after  death,  or  even  dur- 
ing life,  by  means  of  incisions.  The  infected  pig  should 
be  separated  from  the  others,  marked,  and  its  sale  pre- 
vented. Special  slaughter-houses  should  be  organized 
for  pigs,  and  the  flesh  examined  by  veterinary  practi- 
tioners ;  and  the  public  themselves  are  warned  never  to 
eat  raw  pork  under  any  form,  but  strictly  to  consume 
it  only  well  salted  or  smoked,  boiled  or  roasted. — 
EoKkange. 

Etb-wa8he8  ooKTAnrara  acvtate  or  lead  have  been 
found  to  produce  a  precipitate  of  chloride  of  lead  upon 
the  cornea  which  renders  it  dim,  and  forms  erosions 
upon  it  by  destroying  the  epithelium.  The  ulcers  which 
are  formed  are  very  obstinate,  and  a  condition  of  things 
ia  induced  far  worse  than  the  originid  trouble  for  which 
the  lotion  was  prescribed. 

ExCTSrON  AKD  RXOENERATIOM  OW  TBI  EnTIRB  ClAVICLS. 

— J.  W.  Irvine,  L.R.C.S.^  Edin.  {LaneeC)^  reports  a  case  of 
excision  and  regeneration  of  the  entire  clavicle  of  a 
lad  aged  sixteen.  The  necrosis  of  the  clavicle  which 
necessitated  the  operation,  was  caused  by  severe  ostei- 
tis following  rheumatism.  On  admission  to  the  West 
Derby  Union  Hospital,  June  18,  the  patient  was  much 
exhausted;  there  was  a  constant  purulent  discharge 
from  a  wound  which  lefl  an  inch  and  a  half  pf  the 
central  portion  of  tlie  right  clavicle  bare  and  dead.  He 
continued  to  lose  flesh  until  the  2d  of  July,  when  ab- 
scesses beinn  to  show  themselves  near  the  sternum  and 
scapula.  This  latter  circumstance  decided  the  surgeon 
to  operate. 

Chloroform  having  been  administered,  an  incision  was 
made  over  the  entire  length  of  the  bone,  and  then,  as 
far  as  possible,  the  periosteum  was  dissected  from  its 
superficial  surfiice.  Then  the  stemo-clavical  end  .was 
disarticulated,  and  a  spatula  so  placed  as  to  elevate  the 
bone,  and  aUow  of  an  easy  separation  of  the  periosteum. 
The  operator  found  it  necessary  to  dissect  with  extreme 
oare  owing  to  the  painfrd  perceptible  pulsation  of  the 
subclavian  artery,  but  with  perseverance  he  managed 
to  remove  the  clavicle  oomparatively  free  from  its  peri- 
osteal covering.  During  tne  removal,  hemorrhage  oc- 
curred from  seven  souroea  Three  vessels  were  con- 
trolled by  torsion,  and  he  found  it  necessary  to  apply 
four  ligi^res^  The  wound  was  brought  together  by 
eight  wire  sutures;  the  arm  was  confined  at  right  angles 
across  the  chest  by  means  of  bandages,  and  cold  water 
dressings  were  i4>plied.  No  secondary  hssmorrhage 
occurred,  and  in  a  week  the  scapular  end  of  the  wound 
had  healed  by  the  first  intention,  and  the  arterial  liga- 
tures had  been  removed.  The  abscesses  which  had 
.  threatened  to  point  near  the  sternum  and  scapula  had 
discharged  themselves  at  the  line  of  incision.  The 
eternal  end  of  the  wound,  which  was  healing  by  the 
granulating  process,  had  a  tendency  to  gape,  but  filled 
up  ver^r  satioaotorily ;  the  patient  being  confined  to Jiis 
right  side,  and  having  his  head  thoroughly  elevated. 
On  September  1,  two  months  after  operation,  the  en- 
.  tire  wound  had  cicatrised,  and  the  patient  had  Rained 
in  weight.  He  had  been  able  to  sit  up,  and  use  his  arm 
in  playing  dominoes,  for  ten  days  past. 

On  September  20  he  expressed  himself  as  auite  able 
to  follow  his  employment,  and  as  it  was  evident  that 
the  olavide  was  being  regenerated  he  was  disohaiged 
with  the  caution  to  use  the  arm  of  that  side  ten- 
derly. The  operator,  in  oommenting  upon  the  case, 
remarks,  that  an  examination  of  the  davide  afVer  re- 
moval convinced  him,  and  every  other  surgeon  who  saw 
it,  that  any  operation  short  of  entire  extirpation  would 
have  proved   uQavailing.     The  acapdlar  end  of  the 


diseased  bone,  espedally  its  under  surface,  was  found 
to  be  most  afllSected,  but  the  sternal  end  was  consider^ 
ably  disorganized.  The  articular  surface  of  the  sternum 
was  healuby.  On  the  31st  of  December,  six  months 
after  operation,  he  bad  an  opportunity  of  seeing  the 
patient  for  the  first  time  after  his  discharge,  and  found 
that  he  had  meanwhile  been  activdv  employed  at  his  own 
business,  and  had  for  some  weeks  been  able  to  use 
his  right  arm  as  perfectly  as  ever.  Occupying  the  place 
of  the  resected  clavicle  is  a  new  bone,  of  rather  beyond 
the  normal  length,  and  considerably  wider,  but  more 
flat  and  thinner,  than  the  original  one.  This  regene- 
rated davide  played  its  part  with  perfection,  allowing  the 
boy  to  use  his  arm  as  efficiently  as  though  no  distur- 
bance of  the  parts  had  taken  place.  It  was  interesting 
to  him  to  notice  the  accuracy  with  which  the  Umits  <» 
attachment  of  the  daricular  muscles  could  be  clearly 
defined  when  muscular  eflbrts  are  made. 

Rkpbated  RisicnoH  or  thi  Kkeb-Joint.— Several 
cases  have  occurred  in  which  deby  in  healing,  and  the 
evident  occurrence  of  necrosis  after  resection,  has  ren- 
dered a  second  operation  necessary.  At  Km^s  CoUege 
Botpitdlf  under  such  drcumstancee,  it  is  thought  better 
to  repeat  the  resection  rather  than  to  amputate  the 
thiffh.  Sir  William  F^^usson  has  had  three  or  four 
such  cases,  whidi  have  done  weU ;  and  Mr.  H.  Smith 
had  one  in  which  the  proceeding  answered  perfectly. 
On  Saturday  last  Mr.  Smith  again  a^pted  the  plan  in 
the  case  of  a  lad  whose  knee-joint  he  had  excised  in 
Jul  V  last  The  boy  went  on  well  at  first,  then  fell  back, 
and  was  sent  into  the  country  for  a  few  months—not 
to  much  purpose,  however,  for  sinuses  about  the  wound 
persisted,  and  showed  the  presence  of  dead  bone,  and 
the  boy's  health  was  suffering  from  the  prolonged  iiri- 
tation.  On  opening  up  the  wound,  firm  anchylosis  was 
found  to  a  limited  extent  between  the  femur  and  tibia. 
Lying  behind  the  former  bone  was  a  ragged  sequestrum, 
an  inch  or  two  long,  representing  the  intercondyloia 
space  of  the  femur — that  portion  of  bone  which  is  so 
often  exposed  to  necrosis.  There  was  an  abscess  in  the 
head  of  the  tibia.  Mr.  Smith  removed  a  thin  section 
of  this  latter  bone  and  a  portion  of  femur,  and  brought 
the  bones  into  apposi  ion  again  just  as  in  ordinary  re- 
section. When  the  sequestrum  came  to  be  exammed, 
an  old  arterial  ligature  was  found  lying  about  it.  This 
must  have  been  accidentally  dropped  into  the  wound 
in  July  last,  at  the  time  of  operation,  and  there  it  bad 
since  rested.  Was  it  the  presence  of  this  piece  of  string 
which  exdted  inflammation  leading  to  the  death  of  the 
shell  of  bone  described? — L<mc0t, 

Narciine. — The  employment  of  narceine  is  becoming 
very  fiishionable  in  France,  morphia  being  in  the  mean- 
time thrown  virtually  aside.  It  is  said  to  possess  the 
property  of  producinfi^  a  tranquil  sleep,  at  the  same 
time  none  of  the  un^Heasant  effects  belonging  to  other 
narootict  are  felt  on  waking.  It  has  another  valuable 
property  of  not  interfering  with  the  regular  and  normal 
action  of  the  bowels. 

Fob  Rblaxxd  akd  Elokoatcd  Uvula. — A  corremon- 
dent  of  the  Lancet  calls  attention  to  the  benencial 
effects  of  the  local  application  of  a  strong  solution  of 
sesqui-chloride  of  iron  to  the  throat  in  cases  of  rdaxa- 
tion  of  the  uvula.  It  should  be  applied  twice  daily 
with  a  camelVhair  brush. 

A  Cause  for  ths  iNiFFicmror  of  ths  Davt  Lamf. 

— The  evidence  given  in  reffard  to  one  of  the  recent 
colliery  explosions  in  England  shows  thHt  the  men  were 
in  the  habit  of  smokine  in  the  pit,  and  t:hat  they  carried 
duplioftte  keys,  by  which  they  opened  the  saTety-laaps. 


THE  MEDICAL  RECORD. 


8ft 


The  Medical  Record. 

^  Jkiiii-Pmtt|l2  loonml  of  9tbichie  mdi  Stttgerg. 
Gbobgb  F.  Shbadt,  M.D.,  Edttob. 

PnbUalMd  OB  tb*  lat  and  15th  of  Moh  Month,  tof 
WILUAM  WOOD  A  00^  61  Walkxi  9tbxr;  New  Tobx. 


rOREWJf  AaBSOIE& 


Lovoov—Tbomkb  k  Go. 

pABa—BoMAHOB  ST  OlB. 


tLBIPBIO— B*  HSBMAHir. 
Bio  Jambibo-^tbphbiib  t  Oa 


New  ITorlc  A.prU  lO.  1S67. 


THE  CONVENTION  OF  MEDICAL  TEACHERS. 

A  GoNTximov  of  Medical  Teachers,  in  accordance  with 
the  recommendation  of  the  American  Medical  Associa- 
tion, is  to  be  held  in  Cincinnati,  on  the  3d  of  May  next 
The  object  of  the  meeting  is  a  thorough  revision  of  the 
present  system  of  medical  college  instruction.  The 
conmiittee  appointed  to  carry  ont  the  spirit  of  the  re- 
solution have  issued  the  call,  and  have  propounded  certain 
questions  which  they  desire  the  several  delegates  to 
eonsider,  and  be  prepared  to  act  upon. 

The  first  subject  to  which  they  are  asked  to  give  at- 
tention, is  the  establishment  of  a  uniform  and  just  rate 
of  lecture  fees.  It  is  well  known  that  many  of  the 
•astern  colleges  hare  inoreased  their  rates  diuing  the 
past  season,  while  others  have  chosen  to  adhere  to  the 
old  price.  The  experiment  has  received  a  fair  trial,  and 
the  results  must  prove  the  wisdom  or  folly  of  the  change. 
We  Are  not  among  those  who  are  disposed  to  cheapen 
medical  science,  and  are  in  favor  of  teachers  being  de- 
cently, in  fact  wen  paid ;  but  at  the  same  time  the  stu- 
dents should  have  a  decent  show.  If  those  attending 
Iscturea  have  been  satisfied,  as  may  be  shown  by  their 
ooming  out  in  numbers  proportionate  to  former  years, 
there  is  no  argument  against  the  adherence  to  the  pre- 
lent  rates ;  but  if  the  reverse  can  be  demonstrated  to  be 
the  case,  some  compromise  must  be  settled  upon.  As 
^  as  we  can  learn,  however,  those  schools  which  have 
raised  the  tariff  are  satisfied  with  their  ootirse,  and  are 
wiDmg  to  urge  every  reason  in  favor  of  ito  universal 
adoption;  maintaining  that  any  lack  of  attendance  can 
be  explained  by  other  causes  than  those  which  refer  to 
a  mere  advance  of  thirty  or  forty  dollars  on  former  years. 
It  is  probable  that  the  argumento  of  these  gentlemen 
win  have  merit  enough  to  convince  other  members  of 
the  amventionofthe  practicability  of  their  plan.  If  they 
nooeed,  a  settlement  upon  a  uniform  rate  of  charges 
will  not  be  difficult.  But  after  all,  the  matter  is  not  of 
toiflh  importance,  only  as  it  bears  upon  anofher  ques- 
twn,  which  b  advertised  to  be  presented,  via.  the  in- 
«n8e  of  the  lecture  term,  and  of  the  number  of  pro- 
AnorriupsL    The  ad<^tian  of  audi  a  measure  would 


certainly  involve  an  increase  of  expenditure,  and  would 
necessitate  a  proportionate  increase  in  leeture  fees. 
This  must  be  the  main  ground  upon  whidi  its  justice  is 
to  be  founded.  If  the  teachers  promise  to  extend  the 
lecture  season  and  increase  the  number  of  profesioi> 
ships,  it  is  but  right  that  their  patrons  should  stand 
ready  to  help  them  pecuniarily ;  but  if  no  increased 
advantages  are  offered,  they  should  show  some  very 
good  reasons  why  they  cannot  adhere  to  the  old  prioes. 
The  propriety  of  increasing  the  lecture  term  has  been 
already  discussed  in  our  colunms.  We  have  taken  occa- 
^on  to  raise  our  voice  against  the  miserable  cramming 
system  involved  in  the  giving  of  six  lectures  a  day,  and 
to  urge  the  practicability  of  having  but  three  or  four. 
There  is  no  earthly  reason  why  the  course  shbuld  not 
be  nine  months  instead  of  five.  The  professor  may  do 
the  same  amount  of  woiic  in  that  time  that  he  now  per- 
forms in  a  shorter  one,  the  only  difference  being,  that 
by  allowing  time  for  the  student  to  digest  what  he  has 
heard,  he  can  do  proportionatdy  more  good.  But  we 
cannot  dilate  upon  this  poiat  without  the  risk  of  re- 
peating views  already  familiar  to  our  readers. 

If  the  lecture  term  be  extended,  the  increase  in  Ito 
professorial  corps  can  naturally  follow.  In  fact  the  agree- 
ment to  the  first  proposition  would  be  absolutely  ne- 
cessary, unless  the  poor  victims  of  over-lecturing  are  to 
be  crowded  still  more.  The  increase  in  the  number  of 
professors  would  hardly  involve  the  necessity  for  more 
than  one  to  each  branch,  unless  a  more  systematic  course 
of  instruction  than  is  now  followed  out,  is  agreed  upon. 
This  would  seem  to  be  the  intention  of  the  committee, 
in  an  invitation  to  a  oonsideration  of  the  third  questioa, 
in  which  they  urge  the  **  adoption  of  measures  for 
securing  more  borough  attention  on  the  part  of  stu- 
dents to  the  more  elementary  branches  of  medical  sci- 
ence, and  a  more  progressive  <»'der  of  medical  studies.** 
The  only  wAy,  in  our  opinion,  this  can  be  done,  is  by  a 
regular  divi»on  of  the  class  rato  yearly  grades,  the  adop- 
tion of  which  measure  we  have,  in  a  preceding  number, 
taken  pains  to  urge  upon  all  the  medical  colleges.  'Rxq 
reasons  for  our  oonvictions  have  been,  we  think,  fiuriy 
presented,  as  affording  the  best  means  for  pr<^pMrly  re- 
gulating the  studies  of  the  different  branchea  If  the 
medical  class  is  divided  into  first,  second,  and  even  third 
course  students,  it  may  then  be  requisite  to  have  two, 
or  even  three  professors;  but  in  that  case  each  teaoher 
should  have  his  own  pupils,  so  that  any  of  his  peodiar 
views  may  not  be  combated  by  his  confrere. 

The  proper  discussion  of  the  question  in  refereooe  to 
Uie  establishment  of  a  more  progressive  order  of  studies, 
covers  considerable  ground.  In  the  first  place,  ^e  pro- 
priety of  establishing  recitations  is  one  which  should  be 
oonsid^red  as  having  a  very  important  bearing,  and  in 
the  seoond  plaoe,  the  neoessity  of  havhig  examinatioos 
for  the  different  grades.  Becitations  should  be  regu- 
larly carried  on,  and  no  student  should  be  allowed  to 
pass  into  a  higher  grade  until  he  has  given  satisfaotoiy 
evidence  of  his  fitness  by  a  sufficiently  rigid  test 


86 


THE  MEDICAL  RECORD. 


The  proposition  to  exftct  Atteadanoe  upon  three  an- 
nnaSi  courses  instesd  of  t^^o,  is  one  to  which  the  atten- 
tioQ  of  the  conrentioQ  should  be  senooslj  directed.  We 
cannot  see  what  ol^ectioa  there  can  be  to  its  unanimous 
adoption ;  the  majority  of  the  students  are  already  in 
the  habit  of  attending  three  courses  instead  of  the  two 
which  they  are  compelled  to.  The  only  difference  it 
would  make  to  them  by  eztpa  attendance  being 
compulsory  instead  of  a  ooatter  of  choice,  would  be  the 
increased  expense  which  such  a  regulation  might  in- 
Tolye.  But  this  can  be  reduced  to  the  minimum  by  the 
colleges,  especially  if  most  of  the  course  be  devoted,  as 
proposed,  to  clinical  instruction.  It  could,  in  fact,  be 
so  arranged  tliat  an  extra  pecuniary  outlay  would  be 
uncalled  for. 

Lastly  comes  the  sutgect  of  preliminary  education. 
We  are  glad  to  see  that  the  committee  has  the  hardi- 
hood to  propose  the  question  and  rank  it  in  equal  im- 
portance with  the  preceding  ones.  If  they  had  left 
this  out,  a  general  discussion  upon  college  education 
-would  be  without  much  practical  result  The  commit- 
tee do  not,  we  imagme,  intend  to  do  more  than  make  a 
beginning  in  tliis  matter.  The  regulations  cannot^  to 
atart  with,  be  rery  stringent  The  young  men  who  are 
candidates  lor  the  study  of  medicine  should  not  be  star- 
tled with  the  announcement  that  unless  they  are  versed 
in  the  dead  languages,  and  proficients  in  those  other 
branches  taught  in  our  literary  institutions,  they  can- 
not enter  a  medical  college.  It  would  be  much  bet^ 
ter  for  the  science  if  some  such  regulations  could  be 
adopted,  but  in  the  present  state  of  alSairs  we  must 
look  at  soch  a  culmination  of  our  hopes  as  afar  off 
But  how  is  a  beginning  to  be  made  ?  Simply  by  in- 
sisting at  first  upon  a  reasonably  low  standard;  by  the 
estaUishment  of  a  code  of  requirements  which  shall  be 
rigidly  and  impartially  adhered  to.  By  so  doing,  those 
proposing  to  enter  upon  the  study  of  our  art  can  be 
made  to  understand  that  the  portals  of  our  colleges  are 
not  open  to  every  blockhead  who  may  have  money 
Plough  to  purchase  his  tickets.  After  a  while  we  can 
gradually  increase  the  stringency  of  our  demands  and 
eventually  equal  those  of  the  colleges  of  Europe.  Let 
Its  be  satisfied  at  first  with  a  little,  but  let  us  have  that 
Uttle  at  aU  hasarda. 

There  will  probably  be  a  multiplicity  of  topics  grow- 
ing out  of  the  sul^ects  which  are  to  be  presented  by  the 
committee ;  but  with  these  we  have  nothing  at  present  to 
do.  We  only  deure,  in  the  cursory  review  of  the  sub- 
jects proposed  by  the  committee,  to  offer  a  few  sugges- 
tions upon  the  pursuance  of  a  course  which  will  meet 
with  the  support  of  the  majority  of  the  professicm. 
There  can  hardly  be  a  doubt  that  the  convention  will 
be  a  large  one,  and  that  every  medical  school  in  the 
country  will  feel  enough  interest  in  the  objects  of  the 
meeting  to  be  represented  by  delegates.  If  we  are 
right  in  our  conjectures,  and  the  meeting  be,  as  we  hope  it 
will,  a  harmonioua  one,  the  members  will  have  the  op- 
portunity ci  settling  many  points  whidi  have  heretof<»e 


remained  unsettled  from  the  lack  of  a  properly  recog- 
nised power  to  t^ce  them  in  hand. 

Not  only  do  we  hope  this  meeting  will  be  well  at- 
tended, but  that  out  of  it  may  grow  a  regular  organisa- 
tion of  medical  teachers,  which  shall  be  an  auxiliary  of 
the  American  Medical  Association,  and  shall  meet  as 
often  as  occasion  may  require  to  discuss  all  matters  re- 
lating to  medical  education.  The  establishment  of  such 
a  society  would  in  fact  be  the  only  means  we  at  pre* 
sent  can  have  of  raising  the  standard  of  medical  learning. 
We  may  exact  this  and  that  at  our  medical  organiza- 
tion, concerning  what  college  shall  and  shall  not  do ; 
but  what  does  it  avail  us  if  the  professors  refbse  to  com- 
ply with  our  demands  ?  If)  however,  we  have  a  recog- 
nised association  of  teachers  who  understand  what  is 
to  be  done,  and  who  agree  to  act  in  accordance  with 
their  convictions,  we  shall  have  something  tangible 
upon  which  to  rest  our  hopes  of  radical  and  practical 
reform. 

The  Society  for  the  Prevention  of  Cruelty  to  Animals 
seems  determined  to  stultify  itself,  not  only  in  the  eyes 
of  medical  men  but  of  the  public  at  large.  No  one  seems 
proof  against  the  misdirected  zeal  of  its  representative. 
Not  long  ago  we  had  occasion  to  allude  to  an  attack 
made  upon  a  distinguished  professor  of  physiology,  of 
our  city,  for  exerdsing  unwonted  cruelty  upon  animals 
which  he  experimented  upon.  The  sensational  breeie 
which  this  charge  against  that  gentleman  made  in  the 
public  prints  was  happily  of  short  duration,  in  conse- 
quence of  the  very  sensible  and  able  defence  that  was 
made.  But  the  indefatigable  chairman  of  the  association 
has  seemingly  not  been  contented  with  this  rebuke,  and 
we  find  him  drawing  his  quill  against  another  party, 
upon  an  equally  frivolous  and  unfounded  pretence.  It 
seems  that  a  certain  party  complained,  in  the  sentimen- 
tal style  peculiar  to  abnormal  tender-heartedness,  that 
the  well  known  manager  of  a  museum  was  in  the  habit 
of  feeding  his  snakes  with  live  rabbits,  which  were 
thrust  into  the  reptiles*  cage.  This  seems  to  have  been 
enough  to  arouse  the  champion  of  animal  rights,  and  a 
correspondence  was  at  once  commenced.  The  show- 
man was  not  backward  in  his  reply,  and  proved,  as 
any  one  couW  easily  do  who  was  acquainted  with 
natural  history,  that  it  was  necessary  to  feed  these  rep- 
tiles in  the  way  he  did.  Not  wishing  to  rely  upon  his 
own  opinion  he  solicited  that  of  the  distinguished  savant, 
Agassiz,  who  gives  the  following  amusing  and  sugges- 
tive reply :  "  I  do  not  know  of  any  way  to  induce 
snakes  to  eat  their  food  otherwise  than  in  their  natural 
manner;  that  is,  alive.  Your  museum  is  intended  to 
show  to  the  public  the  animab  as  neariy  as  possible  in 
their  natural  state.  The  society  of  which  you  speak  is, 
I  understand,  for  the  prevention  of  %mnece89ary  cruelty 
to  animals  It  is  a  most  praiseworthy  object,  but  I 'do 
not  think  the  most  active  member  of  the  society  would 
object  to  eating  lobster  salad  because  the  lobster  was 
boiled  alive,  or  refuse  roasted  it^ters  because  th^ 
digitized  by  VJ iJ Ok  ^_ 


THE  MEDICAL  RECORD. 


SI 


were  cooked  alive,  or  raw  oysters  beoaase  they  must 
be  swallowed  alive."  If  dmtlar  senseless  exhibitions  on 
the  part  of  the  attacking  party  are  made,  the  pabh'c  will 
eventually  look  upon  the  society  in  the  same  way  as 
the  profeesion  have  been  led  to  do,  and  much  distrust 
will  be  engendered  as  to  any  of  the  real  benefits  which 
mi^t  grow  out  of  a  proper  direction  to  its  efforts. 

Wi  are  glad  to  notice  that  the  enormity  of  the  crime 
of  abortion  is  beginning  to  attract  the  attention  of  those 
laymen  whose  opinions  upon  moral  and  religious  ques- 
tions command  the  respect  of  the  oommnnity.  The 
NhrA-  Western  Christian  AdvocatOj  of  Chicago,  in  a  well 
written,  elaborate,  and  truthful  article,  fearlessly  com- 
mences the  discussion  of  this  subject  This  is  the  first 
iaitance  in  our  knowledge  in  which  a  religious  paper 
hts  dared  to  give  the  theme  a  fanr  and  fiiU  notice,  and 
it  it  to  be  hoped  that  the  community  to  whom  the  re- 
marks are  addressed,  may  receive  them  in  the  same  spi- 
ni  in  which  Uiey  are  given.  The  example  of  this  peri- 
odical should  be  followed  by  others,  as  by  the  proper 
presentation  of  the  ample  facts  in  the  case  it  will  un- 
doubtedly be  productive  of  great  good. 


Vitmmsi. 


Thi  iNDiassnoNS ;  or  Diseases  of  the  Digestive  Oroans 
ruvonoNALLT  TREATED.  By  Thomas  Kino  Chambers, 
M.D.,  Honorary  Phyiician  to  H.R.H.  the  Prince  of  Wales; 
CoQsuItiog  Physidan  and  Lecturer  on  the  Practice  of  Me- 
dicine at  St.  Mary's  Hospital ;  Oonsultiog  Physician  to  the 
Lock  HoBpital;  Author  of  "Lectures,  chiefly  Clinical," 
etc  London :  John  Churchill  t  Sons,  New  Burlington 
street     1867.    8va,  pp.  290. 

The  work  before  us,  coming  as  it  does  from  the  pen  of 
one  of  the  most  accomplished  authors  of  Great  Britain, 
ctnnot  fail  to  be  received  with  favor  on  this  side  of  the 
Atlantic.  Any  one  who  has  read  Dr.  Chambers's  "Re- 
newal of  Life,"  will  be  prepared  to  learn  that  his  remarks 
OQ  indigestions  are  thor^hly  practical,  and  full  of  most 
valuable  suggestions.  We  have  presented  to  us.  first, 
an  introduction,  in  which  the  importance  of  attention  to 
the  various  phenomena  connected  with  defective  diges- 
tion is  urged;  and  then  follows  the  regular  discussion  of 
the  subjects  under  the  following  heads:  1.  Indigestion 
of  various  foods  •  2.  Habits  of  social  life  leaSng  to 
indigestion  j  3.  Abdominal  pains ;  4.  Vomiting ;  6. 
Vlatelence ;  6.  Diarrhoea ;  7.  Constipation  and  costive- 
neas :  8.  Nervous  diseases,  connected  with  indigestion  ; 
and  lastly,  an  analysis  of  the  whole  work.  The  work 
is  made  np  principally  of  a  detail  of  well  selected  and 
tjrpical  cases,  to  each  one  of  which  are  added  comments 
I«rely  clinical  in  character.  The  cases  cover  every  con- 
mrMe  grade  of  functional  indigestion,  ^m  the  slight- 
est inconyenience  after  meals  to  that  condition  whic^ 
actually  ends  the  life  of  the  patient  Every  useful 
detail  is  faithfuDy  figured,  in  order  to  carry  out  the 
•vident  desic^  of  the  writer  in  making  the  work  as 
eompiete  and  as  thorough  as  possible.  No  practitioner 
osa  peruse  it  without  benefit,  nay,  without  comfort,  for 
he  cannot  fail  to  find  some  of  his  most  puzzling  cases  of 
indigesUon  explained  in  a  clear,  practical,  and  masterly 
laanoer.  The  different  plans  of  treatment  are  rational, 
iiinple,  and  effective,  and  the  reader  is  all  the  time 
made  conscious  that  they  are  founded  upon  clinical 


experience  alone.  Associate  with  this  the  rare  faculty 
which  Dr.  Chambers  has  of  infusine  an  enthusiasm  in 
his  subject^  and  we  have  in  this  little  work  all  the  ele- 
ments which  make  it  a  model  of  its  sort.  We  have 
perused  it  carefiiUy ;  have  studied  every  page ;  our 
interest  in  the  subject  has  been  intensified  as  we  pro- 
ceeded, and  we  are  enabled  to  lay  it  down  with  unqua- 
lified praise.  It  is  just  such  a  work  as  every  practi- 
tioner should  have,  if  he  wishes  to  treat  inteUigently 
the  majority  of  the  patients  who  seek  his  advice.  If 
the  book  does  not  prove  a  great  success,  and  pass 
through  several  editions,  it  will  be  because  the  profes- 
sion do  not  appreciate  nne  writing,  sound  philosophy, 
and  sterling  common  sense.  The  work  is  got  up  in  the 
usual  elegant  style  of  the  London  House  fix>m  which  it 
emanates. 

An  American  reprint  of  this  work  has  been  issued 
by  H.  0.  Lea,  of  Philadelphia. 

The  Renewal  of  Life.     Lectures,  chiefly  Clinical.     By 
Thomas  Kuro  Ohakbebs,  M.D.,  Honorary  Phjsioian  to 
H.  R.  H.  the  Prince  of  Wales ;  Goosulting  Physician  and 
Lecturer  on  the  Practice  of  Medicine,  at  8t  Mary's  Hospi- 
tal; Oonsolting  Physician  to  the  Look  Hospital.     Second 
Amerioan,  from  fburth  London  edition.  Philad^phia:  Lindr 
say  k  Blakiiton.    1866.    Svo^  VP-  ^^' 
The  title  of  this  work  is  suggestive  of  its  contents.    The 
author  starts  with  the  assumption  that  disease  is  the 
result  of  defective  vitiJ  action,  and  that  the  business  of 
the  physician  in  treating  it  is  to  renew  that  action.   The 
first  chapter,  which  is  a  condensation  of  two  introduc- 
tory lectures  delivered  at  St.  Mary's  Hospital,  on  the 
Relations  of  Death  and  Life,  lays  an  excellent  founda- 
tion for  the  treatment  of  the  difierent  diseases  touched 
upon  in  the  rest  of  the  work.    The  author  likens  the 
human  body  to  a  stately  mansion,  the  different  parts  of 
which  are  constantly  undergoing  a  decay,  with  greater 
or  less  rapidity.    In  order  to  keep  this  beautiful  edifice 
in  repair,  the  wasted  materials  must  be  regularly  and 
persistently  supplied.    This  power  is  known  as  health; 
a  want  of  it,  disease;  and  a  total  cessation  of  it,  death. 
Life,  then,  rests  upon  the  power  to  renew  the  materials 
of  tne  body. 

In  speaking  of  disease  and  the  importance  of  associ- 
ating it  in  the  mind  of  the  physician  with  defective 
vital  action,  he  says :  "  He  must  look  at  his  pharmar 
copceia  with  this  thou^t  constantly  present  before  him^ 
with  an  eye  to  the  ultimate  benefit  of  the  patient  to  a 
goal  beyond  that  of  the  immediate  effects.  He  should 
make  his  chief  thought  how  each  of  the  re-agents  em- 
ployed will  finally  touch  life ;  whether  they  are  calcu* 
lated  to  add  to  or  diminish  the  vital  functions,  to  add  to 
or  diminish  the  vitalized  substance  of  which  nis  patient 
is  made ;  whether  by  temporarily  diminishing  the  fiinc- 
tions  or  substance  he  may  not  remove  an  impediment 
to  their  balanced  actions,  so  as  to  lead  to  a  final  increase, 
or  whether  this  artificial  diminution  of  fbnctions  or  sub- 
stance may  not  become  more  permanent,  and  inflict 
permanent  injury  on  his  patient  '  The  final  goal  of  life- 
renewal  must  be  consciously  or  unconscioudy  in  the 
heart  of  the  physician  or  in  the  heart  of  his  guides, 
otherwise  I  am  sure  that  he  contribntes  more  to  the  ill 
health  than  to  the  good  health  of  mankind." 

This  belief  of  the  author  is  the  result  of  logical  deduc- 
tions from  an  extensive  clinical  experience,  as  will  be 
seen  by  a  carefid  perusal  of  the  diflbrent  diseases  whidi 
are  treated  of.     The  remarks  upon  his  cases  are  so 

Practical,  his  associations  of  cause  and  effect  so  minute, 
is  plans  of  treatment  so  simple,  the  descriptions  so  gra- 
phic, and  style  so  attractive,  that  the  reader  is  only 
made  to  regret  that  the  range  of  subjects  is  not  wider, 
and  that  the  work  is  not  a  complete  treatise  on  the 


88 


THE  MEDICAL  RECORD. 


practice  of  mediciae.  We  cannot  too  strongly  advise 
every  medical  man  who  wishes  to  acanaint  himself 
more  thoroughly  with  that  system  of  therapeutics 
founded  on  the  soundest  philosophy,  to  possess  the  book^ 
to  study  it  carefhlly,  and  follow  its  precepts  faithfully. 
We  know  of  no  production  which  will  have  a  greater 
tendency  to  place  rational  medicine  upon  that  elevated 
position  which  it  is  so  justly  entitled  to. 

Vitpovts  0f  0ocittie0«x 


NEW  YORK  PATHOLOGICAL  SOCIETY. 

Stated  MEETiNa,  Jan.  23,  1867. 

Dr.  H.  B.  Sands,  Prbsidbnt,  in  the  chair. 

0ARIB9  AT  THE  8ACRO-ILIA0  JUNCTION. 

Db.  F.  H.  Hamilton  presented  a  specimen  of  caries  at 
the  Sacro-Hiac  Junction,  with  the  foUowiDgaccount  of 
the  case,  furnished  by  his  house-surgeon,  Dr.  D.  M.  Cory. 

Catdiarine  Bradford,  8Bt  thirty-four,  a  native  of  Ire- 
land, was  admitted  to  Bellevue  Hospital,  November  26, 
1866.  She  had  enjoyed  uninterrupted  health  up  to  the 
commencement  of  the  illness  from  which  she  died.  As 
fkt  as  could  be  learned  she  inherited  no  disease ;  nor 
could  she  recollect  of  ever  having  sustained  a  severe 
injury  of  any  kind. 

In  June  last  she  began  to  experience  pain  across  the 
loins,  especiallv  when  stooping,  accompanied  with 
lameness  in  walking.  The  pain  was  increased  by  efforts 
to  turn  in  bed,  or  by  lying  upon  the  affected  side. 
These  symptoms  became  ag^avated,  and  she  at  len^ 
noticed  a  swellinff  in  the  right  lumbar  region,  which 
gradually  increased  in  size  to  the  date  of  her  admission. 
When  examined  at  this  time  it  was  large  and  fluctuat- 
ing, and  very  near  the  surface.  There  were  no  abnor- 
mal projections  along  the  course  of  the  spine,  nor  was 
there  tenderness,  except  over  the  last  lumbar  vertebra 
and  the  ri^ht  sacro-ihac  junction.  She  walked  with 
very  little  difficulty ;  the  liltle  pain  which  it  occasioned 
being  referred  to  the  sacrum;  when  she  stood  she 
leaned  upon  the  sound  limb,  and  kept  the  knee  of  the 
affected  side  sli|;htly  bent  and  abducted.  A  small  open- 
ing was  immediately  made  into  the  abscess,  and  its  con- 
tents (dark  and  unhealthy  pus)  evacuated.  By  the 
probe  a  sinus,  pursuing  a  very  tortuous  course,  was  dis- 
covered, leading  apparently  towards  the  vertebral 
column,  but  its  precise  origin  could  not  be  reached.  She 
felt  relieved  afler  the  abscess  was  opened,  and  in  a  few 
days  was  allowed  to  get  up  and  walk  about  the  ward. 
In  a  short  time  the  discharge  began  to  increase,  and 
symptoms  of  oonsecutive  fever  beoime  ai^>arent  The 
pain,  from  which  she  had  been  relieved  for  a  short  time, 
returned,  particularly  in  the  course  of  the  sciatic  nerve 
and  over  the  sacro-iliac  junction.  She  could  not  lie 
upon,  the  right  side,  but  was  ^uite  comfortable  upon  her 
back,  with  her  limbs  in  a  straight  position.  An  attempt 
was  made  carefully  to  dilate  the  sinus,  by  means  of  a 
tent  made  from  sl^pery-elm  bark,  but  owing  to  the 
irritation  which  it  produced  it  was  discontinued.  On 
the  second  of  January  she  had  a  chill,  followed  by  a 
cold  sweat;  her  stomach  became  very  irritable.  The 
disduu^  from  the  sinus  diminished ;  chUs,  succeeded 
by  cold  sweats,  occurred  daily ;  and  llie  general  symp- 
toms of  systemic  infection  became  fully  established,  in 
a  few  days  her  right  leg  became  oedematouA,  exquisitely 
tender,  and  at  certain  points  emphysematous.  £fiusion 
ocouned  into  the  knee-joint,  ana  the  integument  around 
this  joint  had  a  dusky  hue,  which  soon  changed  into 


a  marked  gangrenous  appearance.  The  patient  now 
became  delirious,  and  in  that  condition  died,  January 
11,  1867. 

8B0TI0  CADAVERIS,   EIGHTEEN  HOURS  AFTER  DEATH. 

Riffor  mortis  well  marked ;  right  leg  swollen  to 
double  its  size,  and  gangrenous. 

Brain  not  examined ;  heart  and  lungs  healthy.  Ab- 
domen.— The  liver  was  fatty,  and  the  seat  of  recent 
peri-hepatitis.    This  lesion  was  present    aI{^>   in  the 

?>leen.  The  kidneys  were  fattjr,  weighing  nine  ouncea 
he  sinus,  which  had  opened  in  the  right  lumbar  re- 
gi.^n,  was  traced  backwards,  and  was  found  to  pass 
Uirou^h  the  quadratus  lumborum  just  above  the  crest  of 
the  ihum,  and  to  lead  to  a  large  abscess  posterior  to  the 
lumbar  vertebra.  A  pouch  communicating  with  this  ab- 
scess had  dissected  underneath  the  fascia  of  the  gluteus 
maximus  muscle,  and  was  connected  to  the  later  by  a 
sinus  which  pasised  over  the  crest  of  the  ilium.  In 
front  of  the  vertebras  there  was  an  abscess  behind  the 
psoas  muscle,  and  within  its  sheath,  which  communicated 
directly  with  the  sacro-iliac  junction ;  the  abscess  ex- 
tending downwards  along  the  psoas  muscle  to  its  inser- 
tion. There  was  slight  superficial  roughness  of  the 
right  transverse  process  of  the  fourth  lumbar  vertebra, 
at  which  point  £ree  communication  was  established  be- 
tween the  lumbar  and  psoas  abscesses.  The  anterior 
portions  of  the  bodies  of  the  last  two  lumbar  and  two  up- 
per sacral  vertebrae  were  rougliened,  and  the  periosteum 
and  anterior  ligament  were  separated  from  them  by  a 
small  collection  of  pus.  The  sacro-iliac  junction  was 
extensively  diseased.  The  joint  was  loosened,  con- 
tained pus  and  sequestra.  Another  opening  was  found, 
and  near  the  bottom  of  the  sacro-iliac  junction,  at  the 
upper  margin  of  the  ischiatic  notch.  The  bony  waUs 
of  the  first,  second,  and  third  sacral  foramina  of  the  right 
side,  were  roughened  and  partially  destroyed.  The 
lower  lumbar  and  upper  sacral  nerves  of  right  side 
were  compreJ»8ed  by  the  thickening  of  tissues,  and 
the  pressure  of  pus  around  them.  The  psoas  abscess, 
in  its  passage  underneath  Poupart's  ligament,  ran 
alonff  the  course  of  the  vessels,  between  the  tendons 
of  the  psoas  and  iliacus  internus  muscles.  Nothing 
abnormu  was  found  in  the  interior  of  the  vessels  of  the 
thigh,  but  there  was  considerable  inflammation  around 
them,  uniting  them  together.  The  cellular  tissue  of  the 
thigh  was  infiltrated  by  purulent  matter,  and  some  gaf 
escaped  on  cutting. 

Dr.  Hamilt  n  further  remarked — 

The  following  conclusions  may  be  drawn  from  the 
case; — 

1.  Disease  of  the  sacro-iliac  junction  may  occur  in  i 
healthy  person  without  being  traceable  to  any  special 
iiyury. 

2.  The  disease  may  make  pretty  extensive  progrert 
without  materially  affecting  the  general  system,  and 
without  causing  much,  if  any,  lameness,  or  distortion 
of  the  limb. 

3.  The  abscess  consequent  upon  the  caries  mav  fol- 
low the  course  of  the  psoas  magnu&  entering  the  fi^^ 
posteriorly  where  the  &scia  is  weaK,  and  present  itself 
upon  the  front  or  inside  of  the  thigh;  it  may  penetrate 
the  quadratus  lumborum,  and  passing  outside  of  the 
sacro-lurabalis  and  latiss:mus  dorsi,  open  upon  the  back 
just  above  the  crest  of  the  ilium,  or  it  may  dissect  op 
the  periosteum  and  fasciae,  and  present  itself  at  the 
sacro-sciatic  notch,  in  the  rectum,  in  the  vagina,  or  any- 
where in  the  perineal  region,  but  especially  near  the 
point  of  the  sacrum. 

4.  By  descending  between  the  sheath  of  the  psoas 
muscle  and  the  muscle  itself,  and  thus  not  involring 
the  substance  of  the  muscle,  it  may  not  cause  pain  wbee 


THE  MEDICAL  RfiSCOSI>. 


89 


the  thigh  is  straightened  upoa  the  body,  or  give  rise  to 
•Dj  other  symptom  indicating  the  presence  of  the  ab- 
scess in  the  vicinity  of  the  psoas  muscle.  And,  in- 
asmuch as  an  abscess,  arising  from  caries  of  any  of 
those  Tertebre  from  which  the  psoas  muscle  has  its 
oriein,  ahnost  uniformly  diyides  the  head  of  the  muscle, 
and  thus  penetrates  iato  its  substance,  sometimes  de- 
stroying it  80  completely  that  nothing  but  the  sheath 
remaios ;  therefore  it  may  be  proper  to  coudude,  that 
ia  the  case  of  a  well  recognised  psoas  abscess,  the  ability 
of  the  patient  to  straighten  the  thigh  before  the  body 
without  pain  or  inconrenience,  mignt  be  regarded  as 
poiatin^  to  its  origin  in  its  last  lumbar  yertebra,  or  the 
sacro-ihac  junction ;  and  that  this  circumstance  might 
sometimes  be  employed  as  a  means  of  diagnosis  between 
a  psoas  abscess,  arising  from  caries  of  the  last  dorsal,  and 
from  the  upper  lumbar  vertebra  on  the  one  hand,  and  a 
pjoasabeo^  arising  from  caries  of  the  last  lumbar  ver- 
tabra,  or  caries  at  the  sacro-iliac  junction,  on  the  other 
hand. 

Unfortonately  it  does  not  appear  that  any  practical 
deductions  as  to  the  treatment  can  be  drawn  from  this 
case;  unless  it  be  that,  inasmuch  as  the  9y mptoms  be- 
came rapidly  more  serious  afler  it  was  opened,  life 
might  have  been  prolonged  by  having  kept  it  closed. 
It  is  possible,  also,  that  if  the  diagnosis  had  been  made 
early,  by  rest  in  the  recumbent  posture,  and  other  appro- 
priate remedies,  the  disease  mi^ht  have  been  arrested. 

The  rapid  swelling,  the  pam,  and  the  death  of 
the  right  limb  may  be  ascribed  to  pressure  upon  the 
SMTal  nerves  by  the  abscess  at  their  roots ;  by  in- 
flsBunation,  extending  from  the  abscess  connected  with 
the  psoas  moacle  to  the  neighboring  absorbentSL  veins, 
and  arteries,  to  thrombosis,  or  to  septicaemia.  One,  or 
all,  of  these  several  causes  must  have  operated* 

MEDICAL  SOCIETY  OF  THE   COUNTY  OF 
NEW  YORK. 

Stated  Mbetiiio,  March  4,  1867. 

Thu  Saxuel  T.  Hubbard,  President,  in  the  Chair. 

Thi  President  announced  that  it  had  been  voted  to 
grant  certificates  of  membership  to  Drs.  Watts,  Oady 
Lifingston,  Gerardus  H.  Wynkoop,  F.  Munsoo  Cone, 
Alonxo  J.  Cassidy.  Max  Herzog,  Albert  0.  Treat,  and 
^ohn  Sidney  Warren. 

DISEASES  or  THB  MONTH. 

Dr.  Dunstsb,  of  the  Committee  on  Diseases,  report- 
ed that  the  total  mortality,  1,719,  of  the  four  weeks 
preceding  February  23d,  was  somewhat  less  than  that  of 
tberaonUi  previous,  and  than  that  of  the  corresponding 
period  of  last  year.  Zymotic  diseases  accounted  for 
about  one-fifth  of  the  deaths ;  and  under  this  head  was 
Boted  a  slight  decUne  in  the  iatality  from  scarlatina, 
tTpbut,  and  typhoid,  with  an  increase  in  that  from  di- 
arrbosal  diseases;  whooping-cough  and  measles  had 
bean  very  prevalent.  Under  respiratory  diseasesu 
pnemuonia  aione  was  charged  with  149  deaths,  and 
bronchitis  with  67,  thooffh  this  showed  little  change 
from  the  preceding  month.  Children  had  suffered  ae- 
yerdy,  one-fourth  of  the  whole  mortality  belonging  to 
inSnts  under  one  year,  and  nearly  one-Kalf  to  children 
v&der  five.  A  remarkable  immunity  attached  to  the 
ages  from  five  years  to  twenty.  Genuine  typhus  had 
appeared,  during  the  month,  in  several  distinct  and  even 
widdy  separated  localities ;  but  it  was  believed  to  be 
tiacetble,  in  every  case,  either  to  recently  arrived  immi- 
piats  or  to  their  associates  at  the  benevolent  lodging- 
aoQasB  where  they  find  shelter.  A  very  mild  form  of 
typhoid  had  been,  for  some  time  past,  prevailing  along 


the  western  shore  of  the  city,  only  two  cases  out  of 
fifty-six  resulting  fatally.  During  December  last  there 
occurred  an  outbreak  of  this  fever  at  the  Deaf  and 
Dumb  Institution.  The  inmates  were  dispersed  to  their 
homes,  and  the  disease  proved  thereafler  quite  tractable, 
none  of  the  numerous  patients  succumbing  to  it  The 
Institution  was  closed,  and  thoroughlv  renovated  at  an 
expense  of  some  $20,000 ;  yet  upon  its  re-opening,  the 
first  of  February,  the  fever  reappeared.  It  is  said  that 
the  mattresses  upon  which  the  fever-patients  had  slept^ 
were  not  disinfected  except  by  exposure  to  the  air,  and 
also  that  the  privies  were  left  uncleansed.  These  state- 
ments, if  correct^  may  account  for  what  would  other- 
wise seem  an  extraordinary  tenacity  of  the  fever-poison 
in  clinging  to  its  old  haunts. 

The  President  announced  the  death,  since  the  last 
meeting,  of  Dr.  Wm.  E.  Stillwell,  a  member  of  the  So- 
ciety. 

cholera:  is  it  oontaoious? 

Dr.  Wm.  C.  Roberts  read  an  elaborate  paper  upon 
^^  The  Contagiou:<ness  of  Cholera  shown  from  its  Analo- 
gy to  other  Epidemics  and  the  Laws  of  Specific  Poi- 
sons." The  essay,  which  occupied  about  an  hour  and 
a  half  in  delivery^,  reviewed  the  whole  subject  of  the  com- 
municability  of'^  disease,  the  writer  fortifying  his  posi- 
tions by  extracts  from  numerous  authorities,  and  the 
citation  of  a  number  of  cases.  Any  abstract  must  fail 
to  give  an  adequate  idea  of  the  paper ;  but  we  subjoin 
the  chief  points  of  the  argument,  as  far  as  possible  in 
its  own  words. 

Specific  morbid  poisons,  while  exhibiting  individual 
differences  in  their  mode  of  action  and  of  propagation, 
which  determine  their  specific  character,  are  yetgeneri- 
cally  allied.  All  epidemic  diseases  are  due  to  such  poi- 
sons, and  show  a  similar  generic  likeness,  the  morbific 
principle  being  in  general  reproducible  in  the  bodies  of 
the  sick,  and  so  becoming  animal,  zymotic,  and  conta* 
gious.  Every  specific  zymotic  epidemic  is  necessarily 
contagious. .  Cholera  is  clearly  a  specific  epidemic,  and 
we  have,  then,  only  to  show  it  symotic  in  order  to 
prove  its  contagiousness ;  and  this  whether  the  zymosis 
be  intra-corporeal  or  extra -corporeal  (perhaps  intra- 
aerial).  For  though  we  ma^  be  constrained  to  admit 
some  meteoratious  epidemic  mfiuence  to  account  for  its 
rapid  diffusion,  vet  this  influence  must  depend  for  its 
activity  upon  the  ^)edfic  germ,  which,  whatever  its 
genesis  and  its  means  of  subsequent  reproduction  and 
xx>nvection,  is  still  the  essential  element  of  contagion* 
Now  that  cholera  is  zymotic  we  may  infer  from  its 
analogy  to  other  diseases  universally  recognised  as  con- 
tagious zymotici.  If  typhus  and  small-pox  are  zymo- 
tic, how  much  more  must  this  be,  which  surpasses  item. 
as  it  does  all  other  epidemics,  as  well  in  the  swiftness  of 
its  march  as  in  the  violence  of  its  sttack,  and  our  pow-^ 
erlessness  to  cope  with  it. 

As  to  the  mode  of  elimination  of  the  poison,  it  is  proba- 
ble that,  as  in  typhus,  it  is  excreted  most  abundantly 
by  the  gastro-intestinal  mucous  membrane;  so  that 
fomites  soiled  with  the  idvine  dischar^  are  especially 
liable  to  conmiunicate  the  disease;  while  the  ^rras  from 
the  desiccated  dejections  may  be  suspended  in  the  at- 
mosphere, rendering  it  infection?,  fiut  we  cannot  al* 
low  that  this  is  the  only  mode  of  elimination,  nor  that 
iufeoUon  may  not  find  its  way  throfigh  other  channels 
Facts  do  not  bear  out  the  conclusion  that  cholera  is  not 
communicable  even  by  contact  between  individuals. 

It  is  possible  that  the  diolera-poison  may  even  now 
be,  at  times,  produced  de  novo^  as  that  of  typhus  is  be- 
lieved to  originate  from  ochletic  miasm.  But  more 
probably  both  these  and  other  specific  diseases  are,  in 
the  cases  of  apparently  spontaneous  origfai  4?^®^^^_ 


90 


THE  MEDICAL  RECORD. 


from  their  proper  virus,  long  dormant,  but  suddenly 
brought  to  bght  and  aroused  to  activity  by  fovoring  con- 
ditions. 
Voted  that  the  paper  of  Dr.  Roberts  be  accepted. 
pRorissoR  Flint,  in  rising  to  discuss  the  subject, 
said,  that  owing  to  the  lateness  of  the  hour,  he  should 
speak  briefly  and  only  upon  important  points.  He 
snould  use  the  term  "contagion"  in  its  broad  and 
popular  sense,  to  denote  the  communication  of  a  dis- 
ease by  a  morbid  product,  either  palpable  or  impalpable, 
Eroduced  within  tne  body,  though  it  would  be  well  to 
mit  the  term  to  communication  by  a  palpable  virus, 
reserving  "  infection"  for  that  by  a  poison  which  eludes 
the  senses.  The  term  "  portable,"  for  whidi  we  are  in- 
debted to  the  late  Professor  Mitchell  of  Philadelphia^ 
had  always  seemed  to  him  very  good  and  convenient  to 
express  a  cause  that  may  be  transported  by  '^  fomites," 
using  this  word  as  applicable  not  idone  to  clothing,  but 
to  anything  which  may  carry  the  poison. 

In  considering  a  question  of  this  character,  we  must 
be  careful  to  free  ourselves  from  the  influence  of  the 
views  that  may  chance  to  be  at  the  time  prevailing.  The 
popularity  of  a  theory,  even  wiUiin  the  profession,  is 
very  fluctuating,  and  can  frmaish  no  ground  for  an  opi- 
nion. For  instance,  in  the  epidemic  of  186^,  very  few 
believed  cholera  contagious,  while  now  a  considerable 
number  seem  to  hold  it  such. 

He  did  not  feel  like  accepting  the  argument  of  the 
paper  just  read  by  the  distinguished  gentleman,  that, 
oecause  cholera  is  specific  and  epidemic  and  zymotic, 
therefore  it  is  contagious.  Influenza,  and  various  other 
symotic  affections,  with  those  endemic  and  zymotic, 
Uke  yellow  fever  or  cerebro-spinal  meningitis,  would 
hardly  be  considered  contagious.  Nor  must  we  judge 
of  the  contagiousness  of  this,  or  of  any  disease,  from 
special  isoUted  facts,  such  as  had  been  cited.  As  in 
theology  it  is  easy  to  prove  any  dogma  by  isolated 
texts  of  Scripture,  so  in  medicine  rme  may  easily  find 
facts  upon  either  side  of  a  question  in  dispute.  The 
recent  report  of  the  Registrar  of  Vital  Statistics,  would 
ftimish  an  apt  iQustration.  The  fburth  of  the  early 
oases  of  the  epidemic  of  last  season  is  recorded  {Report 
ofAieCropolUanBoardo/HeaHhfDr  1866,  p.  169),  as  that 
ci  **  the  fearless  and  strong  woman  who  washed  the 
soiled  dothing  and  bedding  of  her  brother-in-law ''  and 
the  impression  is  left  that,  in  the  opinion  of  the  Regis- 
trar, this  was  the  cause  of  her  attack.  Now  turn  to 
page  271  of  the  same  report,  where,  in  the  paper  of  Dr. 
I  ale,  we  have  an  account  of  the  number  of  cases' 
which  occurred  amongafl  who  were  engaged  in  wash- 
ing the  clothing  upon^Iackwell's  Island.    He  says: 

"At  the  asylum  were  employed  about  twenty  washer- 
women ;  of  these  one  bad  cholera^  This  is  only  five  per  cent., 
or  a  coDsiderably  smaller  percentage  than  among  those  not 
so  employed.  At  the  work-bouse  twelve  washerwomen 
died,  their  places  beino;  supplied  by  others ;  the  total  number 
being  thirty-four.  This  proportion  ^35  per  cent.)  is  some< 
what  heavier  than  among  those  who  did  not  wash.  At  the 
Aknshouse  the  precise  number  of  washerwomen  attacked  is 
not  stated,  but  the  washing  is  chiefly  done  by  the  nursery 
women  firom  the  wards  45,  46,  47,  and  48,  which  have  been 
already  mentioned  as  having  but  four  cases  in  all,  which  is 
certainly  below  the  averaga  At  the  PenitentUuy  I  neglect- 
ed to  inquire  upon  the  point  At  Charity  fioq»tal  no 
washerwoman  was  sdized.  The  amount  of  danger  from  in- 
(ected  articles  would,  in  ell  probability,  be  very  slight  where 
disinfectants  were  freely  used;  but  for  the  first  few  days  of 
the  epidemic  this  matter  was,  in  the  main,  overlooked,  and 
fall  play  was  then  allowed  for  the  action  of  any  infectious 
material" 

Dr.  P.  had  been  in  hospital  service  during  the  epi- 
demic of  1849,  and  could  say  positively  that  at  the  in- 


stitutions with  which  he  was  connected,  none  of  those 
engaged  in  washing  the  clothing  of  cholera  patients 
were  attacked  by  the  disease.  , 

It  is  essential  to  setUe  the  principles  upon  which,  by 
means  of  aggregated  fitcts^  the  contagiousness  or  the 
non-contagiousness  of  a  disease  is  to  be  established. 
He  would  enumerate  a  few  of  the  most  important: 

A  contagious  disease  extends  fit>m  the  localities 
where  it  becomes  established,  through  the  proximate 
localitiee ;  and  though  it  may  graduaify  extend  to  those 
more  or  less  distant,  yet,  in  a  certain  proportion  of  these 
instances,  it  should  be  practicable  to  trace  the  conta- 
gion. This  is  certainly  true  of  most  of  those  diseases 
universally  considered  contagious,  as  typhus  and  scarla- 
tina. How  with  regard  to  cholera?  Upon  this  point 
the  earliest  cases  in  an  epidemic  are  of  the  greatest 
value.  Referring  again  to  the  Registrar's  Report  (Op. 
city  pp.  167-171),  we  find  the  history  of  the  first  nine 
cases  of  the  late  epidemic  in  this  district,  with  dates 
and  residences  as  follows : 

April  30.  Wonum,  Ninety-third  street  and  Third 
avenue,  died  next  day. 

May  2.    Woman,  116  Mulberry  street,  recovered. 

June  3.    Man,  303  Broome  street,  died  next  day. 

June  6.    Woman,  same  place,  died  same  day. 

June  9.  Woman,  West  Twentieth  street,  fully  two 
miles  fi^m  an  v  of  the  preceding. 

June  9.    Man,  Hester  street^  laboring  at  East  River. 

June  11  Woman,  W.  Thirty-fourth  street,  between 
Fifth  and  Sixth  avenues,  had  been  visiting  near  Pitt 
and  Willett  streets,  died  13th. 

June  13th.    Man,  61  Cherry  street,  died  same  day. 

Same  date,  man  arriving  from  Troy,  breakfasting 
near  Greenwich  and  Liberty  streets,  and  visiting  in 
Waverley  Place,  died  same  day. 

These  places  are  certainly  sufficiently  remote  from 
each  other,  and  from  any  probable  common  source  of 
contagion.  Were  this  wide  separation  of  the  early 
cases  characteristic  only  of  the  last  epidemic,  it  would 
be  less  noteworthy;  but  it  is  unquestionably  true  of 
the  majority  of  epidemics.  The  speaker  had  had  occa- 
sion in  1849  to  trace  the  history  of  the  epidemic  at 
Bufialo,  N.  Y.,  where  he  there  found  the  first  cases 
occurring  almost  simultaneously  in  localities  so  far  apart 
that  it  would  have  been  impossible  to  admit  any  con- 
nexion between  them.  So  fiur  then  as  this  ground  is 
concerned,  we  find  no  evidence  of  the  contagiousness 
of  cholera. 

A  secondamportant  ground  of  decision  is  to  be  found 
in  the  number  of  persons  who,  coming  firom  an  infect- 
ed district  to  a  healthy  one,  are  there  attacked  and 
become  foci  of  infection.  Now  it  is  doubtless  possible 
to  collect  a  number  of  strong  instances  that  seem  to 
sustain  the  doctrine  of  contagiousness.  But  such  cases 
are  very  few  as  compared  with  tiie  great  number 
where,  under  like  conditions,  no  such  result  follows. 
It  is  true,  this  may  be  called  negative  evidence ;  but 
then  it  is  possible  for  a  vast  amount  of  such  evidence 
to  outwe^  positive  evidence  of  doubtful  character. 
For  the  cases  relied  upon  by  the  contagionists  are  per- 
haps all  capable  of  explanation  by  the  theory  of  the 
portability  of  the  special  cause,  without  admitting  its 
production  in  the  human  body. 

Again :  Of  those  brought  into  personal  contact  with 
the  patients,  is  a  larger  proportion  attacked  than  of 
those  not  so  exposed  ?  This  Dr.  F.  deemed  one  of  the 
stron^st  points ;  and  he  believed  he  was  perfectiy  cor- 
rect m  saying  that,  taking  a  large  collection  of  in- 
stances, a  greater  proportion  of  those  brought  into  con- 
tact with  the  cholera  patients  escape  the  disease,  than 
those  similarly  circumstanced  who  have  no  connexion 
with  such  patients.     ^^.^^^^^ „      ^_ 


THE  MEDICAL  RECORD. 


91 


Certain  points  connected  with  analogy  are  of  some 
moment  Contagious  diseases,  except  those  of  parasi- 
tic origin, — all  zymotic  contagious  diseases,  that  is, — 
grre,  as  a  rule,  immanity  from  a  second  attack ;  though 
this  is  also  the  case  with  some  diseases  not  contagious, 
like  yellow  fever.  If  cholera  were  contagious,  we 
diould,  then,  expect  this  immunity  as  the  law;  but 
it  appears  to  giye  us  no  such  protection.  Again,  con- 
tagious diseases  of  zymotic  character  cannot^  as  a  rule, 
be  arrested.  Probably  no  one  present  would  doubt 
that  we  do  have  the  means  of  arresting  cholera;  that  it 
may  be  prevented  by  very  simple  means  in  the  pre- 
mL>nitory  period ;  and  that  we  are  able  sometimes  to 
arrest  it  after  it  is  fully  developed.  Another  point 
would  be  barely  mentioned :  A  disease  properly  con- 
tagious is  not  limited  in  its  duration  in  a  given  place  by 
any  law.  It  continues  so  long  as  there  are  fresh  sub- 
jects for  it.  But  it  is  believed  we  all  know  the  case  is 
different  with  regard  to  cholera,  which  generally  con- 
^aes  three  or  four  months  and  then  disappears. 

In  closing,  Dr.  Flint  referred  again  to  the  Report  of 
the  Board  of  Health,  in  regard  to  Uie  prophylactic  mea- 
sares  employed  nnder  its  oirection.  ft  is  well  known 
that  disinfectants  were  used  more  fully  and  more 
promptly  during  the  last  epidemic  than  probably  ever 
before ;  and  the  facts  would  seem  to  show  that  by  their 
means  we  have  the  power  not  only  of  removing  the 
predisposing  causes  of  oholera,  but  even  of  destroying 
the  special  cause  itselt  This  must  not  be  construed 
into  an  admission  of  contagiousness ;  for  there  is  no  rea- 
son to  suppose  that  the  disinfectants  may  not  be  as  effi- 
cient against  poisons  not  derived  from  the  human  body 
48  against  those  which  adcnowledge  this  source.  If  it 
be  true  that  we  have  learned  bow  to  prevent  this  dis- 
ease, we  have  made  an  immense  advance. 

Db.  Mabx  Herzoo  insisted  that  the  question  was 
one  demanding  the  most  rigid  scientific  investigation, 
and  must  be  determined  by  reference  to  certain  great 
natural  facts  which  could  only  be  settled  by  experts. 
The  authority  of  such  ^naH  scientific  bodies  as  the 
lotematiooal  Commission  at  Constantinople  was  quite 
vaiuaUe :  while  the  highest  importance  attached  to  the 
labors  or  men  like  Pettenkofer  and  Drasche,  whom  he 
was  a^nished  not  to  have  heard  named  by  either  of 
the  gentlemen.  To  these  men,  indeed,  more  than  to 
any  one  dse,  are  we  indebted  for  everything  positively 
known  upon  the  subject  Considering  the  discoveries 
already  made,  he  had  no  doubt  that  within  our  own 
lifetime  we  should  have  the  miasm  made  sensible  to 
chemical  or  microscopic  observatioik  He  then  gave  an 
exposition  of  Pettenkofer*s  well  known  theory :  that 
for  the  production  of  cholera  the  first  requisite  is  the 
raeci&c  cholera  germ.  This  exists  most  abundantly, 
tboagh  perhaps  not  solely,  in  the  discharges  of  patients 
affected  either  with  cholera  or  with  choleraic  diarrhoea. 
These  discharges  are  harmless  until  they  have  under- 
gone a  certain  putrefactive  process,  and  again  after  this 
proeess  has  progressed  beyond  a  certain  limit — as  clear- 
ly proved  by  Thiersch's  experiments  upon  animals. 
The  second  requisite  for  the  disease  to  become  epide- 
mio,  is  a  favonng  condition  of  the  soil,  which  must  be 
porous,  and  subject  to  changes  of  level  in  the  subsoil 
water  (ground- water).  It  is  especially  after  the  sub- 
Bdeoce  of  this  water  that  the  (Hrganio  matter  left  be- 
hind  ij  in  the  {ooper  state  for  the  zymotic  reproduction 
of  the  poison.  And  here,  as  in  the  case  of  the  dis- 
ciiarges,  the  fermentation,  once  established,  runs  a 
definite  and  limited  course,  during  which  alone  are  the 
teBorio  emanations  noxious.  |  This  theory  was  based 
opOQ  very  extensive  observations  made  by  the  most 
competent  men  throughout  the  whole  continent  of  Eu- 
rope, except  in  France.    Dr.  H.  regretted  that  similar 


observations  had  not  been  made  hepe,  during  the  late 
epidemic,  particularly  in  regard  to  the  varying  level  of 
the  ground-water,  which  served  to  explain  so  many 
apparent  anomalies.  This  point  was  of  equal  interest 
in  epidemics  of  typhus.  He  exhibited  a  chart  showing 
the  relation  of  the  level  of  the  subsoil  water  to  the  {O'er 
valence  of  typhus,  in  a  given  locality,  for  fen  years, 
which  gave  results  strictly  accordant  with  the  above 
views.  He  was  happv  to  be  able  now  to  correct  tbe 
false  impression  that  these  fundamental  laws  had  found 
an  exception  in  a  certain  part  of  Austria;  and  the  puz- 
zling case  of  the  pilot  of  the  England  had  at  last  found 
a  smution  in  the  tact  that  his  boat  was  towed  near  the 
ship's  drain-pipe,  where  he  was  necessarily  exposed  to 
the  effluvia  ^om  the  decomposing  discharges.  Statis- 
tics of  15,000  or  16,000  cases  in  Gkrmany  showed  that 
cholera  does  not  twice  attack  the  same  person  dusing 
the  same  epidemic.  He  would  advise  a  man  who  had 
had  diarrhoea,  in  a  house  where  cholera  had  prevailed 
for  sixteen  or  eighteen  days,  not  to  remove :  as  in  that 
period  the  poison  loses  its  power.  For  lack  of  time  he 
would  not  read  the  paper  be  had  prepared,  but  he  had 
said  what  he  deemed  most  essentiaL 

Db.  Thoks  called  attention  to  the  fact  as  shown  by 
a  chart  prepared  for  another  purpose,  that  in  toe 
twelfth  wajtl,  where  the  cholera-hospitals  were  located, 
the  ratio  of  cholera-mortality  to  the  population  was 
nearly  as  great  as  in  the  fourth  and  sixth  wards,  where 
the  class  of  people  and  the  hygienic  oonditions  were 
esteemed  the  worst  The  cases  in  the  hospitals  theni- 
selves  were  properly  accredited  to  their  respective 
wards. 

Dr.  Alix.  H.  Stivsms  thought  the  discussion  mainly 
a  dispute  about  words.  It  does  not  follow,  because 
cholera  may  not  be  communicable  in  the  same  manner 
as  small-pox,  that  it  is  not  contagious.  As  well  deny 
the  contagiousness  of  syphilis,  because  we  do  not  cat<^ 
it  in  walking  the  wards.  Every  poison  has  its  own 
laws  of  oommunicabihty,  which  must  be  met,  for  it  to 
produce  in  any  case  its  specific  effects. 

The  President  announced  that  at  the  next  meeting 
Dr.  Fowler  would  read  a  paper  upon  a  subject  connect- 
ed with  cholera. 

By  courtesy  of  th^  Sodety,  Dr.  Hubbard,  of  IHinw, 
exhibited  a  truss  of  his  own  invention,  for  which  he 
claimed  several  points  of  superiority. 

The  meeting  then  adjourned. 

'  ^  •  ^1    

EAST  RIVER  MEDICAL  ASSOCIATION*  . 
Stated  Mketino,  March  5,  1867. 
Db.  v.  Morse,  President,  in  the  Chair. 
(Oonttdned  fkx>in  pag*  ST.) 
CERTAIN  POINTS  IN  THE  TREATMENT  OF  SCARLATINA. 

Dr.  Buttles  related  a  case  where  the  bisulphite  of 
soda  was  used  as  a  prophylactic  in  scarlatina,  and 
which,  in  the  main,  corroborated  the  testimony  give^ 
in  its  favor  by  Dr.  M.  L.  Smith. 

Dr.  Newman,  however,  regarded  its  effects  as  more 
than  uncertain. 

Dr.  Bctttlbs  urged  early  and  continued  greasing  dur- 
ing the  progress  of  the  disease,  as  a  very  essential  ele- 
ment in  its  treatment.  This  method  is  reputed  to  be 
much  relied  on  by  German  practitioners 

Db.  T.  Nichols  regarded  the  use  of  Dover's  powder 
as  admissible  when  great  jactitation  or  troublesome 
delirium  was  present,  the  only  oontra-indioation  being 
active  congestion  of  the  brain. 

Dr.  Thoms,  while  he  questioned  its  prophylactic 
properties,    was  disposed   to   pn>nounps>.  belladonna, 

Digitized  by  VjC  „       ^_ 


M 


THE  MEDICAL  RECORD. 


"Which  according  to  some  exerted  its  power  upon 
the  pneumogastric  nerve,  a  verj  ralaable  anodyne,  and 
one  not  to  be  ruthlessly  discarded  simply  because  it 
had  once  been  much  lauded  by  "  irregulars.*'  The  &ct 
of  its  having  been  overrated  shoald  not  prejudice  us 
agmnst  its  more  humble  claims. 

Ds.  M.  L.  Smfth  then  gave  the  history  of  two  cases 
of  extensive  abscess  on  the  anterior  and  lateral  sur- 
fisu^es  of  the  neck,  after  scarlatina. 

The  meeting  then  adjonmed. 
m  %  ^ 

PHILADELPHIA    COUNTY  MEDICAL 
SOCIETY. 

CoNVEBSATioNAL  Meetino,  March  13,  1867. 
Db.  Akdrew  Nbbinoer,  Pbesidert,  in  the  Chair. 

(Specially  Reported  for  the  Mcdioal  Bsoosd.) 
the   status  of  female  PRACTinONBRS  OF  MEDICINE. 

The  report  of  the  Conmiittee,  to  whom  had  been  re- 
ferred we  subject  of  a  resolution  laid  over  from  the  last 
meeting  of  the  Medical  Sooiett  of  the  State  of  Penn- 
sylvania, held  at  Wilkesbarre,  Pa.,  in  June  last,  to  the 
effect  that  nothing  in  the  resolution  of  1860,  declaring 
it  unprofessional  for  members  to  consult  with  the  pro- 
fessors or  graduates  of  Female  Medical  Ci^leges.  as  at 
present  (I860)  organized,  should  be  so  constmea  as  to 
prevent  members  from  consulting  with  properly  quali- 
fied female  practitioners,  who  strictly  observed  the  code 
of  ethics,  was  read  by  the  ohairman,  Dr.  D.  Francis 
Condie,  and  is  as  follows : — 

*'  To  the  Philadelphia  Oomty  Medical  Society. ^The 
subject  submitted  for  the  consideration  of  your  Com- 
mittee may  be  comprised  in  the  following  Question, 
namely : — ^Is  the  recognition  of  female  me£cat  gradu- 
at^by  our  profession,  proper  and  expedient? 

''It  cannot  be  denied  that  there  are  in  our  midst 
-  women  of  fine  natural  abilities,  cultivated  by  a  thorough 
liberal  education ;  nor  will  it  be  doubted  by  any  one 
that,  were  one  of  this  dass  of  women  to  be  thoroughly 
instmoted  in  the  institutes  and  practice  of  medicine, 
she  would  be  as  likely  to  become  as  successfiil  a  prac- 
titioner of  the  healing  art  as  any  male  graduate ;  and 
were  a  woman  thus  qualified  to  confine  herself  to 
the  investigation  and  treatment  especially,  of  the  dis- 
eases of  her  own  sex,  and  of  children,  we  do  not  believe 
that  the  association  with  her  at  the  bed-side  of  the  sick 
would  be  objected  to  by  any  liberal-minded  practitioner 
of  the  other  sex.  But  to  inundate  our  profession  with 
a  host  of  females  possessed  of  no  higher  qualifications, 
professional  or  ethical,  than  are  possessed  by  the  gradu- 
ates of  badly  organized  and  irresponsible  schools,  cannot 
be  too  strongly  deprecated.  There  are  just  grounds  to 
believe  that  such  will  most  surely  be  the  case  as  schools 
,  for  the  manu&cture  of  female  doctors  multiply,  and 
their  benches  become  thronged  by  women  who  are 
prompted  to  the  pursuit  of  medicine  by  no  higher 
motive  than  what  results  from  a  feeling  that  it  is  one 
more  respectable,  less  confining,  and  more  remunerative 
than  any  of  the  ordinary  pursuits  thsX  are  now  open  to 
them. 

*'  Even  to  those  ladies  who  are  conscious  of  possessing 
all  the  qualifications,  intdlectual  and  educational,  to 
enable  them  to  enter,  with  a  fair  prospect  of  success, 
upon  the  study  and  practice  of  the  healing  art,  we 
would  say,  "Pause  before  yon  assume  the  toil  and 
anxious  cares,  ihe  heavy  responsibilities,  incident  to 
the  life  of  a  {mysician.  Becoflect,  also,  that  in  devot- 
ing your  days  to  the  practice  of  medicine,  you  must 
necessarily  forego  that  mgh  and  noble  mission,  for  the 
-fnlfilaient  of  which  you  were  destined  by  your  Maker. 


You  cannot  hope  to  become  the  central  sun  of  the 
domestic  drde,  diffusing  throughout  it  a  genial  light^ 
and  warmth,  and  beauty  ;  you  must  give  up  the  pleas^ 
ing  task  of  developing — as  none  but  a  mother  can — the 
physical,  moral,  and  intellectual  faculties  of  the  young; 
and  of  acting  out  your  appropriate  r61e  of  becoming  at 
all  times,  and  in  all  thinss,  a  help  meet  for  man.  To 
practise  medicine  faithfully  and  successfully,  demands  a 
concentration  upon  the  work  of  the  whole  mmd — of  the 
entire  life.  It  wiU  aUow  of  no  other  pursuit  being  car- 
ried on  in  connexion  with  it;  scarcely  of  any  turning 
aside  for  necessary  relaxation  and  repose. 

'  ^  There  is  another  imp(»rtant  preliminary  to  be  disposed 
of  by  the  female  before  it  wiU  be  prudent  for  her  to 
assume,  as  the  pursuit  of  her  future  life,  the  arduous, 
never-ending  ti^  the  anxious,  exacting  duties  of  a 
medical  practitioner ;  and  that  is,  to  determine  whether 
her  physical  strength,  and  the  physiological  peculiari- 
ties of  her  organization,  are  such  as  will  enable  her  to 
fulfil,  faithfully,  the  duties  of  a  medical  practitioner, 
without  incurring  the  risk  of  an  early  loss  of  health, 
leading,  it  may  be,  to  an  eariy  extinction  of  life. 

'*  In  disposing  of  the  question  submitted  for  the  con- 
sideration of  your  Committee,  the  fact  must  be  taken 
into  consideration,  that  female  practitioners,  authorieed 
by  the  authority  of  the  State,  abready  exist,  with  a 
cfear  prospect  that  their  increase  in  the  future  will  be 
far  greater  than  it  has  been  ift  the  past.  In  view  of 
this  fact,  your  Conmiittee  would  respectfully  suggest 
whether  the  wisest  course  for  us  to  pursue  would  not 
be  to  offer  every  encouragement  and  facility  to  insure 
to  the  female  graduate  such  educational  and  professional 
acquisitions  as  will  enable  her  to  enter  with  safety  and 
with  credit  upon  the  practice  of  medicine. 

"  We  confess  that  we  are  opposed  to  female  medical 
colleges  as  now  organized.  If  we  are  to  have  female 
physicians,  let  them  emanate  from  the  same  schools  at 
which  our  male  physicians  receive  their  professional 
education.  Our  leading  medical  colleges  are  constantly 
embracing  in  their  faculties  the  b^  talents  of  the 
country,  enlarging  their  courses  of  instraction,  and  ele- 
vating their  requisites  for  graduation.  Let  these 
advantages  be  extended  fi-eely  to  female  students.  If 
objection  is  made  to  females  being  taught  in  the  same 
classes  with  the  male  students,  they  may  be  formed 
into  separate  classes,  and  receive  instruction  at  hoars 
appropriated  especially  to  them. 

**  Your  Committee  trust  that  the  medical  profession 
will  never  improve  of  a  recognition  of  every  female 
graduate,  without  ^Liscrimtnation,  as  a  legitimate  mem- 
ber. Tour  Committee  believe,  nevertheless,  that  it 
would  be  a  judicious  measure— one  indeed  of  policy  and 
of  justice — to  draw  a  broad  line  of  demarcation  betwe^i 
the  worthy  and  the  unworthy,  the  competent  and  the 
incompetent  of  these  females  who  come  forward  as 
practitioners  of  medicine,  and,  while  without  hesitation 
the  unworthy  and  the  incompetent  are  repudiated,  the 
hand  of  fellowship  be  extended  to  the  opposite  dass, 
in  all  good  faith;  confirming  them  thus  in  an  ho- 
norable career,  and  at  the  same  time  granting  to 
them  the  same  rights  and  privileges  that  are  secured  by 
our  code  of  ethics,  to  every  member  of  the  profession, 
and  subjecting  them  to  the  same  penalties  for  jmy 
infringement  by  them  of  the  provisions  of  that  code. 

"  When  we  shall  be  prepared  to  draw  such  a  line  of 
demarcation,  and  by  what  authority  it  shall  be  esta- 
blished, are  questions  which  cannot  be  definitively  set- 
tled until  all  necessary  regulations  in  respect  to  the 
education  of  iismale  a^irants  to  the  doctorate  in  medi- 
cine shall  be  established,  and  the  nature  of  the  security 
that  shall  be  required  o£  them  for  a  strict  complianoe 
on  their  part  with  such  regulatio^^^ahali  be  Eettled* 


igitized  by  LjOO^- 


THE  MEDICAL  RECORD. 


as 


^Having  thus  presented  very  candidly  their  opinion 
on  the  subject  submitted  for  their  considerfttion,  yoar 
Oommitted  would  present  for  your  adoption  the  follow- 
ii^  resolution,  namely : 

^Rmhtd^  That  the  Philadelphia  Oounty  Medical 
Society  cannot  consent  to  the  repeal  of  the  resolution 
paaod  by  the  Medical  Society  of  the  State  of  Pennsyl- 
Tania,  at  its  session  of  I860,  in  reference  to  '  the  gi-adu- 
ates  of  Femde  Medical  Colleges,  as  <U  present  consii- 
Med;'  and  they  hereby  instract  the  delegates  from  the 
Sodety  to  the  next  session  of  the  State  Society,  to  use 
aU  honorable  means  to  prerent  the  repeal  of  the  said 
reflation,  which  they  belieye  to  be  as  loudly  called  for 
DOW  as  at  the  period  when  it  was  passed. 

'^  Ail  of  which  is  most  respectfully  submitted  by 
"D.  Fbanoxs  Condie, 
''John  F.  Lamb. 
''  A  minority  of  the  Committee. 
•FiiiULMtmA,^arch  18^  ISST."* 

A  very  animated  and  prolonged  discussion  ensued 
when  the  resolution  appended  to  the  above  report  came 
op  for  consideration.  The  report  itself  gave  apparent 
general  satisfaction.  Every  speaker  who  referred  to  it 
oommended  it^  and  not  a  single  voice  was  raised  depre- 
catory to  it.  The  speakers  seemed  divided  into  three 
classes:  those  totally  opposed  to  female  medical  prac- 
tinners,  under  any  circumstances;  those  willing  to 
extend  to  them  the  hand  of  fellowship  at  once ;  and 
those  who  were  undecided  in  regard  to  the  subject,  and, 
althoogh  disapproving  of  femato  practitioners  in  the 
abstract,  were  willing  to  admit  the  expediency  of  receiv- 
ing them,  either  at  once,  or  at  no  distant  period,  when 
tome  standard  of  professional  requirements  should  be 
adopted.  Then  came  up  the  question  as  to  the  nature 
of  the  standard  to  be  required.  Some  sud,  let  us 
receive  graduates  of  schools  which  may  be  hereafter 
recognised  by  the  American  Medical  Association.  To 
this,  answer  was  made  that  there  is  but  little  chance 
for  a  fair  bearing  on  the  part  of  the  female  practitioner, 
for  neither  she  nor  those  associated  with  her  could  be 
received  as  a  delegate;  besides  vi4uch,  the  code  of 
ethics,  in  prescribing  the  requisites  for  consultation, 
impli^  that  the  status  of  a  physician  should  be  deter- 
mined in  the  community  where  he  resided,  rather  than 
by  the  American  Medical  Association.  It  was  also 
wged  that  the  resolution  opposed  the  liberal  spirit  of 
the  report.  It  was  also  urged  in  opposition  to  the 
adoption  of  the  resolution* appended  to  the  report,  that 
to  a  certain  extent  the  disability  existing  in  1860  did 
not  exist  in  1867,  it  being  represented  that  the  profes- 
sors of  one  female  medical  college  in  the  country,  at 
least,  were  regular  graduate^  and  otherwise  than  in 
their  connexion  with  the  college,  in  good  standing; 
and  that  the  requisites  for  graduation  by  that  institution 
were  as  stringent  in  eVery  respect  as  at  the  leading 
medical  schoms  in  the  country.  That  therefore,  in  fac^ 
this  college  was  now  differently  organized  from  what  it 
had  been  in  1860,  and  that,  therefore,  literally,  that 
school  was  no  longer  subject  to  the  discipline  of  the 
resohition.  It  was  also  urged  in  the  same  connexion, 
that  nfecetnty,  and  not  choice,  had  compelled  the  female 
ooQeges  to  put  up  with  the  best  instructors  they  could 
obtain ;  for  again  and  again  had  female  students  Icnocked 
tbr  admission  at  the  doors  of  our  regular  medical  insti- 
tntioDB,  and  as  regularly  had  they  l^n  refused.  That 
tfary  were  anxious  to  become  thoroughly  instructed, 
and  it  was  l^eir  misfortane  and  not  their  fault  that 
fliey  received  instruction  of  inferior  quality. 

U  was  proposed  to  substitute  for  the  resolution  of  the 
Committee,  one  approving  of  the  adoption  of  the  reso- 
hitioa  oflensd  by  br.  Mowry  at  Uie  State  Society,  per- 


mitting consultation  with  properly  qualified  female 
practitioners  who  observed  the  code  <^  ethics ;  but  it 
was  at  once  met  by  the  objection  of  an  unwillingness 
to  permit  any  man  to  judge  for  himself  as  to  who  was 
or  who  was  not  properly  qualified ;  and  that  the  stand- 
ard of  such  qualification  must  be  decided  by  a  compe- 
tent medical  body,  and  not  by  the  individual. 

At  length,  after  much  discussion  pro  and  coil,  the 
following  resolution  was  offered : 

"Nevertheless,  nothing  in  the  foregoing  resolution 
shall  be  construed  to  forbid  any  member  of  this  Society 
from  consulting  with  any  female  practitioner,  who 
shall  be  declared  by  the  American  Medical  Association 
as  regjularly  educated,  and  who  gives  sufficient  evidence 
of  strict  adherence  on  her  part,  to  the  code  of  medical 
ethics." 


Special  Comvibsatiohal  Mkktino,  March  20, 1867. 

The  DisotrssioN  ow  the  Status  of  Female  Practi- 
tioners OF  Medicine  was  continued.  A  preamble  and 
resolutions  were  offered  as  a  substitute  for  the  resolution 
under  consideration,  the  principal  feature  of  which  was, 
that  the  Female  Medical  College  mentioned  upon  the 
previous  occasion,  being  at  present  a  regularly  organized 
institution,  requiring  the  same  qualifications  for  gradua- 
tion as  the  regular  medical  colleges,  their  professors 
and  graduates  should  be  entitled  to  recognition  in 
consmtation.  Under  the  impression  that  all  the  profes- 
sors of  this  institution  were  in  good  standing,  and 
observed  the  code  of  ethics,  it  is  likelv  that  the  preamble 
and  resolutions  referred  to,  and  of  which  it  is  unneces- 
sary to  be  more  explicit  in  this  report,  would  have 
been  passed  after  undergoing  some  modifications.  But 
the  exhibition  by  one  of  the  members  of  a  printed  cir- 
cular of  one  of  the  professors  of  this  Female  Medical 
College,  calling  the  attention  of  the  public  to  the  superior 
and  inwllible  superiorities  of  certam  cholera  remedies^ 
and  other  secret  remedies,  prepared  solely  by  himselr, 
and  calling  attention  to  the  fact  that  he  was  prepared, 
at  certain  office  hours,  to  be  consulted,  in  certain  lan- 
guages, upon  any  diseases  incident  to  either  sex,  etc., 
completely  nullified  the  effect  produced  by  the  pream- 
ble, and  the  discussion  which  had  thus  far  followed  it, 
and  the  resolutions  were  lost  without  a  dissenting 
voice. 

Then  the  following  preamble  and  resolutions  were 
offered  by  Dr.  Bell,  and  adopted  unanimously : — 

Whereas,  in  looking  to  the  usefulness  and  dignity 
of  the  profession  which  are  inseparably  connected  with 
the  welfare  of  the  community,  we  are  met  with  yery 
grave  objections  to  women  takking  on  themselves  the 
heavy  duties  and  responsibilities  of  the  practice  of  medi- 
cine. Their  success  in  the  walks  of  general  literature, 
and  even,  in  some  instances,  of  science,  which  allow 
them  a  choice  of  time  and  season  for  intellectual  labor, 
cannot  be  adduced  as  argument  in  &vor  of  their  ability 
to  bear  up  under  the  bodily  and  mental  strain  to  which 
they  would  be  unceasingly  subjected  in  this  new  voca- 
tion. The  physiological  peculiarities  of  a  woman,  even 
in  single  life,  and  the  disorders  consequent  upon  them, 
cannot  fail  frequently  to  interfere  with  the  regular  dis- 
charge of  her  duties  as  physician  in  constant  attendance 
on  the  sick.  How  much  greater  must  be  the  interrup- 
tion to  her  duties  if  she  enters  the  married  state,  and 
becomes  a  mother  and  nurse.  Her  delicate  organisa- 
tion, and  predominance  of  the  nervous  system,  render 
her  peculiarly  susceptible  to  suffer,  if  not  to  sink  under 
the  fatigue  and  the  moral  shocks  which  she  must 
encounter  in  her  professional  rounds.  Man,  with  his 
robust  frame,  and  habitual  seff-command,  is  often  barely 


94 


THE  MEDICAL  RECORD. 


equal  to  the  task.  The  home  inflnenoe  of  women  is 
one  of  the  greatest  benefits  growing  out  of  Christian 
ciTilization.  More  e^ecially  is  this  manifest  when  we 
look  at  her  as  head  oi  the  household,  a  helpmate  to  her 
husband,  and  the  confidant,  guide,  instructor,  and  loving 
IHend  of  her  children,  whose  future  happiness  and  re- 
spectability so  much  depend  on  her  tuition  and  exam- 
ple. What  would  be  the  state  of  the  household,  what 
the  present  condition  and  future  prospects  of  the  chil- 
dren, deprived  to  a  considerable  extent  of  their  natural 
guardian,  who  would  be  engaged  all  day,  and  not  secure 
s^nst  calls  in  the  night,  in  the  service  of  the  sick  ? 
Nor  when  at  home,  can  the  mother,  worried,  and 
fretted,  and  anxious  about  her  patients,  be  in  a  fit  frame 
of  mind  to  interchange  endearments  with  her  beloved 
little  ones,  to  receive  their  confidence  and  offer  advice. 

Once  embarked  in  the  practice  of  medicine,  a  female 
physician  will  not  long  confine  herself  to  attendance 
on  persons  of  her  own  sex ;  and  it  is  easy  to  conceive 
the  embarassments  on  both  sides,  which  would  be  met 
with  in  her  visiting  aud  prescribing  for  persons  of  the 
opposite  sex.  If  her  services  be  restricted  to  the  &male 
portion  of  a  family,  there  must  be  a  male  physician  to 
attend  on  the  males ;  and  thus  there  will  be  constantly 
two  physicians  in  the  regular  service  of  a  family,  with 
all  the  chances  of  counter-prescription  and  advice,  and 
breach  of  ethics,  misunderstanding,  and  heart-burnings. 
With  this  new  element  of  probable  discord,  it  will  be 
doubly  difficult  for  us  to  conform  to  the  code  of  medical 
ethics.  If  a  female  physician  be  once  received  in  full 
standing  and  professional  intercourse,  by  consultation, 
or  otherwise,  with  a  physician  of  our  own  sex,  the 
greatest  latitude  will  be  allowable  in  the  statement  of 
the  case,  its  symptoms  and  causes,  and  question  of 
treatment,  therapeutical  and  psychical  Will  woman 
gain  by  forgetting  to  blushj  and  by  discussing  every 
topic  as  it  comes  up  with  philosophic  coolness  ?  or  man 
be  improved  in  the  delicate  reserve  with  which  he  is 
accustomed  to  address  women,  both  in  the  sick-room 
and  elsewhere  ?  The  limits  of  modesty  once  passed  in 
this  professional  intercourse,  is  there  no  danger  of  fur- 
ther advances,  in  which  a  sensitive  nature  would  repel 
as  familiarities,  what  under  other  circumstances  would 
be  inadmissible  ? 

Oould  women  be  induced  to  see  the  true  line  of  duty 
in  relation  to  medicnl  study,  it  would  be  to  learn  pre- 
ventive medicine,  and  acquire  a  suitable  knowledge  of 
physiology  and  hygiene,  so  as  to  be  able  to  preserve 
their  own  health  and  that  of  their  children ;  and  to 
inculcate  on  the  latter  the  close  connexion  between  the 
physical  and  moral  well-being  of  our  nature.  The  field 
IS  large,  and  its  cultivation  would  richly  repay  the 
laborers  in  it. 

In  no  other  country  than  our  own  is  a  body  of 
women  authorized  to  engage  in  general  practice.  The 
specialty  of  midwifery  practice  in  France  is  hedged  in 
by  restrictions  which  call  for  the  assistance  of  medical 
men  in  every  case  of  difficulty  or  doubt. 

Moved  by  these  considerations,  be  it  therefore 

Besokfcd,  That  in  conformity  with  what  we  believe 
to  be  due  to  the  profession,  the  ccmmunity  in  general, 
and  the  female  portion  of  it  in  particular^  we  cannot 
ofier  any  encouragement  to  women  becoming  practi- 
tioners of  medicme, .nor  can  we  consent,  on  these 
grounds,  to  meet  in  consultation  such  practitioners. 


Pboceeos  of  the  Ball  ik  Aid  op  the  Nttrsery  and 
Child's  Hospital. — The  Treasurer  of  the  Nursery  and 
Child's  Hospital  has  received  the  sum  of  $12,383  69, 
being  the  net  proceeds  of  the  ball  given  for  the  benefit 
of  that  institution  on  the  4th  of  March  last 


NEW  YORK  ACADEMY  OF  MEDICINE. 
Stated  MssnNa,  Maboh  20,  1867. 
Dr.  a.  C.  Post,  President,  in  the  Chair. 

Dbs.  James  Anderson  and  Charles  A.  Budd  pre- 
sented to  the  Academy  seyeral  volumes,  confided  to 
^em  for  that  purpose. 

the  souroe  of  urea. 

Dr.  John  C.  Draper  called  the  attention  of  the  Fel- 
lows to  the  corroboration  of  views  regarding  the  source 
of  Urea  which  had  been  advocated  by  him  in  a  thesis 
some  ten  years  ago.  The  opinion  then  expressed  result- 
ed firom  a  series  of  experiments,  which  had  covered  a 
previous  period  of  two  vears.  About  this  time  he  had 
also  published  in  the  ola  Journal  of  Medicine  a  paper,  in 
whidi  he  maintained  that  the  "  Urea  merely  represented 
the  access  of  nitrogenized  material  consumed,  and  was 
not  indicative  of  the  amount  of  mus  ular  action."  In 
1860,  May  20,  he  read  before  this  body  another  paper, 
in  which  it  was  shown  that  the  effete  materials  arising 
during  muscular  action  are  evacuated  as  insensible  per- 
spiration, by  skin  and  lungs,  and  that  the  loss  by  these 
cnannels  is  much  greater  than  by  the  kidneys.  He  was 
thus  explicit  in  his  statements,  because  the  doctrines 
then  enunciated,  and  which  had  now  begun  to  excite 
attention  in  Europe,  were  in  reality  directed  against 
Lehman^s  theory  that  urea  was  theproduct  of  muscu- 
lar disintegration.  Dra  Nick  and  mdicenius  now  also 
assert  that  muscular  force  is  the  result  of  oxidation  of 
fats.  They  regard  a  bundle  of  muscular  fibres  as  a 
species  of  machine,  formed  of  nitrogenized  material,  as 
an  engine  is  made  of  iron  and  brass.  As  coal  is  the  ori- 
gin of  force  in  the  latter,  so  the  combustion  of  fat  is 
the  producer  of  force  in  tne  former ;  and  as  in  the  en- 
gine there  is  a  slow,  gradual  rust  and  wear  taking  place, 
so  in  the  muscular  fibre  there  is  also  a  similar  destruc- 
tion of  material  which  bears  an  infinitely  small  ratio 
to  the  force  produced.  The  analogy  instituted  was  cer- 
tainly a  beautiful  one  and  exceedingly  suggestive. 

DB.  Hubbard's  truss. 

Dr.  N.  W.  Hubbard,  of  Dlinois,  was  then  introduced, 
and  adjusted  his  truss  upon  a  patient  afflicted  with 
double  inguinal  hernia.  He  claimed  that  his  instru- 
ment had  above  all  others  the  advantage  of  simplicity 
and  perfect  adaptability  to  eyery  variety  of  condition, 
staffe  of  development,  and  complication  of  hernia.  The 
pad,  which  was  of  wood,  might  be  adjusted  to  any  angle, 
so  as  to  fit  the  corpulent  or  spare,  while  the  pressure  was 
capable  of  a  like  variation.  It  also  possessed  a  retentive 
power,  which  might  be  rated  as  three  times  greater 
than  the  actual  pressure. 

The  Truss  will  not  cramp  or  more  when  the  patient 
gets  into  any  position,  and  it  is  easy  and  pleasant  to 
wear,  as  a  necessity,  resulting  from  its  perfect  adapta- 
tion. 

Owing  to  the  fact  that  the  girdle  was  made  of  steel, 
which  was  annealed  to  within  a  short  distance  of  the 
pad,  the  instrument  could,  with  a  reasonable  amount  of 
strength,  be  moulded  to  any  shaped  pelvis.  The  l>eri- 
phery  of  the  pad,  also,  as  in  the  case  of  femoral  hernia  in 
the  female,  might  be  pared  down  to  meet  the  emergencies 
of  the  case.  In  fact,  any  necessary  or  desirable  altera- 
tion in  size  or  shape  of  truss,  position  of  pad,  or  pres- 
sure, can  be  made  at  pleasure,  so  that  the  patient  will 
feel  that  no  further  improvement  is  requiiute,  or  can  be 
made. 

Dr.  Hamilton  said  that  no  new  principles  had  been 
involved  in  the  construction  of  the  .truss  exhibited.  The 
digitized  by ^ ^_ 


THE  MEDICAL  RECORD. 


96 


pad  was  of  the  old  Chase  pattern,  and  the  tractable 
girdle  had  likewise  been  previously  used.  But  he,  for 
one,  bad  always  avoided  the  eDcouraging  of  patented 
instruments,  and  to  this  objection  the  present  truss  was 
open. 

Db.  Jcmsl  F08TBR  professed  to  have  made  himself 
familiar  with  almost  every  variety  of  truss,  and  had 
aeca  the  success  of  Dr.  Hubbard's  instrument  in  one  or 
two  cases.  He  had  been  favorably  impressed  with  its 
peculiarities,  and  had  therefore  invited  the  gentleman  to 
exhibit  it  before  the  Academy. 

Ds.  Hamiltoit  had  intended  no  personal  discourtesy ; 
he  merely  battled  for  the  principle,  and  claimed  to  re- 
pr^ent  his  profession.  He  thonght  that  all  medical 
bodies  should  be  very  chary  of  their  endorsements  of 
any  article,  on  account  of  their  liability  to  take  the 
form  of  advertisements.  He  thought  that  all  were  apt 
to  be  misled  by  the  expertness  of  instrumeut-lnventors, 
•nd  in  this  way  were  fed  to  endow  the  instrument  with 
soperior  qualities.  It  was  thus  that  the  general  practi- 
tioner so  often  failed  in  the  application  of  these  appli- 
aneea.  In  short,  it  was  not  the  perfection  of  the  instru- 
ment, but  the  sloll  of  '^  the  ea^ptri,'^  in  a<jljustment,  which 
wrought  the  wonder. 

TSC  STATE  MBDIOAL  800IETT. — CBDONAL  ABORTIOV. 

Dr.  Jastes  Andersoit,  as  one  of  the  delegates  to  the 
Medical  Society  of  the  State  of  New  York,  reported 
that  the  session  had  been  marked  by  the  bpst  of  feeling. 
The  meeting,  he  stated,  was  large,  and  according  to  the 
impressions  of  numerous  delegates,  more  interesting  than 
any  previously  held.  As  an  episode  in  the  transactions, 
he  would  mention  the  fact,  that  a  prominent  senator 
bad  suggested  to. him  an  official  recommendation  on 
the  part  of  the  Society  to  the  State  Legislature,  that  the 
drculatioD  of  infamous  circulars  in  the  community  be 
^oppressed  by  law.  He  (the  senator)  was  satisfied,  upon 
his  own  convictions,  that  these  exerted  the  most  delete- 
rious influence.  The  doctor  was  himself  pained  at  the 
enormous  extent  to  which  criminal  abortion  prevailed, 
and  hoped  that  the  profession  might  be  purged  of  those 
members,  who,  tested  bv  the  association  of  names  with 
the  practice,  had  forfeited  their  position  in  a  most 
honorable  calling.  He  feared,  too,  that  notwithstand- 
ing the  incompleteness  of  testimony,  there  was  no 
aUence  of  guilt ;  and  that  the  expression  of  the  dis- 
appointed applicant^  "  If  you  will  not,  so-and-so  will,** 
was  founded  on  something  more  than  pure  fiction. 
This  was  the  class,  he  apprehended,  that  would  bear 
watering. 

The  Academy  then  adjourned. 


Corre0t>0nl»encf. 


THE  LATE  DR.  T.  K.  CHANDLER. 

To  THS  Editor  or  tds  If  xdioal  Rroord. 

%m — I  find  in  the  number  of  your  journal  for  March 
Ist  a  nodce  of  the  death  of  Dr.  Thomas  K.  Chandler.  Act 
Passed  Aast.  Surg.  U.  S.  Navy. 

Dr.  Chandler  was  a  few  vears  ago  so  well  and  fa- 
vorably known,  by  many  of  the  profession,  in  your  city, 
that  some  more  marked  notice  of  his  deatn  than  a  mere 
news  item,  seems  but  due  to  his  memory. 

He  came  to  New  York  firom  Fredonia,  Ghautanque  co., 
•ome  time  in  1860,  and  matriculated  at  the  College  of 
Physicianfl  and  Surgeons. 

An  illustration  of  the  determination  to  overcome  all 
obstacles,  which  was  characteristic  of  the  man,  will  be 
(bond  in  the  fact  that  while  attending  the  lectures  he 
was  Boffering  so  severely  from  necrosis  of  the  femur  as  to 


be  obliged  to  use  two  crutches  constantly.  I  mention 
this,  too,  because  it  will  recall  him  at  once  to  every  mem- 
ber of  the  classes  of  *60,  '61,  *62.  On  graduating  in  1862 
Dr.  Chandler  became  an  interne  of  Bellevue  Hospital,  and 
on  the  expiration  of  his  term  of  service,  April,  1863,  en- 
tered the  volunteer  navy. 

He  was  almost  immediately  ordered  to  the  Steamer 
Princess  Royal,  and  served  on  her  in  the  Mississippi  and 
Qulf  Squadrons  until  the  close  of  the  war.  He  was  after- 
ward assigned  to  duty  at  the  Washington  Naval  Hospital, 
and  finally  was  ordered  to  the  Penobscot,  on  ipniich 
vessel  he  laid  down  his  life  in  performance  of  his  pro- 
fessional duties.  During  his  residence  in  Bellevue,  his 
professional  enthusiasm,  his  genial  disposition,  and,  more 
than  all,  his  irresistible  humor,  won  from  each  one  of  us, 
his  associates  on  the  resident  stafi*,  a  most  hearty  recog- 
nition of  his  worth ;  and  now  that  he  is  gone  from  us. 
no  one  of  us  but  will  remember  him  with  pleasure  ana 
regret  his  early  death. 

I  am,  sir,  yours  truly, 

W .  C.  Prter,  M.  D 

Nkw  Roceblu,  MaKh  6, 1M7. 


MEDICAL  ADVERTISING. 

To  THa  EDnoa  of  the  Mbdxoal  Bboobd. 

Sir — ^In  the  Medical  Record  of  March  15,  appeared 
an  editorial  headed  '^  Medical  Advertising  again,*'  refer- 
ring to  the  use  made  of  my  name  in  a  popular  newspaper. 

I  had  considered  it  unnecessary  to  notice  the  article 
as  it  appeared  in  the  newspaper,  well  knowing  that  my 
associates  and  scientific  firiends  were  fully  aware  that 
this  "  quasi  advertisement "  was  not  sanctioned  by  me ; 
and  that  even  a  disavowal  under  my  name  would  sub- 
ject me  to  further  suspicion  of  advertising.  But  see- 
ing your  notice  of  it,  placing  me  in  such  an  unenviable 
and  unfiiir  position,  I  gladly  accept  your  invitation  to 
disavow  any  such  use  of  my  name  as  was  there  mi^e. 

My  whole  duty  in  this  matter  is  to  give  you  the  facts 
and  assure  you  that,  if  the  article  in  ^e  EagU  has  pained 
you  as  a  medical  journalist,  this  use  of  my  name  has 
been  much  more  painful  and  distressing  to  me. 

A  report  of  the  case  which  I  had  presented  to  one  of 
our  medical  societies,  served  for  the  "  extract  ftom  her 
physician's  diary."  As  for  adding  the  *'  endorsement 
of "  my  "  medical  name  and  reputation,"  this  I  have 
scrupulously  withheld,  as  is  well  known  by  the  medical 
gentlemen  who  have  seen  the  case  with  me. 

You  must  be  aware  how  difficult  it  is  to  keep  a 
case  so  unusual  out  of  the  hands  of  reporters,  and  you 
must  also  appreciate  the  unpleasant  and  trying  position 
of  the  physician  in  charge.  I  have  been  accused  of  be- 
lieving in  spiritualism  and  clairvoyance,  of  being  myself 
a  humbug  and  humbugged.  I  have  been  pursued  by 
reporters,  strangers,  and  physicians  (male  and  female), 
for  the  particulars  of  this  case,  for  months.  But  in 
every  wav  have  endeavored  to  keep  it  as  professional 
as  possible ;  and  now  that  the  case  has  so  many  times 
been  made  public,  should  not  be  held  responsible  for 
anything  but  my  own  acts.  I  appreciate  the  sym- 
pathy e^^pressed  in  your  criticism,  and  can  only  say 
that,  in  the  discharge  of  my  duty,  when  the  proper 
time  comes,  I  shall  be  glad  to  report  the  case  to  the 
profession  generally  as  i  have  already  done  partially. 

Should  you  be  disposed  to  set  me  right  before  the 
readers  of  The  Record  by  publishing  this  note,  or  any 
portion  of  it,  you  are  quite  at  liberty  to  give  my  name. 
But  in  order  to  avoid  even  the  appearance  of  fbrtfaer 
advertising  mysdf  in  connexion  with  the  matter,  my 
own  preference  would  be  to  omit  the  name  ae  yon  did. 

Verytrulv^      ♦      \ 

Digitized  by  VjOOQ  IC 


96 


THE  MEDICAL  RECORD. 


iUeltical  Urns  anlr  3tem0« 


PERSONAL. 

Brevet  Lieutenant-Colonel  W.  R  Dewitt.  Jr.,  Sur- 
geon in  Chief  of  the  Freedmen*8  Bureau  for  tne  District 
of  Maryland,  has  been  relieved  from  duty  at  headquar- 
ters in  Baltimore  and  ordered  to  report  to  the  Assistant 
Commissioner  at  Louisville,  Ky.,  for  assignment  to  duty. 

Surgeon  Greorge  Peck  has  been  ordered  to  report  for 
du*y  April  1,  at  the  Navy  Yard,  K  Y.,  vice  Surgeon 
C.  Eversfield  to  be  detached. 

Surgeons  L.  R  Hunter  and  J.  M.  Qreene  have  been 
ordered  to  duty  as  examining  surffeons  to  the  medical 
b6ard  at  the  Philadelphia  Navy  Yard. 

Passed  Assistant  Surgeon  John  H.  Murphy  has  been 
detached  from  the  Lancaster  and  placed  on  waiting  or- 
ders. 

Passed  Assistant  Surgeon  J.  Buckley  has  been  order- 
ed from  the  Lancaster  to  the  Constellation. 

Surgeon  Eus&a  GmtwoLB^  United  States  Volun- 
teers, mustered  out  of  service,  to  date  March  18,  1867. 

Augustus T.  Peck,  M.D.,  has  been  appointed  an  Assist- 
ant Surgeon  U.  S.  N.  Commission  to  date  from  Feb- 
ruary 25,  ult 

Dr.  Russell  B.  Brownell  of  Sharon,  Conn.,  died  of 
phthisis  on  the  27th  of  January,  at  a  place  about  twenty 
miles  above  Edfou,  on  the  river  Nile  in  Upper  Egypt. 

Dr.  John  Gkdvan,  an  Alumnus  of  the  Collegje  of  Phy- 
sicians and  Surffeons,  N.  Y.,  class  of  1855,  died  in  this 
city  of  acute  phthisis,  March  28,  in  the  33d  year  of 
his  age. 


Dklioatcs  Eliot  to  the  Amxrioak  Medical  Absooia- 
TiOH. — lYom  ihe  Medical  SoeUiy  of  the  Chunty  of  New 
Tork, — ^Drs.  Lewis  A.  Sayre  {Chairman)^  Joel  Foster, 
William  N.  Blakeman,  Thomas  C.  Fmnell,  Samuel  T. 
Hubbard,  James  Kennedy,  H.  Mortimer  Brush,  John  P. 
Garrish,  Thomas  S.  Bahan,  Edward  Bradley,  James  J. 
Connolly,  Henry  S.  Downs,  Louis  Blsberg,  Horace  P. 
Famham,  Edward  Fowler,  N.  Marsten  Freeman.  Abbott 
Hodgman,  E.  Lee  Jones,  B.  M.  Keeney,  Wm.  B.  Lewis, 
William  M.  McLaury,  Robert  Newman,  Wm.  C.  Rob- 
erts, Stephen  RogersJAnthony  Ruppaner,  Edward  H. 
M.  Sell,  Gustavns  S.  Winston. 

From  tfte  N,  Y,  Aoademy  of  Jledieine. — Drs.  James 
Anderson  (Chairman)^  Jas.  L.  Banks,  Edwd.  L.  Beadle, 
Mark  Bkmenthal,  Henry  D.  Bulkley^Fred  A.  Burrall, 
John  Byrne,  John  C.  Draper,  Wm.  H.  Draper  DeWitt 
C.  Enos,  Joel  Foster,  Elisha  Harris.  Max  Herzog,  J. 
Foster  Jenkins,  E.  S.  F.  Arnold,  Joseph  Kammercr, 
Ernst  Krackowizer,  John  Ordronau3L  Samuel  S.  Purple, 
Benjamin  L  Raphael,  Gouverneur  M.  Smith,  S.  Fleet 
Spier,  Edward  B.  Squibb,  Alfred  Underbill,  Moses  D. 
Van  Pelt,  Lothar  A.  V.  ss,  and  Henry  W.  B.  WoodhulL 

Drom  the  EaH  River  Medical  Aeeociation, — Drs.  Yer- 
ranus  Morse,  John  Hart,  John  Shrady,  and  Montross  L. 
Smith. 

jFVom  ^  N,  T  Mediedl  Umoiu— Drs.  ^  Lee  Jones 
and  Stephen  Rogers. 

The  RnrDEKPBST  m  Frajtob  axd  BBLonnr.— The  De- 
Mrtment  of  State  has  received  a  despatch  from  the 
United  States  Lesation  at  ^^  Hague,  dated  March  16, 
in  which  the  writer  says:  ''Sraee  my  last  letter  the 
rinderpest  has  spread  into  Be^um  tfid  France.  The 
report  of  its  progre«  in  Holland  from  the  5th  of  Janu- 


ary to  the  17th  of  February,  shows  a  decline  from  week 
to  week.  The  number  of  oases  during  that  period  was 
nearly  18,000;  deaths.  7,175;  slaughtered,  4,441,*  being 
a  total  loss  of  11,596/' 

Army  Medtcal  Museum. — The  Acting  Quartermaster- 
Gkneral,  D.  H  Ruokbr,  has  issued  an  order  authorising 
officers  of  the  Quartprmaster's  Department,  in  charge 
of  the  Grovemment  trains  returning  from  the  frontier 
and  other  remote  points,  upon  the  requisition  of  medi- 
cal officers,  to  furnish  tran^rtation  by  such  trains  for 
collections  of  specimens  for  the  Army  Medical  Musaum, 
when  such  transportation  can  be  furnished  without  in- 
jury to  the  public  service. 

SuDDEH  Deats  IK  A  Dentist's  OmcE. — ^In  a  recent 
number  of  the  Medical  and  Surgical  JReporter  an  ac- 
count of  the  following  curious  case  is  given: — 
Edmund  Eerosin,  a  young  man  about  twenty-three 
years  old,  entered  the  office  of  Dr.  Ralph  Lee,  a  dentist 
of  this  dty,  to  have  a  tooth  extracted.  Aniesthesia  wm 
produced  by  nitrous  oxyd  ffas,  a  cork  having  been 
placed  between  the  teeth  to  keep  the  mouth  open.  As 
the  tooth  was  extracted,  we  understand,  it  slipped 
from  the  forceps,  and  with  the  cork  was  drawn  into  the 
mouth.  The  tooth  was  subsequently  thrown  up  from 
the  stomach,  but  the  cork — which  does  hot  seem  to 
have  been  missed— entered  the  larynx,  and  bv  its 
presence  ther^  caused  suffocation  and  death  in  an  hoar. 
A  post-mortem  revealed  the  presence  of  the  cork  in  the 
larynx  and  the  cause  of  death.  This  case,  and  its  la- 
mentable result,  should  serve  as  a  caution  to  those  who 
employ  such  aojjuncts  in  the  dental  laboratory;  and  the 
physician  who  may  be  suddenly  summoned  to  patients 
m  a  dentist's  office,  should  bear  in  mind  the  possibility 
of  an  accident  Uke  this,  and  be  prepared  to  open  the 
larynx,  if  need  be,  which  in  this  instance  would  in  all 
probability  have  given  instant  relief  and  saved  the  li£» 
of  the  young  man. — Medical  and  Surgical  Bqfortcr^ 
February  2. 

Hudson  River  State  Lunatio  Astlum. — The  Board 
of  Managers  of  the  Hudson  River  State  Lunatic  Asy- 
lum met  at  the  Morgan  House,  Poughkeepsie,  N.  i ., 
and  elected  Mr.  Abtah  W.  Palmer,  of  Amenia.  Dutchess 
county.  President :  and  Dr.  J.  m!.  Gleaveland,  Medical 
Superintendent  rrelimtnary  arrangements  were  also 
made  to  receive  plans  and  specificatiuns  for  the  erection 
of  the  edifice. 

Dr.  David  Livingston,  the  celebrated  African  ex- 
plorer, it  is  now  definitely  ascertained  was  murdered 
by  a  roving  tribe  of  Africans,  about  the  25th  of  October 
last  He  was  last  heard  of  at  '*  N*Doude,"  at  the  con- 
fluence of  the  Novuma  and  Niende.  The  Hon.  Edward 
D.  Ropes,  United  States  Consul,  writes  from  the  island 
of  Zanzibar,  under  date  Dec.  9,  1866,  as  follows;  "  We 
have  information  that  he  proceeded  further  west  to 
Mataka,  a  Miao  chief,  who  gave  presents  of  cattle  and 
food.  At  this  point  the  Indian  sepoys  remained  behind 
and  have  since  returned  to  Zansibar.  I^m  Mataka  to 
a  lake  was  eight  days'  march.  On  crossing  a  wide 
water  in  Oanves,  thev  followed  the  border  of  the  Uk» 
for  several  days,  and  thus  struck  inlandL  They  were 
suddenly  attacked  in  a  bush  country,  about  nine  ajc, 
by  a  band  <^  Mavite.  Dr.  L.  killed  the  most  forward  of 
the  attacking  party,  but  was  surrounded  and  cut  down 
b^  one  blow  of  a  battle-axe,  which  cut  half  throagfa 
his  neck.  Beyond  this  we  have  no  details^  for  those 
who  returned  were  the  fir*  t  to  flee.  Almost  all  who 
stood  near  Dr.  L.  were  killed,  although  they  seem  to 
have  done  considerable  with  their  jtfes.*' 


Digitized  by 


Google 


TISE  MBDIPAL  BECOBD* 


91 


©riginol  C0mmumcott0n«. 


jTIVE  UNPUBLISHED  OASES  OF 

LIGATURE  OF  THE  SUBCLAVIAN  ARTB^Y, 

JOB  AXILLAKT  AND  SUBCLAVIAN  ANEURISM, 

By  WILLARD  PARKER,  M.D^ 
nor.  FBVomBt  am»  vuAfirum  or  tintanT,  ooujmk  ov  rwmm^n 

AMD  SUBOBOSB,  KXW  TOBX. 

Ga8b  I. — A.  R,  set.  31,  a  msti  of  good  constitutioD,  fell 
down  »  p«88age-way  on  the  5tli  of  February,  1849, 
and  a  wooden  pencil,  which  was  in  the  side-pocket  of 
his  coat^  was  forced  up  into  the  right  axiUa,  producing 
a.  wound  of  the  wrillary  artery.  In  a  few  days  swelling 
ippeared  in  the  situation  of  the  wound,  accompanied 
with  pulsation.  On  the  18th,  eome  hemorrhage  occur- 
red through  the  wound  in  the  ajvilla.  It  was  proposed 
by  the  physicians  in  chaii^e  to  effect  a  cure  by  pressure, 
but  haemorrhage  repeatedly  recurring,^ that  plan  was 
abandoned,  and  on  the  morning  of  the  23d  I  was  sent 
for  to  ligate  the  subclavian  artery.  I  performed  the 
operation  in  t'le  usnal  way,  and  placed  a  ligature  upon 
the  artery  in  its  third  Stage. 

On  the  4ih  of  March  there  was  a  return  of  heemor- 
ihage  from  the  wound  in  the  axilla.  No  pulse  at  wrist. 
^^  the  0tb,  tiixere  was  a  rocurreoce  of  h»morrhage 
ad  I XX ;  on  the  8th,  there  was  oozing  throughout  the 
morning  and  a  pretty  free  haemorrhage  at  one  o'clock. 
Shoulder  livid,  hand  and  arm  oold  but  not  numb,  tongue 
nioisl,  no  appetite.  On  th«  9th,  J  cut  down  upon  and 
freely  laid  open  the  aneurism.  The  wound  in  the  artery 
bdng  searched  for  and  found,  two  ligatures  were 
placed,  one  on  either  side  of  it.  The  ligatures  came 
away  on  the  18th  day,  every tbing  progressed  well,  and 
the  patient  finally  recovered  with  the  lo?8  of  the  hand. 
Case  2. — J.  F.,  st.  32,  was  admitted  into  the  New 
York  Hospital,  December  5,  1859.  He  stated  that 
qine  weeks  ago  at  sea,  in  attempting  to  step  upon  a 
water-cask,  he  missed  bi^  footing  and  fell  a  distance  of 
four  feet  to  the  deck,  striking  on  bis  right  shoulder. 
He  thought  that  he  had  simply  received  a  sprain,  but  the 
next  day  the  arm  began  to  swell,  was  painful  and 
ecchymosed.  There  was  a  throbbing  in  the  axilla  and 
pain  extended  down  into  the  hand.  In  the  course  of 
the  week  a  tumor  made  its  appearance  in  the  axilla, 
which  slowly  increased  in  size.  Foor  days  previous 
to  admission,  in  lifting  a  bucket  of  water,  he  felt  some- 
thing give  wav  in  the  tumor,  the  effort  being  followed 
by  increased  throbbing  and  pain  down  the  arm. 

The  patient  looks  an®mic,  but  his  general  health  is 
tolerabj^  good.  The  right  arm  hangs  powerless  by  the 
ade.  'Die  hand  and  arm  are  of  lower  temperature  than 
natural  The  shoulder  is  somewhat  elevated,  and  in 
•  ^  axiOa  is  discovered  an  Hi-defined,  pulsating  tumor. 
Pressure  made  upon  the  subclavian  artery  stops  all 
poLgation  and  bnut  in  the  tumor. 

December  13.-r-I  tied  the  subclavian  artery  in  its 
third  division,  in  the  usual  manner. 

December  14. — ^Patient  slept  well  during  the  night. 
This  morning  there  is  some  heat  of  skin ;  puke  96^, 
feeble. 

December  IB, — ^This  morning  he  had  a  severe  rigor,  fol- 
lowed by  fever  and  profuse  sweating ;  pulse  100 ;  more 
feeble.  Complains  of  nausea;  tongue  coated.  This 
afternoon  he  had  another  chill,  followed  by  fever  and 
sweating. 

December  16.— Did  not  sleep  last  night;  complains 
of  pain  in  head  and  shoulder;  surface  warm,  pulse  96 ; 


very  weak.  This  morning  he  had  a  slight  chill.  Four 
o'clock  p.m.,  he  had  a  severe  rigor,  followed  by  fever, 
sweating,  and  delirium.  During  the  evening  and  night 
he  sank,  and  on  the  morning  of  the  17th  he  died. 

At  the  autopsy,  the  rupture  of  the  artery  was  dis- 
covered just  beyond  where  the  vessel  emerges  from 
between  the  two  trunks  of  the  median  nerve.  Some 
clotted  blood  was  found  in  the  tumor,  but  it  was  mainly 
fluid.  The  lungs,  liver,  and  intestines  healthy.  Heart 
fatty,  soil,  dilated  and  flabby.  No  clots  in  any  of  its 
cavities.  No  clot  in  any  of  the  large  vessels.  Kidneys 
fatty.  There  is  no  record  of  the  urine  having  been 
examined. 

Case  3. — J.  D.  set.  39,  seaman,  was  admitted  into  the 
New  York  Hospital,  October  30,  1860,  and  gave  the 
following  history:  Six  years  ago,  while  in  China^  he 
contracted  syphilis,  and  was  treated  by  mercury.  Dur- 
ing treatment  he  took  cold,  and  lost  the  use  of  his 
limbs,  and  it  was  three  montlw  before  he  recovered  ftom 
t^e  paralysis.  He  is  now  suffering  fi*om  secondary 
symptoms,  and  in  addition  suffers  from  an  axillary 
aneurism  of  the  right  side.  The  tumor  is  situated 
under  the  clavicle  and  pectoral  muscle;  it  is  com- 
pressible; pulsation  is  very  distinct;  and  the  aneu- 
rismal  bruit  is  clearly  heard.  Since  admission  to  the 
Hospital  Uie  aneurism  has  been  increasing  in  size. 
November  13,  at  a  consultation,  it  was  determined  to  tie 
the  subclavian  in  the  third  stage.  The  artery  was 
reached  without  difficulty  and  a  ligature  was  placed  upon 
it.  When  the  ligature  was  tightened,  the  aneurismal 
thrill  and  bruit  entirely  ceased,  and  in  the  course  of  a 
cmarter  of  an  hour  the  size  of  tiie  tumor  had  considera- 
bly diminished. 

Nothing  occurred  in  the  after  treatment  worthy  of 
especial  notice.  The  Kgature  came  away  on  the  six- 
teenth day.  The  tumor  diminished  considerably,  and 
became  firm  to  the  touch.  Numbness  and  loss  of 
strength  continued  more  or  less  until  May  15,  1861, 
when  the  patient  was  discharged  cured. 

Case  4. — Mr.  D,  set.  37,  a  farmer  firom  Conn.,  of 
healthy  and  temperate  habits,  stated  that  four  years  ago, 
after  recovery  from  an  attack  of  pneumonia,  he  ms- 
covered  a  small  tumor  just  below  the  left  clavicle.  This 
tumor  gradually  grew  larger,  and  he  observed  that  it 
pulsated,  and  he  could  hear  a  noise  in  it.  Six  months 
ago  it  began  to  be  painful.  He  spoke  of  going  to  the 
war,  and  consulted  his  physician,  by  whom  he  was  in- 
formed of  the  seriousness  of  his  disease,  and  recom- 
mended to  live  a  life  of  quietness,  and  to  avofd  all  ex- 
ertion. On  the  17th  of  September,  1861,  he  shouldered 
a  sack  of  com  to  take  it  to  the  mill,  and  immediateb^ 
felt  that  he  had  hurt  himself  in  the  tumor.  From  this 
time  it  has  increased  rapidly,  and  become  very  painfnl ; 
pains  also  traverse  the  arm  and  hand.  Dr.  Bostwick 
now  wrote  to  me,  and  I  visited  the  patient  at  his  home 
on  the  1st  of  October. 

On  examination,  I  found  a  pulsating  tumor  which 
filled  the  axUla,  and  extended  under  the  whole  scapula 
behind,  and  under  the  pectoral  muscles  in  front.  The 
scapula  was  raised,  as  was  also  the  clavicle.  The  mea- 
surement on  the  left  side,  from  the  centre  of  the  clavi- 
cle to  the  spine  of  the  Scapula,  was  twenty  inches. 
That  on  the  right  side,  firom  the  same  points,  was 
twelve  and  a  half  inches. 

Oct,  2. — ^Everything  being  in  readiness,  the  patient 
was  etherized,  and  I  tied  the  subclavian  artery  in  its 
third  division.  Some  little  difliculty  was  experienced  in 
the  operation  from  displacement  of  the  parts,  and  the 
artery  was  found  to  be  very  deep.  The  vein  was  pushed 
upwards  from  under  the  davicle. 

Nov,  16. — I  received  a  letter  fcom  Dr.  B.,  in  which 
he  stated  that  the  patient  was  "  up  and  about.*'    He 


98 


llaE  MBDICAL  RECORD. 


oxnitted  to  state,  however,  the  period  of  separation  of  tiie 
ligature. 

AprH  14, 1862. — Mr.  D.  called  upon  me,  oad  reported 
himself  ia  excellent  health.  The  tumor  has  dimini^ed 
in  size  one-half,  and  is  no  longer  a  source  of  annoyance. 
Case  5. — In  which  the  subclayian  was  tied  in  its 
first  portion,  together  with  the  common  carotid  and 
vertebral  arteries.  (This  case  is  partially  reported  in  the 
Transactions  of  the  Pathological  Society,  in  the  Ameri- 
can Mediedl  Times,  March  5,  1864.) 

H.  D.,  aet  32,  caroenter,  had  enjoyed  good  health 
until  August,  1862.  At  that  time  he  noticed  a  tumor  as 
large  as  a  walnut,  immediately  above  the  centre  of  the 
right  clavicle.  Thi"',  he  said,  came  on  without  any  in- 
jury or  blow  that  he  could  remember.  It  remained  of 
*  !;  but  for  the  last  three 
enlarging. 

t,  1863,  and  the  diagnosis 
e.  The  tumor  was  con- 
,  and  by  pressure  upon  the 
nuch  pain  and  numbness 
e  present,  he  was  advised 
ountry,  to  take  no  violeatt 
igetable  diet. 

returned  to  the  city,  and 
ork  Hospital  The  tumor 
»d  in  size.  It  extended 
from  the  outer  edge  of  the  right  stemo-cleido-mastofd 
backwards  for  three  inches^  to  the  anterior  border  of  the 
trapezius,  and  upwards,  ror  about  two  inches.  His 
nights  were  sleepless,  and  there  was  a  very  singular 
change  in  his  circulation.  When  last  seen  the  pulsations 
in  each  wrist  were  regular,  and  numbered  76 ;  now  the 
pulsations  in  the  right  wrist  could  hardly  be  appreciated, 
and  on  the  left  side  there  was  nearly  the  same  condition 
of  things  present.  The  pulsation  of  the  carotid  varied 
from  120  to  130. 

A  consultation,  which  was  called,  resulted  in  a  de- 
cision to  tie  the  common  carotid  near  the  bifurcation, 
and  secure  a  good  plug,  and  also  the  subclavian  Inside 
of  the  scalenus,  together  with  the  vertebral  artery.  It 
was  thought  best  to  tie  the  vertebral,  in  order  to  guard 
against  the  accident  which  occurrect  in  Dr.  Rodgers's 
case  of  Hgature  of  the  left  subclavian  in  1845. 

OpercOion. — An  incision  was  made  from  the  centre  of 
the  mterclavicular  ligament  upwards  for  two  and  a  half 
inches.  A  second,  beginning  at  the  same  pointy  and  fof^ 
lowing  the  upper  margin  of  the  clavicle,  was  extended 
outwards  a  distance  of  four  inches.  The  integument^ 
fascifld,  and  platysma  were  then  raised  and  turn^  aside. 
The  sterno-mastoid,  stemo-hyoid,  and  stemo-thyroid 
were  then  divided  as  near  as  possible  to  the  clavicle, 
and  dissected  up.  The  carotid  was  now  seen,  some- 
what enWgcd,  and  a  ligature  passed  around  it  without 
tyinff,  while  search  was  made  for  the  subclavian.  After 
carenil  dissection  a  ligature  was  passed  around  the  sub 
clavian  close  to  the  innominata.  The  carotid  was  then 
tied  one  hidf  inch  above  its  origin.  Search  was  now 
made  for  the  vertebral,  which  was  found  somewhat 
deeply  situated,  and  it  was  tied  a  quarter  of  an  inch 
from  Its  origin.  The  subclavian  was  then  tied  close  to 
tiie  innominata.  The  vessels  all  appeared  to  be  healthy ; 
the  wound  was  dosed,  and  cold  water  dressing  applied. 
The  case  progressed  exceedingly  weU  until  the  tenth 
day,  when  there  was  a  slight  haemorrhage,  which,  how- 
ever, was  easily  controlled. 

On  the  twelfth  day  the  ligature  from  the  vertebral 
art3ry  came  away. 

On  the  fifteenth  day  the  ligature  of  the  carotid  came 
away.  This  was  followed  oy  a  slight  hsmorrhage, 
■▼hicb,  however,  had  nothing  to  do  with  the  artery 


The  ligature  of  the  subclavian  came  away  on  the 
twenty-fourth  day. 

On  the  29th  of  September  there  was  a  slight  and 
easily  controlled  haemorrhage. 

Oct  1. — Suppuration  from  the  wound  was  very  free, 
although  nature  has  done  a  great  deal  towards  dosing 
the  wound,  the  tissues  having  gradually  broken  away 
under  the  influence  of  pressure,  and  the  persulphate  o/ 
iron  which  has  been  used  to  check  the  bleeding. 

Oci.  7.— Haemorrhage  to  the  extent  of  three  ounces, 
and  pietiy  free.  In  the  evening,  again,  hssmorrhage  one 
ounce.  He  rallied,  however,  from  all  this  until  the 
forty-second  day  after  the  operation,  when  hsemorrhage 
again  occurred,  and  he  died. 

The  autopsy,  which  was  made  by  Dr.  Sands,  will  be 
found  fully  reported  in  the  number  of  the  American  Med' 
tad  Hmee  previously  referred  to.  It  may  be  well  enough 
to  state,  however,  that  the  innominata  was  found  com- 
pletely filled  with  a  firm  cpagulum.  There  was  alio  a 
plug  in  the  distal  end  of  the  carotid,  and  in  the  distal 
end  of  the  vertebral.  The  distal  end  of  the  subclavian 
did  not  contain  any  clot,  and  water  injected  into  the 
aorta  made  its  eacape  from  the  wound  through  the  open 
mouth  of  this  arteiy. 
Nbw  Tobk,  87  East  IMi  Btr^t 


THE  MEDICAL  USE  OP  ELECTRICITY. 
Br  O.  M.  BEARD,  ILD.,  nm  A.  D.  ROCKWELL,  M.D., 

OF  KKW   TOBX. 

No.  in 

In  the  case  of  a  woman  afflicted  with  syphilitic  rheu- 
matism and  neuralgic  pains  of  the  left  shoulder,  we  were 
able  at  first  to  give  only  a  verv  temporary  relief  The 
first  dx  applications  enabled  her  to  raise  her  hand  to 
the  top  and  back  of  the  head,  which  she  had  not  been 
able  to  do  for  a  number  of  months ;  but  die  soon  re- 
lapsed, and  was  as  bad  as  ever.  8he  seemed  inclined  to 
persevere,  and  we  continued  to  give  her  applications  of 
the  faradaic  current^  descending  and  ascending,  alter- 
Lately,  over  the  affected  shoulder. 

Occasionally,  also,  we  operated  over  the  vital  organs. 
After  a  protracted  treatment  of  over  two  months,  we 
succeeded  in  greatly  relieving  her  neuralgic  symptoms. 
She  did  not  recover  the  fbllnse  of  her  arm.  although 
she  oould  easily  raise  it  to  the  top  and  back  or  the  head. 
Her  appetite,  which  had  been  poor,  decidedly  improved. 

Case  Filth. — Mrs.  R.,  of  Rochester,  a  married  lady, 
»t.  38,  came  to  us  in  August,  1866,  complaining  of  severe 
and  protracted  paroxysms  of  pain  in  tne  fourth  toe  of 
both  feet,  that  bad  distressed  her  for  eleven  vears.  Her 
story  was  a  singular  one,  but  in  its  essential  particulars 
was  typical  of  some  of  the  cases  that  we  are  called  upon 
to  treat  She  represented  that  for  a  long  time  hardly  any 
week  had  passed  in  which  she  had  not  suffered  pain, 
that  often  extended  up  the  leg  to  the  hip;  and  that  her 
mental  emotions — anxiety,  terror,  depression — at  once 
teleerapbed  themselves  to  the  diseased  nerve  and  ex- 
cited pain.  Her  general  health  was  onlv  fair,  and  her 
temperament  was  decidedly  nervous.  Sitting  too  long 
in  over-heated  rooms  or  in  crowded  assemblies — ^fii- 
tigue,  produced  by  any  cause,  even  the  annoyance  of 
listening  to  a  dull  sermon,  or  a  sight  of  a  strange  dergy- 
man  in  the  pulpit,  would  make  themselves  rait  in  the 
offending  members,  and  give  rise  to  intense  agony. 
There  were  no  evidences  of  inflammation  of  the  ^ues 
of  either  toe,  other  than  soreness  of  ihe  first  joint 
Eight  general  applications  of  the  descen(^ng  faradaic 
current  were  given,  but  the  patient  apparently  received 
no  benefit  C^  r^r^r-^\r->. 

Digitized  by  VjOOQIC 


THE  MEDICAL  BBCORD. 


Her  pains  still  oontinued  at  intenrals ;  nor  was  her 
general  condition  improved  as  much  as  usual  in  such 
eases.  Moreoyer,  slight  (edematous  symptoms  i^peared. 
She  left  us,  and  as  we  supposed^  entirely  discouraged. 

Four  weeks  4go,  she  came  into  our  office,  looking 
fresh  and  healthml.  She  said  that  for  three  months 
after  leaving  us  she  had  experienced  no  pain;  that  her 
general  health  also  steadily  improved ;  but  that  a  slight 
attack,  a  few  days  previous,  brought  on  by  a  cold,  had 
wam^  her  of  the  liability  of  a  recurrence  of  her  old 
paroxysms,  and  for  that  reason  she  desired  an  applica- 
tioD. 

There  can  be  little  doubt  that  she  is  destined  to  suffer 
other  attacks  at  times ;  for  if  the  theory  that  such  painful 
symptoms  are  caused  by  inflammations  withm  the 
eneath  of  the  nerve  be  true,  then  a  paroxysm  may  be 
faroaght  on  at  any  time  by  long-continued  exposure  to 
cold. 

Anjbhia,  Dtspspsia,  and  Geksral  Dxbilitt. — Our 
attention  was  first  called  to  the  utility  of  electricity  in 
dy^>ep8ia.  by  patients  who  were  treated  for  other  dis- 
eases, with  which  indigestion,  in  its  various  phases,  was 
complicated. 

Those  upon  whom  general  applications  were  made, 
reported  an  increase  of  appetite,  relief  of  constipation, 
diminution  in  the  frequency  of  attacks  of  sick  headache. 

Case  First— Mr.  S.,  of  Connecticut,  came  to  us, 
complaining  of  headache,  ringing  in  the  head,  vertigo, 
acidi^  of  Uie  stomach,  distress  uter  eating— in  short, 
of  all  the  usual  symptoms  of  dyspepsia,  flis  organiza- 
tion was  Aiatressingly  nervous^  AH  Lis  movements  were 
characterized  by  an  unusual  swiftness  and  haste.  In  his 
conversation,  business  and  pleasure,  the  world  and  reli- 
gion, were  strangely  mingled. 

We  half  suspected  incipient  insanity.  We  told  him 
that  the  treatment  would  be  protracted,  and  advised  him 
to  receive  an  application. once  or  twice  a  week,  at  least 
For  the  first  week  or  two  there  was  no  very  marked 
improvement,  although  he  said  he  always  felt  very  much 
exhilarated  after  each  application.  After  four  or  five 
sittings,  the  change  for  the  better  was  very  decided. 
Not  only  were  his  dyspeptic  symptoms  relieved,  but  his 
general  nervousness  was  dimiuiahed. 

His  appetite  was  less  capricious  and  exacting.  Said 
he,  ''Before  I  tried  electricity,  I  had  to  eat  seven  meals 
a  day ;  now  I  can  get  along  with  only  three."  His 
brain  seemed  to  progress  with  his  stomach.  His  con- 
venation  was  more  subdued  and  logical  When  we 
]a«t  saw  him,  he  was  a  calmer  as  well  as  sturdier  man, 
although  not  wholly  free  from  dyspeptic  symptoms. 

In  his  Cdse,  there  was  no  increase  of  muscular  deve- 
lopment, wluch  is  so  often  observed  after  repeated 
general  applications. 

Case  Second. — Mr.  T.,  a  bookseller,  aged  31,  stated 
that  for  a  number  of  years  he  had  suffered  from  chronic 
dyspepsia,  which  had  rendered  his  life  miserable.  He 
had  lost  much  in  flesh.  Although  5  fl.  8  in.  in  hei^t, 
his  weight  was  but  about  one  hundred  pounds.  He 
complaiDcd  of  regurgitations  from  the  stomach  of  an  in- 
tensely fiouT  liquid,  and  on  rising  in  the  morning  he  was 
often  troubled  with  porosis.  Tympanitis  was  a  frequent 
symptom,  and  oftentimes  the  accumulation  of  gas  with- 
m  the  stomach  embarrassed  the  respiration,  and  dis- 
turbed the  action  of  the  heart.  Treatment  was  com- 
meoced  abovt  the  middle  of  October,  1866,  and  oon- 
timied  for  four  weeks,  the  faradaic  current  bein^  applied 
three  times  each  week.  The  daOy  regurgitations,  the 
tympanitis,  and  pyrosis,  gradually  ceased  to  annoy  him ; 
and  after  the  tenth  application,  he  informed  us  that  du- 
ring the  month  he  had  increased  in  weight  some  fifteen 
poondu 


About  the  begii 
us,  stating  that  his 

total  increase  in  weignc,  since  ne  nrst  commencea  treat- 
ment by  electricity,  was  some  thirty  pounds.  He  said 
that  he  did  not  feel  that  his  digestive  organs  were  as 
strong  as  they  had  been,  before  he  was  attacked  with 
dyspepsia,  but  they  had  ceased  to  give  him  any  con- 
siderable annoyance. 

Case  Third. — ^M rs.  H.,  a  widow  lady,  aged  32,  came  to 
us,  Dea  Ist,  complaining  of  a  stiffness  of  the  left  knee, 
which  had  annoyed  her  for  more  than  fifteen  months,  to 
such  an  extent  that  at  times  she  was  absolutely  unable 
to  walk.  She  was  also  troubled  with  an  unpleasant 
cough,  and  some  difficulty  of  the  throat  Her  bowels 
were  much  constipated,  her  digestion  imperfect,  and  her 
circulation  languid. 

She  was  exceedingly  nervous,  and  at  times  her  sleep 
was  much  distorbed.  From  the  fact  that  other  joints 
were  occasionally  affected,  we  were  inclined  to  the  opi- 
nion that  rheumatism  was  the  cause  of  the  swelling  and 
stiffness  of  the  knee. 

General  tonic  applications  were  recommended,  down 
the  spine,  over  the  ston\ach,  liver,  and  bowels,  and  espe- 
cially over  the  affected  joint.  Immediate  relief  was 
experienced  afler  the  first  siance.  She  was  able  to  raise 
her  left  foot  foi^r  inches  from  the  floor,  and  the  pain  was 
greatly  soothed.  The  next  day  she  complained  of  some 
soreness,  which  is  very  often  the  case  after  the  first 
general  application.  The  same  treatment  was  continued 
for  one  month,  the  patient  visiting  us  three  or  four  times 
a  week.  We  examined  her  throat  with  the  laryngo- 
scope, and  found  a  slight  pharyn^tis  and  laryngitis, 
that  readily  yielded  to  topical  applications  of  nitrate 
of  silver.  The  improvement  was  more  rapid  than 
we  had  anticipated.  Her  appetite  became  exceedingly 
keen,  the  bowels  regular,  her  sleep  refreshing,  and  the 
color  returned  to  her  cheeks.  Moreover,  the  cough,, 
which  had  caused  her  much  unnecessary  alarm,  nearly 
disappeared.  The  patient  was  so  pleased  with  the  in- 
vigorating effects  of  the  applications,  that  she  persisted 
in  the  treatment  for  some  time  after  the  knee  had  ceased 
to  trouble  her.  A  short  time  ago  she  fell  and  injured 
her  knee,  causing  it  to  exhibit  inflammatory  symptoms, 
that  readily  yielded  to  a  repetition  of  the  same  treat- 
ment Her  general  condition  continued  to  be  excel- 
lent It  is  probable  that  she  will  have  recurrences  of 
thus  affection  of  the  joint 

AMSNORRnoBA. — ^Elcctricitv  has  been  used  for  both 
suppression  and  retention  of  the  menses,  by  several  con- 
tinental physicians,  and  with  excellent  results.  Dr. 
Garratt  treats  such  cases  continually  and  successfully. 

Dr.  Pordyce  Barker  has  reported  two  or  three  cases  of 
amenorrhoea  successfully  treated  by  electricity,  in  the 
New  York  Medieal  Journal* 

Case  First — ^In  the  early  part  of  September,  1866,  a 
young  lady  of  eighteen  came  into  our  office  and  inquired 
what  we  could  do  to  cure  her  disease  of  the  heart  Her 
speech  was  only  in  broken  utterances,  and  her  breath- 
ing was  short  and  rapid.  She  was  aecidedly  anaemic, 
and  had  been  troubled  with  amenorrhoea  for  two  months. 
The  patient  was  so  hysterical  that  the  first  application 
was  given  with  difficulty.  Whenever  the  strength  of 
the  current  was  much  increased,  faintness  was  at  once 
produced.  After  the  first  weeic,  however,  she  could 
bear  a  current  of  ordinary  strength  without  discomfort 

The  treatment  was  oontinued  for  one  month — ^the 
patient  visiting  us  every  other  day.  By  that  time  her 
apparent  cardiac  symptoms  had  disappeared ;  her  breath- 
ing was  more  natural;  her  cheeks  full  of  color,  and  her 


•  V0I.I.P.IS8. 

Digjtiz:ectby 


Google 


100 


T&B  MBUICAL  RECORD. 


step  more  firm.  Her  menses  returned  after  the  eighth 
application. 

Case  Second. — Miss  D.,  aged  25.  was  sent  to  us  by  Dr. 
James  L.  Brown,  to  be  treated  for  suppression  of  the 
menses,  caused  by  a  sea  voyage  five  months  previous. 
She  was  stout  and  vigorous,  and  complained  of  no  other 
symptom.  According  to  Di.  Brown's  diagnosis,  there 
was  no  org^ic  uterine  disease.  We  gave  her  a  gene- 
ral application  with  the  descending  uradaic  current 
The  next  da^  she  said  that  some  blood  had  appeared. 
The  application  was  repeated,  a  strong  current  passing 
over  tne  bowels  and  lower  portion  of  the  spine.  With 
that  utter  disregard  for  the  interests  of  science  that  is 
not  unconmion  with  that  class  of  people,  she  visited  us 
no  more.  Two  weeks  afterwards,  one  of  us  met  her  by 
chance,  and  ascertained  that  she  had  a  healthful  flow 
for  two  or  three  days  after  she  lefl  our  office. 

Case  Third. — ^In  the  case  of  a  Mrs.  L.,  aged  37.  also 
sent  to  us  by  Dr.  Brown,  we  were  not  as  successful ;  but 
the  case  is  of  interest,  as  exhibiting  the  tonic  effeo^ 
of  general  and  persistent  implications  of  the  induced 
current 

For  eighteen  months  she  had  not  seen  her  courses, 
although  she  had  been  skilfully  treated  for  a  long  time. 
Her  general  health  was  poor,  and  she  was  somewhat 
ansmia  Her  appetite  was  feeble  and*  capricious,  and 
her  rest  was  much  disturbed.  She  was  also  annoyed 
with  constipation,  and  with  neuralgic  pains  in  the  hip. 
She  was  so  near  the  change  of  life,  and  had  given  so 
little  evidence  of  yielding  to  her  previous  treatment, 
that  we  gave  her  but  slight  encouragement.  Six  or 
seven  applications  with  the  descending  faradaic  current 
were  given  with  good  results,  so  fer  as  her  general 
health  was  concerned ;  but  her  menses  did  not  appear. 
We  then  applied  the  positive  electrode  against  tne  os, 
and  swept  the  negative  over  the  lower  part  of  the  bow- 
els and  spine,  and  vice  versA,  until  we  became  convinced 
that  it  was  useless  to  continue  the  treatment  any  longer. 
When  she  left  us,  her  appetite  was  ttood,  and  her  bow- 
els r^^lar*  she  could  sleep  soundly,  and  no  longer 
experienced  the  neuralgic  paios-^but  there  were  no 
inaications  of  a  return  of  her  courses. 

We  believe  that  merdy  local  appUaUumSj  however  varied 
and  j^iutent  they,  may  6«,  wut  give  very  wncmiain  re^ 
sutU  tn  the  treatment  of  amenorrhwi, 

Chorba  or  St.  Vrnrs's  Danob. — ^This  strange  and  fre- 
({uent  malady  we  find  to  yield  to  repeated  tonic  applica- 
tions^ in  nearly  every  ease,  although  the  treatment 
must  often  be  quite  protracted. 

Mary  S ^  aged  14,  first  exhibited  symptoms  of 

chorea  in  the  nght  side  of  the  face,  and  m  the  right 
arm,  April,  1866.  She  grew  worse  slowly,  until  No- 
veml>er,  when  she  came  to  us  for  treatment  GKm- 
eral  tenic  implications  were  made  about  three  times 
a  week.  Over  the  cerebellum,  the  head  was  far  more 
than  ordinarilv  sensitive  to  the  current  After  two 
weeks  we  could  discern  not  the  slightest  improvement^ 
and  all  parties  concerned  apprehended  a  failure.  The 
treatment  was  continued  a  month  longer,  and  with 
most  pleasing  results.  She  had  good  control  over  every 
movement,  and  her  general  heSth  was  excellent  In 
all  cases,  we  find  that  the  spasms  diminish  in  proportion 
to  the  bettering  of  the  general  oondition. 

The  above,  both  in  its  results  and  in  its  difficmlties, 
is  typical  of  a  number  of  cases  that  have  come  under 
oar  treatment  To  what  extent  relapses  will  occur,  if 
at  all,  time  alone  can  determine. 

BHEUMATEBif  AKD  Paraltbis.— The  professiou  are  so 
familiar  with  the    i^fohs  of  electrical    treatment  in 


cases  of  paraly tio  and  i^eumatio  afiectioos,  that  it  seems 
almost  si^>erfluous  to  detail  our  experience  with  them. 
We  employ  the  induced  current  successfully  in  all  the 
stages  of  rheumatism.  Where  there  is  active  inflam- 
mation, the  cure  is  usually  more  sure  and  more  speedy 
than  in  passive  chronic  states.  Under  ihe  cairejvl  use 
of  the  aeecending  Juradaic  ewrentf  angry  joints  are 
soothed,  burning  pains  subside^  amd  the  fiery  skin  is 
reduoea  in  iemper(Uure,  Upon  these  &cts  of  our  eiq>e- 
rience,  we  lay  special  emphasis,  because  to  use  electri- 
city in  acdve  inflammation  is  contrary  to  all  the  teach- 
ings of  the  past  We  have  met  with  the  same  gratiQring 
results  in  our  applications  to  recent  sprains  and  acute 
conjunctivitis.  It  may  here  be  remarked  that  we  often 
fail  in  rheumatic  cases,  unless  we  employ  general  as 
well  as  local  applications.  The  ordinarv/ method  of 
passing  the  current  through  the  affectea  joints  only, 
usually  does  some  good,  but  rarely  works  a  cure. 

Case  First— C.  W.  R,  aged  25,  had  been  afflicted  with 
subacute  articular  rheumatism  for  more  than  three  years. 
At  times  he  would  seem  to  be  almost  entirely  free  from 
his  trouble ;  but  about  twice  a  year,  a  severe  attack 
would  come  on,  lasting  generally  from  two  to  three 
months.  In  the  middle  of  July,  1866,  after  several 
months  of  comparative  ease,  the  rheumatism  again 
showed  itself,  and  this  time,  with  but  little  delay,  he 
came  to  us  for  treatment. 

On  the  3d  of  Au°;ust,  when  first  seen,  his  right  anMe 
was  so  swollen  and  painful  that  he  could  with  difficulty 
ascend  th^  stairs  to  our  office.  His  left  shoulder  and 
hip,  together  with  several  of  the  joints  of  his  toes  and 
fingers,  were  also  somewhat  enlarged.  Ap'*plications 
were  given  at  first  every  other  day,  and  then  every 
third  day  for  tliree  weeks,  at  the  end  of  which  time  the 
swelling  in  all  the  joints  was  dissipated,  and  the  accom- 
panying pain  entirely  relieved.  According  to  his  state- 
ment the  patient  had  never  experienced  a  more  severe 
attack,  and  its  duration  had  invariably  been  fit>m  two 
to  three  months.  In  ihh  instance  he  suffered  but  for 
one  month  from  the  beginning  of  the  attack,  treatment 
having  been  commenced  after  the  lapse  of  about  fifteen 
days.  He  promised  to  report,  if  he  should  have  a 
return  of  his  difficulty,  but  up  to  this  time  (February, 
1867)  we  have  heard  nothing  from  him. 

Case  Second. — Miss  L.  was  a  sufferer  torn  severe 
pains  in  the  shoulder,  wrists,  and  manj^  of  the  joints  of 
the  fingers.  The  rignt  wr'st  was  considerably  swollen, 
together  with  the  second  joint  of  the  thumb,  third  joint 
oi  the  first  finger,  and  the  second  joint  of  the  secondL 
third,  and  fourth  fingers  of  the  right  hand.  Of  the  left 
hand,  the  third*  joint  of  the  first  finger  and  Uie  second 
joint  of  the  third  finger  were  enlarged.  Some  of  the 
joints  were  of  great  size,  and  this  state  of  thmgs  had  per- 
Biaied  with  little  change,  for  over  one  year.  Treatment 
was  commenced,  and  continued  for  three  weeks.  On  the 
arms,  hands,  and  fingers,  the  ascending  faradaic  current 
was  used  exclusivmy.  Thorough  applications  were, 
however,  made  over  the  digestive  organs,  particulaiiy 
the  stomach. 

AfUr  the  first  implication,  the  patient  expressed  her- 
self as  entirely  relieved  of  the  pain  in  the  shouMer.  The 
saocmd  sitting  served  to  dissipate  the  swelling  of  the 
wrists,  but  as  yet  no  decrease  was  observed  in  the  siae 
of  the  joints  m  the  fingers.  These,  however,  began  to 
yield  alter  the  fourth  application,  and  rapidly  d^reased 
m  siae  until  a  cure  was  effected. 

Time  must  decide  how  long  cases  like  these  wiH  re- 
main exempt  from  their  rheumatic  symptoms  afler  tbev 
have  been  once  dissipated  by  applications  of  electri- 
oity. 

.MI^,.,.  oig,,ed  by  Google 


THE  MBDIOAL  BSCIORD. 


101 


PROPOSAL  OP  A  NBW  MBTHOD 

VOB  FAOXUTATUfO 

THE    OPERATION    FOR    BADLY   UNITED 
FRACTURES, 

By  PRBDBRICK  D.  LENTB,  M.D., 

OF  00U>  SFROrO,  V.  T. 

Gallsd  recently  to  a  long  distance  from  this  place  to 
▼iaky  in  consultation,  a  case  erroneously  represented  to 
me  to  be  a  badly  united  fracture  of  the  bones  of  the 
1^,  of  some  eight  or  nine  weeks'  standing,  with  a  re- 
quest to  "  bring  ether  and  chloroform,  and  all  necessary 
iostnimenta,'*  and  thinking  over  the  means  at  m^  dis- 
posal for  effecting  an  improvement  in  the  anticipated 
defiwmity,  without  resorting  to  a  severe  operation,  I 
concluded,  in  ease  of  the  caUw  bein^^  fimuy  consoli- 
dated, to  adopt  Brainard's  method  (drilling  it  in  various 
directions  through  one  puncture  of  the  skin,  so  as  to 
weaken  it;  then  rupturing  by  forcible  extension  com- 
bined with  lateral  pressure  and  counter-pressure*)  viiien 
the  idea  occurred  to  me  to  try  an  improvement  d  this 
method  in  the  following  manner :  To  use  a  drill  of  very 
smaU  size  for  perforating  the  centre  of  the  callus  through 
a  mere  puncture  in  the  skin ;  then  to  follow  this  with 
an  instrument  which  I  shaU  call  a  8ubeutanm>u9  saw. 
The  teeth  only  extend,  from  its  rounded  points  about 
ooe  inch,  the  blade  being  smaller  than  the  dnlL  By 
this  arrangement  the  saw  may  be  worked  to  a  limited, 
though  a  suflkaent  extent  to  cut  throtigh  edS$u  very 
rapidly,  and  yet  not  to  touch  the  soft  parts  with  the 
teeth ;  and  may  be  turned  to  cut,  first  in  one  direction, 
and  then  in  another,  without  withdrawing  from  the 
poocture.  Should  there  be  any  important  vessel  or  nerve 
lying  in  dose  proximity  to  the  distal  side  of  the  cdUtUy 
which  the  end  of  the  saw,  though  bhmt,  might  irritate 
or  wound,  it  would  be  unnecessary  to  perforate  its 
whole  thickness;  nor  would  it  be  necessary  to  saw 
through  its  whole  substance  on  either  side,  as  a  portion 
could  be,  indeed  had  better  be,  ruptured  by  moderate 
foroa. 

I  As  it  turned  out,  no  operation  was  required 
in  the  case  above  alluded  to;  but  I  have  thought 
that  some  other  surgeon  might  wish  to  make  a 
practical  application  of  my  idea.  I  happened 
to  have  on  lund  just  the  instrument  which, 
witii  a  slight  aheratioo,  was  requisite;  one 
which  I  had  had  fashioned,  when  a  medical 
student,  for  making  curved  sections  of  the  tem- 
poral bone  for  exhibiting  the  different  parts  of 
the  auditory  apparatus  Sierein  contain^  It  is 
here  detineated  somewhat  reduced  in  size. 
The  advantage  of  this  instrument  in  certain 
cases  of  vicious  uniott  of  fracture  will  probably 
at  once  occur  to  the  mind  of  any  surgeon  w1k> 
b«  had  to  deal  with  such  cases.  The  treat- 
ment advised  in  the  standard  works  on  surgery, 
in  a  case  where  the  caUua  eaimot  be  rupturea 
by  a  safo  degree  of  force,  is  the  very  serious 
procedure  of  converting  it  into  a  severe  com- 
pound fractvre,  by  dividing  the  soil  parts  more 
or  less  extensively,  and  sometimes  removing  a 
portion  of  the  bone.  In  certain  cases  Uiis 
treatment,  or  even  the  more  serious  alternative 
of  amputation,  will  of  course  now  and  then  be 
required ;  but  it  is  to  be  hoped  and  expected 
that  the  plan  here  proposed  may  very  materi- 
ally diminish  the  number  ^  such  eases.  This 
treatment  is,  however,  not  oxAy  applicable,  it  is 

*  Dr.  BnliMrd  WM  Meliitoin«d  to  waH  *  '^•pMiiled  tim**"  after  drill- 
ai,  to  alow  tlio  eallm  to  boeome  softenea  boforo  eompleting  the 
"—^^  F.  D.  L. 


suggested,  to  cases  ot  very  firmly  consolidated  union,  but 
to  such  as  are  usually  treated  by  severe  pressure  and 
counter-pressure,  alone  or  combined  with  forcible  ex- 
tension ror  a  period  more  or  less  prolonged  j  since  the 
latter  procedure,  even  in  cases  admitting  of  its  success- 
frd  application,  is  tedious,  troublesome,  and  painful,  and 
not  unattended  by  danger.  The  existence  of  a  very 
considerable  overlapping  of  the  fragments  would  not 
necessarily  be  a  bar  to  the  adoption  of  this  treatment, 
since  I  have  known  a  case  treated  in  the  New  York 
Hospital  by  refracture  a  year  after  the  accident,  where 
the  shortening  of  the  femur  amounted  to  more  than 
three  inches,  and  was  reduced  to  less  than  one  inch  by 
the  operation. 

The  instrument  will  sometimes  be  found  useful  in 
another  and  entirely  different  class  of  cases.  Thus, 
two  weeks  ago,  I  was  called  to  a  case  of  compound 
fracture  of  bot^  bones  of  the  leg;  the  sharp,  bevelled 
extremity  of  the  upper  fVragment  of  the  tihia  protruding 
an  indi  through  a  small  wound.  It  was  reduced  with 
S0me  difficulty ;  but  three  days  a^o  it  was  found  again 
exposed,  in  consequence  of  sloughmg  of  a  portion  of  the 
integument,  and  evidently  doomed  to  necrosis.  I  was 
an^us  to  DO  rid  of  it ;  but  it  was  much  too  thick  to  be 
cut  off  bodily  with  the  bone-forceps,  and  a  chain-saw 
could  not  be  passed  around  it  and  worked  witliout  dis- 
turbing the  wound  and  the  fracture  very  much.  So, 
with  Sie  assistance  of  my  partner,  Dr.  Barker,  who 
^ervated  the  soft  parts  slightly  with  a  narrow  curved 
retractor,  I  let  the  point  of  the  saw  pass  under  them 
thus  guarded,  and  gently  sawed  through  the  hardest  part 
of  the  bone,  while  another  assistant  neld  its  extremity 
with  a  pair  of  suitable  forceps,  and  then  completed  the. 
section  with  one  clip  of  the  bone-forceps  without  ma- 
terially disturbing  the  limb,  which  hung  suspended  in 
Smith's  ^'  anterior  splint,"  and  with  very  trifling  pain 
to  the  patient. 

It  is  possible,  it  is  further  eoggested,  that  the  method 
might  be  applied  to  old  cases  otvamniied  fracture,  when 
it  is  expedient  to  fhtshen  the  fragments  by  removing 
their  smooth  and  rounded  extremities,  it  could  be 
more  effectually  and  rapidly  effected  in  this  maimer 
than  by  Uie  means  usually  employed,  and  through  a 
smaller  wound  of  the  soft  parts.  In  fact,  the  opening 
in  l^e  latter,  necessary  for  the  working  of  this  saw  in 
any  case,  need  not  be  larger  than  that  made  by  the 
smallest  tenotomy  knife,  and  would  probably  heal  in 
twenty-four  hours. 
Mamb  8,  ISST. 

Ths  Alumki  Associatioh  of  Bbllevtji  Hospital 
Medical  Oollboe  held  their  first  regular  meeting  at 
Belleyue  College,  February  28,  1867,  and  adopted  a 
constitution.  They  then  dected  the  officers ;  who  are 
in  future,  with  the  exception  of  the  Recording  Secre- 
tary, to  be  chosen  annually.  The  following  is  the  list 
of  officers:  For  President,  Dr.  W.  T.  Lusk;  Vice- 
President,  Dr.  J.  XJ.  Southack;  Recording  SeCTetary, 
E.  8.  Belden;  Corresponding  Secretary,  Dr.  L.  M. 
Yale ;  Treasurer,  Dr.  H.  Rapm^el ;  Executive  Commit- 
tee, Drs.  L.  B.  Irish,  J.  Ferguson,  Griffin  H.  Rockwell, 
J.  B.  Done,  W.  H.  Van  Wyck,  C.  A.  Leal,  W.  C.  Oste- 
loh,  P.  A.  Castle,  W.  A.  James,  B.  8.  Thwnpson,  J. 
Cushman,  P.  R.  Cortelyou,  C.  F.  Roberts,  and  R.  A. 
Vance.  Prof.  James  R.  Wood  has  offered  to  the  asso- 
ciation a  prize  of  one  hundred  dollars,  for  the  best  essay 
on  any  subject  connected  with  Surgical  Pathology  or 
Operative  Surgery ;  to  be  awarded  at  the  annual  meet- 
ing in  1869,  at  which  time  the  said  essay  is  to  be  read. 
The  Committee  to  examine  the  ei^s^nd  award  the 
priie,  is  to  consist  of  Professors  W.  H.  Van  Buren, 
Austin  Flint,  Sr.,  and  Stephen  Smith.  ^  t 

digitized  by  VjOOQIC 


102 


THE  MEDIOAL  RECORD. 


©rifiinal  Cetturw. 


SCROFULOSIS  AND  TUBERCULOSIS. 

BXINa  A  LSOTURB  BBFORI  THE  CLASS  OT 

THE   JEFFERSON   MEDICAL   OOLLEGB. 

Session  1866-7. 

Bt  S.  H.  DICKSON,  M.D., 

pBomsoi  or  tbxokt  ajid  pBAonoi  or  iaa>iciR& 

Pabt  IIL 

TuBEBOULOSis  differs  from  scrofulosis  ia  this,  that 
supposing  a  general  constitutional  deterioratioa  or 
cachexia,  it  has  but  one  manifestation^  we  know  it  but 
one  way,  and  that  i3  by  the  deposit  of  a  particular 
matter.  It  is,  as  Y ogel  calls  it^  a  protein-K^ompound  con- 
sisting of  an  amorphous  stroma  (which  is  at  firdt  probably 
deposited  in  a  fluid  state),  with  some  earthy  salts,  and 
with  a  certain  amount  of  &t.  There  is  albumen,  as  the 
base,  or  fibrine,  unquestionably.  We  find  it  in  yarious 
conaitions,  very  rarely  in  the  fluid  state ;  rarely  in  the 
colloid  or  jelly-like ;  yet  it  is  sometimes  found  so,  as  is 
afiBrmed  by  (jarswell  and  others.  When  we  first  meet 
with  it^  generally  it  is  as  the  grey  or  miliary  tubercle. 
What  is  it  ?  Who  knows  ?  Microscopists  haye  failed  to 
tell  us  clearly;  the  chemists  have  failed;  there  is  greAt 
diflerence  of  opinion  as  to  its  nature.  Addison  says  it  is 
the  white  corpuscle  of  the  blood  "  stagnated  and  con- 
yerted;"  Virohow  says  it  is  "inspissated  pus;"  if  so  a 
blood  corpuscle,  a  pus  OOTpuscle,  and  a  tubercular  cor- 
puscle, are  the  same.  You  will  find  if  you  trace  up  the  ya- 
rious opinions  and  conclude  that  concrete  pus  and  tubercle 
are  the  same,  you  have  nothing  bnt  the  corpuscle  to 
constitute  thui  peculiar  morbid  matter,  the  yery  presence 
of  which  strikes  eyery  one  with  dread.  At  first  we 
find  it  as  grey  matter;  it  soon  degenerates  into  the 
yellow  tuberde,  distinguished  ohemically  by  a  greater 
amount  of  adipose  matter.  Is  this  a  degeneracy  ?  If 
ao,  it  would  seem  that  we  do  not  follow  nature  when  we 
giye  the  oily  diet  to  a  tuberculous  patient.  Robin 
doubts  whether  this  grey  matter  is  tubercle ;  he  thinks 
it  can  be  distinguished  firom  ir^  and  that  tubercle  is 
always  deposited  as  the  yellow  matter.  Ton  find  this 
grey  matter  in  many  positions  in  which  the  yellow*is 
never  found,  as,  for  instance,  in  tubercular  meningitis, 
to  which  many  ascribe  the  presence  of  hydrocephalus. 
Theselittle  points  which  haye  been  considered  tuber- 
cular are  of  the  grey  tubercle,  and  never  degenerate; 
the  yellow  mass  is  neyer  found  there.  Yirchow  speaks 
of  tubercle  very  contemptuously ;  he  says  it  is  a  pitiful 
birth,  a  very  small  cell.  The  tuber  neyer  enlar|B;e8 ;  the 
tubercle  enlarges  by  agglutination,  only  differing  from 
the  cancer  cell  because  it  is  larger.  Yirchow  says,  ^if 
you  do  not  know  where  it  comes  from,  you  do  not 
know  what  it  is ;"  and  says  that  tubercle  is  nothing  but 
concrete  pus;  and  as  the  cancer  cell  differs  only  in  siee, 
you  haye  no  difference  histologically  between  a  pus 
corpuscle  and  a  cancer  cell 

As  we  meet  with  tubercle,  it  is  most  frequently 
found  in  the  lung,  and  upon  mucous  sur&ces.  Carswell 
oontends  that  it  is  upon  the  mucous  surface  that  it  is 
usually  deposited.  It  takes  the  mould  of  the  part  on 
which  it  is  plaeed.  It  must  be  deposited  in  a  fluid  state, 
but  goes  on  to  accumulate  in  masses.  Louis  says  you 
will  never  meet  with  it  elsewhere  without  finding  it  in 
the  lung  also.  Whereyer  you  do  meet  with  tubercle  it 
seems  to  haye  a  particular  tendency  to  fix  its^f  in 
one  part  of  that  organ.  Thus  it  is  much  more  likely  to 
^  found  in  the  apex  of  the  lung  than  in  any  other 


part ;  so  in  a  particular  part  of  the  brain  rather  than 
any  other;  it  is  found  in  the  ileum  rather  than  in  any 
other  part  of  the  intestine.  It  is  found  in  the  cayity  of 
the  uterus  at  times.  There  is  no  or^an  of  the  body  in 
which  tubercle  may  not  be  deposited;  but  wherever 
found,  it  has  a  particular  locality  in  reference  to  the 
structure  of  that  organ  where  it  is  usually  found.  This 
peculiarity  has  not  yet  been  explained. 

The  tubercle  is  usually  contained  mthin  its  own  cdl- 
wall,  not  in  a  cyst.  It  is  debated  whether  it  contains 
nuclei  or  not  All  ^e  changes  which  go  on  in  the 
tubercle  commence  in  the  centre.  Yirchow  speaks  of 
it  as  a  pitiful  product  Carswell  says  it  is  uncxganizable. 
It  has  been  conyeyed  by  inoculation  to  a  healthy  animal, 
and  has  there  germinated.  The  highest  proof  of  vitality 
that  1  can  conceive  of  physiologically  is  the  germinal 
power.  This  looks  as  if  Laennec  and  Baron  were  rieht 
when  they  ascribe  to  it  a  sort  of  individuality.  We 
find  that  a  tubercle  communicates  tuberculosis  from  a 
diseased  to  a  healthy  animal ;  therefore  it  is  not  unor- 
ganized, unorganizable ;  it  possesses  its  own  vitality, 
which  must  be  of  high  order. 

How  does  a  tuberde  change  from  the  centre  ?  This 
fiict  was  a  great  obstacle  to  tnose  who  believe  it  unor- 
ganizable. The  most  important  chan^  is  softening, 
which  begins  the  process  of  death  m  phthisis.  A 
tubercle  itself  does  not  seem  to  be  injunous  but  by 
softening.  If  you  turn  over  Aitken's  pages  you  find  a 
remarki^le  contradiction;  he  admits  on  one  page  that 
it  is  often  deposited  independent  of  inflammation ;  read 
on  a  little  further  and  he  comes  to  speak  of  tuberculosis, 
and  says  we  have  hardly  a  right  to  speak  of  tubercular 
deposition — ^it  is  only  a  tubercular  form  of  inflamma- 
tion. 

Tubercle  is  often  entirely  indolent.  On  the  dissect- 
mg  table  you  will  meet  with  cases  where  you  will  find 
tubercle  around  which  there  is  no  chans;e  of  condition 
or  of  the  tissue  in  which  it  is  deposited,  inflammatory 
or  otherwise ;  perhaps  a  little  thickening  or  hardeninf^, 
which  may  be  the  result  of  mere  pressure ;  yet  it  is 
often  deposited  under  the  excitement  of  inflammation 
as  a  result  of  the  hyperemia  which  belongs  to  the  his- 
tory of  tuberculosis. 

Lebert  says  that  tuberculosis  attacks  the  internal 
organs ;  scrofulosis  the  skin  and  periosteum.  We  have 
attempted  to  show  that  scrofula  does  not  occur  from  any 
one  smgle  cause ;  that  a  concurrence  of  circumstances 
must  act  upon  the  subject^  and  act  slowly,  to  produce 
this  cachexia.  I  beheve  that  point  may  be  considered 
as  settled.  Dr.  McConahey,  of  Ohio,  maintains  the  old 
belief  that  the  use  of  the  hog  as  food  is  the  sole  cause  of 
scrofula,  and  that  those  only  who  use  the  iiog  in  various 
modes  as  food  are  subject  to  it  I  have  no  doubt  that 
this  animal,  of  all  others  used  as  food,  is  the  most  fi«- 
quentiy  diseased.  All  wild  animals  become  tuberculated 
in  confinement;  I  will  not  say  scrofulous.  I  examined 
a  Uon  who  died  in  one  of  our  menageries.  I  found 
tubercle  in  all  the  organs  of  the  animal's  body.  Sauvag  8 
calls  Uie  farcy  of  the  horse  a  scrofula ;  monkeys  in  the 
zoological  gardens  die  of  consumption  tuberculated.  The 
horse  is  a  very  delicate  animal  when  tampered  by  domes- 
tication. All  domestic  animals  become  delicate  except 
Uie  cat;  this  animal  seems  to  retain  its  tenacity  for  its 
nine  lives  whether  wild  or  tame,  and  is  the  only  animal 
domesticated  without  deterioration  of  its  powers  of  life. 
But  while  we  find  that  scrofula  is  hot  very  readily  mani- 
fested primarily  on  the  external  surface  in  those  subjeota 
in  whom  we  recognise  the  affection  in  the  lymphatic 
glands  as  separate  from  tubercle, — while  we  are  dear 
on  this  subject,  as  requiring  climate,  diet,  atmospheric, 
hygienic,  and  odier  influences  to  produce  this  cachexia, 
we  know  that  the  separate,  modinedj^r  distinguishable 

digitized  by  VjC  „      ^_ 


THE  MEDICAL  BBOOBD. 


103 


cachexia  tuberculosis  is  producible  rapidly  and  under 
morbidly  favorable  circumstances.  If  typhosis  is  tuber- 
cnkwis — but  when  there  is  a  deposit  I  suppose  it  to  be 
tubercular,  for  we  are  told  you  cannot  distinguish  it 
from  tubercle, — ^we  find  in  typhus  fever,  very  frequently, 
sadden  tuberculosis.  Bell  says  this  is  common  in 
Glasgow,  and  you  find  it  occur  occasionally  everywhere ; 
both  in  true  typhus,  and  perhaps  more  especially  in 
typhoid  fever,  the  patient  frequently  dies  of  tubercu- 
losis—of the  lung  even — when  not  suroected  of  haviuR 
tubercles.  How  is  it  produced  ?  By  the  vitiation,  shall 
we  say.  of  the  fluids?  of  the  solids,  too,  then ;  how  shall 
we  make  a  distinction  between  them?  The  question 
has  been  asked  concerning  many  cachexias  and  morbid 
diatheaea  where  do  the^  arise,  in  the  solids  or  in  the 
fluids  ?  I  once  thought  it  a  matter  of  some  consequence 
to  determine  this  point;  I  now  regard  tbe  solids  and 
fluids  physiologically  as  the  same — me  blood  is  floating 
flesh.  If  we  believe  the  doctrine  of  correlation  of  forces 
we  must  believe  that  heat  is  a  mere  dynamic  force^  to 
use  a  tautology.  I  am  not  a  believer  in  this  doctrme, 
yet  it  has  its  value  and  there  is  a  certain  amount  of 
truth  in  it  Take  an  egg  in  its  natural  condition ;  you 
say  that  it  is  fluid,  nothing  solid  about  it  but  the  cell-wall ; 
the  yolk  itself  ia  composed  of  cells  and  is  a  fluid ;  but 
now  you  expose  it  to  heat — ^a  mode  of  motion,  says 
Tindail — and  what  hi^pens?  Is  there  any  diflferenoe, 
then  ?  Can  you  say  of  an  egg,  as  the  source  of  all 
peculimrities  as  well  of  health  as  of  disease,  that  it  is  the 
fluids  or  the  solids  which  are  concerned  ?  By  subtract- 
ing heat  you  cannot  bring  the  egg  back  again  to  a  state 
of  fluidity,  though  you  can  water,  which  has  been  firocen 
B<£d,  by  supplying  it  Thus  we  may  argue  that  the 
fluids  and  sohds  are  the  same  Mt  is  a  question  of  dis- 
tinction without  a  difference.  We  do  not  know  where 
the  evfl  begins;  everything  is  fluid,  and  everything  is 
solid ;  the  same  atom  fixed  at  one  moment  is  flowing  at 
the  next  The  blood  is  not  a  solution  of  solids  in  water, 
it  is  an  interfusion  of  solids  in  water.  It  is  impossible, 
logically  or  pathologically,  to  distinguish  between 
land  ac^ds. 

The  evil  begins  unquestionably,  as  we  see,  in  the  very 
genu  itself  Foetuses  are  bom,  dead  perhaps,  living 
perhaps^  but  tuberculated.  There  are  two  such  in- 
•tanoes  mentioned  in  your  text-book,  of  tubercles  formed 
in  the  lung  before  birth.  The  child  is  often  bom  scr<^- 
VntL  as  we  see  by  the  condition  of  the  skin,  so  that 
boCn  these  forms  are  transmissible  from  the  earliest 
periods  of  existence.  The  subsequent  developments 
are  different  and  therefore  antithetic,  and  assist  in  sepa- 
nting  them.  When  we  deal  with  scrofiila,  everythmg 
we  see  on  the  surface  is  of  an  inflammatory  character, 
modified ;  on  the  eye,  on  the  &ce,  little  vehicular  points 
containing  lymph — I  have  watched  them  scores  of  times. 
Ws  dries  and  a  little  ulcer  forms,  which  heals  for  the 
most  part  readily ;  as  soon  as  the  ulcer  ceases,  she  red- 
ness disappeanLand  everything  is  right  except  a  little 
opaque  i^t  This  will  happen,  sometimes,  upon  the 
cornea,  i  on  find  the  Meibomian  glands  exposed  to 
iiritation  and  inflammation ;  and  scrofulous  eyelids  are 
very  common;  sometimes  the  resulting  thickening  will 
hst  a  whole  life,  the  patient  being  very  susceptible  to 
the  ibrination  of  styes.  The  various  cutaneous  affec- 
tioos  are  all  inflammatory ;  so  are  the  affections  of  tbe 
riaods:  and  the  changes  in  the  glands,  notwithstanding! 
rnC  Flint,  whose  book  I  so  of^n  press  upon  you  as 
worthy  yonr  most  careful  study,  says  that  the  condition 
of  the  gland  is  very  similar  to  the  condition  of  the 
tuberculated  swelling.  Far  from  it :  there  is  no  tuber- 
Qdar  deposit  in  the  £^nd;  it  is  a  cnange  there,  corre- 
sponding to  tiiat  going  on  in  the  formation  of  an  abscess, 
ttd  in  the  oentre  there  will  be  formed  pus;  or  in  some 


part  of  it,  after  it  thickens  and  hardens,  like  a  common 
phlegmon,  you  will  find  it  soften.  Pus  is  formed  in 
that  strange  way  in  which  blood  corpuscles  are  converted 
into  pus  corpuscles ;  but  tubercular  deposit  does  not  take 
place;  sometimes  it  wiU  be  laudable  pus.  Sometimes 
it  breaks  down,  becomes  oily,  curdy,  etc.,  but  still  it  is 
inflMnmation^  and  is  to  be  treated  as  such.  You  leara 
to  do  with  it  all  that  is  necessary  in  the  case  of  an 
abscess ;  you  poultice  it,  you  open  it,  so  that  it  shall  not 
cause  an  unsightly  scar  by  opening  of  itself;  but  in 
tuberculosis  this  does  not  liappen. 

Every  living  thing  increases  and  undergoes  changes 
from  the  centre.  It  has  been  a  great  puzzle  to  man^ 
pathologists  to  know  why  tubercles  soflen,  undergo  their 
change,  in  the  oentre  first,  as  a  general  rule ;  but  so  it 
does  in  the  glands,  though  it  is  a  different  chanpre.  What 
is  the  change  taking  place  in  a  tubercle  ?  There  are 
several  such  changes;  one  is  the  soflening  witli  which 
you  have  much  to  do  in  phthisis.  This  is  a  very  impor- 
tant change;  it  is  always  attended,  as  far  as  we  know, 
with  inflammation  around  it;  it  excites  inflammation 
near  it,  breaks  and  softens.  It  undergoes  other  changes 
which  are  contrasted  with  the  softening,  in  that  thejr 
tend  towards  the  healing  condition.  Obsolescence  is 
one ;  the  tubercle  seems  to  lose  its  normal  form.  Vir- 
ohow  insists  that  tubercle,  itself  never  masses  itself; 
that  it  is  an  agglutinated  condition ;  it  always  consists 
of  crey  masses  of  little  tubers,  which  do  not  coalesce  in 
their  ordinary  condition;  they  are  always  tubercles, 
therefore  the  appropriateness  of  the  diminutive.  Beale 
says  that  these  changes  in  the  oentre  are  a  peculiarity  of 
life  itself  When  the  obsolescence  commences  in  the 
centre  it  becomes  like  old  cheese,  often  as  hard  as  horn, 
and  in  this  state  it  is  only  mechanically  an  irritant  for  a 
little  time,  and  becomes  afterwards  entirely  indolent 
and  does  no  harm.  It  undergoes  another  change.  An 
absorption  takes  place  of  the  animal  matters,  the  albu- 
minous and  fiitty,  etc.,  leaving  the  earthy  matters,  and 
you  have  a  cretaceous  substance  left;  there  which  is  some- 
times spit  up,  and  the  patient  gete  well,  with  a  pucker- 
ing of  the  lung.  If  it  is  not  q)it  out  it  is  in  an  indo- 
lent condition,  and  is  nothing  more  than  a  mechanical 
irritant  It  is  the  softening  .of  the  tsobercle  that  is  a 
specific  and  dangerous  element  Again,  osseous  matter 
is  sometimes  deposited  strangely  enougn.  Under  what 
peculiarity  of  circumstances  the  tubercle  becomes  osse- 
ous, we  c(o  not  know;  but  when  it  does  become  so,  it 
ia  only  a  mechanical  difficulty,  and  does  not  do  any 
harm.  Now,  these  changes  do  not  occur  in  the  scrofu- 
lous affections.  They  are  marked  in  their  difference  in 
this  req>6ct,  and  thus  we  separate  the  two  diseases  to  a 
certain  extent  I  acknowledge  that  thejr  run  together 
to  a  certain  degree.  Another  writer  says  that  scrofu- 
losis  is  curable,  and  tuberculosis  incurable.  I  do  not 
think  this  is  a  matter  of  certainty.  Le  Grand  maintains 
that  in  scrofula  the  blood  is  impoverished,  and  the  inflam- 
matory element  is  taken  away ;  on  the  other  hand,  that 
tubercle  implies  the  retention,  at  least,  of  that  portion 
of  the  blooa  which  is  liable  to  inflammation.  Ringer 
and  Dr.  Parkes  have  been  making  some  careful  experi- 
ments with  the  thermometer,  and  they  maintain  that 
in  all  cases  while  tuberculosis  is  going  on,  the  heat 
of  the  body  rises  above  the  average  rate^ — rises  up  to 
102**  P.,  perhaps— and  this  for  a  length  of  time.  They 
do  not  give  us  any  experiments  upon  the  condition  oi 
the  body  while  a  scrofulous  gland  is  undenfoing  inflam- 
mation. In  many  of  these  oases,  the  inflammation  ii 
enough  to  produce  fever,  and  the  thermometer  would 
show  the  increase  then.  Sometimes  they  go  on  with- 
out affecting  the  constitution  with  fever.  It  is  certain 
that  when  the  tubercle  begins  to  soften,  this  is  the  fact ; 
hectic  fever  is  fUUy  developed,  and  thei^ifferent  parts 

digitized  by  VjC  „      ^_ 


104 


THB  MEDICAL  BECOBD. 


around  the  tabercle  undergo  a  decided  change.  Not 
80  with  the  scrofulous  gland,  which  does  not  necessa- 
rily inflame  the  parts  about  it  to  any  great  degree, 
though  there  is,  or  course,  some  irritation  of  the  parts 
around.  It  is  important  to  get  rid  of  scrofttla,  to  under- 
stand the  nature  of  the  hypenic  conditions  which  favor 
it,  and  the  hyeienic  conditions  opposed  to  it 

We  do  not  know  entirely  the  condition  of  savages, 
yet  I  do  not  believe  that  they  are  free  altogether  from 
tuberculosis;  this  can  be  built  up  suddenly.  I  do  not 
know  that  there  is  any  proof  of  scrofulous  affections 
attacking  the  savage,  or  half-barbarous  man,  living  in 
a  wild  state^  and  in  a  ffood  climate.  Our  navigators 
tell  us  nothing  of  scromla  affecting  the  natives  in  the 
cold  countries;  and  in  warm  climates,  the  frequent 
exposure  to  the  open  air  prevents  the  occurrence  of 
scrofula  pretty  effectually.  We  know  less  of  scrofola 
in  warm  ctimates  than  in  temperate  and  colder  ones; 
not  on  account  of  the  temperature,  but  on  account  of 
the  housing  up  and  avoiding  of  fresh  air  to  protect 
from  the  cdd.  * 


Eq)0rtd  0f  I§00))ital2. 


LONG  ISLAND  COLLEGE  HOSPITAL. 
CuNic  or  Pbof.  Austin  Flint. 

CASES  OF  HEART  DISEASE. 

0 ASB  L —  Valvular  Lenoru :  AorUc  Direct ^  and  Aortic 
Regurgitant  I£urmur$, 

History. — John  Schantz,  et.  fifry  years,  a  shoemaker. 
He  scates  that  for  several  years  he  has  experienced  de- 
ficiency of  breath  on  exercise,  and  occasional  palpita- 
tion. Complains  of  a  sense  of  distress  referred  to  the 
prseoordia,  and  latteriy  has  suffered  lancinating  pain  in 
this  region,  shooting  throngh  to  the  shoulder-blade. 
Seldom  has  ooueh ;  never  had  dropsy ;  pulse  is  feeble, 
somewhat  irregular,  quick,  and  jertdng.  Visible  pulsa- 
tions in  the  carotid  arteries  are  strongly  marked.  He 
is  notably  ansBmio;  appetite  poor;  bowels  regular. 
Never  had  artienlar  rheumatism. 

Physical  JBxamination, — The  pulmonary  organs  are 
normal  The  impulse  of  the  apex  beat  is  in  the  fifth 
intercostal  space,  and  frJls  in  a  vertical  line  pasnng 
through  the  nipple.  Percussion  reveals  only  modertde 
enlargement  of  the  superficial  or  deep  cardiac  regions. 
On  applying  the  stethoscope  over  different  portions  of 
the  heart,  two  murmurs  are  discovered,  viz.  aortic 
direct,  and  aortic  regurgitant  The  latter  has  its  maxi- 
mum of  intensity  over  the  body  of  the  organ,  near  the 
nipple.  It  is  feeble,  but  still  appreciable  at  the  base. 
The  former  is  heard  loudest  over  the  base  of  the  heart. 
It  occurs  with  the  first  sound,  and  is  propagated  into 
the  carotids. 

B.    Tinct  Perri  Mur.,  fl.  |  i. 
Sig.    20  drops  three  times  a  day. 

Moderate  exercise  in  the  open  air,  and  a  nutritious 
diet,  were  also  advised. 

Progrem  of  the  Case. — ^March  20,  patient  has  continued 
to  take  the  medicine  for  two  weeks.  He  reports  that 
he  feels  better.  The  pain  has  lefr  hkn,  and  his  appetite^  murmcv. 
and  strength  are  improving.  He  was  advised  to  con- 
tinue the  same  plan  of  treatment^  having  reference  to 
his  anesmia  and  general  condition. 

Commsnils. — ^£idocardial  murmnrs  are  termed  dia»- 
tolic  or  systolic,  according  as  they  oocur  during  the 
diastole  or  systole  of  the  vei^trides.  Thus  the  mitral 
regurgitant  and  the  aortic  direct  are  systolic;  the  mitral 


direct  and  the  aortic  regurgitant  are  diastolic.  Corre- 
sponding murmurs  referred  to  the  tricuspid  and  pulmo- 
nic semuunar  valves  are  of  extremely  rare  oecurrence. 
The  localization  of  cardiac  murmurs  does  not  invc^ve  so 
g^at  a  refinement  in  the  application  of  the  principles  of 
physical  exploration  as  those  who  have  paid  no  atten- 
tion to  the  subject  are  apt  to  imagme.  Fractioe  only  is 
requisite  to  enable  the  auscultator  to  readily  refer  them 
to  theu*  proper  source.  It  is  only  when  the  normal 
rhythm  of  the  heart-sounds  is  greatly  disturbed  by 
irregular  or  excessive  action,  that  much  difficulty  is  ex- 
perienced. 

The  points  which  require  attention  in  the  discrimina^ 
tion  of  murmurs  are  chiefly  three,  viz.  the  situation  of 
the  maximum  of  intensity,  the  direction  in  which  they 
are  best  propagated,  and  their  rdation  in  point  of  time 
to  the  normal  heart-sounds. 

A  murmur  occurring  with  the  first  sound,  heard  with 
its  maximum  of  intensity,  at  or  near  the  apex  of  the 
heart,  and  best  propagated  laterally  towards  the  lower 
angle  of  the  scapula,  can  be  no  other  than  a  mitral  re- 
gumtant  A  murmur  heard  during  the  same  interval 
of  time,  loudest  at  the  base  of  the  heart,  and  propagated 
in  the  oirection  of  the  large  yessels,  must  be  an  aortic 
direct. 

Again,  if  the  murmur  be  confined  to  a  circumscribed 
space  near  the  apex,  preceding  and  endinj^  with  the 
first  somid,  it  is  mitral  direct.  And  lastly,  if  the  mur- 
mur be  heard  over  the  body  of  the  organ,  occurrinjg 
with  the  second  sound,  it  is  aortic  regurgitant  This 
murmur  has  been  erroneously  stated  to  have  its  maxi- 
mum of  intensky  over  the  base  of  the  heart 

By  doe  attention  to  these  points,  even  when  several 
murmurs  coexist,  they  can  generally  be  distinguished 
without  difficulty. 

It  wouki  appear  that  the  mitral  direct  and  the  aortic 
regurgitant  murmur,  by  both  occurring  in  the  same 
interval  of  time,  and  being  heard  over  the  same  region 
c^  the  heart,  might  occasion  coofhsion ;  but,  practicnQy, 
these  murmurs  are  as  readily  distinguished  as  others. 
The  former  is  really  more  closely  associated  with  the 
first  than  second  sound.  It  is  sometimes  called  pre- 
systolic. It  b^ns  feeble,  and  gradually  increases  in 
intensity,  untU  it  is  finally  cut  uiort  by  the  doeure  of 
the  mitnl  valve.  It  also  possesses  a  peculiar  vibratory 
quality  which  is  quite  diatmctive. 

The  aortic  regurgitant,  on  the  other  hand,  is  more 
closely  associated  with  the  second  than  the  first  sound.  It 
begins  with  its  maximum  of  intensity  and  gradually  dies 
away.  It  is  often  useful,  in  identifying  the  first  sound, 
to  recollect  that  it  occurs  synchronously  with  the  im- 
pulse in  the  carotid  artery. 

Cardiac  murmurs,  although  interesting  as  exemplify- 
ing the  wonderfiil  precision  to  which  the  art  of  physusal 
diagnosis  has  attained,  yet  derive  their  chief  practical 
importanoe  firom  their  connexion  with  the  valvolar 
lesions  which  they  represent  We  should  never  aMmdti 
too  great  importance  to  the  presence  of  a  mere  cardiac 
murmur,  since  neither  the  mtensity  nor  quality  of  a 
murmur  affords  any  criterion  of  the  amount  of  damage 
which  the  valve  has  sustained.  The  most  serious  lesions 
are  often  found  associated  with  feeble  murmurs,  and,  mes 
vertdj  a  trivial  lesion,  which  involves  neither  obstruction 
nor  regurgitation,  not  unfirequentiy  eives  rise  to  a  loud 
murmur.  Thus  a  littie  roughness  of  the  curUins  or  seg- 
ments of  a  valve,  caused  by  a  small  deposit  of  lymph  m 
endocarditis,  while  occasioning  but  Httle  or  no  impair- 
ment of  its  functions,  may  yet  be  sufficient  to  produce 
a  very  loud  murmur.  The  term  '^  Regurgitant,^'  there- 
fore, used  to  designate  murmurs,  is  open  to  objection, 
as  finequentiy  involving  a  misnomer.  Assumhig  that  we 
possess  the  means,  in  any  given  case^d*  deciding  whether 

Digitized  by  VjC  „       ^_ 


THE  MEDICAL  RECORD. 


105 


Um  lesion  has  actually  occasioned  insufficiency  of  the 
Tthe — and  this  point  we  may  generally  detennine  by 
characters  relating  to  the  poise,  diffusion  of  the  mur- 
mnr,  and  other  si^s— more  ezpressiYe  terms  wouW 
be,  •'Aortic  Diastohc  with  Regurgitation;"  and  so  also, 
"lObral  Systolic  with  Regorgitation,"  ot  **  Mitral  Sys- 
tolic without  Eeffurgitation."  We  may,  by  means  of 
the  stethosoope,  directly  iuterrogiate  the  valves  in  audi 
a  manner  as  to  derive  information  respecting  their  phy- 
sical condition,  and  thereby  ascertain  to  what  extent 
their  function  is  impaured,  if  at  all  This  is  an  important 
^yplication  of  auscultation,  to  which  attention  has  espe- 
cuill^  been  called  of  late.  It  consists  in  comparing  ^e 
aortic  and  pulmonic  second  sounds  by  listening  over  the 
fBlpons  where  they  are  respectively  heard  with  their 
mazhnum  of  intensity.  These  regions  are  in  the  second 
intercostal  spaces,  near  to  the  sternum,  on  the  right  side 
and  on  the  left.  Normally,  the  aortic  second  sound  has 
a  greater  intensity  than  the  puhnonia  Now,  the  effect 
01  lesions  involvmg  obstruction  or  insufficiency  of  the 
valves  is,  after  a  time,  to  weaken  the  aortic  second 
soond,  and  thereby  renoer  the  pulmonic  relatively  more 
intenae.  Whenever,  therefore,  on  comparing  the  aortic 
ttid  pulmonic  second  soundsi  we  find  their  normal  rela- 
tion of  intensity  preserveo,  though  a  loud  murmur 
should  coexist,  we  may  yet  safely  infer  Uiat  it  denotes 
but  a  trivial  lesion,  and  that  the  valve  still  performs  its 
fhnction  well  It  thus  i^pears  that  endocardial  mur- 
murs, though  interesting  and  important,  as  implying  the 
existence  seat^  and  chanuster  of  valvular  lesions,  are  yet 
fimited  in  their  significance  to  these  points.  As  regards 
the  intrinsic  nature  and  extent  of  these  lesions,  they 
give  us  little  or  no  information.  Aortic  valvular  lesions, 
as  contrasted  with  mitral,  present  certain  traits.  Pain 
mnch  more  frequently  accompanies  the  fbrmer.  Their 
patboloffical  phenomena  are  most  apt  to  be  manifested 
pmnariiy  m  Ihe  heart  itael^  while  those  of  mitral 
nsions  are  manifested  primarily  in  the  pulmonary  organs. 
Finally,  as  relating  to  i>rogno6is,  aortic  lesions,  when 
oocasionine  great  obstruction  or  regurgitation,  by  tend- 
i^  direcuy  to  induoe  dilatation  and  weakenmg  of  the 
left  ventride,  involve  a  greater  liability  to  sudden 
death. 


JEFFERSON  MEDICAL  COLLEGE, 

rmnADMLrwLA, 
suBcooAL  cluoo  of  PBOr.  gbobs. 

Batumdat,  Dboxhbbb  2i»  186S. 

8eirrhu$  of  the  Mammary  Oland,  wiih  Atrophy — 
RemavaL — A  mammary  gland  has  just  been  removed 

from  Mrs.  S ^  nt  45^  well  nourished.    In  the  upper 

pari  of  the  tumor  there  is  a  cyst  which  was  surrounded, 
when  cut  into,  with  firm,  hara,  whitish  walls.  Soirrhus 
may  form  the  walls  of  this  cyst,  for  when  opened  there 
escapes  a  brownish,  chocolate-colored  fluid.  There  is 
very  little  of  the  glandular  structure  left  in  the  tumor, 
it  having  become  atrophied,  but  there  is  an  immense 
•mount  of  adipose  tissue— much  more  than  I  have  ever 
witnessed  in  proportion  to  the  siie  of  the  tumor.  The 
retraction  o£  the  nipple  is  very  marked  in  this  case,  the 
existence  of  which  retraction  is  one  of  the  most  diag- 
nostic symptoms  in  doubtiul  oases.  There  was  very 
little  hardness  and  swelling,  and  the  patient's  general 
health  is  most  excellent 

I  saw  this  patient  a  few  months  ago  at  my  office,  and 
ezprened  doubts  as  to  the  nature  of  the  case,  and  gave 
her  strict  injunctions  to  keep  her  hands  and  fingers  off 
^  organ.  Testerday  she  returned,  and  I  found  the 
nipple  retracted,  in  a  shght  degree  as  yet^  but  Well  mark- 


ed, although  there  was  no  considerable  induration  or 
enlargement  anywhere ;  and  I  therefore  advised  her.  as 
a  matter  of  safety,  to  submit  to  the  operation  which  has 
just  been  performed. 

fiomethnee,  egpedally  in  women  &r  advanced  in  life, 
we  occasionally  meet  with  a  ferm  of  sdrrhus  of  the 
mammary  gland,  a  tumor  not  larger  than  the  smallest 
pullet's  eggf  or  an  almond  in  its  £ell  Tina  is  soirrims 
of  ihe  atrophic  variety — sdrrhus  combined  with  atrophy 
of  ^e  mammary  gland — an  uncommon  occurrence,.  aiKl 
one  in  which  the  prognosis  is  as  a  general  rule  rather 
fevorable.  The  patient  may  frequently  live  a  number 
of  years  without  any  tendency  to  ulceration  or  lympha- 
tic involvement,  or  constitutional  contamination;  and 
if  the  operation  be  finally  performed,  there  will  be  less 
disposition  to  a  recurrence  of  the  disease  at  the  sutnres 
in  the  neighborhood  of  the  wound,  or  in  other  parts  of 
the  body. 

The  best  plan  is  not  to  excise  the  mammary  gland 
when  in  this  condition,  but  to  let  it  alona  The  patient 
may  live  for  years,  and  die  from  scHoae  intercurrent 
disease,  without  the  affection  of  the  mammary  gland 
taking  on  any  diseased  action. 

In  dressing  the  wound  left  after  the  removal  of  the 
mammary  ghmd,  I  prefer  long  and  narrow  strips  to 
broad  ones,  on  account  of  greater  feciUtv  for  drainage. 
In  addition  to  the  strips  crossing  eacdi  otner  in  different 
directions,  we  make  use  of  the  compress  to  bring  the 
contiguous  surfaces  in  contact  with  each  other  every- 
where. The  adhesive  strips  do  this  to  some  extent^  but 
not  firmly,  and  therefore  we  aid  them  by  the  applica- 
tion of  an  oiled  compress,  not  too  large,  ror  that  would 
encumber  the  parts  and  render  them  too  warm.  Atten- 
tion to  this  point  is  a  matter  of  great  impOTtance.  Then 
tiie  compress  should  be  confined  by  a  roller  bandage 
passed  around  the  chest.  The  dressings  should  be  re- 
moved at  the  expiration  of  the  third  day,  or  sooner  if 
there  is  any  considerable  discharge.  It  the  dressing 
remains  perfectly  sweet,  it  need  not  be  disturbed  for 
four,  five,  or  six  days,  according  to  circumstances. 

Satukdjlt,  Dscsmbib  99, 1SS6. 

€fhr<mic  Ahscem  of  the  5f%^A.— Clara  B ^  set. 

12,  has  an  abscess  upon  the  thigh,  which  was  first 
noticed  eight  weeks  ago.  It  began  apparently  spon- 
taneously, with  great  pains  in  the  upper  porticm  of  the 
thigh.  The  patient  ha  also  Potts'  disease  of  the  spine, 
a  large  curvature  low  down  posteriorhr.  These  parts 
are  consolidated;  the  diasm  which  formerly  existed 
having  been  bridged  over  with  callus  or  new  bone. 

WiUi  reg^  to  the,  abscess :  we  have  here  an  affec- 
tion coming  on  two  months  ago,  engrafted  upon  a  con- 
stitution not  very  strong,  with  general  health  not  very 
^food,  occurring  in  a  scrofolous  state  of  the  system  as 
indicated  by  ^e  Potts'  disease  of  the  spine  existing  at 
a  former  period,  but  now  perfectly  weU.  There  is  a 
large  swelung  upon  the  outer  and  upper  portion  of  the 
right  thigh ;  there  is  discoloration  over  a  considerable 
space ;  also  some  enlargement  of  the  subcutaneous  veins, 
which  are  seen  swollen  and  congested ;  there  is  very 
mreat  heat  in  the  swelling — very  much  greater  than  the 
heat  of  the  limb  below  it,  and  considerably  greater  than 
the  temperature  of  the  limb  above  it :  there  is,  there- 
fore, inflammation.  The  patient  has  shooting  pains  oc- 
casionally, but  the  pain  is  not  sufficient  to  prevent  sleep 
at  nig^t ;  feels  chilly  sometimes,  and  the  feet  are  always 
cold. 

The  swelling  is  not  hard ;  the  finger  sinks  in  it  very 
readily,  not  indenting  the  parts  as  in  anasarca  or 
oedema,  for  ^e  moment  the  finger  is  removed,  tlie 
parts  resume  their  former  condition.  Palpation 
evinces  fluctuation — the  presence  of  a  fluid. 


106 


THE  MEDICAL  RECORD* 


The  question  arises,  what  is  the  natare  of  this  fluid? 
IB  it  blood?  is  it  water  ?  is  it  pus  ?  If  it  be  blood,  its 
existence  would  impi  j  the  iDfliction  of  violence,  or  the 
existence  of  a  rupture  of  some  of  the  Uood-vessels  of 
the  part,  either  spontaneously,  or  as  the  result  of  injury 
or  of  disease.  There  has  been  nothing  of  this  kind  in 
the  history  of  the  case ;  it  came  on  without  anr  assign- 
able cause ;  therefore  we  exclude  that  view  from  the 
diagnosis.  With  regard  to  its  being  an  accumulation  of 
water;  the  disease  is  of  two  months  standing,  and 
there  is  nothing  in  the  history  of  the  case  which  would 
afford  reason  to  believe  that  there  is  anything  of 
this  kind,  which  would  imply  the  presence  of  a  cystic 
tumor,  or  an  accumulation  as  occasionally  happens  in 
the  connective  cellular  tissue  beneath  the  skin,  or 
between  the  muscles  and  the  skin.  Then  we  come  to 
the  consideration,  is  it  pus?  It  is  undoubtedly  of  that 
description;  the  tumor  has  been  growing  steadily  with 
all  the  evidences  of  inflammation.  Then  it  is  an  abscess. 
Is  it  a  phlegmonous,  or  a  chronic  strumous  abscess  ? 
The  previous  history  gives  evidence  of  its  being  a  stru- 
mous abscess ;  the  disease  is  chronic.  A  phlegmonj^os 
abscess  is  rapid  in  its  formation,  and  attended  with  a 
great  deal  of  pain.  The  disease  is  simply  a  reflection  of 
this  peculiar  strumous  diathesis,  which  has  prevailed 
probably  ever  siuce  the  birth  of  the  child,  to  a  mater 
or  less  extent,  displaying  itself  at  about  the  fourth  year 
of  affe  by  Potts*  disease  of  the  spine.  The  abscess, 
which  is  quite  large,  is  situated  superficially  in  the  sub- 
cutaneous cellular  tissue ;  I  have  no  idea  that  it  oom- 
municatee  with  the  articulation.  The  child  has  been 
becoming  lame  for  the  last  six  or  seven  months;  this 
right  leg  was  stiff  and  she  could  not  bend  it  It  is 
therefore  possible  that  there  may  be  some  oomnlication 
with  hip-]oint  disease,  but  the  existence  of  sudi  a  con- 
dition of  things  is  doubtful.  The  child  has  had  no 
rigors,  nor  niffht-sweats.  This  absoess  is  lined  by  a 
pyogemc  membrane,  formed  out  of  the  fibrine  or  lymph 
c«  the  blood  thrown  ont  by  the  process  of  inflammation, 
in  which  the  pus  is  contained,  b^  which  it  is  surrounded 
and  circnmscribed,  by  which  its  diffusion  among  ^e 
surrounding  structures  is  prevented.  Such  an  abscess 
may  exist  for  many  months  without  awakening  any 
considerable  degree  of  constitutional  disturbance  or 
sympathetic  derangement,  as  long  as  it  is  permitted  to 
have  its  own  course ;  but  when  interfered  with,  by  an 
opening  being  made  so  as  to  allow  of  the  ingress  of  the 
air,  then  severe  constitutional  symptoms  are  excited, 
sympathetic  irritation  is  provoked,  followed  b^  heolie 
irritation,  or  hectic  fever,  as  commonly  called ;  m  other 
words,  by  night-sweats,  by  great  depression  of  the 
system  at  large,  by  exhaustion,  bj  a  sort  of  typhoid 
condition  of  th^  system,  and  sometimes  by  colliquative 
diarrhoea.  When  these  symptoms  prevail,  there  is  great 
danger  with  regard  to  the  life  of  the  individual,  and  it 
is  exactly  the  same  things  which  prevails  in  the  latter 
stages  of  consumption,  m  affections  of  ^e  hip-joint^ 
also  in  affections  of  the  knee-joint,  the  larger  articula- 
tions ;  the  same  thing  which  ocours  not  unfreqnently  in 
scrofulous  diseases  of  the  bones,  especially  the  smaller 
bones,  and  the  articular  extcemities  of  the  long  bones. 

The  question  arises,  what  should  be  done  in  a  case  of 
this  Idnd?  The  matter  is  making  rapid  progress,  and 
by  its  pressure  produces  in  the  skin  unnatural  heatL  un- 
natural discoloration,  a  congested  condition  of  the  blood- 
Teseels  of  the  part^  of  the  veins  especially.  There  is  a 
tendency,  thermre,  over  a  considerable  surface,  to  ulcer- 
ation, which  is  hastened  or  promoted  by  the  pressure 
which  the  pus  itself  exercises  on  the  skin ;  and  if  the 
parts  are  permitted  to  remain  in  this  condition,  the  pus 
will  force  a  vent  or  opening  for  itself  in  a  compiaratively 
short  period ;  perhaps  within  the  next  ten  or  twelve 


da^s ;  perhaps  sooner.  I  propose  therefore  to  anticipate 
this  opening,  making  an  indsion  at  the  most  dependent 
portion  of  Sae  abscess,  so  as  to  give  free  vent  to  the 
fluid  as  fast  as  it  is  deposited  within  this  pyogenic  sao : 
then,  by  means  of  pressure  made  with  a  compress  and 
adhesive  strips,  we  shall  bring  together  the  opposite 
surfaces  of  the  abscess,  and  in  this  manner  diminish  its 
cavity,  and,  at  the  same  time,  guard  against  the  intro- 
duction of  the  air  as  much  as  possible.  The  air  itself  is 
comparatively  innocuous,  but  when  it  is  brought  in 
contact  with  pus  in  an  abscess,  it  leads  to  a  decomposition 
of  the  pus,  or  putrefaction,  and  in  this  way  becomes  tk 
source  of  irritation.  Whether  the  pus  is  absorbed  into 
the  system  or  not,  simply  by  its  contact  wiUi  tho 
pyogenic  membrane,  or  the  surface  with  which  it  ^s 
m  contact,  some  may  get  into  the  blood  and  poison  it; 
its  contact  with  the  affected  surface  is  sufficient  to 
bring  about  this  local  and  systemic  irritation  which  we 
call  pyssmia.  We  transfix  the  wound  produced  by  tho 
puncture  with  a  pin,  and  then  cover  it  in  with  adhe- 
sive strips.  Should  the  edge  unite,  it  will  be  very  easy 
to  make  another  puncture  m  a  few  davs  in  order  to  let 
out  some  more  pus.  Immediately  after  the  operation 
we  give  the  chad  a  full  dose  (twenty-five  drops)  of 
laudanum,  which  is  less  likely  to  produce  perspiration 
than  morphia,  to  prevent  undue  reaction  after  the  per- 
formanoe  of  the  operation.  It  is  well  alway$  to  antici- 
pate this  reaction,  and,  if  possible,  to  prevent  it.  A  full 
anodyne  will  quiet  the  system,  quiet  the  heat,  and  oom- 
duoe  to  sleep.  Then,  it  will  be  well  to  put  the  patient 
gradually  on  the  use  of  quinine  and  aromatic  sulphurio 
acid,  two  grains  of  the  alkaloid  with  twelve  drops  of  tho 
acid,  four  times  in  the  twentv-four  hours.  Sulphurio 
acid  is  the  great  remedy  in  colliquative  sweats  and  hec- 
tic irritation. 

The  pus  drawn  horn  this  abscess,  eighteen  ounces  in 
quantity,  contains  a  large  quantity  of  Tatty  matter,  and 
large  peculiar  flakes,  looking  like  soft-boiled  rice,  much 
like  the  pus  expectorated  after  cavities  have  formed  in 
pulmonary  consumption ;  the  thinner  portions  will  remain 
on  the  surface,  and  the  caseous  portion  will  subside  to 
the  bottom,  and  the  supernatant  Hquid  will  present  a 
sort  of  oleaginous  appearance.  This  operation  may  bo 
repeated  in  a  week  or  ten  days,  and  finally,  when  tho 
system  has  become  intired  or  accustomed  to  the  suffer- 
ing, the  abscess  must  be  opened  fireely,  a  tent  be  in- 
serted in  the  bottom,  so  as  to  give  the  parts  a  chance 
to  heal  by  the  granulating  process ;  or  a  seton  may  be 
inserted  through  the  walls  and  be  allowed  to  remain 
thirty-six  or  for^-eijB;ht  hours,  and  some  irritatingfluidy 
as  a  weak  solution  of  the  tincture  of  iodine,  may  be  in- 
jected ;  but  I  proffer  to  lay  open  the  abscess  Ireely,  not 
immediatdy,  except  where  it  is  very  superficial,  as  on 
the  chest,  with  the  view  of  exdting  the  granulating 
process ;  but  in  a  case  like  the  present  it  is  better  to 
proceed  more  cautiously.  The  patient  must  be  provided 
with  a  nutritious  diet. 


Damoebs  or  "  Watbbtalls."— According  to  the  autho- 
rity of  M.  Linderman.  a  Russian  savant,  seventy-five 
per  cent,  of  the  fiilse  hair  used  for  chignons  in  Russia^ 
IS  invested  with  a  parasite  to  which  the  name  of  frega- 
rine  is  given.  This  hair  is  very  like  other  hair  m  ap- 
pearance, but  on  close  inspection  little  y  dark-brown 
knots  are  seen  at  its  free  end,  and  may  even  be 
distinguished  by  the  naked  eye.  These  are  the  para- 
sites. It  has  been  found  very  difficult  to  destroy  them 
with  any  reagents  that  will  not  also  destroy  the  hair. 
The  presence  of  gregarines  is  doubtless  due  to  the 
filthy  habits  of  the  women  who  supply  the  hair  to  the 

dSfferent'markets,  r^r^r^n]r> 

Digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


107 


POLTFUB  or  TBI  PBOCtTAnO  PoRTIOH  OF  THE  UbBTHRA. 

— A  case  is  related  in  the  "  Union  Midicale  '*  of  Octo- 
ber 6y  of  ft  joang  man  who  was  troubled  with  his 
wine,  and  had  seniinal  emissions.  He  submitted  to 
canteriiation  of  the  prostatic  portion  of  the  urethra  with 
LaDemand*8  porte-caustique,  and  the  surgeon  in  witii- 
drawing  it  met  with  a  painful  resistance  which  he 
■opposed  to  be  CMised  by  a  mucous  fold  of  the  urethra 
oaught  in  the  instrument  in  sheathing  it;  but  on 
ramoTing  the  instrument  a  urethral  polypus  accom- 
panied iL  and  was  found  to  have  been  the  cause  of  the 
nzmaiy  oisturbance. 

TSMPBRATURE  OF  THE  BODT  VK  OoWVULfllVl  BmASB. 

— ^Dt&  Charcot  and  Bouchard  state  that  there  is  no 
aensible  increase  of  the  general  temperature  of  the 
body  during  the  clonic  contractions  of  muscles.  The 
aogmentation  of  temperature  due  to  muscular  contrac- 
tion, as  in  epilepsy,  occurs  only  during  the  tonic  con- 
tractions. Tbey  assert  that  in  the  most  marked  forms 
oi  paralysis  agitans.  and  in  chorea^  there  is  no  ap- 
preciable increase  of  the  animal  heat.  These  opinions 
are  sustained  by  their  pbysioloffical  essays  on  cats  and 
rabbits,  which  animals  were  thrown  into  convulsions 
bj  injections  of  sulphate  of  strychnia,  or  by  the  appli- 
Gadon  of  electricity.  The  bulb  or  a  thermometer 
placed  in  the  rectum  of  the  animal  enabled  the  experi- 
menters to  note  the  variations  of  the  instrument  as  the 
toaie  convulsions  succeeded  orraeoeded  tlie  clonic  oon- 
tntidom.—GijmetU  liidieaU  ofParii. 

IVFLunroB  or  Yaso-motob  Nisvis  ovsr  Bkorition. 
— M.  Brabant,  of  Beims,  has  put  forward  a  theory  of  the 
retadve  action  of  the  sympathetic  and  ordinary  nerves, 
w^ifBk  is  different  from  that  of  M.  Bernard,  and  which 
wmmm  plausible  enough  at  first  sight  Taking  the  submax- 
illary gland  as  an  illustration,  be  says  this  organ  is  pro- 
vided with  two  distinct  sets  of  nerves :  the  chorda  tym- 
pani,  and  the  filaments  of  the  symoathetic  system.  The 
apluBcters  of  the  vessels  of  inosculation  obey  the  chorda 
tvmpani,  and  those  of  the  capillariea  obey  the  sympa^ 
UMtio.  If  no  excito-motor  action  excites  the  chorda 
^nopuiii  the  vessels  of  inosculation  remain  open,  and 
the  blood  passing  firom  one  set  of  vessels  to  the  other 
does  not  enter  the  minute  capillaries;  oonsequently 
tbare  is  no  secretion :  the  gland  remains  inactive.  If| 
oo  the  contrary,  sa^s  M.  Bryant,  the  chorda  tympam 
m  eaUed  into  action,  it  produces  contraction  of  the 
flpluBcters  of  the  inosculating  vessels,  and  these  latter 
bciag  dosed,  the  blood  flows  on  to  the  ultimate  capiUa- 
,  and  thus  secretion  takes  place. — Laned, 


Seqitbui  or  Suroioal  Operations. — M,  Maison- 
Deove  thinks  that  of  every  hundred  patients  who  die 
after  surprical  operations  at  least  ninefy-ftve  are  poi- 
soned. This  be  explains  by  showing  that  in  most 
caaea  of  the  kind  referred  to,  certain  morbid  products, 
the  result  of  the  operation,  are  developed  eitror  in  the 
blood  or  on  the  surface  of  the  body,  and  make  their 
way  into  the  system.  He  formulates  his  remarks 
thus:— (1)  The  blood  and  other  animal  fluids,  when 
exposed  freely  to  the  air,  or  in  contact  with  aque- 
ous substances,  soon  lose  their  vitality.  (2)  Once 
dead,  they  are  liable  to  putrefy  under  the  influence  of 
heat,  nunsture,  and  air.  (8)  The  products  of  audi 
putrefaction  are  highly  poisonous.  (4)  It  is  the  same 
with  such  secretions  as  the  urine,  bile,  and  intestinal 
juices.  (5)  In  infiltrating  the  permeable  tissues  with 
which  they  are  in  contact^  these  poisoned  Uquids  give 


rise  to  gangrene,  erysipelas,  &c  (6)  These  same 
liquids,  either  by  themselves  or  mixed  with  the  special 
products  of  inflammation  they  provoke,  can,  in  enter- 
mg  the  circulation,  alter  the  blood  and  distul'b  important 
functions.  (7)  After  their  expulsion  from  the  ^reneral 
blood-vessels  they  may  remain  in  the  capillanes,  the 
parenchymata,  serous  tissue,  itCy  and  give  rise  to 
abscess,  anthrax,  &c  (8)  The  entirety  of  the  dis- 
turbances constitutes  surgical  fevers.  To  prevent 
these  terrible  consequences  of  operation,  M.  Maison- 
neuve  suggests  the  adoption  of  the  subcutaneous 
method,  and  the  employment  of  all  means  of  prevent- 
ing putrefactive  process. — Lancet, 

Clxaiuno  Buildings  bt  Steam. — ^A  new  process  for 
d^aning  the  facades  of  public  buildings  and  dwelling- 
houses  is  now  being  experimented  on  in  Paris.  A 
steam-engine  supplies  pipes  of  gutta-percha  with  a  con- 
stant stream  of  the  vapor.  These  are  applied  to  the  stone 
of  the  brick  surface  of  buildings,  one  man  directing  the 
steam  jet  and  the  other  using  a  brush.  The  building, 
after  the  application  of  this  system,  looks  as  clean  and 
new  as  when  erected.  A  couple  of  men  in  three  days 
will  thus  wash  the  facade  of  a  hotd  at  a  great  economy 
of  time  and  money  over  the  old  mode  of  deansing. — 
American  Artisan. 

Blistering  is  a  favorite  remedy  with  many  prac- 
titioners, and  is  resorted  to  for  various  purposes.  Not 
long  ago  all  internal  inflammations  were  treated  by 
external  vesication,  perhaps  soidy  from  its  supposed 
derivative  or  substitutive  effect  Puerperal  inflamma- 
tion once  combated  with  venesection,  mercurialiaation, 
and  extensive  external  vesication,  is  now  more  sucoess- 
fullv  trec^  with  anodynes,  and  simple  fomentations. 
Inflanmiation  of  the  lungs  and  pleura,  formerly  treated 
by  the  whole  armament  of  depletion,  is  now  in  the  best 
manner  controlled  by  rest,  position,  and  anodynes,  the 
blistering,  bleeding,  and  starvaUon  wholly  omitted. 
Inflfljnmation  of  the  eye,  in  its  various  forms,  formerly 
submitted  to  leeching,  blistering,  cauterizing,  low  diet, 
etc.,  is  not  often  at  the  present  time  subjected  to  the 
action  of  such  remedies,  but  terminates  more  safdy 
under  milder  measures.  The  diseases  most  eminently 
requiring,  as  supposed,  the  action  of  these  remedies,  are 
now  known  to  recover  as  rapidlv  and  certainly  without 
them,  and  thus  we  are  furnished  with  presumptive 
evidence,  at  least  that  thev  are  nearly,  pernaps  wholly 
iiiicapable  of  good  better,  if  we  could  also  add  of  harm, 
but  we  are  obliged  to  confess,  that  if  unproductive  of 
good,  they  are  yet  notent  for  evU. — Dr,  JuUubF,  Miner ^ 
Bujmo  Mod.  and  Surg,  Jour, 

The  IJbbtrra  Viewed  bt  a  Magnesiitm  Light. — 
Dr.  E.  Andrews,  in  an  artide  upon  this  subject  in  the 
Chicago  Medical  HoamineTj  says,  '^Some  months  ago 
I  had  an  endoscope  constructed  alter  the  Parisian  plan, 
and  used  it  with  some  degree  of  satisfaction ;  but  there 
is  often  a  defidency  of  light  in  these  instruments,  ren- 
dering the  view  unsatis&ctory,  unless  all  parts  are  in 
perfect  order.  Seeking  to  overcome  this  evil  I  one 
dav  procured  some  smafi  magnesium  wire,  which,  when 
held  in  the  flame  of  a  lamp,  bums  with  a  white  light, 
whose  brilliancy  dazzles  like  the  glare  of  the  sun  at  noon- 
day. Introducing  the  endoscope  into  the  urethra  of  a 
patient,  I  caused  a  friend  to  insert  the  wire  into  the 
flame  of  the  lamp.  The  result  was  to  illuminate  the 
urethra  magnificently.  The  mucous  membrane,  with 
every  httlefold  or  patch  of  varied  color,  was  as  plainly 
in  view  as  could  possibly  be  desired.  It  could  not 
have  been  seen  any  better  had  it  been  dissected  and 
laid  in  the  sunli^t  By  gradually  withdrawing  the 
tube,  the  whole  of  the  canal  may  sucoessively  be  seen 


IDS 


THE  MEDICAL  RE€X)ED. 


at  it  0011^)868  ftcrofls  the  end  of  the  tube.  Seeing  ibe 
perfection  of  this  iUiunination,  I  ha^e  ordered  a  spnng 
and  some  small  wheel-work  attached  to  the  lamp,  so 
that  the  wire  may  be  made  to  advance  into  the  name 
without  the  help  of  an  assistant  In  this  waj,  no 
doubt^  the  difficulty  of  the  illumination  will  be  ftilly 
overcome,  and  the  urethra  can  be  inqfwoted  almost  as 
easily,  and  quite  as  perfectly,  as  the  tongue.'* 

Treatment  op  Gk>NORRHaBA — Mr.  Barwell  has  for 
years  past  treated  gonorrhoea  as  a  simple  non-specific 
disease,  avoiding  copaiba,  which,  hj  disordering  the 
stomach  and  causing  loss  of  appetite,  depresses  the 
health,  and  is  apt  to  increase  or  lengthen  the  disease. 
In  ease  of  a  first  attack^  in  wMch  inflammation 
runs  high,  a  purge,  hot  bathing,  and  an  alkaline  medi- 
cine, either  diuretic  or  aperient,  as  maj  be  indicated, 
followed  by  an  ii^jection  of  sulphate  of  zmc—two  gvuns 
to  the  ounce.  Second  or  snbsequent  attacks  mi^  be 
treated  without  such  preparation  by  ixyeotkm,  free 
action  of  the  bowela  being  secured^  if  necessary,  by 
medicine.  If  the  patient  apply  on  the  first  day  of  the 
discharge  showing  itself  a  week  may  often  suffice  to 
check  it^  More  chronic  casea  may  be  advantageously 
treated  with  tannic  acid — three  or  four  grains  to  Ihe 
ounce :  and,  in  order  that  the  fluid  may  remain  longer 
m  contact  with  the  mucous  membrane,  it  may  be  thick- 
ened with  starch  or  sugar.  Mr.  BarweU  has  not  foand 
that  orchitis  follows  the  use  of  injections  of  the  abova 
strength  more  firequently  than  it  succeeds  to  gonorrhoBa 
not  locally  treated ;  and  stricture  is  certaimy  a  rarer 
sequela  to  such  treatment  than  to  a  clap  allowed  to  run 
on  for  weeks  or  months.  The  slight  but  continuous 
discharge  of  a  gonorrhoea  become  chronic  is  often  diffi- 
cult of  cure.  Turpentine,  either  Chian  turpentine  or 
Canada  balsam,  with  black  or  Cayenne  pepper,  is  fi'e- 
quently  useful  Tincture  of  steel  and  tincture  of  cap- 
sicum oflen  avwls.  As  a  pepper,  cubebs  will  have  a 
similar  effiact ;  but  it  is  not  better,  and  is  more  clumsy, 
than  the  above-named  sorts.  The  most  certain  and 
efficacious  treatment  is  by  an  ointment  containing 
from  three  to  five,  and  even  to  ten,  grains  of  nitrate  of 
silver  to  the  ounce  of  lard.  A  smiul  bougie  smeu^d 
thickly  with  the  ointment  is  passed  fh)m  hidf  an  inch 
to  an  inch  and  a  half  down  the  urethra,  and  left  there 
for  half  a  minute  or  more  ;  and  this  should  be  repeated 
at  least  every  other  day.  In  general,  commencing 
with  the  mildest  ointment,  one  need  not  increase^  the 
strength  beyond  five  grains  to  the  ounce.  In  only  one 
very  obstinate  ease  was  it  used  ten  grains  to  the  ounce; 
but  the  patient  got  well  without  a  bad  symptom. — 
Lancet, 

The  Inooulabilitt  of  Tubercle. — A  very  interest- 
ing oommunication  has  been  made  to  the  Fa^ological 
Society  by  the  President  (Mr.  Simon,  J.R.S.),  in  re- 
ference to  ibe  production  of  tuberculosis  by  inoculation. 
Mr.  Simon  said  he  had  followed  up  the  novd  experi- 
ments of  Continental  observers,  and  had  succeeded,  by 
the  introduction  of  the  tuberculous  matter,  in  producing 
toberculous  deposit  in  several  rabbits,  some  of  whom 
belonging  to  the  same  litter  on  whom  this  experiment 
had  not  been  performed  were  entirely  free  from  any 
disease  of  the  kind.  In  the  case  of  rabbits  inoculated 
with  matter  obtained  from  other  rabbits  in  whom  tuber- 
culosis had  been  produced,  the  development  of  tubercle 
was  much  more  general  through  the  lungs  and  the  body 
(and  also  in  greater  amount),  as  though  the  tubercle  had 
become  acclimatised,  so  to  speak,  to  the  system  of  the 
rabbits.  In  one  case,  that  of  a  doe,  the  only  M>parent 
effbct  was  to  cause  every  fresh  litter  to  be  stflf-bom. 
Mr.  Simon  observed  that  his  experiments  seemed^  to 
sikow  that  the  disease  was  produced  as  well  when  the 


yellow  tubercular  deposit  was  used  as  when  the  grey 
granulation  material  was  employed.  Dr.  Andrew  Clark 
recounted  his  own  researches  on  the  subject,  and  sug- 
gested that  it  would  be  desirable  to  suspend  judgement 
upon  the  question  in  consequence  of  the  startfinginfe^ 
ences  that  would  necessarily  be  drawn  if  such  experi- 
ments were  accepted  as  true.  He  thought  that  sufficient 
arguments  were  at  hand  to  call  in  question  the  results 
of  the  experiments  of  Continental  observera  In  the 
first  place,  the  deposit  in  the  rabbit  was  essentially  eel- 
luhir,  whereas  the  grey  granulation  of  tuborole  was  cor- 
puscular. He  had  never  seen  the  secondary  coooo- 
mitants  in  the  case  of  the  disease  induced  artificially  in 
rabbits,  such  as  pneumonia  and  the  like.  The  condition 
described  as  tuberculisation  might  be  produced  by  in- 
troducing any  aplastic  fluid  into  the  system ;  and  the 
experiments  already  recorded  b^  different  observers 
seemed  in  some  measure  contradictory :  some  of  them 
producing  the  artificial  tuberculization  with  yellow, 
others  with  grey  tuberculous  matter. 

The  specimens  of  Mr.  Simon,  lumded  rouu'l,  showed 
to  all  appearances  tubercular  matter*  and  they  were 
referred  to  a  committee  for  a  report  The  facts  relative 
to  these  pathological  specimens  are  of  great  interest,  as 
the  reception  given  to  Mr.  Simon's  remarks  clearly  in- 
dicated.— LcuMt, 

Electrolttio  Treatment  or  Tumors. — At  a  meeting 
of  the  London  Medical  Society,  Dr.  Althaus  read  ^ 
paper  on  the  electrolytic  treatment  of  tumors,  this 
consisting  in  the  passing  of  a  continuous  current  of 
electricity  through  the  structure  to  be  operated  upon 
from  the  negative  pole  of  a  battery.  He  exhibited  a 
very  ingenious  battery,  and  a  variety  of  instruments  to 
be  used  in  this  process,  and  showed  their  effects  on 
saline  solutions,  albumen,  and  muscle.  The  diseases  best 
suited  for  this  plan  of  treatment  were  tumors  such  as 
nssvus,  bronchocele,  hydatids,  cancer,  etc.,  aneurisms^ 
varicose  veins  and  piles,  serous  efiusions  and  strictures, 
as  it  caused  no  bleeding,  little  or  no  pain  or  shock,  no 
sloughing,  or  other  bad  effect  He  had  used  it  with 
apparent  good  effect  in  cases  of  bronchocele,  sckrhuSi 
and  molluscum,  but  thought  it  capable  of  much  wider 
extension.  Mr.  W.  Cooke  suggested  that  as  the  effects 
were  so  local,  and  as  the  in&oduction  of  the  needles 
into  the  tumor  would  always  give  rise  to  a  certain 
amount  of  irritation,  the  tumor  if  cancerous  might  grow 
faster  than  it  was  destroyed.  Pr.  Handfield  Jones  had 
tried  it  for  the  removal  of  a  wart,  but  had  found  the 
pain  intense.  Dr.  J.  Brown  thought  the  treatment  took 
too  much  time  to  be  substituted  mr  such  a  simple  ope- 
ration as  that  for  piles.  Dr.  Sansom  thought  the  stimu- 
lus of  the  vaso-motory  nerve&  and  the  consequent 
diminution  of  the  quantity  of  blood  supplied  to  the 
part,  might  have  as  much  to  do  with  the  lessening  of 
the  tumor  as  any  mechanical  or  chemical  action  induced 
by  the  current — Med,  limes  and  Qijmette, 

The  Berlih  Ware  so  mu<^  celebrated  for  its  power 
of  withstanding^  heat,  acids,  and  alkalies,  is  composed, 
acoording  to  Dmgler's  Polytechnic  Journtd,  of  45  parta 
kaolin,  37i  alumina,  and  16|  felspar.  The 'enamel  is 
composed  of  42  parts  sand,  33  kaolin,  13  unburat 
gypsum,  and  12  of  the  baked  body  composition  above 
described. — Sdenltific  Am, 

Chorea  treated  et  Etbbr  Sprat. — A  case  of  ob* 
stinate  chorea  successfiiUy  treated  by  ether  spray,  has 
been  reported  by  Dr.  liibelski,  in  a  recent  number  of 
the  ChutU  Edbdomaaaire,  The  vi^r  was  thrown 
upon  the  sides  of  the  spinal  column  by  means  of  the 
double-nozsled  M>paratQS  of  Bichardson. 


THE  MEDICAL  KBCOKZX 


10^ 


The  Medical  Record. 

Gbobgb  F.  Se^bapt,  M.D.y  Editob. 


FobUalMd  <m  tte  1st  and  Ulh  of  OMh  Molld^  bf 
WILLIAM  WOOD  ft  CO.,  61  VfAsxn  Stkir,  Nbw  Tobk. 


FORSlQJSr  AQEKOIJBB, 

LoBw»-^B0Bim  A  Go. 
p4Mi   BniwiW««  wt  On. 


ILmmio— B.  Hbbmaitn. 
Bio  jAMaiio— Stbphxkk  t  Ojl 


N"ew  Yorlc.  SCagr  1.  ISar. 

THE  MEETING  OF  THE  AMERICAN  MEDI- 
CAL ASSOCIATION. 

Oa  oi  the  medicftl  events  of  the  year  will  be  the  meet- 
iog^  of  the  American  Medical  Association,  which  is  to 
be  h^  in  Cincinnati,  on  the  7ih,  8tb,  and  9th  of  this 
nmth.  The  locality  has  been  happily  selected,  and 
from  the  fact  of  its  being  a  central  one,  will  no  doubt 
cdl  forth  a  large  attendance  of  delegates.  But  we  are 
aot  to  look  to  this  alone  as  an  indication  of  a  fuU  meet- 
ii^  Last  year  we  had  occasion  to  notice  the  panotty 
of  Bonthem  members,  and  \a  deplore  the  existence  of 
ttjr  snpposed  political  misunderstanding  which  might 
ieoooDt  for  it  This,  if  it  even  did  exist,  is  now,  we 
trusty  nombered  with  the  things  that  were.  The  civU 
WIT  is  long  enough  over  to  heal  all  the  festering  sores 
wluoh  party  prejudice  has  given  rise  to ;  and  we  n:iay 
reasonaUy  expect  a  considerable  accession  of  members 
from  the  South,  among  whom  wOl  be  many  beloved 
ud  reelected  and  too  long  absented  brothers. 

We  cannot  predict  that  the  meeting  wiU  b6  more 
thia  an  ordinary  one,  in  which  the  usual  number  of 
r^KRis  and  resohitions  will  be  offered,  unless  there  be 
iBttle  diversion  upon  the  subject  of  specialties.  This 
win  undoubtedly  be  brou^t  up,  and  will  be  as  much  if 
not  more  talked  about  than  at  the  last  session.  But 
ii  the  Association  any  better  prepared  to  discuss  it  than 
Oie  year  ago  ?  Certainly  not ;  and  after  all,  if  Jit  were 
Ktdy  and  willing  to  look  at  it  with  an  unprejudiced 
Tiew,  no  good  would  come  of  any  legislation  upon  the 
•object  No  well  qualified  speoiitdist  will  feel  himself 
called  upon  to  abandon  his  field  of  practice,  simply  be- 
\  the  American  Medical  Association  sees  fit  to  com- 
him  so  to  do ;  neither  will  the  general  praetl- 
tkxien  concede  that  the  q>ecialist8  are  orthodox; 
beoiuse  a  mfljority  vote  in  favor  of  them.  Specialism 
is  in  its  youth  in  this  country,  and  its  real  merits  or 
teaerits  have  not  yet  been  fully  appreciated  If  it  have 
•ny  merits  they  wiU  become  apparent  afW  a  while,  with- 
oat  any  special  anticipatory  or  puffing  resolutions.  The 
•affie  t»n  be  said  regarding  its  shortcomings.  A  great 
miiiake  has  been  made  m  agitating  the  sul^t  too 


much,  4nd  giving  it  an  undue  importanoe.  If  it  ^ 
possible  for  some  of  the  qyedalistffand  anti-specialistB  to 
hold  their  peace  at  the  coming  meeting,  no  one  would 
sufier,  and  all  would  be  benefited  by  the  amoimt  of 
time  ipained.  We  owwot)  however,  hope  for  thi%  and' 
must  eone  prepared  to  hear  the  same  old  argfuments,  the 
same  pleading  for  protection  of  rights,  the  same  call  fOr 
sympaUiy  with  injured  innocence,  and  the  same-^tow 
of  eloquence  which  have  characterized  other  disctkssions 
of  the  sort;  and  we  can  assure  ourselves  in  advance,  that 
the  result  wiQ  be  the  same. 

H  th6  Oonvention  of  Medical  Teachers  bring  in  their 
report  mudi  interest  vnll  b^  added  to  Che  meetbg.  W6 
have  no  doubt  the  measures  whidi  the  professors  may 
recommend  will  be  practicable  and  sensible;  and.thd 
Association  will  have  much  to  base  a  discussion  upoo. 
In^^his  event  tiiey  will  have  the  subject  of  medical  edu- 
cation presented  Wore  them  in  a  tangible  form,  and 
may  be  encouraged  to  legidate  upon  it  in  the  hope  that 
sttoh  action  may  accompHih  some  good.  If  the  conveii* 
tion. of  teachers  agree  to  come  at  the  question  ^th  the 
right  ^irit  and  in  the  proper  way,  they  may  hope  for  a 
hearty  endorsement  of  their  views  by  the  AssOeiatioQ, 
and  a  prompt  action  upon  the  propositions  which- they 
may  advance. 

An  interesting  feature  in  last  year's  meeting,  was  the 
deUvery  <^  a  lecture  before  the  Association.  This  was 
so  well  received  that  the  committee  6f  arrangemtotsr 
should  take  the  hint,  and  provide  for  a  repetition  of  that 
part  of  the  programme  by  the  selection  of  some  suiiaUe 
person  who  could  ofier  remarks  upon  a  subject  of  inte^ 
rest  to  aU.  We  would  venture  to  say,  that  more  wertr 
benefited  by  the  discourse  on  nervous  affections  thaa 
by  any  other  topic,  not  even  excepting  that  of  cholera. 
The  Assoeiation  will  be  better  prepared  to  dtscust 
the  propriety  of  quarantine  than  last  year,  as  many  of 
those^  who  voted  against  it  then  have  had  ample  oppor- 
tunity to  change  their  views.  A  proper  decision  of  tbia 
question  involves  great  interest;  and  if  the  subject  ie 
brought  tfp  at  all,  it  is  to  be  hoped  tiiat  a  calm  and 
deliberate  vote  be  taken,  abd  that  the  body  clears  Stsdf 
of  the  stigma  which  still  rests  upon  the  action  taken 
last  year. 

The  meetings  of  the  sections,  which  may  be  consi-' 
dered  as  interesting  and  profitable  as  any  of  the  Assoo** 
ation  proper,  should  be  well  attended ;  and  in  order  thiit 
m<»re  business  can  be  transacted  than  is  usual,  eadk 
gentleman  who  proposes  to  read  a  paper,  especially  if  the 
hitter  is  a  lengthy  one,  should  be  prepared  to  pireseiit 
only  an  abstract  of  the  same.  In  this  way  two  or  three 
articles  could  be  laid  before  the  section  in  the  tlin^ 
which  it  has  Ordinarily  taken  to  read  one  entire.  The 
sessions  are  necessarily  short,  and  too  much  time  Can- 
not be  given  to  one  docun^nt  to  the  exdu^on  of  other 
equally  meritorious  ones.  The  entire  paper  could  be 
hand^  Ui  th&  Coihmittee  on  Publication,  tiie  AbstiAot 
being  prepared  only  for  the  sake  of  the^^iscuasion  |l 
mayelkdt  Digitized  by  VjOOQ IC 


110 


THE  MEDICAL  RECORD. 


The  plaoes  of  meeting  of  the  sections  should  be  m 
near  together  as  possible,  and  within  a  short  distance 
of  the  general  assembly  hall.  This  would  enable  more 
members  to  be  present,  and  the  interest  in  the  meet- 
ings would  be  proporUonably  promoted.  We  have  no 
doubt,  however,  that  our  brethren  of  Cincinnati  wiH  do 
all  for  the  delegates  which  can  be  done,  to  make  the 
Tisit  to  the  Queen  of  the  West  as  agreeable  as  we  hope 
it  win  be  profitable. 


ture,  which  strikes  at  the  root  of  the  eyil  by  making  it 
a  misdemeanor,  punishaUe  with  fine  and  imprisonment^ 
to  circulate  infamous  publications  throughout  the  State. 
Thus  the  agitation  of  this  question  of  "  voluntary  abor- 
tion," inaugurated  by  the  profession,  has  already  begun 
to  manifest  its  influence  in  cirdes  which  are  more  apt 
than  our  own  to  work  reform,  because  gifted  with  a 
greater  executive  power. 


Ik  our  last  issue  we  took  occasion  to  refer  to  the 
&ct  that  the  religious  press,  as  represented  by  the 
Ihrth-Wegtem  Christian  Advocate  of  Chicago,  had 
,  opened  its  columns  to  the  discussion  of  criminid  abor^ 
tion.  The  article  in  question  is  understood  to  have 
been  written  by  the  Be  v.  Arthur  Edwards,  the  asso- 
ciate editor,  long  and  favorably  known  in  the  religi^iBS 
world.  Since  tiien.  The  ChngregationaJMt,  of  Boston, 
in  a  recent  issue,  publishes  another  article  bearing  upon 
the  same  subject,  under  the  caption,  '' Fadiionable  Mur- 
der." The  author,  the  Rev.  Dr.  John  Todd,  of  Pitts- 
field,  Mass.,  firom  whose  '^  Student's  Manual,"  in  our 
boyhood,  we  derived  many  an  ambitions  impulse,  and 
who  will  be  at  once  recognised  by  some  of  our  readers 
as  one  of  the  original  thinkers  of  the  day,  addresses 
himself  to  the  task  with  his  usual  vigor. 

He  B&J8  very  truly,  after  complimenting  the  medical 
profession  as  a  dass  for  their  noble  stand :  "  Even  now, 
as  I  have  reason  to  fear,  aU  the  profession  are  not 
beyond  the  reach  of  personal  i^peal,  or  an  enormous 
fee;  and  I  do  wish  tiiat  every  such  a  one  oonld  see 
tiiat  a  fee  steeped  in  blood  and  crimsoned  with  shame, 
cannot  bring  a  blessing  to  his  fiimily.*'  We  regret  that 
our  limited  space  -forbids  more  liberal  quotations  firom 
Ubid  artide,  bnt  cannot  refrain  from  giving  the  dosing 
paragraphs: 

"  If  it  be  said  that  I  have  in  any  measure  eAgge- 
rated  the  evil  and  the  fashion  of  the  day,  I  wftf^  I 
would  not  advise  any  one  to  challenge  fiirther  dls- 
closnres— -dse  we  can  show  that  France  with  all  her 
atheism,  that  Paris  with  all  her  license,  is  not  so  guOty 
in  this  respect  as  is  staid  New  England  at  the  present 
hour.  Facts  can  be  addn^d  that  will  make  the  ears 
tingle.  JBvit  we  don*t  want  to  divulge  them ;  but  we 
do  want  the  womanhood  of  our  day  to  understand 
that  the  thing  can  be  no  longer  concealed,  that  com- 
monness or  fashion  cannot  do  away  with  its  awfiil 
guilt  It  is  deliberate,  cold  murder;  and  if  anything 
^ort  of  the  murderer's  doom  shall  fall  upon  the  per- 
petrators of  it  at  the  judgment,  the  reason  will  be  that 
there  has  been  great  ignorance  of  its  guilt. 

"  I  have  now  done  a  painful  duty,  and  have  done  it 
fbarlessly.  To  the  attention  of  the  gentie,  tender  heart 
and  consdence  of  woman  I  commend  this  subject  with 
earnest  prayer." 

In  this  connexion  we  may  state  that  the  late  Tteair 
dent  of  the  New  York  Academy  read  before  that  )lK>dy, 
ikt  its  last  session,  the  copy  of  a  bill  before  the  Le^^isla^ 


VitOXttOSi* 


Tee  SoiBNCi  and  Peacjtioib  of  Medicine.  By  William 
Attken,  M.D.,  Edinburgh ;  Prof,  of  Pathology  in  the  Army 
Medical  Sdiool ;  Oorr^bpDnding  Member  of  the  Royal  Im- 
perial Bodety  of  Physicians  of  Vienna ;  of  the  Sodety  of 
Medicine  and  Natural  History  of  Dresden,  etc.,  eta  In  2 
volumes.  From  the  fourth  Londcm  edition ;  with  additions 
by  MxnxDrrHCLTMBB.  MD.,  late  Professor  of  the  Institutes 
and  Practice  of  Medicine  in  the  IJniversi^  of  New  York; 
formerly  0)n8ultiDg  Physician  to  the  Philadelphia  Hospt- 
tiO^eta  Philadelphia:  Lindsay  ABlakiston.  1866.  8va 
pp.  966  and  1114. 

The  author  teQs  us  in  his  preface  that  in  the  comiala* 
tion  of  this  hand-book  he  nas  attempted  to  give  a  con- 
densed view  of  the  existing  state  of  the  sdence  and 
practice  of  medicine.    His  pun  has  been  carried  out  to 
that  perfection  that  the  treatise  is  as  complete  a  one 
as  can  be  found  in  any  language.    Every  department 
of  medicine,  whether  relating  to  pathology,  nosology, 
diagnosis,  or  treatment,  is  most  elaborately  and  tho- 
roughly discussed.    One  qf  the  most  important  features 
of  the  work  is  that  assigned  to  the  department  of  medi- 
cal geography,  or  the  geographical  di^^bution  of  health 
and  disease.    In  this  section  a  phBosophical  study  <^ 
the  distribution  of  diseases  is  taken  up,  particularly  in 
relation  to  the  physical  condition  of  the  earth's  surfiice, 
and  to  the  variations  of  their  types  in  the  different 
regions  of  the  earth.    This  important  branch,  which 
has  lately  received  so  much  attention  as  aasodated  with 
sanitary  science,  has,  for  the  first  time,  been  reguliiif^ 
incorporated  in  a  systematic  work.     The  other  subg^ota 
in  the  work  receive  their  proportionate  amount  of  atten- 
tion, and  there  is  everywhere  manifest  a  care  on  the 
part  of  the  author  to  gi^e  all  the  information  to  his 
readers  which  the  most  extensive  research  and  stody  are 
capable  o£  The  editor.  Dr.  Meredith  Oly  mer,  has  contri- 
buted his  share  to  tiie  work,  by  many  iudicious  addi- 
tions to  the  original  text,  wmch  makes  the  work  parU- 
cttlarly  valuable  to  the  American  practitioner.    Among 
them  may  be  named  artides  on  the  tvpho-malarial  fev^, 
chronic  camp  dysentery,  cholera  in&ntum,  aphasia^  and 
the  treatment  of  the  diseases  of  the  r^iratory  organs 
by  atomised  fluids.    The  work,  as  a  whole,  now  forms 
a  complete  cycl<^>8edia  of  medidne,  and  commends 
itself  to  those  practitioners  and  students  who  have  a 
desire  to  perfect  their  knowledge  of  our  art,  and  gaia 
much  of  that  information  which  is  crowded  out  of  the 
smaller  text-books. 

The  publishers  deserve  credit,  not  only  for  the  style 
in  which  they  have  ^ot  up  the  work,  but  for  ttosir 
enterprise  in  roprodocmg  such  a  valuable  addition  to 
medical  hterature. 

GoKTiaBUTTONS  TO  THE  PATHOLOaT,  DiAOKOSIfl,  AlfD  TbIAT» 

KENT  or  AxamJLB  Oubvature  OF  THE  Spine.    By  Bee- 

jjlhikLeb,  M.D.    Philaddphia:  J.  B.  Lippincott  &  Co. 

1867.    12mo.,  pp.  129. 

Tms  little  book  is  written  for  the  purpose  of  |>ointing 

out  the  necessity  for  proper  mechanic^  !!^PP<^^  in^caset 


THE  MEDICAL  RECORD. 


Ill 


of  angular 'Curvature  of  ihe  spine.  Tbe  author  starts 
wi^uie  proposition  that  the  diaease  is  generally  of  the 
nature  <»  a  simple  inflammation,  often  the  result  of 
•ztemal  fiolence.  and  in  (yder  to  treat  the  affection 
properly,  maintains  that  the  yertebm  must  be  in  a 
state  of  rest  by  being  relieved  from  pressure.  If  this 
ii  not  done,  disastrous  results  follow,  in  the  shape  of 
earies  and  deformi^.  He  takas  oocasioo,  in  the  course 
of  his  monogpri^h,  to  cry  out  against  the  practice  so  rife 
amongst  most  practitioners,  vis.  oounter-irritation,  as 
not  only  irrational  but  cruel,  as  it  oftentimes,,  if  not 
inranably,  increases  the  existing  inflammation,  and  adds 
to  tbe  diacomfort  of  the  patient.  The  apparatus  which 
he  adviaee  is  the  one  known  aa  Dr.  Taylor's,  which  has 
for  its  object  the  unbendmg  of  the  abnormalljr  curved 
apine^  by  the  adiqjtation  of  an  mlianoe  which  is  curved 
in  the  opposite  direction,  the  oblique  processes  being 
used  as  the  fulcrum.  The  principles  of  treatment  are 
dearly  and  lo^cally  put,  and  the  cases  which  are 
detailed  oonclusively  demonstrate  their  value.  It  is  a 
veiT  practical  and  useful  Httle  work,  and  should  be 
read  by  every  practitioner  who  may  be  unfortunate 
enoogh  to  hold  to  the  old-fkcihioned  views  oonceming 
tha  pathology  and  treatment  of  this  very  prevalent  and 
heretofore  ahnost  incurable  disease.  Dr.  Lee  has  de- 
voted himself  for  some  years  past  to  the  study  of 
neshanical  therapeutics,  and  haa  done  good  service  to 
hia  profoanional  brethren  in  embod5ring  his  views  in  this 
neat,  usefhl,  not  to  say  attxaotive,  volume; 

Immas  or  the  Spihe^  with  ax  Avaltsisof  nsablt  Eoub 
HijKBBBD  CAflia.  By  Jokk  Ashhubst;  Jr,,  A.M.,  ILD., 
Fellow  of  the  Oollage  of  Pbysieiaos  of  Philadelphia ;  Mem- 
ber of  the  Academy  of  Natural  SoioBces  at  Philadelphia. 
J.  K  LippiacoU  k  Co,  London:  Trabner  ifc  Ck>.  1867. 
ISoKX,  i^  127. 

Inumaa  of  the  spine  have  not  been  studied  as  they 
ahoddbe.  This  is  in  part  due  to  tbe  foot  that  the  cases 
w^adk  are  snbject  to  such  accidents  have  been  confosa- 
cAj  iM^less;  and  that  there  has  been  no  inoen- 
tive  to  research.  Again,  the  cases  are  not  of  «very  fre- 
qoeot  ooourrence  compared  with  other  sursioa]  troubles 
more  interesting  to  study,  and  more  amenM>le  to  treat- 
ment. Dr.  Ashburst,  with  an  industry  that  deserves  the 
thanki  and  appreciation  of  his  brethren,  has  given  us  a 
wock  which  will  be  considered  authoritative,  and  which 
most  necessarily  form  ^e  basis  tat  all  foture  mono- 
graphs upon  the  subject  His  cases,  nearly  four  hnn- 
ored  in  number,  have  been  ooHected  from  every  availa- 
ble sooroe,  and  have  been  analysed  with  rare  skill  and 
judgment.  He  has  directed  his  energies  principally 
towards  deciding  many  questionable  points  in  the  patho- 
logy and  treatment  of  ii\jurieB  ci  the  spine,  and  has 
been  enabled  to  arrive  at  the  foBowing  cfmohisions  :^ 

^  L  Injuries  of  the  spine  are  not  nearly  so  fatal  as  is 
gwerally  supposed,  and  they  have  been,  not  unfre- 

ritly,  complet^y  recovered  from.  2.  By  watching 
ajniptoms  and  knowing  the  lesions  which  they 
iaffioaCe,  the  patient's  progress  towards  h^th  or  death 
can  be  pretty  accurately  foreseen  in  most  cases.  3. 
Whenever  there  is  reason  to  believe  that  one  or  more 
vertebm  have  been  displaced,  extension  should  be  em- 
ployed temporarily,  if  that  be  saffident ;  if  not,  condnu- 
my.  4.  in  no  case  do  resection  or  trephining  offer  a 
ntaonahle  prospect  of  improvinff  tbe  patient's  condi- 
tion, but  on  the  contrary  there  a  reason  to  fear  that 
thc7  would  increase  the  chances  of  a  fotal  termination. 
5.  Tbose  cases  of  spinal  injury  which  are  not  adapted 
fir  Um  employment  of  extension  should  be  treated  in 
■oeordanoe  vrith  ordinary  rational  and  physidogu»l 
pnodplea.  6.  No  new  mode  of  treatment  is  entitled  to 
•Aoptun  in  a  daas  of  ii^juriea  so  serious  as  this,  unless 


it  can  be  shown  by  clinical  experience  that  it  is  at  any 
rate  not  leas  sucoessfol  than  the  modes  commended  to 
us  aUke  by  reason  and  long  experience."  The  appen- 
dix is  occupied  by  an  elaborate  tabulation  of  394  cases. 
Twenty-six  of  these  were  cases  in  which  resection  of 
the  spine  has  been  performed  for  traumatic  injuries, 
and  but  one  of  aU  this  number  was  relieved  by  such 
treatment.  The  book  is  got  up  in  handsome  shape, 
on  tinted  paper,  and  tastily  bound. 


Vit^oxts  of  0aciette«* 


N.  Y.  PATHOLOGICAL  SOCIETY. 

Statid  Mxrdis,  Jakuabt  23, 1867. 

i)B.  H.  B.  SAxns,  Fbssidemt,  in  the  Chair. 

SUPTURB  OF  uvkr: — flTDATina. 

Db.  Wood  exhibited  a  specimen  of  rupture  of  the 
liver  and  hydatids  of  that  organ.  The  patient  was 
found  by  a  policeman  lying  across  the  raikoad  track  in 
Chandra  atreet,  and  was  soon  after  admitted  into 
BelleYue  Hospital  in  a  collapsed  state.  Death  took 
place  1^  the  end  of  two  hours  after  admission. 

On  opening  the  thoracic  cavity,  a  considerable  quan- 
tity of  olood  was  found  in  the  right  pleural  sac,  and 
betiM[een  the  oblique  muscles  of  that  side  of  the  abdo- 
men,  a  laree  amount  of  blood  was  effused.  Of  tha 
existence  of  this  latter  lesion  there  was  ample  evidence 
during  life  in  a  notable  prominence  in  the  right  hypo- 
chondrium,  attended  with  dulness  on  percussion.  A 
large  quantity  of  blood  was  also  found  in  the  abdominal 
cavity.  The  riffht  lobe  of  the  liver  was  extensively 
rupture^  as  well  as  the  diaphragm^  affording  a  free  com- 
munioaAn  between  the  two  visceral  cavities.  The 
ninth  rib  was  fractured,  and  the  intercostal  muscle 
between  that  and  the  rib  above  was  torn.  In  the  track 
of  the  laceration  several  well  developed  hydatid  cysts 
were  discovered. 

HXCBOSIS  OF  mniBE  RAMUS  OF  LOWER  JAW. 

Dr.  Pon  exhibited  a  q>eciinen  of  necrosis  of  ahnost 
the  entire  ramus  of  the  lower  jaw,  which  he  bad  re- 
moved from  a  litde  g[irl  eight  years  old.  About  eighteen 
months  ago.  the  patient  nrst  comj^ained  of  tootnache, 
and  Hiat  sioe  of  the  jaw  became  in  consequence  much 
swollen.  An  abaceae  formed.  Two  weeks  ago  she  was 
presented  to  the  clinic  of  the  professor,  when  on  exa- 
mination of  the  part  denuded  bone  was  discovered. 
The  exposed  portion  of  the  necrotic  mass  was  seized 
with  the  forces,  and  the  specimen  was  extracted  entire 
vnthout  mach  difficulty.  A  new  ramus  had  already 
commenced  forming. 

MBSBIITIRIO  HERNIA. 

Dr.  Kasov  presented  a  specimen  of  mesenteric  hernia 
whioh  was  taken  from  a  dissecting-room  subject  The 
sigmoid  flexure  of  the  colon  and  greater  portion  of 
descending  colon  had  been  forced  through  an  opening 
in  the  mesent^y,  and  was  actually  in  a  state  of  gan- 
grene. 

Dr.  &IITH  remarked  that  he  had  presented  a  some- 
what similar  n)ecimen,  in  which  almost  the  entire  small 
intestine  had  necome  strangulated,  and  in  consequence 
of  the  latter  condition,  the  ci^illaries  of  the  part  had 
ruptured,  accounting  for  the  rapid  death  of  the  patient. 

i)r.  Foot  referred  to  the  case  of  a  child  who  had  died 
many  years  ago  with  qrmptoms  of  strangulated  hernia. 
On  mMdng  t&  post-mortem  examination  he  found  five 
feet  of  small  intestine,  strangulated  through  an  opening 


112 


THE  MHDiOAL  RBCORD. 


formed  bj  an  adyentitious  band  whioh  was  attached  to 
the  mesentery.  The  first  sjmptomfl  which  preceded 
death  were  those  which  attended  stranffulatioa  by  a 
peanut  shell,  but  these  were  afterwards  maiked  by 
the  abdominal  symptoms  soon  after  ushered  in.  The 
adventitious  band  seemed  to  contain  in  its  centre  a 
piece  of  the  fin  of  a  fish  which  had  previouslT  been 
swallowed,  and  after  having  ulcerated  its  way  through 
the  intestine  became  indo^  in  fibrmous  exn^atiom. 

Dr.  Sakds  related  the  following  remarkaUe  instance 
of  hernia.  A  little  more  than  a  year  ago,  he  went  a 
few  miles  out  of  town  to  see  «  genUeman  iuffering  from 
the  rational  signs  of  hernia.  The  history  was  one  of 
original  hernia  of  the  right  side.  The  hernia  had  been 
a  reducible  one,  but  had  not  descended  in  several  yeara 
The  symptoms  at  the  time  were:  obstinate  oonatipa- 
tion,  vomiting,  some  tumefisustion  of  the  abdomen,  toge- 
ther with  signs  of  great  prostratioB.  AfW  a  oareM 
examination  of  the  case,  he  felt  so  confident  that  no 
hernia  existed  that  he  dismissed  from  Us  mind  even 
the  probability  of  sudi  an  oocurrenoe.  1^  man  died  on 
the  same  day.  On  making  the  autopsy  it  was  found 
that  death  was  aft«r  all  caused  by  a  heroia,  but  by  sudi 
a  one  as  could  not  possibly  liave  been  reooj^nised 
4arinff  life.  The  lesion  was  upon  the  right  nde.  Only 
a  smul  segment  of  the  small  mtestine  was  oonstrioted, 
and  was  occasioned  by  the  gut  slipping  behind  the 
peritoneal  fascia  and  between  it  and  the  rectal  muscle, 
tbrming  there  a  complete  pockety  ^e  oonstrioted  portion 
of  which  was  formed  by  a  band  of  Iklse  membrane. 
This  strangulation  was  sufficient  to  obstruct  the  fleces 
but  not  enough  to  cause  gangrene. 

He  also  referred  to  a  second  case  tff  ihaskcd  hernia, 
which  was  also  diagnosticated  only  at  the  autopsy.  The 
patient  was  a  lady,  who  after  being  out  ridivig,  suddenly 
died  of  prostration.  In  that  case  there  wm  femoral 
hernia  of  the  left;  side,  but  no  external  siAs  of  its 
existence  could  be  ascertained,  either  by  piSpation  or 
percussion.  The  difficulty  in  making  a  tuagnoeis  could 
be  v^counted  for  by  the  existenoe  of  two  inches  of  &t 
over  the  part 

Dr.  Wood  alluded  to  a  case  of  hernia  which  had  oome 
under  his  observation,  and  in  which  the  sac  was  formed 
by  ^e  sheath  of  the  psoas  muscle.  The  gut  was  not 
mortified,  although  it  was  evident  that  the  strangulation 
had  existed  for  some  little  time.  In  this  connexion  he 
remarked,  that  his  experience  led  him  to  believe  that  in 
those  cases  of  internal  hernia  where  the  mesentery 
was  involved  or  the  intestine  entan^ed  w^  old  adhe- 
sions, gangrene  of  the  incarcerated  Ussues  did  not  take 
place. 

Dr.  Sands  was  of  the  opinion  that  the  cause  of  the 
accident  in  the  first  case  reported  by  him,  was  due  to 
an  abuse  of  the  truss. 

MSMINOKAL  APOPLIXT  IK  KIW-BORH  INFAIIT. 

Dr.  Lbwib  SmTH  presented  a-specimen  of  meningeal 
apoplexy  in  a  new-bom  in&nt  The  mother  of  the 
diild  had  symptoms  in  the  latter  part  of  gestation, 
which  weres  upposed  to  threaten  urasmic  oonvt^dsioaa 
She  had  pretty  persistent  headache  as  well  as  albuminu- 
ria. The  physicians  who  were  visiting  her  were  con- 
templating the  propriety  of  induoing  premature  labor, 
when  the  labor  pains  set  in.  and  a  foetus  of  eight  months 
was  expelled.  The  child  presented  by  the  breech. 
The  first  stage  lasted  about  six  hours,  and  passed  off  in 
the  usual  manner  without  any  untowara  Sjrroptom. 
The  second  stage  was  much  shorter,  being  hastened  by 
•manipulation. 

The  infant  at  first  seemed  to  be  doing  well,  but  after 
^dme  attention  was  directed  ^>  its  respiration.     It 


became  labored  and  embarrassed,  and  was  decidedly 
stertorous  in  character. 

On  making  the  post-mortem  examination,  the  abdo- 
minal organs  were  found  healthy.  The  heart  ako 
seemed  to  be  in  its  nonaal  state.  The  superior  and 
middle  portion  of  the  right  lung  was  inflatea,  with  tbe 
exception  of  a  daric  red  portion.  The  posterior  lobes 
on  both  sides  had  apparently  not  been  inflated,  were  of 
a  still  daricer  red,  ana  were  non-crepitant 

The  lesion  of  chief  interest  was  found  in  the  cranial 
cavitj.  On  removing  the  cranial  bones,  we  found  aa 
efiusion  of  blood  extending  up  upon  the  vertex  so  as  to 
cover  the  two  posterior  cerebral  lobes,  over  the  poste- 
rior surface  of  tne  brain,  and  under  the  cerebellum.  In 
this  latter  situation  a  tnick  dot  was  discovered,  oom- 
municating  with  an  opening  in  the  meningeal  artei^. 

Dr.  SiOTH  stated  that  he  nad  seen  a  similar  condition 
of  things  in  two  other  cases.  In  both,  however,  the 
labor  was  mu(^  protracted,  in  one  forcepls  being  used. 

AHKUmSM  or  AOBTJL 

Dr.  NiwifiK  presented  a  specimen  of  aneurism  of 
the  aorta,  wMch  was  removed  firom  a  young  naaa, 
twenty-seven  years  of  age,  who  returned  home  fixm 
his  office  with  headache  and  died  almost  immediat^y 
after,  befcwe  the  arrival  of  the  physician.  It  seems  th«b 
the  patient  had  been  treated  eighteen  months  ago  for 
epilepsy,  but  had  reoovered  fi^m  his  more  frequent 
attacks,  being  left  with  a  numbness  of  his  left  arm. 
There  were  no  other  symptoms  noticed  during  life  that 
would  lead  to  the  suspicion  4>f  any  serious  trouble. 

The  post-mortem  was  made  fourteen  hours  after 
death.  The  pericardium  was  found  filled  with  liquid 
blood  which  had  escaped  throudbi  a  small  opening  in 
the  posterior  part  of  tne  aorta.  The  heart  was  entirely 
empty.  Nothing  aside  from  a  turgidity  of  the  oerebral 
vessels  and  a  blueness  of  the  dura  mater  was  noticed  as 
the  result  of  an  examination  of  the  cranial  cavity. 

Dr.  Newmait  aUuded  in  connexion  with  his  q>eciman 
to  the  preservative  power  of  carbolic  acid,  which  was 
in  the  proportion  of  3  iss  to  a  pint  of  water. 

Dr.  Jaoobi  was  surprised  to  find  that  so  small  an 
aneurism  had  rupturea  when  tiie  arterial  coats  were  so 
thick,  and  the  atheromatous  deposit  was  only  in  ita  first 
sti^ 

Dr.  Post  exhibited  a  specimen  of  fibro-celuUar  tumor 
the  siae  of  a  pullet's  eggj  which  he  removed  three 
weelra  ago  from  the  upper  lip  of  a  man  in  New  Jersey. 
It  had  developed  between  the  skin  and  mucous  mem- 
brane, and  was  of  seven  years'  standing.  Being  attached 
to  the  macous  membrane,  that  portion  of  the  mass  was 
removed  by  an  dliptical  incisioD,  the  whole  lip  being 
cut  through  as  in  the  operation  for  hare-lip.  The  tumor 
was  examined  microscopically  by  Dr.  W.  B.  Lewis. 

Dr.  BooEBS,  aft»r  aakmg  several  questions  in  regsrd 
to  Dr.  Hamilton's  case,  which  are  however  noted  in 
the  history,  stated  that  the  absence  of  exeeooiTe 
pain  was  a  very  remarkable  feature.  In  all  those  oases 
which  he  had  read  or  heard  o^  the  very  opposite  oon- 
dition  of  things  existed. 

Dr.  Hjlmilton  remarked  that  such  a  circumstauoe 
formed  one  of  the  most  interesting  points  in  the  history. 

MEDICAL  SOCIETT  OF  THE  COUNTY  OP 
NEW  YORK. 

Stated  Msitino,  April  1,  1867. 

Dr.  Sakukl  T.  Hubbabo,  Prbsii)ENt,  in  the  Chair. 

Thb  PRBSiDEirr  announced  that  the  Comitia  Minora 
had  voted  to  grant  certificates  of  membership  to  Drs. 
Alphopso  D.  Bockwell,  Gk>verpeur  Mather  Smith,  John 


THB  MKDKJAL  BECOBD. 


118 


a  Peter?,  Edward  Shell  ^olay,  John  PhflUps  Pajson 
White,  and  Wm.  W.  Strew. 

DISEASES  or  THE  MONTH. 

Db.  Ditmstir,  from  the  Committee  on  Diseases,  re- 
ported the  total  tnortality  lor  the  four  weeks  ending 
much  23,  at  1,621,  or  9S  less  than  for  the  preTious  four 
weeks.  The  causes  of  death  were  distributed  as  fol- 
k>W8:  Zjmotic  disoatMi — 306;  scarlatina  still  holding 
the  lead,  though  ratheir  declining;  diphtheria  slightly 
increased;  croup  diminiebed  nearly  one-half;  typhus 
and  typhoid  uneoan^ed.  Constitutional  diseases^  430^ 
the  tubereular  ocmtmoinff  io  dum  q[»ecial  attention, 
tiiere  bejj:ig  243  deaths  from  nhthisis,  70  from  tabes 
mesentericm,  and  46  from  hywooephalus.  Local  dis- 
eases, 642--of  whidn  pneumonia  gave  134  cases,  and 
bronchitis  28^  Developmental  dSsMses^  134.  Violence, 
40.  There  was  s^  an  immense  preponderance  of 
dsaths  among  the  young,  468  ooeorring  und^  one  year 
efage;  and  nearly  one-half  the  whole  numbw  under 
five  years.  Thirty^three  persons  had  died  abore  the 
age  Weighty.  The  diminution  of  tbe  aggregate  mor- 
t&ty  was  attributed  in  part  to  the  &yorable  atmo- 
spboio  conditions,  as  diown  by  tlie  r^xMrtof  the  meteo- 
wtogical  committecL  and  in  part  to  the  prompt  and  effi- 
eisnt  action  of  the  health  authorities  in  preTentiug  the 
spiead  of  oonta^ous  diseases. 

Tn  PmsmBiiv  announced  the  death,  since  the  last 
iceeting,  of  Db.  Ajltar  Htub  Tvbxbh,  a  member  of  the 
Sodety  since  1862. 

alcohol:  m  htbcts  upoh  the  pubuo  health. 

Dm.  Wif .  F.  Tboics  read  a  paper  upon  "  The  Effects 
of  &8  Habitual  Use  of  Akioholic  Liquors  on  the  Public 
Eeahh."  After  an  historical  in^oductlon,  he  said  that 
the  ratio  of  deaths  from  alooholio  poisoning  in  the  city 
of  New  York  n  one  to  every  4,070  of  the  population 
per  annum.  /Phis,  at  the  usual  rate  of  28  mk  to  one 
death,  would  give  to  the  whole  city  one  sick  from  the 
dbcts  of  alcohol  to  every  146  of  the  population.  Li 
the  bwer  wards  of  the  city  there  is  at  least  one  drun- 
kard to^  every  60  of  the  population,  and  the  sickness 
from  this  cause  is  very  greats  In  the  various  di^)enaa- 
oes  and  missions  with  which  he  is  oonneoted,  at  least 
one-half  of  all  the  cases  of  sickness  that  come  for  treat- 
ment are  caused  direcUy  or  iniMrectly  by  the  effects  of 
alcoholic  liquors.  The  ratio  of  sickness  from  this  cause 
in  the  countrr  is  1  in  760.  In  Loudon  the  ratio  of 
deaths  fit>m  this  cause  is  1  in  12,800,  and  the  sickness 
late  1  in  466.  The  mortality  is  1^  in  London  than  in 
New  Tork^  beoause  the  liquor  chiefly  used  in  the  former 
city  is  gin,  which,  acting  on  Uie  kidneys,  produces  a  less 

S'urions  efleot  than  toe  oth^  aleohofio  preparations. 
m  number  of  deatiis  in  London  has  risen  and  fallen 
aeearding  to  the  &cilities  granted  for  manu£M:turing, 
vending,  and  pundiasinjg  ale^lic  Hquors.  Whenever 
the  government,  to  satisfy  disttllets  and  venders,  open- 
ed the  floodgates  and  suffered  them  to  pour  out  the 
poison  upon  the  community,  then  the  bills  of  mor- 
tality invariably  rose.  When  the  evil  became  too  great 
to  be  borne  and  the  government  laid  on  heavy  duties, 
checked  importation  and  hedged  in  the  traffic,  then  the 
mortality  was  lessened.  In  the  whole  of  England  the 
death-rate  fit)ra  this  cause  is  1  in  26,000,  and  the  sick- 
De»  rate  1  in  860^  varying  according  to  the  &cilities  for 
obtaining  alcoholic  liquors.  Their  introduction  into 
general  use  imparted  increased  virulence  to  the  charac- 
ter of  many  diseases;  and  even  new  diseases  began  to 
ttake  their  a|^>earance  from  this  source.  The  conse- 
qaeBoes  of  liquor-drinking  were  so  serious  in  ihigland 
m  1726  as  to  cause  the  College  of  Physicians  to  make 
poblic  repreeentation  of  tiiem ;  and  im  1760,  when  the 


habit  was  so  general,  the  same  body  stated  they  had 
14,000  gin  cases  under  their  care,  most  of  which  baffled 
all  their  skill  in  medicine. 

Among  the  European  regiments  in  India,  according 
to  late  information,  there  was.  daily,  1  in  every  9.8  in- 
temperate men  admitted  to  the  hospital,  while  of  the 
temperate  class  of  soldiers  there  was  only  1  in  27.1. 
The  death-rate  for  l^e  year  1866,  among  the  same 
troops,  was  I  in  16.4  temperate ;  1  in  7.2  intemperate. 

L^  insurance  oompanies  will  not  issue  policies  to 
those  whose  habits  are  known  to  be  intemperate ;  and 
if  it  be  discoT^^  after  death  that  a  policy  has  been 
obtained  by  the  concealment  of  such  habits,  it  ia  for- 
feited. 

From  Nelson's  "  Vital  Statistics  "  it  appears  that  the 
intemperate  have  a  greatly  increased  mortality  fttmi 
diseases  of  the  head  and  of  the  digestive  organs  (espe- 
cially the  Kv^),  whfle  they  suffer  less  than  others  fi^ 
respiratcMT'  diseases.  The  following  table  shows  the 
ratio  of  deaths  fr<Mn  these  causes  to  those  from  all 
causes  in  the  temperate  and  the  intemperate  respec- 
tive: 

J¥om  di$eam$  </ A#  Ttmptra$&.  JMemprn'oU* 

HMd,  IdeaUilnlOSdeftUii.       1  dMth  in  86  daatiui 

DbmetlTA  orgau  (esp. 

ffver) ;.......:  i^-iw*        i^-a* 

BeeptratoryorgMM...    1»*S0»»  lau^ga 

From  all  the  cIamm 
oombined. 1*»".SO»*10"»»1S'* 

The  mortality  of  the  intemperate  at  from  21  to  30 
years  of  age  is  five  times  that  of  the  temperate;  at 
from  30  to  ^,  four  times. 

The  following  table  shows  the  comparative  chances 
of  longevity  with  temperate  and  intemperate  persons : 


A  temperate  person's 
chance  of  living  is : 
At  20,  44  years  longer. 
At  30,  36  years  longer. 
At  40,  28  years  longer. 
At  60,  21  years  longer. 
At  60,    14  years  longer. 


An  intemperate  per- 
son's chance  of  living  is: 
At  20,  15  years  longer. 
At  30,  13  years  longer. 
At  40,  11  years  longer. 
At  60,  10  years  longer. 
At  60,      9  years  longer. 


The  average  duration  of  life  after  the  commencement 
of  the  habits  of  intemperance  is,  among  mechanics  and 
laboring  men,  18  years ;  among  diofH-keepers  and  mer- 
chants, 17  years ;  9moiig  proltMsional  men  and  gentle- 
men. 16  years ;  among  females,  14  yeari. 

With  reference  to  the  effects  of  alcohol  in  cholera^ 
the  paper  recited  that  all  experienoe,  both  in  this  coun- 
try and  in  Europe,  has  proved  that  those  who  bare 
been  addicted  to  drinking  alcoholic  liquors,  have  been 
the  g^atest  suflPerers  ftom  that  ^idemic.  In  confirsaa- 
tion  of  this  statement^  a  diagram  was  displayed  showing 
the  relation  of  the  number  of  deaths  fr^m  cholera  and 
from  all  causes  to  the  number  of  liquor-stores,  in  the 
several  wards  of  this  city,  during  the  last  season.  From 
the  numerous  authorities  quoted  in  support  of  the  i>o8i- 
tion,  we  give  brief  extracts.  Dr.  SewaU,  of  Washing- 
ton, while  on  a  visit  to  the  cholera  hospitals  in  this  dty, 
in  1832,  writes  thus:  "Of  204  cases  of  cholera  in  the 
Park  Hoqdtal,  th«ee  were  only  six  temperate  persons, 
and  they  recovered  speedily^  while  122  of  the  others, 
persons  of  mtemperate  habits  (when  he  wrote),  had 
died.  Similar  e^merienceSi"  adds  the  Doctor,  '*  meet  us 
in  every  other  hospital."  "At  Albany,"  states  Dr. 
ICussev,  ^during  the  same  season,  cholera  prevailed  fbr 
several  weeks,  attended  with  a  severe  mortality ;  and 
it  is  a  remarkable  £ict  that,  during  its  whole  period,  it 
is  not  known  that  more  than  two  mdividaals  out  of  the 
6,000  members  of  the  temperance  societies  in  that 
cit^r  became  its  victims."  Mr.  Huber^  who  saw  2,160 
perish  in  26  days,  in  one  town  in  Bussia,  says:  "  It  is  a 
most  remarkaue  oircumstanoe,  that  pen*sons  given  to 
drinking. have  been  swept  away  like  flies.    In  Tiflis, 


Digitized  by 


Google 


114 


THE  MEDICAL  RECORD. 


oontaiDing  20,000  mhabitantB,  eyery  drunkard  has 
£EJlen ;  all  aro  dead ;  not  one  remains. 

The  Doctor  then  dwelt  at.  considerable  length  upon 
the  injurious  eflEects  of  intoxicating  liquors  upon  per- 
sons suffering  from  fever,  quoting  from  the  works  of 
eminent  physicians  to  support  lus  arffuments.  Not  only 
is  this  the  case  in  cholera  and  fever,  but  in  almost  every 
variety  of  disease  that  afflicts  mankind.  In  conclusion 
of  this  part  of  the  suljeot,  he  gave  as  tbe  results  of  his 
observations  in  regard  to  the  effects  of  alcoholic  liquors 
on  the  human  system:  First,  ihiej  destroy  the  healihy 
relations  of  the  system;  second,  they  diminish  and 
finally  destroy  the  vital  powers ;  third,  they  act  inju- 
riously on  the  human  system  in  {nreventing  the  organs 
of  restoration  from  peiforming  their  functions  in  a  heal- 
thy manner ;  fourth,  they  prevent  the  effectual  sepa- 
ration of  old  and  useless  matter,  and  also  prevent  the 
new  matter  from  possessing  that  healthy  nature  essen- 
tial to  proper  restoration ;  fijftb,  they  have  a  deteriorat- 
ing influence  in  respect  of  the  physical  energies  of  the 
present  generation  at  large. 

Some  curious  computations  were  then  ffivea,'  by 
which, — counting  a  man's  time  worth  one  dollar  per 
day,  and  313  working  days  in  the  year, — ^it  was  calcu- 
lated that  the  State  of  New  York  loses  annually,  from 
the  habitual  use  of  alcohol,  the  sum  of  $16,257,920. 

The  paper  was  accepted. 

Dr.  OHAOflvr  thonght  it  impossible  to  get  a  correct 
return  of  the  deaths  from  alcohol  in  this  city.  With 
reference  to  persons  of  the  Roman  Catholic  faith,  a 
return  of  their  deaths  from  its  use  would  prevent  their 
burial  in  consecrated  ground ;  and  be  believed  it  custo- 
mary in  such  cases  to  suppress  this  as  a  direct  or  pre- 
disDOsing  cause  of  death. 

Dr.  John  0.  Stoki,  while  recoffnising  the  value  of 
the  paper  as  presenting  matter  for  careful  thought, 
doubted  the  accuracy  of  some  of  its  sta^tics  and  the 
calculations  based  upon  them.  Especially  in  regard  to 
the  effects  of  regular  moderate  drinking,  upon  which 
the  gentleman  had  enlarged,  he  thought  it  would  be 
impossible  to  obtain  facts  that  should  be  trustworthy. 
He  was  surprised  also,  at  the  conclusions  drawn  from 
the  comparison  or  the  death-rate  in  the  various  wards 
with  their  number  of  drinking-houses.  Such  methods 
would  open  the  way  to  g^ve  error.  It  is  true  that  the 
Uqnor-shops  are  most  numerous  in  the  poorer  districts, 
and  that  these  also  furnish  the  heaviest  mortalit^btlls. 
But  here  a  multitude  of  causes  combine  to  increase  the 
rate  of  sickness  and  death.  And  it  is  not  even  certain 
that  more  liquor  is  consumed  here  than  in  the  richer 
and  healthier  districts.  For  whfle  the  poor  fi^uent 
the  dram-shops,  and  rarely  take  much  hquor  to  their 
cabins,  the  rich  supply  themselves  in  quantity,  and  have 
the  means  of  indulgence  constantly  at  hand.  He  be- 
lieved that  if  there  was  any  salvation  for  the  wretched 
dwellers  in  our  ill-drained,  ill-ventflated  tenement- 
houses,  it  was  a  fllass  of  whislcsy.  The  great  difficulty 
was,  they  expended  so  much  money  fbr  whiskey,  that 
they  had  not  enough  left  for  food.  Fut  the  same  per- 
sons under  better  hygienia  conditions,  and  let  uiem 
drink  as  much  as  at  present^  and  they  would  probably 
not  be  harmed  by  it.  We  see  constantly,  among  the 
wealthy,  those  who  use  alcohol  hsbitually  vrithout  in-> 
jury.  Me  had  been  surprised  at  the  ereat  longevity  of 
this  class  in  England,  wnere  it  is  well  known  they  are 
wont  to  indulge  in  free  drinking.  The  evils  of  intoxi- 
cation were  reoognised  by  aJl,  and  he  only  objected  to 
taking  a  magnified  view  of  them. 

Dr.  Tboms  replied  that  for  his  statistics  in  regard  to 
Hie  longevity  of  moderate  as  well  as  other  drinkers,  his 
authority  vfas  Neison.    In  regard  to  the  ratio  of  deaths 


to  the  number  of  liquor-stores,  he  bad  simply  given  the 
facts,  without  attemptinf^  to  fitmoe  a  theory. 

Dr.  Bibbins  said  tnat  if  the  gentleman's  figures  would 
fiighten  any  one  into  habits  of  temperance  he  should  be 
gild  of  it;  but  he  could  not  reconcile  them  with  the 
statistics  of  returns  ttom  the  British  custom-bouses, 
lately  presented  to  a  committee  of  the  House  of  Com- 
mons having  under  consideration  the  subject  of  taxatioii 
for  raising  revenue.  rPhe  tables  had  been  published  in 
the  !Mbune.)  From  these  it  appeared  that  tax  imported 
liquors  as  you  might  it  affected  scarcely  at  all  tiie 
amount  consumed.  Cost  what  they  would,  the  peo^ 
would  have  them.  This  was  in  direct  conflict  with  the 
statements  of  the  paper  just  read  concerning  the  fluc- 
tuations in  the  consumption  of  aloohdic  drinks  in  Eng- 
land, as  dependent  upon  government  taxation.  Wh^e 
shoidd  we  look  for  reliable  figures  upon  the  question,  if  not 
to  the  custom-house  reoords^nd  the  finance  committee 
of  the  Houseof  Commons?  He  would  have  the  Society, 
as  a  scientific  body,  pause  before  oommitting  itsdf  to 
conclusions  opposed  by  such  authority. 

Dr.  Pbaslbb  oould  not  harmonize  Dr.  Bibbins*s  state- 
ment with  any  •principle  of  political  economy.  He  could 
easily  see  how  a  heavy  duty  upon  spirits  might  not 
diminish  the  revenue,  for  the  rich  would  still  consume  as 
much  as  before^  but  that  it  should  not  diminish  the 
consumption  he  could  not  help  doubting,  for  the  poor 
would  be  inevitably  deprived  of  their  wonted  amount. 
He  continued,  that  at  this  day,  when  the  war  had  so 
greatly  increased  the  use  of  stimulants ;  when  chemists 
were  assummg.  but  without  a  particle  of  physiological 
proof,  that  alcohol  could  take  the  place  of  food,  by  check- 
ing waste  of  tissue ;  and  when  learned  theolonans  were 
ranging  themselves  upon  the  same  side,  he  thought  it 
required  a  good -deal  of  moral  courage  to  take  a  stand  on 
the  ground  of  temperanoe.  He  was  disposed  to  accept 
the  argument  of  the  paper  as  essentially  sound,  and  its 
conclusions  as  generally  true,  and  not  to  cavil  at  any 
slight  errors  in  its  details.  His  extensive  observation 
had  taught  him  Uiat  to  both  young  and  old  the  exces- 
sive use  of  ardent  spirits  was  only  harmful.  The  quesr- 
tion  of  their  moderate  use  was  more  troublesome ;  but, 
according  to  his  experience,  a  young  man  of  twenty 
who  drmks  moderately  to-day,  will  drink  excessively 
twenty  or  thirty  years  hence ;  though  if  the  habit  of 
habitual  drin^ng  be  not  formed  until  the  age  of  forty- 
five  or  fifty,  it  may  very  likely  be  continued  in  modera- 
tion to  the  dose  of  life.  He  would  not  interfere  wHii 
any  man's  private  practices ;  but  thought  it  the  duty  of 
physidaas,  in  thdr  professional  ci^>adty,  to  avoid  care- 
lessly indcudng  or  fostering  habits  (2f  intemperance  in  the 
young. 

Dr.  BiBBiifs  responded  that,  if  he  mistook  not,  the 
committee  above  named  had  gone  into  calculations  to 
show  how  the  poor  man,  by  economising  in  other  wajrs, 
managed  still  to  get  his  usual  allowance  of  liquor  in 
spite  of  the  government  duty. 

Thi  Extbavaoahcx  OB  Allowing  Bonus  to  Dbcat. 
— Some  of  the  French  utilitarianists  propose  to  put  the 
corpses  which  are  now  allowed  to  rot  and  waste  away 
in  our  grayerards,  tOsSome  more  useful  purposes,  vis. — 
that  of  making  an  illuminating  gaa  They  estimate 
that  a  medium-sized  adult^  by  a  process  of  combustion 
in  retorts,  is  capable  of  malcing  an  amount  of  ^as  valued 
at  about  eiffht  fVancs,  and  large  sised  corpses  m  propor- 
tion.   Yerily  we  live  in  a  practical  age. 

A  Casi  of  LoKGiviTT, — Jacob  Near,  of  Webster, 
Monroe  county,  N.  T.,  died  on  the  28th  ult,  aged  110 
years.  He  retained,  until  about  a  month  ago^  to  a 
remaricable  degree,  his  intellectual  Acuities. 


Digitized  by 


Google 


THE  MEDICAL  KECORD. 


115 


Urn  3nssttnmtntsi. 


KMMEPS  MODIFICATION  OF  SIMS'S  TJTE- 
RINE  ELEVATOR. 

Som  jears  ago.  Dr.  Sims  published  in  the  Afnerican 
JommtUo/ihe  AMkdl  8eience$,  Philadelphia,  an  account 
of  a  uterine  elerator  devised  by  him.  It  was  an  inge- 
BI0Q8  instrument,  and  replaced  a  retroverted  uterus 
with  great  &cilitj;  but  it  was  impossible  in  most  oases 
to  withdraw  it  from  tiie  uterine  canal,  without  >4[&iQ 
rttrorerting  the  organ  to  a  great  extent  Dr.  Em- 
met has  lately  modified  the  instrument  with  a  riew  of 
ofwcoming  this  difficulty.  The  patient  is  placed  on  the 
left  tide  (or  better,  on  the  knees  and  elbows  if  the  va- 
gina is  smaD),  and  8ims's  speculum  introduoed  as  far  as 
an  ordinary  vaginal  exammation.  In  the  latter  poei- 
tioD,  if  the  operator  is  without  an  assistant,  he  can 
readily  hold  the  speculum  in  the  left  hand  and  use 
the  elevator  with  the  right,  for  atmospheric  pressure  will 
fbUy  dilate  the  vagina  if  the  clothing  of  the  patient  has 
been  preTioualy  loosened  about  the  waist  The  stem 
portion  of  the  instrument  is  forced  into  the  uterine 
canal,  and  by  sentle  pres^re  backwards  into  the  eul- 
^Moe^  the  fundus  is  iiiled  into  place  or  anteverted  at 
From  the  ring  on  tne  slide  at  A,  a  stilet 


1 


Msees  throurii  the  instrument  beyond  the  joint  at  B, 
aj  drawing  Uie  slide  back,  the  joint  B  is  fi'eed,  and  on 
■akiiiff  pre«ure  upwards  and  backwards  against  the 
base  of  Uie  bladder  in  front  of  the  uterus,  the  organ 
is  prevented  from  turning  over  again,  while  at  the 
•MM  time  the  stem  is  pushed  out  of  the  oanaL  This 
iaiknment  has  an  adTantage  in  the  fact  that  the  only 
point  of  preesare  made  is  at  the  os  by  the  bulb  0,  with- 
out the  ride  of  laceratinff  tlie  lining  membrane  of  the 
cual  as  when  the  sound  is  used,  or  any  other  instru- 
Blent  lifting  the  organ  by  its  extremities  alone.  The 
mtra-Qterine  portion  should  be  of  several  lengths,  and 


the  one  used  ought  always  to  be  about  half  an  inch 
shorter  than  the  canal.  It  is  screwed  into  the  bulb  at 
0,  and  beinji;  made  of  copper,  it  can  be  bent  in  con- 
formity to  t£e  curve  of  the  canal,  if  a  flexure  exists. 
The  instrument  has  also  the  advantage  that  with  its  use 
adhesions  can  be  readily  detected,  with  a  perfect  appre- 
ciation on  the  part  of  the  operator  as  to  the  actual 
amount  of  force  he  is  exerting. 


€ont»pon\^tnct. 


FOUR  CHILDREN  AT  ONE  BIRTH, 
AVBBAonio  nvi  pouiiDB  xaoh;  all  livino  akd  vmui, 

▲VD  irUBBIMO  THB  MOTHIR. 
To  THB  Bmtob  (iw  nu  Mbdioai  Bbo(nu>. 

Sib — Some  few  weeks  ago,  the  following  letter  was  re- 
ceived from  a  graduate  of  uie  New  York  Uiuversity,  dated 
Taylor's  Tum-Out  S.  C,  March  7,  requesting  any  re- 
marks which  I  might  think  proper  to  miBtke,  in  reference 
to  the  interesting  case  which  he  details.  Accordingly, 
after  reading  the  case,  I  thought  it  of  sufficient  impor- 
tance to  the  readers  of  your  journal  to  give  it  in  full, 
as  presented  by  Dr.  Faust.  I  have  also  taken  the 
liberty  of  adding  my  comments  upon  the  same. 
1  am,  sir,  very  truly, 

GuNMOfo  S.  Bedfobd,  M.D. 

OKAaAii*t  TvKir-OuT,  B.  0.,  \ 
March  7, 1867.     f 

Psor.  G*.  S.  Bedford,  66  ¥iSth  Avenue,  New  York: 

Mt  Dbab  Doctor  : — ^I  have  just  visited  a  lady  who  has 
been  delivered  of  four  healthy  male  children  at  one 
birth.  One  of  the  children  was  bom  on  the  26th  of 
last  February,  at  11  o*dock  a.m.,  the  pther  three  were 
bom  on  the  Knowing  daWthe  27tb),  between  the  hours 
of  6  and  8  o'clock  ajl  lliere  was  but  one  plaoenta, 
which  was  square ;  cord  attached  to  each  comer.  The 
mother  is  just  25  years  of  age,  and  is  doing  well.  All 
the  children  nurse  the  mother,  and  will  average  5  lbs. 
each  in  weight 

Thinking,  perhaps,  that  you  had  not  seen  such  a  case 
recently,  and  especially  where  all  the  children  were 
living  and  doing  well  I  deemed  it  my  duty,  as  an  old 
student  (^  yours,  toiniorm  you  of  the  tact,  as  obstetrics 
was  ahrays  ^our  favorite  branch.  Please  let  me  know 
what  you  thmk  of  such  cases,  and  how  often  they  occur. 
I  remam,  yours  very  tmly, 

0.  J.  Faust,  M.D. 

Btphf. 

M  Wan  Arsinm,  Nsw  Tokk,  ) 
]i«^lhi0tt^l8S7.     f 

Mt  Diar  Doctor: — ^Your  very  kind  letter  of  7th 
instant  I  received  with  much  interest  The  case  of 
quadruple  birth  which  you  describe  is.  indeed,  a  remark- 
able one.  You  ask  me  '^  what  I  think  of  sucn  cases,  and 
how  often  they  occur?  "  Well,  I  tell  you  very  frankly, 
that /hit  children  at  one  birth,^,and  all  *'  living,  and  doing 
well,"  may  be  regarded  as  among  the  extremely  rare 
phenomena  of  the  lying-in  room.  I  myself  have  never 
met  with  an  instance  of  such  fecundity — the  richest 
reproductive  result  in  my  practice  being  once,  an  exam- 
ple <^  triplets,  two  of  the  mfants,  with  the  mother,  sur- 
viving; the  ttiird  was  still-bora.  It  has  been  my  fortune 
to  bring  33  twins  into  the  world,  one  of  which  cases 
I  wiU  briefly  mention,  as  illustrating  the  fact  that  the 
procreation  of  twins  seems  to  be  peculiar  to  certain 
mdividuals  and  fromlies.  Some  years  ago  I  attended  a 
lady  in  child-bed  with  twins.  This  ladv  I  confined 
three  times  successively  with  twins.    She  married^a 


Digitized  by 


Google 


116 


THE  HEPICAL  RQCORD/ 


(German  gentleman.  Her  fatisbwid  was  a  twin,  and  his 
annt  on  me  maternal  aide  I  delivered  twice  oonseeutire- 
Ij  of  two  children  at  each  birth. 

It  would  seem  that  a  twin  pregnancy  oocnrs  in  the 
varying  prooortion  of  one  in  sixty  to  one  in  ninety- 
fire  cases.  Madame  La  Chapelle  records,  that  in  37,441 
births  there  were  36,992  single  delireries,  444  instances 
of  twins,  and  but  five  cases  of  triplets ;  and  it  is  an 
interesting  fact  that  in  108,000  births  in  the  Hot^  Dieu, 
and  Maternity  of  Paris,  from  the  vears  1761  to  1826, 
there  was  not  one  example  of  quadruple  gestation.  In 
129,172  deliveries  in  the  lying-in-hospital  of  Dublin, 
there  were  2,062  cases  of  twms;  29  of  triplets;  and 
but  one  instance  of  a  quadruple  hirih,  Haller  (Physio- 
logia,  929),  observes,  "  non  rairo  fendna  geminos  fcstus 
parit;  rarius  patdo  tree,  neque  unquam  supra  quinque,  . 
Among  British  praotitionersy  in  257,935  births,  ac- 

^ (43  cases  of  twins, 

ts,orlin5,56li; 

were  336  cases  of 

I  in  6,568 ;  aoiong 

re  4,239  cases  of 

ts,  or  1  in  9,765. 

ases,  and  8;006  of 

lets,  or  1  in  7,443. 

rate  of  mortality: 

lildren),  636  were 

lost,  or  about  1  in  4;  and  of  12  instances  of  triplets  (i,e. 

36  children),  11  were  lost,  or  1  in  3.    The  mortality  to 

the  mother  in  twin  cases  has  been  computed  as  1  in  20. 

The  general  rule  is  that,  in  plural  pregnancy,  each 

foetus  possesses  its  own  membranes  and  placenta;  Mid, 

in  this  particular,  it  shnulates  a  single  ^tatton,  with  the 

exception  that  sometimes  there  wiU  be  an  inosculation 

of  blood-vessels  between  the  different  phicente.    On 

the  other  hand,  it  will  occasionally,  though  rarely,  hato- 

pen  that  there  Is  but  one  after-birth  for  the  two 

children ;   and   it  has  been  suggested  by  Dr.   Tyler 

Smith,  that,  in  these  latter  instances,  the  one  ovule  has 

contained  two  yelks,  and  two  germinal  vesicles,  m  is 

sometimes  observed  in  the  case  of  birds— one  egg  with 

a  double  yelk  producing  two  individuals.     The  foetuses 

in   plural   pregnancy  are  usually  smaller  than  when 

there  is  but  one  child  in  utero,  and  there  is,  also  a 

steong  predisposition   to  premature  deUvery.     When 

there  are  more  than  two.  the  expulsion  is  still  more 

apt  to  be  premature,  and  the  children  rarely  mevive 

beyond  a  short  time.    It  must,  however,  be  admitted 

that  there  are  well  authenticated  exceptional  examples 

of  the  reverse  of  this  latter  rule.     Dr.  Collins  cites, 

within  his  own  knowledge,  two  instances  of  tripled 

having  arrived  at  the  full  period  of  utero-gestation,  and 

were  reared  healthy  children. 

In  the  great  majority  of  cases  in  twin-births,  statistics 
show  that  the  second  child  is  delivered,  by  the  resources 
of  nature  alone,  ft-om  fifteen  to  thirty  minutes  after  the 
birth  of  the  first  In  212  instances  recorded  by  Dr. 
Co&ins,  in  which  the  interval  is  accurately  marked,  in 
38,  it  was  five  minutes;  in  29,  ten  mhiutes;  in  48,  fif- 
teen minutes;  in  23,  twenty  minutes:  in  30,  half  an 
hour;  in  6,  three-quarters  of  an  hour;  m  16,  one  hour: 


and  may  be  either  Uving  or  dead.  This  fact  is  very 
satisfactory  proof  that  the  lives  of  the  two  children  are 
quite  independent  one  of  the  other.*  Again,  both 
children  may  be  fiilly  developed,  and  alive,  but  one 
much  larger  than  the  other.  Gases,  such  as  I  have  just 
mentioned,  may  very  naturally  give  rise  to  the  idea  of 
super-foekUionf  and  have  been  attempted  to  be  explained 
by  some  writers  exclusively  upon  this  hypothesis ;  but 
super-foetaium^  in  my  judgment,  is  not  at  all  necessary 
for  the  elucidation  of  the  phenomena — ^they  may  exist 
independently  of  any  sucn  influence.  For  example : 
this  mequality  may  be  due  either  to  some  original  do* 
feet  in  one  placenta  or  fimis,  or  in  one  of  the  fbetuses ; 
or  it  may  result  from  compression  exercised  in  utero  by 
one  child  on  the  other.  There  can  be  no  doubt  of  lihe 
occasional  operation  of  either  of  these  influences. 

A  plural  pregnancy  does  not  necessarily  imply  that 
the  labor  will  not  be  natural ;  on  the  contrary,  nature, 
unless  there  should  be  some  complication,  such  as  mal- 
position of  the  foetuses,  will  be  adequate  to  accomplish 
the  delivery,  through  her  own  unaided  resources.  The 
labor,  however,  as  a  general  rule,  will  be  more  pro- 
tracted, because  the  uterus,  having  been  subjected  to  a 
greater  degree  of  distension,  loses  in  proportion  its 
contractile  tonicity,  and  therefore  a  longer  period  is 
needed  for  the  acmevcment  of  the  process.  And,  also, 
when  there  is  more  than  one  foetus  in  utero,  the  organ 
cannot  concentrate  its  power  as  in  a  single  gestation. 

The  following  tabl^ -exhibiting  presentations  of  the 
foetus  in  808  labors  with  twin  children,  has  been  con- 
structed by  Prof  Bimpsont  from  the  returns  of  twin- 
births,  as  observed  in  the  Dublin  and  Edinburgh  LjFing- 
in  Hospitals,  and  among  the  patients  of  the  London 
Maternal  Charity: 


Beportar. 


Total   ^ 
namber  of 
Oases. 


Clarke 

CoIUm 

Hardj  and  IfoOllntock. 

Bamabotham 

Simpcon 

ildTT. 


BeM 


Total. 


196 
449 
100 

778 
SO 
48 


1,615 

Proportiont  among  twin  children. . . 
Proporttona  among  all  Urtha. 


Nomber 
of  Head 
Presenta- 


7S 
800 

182 
088 

88 
85 


1,084 

67  In  100 
06  in  100 


Number 

of  FelTlo 

Preaenta- 

tlon& 


58 

188 
68 

881 

7 

88 


408 


linS 
linSl 


Namber 
of  Trana- 
▼erae  Fx^ 
aentaUonai 


T 
6 

10 


1  in  401 
linSM 


m  8,  two  hours;  in  3,  three  hours;  in  2,  six  hours;  in 
1,  seven  hours;  in  1,  eight  hours;  in  1,  ten  hours:  in 
1,  twenty-four  hours.* 

In  plural  pregnancy,  it  will  occaaonally  happen  that 
one  foetus  is  healthy,  and  perfectly  developed,  while  the 
other  bears  evidences  of  an  early  arrest  in  its  growth, 

•  1^  Meniman  dtes  the  following  caae,  reported  In  the  JUddcal 
QffFh^ti^Joumal  for  April,  1811.  vol  xxv.,  p.  811.  In  an  Instance 
of  twins,  the  second  ddM  was  retained  for  fbnrteen  dajs  after  the  Mnh 
^the  flrrt,  and  the  writer  remarks  thai  another  example  had  apme  to 


And  now,  my  dear  Doctor,  I  must  close  this  letter, 
trusting  that  it  will  not  be  altogether  without  interest 
to  you.  You  certain!^  have  accomplished  something 
to  be  proud  of;  and  I  am  much  pleased  that  you  have 
added  to  your  little  State  of  South  CaroHna/aur  molM. 
Believe  me  to  be,  most  truly  yours, 

GuimiNO  S.  Bedford,  M.D. 
C.  J.  Faust,  M.D. 


Death  fbom  Chloroform. — ^A  stableman  recently 
died  under  the  influence  of  chloroform  at  Saint  Mary^ 
Hospital,  London.  It  was  administered  to  facilitate  the 
reduction  of  dislocation  of  the  thumb. 


*  There  Is  no  difflenltj  in  aocamDlatlng  proof  of  the  independence  of 
the  two  fostal  Uvea ;  bat  the  foOowing  Is  certainty  a  most  hiteresting 
demonstration  of  the  fuA :  A  pregnaat  woman  was  attacked  wiUi  small- 
pox, and  reoorered.  She  wsa  aoon  afterwarda  delivered  of  iwlno,  the 
one  having  received  the  small^pox  in  utero,  the  other  not.  Tlie  case 
has  been  i^eported  In  the  Jbrnmal  ds  Mid&Bin»t  edited  br  Vaader^ 
DMrda. 

t  Simpson's  Obstetric  WorkA  YoL  IL.  p.  IBl 

t  The  same  tendency  to  malprcsentatlon  also  exists  in  the  casa  of 
triplets. 


Digitized  by 


Google 


THE  MEDICAL  RECQBI>. 


ni 


TURKISH  AND  RUSSIAN  BATHS. 

To  TBB  Emtob  of  nn  Mbdioal  Bsoobd. 

Sib— In  these  days,  when  the  laws  of  hygiene  are 
beginning  to  receive  the  attention  which  they  deserve, 
aad  when  their  capabilities  for  diminishing  the  number 
ind  seyerity  of  cases  of  preventable  disease  are  recog- 
nised &ct8,  an  appeal  for  the  more  widely  extended  use 
of  the  only  thorough  methods  oi  bathing  may  contri- 
bute to  the  general  good. 

I  advocate  the  Turkish  and  Russian  baths  for  those 
who  have  no  org^anic  or  functional  diseases  to  contra- 
kidicate  their  use. 

Many  physicians  are  personally  familiar  with  their 
benefits;  many  more  recommend  them  in  special  cases, 
tod  approve  of  their  use  by  those  desirous  of  making 
a  trial  of  them.  But  veir  many  know  nothing  person- 
ally of  the  subject,  and  hesitate  to  recommend  them, 
even  to  healthy  persons  interested  in  these  baths  from 
cariosity,  or  for  other  reasons.  Others  are  influenced 
^y  the  reports  made  by  patients  who  have  bathed  once 
or  twice,  and  perhaps  then  imperfectly  or  injudiciously. 

The  whole  question  is  yet  m  the  germ  of  practical 
utility;  but  my  convictions  and  my  personal  experience 
kare  no  doubt  in  my  mind  of  its  inherent  vitality,  and 
of  its  ultimate  development  into  another  of  our  na- 
tiooal  institutions. 

The  American  people  display  tendencies  to  dyspeptic 
oooditions;  to  sluggish  skins,  prematurely  yellow  and 
wrinkled.  They  are  distinguished  for  their  inordinate 
mental  activity,  and  for  the  display  of  an  energy  in 
thdr  various  occupations  which  leads  them  to  sacrifice 
lepoee,  and  many  hygienic  influences,  more  appreciated 
in  oUier  coud tries.  We  inhabit  a  country  with  a  dry 
oiimate  influencing  most  markedly,  the  evaporations 
from  the  skin,  and  stimulating  us  to  activity.  We  suf- 
fer from  the  most  marked  varieties  of  temperature.  We 
awelter  in  the  summer,  and  we  shiver  m  the  winter. 
The  ethereal  mildness  of  the  balmy  spring  is  received 
by  OS  on  the  authority  of  the  English  poets,  and  there 
remains  only  the  ^ory  of  our  American  autumn  as  a 
mUeot  of  just  nationiu  dimatic  pride  and  congratulation. 

All  uni^vorable  influences  of  climate  and  national 
habits  combine  to  suggest  the  more  extended  use  of 
the  Turkish  and  Bussian  baths  as  a  national  need ;  and 
iorely,  if  slowly,  will  their  hygienic,  their  soothing, 
their  invigorating  influences,  commend  themselves  to 
oar  overworked,  harassed,  and  sedentary  population. 

The  American  people  have  purged  themselves  too 
long  and  too  often  of  their  "peccant  humors"  through 
the  bowels.  Some  emunctory  must  be  opened  for  our 
idief;  some  safety-valve  must  be  contrived  for  our 
high-pressure  lives ;  and  the  intestinal  mucous  tract  has 
bewi  spurred  and  forced  to  perform  much  of  that  duty 
which  nature  has  assigned  to  the  healthy  skin. 

Is  it  probable  thai  the  frequenters  of  the  Boman 
baths  would  have  displayed  as  many  post-mortem  evi- 
dences of  renal  disease  as  the  great  unwashed  and  seden- 
taty  populations  of  our  times?  Do  we  not  all  force  the 
akin  to  renewed  activity  when  its  voke-fellow,  the  kid- 
nay,  is  struggling  with  disease  ?  is  it  not  certain  that 
a  more  thorough  and  systematic  attention  to  the  func- 
tions of  the  skin  would  prevent  many  of  the  diseased 
oooditions  of  the  kidney,  so  widely  spread,  that  healthy 
kidneys  are  rarely  met  with  in  autopsies  and  dissecting- 
rooms? 

Many  eaaoe  of  dyspepda  are  susceptible  of  relief  in 
this  way.  That  theee  baths  facilitate  digestion  was 
known  of  old,  and  the  manner  in  which  thev  were  used 
tx  the  relief  of  gormandizers  has  been  made  one  of  the 
Wpiea  of  JavenaTs  satire.  For  the  relief  of  rheumatic 
paiii%  and  aa  a  prophylaxis  of  rheumatism,  there  can 


be  no  question  as  to  their  value.  They  are  better  worth 
than  dna^  and  ointments  for  many  cutaneous  diseases. 
For  psoriasis — an  opprobrium  medicorum — they  fulfil 
the  chief  indication.  The  cure  of  scabies  can  be  hastened 
by  their  use,  and  the  risks  of  tegumentary  irritation 
from  the  prolonged  use  of  sulphur  obviated. 

The  dark  ages  were  the  dirty  ages;  and  with  aH  the 
development  of  learning,  the  wonderful  contrivances  of 
printing,  postage,  and  the  telegraph,  for  disseminating 
and  transmitting  information ;  with  all  the  luxuries  of 
dress  and  home-oomforts  that  mark  the  civilization  of 
our  day ;  with  the  expenditures  for  water  supply,  and 
the  pnceless  treasures  of  our  Croton,  we  are  not  as 
clean  in  our  persons  now  as  the  old  Bomans  were. 

Urquhart,  and  others,  are  enthusiastic  regarding  the 
applicability  of  these  baths  to  the  cure  of  tuberculosis ; 
and  when  one  remembers  the  benefits  claimed  for  these 
patients,  when  they  pass  hours  in  the  sugar-boiling 
houses  on  the  plantations,  it  is  evident  that  if  any  reme- 
dial agents  were  to  be  found  there,  the  chief  must  have 
bees,  heat  and  moisture. 

These  baths  should  be  attached  to  our  hospitals,  where 
the  existing  necessities  for  large  boilers  would  permit 
their  introduction  at  a  moderate  outlay.  They  should 
be  afforded  at  a  low  rate  to  the  packed  masses  of  our 
tenement-house  population. 

Cleanhness  is  next  to  godliness;  and  cleanliness  can 
be  attained  so  thoroughly  by  no  other  method,  as  those 
well  know  who  have  taken  these  baths  often  enough  to 
have  their  scarf-skin  peeled  off,  and  witness  the  difference 
in  the  rapidity  and  amount  of  their  perspiration,  after  the 
skin  has  attained  to  something  like  a  condition  of  health 
and  freedom  in  its  action.  Sir  Francis  Head  reports  a 
Frenchman  to  have  said,  afler  taking  the  baths  at  Dchlan- 
genbad,  "  On  y  devient  amoureux  de  soi-m^me."  At 
least,  one  may  learn  to  entertain  a  proper  respect  and 
appreciation  for  his  own  skin  after  these  baths  have  in- 
structed him  in  its  capabilities. 

Try  them  for  yourselves,  all  those  who  have  healthy 
hearts  and  sound  arteries;  but  try  them  frequently 
enough  to  know  by  experience  their  capabilities  for 
improving  your  health  and  adding  to  the  comfort  of 

Jour  life.  And  though  you  avoid  the  gravida  $u$  of 
uvenal,  be  sure  not  to  neglect  to  take  a  lunch  before 
you  go.  For  my  own  part,  I  prefer  the  baths  of  Dr. 
Gutman,  in  Fourth  street,  between  Lafayette  plaoo 
and  JSourth  avenue,  where  they  can  be  taken  in  combi- 
nalton,  and  where  one  can  pass  directly  from  the  enjoy- 
ment of  the  Turkish  to  that  of  the  Russian  bath.  '*  But 
let  every  one  be  persuaded  in  his  own  mind." 
Tours  respectfully, 

Geo.  T.  Elliot,  Jr. 

18  WBT  TWBirTT-MINTH  STEER. 

^     I    ^    

PUBIC    VERSION   IN    UTERO— THE   WOMAN 

PLAOSD  OK  HER  KNEES  AND  CHEST. 

To  Tine  EorroB  or  the  Medical  Bbcoed. 

Ih  an  article,  published  in  the  Medical  Record,  August 
15,  1866,  I  remarked  that  pubic  version,  in  my  opi- 
nion, could  be  performed  much  easier  were  the  woman 
placed  on  her  knees  and  chest  than  b^  the  usual 
method.  I  do  not  refer  now  to  the  operation  by  exter- 
nal manipulation,  but  only  to  one  where  the  hand  is 
required  to  be  introduced  into  the  uterine  cavity. 

Since  the  publication  of  that  article  I  have  attended 
three  cases  of  confmement,  wherein  pubic  version  was 
required,  and  could  not  be  performed  by  external 
manipulation  in  cotisequenoe  of  the  bodies  of  the  chil- 
dren being  impacted, .  and  have  done  the  operation 
according  to  the  above  plan  with  eminent  success. 

Case  L— Was  a  Mrs.  N j  twenty-ei^ht  years  of 

Digitized  by  VjOOQIC, 


X18 


THE  MEDICAL  RECORD. 


age,  in  her  fourth  confinement.  When  I  readied  her 
bed-side  I  ascertained  that  she  had  been  in  labor  seve- 
ral hours,  and  that  her  pains  had  been  ▼etr  strong.  I 
examined  her,  and  found  the  nmbilical  cord  presenting, 
prolapsed  about  twelve  inches,  cold  and  feebly  pulaat- 
mff ;  also  the  body  of  the  child  lying  transrersely,  con- 
siderably impacted.  I  placed  the  woman  in  the  posi- 
tion above  described;  administered  chloroform ;  return- 
ed the  cord  by  Dr.  T.  G,  Thomas's  method,  and  without 
withdrawing  mv  hand,  or  changing  the  woman's  posi- 
tion, seized  Uie  toot,  and  turned  and  delivered  the  chdd  in 
a  few  moments'  time,  successfully,  alive  and  nnii^'ured. 

Case  IT. — ^A  Mrs.  D  ,  aged  thirty-five,  in  her 
eighth  confinement  This  case  was  similar  to  that  of  Mrs. 

N >,   excepting   the  funis  was  not  prolapsed;   the 

side  of  the  child  presenting.  I  arranged  her  in  the 
same  position,  and  operated  in  the  same  manner,  with- 
out administering  chloroform,  with  like  success. 
Aniesthesia  was  not  resorted  to  in  oonaequenoe  of  her 
preference  to  suffer. 

Case  III. — A  Mrs.  B— ,  in  her  fifth  confinetttent, 
aged  thirty.  In  this  case  the  shoulder  was  presenting 
and  so  impacted  that  it  was  difficult  to  distinguish  it 
from  a  breech-presentation.  On  being  satisfied  that  it 
was  nut  breech,  I  placed  her  in  the  position  required 
by  the  method,  administered  chloroform,  and  peiform- 
ed  the  operation  with  the  same  success  as  related  in 
the  other  cases.  Mother  and  child  doing  weU  $8  the 
above. 

The  position  of  the  women  in  these  three  instances  I 
am  thoroughly  convinced  rendered  operations  very 
easT,  which  otherwise  would  have  been  very  difiknlt. 

The  advantages  gained  over  the  usual  method  by 
thus  operating  are  obvious  to  any  practical  obstetrician. 

The  first  is,  the  relaxation  of  vaginal  sphincter  and 
walls  J  the  second,  the  gravitation  of  utenne  contents 
relievmg  impaction ;  the  third,  the  retaining  of  the 
amniotic  fluid  during  the  operation;  the  fourth,  the 
hand  and  arm  maj  be  introduced  into  the  utenne 
cavity  more  nearly  m  a  line  of  the  axis  of  the  superior 
strai^  the  cervix  and  perinenm  being  pelding. 

Alix.  Haddht,  M.D. 


(Dbttuatn. 


CASPAR  WISTAR,  M.D., 


Thi  death  of  this  excellent  man  wiU  be  a  sonroe  of 
deep  and  unalloyed  regret  to  all  who  knew  him,  for 
his  qoalities  of  mind  and  heart  were  such  a?  secured  for 
him  the  love  and  respect  not  only  of  a  large  family  cir- 
cle, but  also  of  a  yeiy  extensive  general  aoquaintanca 
Indeed,  no  one  could  i»proach  hmi  without  beiag  Ik- 
vorably  impressed  by  ms  frank,  open  manners,  and 
his  kind,  earnest,  genial,  and  sympathizing  disposition. 
The  son  of  the  late  venerable  Thomas  Wistar,  and  the 
nephew  of  the  eminent  anatomist  and  surgeon  whose 
name  he  bore,  he  naturally  inclined  to  the  adoption  of 
a  profession  which  had  been  so  signally  illustn^ed  in 
his  family;  and  accordingly,  after  the  decease  of  bk 
distinguished  relation,  he  entered  the  office  of  the  kte 
Joseph  Parrish,  imder  whose  instrucUons  and  thoae  of 
his  associate,  Dr.  Wood,  he  prepared  himself  fer  the 
degree  of  Doctor  of  Medicine,  which  was  conferred  on 
him  in  the  year  1S24.  Immediately  after  his  gradua- 
tion in  the  medical  department  ot  the  Uniyerskr  of 
Pennsylvania,  he  was  elected  to  the  office  of  Resident 
Physician  of  the  Pennsylvania  Hospital ;  where  Ib^the 
spaoe  of  two  years,  he  ei^yed  advantages  for  the  ao-  j 


(]^uisition  of  practical  medical  knowledge  sodi  as  at  that 
time  were  to  be  found  nowhere  else  in  our  country. 
Thus  qualified  for  the  successful  pursuit  of  his  profes- 
sion, possessing  excellent  natural  endowments,  having 
the  certain  support  of  a  numerous  connexion,  the  p»-> 
tronage  of  a  wealthy  and  estimable  body  of  Christians — 
which  then  bore  a  much  greater  relation  in  proportion 
to  the  population  of  the  city  than  it  now  doea^  though 
it  has  m  no  deeree  declined  from  its  former  mfluence 
and  respectability — as  well  as  the  prestige  of  a  beloved 
and  celebrated  name,  he  might  have  confidently  antid- 

{>ated  a  lucrative  practice,  and  the  attainment  of  the 
dghest  medical  honors  and  position.    The  path  of  i»x>- 
fessional  life.  mgfi;ed  and  difficult  to  others,  had  been 
made  smootn  and  easy  to  him;  but  whether  owing  to 
increasing  domestic  responsibilities,   aversion  to  the 
steady,  laborious,  and  exclusive  application  which  is 
imperatively  required  to  reach  a  foremost  place  in  medi* 
cine,  as  indeed  in  all  other  branches  of  knowledge, 
an  unwillingness  longer  to  subject  a  nervous  and  im- 
petuous temperament  to  the  harassing  toils  and  men- 
tal disquietudes  inseparable  from  the  life  of  a  physidan, 
or  to  some  other  cause  unknown  to  the  writer,  he  soon 
began  to  relax  his  exertions;  and  after  a  few  years  of 
successful  practice,  during  which  he  abundantly  demon- 
strated how  much  more  he  could  have  accomplished,  be 
retired  from  the  field,  and  devoted  himself  henceforth 
almost  exdusively  to  the  duties  of  private  life,  and  the 
promotion  of  objects  of  general  beuevolence  and  utility. 
It  was  in  occupations  such  as  these  that  he  appeared 
in  all  the  beauty  and  attractiveness  of  his  character. 
He  was  always  ready  to  take  a  put  in  every  enter* 
prise  having  for  its  object  the  alleviation  of  the  mise- 
ries and  the  cultivation  of  the  charities  of  human  life: 
and  many  of  our  public  institutions  are  greatly  indebted 
to  him  for  his  active  interest  and  fostering  care.    The 
Philadelphia  Dispensanr  espedally  owes  more  to  him 
than  perhaps  to  any  other  person;  for  throughout  the 
lon^  period  of  finty  years,  during  which  he  held  the 
positions  of  Secretary  and  President  of  that  admirable 
charity^  its  management,  of  necessity,  devolved  chiefly 
upon  mm ;  he  continued  to  watch  over  its  welfare  witM 
unflagging  seal  to  the  day  of  his  death ;  and  its  past 
usefiUnees  and  present  prosperity  bear  testimony  to  the 
wise  economy  and  prudence  wiui  which  its  affairs  have 
been  administered.    The  Umited  spaoe  to  which  this 
notice  is  re^'tricted  would  hardly  suffice  for  the  bare 
ennmeration  of  a  tithe  of  what  he  effected  in  almost 
erery  department  of  philanthropic  effort    He  was  s 
prominent  member  of  the  Sodety  of  Friends,  and  with 
the  active  benevolence  for  which  that  body  of  Christians 
is  so  honorably  distinguished,  his  whole  life  was  de» 
yoted  to  the  promotion,  in  some  way,  of  the  wel&re 
of  others.    A  large  share  of  his  attention  was  directed 
to  the  improvement,  in  every  mode,  of  the  colored  popa- 
lation  of  the  city;  and  for  several  years  he  acted  as 
physician  to  the  Home  for  Colored  Children.    His  sym- 
pathies were  ever  most  deeply  moved  by  fallen  man  in 
bis  most  helpless  and  degpraded  state;  and  hence  the 
lively  solidtude  he  evinced  for  the  well-being  of  the 
inmates  of  our  prisons,  houses  of  refuge,  and  other  re- 
formatory institutions,  in  the  direction  or  which  he  bore 
an  important  and  conspicuous  part    The  suli^ect  of 
slavery  eariy  engrossed  his  thoughts;  and  while  his  voice 
was  ever  heard  m  indignant  condemnation  of  that  bar- 
barous system,  his  feeling  heart  and  energetic  mind 
were  constantly  employed  in  the  furtherance  of  mea- 
sures for  its  adoptioa    To  this  end  he  thought,  spoka 
and  wrote  with  unwearied  diligence.    As  a  means  of 
extending  his  usefulness,  and  itmnendnff  the  minds  of 
others  beyond  the  sphere  of  his  personal  acquaintance, 
he  assisted  at  one  period  in  the  editorial  supervision  c£ 


igitized  by 


THE  MEDICAL  RECORD. 


119 


"Re  Friend,"  a  weekly  pablicati<Hi  belonging  to  his 
8ooiet7,  and  was  at  all  times  a  frequent  and  valued 
ooDtributor  to  its  columns.  He  was,  of  course,  opposed 
to  the  war — ^in  which,  however,  one  of  his  numerous 
laiDilj,  General  Isaac  J.  Wistar,  who  was  badly  wounded 
in  the  battle  in  which  the  lamented  Colonel  Baker  fell, 
bore  a  prominent  share — ^but  he  foresaw  at  least  one 
nod  result  of  the  murderous  and  unnatural  strife,  in 
Uie  OTerthrow  of  African  bondage.  His  nature  was 
ndent,  his  perceptions  quick,  and  nis  acute  and  ready 
mind  possessed  the  faculty  of  fixing  almost  intuitively 
CD  the  strong  points  of  B,nj  subject  submitted  to  its 
consideration.  His  friendships  and  attachments  were 
strong  tnd  unwavering;  his  address  warm  and  cordial; 
his  conversation  interesting  and  instructive,  abounding 
in  sneodote  and  illustration;  he  was  fona  of  humor, 
prompt  in  repartee,  and  was  a  person  whom  it  was 
ahrays  a  happiness  to  meet,  and  from  whose  presence 
one  rarely  departed  without  pleasure  and  improvement 
Sach,  in  very  brief  and  imperfect  outline,  is  the  cha- 
racter of  Dr.  Wistar.  as  it  appeared  to  your  correq>on- 
dent;  but  it  would  be  incomplete  indeed,  if  it  failed  to 
convey  the  iropresston  that  he  was  an  humble  and  con- 
flisteot  follower  of  the  Divine  Redeemer.  The  true 
Christian  was  regarded  by  our  departed  friend  as  the 
hi|he6t  style  of  man ;  and  though  conscious  of  his  own 
tniraiities  and  impeifections,  he  laBored  earnestly  for 
the  attainment  of  such  exeeflence.  Orthodox  in  his 
belief  and  reverent  in  his  deportment,  he  faithfully  en- 
deavored to  order  his  daily  walk  in  accordance  with 
that  of  his  great  Exemplar,  and  to  bring  every  impulse 
of  a  somewhat  excitable  temperament  into  subjection 
to  His  precepts.  This  was  more  particularly  remark- 
able towards  Uie  doae  of  his  life ;  when,  impressed  with 
the  conviction  that  the  end  was  approaching,  his  dispo- 
sition and  manner  became  singulany  childlike  and  affec- 
tiooate,  calling  forth  the  love  and  admiration  of  all 
iroond  him.  He  died  at  his  jesidence  in  Philadelphia, 
00  the  4th  of  April,  1867,  after  a  short  iUness,  of  serous 
ipoplexy,  in  the  66th  year  of  his  age;  meeting  the  ap- 
praadi  of  death  with  the  calmness  and  resignation 
whidi  characterized  his  life,  and  with  humble  coxifidence 
in  the  merits  of  his  Saviour. 

Life  will  take  a  darker  hue  from  his  departure ;  but 
the  remembrance  of  his  beaming  smile,  his  hearty  wel- 
come, his  words  of  hope  and  encouragement,  his  uncon- 
^Mrable  resolution,  hb  love  of  rij^ht  and  scorn  of  wrong, 
and  his  undoubting  fiuth  in  the  final  triumph  of  go^ 
OTcr  evil,  remain  to  cheer  and  comfort  us  during  the 
remainder  of  our  pilgrimage,  and  to  allure  us  onward 
and  upward  along  the  path  which  he  trod. 


All,  «n  Are  fose:  but  mid  the  gloom 

▲  bright  Mid  oneering  ray  it  ebed, 

Aad  memorr,  bemttng  o'er  hie  tomh, 


In  certeia  fkith  bevetle  her  deed. 


Pblabclpua,  AprU  IT,  1887. 


Um  publications. 


Books  avd  Paxfhlbts  Rbobivid. 
Trbd  Ajtvual  Bei>obt  or  thb  Boabd  or  Statb  OHABmss 

orllASBACHuavns.    Jaooary,  1867. 
OavnrcnoN  amd  Bt-Laws  or  thb  Dhtrigt  ICbdioal  Sooi- 

■FT  or  THX  CouHTT  or  Huneox,  Nsw  Jebsbt,  1807. 
Ai  IiQuuiT  iHTO  Tmi  Osroiir  q&  Modbbit  AasarBMSiJL 

^  the  Hod.  Tbuxam  Smith,  Member  of  the  U.  &  House 

«  Bepneentativee  for  the  26th,  27th,  29th,  and  80th  Con* 

ftiMi.  and  of  the  U.  a  Senate  for  the  Slat,  82d,  and  88d 

CoBfren. 
BdsabBB  Mbdioal    Collbgb,   Fobtt-foubth  Ansiual 

Catalooub.    1867. 


RBPOBT  or  THB  PBiniSTLVAinA  HOSPTTAL  rOB  THB  IHBAXB, 

for  the  year  1866.     By  Thomas  S.  Eibkbridob,  M.D., 
Pbysican  in  Chief  and  Superintendent    1867. 

Fobtibth  Annuai.  Rbpobt  or  thb  Boabd  or  Inspbotobs  or 
THB  Wbstbbb  PBEriTBNTiABT  or  Pbnnstlvania,  for  1866. 

Adviob  to  Students.  Ak  Addbbss  Dbliverbd  at  thb 
Opbhino  or  THB  Medical  Lectures  or  Harvard  Uki* 
VBRsrrr,  Nov.  7,  1866.  By  Pro£  C.  K  Browk-SAquard, 
M.D.,  1867. 

MBDIOnni  AN  AOGBBOATE  or  PB06BB8SIVB  SCIBNOBS.    YaLB- 

diotort  Addrbss  at  the  Commencement  or  the  Univeb- 
smr  or  Maryland.    By  ProC  F.  Donaldson,  M.D.,  1867 

Practical  Dissections.  By  Richard  M.  Hodobb,  former* 
ly  Demooatrator  of  Anatomy  in  the  Medical  Department 
of  Harvard  University.  Second  Edition,  thoroughly  reviaed. 
Philadelphia :  H.  C.  Lea,  1867. 

YALSDiOToaT  Addbbss  BEroBB  National  Medical  Collbob 
or  Washington.  By  John  Ordronaux,  M.D.,  ULB., 
ProC  of  Physiology  and  Medical  Juriaprudenoe.    1867. 

Rbpobt  or  Boabd  or  Trustees  or  Mass.  Gen.  Hospital. 
1866. 

Obstetrics  the  Soienob  and  thb  Art.  By  Charles  D. 
Mbios,  M.D.,  late  Professor  of  Obstetrics,  Jefferson  Medi^ 
oal  College.  Fifth  BdiUon.  Philadelphia:  H.  C.  Lea^ 
1867. 


Mibkai  Urns  antr  3Hem8. 

Dr.  L  Bat,  the  well  known  psychologist,  has  retired 
on  account  of  ill  health  from  the  superintendency  of 
the  BuUer  Hospital  for  the  Insane  at  Providence.  Dr. 
John  W.  Sawyer  is  his  successor. 

A  Needle  nr  the  Pebioabdium,  oausino  death  bt 
Hjbmorrhaob. — A  woman,  aged  forty,  was  recently  ad- 
mitted and  died  rapidly  with  symptoms  of  fainting,  and 
on  examination  after  death  the  pericardium  was  found 
full  of  blood  which  had  escaped  from  wounds  ca^ised 
by  a  needle.  The  needle  was  probably  swallowed  and 
eventually  worked  its  way  from  the  cesophaffus,  in 
which  it  probably  at  firal  lodged  on  its  way  to  its  final 
destimatioiL 

TkeKewYobk  Quabantinb  Bill. — ^The  new 'Qua- 
rantine l»ll  recently  passed  the  Senate,  provides  that 
the  proposed  buildings  for  the  detention  of  passengers 
coming  in  infected  vessels  but  not  actually  sick,  uiall 
be  buUt  on  the  West  Bank ;  but  in  case  it  becomes  ne- 
cessary to  use  a  temporary  site  until  the  buildings  are 
erected,  Barren  Island  may  be  used.  It  also  provides 
that  the  boarding  station  of  the  Health  Officer  ^all  be 
on  the  west  end  of  Coney  Island,  and  no  infected  ves- 
sel shall  be  permitted  to  anchor  in  Ghravesend  Bay.  One 
hundred  thousand  dollars  are  appropriated  for  these 
purposes. 

Cholbba  is  reported  to  have  l»x>ken  out  at  Port 
Glasgow  and  Jersey. 

Bbgibtbrino  Nbw-Bobm  CHnDBEN  IN  France. — ^A 
long-standing  n>gtilation  in  France  requires  each  father 
or  mother  to  take  their  children,  within  three  days  of 
their  birth,  to  the  Town-halL  and  there  show  them  to  the 
registrar.  There  has  been  of  late  considerable  discussion 
in  the  various  French  papers  concerning  the  absurdity 
of  Uie  practice.  Many  children  are  said  to  have  lost 
their  lives  by  a;complianoe  with  the  regulation ;  espe- 
cially has  this  been  proved  to  be  the  case  with  those 
little  ones  who  have  oeen  thus  carried  out  in  inclement 
weather  and  duiing  the  severe  winter  months.  jTp 


c^l 


IfiO 


THE  MBDICAL  RBCOKD. 


DiLBOATES  to  American  Medical  AMoeialioa  from 
New  York  Patholojrical  Society. — Dre.  Ellsworth  Eliot, 
W.  B.  Bibbins,  £).  Ejackowiser,  A.  £.  M.  Pufdy.  W. 
Parker.  L.  A^yre,  W.  H.  Dnmer,  H.  B.  Sandc  A.  C. 
Post.  R.  F.  Weir,  S.  Rogers,  T.  C.  mnell,  and  George 
P.  Shrady. 

M.  FoLLiN,  the  distinguished  editor  of  the  "  Arch, 
O^.  de  Medecine."  was  recently  elected  member  of  the 
Academy  of  Meoicine,  subject  to  the  approval  of  the 
Emperor.  The  candiaates  were  M.M.  Xegoueat,  Do* 
marquay,  A.  Gu^rin,  Girald^  and  VerneuiL 

Pkof.  John  Gk)0Dsm,  of  the  UniveFBity  of  Bdinborgh, 
died  March  6,  at  Wardie. 

A  School  for  VivisioTioir.  —There  is  about  to  be 
establMied  at  Paris  a  special  department  of  Ihe  School 
of  Medicine  for  the  study  of  practical  physiology. 
What  a  pity  it  is  that  we  cannot  Mow  the  example,  if 
for  no  oUier  reason  than  to  supply  the  PresideBt  of  the 
Society  for  the  Prerentkm  of  Cruelty  to  Animals  aome 
more  material  for  sensational  coirre^)ondenoe  in  the 
pnbHo  prints. 

TvB  Iktebnational  Mbdioal  Corgbem  at  Paub  will 
meet  on  the  16th  of  August  next^  and  remain  in  session 
two  weeks. 

BirPBB-HXATBD  Stbam. — ^A  oompauy  has  been  orga- 
nised in  this  city  for  the  purpose  of  introducing  Gatral- 
ho*s  patent  for  soper-heatinff  steam.  The  i^paratus  is 
c^>able  of  supplymg  pure,  dry  steam,  of  anj  required 
temperature.  The  yalue  of  this  agent^  as  a  disinfectant, 
has  been  so  well  established  by  the  experiments  of  Dr. 
Bell,  of  Brooklyn,  that  any  means  to  perfect  its  appli- 
cation deserve  a  thorough  trial 

Prbtintion  or  Pitrulimt  Resosptiov  bt  Eroouhb. 
— ^Dr.  Labat,  of  Bordeaux,  claims  that  the  administra- 
tion of  ergotine  in  eight  closes  of  five  or  six  grrammes 
daily,  for  eight  or  ten  days,  is  attended  with  Tery  bene- 
ficiu  results  in  preventing  purulent  infection. 

Amblyopia  produced  bt  Smokoto. — ^M.  Yiardia  has 
reported  three  cases  of  amblyopia  produced  by  smoking. 

Mbdical  ChWi  OF  LoHDON. — The  medical  dub  so  long 
talked  of  in  London  has  at  Isngth  been  fidrly  esta- 
blished, and  numbers  nearly  six  hundred  member^. 

PfinwoAL  Gultubi. — A  gymnasiuM  establishment 
upon  a  capital  stock  of  $25,000.  in  shares  of  $60  each, 
is  talked  of  in  this  dty,  in  whion  every  branch  of  phy- 
sical culture  shall  be  taught 

A  Suggestive  Fact. — ^Damascus,  the  oldest  dty  in 
the  world,  contains  84,000  people.  Leavenworth, 
Kansas,  though  founded  only  twelve  years  ago,  has 
nearly  25,000  inhabitants. 

FoBOBD  Medical  Attbndanok — The  physicians  in 
Pern  are  compelled  to  attend  any  one  who  may  call  on 
them,  at  any  hour  dav  or  night,  and  in  case  of  refiisal 
are  liable  to  a  fine  of  fifty  dollars.  An  ui^ust  as  well 
as  unnecessary  measure. 

New  Yobk  Hospital  akd  Bloomihgdalb  Astlttk. — 
From  the  annual  report  of  the  Governors  of  the  Sodety 
of  the  New  York  Hospital  and  the  Asylum  for  the  re- 
ception of  the  insane  at  Bloomingdale,  it  appears  that 
the  whole  number  of  patients  trcMed  in  the  New  York 
Hospital  during  the  vear  1866  was  2,645.  The  number 
of  patients  m  the  hospital  on  the  31st  of  December, 
1865,  was  243,  and  there  were  admitted  during  Uie 
year  1866.  2,402.  The  number  cured  was  1,536 ;  *re- 
fieved,  475;  discharged  at  request,  68;  discharged  as 
improper  objects,  23 ;  eloped  or  discharged  as  disorder- 


ly, 82 ;  died.  283 ;  total,  2,412.  Bemaininff  Slst  De- 
cember, 1866,  233,  makinff  a  grand  total  of  2,640. 
There  were  95  inquests  held  at  the  hospital  during  the 
year,  of  which  10  were  in  cases  of  railroad  aoddent. 

The  number  of  patients  in  the  Bloomingdale  Asylum 
on  the  31st  dav  of  Deoember,  1865,  was  171,  and  there 
were  admitted  during  the  year  132,  making  a  total  of 
303.  Of  these,  66  were  disohar^  recover^ ;  33  im- 
proved ;  12  not  improved ;  24  died,  and  168  remained 
on  the  31st  of  December,  1866. 

The  receipts  of  both  institutions,  during  1866,  amount- 
ed to  $209,697.44;  the  enenses  to  $198,111.94.  On 
the  3l8t  of  January,  1865,  the  indebtedness  was 
$96,450.50,  against  $84,872,  at  the  same  date  in  186a 

The  rate  of  board  £br  seamen  entitled  to  the  benefit 
of  the  United  States  Hospital  fund,  has  been  raised 
fVom  $6  to  $7  per  week;  the  raite  for  other  patients  is 
$6  per  week  for  males,  and  $5  for  females — ^much  less 
than  the  actual  cost  of  each  patient  to  the  Institution. 

N.  Y.  State  Titebriate  AstluH. — ^The  trustees  of 
the  State  Inebriate  As^^lum,  at  Binghampton,  N.  Y., 
have  secured  the  services  of  Albert  Day,  M.D.,  as 
superintendent  He  was  the  originator  and  suco^sfiil 
manager  of  the  Washington  Home,  of  Boston,  for  the 
treatment  and  cure  of  inebriates.  They  hope  to  open 
the  institution  for  the  reception  of  patients  about  the 
Ist  of  May  next 

Manaoebs  of  thb  Hudsoh  Rivbb  State  Hospital 
FOB  THE  Ihsakb. — The  fdlowing  managers  have  been 
dulv  appointed  by  the  Legislature : — ^Abiah  W.  Palmer, 
of  Amenia ;  William  Kelly,  of  Rhinebeck ;  Dr.  Cornelius 
R  Affnew,  of  New  York  city ;  Dr.  A.  Cooke  Hull,  of 
Brooklyn ;  Amasa  J.  Paricer,  of  Albimv ;  Dr.  Edward 
L.Beaale,  of  Poughkeepsie;  (George  Ciarke.  of  New* 
burgh ;  Joseph  Howland,  of  Fishlull ;  and  John  P.  H. 
Tallman,  of  roughkeepsie. 

riouLiABiTiES  OP  Ohinesb  Pbaotioe. — ^The  phjTsician 
approaches  the  sick-room  with  courtesy  and  pobteness, 
and  having  ascertained  the  nature  of  the  disease  of  his 
patient,  proceeds  to  prepare  his  prescription.  Thefr 
prescriptions  generally  are  vast  compounds ;  they  go  on 
the  supposition,  very  common  with  other  practitioners, 
that  it  is  best  to  give  several  remedies  together,  so  that 
one  or  another  of  them  will  hit  the  case.  Sometimes 
ther  compound  as  manv  as  fifty  to  eighty'ingredients, 
and  stew  them  all  together  and  then  administer.  They 
hardljr  ever  prescribe  less  than  fifleen  or  twenty  simple 
medicines.  The  physician  is  not  so  much  a  preecriber  as 
a  seller  of  medicines.  He  tells  his  customers  what  he 
thinks  is  best  for  them,  or  their  friends ;  but  it  is  very 
frequently  the  case  that  they  make  the  selection.  For 
instance,  he  may  make  up  a  prescription  often  or  thirtT 
remedies  to  be  compoimded,  when  the  question  will 
arise,  how  much  is  tms  to  cost  ?  The  physician  makes 
as  low  an  estimate  as  possible,  and  replies.  The  patient^ 
or  firiend,  may  think  it  is  too  high,  that  it  can't  be 
afforded :  and  one  article  and  another  is  thrown  out^  to 
reduce  tne  oost^-often  ^e  articles  most  valuable  to  the 
patient.  In  some  cases  they  cannot  agree  on  a  prescript 
tion,  or  its  price,  and  the  padent  deliberately  gives  him- 
self to  die  rather  than  My  the  price  demanded. — Db. 
WiLET,  Cinn,  Lancet  ana  OUtrver. 

Db.  Joseph  Bmbbb,  of  Vienna,  one  of  the  lectarers  in 
the  University,  gives  popular  lectures  on  ''  The  Bar. 
and  its  Proper  Care,"  m  the  hall  of  the  Imperial  Royal 
Academy  of  Sdenees,  in  Vienna,  to  which  ladies  and 
ffentlemen  are  admitted  free  of  charge.  This  would 
hardly  do  in  New  York. 

Choleba  is  impearing  in  Beriin,  although  in  a  spora- 
dic form ;  yet  showing  epidemic  tendencies. 


•  THE  MEDICAL  EEOORD. 


121 


2lmmcan  MtVvcai  Zaaomikvu 

HGHTEENTH  ANNUAL  MEETING,  CINN.,  O. 
TuESDAT,  Mat  7,  1867. 

nB8T  DAT. 

The  AskX^iadon  convened  at  11  o'clock,  in  Hopkins's 
Mofiic  Hall,  and  was  called  to  order  by  the  President, 
Db.  H^rt  F.  Askew,  of  Delaware.  After  a  prayer  by 
Eev.  H.  M.  Storrs,  D.D.,  of  Cincinnati,  Dr.  John  A. 
Harphy,  ats  Chairman  of  the  Committee  of  Arransre- 
mentfl,  welcomed  the  delegates  in  a  brief  address  ]  after 
whidi  he  announced  the  places  of  meeting  of  the  differ- 
ent"  Sections." 

Db.  Morpht  also  announced  the  time  and  places  of 
the  Tarious  entertainments  and  receptions. 

After  the  calling  of  the  roll  of  dele^tes  by  the 
Secretary,  the  President  delivered  his  manual  ad- 
dress, a  copy  of  which  was  requested  for  pubhoation. 

REPORTS  OF  OOmaTTBES. 

The  Reports  of  Committees  were  next  called  for,  and 
dinDoeed  of  as  below  designated. 

Oq  Qoarantine,  Dr.  Wilson  Jewell,  Pennsylvania, 
Chuirman.  Not  present;  subject  dropped.  On  Liga- 
ture of  SabdaTian  Artery,  Dr.  Willard  Parker,  of  New 
York,  Chairman.  Postponed  for  the  present  On  Pro- 
aeaa  of  Medical  Science,  Dr.  Jerome  C.  Smith,  New 
lork,  Chairman.  No  report  ready  j  Committee  dis- 
cbmed.  On  the  Comparative  Value  of  Life  in  City 
ind  Country,  Dr.  Edward  Jarvis,  Massachusetts,  Chair- 
man. Pos^ned  for  the  present  Drainage  and 
Sewerage  of  Cities,  eta,  Dr.  Wilson  Jewell,  Pennsyl- 
vama,  Chairman.  Absent  in  Europe ;  Committee  dis- 
cliamd.  On  the  .Use  of  Plaster-of-Paris  in  Surgery. 
I^.  lames  L.  Little,  N.  Y.,  Chairman.  Report  referred 
to  the  Section  on  Surgery.  On  Instruction  in  Medical 
CoHeges,  Dr.  Nathan  ^  Davis,  lU.,  Chairman.  Made 
mdal  order  for  Wednesday  morning  at  10  o'clock, 
nie  report  on  Medical  Education  took  a  similar  course. 
On  Bank  of  Medical  Men  in  the  Army,  Dr.  D.  H. 
Storer.Mai^  Chairman. 

Dr.  D.  H.  Stobxr  stated,  that  owing  to  illness  dunng 
a  portion  of  the  tame  allotted  him  to  give  the  subject 
requisite  attention,  he  was  unable  to  report ;  that  one 
member  had  been  absent  for  some  time,  and  another 
hid  assured  him  that  it  was  inexpedient  at  present  to 
urge  further  reforms.  Report  received  and  Committee 
montinned. 

rank  of  medical  mbn  nr  thb  kavt. 

Dr.  W.  M.  Wood,  U.  S.  N.,  Chairman,  reported 
through  Dr.  Ninian  Pinkney,  U.  S.  N.  He  contended 
that  while  men  of  the  medical  profession  were  everywhere 
recognised  as  the  equals  of  those  in  other  professions, 
in  the  nary  they  were  degraded  below  the  military, 
inferior  in  a^,  in  experience  .and  rank.  He  said: 
"  Oar  service  is  overgrown  with  usages  which  sprang 
op  in  the  earlier  and  ruder  ages  of  naval  life,  and  stifi 
dmg  to  it  with  a  power  and  tenacity  which  almost  de^ 
mo&m  enlightenment^  progress,  and  even  law.  It  is 
probable  that  the  national  authorities  which  organized 
the  ejustnig  rank  of  medical  officers  intended  to  confer 
a  more  aubatantial  fact  than  the  usages  of  shipboard  life 
have  permitted.  Among  the  usages  of  the  service  is 
that  which  limits  an  officer's  rights  and  comforts  to  the 
apartments  in  which  he  messes,  even  though  his  rank 
actually  entiUes  him  to  higher  privileges  and  ereater 
comfiitts  than  bdong  to  those  of  an  intarior  rank  who 


make  up  the  majority  of  the  inmates  of  that  apart- 
ment. The  steerage  is  the  most  humble  of  those  apart- 
ments, and  is  the  dwelling-place  of  the  very  young,  or 
those  of  no  responsibility.  The  ward-room  gathers  in 
it  most  of  the  commissioned  and  some  warrant  officers, 
and  was  originally  occupied  by  none  of  higher  rank 
than  lieutenant  All  its  usages  and  government  are 
still  conformed  to  the  scale  of  that  grade. 

'^  Now,  make  a  medical  officer  in  name  an  Admiral, 
and  leave  him  to  be  ward-room  officer,  and  the  title 
becomes  ridiculous.  It  is  sunk  below  tne  usages  and 
restrictions  originally  designed  for  those  of  junior  years 
and  inferior  rank. 

'^  There  is  only  one  mess  which  is  superior  to  these 
restrictions,  and  that  is  the  mess  or  messes  of  the  com- 
manding officers,  and  their  associates,  who  may  range 
in  rank  from  a  Lieutenant-Commander  to  an  Admiral 
Sometimes  there  are  one,  sometimes  two  of  those 
messes.  This  is  very  properly  left  to  the  will  of  the 
Commander-in-Chief,  who  may  choose  that  he  and  his 
Captains  may  have  one  or  separate  establishments.  The 
Assistant  Surgeon  enters  the  service  with  the  rank  of 
'  Master.'  That  this  title  may  not  be  misunderstood, 
it  ma^  be  necessary  to  explain  that  it  is  the  lowest 
rank  in  the  ward-room.  For  the  incumbent  is  in 
modem  times  generally  a  graduate  of  the  Naval  Aca- 
demy, awaiting  his  promotion  to  lieutenancy,  like 
the  ^Master,*  the  Assistant-Surgeon  at  once  becomes  a 
member  of  the  ward-room  mess,  and  unless  tibe  num- 
ber of  partitioned  off  sleepine-berths  (yntained  in  the 
ward-room  are  occupied  by  his  seniors,  he  may  have 
the  good  fortune  to  occupy  one  of  those  that  are  dimly 
Hghted  by  an  air  port,  six  inches  in  diameter.  This 
space  is  so  restricted,  and  the  separation  from  the  com- 
mon apartments  is  so  slight,  that  words  in  an  ordinary 
voice  in  another  become  common  property," 

After  further  presenting  the  discrimi Rations  against 
medical  men  in  regard  to  shipboard  accommodations, 
the  Doctor  said : 

"  The  general  law  is,  that  no  officer  shares  in  prize 
money  unless  his  name  be  borne  upon  the  books  of  the 
yesael  making  the  clotures,  and  the  Admiral  or  Com- 
mander-in-Cmef  has  a  percentage  on  all  prizes  made. 
The  Fleet-Surgeon,  as  a  member  of  the  Commander-ia- 
Cbief  s  staff,  must  be  with  him  in  the  flag-ship^  and  as  a 
rule  at  the  post  of  greatest  risk,  responsibility,  and 
hazard ;  consequently  he  is  not  likely  to  have  his  name 
borne  upon  the  books  of  the  subordinate  vessels  making 
captures,  and  yet  no  share  of  prize-money  is  aUowed 
him." 

The  report  suggests  the  following  as  the  remedy  for 
these  evils : 

1.  After  they  have  reached  the  rank  of  Commander, 
or  are  filling  the  position  of  Fleet  Surgeon,  let  them  be 
by  right,  as  they  often  have  been  by  courtesy,  members 
of  the  cabin  mess.  If  the  mess  of  the  Commander-in- . 
Chief  be  too  exalted  a  social  position  for  the  members 
of  yoor  profession  who  fre  filling  the  important  po>i- 
tion  of  Fleet-Surgeon,  then  let  them  be  members  by 
right  of  the  mess  of  the  Commander  of  the  ship  and 
pie  Fleet-Ca^ptain. 

^  2.  An  equitable  arrangement  of  prize-money,  most 
important  m  |)rinciple,  your  Committee  hope  to  see 
effected.    It  will,  however,  require  future  legislation. 

In  European  countries,  tne  Doctor  said,  more  liberal 
regulations  prevail  in  regard  to  naval  surgeons  thau  in 
democratic  America. 

The  late  Admiral  Foote,  so  justly  distinguished  for 
his  large  medical  liberality,  advocated  the  highest  rank 
for  naval  medical  officers.  An  Admiral  among  the 
most  distinguished  in  the  service,  has  anthorized  it  to 
be  officially  said,  that  he  thought  the  Fleet-Snrgeon 


Digitized  by 


Goo^. 


122 


THE  MEDIOAL  RECORD. 


should,  in  our  service,  as  in  the  French,  be  a  member 
of  the  Commander-in-Chiefs  staff  and  family.  We 
regard  it  as  opposed  to  the  public  interests  of  the  ser- 
vice, which  can  never  be  sacrificed  to  gross  indignity 
without  detriment. 

Dr.  John  C.  Hupp,  of  Wheelmg,  W.  Va.,  offered  the 
following : 

ResoUaed,  That  the  able,  practical,  and  eloquent  report  jost 
read  by  Commodore  Pinkney,  in  behalf  of  medical  officers  of 
the  navy,  be  referred  to  the  Committee  on  Publication,  with 
instructions  that  it  be  published.    Carried. 

Da  PiNKNET  then  offered  the  following: 

ResolvedL,  That  a  special  committee  of  five  members  be  ap- 
pointed by  the  President,  to  present  this  subject  before  the 
President  of  the  United  States  and  the  Secretary  of  the  Navy, 
and  urge  the  adoption  of  the  changes  proposed.    Carried. 

Dr.  Post^  of  Kew  York,  moved  that  the  same  com- 
mittee be  instructed  to  memorialize  Congress  on  the 
subject  of  awarding  prize  money  to  medical  naval  offi- 
cers.   Carried. 

The  Committee  on  Insanity,  Dr.  Isaac  Ray,  of  R.  I., 
Chairman,  made  no  response. 

Dr.  H.  R.  Storer,  of  Mass.,  opposed  the  motion  to 
drop  the  subject,  and  commented  upon  the  exclusive- 
nesfl  of  Insane  Asylum  Superintendents.  He  said  that 
the  Committee  evidently  did  not,  in  accordance  with 
their  policy,  intend  to  report^  and  alluded  to  their  spirit 
as  manifested  in  Dr.  Ray  s  prmted  statements,  that  none 
but  experts  shAild  testify  m  ike  courts  regarding  mat- 
ters affecting  the  sanity  of  the  individual.  He  sug- 
gested, therefore,  that  this  Conmuttee  be  discharged 
and  a  new  one  created. 

The  subject  was,  on  motion,  postponed  for  further  con- 
sideration. 

The  Committee  on  American  Medical  Necrology,  Ik. 

C.  C.  Cox,  Md.,  Chairman,  reported  the  performaooe  of 
its  duties,  bat  owing  to  the  length  of  the  document^ 
the  reading  waafor  the  present  deferred. 

The  following  Committees,  not  being  present,  w«re 
discontinued : 
On  the  Causes  of  Epidemics,  Dr.  Thomas  Antisell, 

D.  C,  Chairman.  On  Compulsory  Vaccination,  Dr.  A. 
N.  BeU,  N.  Y.,  Chairman.  On  Leakage  of  Gas-Pipes, 
Dr.  J.  C.  Draper,  N.  Y.,  Chaurman.  On  Alcohol  and 
its  Relations  to  Man,  Dr.  J.  R.  W.  Dunbar,  Md.,  Chair- 
man. 

The  Committee  on  the  Various  Surgical  Operations 
for  the  Relief  of  Defective  Vis'on,  Dr.  M.  A.  Pallen, 
Mo.,  Chairman,  had  no  report.  Dr.  Fallen's  request  to 
be  excused  from  further  service  on  the  Committee  was 
granted. 

The  following  Committees^  having  made  no  response, 
were  on  motion  also  discontinued. 

On  Local  Ansosthesia,  Dr.  R  Krackowizer,  N.  Y., 
Chairman.  On  the  Influence  upon  Vision  of  the  Ab- 
normal Conditions  of  the  Mtiscular  Apparatus  of  the 
Eye,  Dr.  H.  D.  Nove?,  N.  Y.,  Chairman.  On  the  Com- 
parative Merits  of  the  Different  Operations  for  the 
Extraction  of  Vesical  Calculi,  Dr.  B.  I.  Raphael,  N.  Y., 
Chairman.  On  the  Therapeutics  of  Inhalation,  Th:  J. 
Solis  Cohen,  Pa.,  Chairman. 

The  following  Committees  were  represented  as  Hkely 
to  report,  and  passed  for  the  present: 

On  the  Deleterious  Articles  used  in  Dentistiy,  Dr. 
Augustus  Mason,  Hass^,  Chairman.  On  Medical  Ethics, 
Dr.  Worthington  Hooker,  Conn^^Chairman. 

Of  the  Oommittees  "On  the  Climatology  and  Epide- 
mics of  the  several  States,"  the  reports  of  Drs.  Alfred 
C.  Gktrrett,  of  Massachnsetts,  and  tt.  C.  HamiL  of  Illi- 
nois, being  the  only  ones  ready,  were  referrea  to  the 


Section  on  Meteorology,  Medical  Topography,  and  Epi- 
demic Diseases. 

The  Reports  of  the  Treasurer  and  of  the  Publication 
Committee  were  then  submitted. 

The  recommendation  of  the  Publication  Committee 
that  the  payment  of  money  for  prize  essays  be  abolished, 
and  that  in  lieu  thereof  a  certificate  with  a  hundred 
printed  copies  of  the  essay  be  furnished  the  author,  was 
debated  as  a  motion,  and  deferred  for  further  deliberar- 
tion  on  the  morrow. 

The  following  papers  were  read  by  title  and  disposed 
of  as  below  designated. 

"  On  the  Causes  of  Cholera."  By  Dr.  N.  a  Davis, 
of  niinois.  Referred  to  Section  on  Meteorology,  Medi- 
cal Topography,  and  Epidemic  Diseases. 

"  On  a  New  Medium  for  the  Preservation  of  Anato- 
mical and  Pathological  Specimens."  By  Dr.  Clapham. 
Referred  to  Section  on  Anatomy  and  Phjrsiology. 

"  On  the  Action  of  Belladonna  in  Diseases  of  the 
Cornea."  By  Dr.  Joseph  S.  Hildreth,  of  Chicago.  Re- 
ferred to  Section  on  Surgery, 

"A  Bibliography  and  Observations  on  the  Present 
Condition  of  Aural  Medichie  and  Surgery."  By  Dr. 
Lawrence  TumbuU,  of  Philadelphia.  Referred  to  Sec- 
tion on  Surgery. 

"  An  Abstract  of  the  Report  on  the  Therapeutics  of 
Inhalations."  Referred  to  Section  on  Practioel  Medi- 
cine and  Obstetrics. 

"  Observations  on  the  Application  of  Rhinoscopy  in 
Diseases  of  the  Ear."  By  Dr.  Lawrenoe  TumbuU. 
Referred  to  Section  on  Surgery. 

"Clinical  Thermometry  in  Diphtheria."  By  Dr. 
Joseph  O.  Richardson.  Referred  to  Section  on  Practi- 
cal Medicine  and  Obstetrics. 

"On  Extra-Uterine  Foetation."  By  Dr.  Stephea 
Rogers,  of  New  York.  Referred  to  Section  on  Practi- 
cal Medicine  and  Obstetrics. 

"  On  the  Treatment  of  Diseases  by  Atomized  Medi- 
cinal Substanees."  By  Dr.  I  JKeld,  of  Iowa.  Referred 
to  same  Section. 

The  hour  for  the  meeting  of  the  various  Sections  was 
fixed  at  3  p.m. 

The  Meeting  then  a<^oumed  to  meet  on  Wednesday 
at  9  A.1L  ^ 

WimnsDAT,  Mat  8,  1867. 

SSOOND  DAT. 

Dr.  Henrt  F.  Askew,  President)  in  the  Chair. 
The  Association  met  pursuant  to  adjournment    The 
following  were  announced  members  of  the  Association 
by  invitation : 

Drs.  J.  Taylor  Bradford,  AuguatiL  Kentooky.  John 
P.  Phister,  MaysviUe,  Kentucky.  Wm.  L.  Atlans,  Geo. 
H.  Whiting,  A.  B.  Duke,  M.  L.  Forsythe,  Paul  Rankin, 
of  Kentucky.  M.  W.  Junkins,  Galen  Hart,  R  P.  Har- 
rison, of  Ohio.  D.  R.  Greenly,  Meadville,  Pennsyl- 
vania. Fred.  Wol^  Concord,  Maryland.  Eugene  B. 
Harrison,  Napoleon,  Ohio.  B.  F.  Hart,  Marietta, 
Ohio. 

Dr.  Atkinson  moved  that  a  recess  of  five  minntes  be 
granted  to  enable  the  delegates  to  make  their  appoint- 
ments to  the  Committee  on  Nominations.    Cameo. 

The  time  having  expired,  the  Secretary  announced 
the  Nominating  Committee : 

For  Vermont,  J.  N.  Styles;  Mass..  H.  R.  Storer; 
R.  I.,  Otis  Bullock;  Conn.,  B.  H.  Catfin;  N.  Y.,  Ells- 
worth Eliot ;  N  J^  Samuel  S.  Clarke ;  Penn.,  John  L. 
Atlee ;  Del,  H.  F.  Askew ;  Md.,  J.  J.  Oockrill ;  W. 
Va.,  J.  C.  Hupp;  Ohio,  R.  McDvaine;  Ky.,  D.  W.  Yar- 
nell;  Indiana,  J.  S.  Bobbs ;  HI,  H.  A.  Johnson ;  Ifich., 
A.  B.  Pahner;  Iowa,  J.  0.  Bladcbum^  Md.,  B.  F.  Shu- 
Digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


123 


vmd;  Texas,  Htord;  D.  0.,  Johnson  Eliot;  U.  S.  N., 
Ninian  Pinkney;  U.  S.  A.,  J.  J.  Woodward;  Wis- 
oonni.  N.  Dalton ;  Kansas,  John  Parsons ;  Caufomia, 
T.  M.  Logan ;  Tenn.,  T.  A«  Atchison. 

A  commnnication  from  Prof.  Alden  March  was  then 
read,  in  which  he  announced  for  transmittal  to  the  cus- 
tody of  its  proper  officer,  an  album  containing  the  pho- 
tographs of  the  Presidents  of  the  Association,  from  its 
Organization  up  to  the  present  period.  He  also  declared 
his  intention  to  add  the  portraits  of  ftiture  Presidents. 

The  gift  was  accepted  witii  thanks. 

Db.  Maboh  made  a  few  pertinent  remarks  in  return. 

Dh.  Cox  read  the  report  of  the  delegation  to  the 
Foreign  Medical  Associations,  giving  an  interesting  re- 
som^  of  the  proceedings  of  the  -British  Medical  Asso- 
ciation, which  met  in  (Siester,  England,  August,  1866. 

Beport  received  and  referred  for  publication  to  the 
ippropriate  Committee. 

DILEGATBS  TO  THE  INTERNATIONAL    MEDICAL  OONOBiae. 

The  President  then  appointed  as  deles;ate&  to  the 
International  Medical  Congress,  Drs.  B.  F.  barker,  J. 
K.  Tjler,  and  T.  C.  Brinsmade.  ,   ' 

Dr.  Atlex  moved  that  the  Nominatiikig  Committee  be 
instructed  to  suggest  additional  nanaes.    Carried. 

Dr.  H.  R.  Storer  rose  to  di^daim  any  intention  of 
personality  in  the  remarks  qnUle  by  him  the  day  pre- 
Tioua  As  he  had  learjied  that  Dr.  Ray,  of  Rhode 
Island,  intended  to  re^  the  report  of  his  Committee 
before'  the  A580ciatij>6,  he  moved  that  he  be  made  a 
member  by  invitation,  and  be  rec^uested  to  read  his 
paper  at  9  o'doc^to-morrow  mommg. 

Dr.  Hibbaeo  Objected  to  departing  from  the  rule  of  re- 
ferring such  nftpers  to  appropriate  sections,  as  it  would 
estahliflh  a  wecedent  that  might  confiume  valuable  time 
of  the  Ass<|6iation  hereafter. 

Dr.  Wadceb,  of  Mass.,  in  a  few  remarks  defended  the 
nperintetidents  of  Asylums  for  the  Insane.  He  claimed 
that  no  oiacourtesy  to  the  Association  was  intended  by 
those  ^ntlemen.  He  explained  that  the  reason  why 
the^  did  not  unite  with  this  organization  was,  that 
their  duties  and  interests  as  hospital  superintendents 
weiie  cUjQTerent  from  those  of  ordinary  physiciana 

2)r.  Gross  hoped  the  re^rt  of  Dr.  Ray  would  not  be 
i^erred,  but  be  treated  with  the  courtesy  of  a  hearing 
%  open  session. 

Dr.  H.  R.  Storer  again  disclaimed  any  intention  to 
give  offence.  He  had  endeavored  to  satisfy  Dr.  Walker 
of  this,  but  he  did  not  succeed. 

The  report  of  Dr.  Ray  was  then  made  the  special 
order  for  Thursday,  at  9  a.m. 

The  Conunittee  on  nominations  were  instructed  to 
meet  in  the  Reception  Room. 

Dr.  Atkinson  proposed  that  the  committee  called  for 
by  Dr.  Pinkney's  resolution  consist  as  follows :  Dra  N. 
a  Davis,  Ills. ;  J.  M.  Toner,  D.  C. ;  S.  D.  Gross,  Pa.  ; 
J.  J.  Cockerin,  Md. ;  H.  F.  Askew,  Del    Carried. 

The  report  of  the  Conmiittee  on  Medical  Education 
tlien  came  up  pursuant  to  a  previous  resolution  making 
it  a  special  order. 

Dr.  Gross,  as  Chairman  of  the  Committee  on  Medi-> 
cal  Education,  presented  the  report  of  the  same,  which 
was  on  motion  referred  to  the  Committee  of  Publica- 
tion. 

Dr.  Stille  followed  with  a  sunmiary  of  the  proceed- 
ines  of  the  Convention  of  Medical  Teachers. 

Dr.  Davis,  as  Chairman  of  the  Committee  ion  Medical 
Instruction,  then  submitted  his  report  Referred  to 
Committee  of  Publication. 

Dr.  Hughes  took  the  chair  during  the  temporary 
tbsence  of  the  President 


the  prize  essats. 

The  Committee  on  Prize  Essays  announced  that 
eight  essays  had  been  presented  in  competition,  and  that 
the  following  were  recommended  as  worthy  of  the 
award. 

1.  ^'On  the  cause  of  Intermittent  and  Remittent 
Fevers."    With  the  motto,  "  Fortis  est  Veritas." 

2.  ^'  On  the  treatment  of  certain  Abnormities  of  the 
Uterus."  With  the  motto,  *'  Empiricism  in  Medicine  and 
Surgerjr  is  fast  giving  away  to  the  rationalism  of  true 
diajposis." 

The  envelopes,  opened  in  presence  of  the  delegates, 
were  found  to  contain  the  names  of  (1)  Dr.  J.  D.  Black, 
Newark  Ohio,  for  the  first  prize,  and  (2)  Dr.  M.  A.  Pal- 
len,  S>.  Louis,  Mo.,  for  the  second  prize. 

TVe  papers  were,  on  motion,  referred  to  the  Com- 
m^tfee  ofPublication. 

^  Dr.  Cox  then  read  an  abstract  of  the  Report  of  the 
Committee  on  American  Medical  Necrology.  Referred 
to  Conmiittee  as  above. 

THE  REPORT  OF  THE  CONVENTION  OP  MEDICAL  TEACHERS. 

Dr.  Satre  offered  the  subjoined: 

Betokedf  That  this  Association  most  cordially  approve  of 
the  whole  action  of  the  Convention  of  Delegates  from  Medi- 
cal  Colleges,  assembled  in  CincinDati,*  l£ay  3,  1867,  and  urge 
its  practical  adoption  by  all  the  medic^  colleges  in  our 
country. 

Dr.  Post,  of  New  York,  wished  to  offer  some  change 
in  the  course  of  instruction  proposed. 

Dr.  Davis  reminded  him  that  the  college  to  which  he 
was  attached  had  been  invited  to  be  present  and  take 
part  in  the  proceedings  of  that  Convention,  but  had  not 
seen  fit  to  do  so.  He  could  at  the  next  meeting  of  that 
Association  offer  any  amendment  he  chose,  but  he 
clafaned  that  this  body  had  no  power  to  act  in  the 
matter. 

Dr.  C.  a.  Lee,  of  Buffalo,  though  not  present  at  the 
Medical  College  Convention,  approved  of  all  that  was 
doaa.  He  had  for  many  ;^ears,  as  a  teacher  in  a  medi- 
cal c^ege,  contemplated  just  such  changes  as  had  been 
recommended. 

The  resolution  was  then  adopted. 

Dr.  Bibbtns  moved  that  the  resolution  abolishing  the 
payment  of  money  for  prizes  be  taken  up. 

After  an  animated  discussion,  in  which  Drs.  Davis, 
Bronson,  Bibbins,  and  others,  participated,  the  original 
motion  was  tabled. 

THE  PROPOSED  ANNUAL  ASSESSMENT. 

Dr.  Toner  moved,  for  present  consideration,  his  reso- 
lution offered  two  years  ago,  calling  for  an  amendment 
of  the  Constitution  to  the  effect,  that  every  perma- 
nent member  pay  a  yearly  due  of  five  dollars,  and  as 
a  penalty  for  ne^ecting  the  same  for  three  successive 
vears,  be  liable  to  have  bis  name  designated  by  a  *  or  t 
m  the  catalogue  triennially  published. 

The  motion,  after  considerable  debate,  was  finally 
withdrawn. 

Dr.  Robbinb,  of  HI.,  submitted  the  following: 

JResolved,  That  hereafter  the  Committee  of  Arrangement 
be  directed  to  have  the  ordinances  govemine  the  sections 
printed  on  slips,  and  distributed  at  the  several  places  where 
the  sections  meet 

Carried. 

Dr.  Howard  offered  as  follows: 

Whereas,  There  has  been  issued,  and  still  remahis  in  force, 
an  official  order  from  the  Surgeon*  General  of  the  United  States 
Army,  prohibiting  the  oommunicaUon  of  anv  medical  or  sur- 
gioal  inkrmation,  by  any  medical  officer  of  the  United  States 
Army,  to  any  person  whatsoever,  without  special  permission 
firom  the  Medical  Bureau  at  Washington ;  thus  appropriating 


igitized  by 


124 


THE  MEDICAL  REOOBD. 


as  far  as  the  offldal  power  of  the  Sorgeon-G^eral  can  com- 
pass it,  all  the  vltluable  experienoe  and  statistics  of  all  medical 
men  who  have  served  in  the  yarioua  departments  of  the 
United  States  Army  to  the  ezdusive  use  of  the  Medical  Bu- 
reau'; and, 

Whbrbas,  Under  such  arbitrary  control  an  official  report 
has  already  been  made,  tending  to  create  incorrect  impressions 
on  scientific  questions  of  great  practical  importance  to  the 
profession  and  to  society;  and 

WhsrsaS)  It  is  important  to  the  reputation  of  all  men  who 
served  during  the  war,  that  they  liave  the  opportunity  of  cor^ 
recting  such  erroneous  impressions  by  an  examination  of  the 
original  records ;  therefor^  be  it 

Resolved,  That  it  is  the  opinion  of  this  AssocidUpn  that  the 
monopoly  now  exercised  by  the  Medical  Burea^^ver  the 
medic»l  and  sureical  records  of  the  war,  is  contract  to  the 
genius  and  catholic  spirit  of  our  profession,  and  obswctlve 
to  the  highest  interests  of  science  and  humanity.  i^ 

Retolved,  That  the  Secretary  of  War,  or  other  propel 
thorities,  be  requested  to  direct  that  the  original  records  of 
medical  and  surgical  history  of  the  war  be  rendered  accessi- 
ble, on  certain  regular  days  of  each  month,  for  purposes  of 
scientific  investigation,  to  all  medical  men  who  have  served 
as  such  in  the  army  of  the  United  States. 

Dr.  Howard  spoke  at  length  in  support  of  the  reso- 
lution. He  dwelt  upon  the  jealousy  of  departments 
against  interference  on  the  part  of  outsiders.  He  did 
not  aim  at  any  one  in  particular,  as  a  target ;  he  spoke 
for  the  benefit  of  the  profession. 

Dr.  J.  J.  Woodward  replied  that  he  was  opposed  to 
having  gentlemen  come  here  td  ventilate  their  private 
ffriefs,  at  the  expense  of  the  valuable  time  of  this 
learned  body.  Especially  was  he  opposed  to  it^  when 
the  remedy  sought  for  these  griefs,  whatever  it  may  be, 
cannot  be  applied  except  at  the  expense  of  grreat  pub- 
Uc  interests,  now  being  earnestly  and  honestly  admi- 
nistered by  the  Sur^on-General,  an  able  and  conscien- 
tious officer.  Dropping  therefore  such  minor  matters, 
he  proposed  siinply  to  explam  certain  reasons  for  the 
attitude  of  the  Surgeon-General. 

In  the  first  place,  those  most  anxious  for  premature 
access  to  these  records  are  not  those  who  nave  con- 
tributed most  largely  to  them.  Too  often,  indeed,  they 
belong  to  men  who  might  have  contributed  mucn  but 
who  have  contributed  nothing,  and  who  desire  now  to 
enjoy  the  fruits  of  the  labors  of  others.  It  would  be 
necessary  to  dose  the  record  against  such  men,  even  if 
no  other  reason  for  such  a  course  existed.  But,  in  the 
next  place,  it  would  be  impossible  to  give  such  access 
to  all  the  outsiders  who  desire  it,  prior  to  publication, 
without  gravely  interfering  with  the  scientific  labors 
now  in  progress  and  postponing,  perhaps  indefinitely,  the 
publications  now  preparing. 

It  has  been  said  that  it  is  not  certain  when  any  of 
this  material  will  be  given  to  the  profession.  As  to 
that  ho  was  not  prepared  to  say  too  much,  but  this  he 
would  say,  although  he  did  not  come  here  intending  to 
announce  it^  that  m  the  course  of  the  next  two  months 
the  Surgeon-General  will  give  to  the  pubUc  as  a  &n3t 
instalment  of  the  labors  he  has  undertaken  for  the  good 
of  the  profession,  an  illustrated  catalogue  of  the  mu- 
seum, which  will  contain  about  a  thousand  finely 
printed  q^uarto  pages,  embracing  among  other  tiungs 
the  histones  of  more  than  four  thousand  surgical  cases 
of  which  we  have  specimens.  (Great  applause.)  Other 
material  will  follow  in  due  time ;  but  &r  a  work  like 
this  we  need  time.  As  regarded  the  correction  of 
errors,  the  Surgeon-General  had  never  opposed  any 
obstacles  whatever. 

But  there  is  another  and  still  graver  reason  why 
the  aooees  asked  cannot  be  granted.  These  records  are 
not  used  for  scientific  purposes  alone ;  they  are  employ- 
ed in  settling  the  pensions  of  the  widows  and  orphims  of 


our  dead  soldiers :  and  the  bounty,  back-pay,  and  pen- 
sions of  the  disabled ;  fifty  searchers,  as  many  as  the  na- 
ture of  the  records  permit^  are  daily  at  work  with  them 
for  this  purpose ;  no  outsider  can  be  permitted  to  in- 
trude, without  gravelj  prejudicing  this  work,  the  exe- 
cution of  which  is  imperatively  demanded  by  every 
consideration  of  humanity.  When  he  left  Washington 
there  were  about  six  thousand  unanswered  claims  still 
upon  his  table.  The  question  then  before  the  Conven- 
tion was  simply  this;  Shall  further  obstacles  be  inter- 
posed to  delay  a  work  now  being  honestly  executed? 
He  hoped,  therefore,  for  the  seal  of .  the  Association's 
condemnation  upon  this  attempt  to  meddle  with  a  con- 
scientious public  servant,  in  the  discharge  g£  his  duty. 
He  would  now  move  to  lay  these  resolutions  on  the 
table.    (Great  applause.) 

The  motion  to  lay  on  the  table  was  seconded  and 
carried  ahnost  unanimously. 

Dr.  Cox  presented  advance  proof-sheets  of  "  Provi- 
'  Nomenclature  of  Disease,"  which  was  published 
in^^k)don.  Beferred  to  Section  on  Practical  Medicine. 
Also^fcyier.  "  On  Compulsory  Vaccination,"  by  Dr. 
A.  N.  flBfctf^Brooklyn,  New  lork,  waspresented by 
deputy,  ancQ^^ motion,  referred  to  the  Committee  on 
Hygiene.       ^^^ 

Dr.  Hammer  oM^a  series  of  resolutions  regarding 
certain  proposed  r^|kflin medical pupibige.  Beferred 
to  Committee  on  MefflHBducation. 

Dr.  B.  H.  Gilbert.  ofMM[ork,  exhibited  an  instru- 
ment for  Uie  protection  of  !H||eriostenm  in  exdsions, 
etc.    Beferred  to  Section  on  St^^^^ 

Dr.  Post  read  the  report  of  the^bmmittee  on  Medi- 
cal Literature,  in  which  he  gave  cerfl|D  bibliographieal 
items,  referring  to  reports,  etc  ^v 

Dr.  Satrs  criticised  certain  portions  cAthe  report  as 
being  too  highly  laudatory  of  the  Board  V  H^th  of 
New  York,  and  as  containmg  matter  foreign \o  the  scope 
of  such  a  production.  He  ateo  made  some  reiiAiarkb  upon 
cholera  and  quarantine,  and  claimed  that  tl^re  were 
few  if  any  cases  of  that  disease  to  combat,  an<l  that 
these  same  had  been  introduced  by  breakages  '^f  the 
qnarantine. 

Dr.  Davis  supported  the  spirit  of  the  Commitlee's 
report,  and  moved  that  it  take  the  usual  course  of  ve- 
ference  to  the  Committee  on  Publication,  which  yf^ 
adopted. 

Dr.  Hibbard  offered  the  following : 

Resolved^  That  the  habit  of  using  unoffidnal  preparationb 
of  medicine  by  physicians,  except  where  there  is  no  offi- 
cinal preparation  that  will  answer  the  purpose  as  well,  is 
unscientific  and  imprudent,  tending  to  demoralize  the  thera- 
peutist and  to  encourage  irregular  pharmaceutists  and  nos- 
trum makers,  and  should  be  abandoned. 

Retolvedf  That  the  profession  should  not  patronize  drug- 
gists who  are  engaged  in  the  manufacture  of  nostrums. 

On  motion,  tabled. 

The  following  papers,  in  the  course  of  the  meeting, 
were  read  by  title,  and  disposed  of  as  follows : 

*'  Observations  on  Diseases  of  the  Throat  as  seen  in 
the  Military  Service  from  1861  to  1866."  By  Trot  M. 
K  Taylor.  M.D.  Beferred  to  Section  on  Practical  Me- 
dicine ana  Obstetrics. 

"A  Novel  Case  of  Lithotomy,"  by  Dr.  Edward  Whin- 
nery,  of  Iowa. 

"On  Ligature  of  the  Subclavian  Artery,"  by  Dr. 
Willard  Parker,  of  N.Y. 

Also.  "On  Hip-jomt  Operations,"  by  Dr.  Paul  F. 
Eve,  or  Tennessee.  All  referred  to  Section  on  Sur- 
gery. 

"  On  Oonopulsory  Vaccination,"  by  Dr.  A.  N.  BelL 
Beferred  to  Conmiittee  on  Meteorologyi  Medical  Topo- 
graphy, and  Epidemic  Diseases. 

Digitized  by  VjOOQ  IC 


THE  MEDICAL  RECORD. 


125 


The  Secretary  read  an  authenticated  commanication 
from  the  Chicago  Medical  Society,  announcinff  the  ex- 
puIaoQ  of  Dr.  Jonathan  D.  Brooks  and  Dr.  N.  Feterson 
nom  aforesaid  body  for  yiolation  of  the  Oode  of  Medical 
Jithics.  The  names  in  question  were  ordered  to  be 
dropped  from  the  roll  of  the  American  Medical  Asso- 


A  commanication  proposing  that  no  person  who  is 
not  a  member  Aid  supporter  of  a  local  Medical  Societ^r, 
where  such  a  one  exists,  shall  be  eli^ble  to  membership 
in  the  American  Medical  Association  was,  on  motion, 
kid  over  until  the  next  year,  as  duly  provided  for  by 
the  Constitution. 

The  Associadon  then  adjourned  until  9  o*clock  the 
Mowing  morning. 

Thikd  Dat,  Mat  9, 1867. 
Ds.  H.  F.  Askew,  President^  in  the  Chair. 

MOBNIKa  8BSSI0H. 

The  Association  met  at  9  o'clock  pursuant  to  ad- 
journment 

Dr.  D.  H.  Storer,  of  Mass.,  moved  that  a  recess  of 
fife  minutes  be  granted  before  the  reading  of  Dr.  Ray's 
pi^^er,  which  had  been  set  down  as  the  order  of  &e 
w.    Garried. 

Dr.  D.  H.  Storer  then  proposed  that,  inasmuch  as  the 
Treasury  of  the  Association  was  somewhat  in  debt, 
a  raffident  sum  be  raised  at  the  present  meeting  to  put 
it  into  a  better  financial  condition. 

A  motion  to  levy  an  assessment  of  two  dollars  upon 
each  member  with  the  understanding  that  the  contri- 
bation  should  be  voluntary,  was  made. 

Dr.  C.  a.  Lbb  stated  that  he  proposed  the  same 
method  Ust  year^nd  was  most  happy  to  second  it. 

Dr.  Davis,  of  Illinois,  offered  the  following ; 

lUwked,  That  Dr.  D.  H.  Storer  be  requested  to  draw  up 
a  BDbscriptioa  paper,  and  plaoe  it  in  a  suitable  locality,  ao- 
Gwuble  to  the  members,  and  that  all  present  be  asked  to 
nbecribe  such  amount  as  they  feel  disposed  for  the  purpose 
oT  liquidating  the  indebtedness  of  the  Association  and  reple- 
niihiog  its  treasury. 

Adopted. 

FEMALE  MEDICAL  EDUCATION. 

Dr.  Atlse,  of  Philadelphia,  offered  the  following  pre- 
amble and  resolutions : 

Whereas,  The  subject  of  female  medical  education  is  ex- 
dting  attention,  and  regularly  educated  female  physicians 
have  established  themselves  as  practitioners  of  medicine; 
and. 

Whereas,  Female  medical  colleges,  embracing  all  branches 
taught  in  other  colleges,  and  all  their  oondittons  for  gradua- 
tioB,  exist  in  the  United  States  for  the  separate  education  of 
females;  and, 

Whereas,  It  is  important  that  the  standard  of  education 
(     aod  the  observance  of  the  oode  of  medical  ethics  should  be 

(filtered  and  maintained  by  this  Association ;  therefore, 
lUaoived,  That  the  American  Medical  Association  recog- 
niaes  well-educated  female  physicians  by  the  same  laws  that 
,     gOTem  its  own  members. 

Dr.  BownrrcH  rose  to  a  point  of  order.  He  remind- 
ed the  President  that  the  nve  minutes'  recess  had  just 
expired,  and  would,  therefore,  move  to  lay  the  whole 
matter  on  the  table.    Carried. 

REPORT  01^  COMMITTEE  OK  IHSANTTT. 

Dr.  Clbmxkt  A  Walker,  of  Massachusetts,  apolo- 
giBed  for  the  absence  of  Dr  Ray,  and  stated  that  the 
precarious  condition  of  Dr.  R'a  health  had  impelled  him 
to  reogu  his  position  as  Superintendent  of  the  Asylum. 
He  then  read  the  Beport  of  the  Committee  on  Insanity. 
He  combated  many  of  the  popular  notions  and  even  the 


f)rofessional  theories  on  the  subject  He  alluded  to  the 
aw  of  hereditary  transmissioif,  and  maintained  that 
insanity  was  controlled  by  some  law  of  normal  limita- 
tion, oftentimes  requiring  only  an  exciting  cause. 

Hereditary  disease  must  have  had  an  origin  at  some 
time,  that  it  seldom  passes  through  all  its  stages  in  a 
single  individual.  More  than  one  generation  is  required 
to  develop  all  the  stages  of  the  disease.  The  eifsential 
thing  is  nervous  impairment.  Cerebral  vitiation,  self- 
induced,  strong  distracted  nervous  irritation  during 
pregnancy,  are  heritable.  AU  the  traits  of  one  parent, 
however,  cannot  be  expected  to  descend  to  any  single 
individual  of  his  ofi&pring.  Insan'fty  is  not  therefore  an 
unmitigated  evil,  not  amenable  to  treatment.  Recent 
investigations  have  developed  the  fiict,  that  the  obscurer 
forms  of  the  malady  were  never  ijreviouslv  recognised. 
The  throwing  of  the  veil  of  insanity  over  human  delin- 
quencies as  a  legal  defence^  has  long  stood  in  the  way 
of  a  dispassionate  investigation.  Popular  prejudice  may 
defer  the  verdict  but  cannot  affect  the  truth  of  science. 
He  scouted  the  idea  that  the  students  of  insanity, 
bv  a  strange  perversity,  gradually  come  to  consider  that 
aU  are  more  or  less  insane.  So  then,  the  more 
thorough  the  investigation,  the  more  fallacious  the  con- 
clusions I 

Monomania  was  not  recognised  until  the  present  cen- 
tury»  Moral  perversion  is  an  accident,  not  a  necessary 
accompaniment  of  the  malady.  Considering  the  brain 
as  the  material  instrument  of  the  mind,  it  of  course  is 
subject  to  the  operation  of  physical  and  extrinsic 
causes. 

Insanity  has  no  essential  feature  common  to  every 
case,  but  the  people  will  not  accept  this  axiom  because 
it  conflicts  with  old  opinions.  No  metaphysical  subtlety 
is,  however,  to  be  pitted  against  the  deductions  of  com- 
mon sense.  Responsibility  is  an  available  plea  only 
in  disease,  because  in  heal^  the  mind  is  also  healthy. 

HiorcU  Insanity  is  therefore  something  more  than  a 
mere  fiction. 

As  regards  treatment,  not  to  mention  the  various 
methods  of  purgation,  emesis,  etc.,  the  most  dangerous 
was  founded  on  tiie  theory  that  insanity  was  essentially 
inflammatory.  He  denounced  the  other  modes  of 
phvsical  assault,  powerAil  mental  shocks,  etc.,  and 
eulogised  the  more  rational  treatment  of  cneerful  sur- 
roundings, etc. 

Dr.  El  R.  Storer  moved  the  acceptance  of  the  report 
and  its  reference  to  the  Committee  of  Publication. 
Carried. 

Dr.  CmpLBY,  of  Lexington,  Ky.,  offered  some  re- 
marks in  vindication  of  the  Superintendents  of  Insane 
Asylums,  with  reference  to  their  connection  with  this 
association.  He  alluded  to  the  &ct  that  there  were  five 
such'SuperintendentB  present,  who  were  a  larger  pro- 
portion of  their  class  than  the  representatives  of  any 
other  class  t)f  the  medical  profession  present.  Regard- 
ing the  allegation  that  a  proper  verdict  could  not  be 
rendered  except  by  the  Superintendents,  he  would  in- 
quire whetlier  all  questions  of  trade  were  not  referred 
to  its  own  particular  clasa 

During  his  speech  Dr.  Chipley  paid  a  glowing  tribute 
'to  the  services  of  Miss  Dix,  who  had  done  so  much  for 
the  insane  of  the  country. 

The  Committee  on  Nominations  made  the  following 
report: 

Place  of  meeting  next  year — ^New  Orleans.  Time- 
May. 

OFFICERS  FOR  1868. 

President — Samuel  D.  Gross,  Penn. 
Vice-Presidents— Ist,  A.  C.  Post,  N.  T. ;  2d,  John 
H.  Atlee,  Penn.;  3d,  D.  W.  Yand^ll,  Ky.;  4th,  H.  R. 

Storer,  Mass.  O r\r\cs\o 

Digitized  by  VjOOQ  Ic 


126 


THE  MEDICAL  RECORD. 


Permanent  Secretary — ^W.  B.  Atkin8on,'l*hiladelphia, 
Penn.  * 

Assistant  Secretary — J.  G.  Richardson.  New  Orleans. 

Treasurer— Caspar  Wistar,  Philadelphia,  Penn. 

Committee  of  Arrangements — W.  Storer,  Warren 
Brickell,  S.  Chapin,  John  Foster,  L.  T.  Pimm,  S.  M. 
Bemiss,  and  C.  Beard,  all  of  New  Orleans. 

Committee  on  Medical  Associations — H.  B.  Palmer, 
Mick:  W.  H.  Byford,  IlL;  M.  L.  Linton,  Mo.;  Gus- 
tave  0.  E.  Weber,  Ohio;  H.  R.  Storer,  Mass. 

The  Committee  on  Medical  Necrology  was  continued, 
with  the  following  changes  to  supply  vacancies : 

John  Shrady,  N.  Y. ;  J.  M.  Toner,  D.  C  ;  Thomas  M. 
Doran,  CaL;  A.  G.  Field,  Iowa;  H.  F.  Askew,  Del 

Committee  on  Medical  Literature — Geo.  Mendenhall, 
R  R.  McIIvain,  Qeo,  C.  Blackman,  E.  Williams,  0.  S. 
Connor,  all  of  Cincinnati. 

Epidemics  and  Climatologr — W.  F.  Thorns,  N.  Y. ; 
J.  W.  Hatch,  CaL;  Joseph  Jones,  Tenn. ;  J.  P.  Heard, 
Texas;  and  B.  K.  Hart^  Conn. — substituted  for  Dr. 
B.  H.  Catlin. 

Committee  on  Prize  Essays — ^Burnett  Dawler,  S.  A. 
Smith,  W.  Brickell,  S.  M.  Bemiss,  J.  Scott,  all  of  New 
Orleans. 

Committee  on  Publication — ^F.  G.  Smith,  Caspar 
Wistar,  W.  B.  Atkinson,  W.  Maybury,  all  of  Pennsyl- 
vania; H.  F.  Askew,  Delaware;  H.  R.  Storer,  M^., 
and  W.  W.  Dawson,  Ohio. 

Delegates  to  International  Medical  Congress — ^Drs. 
Paul  F.  Eve,  Edmund  Andrews,  C.  E.  Brown-S^quard, 
Thomas  M.  Logan,  R.  R  McIIvain,  John  M.  Eitchin, 
B.  Fordyce  Barker,  Thos.  C.  Brinsmade,  John  E.  Tyler, 
J.  M^  Toner,  and  Louis  Elsberg. 

The  Committee  recommended  the  adoption  of  the 
following : 

Heiolvedj  That  the  Ck>mmittee  suggest  to  the  AssocMon 
that,  in  future,  the  publishing  committee  be  requested  to  pub- 
lish the  name  of  every  member  of  each  standing  committee. 

A  motion  that  the  report  lay  on  the  table  until  that 
of  the  minority  of  the  Committee  was  read,  was  declared 
lost. 

Dr.  Davis  moved  that  the  report  of  the  Committee 
be  accepted,  and  their  ^resolution  adopted.    Carried 

Dr.  JBibbins,  of  N.  Y.,  asked  the  reason  whv  New 
Orleans  was  named,  and  whether  or  not  any  delegate 
irom  Louisiana  was  present 

Dr.  Davis  moved  that  the  portion  referring  to  the 

nosed  place  of  meetmg,  together  with  the  special 
Committees  and  locSl  Secretary,  be  laid  on  the 
table.    Carried. 

The  report  of  the  Nominating  Committee,  with  the 
exceptions  indicated,  was  then  adopted. 

Dr.  Davis  then  calied  up  the  part  of  the  report  regard- 
ing the  place  of  meeting,  and  again  protested  against 
the  selection  of  New  Orleans,  on  various  g^unds.  He 
presented  the  following : 

"  Revived,  That  the  next  annual  meeting  of  the  American 
Medical  Association  shall  be  held  in  the  City  of  Washington 
on  the  first  Tuesday  in  May,  1868,  and  every  second  year 
thereafter,  Imtil  otherwise  ordered  by  the  Association. 

"  Besolvedf  that  whenever  the  Association  shall  meet  in  tb« 
City  of  Washington,  as  directed  in  the  above  resolution,  the 
Committee  of  Arrangaments  be  strictly  forbidden  either  to 
provide  themselves,  or  accept  provision  by  others,  of  any 
entertainment  or  excursion  whatever." 

Dr.  Yandell,  of  Ky.,  spoke  eloquenUy  in  behalf  of  a 
profession  which  no  war  had  ever  yet  disunited,  and 
claimed  for  his  bretiiren  of  the  South  the  privilege  of 
entertaining  the  Association. 

Dr.  Griswold,  of  Ohio,  moved  the  substitution  of 
Knoxville,  Tenn.,  for  Washington,  D.  C. 


Dr.  Satrb  moved  to  substitute  New  Orleans,  as  in 
the  ori^al  report  He  thought  that,  with  Dr.  Davis's 
resolution  of  restriction  as  to  entertunments,  there 
would  be  no  objection  to  that  place. 

Ds.  Cox  endorsed  all  that  had  been  said  by  his  friend 
from  Kentucky;  was  proud  that  one  man  from  the 
South  had  expressed  hunself  as  standing  on  the  plat- 
form of  the  union  of  the  medical  profession.  He  never 
supposed  the^e  would  be  any  difficulty  fn  reuniting  the 
profession  of  medicine  after  the  war  was  over.  As  to 
the  entertainments  of  the  Association,  he  was  in  favor 
of  them,  and  thought  if  Dr.  Davis*8  measure  was  adopt- 
ed the  usefulness  and  attendance  of  the  Association 
would  be  impaired  In  England  they  did  far  more  eat- 
ing and  drinking  than  was  done  here,  and  yet  they 
accomplished  a  large  amount  of  work. 

Dr.  D.  H.  Storer,  of  Boston,  said  the  object  of  these 
meetings  was  to  bring  as  many  of  the  profession  together 
as  possible,  and  it  should  meet  in  such  places  as  Would 
accomplish  that  object  We  should  not  meet  where 
we  have  not  been  invited  by  resident  members.  The 
probability  was,  we  would  be  well  received,  but  we 
ought  to  wait  for  a  proper  invitatiou. 

A  motion  to  postpone  the  discussion  until  the  next 
Session  then  prevailed,  after  which  the  Association  ad- 
journed to  meet  at  3  p.m. 

AFTERNOON  SESSION. 

The  Association  met  and  adjourned,  there  being  no 
quorum  present 

Friday,  Mat  10, 1867. 

rOTTRTH  DAT. 

Dr.  H.  F.  Askew,  President,  in  the  Chair. 

Drs.  J.  D.  Staebler,  J.  P.  Walker,  and  P.  F.  Maley,  of 
Cincinnati,  Ohio;  Dr.  Gr.  M.  Kellogg,  of  Keokuk,  Iowa; 
Dr.  A.  J.  Larey,  of  Mount  Pleasant,  Kansas;  Dr.'Wm. 
Marsden,  of  Quebec ;  Dr.  John  Dillard,  of  Lexington, 
Kentucky ;  Drs.  S.  S.  Gray,  and  A.  S.  Ashton,  of  Piqua, 
Ohio,  were  made  members  of  the  Association  by  invi- 
tation. 

THE  OASE  OF  DR.  HINKLS. 

A  delegate  presented  papers  involving  charges  against 
Dr.  F.  Hinkle,  and  asked  that  his  name  be  stricken  from 
the  roll  of  members. 

Dr.  Atkinson,  in  presenting  Dr.  Hinkle's  defence, 
moved  a  reference  of  l^e  whde  matter  to  the  Com- 
mittee of  Medical  Ethics. 

The  Chair  ruled  that  the  reference  was  out  of  order, 
and  decided  that  Dr.  Hinkle's  name  be  erased. 

ADDITIONAL  DELEGATES  TO  INTERNATIONAL  OONORESS. 

The  following  were,  on  motion,  elected  additional 
delegates  to  the  International  Medical  Congress  to  be 
held  in  Paris  next  August 

Drs.  Wilson  Jewell,  of  Pennsylvania;  Ninian  Pink- 
ney,ir.  S.  K;  John  Hart,  of  New  York;  and  Charles 
A.  Pope^  of  Missouri. 

Dr.  Hibbard,  of  Illinois,  then  presented  the  follow- 
ing, which  was  carried. 

Whereas^  It  has  been  officially  announced  that  for  the  last 
two  years  the  annual  volume  of  Transactions  of  this  Associa- 
tion could  be  published  only  by  the  members  of  ^e  Publica- 
tion Committee  becoming  individually  responsible  for  the  cost 
of  the  same  above  the  amount  of  funds  in  the  treasuiy;  and 

Wiiereas,  Such  a  condition  of  affiiirs  is  impolitic  for  the  As- 
sociation and  unjust  for  the  Committee :  therefore 

Jieaoloed,  That  the  Association  does  not  expect  the  Com- 
mittee on  Publication  to  issue  the  volume  of  Transactions  for 
the  inreeent  year,  unless  it  can  be  done  with  the  funds  and 
the  credit  of  the  Associa^n. 

Db.  Hildbeth  submitted  a  re8ohi|Li€)n.  t 

digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


127 


*'That  a  Committee  on  Ophthalmologj  be  appointed  to 
report  at  the  next  session." 

Ad<^ted. 

Drs.  Joseph  S,  Hildreth,  of  Ohicago,  Illinois,  Henry 
D.  Noyes,  and  Cornelius  R.  Agnew,  of  New  York, 
were  appointed  said  Committee. 

THE  irBTT  FLAGS  OF  MEETIKO  TO  BB  WASHIICGTON,  D.  0. 

Br.  Davis's  lesolutions  regarding  the  next  place  of 
meeting,  eta,  were  then  ordered  from  the  table. 

Dr.  Hammer  suggested  St  Louis,  Mo.,  as  having 
&vorable  claims  for  the  consideration  of  the  Associn- 
tsoo. 

After  a  lively  debate,  during  which  several  amend- 
ments to  the  original  resolution  were  entertained,  the 
motion  finally  prevailed  in  the  following  form : 

Beaolvedj  That  the  next  annual  meeting  of  the  American 
Hedical  Association  shall  be  held  in  the  city  of  Washington 
00  the  first  Tuesday  in  May,  1868,  and  every  second  year 
^ffireafter,  until  otherwise  ordered  by  the  Association. 

Besdvedf  That  whenever  the  Association  shall  meet  in  the 
dtf  of  Washington,  or  elsewhere,  as  directed  in  the  above 
rnolatiop,  the  Gommittee  of  Arrangements  be  strictly  for-' 
hidden  either  to  provide  themselves,  or  accept  provision  by 
others,  of  any  entertainment  or  excursion  whatever,  which 
win  conflict  with  the  regular  business  of  the  body  or  its 


CULTIVAnON  OF  THE  CINCHONA  TREE. 

Dr.  Atkinson  read  a  communication  from  Dr.  Henry 
P.  Lyster,  Secretary  of  the  Wayne  Co.  (Micb.)  Medical 
Society,  requesting  that  some  action  be  taken  by  Hie 
American  Medicaf  Association  regarding  the  '^  Intro- 
duction of  the  cinchona  tree  in  the  Imited  States." 
I'or  the  sake  of  giving  form  to  the  discossion,  he  pre- 
sented the  subjoined : 

Sesokfed,  That  a  Ck>mmittee  of  three  be  appointed  by  the 
Chair,  whose  duty  shall  be  to  memorialize  Congress  relative 
to  the  cultivation  of  the  Cinchona  tree. 

Carried. 

Brs.  J.  M.  Toner,  and  P.  Howard,  of  Washington, 
D.  C,  and  Dr.  C.  A.  Lee,  of  Poughkeepsie,  N.  Y.,  were 
appointed  said  Committee. 

Da  Atkinson  read  by  title  a  paper  from  Dr.  E.  Har- 
ris, of  N.  Y.,  upon  the  "  Causes  of  Cholera."  Also 
another  by  Dr.  E,  Krackowizer,  on  "Local  Anses- 
thesia." 

Dr.  Davis,  in  view  of  the  fiict  that  the  hour  of  ad- 
joarnment  was  rapidly  approaching,  offered  a  resolution 
which  he  thought  would  meet  all  objections. 

Beaohedf  That  such  papers  and  reports  as  the  several  Sec- 
tioDs  have  not  been  able  to  act  upon,  be  referred  to  a  Special 
Committee  of  three,  to  examine  and  act  upon  in  all  respects 
at  is  required  in  the  proper  Sections. 

Carried. 

The  Committee  as  appointed  consisted  of  Drs.  N.  S. 
Davis,  D.  H  Storer,  and  C.  A.  Lee. 

Dr.  Harris's  and  Dr.Ej-ackowizer's  papers  were  then, 
on  motion,  referred  to  said  Committee. 

Dr.  ATKIK80N  read  by  title  "  Synopsis  of  an  Essay  on 
the  Contagion,  Infection,  Portability,  and  Communicfr- 
bthty  of  iSe  Ajsiatio  Cholera  in  its  relations  to  Quaran- 
^.  With  a  brief  history  of  its  origin  and  course  in 
Canada,  from  1832.    By  Wm.  Marsdea  M.D." 

Dr.  Mabsden  made  a  few  remarks  in  explanation  of 
ti»  objects,  etc.,  of  the  paper. 

Dr.  Satbe  moved  to  refer  the  paper  to  the  Committee 
of  Publication.     Carried. 

ALTERATIONS  IN  THE  PLAN  OF  ORGANIZATION. 

The  ibllowing  was  offidred  by  l)t.  Cox,  of  Maryland: 

Besohedf  That  a  committee  of  five  be  appointed  by  the 

Chair  to  take  into  consideration  such  amendments  or  altera^ 


tions  in  the  plan  of  organization  of  this  Association,  and  to 
remedy  defects,  if  any,  and  increase  its  efficiency,  and  re- 
port at  the  meeting  in  1868.     Adopted. 

Drs.  C.  C  Cox,  J.  M.  Toner,  W.  B.  Atkinson,  J.  J. 
Woodward,  and  John  Shrady,  were  appointed  in  accord- 
ance with  the  above. 

Dr.  Davis  moved  that  the  resolution  referring  Dr. 
Marsden's  pi^er  to  the  Committee  of  Publication  be 
reconsidered.    Carried. 

The  motion  to  refer  said  paper  to  the  special  com- 
mit tee  as  previously  provided,  was  then  carried. 

Dr.  B.  Howard,  of  N.  Y,  owing  to  the  absence  of 
the  Secretary,  read  the  report  of  the  Surgical  Section, 
which,  after  some  corrections,  was  accepted. 

CHOLERA  AND   QUARANTINE. 

Dr.  Charles  A.  Lee,  of  New  York,  then  submitted 
these  resolutions,  bearing  upon  the  subject  of  Cholera, 
which  were  adopted  as  uie  sense  of  the  Convention. 

Whereoij  it  was  declared  by  a  vote  of  Congress  at  its 
last  session,  that  it  is  not  within  the  Constitutional  powers  of 
the  General  Government  to  establish  a  general  and  uniform 
system  of  quarantine  for  the  different  ports  of  the  United 
States,  and  Whereas,  the  cholera  infection  has  been  intro- 
duced into  the  United  States,  and  did  doubtless  manifest  it- 
self in  many  of  the  cities,  towns,  and  villages,  of  our  coun- 
try during  the  present  season,  and 

Whereas^  the  experience  of  the  city  of  New  York  and 
other  places,  both  at  home  and  abroad,  has  demonstrated 
the  efficacy  of  certain  chemical  disinfectants,  especially  carbo- 
lic acid  and  the  atiiphaie  of  iron^  in  destroying  or  preventing 
the  spread  of  cholera  virus,  it  is  hereby  as  urgently  recom- 
mended by  this  Association,  that  the  attention  of  physicians 
of  the  United  States  be  chiefly  and  constantly  directed  to  the 
prompt  and  free  use  of  such  disinfectants  wherever  the  cho- 
lera poison  may  show  itself, — 

Resolved,  That  as  the  experience  of  Europe  and  the  United 
States  has  satisfactorily  shown  that  the  cholera  poison  cannot 
beM  controlled  or  kept  in  check  except  where  the  cordons 
sanUaires  are.  absolutely  prohibitory  of  all  intercourse,  as  was 
the  case  in  the  entire  Island  of  Sicily,  and  the  entire  coasts 
and  frontier  of  Greece,  during  the  recent  cholera  epidemic, 

Whereas,  there  is  no  good  reason  to  believe  that  the  peo- 
ple of  the  United  States  would  not  submit  to  ihe  enforce- 
ment of  such  prohibitory  measures,  and  non  intercourse,  as  is 
necessary  to  hold  the  cholera  poison  in  check,  especially  after 
its  introduction  into  the  country,  it  is  hereby  recommended 
to  all  municipal  bodies  and  Boards  of  Health  to  pay  special 
attention  to  requisite  sanitary  measures,  such  as  the  cleans- 
ing of  streets,  lanes,  and  alleys  ;  the  supply  of  pure  drink- 
ing water  to  the  inhabitants ;  the  ample  provision  of  chemi- 
cal disinfectants,  and  their  prompt  employment  in  necessary 
cases ;  the  separation  of  the  sick  from  the  healthy,  in  the 
same  dwelliug;  the  inspection  and  regulation  of  tenement 
houses;  the  provision  of  nurses,  hospitals,  and  competent 
physicians  for  the  sick  poor,  who  may  be  attacked ;  provision 
for  early  burials  of  the  dead ;  the  separation  of  the  corpses  from 
the  living ;  and  the  prohibition  of  tl»e  custom  of  waking  the 
dead,  and  all  other  measures  which  have  been  found  neces- 
sary to  control  the  progress  of  the  disease 

Resolved,  That  experience  proves  that  the  publication  of 
the  facts  connected  with  the  existence  and  progress  of 
I  cholera  in  any  place,  instead  of  disturbing  the  popular  mind, 
lyhile  it  reveals  the  exact  extent  of  the  danger,  robs  it  of 
the  bold  of  alarm  and  fear,  with  which  the  imagination  sur- 
rounds indefinite  pestilence,  walking  abroad  by  noon-day. 

Dr.  H.  R.  Storer  read  the  minutes  of  the  section  on 
Psychology,  which  were  on  motion  referred  to  the  Com- 
mittee of  rublication. 

The  reports  of  the  section  on  Practical  Medicine,  and 
on  Meteorology,  were  read  and  disposed  of  in  like  man- 
ner. 

The  Committee  on  Nominations  submit! ed  their  re- 
port as  amended.    The  changes  are : 

digitized  by  Google 


128 


THE  MEDICAL  RECORD. 


CommttUe  of  Arrangemenis. — Drs.  Gh-afton  Tyler 
(Chairman)  ;  Wflliam  P.  Johnson,  F.  Howard,  William 
Mayl;»iry,  Lewis  Mackall,  T.  F.  Many,  J.  M.  Toner,  Assis- 
iant  Secreiaryj  J.  W.  H.  Lovejoy ;  Added  to  Com.  on 
Necrology  Dr.  Samuel  WiUey,  of  Minnesota ;  and  Dr. 
Samuel  M,  Welch,  of  Gtilveston,  Texas. 

REMUNERATION  OF  PERMANENT  BEORBTART. 

Dr.  M.  a  Fallen  presented  the  subjoined  : 

Whereas,  it  was  the  intention  of  tbe  resolution  originally 
introduced,  creating  the  ofBce  of  Permanent  Secretary,  to 
pay  said  officer  a  certain  sum  annually,  as  a  salary  for  ser- 
rices  as  such ;  and.  Whereas,  Dr.  William  B.  Atkinson,  our 
present  efficient  and  urbane  Secretary,  has  never  received  any 
money  whatsoever  in  payment  of  said  services,  therefore, 

Bo  it  resolved,  that  the  Permanent  Secretary  hereafter,  and 
from  this  date,  be  authorized  to  draw  a  warrant  upon  tbe 
Treasurer  for  the  expenses  incurred  in  bis  attending  eadi 
session  of  the  Association,  and  that  the  Treasurer  is  hereby 
instructed  to  pay  the  same. 

Unanimously  adopted. 

Dr.  Atleb  moved  that  the  thanks  of  the  Association 
be  tendered  to  the  Permanent  Secretary,  for  past  ser- 
vicea    Carried. 

THE  annual  assessment  AGAIN. 

Dr.  Toner  proposed  the  following,  which  includes  an 
article  of  the  Constitution  with  the  amendments  added  : 
The  sum  of  five  dollars  shall  be  assessed  annually  upon 
each  delegate  to  the  Sessions  of  the  Asasodation,  as  well 
as  upon  each  of  its  permanent  members,  whether  attend- 
ing or  not,  for  the  purpose  of  raising  a  fund  to  defray 
the  necessary  expenses  of  tbe  Association,  and  for  print- 
ing the  Transactions.  The  payment  of  this  assessment 
shall  be  required  of  the  delegates  and  members  in 
attendance  upon  the  Sessions  of  the  Association  pre-, 
viously  to  their  taking  seats  and  participating  in  tbe 
business  of  the  session.  Permanent  members  not  attend- 
ing, shall  forward  their  yearly  dues  to  the  Treasurer, 
and  thereby  shall  be  entitled  to  receive  a  copy  of  the 
printed  Transactions,  the  same  as  delegates.  Referred, 
niter  an  animated  debate,  to  Committee  on  Revision  of 
Constitution  and  By-Laws. 

Dr.  Hibbard  asked  that  Dr.  H.  R.  Storer  be  permitted 
to  use,  in  the  preparation  of  a  paper,  certain  matter 

?reviou8ly  presented  by  himseli  to  the  Association. 
Permission  granted. 

Votes  of  thanks  to  various  railroad  companies,  and 
others,  for  courtesies  extended  the  Association,  were 
then  passed. 

Dr.-  Hibdard*s  resolutions,  regarding  the  use  of  un- 
officinal  preparations,  and  the  relations  between  the 
profession  and  the  venders  of  nostrums,  were  then  called 
up. 

Dr.  Post  called  attention  to  the  proper  distinctions 
between  the  terms,  "unofflcinal"  and  '•magisterial.'* 

Dr.  Cox,  as  "an  amendment,  desired  to  insert  after 
manufacturing,  the  words,  **  advertising  or  selling  quack 
medicines  or  nostrums.'*    Lost. 

Dr.  Bibbins  moved  the  reference  of  the  whole  subject 
to  the  Committee  on  Revision  of  tbe  Constitution,  etc. 
Carried. 

female  eouoation  again. 

Dr.  Atlee  then  pressed  his  resolutions  on  the  subject 
of  Female  Medical  Education.  A  motion  to  iske  them 
from  the  table  was  carried  by  a  vote  of  56  to  52. 

Dr.  Pallen,  of  Missouri,  was  opposed  to  the  discussion 
of  the  subject  Women  were  not  by  nature  fitted  for 
thd  practice  of  medicine.  It  had  been  tried  in  Europe, 
and  had  proved  an  utter  failure.  Ladies  possessed  of 
any  delicacy  could  not  acquire  the  proper  amount  of 
knowledge.    Imagine  a  young  lady,  with  gigantic  chig 


non  and  garbed  in  silks,  entering  the  charnel-house,  and 
bending  over  a  corpse,  microscope  in  hand,  searching 
for  cancer  cells,  etc..  etc. 

Dr.  Davis  thougnt  the  discussion  of  this  subject  at 
this  time,  would  omv  fiimish  new^per  gossips  witn  a 
subject^  and  could  do  no  possible  good.  He  therefore 
moved  to  refer  the  whole  subject  to  the  Committee  on 
Medical  Ethics. 

Dr.  Bowditch,  of  Mass.,  was  opposed  to  this  way  of 
disposing  of  such  an  important  matter.  He  had  moved 
vesterday  to  lay  the  resolutions  on  the  table,  simply 
because  ne  thought  the  Convention  was  not  then  pre* 
pared  to  act  upon  them.  The  question  had  nothinfl^ 
to  do  with  the  laws  of  nature  or  the  manner  in  which 
ladies  were  to  acquire  the  proper  amount  of  knowledge. 
The  question  was  simply  whether  or  not  they  should 
be  recognised  when  they  had  acquired  that  knowledge, 
as  many  of  them  undoubtedly  had. 

The  Doctor  mentioned  several  instances  in  which  the 
practice  o^  medicine  by  lady  phyaidans  had  been  attend* 
ed  with  great  success. 

Dr.  Davis's  motion  to  refer  to  Committee  on  Medical 
Ethics  was  carried  by  a  large  majority. 

Dr.  Hibbard  moved  that  Dr.  Theophilus  Parvin,  of 
Indiana^  be  appointed  to  render  a  special  report  on  the 
Surgical  Diseases  of  Women,  at  the  next  annual  meet- 
ing.   Adopted. 

A  vote  of  thanks  was  tendered  to  Mr.  F.  Hopkins,  for 
free  use  of  his  Hall 

A  communication  from  Dr.  J.  Homberger,  expressing 
his  desire  to  resign  from  the  Association,  was  reoeive<^ 
and  finally  referred  to  Committee  on  Medical  Ethics. 

After  a  resolution,  offered  by  Dr.  S.  C.  Hughes, 
thanking  the  Press  for  impartial  reports  of  the  proved* 
ings,  Dr.  C.  A.  Lee  read  the  following: 

the  provision  for  chrohio  insane. 

Resolved,  That  providing  for  the  poor  chronic  insane  in  the 
jails  and  airoshousee  of  our  country,  as  at  present  practised  in 
nearly  all  tbe  States  of  the  Union,  is  a  gross  violation  of  tbe 
laws  of  humanity,  and  contrary  to  the  Divine  injunction  of 
"  doing  to  others  as  we  would  be  done  by.V 

Resolved,  That  where  the  regular  hospitals  for  the  insane 
of  a  Stake  are  insufficient  to  accommodate  both  acute  and 
chronic  cases  that  are  sent  to  them,  this  Association  would 
strongly  recommend  the  procurement  of  a  suitable  amount  of 
land  in  the  vicinity,  and  the  erection  of  convenient,  well- 
planned,  and  well-ventilated,  but  comparatively  inexpensive 
buildings,  in  connexion  with  and  under  the  same  general 
supervision  as  the  hospitals  themselves,  where  those  who  are 
able  to  labor,  and  would  be  benefited  by  light  and  regulated 
employment,  may  be  suitably  accommodated  and  properly 
cared  for. 

Resolved,  That  the  example  of  Massachusetts  in  establishing 
asylums  for  tbe  accommodation  and  humane  treatment  of  the 
chronic  insane,  is  worthy  of  all  praise  and  imitation,  and  in  tbe 
opinion  of  this  Association,  such  institutions,  if  rightly  inaugu- 
rated and  judiciously  carried  on,  will  be  a  benefit  to  the  State 
in  an  economical  point  of  view,  will  raise  the  character  of  the 
State  Hospitals,  and  will  greatly  subserve  the  interests  of  the 
insane  generally. 

Rss(&;ed,  That  as  the  present  insane  hospitals  are  capable 
of  accommodating  but  a  small  proportion  of  the  40,000  insane 
^of  tbe  United  States,  and  as  almshouse  and  jail  provision  is 
not  adapted  to  their  proper  care  and  treatment,  this  Associa- 
tion would  recommend  to  the  proper  State  authorities,  to 
make  such  further  provision  in  the  direction  above  indicated 
as  may  tend  to  tbe  amelioration  of  their  condition,  if  not  the 
restoration  of  their  rational  and  moral  foculties. 

Adopted, 

Dr.  Bibbins  moved  to  refer  to  a  Special  Committee  of 
five,  to  report  to  the  next  annual  meeting.    Carried. 

Dr.  C.  A.  Lee,  N.T.;  Dr.  Guntry,  Ohio;  Dr.  John 
Fonerdin ;  Dr.  Walker,  Mass. ;  Dr.  Chipley,  Ky.,  were 
appointed  said  Committee.  ^<^  t 

digitized  by  LjOOgle 


THE  MBPICAL  BKOORD. 


129 


Db.  Oox  aobmitted  the  below-named  resolutioDs, 
whidi  were  uzuknimously  adopted: 

THE  LATE  SURGEON  0.  8.  TRIPLER,  U.S.A. 

Retohed,  That  in  the  loss  of  Surgeon  Charles  S.  Triplpr,  U. 
8.  A^  who  died  in  this  oity  since  the  last  meeting  of  the 
Assoda^n,  the  profession  throughout  the  country,  Uid  army 
of  the  United  States,  and  the  Society  especially,  have  ezpeii- 
«oed  a  serious  loss. 

Rewhed,  That  in  the  high  moral  mtegrity,  Christian  charao- 
teff  pcofeasional  ability,  and  conscientious  love  of  his  vocation, 
we  recognise  in  Dr.  Tripler  one  of  the  truest  illustrations  of  a 
ioaiid  pbysicianand  a  good  man. 

B£9olvedf  That  the  condolence  and  sympathies  of  this  As- 
.  Bodttion  are  hereby  tendered  to  the  family  and  relations  of 
the  deceased ;  and  the  Secretary  is  directed  to  communicate 
to  them  a  copy  of  these  resolutions. 

Dr.  Dayis  moved  that  the  Committee  charged  with 
procaring  suitable  accommodations  for  the  A^ociation 
meetings  in  the  Smithsonian  Institution,  in  Washington, 
D.  C ,  be  continued.    Carried. 

Dr.  Aldsn  March,  of  New  York,  offered  the  follow- 
ing: 

Renlved,  That  the  thanks  of  the  Association  are  due,  and 
are  hereby  tendered  to  the  President  and  retiring  officers  for 
the  abOity,  impartiality,  and  courtesy  manifested  in  the  dis- 
charge of  their  arduous  duties. 

Carried. 

Dr.  Cox  moved  that  surplus  copies  of  the  Transac- 
tions  of  the  Association  not  yet  out  of  print^  be  sent 
(0  the  Secretaries  pf  similar  organizations  in  exchange 
hr  the  volumes  published  by  their  own  bodies.  Car- 
lied. 

Dr.  Hughes  presented  the  following : 

Me$ohed,  That  those  members  of  the  Association  who  have 
contributed  to  the  amount  of  five  dollars  to  the  publishing  of 
fhture  Transactions,  shall  be  entitled  to  any  back  volume  of 
the  Transactions  to  the  amount  of  same,  as  they  may  want 

Oanied. 

Alter  the  passage  of  several  votes  of  thanks  the 
meeting  a^joarned  at  two  p.  m.,  to  meet  at  the  time 
and  place  previously  designated! 

iHertiitg  of  ^tctxone. 


SURGICAL  SECTION. 
Susiomi  AT  THE  Medicm.  Colleqs  or  Ohio,  Mat  7  and 

9, 1867. 
The  meeting  was  called  to  order  at  3  p.m.     Prop. 
S.  D.  Gross,  M.D.,  of  Philadelphia^  was  appointed  Cb^- 
man,  and  Dr.  J.  L.  Little,  of  New  York,  Secretary. 

Db.  Joseph  S.  HrLDRBTH,  o.^  Chicago,  111.,  read  a  pa- 
per **  On  the  Action  of  Belladonna  m  Diseases  of  the 
Oomea.**  The  writer  maintains  that  in  certain  condi- 
tions of  the  eye,  the  nenrons  integrity  of  the  cornea 
may  be  so  disturbed  as  to  cause  a  peculiar  state  of 
sottsthesia.  The  dilatability  of  the  pupil  is  correspond- 
ingly lessened,  and  the  effects  of  atropia  are  of  short 
<mration.  There  may  be  either  an  acute  or  a  chronic 
form  of  anaesthesia.  In  corneal  affections  with  an  anaes- 
thesia and  diminished  dilatability  of  the  pupils,  belW 
donna  is  indicated,  but  with  normal  dilatabilitv  of  the 
pupil  and  absence  of  corneal  anesthesia,  belladonna  is 
»ot  required.  A  thorough  division  of  the  ciliary  ring, 
SDd  not  the  evacuation  of  the  aqueous  humor,  affords 
relief  for  corneal  ansesthesia.  Paracentesis  of  the  ante- 
rior chamber  maj,  in  some  cases  of  this  claeo^  prove 
serviceable  by  diminishing  congestion  of  the  atiary 
riitf,  hot  not  otherwise. 

Iridectomy,  in  one  case,  notwithstanding  that  it  re- 
aiOTed  all  intra-ociilar  tension,  tailed  to  reLeve  tiie  cor- 


neal anesthesia.    Division  of  the  cUiarr  ring,  fifteen 
minutes  afterwards,  at  once  accomplished  that  result 

Dr.  Hammxr  remarked  that  according  to  Donders, 
corneal  ulceration  was  due,  not  to  any  nervous  lesion, 
but  to  the  lodgment  of  partides  upon  the  cornea,  the 
presence  of  which  wa^  not  noted  by  the  anesthetic 
cornea. 

Dr.  Hildrsth  thought  that  the  experiments  of  Ma- 
gendie,  which  he  woiud  not  then  recite,  proved  direct- 
ly the  reverse. 

Dr.  Gross  entertained  a  similar  opinion. 

Dr.  Hildreth's  paper  was,  on  motion,  referred  to 
Committee  of  Publication. 

"  A  Report  on  the  Use  of  Plaster  of  Paris  in  Surge- 
ry," by  Dr.  James  L.  Littie,  of  New  York,  was  simi- 
larhr  referred. 

Dr.  B.  Howard,  of  New  York,  read  a  paper  entitied 
"  Ligation,  with  Depletion  of  Varicose  veins  of  the 
Leg,  with  a  Case  of  Radical  Cure.** 

The  operation  consisted  in  first  distending  the  veins, 
by  causing  the  patient  to  stand  upon  the  leg  affected. 
A  stout  unarmed  aneurism  needle  was  passed  behind 
the  vein,  just  above  ike  internal  malleolus,  and  its  points 
caused  to  emerge  on  the  opposite  side.  The  needle 
being  then  armed  with  a  silver  wire  ligature,  withdrawn, 
and  disarmed,  both  free  ends  were  left  ready  to  be 
fastened.  This  process  was  repeated  at  nine  different 
points. 

The  ligature  first  applied  was  secured  by  passing  both 
its  firee  ends  through  a  hole  in  a  small  leaden  disc,  which 
was  capped  by  a  perforation  of  buckshot  Forcible 
compression  with  a  common  plyers  completed  the 
manipulation.  The  two  ligatures  in  the  popliteal  re- 
gions were  similarly  disposed  of. 

The  yein  between  these  extreme  points  was  then 
punctured  in  several  places,  and  the  blood  allowed  to 
escape,  which  it  did  rather  fi*eely.  All  the  ligatures 
were  then  secured. 

Paper  referred  to  Committee  of  Publication. 

The  following,  after  having  been  read,  were  likewise 
leferred  to  the  same  Committee. 

On  a  New  Method  of  Operating  on  the  Bones  for  the 
lengthening  of  the  same.  By  Dr.  J.  C.  Hughes,  of  Iowa. 

A  Report  on  the  Ligature  of  the  Subclavian  Artery. 
By  Willard  Parker,  M.D..  of  N.  Y. 

A  contribution  to  the  Hip-joint  operations  during 
the  late  dvil  war,  being  the  statistics  of  twenty  cases 
of  Amputations,  and  thirteen  of  Resections  of  this  Ar- 
ticulation in  the  Southern  States,  by  Paul  F.  Eve, 
M.D.,  of  Nashville. 

A  collection  of  cases  of  Lumbar  Colotomy  (Amussat's 
operation),  by  Dr.  Geo.  C.  Blackman,  of  Cincinnati 

The  following  papers  were  laid  on  the  table : 

Observations  on  Rhinoscopy,  by  Lawrence  TumbuH, 
M.D.,  of  Philadelphia. 

A  paper  on  the  Bibliography  and  Observations  on 
the  present  condition  of  Aural  Surgery,  by  Lawrence 
Tumbull,  M.D.,  of  Philadelphia. 

On  the  treatment  of  Hernia,  by  Chauncy  F.  Perkins, 
M.D. 

A  novel  case  of  Lithotomy,  by  Edw.  Whinnery, 
M.D.,  of  Iowa. 

The  following  committees  were  appointed  to  report 
at  the  next  Annual  Meeting : 

On  the  Ligation  of  Arteries,  Benj.  Howard,  M.D.,  of 
New  York,  Chairman. 

On  the  treatment  of  Club-foot  without  Tenotomy, 
Lewis  A.  Sayre,  of  New  York,  Chairman. 

On  the  Radical  Cure  of  Hernia,  G^.  C.  Bhickman, 
M.D.,  of  Cincinnati,  Chairman. 

On  tiie  Operations  for  Hare-l^^,  Dr.  Hammer,  of  St 
Louis,  Chairman.  C^nimr^]c> 

Digitized  by  VjOOQ  Ic 


130 


THE  MEDICAL  RECORD. 


On  the  Errors  of  Diagnosis  in  Abdominal  Tumors, 
a.  C.  E.  Weber,  of  Ohio,  Chairman. 
The  Section  then  adjourned  sine  die, 

SECTION   OF   PRACTICE  OF  MEDICINB  AND 
OBSTBTBICa 

SESSION  AT  THE  DENTAL  COLLEGE,  THURBDAT,  KAT  7tH. 

The  section  having  convened  at  3  p.m.,  Prof.  M.  K. 
Taylor,  of  Keokuk,  Iowa,  was  elected  Chairman,  and 
Dr.  Edward  Hall,  of  Auburn,  New  York,  Secretary. 

An  abstract  of  a  report  on  the  Therapeutics  of  Inha- 
lation (J.  S6lis  Cohen,  X  A.  Da  Costa,  and  Louis  Els- 
berg,  committee)  was  read,  and  laid  upon  the  table  until 
the  report  itself  could  be  brought  before  the  section. 

Dr.  Joseph  Q-.  Richardson,  of  New  York,  read  a  paper 
entitled  "  Clinical  Thermometry  in  Diphtheria."  From 
numerous  observations  made  by  the  author  he  had  be- 
come convinced  that  while  the  membrane  is  forming  and 
rapidly  extending,  the  heat  of  the  body  increases,  and 
returns  to  the  normal  standard  as  the  membrane  disap- 
pears. The  temperature  of  the  bodj,  therefore,  affords 
one  of  the  most  valuable  indications  m  the  prognosis  and 
treatment  of  this  disease. 

An  interesting  discussion  in  regard  to  the  tempera- 
ture of  the  body,  not  onljr  in  diphtheria,  but  in  other 
diseases,  took  place,  participated  m  by  Profs.  Johnson. 
Palmer,  Comegys,  Dr.  Severens,  Dr.  Williams,  ana 
others.  It  was  finally  voted  that  the  author  be  re- 
quested to  continue  his  investigations,  and  report  at  the 
next  meeting  of  the  Association. 

An  unfinished  paper^  by  Dr.  A.  G-.  Field,  of  Iowa, 
on  the  "  Treatment  of  Disease  by  Atomized  Substances, 
was  presented,  and  the  author  was  requested  to  read  the 
same  completed  at  a  future  meeting. 

Portions  of  a  paper  by  Dr.  Stephen  Rogers,  of  New 
York,  on  "  Extra-Utenne  Faetation  and  Glestation," 
containing  a  statement  of  the  symptoms,  and  recomr 
mending  abdominal  section,  in  order  to  meet  the  indi- 
oations,  were  read.  It  was  voted  to  recommend  it  for 
publication"  in  the  Transactions.  Remarks  were  made 
by  Profs.  H.  R  Storer,  Palmer,  Byford,  Dr.  Parvin,  and 
others,  afler  which  the  section  adjourned. 
Session,  Mat  9,  1867. 

The  section  was  called  to  order  at  4  p.m.  Dr.  Hib- 
bard  in  the  chair. 

The  minutes  of  the  last  meeting  were  read  and  ap- 
proved. 

The  Secretary  reported  that  he  had  been  unable  to 
procure  the  report  on  the  "  Therapeutics  of  Inhalation." 

After  some  discussion,  it  was  voted  to  recommend  to 
the  Association  to  give  the  Committee  on  Publication 
discretionary  power  in  regard  to  printing  Uus  report^ 
or  portions  thereof,  in  the  Transactions. 

Prof.  M.  K.  Tatlor,  of  Keokuk^  read  a  paper  enti- 
tled, ^*  Remarks  on  the  Diseases  of  the  Hearty  as  observ- 
ed in  the  military  service,  1861-6." 

He  remarked  that  in  many  men  debilitated  by  mala^ 
rious  and  other  diseases,  and  hardship,  a  condition  of 
the  heart  existed  similar  to  hypertrophy.  These  cases 
resulted  from  a  loss  of  muscular  tone ;  were  not  seri- 
ous, and  were  restored  to  health  after  a  len^^y  period 
of  rest,  and  treatment  of  a  tonic  and  hygienic  nature. 

Dr.  Bowditoh  had  observed  a  similar  condition  in 
soldiers  whom  he  had  examined,  as  had  also  Dr.  Oross, 
at  Pittsburgh,  Penn. 

Dr.  Hall,  of  N.  Y.,  remarked  that  in  his  examina- 
tions of  several  hundred  returned  soldiers,  he  had  fre- 
quently detected  the  same  cardiac  condition  accurately 
described  in  the  paper  read  by  Prof  Taylor. 

The  paper  was  recommeoded  for  publication  in  the 
Transactions. 


The  minutes  of  this  meeting  were  read  and  approv- 
ed, and  the  section  adjourned  rine  die, 

SECTION   ON   METEOROLOGY,   MEDICAL 
TOPOGRAPHY,  ETC. 
Session,  Mat  7, 1867. 

Db.  B.  H.  Catlin,  of  Conn.,  was  called  to  the  chair,  and 
Dr.  N.  S.  Davis,  of  EL,  ^)pointed  Secretary. 

Dr.  Hakmil  read  an  interesting  report  on  the  Climar 
tology  of  Illinois,  giving  reports  of  the  sanitary  condi- 
tion and  mortality  rates  of  Chicago.  He  referred  to 
the  singular  fact  that  in  Illinois  cerebro-spinal  menin- 
gitis was  more  prevalent  than  in  any  other  State. 

Dr.  Davis  pointed  out  the  fact  that  erysipelas  was 
once  very  prevalent  along  the  watercourses  crimsoned 
by  the  blood  of  many  slaughtered  animals,  and  that 
the  intensity  of  type  was  proportionate  to  the  depth 
of  tint 

Adjourned  until  Thursday. 

Session,  Mat  9, 1867. 

Dr.  Davis  read  a  paper  on  the  "Causes  of  Cholera," 
as  previously  appointed,  after  winch  the  meeting  soon 
adjourned. 

ri^r  referred  to  Committee  of  Publication. 

SECTION  ON  PSYCHOLOGY. 

The  Section  of  Psychology  was  organized  by  the  elec- 
tion of  Prot  Chas.  A.  Lee,  as  ChauiHan,  and  Prof.  H,  R. 
Storer  as  Secretary. 

After  remarks  had  been  made  by  several  of  the 
members  present  it  was  determined  to  reconmiend  to 
the  Association  the  names  of  the  following  gentlemen 
as  a  Committee  to  report  upon  the  subject  of  insanity 
at  the  ensuing  meeting: 

Drs.  Chas,  A.  Lee,  of  N.  Y. ;  John  B.  Chapin,  of  N. 
Y. ;  A.  B.  Palmer,  of  Michigan ;  W.  W.  Jones,  of  Ohio  ; 
H.  R  Storer,  of  Mass. 

Upon  motion  of  Dr.  Toner,  the  meeting  was  then  ad- 
journed. 


C0iTOention  0f  Mtlxcai  teocljers- 


CONVENTION  OF  TEACHERS  OF  THE 

MEDICAL  COLLEGES. 

Prof.  A.  Still*,  President,  in  the  Chair. 

MORNINO  SESSION. 

Cincinnati,  May  3, 1867. 

The  delegates  met  at  ten  o'clock  in  the  Faculty  Room  of 
the  Medical  College  of  Ohio^d  organized  by  the  choice 
of  Professors  A.  Stills,  of  Philadelphia,  Penn.,  as  Pre- 
sident;  and  Prof  Gustav  C.  R  Weber,  of  Cleveland, 
Ohio,  as  Secretary.  After  a  brief  service  by  those 
gentlemen,  in  a  temporary  character,  the  following  were 
recognized  as  delegates : 

Professors  A.  Hammer,  of  Humboldt  Medical  College, 
St  Louis,  Missouri ;  W.  H.  Byford,  Chicago  Medical 
Cottege,  Chicago ;  A.  Stilld,  University  of  Pennsylvania, 
Philadelphia,  Pennsylvania ;  A.  B.  Palmer,  Universitjr 
of  Michigan,  Michigan;  A.  B.  Palmer,  Berkshire  Medi- 
cal College,  Massachusetts ;  Alden  March,  Alban v  Medi- 
cal College,  New  York ;  A.  J.  Steele,  Chicago  Medical 
College,  Chicago ;  N.  S.  Davis,  Chicago  Medical  College, 
Chicago;  Francis  Owler,  Starling . Medical  College, 
Ohio;  James  M.  Holloway,  University  of  Louisville, 
Kentucky ;  N.  R.  Taylor,  Medical  Department  of  Iowa 
University,  Iowa;  J.  0.  Hughes^  Medical  Department 
digitized  by  VjOO^^_ 


THE  MEDICAL  RECORD. 


131 


of  Iowa  University.  Iowa:  Q-.  C.  E.  Weber,  Charity 
Ho^tal  Medical  ColIeRe,  CSeyeland,  Ohio :  F.  Donald- 
800,  University  of  Maryland,  Maryland;  J.  N.  McDowell, 
Misonri  Medical  Oollege,  Missouri;  0.  G.  Comegys, 
Medical  College  of  Ohio,  Ohio;  George  C.  Blackman. 
Medical  College  of  Ohio,  Ohio-  E.  R  Stevens,  Miami 
Medical  College,  Ohio :  George  Mendenhall,  Miami  Medi- 
cal College,  Ohio :  S.  v,  Grossj  Jeflferson  Medical  College, 
Pennsylvania;  B,  L.  Lawson,  Cincinnati  College  of 
Medicine;  Read,  Cincinnati  College  of  Medicine. 

Professors  HoUoway,  of  Louisville ;  Davis,  of  Chicago ; 
Donaldson,  of  Baltimore;  Blackman,  of  Cincinnati; 
and  March,  of  Albany ;  were  appointed  a  committee  to 
report  on  the  order  of  the  cufferent  subjects  which 
were  to  occupy  the  attention  of  the  Convention. 

After  which  the  convention  adjourned  till  four  o*clock 

APTERNOONSISBION. 

The  committee  on  the  "  Order  of  the  Different  Sub- 
jects to  be  presented  for  Consideration,'^  reported  the 
following  propositions : 

"  1.  That  every  student  applying  for  matriculation  in  a 
Medical  College,  shall  be  required  to  show,  either  by 
satisfactory  certificates  or  by  a  direct  examination  by  a 
committee  of  the  faculty,  t^at  he  possesses  a  thorough 
kaowledge  of  the  common  English  branches  of  educa- 
tion, includinff  the  first  series  of  mathematics  and  the  na- 
tural sciences,  and  that  the  certificates  presented  or  the 
results  of  the  examinations  thus  required,  be  regularly 
filed  as  a  part  of  the  records  of  each  medical  college. 

**  2.  That  every  medical  student  be  required  to  study 
not  only  three  full  years,  bat  also  to  attend  three  regu- 
lar annual  courses  of  medical  college  instruction  before 
being  admitted  to  an  examination  for  the  degree  of  Doc- 
tor a  Medicine. 

'^3.  That  the  minimum  doration  of  a  regular  annual 
lectore  term,  or  course  of  medical  college  instruction, 
shall  be  Aye  calendar  months. 

"4.  That  every  medical  college  shall  embrace  in  its 
earricolum  at  least  thirteen  professorships,  including 
sobstantially  the  following  branches,  namely :  Descrip- 
ttre  Anatomy,  Physiology  and  Histology,  Inoipmic 
Ghemistry,  ^UteriaMedica,  Organic  Chemistry  and  Toxi- 
colo^.  General  Patholo^  and  Public  Hygiene,  Surgi- 
cal Anatomy  and  Operations  of  Surgery,  Medical  Juris- 
Sndence,  Practice  of  Medicine,  Practice  of  Surgery, 
betetrics  and  Diseases  of  Women,  Clinical  Medicine 
and  Clinical  Surgery.  That  these  several  branches  shall 
be  divided  into  three  groups  or  series,  corresponding 
with  the  three  years  required  for  medical  study.  The 
first,  or  fireshmen  series,  shall  embrace,  Descriptive  Ana- 
tomy. Physiology  and  Histology,  Inorganic  Chemistry 
and  Materia  Medica.  To  these  the  attention  of  the 
student  shall  be  mainly  restricted  during  the  first  year 
of  his  studies,  and  on  them  he  shaU  be  thoroughly  exa- 
mined bv  the  proper  members  of  the  faculty  at  the 
dose  of  his  first  course  of  medical  college  instruction, 
and  receive  a  certificate  indicating  the  degree  of  his 
progress.  The  second,  or  junior  series,  sh^l  embrace 
Organic  Chemistry  and  Toxicology,  General  Pathology, 
Pablic  Hygiene,  Sureical  Anatomy  and  Operations  of 
Sorgery  and  McKlical  Jurisprudence.  To  these  the  at^ 
tention  of  the  medical  student  shall  be  directed  dar- 
ing the  second  year  of  his  studies,  and  on  them  he  shall 
be  examined  at  the  close  of  his  second  course  of  medi- 
cal college  instruction,  the  same  as  after  the  first  The 
third,  or  senior  series,  shall  embrace  Practical  Medicine, 
Practical  Surgery,  Obstetrics  and  Diseases  of  Women, 
with  Clinical  Medicine  and  Clinical  Surgery  in  hospital. 
These  shall  oocapv  the  attention  of  the  student  during 
the  third  year  or  his  medical  studies,  and  at  the  dose  of 
the  third  course  of  medical  oollege  attendance,  he  shtdl 


undergo  a  general  examination  in  all  the  departments, 
as  a  prerequisite  for  the  degree  of  Doctor  of  Medicine. 

"  The  instruction  in  the  three  series  of  branches  is  t6 
be  given  simultaneously,  and  to  continue  throughout 
the  whole  of  each  annual  college  term ;  each  student 
attending  the  lectures  on  such  branches  as  belong  to  his 
period  of  progress  in  study,  in  the  same  manner  as  the 
Sophomore,  Junior,  and  Senior  classes  each  pursue  their 
respective  studies  simultaneously  throughout  the  colle- 
giate year,  in  all  our  literary  colleges. 

"  6.  That  the  practice  of  selling  individual  tickets  by 
members  of  medicaV  college  faculties,  should  be 
abolished,  and,  in  place  of  it,  each  student  should  be 
charged  a  specified  sum  for  each  annual  course  of  medi- 
cal college  instruction;  the  sum  being  the  same  for 
each  of  me  three  courses  before  graduating ;  and  any 
student  or  practitioner  who  has  attended  three  full 
courses  in  any  one  college,  ^all  be  entitled  to  attend 
any  subsequent  course  or  courses  in  that  college  gratu- 
itously. The  fees  paid  for  each  annual  course  of  col- 
lege instruction  should  be  paid  to  the  Treasurer  of  Uie 
college,  and  subseauently  distributed  to  each  member  of 
the  Faculty  at  such  time  and  in  such  proportion  as  the 
Trustees  and  Faculty  of  each  college  shall  determine. 

6.  That  inasmuch  as  the  maintenance  of  an  efficient 
Medical  College  requires  a  large  expenditure  of  money 
annually,  and  inasmuch  as  there  is  no  reasonable  hope 
of  adequate  endowments  from  the  several  State  go- 
vernments, the  exaction  of  a  just  and  reasonable  annual 
lecture  fee  is  a  necessity  with  which  all  medical  colleges 
should  comply,  and  that  $105  should  be  the  minimum 
fee  for  each  regular  annual  course  of  instruction  in  any 
medical  college  in  the  United  States." 

The  first  proposition  was  taken  up  and  discussed  by 
Professors  Davis,  Gross,  Comegys,  McDowell,  Hammer, 
Taylor,  and  Palmer,  and  with  an  amendment,  so  as  to 
strike  out  the  words  "  natural  sciences,"  and  a!dd  "  suffi- 
cTent  knowledge  bf  Latin  and  Greek  to  understand  the 
technical  terms  of  the  profession,"  it  was  adopted. 

The  Convention  then  adjourned  to  meet  at  nine  and 
a  hall'  o'clock  on  the  morrow. 

Second  Day— May  4, 1867. 

morniko  session. 

Peof.  a.  Still^,  President^  in  the  Chair.  ' 

The  minutes  of  the  preceding  session  were  read  and 
adopted. 

The  Chair  announced  that  the  next  business  in  order 
was  the  discussion  of  Section  2  of  the  Beport  of  the 
Committee  on  the  Order  of  Bu.<«ine8s. 

Professor  Gross,  of  Philadelphia,  moved  to  amend,  so 
as  to  insert  "  four  "  after  study,  instead  of  **  three." 

Remarks  were  made  by  Professors  Gross,  Hammer, 
of  St  Louis ;  Davis,  of  Chicago ;  Pahner,  of  Michigan ; 
and  McDowell,  of  St.  Louis. 

The  Convention  then  suspended  the  rules,  for  the 
purpose  of  allowing  Professor  Davis  to  introduce  the 
following  resolution : 

"  Besolvedj  That  in  all  distinct  propositions  under  the 
consideration  of  this  Convention,  no  member  shall 
speak  more  than  once  until  all  other  members  have 
spoken  who  wish  to  speak.''    Adopted. 

Prof.  W.  Howard,  of  Washington  City,  moved  to 
amend  by  inserting  *'  not  less  thim  three  years,"  instead 
of  "  three  fiill  years."    Lost 

Prof.  Gross's  amendment  was  then  adopted. 

On  motion  of  Prof  Ghross,  the  entire  section,  as 
amended,  was  unanimously  adopted. 

Prof.  Hammer  moved  to  take  up  for  consideration 
Section  4,  prior  to  Section  3.    Lost 

Section  3  was  read,  viz. :  ^*  That  the  minimum  dura- 
Digitized  by  ^ „       ^_ 


182 


THE  MBDfOAL  RBOORD. 


tion  of  a  regular  annual  lecture  term  or  course  of 
medical  college  instruction  shall  be  five  calendar 
months." 

Prof  Gross  mored  to  amend  by  insi^rting  "six"  in 
place  of  "  five  calendar  months."  Carried. 

Section  3,  as  amended,  was  then  adopted. 

Section  4  being  next  in  order,  came  up  for  discus- 
sion. Prof.  G-ross  moved  to  discuss  the  different  parts 
of  this  section  separately.  First  that  relating  to  the 
different  branches  recommended  to  be  taught  in  the 
schools.  Second,  the  number  of  professorshipa  Third, 
the  division  of  studies.    Adopted. 

Pro£  Hammer  moved  to  add  to  the  different  branches 
Natural  Philosophy  and  Pathological  Anatomy. 

Prof  Donaldson,  of  Baltimore,  moved  to  act  upon 
these  propositions  separately. 

The  vote  on  the  addition  of  Natural  Philosophy  being 
taken,  it  was  rejected. 

The  amendment  adding  Pathological  Anatomy  was 
carried. 

Professor  Byford,  of  Chicago,  moved  to  amend  by 
including  diseiues  of  children.    Carried. 

On  motion,  the  Convention  then  adjourned  to  meet 
at  4  o'clock. 

AFTERNOON  SESSION. 

The  meeting  having  been  called  to  order^  the  second 
part  of  Section  4  was  called  up  for  discussion. 

Professor  Gross  moved  to  amend  bv  inserting  after 
the  words  "  following  branches,"  "  to  be  taught  by  not 
less  than  nine  Professors."    Carried. 

Remarks  were  made  by  Professors  Gross,  Palmer, 
Davis,  Hanuner,  Howard,  and  Taylor. 

The  third  part  of  Section  4,  referring  to  the  di^aion 
of  studies,  was  next  considered. 

Professor  Davis  moved  to  amend,  by  making  th«t 
part  read  as  follows : 

*'  That  these  several  branches  shall  be '  divided  into 
three  groups  or  serie?,  corresponding  with  the  three 
courses  of  medical  college  instruction  required. 

"  The  first,  or  Freshman  series,  shaU  embrace  De-» 
Bcriptive  Anatomy  and  Practical  Dissections.  Physio- 
logy and  Histology,  Inorganic  Chemistry  and  Materia 
Medica,  and  Therapeutics. 

'I  To  these  the  attention  of  the  student  shall  be 
mainly  restricted  during  his  first  course  of  medical  col- 
lege iDStruction,  and  in  these  he  shall  submit  tp  a 
thorbugh  examination  by  the  proper  members  of  the 
Faculty,  at  its  close,  and  receive  a  certificate  indicating 
the  deg^e  of  his  progress. 

'*  The  second,  or  Junior  series,  shall  embrace  Organic 
Chemistry  and  Toxicology,  General  Pathology,  Morbid 
Anatomy  and  Public  Hygiene,  Surgical  Anatomy  and 
Operations  of  Surgery,  and  Medical  Jurisprudence.  To 
these  the  attention  of  the  medical  student  shall  be  di- 
rected during  his  second  course  of  medical  college  in- 
struction, and  in  tbem  he  shall  be  examined  at  the 
clooe  of  his  second  course  in  the  same  manner  as  after 
the  first 

"  The  third,  or  Senior  series,  shall  embrace  Practical 
Medicine,  Practical  Surgery,  Obstetrics  and  diseases 
peculiar  to  women  and  children,  with  Clinical  Medi** 
cine  and  Clinical  Surgery  in  hospital  These  shall  occu- 
py the  attention  of  the  student  during  his  third  course 
of  college  nistrncttoo,  and  at  its  close  he  shall  be  eli- 
gible to  a  general  examination  on  all  the  branches  as  a 
prerequisite  for  the  degree  of  Doctor  of  Medicine. 
The  instruction  in  the  three  series  of  branches  is  to  be 
given  simultaneously,  and  to  continue  throughout  the 
whole  of  each  annual  college  term ;  each  student  at- 
tending the  lectures  on  such  branches  as  belong  to  his 
oeriod  of  progress  in  study,  in  the  same  manner  as  the  I 


Sophomore,  and  Junior  and  Senior  classes,  eadi  pursue 
their  respective  studies  simultaneously  throughout  the 
collegiate  year,  in  all  our  Hte|rary  colleges." 

After  a  protracted  debate,  in  which  Frofessofs  GktM, 
Palmer,  Blackman,  Hammer,  Davis,  and  Taylor  parti- 
cipated, the  motion  of  Professor  Davis  prevailed. 

Professor  Davis  then  moved  the  adoption  of  the 
entire  section  as  amended.    Carried. 

Section  5  was  then  taken  up,  and,  upon  moUon  of 
Professor  Palmer,  laid  on  the  table. 

Section  6  being  in  order,  was  read,  but  on  motion  of 
Professor  Gross  was  also  laid  upon  the  table  until  Mon- 
day morning,  6th  inst. 

On  motion  of  Professor  Davis,  the  Convention  then 
adjourned  to  meet  at  10  a.  m.  on  Monday  morning. 

Thibd  Day.— Mat  6,  1867. 

MOBNUfO  nSSION. 

Prof.  A.  Snui,  President,  in  the  Chair. 

The  minutes  of  the  previous  session  were  read  and 
approved. 

The  Committee  on  Oredenttais  announced  Dr.  T.  M. 
Logan,  of  Sacramento,  California,  as  an  authorized  dele- 
gate from  the  Faculty  of  the  Toland  Medical  College  of 
San  Frandsoo. 

Professor  Gross  moved  to  consider  parts  of  seotioii 
4,  relating  to  the  branches  to  be  taught  in  medieal 
colleges. 

Professor  Hammer  moved  to  suspend  the  rules  kt 
that  purpose.    Carried. 

Professor  Gross  moved  to  amend  part  first,  secttoQ 
4,  by  maerting  the  words  ''Medical  Ethics"  after 
the  words  *^  Medical  Jurisprudence." 

Professor  Palmer  moved  the  adoption  of  the  amend*- 
ment    Carried. 

Professor  Oomegys  moved  the  reconsideratiott  of 
section  one. 

After  suspension  of  the  rules  this  motion  was  adopted. 

Professor  Comegys  moved  to  amend  Section  1,  by 
inserting  "iSements  of  Natural  Sciences"  after  the 
word  "  Mathematics."    Carried. 

Professor  Hammer  moved  the  adoption  of  the  whdi 
section  as  amended.    Carried. 

Section  6  was  then  considered. 

On  motion  of  Professor  Donaldson  it  was  laid  on  the 
table. 

Professor  Palmer  then  introduced  the  following  reso- 
lution : 

Reaolvddy  That  every  medical  college  should  immedi- 
ately adopt  some  effectual  method  of  ascertaining  the 
actual  attendance  of  students  upon  its  lectures,  and 
other  exercises,  and  at  Uie  close  of  each  session  of  the 
attendance  of  the  student  a  certificate,  specifying  the 
time  and  the  courses  of  instruction  actually  attended, 
should  be  given;  and  such  certificate  only  should  be  re- 
ceived by  other  colleges  as  evidence  of  sudi  attendanoe." 

The  resolution  was  adopted. 

Prof  Davis  moved  the  adoption  of  all  the  section  as 
amended.    Carried. 

Prof  Gross  moved  to  transmit  a  copy  of  these  sec- 
iiens  as  adopted  by  this  Convention,  certified  to  by  its 
officers,  to  the  Ainerican  Medical  Association,  at  its 
next  session. 

Prof.  Davis  then  introduced  the  following  resolution : 

"  Re9olvtdj  That  a  committee  of  five  be  Appointed  by 
the  President,  whose  duty  it  shall  be  to  present  the 
several  propositions  adopted  by  the  Convention,  to  the 
tmstees  and  faculties  of  all  the  medical  colleges  in  this 
country,  and  solicit  their  definite  action  thereon,  with  a 
view  to  the  early  and  simultaneous  practical  adoption 
of  the  same  throughout  the  whob  country.    And  that 


THE  MEDIDiSi  BBCOBD. 


188 


Ifae  same  committee  be  authorized  to  call  another  con- 
Tntioii  whenever  deemed  advisable." 

The  Chair  i^pointed  the  following  gentlemen  that 
eonmittee:  Prof.  Davis,  of  Ohicago;  Donaldson,  of 
Bdtifflore;  G-hms,  of  Philade^hia;  March,  of  Albany; 
Bla(^man,  of  Oiocinnati. 

Tke  Chairman  then  introduced  Dr.  Yattier.  President 
of  the  Cincinnati  Academy  of  Medicine,  wno  invited 
ibe  members  of  the  Convention  to  be  present  at  the 
opening  of  the  Academy  in  the  evening. 

ProC  March  moved  to  accept  the  invitation.  Car- 
ried. 

On  motion  of  Prof.  Davis,  a  vote  of  thanks  was  re- 
Ipmed  to  the  Chairman  ^d  Secretary  of  the  Conven- 
tion for  the  efficiency  with  which  thev  had  discharged 
their  duties,  and  to  the  Faculty  of  tine  Ohio  Medical 
CoQege  for  the  use  of  their  halL 

The  P^resident  returned  his  thanks  to  the  members  of 
the  Convention  in  a  neat  and  appropriate  speech. 

Prof.  Stev^is  moved  that  a  iornxal  written  thesis  on 
lome  professional  topic  shall  still  be  regarded  as  one  of 
the  indi^>en8able  requirements  for  the  doctorate. 

Bemarks  were  made  by  Professors  Cdmeygs,  Stevens, 
and  Donaldson. 

Professor  Davis  then  rose,  simply  to  suggest  whether 
there  was  not  some  dang^  of  entering  upon  the  con- 
lidflration  of  propositions  involving  details  that  might 
mmeoessaiily  complicate  the  great  leading  object  for 
vtieh  we  have  been  laboring.  Whether  the  time-hon- 
ored and  universal  custom  of  requiring  the  medical  stu- 
dents to  write  a  thesis  should  be  insisted  on  or  not^ 
would  have  but  little  bearing  on  the  great  principles  in- 
i]olved  in  the  revision  of  our  system  of  medical  educa- 
tion. If  the  standard  (^  preliminary  education  which 
we  have  here  adopted  should  be  carried  into  efiPect  it 
would  remove  one  of  the  objects  for  which  the  writmg 
of  a  thesis  was  ori^oally  demanded.  Yet,  he  said,  it 
WM  desirable  to  retain  the  practice,  if  for  no  other  pur- 
pose than  to  encourage  ev^  student  in  the  habit  of 
expressmg  his  thoughts  on  paper.  But  the  great  and 
iIlinq>ortant  object  of  this  Cfonvention  was  simply  to 
ph^e  the  system  of  tnedical  education  in  this  country 
upon  sound  educational  principles,  by  erecting  a  stan- 
dird  of  preparatory  education,  by  increasing  the  period 
of  ttady,  by  adding  to  the  college  courses,  and  by  deter- 
ioining  a  rational  order  of  study.  This  we  have  now 
done,  80  fiir  as  this  Convention  is  concerned,  by  the  har- 
monious adoption  of  the  five  propositions  already  passed 
upon.  And  he  earnestly  su^^sted  whether  we  had 
iiot  better  stop  here,  and  devote  the  remainder  of  our 
time  to  the  work  of  de?iBing  the  most  efficient  means 
to  secure  the  adoption  and  simultaneous  practical  exe- 
cution of  the  provisions  already  agreed  upon  by  all  the 
ooUeges  of  our  country ;  and  leave  all  minor  matters  of 
detail  to  be  determined  as  time  and  circumstances 
ibooid  indicate  in  the  future. 

Thereupon,  on  the  motion  of  Professor  Hammer,  the 
Gonvention  adjourned  subject  to  the  call  of  the  com- 
mittee. 


DiAiH  raoM  Chloroform. — ^A  death  during  the  admi- 
nistration of  chloroform  took  place  on  March  2d,  at  the 
HorUi  8uff<»:dshiie  Infirmary.  The  patient  was  a  boy 
aged  fifteen,  who  was  about  to  be  operated  upon  for 
tbo  removal  of  necrosed  bone  firom  the  stump  of  an 
amputated  thigh.  Between  two  and  three  drachms 
of  dilorofbrm  were  used.  On  |><M^7iu>rtom  examination 
the  nglit  side  of  the  heart  was  found  loaded  with  dark- 
ookired  bkx>d,  and  the  lungs  were  highly  congested. — 
XoNOdL 


The  Medical  Record. 

^  JStnd-Pbnt^e  lottnml  of  pjtbkme  mtoti  Snijeriti 
Gbobgs  F.  Shsadt,  M.D.,  Editob. 


PubUflhed  on  the  1st  and  lAth  of  Mdi  Month,  by 
WILLIAM  WOOD  ds  CO.,  61  Walxxb  Btekkt,  Nkw  Yobx. 

rORXWir  AQSIFCIS& 


LoKDOH— Tbubitxb  t  Oo. 
Pabis— BoesAsai  sv  Oi& 


Lnpeio— B.  Hxkmahk. 

Bio   jAHBIBO--STSraBllB  T  Oa. 


New  ^orlc  Mtay  IS,  1807. 


THE  LATE  MEETING  OF  THE  AMERICAN 
MEDICAL  ASSOCIATION. 
As  win  be  seen,  the  meeting  of  the  American  Medical 
Association  was  quite  an  interesting  and  profitable  one 
to  all  Uiose  in  attendance.  The  delegates,  of  whom  there 
was  an  unusually  large  number  present,  eWdently  came 
with  a  determinatbn  to  work  faithfully  and  harmoni- 
ously ;  and  as  a  consequence  a  very  considerable  amount 
of  ground  was  travelled  over,  and  mu(^  satisfaction  pror 
vailed  as  to  the  general  results  of  the  deliberations. 

We  were  hardly  prepared  for  the  ominous  silence  up<^ 
the'  subject  of  speciidties,  and  are  now  unexpectedly 
called  upon  to  congratulate  all  parties  concerned  in 
reference  to  a  happy  oondusion,  evidently  very  gene* 
ittUy  shared,  to  drop  all  discussion  upon  it^  at  least  for 
the  present 

The  meeting,  although  larger  than  usual,  was  not 
well  attended  by  Southern  physicians;  but  this  was 
not,  however,  to  be  interpreted  as  owing  to  a  lack  of 
interest  in  the  welfare  of  the  Association,  or  of  a  desire 
to  cultivate  those  feelings  of  professional  brotherhood 
which  .are  above  pvty  spirit  or  sectional  diflferences. 
Dr.  Tandell,  of  Kentucky,  in  an  eloquent  appeal  on 
behalf  of  many  of  his  absent  brethren,  gave  truthful 
utterance  to  their  sympathies  and  opinions  when  he 
assured  the  members  that  there  were  other  reasons 
for  so  many  still  vacant  benches  than  a  want  of  desire 
to  be  present  In  a  word,  many  of  the  physicians  of 
the  South,  in  consequence  of  the  war,  are  much  strait- 
ened in  their  finances,  and  cannot  afford  even  such  a 
temporary  respite  from  their  labors  as  an  attendance 
upon  the  meeting  would  involve. 
*  The  subjects  discussed  were  so  numerous,  and  very 
many  of  them  of  such  importance,  that  we  shall  not 
attempt  to  review  them  in  detail,  but  merely  allude  to 
them  in  passing,  trusting  for  a  more  fitting  opportunity  vH 
future  for  such  comments  as  may  seem  to  be  called  for. 

The  adoption  of  the  resolutions  offered  by  Frofl  C 
A.  Lee,  on  the  subject  of  cholera  and  the  utility  of 
quarantine,  has  committed  the  Association  more  fully 
tiian  heretofore  to  this  great  question j  and  ^e  action^ 


184 


THE  MEDICAL  RECORD. 


which  it  has  taken  will,  no  doubt^  result  in  placing  the 
doctrine  of  the  communicability  of  the  disease  upon 
that  proper  and  scientific  basis  which  it  should  have 
oocQpied  a  year  ago. 

The  Convention  of  Medical  Teachers  was  in  eveiy 
way  a  success,  and  the  endorsement  of  its  report  by  the 
Association  was,  on  the  whole,  very  praiseworthy.  In 
consideration  of  the  step  taken,  the  friends  of  Medical 
Education  may  congratulate  themselves  that  a  practical 
reform  is  initiated,  and  that  there  is  a  promise,  in  the 
virtual  permanent  organization  of  the  body,  of  the  ac- 
complishment of  even  better  things.  But  we  shall 
reserve  more  extended  remarks  upon  this  interesting 
theme  for  a  Hiture  occasion. 

Female  education  has  thrust  its  claims  upon  the  atten- 
tion of  the  members,  and  will  in  tune  furnish  food  for 
a  good  deal  of  discussion  as  to  the  utility  and  practica- 
bility of  a  general  recognition.  Unhappily  for  the 
aspirations  of  the  tender  sex,  the  question  is  destined 
to  lie  over  for  another  year,  during  which  time  ample 
opportunity  will  be  given  to  all  ooncemed  to  weigh 
with  calmneBS  and  deliberation  all  the  arguments  pro 
andcofi. 

The  courtesies  which  were  extended  to  the  members 
by  the  profession  in  Cincinnati  were' all  that  could  be 
expected  from  a  city  celebrated  for  the  hospitality, 
wealth,  and  social  culture  of  its  inhabitants.  In  view 
of  the  enjoyment  of  the  guests  at  the  various  enter- 
tainments, and  the  i^preciation  of  the  kindnesses  ten- 
dered them,  there  is  not  much  hop^  that  the  expressed 
(q>mion  of  a  few  that  these  gatherings  are  detrimental 
to^  the  best  interests  of  the-  Association,  will  meet 
with  general  favor.  There  is  a  time  for  work  and  a 
time  for  recreation;  and  both  should  be  judiciously 
Wended,  in  order  that  each  of  the  annual  sessions  shall 
minister  to  the  social  as  well  as  professional  interests  of 
our  brotherhood. 

m  %  m* 

At  the  end  of  a  notice  of  an  election  for  examiners  in 
the  University  of  London,  occurs  the  following  para- 
graph, which  we  would  respectfully  commend  to  the 
attention  of  Boards  of  Appointment  in  the  United 
States: 

"Candidates  must  send  in  their  names  to  the  Regis- 
trar, with  any  attestation  of  their  qualifications  which 
they  may  think  desirable.  H  U  particularly  desired  hy 
the  Senate  that  no  personal  appHoaUon  of  any  hind  he 
made  to  its  individual  members,^* 

0cm  anxiety  to  furnish  our  readers  with  a  complete 
report  of  the  proceedings,  at  the  earliest  possible  date, 
has  compelled  us  to  delay,  for  a  day  or  two,  the  issue  of 
this  number;  and  in  order  to  give  ourselves  sufficient 
apace  for  the  accomplishment  of  our  purpose,  we  have 
been  compelled  to  defer  several  interesting  commu- 
nications, which  we  would  otherwise  have  been  en- 
abled to  insert 


Vitmms. 


Intantilb  Paraltsib  um  rra  AmHDANT  DsioBifima 
By  Charies  Fayette  Taylor,  BID.,  Beeideot  Surgeon  N.  T. 
Ortbopoedio  Dispensary,  Author  of  Mechanical  Treat* 
ment,  Angular  Curvature  of  Spine,  etc.  Philadelphia, 
J.  B.  lippincott  ftCo.,  1867.     12mo.    Pp.  119. 

For  a  number  of  years  Dr.  Taylor  has  been  giving  hit 
entire  thoughts  and  energies  to  the  development  of  a 
more  rational  and  successml  method  of  treatment,  for  a 
certain  class  of  deformities,  than  is  commonlypractised 
even  by  the  most  intelligent  physicians.  His  labord 
in  this  department,  though  they  have  not  been  unat- 
tended by  a  share  of  the  oppositions  and  despisinga 
with  which  the  human  race  usually  greet  all  schemes 
designed  for  its  amelioration,  have  certainly  been  crown- 
ed with  a  success  that  must  be  most  gratifying,  not 
only  to  Dr.  Taylor  and  his  immediate  coadjutors,  but 
also  to  allprogressive  minds  in  the  profession  every- 
where. The  theory  of  the  movement  cure  is  found- 
ed on  the  best  of  common  sense,  and  its  practice, 
though  requiring  ^ater  patience  and  skill  than  the  ad- 
ministration of  piUs  and  boluses,  is  yet  much  moro 
successful,  as  it  is  far  more  philosophical. 

In  this  little  volume.  Dr.  Taylor  treats  of  a  subject 
of  fkr  greater  importance  than  the  majority  of  practi- 
tioners may  be  willing  to  accord  to  it,  but  those  w^ 
have  been  so  situated  as  to  have  had  opportunity  for 
seeing  these  diseases  at  their  genesis,  and  in  their 
resulting  deformities,  will  surely  admit  the  necessitv  of 
a  clearer  understanding  of  this  subject  among  medbcal 
men. 

The  main  ideas  of  the  work  are  admirably  summed 
up  by  the  author  in  the  following  propositions: 

1.  Infantile  Paralysis  is  an  arrest  of  negative  deve- 
lopment from  some  unknown  cause.  2.  The  character- 
istics of  this  form  of  paralysis  suggest  a  peripheric 
blight  rather  than  a  loss  of  central  nerve  power. 
3.  With  diminished  nutrition^  temperature,  and  muscu- 
lar power,  there  is  also  diminished  muscular  irritability ; 
and  there  is  no  such  thing  as  involuntary  or  reflex  con- 
traction in  infantile  paralysis.  4.  The  shortening  of 
certain  muscles  is  not  a  necessary  consequence  of  in- 
fantile paralysis ;  and  when  it  does  occur^  it  is  simply 
the  adaptation  of  their  length  to  the  position  they  hap- 
pen to  be  in.  5.  It  is  entirely  accidental  which  mus- 
cles become  shortened,  whether  flexors  or  extensors. 
6.  Hence  deformities  are  not  a  necessary  consequenoe 
of  infantile  paralysis,  and  when  they  are  allowed  to 
occur,  the  process  or  recovery  is  arrested.  7.  When 
deformities  have  abeady  formed,  they  should  be  treat- 
ed for  an  ultimate  end,  vis.  to  bring  the  patient  back 
to  the  place  from  which  he  should  not  have  been  allow- 
ed to  diverge,  when  the  treatment  for  his  paralysb 
should  begin.  8.  Hence,  tenotomy  and  mechanical 
appliances  are  only  means  to  an  end,  the  first  steps  of 
a  course  of  treatment  having  in  view  the  restoration 
of  the  muscular  power.  9.  The  most  natural  means 
for  this  purpose  is  the  supply  of  local  heat,  involving 
increased  local  circulation,  together  with  local  exercise 
corresponding  with  the  position  and  ability  of  the  part 
exercised.  10.  The  element  of  time  must  also  be 
taken  into  consideration. 

These  propositions  contain  the  leading  principleB  of 
the  author's  philosophy,  and  that  they  will  stand  the 
test  of  experience  we  nave  no  doubt  His  theory  in 
regard  to  the  pathology  of  infantile  paralysis  is  very 
clearly  put  in  the  following  sentence : 

"if  we  can  conceive  of  a  general  constringinff  of 
the  capillary  vessels,  and  a  shutting  off  of  the  capiuarj 
circulation,  with  such  a  physical  condition  as  would  re- 


THfi  MEDICAL  BBCOKD. 


186 


edit  if  the  limb  had  been  for  a  long  time  tightly  ban- 
daged, we  should  fonn  a  yerj  good  idea  of  the  actual 
eooditioD  in  infantile  paralysis." 

Il  is  oar  belief  that  not  only  infantile  paralysis  but 
ibo  many  ci  the  so-called  hysterical  paralyses  of  adults 
may  be  accounted  for  on  precisely  the  same  theory  and 
demand  the  same  treatment 

The  special  methods  on  which  Dr.  Taylor  relies  to 
increase  the  local  circulation  are,  '*  the  supply  of  local 
beat  and  local  exercise,  corresponding  with  the  position 
and  ability  of  the  part  exercised."  For  carrying  out 
of  the  latter  indica^on,  he  relies  mainly  on  his  mechani- 
cal appliances. 

These,  so  far  as  they  go,  are  admirable,  but  the 
totfaor  makes  no  mention  of  rvibhing  or  of  dedricUyy 
both  of  which  have  for  a  long  time  been  used  with 
BoocesB  in  the  same  class  of  diseases. 

Although  these  agents  have  been  mostly  in  the  hands 
of  charlatans,  who  have  labored  in  blindness  and 
igncnnce,  ana  oftentimes  with  detriment  to  the  health 
as  wen  as  purses  of  their  victims,  they  have  yet  in 
many  instances  stumbled  upon  the  most  brilliant 
enooess. 

Electridans  and  rubbing  doctors,  whether  they  are 
awire  of  it  or  not,  perform  their  cures  in  the  same  way 
as  Dr.  Taylor;  namely,  by  increasing  the  local  circula- 
te. 

Dr.  Taylor  says  that  the  American  people  are  weak 
in  bodily  vigor,  and  that  infantile  paralysis  is  most 
common  among  the  rich.  With  all  deference  to  his 
lane  experience  and  careful  obseifvation,  we  feel  com- 
peuedto  differ  firom  him  on  this  subject  It  is  sin- 
|nlar  that  in  this,  the  only  passage  of  his  book  where 
Dr.  Taylor  shows  any  respect  for  popular  prejudices,  he 
•eems  to  be  entirely  at  mult  Probably  many  in  the 
pn^baaion  wiQ  give  to  this  statement  unquestioning 
anent,  but  we  feel  confident  that  if  Dr.  Taylor  wifi 
take  the  pains  to  investigate  this  subject)  with  the 
ame  courage  and  independence  that  he  has  advocated 
the  dums  of  the  "Movement  Cure,*'  he  will  become 
convinced  that  nowhere  can  be  found  a  nobler  average 
of  physical  and  intellectual  manhood  than  among  the 
Datif  e  population  of  America :  nay  more,  that  the  wo- 
men of  our  better  classes,  even  in  our  large  cities,  are 
measarably  healthy  as  well  as  beautifnl,  and  that  infan- 
tile paralysis  is  as  prevalent,  or  mr>re  so,  among  the 
poor  and  oppressed  as  among  the  cultivated  and  high 
Dom. 

Bat  putting  aside  these  collateral  questions,  which  at 
beat  must  remain  matters  of  opinion,  we  earnestly 
commend  this  work  to  the  careful  attention  of  all  in 
the  profession  who  feel  the  need  of  a  more  rational 
system  of  treatment  in  paralysis  than  has  hitherto 
finmd  &vor. 


Iiri  15  SooTLAOT).— There  are  in  Scotland  216.723 
hooses  of  only  one  apartment,  a  large  number  of  wnich 
'^ accommodate"  ei^ht  or  ten  persons  each.  Nearlv 
8,000  of  these  dwelhngs  have  no  windows!  One  mii- 
fion  <rf  people,  nearly  a  third  of  the  entire  population, 
fi^e  in  these  one-roomed  houses.  Edinburgh  has  fif- 
teen hundred  one-roomed  houses,  and  G1mj?ow  over 
twenty-two  hundred.  And  yet  Scotland  is  regarded  as 
a  part  of  the  civilized  w<ki6L — Pac^  Mediedl  and  Sur- 
TmJonmal. 

A  Niw  Medical  Sooistt  ni  Paris. — ^A  new  society 
om  Just  been  founded  in  Paris  in  order  to  study,  $ena^ 
^  the  different  agents  of  the  materia  medica  hitherto 
ianse. 


Vitpoxta  of  Siaciettes. 


NEW.  YORK  PATHOLOGICAL  SOCIETY. 
,    Stated  Meeting,  February  13,  1867. 
Dr.  H.  B.  Savds,  President,  in  the  Chair. 

THE  OPHTHALMOSOOPB  AND   RENAL  DISEASE. 

Dr.  Notes  exhibited  ^  eye  which  had  been  extirpated 
a  week  ago  last  Sunday,  from  a  lady  40  vears  of  age, 
unmarried ;  and  who  had  regarded  herself  as  being  in 
good  health,  and  who  had  lost  this  eye  twenty  years 
a«;o  by  severe  internal  inflammation.  There  was  dis- 
cioseiL  on  examination  of  the  organ,  a  large  staphylo- 
ma or  the  ciliary  region  of  the  sclerotic :  there  was 
oataract,  the  lens  osallating  back  and  fortn,  and  there 
was  no  perception  of  light.  She  had  not  suffered  any 
inconvenience  from  the  eye  except  a  sense  of  weariness, 
which  would  be  felt  sooner  than  in  other  parts  of  the 
body.  Ten  days  previous  to  the  operation,  she  living 
out  of  town,  had  come  to  the  city  to  attend  the  wed- 
ding of  a  relative,  and  did  not  in  consequence  retire 
as  early  as  usuaL  On  the  following  morning  she 
noticed,  for  the  first  time,  that  the  sight  of  the  previ- 
ously sound  eye  was  very  much  impaired.  She  had 
applied  to  several  gentlemen,  who  had  expressed  the 
opmion  that  the  trouble  was  merely  sympathetic. 

When  she  afterwards  called  on  Dr.  Noyes  for  advice, 
that  gentleman  was  surprised  to  find  on  examination  of 
the  eye  last  affected,  strong  evidences  of  the  existence 
of  Bright's  disease  in  the  8hM>e  a£  extensive  fatty 
degeneration,  and  abundant  eccmymoslB  of  the  retina. 
An  inquiry  into  the  state  of  her  general  health  failed  to 
elicit  anything  satisfactory,  notwithstanding  she  was. a 
very  intelligent  lady,  and  was  observant  of  symptoms. 
Sh'e  stated  that  both  her  parents  and  great-uncle  died 
of  heart  disease.  An  examination  of  her  heart  was 
made,  and  although  it  was  somewhat  imperfect,  the 
doctor  felt  pretty  sure  that  hypertrophy  existed,  de- 
pendent upon  wnat  cause  he  could  not  determine.  A 
careful  examinatioD  of  the  urine  resulted  negatively, 
the  specific,  gravity  was  1,024,  and  there  were  present  a 
few  renal  epithehal  scales  undergoing  fatty  degenera- 
tion, and  some  crystals  of  the  oxalate  of  lime.  He  ad- 
vised the  removal  of  the  diseased  eye  merely  to  get  rid 
of  an  annoyance,  not  viewing  it  in  itself  as  a  source  of 
trouble,  ftevious  to  the  operation,  first  chloroform  and 
then  ether  was  administered.  There  was  considerable 
hsemorrha^e,  but  this  was  by  no  means  as  annoying  as 
a  peculiar  irregularity  of  the  heart's  action,  which  kept 
up  for  the  first  twenty-four  hours  after  the  operation. 

Since  that  time  he  had  carefully  watched  the  case, 
and  had  satisfied  himself  of  the  existence  of  mitral  insuf- 
ficiency. Examination  of  the  urine  afterwards,  discov- 
ered one  or  two  i^pearances  that  the  doctor  felt  assur- 
ed were  casts,  as  well  as  an  abundance  of  vaginal  and 
renal  epithehum.  He  was  therefore  pretty  stronely 
convinced  that  this  was  a  case  of  chrome  disease  of  we 
kidney,  in  which  hypertrophy  of  the  heart  had  super- 
vened^ and  in  which  the  first  symptom  appearing  of 
any  dia^ostic  value,  was  to  be  found  in  the  change  in 
the  retma;  that  change  unrecognised,  but  occurring 
during  one  night,  culminating  in  an  attack  of  neuro- 
retinitis,  which  greatly  impaired  the  vision  of  an  eye 


araiarently  previously  unaffected. 
The  specimen  remc 


specimen  removed  was  suspended  in  a  glass 
cell  in  preservative  fluid,  and  showed  the  retina  com- 
pletely detached  by  fatty  degeneration  between  it  and 
the  choroid.  The  lens  was  &ee  and  floating  about  in 
the  anterior  chamber. 
Dr.  Sands  was  not  inclined  to  think  that  the  opht^J^ 


136 


THE  MEDIGAIi  HBCOIU>. 


zuosoope  cotild  always  decide  as  to  the  existence  of 
renal  disease  when  no  other  symptoms  of  that  trouble 
were  present.  He  had  met  with  two  initances  during 
the  past  year  in  which,  if  he  had  relied  entirely  upon 
an  ophthalmoscopic  examination,  he  would  have  said 
renal  disease  unquestionably  existed.  There  was, 
however,  a  disappointment  m  not  finding  any  other 
evidences  of  kidney  trouble. 

Dr.  Notes  remarked  that  in  the  present  state  of  the 
question  one  or  two  examinations  of  the  urine  should 
not  be  considered  sufficient  to  decide  a^nst  the  exist- 
ence of  Bri^ht's  disease  when  the  ophmahnosqope  had 
decided  for  it. 

Dr.  Newman  referred  to  two  cases  of  Bright*s  dis- 
ease, the  diagnosis  of  which  was  first  made  out  by  the 
ophthalmoscope  in  the  hands  of  Dr.  Althof,  of  New 
X  ork.  In  both  instances  repeated  examinations  of  the 
urine  were  made,  for  a  lonff  time  without  avail,  when 
finally  casts  were  discovered  with  the  other  symptoms 
of  the  disease.  Both  patients  afterwards  died,  and  the 
diagnosis  was  unequivocally  confirmed  by  a  post-mortem 
examination. 

Dr.  Notes  alluded  to  a  case  of  renal  disease  which 
the  ophthalmoscope  had  at  first  pointed  out  to  be  such, 
but  in  which  no  other  evidences  of  the  correctness  <rf  the 
dia^osis  were  afterwards  made  out,  save  in  the  dimi- 
nution of  the  quantity  of  urea  excreted  to  two-fifths  of 
its  normal  amount 

Dr.  Flint  believed  that  the  fact  was  well  established, 
that  there  might  be  a  temporary  disappearance  of  casts 
and  albumen  for  a  considerable  time,  and  yet  the  patient 
be  suflering  firom  advanced  Bright's  kidney. 

Dr.  Notes  stated  that  a  case  had  occurred  to  him 
within  the  last  week,  which  bore  strongly  upon  the 
general  question  under  discussion.  A  young  man  of 
nne,  vigorous  appearance,  who  had  never  suffered  ^m 
ill  healtn,  except  that  occasioned  by  a  capricious  appe^ 
tite,  and  more  or  less  headache,  came  to  his  office  to  be 
treated  for  strabismus.  On  using  the  ophthalmosoope, 
however,  the  characteristic  changes  of  Morbus  Brightii 
were  seen  upon  the  retina,  and  an  examination  bf  the 
urine  afterwards  disclosed  casts  and  albumen. 

Dr.  Flint  exhibited  an  intestinal  calculus  which  had 
been  found  in  the  intestinal  canal  just  above  the  csscum, 
haying  evidently  existed  in  that  locality  for  the  long 
period  of  twenty  years. 

GRADUAL     PERITONITIS    FOLLOWING   PERFORATION    OF 
APPENDIX. 

He  next  presented  another  specimen  which  had  been 
taken  fi-om  the  body  of  a  patient  attended  by  Dr.Chas, 
D.Smith. 

A  young  nian,  aged  18,  was  attacked,  on  the  22d  of  last 
December,  with  some  pain  and  soreness  in  the  abdomen, 
which  was  referred  to  the  right  iliac  region.  It  in- 
creased, but  he  did  not  take  to  his  bed  until  the  26th, 
when  he  was  seen  by  his  attending  physician.  He 
then  presented  symptoms  pointing  strongly  towards 
]>eritoniti3,  but  they  were  not  sufficient  to  found  a  posi- 
tive diagnosis  upon.  On  the  day  following,  these  symp- 
toms were  well  declared,  and  in  the  evening  Dr.  Flint 
was  called  in  consultation.  There  was  then  rigidity  of 
the  abdominal  walls,  moderate  tympanitis,  tenderness 
on  pressure,  pulse  116,  and  the  pupils  were  somewhat 
contracted  from  the  opium  which  had  been  administer- 
ed. The  disease  progressed,  and  on  the  following  day 
the  tympanitis  was  more  marked,  the  pulse  more  fire- 
quent,  and  death  finally  ensued  on  the  28tli. 

The  foti-morUm  examination  gave  evidences  of  gene- 
ral peritonitis.  There  was  a  certain  amount  of  muddy 
liquid  in  the  peritoneal  cavity,  reoent  lymph  agglutm- 
afM  the  intestines,  while  the  whole  serous  membrane 


was  covered  with  an  arborescent  redness.  The  v^rmi- 
form  appendix  was  found  adheroit  to  the  abdommal 
walls,  and  had  a  perforation  about  its  centre.  Within 
the  cavity  of  this  latter  organ  were  two  solid  bodies, 
apparently  fcecal  in  character,  one  of  which  was  sooid- 
what  oval,  the  other  more  rounded. 

The  development  of  the  peritonitis  was  so  gradual 
that  it  was  at  first  snpposed  (contrary  to  what  was 
afterwards  shown)  that  the  peritonitis  was  at  first  idio- 
pathic, and,  of  course,  independent  of  the  perforatioiL 
The  treatment  was  by  opiates  freely  and  persistently 
administered. 

CARDIAC  DISBASI  WITH  PULMONABT  APOPLEXT, 

Dr.  Draper  presented  a  specimen  of  heart  disease^ 
complicated  wiui  pulmonary  apoplexy.  He  gave  the 
following  history  of  the  case : 

The  patient,  a  seaman,  33  years  of  age,  was  admitted 
to  the  New  York  Hospital  on  the  4th  of  this  month. 
He  had  always  been  a  man  of  temperate  habit&  He 
left  Mobile  twelve  days  before  admission,  in  the  enioy- 
ment  (as  he  said)  of  perfect  health.  When  two  days 
out,  he  took  a  cmll,  followed  by  pain  in  the  left  hypo- 
<^ondrium,  and  considerable  difficulty  in  breathing  and 
cough.  He  took  to  his  bed,  and  two  days  after  the 
chill  he  had  some  swelling  of  the  feet,  and  was  unable 
to  resume  his  duties  during  the  pass^.  When  admit- 
ted to  the  hospital  he  was  suffering  from  extreme  dys- 
pnoea, and  the  action  of  the  heart  was  so  tumultuouB 
that  the  house  physician  was  unable  to  detect  any  car- 
diac lesion ;  he  however  observed  that  the  area  of  pre- 
cordial dulness  was  increased.  On  examining  the  lungs 
he  noticed  a  marked  resonance  on  percussions  over  the 
whole  chest,  with  puerile  respiration,  and  some  coarse 
rhonohi.  He  applied  dry  cups  and  sim^isms,  and 
administered  stimulants.  On  the  following  day,  the 
action  of  the  heart  was  sufficiently  regular  to  enable  him 
to  appreciate  the  abnormal  condition.  The  area  of  dul- 
ness was  considerably  increased,  though  the  apex  was 
not  as  much  displaced  as  might  be  supposed,  consider- 
ing the  amount  of  hypertrophy  which  was  presents 
The  apex  beat  in  the  proper  perpendicular,  but  in  tiie 
sixth  intercostal  space.  At  the  base  of  the  organ  there 
was  a  double  murmur*  the  systohc  was  short  and  rough, 
the  diastolic  prolonged,  soft,  and  higher  pitched.  Both 
of  these  were  noticed  at  the  base  of  the  organ.  On 
examining  the  chest,  Dr.  Draper  found  a  different  eo&- 
dition  of  things  from  that  noticed  by  Dr.  Seguin;  there 
was  dulness  on  percussion  postenorly,  and  so  feeble 
was  the  respiration  that  he  was  inclined  to  think  thai 
there  was  pleuritic  or  pulmonary  congestion ;  he  was 
unable  positively  to  aetermine  which.  The  man's 
condition  was  still  very  critical;  the  dyspnoea  'waa 
considerable ;  he  could  not  lie  down  in  bed,  and  suffered 
considerably  from  prsBCordial  distress.  He  continued  in 
this  condition  for  four  days,  when  he  died  from  exhanuH 
tion. 

On  po$tr^mortem  examination  made  a  few  hours  afta 
death,  the  lesions  found  were  as  follows:  The  aorta 
was  considerably  distended  just  beyond  the  aorUc 
valves.  The  aortic  valves  were  insufficient^  the  left 
ventricle  was  considerably  distended,  and  the  mitral 
valves  were  also  insufficient  Both  sides  of  the  heart 
were  considerably  distended  with  blood.  On  further 
examination,  the  left  pleural  cavity  was  nearly  filled 
with  turbid  serum ;  and  the  left  limg,  which  was  con- 
solidated in  consequence  of  effusion,  was  found  also  to 
be  the  seat,  idong  its  marginal  portions,  of  considerable 
interstitial  apoplexy.  The  interesting  point  appeared  to 
him  to  be  the  short  period  during  which  the  i^ktient  suf- 
fered from  heart  symptoms.  He  had  stated  that  he  had 
never  noticed  any  cardiac  symptoms  whatsoever  until 


THE  MEDICAL  RECORD. 


1S7 


aHer  he  bad  left  Mobfle.  It  was  very  evident^  how- 
entj  that  it  had  existed  for  a  concoderable  period, 
as  uxfte  atheromatous  plates  lined  the  aorta  for  a  con- 
aderme  distance  above  the  aortic  Talves.  As  the  re- 
mit (^his  obeenration,  he  remarked  that  the  lesions  of  the 
aortic  yalres  were  those  in  which  the  patient  suffered 
kast)  and  supposed  the  reason  was.  that  the  point  was 
one  most  distant  from  the  pfeneral  yenous  circulation. 
Here,  as  in  most  cases  of  disease  of  the  aortic  valves, 
the  left  ventricle  had  undergone  very  considerable  dis- 
tension, and  until  this  distension  caused  insufficiency  of 
the  mitral  valves,  patients  never  suffer  seriously  from 
pdmonary  congestion.  When^  however,  this  does  oc- 
cur, pulmonary  congestion  is  inevitable.  He  thought 
it  was  very  unusual  to  see  that  amount  of  lesion  when 
DO  cardiac  symptoms  manifested  themselves  until  so 
short  a  period  before  death.  In  conclusion,  he  remark- 
ed that  there  were  two  anomalies,  one  in  the  artery, 
the  right  carotid  opening  in  common  with  the  innomi- 
nata,  and  one  in  the  vein ;  there  being  two  piilmo- 
my  valves  instead  of  three. 

DIITH   WROU   CHLOROFORlf   AT  BKLLSVUE   HOSPITAL. 

Di.  F.  H.  Hamilton  presented  the  severed  head  of  a 
ftmale,  for  the  purpose  of  exhibiting  the  results  of  an 
oafoisbed  operation,  she  having  met  her  death  from 
cUoroform.  The  patient  was  an  Irishwoman,  36  years 
of  age,  who  bad  her  nose  bitten  off,  January  1,  in  a 
brawl  with  a  negro  who  it  was  understood  was  her 
paramour.  She  was  admitted  to  the  Bellevue  Hospital 
on  the  same  day,  and  on  the  day  following  was  seen  by 
Dr.  H.  He  found  that  about  an  inch  and  a  quarter  of 
the  end  of  the  nose  was  gone,  as  well  as  the  septum 
and  oolumna  nasi,  with  perhaps  four-fifths  of  the  alss 
Bin.  At  a  consultation  held  on  the  seventh  day  it  was 
decided  to  operate  for  the  restoration  of  the  nose  im- 
mediately. 

The  first  operation  consisted  in  freshening  (excising) 
tbe  margins  of  the  wound  upon  the  nose  in  the  usuid 
Banner,  and  then  covering  in  the  end  of  the  nose  with 
a  piece  of  integument  taken  from  the  forehead.  This 
frontal  fiap  was  taken  from  the  centre  of  the  forehead, 
and  was  so  prolonged  upwards  in  the  median  line  as  to 
form,  when  brought  down  to  its  place,  a  columna.  The 
p»dide,  or  **  bridge,"  supporting  the  flap,  was  much 
wider  than  other  operators  have  generally  seen  fit  to 
make  it,  so  wide  indeed  as  to  include  a  portion  of  the 
•jrehrows.  This  gives  greater  security  to  the  flap ;  but 
the  width  would  be  objectionable  were  it  not  that  it 
was  intended  to  cut  this  pedicle  eventually,  near  the 
cud  of  the  nose,  and  lay  it  back  in  its  original  situation. 

The  flap  thus  made  was  turned  upon  itself,  and  made 
&at  by  side  sutures. 

A  few  days  later,  when  adhesion  had  taken  place 
through  nearly  all  of  the  resected  margin.  Dr.  Hamilton 
freshened  the  central,  tongue-like  prolongation,  and  fas- 
tening it  below,  constructed  the  columna.  This  united 
well,  and  "you  are  able,"  said  Dr.  Hamilton,  "in  the 
^ecunen  which  I  present  to  you,  to  see  the  result  at 
the  end  of  one  month  from  the  date  of  the  first  opera- 
tion." 

,  It  was  his  intention  now  to  cut  the  pedicle,  and  carry 
It  back  to  its  original  place,  a  method  of  procedure 
which  he  has,  up  to  this  dme,  adopted  in  four  casts,  and 
whkh  he  thought  might  be  reganled,  in  its  application 
to  certain  cases,  as  an  improvement  upon  the  usual 
practice.  No  doubt  it  will  be  better  to  leave  the  pedi- 
cle upon  the  nose  in  all  cases  in  which  the  bridge  of  the 
iK»e  is  depressed,  and  needs  elevation  to  give  it  propor- 
tioii,  but  in  cases  like  this  he  thou^t  his  awn  procedure 
<>oght  to  be  nreferred.  Dr.  Hamilton  did  not  pretend 
to  say  that  the  operation  may  not  have  been  made  in 


this  manner  by  other  surgeons,  only  he  thought  it  was 
not  the  usual  practice. 

In  referenoe  to  the  mode  of  death  in  this  case  Dr. 
Hamilton  remarked,  that  the  chloroform  and  ether  were 
administered  by  a  very  intelligent  house  surgeon.  The 
administration  of  the  chloroform  was  in  his  absence,  but 
this  circumstance  was  accidental.  The  patient  was 
brought  into  the  room  at  ten  o'clock,  and  placed  upon 
the  table,  Ihr.  Hanrilton  having  previously  directed  uiat 
a  little  chloroform  should  at  firot  be  given,  to  be  followed 
by  ether.  The  cU(H^form  was  poured  upon  an  open 
napkin,  and  held  some  distance  from  the  face.  After  a 
short  time  ether  was  substituted  for  the  chloroform. 
Both  the  chloroform  and  the  ether  were  manufactured 
by  Squibb,  and  were  chemically  pure.  Dr.  H..  on  en- 
tering the  room,  found  her  talking  loudly,  and  throwmg 
her  arms  about  She  was  then  taking  ether  from  a 
cone.  The  noise  she  occasioned  was  too  great  to  per- 
mit him  to  speak  to  the  students  upon  the  operation, 
and  he  acoordindy  waited  about  five  minutes  (or  it  to 
subside.  She  then  was  quiet,  and  breathing  naturally. 
Dr.  H.  then  stepped  to  the  other  side  of  the  table  to 
look  to  the  transfer  of  instruments  to  the  opposite  side 
of  the  patient,  then  turned  again  to  the  table,  and  back 
to  the  patient  when  he  discovered  that  she  had  ceased 
to  breathe.  It  is  worthy  of  note  that  she  was  at  that 
time  palhd,  and  that  there  was  no  appearance  of  as- 
phyxia. It  was  Dr.  Hamilton's  beUef  that  the  heart 
bad  then  ceased  its  pulsations.  He  could  not  feel  any 
pulsation  at  the  wrist^  but  did  not  stop  to  ascertain 
whether  the  carotid  beat  He  immediately  commenced 
artificial  respiration;  turning  her  first  upon  the  left 
side,  and  then  upon  her  back,  in  which  latter  position 
the  hand  was  pressed  against  the  ensiform  cartilage. 
In  three-quarters  of  a  minute  after  this  there  was  a  lull 
inspiration,  and  the  patient  was  thought  to  be  compara- 
tively safe.  There  was,  however,  the  same  long  interval 
between  this  and  the  next  inspiration.  It  is  perhaps 
proper  to  say  at  this  moment  that  the  tongue  had  pre- 
viously been  pulled  out,  and  held  in  that  position  by  a 
tenacululn.  The  battery  was  next  ordered  and  implied, 
perhaps  at  the  end  of  eight  minutes  (the  efforts  at  arti- 
ficial respiration  being  in  the  meantime  kept  up).  The 
batterv  was  applied,  with  one  pole  over  the  hearty  on 
the  left  side,  and  one  over  the  region  of  the  diaphragm, 
upon  the  right  side.  This  was  done  without  any  posi- 
tive knowledge  as  to  what  had  been  the  usual  practice 
in  the  application  of  the  battery  in  similar  case&  He 
had.  however,  noticed  since,  that  it  has  been  advised  to 
^)piy  one  pole  in  the  course  of  Uie  phrenic  nerve  some- 
where on  the  neck,  and  the  other  to  the  region  of  the 
diaphragm ;  the  authorities  to  which  he  had  referred 
affirming  that  the  batteiy  under  these  circumstances 
induces  a  spasm  of  the  diaphragm,  and  a  consequent 
sudden  inspiration.  As  it  was  applied  in  this  instance 
no  effect  was  produced.  The  battery  was  then  removed, 
and  the  patient  was  turned  upon  her  left  side,  when  one 
or  two  short  inspirations  followed  the  procedure^  and 
then  respiration  failed  altogether.  It  was  not  until  the 
respiration  had  entirely  ceased  that  the  lips  became 
purple.  Laryngotomv  was  next  resorted  to,  and  a  fiir- 
ther  attempt  at  artificial  respiration  made  for  three- 
quarters  of  an  hour  longer,  when  the  patient  was  re- 
signed as  dead.  Although  the  position  for  inducing 
artificial  respiration  was  not  the  one  recommended  by 
Marshall  Hall,  still  Dr.  H.  thought  in  this  case,  the 
woman  being  large  and  unwieldy,  it  evidently  answered 
every  purpose.  An  autopsy  was  made  on  the  following 
day,  but  nothing  was  found  to  ftimish  any  explanation 
of  her  death. 

Dr.  Hamilton,  in  conclusion,  wished  to  place  on  record 
an  account  of  several  other  caseis  of  a  simile:  operation 


138 


THE  MEDICAL  RECORD. 


to  the  one  intended  to  have  been  made,  all  of  which 
had  terminated  favorably. 

1.  Sept.  22,  1855,  in  presence  of  Br.  Boardman,  of 
Bufi^o,  and  others,  I  operated  on  Dennis  Davy,  Irish, 
9bt  30,  &om  Medina,  Orleans  co.,  N.  Y.  His  nose  had 
been  bitten  off.  seven  days  before,  by  a  man  in  a  fight. 
I  did  not  use  ctiloroform.  Having  freshened  the  edges 
of  the  wound,  I  dissected  up  a  piece  of  integument 
from  the  forehead,  and  transplanted  it  to  the  nose.  It 
united  well.  Thirteen  days  later  I  cut  the  pedicle,  and 
restored  it  to  its  original  position.  The  result  was  com- 
pletely satia&ctory. 

2.  July  3,  1857, 1  operated  in  a  similar  manner  upon 
Dr.  S.  Ward,  of  Silver  Greek,  Cattaraugus  oo.,  N.  Y., 
for  an  epithelioma,  on  the  left  ^  of  the  nose.  The  por- 
tion of  nose  and  face  removed  was  about  one  and  one- 
half  inch  in  diameter.  I  took  the  integument  from  the 
forehead.    The  success  was  perfect 

3.  March  30.  1852, 1  operated  in  the  same  manner* 
upon  Pardon  Davis,  of  Brockport,  N.  Y.,  for  an  epithe- 
Uoma  of  the  side  or  the  nose  and  evelid,  in  presence  of 
Drs.  dark,  Thatcher,  Carpenter,  Wood,  &c.,  of  Brock- 
port.  Mr.  Davis  was  sixty-four  years  old.  The  skin 
united  very  promptly,  but  the  disease  eventually  re- 
turned in  the  bone. 

4  I  made  the  same  operation  for  an  epithelioma  on 
the  side  of  the  nose,  near  the  eye,  in  the  case  of  Par- 
mele  Parmentis,  of  Ohatauque  co,  N.  Y.  She  was 
then  about  twenty-six  years  old.  The  result  was  a  per- 
fect success. 

Dr.  Post  remarked  that  Dr.  Hamilton's  method  of 
treating  the  flap  was  not  unusual  as  that  gentleman  had 
intimated,  but  was  one  generally  employed  by  sur- 
geons. He  thought  that  the  safety  of  the  flap  in  all  these 
cases  depended  more  upon  a  wide  pedicle  and  an  easy 
twist  than  anything  else. 

Dr.  Kraokowizer  thought  it  a  better  plan  not  to 
transplant  the  flap  from  the  forehead,  but  from  a  little 
outside  the  freshened  edges.  He  did  this  in  one  case, 
and  would  have  been  successful  had  he  not  endeavored 
in  the  first  operation  also  to  form  the  columna.  He 
agreed  with  Dr.  Hamilton  in  the  opinion  that  his  method 
^treating  the  flap  was  unusiial,  if  not  entirely  new. 

Dr.  Notes  had  seen  a  rhinoplastic  operation  per- 
formed, the  flap  being  taken  from  the  forehead,  with  a 
good  result  He  also  referred  to  one  that  was  made  by 
Maissonneuve,  where  the  flap  was  taken  from  the  fore- 
head. In  this  case  die  return  circulation  being  painful 
in  consequence  of  the  congestion  caused  in  the  flap',  and 
the  part  being  likewise  of  an  unnatural  reddened  hue, 
a  leech  was  applied  every  twenty-four  hours.  While 
the  leech  was  on  the  normal  hue  returned,  and  the  flap 
eventually  survived. 

Da.  Hamilton  referred  to  a  cut  of  a  case  of  his  pub- 
lished in  the  fourth  volume  of  the  Buflalo  Medical 
Journal,  which  represented  a  method  which  he  had  em- 
ployed of  transpkmting  skin  from  the  palm,  radial  mar- 
gin, and  back  of  the  hand,  to  restore  the  nose  of  a  man 
who  had  lost  much  of  his  nose,  and  was  otherwise 
badly  disfigured  by  a  bum  of  the  face.  In  that  instant, 
by  demand  of  the  patient,  the  flap  was  separated  at  the 
end  of  forty-eight  hours.  The  result  was  that  aboub 
three-quarters  of  the  flap  sloughed,  but  there  was,  how- 
ever, a  very  satis&ctorv  nose  left. 

Dr.  Sands  was  mucn  interested  in  the  description  of 
the  symptoms  of  the  case  of  death  by  chloroform,  be- 
cause he  thought  that  it  tended  to  confirm  the  growing 
impression  that  such  a  result  was  due  to  the  failure  of 
the  heart  rather  than  of  the  lungs.  He  then  related 
the  case  of  a  patient  of  Dr.  Da  Costa,  to  whom  he  ad- 
ministered a  second  time  chlorofonn,  for  some  mani- 
pulation about  the  elbow-joint    At  the  first  adminis- 


tration everything  went  oflf  well,  but  on  the  second 
occasion  the  pulse  began  to  grow  suddenly  feeble,  an^ 
finally  ceased  beating  altogether.  In  that  instance  he 
had  noticed  that  iJie  stonpage  of  the  pulse  preceded 
that  of  the  respiration.  Marahall  Hall's  method  was 
then  resorted  to,  and  the  patient  was  eventually,  with 
much  difficulty,  resuscitated.  He  had  witnessed  death 
in  two  cases  from  ether,  bolii  of  which  occurred  at  the 
N".  Y.  Hospital  In  the  fijrst  case  a  man  was  brought 
into  the  institution  having  accidentally  cut  his  throat 
while  engaged  in  pruning  trees.  The  right  carotid 
artery  was  wounded,  and  there  was  left  a  large  false 
aneurism.  The  consultation  decided  it  to  be  oest  to 
cut  down  through  the  swelling,  and  secure  the  ends  of 
the  wounded  vessel  During  the  administration  of  the 
ether  the  doctor  had  his  hands  upon  the  pulse.  It  ceased 
suddenly  before  the  respiration  did.  In  this  instance 
there  were  some  signs  of  life.  Subsequently  the  pa- 
tient breathed  a^ain,  and  the  pulse  bepin  to  beat^  eo 
that  the  operation  was  proceeded  with:  but  these 
favorable  symptoms  existed  for  only  half  a  minute 
when  the  pulse  ceased,  followed  by  an  arrest  of  the 
respiration.  In  the  other  case  the  patient  had  a  can- 
cerous tumor  of  the  antrmn,  for  which  an  operation  for 
removal  was  to  be  attempted.  The  ether  was  adminis- 
tered, but  the  first  incision  was  only  made  j  a  very  little 
blood  passed  down  the  throat,  and  the  patient  died 
instantly  by,  as  then  supposed,  syncope. 

Dr.  Post  remarked  that  a  similar  case  had  occurred 
at  Saint  Luke's  ^ospital  The  operation  was  for  the 
removal  of  a  tumor  of  the  neck,  and  death  occurred 
suddenly  while  the  patient  was  under  the  influence  of 
ether. 

Dr.  Notes  referred  to  a  similar  case  of  death  from 
ether,  in  which  galvanism  was  resorted  to  by  acuiiunc- 
ture  needles  passed  through  to  the  heart 

Dr.  Hamilton  stated  that  death  had  occurred,  at 
Bellevue,  in  two  eases  besides  his  own,  after  giving 
chloroform,  and  in  one  after  giving  ether.  In  the  latter 
instance  there  was  found,  after  death,  to  be  a  tumor  in 
the  cerebellum.  He  hsid  heard,  incidentally,  of  two 
others  in  this  city,  both  of  which  occurred  m  private 
practice,  one  in  the  practice  of  Dr.  O'Eeilly,  the  other 
m  the  practice  of  Dr.  Van  Buren. 

Dr.  tJuTTER  referred  to  a  case  that  had  occurred  to 
him.  One  part  of  chloroform  and  two  of  ether  were 
given  to  the  patient  by  a  cadet  in  the  Newark  Hospi- 
tal The  proposed  operation  was  one  for  re-amputation, 
and  shortly  ader  it  was  commenced  the  patient  ceased 
to  breathe.  Marshall  Hall's  method  was  resorted  to, 
and  respiration  was  re-established;  chloroform  was 
again  given,  when  the  patient  almost  immediately  died. 
Tne  anaesthetics,  were  given  in  a  paper  funnel,  and  the 
fisktal  result  was  probably  in  no  small  degree  due  to  the 
want  of  a  proper  supply  of  air. 

Dr.  Sands  referred  in  this  connexion  to  the  case 
reported  by  Dr.  Briddon  of  a  child  who,  while  under 
the  influence  of  chloroform,  vomited,  and  a  portion  of 
fried  Uver,  which  she  had  eaten  shortly  before,  lodged 
in  the  larynx,  causing  immediate  suflbcation. 

Dr.  Cutter  then  presented  a  specimen  of  diseased 
humerus,  which  he  nad  exsected.  The  history  of  the 
case  he  then  read  from  the  January  number  of  the 
American  Journal  of  Medical  Sciences^  for  1866. 

Dr.  Hamilton  desired  to  call  attention  to  one  or  two 
points.  In  the  first  place  the  case  was  not  one  of 
removal  of  the  entire  shaft  of  the  humerus  in  a  single 
operation;  an  important  portion,  namely,  the  upper 
one-fourth,  having  been  previoudy  exsected.  It  was 
in  reality  tnen  only  a  removal  of  the  lower  three-fourtha 
of  the  bone.  In  the  second  place,  he  thought  that  the 
operation  was  unnecessary,  and  he  frirthennore  thought 
digitized  by ^: „      ^_ 


THE  MEDICAL  RECORD. 


189 


ft  our  duty  to  make  it  so  understood,  that  it  might  not 
itind  as  a  precedent  for  others.  The  sequestram  was 
entirely  separated  from  the  inrolucrum,  and  could  have 
been  removed  without  removing  the  involucrum.  If 
this  had  been  done  the  patient  would  have  had  a  more 
Qsefol  Hmb  than  at  present,  as  the  involucrum  was  evi- 
dently strong  and  able  to  support  the  limb  tolerably 
wdL  And  again  the  joint  end  of  the  bone  was  not 
detd;  death  having  only  extended  to  the  central  por- 
tion of  the  shaH),  and  there  was  no  occasion,  therefore, 
for  removing  the  entire  joint.  -  He  was  of  the  opinion 
that  in  case  the  dead  bone  could  not  have  been  removed, 
the  next  best  thing  would  have  been  amputation.  It 
was  easy  then  to  infer  that  he  was  not  an  unquaHBed 
ftdrocate  for  resection.  Jn  foot  he  stated  that  he  be- 
lieved, with  that  distinguished  surgeon,  Dr.  March,  of 
Albany,  that  too  many  of  those  operations  had  been 
done  already.  He  doubted  whether  the  man  had  a 
useful  limb  after  all,  and  was  of  the  opinion  that  when 
the  novelty  of  the  apparatus  which  he  was  using  wore 
twav,  he  would  sak  to  have  the  arm  amputated. 
Without  the  apparatus  the  arm  was  useless.  The  appa- 
ratus would  require  constant  repair.  Furthermore,  the 
experience  of  the  "  left-armed  soldiers  "  who  had  been 
training  themselves  in  the  use  of  the  pen,  showed  that 
the  entire  loss  of  even  the  ri^ht  arm  might  in  a  great 
measure  be  supplied.  The  time  had  not  yet  arrived 
for  a  &ir  verdict  upon  those  operations. 

Dr.  Gutter  remarked  that  the  case  was  not  reported 
m  removal  of  the  entire  humerus  in  one  operation,  as 
the  first  operation  of  removal  of  the  head  and  upper 
part  of  the  shaft  was  credited  to  another  surgeon.  The 
wopriety  of  the  operation  was  urged  upon  the  ground 
uiat  there  were  numerous  openings  all  around  the  arm 
leading  to  dead  bone,  that  the  necrotic  tissue  was 
everywhere  felt^  that  the  patient's  health  was  suffering 
hi  consequence,  and  furthermore  it  was  impossible  to 
dii^osticate  precisely  the  relation  of  the  dead  to  the 
living.  He  further  said  that  the  condition  of  the  soft 
tissues  around  the  joint  was  such  as  to  lead  him  to 
8Q^>ect  irreparable  disease  of  that  pari  He  did  not 
think  that  the  involucrum  would  ever  have  become  suf- 
ficiently strong  to  have  made  a  good  arm.  The  patient 
fcemed  perfectiy  satisfied  with  tne  result  of  the  opera- 
tion, ana  would  not  part  with  what  arm  was  left  him 
for  any  consideration. 

Dr.  Potrr  stated  that  he  had  seen  the  patient,  and 
was  satisfied  that  the  operation  was,  under  the  circum- 
stances, an  eminently  proper  one. 

MEDICAL  SOCIETY  OF  THE  COUNTY  OF 
NEW  YORK. 
Stated  Mectino,  April  1,  1867. 
Dr.  Samuel  T.  Hubbard,  President,  in  the  Chair. 

OBOLIRA  ABD  C0VG18TIVB  FEVER — THEIR  ANALOGIES. 
(Ooadiraed  from  page  114) 
Dr.  Edmund  Fowlbr  next  read  a  paper  upon  "  Cholera 
and  Congestive  Fever,  their  leading  Characteristics, 
Relations,  and  Analogies."  Having  premised  that  he 
Itad  not  aystematized  the  subject,  but  should  speak  dis- 
coniyely,  and  after  an  argument  to  prove  that  the  pre- 
monitory diarrhoea  should  be  considered  properly  a  stage 
c^diolera,  Dr.  F.  stated  the  characteristics  or  this  disease 
to  be,  "  Initiative  diarrhoea,  violent  purging,  vomiting, 
cramps,  prtecordial  oppressioiL  restlessness;  a  quick, 
rapid,  thready,  distinctive  pulse ;  cold  surface ;  cold, 
pfoftise  perspiration ;  wrinkled,  sodden  state  of  the  drin 
On  the  extremities ;  intense  thirst;  a  sense  of  burning 
bftat  in  the  epigastric  region,  and  in  the  bowels;  a  rapid 


sinking  of  the  powers  of  life,  collapse,  and  death,  or  re^ 
action  and  consecutive  fever.  In  the  algid  form  of  con- 
gestive fever,  in  the  abdominal  species,  we  have  vomit- 
ing; serous  purging,  which  is  at  times  flocculent;  pr®- 
cordial  oppression,  great  resUessnees,  intense  thirst,  a 
burning  heat  in  tne  epigastric  region  and  bowels,  cold 
skin;  often  cold,  profuse  perspiration;  Ik  small,  quick, 
thready  pulse;  blueness  of  the  lips,  collapse,  and  death ; 
or  reaction,  and  not  unfrequently  consecutive  fever, 
though  this  more  often  attends  remittent  disease.  This 
outline  presents  not  essentially  dissimilar  characteristics." 
The  two  diseases  have  many^  lesions  of  function,  of 
tissue,  of  blood,  analogous,  if  not  identical.  Again, 
they  are  alike  in  what  may  be  called  the  lesions  of  ex- 
pression, which,  although  they  furnish  no  facts  for  the 
dissecting-knife,  are  as  much  a  part  of  the  history  of 
disease  as  changes  in  the  tissue.  The  language  whidi 
addresses  us  from  the  rapid  grouping  of  all  the  features 
of  a  case,  though  hard  to  translate  in  scientific  terms, 
is  often  unmisUikable  in  its  indications,  and  may  deter- 
mine our  happiest  deciffions. 

In  cholera,  all  observation  tends  to  show  that  early  and 
important  changes  occur  in  the  blood,  that  its  lesions 
precede  and  accompany  the  profound  changes  in  the 
mucous,  serous,  and  glandular  tissues.  Both  its  own 
condition  and  its  relations  to  the  system  through  the 
circulation  are  rendered  abnormal.  It  becomes  thick, 
ropy,  and  adhesive,  and  it  stagnates  in  the  oapillarieB 
and  veins,  the  arteries  being  left  nearly  empty.  In 
congestive  fever  one  of  the  fiiit  things  to  be  obi^rved  in 
the  blood  is  its  thickened  condition.  It  is  sometimes 
oily,  and  gathered  into  large,  well-formed  globules ;  at 
other  times  it  is  adhesive,  and  cannot  be  made  to  escape 
from  the  vessel  In  extreme  oases  of  congestion,  prov- 
ing fatal  in  from  ten  to  eighteen  hours,  it  is  perfectly  gela^ 
ti^ized  in  the  veins.  In  these  casea^  if  a  vein  be  liud 
open  to  the  extent  of  twelve  or  eighteen  lines,  so  as 
completely  to  expose  the  blood,  this  will  be  found  of  the 
consistence  of  partially  coagulated  albumen,  dry,  adhe- 
sive, and  retaining  its  cylindrical  form  after  being  care- 
fully removed  from  the  vein.  I  speak  now  of  what  I 
have  witnessed  while  yet  the  patient  was  able  to  walk 
from  his  bath  to  the  bed,  where  he  expired  within  ten 
minutes  after  I  had  exposed  the  blood  to  view.  The 
congestion  in  this  case  was  in  the  chest  and  abdomen, 
the  intellect  remaining  clear  and  undisturbed.  This 
patient  was  a  child  of  eight  years,  who  had  been  stricken 
down  with  a  malignant  chiU  two  hours  before.  There 
was  no  vomiting,  purging,  or  excessive  perspiration. 
The  case  was  not  unlike  many  described  by  Mr.  Orton, 
in  the  second  visitation  of  the  cholera  in  India,  in  1818, 
in  which  vomiting,  purging,  and  spasm  were  in  a  great 
measure  absent  A  clu^racteristic  phenomenon  of  con- 
gestive fever  is  that  the  limbs  in  some  instances,  the 
body,  neck,  and  fiice,  very  generally,  are  more  plump 
than  in  health.  In  these  cases  the  congestion  is  very 
profound,  and  attended  with  slight,  if  any,  serous  dish 
charges  ttom  the  bowels.  The  explanation  is  probably 
that  the  blood-plasma,  exosmosed  into  the  subcutaneous 
cellular  tissue,  oecomes  there  partiidly  coagulated  by  a 

£e  change  with  that  seen  in  tne  veins,  and  so  remains 
ed.  It  is  noteworthy  that  the  spissitude  of  the  blood, 
so  apparently  similar  in  tiie  two  diseases  under  consi- 
deration, and  rarely,  if  ever,  found  in  any  others,  should 
be  followed  b  v  such  opposmg  dispositions  of  the  blood- 

Elasma.  In  those  cases  of  congestive  fever,  where  we 
ave  abundant  serous  discharges,  followed  by  sodden, 
wrinkled  skin  on  the  hands  and  feet,  its  parallelism  with 
cholera  icL  of  course,  more  evident. 

The  history  of  congestive  fever  was  next  discussed, 
especially  as  it  had  appeared  in  the  valley  of  the  Missis- 
sippi, and   on   the   borders  of  the  Gulf  of   Mexico 


140 


THE  MEDICAL  RECORD. 


where  it  wae  bo  prevalent  and  so  fatal.  The  ooncksion 
.was  reached  that  prior  to  the  year  1834,  true  conges- 
Jive  iever  was  unknown  there.  Not  that  it  was 
.unusual  to  find  congestion  complicating  fevers  and 
inoreasing  their  danger;  but  that  the  congestion  which 
gave  distinctive  character  to  the  fever  which  first  startled 
the  people  of  that  region  in  1834,  culminating  in  1843, 
was  attended  with  phenomena  so  exceptional  as  to  de- 
mand a  new  name.  Watchful  of  the  influence  of  epi- 
demic cholera  in  modifying  disease,  even  in  sections 
where  no  cases  of  the  epidemic  had  occurred,  physicians 
oould  not  but  remark  the  resemblance  between  the 
known  symptoms  of  that  disease  and  those  of  the  new 
type  of  fever.  Though  the  assembla^  of  symptoms 
cmaraoterizing  congestive  intermittent^is  no  less  marked 
than  that  of  cholera^  its  graphic  desonption  is  less  easy, 
because  of  the  varying  seat  of  the  congestion.  But  m 
^11  cases,  we  observe  that  peculiar  expression  seen  only, 
Dr.F.  believed,  where  the  blood  parts  with  its  plasma, 
and  its  remaining  elements  take  on  the  changes  that 
occur  only  in  these  two  diseases.  An  important  di£fe- 
rential  fistct  between  simple  congestion  and  a^pd  con- 
gestion is  to  be  seen  in  the  effect  of  venesection.  Li 
the  former,  blood  will  flow  quite  freely  from  the  opened 
vein,  and  if  sufficient  be  drawn,  the  pulse  at  the  wrist 
will  become  fuller,  softer,  and  less  frequent^  while  the 
patient  experiences  a  feeling  of  relief.  In  the  latter, 
even  a  small  abstraction  of  bk>od  is  immediately  follow- 
ed by  increased  restlessness,  intenser  thirst,  a  sense  of 
impending  death,  increased  cyanosis  of  the  skin,  and  a 
more  rapid,  thready  pulse,  lu  the  first  case,  the  tempe- 
rature of  the  surface  is  increased  by  venesection;  in 
the  second,  it  is  diminished.  Practically,  and  as  a  basis 
of  dassifloation,  these  conditions  are  as  important  as  the 
lesions  shown  at  po9t-mortem.  Again,  many  cases  of 
congestive  intermittent  present  no  chilly  sensation. 
The  patient  is  dulL  disposed  to  sleep,  complains  cf  k 
feeling  of  "  tired  aching,"  but  is  not  conscious  of  a  chill. 
!rhe  skin  is  cool,  while  he  says  he  is  burning  up  inside. 
Then,  in  the  best  defined  cases,  though  emesis  is  almost 
constant,  no  b'de  is  vomited,  but  a  lai^  amount  of 
muco-serous  fluid.  Another  matter  of  great  moment, 
which  i^pears  to  have  been  overlooked  by  writers,  is 
the  profound  change  in  the  nutrition  of  the  system,  fol- 
lowmg  even  a  single  malignant  paroxysm.  The  system 
becomes  cachectic;  the  skin  is  pale  and  chalky,  and  the 
&ce  wears  a  look  of  despair.  After  a  severe  case,  con- 
tinued far  into  the  inflammatory  stage,  not  less  than 
three  years  will  be  required  to  restore  the  normal  tone 
of  the  system.  Even  the  .traces  left  by  cholera  may  be 
effaced  more  easily.  Both  cholera  and  congestive 
fever  appear  to  have  been  most  fatal,  and  to  have  re- 
sembled each  other  most  closely,  in  cretaceous  dis- 
trict<». 

When  the  miasm  of  yellow  fever  swept  over  the 
Gulf  States  in  1853,  a  new  impression  was  given  to 
the  febrile  diseases  of  that  region.  Now  congestive 
ohiUs  are  rarely  seen  there,  and  since  the  above  date 
these  States,  except  on  the  coast,  have  shown  no  signs 
of  choleraic  influence.  As  an  illustration  of  the  momd- 
ing  power  of  epidemics,  it  has  been  noted  on  two  or 
three  separate  occasions,  in  New  Orleans,  that'whwn 
cdiolera  and  yellow  fever  have  prevailed  together,  cases 
of  the  former  have  shown  the  genuine  black  vomit 
in  the  stomach  at  post-moriemf  while  tiie  cadaver  of 
yellow  fever  has  exhibited  the  muscular  contractions 
diaracteristic  of  cholera. 

Reviewing  the  strong  analogies  between  cholera 
and  cong^tive  fever,  andremembering  that  it  originated 
in  a  locality  reeking  with  miasma,  may  we  not  deem 
cholera  a-fever  also  7  a  fever  of  a  single  paroxysm,  with 
phenomena  as  well  marked  as  those  of  the  other  affec- 


tions classified  under  this  head  ?  Some  of  the  best 
minds  in  the  profession  are  of  this  opinion. 

The  essay  concluded  somewhat  abruptly,  Dr.  F. 
stating  that  time  failed  him  to  speak,  as  was  his  purpose, 
of  the  analogous  states  of  the  capillary  circulation  in  the 
two  diseases.  He  wished  to  acknowledge  bis  indebted- 
ness to  Dr.  Drake  for  many  &ots  and  suggestions. 

The  paper  was  accepted,  but  the  lateness  of  the  hour 
preduaea  any  discussion  upon  it. 

Db.  Downs  presented  a  specimen  of  a  foetus  expelled, 
with  the  membranes  intact,  after  a  considerable  amount 
of  hemorrhage  consequent  upon  a  M.  Dr.  Feaslee 
and  others  were  of  opinion  tnat  the  case  was  one  of 
plaoenta  pnevia. 

Adjourned. 

EAST  RIVER  MEDICAL  ASSOCIATION, 

Stated  Mketino,  April  2,  1867. 

Db.  Y.  Mobsb,  President^  in  the  Chair. 

SPASM  OF   THX  GLOTTIS. 

Db.  Newman  read  a  paper  on  the  above  subject  He 
claimed  that  this  disease  generally  attacks  children  from 
the  fourth  to  the  twelfUi  month.  Before  this  the  health 
of  the  infant  may  be  perfect,  unless  we  except  a  cerUun 
catching  of  the  breath  when  crjring.  for  which  passion 
gets  the  credit.  After  awhile  the  child  becomes  uneasy 
and  restless,  the  head  hot,  the  respiration  difficult,  which 
symptom  may  terminate  in  asphyxia.  The  disease 
mos&y  occurs  during  the  night,  bein^  only  occasionally 
preceded  by  a  slight  cough.  The  in&nt,  after  deeping 
quietly  for  some  hours,  suddenly  awakes  in  great  terror, 
utters  a  piercing  shriek,  immediately  followed  by  suffo- 
cation ;  sometimes,  and  indeed  most  usually,  sufirocation 
commences,  and  the  shriek  is  onlv  heard  when  respira- 
tion is  re-established.  This  shriek  bears  some  resem- 
blance to  that  which  accompanies  croup  or  hooping- 
cough,  but  w  more  acute  and  pie%5ing.  It  has  a  tone  of 
its  own,  easily  recognised  when  once  heard.  The  sur- 
face is  either  of  a  bluish-red  or  quite  discolored :  the 
eyes  are  prbminent  and  fixed,  the  nostrils  extendea,  the 
limbs  contracted  and  cold ;  the  pulse,  small,  hard,  and 
frequent :  there  are  sometimes  violent  convulsions  pre- 
sent, witn  relaxed  sphincters.  Should  this  condition  con- 
tinue beyond  two  minutes,  death  is  likely  to  end  suffer- 
ing by  asphyxia  or  apoplexy.  On  the  oUier  hand,  after 
the  respiration  is  restored,  convulsions,  strabismus,  and 
stiflfhess  of  the  limbs  still  continue.  Sometimes  all  the 
symptoms  disappear  immediately,  leaving  the  child  pale 
and  fatigued,  but  breathing  freely,  and  soon  falling  into 
a  gentle,  refreshing  slunaber.  At  other  times,  and 
mostly  when  the  attack  is  preceded  by  a  cough,  the 
young  patient  is  again  eeized  with  a  convulsive  cough, 
Uke  t^at  of  women  in  violent  hysterical  fits. 

However,  then,  the  fit  may  terminate,  the  child  is 
soon  restored  to  health,  but  not  to  immimity  from  new 
and  gnduaUy  more  frequent  attacks.  At  first  these  only 
occur  in  the  night  and  without  any  i^parent  cause,  but 
before  lon^  they  encroach  upon  the  day,  being  induced 
by  screammg,  passion,  laughing,  running,  or  eating ;  in 
fict,  there  may  be  twenty  attacks  in  twenty-four  hours. 
In  some  fortunate  cases,  flie  fits  are  at  a  greater  distance, 
they  lose  tlieir  intensity  gradually,  and  disappear  after 
lasting  several  months,  or  sometimes  years ;  yet  there 
always  remains  a  predisposition  to  fatal  relapse. 

Spasm  of  the  Glottis  may  occur,  and  has  been  ob- 
served in  children  with  the  best  constitution  and  in  ftdl 
health ;  but  it  is  mostly  common  among  weak,  scrofu- 
lous, and  rickety  children,  dentition,  gastro-muco  intesti- 
nal irritation,  greatly  contributing  to  the  production  of 
the  disease.  ><^  t 

Digitized  by  VjOOQIC 


THE  MEDICAL^  RBOOKD. 


Ul 


Among  the  special  caases  ma^  be  enumerated : 
]it  Inflammation  of  the  brain  and  its  membranes. 
2d.  Alteration  of  the  lymphatic  ganglia  of  the  neck. 
3d.  Hypertrophy  of  the  thymus  gland. 
4th.  Inflammation  of  the  cervical  portion  of  the  me- 
dnBa. 
At  the  commencement  of  meningitis  children  fre- 

aaently  have  couYulsions  j  when  they  scream  or  cough, 
iiey  suddenly  turn  blue,  the  limbs  become  stifle,  the 
body  and  head  are  thrown  backwards,  respiration  is 
suspended^  and  when  restored  its  return  is  ushered  in 
bj  a  jnercmg  shriek ;  these  symptoms  increase  in  fre- 
quency and  violence  with  the  encephalic  affection. 

Case  h-^December  28, 1866.— Was  called  during  the 
Qight  to  see  a  child  six  months  old,  whom  he  found  in  a 
comatose  state :  the  occiput  was  burning,  the  fbce  p^e. 
the  ddn  hot  and  dry.  puke  normal ;  the  pupils  exhibited 
no  peculiar  abnormality,  the  tongue  white,  urine  scanty, 
the  respiration  free,  the  head  thrown  back.  Its  screams 
led  him  at  first  to  suppose  the  child  was  suffering  firom 
colic,  but  the  abdomen  was  soib  and  free  from  pain. 
When  iorced  to  swallow,  the  stomach  would  immediate- 
ly reject  its  contents.  The  child  had  had  several  con- 
TulsioDs  during  the  day  *  but  up  to  this  period  had  en- 
joyed the  best  of  health.  The  parents  were  healthy 
and  robust.  His  diagnosis  was  encephalic  inflammation. 
Ordered  calome  Ipurges,  leeches,  cold  to  the  head,  hot 
fi)ot-baths,  and  fnctions  of  croton  oil  to  the  nape  of  the 

Dtoemher  29. — ^The  calomel  had  operated  fireely,  but 
without  improving  the  condition ;  ordered  more  leeches, 
with  iodide  of  potass. 

Ikoember  30. — ^Violent  convulsions!,  respiration  sus- 
pended, the  &Ge  blue,  the  head  thrown  violently  back- 
wards ;  had  lost  all  hopes,  when  a  violent  shriek  termi- 
nated the  spasm,  and  in  a  few  minutes  the  child  fell  into 
a  quiet  sleep.  Kepeated  the  calomel  and  iodide  with 
the  addition  of  one-sixteenth  of  a  grain  of  the  extract 
of  beHadomuk 

December  31. — Convulsions  intense,  but  during  inter- 
nla  the  child  appeared  more  con^sed ;  the  fits  of  suf- 
ibeation  came  on  several  times  during  the  day  and  nig^t 

January  1,  1867. — Convulsions  less  fi^uent,  and  not 
80  violent ;  had  but  two  attacks  of  suffocation,  takes  the 
breast  readily,  skin  moist^  pulse  sofL  bowels  free.  Con- 
tinned  die  ioaide  of  potass  and  belladonna. 

JrniMary  2.--Convulsions  neariy  ceased,  and  only  one 
fit  of  stiffocation  came  on  during  the  twenty-four  hours. 

JeumaryZ, — ^AU  the  symptoms  have  disappeared;  the 
same  treatment  continued  until  the  9th,  when  he  ordered 
oodrHver  oiL  and  the  child  slowly  returned  to  usual 
beahh. 

The  symptoms  in  this  case  were,  in  his  opinion,  due 
to  Spasm  ot  the  Glottis,  caused  by  encephalic  infliamma- 
tkm. 

Inflammation  of  the  cervical  portion  of  the  medulla 
mw  give  rise  to  spasm  of  the  glottis. 

The  late  Dr.  John  Corrigan,  of  Dublin,  among  others, 
niates  the  fcdlowing  case: 

Otfi  2. — ^A  child  fo6r  months  old,  who  had  always 
been  in  good  health,  suddenly  became  uneasy  and  cross ; 
he  often  cried,  and  during  the  night  shrieked  without 
uy  ^[>parent  cause.  At  the  end  of  a  week  a  fit  of  suf- 
WiSaxm  came  on,  which  lasted  half  a  second;  the  ohild 
turned  blue,  and  seemed  dying,  when  after  an  acute 
ahiiek  the  respiration  was  restored.  These  fits  came  on 
frequently,  and  lasted  from  six  to  eight  seconds.  At 
the  expiration  of  ti^  ,weekB  new  symptoms  appeared, 
the  bands  were  convulsed,  the  thumbs  bent  mto  the 
pdma  of  the  hand,  while  the  fingers  were  flexed  the  oon- 
tnry  way ;  convulsions  oame  on  once  a  week,  then 
ererj  day,  then  twice  in  the  twenty-four  hours.  *^  Three 


months  passed  thus,  the  disease  made  rapid  strides,  and 
all  the  remedies  employed  produced  no  satisfactory  re- 
sults; calomel,  emetics,  and  antispasmodics,  had  been 
tried  and  abandoned.  At  this  period  it  was  remarked,, 
by  chance,  that  the  child  scarcely  moved  its  lower  limbs, 
and  this  fact  led  to  an  examination  of  the  spinal  column, 
when  upon  reaching  the  third  and  fourth  cervical  verte-' 
bra,  the  patient  uttered  a  piercing  shriek.  Four  leeches 
were  immediately  applied ;  a  few  hours  afterwards  a' 
fit  of  suffocation  came  on,  but  of  short  duration.  Two 
days  after  the  leeches  were  re-applied,  and  produced  a 
miraculous  effect.    All  the  symptoms  disappeared. 

Cerebral  affections  are  often  found  to  produce  epilepsy, 
and  physiology  shows  the  influence  of  the  medulla  on 
the  respiratory  apparatus;  and  inflammation  of  the 
spinal  cord  may  be  easily  induced  in  children  by  ex- 
ternal violence,  owing  to  the  want  of  thickness  of  the 
soft  parts  in  early  age. 

Alteration  of  the  lymphatic  ganglia  of  the  neck  and 
chest,  often  produces  crowing  inspirations;  the  diild 
feels  suffocated,  respiration  is  arrested,  and  only  re-es- 
tablished when  a  piercing  shriek  is  heard,  evidently 
resulting  fi:om  a  contraction  of  the  glottis.  It  most  fre- 
quently occurs  at  night;  is  violent ;  the  head  and  trunk 
are  thrown  backwards,  and  the  face  is  pale  and  con- 
vulsed, the  eyes  fixed  and  turned,  and  tiie  limbs  con- 
tracted.   Scrofulous  children  are  usually  the  victims. 

"  Hypertrophy  of  the  thymus"  is  the  fourth  cause 
which  determines  the  spasm  of  the  glottis ;  but  our 
ignorance  as  to  the  uses,  mode  of  development,  and  dis- 
appearance of  the  gland,  has  led  to  many  doubtfy 
pomta  "  Is  hypertrophy  of  the  thymus  congenita],  or 
IS  it  always  Acquired  ?  "  "  Which  are  the  physiological 
connexions  inviting  this  alteration  to  lesions  of  l^e 
hearty  by  which  it  is  so  often  accompanied  dilatation  of 
the  right  cavities,  and  hypertrophy  of  the  lefx  ventricle  ?  " 
^nSese  queries  he  is  unable  to  answer.  It  is  certainly 
evident  that  hypertrophy  of  the  *'  thymus,"  Hke  that  of 
the  Ivmphatic  ganglia,  produces  '*  spasm  of  the  glot- 
tis," by  exercising  pressure  on  the  nmth  pair  of  nerves. 
On  a  post-mortem  examination  it  is  found  that  the 
"  thymus "  is  principally  developed  in  the  upper  part, 
fi^uently  extending  to  the  jugular  veins.  It  is  easy, 
then,  to  understand,  that  the  obstacle  thrown  in  tne 
way  of  the  venous  circulation  of  the  head^  will  cause 
"meningitis;"  and  pressure  upon  the  nmth  pair  of 
nerves,  will  cause  "  spasm  of  the  glotti.s." 

Casb  3. — The  following  case  came  under  his  observa- 
tion in  November,  1858.  A  diild  nine  months  of  age, 
born  of  healthy  parents,  lively  and  cheerful,  took  the 
breast  with  avidity,  seldom  cried ;  it  was  remarked  by  the 
parents  how  different  he  was  from  all  the  other  children, 
for  they  had  been  as  cross  and  ugly  as  this  one  was 
good-natured.  The  night  before  seen  by  him,  after 
sleeping  quietly  for  some  four  or  five  hours,  the  child 
awoke  suddenly  with  all  the  symptoms  of  "  spasm  of 
the  glottis."  The  attack  only  lasted  a  few  seconds,  when 
the  little  patient  fell  asleep.  The  next  day  the  child 
appeared  as  well  as  usual  The  ensuing  night  there 
was  another  attack ;  and  from  that  time  the  fits  came 
on  regularly  every  night.  Very  soon  they  made  their 
ofppearanoe  during  the  day;  were  longer  and  more 
violent ;  crying,  laughing,  or  eating,  would  give  rise  to 
them. 

Novwnher  24t^— The  child  had  a  decided  attack  in  the 
nighty  followed  by  convulsions,  which  continued  for 
alwut  twenty  mmutea,  the  carotids  throbbing  violently, 
the  head  and  occiput  unusually  warm,  pupils  contracted, 
bowels  constipated.  Ordered  leeches  on  the  sub-sternal 
fossa,  ioe  on  the  head,  calomel,  and  iodide  potass  witfi 
belladonna. 

November  25i^.— Convulsions  violent,  ^ajbowels  had 

digitized  by  VjC  -^      ^  _ 


142 


THE  HEDICAL  BECOKD. 


moved  freely,  the  skin  very  hot  and  dry,  had  had  several 
attacks  of  suffocation. 

Novemher  26iA. — ^The  cheeks  are  red,  the  eyes  promi- 
nent; the  child,  after  vomiting,  fell  into  a  comatose 
i^te.  Ordered  leeches  behind  me  ears,  croton  oil  to  the 
nape  of  the  neck,  sinapisms  to  the  feet  and  legs. 

Novemher  27ih. — Passed  a  bad  night ;  the  convulsions 
and  fits  of  suffocation  continued  almost  without  inter- 
ruption, the  hands  clenched,  the  pulse  filiform. 

The  loUowing  day  the  child  died,  during  an  attack  of 
suffocation. 

Post-mortem  examinaiion^  twenty-four  hours  after 
death,  revealed  the  following:  ^e  thymus  gland, 
which  nearly  covered  all  the  anterior  part  of  the  chest, 
extending  from  the  larynx  to  the  diaphragm,  and  from 
one  costal  edge  to  the  other.  The  lungs  and  pericar- 
dium were  entirely  concealed  b^  the  enormous  mass 
which  compressed  the  jugular  vems  at  their  origin ;  the 
mass  weiehed  thirteen  drachms  and  forty-two  grains. 
The  juguW  veins  were  dilated,  and,  with  all  the  veins 
of  the  neck,  contained  a  large  quantity  of  thick  black 
blood.  The  lungs,  though  slightly  developed,  were 
healthy ;  t^e  right  cavities  of  the  heart  pale  and  soft : 
the  left  ventricle  thicker  than  usual ;  the  head  well 
formed.  The  lateral  ventricles  contained  about  an 
ounce  of  bloody  serum ;  the  choroid  plexus  strongly 
injected ;  all  the  other  organs  normal 

EvidenUy,  in  this  case,  "  hypertrophy  of  the  thymus" 
was  tiie  primary  affection,  first  producing  the  fits  of  suf- 
focation, and  later  acute  hydrocephalus,  of  which  the 
convulsions  were  merely  a  symptom. 

The  differential  diagnosis  of  "  spasm  of  th^  glottis  '*  is 
generally  easily  established : 

1st.  From  hooping-cough,  by  the  sudden  i^pearanoe 
of  the  symptoms  during  tne  night,  the  comjplete  su$- 
pension.  and  absence,  of  respiration  and  vomiting. 

2d.  From  cro^^  by  the  nature  of  the  shrie^  and 
the  normal  return  of  the  voice,  and  respiration. 
•  3d.  From  suffoocxtUm,  which  sometimes  suoceeds  pro- 
longed cries,  or  passion ;  by  the  normal  state  of  the 
pul&e,  the  absence  of  cold  limbs,  fiunting,  and  the  patho- 
grnomonic  (?)  scream. 

4th.  From  cyanosU,  bv  being  preceded  by  uneasiness, 
tears,  groans,  blue  lips,  less  marked  suffocation,  and  by 
the  absence  of  any  shriek, 

A  few  words  on  the  aetiology  as  bearing  on  the  diag- 
nosLs.  must  suffice. 

When  "  spasm  of  the  glottis  "  is  produced  by  inflam- 
mation of  tne  brain  or  its  membranes,  or  by  chronic 
hydrocephalus,  the  cerebral  symptoms  necessarily  first 
appear,  and  the  fits  of  suffocation  take  place  only  when 
they  have  attained  a  certain  degree  of  intensity ;  and 
the  suffocation  follows  the  same  course  as  the  encepha- 
lic idSection,  increasing  or  diminishing  with  it 

When  '*  spasm  of  the  glottis  "  is  connected  with  in- 
flammation of  the  medulla,  there  is  generally  some  por- 
tion of  the  cervical  region  painfiil  on  pressure ;  suffo- 
cation is  sometimes  preceded  by  pain  on  the  same  part, 
and  convulsions  only  take  place  in  '*  tJie  thoracic  limhsy** 
if  produced  ''by  a /aJL'' 

**  Spasm  of  the  glottis,"  resulting  from  hypertrophy 
of  the  "  ganglia,*'  is  met  with  in  ^ildren  of  a  scrofii- 
lous  constitution,  seldom  before  the  first  year,  yet  some- 
times much  later.  It  is  frequently  accompanied  widi 
Cough  and  gastric  derangement,  and  preceded  by  con- 
tinual dyspnoea ;  and  by  forcing  the  otiild*s  head  back- 
wards, the  hypertrophied  cervical  ganglia  may  afanoet 
always  be  felt 

Difficult  as  it  is  to  recognise  hy|)ertrophy  of  the  "  thy- 
mus," the  following  symptoms  will  generally  furnish  a 
due  to  a  correct  diagnosis :    These  are  dyspnoea,  most 


severe  when  lyin^  on  the  back;  a  dulness  over  Ae 
region  of  the  thymic  gland;  the  tongue  hanging  out  of 
the  mouth,  even  during  sleep.  Kopp^  Orc^,  and  Kom- 
fRau2,  aver  that  these  signs  have  nev^  been  observed 
except  in  cases  where  "  roasm  of  theglottis  was  induced 
by  hypertrophy  of  the  thymus."  When  the  disease  is 
complicated  by  acute  hydrocephalus,  the  fit  of  suffoca- 
tion precedes  the  cerebral  symptom. 

The  prognosis  is  always  serious,  as  one  single  attack 
of  suffocation  may  terminate  fatally.  The  modifying 
influences  are  age,  diathesis,  probable  cause,  etc 

The  treatment  of  "  spasm  of  the  glottis**  presents  two 
distinct  indications  To  arrest  by  the  use  of  the  most 
efficacious  remedies  the  attack  of  suffooadon :  to  com- 
bat the  cause  which  may  induce  a  return. 

The  resources  in  the  first  case  are  very  few.  The 
voung  patient  must  not  be  allowed  to  lie  on  his  back; 
be  must  be  carefoUy  protected  against  cold  and  damp, 
and  required  to  take  moderate  and  regular  exercise. 
Should  he  be  strong  and  plethoric,  moderation  without 
weakening  the  vigorous  constitution  should  be  the 
rule;  but  i^  on  the  contrary,  he  should  be  weak  and 
anannic,  cod-liver  oil,  iron,  etc.,  are  indicated.  Respira- 
tion bemg  reestablished,  every  jn^caution  must  be 
taken  to  avoid  all  causes  that  may  give  rise  to  another 
attack,  thus :  All  sensations  that  may  either  induce  im* 
moderate  joy  or  grief;  violent  running;  the  diet  should 
be  light,  and  of  such  a  character  as  may  be  swallowed 
with  htUe  effort  Little  of  course  is  to  be  expected 
from  any  attempt  to  act  directly  on  the  thjrmus  gland, 
although  preparations  of  copper,  small  doses  of  calomel, 
ipecac,  iodide  potash,  tartrate  and  citrate  of  iron,  etc^ 
togeth^  with  the  external  use  of  iodine  or  croton  oil 
seem  to  favor  its  decrease.  A  blister  on  the  chest  will 
often  prove  benefidal. 

After  discussing  the  anatomy  and  physiology  of  the 
larynx.  Dr.  N.  conduded  that  among  predisposing 
causes  may  be  reckoned : 

1st,  The  peculiarity  of  distribution  of  the  laryngeal 
nerves: 

2d.  The  high  degree  of  latent  irritability  that  must 
exist  around  the  sphincters  of  the  air  tube,  owing  to 
their  nervous  connexion : 

3d.  The  contractors  of  the  larynx,  being  more  nu- 
merous, and  more  highly  endowed  with  invohmtary 
nervous  energy  than  &e  dilators,  indicated  a  desire  to 
avoid  coniplication  in  the  mechanism  of  our  being,  by 
avoiding  all  unnecessary  expenditure  of  muscular  exer- 
tion in  the  performance  of  any  given  act  Now  the 
larynx,  in  its  quiescent  state,  is  expanded,  or  rather 
dilated,  such  a  state  only  being  compatible  with  exist* 
ence.  Then  the  reason  is  very  evident,  why  audi  a 
state  should  not  require  muscular  exertion  to  maintain 
it  so  continually;  for  we  know  that  the  dilation  of  the 
glottis,  even  alter  the  act  of  deglutition,  depends  more 
upon  the  elastic  and  erectile  properties  of  the  tissues 
adjoining  this  orifice,  than  upon  mere  muscular  exer- 
tion. But  the  contraction  of  the  larynx  depends  alto- 
^ther  on  another  source  for  its  due  performance.  Here 
It  is  that  tiie  muscular  exertion  is  brought  into  proper 
I^ay,  and  here  it  is  most  required.  If  we  swallow  a 
portion  of  food,  the  lar^x  is  nermetically  sealed  while 
the  extraneous  body  is  passing  over  it,  and  this  Is 
done  by  muscular  exertion  only ;  but  the  moment  the 
alimentary  bolus  has  passed  into  the  oesophagus,  the 
exciting  cause  being  removed,  the  larynx  immediatdy 
resumes  its  natural  position,  hot  by  muscular  exertioD, 
but  by  its  own  elasticity,  the  antagonizing  power  of 
the  constrictors  of  the  larynx  having  given  way.  We 
know  that  this  muscular  arrangement  is  indispensably 
necessary,  as  without  it  life  wcnild  cease.  It  is  abso- 
lutely necessary  that  there  should  be  some  guarding 

Digitized  by  VjOOQ  IC 


THE  MEDICAL  fiECORD. 


148 


and  ooDtrolIing  power  oyer  the  orifices  of  this  organ, 
that  they  may  be  dosed  against  the  slightest  particle  of 
offending  matter  presenting  itself  in  their  vicinity :  and 
Low  beantifuny  1^  nature  provided  against  such  in- 
tnisona 

But  if,  in  adult  life,  the  larynx  and  its  muscles  are  so 
highly  endowed  with  sensibility,  how  much  more  so 
must  they  be  in  the  infantile  state,  when  the  nervous 

rem  alone  has  the  ascendency,  ruling  supreme  over 
entire  system ;  morbidly  alive  to  every  impression, 
and  governing  the  functions  of  the  entire  economy  by 
its  influence.  We  all  know  the  wonderful  changes 
which  the  larynx  undergoes,  from  the  period  of  infancy 
to  that  of  puljerty ;  the  siteration  in  the  calibre,  and  in 
the  chordie  vocales.  We  are  also  aware  that  the  young 
system,  in  progressing  towards  jjuberty,  gradually  loses 
that  inordinate  sensibility  and  irritability  it  possessed  in 
ia&ncy,  and  with  it  the  larynx  becomes  less  excitable, 
and  more  under  the  control  of  volition ;  hence  it  is  that 
we  seldom  or  never  find  laryngeal  asthma  attacking 
aduHa. 

From  the  recorded  history  of  this  disease,  from  its 
near  alliance  to  infantile  convulsions,  and  from  our  own 
experience,  we  are  led  to  the  following  conclusions : 

Ist.  That  laryngeal  asthma,  or  the  spasm  of  the 
^ttis,  is  a  disease  peculiar  to  infancy,  by  which  we 
mean  any  period  within  twelve  months  firom  birth. 

2d.  That  those  children  who  have  not  been  nursed 
bj  the  mother,  are  much  more  liable  to  the  disease  than 
others. 

3d.  That  infants  of  nervous  temperament  are  more 
subject  to  attacks  of  laryngeal  asthma  than  those  of  a 
lymphatic  or  sanguineous  constitution.  In  short,  it 
appears  to  be  purely  a  nervous  disease ;  morbid  anatomy 
1ms  done  little  in  clearing  up  the  exact  seat  and  nature 
of  this  disease,  as  there  never  has  b^en  found  any  evi- 
dence of  inflammation  in  the  supposed  trsuts  of  the 
disease  during  those  posthumous  examinations  we  have 
00  record. 

Owiofi^  to  the  lateness  of  the  hour,  the  Association 
tiien  adjourned. 


€ontsipox(imct. 


THE  TUNNEL  UNDER  LAKE  MICHIGAN— THE 
CHICAGO  BOARD  OF  HEALTH. 
To  m  loRoa  or  tbb  MaoieAt  Bscoaa 

Sm— The  twenty-fifth  of  March,  1867,  was  a  day 
tiiat  win  long  be  remembered  with  satis&ction  by  the 
iohabitantB  or  Chicago ;  a  day  to  be  marked  for  ever  with 
a  white  stone  in  the  calendar  of  the  city;  The  famous 
tanod  under  the  bed  of  the  lake,  excavated  for  the 
pmpose  of  bringing  pure  water  to  the  town,  was  for- 
oaUy  c^pened  by  the  civic  authorities,  and  the  Michigan 
water  was  admitted  for  the  first  time  to  the  reservoir. 
Ibr  the  first  time,  I  say,  because,  though  we  have  here- 
tofore be^i  nominally  dependent  Upon  the  lake  for  our 
water-60{^ly,  it  appears  that,  in  consequence  of  the 
Qufbrtonate  location  of  the  pumps  at  the  water-works. 
We  bare  been  too  much  of  the  time  furnished  with 
eifiier  the  sewage  of  the  city  from  the  mouth  of  the 
river,  or  with  the  filtermgs  of  the  cemetery  and  the 
psst-hocne.  For  this  the  officers  who  located  the  water- 
works were  not  so  much  in  fault  as  might  be  at  first 
9spfo%ed,  A  quarter  of  a  century  ago  an  eneine  of  ten- 
bwie  power,  sucking  water  over  the  end  of  the  wharf, 
WM  more  than  sufficient  to  supply  the  wants  of  the 
for^raders ;  but  when  it  became  evident  that  Chicago 
WM  to  be  a  dty,  the  fSskr-seeing  authorities  selected  a 


spot  far  out  of  town,  upon  the  lake  shore,  one  mile 
north  of  the  harbor.  Here  they  erected  an  engine- 
house,  with  all  the  necessary  machinery  for  suppling 
water.  A  stockade  of  piles  driven  into  the  clay,  fencea 
in  an  acre  of  the  lake,  and  thus  the  purity  of  tne  fluid 
was  secured.  Upon  tiie  provisions  then  made  our  citi- 
zens have  been  ever  since  dependent  But  the  growth 
of  the  town  surpassed  all  expectation.  A  few  years 
only  elapsed  before  aline  of  breweries  sprang  up  beyond 
the  water-works.  Population  followed  suit,  and  a  thick- 
ly planted  cemetery  became  conspicuous  upon  the  high 
Cunds  near  the  lake.  The  river^  too,  was  changed, 
tead  of  the  clear  stream  in  which  little  boys  had 
fished  under  the  shade  of  the  willow  trees,  it  became  a 
filthy  cesspool,  in  which  the  contents  of  the  sewers,  Uie 
offal  from  the  pork-packers,  and  the  refuse  of  the  dis- 
tilleries, were  thoroughly  mingled  by  the  keels  of  a 
thousand  ships.  All  this  matter  was  discharged  into 
the  lake,  and  was  carried  directly  to  the  receiver  at  the 
waterworks,  whenever  a  southerly  wind  turned  the 
current  in  that  direction.  Great  efforts  were  made  to 
obviate  the  difficulty,  but  nothing  seemed  adequate  to 
the  occasion.  At  length  the  city  engineer,  Mr.  Ches- 
borough,  proposed  the  excavation  of  a  tunnel  un- 
der the  bed  of  the  lake  to  a  distance  sufficient  to 
insure  communication  with  a  body  of  water  which 
could  never  be  affected  by  causes  operating  along  the 
shore.  This  plan  was  finally  adopted,  and  the  work 
was  commenced  about  three  years  ago.  A  shaft  was 
sunk  near  the  lake  to  a  depth  of  about  eighty  feet,  and 
from  the  bottom  of  this  well  a  tunnel  five  feet  in  dia- 
meter was  carried  horizontally  at  riglit  angles  with  the 
coast  A  huge  crib  was  placed  in  the  lake  at  a  point 
two  miles  from  the  shore.  Here  another  shaft  was 
snnk  to  the  required  depth,  and  from  that  a  countermine 
was  carried  inwards  till  it  met  the  tunnel  from  the  shore. 
The  whole  work  was  pushed  through  the  bed  of  blue 
day  which  underUes  the  lake,  without  quicksand  or 
le<4;e  of  rock  to  interfere  witn  the  operations  of  the 
miners.  Proceeding  without  accident  or  hindrance  of 
any  kind  the  enterprise  was  completed  a  few  days  ago, 
and  was  dedicated,  amidst  the  reioicings  of  the  whole 
city,  on  the  twenty-fiflh  day  of  March.  We  now  re- 
ceive the  sweetest  and  purest  water  that  can  be  found. 
Wholly  free  from  sediment,  it  remains  uninfluenced  by 
the  vicissitudes  of  wind  and  current  which  have 'been 
hitherto  so  strongly  marked.  The  general  use  of  such 
water  cadnot  fail  to  remove  from  the  community  one 
of  the  most  important  of  the  predisposing  causes  of 
disease. 

Another  innovation  fraught  with  blessings  to  our  city 
has  been  recently  inaugurated.  We  now  have  a  board 
of  health  commissioners,  similar  to  your  MetropoHtan 
Board  of  Health.  This  board  consists  of  six  commis- 
sioners, appointed  by  the  judges  of  our  Superior  Court 
Of  these,  three  are  physicians.  The  mavor  is  ex  officio 
a  member  of  the  board,  and  is  its  president  The  lay 
members  are  gentlemen  of  worth,  who  are  desirous  to 
accomplish  all  that  lies  in  their  power.  Our  profession 
is  represented  by  Dr.  John  H.  Ranch,  formerly  a  pro- 
fessor in  Rush  Medical  College,  and  well  known,  during 
the  late  war,  for  his  remarkable  executive  abilities :  by 
Prof  H.  A.  Johnson,  of  the  Chicago  Medical  CoUege, 
one  of  the  most  distinguished  physicians  in  our  city ; 
and  by  Dr.  WilUam  Wagner,  a  noted  German  surgeon* 
Thus  constituted,  the  new  comniission  has  commenced 
work  in  earnest.  The  city  has  been  divided  into  twenty- 
two  districts,  with  a  physician  and  a  special  poHceman 
in  each  one  to  perform  the  duties  of  medical  inspector 
and  guardian  of  the  public  health.  The  duty  of  clean- 
ing the  streets  is  still  retained  by  the  Board  of  Public 
Works,  but  there  is  every  possible  mai^^€!3tation  ofja 


Digitized  by  VjOOQIC 


144 


THE  MEDICAL  RECORD. 


desire  to  act  in  aooordanoe  with  the  recommendations 
of  the  Board  of  Health.  These  new  measures  are  well 
received  by  the  citizens,  and  even  the  Irish  are  gratified 
by  Uie  offlciiJ  visits  of  the  inspectors.  The  only  obstar 
des  to  the  efficiency  of  the  board  vnll  arise  from  the 
magnitude  of  the  area  to  be  occujjied  bjr  their  supervi- 
sion. While  the  Common  Council,  havmg  control  over 
the  matter  of  salaries,  misguided  by  an  unfortunate 
piece  of  advice  proffered  by  the  Medical  Society  of  the 
city,  compel  the  commissioners  to  accept  five  hundred 
dollars  a  year  as  their  only  recompense,  and  while  one 
of  these  overworks!  gentlemen  has  consented,  with- 
out additional  compensation,  to  dischar^  the  duties  of 
sanitary  superintendent,  shouldering  this  great  burden 
in  order,  by  saving  the  expense  of  such  an  officer,  to 
render  the  new  order  of  thmgs  more  acceptable  to  the 
taxpayers,  whatever  credit  may  hereafter  be  assigned, 
none  can  ever  be  dahned  by  those  who  persistently 
opposed  the  adoption  of  all  but  their  own  pet  measures 
for  the  public  welfare.  Secure  of  the  approbation  of  an 
enlightened  community,  time  will  undoubtedly  remedy 
many  of  the  difficulties  which  are  inseparable  from 
every  new  enterprise.  M. 

OmoAOO,  Apbil,  1867. 


Vim  publtcatioiTd. 


Books  and  Pauphlbts  Rbosived. 

Pbophtlazis.  An  Anniversary  Oration  before  N.  Y.  Aca- 
demy of  Medicine  by  John  Ordbonaux,  M.D.,  LL.B* 

TWIHTT-POUBTH  ANNUAL    BbPOBT    OF   TBB  ICaNaOEBS'i  OF 

THB  Statb  Lunatic  Astlum,  for  1866.    N.  Y. 

Ambrioan  as  Compared  .with  Fobbion  FBOUirt)iTT.  By 
H.  R.  Stobkb,  M.D.,  Boston. 

BlOGRAPHIOAL   NOTIGB   OF  &  D.  WiLLLBD.     By  Dr.  F.  B. 

HouoH,  N.  Y. 

Bbsbarohbs  on  Spurious  YAOonrATiov  or  thb  Gonfbderatb 
Armt.  By  JosBPH  Jonbs,  M.D.,  Pro£  Physiology  and 
Pathology,  NashvUle,  Tenn.    1867. 

Chloroform  as  an  Internal  Rbmbdt.    By  A.  P.  MuBRnj., 

M.D. 
Report  of  the  Sbcrbtart  of  the  Navt.    1866. 

Fiftibth  Report  of  Astlxtm  for  the  Relibf  of  Persons 
Dbprivbd  of  their  Reason.    1867. 

Annual  Report  of  Commissioners  of  Emigration  of  N.  Y. 

1867. 
Circular  No.  4,  Sxtroeon-Qbneral^s  Officb. 

A  Theory  of  Inflammation,  Bra    By  Kelson  L.  North, 

M.D.,  of  Brooklyn,  N.  Y.     1867. 
Reports  of  Commissioners  of  Quarantdtb  for  Jan.  M  and 

29,  and  Feb.  16,  1866. 
Report  of  Cmr  Physiouns  of  Providence.    1867. 
The  Intracranial  Circulation  (first  prize  of  Boylston 

Medical  Society,  1867).    By  Thomas  Dwiqht,  Jr.,  House 

Surgeon  of  Mass.  Gen.  Hospital.    1867. 
Human  Testoids  (second  prize  Boylston  Med.  Soc.,  186t). 

By  F.  R.  Sturois,  Hoose-Surgeon  of  Mass.  Oen.  Hospital 

1867. 
"Why  Not?"    A  Book  fob  Every  Woman.    By  H.  R. 

Storer,  MD.,  Boston.   2d  Edition. 
Ttbatmbnt  of  Fractures  of  the  Loweb  Extremity  by  the 

Use  of  the  Anterior  Suspensory  Apparatus.    Bv  N. 

R.  Smith,  M.D.,  Prof,  of  Sureeiy  in  the  University  of  Mary- 
land.   Baltimore:  Kelly  A  Piet  1867. 
Seventh  Annual  Report  of  Commissioners  of  Pubuo 

CHARTTIBS  and  CORRBOnON  OF  N.  Y.     1866. 


MtWai  Urns  an\i  3teme. 


PBBSONAL. 

Surgeon  B.  4*  Clements  has  been  transferred  from 
the  Department  of  the  East  to  the  Department  of  D«k- 
cotah.  Surgeon  C.  H.  Alden.  and  Assistant-Surgeon  Q-. 
M.  McGiil,  transferred  firom  Department  of  the  East  to 
the  Department  of  Missouri.  Assistant-Surgeon  Ely 
McCIellan,  transferrecl  from  Department  of  the  East  to 
District  of  New  Mexico.  Assistant-Surgeon  W.  R. 
Ramsey,  transferred  from  Department  of  the  East  to 
the  Department  of  the  Platte.  Assistant-Surgeons 
Samuel  Adams  and  Henry  McElderry,  transferred  from 
Department  of  the  East  to  District  of  Texas. 

Assistant-Surgeon  C.  R.  Greenlea^  assigned  with 
Examining  Board  at  Louisville  to  relieve  Surgeon 
Lewis  Taylor. 

Thb  Fate  of  Dr.  Livingstone. — Ciformation  hat 
reached  the  British  Admiralty,  which  dispels  the  last 
faint  hope  of  the  &te  of  Dr.  Livingstone.  The  Thneg 
of  India  publishes  additional  evidence  that  the  great  ex- 
plorer is  dead.  An  Arab  had  brought  inteDigenoe 
which  leaves  hardly  any  room  for  hope.  If  the  man  is 
to  be  believed,' he  saw  poor  Livingstone  receive  his 
death-blow. 

The  Leavenworth  Medical  Herald,  is  the  title  of 
a  monthly  to  be  issued  June  Ist,  1867.  from  Leaven- 
worth, under  the  editorial  supervision  of  Drs.  C.  A.  Lo- 
gan and  T.  Sinks.  It  is  to  consist  of  forty-eight  pages 
of  reading  matter,  and  it  is  designed  that  its  typo^aphi- 
cal  make-up  shall  not  be  excelled  by  any  similar  loumal 
in  the  older  States.  Its  contents  will  consist  of  ori^ 
nal  communications  from  the  active  workers  within  its 
range  of  circulation:  of  the  proceedings  of  the  City, 
County,  and  State  societies ;  of  reviews  and  book  no- 
tices; of  correlative  scientific  subjects;  and  of  a  month- 
ly melange  of  the  current  medical  literature  of  the  day. 
The  project  commends  itself  to  the  physicians  of  Kan- 
sas, who  we  hope  will  not  be  backward  with  their 
literary  and  pecuniary  contributions. 

Removal  of  L  Baker  Brown  from  Obstetrical 
SooiBTT  OF  London.  —  Dr.  Baker  Brown  has  been 
removed  from  the  Obstetrical  Society  of  London  fisr 
alleged  unprofessional  conduct  connected  with  the  opera- 
tion of  cht(Hridectomjr.  The  Lancet^  after  stating  that 
the  verdict  bore  no  direct  relation  to  the  utility  or  use- 
fulness of  the  particular  operation,  thus  refers  to  the 
action  of  the  code^:  ''The  point  which  has  lately 
been  at  issue  was  whether  a  Fellow  of  the  Obstetrioal 
Society  was  proved  to  have  so  &r  departed  from  the 
rules  of  professional  honor  as  to  render  his  retention 
in  the  Society  an  outrage  upon  the  feelings  of  the  Fel- 
lows, and  a  discredit  to  the  profession  of  which  they 
are  members.  The  Society  hi^  expressed  its  conclusion^ 
and  this  with  a  unanimity  which  predudea  all  doubt 
as  to  the  necessity  of  the  unusual  step  which  has  been 
taken.  We  may  pronounce  it  as  decided  that  the  medi- 
cal profession,  speaking  through  a  section  of  its  body, 
utterly  discountenances  and  repudiates  the  proceedings 
which  have  made  one  of  their  number  notorious.  It 
protests  indignantly  against  the  performance  of  a  dread- 
ful operation  upon  married  women  without  the  know- 
ledge and  consent  of  their  husbands,  and  upon  married  or 
unmarried  women  without  their  own  knowledge  of  the 
nature  of  the  operation.  It  denounces  the  conduct  of 
a  surgeon  who  deliberately  insults  and  compromises  a 
fellow-practitioner  by  performing  in  his  presenoe  a 
mutilation  as  to  which  his  sanction  is  unasked.  It  acorns 
the  miserable  Quibbling  bv  which  a  palpable  want  of 
veracity  is  sougnt  to  be  defended." 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


145 


©rigmal  €ommumcotton«* 


OSSEOUS  TUMOR  OF  THE  UPPER  JAW. 
Bt  W.  R.  whitehead,  M.D.,  »ro., 

mW  TOBK. 

Oanous  growths  of  the  jaws  present  many  points  of 
interest,  which  are  revealed  by  a  careful  study  of  their 
iDttomical  appearances  and  clinical  features.  It  is  a 
wlgect  eminently  worthy  of  remark,  and  might  be  ap- 
propriately considered  at  this  time.  I  have,  however, 
on  a  previous  occasion  endeavored  to  describe  succinctly 
this  variety  of  diseased  growth  of  the  upper  jaw,  in 
connection  with  other  tumors  of  this  region  equally  in- 
teresting and  deserving  of  notice,*  More  than  a  general 
notice  of  the  subject  now  would  be  departing  from  the 
simple  design  and  original  object  of  this  communication ; 
which  i^Uie  description  oi  a  case  of  excision  of  the 
nperior  maxilla,  of  peculiar  importance,  and  attended 
with  the  most  favorable  results. 

Case. — Mi?s  F.  P ,  from  the  South,  aged  eighteen, 

of  good  constitution,  well  formed,  and  slightly  above 
the  medium  size,  was  afflicted  with  a  tumor  of  the  up- 
per jaw.  She  came  to  New  York  on  the  28th  of  last 
December,  and  placed  herself  under  my  care  for  the 
purpose  oi  having  it  removed.  A  few  weeks  prior  to 
this  date,  I  was  consulted  by  her,  at  which  time  I  ex- 
amined the  growth,  and  became  acquainted  with  its 
previous  history.  At  three  years  of  age  her  nurse  let 
her  fall,  and  she  received  a  blow,  which  bruised  her 
right  cheek :  when  six  years  old,  a  slight  enlargement 
of  the  cheek  on  that  side  was  first  observed,  which, 
however,  was  not  very  apparent,  and  caused  her  parents 
no  uneasiness;  but  at  the  age  of  ten,  the  enlargement 
had  sufficiently  increased  to  excite  their  apprehensions. 

Many  medical  gentlemen  were  consulted,  who  dif- 
fered widely  in  their  opinions  regarding  its  nature. 
Topical  remedies  were  ineffectually  used,  and  consti- 
tntional  means  unavailingly  essayed.  About  four 
years  ago,  the  parents  of  the  young  lady  visited  Rich- 
mond with  her,  and  consulted  a  distin^ished  surgeon, 
the  late  Dr.  Chas.  Bell  G-ibson,  who  advised  the  excision 
of  the  tumor.  This  gentleman  expressed  an  unwilling- 
ness to  give  chloroform  in  the  operation,  and  terrible 
apprehensions  of  pain  deterred  the  parties  from  permit- 
ting it  to  be  undertaken  without  the  use  of  an  anaesthetic. 
She  suffered  constantlv  from  headache,  during  a  year 
preceding  the  removal  of  the  tumor.  Two  or  three 
months  previous  to  its  excision,  it  grew  rapidly,  especi- 
ally towards  the  orbit,  and  the  headache  increased  with 
its  extension  in  this  direction.  Last  &I1  she  had  chills 
and  fevers,  which  persisted  irregularly  until  within  a 
few  weeks  of  the  day  of  the  operation.  My  first  ex- 
amination of  the  patient  permitted  me  to  observe  that 
there  was  considerable  deformity  of  the  face,  caused  by 
a  tnmor  occupying  the  right  superior  maxillary  bone, 
subtly  distorting  the  month,  and  making  the  cheek 
quite  tense.  This  tumor  invaded  the  orbit,  and  pressing 
upwards,  narrowed  the  orbital  cavity  in  its  transverse 
direction,  and  compressed  the  eye.  The  roof  of  the 
month  of  the  right  side  was  slightly  depressed.  By 
passing  the  end  of  my  index-finger  behind  the  extremity 
of  the  alveolar  arch,  feeling  and  circumscribing  the  pos- 
terior and  external  surfaces  of  the  tumor  as  thoroughly 
as  possible,  and  carefully  observing  the  deformity  caused 
by  it,  I  could  judge  with  a  certain  degree  of  precision 
the  extent  of  the  disease.  The  mass  appeared  ovoid,  had 


*  8m  BcmAito  on  etrtain  Tnmort  of  the  BopeHor  MazUla.    New 
TorkMedkalJounul.    YoL  IlL    18S&    No.  XVIL 


a  smooth  and  regular  surface,  and  to  every  part  acces- 
sible to  the  touch  was  exceedingly  hard  on  pressure, 
which  was  without  pain. 

The  headache,  from  which  she  had  si  long  suffered, 
appeared  to  be  due  to  compression  of  the  second  branch 
of  the  trifacial  nerve,  and  its  anastomosing  branches. 
The  two  last  molar  teeth  were  gone,  and  the  remaining 
molar  tooth  was  much  decayed ;  the  other  teeth  on  that 
aide  were  sound.  The  voice  was  but  slightly  nasal  or 
indistinct.  Mastication  was  not  impaired  to  any  extent, 
and  the  patient  swallowed  without  difficulty.  Appre- 
hensions of  the  continued  increase  of  the  tumor,  and 
its  rHpid  extension  recently  towards  the  brain,  excited 
the  fears  of  the  young  lady,  and  caused  her  to  desire 
the  removal  of  this  growth  without  unnecessary  delay ; 
and  although  its  extirpation  was  the  principal  and  most 
urgent  reason  for  the  operation,  yet  a  very  natural  soli- 
citude about  the  extent  of  deformity  which  might  re- 
main afterwards,  was  to  her  a  source  of  considerable  dis- 
quietude, and  made  me  desirous  to  prevent,  if  possible, 
cicatricial  marks  about  the  &oe,  resulting  from  incisions 
of  the  cheek,  or  other  part  conspicuously  apparent. 

Believing  that  moderate-sized  tumors  of  the  upper 
jaw  could  be  removed  without  cutting  the  Up  or  cheek — 
an  opinion  which  has  already  been  expressed  by  Ferguson 
and  some  others,  though  not  convincingly  demonstrated 
— I  experimented  on  the  cadaver  with  a  view  to  deter- 
mine the  degree  of  mobility  of  the  parts  about  the  mouth, 
and  also  the  extent  to  which  this  cavity  can  be  stretched 
by  the  use  of  well-adapted  means.  These  experiments 
were  simple,  and  appeared  satisfactory.  They  con- 
sisted in  exposing  thoroughly  the  bony  opening  of  the 
nares,  by  a  dissection  of  the  sofl  parts  from  the  ante- 
rior nasal  spine  of  the  maxiUee,  and  thus  facilitating  the 
dissection  of  the  anterior  surface  of  either  of  these 
bones,  as  high  up  as  the  orbit,  and  rendering  the  nasal 
and  malar  processes  quite  accessible  to  bone-scissors  and 
other  instruments.  By  the  use  of  cheek  retractors,  a 
gradual  and  very  considerable  dilatation  6f  the  mouth 
was  effected.  These  experiments  encouraged  me  to  hope 
that  I  might  be  able  to  remove  the  tumor  without  cut- 
ting the  lip  or  cheek  of  the  patient.  The  only  objec- 
tion which  occurred  to  me  was,  that  the  distension  of 
the  cheek  or  distortion  of  the  parts  might,  if  the  maps 
were  larger  than  previous  examinations  had  enabled  me 
to  determine,  render  the  anterior  part  of  the  tomor  as 
high  up  as  the  orbit,  inaccessible  to  dissection.  Being, 
prepared,  however,  as  well  as  possible  against  all  con- 
tingencicHS,  and  provided  with  suitable  instruments, 
efficiently  asi^isted,  and  ready  to  avail  myself  of  any 
advantages  wh<di  could  not  be  anticipated,  on  iiiB 
second  of  last  January  I  proceeded  to  remove  the  dis- 
eased growth,  and  to  test  the  value  of  the  experiments 
previously  made  on  the  cadaver. 

OpenJhn, — The  patient  was  seated  in  a  dentist's 
chair  procured  for  the  occasion :  and  afler  she  had  taken 
a  small  quantity  of  brandy  ana  water,  ether  was  admi- 
nistered  to  her,  and  the  operation  commenced  by  detach- 
ing, with  a  pair  of  strong  scissors,  the  soft  parts  from 
the  anterior  spine  of  the  maxillso,  and  partially  exposing 
to  view  the  anterior  bony  opening  of  the  nares.  At  this 
time  the  patient  commenced  to  vomit ;  she  had,  how- 
ever, not  taken  any  break&st  that  morning,  and  the  cause 
of  the  vomiting  was  attributed  to  the  ether.  Consider- 
able delay  was  caused  by  this  interruption  of  the 
operation.  Ether  was  not  again  used,  but  after  she 
had  swallowed  more  brandy  and  water,  she  was 
rapidly  made  insensible  to  pain  with  chloroform,  and 
my  dissection  of  the  gum  from  the  tumor  continued. 
The  dieek  retractors  provided  for  forcibly  stretching  tiie 
orifice  of  the  mouth  were  well  applied,  and  produced  a 
proper  extent  of  dilatation,  which  could  have  been 


146 


THE  MEDICAL  RECORD. 


much  increased.  I  soon  became  conyinced  that  the  tu- 
mor in  this  case  was  too  Urge  and  distended  the  cheek 
too  much  to  be  removed  without  an  external  incision. 
Mv  previous  opinion,  predicated  on  the  fedlity  with 
which  I  could  manipulate  the  parts  on  the  cadarer,  was 
modified  by  the  peculiar  extension  upwards  of  this 
growth,  which  made  its  anterior  and  upper  surfaces  less 
accessible  to  instruments  than  could  be  anticipated  be- 
fore the  preliminary  incisions  of  the  gum.  Reserring, 
therefore,  this  operative  procedure  for  a  case  more  fa- 
vorable to  its  adoption  I  promptly  cut  through  the 
middle  of  the  lip  in  its  furrow,  and  ^extended  the 
incision  around  and  behind  the  right  nostril,  a  short  dis- 
tance up  the  side  of  the  nose.  This  incision,  which  is 
recommended  by  Ferguson,  permitted  me  to  complete 
the  operation  rapidly  and  with  facility.  The  nasal 
branch  of  the  maxilla  was  cut  with  Liscon's  bone-scis- 
sors, and  the  malar  bone  effectively  severed  with  a  meta- 
carpal saw.  An  incision  of  the  soft  parts  was  then 
made  along  the  posterior  border  of  the  palate  bone, 
from  the  end  of  the  alveolar  arch  to  the  middle  palatine 
suture,  and  another  at  right  angles  to  this  incision,  ter- 
minating at  the  alveolar  of  the  lefl  incisor,  which  was 
extracted.  One  blade  of  Listen's  scissors  was  passed 
into  the  right  opening  of  the  bony  nares,  and  the  other 
into  the  mouth,  and  the  palatine  arch  cut  The  tumor 
was  then  wrenched  out  with  a  pair  of  Ferguson's  lion 
forceps,  and  the  remaining  son  parts  adherent  to  it 
were  detached.  One  of  the  little  palatine  arteries, 
throwing  out  a  fine  jet  of  blood,  was  secured,  afler  a 
little  trouble,  by  a  lieature ;  with  this  exception  there 
was  no  trouble  from  hsomorrhage,  but  to  guard  against  it 
considerable  lint,  some  of  which  was  saturated  with  a 
solution  of  Squibb's  sub-sulphate  of  iron,  was  stuffed 
into  the  cavity  left  after  the  extirpation  of  the  tumor. 

The  upper  two-thirds  of  the  external  incision  were 
united  with  ten  or  twelve  silver  wire  sutures,  and  the 
cut  surfaces  of  the  lip  were  held  in  apposition  with  two 
figure-of-eight  sutures.  With  the  valuable  assistance  of 
Dr.  Nathan  Bozeman,  now  of  this  city,  but  late  of  Mont- 
gomery, Ala.,  this  external  incision  was  very  neatly, 
accurately,  and  securely  approximated  throughout  its 
tentire  length.  After  the  implication  of  a  light  dressing 
-to  the  part,  the  patient  was  conveved  to  her  bed,  and 
half  a  grain  of  anlphate  of  morphia  prescribed,  to  be 
;taken  at  night.  In  a  few  hours  the  pulse  commenced 
to  rise,  and  in  the  night  she  had  considerable  fever. 

January  3. — Earlv  in  the  morning  I  found  the  pulse 
120 ;  strong  and  fulL  She  could  swallow  without  diffi- 
(Culty ;  took  strong  beef-tea  everv  few  hours,  and  her 
:mouth  was  often  mopped  oat  with  a  weak  solution  of 
:chlorinated  soda,  and  occasionally  with  glycerine.  She 
took  a  few  times  during  the  day  an  anoayne  and  dia- 
{phoretic  mixture,  containing  sulphate  of  morphia  and 
Wt  spts.  of  nitre ;  had  very  httle  thirst ;  she  became 
irestless,  and  late  in  the  night  her  pulse  increased  to 
about  130. 

Janwiry  4. — ^I  saw  her  eariy  in  the  morning,  and 
•ommenoed  to* give  her  stimulants;  very  soon  ailer 
swallowing  about  half  an  ounce  of  sherry  wine,  her 
pulse  was  lowered  eight  or  ten  beats  to  the  minute. 
-She  took  frequently  during  the  day  brand v-whey,  and 
beef  essence ;  and  eight  drops  of  muriated  tincture  of 
iron  in  solution  were  admiuistered  to  her  every  few 
hours.  In  the  middle  of  the  day  her  pulse  was  120  to 
124,  and  about  the  same  at  my  evening  visit  The 
same  mouth-washes  were  used  as  at  last  visit 

January  5. — She  continned  to  take  the  beef  essence 
ftnd  tincture  of  iron  as  before;  but  substituted  shervy 
wine  for  brandy-whey.  By  means  of  a  rubber  sy- 
ringe with  a  long  pipe,  the  upper  part  of  her  mouth 
was  WMhedout  several  times  with  tepid  suds  of  Castile 


soap ;  afterwards  with  clear  water,  and  then  with  water 
containing  a  drop  or  two  of  creasote.  In  the  evening 
she  was  qaite  restless,  and  had  a  hot  dry  skin,  and  htr 
pulse  was  increased  a  few  beats. 

January  6.— I  saw  her  at  an  early  hour  and  found  her 
much  better;  her  pulse  was  only  96  to  100.  Last 
night  she  was  very  uneasy  and  restless  up  to  twelve 
o'clock ;  about  that  time  she  got  rid  of  a  lint  plue  which 
was  annoying  her ;  but  soon  aflerwards  she  had  a  pro- 
fuse perspiration,  and  improved  rapidly.  She  told  the 
attendants  that  she  was  glad  that  1  would  find  her  in 
the  morning  so  much  better.  She  complained  of  hun- 
ger, and  drank  her  beef-tea  very  gratefully.  To-day 
the  hare-lip  pins  were  removed,  and  the  union  of  the 
lip  was  founci  to  be  perfect  The  same  detersive  and 
medicated  injections  were  used  as  yesterday.  She  took 
some  chicken  broth,  and  continued  to  take  the  beef 
essence  and  tincture  of  iron.  A  gentle  aperient  having 
failed  to  move  her  bowels,  they  were  slightly  relieved 
by  a  suitable  clvster. 

January  7.— Bested  well  last  night;  this  morning  a 
piece  of  lint  became  partially  detached  and  caused  her 
some  discomfort ;  I  removed  this  piece,  and  one  or  two 
others,  with  a  pair  of  dressing  forceps;  syringed  out 
the  mouth  with  Castile  suds,  dear  water,  and  weak 
creasote  water.  Continued  (he  same  medicines  and  nour- 
ishment At  the  evening  visit  I  removed  two  or  three 
pieces  of  lint 

January  8. — ^Took  out  all  the  silver  sutures ;  washed 
the  parts  and  put  fi'esh  isinglass  plaster  to  the  lip  and  side 
of  the  nose,  and  removed  all  tne  lint  plugs.  I  enter- 
tained doubts,  as  I  had  a  few  days  before,  whether  the 
offensive  suppuration  caused  by  the  lint^  was  fully  com- 
pensated by  the  supposed  securitv  afforded  again^ 
hflsmorrhage  by  cranmimg  the  wound  with  this  material. 
If  all  other  necessary  means  for  stopping  hsemorrhaffe 
are  made  available,  and  the  parts  exposed  sufficiently 
long  to  the  air,  I  have  no  doubt  that  sometimes  no  lint 
would  be  required.  It  would  be  fie^r  better  to  have 
only  the  saliva,  whidi  is  bland  and  unirritating,  in  con- 
tact with  the  sur£EK)es  of  the  wound,  than  lint  In  a 
similar  operation,  about  two  years  affo,  which  was  at- 
tended with  most  excellent  results,  I  abstained  firom 
stuffing  lint  into  the  cavity  which  remained  afler  the 
excision  of  the  tumor;  and  I  believe  that  it  would  be 
well,  if  possible^  always  to  adhere  to  this  practice. 

To-day,  she  is  able  to  sit  up  and  syringe  out  her 
mouth  herself;  has  very  little  fever ;  said,  at  the  morn- 
ing visit,  that  she  iblt  quite  comfortable;  Although  I 
have  requested  her  to  observe  strict  silence,  she  will 
occasioiuJly  address  a  sprightly  remark  to  her  sister,  or 
utter  some  pleasant  expression,  indicative  of  her  habit- 
ualJT  cheerful  disposition. 

Januar^f  9. — She  continues  to  improve ;  has  a  re- 
lish for  food;  took  some  soft  boiled  eggs  this  morning; 
uses  the  same  mouth  washes;  discontinued  the  tinc- 
ture of  if  on. 

January  10. — Last  night  she  was  restless,  and 
about  eleven  o'clock  she  had  considerable  fever ;  I  waa 
told  to-day  that  once  or  twice  before  she  has  had  fever 
during  the  night  Fifteen  grains  of  sulphate  of  qui- 
nia  were  prescribed  to  be  given  in  clyster,  but  only  a 
third  of  it  at  a  time,  and  at  three  hours'  interval. 

January  11. — Doing  very  weU;  took  in  the  same 
way  as  yesterday,  twSve  grains  of  quinine. 

January  12.--She  has  not  had  a  return  of  her 
fever;  but  the  quinine  was  repeated  once  more. 

January  18. — ^Daring  the  last  six  or  eight  days,  she 
has  been  able  to  sit  up  and  to  walk  about  the  bouse ; 
and,  if  tiie  weather  were  pleasant,  could  go  out  to 
vralk.  She  went  out  this  morning,  in  a  clos^  carriaffe, 
and  had  her  photognq[>h  taken,  wnicb,  compared  with 


THE  MEDICAL  RECORD. 


147 


the  one  taken  before  the  operatioD,  exhibits  a  marked 
improvement  in  her  personal  appearance,  effected  by  the 
operation  that  reliered  her  of  thig  encroaohing  tamor. 
Desirous  of  having  the  deficiency  of  the  upper-jaw, 
caused  by  excisioq  of  the  tumor,  repaired  by  some 
eompetent  dentist,  I  made  careful  inquiry,  and  learned 
through  a  professional  friend,  that  in  a  similar  operation 
perfi[)nued  in  1842  by  Dr.  R.  D.  Mussy^  of  Cincinnati, 
on  the  patient  Thomas  McQilligan,  Dr.  H.  Crane,  dentist 
of  this  city,  made  a  substitute  for  the  upper  maxillary 
bone  which  the  patient  had  worn  twelve  years  when 
last  seen.  The  contrivance  whic^  the  dentist  Cook 
made,  and  to  which  Mussy  refers  in  bis  publication  of 
the  case,  was  soon  rejected  by  the  patient  as  useless. 
VTins  P.  visited  to-day  the  rooms  of  Dr.  Crane,  who  is 
an  ingenious  and  skilful  dentist.  With  a  little  effort 
she  can  artictilate  quite  distinctly:  this  is  a  very  con- 
siderable advantage,  imd  will  aid  m  obtaining  an  ex- 
cellent result,  when  this  gentleman  makes  for  her  an 
artificial  palate  and  set  of  teeth. 

January  23. — She  left  to-day  for  her  home.  About 
two  weeks  afler  the  operation,  she  was  well  enough 
to  leave,  but  was  detained  by  snow  storms,  which  in- 
terrupted railway  travel  I  have  recently  received  a 
letter  fix>m  her,  dated  February  6tb,  and  MiYL  quote  a 
&w  lines  from  it : 

*^I  am  improving  very  rapidly,  my  color  has  returned 
wirh  my  strengrth,  and  I  am  sure  I  have  abeady  gained 
several  pounds  in  weight;  the  soreness  has  almost  entire- 
ly left  my  mouth,  and  it  is  healing  up  very  nicely." 

Jpnl  3. — ^Miss  P.  has  returned  to  New  York  to  place 
herself  under  the  care  of  the  dentist.  The  parts  are  en- 
tirely healed ;  she  is  no  longer  subject  to  headache,  and 
IS  in  the  roost  excellent  hecdth  and  spirits.  The  space 
kfi  after  the  extirpation  of  the  tumor,  has  closed  up 
remarkably  well ;  the  entire  soft  palate  is  preserved :  and 
the  only  opening  in  the  roof  of  tne  mouth  is  an  oval  ori- 
fice about  an  inch  and  a  quarter  in  its  longest  diameter, 
which  is  antero-posterior.  The  eye  is  well  retained  in 
its  natural  position,  and  its  movements  are  free,  and 
sasQy  executed.  There  is  some  flatness  of  the  cheek, 
and  distortion  of  the  right  side  of  the  mouth,  which  is 
obviously  caused  by  the  disuse  of  the  muscles  on  that 
aide  of  the  face,  wmch  defect  can  probably  be  removed 
l^  tlie  device  of  the  dentist 

April  18. — Dr.  Crane  has  been  eminently  successful 
in  accurately  fitting  to  the  voung  lady's  mouth  an  in- 
genious piece  of  workmanship,  composed  in  part  of  vul- 
canite, with  a  beautiful  arch  of  teeth,  and  rose-colored 
gums  of  porcelain,  appearing  so,  natural  that  they  defy 
dose  scrutiny.  Tnis  dental  attachment,  wliich  she  has 
worn  several  days,  enables  her  to  pronounce  with  per- 
kct  distinctness ;  it  improves  her  appearance,  and  her 
DKmth  feels  more  comfortable  with  it  than  without  it, 
as  ft  causes  not  the  slightest  irritation  or  inconvenience ; 
indeed  it  is  a  most  remarkable  triumph  of  the  dental 
art,  and  has,  1  believe,  never  been  excelled.  Having  ac- 
oomplifihed  the  object  of  her  last  visit  to  New  York,  she 
is  r^y  to  return  to  her  home,  and  now  etyoys  social 
intercourse  with  a  zest  which  she  rarely  experienced 
before  the  removal  of  the  tumor. 

&amination  of  the  Tumor. — The  tumor,  afler  its  ex- 
ctatoo,  was  heavy  and  hard,  and  appeared  like  a  compact 
mass  of  hypertrophied  bone,  weip^hed  fbur  ounces  and 
a  quarter,  and  involves  the  superior  maxUia  and  part  of 
the  malar  bone.  The  greatest  thickness  of  this  growth 
is  measured  by  its  vertical  diameter;  its  superior  sur- 
&oe  correqpoads  to  the  floor  of  the  orbit^  wnich  before 
the  operation,  in  being  displaced  upwards,  diminished 
the  orbital  cavitr  in  this  direction  to  the  extent  of 
■bout  half  an  incm.    The  umer  fractured  border  of  this 


surface  corresponds  to  the  lower  border  of  the  orbital 
plat«  of  the  ethmoid  bone,  from  which  the  tumor  was 
separated  in  wrenching  it  out.  On  the  upper  third  of 
its  anterior  surface  may  be  seen  an  indentation,  corre- 
sponding to  the  external  ori6ce  of  the  suborbital  canal, 
from  which  point  may  be  measured  with  the  eye  the 
extent  of  encroachment  of  the  tumor  upwards.  Its  ex- 
ternal surface  projects  quite  prominenUy,  and  its  infe- 
rior and  posterior  surfaces  also  exhibit  considerable  en- 
largement of  the  maxillary  bone.  A  piece  of  the  tu- 
mor was  sliced  out  by  sawing  to  its  centre ;  and  the  in- 
ternal structure  of  the  mass  was  observed  to  be  similar 
to  that  of  the  most  compact  bone  tumor,  and  which  is 
known  as  the  ivory  exostosis.  Exceedingly  fine  sec- 
tions of  this  piece  were  placed  on  slips  of  glass,  and 
successively  examined^  under  the  microscope,  after  add- 
ing a  drop  of  glycenne  to  each  delicate  section,  and 
f)res8ing  gentlv  its  thin  glass  cover.  Numerous  osseous 
acunse  with  d^eir  diverging  canaliculi,  were  seen  thick- 
ly studding  the  little  masses  within  the  field  of  the  in- 
struments These  osseous  lacunas  were  found  to  be 
present  in  each  specimen  examined,  though  not  so 
numerous  in  some  as  in  others. 

The  tumor  seems  to  be  formed  exclusively  of  bone 
tissue,  and  may  be  considered  as  a  type  of  dense  osseous 
tumors  of  the  superior  maxilla,  and  belongs  to  an  in- 
teresting variety  of  benign  growths. 

CondutionB, — The  growth  is  of  a  benign  character. 
The  origin  of  the  diseased  action  in  the  bone  is  tracea- 
ble to  a  contusion. 

The  upward  extension  of  the  tumor  was  peculiarly 
unfavorable :  the  mass  invaded  slowly  the  orbital  cavity, 
and  probably  would  ultimately  have  caused  a  protru- 
sion of  the  eye  and  an  encroachment  on  the  brain. 

My  experience  in  this  and  a  previous  case  of  exci- 
sion of  the  superior  maxilla  has  been  entirely  favorable 
to  the  use  of  chloroform  in  this  operation.  As  an  ex- 
cellent precautionary  measure,  it  is  well  to  give  brandy 
in  this,  as  in  other  surgical  operations,  before  adminis- 
tering chloroform :  the  brandy  &cilirates  the  action  of 
the  chloroform,  and  materially  diminishes  the  chances 
of  accident  resulting  firom  the  depressing  effects  of  this 
agent  on  the  nervous  system. 

I  believe  that  tumors  of  the  upper  jaw  of  a  moder- 
ate size,  when  favorably  situated,  may  be  excised  with- 
out  an  external  incision  of  the  face. 

The  incision  in  the  furrow  of  the  lip  and  up  the  side 
of  the  nose,  offers  peculiar  advantages  over  other  in- 
cisions of  the  face. 

The  structure  of  the  tumor  will  influence  the  amount 
of  haemorrhage;  causmg  it  to  be  more  or  less  danger- 
ous and  difficult  to  control,  in  propoi  tion  to  the  vascu- 
larity of  the  growth. 

It  is  best,  if  possible,  not  to  stuff  lint  into  the  cavity 
left  after  the  extirpation  of  the  tumor;  leaving  de- 
parts to  the  bland  and  unirritating  contact  of  the 
saliva. 

An  excellent  substitute  of  vulcanite  and  porcelain 
may  be  made  to  repair  the  deficiency  caused  by  exci- 
sion of  the  upper  maxillary  bone ;  and  thus  the  skill  of 
the  dentist  may  essentially  aid  in  correcting  the  con- 
traction of  the  parts  after  healing. 

A  removal  of  the  entire  floor  of  the  orbit  does  not 
necessarily  cause  a  falling  of  the  eye ;  such  was  not  the 
case  after  this  operation. 
lOTEMtirthftrMt    01dllla,6S. 


N«w  Hospital  in  Cinoiknati.— A  new  hospital,  to* 
be  known  as  the  Commercial,  is  to  be  ereeted  in  Gin., 
cinnati,  at  a  cost  of  500,000  doUars..     ><^  t 

digitized  by  LjOOgle 


148 


THE  MEDICAL  RECORD. 


A  BKMABKABLS  GASB 

OF  PENETRATING  AND  LACERATED 

WOUND  OF  THE  ABDOMEN  AND  UTERUS 

OF  A  PREGNANT  WOMAN, 

WITH  BBOAPB  OF  A   UTINO  CHILD  THROVaH  TBS  WOUVD. 

By  E.  J.  MARSH,  M.D., 

▲MISTA.XY  svBoaoir,  virmD  wtArwt  akht. 

On  the  evening  of  AprU  5,  1867,  Mrs.  P.,  aged  42,  the 
mother  of  eight  cbildreo,  and  then  in  the  eighth  month 
of  pregnancy,  was  struck  in  the  abdomen  bj  the  horn 
of  an  enraged  cow.  The  horn  did  not  tear  through  her 
clothes,  but  she  felt  the  /bhild  drop  out,  caueht  it  m  her 
dress,  and  took  a  few  steps  homeward.  Here  she  was 
met  by  a  neighbor,  who  assisted  her  to  the  house, 
distant  about  twelve  yards  from  the  place  of  accident. 
With  this  assistance  Mra  F.  -walked  to  the  house,  and 
then  sat  down,  but  the  neighbors  soon  laid  her  on  the 
floor.  Her  friends  up  to  this  time,  supposed  that  the 
child  had  come  per  vias  naturala,  but  when  they  lifted 
up  the  clothes  they  found  the  bowels  protruding,  and 
"reaching  to  the  feet,"  as  one  of  them  stated.  They 
cut  the  umbilical  cord,  removed  the  child,  endeavored 
to  replace  the  bowels  as  far  as  possible,  covered  them 
with  a  clean  cloth,  and  left  her  in  this  condition  until 
my  arrival. 

I  arrived  at  the  house  about  three-quarters  of  au 
hour  after  the  accident,  and  found  the  woman  lying  on 
the  floor,  extremely  prostrated,  pale,  and  with  a  rapid 
and  barely  perceptible  pulse.  There  was  a  considerable, 
but  not  excessive  amount  of  blood,  soaked  into  her 
clothes,  and  on  the  next  morning  blood  was  found  on  the 
ground  where  t^e  accident  occurred,  and  thence  to  the 
house. 

I  removed  her  to  a  mattress,  and,  on  examination, 
found  several  feet  of  intestine  and  the  uterus  lying  ex- 
posed, protruding  through  a  wound  of  the  abdominal 
wall  The  womb  was  partially  inverted  through  a 
wound  in  itself,  and  the  placenta  was  still  attached  to 
the  sur&ce  of  tiie  inverted  portion.  The  wall  of  the 
abdomen  was  torn  for  about  five  inches,  the  wound  ex- 
tending from  the  umbilicus  outwards  and  somewhat 
downwards  on  the  left  side,  in  an  almost  straight  line. 
I  returned  the  intestines,  removed  the  placenta,  and 
replaced  the  uterus.  This  organ  was  considerably  lace- 
rated, the  wound  being  Y-shaped,  but  with  one  leg 
shorter  than  the  other.  In  the  contracted  state,  the 
wound  was  between  two  and  three  inches  in  length. 
There  was  but  slight  uterine  hs&morrhage  on  the  removal 
of  Uie  placenta.  I  then  united  the  wound  with  sutures, 
plaster,  and  put  on  a  broad  banda^.  She  was  entirely 
conscious,  complained  littie  of  pam,  but  was  very  rest- 
less, throwing  her  arms  about  and  rolling  about  the  bed. 
I  had  given  her  oonstantiy  from  my  amval  small  quan- 
tities of  brandy  and  water,  but  she  did  not  in  the  least 
raUy  from  the  shock ;  the  pulse  soon  became  imper- 
ceptible, and  in  about  an  hour  and  a  half  from  the  recep- 
^AQVk  of  the  injury,  she  died 

The  child  was  a  boy,  was  not  injured  in  any  way, 
and  is  still  Hving. 
Wmt  Poora,  R.  Y^  AinU  18,  INT. 

A  BLESsma  in  Disquibe. — ^A  distinguished  London 
surgeon  has  taken  the  lecture-room  to  reassure  the  la- 
dies in  regard  to  the  "  chignon  fallacy.''  He  says  the 
"  organisms ''  are  neither  entozoa  nor  epissoa,  but  only 
eetosoa,  which  are  comparatively  harmless,  and,  indeed, 
aid  the  droulation  of  the  blood  by  compelUug  the  plea- 
sant exerciae  of  acratohing.— JStecAayi^e.  | 


THE  MEDICAL  USE  OF  ELECTRICITT. 
Br  G.  M.  BEARD,  M.D ,  and  A.  D.  ROCKWELL,  MJ)., 

or  mtir  tokk. 

No.  IV. 

BTNovms. 

Mr.  Gbo.  L.,  aged  35,  stated  that  about  the  1st  of  July, 
1866,  he  was  sunstruck ;  and  between  the  20th  of  the 
same  month  and  the  15th  of  August,  he  suffered  from 
three  strokes  of  paralysis,  resulting  Anally  in  total  blind- 
ness. His  sight  gradually  return^,  but  by  degrees  his 
shoulders  became  lame  and  stiff,  so  that  he  could  with 
difficulty  use  them.  This  state  of  things  continued  un- 
ti^  about  the  middle  of  September,  when  both  knees 
and  ankles  commenced  to  enlarge.  In  November,  when 
the  patient  applied  to  us  for  treatment,  we  found  him 
suffering  from  severe  sub-acute  synovitis.  Both  knees 
were  enormously  swollen,  the  flmd  having  accumulated 
to  such  an  extent  that  the  patellse  projected  forward 
more  than  an  inch.  Four  applications  were  given,  one 
every  day,  but  with  no  marked  effect,  except  that  the 
lameness  of  the  shoulders  and  ankles  was  much  re- 
lieved. 

He  then  left  the  city  and  was  absent  one  week.  On 
his  return  the  improvement  was  found  to  be  very 
great  The  accumulation  of  fluid  in  the  knees  had 
almost  entirely  disappeared,  and  the  swelling  reduced 
in  proportion.  At  nrst,  the  very  strongest  current 
from  ladder's  apparatus  made  no  impression,  when  ap- 
plied down  the  spine.  The  legs  were  but  littie  sensitive 
to  the  electric  stream,  and  the  feet  and  toes,  which  ace 
generally  very  readily  affected,  were  remarkably  torpid. 
The  applications  were  continued  on  Dec.  3d,  4th,  5th,  7th, 
and  9th,  effectually  removing  this  want  of  sensation, 
and  completely  dissipating  the  remaining  swelling  ana 
tenderness  of  the  knees. 

PARALTSia. 

Case  First — Mrs.  S.  was  first  seen  February  6,  in 
consultation  with  Dr.  Moreau  Morris.  Her  history 
was,  that  about  three  years  before  she  had  given  birth 
to  a  child,  since  which  time  she  had  been  an  invalid. 
She  could  waUc  only  with  difficulty,  and  by  the  aid  of 
some  support  A  few  weeks  before  we  saw  her.  she 
had  suffered  an  attack  of  what  appeared  to  have  oeen 
a  rush  of  blood  to  the  nervous  centres,  followed  by  in- 
creased weakness.  She  was  of  slender  form,  and  was 
somewhat  emaciated.  She  complained  of  persistent 
coldness  in  the  feet,  that  at  times  was  almost  painful 
Her  appetite  was  capricious,  her  bowels  very  much 
constipated,  and  she  was  also  annoyed  with  neuraldc 
pains  m  tiie  left  side.  On  examination,  we  found  me 
muscles  of  both  legs  were  inactive  and  shrunken,  and 
were  very  slow  to  respond  to  electrical  excitation.  The 
flexors  of  the  left  leg  had  entirely  lost  their  muscular 
contractility,  and  me  whole  limb  presented  an  un- 
healthy aspect  The  case  appeared  to  be  one  of 
functional  paralysis,  associated  with  general  debility. 
Whether  this  anaemic  state  was  the  result  of  some 
lesion  of  the  nerve  centre,  it  was  manifestiy  difficult 
to  determine.  The  indications  for  treatment  in  this 
case  were, 

1st.  To  improve  the  general  condition  by  some  effeo- 
tive  tonic 

2d.  To  restore  the  muscular  contractility  and  increase 
the  blood  circulation  in  the  lower  limbs. 

As  internal  medication  had  been  tried  in  rain,  it  was 
resolved  to  see  what  could  be  done  by  electricity  alone, 
usine  general  and  local  applications.  During  the  first 
week  of  treatment  the  patient  complained  of  some  rest- 
lesness  at  night,  but  of  no  other  unpleasant  symptom. 
Digitized  by ^ ^_ 


THE  MEDICAL  RECORD. 


149 


From  that  time  there  has  been  a  gradual  progress. 
Her  appetite  has  increased,  her  bowels  have  b^me 
more  regular,  and  her  rest  at  night  is  less  disturbed. 
The  pains  in  the  side  left  her  the  third  week  of  Uie 
treatment,  and  have  returned  but  slightly  on  one  or  two 
ooetsions.  Her  muscular  system  throughout  is  some- 
whtt  firmer  and  harder,  and  consequently  has  very  per- 
ceptibly improved  in  her  general  appearance.  The  cir- 
culation in  her  lower  liml»  has  so  &r  improved  that  she 
complains  less  of  cold  feet,  and  the  color  both  of  the 
ligfat  and  leA.  leg  is  more  natural  She  can  walk  about 
with  greater  ease  and  for  a  longer  time  than  before,  but 
mcfe  on  account  of  the  fact  that  her  general  vigor  is 
pester,  than  from  any  q)ecial  increase  in  ilst  contractil- 
itf  of  the  affected  limbs.  We  shall  hereafter  resort  to 
the  use  of  the  continuous  stream  on  the  muscles  of  the 
kfwer  extremities,  still  continuing  our  general  tonic 
applications  with  the  faradaic  current  Anything  like 
an  absolute  restoration  in  such  cases  is  of  course  not  to 
be  expected. 

Dr.  Todd,  of  London,  has  advanced  the  idea  first  sug- 
gested hj  Marshall  Hall,  that  by  means  of  electric  cur- 
rents we  can  diagnosticate  some  of  the  different  types 
of  ptraljTsis.  His  theory  is  that  when  the  electro-mus- 
colir  excitability  of  the  affected  part  is  lost,  or  nearly 
ao,  or  is  normal,  we  have  a  case  of  curable  paralysis, 
canaed  either  by  lead  poison,  rheumatism,  hysteria  or 
^Kpoeure  to  cold,  or  by  some  other  peripheral  irrita- 
tion; and  when  the  electro-muscular  excitability  of  the 
affeoted  part  is  increased  above  the  healthy  standard, 
we  have  a  case  of  incurable  paralysis,  connected  with 
aome  persistent  irritating  brain  lesion.  These  theories 
win,  we  believe,  stand  the  test  of  experience. 

Case  Second. — ^W.  0-.  was  sent  to  us  by  Dr.  Chalmers 
to  be  treated  for  anaesthesia,  and  partial  loss  of  the  pow- 
er of  motion  of  the  thumb  and  fingers  of  the  left  hand. 
He  stated  that  ten  months  previous  he  had  suffered 
from  swelling  and  pain  in  the  led  hand ;  that  the  "  skin 
burst,"  and  that  he  afterwards  lost  all  sensation  in  the 
^rob  and  fingers.  He  was  unable  to  grasp  anything 
finnly. 

He  complained  of  a  feeling  of  coldness  in  the  affected 
parts,  that,  at  times,  was  quite  annoying.  The  skin 
was  dry  and  shrivelled.  His  general  health  was  so  good 
that  we  employed  only  locd  applications,  and  those 
were  as  strong  as  he  could  possibly  bear.  Both  the  de- 
scending and  ascending  secondary  currents  were  used, 
and  the  electrodes  were  applied  along  the  course  of  Uie 
median  nerve  and  its  brancnes.  The  progress  was  slow 
hot  steady.  The  sensation  gradually  returned,  and  after 
fifteen  applications  was  completely  restored  in  all  tlie 
parts  except  the  tip  of  the  second  finger.  He  then  re- 
turned to  his  occupation,  which  was  that  of  a  house- 
carpenter,  and  found  that  he  could  labor  nearly  as  effi- 
ciently as  ever.  The  feeling  of  coldness  still  continues 
to  annoy  him  occasionally,  more  particularly  in  stormy 
weather. 

Case  Third.— Mr.  C,  a  gentleman  60  years  of  age, 
represented  that  in  October.  1864,  he  began  to  be  af- 
fected with  severe  pains  in  nis  legs  and  feet,  which  were 
most  severe  at  night,  with  alternations  of  heat  and  cold. 
The  power  of  flexion  and  extension  of  the  muscles 
of  the  leg  gradually  left  him,  until  he  could  walk  only 
with  difficulty.  The  pain  also  lefl  him,  and  a  feeling  of 
immbness,  like  that  of  a  *'  foot  asleep,'*  remained,  that 
was  soon  followed  by  entire  loss  of  sensation.  When 
he  first  came  to  us,  J  an.  15.  1867,  he  could  hwrdly  raise 
his  feet,  saying  that  they  felt  "  like  dead  weighU.^*  The 
loss  of  sensation  and  motion  was  more  marked  in  the 
left  foot  than  in  the  right.  He  was  a  large,  well  formed 
man,  and,  notwithstauding  his  age,  appeared  to  be  in 


quite  vigorous  health.  On  making  the  first  application 
it  was  found  that  the  muscular  contractility  was  some- 
what diminished,  especially  on  the  left  leg;  and  the 
sensation  was  so  blunted  that  he  did  not  £^T  the  entire 
force  of  the  battery,  even  when  the  electrode  was 
placed  on  the  extremity  of  the  toes.  Af\er  four  vigor- 
ous applications  of  the  ascending  and  deecending  &ra- 
daic  current  (the  positive  pole  being  pressed  against  the 
ball  of  one  foot,  while  the  negative  was  applied  to  the 
other),  the  sensation  in  a  good  measure  returned,  and 
he  found  that  he  could  flex  and  extend  his  toes  with 
less  difficulty.  The  same  treatment,  continued  for  a  * 
month,  gave  very  favorable  results.  His  gait  was  much 
more  natural  and  the  sensation  to  a  considerable  ex- 
tent returned  in  both  feet. 

Case  Fourth. — ^Mr.  S.,  a  young  man  of  about  30. 
was  sent  to  us  by  Dr.  Austin  flint,  to  be  treated 
for  paralysis  of  sensation  of  both  legs,  firom  which  he 
had  been  suffering  for  nearly  a  year,  caused  by  syphilis, 
as  there  was  some  reason  for  believing.  Four  or  five 
applications  were  made  without  any  observable  re- 
sults. The  patient  then  left  us  scarcely  any  improved. 
Reasoning  from  analogy,  it  would  seem  that  he  might 
have  been  somewhat  benefited  by  a  long  course  of 
treatment. 

INFANTILE  PABALTSIS. 

Case  FiflL — Nathan  H.,  aged  3  years.  During  the 
month  of  July,  1866,  the  little  patient  was  first  brought 
for  treatment.  Both  limbs  were  atrophied,  the  lelt 
more  considerably  than  the  right.  The  child  was 
scarcely  able  to  support  his  own  weight.  About  a 
dozen  applications  were  given,  and  with  marked  im- 
provement, so  far  as  warmth  and  strength  of  limbs  were 
concerned.  During  the  month  of  August  the  treatment 
was  discontmued;  but  on  the  first  of  September,  when 
the  boy  was  again  brought  to  continue  the  applications, 
he  was  able  to  walk  alone  and  with  comparative  ease. 

Case  Sixth. — ^Benj.  A.,  aged  3  years.  His  mother 
stated  that  eighteen  months  before  (April,  1865),  a^r 
suffering  severely  in  teething,  the  paralysis  first  showed 
itself.  For  several  months  the  child  bad  been  taken  to 
public  clinics,  where  cod-liver  oil  had  been  given,  but 
with  no  decided  improvement 

He  was  first  brought  for  treatment  about  the  5th  of 
September,  1866,  and  up  to  October  22,  received  fifteen 
applications  of  the  faradaic  current.  When  first  seen, 
the  lej^s  were  much  atrophied.  The  circulation  was 
deficient,  and  the  limbs  were  powerless  to  bear  the 
weight  of  the  body.  The  improvement  manifested, 
although  very  gradual,  was  encouraging;  and  it  is  to  be 
regretted  that  the  parents,  who  lived  a  considerable  dis- 
tance firom  the  citv,  ceased  to  visit  us.  At  the  end  of 
treatments  the  little  patient  could  easily  stand,  by  the 
aid  of  a  chair.  The  limbs  had  increased  somewhat  in 
size,  and  the  warmth  of  both  was  much  greater  than 
six  weeks  before. 

OHRONIO  INTLAMMATIONS  OW  MUCOUS  MEMBRAITES. 

Having  always  been  taught  that  electricity  was  not 
good  for  inflammations,  we  were  only  convinced  of  the 
error  of  the  theory  by  repeated  observations  of  its  bene- 
ficial effects  on  persons  affected  with  catarrh  and  bron- 
chitis, and  ulceration  of  the  membrana  tympani 

We  find  that  electricity  is  a  powerful  adjuvant  in  the 
treatment  of  all  chronic  inflammations  of  the  pharynx, 
larynx,  and  nasal  passages,  both  for  its  general  tonic 
influence,  and  for  its  local  corrective  power.  It  allays 
the  irritation  caused  by  the  application  of  nitrate  of 
silver,  and  those  upon  whom  we  have  employed  it  for 
this  purpose,  desire  to  have  it  repeated.  Electricity 
has  been  long  used  in  diseases  of  the  eaiswith  various 

digitized  by  LjOO^^_ 


150 


THE  MEDICAL  RECORD. 


success.  It  is  now  known  to  all  aurists  that  deafness, 
in  the  majority  of  cases,  is  a  symptom  of  some  form  of 
inflammation  of  the  auditory  apparatus.  It  is  tlierefore 
logical  to  infer  that  electricity  would  be  of  value  in  the 
treatment  of  such  maladies,  and  so  we  have  found  it  in 
a  number  of  cases. 

Case  First — ^Elisha  L.,  aged  17.  When  five  years 
of  age  he  was  attacked  with  scarlatina.  A  few  weeks 
afler  recovery  he  was  pulled  violently  by  both  ears, 
since  which  time  he  hi^  been  very  dea^  and  could 
with  difficulty  be  made  to  hear  when  q>oken  to  in  a 
boisterous  tone  of  voice.  We  first  saw  him  Jan.  24, 
1867,  when  he  could  hear  the  tick  of  a  watch  only 
when  it  was  pressed  firmly  against  the  ear.  The  mem- 
bran»  tympani  were  somewhat  thickened,  and  there 
were  evidences  of  infianmiation  in  the  right  external 
auditory  canaL  For  the  sake  of  experiment,  we  con- 
cluded to  test  the  effects  of  electricity,  directing  the 
patient  to  place  his  hands  on  the  piece  of  copper  to 
which  the  negative  pole  was  attached,  and  applying 
the  positive  below  and  anterior  to  the  auricle.  At  the 
dose  of  the  operation  he  could  hear  the  watch  foor 
inches  on  each  side.  On  the  next  visit  we  found  that 
he  retained  all  that  he  had  gained,  and  could  hear  con- 
versation much  easier  than  at  first.  We  then  inflated 
the  tympanic  cavities  by  Politzer's  apparatus,  with  the 
result  or  increasing  the  hearing-distance  two  inches  on 
each  side.  We  ha^  intentionally  delayed  this  very  im- 
portant operation  in  order  to  see  first  what  might  be  ac- 
oomplished  by  electricity  alone.  The  tubes  were  readily 
permeable.  The  patient  shortly  after  left  the  city,  and 
we  have  had  no  information  in  regard  to  his  subsequent 
progress. 

In  cases  of  ulceration  of  the  membrana  tympani  and 
chronic  inflammation  of  the  middle  ear,  accompanied 
by  offensive  discharge,  and  associated  with  deficient 
vital  force,  we  have  found  that  general  tonic  applica- 
tions wonderfully  assist  the  local  treatment  of  syringing 
and  astringents.  Of  those  patients  whom  we  treat  for 
pharyngitis  and  ulceration  of  the  membrana  tympani, 
those  upon  whom  we  employ  electricity  as  an  adjuvant 
seem  to  progress  more  rapidly  and  more  satisfactorily 
than 'those  upon  whom  we  do  not;  and  so  marked  is 
the  difference  in  the  results  that  we  now  rarely  treat 
such  cases  for  any  length  of  time  without  resorting 
either  to  general  or  local  applications. 

Case  Second. — Gteorge  B.,  of  Conn.,  a  lad  of  14,  when 
ten  years  old  had  S'jffered  from  the  measles,  that  had  left 
him  with  ulceration  of  the  membrana  timpani,  and 
inflammation  of  the  middle  ear  on  the  left  side,  attended 
with  abundant  and  offensive  discharge.  A  few  months 
before  he  called  upon  us  the  right  ear  had  also  commenced 
to  discharge,  and  some  alarming  symptomn  of  vertigo 
be^an  to  manifest  themselves.  The  pharynx  was  affected 
with  follicular  inflammation,  as  usuallv  obtains  in  such 
cases,  and  an  annoying,  persistent  cough  made  his  friends 
apprehensive  of  tuberculosis.  His  appetite  was  capri- 
cious, his  muscles  flabby,  and  his  general  condition 
below  par. 

Examination  by  the  mirror  and  speculum,  revealed 
the  absence  of  the  left  drum,  and  a  small  perforation  on 
the  inferior  portion  of  the  right  The  hearing  distance 
of  the  left  ear  was  three  inches ;  of  the  right,  two  feet 
The  eustachian  tubes  were  pervious. 

Dr.  D.  B.  St  John  Roosa  afterwards  saw  the  case  in 
consultation,  and  confirmed  the  somewhat  unfavorable 
prognosis  that  we  felt  compelled  to  give.  It  should  be 
stated,  moreover,  that  the  lad  had  been  treated  for  his 
•difficulty  by  various  physicians.  At  one  time  he  sub- 
mitted to  constant  blistering  over  the  mastoid  process, 
for  several  months.  We  decided  to  employ  both  general 


and  local  treatment  The  ears  were  ordered  to  be 
syringed  with  lukewarm  water  every  night,  after  which 
a  solution  of  sulphate  of  zinc  (grs.  iv.  to  3  j.)  was  to  be 
dropped  in  and  retained  for  a  few  minutes,  while  the 
patient  inflated  the  tvmpanic  cavities  by  closing  the 
mouth  and  nostrils  and  blowing  vigorously.  He  visited 
us  over  a  week  regularly,  at  which  times  we  usually 
treated  his  pharynx  by  applications  of  a  solution  of 
nitrate  of  silver,  of  moaerate  strength,  or  by  a  solution 
of  permanganate  of  potash,  and  inflated  and  cleansed 
the  tympanic  cavities  by  Politzer's  apparatus.  There 
was  immediate  temporary  improvement  of  the  hearing; 
but  for  the  first  month  there  was  no  perceptible  dimi- 
nution of  the  discharge.  We  then  began  to  make  use 
of  general  applications  of  the  descending  fiiradaic  cur- 
rent over  the  whole  body,  and  particularly  below  and 
anterior  to  each  auricle,  preswng  the  fingers  firmly 
against  the  skin.  It  was  not  long  before  good  effects 
were  manifest,  so  fitr  as  his  genend  health  was  con- 
cerned, although  the  condition  of  his  ears  improved  but 
slightly.  Whereas,  at  first,  he  was  much  fatigued  by 
the  mere  exertion  of  coming  to  the  city  and  visiting  the 
office,  he  could  now  join  with  alacrity  in  the  vigorous 
sports  of  his  companions.  By  the  Ist  of  February, 
1867,  the  attacks  of  vertigo  became  very  unfrequent, 
the  appetite  had  increased  in  sharpness,  the  sleep 
was  sound  and  undisturbed,  the  pharyngeal  inflam- 
mation and  the  vexatious  cough  had  entirely  disap- 
peared, and  he  had  gained  several  pounds  in  flesn. 
We  now  added  the  internal  administration  of  iron  to 
the  other  remedies;  but  continued  on  with  the  use  of 
the  ear-drops,  and  the  general  applications  of  electricity. 
By  the  1st  of  March  the  discharge  from  the  right  ear 
had  entirely  ceased,  and  in  the  left  had  greatly  subsided. 
Calcined  magnesia,  blown  in  a  few  times  against  the 
inflamed  surface,  at  this  time  seemed  to  operate  favor- 
ably, and  the  patient  was  directed  to  come  occasionally 
for  general  applications,  mostly  discontinuing  the  local 
tieatment  The  hearing  distance  had  increased  on 
the  ri^ht  side  one  foot,  and  on  the  left  two  feet 
In  this  case  the  agents  employed  to  combat  the 
local  inflammation  and  general  debility  were  so  nu- 
merous and  so  varied,  that  it  is  impossible  to  deter- 
mine with  accuracy  just  how  far  the  amelioration  was 
due  to  the  application  of  electricity.  But  as  little  or 
no  progress  was  made  while  mere  local  treatment  was 
employed,  and  inasmuch  as  after  we  began  the  tonic 
applications  all  unpleasant  accompanying  symptoms — 
the  barkiag  cough,  the  irritation  in  the  throat,  vertigo, 
and  generw  weakness— disappeared,  we  naturally  infer 
that  the  electricity  was  a  very  important  if  not  indis- 
pensable adjuvant  to  the  other  remedies. 

Case  Third. — Mr.  L.,  a  clerffymfin  from  Brooklyn, 
came  to  us  Dec.  15,  1866,  compkining  of  a  throat  diffi- 
culty of  fifteen  vears*  standing  that  at  times  had  made 
it  very  difficult  tor  him  to  fulm  his  duties  in  the  pulpit 
Occasionally  he  had  been  compelled  to  rest  entirely,  for 
a  considerable  interval,  from  all  public  speaking.  He 
complained  of  a  feeling  of  heat  and  dryness  in  the 
throat,  and  of  continued  hoarseness,  that  increased  at 
times  so  that  he  could  only  speak  in  a  whisper,  and  also 
of  a  very  annoying  and  persistent  cough.  His  pharynx 
was  so  exceedingly  irritable  that  we  found  it  very 
difficult  at  first  to  make  a  sati^actory  laryngoscopic 
examination ;  but  this  sensitiveness  was  in  a  measors 
overcome  by  perseverance,  and  we  were  enabled 
to  gain  the  vocal  cords,  and  inspect  the  upper  por- 
tion of  the  trachea.  We  found  the  entire  muoooi 
membrane  of  the  pharynx  and  laiynx  affiscted  witfi 
follicular  inflammation.  The  secretion  was  abundant 
especially  in  the  vicinity  of  the  vopaj  cords.    Physical 

digitized  by  Google 


THE  MEDICAL  RECORD. 


161 


examination  of  the  lun^  convinced  us  that  his  cough 
was  mainly  the  result  or  chronic  bronchitis,  and,  as  his 
ffeneral  health  was  excellent,  we  decided  to  emploj 
focal  applications  of  nitrate  of  silver,  and  to  make  use  of 
mhalatioDS,  giving  no  constitutional  treatment  what- 
erer.  He  visited  us  two  or  three  times  a  week,  and 
soon  began  to  improve  slighUj ;  but  as  we  were  not 
satisfied  with  the  progress  he  made,  we  employed 
local  applications  of  electricity.  The  results  were  unex- 
pected. Not  only  were  the  irritating  effects  of  the 
applications  of  nitrate  of  silver  temporarily  relieved, 
but  permanently  beneficial  results  seemed  to  follow  at 

nboth  for  Uie  throat  affection,  and  more  especially 
e  cough,  which  all  along  had  been  one  of  his  most 
^stressing  symptoms.  When  he  discontinued  the  treat- 
ment the  oou^n  had  almost  entirely  disappeared,  and 
the  infiunmation  of  the  larynx  was  in  a  good  degree 
wbdned.  His  vocal  cords  alBo  were  stronger ;  but  we 
advised  him  to  rest  for  a  while  from  his  public  labors, 
in  order  to  avoid  the  danger  of  any  relapse, 
tli  Bboadwat. 


iDrightal  €tctutte. 


OPERATION  FOR  HARE-LIP, 

WITH  REMARKS 

Bt  prof.  FRANK  H.  HAMILTON,  M.D., 

BEFORE  THE  CLASS  OF  '65— *66  OF 

BELLETUE    HOSPITAL   MEDICAL    COLLEGE. 

GiVTLEifEN: — We  brinff  before  you  to-day  a  child,  six 
days  old,  havingsingle  harc-Up,  complicated  with  fissure 
of  the  palate.  Hare-hp,  or  Labium  Leporinum,  as  it  is 
technically  termed,  is  so  called  firom  its  resemblance  to 
the  upper  lip  of  the  hare.  There  are  two  principal 
forms  of  hare-lip,  namely,  simple  and  complicated.  By 
simple  hare-lip  we  mean  that  in  which  there  is  a  fissure 
io  the  lip  only ;  by  a  complicated  hare-lip  we  mean  that 
h  which  there  is  a  fissure  in  the  lip,  and  also  a  fissure, 
more  or  less  extensive,  in  the  roof  of  the  mouth,  or  in 
the  alveolar  arcade.  The  simple  hare-lip  may  be  either 
sn^  or  double ;  that  is,  it  may  exist  on  one  side,  or 
opon  both.  The  complicated  forms  of  harcrlip  also  admit 
01  dirision  into  several  varieties,  but  which  we  will  not 
itop  now  to  describe  particularly. 

Hare-lip  is  a  congenital  affection,  and  is  the  result  of 
an  arrest  of  development  The  upper  lip  being  formed 
from  three  points,  vis.  a  central,  and  two  lateral  points, 
the  arrest  of  development  necessarily  results  in  the  for- 
mation of  a  fissure  upon  one  side,  or  upon  both. 

My  mode  of  procedure  in  operating  for  hare-hp  differs 
somewhat  firom  that  usually  practised;  and  in  order 
that  yon  may  understand  the  value  of  my  experience 
upon  this  subject  I  have  thought  it  proper  to  bring 
before  you  a  tabulated  statement  of  most  of  the  cases 
upon  wluch  I  have  made  operations  in  the  course  of  my 
Hfe;  which  have  been  compiled  by  a  very  intelligent 
young  fi-iend  of  mine.  Dr.  Thayer.  He  has  taken  them 
from  my  various  note-books,  and  from  the  published 
•ccoants  of  my  clinics,  and  has  arranged  them  in  a  con- 
venient form  for  reference.  The  number  which  he  has 
thus  tabulated  is  forty-four  (excluding  two,  which  he 
hai  very  rightly  rejected  as  not  beine  properly  cases 
of  hare-lip).  I  have  been  able  to  find  in  addition  five 
cases,  so  that  this  operation  will  constitute  the  fiftieth 
which  I  have  made  for  hare-Up.  But  the  analysis  which 
I  offer  you  of  my  cases  is  based  upon  these  forty-nine, 
which  are  here  tabulated. 

In  the  first  place  I  have  to  say  that  but  three  times 


in  all  of  the  cases  upon  which  I  have  made  the  opera- 
tion, have  I  failed  to  make  the  Up  unite ;  one  of  these 
was  the  first  case  in  which  I  ever  made  the  operation 
fi)r  hare-Up,  and  in  which  I  committed  the  double  mis- 
take of  employing  hare-Up  pins,  and  committing  the 
patient  subsequently  to  the  charge  of  another  person 
for  treatment  It  is  an  estabUshed  maxim  with  me 
now  never  to  undertake  an  operiition  for  hare-lip,  unless 
I  can  have  the  case  under  my  own  treatment  subse- 
quently ;  beUeving  that  in  a  branch  of  surgery,  in  which 
so  much  depends  upon  minute  detail  both  in  regard  to 
the  operation  and  the  subsequent  dressings,  the  operator 
neither  does  justice  to  himself  nor  to  his  patient,  who 
submits  the  case  subsequently  to  the  care  of  less  expe- 
rienced persons.  Indeed,  I  would  apply  this  rule,  with 
few  exceptions,  to  the  practice  of  any  department  of 
surgery,  which  is  insomuch  an  art  that  it  can  only  be 
acquired  and  practised  skilfully  by  those  who  have  often 
repeated  the  same  manipulation.  When  I  made  my 
firet  operation  for  hare-lip  I  had  heard  the  remarks  of 
Roux,  the  great  French  surgeon,  who  had  declared  that 
two  succenful  results  out  of  every  three  operations 
were  aU  that  could  be  ordinarily  expected.  My  expe- 
rience does  not  confirm  the  accuracy  of  this  statement. 
I  shall  presently  describe  to  you.  with  considerable 
minuteness,  my  own  method,  whicn,  it  will  be  observ- 
ed, is  exceedingly  simple,  both  as  regards  the  mode  of 
prooedure  and  the  instruments  employed. 

The  first  question  which  would  naturaUy  arise  in  this 
connexion  would  be  at  what  period  of  life  is  it  proper 
or  best  to  make  the  operation?  I  reply  in  general 
terms,  other  thinss  being  equiJ,  the  earher  it  is  made 
the  better ;  for  uie  reason,  first,  that  the  earUer  the 
operation  is  made  the  less  the  child  wiU  have  to  dread ; 
second,  the  earUer  the  operation  is  made,  in  my  opinion, 
the  less  the  patient  wiU  actuaUy  suffer  from  uxe  opera- 
tion ;  third,  the  more  prompt  will  be  the  union ;  fourth, 
the  more  perfect  wiU  be  the  configuration  of  the  Up  in 
subsequent  life  *  fifth,  if  it  is  a  compUcated  hare-Up.  with 
fissure  of  the  alveoli,  or  of  the  roof  of  the  mouth,  the 
earUer  tlie  operation  is  made,  the  more  closely  the  sides 
of  this  long  fissure  wiU  eventually  approximate :  and 
finaUy,  the  earUer  it  is  made  the  more  sure  we  are  of 
avoiding  those  future  contingencies  which  from  time  to 
time  may  arise,  and  which  may  rendt^r  a  final  and  com- 
plete deferring  of  the  operation  necessary.  For  exam- 
ple, if  the  child  is  in  complete  health  at  the  period  of 
birth,  we  cannot  be  sure  that  it  will  be  in  actual  health 
again  at  any  subsequent  period.  If  the  child  is  free 
from  eruptive  affections,  we  cannot  be  sure  that  such 
eruptive  affections  may  not  at  any  moment  develop; 
which  eruptions  I  re^urd  as  in  themselves  constitut- 
ing a  sufficient  ground  for  deferring  the  operation. 
Tmrd,  we  shaU  have  to  omit  to  make  the  operation 
during  the  heat  of  the  summer;  it  having  been  my 
experience  that  operations  of  this  kind,  made  upon  in- 
fants or  young  ch  Idren  in  summer,  aie  exceedingly 
Uable  to  prove  fatal,  owing  to  the  fact  that  at  this  season 
of  the  year  aU  infants  are  prone  to  affections  of  the  ali- 
mentary canal;  and  if  we  add  to  the  proneness  to  diar- 
rhoeal  Sections  induced  by  season,  the  provocation  of 
an  operation,  the  danger  from  this  cause  becomes  not 
inconsiderable.  Fourth,  it  is  not,  in  my  judgment, 
proper  to  operate  during  the  period  of  teething ;  and  if 
we  delay  tne  operation  untu  after  teething  has  com- 
menced and  terminated,  then  various  circumstances 
may,  and  are  very  likely  to  interpose  to  prevent  the 
completion  of  the  operation  at  any  subsequent  period ; 
moreover,  by  the  delay  we  have  deprived  ourselves  of 
the  advantages  which  have  already  been  mentioned  as 
belonging  to  the  operation  made  in  early  infancy.  I  have 
not  had  an  opportunity  of  making  an  operation  on  the 


Digitized  by 


operation  on  tn< 

Google 


152 


THE  MEDICAL  RECORD. 


first  day  after  the  birth  of  the  child ;  yet  I  would  not 
hesitate  to  do  so,  if  tie  case  were  presented,  and  the 
condition  of  the  child,  with  the  season  of  the  year,  were 
favorable.  The  earliest  operation  which  I  have  made, 
up  to  this  moment,  has  been  on  the  tenth  day :  and 
from  this  period  I  have  operated  on  all  ages  up  to  thirty- 
five  years  of  life.  Ten  days,  it  was  said  some  years  ago, 
was  the  youngest  age  at  wnich  the  operation  for  hare- 
lip had  been  performed  at  King's  College  Hospital  in 
London.  Dr.  Friedberg  has  operated  three  hours  after 
birth,  ten  hours  after  birth,  and  fourteen  hours  after 
birth;  Bateman  has  operated  four  hours  after  birth; 
Dawson  has  operated  seven  hours  afrer  birth;  Mai- 
gaigne  at  nine  hours;  Dubois  and  Quersant  also  per- 
formed early  operations. 

I  will  now  proceed  to  describe,  with  more  particularity, 
my  own  raetnod  of  operating.  I  employ  in  this  opera- 
tion no  instruments  but  a  common  bistoury,  a  very 
heavy  and  strong-bladed,  sharp  pair  of  scissors,  so  con- 
structed as  that  they  will  not  yield,  and  thus  compress 
without  cutting  the  tissues,  and  a  common  straight  sur- 
geon's needle,  or  one  slightly  curved  at  the  point.  I 
employ  a^so  harness-maker's  silk,  or  the  ordinary  sur- 
geon's silk,  of  large  size,  as  a  suture.  Hare-lip  pins,  in- 
troduced by  Ambrose  Par^,  and  generally  employed  by 
surgeon*?,  from  his  time  down  to  the  present  period,  I 
have  never  used  since  my  first  operation,  which  I  have 
described  as  a  failure.  I  find  no  good  argument  for 
their  use ;  on  the  contrary,  I  find  plenty  of  substantial 
arguments  against  their  use,  and  I  have  come  to  regard 
them  as  a  relic  of  barbarism.  In  addition  to  the  sutures 
I  employ  also  common  adhesive  plaster,  in  a  manner 
which  I  will  hereafter  describe. 

In  regard  to  the  nse  of  anaesthetics  in  this  operation, 
I  may  say  that  I  have  occasionally  employed  them,  and 
I  have  not  seen  firom  them  any  ill  effects.  Infants  pass 
under  the  influence  of  the  anaesthetic  promptly,  and  its 
immediate  and  final  effect  upon  the  circulation  is  less 
marked  than  is  the  case  with  adults.  Nor  do  I  know 
of  an  authenticated  example  in  which  the  life  of  an  in- 
fant has  been  destroyed,  either  directly  or  indirectly,  by 
the  use  of  ether  or  chloroform.  But  inasmuch  as  the 
patients  do  not  suffer  from  apprehension  in  prospect  of 
the  operation,  and  the  operation  can  be  quickly  made, 
and  is  not  apparently  an  exceedingly  painful  one,  rather 
for  the  purpose  of  saving  time  than  otherwise,  I  have 
i^sually,  even  since  the  introduction  of  anassthetics, 
omitted  to  give  them.  I  will,  however,  in  this  case  put 
the  patient  moderately  under  the  influence  of  ether  be- 
fore proceeding  to  the  operation. 

(This  was  done,  the  patient  not  being  completely  in- 
sensible, and  Dr.  Hamilton  then  proceeded  to  make  the 
operation,  adding  the  following  description.) 

I  sei^  the  lip  upon  the  side— if  it  is  a  single  fissure, 
as  in  this  instance— on  which  the  fiii^ure  exists ;  dissect 
up  the  attachment  of  the  Up  to  the  gums,  and  pursue 
the  dissection  until  I  have  completely  elevated  the  ala 
of  the  nose  upon  that  side,  which  is  always  ^rreatly  dis- 
placed; and  without  this  precaution  it  will  be  more 
difficult  to  bring  the  lips  together,  and  the  ala  of  the 
nose  will  remain  permanenUy  diq)laced.  I  then  pro- 
ceed to  the  opposite  side  and  dissect  rapidly  the  slight 
attachments  of  the  margin  of  the  lip  to  the  gums  in 
this  direction  also.  I  now  seize  one  margin  of  the  lip 
between  the  thumb  and  finger  of  my  ledb  band,  and 
with  my  strong  and  sharp  scissors,  I  cut  away  a  straight 
ribbon,  carrying  the  scissors  well  up  into  the  ala  of  the 
nose,  if  the  fissure. extends  Bofkr,  1  then  seize  the  op- 
posite side  in  the  same  manner,  and  remove  a  ribbon 
from  the  margin  of  the  fissure  in  the  same  manner. 
My  purpose  always  is,  to  remove  enough,  so  as  to  make 
the  surfaces  which  are  to  be  brought  into  apposition  as 


broad  as  possible.  I  remember  once  to  have  witnessed 
an  operation  for  ve:jico-vaginal  fistula,  made  by  that 
distinguished  surgeon.  Dr.  Simms.  And  when  he  bad 
completed  his  operation,  I  said  to  him,  "  Doctor,  I  have 
discovered  the  great  secret  of  your  success  in  operating 
for  vesico- vaginal  fistula.  It  is,  I  think,  first,  in  making 
a  very  broad  and  free  incision  of  the  margins  of  the  fis- 
sure ;  second,  in  introducing  your  sutures  far  from  the 
edge."  The  Doctor  acknowledged  that  this  constituted 
the  great  part  of  the  source  of  his  success. 

I  never  use  a  bistoury  for  the  purpose  of  cutting  the 
edge  of  the  fissure ;  for  the  reason  that,  however  sharp 
it  may  be,  it  is  almost  impossible  to  make  the  line  <h 
incision  straight;  and  it  is  difficult  to  secure  the  requi* 
site  breadth  of  surface.  Nor  do  1  deem  it  necessary  to 
use  any  of  those  curiously  constructed  forceps  which 
are  employed  by  some  surgeons,  for  the  purpose  of  seiz- 
ing the  lip  and  indicating  the  direction  in  which  the 
incision  shall  be  made. 

If,  at  this  moment,  the  coronary  artery  springs  with 
a  vigorous  jet,  I  direct  the  assistants  to  seize  upon  th6 
upper  lip  on  either  side  of  the  fissure,  and  hold  it  firmly 
until  I  am  able  to  introduce  my  sutures.    I  introduce 
my  first  suture  at  the  point  of  junction  of  the  vermilion 
border  of  the  lip  with  the  akin,  and  pass  it  directly 
through  to  the  interior  surface  of  the  mouth ;  the  same 
point  of  junction  of  the  vermilion  border  with  the  skin 
upon  the  opposite  side,  indicates  the  point  at  which  the 
needle  must  emerge  in  this  direction.     I  introduce  this 
lower  suture  first,  in  order  that  I  may  bring  the  lower 
margins  of  the  lip  together  for  a  moment,  and  be  able 
to  determine  precisely  at  what  point  upon  the  opposing 
surfaces  of  the  fissure  the  next  suture  should  be  passed. 
The  second  suture — and  it  is  seldom  that  I  use  more 
than  two,  unless  it  is  in  adults — I  introduce,  dcte  to  the 
a' a  of  the  nose  on  the  side  of  the  face  on  which  the 
fissure  exists ;  and  bring  it  out  on  the  opposite  side  at 
such  a  point  as  has  been  determined  by  the  immedi- 
ately preceding  measurement,  is  proper.    Both  of  these 
sutures  are  introduced  far  from  the  edge.    In  a  child 
of  this  age  I  introduce  them  at  least  a  quarter  of  an 
inch  from  the  edge.     If  the  fissure  was  very  wide,  I 
would  introduce  them  half  an  inch  from  the  edge.    And 
in  children  who  are  older,  in  whom  the  skin  is  less  ex- 
tensile, it  is  my  general  practice  to  introduce  the  suture 
half  an  inch  from  the  freshened  margins  of  tlie  fissure. 
I  now  close  the  upper  suture  first,  this  part  of  the  fis- 
sure requiring  the  least  strain,  and  bring:  the  opposing 
surfaces  in  apposition,  and  tie  with  an  ordinary  sur- 
g^eon's  knot,  snugly.    I  then  close  the  lower  suture  in  a 
similar  manner.     Whatever  haemorrhage  has  occurred 
from  die  coronary  vessels,  now  immediately  ceases,  the 
tightness  of  the  sutures  being  always  adequate  to  arreit 
the  haemorrhage  in  these  vessels.    I  do  not  now  apply, 
as  some  have  recommended,  a  small  delicate  suture  to 
the  free  vermiUon  border  of  the  lip,  for  the  purpose  of 
avoiding  the  slight  indentation  at  this  point,  which  oc- 
casionally occurs  after  the  completion  of  the  operation, 
finding  that  the  suture  passing  through  the  free  ver- 
milion border  holds  upon  tissues  which  are  so  exceed- 
ingly frail  and  delicate  that  it  scarcely  ever  fails  to  woHc 
its  way  out  in  the  course  of  a  few  hours,  or  a  few  days 
at  most,  after  the  operation  is  made.    I  have  used  this 
suture  a  few  time^  but  it  serves  no  useful  purpose. 
Now  the  operation  is  completed  by  placing  across  the 
upper  lip  from  one  side  of  the  uice  to  the  opposite, 
strong  bands  of  adhesive  plaster,  drawing  the  lips  to« 
gether  with  as  much  firmness  as  possible ;  so.  indeed, 
as  to  corrugate  the  mouth  into  a  very  unseemly  shape. 
The  object  of  these  adhesive  plasters  is  to  take  off  at 
once  all  strain,  as  far  as  possible,  which  has  been  resting 
upon  the  sutures;  and  to  leave  to  the  adhesive  plasters 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


153 


ntber  than  to  the  eutores,  the  task  of  supporting  the 
fipe;  the  sutures  serving  the  purpose,  mainly,  of  keep- 
ing a  more  accurate  adjustment  of  the  margins  of  the 
ficBore,  and  standing  as  a  ''  reserve  *'  in  case  the  adhe- 
BTe  piaster  should  give  way.  These  adhesive  plasters 
diOQld  be  broad  upon  the  surface  of  the  cheek,  and  com- 
paratively narrow  as  they  cross  the  upper  lip.  It  is  not 
necessary  to  retain  them  in  place  by  bandages,  or  com- 
presses^ ordinarily.  When  these  plasters  are  thus  ap- 
plied, I  add  two  or  three  narrow  strips  of  adhesive  plas- 
%sr  upon  the  lower  portion  of  the  upper  lip,  for  another 
purpose.  I  have  observed  that  if  the  lower  margin  of 
tiie  lip  is  not  covered  by  the  adhesive  plaster,  it  becomes 
dry,  soon  swells,  rolls  ouL  and  cracKs  open,  and  the 
process  of  union  is  defeatea  at  this  point.  While,  if  it 
18  covered  in  by  the  a<fliesive  plaster — the  plaster  im- 
bricating the  lower  margin  of  the  lip  to  the  extent  of 
from  a  quarter  to*  half  an  inch,  it  serves  to  compress  the 
lower  part  of  the  Hp  and  to  prevent  its  swelUne  out ;  it 
keeps  It  in  a  state  of  moisture,  which  is  more  favorable 
(o  tne  reduction  of  inflammatory  action ;  and  what  is 
ofeoaal  importance,  it  protects  the  lip  from  the  spoon 
eoaptoved  by  the  nurse  in  feeding  the  child. 

In  ue  flirther  treatment  of  this  case,  it  is  my  practice 
to  see  the  patient,  if  possible,  twice  daily,  morning  and 
night  If  1  find  that  the  plasters  have  slipped  a  little 
upon  the  face,  or  have  become  moistened,  through  the 
carelessness  of  the  nurse  in  feeding  the  patient,  and 
thus  have  been  permitted  to  stretch,  I  direct  the  assist- 
aat  to  stand  behind  the  head  of  the  patient,  and  to  press 
the  cheeks  forward  well,  while  I  cut  the  centre  ol  one 
or  more  of  the  straps,  remove  them  from  one  side  and 
the  other,  and  substitute  for  them  fresh  straps,  paying 
no  regard  to  the  hct  that  the  straps  which  remain  may 
be  thus  more  or  kes  doubled  up  into  folds  across  the  top 
of  the  Hp,  for  these  are  certain  to  be  moist  and  soft,  and 
make  no  painful  pressure.  At  this  point  it  may  be  well 
to  add  that,  in  order  to  diminish  the  chance  of  the  plas- 
ters' stretching,  when  they  have  become  moistened,  the 
plaster  should  be  cut  in  the  direction  of  the  warp,  and 
not  the  woof,  that  is,  in  the  long  direction  of  the  sheet 
I  wish  also  to  add,  that  I  have  used  the  isinglass  plaster, 
and  other  plasters,  and  I  do  not  find  any  of  them  suit 
my  purpose  so  w^  for  this  operation,  as  the  common 
diicnjlon  plaster. 

I^  withm  twelve  to  twenty- four  hours  after  my  first 
dressing,  I  observe  any  accumulation  of  milk,  or  of 
BOfdes  of  any  kind,  upon  the  surface  of  the  lip,  in  the 
vicinity  of  the  wound,  I  take  pains  to  remove  it  care- 
fiilly  with  a  soft  sponge,  moistened  with  tepid  water — 
the  water  coutainmg  a  little  castile-soap.  This  I  do 
because  I  have  observed  that  a  great  degree  of  the  suc- 
cess in  this  operation  depends  on  keeping  the  lip  con- 
^antly  so  well  cleaned,  and  free  from  excoriating  mate- 
rial, as  that  no  abrasions  occur  to  interfere  with  the  pro- 
cess of  cicatrisation.  It  is  one  of  the  most  important 
means,  also,  in  the  prevention  of  erysipelas. 

At  each  subsequent  observation  of  tne  case,  I  readjust 
or  renew  more  or  less  of  the  plasters,  according  as  the 
exigencies  of  the  case  may  seem  to  demand ;  and  I 
never  ful  to  observe  again  the  condition  of  the  wound 
ai  to  cleanliness^  nor,  after  the  lapse  of  the  second  or 
third  day,  do  I  udl  to  note  particularly  the  condition  of 
the  points  at  which  the  sutures  have  passed  through  the 
flesh ;  and  if  I  observe  anything  like  an  appearance  of 
nkeration,  or  of  giving  way,  I  not  only  cleanse  it  tho- 
roughly with  tepid  water  and  soap,  but  I  spply  to  it  a 
weak  solution  of  nitrate  of  sUver,  say  gr.  L  to  3  ij.  wa- 
ter. I(  on  the  second  or  third  day,  I  observe  that  con- 
■derable  inflammatory  action,  with  more  or  less  uloera-* 
tive  action,  has  ensued,  I  may  deem  it  advisable,  as  I 
have  done  in  a  ftw  casesi  to  remove  the  sutures,  and 


depend  entirely  upon  the  adhesive  plasters.  I  wish  it 
to  be  distincUy  understood,  however,  that  it  is  my 
general  practice,  now,  to  leave  the  sutures  until  the  fifth, 
sixth,  or  seventh  day:  regutling  them  as  important 
means  of  reserve,  if,  by  any  accident,  the  adhesive 
plasters  should  become  suddenly  loosened.  I  do  not 
find  that  the  little  wounds,  which  are  made  in  the  flesh 
by  the  sutures,  leave  any  permanent  marks,  if  the  opera- 
tion is  made  early  in  life.  This  practice  of  renewing 
the  adhesive  plasters,  I  continue  from  day  to  day,  for 
two  or  three  weeks,  and  then  they  may  be  leffe  oflF  with 
safety.  It  will  be  seen  that  the  employment  of  silver 
wire,  or  any  metallic  suture,  in  this  mode  of  operating, 
would  be  attended  with  certain  inoonveniences,  the 
ends  of  the  wires  being  subjected  to  the  pressure  of  the 
adhesive  plasters;  and  as  1  have  been  sufficiently  suc- 
cessful with  bilk  sutures,  and  they  are  not  liable  to  this 
particular  objection,  I  see  no  reason  why  I  should  sub- 
stitute anything  for  them. 

When  I  say  that  of  forty-nine  cases,  forty-six  have 
united,  I  do  not  wish  it  to  be  understood  that  in  all  the 
cases  the  margins  of  the  lip  have  united  to  the  whole 
extent  of  the  surfaces  which  have  been  made  raw.  In 
some  few  instances,  the  margins  have  ^iven  way  above, 
within  the  al»  of  the  nostnls ;  but  this  has  occurred 
particularly,  I  think,  when  the  operation  has  been  made 
late  in  life,  the  tissues  then  bemg  less  extensile,  and 
when  I  have  omitted  to  dissect  up  sufficiently  freely 
the  ala  of  the  nose,  upon  that  side  upon  which  the  fis- 
sure existed.  These  exceptions,  however,  have  occurred 
only  occasionally  in  the  course  of  my  practice.  It  has 
sometimes  also  happened  that  the  lip  has  failed  to  unite, 
completely,  at  its  lower  margin,  particularly  on  its  ver- 
milion border,  and  a  slight  fissure^  or  depression,  has 
been  the  consequence ;  which  I  beheve,  however,  when 
the  operation  has  been  performed  early,  has  been  over- 
come by  the  lapse  of  time ;  certainly  it  has  in  all  those 
cases  in  which  I  have  been  permitted  to  see  the  patient 
after  several  years.  But  I  know  of  no  method  by  which 
this  latter  accident,  viz.  the  giving  wav  of  the  lower 
margin  of  the  lip,  can  be  more  effectually  avoided,  than 
bj  my  own — whether  that  method  consists  in  the  pecu- 
liar mode  of  incision  upon  the  lower  border,  or  in  the 
addition  of  the  supplementary  stitch  upon  this  border. 
I  have  tried  them  myself,  and  have  seen  them  tried  by 
others,  and  I  prefer  my  own  plan.  It  must  not  be  for- 
gotten that  the  lower  stitch  must  be  introduced  pre- 
cisely at  the  point  of  junction  of  the  vermilion  border 
with  the  integument  And  it  mu»t  not  be  forgotten 
that  to  secure  it  still  flirther  amnst  giving  way  at  this 
point,  the  protection  afforded  by  the  adhesive  plaster  is 
absolutely  essential 

During  the  progress  of  the  operation,  and  in  the  after 
treatment  of  the  case,  it  is  my  custom  to  submit  the 
child  to  no  flirther  conflnement  than  is  made  by  with- 
drawing the  arms  from  the  sleeves  of  the  dress,  placing 
them  within  the  waist  of  the  dress,  and  then  putting 
the  belt  around  the  waist.  This  gives  the  child  a  cer- 
tain fireedom  of  motion  of  the  hands,  while  it  does  not 
en^le  it  to  reach  the  face. 

I  have  flirther  to  remark,  that  when  I  speak  of  the 
extraordinary  success  of  my  operation,  I  only  refer  to 
the  matter  of  union  of  the  opposing  surfaces  of  the  lip. 
Death  has  occurred  from  the  operation  in  a  certain  num- 
ber of  cases,  the  precise  number  I  am  not  now  prepared 
to  state ;  but  in  no  instance  has  this  taken  place  until 
after  the  imion  has  been  completed.  It  is  certain,  there- 
fore, that  none  of  these  chiloren  have  died  of  the  imme- 
diate shock  of  the  operation,  since  none  have  died  earlier 
than  the  eighth  or  tenth  day.  None  have  died  from  the 
loss  of  blood.  In  those  cases  which  I  can  now  recol- 
lect, without  reference  to  my  tables^  in  wjuch  death  has 


Digitized  by  VjOO^  _ 


154 


THE  MEDICAL  RECORD. 


taken  place  clearly  traceable  to  the  operation,  the  chil- 
dren hare  died  either  from  diarrhoeaf  affections,  or,  aa 
in  one  instance,  from  an  erysipelatous  inflammation, 
which  supervened  as  late  as  the  fourteenth  day.  It 
must  be  remembered,  also,  that  the  majority  of  these 
infants  are  not  robust.  The  yery  fact  of  an  arrest  of 
development,  in  my  judgment,  usually  argues  some  cod- 
stitutional  defect,  yet  not  invariably.  In  fo^owing, 
therefore,  the  histories  of  these  children,  I  am  not  sur- 
prised to  find  that  not  many  of  them  have  survived 
to  adult  life. 

I  cannot  now  consider  the  double  hare-lip  of  a  simple 
character,  or  that  in  which  the  fissure  does  not  extend 
through  the  alveoli ;  nor  can  I  consider  at  this  time  the 
treatment  which  would  be  applicable  to  the  various 
complications.  My  remarks  have  been  based  entirely 
upon  the  example  of  single  hare-lip,  which  is  now  pre- 
sented to  you.  It  is  true,  however,  that  to  a  very  ^reat 
extent,  the  modes  of  procedure  which  have  here  been 
adopted,  I  have  found  i^plicable  to  all  the  varieties  of 
double  and  complicated  hare-lip.  But  of  these,  we  shall 
have  to  speak  at  some  future  Ume. 

The  reporter  has  made  the  following  analysis  of  these 
tables: 

Of  single  and  uncomplicated  hare-lip  operations,  the 
number  is  17;  of  single  and  complicated,  the  number  is 
22 ;  c^  double  and  complicated,  the  number  is  11.  Total, 
50,  indudiug  the  operation  wnich  has  just  been  made. 
Averaged  according  to  the  ages  they  are  as  follows: 


day,  from  exhaustion.    This  is  case  thirty-two,  ahready 
mentioned  as  an  example  of  partial  fiulore. 


Ag^ 

Stoglo 

and  nncom- 

plioatod. 

Single 

end 

eompUoated. 

Doable 

and 

oomplioated. 

Totri. 

From  7  dftys  to  1 
month. 

1  to  Smooths 

8  to  S  months 

6  months  to  1  yoar 

1  to  S  yean 

Otot  %jt%n 

None. 

4 
S 
2 
None. 
7 

4 

1 

6 

IS 
11 
5 

4 
19 

Cases  in  which  incision  failed  to  unite :  ^ 

Case  23:  Child  2  months  old;  single  and  complica- 
ted. Operation  made  with  hare-Hp  pins,  and  child  left 
in  the  hands  of  another  surgeon. 

Case  35 :  Single  and  complicated ;  child  22  days  old. 
The  mother,  an  Irishwoman,  Uving  in  a  shanty;  did 
not  return  to  Dr.  Hamilton  until  the  fifth  day  after  the 
operation,  when  the  adhesive  plasters  were  found  to 
have  become  entirely  loosened. 

Case  32 :  Single  and  not  complicated ;  feeble  child,  7 
months  old.  Incised  the  edges  of  the  fissure  with  a 
bistoury,  and  did  not  leave  a  sufficiently  wide  margin 
for  adhesion.  Union  had  taken  plaoe  on  the  fourth  day : 
after  which  the  child  rapidly  sank  from  diarrhosa,  and 
died  on  the  tenth  day,  the  union  which  had  occurred  hav- 
ing given  away  through  half  its  extent  by  the  eighth  day. 

CS  those  who  died,  apparently  directly  or  indirectly 
in  consequence  of  the  operation,  the  first  was  a  child 
five  months  old,  the  operation  having  been  made  in 
midsummer.  The  child  died  on  the  eighth  day.  of 
diarrhoea  and  prostration.  In  the  seoond  case,  the  child 
was  three  months  old ;  the  operation  was  made  again 
in  midsummer;  erysipelas,  diarrhosa,  and  a  general 
wasting  supervened,  and  death  occurred  at  the  end  of 
five  weeks.  The  third  oase  was  a  double  complicated 
hare-lip,  in  dhild  four  weeks  old;  died  at  the  end  of  two 
weeks  of  diarrhoea  and  general  marasmus.  The  fourth 
case  was  of  double  complicated  hare-lip,  in  a  child  five 
weeks  and  five  days  old;  died  on  the  fifteenth  day,  of 
general  marasmus.  The  fifth  oase  was  single  and  not 
complicated;  child  seven  months  old;  died  on  the  tenth 


Vitpatte  of  l^0fl)iital0. 


LONG  ISLAND  COLLEGE  HOSPITAL. 

A  SERIES  OF  CASES  ILLUSTKATING  CARDIAC 
DISEASE. 

Selectid  from  Pbof.  Fliht's  Ciiiincs. 

(Reported by 0. C. Spabbow, M.D., CUnloal  Atsletant to tbeChalr of 
PneUoal  Medidne  and  Pathology.) 

Casi  II. — AorUe  Valvular  Lenoru:  Mitral  Dired 
Murmur  implying  no  Lesiom  of  the  MUnd  Vahe, 

Eutory, — ^Bridget  P..  «t.  46  yeanL  a  domestic,  was 
admitted  to  hospital  while  suffering  nrom  intermitttent 
fever.  She  states  that  fifteen  years  ago  she  experi- 
enced a  severe  attack  of  articular  rheumatism,  inverting 
most  of  the  larger  joints  of  the  body ;  was  confined  to 
the  bed  for  several  weeks.  She  has  not  bad  an  acute 
attack  since,  butfrequentlv  experiences  rheumatic  pains 
in  different  parts  of  her  body.  She  complains  of  no 
urgent  symptoms  referable  to  the  heart. 

Physical  EoKvminaiion  of  Heart — The  impulse  of  the 
apex  beat  is  in  the  fifth  intercostal  ^ace,  on  a  vertical 
line  passing  through  the  nipple.  There  is  moderate 
enlargement  of  the  organ,  with  evidence  of  predomi- 
nant hypertrophy.  On  applying  the  stethoscope  an 
aortic  direct  and  aortic  regurgitant  murmur  is  heard. 
The  latter  has  its  maximum  of  intensity  over  the  body 
of  the  organ.  Over  a  circumscribed  space  near  the  apex, 
a  feeble  mitral  direct  murmur  is  distinctly  appreciable. 

CommenU. — The  chief  point  of  interest  belonging  to 
this  oase  relates  to  the  occurrence  of  a  mitral  direct 
murmur,  associated  with  aortic  valvular  lesions.  This 
murmur  has  not  unfrequently  been  observed  in  this 
connexion  during  life,  in  cases  in  which  a  post-mortem 
examination  revealed  no  lesions  of  the  mitral  valve. 
Dr.  Flint  offered  the  foUovnng  original  explaoationy 
which  seems  adequate  to  account  for  its  occurrence 
under  these  circumstances:  Following  inmiediately 
upon  the  diastole  of  the  ventricle,  the  regurgitant 
stream  of  blood  begins  to  enter  the  cavity  of  the  ven- 
tricle from  the  aorta,  and  since  the  systole  of  the  auri- 
cle precedes  by  a  brief  interval  that  of  the  ventricle, 
the  blood  is  also  slowly  trickling  down^  by  force  of 
gravity,  through  the  auriculo- ventricular  orifice.  When, 
therefore,  the  auricle  comes  to  contract,  finding  Uie 
cavity  of  the  ventricle  already  partly  fiUed,  and  the 
curtains  of  the  mitral  valve  floating  out  loosely  in  the 
blood,  they  are  thrown  into  a  state  of  vibration,  which 
produces  the  murmur.  This  explanation  is  rendered 
still  further  probable  by  observing  the  effect  produced 
upon  the  curtains  of  the  valve,  by  ii^ecting  water 
through  the  mitral  orifice  into  the  ventricle.  They 
first  float  out  loosely  upon  its  surfiM)e,  and  are  finally 
dosed,  when  the  cavity  becomes  filled. 

Cao  m. — Valwhr  ZeaionB  :  StAacute  PnmemaniUiM^ 
Albuminwria, 

May  24.— i?titory.-^ames  Clohan,  set  38  yeitfs.  He 
dates  back  his  illness  three  weeks.  Supposes  that  he 
contracted  a  cold;  had  an  annoyinff  cough  and  ex- 
pectoraticm;  sputa  sometimes  streaked  with  blood.  At 
the  end  ot  a  week  these  symptoms  had  nearly  sub- 
sibed ;  when,  without  any  a(^)arent  cause,  the  cough 
became  mucn  increased,  accompanied  by  rusty  sputa. 
Suffered  lancinating  pain  in  the  side,  which  was  most 
severe  at  the  dose  of  a  deep  inspiration.  Felt  chilly 
sensations.  No  marked  f^bnle  movement  His  appe- 
tite has  continued  fiur.    Bowels  regnlar.    Has  not  been 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


155 


coofined  to  the  bed.  Kever  had  artioiilar  rheumatism. 
Has  suffered  some  deficiency  of  breath  on  exercise  for 
seferalyean. 

Phfdcal  BmmmaUon, — Lungn, — Slight  dulness  over 
the  posterior  lobe  of  the  right  lung.  Crepitant  and  sub- 
crepitant  dUes.  Exaggerated  vocal  and  whispering 
resooaooe.  Some  snbOTepitant  r41ee  are  also  heard  on 
the  left  side,  more  marked  behind  than  in  front 

HmrL — The  impulse  of  the  apex  beat  occnpies  its 
normal  situation.  No  enlargement  exists.  He  pre- 
eeots  two  pret^  load  murmurs,  viz.  mitral  direct  and 
aortic  direct. 

Urime, — ^This  has  a  smoky  color,  and  contains  a  oon- 
ilderable  quantity  of  albumen.  No  microscopical  ex- 
imination  was  made. 

5 .    Syr.  papaveris  f  J  ij. 

S.  Teaspooi^  every  fiye  hours. 

Jane  5. — Patient  reports  that  since  his  last  visit  at 
the  dinic  he  has  had  dropsj:.  This  has  chiefly  disap- 
peared, but  there  is  slight  pitting  of  the  skin  over  the 
steraum  and  legs.  His  limbs  have  at  times  been  cede- 
matoos  before.  The  urine  has  a  better  color,  but  still 
ooataios  albumen.  His  cough  continues  troublesome, 
and  he  complains  that  his  appetite  is  becoming  poor. 
Physical  examination  of  the  chest  reveals  about  the 
same  condition  as  at  last  visit 
9  •    Potassii  iodidi  3  ij. 

Tinct  gentiance  comp.  f  §  ij. 

Syr.  papaveris  f  |  L 

Aqu»pur8df|j.  M. 

Sig.  TeaspoonM  every  six  hours. 

Patient  did  not  again  return. 

(hmfiMWiB, — ^We  have  already  seen  that  valvular 
lesoDS,  and  most  of  all,  mitral  obstructive  lesions,  tend 
direcU^  to  induce  congestion  of  the  lungs,  accompanied 
by  vanou^  symptomatic  events,  as  cough,  dyspnoea,  etc. 
Ais  congestion  predisposes  to  bronchitis^  and  even 
pneumonitis.  Idiopathic  bronchitis  has  httle  or  no 
tendency  to  eventuate  in  the  latter.  In  this  case  the 
effects  of  the  obstructive  lesions  have  obvioudy  been 
inopaffated  beyond  the  pulmonary  organs,  to  the  right 
side  of  the  heart ;  reaching  even  to  the  systemic  venous 
drculation.  The  venous  trunks  and  branches,  owing 
to  the  retarded  flow  of  blood,  have  become  engor^d 
and  distended,  until,  by  a  process  of  mere  mechanical 
tamsudation,  a  portion  of  the  blood  serum  has  escaped 
through  the  coats  of  the  vessels ;  and  hence  the  dropsy. 
A  point  of  special  mterest  in  this  case  relates  to  the 
albuminuria.  In  cases  presenting  oardiao  dropsy,  it  is 
not  uncommon  for  the  urine  to  contain  a  trace  of  albu- 
men, without  implying  the  existence  of  any  degenera- 
tive affection  of  the  kidneys. 

Instances,  however,  of  the  existence  of  genuine 
Brig^t's  disease  with  organic  affections  of  the  hearty 
have  been  observed  so  frequently  as  to  lead  to  the 
<^nion  that  they  sustain  a  causative  relation  to  each 
other. 

Assuming  this  to  be  true,  the  question  arises — ^Which 
IS  the  primary  affection  ?  The  anatomical  relations  of 
the  kidneys  render  them  eflj[>ecially  liable  to  passive  con- 
nstkm  by  obstructive  lesions  cf  the  cardiac  valves. 
Now,  whether  congestion  thus  occurring  be  sufficient 
to  induce  organic  disease  of  the  kidneys,  or,  on  the 
other  hand,  whether  the  unemic  oondition  of  the  blood, 
incident  to  Brigfat's  disease,  by  primarily  determining 
spdocarditis  or  pericarditis,  may  thus  lay  the  founda- 
tkm  for  te  organic  cardiac  affection,  are  points  which 
cannot  be  regarded  as  yet  settled.  Ii  is  not  improbable 
that  in  this  case,  the  renal  disease  has  contributed  to 
pvodQce  the  dropsy. 


Intebnal  Strakgulation  of  thb  Bowel  bt  a  band, 

ASSOCIATED  WrTH    A    REDUCIBLE    HeRNIA,    SUCCESSTITLLT 

TREATED  BT  OPERATION. — ^Thomos  Bryant,  P.R.C.S.,  As- 
sistant-Surgeon to  Guy's  Ho^itaL  reports  a  case  with 
the  above  caption  in  the  Lancet.  It  was  that  of  a  gen- 
tleman, aged  fiily-one,  who  bad  been  ill  for  several 
days  with  symptoms  of  intestinal  obstruction.  The 
patient  had  been  the  subject  of  an  inguinid  hernia  on 
the  right  side  for  twenty-five  years,  for  which  he  had 
worn  a  truss ;  during  that  period  the  bowels  had  come 
down  on  several  occasions,  but  it  had  only  given  pain 
on  one— some  six  months  previously.  On  the  morning 
of  December  28th,  during  the  exertion  of  dragging  up 
a  tree,  the  hernia  partially  descended,  but  it  was  at  once 
readily  returned  on  the  application  or  the  hand ;  vomit- 
ing, however,  soon  appeared,  and  pain  situated  on  the 
right  side  of  the  umbilicus.  These  symptoms  continu- 
ing on  the  29th  and  30th,  and  increasing  in  severity. 
Dr.  Wilkinson  was  sent  for.  A  careful  examination 
was  then  made^  but  no  hernia  was  found ;  there  was  a 
large  opening  into  the  abdomen,  but  no  swelling  nor 
pain,  even  on  deep  pressure  being  made.  On  Dec.  31st 
(the  third  day)  the  symptoms  becoming  more  severe, 
vomiting  being  ffecai,  Dr.  Wilkinson,  who  saw  the 
necessity  for  an  operation,  called  in  tne  assistance  of 
the  author.  The  seat  of  the  hernia  was  then  examined, 
but  no  indications  of  anything  wrong  in  these  parts 
could  be  made  out,  yet  marked  symptoms  of  intestinal 
strangulation  existed;  pain  in  the  abdomen  was  very 
severe ;  it  v^as  situated  to  the  right  of  the  umbilicus, 
and  paroxysmal.  Under  those  circumstances  an  ezplo- 
ratonr  operation  in  the  region  of  the  hernia  was  pro- 
posed, and  power  ffiven  by  the  patient  to  do  whatever 
might  be  deemed  £e  best.  Chloroform  was  given,  and 
the  ring  of  the  direct  inguinal  hernia  exposed ;  no  signs, 
however,  of  any  strangulation  of  the  bowel  by  the  parts 
concerned  in  the  hernia  could  be  made  out.  A  piece 
of  omentum  existed  in  the  hernial  saa  but  no  bowel. 
The  finger  could  also  be  readily  passed  into  the  abdo- 
men, and  the  neck  of  the  sac  was  perfectly  free.  The 
bowel  which  came  into  view  was,  however,  clearly 
strangulated,  for  it  was  of  a  bright  cherry  color,  and 
oedematous.  Under  these  circumstances  the  rine  was 
enlarged  upwards  and  the  strangulated  bowel  drawn 
down ;  the  finger  of  the  author's  right  hand  was  then 
passed  along  the  bowel,  used  as  a  guide,  upwards  into 
the  abdomen  towards  tne  point  of  fixed  pain.  When  it 
had  been  passed  as  fiur  as  it  could  go,  and  as  much  trac- 
tion had  been  put  upon  the  bowel  as  was  deemed  justi- 
fiable, a  tight  band  was  clearly  felt  The  abdominal 
incision  was  then  enlarged,  and  the  band,  which  was 
made  tense  by  the  finger,  was  carefully  divided  by  a 
pair  of  scissors  passed  into  the  belly,  its  points  being 
well  pressed  into  the  pulpy  portion  of  the  finger  till  the 
band  was  reached.  The  wound  was  then  dosed.  On 
the  tliird  day  the  bowels  acted  naturaUy,  and  a  rapid 
convalescence  followed. 

Treatment  or  Quinsy  Sore  Throat. — The  London 
Xonoff  publishes  an  interesting  report  of  the  treatment 
of  tonsillitis,  adppted  by  physicians  at  the  several  metro- 
poHtan  hospitals,  firom  which  we  make  a  few  extracts. — 
Dr.  Anstie,  Westminster  Hospital,  believes  that  in  the 
suppuration  variety  two  remedies  only  are  of  real  value. 
If  tne  case  be  seen  eariy — ^i.e.  within  forty-eight  hours 
of  the  occurrence  of  decided  pain,  before  the  swelhnp 
has  become  definite  in  form,  and  more  especially  if 
there  has  been  no  shivering  and  the  febrile  action  is  but 
sBght)  the  application  of  strong  locaL-astringents  is 
Digitized  by  VjC  „       ^_ 


156 


THE  MEDICAL  BECORD. 


almost  certainly  curative.  The  rough  way  of  using 
this  treatment  is  to  order  the  patient  to  gargle  every 
half  hour  with  a  solution  of  alum — twenty  grains  to  the 
ounce.  A  more  precise  and  effective  use  of  the  same 
astringent  can  be  made  by  throwing  such  a  solution,  in 
the  pulverised  form,  against  the  affected  part  Another 
effective  mode  of  lociu  adstriction  is  the  application  of 
tincture  of  sesquichloride  of  iron  on  a  sponge  carried 
by  a  whalebone,  which  may  be  firmly  pressed  against 
the  part.  The  other  remedy  besides  loc^d  adstriction  is 
the  use,  in  suitable  cases,  of  purgative  medicine.  If  (and 
only  in  this  case)  there  is  reason  to  think  the  bowels 
are  loaded,  a  brisk  purge  of  any  kind  which  does  not 
produce  exhausting  serous  exhalation  will  frequently 
give  great  and  speedy  relief. 

If  the  disease  has  plainly  gone  on  to  the  formation  of 
pus,  the  above  remeoies  are  useless,  and  will  only  worry 
the  patient.  Our  attention  should  then  be  directed, 
Dr.  Anstie  believes,  to  soothe  pain,  and  to  keep 
the  swelling  within  boundsL  whHe  we  also  support 
the  patient's  strength.  Hot  fomentations  and  poultices 
should  be  applied  around  the  throat,  the  patient  should 
gently  inhale  the  steam  of  boiling  water,  and  he  should 
be  given  strong  beef-tea  and  small  quantities  of  wine 
or  brandy  every  four  hours.  In  nine  oases  out  of  ten 
the  pus  may  be  left  to  find  a  natural  opening,  and  only 
the  occurrence  of  serious  mechanical  dyspnoea,  or  the 
appearance  of  a  tendency  to  spreading  of  the  suppura- 
tion, should  induce  us  to  use  the  lancet. 

Dr.  WilBon  Pox  (University  College  Hospital)  treats 
ordinary  cases  of  tonsillitis  which  present  themselves 

•  within  the  first  forty-eight  hours  of  the  invasion  of  the 

•  disease  with  a  brisk  mercurial  cathartic,  followed  by  a 
saline  aperient  draught.  In  cases  which  have  even  run  a 
course  of  three  or  four  days,  the  same  plan  is  found  bv 
him  to  be  beneficial,  if  the  bowels  have  not  been  previ- 
ously acted  upon.  Even  in  the  early  stages,  unless  the 
use  of  gargles  gives  much  pain,  he  employs  the  follow- 
ing formula  for  this  purpose : — Chlorate  of  potash,  three 
drachms ;  nitrate  of  potash,  half  an  ounce ;  glycerine, 
half  an  ounce ;  water,  eight  ounces.  When  seen  early, 
this  course  is,  in  his  experience^  almost  invariably 
sufficient  to  cut  short  the  disease  in  a  few  days'  time  ; 
and  he  scarcely  recollects  an  instance  where  it  has  been 
adopted  in  which  abscess  has  ensued.  In  cases  of  very 
severe  swelling,  he  has  occasionally  found  scarification 
useful ;  but  he  regards  these  as  quite  exoeptionaL  If 
ulceration  supervenes,  either  upon  the  tonsus  or  on  the 
fauces,  the  solution  of  nitrate  of  silver,  of  the  strength 
of  fifteen  grains  to  the  ounce,  is,  in  his  opinion,  the  best 
remedy ;  and  it  may  be  advantageously  applied  to  the 
tonsils,  when  suppuration  is  not  present,  in  cases  where 
the  swelling  lasts  longer  than  nve  or  six  days.  Dr. 
Fox  strongly  deprecates  the  use  of  the  soUd  nitrate 
of  silver  in  the  eariy  stages  of  the  disease. 

Dr.  Clapton  (St  Thomas's  Hoqutal)  reoommends  the 
usual  depletory  remedies,  but  objects  to  stimulating 
gargles  in  the  early  stages.  When  a  patient  has  been 
the  subject  of  repeated  attacks  of  acute  quinsy  ending 
in  suppuration,  the  plan  of  applying  a  liniment  of  thin 
extract  of  belladonna  just  below  and  behind  the  ramus 
of  the  jaw  has  been  found  a  most  excellent  one,  rapidly 
relieving  the  pain  and  intense  irritation,  and  in  some 
instances  cuttmg  short  the  progress  of  the  disease 
almost  at  once. 

In  incipient  sore  throat,  of  whatever  kind.  Dr.  firoad- 
bent  (St  Mary's  HosjHtal)  has  for  some  time  given  small 
fragments  of  guaiacum  resin— a  piece  to  be  kept  in  the 
mouth  till  dissolved,  three  or  four  times  a  day.  The 
good  effects  have  been  very  evident,  more  particulariy 
in  superficial  inflammation  of  the  mucous  membrane; 


but  tonsillitis  has  apparently  been  arrested,  and  in 
patients  subiect  to  quinsy  attacks  have  been  averted. 

Dr.  Headland  (Charing-Cross  Hospital)  reles  greatly 
iq>on  chlorate  of  potash  as  a  gargle  and  mild  magnesian 
purges.  None  of  the  physicians  think  it  necessary, 
except  in  extreme  cases,  to  use  the  lancet. 

HiRKDiTART  PBiDiflPOsnTOir  IN  Phthisib. — As  a  gene- 
ral thing,  pulmonary  tuberculosis  is  more  fi-equently 
transmitted  to  the  younger  than  the  older  children  of 
the  family,  and  more  commonly  to  the  females  than  the 
males.  In  a  table  compiled  firom  the  Brompton  Hospi- 
tal Reports,  London,  I  find  that  in  one  hundred  cases 
of  phthisis,  the  disease  is  transmitted  by  the  father  four 
times,  and  by  the  mother  thirteen  times.  The  reason 
for  this  may  be  found  in  the  fact,  that  the  females  are 
more  exposed  to  the  same  inducing  causes  as  their  ma- 
ternal parent  I  have  Imown  several  families  where 
the  disease  was  confined  exclusively  to  the  females — 
the  mether  and  daughters  perishing  with  it,  while  the 
father  and  sons  were  exempt.  We  sometimes  witness 
the  same  thing  in  cancer.  I  am  acquainted  with  the 
history  of  a  f^muly,  where  for  three  ^nerations  nearly 
every  female  died  with  the  malady,  while  there  was 
not  tin  example  among  the  males. — Dr.  Dukher,  Med. 
and  JSurg.  Beporter. 

A  DiAOKOSTIO  AND  PrOONOBTIO  IN  TtPHOID   FeVER. — 

The  attention  of  Dr.  E.  H.  Watts,  of  Ghunesville,  Ala. 
(Med.  and  Surg.  Reporter),  was,  during  1860,  directed 
to  a  peculiai;  discoloration  in  the  &uoes  of  patients  sufier- 
iog  from  typhoid  fever.  This  spot  was  ovoid  in  form, 
varying  in  size  from  three-eighths  to  half  an  inch  in 
length,  and  in  breadth  from  one-fourth  to  three -eighths 
of  an  inch,  and  usually  located  lust  to  the  right  and 
left  of  the  uvula.  It  was  usually  observed  from  the 
fourth  to  the  eighth  day  of  the  attack,  making  its  ap- 
pearance earlier  if  the  attack  was  ushered  in  witli 
severity — the  shade  of  discoloration  ranging  from  a 
Uttle  deeper  pink  than  the  adjoining  mucous  mem- 
brane to  a  deep  purplish  black.  Its  presence  was  proof 
of  the  nature  of  the  disease.  With  a  deeper  shade  of 
color,  as  observed  firom  day  to  day,  the  disease  was 
known  to  be  progressing  unfavorably ;  the  gradual 
lightening  up  of  the  tint  indicated  a  restoration  to 
health;  fading  away  entirely  during  convalescence, 
and  becoming  a  very  deep  purple  in  all  the  cases  that 
terminated  unfavorably.  Seventeen  years  more  of  ob- 
servation have  led  Dr.  W.  to  lay  great  stress  on  its  value 
in  the  diagnosis  and  prognosis  of  typhoid  fever. 
Week  Oitb  Btb  only  n  Bund,  is  w  Pritdikt  to  At- 

TVfPT  TO  &ST0R1  SlOHT  WHILE  TBI  OTHBR  .REMAINS  PIR- 

FBOT  ? — Mr.  Haynes  Walton,  speaking  firom  his  own  ex- 
perience, says,  "Yes."  He  continues :  *'  I  should  be 
deterred  from  operating  only  by  the  probability  of  the 
eye  being  too  much  damaged,  to  ^ve  that  amount  of 
sight  which  is  Imown  as  useful  sight,  on  which  point 
much  discrimination  and  a  long  familiaritv  with  oph- 
thalmic sur^ry  are  imperative.  I  have  selected  those 
oases  only  m  which  I  was  as  sure  as  I  could  be  that 
the  fundus  of  the  eye  was  sound,  and  the  retina  unim- 
paired, and  the  other  conditions  such  as  would  insure 
the  best  amount  of  sight  to  be  derived  fr6m  vach.  an 
operation,  i  e.  making  a  false  pupil.  I  am  certain, 
therefore,  from  the  results  of  practice,  of  the  advisability 
in  certain  cases  of  making  a  false  pupil  when  one  eye 
is  Botmd.  Confusion  of  vision  does  not  and  is  not  likely 
to  result  In  eolohoma  iridii  in  <me  eye,  no  confusion 
foUows."  Mr.  Walton  then  details  cases  of  monocular 
cataract  in  which  he  has  operated  with  success  and 
with  gpreat  benefit  to  the  patient,  as  well  as  some  of  opa- 
city of  the  cornea,  also  monocular,  where  he  did  iridec- 
tomy.— Med  I^fMs  and  Oaxette. 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


ur 


The  Medical  Record. 

Gbobgb  F.  Shradt,  M.D.,  Editoe. 


FiibUited  on  tlM  Ut  and  Ifltfaof  aMh  Month,  bf 
WILLIAM  WOOD  A  CO.,  61  Walub  Stur,  Nsw  Yobx. 


rORMIGir  A0EKOIE& 


LonoK— Tbubvkb  k  Co. 
Pais— BoMAMos  r  Cia. 


ILxiPtio— B.  HnufANir. 
£io  Jamsibo— Stsphutb  t  Oa 


N-ew  ITor^  June  !•  1867. 

THE  DISCOVERER  OF  AN-^THESIA. 

• 
Wheh  any  briUiant  discovery  has  been  made,  it  is  natu- 
ral for  a  number  of  aspiring  and  ambitious  individuals 
to  claim  the  credit  of  it.  This  has  eminently  been 
the  case  with  that  of  anesthesia.  No  sooner  was  it 
fidrly  estabUshed  that  surgical  operations  could  be  per- 
formed without  pain,  than  the  attention  of  the  profes- 
aioQ  was  directed  to  the  settlement  of  the  respective 
daims  of  Wells,  Morton,  and  Jackson,  to  the  credit  of 
ooofening  this  priceless  boon  upon  humanity.  The 
controversy  soon,  however,  became  so  lengtby  and 
complicated  that  the  minority  of  those  who  desired  to 
•ee  fair  play  became  wearied  and  disheartened,  and 
were  Qltiaaately  unable,  in  the  absence  of  testimony 
that  could  be  relied  upon,  to  come  to  any  conclusion 
whatever.  It  was  evident  that  the  honor  belonged  to 
ooe  of  the  three,  but  to  whom  in  particular,  there  did 
iK>t  appear  to  be  any  great  chance  of  determining. 
AsufficieQt  time  has  now  elapsed  since  the  controversy 
alhded  to,  to  enable  all  those  who  have  not  come  to  a 
ooadosion  upon  the  subject,  to  examine  the  facts  of 
the  case  in  the  calm  and  unpr^udiced  manner  which 
should  diaracterise  a  saardi  after  truth.  In  such  an 
igreeable  task  they  have  a  very  timely  aid  in  a  report 
by  the  Hon.  Truman  Smith,  recently  published.  We 
venture  to  say  that  the  facts  which  have  been  brought 
to  light  by  this  distinguished  gentleman,  will  be  found 
to  present  the  qaestion  in  its  true  aspect.  The  argument 
is  a  long  and  sound  one,  and  serves  to  add  not  a  little 
to  the  well  earned  reputation  which  the  Senator  has 
enjoyed  for  rare  legal  attainments.  The  bulk  of  the 
▼okune  has  already  i^peared  in  the  columns  of  the 
Pluladelphia  Medical  and  Surgical  ReporUr^  at  the  time 
when  the  pretended  claims  of  Morton  were  being  ac- 
tively canvassed  at  Washington  before  the  Congres- 
noQil  Committee ;  but  the  subject  is  now  invested  with 
ft  new  importance  in  consideration  of  the  signal  defeat 
of  the  said  Morton*s  claims,  and  the  lapse  of  that 
amooot  of  time  which  allows  of  the  cooling  down  of  all 
prejudice.  The  writer  of  the  volume  has  spared  no 
P«uu  in  aocorately  and  thoroug^y  investigating  his 


subject,  and  were  we  to  follow  him  in  the  different 
steps  which  he  has  found  necessary  to  take  in  order  to 
enable  him  to  point  out  the  true  relation  of  unquestion- 
able facts  sifted  of  their  complications  on  the  question  at 
issue,  we  should  consume  unnecessarily  much  of  that 
space  which  must  be  otherwise  impropriated.  We  will 
then  content  ourselves  with  the  simple  account  of  the 
discovery  of  ansasthesia,  based  upon  the  facts  which  the 
honorable  gentleman  has  given  us,  and  leave  the  re- 
mainder of  the  work  to  the  perusal  of  such  of  our 
readers  who  may  wish  to  satisfy  themselves  concern- 
ing the  foundations  for  the  statements  here  made. 

The  discovery  is  dated  as  far  back  as  the  tenth  of 
December,  1844.  On  the  evening  of  that  day,  Dr.  Horace 
Wells,  a  surgeon-dentist  of  Hartford,  attended  in  that 
city  a  chemical  lecture  by  Mr.  O.  Q.  Colton,  during,  or 
after  which,  the  said  Colton  administered  to  Dr.  Wells, 
Mr.  Cooley,  and  several  others,  some  nitrous  oxide  gas. 
Mr.  Cooley,  while  under  its  influence,  became  much 
excited,  and  in  performing  sundry  evolutions  contused 
and  abraded  both  his  shins.  On  recovering  his  self- 
possession  he  was  interrogated  by  Wells  as  to  the  amount 
of  pain  he  had  suffered  from  the  injuries  received.  In 
reply  Cooley  stated  that  he  was  not  conscious  of  any 
such  occurrence  and  was  surprised,  on  pulling  up  his 
pants,  to  see  a  provision  of  blood.  Wells  immediately 
turned  to  a  friend  and  expressed  his  belief,  "  that  a  man 
could  by  inhaling  the  gas  render  himself  so  insensible 
that  he  could  have  a  tooth  extracted  without  pain." 
While  escorting  his  wife  home,  he  reiterated  an  expres- 
sion of  the  same  belief,  and  again  reiterated  it  to  a 
brother  dentist  and  particular  friend,  on  whom  he 
called  the  same  evening  to  canvass  the  subject  Having 
spent  some  time  in  considering  the  matter,  Dr.  Wells 
declared  it  to  be  his  purpose  to  take  the  gas  the  next  day 
and  have  a  defective  tooth  (a  large  molar)  extracted, 
and  thus  test  the  correctness  of  his  theory.  Accordingly 
the  following  day,  Wells  called  on  Colton,  and  desired 
the  latter  to  take  a  bag  of  the  gas  over  to  the  office  of 
the  dentist  alluded  to.  On  arriving  at  their  place  of  des- 
tination. Wells  placed  himself  in  the  operating-chair,  was 
anaesthetized  by  Colton,  and  the  tooth  extracted.  On 
recovering  consciousness,  the  subject  of  the  operation, 
in  his  satisfaction  at  the  result,  exclaimed :  "  A  new  era 
in  tooth-pulling  1  It  did  not  hurt  me  more  than  the 
prick  of  a  pin  1  '* 

This,  according  to  the  testimony  we  have  before  us, 
was  the  first  operation  performed  with  an  anaesthetic, 
and  to  the  late  Dr.  Horace  Wells  belongs  the  sole  credit 
of  first  conceiving  the  possibility  and  practicability  of 
killing  pain  by  its  administration. 

It  was  not  until  the  30th  of  September,  1846,  that 
Morton  made  a  test  of  the  anesthetic  properties  of 
sulphuric  ether,  at  the  suggestion  of  Dr.  Charles  T. 
Jadcson,  having,  as  it  would  appear,  previously  obtained 
whatever  he  knew  of  the  practicability  of  anesthesia 
from  Wells  himself  with  whom  he  had  been  more  or 
less  intimately  associated.  x^  t 

Digitized  by  VjOOQ  IC 


158 


THE  MEDICAL  RECORD. 


We  have  endeavored  to  present  the  simple  &ct8  of 
the  case  so  dearly  and  satis&ctorily  proved  by  Mr. 
Smith,  with  the  sole  desire  of  doing  our  part  in  giving 
publicity  to  a  matter  which  is  id  the  deepest  e<Micem 
to  every  lover  of  justice ;  and  to  those  who  may  have 
fiuled  to  convince  themselves  of  the  impartiality  of  the 
award  of  this  great  discovery  to  Dr.  Wells,  we  would 
oommend  for  their  diligent  perusal  the  masterly  argu* 
ment  of  the  Hon.  Truman  Smith. 

It  is  with  extreme  satisfaction  that  we  notice  the  com- 
mencement of  a  move  in  the  right  quarter  towards 
checking  the  prevalent  practice  of  producing  and  pro- 
curing abortion.  So  deeply  rooted  has  become  the 
vice,  that  every  influence  which  religion,  morality,  and 
law  can  bring  to  bear  is  now  urgently  needed.  Medi- 
cine has  long  ago  taken  the  lead;  Christianity  followed 
with  its  appeals ;  and  now  law  brings  up  the  van  with 
an  earnestness  for  the  work  which  almost  entitles  it  to 
forgiveness  for  its  former  stubborn  apathy.  The  State 
of  Rhode  Island  deserves  the  honor  of  the  initiative  in 
this  latter  respect,  and  the  following  enactment  is  an 
evidence  of  an  enlightened  legislation  which  does  credit 
not  only  to  the  source  from  which  it  emanates,  but  the 
age  in  which  we  live.  We  quote  the  following  act  re- 
ferring to  the  subject  in  question,  passed  at  the  January 
Session  of  the  General  Assembly,  1867 : 

It  is  enacted  hy  fhe  General  Aseemhly  ae/olhws  : 

Sea  1.  Every  person  who  ediall  be  convicted  of  wil- 
fully administerinff  to  any  pregnant  woman,  or  to  any 
woman  supposed  by  such  person  to  be  pregnantL  or  of 
advising  or  prescribinc  for  such  woman,  or  causmg  to 
be  taken  by  her,  anything  whatever,  or  shall  employ 
any  means  whatever,  with  intent  thereby  to  procure 
the  miscarriage  of  such  woman,  or  of  aiding  and  assisting 
therein,  or  by  counselling  and  procuring  the  same,  un- 
less the  same  is  necessary  to  preserve  her  life,  shall,  if 
the  woman  die  in  consequence  thereof,  be  imprisoned 
not  exceeding  twenty  jrears  nor  less  than  five  years; 
and  if  she  do  not  die  m  consequence  thereof,  shall  be 
imprisoned  not  exceedinc;  seven  years  nor  less  than  one 
year:  Provided,  that  the  woman  whose  miscarria^ 
shall  have  been  caused  or  attempted,  shall  not  be  h'able 
to  the  penalties  prescribed  by  this  section. 

Sec.  2.  Any  person  who  shall  be  indicted  for  the 
murder  of  any  infant  child,  or  of  any  pregnant  woman, 
or  of  any  woman  supposed  by  such  person  to  be  or  to 
have  been  pre&fnan^  may  also  be  charged  in  the  same 
indictment  with  any  or  all  the  offences  mentioned  in 
the  preceding  section,  and  if  upon  the  trial  the  jury  shall 
acquit  such  person  on  the  charge  of  murder,  and  find 
him  guilty  of  the  other  offences  or  either  of  them,  judg- 
ment and  sentence  may  be  awarded  against  him  ac- 
cordingly. 

^  Sec.  3.  Whoever  knowingly  advertises,  prints,  pub- 
lishes, distributes^  or  circulates,  or  knowingiv  causes  to 
be  advertised,  pnnted,  published,  distributed,  or  circu- 
lated, any  pamphlet,  printed  paper,  book^  newspaper, 
notice,  advertisement^  or  reference,  containing  words 
or  language  giving  or  conveying  any  notice,  hint,  or 
reference  to  any  person,  or  to  the  name  of  any  person, 
real  or  fictitious,  from  whom,  or  to  any  place,  honse, 
shop,  or  office,  where  anything  whatever,  or  any  instru- 
ment or  means  whatever,  or  any  advice,  direction,  in- 


formation, or  knowledge  may  be  obtained  for  the  pur- 
pose of  causing  or  procuring  the  miscarriage  of  any 
pregnant  woman,  shall  be  imprisoned  not  exceeding 
three  years. 

Sec.  4.  AH  acts  and  parts  of  acts  inconsistent  here- 
withj  are  hereby  repealed;  provided,  however,  that 
nothing  in  this  adt  contained  ^aU  in  any  wise  affect 
any  complaint  or  indictment  now  pending,  or  that  may 
hereafter  be  made  or  found  for  any  offence  committed 
before  the  passage  of  this  act,  against  the  provisions,  or 
any  of  them,  of  an  act  in  addition  to  chapter  212,  title 
XXX.,  of  the  revised  statutes,  "  of  offences  against  the 
person,''  passed  at  the  January  session,  1861. 

Sec.  5.  This  act  shall  take  effect  on  and  after  its 


Amothsr  death,  occasioned  by  the  careless  compounding 
of  a  prescription,  is  announced  by  the  daily  papers.  It 
seems  that  a  physician  had  prescribed  for  a  patient  in 
Brooklyn,  sufiforing  from  neuralgia,  a  drachm  of  quinine 
and  one  grain  of  nux  vomica,  to  be  divided  in  fifteen 
pills.  This  was  property  made  up  by  an  apothecary,  and 
everything  went  on  well  Having  occasion  to  use  some 
more  of  the  same  medicine  a  messenger  was  sent  to  a 
different  store,  owned  however  by  the  proprietor  of  the 
first  The  cleric  of  the  second  store  sent  to  the  first  store 
for  a  copy  of  the  recipe,  but  instead  thereof  the  copyist 
made  the  egregious  and  unpardonable  blunder  of  trans- 
posing the  quantities,  so  that  the  pill-mass,  when  com- 
pounded by  the  second  party,  contained  a  dra^ihm  of 
nux  vomica  and  one  grain  of  quinine.  The  unfortunate 
patient  swallowed  but  two  doses,  and  died  in  convulsions 
a  few  hours  afterwards.  It  is  not  difficult  to  see  where 
the  blame  for  this  transaction  rests.  The  mistake  was 
not  made  by  the  physician,  for  the  vniting  was  intelli- 
gible enough  to  enable  the  clerk  of  the  first  store  to 
follow  the  directions;  but  the  carelessness  of  the  copyist, 
and  the  stupidity  of  the  subsequent  compounder,  are,  to 
say  the  least,  r  emarkable,  and  deserve  that  severe 
punishment  which  will  probably  be  respectively  meted 
out  to  them. 


ftcotnos* 


Tbaksaotions  of  ths  Amsricak   Medical  Associatiok. 

Vol.  xvil.  Philadelphia.  8vo.  pp.  713. 
This  yearly  volume  comes  to  us  in  its  usual  good  styley 
and  has  the  double  merit  of  being  much  rednc^  in  bulky 
and  at  the  pame  time  containing  many  vahiable  contribu- 
tions. The  report  of  the  annual  meeting  was  so  fully 
given  in  our  columns  that  it  would  be  hardly  more  than 
a  reiteration  to  review  tiie  contents  in  detail.  We  were 
enabled  to  present,  at  the  time  we  published  the  trans- 
actions of  the  body,  an  abstract  of  all  the  important 
papers  that  were  read  at  the  said  session,  and  our  readers 
have  had  long  ago  an  idea  of  the  worth  of  the  volume. 
We  cannot  be  expected  to  do  more  than  refi'esh  the 
minds  of  those  who  havB  not  already  become  the  pos- 
sessors of  this  publication  as  to  some  of  the  more  im- 
portant contributions  which  it  contains.  They  may 
be  summed  up  in  the  following  catalogue:  "On  the 
Relations  which  Electricity  sustains  to  the  Cause  of 
Disease," by  S.  Littell,  M.D.,  Philadelphia;  "Report  of 
Committee  on  Disinfectants ; "  "  Caoses  and  Pathology 


igitized  by  ^^ 


THfi  MEDICAL  REOOBD. 


159 


of  Pyaemia,"  by  J.  J.  Woodward,  M.D.,  U.S.A. ;  "  The 
aMBp-ShiekL'^^by  Pro£  H.  B.  Storer,  of  Boston;  "Para- 
Ijm  of  Vocal  C!ord8  with  Aphooia,"  by  J.  Solis  Oohen, 
of  Philadelphia ;  ^  Lozation  of  Femur  in  Ischiatic 
Notch,  of  ^me  Months'  Standing,"  by  L.  A.  Sayre, 
MJ).;  "Original  Instrument  for  the  Performance  of 
Lithotomy,"  by  Prof.  A.  0.  Post,  New  York;  '' Report 
on  Diphtheria,^*  by  H.  D.  Holton,  of  Vt. :  "  Report  on 
Spotted  Fever"  by  J.  X  Levick,  Philadeli)hia ;  "On 
Etiology  and  Pathology  of  Epidemic  Erysipelas."  by 
Prof  K.  a  Davis,  MjD.,  Chicago:  "Medical  latera- 
tore,"  by  Pro£  0.  A.  Lee:  "Medical  Ethics  of  Spe- 
dihies,"  by  Prof.  W.  Hooker,  New  Haven;  "Treat- 
moot  of  Angular  Curvature  of  Spine,"  by  Benjamin 
Lee.  M.D.,  Philadelphia;  and  "Digitalin,"  by  Prof, 
a  B.  Percy,  New  York  (Prize  Essay).  Altogether, 
the  volume  compares  creditably  with  any  of  its  prede- 
oesBors;  its  typographical  execution  is  admirable,  and 
iti  iUustrations  very  passable. 

TBAiSAcnoHB  or  thb  Yibmont  Medioal  6ooibtt,  for  the 
Twr  I860.    R.  S.  Styles,  Burlington.    Pp.  61. 

Tn  Address  of  the  President,  Dr.  0.  F.  Fassett,  of 
St  Alban's,  is  an  interesting  survey  of  the  mutual  rela- 
tions existing  between  the  people  and  the  profession,  and 
the  rightful  demands  of  the  profession  upon  both 
people  and  the  government.  To  do  the  subject  justice 
woold  require  a  quotation  at  length,  a  pleasure  we  are 
obfiged  to  forego.  "  Statistics  of  Diphtheria  in  Yermont 
Bj  H.  F.  St4>hens,  M.D."  In  1857,  two  ^ears  after 
tub  pablication  of  M.  Bretonneau's  dissertation,  a  few 
cases  are  borne  upon  the  registration  report  of  the 
State  as  deaths  from  "Disease  of  Throat."  Many 
deaths  were  then  very  likely  to  have  been  incorrectly 
credited  to  scarlatina,  which  prevailed  very  extensively 
in  every  county.  It  was  not,  however,  until  the  suc- 
ceeding year,  that  ^phtberia  was  definitively  assigned  as 
a  cause  of  death.  Fourteen  cases  were  then  given,  but 
scarlatina  also  increased  in  fatality.  In  1859, 1860, 1861, 
and  1862,  the  mortali^  from  diphtheria  is  quoted  succes- 
sively  as  60, 212, 441,  and  818,  making  a  gradation  of  2, 
6, 11,  and  18  per  cent  The  compiler  is,  however,  as 
vet  unable  to  draw  conclusions,  since  the  data  are  too 
limited.  "  The  Physiological  Properties  and  Therapeutic 
Action  of  Yeratrum  V&ide.  By  L.  C.  Butler,  M.D." 
(of  Essex).  This  article,  by  die  Secretary  of  the 
Society,  gives  much  valuable  information  in  a  reasonable 
compass,  and  presents  ns  with  a  rose-colored  view  of 
its  general  i^plicabili^  in  therapeutics.  It  is,  however, 
but  just  to  add  that  all  the  statements  are  well  fortifiea 

Sttcts.  "  Case  of  Dropsy.  By  Lemuel  Richmond, 
D.  (of  Derby)."  The  points  of  the  case  are  paracen- 
teds  performed  sixty-eight  times,  and  2383  lbs.  taken 
in  seventeen  months  and  twelve  oays.  "  One  day  pre- 
riwa  to  and  one  day  after  the  operadon  she  would  seem 
somewhat  prostrated,  otherwise  generally  very  com- 
fcrtaUe  and  able  to  go  about,  sometimes  even  to  visit 
har  neighbors.  Notwithstanding  the  rapid  accumula- 
tion  in  her  case,  there  was  but  a  short  time  that  she 
seemed  troubled  with  thirst.  A  post-mortem  exami- 
padon  discovered  an  omental  cake,  a  broad  band  extend- 
ing from  this  to  the  fundus  of  the  uterus,  to  which  it 
was  attached."  ''  Orimmal  Abortion.  By  William  Mc- 
CoDem,  MJ).  (of  Woodstock),"  an  earnest^  able  paper, 
ii  followed  by  another  on  '*  Cerebro-^inal  Meningitis, 
bjr  B.  K.  Ketohum,  MD.  (of  Brattleboro')."  Dr.  K  had 
seen  some  thirty  cases  in  his  locality,  where  the  dis- 
use appeared  about  January  1,  1864.  Having  con- 
cbded  that  the  feeble  pulse  was  dependent  upon  the  con- 
gested condition  of  me  nervous  centres  and  that  a 
vital  organ  was  involved,  he  determined  upon  vene- 
•ection,  as  being  the  only  rational  remedy.    He  claims 


that  it  should  be  performed  early  in  the  disease,  and 
the  blood  let  run  "in  a  full  stream  from  a  large  open- 
ing." Cupping  and  leeching  are  worse  than  temporiz* 
ing  expedients  j  and  "venesection,  practised  in  advanced 
stages  of  the  disease,  or  after  effusion  had  taken  place, 
did  hann,  as  then  we  have  real  debility."  "  Memoir  of 
Dr.  N.  W.  Fairchild,  by  H.  P.  Stevens,  M.D.  (of  St 
Alban's),"  is  next  in  order.  "Morbus  Goxarius,  by 
Benjamin  Fairchild,  M.D.  (of  Milton),  (communicated 
by  the  Ghittenden  County  Medical  Society),"  is  a  practi- 
cal paper,  from  which  many  useful  hints  may  be  derived. 
The  last  contribution  is  from  the  pen  of  Dr.  C.  P.  Frost 
(late  Surgeon  of  the  Board  of  Enrolment,  Second  Dis- 
trict, Vermont),  and  being  relative  to  the  draft  daring 
1863,  1864,  and  1865,  is  statistical  in  character. 

When  we  remember  that  the  present  constitutes  the 
first  published  compilation  of  the  "  Transactions^"  we 
cannot  but  admire  the  enterprise  of  the  Society  in  pre- 
senting so  creditable  an  issue  to  their  brethren,  and, 
above  all,  would  we  commend  that  rare  self-denial 
which  has  in  no  instance  allowed  the  work  to  go  be- 
yond the  material 

Obstktrios:  tbb  Sounob  and  thb  Abt.  By  Charles  D. 
Mnes,  M.D.,  lately  ProfiBssor  of  Midwifery  and  the  Dis- 
eases of  Women  and  Children,  in  Jefibrson  Medical  College 
at  Philadelphia,  and  one  of  the  PhysiciaQS  to  the  LyiDg-In 
Department  of  PeDnsylvaoia  Hospital,  eta,  etc.  Fifth 
edition.  Revised;  wiUi  one  hundred  and  thirty  illustra- 
tiona  Philadelphia:  Henry  C.  Lea.  1867.  8va,  pp. 
754. 

Pbof.  Mnofl's  work  upon  Obstetrics  has  been  before 
the  public  for  the  past  thirty  years,  and  since  its  first 
pubhcation  in  1838,  as  a  modest  volume  of  two  or 
three  hundred  pages,  it  has  kept  its  ground  as  an  autho- 
rity. It  has  passed  through  four  ei&tions,  and  the  fifth 
is  just  issued,  after  having  sufifered  a  thorough  revision 
by  the  author.  Although  not  much  new  matter  has 
been  introduced,  several  parts  of  the  work  have  been 
virtually  re-written,  and  the  results  of  this  labor  are 
given  us  with  the  sad  announcement  that  this  will  pro- 
bably be  the  last  occasion  that  the  writer  will  have  of 
improving  his  book.  The  result  of  this  endeavor  of  our 
author  to  give  the  finishing  touches  to  his  popular 
treaUsei  has  been  to  make  it  of  particular  value  to  the 
student  and  younger  physician  by  the  embodiment 
of  a  vast  number  of  practical  hints  and  useful  sugges- 
tions, gained  by  a  very  long  and  large  clinical  experience. 
To  such  as  may  not  be  acquainted  with  the  merits  of 
the  work  through  previous  editions,  we  would  confi- 
dentlv  recommend  it  as  a  most  reliable,  useful,  practical 
one  for  the  student  and  younger  physician,  as  many 
of  those  very  necessary  details  are  dwelt  upon  which 
may  be  looked  for  in  other  treatises  in  vain.  The 
style  is  attractive,  concise,  and  earnest ;  and  the  reader 
is  all  the  time  made  conscious  that  his  teacher  has  but 
one  object  in  view,  that  of  instruction,  and  that  no  eflTort 
is  spared  by  him  to  fidthfully  and  conscientiously  dis- 
charge such  a  duty. 

CoDi  or  Mboioal  Ethigs,  aooptbd  bt  thb  Aherioan  MBni- 
CAL  AssooiATioir.  Revised  to  date.  New  York:  W. 
Wood  k  Co.,  61  Walker  at.    1867.     18mo.  pp.  89. 

The  publishers  of  this  little  book  have  anticipated  a 
want  long  felt  by  the  profession— that  of  having  in  a 
convenient  shape  the  Uode  of  Medical  Ethics.  There 
is  now  no  excuse  for  any  delinquent  brother  being  un- 
acquainted with  the  rules  which  should  govern  his  ac- 
tions; and  if  any  of  our  readers  should  find  any  such 
who  refuses  to  be  convinced  of  the  error  of  his  ways, 
he  should  purchase  a  copy  and  present  him  with  the 
same. 


Digitized  by 


Google 


uo 


THE  MEDICAL  RECORD. 


Vitpotts  0f  Qmttxtsi. 


NEW  YORK  PATHOLOGICAL  SOCIETY. 

Stated  Mbbtino,  Fibbuabt  27,  1867. 

Dr.  H.  B.  Sands,  President^  in  the  Ch&ir. 

Dr.  Post  exhibited  a  hy^^ma  of  the  neck  which  he 
had  treated  by  excisioD.  The  patient  was  a  woman  twen- 
ty years  of  age,  who  first  noticed  a  painless  enlargemoit 
on  the  side  of  the  neck,  about  two  years  ago.  ^e  his- 
tory was  the  ordinary  one  of  a  cystic  tumor  in  that 
locality.  The  mass  was  first  punctured,  but  the  sac 
soon  filled  again,  when  the  Doctor  determined  to  exaeot 
it,  which  he  did  without  any  great  difficulty.  He  re- 
marked that  this  was  the  first  operation  of  the  sort  whidi 
he  had  done,  and  from  the  good  results  in  this  instance 
he  was  encouraged  to  generally  adopt  the  practice. 

Db.  Samds  asked  if  Dr.  Post  had  been  in  the  habit 
of  injecting  the  pure  tincture  of  iodine  into  these  cysts, 
as  reconunended  by  Syme. 

Db.  Post  had  no  distinct  recollection  of  so  doing. 

Dr.  PsuGNrr  presented  a  heart  and  kidneys  remoyed 
from  a  patient,  who  first  showed  sjrmptoms  of  cardiac 
disease  on  the  first  of  February,  1864.  It  first  com- 
menced with  an  attack  of  dyspnoea,  ending  in  syncope, 
which  lasted  for  several  hours.  On  examination  he 
found  hypertrophy  of  the  heart,  with  emphysema  of  the 
upper  lobe  of  the  left  lung.  At  that  time  there  was  no 
sign  of  any  renal  trouble.  The  patient  had  two  or 
three  attacks  of  syncope  fix>m  that  time  until  last  spring, 
when  he  took  a  trip  to  Europe.  While  abroad  he  con- 
sulted several  distinguished  physicians,  who  virtually 
substantiated  the  diagnosis  of  his  attending  physician. 
When  the  patient  returned  about  Uie  m&dle  of  last 
October,  Dr.  P.  not  only  found  that  the  hypertrophy  had 
very  much  increased,  but  that  oedema  of  both  lungs  was 
superadded  to  emphysema  Professor  Clark  was  then 
ctUed  in  consultation,  and  an  examination  of  the  urine 
being  then  made,  resulted  in  discovering  evidences  of 
Brieht's  disease.  From  that  time,  however,  no  traces 
of  disease  of  the  kidneys  were  discovered,  notwithstand- 
ing repeated  examinations  were  made  for  that  purpose. 
There  were  no  murmurs  detected  during  life,  idthougfa 
the  autopsy  showed  atheromatous  deposits  around  both 
the  mitral  and  aortic  valves,  there  being  besides  a  slight 
rupture  in  one  of  the  latter.  The  lungs  were  found  to 
be  extensively  emphysematous,  and  the  liver  in  the  first 
stage  of  fatty  degeneration. 

In  answer  to  a  question  from  Dr.  No^ea,  he  stated 
that  the  urine  had  been  found  deficient  in  urea  upon 
two  different  occssions. 

Dr.  Drapbr  remarked  that  a  well  marked  contraction 
of  the  aorta,  which  existed  in  the  specimen,  was  of  it- 
self sufficient  cause  of  the  hypertrophy. 

L   0ARIE8  OF  8P1NX  CAU8IK0  ABSCESS. — DEATH  FROM  ASTHMA 
MILLABL      n.   CHEiaOAL  SOLUTIOM  OF  UBINABT  CALCULL 

Dr.  Bauer  presented  a  specimen  of  fracture  of  the 
firat  dorsal  vertebra,  accompanied  with  the  following 
history : — 

The  little  patient  was  but  three  years  and  nine 
months  old.  She  belonged  to  a  healthy  £amily.  About 
four  months  ago  she  met  with  a  fall  firom  a  chair  against 
a  wall,  in  such  a  way  as  to  force  her  head  forward  upon 
the  chest  Since  then  she  has  suffered  severe  pain  at 
the  neck,  and  general  attenuation  with  the  usual  con- 
stitutional disturbances.  I  saw  the  patient  for  the 
first  time  on  the  14th  of  January.  The  cervical  portion 
of  the  spine  was  bent  forward,  and  the  head  strongly 
reclined.    At  the  cervico-thoracic  portion  of  the  spine 


there  was  a  marked  prominence  of  the  several  spinooa 
processes,  of  which  the  first  dorsal  projected  furthest 
While  carefully  proceeding  with  the  examination  the 
patient  was  suddenly  attadced  with  asthma  Millari,  and 
so  intense  and  lasting  was  the  paroxysm  that  I  feared 
instantaneous  death,  the  respiration  being  totally  sus- 
pended for  at  least  fifteen  seconds,  her  face  becoming 
thoroughly  cyanotia  I  did  not  carry  the  examination 
further,  being  satisfied  that  there  was  a  structural  lesion 
of  the  spine,  with  probable  formation  of  abscess  and 
pressure  upon  the  recurrent  nerve.  The  mother  told 
me  that  these  paroxysms  had  been  quite  fi^uent  of 
late,  but  that  the  present  one  was  in  her  estimation  the 
severest  The  treatment  could  be  but  palliative.  I 
ordered  a  water  bed,  the  recumbent  posture,  and  very 
carefiil  handling.  My  apprehension  that  the  child  would 
die  from  the  repetition  of  such  paroxysms  was  soon 
fulfilled.  After  a  few  light  paroxysms  she  succumbed 
to  a  very  violent  attack  on  the  19tn  inst 

Fortunately  an  autopsy  was  permitted.  I  found  an 
abeoess  in  front  of  the  spine,  commencing  at  the 
fourth  cervical  and  terminating  at  the  fourth  tho- 
racic vertebra.  The  anterior  wall  of  this  rather 
narrow  abscess  was  formed  of  the  periosteum  and 
the  longitudinal  ligament^  and  encroached  materi- 
ally upon  the  oesophagus.  The  diseased  portion  of 
the  spine  being  removed,  is  now  exhibited  to  the 
society.  The  specimen  consists  of  the  fragment  of 
the  seventh  cervical,  and  the  second  and  third  thoracic 
vertebriB,  the  next  superior  and  inferior  vertebrsB  being 
substantially  healthy  althouffh  slightly  corroded.  The 
bodies  of  last  cervical  and  first  thoracic  vertebne  are 
entirely  destroyed  up  to  the  place  where  the  bodies  join 
the  respective  ardies.  Of  the  second  thoracic,  a  large 
portion  of  the  body  has  disappeared,  whereas  the  body 
of  the  third  thoracic  has  been  but  slightly  affected. 
The  first  and  second  ribs  on  each  side  have  lost  their 
respective  vertebral  insertions.  The  spinal  cord  is 
deprived  of  its  bony  protection  through  the  destruction 
of  the  two  vertebral  bodies.  There  is  a  small  seques- 
trum remaining,  obviously  belonging  to  the  seventh  cer- 
vical It  is  surprising  that  under  these  circumstances 
no  paralysis  has  supervened.  The  matter  that  fiUed 
the  abscess  was  rather  thin,  but  presented  otherwise  the 
ordinary  attributes.  The  rapid  destruction  of  the  ver- 
tebral bodies  in  comparatively  so  short  a  time,  scarcely 
a  vestige  being  left,  is  a  matter  of  great  pathological 
interest  Next  in  interest  is  the  question  of  causation. 
There  appeared  to  be  nothing  in  the  child  of  a  tuberoa- 
Itf  diathesis,  either  inherited  or  acquired,  nor  have  I 
found  any  morbid  substance  that  could  ponibly  be  con- 
founded with  tubercular  deposit  On  the  other  hand, 
it  is  known  that  the  child  met  with  a  serious  accident^ 
which  was  moreover  of  a  description  to  cause,  if  not  a 
fracture  of  the  vertebral  body,  at  least  a  crushing.  And 
lastly,  it  is  substantiated  thi^  the  patient  was  entirely 
well  until  the  accident  occurred,  and  since  then  has 
been  suffering  from  symptoms  entirely  local  in  origin. 
I  consider  myself^  therefore,  justified  m  assuming  that 
the  specimen  represents  one  of  those  numerous  cases 
of  caries  and  deformity  of  the  spinal  column  that  are 
of  a  strictJy  traumatic  origin. 

He  also  presented  a  few  urinary  calculi,  of  which  the 
largest  weighed  a  little  over  two  drachms,  and  gave  the 
following  account  of  the  patient  firom  whom  they  were 
removed  in  successive  operationa  The  subject  was  a 
child  three  and  a  half  years  of  age.  The  nrst  opera- 
tion was  the  bilateral  one,  and  due  care  was  used  to 
clean  out  the  bladder  and  urethra  afterwards.  The  re- 
covery fiom  the  operation  was  rapid  and  satisfactoiy. 
A  fbrtnight  afterwards,  however,  new  signs  of  the  ex- 
istence of  lithiasis  began  to  show  themselves.     Interfe- 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


161 


renoe  was  deferred  for  four  months,  when  the  sufferings 
of  the  child  becoming  so  intense,  the  old  wound  having 
opened,  and  fistulous  connexions  having  formed  between 
the  perineum  and  bladder,  there  was  no  alternative  left 
bat  to  repeat  the  former  operation,  so  as  to  remove  cal- 
culi and  likewise  dose  up  the  fistulous  track.  On  that 
occasicm  several  small  calculi  were  taken  away.  Dr.  B. 
had  previously  carefully  examined  the  urine,  and  had 
coQTinced  himself  that  it  was  very  much  saturated  with 
urates  and  phosphates.  About  five  or  six  weeks  after 
the  second  operation,  there  were  new  signs  of  stone ;  and 
it  being  evident  that  the  circumstances  of  the  case  for- 
bade the  performance  of  a  third  operation,  he  resolved 
to  treat  the  case  with  chemical  reagents,  after  removing 
aoch  calculi  as  had  become  impacted  about  that  time 
into  the  urethra.  When  he  experimented  with  fragments 
of  the  calculi,  with  a  solution  of  one  part  of  nitric  acid 
in  eight  of  water,  he  discovered  that  be  had  nodifiScul- 
ty  in  almost  entirely  dissolving  them,  there  being  left 
nothing  but  a  soft  pulp.  Under  the  impression  that  the 
bkdder  could  easily  void  such  masses,  he  commenced 
the  iDJection  of  the  solution  into  the  cavity  of  that  or^ 
fUL  The  liquid  was  kept  in  the  bladder  for  two  or 
three  hours  at  a  time,  by  means  of  an  india-rubber  ring 
env^piog  the  end  of  the  penis.  He  watched  the 
effects  of  this  treatment  very  carefully  in  the  beginning, 
aod  soon  felt  assured  that  it  could  be  carried  on  with 
impunity.  Pulpy  masses  were  soon  after  discharged, 
and  finally  even  these  disappeared  at  the  end  of  a  period 
of  nxteen  months,  during  the  whole  of  which  time  the 
iojections  were  continued.  It  is  proper  to  state  that, 
in  the  mean  time,  the  patient  took  intemaUy  the  nitro- 
moriado  acid. 

XXRVSIOV  or  XHTLAJOCATIOir  FROM  A  DRP  OIRVIOAL  AB- 
8CK8S  TO  THX  BBAW. 

Dr.  Notes  presented  a  brain  and  section  of  the  pe- 
trous portion  of  the  temporal  bone,  removed  from  a 
patient  in  the  Charity  Hospital.  On  the  15th  of  Feb- 
ruary his  attention  was  directed  to  a  female  who  had 
been  admitted  on  account  of  severe  trouble  of  the  right 
ear.  She  had  been  an  inmate  of  the  institution  a  cou- 
ple of  days,  but  the  history  of  her  case  was  extremely 
imperfect  All  that  was  known  of  her  was  that  she  had 
suffered  firom  a  severe  pain  on  the  side  of  her  head  for 
the  previous  month.  Although  he  was  able  to  make 
only  a  very  hasty  inspection,  the  foUowiog  peculiarities 
TOe  observed : — ^A  large  swelling  over  the  angle  of  the 
jaw,  head  turned  to  the  opposite  side,  intelligence  very 
xDuch  diminished  though  not  abolished,  no  general  pa- 
ralysia  of  sensation  or  motion.  The  account  given  of 
the  case  looked  towards  the  probability  of  there  being 
caries  of  the  petrous  portion  of  the  temporal  bone,  with 
meningitis  supervening.  Three  days  after  the  patient 
was  again  seen,  when  the  symptoms  of  disease  of  the 
briin  were  even  more  pronounced  than  on  the  previous 
risit.  The  right  eye  was  then  oarefuDy  examined.  The 
popil  had  its  nonnal  reaction  to  light,  the  orbicular  mus- 
cle preserved  its  functions,  although  the  fadal  nerve  was 
paralysed.  This  latter  fact  was,  however,  noticed  at 
the  first  visit  Examination  with  the  ophthahnoeoope 
showed  pulsation  of  the  retinal  veins  with  diminished 
size  of  the  arteries,  and  absence  of  capillary  hypere- 
mia of  the  nerve.  No  evidences  of  actual  disease  of  the 
car  were  found.  The  membrana  tympani  was  normal 
in  appearance.  The  swelling  over  the  an^e  of  the 
jaw  was  opened,  and  dischai^ged  a  small  quantity  of 
ftatid  pus.  A  considerable  porticA  of  the  ramus  of 
the  jaw-bone  was  denuded  ana  dead. 

tiie  general  symptoms,  at  this  time,  were  extreme 
stupor;  not,  however^  amounting  to  ooma.  Tlra  pulse 
was  about  100,  respiration  20,  the  other  phenomena 
bang  as  already  described.    She  died  within  a  few 


hours  after  the  examination.  The  diagnosis  was  that 
the  abscess,  which  was  deeply  situated  in  the  tissues  of 
the  neck,  had  excited  inflammation  of  the  brain ;  but 
how  this  was  done,  was  left  to  the  autopsy  to  determine. 
Auiopsy. — ^The  autopsy  showed  the  following  facts : 
That  there  was  very  considerable  turgescence  of  the  me- 
ninges of  the  brain.  Upon  removing  the  dura  mater, 
pus  was  found  upon  the  side  and  anterior  portion  of 
the  right  hemisphere,  the  led  hemisphere  being  free 
from  any  exudation.  On  removing  the  brain,  pus  ex- 
tended down  over  the  right  hemisphere  to  the  base  of 
the  brain,  occupying  the  whole  inferior  surface  of  the 
organ,  but  concentrated  more  particularly  about  the 
middle  fossa  of  the  right  side.  The  dura  mater  was 
readily  separated  firom  uie  base  of  the  skull,  but  there 
was  no  pus  between  it  and  the  bone.  An  incision  was 
carried  along  the  line  and  angle  of  the  jaw :  the  whole 
bone,  when  exposed,  was  found  surrounded  with  sup- 
puration, which  had  denuded  it  of  its  periosteum  nearly 
down  to  the  dental  foramen.  The  joint  was  completely 
destroyed,  and  disarticulation  was  of  course  effected 
with  perfect  ease.  The  cavity  of  the  abscess  which 
surrounded  the  joint  was  so  situated  as  to  lie  above^  in 
contact  with  the  base  of  the  skull,  within  the  cervical 
vertebne  and  pressing  upon  the  pharynx,  and  extemallv 
covered  with  the  stemo-deido-mastoid  muscle ;  iis  whoie 
capacity  being  about  the  size  of  a  pullet's  egg.  It  was 
at  first  fancied  that  before  death  there  was  a  conununi- 
cation  with  the  brain  through  the  spheno  maxillary 
fossa,  but  this  supposition  was  overthrown  by  the  ab- 
sence of  protrusion  of  the  eyes  and  oedema  of  the  lids. 
A  careAil  examination  of  the  upper  part  of  the  abscess 
with  the  probe,  discovered  that  the  foramina  for  the 
tranmission  of  the  nerves,  particularly  the  foramen  ovale 
and  foramen  spinosum,  nad  their  mamns  denuded  and 
roughened ;  and,  forthermore,  the  basilar  process  of  the 
occipital  bone  presented  a  very  injected  and  succulent 
appearance.  On  examining  the  petrous  portion  of  the 
temporal  bone,  and  making  a  section  of  it,  the  external 
auditory  canal  was  fortunately  laid  open,  and  the  cavity 
of  the  middle  ear.  Both  the  bone  and  the  auditory 
apparatus  were  found  perfectly  healthy.  A  further  pre- 
paration of  this  specimen,  by  Dr.  Weir,  gave  a  very 
satisfactory  exposition  of  the  anatomy  of  the  internal 
ear.  The  case  was  a  very  interesting  one,  as  proving 
an  unusual  course  for  the  extension  of  inflammation 
fit>m  a  deep  cervical  abscess  to  the  cranial  cavity. 

MAUONANT  DISEASC  OT  THE  DURA  MATER. 

Dr.  Draper  presented  a  specimen  of  malignant  disease 
of  the  dura  mater.  The  patient  firom  whom  the  specimen 
was  taken  was  a  young  Irishman,  fifteen  years  of  age, 
who  was  admitted  to  me  hospital  on  the  3d  of  January. 
He  stated  that  he  had  been  m  good  health  until  last 

Sring,  when  he  had  a  severe  attack  of  fever  and  ague, 
e  recovered  from  that  however,  and  continued  at  hiji 
work  until  about  two  months  before  he  entered  the  hos- 
pital, when  he  began  to  suffer  severely  from  pains  in 
the  lower  part  of  the  back,  extending  around  the  abdo- 
men in  front,  and  down  the  thighs.  These  pains  were 
aggravated  by  movement,  and  were  ascribed  to  rheu- 
matism. He  however  kept  at  his  employment  until  ten 
days  before  his  admission^hen  he  was  obliged  to  ^ve 
up  and  take  to  his  bed.  He  walked  into  the  hospital, 
although  his  ^t  was  somewhat  unsteady,  and  he  leaned 
considerably  forward.  When  Dr.  Draper  saw  him  on 
the  3d  of  January,  he  was  suffering  extreme  pain  in  the 
tower  part  of  the  back,  extending  down  towards  the 
pubes  in  firont,  and  the  sciatic  nerves  posteriorly.  The 
pain  was  aggravated  by  movements,  and  also  by  pres- 
sure ;  there  was  tenderness  over  the  lower  dorsal  and 
lumbar  vertebrsd,  and  on  the  lefl  side  there  appeared  to 


Digitized  by 


Google 


162 


THE  MEDICAL  RECORD. 


be  some  swelling  and  greater  tenderness.  His  general 
condition  was  feeble,  me  pulse  was  rapid,  and  the  skin 
hot  The  first  impression  was  that  he  had,  in  all  proba- 
bility, a  lumbar  abscess;  but  as  there  was  an  inability  to 
detect  fluctuation  in  the  sweUin^;  on  the  left  of  the  spine, 
no  positive  opinion  could  be  arrived  at  He  was  obliged 
to  sit  up  in  bed,  and  every  movement  was  accompanied 
by  pain,  which  was  much  aggravated  ,at  night  As  a 
consequence  he  was  kept  under  the  influence  of  mor- 
phine, hypodermically  administered,  during  the  whole  of 
nis  illness.  On  the  third  day  afler  nis  admission,  it  was 
observed  that  he  had  retention  of  urine,  and  on  ex- 
amination there  was  absolute  paralysis  or  motion,  and 
very  considerable  anesthesia.  Although  the  bladder 
was  paralysed^  the  sphincters  retained  their  integrity. 
There  was  a  slight  amount  of  priapism  noticed  at  this 
time.  This  condition  of  absolute  paralysis  of  motion  of 
the  lower  extremities  and  anesthesia  continued  about 
a  week,  when  the  anesthesia  was  lost,  and  the  pa- 
tient became  extremely  hyperesthetic,  intolerant  of 
the  slightest  touch  upon  the  lower  extremities.  There 
were  no  spasms  of  the  lower  extremities,  tlie  reflex 
function  bemg  entirely  abolished.  He  continued  in  this 
condition  until  the  17th  of  February,  when  he  died. 

The  only  symptom  which  indicated  any  change  in  his 
condition  was  that  after  the  p>aralysi8  had  continued 
about  a  weel^  the  rectal  sphincter  gave  way.  The  vesi- 
cal sphincter  continued  good  until  death.  His  condition 
grew  worse,  his  perspiration  profuse  at  night  pulse  fee- 
ble and  rapid,  and  emaciation  extreme.  Within  four 
days  after  there  was  paralysis  of  motion,  a  lai^  bed- 
sore formed  upon  the  sacrum,  and  the  other  prommences 
were  threatened  with  the  same  condition.  It  was 
necessary,  on  account  of  this,  to  protect  him  with  great 
care  with  oakum  ring-pads ;  and  with  the  exception  of 
the  large  bed-sores  on  the  sacrum,  and  others  which 
followed  over  the  trochanters,  he  escaped  further  serious 
trouble  in  this  respect. 

The  autopsy  was  made  twenty-four  hours  after  death. 
The  emaciation  was  extreme.  The  rigor  mortis  was  not 
ver^  considerable.  The  lungs  were  found  to  be  healthy. 
This  is  an  important  fact;  as,  afler  admission,  his  chest 
was  examined,  and  there  was  found  dulness,  a  prolonged 
expiration,  and  increased  vocal  resonance.  The  kid- 
neys were  found  diseased.  The  surface  of  one  of  these 
of^ans  was  marked  with  ill-defined  yellowish  deposits, 
infiltrated  in  the  cortical  substance.  Several  of  the 
mesenteric  glands  were  very  much  enlarged,  and  were 
the  seats  of  medullary  cancer. 

The  cavity  of  the  spine  was  very  carefully  opened, 
and  the  cord  removed  fi*om  the  third  dorsal  vertebra 
down.  On  opening  the  cavity,  the  membranes  were 
found  below  the  dorso-lumbar  enlargement,  and  very 
much  distended  with  fluid ;  and  on  slittine  up  the  mem- 
branes, this  fluid  was  found  perfectly  clear  and  free 
firom  any  lymph  or  purulent  admixture.  On  examining 
the  membranes  a  deposit  was  found,  extending  from  the 
point  of  emergence  of  the  tenth  dorsal  to  the  emergence 
of  the  first  lumbar,  resembling  lymph.  There  was  no 
marked  injection  of  the  membranes,  we  peritoneal  aritch- 
noid  was  free  from  turgescence,  and  the  visceral  arach- 
noid was  scarcely  more  injected  than  normal  The  pia 
mater  was  nearly  natural;  the  consistence  of  the  cord 
was  normal,  both  above  and  beneath  the  deposit  On 
dissecting  the  areolar  tissue  about  the  deposit,  it  was 
found  that  it  had  a  very  well  defined  margin,  and  on 
microscopic  examination,  there  was  an  entire  absence  of 
the  elements  of  inflammatory  exudation ;  but  their  other 
elements  consisted  entirely  of  nuclei,  granular  nucleated 
ceOs,  and  a  small  amount  of  connective  Ustue.  These 
nuclei  were  a  little  larger  than  pus-cells,  beinff  about 
the  two-thousandth  of  an  inch  in  diameter.    The  same 


elements  were  found  in  the  enlarged  mesenteric  glands. 
The  substance  of  the  cord  was  surrounded  by  this 
deposit,  and  many  of  the  ganglionic  cells  were  veij 
granular. 

Dr.  Looms  could  not  see  how  there  could  have  been 
dulness  on  percussion,  increased  vocal  resonance,  and 
prolonged  expiration,  without  some  deposit  in  the  hxng 
to  exphdn  it 

Db.  Eraokowizkr  remarked  that  in  shallow,  hurried 
respiration  all  the  physical  signs  of  absence  of  air  were 
often  given. 

Da.  LooMis  could  conceive  it  possible  that  the  respi- 
ratory motions  should  modify  the  sounds  heard  on  aus- 
cultation, but  they  could  no^  in  his  opinion,  change  the 
vesicular  character  of  the  respiratory  murmur.  In 
order  to  give  all  the  physical  signs  referred  to  by  Dr. 
Draper,  a  solidification  by  efiusion  must  take  place. 

Dr.  Drapbr  remarked  that  the  diagnosisi  at  first,  had 
been  tubercular  deposit  in  the  lung,  with  tne  same  dis- 
ease in  the  spine.  The  autopsy  was  the  only  thing 
that  decided  against  it  The  patient  was  caremlly  ex- 
amined, and  the  physical  signs  were  unmistakable.  As 
there  proved  to  be  an  absence  of  disease  of  the  lung,  he 
was  forced  to  conclude  that  the  phenomena  w'ere  due 
to  other  causeSw  the  most  likely  one  of  which  was  im- 
perfect and  shallow  respiration.  There  was  an  absence 
of  the  usual  amount  of  air  to  give  the  lung  tissue  its 
normal  physical  signs. 

Dr.  liOOMis  contended  that  there  must  be  some  other 
cause  at  the  bottom,  as,  for  instance,  an  efifusion  of  some 
kind.  This  might  have  been  a  temporary  affair,  and  at 
the  time  of  death  left  the  lung  in  a  healthy  condition. 

Db.  Krackowizer  stated  that  simple  congestion  of 
the  lung,  tffWiaui  effusion,  would  produce  many,  if  not 
fdL  the  signs  of  solidification.  The  same  condition  was 
induced  by  the  absence  of  the  normal  quantity  of  air  in 
the  lungs.  He  had  proved  this  in  those  cases  of  croup 
which  had  given  him  reason  at  first  to  suspect  a  com- 
plication of  pneumonia.  He  did  not  beUcve  that  any 
amount  of  congestion  cocdd  alter  the  respiratory  sounds 
to  give  evidences  of  even  a  slight  degree  of  congestion 
unless  there  was  some  effu^on. 

Dr.  Bibbiks  asked  if  there  was  not  dulness  on  per- 
cussion in  the  hypostatic  congestion  of  typhoid  fever. 

Dr.  Eraokowixer  remarked  that  when  that  did  ex- 
ist there  w:as  always  effusion 

Dr.  Weib  presented  the  ulna  of  a  boy  who  had  sof- 
ferred  firom  osteo-myelitis  of  that  bone,  the  result  of  a 
blow  received  by  a  falling  ladder.  The  patient  entered 
St  Luke*s  Hospital  on  the  30th  of  January,  three 
weeks  after  the  receipt  of  the  injuty.  Two  days  alter 
admission  a  swelling  formed  in  the  situation  of  the  in- 
jury, whi(^  being  opened^  discharged  about  two  ounoes 
of  pus.  This  relieved  him  somewhat  fix>m  the  pam 
which  he  had  previouriy  suff*ered,  and  he  went  on  freU 
enough  for  forty-eight  hours,  when  he  began  to  suffer 
fh>m  great  nervous  excitement  and  prostration;  the 
pulse  was  feeble  and  quick ;  there  was  sinking  df  the 
eyes,  toother  with  other  phenomena  marking  g^reat 
constitutional  disturbanoe.  At  the  end  of  twenty-finir 
hours  a  circumscribed  pneumonia  was  found  iust  below 
the  scapula,  as  well  as  a  swelling  near  the  elbow-joint 
of  the  opposite  arm  and  considerable  pain  in  the  calf  of 
the  right  leg,  with  tenderness  and  redness  along  the  femo- 
ral vessels.  The  patient's  condition  kept  about  the 
same  for  three  days  after  this,  when  a  large  absoen  ^was 
noticed  over  the  right  hip-joint,  communicating  with  it 
and  extending  some  distance  down  the  thigh-bone. 
The  swelling  in  the  right  forearm  did  not  augment 
n^idly.  Further  than  this,  there  was  nothing  no- 
ticeable^ with  the  exception  that  there  were  no  chilk^ 
and,  VTith  the  exception  of  two  days  preceding  his 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


168 


death,  no  sweating.  The  treatment  consisted  of  sul- 
phite of  soda  in  3  ii.  doses  three  times  a  day.  The  terope- 
ratare  throughout  ranged  from  104*^  to  105®.  An  ex- 
amination of  the  bone  after  its  removal  showed  its  me- 
duUarj  tissue  reddened,  except  at  the  central  portion  of 
the  canaL  The  redness  was  most  intense  near  the 
dhow-joint^  where  there  was  an  abscess  of  the  bone, 
walled  in  by  adventitious  tissue.  The  examination  of 
the  diseased  portions  by  the  microscope  showed  the 
Qsoal  pathological  characters.  The  wrist-joint  not  in- 
Tohred. 

Dr.  WooeTER  Beach,  Jr.,  presented  two  hearts,  taken 
respectively  from  men  who  had  died  suddenly.  One 
was  the  seat  of  fatty  degeneration,  and  the  other  had 
an  aneurism  above  the  aortic  valves,  causing  fatal  peri- 
carditis. The  previous  histories  or  the  patients  were 
onkoown. 

TUMOB  OF  THE  BRAIN. 

Dr.  Looms  exhibited  a  specimen  of  tumor  of  the 
bnin,  taken  fit>m  a  man  thirty-five  years  of  age.  The 
patient  was  admitted  to  Bellevue  Hospital  on  the  26th 
of  January,  1867,  and  stated  that  some  two  years  before 
he  began  to  be  seized  with  attacks  of  dizziness,  which 
would  last  for  a  moment,  pass  off,  and  be  followed  for  a 
abort  time  with  twinging  of  the  facial  muscles  of  the 
left  side.  These  muscles  afterwards  became  paralysed. 
In  October,  1866,  he  was  suddenly  seized  with  hemi- 
pl^iL  which  lasted  a  week  or  ten  days  and  then  disapn 
peareo,  the  facial  paralysis  continuing,  however,  until 
bis  death.  When  admitted  to  the  hospital  no  evidence 
of  paralysis,  except  in  the  facial  muscles.  Ee  had  the 
trinary  amount  of  trUdHgence  of  a  person  of  his  eUuSj 
and  seemed  to  be  m  comparatively  good  health.  After 
he  bad  been  in  the  holspital  for  a  short  time  he  became 
totally  blind,  and  in  a  week  or  so  began  to  grow  stupid 
aod  finally  died  of  coma. 

At  the  autopsy  a  tumor  was  found  in  the  posterior 
lobe  of  the  lelt  cerebrum,  embracing  very  nearly  the 
wbde  of  that  organ.  It  seemed  to  be  attached  firmly 
to  the  membranes  of  the  brain,  the  dura  mater,  and 
andiQoid.  The  surrounding  brain  tissue  was  very 
mach  soflened,  but  the  tumor  itself  was  well  defined. 
It  was  of  an  opaque  whitish  color  and  mottled  with 
some  i^ey-looking  substance.  On  microscopical  ex- 
amination by  the  curator  of  the  museum,  the  cells  of  the 
grey  portions  were  so  small  that  they  presented  the  ap- 
pevance  of  nuclei  There  was  also  m  this  substance 
a  network  of  fibres  indosine  cells  in  vast  numbers. 
The  tissue  was  finely  vasculanzed  The  white  portion 
presented  the  cells  in  an  advanced  state  of  fatty  de- 
generation. 

The  interest  of  the  case  centred  in  the  long  exist- 
ence of  such  a  disease  without  symptoms,  and  also  to 
the  iici  that  the  hemiplegia  was  on  the  same  side  as 
the  brain  lesion. 

Dr.  Notes  remarked  that  the  sudden  blindness  of  the 
puient  was  evidently  due  to  the  softening  pf  corpora 
qoidrigemina.  "" 

NEW  YORK  ACADEMY  OF  MEDICINE. 

Stated  Meitiko,  April  3,  1867. 

Da.  A.  C.  Post,  Pbisident,   in  the  Chair. 

KPIDEMIO  OONTAOIOir. 

Dt.  Wm.  C.  Robibts  read  a  paper  upon  the  above  sub- 
ject, embodying  the  following  propositions  and  infer- 
ences :— 

Seven  great  epidemics  are  generally  recognised, 
^:  tjrphus,  small-pox,  scarlatina,  messes,  hooping- 
cough,  influenza^  and  cholera,  each  of  which  is  caused 


by  a  separate  and  specific  morbid  poison.  To  this  list 
may  perhaps  be  added  plague,  erysipelas,  puerperal 
fever,  and  mumps  (parotitis).  Plague  is  never  seen 
among  us.  Erysipelas  and  puerperal  fever,  with 
typhus,  seem  to  be  interconvertible,  and  may  be  one 
and  the  same  disease,  and  derivable  firom  the  same  ani- 
mal poison.  Intermittents  are  never  epidemic  nor 
zymotic,  neither  is  yellow  fever  epidemic,  but  its  virus 
is  tran^rtable,  and  its  contagiousness  not  wholly  un- 
doubted. 

Various  hypotheses  as  to  the  nature  of  these  poisons 
exist;  atmospheric,  telluric,  animalcular  (the  most  pro- 
bable), fungoid,  spontaneous,  gaseous,  solid,  etc.,  but 
nothing  is  as  yet  positively  known  on  the  subject. — 
(See  Holland,  Noiee  and  Bef.) 

All  epidemic  poisons  seem  to  have  reached  Europe 
from  the  East^  and  to  have  found  their  way  hither. 
None  have  originated  here;  but  of  the  manner  in 
which  they  originated,  nothing  is  known;  all  are  of 
^at  antiquity.  The  poison  of  cholera  had  existed 
m  India  for  centuries  before  it  was  introduced  into 
Europe,  and  then  into  America^  and  is  now  endemio 
there. 

These  poisons,  however  originating,  infected  the 
human  body  with  a  specific  disease,  which  has  never 
changed  or  lost  its  power  or  property.  Many  of  them 
possessed  the  power  of  re-multiply  ing  themselves  in  the 
body,  by  an  intra-corporeal  zuma,  or  zymotic  (ferment); 
the  germs  so  multinhed  bein^  exhaled  from  the  body 
with  secretions,  and  diffused  m  the  surrounding  atmo- 
sphere, there  again  undergoing  an  extra-corporefu,  intra- 
aerial  zymosis  and  re-production,  and  infecting  those 
brought  into  indirect  contact  with  the  patient,  through 
the  medium  of  the  (impure)  atmosphere.  Contagion 
of  the  second  genus  (J.  M.  Smith).  That  germs,  far- 
ther multiplied  and  diffused  through  the  air  (intra- 
aerial  zymosis),  wafted  by  the  wind,  or  advancing  bv 
their  own  peculiar  powers  of  progression,  invade  vari- 
ous localities  at  intervals,  or  in  succession,  and  produce 
endemics,  or  epidemics,  which  are  a  succession  of  en- 
demics, each  poison  producing  its  own  specific  disease, 
with  its  attending  pnenomena. 

Emanating  thus  from  the  bodies  of  the  sick,  they 
become  animal  poisons — idio-miaemata.  Those  poisons 
which  are  animal^  specific  and  zymotic,  are  both  conta- 
^ous  aod  epidemic ;  no  others  are,  or  become  such. 
To  say  that  a  poison  is  an  animal  one,  is  tantamount  to 
this.  Diseases  of  malarious  origin:  Koino-miasmie 
are  never  extra-oorporeally  zymotic,  never  contagious 
in  any  degree^  unless  mixed  (idio-koino  miasmic),  and 
never  epidemic.  Nor  are  the  poisons  transportable  by 
air  or  other  fomites,  unless  we  say  that  that  of  yellow 
fever  is,  and  allow  it  a  measure  of  contagiousness,  for 
which  some  have  contended. 

Such  diseases  arise  locally  firom  certain  causes,  pre- 
vail locally,  and  do  not  extend  &r  (endemic),  and  cease 
on  the  cessation  of  their  cause,  leaving  behind  no  latent 
germs  of  infection  for  future  development  Bilious 
remittent  and  intermittent  fever  belon|^  to  this  cata- 
gory.  Influenza,  the  genesis  of  which  is  unknown,  is 
per-aerially  portable.  Specific  poisons  communicate 
their  own  action  and  eff(K)t,  analogous  transformations 
in  the  bodies  of  the  sick,  and  the  disease  produced  by 
them  is  always  one  and  the  same  specific,  and  tut 
generis.  In  the  case  of  typhus,  erysipelas,  and  puerpe- 
ral fever,  there  is  observed  a  curious  interconvertibiBty 
of  poisons,  the  one  sometimes  transmitting  the  other, 
which  has  cansed  them  to  be  regarded  as  identical  poi- 
sons and  diseases,  although  each  is  often  seen  unmixed 
and  pure.  Sometimes  they  concur,  and  only  one  poi- 
son IS  transmitted,  either  according  to  its  neater  pro- 
minence, or  under  circumstances  and  iniuences  uur 

digitized  by  VjOOQ IC 


164 


THE  MEDICAL  RECORD. 


known.  Other  morbid  poisons  concur  in  the  same 
indiyidua^s,  and  thns  we  see,  that  while  the  general 
rule  holds  ^ood,  that  specific  poisons  produce  specific 
diseases,  poisons  may  co>exist,  if  they  do  not  blend ; 
and  a  mixed  mongrel  compound,  or  spurious  disease 
exist,  or  result^  not  easily  to  be  classified,  of  which  cer- 
tain forms  of  typho-bilious,  icteroid,  or  malarial  fevers 
are  examples.  The  poison  of  one  disease  seems  super- 
added to  the  other. 

Mr.  Farr,  Reg.  Gen.  of  England,  tells  us  that  "  zy- 
motic" 13  now  substituted,  to  avoid  a  tedious  peri- 
fhrasisfor  "  epidemia''  All  epidemic  (zjrmotic)  diseases, 
believe,  are  contagious,  except  influenza  (which  may 
not  be  zymotic),  extra-corporeally,  although  inter- 
aerially  it  must  be,  to  account  for  its  excessively  rapid 
devtlopment  So  that,  with  this  exception,  all  eptde- 
ifitct,  cholera  included,  are  zymotic  and  contagious; 
and,  because  zymotic  and  contagious,  epidemic,  which 
Others,  not  such,  are  not 

Contagions  of  the  first  genus  (actual  contact),  are 
intra-corporeally  zymotic  in  a  degree,  producing  disease 
only  in  the  body  of  the  recipient  but,  by  infecting  his 
fluids  (blood,  lymph,  pus,  etc.),  enabling  them  to  com- 
inunicate  the  same  diseases  by  actual  contact  (inocula- 
tion.) Thej  are  not  communicable  through  an  atmo- 
spheric medmm,  nor  are  they  mixed ;  for  although,  if 
blood  be  drawn  with  the  vaccine  virus  from  a  syphi- 
Kzed  child,  syphilis  may  be  coomiunicated,  yet  pure 
fi*esh  lymph  alone  communicates  no  such  disease.  The 
exanthemata  concur ;  but  each  eruption  is  distinct 
and  separate;  and  the  rash  of  typhus,  the  rose-colored 
lenticular  spots  of  typhoid  fever,  and  patches  of  erysipe- 
las, may  all  concur  or  co-exist  in  the  same  individual 
Hence  it  seems  difficult  to  consider  them  identical 
poisons.  Two  at  least  of  the  exanthemata  are  inocu- 
lable  also. 

Typhus  and  typhoid  poisons  may  concur  in  the 
•ame  individual  These  are  the  cases  which  have 
caused  the  doubts  as  to  the  separate  identity  of  the  dis- 
eases, and  produce  in  the  same  case  a  coincidence  of  the 
symptoms  and  pathological  lesions  of  each.  Mixture  of 
idioand  koino-miasma  produces  a  hybrid  class  of  fevers, 
of  bilious  or  icteroid  character,  with  yellowness  of  skin, 
and  black  vomit,  which,  as  a  general  rule,  is  not  seen 
in  typhus  fever.  The  typho-malarial  fever,  described  by 
Dr.  Woodward.  U.S. A.,  iu  camp  fevers  (wnich  he  deems 
non-contagious) ;  the  compound  Banker  street  fever  of 
1820;  the  Irish  icteroid  typhus,  or  yellow  fever,  as  de- 
scribed by  Graves  in  his  clinic»Ed  lectures ;  the  Bulam 
fever  of  Africa,  and  the  disease  on  board  H.  M.  S. 
Sclair,  etc.,  seem  all  of  this  character :  and  it  is  verv 
difficult  to  make  the  diagnosis  between  them  and  yel- 
low fever.  A  strong  infiision  of  the  koinic  element 
gives  to  them  their  bilious  character.  A  similarlv  pre- 
dominant idio-miasm  determines  their  typhoid  charac- 
ter, and  imparts  to  them  a  qualified  contagiousness. 
Perhaps  it  is  to  the  super-addition  of  idio-miasma 
(typhus  poison),  firom  without,  or  inwardly  generated 
in  course,  that  the  typhoid  character  of  many  diseases 
80  characterized  is  to  be  attributed. 

A  certain  amount  of  intra-corporeal  zvmosis  is  ne- 
cessary, in  all  cases,  to  produce  disease ;  but,  unless  the 
morbid  product  so  formed  be  eliminated  (extra-corp. 
zymosis),  no  contagion  follows,  and  the  disease  remains 
confined  to  the  body  of  the  recipient  of  the  poison, 
and  not  extending  beyond  him.  1/  animaL  it  may  be 
reproduced  in  another  by  inoculation  witn  his  fluids, 
and  becomes  a  contagion.  If  not,  it  dies  in  the  patient, 
and  is  not  reproduced,  and  hc^ce  is  never  contagious 
or  epidemic  {ex,  gr,  intermittent  fever  poison);  onlv 
certam  kinds  of  persons  seem  to  be  susceptible  of  this 
elimination  of  reproducible  germs,  this  that  I  have 


called  extra-corporeal  zymosis,  and  these  are  the  conta- 
gions proper.  No  disease  is  contagious  in  which  this 
does  not  occur;  and  I  think,  that,  unless  there  were  a 
further  intra-aerial  zymosis,  regeneration,  remultiplica- 
tion,  and  diffusion  per  auram,  of  specific  germs,  waited 
by  currents,  or  progressing  by  means  of  vehicles,  or 
by  a  peculiar  power  of  s^-progression,  whereby  the 
poison  is  rapidly  diffused  and  regenerated,  and  every* 
where  carried  so  that  all  are  subjected  to  its  effects, 
according  to  their  degree  of  predisposition  and  suscep- 
tibility, epidemics  could  not  occur. 

If  tne  poison  generated  in  and  exhaled  from  the 
bodies  of  the  sick  extended  no  fiirther  than  a  few  feet 
from  the  bodies  of  the  sick,  and  was  there  diluted,  or 
destroyed  by  ventilation,  I  don*t  see  how  diseases  could 
spread  as  they  do,  and  become  universal.  Upon  this 
point  there  is  some  difference  of  opinion.  On  the  one 
hand,  it  is  said  that  the  miasms  of  small-pox  and  ty- 
phus extend  only  a  few  feet  from  the  bedside:  that 
"there  are  no  grounds  for  the  popular  opinion  that 
typhus  may  be  propagated  through  the  atmo«)here, 
from  a  poor-hospital  to  the  houses  in  the  neighbornood" 
(Murch.),  which,  aldiough  opposed  to  the  idea  of  intra- 
aerial  zymosis  and  progression,  may  be  true  in  the  ab- 
sence of  any  epidemic  prevalence  of  the  disease. 

On  the  ouier  hand,  it  is  said  that  although  the  spread 
of  the  typhus  virus  is  limited,  that  of  small-pox  does 
extend  through  all  parts  of  the  house,  from  a  single 
bed,  even  fi'om  one  house  to  another  in  the  same  vi- 
cinity (Wood.  Pract  of  Med.).  It  is  known  that  more 
than  fifty  persons  contracted  small- pox  fj  om  the  body 
of  Louis  XV.  by  simply  traversing  the  vast  apartments 
of  the  Palace  of  Versailles,  in  which  he  lay  mortally  ill 
of  a  most  virulent  form  of  that  disorder,  without  ever 
approaching  his  person.  That  the  virus  of  small-pox 
bias  crossed  a  river  1,600  feet  wide,  and  infected  persons 
on  the  other  side ;  that  the  poisons  of  scarlatina  and 
puerperal  fever  infect  all  parts  of  a  house  or  hospital 
tor  long  after  the  removal  of  the  inmates  and  thorough 
purification ;  that  during  a  prevailing  measles  or  scarla- 
tina or  cholera  epidemic,  and  even  yellow  fever,  per- 
sons are  infected  by  walking  the  streets,  and  in  houses, 
without  approach  to  the  sick,  which  is  a  thing  of  daily 
observation  and  occurrence  in  private  families,  and 
could  not  happen  unless  there  were  a  poison  in  the  air. 
Court-houses  nave  been  infected  throughout  by  the  en- 
trance and  transport  of  miasm  firom  filthy,  not  diseased, 
prisoners  (Black  assizes).  Murchison  says  that  "  ty» 
phus  prevails,  for  the  most  part,  in  great  and  wide- 
spread epidemics,  independently  of  smaller  endemics;  ** 
and  Graves  distinctly  says  that  "  typhus  will  spread 
among  hospital  patients  in  the  same  ward,  independ- 
ently of  anything  connected  with  filth  or  foul  air,"  not 
always  communicatetl,  I  should  suppose,  by  the  persona 
of  the  attendants.  We  know  that  these  poisons  exist 
in  the  air,  attack  persons  on  ship-board,  long  and  far 
away  from  land,  persons  in  solitary  confinement  (small- 
pox and  cholera).  In  cholera,,  hundreds  of  cases  occur 
witliin  the  same  day,  at  such  distances,  and  in  such 
diverse  parts  of  a  city,  that  thej^  cannot  have  arisen  from 
personal  intercourse,  or  from  its  infection.  Influenza, 
yellow  fever,  and  otner  malaria  are  felt,  on  apprt^aching 
a  coast  where  they  prevail,  at  some  distance;  and  the 
former  affects  almost  the  entire  population  of  a  city, 
town,  or  neighborhood,  in  a  few  days,  and  spreads  at 
times  over  an  entire  country  or  continent;  its  cause 
being  certainly  portable.  How  shall  we  explain  these 
discrepancies  of  opinion,  or  account  for  the  rapid  and 
wide  spread  of  these  epidemics  ?  By  uniform  personal 
contact?  By  fomiUc  infection ?  By  (ie  n<H;o  genesis, 
or  development  under  meteoratious  or  epidemic  influ- 
ences, which  cannot  apply  to  imported  poisons,  how- 


igitized  by  LjOO^- 


THE  MEDICAL  RECORD. 


165 


erer  much  they  may  favor  it,  and  is  not  known  to  be 
tnie  of  any  ?  Or  by  each  and  all  of  these  causes  com- 
bined, together  with  an  intra-aerial  development  and 
remultiplication  of  infectious  germs  (zymoses)  and  a 
peculiar  method  of  progression  of  germs,  a  zymosis, 
not  in  the  body  alone,  but  in  the  air  and  soil ;  **  the  poi- 
sonous air  becoming  a  ferment  which  produces  its  like/* 
(Clark's  Lectures,  Medical  Record,  lect.  3d).  It  is  not 
necessarVi  it  is  not  possible,  in  any  prevailing  epidemic, 
to  look  for  personal  contagion  in  every  case  as  a  cause 
of  infection.  The  disease  is  too  general,  and  its  spread 
too  rapid.  The  atmosphere  contains  the  poison,  now- 
evcr  introduced  or  developed.  If  the  disease  is  spe- 
cific, the  poison  is  specific,  or  the  disease  could  not  be 
indnced.  If  it  is  intra-corporeally  zymotic,  reproduci- 
ble, that  is.  from  the  bodies  of  the  sick,  it  is  contagious, 
and  the  infection,  in  any  way^  by  a  specific  and  zymotic 
per3on,  is  contagious;  and  except  in  the  case  of  influ- 
cnia,  I  don't  believe  that  any  existing  epidemic  is 
wanting  in  this  character ;  and,  if  all  poisons  are  ab- 
sorbed, communication  of  specific  disease,  in  any  way, 
from  one  person  to  another,  is  contagion,  whether  by 
swallowing  of  air  or  infected  fluids,  or  by  contagious 
or  pulmonary  absorption,  which  is  most  probable.  The 
mode  of  infection  is  the  same  in  all,  no  matter  where 
the  poison  is  derived  from,  breath  or  skin  or  stools,  and 
they  are  all  similarly  contagious  (contracted,  that  is,  in 
the  same  way),  but  not  eaually  so,  which  depends  upon 
the  virulence  and  dose  of  the  poison,  and  the  degree  of 
Bosceptibility  of  the  exposed. 

To  originate  epidemics,  a  contagious  principle  and  a 
meteoratious  influence  may  both  be  needed.  Sponta- 
neous development  does  not  oppose  contagion.  All 
known  contagions  of  epidemic  character  so  originated, 
and  they  may  a^ain  do  so.  But  most  of  them  are  now 
domiciliated  and  domesticated,  and  arise  now  from  de- 
Telopment  of  small  stocks  of  concealed  contagion,  which 
is  always  possible  when  spontaneous  development  is 
saq>ected.  Some — ^yellow-fever,  cholera,  and  influenza — 
are  never  known  to  originate  here;  always  they  are 
imported  poisons,  and  their  germs,  if  not  conta^ous, 
are  at  least  portable.  No  specific  poison  can  be  mtro- 
duoed  anywhere  whose  germs  are  not  portable  and 
specific,  nor  regenerated,  unless  zjrmotic,  intra-aeriaJly 
at  least;  so  that  portability  of  such  germs  may  almost 
be  said  to  be  synonymous  with  contagion.  The  germs 
of  typhus,  small-pox.  hooping-cough,  scarlatina,  and 
eholera,  are  portable  oy  fomites,  perhaps  those  of  ty- 
phoid fever,  and  they  are  all  contagions.  Those  of  yel- 
W-fever  and  influenza  are  transportable  through  the 
air,  regenerable  in  it,  multiplicable  in  it,  and  zymotic  in 
it,  and  infect  by  absorption.  But  if  th*ey  be  not  intra- 
eorporeally  zymotic  and  exhalable  poisons,  they  are  not 
contagions.  Thus  intra-corporeal  E3rmosis  is  the  test 
of  contagious  epidemicity.  iTo  such  property  attends 
the  miasms  of  bilious  remittent  and  intermittent  fever, 
which  are  never  either  epidemic  or  contagious.  Direct 
contagions  of  the  first  germs  differ  from  those  of  the 
Becond  (incKrect)  mainly  in  that  there  is  no  extra-cor- 
poreal emanation  of  contagious  germs.  The  exanthe- 
mata, although  supposed  to  be  usually  of  spontaneous 
origin  (Smith,  Barker,  etc.),  and  certainly  at  times  im- 
ported (small-pox,  especiall  v),  now  generally  arise  from 
rekindlement  of  small  stocks  of  dormant  vims  always 
on  band  in  large  cities,  and  perhaps  elsewhere.  Typhoid 
fbver  is  supposed  to  be  engendered  by  fiscal  fermenta- 
tion, filth,  etc. ;  and  many  attribute  typhus  to  similar 
fecal  causes.  Erysipelas  would  seem,  also,  to  arise 
independently  of  contagion.  These  are  not,  like  cho- 
lera and  influenza,  imported,  and  may  have  new  and 
k>cal  orj;an&  But  it  may  be  that  no  zymotic  poison, 
OQoe  existent,  ever  does  become  wholly  extinct ;  the 


exanthemata  never  have,  and  cholera  is  still  endemic  in 
India,  and  local  circumstances  and  meteoratious  influ- 
ences easily  and  soon  rekindle  them.  Doubtless,  they 
occur  comparatively  less  fi*equently  under  the  improved 
state  of  hygienic  science. 

But  I  doubt  if  we  are  authorized  to  deny,  as  some 
zealous  sanitarians  have  done,  that  there  is  any  such 
thing  as  contagion,  and  assert  that  aU  so-called  *'  con- 
tagions" result,  in  every  instance,  fix)m  neglect  of  san- 
itary precautions.  Diseases,  so  originating  even,  would 
not  the  less  he  contagious,  say  small-pox,  for  example. 
How,  then,  deny  its  existence  ? 

There  is  no  such  thin?  as  contingent  contagion :  it  is 
only  qualified.  Epidemic  diseases  are  not  identical ;  but 
are  all  analogous  in  general  law  and  action,  although 
differing  specifically,  yet  so  much  alike  in  these,  that 
what  is  true  of  one  is  true,  for  the  most  part^  of  alL  In* 
fluenza  seems  to  be  the  only  epidemic  poison  in  which 
zymosis  (and  that  not  extra-corporeal)  is  separable  firom 
contagion.  No  morbid  poisons  originate  within  Uie 
body ;  they  are  all  received  from  the  air  into  it.  Those 
which  are  subsequently  reproduced  in  and  eliminated 
from  it  and  become  animal,  whether  originating  in  an 
idio  or  koino-miasm,  are  zymotic  contagiona  It  is 
curious  how  different  are  the  varieties  and  effects  of 
poisons,  whose  (original)  causes  appear  so  similar.  Epi- 
demic influence  alone  will  not  account  for  them,  and,  if 
it  did,  nothing  is  known  of  its  mode  of  action. 

That  typhuB  originates  fi-om  ochletic  miasm,  is  g^ie- 
rally  believed ;  but  not  by  Watson,  nor  by  Wood,  that 
offensive  effluvia,  filth,  and  poverty  produce  this  spe- 
cific form  of  fever.  But  there  is  between  them,  whether 
as  cause  or  effect,  a  connexion  so  close  that  it  cannot 
be  safely  disregarded. 

Barker  attributes  to  the  foul  effluvia  of  drains,  cess- 
pools, eta,  cases  of  typhus,  and  scarlatina  even ;  and 
Murcmson  thinks  that  typhus  fever  may  be  so  induced. 
The  real  character  of  the  diseases,  if  any^  so  produced, 
is  an  interesting  subject  of  physiological  mquiry. 

These  statements,  in  regard  to  epidemic  contagion, 
are  generally  known,  and  to  be  found  in  most  treatises 
on  practical  medicine,  and  the  influences  from  them, 
right  or  wrong,  are  easily  drawn.  But  I  do  not  know 
where,  ebewhere,  they  are  as  succinctly  collected  and 
enunciated.  _ 

PHILADELPHIA  CX)UNTY  MEDICAL 
SOCIETY. 

Conversational  Meeting,  March  20,  1867. 
Db.  Andrew  Nebinger,  President,  in  the  Chair. 

ANOULAB  OUBVATURl  OF  THE  8PINI. 
(Condoded  from  page  94.)  | 

Dr.  Benjamin  Ln,  Philadelphia,  presented  to  the 
Society  a  copy  of  his  recentljr  published  papers  on  Pott*s 
Disease,  entitled  **  Contributions  to  the  Pathology,  ZHag- 
nosis.  and  Treatment  of  Angular  Curvature  of  the  Spine," 
Dr.  Lee  stated  that  tiie  points  which  he  desired  to  es- 
tablish in  this  series  of  articles  were  threefold : — First: 
The  existence  of  a  symptom  of  this  very  distressing 
affection,  which  could  be  relied  on  almost  unfailingly, 
and  was  present  long  before — months^  even  an  entire 
year,  it  nught  be — before  deformity  made  its  i^pearance ; 
a  symptom  therefore  of  the  first  importance,  as  it  ena- 
bled us  to  commence  our  treatment  of  the  disease  in  its 
most  tractable  stage,  and  before  it  had  materially  de- 
stroyed the  normal  curves  of  the  spine.  This  symptom 
was  a  spasmodic  pain  in  the  abdominal  region,  suffi- 
ciently well  designated  by  the  term  gastralgiaj  although 
it  was  not  confined  to  the  stomach.  A  case  had  oc- 
curred since  the  last  meeting  of  the  Society  which  to 

digitized  by ^ JlC 


166 


THE  MEDICAL  RECORD. 


admirablj  illustrated  this  subject^  that  he  might  be  ex- 
cosed  for  briefly  alluding  to  it. 

A  child,  four  years  of  age,  was  placed  under  his  care 
by  Dr.  Corson,  of  Norristown,  Pa.,  presenting  the  fol- 
lowing history :  Rather  more  than  twelve  months  ago. 
haying  previously  been  in  perfect  health,  on  being  li&a 
by  his  mother  one  morning,  taking  him  under  the  arms 
in  the  usual  manner,  he  suddenfy  shrieked  out  with 
pain,  and  on  being  asked  where  he  was  hurt,  he  put 
Ids  hand  on  the  abdomen.    From  that  day  forward  he 
was  subject  to  constant  similar  attacks,  generally  pro- 
duced at  first  by  some  sudden  or  forcible  movement  of 
the  body,  and  often  causing  him  to  bend  double  as  if 
with  cramps  of  the  abdominal  muscles.    He  gradually 
emaciated,  and  soon  began  to  give  evidence  of  difficult 
locomotion,  the  right  leg  especially  being  affected.    Dr. 
Corson  having  directed  the  attention  of  the  mother  to 
the  spine  as  the  possible  seat  of  the  trouble,  it  was  closely 
watched,  and  not  until  the  Sunday  before  he  was  brought 
to  Dr.  Lee  did  the  deformity  show  itself.    At  this  time 
he  was  having  the  attacks  of  gastralgia  regularly  every 
evening.    The  protuberance  was  in  the  lumbar  region. 
8ec<mcUy :  The  tact,  which  he  firmly  believed,  that  the 
disease  in  question,  although  often  accompanying  the 
strumous  cachexy,  was  not,  as  the  text-books  teach, 
essentially  tubercular  in  its  origin.    And  Thirdly:  That 
the  most  rational  and  succesidnil  method  of  treatment 
was  the  employment  of  force  in  the  antero-posterior 
direction,  for  the  accomplishment  of  which  the  splint  of 
Dr.  Taylor,  of  New  York,  was  the  means  best  adapted. 
Dr.  Hartshorni  said  that  he  had  read  the  work  just 
presented  with  much  interest.   He  considered  the  symp- 
tom dwelt  upon  by  Dr.  Lee  as  of  very  great  importance, 
but  was  at  a  loss  to  know  how  it  was  to  be  distmguishea 
from  the  pain  accompanying  ulcer  of  the  stomach,  in 
the  earlier  stages  of  the  latter  affection,  before  luemate- 
mesb  had  commenced.    He  would  be  much  obliged  to 
Dr.  Lee  if  he  would  indicate  the  signs  on  which  he  re- 
lied to  make  this  distinction.     He  bought  it  the  more 
difficult,  inasmuch  as  Dr.  Lee  had  stated  that  the  spinal 
gastralgia  was  sometimes  produced  by  ti^ung  food  into 
the  stomach. 

Db.  Lei  remarked  in  reply,  that  while  it  was  true 
that  the  abdominal  pains  accompanying  spinal  inflam- 
mation might  be  caused  by  the  prehension  of  food,  it 
was  so  only  in  rare  cases.  The  presence  of  blood  in  the 
matters  vomited,  referred  to  by  Dr.  Hartshome,  would 
in  such  cases  very  soon  decide  the  doubt,  if  any  existed. 
But  there  were  other  points  of  distinction.  The  spinal 
pain  was  usually  spasmodic  in  its  character,  causing  the 
patient  to  shriek  out  suddenly,  and  often  as  suddenly 
ceasing.  It  was  very  often  traceable  to  movements  of 
the  b^y,  even  in  cases  where  it  might  also  be  caused 
by  eating.  It  was  rarely  accompanied  oy  vomiting.  But 
probably  the  most  trustworthy  symptom  was  a  stiffness 
of  the  lower  extremities  on  first  mme  in  the  morning. 
This  morning  rigidity  and  difficulty  of  locomotion  were 
generally  present  as  soon  as  there  was  enough  inflam- 
matory action  to  produce  the  ventral  pains,  and  the 
association  of  the  two  might  be  considered  as  convinc- 
ing evidence  of  its  existence. 


€(fxttsponlemt. 


Eecipbocation  of  Mbdioal  Servtoes.  —  Professors 
Dumreicher  and  Langenbeck,  the  former  Austrian,  the 
latter  Prussian  Surgeon-General,  have  entered  into  an 
unpleasant  discussion  as  to  whether  the  Prussian  medi- 
cal officers  did  or  did  not  neglect  the  Austrian  wounded 
after  the  battles  in  Bohemia.  It  is  a  matter  of  vera- 
Mty,  or  perhaps  the  shield  was  looked  at  from  different 

led.  I 


ABORTION  IN  THE  CHURCH. 

To  Tin  IsiTom  or  thb  Msdioal  RioomD. 

DiAB  Sir — ^I  was  quite  interested  in  the  accouDt 
given  in  your  recent  issues  of  the  stand  taken  by  one  or 
two  church  journals  against  the  crime  of  J>ortioQ. 
Every  medical  man,  and  every  Christian,  has  reason  to 
rejoice  that  the  initiative  has  thus  been  taken,  and  that 
there  is  a  chance  of  placing  the  enormity  of  this  dread- 
ful crime  properly  before  5ie  eyes  of  the  clergy,  as  well 
as  the  members  of  their  flocks.  I  do  not  wish  to  cast  any 
reflection  upon  the  character  of  true  ministers  of  the 
gospel,  for  such  should  always  be  above  su^icion,  bat 
there  are  some  who  unwortnily  assume  the  titles  and 
responsibilities  belonging  to  that  profession,  and  who  not 
only  wink  at  the  practice  but  who  urge  its  committal 
upon  their  own  wives. 

Permit  me,  sir,  to  cite  a  case  in  point:  A  few  weeks 
ago  a  well  known  clergyman  in  the  district  in  which  I 
reside  called  at  my  office  for  a  confidential  profeasionil 
int  rview,  and  in  the  course  of  our  conversation  be 
came  at  the  subject,  which  was  that  of  a  proposal  for 
aid  in  producing  an  abortion  upon  his  wife.  AfUrl 
had  sumciently  recovered  my  surprise  at  this  demand,  I 
expostulated  with  him  and  tried  to  use  the  usual  arga- 
ments  against  the  conunission  of  the  act^  but,  strange  to 
say,  while  admitting  the  truth  of  my  assertions,  as  he 
termed  it,  **  on  high  moral  grounds,"  he  declared  it  to  be 
his  intention  to  have  it  done  by  some  willing  party  upon 
whom  he  intended  to  caU.  It  was  a  matter  of  e]q)e- 
diency  to  him,  he  being,  as  he  said,  so  peculiarly  situated 
that  a  birth  at  the  time  it  would  be  due  would  be  the 
most  inconvenient  thing  in  the  world.  He  was  not 
loath  to  have  a  family,  and  he  pretended  to  believe 
that  the  Almighty  could  protect  his  wife  through  the 
parturient  act,  and  made  quite  a  number  of  pretty  litde 
arguments  in  favor  of  his  project  But  what  was  his 
excuse  ?    Simply  this— He  was  to  siul  shortly  as  a 


missionary,  and  he  did  not  wish  to  have  hu  wife  cot^ 
ed  on  shipboard  I 

I  have  no  doubt  that  other  medical  men  have  simi- 
lar experiences,  but  for  myself  I  must  confess  that 
this  was  rather  a  startling  one,  as  proving  the  deep 
root  which  this  crime  has  taken  among  that  class  of 
individuals  who  should  know  and  do  better.  It  is  this 
class  particularly  that  may  be  benefited  by  the  discus- 
sion of  the  subject  in  religious  papers.  This  man  has 
probably  ere  this  been  served,  but  1  hope,  if  such  be  the 
case,  that  he  will  repent  of  his  sin  on  the  voyage,  aod 
make  himself  a  fit  teacher  for  the  poor  heathen. 

Yours  eta,  H. 

NxwYoBX,Ma7,186r. 


RiSPONSiBiLiTT  or  TBI  Chihise  PaTBioiAir.— The  ph^* 
sician  is  ffreatly  responsible  for  his  patients.  If  he  £uls 
to  cure,  the  patient  or  his  friend  may  prosecute  him  at 
once.  If  through  any  inattention  or  mistake  he  has 
caused  the  death  of  a  person,  he  must  pay  the  penaltj^— 
which  penalty  eenerally  means  the  support  of  the  fiunii;^. 
If  through  a  nttal  medical  blunder  this  happens— he  is 
for  ever  afterwards  prohibited  from  practising  his  pro- 
fession— a  rcKulation  that  mi^t^  pernapa,  prove  advan- 
tageous in  other  countries,  visits  are  never  char^; 
they  simply  charge  for  the  medicine  need,  and  it  is  al* 
ways  on  trust  antU  the  patient  gets  better— conditions 
not  very  favorable  for  large  incomes  and  great  wealth. 
—Dr.  Wxht,  Oinn,  Lancet  and  QH^Mrvtr,     ^ 

Digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


167 


€)bHuars* 


PROF.  J.  M.  ALLEN. 

Pin>  AFBIL  7,  AT  LOWILL,  MAM. 

Db.  Axles  was  born  in  Princeton.  Mass.,  in  the  year 
1815,  and,  in  earlj  life,  enjoyed  only  the  advantaffes  of 
t  oonunoa  school  education  in  that  quiet  Mpricmtural 
town.  He  entered  Yale  College  in  1834.  In  1838,  he 
went  to  Philadelj^ia  to  prosecute  medical  studies  and 
attend*  lectures.  In  1840,  he  graduated  at  the  Univer- 
sitj  of  Pennsylyania,  and  immediately  became  a  teacher 
iod  lecturer  on  anatomy  connected  with  a  private 
institution.  Atlerwards  he  occupied  for  several  years 
the  place  of  Demonstrator  of  Anatomy  in  the  Jefirerson 
Mechoal  College,  and  from  there  he  passed  to  the  Pro- 
fessorship of  Anatomy  and  Physiology  in  the  Pennsyl- 
Tinia  Medical  College,  which  post  he  held  seven  or  eight 
yearsL 

During  this  time  he  prepared  and  published  the 
Ameriean  Medical  DinectoVy  a  work  which  possesses 
great  merit  and  is  used  as  a  text-book  by  medical 
Btodents  throughout  the  country.  Close  and  continued 
application  to  professional  duties  as  well  as  to  scientific 
aod  literary  pursuits,  broke  down  his  health  and  com- 
pelled him  to  suspend  his  labors.  At  this  time  he  had 
a  aevere  and  lingering  fit  of  sickness,  fi*om  which  his 
eoDstiUition  never  fully  recovered.  Some  six  or  seven 
years  ago  he  came  to  New  England  to  vL<dt  his  friends 
aod  recruit  his  health,  makmg  Lowell  mainly  his 
home.  On  account  of  his  feeble  state  of  health, 
he  avoided  alK  public  labors  and  medical  practice, 
exc^t  what  incidentally  came  into  his  hands,  and 
most  of  this  was  a  gratuitous  service  for  the  poor, 
for  whom  his  S3rmpathie8  were  always  warmly  en- 
Kflted,  and  by  none  (except  his  family  and  relatives) 
win  he  be  so  much  missed  or  so  lons^  remembered  as 
by  this  class.  Here  he  was  but  little  known,  except  to 
a  few  individuals  and  families  who  casually  made  his 
aeqnaiotance  or  sought  his  professional  advice.  Being 
hima^  an  invalid,  he  sought  a  quiet  and  retired  course 
of  life.  On  April  1,  he  was  attacked  with  pneumo- 
nia^  which,  with  organic  disease  of  the  heart,  m  a  oon- 
ttitation  already  enfeebled,  afforded  a  very  small 
ciiaoce  of  recovery.  He  was  confined  to  his  room 
oolj  three  days,  when  death  released  him  from  his  suf- 
ferings. 


ittiel^ical  VLtms  anir  3ttms. 


PIB80VAL. 


Dt.  EnwiN  Powell,  of  Chicago,  has  been  promoted 
by  the  President  to  the  rank  of  Colonel  by  brevet  The 
commission  dates  from  the  13th  of  March,  1865,  and 
was  given  *^  for  &ithfiil  and  meritorioua  services  during 

the  war." 


OOCULAB  0RDEB8,  ITC.,  FROM  81TB010ir-€nC!rERAL*8  OFFIOI. 

Washwotoh,  D.  C,  January,  28,  1867:  CiBOtTLAR 
OtWRs  No.  1. — It  is  kiiown  that  during  the  War  of  the 
BebdKon  there  were  instances  of  primary  amputation 
»t  the  hip-joint  fbr  gunshot  iniury,  performed  at  field 
lionHtah,  and  not  made  the  subjects  of  special  reports 
to  tiiis  office.  With  much  difficulty  the  details  of  seve- 
ral inch  cases  have  been  collected.  It  is  believed  that 
others  may  remain  unrecorded.  In  order  that  the  data 
of  the  office  in  relation  to  this  operation  may  be  as 


complete  as  possiUe,  you  are  respectfully  requested  to 
report  any  tacts,  however  slight,  within  your  know- 
ledge, in  reference  to  cases  or  amputation  at  the  hip- 
joint  in  the  miUtary  surgery  of  the  War  of  the  Bebel- 
lion,  bearing  upon  cases  other  than  those  enumerated  at 
page  60  of  Circular  No.  6,  Surgeon-General's  Office, 


L865. 
By  order  of  the  Surgeon-GkneraL 

C.  H.  Crake, 
Amstant  Surgeon-Generalj  U,  S.  A, 

Washimoton,  D.  C,  April  4^  1867 :  Circular  No.  2. 
— Medical  officers,  and  others  mterested  in  the  progress 
of  medical  science,  are  invited  to  forward  contributions 
to  the  Army  Medical  Museum,  which  is  now  prepared 
for  their  reception. 

Besides  interesting  medical  and  surgical  specimens, 
which  will  be  forwarded  as  heretofore,  the  foUowing 
classes  of  articles  will  be  collected  and  forwarded  by 
those  medical  officers  who  have  opportunities  for  so 
doing. 

1.  Rare  pathological  Q)ecimen8  firom  animals,  includ- 
ing monstrosities. 

2.  IVpical  crania  of  Indian  tribes,  specimens  of  their 
anns,  diess,  implements,  rare  articles  of  their  diet^  me- 
dicines, etc. 

3.  Specimens  of  poisonous  insects  and  reptiles,  and 
of  their  effects  on  animals. 

Attention  is  called  to  Circular  Order,  No.  3,  dated 
Surgeon-Oeneral*s  Offiice,  April  3, 1867,  a  copy  of  which 
is  herewith  forwarded. 

J.  K.  Barnes, 
Sturgeon- Oeneralj  U,  S.  A, 

War  Departxeht  :  Washington,  D.  C,  April  3, 1687, 
Circular  No.  3. — The  following  Order  firom  the  Act- 
ing Quartermaster-Qeneral,  U.  S.  Army,  is  respectfiiDy 
furnished  for  information  of  Medical  Officers,  U.  S. 
Army: 

Washinoton,  D.  C,  March  26,  1867:  Quarter- 
master-General's Offiob,  General  Orders  No.  27. 
—Officers  of  the  Quartermaster's  Department,  in  charge 
of  Government  trains  retummg  fi-om  frontier  or  other 
remote  points,  are  authorized,  upon  the  requisition  of 
Medical  Officers,  to  furnish  transportation  by  such  trains 
for  collections  of  specimens  for  the  Army  Medical  Mu- 
seum, whsn  such  transportation  can  be  fiimished  with- 
out injury  to  the  public  service. 

D.  H.  BUOKER, 

Acting  Quariermoiter'GtrLjBrev.  Maj^-Qm,  U,  8,  A. 
By  Order  of  the  Surgeon-GeneraL 

C.H.  Crane, 
Aenetanl  Surgeon- Qenerdlj  U,  S.  A, 

Washington,  D.  O,  AprU  20,  1866.— No.  4— In 
view  of  the  possible  prevalence  of  Cholera  during 
the  approaching  summer  the  following  instructions  are 
promulgated. 

Every  endeavor  wiU  be  made  by  medical  officers  to 
prevent  the  introduction  of  Cholera  from  infected  com- 
mands, or  its  conveyance  firom  point  to  point,  by  a 
"quarantine  of  observation"  upon  all  detachments  of 
recruits  or  troops,  arriving  or  departing  from  depots, 
posts,  or  recruiting  stations,  at  or  near  which  this  dis- 
ease prevails ;  prompt  reports  of  its  appearance  in  oom- 
manoB,  either  en  route  or  in  garrison ;  and  isolation  of 
all  cases  as  far  as  practicable.  In  addition  to  the  strict- 
est hygienic  police,  enforcement  of  personal  cleanliness, 
and  thorough  disinfection,  attention  should  be  paid  to 
the  quality  of  the  water  used  for  drinking  and  cooking 
purposes.  When  pure  rain  water  cannot  be  procured  in 
sufficient  quantities,  and  the  spring  or  river  water  con- 
tains organic  impurities^  it  should  be  purified  by  distil- 


168 


THE  MEDIOAL  RECORD. 


lation,  or  the  noxious  matter  precipitated  by  pennan- 

Snate  of  potaah.  From  half  a  grain  to  one  ^rain  of 
e  ei^staliized  pennanganate  (or  its  equivalent  in 
solutibn),  added  to  one  gallon  of  water,  should  produce 
a  decided  pinkish  hue,  which  disappears  within  twenty- 
four  hours  (if  the  salt  has  "not  been  used  in  excess) ;  the 
water  should  then  be  drawn  off)  and  it  is  ready  for  use. 
Turbid  water,  such  as  that  of  the  Rio  Grande,  Lower 
Mississippi,  and  its  tributaries,  should  be  filtered,  or  al- 
lowed to  settle,  before  using.  The  deposit  of  impurities 
can  be  hastened  by  the  addition  of  powdered  alum  in 
small  quantities  well  diffused  by  stirring.  It  is  always, 
but  more  especially  in  times  of  threatened  danger  of 
pestilence,  the  duty  and  privilege  of  medical  officers  to 
submit  the  practical  suggestions  of  experience  and  pro- 
fessional knowledge  for  the  protection  of  the  health  of 
troops,  to  their  commanding  officers ;  and  the  history 
of  the  epidemic  of  Cholera  in  1866,  shows  that  only  by 
combined  and  untiring  vigilance,  energetic  action,  and 
rigid  enforcement  of  hygienic  measures,  within  reach  of 
every  commander,  can  we  hope  to  avoid,  keep  in  check, 
or  eradicate  this  disease. 

Besides  the  usual  reports  of  sick  and  wounded,  every 
medical  officer  in  charge  of  Cholera  cases  will  forward 
to  the  Surgeon-Generars  office,  at  the  close  of  each 
month,  a  list  of  Cholera  patients  in  the  following  form : 


Special  Report  of  Cholera  Patients  at 

Month  of 186 


Kame. 


a 


1^ 


Beinarlu. 


Surgeon,  U.  S.  A. 

Successful  methods  of  treatment  and  results  of  autop- 
sies will  also  be  communicated. 

The  senior  medical  officer  at  every  post  at  which 
Cholera  appears,  will  make  a  special  report  to  the  Sur- 
geon-General setting  forth  any  £su:ts  he  may  be  able  to 
ascertain  as  to  the  introduction  of  the  dsease,   and 


especially  those  bearing  upon  its  importation  from  in- 
fected points  by  recruits  or  others,  or  its  apparently 
spontaneous  origin  at  the  post. 

J.  K.  Barnes, 
Surffeon^Oeneralj  U,  S,  A. 

Proposed  Repeal  or  Maine  Liquor  Law.— The  Maine 
or  Prohibitory  Law  was  called  up  in  the  Connecticut 
House  of  Representatives,  on  Thursday,  and  afler  much 
warm  discussion,  a  resolution  was  passed  instructing 
the  proper  committee  to  inquire  into  the  expediency 
of  its  repeal,  and  the  enactment  of  a  license  law. 

Vis  MEDrcATRix  Naturjb. — A  correspondent  of  the 
Richmond  Diapaich  has  seen  in  Fluvanna  County,  Ya., 
a  lady,  97  years  of  age,  who,  until  quite  recently,  never 
was  sick,  and  never  took  a  dose  of  medicine  in  all  her 
life.  She  enjoys  even  now  the  full  use  of  all  her  men- 
tal and  bodily  powers. 

Mortality  among  the  Shiep  in  MioniOAN. — Great 
mortality,  owing  to  a  low  grade  of  fever  and  diarrhoea, 
is  said  to  be  prevailing  in  Michigan.  The  pathology  of 
the  disease  has  not  been  ascertained. 


HoHE  FOR  Little  Wanderers. — ^The  foundation  stone 
of  the  new  Home  for  Little  Wanderers,  organised  by 
the  Howard  Mission,  has  been  laid  in  the  Bowery  on 
the  site  selected.  The  house  is  to  be  eighty  feet  long 
and  fifty  deep,  and  will  be  large  enough  to  accommodate 
seven  hundred  children,  and  will  abo  contain  a  hospi- 
tal for  sick  children,  a  day  nursery,  where  mothers  can 
leave  their  infants  while  at  work  out^  besides  having 
spare  lodgings  for  homeless  girls. 

Thb  Population  of  London,  L  e.  the  whole  area  in- 
cluded in  the  circle  of  fifteen  miles  radius  from  Charing 
Cross,  is  estimated  at  3,521,267  souls:  107,992  births 
and  80,129  deaths  were  registered  in  London  last  year, 
both  numbers  being  above  the  average  record,  and  the 
excess  of  births  over  deaths  much  less  than  the  previous 
year.  The  mortality  was  at  the  rate  of  26.5  per  1,000, 
which  is  two  above  the  average  of  the  last  twenty- 
seven  years. — Medical  Tme$  and  GaaeMe, 

The  Springfield  Sooibtt  for  Medical  IicpiiovBiaDrr. 
— The  Boston  Medical  and  Surgical  Journal  calls  our 
attention  to  an  error  in  locating  the  above  society  in 
Illinois  instead  of  Massachusetts.  For  this  the  journal 
in  question  has  our  thanks.  When,  however,  it  charges 
us  with  copying  the  item  in  regard  to  the  Society  from 
their  columns,  it  is  in  error.  The  item  was  sent  to 
us  direct  from  one  of  the  members  of  the  Society  who 
desired  its  insertion,  and  as  no  State  was  mentioned  we 
had  to  guess  at  it  The  idea  of  inserting  '*  Ulinois  '*  to 
cheat  the  "enterprising  and  industrious  friends"  in 
Springfield  of  '*  the  credit  of  their  professional  zeal  "  in 
the  matter  is  simply  preposterous.  Our  readers  will 
please  bear  in  mind  fliat  the  Springfield  Society  for 
Medical  Improvement  is  located  in  MaaMothuaeUs, 

The  Ltino-In  Asylum. — The  forty-fourth  anniTer- 
sary  of  the  Asylum  was  recently  held,  Mrs.  Thomas 
Addis  Emmett  presiding.  The  proceedings  inrere 
opened  with  prayer  by  Kev.  Dr.  Burchard,  who  afVer- 
wards  made  a  forcible  address.  He  spoke  of  the  benefits 
conferred  by  the  institution,  and  said  that  unfortunately 
the  number  of  those  who  had  actively  supported  it  was 
yearly  becoming  less.  The  city  could  not,  he  said,  afiTord 
to  lose  such  an  institution,  and  he  urged  those  present 
to  use  their  influence  in  securing  an  increased  interest 
in  the  Asylum. 

The  Annual  Report  was  then  read,  fix>m  which  it  ^>- 
pears  that  the  total  receipts  of  the  institution  during 
the  year  w^re  $4,616  64.  and  the  expenditures  $3,900 
34,  leaving  a  balance  of  $716  30. 

The  Report  of  the  Resident  Physician,  Dr.  Sterling, 
shows  the  followinc^  facts :  Number  of  confinements  in 
the  house,  104 ;  children  bom,  104 — ^males,  59 ;  females, 
45;  stillborn,  4:  the  number  of  women  who  left  the 
Asylum  aHer  their  confinement  in  good  health  vras 
102 ;  number  remaining  to  be  confined,  5 ;  number  of 
cases  attended  by  district  physicians,  269;  total  number, 
379;  whole  number  confined  in  the  Asylum  since  ita 
foundation,  3,332;  attended  by  district  physicians. 
11,827;  total,  15,159. 

Addresses  were  made  by  Drs.  J.  P.  G^arrish  and  J.  R. 
Wood,  who  spoke  in  eulogistic  terms  of  the  manage- 
ment of  the  Asylum,  and  the  remarkably  successfbl 
treatment  of  patients,  ader  which  the  meeting  adjoame<L 


Sensiblb  Advice. — We  recently  saw,  upon  a 
in  the  interior  of  this  State,  the  advertisement:  Uke  Dr. 

H' '«  amtHhiiioua  PiZZi,  under  which  some  irreverent 

wag  had  written,  ^'  andprejMxre  to  meet  thy  Ood,'* 

Gbrm AH  Hospital  Fuitd. — The  Ladies*  Aid  Society 
have  recently  donated  $3,000  to  the  fond. 

Cholera.— A  case  of  Asiatic  Cholera  has  been  re* 
ported  at  St.  Catharine's,  Canada.^^  t 

__  _,v:.oogle 


THE  MEDICAL  RECORD. 


169 


©rightol  C0mmumcati0n«* 


CASE    OF    ABSCESS    IN   THE    APPENDIX 
VERMlFOftMIS  C-^BCL 

now,   WILLABD  PAREKS'S  OTSRATION  BT  IHOISIOM — ^BJCOOTKRT. 

Bt  J.  H.  HOBABT  BUEGB,  M.D., 

•VBOBOM  TO  lAirO  VSLAm  OOLLMB  H08PRAI.,  Ra 


Mas  E.  S ,  aged  15  years,  attended  a  party  on  Mon- 
day eTenix:ig,  March  4, 1867,  and,  although  not  feeling 
weD,  ate  chocolate  ice-cream.  The  next  mominfi;  ahe 
was  attacked  with  pain  in  the  bowels,  had  two  Mvine 
eiacoationa,  and  Tomited  freely.  The  pain  continuing, 
her  mother  «ive  her  repeated  doses  of  a  morphine  mix- 
ture which  I  had  prescribed  several  months  ago  for  an 
attack  of  colic  in  the  same  patient.  The  pain  was 
not  relieved,  and  I  was  called  in  the  evening.  She 
was  of  nervous  temperament  and  exoeedingfy  aen- 
sidve.  I  found  her  with  knees  drawn  up^  and  abdo- 
men so  tender,  that  she  made  the  muscles  as  tense  as 
possible  to  resist  any  pressure  that  might  be  attempted. 
She  referred  the  pain  to  the  umbilical  region.  I  oraered 
tr.  opii  camph.  3  i.,  to  be  Repeated,  if  necessary,  from 
time  to  time  through  the  night  The  first  dose  relieved 
nfBciently  to  produce  sleep,  yet  upon  waking  the  pain 
was  renewed. 

March  6th. — ^No  reHef ;  ^eral  tenderness  of  the 
abdomen,  but  most  sensitiveness  in  right  inguinid 
region.  Prescribed  mixture  containing  chloroform 
gtl  y.  to  each  dose,  repeat  every  two  hours.  Eve- 
ning visit — patient  has  slept  some ;  bat  still  complain- 
ing. Fearing  there  might  yet  be  8#me  irritating 
matter  in  the  bowels,  I  ordered  an  enema  of  hop-tea 
Omu  oL  ricini  |^i.  jmd  tr.  opii  gtt  xz. 

Mardi  7th.-— The  injection  was  retained.  Patient  has 
dept  some.  Pulse,  from  commencement  of  attack,  has 
been  pretty  uniformly  120.  Repeat  the  injection  with- 
oat  the  limdanum,  continue  the  chloroform  mixture, 
aod  give  tr.  opii  camph.  3  j*  i^  there  is  any  increase  of 
pain.    Boweli  moved  moderately. 

8th. — ^Paregoric  has  been  given  but  twice;  relief 
pardal;  pidn  and  tenderness  more  marked  in  right  iliac 
foHa. 

14th— Bowels  have  been  moved  every  day  mode- 
rately, sinoe  last  record,  and  yesterday  three  times. 
Pain  and  tenderness  partially  controlled  b^  tr.  opii 
oamph.  3  L  morning  and  evening,  and  at  times  aqu» 
oamph.  3L  every  hour.  Has,  to-day,  slight  chuls; 
pdse  130*  tonffue  white  and  moist ;  slan  slightly  dry. 

17lh. — ^bow^  moved  every  day ;  pain  and  tender- 
ness less.  One  teaqpoonful  of  paregoric  morning  and 
evening  has  been  sufficient  to  procure  sleep;  pulse 
bag  fii^Q  to  90;  skin  and  tongue  moist  There  is  a 
firm  mass  in  the  right  inguinal  region,  which  is  ten- 
der on  pressure.  Concluding  that  I  had  one  of  but 
two  things  to  deal  with — either  a  scybalous  mass,  still 
retained  m  the  ccecum,  or  an  abscess  m  the  appendix — 
I  gave  hydrargyri  submuriatis  gr.  vj.,  which  caused  a 
free  evacuation,  but  made  no  impression  on  the  mass. 
The  tumor  was  not  large,  and  no  fluctuation  could  be 
datected. 

18th. — Announced  to  the  family  the  serious  nature  of 
the  case,  and  ctdled  Prof  WOli^  Parker^  who,  upon 
hearing  its  history  and  examining  the  patient,  advised 
an  inunediate  incision.  At  my  request  he  operated, 
while  I  administered  chloroform.     An  incision  was 


thrust  into  the  tumor,  and  at  first  there  seemed  to 
threaten  a  pretty  copious  h»morrha^e.  It  proved,  how- 
ever, to  be  mainly  serum,  and  pus  immediately  follow- 
ed. The  wound  was  enlarged,  a  piece  of  lint  intro- 
duced, and  slippery  elm  poultice  applied.  After  con- 
sciousness returned,  sol.  morph.  (Magendie's)  gtt  x.  was 
given.  Patient  slept  quietly  for  more  than  two-thirds  of 
the  time  for  the  next  thirty-six  hours,  generally  two  or 
three  hours  at  a  time.  Has  not  cared  for  food  since 
first  attacked.  Takes  a  little  milk-punch,  toast,  and 
crackers. 

22d.T-Pul8e,  since  operation,  very  uniformly  100; 
to-day,  112.  Skin  and  tongue  moist ;  no  pain,  no  thirst 
Has  taken  no  medicine  since  the  day  of  the  operation. 
Abscess  continiiies  to  discharge  moderately,  and  incision 
looks  healthy. 

23d,  24th,  25tb.>-Moming,  pulse  92;  evening,  112. 
Appetite  slightly  improving. 

26th. — Some  uneasiness  in  stomach  and  bowels ;  at 
times  amounting  to  pain.  There  is  not  and  has  .not 
been  any  tympanitis  j  pulse  a  little  hard.  Patient  did 
not  rest  as  well  last  m^ht ;  aqnse  camph.  3  i.  every  hour. 

27th. — Had  a  sma]^  natural  passage  last  night;  still 
feels  uncomfortable  in  stomach  and  bowels.  Oraered 
in  the  evening,  an  enema  of  warm  water  Oj.,  and  fine 
salts  3  j-  The  patient  resisted  it  so  stron^y  that  the 
nurse  failed  to  give  it 

28th. — Bested  well,  and  is  yery  comfortable  to-day. 

29th. — ^Pulse  88 ;  discharge  from  abscess  laudable  pus 

Slst — ^Pulse  80;  had  a  small,  natural  alvine  evacu- 
ation last  night ;  wound  granulating  finely. 

April  lOtn. — ^Bowels  quite  regmar;  wound  nearly 
healed;  appetite  good;  patient  gaining  strength  rapidly. 

THE  MEDICAL  USE  OF  ELECTRICTIY. 
Bt  G.  M  beard,  MD.,  and  A.  D.  BOOKWBLL,  M.D . 

or  HSW  TOBK. 

No.  V. 

PROLAPSUS  IfTKRT. 

Dk.  Skilbr,  of  Paris,  published  a  work  in  1860,  enti- 
tled "  Chilvc^itationpar  l7\flumo6f'*  in  which  he  reported 
a  number  of  oases  of  uterine  displacement  that  had 
been  relieved  or  cured  by  electricit^r. 

In  proU^sus  uteri  general  electrization  is  very  often 
of  great  service,  chie^  by  its  tonic  effects  on  the  sys- 
tem at  large,  and  on  the  waUs  of  the  vagina.  All 
gynecologists  will  agree  that  prolapsus  uteri  is  usually 
associated  with  relaxation  of  the  vaginal  walls,  and  also 
with  general  debility,  and  that  whatever  will  give  tone  to 
the  system  and  to  tiie  weakened  parts  must  be  <^  ser- 
vice. 

Miss  T ,  an  unmarried  lady,  aged  30,  api^ed  for 

treatment  for  falling  of  the  womb  of  the  second  degree, 
from  which  she  had  suffered  for  nearly  six  months. 
Previous  to  the  first  symptoms  of  prolapsus,  persistent 
leucorrhoea  had  annoyed  her  for  some  tinae,  and  had  con- 
tinued up  to  the  day  she  came  to  us.  She  complained 
also  of  some  monorrhagia,  and  this,  together  with  the 
constant  leucorrhoea,  lutd  deprived  the  vaflina  of  its 
tone.  These  conditions,  however,  were  evidfeiitly  asso- 
ciated with  no  actual  uterine  disease;  but  her  general 
health  was  <iuite  feeble.  If  it  were  a  case  for  elec- 
tricity at  an,  it  was  plain  that  she  needed  its  tonic  influ* 
ence.  We  commenced,  therefore,  with  mild,  general 
applications,  increasing  the  strength  of  the  current 
at  each  viat,  as  she  was  able  to  bear.  At  each  sitting, 
also,  the  electrode  was  pressed  for  a  few  mmulas  against 


made,  three  inches  in  length,  directly  over  the  tumor. 

its  oentral  portion  exten<flng  through  the  muscles  ana  I , 

the  fmam  transversales.     An  exploring  needle  was  ]  the  qs  and  the  walls  of  the  vagina.    The  beneficial 

Digitized  by  VjOOQIC 


170 


THE  MEDICAL  RECORD. 


results  of  this  course  of  treatment  were  soon  observ- 
able. Her  appetite,  which  had  been  capricious,  became 
more  rational,  and  her  strength  increased  with  marked 
rapidity.  The  vaginal  walls  seemed  to  gain  tone  day 
by  day,  until  after  the  sixth  application  the  uterus  was 
restored  to  its  normal  position. 

We  shall  merely  allude  to  the  other  indications  for  the 
use  of  electricity,  for  if  the  general  principle  in  regard  to 
its  tonic  and  corrective  effects  be  true,  then  it  is  evident 
that  it  may  be  fairly  tested  as  an  adjuvant  wherever 
such  effects  are  desired.  It  has  been  used  in  surgery 
in  the  form  of  galvano-cautery^  for  discussing  tumors^ 
for  stimulating  ulcers,  for  hydrocele  and  chronic  urethri- 
tis. It  has  also  been  used  in  intermittent  feverj  and 
with  good  results.  In  incontinence  of  urine  associ- 
ated with  general  feebleness,  it  often  works  very  effect- 
ively. 

Much  has  been  said  of  its  powers  as  a  galactogogue, 
and  some  interesting  results  as  well  as  Mlures  luive 
been  reported.  In  progressive  locomotor  ataxia,  ot 
Duchenne's  disease,  this  agent  has  not  achieved  very 
great  results.  In  epilepsy  we  have  sometimes  found  it 
to  be  positively  and  speedily  beneficial,  and  sometimes 
it  appears  to  be  entirely  inoperative. 

But  notwithstanding  the  fact  that  electricity,  em- 
ployed in  the  manner  we  have  described,  is  indicated 
in  a  wide  range  of  diseases,  it  is  as  yet  very  far  from 
being  a  panacea,  even  in  the  most  skilful  and  practised 
hands.  For  some  diseases  it  is  found  to  be  in  no  way 
adapted  by  our  method  of  application,  although  a  wider 
experience  may  teach  us  that  the  favU  lies  in  the  method 
of  (administration  and  not  in  the  remedy.  In  the  treat- 
ment of  shaking  palsy,  we  have  uniformly  &iled  to 
give  the  slightest  rehef ;  and  in  cases  of  paralysis, 
dependent  on  persistent  lesions  of  the  nervous  centres, 
we  do  not  expect  to  be  of  much  service.  But  so 
difficult  is  it,  even  for  the  ablest  diagnostician,  to  dis- 
criminate between  the  different  forms  of  paralysis,  that 
we  usually  make  at  least  a  few  trials  on  most  of  the 
cases  that  are  brought  to  us,  in  order  to  ascertain,  if 
po^ible,  by  the  electric  test^  whether  there  be  any 
chance  of  relief.  We  are  oftentimes  agreeably  disap- 
pointed by  a  favorable  issue  in  cases  that  at  first  seemed 
to  promise  but  little. 

» We  have  already  stated  that  faradaization,  as  we 
employ  it,  does  not  seem  to  be  adapted  for  cases  of 
pulmonary  tuberculosis  the  first  stage.  Dr.  Bast- 
ings, of  Brussels,  has  recently  published  a  work,  in 
wbidi  he  claims  to  have  cured  twenty-five  cases  of 
phthisis  by  means  of  the  galvanic  stream,  applied  around, 
not  through,  the  chest,  for  the  purpose  olT  increasing 
the  muscular  development  The  theo^  of  his  treat- 
ment, as  we  understand  it,  is  substantially  the  same  as 
that  advocated  by  Dr.  Davis,  in  his  recent  work  on 
**  Conservative  Surgery."  The  book  is  prepared  with 
apparent  fairness,  and  we  shall  endeavor,  as  occasion 
OTOrs,  to  subject  his  theories  to  a  practical  test 

But  tliere  are  certain  temperaments  and  certain  stages 
of  disease  that  will  allow  only  of  very  mild  applications 
of  electricity,  where  indeed  unpleasant  effects  seem  to 
follow,  temporarily  at  least,  unless  the  treatment  be 
eommenced  with  great  caution. 

Mr.  P.,  sent  to  us  by  Dr.  Fordyce  Barker,  complained 
of  a  kind  of  neuralgia  of  the  neck  of  the  bladder. 
He  was  a  stout,  well  formed  man,  and  in  all  other 
respects  was  in  perfect  health.  The  first  applications 
were  made  with  the  positive  pole  on  the  lower  part 
of  the  spine,  over  the  lower  ptft  of  the  abdomen,  and 
against  the  perineum,  mildly  at  first,  but  afterwards 
with  greater  power.  For  a  number  of  days  af^er  the 
fourth  visit  the  patient  complfdned  of  soreness  of  the 
muscles  (a  not  unusual  temporary  effect  at  the  com- 


mencement of  treatment),  and  of  general  prostration, 
which  annoyed  him  for  several  days.  Such  cases, 
in  healthy  individuals,  however,  are  purely  exceptional. 

For  the  majority  of  patients  even  an  overdose  is  only 
followed  by  a  feeling  of  soreness  that  soon  passes  away. 

Those  who  receive  an  application  of  too  great  power 
will  not  usually  experience  the  prostrating  eflfects  be- 
fore the  following  day;  but  even  to  this  rule  there 
are  exceptions.  In  very  aged  persons,  or  tho^  en- 
feebled by  disease,  we  always  begin  with  mild  appli- 
cations, and  gradually  increase  the  strength  acooidiog 
to  the  indications,  allowing  intervals  of  several  days 
between  the  visits.  It  should  be  remarked,  however, 
that  we  have  obtained  some  of  our  most  successful  re- 
sults in  cases  iJiat  at  first  seemed  to  be  injured  rather 
than  benefited.  Occasionally,  in  those  affected  with 
digestive  derangements,  the  first  operation  causes  pros- 
tration and  vomiting,  that  seems  to  clear  out  the  sys- 
tem, and  prepare  the  way  for  recovery. 

We  close  with  a  few  brief  suggestions  for  the  benefit 
of  any  who  may  be  induced  to  study  this  subject  fbr 
themselves. 

1st  Gkt  the  best  apparatus  and  become  thorouriilv 
familiarized  with  the  details  of  its  management  Mii(m 
of  the  discouragement  tha^  has  thus  far  attended  experi- 
ments in  Uiis  department  has  been  due  to  the  fact 
that  it  has  been  impossible  to  obtain  any  convenient, 
easily  adjusted  apparatus.  The  old-fashioned  magneto- 
electric  machines,  where  the  electricity  is  generated  by 
turning  a  crank,  are  to  the  last  degree  mconvenient,  and 
it  is  not  to  be  wondered  at  that  those  physicians  who 
uSe  them  soon  become  disgusted  with  the  whole  subject 
The  electro-magnetic  apparatus  that  we  employ,  and 
which  we  decidedly  recommend,  is  manufactured  by 
Jerome  Kidder,  of  this  city.  It  has  a  powerftil 
helix,  a  very  readily  managed  armature,  and  is  run  by 
the  ordinary  8mee*B  Battery.  A  moderate  amount  of 
experience  will  enable  one  to  manage  it  successfully,  and 
to  keep  it  always  in  order. 

2d.  Make  the  applications  general.  Localized  eJeetri- 
Motion,  according  to  the  method  of  Duchenne  and  his 
followers,  is  serviceable  in  paralysis,  acute  neuralgia^  and 
kindred  affections ;  but  wnere  a  general  tonic  effect  is 
desired,  as  in  dyspepsia,  rheumatism,  amenorrfaoea, 
chorea,  constipation,  anaemia,  and  in  other  diseases  asso- 
ciated with  deficient  vital  energy,  general  electrizaii^m  is 
indispensable. 

The  modus  operandi  of  general  electrization  is  as 
follows : — ^Male  patients  remove  their  stockings  and  all 
their  outer  and  under-dothing  from  the  upper  part  of 
the  body,  and  place  their  feet  on  the  piece  of^  copper  to 
which  the  negative  pole  is  attached,  while  the  operator 
appUes  the  positive,  either  the  sponge  or  the  hand  (when 
the  current  passes  through  his  own  person),  down  the 
spine  and  over  the  vital  organs.  Ladies  remove  their 
dress  and  loosen  their  under-garments,  and  throw  over 
their  shoulders  a  shawl,  or  sheet,  to  prevent  exposure. 
The  most  tiioroiu^h  form  of  application  demands  that  Uie 
entire  surface  of  the  body  should  be  gone  over  with 
some  regard  to  order. 

Special  pains  should  be  taken  to  avoid  the  scapula, 
davicle,  sternum,  crest  of  the  ilium  and  tibia  (or  when 
they  are  touched,  to  carefully  graduate  the  current),  inas- 
much as  these  and  other  bony  prominences  are  very 
sensitive  to  the  electric  current. 

3d.  Be  prepared  for  the  occasional  occurrence  of  un- 
pleasant or  equivocal  symptoms  at  the  outset  of  a  course 
of  treatment  The  soreness  of  the  muscles,  ^^5^*^ 
and  general  depression,  that  are  sometimes  experienced 
a  day  or  two  following  the  first  application,  will  soon 
pass  away,  provided  the  subsequent  treatment  be  judi- 


cious. 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


171 


ApplicatioDS  to  tbe  head  should  always  be  made  with 
the  naod,  and  g^ould  be  very  mild.  Uases  that  begin 
unfavorably  often  result  in  the  most  complete  cures. 

For  patients  who  are  much  reduced  it  is  best  to  allow 
intervaJs  of  several  days  between  each  application,  espe- 
cially at  the  begiiming  of  the  treatment  In  the  ma- 
jority of  cases  sittings  may  be  held  every  other  day,  or 
wheu  merely  localized  electrization  is  employed,  every 
da  J. 

4tL  Let  the  first  tentative  applications  be  mild  and 
of  short  duration,  say  from  five  to  ten  minutes,  and 
increased  in  strengih  gradually  as  the  patient  is  able  to 
bear.  AfWr wards,  the  strength  of  tho  current,  whether 
employed  with  tbe  hand  or  sponge,  should  be  as  great 
as  can  well  be  borne.  Let  the  patient  be  comfortably 
uncom/briable, 

5th.  For  nearly  aU  chronic  affections  the  treatment 
should  be  persistent.  While  great  and  beneficial  effects 
are  oflen  derived  from  two  or  three  applications,  a  com- 
plete or  approximate  cure  can  oply  be  achieved  by 
continuance  of  the  treatment,  varyinp^  the  strength  of 
tbe  current  and  firequency  of  the  applications  according 
to  tbe  process  which  is  made.  Uases  of  paralysis  of 
long  standing  demand  a  protracted  course  or  treatment, 
even  where  there  is  no  very  serious  lesion  of  the  nerve 
centres.  In  many  cases  of  paralysis,  and  in  some 
phases  of  rheumatism,  the  improvement  may  be  hast- 
eiied  by  the  use  of  the  continuous  galvanic  stream. 

6th.  Although  general  electrization  is  indicated  in  a 
large  variety  or  diseases,  it  is  very  far  firom  being  a  pana- 
cea. It  is  a  tonic^  and  it  is  to  be  ^ployed  on  Sie  same 
principles,  and  subject  to  many  of  the  same  limitations 
•8  are  aU  other  tonics,  except  tliat  it  is  more  rapidly  and 
surely  effective  than  any  internal  medication.  If  the 
system  be  below  par,  as  a  result  of  any  chronic  disease, 
or  combination  of  diseases,  then  general  electrization  is 
indicated  in  conjunction  with  or  prior  to  the  use  of  iron, 
quinine,  bathing,  air,  exercise,  society,  and  all  other  tonic 
infloencee  whatsoever. 

Bat  it  should  eyer  be  remembered  that  it  is  general 
dectnzationj  employed  in  the  manner  we  liave  described, 
and  not  "electricity"  or  ** localized  electrization,"  thac 
produces  constitutional  tonic  effects,  and  thus  cures 
duease. 

The  result  of  the  treatment  wtB  depend  as  much  on 
the  skin  and  perseverance  of  the  operator  as  upon  the 
powers  of  the  agent  he  employs.  Success  in  this,  as  in 
aQ  other  departments  of  science,  is  reserved  for  those 
who,  unswerved  by  prejudice  and  unbiased  by  theory, 
seek  only  for  the  knowled^^e  that  comes  from  careful, 
patient,  and  repeated  expenence. 
tl4  Bkoadwat. 

^   t   f  ■ 

Thi  Beabox  why  our  Teeth  Decay.  —The  reason 
why  the  teeth  of  people  of  later  days  are  more  decayed 
thJsn  were  those  of  past  generations,  is,  that  we  are 
Auw  further  from  Nature's  simple  plan.  Indeed,  the 
terrible  condition  of  the  present  generation  may  be  said 
to  be  one  of  the  penalties  of  civilization  ;  and  the  de- 
cajed  condition  will  increase  in  exact  ratio  with  the 
hixuriousness  of  the  diet.  Dentists  should  discourage 
the  general  use  of  pickles,  lemons,  and  other  acid  sub- 
itances,  and  bring  their  patients  as  near  as  possible 
under  the  influente  of  the  hygienic  law.  Another  great 
ctoae  of  disease  by  the  production  of  acids,  is  the  fer* 
mentation  of  food  lodgmg  in  the  teeth  after  eating. 
The  remedy  for  and  preventive  of  this  is  cleanliness, 
tbeolnte  deanliness.  The  doctor  recgmmended  the  use 
of  a&tadds  with  the  brush.  Solution  of  carbonate  of 
wda,  lime-water,  etc.,  could  be  advantageously  used 
three  times  a  day  for  an  indefinite  period. — Dr.  Cuah- 
«V  {Dental  R^iker).      __ 


EXCISION  OF  THE  ENTIRE  OS  CALCIS  FOR 

CARIES. 

Br  F.  A.  BURRALL,  M.D., 

BintOBOlf  TO  TUB  HOBTHEBH  DIBPKN8ABT«  VUimfO  B17B«B0H   TO  OHAS- 
RT  HOBPTTAL 

WiLUAM  Keooh,  bom  in  the  United  States,  of  Irish 
parents,  and  aged  eight  years,  was  brought  for  the  first 
time  to  my  office,  Oct.  8,  1866,  from  Jersey  City, 
where  he  lived.  I  was  informed  by  his  parents  that 
nine  months  previously  he  had  been  in  the  habit  of 
standing  for  a  long  time  upon  the  ice.  and  on  one  occa- 
sion he  became  much  chilled,  soon  aner  which  a  swell- 
ing occurred  beneath  the  left  external  malleolus,  over 
the  OS  calcis.  This  was  opened  by  the  attending  phy- 
sician and  discharged  purulent  matter,  which  discharge 
continued  to  the  date  of  his  visit  at  my  office.  The 
patient  had  been  under  treatment  at  intervals  since  the 
commencement  of  the  disease,  but  as  is  usual  in  caries 
of  the  tarsal  bones,  the  malady  progressed  steadily, 
and  amputation  of  the  foot  had  at  last  l^en  recommend- 
ed as  the  only  means  of  cure. 

The  general  health  of  the  patient  was  good.  Although 
pale,  his  skin  was  not  transparent,  and  his  appearance 
not  that  of  a  scrofulous  child.  His  parents  were  healthy 
and  did  not  admit  any  strumous  tendency,  while  his  six 
brothers  and  sisters  enjoyed  good  health. 

The  foot  was  somewhat  inverted,  apparently  owing  to 
an  adhesion  over  the  tendons  of  the  peronei  muscles  at 
the  outer  malleolus,  which  prevented  them  firom  contract- 
ing. The  integument  was  red  and  thickened,  and  the 
vicinity  of  the  ankle  much  swollen.  The  lower  portion 
of  the  foot  still  retained  a  marked  healthy  appearance. 
Pressure  over  the  seat  of  disease  did  not  cause  much 
psdn.  A  moderate  purulent  discharge  fiowed  from  three 
small  openings  on  the  external  sur&ce  of  the  foot  over 
the  OS  calcis,  and  a  probe  passed  into  these,  struck  upon 
dead  bone.  This  mscharge  had  often  contained  osse- 
ous particles.  There  was  good  ginglymoid  movement  in 
the  ankle-joint,  but  the  foot  was  useless  for  walking. 

The  parents  being  extremely  anxious  that  the  foot 
should  bet  saved,  a  tentative  treatment  (partly  for  the 
pur^K>8e  of  reducing  the  size  of  the  parts  surrounding 
the  joint)  was  commenced,  consisting  in  the  firm  applica- 
tion of  a  roller  around  the  joini,  the  openings  being  left 
uncovered  and  dilated  with  compressed  sponge.  The 
poultices  which  had  been  in  use  were  discontinued,  and 
the  syrup  of  the  iodide  of  iron  was  ordered  to  be  given 
three  times  daily.  Under  this  treatment  the  joint  became 
smaller;  but  there  was  no  decided  improvement,  so  that 
an  operation  was  considered  necessary.  Dr.  Gurdon 
Buck,  who  saw  the  case  about  this  time,  recommended 
that  a  free  incision  should  be  made  upon  the  outer  side 
of  the  foot  down  to  the  diseased  parts,  and  the  subse- 
quent steps  of  the  operation  be  regulated  by  the  extent 
of  the  disease. 

Nov.  1,  assisted  by  Doctois M.  H.  Henry,  J.  0.  Morton,, 
and  L.  Weber,  the  patient  was  etherized  and  a  horizontal 
incision  made,  extending  from  the  inner  edge  of  the  os 
calcis,  severing  the  ten^p-achillis  and  going  down  to  the 
bone,  to  a  point  opposite  the  calcaneo-cuboid  articula- 
tion. A  vertical  incision  led  from  this  point  to  just 
within  the  sole,  fi*eely  opening  the  calcaneo-cuboid  ar- 
ticulation. While  making  this  incision  the  scalpel 
struck  a  sequestrum  which  proved  to  be  the  loosened 
facet  of  the  os  calcis  which  articulates  vfdth  the  cuboid. 
This  detached  fragment  was  rough  and  bare. 

The  flap  was  now  dissected  downwards,  and  the  os 
calcis  was  found  suppurating  and  disintegrated,  but  stiU 
firmly  held  by  its  attachments.  Partly  by  the  cutting 
edge  of  the  scalpel,  partly  by  its  handle,  and:  partly  b^ 

digitized  by  ^ JIC 


112 


THE  MEDICAL  RECORD. 


evalfflon,  the  bone  was  remoTed.  The  suiroanding  sur- 
&ces  were  in  a  healthy  condition^  with  the  exception 
^  of  the  cuboid,  the  cartilage  of  which  having  been  par- 
tially removed  during  the  operation,  showed  considera- 
ble vascularity  of  thi^  bone.  The  synovial  membranes 
between  the  astragalus  and  os  calcis  were  uninjured,  as 
weQ  as  the  posterior  tibial  vessels  and  nerve.  About 
twenty  minutes  were  consumed  by  the  operation.  The 
peronei  muscles  and  vessels  were  divided,  but  no  liga- 
tures were  required.  An  examination  or  the  removed 
bone  showed  that  its  s^pe  was  very  much  altered  by 
carious  disintegration,  xhe  cavity  was  washed  with  a 
dilute  solution  of  liq.  Bod»  chlorinatae  and  the  edges  of 
the  wound  united  by  silver  sutures.  A  plaster  of  paris 
bandage  was  then  applied  from  the  upper  part  of  the 
leg  to  the  toe^,  so  arranged  as  to  leave  the  wound  un- 
covered. On  the  wound  were  placed  cloths  containing 
ice,  and  directions  left  to  cut  the  plaster  band  should  it 
be  found  too  tight,  and  substitute  cold  water  for  ice,  if 
the  ice  proved  unpleasantly  cold.  The  heel  was  also 
supported  by  a  diachylon  strap. 

ISO  bad  symptoms  followed  the  operation.  Union  took 
place  throughout  nearly  the  entire  line  of  the  wound. 
The  after  treatment  consisted  in  the  use  of  the  plaster  of 
paris  splint,  an  injection  of  the  cavity  with  a  dilute  so- 
lution of  liq.  sodffi  chlorinatss  twice  daily,  scrupulous 
cleanliness  in  the  vicinity  of  the  wound,  water  dress- 
ings, to  which  Labarraque*s  solution  was  also  added,  and 
g(K)d  nourishment  On  the  13th  of  November,  the  pa- 
Bent  was  able  to  go  down  stairs,  the  leg  being  sus- 
pended by  a  band^  which  passed  around  the  neck, 
and  on  the  18th  of  December  all  discharge  had  ceased 
from  the  wound,  and  the  patient  could  walk  with  a 
slight  limp.  At  present  (March  7)  the  boy  attends 
school,  and  walks  and  runs  in  ordmary  shoes  without 
difficulty.  Scarcely  any  limp  remains,  and  no  appara^ 
tus  has  been  necessary.  The  foot  has  become  reauced 
almost  to  the  size  of  its  fellow ;  the  inversion  has  disi^ 
peared,  and  the  heel  is  resuming  a  natural  appearance, 
growing  firm  and  full  The  tendo-achillis  has  become 
strongly  united,  and  the  movements  of  the  foot^  with 
the  exception  of  eversion,  which  was  very  limited  be- 
fore the  operation,  are  performed  with  facility.  It  is 
no  exaggeration  to  characterize  the  result  as  very  satis- 
factory. J 

Bemarlcs, — Different  opmions  have  been  advanced  as 
to  the  comparative  merits  of  ffoufinng;  or  excision  in  dis- 
ease of  the  OS  calcis.  Dr.  B.  M.  So^es,  in  his  work  on 
"  The  Excision  of  Joints^"  uses  the  K>llowing  language 
189: 


0^ 

*^For  the  removal  of  the  os  calcis,  a  regular  operation 
is  performed.  The  operations  of  Mr.  Hanoock  and  Mr. 
Greenhow  in  June  and  August  1848,  are  claimed  to 
be  the  first  instances  of  this,  ^ut  it  was  practised  by 
Monte^gil^  of  Milan,  twenty-five  years  be&re,  and  also 
by  Heme  in  1834.  It  has  now  been  performed  many 
times  for  carious  disease,  and  with  tolerable  success. 
Of  the  twelve  cases  reported  by  Mr.  Q-reenhow,  ten 
were  succes8f\iL  and  in  two  amputation  was  subse- 
quentiy  required.  The  os  calcis  has  also  been  excised 
for  injury:  four  operations  in  the  Crimea,  in  the  year 
1855-56,  having  all  been  followed  by  a  &vorable  re- 
sult 

*^  There  ean  hardly  be  a  doubt,  however,  that  goug- 
ing is  preferable  to  excision,  and  better  applicable  to 
this  bone  than  to  any  other  of  the  tarsus;  its  use  in 
supporting  the  foot,  and  for  the  implantation  of  the 
tendo-aclullis,  may  thus  be  retamed,  as  a  portion  of  the 
bone  and  the  attaiohment  of  the  tendon  are  preserved 
by  the  former  operation,  but  can  never  be  by  the  lat- 
ter.** 

On  the  other  ha&d,  Dr.  T.  A.  Hohnei^  in  one  of  a 


most  interesting  series  of  papers  on  **  The  Treatment  of 
Caries  of  sinele  bones  of  the  Tarsus  and  Metati^sus  by 
Exdsion  of  tiie  Entire  Bone,'''^  says: 

"  What  I  wish  chiefly  to  urge  in  the  present  commu- 
nication, is  the  great  advantage  to  be  derived,  in  cases 
where  tne  greater  part  of  any  of  the  tarsal  or  metatar- 
sal bones  is  carious,  from  the  removal  of  the  whole  hone. 
In  a  previous  paper  "  On  Excision  of  the  Hip,"  I  have 
pointed  out  as  one  of  the  great  obstacles  to  success  in 
that  operation,  the  uncertainty  which  must  always  ex- 
ist as  to  the  extent  to  which  the  softened  bone  usually 
found  in  the  acetabulum  requires  removal ;  that  is  to 
say,  how  much  is  incurably  disorganized,  and  how  much 
will  recover  if  the  other  diseased  parts  are  removed. 
In  consequence  of  mevitable  errors  on  this  head,  we 
often  find  that  the  exposed  sections  of  bone  take  on 
the  same  carious  action  as  the  original  joint-surfaces, 
and  the  operation  is  partially  frustrated.  The  same  is 
the  case  in  the  gouging  operations  practised  on  the  tar- 
sus. But  in  the  case  of  the  hip  we  have  no  choice ;  in 
that  of  the  tarsus,  usually  we  have.  When  only  one 
bone,  or  only  two  contiguous  bones,  are  affected,  it  is 
usually  easy  to  remove  the  whole  organ  diseased  *  and 
when  this  is  done — that  is  to  say,  when  a  wound  is  left 
which  contains  nothing  but  the  soft  parts  and  the  heal- 
thy articuhu*  cartilages  of  the  contiguous  bones,  I  hlive 
never  yet  seen  a  case  in  which  the  wound  did  not  heal 
soundly,  and  I  believe  permanently;  and  this  is,  there- 
fore, the  practice  which  I  now  always  adopt  in  cases 
where  limited  disease  of  the  tarsus  affects  only  one  bone 
to  a  considerable  extent" 

^In  Prof  Syme*s  "  Principles  of  Surgery,"  page  703, 
it  is  stated : 

"  When  the  as  cakis  alone  is  affected,  the  disease  may 
be  eSKtirpated  by  making  a  crucial  incision  on  the  fib^- 
ular  side,  and  then  digging  out  the  carious  part  with  a 
gouge." 

Dr.  Morrogh,  of  New  Jersey,  successfully  removed 
the  whole  of  the  os  calcis,  and  a  case  of  excision  of  the 
entire  bone  in  an  adult  was  published  by  Dr.  Gamo- 
chan  in  the  American  Medical  Gazette  of  June  1,  1857, 
which  terminated  successfully. 

From  the  above  references  it  is  seen  that,  although 
gouging  is  considered  preferable  to  excision  when  the 
disease  is  of  moderate  extent,  yet  Dr.  Holmes  regards 
with  partiality  a  comparatively  early  removal  of  the 
entire  bone.  In  Keogh's  case,  excision  was  the  only 
alternative,  as  the  bone  was  much  disorganized.  Ne- 
crosis was  also  present^  for  tiie  fiicet  of  the  os  calcis 
which  articulated  with  the  cuboid  had  been  separated  in 
bulk  and  was  a  detached  foreign  body.  The  operation 
performed  was  the  one  recommended  by  Dr.  Holmes 
m  the  pimers  to  which  reference  has  been  made. 

It  would  be  difficult  to  lay  the  blame  of  the  carious 
action  in  the  case  upon  a  strumous  diathesis.  The  pa- 
rents of  the  child  are  healthy,  as  they  informed  me  were 
also  their  parents :  his  brothers  and  sisters  also  enjoy 
good  health,  and  ne  is  a  hardy  looking  boy.  It  is  easier 
to  explain  me  origin  of  the  disease  in  the  following 
manner: — ^As  a  result  of  exposure  to  cold  and  mois- 
ture rfirom  standing  upon  the  ice),  the  vitality  of  the  ex- 
ternal side  of  the  os  calcis,  more  superficial  than  the  in- 
ner, and  with  a  more  limited  vascukr  and  nervous  sup- 
ply, became  unusually  depressed,  the  balance  of  the 
circulation  disturbed,  and  a  limited  inflammation  fol- 
lowed. Then  pressure  of  the  periosteum  upon  the  in- 
flamed part  resulted  in  death  of  a  portion  or  tiie  subja- 
cent bone,  and  subsequent  ulceration,  which  from  its 
•eat  was  disposed  to  be  of  a  carious  nature. 

An  interesting  feature  in  this  case  is  the  local  charso- 


'  LondoD  Liii06t,  Jas. 


."•J^jogle 


th: 


£  MEDICAL  RECORD. 


173 


ter  of  the  disease,  which,  although  of  nine  months'  dura- 
tion, was  limited  to  one  bone,  a  dsao  cavity  haying 
been  left  by  its  removaL 

These  operations  are  rather  rare.  If  unsnccessful, 
they  may  be  followed  by  ampatatioQ  of  the  leg;  if 
raooesBAil,  the  remaining  foot  ii  much  better  than  any 
irtificia]  one,  and  in  the  present,  as  probably  fik  many 
odier  instanoes,  almost  as  good  as  its  fellow. 


DEEP   CERVICAL  TUMOR, 

THE  REMOVAL  OF  WHICH  INVOLVED  THE   EX- 

SECTION  OF  A  PORTION  OP  THE  INTERNAL 

JUGULAR  VEIN, 

WITH  BOMB  RDCARKS  UPON 

THE  LIGATION  OF  VEINS  IN  GENERAL. 

Bt  WILLIAM  WARREN  GREENE,  M.D., 

normoB  or  nrBeniT  in  bsbxshibx  mmdwal  oollbos,  and  ni  thb 

MBDIOAL  lOBOOL  OF  MAIBB. 

Oi  the  6th  of  April,  1864,  Mr.  Saunders,  of  Cheshire, 
Goosolted  me  with  regard  to  a  tumor  upon  the  left 
side  of  the  neck  whicn  he  first  noticed  three  years 
before.  It  had  slowly  and  regularly  increased  in  size, 
and  for  three  months  previous  had  been  the  seat  of 
almost  constant  pain,  while  the  whole  side  of  the  neck 
iDd  head  had  been  affected  with  a  neuralgia  sufficiently 
aevere  to  depriye  him,  ill  a  great  measure,  of  deep. 
For  the  past  few  weeks  his  appetite,  flesh,  and  streng^ 
had  £u^d,  and  he  was  very  much  depressed.  The 
growth  was  partially  covered  by  the  stemo-mastoid 
mofide  anterior,  to  which  it  was  quite  prominent  It 
was  regular  in  outline,  fluctuating,  but  tense  and  some- 
what tender.  It  was  apparenMf  quite  movable,  fmd 
seemed  about  the  size  of  a  croquet  ball 

The  patient^  understanding  the  liabilities,  having 
dected  an  operation,  was  etherized  j  and  with  the 
anistance  of  Drs.  Smith  and  Paddock  it  was  performed 
as  Mows :  The  shoulders  being  elevated  upon  a  block 
of  wood,  the  head,  falling  backwards  a  htde,  was  turned 
to  the  right  so  as  to  render  the  coverings  as  tense  as 
possible^  and  an  incision  made  through  the  skin  and 
aoperficial  fiuscia,  commencing  just  behind  the  angle  of 
the  jaw,  and  extending  over  the  most  prominent  part 
of  the  tumor  downwards  nearly  to  the  clavicle.  The 
deep  fascia  was  divided  upon  a  director,  and  the  cyst 
readily  exposed.  Its  walls  varied  in  thickness  at  dif- 
ferent points,  and  were  so  thin  at  the  apex  as  to  burst 
onder  the  pressure  of  the  finger&  The  opening  was 
immediately  cbeed  with  broad-bladed  forceps,  and 
there  was  not  sufficient  collapse  of  the  tumor  to  em- 
bairass  the  dissection.  As  this  was  carried  down  to- 
wards the  base,  the  small  veins  in  its  vidnitv  were 
found  very  much  entailed  a^d  tortuous.  'Three  of 
these  were  tied.  Arouna  the  lower  portion  of  the  cyst 
there  had  been  plastic  inflammation  sufficient  to  blend 
its  suiface  intimately  with  the  sheath  df  the  vessels, 
npaa  opening  which  the  carotid  and  its  accompanying 
nt-rvea  were  fl»and  free,  but  the  vein  was  so  closely 
adherent  to  that  part  of  the  sheath  blended  with  the 
aac,  that  it  was  impossible  to  jseparate  it.  So  firm  was 
the  union  that  (the  venous  coats  being  evidently  soil- 
eoed  by  the  inflammatory  process)  in  the  very  careful 
attempts  to  liberate  it  with  the  finger  and  the  handle 
of  the  scalpel,  the  vessel  ruptured,  and  there  was  a  most 
^darmii^  gush  of  venous  blood.  This  was  instantly 
controlled  by  pressure,  and  but  Httle  time  was  lost  in 
a^il^iog  a  ligature  to  the  cardiac  side.  Being  now 
secure  against  the  entrance  of  air,  sufficient  pressure 
was  made  by  the  flogerg  of  an  assistant^  on  the  distal 


side,  to  control  the  hemorrhage,  the  opening  in  the 
sheath  extended,  and  the  vein  carefully  isolated  from 
the  accompanying  artery  and  nerves  to  a  point  above 
its  attachment  to  the  tumor  where  it  was  tied,  and 
divided  just  below  the  ligature  as  it  was  also  just  above 
the  first  point  of  lijiation.  The  portion  thus  exsected 
was  two  and  a  bau  inches  in  length.  The  dissection 
was  carefully  continued  down  to  the  transverse  process 
of  the  third  cervical  vertebra,  to  which  the  pedicle  was 
firmly  attached.  Around  this  a  smooth,  well  waxed, 
hempen  twine  was  tied,  the  tumor  separated  with  the 
knife,  and  removed  firom  its  bed.  But  one  artery  was 
tied,  and  that  a  very  small  one.  After  all  oozing  had 
ceased  and  the  parts  were  somewhat  glazed,  the  flaps 
were  united  by  mterrupted  silver  sutures,  the  ligatures 
emer^g  from  the  lower  angle  of  the  incision.  Re- 
action came  on  slowly,  but  in  eight  hours  was  well  es- 
tablished. For  four  davs  he  had  considerable  fever,  and 
complained  much  of  headache  and  giddiness.  Was 
delirious  occasionally.  On  the  fiflh  day  the  fever  abated, 
and  from  this  date  he  slowly  but  steadily  improved. 
The  greater  portion  of  the  wound  united  by  first  inten- 
tion. There  was  considerable  purulent  discharge,  but 
of  a  laudable  character.  The  ligature  around  tne  pe- 
dicle came  away  on  the  19th  day,  the  others  havmg 
separated  previously.  On  the  2dth  day  after  the  ope- 
ration he  was  able  to  walk  to  my  office,  and  the  next 
to  ride  home  in  the  cars,  a  distance  of  ten  miles.  At 
this  time  the  wound  was  entirely  healed,  and  he  only 
complamed  of  some  stiffness  of  the  neck  and  of  a 
strange  feeling  in  that  side  of  the  head.  These 
symptoms  passed  away  in  a  few  weeks,  and  he  is  now 
a  stout,  healthy  idan,  able  to  carry  on  his  business  as  a 
fiumer  with  as  much  ease  as  ever. 

Immediately  after  the  operation,  he  commenced  tak- 
ing tr.  fern  muriat.  3  ss.,  every  four  hoinrs,  which  he 
continued  all  the  time  that  he  was  under  my  observation, 
combihingit  with  quinia  after  the  surgical  fever  had 
passed.  While  this  was  active  he  got  a  saline  cathar- 
tic preceded  by  a  mercurial,  veratrum  sufficient  to  con- 
trol the  heart's  action,  Dover's  powder  q.  s.  to  procure 
rest;  cool,  .effervescing  draughts,  etc.  Beef-tea  and 
gruel  for  tne  first  five  &y8,  af&r  which  he  was  allowed 
milk,  steak,  chicken,  and  eggs,  in  moderate  quantities. 

In  common,  I  suppose,  with  all  my  professional 
brethren,  I  was  taught  when  a  student,  both  by  pre- 
ceptor, professors,  and  the  text-books,  that  the  ligation 
of  veins  was  a  most  hazardous  procedmre ;  and  so  em- 
phatic and  oft-repeated  were  the  warnings  given  that  I 
became  thoroughly  impressed  with  the  idea  that  so  great 
was  the  danger  of  pyssmia  as  the  result  of  any  such 
interference,  that  it  was  only  justifiable  in  cases  of  ex- 
treme emergency,  and  for  several  years  my  practice 
was  in  conformity  with  this  doctrine. 

Of  course  when  we  ligate  any  vessel  we  desire  and 
expect  a  certain  amount  of  inflammation,  being  only 
anxious  that  it  shall  be  of  a  character  consistent  with 
the  exudation  and  complete  organization  of  plastic 
niaterial.  In  various  conditions  of  impaired  nutrition, 
and  especially  in  toxaemia^  we  may  fan  to  secure  this 
result  and  have  instead  a  purulent,  or,  what  is  much 
worse,  an  ichorous  exudation,  which,  if  it  finds  its  way 
into  the  general  circulation,  seriously  aggravates  the 
toxsemic  condition ;  but  I  doubt  very  much  whether 
any  valid  reason  can  be  given  why  this  unfortunate 
form  of  inflammation  ahatdd  attack  a  ligated  vein  rather 
than  a  ligated  artery,  or  whether  a  candid  review  of  the 
experience  of  the  profession  would  establish  this  as  the 
fact  If  such  ir\/MmmaHon  occurs,  then  the  ichorous 
pus  is  much  more  likely  to  reach  the  general  circulation 
and  produce  its  deleterious  results,  u  formed  within  a 
vein  than  if  within  an  artery.  Per  in>the  firstrit 
Digitized  by  VjOOQ IC 


174 


THE  MEDICAL  RECORD. 


mingles  with  the  enlarcring  stream,  and  flows  inwards 
without  obstruction  until  it  reaches  the  portal  or  pul- 
monary capillaries,  whereas  the  current  in  the  arteries 
is  forcibly  towards  the  surface ;  and  thus  we  are  more 
likely  to  have  superficial  abscesses  as  the  result  of  ar- 
teritis^ and  yisceral  as  the  result  of  phlebitis ;  but  that 
this  form  of  inflammation  is  more  likely  to  occwr  in 
veins  than  in  arteries  I  very  much  question.  I  do  not 
believe  that  UgcUion  adds  to  the  danger  of  pyaemia  in 
the  case  of  a  wounded  vein,  or  that  any  other  than  plas- 
tic inflammation  follows  in  a  healthy  condition  ot  the 
blood ;  always  presuming,  of  course,  that  no  poison  has 
been  communicated  to  the  wound  during  the  operation. 
In  septic  states  of  the  blood  all  operation^  are  danger- 
ous, and  Chose  upon  veins  especially,  as  for  the  reason 
above  stated,  but  in  case  of  a  wounded  vein  I  do  not 
believe  that  the  ligaiure  adds  to  the  danger  in  any  con- 
dition of  the  system.  Hy  opinions  upon  this  subject 
have  not  been  formed  widiout  much  thought  and  ob- 
servation. I  have  now  ligated  the  internal  jugular 
four  times.  Once  in  a  case  of  attempted  suicide, 
once  in  case  of  a  deep  seated  cervical  tumor  removed 
before  the  class  of  1866,  in  the  Medical  School  of 
Maine,  again  in  the  removal  of  a  bronchocele  last  sum- 
mer, which  case  was  reported  in  this  journal,  and  in  the. 
case  of  exsection  here  recorded.  In  none  of  these 
were  there  any  untoward  results.  I  have  ligated  the 
femoral  vein  alter  amputations  of  the  thigh  m  slip  in- 
stances. Four  made  good  recoveries,  and  two  died 
within  a  few  hours  after  the  operation.  I  have  once 
ligated  the  axillary  vein  in  a  shoulder- joint  amputation 
with  good  recovery.  I  have  repeated  the  same  proce- 
dure upon  the  anterior  and  posterior  tibial  veins  with 
no  ill  effects.  In  many  ligations  made  for  varicosities 
of  the  saphenous  and  spermatic  veins,  for  the  cure  of 
h»morrhoidal  tumors,  "  aneurism  by  anastomosis,"  etcy 
I  have  never  seen  any  of  the  results  of  which  I  stood  in 
so  much  fear  years  ago.  If  I  have  been  more  fortunate 
in  my  cases  than  some  others,  my  experience  is  not  so 
exceptional  as  to  fail  in  demonstrating,  at  least  to  my 
own  mind,  the  comparative  safety  of  the  operation.  I 
am  confident  that  in  several  instances,  by  thus  saving:  a 
small  amount  of  blood,  I  have  turned  the  trembling 
scale  in  favor  of  the  anemic  patient  I  am  equally 
confident,  too,  that  years  ago  I  lost  patients  that  might 
have  been  saved,  simply  from  reluctance  to  *'  tie  veins." 
Frequently  have  I  seen  excellent  surgeons,  after  an 
amputation,  tie  every  bleeding  artery  with  all  haste, 
and  hesitate  to  arrest  by  the  same  means  the  fatal  loss 
of  a  few  drachms  or  ounces  because  it  came  from  a  vein. 
I  have  no  doubt'  that  many  lives  were  thus  sacrificed 
during  the  late  war. 

PrmnxLD,  Mass.,  May,  t807. 


Prof.  Billroth. — After  a  long  discussion  over  the 
various  candidates,  Professor  Billroth,  of  Zurich,  has 
been  called  to  the  chair  of  Surgery  in  the  Vienna  Uni- 
versity, made  vacant  by  the  death  of  Professor  Schuh. 
The  Jiedicimsche  Zeitung  remarks  that  there  is  but  one 
voice  as  to  the  propriety  of  the  choice.  Before  called 
to  Zurich,  Professor  Billroth  was  an  assistant  to  the  fa- 
mous Langenbeck  in  Berlin.  He  has  written  a  work  on 
Surgical  Pathology  and  Therapeutics,  which  has  reached 
a  second  edition.  Pitha,  Dumreicher,  Patruban,  Ulridi, 
Dittl,  and  Lorinser,  together  with  the  last  acquisition, 
are  now  the  surgical  teachers  in  Vienna,  who  assist  in 
maintaining  the  glory  of  that  medical  school  which  has 
80  long  enjoyed  the  highest  reputation.  There  is  per- 
haps no  plaoe  in  Europe  where  so  many  advantages  are 
brought  together  for  medical  study  as  in  Vienna^ 


(IDttgmal  €tctutts. 


AS  IKTBRESTIKO  CASE  OF 

^^ESICO-INTESTINAL  FISTULA: 

DISCHARGE  OP  ASCARIS  LUMBBIOOIDES 
PER  URETHRAM. 

BEINO  REMARKS  HADE  ON  THE  PRESENTATION  OF  THE 
SPECIMEN  TO  THE  N.  T.  PATHOLOGICAL  800IETT, 

March  13,  1867, 
By  E.  KRAOKOWIZER,  M.D., 

OF  VXW  TOBK. 

Mr.  President — I  am  going  to  show  a  specimen  of 
great  interest  and  rarity.  Three  or  four  weeks  ago  a 
medical  friend  in  Schenectady  inFonned  me  of  a  patient 
of  his  who  had  all  the  leading  symptoms  of  vesico- 
intestinal fistula.  I  wrote  to  have  him  sent  on  to  me, 
and  he  arrived  here  on  the  25th  of  February.  I  gave 
him  a  little  rest,  and,  as  the  case  was  to  me  quite  an 
extraordinary  one,  I  instituted  as  close  an  examination 
about  the  history  of  his  life  as  I  well  knew  how. 

He  was  twenty-eight  years  of  age,  of  medium  size 
and  strength,  and  of  healthy  parents.  He  did  not 
know  that  anything  had  ailed  him  up  to  his  eighth 
year;  he  was  quite  positive  that  up  to  that  time  he 
had  no  considerable  sickness  that  had  attracted  his  at-  ^ 
tention,  or  that  was  retained  as  important  in  the  memory 
of  his  parents.  When  he  was  eight  years  dd,  and 
while  on  the  streets  he  felt  a  queer  sensation  at  the  end 
of  bis  penis,  as  if  ne  desired  to  pass  water.  He  made 
an  attempt  to  do  so,  but  without  success.  On  looking 
down  at  the  pjenis  he  discovered  something  protnidmg 
from  the  opening  of  the  urethra^  which  he  grasped  witn 
his  fingers,  and  pulled  it  out  It  proved  to  be  a  worm. 
He  says  it  was  still  living.  It  was  not  preserved.  Be- 
fore that  time  he  had  no  inconvenience  ffom  the  bladder 
or  bowels,  except  that  he  never  remembers  having  had 
well  formed  soHd  stools,  but  always  had  two  evacuations 
daily,  which,  although  liquid,  were  of  nntural  colour. 
From  that  time  forward,  he  would  have  occasionally, 
at  intervals  of  several  weeks  or  month?,  a  queer  sensa- 
tion about  the  penis  or  perineum,  a  little  scalding  sen- 
sation in  passing  water,  and  an  mclination  to  urinate 
a  httle  oftener  than  usual.  This  would  last  a  day  or 
two  and  then  pass  off. 

At  ten  years  of  age  he  emigrated  to  this  country, 
and  when  on  board  the  vessel  he  experienced  the  same 
peculiar  sensation  which  he  had  two  years  before,  and 
in  trying  to  pass  his  water  a  worm  appeared  at  the 
head  of  the  penis.  The  worm  was  extracted  by  his 
parents,  and  it  is  not  known  wh  ther  it  was  living  at 
the  time  or  not.  This  worm  was  not  preserved. 
Seven  years  ago  he  again  passed  a  worm  from  the 
urethra.  This  worm  he  put  in  a  bottle  with  alcohol, 
and  kept  it.  It  was  shown  to  me.  It  is  an  ascaris 
Itmibricoides,  between  five  and  six  inches  long.  A  few 
days  after  that  he  noticed,  for  the  first  time,  that  a  gritty 
substance  passed  through  lus  urethra.  He  showed  it  to 
his  physician,  who  did  not  express  a  decided  opinion 
of  its  nature.  But  the  patient  had  no  doubt  that  it  con- 
sisted of  several  seeds  of  whortleberries.  The  urine 
remained  clear  all  the  time.  He  did  not  have  anymore 
inconvenience,  except  perhaps  at  longer  or  shorter 
intervals,  little  unpleasant  sensations  along  the  urethra 
and  perin»Um ;  in  fact,  he  was  well  enough  four  years 
ago  to  enlist  in  the  army  under  Bumside's  command. 
He  was  also  under  Hooker,  and  participated  in  the 
battle  of  Fredericksburgb,  and  in  the  first  battles  of  die 


THE  MEDICAL  RECORD, 


175 


Wflderness.  He  made  forced  marches  with  the  army 
of  the  Potomac,  participated  in  the  battle  of  Gettys- 
burgh,  and,  having  tiiere  received  a  flesh  wound  in  the 
leg,  was  transferred  to  a  hospital  in  Baltimore.  While 
there,  he  ex{>erieDced  some  difficulty  in  passing  his 
water,  and  voided  some  substances  which  appeared  to 
be  the  seeds  of  berries.  He  was  then  discharged  from 
service — ^more,  however,  on  account  of  the  wound  of 
his  le^  than  his  urinary  trouble.  He  returned  to  his 
home  m  Schenectady,  and  was  well  enough  a  year  and 
a  half  ago  to  get  married.  Soon  after  this  event,  how- 
eyer,  his  urinary  trouble  increased  upon  him,  and  all  the 
rational  symptoms  of  stone  in  the  bladder  presented 
themselves.  The  passages  from  his  bowels  were  al- 
ways from  that  time  liquid,  abundant,  and  frequent. 
When  he  had  a  desire  for  a  passage  from  his  bowels,  he 
had  no  control  over  himself,  but  was  compelled  to  obey 
the  summons  immediately.  These  evacuations  presented 
a  very  evident  urinary  odor,  and  sometimes  consisted 
almost  entirely  of  urine.  The  trouble  in  the  urinarv 
organs  continued  to  increase ;  and  he  not  only  had  all 
the  symptoms  of  stone,  but,  superadded  to  these,  there 
was  no  urine  passed  per  urethram  for  days.  Instead  of 
this  natural  passage,  there  was  great  urinary  tenesmus, 
followed  by  the  voidance  of  mucus  mixed  with  blooa 
and  shreds  of  coagulated  flbrine,  as  we  are  wont  to  see 
it  adhere  to  inflamed  mucous  membranes.  His  sufferings 
then  became  constant,  yet  they  did  not  have  much 
effect  upon  his  constitution  ;  he  grew,  it  is  true,  some- 
what thinner,  but  he  never  had  any  fever,  and  his  ap- 
peute  w^as  good.  He  suffered  principally  at  night  in 
having  his  rest  disturbed  by  the  desire  to  evacuate  his 
bowels,  and  also  with  urinary  tenesmus. 

When  he  came  here  I  first  satisfied  myself  concerning 
the  character  of  the  alvine  evacuationa  They  were 
mostly  derived  from  the  secretions  of  the  bowels,  but 
they  unmistakably  contained  urine.  While  he  was 
here,  he  did  not  pass  any  water  until  the  third  day, 
when  about  half  an  ounce  of  perfectly  dean  urine  was 
voided,  at  the  bottom  of  which  settled  a  moderate  sedi- 
ment of  muco-purulent  matter. 

I  regret  that  no  microscopic  examination  of  this  urine 
was  made  with  a  view  to  determine  the  condition  of 
the  kidneys.  I  was  prevented  from  examining  it  the 
first  day,  and  the  next  day  it  was  so  much  spoUed  that 
I  could  not  make  anything  out  of  it. 

On  the  first  of  March,  I  had  him  put  under  the  influ- 
ence of  chloroform,  and  went  to  work  to  make  a  syste- 
matic examination  of  his  case.  On  introducing  a  steel 
sound  I  at  once  struck  a  hard  substance ;  but  I  was  in 
doubt  whether  I  had  a  large  sii^le  stone  or  several 
smaller  ones.  Immediately  on  introducing  the  sound, 
the  beak  passed  over  a  very  rough  substance,  exciting 
a  grating  sensation ;  and  when  introduced  further  into 
the  bladder,  it  struck  a  smooth  surface  of  considerable 
extent  The  grating  sensation  occasioned  by  this  pro- 
cedure could  be  perceived  by  those  standing  next  to 
the  table.  By  making  a  rotatory  movement  of  the 
sound,  it  seemed  as  if  the  smooth-faced  stone  slipped 
from  one  side  of  the  beak  to  the  other. 

The  next  thing  to  determine  was  the  connexion  be- 
tween the  bladder  and  intestine.  I  suspected  that  this 
connexion  must  be  between  the  'smaller  intestine  and 
Uadder,  as  there  never  had  been  the  least  show  of  any 
broken-down  foecal  matter  in  the  evacuations;  they 
were,  on  the  contrary,  always  liquid ;  and  when  tbe^ 
were  allowed  to  stand,  a  bran-like  sediment  from  epi- 
thelium and  mucus,  stained  with  bile,  settled  at  tne 
bottom  of  the  vessel. 

Moreover  he  never  passed  any  flatus  per  urethram, 
an  occurrence  so  characteristic,  where  the  fistula  exists 
between  the  bladder  and  the  laj-ge  intestines* 


In  order  to  make  out  a  direct  connexion  between  the 
bladder  and  gut.  I  thought  it  well  to  inject  nome  colored 
substance  into  tne  organ  and  watch  the  e£fect  There 
being  no  other  available  coloring  substance  at  hand,  I 
employed  some  wash-blueing,  under  the  impression 
that  it  was  composed  of  the  cyanuro-cyanide  of  iron. 
I  made  a  dilute  solution  of  this,  and  while  the  anus  was 
distended,  L  injected  twelve  ounces  into  the  bladder; 
but  when  I  opened  the  stopcock  of  the  catheter  so  as 
to  allow  the  liquid  in  that  organ  to  escape,  none  came. 
The  injection  then  must  have  left  the  bladder  immedi- 
ately ailer  being  injected ;  it  seemed  strange  that  none 
came  from  the  bowel  An  examination  was  made  as 
high  up  as  it  was  possible  to  make  it,  while  the  anus 
was  distended  with  Sims'  speculum,  but  no  opening  into 
the  gut  was  discovered ;  no  liquid  was  seen  to  dribble  out 
from  the  walls  of  the  rectum,  nor  did  the  finger  reach 
anything  to  determine  the  existence  of  a  fistula;  in 
fact  the  mucous  membrane  of  the  rectum  seemed  so  far 
perfectly  normal 

I  charged  the  attendant  to  mark  particularly  when 
colored  stools  should  appear.  The  injection  was 
made  at  one,  and  at  three  the  first  passage  came, 
and  severaJ  others  at  intervals  afterwards;  all  of 
these  were  separated  one  from  the  other  as  soon  as 
voided,  but  no  color  was  found  in  any.  This  circum- 
stance at  first  appeared  strange,  but  when  I  afterwards 
learned  that  the  blueing  was  (-omposed  of  indigo  simply, 
I  explained  the  non-appearance  of  color  by  the  rapid 
bleaching  which  that  substance  underwent  in  contact 
with  the  ammonia,  the  presence  of  which  in  the  stools 
was  easily  detected  by  the  smelL  To  be  sure  that  this 
explanation  was  correct,  I  filled  a  tumbler  with  a  recent 
fluid  exacuatlon  from  the  bowels,  and  added  a  small 
quantity  of  Uie  washing  blue.  The  bluish  color  which 
it  imparted  to  the  liquid  disappeared  in  a  few  minutes, 
leaving  the  color  as  it  was  before  the  addition  of  the 
washing-blue. 

Two  days  subsequent  to  this,  I  took  the  common  writ- 
ing ink  diluted,  and  injected  six  ounces  of  it  into  the 
bladder.  The  stopcock  of  the  catheter  being  opened 
as  two  days  previously,  no  fluid  escaped  from  its  ex- 
tremity, but  about  ten  nunutes  after,  however,  the  pa- 
tient had  a  stool  which  showed  some  of  the  color ; 
in  the  course  of  two  hours  more  another  stool  was 
colored  nearly  as  dark  as  the  injection  itself;  in  two 
hours  more  another  stool  contained  the  color,  but  not  so 
intense,  and  four  hours  after  the  injection  the  evacua- 
tion had  its  usual  brown  appearance.  This  fact  corro- 
borated the  opinion  which  I  had  previously  held,  that 
the  fistula  was  high  up^robably  between  the  small  in- 
testines and  bladder.  This  beinc:  the  case  it  was  im- 
possible to  devise  any  rational  plan  to  treat  the  fistula, 
but  the  only  indication  to  fulfil  was  to  relieve  the  pa- 
tient of  the  stones  in  the  bladder. 

While  the  patient  was  under  chloroform  I  could  feel  a 
stone  behind  the  prostate,  and  somewhat  overlapping 
the  upper  and  posterior  part  of  the  gland. 

Four  days  after  the  first  examination,  and  two  days 
after  the  second  injection,  the  o^ration  was  made  in 
the  usual  manner  by  the  lateral  incision.  As  soon  as 
the  prostate  was  incised,  the  stafi*  was  withdrawn. 
When  I  afterwards  introduced  my  finger  I  at  once  felt, 
as  I  thought,  small  rough  fragments  in  the  wound, 
which  I  grasped  and  removed.  In  the  bladder  there 
were  found  in  all  nine  stones,  five  large  and  four  smaller 
ones. 

After  the  bladder  was  emptied,  my  attention  was  di- 
rected to  the  finding  of  the  vesical  entrance  to  the  fis- 
tula :  I  discovered  towards  the  right  and  a  little  above ^ 
as  I  thought,  of  the  trigonum,  a  funnel-shaped  receifs 
with  a  concave,  prominent,  tipper  border,^  with  the 


176 


THE  MEDICAL  RECORD. 


lower  border  slanting  off  to  wards  the  trigonum  LieutaudiL 
I  tried  to  introduce  a  probe  into  this  hole,  but  wa«  una- 
ble at  first  to  do  so,  and  fearing  that  I  might  do  damage 
to  the  parts  in  any  fbrther  attempts.  I  desisted. 

The  patient  afler  the  operation  felt  greatly  relteyed. 
and  went  on  for  the  first  three  days  very  satisfactorily, 
The  only  thing  that  I  did  not  like  was  ms  listlessness ; 
he  was,  however,  perfectly  rational  and  had  no  fever. 
During  this  time  au  his  water  passed  through  the  wound. 
At  the  end  of  the  third  day  he  had  f»cS  evacuations 
which  were  nearly  liquid. 

On  the  fourth  day  he  had  quite  a  large  stercoraceous 
evacuation  firom  the  bowels,  of  almost  pultaceous  con- 
sistency.   Its  odor  and  color  were  normal 

On  the  fifth  day,  he  seemed  even  more  drowsy ;  his 
pulse  was  high  and  feeble,  he  had  felt  chilly  several 
times  the  preceding  night  The  skin  felt  rather  cool, 
the  tongue  d^ish.  The  respiration  was  normal.  He 
complained  of  sharp  pain  in  the  hypogastrium.  There 
was  no  tympanitis,  in  fact  the  abdominal  walls  felt  very 
rigid,  a  condition  hardly  ever  wanting  in  such  who  for 
urinary  tenesmus  have  had  the  muscles  of  the  pre- 
lum abdominale  constantly  taxed.  The  wotind  at  the 
perinseum  looked  healthy,  and  the  urine  dribbled  firom 
it  as  from  the  day  of  the  operation.  He  never  vomited, 
and  although  the  pain  was  bearable  under  moderate 
doses  of  opium,  he  grew  weaker  and  weaker  during 
the  day,  and  expired  March  11,  at  one  o'dock  ▲.v., 
five  and  a  half  days  after  the  operation. 

The  post-mortem  was  made  twelve  hours  after  death. 
On  opening  the  abdominal  cavity,  and  throwing  back 
the  omentum,  all  the  contents  of  the  abdomen,  aa  far 
as  they  could  be  seen,  looked  perfectly  natural ;  there 
was  no  injection  of  tne  capilltu-y  vessels  of  the  peri- 
toneum excejpt  near  the  caput  coli,  but  there  was  no 
exudation.  On  pushing  back  the  small  intestines,  which 
brought  the  cSD^um,  sigmoid  flexttre,  and  entrance  to 
the  pelvis  into  view,  the  manner  in  which  the  fistula 
was  established  was  at  once  explained.  The  rermiform 
process  was  seen  to  dip  down  straight  over  the  rim  into 
the  pelvis,  and  be  attached  to  the  posterior  and  lateral 
aspect  of  the  bladder  by  old  adhesions,  which  in  their 
turn  spread  towards  the  right  side  of  the  rectum,  and 
strong  bands  of  old  adhesions  passed  from  the  sigmoid 
flexure  towards  the  parietal  peritoneum  on  the  left  side, 
showing  that  extensive  pelvic  peritonitis  had  occurrea 
at  some  Ume  during  his  life.  By  compressing  the 
lower  end  of  the  ilium,  and  making  pressure  upon 
the  caput  coli,  intestinal  gases  could  be  tnrown  iiito  the 
bladder. 

While  handling  the  abdominal  organs,  three  or  fbur 
ounces  of  a  wen  colored,  thick,  and  odorless  matter 
oozed  up  between  the  bladder  and  rectum.  I  did  not 
see  the  exact  spot  whence  it  came,  but  had  no 
doubt  that  it  came  from  an  extra-peritoneal  abscess  that 
had  burst  in  the  peritoneal  cavity  low  down  in  the 
pelvis  by  the  post-mortem  handling  of  the  parts.  With 
a  view  not  to  spoil  the  specimen,  while  Itook  out  all 
the  pelvic  viscera  with  the  perinseum,  anu&  and  penis 
below,  the  cflecum,  with  the  end  of  the  inum,  and  a 
goodly  portion  of  the  S.  Bomaum  above,  I  Was  very 
careful  to  eet  the  peritoneal  lining  of  the  small  pelvis 
intact.  I  divided  the  peritoneum  by  a  circular  incision 
along  the  rim  of  the  pelvis,  and  peeled  it  off  from  the 
snrrdunding  connective  tissue.  In  doing  so  there  were 
found  in  the  areolar  tissue  of  the  cavity  of  the  sacrum 
three  or  four  small  abscesses,  none  contidning  more 
than  a  thimbleful  of  creamy  yellow,  inodorous  pus.  The 
iliac  and  hypogastric  veins  with  their  branches  con- 
tained liquid  blood,  and  there  was  not  the  first  begin- 
nizig  of  a  thrombus  in  any  of  them. 

All  the  parts  in  their  connexion  with  the  kidneys  by 


the  ureters  being  spread  on  a  table,  the  rermiform 
process  was  found  adherent  not  by  its  extremity,  but 
about  three-fourths  of  an  inch  firom  it. 

The  bladder  being  split  open  in  front  by  a  longitudi- 
nal incision,  did  not  d^ow  a  thickening  of  its  waits.  Its 
mucous  membrane  was  of  a  bright  slate  color,  and 
moderately  congested.  At  the  neck  of  the  bladder  was 
seen  a  large,  sinuous  ulcer,  nearly  encircling  its  whole 
circumference,  and  deeper  on  its  left  side.  In  this,  pro- 
bably, the  four  rough,  smidl  calculi  were  lodged,  and  if 
so,  it  is  accounted  for  why  the  beak  of  the  instrument 
at  times  enoountered  some  difficulty  in  entering  the 
bladder,  and  why  on  this  spot  an  unusually  harsh, 
grating  sound  was  produced. 

The  posterior  angle  of  the  cut  in  the  prostatic  portion 
stops  just  short  of  the  anterior  ra<^ged  border  of  this 
ulcer.  The  wound  from  the  operation  is  smooth  in  its 
whole  extent,  and  leaves  about  one-eighth  of  an  inch  of 
the  left  lobe  of  the  prostate  gland  undivided.  Nowhere 
in  the  neighborhood  of  the  wound,  or  exteriorly  to  the 
capsule  of  the  prostate,  or  in  the  connective  tissue  be- 
tween the  fimdus  of  the  bladder  and  the  rectum,  the  least 
trace  of  infiltration  of  urine,  or  sloughing,  or  an  abscess 
can  be  found. 

One  inch  above  the  entrance  of  the  right  ureter  into  the 
bladder,  a  smooth-bordered  opening  is  seen,  admitting 
readily  the  end  of  a  conical  elastic?  iSmgie,  which  enters 
at  once  in  the  vermiform  process  there  where  it  adheres 
to  the  body  of  the  bladder.  By  giving  the  bougie  an 
upward  and  outward  direction,  its  end  emerges  after 
having  trans-coursed  the  vermiform  process  in  the  cavity 
of  the  csecum. 

About  one-eighth  of  an  inch  below  this  hole  there  is 
another,  smaller,  circular  opening,  which  does  not  com- 
municate with  the  vermifbrm  process,  but  ends  blind  at 
the  depth  of  a  couple  of  lines. 

The  mucous  membrane  of  the  large  intestines,  ttcm 
the  Cfecum  down  to  the  anus,  has  not  undergone  the 
least  change  from  the  nrine. 

The  kianeys  were  somewhat  larger  and  flaccid. 
Their  capsules  peeled  off  readily,  leaving  here  and  there 
small  shreds  of  the  cortical  substance  adherent  to  them. 
The  surface  of  the  kidneys  was  not  smooth,  but  puck- 
ered in  consequence  of  irregular  depressions,  caused  by 
shrinkage  of  the  cortical  substance  from  atrophy  on 
different  spots. 

On  cutting  them  open,  the  cortical  substance  was 
seen  reduced  in  bulk,  forming  here  and  there  only  a 
thin  layer  over  the  base  of  the  pyramids. 

On  the  surface  of  the  left  kidneys  there  was  one 
small  abscess,  the  s^  of  a  small  hempseed,  containing 
thick  yeBow  pus. 

The  calices  and  pelves  of  both  kidneys  were  dilated, 
these  of  the  right  kidney  more  so  than  those  of  the  1^ 
one.  Their  mucous  lining  had  a  lurid  port-wine  color, 
which,  on  closer  inspection,  was  seen  to  be  produced  by 
a  rich  arborescence  of  the  smaller  blood-vessels.  The 
pelves  held  in  their  cavities  a  small  quantity  of  turbid, 
floccular  urine. 

The  peritoneal  lining  of  the  pelvic  cavity  was  fetmd 
in  its  whole  extent  fblly  intact,  its  surface  smooth  and 
glossy.  There  was  novvhere  a  communication  by  nlcer^ 
ation  or  by  an  artificial  rent  with  the  subjacent  con- 
nective tissue. 

I  have  stated  abote,  that  along  the  sacrum  there 
were  in  the  extra-peritoneal  connective  tissue  three  or 
four  small  abscesses.  They  were  filled  with  as  nradi 
matter  as  they  could  holo,  and  nowhere  else  could  a 
cavity  be  detected  of  a  size  to  contidn  three  or  fbur 
ounces  of  matter  that  welled  up  fi^wn  the  bottom  of  the 
pelvis  during  the  progress  of  the  post-mortem  extoni- 
nation,  even  if  a  commtmioatlon  between  the  peritoneal 


THE  MEDICAL  RECORD. 


Ill 


flftc  and  its  snnroundings  had  existed.  But  there  was 
no  lesion  of  the  perttonenm,  and  its  surface  was  just  as 
normal  as  could  be  seen  when  it  is  not  the  seat  of  mor- 
bid action. 

I  cannot  escape  then  the  conclucnon  that  the  matter 
was  the  secretion  of  the  peritoneal  surface  itself 

Although  the  patient  was  rather  drowsy  after  the 
operation,  and  the  kidneys  were  evidently  the  prey  of 
pretty  far  advanced  BrighVs  disease,  yet  Uiere  were  no 
weD  marked  syniptoms  of  ursmia.  fiut  the  symptoms 
of  pelvic  peritonitis,  coming  on  rapidly  on  the  fiftn  day 
after  the  operation,  were  well  pronounced. 

If  I  take  in  connexion  with  them  the  scattered  ab- 
scesses in  the  sacral  region,  and  the  small  abscess  in  the 
Idt  kidney,  the  least  improbable  explanation  seems  to 
me  to  be,  that  pyemia  commenced  on  the  fifth  day, 
establishing  purulent  depots  on  the  enumerated  lo- 
calities. 

That  the  peritoneal  surface  a|)peared  normal,  not- 
withstanding the  purulent  secretion,  seems  surprising, 
but  not  more  so  than  in  other  cases  of  p^semia,  where 
we  see  large  purulent  secretions  in  the  joints  establish 
themselves  in  the  course  of  a  few  hours,  and  yet  the 
poet-mortem  fails  to  detect  the  least  injection,  the  least 
roughening  of  the  synovial  membrane,  the  snudlest 
shred  of  fibrinous  exudation,  the  least  erosion  of  the 
inenistating  cartilage. 

Several  other  interesting  questions  come  up  in  con- 
nexion with  this  case  for  s^tion.  In  the  first  place,  at 
what  ttme  did  this  connexion  between  the  vermiform 
process  and  Uadder  take  place  ?  Now,  we  have  evidences 
of  the  existence  of  quite  an  extensive  peritoneal  in- 
flammation existmg  before  the  last  ilhiess;  here  you 
have  small  bands  from  the  side  where  the  fistula  is  to 
the  rectum,  here  others  between  the  rectum  and  blad- 
der, and  from  the  sigmoid  flexure  there  were  even 
larger  and  stouter  bands  running  towards  the  perito- 
neum. He  is  very  distinct  in  ms  statement,  tnat  he 
never  had  anj^  trouble,  that  he  had  never  been  "laid 
jxb"  until  the  time  I  refer  to,  aud  his  parents  were  un- 
able to  recollect  any  severe  illness  in  his  infancy ;  the 
first  thing  wrong  that  was  noticed  was  the  appearance 
of  the  worm  per  uretbram.  I  do  not  think  it  impossi- 
ble, that  at  a  time  considerably  antecedent  to  the  ap- 
pearance of  the  worm,  he  passed  through  a  pelvic  peri- 
tonitiSj  which  fixed  the  vermiform  process  on  the  lateral 
posterior  a^)ect  of  the  bladder,  and  that  later  a  small 
foreign  substance  lodged  there,  caused  irritation  and 
inflammation,  and  established  a  communication  with 
the  bladder  b^  ulceration.  It  is  well  known  that  these 
local  peritoneal  inflammations  do  sometimes  occur,  and 
do  no  more  for  the  time  than  agglutinate  acyacent  parts, 
and  the  physician  is  not  unfreqoentljr  surprised  by  the 
explosion  of  a  fi|tat  peritonitis,  starting  vom  a  subse- 
quent ulceration. 

The  next  question  to  decide  is  as  to  the  time  when 
tUs  fistulous  connexion  between  the  vermiform  process 
and  the  bladder  took  place?  Most  certainly  it  has  ex- 
isted since  his  eighth  year,  for  then  the  first  worm  was 
voided  from  the  bladder.  But,  how  is  it  that  he  did  not 
Buffer  from  this  communication  before^  even  had  it  then 
eiasted?  I  think  the  true  explanation  is  this: — ^The 
vermiform  proeess,  by  its  adhesion  to  the  bladder,  was 
pretU^  tightly  stretched.  The  communication  witii  the 
oiadder  was  not  at  its  extremity,  but  about  three-quar- 
ters of  an  inch  from  it  The  fistulous  track  in  this 
manner  had  a  perpendicular  direction  towards  the  axis 
of  the  processus.  Moreover,  the  inosculation  between 
the  openiuff  in  the  vermiform  process,  and  the  opening 
in  tb^  bladder,  was  not  immediate,  but  the  fistulous 
trade  between  the  two  cavities  nad  an  appreciable 
ItQgtk     la   &oty  wheft  the  bougie-  was  mtroduced 


from  the  side  of  the  bladder  in  the  venniform  process, 
in  a  direct  line,  it  was  there  arrested,  and  it  was  neces- 
sary to  give  it  an  outward  and  upward  turn  to  carry 
it  on  easily  through  the  vermiform  process  into  the ' 
csscum. 

It  will  be  perceived  that  all  these  circumstances  co- 
operated to  establish  a  valvular  occlusion,  which  never 
by  the  fluid  contents  of  the  bowels,  and  only  accident- 
afiy  and  occasionally  by  solid  bodies,  like  worms,  seeds 
of  berries,  was  overcome. 

As  long  as  there  was  no  impediment  in  the  bladder,  by 
which  the  voiding  of  the  accumulated  urine  per  ure- 
thram  was  made  difficult  or  impossible,  the  said  valvular 
arrangement  at  the  fistula  set  itself  a^nst  a  regurgita- 
tion of  the  urine  filling  the  bladder  into  the  venniform 
process. 

The  occasional  intrusion  of  foreign  bodies  fh)m  the 
put  in  tiie  bladder  at  first  happily  was  got  rid  of  by  their 
immediate  expulsion  per  urethram. 

But  when  once  stones  in  the  bladder  commenced  to 
form  (imdoubtedly  by  such  erratic  blocks  from  the  bow- 
els furnishing  the  nuclei),  this  fortunate  cooperation  for 
a  valvular  occlusion  was  disturbed,  and  the  order  of 
things  indeed  reversed. 

When  the  voiding  of  the  bladder  became  difficult, 
partiy  by  the  mechanical  ocdusibn  from  the  stones, 
partly  by  spasmodic  contraction  at  the  neck,  the  urine 
accumulated  in  the  bladder,  being  under  equal  pressure 
from  all  sides  by  the  action  of  the  detrusores  vesicae, 
sought  an  outiet  where  there  was  the  point  of  least 
resistance.  And  this  was  indeed  there  where  the  en- 
trance to  the  vesico-intestinal  fistula  was  located.  In 
point  of  fact  the  fistula  became  a  vicarious  urethra, 
through  which  the  bladder  expelled  the  urine  as  it 
dribbled  down  from  the  ureters. 

So  it  is  explained,  why  the  last  one  and  one-half 
years,  since  the  urinary  trouble  commenced,  never  any 
fluid  secretion  f^rom.  the  bowels  appeared  per  urethram, 
and  why  only  small  quantities  of  urine,  sometimes  only 
in  mtervate  of  three  to  four  days,  passed  by  the  act  of 
micturition.  It  was  mainly  forced  into  the  bowel,  and 
there  produced  by  its  irritation  an  abundant  secretion, 
and  a  more  rapid  contraction,  with  a  view  to  expel  the 
contents  of  the  viscus.  He  always  passed  large  quanti- 
ties from  his  bowek,  and  during  all  the  time  he  was 
under  my  observation  he  never  passed  less  than  two 
chamber-potfuls  in  a  day;  of  this  probably  kbout  two 
pints  was  pure  urine. 

The  next  question,  and  the  most  important  one,  is 
this : — Oould  he  have  been  relieved  if  the  operation  for 
stone  bad  succeeded?  If  the  complications — ^Bright's 
disease  and  ulceration  of  the  bladder,  which  I  look 
upon  as  the  disposing  cause  to  the  &tal  pyaemia — had 
not  existed,  there  is  no  reason  why  the  operation  of 
lithotomy  snould  not  have  been  successful.  If  it  had 
been  so,  I  do  not  see  why  the  patient  should  not  have 
had  a  quiet  time  again,  just  as  much  as  he  enjoyed 
firom  his  eighth  to  his  twenty-sixth  year,  when  stones  in 
the  bladder  commenced  to  form. 

That  any  rational  plan  could  be  devised  to  close  the 
fistula  I  do  not  believe. 

As  ejects  of  surgical  interference,  cases  of  intestino- 
vesical  fistula  must  be  divided  into  two  distinct  groups. 

The  firti  group,  comprising  cases  in  which  the  fistula 
exists  between  me  bladder  and  the  rectum,  and  can  be* 
seen  and  reached,  permit  surgical  treatment. 

Of  the  $$cond  oass,  where  the  fistula  exists  between- 
the  bladder  and  any  section  of  the  intestines  down  to 
that  part  of  the  rectum  which  already  receives  a  peri- 
tonei investment^  I  think  it  must  be  said  that  it  is* 
beyond  the  reach  of  art 

I'irst)  the  exact  uiuation  of  the  fistuk  mus^-^wayr 


lis 


THE  MEDICAL  RECORD, 


remain  rather  a  matter  of  surmise,  altiiough  the  statis- 
tics indicate  the  csecum  as  that  part  of  the  intestines 
which,  by  its  not  uncommon  lesions,  is  most  frequently 
the  organ  implicated. 

But  eren  granted  that  the  exact  site  of  the  fistula 
could  be  dia^osticated,  how  could  it  be  attacked  ex- 
cept by  openmg  the  abdomen,  detaching  both  viscera 
from  each  other,  and  closing  each  fistulous  opening 
separately  with  sutures  ?  That  such  a  procedure  has 
the  mark  of  fetality  broadly  stamped  on  it,  it  is  unne- 
cessary to  dwell  upon. 

I  refrain,  too,  from  criticising  the  fantastic  plan  of  a 
French  surgeon  (Barbier),  who  proposes  to  make  a 
temporary  artificial  anus  at  the  caecum,  and  to  introduce 
through  it  a  metallic  tube,  reaching  somewhat  above  the 
viJvula  Baahini,  through  which  the  fieces  from  the 
ilium  would  be  led  past  the  fistula,  which,  ceasing  to 
be  the  conduit  of  stercoraceous  matter,  might  then 
close.  After  which  the  artificial  anus  might  be  closed 
also.  The  objections  are  so  manifest,  that  I  forbear  to 
enter  on  their  enumeration. 

Quite  distinct  in  scope  and  technicism  from  Barbier's, 
is  the  plan  to  make  an  artificial  anus  for  the  relief  of  vesi- 
co-intestinal  fistula,  pursued  by  Pennell*  and  T.  Holmest. 
Both  these  surgeons  had  to  do  with  cases  in  which  the 
intestinal  entrance  of  the  fistula  could  not  be  detected 
by  rectal  examination.  But  both  cases  showed  symp- 
toms which  made  it  probable  that  the  intestinal  end  of 
the  fistula  was  below  the  region  in  which,  by  Callisen- 
Amussat's  operation,  an  arSficial  anus  is  established. 
Both  these  gentlemen  succeeded  in  leading  the  contents 
of  the  bowels  out  through  an  artificial  anus  in  the  left 
lumbar  region,  so  that  they  could  no  more  engage  in 
the  fistula  and  reach  the  bladder.  In  PenneU^s  case  the 
patient  did  well,  and  lived  for  many  years.  I  am  not 
able  to  find  out  whether  the  fistula  heued  and  the  arti- 
ficial anus  closed.  In  Holmes's  case,  the  patient  was 
entirely  relieved — ^for  better  than  one  year,  I  believe — 
from  all  the  symptoms  consequent  upon  feces  getting  into 
the  bladder ;  when  these  very  same  troubles  reappear- 
ed, and  the  patient  succumbed.  The  autopsy  revealed 
the  fact,  that  some  time  after  colotomy  by  adhesion  and 
ulceration  a  new  fistula  had  ibrmed,  between  the  csdcum 
and  the  bladder,  the  deleterious  eflects  of  which,  of 
course,  could  not  be  warded  off  by  the  artificial  anus  in 
the  left  lumbar  region.  The  roecimen  was  shown  by 
T.  Holmes  in  the  London  Pathological  Society. 

Although  vesico-intestinal  fistma  is  one  of  the  rarer 
lesions,  yet  there  is  a  goodly  number  of  cases  on  record. 
But  oases  in  which  by  it  the  possibility  arose^for  intes- 
tinal worms  to  get  into  the  bladder  and  be  expelled  per 
urethram,  are  exceedingly  scarce.  C.  Davaine,  in  his 
''  Traits  des  Entozoaires  et  des  Maladies  Yermineuses,*' 
Paris,  1860,  has  collected  only  14  cases. 

In  two  of  these  the  worms  reached  the  bladder  by  a 
vesico-reotal  fistula. 

In  three  cases  the  history  is  quite  incomplete. 

In  one  case  it  is  mentioned  that  deatii  was  imminent 

In  one  case  no  post-mortem  examination  was  made. 

In  five  cases  it  is  mentioned  that  the  troubles  dimin- 
ished or  ceased  after  the  expulsion  of  worma  In  two 
of  these  cases  the  relief  seemed  a  lasting  one.  If  we 
look  at  them  by  the  light  which  our  case  fiirnishes,  I 
think  we  may  greatly  doubt  that  the  fistula  had  healed 
radically. 

In  only  two  cases  the  post-mortem  result  is  reported. 

♦  A  MM  of  striotnre  of  the  rectum,  wberefA  an  artiflclal  anaB  was 
gicoearfWlT  eatabllBhed  in  Uie  lumbar  region.  By  J.  Wltoon  Or<Aer 
Pennell,  Med.  OMr.  Trantaciioru.    ISOflL    YoL  S. 

'^r'  *?■?  ®\  ".™^>»  oolotomy,  sncceaaftiny  performed  for  the  relief  of 
jeslco-inteatln^  flatuU.  By  T.  Holmee,  Ass.  Surg.  9t  George's  Hospi- 
tal,London.   Mtd,  CMr,  Trantacti^,   18«fi.   VoL  4». 


The  case  of  Dr.  William  Kingdon  (MecL  Ohirurg,  B^ 
view,  July,  1842)  bears  such  a  striking  similarity  to 
mine,  that  I  think  it  interesting  to  re-state  it  here : 

A  boy  of  seven  years,  at  the  commencement  of  the 
year  1836,  suffered  from  the  retention  of  urine  for  more 
than  eight  days,  after  which  an  ascaris  lumbricoides 
presented  itaefr  at  the  meatus  urinarius,  and  was  pulled 
out  by  the  child  himself.  One  year  afterwards  the  same 
thing  occurred,  and  the  mother  extracted  a  worm  firom 
the  urethra.  Worms  presented  themselves  successively 
at  the  opening  of  the  urethra  six  months  later,  then  in 
October,  1838,  and  in  January  and  April,  1839.  The 
passing  of  several  worms  per  anum,  violent  pains  in  the 
region  of  the  bladder,  purulent  urine,  which  afterwards 
passed  with  the  stools,  high  and  constant  fever,  tran- 
sient loss  of  sight,  and  extreme  exhaustion,  were  the 
leading  symptoms,  until  death  occurred,  November  16, 
1839. 

Fosi-mortem  ExaminaHon. — The  vermiform  process, 
instead  of  occupying  its  usu^  place,  dipped  down  in  the 
small  pelvik  and  about  one  inch  fi'om  its  extremity  ad- 
hered closely  to  the  upper  and  lateral  portion  of  the 
bladder,  a  little  above  the  junction  of  the  ureter  with 
the  bladder.  The  bladder  it^lf  was  small  .and  con- 
tracted around  a  hard  bi^dy  that  was  recognised  as  a 
stone,  one  and  a  half  inches  lon^  and  two  and  three- 
fourtns  inches  in  circumference.  The  walls  of  the  blad- 
der were  very  much  thickened,  and  opposed  them- 
selves almost  entirely  to  the  passage  of  the  urine  in  the 
direction  of  the  urethra.  The  mucous  membrane  of 
the  bladder  was  ulcerated  on  two  spots,  and  in  a  direct 
line  with  the  orifice  of  the  ureter,  and  a  little  above  it 
were  two  fistulous  openings,  separated  by  a  very  nar- 
row spur,  which  communicated  with  the  interior  of  the 
vermiform  process.  Both  ureters  were  very  much  en- 
larged, and  both  Jridneys,  more  voluminous  than  nor- 
mal, were  so  completely  filled  with  pus,  that  hardly 
a  trace  of  healthj^  tissue  remained. 

Dr.  Eji>gdon  d[ivided  the  stone  with  care,  and  found 
in  its  centre  a  larg:^  pin.  The  stone  had  not  been  re- 
cognised during  life. 

Description  of  the  Stones. — There  were  five  smooth, 
and  four  rough  ones.  Dr.  L.  Voss,  who  assisted  at  the 
operation,  tells  me  there  was  a  very  small  fifth  rough 
one,  which  was  lost  The  smooth  ones  had  a  chalk- 
white  color;  the  largest  was  one  and  a  half  inches 
lon^,  one  and  one-fourth  inches  wide,  and  one  inch 
thicK.  It  was  ovalj  and  only  one  side  showed  a  littJe 
evenness,  from  attrition.  The  other  four  smooth  stones,  of 
which  the  smallest  was  only  half  an  inch  long  and  about 
three-eighths  of  an  inch  in  width  and  thickness,  while 
the  remaining  thv*  e  were  of  intermediate  size  betwe^>n 
the  smallest  and  largest — had  all  originally  a  round  or 
oval  shape ;  but  each  one  bad  the  sphericity  broken  by 
two  plfmes  meeting  at  a  right  angle,  caused  by  the 
grinding  of  the  stones  one  against  the  other.  Thd  four 
stones,  by  putting;  them  together,  the  corresponding 
planes  facing  each  ^ther,  gave  eviaence  that  their  rela- 
tive position  must  have  been  all  but  permanent  The 
larger  stone  must  have  lodged  on  top  of  this  cyclopic 
masonwork. 

The  four  rough  stones  were  ^uite  small;  but  eaoh  one 
was  studded  on  its  surface  with  warty  protuberances. 
Each  two  formed  a  set  in  this  manner — that  each  stone 
offers  a  small  polished  surface  that  corresponds  most 
exactly,  with  a  similar  surface  of  its  mate.  The  fit  was 
as  perfect  as  between  an  axle  and  its  box.  This  cir- 
cumstance makes  it  evident  that  each  set  of  two  stonea 
had  an  independent,  well  secured  spot  in  whidi  they 
were  hdd  so  fast  that  only  the  most  insignificant  slid- 
ing motion  between  each  two  was  permitted*  The  ulcer 
at  the  neck  of  the  bladder  with  the  larger  ezcavatioa 


THE  MEDICAL  RECORD, 


179 


on  fts  lef^  and  the  smaller  one  on  its  right  side,  was  un- 
doubtedly the  bed  for  the  two  sets  of  stoneleta 

Dr.  J.  Praraann,  who  had  the  kindness  to  make  the 
sections  of  the  stones^  giyes  the  weight  of  them  as  fi>l- 
k>w8: 

Smooth  stones,  1  gr.  177    Rough  stones,  6  gr.  29 
"  '*       2  "  143        **  "      6  "  10 

«  «         3    U    IQQ  u  u        8    "      6 

"  «       4  "     80        "  "      9  "     5 

"  «      6  "     22 

528  50 

Together,  gr.  578. 

The  section  of  the  stones  so  far  disappointed  mj  ex- 
pectations that  the  nuclei  did  not  show  anything  char- 
acteristic which  would  lead  one  to  suspect  that  they  had 
immigrated  from  the  intestines.  The  largest  stone  con- 
tained three  nuclei,  so  that  at  one  time  three  separate 
stones  must  have  existed,  which  by  ulterior  earthy  de- 
posits coalesced  in  one.  The  next  largest  stone  had  its 
Dodeus  quite  eccentric,  and  contained  a  large  cavity. 
Compact  and  porous  layers,  in  irregular  alternations, 
characterised  each  stone.  Of  the  rough  stones,  only 
the  largest  admitted  of  being  cut  in  two.  Its  structure 
was  exceedin^y  porou& 

The  mater^  of  all  the  stones  was  the  same — phos- 
phate of  lime  and  a  liberal  admixture  of  carbonate  of 
lime. 


|)re0re««  0f  IRel>tcal  Scttitce. 

NiTRO-MimiATio  Acid  in  Asthma. — Dr.  B.  F.  Records 
reports  a  case  {Medical  and  Surgical  Reporter)  which 
he  considers  to  be  Spasmodic  Asthma  cured  by  the 
internal  and  external  administration  of  this  acid.  The 
dose  was  six  drops  in  half  a  tumblerful  of  sweetened 
water  every  eight  hours.  Ten  drops  of  the  same  in  a 
rill  of  water  were  applied  locally  m  the  region  of  the 
fiver  by  means  of  a  saturated  flannel  doth.  He  does 
not  state  how  long  it  took  to  effect  the  surprising  result. 

SxpiOTORATiON  OF  A  Mofii  Ball.— Dr.  A.  Gteiger, 
Dayton,  Ohio,  publishes  in  a  recent  number  of  the 
Medical  and  Surgical  Reporter  the  case  of  a  soldier  who 
was  wounded  in  the  chest  on  the  7th  of  April,  1864, 
which  shows  a  rather  remarkable  circumstanoe  in  con- 
nexion with  the  subsequent  appearance  of  the  missile. 
The  ball  entered  at  the  lower  margin  of  the  seventh  rib, 
penetrating  the  chest,  and  lodged.  He  bled  severely  at 
the  time,  but  refused  to  be  carried  to  the  hospital,  and 
remained  with  his  comrades  in  camp,  and  after  Ave 
days  started  on  horseback  with  Gkn.  Stoneman's  brigade 
into  Georgia,  South  Oarolina^  etc.,  and  continued  with 
bis  regiment  until  the  close  of  the  war.  He  states  that 
ater  the  healing  of  the  wound  externally,  he  did  not 
experience  much  inconvenience,  except  occasional 
shortness  of  breath,  and  inabiUty  to  perform  active 
exerd  ^  such  as  fast  walking,  nmning,  etc.  Afler 
being  discharged  from  the  army,  he  returned  home,  and 
eng^ed  in  work  at  his  trade,  that  of  a  carpenter,  and 
continued  to  enjoy  tolerable  good  health  ootil  some 
time  in  September,  1866,  he  contracted  by  exposure  a 
severe  cola,  since  which  time  he  has  had  some  cough, 
and  frequent  expectoration  of  blood;  also  at  times 
eomplete  aphonia,  with  sense  of  suffocation*  One  of 
these  attacks  was  so  severe  as  to  produce  spasms  and 
insensibility,  which  continued  for  seyeral  hours.  Oflen- 
time«,  dttnng  a  severe  fit  of  coughing,  accompanied 
sometimes  by  vomiting,  he  would  feel  the  presence  of  a 
hard  body  in  the  windpipe,  which  he  could  almost  at 
the  time  cough  up. 


On  the  26th  day  of  March,  1867,  after  having  been 
at  work  during  the  forenoon,  he  felt  so  unwell  at  noon 
that  he  returned  home,  and  in  a  short  time  afterwards 
was  taken  with  a  severe  fit  of  coughing,  and  soon  ex- 
pectorated a  "  Minid  ball,"  weighing  fliree  fourths  of 
an  ounce,  and  the  one  that  nearly  three  years  previous 
had  entered  the  led  side.  The  ball  was  covered  entire 
with  a  tough  mucous  coat,  and  the  small  cavity  at  the 
base  was  filled  with  pus.  Considerable  haemorrhage 
followed  the  expectoration  of  the  ball,  but  the  relief  he 
experienced  was  so  great,  that  he  rejoiced  to  be  rid  of 
his  unpleasant  companion  that  for  so  long  a  time  had 
been  the  occasion  of  so  mudi  discomfort. 

ABsnmiE. — The  French  Senate  lately  received  a  peti- 
tion that  some  steps  should  be  taken  by  the  Government 
to  prevent  the  sale  and  consumption  of  absinthe.  Baron 
Charles  Dupin  read  a  very  interesting  report  on  this 
petition.  He  pointed  out  that  the  mountains  of  the 
French  Jura  and  the  town  of  Besancon  produced  it  in 
sufficient  quantities  to  supply  the  whole  of  the  French 
market.  It  produced  insanity  afler  a  certain  time;  and 
the  ravages  produced  by  it  in  the  French  army  were 
such  that  Marshal  Forey  had  prohibited  its  sale  at 
the  military  canteens  throughout  his  command.  Baron 
Dupin  suggested  the  imposition  of  a  heavv  tax  as  the 
best  way  of  checking  its  consumption,  which,  if  it  went 
on  at  its  present  rate,  would  have  quite  as  pernicious 
an  influence  on  the  population  of  France  as  opium  had 
on  that  of  China.  He  recommended  that  the  petition 
be  referred  to  the  Government  for  consideration,  and 
this  motion  was  agreed  to  without  a  division. 

How  TO  Strinob  the  Eab.— In  order  that  a  stream 
of  water  may  reach  thoroughly  the  bottom  of  the  ear, 
it  is  necessaiy  first  that  the  wav  that  leads  to  it  be 
straightened  as  far  as  possible.  For  this  purpose  take 
hold  of  the  auricnlum,  or  external  portion  of  the  ear, 
and  draw  it  pretty  firmly  directly  upwards,  and  in  this 
way  the  upper  and  lower  wall  are  brought  as  nearly  as 
possible  into  straight  lines.  Holding  the  ear  in  this 
position  with  the  left  hand,  take  the  syringe  in  the 
right,  and  inject  the  water  gently^  yet  witii  a  UtHe  force, 
into  the  ear,  directing  the  point,  which  should  be  intro- 
duced a  httle  into  the  external  orifice  of  the  meatus, 
inwards,  a  little  downwards,  and  forwards  in  the  general 
direction  of  the  tube.  Of  course  a  cup  must  be  pressed 
against  the  face,  beneath  the  tragus,  in  order  to  catch 
the  water  as  it  escapes.  It  is  reconmiended  to  have 
two  cups,  one  to  contain  the  clean  water  to  be  injected, 
and  the  other  to  catch  it.  The  best  syringe  for  the  ear 
that  I  have  ever  seen,  is  what  is  known  as  the  Ear 
Syringe,  made  of  gutta-percha,  which  is  very  light  and 
very  convenient,  as  well  as  durable.  The  syringing 
operation  is  to  be  continued  till  its  object  is  attained, 
which  is  always  chanlinees. 

Better  use  simple  warm  water,  without  any  soap, 
which  is  supposed  to  irritate  considerably.  It  may  be 
repeated  as  often  as  necessary  for  the  attainment  of  the 
object  in  view.  Some  persons  are  not  affected  at  all  by 
syringing  the  ear,  while  others,  who  are  in  perfect 
health,  and  who  are  anything  else  but  nervotu^  faint 
from  It — Dr.  E.  Williams,  (7t».  Lancet  and  Observer, 

Detection  of  Blood-Stains. — M.  Blondeau,  of  Nancy, 
has  sent  a  memoir  to  the  Academy  of  Sciences,  relative 
to  the  detection  of  stains  of  blood  upon  linen  in  the  oase 
of  legal  surgery.  All  persons  occupied  in  legal  medicine 
comprehend  the  great  interest  attached  to  such  inqui- 
ries; for  after  the  linen  has  been  washed  the  staius 
resemble  very  much  stwns  of  rust  or  iron-mould,  or 
marks  which  certain  organic  acids  or  vegetable  color- 
ing matters  would  leave.  These  are  the  principal  cba- 
Digitized  by ' ^      ^^ 


180 


THE  MEDICAL  XUECOBD. 


racters  indicated  by  the  author:  1.  Stains  of  rust  or 
iron-mould  are  dear  and  dull-  blood-stains  are  of  a 
deeper  color,  and  shiniog.  2.  If  the  linen  be  wetted 
witn  hydrochloric  acid,  the  iron-mould  is  dissolved, 
while  blood-Btaini  remain  unaltered.  In  the  former, 
the  presence  of  iron  is  at  once  indicated,  but  not  so  in 
the  latter.  8.  The  stains  of  acid  fruits  with  iron  are 
bygrometric  and  soluble  in  water.  4.  The  microscope 
should  be  employed,  in  order  to  recognise  directly  the 
gbbules  of  blood  detached  from  the  linen  and  dissolved 
in  oH, — Brit.  Med,  Jour. 

Oon-LrviB  Oil. — ^M.  Naumann  has  airived  at  the  fol- 
^  lowing  conclusions  concerning  the  physical  constituents 
and  we  physiological  action  of  cod-hver  oil :  1.  God- 
liver  oil  travels  through  dry  or  moist  animal  membranes 
with  much  greater  nicility  than  do  any  of  the  other 
fetty  oils.  2.  Brown  cod-liver  oil  possesses  this  pro- 
perty in  the  most  marked  degree.  3.  The  cod-Uver  oil 
which  has  been  the  most  completely  deprived  of  its 
biliary  principles,  almost  entirely  loses  its  power  of 
penetration,  and  acts  only  in  the  same  manner  as  the 
other  kinds  of  oiL  4.  Cod-liver  so  deprived  of  its  biliary 
matter  can  regain  its  power  of  penetration  by  the  ad- 
dition of  bile  to  it.  6.  The  other  kinds  of  ou  treated 
in  the  same  matter  with  bile,  acquire  the  power  of 
more  easily  traversing  the  animal  membranes  tnan  they 
previously  possessed.  The  &t  of  cod-liver  is  more  easy 
of  absorption  than  any  other  fat. 

An  Akodtite  Foricula.— The  following  foEinula  is 
recommended  for  combining  chloroiform  and  morphia 
for  internal  administration:  One  part^  by  weight,  of 
morphia  is  dissolved  in  two  parts  of  rectified  wine- 
Tznegar,  and  twenty  parts  of  rectified  spirit  of  wine ; 
and  the  solution,  when  cold,  is  mixed  with  eighty  parts 
of  chloroform.  One  drop  contains  the  three-hundredth 
part  of  a  gram  of  morphia.  The  dose  for  a  child  is  two 
to  fifteen  drops;  for  an  adult,  thirty  to  forty  drops.  It 
is  said  to  give  rehef  in  most  painful  affections  much 
more  quickly  and  certainly  than  morphia  alone,  and  to 
leave  none  of  the  unpleasant  after-effects  of  opium. 
The  subcutaneous  ii^ectioa  of  morphia  during  chloro- 
form narcosis,  is  strongly  advocated  in  all  those  cases 
where  it  is  desirable  to  maintain  the  state  of  uncon- 
sciousness for  a  lengthened  period. 

Prejudices  ooncbrnivo  Bbeast  Milk. — M.  Devergie 
and  M.  Boudet  have  been  carrying  on  a  discussion 
relative  to  ill-regulated  nourishment  of  infigints,  which  is 
of  some  practical  interest.  M.  Devergie  asserted  that 
nine  months*  milk  was  too  rich  for  a  new-bom  infimt 
M.  Boudet  declares  that  chemical  analysis  demonstrates 
that,  from  the  first  to  the  eifi:hteenth  month,  the  milk 
scarcely  changes  at  all  It  follows  that  the  supposed 
danger  of  feeing  a  new-born  infant  with  tKe  mftk  of  a 
woman  who  has  been  nursing  twelve  months  is 
chimerical.  M.  Boudet  also  combats  the  wide-spread 
opinion,  that  a  new-bom  infant  rejuvenates  the  nurse's 
milk. — British  Medical  Jour, 

Blaxohino  or  the  Hair. — Physiologists  have  been  at 
a  loss  to  account  for  the  sudden  whitening  of  the  hair 
which  is  known  to  be  produced  bv  intense  and  sudden 
terror  or  profbond  gnef.  Mr.  Jbasmus  Wilson,  in  a 
paper  reoenUy  read  at  the  Eoyal  Society,  threw  con- 
siderable light  upon  the  question.  The  paper  was 
founded  on  a  case  apparently  unique,  in  which  every 
hair  of  the  head  was  colored  alternately  brown  and 
white  fipom  end  to  end.  The  white  segments  were 
about  half  the  length  of  the  brown,  the  two  together 
measuring  about  one-third  of  a  line.  Mr.  Wilson  sug- 
gested the  possibilitv  of  the  brown  p<»1ion  representing 
the  day  growth  of  the  hair,  and  the  white  portion  the 


night  growth,  and  this  opinion  was  corroborated  by  the 
remarks  of  Dr.  Sharpey  and  others  of  the  Fellows  who 
took  part  in  the  discussion  which  followed  the  reading. 
Under  the  microscope  the  colors  of  the  hair  were 
reversed— the  brown  became  light  and  transparent,  the 
white  opaque  and  dark;  and  it  was  further  obvious  that 
the  opacity  of  the  white  portion  was  due  to  a  vast 
accumulation  of  air-globules  packed  closely  together  in 
t^e  fibrous  stmcture  of  the  hair,  as  well  as  in  the 
medulla.  There  was  no  absence  of  pigment^  but  the 
accumulation  of  air-globules  veiled  and  obscured  the 
normal  color  and  stracture.  Ifr.  Wilson  observed 
that,  as  the  alteration  in  structure,  which  gave  rise  to 
the  altered  color,  evidently  arose  in  a  very  short 
period,  probably  less  than  a  day,  the  occurrence  of  a 
similar  dian^  throughout  the  entire  length  of  the  shaft 
would  ezplam  those  remarkable  instances^  of  whidi  eo  * 
manv  are  on  record,  of  sudden  blanching  of  the  hair ; 
and  he  ventured  to  suggest  that  durinff  the  prevalence 
of  a  violent  nervous  shock  the  normal  fluids  of  the  hair 
might  be  drawn  inwards  towards  the  body,  in  unison 
with  the  generally  contracted  and  ooQapeed  state  of  the 
sur&ce,  and  that  the  vacuities  left  by  this  process  of 
exhaustion  might  be  suddenly  filled  with  atmospheric 
air.  Dr.  Sharpey  mentioned  a  recent  example  of  sud- 
den blanching  of  the  hair,  which  had  been  observed  by 
Dr.  Landois^  of  GreifewaJde,  as  reported  In  Virohow's 
Archir,  and  which  was  aacertaiDed  to  be  due  to  accu- 
mulation of  air-globules  in  the  fibrous  substance  of  the 
hair. — Lancet, 

On  the  EzAMorATioif  or  DiABsno  URm:  Krw 
Reaoeitt  for  Glucose. — ^Afler  noticing  the  several 
reagents  used,  and  pointing  Out  their  special  incon- 
veniences, MM.  Francqui  and  Yan  de  Yjyete  propose 
a  solution  contuning  oxide  of  bismuth.  The  following 
process  cannot,  they  say,  give  rise  to  any  fiillacy. 
rrepare  the  reagent  by  precipitating  a  solution  of  acid 
nitrate  of  bismuth  by  a  great  excess  of  caustic  potash, 
and  pour  a  solution,  drop  by  drop,  into  the  moderately 
heated  solution,  until  the  precipitated  hydrate  of  bis- 
muth is  completely  redissolved.  To  recognise  a  diabetic 
urine,  heat  a  portion  with  the  above  solution.  After  a 
few  minutes'  ebullition,  the  urine  becomes  brown,  and 
metallic  bismuth  is  then  precipitated  in  the  form  of  a 
black  powder  of  crystalline  appearance,  adherent  to  the 
gla!«s  if  glucose  be  present.  The^  have  satisfied  them- 
selves that  the  principles  contained  in  normal  urine, 
such  as  urea  and  uric  acid,  do  not  precipitate  the  above 
reagent.  Albumen  only  causes  a  brown  color  and  a 
slight  turbidity,  which  they  consider  to  be  due  to  the 
formation  of  sulphide  of  bismuth.  Sulphuretted  urines 
also  give  a  black  precipitate  in  a  solution  of  oxide  of 
bismu^  in  potash  and  tartaric  acid ;  but  this  reaction 
cannot  be  confounded  with  that  caused  by  glucose.  It 
is,  besides,  easy  to  recognise  and  fif  desired^  to  separate 
the  albumen.  Thus,  on  bringing  to  ebullition  the  urine 
of  a  person  suffering  fit>m  Briefs  disease,  the  liquid 
becomes  turbid,  o|Mdeecent,  and  deposits  coagulated 
albumen.  Sulphides  and  sulphuretted  hydrogen  are 
easily  recognised  by  means  of  hydrate  of  leac^  which 
these  compounds  darken. — BazeUe  Midicale  and  Chem- 
ical News. 

PoMADB  roR  CmLBLikiKS. — Jn  an  article  on  chilblaios* 
b^  M  Guersant,  that  surgeon  states  that  the  following 
ointment  is  often  very  valuable :  Lard,  30  parts ;  iodide 
of  potassium,  1  part;  tincture  of  iodine,  1  part 

GoNORRHdAL  Ophthauoa. — ^M.  Gosscliu  stronglv  re-     ^ 
commends  firequent   injections  of  highly  alconoliied 
water  under  the  Uds  in  cases  of  gonorrhceal  ophthal- 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


181 


The  Medical  Eecord. 

^  &oa-9MM  lomial  of  ptbicHie  m&  Sivsgtxt. 
Gbobgb  F.  Shradt,  M.D.,  ^EmroB. 


PnbUdMd  OB  Hm  Ut  tnd  Idlfa  of  Mwh  Month,  bf 
WILUAM  WOOD  A  CO..  61  Waulm  Stber,  N«w  Tobk. 


FOBEIOJSr  AG£ir0IX& 


IionKm— Tbubxib  t  Oo. 
pAnt-SoMA*«i  n  CuL 


I     Lkipbio— B.  HnMfmr. 

1    Bio  Jaitsbo— nP9XH0  t  Oa 


N^w  Yorlc  Jviixe  X5.  ISer. 


THE  EXAMINATION  FOR  ADMISSION  TO 

OUR  MEDICAL  SCHOOLS. 
Theke  are  mjoij  points  ooDnected  with  the  action  re- 
cently taken  hj  the  Convention  of  Medical  Teachers 
^  wliioh  are  deserving  of  notice ;  but  not  the  least  among 
these  18  that  relating  to  the  necessity  of  a  prdiminary 
education  on  the  part  of  all  f^plicants  for  matriculation. 
It  is  too  well  known  that  under  the  existing  system  <rf* 
•dmitting  students  to  our  medical  colleges,  the  only  desire 
Bsems  to  be  to  have  a  large  class,  and  swell  the  treas- 
urer's account;  every  means  is  taken  to  attract  young 
men  to  the  study  of  medicine,  without  taking  into  ac- 
count their  fitness  for  the  undertaking.  The  result  «f 
»D  this  is,  that  the  number  of  students  is  in  the  aggre- 
gite  very  large,  and  the  amount  of  brabs  they  repre- 
sent very  small  There  have  been  no  measures  adopted 
Wetofore  to  ascertain  the  fitoiss  of  any  woijd-be  stu- 
dent of  medidne  for  his  prospective  tasks  in  a  medioel 
college,  other  than  the  ability  to  write  his  name  legibly 
iqjon  the  matriculation  book.  By  that  act  he  becomes  a 
n»«triculant  of  the  college,  becomes  accountable  for  the 
fees  of  his  tuition,  and  that  is  all  that  is  required  of 
hioL 

The  wisdom  of  exactmg  some  standard  of  qualifica- 
tion on  the  part  of  all  applicants  for  medic^  atu4ies 
bM  never  been  doubted,  but  the  policy  of  acting  iqwn 
wch  a  belief  by  those  whose  interests  were  directly  at 
stake,  has  been  quite  another  thing.  The  feculties  of 
oor  coDegee  have  repeatedly,  ahnost  to  a  man,  admitted 
theneoessity  of  preHminaiy  education;  but  at  dM  same 
time  they  tdl  us  that, any  eomptdsory  measures  in  re- 
gard to  it  would  be  highly  impracticable.  They  are 
well  aware,  in  making  such  an  assertion,  that  the«ause 
of  medicai  science  win  not  suffer  so  much  as  the  med- 
ical schools;  they  know  ftiH  well  that  the  number  of 
^08c  in  the  class  who  have  graduated  from  literary  i&- 
"titntions  is  comparatively  very  small,  and  that  those 
who  are  otherwise  well  qualified  to  conmience  attend- 
»oe  upon  lectures,  is  peihi^  still  smallor.  Hence,  if 
■ay  reasonable  demand  were  made  upon  the  applicants, 
the  dass  would  dwindle  down  to  a  very  insignificant 


number.  This  we  must  admit^  in  a  pecuiuary  point  of 
view,  is  an  all-powerfiil  reason  for  so  much  of  the  apathy 
which  has  instilled  itself  into  all  those  measures  con- 
templating reforms  in  medical  education. 

Another  assigned  reason  for  neglecting  to  call  for 
satis&ctory  evid^ces  of  fitness  for  the  conmienoement 
of  the  study  of  medicine,  is  the  want  of  some  agreed 
standard  to  measure  such  qualificatioos  by  the  adop- 
tion of  a  rule  that  could  be  practical,  and  that  could 
be  enforced  without  crowding  out  many  worthy  and 
competent  aspirants  for  service  in  our  ranks.  The  unfaur- 
ness  of  compelling  ev^y  applicant  to  show  a  literary  di- 
plomsj  has  been  too  obvious ;  but  the  question  as  to  how 
much  should  actuapy  be  required,  has  long  been  an  open 
one.  The  recent  decision  of  the  convention  upon  this 
pointy  now  appeals  to  the  common  sense  of  every  Ac- 
uity. The  standard  is  by  no  means  too  high,  and  is  cer- 
tainly low  enough  for  a  fidr  begizming.  All  reasonable 
objection  to  its  general  adoption  would  seem,  at  ^ast 
upon  the  ground  of  ^sasibility,  now  to  be  done  aw^ 
with. 

The  next  question,  as  to  how  the  examinations  for 
admission  should  be  carried  on,  is  another  one  of  great 
importance.  Here  again,  the  stringency  of  even  this 
simple  examination  is  so  apt  to  afiect  the  interests  of 
the  college,  in  regard  to  the  siae  of  the  class,  that  the 
teachers  themselves  would  hardly  be  considered,  on 
general  principles,  as  very  impartial  examiners.  Much 
better  would  it  be  for  those  who  have  no  interests  at 
stake,  to  undertake  this  task;  in  other  words,  let  it  be 
entrusted  to  those  who  are  not  connected  in  a  profes- 
sorial way  with  the  college.  Every  institution  can 
very  readily  select  some  of  the  many  well  educated 
young  physicians  who  have  a  taste  for  literary  and  scien- 
tific pursuits,  to  imdertake  this  labor  for  the  very  honor 
of  being  known  as  members  of  the  examining  board  of 
the  college.  The  work  would  be  by  no  means  arduous, 
as  it  would  only  relate  to  such  of  the  candidates  who 
were  unable  to  show  a  diploma  fix>m  a  literary  institu 
tion. 

The  proper  n^mner  of  conducting  these  examina- 
tions, in  giving  a  free  entiy  to  those  who  had  regularly 
received  a  degree  of  bachelor  of  arts,  would  eventually 
tend  to  encourage  previous  graduation  from  literary  in- 
stitutions; ai^d  young  men  would  by  and  by  consider 
it  as  necessary  and  as  important  to  undergo  suoh  a  traio- 
ing  before  studymg  medicine,  as  they  now  do  to  study 
for  the  nunistry.  In  order  to  encourage  such  a  course, 
it  ndght  be  expedient,  at  least  for  the  time,  to  place  a 
premium  upon  a  literary  diploma,  by  even  shortening  to 
its  posaeisoBS  the  rc^^ular  attendance  upon  lectures,  mak- 
ing the  term  4six  months,  or  even  a  year  less.  This,  con- 
sidering the  great  disparity  of  inteHectual  culture  be- 
tween those  who  have  and  have  not  been  &vored  with 
a  Utenuy  education,  would  certainly  be  allowable. 

Again,  the  adoption  of  a  qrstem  of  preparatory  ex- 
amination would  have  another  good  effect  in  raising 
medical  colleges  in  the  estimation  of  yop 

digitized  by '^ 


182 


THE  MEDICAL  RECORD. 


coaxing  muny  an  ambitious  one  intx>  the  study  of  medi- 
cine, because  the  listswere  not  unworthily  entered.  Our 
literary  colleges  compel  all  applicants  to  undergo  a  pre- 
paratory test,  and  the  consequence  is,  eyery  fortunate 
one  who  is  able  to  enter,  feels  proud  of  the  distinction. 
The  more  rigid  the  preparatory  examinations  are,  the 
more  eager  do  the  applicants  seem  to  be  for  an  admis- 
sion. This  fact  must  also  have  its  due  significance,  when 
applied  to  our  medical  colleges,  and  may  be  taken  in 
evidence  against  the  assertion  that  the  number  of  ap- 
plicants may  Mi  off  when  even  a  nominal  examination 
stands  in  the  way  of  their  admission. 

Now  that  we  have  agreed  upon  a  standard  of  ac- 
quirements, it  remains  to  be  seen  whether  the  various 
colleges  throughout  the  country  will  see  fit  to  adopt  not 
only  the  recommendations  of  tlie  Teachers'  Convention, 
but  of  the  American  Medical  Association,  and  if  not,  it  will 
be  interesting  to  hear  their  excuses  for  a  failure  to  comply. 

But  when  are  these  suggestions  to  be  carried  into 
effect  ?  Obviously  the  sooner  the  better.  All  reason- 
able endeavor  on  the  part  of  the  committee  should  be 
made  to  bring  about  the  concerted  action  of  the  col- 
leges, and  we  see  no  good  reason  why  each  college 
cannot  prepare  itself  to  announce,  by  the  coming  fkU, 
that  preliminary  examinations  would  be  enforced  upon 
all  new  applicants  for  attendance  upon  lectures. 

"Mb.  Stephen  Buckland,  in  the  current  number  of 
leaser,  gives  a  startling  account  of  the  nature  of  the 
supply  of  milk  to  the  inhabitants  of  New  York."  ♦  ♦  ♦  ♦ 
After  the  details  of  the  swill-milk  distilleries  are  given, 
with  which  our  readers  are  quite  familiar,  the  editor  of 
the  Medical  Times  and  Gazette  proceeds : 

"  It  is  from  such  dairies  that  New  York  is  eosduswely 
supplied  with  milk ;  for,  although  public  opinion  is  oc^ 
casionally  excited  against  them,  they  have,  in  feet,  se- 
cured the  monopoly  of  the  entire  supply." 

We  hardly  know  whether  to  pity  or  blame  the  igno- 
rance of  our  British  medical  brethren  as  to  how  we  get 
on  in  New  York.  This  article  is,  in  point  of  reliability 
of  statement^  about  on  a  par  with  the  recent  burlesque, 
entitled  "An  Englishman's  Visit  to  America  during  the 
War,"  in  which  the  traveller  supposes  New  York  to  be 
in  a  state  of  rebellion,  on  seeing  the  hack-drivers  who 
meet  him  on  landing,  and  gets  ready  to  shoot  buffaloes 
and  Indians  on  reachmg  the  Park,  etc.,  etc.  Be  it 
known  to  our  friends  of  the  London  Medical  Thnea  and 
Gazette,  that  although  distillery  milk  is  probably  used 
in  New  York,  by  far  the  greater  portion  of  our 
people,  who  are  American  enough  to  prefer  milk  to 
whiskey  and  Alsop's  bitter  ale,  drink  milk  from  cows 
which  feed  in  Orange  and  Westchester  County  pastura- 
ges, which  are  miles  away  from  distiDeries. 

That  it  is  diluted,  we  cannot  deny,  but  with  water. 
We  also  admit  the  existence  and  use  of  distillery 
milk ;  but  we  must  protest  against  such  wholesale  state- 
ments as  those  which  we  have  quoted,  from  our  usually 
intelligent  and  truth-speaking  neighbors. 


Vitoxms. 


TBAHSAOnOIfB  OF  THB    AMBRICAK    OpHTHALMOLOOTOAL  SO- 

oiBTT. — ^Third  Annual  Mbbting.  Boston,  June,  1866. 
This  .  Society,  whose  proceedings  were  reported  in 
our  columns,  nas  published  the  papers  read  at  the  last 
annual  meetmg,  in  a  handsome  pamphlet  of  46  pa^e& 
The  papers  are  generally  interesting  and  instrucuve. 
In  consideration  of  the  verboseness  of  transactions  of 
medical  societies  in  general,  we  are  hardly  disposed  to 
criticise  this  modest  book  on  that  score ;  yet,  even  here, 
in  one  or  two  instances,  pruning  would  benefit  the 
papers.  They  are  on~l.  Sudden  Monocular  Amaurosis, 
by  Dr.  Sands,  a  most  carefully  observed  and  well  writ- 
ten case.  2.  On  the  same  subject,  by  Dr.  AUin;  the 
want  of  an  immediate  ophthalmoscopic  examination 
deprives  the  case  of  the  interest  of  the  former  one,  leav- 
ing more  for  conjecture.  The  former  was  supposed  to 
be  due  to  haemorrhage  within  the  sheath  of  the  optic 
nerve,  and  the  loss  of  vision  was  permanent.  In  the 
latter  the  loss  of  vision  was  attributed  to  haemorrhage 
producing  pressure  outside  of  the  sheath,  and  sight  was 
restored  to  a  degree  which  ophthalmologists  express  by 
the  fraction  }J,  i.  e.  the  patient  could  read  letters  at 
20  feet  which  should  be  read  at  30  feet.  3.  Dr,  Dyer 
reports  a  fracture  of  the  lens  of  one  eye,  and  of  the  an- 
terior capsules  of  both  eyes,  from  death  by  violent  hang- 
ing (ProDst's  case).  4.  Dr,  HUdrdh,  a  paper  on  Ansee- 
thesia  of  the  Cornea,  without  intra-ocular  tension.  6. 
Dr,  Hay  on  the  refraction  of  a  small  oblique  pencil  of 
diverging  rays  by  a  glass  plate  with  plane  parallel  sur- 
faces. 6.  Dr,  Derby  on  the  necessity  of  employing 
greater  accuracy  in  ascertainingand  expressing  the  de- 
gree of  acuteness  of  vision.  The  author  recommends 
file  use  of  a  steady  flame,  uniform  in  intensity  of  illumi- 
nating power,  always  at  the  same  distance  from  the 
letters,  and  j^aced  in  a  room  from  which  daylight  is 
excluded.  With  almost  Teutonic  minuteness,  two  and 
a  half  pages  are  given  to  the  recommendation  and  ex- 
planation of  this  methdd.  7.  Dr,  Agnew,  a  method  of 
operating  for  divergent  squint  8.  Dr,  Noyes,  Ambly- 
opia produced  by  osmic  acid,  i.  e.  by  its  fumes.  The 
eye  returned  to  its  normal  condition  after  one  day.  9. 
Dr,  Nbyes,  3  cases  of  sub-retinal  effusions,  puncture ; 
two  were  improved.  10.  Dr,  Jejffries,  on  the  Anatomy 
and  Physiology  of  the  Ciliary  Muscle  in  Man.  He  shows 
that  the  circular  fibres  of  Muller  of  the  ciliary  muscie  in 
contracting  only  assist  the  meridional  ones,  and  remarks 
that  he  follows  others  in  supposing  that  the  method  of 
action  of  the  muscle  is  by  contracting  on  its  origin  and 
slackening  up  the  suspensory  Ugament,  allowing  the 
lens  to  become  more  convex,  thereby  accommodating  the 
refractive  media  of  the  eye  to  the  divergent  rays  of  Ught 
from  near  objects,  and  focussing  them  on  the  retina. 
Dr.  Jeffiries  also  quotes  from  Meyer,  of  Bremen,  and  Benle, 
to  show  that  the  ciliary  muscle  differs  so  much  in  ani- 
mals from  that  in  man  as  to  be  useless  in  attempting  to 
adduce  from  them  the  mechanism  of  accommodation  in 
man ;  a  belief  which  the  author  had  previously  enunci- 
ated. 11.  Dr,  WiSiams  (Boston),  Suture  of  the  Flap 
after  Extraction  of  Cataract,  which  has  already  been 
fully  described  in  the  Record. 

Altogether  this  is  a  work  creditable  to  the  new  and 
vigorous  Society. 

Watson  Abridged;  A  Synopsis  of  the  Lectures  on  the 
Principles  and  Practice  of  Physic.  Delivered  at  King's 
CJoUege,  London,  by  Thomas  Watson,  M.D.,  Kellow  of  the 
Boyal  College  of  Physicians,  eta  (Abridged  from  the  last 
English  Edition.)  With  a  Concise  but  Complete  Acoount  of 
the  Properties^  Uses,  Preparations,  Doses,  eta     Tftken 


THE  MEDICAL  RECORD. 


188 


from  the  IJ.Sw  Diapeiuatoiy  of  all  the  Medicines  mentioned 
in  these  Lectures,  and  with  other  valuable  additions  by 
J.  J.  Metlob,  A.M^  M.D.  Philadelphia :  Published  hj 
tbe  Author.    1867.    Pp.  277. 

Tee  Tolume  on  oar  table  is  really  a  Tery  valuable  help 
in  an  anergenoy:  it  ia  a  fidthful  abriOCTient  and  as 
sodx  we  commend  it  to  the  profession.  Still,  Dr.  Wat- 
son, who  has  come  to  be  regarded  as  the  Gk>ld8mith  or 
the  ^oentle  Ella  *'  of  medicd  literature,  has  been  made 
to  ez&aoge  many  a  grace  of  manner  for  the  conciseness 
of  Tacitos.  This  we  somewhat  regret^  but  deem  un- 
avoidable in  a  praotical  age.  The  work  will  be  fre- 
qosQtly  referred  to  by  its  possessor,  and  with  profit 


UPON  •*  SpuaxouB  Vaccination;  "  or,  the  Abnor- 
mal Phenomena  accompanying  and  following  Vaccination 
ia  the  Confederate  Army  during  the  recent  American  Civil 
War,  1861-1865.  By  Joseph  Jones,  M.Dm  Professor  of 
Physiology  and  Pathology  in  the  Hedical  Department  of 
the  Univeraity  of  Nashville,  Tenn.    8vo.,  pp.  182. 

This  monograph  is  perhaps  the  most  exhaustive  one 
that  has  been  written  in  any  language  upon  the  subject, 
and  is  a  credit  not  only  to  t^e  author,  but  to  American 
mediobe.  Tbe  treatment  of  the  different  questions 
connected  wiiJi  the  influence  of  poor  diet,  skin  diseases, 
and  syphilis,  in  affecting  the  inte^ity  of  the  virus,  is 
both  able  and  conclusive.  No  pams  have  been  spared 
by  oor  anthor  to  collect  all  the  material  which  could 
have  any  bearing  upon  the  points  at  issue ;  and  ike  num- 
ber of  facts  from  which  he  makes  his  deductions  are,  to 
say  the  least,  immense.  We  commend  the  pamphlet  to 
the  careful  perusal  of  eveir  general  practitioner,  with 
the  issurance  Uiat  they  will  be  satisfied  that  our  author 
has  most  skilfully  and  effectually  performed  a  very 
OQ^oostaak. 

IVSALATIOKS  IK  THB  TBBATHBNT  OF  D18SASB8  OF  THl  Rx- 

8PIBAT0RT  Passaobs,  particularly  as  effected  by  the  use  of 
Atomized  Fluids.  By  J.  M.  Da  Costa,  M.D.,  Physician  to  the 
Pennsylvania  Hospital,  Fellow  of  the  College  of  Physi- 
cians, etc.,  eta,  eta  Philada.  J.  B.  Lippinoott  k.  Co., 
1867.    pp,  86, 

This  excellent  monograph,  got  up  by  the  publish- 
cre  in  superb  style,  well  suppUes  a  want  felt  by  the 
profession.  The  merits  and  objections  of  the  various 
instruments  employed  for  the  application  of  nebulized 
flaids  are  commented  upon,  and  the  literature  of  the 
aibject  presented  in  an  agreeable  manner.  The  con- 
chaons  of  the  author  given  in  a  previous  number,  ren- 
<ier8  an  extended  review  unnecessary.  The  illustrations 
ve  excellent,  and  the  work  itself  should  be  in  the  hands 
of  every  practitioner  desirous  of  keeping  up  with  the 
tberapeutics  of  his  profession. 

Oi  THE  Action  op  Medioines  in  the  System.  By  Prbd- 
ttiCK  William  Hbadlakd,  M.D.,  B.A.,  P.L.S.,  Fellow  of 
the  Royal  College  of  Physicians,  eta  Fifth  American 
from  the  fourth  London  edition.  Revised  and  enlarged. 
Philadelphia:  Lindsay  &  Blakiston.    1867.    8vo.,  pp.42a 

Whbi  a  work  has  reached  its  fifth  American  and 
fourth  London  edition,  it  hardly  stands  in  need  of  any 
special  commendation.  The  reputation  of  the  author 
it  so  well  established  as  a  plulosophical  thinker,  an 
ardent  worker,  and  a  reliable,  conscientious,  and  prac- 
tical teacher,  that  his  work  wfll  always  find  a  place 
opoa  the  table  of  the  studious  practitioner,  ana  the 
pmciples  which  are  therein  laid  down  be  accepted  and 
respected  by  every  one  who  wishes  for  the  advance^ 
ni«ot  of  the  much  neglected  science  of  Therapeutics, 
^e  cannot  resist  the  temptation  of  oonunending 
^  vahaable  work  to  the  serious  study  of  that  class, 
P^rttenlarly  whose  ideas  of  the  treatment  of  disease  are 
BAn-owcd  down  to  tonics  and  stimulants. 


Praotioal  Dissections.  By  Richard  M.  Hodobs^  M.D.. 
formerly  Demonstrator  of  Anatomy  in  the  Medical 
Department  of  Harvard  University.  Second  Edition, 
thoroughly  revised.  Philadelphia:  H.  C.Lea.  1867. 
12mo.  pp.  271. 
The  work  before  us  fulfils  its  intention  of  being  a  prac- 
tical guide-book  for  the  student  of  anatomy  in  the  ordi« 
nary  prosecution  of  his  studies  in  the  dissecting-room. 
The  author  gives  evidence  upon  every  page  of  his  fitness 
for  the  task,  and  shows  that  appreciation  of  the  actual 
wants  of  the  young  dissector  which  nothing  save  that 
of  demonstrator  could  have  given  him.  The  divisions 
of  the  work  are  most  adnurable,  and  the  plan  of  describ- 
ing the  several  parts  which  are  conjointly  exposed  m  a 
given  dissection,  is  of  obvious  utility ;  while  the  restric- 
tion of  the  demonstrations  to  such  appearances  as  are 
only  to  be  expected  after  an  ordinary  dissection  forms 
a  very  interesting  feature  of  the  work,  and  will  tend  not 
a  Uttle  to  give  wit  encouragement  to  a  beginner  which 
he  80  much  needs.  It  is  very  concisely  written,  and  is 
of  a  very  convenient  size. 


Eev0rt»  0f  Sacirttes. 


NEW  YORK  ACADEMY  OF  MEDICINK  . 
Stateb  Meeting,  April  17,  1867. 
Dr.  Alfred  C.  Post,  President,  in  the  Chair. 

A  IfBOHAHIOAL  APPLIANCE  FOR  CLEPT  PALATE. 

Dr.  Kinoslet,  of  the  College  of  Dentistry,  by  courtesy 
of  the  AcademVi  exhibited  a  patient  to  whom  was 
adapted  an  apphance  for  cleft  palate.  He  sUted,  that, 
according  to  nis  experience,  the  size  of  fissure  bore  no 
relation  whatever  to  the  distinctness  of  articulation.  He 
said  that  the  patient  before  the  Academy  had  the  larg- 
est fissure  uncomplicated  by  hare-lip  he  had  seen. 

medical  evibenge. 

Dr.  Ordronaux  read  a  practical  paper  upon  the  sub- 
ject above  designated,  in  which  he  passed  in  review  the 
various  difficulties  besetting  the  medical  man  upon  the 
witness-stand.  He  said  Uiat  most  suits  for  malpractice  had 
their  origin  in  "  envy,  hatred,  aod  all  uncharitableness," 
and  that  medical  witnesses  onen  were  unsuccessful  fixm 
a  deficient  linguistic  power  and  a  want  of  self-reUance. 
To  say  nothing  of  a  rail  and  abundant  knowledge  of  the 
subject,  others  failed  to  render  themselves  intelhgible 
to  a  jury,  owing  to  a  too  liberal  use  of  technical  terms. 
Again,  lawyers  are  apt  to  insist  on  reasons  when  none 
can  be  given ;  Dr.  Winslow,  of  London,  who  was  per- 
haps onener  summoned  to  court  than  any  expert  in 
England,  was  not  unfirequently  put  in  this  position. 

Lawyers  also  exhibit  a  want  of  precision  and  candor 
in  putting  questions — neither  counsel  nor  witness  un- 
derstand each  other— flo  that  the  testimony  does  not 
become  what  'wsa  intended,  an  unbroken  chain  of  cumu- 
lative evidence.  But  on  the  other  hand,  experts  should 
bear  in  mind  that  they  are  not  partisans,  but  that,  as 
their  duty  is  to  throw  hght,  they  are  advisers  and  coun- 
sellors of  the  court  itself  Being  thus  unpr^udiced, 
their  opmiong  ean  never  be  unilateral  in  character. 

Witnesses  in  these  cases  do  not  testify  on  matters  ^ 
knowledge,  but  of  belief,  as  grounded  upon  the  generah- 
zation  or  fiicta  As  to  conflicts  among  experts  regard- 
ing special  methods  of  therapeutics,  the  court  can  make 
no  cfotinotion,  but  admits  witnesses  as  experts  in  their 
own  calling,  and  leaves  the  decision  regarding  eredibU- 
ity  to  the  jury.  The  court  thus  takes  refuge  under  its 
neutraUty.  ^  ^  ^gjtized  by  ^ I IC 


184 


THE  MBDIOAL  RSCORD. 


SxpertA  are  not  AHoiTed  to  siatd  their  tietr^  in  niat- 
te^  affecting  character,  or  their  opinions  regarding  con- 
duct ^  to  illustrate,  the  court  has  stopped  a  witness  who 
ay^nred  that  a  brother  praetitaoner  had  acted  dishonor* 
ajbly,  such  a  course  being  deemed  extra-profedsional. 

It  ia  not  necessary  &a£  the  "  daUed  vritnesa**  should 
be  engaged  constantly  in  practice^  the  presampttoa  be* 
ing,  tna^  after  having  chil^  collated  authoiiti^  he  re~ 
presents  the  leading  opinionj  He  cannot  read  from 
books  in  court,  becaSifle  the  opinioB  &m^  is  his  own ; 
beflides,  professional  boosts  deal  only  in  naivefsal  propo- 
sitions, while  every  case  has  a  ootn|>]eadon  of  its  own. 

Notes  may  be  used  to  refresh  the  inemory  tonohmg 
faetsTand  it  is  not  eesenlial  that  the  aoript  be  in  his  own 
hand,  or  made  on  the  instant;  if  he  speaks  of  them 
kaowingltf,  his  testimony  loses  nothing  in  vahie. 

The  doctor  dwelt  somewhat  upon  the  confessions  of 
patients,  holding  that  the  only  exo^»tion  to  their  being 
privifeged  commimiclatiwis,  exempt  from  repetition  in 
court,  was  in  caset  wher^  facts,  detrimentid  to  public 
policy,  might  be  concealed.  As  preeedenty  he  oited  a 
case  where  the  physician  was  compelled  to  give  evi- 
dence that  a  prescription  was  sought  from  him  for  the 
criminal  purpose  of  abortion. 

Around  cases  of  insanity  there  clustered  many  diffi- 
culties— other  experts  are  pitted  against  him,  and  when 
called  upon  to  prove  that  a  party  is  or  is  not  insane,  he 
cannot  be  expected  to  offer  what  iB  satis&ctory  to  aH 
Some  questions  being  incapable  of  explanation  cannot 
be  answered  categorically,  ie.  By  y^  or  *». 

Experts  should  carefuUy  avoid. the  common  error  of 
forming  an  opinion  upon  isolated  facts,  and  should  not 
lose  sight  of  the  element  of  contingency.  Above  aH  he 
should  not  be  entrapped  into  branching  off  from  his 
subject,  but  always  keep  this  feet  pronrinentfy  before 
him,  that  fallacies  are  feints  to  majte  an  antagonist  un- 
cover. Such  oueetions  as  ^^  Are  cir  art  rwtwomds  of 
ihelteadmortalP''  "Is  ike  mind  a  imU  or  composUs in  its 
organmOionf''  do  not  admit  of  a  categorical  answer. 
Upon  the  subject  of  insanity  diverse  opinions  wiH  al- 
ways prevail,  according  as  we  cause  may  be  regarded 
as  psychological  or  somatic. 

Experts  may  differ  about  the  degree,  bnt  not  iftkmt 
the  fact  Nor  can  an  opinion  be  based  upon  the  degree 
of  excitability. 

Br.  Andersok  then  read  the  biH  pending  before 
the  Legislature,  which  provides  for  the  suppression  of 
the  circulation  of  pubCcations,  cirfetdars,  etc.,  stigipresting 
means  to  produce  criminal  abortions.  The  pemJi^  at- 
tached is  one  year's  imprisonmeilt  in  the  county  laiL  and 
a  fine  of  $1000.  ^  ^ 

The  Academy  then  adjourned. 


Statto  Mebtwo,  Mat  1,  1867, 
Dtt.  Alfrid  C.  Poot,  PresWent^  in  the  Chair. 

▲  NBW  MXTHOD  OF  RESUSOITATION  FBOU  HTPKRAHiBS- 
THBSIA  BT  OHiiOBOrORIC 

Dr.  Wor8«r  related  a  case  in  which  chlorof(tf>m  had 
been  administered  to  a  patient,  by  a  party  whom  he 
regarded  as  competent,  as  a  preparatory  st^  to  an 
g;>eration,  by  him9Bl£  for  the  relief  of  httmonrhoids. 
Suddenly  the  patient  had  ttertonyus  breatlung,  became 
pulseless,  and  exhibited  all  the  symptoms  of  »  speedy 
dissolution,  but  by  the  simple  expedient  of  reversiiig 
his  position,  and  inclining  his  body  to  an  angle  of  forty- 
five  degrees,  he  was  frdly  restored. 

Da  Chambirlaim  said  that  his  experience  cohioided 
with  observations  of  other  praotitionera,  that  in  all  ope- 
rations about  the  anus,  it  was  exceedingly  difficult  to 
bring  patients  under  the  influence  of  an  f^nffyt^ff^tvy 


Dr.  Riosasds  suggested  ether  spray  as  a  safegaard 
against  accident  in  «ii  operations  of  this  kind. 

EVXRSION  OF  THX  LID  Df  AnSOnONS  OF  THE  KB  Ig 
ALWAYS  IMPORTANT. 

Dr.  Qarrhbi  gave  the  detbite  of  a  case  in  which  a 
young  girl,  after  having  been  ^treated  at  her  home  in 
the  country  for  what  was  termed  "  a  cold  in  the  ^e/' 
cattle  to  him  with  lids  so  tumefied  that  it  was  almoet 
impossible  to  get  at  the  true  condition  of  the  globe, 
whi^  was  then  just  on  the  point  of  evacuating  its  con- 
tents. Soon  after  this,  along  with  the  other  dischaif^ 
appeared  a  sikiall  folded  piece  of  paper,  which,  in  icnitu^ 
tion  of  her  fellow  pupils,  the  little  patient  had  inserted 
beneath  the  upp^r  eyeKd.  He  cited  the  case  mer^y  to 
show  the  importance  of  ahvays  everting  the  lid  in  all 
affections  or  the  eye;  it  was  a  point  not  to  be  too 
strongly  insisted  upon. 

A  oASi  OF  moDucaB  simoLEiroiB  MaocATKm  09  rat 

HUMERUS. 

Dr.  Posf  gave  the  p^oulars  of  a  case  of  8tabgkD» 
Old  dislooatioQ  of  the  os-hrfuhii,  where  etherisation, 
combined  with  Dr.  Nathan  R.  Smith's  method  of  coun- 
ter-extension  from  the  opposite  wrist,  had  foiled,  but  by 
applying  the  heel  to  the  aacilla  in  the  usual  way,  reduc- 
tion had  been  eflfected  witii  comparative  ease.  His  sue- 
cessj  and  this  be  had  before  observed,  was  to  be  attri- 
buted to  the  fatigue  of  the  muscles,  induced  by  the 
previous  manipuli^on. 

PRIQNAlfOT  IF  A  DOUBLE  UTSRUB  DBTSCrEO  DURCfO  Vn. 

Dr.  Pbablee  recited  the  case  of  a  lady  who  had  trt^ 
veiled  some  400  mike  for  an  opinion  regarding  the 
nature  of  a  tumor.  She  was  the  mother  ot  five  child- 
ren, and  insisted  that  she  felt  the  motions  of  a  fcetu^ 
but  the  tumor,  which  wae  sensitive  on  pressure,  and  had 
a  peculiar  nodular  feeling,  was  confined  entirely  to  the 
right  of  the  umbilicus.  Aiter  a  carefiil  examination, 
the  question  arose  in  his  mind,  whether  or  not  it  was  a 
case  of  extra-uterine  pregnancy,  since  the  head^M 
weU  up  in  the  iliac  region  and  to  the  right  side  of  the 
vagina.  But  having  detected  that  the  tumor  was  sepa- 
rated from  his  finger  only  by  a  membrane^  and  having 
discovered  higher  up  the  edge  of  a  thin  septum,  he  con- 
ceded that  the  right  half  of  the  uterus  had  received  the 
oYum,  and  that  the  left  half  had  not  been  impregnated; 
or,  in  other  words,  that  the  patient  had  a  double  utentf. 
It  was  not  long  before  the  husband  summoned  him  to  toe 
bedside  of  the  patient,  with  the  announcement  that  we 
patient  appeared  to  be  in  labor,  which  proved  to  be  the 
fact.  T^e  ftetus  was  six  months  old.  He  thought  that 
this  condition  of  things  was  rarely  detected  during  lire. 

TWO  CABES  of  VOCAL  POLYPI  AS80CIATBD  WFTH  POLTH  OF 
TONSIL  Of  OORRESPOKDING  BIDB. 

Dr.  Eiohabds  gave  two  instances  where  a  HTP^^ 
situate  upon  one  of  the  vocal  chords,  was  associated 
with  a^  fibrous  polypus  of  the  rieht  tonsfl.  This  wm 
not  frequently  suspected  during  hfe,  and  he  mentioned 
it  to  rtiow  that  there  might  be  some  inexplicable  oonnex- 
ion  between  the  two  conditions. 

The  Academy  then  adjourned. 

BeIdt  Mam  Aitthobb  ahd  Doctors.— There  is  » 
"Literary  Bureau  and  Agency"  in  London,  at  "''l***^ 
aeoordmff  to  a  communication  received  by  a  f^®P*jJ^j/ 
sinrgeonfrom  its  conductor,  "  original  well  written  medi- 
cal MSa,  and  a  medical  diploma,  M.D.,  New  Yo^ 
can  be  obtained  for  a  reasonable  sum.  What  a  profi- 
table bunneas  su(^  a  bureau  would  do  on  our  aide  » 

**'«^»*^'         ■      Digitized  by  Google 


THE  MEDICAL  MX30R1>. 


185 


.  i  NEW  TOBK  PATHOLOGICAL  SOCIETY. 

Stated  Hxnao,  Mabca  13, 1867. 

Db.  H.  £.  Sahds,  President)  in  the  Chair. 

Dh.  Post  exhibited  specimens  of  ossification  of  the 
upper  piurt  of  the  aorta  and  radial  arteries,  removed  from 
a  (ussecting-room  subject,  aged  about  sixty  years. 

He  also  presented  some  cal(»u*eous  concretions  taken 
from  the  meibomian  glands  of  s  patient  who  called  to 
his  office  complaining  of  some  fbreign  substance  in  the 
eye.  An  examination  of  the  Hd  disclosed  the  presence 
of  some  small  calculi,  which  were  easily  turned  otrt  with 
the  point  of  a  pin. 

HrPMMmOtPHT  OP  SPLDOr. 

Dr.  Allht  eidnbited  an  eiilarged  spleen,  weighing 
seven  poonds  and  eleven  ounces,  wMch  h»  removed 
from  the  body  of  a  man  who  died  of  apoplexy,  after 
bsvh^  Buffered  fVom  dyspepsia  for  the  last  seventeen  or 
dgfateen  months,  and  from  occasional  attacks  of  dys- 
pnoea for  four  months.  The  tumor  was  recognised 
sereral  months  before  death,  and  was  supposled  to  be 
dne  to  malignant  disease.  The  gross  appearances  of 
the  organ  were  perfectly  normal ;  no  mic^^oecopic  ex- 
amination of  the  tissue  had  been  made. 

Db.  Booebs  alluded  to  the  case  of  the  late  Dr.  Tnttle, 
whose  ^een  weighed  about  seven  pounds. 

Dr.  Finvsll,  on  behalf  of  Dr.  W.  Beach,  Jr»  presented 
a  spedmen  of  extra-uterine  pregnancy.  It  was  re- 
moved from  the  body  of  a  Gkrman  woman  thirty-seven 
yean  of  age.  She  menstruated  regulaxiy  np  to  two  or 
three  monSis  ago ;  three  weeks  ago  a  bloody  cBscharge 
commenced,  which  continued  for  two  weeks,  act  the  end 
of  which  time,  on  Monday  last,  she  was  taken  with 
fident  cramps,  which,  although  they  relaxed  a  Htde 
daring  the  following  morning  finally  terminated  in  her 
death  on  Tuesday  evening.  In  oondnsion.  he  remarked 
tlot  the  case  would  have  been  a  proper  one  for  the 
trial  of  the  plan  of  arresting  the  attendant  hsmorrtiage 
proposed  by  Dr.  Rogers. 

On  motion  of  Db.  Flqit,  a  eommitt^  consisting  of 
Dm  Draper,  Smith,  and  AJlin,  was  appointed  to  make 
a  microBCOpical  examination  of  the  spleen  presented  by 
the  hitter  gentleman,  and  r^ort  at  the  next  meeting. 

AMPUTATIOH  OT  AKKLE-JOUTT,   BTa 

Dr.  Sakds  lastly  presented  a  specimen  of  amputation 
at  the  ankle-joint  accompanied  with  the  ibllowmg  his- 


I  visiting  the  wards  cd  the  New  York  Hospital 
a  fisw  days  ago,  my  attention  was  called  by  the  house 
surgeon  to  a  young  man,  set  21,  who  had  requested 
that  I  should  amputate  his  leg,  on  account  of  a  disease 
of  his  right  ankle  Which  had  troubled  him  more  or  less 
me  childhood,  and  which  had,  for  some  months  past 
diadiled  him  from  going  about.  On  examination  I  found 
the  ankle  somewhat  BWoHen,  with  several  fistulse  on  ite 
inner  8q>ect  leading  down  to  carious  bone.  The  ankle- 
iomt  iq>peared  to  be  firmly  anchyk^ed.  From  the 
length  of  time  the  disease  had  lasted,  and  fitmi  the 
depth  and  extent  of  denuded  bone  detected  by  the 
probe,  I  determined  to  put  the  patient  under  ether,  and 
endeavor  to  amputate  at  the  aiikle-j<Hnt  by  breaking 
up  the  existing  adhesions.  Having  made  the  usual  in- 
CBion,  I  succeeded,  by  enipk)3ring  considerable  force,  in 
wpanitii^  the  foot,  tc^ether  witii  a  thin  sheB  of  bone 
from  the  articular  surface  of  the  tibia.  The  saw  was 
then  apf»lied  to  remove  the  malleoli,  and  the  wound 
hitotoght  together  in  the  ordfeaiy  manner.  I^bsequent 
exaniinatlon  of  the  amputated  foot  showed :  Ist^  bonv 
■KsfaylosiB  at  the  ankle-joint;  thia,  where  it  existe<l^ 


was  very  firm,  as  evifieisd  by  the  fi«cture  which  took 
place  just  above  tiie  level  of  the  articulation,  at  t^ 
time  of  the  operation.  It  did  not  extend,  howevw,  to 
the  surfaces  between  tive  astragialus  and  malleoli,  ^se 
hemg  covered  with  the  soft,  gelatinous  substance  so  ooifr- 
monly  seen  indtBorganiaed  johits.  2d,  bony  anebylotia 
between  the  astragalus  and  os  caleis,  complete,  and  in- 
volving both  the  posterior  and  anterior  calcaneo-as- 
tnigaloid  articulations.  A  fhct  which  seemed  diffi- 
cult to  explain  was  the  strict  limitation  of  the  morbid 
process  to  the  parts  joat  mentioned.  As  the  members 
were  aware^  there  were  two  pairs  of  aiticular  surfiM)6a 
between  the  astaragldus  and  caleaneum.  The  posterior 
of  these  was  pronded  with  a  separate  synovial  sac, 
while  that- of  the  anterior  was  continuous  with  the  af- 
ticulatton  between  the  astragalus  and  soi^hoid.  In  the 
specimen  it  Wotild  be  noticed,  that  the  disease  waastriot- 
ly  confined  to  the  surfooes  between  the  astragalua  and 
caleaneum  ,*  the  head  of  tiie  astragalus,  and  the  corres- 
ponding surfrMo  of  the  scaphoid  bone  being  normal, 
aM  covered  with  healthy  articular  cartili^.  Dr. 
Sands  thought  that  the  &ol9  might  be  most  easily  ex^ 
plained  by  assuming  the  existence,  in  the  case  now  re- 
uited,  of  Bf  distinct  synovial  sae  for  the  attioolatioD  be- 
tween the  aatragidiift  aad  scaphoidv 


SiikTBD  Hnniio,  Kabch  27, 1867. 
Ihb  H.  B.  SAimg,  President,  in  the  Ohair. 

gUB-PLlKJRAL  EXTRAVASATION. 

Dr.  Pdoibll  exhibited  iseveral  specimens,  the  first  of 
which  were  the  lungs  removed  from  a  child  three 
months  old.  The  ni^ent  seemed  well,  when  it  was 
suddenly  sdoed  with  a  ciymg  spell  lasting  for  nveral 
houra,  which  was  evidently  due  to  internal  pain,  after 
whidi  this  dyspnoea  appeared,  and  the  ohild  died  after 
several  hour%  from  suocation. 

The  post-morten^  examination  gave  no  uitemal  leaon 
to  aooount  for  the  pain,  beyond  the  condition  of  the 
lungs,  which  showed  extensive  extravasations  of  blood 
underneath  the  pleura.  There  were  no  evidences  of 
pulmonary  apc^dexy* 

ftUPTURV  Of  LXrT  VBfTRlOLtf. 

The  seoond  specimen  consisted  of  the  heart  and 
kidneys  taken  fi^m  the  body  of  a  man  fifty-five  years 
of  age,  who  had  been  in  ill  health  for  two  or  three 
months  preceding  his  death,  during  the  most  of  which 
time  he  was  obliged  to  keep  his  room.  His  principal 
complaint  was  severe  pain  and  distress  in  the  precordial 
region.  His  phvsician  recognised  some  form  of  heart- 
disease,  and  advised  him  accordinglv.  He  went  out  one 
evening  with  his  daughter,  and  while  passing  through 
the  street  met  some  obstacle  on  the  sidewalk  which  re- 
quired a  little  exertion  on  his  part  to  prevent  a  fhll ;  soon 
mer  he  expired. 

The  post-mortem  disclosed  rupture  of  the  left  ventricle, 
about  its  middle.  The  walls  of  the  organ  were  as  thick 
as  normal,  but  were  subject  to  extensive  fttty  degenera- 
tion.   Both  kidneys  were  found  in  the  same  condition. 

wisnr  FfiAOoffTA. 
The  third  specimen  was  a  fatty  placenta.  The  female 
from  whom  it  wae  disdisrged  had  given  birth  to  five 
living  diildres,  and  was  to  all  appearanoe  in  perfoct 
hei^.  The  last  labor  was  a  perfoctiy  natural  one,  but 
the  child  lived  only  three  hours  after  birth.  The  pk^ 
centa  had  very  much  the  appearance  aa  if  it  were 
sprinkled  over  idtii  a  handful  of  coarse  salt  and  at 
certain  pohite  the  sensation  communicated  to  tne  finger 
was  similar  to  that  idiich  would  be  produced  by  calca- 
reotts  cl^generationsb  ^.^.... j   —  ~,  ^' r^  — 


186 


THE  MEDICAL  RECORD. 


AKKURISM  or  AOBTA^ 

The  foicrth  Bpecimen  consisted  of  a  heart  in  "which 
an  anettfism  had  burst  just  above  the  aortic  valves,  filling 
the  pericardium  with  blood.  The  precise  point  of 
rupture  into  the  sac  could  not,  in  the  hasty  examination 
made,  be  determined.  The  rent  in  the  internal  coat 
appeared  as  if  made  by  a  knife,  and  then  the  blood 
dissected  its  way  for  a  considerable  extent  underneath 
the  cellular  ooat. 

The  fiflh  specimen  was  removed  from  a  man  fifty-five 
years  of  age.  He  had  been  in  ill  health  for  two  months 
before  his  death,  with  hear^eymptoma.  The  day  previous 
he  had  complained  more  than  usual  of  pains  around  the 
precordial  region,  accompanied  with  great  distress.  He 
gradually  sank  afterwards,  and  died.  On  post-mortem 
examination  the  pericardium  was  filled  with  clotted 
blood,  and  on  looking  down  into  the  left  ventricle, 
through  the  aorta,  all  traces  of  the  semilunar  valves  haa 
seemingly  disappeared.  Taken  fix>m  the  same  subject 
was  the  lower  end  of  the  sternum  with  the  eighth  rib 
attached,  showing  a  fintcture  of  the  latter  bone,  and 
which  had  become  united  by  an  overriding  of  the 
fittffments. 

VtL  Kraokowizbh  discovered  the  aortic  valves  which 
were,  on  casual  inspection,  supposed  to  be  absent^  and 
found  tliat  they  were  nearly  sumdent. 

Dr.  Markoe  thought  that  blood  in  this  case  did  not 
empty  directly  into  the  pericardium,  but  that  it  found 
its  way  there  gradually.  If  it  had  escaped  snddenly 
into  the  sac  death  would  have  been  instantaneous,  as 
the  blood  surrounding  the  heart  would  have  prevented 
a  dilatation  of  that  organ. 

THE  EFFEOtS  OF  ABOBTIOK. 

Dr.  Finnell  lastly  exhibited  a  sixth  specimen.  Con- 
sisting of  the  uterus  and  appendages  or  a  victim  of 
abortion.  The  woman  was  twenty-eight  years  of  age, 
and  died  on  Saturday,  March  24.  On  the  22d  of  Febru- 
ary last,  finding  herself  between  three  and  four  months 
g regnant,  she  determined  to  have  an  abortion  produced, 
he  accordingly  applied  to  an  abortionist  on  Third 
Avenue  for  that  purpose,  and  was  operated  upon  by 
him  about  the  20th  of  March.  No  effect  foflowing,  she 
had  the  operation  repeated,  but  nothing  came  of  i^  and 
she  applied  to  him  a  third  time.  A  day  or  two  after 
her  last  visit  to  the  abortionist,  symptoms  of  abortion 
showed  themselves,  and  the  foetus  was  soon  after 
expeUed.  From  that  time,  until  her  death  on  the  24th, 
she  suffered  firom  symptoms  which  were  of  a  pelvic 
character. 

The  autopsy  was  made  with  the  assistance  of  Dr.  W. 
Beach.  On  laying  open  the  abdominal  cavity  tliere 
were*  no  evidences  of  effasion  in  the  peritoneum,  but  a 
large  abscess  was  discovered  in  the  right  iliac  region  in 
the  neighborhood  of  the  broad  ligament  of  the  uterus. 
This  abscess  pressed  upon  the  right  iliac  vein,  which 
accoimted  for  an  oedema  of  the  lower  leg.  On  tracing 
the  veins  in  the  neighborhood  of  the  absbess,  they  were 
found  full  of  coagula.  but  no  pus  was  discovered  in  them. 
The  uterus  was  sotl,  larger  than  natural ;  the  os  was 
intensely  congested,  but  there  were  no  signs  of  recent 
abrasions.  On  the  left  side  of  the  organ,  in  the  neigh- 
borhood of  the  internal  os,  were  two  or  three  darkened 
spots  resembling  sloughy  tissue,  probably  the  results 
of  previous  attempts  at  abortion.  They  had  evidently 
no  direct  connexion  with  the  last  illness  of  the  patient. 
The  site  of  the  placenta  was  at  the  left  and  upper  portion 
of  the  fundus,  as  shown  by  the  characteristic  roughened 
surface.  In  the  right  ovary  two  corpora  lutea  were 
found.  The  opinion  given  of  the  cause  of  death  was 
intra- uterine  phlebitis. 
Dn,  Garbish  asked  if  there  ever  had  been  presented 


before  to  the  Society  a  case  of  abortion,  followed  by 
death,  in  which  no  evidences  of  peritonitis  existed- 

Dr.  Fiknell  was  under  the  impression  that  several 
cases  of  the  sort  had  been  reported,  and  Dr.  Eracko- 
wizer  called  to  mind  one  in  particular,  presented  by 
Dr.  Voss. 

uloerattvb  disease  of  larynx,  etc 

Dr.  Rooebs  presented  the  trachea  and  annexa  re- 
moved fiom  the  body  of  a  lady  thirty-three  years  of 
age.     He  then  gave  the  following  history  of  the  case : 

She  is  said  to  have  contracted  a  syphilis,  some  &Te  or 
six  years  ago,  which  became  constitutional,  and  among 
other  manifestations  presented  that  of  ulcerative  disease 
of  the  larynx,  glottis,  and  epiglottis.  About  two  years 
ago  she  began  to  &il  in  voice,  which  was  gradually 
reduced  in  a  short  tune  to  a  mere  whisper.  About  a 
year  ago  dyspnoea  became  quite  urgent,  she  being 
subject  to  paroxysms  of  greater  or  less  severity  at 
diflierent  times.  About  that  time,  as  I  understand.  Dr. 
Simrock  saw  the  case,  and  made  a  laryngoscopic  exami- 
nation ;  his  diagnosis  was  ulcerative  disease  of  the  larynx, 
involving  the  glottis,  adhesion  of  the  epiglottis  to  the 
upper  rmi  of  the  larynx,  and  a  perforation  of  the 
epiglottis,  through  which  all  the  air  that  was  inhaled 
entered  the  trachea.  Not  many  months  after  this 
Dr.  Parker  was  called  to  the  patient,  and  during  a 
fit  of  dyspnoea,  from  which  she  was  then  suffering, 
introduced  a  tracheal  tube,  which  the  patient  wore 
untd  death.  Total  loss  -of  voice  soon  followed,  and 
within  two  months  complete  occlusion  of  the  air-pas- 
sage above  the  tracheal  tube.  She  was  seen  on  one  or 
two  occasions,  subsequently,  by  Dr.  Simrock,  who  still 
adhered  to  the  diagnosis  previously  made,  and  concluded 
further,  that  in  addition,  there  was  an  occlusion  more  or 
less  complete  of  the  left  bronchus.  She,  in  the  meantime, 
suffered  from  bronchial  symptoms,  of  more  or  less  sever- 
ity, and  for  different  periods.  Yesterday  she  suffered  one 
of  the  ordinary  paroxysms,  and  her  physician,  Dr.  La- 
fayette Ranney,  was  called  to  her.  He  did  not  look 
upon  the  occurrence  as  anything  unusual,  and  soon  left 
the  patient  In  two  hours  i^r  she  expired,  unac- 
countably. 

The  post-mortem  examination  was  made  at  the 
request  of  a  brother  of  the  deceased.  It  is  found,  firsL 
that  a  great  part  of  the  epiglottis  has  been  destroyed 
by  disease,  that  the  remnant  is  adherent  to  the  upper 
rim  of  the  larynx,  as  Dr.  Simrock  had  diagnosticated, 
but  that  the  opening  seen  by  the  laryngoscope  was  a 
common  one  into  the  posterior  part  of  the  larynx,  and 
into  the  oesophagus,  resulting  from  adhesions  of  the 
apex  of  the  pharynx  to  the  fragment  of  the  epiglottis. 
During  the  healing  process  thjB  common  opening  had 
BO  narrowed  down,  that  when  dilated  to  the  utmost^  it 
did  not  seem  to  be  more  than  three-eighths  of  an  inch 
in  diameter,  and  yet  it  is  said  that  the  patient  ate  solid 
food  like  any  one  else.  Passing  the  probe  down  through 
this  opening,  it  is  seen  to  emerge  mto  the  oesophagus. 
InMnediately  aft«r  leaving  the  epiglottis  you  may  ob- 
serve the  point  of  the  probe  fall  into  a  cavity,  which, 
looking  at  it  fi*om  benind,  gives  you  an  appearance 
of  an  ordinary  glottis,  but  mrther  down  you  nnd  that 
it  is  a  cul-de-sac,  the  larynx  being  occluded  at  its  lower 
border,  and  dissecting  from  below  you  come  in  contact 
with  that  occlusion,  which  is  cartilaginous  in  character, 
at  the  lower  rim  of  the  thyroid  cartilage.  By  passing  a 
probe  through  the  opening*  which  I  have  made  at  the 
upper  edge  of  the  larynx,  it  is  seen  to  pass  out  just 
above  this  material  which  occludes  the  passage.  The 
tube  has  been  worn  for  a  period  of  nearly  nine  months. 

Foflowing  the  trachea  down,  w6  have  evidences  of 
\  very  extensive    ulceration.     In  confirmation  <^  tha 


THE  MEDICAL  RECORD, 


187 


dkgDOOs  made  in  regard  to  occlusion  of  the  left  bron- 
chus, a  dark-looking  substance  will  be  seen  in  the 
trachea,  just  near  the  bi^rcation.  The  cause  of  death 
was  fbond  to  he  occlusion  of  the  tube  with  a  large  mass 
of  Yerj  tenacious  mucus. 

Db.  Krackowizbr  remarked,  that  the  occlusion  of 
the  left  bronchus  was  due  to  a  perforating  ulcer  of  the 
trachea  near  the  bifurcation,  which  admitted  the  pro- 
trusion of  one  of  the  lymphatic  glands,  situated  nor- 
mally upon  the  outside  of  the  tube. 
(To  be  oontlnued.) 


€otttsptn(btntt. 


MEDICAL  MATTERS  IN  PHILADBLPmA. 

To  ram  Editob  or  tarn  Midxoal  Eboobo. 

8iE — Items  of  general  interest  among  the  profession 
in  this  city  are  scarce  at  present.  The  latest  moTeraent 
has  been  the  formation  of  the  Philadelphia  Union  MedicjJ 
AsBociation,  an  organization  started  by  some  of  the  gen- 
eral practitioners  in  the  northern  section  of  the  city,  fbr 
the  object  of  promoting  professional  improvement  among 
themselves,  a  better  acquaintance  with  each  other,  and 
of  protecting  their  pecuniary  interests.  Some  fifty 
gentlemen  jomed  the  organization,  appointed  a  commit- 
tee to  qualify  each  other,  and  the  rest  joining,  as  origi- 
nal members,  and  adopted  a  Constitution  and  By-laws, 
and  the  fee-bill  of  the  College  of  Physicians. 

Medical  organizations  are  not  as  numerous,  nor  as 
attractive  in  this  city  as  in  New  York ;  why,  it  would  be 
hard  to  tell.  Some  of  the  societies  have  a  great  many 
members,  who  rarely  think  of  attending  their  meetings, 
whether  for  discussion  or  business,  and  many  such  m- 
attentive  members  occupy  prominent  positions,  and 
could  add  much  to  the  hterary  interests  of  the  organiza- 
tions they  neglect  Then  there  are  a  great  number  of 
practitioners  of  good  repute  and  extensive  practice,  who 
are  not  members  of  any  medical  organization  at  all 
Those  few  who  take  an  active  interest  in  medical  socie- 
ties are  gradually  endeavoring  to  imbue  the  profession 
with  the  idea  that  it  should  be  considered  a  necessary 
evidence  of  good  professional  standing  to  be  connected 
with  at  least  one  society  of  the  kind ;  and  an  effort 
win  be  made,  if  possible,  to  induce  every  practitioner  to 
join  the  County  Medical  Society,  so  as  to  make  it  the 
diief  representative  bodv,  in  connexion  with  the  scheme 
of  State  Societies  and  the  American  Medical  Associa- 
tion. 

There  is  veiy  much  needed  in  the  city  a  sort  of  a 
Journal  Association,  somewhat  similar  to  that  in  New 
York ;  and  an  ineffectual  effort  was  made  some  years 
ago  to  create  a  library  of  current  medical  literature  in 
connexion  with  the  County  Medical  Society.  There 
are  several  book-clubs,  private  organizations,  consisting 
of  from  twelve  to  thirty  gentlemen,  who  club  in  this 
manner  to  subscribe  to  certain  journals,  or  to  purchase 
certain  monopjraphs,  which  they  receive  in  a  certain 
SQcceasion.  But  in  this  manner  a  journal  is  sometimes 
several  months  old  before  it  has  gone  the  rounds,  and 
the  object  should  be  for  all  to  have  early  access  to  it 
This  can  be  accomplished  only  by  the  establishment  of 
a  reading-room  where  the  journals  shall  be  kept  open  to 
the  inspection  of  members,  but  firom  which  they  should 
not  be  taken  until  the  lapse  of  a  certain  period  after 
their  date  of  publication.  It  is  part  of  the  design  of 
the  new  medical  organization  to  establish  a  reading-room 
of  this  kind,  with  which  view  efforts  win  be  made  to 
peeure  a  h'st  of  members  suflRciently  large  to  meet  the 
necessary  expense. 


The  summer  sessions  at  the  College  are  in  full  operA- 
tion,  and  attended  better,  if  anything,  than  last  year. 
The  practical  course  at  the  Jefferson  Medical  College  is 
a  complete  success,  and  many  of  the  students  are  gain- 
ing more  actual  insight  into  the  details  of  their  profes- 
sion than  they  did  in  the  winter,  when  so  many  andflo 
varied  a  variety  of  subjects  were  presented  en  masse  to 
their  crude  nnderstanding^j  and  they  will  be  able  to 
enter  upon  their  ensuing  wmter  course  with  such  pre- 
paration as  will  ^able  mem  to  appreciate  it 

The  action  of  the  Convention  of  Medical  Teachers  re- 
cently held  in  Cincinnati,  appears  to  give  general  satia- 
faction  to  the  profession,  and  to  most  of  such  as  are 
engaged  in  assisting  students  with  their  studies ;  that 
is,  the  class  of  gentlemen  engaged  in  private  tutorship 
and  quizzing  j  but  the  concurrence  of  the  colleges,  as  a 
body,  is  considered  extremely  doubtful;  and  indeed  it 
i^  much  to  be  doubted  whether  any  innovation  at  all 
will  be  permitted  to  interfere  with  the  present  incom- 
plete method  which,  much  as  it  might  have  been  all- 
efficient  even  thirty  years  ago,  is  markedly  inefficient 
at  the  present  day,  though  many  good  doctors  are 
turned  out  in  spite  of  the  system.  The  probabilities 
are,  that  unless  coerced  by  the  simultaneous  action  of 
other  colleges  in  adopting  a  gradation  in  tuition  the 
present  system  of  instruction  will  continue  in  Philadel- 
phia for  some  years  to  come,  outside  influence  to  the 
contrary  notwitlttianding. 

Dr.  K.  J.  Levis,  in  connexion  with  his  course  on 
ophthalmic  and  aural  surgery,  at  Jefferson  Medical  Col- 
lege, has  established  an  ophthalmic  clinic  which  has 
been  very  instructive.  There  presented  himself  re- 
cently, at  this  clinic,  a  German,  N.  H.,  set  thirty,  with 
an  enormous  elephantiasis,  or  hypertrophy  of  integu- 
ment of  the  left  side  of  forehead,  including  the  brow 
and  upper  eyelid,  with  lobed  fibro-cellular  outgrowths. 
The  color  of'^ the  skin  is  normal,  but  the  weight  of  the 
tumor  has  dragged  the  upper  eyehd  down  over  the 
lower  one  and  beyond  it,  clear  down  to  the  ala  of  the 
nose,  by  the  side  of  which  it  lies,  everted. 

This  patient  was  delivered  with  the  forceps,  and  at 
birth  was  noticed  to  have  upon  his  forehead  a  small 
lump  the  size  of  a  pea,  which  continued  to  grow,  nntil 
at  the  age  of  fourteen  the  eye  became  obscured ;  since 
which  time  it  has  grown  very  slowly.  On  forcibly  ele- 
vating the  eyelid,  3ie  eye  was  observed  to  be  cataract- 
ous,  with  no  perception  of  light  The  patient  suffers 
from  photophobia  with  the  other  eye.  and  his  intellect 
is  somewhat  obtuse. 

Prof.  Gross  recently  showed  his  class  Maggie  T , 

»t  fifteen,  firom  whom,  at  nine  years  of  age,  he  removed 
the  left  lower  limb  at  the  hip-joinf^  on  account  of  de- 
formity and  incurable  disease,  the  result  of  a  very  bad 
scald.  The  patient  at  the  time  was  very  much  prostrat- 
ed ;  recovery  was  apparentiy  hopeless,  and  at  the  con- 
sultation, two  distinguished  surgeons  of  this  city  ex- 
pres^d  themselves  averse  to  the  operation,  which  was, 
4iowever,  performed,  as  affording  the  only  chance  of  re- 
lief;  and  to  the  surprise  of  all  concerned,  the  patient 
got  well  without  a  single  untoward  symptom,  though 
she  was  so  much  emaciated  at  the  time  that  compres- 
sion of  the  aorta  was  easily  effected  through  the  ab- 
dominal parietes. 

The  annual  meeting  of  the  Medical  Society  of  the 
State  of  Pennsylvania  will  take  place  within  a  fort- 
night, and  considerable  interest  is  felt  as  to  what  will 
be  the  action  with  regard  to  the  status  of  female  phyed- 
oians,  or  **  women  doctors,"  as  they  are  now  being  called, 
in  consequence  of  the  recent  change  of  name  of  the  Fe- 
male Medical  College  of  this  city,  to  that  of  Women's 
Medical  College,  in  order,  it  has  been  maliciously  said, 
to  leave  no  doubt  as  to  tne  order  in  the  animal  scale  of 


188 


THE  MSSDIGAL  RECORD. 


those  to  be  educated  there,  inasmuch  as  the  word  fe- 
male was  not  sufficieDtly  distinctive. 

Tours  truly, 

O.J. 

Philadelphia,  /one  1,  18«r. 


A  REVIEW  OF  A  BSYISWER. 

LITTER  ntOM  DR.  H.  O.  DATI8. 
To  TBI  SoiTOB  or  TKs  Mmnui.  Bboob9, 
Sib— It  is  with  reluctance  that  I  ask  a  place  in  your 
columns  to  correct  some  mistakes  that  were  pubhsbed  in 
another  jourAal,  the  editors  cf  which  are  unwilling  to  ad- 
mit corrections.  The  statements  I  make  are  not  limited 
in  their  influence  to  myseli^  for  I  trust  th^t,  as  a  profes- 
don,  we  entertain  a  feeling  of  national  pride,  and  a  de- 
sire, not  only  to  do  all  within  our  power  for  its  adratice- 
ment,  but  to  maintain  our  claims  Cor  whatever  we  may 
accomplish  before  the  world. 

The  March  number  of  the  i^eu^  For^  iliNlmZ /(mrfu^ 
contains  an  extended  review  oi  my  work,  entitled 
"  Conservative  Surgery."  The  reviewer,  in  8<»ne  in- 
stanceS)  unfortunately  has  mlstdDen  words  for  ideas, 
quoting  from  other  authors  words  similar  to  those  em« 
ployed  by  me  in  CJonservative  Surgery,  and  representing 
said  lang^iage  as  expressing  my  i£as,  or  as  definmg  the 
processes  mentioned  in  my  work,  when,  in  feot,  they 
are  entirely  dissimilar,  not  possessing  the  least  re8€m' 
Uaaiee, 

The  reviewer  says:  "In  the  first  chapter  (on  frac- 
tures) Dr.  Davis  writbs:  'This  princQ>le  of  treating 
fractures  by  simple,  continued,  Mastic  extension,  was 
urged  bv  us  upon  the  professicm  in  the  early  part  of  the 
year  1866,  etc.*"  He  then  inquires:  "What  may  be 
asked,  was  the  principle  generally  recognised  by  the 
profession  who  have  used  the  straight  ^Unts  oi  Des- 
sault  and  Boyer,  and  their  several  modifications,  with 
extension  and  counter-extension?"  This  inquiry  can 
be  the  best  answered  by  describing  the  mechanical  ap- 
pliances used  by  these  gentlemen  for  effecting  extension 
and  counter-extension.  In  these  splints  the  extending 
force  ie  applied  ihrough  a  screw ,  or  its  equivalent ;  this 
screw  is  turned  until  the  parts  are  as  tense  as  the  sur- 
geon desires.  This,  be  it  remembered,  is  done  while 
uie  muscles  are  contracted,  and  it  fails  to  weary  and 
tire  them  by  continuing  to  act>  but  remains  unchanged, 
without  pulling  or  extending  beyond  the  point  where 
the  limb  was  when  the  surgeon  ceased  turning  the 
screw,  and  thus  it  must  remain,  for  i^  that  the  fixtures 
themselves  can  do  to  change  it  Tbere  is,  tiien,  abso- 
lutely no  extension  when  the  surgeon  ceases  turning 
the  screw.  Theoretically,  the  limb  simplv  remains 
fixed  at  the  length  it  was  left  by  the  surgeon,  but  in  fact 
it  is  constantly  losing,  as  the  appliances  always  will 

S'eld,  more  or  less.  Isrow,  if  the  screw  i^  not  turned, 
ere  will  necessarily  result  a  loss  of  the  distance  first 
gained,  or  of  an  amount  of  extension  equal  to  the  first 
amount  It  requires  no  argument  to  Drove  that  the 
screw  or  its  equivalent  cannot  of  Itself  e£(&t  a  continuous 
puUinff  or  extension )  it  is  <mLy  while  the  screw  is  being 
turned  that  extension  is  made ;  consequently,  while  the 
screw  remains  unchanged,  the  limb  is  simply  fixed,  as 
though  it  were  nailed  to  the  splint  The  result  is  not 
changed  when  the  screw  gives  place  to  an  equivalent  in 
the  ferm  of  a  twisted  rope,  as  used  by  Dr.  Neil,  of 
Philadelphia.  This  surgeon  did  not  aim  to  keep  up  a 
continuous  pulling ;  he  mibstituted  the  rope  as  a  cheaper 
and  more  simple  equivalent  4br  ^e  screw. 

Although  Prof  NAthan  Smith,  MJ).,  of  New  Haven, 
Conn.,  employed  the  cord,  pulley,  and  weight,  yet  his 
dependence  in  treating  a  fracture  w^s  upon  the  indined 
plan^    Pro!  Smith ssys:  "In  most  in^aoces  in  which 


the  limb  has  been  thus  dressed  (on  an  inclined  plane), 
almost  every  source  of  irritation  being  avoided,  and  the 
attitude  natural  and  easy  to  the  mnsclM,  Ihave  not  found 
it  necessary  to  ttse  permanent  extension." 

We  were  not  cognizant  of  this  use  of  the  cord  and 
pulley  by  Dr.  SmiSi  untal  recently;  had  we  been,  it 
would  not  have  detracted  from  our  daim  for  having 
been  the  first  to  recommend  "  simple^  continued,  elastu: 
extension"  as  the  only  means  necessary  for  the  treatment 
of  fractwre  vn  ^6n«ra}— extension,  be  it  understood, 
iffi&out  even  eo-aptaimg  splints,  HhB  extension  we  use 
differs  from  the  screw  and  its  equivalents,  in  that  it  con- 
stantly acts;  it  nevw  ceases  pulling.  It  is  this  oeeae- 
less,  unremitting  extension  that  wearies  the  contracting 
muscles,  overcoming  their  resistance,  and  thereby  per- 
mits the  fractured  bones  to  come  into  their  natural  posi- 
tion. 

If  the  reviewer  cannot  appreciate  the  difference  be- 
tween extension  (as  it  is  termed)  by  the  screw  and  its 
equivalents,  and  continued  elastic  extension,  as  here 
expluned,  we  must  ask  him  to  perform  both  kinds  by 
his  own  hands.  Chi  one  he  will  pull  or  make  extension 
only  until  his  extension  can  be  secured  and  fixed  by 
this  screw ;  in  the  latter,  ^ere  being  no  screw  to  secure 
the  extension  already  made,  he  must  remain  at  his  post, 
pulling  or  extending  unremittingly. 

The  reviewer  becomes  quite  /acetious  over  a  new 
mode,  recommended  by  us.  for  overcoming  muscular 
contraction  in  fitu^tures  for  the  patella;  and  some  of  the 
processes,  where  application  for  this  purpose  cannot  be 
made  to  the  parts  fractured. 

He  stated  that  we  applied,  in  a  fon-shape,  adhesive 
plasters  over  the  hdlies  ofUh/t  muscHes  to  he  overcome,  apd 
then  made  continued  extension  from  their  united  in- 
ferior ends,  by  means  of  a  cord,  j)ulley,  and  weight. 
The  manner  of  applying  the  adhesive  straps  we  iHus- 
I  trated  by  several  fine  cuts.  That  this  mode  does  not 
differ  fit>m  all  other  modes  of  treating  these  fractures, 
requires  and  demands  something  more  tangible  than 
ridicule  to  prove. to  the  contrary,  particularly  as  the 
reviewer  acknowledges  it  "  to  be  a  good  one." 

We  should  have  thought  the  character  of  the  sentence 
against  which  he  enters  his  protest  would  have  sug- 
gested to  him  that  some  qualifying  word  (apparenUy, 
for  instance)  had  been  omitted  by  the  printer.  We 
will  add,  for  the  information  of  the  reviewer,  that  the 
pateUa,  mentioned  in  our  work,  as  treated  upon  this 
plan,  yet  remains  firmly  united  after  a  period  of  fifteen 
months,  which  we  think  is  quite  uni^ial,  to  say  the 
least,  for  one  separated  two  puid  a  half  inches  at  the 
time  of  its  fructure. 

We  come  now  to  the  reviewer's  remarks  upon  our 
claims  to  having  introduced  some  novel  views  of  the 
pathology  and  treatment  of  diseases  of  the  joints.  The 
reviewer  quotes  what  he  designates  as  our  "  claims  as 
distinctly  formularieed."  The  sentence  he  quotes  is, 
however,  simply  a  statement  of  what  first  arrested  our 
attention,  and  led  us  to  the  investigation  of  the  mecha- 
nical causes  operating  injuriously  in  joint  diseases,  and 
not  the  discoveries  themselves.  There  is  perhaps  some 
'excuse  for  this  mistake,  as  the  word  discovery  is  used 
in  thf»  sentence  in  the  sense  of  first  noticed. 

The  dainL  as  distinctly  stated  by  us,  can  be  found  on 
page  206  or  Conservative  Surgery,  and  is  as  follows : 
"We  consider  it  fiiUy  established,  thai  when  diseate 
about  a  Joint  renders  the  movement  cf  thc^t  joint  painfiUy 
it  is  always  Uable  to  be  destroyed  by  vmnierrupUd  prea^ 
sure  effected  throu^  the  ooniraciion^mttsdes  passing  over 
it  l%ey  do  ihis  by  preventing  the  p(»rts  pressed  upon  fron^ 
receiving  nourishment,  in  ihe  same  way  cls  a  bedsore  ie 
produced.  This  view  was  first  brought  to  the  notice  <^ 
the  profession  in  a  pi^ier  read  be£ere  the  New  York 
digitized  by  V^jOO^^_ 


THE  MEDICAL  RECORD. 


189 


Academy  of  Medicioe  in  I860.*'    On  page  210,  there  is 
i  amilar,  but  more  comprehensiye  statement. 

We  consider  this  an  miportant  fact  in  the  pathology 
of  joint  diseases,  and  as  distincUy  stated,  notwithstaoo- 
ing  the  reviewer's  assertion,  "l?hat  they  are  not  men- 
tioned in  the  work.** 

As  to  pressure  upon  diseased  joints,  the  reviewer's 
quotations  from  Beale,  Ford,  and  others,  apply  onby  and 
mduaivdy  to  pressure  from  ^  weight  of  the  body,  and 
not  to  that  ^eded  by  the  contraction  of  ihs  muscles 
passing  over  thej'omt 

In  his  quotation  from  Ford,  he  (FoTd^  expressly  says, 
in  reference  to  morbus  ooxarius:,"  Nothing  can  be 
deaier  than  that  patients  nmst  feel  ease  and  advantage 
from  every  expedient  to  prevent  the  weight  of  the  body. 
in  any  degree  whatever,  from  pressing  on  the  joint.'* 
Bat  Jrord  goes  further,  and  upon  the  uext  page  says, 
'^aod  that  this  shortening  of  tine  Hmb  does  not  depend 
upon  spasm  and  con^rodion  of  the  muscles'*^  Here  he 
e^resdy  denies  what  the  reviewer  by  implication 
MBert& 

The  reviewer  quotes  Beale  as  saying  in  reference  to 
Ddpech's  apparatus :  "  Any  benefit  which  may  result 
from  such  an  i^paratus  must  be  derived  from  the  power 
of  extension  in  overcoming  the  contraction  of  muscles.** 
Is  Beale  speaking  of  the  contraction  of  muscles  in 
diseased  joints  ?  By  no  means ;  he  is  speaking  of  lateral 
curvature  of  the  spine.  In  no  instanee  does  he  speak 
of  pressore  as  being  effected  in  a  joint  through  contrac- 
tion of  the  muscles  passing  over  said  joint  All  the 
quotations  frt>m  authors  miule  by  the  reviewer  are  not 
appHeable,  and  do  not  m  the  most  remote  degree  inva- 
lidate our  claims  to  the  disoovery  that  the  contraction 
of  the  muscles  passing  over  a  joint,  holding  it  motionless, 
would  destroy  it  by  preventing  the  nutrition  of  the  parts 
pressed  upon,  in  {he  same  way  that  a  bed-sore  is  pro- 
duced by  pressure: 

Even  Sir  Benjamin  Brodie,  although  he  used  the  cord. 
puBey,  and  weight,  did  not  employ  them  as  a  remedial 
measure,  neither  did  he  recognise  in  any  instance  that 
the  contraction  of  the  muscles  Was  a  constanUv  acting 
force  to  destroy  the  joint  We  have  stated  this  case 
fuDy,  and,  as  we  conceive,  fairly,  in  our  work. 

Dn,  Harris  and  March  Doth  treated  morbus  coxarius 
by  fiidng  the  limb  by  the  screw,  seeking  only  rest  to 
thejoint,  and  anchylosis  as  the  beet  result 

rius  certainly  does  not  look  tike  an  effort  to  effect  an 
entire  separation  of  the  head  of  the  femur  from  the 
aoetabulum,  and  to  prevent  all  pressure  from  n^iatever 
cause  during  the  whole  period  of  treatment 

Here  we  leave  the  subject,  with  a  consciousness  of 
having  endeavored  to  set  the  professional  public  right 
in  reeard  to  the  truths  we  have  advanced,  with  a  firm 
conviction  Uiat  the  principles  advocated  in  Consirva- 
nn  ScTRGKBT  are  destined  to  occupv  an  important  place 
in  the  progress  of  things — not  only  in  this,  but  in  all 
ooontries  where  science  and  art  are  held  in  estimation. 
Truly  yours,  H.  Q.  Datib. 

VtirToi)L,lU7l^l8^. 

Cboliba  akd  QuARAnmnt-^We  are  reqqested  to 
itcte  that  it  was  not  the  hitention  of  Pro£  C.  A.  Lee,  in 
his  resolutions  upon  diolera  and  cniara&tine  offered  at 
tlw  late  meeting  of  the  American  Medical  Association, 
to  express  the  opinion  tbat  aB  qaarantine  measnres  al 
our  ports  are  xmesB  in  prevantoig  the  introduction  of 
cholera  into  ovtrooontry;  fbr  the  cdaease  had  been  kept 
oonfbed  to  the  lower  bay  of  New  York  more  than  six 
aonths  l^  nu^  quaranthie  a»  then  existed;  bat  that, 
having  onoe  gained  a  foothold,  no  means  short  of  iion«» 
intatoarser  cotdd  pnvent  its  qpvead  to  othier  pkiees. 


THE  AEMY  MEDICAL  BUREAU,  AND  THE 
AMERICAN  MEDICAL  ASSOCIATION. 


Tai 


I  Bdroe  ov  1 


:  MaDiOAL  BxooBD. 


Sm — ^I  am  happy  to  learn  officially  that  the  unequal 
r^rt  of  that  part  of  the  proceedings  of  the  AmMican 
Medical  Association,  relating  to  the  resolutions  on  the 
Army  Medical  Bureau,  was  simply  the  resuR  of  una* 
voidable  accidents.  Ab,  apart  from  any  daim  of  equal 
justice,  the  actkm  of  the  Amociation  is  an  additional  and 
special  reason  why  the  resolutions  and  t^e  reasons  then 
given  for  ofienng  them,  should  be  fairly  presented  and 
clearly  understCKod,  I  respectfblly  request  that  the 
accompanying  communication,  with  the  original  synop- 
sis of  remarm  ftnnidied  previous^  by  request,  be  puV 
lidbed  in  the  next  number  of  your  JoumaL 

'^Dr.  BxNJiMiif  Howard,  of  New  York,  ofibred  the 
foUcwing  preamt^  and  resolutiODS : 

"  <  Whereas,  There  has  been  issued,  and  still  remains  in 
Ibroe,  an  official  order  from  the  Surgeon-(}eneral  of  the  United 
States  Army,  prohfiriting  the  communieation  of  any  medlcad 
or  surgical  imbrmation  by  any  medical  officer  of  the  United 
States  Army,  to  any  person  whatsoever,  without  special  per- 
mission from  the  He<ttoBl  Bureau,  at  Washington— thus  appro- 
priating, as  Cmt  as  (he  official  power  of  the  Soigeon-Qeneral 
can  compass  it^  all  .the  valuable  ezperieooe  and  statisUos  of 
all  medical  men  who  have  served  in  the  various  departments 
of  the  United  States  Army,  to  the  exclusive  use  of  the  Medi- 
cal Bureau.    And, 

" '  Whereas,  Vn6et  sudi  arbitrary  control,  an  official  rqK>rt 
has  already  been  made,  tending  to  create  incorrect  impressions, 
on  scientific  questions  of  great  practical  importance  to  the 
profession  and  to  society.    And, 

" '  Whereas,  It  is  important  to  the  reputation  of  all  medical 
men  who  served  during  the  war,  that  they  have  the  opportu- 
nity of  eorrecthig  such  erroneous  impressions  by  an  examina- 
tion of  the  originiEd  records.    Therefore,  be  it 

"  *  Resolved,  That  it  is  the  opinion  of  this  Association  that 
&ie  monopoly  now  exercised  by  the  Medical  Bureau  over  the 
medical  and  surgical  records  of  the  war,  is  contrary  to  the 
gonios  and  cathc^c  spirit  of  our  profession,  and  obstructive  to 
die  highest  interests  ef  sdenoe  and  humanity. 

***  Resolved,  That  the  Secretary  of  War,  or  other  proper 
authorities,  be  requested  to  direct  that  the  original  records  of 
the  Medical  and  Surgical  History  of  the  War  be  rendered 
aooessil^on  certain  regular  days  of  each  month,  for  purposes 
of  scientific  investigation  to  all  medieal  men  who  have  served 
as  soch  hi  tiie  army  of  the  United  States.' " 

"  In  supporting  the  above  resolutions,  Dr.  Howard 
stated  thM  they  were  presented  in  the  special  interest 
of  many  memliers  of  the  Association,  and  those  not  the 
least  honorable,  either  oti  account  of  professional  achieve- 
ment or  patriotic  devotion.  They  contemplated  lUike 
the  benefit  of  the  profession,  and  of  humanity  through- 
out the  world,  no  leas  than  the  greatest  ultimate  effi- 
ciency of  the  Statistieai  Department  of  the  Medical 
Bureau.  Many  reasons  were  then  stated  at  length  why 
medical  men  who  had  served  in  the  army  should  be 
aQowed  access  to  the  records,  at  least  of  their  own 
recent  cases,  of  which  the  following  is  a  synopsis : 

"  As  tiie  publication  of  the  oAciu  reports  is  suMect  to 
poHticai  contingencies,  such  publication  may  be  indefi- 
nitely postpon^  or  the  project  become  totally  aban-* 
dolled. 

**  Meanwhile,  avast  amount  of  unrecorded  experience 
complementary  to  data  in  the  Medical  Bureau  h  beins^ 
forgotten  and  lost.  For  though  these  together  would 
fomidi  complete,  aiid  refiable  mformation,  apart^  eadi 
may  be  unreliable  and  worthless. 

**  Bcme  members  of  this  Association  have  been  most 
carefolly  putstdne  various  and  distinct  Imes  of  original 
investigation,  and  require  eadi  to  studv  out  the  same 
hi  entirely  different  aspects;   Shomd  the  promised 


190 


THE  MEDICAL  RECORD. 


pubL'cation  ever  Tippear,  no  matter  wliat  its  methods 
of  classification,  they  cannot  correspond  to  each  of  these 
original  and  separate  lines  of  investigation,  and  there- 
fore must,  to  at  least  the  mfajoritj  of  such  members, 
be  simply  worthless." 

'^  Not  a  few  of  the  best  minds  in  the  profession,  having 
been  officially  prohibited  any  item  of  information,  even 
80  much  as  to  whether  certain  late  patients  of  theirs 
were  dead  or  discharged,  are  kept  at  a  steady  halt  in 
the  midst  of  important  researches,  and  valuable  papers 
which  otherwise  might  long  ago  have  been  in  the  pos- 
session of  this  Association,  are  consequently  uncertain 
of  ever  reaching  completion. 

"  Our  professional  brethren  throughout  Eiurope,  appre- 
hensive of  instant  and  general  war,  are  anxiously  send- 
ing for  the  results  of  our  recent  and  unprecedented 
experience;  but  those  who  otherwise  would  be  best 
qualified  to  furnish  to  them  and  the  future  sufferers,  the 
common  charity  they  crave,  are  able  only  to  echo  the 
response  of  the  Medical  Bureau,  and  reply  that  it  is 
contrary  to  the  official  order  of  the  Surgeon-General  to 
furnish  any  such  information,  until  duly  and  officially 
pubUshed. 

*'  The  only  plausible  reason  for  this  exdusive  policy  of 
the  Bureau  is,  that  it  is  necessary  to  the  •uooesafid  oom- 
pilation  of  the  Records.  Two  days  of  each  month  for 
opportunities  of  reference  could  not  be  a  very  serious 
source  of  delay.  The  Bureau  would  by  such  reference 
lose  nothing ;  but  it  would  thereby  gain  the  superior 
advantages  of  comparison  and  correction  from  tiiose 
best  acquainted  with  the  facts  at  the  time  they  oc- 
curred, while  it  would  obviate  any  tendency  to  that 
suspicion,  which  is  inseparable  from  monopolies.  In 
condusion,  our  experiences  during  the  late  wai^  in  so 
far  as  they  may  serve  to  ameliorate  human  snfierings, 
belong  not  exclusively  to  the  Medical  Bureau,  to  any 
State,  or  any  country,  but  are  the  rightful  property  of 
the  whole  world." 

These  statements,  noted  nearly  verbatim  soon  after 
they  were  made,  interspersed  with  illustrative  facts,  con- 
stituted the  more  salient  points  of  my  remarks  on  that 
occasion.  On  referring  to  the  printed  report  of  my 
friend  Dr.  Woodward's  speech,  a  single  glance  will  dis- 
cover that  instead  of  being  a  reply  fo,  it  was  a  most 
success^  diversion /rom,  &e  principal  questions  pre- 
sented, to  a  dutiful,  but  entirely  gratuitous  vindication 
of  the  "honesty,"  "ability,"  "humanity,"  and  "con- 
scientiousness" of  the  Surgeon-General,  as  if  such  were 
not  the  traditional  qualities  belonging  essentially  to  that 
office. 

In  my  friend  Dr.  Woodward's  speech,  I  discover  but 
two  statements  le^timately  based  upon  the  resolutions, 
or  remarks  precedmg.  The  first,  respecting  the  time  of 
pubUcation,  was  to  the  effect  that  within  two  months 
would  be  issued  a  catalogue  of  the  museum,  of  about  a 
thousand  pages.  To  this  my  reply  now  is— The  greater 
the  volumes,  the  greater  the  delusion  and  the  blunder, 
if,  instead  of  furnishing  just  what  is  most  needed  in  the 
manner  alone  in  which  it  can  be  available,  they  be  pub- 
lished as  professional  bulls,  with  such  sacred  and  unal- 
terable errors  and  misconstructions  as  may  be  found  in 
the  volume  already  issued. 

The  other,  and  the  only  one  not  anticipated  in  my 
first  remarks,  entitled  "  the  still  graver  reason  why  the 
access  asked  cannot  be  granted,  is,  that  it  would  be  an 
additional  obstacle  to  the  adjustment  of  the  claims  of 
pensioners.  In  reply  to  this,  by  far  the  strongest  lyid 
most  pertinent  objection  raised,  I  would  simply  ask — 
suppose  any  one  clerk  in  charge  of  any  one  set  of  books, 
under  a  particular  officer,  searches  for  a  pai  ticular  fact 


prevent  or  delay  the  adjustment  of  any  pension  any 
more  than  if  the  same,  or  a  similar  fact  concerning  the 
same  case,  be  sought  for  by  the  same  clerk,  for  the  same 
officer,  for  insertion  in  the  official  catalogue  of  the  Armj 
Medical  Museum  ?  If  the  opportunity  of  a  little  addi- 
tional reference,  like  that  necessary  to  every  item  in  the 
great  compilation  in  progress,  is  totally  objected  to  be- 
cause it  would  delay  the  adjustment  of  pensions  whose 
settlement  is  so  imperatively  "  demanded  by  every  con- 
sideration of  humanity,"  by  what  rule  of  boasted  "hon- 
esty," or  "conscientiousness,"  has  similar  investigation 
been  unremittingly  pursued  in  each  of  the  four  tbonsand 
cases,  the  publication  of  which,  in  a  volume  of  about  one 
thousand  pages,  is  promised  us  within  the  next  ^o 
months  ?  After  careful  attention  to  every  attempf  at 
justification,  by  the  Medical  Bureau  and  its  agent,  I  am 
still  waiting  to  discover  the  shadow  of  an  honest  reason 
why  the  medical  men,  who  at  every  sacjifiee  of  com- 
fort, and  fi^quently  at  imminent  risk  of  their  Uves,  ope- 
rated upon  and  treated  patients  with  most  careful  assi- 
duity, and  thus  laid  the  foundation  of  the  greater  part 
of  whatever  is  of  any  interest  or  value  in  the  sureical 
and  statistical  department  of  the  Bureau — why  these 
men  should  be,  as  now  they  are,  denied  any  and  all  in- 
formation respecting  any  one  of  those  cases  whidi  they 
have  treated,  and  which  they  may  have  risked  their  lives 
to  save. 

B.  HOWASD. 
40  W.  8l8t  St.,  New  York. 


©bituarg. 


respecting  a  particular  case,  that  fact  being  required  by 
Biua  officer  for  me — ^the  original  contributor;  does  that 


JOBERT  (DB  LAMBALLE), 

I  OF  PARIS. 

The  Paris  Gcuette  MdiodUj  of  May  4th.  reports  the 
recent  decease  of  this  eminent  surgeon.    His  obsequies, 
which  took  place  the  Friday  preceding  at  the  church  of 
the  "  Madeleine, "   were  attended  with  great  pomn, 
and  an  inmiense  concourse  of  persons.    Marshal  Vau- 
lant  represented  the  presence  of  the  Emperor.    The 
Imperial  Academy  of  the  Sciences  and  the  Academy 
of  Medicine  testified  by  the  attendance  of  their  respec- 
tive presidents  and  members  the  high  and  honored 
position  which  Jobert  occupied  as  a  member  of  these 
scientific  institutions.     The  Paris  School  of  Medicine 
was  represented  by  a  deputation  of  professors  and  as- 
sistant professors  in  their  robes,  headed  by  the  Dean  of 
the  Faculty.    Several  funeral  discourses  were  pronoun- 
ced over  the  corpse  : — Dr,  Conneau,  first  physician  to 
the  Emperor,  spoke  in  the  name  of  his  Maiestj^ ;  M. 
Gosseliii  in  tlje  name  of  the  Paris  School  of  Medicine : 
M.  Legouest  exnressed  the  feeling  of  the  Academy  of 
Medicine  ;  and  M.  Amal  those  of  the  personal  firiends 
of  Jobert.    The  Ead  misfortune  which  Overtook  this 
great  and  distinguished  man  before  his  death,  is  known 
to  alL    In  the  wreck  of  his  intelligence  were  explained 
those  eccentricities  which  frequently  characterized  his 
private  life.  He  commenced  his  medical  career  in  1819, 
from  an  humble  origin,  with  an  imperfect  education,  and 
in  extreme  indigence ;  with  an  mtellect  brilliant  and 
ardent^  dominated  by  an  inflexible  will  and  fixedness 
of  purpose   in  the    pursuit  of  distinction,    and  the 
attainment  of  excellence  in  his  profession,  Jobert  had 
many  warm  friends,  and  some  bitter  personal  enemies. 
By  his  irresistible  will  and  unremitting  application,  he 
attained  to  distinction,  and  the  possession  of  a  most 
ample  fortune.    As  surgeon  to  the  Emperor  ;  member 
of  the    Imperial  Academy  of  the  Sciei;cds  ;    of .  the 
Academy  of  Medicine  ;    member  of  the  Institute  of 
France ;  commander  of  the  Legion  of  Honor  ;  profe^or 
of  the  School  of  Medicine  at  Paris,  Jobert  was  suffi* 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


191 


cientlj  entitled  to  the  mortuwy  pomp  and  splendor 
which  commemorated  the  respect  of  the  French  nation, 
•seyinced  throucrh  its  high  dignitaries  and  scientific 
bodies.  The  appucatfon  of  hit  physiological  researches 
to  woands  of  the  intestines  by  the  immediate  contact 
of  their  serous  surfiices,  originating  the  extensively- 
•dopted  procedure  oalled  the  suture  by  '*  invagina- 
tion ;''  his  important  advanoat  in  the  treatment  of  vesico- 
Ttginal  fistula  by  the  method  called  that  of  ^'glisae- 
meoi,'*  though  fiu*  surpassed  by  the  inventive  genius  of 
American  surgery  ;  his  numeroos  publications,  and  his 
brilliant  operative  sld^l ;  these  are  distinctions  which 
ckim  for  Jobert  the  regard  of  all  medical  men. 


Um  publtcatton0« 


Books  Aim  Pamphlvts  RiOBnnn), 
An  Ebsat  on  ths  Clihatb  aud  Fivbss  or  thb  Southwubt^ 
wax,  Southern,  and  AiLAimo  Statbb.     By  Jamieb  C. 
Harkis,  H.D.,  of  Wetompka,  Ala. 

RiPOBT,  TO  THE  InTBBNATIONAL  SaNITABT  C!0KFEftBN0B,  OF 

A  Coiofissiosr  rBOM  that  Boot,  on  the  Obxgin,  Endemi- 
crrr,  Tbansmissibility,  and  Propagation  or  Asiatio 
Cholera.  Translated  by  Samuel  L.  Abbott,  M.D.,  Phy- 
sidan  of  Mass.  General  Hospital,  etc 

The  Wine  Culture  in  California.    By  H.  Gibbons,  M.B. 
San  Fraocisoo.     1867. 

TmiTEivTH  Registration  Report  OF  Rhode  Island.  1865. 

Mechanical  Surgery.  By  B.  D.  Hudson,  M.D.,  N.  T.  1867. 


£SitV\tai  Xlm»  antr  3tem0* 


Dr.  Daniel  G.  Brinton,  formerly  Surgeon  and  Bre- 
vet laeuC-GoI.  XT.  S.  V.,  has  become  an  associate  with 
Dr.  a  W.  Butler,  editor  PhUa,  Medical  and  Surgical 
Rtpofi&t, 

Dr.  Martth  Payne,  the  yenerable  Professor  of  Ma- 
teria Medica  in  the  University  Medical  College,  has  re- 
tired from  the  active  duties  of  his  chair,  after  an  accept- 
aWe  service  of  twenty- five  years,  and  is  now  Bmeritus 
Professor.  His  successor,  Dr.  William  H.  Thompson, 
brings  eminent  qualifications  to  the  poaitioii. 

National  Asylum  for  Disabled  Soldiers.  —  The 
Board  of  Managers  hare  decided  to  purchase  the  Ohio 
White  Sulphur  Springs  property,  near  Columbus,  Ohio, 
as  the  Central  Asylum ;  Dr.  0.  M^Dermont  being  elected 
medical  officer.  From  a  Washington  despatch  to  the 
Dewspapers  we  cHp  the  following,  which  gives  much 
Tueful  information : 

The  Board  of  Managers  of  the  National  Asylum  for 
Disabled  Vohioteers  gives  notice  that  it  is  now  prepared 
to  reoeiye  beneficiaries  into  the  branches  located  near 
Augusta,  Maine;  Milwaukee,  Wisconsin:  or  into  the 
Central  Asylum,  near  Columbus,Ohio.  Volunteers  are 
admitted  upon  application,  by  letter,  to  either  of  the 
managers,  whereupon  a  blank  application  will  be  sent 
to  the  applicant,  and,  if  duly  qualified,  transportation 
win  be  furnished  him.  The  requirements  are :  ^rst, 
aoy  honorable  disdiarge  from  the  Tohmteer&  Sec(mdfy, 
dinibility  by  wound  receiTed  or  sickness  in  the  line  of 
do^.  If  the  applicant  is  unable  to  travel,  or  for  other 
loffldent  cause,  relief  will  be  furnished  under  direction 
of  the  manager  to  whom  application  is  made.  Over- 
seers of  all  alms-houses  and  chanty  hospitals,  baring 
diaabM  soldiers  subsisting  upon  private  beneficence, 
are  retq^fully  urged  to  report  such  caiee  to  either  of 
the  managers,  as  it  is  not  fit  that  meritorious  disabled 


soldiers  of  the  nation  should  be  supported  by  private  or 
public  charity.  Soldiers  are  especially  informed  that  the 
asylums  are  neither  hospitab  nor  alms-houses,  but 
houses  where  subsistence,  care,  education,  religious  in- 
struction, and  employment  are  provided  for  disabled 
soldiers  by  the  Congress  of  the  United  States,  to  be 
paid  for  by  forfeitures  and  fines  of  deserters  from  the 
army.  The  provision  is  not  a  charity.  It  is  a  contri- 
bution by  bounty-Jumpers  and  bad  soldiers  to  the  brave 
and  deserving,  and  is  their  right.  Soldiers  having  a 
wife,  child,  or  parents  dependent  upon  them,  are  not 
required  to  give  op  their  pensions  upon  coming  to  the 
asylum.  Other  soldiers  are  required  to  assign  their  pen- 
sions to  the  asylum,  in  roecial  cases  only,  to  be  deter- 
mined by  the  Boanl  Suitable  compensation  will  be 
given  for  profitable  labor  in  the  asylums.  Qood  be- 
havior win  insure  the  kindest  treatment  Wives  and 
children  will  not  be  cared  for  at  the  asylum  until  after  a 
soldier  has  shown  his  ability  to  aid  himself  and  them  in 
part  by  his  labor  and  steadiness,  so  that  taking  his 
family  m  charge  will  not  increase  his  expenses  to  the 
asylum  above  we  cost  of  other  helpless  beneficiaries,  in 
which  cases  provision  will  hereatler  be  made. — (fine 
Lancet  and  Oo$erver, 

New  Luhatio  Astluk  m  Ohio. — ^An  act  has  passed 
the  Legislature  of  Ohio  to  establish  a  lunatic  asylum  in 
the  souUi-eastem  part  of  the  State.  No  location  is  as 
yet  selected. 

Asylum  for  Aoed  Iitoioemt  Fexalcs. — ^Dr.  P.  A. 
Burrall  has  been  appointed  attending  physician  to  this 
Institution,  vice  Dr.  James  S.  Cooper,  deceased. 

The  Quarterly  Journal  of  PsrcHOLoaiCAL  Medioihe 
AND  Medioal  Jurisprudence,  is  to  be  the  title  of  a  new 
medical  Periodical  to  be  issued  on  the  1st  of  July  next. 

The  contents  will  embrace:  1.  Original  articles  on 
the  Physiology  and  Pathology  of  the  Mind  and  Nervous 
System,  and  on  questions  of  Medical  Jurisprudence. 
2.  Selections  and  Translations  of  Memoirs  fit)m  Foreign 
Journals.  3.  Reviews  and  Bibliographical  Notices. 
4.  Chronicle  of  the  Physiology  and  Patholo^  of  the 
Miod  and  Nervous  System  and  of  Medical  Jurispru- 
dence. It  will  bo  edited  by  Willlam  A.  Hajdcond, 
M.D.,  of  this  city. 

Climate  ahd  Disbabes  of  Utah. — The  eruptive  fevers, 
measles,  scarlatin^  and  small-pox  prevail  more  or  less 
throughout  Salt  Lake  valley,  but  m  general,  epidemics 
are  not  conunon.  The  healthfulness  of  the  cHmate, 
and  the  manner  of  life  of  the  Mormons,  are  not  &vor- 
able  to  the  production  of  disease.  Physicians  do  not 
flourish  in  Salt  Lake  Citv.  But  two  were  living  there 
at  the  time  I  leil  the  valley,  and  both  were  in  a  state  af 
destitution.  The  Mormon  bishops  cure  all  diseases  by 
the  imposition  of  hands,  or  themselves  administer  the 
remedies;  they  will  not  permit  the  services  of  a  phy- 
sician, and  do  not  scruple  to  denounce  the  use  of  carnal 
means  to  promote  recovery.  The  faith  of  the  ignorant 
Mormon  people  should  not  surprise  us.  since  we  know 
that  many  diseases  are  self-limited,  and  nence  the  efforts 
of  the  bishops  and  elders  seem  in  most  cases  to  be  suc- 
oessfiiL  The  Mormon  belief  in  the  efficacy  of  prayer 
is  quite  as  sensible  as  the  blind  confidence  of  many  in- 
telligent people  in  the  dicta  of  Hahnemann.  The  absence 
of  morbific  causes,  and  the  healthfulness  of  the  dimate, 
render  the  valley  of  the  Gkeat  Salt  Lake  espedally 
desicable  as  a  residence  for  invalids.  There  is  probably 
no  part  of  this  country  more  favorable  for  consumptive 
invalids. — Bariholow.  (Cin.-^Laneet  and  Ob$erver). 

Protisions  fob  the  Physical  A2a>  Medioal  WAjrrs 
or  THE  Metropolis  in  the  tax  levy  ado{>ted  by  the 
late  State  Legislature.    Among  the  apportionments  of 

digitized  by  ^ ^-- 


102 


UBS  MEDICAL  REOOBD. 


4he  ttx  lery  we  notice  the  foUowuig:  City  DiepeDsaridB, 
$11,000;  Donation  to  St  Francis  HospUaL  $5,000: 
to  House  of  Good  Shepherd,  $5,000 ;  Women'9  Medical 
College  and  ChUdren^s  Ho9pital,  $5^000;   Donations, 
Five  roints  Houee  of  Industry,  (or  a  Wodang  Women's 
Home  (provided  the  same  sum  is  raised  by  jMivate  sub- 
soriBtion  within  1867).  $20,000 ;  donations,  Institution 
of  Mercy,  Houston  street  (on  condition  aa  equal  sum 
be  rwsed  by  prirate  donation  in  1867),  $30,000;  dona- 
tions to  the  blind,  distributed  by  Cc^nmissioners  of  Cha- 
rities, $20^000;   Northwestern  Di^ensary  (when  the 
same  sum  is  raised  from  private  souroes)  Sot  new  building, 
$15,000  ;  for  constructing  Inebriate  Asylum,  $100,000. 
A  Substitute  for  thb  SroicioH-PuiCP. — ^Dr.  R.  W. 
Park,  of  Mobile,  Ala.  (Med.  and  Surg.  JB$porter),  calls 
the  attention  of  tiieprofession  to  a  ready  substitnte  for 
a  stomach-pump.    Tne  appiratus  consists  of  a  common 
Davidson's  In(Ua  rubber  syiin^  and  a  large  size  gnm 
elastic  catheter  attached  to  it    By  introdocing  tbe 
catheter  (or  what  is  still  better,  a  stomadi-tiibe)  into 
the  stomach,  and  attaching  it  to  one  end  of  a  Davidson's 
syringe,  the  stomach  can  be  fiBed  in  a  few  seconds  with 
water,  and  by  reversing  the  syringe  as  qnicidy  erupted. 
Dut  for  the  Imfant. — ^The  beet  of  aH  diets  for  an  in- 
fant who  cannot  have  the  bieast^  is  (me  part  of  eceam, 
two  or  three  parts  of  water,  acooitling  ta  the  density  of 
the  oream,  and  enough  sugar  1k>  make  ^e  pnixtore  very 
sweet    The  chemiBts  who  have  analysed  the  milk  pro* 
dnced  by  various  animals,  teUl  us  that  the  fluid  pro- 
duced by  the  woman  and  the  ass  contain  the  smallest 
amount  of  curd,  and  that  both  are  very  saccharine ;  and 
experience  tells  us  that  the   mixture,  recommended 
above,  forms  the  nearest  i^iproaoh  to  the  maternal 
fluid. — Dr.  Inman,  (London  Uodkal  Mnor). 

All  Item  im  the  History  of  the  JK^oval  of  Ovarian^ 
Gtsts. — '*A  woman,  betwixt  twenty  and  thirty  years  of 
age,  had  been  tapped  twice  for  an  ascites,  ^d  a  large 

Quantity  of  water  taken  awi^  at  each  time  *  but  a^r 
le  ^st  operation  the  puncture  did  not  heaJ,  and  in  a 
little  time,  a  substance  ^ley  did  not  understand  pro- 
truding, I  was  desired  to  see  her.  It  was  evidently  a 
part  ot  a  cyst,  and.  as  it  had  already  dilated  the  sore,  I 

Fided  her  to  let  it  alone  till  me  openiog  beoame 
,  in  hope  of  a  better  opportuni^  of  affording  re- 
Accordingly,  in  ten  days  or  a  fortnight  the  pro- 
trusion was  much  larger^  and  by  the  Jielp  of  a  diy  clotii 
a  cyst  that  would  contain  five  or  six  ^dlons  of  water 
was  gradually  extracted.  More  than  a  quart  of  matter 
imm^iately^  foUowed,  and  more  was  daily  discharged 
for  some  time,  yet  the  woman  recovered  without  ftir- 
ther  trouble  than  keeping  the  parts  dean,  and  afterwards 
bore  several  children.  * 

We  have  extracted  the  above  flx>m  ^t  interesting 
and  valuable  work  written  by  Thos.  Kiridand,  entitlec^ 
"  An  Inquiry  into  the  Present  State  of  Medical  Bur 


who  think  the  subject  deserving  attention,  and  time 
win  probably  determine  the  question.'* 

Eighty  years  have  passed  since  the  above  was  pub- 
lished, and  tin^  h|is  determined  the  question,  and  th^l^ 
too,  most  emphatic^y  in  &vor  of  Mr.  Kirkland's  propo- 
sition.— Eomamg^ 


gery,"  published  in  London  in  1786^  vol  2,  p.  195.  We 
give  it  as  an  interesting  item  in  the  history  ofthe  removal 
of  ovarian  cysts,  and  we  may  fiirther  add  that  in  the 
appendix  to  the  same  volume,  p.  570,  Mr.  ^iridand 
makes  the  following  proposition : 

**  We  have  given  an  instance,  p.  196,  where  a  cyst 
being  taken  away  cured  an  ascites^*  and  seeing  medi- 
cines do  not  avail  in  encysted  dropsies  of  the  aMomen, 
is  it  not  worth  our  while  to  consider  whether,  when 
the^  are  unconnected  with  the  acyacent  parts,  after 
takmg  away  the  water,  the  patient  mi^t  not  sometimes 
be  cured  by  enlarging  the  puncture,  pressing  the  cysts 
forwiurd,  and  draining  it  out?"  He  then  proceeds  to 
examine  the  difficulties  in  the  way  and  the  ofc^tions 
which  may  be  brought  against  the  operation,  and  thus 
eonchides:  "At  present^  I  offer  these  hints  to  those | 


The  SiGiis  or  A«e. — ^Bnt  the  aged  are  fer  more 
readDy  pulled  down  by  medicine  than  the  young.    An 
aperient  dose  which  ymL  make  a  lad  more  liv^  than 
before,  will  give  his  father  half  a  week  of  flatuWoy ; 
and  the  blne-pBl  which  was  thought  to  dear  the  Hver  of 
tbe  juvenile  hon-vinmni  is  sore  to  promote  biliousness  in 
the  senile  feaster.    Those  who  in  advanced  years  go  to 
the  druggist  for  a  calomel  purge  to  dear  away  the 
remains  of  some  aldermanic  feast  are  those  most  apt 
to  die  suddenly  of  apoplexy,  and  that  which  has  long 
been  trusted  as  a  Talued  friend,  becomes  at  length  the 
deadliest  oi  -enemies.    But  there  is  another  point  oon- 
neeted  with  advandng  years  which  we  must  advert  to, 
tender  though  the  ground  may  be.    There  is  a  time  in  the 
life  of  a  woman  when  Nature  sets  a  limit  to  her  power 
of  reproduction.  There  are  few  like  Sarah,  who  bec<Hne 
mothers  in  old  age.    In  man.  however,  there  is  no  such 
limit    Abraham,  we  are  tola,  had  a  family  by  Ketorah 
after  his  first  old  wife  was  dead :  and  thoufi^  the  aged 
David  could  lie  quietly  by  the  lovely  Abishag,  at  the 
age  of  eighty,  or  thereabouts,  yet  the  story  runs  that 
'^Old  Parr"  was  arrai^ed  at  a  stiU  more  advanced 
period  of  his  life  for  havmff  violated  some  young  woman. 
A  wide  experience  of  ue  world  tdls  that  marnagfs 
occasionally  are  solemnised  between  affed  men  and 
young  wives,  and  are  sometimes  followea  by  a  fiunily, 
whose  patemi^  is  undoubted.    This  being  so,  there  is 
a  general  belief  that  men  usually  carry  into  years  the 
pow^v  they  h»ve  m  youth,  and  they  oonseqifently  try 
to  demonstrate  year  after  year  to  themselves  that  no 
sign  of  age  has  yet  feUen  on  them.   I  once  heard,  with 
the  most  profound  disgust^  an  old  colonel  of  sevens- 
five  say,  in  a  mixed  eompai^,  that  his  fourth  wife  wfs 
as  well  treated  as  his  first,  and  his  tone  and  manner 
showed  how  proud  he  was  of  making  the  boast    A 
few  months  only  elapsed  ere  he  succumbed  to  an  at- 
tack of  fever,  apparently  mild. — Thomas  Inman^  M.D, 
(Londam  Medical  Mirror), 

Tps  CiTT  or  Austin,  Nevada^  is  six  thousand  feet 
above  sea  level,  where  the  air  is  so  thin  that  the  least 
physical  labor  causes  great  shortness  of  breath,  and  the 
atmospheric  pressure  is  so  light  that  those  of  its  fowr 
thousand  inhal^tants  who  find  it  necessary  to  wear  ar- 
tificial teeth  experience  extreme  difficulty  in  keeping 
tli^ir  sets  in  position. — ScL  Amerietm. 

Ax  EzTDfOT  Baob. — One  of  the  most  remarkable 
races  that  ever  inhabited  the  earth  is  now  extinct 
They  were  known  as  the  (ahianohes,  and  were  the 
abongines  of  the  Canary  Islands.     In  the  sixteeoch 
century,  pestilence,  slavery,  and  the  cruelty  oC  the  Smd- 
iards  succeeded  in  total^  exterminating  them.    They 
are  described  as  having  been  gigantic  in  stature,  but  of 
a  singularly  mild  and  gentle  nature.    Their  food  oonr 
stated  of  barley,  wheat,  and  goat's  milk,  and  their  agricul- 
ture was  of  the  mdest  land.    The^  had  a  religion  which 
taaght  them  of  a  future  state,  of^rewacds  and  puniah- 
menU  after  death,  amd  of  good  and  evil  spirits.    They 
regarded  the  vokwoo  of  Tenerifie  as  a  poniahment  wt 
the  bad.    The  bodies  of  their  dead  were  oarefiiUy  eoK 
balmed  and  deposited  in  catacombs,  which  still  continaa 
to  be  an  object  of  onriosity  to  those  who  visit  the 
island.    Th^r  Boarriage  rites  were  very  solemn,  and  ber 
fore  engaging  in  them  the  brides  were  fettened  on  miDc. 
At  the  present  day,  these  strange  people  are  totals  ex- 
tinct—ifaei  amd  Sitr§.  Eeporier. 


Digitized  by 


Google 


THE  MEtolCAL  RECORD. 


193 


€>ri0mal  Communitatona. 

OUB  PRESENT  EXACT  KNOWLEDGE  OF 
THE  CAUSES  OF  CHOLERA. 

RSAD  BSrOBB  THE  NIW  YORK  MEDIOAL  JOURNAL  ABSOOIATION, 

By  M.  fiERZOG,  M.D., 

or  KXW  TOBK. 

Thi  history  of  our  knowledge  of  the  propagation  of 
Cholera  can  be  divided  into  two  periods.  I.  From  the 
year  1830  to  1849,  and  H.,  from  1849  to  the  present  time. 
This  first  period  is  distinguished  according  to  the 
metaphy«ical  tendencies  of  that  time,  more  by  abstract 
doctrines  and  the  statement  of  £ftcts  without  connect- 
ing causes  and  effects,  than  by  any  systematic  attempt 
it  scientific  investigation.  We  nnd  after  every  epi- 
,emic  in  every  part  of  the  world  the  medical  profession 
iivided  into  two  great  factions,  contagionists  and  anti- 
contagionists ;  and  their  respective  Opinions,  formed  on 
accidental  and  general  impressions,  or  through  prejudi- 
cial teachings  of  men  high  in  professional  auuiority,  and 
never  discussed  on  the  merits  of  their  own  case, 
but  only  on  the  weakness  or  shortcomings  of  the  others, 
have  found  the  best  reflex  in  the  pubUc  opinion  on  the 
prevention  of  Cholera.  The  people,  bewildered  by  the 
great  mortality  of  every  Cholera  Epidemic  and  the  ap- 
parent ignorance  of  the  physicians,  resorted  to  such 
extraordmary  preventive  measures  as  the  wearing  of 
amulets  and  drinking  Cholera  drops,  to  fumigating 
the  air  with  suffocating  bonfires,  and  sending  tobacco- 
smoking  soldiers  through  infected  streets.  In  some 
places  of  Italy  the  fanatic  ignorance  has  reached  such 
a  pointy  that  physicians  and  Jews  have  been  murdered 
upon  suspicion  of  poisoning  the  wells  and  producing  the 
disease.  But  prominent  and  good  observers  of  the  na- 
ture of  the  disease  have  been  found  at  all  times,  and 
even  this  period  of  conclusions  post  facta  has  produced 
some  records  and  essays  on  Cholera  which  have  been 
made  the  basis  of  future  exact  and  natural  scientific  in- 
vestigation. 

To  English  writers,  as  Jameson  of  India,  Simpson, 
Parkes,  Budd,  and  many  others,  more  than  to  all  conti- 
nental writers  of  that  period,  belongs  the  honor  of  a 
correct  and  comparatively  true  interpretation  of  the 
causes  of  the  Propa^tion  of  Cholera. 

A  curious  historic^  fact  may  be  here  briefly  alluded  to : 
The  very  first  report  made  in  Europe,  1829,  by  twenty- 
four  Russian  physicians  sent  by  the  Kussian  Gkvemment 
to  the  Asiatic  frontier  to  study  and  observe  the  nature  of 
the  approaching  disease,  and  published  by  Prof  Tilesius, 
1830,  has  the  following  conclusion:  "I  do  not  know 
much  about  fixed  and  volatile  contagion,  but  the  fact 
seems  to  me  very  important,  that  Cholera  Is  positively 
infectious  through  privies." 

The  epidemic  in  Great  Britain,  1849,  brings  us  to  the 
second  period — to  the  period  of  our  more  exact  and  sci- 
entificauy  connected  knowledge  of  the  causes  of  Cholera. 

Snow's  and  Simon's  very  valuable  and  positive  de- 
monstration of  the  influence  of  drinking  water  from  wells 
and  aqueducts  polluted  with  sewers  from  privies,  must 
be  considered  as  the  first  link  in  our  future  chain  of  ex- 
act knowledge. 

Parr's  excellent  tables  on  the  difference  of  mortality 
of  Cholera  according  to  the  elevation  of  the  ground,  are 
also  truthful  contributions  to  our  exact  knowledge, 
when  the  nature  of  the  ground  and  the  communication 
•re  comparatively  the  same. 

A  very  interesting  feature  of  the  epidemic  in  Eng- 


land, 1849,  was  the  attempt  of  eminent  men  to  give  a 
distinct,  fixed  expression  as  to  the  nature  of  Cholera 
poison  through  researches  of  the  microscope ;  but  it  fail- 
ed totally,  and  had  the  evil  result  of  bringing  this  doc- 
trine into  distrust,  particularly  amongst  the  eminent 
men  in  this  country.  The  fault  was  not  m  the  inert  truth 
of  the  fact,  but  in  the  unmethodical  and  unsystematical 
w^  of  investigation. 

Britton  and  Swayne  reported  to  the  Bristol  Society 
of  Physicians  that  they  found  ring-formed  objects  which 
have  not  been  discovered  in  other  evacuations.  Budd 
examined  the  drinking  water  of  the  infected  districts  and 
found  similar  objects,  each  of  the  gentlemen  giving  dif- 
ferent names,  according  to  his  own  impression,  as, 
Cholera  cells.  Cholera  fungi,  and  Cholera  sporuli. 

Baley  and  Cull,  in  a  report  to  the  College  of  Physi- 
cians, in  London,  denied  the  existence  of  every  one  of 
the  objects  seen  by  the  Bristol  Committee  as  character- 
istic of  Cholera^  and  maintained  that  they  might  have 
been  introducea  into  the  system  by  food  or  medicines, 
and  were  not  to  be  found  in  Cholera  foci. 

A  Later  Qorman  critic  believed  that  the  Bristol  Com- 
mittee had  seen  eggs  of  helminths,  and  another  eminent 
microscopist  exclaims  in  despair,  that  he  cannot  make 
out  what  the  different  objects  were,  these  different  men 
in  England  have  seen  and  described. 

The  great  idea  of  fermentation  so  ingeniously  illus- 
trated and  described  by  Liebig  in  his  Chemical  Letters 
and  the  Doctrine  of  the  Origin  and  Growth  of  Spores,  a 
distinct  science,  so  extensively  cultivated  in  France  and 
Germany,  seems  not  to  have  been  the  foundation  relied 
upon  in  the  English  investigations. 

The  epidemic,  1854,  found  in  EngUind  superior  saa- 
itary  officers,  with  excellent  advantages  derived  fi^om  the 
published  Report  of  the  Causes  of  Mortality  of  Cholera 
in  1849,  and  prepared  with  practical  preventive  mea- 
sures. 

In  Germany.  1864,  we  find  the  old  difference  of  opin- 
ion on  theoretical  points :  no  sanitary  preventive  mea- 
sures whatever,  care  and  hospitals  for  the  poor,  physi- 
cians and  medicines  firee  of  charge,  a  police  order  against 
sour  beer,  unripe  fruits,  and  old  meat :  excellent  mea- 
sures, as  Pettenkofer  remarked,  the  whole  year  round, 
but  it  was  nothing  specific  against  Cholera. 

The  intensity  of  the  epidemic  in  Bavaria,  1864,  was 
great;  16,000  well  marked  cases,  with  the  usuid mortal- 
ity of  55— -60  per  cent  This  epidemic  was  fruitfiil  of 
great  scientific  investigations  and  the  most  important 
practical  results. 

Professor  Pfeufer,  the  well  known  clinical  teacher  and 
the  most  experienced  in  personal  observation  of  Cholera 
all  over  Europe  from  1830  to  1854,  was  in  1854  as  non- 
committal on  the  causes  of  propagation  of  Cholera  in  his 
cUnical  lectures,  as  we  have  seen  our  distinguished 
Professor  Clark  in  1866;  but  one  thing  was  clear  to  his 
mind,  that  this  problem  could  never  be  successfully 
solved  by  sanitary  officers  or  physicians  alone ;  that  the 
specific  laws,  regulating  this  universal  specific  and 
uniform  disease,  could  only  be  interpreted  by  the  high- 
priests  of  medicine — that  is,  the  leadmg  minds  in  natural 
sciences. 

Meteorology,  Ceology,  Chemistry,  Zoology,  Botany, 
Microscopy,and  PathoIo^icalAnatomy,  were  represented 
in  this  scientific  commission  by  the  most  eminent  of  (Ger- 
man natural  philosophers ;  sanitary  officers  and  physi- 
cians, in  distinct  contrast  to  former  and  later  reports, 
taking  only  the  part  of  co-workers  and  faithfid  reporters 
of  facts,  but  not  of  expounders  of  "  post  hoc,  ergo  prop-' 
ter'  hoc  "  conclusions. 

The  axioms  laid  down  by  this  conmiission  have  be- 
come,  as  you  will  easily  perceive,  international  property, 
^e  leading  and  comprehensive  mind  oftius  commiSEdpn, 


194 


THE  MEDICAL  RECORD. 


Pettenkofer,  who  is  a  strictly  positive  and  ingenious 
scholar,  has  become,  by  his  unsurpassed  and  excellent 
essays  onthis  and  similar  subjects,  tne  attractive  centre  of 
all  medical  and  sanitary  authorities  of  the  present  time.'*' 

I  may  close  my  remarks  on  this  general  subject  with 
the  same  words  as  I  closed  a  communication  to  the  Sani- 
tary Committee  of  this  city  more  than  a  year  ago.  "  The 
value  of  this  scientific  report  has  made  it  a  standard 
and  a  guide  for  future  investigations  and  actions." 

The  actions,  as  you  well  know  have  been  faithfully 
and  successfully  executed  by  the  Sanitary  Committee — 
the  future  investigations  belong  to  the  specialist  of  our 
profession. 

In  bringing  before  you  the  leading  points  essential  to 
produce  Cholera,  I  shall  keep  myself  strictly  to  the  three 
fundamental  laws  laid  down  by  Prof  Pettenkofer,  leav- 
ing out  the  fourth  law — the  individual  disposition — the 
physiology  and  pathology  of  which  has  not  advanced 
enough  lor  exact  knowledge. 

I  shall  endeavor  to  illustrate  each  point  by  our  actual 
and  practical  experience,  acquired  in  the  last  and  former 
epidemics. 

/.  The  specific  germ  is  propagated  in  Cholera  Diar- 
rhcoa^  or  in  the  evacuaUons  of  persons  coming  from  places 
infected  vnth  Cholera, 

This  term, "  specific,"  has  been  given  to  Cholera  by  a 
thousand-fold  repeated  observations  of  its  nature,  and 
by  hundreds  of  excellent  observers. 

I  will  now  inquire  into  the  exact  nature  of  "  specific 
germs,"  in  contrast  with  other  intestinal  evacuations. 

The  discharges  of  Cholera,  and  the  rice-water  and  pri- 
mary diarrhoea,  have  invariably  an  alkaline  reaction. 
The  diarrhoea,  in  contact  with  other  organic  matter, 
particularly  excrements,  has  the  power  of  imdergoing  a 
chemical-  process  (fermentation),  producing  an  enor- 
mous fauna,  in  contrast  with  other  evacuations  under 
similar  conditions — a  fact  described  after  careful  com- 
parisons by  Prof.  Siebold,  the  greatest  zoologist  of 
Europe.t 

This  diarrhoea,  in  itself  harmless,  undergoes  first  a 
chemical  process  that  gives  it  the  property  of  a  metabolic 
poison,  with  reproductive  power  j  secondly,  this  meta- 
bolic poison  has  a  time  of  incubation,  exhausts  its  effects 
on  the  organism  with  one  attack,  that  is,  imparts  to  the 
same  an  immunity  for  a  long  time  after.  Ingenious  and 
successful  experiments  of  infection  on  &nimals,  produc- 
ing the  characteristic  symptoms  and  anatomical  altera- 
tions, made  by  Lindsey  in  Edinburgh,  and  by  Thiersch 
in  Munich,  tmder  the  direction  of  eminent  chemists  and 
anatomists,  give  the  most  important  evidence  in  favor 
of  the  term  specific,  in  contrast  with  other  evacuations 
not  having  this  infecting  power,  and  in  contrast  to  ab- 
solute contagious  diseases  like  measles,  scarlatina,  small- 
pox, producing  apparently  at  once  a  "ready-made" 
contagion.  Without  anticipating,  I  may  briefly  state 
here,  that  Pettenkofer  and  Thiersch,  in  1856,  advanced 
the  idea,  that  this  cholera  ferment  must  finally  produce  an 
organic  cell  or  spore,  embodying  the  propagating  power, 
and  that  Liebig.  in  a  popular  essay,f  eicpressed  his  de- 
cided opinion  tnat  the  whole  cholera  process  is  to  be 
found  in  a  yeast-spore.  I  would  certainly  rely  on  such 
Interpreters  of  natural  phenomena  in  organic  chemistry. 
I  may  plainly  ask  you,  "  Who  knows  better  ?  " 

Tins  distinct  characteristic  symptom  for  Cholera  and 
diarrhoea  may  have  been  sufficient  for  the  term  specific; 
but  the  last  epidemic  of  1866,  in  Austria  and  Prussia, 
brought  forward  the  most  interesting  and  surprising 
facts,  corroborating  fully  the  above  investigations  and 


•  International  Cholera— Conference  at  Weimar, 
t  Beport  on  Cholera,  bythe  Royal  Bavarian  OommlBslon  for  Soie&tmo 
lATestlgaUon,  Manioh,  l£i67. 
t  Aagsbarg  Allgemeina  Zeitong,  24  Jan.,  1866. 


opinions.  I  hope  that  in  due  time  a  more  competent 
person  will  be  found  to  explain  to  you  the  microscopical 
details,  and  I  will  to-day  only  lay  before  you  the  most 
important  results  with  the  drawings  of  both  works. 

Klob's  studies  on  Cholera,  publiSied  this  year  in  Vi- 
enna, have  been  made  with  the  view  of  comparing  the 
different  consecutive  stages  of  Cholera,  from  diarrhoea  to 
rice-water  stools,  with  the  evacuations  of  other  patients, 
taking  dysenteria,  typhus,  marasmus  of  children,  simple 
diarrhoea,  and  healthy  fssces,  as  the  bases  of  his  microsco- 
pical and  comparative  chemical  investigations.  It  is  a 
well  known  fact  to  you,  that  spores  in  different  forms 
have  been  found  in  muguet,  and  sarcina  in  the  stomach, 
and  certainly  in  the  mucous  membranes  of  the  intestines, 
connected  witii  physiological  fimctions  and  pathological 
processes ;  but  Prof  Klob  discovered  inCholera  dejections 
such  enormous  quantities  of  spores  and  fungi  extend- 
ing gradually  firom  the  oesophagus  over  the  stomach 
down  to  the  intestinal  canal,  as  to  form  a  perfect  gela- 
tinous substance  in  the  int^tines  (called  in  zoological 
terms  "  Termo  Zooglea,"  spore-bed)  and  not  to  be  mis- 
taken for  mucus  or  albuminous  aggregates. 

This  form  of  fungi,  its  quantities,  and  its  distinct, 
characteristic,  genetical  progress,  has  never  been  before 
observed  or  described,  according  to  Klob,  by  any  other 
authority,  in  the  intestinal  discharges,  from  the  first 
slight  discharge  to  the  rice-water  stools.  Klob  describes 
the  difierent  consecutive  phases  of  the  organic  life  of 
the  spores,  and  maintams  that  in  the  last  stage  they 
have  lost  their  peculiar  movements,  and  losing  the 
characteristic  aspect,  undergo  the  decaying  metamor- 
phosis of  all  spores  which  is  called  by  zoologi^  bacterian 
gelatina 

Klob  promised  to  publish  in  his  next  paper  the  re- 
sults of  experiments  with  the  characteristic  Cholera 
fimgi  in  regard  to  its  breeding  properties. 

Independent  of  Klob,  in  Vienna,  and  in  the  same 
month,  February,  1867,  we  find  published  at  Berlin 
(Virchow's  Archiv,)  by  Dr.  Thom^,  Professor  of  Botan- 
ical Zoology,  the  discovery  of  a  new  exotic  yeast- 
spore,  specific  to  Cholera,  bred,  nursed,  and  fructified  in 
the  difierent  stages  of  Cholera  and  diarrhoea,  in  living 
persons,  described,  defined,  and  designed  in  accordance 
with  Klob's  results,  only  more  practically  characterized, 
and  the  spore's  Hfetime  more  brilliantiy  interpreted  and 
illustrated.  With  true  scholar-like  enthusiasm,  he  bap- 
tized the  new  foundling  with  an  endless  number  of 
Q-reek  and  Latin  names. 

For  the  careful  student  of  Cholera,  the  origin,  exist- 
ence, and  decay  of  this  spore,  are  the  most  interesting 
photograph,  a  perfect  miniature  picture  of  the  laws  reg- 
ulating the  propagation  of  Cholera,  as  will  be  seen  by 
taking  into  account  the  necessary  time  to  fructify  (repre- 
sented as  incubation);  the  tendency  to  multiply  and  fruc- 
tify, when  taken  from  the  first  stages  of  diarrhoea  (a 
danger  long  ago  jwinted  out  by  Pettenkofer) ;  the  in- 
tensity of  multiplication,  under  more  or  less  favorable 
conditions  of  fermentation  (expressed  in  Pettenkofer's 
infectious  focus) ;  the  shrinking  and  immediate  stopping 
of  vitality  in  the  least  contact  with  mineral  acids  and 
metallic  salt<«,  and  the  perfect  disorganization  of  the 
spore  under  the  influence  of  70  degrees  Reaumer  (pro- 
totyped as  usefiil  disinfectants) ;  the  relative  insensibility 
and  continuation  of  vitality  under  contact  with  alkaline 
solution  (demonstrating  the  insufficiency  of  chloride  of 
lime,  so  long  recommended  by  sanitary  officers) ;  and 
a  limited  period  of  the  spore's  lifetime  (the  exact  expe- 
rience laid  down  in  the  Bavarian  report  of  the  limited 
time  in  which  certain  localities  and  their  inhabitants 
are  exposed  to  Choler;a  raorbilhty,  and  after  this  time 
the  existing  ferment  has  lost  its  specific  danger). 
I  The  most  important  result  of  Klob^  and  Thomas 
Digitized  by  V^jOO^  ^  _ 


THE  MEDICAL  RECORD. 


195 


inTesUgation  is  the  fact  that  in  the  last  stages  0f  Cholera 
the  spores  have  lost  their  specific  form,  yitalitj,  and 
ha?e  already  uodergone  a  decomposition,  not  exclusive, 
idiopathic  of  Cholera.  Thom^  could  never  succeed  in 
cultivating  and  fructifying  Cholera  spores  from  the  last 
stages. 

We  are  not  without  analogous  observations  in  daily 
practice :  the  epidemic  cattle-plague,  the  infectious  in- 
flammation of  the  spleen  (Melzbrand),  have  been  posi- 
tively explained  and  demonstrated  by  the  presence  of 
specific  epores.  The  grape-vine  and  potato  disease  have 
each  their  defined  and  classified  spore. 

Thiersch  made  it  an  axiom  for  all  metabolic  poisons 
that  the  time  of  their  propagating  possibility  was  limited. 
There  can  be  no  doubt  that  scarlatina,  measles,  and 
hooping-cough  have  their  times  of  contagiousness  and 
non-contagiousness,  only  not  so  fuUy  studied  and  de- 
monstrated as  in  cholera. 

The  studies  of  incubaiion  and  quarantine  are  insep- 
arably connected.  There  was  never  a  Cholera  quaran- 
tine in  this  country,  from  the  first  establishment  to  the 
present  day.  Quarantines  have  never  been  overleaped 
by  the  Cholera  poison ;  the  doors  have  been  ignorantly 
left  wide  open.  Cholera  patients  have  been  scrupulous- 
ly guarded, — very  innocent  parties;  but  intected  and 
apparently  healthy  passengers  have  been  discharged 
daring  the  time  of  incubation,  positively  the  most  dcmger- 
ottt  partieSf  propagating  by  their  cholera-fructified  dis" 
thargeSj  as  disseminating  foci,  the  disease  as  quick  as 
railroads  and  steamers  will  bring  them.  From  the  ig- 
norance of  this  law  of  propagation  we  are  enabled  to 
explain  all  the  "mysterious  subtlety  of  the  volatile 
choler»-poison,"  so  often  alluded  to  by  sanitary  officers. 
The  infection  of  Ward's  Island,  November,  1865,  by 
a  norse  discharged  firom  the  cholera  ship  "Atlanta^" 
and  readmitted  for  a  sore  foot  on  Ward's  Island,  never 
suspected  or  treated,  is  fresh  in  the  recollection  of  all. 

Pettenkofer,  more  than  twelve  years  ago,  pointed 
(rat  the  great  danger  of  slight  diarrhcea,  as  cause  of  pro- 
pagation,* and  Klob's  and  Thome's  experiments  have 
confirmed  it  as  exact  knowledge,  that  the  last  stage  (rice- 
water)  represents  the  state  of  the  disease  emasculated 
(non-contagious) . 

The  many  puzzling  quarrels  of  contagionists  and  non- 
contagionists  must  be  explained  by  these  facts;  the 
striking  exemption  of  physicians,  nurses,  and  washer- 
women, in  regular  Cholera  hospitals,  where  mostly  the 
last  stages  are  brought  ia,  is  now  better  understood,  and 
the  mysterious,  intense,  volatile  poison,  supposed  as  pro- 
pagdted  through  distances,  in  the  air,  will  mvariably  be 
found  to  have  a  very  limited  and  localized  focus  estab- 
lished by  a  specific,  perhaps  hardly  perceptible — diar- 
rhoea. 

Quarantines  may  be  entirely  abolished  as  impracti- 
cable for  international  and  commercial  intercourse,  and 
disinfectants  only  relied  on ;  but  I  warn  you  against  the 
fiollowing  lesson,  taught  to  us  in  the  Beport  of  the 
Board  of  Health. 

"Ole^iaing  of  the  emigrants  and  their  baggage,  but 
not  the  absurdity  of  protracted  detention,  testing  the 
limitation  of  infection  self-productive,  are  required  in 
the  most  absolute  sense  for  the  security  of  the  public 
h«dth,  and  scarcely  less  for  the  welfare  of  emigrants 
themselves."  + 

Obedience  to  the  laws  of  nature  may  sometimes  be 
ine^edient  and  impossible:   but  the  above   opinion 
could  only  have  been  formed  in  ignorance  of  our  pres- 
ent exact  knowledge. 
The  connection  of  disinfections  with  cholera-diar- 


*  UnAQimoasly  Adopted  by  the  Cholera  CoDference,  In  Oonatantfiu)- 
pKManb81,ld«6.  t  Pages  IM,  157. 


rhosa,  so  well  known  by  the  doctrines  of  Pettenkofer  and 
great  practical  successes  of  sanitary  officers,  has  been  in- 
geniously confirmed  by  the  experiments  of  Thom^ ;  but 
the  first  case  of  infection  in  a  given  locality  (house  or 
institution)  discovered,  and  disinfection  is  no  protection 
any  more  for  the  inhabitants  of  the  same  place ;  always 
practicable^  always  justified,  it  leaves  the  people  (inside 
the  focus)  to  the  mercy^of  their  own  personal  resistance, 
differing  only  in  time  of  incubation,  and  protecting  t^e 
new  arrivab  fi'om  the  action  of  the  ^ecific  poison,  and 
preventing  further  propa^ting  possibilities. 

The  disinfections  at  Blackwell's  Island,  justified  by 
every  experience,  and  executed  with  practical  prompt- 
ness, are,  in  facts,  dates,  maps,  time  of  morbillity  and 
mortality,  the  best  proof  of  the  perfect  inaction  of  dis-- 
infection  at  such  a  late  period  of  the  disease.  Greater 
mortaUty  has  been  perhaps  prevented  by  hygienic 
measures  ordered,  making  individual  persons  more 
resistible  against  the  disease,  but  the  specific  cholera- 
poison  has  taken  its  usual  time  of  waving  intensity, 
for  about  four  weeks  after,  independent  and  iindisturbed 
by  disinfections,  it  was  limited  only  by  the  naturally  ac- 
quired immunity  of  the  inhabitants.  I  may  safely  assert 
that  the  conclusions  drawn  and  indorsed  by  excellent 
names  in  this  city  on  the  Blackwell's  Island  disinfection, 
will  at  once  be  repudiated  by  Pettenkofer,  as  not  war- 
ranted by  our  present  exact  knowledge  of  the  natural 
course  of  the  disease. 

I  come  now  to  the  second  essential  point  for  Cholera 
epidemic : — 

II.  A  soU  impregnated  wit^  organic  matter  and  permea- 
ble for  air  and  toater  to  a  certain  depth,  {To  ihe  depth  of 
the  sub-soil  water.) 

To  meet  in  advance  certain  objections  I  must  explain 
that  the  word  *soil'  must  not  be  exclusively^  taken;  it 
is  only  in  the  largest  scale  the  representative  idea  of 
certain  chemical  processes  in  combination  with  water 
and  air.  A  spon^  with  a  specific  diarrhoea,  a  wooden 
bed-chamber,  clotSdng,  a  wooden  drain-pipe  in  an  emi- 
grant ship  impregnated  with  specific  diarrhoea,  exposed 
to  humia  air  have  been  over  and  over  again  admitted 
by  Pettenkofer  as  small,  very  circumscribed  infectious 
foci  I  must  further  mention  that  the  objection  made 
to  the  whole  doctrine  of  this  second  point  by  Drasche, 
and  quoted  in  Prof.  Clark's  Lectures  and  Dr.  Burrall's 
book,  has  been  already  fully  contradicted,  1861,  as  un- 
founded on  factH* 

The  comprehension  of  these  differences  of  soil,  in  con- 
nection with  Cholera  diarrhoea,  must  for  ever  abolish 
strict  contagionists  and  non-contagionists. 

The  soil,  as  the  natural  receptacle  for  human  excre- 
ments, is,  under  the  above  conditions,  the  great  chemical 
ferment-basis  for  spore-breeding,  so  beautifiilly  imitated 
in  Thomas  laboratory ;  while  in  contrast,  the  impermea- 
bility of  the  soil  for  water  and  air  represents  the  chemi- 
cal process  so  well  known  as  Munimification,  or  Local 
Immunity  against  Cholera. 

A  number  of  charts,  published  by  Pettenkofer  in  con- 
nection with  the  Bavarian  Scientific  Report,  1854,  repre- 
sent in  differently-colored  lines  a  large  number  of  places 
inflicted  with  or  exempted  from  Cholera,  according  to  the 
permeability  or  impermeabifity  of  the  soil  for  water  and 
air,  independent  of  mineralogical  aggregations,  but  al- 
ways influenced  by  physical  compactness  or  porosity 
of  the  ground.  Similar  constant  old  exemptionB  have 
been  ol^erved  in  many  places  of  the  world,  but  never 
understood  or  explained  on  their  scientific  relations.! 

•  Joamal  t  BioloKie,  toI  1.  page  11. 

t  Pettenkofer  complained  hi  one  of  hia  late  wrftingB  that   the 

cbarta  are  so  little  known  amongst  sanltaiy  officers;  tbey  will  hare 

formed  the  meet  Interesting  feature  in  the  Cholera  Gonferenoe  at 

Weimar.  i 

Digitized  by  ^ 


unoiera  i;onrere] 

Goo^. 


196 


THE  MEDICAL  RECORD. 


These  charte  will  definitively  answer  Prof.  Clark*8  ques- 
tion in  his  lectures  on  Propagation  of  Cholera.  Why, 
if  Cholera  is  contagious,  is  it  only  contagious  in  Cumber- 
land and  Columbia,  and  not  in  other  places  where  in- 
fected people  have  been  communicated  with,without  pro- 
ducing an  Epidemic  ?  The  infected  or  exempted  locali- 
ties in  Pennsylvania  must  logically  find  their  places  un- 
der the  blue  or  red  lines  of  Petienkofer's  charts,  but 
more  than  that,  a  study  of  the  facts  and  ideas  expressed 
by  these  differently-colored  lines,  based  on  unsurpassed 
exact  investigations,  makes  us  independent  of  all  dif- 
fused generahties,  as  Cholera-fields,  dampness,  dirt,  ill- 
ventilation,  etc.,  helping  only  as  intensifying,  but  never 
as  producing  causes. 

We  find  this  fact  illustrated  in  our  daily  experience 
€k)vemor's  Mand  and  Hart's  Island,  U.  S.  military 
posts,  as  well  kept  as  any  similar  places  in  the  world, 
afiOlicted  with  Cholera.  Tybee  Island,  a  model  of  venti- 
lation, we  find  a  hot-bed  for  Cholera.  Andersonville  and 
Libby  prison,  verily  cholera-fields,  without  the  least 
suspicion  of  the  disease. 

An  ill-ventilated,  crowded  tenement-house,  vnth  ex- 
traordinarily dirty  inhabitants,  may  safely  overcome  the 
specific  germ  brought  there  if  their  excrements  are 
washed  constantly  with  fi'esh  water,  neutralizing  as  the 
most  natursi  disinfecters  the  ferment  process  of  a  per- 
meable soil ;  or  immunity  may  take  place,  if  their  privies 
by  fortunate  accident  are  located  on  a  piece  of  ground, 
where,  by  iropermeabihty  to  humid  air,  mummification 
must  take  place.  A  excellent  country-house — on  por- 
ous soil  and  with  unexceptionable  sanitary  inhabitants 
and  regulations,  may  be  visited  by  an  unsuspected  specific 
diarrhoea — the  privies,  in  the  house,  behind  or  slightly  in- 
clining against  the  house,  and  a  cholera- field  is  produced 
— a  subtle  mystery  in  general  sanitary  expressions. 

Farr*s  Tables  on  the  Influence  of  Elevation  on  Mortal- 
ity of  Cholera  are  the  true  index  of  actual  facts,  when  the 
soil  is  equally  porous,  and  the  specific  germ  is  dissemi- 
nated through  the  soil. 

Medical  officers  in  India  and  the  Crimea  give  very  in- 
structive lessons  of  the  great  danger  of  privies  situated 
higher  than  the  camping  ground.  The  dissemination  of 
liquid  matter  in  a  porous  inclining  ground  takes  place, 
not  alone  to  a  relative  large  extent,  but  with  great  rapid- 
ity. I  know  a  case  fi-om  personal  experience,  where  two 
old  bedridden  persons  in  a  village,  wUhout  the  least 
personal  communication  from  without,  both  died  in 
twenty-four  hours  of  Asiatic  Cholera ;  200 — 300  feet 
above  in  a  straight  line  a  cholera  focus  existed.  I  reported 
the  waves  of  the  wind  as  tlie  communicating  medium ;  but 
Pettenkofer,  not  beUeving  in  dissemination  of  Cholera 
through  the  air  at  such  distances,  found  by  the  aid  of 
the  axe  and  the  shovel,  that  the  greater  part  of  the' 
liquid  exorements  firom  the  house  above  reached  their 
last  resting-place  underneath  the  house  so  mysteriously 
afflicted  with  cholera. 

In  such  exceptional  cases  the  soil  is  not  only  the  pro- 
ducer, but  also  the  propagator  of  the  specific  infection 
to  some  distance,  without  the  necessary  personal  inter- 
course. I  suspect  the  house  epidemic  of  the  Broome 
street  lawyer  accused  of  a  damp  basement  to  have  a 
similar  specific  connection'*' 

Pettenkofer's  personal  investigation  and  description 
of  the  Cholera  in  Switzerland  gives  us  the  facts  of  an  in- 
tense epidemic  in  a  high  mountain  village,  with  perfect 
immunity  for  tlie  villiSfes  below ;  the  difference  in  the 
permeability  of  the  soil  determined  the  infection  or  ex- 
emption. Cholera  is  independent  of  height  or  depth 
in  an  absolute  sense  of  the  word.    Alluvial  soil  has  been 


*  Cholers  Beport  of  Dr.  RuriB  for  1666,  page  167. 


found  to  Bxist  on  the  Alps  as  well  as  on  the  top  of 
the  Pyrenees.  The  greatest  mortahty  in  Europe,  in 
proportion  to  population,  was  amongst  the  thousands 
of  laborers  during  the  building  of  the  great  Somering 
Mountain  Railroad. 

Pettenkofer  visited  this  place.  Besides  the  necessary 
conditions  for  Cholera — specific  germ  and  porous  soil — 
their  terrace-like  built  huts  had  invariably  their  privies 
behind  and  above  them.  Fresh  mountain  air,  unpol- 
luted spring-water,  regular  employment,  and  whole- 
some fbod,  had  hardly  any  mitigating  influence  in  pres- 
ence of  this  ignorance  of  the  laws  regulating  the  propa- 
gation of  the  specific  cholera-poison. 

You  will,  of  course,  ask  the  question — ^How  can  Cholera 
prevail  with  fermentation  as  the  fundamental  principle, 
which  never  can  take  place  in  freezing  temperatures 
many  degrees  below  zero?  In  Russian,  French,  and 
German  cities  privies  are  in  the  houses  or  cellars,  well 
protected  against  such  low  temperature ;  and  Petten- 
kofer initiated  the  sugar  fermentation  successfully  in 
such  places  during  winter  time.  Open  countries,  and  I 
believe  the  United  States,  with  difierent  arrangements 
for  privies,  have  never  been  visited  by  Cholera  during 
the  winter  season. 

Tlie  greater  part  of  this  city  (New  York)  is  above 
the  malign  influence  of  a  permeable  soil  in  relation  to 
epidemic  Cholera.  Our  privies,  constantly  flooded  with 
firesh  water,  are  self-disinfecting,  fermentation-prevent- 
ing institutions.  A  case  infected  outside  may  end 
fatally  in  Madison  Avenue,  and  by  the  very  limited 
infectious  focus  of  Hnen  and  clothing  infect  the  nearest 
persons  accidentally ;  but  that  powerful  ferment  (specific 
miasma)  producer — the  soil — ^is  harmless  for  the  greatest 
part  of  this  city. 

This,  my  personal  opinion,  I  expressed  long  before 
the  outbreak  of  Cholera  in  this  city,  and  I  see  it  fully 
confirmed  from  the  mortality  in  streets  and  houses*  dur- 
ing the  last  epidemic.  No  allusion  is  made  or  conclu- 
sion formed  in  the  Report  for  1866  on  these,  for  many  of 
our  fellow-citizens,  so  important  and  consoling  facts. 

I  give  you  the  analogous  experience  made  in  my 
own  native  city,  Munich,  1854,  to  justify  my  deliber- 
ately expressed  opinion.  During  the  whole  intense 
epidemic,  two  houses,  a  poor-house  and  a  penitentiary, 
situated  on  porous  soil,  surrounded  by  Cholera,  without 
any  restricted  intercourse,  without  any  disinfectants, 
the  specific  germ  introduced  (by  light  and  fatal  cases), 
the  Cholera  never  took  hold  in  the  slightest  degree, 
amongst  the  hundreds  of  generally  susceptible  people 
of  this  institution ;  a  remarkable  and  surpiising  excep- 
tion I  Springs  rising  on  the  top  of  the  hill  were  run- 
ning in  their  course  to  the  river  below,  beneath  the 
soil  of  the  two  large  buildings,  and  prevented,  by  con- 
stantly fi'esh  water,  the  genetical  and  dangerous  growth 
of  the  exotic  sporej — the  product  of  the  specific  Cholera 
fermentation. 

Besides  the  striking  analogy  of  these  two  institutions 
in  Munich,  and  our  Cro ton- water  washed  privies,  such 
case^  teach  us  the  moral  lesson,  that  sometimes  ap- 
parent deviations  in  facts,  with  exact  investigations, 
become  convincing  proofs  of  fiindamental  truths. 

The  practical  conclusions  on  this  second  point  are 
covered  mostly  by  the  well  known  doctrines  of  the 
constant  preventive  disinfection  of  every  ground, 
before  suspicious  diarrhoea  is  contaminating  the  soiL 

The  plans  in  building  of  dwelling  houses  in  relation 
to  privies,  the  direction  of  cholera  fugitives,  may  be 
guided  by  the  exploration  of  the  physical  aggregations 


*  Metropolitan  Board  of  Health  Report,  pp.  888, 
t  In  contrast  to  the  epore  prodaoed  by  Ohol«ra 
AiohlT,  February,  186T.) 

Digitized  by 


988,894,8 

nostra 


Ggogle 


THE  MEDICAL  RECORD, 


197 


oomposmg  different  soils.  The  selection  of  quarantine 
grounds  for  slightly  infected  persons  has  to  depend 
entirely  on  the  broad  comprehension  of  this  part  of  our 
exact  knowledge  of  the  causes  of  cholera. 

In  intimate  connection  with  the  study  of  the  fixed 
composition  of  the  soil  is  the  third  Cvssential  point  for 
epidemic  propagation  of  Cholera,  as  follows : 

in.  Ocoasionai  tncrease  and  variaticns  of  humidiiy  in 
Aii  oQumal  soUj  marU/mted  in  the  most  plain  and  reliable 
manner  by  the  different  devaUone  of  the  enb-eoU  water 
{OruHdw<user)y  vU  greaU^t  danger  being  when  the  tub' 
tod  water  begint  to  recede  Jrom  an  unutudl  height 

This  doctrine  corers  the  ground  for  timely  (tempo- 
rary) disposition  of  certain  localities,  cities,  streets,  or 
booses,  and  will  be  the  scientific  answer  to  the  ofien- 
repeated,  vexed  question  discussed  by  sanitary  officers 
and  newspapers— -Shall  we  have  epidemic  cholera  this 
jear,  or  shall  we,  independent  of  quarantine  and  dis- 
infectants, escape  the  danger  of  a  well-disposed  soil  in 
connection  with  the  fructifying  growths  of  the  imported 
exotic  spores? 

I  say  it  win  answer  this  question  months  in  advance 
with  great  decision  and  scientific  accuracy,*  as  Petten- 
kofer*8  interesting  researches  for  the  last  twelve  years, 
on  this  original  subject,  have  taught^  but  only  hydraulic 
enginee^ng  and  geology  combinea  can  guide  clinical 
and  sanitary  science  in  this  direction. 

Let  me  repeat,  in  a  few  words^he  great  ideas  of  the 
whole  doctrine  laid  down  by  Pettenkofer  from  the 
experience  of  thousands  of  cases,  from  the  personal 
inrestigations  of  over  thousands  of  miles  of  difierent 
countries,  from  the  intuitive  studies  of  writers  of  all 
nadonS)  guided  only  by  natural  science,  and  interpreted 
with  the  thoughts  of  a  reflecting  mind : — 

1.  The  absolute  necessity  of  a  specific  germ  repre- 
sented in  the  evacuations ; 

2.  The  presence  of  a  well  disposed  breeding-place 
most  extensively  expressed  in  the  alluvial  soil ; 

3.  The  favorable  or  unfavorable  time  to  bring  this 
germ  to  a  specific  ferment,  dependent  on  the  well- 
defined  local  variations  in  the  elevation  of  the  sub-soil 
water.t 

More,  a  great  deal  more,  has  yet  to  be  learned ;  but 
we  have  a  right  to  speak  of  tome  exact  knowledge  of 
the  causes  of  Cholera. 


AxXEURISM  OF  THE  ABDOMINAL  AORTA. 
Br  EDWARD  T.  CASWELL,  M.D., 

or  FBOTIDIIfOS,  B.  L 

Iv  an  elaborate  and  instructive  article  upon  Internal 
Aneurism  in  the  American  Journal  of  Medical  Sciences 
for  January,  1867,  by  Dr.  Liddell  of  New  York,  it  is 
itated  that  abdominal  aneurisms  sometimes  break  into 
the  left  {denral  cavity,  and  no  reference  is  made  to  any 
other  disposition  above  the  dii^hragm  of  the  contents 
of  the  sac  of  an  abdominal  aneurism.    In  the  following 


*  Tld«  JcmmA]  1  Btologl«,  19M. 

t  ▲  taHl  exposition  of  all  hets  connected  with  point  No.  IIL  wonid 
MTe  too  nraen  extended  the  porpoee  of  this  paper ;  bnt  It  mar  be  In- 
^cvMtiBg  to  state  that  the  International  Cholera  Oonferenoe  in  Oon- 
ftMliBople  has  acknowledged  a  real  probabiUtr  of  Pettenkofer*s  opin- 
JM  (Aoswer  XXYl.X  without  knowing  at  that  time  that  Pettenkofer, 
«  Ut  eritte  on  **  Maepherson^B  Cholera  in  its  Home,**  has  made  the 
M^SBrieity  in  India  as  depoident  firom  the  same  natnral  law  as  a  tempo- 
rary epidemic  Is  in  Europe  or  in  the  United  States.  The  Weimar  Conrer- 
•aee  s  few  weeks  sgo,  hss  nnaoimoosly  adopted  the  truth  of  this  p<dnt 
(S«.IIU  after  a  brief  personal  explanation  of  its  details  by  Prat  Petten- 
mr ;  ^sMntlnr  opinion  (firom  Bnssia),  based  on  negative  results,  being 
nOfoatwelgbed  b7  the  oorroboraUng  researches  oi  Prof.  POlsch.  ex- 
HM^[  hia  inresugadons  of  the  sub-eoil  water,  over  six  years  in  8t 
"etetsburg,  and  finding  the  relatlTe  inflnenoe  on  epidomio  QK^era  ab- 
kdatsly  tnt^AU,  zShmg,  Mai,  ISiTT. 


case  an  outlet  was  found  into  the  right  pleural  cavity^ 
and  as  the  writer  mentioned  records  no  such  instance,  1 
infer  that  it  is  comparatively  rare. 

William  A.,  of  about  thirty-five  years  of  age,  and  of 
spare  habit,  nad  been  treated  for  some  months  by 
several  physicians  for  complaints  which  had  been  as* 
cribed  by  one  to  the  stomach  and  by  another  to  the 
liver.  In  the  month  of  September  last  I  was  requested 
about  two  o'clock  in  the  morning  to  visit  him^  the  messen- 
ger stating  that  he  was  suffering  from  "  a  swelling  in  his 
stomach  which  throbbed."  As  he  resided  some  dis- 
tance out  of  town  I  sent  him  an  anodyne  and  promised 
to  see  him  early  in  the  morning.  On  arriving  I  found 
that  he  had  died  at  7i  ▲.!(.  He  had  been  employed  as 
engineer  on  a  tug-boat,  ^d  was  an  industrious  and  tem- 
perate man.  I  learned  that  he  had  complained,  while 
on  his  boat  at  noon  on  the  preceding  day,  of  severe  pain, 
apparently  in  the  epigastrium,  and  had  been  put  ashore. 
He  remamed  until  6  p.m.  near  the  landing,  and  then 
walked  an  eighth  of  a  mile  up  a  hill  to  hu  house  and 
then  up-stairs.  During  the  m'ght  he  suffered  intense 
pain  and  had,  as  it  was  stated,  "two  or  three  attacks  of 
trembling  with  stiffness  of  the  limbs.*'  He  got  but  little 
sleep ;  at  times*  he  would  walk  up  and  down  in  great 
distress,  and  then  would  lie  down,  but  he  could  not  re- 
main on  the  bed.  Ten  minutes  before  he  died  he 
walked  across  the  room  and  conversed  with  members 
of  his  family. 

I  made  an  autopsy  twenty-six  hours  after  death,  and 
the  following  statements  are  taken  firom  my  own  notes 
and  from  those  of  Dr.  Mason,  who  kindly  assisted  me. 
Upon  opening  the  thorax  blood  was  seen  to  issue  firom 
ins  right  thoracic  oavit3r,  and  when  the  sternum  was 
removed  the  whole  cavity  seemed  filled  with  dotted 
blood  and  serum.  Two  quarts  were  removed.  The 
lung  was  greatly  compressed;  indeed  it  seemed  scarcely 
larger  than  my  fist.  In  the  posterior  mediastinum,  and 
extending  down  the  course  of  Uie  oesophagus,  there  was 
a  firm  dot  which  passed  down  through  the  oesophageal 
opening  in  the  diaphragm.  The  left  Uioradc  cavity  pre- 
sented nothing  abnormal  save  some  old  pleuritic  adhe- 
sions. The  heart  and  the  pericardium  were  firee  fi*om 
disease.  On  inspecting  the  abdomen  a  large  finn  clot 
was  foimd  around  the  posterior  cardiac  surface  of  the 
stomach,  glueing  it  and  the  intestines  together.  The 
adjoinine  portions  of  the  peritoneum  were  mudi  thick- 
ened. On  breaking  up  the  clot  the  aneurismal  sac  was 
exposed.  It  was  developed  about  the  coeUao  axis,  just 
above  the  superior  mesenteric  branch  of  the  aorta,  and 
projected  from  the  left  side  of  th^  latter.  It  opened 
into  the  aorta  by  a  single  mouth,  three-auarters  of  an 
inch  in  diameter.  It  was  composed  of  all  the  coats  of 
the  vessel  and  was  somewhat  lar^r  than  a  goose-egg, 
having  two  pouches  developed  in  its  walls,  the  larger  of 
which  was  about  two  inches  long  and  one  and  a  half 
inches  in  diameter.  It  was  lined  with  several  layers  of 
lymph,  and  these  in  one  portion  formed  a  projection  into 
the  cavity — a  stalagmite  growth  as  it  were — about  an 
inch  broad  at  its  base  and  projecting  three-quarters  of 
an  inch  into  the  cavity.  Tne  walls  of  the  sac  were  in 
some  places  quite  thin,  and  the  rupture  had  taken 
place  in  its  upper  or  diaphragmatic  portion.  Beine 
unable  to  rupture  the  peritoneum  the  blood  had  found 
a  way  for  itself  througn  the  connective  tissue,  along  Uie 
fibre  of  the  oesophagus;  thus  passing  up  into  the 
pK>sterior  mediastinuni,  had  found  some  weak  qpot  in  Uie 
right  pleura  and  poured  itself  out  as  I  have  stated,  into  the 
right  thoradc  cavity.  The  aorta  was  atheromatous,  and 
deposits  <^  a  similar  nature  could  be  felt  in  the  radial 
artery  on  both  sides*  portions  of  the  aneurismal  one 
were  also  found  in  a  like  condition. 
It  seems  as  if  the  diagnosis  of  an  aneurism  could  have 

digitized  by  ^ „      ^_ 


198 


THE  MEDICAL  RECORD. 


been  very  easily  made  in  this  case,  if  any  careful  exam- 
ination had  been  iostituted.  That  it  could  have  attained 
such  a  development,  and  escaped  detectioD,  seems  almost 
impossible.  It  would  be  interesting  to  determine  if  we 
could  discover  the  relation  between  the  subjective  symp- 
toms the  last  fifteen  hours  of  life  with  the  pathological 
condition  developed,  but  that  can  only  be  a  matter  of 
speculation.  It  seems  every  way  probable  that  the 
patient  must  have  survived  the  rupture  of  the  sac  for 
some  little  time. 

This  instance  of  an  abdominal  aneurism  opening  into 
the  thorax  may  perhaps  with  propriety  be  placed  in 
apposition  with  a  specimen  to  the  rathological  Society 
of  London  by  Mr.  Pick,  and  reported  in  the  MedtccU 
Timea  and  wtzette  for  January  12,  1867.  In  this  cate 
a  thoracic  aneurism  of  large  size  discharged  its  contents 
into  the  peritoneal  cavity.  The  evacuated  blood  fol- 
lowed down  the  muscular  fibres  of  the  oesophagus  and 
penetrated  the  peritoneum  close  to  the  cardiac  orifice 
of  the  stomach. 


REMARKS  ON  THE  TREATMENT  OF  FRAa 
TURES  OF  THE  PATELLA. 

WITH  ▲  DMCBIFnON  OF  THl  LATI  DB.  THOMAS  TUBirSB^ft  ▲PPASATQlt 

[By  FRANCIS  V.  WHITE,  M.D., 
or  rav  TOBK. 

Sm  AsTLET  Cooper*  believed  ligamentous  union  resnlt- 
ed  in  fractures  of  the  patella,  generally ;  rarely  osseous. 
He  arrived  at  this  conclusion,  fi-om  his  experiments  and 
observations  on  the  rabbit  and  dog,  having  produced 
fi-actures  of  usual  varieties  in  both ;  in  different  periods 
of  time  noted  efforts  of  nature  in  reparation ;  he  states  that 
there  is  no  callus  to  interfere  with  the  joint;  and  advises 
that  the  surgeon  should  make  the  ligament  short  as  pos- 
sible, for  the  welfiire  of  the  patient^  in  transverse  fractures. 
He  presents  two  modes  of  treatment:  1st,  he  places  the 
patient  in  semi-recumbent  position,  with  the  extremity  on 
a  well  padded  posterior  splin^  leaving  the  knee  exposed, 
to  combat  inflammation.  When  proper,  he  bandages 
to  the  knee,  then  makes  a  sufficient  number  of  circSar 
turns  below  and  above  the  joint,  approximates  these  and 
thereby  the  fragments^  by  broad  tapes  at  right  angles  and 
under  these  on  each  side,  being  tied  toge&er.  He  cau- 
tions any  violence  in  bringing  the  upper  firagment  down. 
2d,  the  leg  being  bandaged,  he  places  a  leather  strap 
around  thigh  above  the  fi-aoture,  firom  this,  a  strap  around 
the  sole  of  the  foot  up  to  the  thigh-strap  and  kept  in 
place  by  tapes. 

The  treatment  continues  five  to  six  weeks,  then 
cautious  passive  motion  is  made,  until  use  of  the  limb 
iff  acquired.  He  says  he  saw  the  patient  of  M.  Chopart 
at  Paris,  who  appeared  to  have  bony  union  and  men- 
tions a  case  published  by  Mr.  Fielding  of  HuU. 

He  considered  the  absence  of  perfect  coaptation  <jf 
the  fragments  in  these  fractures,  to  be  the  cause  of  non- 
ossific  union. 

Mr.  Qulliver,t  also  made  elaborate  investigations  of 
the  powers  of  nature,  in  the  artificial  fixtures  he  made 
of  the  patellflo  of  rabbits  and  dogs;  concluding,  in 
fracture  of  the  patella,  if  the  aponeurosis  is  entirely 
ruptured,  no  bony  union  results.  The  inter- substance  is 
vascular,  therefore  the  absence  of  bony  union  is  not  from 
proper  nourishment    Bony  union  results  firom  perfect 


jIS?  A^^i^:!iS:^.  ^Dislocations  and  Fr.ctnre.  of  the 
t  Edlnbugh  Medical  a^  Burgica]  Journal,  voL  xlvil.,  p.  16a 


adjustment  of  the  firagments,  if  the  aponeurosis  is  not 
entirely  divided.  Fibrous  tissue  precedes  bony.  Hb 
object  was  to  demonstrate  what  results  we  might  ex- 
pect in  treatment  of  firactured  patella.  He  suggested  no 
apparatus. 

Mr.  W.  Adams,*  in  a  paper  before  the  Harveian 
Society,  refers  to  having  presented  before  the  Pathological 
Society  of  London  in  1850,  two  specimens  of  fractured 
patella.t  One,  true  ligamentous  union ;  the  other  an 
ununited  fracture.  He  had  not  seen  a  separation  of 
over  one  and  a  half  inches  in  true  ligamentous  unions, 
usually  half  to  one  inch.  He  alludes  to  Mr.  Holtliouse^ 
specimen,  presented  subsequently,  of  two  and  a  half 
inche&  What  he  calls  ununited  firacture,  previously 
was  considered  elongated  ligaments ;  he  proved  it  to  be 
a  thickening  of  the  fascia,  and  aponeurosis,  and  bursa. 
Length  of  second  specimen  was  five  inches,  a  line  to  one 
eighth  of  an  inch  in  thickness.  Of  thirty-one  specimens 
he  examined  in  the  six  principal  museums  of  London, 
fifteen  were  ununited,  twelve  ligamentous,  and  four 
obscure  from  being  dried.  He  suggests  in  the  treatment^ 
1st,  subdue  inflammation ;  2d,  approximate  the  frag- 
ments as  soon  as  possible ;  3d^  retention  sufficient  time,  to 
insure  true  bone,  or  short  hgamentous  union,  avoidmg 
eversion  of  the  fragments,  and  a  slipping  of  the  fasciiL 
aponeurosis,  etc.,  between,  that  being  the  cause  of 
ununited  results.  Becommends  M.  Malgaigne's  appa- 
ratus in  treatment.  Notes  its  extensive  use  in  France; 
that  no  serious  inflammation  was  produced  by  its  use ; 
generally  borne  without  inconvenience  or  pain.  May, 
1853,  M.  Malgaigne  informed  him,  the  hooks  had  been 
used  eleven  times  with  complete  success.  He  used  them  in 
one  case  of  ununited  fi-acture  of  patella  of  long  standing, 
^^taching  by  subcutaneous  section  the  aponeurotic 
structures,  coaptated  the  firagments,  with  Qie  hooks. 
Borne  for  two  weeks  without  inconvenience.  Qreatly 
improved.    Besult  not  given. 

Mr.  Malgaigne  §  has  an  ably  written  article  on  frac- 
tured pateUa.  He  thinks  thirty  to  forty  days'  treatment 
sufficient  for  fibrous  or  bony  union.  Calls  attention  to 
the  danger  of  anchylosis;  as  varying,  fix)m  degree  of  in- 
flammation, time  of  confinement,  pressure  by  the  appa- 
ratus, whether  the  apparatus  was  appUed  before  or  after 
inflammation.  The  greatest  separation  he  knew  of,  was 
the  case  of  Sir  A.  Cooper,  viz.  over  four  inches. 
Alludes  to  Gulliver's  investigations,  also  Sir  A.  Cooper's. 
Never  applied  apparatus  until  inflammation  was  sub- 
dued. Kemoved  it  in  forty  days,  anchylosis  disappear- 
ing shortly. 

Observing  the  inefficiency  of  the  apparatus  for  ossific 
results,  he  invented  his  hook  apparatus,  which  consists 
of  two  steel  plates;  inner  one,  one  and  a  fifth  inches  in 
length,  on  account  of  the  obliquity  of  t^e  patella,  two- 
thirds  of  an  inch  wide,  free  extremity  l^mrcated  into 
two  very  sharp  hooks,  one-third  of  an  inch  apart;  outer 
one,  one  inch  long,  same  width  as  inner  one,  hooks  two- 
thirds  of  an  inch  apart.  Sliding  of  the  plates  upon  each 
other  regulated  by  a  screw.  Apply  the  hooks  of  inner 
one  first,  just  below  the  point  of  the  patella,  drawing^ 
the  skin  down  somewhat,  then  coapt  the  fragments^ 
drawing  the  integuments  up,  insert  the  outer  hooks  just 
above  the  base,  using  force,  by  the  screw ;  an  improve- 
ment of  M.  Charri^re,  which  the  patient  cannot  tamper 
with,  the  plates  slide  upon  each  other  approximating 
the  fragments.  The  only  ill  he  observed,  was  that  the 
upper  hooks  slipped  about  the  seventeenth  or  twentieth 
day. 


•  British  Medical  Joarnal,  vol  L,  1864,  p.  S4fi. 

t  Transactions  of  the  Pathological  Society  of  London,  toL  IL,  ld50« 

't  Mpdical  Times  and  Gaxeite,  vol.  1.,  1882,  p.  281. 
$  M.  Malgaigne  on  Fractures,  Packard,  1809,  p.  609. 


jogle 


THE  MEDICAL  RECORD. 


199 


Dr.  Packard,*  of  Philadelphia,  pablishes  a  case  of 
transverse  fracture  of  the  patella,  which  he  treated  suc- 
oessfuUj  with  the  hooks.  He,  assisted  by  his  friend, 
Dr.  Brinton,  could  not  perforate  the  patella  to  thejoint, 
by  Yiolence,  with  the  nooks,  on  the  cadaver.  He  be- 
fie?es  if  the  hooks  are  properly  applied,  there  is  no 
dinger  of  the  slipping  Malgaigne  spoke  o£  He  oon- 
dndes  fix>m  his  case,  that  there  is  no  fear  of  ulceration 
or  necrosis.  The  pain  is  not  severe  in  the  application 
of  the  hooks.  Ansesthedcs  could  be  used,  if  necessary. 
Esteems  the  hooks  the  best  appliance  for  firm  coapt- 
ation of  the  fragments.  Other  modes,  apt  to  have  a 
tiiting-up  of  the  fragments,  viz.  a  V  gap  between. 

GcMiptation,  tested  by  hooks  and  bone  moving  as  one 
mass.  Dr.  Ellis,  Boston,  informed  hun  of  the  estimation 
of  the  hook&  "  Thejr  are  not  liked  here,  and  never 
uaed"  Dr.  Noyes,  New  York,  wrote  to  him,  1854,  that 
Dr.  Buck  had  used  the  hooks,  and  that  such  inflamma- 
tion resulted  in  two  weeks,  that  they  had  to  be 
removed.  Abscesses  formed  about  the  joint,  which 
prolonged  the  treatment  twice  the  usud  period.  Re- 
Bolt,  bony  union.  The  joint  was  quite  rigid  when  the 
patient  was  last  seen.  '^  This  case  was  pretty  gen,erally 
known  among  New  York  surgeons,  and  its  results 
proved  condenmatory  of  the  hooks."  Dr.  Packard  t 
publishes  the  same  case,  refractnred,  about  hix  months 
sobsequendjr.  On  the  first  occasion,  he  applied  ^e 
hooks  the  eighth  day,  retained  them  thirty-one  days. 
There  was  g^od  use  of  the  limb  in  two  months*  time. 
Second  time  retained  them  twenty-nine  day& 

Eighty-six  days  following,  inter-substance  was  not 
more  than  half  an  inch.  No  halt  in  gait^  only  in  going 
op  and  down  stairs.  Believes  he  had  bony  union  on 
first  occasion,  as  a  sharp  crack  was  observed  when  last 
fracture  occurred,  and  from  his  manipulation  of  the 
fragments  he  was  satisfied  of  it 

Campbell  de  Moi^n,^  F.R.S.,  Surgeon,  Middlesex 
Hospital,  states  M.  Malgtugne's  hooks  had  been  used 
fiiequently  and  satisfactorily.  Mr.  Henry,  his  colleague, 
directed  his  attention  to  cases  where  there  probably 
were  bony  unions.  He  appears  to  esteem  the  hooks 
as  highly  as  Dr.  Packard.  Relates  a  case  where 
both  patelke  were  fractured;  one  treated  by  the 
books;  other,  by  position.  Result  of  former  pretty 
dfxelj  approximated;  latter,  the  separation  from  half 
to  ^u^e-quarters  of  an  inch.  Another  case ;  female,  far 
advanced  in  pregnancy;  hooks  were  applied;  nothing 
unfortunate  occurred;  still  under  treatment  Only 
objection  he  makes  is  the  tendency  to  a  V  gaping  of 
one-eighth  of  an  inch  superiorly,  which,  he  remarks, 
can  usually  be  avoided  by  altering  direction  of  the  upper 
books.  If  the  parts  are  kept  at  rest,  he  considers  the 
hooks  firee  from  irritation,  as  metallic  sutures  are. 

Q.  E.  Pyle,§  House  Surgeon  to  Middlesex  Hospital, 
records  eight  cases  treated  by  Malgaigne's  hooks ;  com- 
mends them ;  closes  with  a  synoptic  table  of  sixteen 
cases,  eight  treated  by  Malgaigne*s  hooks,  and  eight  by 
the  usuiu  means. 

J.  M.  Chelios,  |  University  of  Heidelberg,  mentions 
the  separation  in  transverse  fractures  of  the  patella  may 
be  four  to  five  inches.  Crepitation  is  not  observed,  as 
the  fragments  cannot  be  immediately  approximated; 
may^  in  vertical,  oblique,  or  splintered  varieties.  Quotes 
Gulliver's  conclusions.  Believes  treatment  results  in  a 
fibrous  inter-subetanoe,  on  account  of  tiie  difficulty  of 
perfect  coaptation  of  the  fragments.    He  condemns  as 


.  Joor.  of  the  Med.  Sdences,  roL  zti.  1861,  p.  896. 
t  Ibid.  ToL  zHf.  1861,  p.  575. 

iBfttfah  Med.  JonriMl,  yoL  1. 1868.  p.  548. 
Med.  Times  and  ChoeUe,  voL  1. 1864,  p.  86. 
^Fatem  of  Sorgery,  translated  from  Oerman,  J.  F.  Soath,  1845, 
v««.l.p.W6. 


unsuitable,  especially  tight  bandages,  as  pr.oducing  an- 
chylosis and  adhesion  of  the  patella  with  the  femur, 
also  liability  to  atrophy  of  quadriceps  femoris,  a  termina- 
tion to  be  deprecated  more  than  a  long  inter-substance. 
His  treatment,  mainly  by  position,  the  extremity  flexed 
on  the  body,  and  the  body  on  it  pillows  being  placed 
under  the  extremity  and  the  trunfe,  binding  lower  por- 
tion of  the  thigh,  and  fretening  to  the  bed,  the  frag- 
ments being  thus  pretty  easily  coapted:  or  a  long 
posterior  splint^  with  footboard  well  padded.  Cites 
Alcock's  application  of  adhesive  plaster,  with  his  mode, 
as  advanta^ous.  If  there  is  powerfrd  muscolar  action 
to  be  overcome,  his  appliances  are  complicated  and 
cumbrous,  viz.  the  fragments  being  coapted,  pads  are 
placed  above  and  below,  and  retained  by  figure-of-eight 
oandage;  over  the  whole  an  invaginated  band;^  is 
fixed  longitudinally. 

Liston  asserts,*  in  transverse  fracture  of  the  patella 
bony  union  is  rare,  "  one  not  to  be  expected  or  favored," 
Treatment  by  position,  on  an  inclined  plane ;  apf)ly  a 
bandage  from  toes  to  above  the  fragment^  not  tight. 
Objects  to  form  figure-of-eight,  bandaging  over  com- 
presses of  cork  or  other  material,  or  straps  and  buckles. 

Skeyt  advises  in  transverse  fracture  of  the  patella  to 
guard  against  retraction  of  upper  fragment  by  c[uadri- 
ceps  femoris,  by  placing  the  patient  in  position^  or 
have' him  sit  up  in  bed.  rubs  and  kneads  the  thigh  from 
above  downwards;  ir  unsuccessfiil,  uses  chloroform. 
When  the  muscles  are  relaxed,  he  applies  a  bandage 
from  the  groin  down  to  a  safe  distance  from  thejoint,  so 
as  not  to  mcrease  effusion  nor  tilting  of  the  upper  frag- 
mant.  If  a  failure,  leaves  nature  untrammeUed  in  a 
sitting  posture.  Fixes  the  lower  fragments  with  a  pad 
of  lint,  retained  by  adhesive  plaster.  Gives  no  results. 
Regards  ligamentous  union  as  not  producing,  universally, 
difficulty  of  locomotion.  Mentions  a  case  of  permanent 
separation  of  one  and  a  half  inches,  and  locomotion  was 
perfect. 

Q-ibson  J  speaks  of  the  comparative  weakness  of  fitw)- 
tured  patella.  Prone  to  refracture ;  the  difficulty,  perhaps 
impossibility,  in  transverse  fractures  to  coaptate  frag- 
ments ;  therefore  no  osseous  union.  Inter-substance  re- 
sulting, remaining  so£t>  is  easily  torn,  for  a  lengtli  of 
time.  Bony  imion  extremely  rare!  Cites  Sir  A. 
CJooper's  experiments.  Warns  of  the  danger  of  the 
firacture  of  sound  patella  from  strain  superinduced. 

Miller§  avers  that  in  transverse  fractures  of  the  pa- 
tella bony  union  may  occur,  but  undesirable,  from  danger 
of  refracture  or  anchylosis;  thinks  a  short  inter-substance 
obviates  difficulty.  Treatment,  ordinarily  by  position; 
bandages  leg,  and  applies  figure-of-eight  if  necessary ;  if 
not,  suggests  broad  leather  belts  above  and  below  tiie 
joint;  by  cross  belts  approximating,  produces  coaptation ; 
or  Lonsdale's  apparatus,  which  consists  of  a  posterior 
spUnt  with  foot-piece  movable,  to  accommodate  differ- 
ent limbs ;  in  the  region  of  the  knee  are  two  vertical 
bars  of  iron  connected  to  the  splint,  each  supporting 
horizontal  arms  bent  at  right  angles,  which  sUde  on 
the  vertical,  being  arrested  by  screws  to  which 
horse-shoe  formed  plates  are  attached  by  a  hinge-joint. 
Being  well  padded,  bandage  the  foot  and  leg  to  the 
splin^  coapting  the  fragment ;  the  upper  horse-shoe 
with  intervening  soft  pad  is  applied  firat,  just  above 
the  fragment,  not  touching  the  patella;  lower  plate 
applied  just  below,  secured  by  the  screws ;  then  bandage 
the  thi^h  and  upper  part  of  the  splint ;  whole  limb 
placed  m  position  by  a  pillow  placed  under  it.  Mode 
of  Dr.  NeiU,  of  Philadelphia,  is  most  convenient  and 

•  Listen's  Sorgerf.  1846,  p.  9t. 
t  Skey*8  Surgery,  1861.  p.  167. 
±  Gibson's  Snrgery,  vol.  1 1850,  p.  271. 

%  Mlller'sSargety,  Amer.  £d.,l857,  p.  617.         f^  y-w  ^^,r-t  I  ^ 
digitized  by  VjOOQ  Ic 


200 


THE  MEDICAL  RECORD. 


efficient ;  viz.  application  of  one  or  more  strips  of  adhe- 
sive plaster  above  and  below  the  fragments  obliquely 
attached  to  the  posterior  splint  j  no  strangulation  of  the 
limb,  as  in  figure-of-eight  bandaging. 

Smith'*'  affirms  that  crepitation  is  almost  impossible, 
except  in  oblique  fractures  of  the  patella ;  bony  urfion 
rare.  Advises  accurate  adjustment  of  the  fragments  to 
obtain  bony  union ;  if  not,  a  short  inter-substance,  for 
power.  Has  a  specimen  of  bony  union  in  his  cabinet; 
history  unknown.  Treatment,  viz.  Dessault's:  strip  of 
muslin,  two  and  a  half  inches  wide,  from  g^roin  to  foot, 
retained  by  bandaging  the  lower  extremity ;  cut  two 
slits  in  the  strip  opposite  the  knee,  to  pass  the  fingers 
through,  to  coaptate  the  firagments,  retaining  them  by 
compresses,  with  figure-of-eight  bandages;  then  ban- 
dage thigh  to  overcome  the  muscles;  place  the  hmb  on 
a  well  padded  inclined  plane  splint,  thereby  favoring 
muscular  relaxation,  and  return  of  blood,  reducing  in- 
flammation. Beyer's :  a  compress  is  placed  above  the 
superior  fragment;  by  figure-of-eight  bandage  brought 
down ;  coaptation  is  completed,  by  figure-o&ight  ban- 
dage; the  leg  having  been  bandaged,  bandage  the 
thigh ;  apply  a  posterior  splint  as  in  Dessault's  mode. 
Prof  borsey's  is  one  of  power:  a  well  padded  posterior 
splint,  length  of  the  extremity ;  two  strips  of  bandage 
tacked  on  the  back  of  the  splint ;  sufficient  separation, 
opposite  the  knee ;  the  fragments  being  coapted,  ana 
by  compresses  above  and  below  firagments:  held  by 
tying  the  strips  obliquely  over  them.  He  believes  this 
will  hold  the  fragments  m  accurate  apposition,  but  risk 
of  inflammation  and  ulceration.  He  thinks  Malgaigne's 
hooks  would  more  thoroughly  coapt  fragments,  bnt 
objects  to  them  not  only  from  danger  of  perforating  thg 
joint,  but  from  erysipelas.  His  best  treatpient  is  the 
application  of  adhesive  plaster,  coaptating  the  fragments, 
combined  with  a  posterior  elevated  splint ;  plaster  shoula 
be  three-quarters  of  an  inch  wide,  long  enough  to  pass 
obhquely  around  the  limb ;  the  lower  fragment  beinr 
fixed,  apply  first  strip  from  behind  the  tibia,  around 
lower  tip  of  patella,  upwards;  upper  fragment  being  co- 
aptated,  apply  strips  m  an  opposite  direction,  forming 
two  semicircles  about  the  jomt;  dressed  occasionally 
as  indicated;  dressings*  con  tinned  Ave  or  six  weeks; 
cautious  passive  motion  commenced  about  the  third 
week.  He  remarks,  adhesive  plaster  had  been  emploved 
for  thirty  years  past  in  Pennsylvania  Hospital,  by  fiar- 
ton  and  others,  satisfactorily.  Attention  was  recalled- 
to  it  by  Neill,  of  Philadelphia.  Gama,  of  the  Val  de 
Grace,  Alcock,  of  England,  and  Hanailton,  of  New 
York,  all  approve  of  it;  each  has  slightly  modified  it^ 
still  using  the  adhesive  strips.  Gkrdy's  plan,  liable  to 
cause  pain ;  it  is  an  invagmated  bandage,  with  com- 
presses above  and  below  the  fragments,  retaining,  by 
bandaging,  the  whole  extremity. 
-  Grosst  never  had  seen  complete  ossific  union  of  trans- 
verse fractures  of  the  patella;  speaks  of  the  difficulty  of 
muscular  action  on  the  upper  fragment,  to  overcome 
which  is  the  chief  indication  of  treatment  Apparatus^ 
than  which  he  considers  nothing  better,  is,  viz.  a  well  pad- 
ded tin  case  applied  posteriorly,  from  miadle  of  thigh  to 
same  point  of  leg ;  bandage  from  toes  upwards,  and  from 
ffroin  downwards,  upper  fragment  being  reduced ;  is  con- 
fined by  adhesive  strips,  placed  around  the  bone  above  and 
below  the  joints  and  connected  by  vertical  and  transverse 
pieces;  dressing  completed  by  application  of  a  long, 
thick,  and  rather  narrow  compress,  extended  around 
upper  border  of  the  patella,  confined  by  two  bandages 
around  the  joint,  figure-of-eight;  no  danger  of  displace- 
ment   Gives  a  cut  of  the  mode  of  Prof.  Hamilton,  with 

•  Smith's,  H.  H.,  SuTRery,  1868.  vol.  L  p.  €8i. 
t  Gkjbs'i  Sorgery,  ISM,  ▼ol.  1.  p.  M6. 


comment,  that  it  i&^  with  slight  modifications,  that  of 
Pennsylvania  Hospital.  He  commences  passive  mo- 
tion about  the  third  week,  repeated  every  other  day, 
subsequently  every  day;  m  four  weeks  removes  the 
tin  splint,  applying  a  posterior  leather  splint:  permits 
the  patient  to  walk  with  crutches ;  guards  agamst  early 
extensive  use  of  the  hmb  under  three  or  four  months. 
Heath  :'*'  Treatment  not  to  commence  till  inflanunation 
is  subdued;  accomplished  by  position,  having  the  pa- 
tient sit  up,  with  the  extremity  raised,  etc. ;  appa- 
ratus, simple  splint  back  of  knee,  with  two  strips  of 
adhesive  plaster  to  coapt  fi^agments;  or  Wood's 
splint,  which  is  a  back  splint,  with  hooks,  as  fixed 
points  for  the  bandage  to  act  from,  vide  Ferguson,  p.  393, 
and  Druitt,  p.  285.  Recommends  broader  splints  than 
generally  used,  preventing  pressure  of  sides  of  the 
knee;  well  to  bandage  thigh  from  groin  to  control 
quadriceps  femoria  When  danger  is  over  to  the  joint, 
advises  plaster  of  Paris  and  starch  appliances,  alone  or 
with  light  back  splint,  for  out-patients. 
{To  he  corUinited.) 


Vitparts  of  s^0«pital«. 


CHARITY  HOSPITAL,  BLA^CKWELL'S  ISLAND, 

k  Y.       ' 

BEPORT  or  A  OASB  OF  TRIPLE  BIRTH. 
BXPOBTXD  BT  OHAXLU  OULVXR,  JUHIOB  AMISTAirT  KB8IDEIT  PBTBIOLUI. 

DcLiA  O'Brien,  a  native  of  Ireland,  thirty-five  years  of 
age,  was  admitted  to  this  hospital,  March  19,  1867. 
On  Thursday,  the  sixteenth  instant,  she  first  noticed 
some  slight  pains  during  the  forenoon,  but  did  not  call 
the  attention  of  any  one  until  about  two  o'clock,  when 
she  felt  the  waters  escaping.  She  was  immediately 
placed  in  bed,  when  a  child  presenting  by  the  head 
was  expelled  before  an  examination  for  position  could 
be  made.  The  uterus  still  remaining  large,  a  hard 
mass  being  felt  at  the  fundus,  auscultation  was  resorted 
to,  the  placental  bruit  was  heard  on  the  left,  and  a  foetal 
heart  on  the  right  side  of  the  abdomen ;  an  examination 
by  the  vagina  revealed  the  presence  of  a  bag  of  waters 
protruding  fi'om  the  os  uteri,  inside  of  which  the  feet  of 
a  child  were  distinctly  felt ;  the  rapid  contractions  of  the 
uterus  soon  crowded  this  child  down,  and  it  passed 
rapidly  through  the  well  dilated  passages,  no  part 
bemg  arrested ;  one  dram  of  the  tr.  ergot  was  now  ad- 
ministered, which  quickened  the  pains,  that  were  grow- 
ing less  frequent. 

The  vertex  of  the  third  child  was  felt  engaging  at 
the  superior  strait  in  the  first  position,  viz.  occiput  to 
the  left  acetabulum.  This  child,  like  the  preluding, 
was  quickly  delivered.  Firm  pressure  was  made  over 
the  fundus  uteri,  and  the  placentae  were  cast  off;  that 
of  the  first  child  being  single,  the  other  having  a  double 
placenta,  to  which  two  cords  were  attached — one  near 
the  edge,  after  the  manner  of  a  battledore  placenta, 
the  other  cord  was  attached  as  usual— «ach  child  was 
inclosed  in  a  separate  cavity,  and  surrounded  by  mem- 
branes of  its  own.  They  were  all  perfectly  formed 
female  children,  and  their  combined  weight  was  eighteen 
pounds  and  twelve  ounces.  The  entire  delivery  waa 
accomplished  in  an  hour  and  a  half  The  mother  had 
previously  had  three  children,  all  single  births ;  one  of 
them  weighed  twelve  pounds  at  birth.  She  was  not 
in  the  least  exhausted,  and  declared  her  abiUty  to  walk 
about.  She  assures  me  that  there  is  no  hereditary  ten- 
dency to  multiple  pregnancies,  either  in  her  own  family 
or  that  of  her  nusbandL 


*  Christopher  Hoath^s  Manual  of  Minor  Surgery,  IBM,  p.lSa 


THE  MEDICAL  RECORD, 


201 


©riginal  ffectu«0. 


LECTURE  ON  CERTAIN  MORBID  AFFEC- 
TIONS OF  THE  FINGERS  AND  TOES. 

By  ALFRED  0.  POST,  M.D., 
FBomaoB  OP  svBauT  in  tbm  jcvdioal  DBPABxmnr  or  thb  itnitbb- 

8ITT  or  KSW  TOBX. 

Gentlemen: — ^There  are  certain  diseases  of  the  fin- 
gers and  toes,  to  which  I  will  now  direct  /our  atten- 
tion. The  first  of  these  is  in  common  language  called 
a  felon  or  whitlow.  It  is  technically  called  paronychia, 
the  term  being  derived  from  the  Greek  words  Ha^a,  be- 
yond, and  owS,  a  naU.  It  is  an  acute  inflammatory  affec- 
tion, involving  primarily  the  sjmovial  membrane  which 
lines  the  sheath  of  the  flexor  tendon,  and  extending 
secondarily  to  the  periosteum  of  the  adjacent  phalanx, 
and  to  the  integument  covering  it.  It  may  be  the  re- 
sult of  a  puncture  or  contusion,  or  of  exposure  of  the 
part  to  excessive  heat  or  cold.  It  sometimes  occurs 
without  any  obvious  exciting  cause.  The  first  symptom 
IB  a  dreumscribed  dull  pain,  referred  to  the  palmar  sur- 
&ce  of  one  of  the  phalanges,  and  increased  oy  pressure 
upon  the  affected  part  This  pain  gradually  increases 
in  severity,  until  it  amounts  to  almost  intolerable  agony. 
It  assumes  a  distinctly  pulsatory  or  throbbing  character, 
and  is  greatly  aggravated  by  a  depending  position.  The 
severity  of  the  pain  is  such  as  to  incapacitate  the  patient 
for  bodily  or  mental  exertion  during  the  day,  and  in 
a  great  measure  to  prevent  him  firom  sleeping  at 
ni^t  When  the  disease  is  lefl  to  itself,  it  continues  to 
torment  the  patient  by  day  Aid  by  ni^ht,  during  a  period 
varying  from  one  to  two  weeks,  until  the  sloughing  of* 
the  fibrous  investments,  and  the  ulceration  of  the  iu- 
tegoment,  relieve  the  tension  of  the  inflamed  parts,  and 
give  issue  to  a  collection  of  purulent  matter  resulting 
m>m  the  inflammatory  action.  At  the  commencement 
of  a  paronychia  there  is  very  little  swelling,  and  as  the 
disease  advances,  the  swelling  takes  place  very  gradu- 
ally, in  consequence  of  the  density  of  the  tissues  which 
are  involved  The  swelling  is  at  first  confined  to  the 
anterior  surface  of  the  affected  phalanx,  and  then  slowly 
spreads  along  the  adjacent  phalanges,  both  in  a  proxi- 
mal and  distal  direction.  It  also  secondarily  involves 
the  dorsal  sur^e  of  the  affected  member,  and  at  an  ad- 
vanced period  tbe  dorsal  swelling  sometimes  exceeds 
that  which  exists  on  the  palmar  surface.  Under  these 
circumstances,  it  is  a  matter  of  great  practical  import- 
ance to  avoid  the  error  which  I  have  known  to  have 
been  committed — viz.  that  of  regarding  the  dorsal  in- 
flammation as  the  main  disease,  and  directing  the  prin- 
cipal treatment  to  its  relief.  Under  such  a  mistaken 
view  of  the  disease,  and  the  consequent  erroneous  treat- 
ment, the  sufferings  of  the  patient  are  unnecessarily  pro- 
tracted, and  the  habilitv  to  disorganization  and  deform- 
itv  is  greatly  increased.  The  swollen  parts  exhibit  a 
blush  of  redness  more  or  less  deep,  and  tne  temperature 
of  the  surface  is  elevated  considerably  above  the  normal 
standard. 

When  a  spontaneous  opening  has  occurred,  the  in- 
tensity of  the  patient's  sufferings  is  relieved,  and  he  is 
able  to  sleep.  But  a  considerable  time  elapses  before 
the  pain  and  swelling  subside,  and  the  tenderness  on 
pressure  ceases  to  annoy  the  patient  Before  the  part 
returns  to  a  painless  condition,  it  oflen  happens  that  the 
flexor  tendons  have  sloughed,  and  the  patient  has  thus 
permanently  lost  the  power  of  flexing  the  finger.  The 
mflammation  often  extends  to  the  periosteum  and  to  the 
bone,  giving  rise  to  caries  or  necrosis,  followed  by  per- 
manent deformity  of  the  affected  member.    In  some 


cases,  fortunately  rare,  the  inflammation  becomes  dif- 
fuse, es^tending  along  the  palm  of  the  hand,  and  up  the 
forearm  and  arm,  sometimes  rendering  necessary  the 
amputation  of  the  limb.  In  one  case,  occurring  m  the 
practice  of  a  professional  fnend.  the  patient's  life  was 
barely  saved  by  amputation  at  tne  shoulder-joint. 

Notwithstanding  the  severity  of  this  disease,  and  the 
injurious  consequences  to  which  it  leads,  when  left  to 
itself  I  have  always  found  it  amenable  to  treatment.  At 
a  very  early  period,  before  any  considerable  swelling 
has  occurred,  the  disease  may  sometimes  be  arrested  by 
the  application  of  poultices  or  fomentations,  at  as  high 
a  temperature  as  the  patient  is  able  to  endure.  But  the 
remedy  on  which  the  principal  reliance  is  to  be  placed, 
is  a  free  and  deep  incision  extending  into  the  sheath  or 
the  tendon.  A  superficial  incision  will  afford  little  or 
no  reUef ;  and  a  puncture,  extending  into  the  synovial 
sheath,  and  giving  exit  to  pus,  will  faU  to  afford  the  com- 
plete and  immediate  relief  which  is  the  result  of  a  free 
incision.  The  object  of  the  incision  is  not  merely  to 
give  exit  to  pus,  but  to  relieve  the  tension  of  the  fibrous 
membranes  which  strangulate  the  inflamed  parts,  or 
which  have  tliemselves  become  involved  in  inflamma- 
tory action.  The  manner  of  making  the  incision  is  a 
matter  of  some  practical  importance.  If  an  attempt  be 
made  to  open  a  paronychia  in  the  same  manner  in  which 
an  abscess  is  usually  opened — ^viz.  by  inserting  the 
point  of  a  lancet  or  bistoury,  and  then  cutting  out 
towards  the  firee  surface  of  the  skin,  the  opening  will 
be  very  apt  to  be  insufficient.  The  best  method  is  to 
lay  the  back  of  the  hand  on  a  towel  resting  upon  a 
table,  and  having  the  finger  firmly  held  in  an  extended 
position,  to  cut  boldly  with  a  sharp  scalpel  fi-om  the  sur- 
face into  the  synovial  sheath,  to  the  extent  of  half  or 
three-quarters  of  an  inch.  If  the  patient  is  not  under 
the  influence  of  an  ansssthetic,  the  incision  occasions  a 
severe  but  momentary  pain,  followed  by  a  Smarting  or 
burning  sensation,  of  variaole  duration,  but  not  usu- 
ally of  great  severity.  The  throbbing  and  aching 
pain  of  the  disease  is  almost  instantaneously  relieved  by 
the  incision^  when  it  is  properly  made.  T!liere  may  be 
some  question  as  to  the  time  when  a  paronychia  should 
be  laid  ope'n.  Most  patients  prefer  waiting  until  they 
have  passed  several  sleepless  nights,  before  they  make 
up  their  minds  to  imder^o  the  operation.  My  own 
opinion  is  in  favor  of  making  the  incision  at  as  early  a 

rriod  as  the  disease  can  be  accurately  diagnosticated, 
do  not  wait  for  the  occurrence  of  suppuration.  If 
this  can  be  anticipated,  it  will  save  the  patient  much 
suffering,  and  the  wound  will  heal  more  promptly  than 
if  the  incision  had  been  made  at  a  later  period.  When 
the  incision  has  been  made  at  an  early  period,  before 
much  swelling  has  taken  place,  the  only  dressing  re- 
quired will  be  a  compress  of  lint  wet  with  cold  water, 
and  wrapped  around  the  finger.  But  when  the  incision 
has  been  made  at  a  more  advanced  period  of  the  dis- 
ease, when  there  is  great  swelling,  with  copious  suppu- 
ration, emollient  poultices  may  be  applied  with  advan- 
tage. But  they  should  not  be  contmued  more  than 
three  or  four  days  after  the  operation,  as  their  protracted 
use  produces  too  much  relaxation^  and  retards  the  heal- 
ing of  the  sore.  When  the  poultices  are  laid  aside,  the 
sore  may  be  dressed  with  lint  spread  with  a  moderately 
stimulating  ointment,  as  ung.  resin,  etc.  When  necro- 
sis or  canes  of  the  bone  has  taken  place,  the  diseased 
or  dead  bone  may  be  removed,  or  the  finger  may  be 
aniputated. 

It  is  rare  to  meet  with  paronychia  of  the  toes.  The 
thumb  and  fingers  are  the  usual  seat  of  the  disease. 

The  disease  known  as  onychia  is  liable  to  occur  in 
the  toes  as  well  as  the  fiingers.  It  affects  the  great  toes 
more  frequently  than  the  smaller  ones,  and  I  Uiink  that 


Digitized  by 


Google 


202 


THE  MEDICAL  RECORD. 


I  have  observed  it  more  frequently  in  the  thumbs  than 
in  the  fingers.  The  disease  is  an  inflammation  of  the 
matrix  of  the  nail,  and  of  the  adjacent  portions  of  the 
skin.  It  is  often  occasioned  by  contusion  of  the  distal 
extremities  of  the  fingers  or  toes.  Sometimes  it  occurs 
from  constitutional  causes.  A  very  severe  form  of  the 
disease  occurs  in  connexion  with  constitutional  syphi- 
lis. The  disease  known  in  common  language  as  a  *'  run- 
round  "  is  a  mild  form  of  onychia.  The  more  severe 
form  of  onychia  is  a  very  obstinate  and  painful  disease, 
often  contmuing  for  years,  and  shovnng  no  tendency  to 
amelioration  except  under  the  influence  of  appropriate 
treatment  The  extremity  of  the  affected  finger  or  toe 
becomes  greatly  swollen,  presentmg  a  livid  red  color, 
with  ulceration  beneath  the  naiL  and  giving  issue  to  an 
offensive  sanious  discbarge.  The  nail  itself  becomes 
partially  detached,  presenting  a  broken  and  irregular 
outline,  and  having  a  dark  color.  In  its  abnormal  con- 
dition, it  acts  as  a  foreign  body,  and  its  presence  main- 
tains a  persistent  irritation. 

The  first  step  in  the  treatment  of  this  troublesome 
and  obstinate  disease  is  the  evulsion  of  the  diseased 
naiL  The  nail  should  first  be  divided  longitudinally 
with  a  pair  of  strong  scissors,  and  then  each  half  should 
be  separately  seized  and  extracted  with  a  pair  of  chiro- 
podist's forceps.  After  the  bleeding  has  ceased,  the 
whole  ulcerated  surface  should  be  lightly  touched  with 
nitric  acid,  after  which  cold  water  dressings  should  be 
applied.  At  intervals  of  forty-eight  hours,  the  surface 
may  be  brushed  over  with  nitrate  of  silver,  or  with  the 
compound  solution  of  bromine.  The  cold  water  dress- 
ings may  be  continued  with  advantage  until  the  parts 
are  restored  to  a  sound  condition,  or  a  lotion  may  be 
employed  of  liquor  sodee  chlorintft.  diluted  with  eight 
parts  of  water.  When  a  toe  is  the  seat  of  the  disease, 
the  lower  extremity  should  be  kept  in  a  horizontal  posi- 
tion. Under  the  treatment  which  I  have  recommended 
the  disease  has  generally  been  cured  within  a  few  weeks. 
When  onychia  has  occurred  from  constitutional  causes^ 
appropriate  internal  remedies  should  be  administered. 

Onjrxis,  or  inverted  toe-nail,  is  a  disease  which  affects 
almost  exclufflvely  the  great  toe.  It  presents  the  char- 
acter of  an  inflamed  ulcer,  involving  the  dorsal  integu- 
ment of  the  toe,  on  one  side  of  the  nail,  the  angle 
formed  by  the  junction  of  the  side  of  the  nail  with  its 
anterior  extremity,  being  imbedded  in  the  substance  of 
the  inflaiHecl  and  ulcerated  skin,  and  thus  keeping  up 
the  irritation,  and  preventing  the  ulcer  firom  healing. 
This  painfiil  and  troublesome  disease  is  occasioned  part- 
ly by  an  original  malformation  of  the  nail,  partly  by 
wearing  a  shoe  or  boot  too  narrow  for  the  foot,  and 
partly  by  cutting  the  nail  too  short  at  its  angle,  so  tiiat 
It  is  overlapped  b^  the  integument  In  order  that  the 
patient  should  enjoy  any  degree  of  comfort,  and  that  a 
chance  should  be  afforded  for  the  cure  of  the  disease,  it 
is  indispensable  that  the  sole  of  the  boot  or  shoe  should 
be  sufficiently  wide  to  prevent  any  injurious  lateral 
pressure.  In  cases  where  the  disease  is  of  short  dura- 
tion, and  of  moderate  severity,  rehef  may  be  afforded 
by  lifting  up  the  angle  of  the  nail  with  the  handle  of  a 
scalpel,  and  interposing  a  small  pieoe  of  soft  linen  rag 
between  the  nail  and  the  skin.  Benefit  will  also  be 
derived  from  cutting  the  free  extremity  of  the  nail,  so 
as  to  present  a  concave  line,  the  middle  of  the  nail 
being  cut  shorter  than  the  angles.  The  nail  may  also 
be  soaked  in  warm  water,  and  scraped  vnth  glass,  so  as 
to  make  it  thin  and  flexible.  When  relief  is  not  afforded 
by  these  meanfr  the  surgeon  may  avail  himself  of  the 
plan  of  treatment  suggested  by  Dr.  J.  P.  Batchelder,  of 
this  citjr.  This  plan  consists  in  cutting  a  longitudinal 
groove  in  the  nau  at  a  short  distance  from  its  inverted 
edge,  the  groove  extending   nearly,  but  not  quite. 


through  the  thickness  of  the  nail,  and  then  lifting  up 
the  e^e  of  the  nail,  and  interposuig  a  linen  rag  between 
it  and  the  skin.  By  this  means  a  change  in  the  direc- 
tion of  the  nail  is  effected,  sometimes  leading  to  a  radi- 
cal cure. 

In  the  most  severe  and  obstinate  cases  of  the  dis- 
ease, evulsion  of  the  nail  becomes  necessary.  The 
nail  should  first  be  scraped  in  the  middle,  and  then 
divided  longitudmallv  with  scissors,  after  which  the  two 
lateral  portions  should  be  extracted  with  a  chiropodist's 
forceps.  The  operation  is  sometimes  performed  by  ex- 
tracting only  the  lateral  half  of  the  nail,  corresponding 
with  the  side  on  which  the  inversion  existed.  I  am 
satisfied,  from  personal  observation,  that  the  relief  af- 
forded in  this  way  is  not  as  complete  as  when  both 
lateral  portions  of  the  nail  are  extracted,  and  that  the 
new  ntul  which  afterwards  grows  is  not  as  perfect  in 
shape.  After  removing  the  nail,  the  foot  should  be 
kept  elevated,  and  cold  water  dressings  constantly  ap- 
phed.  As  the  new  nail  begins  to  grow,  care  should  be 
taken  to  prevent  its  margin  from  being  imbedded  in  the 
skin,  and,  as  soon  as  practicable,  the  margin  should  be 
elevated,  and  a  soft  rag  interposed  between  it  and  the 
integument 

Hyponychial  or  Subtmgucd  Exostosis, — This  is  a  bony 
excrescence  from  the  dorsal  surface  of  the  last  phalanx 
of  the  toe,  where  it  is  covered  by  the  naiL  In  the 
great  majority  of  cases,  it  occurs  on  the  great  toe,  but 
it  is  occasionally  seen  on  one  of  the  smaller  toes.  It  ia 
ordinarily  a  result  of  a  contusion  of  the  affected  toe. 
The  patient  complains  of  pain  beneath  the  toe-nail,  and, 
when  the  part  is  examined,  the  nail  is  found  to  be  ab- 
normally prominent  Th%  morbid  growth  is  frequently 
situated  so  far  forward  that  it  elevates  the  free  extre- 
mity of  the  naiL  and  gives  it  an  abnormal  direction. 
The  pain  is  chieny  occasioned  by  the  resistance  which 
the  dense  structure  of  the  nail  opposes  to  the  growth  of 
the  tumor.  It  constitutes  a  serious  annoyance  to  the 
patient,  and  greatly  interferes  with  his  comfort  in 
standing  and  walking.  The  indication  of  treatment  is 
to  remove  the  morbid  growth  in  such  a  manner  as  to 
prevent  its  reproduction.  The  nail  must  first  be  di- 
vided longitudinally  vnth  scissors,  and  the  lateral  halves 
extracted  with  forceps.  The  bony  tumor  may  then 
be  removed  with  a  chisel  or  gouge,  care  being  taken 
to  carry  the  excision  below  the  normal  level  of  the 
dorsal  surface  of  the  phalanx;  or,  a  stratum  of  the 
phalanx,  including  the  base  of  the  tumor,  may  be  re- 
moved by  means  of  a  metacarpal  saw.  The  wound 
may  then  be  left  to  granulate  and  cicatrize.  During 
the  healing  process  the  limb  should  be  kept  in  a  hori- 
zontal or  dightly  elevated  position. 


Dr.  Minot,  in  the  Boston  Medical  and  Surgical  Jbur^ 
naif  gives  the  following  case.  A  child  three  years  old 
sickened  December  21st ;  an  eruption,  supposed  to  be 
that  of  measles,  appeared  on  the  25th.  The  diagnosis 
at  first  was  a  Uttle  doubtfiil,  owing  to  the  eruption  be- 
ing complicated  by  urticaria  for  two  days.  After  this 
time,  it  had  a  perfectly  normal  appearance,  and  was  at- 
tended by  catarrh  and  other  general  symptoms  of 
measles.  A  companion,  who  saw  him  early  in  the 
disease,  was  attacked  with  measles  exactly  a  fortnight 
afterwards.  A  sister  of  the  first  patient  and  a  young 
lady  visiting  in  the  family  also  took  the  disease  at  inter- 
vals of  a  few  weeks.  On  February  3d,  after  a  few  days' 
indisposition,  the  eruption  rei^peared  on  the  first  patient^ 
and  went  through  its  course  in  the  usual  manner.  The 
interval  between  the  attacks  was  six  weeks.  Singularly 
enough,  of  the  three  who  took  the  disease  from  this 
patient,  two  had  had  the  disease  before. 

Digitized  by  VjOOQ  IC 


THE  MEDICAL  RECORD. 


203 


^to^ttss  of  iEelricol  Scxtnct. 


AcnoK  OP  Chloroform  on  the  System. — Most  of 
those  who  have  carefully  studied  the  effects  of  chloro- 
form when  administered  in  vapor  to  animals  are  of 
opinion  that  the  first  effect  of  the  ansesthetic  is  excit- 
ant) and  that  this  is  followed  by  a  sedative  effect  This, 
however,  is  not  the  conclusion  of  M.  P.  Bert,  who  has 
presented  a  memoir  to  the  French  Academv  on  the 
action  of  chloroform  as  an  aneesthetic.  From  his  expe- 
riments on  dogs  and  other  mammals,  M.  Bert  concludes 
that  the  excitant  action  of  chloroform  is  a  &lse  one, 
and  that  it  does  not  depend  on  any  systemic  effect  of 
the  vapor.  He  asserts  that  the  excitant  action  is  due 
to  the  effect  of  the  vapor  on  the  mucous  coverings  of 
the  eyes,  noee,  mouth,  and  glottis :  the  chloroform  irri- 
tates these  surfaces,  and  produces  the  movements  gene- 
rally observed,  ana  usually  attributed  to  the  effect  of 
the  ab9orhed  vapor.  It  proof  of  this,  M.  Bert  cites  the 
foOowing  expenment :  '*  I  opened  the  trachea  of  a  dog, 
and  inserted  into  it  a  small  glass  tube  connected  wi3i 
an  inhaling  apparatus.  Into  the  latter  I  put  some 
pieces  of  wool  steeped  in  chloroform.  Anesthesia  soon 
took  place,  but  the  animal  slept  tranquilly,  and  there 
was  no  period  of  excitation." — LanceL 

CrsncBRous  Osllulosjb  m  thb  Anterior  Chambbr 
or  THi  Eyk.— Oct.  10,  1866,  Mrs.  A.  G.,  28,  sought  the 
advice  of  Pro£  Forstery  of  Breslau,  on  account  of  her 
left  eye.  About  fourteen  days  before,  she  discovered 
that  objects  seen  by  that  eye,  in  direct  vision,  seemed 
as  if  covered  by  a  veil  or  cloud;  there  had  never  been 
any  pain  or  redness  in  the  eye ;  her  husband  saw  a 
whitish  round  spot  on  the  lower  portion  of  the  cornea, 
hence  she  came  to  Dr.  Forster.  In  the  anterior  cham- 
ber a  vesicle  is  seen  which  is  immediately  recognised 
as  a  cysticercos  cellulosee ;  it  is  about  two  millimetres 
in  diameter ;  of  a  grayish  white  color ;  very  translu- 
cent, and  is  adherent  to  the  lower  portion  of  the  iris  by 
a  Tery  fine  pedicle  (stiel).  This  pedicle  is  so  short  as 
acaroely  to  deserve  the  name.  It  appears  rather  like  a 
point  of  the  vesicle  which  is  adherent  to  the  iris.  On 
motioo  of  the  eye,  the  vesicle  floats  about  somewhat, 
though  hindered  by  its  connexion  with  the  iris.  The 
iris  is  normal  in  color,  and  in  its  secretion*  A  weak  so- 
hition  of  atropine  dropped  into  the  eye  shows  that 
there  is  oo  adherence  of  the  iris  to  the  capsule  of  the 
lens,  and  presses  the  vesicle  near  to  the  lower  corneal 
cords.  There  are  changes  in  the  form  of  the  vesicle, 
which  occur  somewhat  spasmodically.  It  then  loses  its 
round  contour,  becomes  irregularly  polygonal,  and  seen 
by  a  magnifying  glass,  the  vesicle  seems  to  contract  to- 
wards a  centrd  point  A  milk-white,  almost  opaque 
^KH,  represents  the  position  of  the  head  and  neck.  The 
eye  is  free  from  pain ;  free  from  irritation  and  injection ; 
the  cornea  is  fully  transparent,  except  in  two  extreme- 
ly small  points  lying  on  the  posterior  corneal  surface ; 
the  media  are  clear,  direct  vision  is  unimpaired,  the 
▼isual  field  is  a  little  cloudy  below.  The  patient  in 
other  respects  is  welL 

Oct  13. — ^After  the  effect  of  the  atropine  had  passed 
away,  the  extraction  of  the  cysticercus  was  done  by  Prof. 
Forster.  A  cataract-knife  was  introduced  into  the  ante- 
rior chamber  through  the  cornea,  passing  the  knife 
under  the  vesicle.  As  the  ac[ueous  humor  escaped, 
the  peripheral  portion  of  the  iris  bulged  forward,  and 
with  gentle  stroking  of  the  cornea  with  a  DavieVs 
S>ooD,  from  above  downwards,  the  cysticercus  ran 
pQt,  having  been  loosened  from  its  adherence  to  the 
iris  without  further  instrumental  aid.  The  prolapsed 
iris  was  cut  off. 


On  the  9th  day  after  the  operation  patient  went 
home.  The  cysticercus  hved  for  some  tmie  in  tepid 
water,  making  distinct  movements,  but  the  head  could 
not  be  caused  to  protrude  by  pressure.  This  is  the 
first  case  of  cysticercus  in  the  anterior  chamber  which 
has  been  seen  by  Professor  Forster  among  30,000  eye 
cases  observed  by  him. — Dr.  Kruger.  Zehmder'a  Jovr- 
nai,  Y.^Yahrgang;  Marzund  April,  1867. 

Thb  Enucleation  or  N^vus. — ^Mr.  Thomas  P.  Teale, 
Jr.,  read  a  paper  before  the  Boyal  Medical  and  Ohinir- 
giwd  Society  on  this  subject.  He  advocated  two  prin- 
ciples which  have  received,  as  yet,  little  attention  from 
surgical  writers.  The  first  is,  that  there  exists  in  most 
cases  of  large  nssvus  a  distinct  capsule  which  will  en- 
able the  surgeon  to  enucleate  the  tumor  without  cutting 
wide  of  the  disease,  and  thereby  endangering  lai]ge 
blood-vessels  or  nerve&  Mr.  Paget  advancMsd  this  prin- 
ciple in  Holmes'  Surgery,  vol.  i,  p.  498  (three  cases  are 
there  adduced  as  proofs  of  it).  The  second  principle  is,  that 
when  a  portion  of  skin  covering  a  nsdvus  is  involved 
in  the  disease,  it  is  not  necessary  to  sacrifice  such  dis- 
eased skin,  as  it  may  be  dissected  off  the  tumor,  and 
bein^  retained  as  a  cover  to  the  wound,  will  eraduall^ 
regain  its  natural  appearance.  This  slow  cnange  is 
brouffht  about  by  the  gradual  contraction  of  the  in- 
temfd  cicatrix,  by  which  the  naevoid  skin  becomes 
united  to  the  wound  which  it  covers.  It  is  an  instance 
of  the  value  of  the  designed  production  of  atrophy  by 
means  of  cicatrix. 

Mr.  Ourling  remarked  on  the  general  dread  of  using 
the  knife  in  such  cases,  as  there  have  been  some  deaths 
fi^m  haemorrhage.  Mr.  Teale  has  adopted  the  pro- 
cedure mentioned  in  the  paper  in  some  very  formida- 
ble cases;  but  it  was  not  smtable  to  alL 

Mr.  Prescott  Hewett  thought  surgeons  were  too  prone 
to  early  operation,  as  nsdvi  will  often  disappear  in  time. 

Mr.  Bincett  stated  that  in  one  case  where  there  were 
twenty  or  more  nasvi,  all  were  now  g^ne. — MecUoal 
Times  and  QazeUe, 

The  Yalue  or  Ch&boform. — As  we  have  given  phwe 
recently  to  the  opinions  of  Prof.  Petrequin  on  the  re- 
spective value  of  ether  and  chloroform  to  produce  ansss- 
thesia,  it  is  but  just  that  we  do  the  same  for  the  con- 
trary views  of  Prot  Sedillot;  the  former  represents  the 
Medical  School  of  Lyons,  and  the  latter  that  of  Stras- 
boarg.  SediUot  has,  like  many  surgeons,  given  up  long 
ago  Uie  use  of  ether  for  that  of  chloroform :  for  this  lus 
practical  reasons  are  very  likely  stronger  and  more  cohe- 
sive than  his  theoretical  ones,  which  are  few,  but  rather 
discordant.  He  literally  says :  1st.  Every  time  we  have 
recourse  to  chloroform  the  question  is  of  life  or  death. 
2d.  Chloroform  is  an  art  which  requires  an  attention  of 
everyinstant,  and  great  skill  and  experience.  Sd.  Ohio* 
reform  perfectly  pure  and  properly  applied  never  kills. 
But  his  remarlra  on  certain  points  of  application  deserve 
better  attention.  When  using  chloroform,  Ist  Let  us 
avpid  those  deep  inspirations  as  they  are  sometimes 
produced  after  a  cough,  or  a  momentary  stop  in  the 
Oreathing  process  consequent  upon  laryngeal  spasm — 
a  single  inspiration  of  the  kind  may  be  fatal.  2d.  The 
i^parent  regularity  of  the  respiratory  movements  is  rio 
proof  that  air  penetrates  into  the  cnest<  The  glottis 
may  be  shut,  and  we  must  always  ascertain  the  reality 
of  the  noise  that  is  produced  by  the  passing  of  the  air 
through  the  glottis.  3rd.  The  cough  shows  the  persist- 
ency of  irritability  of  the  nerves  and  muscles  which 
could  be  allayed  by  continuing  to  use  the  ansosthetic 
agent.  Yomitiogs  are  also  proofe  of  commencing  anaes- 
thesia, and  are  stopped  by  renewed  inhalations.  4th.  It 
would  be  dangerous  to  try  to  completely  paralyse  the 
muscles  in  view  of  facilitating  the  reduction  of  luxations, 

digitized  by  ^ ilC 


204 


THE  lOSDIOAL  RECORD. 


becanse  their  mobility  is  increased  with  sreater  energy 
as  sooli  as  extension  is  practised.  In  opnthahnic  oper- 
ations the  same  remark  obtains.  6th.  Paralysis  of  the 
ton^e  most  be  avoided  because  it  falls  on  the  larynx, 
renderiDg  asphyxia  imminent  6tb.  Among  the  causes 
for  suspending  momentarily  the  inhalations,  are:  the 
quantity  of  chloroform  inhaled,  the  coming  of  a  period 
of  excitement,  mutism,  insensibility  to  contact,  rever- 
sion of  the  globe  of  the  eye,  incipient  resolution  of  the 
limbs. 

Practically  acknowledging  the  difficulties  which  sur- 
round chloroformization,  Dr.  Sedillot  advises  the  use  of 
ether  by  inexperienced  hands,  and  confesses  that  all  the 
Strasbourg  surgeons  have  recourse  to  the  skill  of  Dr. 
Eteer  to  produce  anaesthesia  in  their  surgical  practice; 
Elser  having  operated  for  the  learned  faculty  14,000 
times^  meeting  with  no  accident,  and  giving  the  greatest 
secunty  to  the  operators  who  have  recourse  to  his  skill. 

Thus  Sedillot  avoids  the  question  of  principle,  and 
finds  for  his  opinion  the  refuge  of  the  extraordinary  skill 
of  Dr.  ISser.  Let  us  hope  there  will  be,  if  possible^  a 
few  more  Elsers,  or  a  better  and  wide-spread  knowledge 
of  chloroformization. 

Ihooulabilitt  or  Tubsrole. — ^In  the  ChzetU  Htbdo- 
madcUre  we  have  a  continuation  of  N.  Yilleman's  re- 
searches as  to  the  inoculability  of  tubercle.  In  rabbits, 
he  has*  again  and  again  succeeded  in  reproducing  it  in 
this  manner,  not  omy  when  taken  firom  tine  human  sub- 
ject bat  still  more  rs^idly  when  taken  from  the  cow ; 
furtner,  the  tubercular  matter  thus  produced  in  one 
rabbit  could  be,  in  like  manner,  transmitted  to  another, 
in  the  same  way  as  syphilis. — Medical  Times  and  Oa^ 
zette. — Richmond  Medical  Journal 

Afplioation  07  Collodion  in  Cholera  (L' Union 
Midicale), — Dr.  Drouet,  of  La  Gkand-Montrougue,  main- 
tains that  the  external  application  of  collodion  will 
arrest  the  premonitory  diarrhoea,  and  afford  an  excel- 
lent means  of  restoring  warmth  in  confirmed  cholera. 
He  uses  a  mixture  of  collodion  6  parts,  castor  oil  I 
part,  smeared  over  the  abdomen,  and  covered  with  cot- 
ton wool  The  evaporation  of  the  ether  at  first  causes 
a  sensation  of  cold,  but  in  a  few  minutes  this  is  followed 
by  a  feeling  of  warmth,  which  increases  in  intensity, 
without,  however,  becoming  so  intense  as  to  cause  dis- 
tress. This  apphcation,  he  says,  will  certainly  arrest 
the  progress  of  the  disease,  if  used  dm*ing  the  first  hours 
of  the  attack,  and  provided  it  be  not  of  an  extremely 
yiolent  nature. — ^  71  Medicai  Joumai, 

A  New  Form  or  Suture. — Dr.  Albert  H.  Hoy,  of 
Bacine,  Wis.,  in  speaking  of  the  rubber  suture.  sa3r9^ 
'*  We  have  repeatedly  used  a  suture  to  which,  not  Know- 
ing of  its  being  mentioned  in  any  treatise  on  surgery,  we 
desire  to  call  tne  attention  of  the  profession,  trusting  they 
will  find  that  it  meets  the  indications  of  a  good  suture, 
viz.:  Ist,  adaptation  ofthe  edges  of  the  wound  ;  2d,  pro- 
docinff  httle  irritation;  3d,  easily  appUed.  In  using  it. 
the  following  Uiings  are  required :  IsL  a  paper  of  ladies 
sewing  needUes,  the  points  of  which,  for  one  third  theit 
length,  have  been  heated  in  a  lamp  and  curved  like  a 
8urgeon*8  needle ;  No.  4  is  the  best  size ;  2d,  some  rub- 
ber elastic  bands,  cut  into  inch  lengths;  that  having  a 
width  of -Af  of  an  inch  will  be  found  most  generally  use- 
ful; 3d,  a  pair  of  small  pliers  and  wire-cutters.  To  in- 
troduce the  suture,  one  of  the  needles  is  taken  firmly 
by  the  eye  with  the  {^iers,  and  a  piece  of  the  rubber 
band  is  strung  on,  near  one  of  its  ends,  and  liie  needle, 
thus  armed,  is  thrust  through  the  edges  of  the  wound, 
thus  holding  them  together.  The  free  end  of  the  rub- 
ber band  is  then  strung  over  the  point  of  the  needle, 
oare  being  taken  to  give  the  band  just  sufficient  tension 


to  hold  the  lips  of  the  wound  snugly  together.  The 
points  of  the  needles  are  then  snipped  off  with  the  cut- 
ters, and  the  suture  is  complete.  The  above  suture  is 
highly  recommeded  in  hardip  and  other  plastic  opera- 
tions, where  speedy  union  or  the  cut  surfeces  is  of  the 
greatest  importance." — Chicago  JoumdL 

BUPTURSD    HkART;     iNSUFnOISNOT    OF    TBI    AoRTIO 

Valve  ;  Htfbrtropht  and  Dilatation. — ^In  the  Boston 
Medical  and  Surgical  Journal  Dr.  Shattuck  relates  the 
following  case.  A  man  agea  60.  previously  in  good 
health,  after  sleeping  in  a  cold,  aamp  room,  awoke  in 
the  morning  with  pain  in  his  chest,  a  fi^quent^  loose 
cough  vnth  frothy  expectorations,  streaked  with  blood. 
These  symptoms  continued,  with  /considerable  dyspnoea 
and  pain  on  taking  a  long  breath.  The  first  sound  of 
the  heart  was  loud  and  accentuated,  followed  by  a  short 
murmur.  There  were  no  r&les ;  diminished  resonance 
and  bronchial  inspiration  and  respiration  in  right  supra- 
spinous fossa.  Kesonance  marked  over  the  fi^nt  on 
each  side  of  the  chesty  and  loud  respiration  imder  both 
davicles,  and  even  in  cardiac  region.  In  the  course  of 
ten  days  there  had  been  much  improvement^  but  after- 
wards suffered  greatly  from  asthmatic  breathmg ;  while 
sibilant  and  sonorous  r41es  were  heard  all  over  me  chest, 
but  more  distinct  in  front  Subsequently  the  dyspnoea 
became  extreme:  he  had  profuse  sweats  and  sometimes 
delirium.  The  diastoUc  murmur  became  louder  over 
the  aortic  than  over  the  pulmonic  valves.  About  two 
months  after  being  attacked  *'  he  had  an  exceedingly 
sevo^  paroxysm  of  dyspnoea^  and  while  tossing  about 
on  the  bed,  suddenly  sprang  up,  threw  himself  back,  and 
after  gasping  for  a  moment^  expired."  An  autopsy  re- 
vealed the  following :  pleura  of  right  lung  universally  ad- 
herent to  costal  pleura  and  the  diaphragm.  In  left  pleural 
cavity  were  found  twenty-eight  ounces  of  reddish,  straw- 
colored  serum,  and  the  lining  membrane  of  bronchial 
tubes  of  a  deep  red  color.  Leh  lung  oedematous  in  upper 
lobe,  and  right  lung  somewhat  oedematous.  The  peri- 
cardium contained  three  ounces  of  dark  fluid  blood. 
Several  white  patches  seen  on  external  surface  of  heart 
Nearly  over  the  septum  between  the  ventzicles,  to  the 
right  of  the  coronary  vein,  on  the  anterior  surface  ofthe 
hearty  and  one  inch  and  an  eighth  from  the  apex,  is  seen 
a  rent^  looking  like  an  incised  wound,  running  in  a 
direction  parallel  with  the  septum.  The  rentgu>ed  but 
slightly,  was  five  Unes  long,  and  communicated  fi^y 
with  the  cavity  of  the  right  ventricle.  One  of  the  aortic 
valves  had  its  free  edge  contracted,  and  another  was 
thickened  by  warty  deposits.  The  mitral  valve  was 
healthy.  The  ascending  aorta  was  dilated,  and  the  up- 
per two  and  a  half  inches  of  the  thoracic  aorta  were 
much  dilated,  and  the  artery  much  thickened  by  athero- 
matous deposits. 

Poisoning  by  Strychnine. — ^Dr.  John  Bartlett,  foiv 
merly  of  Chicago,  strongly  recommends  common  salt 
as  a  curative  of  strychnine  poisoning.  He  reports  as 
many  as  twenty  experiments  on  dogs,  in  which  violent 
symptoms  following  large  doses  ^  strychnia  ceased 
ailer  emesis,  induct  by  drenching  the  animals  with 
water,  holding  in  solution  several  handfiils  of  salt. — 
Chicago  Mediood  Journal, 

Hypodbrmio  Injections. — They  will  be  found  inyalu- 
able  in  relieving  pain  and  nervous  irritability  in  all  sur- 
gical accidents.  It  has  also  been  found  to  prolong  the 
aufesthesia  from  chloroform.  I  now  inject  one-quarter 
to  one-half  grain  of  morphine,  when  I  expect  my  pa- 
tient to  be  continued  under  chloroform  for  a  length  of 
time.  The  attention  of  the  profession  is  respectfully 
called  to  this  fact. — Wm.  A.  Greene,  M  J).,  in  the  Aikmta 
Msddoal  and  JdurguxU  JoutmaL         ^ 

Digitized  by  VjOOQ  IC 


THE  MEDICAL  RECORD. 


205 


The  Medical  Record. 

Gborge  p.  Shbady,  M.D.,  Editob. 


PnblidMd  on  tin  Iflt  and  IdOi  of  oaoh  Month,  lyf 
WILLIAM  WOOD  &  GO^  61  Walub  Steket,  Nbw  Tobx. 


FORJSIOir  AGSJSrOIJBS, 


LcnrDov— TBVBifsm  *  Co. 

PaBU— BOMABOB  BT  Cu. 


ILbipsio— B.  HBBMAinr. 
Bio  Jakbibo— TBPaBifB  t  Oa 


Now  York,  Jixly  1.  1867. 


THE  UTERINE  ELEMENT  IN  PEACTICE. 

Thb  adyances  which  have  been  of  late  years  made 
in  the  department  of  uterine  pathology  have  not  been 
without  their  effects  upon  general  practice.  The  brilliant 
SQCcess  which  has  associated  itself  with  the  labors  of  a 
few  pioneers  in  this  branch,  has  thrown  open  the  lists  to 
Teiy  many  aspiring  imitators,  a  class  which  has  notably 
increased  within  the  past  few  years.  So  great  indeed 
has  been  this  infusion  of  the  uterine  element  into  prao- 
tice,  that  it  is  considered  one  of  the  necessary  accom- 
plishments  of  almost  every  general  practitioner  to  make 
araginal  examination  of  every  female  who  falls  into  his 
hands,  and  discover  as  the  inevitable  result  of  such  a 
procedure,  some  more  or  less  important  uterine  disease. 
IT  aay  female  is  the  possessor  of  any  anomalous 
BTmptoms,  if  she  escapes  nowadays  without  a  oarefid 
examination  with  the  speculum,  a  few  leeches  to  the  os, 
a  cauterization  of  the  cervix,  a  pessary,  a  sponge  tent; 
or  a  sea-tangle  bougie,  she  is  exceedingly  fortunate. 

To  any  one  conversant  with  current  medical  Uterature, 
the  fact  is  a  very  patent  one  that  uterine  diseases,  if  not 
on  the  increase,  are  certainly  claimed  to  be  very  preva- 
lent This  ftay  be  in  a  measure  accounted  for  by  the 
progress  which  has  recently  been  made  in  the  more, 
thorough  study  of  such  affections,  and  the  more  satisfac- 
tory means  ftt  our  command  for  arriving  at  a  correct 
diagnosis ;  but  we  are  compelled,  from  the  circumstances 
of  the  case,  to  go  a  step  further  in  assigning  the  reason 
for  this  so-called  remarkable  increase  of  uterine  affec- 
tions, and  assume  that  the  vast  majority  of  them  exist 
only  in  the  imagination  of  the  attending  physician.  Un- 
fortunately for  the  cause  of  science,  diseases  of  the  uterus 
are  as  fashionable  with  physicians  as  with  their  nervous 
and  hardly  less  senseless  patients.  Almost  every  third 
female  invalid  comes  to  the  conclusion  that  she  has  that 
tnditional,  and  as  she  thinks  expressive  complaint,  *'  fall- 
ing of  the  womb,'*  and  her  family  phy^cian  rarely  fails 
to  discover  'some  slight  enlargement  of  the  cervix,  a 
ring  of  congestion  around  the  os,  or  a  trifling  amount  of 
di^klaoement  I  The  usual  routine  treatment  is  instituted, 
the  cervix  is  either  melted  down  with  potassa  fusa  or 


nitrate  of  silver,  and  then  an  interesting  little  ^contri- 
vance in  thi  shape  of  a  pessary — an  instrument,  the  oft- 
demonstrated  exponent  of  ignorance  and  hobbyism — 
is  applied,  and  the  indications  of  the  case  are  supposed 
to  be  met 

The  testimony  of  all  the  experts  in  this  branch  is  to 
the  effect  that  the  prevalence  of  uterine  troubles  is  more 
than  overestimated,  and  these  assertions  are  based  upon 
the  fact,  that  very  few  of  all  the  patients  sent  them 
have  anything  in  the  shape  of  uterine  abnormality  what- 
ever. But  as  this  statement  only  refers  to  thosb  which 
are  supposed  to  be  desperate  cases,  what  can  be  said  con- 
cerning the  trivial  ones  which  are  treated  in  the  routine 
of  a  general  family  practice  I  Can  there  be  much  of 
error  in  the  assertion  that  much  is  done  for  the  large 
number  of  supposed  sufferers  which  is  not  only  utterly 
useless,  but  positively  detrimental  to  the  well-being  of 
one  of  the  most  important  organs  in  the  economy? 

It  is  perfectly  natural  for  the  uterine  specialist  to  meet 
with  any  number  of  cases  that  are  of  comparative  rarity, 
but  hardly  possible  for  every  general  practitioner  to  be 
equally  favored ;  there  is  a  certain  law  which  governs  the 
proportion  of  remarkable  cases  which  cannot  be  ignored 
even  by  those  who  court  uterine  practice,  while  the 
plea  of  a  correct  diagnosis  in  every  case,  is  in  itself  evi- 
dence of  a  transcendentalism,  that  is,  tO'say  the  lease, 
absurd. 

Aside  from  the  assumed  prevalence  of  diseases  of  the 
uterus,  there  is  an  excuse  for  an  extensive  practice  in 
this  branch,  in  that  it  is  so  remunerative ;  and  it  is  pretty 
generally  understood  that  a  gentleman  skilled  in  intro- 
ducing speculums  and  diagnosticating  obscure  womb  dis- 
eases, has  the  strongest  possible  recommendations  for 
business  among  that  large  class  of  would-be  sufferers — 
the  women.  In  this  connexion  we  may  remark  that  we 
recently  heard  it  asserted  by  a  gentleman  long  engaged 
in  general  practice,  and  who  is  supposed  to  be  ac- 
quainted with  all  its  requirements,  that  there  were  more 
fees  collected  for  the  treatment  of  diseases  of  the  uterus, 
that  were  not  fairly  earned,  than  for  those  of  any  other 
organ  or  sets  of  organs  in  the  body.  Nb  one  acquainted 
with  the  merits  of  the,  case  as  he  was  could  fail  to 
come  to  the  same  conclusion. 

It  is  legitimate  enough,  on  general  principles,  to  ex- 
tend the  circle  of  any  one's  practice,  and  if  there  is  a 
demand  for  services  to  the  uterus  it  must  not  be 
neglected  any  more  than  to  the  eye,  the  throat,  the  ear, 
the  bladder,  or  the  anus;  but  the  significant  question 
here  obtrudes  itself— Is  the  profession,  by  ite  treatment 
of  these  cases,  doing  its  best>  not  only  to  lessen  the  suf- 
fering of  uterine  patients,  but  to  persuade  them  at 
the  same  time  that  their  ills  are  more  imaginary  than 
real?  If  the  latter  part  of  their  duty  is  not  conscienti- 
ously performed,  the  only  excuse  for  indiscriminately 
cauterizing,  incising,  leeching,  and  ^^  supporting ''  a  com- 
paratively inoffensive  organ,  is  to  be  found  in  a  disgraceful 
and  therefore  culpable  ignorance  of  the  fimdamental 
doctrines  of  uterology.  ^^  ^ 

Digitized  by  VjOOQIC 


206 


THE  MEDICAL  RECORD. 


This  want  of  knowledge  is  the  <m\j  would-be  uterine 
pathologists  excuse,  and  its  worthlessness  m  apparent, 
when  he  has  within  his  grasp  all  the  improvements 
which  the  labors  of  his  more  practical  and  scientific 
brethren  have  placed  before  him.  He  pretends  to  im- 
itate them,  when  in  reality  he  has  become  so  poisoned 
with  routine,  that  he  is  ten  years  behind  the  age.  Even 
allowing  a  wide  margin  for  all  exaggeration  as  to  the 
increased  prevalence  of  the  diseases,  there  is  no  reason 
why  there  will  not  be  enough  to  claim  the  serious  atten- 
tion of  every  general  practitioner;  but  in  the  name  of 
science  and  humanity,  let  them  be  treated  intelligently, 
let  there  be  more  exact  knowledge  and  less  empiricism, 
more  brains  and  fewer  instruments. 


We  have  an  announcement  from  an  authoritative 
source,  to  the  effect  that  it  is  the  intention  of  the  Med- 
ical Staff  of  Bellevue  Hospital  to  issue  a  yearly  volume 
of  interesting  cases  occurring  in  that  institution.  This, 
if  the  project  is  carried  out,  will  be  the  first  instance 
within  our  knowledge  in  this  country  of  collecting  in 
an  endurable  form  the  valuable  material  of  a  large  charity. 
The  example  of  the  faculty  of  that  hospital  deserves  to 
be  followed  by  other  and  older  institutions  throughout  the 
country.  There  are  not  a  few  of  these,  among  which 
may  be  prominently  mentioned  the  New  York  Hosj^. 
tal,  whidi  has  volumes  of  manuscript  cases,  and  for  the 
want  of  a  suitable  vehicle  for  their  publication,  they  are 
hidden  from  all  save  those  favored  few  who  have  access 
to  the  library.  Many  of  the  very  interesting,  not  to 
say  important  cases,  never  have  seen,  or  will  see,  the 
light,  except  some  such  means  are  taken  to  present 
them  to  the  profession.  Except  for  the  occasional  ap- 
pearance of  an  isolated  report  of  an  operation  or  two 
by  some  members  of  the  House  Staff,  or  the  occasional 
mentioning  of  a  case  to  a  society,  the  medical  public 
would  hardly  be  aware  of  the  existence  of  the  hospital 
The  same  may  be  said  of  other  similar  institutions  not 
very  far  off.  It  occurs  to  us  that  it  would  be  feasible,  in 
carrying  out  the  plan  of  such  a  publication,  to  appoint 
clinical  clerks  whose  duties  should  be  to  write  up  idl 
the  cases  for  publication,  and  submit  the  same  to  each 
interested  party  for  revision,  the  corps  being  under' the 
direction  of  a  competent  person,  whose  duty  it  should 
be  to  group  and  arrange  them  as  would  best  suit 
the  purposes  of  such  a  volume.  For  the  faithful  and  ac- 
ceptable performance  of  such  duties  a  liberal  salary  should, 
be  allowed  to  all  concerned^  to  stimulate  industry  and  in- 
fuse a  proper  interest  in  the  work.  The  material  of 
Bellevue  is  ample,  and  there  are  plenty  of  men  who 
would,  for  a  consideration,  be  willing  to  perform  the 
necessary  labor ;  and  if  the  project  &ils  it  will  only  be 
for  the  lack  of  a  suitable  appropriation  to  carry  it  out 
The  profession  will  undoubtedly  gladly  receive  the  vol- 
ume, and  the  amount  of  pecuniary  returns  which  the 
projectors  will  realize  will  be  sufficiently  ample  to  enable 
them  to  meet  all  ihair  necessary  liabilities. 


Vimms. 


Insanttt  in  rrs  Medico-Legal  Relations.  Opinion  rela- 
tive to  the  Testamentary  Capacity  of  the  late  James  GL 
Johnston,  of  Chowan  County,  S.  0.  By  W.  A.  Hammond, 
M.D.,  etc.  New  York:  Baker,  Voorhees  &  Co.  1866. 
8vo.,  pp.  72. 

Tms  Is  an  interesting,  suggestive,  and  instructive 
pamphlet,  treating  upon  several  important  points  con- 
nected with  moral  insanity,  the  principal  of  which  is 
that  referring  to  the  non-existence  of  any  lucid  interval 
in  the  monomaniac.  Numerous  interesting  cases  are 
cited  by  the  author  to  prove  his  position,  and  the  argu- 
ments which  he  offers  are  convincing.  Every  physician 
who  may  wish  to  prepare  himself  to  testify  in  a  court 
of  law  upon  the  question  at  issue,  should  read  this 
''ork,  and  profit  bv  the  fiMJts  which  are  presented 
in  it.    It  is  written  in  the  usual  elegant  and  attractive 


ipon 
little  work,  and  profit  bv  the  fiMJts  wlbich  are  presented 
in  it.    It  is  written  in  the  usual  elegant  and  i  " 
style  of  this  well  known  and  talented  author. 

Die  Chbonisohen  KEHLKOPFES-KRANEiHBrrEN,  mit  specieller 
Biincksicht  auf  Laryngoskopische  Diagnostik  und  locale 
Therapie,  von  Db.  Adelbert  Tobold,  Sanitatsrath  und 
Docent  der  Berliner  Universitat    (Chronic  Diseases  of  the 
Laiynx,  with  Special  Reference  to  Laiyngoscopic  Diagnosis, 
by  Db.  Adelbert  Tobold,  Lecturer  in  the  University  of 
Berlin.) 
There  are  not  a  few  who,  having  heard  of  laryngoscopy 
only  as  an  interesting  and  beautiful  wonder,  suppose 
that  at  best  it  is  merely  a  scientific  plaything,  which 
can  have  no  very  radical  influence  on  the  therapeutics 
of  the  affection  that  it  aids  us  to  diagnosticate.    If  we 
mistake  not,  this  is  the  opinion,  or  at  least  the  impres- 
sion, of  the  great  majority  of  the  profession.    It  would 
be  a  great  benefit,  therefore,  if  either  a  translation  of  this 
work  of  Dr.  Tobold,  or  some  original  work  in  our  own 
tongue,  could  be  introduced  into  general  professional 
circulation. 

The  short  period  of  a  little  more  than  eight  years 
which  has  elapsed  since  the  discovery  of  the  laryngoscope 
has  been  marked  by  great  activity  in  the  literature  of 
that  subject,  and  yet  until  the  recent  appearance  of  tliis 
work  of  Dr.  Tobold  there  was  scarcely  any  treatise  of 
much  length  devoted  exclusively  to  chronic  diseases  of 
the  throat.  If  we  except  a  few  brochures  treating  of 
some  special  affections,  nearly  all  the  treatises  on  this 
subject,  excepting  the  very  unsatisfactory  work  of  Dr. 
Gibbs,  are  cniefiy  occupied  with  explanatiMis  of  the  use 
of  the  laryngoscope  and  the  history  of  ns  discovery. 
Dr.  Tobold  assumes  that  his  readers  are  familiar  with 
the  instruments  employed,  and  after  giving  a  few  hints 
in  regard  to  the  possibility  of  always  makmg  a  success- 
fiil  examination  with  them,  he  devotes  the  greater  por- 
tion of  the  work  to  the  pathology,  aetiology,  prognosis, 
and  therapeutics  of  laryngeal  diseases. 

The  chapters  on  new  formations  ought  to  convince 
the  most  sceptical  that  the  discovery  of  the  laryngo- 
scope has  introduced  an  era  in  medicine. 

The  author  has  very  little  faith  in  inhalations,  at  least 
for  the  portion  of  the  mucous  membrane  that  lies  above 
the  vocal  cords..  We  think  that  in  this  particular  Dr. 
Tobold  does  not  sufficiently  recognise  the  necessity, 
that  is  everywhere  laid  upon  physicians,  of  consulting 
the  feelings  of  their  patients.  Those  who  will  not  en- 
dure the  sponging  and  injecting  with  strong  solutions  of 
nitrate  of  silver,  alum,  or  sulphate  of  zinc,  that  he  finds 
so  efficacious,  may  be  perfectly  willing  to  inhale  the 
same  substances,  and  so  put  themselves  in  the  way  of 
cure,  though  ^e  course  of  treatment  may  be  more  pro- 
tracted tban^nder  the  heroic  system. 
Certainly  the  use  of  medicated  inhalations  is  now 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


207 


advocated  by  higher  authority  than  that  of  charlatans. 
The  ideas  advanced  on  the  relation  of  laryngeal  ul- 
ceration to  tubercular  deposits  in  the  lungs  should  be 
thoroughly  considered  by  every  practitioner.  If  it  be 
true,  as  the  author  asserts,  that  "  laryngeal  tuberculosis 
is  exclusively  a  secondary  product  of  lung  tuberculosis." 
then  the  time  has  already  come  when  no  one  should 
presume  to  be  authority  on  diseases  of  the  lungs  who 
18  not  familiar  with  the  use  of  the  laryngoscope ;  for  by 
as  much  as  the  evidence  of  the  eye  is  more  reliable  than 
that  of  the  ear  in  medical  study,  by  so  much  must 
the  inspection  of  the  larynx  be  a  more  satisfactory  aid  in 
the  diagnosis  of  certain  stages  of  lung  affections  than 
the  auscultation  of  the  chest  Original  and  interesting 
as  is  this  work  of  Dr.  Tobold,  we  think  that,  had  a  de- 
tailed exhibition  of  a  limited  number  of  cases  been 
added,  its  value  would  have  been  much  increased. 


Viepoxts  of  pocittxts. 

N.  Y.  PATHOLOGICAL  SOCIETY. 

Stated  Mbetino,  Maboh  27,  1867. 
Dr.  H.  B.  Sands,  President,  in  the  Chau*. 
Dr.  Rogers  next  made  some  allusion  to  the  case  of 
Paflopian  pregnancy,  presented  by  Dr.  Finnell  at  the 
last  meeting,  more  especially  in  connexion  with  the 
practicability  of  performing  gastrotomy  with  the  view 
of  arresting  the  haemorrhage.  He  had  made  it  his  busi- 
ness to  inquire  into  all  the  circumstances  of  the  case, 
and  had  been  enabled  to  arriye  at  the  conclusion,  that, 
had  the  patient  been  seen,  in  the  early  part  of  her  illness, 
hy  an  intelligent  practitioner,  her  life  might  have  been 
saved.  It  may  be  remarked,  in  passing,  that  Dr.  Fin- 
nell had  no  previous  knowledge  of  the  case  before  he 
was  called  upon  to  make  the  autopsy.  Dr.  Rogers  as- 
certained that  in  addition  to  the  symptoms  which  oc- 
curred ten  days  before  death,  the  patient  had  been 
ill  for  some  time,  something  like  six  weeks,  during 
which  period  she  had  supposed  herself  pregnant.  She 
had  been  unable  to  leave  her  bed  for  a  period  of  three 
weeks.  At  that  time  she  thought  that  she  was  about  to 
abort,  and  was  said  to  have  had  a  sanguineous  discharge 
one  week  before  her  pains  came  on.  The  remarkable 
circumstance  was  that  she  was  ill  enough  to  frighten 
her  neighbors  for  a  period  of  a  whole  week,  and  yet  no 
physician  was  sent  for.  The  pains  in  the  afternoon  of 
the  first  day  subsided  after  a  time,  but  subsequently  it, 
was  noticed  by  her  attendants,  her  daughter  and  a 
neighboring  woman,  t^at  her  belly  became  much  en- 
lar^d,  was  very  soft,  and  seemed,  as  they  expressed  it, 
to  be  filled  with  water.  This  was  a  very  unportant 
symptom  for  any  physician  who  might  have  seen  the 
case.  The  other  important  point  had  reference  to  the 
situation  of  bleeding.  The  opening  was  a  very  small 
one,  not  larger  Uian  the  diameter  of  a  crow-quiU.  She 
was  seen  by  a  physician  about  two  hours  before  she 
died,  who  pronounced  her  case  one  of  colic. 

In  reference  to  the  remark  made  by  Dr.  Finnell  in 
regard  to  the  chance  of  saving  the  woman  by  an  opera- 
tion, Dr.  R.  remarked,  that  the  more  he  thought  of  the 
caee  the  more  he  became  convinced  that  her  life  might 
have  been  saved.  If  she  had  been  seen  the  first  day 
there  could  have  been  no  danger  of  a  wrong  diagnosis. 
cancerous  testis. 

Dr.  Markoe  presented  a  cancerous  testis,  and  remark- 
ed upon  it  as  follows : 

I  have  a  specimen  which  I  merely  present  to  the 
Society  as  a  fact  to  which  I  hope  hereafter  to  add  a  his- 
tory; a  fact,  which  is  somewhat  interesting  from  the 


rarity  of  its  occurrence,  and  the  pathological  interest 
which  attaches  to  the  certainty  and  rapidity  of  the  re- 
production of  this  disease.  A  child,  between  two  and 
three  years  of  age,  received  some  six  months  before  I 
saw  it  an  injury  of  the  left  testicle.  The  organ  enlarged, 
gave  a  great  deal  of  pain  and  distress  for  a  certain  time, 
and  then  subsided.  From  that  time  the  testicle  gradu- 
ally increased  in  size,  without  a  great  deal  of  pain,  or 
without  any  indication  of  inflammatory  action,  until  the 
time  at  which  it  presented  itself  to  me.  At  that  time, 
now  about  two  weeks  ago,  the  testicle  had  attained  the 
size  of  an  orange;  the  scrotum  was  red :  the  swelling 
was  somewhat  pyriform,  hanging  very  low  as  though 
dragging  upon  the  cord;  the  cord  was  rather  slender, 
and  tree  from  any  contamination ;  one^half  of  t^e  tes- 
ticle was  of  a  dark  red,  and  the  other  was  of  a  darker 
color  and  purple.  The  only  question  that  could  sug^ 
gest  itself  at  first  was,  that  the  mischief  might  have  the 
character  of  an  haematocele.  I  introduced  an  exploring 
needle,  which  was  followed  by  the  exudation  of  a  serous 
fluid,  and  then  by  blood.  I  then  determined  to  extir- 
pate it,  which  I  did  immediately,  and  here  it  is.  On 
examination  the  evidences  were  very  satisfactory  of  its 
malignant  character.  Its  gross  appearance  is  very  char- 
acteristic of  soft  cancer. 

In  conclusion  he  referred  to  a  similar  case  operated 
upon  by  Dr.  Parker,  with  a  similar  result 

Dr.  F.  DELAFiELn,  in  reply  to  a  question  from  Dr. 
Sands  in  regard  to  the  microscopical  character  of  the 
diseased  mass,  stated  that  it  was  composed,  for  the  most 
part,  of  large  round  nucleated  cells  in  well  formed  areo- 
la, many  of  the  cells  being  in  an  advanced  sta^e  of 
fatly  degeneration.  There  were  ahnost  no  fusiform 
cells.  '' 

Dr.  Sands  stated  that  the  reason  why  he  asked  the 
question  was  that,  having  had  occasion  to  examine  the 
testis  removed  by  Dr.  Parker,  he  had  found  it  to  be 
made  up  of  the  fusiform  cells  peculiar  to  the  fibro- 
plastic tumor.  He  had  considerable  difficulty  in  this 
examination,  on  account  of  the  abundance  of  fatty  de- 
generation present  He  remarked  that  he  had  con- 
sulted Holmes's  Surgery  on  the  subject  of  tumors  of  the 
testicle,  and  had  found  mention  made  there  of  a  similar 
specimen,  which  had  been  examined,  and  found  to  be 
fibro-recurrent,  but  the  history  of  the  tumor  showed  it 
to  be  malignant,  that  is  it  had  a  fatal  termination  by 
recurrence.  Some  surprise  was  expressed  in  the  work 
referred  to,  that  a  tumor  having  these  microscopical 
characters  should  have  returned. 

CYST  OF  ovary: — OVARIOTOMY. 

Dr.  J.  B.  Cutter  presented  a  specimen  of  single  cyst 
of  the  left  ovary,  which  he  had  removed  by  operation 
thirteen  days  before.  The  patient  was  an  unmarried 
lady,  twenty-three  years  of  age.  The  disease  had  exist- 
ed five  and  one-half  years.  She  had  been  tapped  in  that 
time  four  times,  about  a  year  apart  The  fluid  at  each 
tiiue  was  albuminous  and  dark  in  color.  The  incision 
was  made  in  the  median  line  of  the  abdomen,  midway 
between  the  umbilicus  andpubes,  and  was  four  inches  in 
length.  There  was  one  adhesion  upon  the  right  side  of 
the  tumor,  which  was  to  omentum.  The  extent  of  ad- 
hesion was  about  six  inches,  the  vessels  were  very 
large  and  tortuous,  some  of  them  being  equal  in  size  to 
a  lead  pencil  It  was  decided,  however,  to  tap  the  cyst, 
and  remove  it  There  was  another  small  attachment  to 
the  tumor,  but  its  exact  character  it  was  not  prudent 
to  ascertain.  This  was  tied  with  a  stout  silk  ligature, 
and  then  a  clamp  was  placed  upon  the  omentum,  which 
was  divided  so  close  that  the  cyst  was  cut  into.  The 
pedicle,  which  was  a  long,  slim  one,  was  next  divided, 
and  tied  with  a  double  silk  ligature.     The  omentum 

Digitized  by  VjC  „       ^_ 


208 


THE  MEDICAL  RECORD. 


was  next  examined,  when  it  was  found  that  there  was 
hsemorrhage  below  the  point  ligatored;  the  part  was 
then  secured  again,  and  the  mass  beyond  the  ligature 
cut  oflf.    Each  pedicle  was  included  in  the  wound. 

Ether  and  chloroform  were  first  a^inistered,  but  not 
acting  well,  ether  alone  was  employed.  She  vomited 
shghdy  but  once  during  the  administration.  Ailer  the 
patient  was  placed  in  bed,  she  complained  of  some  sore- 
ness about  the  wound,  and  twenty-five  drops  of  Mc- 
Munn's  elixir  of  opiimi  were  ordered.  She'never  suJQfered 
from  any  pain  from  that  time,  and  the  abdomen  re- 
mained perfectly  flat  On  the  third  day  in  the  momine 
ten  drops  of  McMunn's  elixir  were  again  administered 
with  a  view  of  keeping  in  check  the  peristaltic  action  of 
the  bowels.  On  we  tenth  day  the  ligature  from  the 
omentum  came  ftway.  There  was  suppuration  at  each 
pedicle.  On  the  fourth  day  there  was  a  slight  fscal 
discharge,  and  the  Mc'Munn's  elixir  was  substituted  by 
tinct.  of  opium,  and  no  movements  took  place  until  the 
eighth  day,  when  a  dose  of  oil  was  administered. 

In  answer  to  a  question  from  Dr.  Rogers,  he  stated 
that  it  was  not  considered  at  all  dangerous  to  leave 
blood  in  reasonable  quantity  in  the  peritoneal  cavity. 

VESICO-IKTESTDCAL  FISTUIiA. 

Dr.  Robert  Watts^  Jr.,  presented  an  interesting  spe- 
cimen of  communication  of  the  bladder  with  the  intes- 
tinal canaL  It  was  removed  from  a  woman,  who  was 
an  inmate  of  the  Charity  Hospital,  on  account  of  phthi- 
fib  and  syphilis.  Soon  after  admission  she  was  seized 
with  diarrhoea,  which  continued  imtil  her  death.  On 
two  or  three  occasions  she  had  hsemorrhage  from  the 
bowels,  but  never  to  any  great  extent.  Last  November 
she,  by  mistake  for  Magendie's  solution  of  morpKine, 
took  a  grain  of  atropine.  This  was  followed  by  the 
symptoms  pecuhar  to  poisoning  by  this  alkaloid,  viz. 
extreme  dizziness,  dryness  of  the  fences,  and  extreme 
dilatation  of  the  pupil.  She  was  treated  immediately 
with  an  emetic  of  sulphate  of  zinc,  and  the  stomach- 
pump.  But  although  she  recovered  from  the  immediate 
effects  of  the  poison,  she  had  persistent  vomiting,  being 
only  at  times  able  to  retain  lime-water  and  milk,  with 
which  she  was  of  necessity  constantly  fed.  During  the 
course  of  her  sickness  her  urine  was  examined,  and 
found  to  contain  albumen  and  casts.  There  was  nothing 
peculiar  about  her  alvine  dejections. 

On  making  the  post-mortem,  the  stomach  was  found 
perfectly  hewthy.  The  Uver  was  fatty,  and  the  lungs 
tuberculous.  Both  kidneys  were  found  the  seats  of 
fatty  degeneration. 

The  cavity  of  the  pelvis  gave  evidences  of  old  peri- 
tonitis, and  all  the  organs  were  found  bound  together 
as  the  result.  The  rectum  was  pushed  over  to  the  right 
side,  and  returning  on  itself  again  had  formed- a  lar&^e 
loop,  the  two  ends  of  which  were  bound  down  closely 
to  the  bladder,  and  from  each  end  there  was  a  direct  com- 
munication with  the  bladder.  The  left  kidney  had  two 
ureters,  which  ran  side  by  side,  and  opened  at  one  point 
by  separate  orifices  in  the  bladder.  The  patient  had  no 
bladder  trouble,  nor  symptoms  of  peritonitis  during  tier 
stay  in  the  hospital.  Death  was  occasioned  simply  by 
exhaustiop. 

The  Society  then  adjourned. 


Stated  Mbetiko,  April  10,  1867. 
Db.  H.  B.  Sakds,  President,  in  the  Chair. 

riBRO-PLASTIO  TUMOR  OP  KTE-BALL. 

Dr.  p.  Dxlafield  exhibited  a  tumor  of  the  eye,  which 
he  had  removed  on  the  29th  of  March  from  a  patient  of 
the  N.  Y.  Eye  Infirmary.    The  patient  was  45  years 


of  age,  of  large  frame,  and  apparently  in  the  enjoyment 
of  penect  health.    About  three  years  ago.  he  first  no- 
ticed an  impairment  of  the  inner  half  or  the  field  of 
vision  of  the  right  eye.    This  condition  of  things  grew 
worse  and  worse,  until  finally  he  lost  the  si^t  of  that 
eye  altogether.    There  was  at  no  time  that  he  recol- 
lected any  symptom  of  inflammation  about  the  organ 
to  account  for  tne  phenomenon,  neither  had  he  received 
any  injury  to  the  eye.    On  the  26th  of  December,  he 
first  presented  himself  for  treatment  at  the  Eye  Infir- 
mary ,'  and  at  that  time  complained  of  pain  in  the  eye- 
ball, and  in  the  forehead  over  the  eye.    On  examination 
of  the  affected  organ,  the  pupil  was  dilated,  the  lens 
opaque,  and  only  the  external  half  of  the  retina,  vnth 
two  or  three  blood-vessels  upon  it,  was  visible.    The 
conclusion  arrived  at  was,  that  there  was  a  tumor  of 
the  choroid  or  retina,  lifling  up  the  latter.    Extirpation 
of  the  eye  was  accordingly  advised ;   but  the  patient 
refused  to  have  the  operation  performed.    He  was  seen 
on  two  or  three  different  occasions  after  this,  and  was 
found  to  be  about  the  same,  and  then  he  was  lost  si^t 
of  until  the  20th  of  March  last.    B!e  then,  returned  to 
the  Infirmary  vnth  the  story,  that,  for  the  previous  four- 
teen days,  the  pain  in  the  eye  and  forehead  had  very 
much  increased — so  much  bo,  that  he  had  not  been  aWe 
to  obtain  any  rest  day  nor  night.    The  pupil  was  then 
found  still  more  dilated,  the  conjunctiva  ecchymosed, 
the  eye-ball  exceedingly  tense,  and  the  retina  in  any 
part  was  no  longer  to  be  seen.    Consenting  to  extirpa- 
tion, the  operation  was  soon  after  performed.     On 
examination  of  the  organ  after  removal,  the  posterior 
third  of  the  eye  was  occupied  by  a  tumor  springing 
from  the  choroid,  and  detadiing  the  retina,  so  that  the 
latter  was  folded  together  and  much  atrophied.    The 
mass  consisted  entirely  of  fusiform  cells,  with  oval 
nuclei;   and,  what  was  somewhat  remarkable  for  a 
choroidal  tumor,  there  was  no  deposit  in  its  substance 
of  pigmentary  matter. 

SUPERNUMERART  ITNOERS. 

Dr.  Post  presented  two  supernumerary  fingers,  one 
from  the  right  and  the  other  fix>m  the  left  hand  of  a 
little  patient  three  months  old.  One  of  these  was 
possessed  of  a  rudiipentary  naiL  The  interest  of  the 
case  centred  in  the  proof  of  a  remarkable  hereditary 
freak.  The  mother  nad  a  scar  upon  one  of  her  hands, 
marking  the  situation  of  an  amputation  of  the  same 
finffer  upon  the  same  side,  and  had  given  birth  to 
eight  previous  children  without  any  blemish ;  and  what 
seemed  more  curious  was,  that  her  supernumerary 
finger  had  a  rudimentary  nail  upon  it  precisely  as  the 
same  finger  removed  from  the  same  hand  of  her  ninth 
issue. 

In  answer  to  a  question  from  Dr.  Rogers,  he  remarked 
that,  in  bis  opinion,  this  was  an  illustration  of  hereditary 
transmissioD,  whicn  had  allowed  of  a  long  interval  of 
time  to  show  itself. 

RAPID  EXFOLIATION  OF  BONE. — NON-FORMATION  OF 
INVOLUORUM. 

He  next  exhibited  a  rather  unusual  instance  of  ne- 
crosb  of  the  fibula,  which  he  had  removed  by  operation 
from  a  boy  ten  years  of  age.  On  New  Year's  day  the 
patient  went  out  skating.  His  skate  on  the  affected 
leg  was  strapped  unusually  tight,  and  interfered  with  the 
circulation  or  the  Hmb.  which  became  very  much  chilled. 
On  his  return  home,  ne  experienced  considerable  pain 
in  the  leg,  attended  with  fever  and  headache :  inflamma- 
tion followed,  which  was  regarded  as  erysipelatous  in 
character,  and  was  accompanied  with  much  swelling. 
During  the  first  four  days,  in  addition  to  the  other 
symptoms,  there  was  pretty  active  delirium.  About  Fe- 
bruary 1st,  after  leedies  had  been  applied,  there  was 


Digitized  by 


Google 


THE  MEDICAL  RECORD, 


200 


cbachirge  of  matter  through  one  of  the  bites,  and  subse- 
queotly  some  scales  of  bone  made  their  exit.  The 
diild  was  presented  to  Dr.  Post  for  the  first  time  on 
the  9th  instant  On  examination,  he  discovered  two 
anuses,  one  of  which  was  situated  an  inch  above  the 
inkle-joint,  and  the  other  about  two  inches  higher. 
There  was  no  appearance  of  inflammation  above  this 
Utter  point  The  probe  introduced,  discovered  bare 
bone;  and,  after  enlarging  the  lower  opening,  almost 
the  entire  fibula  was  withdrawn  with  little  difficulty. 
The  necrotic  tissue  was  very  dense  and  heavy,  and 
there  seemed  to  have  been  very  little  if  any  tendency 
to  the  formation  of  an  involucrum.  He  regarded  the 
specimen  as  interesting  in  relation  to  the  short  interval 
of  time  which  elapsed  between  the  commencement  of 
the  attack  and  the  ultimate  exfoliation  of  the  bone. 
Both  articular  extremities  of  the  fibula  were  lef\;  intact, 
sad  were  not  involved  in  the  diseased  action. 

Dr.  Rogers  thought  that  it  was  very  remarkable 
that  the  articular  extremities  should  escape  under  such 
drcumstances. 

Dr^  Kraokowizih,  on  the  contrary,  stated  that  it  was 
no  uncommon  thing  to  have  the  disease  in  growing 
persons  arrested  at  those  points.  In  fact,  it  was  the 
role  rather  than  the  exception.  The  true  point  of  in- 
terest,was  in  the  exfoliation  of  so  lar^e  a  portion  of  the 
fibnla  under  any  circumstances,  as  the  death  of  that 
bone  was  almost  always  partial  and  confined  to  mere 
shells,  even  where  the  tibia  at  the  same  time  was  almost 
entirely  destroyed. 

Dr.  Sands  asked  if  the  periosteum  was  removed 
with  the  dead  bone,  and  was  answered  in  the  negative. 
Dr.  Rooxrs  did  not  think  that  there  would  be  likely 
to  be  a  regeneration  of  the  bone,  as  there  was  at  the 
time  of  the  operation  no  disposition  to  the  formation 
of  sn  involucrum. 

Dr.  Post  was  of  the  opinion  that  there  had  been  no 
time  for  the  proper  formation  of  the  involucrum,  and 
that  eventually  new  bone  would  be  produced  to  occupy 
the  place  now  left  vacant 

Dr.  Sands  alluded  to  a  specimen  of  necrosis  of  the 
tibia,  which  he  had  presented  on  behalf  of  a  surgeon  of 
Halifax  In  that  instance,  the  operation  was  of  neces- 
sity perfonned  so  near  the  initiation  of  the  disease,  that 
the  periosteum  was  found  so  firmly  attached  to  portions 
of  the  dead  bone,  that  it  was  removed  with  it.  After 
the  operation,  there  was  ^nch  a  feeble  attempt  at  repro- 
dnction  of  bone,  that  the  limb  was  finally  declared  use- 
less, and  was  subsequently  removed.  In  that  case,  the 
time  which  elapsed  between  the  receipt  of  the  injury 
tod  operation  was  much  longer  than  in  Dr.  Post's  pa- 
tient There  was,  of  course,  no  attempt  at  the  forma- 
tion of  involucrum ;  still,  he  believed  that,  could  the 
periosteum  have  been  left  new  bone  would  in  time 
nave  taken  the  place  of  tne  osseous  tissue  removed. 
He  was  inclined  to  concur  with  Dr.  Post  that,  in  the 
ctte  presented  by  that  gfUtleman,  the  prognosis  was 
good  for  the  ultimate  regeneration  of  the  fibula. 

DOUBLE  SOIBRHUS  OF  MAMM^ 

Dr.  Post  next  presented  two  specimens  of  scirrhus  of 
the  breast  One  of  the  specimens  removed  from  a 
patient,  axty  years  of  age,  was  remarkable  for  its  situa^ 
tion,  it  being  confined  to  the  inner  side  of  the  organ, 
nesr  its  sternal  margin.  The  other  specimen,  taken  from 
a  female,  forty  years  of  age,  showed  a  dissemination  of 
the  disease  throughout  the  whole  Iweast,  and  presented 
••Hne  peculiar  microscopical  characters,  wliich  are  thus 
described  by  Dr.  Lewis,  the  gentleman  who  examined 


Both  tumors  are  specimens  of  scirrhous  cancer — that 
oae  which  lay  near  the  median  line  being  specially  in- 


teresting ;  first,  because  it  lay  at  the  inner  margin  of  the 
mamma,  the  portion  least  frequently  invaded  by  carci- 
noma ;  and,  secondly,  because,  while  to  the  naked  eye 
its  boundary  appears  very  well  marked,  under  the  mi- 
croscope it  was  clearly  very  indefinite,  the  signs  of' 
cancerous  infiltration  being  only  less  manifest  beyond 
than  within  the  apparent  boundary ;  that  is,  the  stroma 
consists  of  the  nominal  fibro-cellular  tissue  of  the  part, 
changed  in  the  centre  of  the  tumor  by  the  substitution 
of  elongated  fibroid,  nucleated  cells  for  the  fibrous 
columns,  having  the  interspaces  densely  filled  with  va- 
rious cell  elements ;  so  that,  in  this  portion  of  the  tumor, 
the  outline  of  the  individual  cells  could  not  be  distin- 
guished, only  a  vast  number  of  nuclei,  wi^  bandb  of 
fibroid  cells  running  in  various  directions ;  but  beyond 
the  apparent  limit  these  nuclei  were  fewer  in  number, 
and  became  less  and  less  numerous,  until  scarcely  a  cell 
was  to  be  seen  in  the  areolar  spaces. 

The  cancer-cells,  as  seen  in  the  "  cancer  juice  "  and  the 
marginal  portions  of  the  growth,  were  spindle-shaped, 
oval,  pyriform,  large,  and  small,  and  some  of  the  former 
possessed  two  or  three  nuclei. 

This  tumor  was  hardest  at  its  central  portion ;  the 
second  was  fuUy  as  hard  and  dense  near  tne  surface  at 
and  in  its  centre. 

Upon  pressing  this  second  mamma  a  thick  milky 
fluid  escaped  from  the  nipple,  which  was  also  found 
upon  making  a  deep  section  through  the  diseased  mass. 
Under  the  microscope  this  was  found  to  consist  of  mul- 
titudes of  oil  globules,  measurmg  from  ^77  to  rthns  of  an 
inch,  and  of  larger  corpuscles,  which  may  have  been 
colostrum  corpuscles,  or  the  exudation  corpuscles  (gra- 
nule corpus,  of  Virohow),  measuring  from  n^  to  ytu  of 
an  inch. 

The  fluid  scraped  from  the  cut  surface  of  this  speci- 
men contained  various  forms  of  cells,  long  nucleated 
fibroid  ceUs,  small,  oval,  or  irregularly  shaped,  and 
spindle-shaped  ceUs.  Some  of  the  larger  of  tne  ovoid 
or  irregularly-formed,  contained  several  nuclei. 

The  stroma  of  this  tumor  was  not  investigated. 

HAIR-Pm   IN   BLADDER  OF  A  FEKALE. 

Dr.  Weir  exhibited  a  specimen  of  calcareous  deposit 
upon  a  hair-pin.  The  body  was  introduced  into  the 
bladder  of  a  single  female,  »t  28,  as  she  says  by  acci- 
dent, but  probably  either  by  desiprn  or  mistake.  It  re- 
mained there  until  the  first  of  February,  she  having 
entered  St  Luke's  Hospital  at  that  time  for  the  purpose 
of  treatment  Before  being  sounded,  in  one  of  her 
frequent  acts  of  micturition  she  experienced  more  than 
her  usual  amount  of  pain  and  inconvenience,  and  in  the 
course  of  eight  hours  afterwards,  the  hair-pin  passed 
with  the  bent  end  forwards,  she  completing  tne  removal 
with  her  fingers.  The  incrustation  was  almost  entirely 
confined  to  the  middle  portions  of  the  arms  of  the  pin, 
the  looped  extremity  and  the  free  ends  being  free.  The 
weight  of  the  deposit  was  29  grains. 

Some  discussion  took  place  in  regard  to  the  reason 
for  the  peculiar  situation  of  the  deposit  upon  the  pin, 
but  nothing  satisfactory  was  arrived  at 

[Might  it  not  be  possible  that  the  pin  had  previously 
been  legitimately  used  in  the  hair,  thus  becoming 
eroded  in  the  middle  portion  of  its  arms,  and  this 
roughened  surface  afterwards  inviting  the  deposit  of 
calcareous  matter  when  the  instrument  found  its  way 
into  the  bladder  ?] 

OVARIAN  C3T8T :— OVARIOTOIIT. 

Dr.  Cutter  next  presented  a  specimen  of  ovarian 
cyst,  removed  by  ovariotomy  from  a  patient  two  days 
before.  She  was  60  years  of  age,  and  first  discovered  the 
tumor  18  years  ago.  The  tumor  grew  very  slowly 
for  the  first  dozen  years,  but  subsequently  increased  in 


210 


THE  MEDICAL  RECORD. 


size  with  great  rapidity,  interfering  with  the  circulation 
of  the  lower  extremities.  Two  or  three  years  ago  she 
had  be^n  tapped,  and  30  or  40  pounds  removed,  and 
nine  months  after,  the  same  operation  was  repeated, 
and  about  the  same  quantity  of  fluid  evacuated,  but  or 
thinner  consistency.  In  the  course  of  six  months  after, 
was  tapped  twice  more,  each  successive  time  the  fluid 
being  thinner  than  before.  In  consequence  of  exhaus- 
tion and  troublesome  obstruction  to  ihe  circulation,  she 
clamored  for  an  operation,  and  her  request  was  acceded 
to.  An  incision,  three  or  four  inches  in  length,  was 
made  in  the  median  line  of  the  abdomen,  and  a  few 
trivial  adhesions  having  been  discovered,  the  wound 
was  afterwards  enlarged.  The  adhesions  were  then 
broken  up  with  the  hand,  and  the  contents  of  the  sac 
evacuated.  In  attempting  to  remove  the  sac  there 
were  found  three  or  four  adhesions  to  the  omentum, 
at  different  points,  and  one  to  the  vermiform  appendix, 
about  its  middle;  this  latter  was  tied.  The  pedicle 
was  as  broad  as  the  two  hands,  and  occupied  nearly  the 
whole  of  the  right  broad  Ugament.  It  was  tied  in 
halves,  by  double  silk  ligatures,  and  no  hsBmorrhage 
whatever  followed.  The  patient  was  doing  well  up  to 
the  time  of  reporting  the  case.  In  making  the  second 
cut  into  the  abdominal  wall,  the  scissors  was  used  in- 
stead of  the  knife,  and  there  was  noticed  a  marked  dif- 
ference in  the  amount  of  hsemorrhage,  the  latter  instru- 
ment seeming  to  be  the  preferable  one. 

Db.  Howard  stated  that  he  had  seen  five  cases 
operated  upon  by  Baker  Brown,  in  which  the  pedicle 
was  severed  by  actual  cautery.  In  none  of  these  was 
there  any  subsequent  haemorrhage,  notwithstanding 
that  in  one  the  pedicle  was  quite  broad. 

Dr.  Cutter  remarked  that  it  was  the  general  belief 
that  cases  operated  upon  in  that  manner  were  ordin- 
arily followed  by  secondary  h»morrhage. 

THE  PATHOLOGY  OF   "  H0D8B-MAIDS*   KNEE." 

Dr.  Markos  presented  an  enlarged  bursa,  removed 
firom  the  right  knee-joint  of  a  middle-aged  woman.  It 
had  been  gradually  increasing  in  size  for  a  period  of 
four  or  five  years,  and  no  cause  was  assigned  for  its  i^- 
pearance.  The  walls  of  the  sac  were  remarkably  thick,  but 
the  evidences  of  the  existence  of  a  fluid  in  its  interior 
were  sufficiently  strong  to  make  the  diagnosis  easy.  The 
operation  for  its  removal  promised  to  be  equally  easy  and 
simple.  On  cutting  down  upon  the  mass  it  was  ob- 
served that  there  was  no  line  of  demarcation,  and  its 
removal  was^^only  accomplished  by  a  rather  tedious 
dissection  through  a  very  close  and  firm  fibro-cellular 
tissue.  At  one  point  it  was  impossible  to  separate  the 
tumor  from  the  external  layers  of  the  aponeurosis  of 
the  leg,  and  the  operation  was  only  completed  by  cut- 
ting through  a  broad  portion  of  this  fascia.  He  remarked 
that  Errichson  had  alluded  to  this  incorporation  of  the 
walls  of  the  sac  with  the  aponeurosis  referred  to,  and 
thought  it  was  a  fact  to  be  borne  in  mirfd  by  younger 
surgeons  who  may  be  called  upon  to  extirpate  eStltx 
growths. 

The  inner  wall  of  the  tumor  had  a  flocculent  mass 
a^ttached  to  it,  while  the  contents  of  the  sac  were  very 
thick  and  semi-gelatinous  in  appearance.  In  connex- 
ion with  the  specimen  it  became  an  interesting  ques- 
tion as  to  what  was  the  origin  of  the«e  tumors — were 
they  natural,  in  the  first  instance,  or  acquired?  He 
was  inclined  to  the  behef  that  no  bursa  existed  over  the 
li^mentum  patellsB  or  patella  itself,  in  the  natural  con- 
dition of  the  parts,  as  it  was  not  found  in  young  sub- 
jects and  in  many  adults.  In  confirmation  of  this  latter 
statement  he  remarked,  that  Prof.  Watts  had  given  at- 
tention to  this  very  matter  some  years  ago,  and  had 
looked  over  all  the  subjecta  in  the  dissecting-room  for 


one  season,  and  had  not  suoceeded  in  finding  a  ^gle 
one  of  the  burs». 

Dr.  Post  said  that  he  had  occasion  to  remove  three 
cysts  in  that  situation.  In  all  there  was  considerable 
difficulty  attending  their  enucleation. 

In  answer  to  a  question  from  Dr.  Sands,  Dr.  Markoe 
stated  that  the  bursas  were  most  prominent  over  the 
tubercle  of  the  tibia. 

Dr.  Post,  as  an  argument  in  favor  of  the  original  ex- 
istence of  a  bursa  in  that  locality,  stated,  that  he  had 
met  with  an  acute  abscess  completely  confined  to  those 
limits.  * 

Dr.  Finnell  presented  a  large  pendulous  cutaneous 
tumor,  removed  from  the  inner  aspect  of  the  arm  of  an 
old  laay  who  had  carried  it  for  ten  years.  It  was  re- 
moved by  simply  severing  a  pedicle  three  inches  long 
and  an  inch  thick. 

Dr.  Allin,  as  one  of  the  committee  appointed  to  re- 
port upon  the  enlarged  spleen  presented  by  him  at  the 
previous  meeting,  stated  that  the  organ  was  found,  on 
microscopical  examination,  the  seat  of  simple  hyper- 
trophy. 

The  Society  then  went  into  executive  session* 


AMERICAN  OPHTHALMOLOGICAL  SOCIETY. 

Fourth  Anhttal  MsEnNo. 

The  Society  met  at  the  Cataract  House,  Niagara  FaDs, 
Tuesday,  June  11,  1867,  at  12  m.  In  the  absence  of 
the  President,  Dr.  Edward  Delafield,  of  New  York,  the 
Vice-President,  Dr.  Henry  W.  Williams  of  Boston, 
called  the  meeting  to  order,  and  made  a  few  congratu- 
latory remarks,  in  the  course  of  which  he  stated  tiiat  it 
was  believed  that  the  Society  had  done  good,  in  in- 
creasing the  respect  felt  for  special  labors  in  the  field  of 
Medicine.  The  following  members  were  found  to  be 
present: 

Boston,-— Bts.  Henry  W.  Williams,  Haskett  Derby,  B. 
Joy  Jeffries*  ATeti;  York — C.  E.  Agnew.  EL  D.  Noyes, 
H.  Althof,  D.  B.  St.  John  Roosa;  Albany. ^CX  A. 
Robertson ;  Bochester.^C.  E.  Rider  •  Philadelphia, — T. 
Q-.  Morton,  K  Dyer  iBaliimore, — E.  Loring;  Chicago. 
—J.  S.  Hildreth^.  Holmes ;  St,  Louis. — John  Q-reen ; 
Cincinnati, — E.  WilUams;  Detroit, — J.  F.  Noyes. 

Various  committees,  on  nominations,  reception  of  pa- 
pers, &c.,  were  then  appointed  by  the  President 

Dr.  G.  A.  Hat,  of  Boston,  was  appointed  the  Com- 
mittee on  the  Progress  of  Ophthalmology,  for  the  ensu- 
ing year. 

On  the  suggestion  of  the  Secretary,  Dr.  Rider  was 
elected  Reporter,  whose  duty  it  should  be  to  report  the 
remarks  on  papers  and  cases. 

the  progress  of  ophthalhologt. 

Dr.  B.  Jot  Jeffries  then  read  the  report  on  the  Pro- 
gress of  Ophthalmology.  The  committee  deprecated  the 
publication  of  compUations,  handy-books  or  books  of 
ophthalmology,  which  become  the  guide  of  the  practi- 
tfcner  in  the  particular  place  where  published,  and 
which  after  all  were  quasi  advertisements.  We  should 
rather  encourage  the  publication  of  Monographs,  on 
topics  in  ophtluJmology.  In  1865  one  hundred  and 
thirty-seven  books  were  published  in  our  department ; 
in  1866,  two  hundred  and  twenty-four.  There  has 
been  some  recognition  by  Medical  schools  that  ophthal- 
mology should  form  a  part  of  the  curriculum.  The  ne- 
cessity of  going  to  Europe  for  instruction  in  Eye  dis- 
eases had  turned  the  attention  of  the  profession  and  the 
digitized  by  ^ ^_ 


THE  MEDICAL  RECORD. 


211 


bitj  to  the  Medical  schools  abroad  and  to  the  necessity 
for  every  medical  man  of  a  knowledge  of  French  and 
German.  The  new  operations  for  cataract  were  only 
alluded  to  since  this  disease  was  the  subject  for  discus- 
sion. France  had  now  three  great  text  books  of  oph- 
thalmology, viz.  Wecker,  Farro,  and  a  translation  of 
MacKenzie.  We  had  none  in  English.  The  Ophthalmic 
BibUography,  fix)m  Zthender's  Journal,  was  appended  to 
the  report,  as  well  as  a  list  of  the  Eye  Hospitals  and  In- 
firmaries of  the  world,  compiled  from  Dr.  Knapp*s  bro- 
chure, to  which  additions  h«i  been  made  by  Dr.  Jeffries. 
The  report  of  the  committee  was  accepted  with  the 
thanks  of  the  Society,  and  referred  to  tne  Pubhcation 
Committee. 

I«LBOATXB    TO    INTEB5ATI0NAL    OPHTHALMOLOOICAL    CON- 


Dr.  F.  J.  BuMSTKAD,  of  New  York,  and  Dr.  W.  W. 
Seely,  of  Cincinnati,  members  of  the  Society,  were  ap- 
pointed delegates  to  the  Congress  of  Ophthalmologists 
in  Paris, 

Dr.  J.  Green  then  read  a  paper  entitled  "Visual 
Tes^  with  special  reference  to  the  detection  of  Astig- 
matism, with  an  analysis  of  forty-one  cases  of  Ametro- 
pia." 

This  interesting  and  Taluable  paper  was  an  amplifica- 
tion of  an  article  by  Dr.  Green,  in  the  American  Jour- 
nal of  the  Medical  Sciences  for  January.  1867. 

The  Society  then  took  a  recess  tdl  hidf-past  four 
o'dock  P.M. 

Afternoon  Session. 

IKCCIAiTION  of  globe  FOB  STMPATHITIO  OPHTHALMIA. 

"  The  Society  came  to  order,  and  Dr.  J.  F.  Noyes  read 
a  report  of  a  case  of  "Enucleation  of  the  Globe  for 
Sympathetic  Ophthalmia."  Osseous  degeneratio  nwas 
fonnd  in  the  interior  of  tJie  eye. 

Some  remarks  were  made  on  the  rarity  of  true  bony 
degeneration,  by  Dr.  Althof ;  the  depositions  were  gen- 
erally calcareous,  altiiough  bony  deposition  did  occur. 

Dr.  WiLLiAifS,  of  Cincinnati,  did  not  enucleate  the 
g^be  in  sympathetic  ophthalmia,  but  performed  abscis- 
sion, except  when  bony  or  malignant  growths  have  oc- 
curred or  a  large  foreign  body  was  in  the  eye. 

A  rule  was  adopted  restricting  remarks  on  papers  to 
three  minutes  to  each  member. 

XNOEPHALOin  DISEASE  OF  FUNDUS  OF  BYE. 

Dr.  T.  G.  Morton  read  the  report  of  the  case  of  "  En- 
oephaliod  disease,  springing  from  the  fundus  of  the  eye, 
near  the  macula  lutea,  simulating  glaucoma." 

The  patient  was  forty-one,  eye  was  hard,  lens  com- 
pletely cataractous,  and  there  was  severe  pain.  Patient 
said  that  blindness  had  come  on  suddenly,  and  iridec- 
tomy was  done  to  relieve  pain.  It  did  not  accomplish 
the  desired  result  Two  weeks  after  the  eye  was  enu- 
cleated, when  pain  was  relieved.  An  encephaloid  tu- 
mor, seemingly  arising  from  the  retina^  was  foimd  two 
lines  from  the  optic  papilla.  The  pedicle  of  the  tnmor 
seemed  to  be  attached  to  tiie  dioroid;  there  was  no  in- 
sertion in  the  sclerotica. 

Dr.  Althof  asked  if  relief  to  pain  was  to  be  expect- 
ed from  iridectomy  in  a  case  of  glaucoma,  advanced  to 
total  blindness,  as  in  this  case.  I)f .  Morton  had  seen  it, 
and  80  had  Drs.  Agnew  and  Williams  (Gin.).  Dr.  Morton 
stated  in  answer  to  a  question,  that  nucleated  and  fusi- 
form cells  were  found  on  microscopic  examination  of 
the  tumor.  He  had  accidentidly  omitted  to  bring  the 
tomor  with  him. 

TUMORS  OF  THE  BRAIN  OAUSINO  AMAUROSIS. 

Dr.  E.  Wiluams  then  read  a  paper  on  "  Tumors  of 
the  Brain,  causing  Amblyopia  or  Amaurosis." 


This  was  a  detailed  account  of  several  cases  of  brain 
disease,  in  two  of  which  the  presence  of  tumors  had 
been  diagnosticated  by  Dr.  Williams,  and  the  post-mor- 
tem veritied  the  diagnosis.  The  other  cases  were  sup- 
posed to  be  of  the  same  nature. 

In  answer  to  Dr.  Loring,  Dr.  Williams  remarked 
that  he  thought  the  presence  of  the  tumors  might  have 
been  diagnosti^ted  without  the  ophthalmoscope,  al- 
though mistakes  had  been  made  in  these  very  cases, 
where  that  aid  was  not  employed.  The  ophthalmos- 
copic symptoms  were  swelling  of  the  optic  papilla,  tur- 
^soence,  and  tortuosity  of  the  vision,  with  no  change 
m  the  arteries,  they  being  straight. 

Dr.  Notes  made  some  remarkH  as  to  the  necessity  of 
thoroughly  investigating  the  condition  of  the  kidneys 
in  neuro-retinitis,  in  order  that  we  may  make  an  accu- 
rate diOferential  diagnosis  between  the  effects  on  the 
brain  and  kidneys.  The  patient  should  be  watched  for 
ft  long  time,  and  the  amovnt  of  urea  passed  be  noted. 

Drs.  W.  A.  Hall,  of  Philadelphia,  and  S.  PoUak  of 
St.  Louis,  whose  names  were  presented  by  the  Com- 
mittee on  new  members,  were  elected  members  of  the 
Society. 


Second  Day,  June  12. 
Minutes  of  previous  meetings  read  and  approved. 

OFFICERS  FOR  ENSUINO  TEAR. 

The  following  named  gentlemen  were  re-elected  offi- 
cers for  the  ensuing  year : — 

Prmdent, — Dr.  Edward  Delafield,  of  New  York. 

Vice-Presideni. — Dr.  Henrt  N.  Williams,  of  Boston^ 

Recording  Secretary  and  Treasurer, — Dr.  Henry  D. 
NoYBS,  of  New  York. 

Corresponding  Secrete^, — Dr.  H  Althof,  of  New 
York. 

After  some  discussion  as  to  a  proposed  amendment 
to  the  By-Laws,  making  the  meetings  every  other  year 
instead  of  yearly,  the  proposed  amendment  was  rejected, 
and  the  Society  voted,  that  when  they  adjourned^  it  be  to 
meet  in  Newport,  R.L,  on  the  3d  Tuesday  m  July, 
1868. 

The  following  subject  was  adopted  for  discussion  at 
the  next  meeting  : — 

"The  Influence  of  the  Internal  Recti  Muscles  on 
Binocular  Vision." 

THE  production  OF  ACUTE  OLAUOOMA  BY  ATROPINE. 

Dr.  Derby  read  a  report  of  "  Two  cases  in  which  the 
instillation  of  Atropine  induced  acute  attacks  of  Glau- 
coma." Wharton  Jones  alludes  to  this,  but  Graefe  does 
not.  Dr.  Derby  only  adduced  the  cases  in  order  to  pro- 
voke inquiry,  as  he  did  not  at  all  think  that  these  casei 
proved  the  injurious  influence  of  atropine  in  cases  on 
giMicoma. 

Dr.  Roosa  spoke  of  a  case  of  glaucoma,  in  which  Dr. 
Hinton  operated,  where  the  statement  of  the  patient 
was  very  decided  as  to  the  occurrence  of  an  exacerba- 
tion of  the  disease  after  the  instillation  of  atropine. 

Dr.  Williams,  of  Cincinnati,  never  saw  any  deleterious 
influences  from  atropine  thus  used.  He  expected  these 
acute  attacks,  with  or  'without  the  use  of  atropine. 

PROBES  FOR  THE  LAOHRYMAL  PASSAGES. 

Dr.  AoNEW  was  here  called  to  the  chair,  while  Dr. 
Williams,  of  Boston,  read  a  paper  on  "  Modification  of 
Probes  for  the  Lachrymal  Passages."  Dr.  Williams  uses 
probes  with  bulbous  extremities,  made  of  alloyed  silver. 

Dr.  WiLLLiMS,  of  Cincinnati,  used  a  large-sized  probe, 
digitized  by  ^ ^_ 


212 


THE  MEDICAL  RECORD. 


when  a  small  one  would  not  enter;  also  used  those  made 
of  tin  in  some  cases. 

Dr.  Jetfbibs  stated  that  Dr.  Jeffries,  Sr.,  has  been  in 
the  habit  for  years  of  usin^  probes  Uke  Bowman's,  bent, 
having  bulbous  extremities,  and  he  himself  has  often 
turned  from  the  use  of  Bowman's  to  these. 

Dr.  Dteb,  spoke  of  further  investigation  on*  the  sub- 
ject of  "Lenses  fractured  by  banging,"  and  was  allow- 
ed permission  to  present  a  complete  report  to  the  Pub- 
lication Committee,  the  investigations  and  experiments 
being  too  recent  to  allow  it  to  be  furnished  this  time. 

Dr.  JEFreiEs  read  a  paper,  entitled  a  "  Ready  method 
of  permanently  registering  the  field  of  vision,"  with  a 
register  for  the  same."  The  patient  sits  down  with  his 
head  firmly  supported,  and  the  field  of  vision  is  mapped 
out  in  the  usual  way,  cross  lines  of  pack-thread  beine 
made  over  the  board,  so  that  the  field  can  be  measured. 

The  Dr.  distributed  copies  of  the  register  among  the 
members. 

STRABISMUS. 

Dr.  H.  D.  Noyss  read  a  paper  on  Strabismus,  detail- 
ing some  interesting  cases.  The  principal  object  of  the 
paper  was  to  call  attention  to  the  necessity  of  taking 
^eat  pains  in  securing  the  last  of  the  three  effects  desired 
in  the  operation  for  Strabismus,  viz :  1.  The  correction 
of  the  mechanical  defect  2.  XJorrection  of  the  error  of 
refraction.    3.  Securing  Binocular  vision. 

He  had  lately  performed  the  operation  suggested  by 
Liebreich,  in  which  such  free  incision  is  made,  i.  e.  parte 
freely  dissected  up,  and  afterwards  a  conjunctival  suture 
inserted,  and  in  a  case  where  there  was  a  convergent 
squint  of  seven  lines,  the  final  result  was  a  deviation  of 
one  and  a  half  lines.  There  was  apparent  parallelism  for 
four  days.  One  week  after  patient  could  direct  both 
eyes  upon  the  fingers  at  twelve  inches  distance.  Dr. 
Noyes  showed  Javal's  instrument  for  training  the  eyes 
to  binocular  vision,  also  a  stereoscopic  fitune,  contrived 
by  himself,  in  which  all  the  different  kinds  of  glasses  for 
the  correction  of  Ametropia  could  be  placed. 

Dr.  Hn>DRBTH  read  a  paper  on  the  ^*  Cause  of  Anaes- 
thesia of  the  cornea  and  radiating  fibres  of  the  iris,  with- 
out intra-ocular  tension." 

Dr.  E.  L.  Holmes  read  a  report  of  ten  cases  of  Sym- 
pathetic Ophthalmia. 

Dr.  H.  W.  Williams,  of  Boston,  began  the  subject  of 
Cataract,  by  reading  a  paper  on  the  use  of  sutures  of  the 
cornea  after  the  extraction  of  cataract. 

The  Society  then  took  a  recess. 

SEOOND  DAT. — ^AFTERNOON  8E8SI0K. 

The  discussion  ou  cataract  was  carried  on  by  Drs. 
Agnew,  Noyes,  Robertson,  E.  Williams,  H.  W.  Williams, 
Morton,  and  Hildreth.  The  discussion  turned  princi- 
pally on  the  method  of  performing  the  operation  and  on 
the  after  treatment  The  flap  operation  was  generally 
employed,  and  a  bandage  afterwards,  but  no  pressure. 

Dr.  Notes  had  operated  by  Graefe's  new  method  in 
seventeen  cases.  He  advocated  a  larger  incision  than 
recommended  by  Q-raefe. 

The  Society  adjourned  at  4  p.m.,  to  meet  at  Newport, 
R.  L,  on  the  third  Tuesday  of  July,  1868. 

Novel  Mode  of  Swdtdlino  a  Phtsioian. — In  a  re- 
port of  the  Medical  Association  of  Moselle,  we  are  told 
of  a  case  in  which  a  woman  refused  to  pay  her  doctor 
for  more  than  one  visit  She  admitted  in  court  that  he 
had  cured  her  of  a  severe  illness ;  but  she  said  she  only 
sent  for  him  once ;  if  he  came  oflener;  that  was  his  own 
look-out  The  judge  took  the  same  view  of  the  case, 
and  the  doctor  got  for  his  action  an  order  to  pay  the 
costs  of  it! — British  Medical  Journal, 


€(intspovit^tnct. 


MEDICAL  MATTERS  IN  PARIS. 

To  THX  Editor  of  thb  Hioioal  Bioosik 

Sm — In  PariEL  the  absence  of»  the  excitement  afforded 
by  political  elections  is  amply  compensated,  for  a  lim- 
ited circle  of  people  at  least,  by  the  continually  recur- 
ring elections  at  the  Academy,  and  nominations  at  the 
concours.  You  are  aware  that  idl  the  hospitals  in 
Paris  are  under  the  control  of  a  central  administration, 
who  appoint  all  the  physicians.  The  appointment  is 
made  by  the  decision  of  a  jury,  drawn  by  lot,  from 
among  the  actual  hospital  physicians,  who  decide  the 
merits  of  the  various  candidates  for  a  vacancy,  after 
submittiug  them  to  severe  dioical  examinations.  A 
concours  of  this  kind  has  just  terminated,  in  a  manner 
infinitely  disappointing  to  fifty  of  the  candidates  who 
were  rejected,  and  highly  agreeable  to  the  two  who 
were  deemed  worthy  for  the  important  position.  The 
successful  candidates  were  MM.  OUiver  and  Praust 

A  new  contest  is  now  going  on  at  the  Academy, 
which  is  busy  in  deciding  upon  nominations  to  the 
chairs  of  surgery  and  medicine,  left  vacant  by  the  death 
of  Jobert  and  Roscan.  Among  the  foremost  candidates 
for  the  first  position  is  M.  L&ngier,  who  has  recently 
added  to  his  previous  claims  to  distinction  by  an  ex- 
ceedingly interesting  memoir  upon  cerebral  concussion. 
The  phenomena  occasioned  by  this  accident  are  ana- 
lyzed with  the  greatest  care,  and  referred  to  that  part 
of  the  enoephalon  which,  according  to  present  physio- 
logical ideas,  presides  over  the  functions  compromised. 
The  cerebral  hemispheres  are  certainly  affected,  for  the 
intelligence,  all  voluntary  and  affective  faculties,  and 
the  consciousness  of  all  sorts  of  nervous  irritation,  are 
entirely  suspended.  Unconscious  sensibility,  on  the  con- 
trary, and  all  movements  resulting  from  reflex  action, 
are.  however,  preserved,  which  proves  that  the  pons 
arolii,  and  probably  the  corpora  striata  and  thidami 
optid  are  in  all  their  integrity.  M.  Langier  discusses 
the  question,  why  the  hemispheres  alone  should 
suffer  from  a  shock  that  must  be  transmitted  to 
them  through  portions  of  the  encephalon  that  remain 
uninjured.  He  accounts  for  this  immunity  on  the  part 
of  the  pons,  the  bulb,  etc.,  by  the  fact  of  their  superior 
firmness  of  structure,  and  the  more  secure  position  of 
their  gray  masses,  which,  being  in  the  centre  of  the 
white  tis^e,  are  much  less  exposed  to  shock  than  the 
gray  substance  of  the  hemispheres  distributed  over  their 
surface. 

It  is  not  certain  whether  this  memoir  will  elect  M. 
Langier,  but  it  is  discussed  in  his  favor.  Another  il- 
lustration of  the  value  of  disease  in  dissecting  apart  the 
involved  functions  of  the  brain,  is  furnished  us  this 
week  by  a  most  interesting  case  at  Uie  Hdpital  St. 
Antoine,  in  the  service  of  M.  Jaccaud.  It  was  a  case  of 
aphasia,  the  disease  that  has  been  rendered  so  famous 
by  M.  Broca's  theory,  which  attaches  it  to  a  lesion  of 
the  third  anterior  convolution  of  the  Uft  cerebral  hem- 
isphere. The  accident  is  not  uncommon,  but  the  op- 
portunity for  verifying  the  diagnosis  by  an  autopsy  is 
comparatively  rare,  at  the  disease  is  rarely  or  never  di- 
rectly fatal  Hence  this  case,  which  afforded  such  an 
opportunity,  is  one  specially  valuable. ' 

The  patient  in  question  was  already  a  victim  to 
Bright's  disease  of  the  kidney,  for  which  he  had  been 
in  the  hospital  since  last  June.  At  the  period  of  the 
accident  he  suffered  firom  an  extensive  OBdema,  without 
ascites ;  albumen  was  abundant  in  the  urine ;  he  pre- 
sented, moreover,  a  systolic  souffle  at^e  point  of  the 


igitized  by  LjOO^- 


THE  MEDICAL  RECORD. 


213 


heart.  On  the  22d  of  January,  without  any  premoni- 
tory symptoms,  this  patient  suddenly  discovered  that 
he  had  lost  the  power  of  speech,  and  on  the  morning 
Tiflit,  the  next  day,  he  was  found  in  a  state  of  great 
disquiet,  pointing  to  his  Ups  and  tongue,  indicating  by 
signs  that  he  wished  to  speak  but  could  not.  There 
was  not  the  slightest  lesion  of  any  of  the  limbs,  and  at 
the  face  only  a  slight  paralypis  of  the  zygomatic  and 
elevator  muscles  of  the  right  side  of  the  mouth,  which 
was  drawn  a  Uttle  to  the  left. 

The  understanding  was  not  in  the  least  impaired;  he 
took  up  any  article  that  was  named  to  him,  but  could 
not  name  them  himsel£  When  a  person  pronounced 
before  bim  a  word  distinctly  articulated,  he  examined 
carefully  the  motion  of  the  hps,  and  succeeded  in  utter- 
ing some  monosyllable,  as  "bien,"  "  vous,"  but  that  was 
aS.  He  was  equally  .unable  to  write  as  to  speak,  never 
getting  beyond  the  first  letters  of  his  name. 

In  presence  of  these  ^mptoms,  and  on  account  of 
the  mitral  insufficiency,  M.  Jaccaud  pronounced  a  diag- 
noeis  of  lesion  of  the  third  frontal  convolution,  probably 
at  Uie  left  (since  that  is  the  case  seven  times  out  of 
ten),  and  probably  in  consequence  of  an  embolus. 

The  aphasia  began  to  disappear  by  the  end  of  the 
30th,  and  by  the  end  of  February  was  entirely  gone. 
The  patient  died  on  the  22d  of  April,  and  at  the  autop- 
sy the  diagnosis  was  fully  confirmed  by  the  discovery 
of-Hfirst,  complete  fatty  degeneration  of  the  kidneys ; 
second,  vegetations  on  the  mitral  valve,  and  insufficien- 
cy; third,  buried  m  the  white  substance  of  the  third 
frontal  convolution  of  the  left  hemisphere  were  two 
hwDorrhagic  cysts,  which  contained  some  drops  of 
Hqoid.  One  of  these  cysts  was  the  size  of  a  pea,  and 
sitaated  at  the  right  of  second,  whose  volume  was  three 
times  as  considerable.  The  surface  of  the  section  was 
distinct  and  well  limited ;  not  only  the  lesion  did  not 
extend  beyond  the  convolution  in  question,  but  the 
gray  matter  of  that  was  untouched,  and  from  the  exte- 
rior appeared  perfectly  healthy.  The  other  parts  of 
the  encephidon,  as  also  the  membranes  and  the  arteries, 
were  examined  with  great  care,  and  found  perfecdy 
sound. 

Hence  this  case  brings  fresh  support  to  the  theory 
that  places  the  power,  not  merely  of  speech,  but  also 
expression  by  writing,  in  this  Umited  part  of  the  brain. 

Among  the  candidates  for  the  vacant  place  in  medi- 
cine at  the  Academy,  M.  H^rard  is  one  of  the  most 
prominent.  His  claims  to  the  honor  chiefly  rest  upon 
a  work  that  be  has  published  this  year  upon  pulmonary 
consumption.  The  initial  idea  of  this  striking  book  was 
originally  promulgated  in  Germany  by  Beinhardt,  but 
M.  H^rard  and  his  colleague,  Gomil,  have  done  much, 
not  merely  to  f)opularize  Eeinbardt's  views,  but  to  bring 
to  their  support  abundant  cUnical  demonstration.  You 
are  aware  that  Beinhardt  completely  upsets  the  old  de- 
scripticois  given  by  Laennec  and  Louis  of  the  cheesy 
tuberde.  According  to  recent  microscopical  researches, 
the  yellow  masses  thus  denominated  are  formed,  not  by 
the  olterior  development  of  a  heterologous  deposit,  but 
of  a  pneumonia,  excited  by  the  presence  of  the  crude 
toberclea  in  the  connective  tissue  of  the  lung.  This 
pneumonia  differs  from  ordinary  acute  pneumonia, 
rather  in  its  anatomic  and  microscopic  characters,  than 
in  its  constitutional  effects.  Instead  of  an  exudation 
of  fibrine  into  ihe  alveoles,  there  is  an  exudation  of 
parement  epithelium  and  leucocythes.  In  other  words, 
It  is  a  c€Uarrhal  pneumonia,  similar  with  that  caused  by 
artificial  experiment.  To  this  pneumonia  H^rard  and 
Comil  refer  all  the  general  symptoms  of  phthisis,  the 
fever,  emaciation,  and  destruction  of  the  vital  forces. 
They  maintain  that  the  presence  of  the  crude  tubercle  in 
the  mng  excites  no  general  disorder,  and  it  may  remain 


latent  for  an  indefinite  period,  until,  generally  in  conse- 
quence of  some  specisd  accident,  the  tissue  surround- 
ing it  inflames.  This  inflammation  may  subside  spon- 
taneously or  under  the  influence  of  treatment,  but 
relighted  again  and  again,  it  finishes  by  entering  upon 
the  cheesy  stage  (pneumone  ccueiise).  At  this  stage 
the  contents  of  the  alveoles  liquify,  the  hepatised  lung 
softens,  and  the  cavern  is  formed  which  for  so  long  has 
been  exclusively  attributed  to  the  softening  of  the  tu- 
bercles. These  also  soflen.  but  their  size  always  re- 
mains the  same  as  that  of  tne  original  gray  granulation. 
Even  when  softened  they  may  be  distinguished  from 
the  masses  of  pneumonic  lung  through  which  they  are 
disseminated,  by  the  presence  of  small  nuclei  and  the 
cellules,  called  by  Robin  cytoplastians. 

In  consequence  of  this  view  of  the  anatomy  of  phthisis 
(which  approaches  in  its  nature  somewhat  to  that  pro- 
claimed by  Broussais)^  M.  H^rard  lays  special  stress 
upon  local  revulsives  m  the  treatment,  iodic  frictions, 
blisters,  and  the  actual  cautery.  The  tonic  and  stimu- 
lant general  treatment  is  of  course  also  maintained, 
though  our  American  use  of  alcohol  is  rejected.  To  a 
certain  extent,  a  moderate  use  of  tartar  emetic,  as  re- 
commended by  Foussagrines,  is  counselled. 

This  treatment  does  not  procure  brilliant  results  in 
the  hospitals,  where  the  patients  generally  are  too  far 
advanced  to  be  saved,  but  M.  H^rard  declares  that  a 
fair  share  of  success  may  be  obtained  in  private  prac- 
tice, where  the  disease  is  treated  at  the  very  beginning. 

M.  Marriothe  communicates  to  the  Bulletin  de  Theror- 
peuitquey  an  account  of  some  clinical  experiments  made 
by  himself  this  winter  with  muriate  of  ammonia,  in  the 
treatment  of  catarrhal  fevers  that  have  been  epidemic 
in  Paris.  These  fevers  assumed  a  remittent  or  inter- 
mittent type,  without  losing  their  distinctively  catarrh- 
al character,  but  proved  quite  obstinate  to  sulphate  of 
quinine.  In  accordance  with  a  suggestion  by  Schmidt- 
mann,  who  was  in  the  habit  of  giving  muriate  of  ammo- 
nia In  the  dechnine  period  of  gastric  fevers  when  they 
assumed  a  periodical  form.  M.  Marriothe  tried  the 
experiment,  at  first  in  some  cases  complicated  with 
very  severe  neuralgies,  which  interrupted  sleep,  and 
even  extorted  cries  from  the  patient.  The  effect  of  the 
muriate  was  surprising.  In  mild  cases  the  febrile  at- 
tacks and  the  neuralgies  ceased  upon  the  first  or  second 
day;  in  more  severe  forms  the  success  was  not  com- 
plete till  the  third  or  fourth,  but  there  was  always  ameli- 
oration by  the  first  or  second. 

M.  Marriothe  thinks  that  the  salt  has  an  important 
influence  in  moderating  the  erethism  of  the  mucous 
membranes,  but  that,  besides,  it  acts  directly  on  the 
nervous  system,  without  the  occurrence  of  any  inter- 
mediate phenomena,  as  vomiting,  sweating,  diarrhoea, 
etc.  The  dose  found  necessary  to  arrest  the  febrile  a.p- 
tacks  and  calm  the  neuralgia,  varied  from  thirty  to  sixty 
grains  in  the  course  of  the  day,  being  administered  in 
portions  of  7-15  3  every  three  or  four  hours. 

An  operation  that  Dr.  Brown  has  done  much  to 
bring  into  favorable  notice  in  England,  is  beginning 
again  to  excite  the  attention  of  French  physicians.  I 
mean  the  capital  operation  of  ovariotomy,  upon  which 
M.  Boinet  has  just  read  an  elaborate  report  before  the 
Academy.  The  report  begins  with  reference  to  an 
American,  the  first  who  practised  ovariotomy  with  the 
definite  intention  of  extirpating  the  diseased  organs, 
Dr.  Ephraim  MacDowell,  or  Kentucky.  This  surgeon, 
between  1809  and  1830,  operated  thirteen  times,  and 
obtained  eight  cures.  Baker  Brown  reports  twenty- 
nine  successful  cases  out  of  thirty-two  operations. 
Even  were  the  success  in  much  smaller  proportiomthan 
this  (and  the  recent  expos^  of  Brown*s  character  ren- 
ders us  cautious  about  accepting  his  statistics),  the  oper- 


214 


THE  MEDICAL  RECORD. 


atioQ  would  be  legitimate  in  a  disease  that  conducts  its 
victims  almost  inevitably  to  the  grave,  the  deaths  be- 
ing 95  in  100.  M.  Boinet  reprobates  the  timidity  of 
the  French  surgeons,  who  have  so  long  recoiled  before 
this  operation,  and  proceeds  to  give  many  useful  hints 
upon  the  precautions  necessary  to  insure  success. 

In  the  first  place,  the  operation  should  never  be  per- 
formed at  a  hospital,  where  peritonitis  invariably  fol- 
lows the  opening  of  the  abdomen ;  a  healthy,  isolated 
locality  should  be  selected,  and  a  room  prepared  whose 
temperature  should  be  maintained  at  20  to  25  degrees 
centigrade.  Secondly,  the  nature  of  the  cyst  must  be 
carefully  considered.  If  it  be  simple,  unilocular,  con- 
taining a  liquid,  clear,  hmpid,  and  serous,  or  even  puru- 
lent or  sanguinolent,  the  operation  is  inappropria^. 
Nelaton*s  system  of  iodine  injections  should  be  first 
tried.  But  if  the  liquid,  though  at  first  serous,  becomes 
unctuous  and  fatty,  ovariotomy  is  the  only  resource. 
Other  proofs  that  the  cyst  is  multilocular,  or  that  it 
contains  pathological  productions  contra-indicating  the 
use  of  iodine,  signs  of  the  increase  of  the  tumor,  and 
exhaustion  of  the  patient,  are  circumstances  that  should 
also  call  for  the  operation.  Among  the  contra-indica- 
tions  should  be  reckoned  the  existence  of  grave  compli- 
cations, an  early  stage  of  the  disease,  pregnancy,  or  tu- 
mors in  the  uterine  walls. 

The  operator  should  place  himself  at  the  right  of  l^fl 
side  of  the  patient,  instead  of  between  the  knees,  as 
recommended  by  some  surgeons.  The  incision  should 
be  made  on  the  median  line,  and  of  sufficient  size  to 
admit  the  free  introduction  of  the  hand  in  the  cavity,  for 
the  purpose  of  recognising  the  size  and  position  of  the 
tumor  and  the  extent  of  the  adhesions,  which  exist 
three  times  out  of  four.  When  these  adhesions  are 
slight  and  can  be  easily  torn,  they  occasion  no  incon- 
venience; but  if  large  and  resistant,  their  action  fre- 
quently causes  dangerous  haemorrhage.  The  dangers  of 
too  short  an  incision  have  been  frequently  exposed;  the 
adhesions  are  not  distinctly  perceived,  the  cyst  is 
imperfectly  grasped,  the  other  ovary  cannot  be  seen, 
the  pedicle  is  tied  with  difficulty,  and  sanguineous  effu- 
sions may  take  place  in  the  abdominal  cavity  without 
the  knowledge  of  the  surgeon..  Should  the  first  incision 
prove  too  short  to  avoid  these  inconveniences,  a  second 
can  always  be  practised  with  safety. 

The  incisions  should  divide  the  different  layers  of  the 
abdominal  wall  in  succession,  to  avoid  too  sudden  en- 
trance into  the  cyst  As  soon  as  this  is  discovered, 
the  hand  should  be  introduced,  to  ascertain  the  exist- 
ence of  adhesions  or  neighboring  tumors.  In  the 
second  case,  it  is  only  necessary  to  enlarge  the  incision ; 
in  the  first,  the  adhesions  must  be  detached  by  the 
hand,  or  destroyed  by  the  scissors  or  hot  iron.  They 
should  not  be  torn. 

Before  tapping  the  cyst  two  assistants  should  press  upon 
the  abdominal  walls,  in  order  to  force  the  cyst  to  project 
between  the  lips  of  the  incision.  The  puncture  is  tien 
made  with  a  trocar,  and  by  means  of  the  foregoing  pre- 
caution the  liquid  is  prevented  from  running  into  the 
peritoneal  cavity.  If  there  is  more  than  one  pouch, 
the  first  should  be  held  by  pincers,  or  tied,  while  the 
others  are  drawn  out  of  the  cavity.  If  the  cyst,  on  its 
retreat,  draws  a  portion  of  its  adherent  intestine,  it  is 
important  that  this  be  detached;  if  that  be  impossible, 
a  piece  of  the  cyst  must  be  cut  out,  and  left  attached  to 
the  intestine.  Care  must  be  taken,  however,  to  remove 
the  internal  secreting  membrane  from  this  fragment. 

All  bleeding  vessels,  whose  volume  is  not  too  consid- 
erable, should  be  twisted,  or  cauterized  with  a  hot  iron 
or  the  perchloride.  Only  when  this  method  is  impossi- 
ble should  the  vessels  be  tied. 

The  wound  should  not  be  closed  until  the  last  drop 


of  liquid  has  ceased  to  flow.  An  eminently  usefiil  pre- 
caution consists  in  placing  in  the  inferior  angle  of  the 
wound,  or  in  the  recto-vaginal  cul-de-sac,  a  caoutchouc 
tube,  by  which  any  Uquid  subsequently  effused  may 
drain  off.  MM.  Keith  and  Koeherle  attribute  a  great 
number  of  their  successes  to  the  observance  of  this  pre- 
caution, Boinet  has  no  dread  of  the  introduction  of 
air  into  the  peritoneum,  attributing  all  inflammation  to 
the  action  of  liquids,  and  not  air. 

A  double  line  of  sutures  is  necessary,  one  deep, 
the  other  superficial  M.  Boinet  decides  in  favor  of  in- 
cluding the  peritoneum  in  the  suture,  to  avoid  the  dan- 
ger of  this  .membrane  contracting  adhesions  with  the 
mtestine.  The  pedicle  should  be  compressed  by  a 
toothed  clamp,  which  has  the  advantage  of  compressing 
the  tissues  and  preventing  haemorrhages.  If  the  pedi- 
cle is  voluminous,  it  should,  however,  be  tied,  or  the 
ligature  combined  with  the  clamp.  When  the  size 
of  the  pedicle,  or  its  insertion  on  the  uterus,  presents 
unusual  difficulties,  a  thread  of  ligature  should  be  passed 
around  it  before  the  cyst  is  cut  away. 

M.  Boinet  concludes,  "  that  the  ovariotomy  should 
be  accepted  with  as  much  enthusiasm  as  all  other  01^)1- 
tal  operations ;  and  that  now  that  the  bases  of  diagnosis 
are  better  assured,  and  the  operative  procedures  more 
perfect,  the  subsequent  treatment  better  understood, 
more  advantageous  results  will  doubtless  be  obtained. 

M.  Demarquay,  surgeon  of  a  Maison  de  Sant^,  pre- 
sents a  report  on  the  topical  apphcation  of  iodoform  in 
the  treatment  of  cancer  of  the  uterus.  This  agent  em- 
ployed in  the  crystalline  form,  in  a  dose  of  7  to  15  grains, 
is  mixed  with  a  sufficient  quantity  of  butter  of  cocoa, 
and  the  suppository  thus  formed,  introduced  into  the 
vagina,  or  an  ulceration  of  the  carcinoma,  if  that  exists, 
— a  tampon  of  cotton  is  placed  in  front.  The  general  ef- 
fects are  slightly  observable,  although  the  iodine  from 
the  drug  (C^HI*)  is  absorbed  and  may  be  discovered 
in  the  saliva  and  urine.  But  the  local  suffering  is  al- 
most infallibly  soothed;  the  swelling  of  the  abdomen 
diminishes ;  and  the  ease  procured  lasts  as  long  as  the 
medicament  is  continued,  is  broken  up  by  the  inter- 
ruption of  its  administration,  and  reestablished  when 
that  is  renewed. 

Dr.  Morel,  the  distinguished  alienist,  writes  an  inter- 
esting article  in  the  Archives  of  Medicine  for  May, 
upon  progression  in  hereditary  insanity  and  nervous 
diseases.  Not  content  with  the  vulgar  feet  of  heredi- 
tary influence  in  the  transmission  of  sudi  disorders,  he, 
in  company  with  an  army  of  modern  confreres,  seeks  the 
laws  that  govern  this  hereditarv  transmission.  I  have 
not  space  left  to  enter  into  all  the  details  of  his  curious 
paper,  I  can  only  mention  three  or  four  of  the  most  strik- 
ing conclusions,  drawn  from  a  great  number  of  facts :  1st. 
Insanity,  epilepsy,  hysteria,  chorea,  eccentricities,  dypso- 
mania,  etc.,  are  only  the  branches  of  an  identical  consti- 
tutional vice  of  the  nervous  system,  and  may  be  trans- 
formed^ the  one  into  the  other,  by  way  of  hereditary 
transmission.  2d.  Such  transformation  is  more  fre- 
quent than  the  transmission  of  the  same  form  of  disor- 
der. When  a  simple  eccentricity  of  a  parent  becomes 
insanity  in  a  child,  &c.,  the  hereditary  taint  is  said  to 
be  progressive  ascendant,  and  the  opposite  case  pro- 
gressive descendant.  3dL  Whenever  the  several  chil- 
dren of  parents  presenting  a  nervous  taint,  are  marked^ 
ly  dissimilar  in  appearance  and  character,  the  taint  will 
almost  surely  be  transmitted,  and  progressive  ascendant. 
It  seems  in  this  case  as  if  the  whole  force  of  femily 
likeness  was  concentrated  in.  the  depths  of  the  nervous 
system.  4th.  In  such  families  it  is  common  to  observe 
that  one  or  more  of  the  members  are  gifted  with  re- 
markable intellectual  ability,  while  others  are  idiots. 

The  third  proposition  especially  constitutes  the  theme 


THE  MEDICAL  RECORD. 


216 


of  M.  Morel's  present  paper.  The  fourth  identifies  his 
views  with  those  of  Dr.  Moreau^  who,  in  his  remarkable 
woric  on  morbid  psychology,  unhesitatingly  ranks  genius 
amoDg  the  neuroses,  and  assigns  to  it  an  origiti  identi- 
cal with  that  of  epilepsy,  insanity,  and  idiocy. 
Paib,  Jone  18, 1887. 

P.  C.  M. 


CONGESTIVE  FEVER  IN  THE  SOUTH. 

To  THS  Editor  op  tbb  Mkdioal  Bscobd. 
Sir— In  the  reported  proceeding  of  the  Me<lical  So- 
riety  of  the  County  of  New  York,  April  1,  1867,  it  is 
stated  that  "  the  history  of  congestive  fever  was  next 
di^«usfled,  especially  as  it  appeared  in  the  Valley  of  the 
Mississippi  and  on  the  borders  of  the  Gulf  of  Mexico, 
where  it  was  so  prevalent  and  fatal  The  conclusion 
was  reached  that  prior  to  the  year  1834,  true  conges- 
tive fever  was  unknown  there.  Not  that  it  was  un- 
usual to  find  congestion  complicating  fevers  and  in- 
creasing their  danger ;  but  that  the  congestion  which 
gave  distinctive  character  to  the  fever,  which  first 
startled  the  people  of  that  region  in  1834,  culminating 
in  1843,  was  attended  with  phenomena  so  exceptional 
as  to  demand  a  new  name." 

The  impression  which  this  statement  is  calculated  to 
make  upon  the  professional  mind  is,  I  think,  erroneous. 
Il  certainly  is  a  mistake  to  say  that  congestive  fever  in 
all  its  intensity  and  fatality  was  unknown  in  that  quar- 
ter until  1834.  When  I  went  to  that  country  in  1819 
thia  form  of  fever  was  common,  and  it  had  been,  as 
represented  to  me  at  that  time,  for  many  years  before — 
even  from  the  first  settlement  of  the  country.  In  some 
parts  of  Louisiana,  and  the  southern  portions  of  Alabama 
and  Mississippi,  congestion  was  such  a  distinctive  cha- 
racterktic  of  the  prevailing  fevers,  that  they  were  com- 
monly designated  by  the  term  Cold  Plague^  and  the 
mortality  from  this  form  of  disease  was  greater  before 
1820,  and  even  before  1830,  than  it  has  been  since. 
But  the  same  congestive  characteristics  have  accom- 
panied the  graver  forms  of  fever  to  the  present  time, 
and  with  as  little  variation  of  symptoms  as  has  attend- 
ed upon  small-pox  during  the  same  period  in  New 
York  city,  or  elsewhere.  In  some  years  it  is  more 
Tiolent  and  fatal  than  in  others,  but  people  die  of  it 
every  year  fi-om  Memphis  to  the  Gulf.  As  stated  in 
my  published  lectures  on  the  subject,  "  my  belief  is,  the 
(wacter  of  the  disease  has  undergone  little  change 
ance  the  tinae  of  Hippocrates.  Names  alone  have 
changed;*'  and  in  the  South  we  have  been  treated 
with  many  of  these  changes,  not  by  any  means  begin- 
ning at  so  late  a  period  as  1834. 

As  congestive  fever  is  the  great  outlet  of  human  life 
in  the  South,  and  the  form  of  disease  eminently  to  be 
feared  by  immigrants,  it  may  be  of  importance,  what- 
ever may  be  said  of  its  pathology  and  therapeutics, 
that  its  "  history''  be  correctly  written. 

Truly  yours,  ^ 

A  P.  Merrill,  M.D. 

HnrTofk,Jime20,lSC7. 

Poisonous  Bread. — M.  Nickles,  Professor  of  Chem- 
istry at  Nancy,  has  just  discovered  a  circumstance  which 
may  torn  out  to  be  of  ereat  importance  to  public  health. 
It  seems  that  bakers  nave  been  lately  in  the  habit  of 
headne  their  ovens  with  old  painted  wood  got  cheap 
from  tne  demolition  of  houses.  But  bread  baked  in 
such  an  oven  acquires  poisonous  qualities  firom  the 
white  lend,  verdigris,  and  other  noxious  substances 
contained  in  the  paint;  and  M.  Nickles  shows  that 
these  substances  are  absorbed  by  the  crust,  and  do  not 
penetrate  to  the  cnimh. 


Vitas  Jfnetruntenls* 


THE    MODIFICATION    OF    SMITETS    PILE 

CLAMP. 

The  accompanying  wood-cut  represents  a  very  useful 
modification  of  the  Clamp  of  Mr. 
Henry  Smith,  of  London.  The 
original  was  arranged  so  that 
the  blades  closed  like  those  of  a 
scissors,  and  when  the  haamor- 
rhoid  was  grasped  it  necessarily 
became  more  or  less  pinched  at 
one  point,  while  it  was  com- 
paratively free  at  the  other. 
This  objection  to  its  use,  when 
the  Buflferer  was  not  under  the 
influence  of  chloroform,  was  a 
serious  one,  causing  much  un- 
necessary pain,  and  even  when 
the  patient  was  insensible  to 
pain  the  pile  was  not  uniformly 
compressed.  Mr.  Stohlmann,  of 
the  firm  of  Tiemann  &  Co.,  of 
this  city,  appreciating  the  diffi- 
culties in  the  way,  contrived  a 
modification,  by  which,  as  will 
be  seen,  the  two  blades  come  to- 
gether perfectly  parallel  to  each 
other,  and  by  means  of  the  screw 
in  the  handle,  are  made  to  close 
evenly  upon  the  mass  to  be 
separated.  The  haemorrhoidal 
mass,  being  tightly  inclosed,  may 
be  simply  strangulated,  and  after- 
wards separated  with  the  knife, 
and  a  hot  iron  applied  to  the  sur- 
face ;  or  this  latter  may  be  done, 
if  the  tissue  is  not  too  dense,  without  the  knife.  If  the 
knife  alone  is  used  haemorrhage  may  be  prevented  by 
applying  persulphate  of  iron  in  powder  or  solution,  to 
the  severed  part  before  the  clamp  is  removed.  The 
surfaces  of  the  blades  which  2^q  applied  to  the  integu- 
ment of  the  patient,  are  guarded  with  ivory  plates,  in 
order  that  no  heat  be  communicated  to  the  sensitive 
parts  when  the  hot  iron  is  used. 


©bituarg* 


Benjamin  Ooden,  M.D.,  who  was  long  and  favorably 
known  as  one  of  the  earliest  psychologists  of  this 
country,  expired  at  College  Point,  L.  I.,  on  Tuesday, 
June  18,  aged  70  years.  He  had  for  some  months  been 
a  sufferer  from  paralysis,  but  a  mitigation  of  his  symp- 
toms at  one  time  seemed  to  indicate  an  ultimate  recov- 
ery, and  as  it  was,  his  death  occurred  somewhat  sud- 
denly. At  the  last  session  of  New  York  Academy, 
after  several  eulogies  upon  the  deceased,  the  following 
resolutions  were  unanimously  adopted : 

Resolved— TYiBi  the  Academy  hears  to-night  with  heartfelt 
sorrow  of  the  death  of  oue  of  its  original  founders.  Doctor 
Benjamin  Ogden,  who  died  yesterday,  June  18. 

Resolved— ThsX  in  Doctor  Ogden  we  recognize  one  who 
has  adorned  and  beautified  his  profession  by  nearly  half  a 
century  of  useMness  in  this  the  city  of  his  birth ;  nor  was 
the  knowledge  of  his  worth  confined  to  its  narrow  limits, 
for  the  brightness  and  goodness  of  his  character,  and  his 
reputation  and  his  speciality  as  an  alienist,  were  oo-extensive 
with  our  country.  C^  r\r\r%\o 

Digitized  by  VjOOQ  Ic 


216 


THE  MEDICAL  RECORD. 


Besolved — ^That  he  who  was  so  foremost  in  every  good 
word  and  work  deserves  our  wannest  esteem,  and  should 
excite  and  stimulate  our  earnest  emulation. 

Besolved — ^That  the  Academy  will  attend  the  fVmeral  of 
Doctor  Ogden,  which  will  take  place  from  St  James  Luther- 
an Ghur(£,  in  15th  Street,  between  3d  and  2d  Avenues,  on 
Thursday  (to-morrowX  at  2  p.m. 

S.  PoBfEROT  WmTB,  M.D.,  died  June  6th,  1867,  of 
typhus  fever,  in  the  66th  year  of  his  age.  The  New 
^ork  Academy  of  Medicine,  in  memory  of  the  de- 
ceased, passed  the  followlDg : 

Resolved — ^That  the  New  York  Academy  of  Medicine 
learned  with  profound  regret  of  the  death  of  one  of  its  first, 
its  oldest,  and  most  esteemed  fellows,  Doctor  S.  Pomeroy 
White,  Who  died  on  the  6th  day  of  June  instant,  of  typhus 
fever. 

Besolved — That  the  Academy  bears  testimony  to  the 
lustre  which  in  early  life  Doctor  White  shed  upon  American 
surgery :  as  well  as  to  a  long  life  in  our  midst  of  useful  and 
honorable  professional  career. 

Re8olved--ThaX  the  profession  has  lost  a  valued  and  use- 
fVil  member,  the  community  an  honorable  and  upri^t  man, 
his  family  a  fond  and  devoted  head ;  and  we  desire  to  ex- 
press our  sympathies  in  this  their  bereavement 

Resolved — ^That  a  copy  of  these  resolutions,  signed  by  the 
Presi4ent  and  Secretary,  be  f\imished  to  the  family  of  the 
deceased* 

Died  on  Sunday  evening,  June  16,  at  the  house  of 
Dr.  E.  E.  Squibb,  m  Brooklvn,  Robbht  0.  Abbott,  Bre- 
vet-Colonel and  Surgeon,  United  States  Army,  aged  43 
years. 


Vitas  |)ubltcatt0n0. 


Books  and  Pamphlets  received. 

Ununited  Fbaoture,  with  Remarks  on  the  Operation.  By  H. 

J.  BiGBW)W,  M.D.,  Professor  of  Surgery  Harvard  Univer^ty, 

etc 
OntoxTLAB  Na  6 ;  War  Department,  Surgeon  Qeneral's 

Oppicb— Report  on  Epidemic  Cholera. 
EucHBN  ON  Nervous  Injuries.    Philadelphia.    H.  C.  Lea. 

1867. 
The  Mineral  Waters  op  United  States  and  Canada. 

By  J.  J.  Noorman,  M  J>.,  of  Roanoke  College,  Virginia. 

Baltimore.    Ejellt  k  Piet.    1867. 
The  Cholera  as  it  Appeared  in  Nashville  in  184d-'60 

and  66  by  R.  K.  Bowlino,  M.D. 
Report  New  York  City  Lunatic  Asylum. 
Phtsioloot  of  the  Heart.    By  Claude  Bernard.    Trans- 
lated by  J.  8.  Morel.    Savannah,  Georgia. 


itteltical  Itetufl  anlr  HXtvM. 


The  New  Hospital  on  Ward's  Island— Adopting 
the  suggestiou  of  Mr.  Richard  O'Gorman,  the  Commis- 
sioners of  Emigration  have  resolved  to  give  the  new 
Hospital  on  Ward's  Island  the  name  of  their  President, 
Mr.  Gulian  C.  Verplanck. 

The  State  Medical  Society  of  Iowa  held  its  last  meet- 
ing May  22, 1867,  at  Davenport  The  attendance  was 
large,  and  many  interesting  papers  were  read  by  dif- 
ferent members.  The  following  officers  were  elected 
for  the  ensuinffyear :  President — Dr.  William  Watson, 
of  Dubuaue.  Vice-President — Dr.  Edward  Whineir, 
of  Fort  Madison.  Recording  Secretary — Dr.  A.  6. 
Field,  of  Des  Moines.  Treasurer — Dr.  M.  B.  Cochran, 
of  Davenport  Corresponding  Secretary — Dr.  E.  J. 
B.  Statler,  of  Marshalltown. 


HoMiBOPATHT  ON  THE  Eye. — The  Dircctors  of  the 
New  York  Ophthalmic  Hospital,  having  substituted 
homoeopathy  for  the  allopathic  system  of  cure,  have  em- 
ployed Drs.  Allen,  Bacon,  Wetmore,  and  Leopold. 
The  retiring  physicians  are  Dra  William  F.  Holcombe, 
Giovanni  deccarini,  J.  M.  Camochan,  and  Marcus  P. 
Stephenson. 

Condition  op  Poor-Houses  of  New  Jersey. — ^In  the 
report  of  the  State  Sanitary  Commission  to  the  €k>yer- 
nor  of  New  Jersey,  for  the  year  1866,  we  find  the 
following  allusion  to  the  condition  of  the  poor-houses : 

"  In  connection  with  our  attempted  investigations  as 
to  the  insane  and  idiotic  in  county  and  township  poor- 
houses,  we  instituted  some  inquiries  in  rel'erence  to 
these  institutions,  and  it  has  become  quite  apparent  to 
us  that  in  parts  of  our  State  '  the  poor  system '  is 
essentially  defective ;  while  in  some  parts  the  poor  are 
farmed  out  to  the  lowest  bidder,  in  others  they  are  con- 
gregated together  without  sufficient  regard  to  the  use 
of  those  means  which  prevent  pauperism  as  well  as 
provide  for  it  On  the  other  hand,  we  are  not  without 
models  in  our  own  State,  which  other  towns  and  town- 
ships might  imitate,  and  our  error  is  in  having  no  pub- 
he  officer  whose  duty  it  is  to  regard  these  and  other 
interests  of  public  hygiene  and  to  bring  them  to  the 
attention  of  those  wno  are  themselves  conscious  of 
defects,  but  for  the  want  of  such  correspondence  and 
information  know  not  how  best  to  remedy  existing 
evils.  It  is  noble  to  provide  for  the  afflicted  and  the 
destitute,  and  right  to  punish  the  criminal^  but  the 
philanthropist  wlio  sees  one  generation  of  paupers  pro- 
viding the  ne^  who  beholds  insanity  too  often  trans- 
mitted or  originated  as  a  result  of  errors  in  marriage  or 
habits,  and  who  sees  vice  spring  out  of  the  filth  and  bad 
air  and  unfit  homes,  and  then  subjected  to  punishment, 
not  reformatory,  cannot  but  inquire  if  it  would  not  be 
wiser  and  more  economical  legislation,  by  sanitary  re- 
gulation and  information,  to  dry  up  the  sources  of  degra- 
dation as  well  as  to  make  provision  therefor.  Ounces 
of  such  prevention  are  better  than  manifold  pounds  of 
cure.'** 

QuALirioATioNS  FOR  A  SuBOEON. — Every  aspirant  for 
surgical  honors  is  sure  to  be  told  early  in  his  course  by 
some  kind  friend  or  other,  that  to  be  a  good  surgeon  a 
man  must  have  a  lion's  heart  and  a  lady^s  hand.  Well 
— he  looks  down  at  a  hand  of  anything  but  feminine 
proportion,  and  looks  back  to  his  sensations  at  the  fiirst 
operation  he  witnessed ;  and  he  is  apt  to  conclude  tliat 
he  has  chosen  the  wrong  path  in  life.  By-and-by  he 
finds  that  by  constant  practice  in  the  use  of  instruments 
his  finger^  have  acquired  a  new  delicacy  and  flexibility  ; 
and  he  finds,  too,  that  as  the  source  of  the  lion's  courage 
hes  in  consciousness  of  strength,  so  the  moral  courage 
and  firmness  typified  by  the  lion's  heart,  may  come  to 
aim  as  sure  results  of  better  knowledge  and  training 
and  self-reliance.  Uncertainty  and  ignorance  can 
hardly  produce  anything  but  cowardice  or  rashnees; 
true  courage  is  associated  with  judgment  and  reflection. 
— Introductory  Address  at  St  TJwmas's  Hospital^  Oct. 
2,  1865,  by  William  M.  Ord,  M3.,  London.— J/ecKeal 
times  ana  Cfaeette. 

Yellow  Fever. — ^In  consequence  of  the  arrival,  on  the 
24th  ultimo,  of  a  ship  at  Fortress  Monroe  from  Matantas 
with  yellow  fever  on  board,  the  Health  Officer  of  this 
Port  has  ordered  all  vessels  arriving  fi*om  the  infected 
port  to  anchor  at  the  Lower  Bay.  The  disease  is 
also  reported  to  have  made  its  appearance  at  New 
Orleans. 


EaiATJu—On  iMg«  Sll,  twelfth  line  from  top,  tf^  vision  nsd^titn. 


THE  MEDICAL  RECORD. 


217 


©rifltnol  Communicattong. 

CUNICAL  THERMOMETRY  IN  DIPHTHERIA* 
Br  JOSEPH  a.  RICHARDSON,  M.D., 

DBLBOATB  VftOX  TH«  OATUOA  00.  MXDtOAh  SOOXSTT,  RSW  TOBX. 

Though  simplest  among  the  many  contributions  which 
during  the  past  decade  medicine  has  received  at  the 
binds  of  her  sister  sciences,  such  as  the  endoscope, 
sphygmograph,  and  laryngoscope, 'the  clinical  thermo- 
meter seems  to  promise  the  ilist  general  and  practical 
advantage,  inasmuch  as  it  requires  tor  its  application  no 
prolonged  ezi>erience  or  particular  instruction,  and  may 
be  asemlly  employed  in  almost  every  case  which  demands 
the  study  of  either  specialist  or  general  practitioner.  Its 
instmmental  aid  has  thus  far  been  invoked  and  its  capa- 
cities tested  more  or  less  completely  in  a  majority  of  the 
diseases  which  come  beneath  our  notice ;  but  among  the 
minority  which  have  hitherto  remained  almost  untried 
by  its  standard,  probably  none  are  of  more  importance 
than  diphtheria,  which,  on  account  of  its  general  pre- 
valence and  its  obscure  etiology,  as  well  as  its  fatality, 
80  great  and  sometimes  so  unexpected,  appears  to  re- 
quire further  elucidation  at  the  hands  of  every  scientific 
physician.  The  seeming  neglect  in  this  respect  which 
It  has  undergone  may  be,  no  doubt,  in  part  ascribed  to 
the  &ct  thai  it  is  a  disease  not  very  common  in  our  chief 
ddes,  and 'especially  unusual  in  those  lars^e  hospitals 
where,  judging  by  notices  published  in  medical  period- 
icals both  of  this  country  and  of  Europe,  most  tiiermo- 
metric  researches  thus  far  recorded  have  been  carried  on. 
The  circumstance  of  being  located  in  an  intensely  diph- 
theritic region,  by  rendering  necessary  an  almost  daily 
mtercourse  with  different  grades  of  the  affection  during 
the  past  winter,  has  afforded  me  an  opportunity  tj  sup- 
ply ttiis  omission  and  to  record  numerous  observations 
opon  the  range  of  temperature  in  diphtheria,  of  which 
I  propo^  to  give  an  abstract  in  this  paper,  and  aW)  to 
set  forth  a  few  important  deductions  as  to  their  prog- 
nostic and  therapeutic  worth,  which  I  hope  may  at  least 
famish  a  basis  of  data  for  more  extended  investig  ition, 
and  constitute  a  nucleus  around  which  may  be  gathered 
other  facts  which  shall  combine  with  the-^e  to  atford  in- 
valuable assistance  in  many  a  future  struggle  with  this 
formidable  affection.  Who,  indeed,  that  has  been  called 
wpon  to  combat  this  most  deceitful  malady,  and  has  be- 
held the  insidious  foe  creeping  onward  and  downward 
towards  the  tracheal  aperture  with  an  unseen  and 
stealthy  progre-^s,  which,  if  unchecked,  must  soon  hurry 
its  victim  to  the  grave,  has  not  ardently  desired  some 
feasible  method  of  discovering  how  rapid  was  its  course 
when  it  passed  beyond  the  bound  of  direct  vision,  and 
bow  soo.i  the  cessation  of  its  advance  might  be  expect- 
ed? that  he  might  on  the  one  hand  inspire  with  new 
hope  the  despairing  patient,  or  on  the  other  arouse  to 
new  energy  his  own  and  the  attendants'  efforts.  Or, 
igain,  which  of  us  who  ha<»  been  called  upon  to  under- 
take the  heavy  responsibility  of  performing  or  abstaining 
from  tracheotomy  has  not  felt,  as  the  diphtlieriiic  patient, 
gating  for  breath,  turned  upon  us  his  imploring  eye 
with  a  whispered  but  eloquent  appeal  for  relief  from  his 
agonizing  snfferinj;^,  an  anxious  longing  for  some  test 
which  should  indicatfe  with  an  approach  to  certainty 
how  n  'ar  the  violence  of  the  disease  was  spent,  and 

♦  TWs  paper  was  read  before  its  npproprlate  section  at  the  late 
oieetin^uf  the  American  Medical  AsAocfatton,  at  Cincinnati;  bnt  on 
acouanc  of  the  limited  namber  of  case»  observed,  retarued  fur  oonflrma- 
tton  of  its  concTa:«ion8  by  farther  data.  In  order  to  obtain  these  the 
lothnr  invites  tbo  aaeistanee  nf  anj  members  of  the  profession  who  may 
fee)  iatereeted  in  the  snbiect,  assnring  them  that  their  oontribntlons 
vill  be  moet  ttaankfally  acknowledged. 


also  what  stock  of  failing  strength  remained  to  support 
the  system  under  the  operation  ?  Such  a  means  we 
have  oflfered  to  us  in  the  clinical  thermometer,  which 
for  its  aid  to  our  profession,  not  only  in  diphtheria,  but 
likewise  in  others  of  "  the  ills  that  flesh  is  heir  to,"  must, 
I  think,  hold  its  place  with  the  stethoscope  of  Laennec 
and  the  pleximeter  of  Piorry. 

Perhaps  these  statements  can  be  most  satisfactorily 
illustrated  by  transcribing  from  my  note-book  the  re- 
cords of  two  or  three  severe  cases,  and  then  giving  an 
abstract  of  results  from  the  whole  series  of  thermometrio 
observations,  which  are  about  sixty-five  in  number.   The 
first  case  selected  was  remarkable  for  the  high  tempera^ 
ture  (being  more  elevated  than  any  other  noted),  the 
quantity  and  rapid  formation  of  the  exudation  thrown 
out,  and  the  promptness  with  which  it  yielded  to  treat- 
ment.   Miss  Sarah  S.,  aged  seventeen,  of  fair  complexion, 
.nervous  temperament,  and  rather  deUcate  constitution, 
was  attackea  on  the  21st  of  February,  1867,  with  very 
severe  headache,  pains  in  the  back  and  limbs,  accom- 
panied at  first  by  slight  rigors,  which  gave  way  after  a 
few  hours  to  high  febrile  action.    About  9  p.m.,  when  I 
saw  her  first,  her  pulse  was  132  per  minute,  and  her  tem- 
perature, as  ascertained  by  introducing  the  bulb  of  a  clin- 
ical thermometer  into  the  axiUa,  closing  the  arm  tightly 
over  it,  and  allowing  it  to  remain  eight  minutes,  was 
found  to  be  102^  degrees.     Her  right  tonsil  was  much 
swollen,  deeply  injected,  and  very  painful,  but  had  only 
three  small  spots  near  its  centre ;  her  strenpfth  was  much 
prostrated,  so  that  she  sat  up  with  difficulty  for  me  to 
examine  her  throat  On  the  following  morning,  February 
22,  her  pulse  was  120  per  minute,  her  temperature  102 
degrees,  the  risrht^  tonsil  was  covered  with  a  patxjh  of 
thick,  heavy,  false  membrane,  whose  area  was  estimated 
at  70  square  lines,  while  the  left  exhibited  a  similar  de- 
posit over  about  half  that  much  surface.    Her  headache 
was  much  relieved,  although  the  pain  in  her  limbs  and 
prostration  of  strength  remained  about  the  same ;  her 
tongue  was  much  coated,  breath  very  offensive,  and 
anorexia  complete.     In  the  evening  her  pulse  had  fallen 
to  100  beats  per  minute,  and  her  temperature  to  100  de- 
grees; the  superficial  area  of  false  membrane  on  each 
tonsil  was  about  the  same  as  observed  on  the  previous 
visit,  but  the  circumjacent  redness  had  somewnat  less- 
ened ;  she  had  hardly  any  hea'lache ;  the  pains  in  her 
extremities  were  much  diminished;  her  appetite  had 
commenced  to  return,  and  she  had  attempted  to  sit  up 
daring  the  afternoon,  though  compelled  soon  to  relin- 
quish the  effort  on  account  of  the  nausea  which  it  pro- 
duced.   February  23. — I  found  that  my  patient  had  slept 
well  the  night  before,  and  that  her  relish  for  food  was 
greater,  although  the  tongue  was  much  furred,  and  she 
had  still  a  little  headache ;  her  pulse  beat  88  times  in  the 
minute,  and  her  temperature  had  sunk  to  99^  degrees. 
Most  of  the  false  membrane  had  disappeared ;  on  the 
right  tonsil  a  suvfiice  of  about  20  square  lines,  and  on 
the  left  one  of  30  square  lines  was,  however,  still  cov- 
ered ;  the  soreness  at  the  time  of  my  visit  greater  on  the 
left  sile  than  on  the  right,  although  the  latter  had  been 
first  attacked.     February  24. — Patient  sitting  up ;  pulse, 
108;  temperature,  98^^;  d'jht  tonsil  clear  of  false  mem- 
brane; paU^h  on  left  tonsil  of  about  6  square  lines, 
situated  near  the  top;  has  a  little  pain  on  swallowing, 
but  less  than  yesterday ;  headnchv'  and  pain  in  the  limbs 
entirely  gon*»,   appe'ite  good,  tongue   cleaner,  fauces 
almost  natural  in  color.     February  25. — ^Pulse,  84;  tem- 
perature, 97i ;  throut  quite  clear  of  deposity  although  the 
act  of  swallowing  is  still  accompanied  by  a  little  pain ; 
no  headache ;  feel^  stronger ;  and  has  a  good  appetite, 
with  whose  assistance  she  rapidly  convalesced. 

Case  II.  is  chiefly  worthy  of  note  as  showing  the 
energetic  efforts  made  by  nature  to  overcome  a  violent 


218 


TIIE  MEDICAL  RECORD. 


attack  of  the  disease,  aided  by  unfiivorable  hygienic  in 
fluences.  It  is  that  of  Mr.  Gilbert  C,  aged  twenty,  of 
Tigorous  frame  and  strong  constitution,  having  never 
b^n  sick  bcffore  in  his  life,  who  was  attacked  on  the  Ist 
of  March,  1867,  with  severe  sore  throat,  headache,  pains 
in  his  limbs,  &c. ;  but,  being  unacquainted  with  illness, 
refused  to  see  a  physician  until  the  morning  of  the  4th 
of  March,  when  I  was  sent  for  and  found  him  suffering 
from  a  good  deal  of  headache  aod  pain  in  hia  throat, 
which  upon  examination  exhibited  great  swelling  of  the 
tonsils,  so  that  they  met  in  the  middle,  pushmg  the 
elongated  uvula  forwards;  the  right  tonsil  was  the  most 
affected,  being  covered  with  a  layer  of  yellowish  false 
membrane,  estimated  at  170  square  lines  in  area,  while 
the  left  was  coated  to  the  extent  of  about  80  square  lines; 
his  pulse  was  80  per  minute;  temperature,  99}.  At  6 
P.M.  of  the  same  day  his  pulse  beat  90  per  minute,  and 
his  temperature  had  risen  to  101  f  degrees.  He  stated^ 
that  he  tiiought  he  had  taken  more  cold  the  evening 
before,  that  his  throat  was  fuller,  and  he  felt  more  as  if 
he  must  strangle  during  the  night.  March  5,  at  10 
A.M.  his  pulse  was  87;  his  temperature,  lOOf ;  hud  great 
difficulty  of  breathing  all  night— so  much  so  Uiat  he  was 
unable  to  lie  down,  but  sat  up  in  a  chair ;  was  too  dis- 
tressed to  admit  oi  any  exammation  of  the  fauces.  At 
8  p.if .  on  the  same  day  his  pulse  was  84,  and  his  tempe- 
rature 100  degrees.  March  6,  9  a.m. — ^Pulse  86,  and  more 
feeble ;  temperature,  100  degrees ;  throat  feels  sore,  but 
not  much  painful  when  at  rest;  on  exauiination  found  to 
be  less  red  and  tumefied,  so  that  the  tonsils  lay  one  quarter 
of  an  inch  apart  The  udse  membrane  «n  the  right  tonsil 
covered  ab  tut  60  square  lines,  on  the  left  30  square  lines. 
Sat  up  all  night  in  his  ohair,  but  dozed  a  Uttle ;  ate  a 
good  breakfast  with  some  relish;  but  his  whispering 
voice  and  slight  croupy  cough  made  me  feel  f  ery  anxious 
in  regard  to  his  safety.  At  6  p.m.  his  pulse  was  96 ;  his 
temperature,  99{^.  He  complained,  however,  that  his 
head  ached  a  good  deal,  and  both  he  and  his  relatives 
dreaded  the  occurrence  of  brain  fever,  to  which  they 
stated  their  family  was  prediq)Ost?d.  The  visit  this  even- 
ing was  made  in  consultation  with  Dr.  Test;  and  although 
the  suppressed  croupy  cough  (much  more  marked  since 
morning),  the  severe  headache,  and  the  intense  feeling 
«of  strangulation,  all  combined  to  render  our  prognosis 
^unfavorable,  yet  the  regular  decrease  of  temperature,  as 
indicated  by  the  thermometer,  from  101  i  on  the  evening 
'of  the  4th  to  lOOf  on  the  morning,  lOOj^  on  the  evening 
•of  the  5th,  100  in  the  morning,  and  99J  at  the  time  of 
our  visit  on  ^e  6th,  encouraged  us  to  entertain  the  hope 
that  the  disease  was  so  far  abating,  that  should  these 
:8jmptoms  be,  as  we  anticipated,  the  results  of  partial 
.'Separation  of  the  false  membrane,  about  to  come  away, 
a  Mivorable  termination  might  yet  be  expected. 

On  the  morning  of  the  7th,  at  9  a.m.,  I  found  his  pulse 
<only  76 ;  his  temperature,  99^;  his  cough  loose  and  reso- 
mant^  and  his  breathing  comparatively  unembarrassed. 
I  learned  from  his  attendants  that  although  the  cough 
'continued  to  become  more  croupy  during  the  night, 
about  5  A.M.  something  seemed  to  loosen  in  his  throat, 
feeling,  as  described  in  the  patient's  own  words,  as  if 
'**  a  cork  was  going  backwards  and  forwards  in  his  wind- 
-pipe,"  which  flapped  up  and  down  with  a  noise  audible 
tto  his  nurse  for  about  half  an  hour,  and  was  finally  ex- 
jpelled  with  a  violent  struggle,  during  which  suffocation 
appeared  imminent.  Since  that  time  he  had  felt  much 
easier,  slept  for  about  an  hour,  and  was  able  to  breathe 
«nd  Bwallpw  with  much  more  comfort 

At  6  pjc.  on  the  7th  I  found  his  condition  still  im- 
proved, except  that  his  pulse,  which  was  84  per  minute, 
^was  ratiier  more  compressible;  his  temperature  was  99{.  I 

I  learned  that  about  four  and  five  o'clock  that  after- 
"xoon,  respectively,  he  had  severe  choking  speUs,  and  after ' 


violent  efforts  coughed  up  two  pieces  of  false  membrane, 
which  had  been  saved  and  were  shown  to  me.  The  larger 
fragment  was  about  two  and  a  half  inches  long,  half  to 
three-quarters  of  an  inch  broad,  and  one-sixteenth  of  an 
inch  in  thickness.  The  am aller  was  nearly  an  inch  square, 
assumed  when  floated  out  in  water  a  semi-cylindrical 
form,  and  bore  upon  its  thin  convex  surface  distinct  im- 
pressions of  three  of  the  tracheal  rings,  rendered  more 
distinct  by  the  fact  that  the  intermediate  portions  of 
membrane  were  stained  of  a  pinkish  tint,  apparentiy 
from  the  extravasation  of  blood. 

March  8,  9  a.m. — His  pulse  beat  88,  his  temperature 
stood  at  9d}  degrees.  The  tonsils  were  less  swollen,  and 
the  exudation  so  far  diminished  that  it  covered  an  area 
of  only  about  ten  and  five  square  lines  on  the  right  and 
left  sides  respectively.  Had  a  severe  attack  of  epistaxis 
last  evening,  notwithstanding  which  he  slept  some  four 
hours,  and  felt  better  at  the  time  of  my  visit. 

In  order  to  avoid  occupying  valuable  time  unneces- 
sarily, I  will  proceed  no  further  with  particular  notes  of 
this  case,  merely  stating  that  after  arekpse  of  diphtheria, 
apparently  the  result  of  taking  cold,  he  gradually  im- 
proved until  the  10th  of  Apnl,  when  I  was  recalled  to 
his  bedside,  and  found  him  the  subject  of  double  pneu- 
monitis, contracted  by  sitting  at  a  window  without  a 
vest  on,  which  proved  fatal  on  the  fifth  day  of  its  course. 

Case  IIL — ^Miss  Caroline  S.,  set  thirty-six,  medium 
height,  dark  complexion,  naturally  of  good  constitution 
— perhaps  a  littie  debilitated  by  an  attack  of  diphtheria 
about  two  years  ago— was  seized  with  sore  throat  on  the 
27th  of  April,  1867,  while  riding  out  after  dark.  When 
called  to  see  her  the  day  following,  at  5  p.il,  I  found  her 
pulse  120,  her  temperature  in  uie  axilla  102  degrees. 
The  right  tonsil  was  a  littie  swollen,  and  had  two  or 
three  small  specks  of  exudation  upon  it;  the  left  was  a 
good  deal  tumefied  and  reddened,  snowing  near  its  upper 
part  a  patch  of  whitish  false  membrane,  covet  ing  an  area 
of  30  square  lines.  April  29,  at  5^  ^*^*lJ  ^ound  her 
pulse  112.  her  tempetatura  101  degreea  Her  headache 
was  nluch  less,  but  her  throat  was  more  sore  and  the 
difficulty  of  swallowing  greater ;  slept  about  half  of  laat 
night,  and  has  eaten  some  food,  but  without  relish.  False 
membrane  on  right  tonsil  about  10  square  lines,  on  left 
tonsil  140  square  lines ;  palate  very  oedematous,  but  not 
coated  with  exudation.  April  30. — Her  pulse  was 
beating  108  times  per  minute ;  her  temperature,  101^  de- 
grees ;  respirations,  24  per  minute.  Left  tonsil  less  sore 
and  less  swollen,  but  entirely  covered  with  a  patch  of  false 
membrane,  estimated  at  180  square  lines.  Bight  tonsil 
felt  sore  to-day  for  the  first  Ume.  and  at  the  period  of 
my  visit  was  quite  painful  and  swollen,  coated  with  about 
100  square  lines  of  exudation.  Slept  a  little  last  night, 
but  was  awake  often.  Feels  weaker  than  yesterday,  so 
that  it  makes  her  dizzy  to  try  to  stand  erect;  but  the 
headache  and  the  pain  in  her  limbs  rather  easier. 

May  1. — Her  pulse  beat  104,  her  temperature  lOOJ 
degrees,  and  her  respirations  26.  Left  tonsil  exhibited 
120  square  1  nes  of  false  membrane,  which  waa  quite 
ragged  and  much  loosened  at  the  upper  part;  right 
ton^  more  coated  than  yesterday,  showing  about  140 
pquare  lines.  Had  no  pam  in  her  limbs,  and  lees  in  her 
tiiroat,  but  feels  much  weaker,  and  her  head  aches  more. 

May  2,  5  p.M.»Pulse  104,  temperature  100^  degrees. 
Slept  better  the  night  before,  and  had  neither  headache 
nor  nausea  during  the  day ;  did  not  feel  any  weaker  than 
the  day  previous.  Right  tonsil  about  the  same  coating 
as  yesterday,  140  square  lines ;  left  tonsil  70  square  lines, 
and  reduced  to  about  half  the  magnitude  it  had  yester- 
day. 

May  3. — ^Pulse  100  per  minute,  temperature  100  de- 
grees. Left  tonsil  dear  of  exudation,  but  the  posterior 
half  arch  behind  it  is  covered  with  an  elongated  patch  of 


THE  MEDICAL  RECORD, 


219 


about  30  square  lines  in  area;  false  membrane  upon  the 
right  tonsil  estimated  at  90  square  lines.  Palate  still 
a^ematous,  but  less  so  than  yesterday.  Soreness  of 
throat  diminished.  No  headache,  no  nausea.  Slept 
most  of  the  night,  but  perspired  nreely  since  daylight, 
and  felt  weaker  than  the  day  previous. 

May  4 — ^Pulse  92,  temperature  99^  degrees.  Left 
tonsil  quite  dear,  and  its  posterior  half  arch  only  coated 
to  the  extent  of  about  5  square  lines.  Exudation  on  right 
tondl  estimated  at  70  square  line&  Slept  all  night; 
throat  less  painful;  and  although  she  took  less  stimulus, 
she  felt  stronger  than  she  did  the  day  previous  at  the 
time  of  my  visit  Being  the  last  time  1  saw  the  patient 
before  my  departure  for  Cincinnati,  I  can  give  no  further 
notes  of  the  case,  which  I  hope,  however,  has  by  this 
time  progressed  to  a  favorable  convalescence. 

As  these  three  weU  marked  examples  of  the  disease 
give  a  very  fair  exposition  of  the  thermometric  changes 
which  occur  during  its  course,  I  need  occupy  no  more 
time  in  the  narration  of  particular  cases,  but  may  pro- 
ceed at  once  to  detail  briefly  an  abstract  of  aU  the  ob- 
servations I  have  made  in  me  whole  series  of  twelve 
attacks.  Of  the  first  day  of  an  v  attack  I  bave  no  record. 
On  the  second  my  notes  give  the  mean  temperature  lOOi, 
an  average  of  thirteen  observations,  of  which  the  highest 
was  102^  degrees,  occurring  in  two  instances,  and  the 
lowest  99  degrees;  the  average  pulse  on  the  same  day 
was  104  beats  per  minute.  On  the  third  day  I  find  the 
mean  temperature,  as  deduced  from  fourteen  observa- 
tion?, 99f  degrees;  the  pulse  averaging  96  beats  per 
minute.  On  the  fourth  day  the  average  of  ten  observa- 
tions gave  a  temperature  of  98  J  degrees,  while  the  aver- 
age pulse  had  fallen  to  85 per  minute;  while  on  the  fifth 
day  the  average  temperature  had  reached  the  normal 
standard  of  98^,  while  the  pulse  beat  72.  I  should 
mention  that  two  of  these  patients  were  the  subjects  of 
valvular  disease  of  the  heart,  and  that  the  slow  rate  of 
^eir  natural  pulse  has  some  slight  effect  in  reducing 
the  average  frequency  of  the  pulse  as  above  given. 

While  Sie  cases  thus  detailed  are  perhaps  too  few  in 
number  to  insure  absolute  certainty  for  the  following  de- 
ductions, which  further  observations  may  in  some  minor 
respects  modify,  yet  it  would  seem  that  we  may  safely 
draw  the  following  general  conclusions : 

JPirsi — That  the  thermometric  range  in  diphtheria  is 
leffl  elevated  than  that  of  most  other  acute  diseases,  and 
that  hence  in  marked  cases  a  comparatively  low  temper- 
ature of  102  or  102i  degrees  should  not  mislead  the 
physician  into  considering  the  attack  as  of  little  im- 
portance. 

Second — That  as  the  changes  of  temperature  appear 
to  bear  a  closer  relation  to  the  amount  of  false  membrane 
than  do  the  variations  in  the  pulse^  we  may  on  the  one 
hand  feel  more  assured  of  approachmg  convalescence  by 
its  fall,  or  on  the  other  hand  must  entertain  graver  fears 
for  our  patient's  safety,  should  it  steadily  rise,  than  by 
finding  corresponding  alterations  in  the  rapidity  of  the 
heart's  action. 

And  thirdly^  therefore,  that  in  these  alarming  cases 
where  the  disease  invades  the  larynx,  and  we  are  called 
upon  to  perform  tracheotomy,  if  it  affords  any  hope  for 
the  patient,  a  careful  record  of  the  thermometric  changes 
iupplies  us  with  the  best  g^ide  hitherto  discovered, 
whether  the  exudation  will  be  apt  to  extend  rapidly 
further,  and  so  render  that  serious  operation  utterly 
fruitless. 


Thi  CiNcnmATi  Journal  ofMewctne  has  been  trans- 
ferred to  Indianapolis,  and  its  name  has  been  changed 
to  that  of  TM  WeiUm  Journal  of  Medicine,  Dr.  T. 
Parvin  is  the  editor. 


RBMARKS  ON  THB 

EMPIX)YMENT   OF   CHLOROFORM 

AS  A  THERAPSXrriO  AGENT,    WHEN  TAKEN  INTO  THB 
STOMACH. 

Bt  E.  McOLELLAN,  M.D., 

kSSlgtkXn  BUBOXOK  AlTD  BBSVXT  MAJOR,   r.8.A. 

The  internal  administration  of  chloroform,  in  the  treat- 
ment of  delirium  tremens,  and  other  neuroses,  which 
has  lately  been  revived  with  much  success,  .is  by  many 
medical  gentlemen  considered  a  procedure  of  question- 
able propriety.  These  doubts  of  the  therapeutic  value 
of  this  drug  arise,  in  the  majority  of  instances,  from  the 
fatality  which  has  attended  its  use  as  an  anaesthetic 
agei\t  But  objections  are  frequently  advanced  upon 
the  ground  that  the  exhibition  of  chloroform  sometimes 
fails  to  relieve  insomnia,  and  the  consequent  dehrium, 
and  that  not  unfrequently  it  induces  &ee  emesis,  in 
place  of  acting  as  a  remedy  for  nausea  and  vomiting. 

It  would  indeed  be  strange,  if  among  inebriates,  who 
unfortunately  compose  a  numerous  class  in  every  large 
community,  idiosyncrasies  were  not  observed,  and  if 
in  the  treatment  of  that  disease  to  which  they  are 
liable,  any  proposed  remedy  should  invariably  produce 
the  same  resuhs ;  but  if  in  the  majority  of  a  given 
number  of  cases  a  decided  and  beneficial  action  is  ob- 
tained, the  cause  of  failure  in  the  minority  may  as 
justly  be  sought  in  the  individual,  or  in  extraneous 
causes,  as  in  the  drug.  Thus  chloroform,  which  has 
been  highly  considered  in  the  trratment  of  nausea  and 
vomiting,  produced  by  sea-sickness,  pregnancy,  and 
nervous  irritation  from  other  causes,  may,  when  con- 
taining impurities,  only  aggravate  the  disorders  for  the 
removal  of  which  it  is  administered.  On  the  other 
hand,  idiosyncrasies  may  be  combated  in  vain,  since 
they  are  not  to  be  overcome ;  the  instances  are  so  well 
known  of  certain  drugs,  harmless  to  the  many,  but 
exercising  invariiibly  an  unpleasant  inQuence  over  a  few, 
that  any  enumeration  would  be  unnecessary.  In  a 
somewhat  extended  experience,  in  which  the  remedial 
power  of  chloroform  has  been  carefully  observed,  very 
few  instances  have  occurred  in  which  its  administration, 
caused  vomiting;  and  even  in  these  cases,  with  but 
one  exception,  the  same  amount  having  been  repeated,, 
af^^r  a  snort  interval,  was  retained,  and  produced  the 
desired  effect  Of  the  instance  in  which  it  became  im- 
practicable to  continue  its  employment,  the  cause  was. 
found  in  an  intense  repugnance  which  the  patient  con- 
ceived, and  which  became  so  strong,  that  from  that, 
time  the  ethereal  flavor  invariab  y  produced  nausea  and. 
vomiting. 

It  may  safely  be  accepted,  that  an  over-dose  of  chlo- 
roform would  most  likely  be  quickly  ^'ected  by  the 
stomach.  To  this  fact  are  to  be  attributed  the  very  few^ 
instances  on  record  in  which  death  has  resulted  from 
over-doses,  which  have  been  taken  either  by  accident 
or  from  criminal  purposes.  Still  this  proposition  must 
admit  of  qualification,  since  chloroform  has  produced 
violent  poisoning  in  some  cases  on  record — in  a  few 
others,  death. 

In  the  successful  employment  of  chloroform  as  a 
remedial  agent,  much  stress  has  been  laid,  by  observers, 
on  the  great  variations  which  may  be  made  from  a 
standard  dose.  A  fluid-drachm,  which  in  the  majority  of 
adults  will  procure  sleej),  being  taken  as  a  standard,  it 
may  be  increased  or  diminished  pro  re  ncUa ;  but  in 
those  cases  which  indicate  the  production  of  a  decided! 
hypnotic  effect,  it  is  certainly  advisable  to  bring  the 
patient  rapidly  under  its  influence.  In  fact,  it  will  be- 
found,  that  among  the  most  frequent  causes  of  failure- 


220 


THE  MEDICAL  RECORD. 


in  the  use  of  chloroform,  are  the  insufficient  doses 
exhibited,  and  the  length  of  the  interval  between  them 
on  their  repetition. 

The  impunity  with  which  chloroform  may  be  given 
in  large  do>es  has  been  frequently  illustrated  within  my 
observation,  and  its  appHcation  has  not  been  confined 
to  the  treatment  of  delirium  iremetis  alone.  In  a  case 
of  epidemic  cholera  occurring  in  a  delicate  female,  who 
was  in  collapse,  pure  chloroform,  in  drachm  doses,  was 
four  times  administered,  at  intervals  often  minutes,  with 
the  most  decidedly  beneficial  resu.t^  The  cramps,  vomit- 
in-r,  and  purging  were  arrested,  after  which  the  remedy 
was  repeated  in  half-drachm  doses  every  thirty  minutes, 
for  two  hours,  when  reaction  was  fully  established. 
But  still  more  encouraging  has  been  my  experience  of 
the  advantages  to  be  derived  from  its  exliibition  in  full 
dos^s,  at  tbe  inception  of  di8e;i8e;  and  especially  does 
this  refer  to  the  treatment  ot  delirium  tremens.    * 

It  is  imperative  that  chloroform  about  to  be  ingested 
should  be  chemically  pure ;  as  the  employment  of  a 
specimen  which  has  been  atlulterated  with  ether  or 
alcohol,  or  one  in  which  decomposition  has  taken  place, 
or  in  which  the  heavy  volatile  oils  are  present,  will 
either  yield  negative  results  or  may  be  positively  inju- 
rious. In  order  to  avoid  this  danger,  whenever  a 
doubt  exists,  the  specimen  should  certainly  be  subjected 
to  the  various  tests. 

Care  should  always  be  taken  when  about  to  adminis- 
ter chloroform  by  the  stomach,  especially  to  persons  of 
a  delicate  organization,  that  it  be  suspended  or  enve- 
loped in  some  vehicle  which  will  disguise  the  pungent 
sweetnes-'  of  its  taste,  as  from  it  alone  nausea,  vomiting, 
or  an  intense  antipathy  may  arise.  To  others  less  sensi- 
tive a  small  quantity  of  iced  water  will  be  sufficient ;  for 
the  stimulation  of  the  mouth  and  fauces,  as  the  remedy 
passes,  is  but  momentary,  not  more  unpleasant  or  pow- 
erful tnan  the  same  amount  of  pure  alcohol  would  be  to 
an  uneducated  surface ;  and  when  it  i  caches  the  coats 
of  the  stomach,  the  sen.<aiion,  bein;^  that  produced  by 
a  d  ffusible  stimulant,  is,  in  the  miijnrlty  of  instances,  a 
pleasing  one.  That  pure  chlorofoim  canuot  long  remain 
inert,  wht  n  taken  into  the  stoma(;h,  will  readily  be  con- 
ceived from  its  physical  properties.  Impelled  by  its 
specific  gravity  it  must  pjiss  quickly  from  the  stomach 
into  the  intestinal  canal,  and  through  its  peculiar  vola- 
tility is  soon  converted  into  vapor.  The^e  characteris- 
tics render  its  absorption  not  only  more  i>rompt  than 
those  of  the  majority  of  other  remedies,  but  more 
certain,  even  when  the  vit  >1  powers  are  all  but  ex- 
hausted. The  rapid  penetration  of  tlje  densest  tissues 
by  chloroform  vapor,  and  its  power  as  an  antiseptic, 
have  been  established  by  the  experiments  of  Augend 
and  Eobin. 

The  effect  produced  by  chloroform  upon  the  nervous 
system  can  at  best  be  ill  defined.  That  it  acts  peculi- 
arly for  the  relief  of  disordeied  nerve  ganglia ;  that  it 
diminishes  congestion  in  its  varied  forms  ;  and  that  it 
differs  materially  in  its  operation  through  the  stomach, 
from  its  ac  ion  when  employed  as^n  anaesthetic  tbiough 
the  lunps,  is  evident,  from  the  results  obtained. 

Admini>tered  to  the  digestive  orj^ans  it  acts  as  a 
diffusible,  stimulathig  hypmc,  possessed  of  diuretic  and 
diaphoretic  properties,  and  when  tiiken  in  unusual 
•doses,  as  an  inebriant  and  irritant  Its  therapeutic 
action  is  peculiarly  that  of  a  neurotic,  and  influenced 
by  the  extent  to  which  it  is  admiiii.^tcred,  may  be  ena- 
ployed  to  njuse  the  nervous  feystem  when  depressed, 
and  to  tranquillize  it  when  over-excited ;  or  in  other 
xwords,  its  contact  with  the  nerve  centres  is  sufficient 
to  res'oe  to  them  the  power  of  recoverini?  their  equi- 
librium, and  of  reestablishing  then*  normal  influence 
over  dependent  structures.     This  is  shown  iu  deUrium 


tremens,  the  delirium  of  fever,  insomnia,  and  diseases 
of  that  dass,  by  the  natural,  not  comatose  or  ansestbetic  . 
sleep,  which  will  continue  for  hours  after  the  quantity 
introdueed  through  the  stomach  into  the  system  has 
been  eliminated.  Its  power  is  further  shown  in  tbe 
cold  stage  of  intermittent  fever,  and  in  the  various 
rigors  in  which  the  nervous  depression,  with  its  dis- 
tressing symptoms,  is  relieved,  and  reaction  estabhshed. 
Also  in  epilepsy,  mfantile  and  puerperal  convulsions, 
painful  spasmodic  affections,  and  Kindred  disorders ;  it  is 
manifested  by  the  rapidity  with  which  the  brain  recov- 
ering from  its  temporary  irritation,  the  convulsive  or 
spasmodic  movements  are  arrested.  But  still  more 
striking  is  the  power  exerted  over  congest  ion,  by  restor- 
ing the  tonicity  of  the  blood-vessels,  and  thus  reUeving 
the  local  hyperaemia. 

Such  exhibition  of  chloroform  does  not,  Id  tbe  vast 
majority  of  instances,  derange  or  impair  the  digestive 
power ;  but  reversely,  its  effect,  again, by  ganglionic  influ- 
ence, is  that  of  a  *•  food  tonic,"  and  in  certain  impaired  or 
depraved  conditions  of  the  system,  even  in  those  whose 
chief  characteristic  is  extreme  irritability  of  the  sto- 
mach. Alter  its  exhibition  large  quantities  of  concen- 
trated nourishment  are  eagerly  received.  This  craving 
for  food,  or  ability  to  receive,  retain,  and  digest  unusual 
amounts  of  nourishment,  is,  in  sucn  cases,  due  to  the 
cliloroformic  awakening  of  the  great  life  centres  to  the 
requirements  of  the  system,  and  should  not  be  counter- 
acted by  other  means  than  the  natural  stimulus  of  the 
body— food. 

Perhaps  one  of  the  most  interesting  exhibitions  ot 
the  power  of  chloroform  is  the  rapidity  with  which, 
acting  as  a  diuretic,  it  removes  bile  from  the  blood 
and  skin.  In  a  case  of  jaundice,  in  which  the  entire 
surface  of  the  bodv  was  tinged,  1  gave  chloroform  in 
3  V.  doses  every  three  hours.  The  diuresis  was  exces- 
sive on  the  second  day ;  the  skin  and  conjunctiva  were 
nearly  clean,  and  by  the  termination  o^  the  third,  the 
elimination  was  complete.  The  affinity  which  exists 
between  chloroform  and  bile  has  led  the  former  to  be 
suggested  as  a  test  of  the  presence  of  the  latter. 

The  experience  of  such  cases  indicates  that  the  elimi- 
nation of  ingested  chloroform  occurs  mainly  by  the  kid- 
neys, and  that  the  medium  of  the  lungs  and  skin  is  but 
little  employed.  This  theory  is  resolving  itself  into  a 
fact,  despite  the  contrary  assertions  of  tJieoreUocU  eacpcri' 
Tnenitrs. 

Fully  satisfied  that  observation  will  convince  the 
most  sceptical  that  chloroform  may  be  internally  em- 
ployed, not  only  without  en  iangering  lite,  but  with 
advantage  as  a  remedial  agent,  I  have  ventured  to 
submit  to  the  profession  the  foregoing  remarks  upon  its 
internal  administration,  in  a  few  of  3ie  many  forms  of 
human  suffering  which  it  is  most  probably  destined  to 
relieve. 


Early  Mknstkuation. — W.  A.  Simmons,  M.l>.,  in  tbe 
Cincinnati  Joumul  of  Medicine^  relates  the  following 
case :  M.  F.  P.,  aged  eight  years,  of  short  stature,  lair 
skin,  of  nervous -sanguine  temperament,  commenced  to 
menstruate  at  the  age  of  seven  years  and  seventeen 
days,  and  has  had  a  catamenial  discharge  regularly  every 
lunar  month  since  that  period— one  year.  The  mental 
and  physical  signs  usual  at  such  times  in  menstruating 
women,  are  well  marked.  She  is  rather  larger  than 
girls  of  her  age,  and  usually  healthy.  The  munmse  are 
developed  but  slightly  more  than  ordinarily,  and  no 
other  signs  of  puberty.  They  are  people  in  ordinary 
circumstances,  and  have  not  been  surfeited  with  the 
good  things  oi  this  world,  exceptuig  plenty  of  outdoor 
exercise.  /^-^  t 

Digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


221 


REMAEKS  ON  THE  TREATMENT  OF  FRAG- 
TURES  OF  THE  PATELLA. 

vm  ▲  DMOBimoH  or  tbm  lati  dx.  thomas  nrKNis'i  appabatus. 
By  FRANCIS  T.  WHITE,  M.D., 

OF  >itr  TOUC 

{Continued  frompagt  200.) 

I  HAVE  consulted  the  last  edition  of  Prof.  P.  H.  Hamil- 
too's  able  work,*  and  find  nothing  regarding  appliances  for 
treating  fractured  patella^^  but  that  is  already  mentioned. 
He  had  seen  bony  union  in  two  cases.  He  employs  the 
same  dressing  as  in  the  edition  I  have,  viz.  a  single  in- 
dined  plane,  well  padded,  e^'pecially  under  the  knee ; 
bandages  the  leg  and  thigh,  in  part,  flexes  the  body  on 
the  tlugh  to  relax  quadriceps  femoris ;  applies  a  com- 
press longitudinally  of  muslin,  one-quarter  of  an  inch 
thick,  breadth  of  knee,  extend  ng  from  four  inches  above 
the  (»tella  over  on  the  tibia ;  an  assistant  approximates 
fragments,  the  surgeon  secures  them  with  adhesive  plas- 
ter, two  or  two  and  a  half  inches  wide,  the  length  suffi- 
cient to  pass  obliquely  on  the  splint,  through  the  notches, 
commencing  upon  the  compress  partly  above  and  upon 
the  upper  fragment,  strapping  the  knee  entirely  ("  im- 
bricating **).  The  whole  extremity  is  to  be  bandaged 
L'gfatly  for  support  His  plane  is  ingeniously  fabricated ; 
the  foot  piece  is  arranged  by  a  hook  contrivance.  The 
inclination  may  be  varied  from  six  to  eightepn  inches ; 
the  plane  is  six  inches  wider  than  the  limb  at  the  knee, 
•nd  is  notched  on  both  sides,  four  inches  below  the 
.  knee,  the  object  being  not  to  ligate  the  knee.  The  best 
result  he  g^ves  is  a  quarter  of  an  inch  intersubstance. 

I  quote  from  his  last  edition :  "  Malgai^rne's  hooks  or 
damps  I  regard  as  liable  to  more  serious  objections, 
and  notwithstanding  considerable  testimony  in  their 
&yor,  I  should  be  reluctant  to  recommend  them.'* 

I  select  the  following  cases  from  the  London  Lancet^ 
1852,  vol.  i.,  p.  233 :  An  interesting  one  in  Middles'^x 
Hospital,  under  care  of  Mr.  Shaw.  The  patient,  twelve 
years  previously,  was  treated  in  the  hospital  for 
fractured  left  patella,  resulting  in  half  an  inch  intersub- 
stance. A  year  subsequently  he  refractured  it,  sub- 
mitted to  no  treatment,  and  in  a  few  weeks  walked. 
Mr.  8.  had  an  apparatus  (not  described)  to  protect  the 
joint,  which  was  greatly  exposed,  from  mjury,  viz., 
separation  of  the  fragments  six  inches,  extensor  muscle 
atrophied.  The  same  article  states  that  Mr.  Adams,  at 
the  London  Hospital,  treated  two  cases  by  position, 
learing  nature  to  herself.  One,  a  male,  was  treated 
lets  than  a  month;  the  other,  a  female,  was  treated 
a  tittle  more  than  a  month.  The  results,  firm  as  usual, 
separation  ,a  quarter  of  an  inch.  Mr.  Harvey  exhibited 
in  1858  to  London  Pathological  Society,  an  ununited 
fracture  of  the  patella.  The  patient  rheutnatic  and 
gouty.  Death  resulted  from  his  condition  affecting  his 
car.  The  treatment  of  patella  produced  rheumatism  of 
his  limb.  The  Society  considered  that  this  case  proved 
that  a  rheumatic,  gouty  condition  opposed  union. 
Mr.  Gamgee  in  the  same  journal,  pai^e  366,  says: 
"  The  treatment  of  fracture  of  the  patella  'was  often 
regarded  as  very  simple,  but  there  were  more  cases 
of  cripples  from  fractures  of  this  than  from  any  other 
bone.  The  disputed  point  of  bony  union  is  re- 
ferred to.  Two  cases  are  also  related,  treated  by  Mr. 
Cooke,  Boyal  Free  Hospital:  One,  oblique  fracture 
of  the  patella,  dressed  a  few  hours  after  injury,  the 
fragments  widely  separated  by  a  figure  of  eiglit, 
•tarched  bandage;  result  appeared  osseous,  favored  by 


*  HamlUoD  on  Frmotuei  and  DMoottioos,  Id.  ISSO,  pw  488. 


the  speedy  dressing.  The  other  case  a  transverse  frac- 
ture, dres^ngs  the  same,  time  not  no^ed,  the  result 
ligamentous.     Neither  was  confined  to  b^d. 

Mr.  Partridge,  in  1861,  exhibited  to  the  Pathological 
Society  of  Lnnilon  a  paUlla  fractured  by  direct  violence ; 
bony  union  resulting.  Autopsy  made  oneyea^  after  the 
fracture.  He  remarked  the  scarcity  of  specimens  ot 
o8S?ous  union  found  in  the  museiums  of  Londo  ?,  there 
being  but  two  or  three.  Mr.  Brooke  mentioned  cases 
of  bony  union,  after  violence,  resulting  from  wearing 
an  unyielding  splint  several  months,  in  the  popliteal 
'^pace,  after  leaving  the  ht^spital. 

A  case  of  transverse  fracture,  of  a  pregnant  woman, 
coaptated  and  held  in  position  twenty-four  hours  after- 
ward^*,  by  a  posterior  splint  from  the  middle  of  the  thigh 
to  the  calf,  in  which  were  hooks  for  extension  and 
counter-extension,  is  reported  in  Lancet  for  1861,  p.  484. 
In  six  weeks  it  appeared  perfectly  unite  d.  A  posterior 
jnitta-percha  splint  was  fixed,  to  favor  consolidation 
and  prevent  too  extended  movement.  The  seventh 
week  she  had  typhoid  fe^ver,  pneumonia  following,  and  a 
miscarriage  on  eighth  day  of  fi^ver.  Died  on  the  ninth 
day.  During  delirium  was  uncontrollable;  flexed  her 
knee;  twenty-eight  hours  before  death  the  fracture 
gaped  fully  an  inch.  Necropsy  revealed  suppuration 
of  the  new  tissue  of  the  patella. 

Mr.  Wilkinson  King*  described  a  patella  broken 
transversely,  with  osseous  union. 

Dr.  T.  S.  Kirkbridt'jt  late  resident  physician  of  Penn- 
sylvania Hospital,  reports  six  cases  of  fractured  pat^lla^ 
during  two  years  he  was  there.  In  the  first  and  third 
cases,  females,  the  result  was  rather  more  than  a  quarter 
of  an  inch  shortening.  She  returned  with  fracture  of  the 
other  patella  in  about  six  month**.  The  result  one-eighth 
of  an  inch,  the  upper  fra.rment  a  little  depressed.  Second 
case,  the  union  perfect,  no  separation  appreciable. 
Fourth  case,  no  separation  except  the  small  fragment 
a  httle  depressed.  The  fifth  a  difficult  case ;  had  Toania 
apotu;  the  result  less  than  a  quarter  of  an  inch;  he 
would  not  submit  to  advice ;  accidentally  refractured 
it;  separation  between  two  and  three  inches,  intersub- 
stance. He  returned  to  the  hospital  for  treatment. 
Sixth  case,  a  compound  fracture,  was  under  treatment. 
No  particular  treatment  n'»ticed. 

Reports  of  surgical  pradiccl — Six  cases  of  fractured 
patella,  including  two  refractures;  of  the  latter,  one 
appears  to  have  been  osseous.  The  patient  declared 
there  was  no  line  of  fracture.  On  examination,  the 
dresser,  Mr.  Pern,  heard  crepitus.  The  m«>de  of  treat- 
ment of  ordinary  fracture  of  the  patella,  at  St.  Thomas's, 
is  as  follows :  After  the  subsi'len<re  of  any  ex  sting  syno- 
vitis, adapt  leather  or  gutta-percha  cap  splint,  cut  out, 
to  receive  the  fiagments,  coaptated  by  horse-shoe 
shaped  strap.  A  Liston  splint  applied,  limb  raised  at 
the  foot.  "In  some  casi'S  only  the  long  pieces  of  strap- 
ping running  from  each  side  of  the  skin  to  above  the 
upper  fragment,  and  a  shorter  piece  pulling  upwards 
the  lower,  are  made  use  of  M.  Malgaigne's  hooks  do 
not  find  favor  at  St.  Thomas's." 

Ring  ap/)i«iwce.§— Dr.  W.  A  Gibson  (St.  Louis  Med. 
and  Surg.  Jour.,  Oct.,  1866)  reports  a  ca-^e  of  transverse 
fracJure  of  the  patella.  He  measured  sound  patella,  for 
the  pattern  of  a  ring,  allowing  for  padding  with  cotton, 
which  was  cit  in  strips,  and  held  by  a  bandage  around 
the  ring.  He  sewed  strips  of  muslin  to  each  side, 
placed  a  well  padded  poi*tsrior  splint,  twenty-four 
inches  long,  secured  by  a  bandage,  at  the  lower  and 
upper  ends,  lightly  applied;   approximated  the  frag- 

•  Briti(«h  and  Foreign  M«»dlcal  Rerlew,  voL  xir.,  p  188w 
t  Amer.  Jour,  of  the  Medical  Si'ienoes.  toI.  xvI.,  p.  880i 
i  Med.  Times  and  Oaz««tte.  London,  Feb.  1S»  1867. 
$  Atner.  Joar.  of  the  Med.  Sciences  vol  UlL,  pp.  881  and  668. 


U141068.      T. 

_>ogle 


222 


THE  MEDICAL  RECORD. 


ments,  applied  the  ring  over,  tied  the  strips  over  the 
splint,  securing  the  ring  in  its  place,  and  keeping  the 
fragments  in  apposition,  giving  the  best  chance  for 
osseous  union ;  removed  3ie  dressing  in  thirty  days ; 
made  passive  motion;  found  bony  union  complete. 
June  15th,  had  very  good  use  of  the  limb.  He  Bays: 
"  The  appliance  did  not  give  the  patient  the  least  pain, 
and  there  was  no  interruption  of  the  circulation  by  the 
bandages.  It  was  impossible  in  this  case  for  the  pa- 
tella to  escape  firom  the  ring,  but  possibly  in  some 
cases,  as  of  women  where  there  is  a  good  deal  of  adi- 
pose tissue,  and  but  little  prominence  of  the  patella,  it 
may  not  be  so  easy  to  apply  the  ring ;  but  I  am  per- 
suaded that  it  will  give  entire  satisfaction  in  all  cases. 
I  claim,  by  the  application  of  the  ring,  to  have,  reduced 
one  of  the  ugliest  fractures  of  the  human  frame  to  one 
of  the  simplest  for  treatment." 

Prof.  Paul  F.  Eve,  Nashville  (NiKhvUle  Jour,  Med. 
and  Surg.,  Feb.,  1867).  records  two  cases  successfully 
treated  by  the  above  plan. 

I  discovered  in  my  researches  that  the  literature  of 
our  profession  was  very  barren  of  subsequent  conditions 
of  .^actured  patella,  sav  a  year  or  more,  after  treatment, 
both  as  appUcable  to  the  hving  and  dead. 

Prom  tne  preceding  investigation  and  the  observations 
already  made,  I  think  myselt  not  presumptuous  in  con- 
cluding, that  it  is  within  our  power  to  have  osseous  union 
in  ordinary  fractures  of  the  patella,  if  the  fragments  can 
be  closely  coaptated,  even  if  the  aponeurosis  is  ruptur- 
ed. As  near  a  result  should  be  attained  by  art  as  possi- 
ble, to  the  preceding  natural  condition,  the  work  of 
the  great  Architect. 

I  believe  the  invention  of  the  late  Dr.  Thomas  Tur- 
ner, Resident  Physician  to  Kings  Co.  Hospital,  L.  I., 
New  York,  is  the  appliance  to  accomplish  the  above. 


The  cut  represents  its  mechanism.  The  apparatus, 
manufactured  by  Tiemann  &  Co.,  New  York,  consists  of 
thigh  and  leg-pieces  of  sheet-iron,  with  two  buckled 
straps  attached  to  each,  united  by  two  lateral  bars  and 
one  posterior  bar  of  steel.  To  the  posterior  bar  are  two 
troughs  (part  of  a  circle),  on  a  double  reversed  screw,  and 
by  turning  the  key  in  opposite  directions  the  troughs  sep- 
arate or  approach  each  other.  The  apparatus  being  japan  - 
ned,  is  always  ready  for  new  cases  when  cleaned.  The 
apparatus  should  be  applied  in  simple  fractures  as  soon 


as  possible ;  but  if,  in  the  opinion  of  the  surgeon,  it 
would  aggravate  existing  inflammation,  thereby  jeopar- 
dizing the  joint,  it  could  be  applied  as  a  posterior  splint, 
without  using  the  coapting  appliances,  until  antiphlo- 
gistic measures  make  it  safe.  Tne  apparatus,  to  be  ap- 
plied properly,  should  be  well  padded  with  flannel  or 
other  material,  for  protecting  thigh  and  leg  from  the 
splint  and  straps,  quadriceps  femoris  should  be  relaxed, 
the  limb  held  by  the  thigh  portion,  and  buckled ;  also 
buckle  the  leg  portion.  Use  an  anaesthetic  if  necessary. 
First  fix  the  lower  fragment,  by  drawing  it  up,  smooth- 
ing the  integuments  down ;  this  being  held  by  an  assis- 
tant^ the  surgeon  applies  a  strip  of  adhesive  plaster,  of 
sufficient  width  to  hold  the-  fragment^  and  overlaps  it 
sufficiently  to  prevent  any  tilling  up,  passes  the  free  ends 
of  the  adhesive  plaster  around  the  upper  trough,  crosses 
them  and  applies  them  to  the  skin.  The  upper  fragment 
being  coaptated,  the  integuments  being  smoothed  up,  a 
similar  piece  of  plaster  is  applied  around  the  lower  trough 
as  atound  the  lower  fragment  Interpose  something 
where  the  plasters  cross  each  other,  to  prevent  their 
sticking  together. 

For  firmness  use  double  strips  of  plaster.  Snip  the 
upper  edge  of  the  upper  plaster ;  thus  a  rounded  edge 
instead  of  a  cutting  edge  will  be  presented  to  the  integu- 
ments, avoiding  in  a  degree  excoriation. 

The  next  case  of  simple  transverse  fracture  of  the 
patella  I  shall  have  to  treat,  I  shall  use  a  part  adhesive 
plaster  and  rubber  coapting  appliance,  viz.  taking 
measurement  and  having  rubber  tubing  of  sufficient 
length,  say  half  the  distance,  with  rings  affixed  to  ex- 
tremities, and  the  other  half  adhesive  plaster.  The 
adhesive  plaster  having  been  passed  through  one  ring 
on  one  side  and  fixed,  Uie  strap  being  applied  to  patella 
as  previously  stated,  is  passed  with  the  tubing  around 
the  trough,  the  free  end  of  the  plaster  being  passed 
through  me  other  ring  and  made  adherent,  marking  the 
plaster  to  note  any  slipping.  If  there  should  be  a  V- 
tilting,  a  compress  can  be  applied  over  the  patella.  If 
position  is  necessary,  a  pillow  can  be  placed  under  the 
leg.  Place  a  pad  in  popliteal  space  if  necessary.  As 
the  dressing  may  loosen,  move  the  screw,  and  thereby 
separate  the  troughs,  which  will  tighten  the  dressings. 
Apply  new  dressing  when  necessary.  If  there  is  much 
inflammation,  apply  bags  of  ice  (of  bladder  or  oil  silk) 
intermit tingly  every  fifteen  minutes  over  the  dressings 
and  joints,  thereby  keeping  the  dressings  dry.  The 
apparatus  should  remain  applied  thirty  or  forty  days ; 
slight  passive  motion  should  be  commenced  on  third  or 
fourth  week,  the  patella  being  held,  although  I  deem 
it  hardly  necessary,  as  I  noticed  in  the  treatment  of 
my  case,  that  after  the  apphcation  of  the  apparatus, 
slight  movement  could  be  made  without  strain  upon 
the  patella.  When  new  dressings  are  applied,  the  patella 
being  held,  cautious  passive  motion  may  be  made  until 
the  apparatus  is  permanently  removed. 

After  the  apparatus  is  removed,  the  patient,  to  favor 
consolidation,  should  wear  somethiug  to  prevent  too 
much  use  of  the  patella — say  for  four  or  six  months, 
viz.  elastic  knee-cap,  with  a  ring  arrangement  over  pa- 
tella, or  posteriorly  a  piece  of  gutta-percha  or  leather 
strapped  above  or  below  the  joint,  either  of  which  being 
softened  by  warm  water,  can  be  applied,  and  allow  of 
a  certain  flexion.  Passive  motion  can  be  occasionally 
made,  but  not  extreme  under  six  months. 

The  advantages  of  the  apparatus  are:  the  ease  of  its 
application ;  efficiency  indicated  by  the  combining  of  a 
posterior  splint  with  coapting  means.  The  knee-joint 
is  exposed  to  the  view  of  the  surgeon  and  patient, 
thereby  saving  anxietv.  Without  further  expatiating, 
I  would  state  I  would  not  dare  to  use  any  other  apph* 
ance  that  I  am  acquainted  with;  and  I  think  I  am 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


223 


sustained  in  this  assertion  bj  the  letters  I  have  the 
honor  to  p083e«»  of  distinguished  gentlemen  of  our 
profession,  and  the  result  of  my  own  case.  It  may  not 
oe  inappropriate  to  state  that  I  had  an  interview  with 
Dr.  Turner  in  the  sunmier  of  1860.  I  congratulated 
him  on  his  bene&ction  to  our  profession  and  humanity. 
I  remarked  the  trouble  and  time  I  expended  in  the 
treatment  of  fractured  patella,  when  house-surgeon  in 
Belletue  Hospital  in  1856-1857,  by  the  single  incHned 
plane  and  coapting  compresses,  bandaging  the  whole, 
etc. ;  whereas,  if  I  had  had  his  appliance,  I  could  have 
saved  time,  and  had  the  best  of  results. 

Dr.  T.  informed  me  that  his  intention  was,  after 
danger  to  the  joint  was  over,  to  allow  the  patient  to  be 
np  and  attend  to  business  with  the  apparatus  on,  thus 
allowing  nature  to  repair  the  injury.  He  showed  me 
the  original  apparatus  which  he  fabricated  for  a  poor 
fellow,  with  fractures  of  both  patellae,  of  whom  he  made  a 
nurse,  and  who  was  able  in  a  short  time  to  walk  about, 
resulting  in  coaptation.  I  suggested  to  the  doctor  the 
propriety  of  introducing  his  apparatus  to  the  profe=5sion 
unmediately.  He  thought  it  prudent  not  to,  until  by 
experience  he  could  improve  it. 

1  asked  his  permission  to  allow  me  to  do  so.  He 
acquiesced,  promising  to  write  a  paper  subsequently. 
On  consulting  a  valued  friend  in  onr  profession,  I  was 
advised  not  to  do  so  until  I  could  present  at  least  six 
cases  in  which  it  had  been  used.  For  this  and  for  other 
reasons  unnecessary  to  mention,  it  has  been  delayed 
until  the  present 

During  the  last  few  years  the  merits  of  Dr.  Turner's 
apparatus  have  been  thoroughly  tested  by  not  a  few 
eminent  surgeons  of  New  York  and  vicinity,  all  of  whom 
tpeak  of  it  in  the  highest  terms  of  commendation. 
Amonff  these  gentlemen  I  may  mention  Drs.  J.  M. 
Camochan,  W.  Detmold,  J.  C.  Hutchison,  G.  Cochran, 
R.  C.  Styles,  and  K  C.  Mundy. 

In  conclusion  I  beg  leave  to  detail  the  following  in- 
teresting ca?e  oocurrmg  in  my  practice,  in  which  the 
i^oaratus  was  satisfactorily  used. 

Mrs.  R.,  Houston  street,  healthy,  fleshy,  aged  41, 
received  a  transverse  fracture  of  her  left  patella,  about 
its  middle,  July  11,  1860,  by  muscular  action,  in  going 
np  her  stoop,  her  left  foot  having  slipped  on  the  first 
8l€j).    She  fell  in  a  sitting  posture. 

I  placed  the  whole  extremity  in  position  on  a  well 
padded,  inclined  plane,  and  applied  lotions.  On  my 
evening  visit,  the  patient  complaining  of  an  unendura- 
We  burning  sensation  about  her  foof^  I  removed  the 
dressings, leaving  nature  untrammelled  in  position. 

I  applied  Dr.  Turner's  apparatus  the  14th  instant, 
continuing  the  lotions.  On  the  16th,  dressings  being 
loose,  I  reapplied  them.  Stopped  the  lotions.  I  dressed 
the  fracture  subsequently  as  was  indicated.  I  used 
doable  straps  of  adhesive  plaster  about  two  inches  wide, 
wd  of  sufficient  length  to  cross  each  other  on  the 
troughs,  and  brought  up  the  sides,  marking  the  ends,  to 
note  slipping.  The  upper  strap  produced  a  little  exco- 
riation, which  was  reheved  at  the  suggestion  of  my 
patient,  by  snipping  the  edge  of  the  plaster,  which,  on 
application,  presented  a  rounded  surface;  even  after- 
wards I  was  somewhat  troubled ;  but,  by  varying  the 
pirereure,  underlay  ing  with  a  small  piece  of  iint,it  did  well. 
Placed  a  pad  in  the  pop'iteal  space,  for  support  I  tried 
straps  of  adhesive  flannel,  they  slipped,  and  crescentic 
pads  of  cork  covered  with  shammy ;  they  produced  pain. 
I  used  the  screw  as  indicated.  On  September  8th,  per- 
mitted mj^patient  to  walk  about  her  room,  with  appa- 
ratus on;  the  action  produced  inflammation  of  the  integu- 
ments, where  the  straps  were  applied.  September  21st, 
removed  the  i^paratus,  after  a  treatment  of  sixty-nine 
days.    My  object  was  to  obtain  bony  union.    I  cau- 


tiously made  passive  motion  first  about  the  third  week ; 
afterwards,  when  I  applied  new  dressings,  I  noticed  the 
apparatus  would  allow  some  movement  of  the  joint,  not 
enough,  though,  to  put  strain  on  the  ligament.  Aft^er 
the  removal  of  the  apparatus,  I  increased  my  passive 
motion.  Had  the  patient  occasionally  sit  on  a  table,  and 
swing  the  leg.  I  did  not  apply  any  protection  to  the 
patella,  either  knee-cap  or  splint,  in  popliteal  space, 
which  I  now  regret,  as  nature  might  in  six  months  have 
consolidated  the  union.  November  28th,  I  made  my  last 
professional  visit  At  that  time  the  patella  appeared 
united  by  bone,  as  I  thought  The  functions  of  the 
joint  were  restored.  My  case  tested  the  apparatus, 
there  being  a  large  thigh  and  leg  and  small  patella,  about 
half  an  inch  of  integument  fiitscia,  etc.,  over  the  patella 
(judging  from  other  patellse),  with  the  swelling,  making 
a  thickness  of  over  an  inch,  through  which  I  had  to  co- 
aptate  the  fragments.  I  believe  I  could  not  have 
treated  her  with  any  other  apparatus  with  a  shadow  of 
success. 

I  made  an  examination  of  the  patella,  April  22nd, 
1867.  Found  an  intersubstance  of  about  half  an  inch. 
Integuments  over  patella  movable,  but  thicker  than 
over  opposite  pafella.  She  has  perfect  use  of  her  limb, 
with  the  exception  of  going  down  stairs ;  notices  a  feel- 
ing of  lack  of  support 

80  Ffarst  street. 

CASE  OF 

ENTIRE  ABSENCE  OP  ANUS    WITH  RECTO- 
VAGINAL FISTULA 

SnCOESSFULLT  TREATED  BY 

HOWARD  PINKNEY,  M.D., 

SUBOKOSr  TO  OUT-DOOa  DIPAimiBIlT  BBLLKTCI  HOSPITAL. 

CoRiNNA  P — J  aged  8  months,  was  first  seen  by  me  21  st 
November,  1866.  The  infant  was  exceedingly  small,  very 
thin,  and  had  a  sallow  unhealthy  appearance  of  the  skin, 
and  very  fretful.  Mother  states  that  the  child  has  never 
had  a  free  discharge  from  its  bowels,  and  that  at  the 
present  time  it  is  only  after  severe  straining  eflfbrts  in 
which  the  little  sufferer  turns  almost  black  in  the  face, 
that  a  small  thread-like  portion  of  &scal  matter  is  forced 
through  the  vagina.  She  also  says  that  since  the  birth 
of  the  child  she  has  never  been  able  to  keep  its  extrem- 
ities warm. 

On  examination  I  found  an  entire  absence  of  any- 
thing that  resembled  an  anus.  The  skin  between  the 
ischiatic  tuberosities,  vagina,  and  coccyx,  was  distended 
and  smooth,  with  tne  exception  of  a  raised  ridge  or 
raph€,  extending  from  the  posterior  fourchette  to  the 
coccyx.  On  examining  the  vagina  I  found  a  small  open- 
ing (sufficient  only  to  admit  a  large-sized  probe)  on  the 
posterior  wall  of  the  vagina,  and  about  a  quarter  of  an 
inch  from  its  orifice,  communicating  with  the  rectum, 
and  through  which  fecal  matter  was  forced  during  the 
straining  efforts.  Examining  the  abdomen,  I  found  it 
very  much  swollen  and  distended. 

As  the  child  was  rapidly  &iling,  and  as  the  mother 
and  friends  had  given  up  all  hopes  of  its  recovery,  I  ad- 
vised an  immediate  operation  as  the  only  means  of  re- 
lieving the  little  patient.  The  mother  consented  after 
a  few  days,  and  on.  November  28,  assisted  by  Dr.  R. 
F.  Weir,  I  operated  as  follows :  The  child  being  placed 
on  the  lap  of  an  assistant,  was  brought  under  the  influ- 
ence of  chloroform  by  Dr.  Weir,  and  being  then  placed 
in  the  position  for  lithotomy,  a  probe  was  introduced 
through  the  opening  and  directed  towards  the  perineum. 
I  then  made  an  incision  from  a  point  a  few  lines  pos- 
terior to  the  fourchette  to  near  the  point  of  the  coccyx  in 


Digitized  by 


Google 


224 


THE   MEDICAL  RECORD. 


the  median  line,  and  carefully  dissected  inwards  in  this 
line  until  I  came  to  the  rectum,  which  was  readily  dis- 
tinguished, as  it  was  greatly  distended  by  impacited 
faecal  matter.  The  incision  posteriorly  extended  a  little 
more  than  an  inch  in  depth ;  anteriorly  4  or  5  Imed. 
The  probe  that  was  passed  through  the  opening  was 
forced  down,  and  could  be  readily  felt  at  the  bottom  of 
the  sac.  Opening  the  gut  upon  the  point  of  the  probe, 
I  introduced  a  director  bent  nearly  at  right  angles,  and 
then  by  means  of  a  probe-ptduted  bistoury  enlarged 
the  opening  to  the  size  of  ihe  external  wound.  As 
soon  as  the  gut  was  exposed  straining  efforts  com- 
menced, which  continued  after  it  was  opened ;  but  no 
fsecal  matter  came  away,  althou<zh  it  could  be  readily 
seen  impacted  there  in  large  quantity.  By  means  of  the 
handle  of  a  spoon  and  of  a  scalpel,  I  was  enabled  to  dig 
out  a  large  quantity  of  hardened  feces,  when  a  lar^e 
quantity  of  consistent  fssces  ome  away,  taking  the 
form  of  the  external  opening  and  being  at  least  an  inch 
in  diameter.  After  carefully  watching  out  the  bowels 
with  an  injection  of  warm  water,  I  brought  down  the 
edges  of  the  divided  intestine,  and  united  them  to  the 
margin  of  the  external  wound  by  means  of  silver  su- 
tures ;  then  placing  a  pledget  of  oiled  tin  tin  the  opening  to 
keep  the  sm-faces  from  uniting,  the  operation  was  com- 
pleted. 

The  next  day,  on  visiting  my  little  patient,  I  found 
her  looking  much  brighter  than  1  had  ever  seen  herybe- 
fore.  She  had  slept  well,  and  had  had  one  or  two  free 
movements  from  the  bowels.  Examining  the  wound  I 
found  the  sutures  through  the  intestine  torn  out,  and 
the  intestine  retracted  within  the  wound.  I  made  no  at- 
tempt to  draw  it  down,  but  merely  removed  the  sutures, 
and  distended  the  opening  (which  showed  a  tendency  to 
unite)  by  means  of  my  finger  and  the  blades  of  a  dressing 
forceps,  after  which,  I  renewed  the  pledget  of  lint.  This 
treatment  of  dilatation  by  means  of  the  finger  and  for- 
ceps, with  the  occasional  use  of  a  rectal  bougie,  was  con- 
tinued almost  daily  up  to  Dec.  14,  when  the  wound 
was  entirely  healed,  and  was  lined  by  a  smooth  and 
shining  membrane.  This  opening  was  sufficiently  large 
to  admit  a  number  1 1  rectal  bougie.  There  seemed  also 
to  be  a  tolerably  wt  11  fonned  spbinc-er  developed, which 
kept  the  external  openmg  closed,  and  would  grasp  the 
finger  when  introduced.  No  attempt  was  made  to 
clo?e  the  recto- vaginal  opening,  except  by  cauterization 
of  its  edges  with  nitrate  of  silver,  hoping  that  it  might 
possibly  close  of  itself,  or  in  case  it  did  not,  intending  to 
operate  at  some  future  time. 


©riginol  Cectuw«. 


Old  Folks. — The  St.  Louis  Medical  Reporter  speak- 
ing of  "  Old  Ft»lks/'  says :  The  entire  number  of  persons 
who,  according  to  the  census,  have  attained  the  great 
age  of  100  years  and  upward^,  is  probably  larger  than 
most  of  our  rea<.ler3  would  guess.  It  is  just  1,200 ;  of 
these  there  are  white,  440;  bla*i,  683;  mulatioes,  66; 
Indians,  26.  Women  attain  a  high  longevity  in  greater 
numbers  than  men,  and  black  people  than  white.  The 
oldest  persons  are  a  white  woman  in  South  Carolina, 
and  an  Indian  woman  in  California,  aged  140  years. 
The  oldest  blacks,  two  males  and  two  females,  are  130 
years.  In  proportion  to  numbers,  twelve  times  as 
many  blacks  as  whites  exceed  a  hundred  years  of  age. 
By  the  best  calculations  made,  it  is  ascertained  that  me 
average  duration  of  human  life  is  greater  in  the  United 
States  than  in  any  other  nation. 
^  I  ^ 

Milk  in  the  Breast  of  a  Male  Infant. — Mr.  Owens 
reports  a  case  in  a  recent  number  of  the  Lancet,  of  a 
male  child,  9  days  old,  from  each  of  the  breasts  of  whom 
he  obtained  half  a  drachm  of  milk. 


OPERATION  FOR  HARELIP. 

WITH  RBMARKS 

Br  PROF.  FRANK  H.  HAMILTON,  M.D., 

BEFORE  THE  GLASS  OF  '65 — ^"66  OF 

BELLEVUB  HOSPITAL  MEDICAL  COLLEGE. 

(Continued  from  page  154.) 

Gentlemen— In  connection  with  my  account  of  a  sin- 
pie  fiss  ire,-I  ought  to  describe  to  you  a  method  which 
I  have  devised  and  practised  for  the  cure  of  those  simple 
indei  tatlons  of  the  lip  which  are  sometimes  congenital, 
but  much  more  often  the  result  of  a  partial  failure  in 
the  attempt  to  close  a  harelip. 

When,  for  example,  the  fissure  only  extends  up  into 
the  lip  two,  three,  or  four  lines,  I  proceed  as  follows : — 

With  a  narrow,  sharp-pointed,  straight  bistoury,  I 
transfix  the  tip  at  a  point  about  three  lines  above  the 
apex  of  the  fissure,  and  proceed  to  cut  downwards  and 
outwards  until  within  tnree  or  four  lines  of  the  free 
border  of  the  lip.  Carrying  my  knife  back  to  the  point 
at  which  the  incision  commenced,  I  cut  downwards  and 
outwards  aga'n,  parallel  to  the  opposite  margin  of  the 
fissure,  to  within  three  or  four  lines  of  the  free  margin 
of  the  lip.  The  triangular  loop  thus  formed  is  at  once 
forced  downwards,  and  the  raw  and  opposing  edges  of 
the  fissure  brought  snugly  in  contact  by  one  or  two 
sutures. 

If  the  fissure  was  pretty  deep,  the  loop  thrown  down 
will  be  long,  and  will  require  the  support  of  a  single  fine 
suture  to  retain  it  in  place ;  and  even  then  it  will  hang 
down  very  obtrusively ;  but  by  the  gradual  contraction 
of  its  tissue,  and  perhaps  in  part  by  ulceration,  it  will 
eventually  assume  a  very  natural  appearance. 

If,  however,  the  fissure  was  not  deep,  the  loop  will 
take  care  of  itself  and  the  result  will  be  a  perfect  resto- 
ration of  the  line  of  the  lip. 

You  must  not  omit,  gentlemen,  to  apply  the  adhesive 
plasters  in  this  case  any  more  than  in  a  case  of  complete 
fissure ;  nor  to  extend  them  well  down,  so  as  to  com- 
pletely cover  in  the  lower  margin  of  the  upper  lip. 
This  measure  I  regard  as  of  great  importance  in  itB 
bearings  upon  your  complete  success. 

DOUBLE     HARIUP,    OOMPLIOATBD    WITH    FISSURE    OF    THE 
BONES)   ETC. 

It  is  very  s  Idom  that  we  meet  with  double  harelip 
not  associated  with  fissure  of  the  bones.  This  variety 
of  harelip  (with  fissure  of  the  bones)  is  found  to  exist 
in  two  principal  forms : 

First,  That  in  which  the  central  piece  of  alveolus  oc- 
cufiies  its  normal  position.;  that  is  to  say,  is  situated  in 
the  line  of  the  alveolar  arcade,  and  in  which  case  it  is, 
in  general,  pretty  well  covered  in  front  by  integument. 
This  central  piece  of  integument  may  be  either  quadri- 
lateral or  nearly  triangular,  with  its  apex  directed 
downwards. 

My  method  of  operating  in  these  cases  is  the  same  as 
in  single  harelip,  with  only  such  few  points  of  dififerenoe 
as  the  peculiarities  of  the  deformity  will  render  neces- 
sary. 

The  central  piece  is  first  fi-eshened,  or  excised  freely, 
on  its  two  margins  down  to  the  alveoli ;  bi4  not  dis- 
sected up  or  detached  in  any  degree  from  the  alveolL 
This  part  of  the  operation  ought  to  be  made  first,  be- 
cause the  principal  source  of  the  haemorrhage  is  from  the 
second  or  next  step  of  the  operation. 


Digitized  by 


Google 


THE  MEDICAL  RECORD, 


225 


If  the  central  piece  is  very  short,  whatever  its  form 
may  be,  it  must  be  made  iuto  a  triangular  form  by  in- 
ciSiOns,  with  its  apex  directed  downwards. 

The  outer  margins  of  each  fissure  are  next  to  be  dis- 
sected from  the  bone,  and  usually  to  a  point  fidrly  up 
underneath  the  alae.  These  margins  are  then  cut 
straight  and  freely  with  very  strong  scissors. 

A  large  straight  needle,  armed  with  a  strong  silk 
ligature,  is  now  made  to  enter  near  the  outer  margin  of 
tlie  ala,  upon  one  side;  it  is  then  earned  across,  in 
front  of  the  central  piece  of  alveolus,  beneath  the  base 
of  the  integument  covering  this  piece,  and  brought  out 
at  a  corresponding  point  under  the  opposite  ala.  This 
suture  is  then  tied  firmly  over  the  central  piece  of  in- 
teoTiment,  having  previously  protected  the  integument 
by  a  small  roll  cr  patent  lint  With  this  precaution 
there  is  no  danger  of  strangulating  the  central  piece. 

A  second  suture  is  now  passed  near  the  lower  margin 
of  the  fissures  in  the  same  manner,  only  observing  the 
rales  laid  d-wn  when  speaking  of  single  fissures, 
namely,  to  introduce  the  needle  far  from  the  incised 
margin  and  at  the  junction,  or  immediately  above  the 
janction  of  the  vermilion  border  with  the  skin ;  and  to 
brin<»  the  needle  out.  at  a  corresponding  point  on  the 
opposite  side. 

The  second  suture  is  now  closed;  and  in  a  similar 
manner  a  third,  intermediate  between  the  two,  may  be 
introduced  if  it  is  thought  necessary.  The  dressing  is 
completed  by  applying  the  adhesive  straps  as  already 
de:5cribed. 

You  will  be  surprised,  gentlemen,  to  find  how  wide 
a  chasm  you  can  in  this  way  close  up ;  and  if  the  opera- 
tion is  carefully  and  thoroughly  performed,  there  is  but 
little  if  any  more  danger  that  it  will  give  way,  or  refuse 
to  unite,  than  in  a  simple  and  narrow  fissure. 

It  seems  to  me  absurd  to  talk  of  making  this  opera- 
tion at  "two  times,"  as  some  have  done — that  is,  of 
dosing  first  one  yide,  and  when  this  has  healed,  pro- 
ceeding to  close  the  other.  It  can  always  be  done  more 
easily,  and,  as  I  think,  more  perfectly  at  one  operation. 

The  second  form  of  double,  complicated  harelip  is 
that  in  which  the  central  piece  of  alveolus  is  not  on  a 
line  with  the  alveolar  arcade,  but  is  projected  more  or 
less  forward-",  in  some  cases  standing  directly  forwards, 
and  appearing  as  if  it  was  a  prolongation  of  the  nose. 

In  order  to  comprehend  the  surgical  treatment  of 
this  cla-8  of  cases,  it  will  be  necessary  to  say  a  few 
words  in  relation  to  the  anatomy  of  this  central  piece. 

The  alveolar,  or  dental  arcade  of  the  upper  jaw,  is 
formed  from  four  centres  of  ossjification.  The  two 
lateral  portions,  incluiling  the  sockets  of  all  the  teeth 
exc<*pt  the  incisoi-s,  are  formed  each  from  a  single  point 
of  ossification.  The  central  portion,  including  the 
sockets  of  the  four  incisors,  is  formed  also  firom  two 
separate  points,  wliich,  in  the  process  of  growth, 
soeedily  come  in  contact  by  their  opposing  surfaces 
*ong  the  median  line,  but  do  not  actually  blend  with 
each  other;  consequently,  even  in  adult  life,  the  two 
upper  maxillary  bones  can  generally  be  easily  separated 
between  the  central  incisors.  Where  the  two  halves 
of  the  incisive  portion  of  the  dental  arcade  lie  in  con- 
tact, two  thiu  plates  are  finally  projected  upwards,  one 
from  each  margin  to  form  a  junction  with  the  triangular 
Cartilage  and  the  vomer ;  the  whole  of  which  together 
forms  the  septum  nasi.  The  anterior  extremity  of  these 
parallel  plates  is  known  to  anatomists  as  the  anterior 
nasal  spine.  How  complete  is  the  union  which  finally 
takes  place  between  these  thin,  short,  vertical  plates  on 
the  one  hand,  anil  the  vomer  and  cartilage  on  the 
other,  I  cannot  positively  say ;  but  they  are  easily  sepa- 
rated by  maceration.  It  is  my  opinion  that  in  early 
ife  the  union  is  very  incomplete;  aijd  that  at  the  period 


of  two  or  three  years,  that  process  which  unites  the 
vomer  to  the  incisive  portion  is  very  narrow  and  feeble. 
So  that,  in  forcing  the  central  portion  back,  by  pressure 
applied  in  front,  the  septum  would  be  more  likely  to  be 
bent  or  twisted  than  broken. 

Upon  the  anterior  and  lower  margin  of  this  septum 
is  situated  a  bulbous  lookine  expansion ;  which  is  that 
portion  of  the  alveolar  arcade  containing  the  germs  of 
the  four  incisors. 

Several  snrgical  writers  have  spoken  of  this  central 
portion  as  containing  two  teeth,  or  theur  gums.  In  all 
the  specimens  examined  by  us  it  has  contained  four 
teeth,  or  their  rudiments ;  and  of  these  two  have  gen- 
erally been  found  on  the  outer  margins  of  the  central 
piece,  and  not  upon  its  lower  margin ;  so  that,  in  the 
progress  of  their  development,  these  teeth  have  stood 
directly  outwards  laterally — ^while  the  two  remaining 
teeth  were  directly  forwards,  or  forwards  and  down- 
wards. I  do  not  think,  therefore,  that  it  is  in  general 
advisable  to  attempt  to  save  the  central  piece.  The 
teeth  which  it  contains  will  not  grow  harmoniously ; 
and  its  pedicle  or  that  process  which  connects  it  with 
the  septum  nasi,  and  wnich  constitutes  its  only  basis  of 
support,  is  too  feeble  to  make  it  useful.  I  have  in  most 
cases  cut  it  away.  In  this  case  the  operation  must  be 
made  at  three  times,  as  follows. 

Mrsij  the  central  piece  of  integument,  which  I  have 
never  found  of  sufficient  length  to  serve  any  purpose 
in  the  formation  of  the  upper  lip,  must  be  dissected 
up  from  the  alveoli,  and  left  attached  to  the  end  of  the 
nose,  to  be  used  at  a  subsequent  period  in  the  formation 
of  a  columna  nasi.  At  the  same  time,  the  pedicle  which 
supports  the  central  piece  of  bone  is  to  be  divided  with 
a  pair  of  sharp  bone  cutters,  or  with  a  strong  pair  of 
scissors.  In  cuviding  these,  great  care  must  be  used  to 
make  the  section  as  far  forward  as  possible.  If  too  much 
of  septum  is  removed,  the  nose  will  have  an  unpleasant 
cavernous  look.  It  is  better  to  cut  away  too  little  than 
too  much. 

The  bleeding  from  the  artenr  of  the  septum  I  have 
always  found  troublesome.  It  is  generally  impossible  to 
secure  the  artery  with  a  U^ture ;  but  pressure  with  the 
finger  continued  a  few  minutes,  will  often  succeed  in 
arresting  the  bleeding.  If  necessary  we  may  place 
upon  it  a  pledget  of  lint,  and  secure  it  in  place  with  an 
adhesive  strap  laid  across  the  face.  This  completes  the 
first  operation. 

The  second  operation  cannot  be  made  safely  until 
afler  the  lapse  of  one  or  two  months.  This  is  simply 
an  operation  for  the  closure  of  the  fissure,  and  the  several 
steps  of  the  procedure  will  differ  in  no  material  respect 
from  the  operation  already  described  for  simple  harelip. 
It  is  not  well  to  attempt  to  make  the  columna  at  this 
time. 

The  third  operation  is  not  to  be  undertaken  within 
less  than  three  months  after  the  last  operation,  for  the 
reason  that  any  lesion  of  the  new  lip,  along  the  median 
line  where  it  has  but  recently  united,  is  likely  to  result 
in  a  destructive  ulceration ;  and  the  columna  cannot  be 
made  fast  below  to  the  hp  without  causing  such  a 
lesion. 

The  operation  is  as  follows.  The  posterior  surface  of 
the  central  piece  is  freshened,  and  the  two  lateral  sur- 
&ces,  with  the  lower  end,  cut  into  shape,  leaving  it  if 
possible  about  as  wide  as  you  desire  the  columna  to 
be  when  the  wounds  have  healed.  The  anterior  sur- 
face of  the  bony  septum  is  next  freshened  by  scraping 
it  with  the  edge  of  a  knife ;  a  point  at  the  base  of  the 
lip  is  made  raw ;  the  lower  extremity  of  the  central 
piece  is  then  fastened  by  a  delicate  suture  to  the 
upper  lip,  in  such  a  manner  as  the  peculiarities  of  the 
case  and  your  own  ingenuity  will  suggest.    In  order 


Digitized  by 


Google 


226 


THE  MEDICAL  RECORD. 


to  assist  the  uoion  of  the  columna  to  the  septum,  a 
small  pledget  of  lint  covered  with  cerate,  should  be 
laid  aeainst  Hie  front  of  the  columna,  and  secured  in 
place  by  adhesive  plaster  bands.  The  subsequent 
dressings  and  management  of  the  case  roust  be  left  to 
the  ^dgment  of  the  surgeon.  Beyond  these,  no  more 
precise  rules  can  be  given. 

After  the  cure  is  complete  a  good  dentist  may  supply 
the  deficient  teeth  and  alveoli ;  and  he  may  improve 
greatly  the  form  of  the  upper  lip,  giving  it  proper  sup- 
port from  behind.  In  some  cases  it  is  better  that  the 
teeth  should  have  been  fitted  and  worn  some  time 
before  completing  the  formation  of  the  columna. 


Vitpoxts  of  hospitals. 


BELLEVUE  HOSPITAL. 

OASES  OF  ABSCESS  FROM  PNEUMOKIA  OF  LEFT  LUNG. 

Bt  dr.  tiEWlS  A.  SAYRE, 
now,  or  OBTBOPonno  bvbqsbt  at  bsllbtttb  hkdioal  oollcom. 

John  Anderson,  cet.  48,  butcher ;  three  years  ago  first 
had  pneumonia  of  left  lung;  since  v^hich  time  he  has 
coughed  more  or  less,  and  expectorated  freely.  Three 
months  ago  the  expectoration  entirely  ceased,  and  at 
that  time  he  first  noticed  a  small  tumor  in  its  present 
position  over  the  junction  of  the  last  dorsal  and  first 
lumbar  vertebrae.  He  states  that  a  short  time  before 
the  appearance  of  this  tumor  he  felt  pain  over  the  left 
lung,  which  seemed  to  work  around  until  it  became 
seated  in  the  present  position  of  the  tumor.  He  has 
lateral  curvature  of  the  spine,  and  a  slight  angular  cur- 
vature in  the  dorsal  vertebrse ;  though  no  history  of  dis- 
ease of  the  vertebrss  can  be  elicited,  nor  any  signs  of  a 
still  existing  disease  discovered. 

The  tumor  rises  abruptly  on  the  left  side  of  the  spinal 
column,  about  four  inches,  and  extends  over  to  the  pos- 
terior superior  crest  of  the  ilium,  being  22i  inches  in 
circumference,  10  in  transverse,  and  11  in  longitudinal 
diameter.  The  integument  covering  it  is  somewhat 
discolored  and  quite  tense.  By  pressure,  the  tumor 
may  be  partially  emptied ;  and  is  again  filled  by  allow- 
ing the  patient  to  cough.  The  distance  from  the  sternum 
over  the  lefl  nipple  to  the  vertebral  column  is  four  inches 
less  than  that  over  the  right  nipple.  The  ribs  on  the 
left  side  incline  downwards,  and  overlap.  There  is  in- 
distinct respiratory  murmur,  and  dulness  on  percussion 
over  the  greater  part  of  the  left  lung,  showing  probable 
infiltration ;  but  over  a  small  portion  near  the  wall  there 
are  signs  of  a  cavity.  It  is  unpossible  for  him  to  take 
a  long  breath. 

•  Operation, — ^An  exploring  needle  introduced  into  the 
most  dependent  portion  of  the  tumor,  showed  it  to  be 
filled  with  pus  and  serum.  On  being  opened  it  dis- 
charged three  pinta  The  opening  was  then  closed  by 
adhesive  straps,  and  a  bandage  applied.  After  the  ope- 
ration there  was  an  increased  resonance  on  percussion, 
the  patient  breathed  much  more  easily,  and  could  take 
a  full  inspiration.  In  three  days  after  this  operation 
the  abscess  began  to  fill  again,  and  was  again  opened, 
when  it  discharged  fourteen  ounces  of  pus  and  serum. 
The  patient  is  now,  two  weeks  ader  the  operation,  4oiQg 
well,  walking  and  riding  about 

Case  2. — W.  W.,  »t.  10 ;  presented  all  the  symptoms 
of  pneumonia,  with  free  expectoration.  He  remained 
in  tnis  condition  for  about  two  months,  gradually  sink- 
ing, with  no  abatement  of  the  cough,  but  increase  of 
expectoration,  and  constant  pain  in  the  left  side.  About 
this  time  the  left  side  began  to  dilate  sen^bly,  and  gave 


a  dull  sound  on  percussion  over  nearly  its  whole  extent. 
The  respiration  was  almost  inaudible,  and  the  heart  ap- 
pears to  the  right  of  the  sternum,  with  its  apex  pulsat- 
ing near  the  ensiform  cartilage,  showing  that  efiusion 
had  taken  place  into  the  cavity  of  the  pleura.  The  ex- 
pectoration was  checked  for  a  few  days,  as  the  effusion 
went  on  in  the  pleura ;  but  in  a  short  time,  when  the 
side  became  distended,  and  the  cavity  appeared  full,  it 
became  as  free  as  before ;  leading  to  the  belief  that  ul- 
ceration had  tfdcen  place  between  the  abscess  in  the 
lung  and  the  cavity  of  the  pleura.  The  patient  was 
much  prostrated.  He  remained  in  this  condition  six 
weeks,  at  which  time  pain  in  the  side  increased ;  a  pul- 
sating tumor  b€^an  to  make  its  appearance  between 
the  cartilages  of  the  third  and  fourth  ribs,  near  the 
sternum,  simulating  an  aneurism  so  much  that  upon 
consultation  an  operation  was  refused.  The  tumor  be- 
gan to  soften,  and  in  two  months  after  its  appearance 
it  ulcerated  and  discharged  a  quart  of  very  offensive 
pus. 

The  opening  was  dilated,  and  the  discharge  continued 
very  free,  and  the  expectoration  ceased  entiretyj  the  bow- 
els became  regular,  the  anasarca  disa[)peared,  and,  in  a 
word,  all  his  symptoms  were  very'  much  improved.  He 
was  placed  upon  supporting  treatment.  He  continued 
improving  for  two  weeks,  when  the  opening  in  the 
chest  became  closed,  and  the  expectoration  rehimed  as 
free  as  at  firsty  and  of  precisely  the  same  nature  as  thcU 
dischcarged  by  the  external  opening.  Then  fever  re- 
turned with  loss  of  appetite,  and  I  was  called  agmn  to 
see  him.  I  opened  the  wound,  and  discharged  nearly 
a  quart  of  pus.  The  expectoration  ceased  again  entirdy, 
and  a  discharge  of  the  same  nature  continued  through 
tiie  external  opening,  showing  that  ulceration  had  taken 
place  between  the  pleura  pmmonalis  and  an  abscess  in 
the  lung,  communicating  with  the  bronchia ;  and  when 
the  ulceration  had  taken  place  in  the  pleura  pulmonalis, 
the  matter  in  the  abscess  was  discharged  into  the  cavity 
of  the  pleura,  which  accounted  for  the  check  in  the  ex- 
pectoration during  the  filling  of  that  cavity,  and  its  re- 
turn when  the  side  became  fully  distended.  The  ulcera- 
tion continued  on  through  the  pleura  costalis,  intercostal 
muscles  and  integuments,  at  the  superior  instead  of  the 
inferior  and  most  dependent  part,  as  we  generally  find 
it  The  heart  being  pressed  out  of  its  normal  position 
by  the  presence  of  tlie  fluid,  brought  the  arch  of  the 
aorta  directly  under  the  tumor,  which  accounted  for  its 
strong  pulsations,  and  caused  the  difficulty  in  its  diag- 
nosis. 

The  discharge  continued  free  for  two  or  three  months, 
but  (i^^ually  subsided,  and  in  seven  months  from  the 
first  discharge  it  had  healed  entirely ;  leaving  him  much 
deformed,  tlie  circumference  of  the  left  measuring  seve- 
ral inches  less  than  the  right  side.  Respiration  could 
not  be  heard  over  the  left  side ;  but  there  was  a  blow- 
ing sound,  which,  however,  gradually  gave  way  to  the 
natural  murmur.  The  patient  has  now  assumed  nearly 
the  natural  murmur.    He  now  enjoys  perfect  health. 

From  the  time  of  the  operation  the  child  rapidlv  im- 
proved in  health  and  strength,  became  cheerful  and 
playful,  and  t^e  sallow  and  unhealthy  appearance  of  its 
face  was  changed  to  a  healthy  and  even  a  ruddy  glow. 

I  have  related  this  case,  not  because  of  any  particular 
difficulty  experienced  in  operating  or  because  of  any- 
Uiing  original  in  the  modus  operandi,  but  to  show  the 
rapid  improvement  which  followed  the  operation,  the 
great  relief  afforded  by  it,  and  the  necessity  of  operating 
in  similar  cases  as  soon  as  the  bowels  become  at  aS 
constipated.  So  long  as  the  contents  of  the  bowels  re- 
main fluid  (which  they  did  in  the  case  above  related  for 
the  first  four  or  five  months)  little  difficulty  and  suffer- 
ing are  experienced;  but  just  so  soon  as  they  become 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


227 


hardened,  so  soon  do  ineffectual  efforts  commence,  the 
bowels  gradnallj  fill  up  with  feeces  and  gas,  digestion, 
drcalation  and  respiration  are  interfered  with,  and  the 
sufferings  of  the  patient  are  gradually  aggravated  until 
either  relieved  by  the  surgeon  or  death. 


|)r00rc««  of  £BitV\cal  Science. 


Death  bt  Drownino. — In  the  January  number  of  the 
Umon  MicUcale  de  la  (Tiromts,  published  at  Bordeaux, 
is  an  interesting  paper  by  ProC  J.  E.  Petrequin,  of 
Lyons,  in  which  are  expressed  some  ori^nal  views  con- 
cerning this  subject  Opportunities  were  enjoyed  by 
this  gentleman,  m  1864,  to  study  it  in  a  special  man- 
ner. His  experience  led  him  to  the  adoption  of  a  das- 
sfication,  based  upon  a  diagnosis  of  the  physiological 
and  pathological  conditions  which  inmiediately  precede 
and  accompany  asphyxia  by  drowning.  Cerebral  apo- 
plexy, as  a  concomitant  pathological  state,  denied  by 
Orfila,  and  admitted  by  Dever^e.  he  asserts  to  be  one 
of  the  distinguishing  forms  of  death  by  submersion. 
The  symptoms  of  those  who  are  submerged  during  re- 
pletion of  the  stomach,  as  after  a  copious  repast,  belong 
to  his  second  class,  and  especiaUy  call  for  the  evacuation 
of  that  cavity.  His  third  class  refers  to  those  who, 
from  fright,  faint  at  the  moment  of  being  submerged. 
His  fourth  class  comprises  that  condition  described  by 
most  authors  as  characterizing  death  by  drowning,  and 
in  whidi  therapeutic  means  are  designed  especially  and 
iauuediately  to  re-establbh  the  respiratory  function. 

The  Diagnosis  or  Indurated  Chancrx. — Dr.  Lagneau 
ofiers  some  judicious  remarks  in  the  Oaxette  Hebdoma- 
dairt^  of  the  8th  March,  on  the  subject  of  simple  and 
infecting  or  indurated  chancres.  The  period  of  incu- 
bation of  the  indurated  chanore  may  be  less  or  greater 
thin  fifteen  to  twenty-five  days.  Between  the  per- 
fectly soft  and  well  marked  indurated  chancre,  there 
are  many  intermediate  degrees,  which  practically  do 
not  permit  a  positive  diagnosis  of  the  specific  character 
of  the  sore.  There  are  other  reflections  of  interest  and 
practical  importance  noted  in  Dr.  Lagneau's  communi- 
cation, which  is  an  excellent  summary  of  the  different 
0|«uon8  on  this  matter,  collected  from  periodical  pub- 
iKiations. 

Explanation  of  the  Favorable  Effect  of  Iridectomt 
nr  Acute  Glaucoma,  by  Fano. — It  is  generally  accepted 
that  glaucoma  is  an  irido-choroiditis,  with  hypersecre- 
tion of  the  fluids  of  the  eye,  by  means  of  which  latter 
a  compression  of  the  retina  with  consecutive  anaesthesia 
of  this  membrane  occurs.  The  excision  of  a  piece  of 
iris  is  said,  by  diminishing  the  secreting  surface^  to  relax 
the  tension  and  restore  the  normal  pressure.  In  oppos- 
ing this  view,  the  author  calls  attention  to  the  changes 
in  the  vitreous  in  the  beginning  of  acute  glaucoma, 
wbich  become  a  physical  hindrance  to  vision.  An  acute 
QMlema  of  the  conjunctiva  is  also  observed  in  some 
cases,  which  indicates  disturbance  in  the  venous  system. 
The  vitreous,  having  no  vessels,  is  nounshed  by  imbi- 
bition from  the  arteries  of  the  choroid,  of  the  ciliary 
processes  and  of  the  retina,  and  the  diminished  trans- 
parency of  these  parts  ^hows  a  change  in  the  circula- 
tion of  ^e  vessels.  If  we  consider,  now,  the  rapid 
appearance  of  this  symptom,  with  the  coincidence  of 
severe  pain,  as  w  observed  in  senile  gangrene,  may  we 
not  contdder  glaucoma  as  an  inflammation  of  the  arterial 
system  of  the  eye?  Ir  dectomy  always  (?)  causes  a 
wemorrhage  into  the  anterior  chamber,  whereby  a  direct 
depletion  of  the  inflamed  vessels  occurs.  This  may  be 
the  proper  explanation  for  the  fevoraWe  result  from 
iridectomy. — L  Union  Midicakj  MemorabQien  BeUbronn. 


Alterative  Laxative  Pill.  —  Dr.  Gilman  Davies 
(Boston  Med.  and  Surg,  Jour.)  extols  the  virtues  of  a 
laxative  pill  prepared  after  the  following  formula:  3 
PiL  Aloin.  c.  Perro  p.  xxiv,  Ext  Nucis^om.  ale,  gr.  vi., 
Pulv.  Ipecac.,  gr.  vi.  M.  Fiant  pU.  No.  xviii.  Dose,  a 
single  pill.  The  pills  are  small,  about  half  the  usual  pill- 
size.  "  One  of  these,  taken  each  night,  keeps  the  bowels 
in  a  regular  condition,  operating  without  pain,  and  of 
course  chiefly  by  its  tonic  power;  while  the  whole  sys- 
tem gently  but  surely  feels  the  strengthening  effect  of 
the  iron  and  nux  vomica." 

Cutaneoits  Absorption. — ^M.  Cliarles  Hoffmann  has 
laid  before  the  Paris  Apaderay  of  Science  a  paper  on 
this  subject.  His  experiments  have  been  made  on  digi- 
talis, iodide  of  potassium,  and  chloride  of  sodium.  He 
comes  to  the  following  conclusions.  1.  Chemical  and 
other  agents,  dissolved  in  water,  penetrate  slowly  but 
obviously  into  the  animal  economy,  by  the  external 
tegument,  and  it  is  only  when  the  blood  and  other 
fluids  are  saturated  by  them  that  the  organism  expels 
them.  2.  All  medicaments  are  not  absorbed  in  the 
same  degree.  3.  The  contradictory  results  hitherto  ob- 
tained were  only  due  to  the  insumcient  length  of  the 
time  devoted  to  the  experiments. — British  Med.  Jour. 

Arsenio  in  PROSTATTns. — ^Dr.  T.  B.  Buchanan,  of 
Nashville,  reports  that  some  time  since  he  gave  a 
patient  Fowler's  Solution  of  Arsenic,  for  sycosis  menti ; 
af\er  using  it  a  week,  the  remedy  was  discontinued  and 
the  application  of  sulphite  of  soda  relieved  the  case. 
The  patient  had  been  suffering  for  ten  years  with 
chronic  prostatitis,  caused  by  a  protracted  attack  of 
gonorrhoea,  rendering  him  miserable  and  at  times  im- 
potent. Nearly  every  remedv  that  has  been  recom- 
mended by  the  profusion  had  been  used  in  his  case, 
but  with  little  benefit.  ^'  T<  the  delight  of  the  patient 
and  my  utter  astonishment^'*  says  he,  "  he  is  now  per- 
fectly well,  and  has  been  for  more  than  a  month." 
Since  arsenic  has  proved  beneficial  in  hcemorrhoids, 
might  it  not  have  relieved  the  prostatitis,  as  the  haemor- 
rhoidal  and  prostatic  plexus  of  veins  are  intimately 
commingled  ?  Arsenic  probably  effects  its  cure  upon  the 
skin  in  disease,  and  that  condition  of  the  spleen  and  liver, 
after  intermittenta  of  long  standing,  not  by  any  specific 
action  upon  the  blood,  but  upon  the  vessels  themselves, 
thereby  equalizing  tne  circulation  and  rendering  it 
normal. — Paul  L.  Eve. — Nashville  Journal  of  Medicine 
and  Surgery. 

Gun-shot  Wounds  uottiko  bt  first  intention.— Dr. 
J.  W.  Thompson,  in  the  NdshviQe  Joitmai  of  Medicine 
and  Surgery^  gives  four  instances  of  wounds  healing 
^  ithout  suppurating.  Three  were  in  hospital  practice, 
and  one  was  in  a  private  patient  Two  of  the  hospital 
cases  were  long  flesh  wounds,  and  all  would  be  classed 
as  deep-seate(L  Two  were  made  by  mini^  balh,  the 
third  by  a  small  round  ball  There  was  no  swelling  or 
redness  following  the  wounds  in  the  hospital  cases.  A 
small  scab  formed  over  the  entrances  and  exits,  when 
they  healed.  Ajb  regards  the  case  in  private  practice, 
the  ball  was  dl^harged  firom  a  Derringer  pistol,  entered 
beneath  the  inferior  maxillary  bone  on  the  left  side,  and 
lodged  near  the  corresponding  submaxillary  gland  on  the 
other  side.  This  patient  recovered  in  a  reasonable 
time.    The  wound  now  gives  him  no  trouble. 

The  Human  Bite  Poisonous.— A  singular  occurrence 
has  just  happened  in  Arth,  Prance.  A  Lieutenant 
Felchin  was  some  time  ago  bitten  in  the  thumb  by  a 
man  named  Muller;  but  he  thought  nothing  of  the 
wound,  and  went  next  day  a  journey  on  his  private 
affairs.  On  reaching  the  Balse.  he  found  his  hand  and 
arm  began  to  swell,  and  a  meaical  man  declared  that 


Digitized  by 


Google 


228 


THE  MEDICAL  RECORD. 


the  case  was  one  of  poisoning  by  a  human  bite.  He 
at  once  returned  home  in  haste,  but  refused  to  have  the 
arm  amputated.  The  inflammation  increased  fright- 
fully, and  he  died  some  days  after  in  horrible  suffermg. 
— NashviUe  Journal  of  Mtdieine  and  Surgery, 

Perchloride  of  Iron  as  a  Hjsmostatio. — The  Ant- 
werp Journal  states  that  perchltride  of  iron  combined 
with  collodion,  is  a  good  hemostatic  in  case  of  wounds, 
the  bites  of  leeches,  &a  To  prepare  it,  one  part  of 
crystallized  perchloride  of  iron  is  mixed  with  six 
parts  of  collodion.  The  iron  should  be  added  gradu- 
ally and  with  care,  otherwise  such  a  quantity  of 
heat  will  be  generated  as  to  cause  the  collodion  to 
boil.  The  composition,  when  well  made,  is  of  a  yellow- 
ish-red color,  perfectly  limpid,  and  produces  on  the  skin 
a  yellow  ^ellide,  which  retains  great  elasticity. — Naeih- 
viUe  MeduxU  and  Surgical  Journal, 

Ether  Sprat^  in  Strangulated  Hernia. — Dr.  John 
Borelay  reports  in  the  British  Medical  Journal^  a  case 
of  strangulated  hernia,  in  which  reduction  was  ac- 
complished after  the  use  of  ether  spray.  The  pain  in- 
duced after  the  most  gentle  handling  of  the  hernial 
tumor  was  so  intense,  that  Dr.  B.  had  to  desist  from 
taxis.  Having  with  him  Eichardson's  Ether  Spray 
Apparatus,  and  thinking  it  might  be  useful  in  lieu  of  ice, 
it  was  determined  to  invert  the  patient^  »pply  the  ether 
spray  short  of  freezing  the  skin,  then  to  attempt  the 
reduction,  and  if  failure  was  the  result,  to  operate  witii 
the  knife.  The  head  and  shoulders  then  being  sup- 
ported on  the  floor  by  some  pillows,  and  the  buttocks 
raised  as  much  as  possible  against  an  inclined  plane, 
extemporiEed  by  an  inverted  bedroom  chair,  the  ether 
spray  was  directed  in  the  usual  way  on  the  swelling, 
for  about  forty  seconds,  when  a  minute  spot  appeared 
white.  The  spray  was  at  once  removed,  and  on  apply- 
ing the  fingers  of  the  left  hand  on  the  swelling  for 
about  ten  seconds,  accompanied  by  the  most  trifling 
pressure,  the  hernia  was  reduced,  to  the  great  delight 
and  satisfaction  of  all.  The  man  made  a  first-rate  recov- 
ery.—itfctiicaZ  and  Surgical  Reporter. 

Quinine  as  a  Preventive  of  Malarial  Fever. — Dr. 
0.  White,  in  a  report  to  Gen.  Ripley  (of  the  late  Con- 
federacy) in  regard  to  the  "  health  of  several  encamp- 
ments on  Jameses  Island  and  in  St.  Andrew's  Parish, 
and  also  upon  the  prophylactic  virtues  of  quinine 
aiB:ainst  country  fever,"  says:  **  Of  the  prophylactic 
virtues  of  quinine  against  malarial  impressions,  it  may 
be  asserted  with  confidence,  that  fortified  with  that 
wonderful  drug  none  need  fear  venturing  at  any  time 
into  the  heart  of  our  low-lands  in  summer — inhaling 
with  impunity  its  deadly  miasm.  Abundance  of  evi- 
dence can  be  brought  to  prove  this  assertion.  This  re- 
lionce  in  its  virtue  to  renst  malarial  disease  isunUmited. 
Many  have  lived  protected  by  it  for  ten  years  or  more, 
spending  summer  after  summer  in  the  sickliest  regions." 

Dr.  Barker  and  the  Government  members  of  the 
Niger  expedition,  being  abundantly  supplied  with  qui- 
nine, encamped  with  safety  upon  the  banks  of  that  fatal 
river  for  over  twelve  months. 

The  African  explorers  under  Dr.  Livingston,  were 
preserved  entirely  free  from  the  pernicious  fevers  of  the 
climate,  by  the  habitual  use  of  quinine.  Further  evi- 
dence of  the  prophylactic  virtues  of  quinine  has  also 
been  afforded  to  many  of  the  officers  of  the  British 
Government  stationed  on  the  coast  of  Africa,  in  reports 
from  the  various  stations  collected  and  arranged  by  Dr. 
Alex.  Bryson.  Tht»  British  steamer  Eliaia  steamed  up 
the  river  Niger  in  July,  ascended  the  river  Chaddon, 
and  returned  t«)  England  without  the  loss  of  a  single 
man — all  owing  to  the  proper  administration  of  quinine 


The  party  included  sixty,  and  the  expedition  was  in 
the  nver  180  days;  twice  as  long  as  the  expedition  of 
'42,  which,  unprovided  with  quinitoe,  ended  in  so  fear- 
ful a  loss  of  life.  Surely  no  fui  ther  evidence  can  be 
needed  to  prove  that  the  daily  and  proper  use  of  quinine 
in  malarious  regions  is  capable  of  so  modifying  t;»c  «y?- 
tem  as  to  render  it  capable  of  resisting  the  deleterious 
influences  of  climate,  and  of  protecting  individuals  fiom 
intermittent  or  remittent  fevers. 

The  dose  usually  prescribed  under  such  circumstances 
is  from  three  to  five  grains,  regularly  tak^n every  morn- 
ing before  breakfast — NashvUU  Journal  of  Medicine  a^d 
Surgery. 

Malpositiok  or  the  Kiditets. — The  following  case  of 
Malpo.-'ition  of  the  Kidneys  is  related  in  the  N.  i.  Medi- 
cal Journal^  by  Dr.  Jones  H.  Butler.  On  the  14th  of  No- 
vember last,  the  body  of  a  negro  was  brou«:ht  in^o  the 
dissecting-room  of  the  University  of  Maryland ;  during 
the  dissecting,  the  abnormal  position  was  observ'ed  as 
follows :  **  The  kidneys,  instead  of  occupying  the  lumbar 
region,  were  found  in  the  pelvic  cavity.  Both  organs 
"were  united  or  fiised  into  one,  with  a  central  line  or 
raph^  making  a  longitudinal  fissure  over  the  sutface  of 
them,  better  marked  on  the  posterior  than  on  the  un- 
terior  part  In  length,  they  extended  from  the  lower 
border  of  the  lumbar  aorta  downwards,  over  tlie  pro- 
montory of  the  sacrum,  to  the  middle  of  that  bone — in 
all,  five  inches;  and  in  breadth  measured  three  and 
three-fourths  inches.  The  ureters  sprang  from  the  pel- 
vis, which  occupied  the  central  anterior  part  of  the  or- 
gans, and  then  passed  off  on  each  side,  and  emptie'i  into 
the  bladder  on  each  side.  The  tumor  formed  by  the  kid- 
neys could  be  readily  felt  by  examining  with  the  fin- 
ger per  rectum.  The  arteries  supplying  the  organs  were 
four  in  number.  Above,  a  single  large  trunk  came  from 
the  aorta,  just  at  the  bifurcation,  immediat<»ly  in  front  of 
the  sacra  media  artery,  passed  downwards,  and  before 
entering  the  substance  of  the  organs,  broke  up  into  hve 
smaller  branches;  on  the  left  side,  two  arteries  came 
from  the  left  internal  iliac,  near  its  commencement,  and 
on  the  light  side  an  artery  passed  into  the  organs  from 
the  right  internal  iUac."  The  patient  died  of  pneu- 
monia. 

EUBEOLA  WITH  PECULIAR  FoRlT  OF  ErUPTION.— John 

H.  Cobb,  aged  13,  (under  the  care  of  Owen  Daly,  M.D., 
of  Hull  Q-eneral  Infirmary),  was  attacked  with  rigors  on 
November  24th,  and  admitted  on  the  27th  in  a  severe 
febrile  condition ;  having  ^catte^ed  irregularly  over  the 
extremities  numerous  spots,  or  rather  circulw"  patches, 
varying  in  diameter  from  one-quarter  to  thn  e-qnarters 
of  an  inch,  of  a  dusky  red  color,  slightly  pale  in  the  cen- 
tre, not  elevated,  facfing,  but  not  entirely  disappearing, 
on  pressure.  Similar,  but  larger,  patches  covered  p  irt 
of  the  hands,  and  enveloped  the  ends  of  the  fingers.  Eh 
face  was  flushed;  lips  dusky;  tongue  dry  and  gazed; 
pulse  120,  very  feeble;  respiration  hurried  and  alv^om- 
mal,  without  cough  or  coryza.  He  was  onlered  milk- 
diet,  beef-tea,  six  ounces  of  wine,  and  a  saline  mixture. 
During  the  following  week,  fresh  spou*.  exa*  tly  simi- 
lar in  character,  appeared  daily ;  and  the  nands  and  feet 
were  quite  enveloped  by  confluent  patches ;  but  on  De- 
cember 1st,  the  lower  extremities  weie  covered  by  a 
mottled  rash  like  ordinary  rubeola.  This  was  mon*  gen- 
eral on  the  following  day ;  on  the  evening  of  whict»  it 
began  to  fade,  and  rapidly  disappeared.  Desquamation 
of  the  cuticle  followed,  as  extensive  as  in  scarlet  fever, 
the  palms  and  palmar  aspect  •>f  the  fingers  being  quite 
denuded.  His  general  con<1ition  steadUv  improved  al- 
most from  the  time  of  adniisi^ion,  and  on  becember  20th 
he  was  discharged  convalescent.— .BK^A  J/ad  Jour. 

digitized  by ^ „      ^_ 


THE  MEDICAL  RECORD. 


229 


The  Medical  Keoord. 

^  j$eim-3[0itl^ll!  Imtnml  of  Ptbidnt  anb  Siursers. 
George  F.  Shbadt,  M.D.,  Editob. 

PnbUahMi  on  tlM  1st  and  15th  of  Mch  Month,  bf 
WILLIAM  WOOD  St  CO.,  <1  Walkbk  Bthbbt,  Nkw  Toss. 


FOBEIQN  AOENQJB& 

LovDOH— Tkubbbb  k  Go.  I     Lmpeio— R  Hkbicaitk. 

Paus— BoWAVOi  R  Gib.  1     Sio  jAMBXBO--TBruBiri(  t  Ga. 


New   York,   July  15,  1867. 

TEACHERS*  CONVENTION  AND  THE  EXTBN- 

SION  OP  LECTURE  TERM3. 
The  circumstances  attending  the  adoption  of  the  re- 
solation  concerning  the  period  of  study,  by  the  Con- 
Tention  of  Medical  Teachers,  at  Cincinnati,  carry  with 
them  no  small  amount  of  significance.  When  the 
original  proposition  was  put,  that  the  term  should  not 
be  less  than  three  years,  it  failed  to  meet  with  general 
ikvbr ;  and  the  unanimity  with  which  the  amendment 
of  Prof.  Gross,  of  Philadelphia,  was  passed,  conclu- 
sively proved  the  importance  which  was  attached  to  its 
ftirtber  extension.  The  proposition  coining,  too,' from 
a  gentleman  long  engaged  in  pablic  teaching,  and  asso- 
ciated with  one  of  the  first  medical  institutions  in  the 
country,  is  an  earnest  of  the  good  &ith  and  laudable  de- 
sire of  all  those  particularly  interestei  in  the  advance 
of  medicd  education.  The  origin  of  the  motion,  then,  is 
unexceptionable ;  and  the  motives,  it  must  be  admitted, 
were  as  laudable  as  the  necessities  of  the  case  are  im- 
perative. The  probability,  however,  that  it  will  be  gen- 
erally adopted  is  not  so  certain  as  we  might  expect 
The  main  obstacle  that  we  opine  will  be  urged  against 
it  will  be  the  conflicting  interests  of  the  several  smaller 
scboolfl.  Many  of  these  latter  institutions,  catering  to 
the  popular  desire  to  manufacture  doctors  in  a  hurry, 
base  not  a  small  amount  of  their  patronage  upon  the 
possibility  of  crowding  very  much  learning  into  a  small 
^pace  of  time ;  and  while  they  make  a  show  of  many 
advantages,  which  are  pecuHar  to  themselves  and  the 
localities  in  which  the  institutions  may  be,  give  the 
students  to  understand  that  time  is  of  the  least  import- 
ance. Such  schools  will  doubtless  strongly  object  to 
this  movement,  and  will  set  up  the  cry  that  an  unfair 
advantage  is  taken  of  their  established  rules,  and  that, 
consequently,  no  body  of  men  have  a  right  to  dictate 
to  them  concerning  a  change  so  fundamental  and  so 
damaging  to  their  patronage.  But,  after  aD,  this  resist- 
ance cannot  but  be  short-lived,  and  those  who  are  deter- 
mined to  hold  out  against  the  measure  must  inevitably, 
in  the  course  of  time,  cease  to  exist.  If,  then,  the  reso- 
Qtion  does  no  more  than  this — ^lessening  the  num- 


ber of  our  small  one-horse  institutions — it  will  ulti- 
mately be  the  first  step  in  the  advancement  of  our 
college  standard,  and  take  the  edge  off  the  sneer  with 
which  our  "  manufactories  of  doctors,'*  so  called,  are  re- 
ferred to  by  transatlantic  medical  men. 

We  have  no  doubt  that  the  plan  of  extension  will 
meet  with  the  approval  of  the  majority  of  students.  It 
only  is  necessary  to  make  a  start  with  the  coming  fall 
to  insure  its  success,  and  if  but  a  few  of  the  larger  insti- 
tutions would  do  this,  they  could  sweep  everything  be- 
fore them,  and  compel  the  smaller  ones  to  follow  their 
example.  This  is  ^e  only  way  a  beginning  can  be 
made ;  the  adoption  of  resolutions  by  a  convention  of 
never  so  respectable  and  honorable  men,  avails  nothing, 
unless  there  is  a  proper  spirit  and  determination  behind 
to  enforce  them.  The  experiment  can  hardly  be  con- 
sidered a  dangerous  one,  as  it  is  but  a  small  increase  of 
time  compared  with  what  the  majority  of  our  students 
are  accustomed  to  spend  in  our  colleges ;  the  only  es- 
sential change  being  the  actual  enforcement  of  such  an 
attendance  as  to  time,  as  shall  be  necessary  to  entitle 
them  to  final  examination. 

Another  good  effect  of  the  adoption  of  compulsory 
measures  in  this  respect^  would  be  the  prevention  of  the 
miserable  system  lately  so  much  in  vogue  among  many 
with  the  plea  of  limited  time,  of  cijowdmg  two  full 
courses  into  a  year,  by  attendance  during  the  summer 
months  upon  other  institutions.  While  making  this 
statement  we  are  perfectly  aware  that  it  is  the  intention 
of  these  colleges  to  exact  the  legal  requirement  of  three 
years'  study  in  the  office  of  a  practitioner  of  medicine ; 
but  all  who  are  even  indirectly  connected  with  these 
schools  know  full  well  that  it  is  as  easy  to  procure  a 
certificate  of  the  requisite  amount  of  study  as  it  is  to 
get  one  of  good  moral  character.  This  may  be  true  of 
any  college,  or  under  any  system  of  management ;  but 
we  claim  that  it  is  more  especially  so  in  connection 
with  the  practice  to  which  we  allude. 

As  the  question  now  stands,  the  length  of  time  allot- 
ted to  studies  is  all  that  can  reasonably  be  asked  for.  It 
is  now  only  enjoined  upon  the  student  to  attend  three 
full  courses  of  lectures,  and  there  is  left  to  him  a  year 
to  prepare  himself  for  attendance  at  college.  If,  besides 
this,  he  be  fortunate  enough  to  reside  in  proximity  to 
the  school,  he  can  spend  not  a  little  of  his  time  in  at- 
tendance upon  such  of  the  lectures  as  may  agree  with 
his  preparatory  studies. 

The  wording  of  the  third  resolution  implies  that  it 
shall  be  obligatory  on  the  part  of  the  student  to  attend 
three  full  courses  of  lectures  before  he  shall  be  entitled 
to  receive  his  examination  for  a  diploma.  The  difficulty 
in  carrying  out  such  a  compulsory  measure  will  be  by 
no  means  great,  and,  practically  speaking,  there  can 
hardly  be  any  impediment  at  all  to  its  general  adoption 
for,  as  we  have  already  intimated,  there  are  not  only  a 
majority  of  the  students  who  will  attend  in  any  event 
on  lectures,  but  a  great  number  consider  it  a  privilege 
to  remain  connected  with  the  college/t&ree  tenns  in- 
^igitized  by  VjOOk^- 


230 


THE  MEDICAL  RECOKD. 


stead  of  two.  All  sensible  candidates  for  a  degree  are 
well  aware  that  their  chances  for  success  at  the  final  ex- 
amination are  proportionately  increased  as  they  length- 
en their  term  of  stay  beyond  the  time  allotted ;  and  to 
those  who  are  in  too  great  a  hurry  to  do  this,  it  does 
not^  as  far  as  any  good  to  the  profession  is  concerned, 
matter  much  whether  they  can  graduate  or  not 

As  regards  the  length  of  each  course — that  of  five 
months— we  are  not  much  better  off  than  we  were  be- 
fore, save  the  naming  of  that  period  as  the  mini- 
mum. The  larger  colleges  have  almost  to  a  single  one 
adopted  this  as  the  standard,  and,  we  are  glad  to  say, 
by  the  establishment  of  summer  courses,  seem  in- 
clined to  do  more,  so  that  there  need  not  be  on  their 
part  any  change.  But  to  those  schools  who  have  of 
late  been  curtailing  their  time  and  increasing  their  pro- 
fessors, the  matter  will  be  certainly  somewhat  different, 
and  may  seriously  interfere  with  those  pet  little  plans 
which  they  may  have  formed  for  making  money  easily, 
and  having  a  decently  large  class  of  students.  But  we 
may  say  of  these  institutions  as  we  have  said  of  the 
students  who  attend  them,  that  the  profession  can  get 
along  profitably  without  either.  Iii  fact,  if  the  changes 
spoken  of  can  Mrly  be  inaugurated  by  responsible 
schools,  so  that  the  smaller  ones  are  compelled  to  fol- 
low the  example,  one  of  two  effects  will  follow :  either 
very  many  of  the  smaller  schools  will  be  forced  to  raise 
their  standard  to  the  level  of  their  leaders,  or  else  pass 
out  of  existence  altogether  for  the  want  of  even  a  meagre 
patronage  which  may  enable  them  to  drag  out  a  miser- 
able and  pitiable  existence. 

There  is  no  question  but  that  the  medical  mind  is 
prepared  for  the  extension  of  the  term  of  study,  and 
that  the  colleges  that  second  the  endeavor  of  the  Ck)n- 
vention  of  Medical  Teachers  wiU  be  appreciatingly  re- 
warded by  the  patronage  of  the  best  class  of  young 
men,  and  the  chances  of  a  continued  increase  in  attend- 
ance will  be  conmiensurably  great  in  accordance  with 
the  spirit  with  which  the  intentions  are  carried  out 
As  regards  the  increased  expenses  of  board,  etc.,  which 
such  an  attendance  would  involve,  all  we  have  to  say 
is,  that  it  would  be  too  trivial  to  many  to  be  weighed 
at  all  in  the  balance  of  expediency  ;  and  the  number  of 
those  dissatisfied  students  who  would  complain  of  pov- 
erty would  be  very  much  decreased,  when  they  discov- 
ered that  they  were  compelled  to  spend  the  amount  of 
time  required,  or  else  be  deprived  of  a  chance  to  obtain 
their  examInation& 

There  does  not  seem  to  be  much  doubt  but  that  the 
metropolitan  schools  will  adopt  the  plan,  their  intention 
being  foreshadowed  in  the  inauguration  of  their  sum- 
mer courses;  but  as  to  the  others,  we  must  be  patient 
and  wiut 

Thus  far  we  are  free  firom  any  of  the  epidemic  influ- 
ences of  cholera.  There  have  been  but  a  very  few  spo- 
radic cases  reported  up  to  the  time  of  our  going  to  press. 
The  opinion  of  distinguished  sanitarians  is  to  the  effect 


that  the  city  and  suburbs  will  in  aU  probability  escape 
the  ravages  of  this  dreadful  scourge.  But  in  view  of  this 
comfortable  assurance  of  safety,  it  becomes  a  matter  of 
no  small  concern  to  consider  the  probabiUty  of  our  being 
equally  fortunate  with  reference  to  Yellow  Fever. 
Everything,  however,  is  being  done  by  the  authorities  to 
prevent  its  entrance  into  our  port,  and  we  hope  that 
their  endeavors  will  be  crowded  with  that  suocess  which 
they  deserve. 

We  would  especially  commend  the  remarks  made  by 
our  Philadelphia  correspondent,  in  regard  to  the  difficul- 
ties attendant  upon  reporting,  to  many  of  those  gentlemen 
who  are  so  willing  to  talk  and  so  unwilling  to  have  their 
remarks  published.  His  views  concerning  the  matter 
will  certainly  be  endorsed  by  those  of  our  readers  who 
desire  to  be  kept  informed  of  the  doings  of  our  different 
scientific  bodies. 


Ueoiewa. 


On  Railway  and  other  injubibs  of  the  Nervous  System. 
By  John  Eric  Erichsbn,  FeUow  of  the  Royal  College  of 
Surgeons,  Protjyf  Surgery  aod  Clinical  Surgery  in  Uai- 
•versity  College,  eta,  etc.  Philadelphia:  H.C.  Lee.  1867. 
8vo.  pp.  103. 

The  number  of  cases  of  railroad  injuries  that  are  con- 
stantly occurring,  and  t^e  number  of  instances  in  which 
suits  against  railway  companies  are  being  multiplied, 
invest  the  particular  subject  treated  of  by  Mr.  Erich- 
sen  with  a  great  deal  of  importance.  The  professional 
mind  has  of  late,  in  regard  to  these  cases,  become  tinc- 
tured with  much  of  the  prejudice  that  has  belonged  to 
juries,  and  physicians  have  persuaded  themselves  that 
many  of  the  effects  of  shocks  complained  of  by  patients 
have  no  foundation  in  fact,  and  are  only  trumped  up  by 
the  injured  one  for  the  sake  of  obtaining  heavy  damages. 
To  such  surgeons  this  little  work  paiticularly  app^Js. 
The  subject  of  injuries  to  the  nervous  system,  by  com- 
paratively trivial  shocks,  directly  or  indirectly  inflicted 
upon  the  spinal  column, is  very  lucidly  discussed;  and  the 
reader,  on  perusing  the  work,  will  not  fail  to  be  con- 
vinced of  the  firequency,  as  well  sa  danger,  of  these  occur- 
rences. The  author  assumes  that  a  shock  may  be  re- 
ceived by  a  mere  concussion  of  the  body  as  a  wholes 
without  giving  any  evidences  of  external  iniury,  and 
ultimately  lead  to  organic  disease  of  the  membranes  or 
cord  itaeAt  The  cases  which  the  author  cites  in  proof  of 
this,  and  the  deductions  which  be  draws  firom  them  in 
regard  to  diagnosis  and  prognosis,  are  peculiarly  valuable 
to  the  medical  jurist.  This  particular  part  of  the  sub- 
ject of  railroad  accidents  has  not  been  treated  of  in 
any  work  within  our  knowledge;  and  it  is  a  fortunate 
thing  for  the  profession  that  the  distinguished  Lon- 
don surgeon  has  added  the  weight  of  his  name  to  the 
elucidation  of  such  an  important  and  interesting  class 
of  affections. 

Chemistry  of  the  Farm  and  Sea:  with  other  Chemical 
Essays.  By  Jas.  R.  Nichols,  M.D.,  Editor  Boston  Jour- 
nal of  Chemistry,  Member  of  Mass.  Institute  of  Technology, 
etc.    Boston :  A  Williams  A  Ca    1867.    12mo.  pp.  122. 

The  work  before  us  is  calculated  for  the  instruction 
of  the  public  in  matters  of  science,  and  will  serve  the 
purpose  for  which  it  was  written.  The  author  Is  well 
informed  on  all  the  subjects  that  he  discusses,  and  has  a 
facultv  that  will  be  appreciated  by  the  general  reader 
of  making  things  dear  and  intelligible.    It  is  a  very 

^       ^l( 


Digitized  by  V^OOQ  IC 


THE  MEDI9AL  RECORD. 


231 


saggestive  and  edifying  work  to  any  who  have  not  given 
attention  to  the  applied  scieaces ;  but  to  the  majority  of 
our  readers  it  would  be  simply  as  an  old  story  told 
anew. 

"Why  Kot  ?  A  Book  for  every  Woman.  The  Prize  Essay  to 
which  the  American  Association  awarded  the  Gold  Medal 
for  1865.  By  HoaATio  Robiksow  Storer,  M.D.,  of  Bos- 
ton.  Surgeon  to  Franciscan  Hospital  for  Women,  eta,  eta 
Boston :  Lee  &  Sbepard.    ISGt.    16mo.  pp.  99. 

This  essay,  we  are  glad  to  learn,  has  within  the  short 
space  of  a  few  months  advanced  to  a  second  edition, 
giving  unmistakable  and  gratifying  evidence  of  its  ac- 
ceptance by  the  community. 

Tkeathekt  op  Pnextmonia  with  the  Preparations  of  Vera- 
tnim.    By  Dr.  Kocher,  eta    (Behandlung  der  Croup5sen 
PDennK>nie  mit  Yeratmm  praparaten.      Yon  Dr.  Theodor 
Kocber,  in    Bern.     Wurzburg.    Druck  und  Verlag  der 
Stahsl-sohbn,  Buch  und  Kunsthandlung.    1866.) 
Dr.  Theodor  Kooher,   of  Bern,  presents  us  with  a 
work  of  ninety-four  pages,  on  the  "  Treatment  of  Pneu- 
monia by  the  Preparations  of  Veratrum."    Considering 
the  probability  of  the  disease  ending  favorably  in  a  cer- 
tain time,  if  left  to  itself,  Dr.  K.  thinks  we  should  still 
seek  for  remedies  which  will  ahori  it. 

The  book  is  mostly  composed  of  the  results,  histories, 
and  treatment  of,  and  reflections  on  sixty  cases  of  pneu- 
monia, where  veratrum  was  used,  under  the  care  of 
Professor  Biermer,  in  Bern.  The  resina  veratri  viridis 
was  given  usually  in  i  grain  doses,  hourly,  until  four 
pills  bad  been  given ;  then  stopped  to  avoid  sickening. 
The  pulse  and  temperature  often  fell  very  quickly.  The 
mortali^  of  t^hese  cases  is  stated  at  8.3  per  cent.  The 
average  duration  of  treatment  five  days  and  twenty-one 
hoois.  The  veratrum  is  supposed  to  affect  only  the 
fever  diredSy ;  it  lowers  the  pulse  and  temperature. 
The  crisis  is  only  caused  in  the  first  twenty-four  hours 
of  the  disease,  near  the  time  of  the  spontaneous  cessa- 
tion of  the  fever. 

The  indirect  influence  on  the  local  process,  rather 
than  the  avoidance  of  the  consumption  by  the  fever, 
causes  the  favorable  statistics  of  the  veratrum  treatment. 
The  remedy  is  contra-indicated  where  the  fever  is 
alight,  or  where  the  patient  is  so  weak  that  he  may  not 
be  further  reduced.  When  not  too  much  debilitated, 
and  in  drunkards,  stimulants  may  be  simultaneously 
employed.  The  necessary  quantity  of  veratrum  must 
be  given  in  a  short  time,  and  the  medicine  stopped  as 
soon  as  nausea  or  lowering  of  the  pulse  or  temperature 

The  Curabilitt  of  Phthisis  PuLMOXALia  Examined 
Historically,  Pathologically,  and  Therapeutically,  eta 
(Die  Frage  tiber  die  Heilbarkeit  der  Luogen  Phthisen, 
Hlfltorisch,  Patbologiflch,  und  Tberapeutisch,  untersucht 
von  Dr.  John  Bapt.  TJLLERSPBROBa  Wtirzburg.  Druck 
nnd  Yerlag  der  Stahel-schen  Buch  und  Kunsthandlung. 
1867.) 

This  is  a  book  of  275  pages,  on  "  The  Curability  of 
Pulmonary  Phthisis.*'  The  disease  is  said  to  be  the 
cause  of  about  one-fifth  of  all  deaths,  and  of  about  one- 
half  of  those  occurrinc;  between  the  ages  of  fifteen  and 
thirty  years.  The  nrst  part  of  the  book  is  occupied 
with  the  relation  of  oases  that  have  terminated  in  cure, 
under  different  methods  of  treatment. 

The  author  seems  to  have  drawn  his  material  from 
various  sources,  French,  German,  English,  and  Russian 
authors  being  quoted.  Indeed,  Dr.  U.  speaks  as  if  his 
work  were  intended  as  a  redum^  of  all  that  has  been 
written  on  the  subject,  with  the  addition  of  observa- 
tions of  his  own. 

The  most  important  part  of  the  treatment  is  con- 


sidered to  be  prophylaxis.     "It  is  easier  to  prevent 
phthisis  than  to  cure  the  dightest  case  of  W* 

Among  the  prophylactic  means  is  mentioned  residence 
at  the  sea-shore.  This  is  useful  in  chronic  phlogosis  of 
the  pulmonary  mucous  membrane,  with  tubercle  threat- 
ening or  just  deposited,  but  is  injurious  in  the  stage  of 
softening. 

Another  important  point  in  prophylaxis  is  the  avoid- 
ance of  marriages  between  relatives  or  tuberculous  per- 
sons. The  choice  of  climate  for  the  residence  of  tuber- 
culous patients  has  always  been  considered  very  im- 
portant, and  the  advantages  of  the  different  places 
recommended  are  here  very  extensively  discussea. 
.  Among  the  methods  of  treatment  proper,  those  by 
nebulized  fluids,  iodine,  cod-liver  oil,  raw  meat,  and 
alcohol,  etc.,  are  mentioned  at  some  length. 


1^cp0rt«  0f  Saciettes. 


N.  Y.  PATHOLOGICAL  SOCIETY. 

Stateu  Mebtino,  April  24,  1867. 

Dr.  H.  B.  Sands,  President,  in  the  Chair. 

ovariotomy,  sffeot  of  intra-abdominal  lioaturs. 

Dr.  Cutter  presented  the  remains  of  the  ovary  of  the 
patient  upon  whom  he  had  operated  a  few  weeks  ago. 
The  case  was  that  of  the  old  lady  reported  at  the  last 
meeting,  who  died  the  fourth  day  aflter  the  operation, 
firom  exhaustion.  He  desired  simply  to  exhibit  the 
specimen  as  an  illustration  of  the  effects  of  intra-abdom- 
inal ligature.  There  was  found  on  post-mortem  exam- 
ination, union  throughout  the  whole  extent  of  the 
wound,  and,  with  the  exception  of  a  little  bloody  se- 
rum in  the  cavity  of  the  i&)domen,  nothing  abnormal 
was  noticed.  The  point  at  which  the  ligature  was  ap- 
plied to  the  pedicle  was  considerably  shrunken,  so  that 
the  ligature  itself,  while  being  partially  encysted,  was 
quite  loose ;  but  what  at  first  sight  seemed  remarkable, 
was  that  the  vitality  of  the  pedicle  beyond  the  ligature 
was  preserved.  This  he  thought  was  in  part  due  to  a  con- 
nectmg  band  from  the  proximal  side  to  the  pelvis. 

Dr.  Sands  thought  that  the  latter  circumstance  could 
be  explained  by  the  recollection  that  a  very  large  ves- 
sel was  tied  in  a  very  thick  pedicle,  and  that  the  sub- 
fiequent  shrinking  of  the  tissues  in  the  neighborhood 
allowed  the  artery  to  expand  sufficiently  to  give  the 
necessary  supply  of  blood  to  the  parts  beyond.  He 
also  believed  that  the  ligamentous  band  connecting  the 
pedicle  with  the  pelvis  had  considerable  to  do  with  the 
preservation  of  the  life  of  the  distal  end  of  the  ligated 
portion. 

Dr.  Pobt  presented  a  specimen  of  disease  between 
the  first  and  second  phalsmges  of  the.  finger  of  a  child 
two  years  old.  The  disease  existed  about  a  year,  and 
the  finger  at  the  affected  point  was  so  enormously 
swollen  that  the  doctor  was  inclined  to  believe  that  the 
bone  was  affected.  On  removing  the  member  by  am- 
putation, the  said  enlargement  was  found,  much  to  his 
surprise,  to  be  confined  mostly  to  the  soft  tissues.  The 
articulation  itself  was  the  seat  of  caries. 

WELL  DEVELOPED  MAMMARY  GLANDS  IN  A  MALE. 

Dr.  Watts,  Jr.,  exhibited  an  Irishman,  fifty  years 
of  age,  who  was  malformed  in  rather  a  remarkable 
manner.  Li  the  first  place,  he  had  a  pair  of  Well  de- 
veloped mammary  glands,  and  secondly,  his  penis  was 
only  about  three-quarters  of  an  inch  in  len^,  and 
the  different  parts  of  the  organ  were  proportioned  in 
size.  The  subject  of  these  phenomena  wa<*  fifty  years 
of  age,  was  one  of  thirteen  well  formed  children,  had 


Digitized  by 


Google 


232 


THE  MEDICAL  RECORD, 


beea  married,  and  was  enabled  to  have  sexual  inter- 
course and  seminal  emissions.  He  never  had  any  chil- 
dren. Since  he  has  become  a  widower,  he  is  not  un- 
frequently  troubled  with  Ubidinous  dreams.  There 
was  no  blood  relationship  between  his  father  and 
mother.  The  mammae  had  all  the  appearance  and 
feel  as  if  made  up  of  lacteal  tissue. 

TUBEROULOUS  DISEASE  OF  LIYXB. 

Dr.  Lewis  Smith  exhibited  a  liver  removed  from  a 
female  seventy-six  years  old,  who  died  of  old  age.  In 
the  left  lobe  of  the  organ  was  situated  a  circumscribed 
whitish  granular  cheesy  tumor,  having  very  much  the 
appearance  of  a  tuberculous  mass.  He  was  inclined  to 
believe  that  the  appearances  were  due  to  an  hydatid 
cjst,  which  had  undergone  a  distinctive  metamorpho- 
sis. In  confirmation  of  this  view  he  quoted  some  re- 
marks from  French's  work  on  the  liver.  No  micro- 
scopical examination  sufficiently  thorough  had  been 
made,  for  the  purpose  of  finding  die  characteristic  hooks 
of  the  echinococcus. 

On  motion,  Dr.  Smith  was  requested  to  make  such 
an  examination  and  report  the  result  at  the  next 
meeting. 

Dr.  Smith  next  presented  a  lung  taken  from  a  child, 
who  died  at  the  nursery,  BlackweU's  Island.  The  pa- 
tient was  ten  months  old,  and  had  symptoms  of  pneu- 
monia twelve  days  preceding  its  death.  The  seat  of 
the  pneumonia  was  detected  by  auscultation  and  per- 
cussion ;  there  was  dulness  on  the  right  side  and  below 
the  scapula,  and  some  dulness,  less  in  degree,  on  the 
left  side.  When  this  child  had  been  sick  about  six  days, 
it  began  to  have  a  croupy  cough.  At  the  same  time 
there  was  upon  the  left  side  considerable  inflammation 
of  the  cervical  glands  and  neighboring  cellular  tissue 
On  examining  the  iauces  there  was  noticed  a  consider- 
able deposit  of  lymph  upon  the  fauces,  and  a  diagnosis 
of  diphtheria  supervening  on  pneumonia  was  made. 
The  child  finally  died  of  debility.  On  post-mortem  ex- 
amination the  faucial  deposit  was  granular  in  appear- 
ance, and  under  the  microscope  revealed  the  fibrillse.  as 
well  as  the  pyoid  corpuscles.  This  deposit  extended  as 
far  down  as  the  rima  plottidis.  Qne  point  of  interest 
was  the  impossibility  of  inflating  that  portion  of  the 
lung  which  had  been  the  seat  of  pneumonia.  He  re- 
marked that  Bouchut  had  stated  &at  in  the  first  and 
second,  and  sometimes  even  in  the  third  stage  of  that 
disease,  the  infantile  lung  was  inflatable. 

WAS  IT  A  rBACTURE  OP  THE  ACROMION? 

Dr.  Hamilton  presented  a  scapula  which  had  been 
sent  him  by  a  gentleman,  asking  if  there  had  been  a 
fracture  of  the  acromion  process.  From  an  examination 
of  the  specimen  he  was  enabled  positively  to  decide 
that  it  was  not.  This  condosion  was  based,  in  the 
first  place,  upon  Xhe  fact  that  the  disjunction  was  in  the 
situation  of  one  of  the  epiphyses  of  the  acromion.  In 
passing,  he  remarked  that  the  acromion  process  was 
formed  of  two  epiphyses,  the  shorter  one  being  very 
fi^uently  found  separated,  and  the  other  less  often. 
It  was  this  last  one  which,  not  being  united,  was  mis- 
taken for  a  firacture.  In  the  second  place,  there  was 
no  displacement ;  and,  thirdly,  it  had  a  perfect  capsule. 
This  last  argument  was  used  with  the  full  knowledge 
that  such  a  condition  might  exist  after  some  fractures, 
but  only  in  such  as  were  kept  constantly  in  motion. 
Lasthr,  at  the  seat  of  the  separation  there  was  an  ele- 
vated crest  or  margin,  acondition  which  was  never  met 
with  in  a  case  of  fracture  with  a  capsule.  The  patient 
was  a  male,  seventy  years  of  age,  and  a  thorough  ex- 
amination of  the  skeleton  failed  to  detect  any  other 
epiphyseal  separations;  an  argument  which,  by-the-by, 


was  used  in  support  of  the  supposition  that  the  lesion 
exhibited  was  a  fi*acture. 

EPITHEUOMA    OP    PREPUCE     FOLLOWING     CONOBNITAL 
PHTM06IS. 

Dr.  ELiMiLTON  next  exhibited  an  epithelioma  of  the 
prepuce  which  he  had  removed  a  few  days  ago.  The 
patient  was  thirty-one  years  of  age,  and  had  a  congen- 
ital phymosis,  and  had  never  been  able  to  retract  the 
foreskin.  About  the  latter  part  of  last  January  he  re- 
ceived an  injury  of  the  penis,  in  consequence  of  which 
it  became  swollen.  About  a  month  ago  the  integu- 
ment in  front  of  the  extremity  of  the  prepuce  became 
thickened,  and  cracked.  Instead  of  ian  ulceration  at  the 
latter  point  there  was  disclosed  a  fungus  the  size  of  a 
ten-cent  piece,  which  was  flattened,  and  had  a  firm  and 
indurated  base. 

He  stated  that  this  was  the  seventh  case  of  epithelio- 
ma of  the  penis  upon  which  he  had  operated ;  and  of 
these,  five  were  examines  of  congenital  phymosis.  He 
regarded  that  simple  circumstance  in  itself  sufficient 
reason  why  we  should  make  haste  to  operate  upon  all 
such  cases  in  early  life.  He  had  observed  that  in  all 
the  cases  it  seemed  to  have  commenced  in  the  integu- 
ment of  the  prepuce.  In  five  of  the  seven  it  had  already 
involved  the  gland ;  in  all  it  seemed  to  have  commenced 
in  the  prepuce.  In  six  of  the  seven  he  had  amputated 
more  or  less  of  the  penis ;  in  five  of  the  seven  had  made 
amputations  primarily,  and  in  the  remaining  sixth  the 
operation  of  cutting  away  the  phymosis  was  extended 
to  amputation  on  account  of  finding  the  penis  diseased. 
In  reference  to  the  amputation  he  remarked  that  in  all 
save  the  last  he  had  used  the  knife  and  had  been  both- 
ered with  secondary  haemorrhage ;  in  the  last  case,  how- 
ever, the  ^raseur  was  employed,  and  no  such  unpleasant 
results  followed.  From  the  satisfactory  behavior  of  the 
stump  in  that  instance  he  had  made  up  his  mind  to  pre- 
fer the  ^raseur  hereafter. 

Dr.  Finnell  presented  a  cacum  removed  from  a  per- 
son who  died  of  heart  disease.  The  appendix  vermi- 
formis  was  found  perforated  with  an  alvine  concretion, 
and  adherent  to  the  caecum.  No  history  of  the  case  was 
obtainable. 

Acy'oumed. 

Stated  Meeting,  Mat  8,  1867. 
Dr.  Henrt  B.  Sands,  President,  in  the  Chair. 

incised  wound  through  heart. 
Dr.  Thomas  0.  Finnell  presented,  on  behalf  off  Dr. 
John  Beach,  a  heart  taken  from  a  man  who  was  stabbed 
with  a  butcner-knife  on  the  left  side,  below  the  nipple. 
The  weapon  entered  the  thorax,  between  the  sixih  and 
seventh  ribs,  pierced  the  pericardium  and  the  left  ventri- 
cle of  the  neart,  cutting  the  apex  across.  He  lived 
long  enough  to  descend  a  flight  of  stairs,  when  he  fell 
and  expired.  The  lungs  were  much  compressed  with 
blood  ^t  filled  the  left  pleural  cavity. . 

DEATH  produced  FROM  ABORTION. 

Dr.  Finnell  presented  another  specimen,  on  behalf  of 
Dr.  Leo :  the  generative  organs  of  a  woman  thirty-nine 
years  of  age.  She  was  in  the  eighth  month  of  her 
pregnancy,  and  tried  to  produce  an  abortion  on  herself 
by  various  means.  She  used  a  glass  chimney  as  a  specu- 
lum, before  a  mirror,  and  irritated  the  uterus  with  a 
whalebone,  longhair-pins,  etc.  However,  she  did  not 
succeed,  and  went  to  an  abortionist  in  Amity  street, 
who  had  performed  a  similar  operation  on  her  twice 
before.  She  was  delivered  of  a  child  on  April  4.  Dr. 
F.  saw  her   first   on  April   21,    and   diagnosticated 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


23a 


uterine  phlebitis.  Pulse  was  130,  and  kept  the 
same  way  for  ten  days.  She  died  on  the  nineteenth 
day  after  the  operation  of  pyaemia.  She  had  marked 
chiUs  twice  a  day  a  short  time  before  her  death,  not 
much  feyer,  but  severe  pun  and  vomiting. 

Pott-Ifortem, — The  uterus  was  much  enlarged,  and 
presented  a  dark  appearance;  the  attachment  of  the 
placenta  could  be  distinctly  seen.  On  the  left  side  of 
cervix  uteri  was  an  extravasation ;  abscesses  were  found 
in  both  ovaries,  and  matter  exuded,  on  cutting  into  them. 
The  veins  were  filled  with  coagula.  The  vagina  had  a 
Email  discoloration ;  the  uterus  was  almost  gangrenous, 
discharging  a  thick  muco-purulent  matter,  of  a  yellow- 
ish color.  There  was  no  peritonitis,  nor  any  other 
signs  worthy  of  note. 

IXEURISM  OP  THE  RIGHT  SUBCLAVIAN  ARTEBT. 

Dr.  Mabkoe  presented  the  heart,  aorta,  and  its  prin- 
cipal branches,  taken  from  the  body  of  a  man  at)Out 
fifty  years  okL  The  patient  was  a  drv-goods  clerk, 
married,  and  regular  in  habits,  though  not  of  ro- 
bust health.  About  the  1st  of  January  last  he  began 
to  have  occasional  attacks  of  dyspnoea,  for  which  he 
consulted  Dr.  Hunter,  who  recognized  aneurism  of  the 
right  subclavian  artery,  and  sent  him  to  the  clinique  of 
the  College  of  Physicians  and  Surgeons.  The  aneurism 
was  discovered  about  the  size  of  half  an  egg^  situated 
just  where  the  artery  emerges  from  the  scaleni.  The 
pulsation  was  very  distinct  and  forcible,  the  tumor 
swelling  out  to  twice  its  size  at  every  pulsation  of  the 
heart  The  pulsation  of  all  the  hu*ger  arteries  of  the 
neck  was  very  active,  though  no  other  aneurismal  di- 
•  latation  was  noticed.  The  same  energetic  pulsation  was 
observed  m  the  iliac  and  femoral  arteries.  The  man's 
gen  ral  appearance  was  pale  and  anaemic,  though  he 
suffered  no  pain,  and  indeed  presented  no  symptom  of 
disease  except  the  occasional  attack  of  dyspnoea,  which 
most  commonly  came  on  at  night  There  was  a  marked 
bruit  (de  soufflet)  alone  the  course  of  the  aorta,  but  no 
duhiess  in  any  part  of  the  chest,  which  would  indicate 
iutemal  aneurism.  The  bruit  was  thought  from  its 
softness  to  be  anaemic. 

It  was  noticed  that  the  pulse  on  the  left  side  was 
veiy  faint  and  small  as  compared  with  that  of  the  right 
side.  This  paroxysm  of  dyspnoea  increased  gradually 
in  frequency  and  in  severity,  and  he  finally  succumbed 
onMav  5. 

The  heart  was  enlarged,  and  its  tissue  had  undergone 
some  degree  of  fatty  degeneration.  The  aortic  valves 
were  thickened,  corrugated,  and  at  their  base  calcified. 
The  aorta  was  larj^ely  dilated,  atheromatous  and  calci- 
fied. The  innominata  was  natural  in  size,  but  some- 
what irregular  and  puckered  on  its  surface.  The  right 
carotid  was  thickened  in  its  whole  course,  so  that  its 
caKbre  was  diminished.  The  right  subclavian  was  of 
natural  size,  till  it  emerged  from  the  scaleni,  and  there 
presented  a  sudden  dilatation^  apparently  of  all  the 
coats,  which  formed  an  aneurism,  now  much  smaller 
than  it  appeared  in  life,  entirely  empty  of  blood,  and 
occupying  about  an  inch  and  a  half  or  the  vessel.  Be- 
vond  this  aneurism  the  artery  suddenly  resumed  its 
Wthy  condition.  The  left  carotid  was  slightly  dilated, 
iud  the  left  subclavian,  commencing  beyond  the  thyroid 
axis,  was  so  contracted  that,  at  one  point,  its  calibre 
wag  diminished  at  least  two-thirds.  All  these  dihitations 
were  of  the  fusiform  variety,  and  embraced  all  the  coats 
of  the  artery.  That  the  arterial  coats  were  diseased 
was  manifested  not  only  from  their  thickened  and  irregu- 
lar sorfkces,  but  firom  the  fact  that  the  surrounding 
tissues  were  morbidly  adherent  to  thetn  at  every  point 
making  dissection  oifficult;  a  condition  which  would 


pretty  certainly  make  a  difference  in  the  facility  and 
success  of  any  operation  to  be  performed  on  them. 

Dr.  Markoe  remarked  that  he  had  wat^ihed  this  case 
with  unusual  interest,  as  he  had  at  one  time  hoped  he 
might  be  able  to  do  something  for  its  relief  by  an  ope- 
ration. He  did  not  believe  that  it  was  sound  surgery 
ever  to  put  a  ligature  on  the  subclavian  in  the  fit  st  part 
of  its  course,  as  there  was  not  room  for  a  clot  to  form, 
on  account  of  the  return  current  through  the  vertebral, 
and  in  every  case  when  death  had  occurrtjd  from 
haemorrhage  it  had  been  from  the  distal  side.  He  had 
determined  in  his  own  mind,  if  ever  the  opportunity 
offered,  to  apply  in  a  similar  case  a  ligature  to  the 
innominata  near  its  bifurcation,  and  also  one  upon  the 
common  carotid,  just  above  its  origin.  He  believed 
that  this  was  the  only  operation  on  subclavian  aneu- 
rism which  promised  success.  Dr.  Mott,  in  his  history 
of  the  operation  on  the  innominata,  makes  the  same 
suggestion. 

GRANCTLAR  DISEASE  OF  THE  KIDNEY. 

Dr.  Notes  exhibited  a  kidney,  which  was  brought 
to  him  by  a  country  practitioner.  The  specimen  was 
particularly  presented  to  show  that  wiih  tne  aid  of  the 
ophthalmoscope  a  correct  diagnosis  can  be  made  of 
Bright's  disease.  He  saw  the  patient  in  the  latter  part 
of  January.  The  patient  was  a  fanner,  49  years  old  • 
the  last  four  months  he  had  complained  of  impaired 
sight,  loss  of  appetite,  and  an  increasing  weakness. 
Dr.  N.  found  retinitis,  an  albuminous  urine,  and  made  a 
positive  diagnosis  of  morbus  Brightii.  There  was  no 
heart  disease. 

Dr.  Sands  remarked,  that  he  had  examined  a  patient 
with  albuminuria  two  months  ago  and  also  found  no 
heart  disease. 

Dr.  Notes  found  in  the  case  under  consideration  no 
ecchymosis  in  the  retina,  which  is  always  seen  in  cases 
associated  with  heart  disease. 

ANEURISM  OF  CCBUAO  AXIS. 

Dr.  E.  C.  Seouin  presented  a  specimen,  which  was 
removed  from  the  body  of  a  sailor,  36  years  of  age, 
who  died  on  the  3d  of  May,  in  the  New  York  Hospi- 
tal. On  admission,  April  30,  he  gave  the  following 
history : 

Two  months  previously  he  began  to  suffer  from 
rheumatic  pains  in  the  legs,  arms,  and  left  side  of  body, 
which  pains  had  been  decidedly  nocturnal.  The  pain 
in  the  abdomen  he  located  in  the  epigastiium,  poing 
through  to  the  lumbar  region,  around  the  left  hypo- 
chondriac space;  and  he  described  it  as  very  sharp  and 
severe.  He  stated  that  until  one  month  a>iO  he  never 
had  any  dyspnoea;  that  he  never  had  suffered  from 
acute  rheumatism,  or  received  any  injury.  Five  years 
previously  he  contracted  syphilis,  and  since  has  had 
skin  and  throat  secondary  symptoms.  He  had  con- 
tinued the  duties  of  an  able  seaman  during  the  first 
month  of  illness,  but  had  after  that  time  taken  to  his 
bed.  He  noticed  about  three  weeks  ago  that  lying 
on  his  back  caused  increased  pain. 

On  being  examined  in  the  wurd,  he  was  found  lying 
upon  his  right  side,  his  knees  drawn  up,  his  face  being 
pale  and  expressive  of  pain  and  anxiety.  The  tibisa 
and  uhue  were  found  swollen  and  tender;  and  the 
glands  about  the'  elbows  and  neck  enlarged.  Gre^ 
tenderness  was  found  in  the  abdomen  over  the  left 
hypochondriac  region,  the  epigastrium,  and  over  the 
lower  ribs  near  the  spine.  In  the  epigastrium  a  pulsa- 
tion was  distinctly  visible,  and  on  applying  the  hand  a 
little  firmly,  a  distinct  aneurismal  thnll  was  perceived- 
Auscultation  showed  the  heart  and  arch  of  aorta  fVee 
from  abnormal  sounds,  but  about  an  inch  above  the 


Digitized  by 


Google 


234 


THE  MEDICAL  RECORD. 


ensiform  cartilage  in  the  median  line,  a  loud,  hard  sys- 
tolic murmur  was  heard.  On  tracing  it  downwards,  it 
appeared  loudest  at  the  apex  of  the  sternal  appendix, 
getting  fainter  helow  that  point  untQ  lost  midway 
between  the  umbilicus  and  pubes.  In  the  back  no 
true  murmur  was  to  be  found,  but  a  sort  of  shock  or 
"  thud/*  with  the  systole  of  the  heart,  was  audible  over 
the  tenth  dorsal  vertebra.  No  anenrigm  was  to  be 
found  in  any  of  the  superficial  Arteries.  A  careftil 
examination  of  the  urine  failed  to  reveal  albumen  or 
casts. 

The  diagnosis  was  made  of  aneurism  of  the  aorta  in 
the  neighborhood  of  the  coeliac  axis. 

Preparations  were  made  to  put  him  upon  the  postu- 
ral plan  of  treatment,  and  meanwhile  morphia  was 
given  hypodermically  to  allay  the  pain.  Unfortunately 
the  issue  was  nearer  than  anticipated;  on  May  3,  at 
1  P.M.,  the  patient  put  his  hand  upon  the  tumor  and 
fell  into  a  fatal  syncope.  No  imprudent  movement 
was  made  previous  to  this. 

The  autopsy  was  made  24  hours  post-mortem.  The 
abdominal  cavity  contained  an  enormous  anantity  of 
blood ;  3f  lbs.  of  clot,  and  4  lbs.  of  liquid  blood.  The 
heart  and  lungs  were  healthy.  The  aorta  was  removed 
as  far  as  its  division  in  the  pelvis.  The  valves  were 
healthy,  but  the  vessel  was  extensively  atheromatous; 
in  the  arch  anteriorly  an  aneurismal  pouch  had  com- 
menced to  form.  Lower  down  opposite  the  coeliac 
axis,  no  dilatation  was  to  be  found ;  the  branches  of 
the  vessel  arising  in  a  normal  manner.  But  on  tracing 
out  these  branches,  a  large  aneurism  was  found  con- 
nected with  the  coeliac  axis  proper,  adherent  on  the 
left  to  the  supra-renal  capsule,  on  the  right  to  the  lobus 
Spigelii  of  the  liver,  and  above  intimatdy  connected 
with  the  diaphragm.  The  branches  of  the  axis  escaped 
from  the  lower  part  of  the  sac,  whose  walls,  i  of  an  inch 
thick,  were  rough  internally,  made  up  of  very  old  layers 
of  fibrin ;  the  rupture  having  taken  place  (an  opening 
•i-  inch  across)  at  the  anterior  edge  of  the  adhesion  with 
the  liver.  The  sac  contained  but  a  litUe  liquid  blood 
and  clot  The  remaining  abdominal  vessels  were 
healthy. 

The  spleen,  liver,  and  kidneys  were  healthy.  The 
physical  signs  in  the  case  are  remarkable,  and  might 
nave  been  suflScient  for  the  making  of  an  exact  diagno- 
sis. There  was  no  doubt  as  to  the  weight  of  the 
aneurism,  and  dilatation  of  the  aorta  might  have  been 
excluded  on  account  of  the  absence  of  bruit  in  the 
back.  It  is  very  remarkable  that  the  patient  had  never 
suffered  fix)m  vomiting  or  any  disorder  of  the  digestive 
orgins  excepting  constipation. 

The  Society  then  went  into  executive  session. 

ExTRAORDiNABT  Obisitt. — ^A  woman  named  Hogan, 
wife  of  a  comfortable  farmer  living  at  Kihnastulla,  Ire- 
land, died  recently  from  obesity.  Mrs.  Hogan,  in  her 
youth,  showed  symptoms  of  attaining  more  than  ordi- 
nary proportions,  and  she  continued  to  increase  in  size 
until,  at  the  time  of  her  death,  she  had  reached  the 
extraordinary  weight  of  forty-eight  stone  (672  pounds)  I 
She  was,  for  the  last  few  years  of  her  life,  scarcely 
able  to  walk,  and  for  some  time  past  entirely  confined 
to  her  bed. 

HoopiNO-CouGH. — A  correspondent  of  the  Laruet 
says  that  he  has  very  often  succeeded  in  cutting  short 
the  paroxysms  in  this  disease  by  applying  a  blister  or 
sinapism  to  the  nape  of  the  neck  or  the  shoulders  of  the 
little  sufferer.  This  may  be  repeated  as  occasion  may 
require.  It  has,  of  course,  no  effect  upon  the  bronchi- 
tio  and  pneumonic  complications. 


Carregponljenc^ 


THE   PUBLICATION   OP  REPORTS  OP  SOCTE- 

TIES. 

To  THS  Edttob  of  tbb  Mkdioal  Bmoed. 

Sir — ^With  the  advent  of  warm  weather  in  earnest, 
many  of  our  patients  are  departing  for  the  sea-side,  the 
springs,  the  mountains — anywhere  out  of  the  heat,  and 
out  of  the  bustle  of  the  city ;  and  some  of  the  uniortu* 
nate  can*t-get-awav  doctors  are  parting  for  a  time  with 
their  domestic  enaearments  to  lead  a  bachelor  life  in 
the  city,  until  the  season  becomes  suitable  for  the 
return  of  their  &miltes.  Summer  courses  of  medical 
instruction  are  suspended,  clinics  closed,  societies  ad- 
journed ;  what  matters  of  professional  interest  are  there 
to  write  about  ?  In  the  want  of  something  to  chroni- 
cle, let  me  chat  to  you  a  bit  about  ihe  puhlication  of 
Reports  of  Societies  in  medical  journals.  This  is  a  sub- 
ject which  during  the  past  year  Has  exercised  some  of 
the  members  of  the  profession  here  a  good  deal,  and 
culminated  at  a  business  meeting  of  the  County  Medi- 
cal Society,  a  few  months  ago,  in  a  resolution  prohibit- 
ing the  report  of  their  discussions  in  medical  jouraals, 
whether  by  professional  reporter  or  member  of  the 
society,  without  certain  oflBcial  sanction,  and  the  indi- 
vidual supervision  of  those  members  participating  in 
the  discussion.  So,  sir,  unless  your  correspondent  has 
influence  enough  in  the  fall,  to  have  this  resolution,  or 
motion,  or  whatever  it  was,  reconsidered,  you  will  have 
to  strike  from  your  columns  the  reports  of  the  Phila- 
delphia County  Medical  Society. 

Now,  sir,  what  are  the  objections  urged  against  the 
publication  of  the  reports?  That  they  are  not  oflScial, 
that  they  are  often  incorrect,  or  to  use  an  offensive 
phrase,  "garbled,"  and  that  they  are  not  subjected  to 
the  revision  of  the  speakers. 

Now,  sir,  in  my  opinion,  the  report  of  a  discussion, 
such  as  has  been  contributed  at  times  to  your  columns, 
is  not  intended  as  an  ofl&cial  transaction^  nor  as  a  sub- 
stitute for  such ;  it  is  simply  a  record  of  such  comment 
as  certain  subjects  call  forth  at  the  time.  Every  one 
who  reads  the  Journal  knows  exactly  the  manner  in 
which  discussions  on  special  medical  subjects  take 
place,  and  does  not  expect  the  language  or  precision  of 
an  official  promulgation.  He  knows  that  a  paper  is 
read  by  a  member,  or  a  subject  introduced  extempora- 
neously; that  comment  is  elicited  from  those  who 
listen;  that  pertinent  matter  overlooked  by  previous 
speakers  is  referred  to  by  succeeding  ones ;  that  pecu- 
har  views  are  enunciated,  and  those  already  advanced 
endorsed  or  combated;  tnat  sometimes  speakers  arise, 
occupy  a  good  deal  of  time  without  bringing  forward 
any  new  idea,  or  merely  reiterate  what  has  already 
been  brought  forward  more  distinctly ;  that  others 
branch  off  from  the  subject  and  give  valuable  disserta- 
tions on  extraneous  topics ;  that  later  in  the  discussion 
some  one  reviews  the  entire  debate :  and  finally,  when 
all  that  have  desired  to  express  their  views  remain 
silent,  the  discussion  closes. 

There  is  a  good  deal  of  information  to  be  gained 
from  these  discussions;  practical  experience  is  narrated 
which  would  never  be  otherwise  recorded ;  the  accord- 
ance or  non-accordance  of  theories  subjected  to  the  prac- 
tical test — and  naturally  a  medical  journal  w  anxious 
to  avail  itself  of  whatever  value  arisen  therefi^m ;  and 
hence  the  prominent  place  usually  accorded  to  Reports 
of  Societies  in  such  journals. 

To^print  in  full  a  paper  which  may  have  taken  an 
hour  or  more  to  read,  to  print  in  extenso  the  remarks 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


235 


that  it  may  have  called  forth,  is  the  province  of  those 
haying  in  charge  the  publication  of  tne  official  Trans- 
actionB  of  the  AjBsociation. 

The  province  of  the  Medical  Journal  is  to  mention 
the  subject,  present  a  short  synopsis  of  the  paper,  or 
describe  its  tenor,  indicate  the  nature  of  the  discussion 
which  ensued,  and  call  attention  to  anything  new  or 
Tahiable  that  may  have  been  elicited  in  consequence. 
This  is  to  be  done  to  the  best  of  the  ability  of  the  party 
to  whom  the  matter  may  be  intrusted  by  his  editor, 
and  a  certain  amount  of  discretionary  responsibility 
most  rest  upon  that  individual,  as  to  how  much,  and 
what  much  of  the  paper  and  discussion  is  to  be  reported. 
A  full  report  is  always  too  bulky  for  the  pages  of  a 
medical  journal,  and  would  often,  perhaps,  command 
perusal  less  frequently  than  a  synopsis ;  and  then  many 
societies  claim  equal  representation. 

To  present  for  individual  revision  the  copy  of  the 
remarks  made  by  those  taking  part  in  the  discussion  is 
irksome,  for  many  reasons.  Not  so  much  on  account 
of  a  change  of  language  which  some  might  desire  to 
substitatej  but  because  of  the  impossibility  of  pleasing 
every  individual  as  to  the  particular  report  of  his  own 
remarks.  One  gentleman  would  re-write  the  whole 
thing,  inserting  many  things  which  escaped  his  atten- 
tion daring  his  own  participation  in  the  debate,  and 
perhaps  nmlifying  entirely  the  value  of  the  remarks  of 
acme  later  speaker,  who  had  been  induced  to  take  part 
solely  because  such  topics  had  not  been  alluded  to 
before.  Another  gentleman  would  send  his  copy  back 
re-written,  occupying  three  or  four  times  the  space  that 
had  been  allowed  for  him,  with  a  polite  note,  that  he 
would  prefer  his  remarks  to  be  published  as  re-written 
by  himself  Another  gentleman  would  keep  his  copy 
three,  fisur,  or  twelve  weeks  aHer  all  the  rest  had  been 
returned,  and  thus  publication  would  be  delayed,  the 
editor  annoyed,  and  the  reporter^worried.  Then,  after 
an  was  ready  for  the  press,  some  matter  would  have  to 
be  eat  ont,  and  how  to  do  this  without  offending  those 
vbo  had  gone  to  the  trouble  of  correcting  the  copy  of 
their  own  remarks,  would  puzzle  even  those  most 
et^  offended. 

miere  a  Society  publish  their  Transactions  regularly, 
in  pamphlet,  or  m  some  certain  medical  journal  all 
these  matters  are  attended  to,  and  there  is  a  complete- 
ness about  the  production  that  would  be  sought  K>r  in 
vain  in  a  journal  account  In  the  latter,  elegance  of 
diction  is  not  oflen  looked  for,  because  but  few  possess 
such  extemporaneous  ability ;  methodical  consideration 
of  the  subject  is  expected  only  from  the  party  intro- 
ducing it,  because  it  has  been  his  duty  to  prepare  him- 
self; those  following,  often  speak  on  the  spur  of  the 
moment^  and  their  remarks  lack  the  finish  that  would 
pervade  an  essay  emanating  from  their  study ;  so  that 
It  is  necessarily  inferior  in  every  respect  to  an  official 
record.  Yet  for  that  reason  it  need  not  be  incorrect, 
because  it  records  something  a  gentleman  did  say,  but 
did  not  mean  to  say ;  nor  need  ii  be  garbled  because  it 
has  selected  frt)m  a  gentleman's  remarks  those  consi- 
dered most  novel  or  most  instructive,  or  changed  the 
record  into  narrative,  in  order  to  economize  space. 

Beside^  the  record  of  a  Society  meetmg,  as  usually 
reported,  without  referring  the  copy  to  the  speakers  for 
revision  or  approval,  may  prompt  participants  in  a  dis- 
CQssion  to  more  care  in  their  remarks,  to  a  habit  of 
coming  to  the  meeting  booked  up  on  the  subject^  so  as 
to  avoid  the  poasibihty  of  saying  what  they  did  not 
mean  to  say.  But,  where  a  good  deal  of  latitude  is  to 
be  allowed  in  re-arranging  remarks,  interpolating  what 
was  forgotten,  etc,  less  attention  will  be  paid  to  the 
tobject  at  the  time  of  speaking  by  those  who  would  de- 
pend upon  a  future  opportumty  to  correct  inadverten- 


cies or  supply  deficiencies;   and  thus  the   discussion 
would  not  then  be  faithfully  reported. 

I  trust  that  those  who  have  virtually  secured  for  the 
present  the  exclusion  of  reports  of  the  Philadelphia 
County  Medical  Society  from  the  pages  of  the  medical 
press,  will  be  led  to  adopt  views  more  consonant  with 
the  liberal  Catholicism  of  the  profession,  that  their  col- 
leagues elsewhere  may  not  be  deprived  of  the  chance  of 
occasional  participation  in  the  crumbs  of  information 
which  are  sometimes  dropped  from  the  deliberative  table 
of  that  body. 

Messrs.  Lutdsat  &  Blakiston,  medical  publishers,  of 
this  city,  have  moved  their  salesroom  from  the  ground 
floor  of  their  establishment  to  the  second  story,  which  has 
been  neatly  fitted  up  for  the  purpose ;  and  it  is  said  to  be 
their  intention  to  devote  themselves  to  the  publication 
of  works  on  medical  subjects  more  exclusively  than 
heretofore.  Their  recent  editions  of  Aitken's  Practice, 
of  Waring's  Therapeutics,  and  of  Cazeau*s  Midwifery, 
have  been  introduced  into  the  17.  S.  Army.  They  an- 
nounce the  reception  of  the  third  part  of  Trousseau's 
Clinique  M^dicale,  and  the  appearance  of  a  new  edition 
of  Harris's  Dental  Dictionary ;  of  TafVs  Operative  Den- 
tal Surgery;  and  of  their  Physicians'  Visiting  List  for 
the  coming  year. 

Tours  truly, 

0.  J. 
PuiLAOBLPHiA,  July  & 

NEW  METHOD  OF  "COMPLEnNO" 

T^E  REDUCTION  OP  OLD  DISLOCATIONS  OP 
THE  SHOULDER, 

TWO  CASES  REPORTED. 

Bt  dr.  M.  C.  CUYKENDALL,  OF  BuoYBUS,  Omo, 

nV  A  LBTTEB  TO  DR.   HAMILTON. 
To  TBB  BonoB  or  Tm  Mkdioal  Bmokd. 
Dear  Sir: — ^The  manoeuvre  adopted  by  Dr.  Cuyken- 
dalL  in  his  last  attempt^  was  original  and  ingenious,  and 
iBf  I  think,  worthy  of  a  notice  in.  the  Reoobd. 

Yours  truly,  P.  H.  Hamilton. 

The  following  is  the  report  of  the  case : 

Prof.  Hamilton,  64  Madison  ave. — Dear  Sir — Be- 
lieving that  cases  hke  the  following  interest  you,  I  bee 
leave  to  report  it.  I  would  have  done  so  at  the  time  I 
treated  the  case,  but  I  saw  a  notice  that  you  were 
about  publishing  the  third  edition  of  "  Fractures  and 
Dislocations,"  and  I  deferred  it.  Since  I  procured  that 
work,  and  perused  it  in  parL  I  have  concluded  to  send 
you  the  report,  which  is  as  follows : 

Mr.  V.  Seaton,  of  thife  county,  aged  62  years,  a 
farmer,  of  spare  habit,  fell  from  his  horse,  and  disloca- 
ted the  right  shoulder,  forwards,  under  the  daricle. 

An  Irregular,  who  saw  him  a  few  minutes  after  the 
accident,  pronounced  it  a  sprain,  and  advised  cooling 
lotions.  Seven  weeks  afterwards,  he  applied  to  me, 
when  the  head  oould  be  distinctly  felt^  and  seen,  in  the 
sub-clavicular  fossa. 

I  made  three  attempts,  of  one  hour  each,  at  reduc- 
tion, with  Jarvis's  Adjuster,  assisted  by  Drs.  Meyer  and 
Keller,  of  this  phice,  and  failed,  as  I  believe,  because 
we  only  made  extension  downwards,  and  the  axilla 
pad,  from  its  shape,  pressed  too  hard  upon  the  edges  of 
the  pectoralis  and  fatissimus  dorsi  muscles,  although 
we  filled  the  axilla  as  well  as  we  could.  The  patient 
was  fully  under  chloric  ether  each  time,  and  before  ap- 
plying the  adjuster,  the  arm  was  forcibly  rotated,  and 
moved  in  different  directions  some  fifteen  or  twenty 
minutes.  There  was  an  interval  of  twenty-four  hours 
between  each  trial,  and,  after  the  third  tLme,  the  parts 

Digitized  by  VjOOQIC 


236 


THE  MEDICAL  RiECORD. 


became  so  sore  and  painful,  that  the  patient  decided 
that  be  would  have  not'iinjr  further  done.  However, 
twelve  days  after,  it  being  sixty-foup  days  after  the 
dislocation,  be  consented  to  another  trial,  and  this 
time,  assisted  by  Dr.  Richey,  of  this  county,  I  suc- 
cee  led. 

The  patient  was  laid  upon  the  floor,  the  double 
pulley  secured  to  t^ie  wrist,  and  Skey's  knob  in  the 
axilla,  and  put  fully  under  the  influence  of  chloric 
ether,  and  extension  applied  direetly  downwards,  break- 
inp:  up  many  adhesions,  b«it  not  reducng  the  bone.  I 
then  secured  the  opposite  arm,  and  mada  exten-sion  at 
right  angles  for  some  time,  but,  not  succeeding,  I  se- 
cured the  scapula  with  a  band  acr  83  the  top,  and  made 
extension  directly  upwards,  breaking  up  many  and  ex- 
teu'^ive  adhesion^^  and,  as  I  thought  then,  placing  the 
head  of  the  bone  m  its  socket;  but,  upon  removing  the 
pulley?  and  bringing  the  arm  down  the  head  was  found 
resting'  upon  the  edge  of  the  glenoid  cavity,  and  no  ex- 
tension, that  I  afrerwanls  applied  in  any  direction,  did 
any  Mpparc  nt  good.  I,  as  a  la«t  resort,  secured  the  pul- 
leys aNove  the  elbow,  the  knob  in  axilla,  flexed  the 
arm,  and  maile  extension  downwards  and  forwards,  and 
when  well  extended  I  moved  his  boiy  under  the 
pulley  ropes,  so  as  to  bring  the  arm  forcibly  across  the 
breast,  and  then  keeping  up  the  extension,  I  had  Dr. 
Richey  place  his  knee  upon  the  top  of  the  scapula,  and 
lock  his  finpfers  around  the  elbow,  while  I  placed  my 
knee  ag-ainst  the  elbow  and  locked  my  fingers  around 
the  top  of  the  scapula,  and  directing  the  extension  re- 
moved, we  forced  the  bpne  upwards  and  outwards  to 
its  socket.  During  this  last  operation,  the  breaking  of 
adhesions  was  perceptible,  not  only  to  Dr.  Richey  and 
myself,  but  also  to  the  patient,  who  was  then  partially 
recovered  from  the  effects  of  the  anaesthetic.  We  had 
the  patient  under  the  influence  of  chloric  ether  four 
hours.  His  recovery  was  rapid,  and  he  has  perfect  use 
of  his  arm. 

This  is  the  second  case  of  old  dislocation  of  the 
humerus,  where  I  have  succeeded  in  completing  the 
reduction  by  securing  the  seapula  and  pushing  the  bone 
upward^  and  outwaras,  after  having  failed  with  pulling. 

Should  your  time  permit  you  to  do  so,  I  would  be 
pleased  to  receive  an  acknowledgment  of  this,  with 
your  views. 

I  am,  sir,  very  respectfully, 

M.  C.  ClTTKENDALL. 

THE  EFFECTS  OF  IMMERSION  OF  LUNOS  IN 
ALCHOIIOL  IN  RELATION  TO  THE  QUESTION 
OF  INFANTICIDR 

To  TBB  EoiTOB  or  Tm  Medical  Sbcokd. 

Sir— On  the  19th  ult.  I  was  called  to  inspect  three 
infants  that  had  b?en  f  »und  in  a  street  ash  barrel.  Sus- 
picion of  infanticide  b<  ing  entertained,  an  autopsy  was 
ordered  by  the  coroner,  the  results  of  which  I  think 
are  worthy  of  record.  The  bodies  had  the  appearance 
of  foetuses  of  five,  six,  and  seven  months'  growth,  re- 
spectively. They  had  apparently  been  preserved  in 
alcohol.  The  cords  in  eacM  hai  been  properly  cut  and 
secured.  There  were  no  unusual  marks  on  the  sur- 
face, and  the  presumption  was  strong  from  external  ex- 
amination that  the  bodies  were  those  of  foetuses  that  had 
been  kept  in  alcohol  for  exhibition. 

The  internal  organs  were  somewhat  hardened  by  the 
preservative  fluid  in  which  the  bodies  had  been  placed. 
The  lungs  had  the  appearance  peculiar  to  foetal  life. 
Their  cmdensed  structure,  small  size  and  sharp  edges  of 
their  lobes  proved  to  my  mind  that  they  had  not  been 
ed. 


Both  lung8,with  entire  thoracic  contents, were  thrown 
into  water  and  floated  huoyanUy,  Large  and  small  sec- 
tions of  lung  acted  in  the  same  way.  The  small  pieces 
were  firmly  pressed  and  still  floated.  A  very  small 
piece  when  squeezed  with  a  great  deal  of  strength  was 
made  to  sink.  The  compression  required  to  produce 
this  result  was  far  more  than  is  necessary  to  expel 
air  in  ordinary  cases  when  gas  is  generated  from  pu- 
tridity. 

The  peculiar  character  of  these  lungs  I  think  must  be 
due  to  the  effect  of  the  alcohol  upon  them.  Pieces  of 
liver  thrown  into  water  floated  just  as  the  lungs  did. 
The  appearance  of  the  organs  was  not  such  as  is  usually 
seen  when  decomposition  has  set  in.  There  were  no 
air  vesicles  on  the  surface,  nor  change  in  their  internal 
structure  nor  fetid  ordor.  It  is  possible  that  the  alcohol 
merely  modified  the  putrefactive  process,  causing  a  very 
different  change  in  the  tissue  firom  that  produced  by  ex- 
posure to  the  air  or  water. 

The  lungs  of  the  three  bodies  were  subjected  to  the 
same  tests  with  like  result. 

This  peculiarity  of  tissues  subjected  to  the  action  ol 
alcohol,  it  appears  to  me,  has  an  important  bearing  on 
medical  jurisprudence.  A  case  mignt  occur  where  the 
body  of  an  mfant,  in  suspected  infanticide,  should  be 
preserved  in  alcohol  for  a  length  of  time  before  being 
subjected  to  post-mortem  examination  and  the  hydro- 
static test  make  it  i^^pear  that  a  still-bom  child  had  been 
born  alive.  It  is  true  that  we  are  advised  before  the 
application  of  this  test  to  press  the  lungs  thoroughly, 
but  to  expel  the  air  the  amount  of  pressure  required  in 
the  lung  subjected  to  the  action  of  alcohol  bears  no 
proportion  to  that  ordinarily  used  to  free  it  firom  the 
gases  of  putrefaction. 

WoosTBR  Beach,  Jil,  M.D. 


EXTENSIVE    ADHESION   OF   PELVIC   OR- 

GANS,  ETC., 

AND  THE  ACCOMPANYING  SYMPTOMS. 

To  Tin  Edrob  of  tsb  Mbdioal  Bioobd. 

Sir — I  beg  leave  to  offer  the  following  account  of  the 
singular  developments  of  a  post-'mortem  examination 
recently  made.  The  subject  of  this  examination  was  a 
married  lady,  twenty-six  years  of  age,  without  children. 
About  a  week  prior  to  her  marriage,  in  November,  1865, 
while  residing  in  Chicago,  IlL,  she  took  cold- during  her 
monthly  period,  by  sleeping  in  a  damp  room,  which 
caused  a  suppression  of  the  menses,  followed  in  a  few 
days  by  "  inflammation  of  the  womb."  She  was  very 
dangerously  ill,  and  her  life  was  at  one  time  despaired  o£ 
The  ordinary  symptoms  of  this  acut«  disease  gradually  as- 
sumed a  chronic  form,  and  others  of  great  severity  and  in- 
tractable nature  were  superadded.  Thus  she  continued  to 
suffer  ihroughout  the  winter  fi^m  an  exhausting  diarrhoea, 
from  frequent  and  painfiil  micturition,  and  firom  daily  par- 
oxysms of  agonizing  pain  in  her  back  and  hips.  By  spring 
she  was  reduced  to  the  condition  of  a  skeleton,  having 
lost  50  lbs.  of  flesh.  Her  w^ht  in  the  fall  had  been 
128  lbs.— it  was  now  76.  Very  naturally,  she  was 
thought  to  be  "  in  a  decline,"  and  her  disease  was  pro- 
nounced incurable  by  her  attending  physicians;  their 
diagnosis  being,  "consumption  of  me  bowela"  It 
was  not  even  thought  safe  to  arrest  the  diarrhoetk 
"  lest  it  should  lead  to  a  deposit  of  tubercle  in  t^e  lungs. 
There  also  had  existed  for  several  years  a  grave  disease 
of  the  hearty  which,  however,  had  not  given  rise  to  any 
urgent  or  painful  symptoms.  In  this  condition  she  was 
brought  from  Chicago  in  a  "sick  car,"  and  reached 
her  home  in  Suffield,  Conn.,  Apr^J^,  1866.  ^A  monlh 

digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


237 


later  she  came  under  the  care  of  the  writer,  having 
previously  abandoned  all  hope  of  recovery,  and  having 
Decome  quite  averse  to  any  further  treatment. 

From  a  careful  survey  of  the  case  it  was  thought  that 
her  disease  wa^  not  tuberculous  nor  const  itutioual  but 
local,  and  confined  mainly  to  the  pelvic  organs.  Upon 
examination  the  os  and  cervix  uteri  and  posterior  wall 
of  bladder  were  found  exceedingly  sensitive  and  irritable, 
and  paUent  could  not  bear  the  lightest  pressure  exter- 
nally in  the  pubic  region.  As  a  state  of  chronic  inflam- 
mation, with  great  irritability  of  these  organs,  is  not 
unc«>mmon  in  wompn.  producing  a  train  of  distressing 
symptoms  not  nnlike  those  of  our  patient  (with  the 
exception  of  the  diarrhoea,  which  soon  yielded  to  treat- 
ment), her  case  was  not  considered  hopeless.  Without 
going  into  details  it  is  sufiScient  to  state  that  by  a  dogged 
perseverance  on  the  part  of  her  very  wilful  doctor  and 
most  tenderlv  sympathizing  mother,  and  with  a  patience 
more  than  sokUerly,  because  woTnanly,  on  her  part,  in  the 
use  of  fomentation?^  poultices,  neuraicic  liniments,  plas- 
ters &c.,  in  the  hypog  istric  and  sacral  regions,  together 
with  injections  and  suppositories  per  vaginam  and  per 
rectum,  and  various  internal  remedies  (her  extreme  ema- 
ciation and  debility  forbidding  the  use  of  more  efficient 
treatment  by  leeches,  cups,  and  caustics),  she  was  at 
length  brought  to  a  condition  of  comparative  ease  and 
comfort — suffering  only  from  her  evacuations,  which  at 
times  were  still  very  distressing.  The  persistence  and 
occasional  severity  of  these  troubles  sometimes  shook 
mj  &ith  in  my  dia^o>^i^,  but  never  suggested  any  such 
extensive  organic  bsions  as  the  sequel  wiU  show  were 
found  after  death.  The  neuralgic  pain  in  her  back  and 
limbs  wholly  subsided.  She  became  very  cheerful  and 
hopeful,  and  by  the  Ist  of  August  had  gained  20  lbs.  of 
flesh.  She  was  at  this  time  able  to  ride  out,  and  some 
weeks  later  made  a  four  days'  visit  to  her  sister,  in 
Meriden,  40  miles  distant :  going  and  coming  by  stage 
and  railway.  Her  monthly  periods  were  never  eatab- 
lishcd,  except  by  the  occurrence  of  vicarious  menstruation 
in  the  form  of  epistaxil,  with  generally  an  aggravation  of 
all  existing  symptoms.  Though  subject  to  such  ailments, 
she  continued  to  improve  till  about  the  1st  of  January, 
when,  happening  to  take  cold  after  a  fa'iguing  day's 
labor  (upon  a  hoop  skirt  f),  she  had  an  attack  of  acute 
rheumatism,  which  confined  her  to  the  be<)  three  weeks 
or  more.  Prom  this  attack  she  never  fully  recovered, 
lost  her  appetite,  never  after  sat  at  the  table  with  the 
family  as  before.  She  remained  in  a  state  which  made 
it  doubtful  whether  she  could  rally  or  sink  for  some 
weeks,  and  died  quite  suddenly  April  4. 

In  accordance  with  the  patient's  often  expressed  wishes 
an  examination  of  the  body  was  made  ten  hours  after 
death,  with  the  assistance  of  my  professional  brethren, 
Drs.  A.  Rising  and  W.  H.  Mather. 

The  heiirt  was  found  much  enlarged— of  more  than 
twice  its  normal  size — weighing  a  pound  and  a  quarter. 
The  hypertrophy  of  the  left  ventricle  was  especially 
noticeable,  its  walls  being  ^ly  an  inch  in  thickness. 
This  condition  was  found  to  have  been  occasioned  by  an 
oflidfic  deposit  in  the  mitral  valve,  causing  something  of 
a  contraction  in  the  auriculo-ventricular  orifice,  but  more 
of  an  insufficiency  in  the  valve  itself,  with  consequent 
regurgitation.  The  stage  of  dilatation  apparently  had 
not  been  reached,  hypertrophy  much  predominating, 
which  would  account  for  the  extraordinary  vigor  of  the 
patient's  circulation.  Her  extremities  were  never  cold, 
notwithstanding  her  low  condition,  and  she  requirea 
much  less  clothing  on  her  bed  than  any  other  member 
of  the  fiamilv.  This  disease  of  the  heart,  no  doubt,  ori- 
ginated in  former  attacks  of  rheumatism,  to  which  the 
patient  had  been  subject.  Further  investigation  led  us 
to  believe  that  it  was  not  the  principal  cause  of  her  Ill- 


health  nor  of  her  death,  although  it  was  of  long  standing . 
Previous  to  her  illness  her  liusband  could  see  a  book 
shake  in  her  hands  across  the  room,  from  the  viuU  nt 
action  of  her  heart,  and  could  always  feel  its  impulse 
through  her  hand  resting  on  his  arm ;  and  yet,  strange 
to  say,  no  complaint  was  ever  made  by  the  patient  in 
regard  to  her  heart  while  under  my  care. 

The  liver  was  of  large  size,  its  left  lobe  extending 
quite  across  the  epigastrium  into  the  left  hypochondrium, 
where  the  spleen  was  found  firmly  adherent  to  it  through- 
out three-fourths  of  its  extent.  As  the  liver  had  con- 
tracted no  other  adiiesion,  and  was  liealthy  in  appearance, 
it  was  inferred  that  the  patient  had  suffered  an  attack  of 
splenitis  in  former  years;  but  ho  such  attack  was  ever 
recognised.  She  ofbin  complained  of  a  feeling  of  tight- 
ness acro3«j  the  epigastrium,  especially  after  eating. 
Beyond  this  ^liQ:ht  inonvenienee  it  is  believed  no  harm 
resulted  from  this  unwonted  intimacy  between  two  not 
very  neic^hborly  organs. 

Directing  our  atienion  to  another  rerion  of  the  ab- 
domen, we  quickly  disct^vered  evidence  of  luo-t  extensive 
disease  in  the  adhesion  to  the  bladder  and  uterus  of  all 
the  adjacent  viscera.  Indeed,  it  is  no  exairgeration  to 
say  that  there  was  an  ajrglutinaiion  of  all  the  pelvic 
organs!  In  endeavoring  to  separate  coils  of  intestine 
from  the  bladd  r,  irs  po  terior  vNall  was  easily  torn  off; 
showing  that  the  inflnmrnation  of  the  organ  had  been  so 
intense  as  to  produce  an  organic  deg'^neration  of  portions 
of  its  sub-mncous  Ci^'llular  tissue  and  muscular  fiure.  The 
mucous  membrane  w*  s  of  a  pale  ash-color,  witli  a  patch 
in  the  bas-fond  of  a  dark  date-color.  The  capacity  of  the 
organ  was  reduced  to  a  few  ounces,  and  its  contract- 
ibi  ity  must  have  been  greatly  ijnpai  ed.  All  of  which 
is  in  harmony  with  tlie  pin  and  difl&culty  attending  its 
evacuation,  and  with  the  small  quantity  of  water  voided, 
bui  not  at  all  in  harmony  with  its  herdthy  appearance, 
since  no  unusual  color  or  uilor,  nor  any  muco-purulent, 
or  other  abnormal  deposit  (witd  the  single  exc'j)Uon  of 
the  urate  or  litliate  of  ammonia,  which  is  Scimciently 
common  in  those  subject  to  rheumatiini),  was  ever 
noticed. 

Of  the  uterus  and  its  I'gaments  only  a  cursory  exomi- 
nation,  I  regret  to  s.ty,  was  made,  and  nothing  remai  ked 
beyond  their  adlie>ions. 

The  small  i;!testines  showed  unmistakable  sij,'ns  of 
having  been  involved  in  the  iuflamination  of  the  neigh- 
boring organs,  and  from  their  adiiesion  to  them  could 
have  had  but  little  peris'  aiti  •  action ;  wliieh  fully  accounts 
for  the  pati.'ut's  diarrhoea  in  the  ea.  lie!  mouths  of  her 
sickness,  and  f  t  her  subsequent  impaired  di;M>stion  and 
painful  defecation — the  latter,  however,  may  have  been 
occasioned  by  a  fi-sure  in  an  *,  or  internal  piles;  but  no 
examination  was  made  of  thj  rectu'ii,  and  only  the  ex- 
tremely cont  acted  sta'e  of  the  laige  bowel  noticed, 
which  see:iis  to  be  co'  monly  ol'Ser\ed  in  autopsies. 

The  lungs,  kidtaeys,  an  i  other  ergans  not  mentioned, 
were  he  «lthy,  and  nj  tubercles  were  Iband  in  any  part 
of  the  body. 

Tours  truly, 

J.  K.  Mason,  A.M.,  M.D. 

SurriKLD,  CoKif. 

THE   DEATH  OF  DR.  GEO.  K.  AMERMAN, 

or  oniCAGO. 
To  THB  Editor  of  the  AIbdical  Kk<v>rd. 

StR — Death  has  or.ce  more  vi^'itcd  our  profeSv«?ion, 
and  claimed  his  tithes  of  the  choicest  and  the  best.  Dr. 
G-eorge  K.  Amcman  expired  at  his  home  in  Man*ellus, 
N.  Y.  on  the  20:h  June,  1867,  cut  oft'  in  the  prime  of 
life  by  thnt  fell  de^^troyer,  fhthiiis  pvlmonalis.  Fur 
nearly  two  yenrs  his  health  has  beea-4ailing,  buW  with 
Digitized  by  VjOOQIC 


238 


THE  MEDICAL  RECORD. 


indomitable  energy  the  doctor  continued  to  hold  his 
climes  at  the  hospital  during  the  winter,  and  to  yisit 
his  patients,  in  spite  of  the  admonition  of  his  friends, 
until  he  was  completely  prostrated  by  tubercular  pleu- 
ritis  and  laryngitis,  fedlying  a  little,  he  left  the  city, 
early  in  April  last,  fully  determined  to  visit  Europe 
during  the  summer,  and  confident  of  complete  recoveiy. 
It  was  only  after  an  interview  with  the  highest  medi(»l 
authority  in  New  York,  that  he  could  be  persuaded  of 
his  danger.  Betuming  then  to  the  home  of  his  boy- 
hood, he  arrived  in  time  to  close  the  eyes  of  his  wife, 
who  died^  after  a  ehort  illness,  of  acute  pneumonia. 
His  disease  seemed  to  receive  new  impetus  from  this 
shock:  he  sank  rapidly,  and  ceased  to  breathe  at  4.30 
A.M.,  June  20th.  This  sorrowful  event  was  announced 
to  the  Chicago  Medical  Society  at  their  last  meeting. 
The  following  Resolutions  were  presented  by  a  com- 
mittee for  the  action  of  the  Society : 

Having  been  informed  of  the  death  of  their  associate, 
George  K.  Amerman,  M.D.,  the  members  of  the  Chicago 
Medical  Society  desire  to  testify  for  the  deceased  their  respect 
and  their  feeliDga  of  personal  loss,  by  these  resolutions : 

JVr«^  Tliat  in  this  affliction  we  lament  the  death  of  one 
who,  long  identified  with  our  commnnity,  tho!}gh  young  in 
years,  was  old  in  professional  renown.  A  man  whose  life 
was  a  career  of  brilliant  snocess,  a  Christian  in  deed  as  well 
as  in  name,  at  the  height  of  his  reputation, — ^he  has  now  re- 
ceived the  crown  of  immortality. 

Second^  That  to  the  members  of  our  profession  we  earnestly 
commend  the  example  afforded  by  the  life  of  our  departed 
associate. 

Third,  That  to  the  surviving  relatives  of  our  beloved  friend 
we  tender  this  expression  of  our  sympathy,  in  view  of  their 
bereavement,  ever  desiring  with  them  to  bow  in  humble  ae- 
knowledgment  of  the  almighty  power  of  that  God  in  whose 
hand  are  the  issues  of  life  and  death. 

Iburtk,  That  a  copy  of  these  resolutions  be  fhmished  to 
the  relatives  of  the  deceased,  and  to  the  medical  journals  and 
daily  newspapers  of  the  city. 

The  report  of  the  Committee  was  accepted.  Dr.  Ross 
then  read  a  technical  history  of  the  last  illness  of  the 
departed  brother.  Dr.  A.  R.  Gk)re,  who  had  known  Dr. 
Amerman  ftom  infancy,  being  invited  to  address  Hie 
Society,  proceeded  to  relate  the  following  interesting 
facts  concerning  his  friend : 

At  the  time  of  his  death  Dr.  Amerman  was  in  his 
thirty-fifth  year.  The  son  of  a  rural  farmer  in  Central 
New  York,  his  boyhood  was  distinguished  by  fondness 
for  study,  and  by  disinclination  to  the  drud^ry  of  farm 
work.  He  was  obedient  and  kind,  but  gooa/or  nothing 
on  the  farm.  He  early  manifested  a  passion  for  teach- 
ing, and  at  the  age  of  sixteen  his  only  ambition  was  to 
become  a  schooJ-teacher.  His  father,  however,  pro- 
posed that  he  should  study  medicine.  To  this  he  con- 
sented. Placed  under  the  guidance  of  Dr.  Gore,  then 
a  practising  physician  in  Owasco,  New  Yorl^  he  pledged 
himself  to  pursue  the  studv  of  medicine,  suoject  to  the 
direction  of  his  preceptor,  for  five  years,  oefore  attempt- 
ing to  commence  its  practice.  He  accordingly  attended 
three  courses  of  lectures  in  the  University  Medical  Col- 
lege of  New  York,  graduating  with  honor  in  the  spring 
of  1854.  Still  acting  under  the  guidance  of  his  pre- 
ceptor, he  secured  a  position  for  one  year  on  the  resi- 
dent medic^  staff*  of  Bellevue  Hoepitu.  The'  next  year 
he  became  a  member  of  the  resident  surgical  staff  of 
the  same  hospital  There^  in  the  enjoyment  of  the 
friendship  and  confidence  or  the  most  distinguished  phy- 
sicians and  surgeons  of  New  York  city,  Dr.  Amerman 
completed  the  fifth  year  of  his  course  of  study.  At 
once  received  into  partnership  by  his  former  preceptor, 
and  removing  to  Chicago,  he  commenced  the  practice 
of  his  profession  in  1866.  He  was  jypointed  surgeon  to 
the  Dlmois  Central  Railway,  an  office  which  he  filled 


with  great  credit  until  the  time  of  his  death.  He  was 
also  one  of  the  surgeons  to  the  City  Hospital  until  that 
institution  was  closed,  during  the  war;  and  was  the 
leading  spirit  in  the  surgical  staflF  of  the  County  Hos- 
pital from  the  time  of  its  renovation  until  failing  health 
compelled  him  to  surrender  his  large  and  lucrative  prac- 
tice. 

After  listening  to  the  remarks  of  different  gentlemen 
who  united  in  eulogizing  the  memory  of  the  deceased, 
the  resolutions  were  adopted,  and  the  Society  ad- 
journed. 

A  series  of  similar  resolutions  was  adopted  by  the 
Medical  Board  of  the  County  Hospital,  an  institution  of 
which  Dr.  Amerman  may  be  said  to  have  been  the 
founder  and  chief  executive  officer.  Beloved  by  all  his 
associates,  he  possessed  the  unbounded  confidence  of  a 
large  circle  of  patients ;  and  throughout  the  whole  range 
of  an  extensive  acquaintance,  his  influence  was  felt  to 
a  degree  which  no  other  physician  in  this  city  could 
approach. 


CmoAOO,  Jnlj,  186T. 


M. 


HeiD  3n»trutnent3. 


A  POST-MORTEM  NEEDLE. 
Bt  J.  H  HOBART  BURGB,  M.D., 

BBOOKLTV,  V.  T. 

There  is  no  part  of  an  autopsy  so  much  dreaded  as  the 
sewing  up.  Hardly  a  surgeon  has  escaped  pricking 
himself  with  the  needle.  Sometimes  the  integument 
is  80  tough  that  we  are  in  danger  of  puncturing  our 
fingers  with  the  blunt  extremity  of  tne  needle.  A 
thimble  does  not  obviate  the  difficulty,  since  with  its 
best  aid  the  needle  may  either  turn  back  or  break.  At 
my  last  experience  of  this  sort,  I  resolved  to  devise  an 
instrument  which  should  answer  all  the  indications. 
The  following  is  the  result: 


The  needle  may  be  of  any  convenient  length,  with 
the  eye  sufficiently  removed  from  the  end  to  admit  of 
its  being  accurately  fitted  to  the  calibre  of  a  cylindrical 
stile,  which  has  a  firm  handle  at  the  other  extremity.  I 
hardly  need  describe  its  use.  When  threaded,  pass  it 
through  the  integument  like  an  awl, — seiae  the  needle 
with  the  thumb  and  forefinger,  and  withdraw  the 
handle, — ^now  draw  the  thread  tight  Re-insert  the 
needle  in  the  handle,  and  take  the  next  stitch,  and  so 
on,  and  sew  on.  It  is  hoped  this  little  contribution  may 
not  only  prove  a  comfort,  by  facilitating  that  which  is 
sometimes  a  real  labor,  but  also  by  saving  much  valu- 
able time  to  those  who  procure  for  us  oui^most  valuable 
pathological  specimens,  and  better  still,  that  it  lessens 
the  number  of^hose  sad  sacrifices  to  science — the  deaths 
from  dissection  wounds.  The  instrument  is  made  by 
Gteorge  Tiemann  &  Co.,  63  Chatham  st.  New  York. 

Novel  Method  or  Manufaoturino  Q-as. — According 
to  a  Swiss  journal,  a  means  has  been  discovered  of  utili- 
zing cockchafers.  The  JEstafeUe  of  Lausanne  states  that 
between  four  and  five  millions  of  these  insects  were  re- 
cently sent  to  Friburg  for  the  manufacture  of  gas,  and 
the  residue  forms  an  excellent  carriage  grease. 


THE  MEDICAL  RECORD. 


Ueto  |)ublicatian:3* 


The  Bsssntials  op  the  Pbinctiples  axd  Pbacticb  op  Med- 

lOKB.  A  HANDT-BOOK  POR  STUDENTS  AND  PbACTITIONBBS. 

By  Henry  Hartshobne,  M.D.,  Professor  of  Hygiene  in 
the  University  of  Peon.  Auxiliary  Faculty  of  Medidiie, 
eta,  etc.    Philadelphia:  H.  a  Lea.    1867. 

Os  Ligature  op  Funis*    By  A.  F.  A.  Kinq,  M.D.    Wash- 
ington, D.  0. 


£BitVicai  3Ums  avitt  Uerosi. 


PERSONAL. 

Dr.  Ernst  Ksackowisbr  has  been  elected  one  of  the 
atrendin^surgeons  to  the  New  York  Hospital,  vice  Dr. 
Willard  rarker,  resigned. 

Dr.  Thomas  M.  Marroe  has  been  appointed  a  Visit- 
ing Surgeon  to  Bellevue  Hospital,  to  fill  a  vacancy 
occasioned  by  the  death  of  Dr.  William  H.  Church. 

Da.  WnxiAM  H.  Vak  Buren  was  recently  elected  one 
of  the  Consulting  Surgeons  to  the  New  York  Hospital. 

Dr.  John  Simmons,  for  a  number  of  years  Medical 
Adviser  to  the  Citv  Prison,  died  of  congestion  of  the 
brain,  June  14th,  ult. 

Mr,  Hoff  and  the  N.  Y,  Academy  oe  Medicine. — At 
the  last  meeting  of  the  Academy  of  Medicine,  the  fol- 
lowing resolutions  were  unanimously  adopted ; 

Whereas,  W.  L.  Bofl;  proprietor  or  agent  of  the  "  Hoff 
Malt  Extract,"  is  issuing  publications  through  the  secular 
papers,  and  by  means  of  pamphlets  and  circulars,  professing 
to  qoote  favorable  opinions  expressed  in  a  report  of  a  com- 
mittee of  the  Academy ; 

And,  wherecu,  the  said  Hoff  is  widely  circulating  a  letter 
parporting  lo  have  been  written  by  a  Fellow  of  Sie  Acad- 
emy; 

And,  whereas^  the  publications  of  said  Hoff  are  so  adroitly 
and  designedly  worded  as  to  impress  the  mind  of  the  reader 
with  the  belief  tliat  the  Academy  has  endorsed  his  noetrum, 
iDd  has  thus  apparently  compromised  its  dignity  and  pro- 
femonal  standUig — ^Therefore, 

Beaohfedy  That  the  N.  Y.  Academy  of  Medicine  does  here- 
by proclaim  and  declare  that  it  has  not  expressed  any  opin- 
ioa  in  regard  to  **  Hoffs  Malt  Extract,"  and  that  any  and 
ereiy  use  of  its  name  in  recommending  said  Extract  is  unau- 
thorized by  the  Academy. 

Besolved,  That  a  copy  of  the  above  preamble  and  resolu- 
tions be  sent  to  the  Medical  journals  of  this  city,  and  that 
the  Medical  journals  throughout  the  country  be  requested  to 
copy  the  same,  in  justice  to  the  Academy  and  the  profession. 

Quaramtuce  Intelligence. — ^Fromall  the  West  Indian 
Islands  reports  have  recently  been  received  that  yellow 
fever  is  prevailing  to  an  alarming  extent  On  the  8th 
of  last  month  the  United  States  Consul  at  Kingston, 
JamaiciL  notified  the  Collector  of  Customs  at  this  port 
that  yeUow  fever  was  prevailing  at  that  place  in  the 
form  of  an  epidemic  of  a  malignant  type,  and  that  at 
least  twenty-five  per  cent  of  the  cases  had  proved  fatal 
From  New  Orleans  many  contradictory  reports  have 
been  received,  and  one  of  the  latest  telegrams  relative 
to  the  sanitary  condition  of  that  city  was  received  by 
Messrs.  H.  B.  Cromwell  &  Co.,  on  the  3d  inst  It  con- 
tains the  following:  "Am  officially  advised  by  the 
Board  of  Health  in  this  city  that  only  eight  cases  of 
yellow  fever  have  occurred  during  the  last  two  weeks; 
six  proved  fatal ;  no  indications  of  its  assuming  an  epi- 
demic form.  City  generally  healthy ;  one  hundred  and 
seven  deaths  during  the  week  ending  Sunday." 


At  Quarantine  there  has  only  been  one  death  during 
the  present  year,  and  that  occurred  some  months  ago. 
At  the  present  time  there  are  no  cases  of  contagious 
sickness  on  board  the  hospital  ship,  all  reports  to  the 
contrary  notwithstanding.  On  the  4th  iust,  the  bark 
Kin|f  Harold,  fbom  Matanzas  for  Greenock,  Scotland 
put  mto  this  port  in  distress.  She  reported  that  the 
captain  died  m  hospital  of  yellow  fever  before  leaving 
Matanzas*  The  mate  then  assumed  command,  and 
during  the  voyage  he  also  sickened  and  died  of  the 
same  disease,  and  on  the  Ist  inst.  two  of  the  crew  died. 
On  arriving  at  this  port  the  remaining  members  of  the 
crew  were  completely  prostrated  with  ovtr  exertion  and 
fear,  and  it  was  found  necessary  to  remove  several  of 
them  to  the  hospital  ship  Falcon,  where  they  are  now 
reeuperating. 

The  steamship  BisingStar,  from  New  Orleans,  is  now 
detained  in  the  lower  bay  for  the  purpose  of  furnisration. 
—K  Y.  Herald,  Jtdy  7ih.  ^ 

An  Orqahization  op  Medical  Teachers  for  the  pur- 
pose of  advancing  the  interests  of  medical  education  has 
been  formed  in  England. 

The  Cattle  Plaoue  has  reappeared  in  several  parts 
of  Great  Britain.  ^ 

The  Leavenworth  Medical  Herald. — We  have  re- 
ceived the  first  number  of  this  Medical  Monthly  and 
are  well  pleased  with  its  contente  and  style  of  make-up. 
It  is  under  the  editorial  management  of  C.  A  Logan' 
M.D.  and  T.  Sinks,  M.D.,  both  of  whom  give  evidences 
for  their  fitness  to  the  undertaking.  We  wish  success 
to  the  enterprise. 

The  American  Journal  of  Dental  Science  has  been 
revived;  Drs.  A.  Snowden  Piggot  and  F.  J.  S.  Gorgas 
are  the  editors.    It  is  published  at  Baltimore. 

Abortion  in  Cows.— The  New  York  Legislature  at 
its  last  session  made  provision  for  a  commission  to  in- 
vestigate the  subject  of  Abortion  in  Cows.  Prof:  John 
C.  Dalton  has  been  appointed  one  of  the  commissioners 
and  will  be  assisted  in  his  investigations  by  Drs.  Car- 
malt  and  Haigh  of  this  city. 

Medical  Society  of  New  Jerskt.— The  Medical  So- 
ciety of  New  Jersey  held  its  one  hundred  and  first  ses- 
sion in  Newark,  on  the  28th  and  29th  of  May.  The 
following  officers  were  elected  for  the  ensuing*  year  • 
President,  John  0.  Johnson,  of  Blairstown;  Vioe-Presi^ 
dents,  Thos.  J.  Corson,  of  Trenton,  Wm.  Pearson  of  Or 
ange,  and  Thos.  F.Cullen,  of  Camden;  Correspondine 
Secretary,  0.  Hodge,  of  Trenton ;  Recording  Secretarv 
Wm.  Pearson,  Jr.,  of  Orange.  ^* 

Speclu.  DEPARTifMCTS  foF  Eye^  Ear,  and  Skin,  have 
been  established  at  the  London  Hospital 

Albany  Medical  College.— The  following  appoint- 
ments have  recently  been  made  in  the  faciSty  of  this 
institution.  Dr.  S.  Oakley  Vanderpoel,  M.D.,  Prof,  of 
General  Pathology  and  Qinical  Medicme;  James' E. 
Pomfret,  M.D.,  ProC  of  Physiology ;  and  John  V.  Lans- 
ing,  M.D.,  Prof  of  Materia  Medica. 

Preparing  Oxygen.— Sub-chloride  of  copper  when  ex- 
posed to  the  air  absorbs  a  large  quantity  of  oxygen  and 
when  the  metal  is  afterwards  gently  heated,  readSy  parts 
with  the  gas.  ''  ^ 

Medical  Baronetcies.— Mr.  Wm.  Lawrence  the  em- 
inent surgeon,  has  recently  had  the  honor  of  a  baronet- 
cv  conferred  upon  him,  and  Dr.  G.  Duncan  Gibb  of 
Westminster  Hospital  has  succeeded  to  the  baronetcy 
of  Gibb  of  Falkland  Kfe.  We  regret  to  learn  that  the 
forhier  gentleman  has  since  been  stricken  with  palsy 
and  that  but  fidnt  hopes  for  recovery  are  indulgea  in. 


240 


THE  MEDICAL  RECORD. 


Htrtl*8  Magnificent  Anatomical  Museum  has  been 
purchased  by  ati  American  College  for  $8,000,  it  having 
been  offered  for  sale  at  the  Paris  Exposition.  Hyrtl  is 
the  Professor  of  Anatomy  at  Vienna,  and  from  personal 
observation,  we  are  prepared  to  testify  to  its  value. 
What  college  has  the  treasure  ? 

Cholera  at  Vienna. — On  May  4,  a  man  was  at- 
tacked with  cholera  at  Vienna,  6ie  first  case  of  the 
season. 

Electro-Therapeutics. — Two  wards  have  been  set 
apart  in  the  Vienna  Hospital  for  Electro-Therapeutical 
purposes. 

Professor  Junoken,  of  Beriin,  at  seventy-six  years 
of  age,  is  still  in  active  practice,  performing  such  ope- 
rations as  extraction  of  cataract,  iridectomy,  and  enu- 
cleation of  the  globe. 

To  BECOME  Well-informed  Practitionebs.  —  You 
must  mingle  with  other  men  in  medical  societies,  other- 
wise you  will  soon  become  contracted  in  your  views ; 
for,  you  must  remember,  if  you  are  guided  simply  by 
your  own  limited  experience,  you  will  surely  go  wrong. 
Laws  and  deductions  in  medical  sciences  ought  to  be 
drawn  from  large  numbers  of  observations.  Let  your 
libraries  be  in  receipt  of  the^really  valuable  medical  lite- 
rature, as  it  coma**  from  *he  press,  especially  of  the  mo- 
nographs and  works  of  the  most  disiinguLshed  authors. 
Let  your  books  be  your  greatest  luxuries — let  your 
shelves  be  the  last  places  where  you  economize  in  your 
expenditures.  Money  spent  there  is  well  spent ;  new 
books  are  as  nece^^sary  to  you  as  tools  are  to  a  mecha- 
nic ;  you  cannot  do  your  work  well  without  them.  Do 
not  confine  your  purchases  to  home  publications,  but 
keep  your  orders  at  the  importer.  Let  your  office  table 
be  supplied  with  the  most  prominent  domestic  and 
foreign  journals  and  reviews.  As  Tyler  Smith  has  ex- 
pressed it — **In  consultations  two  or  three  meet;  in 
societies  hundreds  stan  1  face  to  face,  and  have  the  privi- 
lege of  exchanging  thoughts,  but  in  the  periodical  press 
we  have  the  collision  of  thousands  of  minds  busied  with 
the  same  subject ;  thus  more  truth  is  elicited,  more  pro- 
gress ma-le  than  could  be  by  solitary  thinkers." — Ad- 
dress of  Prof,  F,  Do^icUdson,   University  of  Maryland^ 

1867. 

Abortion  and  Insanity. — I  have  for  many  years  re- 
ceived and  treated  patients  whose  insanity  was  directly 
traceable  to  this  crime,  through  its  moral  and  physical 
eft't  cLs.  Some  have,  after  recovery,  given  a  sad  chapter 
of  perverted  life,  and  disclosed  the  revolting  fact  that 
the  suggesters,  aiders  and  abettors  of  this  heinous 
oflf'^nce  aga  n.>it  God  and  nature — this  rude  violation  of 
the  best  instincts  of  women — were  persons  of  their 
own  sex.  One  woman  told  me,  and  tne  statement  was 
verified  by  her  husband,  that  seven  successful  abortions 
were  procured  on  her  by  one  of  her  female  friends — 
and  both  these  wonjen  were  highly  respectable  persons 
and  members  of  the  church.  When,  in  broken  health 
an* I  after  failure  in  tlie  eighth  attempt,  she  applied  to  a 
physician,  he  infurnied  her  of  the  crirain:dity  of  the  act. 
Its  dire  con-cqu(."nres  to  health,  and  advised  her  against 
the  continuance  of  such  a  practice.  She  subsequently, 
huWcver,  obui'mHl  tb'  STvices  of  a  charlatan,  who  suc- 
ceeded in  inducing  abortion;  and,  some  months  later, 
this  woman  wa-^  admitted  to  the  Asylum  in  wretched 
health  and  suffering  from  melancholia,  which  her  pas- 
tor, ignorant  of  her  true  history,  attributed- to  religious 
excitement.  A  minister  recently  informed  me  that,  in 
his  congregation,  in  a  country  village,  one  of  the  pro- 
minent women  approached  his  wife  with  a  proposition 
that  she  should  destroy  her  prospective  oflrepring,  de- 


claring that  she  thought  it  right  to  do  so,  and  men- 
tioned others  who  resorted  to  the  practice,  rather  than 
be  troubled  with  children.  It  cannot  be  possible  that 
such  women  are  ignorant  of  the  crime  oi  infanticide. 
The  only  plea  that  can  be  made  for  them  is  that  they 
do  not  comprehend  the  turpitude  and  criminality  of  the 
act^  and  do  not  recognise  the  solemnity  of  marriage  and 
the  true  dignity  of  maternity.  One  could  almost  wish 
that  such  women  might  not  be  mothers. — John  P, 
Orayy  M.  /).,  24(^  AnnucU  Report  of  State  Lunatic  Aty- 
lumfor  1766. 

The  Anatout  op  the  Gorilla. — ^The  variation  in 
the  sisse  of  the  brain  is  considerable  in  the  human  spe- 
cies, but  I  think  the  position  and  the  quality  of  the 
brain  have  more  to  do  with  the  intellectual  manifesta- 
tion in  man  than  the  size,  although  the  intelligence  is 
visibly  altered  according  to  the  weight  of  the  cerebral 
deposit  The  cranial  capacity  of  a  young  gorilla  id>oat 
a  year  or  two  old  is  from  twenty  to  twenty-two  cubic 
inches.  Supposing  a  subsequent  development  equal  to 
that  in  man,  this  would  produce  an  animal  of  a  high 
grade  of  intelligence,  but  it  is  only  the  bones  of  tne 
skull  that  increase  in  the  gorilla,  as  it  grows  in  years, 
not  the  brain  itself,  which  remains  about  the  same  in 
the  adult  specimen  as  in  the  infant  young.  This  proves 
conclusively  that  the  animal  has  very  small  power  of 
intelligence,  and  fix)m  my  own  experience  1  believe 
the  limit  of  that  intelligence  is  reached  within  a  year  or 
two  after  the  birth  of  the  young  gorilla.  In  the  Cau- 
casian skull  the  average  capacity  of  the  brain  is  about 
ninety  cubic  inches,  and  the  maximum  has  been  found 
to  be  one  hundred  and  fourteen  inches.  In  man  the 
position  of  the  head  and  the  currature  of  the  vertebra 
column  make  the  ertct  position  the  only  natural  one 
any  other  being  quite  painful  after  a  while.  This  dif- 
ference is  an  organic  one,  resulting  not  from  habit,  but 
from  natural  structure.  The  whole  frame  of  man  pro- 
claims that  he  was  made  to  carry  himself  in  an  erect 
posture ;  and,  unlike  the  quadrumanous  apes,  his  supe- 
rior extremities  do  not  perform  any  service  in  the  act 
of  locomotion.  Then  comes  the  head,  too,  with  its 
enormous  expansion  of  brain ;  the  condyles  of  the  occi- 
put are  brought  forward  to  the  base  of  the  skull,  and 
by  this  balance  of  the  head  on  the  neck  bone,  the  arms 
in  man  are  in  more  symmetrical  proportion  with  the 
length  of  the  legs.  The  lower  limbs,  or  legs,  are  longer 
than  in  any  apes,  the  pelvis  is  broader  than  it  is  long, 
the  iUac  bones  inclined  steeply,  the  humerus  is  larger 
than  the  fore-arm,  and,  finally,  the  thumb  of  man  is 
much  larger  than  in  any  ape,  and  the  most  useftil  mem- 
ber of  the  hand.  Accordmg  to  Dr.  Gratiolet,  of  Pans. 
even  in  the  lowest  idiots  the  brain  presents  the  material 
and  zoological  character  of  man,  and,  although  often 
inferior  in  appearance  to  that  of  the  chimpanzee  or 
other  apes,  it  is  nevertheless  an  undeniable  human 
brain.  ^Disease  or  degradation  in  continued  reproduc- 
tion may  dwarf  a  man,  but  will  never  make  him  an 
ape.  Although  there  is  great  dissimilarity  between 
the  long  frame  of  man  and  that  of  the  gorilla,  there  is 
also  an  awfiil  likeness,  which  in  the  latter  resemUes  a 
hideous  caricature  of  a  human  being. — 2£,  Paid  du 
ChailltL 

Rigid  Perineum  ;  Division  op  the  Soft  Parts. — Dr. 
Beattie,  in  the  DuhUn  Journal  of  Medical  Sciences,  re- 
commends in  cases  of  rigid  perineum,  that  the  soft  parts 
be  divided  by  probe-pointed  scissors  sufficiently  to  allow 
the  head  of  the  child  to  pass.  By  this  method  of  pro- 
cedure, the  duration  of  labor  may  be  shortened  some- 
times by  several  hours. — CincmnaH  Journal  of  Medi- 


cine, 


igitized  by 


THE  MEDICAL  RECORD. 


241 


©riginal   Camtmimcat'witg. 

HEPATIC  ABSCESS  :  TWO  CASES. 
By  R  B.  MATJKY,  M.D. 

FOBT  euaOK,  1088. 

Li  the  midst  of  conflic^n^  opinioDS  concerning  the  ed- 
<Aofj  of  this  disease,  it  is  just  to  suppose  that  me  publi- 
catK>n  of  all  fevthfully  recorded  oases,  which  may  throw 
any  li^t  upon  the  subject,  will  be  acceptable  to  the 
profession. 

There  ia  a  very  large  mass  of  clinical  eyidence  which 
aasociateB  this  lesion  with  the  ulceration  of  dysentery ; 
tnd  thou^  a  number  of  excellent  observers  seem  inclin- 
ed to  behove  that  this  relation  is  not  that  of  an  effect 
to  a  cause,  but  that  the  two  diseases  are  the  joint  effect 
of  a  common  caus^  I  do  not  think  they  have  adduced 
satisfactory  reasons  to  support  suoh  a  view ;  still  less  do 
I  think  that  facts  will  sustain  them  in  endeavoring  to 
ascribe  hepatic  abscess  to  remittent  fever;  or  that  in 
dysentery  there  is  necessarily  or  generally  (outside  of 
India)  any  spedal  derangement  of  the  fiinotions  of  the 
Hvcr. 

With  these  views  the  history  of  two  cases  is  here 
presented :  L  The  first  is  that  of  Gkorge  H.,  an  old 
negro,  between  65  and  70  years  of  age,  who  came 
under  my  care  early  in  February,  1860,  lor  the  relief  of 
dnonic  dysentery  and  enlarged  prostate.  The  enlarge- 
ment of  the  prostate  had  been  a  source  of  trouble  to 
him  fcH*  nearly  three  years,  and  became  rapidly  more  so 
after  I  saw  him.  He  had  suffered  from  dysentery  about 
fifteen  months.  He  died  28th  of  June,  1860.  Nothing 
of  peculiar  interest  had  been  presented  in  the  history  of 
the  case,  further  than  the  disease  of  the  prostate,  and  for 
the  examination  of  this  an  autopsy  was  held  ten  hours 
after  death. 

The  usual  appearances  of  senile  hypertrophy  of  the 
giand  were  presented.  The  third  lobe  was  enlarged, 
and  had  proved  a  serious  obstacle  to  the  passage  of  urine : 
the  bladder  was  thickened  and  ulcerated.  The  kidneys 
presented  no  appearance  of  disease.  The  large  intestine 
was  studded  wim  ulcers,  chiefly  along  the  course  of  the 
descending  c<^on  and  rectum.  The  liver,  to  outward 
appeiu-anoe,  was  healthy,  but  upon  being  opened,  was 
loond  to  contain  two  abscesses  m  its  right  lobe;  these 
were  smaQ,  and  were  circumscribed  by  a  distinct  sao ; 
they  were  of  an  oval  shape,  and  respectively  about  one 
and  two  inches  in  long  diameter ;  they  seemed  to  be 
quiescent  or  retrograding,  no  inflammation  being  aroa- 
rent  in  their  walls :  one  contained  pure  pus  somewhat 
thickened;  the  otner  contained  a  yellowish  matter  of 
cheesy  conaistenoe,  which  was  evidently  pus  also.  The 
hrngs  were  healthy,  with  the  exception  of  old  pleuritio 
adhesiocis^ 

During  the  time  that  this  man  was  my  patient,  no 
lypmtoms  were  presented  which  attracted  attention  to 
the  liver  in  any  way,  and  I  was  surprised  to  find  the 
ib<ceases  after  death.  He  had  had  no  attack  of  feyer 
Gem*  several  yearsi  and  his  case  may  furly  be  quoted  as 
aa  iUustratioa  or  that  relation  whidi  has  been  found  to 
exist  between  hefwtic  abscess  and  dysentery. 

In  connedioii  with  this  case  I  may  add,  that  two  years 
before,  I  saw  in  Bellevue  Hospital,  a  similar  instance  in 
which  multiple  circumscribed  abscesses  of  the  ri^ht  lobe 
were  stunnbtod  upon  in  a  post-mortem  examination  of  a 
case  of  chronic  dysentery. 

2.  My  second  case  was  tiiat  of  H.  S.,  a  young  man, 
d2  years  of  age,  a  native  of  Switzerland,  who  pre- 
anted  hinnself  on  7th  June,  1866.  He  was  of  splendid 
pfajftque,  and  had  been  keeping  bar  for  twelve  monihs, 


but  his  proper  occupation  was  that  of  a  stone-cutter, 
which  calling  he  had  followed  up  to  the  date  of  his 
beooming  a  soldier  in  the  army  of  Northern  Virginia, 
five  years  before.  During  his  term  of  miHtary  service 
he  had  never  been  woun&d,  and  with  the  exception  of 
two  slight  attacks  of  diarrhoea,  which  had  lasted  a  few 
days  omy,  he  had  been  entirely  exempt  from  disease.  In 
his  whole  life  he  had  but  one  attack  of  illness;  in  this 
all  the  symptoms  pointed  to  the  liver,  and  for  it  he  was, 
for  several  months,  imder  the  treatment  of  a  physician 
in  Memphis;  this  occurred  eight  years  before.  For  ten 
years  his  habits  had  been  very  irreg^ar,  and  occasionally 
he  drank  to  great  excess  j  now  and  then,  of  late  years, 
after  unusual  indulgence  m  drink,  he  would  suffer  from 
"  little  bilious  attacks  "  for  a  day  or  two.  He  had  never 
had  S3rphili8,  had  never  been  jaundiced,  nor  had  he  ever 
had  hiasmorrhoids. 

Three  months  previously  to  his  consulting  me,  imme- 
diately after  a  debauch,  and  while  suffering  from  a  severe 
cold  and  cough,  he  was  suddenly  seized  with  violent 
pain  through  the  region  of  the  liver  from  side  to  side: 
this  continued  for  several  hours,  when  the  pain  disap- 
peared fh>m  the  left  side ;  but  became  fixed  on  the  right^ 
and  extended  thence  to  the  abdomen.  His  physician 
thought  the  disease  bilious  colic,  and  gave  mercurials 
for  several  days,  but  without  much  relief.  He  soon  came 
under  the  care  of  another  physician,  who  considered  the 
case  one  of  pulmonary  d^ase.  Under  his  treatment 
the  febrile  symptoms  passed  away,  and  the  patient  con- 
valesced so  as  to  return  to  business  and  old  habits. 

When  I  saw  him  in  June,  his  appearance  was  nearly 
that  of  heidth,  and  he  complainea  of  nothing  except  a 
dull  pain  at  ba^  of  the  right  chest  posteriorly  and  lateral- 
ly. He  had  no  cough,  the  bowels  and  kidneys  were  act- 
ing properly,  and  the  skin  was  moist;  but  the  pulse  was 
1 10.  On  physical  examination,  there  was  found  slight 
oomparative  dulness  at  the  right  base  posteriorly ;  over 
the  same  re^on  yocal  resonance  was  somewhat  duxiinish- 
ed,  respiration  feeble,  and  the  heart  sounds  abnormally 
distinct :  with  these  exceptions,  no  deviation  from  health 
was  fonnd  on  a  very  careful  examination  of  both  heart 
and  lungs.  I  was  embarrassed  in  diagnosis,  and  was 
inclined  to  think  he  had  had  in  February  an  attack  of 
pleurisy  with  efiusion,  which  had  not  been  entirely  re- 
moved, and  that  he  now  had  a  subacute  attack.  He 
had  never  had  epistaxis,  nor  had  he  ever  vomited  blood. 
Iodide  potass,  internally,  tr.  iodine  to  the  chest  exter- 
nally, were  prescribed. 

On  the  14th  June  he  returned,  being  worse :  pain 
was  on  the  increase,  bowels  confined  and  urine  highly 
colored :  skin  very  moist :  pulse  110.  He  was  advised 
to  take  one  grain  of  calomel  morning,  noon,  and  night 
for  two  days,  and  then  to  have  it  gently  carried  (M 
by  small  doses  of  sulphate  of  magnesia.  From  this 
time  to  the  20th  of  June,  he  was  observed  to  have  fever 
every  eyening  and  night,  followed  next  morning  by 
heavy  sweats;  the  pain  steadily  increased^  itnd  now 
required  the  use  of  morphine  in  small  quantities ;  the  i^ 
petite  ftiled,  and  the  tongue  became  red  and  divested 
of  epithelium  at  the  tip. 

On  ^e  20th  June  a  dedded  tumor,  five  inches  in 
diameter,  was  made  out  on  the  jight  side  of  the  body, 
about  Hie  base  of  the  chest,  and  corresponding  to  the 
hepatic  region ;  its  lower  margin  was  ona  line  with  the 
tenth  rib;  it  presented  no  redness,  but  its  temperature 
was  raised  above  that  of  the  surrounding  tissue ;  the 
rig^t  rectus  abdonunis  muade  was  very  hard  and  resist- 
ing; anterior  posterior  vertical  hepatic  dulness  was 
somewhat  increased ;  there  was  no  pain  referred  to  the 
right  shoulder.  The  bowels  were  moved  naturally 
every  day  or  two ;  there  was  no  nausea ;  the  urine, 
though  free,  was  high  colored;  8p.gr.  1024;  noalbumen, 


Digitized  by 


Google 


242 


THE  MEDICAL  KECORD. 


no  biliary  ooloring  matter,  and  no  biliary  acids  present 
in  it  In  the  forenoon,  the  pulse  was  100 :  the  tempera- 
ture in  the  axilla  98^  to  ^^ ;  in  the  anemoon,  pulse 
115  to  120,  and  the  temperature  101^. 

Poultices  to  the  tumor,  and  morphia  at  nighty  consti- 
tuted the  treatment  at  this  time.  The  ease  now  presentr- 
ed  the  appearance  of  hepatic  disease,  but  all  the  reoog>- 
nised  causes  of  abscess  of  the  liver  could  be  excluded. 
The  patient  had  never  had  remittent  fever,  nor  dysente- 
ry ;  nor  had  he  ever  had  any  symptoms  of  biliary  oaloulL 

On  the  5th  July,  my  notes  state  that  the  patient  was 
evidently  losing  ground;  that  he  had  become  pf^  anae- 
mic, and  sallow ;  much  emaciated  and  very  feeble ;  the 
hectic  symptoms  were  decided  and  regular;  the  tumor 
had  enlarged  and  become  very  painful,  so  that  opiates 
were  required  constantly.  Elixir  vitriol  was  given  to 
control  the  heavy  and  e^diausting  sweata.  The  tempe- 
rature in  the  axilla,  in  the  foomoon,  did  not  rise  above 
98** ;  in  the  evemng  it  was  101^. 

July  7. — ^Under  tne  influence  of  chloroform,  the  tnmor 
was  explored,  and  punctured  with  a  tenotomy  knife ;  a 
very  small  opening  was  mada  and  pus  evacuated  in 
moderate  quantity,  with  great  relief  to  ih»  patient's 
sufferings.  The  pus  was  healthy  in  appearance,  and 
of  no  peculiar  smelL  He  was  ordered  to  use  stimulants 
f^ly,  and  concentnU^  nourishment. 

July  14. — He  loses  an  immense  quantity  of  pus, 
which  is  of  a  reddish-brown  color;  is  failing  rapidly, 
the  pulse  becoming  more  frequent^  and  the  urine  very 
scant ;  will  take  nothing  but  stimulants,  and  food  in  very 
sm^U  quantity ;  sweats  all  the  time  profusely. 

July  25. — ^A  large  slough  is  forming  ajr oui^  the  opeiir 
ing  made  for  the  evacuation  of  pus ;  frequent  small 
hemorrhages  have  occurred  and  coagula  often  obstruet 
the  orifice ;  tlie  tongue  is  naked,  dry,  ulcerated,  and  the 
same  condition  seems  to  have  extended  to  the  pharynx; 
deglutition  is  almost  impossible.  The  pus  now  shows 
signs  of  decomposition ;  the  urine  looks  like  strong  ley, 
but  no  bile  can  be  detected  in  it  on  careful  testing. 
Pain  is  complained  of  in  the  left  hypoohondrium,  when 
he  tiu*ns  on  that  side  to  have  the  abscess  dressed.  To 
this  time  the  tension  and  resistance  of  the  rectos  and 
other  muscles  on  the  right  side  of  the  abdomen  have  been 
well  marked :  no  pain  has  been  refonred  to  the  right 
shoulder. 

July  30. — ^He  died  this  day«  Autopsy  held  one  hcmr 
and  a  half  after  death;  body  warm;  no  rigor  mortis; 
emaciation  excessive. 

The  body  being  opened,  the  lungs  were  found  very 
pale,  and  presented,  anteriorly,  large  pauses  of  dark  pi|^ 
ment ;  they  were  both  adherent  over  a  very  great  extent 
of  the  costal  pleural  surfaces:  the  adhesions  were£nn 
md  old.  With  this  exception  there  was  no  evidence  of 
disease  about^  them.  The  pezioardium  contained  diKmt 
an  ounce  of  serum;  the  heart  was  so  completely  cover- 
ed with  a  superficial  layer  of  fat,  that  the  muscular  tis- 
sue could  be  discerned  in  two  or  three  places  only ; 
otherwise  it  was  healthy. 

The  cavity  of  the  abaomen  being  opened,  the  liver  «» 
fft^  did  not  appear  enlarged ;  its  odor  was  a  yeUowish- 
blowSL  aind  it  presented  to  the  naked  eye  the  appear- 
ance ^  fhtty  de^neration.  Slight  and  easily  torn  adfae^ 
Kons  connected  the  upper  surface  of  the  left  lobe  with 
the  diaphragm ;  the  und^  sur&ce-of  the  same  lobe  was 
adherent  to  the  anterior  wall  of  the  stomach,  and  when 
separated  from  it,  i^owed  that  an  abscess  had  pointed 
there,  and  would  in  time  have  emptied  itsdf  into  Ihe 
eavity  of  that  viscua  The  outer  portion  of  the  npper 
smr&ce  of  the  right  lobe  was  abo  adherent  to  the  dift^ 
phxa^  and  at  a  point  oorresponding  to  the  external 
opemng  through  which  pus  had  been  discharged  during 
the  adhefiionB  were  very  thick  and  skong^  and 


further  examination  showed  that  here  a  large  abscess  in 
the  right  lobe  had  pointed  and  emptied  itself.  On  the 
upper  surface  of  the  right  lobe,  near  the  median  line, 
was  seen  the  thinned  wall  of  a  third  abscess,  which  must 
soon  have  contracted  adhesions  with  the  diaphram,  and 
would  ultimately  have  emptied  itself  into  the  right  pleu- 
ral sac.  The  wall  of  this  abscess  was  here  not  more  than 
two  lines  thick,  very  convex,  and  the  pus  coud  be  seen 
through  it  before  it  was  opened.  The  intestines  in  situ 
appeared  normal ;  there  was  no  peritoniti^  except  at 
the  points  where  the  adhesions  mentioned  had  been 
formed. 

On  removing  the  liver,  it  was  found  thickened  on  its 
posterior  margm,  being  nearly  doable  the  normal  thick- 
ness ;  and  upon  dissection  there  were  seen  in  the  right 
lobe  two  large  abscesses,  already  described,  each  the 
sixe  of  a  chilos  fist^  and  with  jagged  irregular  waUs,  no 
sac  ciroumscribmg  them.  The  abscess  in  the  left  lobe 
was  nearly  as  large  as  either  of  those  in  the  right,  and 
was  of  the  same  character.  The  contained  pus  was  of  a 
greenish  ydlowish  color,  and  unlike  that  discharged 
during  life.  The  abscesses  were  each  distinct,  and  had 
no  connexion  the  one  with  the  others. 

Besides  these,  there  was  found,  near  the  outer  margin 
of  the  left  lobe,  and  on  its  under  surface,  a  puckered 
cicatrix,  the  remains,  without  doubt,  of  an  ola  abscess 
of  small  size,  which  was  tied  to  the  transverse  colon  by 
aureus  band  an  inch  kmg ;  the  band  was  of  a  whitisn 
color,  and  <very  hard,  and  so /was  the  cicatrix,  and 
neither  presented  any  traces  of  recent  inflammation. 
This  feature  is  of  especial  interest  in  connexion  with 
the  attack  of  the  liver  fVom  which  the  patient  tiad  sof- 
fered  eight  years  before.  A  minute  inquiry  into  the 
history  of  that  attack,  however,  fidled  to  estatiish 
the  existence  at  that  time  of  any  of  the  known  causes 
of  abscess.  The  portal  vein  appeared  hei^thy.  The 
gall-bladder  filled  with  yellow  inspissated  bile  contain- 
ed no  calculi,  and  presented  no  appearance  of  ulcera- 
tion. The  stomach  and  several  feet  of  small  intestine 
were  carefully  scrutinised  with  a  view  to  discover 
traces  of  old  ulceration,  if  any  existed,  but  nothing  was 
found :  the  entire  length  of  the  small  and  large  mtea- 
tines  was  firee  from  disease. 

The  kidneys  presented  no  appearance  of  change,  ex- 
cept that  they  l<Miked  iktty  Uke  the  hver ;  their  capsule 
was  easily  separated,  and  nowhere  a(^i^nti  Supra- 
renal ca|>sule6  were  normal  Pancreas  was  so  lilrawise. 
The  spleen  was  a  little  larger  than  usual,  but  appeared 
healthy.    No  enlargement  of  mesenteric  gland& 

It  is  to  be  regretted  that,  in  the  study  of  this  case,  no 
ohie  could  be  found  to  the  cause  of  the  abscesses ;  the 
same  may  be  said  of  the  case  presented  by  Dr.  Geo.  Pep- 

?er  to  the  Philadelphia  Pathological  Soaetyj  Febroarj 
4, 1866.  The  puckered  cicatrix  found  in  the  left  lobe, 
and  bound  by  a  fibrous  band  to  the  transverse  colon, 
without  doubt  the  remuns  of  an  old  abscess,  was  proba- 
bly a  connecting  link  between  his  last  illness  and  the 
attack  from  whicm  he  sufSored  eight  years  before.  It  is 
possiUe  that  he  then  had  multiple  abscesses  which  be- 
came encysted  and  remained  statioaaiy ;  that,  in  one  of 
them,  the  pus  underwent  those  degenerative  changes 
neceasary  to  absorption,  the  eavity  of  the  abscess  was 
obliterated,  and  only  a  doatrix  left  to  mark  its  place ;  the 
other  three,  after  being  inactive  for  a  period  of  eight 
years,  for  some  unknown  cause  took  on  new  inflamma- 
tion, and  proceeded  to  the  destraotion  of  life. 

That  such  a  coarse  is  pathok>gically  possible,  may  not 
be  easily  demonstrated,  but  it  may  be  inforred  from  the 
remarks  of  Mr,  Paget  on  oid  abocessee. 

« (Qie  abscess  h^  a  natnnd  tendeiKr^  to  open,  unless 
an  (he  inflammation  in  which  it  had  its  oHgm  subsides. 
Ittflsmmationi^ears  to  be  not  only  conducive,  but  es- 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


24g 


seDti^  to  the  spontaneous  opening  of  abscesses;  for 
where  it  is  absent  the  matter  of  chronic  abscesses  will 
remain  like  the  contents  of  buy  cyst  quiet  for  weeks, 
or  months,  or  years."  {Surgical  Pathology ^  3d  American 
edition,  p.  283.) 

Special  attention  was  paid  to  the  temperatnre 
throughout  the  case,  and  the  thermometer  was  never 
fi)und  to  vary  from  the  result  given  in  the  foregoing  his- 
tory.    _ 

8PHYGM0METRY. 
By  E.  SEGUnT,  M.D., 

VKW  TOBK. 

Thi  pulse,  as  the  external  expression  of  circulation,  has 
always  been  the  beacon  of  physicians:  and  though 
pathological  temperature,  as  expressed  by  tiie  thwmome- 
ter,  bids  fur  to  take  the  lead  in  diagnosis,  the  pviUe  may 
finally  remain  what  it  primarily  was,  if  we  improve  the 
means  of  perceiving  and  reading  it,  as  we  nave  the 
other  clinical  signs. 

The  appreciation  of  the  pulse  is  not  necessarily  con- 
fined to  the  medical  touch.  In  a  time  not  very  &r  back, 
physidanahad  only  the  bulb  of  their  fingers  to  perceive 
It  Then  the  detached  second-hand  of  the  watch  came 
to  their  aid;  and  lastly,  we  have  the  "  pulse  writer,"  the 
sphygmograph,  to  add  precision  to  perception,  and  at 
the  same  time  register  aoourately  the  variations  of  pulse 
carves. 

k  revolution  of  this  sort  is  neither  to  be  deprecated 
aor  avcHded ;  it  is  merely  to  be  complied  with,  or  submit- 
ted to,  not  in  »  ^irit  of  blind  restlessness  and  of  wor^my- 
ping  of  what  is  new,  for  novelty  sake ;  but  with  the 
steady  and  holy  q>irit  of  pro^^ress ;  not  as  the  aimimU 
beat  but  as  Hidpremnit  best  inslramentof  observation 
of  the  phenomena  of  circulation. 

The  instrument  of  Professor  Marey  serves  to  per- 
ceive circulatory  phenomena  unknown,  or  impeifectly 
known,  and  to  record  them. 

Though  the  pulse  may  be  considered  as  a  tiiit^,  it  may 
also  be~-it  has  been  in  fact — studied  analytically  in  re- 
gard to  its  volume,  strength,  rhythm,  frequency,  and  the 
shape  of  its  waves.  The  three  first  properties  may  be 
perceived  by  the  medical  touch ;  the  fourth  may  be  guess- 
ed by  the  same  sense,  but  ean  only  be  measured  with  a 
chronometer:  the a^(^o/(^ iMnrasq/* <^ Nooci eseopes 
ahnoet  entirely  the  most  gifted  fingers,  and  what  is 
known  as  the  *'  dicrotic  pmse,"  stands  as  a  monument 
of  the  incapacity  of  ov  ^maided  sense  to  perceive  afliy^ 
thmg  further. 

We  admitted  that  the  volume,  stren^,  and  rhythm 
may  be  perceived  by  the  touch :  but  is  it  sure  that  they 
I  Qo^xmly  and  always  aie?  Ii  so,  how  is  it  that  phy- 
sicians ^>preciate  them  so  differently,  and  express  tbcnn 
•0  variously,  that  they  hardly  uiMeratand  and  trust 
ea^  other  about  the  piuse  V  Medical  taot  has  never  been 
especially  educated  in  schools  or  hospitals,  and  phy-* 
licians  hikve  had  to  fbni\  their  own  notions  about  it ; 
and  no  particular  language  could  possibly  connect  their 
easentiuly  iodividual  id^  on  the  solgect  This  judg- 
ment is,  periiaps,  more  forcibly  ^qtressed  in  the  laogua^ 
of  two  men  of  jfEsat  aath<Mnty.  Pio£  A«  Flint,  Jr., 
says:  "  It  is  evident  that  few  of  the  characters  of  a 
pulsation,  occupying  b&  it  does  but  a  seventieth  part  of 
a  minnte,  can  be  asoertained  bry  the  sense  of  touch  alone." 
-^PkyMo^  cf  Man^  vol  i.  p.  261.)  And  '^conaid^ 
cn^  practaee  scarcely  teaches  us  to  estimate  the  exact 
dcjpee  of  the  alterations  of  the  pulse;  but  certainly  not 
with  saffident  distinctness  to  convey  to  others  an  ao- 
curate  idea,  or  even  to  be  able  ourselves  to  eevpaps  one 
denervation  vrith  another."  (Daoosta  in  Diagnona,) 
This  double  incapacity  to  read  the  pulse  with  the  tact 


even  aided  by  the  watch,  and  to  express  it  in  words 
susceptible  of  being  agreed  and  assented  to,  has  led  in- 
gensons  minds  to  contrive  instruments  susceptible  ot 
completing  the  observations  begun  with  tactile  imper- 
fection. Sefore  speaking  of  the  last  and  b^t  of  them 
we  ought  not,  in  justice,  to  omit  (he  first  one.  As  far 
back  as  1833,  Dr.  Jules  Herrisson  presented  to  the 
Institute  of  France  his  ^pkygmometre^  accompanied  with 
an  exodlent  notice,  and  sixt^  observations  of  diseases 
of  the  hearty  observed  with  his  instrument  The  sphyg- 
mometre  had  for  its  object  to  render  wery  action  of  Uie 
arhriei  apparent  to  ^  eye.  Its  first  advantage,  ex- 
presdy  says  the  author,  is  to  enable  the  physician  to 
write  down  an  exact  description  of  the  pulse  during 
health,  and  to  keep  it  at  the  standard  to  which  he  ought 
to  bring  the  pulse  back  in  case  of  disease. 

It  was  to  be  appUed  in  hospitals,  to  allow  the  pupils 
to  judge  vnth  their  own  eves,  histead  of  relying  on  the 
assertion  of  the  teacher,  whose  experienced  toudi  would 
not  give  the  same  sensation  as  their  inexperienced  one. 
In  consultation  every  physician  might  apply  the  instru- 
ment in  his  turn  and  exhibit  it  to  all.  In  written  con- 
sulUtions  a  ftr  greater  degree  of  accuracy  was  prom- 
ised by  measuring  the  movements  of  the  pulse,  tlum  by 
describing  them  m  words.  Changes  might  be  written 
down  as  often  as  they  occurred,  according  to  the  march  of 
the  disease,  or  to  the  efibcts  of  remedies.  The  sphyg- 
mometer gave  indications  of  some  disease  of  the  chest 
that  percussion  or  stethoscopy  could  not  find.  It  re- 
vealed certain  particularities  of  the  arterial  circulation 
whidi  the  tact  could  not  detect 

Its  construction— the  device  of  a  reputed  engineer 
Paul  Gemier— was  very  simple,  and  rather  in  keeping 
with  the  few  rude  medical  ana  surgical  instruments  of 
that  time.  It  consisted  of  a  glass  tube  backed  by  a  paper 
with  the  graduated  figures  marked  on  it  The  end  of 
this  glass  tube  was  inserted  into  a  steel  stem,  terminated 
by  an  inverted  cop.  wluch  was  closed  by  apiece  of  gold- 
beater's skin  stretimed  over  its  mouth,  and  secured  by  a 
rhn.  as  is  the  head  of  a  diiim.  The  reservok-  was  med 
with  mercury,  and  oomnranicatiion  might  be  intercepted 
between  the  cup  and  the  capillary  glass-tube  by  a  stop- 
cock. When  the  heart  or  pulse  were  to  be  examined, 
the  nhy^ometre  was  secured  m  situ,  its  ups  and  downs 
notea,  and  the  8t(^>-cock  applied  whenever  any  point 
readied  by  the  mercury  needed  to  be  ascertained. 

It  was  a  measurer,  not  a  writer  of  the  pulse ; '  it 
actually  showed  itw  what  the  sphymograph  does  not  do 
— Itoi  somebody  had  to  write  its  results,  otherwise 
they  would  pass  away  unrecorded 

tmperfeot  as  the  ephygmometre  may  have  been,  but 
pregnant  with  the  fiiture  progress  of  diagnosis,  it  was 
presented  to  the  appredation  of  the  Institute  ofFrance. 
where  it  received  an  ofilcial,  that  is,  deadly  reception 
fipora  the  commiSBariea  Magendie  killed  it,  under  the 
pretence  that  there  was  a  discrepancy  between  the  results 
of  the  two  observers  requested  by  the  commission  to 
experiment  upon  the  sanoe  patient  with  the  new  instru- 
ment; but  in  reality  for  the  reason  that  the  eminent 
reporter  was,  or  exnected  soon  to  be,  engaged  himself 
in  experiments  of  me  same  nature.  This  plain  accu- 
sation, of  whieh  we  are  not  judge,  but  often  proffered 
in  similar  eases,  is  item  Dr.  B.  8.  Blundell,  who,  in  1835, 
publieAied  the  sphygmometre  in  London,  with  some 
modifications  of  his  own,  but  giving  full  credit  to  Dr. 
J.  Herxiason  for  his  dtsoovery.  But  it  takes  men  like 
Fulton,  acnd  discoveries  like  his,  to  resuscitete  from  the 
sdeottnc  guHiotn^e  of  the  Masarine  palace.  Herris- 
son's  and  Bhmdell's  ideas  on  sphygmometry  were 
sank  in  oblivion.  Viefordt  took  up  the  French  idea— 
as  it  is  usual  for  Qermans  to  do— and  transformed  the 
sphy gmo-fusABT  into  a  sphygmo-grapK   Progress^  in  gm 


244 


THE  MEDICAL  RECORD. 


sense,  since  the  Gkrman  instrument  recorded  the  pnlse ; 
retrograde,  in  another  sense,  since  it  gave  onlj  the  nps 
and  downs  of  the  waves,  but  not  their  peculiar  undula- 
tions, which  could  be  pl^nly  read  on  the  sphygmometer. 
Yierordt*8  instrument,  however,  did  not  attract  the 
notice  of  the  profession. 

To  Professor  Marey,  of  the  OoUige  de  IVanee,  belongs 
the  honor  of  having  taken  up  the  idea  of  Herrisson. 
ffiving  it  a  new  form,  with  the  aid  of  recent  mechanical 
mgenuity,  and  to  have  presented  it  at  a  time  when  the 
foremost  men  of  the  profession  seemed  ready  to  forward 
it,  together  with  other  improvements  in  diagnosis.    The 


hereafter. 

It  does  not  give  positively  the  volume,  nor  the 
strengdi,  nor  the  rhythm,  nor  the  frequency,  though  it 
indicates  more  or  less  these  properties;  but  it  does  give 
positively  the  shape  of  the  waves  assumed  by  the  cir- 
culating fluid ;  shime  that  the  tact  alone  cannot  perceive 
with  any  degree  of  precision,  nor  the  language  retrace 
from  the  tacdle  impression  in  words  readily  understood. 

It  serves  already  to  register  the  unduiations  of  the 
pulse  dependent  upon:  Mrst,  organic  changes  in  the 
channels  of  circulation ;  Second,  functional  alterations 
of  the  same,  in  disease ;  at  various  stages  of  disease ; 
and  during  the  morning  and  evening  oscillations  of 
fever. 

But  the  chief  use  of  the  sph^gmograph  will  be,  as 
admirably  foretold  by  Dr.  Hemsson,  to  determine  the 
normal  pulse  in  healm  as  a  standard  of  comparison  for 
future  clinical  observations ;  to  determine  it  in  infancy,  in 
youth,  at  the  climacteric  epochs  of  life,  and  in  any  criti- 
cal circumstance  which  may  modify  it  For,  let  us 
remember,  the  movement  of  the  circulation  is  not  inva- 
riably identical  in  all  men,  at  all  ages,  nor  in  the  same 
man  under  various  contingencies.  Whilst  physiological 
temperature,  once  establi^ed  for  our  race,  holds  good 
as  the  standard  of  health  for  everybody,  phy^dogical 
circulation  presents  such  changes  above  and  below  its 
mean  reckoning  that,  when  we  are  called  to  a  new 
patient,  we  never  know,  and  can  rarely  suspect,  what — ^if 
any — ^was  the  deviation  of  the  healthy  pulse  from  the 
would-be  average.  In  this  trying  and  frequent  occur- 
rence, we  know  very  well  what  the  pathological  pulse 
is ;  but  how  can  we  form  a  judgment  upon  the  distance 
which  separates  this  pulse  &om  the  healthy  one?  since 
to  establish  our  proportion  we  miss  the  most  important 
term,  the  normal  pulse. 

In  this  respect  alone  the  ^hymograph  will  fill  up  a 
larger  gap  in  our  means  of  diagnosis.  The  thing  is  sim- 
ple enough.  Nearly  every  j^rofession  but  ours  has  its 
kndmarks.  The  police,  for  mstance.  has  its  pasaporii, 
wherein  the  features,  proportions,  and  individualities  are 
recorded,  so  that  a  thief,  wherever  he  goes,  may  be  at- 
tended to  according  to  his  desert  But,  strange  enough, 
wherever  an  honest  man  falls  a  prey  to  accidents  carry- 
ing with  them  disorders  of  the  vital  forces,  even  inca- 
pacity of  communicating  de  voce  with  a  physician,  no 
record  of  his  normal  pulse,  general  habits,  etc.,  can  be 
found  in  his  pocket ;  he  has  no  piuspari  throwing  light 
upon  his  past  health  and  reflecting  that  light  upon  the 
course  to  be  pursued  in  his  treatment  Thus  men  have 
been  bled  to  death,  because  the  power  of  their  pulse  was 
unknown  to  their  attending^  physician ;  and  others  have 
ruptured  important  vessels  in  Uie  act  of  vomiting,  whidi 
would  never  have  been  provoked  by  an  emetic,  if  cer- 
tain curves  in  the  waves  of  their  pmse  had  previou^y 
revealed  the  state  of  these  vessels.  What  signify  eighty 
beats  in  a  patient,  whose  normal  pulse  is  seventy,  and  in 
another  whose  normal  pulse  is  one  hundred,  if  both 


standards  are  ignored  by  the  physician?  And  what 
meaning  must  be  attached  to  the  absence  of  every  fifth 
or  seventh  beat  if  it  has  lasted  for  years,  or  just  made  its 
appearance  ?  The  which  we  do  not  Know.  Nothing 
but  records  of  the  sphygmograph  can  give  us  anv  dew 
as  to  the  physiologic  pulse,  the  basts  of  all  pathological 
judgment  Here,  more  than  anywhere  else  in  diagno- 
sis, conjecture  must  mi^e  room  for  positive  knowledge. 

But  the  sphygmogri^h  has  met  with  two  objections, 
which  happily  l^ar  not  upon  its  principle,  and  hardly 
upon  any  temporary  defects  in  its  construction. 

1st  "The  Y&ry  perfection  and  nicety  of  the  instru- 
ment," says  A.  Flint,  Jr.,  in  his  admirable  treatise  on 
Phvsiology  of  Man,  "  presents  almost  insurmountable 
difficulties  in  the  way  of  its  use  by  the  general  practi- 
tioner." Though  tfaos  objection  bears  more  upon  our 
personal  incapacity  than  upon  the  instrument,  we 
hope  to  see  tins  last  improved,  so  that  its  handling  will 
become  more  easy  to  practitioners.  Anyhow,  the  diffi- 
culty resulting  from  the  want  of  skill  of  phyucians  in 
using  delicate  instruments  of  precision,  needs  to  be  re- 
moved; the  sooner  the  better.  Nowadays  surgeons 
handle  efliciently  instruments  that  Ambrois  Par^  would 
not  have  Imown  how  to  use ;  ordinary  mechanics  and 
single  girls  easily  manage  instruments  of  labor  that  their 
grandparents  would  have  been  burned  for  as  the  devices 
of  witchcrafb;  and  we  (average  physicians)  are  accused 
by  a  competent  writer,  and  likely  not  without  reason,  of 
bein^  inci^ble  of  handling  the  most  efficient  instrument 
of  diagnosis,  beeau$e  of  its  nicety  and  perfection  /  This 
avowal  cannot  put  to  shame  the  instrument,  but  those 
who  cannot  manage  it  And  this  inci^adty  leads  us 
to  remark,  that  in  our  medical  colle^  and  hospitals 
there  is  nothing  like  a  systematic  trainmg  of  the  medical 
$enae»,  very  little  of  handling  of  the  instruments  of  phy- 
sical diagnosis,  and  none  at  sJl  of  the  manoeuvring  of 
the  instruments  of  positivism  in  diagnosis,  as£be  sphyg- 
mograph. Can  it  be  hoped  that  this  deficiency,  once 
signalized,  will  be  soon  supplied? 

2d.  The  other  objection  to  the  sph^fmograph  comes 
from  its  writing  the  pulse  on  a  straight  phm,  so  short 
that  it  can  only  receive  the  imprint  of  the  moves  taking 
place  during  ten  seconds.  But  as  there  are  changes  of 
rhythm  which  are  separated  by  more  than  that  time, 
such  changes  may  not  chance  to  be  induded  in  our  ob- 
servation, or  may  be  reproduced  very  irregukriy  on 
these  ten-second  diagrams.  But  this  imperfection  could 
easily  be  corrected  by  adapting  to  the  spnygmograph  of 
Marey  a  droular  (dan  like  Hierordt's,  but  moving  in  an 
ascending  spirole,  which  would  present  to  the  pen  a 
fidd  sufficient  to  write  down  the  undulations  of  one  or 
two  minutes. 

We  did  not  hear  of  any  other  ciitidsm  of  the  instru- 
ment of.  Professor  Marey,  and  tho^fore  we  deem  it  as 
valuable  to  the  practitioner  as  it  has  been  to  the  phy- 
dologisi^— foremost  among  our  means  of  positive  diag- 
nosis. 


Festival  DomB  to  Dbs.  Wade,  Staats,  and  Mo- 
Nauohton. — The  Albany  Medical  ScMciety  recently  gave 
a  festivid  dinner  in  celebration  of  the  completion  of  half 
a  centuiT  in  the  practice  of  medidne  by  Drs.  James 
Wade,  Barent  P.  Staats,  and  James  McNaughton. 
Thf  affiiir  was  as  interesting  as  it  was  unique.  Speedies 
appropriate  to  the  occasion  were  made  by  Drs.  Staats, 
MoNaughton,  Alden  Mardi,  and  others.  The  recipients 
of  the  iKmor  are  stilL  we  are  hi^py  to  say,  in  the  en- 
joyment of  good  health,  and  *'  may,  *  in  the  language  of 
one  of  the  toasts,  "  their  days  be  filled  vrith  the  abun* 
dance  and  beauty  of  a  glorious  autumn,  and  their 
lengthening  years  be  crowned  with  honor."-  - 


THE  MEDICAL  RECORD. 


246 


OVARIOTOMY—REMOVAL  OF  A  MALIG- 
NANT TUMOR— RECOVERY. 
By  EDW.  T.  CASWELL,  M.D., 

or  PBonDBNcm 

The  operation  for  ovariotomy  has  become  bo  well 
knowiL  and  so  many  cases  have  ended  successfnlly,  that 
an  apology  might  be  needed  for  the  publication  of  the 
present  case,  were  it  not  for  the  character  of  the 
tumor.  It  occurred  in  the  practice  of  Dr.  Miller,  and  is 
reported  with  his  consent. 

JkL  M.,  an  Irish  woman,  45  years  of  age,  married  ten 
years  ago :  her  husband  died  two  years  since.  She  has 
had  two  cnildren  and  two  miscarriages;  the  last  child 
was  bom  six  years  ago,  and  the  last  miscarriage  oc- 
curred in  the  same  year.  Ever  since  the  dei^th  of  her 
husband  there  has  been  an  irregularity  in  menstruation. 
She  first  noticed  a  swelling  in  Uie  hypogastric  region  a 
^ear  ago  last  August,  and  a&other  prominence  showed 
Itself  last  March  in  the  left  lumbar  region.  The  swell- 
ing constantly  increased — ^the  lower  becoming  the  most 
prominent.  There  was  some  tenderness  and  pain.  She 
orst  came  ander  Dr.  Miller^s  eye  abont  midsummer.  The 
abdomen  wa<9  then  much  distended  with  fluid,  and  in 
the  latter  part  of  August  she  was  tipped,  and  five  quarts 
of  a  clear  fluid  were  withdrawn.  The  distension,  how- 
ever, was  not  wholly  remoyed.  In  the  course  of  a 
month  she  again  suffered  from  the  amount  of  fluid  col- 
lected, and  upon  examination  it  was  decided  that  there 
was  a  tumor  of  ovarian  origin,  and  the  operation  of 
ovariotomy  was  proposed,  to  which  the  patient  readily 
jielded  her  assent.  The  operation  was  performed  on 
the  10th  of  October.  At  that  time  the  abdomen  was 
as  mach  enlarged  as  it  is  in  the  seventh  month  of  preg- 
nancy. Fhictuation  was  very  manifest  over  the  left 
side  and  towards  the  middle  line.  There  were  two  com- 
paratively hard  prominences  to  be  felt  through  the  ab- 
dominal walls  corresponding  to  the  two  points  at  which 
the  patient  had  first  noticed  the  swelling.  The  one  in 
the  left  lumbar  region  seemed  the  most  firm,  and  was 
somewhat  sensitive  upon  pressore.  There  was  some 
doubt  expressed  as  to  the  result  of  the  operation,  but  in 
accordance  with  the  earnest  entreaties  of  the  patient  it 
was  determined  to  proceed  with  it. 

The  patient  was  placed  upon  a  table  in  a  wdnn  room 
and  brought  under  the  influence  of  chloroform.  After 
she  was  completely  unconscious,  ether  was  substituted 
for  the  chloroform.  An  incision  was  made  in  the  middle 
line,  commencing  nearly  an  inch  below  the  umbilicus, 
and  carried  down  almost  to  the  symphisis  pubis.  On 
reaching  the  peritoneal  cavity  there  was  a  gush  of  fluid, 
proceeding  from  a  small  cyst,  which  was  found  to  be 
attached  to  the  anterior  wall  of  the  abdomen.  The  sur- 
face of  the  tumor  was  now  exposed.  It  was  lobulated, 
and  in  some  of  the  lobes  there  were  cysts  manifestly 
containing  fluid.  There  were  some  points  of  adhesion 
to  the  w^  of  the  abdomen,  and  some  to  the  intestines. 
These  adhesions  were  broken  up  without  much  difficulty 
— one  of  some  sise  attached  to  the  small  intestines  was 
separated  with  the  ^craseur.  The  ones  containing  fluid 
were  then  punctured.  From  one  a  quantity  of  clear 
serous  fluid  escaped,  from  another  a  gelatinous  substance, 
and  from  another  a  thick  whitish  fluid,  resembling  rioe- 
water  in  appearance  and  consistency.  Another  portion 
of  the  tumor  was  decidedly  hard.  It  was  manifiwt 
therefiyre  that  the  tumor  was  not  as  simple  as  had  been 
supposed.  It  proceeded  firom  the  left  ovary.  The  pe- 
dicle could  be  distinctly  felt,  and  the  whde  of  the  tumor 
surrounded.  In  order  to  gain  more  room  the  original 
incision  was  extended  up  to  the  umbilicus.  The  tumor 
was  DOW  everted.    The  pedicle  was  attached  to  the 


broad  ligament,  and  just  outside  of  it  could  be  seen  the 
mouth  of  the  Fallopian  tube,  with  a  small  cyst  as  large 
as  a  i>en  upon  its  extremity.  The  pedicle  of  the  tumor 
was  isolated,  and  three  ligatures  of  double-twisted 
saddler's  silk,  waxed,  were  passed  through  it,  thus  divid- 
ing the  pedicle  into  three  portions.  Each  was  tied  se- 
curely, and  one  end  of  each  ligature  was  cut  off  close  to 
the  pedicle ;  the  pedicle  was  then  cut  off  without  hae- 
morrhage. The  small  cyst  upon  the  extremity  of  the 
Fallopian  was  then  cut  off,  ana  as  a  slight  flow  of  blood 
followed  the  knife,  a  single  ligature  was  passed  around 
the  bleeding  extremity.  The  pedicle  was  then  returned 
into  the, abdominal  cavity,  and  some  fluid,  which  had 
unavoidably  escaped  into  the  cavity  of  the  pelvis,  was 
absorbed  by  soft  sponges.  During  the  latter  part  of  the 
operation  sickness  at  the  stomach  occurred,  and  caused 
some  embarrassment,  in  consequence  of  the  movement 
of  the  bowels  which  it  created.  They  were,  however, 
retained  in  their  place  as  far  as  possible  by  gentle  and 
firm  pressure  upon  warm  cloths.  The  edges  of  the 
wound  were  then  brought  together  and  fastened  by  six 
sutures  of  silver  which  passed  through  the  peritoneal 
coat.  The  intervening  spaces  were  drawn  together 
with  adhesive  plaster,  and  the  ligatures  brought  out  at 
the  lower  extremity  of  the  incision.  A  thick  woollen 
pad  was  then  laid  upon  the  abdomen,  and  over  this  a 
broad  swathe.  The  patient  was  then  put  to  bed,  and 
came  out  from  the  effects  of  the  ansBsthetics  without 
unpleasant  symptoms,  save  a  quite  feeble  pulse.  She 
received  some  stimulus  immediately  after  the  operation, 
and  after  a  short  time,  as  she  complained  of  pain,  a  small 
anodyne. 

The  tumor  weighed  six  pounds  and  a  half.  It  was  a 
composite  tomor,  made  up,  as  has  been  said,  of  cysts  and 
intermediate  portions  of  considerable  finnness ;  uie  same 
variety  of  contents  was  observed  in  the  cysts  as  has  been 
mentioned.  The  hard  portion  of  the  tumor,  when  exa- 
mined microscopically,  showed  numeroiis  round  proli- 
ferous cells  with  nuclei  and  nucleoli,  and  presented  the 
general  appearance  of  medullary  cancer.  The  whole 
tumor  corresponded  very  well  to  the  description  which 
Rokitansky  ^vea  of  cy stoid  tumors  combined  with  me- 
dullary carcinoma.  The  result  of  the  examination, 
therefore,  seemed  to  lead  to  an  unfiivorable  prognosis 
eventually,  even  if  the  patient  should  recover  from  the 
operation. 

The  patient  was  allowed  a  mild  diet^  with  occasional 
doses  of  an  anodyne  for  the  first  few  days.  Each  night, 
for  a  week  or  ten  days,  she  received  a  subcutaneous  in- 
jection of  morph.  sulph.  gr.  i.  The  catheter  was  passed 
twice  a  day  for  two  weeks,  as  she  could  not  void  her 
urine  without  change  of  position.  Her  bowels  were 
kept  quiet  for^  one  week  after  the  operation.  At  the 
expiration  of  two  weeks  the  small  ligature  around  the 
mouth  of  the  Fallopian  tube  came  away,  and  some  of 
the  sutures  were  removed.  At  the  ena  of  the  third 
week  she  sat  up  in  bed,  and  at  the  expiration  of  a 
month  she  left  the  bed,.  The  first  of  the  large  liga- 
tures came  away  between  three  and  four  weeks  after 
the  operation,  a  second  was  removed  after  an  interval 
of  six  weeks,  and  the  third  and  last  came  away  on  the 
29th  December.  The  patient  recovered  firom  the  opera- 
tion without  any  drawback. 

More  than  six  months  have  now  elapsed  since  the 
operation,  and  Uie  patient  emojrs  perfect  health;  she 
says  she  has  not  been  so  well  in  years.  There  is  no 
sign  of  any  r^roduction  of  the  malignant  growth,  nor 
is  there  any  trace  of  disease  in  the  ovary  of  the  other 
side.  Gertamly,  if  a  malignant  growth  is  ever  entirely 
removed,  this  seemed  to  nave  been.  The  only  unfor- 
tunate circumstance  in  connexion  with  the  operation, 
and  one  that  I  do  not  remember  to  have  seen  mention- 


igitized  by 


Google 


246 


THE  MEDICAL  RECORD. 


ed  in  any  case,  ia  that  within  the  last  two  mondiB  a 
small  hernia  has  riiown  itself  on  the  right  aide  of  the 
Incision  where  one  of  the  suture  wires  passed.  As  this 
did  not  show  itsdf  for  four  months,  and  not  until  the 
patient  had  been  upon  her  feet,  as  usual,  for  six  weeks 
or  more,  it  seems  evident  that  it  can  only  be  connected 
with  the  operation  indirectly.  A  small  pad,  which  she 
wears,  suffices  to  keep  the  bowel  in  place. 
Arsn.  S9,  1887. 

TWO  CASES  OF 

PENETRATING  BAYONET  WOUNDS  OF 

THE  CHEST. 

Bt  S.  BARUOH,  M.D. 

Camdbit,  8.  0. 

Case  L — ^Priy.  Wm.  Tintler  was  wounded  in  a  bay- 
onet charge  on  the  8th  of  May,  1864,  at  Spotteylvania 
0.  H.,  Virginia.  He  was  brought  to  the  division  in- 
firmary an  hour  after  reception  of  his  wound.  On  ex- 
amination, two  apertures  were  discovered,  one  a  tri- 
angular, ragged  opening  in  the  back,  about  one-half 
inch  to  the  nfi;ht  of  the  tenth  dorsal  vertebra,  and  the 
other  a  small  puncture,  three  inches  below  the  right 
nipple,  near  the  angle  of  the  ninth  rib. 

He  states  that,  as  the  charging  line  advanced  with 
fixed  bayonet,  he  was  in  a  stooping  posture,  loading 
and  firing  rapidly.  While  thus  engag^  he  was  trans- 
fixed bv  a  bayonet,  and  he  asserts  positively  that  he 
distinctly  felt  the  withdrawal  of  the  weapon. 

When  first  brought  to  me,  the  following  symptoms 
presented  themselves:  His  face  was  pallid  and  anxioos, 
nostrils  distended;  skin  cool,*  pulse  weak,  but  some- 
what excited;  breathing  difficult  and  labored.  There 
was  slight  oozing  of  blood  from  the  posterior  orifice, 
which  w<u  contrcKUi;  and  bloody  expectoration  sinoilar 
to  that  occurring  in  ^nshot  wounds  of  the  lungs. 
These  symptoms,  oomomed  with  the  direction  of  tlie 
wound  and  history  of  the  case,  led  me  to  the  belief  that 
atub  right  lung  was  transfixed.  The  ''bent''  position  of 
the  patient  prevented  implication  of  the  right  lobe  of 
the  uver,  as  m  that  posture  the  liver  is  separated  firom 
the  diaphragm,  and  thus  the  bayonet  avoided  this 
organ. 

May  9. — ^Patient  expectorates  bloody  mucus,  com- 
plains of  pain  in  the  right  lung,  has  but  little  cough ; 
shock  has  passed  off  and  he  is  tranquil 

May  12. — ^Bloody  expectoration  ceased,  but  pain  still 
continues.  Auscultation  and  percussion  reveal  no  signs 
of  pneumonia  or  pleuritis. 

May  13. — Posterior  wound  is  healed  over  by  scftb- 
bing.    Still  no  svmptoms  of  pneumonia. 

May  16. — Patient  is  doing  finely ;  Uiere  is  some  accel- 
eration of  the  circulation  and  dyspnoea,  but  no  phynoal 
symptom  of  lung  disease. 

May  17. — Sent  to  general  hoq;Htal  in  fine  ^irits. 

Oass  n. — Corporal  G-.  Percival,  a  man  of  large  firame 
and  good  constitution,  was  wounded  in  the  same  charge 
as  Case  I.  His  case  was  brought  to  my  notice  about 
three  hours  after  the  wound  had  been  inflicted.  Di- 
vesting him  of  his  shirt,  which  had  an  opening  in  the 
back,  I  examined  the  chest  carefiiUy.  and  found  two 
apertures  of  a  triangular  shape,  one,  toe  largest,  in  the 
back,  iust  below  the  inferior  angle  of  the  left  scapula, 
and  tiie  other,  very  small,  over  the  sternum,  near  its 
li^t  border,  on  a  hue  with  the  foml!:  rib. 

Patient  was  lying  on  his  abdomen  and  partially  on 
his  left  side,  behind  a  small  rail  pilo,  when  he  was 
transfixed  by  a  bayonet.    When  broi  <;ht  to  the  infirm- 


ary, his  countenance  was  pale,  but  did  not  wear  that 
expression  of  anxiety  so  peculiar  in  penetrating  wounds 
of  the  chest;  his  svmptoms  indicated  a  shock  to  the 
nervous  system,  inauced  by  the  intense  excitement  in- 
cident to  a  hand-to-hand  conflict  The  whole  system 
seemed  to  suffer  from  depression  following  great  ex- 
citement Acting  on  this  view  of  the  symptoms,  I  ad- 
ministered some  stimulants  and  an  anodyne,  which 
partially  restored  the  patient,  and  enabled  him  to  recite 
nil  encounter. 

Under  peiseverince  of  this  treatment  the  pulse  ral- 
lied, and  skin  became  warm.  There  was  but  slight 
dyspnoea,  no  cough,  and  very  little  bloody  expectoration; 
ail  indicating  that  the  injury  to  the  lungs  was  not  ex- 
tensive. A  carefiil  investigation  of  the  posture  of  the 
patient  duiing  reception  of  the  wound,  and  a  consi- 
deration pf  its  direction,  <;onvinced  me  that  the  weap- 
on entered  the  back,  grazing  the  right  border  of  the 
posterior  portion  of  the  left  lung,  passing  through  the 
posterior  mediastinum  and  evading  the  hearty  whidi 
was  displaced  by  the  patient  leaning  somewhat  on  his 
lefii  sida 

May  9. — ^Patient  has  recovered  firom  shock  and  ner- 
vous depression ;  this  fact  confirmed  me  in  the  belief  that 
the  lung  was  not  seriously  implicated,  and  that  the 
heart  and  great  vessels  had  escaped  entirely.  His 
countenance  wears  a  more  cheerfiil  look;  pulse  some- 
what excited,  but  it  seems  to  be  more  of  a  nervous  than 
febrile  excitement  Yery  slight  expectoration  of  bloody 
mucus,  and  he  coughs  only  when  he  makes  an  effort  to 
diange  his  po8iti(»[L 

May  11. — ^Doing  w^ ;  dyspnoea  inconsiderable,  and 
no  physical  signs  of  pneumonic  or  pleoritic  inflamma- 
tion. His  bowels  having  been  costive,  a  mild  cathar- 
tic was  ordered. 

May  16. — Still  IVee  firom  pulmonary  inflammation : 
but  he  complains  of  pain  in  the  epigastric  and  umbilical 
region.  Emollient  poultices  were  applied,  and  an  ano- 
dyne administered  at  bedtime. 

May  17. — ^Pain  has  discontinued,  and  patient  is  again 
in  good  spirits. 

liay  19. — Sent  to  general  hoq>itaL  In  the  following 
July  both  of  these  patients  were  again  on  duty  with 
their  command. 

JRemarks. — ^Besides  these  cases,  a  number  of  others 
of  a  less  serious  nature  presented  themselves  for  treat- 
ment, nearly  all  of  whicn  recovered  at  the  field  infirm- 
ary and  were  returned  to  duty. 

The  limited  e^erienoe  derived  from  the  treatment 
of  these  eases  induces  me  to  consider  bayonet  wounds 
as  very  simple  injuries,  readily  healing  by  first  inten- 
tion, under  favorable  conditions. 

Perfect  tranquillity  and  continued  application  of  cold 
water  to  the  openings  of  exit  and  entrance  are  most 
essential,  I  found  that  the  diest  cases,  though  present- 
inff  a  more  extensive  track  than  those  of  the  hands, 
loms,  shouldea^  and  hips,  healed  more  rapidly,  for  this 
reason,  that  the  slightiy  punctured  patients  would  not 
obey  my  injunctions  to  keep  quiet 

The  sequelae  of  bayonet  wounds  are  not  as  serious  as 
those  of  ^nshot  ininries.  Not  one  of  the  men  who  re- 
ceived injuries  of  this  kind,  was  rendered  unfit  for  ser^ 
vice.  There  was  no  exudation  of  superfluous  lymph, 
no  irregular  gluing  of  muscular  fibres,  no  pennanent  or 
even  temporary  contraction  of  muscles  or  tendons.  Our 
knowledge  of  bayonet  wounds  has  been  so  limited 
that  tiieir  effects  have  been,  until  a  recent  period^n- 
volved  in  considerable  doubt  and  even  mystery.  Bx- 
perienoe,  however,  teaches  that  we  have  exaggerated 
the  nature  of  these  injuries,  and  attributed  to  them  for- 
midable  qualities  which  they  happily  do  not  possess. 

Why  is  it,  that  soldiers  have  such  terrible  fear  of  the 


Digitized  by 


Google 


THE  MEDICAL  RECX)RD. 


24? 


biyonet  ?  Why  is  it  that  the  determined  approach  of 
a  hoe  of  ghstening  steel  makes  the  cheek  blanch  and 
causes  the  bravest  hearts  to  waver?  Why  do  we  in 
many  battles  witness  the  rout  of  lines  that  have  un- 
flinchingly withstood  a  contmued  galling  fire  of  muske- 
try and  flutilleiy,  as  soon  as  the  opposing  line  approach- 
es closely  with  fixed  bayonets  ?  This  dread  of  "  cold 
rteey  is,  in  my  humble  opinion,  mainly  attributable  to 
iniorance  of  the  nature  of  the  injuries  inflicted  by  it. 
There  appears  to  exist  in  the  minds  of  men  a  vague 
dread  of  transfixion  by  the  bayonet  But  this  would 
probably  not  be  so,  were  it  generally  known  that  bay- 
onet wounds  are  ahnost  harmless,  when  compared  to 
the  ploughed  tracks  which  the  terrible  mini^  bores 
through  tt)e  tissues.  The  bayonet  on  account  of  its 
fees  velocity,  is  easily  diverted  firom  a  straight  course  by 
bony,  cartilaginous,  and  tendinous  tissues,  and  forms  a 
onooth  track,  whilst  the  mini^  is  relentless  in  its 
course,  whirling  with  unimpeded  force  through  all  op- 
posing structures,  crushing,  tearing,  maiming  all.  A  bay- 
onet wound  almost  invariably  heals  by  first  intention 
under  auspicious  circumstance^  and  leaves  no  deformity 
behind,  whilst  the  simplest  ball  wound  requires  weelra 
for  a  complete  recovery,  and  then  perhaps  leaves  the 
sofierer  with  a  contracted  and  useless  limb» 


©rtglnal  Cecturw. 


TEE  PBODUCnON  OF  MUSCULAR  FORCE. 

BmrO   RIHABE8   HADE 

Bt  Pro?.  J.  C.  DRAPER,  M.D., 

AT  KEW   TORS   HKDICAIi   JOITRNAL  ASSOCIATION. 
MAT  81,  ISflT. 

Hb.  Chaibman — ^Until  a  comparatively  recent  period, 
the  opinion  of  Liebig  that  muscular  force  was  the  direct 
product  and  consequent  of  oxidation  of  muscle-fibre, 
was  very  generaUj^  received  and  adopted  by  the  ma- 
jority or  physiologists  of  reputation.  The  urea  of  the 
vine  was  at  the  same  time  regarded  as  the  result  of 
this  action,  and  therefore  the  quantity  of  this  injnredient 
was  supjsofled  to  be  dependent  on  the  degree  of  muscu- 
Ur  activity.  Impressed  with  this  idea^  about  twelve 
years  ago  I  undertook  a  series  of  experiments,  in  order 
to  detennine  the  amount  of  urea  produced  by  various 
degrees  of  muscular  action.  The  results  of  these  expe- 
riments were  altogether  different  from  what  was  ex- 
pected, and  they  were  embodied  in  the  form  of  a  thesis, 
which  was  published  in  the  New  York  JowmcH  of  Mt- 
dieme,  for  Febniary,  1856. 

In  this  paper  it  was  shown  that  there  was  no  relation 
whatever  between  the  quantities  of  urea  and  muscular 
action ;  and  that  a  movement  of  thirteen  miles  on  a 
level  road,  instead  of  producing  an  increase  in  the 
diurnal  quantity  of  urea^  actually  caused  a  reduction ; 
there  being  less  urea  secreted  during  the  twenty-four 
hours  in  which  the  work  was  done,  t^m  during  twenty- 
four  hours  in  a  state  of  rest,  as  is  demonstrated  by  the 
following  table : 

1,000  of 


i^utotltf  of  Urine. 


Salid  BMiOiie.    Utm. 


•Idaa 
contain 
of  Urea. 


StaniUnL 
Vfciant^ 


l,10Senblocentlinetrei,    SS-SS^gn.  97-028  gn.    490. 


It  had  already  been  proved  by  Liehman,  that  varia- 
tions in  diet  produced  very  great  variations  in  the  diur- 


nal amount  of  urea,  and  I  therefore  concluded  that  urea 
was  produced  directly  from  the  food,  and  was  not  the 
representative  of  muscular  action ;  and  that  if  muscle 
was  disintegrated  in  order  to  produce  force,  the  pro- 
ducts of  that  disintegration  were  voided  firom  the 
system  by  some  other  chaimel  than  the  renal  appa- 
ratus. 

Bischoff  and  Voit  soon  after  advocated  the  opinion 
that  muscular  force  was  not  the  product  of  the  oxida- 
tion of  muscular  tissue;  and  the  investigations  of 
Edward  Smith  demonstrated  that  musculiu>  activitv 
increased  the  secretion  of  carbonic  acid  very  consi- 
derably, while  there  was  v^ry  little  variation  in  the 
quantity  of  urea,  as  is  shown  in  the  following  table: 


Oondittoa. 


Oftrbonlo  Add,  per  boor. 


Boring  Bleep, 

Lvlng  down  and  sleep  approaehing,. 

SlttlDg  pofture, 

WaUung,  rate  8  miles  per  boor, 

««  u      g      u  a 


. .    19  grains. 
..    88      " 
.    29      « 
.  70B      " 
.1006      •« 


The  doubt  which  was  thus  thrown  on  the  theory  of 
Liebig  has  been  still  ftirther  increased  by  the  experi- 
ments of  Drs.  Pick  and  Wislicenusof  Zurich,  who  advo- 
cated the  opinion  of  Fraube,  that  muscular  force  is  not 
in  any  degree  dependent  on  the  oxidation  of  muscular 
fibre,  but  is  produced  by  tiie  combustion  of  the  hydro- 
carbons. 

They  regard  a  muscle-fibre  as  an  apparatus  or  enmne, 
in  which  hydrocarbons  undergo  oxidation,  which 
results  in  the  production  of  force  and  heat;  and  just  as 
in  an  ordinary  machine  consisting  of  iron  and  steel, 
though  the  power  is  developed  by  the  combustion  of 
coal,  there  is  a  Uttle  wear  and  rust  of  the  machine,  so 
in  muscle-fibre  there  is  a  similar  small  amount  of  disin- 
tegration of  tissue,  which  may  be  represented  hj  urea, 
or  some  other  nitrogenized  constituent  of  the  unne. 

The  experiments  on  which  these  conclusions  are 
based  are  of  sufficient  importance  to  justify  a  detailed 
account.  They  consisted  in  the  ascent  of  one  of  the 
peaks  of  the  Swiss  Alps,  known  as  the  Faulhom ;  the 
path  chosen  was  the  steepest  that  was  practicable,  and 
the  height  attained  about  2,000  metres  above  the  Lake 
of  Brienze.  In  order  to  reduce  the  amount  of  urea  to 
the  lowest  point,  no  nitrogenized  food  was  taken  for 
about  eleven  hours  before  the  ascent  was  commenced. 
The  avera^  amount  of  nitrogen  per  hour  during  this 
period,  which  represented  nighi  urkiej  was  for  Fick,  '63 
grains;  for  Wislicenus,  '61  grains. 

The  ascent  wag  begun  at  6i8  a.m.,  'and  was  complet- 
ed in  about  eight  hours,  duringwhich  time  only  hydro- 
carbons were  taken  as  food.  The  excretion  of  nitrogen 
by  the  kidneys,  was  for  Fick,  '41  grains,  Wislicenus/39 
grains  per  hour,  and  represented  the  work  urine.  The 
urine  passed  for  five  and  a  half  hoars  after  the  comple- 
tion of  the  ascent,  and  was  also  collected  and  desijpated 
as  the  after^tpork  urine.  It  showed  an  excretion  of 
nitrogen  equivalent  to  *40  gruns  per  hour  for  Fick,  and 
•40  grains  for  Wishcenus.  At  the  close  of  this  period, 
which  was  at  7  p.m.  on  August  30th,  a  hearty  meal,  con- 
sisting mainly  of  nitrogenized  food,  was  taken;  and  the 
urine  of  the  succeeding  ten  and  a  half  hours,  f.  e.  to  5*30 
A.M.  of  August  3 1st  J  collected.  It  gave  for  Fick  -45 
grains,  and  for  Wishcenus  '51  grains  of  nitrogen  per 
hour,  and  represented  the  affer'Work  night  terine.  Ar- 
ranging these  results  in  a  tabular  form  we  find : 


NIgfat  urine, 

Workwine^ 

Alter  work  nrlne, 

After  work  night  mine,.. 


.Ildc,  ■ttgralna. 
.    *^  '41    •• 
.    *»     -40    •» 


41  .^Q  U 

••         -51      •• 


During  and  after  the  period  of  labor  the  smalleet 


248 


THE  MEDICAL  RECORD. 


proportion  of  nitrogen  was  excreted,  which  agrees  with 
the  results  that  I  published  in  the  article  previously 
mentioned. 

On  the  data  fumished  b^  these  results,  Drs.  Fick 
and  Wifllicenus  argue  that  since  Rauke  and  Shiry  have 
shown  that  neither  the  perspiration  nor  the  breath  con- 
taiued  any  appreciable  amount  of  nitrogenized  com- 
pounds, it  would  therefore  appear  that  muscular  force 
cannot  be  the  product  of  disintegration  of  muscular 
tissue ;  but  that  the  idea  of  Fraube  is  probably  correct, 
and  that  we  must  regard  the  combustion  of  hydro- 
carbons as  the  true  source  of  such  force. 

In  order  to  place  in  a  little  stronger  light  the  results 
obtained  in  their  experiments,  these  genUemen  adduce 
an  extended  calculation  to  demonstrate  that  the  oxida- 
tion of  an  amount  of  muscle-tissue  equivalent  to  '40 
grains  of  nitrogen  per  hour,  is  altogether  inadequate  to 
the  production  of  tne  power  required  to  accomplish  the 
work  represented  by  the  ascent  of  the  mountain ;  and 
if  the  action  of  the  heart  and  other  muscles  engaged  in 
carrying  on  the  functions  of  the  body  is  token  into 
account,  the  work  accomplished  is  at  least  three  times 
greater  than  the  utmost  amount  offeree  that  could  have 
been  produced  by  the  nitrogenized  matter  consumed. 
They  therefore  conclude,  "that  since  the  burning  of 
nitrogenized  material  cannot  be  the  only  source  of  mus- 
cular power,  it  is  not  in  any  way  concerned  in  its  pro- 
duction ;  and  considering  the  delicacy  of  &  muscle-nbre 
it  is  not  likely  that  dmerent  kinds  of  chemical  pro- 
cesses should  be  employed  to  produce  the  same  effect. 
Even  steam-engines  are  not  indifferent  as  to  the  mate- 
rial burned  in  them.  In  one  made  to  bum  wood,  it 
would  not  do  to  use  coaL  How,  then,  is  it  possible  to 
conceive  that  the  muscle-machine  was  constructed  espe- 
cially to  consume  nitrogenized  material,  and  that  when 
enough  is  not  to  be  h^i,  it  puts  up  contentedly  with 
non-nitrogenized  fuel  ?  That  it  does  make  use  of  non- 
nitrogenized  material,  we  have  by  our  own  experiment 
proved,  beyond  a  doubt  We  therefore  conclude  that, 
since  the  muscle  machine  can  he  heated  by  means  of  the 
non-nitrogenized  fad^  this  fuel  is  in  aU  cases  that  hest 
suited  for  it.'* 

For  additional  support  to  this  doctrine^  attention  is 
drawn  to  the  care  with  which  the  digesUve  apparatus 
of  ruminants  is  adapted  to  the  digestion  of  cellulose,  a 
non-nitrogenized  bodjr  •  and  to  the  fact  that  animals  of 
great  strength  and  swimiess  subsist  on  food  containing 
very  little  albuminous  matter.  The  statement  of  Dr. 
Piccard  is  also  cited,  that  the  chamois-hunters  of  Swit- 
zerland, in  their  expeditions,  take  with  them,  as  provi- 
sions, nothing  but  bacon-fat  and  sugar,  liaving  found  by 
experience  that  they  answer  their  purposes  for  a  time 
better  than  meat 

The  experiments  of  Dr.  Zalesky,  given  in  the  Lancet^ 
for  March,  1866,  show  that  on  removing  the  kidneys 
the  amount  of  urea  in  the  blood  is  not  increased,  but 
on  ligating  the  ureters  it  increases  very  rapidly,  which 
goes  to  prove  that  urea  is  not  the  product  of  muscle 
disintegration,  but  is  formed  in  the  kidney.  This  con- 
clusion favors  the  opinion  of  Fick  and  Wislicenus,  that 
muscular  force  is  the  result  of  the  oxidation  of  non- 
nitrogenized  matter  only,  and  that  combustion  of  albu- 
minoid bodies  has  nothing  whatever  to  do  with  it 

Dr.  Zalesky,  in  connection  with  these  experiments, 
draws  the  important  conclusion,  that  since  the  kidneys 
form  the  urei^  the  so-called  uremic  accidents  that  occur 
when  the  secretion  is  suppressed,  are  not  due  to  the 
presence  of  urea  in  the  blood,  since  that  substance  is 
not  produced  under  such  circimistances,  but  that  the 
poisoning  is  the  consequence  of  the  non-separation  of 
some  of  the  constituents  of  the  extractive  group. 
^   From  this  momentary  digression  we  revert  to  the  | 


discussion  of  our  subject,  by  referring  to  an  article  pub- 
lished in  the  Philosophical  Ifagaeine  for  Sept,  1866, 
by  Professor  Frankland,  in  which  he  first  notices  that 
the  experiments  of  Fick  and  Wislicenus  lose  a  portion 
of  their  importance  on  account  of  the  fact  that  the 
amount  of  actual  energy  generated  by  the  oxidation  of 
a  given  weight  of  muscle  in  the  human  body,  is  un- 
known ;  and  that  there  were  no  accurate  data  of  the 
heat  of  combustion  of  muscle,  nor  of  its  nitrogenized 
residue,  urea.  This  missing  link  Prof  Frankland  pro- 
ceeds to  supply  by  means  of  a  series  of  experiments 
with  the  calorimeter  of  Lewis  Thompson ;  the  combus- 
tion being  accomplished  b;^  means  of -chlorate  of  potassa. 
The  results  are  expressed  in  heat  wnitSj  each  of  which  is 
equal  to  one  grain  of  water  raised  through  l^C  <rf  temr 
perature,  while  the  mechanical  equivalent  of  heat  is 
that  of  Joule,  in  which  1  kilog.  of  water  raised  l^C,  — 
423  metre  kilogs.    They  are  as  follows : 

Substance  dried  at  lOOoO.       Arertge  beat  unit     ^S^ftf^S 

Beef  moMdewaifaed  with  ether 0,106 2,161 

Purified  albamen, 4,908 9,117 

Beef  fat, »,0«» M« 

Hlppurioadd, 5,888 2,«0 

Uric  add 2.615 1,118 

Urea, 9,806 984 

It  is  to  be  remembered  that  the  amount  of  actual 
energy  produced  in  the  body  is  lees  than  that  given  in 
the  above  table ;  for  under  these  circumstances  the  oxi- 
dation is  not  complete,  urea  being  produced  instead  of 
carbonic  acid,  water  and  nitrogen  ;  and  since  dry  mus- 
cle yields  one-third  its  weight  of  urea,  the  amount  of 
energy  produced  in  the  body  can  only  be  for  "  Beef 
musde  washed  with  ether,"  heat  unit  4,368,  metre 
kilogs  of  force,  1,848. 

Applying  this  result  to  the  experiments  of  Fide  and 
Wishcenus,  and  allowing  for  the  fact  that  probably  at 
least  half  the  oxidation  was  lost  as  heat,  rrof  Frank- 
land  finds,  that  "  scarcely  one-fifth  of  the  actual  energy 
required  for  the  work  performed  could  be  obtainw 
from  the  amount  of  muscle  consumed." 

Though  Prof  Frankland  admits  the  truth  and  force  of 
the  experiments  of  Fick  and  Wislicenus,  he  by  no 
means  admits  that  nod-nitrogenized  articles  alone  are 
consumed  to  produce  force ;  for  he  states  that  the  nitro- 
genized also,  inasmuch  as  they  are  combustibles,  and 
consequently  capable  of  furnishing  actual  energy,  might 
be  expected  to  be  available  for  the  same  purpose ;  and 
such  an  expectation  is  confirmed  by  the  experiments  of 
Savory  upon  fats  (Lancet,  1863,  pages  381  and  412), 
which  show  that  these  animals  can  Uve  for  weeks  in 
good  health  upon  food  consisting  exdosively  of  "mus- 
cular fibre."  The  conclusions  finally  drawn  fi^m  an 
extensive  series  of  experiments  are  announced  by  Pro£ 
Frankland  as  follows : — 

"  Ist.  A  muscle  is  a  machine  for  the  conversioQ  of 
potential  energy  into  mechanical  force. 

"  2d.  The  mechanical  force  of  the  musdee  is  derived 
chieflv,  if  not  entirely,  fi^m  the  oxidation  of  matters 
contained  in  the  blood,  and  not  fi'om  the  oxidation  of 
the 'muscles  themselves. 

"3d.  In  man  the  chief  materials  used  for  the  pro- 
duction of  muscular  power  are  non-nitrogenized ;  but 
nitrogenized  matters  can  also  be  employed  for  the  same 
purpose;  and  hence  the  greatly  increased  evolution  of 
nitrogen  under  the  influence  of  a  flesh  diet^  even  with 
no  increase  of  muscular  action. 

"  4th.  lake  every  other  part  of  the  body  the  rausdes 
are  constantly  being  renewed,  but  this  renewal  is 
scarcely  perceptibly  more  rapid  during  great  muscular 
acdvitv  Uian  during  comparative  <juie8oenoe. 

'*  5tJ^.  After  the  supply  of  sufficient  albominoid  mat- 


THE  MEDICAL  RECORD. 


249 


ters  in  the  food  of  zoan  to  provide  for  the  necessary 
reoewal  of  the  tissues,  the  b^t  materials  for  the  produc- 
tion both  of  internal  and  external  work  are  non-mtrogen- 
ized  matters,  suoh  as  oil,  fat)  sugar,  starch,  gum,  etc. 

'^  6th.  The  non-nitrogenized  matters  of  food  which 
find  their  way  into  the  blood,  yield  up  all  their  poten- 
tial energy  as  actual  energy;  the  nitrogenized  matters 
on  the  oSier  hand  leave  the  body  with  a  portion,  at  least 
(me-seventh,  of  their  potential  energy,  unexpended. 

'*7th.  The  transformation  of  potential  energy  into 
muscular  power  is  necessarily  accompanied  by  the  pro- 
duction of  heat  within  the  body,  even  when  the  mus- 
cular power  is  exerted  externally.  This  is  doubtless 
the  chie^  and  probably  the  only  source  of  animal  heat.'' 

Comparing  these  conclusions  with  those  of  Fick  and 
Wishcenus,  we  find  that  while  the  first  are  stated  at 
greater  length,  they  only  differ  fix>m  the  latter  in  sup- 
posing that  nitrogenized  substances  can  be  and  are  em- 
ployed in  the  muscles  for  the  j^oduction  of  force. 

Li  a  paper  on  Insensible  rerspiration,  read  before 
the  Academy  of  Medicine,  May,  1864,  and  which  was 
based  on  a  long  series  of  experiments,  I  arrived  at  the 
conclusion,  that  the  effete  material  arising  during  the 
production  of  muscular  force,  was  evacuated  as  nitro- 
gen, by  the  skin  and  lungs,  and  not  as  urea,  by  the 
kidneys.  The  experiments  of  Prof  Frankland  do  not 
miliiate  against  tins  opinion. 

There  ^lU  remains  one  element  in  the  problem  to  be 
yet  solved :  it  is  the  variation  in  the  proportion  of  sul- 
nhates  excreted  during  rest  and  motion.  To  this  I 
hope  to  devote  some  time  during  the  ensuing  summer. 
If  It  is  found  that  violent  muscular  action  produces  a  cor- 
re^>ODding  increase  in  the  amount  of  sulphates,  it  wiU 
tend  to  show  that  mu&cular  tissue  does  undergo  disinte- 
gration during  the  period  of  activity ;  while,  if  it  is 
not  matenallv  increased,  the  conclusions  of  Fraube. 
Fick,  and  Wislicenus  will  be  demonstrated  beyond 
peradventure,  and  we  shall  be  obliged  to  accept  the 
doctrine  that  muscular  action  is  the  product  of  oxida- 
tion of  non-nitrogenized  material  alone. 

Otbticercus  in  the  Brain. — Dr.  John  Harley  re- 
ported (jAxncd)  an  interesting  case,  in  a  pathological 
point  of  view,  to  the  Medico-Chirurgical  Society,  illus- 
trating the  development  of  the  larval  form  of  the  com- 
mon tapeworm  in  the  substance  of  the  brain,  about 
sixty  cases  of  which  are  on  record;  the  affection  is, 
therefore,  a  rare  one.  The  subject  of  the  present  case 
was  a  healthy  boy,  fifteen  years  old.  He  died  of  acute 
rfaeamatismal  pericarditis  and  encephalitis,  after  a 
week's  illness.  Only  a  solitary  larva  was  found  in  the 
body,  and  this  was  imbedded  in  the  right  corpus  stria- 
tum and  dightly  projecting  into  the  ventricle.  The 
cyst  waa  no  Wger  than  a  pea,  and  contained  within  its 
interior  the  retracted  head  and  neck  of  the  parasite. 
The  species  was  distinguished  by  the  large  size  of  the 
great  curvature  and  the  strong  bases  of  their  booklets, 
and  by  the  development  of  danc  violet  pigment  granules 
about  the  hook  sacs.  The  boy  had  always  enjoyed  good 
health,  and  the  only  evidence  of  cerebral  disorder  was 
manifested  during  the  last  two  months  of  his  life.  It 
consisted  of  frontal  headache  and  an  uncontrollable  ten- 
dency to  deep— «ymptoms  which  were  probably  caused 
by  the  presence  of  tne  parasite. 

Wet-Nursino  in  Fbanok. — A  petition  has  been  pre- 
sented to  the  French  Senate  asking  that  all  mothers  be 
compelled  to  nurse  their  own  children. 
^  »  ^1 

Jaoib,  the  difltinguiahed  German  oculist^  recently  died 
«i  Ylenna^  aged  ei|^ty-four  years. 


Ucportd  0f  ^00pttald* 


JEFFERSON  MEDICAL  COLLEGE,  PHILA- 
DELPHIA. 
CLmiCS  OF  PROF.  GROSS. 

08TB0-MTELITI8 — TRIPLE    AMPUTATION    IN    CONTINUITY   OP 
HUMERUS  AND  AT  THB  SHOUIiDER-JOINT. 

Mr&  F ^R,  aet.  43,  much  older  looking,  very  much 

emaciated  by  suffering,  not  weighing  over  70  lbs.,  was 

sent  to  the  clinic  April  17,  1867,  by  Dr.  K r,  for 

what  was  at  first  supposed  to  be  an  ordinary  case  of 
inflammation  of  the  elbow-joint  resulting  in  anchylosis, 
with  more  or  less  implication  of  the  bone.  Two  years 
ago  this  patient  fell  upon  the  curbstone  striking  her 
left  elbow,  which  had  been  stiff  ever  since  the  accident. 
The  elbow  was  a  good  deal  swollen,  very  painful,  and 
presented  a  number  of  openings  communicating  with 
the  articulation,  firom  which  there  was  a  good  deal  of 
discharge ;  some  spicula  of  bone  had  been  discharged 
at  times.  The  general  health  of  the  patient  was  not 
good,  and  she  was  suffering  from  the  remains  of  a 
disuThoea.  The  patient  was  ordered  some  tonic  treat- 
ment, and  told  that  were  ^e  strong  enough,  her  arm 
would  be  amputated  as  the  only  means  of  procuring 
relief;  but  the  poor  woman  begged  so  hard  to  have  the 
limb  removed  at  6nce,  and  thus  be  put  out  of  suffering, 
that  Prof.  Gross  consented  to  perform  the  operation. 
OUoroform  was  carefully  administered,  and  at  ^^ 
moment  of  aneasthesia,  the  arm  was  removed  by  flap 
operation  at  its  middle;  but  tlie  moment  the  saw 
entered  the  bone  it  sank  into  the  medullary  cavity, 
showing  that  a  more  serious  state  of  affairs  was  present 
than  had  been  anticipated,  and  therefore  on  its  removal, 
the  stiunp  was  immediately  amputated  high  up,  without 
waiting  to  renew  the  anesthesia,  which  had  gone  off 
Here  again  the  same  condition  prevailed,  and  it  was 
found  that  the  entire  bone  was  diseased,  whereupon  a 
third  amputation  was  immediately  performed  at  the 
shoiflder-joint,  digital  compression  controlling  the  sub- 
clavian. This  last  was  under  peculiar  dificulty  from 
the  extreme  shortness  of  stump  left  by  the  two  pre- 
vious amputations.  The  flaps  were  taken  from  the 
wasted  deltoid,  and  the  great  pectoral  and  broad  dorsal 
muscles.  The  entire  humerus  was  diseased,  the  head 
of  the  bone  crushing  under  moderate  compression 
between  the  thumb  and  forefinger.  The  glenoid  cavity 
was  not  tinvolved,  and  there  was  therefore  hopes  ot 
recovery,  if  the  patient  should  get  over  the  shock,  for 
the  last  two  operations  were  not  performed  under 
ansssthesia. 

The  patient  was  placed  under  the  influence  of  tinc- 
ture of  the  chloride  of  iron  with  quinine,  and  milk 
punch,  with  a  nutritious  diet ;  and  promptly  recovered 
without  a  single  untoward  symptom,  improving  in  flesh 
and  strength  during  the  union  of  the  flaps. 

PISTULE  IN  THX  ANUS. 

Wm.  G T,  8Bt  48,  by  trade  a  tailor,  presented  him- 
self to  the  clinic,  Dec.  29.  1866.  About  eleven  weeks 
ago  his  attention  was  called  to  an  anal  abscess,  which 
was  very  painful,  and  in  about  three  weeks  opened 
without  surgical  mterference.  the  discharge  not  being 
very  great  The  result  has  oeen  the  formation  of  an 
anal  &tule. 

There  are  two  kinds  of  abscesses  at  the  verge  of  the 
anus;  one  is  phlegmonous,  similar  to  the  abscess  liable 
to  form  in  any  other  part  of  the  body.  The  svmptoms 
of  such  an  abscess  are  acute,  well  characterized,  and  the 


250 


THE  MEDICAL  RECORD. 


pus  is  of  a  peculiar  consistent  character,  containing  an 
immense  number  of  globules,  comparatively  little  tatty 
matter,  and  it  is  of  a  whitish  cream-like  appearance. 
Then  there  is  a  strumous,  scrofulous,  tuberculous,  or 
chronic  abscess,  which  is  liable  to  form  in  this  situation 
in  persons  predisposed  to  consumption,  or  who  are 
laboring  imder  that  affection,  who  labor  under  this 
peculiar  strumous  or  scrofulous  diathesis, — not  liable  to 
form  in  all  persons  any  more  than  pulmonary  consump- 
tion is  liable  to  form  in  all  constitutions.  A  person 
must  have  a  predisposition  to  the  formation  of  such  an 
abscess,  or  else  it  could  not  take  place,  and  it  is  fre- 
quently attended  with  a  tuberculous  deposition  in  the 
follicles  of  the  mucous  membrane  of  the  rectum.  This 
tubercular  matter  gradually  softens,  disorganization 
ensues,  and  at  length  an  ulcer  forms  which  becomes  a 
source  of  irritation ;  this  irritation  is  gradually  transferred 
to  the  tissues  around, — and  finally  there  is  gradually 
formed  an  abscess  of  the  character  mentioned.  The 
patient  before  the  class  had,  from  the  account  fliven  of 
Ids  symptoms,  a  phlegmonous  abscess,  for  he  has  not 
had  cough,  shortness  of  breath,  ni^ht-sweats,  or  loss  of 
flesh,  and  nis  tongue  is  dean,  and  his  bowels  regular. 

In  examining  such  a  case,  we  insert  a  grooved 
director  along  uie'  tract  called  the  fistule,  at  the  same 
time  passing  the  finger  of  tlie  other  hand  into  the  in- 
terior of  the  bowel ;  the  patient  being  on  his  elbows 
and  knees,  the  head  low  down,  and  the  knees  forward, 
the  legs  beinff  widely  separated ;  for  in  this  manner  the 
breech  is  fairly  presented.  The  onening  in  the  present 
instance  is  larger  than  the  barrel  of  a  goose-quill,  and 
readily  reoeives  the  point  of  the  instrument,  which 
passes  readily  into  the  rectunL  There  is  but  one  track. 
It  is  therefore  what  we  call  a  complete  fistule  in  the 
anus. 

There  are  two  forms  of  incomplete  fistuks  in  the  anus ; 
one  in  which  there  is  an  external  opening  leading  up 
to  the  bowel,  but  not  into  it,  not  passing  through  the 
wall  of  the  bowel ;  this  is  called  an  external  incomplete. 
or  an  external  blind  fistule : — then  there  is  an  intemu 
fistule  in  which  tiie  opening  passes  from  the  interior  of 
tlie  bowel  into  the  connecting  cellular  tissue  around  the 
tube,  not  communicating  with  the  skin,  and  conse- 
quently not  opening  on  the  external  surface ;  this  is 
called  an  internal  incomplete,  G£  internal  blind,  or 
internal  occult  fistule. 

The  complete  JUttUe  is  that  yariety  most  firequenUy 
met  with,  and  nere  there  is  a  direct  passage  from  the 
external  sur&ce  into  the  interior  of  the  bowel  There 
may  be  but  one  external  opening,  or  there  mav  be  two, 
three,  five,  or  seven,  so  that  the  sur&ce  around  presents 
a  cubriform  or  perforated  swivel-like  appearance. 
Generally  there  is  but  one  opening,  which  is  either  at 
the  side,  as  in  the  present  instance,  or  in  front  towards 
the  scrotum,  or  behind  towards  the  coccyx.  When 
there  are  several  external  openings  they  generally  com- 
municate with  the  main  sinus;  but  sometimes  they 
open  separately  into  the  interior  of  the  bowel.  This 
internal  opening  is  usually  single ;  although  sometimes 
there  are  two,  sometimes  three ;  but  this  is  uncommon. 
Then,  this  internal  opening  is  situated  immediately 
above  the  internal  spmncter  muscle,  at  the  height  of 
about  four  and  a  half  to  mx  lines  above  the  verge  of  the 
anus,  sometimes  not  more  than  three  lines ;  not  situated 
h^h  up,  as  was  formerly  supposed  by  the  older  patho- 
logists and  surgeons,  at  the  distance  of  firom  one  to 
two  or  three  inches,  but  just  above  the  verge  of  the 
anus. 

In  former  times  t^  operation  for  anal  fistule  was  a 
^ost  barbarous^   cruel,  and  painful  one,  and  even  a 

ingerous  one,  in  consequence  of  the  supposition  on  the 

rt  of  the  surgeons,  that  the  internal  opening  passed 


high  up,  for  the  bowel  was  slit  open  to  that  extent,  a 
proceeding  frequently  dangerous  on  account  of  tiie 
resulting  haemorrhage,  and  the  cure  was  always  pro- 
tracted m  consequence  of  the  severity  of  the  operation. 
It  remained  for  Eliper,  an  eminent  French  surgeon,  to 
place  this  part  of  pathology  ii;  its  true  li^ht,  by 
showing  that  the  internal  aperture  always  exists  just 
above  tiie  verge  of  the  anus,  or  just  above  the  true 
sphincter  musde  at  a  distance  from  three  to  five  lines, 
and  sometimes,  as  an  exception  to  the  rule,  even  to  the 
distance  of  an  mch. 

When  there  are  a  number  of  external  openinge^  as 
not  unfirequently  happens  in  cases  of  long  standing, 
then  the  parts  are  callous  fi-om  interstitial  deposits  of 
plastic  matter,  usually  more  or  less  in  a  state  of  irrita- 
tion, or  even  constant  inflammation^  attended  with 
a  great  deal  of  discharge  of  mucus,  and  often  fiscal 
matter. 

The  diagnoiis  of  an  affection  of  this  kind  can  always 
be  readily  determined  by  a  careful  exploration  of  the 
bowel ;  t^  contents  having  been  cleared  out  as  a  pre- 
liminary step  by  some  slight  laxative  the  previous 
evening,  or  by  means  of  the  enema. 

If  the  patient  be  a  female,  she  is  placed  upon  the  side 
in  bed ;  if  a  male,  in  the  position  alreadjr  described ; 
Hie  fore-finger,  well  oiled,  is  then  carefully  inserted,  by 
a  sort  of  rotary  movement,  into  the  bowel,  and  then  by 
separating  the  parts,  you  look  for  the  external  opening, 
wnose  situation  is  frequently  indicated  by  the  existence 
of  a  little  papule,  a  sort  of  nipple-shi^ed  projection — ^no- 
thing, however,  but  a  mass  of  granulations :  then  you 
pass  your  probe  into  the  centre  of  that^  and  at  once  it 
proceeds  along  into  the  main  channeL 

Performing  the  operation  with  a  sharp  probe-point- 
ed bistoury,  you  introduce  the  finger  into  the  bowel, 
then  insinuate  the  probe-pointed  bistoury  along  the 
fistule,  and  when  the  point  of  the  instrumient  comes  in 
contact  with  the  finger  in  the  bowel  cut  fi-om  within 
outwards,  in  this  way  withdrawing  the  finger  and  in- 
strument at  the  same  time. 

This  is  not  the  way  in  which  we  now  perform  this 
operation.  We  employ  here  a  process  much  more 
simple,  and  by  which  a  man  may  operate  in  the  dark 
without  any  difficulty.  The  grooved  director  is  pushed 
through  the  fistule,  and  brought  out  across  the  oppo- 
site nates,  exposing  the  whole  thing,  and  then  the  trach 
is  slit  open  with  the  knife. 

As  the  case  before  us  is  a  recent  one,  it  is  not  neces^ 
sary,  after  the  operation^  to  pare  the  edges  of  the  inci- 
sion; an  operation  which  sliould  never  be  neglected 
when  the  parts  are  callous,  indurtjtod,  and  irregular. 
A  well-oiled  tent  of  patent  lint  is  introduced  into  the 
wound  with  the  object  of  making  it  heal  from  the  bot- 
tom by  the  granulating  process.  The  tent  is  to  be 
retained  for  forty-eight  nours  and  then  removed,  and  it 
need  not  be  replaced  by  a  fresh  one.  The  bowels 
should  be  locked  up  for  at  least  three  dajrs,  keeping  the 
parts  in  a  quiescent  condition;  then  an  enema  may  be 
administered,  or  what  is  generally  preferable,  a  dose  of 
castor- oi^  or  an  ounce  df  sulphate  of  magnesia,  or  a 
portion  of  rochelle  salts,  etc. 

The  patient  should  observe  great  cleanliness,  the 
parts  should  be  washed  after  the  removal  of  the  tent 
several  times  in  the  twenty-four  hours.  The  diet 
should  be  simple,  nutritious,  and  not  calculated  to  dis- 
tend the  sdimentary  canal  habitually;  and  thus  the 
treatment  is  continued  until  the  patient  gets  well,  in 
from  a  fortnight  to  a  fortnight  and  a  half  after  the 
operation. 

A  male  infimt,  set.  9  months,  was  brought  to  the 
dinio  April  17,  1867,  with  an  anal  fieivle  which  C091- 
menced  three  months  .previous  in^^a  abeces&r  There 
digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


2&1 


were  three  external  openings,  one  upon  the  right  side 
and  two  upon  the  left,  there  being  complete  anS  fistule 
upon  each  side.  One  of  the  fistules  in  the  left  side  was 
dirided,  and  the  other  was  not  disturbed,  in  the  hope 
that  repose  of  the  sphincter  would  permit  the  other  to 
heal  up  without  interference. 

This  case  is  interesting  on  account  of  the  tender  a^ 
of  the  patient,  for  anal  fistule  rarely  occurs  so  early  m 
life. 


ptOQctas  0f  MtVxcd  0ctertce. 


Broxtdb  of  Potassium  in  Functional  Epilkpst.^- 
Dr.  0.  L.  Hubbell,  of  Troy,  N.  Y.,  in  an  article  on  some 
of  the  uses  of  bromide  of  potassium,  published  in  the 
Bofton  Med.  and  Surg,  Jour,^  relates  several  cases  of 
functional  epilepsy  treated  by  this  salt  He  administers 
it  in  solution,  in  the  proportion  of  3  i  of  the  sale  to  three 
ounces  of  water,  the  dose  being  a  teaspoonfhl  idfter 
each  meal 

Thx  Tbeatmbkt  or  MiNORRHAau. — ^A  recent  number 
of  the  Lancet  gives  a  very  interesting  account  of  the 
treatment  of  menorrhagia,  as  carried  on  by  the  gentle- 
men connected  with  the  out-door  department  of  the 
several  London  hospitals.  When  we  take  into  account 
the  number  of  organic  troubles  of  which  menorrhagia  is 
but  ft  symptom,  we  can  easily  oonclude  that  its  treat- 
ment must  depend  upon  a  variety  of  circumstances. 
The  number  of  cases  which  present  themselves,  and  the 
dispatch  which  is  necessary  in  prescribing  for  such,  has 
given  rise  to  a  certun  routine,  which,  considering  the 
practical  results  obtained,  is  of  value. 

Dr.Q-RtENHALGB  (St.  Bartholomew's  Ho6pital),assuines 
that  the  majority  of  cases  of  menorrhagia  are  due  to 
fibroid,  or  fibrous  out-growtJis  or  in-growtha  fix)m  the 
utems.  These  are  mostly  treated  by  a  pill  composed 
of  one-twelfth  of  a  grain  of  bichloride  of  mercury  com- 
bined with  quinine  and  belladonna,  to  which  are  frequent- 
ly added  smaU  quantities  of  the  aqueous  extract  of 
aloes,  taken  night  and  morning  for  some  weeks;  a 
mixture  composed  of  dilute  sulphuric  acid,  tincture  of 
Indian  hemp,  mucilage,  liquid  extract  of  ergot,  syrup 
and  infusion  of  quassia,  three  or  four  times  a  day,  being 
ordered  just  prior  to  and  during  the  catamenial  flow. 
Between  the  "  periods  "  a  draugnt  of  iodide  or  bromide 
of  potass^  with  the  liquid  extract  of  ergot,  sal  volatile, 
and  infusion  of  quasda,  is  given  twice  a  day.  If  the  loss 
of  Uood  has  been  very  great,  or  the  patient  be  ansemio, 
the  tincture  of  sesauichloride  of  iron  with  the  liquid 
extract  of  ergot,  chloric  ether,  syrup,  and  infusion  of 
quassia,  twice  or  thrice  a  day,  with  the  pills,  are  pre- 
acribed.  Where  the  patient  is  more  or  less  plethoric, 
whidi  is  rarely  the  case,  the  sulphate  of  magnesia  and 
digitalis,  either  with  dilute  sulphuric  acid  or  salines, 
ai^  scarifications  or  leechings  of  the  cervix  uteri,  are 
found  most  serviceable.  In  cases  of  subinvolution  of 
the  uterus,  attended  with  menorrhagia  due  to  imperfect 
reoovery  from  labor  or  miscarriage,  hyperlactation^  or 
ot^r  i^Rdctions  leading  to  constitutional  debility, 
especially  in  the  strumous  habit, the  syrup  of  the  iodide 
of  iron,  witii  or  without  ergot,  and  with  the  pill  above 
referred  to,  are  found  very  efficacious.  A  similar  course 
18  pursued,  sometimes  with,  sometimes  without,  the 
pills^  where  the  commencement  of  malignant  disease  is 
the  exciting  cause  of  this  symptom.  In  cases  of  Bright's 
disease  and  other  affections  mterfering  with  the  stasis 
of  the  blood,  gallic  or  tannic  acid,  usually  combined 
with  henbane,  prove  valuable  hsamostatics;  some  pre- 
paration of  iron  with  arsenic  bemg  usually  ordered  be- 
tween the    "periods.'*      Where   polypi,  portions   of 


retained  ovum,  or  fibrinous  dots  are  detected,  they  are 
removed. 

Dr.  Greenhalgh  particularly  draws  attention  to  the 
frequency  of  menorrhagia  as  the  result  of  collections  of 
fbcal  matter  in  the  large  intestines  and  rectum,  and  of 
hepatic  derangements  occasioning  mechanical  irritation 
and  congestions  of  the  haomorrhoidal  vessels  and  uterus. 
For  calculi,  in  addition  to  the  pills,  he  prescribes  repeat- 
ed doses  of  the  compound  decoction  of  aloes^  with 
tincture  of  nux  vomica. 

In  all  cases  he  recommends  quiet  of  mind  and  body ; 
rest  in  the  recumbent  posture ;  nutritious  and  unstimu- 
lating  diet ;  cold  acid  drinks ;  tepid  or  cold  water  vaginal 
injections;  great  moderation  or  total  abstinence  from 
sexual  excitement  He  now  and  then  has  recourse  to 
the  following  means : — ^Matico-cotton  plugs  or  pessaries ; 
astringent  vaginal  injections ;  sponge  tents ;  iodide  of 
lead,  and  atropine  pessaries;  iodised  cotton;  Hodge's 
and  other  pessaries  in  cases  of  misplacements  of  the 
uterus,  etc. 

Dr.  Greenhalgh  adds  that,  eastertsparihtUj  menorrhagia 
is  more  prevalent  among  women  of  lax  fibre,  more 
especially  if  they  have  had  many  children  or  abortions, 
in  rapid  succession ;  in  those  subject  to  acne,  pruritus, 
or  eczema,  and  about  the  climacteric ;  in  those  of  intem- 

Eerate  habits  of  various  kinds,  etc  He  considers  it  is 
y  no  means  always  easy  to  determine  whether  the 
case  is  one  of  menorrhagia  or  threatened  abortion. 

Dr.  Q-railly  Hbwitt  (University  College  Hospital) 
has  little  faith  in  mere  palliative  remedies,  but  thinks 
that  the  treatment  should  be  mainly  directed  to  remedy- 
ing tiie  organic  conditions  which  he  considers  are 
idmost  invariably  present.  He  does  not,  however,  un- 
derrate the  cold  vs^nal  douche,  rest  during  the  period, 
and  the  administration  of  ferruginous  compounds,  and 
also  ergot  in  powders  (  3  ss  three  times  a  day). 

Dr.  Murray  (Great  Northern  Hospital)  is  in  the 
habit  of  treating  functional  menorrhagia  by  the  com- 
bined use  of  gsdiic  (grs.  v-x)  and  dilute  sulphuric  acids 
(gtt.  xv~xxv^,  principally  with  as  much  rest  as  can  be 
obtained.  This  treatment  may  continue  for  a  period 
extending  over  two  months.  He  has  occasionally 
found  mustard  over  the  sacrum  every  other  night,  or 
even  a  blister,  of  service  in  that  form  where  after  child- 
bearing  a  large  uterus,  with  a  patulous  os,  is  continually 
pouring  out  blood,  and  every  now  and  then  doing  so  in 
gushes,  accompanied  with  clots.  He  also  advises  the 
^>plication  of  cold  water  in  the  lower  part  of  the  spine 
in  cases  of  continued  discharge  (not  leucorrhoeal) 
between  the  periods.  He  has  not  found  the  use  of  iron 
at  all  satisfactory.  Enemata  of  cold  water  have  been 
useful,  especially  at  those  moments  when  the  ^shes  of 
blood  with  clots  take  place,  a  gentle  non-irritating 
purgative  being  also  given. 

Dr.  Parson  (Charing-Gross  Hospital)  favors  an 
astringent  mixture  composed  of  tannic  acid  (5  to  10 
strains),  dilute  sulphuric  acid  (10  to  30  minims),  and  the 
fluid  ext  of  ergot  of  the  British  Pharmacopoeia  (5  to  10 
min.),  every  four  or  five  hours  for  the  first  few  days.  If 
there  is  much  pain,  5  to  10  minims  of  tinct.  of  Indian 
hemp  are  added  to  each  dose.  Iron  is  only  adminis- 
tered when  the  tendency  to  excessive  flow  has  ceased. 

The  treatment  employed  by  the  above  physicians 
applies  of  course  mainly  to  functional  menorrhagia; 
but  when  the  discharge  is  dependent  upon  organic 
troubles  the  indications  depend  upon  the  character  oi 
the  lesion  that  may  be  present,  the  satisfactory  termina- 
tion of  the  case  depending  in  adl  such  instances  upon  the 
removal  of  the  cause. 

Oil  07  PiTROLBUic.  says  the  Union  MtduxUeAa  a  pow- 
erfiil  agent  for  the  aestruction  of  insects^    The  crude 

digitized  by  LjOO^^_ 


252 


THE  MEDICAL  RECORD. 


oil  is  the  best  for  the  purpose.  A  few  grammes  of  pe- 
troleum diluted  with  water,  and  sprinkled  by  means  of 
a  watering-pot  over  strawberry  plants,  destroys  the 
mam,  or  "  white  worm  of  the  beetle  which  infests  those 
plants.  The  crude  oil  mingled  with  a  large  proportion 
of  water  is  a  sure  poison  for  crickets.  The  mixture  is 
to  be  poured  through  a  funnel  into  the  holes  frequented 
by  them.  The  acarus  scahiei  is  very  promptly  and  radi- 
cally destroyed  by  inunctions  with  the  oil.  Frictions 
with  petroleum  water  (60  gr.  par  litre)  immediately 
cleanse  the  domestic  animafi  of  the  parasitic  insects 
which  annoy  them.  The  am'mals  should  be  washed 
with  soapsuds  a  few  minutes  after  the  friction.  It  is 
also  stated  that  a  house  infested  with  rats  and  mice  was 
freed  from  these  guests  a  little  while  after  the  introduc- 
tion of  a  lar^e  quantity  of  the  oil  into  the  cellar. — Boih 
ton  Med.  and  Surg.  Journal. 

Ghloroforh  to  the  Dtino. — Dr.  Joseph  Buller,  Phy- 
sician to  the  Royal  South  Hants  Infirmary,  in  an  ar- 
ticle with  the  above  caption  in  the  British  MedicalJour- 
ndl,  makes  some  interesting  remarks  upon  the  propriety 
of  administering  chloroform  to  the  dyino^.  The  oases  to 
which  its  use,  in  his  opinion,  seems  appucable,  are  those 
in  which  there  are  extreme  restlessness  and  sleepless- 
ness.  accompanying  the  exhaustion  of  the  last  days  or 
weeks  of  the  life  of  the  very  aged,  especially  when  (as 
is  often  the  case)  the  mental  consciousness  is  still  active 
and  the  &ilure  of  power  in  the  vital  organs  is  actually 
felt,  with  none  of  that  physical  courage  to  bear  the  suf- 
fering which  the  same  patients  had  when  younger  and 
stronger.  At  this  time  opiates  seem  useless ;  in  fact,  all 
efforts  towards  alleviation  of  the  distressing  symptoms 
seem  utterly  fiitilfi  without  the  an»sthetic.  From  some 
cases  that  he  records  as  having  come  under  his  personal 
observation,  it  would  seem  that  the  chloroform,  property 
regulated,  acted  as  a  nerve  stimulant,  quieting  pain,  but 
stSl  not  interfering  witli  the  process  of  intellection. 

Extraction  of  a  G-lass  Bottle  from  the  Rectum. — 
The  following  remarkable  case  wss  admitted  into  Dar- 
lington .Hospital,  under  the  care  of  Dr.  Howison : 

T.  W ,  aged  thirty,  a  workman  in  the  gas-house, 

was  with  some  companions  amusing  himself  with  jump- 
ing over  bottles  placed  above  each  other  with  their 
small  ends  uppermost.  After  he  had  in  his  turn  jumped 
over  the  bottles,  the  top  one  was  missing,  and  it  appear- 
ed to  have  passed  through  a  thin  pair  of  flannel  trousers 
into  the  rectum.  The  man,  a  patient  of  Dr.  Howison, 
was  brought  to  the  hospital  next  morning.  He  gave 
very  little  appearance  of  anything  being  the  matter. 
Immediately  after  the  accident  he  felt  very  sick  and 
fSiint  He  went  to  bed,  after  trying  to  protrude  the 
bottle.  On  his  admission,  the  base  of  Hie  bottle  was 
found  at  the  extremity  of  the  ascending  colon,  though, 
from  his  description  of  its  situation,  soon  aft«r  the  acci- 
dent, it  was  just  about  the  junction  of  the  transverse  and 
descendmg  colon.  An  injection  of  warm  soap  and  water 
was  at  once  given.  This  had  the  effect  of  bringinjg  the 
bottle  within  extreme  reach  of  the  finger.  Dr.  Marion 
Sims'  vaginal  speculum  was  used  to  expand  the  rectum, 
and  after  several  attempts  to  seize  and  draw  it  out  by  a 
pair  of  oesophageal  forceps,  it  was  at  length  expelled  in 
a  great  measure  by  the  action  of  the  bowel,  assisted  by 
manipulation.  With  the  exception  of  the  pain  expe- 
rienced in  expanding  the  rectum,  the  extraction  gave 
the  patient  UtUe  uneasiness,  and  he  walked  home  seem- 
ingly very  httle  the  worse.  He  was  directed  to  remkin 
in  oed  for  a  day,  and  very  soon  recovered.  The  bottle 
is  a  castor-oil  bottle,  such  as  is  usually  sold  by  druggists, 
and  is  eight  inches  Ions,  four  inches  round  at  the  thick 
extremity,  and  one  incm  and  a  half  round  th^  neck.  It 
is  rather  carious  that  the  bottle  should  have  been  plump- 


ed down  upon  so  exactly  at  the  anal  orifice  as  to  pass 
up  without  much  pain.  What  the  consequences  would 
have  been  had  the  bottle  broken  in  its  passage,  it  is 
rather  unpleasant  to  conjecture. — Lancet. 

An  Ingenious  Bullet  Detector. — A  very  ingenious 
piece  of  mechanism  for  the  detection  and  extraction  of 
bullets  in  wounds  has  been  devised  by  Mr.  Sylvan  De 
Wilde.  It  seems  that'  at  the  time  Q-aribaldi  was  suffer- 
ing from  the  effects  of  an  undetected  bullet  in  his  limbi 
and  pained  by  the  fruitless  efforts  of  operators  to  de- 
tect it^  it  occurred  to  several  individuals  of  a  philoso- 
phic turn  of  mind  that  electricity  might  very  well  be 
employed  in  the  detection  of  metallic  substances  lodged 
within  the  human  tissues.  In  France,  M.  Edmond 
Langlois,  M.  Favre,  and  Dr.  Lecompte  of  the  French 
Army  Medical  School  at  Val-de-Gr&ce,  assisted  by 
M.  Khumkoff,  all  made  use  of  it  in  the  elaboration  of 
suggestions  on  the  point.  There  is  this  manifest  advan- 
tage, that  the  structures  of  the  body  are  non-conductive 
— a  fact  that  renders  the  action  of  the  electric  current 
more  perfect. 

Mr.  De  Wilde  has  apparently  produced  the  most  prac- 
tical result :  and  his  instruments  have  been  submitted 
to  the  naval  and  military  authorities,  who  have  made  a 
complimentary  report  about  them.  The  apparatus  con- 
sists of  a  probe  and  forceps,  a  battery,  and  an  alarum, 
contained  in  a  box  eleven  inches  long  by  three  broad, 
and  two  inches  and  a  half  deep.  The  elements  for  the 
generation  of  a  current,  which  remains  constant  for 
some  weeks,  are  zinc  and  carbon.  The  probe,  consist- 
ing of  two  steel  wires,  insulated  from  each  other,  is  con- 
nected with  an  electric  horse-shoe  magnet  and  a  bell, 
and  when  (introduced  into  the  wound)  it  touches  the 
bullet  the  circle  is  completed,  and  the  bell  rings.  The 
forceps  act  on  the  same  principle,  and  are  intended  first 
to  detect,  then  to  seize,  the  bullet  They  have  curved 
points,  and  not  pallets  or  spoons.  The  points  of  the , 
probe  are  kept  sheathed  on  introduction  to  a  wound, 
and  not  uncovered  till  the  supposed  bullet  is  felt  This 
is  effected  by  means  of  a  sliding  tube.  The  advantages 
of  Mr.  De  Wilde's  probe  over  others  of  its  kind  are  very 
marked,  and  the  army  and  navy  officers  will  no  doubt 
find  it  a  great  aid.  The  probe  is  a  sensltiTe  artificial 
finger,  which  enters  deeply  into  the  tissues,  and  gives 
the  si^al  at  once  when  it  detects  the  hidden  source  <^ 
mischief  below. — Lancet 

Puerperal  Peritonitis  treated  htpodbrmioally  with 
Morphine. — J.  H.  Beech,  M.D.,  in  the  Detroit  Review 
of  Medicine  and  Pharmacy^  after  relatingthe  history  of  a 
case  of  Puerperal  Peritonitis,  says:  "Having  seen  no 
report  of  hypodermic  treatment  of  Puerperal  Peritoni- 
tiS)  I  conceive  that  this  may  encourage  others  to  give  it 
a  trial.  It  will  be  observed"  (in  the  history  above 
mentioned),  '^  that  no  efficient  medicines  were  retain- 
able by  the  stomach,  except  hydL  chl<  mit  grs.  iij.  and 
morpli.  sulph.  gr.  i.  very  early  in  the  attack,  and  no 
efficient  use  of  enemata  was  secured  until  the  danger 
had  subsided,  while  the  effect  of  the  hypodermic  injec- 
tions was  well  marked  and  salutary.  Do  others  find 
that  this  method  of  using  morphia  constipates,  or  even 
restrains  the  bowels  ?  Some  other  cases  have  led  me  to 
think  that  it  affects  them  very  little,  if  any." 

Tetanus  Caused  bt  Suboutaheous  Tkjbotions  op 
QuiNiA.— The  GaaKtic  JSebdomadaire,  of  the  28th  June, 
mentions  that  two  patients,  one  an  adult  and  the  other 
a  child,  died  recently  firom  the  effects  of  quinia  injected 
subcutaneouslv"  for  the  cure  of  intermittent  fever.  The 
same  journal  also  alludes  to  a  case  of  tetanus  attributed 
to  the  same  cause,  reported  in  the  Southern  Jownial  of 
Medical  Sciences,  and  copied  into  a  British  journal. 

digitized  by  ^ „      ^_ 


THE  MEDICAL  RECORD. 


25S 


The  Medical  "Record. 

^  Stmi-Poitt^IS  lottrnal  of  Ptbinne  anb  Snrgers. 
Geobgb  p.  Shbadt,  M.D.,  Editoe. 


PoblialMd  on  tlM  1st  aiid  15th  of  each  Mouth,  bf 
WtLLIAU  WOOD  &  CO.,  61  Wixkxb  Strset,  New  York. 


FOREIGN  AQEJSrCl^, 


LoVDOV—TRUBBmB  k  Co. 

Pahs— BoeeASOK  kt  Cib. 


Lkipno — B.  Hbrmahn. 

Bio   jAMBIBO^nPHKNII  T  Oa. 


Nevr   Yorli:.   A.\ign8t  1.  186r. 


PRESCRIBma  APOTHECARIES. 
Etery  youDg  graduate  who,  for  the  first  time,  feels 
that  he  is  legally  entitled  to  the  appeilation  of  Doctor 
of  Medicine,  rightly  concludes  that  he  by  it  should  be 
distinguished  from  others  not  so  fortunate.  When, 
however,  he  has  beoome  engaged  in  the  active  duties 
of  his  profession,  he  is  very  soon  undeceived,  and  be- 
eomes  aware  that  the  title  is  an  exceedingly  cheap 
•ne ;  that  the  man  who  concocts  some  patent  vegetable 
pills  with  singular  cure-all  properties,  who  manu&ctures 
I  hair-dye,  a  pile  ointment,  a  youthful  invigorator  "  for 
declining  manhood,'*  or  who  invokes  the  aid  of  spirits 
u  the  selection  of  a  particular  herb  to  meet  his  patient's 
case,  or  who  is  content  to  dispel  disease  by  some  mira- 
cdous  touch,  is  not  by  name  to  be  distinguished  from 
him.  But  there  is  even  a  comfort  in  the  thought  that 
all  such  are  the  most  pitiable  of  charlatans,  and  that  the 
motiyes  which  actuate  them  in  the  performance  of 
sach  deeds  are  either  pardonable  on  account  of  the  im- 
becility of  which  they  are  the  offspring,  or  are  in  their 
wickedness  too  despicable  for  honest  contemplation. 
He  is  in  fact  prepared  to  pity  the  one  or  despise  the 
other;  and  in  this  he  is  upheld  by  the  sensible  portion 
of  the  general  community. 

There  is,  however,  a  distinct  class  of  these  pretenders 
to  the  title  who,  from  their  position,  are  more  apt,  by  a 
too  credulous  people,  to  be  voted  the  right  to  use  the 
trademark  of  tiie  profession  and  stamp  the  same  upon 
all  their  doings ;  we  refer  to  the  apothecaries.  If 
any  one  would  undertake  to  examine  into  their  motives 
for  appropriating  the  name  and  assuming  the  privileges 
of  the  well-qualified  and  licensed  physician,  it  would  not 
he  found  very  diflBcult  to  arrive  at  a  result  by  no 
means  creditable  to  the  probity  of  the  guilty  party. 

A  well-educated  and  well-behaved  apothecary  is  so 
indupensable  to  the  physician,  and  the  mutual  relations 
which  should  exist  between  the  two  are  so  peculiar, 
that  they  cannot^  in  the  interest  of  both,  be  too  jealous- 
ly guarded.  For  the  most  part,  the  reg^ular  pharmaceu- 
tists are  men  of  integrity,  learning,  and  sterling  worth, 
but  they  form  altogether  too  small  a  maj<mty. 


We  do  not  propose  to  canvass  all  the  littie  devices 
which  our  druggists  are  guilty  of  to  catch  a  penny,  or 
the  very  questionable  and  reprehensible  little  practices 
of  abetting  quack  advertisements,  and  sundry  other 
littie  things  which  they  so  naively  acknowledge  to  be 
"  tricks  of  the  trade,"  but  we  cannot  longer  delay  a  re- 
ference to  a  practice  which  is  as  rife  among  them  as  it 
is  disgracefiil,  viz.  that  of  prescaribing  for  those  who  may 
call  at  their  shops  for  advice. 

As  soon  as  tiie  merest  shop-boy  becomes  employed 
around  a  drug-store,  he  earns  for  himself  the  appella- 
tion of  doctor,  and  is  at  once  looked  upon  by  his  asso- 
ciates and  acquaintances  as  one  versed  in  the  arts  of 
cure.  He  is  at  first  staggered  with  the  title,  but  as  the 
simple  result  of  being  in  the  habit  of  hearing  it  coupled 
with  his  name,  he  becomes  so  accustomed  to  it  that  he 
tacitiy  acknowledges  his  right  to  it,  and  commences  to 
govern  his  acts  accordingly.  After  he  graduates  from 
his  first  position  and  is  able  to  compound  a  prescription, 
his  title  becomes  imquestioned,  and  whenever  occasion 
offers  he  embarks  in  the  practice  of  physic  with  an  auda- 
city that  is  really  amusing.  The  very  excellent  oppor- 
tunities they  have  of  flattering  a  dangerous  pride  are  too 
great  for  most  of  these  so-called  "  drug-store  doctors  " 
to  withstand,  of  giving  a  littie  advice  along  with,  a  littie 
medicine,  and  not  unfrequentiy  they  become  the 
Courts  of  Appeal  for  a  patient  who  may  not  exactly 
understand  why  his  physician  prescribes  this  or  that 
article. 

We  speak  advisedly  when  we  affirm  that  the  number 
of  shops  in  this  city  in  which  this  abominable,  disgrace- 
ful, unprofessional,  and  dishonorable  practice  of  indis- 
criminate prescribing  is  forbidden,  can  perhaps  be  fixed 
at  a  dozen  or  two.  The  time  has  come  when  a 
physician  can  hardly  enter  any  of  these  so-called  re- 
spectable metropolitan  stores  without  his  professional 
character  being  insulted  by  the  most  impudent  and 
ignorant  pretensions  of  some  stripling  knight  of  the 
pestle,  who  does  not  hesitate,  imder  any  circumstances, 
to  prescribe  for  any  tiling  which  may  come  along;  and 
if  perchance  he  should  insist  upon  the  propriety  of 
seeing  the  patient  first,  and  not  run  the  trifling  risk,  so 
to  speak,  of  taking  the  word  of  a  messenger,  it  is  a 
species  of  refinement  in  drug-store  practice  very  seldom 
indulged  in.  This  statement  would  under  ordinary  cir- 
cumstances appear  paradoxical  in  view  of  the  oft-re- 
peated assertions  of  these  individuals  concerning  pro- 
fessional honor,  and  other  similar  phrases,  of  which  they 
are  nowadays  so  willingly  ignorant. 

ye  are  inclined  to  be  charitable  enough  to  suppose 
that  it  is  not  altogether  the  fault  of  these  presoribers 
that  they  have  patients;  in  other  words,  that  they  hard- 
ly solicit  patronage;  but  when  we  have  said  thus  much, 
we  have  given  them  all  the  extenuation  which  they 
(Reserve.  When  we  contemplate  the  deliberate  act  for 
which  they  alone  are  accountable,  that  of  complying 
with  what,  on  the  fiwje  of  it,  is  a  request  they  know  is 
improper,  our  charity  for  the  apothecary  £u1b  us,*  He 
Digitize^  „, iOQlC 


254 


THE  MEDICAL  RECORD. 


may  be  solicited  to  give  advice ;  but  knowing,  as  he 
must^  that  the  giving  of  it  is  wrong,  not  only  to  his 
would-be  patient,  but  to  the  profession  whose  confi- 
dence he  outrages,  he  has  no  excuse  to  urge  for  so 
doing. 

There  are  many  aspects  in  which  this  subject  of  in- 
discriminate prescribing  may  be  viewed  in  relation  to 
the  injurious  influence  it  must  exert  upon  the  profession, 
not  the  least  of  which  is  the  cheapening  of  the  services 
of  competent  physicians — ^men  who  have  to  depend  for 
a  Uving  upon  professional  fees,  and  who  have,  perhaps 
unfortunately  for  themselves,  no  drugs  to  dispose  o^ 
and  thus  strike  a  balance  to  their  credit.  Many  apo- 
thecaries are  wont  to  swell  their  honest  bosoms  with 
proud  contempt  at  the  idea  that  many  physicians  would 
stoop  so  low  as  to  receive  a  percentage  upon  their 
prescriptions,  yet  while  making  these  pharisaical  de- 
monstrations, they  are  cheating  the  honest  practitioner 
out  of  many  a  legitimate  fee. 

If  our  apothecaries  were  educated  to  prescribe,  as  is 
the  case  with  those  of  Great  Britain,  for  instance,  the 
matter  could  safely  be  trusted  in  their  hands ;  a  certain 
class  of  cases  would  then  naturally  drift  into  their  way^ 
and  no  one  would  be  injured.  But  as  the  case  now 
stands,  these  individuals  are  practising  under  false  pre- 
tences ;  and  on  account  of  this,  and  of  the  evils  which 
naturally  grow  out  of  it^  the  professional  man  has  a 
right  to  demur. 

It  will  be  perceived,  by  reference  to  the  action 
recently  taken  by  the  East  River  Medical  Association, 
that  a  movement  is  about  being  made  in  the  right 
direction  by  calling  the  attention  of  apothecaries  to  the 
impropriety  and  danger  of  repeating  prescriptions  with- 
out the  physician's  authority.  Let  them  heed  this,  and 
the  next  step  will  be  expostulation  against  the  appro- 
priation for  their  own  purposes  of  the  prescriptions  of 
such  physicians  as  may  send  their  patients  to  their 
shops.  These  recipes  are  too  frequently  used  as  spe- 
cifics for  certain  diseases,  and  the  patients  are  made 
aware  of  the  &ct  that  this  is  Dr.  A's  or  B's  favorite 
recipe  for  a  particular  disease.  If  this  practice  were 
confined  to  a  few  of  the  drug-stores,  it  would  hardly 
be  a  matter  of  much  importance ;  but  considering  its 
great  prevalence,  it  becomes  the  profession  to  concern 
itself  in  reference  to  some  practical  measures  for  pro- 
tection against  such  firaudulent  dealings. 

Wk  have  received  a  copy  of  a  circular  which  has  been 
addressed  to  all  Universities,  Colleges,  Schods  of  Medi- 
dhe,  and  Medical  Societies  in  Canada,  requesting  ihem 
to  send  delegates  to  a  convention  which  is  to  assemble 
at  Quebec  on  the  9th  day  of  October  next,  for  the  pur- 
pose of  aiding  and  cooperating  in  ''  the  protection  of  the 
interests,  the  advancement  of  the  knowledge,  and  the 
extension  of  the  uaefiilness  of  the  medical  profession 
of  Canada.'' 

As  the  Union  of  l^e  Provinces  of  Canada,  Nova 
Sootta>  and  New  Brunswick,  is  effected,  and  united 


Legislative  and  Executive  action  thus  secured,  it  seems 
essential  that  there  should  also  be  uniformity  in  the 
laws  which  regulate  life  and  health,  and  especially 
those  relating  to  the  exercise  of  the  medical  profession, 
Accordingly,  at  a  meeting  of  the  medical  profession, 
held  on  the  18th  of  June  last,  at  the  "Laval  University" 
in  the  city  of  Quebec,  the  following  action  was  had : 

Resolved,  1.  That  in  the  interest  of  the  public^  and 
the  medical  profession,  it  is  desirable  to  adopt  such 
means  as  will  insure  a  uniform  system  of  granting 
license  to  practice  Medicine,  Surgery,  and  Midwifery, 
throughout  the  Dominion  of  Canada. 

Resolved,  2.  That  in  future,  all  medical  degrees  or 
diplomas,  of  Universities,  Colleges,  or  Schools  of  Medi- 
cine, shall  have  merely  an  honorary  value,  and  licenses 
to  practise  Medicine,  Surgery,  or  Midwifery,  in  the 
Dominion  of  Canada,  shaU  be  granted  by  a  Central 
Board  of  Examiners,  in  each  Province,  before  whom 
all  holders  of  Degrees  in  Medicine,  or  Diplomas  for  Sur- 
gery or  Midwifery,  shall  appear  for  examination. 

Resolved,  3.  That  a  committee  of  seven  members  be 
named  by  the  Medical  Society,  to  confer  with  the  vari- 
ous Universities,  Colleges,  and  Medical  Schools  in 
Canada,  on  the  sul^'ect  of  the  establishment  of  a  Central 
Board  of  Examiners,  before  which  all  candidates  for 
license  to  practise  medic'me  in  the  Dominion  of  Canada 
shall  be  examined. 

Resolved,  4.  That  the  Quebec  Medical  Society 
recommends  the  calling  of  a  Convention  of  Medidd 
Delegates,  from  Universities,  Colleges,  Schools,  MedicAl 
Societies,  &c.,  in  the  Dominion  of  Canada;  to  meet  at 
the  city  of  Quebec,  on  the  second  Wednesday  in  Octo- 
ber, 1867,  fbr  the  purpose  of  adopting  some  concerted 
action,  on  the  subject  of  medical  legislation,  in  oon- 
formity  with  this  report,  and  for  the  formation  of  a 
''Canadian  Medical  Association.*' 

The  whole  respectfully  submitted. 

W.  Marsden,  M.D.,  Chairman. 
R.  H.  RtTSSKLL,  M.D.,  Secretary. 
Lay«l  UnlTenity.     Quebec,  18th  Jane,  186T. 

The  above  resolutions  were  unanimously  adopted, 
and  are  to  be  submitted  to  the  medical  profession  of 
Canada,  at  the  proposed  Convention  in  October  next 


These  is  a  movement  also  on  foot  in  Canada  to  establish 
an  efficient  and  general  system  of  quarantine  in  accord- 
ance with  the  enlightened  views  of  the  authoritieB  on 
the  subject,  and  in  keeping  with  those  already  expressed 
in  these  columns.  As  tmder  the  "  Federal  Union  "  of 
Canada  the  quarantine  and  marine  laws  will  necessarily 
come  under  the  federal  control,  and  not  the  provincial 
and  municipal,  as  unfortunately  is  the  case  in  the  United 
States,  we  trust  that  it  will  be  adopted  by  the  Central 
Qovemment ;  and  we  know  no  person  whose  qualifica- 
tions so  preeminently  fit  him  to  be  placed  at  the  head  of 
Quarantine  and  the  sanitary  laws  of  the  kingdom,  as 
William  Massdes,  M.D.,  of  Quebec  His  long  and 
invaluable  services  in  connexion  with  these  subjects, 
both  in  Canada  and  the  United  States,  richly  entitle 
him  to  such  distinction ;  and  we  are  satisfied  not  only 
that  the  medical  profession  of  Canada,  but  of  our  whole 
country,  would  hail  such  an  appointment  with  approba- 
tion as  one  most  fit  and  proper  to  bemade. 

digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


255 


Vitoxtvm* 


Tbbatmbnt  op  Praoturbs  op  the  Lower  Extremity  bt 
the  usb  op  the  anterior  suspbnsort  apparatus.  by 
N.  R.  Smith,  M.D.,  Professor  of  Surgery  in  the  University 
of  Maryland.  Baltimore :  KeUy  A  Piet  1867.  8vo.  pp. 
Id 
The  purpose  of  the  monograph  before  us  is  to  illustrate 
the  good  effects  of  a  particular  kind  of  treatment  of  frac- 
tures of  the  lower  extremities,  more  particularly  of  the 
thigh,  as  well  as  other  injuries  of  those  parts  which  re- 
quire absolute  rest.  The  profession  during  the  past  few 
years  has  had  presented  to  it,  by  American  Surgeons, 
many  devices  for  the  accompusmnent  of  this  end,  and 
many  of  them  are,  as  has  been  abundantly  proved  by 
experience,  excellent  of  their  kind.  In  fiwt,  the  proper 
treatment  of  jQractures  has  become  an  American  spe- 
cialty •  and  by  foreign  surgeons  our  results  have  been 
considered  so  surprisingly  good,  that  they  are  willing  to 
be  instructed  by  ns  in  this  most  important  department  of 
our  healing  art.  The  investigations  into  the  nature  of 
the  injuries  have  been  so  carefully  made,  and  the 
ingenuity  of  the  American  has  been  so  often  taxed  to 
meet  the  indications,  that  it  would  be  remarkable  if 
great  progress  had  not  been  attained  by  us  in  this 
brandu  But  of  the  number  of  flints  that  have  been 
invented,  while  they  plainly  show  a  fertility  of  resource 
that  is  remarkable,  comparatively  few  have  outlived 
the  teat  of  experience  in  their  employment.  In  this 
Utter  respect^  Trof.  Smith's  vriU  hardly  prove  to  be  a 
notable  exception. 

Let  us  in  a  cursory  review  of  the  contents  of  this 
little  book  ascertain  for  ourselves  the  soundness  of 
those  views  upon  which  the  author  founds  his  practice. 
Tb«  author^  in  the  first  place,  afifirms  that  there  is  a 
SQuroe  of  deformity  and  shortening,  especially  in  firao- 
tures  of  the  thigh,  which  has  been  very  much  overlooked ; 
sod  that  is  a  tendency  in  all  such  injuries,  when  the  pa- 
tient is  in  a  recumbent  position  of  the  trunk,  to  slide  to- 
ward the  foot  of  the  bed.  This  is  partly  attributable  to 
the  yielding  of  the  bed,  and  partly  to  the  impossibility  of 
fixing  the  trunk  and  limb  in  a  relatively  immutable  pos- 
ture, without  the  most  intense  suffering  on  tiie  part  or  tiie 
patient.  The  proper  relations  of  the  trunk  with  Uie  frao- 
tured  limb  being  then  lost,  it  naturally  foUows  that  the 
fragnoents  are  proportionately  disturbed  in  such  a  way 
thftt  the  upper  one  is  made  to  overli^  the  lower.  Assu- 
ming this  to  be  true,  which  he  claims  he  has  a  right  to  do 
from  ofVrepeated  and  careful  observations,  he  maintains 
that  ^'  the  objects  to  be  attained  in  fi-actures  of  the  lower 
extremity  are :  Ist.  To  furnish  a  sor&ce  of  support 
wludi  sludl  be  accurately  and  permanently  adi^ted  to 
the  surface  and  form  of  the  limb  which  reposes  on  it 
2d.  To  so  adi^t  the  surface  of  the  support^  as  that  the 
limb  sinking  into  it  shiJl  maintain  its  form  by  its  own 
weight,  without  the  necessity  of  any  lashings  here 
sod  thm  to  secure  it  to  the  rigid  portions  of  the  appa- 
ratus. 3d.  To  make  the  limb  obedient  to  all  the  una- 
voidable movements  of  the  trunk,  so  that  the  ui^>er  frag- 
ment shall  not  b^  jammed  upon  the  lower,  nor  contort- 
ed in  relation  to  it  by  the  movements  of  the  trunk.  4th. 
To  obviate  the  contraction  of  the  muscles  by  the  employ- 
meotof  an  extending  force,  uniform  in  its  action,  easily 
graduated,  and  not  requiring  the  application  of  bands  to 
the  ankle.  5th.  So  to  arrange  the  supports,  that  in 
compound  fractures  we  may  nave  free  access  to  the 
seat  of  injury,  without  removing  any  of  the  essendal 
■opports  of  the  limK  6th.  To  efiect  these  objects  by 
a&  apparatds  simpie  in  oonstmction,  capable  of  being 
anywhere  procured,  easy  of  implioation,  not  requiring 
to  be  readjusted,  and  of  but  trifling  expense." 


Thus  much  having  been  said  concerning  the  uses  of 
the  apparatus,  its  construction  and  mode  of  application 
may  next  be  considered,  in  so  far  as  they  may  tend  to 
venfy  the  truth  of  the  assertions.  A  single  splint  con- 
structed of  iron  wire  for  a  framework,  upon  which  muslin 
is  stretched,  forms  the  whole  of  the  rigid,  or  support- 
ing part,  of^the  contrivance.  The  surface  of  the  splint 
is  flat,  and  has  the  shape  of  a  long  parallelogram,  being 
bent  in  three  different  portions  of  its  course,  at  andes 
to  correspond  with  the  upper  flexures  of  the  ankle, 
knee,  and  hip  joints,  these  anj^les  being  modified  accord- 
ing to  the  q>ecial  indications  growing  out  of  the 
position  of  the  fracture ;  the  main  idea  being  to  accom- 
modate the  position  of  the  distal  fragment  with  the 
proximal  one.  The  required  position  having  been 
obtained,  the  splint  is  applied  on  the  upper  suface  of  the 
Hmb,  and  secured  by  the  wet  bandages,  encircling  it 
severaUy  as  follows :  one  abore  the  ankle,  one  above 
and  one  below  the  knee,  and  one  on  the  upper  portion 
of  the  thigh.  The  suspending  apparatus  is  next  to 
be  applied.  As  the  degree  of  obliquity  of  the  sus- 
pending cord  in  relation  to  the  position  of  limb  is  said 
to  have  a  great  deal  to  do  widi  the  degree  and  direction 
of  the  extension  employed,  Proibssor  Smith  is  very 
particular  upon  the  point.  Before  proceeding  further, 
we  give  the  description  of  this  portion  of  the  splint  in  his 
own  words : — "  A  small  iron  pulley  is  to  be  screwed  into 
the  ceiling,  over  the  bed  of  the  patient,  perpendicularly 
over  the  middle  of  the  skin,  or  neariy  so.  A  cord  about 
as  thick  as  the  wire  of  the  spHnt  passes  over  the  pulley, 
and  is  reeved  through  a  small  tent-block,  by  which, 
slipping  it  upwards  or  downwards,  we  elevate  or  de- 
press me  limb.  Ihe  eccentric  pressure  prevents  the 
weight  of  the  limb  fh>m  causing  it  to  slip ;  if  not,  rub 
it  widi  chalk.  This  single  cord,  which  depends  fi*om  the 
block,  has  a  loop  at  its  end  about  two  ffeet  or  more  above 
the  limb.  Through  this,  another  cord  about  five  feet 
long  passes,  and  hangs  double  from  the  loop  by  its 
oentre.  Each  end  has  a  hook  attadied  to  it,  and  when 
eyerything  is  ready  they  are  hooked  in  appropriate 
loops  in  uie  cross-bars  which  are  situated  at  different 
portions  of  the  spliat.  Now,  as  to  the  points  of  attach- 
ment of  these  hooks,  the  author  maintains  that  it  is  of 
great  importance,  in  order  that  the  centre  of  gravity  of 
tiie  limb  be  properly  adjusted,  and  gives  numerous 
directions  as  to  how  this  can  best  be  done.  Lastly,  the 
roller  bandage  is  applied;  and  in  order  to  complete  the 
appKcation  of  the  principle,  the  extending  or  counter- 
extending  forces,  all  that  is  necessary  is  **  to  move  the 
bed  of  the  patient "  headways.' " 

Havmg  thus  given  the  author's  views,  let  us  look  at 
the  other  side  of  the  question. 

The  first  objection  which  can  be  raised  against  the 

Splint  is,  that  it  maintains  the  limb  in  a  more  or  less 
(Bxed  position.  It  is  now  pretty  well  settled  by  the 
majority  of  the  authorities  upon  the  subject,  that  sudi  a 
position  has  too  many  disadvantages  attached  to  it  to  bear 
a  strong  recommendation,  and  it  seems  to  us  that  our 
auttior  hazards  a  great  deal  when  he  so  boldly  departs 
from  an  accepted  rule  without  giving  any  better  rea- 
sons than  he  does  for  so  doing.  His  arguments  would 
appear  sound  enough  if  we  were  willing  to  accept  his 
premises.  In  starting  with  the  assertion  that  the  upper 
migment  of  a  fracture  of  the  thigh,  for  instance,  is 
tilted  up  by  the  action  of  the  flexors,  he  assumes  tnat, 
in  order  to  get  the  two  ends  of  the  bones  in  proper 
position,  Uie  distal  firagment  must  be  brought  up  to  the 
proximal  one.  Now,  It  strikes  us  that  under  ordinary 
circumstances^  the  more  the  thiffh  is  flexed  upon  me 
pelvis,  the  greater  theohanoe  will  be  of  tilting  the  firag- 
ment further  forward ;  for.  by  relaxing  the  quadrioeps 
extensor,  the  extremity  or  the  firagment  loses  much  of 


256 


THE  MEDICAL  RECORD. 


that  support  which  it  would  otherwise  have.  These 
muscles  of  the  thigh,  acting  as  so  many  natural  splints, 
help  to  counteract^  in  no  small  degree,  the  action  of  the 
psoas  and  iliacus  intemus  muscles.  Mis  object  is  also 
to  give  a  uniform  support  to  the  limb  without  "lash- 
ings." But  is  this  accomplished  ?  Suppose  a  limb  is 
suspended  in  the  splint  as  proposed,  what  is  the  inevi- 
table  result?  The  weight  of  it  upon  the  bandaRCS 
causes  a  more  or  less  extension  of  the  fabric,  and  me 
limb  sinks  into  them.  If  it  did  nothing  more  than  this, 
the  support  might  be  equable  and  agreeable ;  but  it  is 
not  likely  to  stop  here.  The  limb,  having  lost  its  con- 
tinuity at  the  point  of  fracture,  is  not  apt  to  keep  itself 
in  line,  and  its  whole  weight  is  apt  to  be  felt  upon  the 
weakest  point ;  and  as  t£e  resmV  there  is  a  bowing 
backwards  of  the  fragments.  We  speak  advisedly 
when  we  say  that  this  has  occurred  in  numerous  instan- 
ces in  which  the  splint  has  been  tried,  and  especially 
has  it  been  noted  in  cases  of  compound  fracturea,  in 
which  the  opening  being  posteriorly,  even  the  small 
support  of  sound  tissue  in  mat  locality  is  lost 

It  is  true  that  the  limb  suspended  in  the  ^paratus  is 
more  or  less  obedient  to  the  movements  of  the  body, 
but  this  apparent  good  is  more  than  counterbalanced 
by  the  resulting  e*^;  for  the  splint  being  attached  in 
common  to  the  limb  and  the  pelvis,  we  have  a  right  to 
inquire  how  the  extension  is  to  be  effected.  We  have, 
it  IS  true,  an  apology  for  extension  in  the  degree  of  the 
obliquity  of  the  suspending  cord;  but  how  does  it  act 
upon  the  fracture  ?  The  two  extremities  of  the  bone 
are  as  firmly  held  together  as  bandage  and  iron  wire  can 
keep  them,  and  steadied  with  firm,  if  not  unyielding, 
appliances  to  the  trunk.  The  extension  is  in  reality 
exerted  upon  the  abdomen  of  the  patient,  while  the 
counter-extension  is  effected  by  the  weight  of  the  rest 
of  the  body  upon  the  bed. 

Even  if  the  contrivance  would  admit  theoretically  or 
practically  of  extension,  we  cannot  see  what  advantage 
the  flexed  position  could  have  upon  the  straight  For 
by  the  former  we  shorten  the  distance  between  a  mus- 
<ue  given  to  contraction,  and  at  the  same  time  virtually 
lift  up  the  distal  end  of  the  proximal  fragment  by  de- 
priving it  of  the  support  of  the  natural  muscular  splints. 
In  the  straight  position,  when  extension  is  properly 
made,  everyming  is  tak^n  advantage  of:  the  extensors 
are  put  upon  the  stretch,  and  help  to  pull  down  the  tilt- 
ing fragment,  while  that  same  force  continuing  and  the 
fragment  being  proportionably  braced,  extension  is  next 
felt  upon  the  psoas  and  iliacus  internal  muscles,  and 
they  eventually  become  wearied  out^  and  give  way. 

The  advants^ge  of  free  aooess  being  afforded  to  parts, 
the  subject  of  oonmound  fracture,  is  something  to.  take 
into  account ;  but^  for  reasons  already  stated,  the  straight 
position  would  be  the  frir  preferable  one. 

The  claim  of  simplicity  of  the  apparatus  is  not  to  our 
mind  so  weU  established  when  we  take  into  account 
the  many  necessary  little  fizines  which  must  be  attend- 
ed to— the  procuring  of  the  splint  in  the  first  place,  its 
bending,  then  the  care  of  applying  it,  and  last  but  not 
leasts  the  inconvenience  of  attachmg  the  whole  to  the 
ceilinff.  Whatever  may  be  claimed  by  our  author  for 
the  ^lint  on  practical  grounds,  he  can  hardly  urge  the 
one  of  simplicity  as  a  reconmiendation  for  favor. 

As  a  wnole,  we  hardly  think  that  the  views  of  the 
author  will  commend  themselves  for  the  adoption  of 
practising  surgeons.  The  whole  work  bears  evidence 
of  n>^cial  pleading  in  favor  of  an  wparatus  which  the 
professor  believes  is  unequalled;  and  although  his  con- 
victions are  stated  in  that  good  faith  which  uiould  cha- 
ractOTize  every  true  worker  in  some  new  field  of  inves- 
§gation,  they  lose  all  their  force  when  the  arguments 
for  their  support  are  candidly  examined.    We  doubt 


not  that  in  Professor  Smith's  hands  the  apparatus  has 
done  well:  but  its  defects  in  arrangement  and  principle 
of  action  have  doubtless  been  so  modified  by  nis  own 
peculiar  surgical  skill,  that  we  can  hardly  expect  its  em- 
ployment to  be  attended  with  equal  good  results  in 
less  proficient  hands. 

From  considerable  experience  in  the  treatment  of 
fractures  of  the  thigh  by  the  stnught  portion,  we  con- 
fess ourselves  prejudiced  in  favor  of  it,  but  not  so 
strongly  as  not  to  be  open  to  conviction  and  change ; 
but  Rofessor  Smith's  work^  far  from  altering  our  opi- 
nion, tends  only  to  confirm  it 


Vitpoxts  0f  ^acitixts. 


K  Y.  PATHOLOaiCAL  SOCIETY. 

Stated  Meetino,  June  12,  1867. 

Dr.  H.  B.  SAin>8,  Prbsidekt,  in  the  Chair. 

OAKOXROUS  LIVER  AND  SPLEEN. 

Dr.  Cutter  presented  a  specimen  of  cancerous  liver 
and  spleen,  accompanied  with  the  following  history : 

June  2d.  was  called  to  see  Mrs.  D.,  age  53  years  9 
months,  who  was  said  to  be  suffering  from  a  tumor  in 
the  abdomen. 

I  found  my  patient  confined  to  her  bed^  very  much 
emaciated,  with  that  peculiar  countenance  mdicative  of 
cancer. 

Upon  making  an  examination  of  the  abdomen  I  found 
a  large  tumor  m  the  epigastric  reeion,  which  pulsated 
strongly,  had  a  bruit  and  a  thriU  which  were  no  longer 
discovered  when  the  tumor  was  lifted  from  the  aorta. 

She  at  the  same  time  drew  my  attention  to  a  '^  wind 
tumor,"  as  she  termed  it,  in  the  right  iliac  regioa;  it  was 
not  very  prominent;  fluctuation  was  distinct;  and  the  feel 
was  verv  peculiar,  as  if  the  wall  of  the  cyst  were  com- 
posed of  parchment 

I  took  it  at  once  to  be  a  cyst  of  the  ovary  until,  she 
informed  me  that  it  had  existed  since  she  was  ten  years 
of  age. 

At  that  time  she  had  had  intermittent  fever  for  about 
ten  months;  this  made  its  appearance  shortly  afber;  it 
was  described  as  an  ^'  afi;ue  cfdce,"  occupying  the  abdo- 
men high  up  on  the  right  side. 

Eighteen  years  a^o  it  suddenly  fell  into  the  pelvis; 
this  was  attended  vnth  great  pain  for  about  48  hours. 
Should  she  arise  suddenly  or  move  about  without  stays 
or  support  she  would  suffer  greatly  with  colio.  Other- 
wise It  has  given  her  no  inconvenience  since. 

The  fiist  symptoms  of  her  disease  began  about  sax 
months  ago. 

The  firet  complaint  was  a  sense  of  uneasiness  at  the 
pit  of  the  stomach,  which  came  on  without  fever  or 
other  illness,  and  was  always  aggravated  by  taking  food. 
This  uneasiness  was  attended  with  impairment  oiappe- 
tite  and  with  flatulence,  heartburn,  etc. 

Vomiting  was  more  or  less  prominent  from  the  be- 
ginning to  the  end  of  the  disease.  The  four  days  pre- 
vious to  her  death  she  took  no  nourishment  by  the 
stomach,  but  having  an  inces$afU  thirsty  she  drauK  cold 
ice-water  in  lar^e  quantities,  and  vomited  immediateUf 
after  each  draught 

She  had  not  a  particle  of  pain  from  the  first  appear- 
ance of  the  disease  to  its  termination,  and  died  worn 
out  bv  want  of  nourishment  and  broken  rest^  about  six 
months  after  the  disease  first  apj^eared. 

The  tumor  presenting  such  a  peculiar  af^)earaiice,  and 
the  doctor  not  having  had  an  opportunity  to  examine 
thoroughly  into  its  condition,  a  committee  was  appoint- 


THE  MEDICAL  RECORD. 


257 


ed,  composed  of  himself  and  Dr.  Rogers,  to  report  upon 
the  same  at  the  next  meeting. 

SPONTAKEOnS  ASD  DIVrUSB  OSTIO-MTELrnS. 

Dr.  Loins  Bauer  gave  the  history  and  exhibited 
the  specimen  of  a  case  of  spontaneous  and  diffuse  osteo- 
mjelitis,  caries  of  the  tibio-tarsal  and  intertarsal  articu- 
lations, and  multilocular  abscess. 

The  patient  belongs  to  a  very  healthy  family.  Since 
her  infancy  she  has  herself  been  of  delicate  constitution 
vrith  a  strongly  marked  nervous  temperament,  though 
never  before  so  sick  as  to  require  medical  attendance. 
In  August  last  she  was  attacked  with  rigor  and  sub- 
sequent fever.  The  attending  physician  regarded  the 
same  as  intermittent,  and  prescribed  the  ordinary  re- 
medies, to  which  it  readily  yielded.  A  few  days  after, 
he  noticed  a  circumscribed  swelling  at  the  middle  ana 
in  front  of  the  left  leg  and  another  at  the  inner  side  of 
the  corresponding  ankle-joint,  which  rapidly  matured 
into  an  abscess.  The  pain  attending  their  formation  was 
but  insignificant,  and  the  genersd  health  was  scarcely 
disturbed.  No  cause  could  be  assigned  for  the  existing 
trouble. 

On  the  9th  of  September  the  patient  was  transferred 
to  the  care  of  Dr.  Bauer.  On  examination  the  patient 
i^>peared  very  much  excited  and  adverse  to  being  dis- 
turbed. Her  pulse  ran  as  high  as  116  per  mmute; 
there  was,  however,  no  increase  of  temperature  or  de- 
rangement of  the  vital  functions.  Appetite,  alvine  and 
urinary  discharges  were  in  the  best  order. 

At  the  inner  surface  of  the  tibia  there  was  a  small 
•perture,  surrounded  by  moderate  thickening  of  the 
alveolar  tissue.  Its  discharge  was  of  a  sero-puru- 
lent  character  and  moderate  in  quantity.  There  wfts  a 
similar  opening  at  the  ankle-joint  with  more  circum- 
ferential intumescence,  eta  Both  leg  and  foot  were 
cedematoua 

Except  the  accelerated  pulee,  none  of  the  appearances 
denoted  an  aggravated  condition  of  the  patient,  and 
that  might  be  satisfactorily  expl^ned  by  the  excitement 
•nd  the  prevailing  an»mia.  However,  it  was  deemed 
prq)er  to  examine  the  fistulous  openings  under  anaes- 
thesia, to  ascertain  the  condition  of  the  osseous  struc- 
ture in  order  to  form  a  clear  diagnosis.  At  the  upper 
one  the  tibia  was  found  to  be  bare  and  rough  to  an  in- 
considerable extent.  The  lower  aperture  led  directly 
into  the  joint  and  the  probe  touched  bare  bone.  The 
serious  character  of  the  complaint  was  thus  fully  estab- 
lisbed.  So  obscure  as  to  the  cause,  so  difficult  was  it  to 
ascertain  the  relation  of  the  co-existing  affections.  To 
all  appearance,  the  two  abscesses  had  formed  contempo- 
raneously ;  but  there  were  no  indicati<ms  of  an  anato- 
mical connection. 

Liberal  diet  and  proper  hygiene  were  insisted  on, 
quinine  with  iron  prescribed^  and  the  affected  limb  fer- 
mented and  batiied  with  an  mfusion  of  chamomile. 

Thus  had  the  case  proceeded  a  fortnight,  when  diar- 
ihoea  rendered  the  discontinuance  of  the  iron  and  the 
use  of  opium  neoessary.  Shortly  after,  medication  had 
altogether  to  be  suspended  on  account  of  gastric  de- 
rangement Scarcely  had  this  been  done,  vmen  a  cold 
abscess  at  the  left  hip  formed.  Being  evacuated  by 
puncture,  its  contents  proved  to  be  pu^  which  mea- 
sored  about  from  six  to  eight  ounoes.  Quinine  was  of 
coarse  resumed.  It  is  worthy  of  note  that  the  sus- 
pension of  that  remedy  on  two  more  occasions  was 
again  followed  by  abscesses,  respectively  at  the  right 
infra-clavioolBr  q>aoe  and  the  right  hip.  On  none  of 
these  oocasions  was  there  any  constitutional  aggravik- 
tion ;  nor  did  the  abscesses  cause  the  slightest  inconveni- 
ence to  the  patient  during  their  ephemeral  existence. 
The  latter  part  of  the  existing  trouble  offered  very 


little  material  for  cHnical  observation.  The  fistulous 
openings  became  of  course  more  numerous  along 
the  lower  half  of  the  tibia  and  around  the  ankle-joint; 
the  integuments  of  the  leg,  and  particularlv  about  the 
tarsus,  were  greatly  swollen,  infiltrated,  and  hardened. 
Though  a  flat  shell  of  newly-formed  bone  was  eliminate 
ed  from  the  upper  part  of  the  tibia,  which  was  followed 
by  cicatrization  of  corresponding  fistulous  apertures, 
yet  the  disease  made  more  rapid  strides  towards  the 
disintegration  of  the  tarsal  bones,  involving  their  re- 
spective joints,  and  amputation  suggested  itself  as  the 
only  remedy  of  the  malady.  It  was  performed  on  the 
25th  May  ultimo. 

The  specimen  now  exhibited  fully  sustains  the  wisdom 
of  the  proceeding.  Moreover  it  discloses  a  state  of 
disintegration  totally  out  of  keeping  with  the  clinical 
character  placed  on  record.  It  consists  of  the  lower 
part  of  the  femur,  the  entire  tibia  and  fibula,  the  tarsus, 
and  a  fragment  of  the  metatarsus.  The  doctor  had  in* 
deed  hoped  and  attempted  the  saving  of  the  knee-joint, 
but  finding  the  tibia  softened  and  not  free  from  disease 
high  up,  he  had  to  include  the  articulation  in  the  opera- 
tion. 

Although  the  focus  of  the  disease.was  obviouslj  limited 
to  the  lower  two-thirds  of  the  tibia,  having  extended 
downwards  to  the  foot,  nevertheless  the  remaining  por- 
tion of  the  shin-bone  was  rough  on  the  surface  and  soft  in 
consistence;  the  articular  cartilages  were  white  and 
opaque,  implying  some  £itty  degeneration  of  their  re- 
Gmective  ceUs,  there  was  a  sUght  increase  of  synovia,  and 
the  femur  exhibited  in  the  fresh  state  a  degree  of  vas- 
cularity and  h3rper8smia  not  at  all  foreseen. 

For  the  better  appreciation  of  the  specimen,  the  bones 
of  the  leg  had  been  divided  transversely,  and  the  lower 
half  of  the  tibia  and  the  tarsus  longitudinally. 

It  should  be  mentioned,  that  the  periosteum  was  by 
no  means  notably  thick,  but  that  the  soft  parts  of  the 
amputated  extremity  were  very  succulent  from  oedema- 
tous  infiltration,  and  the  muscles  pale  and  fatty. 

In  viewing  the  tibia  on  its  surface,  there  was  no  at- 
tempt at  demarcation.  The  lower  two-thirds  consisted 
of  new  bone  which  overlapped  above  the  old  bone,  like 
a  shingle.  At  the  middle  the  new  bone  was  osteoporotic, 
obviously  from  caries;  thereabout  was  an  ovoid  cloaca 
leading  to  the  medullary  cavity. 

At  mo  transverse  section,  the  new  bone  surrounded 
the  old  tibia  two-thirds;  or  the  latter  there  is  but  the 
posterior  wall  covered  with  semifluid  and  homogeneous 
pus. 

On  the  longitudinal  section  of  the  tibia,  there  were  but 
a  few  isolated  remnants  of  the  old  structure  (sequestra) ; 
the  substance  was  made  up  of  osteoplastic  formations. 
The  chamber  was  fiHed  with  pus ;  no  vestige  was  left  of  the 
medullary  structure.  From  the  chamber  a  few  doacae 
perforate  the  involucrum,  one  of  which  penetrates  the 
tibio-tarsal  articulation,  and  has  thus  given  rise  to  the 
affection  of  tiiat  and  of  the  tarsal  joints  and  bones.  The 
two  lower  extremities  of  tibia  and  fibula  were  connected 
by  copiously  formed  new  bone-substance. 

In  conclusion,  Db.  Baubb  made  the  following  remarks: 
From  the  charaoter  of  the  specimen  osteo-myelitis  must 
be  inferred.  The  periosteum  is  in  the  main  healthy,  and 
it  was  thus  capable  of  supplying  the  vast  material  that 
encased  gradually  the  remnants  o(  the  vanc^uished  por* 
tion  of  the  tibia.  Where  it  has  suffered  dismtegratioo^ 
it  is  tiM  effect  of  the  internal  trouble  of  the  bone. 

In  accepting  the  clinical  views  of  Herman  Demme  as 
authority,  ^d  he  is  unquestionably  the  best  informed 
monographist  on  the  subject,*  the  sympUnns  in  the  c — 


•  Aroblve  of  GUnletl  Soxgeiy,  I7  B.  l4aig«nb«ok,  BlUroUi,  nd  Qifi^ 
Trt.Ul.B«Ua.im  Digitized  by  ^ ^._' 


258 


THE  MEDICAL  RECORD. 


did  by  no  means  justify  that  diagnosis.  The  disease 
was,  as  it  were,  sprang  upon  the  patient.  Neither  its 
beginning  nor  its  course  was  characterized  by  that 
deep-seated  pain  and  sweHing  upon  which  that  author 
lays  so  much  stress.  There  was  no  epiphysal  separation, 
nor  were  ^ose  ichoraemic  constitutional  symptoms  ob- 
served to  which  he  attaches  so  much  diagnostic  impor- 
tance. The  very  mode  in  which  the  local  abscess  formed 
in  this  case  gave  the  contradiction  to  Demme.  The 
extraordinary  clinical  character  of  the  case  under  con- 
sideration must  therefore  be  admitted.  The  specimen 
fortunately  furnishes  the  key  to  the  clinical  divergence 
of  the  case.  There  is  that  early  perforation  of  the  me- 
dullary cavity  into  the  ankle-jomt  which  allowed  in  a 
measure  the  escape  of  the  matter  formed  inside  of  the 
bone,  and  this  certainly  accounts  for  the  absence  of  pain 
and  deep-seated  swelling  at  the  circumference  of  the 
tibia.  Whatever  the  causes  of  the  multilocular  abscess 
may  have  been,  they  certainly  could  not  have  resulted 
from  septsemia,  because  there  was  no  constitutional 
evidence  of  that  description. 

In  summing  up  the  results  of  our  investigation,  we  are 
led  to  the  conclusion  that  the  early  perforation  of  the 
medullary  cavity  relieves  the  most  aggravated  symp- 
toms of  osteo-myelitis,  and  changes  materially  its  clini(»l 
manifestations. 

AMPUTATIOM  AT  THE  KN££-J0INT. 

Dr.  Post  expressed  great  doubt  as  to  whether  mere 
softening  of  the  lower  portion  of  the  femur  was  an 
obstacle  to  amputation,  as  he  had  often  found  the  bone 
in  that  condition,  the  result  of  inflammation;  and  with- 
out hesitation  cut  through  it  with  the  saw,  and  had 
never  any  bad  results. 

Dr.  Bausr  was  against  amputation  at  the  knee-joint, 
and  always  preferred  to  miJce  his  section  above. 

Dr.  Post  remarked  that  the  first  case  of  amputation 
at  the  knee-joint  that  he  had  met  with,  was  performed 
by  an  army  surgeon  upon  a  soldier  who  nad  been 
wounded  in  the  Seminole  "War.  After  the  operation, 
the  patient  was  admitted  into  the  N.  T.  Hospital,  and 
came  under  his  charge.  He  was  struck  not  only  with 
Uie  excellent  stump  which  resulted,  but  was  also  well 
pleased  with  the  l^adth  of  surface  which  was  left  at 
the  extremity.  The  patient  in  a  short  time  was  able  to 
walk  about  withotit  difficulty,  and  at  one  time  per- 
formed a  journey  upon  it  of  twenty  miles  with  a  com- 
mon peg-leg.  It  was  in  fact  a  better  stump  than  he  had 
ever  seen  after  amputation  of  the  thigh.  He  stated 
further  that  Yelpeau,  in  his  discussion  of  the  subject, 
had  most  conclusively  pointed  out  the  advantage  of 
unputation  at  the  knee-joint,  and  Dr.  Markoe,  in  his 
paper  upon  the  same  operation,  had  shown  its  value, 
in  all  the  cases  that  had  come  to  Dr.  Post's  knowledge, 
the  patient  was  able  to  bear  the  weight  of  the  body 
directly  upon  the  end  of  the  stump,  which  it  was  well 
known  was  not  often  the  case  when  the  section  was 
made  higher  up. 

Dr.  Baiter  thought  that  the  number  of  operations 
that  had  been  performed  at  the  knee-joint,  did  not^  as 
&r  as  comparative  statastics  with  reference  to  the  femur 
were  concerned,  enable  any  one  to  arrive  at  a  fWr  con- 
dution.  The  best  surgical  writers  of  the  day  express 
their  views  with  great  caution,  and  prefer  to  quote  Dr. 
Mar]a>e  and  his  experience  and  his  conclusions,  rather 
than  give  their  own.  In  this  reeard  the  opinion  in  favor 
of  knee-joint  amputation  could  hardly  be  considered  as 
oondusive.  In  reference  to  statistics,  there  could  be  no 
better  of  the  knee-joint  than  he  had  of  the  thigh ;  he 
had  thirty-seven  amputations  in  the  middle  and  lower 
tortious  of  the  thigh,  and  had  lost  but  one  patient. 

3  believed  further,  that  as  far  as  the  latter  operation 


was  concerned,  the  statistics  were  improving  every  day, 
and  that  the  old  opinion  relative  to  th^  danger  to  Ufe 
the  nearer  the  trunk  was  approached,  was  being  rapidly 
overthrown.  A  certain  (jerman  professor  had  shown 
this  by  the  results  in  his  cases,  and  explains  the  fact  by 
asserting  that  he  does  not  irritate  the  stumps  with 
straps;  that  he  allows  them  to  swell,  gives  a  chance  for 
the  fluid  to  escape  ,*  and  it  is  by  this  plan  of  treatment 
alone,  and  nothing  else,  that  his  successes  far  exceeded 
any  on  record.  Dr.  Bauer  had  been  so  fbrdbly  struck 
with  this  assertion,  that  he  had  ever  since  followed 
that  surgeon's  maxims.  As  bearing  upon  the  point 
at  issue,  he  would  remind  the  members  that  the 
removal  of  the  cartilage  of  incrustation  was  now  being 
recommended  in  all  amputations  through  the  joint,  as 
it  was  thought  to  give  a  better  chance  for  the  healing 
of  the  stump. 

At  this  stage  of  the  proceedings,  Dr.  Jaoobi  moved 
that  as  there  were  a  number  of  specimens  awaiting 
presentation,  and  as  the  time  was  getting  limited,  tiiat 
the  discussion  upon  the  prolific  and  perplexing  question 
be  for  the  present  deferred. 

DTTRA-ABDOMINAL  TUMORS  IN  FCETUS  OAUSINO  OOMPUOATED 
LABOR. 

Dr.  Finnbll  next  exhibited  two  interesting  intra- 
abdominal tumors,  which  were  contained  in  the  body  of 
an  infant,  and  gave  the  following  account  of  the  pecu- 
liar influence  these  had  upon  its  birth. 

The  mother  was  twenty-one  years  of  age;  had  been 
married  one  year ;  and  supposing  herself  eight  months 
pregnant,  was  taken  in  labor  at  five  o'dock  in  the  even- 
mg.  Her  medical  attendant  remained  with  her  during 
the  nighty  and  at  five  in  the  morning,  the  labor  steadily 
progressing,  the  membranes  ruptured  and  the  waters 
were  discharged.  At  eight  o'clock  the  head  was  deliv- 
ered, but  beyond  this  point  there  was  no  progresa 
The  gentleman  in  attendance  made  all  reasonable  force 
to  extract  the  child,  but  could  not  succeed.  He  then 
sent  for  a  friend,  and  after  a  great  deal  more  force  witt 
expended,  the  onild  was  in  the  same  position.  A  third 
assistant  was  then  summoned,  but  his  efforts  were  alike 
unsuccessfhl,  except  that  he  succeeded  in  bringing  down 
the  arms;  and  when  exhausted  he  raised  the  head  and 
found  it  severed  fsimi  the  body.  Dr.  Finnell  was  sum- 
moned, and  supposing  l^e  case  to  be  one  of  hydro- 
thorax,  introduced  a  perforator,  but  only  a  small  quan- 
tity of  blood  escaped;  and  in  taking  up  the  arms  to 
make  traction,  they  also  were  found  to  be  separated, 
and  had  to  be  laid  aside.  The  feet  were  then  grasped, 
and  version  performed.  When,  however,  the  feet  were 
brought  down,  it  was  fbund  impossible  to  get  the  body 
out  Supposing,  then,  that  it  must  be  a  case  of  ascites, 
the  abdomen  was  next  perforated,  but  no  water  came; 
and,  almost  in  despair,  the  efforts  at  extraction  w^re 
renewed,  and  after  a  good  deal  of  hard  work  the  body 
of  tiie  child  was  withdrawn.  On  introducing  the  hand 
into  the  uterus,  for  the  purpose  of  withdrawing  the 
placenta,  another  mass,  oblong  in  shi^,  and  somewhat 
larger  than  tiie  closed  fist,  was  fbund  floating  freely 
about 

On  cutting  open  the  body  of  the  child,  a  tumor,  pre- 
cisely similar  to  the  one  found  in  the  uterus,  was  dis- 
covered lying,  with  but  slight  attachments,  in  the  abdo- 
minal cavity.  It  seemin^y  took  its  <mgin  from  the 
peritoneum.  In  the  opposite  side  of  the  abdomoi  was 
a  space  left  which  corresponded  in  size  to  the  tumor  in 
l^e  uterus.  It  was  then  evident  that  it  had  originally 
occupied  l^at  situation,  and  had.  in  the  efforts  at  extrac- 
tion, been  squeeeed  outside  of  the  child's  body  through 
the  opening  made  by  the  perforator ;  and  tha^  in  com- 
mon with  its  fellow  found  in  Htu^  was  the  singular 


THE  MEDICAL  RECORD. 


259 


CHtse  of  the  difficult  labor.  The  child  was  perfectly 
well  formed  erery  other  way,  and  the  mother  waa  doing 
well 

Dr.  Booers  asked  if  any  testicles  were  discovered  in 
the  scrotum  of  the  child. 

Db.  FnofiLL  was  nnder  the  impression  that  he  felt  for 
the  testicles  aod  found  Uiem  descended. 

Di;.  Jaoobi  thought  they  might  either  be  supra-renal 
capeules  or  enlarged  peritoneal  glands. 

Dr.  Kraokowizcr  thought  that  inasmuch  as  the  tumors 
were  so  symmetrical,  and  both  occupied  the  same  posi- 
tion in  the  abdominal  cavity  of  the  child,  they  were 
the  results  of  an  emlargement  of  twin  organs,  and  that 
it  would  hardly  be  probable  that  tlie  two  peritoneal 
glands  should  so  eyeniy  devebp  themselves. 

Dr.  Roqibs  stated  that  he  had  had  the  opportunity  of 
examining  the  organs,  and  found  them  to  be  fibro-cystic 
tumors  of  the  purest  character ;  and  as  many  of  the  cysts 
were  lined  with  tesselated  epitheliuin.  it  would  seem 
as  if  the  masses  were  nothing  more  tnan  abnonnaUy 
developed  testes.  It  was  on  account  of  such  an  opinion 
that  he  had  asked  thus  particularly  concerning  the  pre- 
sence of  those  organs  in  the  bcrotum.  In  answer  to  a 
question  from  Dr.  Sands,  he  stated  that  the  stroma  w^as 
composed  aknost  entirely  of  fibre  and  cell-structure. 

On  motion  of  Dr.  Bibbins,  a  committee  of  three,  con- 
sisting of  Drs.  Finnell,  Kradiiowizer,  and  Borers,  were 
appointed  to  examine  the  growths  microscopically,  and 
report  the  result  at  the  next  meeting. 

MITRAL  DIRIOT  AND  BEGlTRarrANT  MtTRMUR,  AND  PROBABLY 
TRIOXTSFID  DraECT  MURMUR. 

Db  Funt  next  presented  a  hearty  for  which  he  was 
indebted  to  Dr.  George  K.  Smith,  of  Brooklyn ;  the 
patient  from  whom  it  was  removed  being  under  the 
observation  of  that  gentleman  for  over  a  year.  Dr. 
Flint  was  not  prepared  to  give  the  details  of  the  history, 
but  presented  the  specimen  merely  with  reference  to 
an  anatomical  point,  and  also  in  reference  to  a  point 
connected  with  physical  exploration.  He  would  say 
that  the  patient  had  the  signs  of  organio  disease  of  the 
hearty  and  finally  death  occurred  from  some  intercur- 
rent affection.  The  interest  of  the  specimen  centred  in 
(he  existence  of  obstructive  valvular  disease  at  both 
the  tncuspid  and  mitral  orifices.  There  was  a  very 
considerable  degree  of  obstruction  at  tJie  latter  orifice, 
in  consequence  of  which  it  was  so  reduced  in  size  as 
tearoely  to  admit  the  end  of  the  finger ;  the  curtains  of 
the  valve  being  thickened,  but  nevertheless  capable  of 
vibration.  On  the  opposite  side  the  nature  of  the  lesion 
was  much  the  same,  and  both  were  evidently  of  long 
standing.    There  were  also  aortic  lesions. 

''  The  first  time^"  said  Dr.  F., ''  that  the  patient  came 
Bnder  my  observation  was  accidentally  about  a  year 
a^o.  Then  there  was  a  loud  mitral  direct  murmur 
without  a  mitral  regurgitant  Inasmuch  as  the  exist- 
eooe  of  this  murmur  is  denied  by  some,  this  case  would 
aflbrd  a  very  good  illustrati(m  d  its  existence.  It  was 
so  loud  and  d^tinct  that  I  used  the  patient  to  verify  its 
character  #o  quite  a  large  number  of  students. 

"  There  is,  however,  another  pwnt  which  relates  to 
the  probable  existence  of  a  tricuspid  direct  murmur. 
This  is  a  murmur,  the  existence  of  which,  so  far  as  I 
know,  has  not  been  distinctly  made  out ;  I  do  not  think 
that  iu  existence  has  been  established.  There  is,  how- 
stfer,  no  reason  why  we  should  not  have  such  a  mur- 
mnr  under  conditions  similar  to  liiose  which  fiimish  the 
mitral  direct,  viz.  firmness  witli  vibration." 

'^Dr.  Smitb,  who  has  given  eonsiderable  attention  to 
phyncal  sign%  feels  very  well  satisfied  that  both  mur- 
nmrS)  the  mi^  direct  and  tricusfnd  direct,  were  audi- 
ble; and  he  bases  his  opinion  upon  this  fact,  that  ^e 


pre-systolic  murmur,  instead  of  being  limited  to  a  small 
area  surrounding  tiie  apex,  which  is  true  of  the  mitral 
direct  had  a  wider  area,  and  extended  to  the  right  bor- 
der or  the  heart 

ABORTION  OAUSBD  BT  UTERINE    DISEASE  AT  THE    TIME  OP 
OONOEPTION. 

Dr.  Jaoobi  exhibited  the  products  of  abortion  fix>m  a 
ladv  twenty-five  years  of  age.  She  had  had  two  living 
children,  the  oldest  being  four  years,  the  youngest  two. 
Soon  after  the  birth  of  this  last  she  suffered  from  uterine 
catarrk  for  which  she  was  under  treatment  during  last 
fall  and  winter.  Up  to  the  beginning  of  January  she 
was  much  improved,  butTwas  not  considered  welL  She 
stayed  away  n:om  the  office  from  this  time  because  men- 
struation ceased,  and  she  had  become  pregnant  In  all 
probabihty  she  became  so  about  the  middle  of  January, 
bhe  felt  quite  well  until  six  or  seven  weeks  ago,  when 
she  began  to  notice  now  and  then  a  little  bloody  dis- 
charge. As  I  thought  miscarriage  was  threatened  I 
ordered  her  to  bed  for  a  time,  and  repeatedly  kept  her 
in  a  recumbent  position  on  the  recurrence  of  the  dis- 
charge. Finally  observing  that  her  abdomen  did  not 
enlarge  as  it  should,  I  allowed  her  to  remain  up  per- 
manently, supposing  that  the  foetus  was  dead,  and  ^at 
it  would  be  in  time  discharged.    It  was  voided  to-day. 

The  specimen  is  interesting,  first  in  regard  to  the  con- 
dition of  the  placenta,  which  shows  the  signs  of  quite 
extensive  inflammation,  in  the  shape  of  fatty  and  fibrin- 
ous exudation.  Secondly,  the  insertion  of  the  cord  is 
filamentous.  This  is  of  comparatively  rare  occurrence, 
as  it  is  only  once  in  250  times  in  which  it  takes  its  ori- 
gin in  the  membranes,  and  not  in  the  placenta  itself. 
The  cord  is  unusually  lonff,  so  that  it  surrounds  the 
neck,  and  spreads  over  a  lar^e  surface  of  the  body. 
Then  again  it  looks  as  if  there  is  a  knot  in  the  cord  at 
one  point  and  at  several  places  it  ia  surrounded  with 
fibrine.  There  are  moreover  fibres  attached  to  the  am- 
nion and  extending  to  the  body  of  the  diild,  while  upon 
the  foot  adhesions  have  taken  place  with  the  toes  in 
such  a  way  as  to  crowd  them  down  in  rather  a 
curious  manner.  In  conclusion  Dr.  Jacobi  expressed 
the  opinion  that  the  inflammation  of  the  deddua  and 
placenta  was  due  to  the  metritis  existing  at  the  time  of 
impregnation. 

Dr.  Sands  exhibited  a  specimen  of  extra-uterine 
foetation.  During  the  month  of  August  he  was  sent  for 
to  see  a  lady  who  was  supposed  to  be  suffering  from 
cholera.  He  was  told  that  she  was  seised  with  abdo- 
minal pain  on  the  evening  previous,  which  was  both 
sudden  and  severe,  and  had  extended  up  to  a  short 
time  before  the  visit  When  seen  she  was  almost  mori- 
bund, her  lips  were  blanched,  her  sar£M)e  cold,  and  her 
voice  was  reduced  almost  to  a  whisper.  She  had,  how- 
ever, no  vomiting  or  pwging.  It  was  ascertained  that 
she  had  menstruated  six  weeks  previously,  and  that  for 
the  last  day  or  two  she  had  had  a  slight  discharge  firom 
the  vagina.  The  symptoms  pointed  towards  internal 
luemorrhage.  She  on^  survived  a  fbw  hours ;  and  on 
post-mortem  examination  a  foetus  was  found  developed 
m  the  Fallopian  tube,  midway  between  the  uterus  and 
fimbriated  extremity.  There  were  several  pints  of 
blood  in  the  periton^  cavity. 

Adjourned.. 

Special  Departments  in  Kino's  Golleob  Hospital. — 
It  is  in  contemplation  to  make  two  special  departments 
in  King's  Oollege  Hospital:  one  for  diseases  of  the 
throat,  whidi  for  the  present  vriH  be  under  the  char^ 
of  Dr.  George  Johnson,  who  will  ^ve  laryngoscopi(5 
demonstrations;  and  the  other  for  diseases  of  tne  sMn^ 
which  Dr.  Duffin  will  superintend.      ^  t 

digitized  by  VjOOQIC 


2&0 


THE  MEDICAL  RECORD. 


EAST  RIVER  MEDICAL  ASSOCIATION. 

Stated  Meetiko,  Juin  4,  1867. 

Dr.  Yerbanus  Mobse,  President,  in  the  Ohair. 

Dr.  W.  F.  Thoms.  in  behalf  of  the  Delegation  to  the 
American  Medical  Association,  presented  a  brief  sum- 
mary of  the  questions  discussed  at  Uieir  last  session. 

SCARLATINA    AND    RUBEOLA — ARE  THBT    STRICTLY  GONTA- 
OIOUS? 

A  discussion  relative  to  the  late  classification  of  scar- 
latina and  rubeola  among  th^  contagious  diseases,  by 
the  Metfopolitan  Board  of  Health,  resulted  in  the  ap- 
pointment of  a  special  committee  to  report  at  the  next 
meeting.  The  committee  as  appointed  consisted  of  the 
followine: :— Drs.  G-.  V.  Skiff,  ML  S.  Buttles,  W.  F.  Thoms, 
R.  J.  OSullivan,  and  Truman  Nichols. 

A  CASE  OF  AZILLART  TUMOR. 

Dr.  Abbott  presented  an  interesting  case  of  tumor 
in  the  axilla  of  a  boy,  which  involved  several  doubtful 
points  in  the  diagnosis. 

the  UNAUTHORIZED  RENEWAL  Of  PRESCRIPTIONS  BY  APOTHE- 
CARIES. 

Dr.  G'Sulltvan  presented  the  evils  of  the  above  cus- 
tom in  forcible  terms,  and  called  for  the  appointment  of 
a  conmiittee  to  be  charged  with  the  drafting  of  the  reso- 
lutions, necessary  to  bring  the  matter  before  the  parties 
concerned.  Drs.  O'SuUivan^  Newman,  and  M.  L.  Smith, 
were  constituted  said  committee. 

A  PBS8ARY  ON  A  HEW  PRINCIPLB. 

Dr.  Buttles  exhibited  a  pessary  invented  by  himself, 
for  which  he  claimed  the  possession  of  at  least  one  de- 
sirable quality,  that  of  harmlessnessj — although  of 
course,  he  expected  to  have  other  requisites  of  a  more 
positive  character.  But  those  who  had  occasion  to 
witness  some  of  the  evils  resulting  from  even  properly 
applied  pessaries,  such  as  the  horse-shoe,  or  double  S, 
would  appreciate  his  remark. 

Among  these  evils  might  be  mentioned  ulceration  at 
the  points  of  contact  between  the  instrument  and  the 
tissues,  to  say  nothing  of  the  fact,  that  occasionally  the 
atcending  rami  of  the  pubes  had  even  been  deprived  of 
periosteum  as  a  result  of  prolonged  use. 

He  recognized  the  principle  that  the  vagina  was  the 
chief  support  of  the  uterus,  and  that  while  the  broad 
end  or  base  of  this  gutta-percha  pessary,  now  exhibited, 
held  up  the  uterus,  the  smaller  one  floated  in  the  vagina. 
It  also  possessed  another  advantage,  that  of  being  readily 
moulded  to  any  shape  hj  dipping  in  oil  and  passing 
through  the  flame  of  a  spirit  lamp.* 

CONTINUED  VOlOTINa  AFTER  THE  APPARENT  COMPLETE  RE- 
DUCTION OF  A  STRANQULATED  HERNIA. 

Dr.  Stein  gave  the  details  of  a  case,  which  had 
occurred  in  his  own  practice,  where  the  vomiting  con- 
tinned  after  the  hernia  had  been  to  all  intents  and  pur- 
poses reduced.  This  he  explained  on  the  hypothesis 
that  a  small  portion  of  the  intestine  had  been  indosed 
between  the  muscular  fibres  of  the  over-lying  muscle, 
and  there  was  in  fisM^t  virtual  strangulation,  although  to  a 
ve^  limited  extent    The  patient,  however,  recovered. 

Dr.  Nichols  had  remarked  the  same  phenomenon 
once  or  twice  n  his  own  practice. 

Dr.  M.  L.  Smith  related  a  case  in  which  the  protru- 
aon  had  been  returned  "  en  masse,*  and  an  autopsy  reveal- 
ed the  presence  of  membranous  girdle  which  encircled 
and  tightly  grasped  a  knuckle  of  intestine.    He  regard- 


•  A  wood«ut,  ftBd  fuller  deflcrlptlon  of  tbit  peMiiy,  will  probablj 
>pMT  la  a  MibMqatnt  mmiber  of^the  Midioal  BBOomi».»At. 


«PPMT 


ed  Dr.  Stein's  explanation  as  not  only  probable  but 
correct. 
The  meeting  then  adjourned. 


Stated  MBBToro^  July  2,  1867. 
Dr.  Verranus  Morse,  President,  in  the  Chair. 

REPORT  or  THE  COMMITTEE  ON  THE   PROPHYLAXIS  OF  SCAR- 
LATINA AND  RUBEOLA. 

Dr.  Skiff  read  the  following  report,  which  was  signed 
by  all  the  members  of  the  committee,  and  which  was 
subsequently  adopted  as  the  sense  of  the  meeting : 

Keeping  within  the  province  of  the  subject  sketched 
out,  it  wiU  answer  the  purpose  of  the  committee  to 
consider  such  characteristics  as  are  common  to  both 
measles  and  scarlatina.  In  compliance  with  this  jdan, 
and  adopting  the  hypothesis  most  generally  entertained 
respecting  the  matter  of  contagion,  and  the  miasm  of 
infection,  we  observe: 

1.  Measles  and  scarlatina  are  incident  to  diildhood, 
but  may  occur  at  any  age. 

2.  That  having  occurred  once,  they  constitute  an 
immunity  against  an  attack  of  the  same  disease. 

3.  That  they  are  each  caused  by  a  miasm  extraneous 
to  the  human  body,  and  portable  by  means  of  fbmites. 

4.  That  they  are  not  moculable.  or  preventAble  to 
any  extent  by  substituting  a  less  fatal  ot  a  less  infections 
disease. 

5.  That  they  are  not  peculiar  to  any  social  condition 
of  society ; — the  malign  or  non-malign  diaracters  being 
mostly  dependent  on  a  more  or  less  pernicious  epidemic, 
the  peculiar  condition  or  idiosyncrasy  of  the  individual 
attacked,  or  the  complications  which  may  occur  in  the 
course  of  the  disease. 

6.  That  they  are  self-limiting  diseases. 

7.  That  the  fatality  seems  to  depend  more  on  the 
virulence  of  the  particular  epidemic  tiian  the  amount  of 
miasmatic  infection  entering  the  system. 

The  committee  concluded  that: 

1.  Measles  and  scaiiatina,  though  originating  from 
causes  extraneous  to  the  body,  are  so  commonly  preva- 
lent that  they  are  naturally  diseases  of  childhood, — but 
are  nevertheless  incident  to  any  period  of  Kfe.  As  then 
there  is  no  certain  exemption  from  these  diseases,  it  would 
seem  desirable  for  prudential  reasons  that  they  should  be 
contracted  in  infancy,  while  the  child  is  surrounded  by 
parents  and  fHends  who  can  supply  the  adequate  nursing 
and  attention. 

2.  It  is  evident  that  if  every  case  of  measles  and 
scarlatina  could  be  completely  isolated  from  the  non-in- 
fected, and  all  healthy  persons  ibr  ever  unexposed  to  the 
poisonous  infection,  the  diseases  in  question  would 
become  extinct  But  although  this  is  impossible,  the 
other  extreme  of  allowing  a  virulent  epidemic  to  pre- 
vail  vTithout  the  opposition  of  the  humanitarian  or 
physician  would  be  unreasonable,  nay  more,  unnatural 
The  happy  me«i  chaDenges  our  attention  as  at  once 
practical,  philosophical,  and  charitable. 

So  then  since  amila  form  of  either  measles  or  scarla- 
tina is  a  conservator  as  efiectnal  as  the  most  malignant 
against  a  second  invasion  in  the  individual,  the  indica- 
tions are  to  avoid  the  more  malignant  if  practicable. 

3.  Practically  tiie  idea  may  be  elaborated  thus : — 
a.  Isolation  should  be  enforced  in  the  case  of  patients 

suffering  from  any  disease  but  ill  calculated  to  bear  any 
additional  burden.  To  these  may  be  added  a  sub-dass 
of  pregnant  women. 

h.  In  a  serious  epidemic,  the  infected  should  be  isola- 
ted from  tiiose  wno  have  not  yet  been  attacked ;  to 
this  plan  may  be  added,  thorough  ventilation,  deanliness, 
and  the  use  of  distufbctants. 


igitized  by 


Google 


THE  MEDICAL  RECORD. 


261 


In  the  investigation  of  the  subject  under  consideration 
the  Committee  called  upon  Dr.  Elisha  Harris,  Secretary 
of  the  Board  of  Health,  and  received  in  reply  to  their 
questions  the  following  letter : — 

Omoi  OP  THB  MtnoPOUTAN  BoABD  OF  Hbalth, 
No.  801  Mott  BtMot,  N.  Y^  Jnne  6, 1697. 

In  reply  to  the  questions — 

1.  What  sanitary  measures  are  now  adopted  and 
suggested  by  the  Board  of  Health  to  prevent  and  to  miti- 
gate scarlatina,  small-pox,  and  measles? 

2.  What  is  recommended  to  the  physicians  who  have 
patients  with  these  diseases?  the  following  statements 
are  submitted  as  embodying,  in  an  tmofficial  form,  all 
the  &ct8  on  the  subject  so  far  as  the  officers 'of  the 
Board  have  given  advioe  or  orders  relating  to  these  dis- 


a.  The  persons  sick  with  any  of  these  diseases  among 
the  poor  or  ignorant  classes  should  be  kept  isolated 
entirely  from  all  except  the  members  of  their  own  fam- 
ilies or  nurses. 

Generally  it  is  expected  that  a  person  sick  with  small- 
pox or  varioloid  must  be  sent  to  me  Small-pox  Hospital 
on  BlackweU's  Island ;  and  upon  most  such  cases  the 
Sanitary  Superintendent  issues  his  official  order  for  the 
transfer  of  the  sick  person. 

b.  The  sick  rooms  and  all  that  pertains  to  them  must 
be  kept  oongtcmtly  venUUUedy  and  the  fire-place  be  kept 
open,— occasionally  or  constantly  having  a  little  fire  in 
it,  if  there  is  such  a  fire-place. 

c.  Fresh  chloride  of  hme  or  flasks  of  fluid  carbolic 
add  are'  advised  to  be  kept  in  the  room,  placed  in  se- 
cure position. 

d.  jSvery  article  of  personal  clothing  and  bedding 
that  has  been  in  contact  with  the  sick  person  should  m 
placed  in  boiling  water  or  in  a  solution  of  some  positive 
disinfectant — such  as  solut.  permang.  potassa  (4  3  to 
2  or  3  gaUs.)  or  one  of  the  chlorine  solutions.  The  same 
dilute  solutions  of  the  disinfectants  should  be  sprinkled 
about  the  rooms  where  the  sick  lie,  or,  what  is  better, 
^ey  may  be  evaporated  firom  wet  cloths  suspended. 
This  practice  is  recommended  where  there  is  an  epide- 
mic in  a  crowded  population. 

c.  The  cleansing  of  the  houses  and  premises  where 
any  such  infectious  disease  has  prevailed  is  also  impor- 
tant Whitewashing  with  fresb-slaked  lime  or  with 
chloride  of  lime ;  scrubbing  floors  and  all  woodwork  and 
hard  walls  with  hot  solutions  of  chloride  of  lime ;  and 
the  keeping  of  windows  and  doors  open  for  several  days, 
are  the  chief  meastires. 

This  practice  is  now  applied  to  diphtheria,  typhus, 
typhoid,  "spotted  fever,'^  and  cholera;  but  the  few 
cases  or  spotted  fever  hitherto  seen  are  not  supposed 
to  have  been  infectious ;  they  were  surrounded  by  lo- 
calizing sources  of  disease. 

(Signed)  E.  Harris, 

Cor.  Secretary  of  Metropolitan  Board  of  Health, 

In  conclusion,  the  Committee  would  make  the  foUow- 
m?  practical  suggestions : 

1st  That  during  an  ordinary  epidemic  of  measles  or 
scarlatina,  no  sanitary  measures,  except  ventilation  and 
cleanliness,  should  be  employed. 

2d.  That  during  a  severe  epidemic  of  these  diseases 
tiie  foUowing  sanitary  measures  should  be  adopted. 

A.  IsolaUon,  The  patient  should  be  placed  m  a  room 
apart  from  the  rest  of  the  family  and  attended  hj  a 
person  who  has  had  the  disease — ^no  communication 
being  allowed  with  the  rest  of  the  family. 

B.  VetUOaUen  and  Cleanlinm$.  The  windows  of  the 
room  should  be  kept  constantly  open,  and  whenever 
practicable  a  fire  in  a  fire-place,  with  a  view  to  add  to 
these  means,  should  be  constantly  maintained. 

The  most  thorough  deanliness  should  be  insisted  upon 


— and  bed-linen  ought  to  be  changed  as  often  as  prac- 
ticable. 

C.  Dinn/edum.  Every  artide  of  personal  dotBing  and 
bedding  once  in  contact  with  the  patient  should  be 
steeped  in  boiling  water  or  in  a  solution  of  the  perman- 
ganate of  potassa  (1  os.  of  the  permanganate  to  three  gal- 
Ions  of  water). 

The  chamber  vessels  should  be  disinfected  by  a  solu- 
tion of  sulphate  of  iron  and  carbolic  acid. 

D.  FwntigaiUm,  After  patients  have  recovered,  the 
room  in  which  they  were  sick  should  be  vacated  for  at 
least  twelve  hours, — every  window  and  aperture  dosed, 
and  upon  an  iron  pipkin  or  kettle  with  legs  bum  a  few 
ounoes  of  sulphur. 

Let  the  room  be  kept  dosed  for  eight  hours  and  then 
ventilate  thoroughly. 

PRESCRIPTIONS  THE  PROPERTY  OF  THE  PRESORIBINO 
PHTSIOIAN. 

Dr.  O'Sulltvan,  as  chairman  of  the  committee  upon 
the  Grievances  of  Practitioners  and  their  right  to  prevent 
the  unauthorized  repetition  of  their  prescriptions,  report- 
ed that  as  far  as  interviews  with  apothecaries  had  been 
obtained  the  latter  fiiHy  agree  with  the  committee  that 
the  proposed  action  of  the  Association  is  necessary  and 
of  great  importance.  Many  of  these  pharmaceutists 
indeed  expressed  themselves  surprised  that  the  profes- 
sion did  not  move  in  this  matter  at  an  earlier  date, 
thereby  relieving  them  of  great  responsibility,  and 
placing  the  control  of  this  matter  more  directly  m  the 
hands  of  the  profession.  A  few  did  not  refuse  to  ac- 
cede, but  firom  their  answers  it  was  evident  they  would 
be  governed  by  the  action  to  be  taken  by  the  physicians 
in  the  matter.  The  committee  hoped  that  tne  resolu- 
tions about  to  be  presented  were  sufficient  and  explicit 
enough  to  meet  these  objections  They  further  had  the 
pleasure  to  report,  that  tne  members  of  the  profession 
addressed  on  the  subject  approved  the  movement  and 
thought  that  it  would  become  general,  not  only  in  this, 
but  in  other  cities  of  this  State  and  country.  They  say, 
further,  that  it  is  understood  the  Academy  of  Medicine 
and  other  societies  of  this  city  will  move  in  this  matter 
immediatelv. 

The  resolutions  were  then  adopted  and  are  as  follows: 

WhereoB^  The  attention  of  this  Society  has  been  called 
to  consider  the  propriety  of  taking  action  relative  to 
the  practice  of  druggists  renewing  the  prescriptions  of 
physicians  without  their  written  order,  thereby  injur- 
mg  very  materialijr  the  pecuniary  interests  of  the  pro- 
fession, without  gaining  any  particular  benefit  to  them- 
sdves ;  and 

Whereas^  In  view  of  the  graver  and  more  important 
consideration  that  the  interests  and  lives  of  patients  are, 
in  consequence,  endangered,  we  consider  it  a  duty  to 
guard  to  the  utmost  of  our  ability  against  the  liability 
to  mistakes  which  should  be  prevented  rather  than  de- 
plored ;  be  it  therefore 

Resolved^  That  we  cordially  invite  the  earnest  coope- 
ration of  every  druggist  in  this  dty,  especially  in  our 
immediate  districts^  to  fiirther  this  laudable  purpose ; 
and  be  it  further 

Euohed,  That  we  respectfiiUy  request  that  no  druggist 
will  renew  the  prescriptions  of  any  physician  connected 
with  this  Society,  without  due  authority  for  each  and 
every  such  renewal  Further,  we  will  regard  as  un- 
worthy of  our  patronage  any  druggist  who  &il8  to 
comply  with  the  requirements  of  these  resolutions. 

I&aohed,  That  a  copy  of  these  resolutions,  with  a  blank 
card^  be  sent  to  each  and  every  druggist  in  our  districts, 
with  a  request  that  the  card  be  returned  within  two 
weeks  to  the  Secretary,  signifying  their  intentions,  with 


262 


THE  MEDICAL  RECOKD. 


reference  to  compliance,  or  non-compliaooe,  with  theae 
resolutions. 
The  Association  then  adjoorned. 


C0tre«jifliTi>«itce* 


THE  UTERINE  ELEMENT  IN  PRACTICE. 

To  m  SorroE  of  thb  Msdical  Rsoord. 

Sir — ^I  cannot  withhold  mj  ^probation  of  your  article 
on  this  subject  in  your  number  for  July  1.  Such  plain 
talk  is  eminently  necessary  at  the  present  time.  Cor  the 
uterus  has  come  to  be  the  arena  for  the  most  ccring 
abuse  that  exists  in  our  profession.  There  is  both 
more  ultraism  and  more  quackery  exhibited  by  respect- 
able medical  men  in  connexion  with  this  organ  than 
any  other  part  of  the  syst^n.  The  speculum  has  be- 
come as  common  in  some  quarters  as  the  stethoscope, 
and  many  women  talk  as  freely  about  diseases  of  the 
womb  as  they  do  about  those  of  the  stomach  or  lungs. 
Thirty  years  ago  Dr.  Balbirnie,  a  Scotch  physician,  held 
this  language  of  the  speculum :  "  We  go  forth  its  advo- 
cate ;  we  proclaim  ourselves  the  apostles  of  the  tpectUim, 
With  that  instrument  we  link  our  fate,  and  by  that  we 
will  stand  or  fall."  How  the  apostles  of  this  instru- 
ment have  multiplied  since  then  I  They  are  in  every 
city,  and  in  multitudes  of  towns,  and  even  villages. 
This  apostleship  is  the  best  stock  in  trade  of  many  a 
rising  doctor. 

Far  be  it  ftom  me  to  decry  the  speculum  and  other 
kindred  uterine  instruments ;  but  1  honestly  believe 
that  on  the  whole  they  are  used  ten  times  as  often  as 
they  ought  to  be.  Indeed,  some  who  intend  to  use  the 
speculum  within  proper  limitations  are  obliged  to  em- 
ploy it  more  than  they  wish  to,  because  the  in- 
fluence of  other  physicians  is  so  strong  for  il. 
This  is  true  of  myselt  It  occurs  in  this  way :  A  pa- 
tient presents  herself  who  has  formerly  been  under  the 
care  of  one  of  those  aforesaid  apostles.  She  is  terribly 
familiar  with  the  speculum,  and  with  all  the  technical 
as  well  as  common  language  about  the  uterus,  for  these 
apostles  are  wonderfiilTy  instructive  to  their  patients. 
She  imagines  that  she  has  an  ulcer  on  the  mouth  of  the 
uterus ;  and  though  I  not  only  see  no  evidence  of  this, 
but  positive  evidence  to  the  contrary,  I  am  forced  to 
use  me  speculum  in  order  to  satisfy  he|^  that  I  am  cor- 
rect in  my  diagnosis.  Sometimes  the  influence  is  less 
direct,  but  none  the  less  powerfbl,  at  least  in  some  of 
the  cases.  What  the  patient  has  heard  fix>m  her  friends 
Mrs.  A  and  Mrs.  B,  who  hare  been  under  the  touch 
of  those  apostle!*,  may  have  so  convinced  her  that  she 
has  disease  of  the  womb,  and  that  it  must  be  looked 
into,  that  the  speculum  must  be  introduced,  or  the 
patient  will  pass  mto  other  hands. 

There  are  fashions  in  disease  as  w«U  as  in  modes  of 
practice.  Certain  diseases  prevail  at  certain  periods, 
not  because  they  are  really  more  abundant  then  than  at 
other  times,  but  because  there  are  abounding  thoughts 
about  them,  both  in  the  medical  and  in  the  public  nund. 
When  Corvisart  published  his  book  on  diseases  of  the 
heart,  those  diseases  were  at  once  very  prevalent  At 
one  ume  dyspepsia  was  t^e  most  common  word  on  the 
tongues  of  inviuids ;  at  another,  throat  diseaset  were  in 
the  fadiion,  and  toiisils  were  dipped  and  throats  swab- 
bed; at  another,  spinal  comphunts  were  all  the  rage; 
but  now  female  diseases  are  m  the  ascendency.  Womb 
on  the  brain  is  a  very  common  disorder,  and  a  hard  one 
to  treat  I  have  seen  many  patients  who  oould  have 
been  cured  mudi  quidcer  than  they  were,  if  aU  kaow- 
ledfl^  of  the  existence  of  such  an  organ  as  the  uterus 
i»uid  have  been  blotted  out  of  their  minds. 


The  medical  profession  is  ever  running  into  extremes, 
and  these  extremes  alwajrs  furnish  matmal  i<a  the  shc- 
oem  of  routinists,  and  those  who  are  ever  ready  to  take 
advantage  of  the  credulity  of  the  public.  There  are  some 
who  are  always  found  on  the  topmost  wave  of  public 
opinion  and  feeling.  They  id^itity  themselves  as  much 
as  they  can  with  whatever  most  attracts  the  attention 
of  the  many.  They  of  course  have  seen  many  cases  of 
every  disease  that  occasions  conversation  and  inquiry, 
and  are  ready  to  communicate  what  they  assume  to 
know  on  t^  subject 

Such  men  are  apt  at  the  present  time  to  make  much 
of  female  diseases.  It  is  the  easiest  tiling  in  the  world 
to  foist  up  a  reputation  for  skill  in  them.  A  hint  drop- 
ped here  and  there,  some  occasional  wise  saws  about 
the  modem  advances  in  the  appliances  of  our  art,  and 
the  importance  of  thorough  investigation,  and  the  use 
of  the  speculum  in  aH  cases  where  there  can  be  any 
plausible  reason  given  fbr  its  use — such  means  can  cre- 
ate a  reputation  even  in  spite  of  consummate  ignorance, 
especially  if  there  be  coupled  with  it  a  goodly  share  of 
cunning,  as  there  often  is. 

There  is  great  temptation  to  aspire  after  such  a  repu- 
tation, in  the  fact  that  the  favor  of  the  women  is  one  of 
the  best  means  of  obtaining  a  general  practice.  Hence 
it  is  that  so  many,  even  of  young  practitioners,  adopt 
female  diseases  as  their  specialty,  to  be  plied  as  the 
chief  means  of  gaining  both  general  notoriety  and  an 
introduction  into  famiSes.  I  have  known  this  expedi- 
ent to  succeed,  even  in  the  case  of  young  men  at  the 
very  outset  of  their  prac'ice. 

A  word  or  two  as  to  the  frequency  with  which  dis- 
eases of  the  uterus  occur.  One  would  think  from  the 
representations  of  some  physicians,  that  the  womb  of 
almost  every  woman  is  more  or  less  out  of  place. 
Some  of  us  that  have  been  in  practice  a  good  while 
have  certainly  had  a  small  experience  in  tois  respect 
compared  with  that  which  some  rather  recently-fledged 
ones  claim  to  have  had.  If  we  are  wrong^  if  many  of 
our  patients  have  really  had  flexions  and  oisplacementB 
of  the  uterus,  and  we  have  not  known  it,  the  inference 
is  a  pretty  clear  one  that  such  difficulties  can  exist  with- . 
out  doing  much  harm.  This  we  do  not  bdieve,  and  so 
we  infer  that  the  alleged  difllculties  do  not  exist  any- 
thing like  as  often  as  some  suppose.  A  case  now  and 
then  occurs  which  throws  some  light  on  this  point  I 
give  a  single  one : — A  lady  had  been  under  my  care  for 
a  difficulty  which  was  manifestly  essentially  nervous, 
and  was  gradually  recovering,  though  not  with  uniform 
progress ;  for  such  cases,  above  all  others,  are  liable  to 
occasional  relapses.  In  one  of  these  relapses  ^q  passed 
into  the  care  of  one  who  was  famous  for  having  many 
cases  of  uterine  misplacements.  He  pronounced  l^r 
difliculty  to  be  mainly  anteversion  of  the  uterus,  which 
I  knew  was  not  so.  I  speak  positively  on  this  pointy 
because  I  had  shorlly  before  made  an  examination 
which  would  have  revealed  this  misplacement  if  it  had 
existed.  The  result  showed  tliat  I  was  right  If  there 
was  such  a  displacement,  a  rapid  recovery,  as  was  pro- 
mised, should  surely  have  followed  the  adjustment  of 
the  organ.  But  instead  of  this  there  was  the  same  era- 
dual  but  irregidar  reoovery  that  had  been  going  on  while 
she  was  under  my  care.  The  (question  here  arises  whe- 
ther there  is  not  some  hazard  in  making  sach  promises 
of  rapid  recovery  in  such  cases.  Not  much ;  for  the 
patient  may  become  what  benefited  by  the  cordial  influ- 
ence of  the  new  hope,  imagination  helpisff  on  the 
chanfi;e;  and  if  the  reoovery  be  as  s'ow  as  before,  this 
may  be  plausibly  attributed  to  the  length  of  time  tiiat 
she  had  suffered  from  the  misplacement  Or  it  may  be 
pretended  that  there  are  occasional  partial  returns  of  the 


THE  MEDICAL  RECORD. 


263 


difllocatioii  requiring  a  new  adjustment,  and  that  this  of 
course  retards  the  recoyery. 

There  are  some  Qth&t  points,  as  nloeration  of  the  os 
uteri,  that  I  intended  to  touoh,  but  this  artide  is  already 
BofikienUy  long,  and  1  leave  Uioee  for  your  next  nnm- 
bec.  * 

ANTEMOB  LUXATION  OF  THE  CARPAL 
EXTREMITY  OP  THE  ULNA. 

To  THS  EOITOB  or  TBM  HXDIOIL  BBCOKD. 

Dm  Sir — I  communicate  the  following  history  of  a 
▼erj  rare  accident,  in  order  that  you  ma^  place  it  where 
it  may  be  of  service  to  the  profession. 

Kate y  an  Irish  domestic,  of  about  twenty  years  of 

age,  and  rather  slender  form,  presented  herself  at  the 
ifemilt  Dispensary  on  the  19th  of  June,  1867,  and  gave 
the  following  account  of  her  accident.  On  or  about  the 
Ifit  of  the  month,  while  wringing  clothes,  she  suddenly 
felt  her  wrist  give  way,  experienced  considerable  pain 
in  it,  and  noticed  that  she  could  not  move  it.  nor  rotate 
the  forearm.  Regarding  it  as  a  wrench  or  the  joint, 
rarioos  domestic  prescriptions  were  employed,  dunng  a 
period  of  some  aays,  with  unsatisfactory  results.  Bj 
the  advipe  of  friends  she  then  applied  to  the  "  Institu- 
tion for  the  Ruptured  and  Crippled."  The  character  of 
her  injury  was  there  recognised,  and  diagnosed  as 
"Spontaneous  dislocation  of  the  lower  extremity  of  the 
uhia.** 

Best  upon  a  splint  prescribed.  Not  satisfied  with  her 
progress  towards  reoovery,  the  patient,  after  waiting 
many  days,  finally  came  to  the  Dispensary,  as  above 
stated,  still  carrying  her  wrist  upon  the  splint  The 
Hmb  presented  the  following  deformity.  Forearm  fixed 
in  a  supine  position ;  the  wrist  almost  immovably  fixed 
in  the  position  of  moderate  extension ;  and  the  fingers 
moderately  flexed  and  much  stiffened.  The  styloid 
eminence  of  the  ulna  was  altogether  absent,  the  wrist 
on  its  posterior  aspect  sloping  downwards  and  inwards 
toward»  the  ulnar  border  <^  the  limb.  On  the  palmar 
aspect  oi  the  wrist  the  head  of  the  ulna  was  distinctly 
recogniaable,  i^n^  up  the  natural  depression  immedi- 
atdy  behuid  the  pisiform  bone,  and  even  rising  above  its 
levd.  The  exact  position  of  the  bones  of  the  forearm 
in  this  defi>rmity  I  beheve  to  be,  the  resting  of  the  in* 
iemalpahnar  border  of  the  sigmoid  cavity  of  the  radpuSf 
m  the  depression  on  the  dorsal  surface  of  the  kZaa,  be- 
tween the  styloid  process,  and  its  head,  the  depression 
forming  the  groove  for  the  tendon  of  the  extensor  carpi 
ulnaris  muscled  This,  as  a  reference  to  the  skeleton  will 
^ow,  produces  a  palmar  displacement  of  the  carpal  end 
of  the  ulna  of  half  to  three-fourths  of  an  inch.  It  re- 
soUs  in  the  rupture  of  the  anterior  radio-ulnar  hgament^ 
inevitably,  and  perhaps  of  the  corresponding  posterior 
ligament  The  inter-articular  fibro-cartilage  is,  in  all 
pffobabiHty,  also  torn  at  its  attacliments  or  in  its  con- 
tmoitv.  This  position  also  results  in  putting  upon  the 
stretch  the  tenoon  of  the  extensor  carpi  ulnaris ;  portions 
of  anterior  carpal  Ugament^  and  the  internal  lateral  liga- 
ment, as  well  as  the  interosseous  ligament.  I  believe 
^e  obstacle  to  reduction  is  mostly  to  be  found  in  this 
last  ligament  I  do  not  regard  the  pronator  quadratus 
as  involved  in  this  accident,  it  being  no  doubt  in  a  state 
of  relaxation.  With  this  view  of  the  anatomy  of  the 
luxation,  its  reduction  was  easily  accomplished  by  first 
steadily  extending  the  hand  and  then  flexing  it  laterally 
towards  the  radial  border,  ^us  creating  a  fulcrum  of  the 
radio-carpal  surface  by  which  to  em^oy  the  diain  of 
csrpal  bottea  as  a  lever  to  raise  the  uhia  ^om  the  radius 
throng^  the  infenmal  lateral  ligament^  the  medium  of 
sttachment  of  the  weight  or  resiatanoe :  and  secondly, 
by  a  graipiag  antero-posterior  pressve,  e^S^ted  by 


placing  the  fingers  upon  the  palmav  aspect  of  the  lower 
end  of  the  ulna,  and  the  thumb  of  the  same  hand  upon 
the  dorsal  surface  of  the  corresponding  portion  of  the 
radius.  This  combined  force  of  extension  and  pressure 
promptly  restored  the  bones  to  their  normal  position, 
but  without  snapping,  sudden  slipping,  or  other  usual 
phenomena  of  the  return  of  dislocated  bones  to  articular 
cavities.  It  is  also  more  than  probable  that  this  process 
of  extension  had  the  additional  value  of  extricating  the 
styloid  prominence  of  the  ulna  from  the  carpal  bones 
and  ligaments,  for  they  are  undoubtedly  more  or  less 
approximated  by  the  tension  of  the  ligaments  and  ten- 
dons already  enumerated.  Mobility  or  the  forearm  and 
wrist  was  at  once  restored,  and  the  joint  presented  the 
same  conformation  as  the  opposite  one.  No  experi- 
ments were  practised  with  the  view  of  testing  the  ten- 
dency to  a  reproduction  of  the  dislocation.  The  forearm 
and  hand  were  laid  in  the  prone  position  upon  a  board, 
a  cushioned  roller  placed  under  the  wrist  between  it  ana 
the  board  for  the  purpose  of  maintaining  a  semiflexed 
position  of  that  joint,  and  the  whole  secured  by  a  band- 
age. Four  days  later  this  dressing  was  removed,  and 
free  but  gentle  movements  of  the  wrist  and  forearm  re- 
commended and  practised.  There  was  at  this  time  no 
manifest  tendency  to  redislocation.  Some  six  days 
later  the  movements  of  the  wrist  were  perfectly  firee 
and  painless,  but  there  was  considerable  tenderness  over 
the  radio  ulnar  joint,  some  swelling,  and  the  movements 
of  pronation  and  supination  were  executed  slowly  and 
witii  much  discomfort. 

Prognosis,  slow  recovery  of  this  movement. 

No  manifest  tendency  to  redislocate. 

I  do  not  presume  that  this  historj^,  or  the  remarks  in 
connexion  with  it,  will  present  anything  peculiar  or 
instructive  to  all  of  your  readers,  but  as  a  rare  accident, 
it  appears  to  me  to  merit  a  record. 

The  prolonged  presence  of  the  bones  out  of  their 
normal  position  in  this  case — a  week  or  ten  dajrs  longer 
than  there  was  any  excuse  for  their  remainmg — had 
doubtless  much  to  do  in  the  production  of  the  sub- 
8e(juent  protracted  tenderness  of  the  radio-ulnar  articu- 
lation and  of  the  unfavorable  prognosis. 
Truly  yours, 

Stkphbn  Roosbs. 
S83  West  Stoi  Snuor. 


A  NEW  STRINGB  FOR  THE  EAR. 
To  1HB  BDiTom  or  tub  MsDioiLL  Riookd. 

DsAR  Sir — ^In  your  issue  of  June  15,  **How  to 
syringe  the  ear"  reminded  me  of  an  ingenious  apparatus 
for  this  purpose,  contrived  by  Surgeon  W.  S.  W.  Kusch- 
enberger,  U.  S.  N.,  and  exhibited  to  me  in  1862  at  the 
Navy  Yard,  Boston. 

Never  having  seen  such  an  arrangement  elsewhere, 
and  presuming  the  doctor's  well  knovm  modesty  pre- 
vented bun  from  giring  pubticity  to  so  simple  a  thine, 
I  pidi:  it  up  88  a  crumb  which  seems  to  me  to  be  worth 
saving. 

It  consisted  of  a  tin  quart  cup  divided  into  two  equal 
eompartments  by  a  septum  of  tin,  fi*om  top  to  bottom. 
In  the  compartment  next  the  handle  of  the  cup  was 
fixed  perpendicularly  a  proper  syringe  with  a  pipe  lead- 
ing up  and  across  the  top  of  the  cup.  The  end  of  the 
pipe,  near  the  nozzle,  was  made  flexible  for  a  short  dis- 
tance, for  convenienoe  of  direction.  When  an  ear  was 
to  be  wa^ied  out^  the  doctor  filled  the  syringe  compart- 
ment with  pure  vrater,  or  other  u^ection,  plaoea  the 
ed^  of  liie  firont  conopartmeiit  against  the  neck,  and 
proceeded  to  inject  The  regurgitating  fluid,  together 
with  the  uK^bia  secretions  of  the  ear,  flowed  into  tho 


Digitized  by 


Google 


264 


THE  MEDICAL  RECORD. 


front  compartment  without  communicating  with  the 
syringe,  thus  giving  him  the  advantage  of  repeated 
dean  injections.  ' 

W*.  J.  BuBOB,  M.  D. 
ATomsoN,  Kahbas. 


tltttt  lJublicatiang* 


The  Phybioloqt  AND  Pathology  OP  THB  Mind.  By  Henry 
Maudsley,  M.D.,  LondoD,  Physician  to  the  West  London 
Hospital,  Honorary  Member  of  the  Medico-Psychologica' 
Society  of  Paris,  etc    New  York :  Appleton  &  Co.    1867 

The  Medical  Use  op  Electricity,  with  Special  Reference  to 
General  Electrization  as  a  Tonic  in  Neuralgia,  Rheumatism, 
etc.  By  Geo.  M.  Beard,  M.D.,  &  A.  D.  Rockwell,  M.D. 
New  York :  W.  Wood  &  Co. 

Notes  on  the  Nature,  Prevention,  and  Treatment  of 
Asiatic  Cholera.  By  John  C.  Peters,  MD.  Second 
edition,  with  an  Appendix.  D.  Van  Nostrand,  192  Broad- 
way.    1867. 

A  Practical  Guide  to  the  Study  op  Diseases  of  the  Byb. 
Their  Medical  and  Surgical  Treatment.  By  H.  W.  WiL- 
ll\M8,  M.D.  Cantab.,  Ophthahnic  Surgeon  to  the  City  Hos- 
pital, etc.,  Boston,  etc.,  etc.  Second  Edition.  Revised  and 
enlarged.     Boston :  Ticknor  &  Fields.    1867. 


ijBel^tcal  3tent«  anb  ttetos. 


I 


Death  of  Civiale. — Oiviale  has  just  terminated  his 
long  and  useful  career.  The  merit  of  this  specialist  is 
universally  conceded.  His  discovery  of  lithotrity,  and 
his  excellent  treatise  on  diseases  of  the  urinary  organs, 
are  titles  to  scientific  distinction.  He  has  always  been, 
however,  a  popular  subject  of  raillery  with  some  of  the 
Paris  doctors ;  and  those  who  accorded  to  him  an  incon- 
testable excellence  as  a  patient  and  skilftd  manipulator 
of  the  bougie,  failed  to  express  a  respectftd  regard  for  his 
mtellectual  capacity.  We  shall  not  attempt  to  discuss 
the  causes  of  this  feehng ;  either  that  Civiale  attempted 
to  encroach  too  much  with  his  specialty  on  the  domain 
of  general  surgery,  or  that  he  was  not  properly  appre- 
ciated. A  correspondent  of  the  O^zcWe  Medicdlej  who 
judges  him  with  severity,  refuses  to  acknowledge  that 
he  had  either  grace,  eloquence,  or  wit;  the  same  gentle- 
man, however,  intorms  us  that  he  possessed  a  high 
order  of  financial  ability  in  the  practice  of  his  specialty, 
by  which  he  accumulated  five  millions  of  francs.  Those 
who  do  not  esteem  Oiviale  for  this  species  of  talent,  let 
them  throw  the  mantle  of  professional  charity  over  his 
mental  infirmitieSj  and  recollect  only  the  good  that  he 
has  accomplished  m  his  special  department. 

Death  of  Trousseau  and  Follin.— The  Faculty  of 
Paris  has  again  to  mourn  a  serious  loss  in  the  death  of 
two  of  its  distinguirfied  members:  Follin,  the  accom- 
plished surgeon,  and  the  principal  editor  of  the  "Arch. 
G^n.  de  Medeoine,"  has  been  cut  down  in  middle  life  :— 
Trousseau,  the  eminent  physician,  learned  professor,  the 
fluent  and  eloquent  orator,  has  recently  died  from  can- 
cer of  the  stomach.  Follin  belonged  to  the  trio  desig- 
nated at  one  time  with  a  slight  irony  the  "  jeune  Ajole ; " 
Broca  and  Vemeuil  remain.  Eminently  practical,  pos- 
sessed of  an  excellent  judmnent,  a  vast  erudition,  and 
inde&tigable  in  his  zeal  and  efforU  to  advance  the  pro- 
gress of  medical  science,  Follin  always  evinced  a  just 
appreciation  of  the  labws  of  his  own  country men»  and 
regarded  with  justice  and  fitting  discrimination  the 
Tiduable  accessions  to  surgery  in  other  countries.  He 
was  the  first  to  introduce  the  ophthalmoscc^  into 


France,  to  improve  it,  and  to  extend  its  use.  He  was 
one  of  the  first  to  encoun^  the  American  operative 
method  for  vesico-vaginal  fistula.  At  the  request  of 
M.  Robert,  Dr.  Bozeman,  of  this  country,  operated  suo- 
cessfiiUy  for  vesico-yaginal  fistula  at  the  Hotel  Dieu  of 
Paris^  using  his  button  suture ;  a  few  months  later  Follin 
practised  this  method  successfully,  and  in  two  or  three 
publi^ed  articles  discussed  its  value.  The  subject  of 
resections,  the  much-controverted  question  of  syphilis, 
and  many  other  topics,  received  a  large  share  of  his  at- 
tention. The  soundness  of  his  judgment  and  the  vast- 
ness  of  his  accurate  knowledge,  made  the  "  Arch.  G^n. 
de  M^ecine"  an  arbiter  of  the  eventful  questions  which 
at  difierent  times  engaged  the  attention  of  the  medical 
public  in  France.  He  was  the  embodiment  of  success- 
mi  merit,  and  an  example  of  energy  and  application. 
The  vigor  and  freshness  of  his  intellect  elicited  from 
M.  Yerneuil  the  beautifiilly-expressed  sentiment  which 
compared  him  to  a  tree  bearing  on  the  same  branches 
the  flowers  of  youth  and  the  fruit  of  mature  age. 

Trousseau  was  bom  in  1801,  and  died  on  the  23d  of 
last  June,  at  the  age  of  66.  As  the  pupil  of  Bretonneau 
he  commence  his  medical  career,  which  was  long,  active, 
and  useful,  and  the  me<Moal  profession  sincerely  laments 
in  its  loss  of  him  one  of  its  most  valuable  members.  He 
was  extremely  interesting  as  a  professor  of  materia 
Diedica,  and  impressive  as  a  clinical  lecturer.  His  im- 
pressive, chaste,  and  ele^nt  diction,  charmed  and  fixed 
the  attention  of  his  auditors,  equally  with  the  clearness 
of  his  thoughts.  His  manner  was  cordial  and  ^mpa- 
thetic.  His  popularity  and  his  eloquence  caused  him  at 
one  time  to  enter  the  arena  of  political  life,  and  he  was 
elected  to  a  place  in  the  deUberative  council  of  his  na- 
tion by  a  majority  of  26.000  votes  from  the  "  D^parte- 
ment  dfe  rEure-et-Loire.'' 

He  published  many  memoirs  and  articles  in  the 
medical  periodicals  of  the  day,  especially  the  "  Archives," 
**Jour.  des  Con.  Medico-Chirurg.,"  and  the  **  Union 
M^icale  " ;  and  his  work  on  Materia  Medica  isjustly 
esteemed  in  France  as  an  excellent  treatise.  He  has 
also  written  a  large  and  valuable  work  on  clinical  medi- 
cine. Some  of  the  French  daily  journals  relate  a  few 
interesting  incidents  to  show  the  serenity  and  stoicism 
with  which  he  regarded  the  approach  of  death.  He  point- 
ed out  to  his  most  intimate  medical  friends  and  favorite 
pupils  the  different  symptoms  and  physical  signs  of  his 
disease,  commenting  upon  the  progressive  development 
of  the  gastric  tumor  from  day  to  day  preceding  his 
dea^  with  the  same  precision  and  impressivenees 
that  characterized  his  clinical  lectures  in  the  wards  of 
his  hospital 

Previous  to  his  death  he  addressed  a  short  and  afieo- 
tiouate  letter  to  the  President  of  the  Academy  of  Medi- 
cine of  which  he  was  a  prominent  member,  requesting 
that  no  discourse  should  be  prononnced  at  nis  funeraL 

AifiRiCAH  PnABMACEuncAL  A8S00UTI05. — The  Fif- 
teenth Annual  Meeting  of  the  American  Pharmaceu- 
tical Association  will  be  held  in  this  dty,  oommencing 
at  3  o'clock  P.  M.,  on  the  second  Tuesday  in  Septem- 
ber (10),  1867. 

Heart  Diseases  in  Californu. — ^An  extraordinary 
prevalence  of  diseases  of  the  heart  and  arteries  is  re- 
ported in  Califomia,  owing,  it  is  thought  by  the  physi- 
cians in  that  locality,  to  the  habit  of  using  such  hu-ge 
quantities  of  intoxicating  liquors. 

Tbeatmiht  Of  Ttphus  Fever  bt  Tea.— Dr.  T.  W. 
Ghimshaw,  of  Dubl'm,  relates  33  cases  of  typhus  lever,  of 
which  number  21  weresuccessfiiUy  treated  by  tea,  with- 
out any  oUier  internal  remedy  of  importanoe ;  and 
some  01  them  were  of  a  severe  character. — Medioal  Neum. 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


265 


©rtginol   C0mmumcati0n0* 


ANEURISM  OF  THE  ARCH  OF  THE  AORTA 
AND  INNOMMINATE  ARTERY. 

OOOLUSION    or    THS   MOUTHS    OF    THB    RIGHT    SUBOLAYIAM 

AND     BOTH     COMMON     CAROTID     ARTERIES;     BRAIN 

DIRSOTLT  SUPPLISD  ONLY  THROUGH  THE  LETT 

VERTEBRAL   ARTERY. 

By  J.  0.  HUTCHISON,  M.D., 

OV  BIOOKLTir,  V.  T. 

Richard  Murphy,  an  Irish  laborer,  48  years  old,  was 
fottnd  lying  in  the  street,  suffering  from  dyspnoea  and 
partial  insensibility,  on  I2th  December,  1866,  and  was 
at  once  conveyed  to  the  Brooklyn  City  Hospital  On 
the  following  dav  he  stated  that  he  was  perfectly  well 
nnt^  five  months  ago.  when  he  began  to  experience 
"  shortness  of  bream  '  afler  exertion,  and  aboot  the 
same  time  he  noticed  a  swelting  at  the  right  stemo- 
davicalar  articnlatioiL  The  tamor  gradually  increased 
in  siae,  accompanied  by  a  proportionate  increase  in  the 
frequency  and  severity  of  the  paroxysms  of  dyspnoea, 
which  has  incapacitated  him  for  work  for  the  past  two 
mouths.  He  Luis  some  cough,  and  complains  of  dys- 
phagia; but  his  general  health  is  remarkably  good. 
ruLsation  in  the  tumor  is  marked^  accompanied  by  the 
aneurismal  bruit;  pulsation  in  the  right  carotid  and 
udllary  arteries  very  feeble ;  no  pulsation  in  the  radi- 
cal artery,  and  he  complains  of  severe  pain  and  numb- 
ness in  Uie  forearm  and  hand,  along  the  course  of  the 
nerves. 

Dr.  Daniel  Eissam,  during  whose  service  the  padent 
was  admitted,  recognised  aneurism  of  the  arteria  in- 
nomiaata,  and  Vals£lva*s  treatment  for  internal  aneurism 
was  adopted,  viz.  rest  in  the  recumbent  posture,  dimi- 
nished diet,  occasion^  abstraction  of  blood  from  the 
arm,  and  locally  from  the  vicinity  of  the  tumor,  to- 
gether with  15  drops  tinct  digitalis  three  times  a  day. 
This  treatment  was  continued  for  a  month  without 
apparent  benefit;  indeed  the  paroxysms  of  dyspnoea  had 
increased  so  as  to  threaten  a  fatal  termination  at  any 
moment. 

At  a  consultation  of  the  8urj;eoDS  of  the  Hospital, 
held  on  the  10th  January,  1867,  it  was  decided  to  hgate 
the  arteries  on  the  distal  side  of  the  aneurism,  as  sug- 
gested by  Brasdor. 

Jan.  13  th. — Last  night  he  had  three  severe  paroxysms 
of  dyspnoea,  during  which  his  surfiice  became  livid  and 
cold,  eyes  fixed,  pupils  dilated;  violent  convulsions 
also  occurred,  alter  whidi  he  remained  for  some  time 
unconscious. 

On  the  16th  January,  with  the  concurrence  and 
asgjstanoe  of  my  colleagues  of  the  surgical  stafif,  I 
determined  to  ligate.the  ri^ht  common  carotid  and  sub- 
clavian arteries.  An  incision  was  made,  commencing 
at  the  upper  border  of  the  sternum  in  the  mesial  line, 
and  extending  outwards,  just  above  the  clavicle,  for 
three  inches;  another  incision  of  the  same  length  ex- 
tended along  the  outer  margin  of  the  stemo-mastoid 
moscle,  and  joined  the  first  at  the  top  of  the  sternum. 
The  integuments,  the  platysma,  the  cervical  fiisda,  and 
both  origms  of  the  sterno-mastoid,  were  divided  in 
succession,  and  turned  outwards ;  the  stemo-hyoid  and 
stemo-thyroid  were  drawn  inwards  without  beioff 
divided;  the  sheath  containing  the  conmion  carotid 
was  now  exposed  and  open^  and  a  ligature  was 
tt>l£ed  to  the  vessel  about  an  inch  above  its  origin.  I 
then  Mowed  the  carotid  towards  its  origin  K>r  the 
porpose  of  reaching  the  subclavian  at  its  first  part;  but 


I 


failing  to  find  this  portion  of  the  vessel,  I  passed  the 
finger  along  the  margin  of  the  scalenus  anticus  down 
to  the  first  rib,  exposed  the  vessel  tbere,  and  applied  a 
ligature  on  the  outside  of  the  scaleni  muscles.  The 
bradiial  plexus  was  exposed,  and  care  was  taken  to 
prevent  the  aneurismal  needle  from  engaging  any  of  its 
branches.  There  was  no  distinct  pulsation  in  the  sub- 
clavian artery.  Not  more  than  two  ounces  of  blood 
was  lost  during  the  operation.  The  wound  was  closed 
by  the  interrupted  suture,  and  dressed  with  cold  water, 
and  an  anodyne  was  administered. 

January  17th. — Patient  has  had  a  more  comfortable 
night  than  for  several  weeks  before;  wound  united 
throughout  nearly  its  whole  extent;  two  sutures  re- 
moved;, he  moves  his  head  in  all  directions  with  as 
much  fadlity  as  if  his  right  stemo-mastoid  had  not  been 
divided.  Stimulants  were  freely  given  with  full  diet 
January  28th. — Ligature  on  the  carotid  came  away 
to-day ;  he  breathes  quietly  and  has  been  very  com- 
fortable io  all  respects  since  the  operation,  with  th 
exception  of  ttie  continuation  of  the  pain  and  numbness 
in  the  right  arm  and  hand  which  he  nad  for  a  long  time 
before  the  operation. 

Feb.  7th. — The  nurse  states  that  while  dressing  the 
wound  this  morning  he  removed  the  subclavian  ligature, 
which  was  lying  detached  upon  the  surface  of  the 
wound,  and  threw  it  away;  patient  very  comfortable. 

Feb.  25th.-- Since  the  last  record  the  patient  has  had 
slight  erysipelas  of  the  right  side  of  neck  and  face,  and 
for  two  or  three  days  has  suffered  fix)m  occasional 
paroxysms  of  dyspnoea  similar  to  those  which  he  had 
Wore  the  operation,  but  less  severe. 

He  died  from  suffocation  on  the  26th  February,  41 
days  after  the  operation. 

Post^marttmij  24  haun  after  dea&i,  A  careful  dissec- 
tion of  the  neck  was  made  by  Dr.  Speir,  Curator,  and 
one  of  the  physicians  of  the  hospital,  in  the  presence 
of  Drs.  H.  S.  Smith,  Bell,  Landon,  and  myseff.  The 
specimen  showed  aneurism  of  the  arch  of  the  aorta  and 
innominate  artery,  involving  the  origins  of  the  right 
subclavian  and  common  carotid ;  the  two  latter  vessels 
being  separated  where  they  pass  off  from  the  tumor, 
about  one  inch.  The  aneurismal  sac  was  nearly  filled 
with  concentric  layers  of  fibrine;  the  orifices  of  the 
right  subdavian.  right  and  left  common  carotids,  were 
finnly  closed  by  clot,  the  left  subclavian  being  the  onlv 
vessel  arising  from  the  arch  of  the  aorta  through  which 
the  blood  oould  be  tnansmitted.  The  clot  in  the  right 
subclavian  extended  to  the  distal  side  of  the  vertebral 
artery;  tiiat  in  the  right  common  carotid  to  tlie 
point  at  which  the  artery  was  cut  through  by  the 
ligature,  one  inch  above  its  origin,  and  from  thence  to 
the  bifurcation  into  internal  aod  external  carotid.  Ti  e 
right  subclavian  was  pervious  at  and  beyond  the  point  to 
which  I  had  supposed  the  ligature  was  applied,  and  the 
coats  of  the  vessel  exhibited  no  evidence  of  having  been 
Ugated.  ,  The  brachial  plexus  of  nerves  and  the  omo- 
hyoid muscle  were  carefully  examined,  and  found  to  be 
in  a  normal  condition.  The  trachea  was  very  much  com- 
pressed by  the  tumor,  and  this  was  the  immediate 
cause  of  death.  The  left  vena  innominata  was  obliterated. 
The  left  vertebral  artery  not  enlarged. 

Bmnark$. — The  above  case  presents  several  points  of 
interest  First — ^The  brain  received  its  direct  supply 
of  blood  only  through  the  left  vertebral  artery,  all  the 
vessels  going  off  from  the  arch  of  the  aorta,  except  the 
left  subclavian,  being  firmly  occluded  for  a  long  time 
before  death,  judging  from  the  appearance  of  the  clots 
they  contained.  Notwithstandmg  this,  the  brain  did 
not  appear  to  suffer  from  a  want  of  a  due  supply  of 
blood ;  his  intelligence  was  perfect  to  the  last  moments 
of  his  life,  *  ^  J 

Digitfzed  by  VjOOQ  IC 


266 


THE  MEDICAL  RECORD. 


Second. — ^Tbe  right  arm,  both  before  and  after  the 
operation,  had  the  same  temperature,  judging  from  the 
sense  of  touch,  and  was  as  well  nourished  as  the  left*. 
The  blood  must  have  reached  it  through  the  anastomosis 
of  the  right  superior  intercostal  with  the  aortic  inter- 
costals,  me  anastomosis  of  the  inferior  thyroids,  as  well 
as  the  right  internal  mammary  and  epigastria 

Tliird. — To  what  was  the  second  ligature  applied  ? 
I  am  disposed  to  regard  the  suggestion  made  by  my 
friend,  Dr.  Krackowizer,  that  it  was  applied  to  the  sheaih 
of  the  vessel,  as  the  sheath  was  unfortunately  not  exa- 
mined at  the  post-mortem, — ^most  probable.  The  sub- 
clavian was  situated  at  an  unusual  depth,  and  it  did  not 
pulsate  decidedly  where  it  was  exposed,  although 
pulsation  was  observed  in  the  axillary  before  the 
operation.  Every  surgeon  knows  that  the  pulsation  of 
an  artery  is  much  more  distinct  before  it  is  uncovered 
than  afterwards.  Repeated  examinations,  made  with 
the  greatest  care  by  myself  and  the  House  Surgeon, 
Dr.  Shephard,  failed  to  detect  pulsation  in  the  axillary 
artery  after  the  operation.  The  pressure  made  by  the 
displacement  of  the  parts  around  the  vessel  appears  to 
have  been  sufficient  to  arrest  its  pulsations. 

The  rehef  which  the  patient  experienced  aft^r  the 
operation,  continuing  until  a  few  days  before  his  death, 
was  owing  to  the  division  of  the  cervical  fascia  and 
muscles,  which  permitted  the  tumor  to  recede  from 
the  trachea. 

|A  CASE  OF 

AMPUTATION  AT  THE  HIP-JOINT  FOR 
GUNSHOT  WOUND  OF  THE  HEAD  OF 
THE  FEMUR. 

Bt  H.  a  DUBOIS,  M.D., 

ASSISTANT  SITROEON  AKD  CAPTAIN  U.   B.  ABMT. 

Antonio  Mutieries,  a  Mexican,  aged  about  33,  em- 
ployed by  the  Quartermaster's  department  as  a  team- 
ster, was  received  into  hospital.  May  11,  1867.  Early 
that  morning  he  had  had  a  difficulty  with  another  Mex- 
ican employed  in  the  same  train,  which  resulted  in  his 
drawing  a  pistol  upon  his  opponent,  who  instantly  drew 
and  fired  his  revolver  at  him,  the  ball  taking  effect  in 
his  left  hip.  I  saw  the  case  soon  after  his  admittance. 
At  about  11  A.if.,  and  found  the  wound  of  entrance 
About  two  inches  beneath  and  a  little  in  front  of  the 
Anterior  superior  spinous  process  of  the  iliuuL  He  was 
suffering  Utile,  and  there  was  little  or  no  hemorrhage. 
I  enlarged  the  wound,  introduced  mv  finger,  and  traced 
the  ball  to  the  neck  oi  the  femur,  where  it  was  firmly 

.  lodged  at  the  point  where  it  joined  the  head  of  the 
bone.  With  a  Tiemann*s  forceps  I  with  some  trouble 
removed  the  ball  and  a  small  piece  of  wadding.  It  was 
an  ordinary  conical  revolver  ball,  and  was  fired  at  a  dis- 
tance not  exceeding  two  to  three  yards.  The  man  was 
kept  peifectly  quiet,  a  cold-water  dressing  applied,  and 
he  was  fed  with  eai^ily  digested  and  nouriuiing  food. 

.  At  this  time,  and  for  the  period  of  some  two  weeks, 
there  was  no  infiammation  involving  the  joint — a  smart 

.  blow  on  the  heel  causing  no  pain. 

The  patient  gradually  lost  flesh,  but  suffered  little. 
The  discharge  from  the  wound  consisted,  for  the  most 
part,  of  ill-formed  i)us,  having  Uttle  smell,  and  occa^ 

.  sionally  streaked  with  blood.  A  few  small  pieces  of 
bone  were  subsequently  exfohated.  The  patient  slept 
iitUe,  and  perspired  much  at  night ;  his  appetite  also 
diminished,  and  he  was  evidently  losing  strength  daily. 
In  addition  to  the  above  symptoms,  the  following  were 
.afterwards  superadded :  Internal  pain  running  up  the 
side  and  down  the  thigh  to  the  ankle,  much  aggravated 


by  the  slightest  movement,  or  by  the  least  pressure  on 
the  heel.  These  symptoms  increasing,  I  proposed  the 
operation  afterwards  performed,  but  could  not  gain  his 
consent  thereto,  he  informing  my  interpreter  that  he 
would  be  up  and  on  his  crutches  in  two  weeks.  I  had 
previous  to  this  made  up  my  mind  as  to  the  propriety 
of  amputating  at  the  hip,  and  felt  confident  of  ulti- 
mately obtaining  the  patient's  consent,  as  a  relief  from 
the  terrible  pain  suffered  in  these  cases.  I  had  rejected 
the  operation  of  excision,  as,  in  the  only  case  in  which 
I  had  performed  it,  it  had  caused  a  shock  as  great  to  the 
system  as  I  believed  would  result  from  amputation; 
and  though  I  found  any  number  of  authors  who  recona- 
mended  excision  in  preference  to  amputation  in  this 
class  of  cases,  I  found  also  that  they  had,  with  few  ex- 
ceptions, never  tried  or  seen  it  tried  in  cases  resulting 
from  gunshot  injuries.  Of  the  thirty-two  cases  in 
which  excision  was  performed  during  the  late  war,  fonr 
only  were  successful,  and  how  far  they  succeeded  in 
giving  a  usefiil  Umb  is  not  fuUv  recorded. 

Surgeon  J.  C.  McKee,  U.  S.  A.,  visiting  the  post  at 
this  time,  I  asked  him  to  examine  the  case,  which  he 
did,  and  advised  amputation  in  preference  to  excisioB. 
Some  ten  days  after  I  first  proposed  the  operation,  I 
obtained  the  patient's  consent,  and  as  I  deemed  it  advi- 
sable, owing  to  the  rapid  loss  of  strength,  that  the  ope- 
ration should  be  performed  as  early  as  possible,  1  at 
once  made  my  arrangements ;  and  on  the  22d  of  Jane, 
having  obtained  the  assistance  of  Doctor  Shout,  of  Los 
Vegas,  Doctor  Simpson,  of  Moro,  and  Hospital  Steward 
Enfield,  U.  S.  Army,  I  proceeded  at  12.30  a.m.  to  am- 
putate. I  had  had  previously  constructed  by  a  black- 
smith a  rough  clamp  for  compressing  the  aorta.  The 
patient  was  quickly  put  under  the  influence  of  a  mix- 
ture of  ether  and  chloroform,  removed  to  the  operating- 
table,  and  all  of  my  assistants  having  previously  been 
informed  of  their  duties,  the  operation  was  quickly  and 
readily  performed — the  thigh  being  removed  in,  I  am 
told,  about  fifteen  seconds.  The  clamp  controlled  the 
arterial  haemorrhage  well,  in  fact  so  well  that  it  was  ex- 
tremely difficult  to  find  out  and  secure  the  arteries;  but 
the  venous  haemorrhage  was  more  troublesome.  Some 
fifteen  Ugatures  were  used  in  all.  Little  blood  was  lost^ 
however.  The  acetabulum  was  found  much  necrosed, 
and  the  tissues  a  good  deal  diseased.  The  diseased  bone 
and  tissues,  as  far  as  practicable,  were  removed,  and  a 
cerate  cloth  laid  between  the  flaps,  and  the  patient  was 
then  put  to  bed. 

His  condition  during  the  operation  was,  on  the  whole^ 
good,  the  pulse  severw  times  becoming  extremely  fee- 
ble, but  it  quickly  rose  a^^  under  slight  stimulation. 
The  breathing  was  free.  The  clamp,  which  made  pres- 
sure one  inch  above  and  to  the  left  side  of  the  i|mbiH- 
CUB,  apparently  caused  no  inconvenience,  and  certainly 
interfered  little,  if  any,  with  his  regular  breathing. 

The  anterior  flap  was  made  long,  while  the  posterior 
was  made  extremely  short  The  patient,  before  taking 
the  ansBsthetic,  received  hypodermically  one-half  ^rahi 
of  morphise  sulph.,  and  on  recovering  from  their  joint 
influence  he  said  he  felt  no  pain,  talked,  and  seemea  at 
perfect  ease.  He  was  given  small  quantities  of  brandy 
and  beef-tea,  also  a  little  ammonia,  as  the  pulse  was 
feeble  and  rapid.  He  complained  of  great  thirst,  and 
craved  ice,  which  was  given  him  in  small  quantities.  I 
hoped  by  these  means  to  bring  about  reaction,  and  to 
overcome  the  profound  shock  under  which  his  system 
was  laboring.  His  pulse  gradually  became  more  ieebl^ 
ran  up  to  1§0  and  180,  and  became  imperceptible;  sua 
yet  he  was  lively,  taUred  much,  and  was  in  every  way 
perfectly  sensible.  He  complained  of  hunger,  said  he 
was  *'  as  hungry  as  a  dog,*'  and  rejected  almost  imme- 
diately everything  he  took  into  ms  stomacL    In  this 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


267 


oondidoQ  I  resorted  to  hypoMdermic  injections  of  tinct* 
opii,  with  the  effect  of  bnogioff  up  the  pulse,  and  quiet- 
ing to  some  extent  the  irritability  of  the  stomach.  In 
this  stAte  he  lingered  about  thirty  hours,  sometimes  al- 
mo3t  or  entirely  pulseless,  but  with  a  warm  skin,  and 
perspiring  profusely ;  at  other  times  with  a  quick,  feeble 
pulse,  sleeping  a  few  moments  at  a  time,  until  half  past 
five  on  the  evening  of  the  day  after  the  operation,  when, 
taking  a  piece  of  ice  in  his  mouth,  he  said,  "  I  am  go- 
ing,*' and  died  almost  immediately. 

A  post-mortem  showed  the  flaps  ^azed  to  some  ex- 
tent, but  not  united.  The  acetabulum  and  head  of  the 
femur  were  both  extensively  neorosecL  and  the  tissues 
much  diseased  Wire  sutures,  it  should  be  added,  were 
used  to  close  the  wound,  which  was  done  some  ten 
hours  afler  the  operation. 

If  the  operation  did  not  save  the  life,  it  at  least  pro- 
moted the  happ^  dying  (euthanasia),  which  Hippocrates 
says  the  physician  should  have  as  nis  second  object — 
considering  the  saving  of  life  his  first. 

FoBT  Uaiox,  Nxw  Mxxioo. 


SYPHILITIC  AFFECTIONS  OF  THE  CON- 
JUNCTIVA. 

VRANSLATSD   FROM    THE    FBKNOH  OF  U.  LI  DOOTKTTR  DS8- 

MAURIS,     PROFE88II7R      Dl  OlilNIQUI    OPHTHALMIQUE, 

OHIVALtER  DI  LA  LIOION  d'HONNEUR,  ETC., 

By  WM.  mason  TURNER,  M.D. 


OHANORI. 

Wb  have  already,  iiv  our  first  volume,  studied  the  syphi- 
Ltic  aflfections  of  one  of  the  constituent  parts  of  the 
visional  apparatus  (Affections  8yphiUHque$  du  paupih-es, 
p.  620).  Ptjrhaps  it  will  not  be  inopportune  here  to 
refer  to  a  case,  in  which  the  chief  symptoms  of  chancre, 
of  imdoubted  genuineness,  were  found  on  the  conjuncti- 
va. This  case  has  this  curious  point  connected  with  it, 
that  not  only  has  the  ulcer  shown  every  characteristic  of 
the  primitive  specific  affection,  but  that  it  has  been  early 
considered  as  cause  of  a  foreseen  constitutional  ejection. 
Indeed  for  the  one  part,  it  was  deep,  its  borders  were 
perpendicular,  the  bottom  was  covered  with  the  grayish, 
pultaceous  matter,  only  found  in  primitive  ^philitic 
ulcerations;  and  on  the  other  hand,  the  indolent  en- 
gorgement of  the  neighboring  lymphatic  glands  (indo- 
lent non-suppurative  adenitis)  indicated  clearly,  after  all, 
a  small  glinmiering  of  the  constitutional  affection,  which 
would  soon  show  itself  bv  pathognomonic  phenomena, 
and  which  would  demand  an  appropriate  constitutional 
treatments 

Facts  of  this  species  being  sufficiently  rare,  we  will 
report  in  eactenso  this  experience,  the  details  of  which 
are  sufficiently  complete,  sufficiently  retrenched,  to  en- 
able U8  to  dispense  wit^  tracing  a  general  history  of 
chancre  of  the  conjunctiva. 

Case  L — On  the  31st  July,  1854,  Madame  M.,  em- 
broiderer, aged  thirty-four  years,  presented  herself  at 
my  dinic. 

In  the  large  angle  of  the  lefl  eye,  in  the  depression 
at  the  internal  extremity  of  the  upper  eyelid,  there 
was  a  tumor  of  the  size  of  three  hemp-jseeds,  presenting 
the  form  and  appearance  of  an  influned  foUicle.  The 
swelling  in  the  neighboring  parts  was  very  considerable ; 
the  tissues  were  of  a  vivid  red;  the  central  part  of  the 
tamor  was  much  more  prominent  than  the  circumfer- 
enoe.  The  portion  of  the  conjunctiva  which  surrounded 
and  completed  the  cti2-cIe-Mic,  was  likewise  very  red  ] 
the  carunculus  was  tumefied,  and  the  eye  constantly  wet 


with  tears.  Touch  of  considerable  pressure  produced  no 
pain.  The  patient  could  give  no  satisfitctory  account  of 
the  affection.  Believing  it  to  be  nothing  more  than  an 
inflamed  follicle,  accompanied  by  an  intense  conjunctivi- 
tis, I  was  induced  to  prescribe  a  collyrium  of  the  subace- 
tate  of  lead  for  fomentations,  and  cataplasms  made  of 
the  ashes  of  lettuce  leaves,  to  oe  placed  over  the  left  eye 
at  night 

Ou  the  ?4th  of  August^  the  patient  returned  to  the 
clinic.  The  most  salient  part  of  the  tumor  had  ulcera- 
ted. The  loss  of  substance,  of  about  one  centimiire  in 
size,  measured  nearly  the  entire  diameter  of  the  tumor 
which  has  been  described.  Its  aspect  was  characteristic ; 
the  borders  were  abrupt  and  peipendicular ;  the  bottom 
was  covered  with  a  yellowish-jpray  matter,  precisely 
similar  to  that  which  we  see  m  primitive  syphilitic 
ulcerations.  At  the  same  time  I  determined  a  manifest 
engorgement  of  the  lymphatic  pre-auriculav  and  sub- 
maxillary glands,  painless  and  accompanied  with  no 
change  of  color  in  the  dermis.  Of  course,  I  was  no 
lonffer  in  doubt^  and  for  my  first  diagnosis  I  unhesita- 
tin^y  substituted  this:  speqfic  ulceration  of  the  con- 
junctiva. Inflammatory  symptoms  being  very  marked, 
I  directed  the  continuation  of  the  emoUients,  and  pre- 
scribed in  addition,  wherewith  to  bathe  the  eye  seven 
or  eight  times  a  day,  the  following  collyrium : 
3.  Aqu»  destiL  100  gram 
Hydr.  chlor.  corros.  0.06. 
M. 
and  directed  the  patient  to  take  a  S^dillot  pill,  night  and 
morning.  (This  pill  is  sometimes  called  the  saponcu:e- 
ous  mercurial  piUj  and  is  as  follows:  unguent  mercur. 
(equal  parts)  12  gram.,  sapo.  medicat  8  gram.,  pulv. 
glycyrrn.  4  gram.,  M;  ft.  pil.  of  20  centigrammes  each. 
Each  piU  contains  five  centigrammes  of  mercury. — 
Translator,) 

On  the  7th,  the  ulcer  was  in  the  same  condition. 
The  gums  were  swollen  a  little  and  showed  signs  of 
conmiencing  stomatitis  mercurialis.  The  pills  were  dis- 
continued ;  gargles  of  water,  and  vinegar  of  squills,  with 
sarsaparilla  as  a  drink,  were  ordered.  On  the  9th  I  ex- 
amined the  patient  in  consultation  with  M.  le  docteur 
Clerc,  who  recognised  at  once,  with  me,  the  apparent 
characteristics  of  chancre  in  ^e  ulcer,  but  did  not  ven- 
ture to  affirm  anything  definitely  as  to  the  nature  of  the 
affection,  without  a  new  examination,  to  be  repeated 
after  some  days ;  he  advised  solely  a  purely  expectant 
treatment.  Emollient  fomentations^  and  a  collyrium  of 
borax,  were  ordered. 

On  the  24th  of  August,  my  honorable  confrere  sent 
me  the  patient  with  this  note :  "  There  is  nothing  to 
suspect  from  the  i^pearance  of  the  genital  organs ;  the 
persistence  of  the  auricular  adenitis,  and  the  adenitis  of 
the  walls  of  the  mouth,  creates  a  presumption  of  a  con-  • 
stitutional  infection,  which,  in  a  word,  wiU  not  be  well 
before  a  month.*'  Finally,  on  the  2l6t  September, 
Madame  M.  returned  to  see  me,  with  this  diagnosis 
from  Doctor  Clerc:  Papular  lenticular syphUide,  The 
mercurial  stomatitis,  having  been  cured  for  over  three 
weeks,  the  patient  was  subjected  to  a  treatment  by  the 
prot-iodide  of  mercury. 

On  the  29th  of  the  same  month,  the  ulceration  of  the 
oomunctiva  had  completely  cicatrised.  The  papulous 
syphilide  diminished  rapidly,  and  the  auricular  gangUoa 
was  in  the  way  of  improvement.  It  is  needless  to  say 
that  the  most  pressing  questions  addressed  to  the 
patient,  Med  to  produce  a  satisfiictory  response  as  to  the 
origin  of  the  complaint. 

In  our  first  article  on  syphilitic  ulcers  of  the  eyelid^. 

we  noted  a  fiict  of  the  same  nature  as  the  preoeding, 

observed  by  us  in  a  midwife  (sag^/emme)^  and  whom 

we  sent  to  our  confr^rs^  M.  le  docteur  Pajot,  Pr^m 

Digitized  by  ^ -r^- 


268 


THE  MEDICAL  RECORD. 


iigr^i  cPacoattchemmUa  to  the  Faculty  of  Medicine  of 
Paris. 

Below  I  append  a  titUe  history  of  this  other  case, 
which  one  cannot,  without  some  interest,  compare  with 
that  which  has  been  given. 

Cask  II. — Madame  Q-.,  sage-femme,  aged  thirty  years, 
of  a  lymphatic  constitution,  of  good  general  health,  very 
regular,  and  never,  as  she  assured  us,  had  been  sick  at  all. 
She  was  not  subject  to  rheumatism,  and  showed  no 
traces  of  engorged  or  suppurative  glands.  She  presented 
herself  at  the  clinic,  for  the  first  tune,  on  tne  2d  of 
February,  1852.  Her  left  eye  had  been  ailing  for  fifteen 
days.  The  inferior  palpebral  conjunctiva  had  been 
much  swollen  during  this  time.  There  had  been  no  pain, 
and  none  existed  at  the  time  she  came  to  the  clinic.  In 
the  middle  of  the  conjunctiva,  in  the  inferior  cu2-<20-mc, 
was  a  tumor,  a  little  elongated,  about  the  size  of  a  garden 
pea,  and  at  the  summit  of  which  was  an  ulceration 
showing  ragged  and  perpendicular  edges,  and  giving  oat 
a  little  pus.  This  tumor,  we  said,  made  substance  with 
the  conjunctiva,  under  which  it  was  imbedded,  in  the 
form  iof  a  spindle;  it  adhered  completely  to  the  mucous 
surface.  It  dM>wed  exactly  the  characteristics  which 
a  primitive  specific  ulceration  on  the  preputial  mucous 
tissue  would  present.  The  eye  was  very  red,  and 
secreted  a  little,  e^)eciaUy  at  night  (j^cUpebro-buIbar 
eanjunetivitis), 

A  large  pre-auricular  ganglion,  of  the  size  of  a  full 
grown  hazelnut,  which  could  be  felt  under  the  finger, 
aided  in  the  diagnosis.  In  the  meanwhile,  as  the 
patient  could  not  recall  any  recent  acoouchemerU  with 
mfected  women,  on  whom  she  had  attended,  and  as 
she  affirmed  that  she  had  not  submitted  to  any  suspicious 
embraces,  I  sent  her  to  M.  Ricord,  who,  after  an  atten- 
tive examination,  returned  her  to  me  with  the  following 
diagnosis:  chancre  of  the  conjunctiva,  with  its  symp- 
tomatic adenitis.  Following  the  advice  of  my  wise 
con/rire  and  friend,  I  cauterised  the  ulceration  on  the 
3d  of  February  with  nitrate  of  silver.  On  the  4th, 
ten  leeches  were  applied  over  the  pre-anricular  ganglion ; 
on  the  evening  o{  the  same  day,  a  saline  pureative  was 
administered.  On  the  5th  the  ganglion  was  less  turae- 
fiedj  the  conjunctival  tumor  had  not  improved  in 
dimmntion.  I  am  ignorant  how  this  case  terminated, 
the  patient  failing  to  return  to  the  clinic. 

These  two  cases,  similar  in  detail  to  those  with 
which  I  commenced  to  speak  of  chancre  of  the  eyelids, 
-appear  to  me  sufficient  to  complete  the  history  of 
•  chancre  of  the  conjunctiva. 

STPmUDES. 

I  have  never  had  occasion  to  observe  the  ptutuloua 
plates  (plaques  musquettses),  nor,  as  A.  Sm^,  the. coppery 
eruptions  (IV  Annai,  cPOcuL,  voL  xiv.,  p.  31),  on  the 
oculo-pa  pebral  conjunctiva;  out  in  the  generality  of 
cases,  I  have  found  on  this  membrane,  tuberculous 
.-syphilis.  For  instance,  an  example:  A  man,  an  old 
wuet  de  chambre  of  the  Duke  of  Mootpensier,  came  from 
Spain  to  Paris  to  consult  me  in  regard  to  a  grave  afiec- 
rtion  of  his  eyes.  When  I  saw  mm  for  the  first  time, 
he  was  suffering  with  a  double  iritis,  which  became  very 
intense,  especiuly  on  the  left  side.  The  pupil  was 
not  slow  in  dosing,  and  I  perceived  upon  the  iris 
"thos^  tumors  which  I  have  described  under  the  head  of 
eondyhmes.  One  of  these,  larger  than  the  others, 
situated  to  the  outer  side,  made  a  protuberance  under 
^the  conjunctiva,  through  the  sclerotica.  At  the  same 
time  on  aU  sides  of  the  conjunctiva,  I  saw  raised  above 
the  level,  small  indobnt  tumors,  very  hard,  oblong, 
•^caotly  like  syphilitao  tnberdes,  which,  as  those  to 
the  nde  of  the  ocular  apparatus,  covered  equally  the 
.integmnento  of  the  body.    The  skin  of  the  eyeUd  was 


pierced  through  and  through.  This  man,  whom  I  saw 
with  M.  le  docteur  Horteloup,  MSdecin  de  THoid  Dieu^ 
was  in  such  a  weak  condition,  that  we  deemed  it  dan- 
gerous to  resort  at  the  time  to  a  specific  treatment,  on 
which  we  had  not  indeed  decided,  except  conditionally, 
the  patient  asserting  in  the  most  energetic  manner  that 
he  had  never  had  any  symptoms  of  primitive  infection. 
I  have  learned  since  that  me  patient  (who  quitted  as) 
was  treated  by  Dr.  Boinet.  At  the  very  beginning  he 
instituted  a  specific  treatment,  and  performed  in  the 
end  a  complete  cure.  The  left  eye,  however,  remained 
entirely  lost.  I  have  likewise  determim^d  for  myself  the 
cure,  for  the  patient  revisited  me  many  months  after- 
wards. Here  the  success  obtained  by  antisyphilitic 
medication  was  a  proof  that,  notwithstandino;  denials 
on  the  subject,  we  have  had  tuberculous  syphilides  of  the 
conjunctiva. 


SUCCESSFUL  OVARIOTOMY. 
By  HAZABD   a.   POTTEB,   M.D., 

Jake  Kielte,  aged  38  years,  unmarried,  has  been  suf- 
fering with  ovarian  dropsy  for  the  past  two  years.  The 
disease  having  reached  that  point  where  an  operation 
becomes  the  only  alternative,  I  decided  to  operate, 
which  I  did  on  the  23d  ultimo.  Chloroform  having 
been  administered  by  Dr.  George  N.  Dox  (to  whom 
the  patient  belonged),  an  incision  was  made,  about  four 
inches  in  length,  between  umbilicus  and  pubes  \  slight 
adhesions  were  separated  with  the  hand,  the  fluid  eva- 
cuated, and  the  right  ovary  removed.  The  tumor  and 
contents  weighed  eighty-five  pounds.  The  left  ovaiy, 
being  diseased,  was  aJso  taken  away.  The  pedicle  was 
about  five  inches  in  breadth.  I  divided  its  peritoneal 
covering  by  a  cdight  stroke  of  the  knife,  and  ligated  ^e 
pedide  with  its  main  artery,  and  also  one  smaller  artery, 
by  separate  ligatures,  between  the  incised  peritoneal 
edges.  The  ligatures  were  removed  through  the  inci- 
sion. 

From  experience,  I  am  led  to  the  opinion  that  when 
any  portion  of  the  peritoneum  is  ligated,  the  causes  of 
peritonitis  are  greatly  multiplied,  and  the  chances  of 
recovery  correspondingly  lessened;  the  character  of 
that  coat  is  such  as  to  resist  the  removal  of  the  ligature 
for  a  longer  time  than  is  usual  when  arterial  or  other 
tissues  are  ligated. 

I  divide  the  peritoneum  entirely  around  the  pedide, 
ligating  separately  any  smaller  arteries  that  may  be  cut, 
tie  the  main  artery  between  the  incised  peritoneal  edges, 
and  thus  exclude  the  peritoneum  from  the  ligated  parti. 

The  actual  cautery,  clamp,  and  other  appliances, 
which  have  undoubtedly  been  made  effectual  m  some 
cases,  are  scarcely  equal  to  the  well-tried  ligattire,  which 
has  so  long  and  so  successfully  met  the  demands  of  sur- 
gical sdence  and  art.  The  mortality  in  ovariotomy 
arises  not  so  much  firom  the  immediate  effects  of  the 
operation,  as  from  the  morbid  and  debilitated  condition 
of  the  system  when  the  operation  is  performed. 

Bemedial  measures  are  tried  until  every  hope  is  ban- 
ished, and  when  the  unfortunate  patient  dies  a^er  ova- 
riotomy, sargery  is  condemned  for  its  inability  to  save 
life  which  was  already  a  forfeit  to  disease.  By  operat- 
ing as  eariy  as  possible,  we  may  modify  to  a  great  and 
favorable  degpree  the  mortuary  statistics  of  ovarioto- 
my. 

It  is  now  eighteen  days  since  the  operation,  and  our 
patient  has  made  a  rapid  recovery. 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


269 


TRAUMATIC  DESTRUCTION  OF  THE  POS- 
TERIOR PORTION  OF  URETHRA, 

SLOUGHINa  OF  SCROTUM  AND  RESTORATION 
OF  PARTa 

By  GEORGE  WILSON,  M.D., 

HSW  TOBX. 

The  case  was  one  of  traumatic  deetruotion  of  the  pos- 
terior portion  of  the  urethra  of  some  ten  inches  in  ex- 
tend with  sloughing  of  a  lar^e  portion  of  the  scrotum, 
80  that  both  testes  were  freelv  exposed  to  view,  with 
restoration  of  the  continuity  of  the  parts.  A  young  man, 
about  twenty  years  of  age,  a  painter  by  occapation,  was 
ei^ged  on  a  warm  day  in  June,  in  painting  the  front 
part  of  a  three-story  house.  At  the  tune  of  the  accident, 
he  was  standing  on  the  window-sill  of  the  second-story 
painting  the  outside  sash;  on  raising  his  hand  up  to 
push  down  the  top  sash,  he  lost  his  balance,  turned  a 
somerset  as  he  fell,  and  landed  astride  the  iron  railing 
in  fit>nt  of  the  area,  which  was  slightly  bent  by  the 
weight  of  his  fall.  He  was  conveyed  to  his  house ;  and 
on  examination,  I  found  a  fracture  of  the  pelvis  on  the 
xi^t  side  through  the  pubia  portion — ^wiui  laceration 
of  the  lower  portion  of  the  penis  involving  the  spongy, 
and  as  I  afterwards  thought,  the  bulbous  portion  of 
the  urethra,  with  severe  contusion  of  the  scrotum  and 
testes,  so  that  through  the  wound  there  was  a  strong 
seminal  odor,  which  at  the  same  time  caused  me  con- 
aderable  uneasiness  for  fear  of  loss  of  one  or  both  testes. 
After  brindng  about  reaction,  which  was  very  slow, 
however,  the  nervous  shock  being  so  great,  the  first 
thing  he  complained  of  was  a  feehng  of  fulness  in  the 
region  of  the  bladder,  ivith  a  desire  to  urinate,  and  an 
tn&ility  to  do  so.  Ailer  some  difficulty,  I  finally  suc- 
ceeded in  introducing  the  catheter,  and  drew  off  a  large 
Qoantity  of  blood,  wSch,  from  the  heat  of  the  body  and 
tne  weather  was  inclined  to  coagulate,  and  which  added 
greatly  to  the  difficulty  of  getting  it  to  flow  through  the 
catheter.  I  judged  from  the  hsemorrhage,  that  the  bul- 
bous portion  of  the  urethra  was  involved  in  the  lacera- 
tion, and  that  the  hsemorrhage  came  from  the  artery  of 
&e  bulb.  In  the  course  of  a  couple  of  hours  I  again 
introduced  the  catheter,  and  found  that  the  hsemorrhage 
still  continued,  and  drew  off  a  considerable  quantity 
more  of  blooq.  I  then  surrounded  the  scrotum  and 
hypogastric  region  with  pounded  ice,  and  allowed  the 
catneter  to  remain  in  the  bladder,  and  in  this  way  I 
finally  succeeded  in  arresting  the  hsemorrhage.  At  the 
same  time  I  kept  giving  him  stimulants,  and  in  that 
way  managed  to  keep  the  life  in  him,  which  at  times 
se^oied  to  be  fast  ebbing  away.  The  next  morning,  I 
was  suddenly  called  to  see  him,  as  his  attendant  thought 
that  he  was  dying,  and  I  do  assure  you  he  was  very 
near  it  I  was  by  his  bedside,  and  gave  him  carb. 
ammonia  dissolved  in  brandy  and  water  until  he  gradu- 
ally rallied ;  he  had  one  more  sinking  turn,  and  after 
that  be  went  along  and  made  very  &ir  progress  towards 
recovery.  The  contused  parts  went  on  sloughing,  so 
that  finally  the  catheter  was  exposed  for  some  two 
inches  in  extent;  then  followed  purulent  infiltrations 
in  the  scrotum,  which  were  relieved  by  fi^e  incisions; 
then  came  sloughing  of  the  scrotum  in  which  both 
testes  were  fi*eely  exposed,  so  that  as  the  scrotum  lay 
upon  a  cushion  which  supported  it  you  could  take  them 
between  your  fingers.  The  catheter  I  kept  constantly 
in  the  bladder,  removing  it  about  once  in  twenty-four 
honn,  as  at  the  end  of  this  time  there  was  considera- 
ble deposit  of  earthy  phosphates  upon  the  end  of  it, 
which  caused  considerable  distress  to  the  patient  on 
withdrawing  it,  and  also  retarded  very  mucn  the  heal- 
ing process^  owing  to  the    rough  accumulation  lacer- 


ating the  parts  on  its  withdrawal,  and  undoing  all  that 
I  hi^  done  in  getting  the  parts  to  heal.  But  by  steady 
perseverance  day  by  day,  we  gained  little  by  little ;  the 
pa^ts  began  to  heal  kindly,  the  deposits  on  the  catheter 
grrewless  and  less,  and  still  keeping  the  catheter  in  the 
bladder  u^til  the  parts  had  all  grown  over  it,  and  by 
drawing  the  scrotum  together,  we  succeeded  in  getting 
that  to  heal  also  with  nothing  to  opeu ;  so  that  to  all 
appearances  he  was  as  good  as  ever,  as  far  as  practi- 
cal purposes  were  required.  The  testes  gave  me  no 
trouble,  and  I  presume  that  they  were  in  their  normal 
condition.  He  got  married  afterwards,  but  whether  he 
ever  had  children  or  not,  I  do  not  know.  The  fracture 
of  the  pelvis  I  treated  with  a  broad  leather  belt,  which 
was  made  to  buckle  snug  around,  and  which  answered 
all  the  purpose  for  which  it  was  required.  I  attribute  the 
recovery  in  this  case  in  a  great  measure  to  the  patient 
himself.  At  the  time  of  the  accident  his  system  was 
in  a  very  good  ootuiition :  he  possessed  a  great  deal  of 
nerve,  very  sanguine  and  ouoyant  in  his  temperament; 
he  had  a  good  deal  of  what  is  called  vw  -into  or  tenacity 
of  life.  Uad  he  not  possessed  this  physical  organization, 
he  would  most  unaoubtedly  have  sunk ;  but  possess- 
ing it,  he  raUied,  clyng  to  life,  and  recovered. 

©riginal  €tctuxts. 

ON  NECROSIS  AND  REPRODUCTION  OF 
BONE. 

DELIVERED     BT 

Prop.  JAMES  R.  WOOD,  M.D., 

▲T  BBLLBTVE  BOBPXTAL,  IT.  T. 

GxNTLSMEK — ^I  proposc  to  Say  a  few  words  to  you  this 
afternoon  on  the  subject  of  mortification,  caries,  and 
reproduction  of  bone.  Ulceration  in  the  soft  parts  has 
its  analogue  in  the  osseous  tissues, '  and  is  known  by 
the  name  of  caries.  Then  again  you  have  the  compact, 
bony  tissues  dying  as  well  as  the  softer  ones,  and  this 
death  is  called  necrosis.  They  slough  as  the  soft  parts 
sloug;h,  and  are  cast  off,  thus  constituting  what  we  call 
exfoliation.  This  state  of  things,  produced  in  conse- 
quence of  violence,  may  be  due  to  constitutional 
troubles,  or  mechanical  and  chemical  agents.  The  bone 
may  be  injured,  so  that  that  which  begets  bone  (the 
periosteum)  may  be  directly  destroyed  by  the  violence 
inflicted,,  or  by  the  inflammation  which  takes  place  sub- 
sequently ;  consequently,  this  injury  to  the  periosteum 
and  the  endosteum  will  cause  necrosis  on  the  one 
hand  or  caries  on  the  other.  If  the  man  is  of  a  stru- 
mous or  scrofulous  diathesis^  he  may  have  this  peculiar 
vice  engrafted  upon  the  penostemn  or  endosteum,  and 
he  will  have  what  is  called  the  strumous  or  scrofulous 
necrosis.  A  man  who  has  the  tertiary  form  of  syphilis, 
will  have  a  peculiar  inflammation  of  the  pericranium, 
or  what  is  cadled  corona  veneris,  or  inflammation  of  the 
periosteum,  or  any  of  the  other  superficial  bones;  or 
ne  may  have  what  is  called  a  node.  Then  you  will 
see  cancer  and  heterologous  deposits  in  and  upon  bone, 
producing  necrosis  and  mortification.  In  other  cases 
you  will  find,  as  in  this  specimen  I  show  you,  the  effect 
of  the  chemical  agent,  phosphorus.  The  fiunes  of 
phosphorus  killed  this  jaw,  afler  exciting  inflammation 
in  the  periosteum. 

We  commence  with  the  proposition,  that  no  matter 
whether  the  periosteum  be  superficial  or  central,  upon 
the  surface  or  the  bone,  or  lining  the  medullary  canal, 
this  fibrous  membrane  is  the  matrix  of  bone;  and 
without  it  ybu  cannot  have  osseous  tissue.  You  may 
have  the  various  salts  of  lime  or  calcareous  deposits 


270 


THE  MEDICAL  RECORD, 


taking  place  indepeodentlj ;  but  without  the  agency 
of  the  periosteum  no  Haversian  canals  are  produced 
— in  a  word,  true  bone  is  not  there.  It  is  the  disease  of 
this  matrix,  this  mother  of  bone,  that  causes  necrosis. 
If  you  interfere  with,  and  separate  the  pericraniam  and 
the  dura  mater,  the  externeJ  fibrous  covering  of  the 
brain,  you  cause  the  death  of  the  bone.  Precisely 
this  occurs  in  Pott's  tumor  of  the  scalp.  There  is 
more  or  less  contusion  at  first ;  then  after  a  few  days 
or  weeks  there  is  considerable  pain  at  the  point  of 

X'  *  iry ;  and  by  and  by  the  brain  is  disturbed,  and  soon 
r  he  will  have  a  rigor :  and  upon  examination  there 
is  a  little  puffy  tumor  of  the  scalp.  What  has  taken 
place?  The  pericranium  has  been  separated  from  the 
bone ;  and  you  will  find  that  this  tumor  is  always  an 
index  to  trouble  like  this.  It  tells  you  that  the  bone 
has  been  robbed  of  its  periosteum  or  pericranium,  and 
that  there  may  be  trouble  below.  The  constitutional 
symptoms  also  direct  you  to  this.  You  cut  into  that 
tumor  and  what  do  you  find  ?  You  find  bone  like  ivory 
in  color,  pretenting  none  of  those  little  red  points 
which  are  wiown  in  bone  that  is  covered  by  this  fibrous 
tissue,  or  pericranium.  You  cut  through  this,  and  you 
find  that  the  pericranium  has  separated  firom  the  bone, 
and  that  there  has  been  suppuration  here,  shown  by 
the  presence  of  pus. 

If  the  external  periosteum  be  diseased,  contused,  or 
infiamed,  you  will  have  what  is  called  peripheral 
necrosis — ^necrosis  confijied  to  Hie  outer  layers  of  the 
bone.  But  if  you  have  the  internal  covering  of  the 
bone,  the  endostt^um,  diseased  or  inflamed,  and  sepa- 
rated from  the  bone,  you  will  have  internal  necrosis,  or 
you  may  have  deatn  of  the  whole  bone.  In  the  first 
instance  you  will  merely  have,  what  you  saw  in  a  case 
a  few  days  ago,  where  I  chiselled  out  a  portion  of 
the  tibia  of  a  man  who  came  here  to  have  his  leg  am- 
putated because  of  this  disease.  I  chiseled  away  the 
necrosed  portion  of  the  bone,  and  found  that  it  was  a 
case  of  peripheral  necrosis.  He  had  talipes  equinus, 
for  which  I  cut  the  tendo  Achillis;  and  now  the  patient 
is  able  to  put  his  foot  upon  the  ground ;  and  I  find 
that  the  periosteum  is  extending  itself,  and  covering 
up  the  opening  in  the  bone,  filling  up  the  gutter  made 
by  the  removal  of  this  necrosed  tissue,  and  he  will  soon 
have  a  very  good  leg ;  much  better  than  any  artificial 
Umb  that  comd  be  made. 

Let  us  see  what  will  take  place  if  the  bone  dies. 
Suppose,  for  instance,  there  is  inflammation  in  the 
external  and  internal  coverings  of  the  femur,  the  perios- 
teum and  endosteum ;  the  result  will  be  as  I  show 
^ou  in  this  case.  I  examined  this  case  from  time  to 
time — the  stump  was  not  closed,  as  it  was  at  a  time 
when  we  had  a  great  deal  of  trouble  here  because  of 
pyaemia;  and  I  saw  this  bone  cast  off  because  the 
endosteum  and  periosteum  were  separated  firom  it.  The 
patient  died;  and  you  see  in  this  specimen  how 
oeautifuUy  nature  sawed  through  that  bone.  The 
bone  separated  just  as  the  soft  parts  separate  when  dead, 
the  absorbents  doing  their  part  here  also.  Up  to  the 
limit  of  destruction  or  separation  of  the  periosteum, 
there  is  deat^  Here  the  line  of  demarcation  is  formed, 
and  the  periosteum  throws  out  a  soft  pulpy  matter 
which  is  deposited  between  the  healthy  and  unhealthy 
tissues  and  the  absorbents,  and  saw  through  the  dead 
bone  and  set  it  free.  They  did  so  here,  and  I  removed 
this  piece  of  necrotic  tissue. 

It  is  because  of  this  pathological  condition  of  bone 
that  the  great  majority  of  amputations  are  performed ; 
and  until  very  lately  advantage  was  not  taken  of  the 
physiological  functions  of  the  periosteum,  little  respect 
was  paid  to  this  insignificant  membrane,  and  repro- 
duction of  bone  was  not  sought  after. 


You  will  find,  if  you  look  through  your  works  on 
surgery,  that  statistics  will  show  tliat  the  great  majority 
of  amputations,  except  in  time  of  war,  have  been  per- 
formed  for  necrosis  of  the  bone.  Surgeons  have  here- 
tofore cut  without  regard  to  the  periosteum ;  they  have 
looked  for  the  dead  bone  without  any  respect  for  that 
which  in  the  beginning  makes  the  bone,  and  that  which 
only  makes  it  to  the  last.  You  will  find  in^  your 
operations  for  necrosis,  that  if  the  periosteum  is  not 
respected,  you  will  increase  your  original  trouble,  and 
m^  in  the  end  have  to  resort  to  amputation. 

I  used  to  amputate  such  limbs,  within  these  walls; 
and  I  am  sorry  to  say  that  I  have  cut  off  a  great  many 
limbs  that  I  perhaps  ought  not  to  have  removed.  But 
I  did  this  in  accordance  with  the  best  knowledge  we 
then  possessed,  believing  in  common  with  others  that 
unless  I  did  so  my  patients  would  die ;  and  they  would 
have  died,  had  I  done  nothing.  The  periosteum  was 
being  destroyed,  and  this  destaruction  of  bone  and 
periosteum  was  extending  to  the  joints ;  and  when  the 
joints  were  affected,  the  constitutional  trouble  was  so 
great  that  unless  I  amputated  the  Umb  my  patient  moat 
succumb.  But  I  am  ^lad  to  be  able  to  say  that  it  is 
not  a  common  thing  tor  me  to  perform  an  amputation 
now.  Conservatism  in  surgery  is  being  established, 
which  aUowB  us  to  cure  these  cases  by  a  knowledge  of 
the  physiological  function  of  that  litde  thin  and  insig- 
nificant membrane  which  is  spread  over  the  bone  and 
Unes  the  medullary  canal  of  the  bone.  You  are  to  be 
careful  to  preserve  the  periosteum.  If  you  have  a  patient 
with  deep-seated  agonizing  pain  in  the  limb,  with  rigors 
which  do  not  observe  periodicity ;  thoughy  ou  may  notob- 
serve  periostitis,  do  not  wait  for  matter  to  come  to  the 
smrface ;  do  not  wait  for  this  matter  to  bore  throu^  the 
bone,  and  then  through  the  periosteum,  separatmg  it 
firom  the  bone,  and  macerating  and  digesting  it,  untal 
there  is  nothing  left  of  it,  as  we  once  did:  but  cut  down 
upon  the  bone  as  you  would  in  syphilitic  periostitis, 
or  in  the  old  Ck)rona  Veneris.  Cut  down  through  the 
periosteum  to  the  bone,  and  let  the  matter  escwpe.  Make 
free  that  tense  membrane  which  is  producing  all  these 
constitutional  troubles,  and  if  this  pain  is  persistent,  it 
may  be  necessary  to  take  a  small  trephine  and  cut  down 
into  the  medullary  canal.  In  many  cases,  before  you 
reach  this  canal,  you  will  prove  the  correctness  of  your 
diagnosis;  you  will  find  that  there  is  a  bony  abscess  there, 
and  periosteal  inflammation.  In  this  way  you  can  save 
a  great  many  limbs;  and  even  after  a  large  portion  ot 
the  bone  is  mortified,  you  will  be  enabled  to  save  the 
limb,  and  to  reproduce  the  parts  destroy  ed. 

You  see,  in  specimens,  numerous  openings  leading  to 
the  internal  portion  of  the  bone.  These  canals  leading 
from  the  periphery  to  the  centre  of  the  bone,  allow  tha 
matter  to  escape.  Nature  has  done  this^  and  has  told 
you  what  you  ought  to  do.  She  does  it  with  the  ab* 
sorbents ;  you  are  to  do  it  with  the  scalpel  and  trephine. 

Take  for  example  a  simple  whitlow.  Some  of  you,  I 
presume,  can  hold  your  crippled  fingers  up  as  monu- 
ments of  bad  surgery.  Many  of  you  have  had 
periosteal  inflammation ;  matter  has  formed  beneath  the 
periosteum  of  the  last  phalanx,  if  it  be  in  that  locality, 
and  has  been  allowed  to  remain  until  the  bone  has  been 
destroyed.  Kow,  if  you  had  only  carefully  enucleated 
the  periosteum  from  the  bone,  although  it  were  dead  it 
might  have  been  taken  out  and  another  one  been  pro- 
duced. We  do  it  here  in  the  hospital  everv  day.  This 
fact  is  importantw  Supposing  m  man  has  whitlow  on  his 
index  finger,  it  is  important  tiiat  the  last  phalanx  should 
be  preserved.  AH  of  it  should  be  preserved,  especially 
in  a  mechanic.  This  is  a  rule  whicn  you  should  idways 
observe.  Every  Une  of  the  finger  on  the  organ  of 
prehension  of  the  laboring  man  is  of  the  most  vital  im*- 
digitized  by ^ ^_ 


THE  MEDICAL  RECORD. 


2n 


portance  to^him^  and  hence  you  cannot  be  too  careful 
to  treat  them  properly. 

Let  ufl  now  consider  the  reproduction  of  bone.  I 
have  been  engaged  for  the  last  twenty  years  in  repro- 
ducing bones,  and  with  success,  as  my  specimens  will 
show.  It  was  not  until  I  had  read  Duhamel,  that  I  con- 
odved  the  idea  that  this  subject  would  be  of  so  much 
value  and  importance  in  the  saying  of  life  and  limb.  Up 
to  the  time  of  Duhamel  I  will  say  nothing  with  refer- 
ence to  the  experiments  on  the  reproduction  or  growth 
of  bone.  He  taught  that  the  periosteum  produces  and 
reproduces  bone ;  and  if  you  look  over  the  literature 
of  this  subject,  you  will  find  that  he  had  a  very  warm 
contest  with  Haller  and  his  contemporaries,  because  he 
sought  to  give  the  importance  to  the  periosteum  that  he 
did.  Duhamel  and  Flourens  by  experiments  upon  beast 
and  bird,  proved  beyond  a  doubt  that  periosteum  was 
the  agent  that  reproduced  bone,  ^e  looked  at  frac- 
tures and  noticed  what  occurred  after  the  accident. 
He  saw  that  there  was  a  thickening  of  this  periosteum ; 
that  while  in  the  normal  state  it  was  so  thin  that  it  was 
difficult  to  remove  it  from  the  bone,  it  had  now  be- 
come much  thicker,  and  he  became  conyinced  that  this 
was  the  matrix  of  the  bone.  He  tried  experiments 
upon  rabbits,  fracturing  their  limbs ;  exsected  portions 
or  bone  from  a  number  of  animals,  and  united  the  parts 
by  a  reproduction  of  bone  depending  upon  the  peri- 
osteum. Sides  were  taken,  and  a  great  deal  of  con- 
troversy was  the  result  of  this  theory  of  Duhamel's.  In 
1847,  Kourens,  of  Paris,  published  his  experiments  and 
their  results  to  the  world,*  having  practised  all  of  Du- 
hamel's experiments,  and  duplicated  them,  he  estab- 
lished beyond  a  doubt  that  not  only  the  periosteum 
rq>roduces  bone,  but  also  the  lining  of  the  medullary 
canal,  the  endosteum.  Before  this  work  appeared  I  was 
^gAged  in  study  upon  this  subject,  and  I  examined  a 
mat  many  fractures  to  ascertain  how  the  callus  was 
formed,  and  what  deposited  this  callus,  and  I  went  so  far 
as  to  separate  all  the  sofl  parts  except  the  periosteum  from 
the  fractured  ends  of  the  bones,  and  placed  the  parts  in 
radi  a  position  that  I  could  see,  from  day  to  day,  and 
from  hour  to  hour  almost,  the  process  of  reproduction. 
I  performed  a  number  of  experiments  upon  bone ;  and 
became  satisfied  that  there  was  a  great  deal  to  be 
practised  that  would  be  conservative  in  surgery,  and 
that  would  save  life  and  limb.  I  therefore  commenced 
the  enucleation  of  bone.  I  had  read  all  I  could  find 
upon  the  subject,  and  consulted  John  Heunter,  and 
many  other  authors ;  [and  there  was  but  little  in  our 
speciality  of  the  profession  that  he  did  not  investigate 
intelligently,  although  but  a  carpenter  by  trade.]  You 
will  &d  that  at  an  early  period  he  burned  with  the 
actual  cautery  the  foot  of  an  ass,  and  destroyed  the 
soft  parts  including  the  periosteum,  leaving  the  bone 
dead  below,  and  he  saw  that  the  periosteum  and  ad- 
jacent tissues,  as  he  thought,  reprodured  bone,  and  thus 
filled  up  the  chasm  which  had  been  made  by  nis  actual 
cautery. 

I  do  not  propose  to-day  to  treat  this  subject  in 
atienso,  bat  to  illustrate  all  that  I  have  said,  and  more 
too ;  by  the  experiments  that  I  have  made,  I  have  re- 
produced nearly  all  of  the  bones  of  the  body,  and  have 
the  proofs  before  you  that  what  Duhamel  and  Flourens 
did  upon  the  brute  and  the  bird,  I  have  done  upon  the 
human  subject. 

The  experiments  whidi  Duhamel  made  were  with  a 
▼iew  of  proving  that  the  periosteum  was  the  matrix  of 
the  bone,  and  that  it  was  the  only  organ  that  repro- 
duced bone.  But  Flourens  believed  that  there  was 
a  tissoe  within  the  bone,  a  tissue  comparable  to  the 
periosteum  that  would  also  produce  bone,  and  he  made 
nis  ingenious  and  beautiful  experiments  to  prove  this. 


He  drilled  a  hole  through  the  bone  and  introduced  into 
it  a  silver  canula;  he  then  separated  the  endosteum 
from  its  connection  with  the  bone,  and  left  this  canula 
in  this  position.  By-and-by  it  grew  little  by  little  into 
this  canula,  and  made  its  appearance  at  the  outer  open- 
ing. He  united  this  with  the  periosteum,  and  he 
secured  a  bony  connection  between  the  periosteum  and 
the  endosteum,  growing  through  this  canula.  He  then 
promulgated  to  the  world  that  he  could  make  bone, 
multiply  and  duplicate  bones  at  his  own  pleasure — and 
he  told  the  truth,  for  it  can  be  done. 

Now  I  wish  to  refer  to  the  recent  theory,  for  such  it 
should  be  called,  with  reference  to  the  internal  perios- 
teum. It  has  been  taught  by  one  or  two  physiologists 
that  there  is  no  interniu  periosteum,  but  that  there  are 
what  are  called  bone  cells  in  this  medullary  tissue,  and 
that  when  these  cells  are  inflamed  bone  is  deposit- 
ed, and  in  this  way  the  internal  growth  of  bone  is 
established. 

Fifteen  years  ago,  or  a  little  more,  there  was  a  patient 
in  this  hospital  who  bad  phthisis,  and  an  abscess  formed 
on  the  side,  opened,  and  led  to  necrosis  of  the  rib.  I 
carefully  took  out  this  piece  of  necrosed  bone  from  this 
nb,  and  in  the  course  of  eighteen  months  this  poor 
woman  died.  I  examined  and  found  that  a  portion  of 
the  rib  had  been  reproduced  perfectly,  as^you  see  here, 
by  the  periosteum  which  I  had  left.  The  continuity 
was  perfectly  established,  and  I  was,  of  course,  made 
glad  bv  my  efforts,  and  encouraged  to  go  on.  And  I 
have  done  so,  and  established  the  continuity  where  it 
was  lost,  in  many  of  the  bones  of  the  body.  Now  these 
facts  speak  for  themselves,  and  we  cannot  do  away 
with  them.  They  are  truths,  and  they  are  now  being 
realized  as  such  by  the  profession. 

Here  is  a  specimen  taken  firom  a  case  in  which  I  re- 
moved the  greater  portion  of  the  clavicle,  leaving  as 
much  of  the  periosteum  as  I  could ;  and  you  see  how 
bountiful  nature  has  been,  or  how  bountiful  this  matrix 
has  been.  She  has  given  us  an  exuberant  quantity,  it 
is  true,  and  shortened  the  bone  a  little ;  but  she  has 
made  firm  the  continuity  which  she  has  established. 
This  is  really  a  beautiful  effort,  and  let  me  assure  you 
that  having  become  engaged  in  this  process  of  nature 
you  will  become  so  enamored  with  it  that  you  will 
hardly  be  willing  to  amputate  a  limb,  or  to  perform 
a  surgical  operation  where  the  periosteum  is  implicat- 
ed, unless  you  have  previously  made  an  effort  to 
save  it 

Here,  gentlemen,  is  a  patella  which  was  taken  from  a 
child  about  ten  years  old.  The  bone  was  very  much 
diseased,  and  I  cut  down  to  attempt  to  free  the  abscess 
in  which  it  was  swimming,  and  bemg  digested.  I  saw 
that  there  was  inflammation  about  uie  joint  and  syno- 
vitis ;  btit  the  ulceration  did  not  extend  into  the  joint, 
nor  did  it  extend  through  the  periosteum  and  the 
tissues  which  surround  the  patella.  I  enucleated  this ; 
and  after  several  months,  when  it  was  presented  in 
this  theatre,  the  patella  was  twice  the  size  of  the  oppo- 
site one,  but  all  the  motions  of  the  joint  were  complete. 
It  is  well  known  that  ordinarily  when  a  disease  of 
this  kind  obtains,  amputation  is,  or  has  been,  almost 
uniformly  the  result.  But  it  is  now  an  established  point 
that  with  care  you  can  make  a  new  patella. 

Here  is  a  portion  of  bone  which!  removed  from  an 
old  lady  by  enucleation;  I  separated  the  periosteum 
from  the  bone ;  and  although  the  bone  would  not  sustain 
itself  after  I  had  removed  this  portion,  I  succeeded,  by 
splints,  in  keeping  it  in  position  until  the  periosteum 
had  deposited  siSScient  osseous  tissue  to  give  her  a 
good  and  substantial  arm. 

I  have  here  also,  portions  of  the  tibia  that  I  have  re- 
moved ;  and  in  all  of  these  cases  new  bone  has  been 


272 


THE  MEDICAL  RECORD. 


produced.  Here  you  see  nearly  the  whole  of  the  tibia 
has  been  removed.  This  specimen  proves,  not  only  the 
doctrines  of  Duhamel,  practised  by  Flourens,  but  it  also 
proves  the  experiment  that  I  alluded  to  as  bearing 
upon  the  function  of  tlie  internal  fibrous  membrane, 
whether  it  be  periosteum  or  bone  cells.  The  next  is  a 
specimen  taken  firom  a  man  whom  I  found  in  this  hos- 
pital some  years  ago,  who  had  his  leg  jammed.  He  stub- 
bornly refused  to  have  it  amputated.  I  saw  him  in  the 
hospital,  and  found  upon  examination  that  the  perios- 
teum had  not  been  destroyed,  although  nearly  the 
whole  of  the  shaft  of  the  bone  was  dead. ,  Little  islands 
of  bone  were  found  deposited  under  the  periosteum  in 
that  pulp  which  is  secreted  and  deposited,  and  which 
beomes  periosteum  and  bone.  You  see  here  that  we 
had  an  internal  growth  of  bone,  and  subsequent  death, 
and  the  internal  periosteum  contained  this  sequestrum. 
Here  is  nearly  the  whole  of  the  tibia,  which  I  removed ; 
'  this  beautiful  specimen  shows  the  death  of  the  old  bone, 
and  the  effort  which  was  made  by  nature  before  death, 
to  make  a  bone  within  the  old  bone ;  resulting,  as  you 
see,  in  the  formation  of  a  shaft  which  nearly  fills  the 
medullary  canal  of  the  tibia  in  which  it  was  formed.  I 
enucleated  the  periosteum  from  this  bone,  and  gave  the 
man  as  good,  and  a  stronger  leg  than  the  one  which 
was  not  diseased,  because  where  you  reproduce  such 
tissue  the  tione  is  always  larger. 

These  different  bones  are  reproduced,  gentlemen,  and 
the  patients  leave  the  hospital  perfectly  well ;  and  this 
subject  might  be  continued  untU  I  had  shown  you  spe- 
cimens of  all  the  bones  of  the  body  which  have  been 
removed  in  this  way  and  with  this  result. 

In  using  your  instruments  for  separating  the  perios- 
teum from  the  bone,  you  should  take  great  care,  and 
wait  until  it  has  gained  some  firmness,  because  of  the 
deposit  you  are  anxious  to  effect,  or  you  will  destroy 
tins  new  bone.  Therefore,  you  are  to  treat  it  very 
kindly,  to  enucleate  it  gradually,  and  at  long  intervals, 
with  tne  instrument  best  adapted  to  the  case ;  and  as 
you  separate  it  you  discover  that  it  becomes  hard,  and 
you  completely  pass  around  the  bone  in  this  way. 

In  this  case  occurring  in  the  thigh,  a  portion  of  which 
I  show  you,  I  cut  down  upon  the  bone,  and  found  be- 
tween it  and  the  periosteum,  matter.  An  opening  was 
made,  extending  from  the  periphery  to  the  medullary 
canal,  incising  the  periosteum  about  four  inches ;  the 
bone  was  found  dead.  I  enucleated  the  periosteum 
from  time  to  time  fiom  this  segment  of  the  femur, 
and  found  a  fistulous  opening  extending  to  the  medul- 
lary canal,  and  saw  the  periosteum  throwing  out  crys- 
tals of  bone,  if  you  will  allow  the  term,  until  a  new 
femur  had  formed.  At  the  time  of  the  operation  by 
which  I  removed  this  necrotic  mass,  the  new  bofte  was 
about  half  an  inch  thick. 

Now,  how  would  you  remove  that  bone?  How 
could  I  get  that  bone  through  without  destroying  the 
new  bone  ?  This  opening  was  at  the  lower  extremity 
of  the  diseased  bone.  With  a  small  trephine  I  made 
an  opening  through  the  new  bone  down  to  the  old 
one,  opposite  to  the  opening  which  existed,  and  then, 
with  a  chisel  and  saw,  I  mortised  out  a  piece  of  the 
new  bone ;  and  reaching  the  dead  bone,  removed  tiie 
segment  of  this  femur,  comprising  the  whole  circumfer- 
ence of  the  bone,  and  being  about  four  inches  in  length. 
Now,  my  patient  had  as  good  a  femur  as  he  ever  had ; 
the  bone  was  firm,  and  he  walked  without  any  trouble, 
and  without  limping.  There  are  very  few  thighs  saved 
where  tiiis  condition  of  things  exists,  unless  the  sur- 
geon has  fully  considered  the  physiological  fimction 
of  this  maker  of  bone  Now,  if  I  had  attempted  to 
remove  this  dead  bone,  which  I  hold  in  my  hand,  be- 
fore the  new  one  was  suflficiently  deposited,  I  should 


have  destroyed  all  chances  of  saving  that  man's  limb ; 
but  by  careful  enucleation  practised  for  some  two 
months,  the  result  desired  was  obtained. 

I  have  here  all  of  the  superior  maxillary  bone  of  the 
right  side  except  the  orbital  process,  and  a  portion  ot 
the  superior  maxillary  bone  of  the  left  side.  The  patient 
from  whom  this  specimen  was  taken  was  a  lady  who  had 
inflammation  of  the  periosteum  and  loss  of  her  teeth, 
and  came  to  me  with  disease  of  the  superior  maxillary 
bone.  I  made  an  incision  along  on  the  side  of  the  gam 
cutting  down  to  the  periosteum  on  the  inside  and  outSde, 
and  by  enucleation  separated  this  bone,  and  as  I  gradually 
separated  the  periosteum  from  the  bone,  the  bone  be- 
came hard  and  dense,  and  she  had  a  new  jaw  without 
any  deformity.  She  wears  artificial  teeth,  and  you  would 
not  dream  that  she  had  lost  her  jaw. 

Here  is  a  specimen  taken  from  a  patient  from  whom 
I  removed  the  whole  of  the  lower  jaw.  I  wish  you  to 
remember  the  importance  of  making  your  incision  in 
this  operation,  beneath  and  behind  the  jaw  as  much  as 
possible,  in  order  that  the  cica  rix,  when  it  fonns^  shall 
not  disfigure  the  patient. 

I  have  here  two  jaws  which  were  recovered  frwn 
the  effects  of  vapor  of  phospnorus.  In  this  case,  which 
was  of  a  young  lady,  the  periosteum  was  enucleated 
and  the  reproduction  of  a  new  jaw  was  the  result,  with 
very  slight,  if  any  deformity.  This  girl,  when  she  got 
well  of  this  operation,  left  the  hospital  with  a  new  jaw, 
returned  to  her  old  friend  and  employer,  and  a^n 
engaged  in  the  manufacture  of  lucifer  matches.  She 
had  a  decayed  tooth  in  her  upper  jaw,  which  was  re- 
moved, and  the  vapor  then  attacked  the  periosteum  of 
the  left  upper  jaw,  and  I  removed  the  most  of  this, 
and  reproduced  the  jaw.  So  I  not  only  reproduced 
this  portion  of  the  upper  jaw,  but  the  whole  of  the 
lower  jaw  complete,  and  I  believe  this  is  a  unique 
specimen. 

In  this  other  specimen  which  I  show  you  of  the  re- 
production of  the  lower  jaw,  all  its  motions,  fimctions, 
and  processes  are  com{)lete.  You  see  the  processes  to 
whicn  the  muscles  passing  between  the  hyoid  bone,  the 
tongue  and  jaV,  are  attached,  and  you  observe  that  the 
coronoid  processes  are  perfect^  reaching  up  under  the 
zygoma;  and  more  than  this,  you  perceive,  what  is 
denied  by  many,  that  the  surgeon  can  reproduce  a  joint. 
Many  operators  will  tell  you  that  you  cannot  reproduce 
a  joint  where  you  have  removed  the  bones  forming  it. 
But  you  see  here  the  condyloid  process  shining  beneath 
the  synovial  membrane,  with  the  cartilage  of  incrustation 
and  the  ligaments  attached  to  it^  performing  all  their 
functions.  The  synovial  membrane,  the  cartilage  of 
incrustation,  and  the  ligaments,  are  intact,  and  all  the 
functions  of  the  jaw  are  perfect.  This  poor  girl  died 
subsequently  of  absoess  of  the  brain. 

You  can  even  do  more  than  this  sometimes.  I  was 
asked  by  a  gentleman,  who  had  heard  me  describe  this 
operation  and  its  results  some  time  after  that  reproduc- 
tion of  the  lower  jaw,  "if  the  teeth  were  through  yet 
in  the  new  jaw  T*  1  told  him  they  were  not  But, 
gentlemen,  I  have  left  the  old  teeth  in  the  new  jaw ;  and 
this  specimen  was  taken  from  a  patient  that  I  operated 
upon  in  this  hospital  with  this  result.  I  enucleated 
the  bone,  and  found  that  the  four  incisor  teeth  were 
becoming  firmly  attached  to  something.  I  separated 
carefully  the  bone  beneath  the  periosteum  which  was 
beooming  solidified,  and  I  discovered  that  the  teeth  were 
being  embraced  by  the  new  bone,  that  it  was  forming 
a  oast  round  about  the  teeth,  and  at  the  time  of  the 
operation,  after  I  had  enucleated  and  made  solid  the 
periosteum,  I  lifted  the  old  bone  out,  and  left  the  pa- 
tient's teeth  in  the  new  jaw  I  Eighteen  months  after  this 
operation  my  house  surgeon,  Dr.  Phelps,  and  myself  saw 


THE  MEDICAL  RECORD, 


273 


her,  and  the  taeth  were  very  firm,  and  as  useful  as  they 
were  in  their  old  place. 

^  There  is  a  pomt  to  which  I  wish  to  call  your  atten- 
tion, VL^,  with  reference  to  the  notions  of  those  who  did 
not  believe  that  the  periosteum  and  endosteum  pro- 
duced bone.  They  contended  that  the  periosteum  and 
the  tissues  in  the  neighborhood  of  the  bone  reproduced 
it;  and  before,  at  me  time  the  chemist  discovered 
that  there  were  such  deposits  as  calcareous  deposits, 
this  was  brought  up  as  proof  that  the  tissues  m  the 
neighborhood  of  the  bone  reproduced  bone,  as  well  as 
the  periosteum.  This  specimen  is  simple  and  to  the 
point.  Here  was  an  extensive  abscess  forming  in  the 
E>one,  Mid  going  through,  making  an  opening  at  or  near 
the**lower  end,  like  a  tent,  separating  it,  as  you  see, 
some  inches  firom  the  bone.  I  found  new  bone  was 
forming  in  this  extended  periosteum  so  remote  from  the 
bona  layer  after  layer ;  and  in  this  way  was  produced 
this  bone  which  I  show  you.  This  to  a  great  extent  ex- 
plains away  and  disproves  the  theory  that  other  tissues 
than  the  periosteum  reproduce  bone. 

We  have  also  seen  that  the  periosteum  will  not  only 
reproduce  bone,  but  will  extend  itself,  covering  the 
bone,  and  extending  itself  over  the  ends  as  well  as  the 
lateral  portions  of  the  bony  tissue. 

^ow  I  maintain,  that  when  the  periosteum  is  in- 
flamed or  lacerated  it  will  grow  into  other  tissues, 
if  allowed  to  do  so.  Here  is  a  case  of  luxation  at  the 
hip,  occurring  during  morbus  coxarius.  You  see  the 
upper  border  of  the  old  acetabulum  destroyed,  and  you 
see  here  a  partial  dislocation  upwards  cf  the  head  of  the 
femur;  an^  the  ligaments,  because  of  the  periosteum 
that  has  been  extended  to  them,  have  ossified ;  and  in 
this  hard  and  ossified  material  you  may  discern  the  im- 
pression of  the  fibres  of  the  capsular  ugament,  and  the 
cervical  ligaments. 

I  have  two  more  specimens  that  I  wish  to  show  you 
before  closing  these  remarks.  This  leg  was  taken  from 
a  boy  who  had  a  strumous  cachexia,  who  had  perios- 
titis and  ostitis.  I  made  an  incision  the  whole  length 
of  the  tibia,  and  through  the  periosteum  down  to  the 
bone,  which  was  dead,  and  a  portion  of  the  periosteum 
on  the  anterior  surface  of  the  tibia  was  also  destroyed. 
Neariy  the  whole  of  the  tibia  died.  The  boy  was 
weak  and  feeble,  and  I  gave  him  nourishing  diet — 
iron,  phosphates  of  lime,  and  everything  that  could 
Dounsn  him,  and  mi^e  his  blood  plastic,  and  calculated 
to  administer  to  the  wants  of  the  periosteum ;  and^en 
I  commenced  enucleating  the  periosteum  from^the 
bone — and  you  see  how  far  I  had  advanced.  I  had 
enucleated  the  periosteum  from  time  to  time  on  this 
dead  bone — and  you  see  the  new  bone  is  deposited  in  it 
— all  along  the  side  of  the  tibia,  and  in  a  littie  while  I 
should  have  had  that  dead  bone  out,  and  a  new  tibia 
formed  there  in  its  place.  But  one  day  I  was  called  to 
see  him  as  he  had  nad  a  rigor  and  terrible  pain  at  the 
upper  and  lower  end  of  the  tibia;  and  his  ankle-joint 
was  terribly  swollen.  I  found  there  was  synovitis  about 
the  ankle,  and  that  his  constitution  was  terribly  shocked 
by  what  was  going  on.  There  was  matter  in  the  joint, 
and  to  save  his  life  I  amputated  the  thigh.  On  making 
section  of  the  bone  I  found  tuberculous  deposit  at  the 
lower  end  of  the  bone  communicating  with  Ae  ankle- 
joint — and  also  a  tubercle  deposited  at  the  lower  end  of 
the  tibia. 

I  have  a  great  many  other  beautiful  specimens 
by  which  I  can  illustrate  this  important  subject; 
Imt  I  only  propose  to-day,  to  give  you  an  idea  of  what 
can  be  done  in  the  way  of  conservative  surgery,  by 
the  reproduction  of  bone.  I  can  exhibit  to  you  but  one 
more  specimen,  and  give  you  the  history  of  the  case. 
This  portion  of  the  thigh  bone,  about  six^  inches  in 


length.  I  enucleated  in  a  man  upon  whom  I  finally  per- 
formed amputation.  The  bone  died,  the  stump  was  not 
clofed.  and  I  had  an  opportunity  of  watching  the 
growtn  of  new  bone  firom  the  time  me  old  bone  b^same 
necrotic,  until  I  removed  it  by  enucleation.  In  this 
case  at  the  time  of  enucleation  there  were  three  firm, 
well  formed  bony  cylinders;  the  first  and  peripheral, 
formed  by  the  external  periosteum;  the  second,  the 
sequestrum  of  the  old  dead  femur;  and  the  third, 
formed  by  the  internal  periosteum  and  bone-cells. 
From  between  the  first  and  second  I  removed  this,  the 
old  femur,  the  specimen  I  now  present  to  you.  The 
thigh  bones,  for  we  must  use  the  plural  here,  are  at 
least  four  times  larger  than  the  original  femurs.  This  is 
one  of  my  most  vamable  specimens,  as  showing  the  re- 
production of  bone,  and  deposit  of  tuberculous  matter 
m  bone. 


l^ejjorta  0f  ^oapttola* 


JEFFERSON  MEDICAL  COLLEGE 

or   PHILADSLPmi. 

Surgical  Clinics  of  Pbof.  Gross. 

enlarged  spleens — ^differentujl  diagnosis  from 
ovarlan  and  omental  tumors.    - 

Case  L — Enlarged  Spleen. — ^August  T ^r,  set  25, 

employed  in  a  manufaotoir  of  gas  fixtures,  has  been  in 
the  U.  S.  service  four  and  a  half  years — temperate  in 
his  habits.  He  was  sick  seven  or  eiffht  years  ago,  and 
says  he  took  a  great  deal  of  quinine,  his  account  of  his 
case  pointing  to  a  probable  attack  of  intermittent  fever. 
There  is  great  enlargement  of  the  abdomen,  with  an 
appearance  very  much  that  of  ascites ;  and  on  examina- 
tion, though  there  may  be  water  present  in  the  abdo- 
men, this  18  by  no  means  the  sole  cause  of  the  swelling. 
There  is  a  tumor  occupjring  a  large  portion  of  the  um- 
bilical and  left  hypocnondriao  regions,  and  a  portion 
of  the  iliac  region.  The  tumor  projects  towards  th« 
right  side  of  t£e  umbilicus,  and  its  outlines  can  be  dis- 
tinctly defined  when  the  limbs  of  the  patient  are  flexed 
so  as  to  relax  the  abdominal  muscles.  It  is  a  sharply 
defined  tumor,  projecting  back  into  the  ileo-lumbar 
region  a  considerable  distance,  under  the  ribs  of  the  left 
side  as  high  as  the  ensiform  cartilage.  Its  surface  ap- 
pears to  be  uniform,  there  is  no  nodosity,  no  lobulation 
of  the  surfiice,  it  is  perfectly  smooth,  and  its  edges 
sharp.  It  is  more  distmct  on  the  outside  of  the  tumor 
and  below,  not  so  much  so  above.  The  patient  is  feeble 
and  emaciated,  and  has  lost  a  good  deal  of  flesh.  He 
complains  of  having  terrible  pains  last  week,  which  he 
describes  as  "  fiichttul,  so  that  he  could  not  rouse  him- 
self on  account  of  them.'*  When  the  weather  changes, 
his  pain  increases.  Appetite  tolerable,  tongue  somewhat 
reddened,  moist,  and  expanded;  bowels  regular;  sleep 
poor;  urine  brownish-yellow,  about  a  quart  being 
voided  every  night ;  no  cough,  no  palpitation  of  the 
heart ;  no  fever  at  night,  but  a  good  deal  of  perspira- 
tion. The  probability  is,  however,  that  there  may  be  a 
slight  febrile  condition  at  night  vnthout  the  patient 
recognising  it 

The  history  of  the  case  points  to  the  nature  of  the 
enlargement.  We  have  reason  to  believe  that  the  pa- 
tient suffered  seven  or  eight  years  ago  fix>m  intermittent 
fever;  which,  when  long  continued,  is  likely  to  give 
rise  to  enlargement  of  the  spleen,  which  is  a  fact  very 
well  known ;  and  this  enlargement  firequently  continues 
to  an  enormous  extent,  so  that  it  may  acquire  a  weight 
of  five,  eight,  ten,  or  even  fifteen  pounds.  This  tumor 
will  be  hfurd,  firm,  and  resisting,  andvnll  extend  by  and 
digitized  by ^ „      ^_ 


274 


THE  MEDICAL  RECORD. 


by  in  every  direction,  so  as  to  encroach  on  the  dia- 
phragm and  everywhere  on  the  walls  of  the  abdon^n, 
descending  even  into  the  pelvis. 

This  appears  to  be  the  nature  of  the  present  case,  a 
chronic  enlargement  of  the  spleen  originating  in  a 
miasmatic  fever,  and  slowly  and  surely  enlarging  and 
undermining  the  health.  In  some  cases  of  this  kind 
the  inflammation  which  always  accompanies  enlarge- 
ment terminates  in  ulceration.  This  is  a  rare  event. 
Dr.  Gross  has  seen  one  such  case,  and  but  one  in  his 
entire  experience.  There  is  another  circumstance  in 
reference  to  the  diagnosis  of  this  tumor,  and  that  is  its 
outline  and  its  situation.  It  lies  on  the  left  side  where  the 
spleen  is  situated,  and  the  tumor  has  a  sharp  outline,  and 
a  well-defined  margin,  much  more  so  than  an  enlarged 
liver  would  have.  In  the  female  such  a  case  might  be 
mistaken  for  an  enlargement  of  the  ovary.  It  mi^ht 
be  mistaken  for  an  enlargement  of  the  omentum,  which 
is  liable  to  canceroma  and  hypertrophy,  sometimes 
forming  an  enormous  tumor ;  but  then  this  lies  in  front 
of  the  bowels  nearly  equally  on  both  sides.  It  is  liable 
to  irritate  the  pelritoneum  and  produce  ascites,  as  will 
all  tumors  of  the  abdomen  or  pelvis.  Another  effect  is 
pressure  on  the  diaphragm,  producing  difficulty  of  res- 
piration. There  is  also  some  pain  Irom  pressure  on 
the  surrounding  parts.  The  patient  Ues  on  the  right  side. 
Treatment, — Tne  patient  will  be  given  four  times  a 
day  15  grains  of  the  hydrochlorate  of  ammonia  in  solu- 
tion. If  there  is  pain  at  night,  an  anodyne  should  be 
administered.  He  should  take  a  concentrated  nourishing 
diet,  with  milk  punch  ;  and  locally  employ  one  part  of 
biniodide  of  mercury  to  eight  parts  of  simple  cerate.  This 
is  a  most  powerful  stimulant  to  the  absorbent  vessels. 

Extiipation  of  the  spleen  has  been  occasionally 
resorted  to  from  the  sixteenth  century  even  to  the 
present  time;  but  the  operation  has  usually  proved 
lataL  Portions  of  the  organ  extruding  from  wounds  of 
the  parietes  have  been  occasionally  excised ;  and  as  in 
the^case  of  Powell  of  Covington,  Ky.,  the  patient  has 
recovered,  showing  a  tolerance  of  interference  by  this 
or^an.  The  removal  of  the  spleen  in  some  of  the  lower 
animals  is  known  to  have  rendered  them  fat  and 
indolent 

Cask  JL—Nov.  21,  1866.— ^nZar^«d  iSjpfoen.— Elijah 
A- — r,  est.  34,  a  laboring  man,  accustomed  to  heavy 
lifting.  Has  had  an  enlarged  abdomen  for  two  yeara 
On  two  occasions  he  has  been  tapped,  but  at  neither 
time  was  there  any  escape  of  fluid  to  any  considerable 
extent,  about  two  ounces  escaping  at  the  moment  of 
puncture,  followed  by  gradual  drainage  to  the  amount 
of  three  gallons.  There  is  a  good  desJ  of  tumefaction 
of  the  abdomen,  but  not  to  as  great  an  extent  as  before 
the  last  tapping.  The  increase  in  circumference  during 
the  past  six  months  has  not  exceeded  four  inches.  On 
the  leftside  of  the  tumor,  at  the  bottom,  there  is  some 
pain,  but  no  pain  in  the  tumor  itself;  no  pain  on  taking 
a  long  inspiration ;  in  walking,  pain  is  produced  by  the 
jarring  of  the  mass ;  the  facility  of  breathing  is  much 
embarrassed ;  at  present  the  patient  can  lie  down  pretty 
low,  but  a  year  ago  he  had  to  be  kept  propped  in  the 
semi-erect  position ;  the  bowels  are  costive  at  present, 
but  sometimes  they  are  regular;  appetite  is  strong; 
sleep  is  not  good,  though  diere  is  no  pain  at  night, 
except  that  complained  of  on  the  left  side ;  patient  lies 
equally  well  on  the  back  or  on  either  side;  passes 
about  three  pints  of  urine  in  the  twenty-four  hours,  and 
this  urine  deposits  a  brick-colored  sediment ;  and  once 
or  twice  since  being  tapped  he  has  passed  over  a  gallon 
of  urine ;  emaciation  has  been  increasing  progressively. 
There  is  no  discoloration  of  the  skin  over  uie  tumor, 
no  enlargement  of  the  subcutaneous  veins. 

The  tumor  is  hard,  extending  firom  the  ribs  down  as 


far  as  the  pubic  bone ;  it  reaches  fer  back  into  the  left 
iliac  region:  there  is  a  distinct  line  of  demarcation  on 
the  right  or  the  umbilicus,  with  a  rather  sharp  margin 
well  defined.  There  is  resonance  on  percussion,  showing 
that  the  intestine  is  there  distended  with  air ;  higher  up 
percussion  is  dull,  on  the  left  side  it  is  flat;  the  reson- 
ance forms  a  Une  across  of  about  four  and  a  half  inches. 
This  patient  states  that  he  has  never  had  intermit- 
tent fever;  and  that  the  disease  came  on  without  any 
assignable  cause. 

It  is  a  case  of  enlargecl  spleen.  The  tumor  occupies 
the  situation  in  which  the  enlarged  spleen  is  usually 
found,  the  left  side ;  the  surface  is  smooth  and  per- 
fectly uniform,  there  is  nothing  nodulated  about  it;  it 
has  a  peculiar  sharpness  of  border,  and  its  edge  is  felt 
nearly  at  the  middle  line.  It  is  probably  firmly  adhe- 
rent to  the  parietal  portion  of  the  peritoneum.  It  is 
not  likely  fiiat  it  is  an  affection  of  the  omentum, 
which  occasionally  becomes  the  seat  of  disease,  morbid 
formations  being  liable  to  form  in  it,  especially  coUoid, 
a  form  of  malignant  disease  of  which  Prof.  Gross  has 
seen  but  two  examples  in  this  particular  situation; 
one  occurring,  during  his  residence  in  Cincinnati,  in 
a  man  who,  four  years  before,'  had  had  a  severe  attack 
of  cholera,  and  the  other  in  a  wholesale  druggist,  of 
Louisville,  Ky.,  both  of  which  were  fatal,  and  the 
tumors  were  found  to  be  enormous,  extending  firom  the 
pelvic  region  as  high  as  the  diaphragm,  involving  the 
bowels  and  portions  of  the  liver.  The  omentum  is 
also  liable  to  take  on  hypertrophy,  a  sort  of  sarcoma- 
tous, fleshy,  or  fibroid  enlargement  of  its  substance,  in 
consequence  of  which  it  would  form  a  tumor  of  con- 
siderable bulk,  but  hardly  as  large  as  "that  attained  in 
the  tumor  under  consideration.  * 

With  regard  to  the  tumor  on  the  right  side,  a  por- 
tion of  it  is  soft  and  is  ascitic,  depending  upon  an 
accumulation  of  serum  in  the  pentoneal  sac.  The 
patient's  medical  attendant  informs  us  that  he  tapped 
the  man,  and  three  gallons  of  fluid  escaped  eight  days 
after  the  operation.  Any  tumor  of  this  kind  fretting 
the  peritoneal  surface,  will  provoke  a  secretion  and 
produce  ascites.  There  is  another  portion  of  the 
swelling  which  is  solid,  where  there  is  no  gas,  no 
resonance,  no  distinct  fluctuation.  This  is  possibly  an 
enlargement  of  the  liver,  but  it  may  be  something  else ; 
it  is  not  quite  as  solid  as  an  enlarged  or  hypertrophied 
liver  should  be.  There  may  be  a  cyst  in  the  liver,  or  a 
cy^M)ver  the  Uver. 

This  patient  has  been  treated  with  jjreparaticms  of 
iodine.  If  the  diagnosis  is  correct,  the  ointment  of  the 
biniodide  of  mercury  —  one  part  to  eight  or  ten  of 
simple  cerate— by  inunction  might  do  some  good.  The 
ointment  of  the  shops  is  too  severe  for  this  purpose,  it 
acts  as  a  powerful  irritant.  During  the  progress  of 
treatment  it  is  probable  that  the  ointment  may  be  in- 
creased in  strength,  but  it  is  best  to  begin  with  it  as 
weak  as  possible,  so  as  not  to  excite  too  much  irritation 
of  the  skm.  It  should  be  rubbed  on  effectually,  once 
in  the  twenty-four  hours,  keeping  the  surface  covered 
in  the  mean  time  with  flannel  and  oiled  silk  over  it,  so 
as  to  protect  the  dothing. 

Internally  we  will  use  the  hydrochlorate  of  ammonia 
in  doses  of  10  grains  at  first,  gradually  increased  to  12, 
15,  or  20  grs.,  three  times  daily,  in  solution ;  combining 
with  each  dose  one-twelfth  gr.  of  the  bichloride  of  mer- 
cury. The  treatment  is  sorbefacient,  to  try  and  reduce 
the  size  of  the  spleen. 
The  diet  is  to  be  simple,  nutritious,  and  generous. 

Absorption  or  Gases. — Charcoal  firom  the  shell  of 
the  coooanut  is  said  to  possess  extraordinary  power  of 
absorbing  gases.  ^  t 

Digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


276 


Thb  Orioiv  of  Progrkssiye  Muscular  Atrophy. — 
Dr.  L.  Dum^nH,  Surgeon-iu-Chief  of  the  Hotel  Dieu, 
At  Bouen,  reports  two  cases,  the  subject  of  the  most 
careful  dinical  observation,  cadaveric  and  microscopic 
examinations.  He  shows  this  disease  to  be  due  not 
to  atrophy  primitively  occurring  in  the  muscular  fibres, 
but  on  the  contrary  originating  in  atrophy  of  the  nerve 
tubes  of  the  trunks  and  branches  supplying  the  muscles 
with  nerve  stimulus.  It  seems  that  Scbneewogt  was 
the  first  to  signalize  this  pathological  condition  of  the 
nerve  tubes  in  progressive  muscular  atrophy,  and  that 
afterwards  M.  Jaccoud,  in  1864,  reported  two  cases. — 
ChmeUe  Bebdamadaire. 

HuoB  Renal  Ctst  mistakkk  fob  Ctst  of  the  Oyart. 
— M.  B^hier  recently  presented  to  the  Paris  Academy 
of  Medicine  an  interesting  post-mortem  specimen  of  a 
huge  renal  cy  st^hich  during  life  was  thought  to  be  an 
ovarian  cyst.  The  tumor  had  been  tapped  twice,  and 
had  furnished  each  time  a  chocolate-colored  liquid, 
which  never  presented  any  of  the  characteristics  of 
luine.  The  obstruction  of  the  orifice  of  the  ureter  by 
two  large  calcuL*,  appeared  to  be  the  cause  of  this  cystic 
tumor.  M  B^ier  called  attention  to  the  importance 
of  the  diagnosis  in  this  case,  and  remarked  that  the  pos- 
sibility of  such  a  mistake  should  not  be  forgotten  in  the 
operation  for  ovariotomy. — Gazette  EMonUtdaire, 

Rhsttmatism  and  Heart  Affections. — M.  Vemay,  in 
a  communication  recently  addressed  to  the  Academy  of 
Medicine  of  Lyons,  establishes  fully  by  observation, 
based  upon  several  hundred  cases  of  acute  articular  rheu- 
matism, the  coincidence  first  pointed  out  by  Bouillaud, 
of  this  disease  with  endocarditis  and  endopericardilis. 
He  found  the  coincidence  of  endocarditis  to  be  the  rule, 
and  non-coincidence  the  exception.  He  expresses  an 
opinion,  however,  differing  slightly  firom  that  of  Bouil- 
laud ;  and  which  is,  that  not  only  the  intensity  of  the 
rheumatic  affection  constitutes  the  danger  of  endocardiac 
complication,  but  that  it  is  also  especially  indicated  by 
the  shiiling  character  of  tlie  articular  pains. —  Union 
MidtcdU  de  la  Qironde, 

Endocardial  Ulceration  or  supposed  STpmLmo 
Origin. — ^M.  Villard  presented  to  the  Academy  of  Medi- 
cine of  Marseilles  a  heart  in  which  one  of  the  aortic 
valves  offered  a  peculiar  ulceration ;  there  were  also  some 
small  fungous  grow  ths  on  this  valve :  the  two  others  were 
by  ulcerations,  the  bordei-s  of  which  were  covered  with 
perforated  fibrinous  excrescences,  and  the  centre  of  the 
ulcerations  was  of  a  gravish  color.  Their  peculiar  color, 
and  the  co-existence  of  eruptions  of  secondary  syphilis 
on  the  skin,  induced  the  opinion  that  this  endocardial 
lesion  was  nf  a  syphilitic  nature. — Bulletin  de  la  SocieiS 
de  Med,.  Margeiuee,  Jan,  1867,  and  extracted  from  the 
Union  Med.  de  la  Qvronde, 

Patty  **  Emboulib." — It  seems  that  the  first  cases  of 
papillary  distension  by  liquid  fat,  and  which  were 
especiafly  observed  in  thelun^  were  noriced  about  four 
years  aro  by  2knker  and  Wagner,  and  they  both  at- 
tributed this  capillary  obstruction  to  an  "emboulie  "  of 
&t  globules.  Tois  condition  was  supposed  and  asserted 
bv  Grohe  to  be  only  an  agglomeration  of  fat  and 
iHood  corpuscles,  due  to  the  diminished  rapidity  of  the 
circulatiDg  current  immediately  preceding  death. 

Busch,  of  Koni^^rg,  Prussia,  desirous  to  throw 
light  upon  tUjB  subject,  oarefiilly  studied  the  conditions 
which  favor  Qie  phenomenon  of  fatty  "  emboulie,"  in 
order  to  determine  if  this  was  caused  by  the  crushing  of 


bone  containing  considerable  marrow,  as  a  few  oases 
already  observed  seemed  to  show.  By  experiments  on 
rabbits,  in  which  he  crushed  the  bones  of  their  hind  legs, 
he  incontestably  proved  this  fatty  embolia  to  be  due  to 
the  disorganization  of  the  marrow,  and  the  absorption 
of  its  fat  globules  by  the  circulatory  System.  This  pecu- 
liar accumulation  of  fat  globules  has  in  certain  rare  cases 
been  observed  consecutively  in  diseases  not  connected 
with  the  bones,  as  in  endometritis  and  metrophlebitis ; 
but  especiidly  in  suppuration  of  tissues  containing  much 
fat  Fatty  embolia  generally  does  not  sensibly  affect 
the  health,  and  appears  to  be  of  more  interest  physio- 
logically than  pathologically.  The  cases  in  which  it 
appears  to  have  been  the  only  cause  of  death,  and  some- 
times of  sudden  death,  are  exceedingly  rare. 

Death  from  the  entrance  of  Am  into  the  Veins 
OF  THE  Uterus.— Professor  Olshausen  relates  a  case  in 
which,  during  parturition,  the  cervix  not  dilating  rapidly 
enough,  the  uterine  douche  was  applied.  It  was  used 
three  times,  and  about  eight  minutes  after  the  last  ap- 
plication, the  patient  complamed  of  difficulty  of  breath- 
ing, suddenly  rose  straight  up  in  bed,  and  then  fell, 
and  after  a  few  convulsive  efforts  died.  Emphysema- 
tous crepitation  could  be  produced  by  pressure  on  the 
abdomen.  At  the  post-mortem  examination  a  consider- 
able  quantity  of  air  bubbles  was  found  in  the  coronary 
veins  of  the  heart  The  small  quantity  of  blood  con- 
tained in  the  right  heart  was  very  fi*othy.  The  womb 
crepitated  on  pressure;  the  surrounding  vessels  were 
filled  with  air  bubbles,  as  also  the  ascending  vena  cava. 
The  two  placentas  (it  was  a  case  of  twins)  were  de- 
tached, and  one  of  them  formed  with  the  interior  wsJl 
of  the  uterus  an  inflated  pouch. 

Remarkable  Case  of  Deposit  in  the  Lung. — ^Zenker 
reports  that  a  woman,  whose  occupation  in  a  factory 
exposed  her  to  the  inhalation  of  minute  particles  of 
oxide  of  iron,  died  a  few  weeks  afler  exhibiting  some 
of  the  general  symptoms  of  pulmonary  consumption, 
but  with  negative  results  on  auscultation  and  percussion. 
At  the  sectio  cadaveris  the  luncrs  were  observed  to  be 
infiltrated  with  the  red  oxide  of  iron,  which  was  found 
to  be  about  two-thirds  of  an  ounce,  and  of  the  same 
nature  as  that  daily  used  by  her  in  her  work,  and  which 
was  deposited  in  the  tissue  of  the  lungs  in  the  same  man- 
ner that  charcoal  dust  is  seen  after  death  in  the  lungs  of 
miners  and  others,  who  constantly  live  in  an  atmo- 
sphere of  coal-dust.  Possibly  the  Pittsburg  doctors  have 
ampler  facilities  for  the  study  of  coal  dust  and  other  de- 
posits in  the  lungs  than  Zenker,  and  might  elucidate 
this  murky  subject 

Experiments  with  Bromide  of  Potassium. — Messrs. 
Eulenburg  and  Gutmann  have  stated,  before  the  Aca- 
demy of  Medicine  of  Paris,  that  doses  of  fi-om  thirty  to 
sixty  grains,  either  bv  the  stomach  or  injected  under  the 
skin,  kill  a  rabbit  in  mm  ten  to  forty  minutes.  Smaller 
doses  momentarily  disturb  the  action  of  the  heart  and 
paralyse  the  power  of  moving  and  feeUng,  causing  a 
few  antecedent  shivers.  On  a  post-mortem  examina- 
tion of  the  animals,  no  change  but  some  congestion  of 
internal  organs  is  found.  With  frogs,  a  subcutaneous 
injection  oTone  grain  to  two  causes,  after  ten  or  fifteen 
minutes,  loss  of  movement,  reflex  action,  and  feeling, 
with  arrest  of  respiration,  weakening  ana  infre(juency 
of  cardiac  ventricular  action,  retardation  of  penpheral 
circulation,  and  lastly,  complete  diastolic  arrest  of  the 
heart's  action.  These  effects  are  attributed  by  Messrs. 
Eulenburg  and  Gutmann  not  to  the  bromine,  but  to  the 
potassium. — Lancei, 

A  New  Kind  of  Acarus. — 'hi,  Ind^  has  noticed 
among  the  Kabyles  of  Northern  Afiica  a  pruriginoas 


Digitized  by 


Goo^. 


276 


THE  MEDICAL  RECORD. 


complaint  somewhat  like  itch;  where,  however,  the 
acanis,  forming  a  black  spot  on  the  skin,  moving 
about  with  ener^,  is  different  from  the  well-knowu 
acarus  scabieL  The  sulphuro-alkaline  ointment  de- 
stroyed the ,  animalcole.  In  France^  M.  Boujer  has 
noticed  in  the  department  of  Indre,  a  papular  prurigi- 
nous  eruption,  affecting  the  country  people  "mio  had 
handled  the  wheat  somewhat  spoiled  by  the  frequent 
rains  of  last  simimer.  The  same  parasites  were  here 
observed. — Lancet. 

Decapitation. — ^As  is  usually  the  case  after  every 
execution  in  Paris,  the  decimitation  of  the  brutal  mur- 
derer, Lemaire,  has  been  followed  by  statements  in 
the  newspapers  as  to  the  persistence  of  sensibility  for 
some  time  In  the  head  after  decollation.  M.  Bonna- 
font  has,  therefore,  thought  it  worth  while  to  give  ac 
account,  in  a  recent  number  of  the  Union  Mtdiocde^  of 
some  experiments  he  made  many  years  ago  in  Alge- 
ria in  order  to  dissipate  the  belief  then  so  genemly 
held  in  that  colony.  On  the  occasion  of  the  decapita- 
tion of  two  Arabs,  he  had  ready  a  vessel  nearly  filled 
with  pulverized  plaster,  and  placed  on  a  low  table,  and 
a  friend  and  himself  were  provided  with  a  small 
speaking-trumpet  and  a  very  sharp-pointed  probe.  Im- 
mediately the  first  head  was  cut  off  it  was  placed  in 
the  vessel  containing  the  plaster,  in  order  to  arrest  as 
far  as  possible  the  h»morrhage.  The  speaking-trumpet 
was  applied  to  the  ear  of  the  defunct^  and  his  name 
well  shouted  through  it,  but  no  movement  of  the" eyes 
or  of  any  part  of  the  face  manifested  the  sJightest 
perception.  The  eyes  remained  dull  and  motionless, 
and  the  face  colorless,  and  scarcely  any  contraction  of 
the  muscles  was  induced  by  provoking  them  with  the 
pointed  ijrobe.  The  second  head  manifested  in  like 
manner  signs  of  instant  death ;  as,  indeed,  how  could 
it  be  otherwise  than  that  this  must  at  once  ensue  upon 
the  syncope  induced  by  the  section  of  the  large  arte- 
ries? The  numerous  relations  to  the  contrary,  as  well 
as  the  blush  on  Charlotte  Corday*s  cheek,  M.  ^onnafont 
regards  as  fabulous,  and  he  points  out  that  there  is  no 
analogy  between  this  reputed  retention  of  sensibility 
by  the  decapitated  heac^  and  the  fact  of  ducks  and 
turkeys  being  able  to  walk  about  for  some  time  after 
decapitation,  as  shown  in  the  experiments  of  Aldini 
and  Eugene  Sue. — Quar.  Jour,  of  Psychological  Med, 

Effects  %r  MsnioiKES  Intboduoed  into  the  Ure- 
thra.— Professor  J.  L.  Crawcoun  of  New  Orleans,  has 
communicated  to  the  Southern  Jowmal  of  Medical  Sd- 
ences  some  exceedingly  interesting,  and  it  may  prove 
equally  important  experiments  wi^  regard  to  the  con- 
stitutional effects  of^  substances  introduced  into  the 
urethra.  He  concludes  that  the  portion  of  this  canal 
bounded  by  the  prostate  and  neck  of  the  bladder  has 
a  remarkable  power  of  absorption,  which  is  not  pos-. 
sessed  by  the  walls  of  the  bladder  within,  nor  by  the 
membranous  or  spongy  portions  without^  this  being 
due  to  the  rich  nervous  and  vascular  supply  of  the 
part  in  question.  The  conimunication  is  based  upon 
observation  of  nearly  sixty  cases,  in  all  of  whicn  a 
cerate  of  morphia  or  atropia  was  smeared  in  very 
small  quantity  upon  the  extremity  of  a  silver  sound, 
and  allowed  to  remain  in  contact  with  the  parts  from 
one  to  five  minutes. 

In  one  case  less  than  half  a  grain  of  atropine  cerate, 
ten  grains  to  the  drachm,  produced  complete  dilatation 
of  the  pupil  in  three  minutes,  and  active  deUrium  in 
five  minutes.  The  subject  was  a  hospital  patient  not 
suffering  from  urethral  disease.  In  another  case,  a 
portion  no  larger  than  a  pin-head  produced  dilatation 
of  the  pupil  and  huakiness  of  voice  in  five  minutes, 
and  a  staggering  gait  in  ten  minutes.    The  effect  of 


small  amounts  of  morphine  ointment,  one  scruple  to  the 
drachm,  was  no  lets  marked. 

In  one  case  drowsiness  was  produced  in  five  minutes, 
and  eighteen  hours  afterwards  the  patient  returned  to 
be  catbeterice^,  paralysis  of  the  bladder  having  oc- 
curred. 

The  professor  does  not  hazard  a  theory,  the  effects 
obtained  appearing  entirely  out  of  proportion  to  the 
amount  of  medicine  used.  He  therefore  merely  sub- 
mits the  fiacts  to  the  medical  public,  hoping  that  in 
cases  of  mania  and  delirium  tremens  they  may  be  of 
service,  and  looking  to  the  friture  for  an  explanation. 

Aneubism  in  the  Horse. — M.  Raymond  has  published 
two  cases  which  refer  to  old  horses.  The  mesenteric 
trunk  was  in  both  instances  the  seat  of  the  aneurism ; 
and  the  author  observes  that  very  few  old  horses  are 
dissected  which  do  not  present  dilatations  of  the  ti-unk 
just  named.  The  clot  often  contains  hard  substances 
and  parasites. — Lancet. 

Case  of  Post-Partum  HjofORRHAGB,  in  which  the 
Ether-Spray  was  Successfullt  Used. — John  Broad- 
bent,  M.R.G.S.,  etc.,  Manchester,  reports  (British  Med. 
Jour.)  a  case  of  post-partum  h»morrhage  successfully 
treated  by  ether-spray.  At  10^  p.m.,  on  April  3d,  1867, 
he  was  called  to  see  Mrs.  T.,  in  labor  of  her  twelfth 
child.  He  found  the  os  uteri  only  slightly  dilated, 
and  the  pains  weak.  The  breech  presented,  and  the 
child  was  bom  the  following  morning,  without  any- 
thing unusual  occurring.  The  placenta  was  adherent, 
and  required  the  introduction  of  the  hand  for  its  removal 
Profrise  haemorrhage  followed ;  and,  though  the  usual 
remedies,  including  ergot,  cold  napkins  to  the  vulva^  etc., 
and  introduction  of  the  hands  into  the  uterus,  were  em- 
ployed, t^e  bleeding  continued,  and  the  woman  became 
almost  pulseless,  and  was  eviaently  sinking  fast  The 
hands  in  the  uterus  moved  about  as  if  in  a  wet  bladder, 
little  or  no  contraction  being  excited  by  it  His  friend 
Mr.  Harrison  saw  the  case  with  him,  and  he  proposed  to 
him  to  applv  the  ether-spray  to  the  hypogastric  region. 
This  he  did,  using  the  double  jet;  and  very  fioon  the 
uterus  begsmi  to  contract  and  the  haemorrhage  ceased. 
There  was  no  relaxation  of  the  uterus  afler  ]  and  the 
woman  ultimately  made  a  good  recovery,  though  verjr 
anaemic  for  some  time  after.  The  haemorrhage  was  evi- 
dently due  to  uterine  inertia ;  and  the  effect  of  the  ether- 
spray  in  producing  contraction  of  the  organ  was  very 
marked  sdfter  the  feilure  of  the  remedies  used  before  it 

NoDiTLATBD  ARTERITIS. — MM.  Kussmaul  and  Muer 
describe  a  new  variety  of  arterial  disease,  characterized 
by  circumscribed  thickenings  of  the  walls  of  vessels, 
commencing  with  an  abundant  proliferation  of  the  cells 
of  the  middle  coat  This  nodulated  arteritis  and  the 
muscular  paralysis  which  accompam'es  it  are  altogether 
incurable.  Its  phenomena  are  the  following: — 1.  A 
generid  paralysis  occurs  wrtliout  known  cause,  and  is 
developed  rapidly,  with  fever,  nephritis,  and  violent 
muscukr  pains.  2.  This  is  accompanied  by  a  nodulated 
peri-artentis,  which,  by  interrupting  the  circulation, 
causes  alternate  contractions  and  dilatations  of  the  ves- 
sels. 3.  The  principal  diagnostic  signs  are  the  rapid 
development  of  muscular  palsy  with  loss  of  contracti- 
lity and  intense  pain,  the  nephritis,  the  arteritis^  and  the 
presence  of  small  arterial  nodosities  under  the  skin.  4. 
When  the  disease  affects  the  intestinal  arteries  extensive- 
ly, it  may  cause  the  same  changes  in  the  mucous  mem- 
brane as  are  produced  by  emboUsnL  5.  The  mufdes 
undergo  &tty  degeneration,  but  as  long  as  they  have 
only  partly  lost  contractility  the  j  may  recover.  6.  In 
order  to  restore  contractility  the  i4)plicatjfn  of  induced, 
and  still  better,  of  constant,  currents  is  desirable. — 
Lancet 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


2n 


The  Medical  Eecord. 

^  Snra-Pmit^IS  |mmml  of  |p[tbxtme  uab  Singers. 
Gbobge  p.  Sheadt,  M.D.,  Editob. 


PabUahad  on  th«  lit  and  15tli  of  MMh  Month,  I7 
WILLIAM  WOOD  M  00^  61  Wauob  Btur,  Nbw  Tobx. 


rORJSIQir  AQBNOJS& 


LoinK>y— TsuBiraB  A  Co. 
PAaa~BoMA«oa  'xr  Cib. 


Laipsio— B.  HiBMAinr. 

Bio  Jam kbo— Stephihh  t  Oa. 


New  York,   ^usnst  16,  ISer. 

THE  SCARCITY  OF  WORKINa  MEDICAL  MEN 

IN  AMERICA 
It  is  a  deplorable  fact^  that  we  have  very  few  actual 
working  men  in  our  country.  The  desire  for  large 
practice  has  taken  such  a  possession  of  us  that  we  have 
lost  sight  of  everything  else,  and  like  a  dangerously  &&- 
cinating  whirlpool  it  has  swallowed  up  in  comparative 
oblivion  some  of  the  best  minds  in  the  profession*  A 
distinguished  medical  writer  has  truthfully  said,  that  a 
large  metropolitan  practice  is  the  bane  of  professional 
progresa  To  a  certain  extent,  the  allurements  held  out 
by  a  ^large  business  are  such  as  none  can  altogether 
withstand ;  the  possession  of  a  handsome  brown  stone 
front,  a  splendid  driving  establishment,  and  a  richly  fur- 
nished office,  with  the  attendant  luxuries  that  associate 
themselves  with  a  handsome  living,  are  temptations 
which  Americans  especially  cannot  be  proof  against, 
and  we  are  fast  beginning  to  think  that  such  is  after  all 
the  main  object  to  be  attained.  It  is  true  we  occasion- 
tlly  deplore  the  existence  of  so  few  scientific  observers 
in  our  midst,  but  our  consciences  very  rarely  do  more 
than  temporarily  upbraid  us  for  our  lack  of  enthusiasm  in 
the  prosecution  of  our  studies,  and  we  soon  settle  down 
into  an  apathy  which  is  both  enervating  and  dangerous. 

In  other  countries  this  is  not  so.  There  are  greater 
numbers  to  be  found  in  Europe,  especially,  who  are  con- 
stantly laboring  in  the  cause  of  science,  patient  observ- 
ers, careful  thinkers,  and  sound  students,  who  are  only 
content  when  they  are  enabled  to  add  some  new  fact, 
or  make  some  new  discovery,  which  may  not  only 
benefit  their  race,  but  their  profession.  We  are  often 
led  to  envy  such,  but  we  very  seldom  go  further. 

As  an  evidence  of  the  want  of  interest  in  scientific 
pUTRiits,  we  have  but  to  refer  to  the  paucity  of  com- 
munications of  those  of  our  representative  men  to  the 
columns  of  the  medical  journals,  and  the  small  number  of 
works  that  are  issued  by  the  American  press.  Thertf 
is  some  good  reason  for  this  in  a  want  of  something 
to  say,  and  in  an  absence  of  an  originality  of  thought 
*nd  observation  which  is  always  associated  with  a  lack 
of  study  and  reflection;  but  even  those  who  are  the 


exceptions  to  the  rule,  who  really  labor  for  the  advance- 
ment of  their  calling,  stop  just  ^ort  of  doing  the  most 
good  by  the  publication  of  their  views  to  their  brethren. 
With  a  few  notable  exceptions,  no  standard  works  have 
been  issued  within  the  past  few  years,  comparable  with 
the  amount  of  talent  which  might  be  developed  by 
patient  industry  on  the  part  of  its  possessors^  The 
standard  medical  literature  of  our  country  is  so  deplor- 
ably deficient  that  we  are  still  hanging  to  the  skirts  ol 
transatlantic  authors,  and  refusing  to  help  ourselves 
with  the  abundance  from  our  own  stordiiouses,  and 
develop  a  home  literature  that  would  be  a  credit  to  the 
profession  of  the  Western  Hemisphere.  Our  book 
authorities  can  be  numbered  by  a  dozen  or  two,  and 
this  in  a  country  peculiariy  blessed  with  the  means  of 
most  extended  observation. 

When  a  fresh  graduate  first  embarks  in  business 
he  seems  fiilly  imbued  with  the  idea  thai  ft  life  of  study 
and  hard  work  is  before  him,  and  with  the  best  <^ 
intentions  resohitely  sets  himself  at  it  But  how  soon 
does  he  forget  his  duty  I  His  microscope  is  liable  to 
become  dirty  and  neglected,  his  books  quietly  rest  upon 
his  shelves,  and  every  other  interest  is  lost,  save  that 
which  centres  itself  upon  a  large  and  lucrative  practice. 
If  half  the  work  were  devoted  to  study  which  is  now  be- 
stowed upon  the  hatching  of  a  good  bank  account^  how 
much  better  off  would  be  our  profession,  and  of  how  much 
more  service  we  might  be  to  humanity!  The  main 
trouble  is,  that  we  are  not  content  with  a  Uvelihood, 
but  must  aim  for  fortunes,  and  really  degrade  our  pro- 
fession to  the  merest  trade.  A  physician's  actual  worth 
is  not  now  measured  so  much  by  his  skill  as  the  ex- 
tent of  his  business,  and  bewildered  with  the  hope  for  a 
like  success,  too  many  are  greedily  following  in  his 
footsteps. 

We  contend  that  no  amount  of  business  should  deter 
any  medical  man  firom  continuing  his  studies,  and  with 
the  really  industrious  man  it  does  not  We  know  of  a 
few,  who,  although  in  extensive  business,  can  always 
find  time  and  opportunity  to  unravel  the  mysteries 
connected  with  a  post-mortem  examination,  and  even 
search  up  the  literature  of  any  particular  subg'ect  c(mi- 
nected  with  a  case  under  investigation ;  and  of  others^ 
unluckily  greatly  in  the  minority,  who  devote  the  early 
morning  hours  to  reading  and  research,  who  never 
neglect  to  record  their  oases  as  they  occur,  and  who 
take  every  pains  to  inform  themselves  of  what  is  going 
on  around  them,  and  who  are  in  reality  the  thinking, 
progressive,  and  original  men  in  our  ranks.  It  is  not 
expected  that  every  one  will  be  an  originator ;  but  if  he 
cannot  lend  a  helping  hand  himself  in  developing  the 
resources  <^  our  art,  it  is  his  bounden  duty  to  keep 
himself  at  least  informed  of  the  doings  of  others,  and 
take  every  advantage  which  experience  and  observa- 
tion can  give.  But  so  seldom  is  this  done  that 
the  performance  of  such  a  duty  is  an  exception  to  the 
rule.  We  have  known  physicians  who  have  allow- 
ed books  upon  subjects  whidi  should  materially  mteiv 

Digitized  by  VjOOQIC 


278 


THE  MEDICAL  RECORD. 


est  them,  to  remain  for  months  upon  their  tables  with- 
out the  leaves  being  cut,  and  journals  to  lie  pfled  in  the 
comers  of  their  rooms  not  even  divested  of  their  wrap- 
pers. This,  we  will  admit,  is  an  extreme  case,  but  a 
great  majority  of  our  practising  physicians  do  not  do 
much  more. 

In  times  gone  by  the  actual  making  of  money  was 
considered  as  secondary  to  the  study  of  disease  and  its 
phenomena;  there  was  that  ardent  desire  for  advance- 
ment and  discovery,  which  centred  itself  in  the  re- 
nowned John  Hunter,  who,  when  disturbed  in  the  midst 
of  his  experiments  by  a  patient,  only  reluctantly  left 
his  subject,  because  he  thought  his  family  might  have  a 
use  for  the  guinea  on  the  morrow.  There  are  too  few 
who  practise  on  such  a  principle,  too  few  who  would 
develop  such  a  relish  for  improvement  as  would  enable 
them  thus  profitably  to  fill  in  their  spare  hours. 

It  is  shameful,  too,  to  notice  what  a  small  amount  of 
work  is  done  in  our  large  societies.  We  might  instance 
that  of  the  American  Medical  Association  as  a  strik- 
ing example.  Year  after  year  conmiittees  specially 
appointed  to  report  on  difierent  subjects  fail  to  make 
any  reply ;  and  the  majority  of  their  members,  although 
appointed  with  reference  to  their  qualifications  for  the 
task,  do  not  care  even  to  offer  a  reasonable  excuse  for 
the  non-perfoimance  of  a  duty.  Then  again  the  com- 
paratively small  number  of  competitors  for  the  prizes  is 
another  indication  of  the  growing  indisposition  to  do 
anything  more  than  the  mere  attendance  upon  their 
patients  involves. 

We  are  not  led  to  make  these  remarks  in  the  hope 
that  we  can  offer  any  particular  remedy  for  the  evil, 
but  merely  to  allude  to  its  existence  as  an  explanation 
for  the  paucity  of  standard  works  among  us,  the  small 
number  of  illustrious  names,  the  almost  total  absence  of 
original  observations  compared  with  what  has  been 
done,  and  is  being  done  elsewhere. 

The  recent  discussion  concerning  the  status  of 
female  physicians  which  took  place  before  a  meeting 
of  the  Philadelphia  County  Medical  Society,  and  was 
published  in  our  columns,  has  given  our  readers  an 
idea  of  the  estimation  in  which  these  doctresses  are 
held  by  our  neighbors.  Shortly  after  the  report  of 
the  same  meeting  appeared  in  the  Philadelphia  Re- 
poritr^  that  journal  was  favored  with  a  communication 
from  a  correspondent  signing  herself  Ann  Preston, 
M.D.,  in  which  she  took  occasion  to  defend  the 
position  of  ftmale  doctors  in  a  manner  more  vehement 
than  logical  In  the  same  journal  appears  an  answer 
to  the  aforesaid  letter,  in  the  shape  of  a  communication 
fit)m  J.  W.  Sherry,  of  Brooklyn,  N.  Y.,  which  is  so 
much  to  the  point  that  we  cannot  forbear  placing  the 
bulk  of  it  before  our  readers.  The  principal  part  of 
the  letter  is  made  up  of  a  aeries  of  questions  pro- 
pounded to  the  fair  defender  of  women's  rights  in  me- 
dicine.   Here  are  some  of  them : 

When  OQHiuUation  is  granted,  are  women  to  be  ad- 


mitted to  all  professional  meetings :  such  as  medical 
societies,  medical  conventions,  medical  quizzes,  etc., 
etc.,  just  as  far  as  their  "  mentai  cravings  "  may  prompt 
them  to  ask  ? 

Does  the  authoress  approve  of  women  and  men  study- 
ing anatomy  over  the  same  dead  suHect— dissecting  in 
company  the  male  or  female  cadaver  ? 

Does  this  lady  approve  of  young  women  walking  the 
hospitals  with  young  men,  the  medical,  and  more  espe- 
cially the  aurgicdl  wards  ? 

Does  she  declare  that  it  is  proper  and  becoming  for 
young  women  to  witness  any  or  all  operations  in  the 
amphitheatres  of  hospitals,  crowded  with  men  ^^  from 
pit  to  dome  ?  " 

Does  she  daim  that  surgery  is  a  legitimate  field  of 
study  for  women  ? 

If  so^  would  she  perform  an  operation  for  phymosis, 
fistula  in  ano,  or  calculus;  or  use  the  catheter  on 
the  male  patient?  Should  any  woman  do  these?  Wo- 
men can  be  found  who  can  perform  such  operations. 
Should  they  ?  "  To  this  complexion  must  we  come  at 
last?" 

Some  twenty  ladies  presented  themselves  at  a  surgi- 
cal clinic  and  lecture  m  one  of  the  New  York  Hospi- 
tals. The  surgeon  announced  that  the  subject  would 
be  hernia;  and,  not  v^ishing  to  shock  the  delicacy 
of  the  fair  auditors,  he  suggested  the  propriety  of 
their  withdrawal.  Several  hundred  young  men  were 
present,  and  he  thought  it  unfitting  tiiat  the  young  la- 
dies should  remain.  They  did  not  retire,  but  occupied 
the  nearest  seat,  while  eighteen  male  patients  were  ex- 
hibited, necessarily  in  a  state  of  NUDrrr. 

Does  Akn  Preston,  MD.,  endorse  the  course  of  the 
young  ladies  f 

At  another  hospital,  lithotomy  was  to  be  performed 
on  a  man.  Eight  members  of  "  the  little  band  of  true- 
hearted  women,  just  entering  the  medical  profession," 
appeared  to  witness  it.  The  surgeon,  from  motives  of 
delicacy,  asked  them  to  retire,  and  he  sat  down  to 
await  the  result.  But  they  moved  not.  He  thereupon 
announced  that  if  they  did  not  withdraw,  the  operation 
would  be  postponed,  or  done  privately.  Then,  they 
left.  Does  Ann  Preston,  M.D.,  msist  they  should  have 
remained,  and  that  the  surgeon  should  have  surmounted 
his  modesty,  and  have  proceeded  with  the  exhibition 
without  a  protest  ? 

When  women  have  fully  attamed  their  so-called 
^^right^*  to  practise  medicine  on  an  equal  footing  with 
men,  does  Ann  Preston,  MD.,  assume  that  they  shall 
treat  any  and  all  diseases  that  "  our  flesh  is  heir  to  ?  " 
Shall  they,  in  the  male,  treat  gonorrhoea,  syphilis,  stric- 
ture, enlarged  prostate,  and  spermatorrhoea? 

ShaU  women  handle  the  genitals  of  men,  apply  es- 
charotics  to  chancres,  introduce  the  urethroscope,  exa- 
mine with  digit  in  ano  the  prostate  to  find  out  its  con- 
dition, etc.,  etc.,  ad  infinitum^  disgustam,  nauseam  f 
Is  it  to  such  a  field  that  lady  practitioners  claim  a 
right?  And  if  so,  t«  it  strange  that  the  medical  pro- 
fession so  generally  oppose  this  "great  movement,** 
this  "evidence  of  the  advancing  civilization  of  the 
dav,**  this  "  revolution  that  is  never  to  go  backwards  ?  " 

Though  the  writer  may  feel  that  she  and  her  "  little 
band  of  true-hearted  women  **  are  called  to  do  this 
work,  though  she  may  "  appeal  to  heaven  to  witness 
the  justice  of  her  cause,"  though  she  may  say  that 
she  "  will  settle  the  question  with  her  God  ;  '*  yet  there 
%re  men  and  women,  the  best  and  purest,  the  most 
thoughtful  and  liberal,  who  cannot  agree  with  her. 
Great  names  and  good  ones  may  lend  their  influence  to 
this  "movement,**  and  it  may  be  claimed  that  the 
moral  sense  of  the  community  sustains  it,  "  but  there 
are  those  who  fail  to  recognise  the  appropriateness  of 


Digitized  by 


Google 


THE  MEDICAI  RECORD. 


219 


vomen  entering  an  arena  containinjr  so  many  repulsive 
features,  "  ao  many  forbidding  conditions." 


I.  Cholera,  as  it  appeared  in  Nashville  (Tenn.),  in  1849, 

1850,   1854,   and  1866.      By  Wm.  K.  Bowung,  M.D., 

1866.     8va,  pp.  27. 
XL  Rbpobt  to  thb  International  Sanitary  Conference 

of  a  Commisaion  from  that  Body,  on  the  Origin,  Endemi- 

city,  Tranemissibility,  and  Propagation  of  Asiatic  Cholera. 

Translated  by  Samuel  L.  Abbot,  M.D.    8vo.,  pp.  104. 

BoatOD,  1867. 
m.  Cibcular,  No.  V.,  "War  Department,  Subgeon-Gbn- 

eral's  Office,  Mat  4th,  1867.    Report  on  Epidemic 

Cholera.    4to.,  pp.  65. 
IV.  Report  of  Citt  Physician  for  the  Year  ending 

April  1,  1867.    Boston,  1867.    8vo.,  pp.  152. 

L  Works  on  cholera  still  continue  to  make  their  ap- 
pearance. There  is  little  doubt  that  the  disease  will  re- 
^>pear  the  present  summer  in  many  of  its  old  haunts ; 
and  indeed,  while  we  write;  we  hear  of  its  fatal  pre- 
vtlence  at  Fort  Harker,  Kansas,  among  the  United 
States  soldiers,  as  well  as  among  civilians  in  the  neigh- 
boring villages,  also  in  many  other  parrs  of  the  country. 
If  we  are  not  mistaken,  it  is  destined  to  take  a  wider 
sweep  the  present  season  than  the  last.  But  it  is 
consolatory  to  know  that  we  are  far  better  prepared  to 
meet  it,  and  successfully  resist  its  progress.  The 
pamphlet  of  Professor  Bowling,  §f  Nashville,  contains 
some  interesting  facts,  combined  with  some  specula- 
tions ;  but  we  look  in  vain  for  any  very  accurate  statis- 
tics in  regard  to  the  disease  in  any  of  the  years  men- 
tioned. We  are  .told  that  "from  tjbe  9th  of  June  until 
the  1st  of  August^  1850,  it  is  probable  600  persons 
perished  in  Neville  and  its  suburbs  from  cholera;" 
ako,  that  "  there  could  not  have  been  less  than  5000 
case*,  in  a  population  of  about  20,000,  of  which  500 
proved  fatal."  No  very  reliable  record,  however, 
seems  to  have  been  kept,  nor  any  minute  and  accurate 
observations  made ;  not  a  single  poat-mortem  is  recorded. 
We  cannot  speak  highly  either  of  the  treatment  which 
is  pronounced  to  have  been  the  most  successful,  viz. 
"4  gre.  opium,  to  five  of  calomel,"  after  each  liquid 
evaeuaUon."  This  treatment  is  declared  to  have  suc- 
ceeded^ "except  among  fruit  and  vegetable  eaters, 
where  it  produced  "  Uttle  or  no  effect."  Ice  eaten  ad 
Ubitum,  is  stated  to  have  best  succeeded  "  in  allaying 
thirst,  eastric  distress,  and  vomiting."  In  1854,  in 
May,  June,  and  July,  to  the  11th  inclusive,  it  is  stated, 
there  were  88  cases  of  interments  from  deaths  of 
cholera  in  south  Nashville  and  suburbs,  including  a 
population  of  about  30,000,  "  a  large  majority  being 
among  negroes  and  children."  The  drinking  water  was 
from  wells,  and  contained  much  lime.  In  other  parts 
of  the  city  hydrant  water  was  chiefly  uf»ed.  The 
generalizations  of  Pro£  B.  would  seem  to  be  rather 
surmises,  or  hypotheses,  than  conclusions  legitimately 
drawn  from  well  established  facts.  For  example,  in 
the  way  of  food,  he  would  forbid,  "  every  description 
o/firuit,  non-cereal  vegetables,  and  animal  prodttctSj  as 
mZI;  and  eggs"  Bread  is  sdlowed:  also,  good  beef, 
matton,  chicken,  ham,  bacon,  crackers,  dry-toast, 
bacait,  plain  corn-bread,  tea  and  coffee.  If  persons 
living  on  such  a  diet^  are  attacked  with  cholera.  "  the 
system  responds  instantly  to  medicine,"  while  it  is 
ttid,  the  contrary  is  the  case  with  the  vegetable-eater. 
Crade,  green,  and  stale  vegetables  are,  no  doubt, 
ttnhealthy  food  in  places  where  cholera  prevails,  and  so 
Are  fresh  ripe  frriita  and  vegetables,  taken  in  excess ; 


but  there  is  no  proof  on  record  that  goes  to  show  that 
either  of  the  latter  t^en  in  moderation  will  either 
excite  an  attack  of  cholera  or  necessarily  insure  a  fatal 
result.  In  1866,  there  seem  to  have  been,  as  in 
former  years,  no  very  accurate  records  of  cases  of 
deaths  from  cholera,  though  Prof.  B.  estimates  the 
latter  at  1000  souls.  " The  cholera  was  twice  as  fatil 
here  as  in  the  great  visitation  of  1850."  The  daily 
number  of  deaths  reached  as  high  as  70.  It  is  to  be 
hoped,  since  the  able  Prof.  Joseph  Jones,  M.D.,  is 
Health  Officer  of  Nashville,  we  shall  have  correct 
mortuary  tables  of  that  city — as  well  as  some  other 
much  needed  municipal  reforms.  As  3000  dollars  were 
expended  for  coffins  tor  "  cholera  paupers,"  it  is  evident 
the  mortality  among  that  class  must  have  been  great 
Two  and  a  half  per  cent,  only,  of  the  population  are 
stated  to  have  died  of  the  malady;  no  excessive  mor- 
tality certainly.  The  large  mortality  on  Blackwell's 
Island,  123  out  of  800,  is  attributed  by  Dr.  B.  to  the 
"  free  use  of  vegetables  in  a  cholera  atmosphere."  "  It 
is  our  dehberate  opinion,"  says  Prof.  Bowling,  "  that 
if  this  rule  is  religiousljr  observed "  (abstinence  from 
vegetables),  "  cholera,  if  it  occur,  is  so  shorn  of  its 
midignity,  as  to  make  it  incapable  of  destroying  life  in 
the  absence  of  doctors." 

In  1833, 174  died  of  cholera  in  Nashville  (so  stated) ; 
in  1835,  66;  in  1849,  311;  m  1850,  316;  in  1854,  88; 
in  1866,  800.  "  The  Board  of  Health,"  it  is  said,  "  did 
all  they  could  to  bring  fully  before  the  people,  the  facts 
of  the  entire  case  1"  But  something  more,  we  think,  is 
necessary ;  not  a  word  about  the  use  of  disinfectants, 
cleansing  of  streets,  houses,  lanes,  alleys,  etc. :  only 
"hydrant  water  was  given  to  any  amount,"  and  *  medi- 
cines fiimished  gratis  by  certain  first-class  apothe- 
caries 1"  The  pamphlet  closes  with  a  very  valuable 
letter  from  Prof.  Jones  from  N.  Y.,  giving  the  results 
of  the  experience  of  the  "Metropolitan  Board  of 
Healtii "  of  N.  Y.,  in  regard  to  the  use  of  disinfectants 
in  checking  the  progress  of  the  malady,  and  also  as  to 
tiie  treatment. 

n.  The. Report  of  the  International  Sanitary  Con- 
ference which  met  at  Constantinople  in  May,  1866,  is 
already  widely  known  to  our  readers,  through  ab- 
stracts already  made  in  our  pages.  It  has  generally 
been  acknowledged  to  be  the  most  important  and 
authoritative  document  on  Asiatic  cholera  that  has  ever 
been  published,  and  as  such  is  worthy  of  the  careftil 
consideration  or  all  municipal  governments  and  mem- 
bers of  the  medical  profession.  It  takes  the  most 
decided  ground  in  favor  of  the  doctrine  of  the  com- 
municability  of  cholera,  of  its  progress  from  place  to 
place  solely  by  human  agency,  of  the  importance  of 
restrictive  measures  to  check  free  communication 
during  cholera  epidemics  with  infected  districts,  and  of 
controlling  the  disease  in  its  natural  home.  It  is  true, 
that  many,  who  had  olosely  studied  the  last  irrup- 
tion of  Asiatic  cholera  into  Europe  fit)m  the  East,  and 
noticed  how  closely  it  followed  the  course  of  travel 
from  that  quarter,  how  its  introduction  into  different 
places,  before  unaffected,  was  distinctly  traceable  to 
infection,  by  the  importation  of  cholera  patients,  had 
become  fully  impressed  witJi  a  belief  of  its  infectious 
character,  long  before  it  made  its  appearance  on  board 
immigrant  vessels  in  the  port  of  New  York  in  the  fall 
of  1865.  Hence  the  Metropohtan  Board  of  New  York, 
with  wise  apd  inteUigent  foresight,  adopted  measures  to 
exclude  the  disease  nrom  the  city  by  a  rigid  system  of 
Quarantine,  which,  though  successful  for  more  than  six 
months — during  which  the  disea-e  was  confined  to 
vessels  in  the  lower  bay — ^yet  eventually  proved  of  no 
avail,  owbig  to  the  want  of  suitable  places  for  detention 
and  classification  of  emigrant  passengers  on  land^ndi 


2B0 


THE  MEDIOAL  RECORD. 


ftlso,  a  relaxation  of  measures  as  regarded  the  intro- 
duction of  persons  into  the  city  laboring  under  choleraic 
diarrhoea,  through  whom,  there  can  be  little  doubt, 
the  disease  was  propagated  to  places  where  it  subse- 
quently appeared  Tins  most  important  fact  has  now 
been  mllj  demonstrated;  for  the  malady  has  been 
traced  step  by  step,  wherever  it  has  appeared,  and  in 
every  instance,  it  nas  been  proved  to  have  been  con- 
veyed through  human  interoourse.  This  was  indeed 
sufficiently  evident  from  facts  in  the  history  of  former 
epidemics  of  cholera;  but  the  old,  obsolete,  unphiloao- 
phical  doctrines  of  aimotpheine  ctyniaTrdnaUon  and  epi- 
demic eomtituUon  of  the  (dr  had  taken  such  complete 
possession  of  the  minds  of  the  profession,  that  it  was 
next  to  impossible  to  eradicate  them.  Even  our 
teachers  of  medidne  were  so  enslaved  by  these  old 
hypotheses,  that  they  were  unwilling  to  admit  the  most 
obvious  facts  wbiBU  placed  before  &em.  Their  minds 
seemed  not  only  befogged,  but  thev  clung  to  their  delu- 
sions with  a  tenacity  which  nothmg  could  weaken  or 
destroy ;  and  even  now,  instead  of  candidly  admitting 
they  were  mistaken,  and  retracting  what  they  had  put 
forth  on  the  subject^  they  continue  to  reiterate  their 
exploded  doctrines,  though  ^e  whole  medical  world 
has  rejected  them. 

Our  limits  will  not  permit  any  extended  notice  of 
this  pamphlet  of  108  pages;  and  we  must,  therefore, 
refer  the  reader  to  it  as  the  most  valuable  document 
which  has  ev^  appeared  on  the  subject.  There  is  one 
question,  however,  discussed,  which  is  so  important  as 
bearing  on  the  question  of  quarantine,  that  it  deserves 
special  notice.  It  is  this :  "Are  there  conclusive  &cte 
which  f(»rce  us  to  admit  that  cholera  can  propagate 
itself  to  a  distance  by  certain  states  of  the  atmosphere, 
by  'winds,  or  by  any  other  similar  change  or  modifica- 
tion of  the  surrounding  mediums  ?  " 

As  it  has  been  abundantly  demonstrated  that  epide- 
mic cholera  has  never  been  developed  spontaneously 
outside  of  India,  it  is  unnecessary  to  discuss  the  ques- 
tion whether  certain  states  of  the  soil,  or  certain  hy- 
gienic condition^,  can  ^ve  rise  to  the  disease  (though 
uiey  may  favor  its  epidemic  prevalence).  The  most 
important  question  connected  with  it  is,  whether  it 
can  be  transported  to  a  distance  by  a  contaminated  at- 
mosphere ;  in  other  words,  whether  the  cholera  virus 
'  can  be  carried  to  a  distance  by  winds,  and  thus  be 
propagated  ?  If  so,  then,  quarantine  restrictions  must 
necessarily  be  of  very  questionable  efficacy.  The  fol- 
lowing quotation  from  the  Beport  of  the  Convention 
shows  their  opinion  regarding  this  point:  "  To  prove 
that  cholera  may  be  propagated  by  the  atmosphere 
beyond  a  certain  distance,  we  need  at  least  one  con- 
clusive &uot:  that  is  to  say,  one  whidi  establishes  the 
paemxge  of  ihe  dieease  from  an  infected  phce  to  a  JieaUhy 
one  tnthimt  any  poae&le  previoue  eovnmunicaUon.  Now 
this  &ct  does  not  exist  in  science :  and  the  Ck>mmission 
has  been  able  to  satisfy  itself  of  the  frivolousness  of  all 
the  assertions  which  have  been  made  of  this  kind." 
Again,  ^.Undoubtedly,  it  has  not  always  been  possible 
to  dehionstrate  the  previous  communication  between 
an  infected  place  and  one  subsequently  infected ;  but 
wherever  the  inc^uiry  has  been  made  with  care,  and 
where  the  conditions  of  the  locality  admitted  of  a  veri- 
fication, this  previous  commimication  has  been  estab- 
lidied."  Agiun,  "  It  is  a  law,  up  to  the  present  time 
without  exception,  that  cholera  has  never  advanced 
more  rapidly  than  man  in  his  migrations." — (p.  40.) 

There  is  another  very  important  pointy  as  the  Com- 
mission state.  An  arrival  of  cholera  at  a  port  is  a  c<Hnplex 
a£^,  comprehending  man  and  all  that  directly  belongs 
to  him:  his  baggage,  his  effects,  his  merchandise,  his 
animals,  the  ship  wmoh  brings  hiTn^  in  fbxA  everytning 


T^hich  accompanies  him ;  and,  as  cholera  is  transmissible 
by  such  means,  a  long  voyage  without  any  outbreak  of 
the  disease,  or  any  apprecialne  symptoms,  is  no  security 
against  danger.  The  present  ruU,  therefore,  that  %f 
emigrant  vessels  coming  from  places  where  cholera  pre- 
vaUs^  have  had  no  cholera  cases  on  hoard  since  they  left 
an  infected  portj  they  are^  therefore,  to  he  regarded  as 
safe,  and  the  passengers  with  their  effects  landed,  and  go 
where  they  please,  is  an  imsafe  rule,  and  shoidd  he  change 
ed.  On  the  contrary,  according  to  the  Commission, 
the  rule  should  be,  to  consider  every  such  arrival  as 
suspected,  and  place  both  ship  and  passengers  under 
proper  restrictions.  We  call  the  attention  of  Health 
officers  particularly  to  this  point 

In  connexion  with  this  pamphlet,  it  may  be  well  to 
call  attention  to  the  conclusions  of  the  "  Cholera  Con- 
ference "  that  recently  met  at  the  City  of  Weimar,  in 
Germany,  composed  of  the  most  distinguished  sanita- 
rians of  Europe;  we  present  this  in  the  form  of 
a  synopsis,  drawn  up  by  the  Renstrar  of  the 
"  Metropolitan  Board  of  Health."  Dr.  Harris,  as  con- 
taining the  latest  and  most  autnentic  conclusions  on 
the  subject : 
"  lb  the  President  Metropolitan  Board  of  Health. 

"  Dear  Sir — Having  been  favored  with  an  abstract  of 
the  discussions  and  concluding  recommendations  of  the 
Cholera  Conference  that  recen%  met  at  the  city  of 
Weimar,  and  having  learned  from  ProC  Pettenkofer 
that  the  fuU  stenographic  report  of  the  Conference  will 
be  pubUshed  at  Leipac  during  the  summer,  I  now  lay 
before  the  Board  of  Health  a  synopsis  of  the  discussions, 
and  their  conclusions  %8  given  in  this  abstract. 

"  You  will  recollect  the  polite  invitation  that  was  ex- 
tended to  New  York  to  be  represented  at  that  impor- 
tant meeting.  It  turned  out  to  be  precisely  such  a 
Conference  as  the  interests  of  public  hygiene  required, 
for  the  most  practical  and  comprehensive  questions 
were  discussed  by  the  leading  sanitary  scholars  of 
Europe,  nearly  sixty  delegates  being  present.  The  fol- 
lowing conclusions  were  adopted,  and  I  beg  leave  to 
present  them  here  before  giving  the  synopsis  of  the 
debates  of  the  Conference. 

"conclusions    ANn    RECOMMENDATIONS. 

"  I.  The  Conference  expresses  as  its  dehberate  con- 
viction that  the  efforts  to  arrest  and  prevent  cholera  by 
disinfectants  should  be  continued  in  the  most  energetic 
manner. 

"11.  Disinfection  will  be  entirely  successful  only  where 
excremental  matters  are  carefuUy  gathered  and  kept 
from  being  cast,  about;  when  attention  is  given  to 
cleanliness,  and  the  means  of  health ;  and  when  the 
disinfection  is  performed  by  sanitary  authorities  in  a 
compulsory  manner. 

"  jtlL  In  places  where  the  entire  locality  or  district 
cannot  be  at  once  disinfected,  it  is  advisable  to  disin- 
fect throughout  the  places  visited  by  the  previous 
epidemics  of  cholera. 

"  IV.  The  general  disinfection  should  be  perform  ed  at 
the  proper  time,  that  i^  before  the  epidemic  is  actually 
prevalent  in  town  or  place.  Every  house  or  spot  that 
becomes  infected,  or  is  suspected  to  be  so.  must  be 
kept  constantly  under  the  influence  of  disinfection. 

"  y.  In  regard  to  the  best  substances  as  disinfectants, 
though  the  testing  of  various  articles  is  not  yet  com- 
pleted, there  have  been  found,  to  the  present  time,  no 
more  effectual  substances  than  sulphate  pf  iron  (copper- 
as) and  the  carbolic  acid ;  and,  as  experience  proves,  we 
have  no  other  disinfectants  that  can  be  employed  with 
greater  facility.  A  combination  of  both  these  disin- 
fectants is  therefore  recommended. 

'^  YL  The  dismfectaon  of  clotluzxg  that  has  become 


igitized  by  VjOO^_ 


THE  MEDICAL  RECOBD. 


281 


infected  by  cholera  excrement  is  e^eoially  an  important 
matter.  For  that  purpose  the  Conference  recommends 
that  all  such  clothing  be  disinfected  by  boiling  in  water, 
or  by  chemical  treatment  in  a  proper  solution  of  "  zinc 
Titriol"  (sulphate  of  chloride  of  zinc^ ;  and  the  CJonfer- 
enoe  also  reconmiends  that  special  arrangements  be 
made  by  which  disinfection  can  be  employed  in  all 
places,  and  at  any  hour,  among  or  for  the  poor. 

^  y IL  For  the  disinfection  of  sewers  and  drains,  the 
Conference  advises  the  trial  of  Mr.  Sauvren's  metiiod. 
fPhe  means  used  by  Mr.  Sauvren  are  not  yet  fully  pub- 
lished, but  they  are  believed  to  be  similar  to  McDou- 
gall's — namelj^,  a  combination  of  carbolic  or  coal  tar 
preparations,  in  a  cheap  form.) 

"  VlLL  Ii  cholera  infects  any  house  or  spot,  it  is  re- 
commended that,  if  practicable,  the  house  so  situated 
m  an  infected  place,  or  beinff  infected,  should  be  va^ 
eated,  and  the  inhabitants  &ould  be  removed  from 
the  infected  spot  ' 

"  IX.  It  is  especially  recommended  that  the  ground- 
water (that  is.  the  water  in  the  gromid)  about  dweUing- 
hooses,  and  all  the  grounds  about  habitations  of  every 
kind,  should  be  preserved  undefiled  by  any  excremental 
matter  of  cholera ;  also,  that  all  drinking  water  be  un- 
defiled  and  pure,  and  that  where  no  pure  water  can  be 
had,  the  water  which  must  be  used  should  be  dis- 
infected by  boiling. 

"  Such  were  the  final  conclusions  of  the  Conference  in 
reference  to  the  first  duties  of  sanitary  authorities  and 
the  people  of  any  town  that  is  threatened  b^  cholera* 
The  discussions  were  based  upon  the  ezpenence  and 
studies  of  the  distinguished  gentiemen  who  had  thus 
agreed  to  meet  and  compare  their  views,  and  the  re- 
sults of  their  observations.     The  attendants  at  the 
Conference  were  from  various  cities  of  Germany,  Hol- 
Imd,  Prussia,  Austria,  Hungary,  and  Bussia.    The  his- 
tory of  cholera  outbreaks  among  the  troops  in  the  war 
last  year  proved  marvellously  interesting,  and  conclu- 
sive on  many  points.    Next  in  order  of  interest  and 
importance  was  the  history  of  infection  by  means  of 
water  contaminated  by  cholera  exerement    Closely  al- 
lied to  the  latter  subject  was  the  examination  of  evidence 
concerning  the  discoveries  that  have  been  made  in 
rmrd  to  the  particular  means  by  which  the  cholera 
inrection  is  transported  and  propagated.    Lastiy,  and 
most  practically  useful,  was  me  examination  of  evi- 
dences concerning  the  proper  and  best  methods  of  disin- 
fection, and  the  relations  of  such  means  to  the  control 
and  promotion  of  diolera  epidemics.    The  chief  me- 
dical officer  to  the  Privy  Council  of  Great  Britain 
presented  the  history  of  the  outbreaks  of  cholera  in 
London  in  connexion  with  the  water  of  the  East 
London  Water  Compuiy.  which,  as  Dr.  Raddiffe  has 
shown,  was  contaminated  by  cholera  excrement    In 
the  district  where  tiiat  water  was  used  the  epidemic 
burst  forth  as  by  explosion;    while,  subsequently, 
in  other  places  it  spread  by  the  more  usual  metiio<is, 
and  in  the  more  usual  manner.     Then,  again,  there 
were  other  instances  where  the  epidemic  spared  all 
persons  in  certain  asylums  and  hospitals  who  used 
privies  that  were  entirely  uncontaminated  by  cholera 
excrement^  while  the  epidemic  decimated  the  classes 
of  inmates  that  used  the  latter.    The  Conference  con- 
ceded that  wells  and  reservoirs  of  drinking  water  were 
frequentij  contaminated  by  the  cholera  poison,  by 
soakage  into  them  of  the  infectious  element  firom  the 
dbotora  stools;    but  Profe.  Pettenkofer,  Wanderlich, 
Simon,  and  others,  agreed  that  drinking  water  was  not 
the  most  universally  common  means  of  communicating 
dH)lera  to  man.    The  influence  of  ground  moisture,  or 
men  precisely  of  the  ordinary  ground-water,  wnile 
sodi  water  or  moisture  is  receding  by  drying  of  the 


ground  after  a  wet  period,  was  proved  by  such  as 
daily  used  the  same  well  water,  Imt  who  used  different 
privies,  and  frequented  different  and  well  separated 
yards,  as  we  saw  the  same  fact  illustrated  in  two  adja- 
cent pavilions  on  Blackwell*s  Island  last  summer.  The 
influence  of  different  kinds  of  grounds  in  receiving  and 
propagating  the  epidemic  virus  of  cholera  was  exam- 
med,  and  Dr.  Pfeiffen  of  Vienna,  showed  the  curious 
course  which  the  epidemic  pursued  in  passing  through 
tbe  great  forest  country  of  Thuringen  last  year; 
while  the  delegates  from  Dresden  and  some  other 
places  showed  what  conditions  of  the  earth  had  per- 
mitted and  favored  the  spread  of  cholera  on  their  soil 
that  covered  certain  granite  rook  districts.  The  out- 
breaks on  Blackwell*s  Island  and  the  rocky  summit  of 
Hudson  City,  fully  bear  out  the  conclusions  of  the  Con- 
ference on  tne  subject  of  cholera  epidemics  on  rocky 
surfaces,  and  do  not  disprove  the  agency  of  the  sur&ce 
soil  in  propagating  the  virus  when  planted  in  such 

E laces.  Examining  the  great  mass  of  facts  presented 
y  the  members  of  the  Conference  in  regard  to  influ- 
ence of  the  ground,  and  its  retentiveness  of  undrained 
water,  or  being  porous,  and  at  times  saturated  and 
again  undergoing  a  course  of  drying  by  evaporation,  the 
more  important  conclusions  seem  to  be  as  follows : 

'^  1.  That  porous  soils^  and  any  kind  of  earth  that 
retains  and  &vors  the  ordmary  kinds  of  fermenting  filth, 
will  readily  retain  and  repropagate  the  virus-of  (m^lera 
when  once  the  germinal  virus  has  been  introduced 
or  planted  by  persons  coming  from  infected  {daces. 
That  the  mere  altitude  of  a  place  is  not  the  question 
that  determines  its  susceptibdity  to  cholera ;  that  the 
moisture  (ground-water),  and  the  fluctuations  of  that 
moisture  in  a  soil  by  rising  and  receding  (drying),  fa- 
vors tiie  propagation  of  cholera ;  that  a  sewer  or  drain* 
may  become  the  chief  source  of  infection  to  some  places 
where  is  no  soil,  or  where  the  ground  and  everything 
except  the  sewers  and  drains  have  been  disinfected. 

"2.  That  Prof  Pettenkofer'su^  of  the  term  ground- 
water should  be  understood,  as  he  intended,  to  mean 
the  standard  of  saturation  by  moisture  in  the  soil,  and 
that  grounds  which,  upon  their  surface  appear  to  be 
high  and  dry,  may,  nevertiieless,  be  saturated  with 
moisture ;  that  is,  nave  an  excess  of  ground-water  (or 
high  ground-water) ;  and  that  the  sanitary  drainage  and 
diying  which  are  necessary  to  protect  a  soil  against  re- 
propagating  tiie  planted  virus  or  germs  of  cholera  must 
be  deep  and  thorough.  The  history  and  topography 
of  the  cholera  fields  of  Halle,  Berlin,  Zwickau,  Thur- 
ingen, Helsingfors,  and  St  Petersburg,  supplied  admir- 
able proofe  of  this  great  doctrine  in  sanitary  dridnage. 

*'3.  G'ood  proo&  were  adduced  that  there  are  some 
kinds  of  soil  that  seem  to  be  natural  disinfectants  of 
cholera  virus,  and  upon  which  an  epidemic  cannot  spread 
except  in  filthy  houses,  sewers,  Ao,  We  have  not  time 
to  make  the  abstract  of  the  facts  that  wiU  illustrate  the 
true  theory  of  this  kind  of  exemption.  We  can  say. 
however,  that  it  is  plainly  important  that  regard  should 
be  given  to  the  kinds  of  earth  and  materiala  used  for 
filling  up  sunken  lots,  and  that  even  the  location  of 
dwelling-places  may  sometimes  be  wisely  a  matter  of 
choice  as  regards  the  nature  of  the  soil. 

"  The  &cts  concerning  specific  disinfection  to  destroy 
both  the  cholera  virus  and  all  susceptibility  to  material 
for  its  recoropagation  in  a  house  or  a  district  were  well 
discussed  in  the  Conference.  The  negative  facts  were 
specially  important,  for  they  showed  that  in  a  few  places, 
as  in  the  great  prison  at  Halle,  the  epidemic  swept  for* 
ward  regardless  of  the  pre^ous  and  continued  disinfec- 
tion of  the  grounds  and  nuisances  with  sulphate  of 
iron.  But  in  those  instances  it  was  proved  that  the 
sewers  and  ^ains  were  not  disinfected,  and  that  not 


282 


THE  MEDICAL  RECORD. 


only  were  the  infected  spots  particularly  exposed  to, 
and  connected  with  such  drains  and  sewers,  but  that 
the  copperas  solution  had  been  relied  upon  without 
admixture  with  carbolic  add,  and  the  powerful  antisep- 
tic agents  which  coal-tar  contains.  In  Berlin  there 
was  great  success  in  the  use  of  permanganate  of  soda, 
with  sulphuric  acid  added — that  is,  the  success  was 
achieved  by  the  most  rapid  and  powerful  oxidization, 
in  the  same  manner  as  we  last  summer  disinfected  the 
defiled  clothing  and  bedding  of  the  cholera  s'ck  by 
means  of  permanganate  of  potassa.  The  expensive- 
ness  of  the  method  is  the  duef  objection  to  it  Yet, 
for  domestic  and  limited  applications  it  is  a  perfect 
method  for  clothing  and  upholstery.  The  feet  that 
with  entire  unanimity  the  Conference  recommended 
that  the  main  reliance  for  disinfection  should  be  placed 
on  the  simpler  and  powerful  agents — sulphate  of  iron 
and  carbohc  acid,  which  the  Metropolitan  Board  unhesi- 
tatingly adopted  at  the  beginning  of  the  epidemic  last 
year — will  be  ample  warrant  for  our  continuing  to  em- 
ploy those  cheap  and  effectual  substances. 

"  The  vital  importance  of  perfect  sanitarv  care  of  pU 
persons  sick  or  infected  with  cholera  was  iUustrated  in 
the  historv  of  the  epidemic  in  every  city.  Disinfection 
alone,  and  especially  the  irregular  and  unsystematic,  or 
unenforced  applications  of  disinfection,  did  not  always 
control  the  prevalence  of  cholera ;  indeed,  such  exclu- 
sive and  unmethodical  sanitary  work  often  resulted  in 
&tal  disappointments.  In  some  cities,  as  in  Erfurth, 
even  the  carbolic  add  was  so  freely  used  in  some  parte 
of  the  town  in  privies,  that  the  wells  in  the  vidnity  of 
the  privies  flooded  with  that  disinfectant  yielded  water 
that  tasted  etronriy  of  it ;  yet  parte  of^  Erfurth  were 
neglected,  and  cholera  was  fearfully  epidemic  there. 
But  it  was  conceded  that  in  cities  in  wnich  there  was 
perfect,  and  systematic,  and  well-regula*ed  sanitary 
disinfection  combined  with  perfect  care  of  the  sick,  and 
of  all  suspected  persons,  as  wag  the  case  in  the  city  of 
Bristol  and  some  other  fevorite  cholera  haunte,  the 
epidemic  was  controlled,  and,  by  like  faithfulness  and 
skill,  that  it  could  and  should  be  generally  controlled  in 
all  dvilized  cities. 

"  Prof.  Hirsch  presented  the  argument  and  studies  that 
favor  the  discovery  of  the  precise  nature  of  the  poison 
that  produces  cholera,  and  the  Conference  commended 
and  urged  on  the  inquiries  that  have  already,  in  the 
hands  of  Prof.  Klob  and  Thome  last  year,  resulted  in 
discovering  a  minute  microscopical  growth  that  seems, 
thus  far,  to  be  exclusively  produced  in  cholera  excre- 
mente,  and  which  obeys  all  the  teste  for  the  destruction 
as  well  as  propagation  of  cholera.  The  spores  of  that 
little  growth  multiply  with  marvellous  rapidity,  and 
they  are  not  destroyed  by  ordinary  doses  of  ddorine  or 
chloride  of  lime,  but  are  killed  by  sulphate  of  iron  and 
carbolic  add. 

"  The  Conference  recommend  that  sdentifio  natural- 
ists, like  the  men  who  are  now  at  work  on  these  ques- 
tions, should  continue  their  researches.  It  was  also 
recommended  that  observers  of  eholera  should  carefully 
s'.udy  the  conditions  under  which  the  epidemic  is  trans- 
ported from  place  to  place,  and  also  study  the  relations 
of  ffTound  moisture  (p-ound-water),  and  other  local 
conditions  that  determme  the  boundaries  of  epidemic 
fields. 

'^  It  will  be  observed  by  these  notes  of  a  discussion 
that  appears  to  have  been  conducted  with  the  single 
object  to  find  out  what  is  known,  that  there  was  a  clear 
knowledge  of  the  practical  wante  of  sanitary  officers 
and  governments.  The  nine  propositions  which  the 
members  of  the  Conference  wive  submitted  as  their 
unanimous  conclusions  and  recommendations  I  have 
placed  at  the  beginning  of  this  abstract,  as  being  pre- 


cisely the  kind  of  information  which  a  Board  of  Health 
most  wishes  to  receive,  and  upon  which  it  can  base 
judicious  practices.  Fortunately  for  the  good  name  of 
your  Board  as  for  the  safety  of  the  city  last  year,  our 
practice  was,  from  the  first,  based  upon  those  doctrines, 
and  the  great  minds  that  led  in  the  Weimar  Confei^nce 
were  the  men  that  had  most  aided  us  in  former  years  to 
deal  with  epidemic  and  infectious  di^icases.  I  am  happy 
to  learn  that  the  Leipzig  report  is  to  be  fully  illustrated 
by  maps  and  charte  to  show  preciselywhat  course  cholera 
has  pursued  in  European  cities.  We  may  hope  to  re- 
ceive copies  next  month.  I  regret  that  the  abstract 
forwarded  by  Prof.  Pettenkofer  cannot  be  [entirely 
translated  and  placed  in  your  hands  to-day.  These 
pages  contain  the  gist  of  the  whole,  but  the  debates 
touched  upon  a  great  many  other  points.  We  are  a 
little  surprised  that  some  conclusion  and  recommenda- 
tion  on  quarantine  was  not  reached.  But,  since  the 
fact  has  been  demonstrated  that  persons  who  travel 
away  from  an  infected  district  may  t'  emselves,  while 
yet  journeying  and  not  sick,  spread  cholera  by  means  ot 
excremental  evacuations,  it  is  not  surprising  that  little 
reliance  should  be  placed  upon  quarantine  regulations 
as  a  means  of  preventing  cholera  from  gpr^diag  in 
Europe. 

"  Respectfully  yours, 
"  Elishjl  Harris,  Corresp.  Sec.  M.  B.  H." 

in. — The  circular  from  the  War  Department  on 
cholera  in  the  U.  S.  Army,  drawn  up  by  Assistant 
Surgeon  J.  J.  Woodward.  M.D.,  is  a  xerj  able  docu- 
ment, made  up  from  official  reports,  with  statistical 
tables  exhibiting  the  monthly  number  of  cases  and 
deaths  from  cholera,  and  the  allied  bowel  affections, 
for  each  post  where  the  disease  prevailed;  and  al- 
though the  total  nnmber  of  cases  is  not  very  great, 
yet  they  bear  a  large  proportion  to  the  number  of  troops 
exposed  to  the  disease;  and  the  circumstances  attending 
the  transmission  of  the  epidemic  from  post  to  post  are 
so  interesting,  and  so  clearly  demonstrative  of  the  in- 
fectious nature  of  the  disease,  that  it  may  be  regarded 
as  one  of  the  most  important  documente  on  the  subject 
yet  published  in  our  country. 

The  first  case  reported  in  the  army,  occurred  at  Fort 
Columbus,  Govemor*s  Island,  New  York  Harbor,  on 
July  3,  1866.  The  disease  then  prevailed  in  New 
York  dty.  Recruite  fix>m  Governor's  Island  carried 
cholera  to  Hart's  Island^  from  thence  it  was  carried  by 
the  troops  to  David's  Island  and  Fort  Schuyler;  total 
number  of  cases  am  ng  the  troops  in  New  i  ork  Har- 
bor, 181,  and  78  deaths.  The  steamship  San  Salvadoi\ 
which  left  New  York  on  the  14th  of  July,  took  on  boara 
476  recruits  from  Governor's  Island ;  on  the  second  day 
out,  cholera  appeared  on  board,  and  she  arrived  at  quar- 
antme  near  Savannah,  Georgia,  with  twenty-five  sick 
with  the  disease,  and  three  dead.  The  troops  wotb 
landed  at  Tybee  Island,  where  cholera  prevailed  dur- 
ing July  and  the  first  few  days  of  August ;  altogether,  202 
cases,  and  116  deaths.  Of  ten  white  citizens  residing  on 
the  island,  nine  were  seized  with  cholera,  and  five  died 
soon  after  the  infected  ship  arrived.  In  the  same  man- 
ner recruits  from  Hart's  Island  carried  the  disease  to 
New  Orleans,  and  Galveston,  Texas.  In  the  former 
city,  there  were  ninety-three  cases  among  the  white 
troops,  and  twenty-four  deaths ;  and  254  cases  and  149 
deatns  among  the  colored  troops.  Hence  the  disease 
was  carried  bjr  detachments  to  the  colored  troops  at 
Forts  St.  Phihp*8  and  Jackson,  below  New  Orleans  on 
the  Mississippi  river,  where  there  were  seventeen  cases 
and  eleven  deaths.  Afterwards  the  disease  appeared 
among  the  troops  at  Ship  Island,  Miss.,  Baton  Bouge, 
La.,  Shreveport,  Brazos  Santiago,  Tex^  White's  Branchy 

digitized  by  VjC  _      ^_ 


THE  MEDICAL  RECORD. 


283 


Tex.,  Broi^nsville^  Indianola,  San  Antonio,  Austin,  Tex., 
Richmond,  Va.,  Norfolk,  Va.,  Carlisle  Barracks,  Pa.,  Jef- 
fereoD  Barracks,  Me.,  Newport  Barracks,  Ky.,  Atlanta 
and  Augusta,  Ga.,  Louisville,  Ky.,  Bowling  Green,  Ky., 
NaahvUfe,  Tenn,  Memphis,  Tenn.,  Vicksburg,  and  Fort 
Biley,  Kansas,  Fort  Leayenworth,  Ks.,  Helena  and  Lit- 
tle Rock,  Kb,^  Hunfersville  and  Fort  Smith,  Arkansas, 
Fort  Gibson,  Cherokee  Nation,  and  a  few  other  places. 

It  spears  from  the  tables,  that  out  of  a  total  of  12,780 
men.  there  were  2,908  cases  of  cholera  reported,  and 
1,209  deaths ;  of  these  there  were  1,749  cases  and  706 
deaths  out  of  a  mean  strength  of  9,083  white  troops; 
and  950  cases  and  501  deaths  out  of  a  mean  strength 
of  3,697  colored  troops.  A  few  isolated  oases  made  up 
a  total  of  2,724  cases  and  1,217  deaths  of  cholera  for 
the  six  months.  Among  tho  white  troops,  the  number 
of  cases  of  cholera  reported  during  the  six  months,  was 
192.6,  with  77.7  deaths  per  1000  of  strength.  Of 
diarrhoea  diseases,  741.8  cases  and  7.5  deaths  per  1000. 
For  the  colored  troops,  the  number  of  cases  of  cholera 
reported,  was  259.4,  with  195.5  deaths  per  1000  of 
Birength;  of  diarrhoea  diseases,  574.5  cases,  and  3.5 
deaths  per  1000 ;  of  all  other  diseases,  833.9  cases,  and 
11.4  deaths  per  1000. 

In  conclusion,  Dr.  Woodward  remarks  that  "  on  the 
whole,  it  must  be  admitted  that  the  general  tenor  of 
army  experience  during  1866,  is  Strongly  in  favor  of 
quarantine,  and  especiaUy  points  to  the  danger  to  the 
army  incurred  by  the  distribution  of  recruits  or  other 
bodies  of  men  from  infected  points." 


^tpoxte  of  Qotxttxts. 


NEW  YORK  PATHOLOGICAL  SOCIETY. 

Stated  Mektino,  May  24, 1867. 

Ds.  H.  B.  Sands,  President,  in  the  Chair. 

imcratJAL  ncjuRT  or  blbow-joint. 

Db.  Buck  exhibited  a  specimen  of  unusual  injury  of  the 
elbowHoint.  Tl;ie  specimen  was  taken  from  a  cadaver, 
about  fifty  years  of  age,  that  was  brought  from  the  medi- 
cal ward,  and  his  attention  was  directed  to  the  elbow.  It 
^•s  represented  to  have  been  fractured  twenty  years 
before.  There  was  no  history  of  the  case  obtainable. 
The  limb,  as  it  lay  beside  the  body,  presented  a  rather 
remarkably  straight  appearance,  not  having  the  slightest 
degree  of  abduction  of  the  forearm  upon  tne  arm,  but  a 
little  inclined  to  adduction,  and  in  a  position  of  rather 
extreme  extension,  so  that  there  was  some  bulging  for- 
ward at  the  elbow.  After  removing  the  specimen,  and 
laying  open  the  joint  posteriorly,  it  was  ascertained 
that  the  articular  extremity  of  the  humerus  was  entire, 
which  was  also  the  case  with  the  head  of  the  radiiis  and 
the  olecranon,  but  the  coronoid  process  had  evidently 
been  separated  by  a  fracture.  There  were  two  pieces 
that  were  fractured ;  the  smaller,  which  occupied  the 
outer  side,  was  equivalent  to  a  good-sized  pea  in  volume ; 
the  other  fragment  was  considerably  larger.  These  two 
^Jgments  were  u filed  to  each  other,  and  to  the  surfaces 
from  which  they  had  been  separated,  by  fibrous  tissue, 
>nd  from  the  smaller  fragment  there  were  threadlike 
fibres  crossing  the  joint,  and  terminating  at  the  outer 
condyle  of  the  humerus.  There  were  two  that  were 
nearly  parallel  with  each  other,  and  were  joined  to- 
gether after  the  manner  of  a  nervous  plexus. 

In  oondusion.  Dr.  Buck  could  not  conceive  of  these 
bands  being  made  up  of  inflammatory  adhesions,  but  was 
indined  to  coincide  with  the  opinion  of  a  friend,  which 
was,  that  portions  or  strips  of  synovial  membrane  had 


been  torn  up  at  the  time  of  the  accident,  and  had 
eventui^y  dwindled  down  to  mere  fibres.  The  speci- 
men, however,  was  especially  interesting  in  connexion 
with  the  extreme  rarity  of  an  uncomplicated  firacture 
of  the  coronoid  process. 

Dr.  Post  thought  that  the  bands  might  be  the  result 
of  adhesive  inflammation,  becoming  much  elongated  dur- 
ing the  course  of  the  twenty  years  since  the  injury.  He 
further  remarked,  that  writers  spoke  of  fractures  of  the 
coronoid  process  invariably  attended  with  dislocation  of 
the  ulna  backwards,  a  phenomenon  constantly  recurring. 
Dr.  Buck's  case,  though  an  exception  to  this  rule,  admit- 
ted of  an  explanation  in  that  there  was  not  enough  of 
the  coronoid  process  knocked  off  to  allow  of  the  dis- 
placement 

Dr.  Jaoobi  remarked,  that  it  would  be  worth  while  to 
decide  as  to  whether  the  bands  referred  to  were  formed 
of  false  membrane  or  not,  by  an  examination  with  the 
microscope.  • 

RUPTUR^   OF    SEIOLUNAR   VALVES:     A   QUESTION    IN   MEDI- 
CAL JURISPRUDENCE. 

Dr.  Finnell,  on  behalf  of  Dr.  John  Beach,  exhibited  a 
heart  taken  from  a  man  fifty  years  of  age.'  The  deceased 
was  of  intemperate  habits,  and  after  a  certain  dinner 
was  noticed  sitting  on  his  chair  dozing,  from  which  he 
slipped  off,  falling  upon  ^e  floor.  On  his  getting  up 
some  persons  present  remarked  that  he  was  intoxicateo, 
which  statement  led  to  a  quarrel,  in  which  the  man  was 
pretty  severely  beaten  about  the  face,  breaking  the 
bridge  of  his  nose,  and  otherwise  inflicting  bodily  inju- 
ries. The  following  morning  he  was  found  lying  upon 
his  face  on  the  floor  of  his  room,  dead. 

On  post-mortem  examination,  at  the  instance  of  the 
coroner,  there  were  no  lesions  found,  except  those  about 
the  heart.  The  disease  of  this  organ  was  mainly  con- 
fined to  the  aortic  valves.  The  lell  ventricle  was  verv 
much  dilated,  the  thre^  semilunar  valves  were  much 
crippled  by  atheromatoaf  deposits,  and  one  of  these  lat- 
ter valves  showed  a  laceration  which  commenced  at  its 
fi^e  margin,  and  extended  a  few  lines  backwards  to- 
wards the  base. 

The  parties  engaged  in  the  quarrel  being  arrested  on 
a  charge  of  murder,  it  was  of  the  utmost  importance  to 
determine  whether  tiie  man  died  as  the  result  of  inju- 
ries received  in  the  quarrel  or  not ;  in  other  words,  was 
the  rupture  of  the  valve  the  cause  of  death  ?  and  if  so, 
was  the  said  rupture  the  direct  result  of  the  beating 
which  the  deceased  is  said  to  have  received  ? 

Dr.  Kraokowizer,  assuming  that  the  rupture  was 
recent,  did  not  think  it  could  have  been  the  cause  of 
death,  inasmuch  as  the  rupture  in  itself  was  not  a  formid- 
able one,  and  besides  the  Uttle  disturbance  which  it 
would  excite  in  the  circulation  would  hardly  serve  to 
make  much  impression  of  a  serious  nature  upon  an  appa^ 
rat  us  already  crippled  for  a  long  lime  with  serious  heart 
lesions.  It  seemed  to  him  that  the  man  might  well 
enough  have  died  independent  of  any  quarrel,  irom,  for 
instance,  paralysis  of  the  heart  from  hyperextension  of 
the  ventricle. 

A  COLLECTION  OF  AK0MALIE8  IN  A  MONSTER. 

Dr.  Jaoobi  presented  the  body  of  a  new-bom  infimt 
which,  considerincr  the  number  of  existing  anomalies, 
was  in  itself  a  coUection  of  specimens.  He  remarked 
upon  the  subject  as  follows : 

This  infant  was  bom  at  full  term,  and,  as  far  as  I  know 
to  the  contrary,  of  healthy  parents;  the  presentation 
was  normal,  no  one  save  a  midwife  was  present  at  the 
birth,  and  the  deceased  lived  but  half  an  hour.  In  the 
body  of  this  child  there  are  a  large  number  of  anomalies. 

The  malformations  found  are  of  three  different  typ 


284 


THE  MEDICAL  RECORD. 


first,  those  which  refer  to  arrest  of  development;  second, 
those  which  refer  to  excess  of  development ;  and  thirdly, 
the  results  of  intra-uterine  disease. 

We  will  dommence  with  the  head.  The  right  eye  is 
perfectly  normal,  but  the  left  is  evidently  much  atro- 
phied, and  contains  in  its  centre  a  yellowish-grey  look- 
ing point  which  is  in  all  probability  the  crystalline  lens. 
The  exact  description  of  the  anomalies  present  has  been 
ftimished  me  by  Dr.  Althof. 

Orbit,  normal ;  fossa  glanduke  lachrymaUs,  very  deep ; 
lids,  lachrymal  apparatus,  and  muscles  well  developed; 
also  the  nerves ;  vessels  could  not  be  traced. 

Eyeball:  longitudinal  axis,  9  mm.;  Tertical  axis, 
6  mm. ;  horizontal  axis,  7  mm. 

Cornea :  Diameter,  2\  mm.  Epithelial  cover  changed 
into  a  compact  mass — its  cells  could  not  be  separated 
into  the  usual  different  layers.  Bowman's  membrane 
only  fragmentary  near  the  periphery.  The  proper  tis- 
sue of  the  coftiea  had  lost  its  characteristics —none  of 
its  normal  constituents  to  be  clearly  distinguished. 
Desoemet's  membrane  very  well  conserved — ^its  ceLs  in 
a  state  of  proliferation.  Iris :  very  much  thickened — 
c»ellalar  tissue  well  conserved — ^no  trace  of  either  elas- 
tic fibres  or  Zinn's  membrane — the  whole  envelc^MKl 
in  a  very  massive  coat  of  organised  lymph — finnly  ad- 
herent to  the  lens.  CiUary  processes ;  have  disappeared 
—covered  by  lymph.  Lens :  dimensions  normal— cap- 
sular (pyramiaal)  cataract — cells  of  anterior  capsule 
partly  conserved — ^lens  fibres  opaque,  broken  and  split, 
fall  of  molecular  deposit — fatty  degeneration  in  some 
parts  near  the  posterior  pole — altogether  enveloped  in 
a  thick  layer  of  orgauixed  lymph — no  trace  of  zonula. 
Corpus  vitreum:  a  tough,  shrunken  mass,  without  any 
organization.  Chorouiea:  fully  developed  in  all  its 
layers— contains  pus  in  great  quantities — ^very  nume- 
rous so-caUed  "ganglion-cells" — exudations  on  glass- 
membrane  (6rst  time  they  came  under  my  observation 
in  so  young  an  eye).  Metina^  entirely  detadied— rods 
and  cones,  also  outer  granulesTotally  destroyed — traces 
of  layer  of  inner  granules — very  fine  ganglion-cells 
(perfectly  normal) — varicose  nerve-fibres  with  numerous 
nuclei  OpUc  nerve:  well  developed — papilla  much 
swollen — central  artery  l^ger  than  usual — ^bonina  cri- 
brosa  to  be  demonstrated  without  any  difficulty— en- 
trance of  nerve  normal 

This  state  of  things  proves  that  we  have  not  to  deal 
with  a  maLformation  of  the  eye,  but  with  an  intra- 
uterine irido-choroiditis. 

The  principal  thing  besides  to  be  exhibited  in  the 
head  is  the  presence  of  double  hare-lip  and  cleft  palate. 
The  soft  palate  is  easily  distinguished  on  the  two  sides, 
the  fissure  being  in  the  median  line.  The  intermaxil- 
lary bone  is  separated  by  a  large  gap  fi>om  the  alveolar 
processes  of  the  maxillary  bone  on  each  side,  and  is 
somewhat  smaller  than  normal,  rounded  on  its  two 
sides,  but  especially  so  on  the  left,  so  that  the  second 
incisor  tooth  is  protruding  through  the  alveolar  process. 
As  in  all  these  cases,  the  integuments  are  more  retracted 
than  the  intermaxillary  bone  itself.  The  vomer  is  nor- 
mal, but  as  usual  bent  a  little  to  one  side. 

Another  arrest  of  development  is  in  the  shape  of  a 
fissure  in  the  abdominal  integuments,  in  the  neighbor- 
hood of  the  umbilicus,  constituting  umbilical  hernia. 
There  is  found  at  the  insertion  of  we  umbilical  cord, 
and  hanging  to  the  right  of  the  median  line,  a  tumor  of 
the  diameter  of  an  inch  or  an  inch  and  a  quarter ;  this 
tumor  evidently  consists  of  nothing  else  but  the  amniotic 
covering  of  the  umbilical  cord,  trough  which,  in  the 
fresh  state  of  the  parts,  intestine  could  plainly  be  seen. 
There  is  another  fissure  in  the  left  side  of  the  diaphragm, 
constituting  what  has  been  called  a  diaphragmatic  her- 
iiia,  through  which  protrudes  a  greater  portion  of  the 


spleen,  as  well  as  the  stomach,  covered,  however,  with 
the  diaphragmatic  pleura.  This  hernia  then  is  not 
complete,  as  far  as  the  viscera  of  the  abdomen  are 
concerned  There  is  still  another  fissure,  to  which  I 
will  return  presently. 

I  will  next  show  the  supernumerary  limbs.  There 
are  two  sixth  toes,  both  adjoining  the  fifth,  both  tole- 
rably well  developed,  both  having  two  phalanges,  and 
both  showing  nails.  This  one  on  the  left  foot  is  con- 
nected withtne  second  phalanx  of  the  fifth  toe,  but  the 
other  one  on  the  right  side  is  connected  by  means  of  a 
joint,  both  to  the  metatarsal  bone  and  the  first  phalanx 
of  the  fiftli  toe.  The  supernumerary  fingers  are  simple 
appendages  joined  to  the  fifth  finger  of  each  hand,  oy 
integumentary  tissue. 

In  regard  to  the  umbilical  hernia  there  was  one 
point  to  which  my  attention  was  directed.  I  thought 
that  inasmuch  as  this  hernia  was  developed  very  early 
in  foetal  life  (the  fifth  or  sixth  week  of  utero-gestation), 
the  development  of  the  intestinal  canal  was  some- 
what impeded.  On  examination,  however,  1  was 
struck  with  the  rather  normal  appearance  of  tihe  intes- 
tines. I  thought  that  the  intestines  might  be  shorter 
than  normal,  but  now  I  find  that  the  colon  of  this  infant 
is  at  least  as  long  as  we  ordinarily  find  it  in  the  fastOB, 
Generally  it  is  very  long  in  the  new-born,  so  much  so, 
that  especially  in  uie  pelvic  region  the  sigmoid  flexure 
is  not  found  on  the  left  side  but  on  the  right;  that 
there  are,  as  a  rule,  sometimes  two,  and  not  unfirequently, 
as  in  this  instance,  three  sigmoid  flexures. 

A  very  important  anomaly  belonghig  to  the  same 
class  will  be  found  in  the  heart.  In  the  first  place,  con- 
trary to  the  rule,  the  left  side  of  the  heart  is  more  devel- 
oped than  the  right;  secondly,  the  aorta,  instead  of 
being  small  between  the  heart  and  the  ductus  arteriosus, 
was  xmusually  large ;  and  thirdly,  the  ductus  arteriosus 
was  very  small  indeed,  notwithstanding  the  pulmonary 
artery  was  of  normal  size.  Searching  for  a  cine  to 
these  phenomena,  I  find  the  inter  ventricular  septum 
open ;  and  fiirther,  the  entrances  into  the  aorta  and  pul- 
monary artery  are  side  by  side,  and  originate  in  the 
same  ventricle.  Thus  this  is  an  instance  of  the  common 
origin  of  the  pulmonary  artery  and  aorta  in  the  left 
ventricle.  I  have  not  been  able  to  look  up  more  than 
one  case  of  the  kind  on  record.  The  possibility  of  a 
child  living  or  developing  to  this  extent  is  simply  ex- 
plained by  the  fact  that  the  two  ventricles  in  tlus  case 
have  acted  as  one,  just  as  if  there  were  present  no  sep- 
tum at  all 

There  are  a  few  other  anomalies;  for  instance,  the 
vertebral  arteir,  instead  of  originating  in  the  subclavian, 
takes  its  rise  from  the  aorta  itself^  which  I  believe  is 
not  so  very  uncommon.  The  vense  cav»  are  large, 
but  normal  in  every  respect 

[To  be  oontinaed.] 

NEW  YORK  ACADEMY  OF  MEDICIlfE. 

Stated  Mextinq,  July  5,  1867. 
Db.  Alfred  0.  Post,  PiiEsmxNT,  in  the  Chair. 

THE  SCONOMT  OF  HUMAN  LIFE. 

Dr.  a.  N.  Bell  read  a  paper  entitled  as  above,  in  which 
he  reviewed  the  various  methods  adopted  by  the  an- 
cients and  modems  to  secure  the  registration  of  statistic- 
al facts  bearing  upon  the  duration  of  human  life.  He 
alluded  to  the  attempts  made  by  Severus,  Verranus, 
and  Aurelius,  wluch  seemed  to  prove  that  the  average 
life  of  the  Roman  citiaen  was  30  years.  The  city  of 
Geneva,  Switzerland,  had  some  valuable  mortuary 
tables,  which  with  some  intermissions  dated  back  to 
1649.     Sweden  and  England  also^uite  eariy  turned 

digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


285 


their  attention  to  the  same  subject — ^in  the  latter  coun- 
try the  Carlisle  tables,  which  were  wrong  in  principle 
and  not  to  be  depended  upon,  although  generally 
adopted  by  Life  Insurance  Companies,  originated. 

He  then  briefly  adverted  to  the  causes  tending  to 
abreviate  life,  and  maintained  that  proper  food  was 
much  more  important  than  good  air  and  the  most 
salubrious  surroundings. 

Dr.  Griscom  commented  upon  certain  portions  of  the 
pi^,  and  alluded  to  the  fact  that  the  21st  ward  con- 
tained Bellevue  Hospital.  This,  he  thought,  was  a  fact 
which  did  not  belong  to  the  ward,  and  should  be  elimin- 
ated in  the  statistiosJ  computations. 

Dr.  Bbll  said  that  the  authorities  were  given  in  the 
Ibot-notes  of  his  paper,  and  that  some  of  them  were 
derived  from  the  reports  of  the  late  City  Inspectors. 

Dr.  Gbisgom  maintained  that  the  statistics  of  the  late 
CSty  Inspectors  were  not  to  be  relied  on 

Dr.  Harris  thought  that  Dr.  Bell  had  treated  his  sub* 
ject  with  a  great  deal  of  candor,  and  had  carefully  dis- 
criminated between  the  practical  and  irrelevant.  He 
moved  that  tiie  thanks  of  the  Academy  be  presented 
to  Dr.  Bell,  which  was  unanimously  carried. 

In  reply  to  certun  inquiries,  he  stated  that  the  re- 
cords or  other  cities  did  not  include  the  period  of  ill- 
nesS)  which  he  regarded  as  of  great  practical  value.  The 
exactness  of  diagnosis  in  fin^  causes  of  death  he  con- 
sidered very  important. 

TBI  POWKRS  OF    THE   HEALTH    BOARD  AND  THE  PREROOA- 
TFVIS  09  00RONER8. 

Dr.  Rogers  alluded  to  a  case  where  '^a  certificate  of 
death"  had  been  given  in  a  case  not  seen  for  three  months 
one  of  the  cortmers  at  the  request  of  a  physician  more 
conversant  with  the  case  and  who  desired  an  antopsy 
to  demonstrate  the  diagnosis,  suspended  the  funeral 
senrioes  for  only  a  short  time.  He  wished  to  know 
whether  the  physician  in  such  cases  would  be  sustained 
by  the  Health  Board. 

Dr.  Harris  thought  it  the  duty  of  the  physician  to 
procure  an  autopsy  when  there  was  a  doubt  regarding 
the  cause  of  death ;  and  said  that  there  was  no  law  to 
prevent  it.  The  case  may  then  be  surrendered  to  the 
coroners. 

Dr  O'Sulltvas  inquired  what  was  to  be  done  in  those 
moribund  cases  seen  only  once,  to  which  physiwans  of 
the  poorer  districts  were  summoned,  evidently  and 
mainly  with  the  view  to  secure  a  certificate  without  the 
intervention  of  the  coroner. 

Dr.  Harris  regarded  it  inconsistent  to  refuse.  The 
proper  plan  would  be,  if  a  post-mortem  were  refused,  to 
give  the  cause  of  death  as  simply  *^  unknown,"  and 
8QM>lement  it  afterwards  if  possible. 

J>R.  Tankleek  desired  to  know  if  the  coroner  was  a 
judicial  officer,  and  if  when  he  was  satisfied  that  there 
was  no  occasion  for  an  inquest  the  physician  could 
demand  an  inquest  in  the  interest  of  vital  statistics 
merely. 

Dr.  Harris  replied  that  it  was  the  coroner's  office  to 
take  cognizance  of  all  cases  of  violent  or  sudden  deaths. 
He  substantially  recited  the  law  on  the  subject 

JThe  question  was  then  debated  at  some  length,  but 
without  arriving  at  any  express  oondusion.] 

Dr.  Dowks  raised  the  point  whether  or  not  as  a  matter 
of  oourtesy  the  attending  physician  should  not  be  invited 
by  the  coroner  to  be  present  at  the  inquest. 

Dr.  Harris  thought  that  the  attending  physiciui 
should  be  invited. 

DBLIOARS  TO  THE  INTERNATIONAIi  MEDICAL  CONGRESS 
OF  PARIS. 

Drs.  John  0.  Dalton,  Fordyoe  Barker,  and  Charles  D. 


Smith  were  unanimously  elected  delegates  from  the 
Academy  for  the  International  Medim  Congress  at 
Paris. 

RESULT  OF  AN  OPERATION  FOR  OARIES  OF  THE 
OS  OALOIS. 

pR.  BiTRRALL  presented  to  the  Academy  the  patient 
upon  whom  he  had  operated  and  whose  case  had  been 
published  in  the  Medical  Record  (vol.  ii.,  p.  171).  The 
success  of  the  operation  was  complete. 

The  Academy  then  acy'ourned. 


Stated  Mkbtino,  June  19,  1867. 

Dr.  Alfred  0.  Post,  President,  in  the  Chair.    ^ 

iNSANrrr. 

Dr.  D.  Tilden  Brown  read  the  paper  with  the  above 
ciqption  firom  the  pHi  of  Dr.  Butler  of  Providence,  R.I. 
a  synopsis  of  which  i^peared  in  the  Medical  Record 
(vol  ii,  p.  126),  as  part  of  the  Proceedings  of  the  Amer- 
ican Medical  Association. 

MR.   HOFF  AND  THE  ACADEMT. 

Dr.  Anderson  presented  a  preamble  and  resolutions 
already  published  condemnatory  of  Mr.  Hoff  for  adroit- 
ly uains  the  name  of  the  Academy  in  seeming  endorse- 
ment of  his  nostrum. 

The  Academy  then  adjourned. 


Called  Meetino,  July  8,  1867. 
Db.  Alfred  C.  Post,  ^resident,  in  the  Chair. 

medical  ELECTRICrrV. 

Dr.  Q-.  M.  Beard  read  an  interesting  paper  upon  this 
sul^ect,  afler  which  the  Academy  adjourned. 


€ontsp0Vit)mce. 


DR.   HERZOa  ON  CHOLERA— LETTER   FROM 
DR.  BURRALL. 

To  TUB  Editob  or  thb  Msdioal  Bsoobd. 

Sir — ^The  following  sentence  in  Dr.  Herzog's  com- 
munication to  the  Record  of  July  Ist  requires  a  slight 
explanation,  lest  the  quotation  made  in  the  little  work 
to  which  he  has  referred  should  be  thought  to  unquiJi- 
fiedly  endorse  Drasche's  views.    Dr.  Hersojg  writes : 

''  I  must  further  mention  that  the  objection  made  to 
the  whole  doctrine  of  this  second  point*  bv  Drasche,  and 
quoted  in  Prof.  Clark's  lectures  and  Dr.  Burrall's  book, 
has  been  already  fully  contradicted,  1861,  as  *infounded 
on  facta." 

In  the  book  referred  to,  after  a  notice  of  Drasche^s 
views,  as  well  as  those  of  Dr.  Lorange  and  Dr.  W.  H. 
Thomson  on  epidemics  of  cholera  in  Beyroot,  the  fol- 
lowing conclusions  were  arrived  at— <x>nclusions  which 
have,  I  think,  not  been  weakened  by  the  teachings  of 
Utie  late  epidemic : 

*^  Such  facts  seem  to  show  that  a  cholera  epidemic 
may  prevail  upon  a  dry  and  rocky  stratum,  in  which 
the  moisture  lies  more  than  fifty  feet  below  tne  sur^e, 
when  it  appears  among  a  people  careless  of  the  ordinary 
laws  of  health,  and  in  the  vicinity  of  an  abundance  of 
decaying  excretions ;  also  that  such  excretions  favor  the 
spread  of  cholera  more  than  a  malarious  atmosphere. 
At  t^e  same  tune,  the  fact  that  the  disease  was  not 


*  The  dependence  of  elioleTa  epldeadct  upon  rabnil  waten  u  OM 
wntkl  point. 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


indefinitely  protracted  does  not  weaken  the  theory  that 
the  dejections  contain  the  infectious  material,  for  the 
striking  mortality  among  the  scavengers  in  Beyroot  is 
an  additional  argument  to  the  many  more  in  its  faror ; 
it  only  proves  that  the  laws  upon  which  the  duration  of 
a  cholera  epidemic  depend  are  still  unknown/' 

Respectfully,  F  A.  Busball,  M.D. 


THE     UTERINE 


IN      PRACTICE 


ELEMENT 
AGAIN. 

To  THs  Edrob  op  thb  Mbdioal  Rboobd. 

giB — In  this  art'cle  I  will  touch  on  some  points  that 
I  had  not  space  for  in  my  previous  one. 

Many  specialists  talk  of  ulceration  of  the  oa  tiieri 
as  if  it  were  a  very  common  thing.  Now  in  my  experi- 
ence, which  has  by  no  means  been  a  small  one,  it  is 
very  uncommon.  And  this  is  the  ^tperience  of  many 
esteemed  friends  in  our  profession.  Tne  lesion  which  I 
have  most  often  found  does  not  at  all  deserve  the  name 
of  ulceration.  It  is  a  small  patch  of  redness,  sometimes 
wholly  on  a  level  with  the  rest  of  the  surface,  and  some- 
times a  little  raised,  and  occasionally  presenting  some- 
thing of  a  fungoid  appearance,  but  never  depressed. 
Commonly  touching  this  a  few  times  with  nitrate  of 
silver  suffices  to  remove  it.  And  I  have  no  doubt  that 
this  lesion  is  often  removed  without  any  local  applicar- 
tion,  bv  the  use  of  remedies  addressed  solely  to  the 
state  of  the  general  system,  just  as  is  true  of  many  other 
local  difficulties ;  not  so  quickly,  however,  as  when  the 
local  application  is  used  also. 

Dr.  Meigs,  who  has  had  a  similar  and  of  course  a 
much  larger  experience  than  mine,  on  this  point,  I  find 
on  referrinpj  to  his  article  on  diseases  of  the  neck  of  the 
uterus  in  the  sixth  volume  of  the  Transactions  of  the 
American  Medical  Association,  speaks  of  the  follv  of  call- 
ing such  lesions  ulcers,  and  says  emphatically  that  "  an 
ulceration  of  the  womb  is  among  the  rarest  of  diseases." 

It  is  astonishing  what  eyes  some  of  these  specialists 
have.  Their  declarations  often  bring  to  my  mind  the 
old  couplet, 

"  Optics  sharp,  It  needs  I  ween, 
To  see  what  is  not  to  be  seen.'* 

In  one  of  the  last  cases  in  which  I  witnessed  the 
lesion  above  referred  to,  a  physician  had  given— yes, 
given — the  patient  womb  on  the  brain  by  telling  her 
that  she  had  a  very  large  ulcer.  I  found  nothing  but 
one  of  these  red  patchesr-quite  a  small  one — which  was 
cured  by  some  three  or  four  applications  of  nitrate  of 
silver.  It  was  far  from  curing  the  patient,  however, 
for  it  did  not  reach  the  chief  source  of  the  difficulty,  the 
brain. 

And  here  I  must  notice  one  practice  which  merits  no 
milder  term  than  abominable,  but  which  I  fear  is  some- 
what common.  I  have  said  that  some  of  the  specialists 
on  female  diseases  are  very  instructive  and  communica- 
tive with  their  patients  and  their  friends.  They  take 
special  pains  to  make  them  understand  the  nature  of 
their  complaints.  In  doing  this  some  have  gone  so  far 
as  to  let  friends  of  their  patients  look  into  the  speculum 
and  see  for  themselves  the  ulcers,  which  was,  of  course, 
a  very  intelligent  and  satisfactory  act.  Perhaps,  in  the 
march  of  modem  improvement,  they  will  soon  get  so 
far  as  to  let  the  patients  themselves  look  in,  by  means 
of  reflectors  adjusted  for  the  purpose. 

In  the  case  I  have  just  referred  to,  this  looking  in 
was  practised,  as  I  learned,  in  this  way ;  On  examining 
the   patient  I  found  that  a  lady-friend  of  hers  was    Medical   Register 
Btan<fing  by  me,  trying  to  look  into  the  speculum,  and  as       John  Sheady,  M. 
I  seemed  rather  surprised,  she  informed  me  that  Dr.  —       88,  85  Centre  St. 


asked  her  to  look  in  and  see  the  awful  ulcer  that  was 
there.      I  have  already  said  that  there  was  nothing 

there  but  a  small  red  patch,  and  yet  Dr. only  a 

few  days  before  saw  a  large  ulcer.     What  the  lady  saw, 
thinking  it  to  be  an  ulcer,  I  know  not^-I  did  not  care 

to  discuss  matters  of  diagnosb  with  her,  though  Dr. 

might  have  done  so. 

Here  is  another  case.  A  physician  of  homely  good 
sense,  who  never  has  used  a  speculum,  but  who  knows 
more  about  female  diseases  than  some  who  make  a 
very  common  use  of  it,  was  consulted  by  a  man  in  re- 
gard to  a  difficulty  affecting  both  himself  and  his  wife, 
and  was  told  plainly  that  he  had  contracted  gonorrhoea^ 
and  had  given  it  to  his  wife,  and  the  doctor  prescribed 
for  both  accordingly.  Soon  after,  being  called  in  to  the 
family  for  some  purpose,  the  wife  said  to  him,  "  I  have 
had  Dr.  — —  to  see  me,  and  he  has  examined  me  with 
an  instrument,  and  he  found  an  ulcer  on  the  mouth  of 
the  womb."    "  Poh  I"  said  he.     "  Well,  it's  true,"  said 

she,   "  for  the  doctor  told  Mrs. to  look  in,  and 

she  saw  it." 

I  give  still  another  case.  A  friend  whom  I  happened 
to  meet,  consulted  me  incidentally  in  regard  to  his  wife's 
case,  stating  that  she  had  for  some  time  been  in  ill-health ; 
that  she  had  recently,  though  very  reluctantly,  come 
under  the  care  of  one  who  had  made  a  specwJty  of 
female  diseases,  and  that  he  had  found  an  ulcer  on  the 
mouth  of  the  womb.  I  doubted  very  much  the  truth 
of  the  diagnosis,  simply  because  he  said  further  that  he 
had  seen  the  ulcer  himself,  and  was  quite  disposed  to 
talk  about  its  appearance.  I  was  so  disgusted  that  I 
had  very  little  to  say  in  regard  to  the  case— disgusted 
not  with  the  husband,  but  with  the  physician,  who  had 
probably  egregiously  imposed  upon  a  non-medical  man, 
and  had  certainly  triinsgressed  the  plainest  rules  of 
delicacy  in  thus  indoctrinating  him  so  unnecessarily, 
and  probably  fruidessly,  on  such  a  subject  and  in  such  a 
manner. 

Perhaps  your  readers  will  say  that  physicians 
who  do  such  things  cannot  be  respectable  men.  But 
really  all  the  three  that  I  have  alluded  to,  have  a  res- 
pectable standing  in  the  profession,  and  one  of  them  is 
a  very  prominent  man,  known  widely,  and  particularly 
as  a  specialist  in  female  disease-'. 

If  tnese  and  kindred  practices  are  allowed  to  extend 
tiiemselves,  we  may  soon  have  ulcers  and  displacements 
of  the  womb  talked  about  in  promiscuous  circles  as 
freely  as  we  now  do  fever,  or  colic,  or  cholera.  I 
have  sometimes  felt  a  little  queer  when  young  ladies 
have  had  something  to  say  in  the  presence  of  gentlemen 
about  cases  of  dysentery  and  diarrhoea,  and  I  am  very- 
much  afraid  that  some  of  them  will  make  me  feel  stiB 
more  queer  by  remarking  on  the  suffering  of  some  of 
their  friends  from  diseases  of  the  womb.  The  tendency 
certainly  is  towards  such  offences  against  propriety  and 
trae  delicacy. 

There  are  some  other  points  still  that  I  must  defer 
to  another  article. 


Um  |)ubltcation0* 


Translations  of  the  Indiana  State  Medical  Society. 
17th  Annual  Session. 

Thb  Prinoiples  and  Peacticb  of  Disinfection.  By  Prof. 
Roberts  Bartholomew,  A.M.,  M.D.  R.  W.  Carroll 
A  Co. 


OF  THB  City   of 
D.,  Editor.    N.  Y. 


N.  T.  FOB  1867. 
Peintikg  Co.,  81, 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


287 


MtVxcai  3ttms  ani  Uma. 


PiBsoNAL. — "Dr.  Mart  E.  Walker,  according  to  a 
Paris  correspondent  (July  8),  waspresent  at  the  Fourth 
of  July  banquet  at  the  Grand  Hotel,  where  she  was 
wrapped  up,  d  la  Eirby,  in  the  American  flag.  She 
evidently  wanted  to  make  a  speech,  but  would  not  be 
heard.  She  wears  her  medal,  voted  her  by  the  Ameri- 
can Congress  for  brave  womanly  cares  and  attentions 
bestowed  upon  sick  and  wounded  soldiers  on  the  field 
and  in  the  hospitals  during  the  war,  and  for  four  months' 
martvrdom  in  the  Libby  prison.  This  medal  has  pro- 
cured the  *  doctor  *  admission  into  the  medical  circles 
here,  and  given  her,  I  am  informed,  great  facilities  for 
observation." 

SuBOEON  J.  H.  Baxter,  United  States  Volunteers, 
late  chief  medical  officer  Provost  Marshal  General's  Bu- 
reau, was  confirmed  by  the  Senate  as  Medical  Purveyor, 
United  States  Army,  with  the  rank  of  Lieutenant- 
ColoneL  This  promotion  in  no  way  interferes  with  the 
completion  of  the  medical  report  of  the  Provost  Mar- 
^  Gkneral's  Bureau,  upon  which,  in  accordance  with 
an  Act  of  Congress,  Dr.  JBaxter  is  now  engaged. 

Brevet-Lieut.-Colonel  J.  R.  Smith,  Surgeon  United 
States  Army,  has  been  relieved  from  duty  as  Medical 
Director  of  the  Fourth  Military  District,  and  assigned 
to  duty  as  Post  Surgeon  at  Jefferson  Barracks,  Missouri, 
relieving  Brevet-Colonel  E.  Smith,  Surgeon  United 
States  Army,  who  has  been  assigned  to  duty  as  Medi- 
cal Director  of  the  Fourth  Military  District. 

Dr.  Wm.  T.  Nealis  has  been  i^pointed  Physician  to 
the  City  Prison  by  the  ConmiiBSioners  of  Pnolic  Chari- 
ties and  Correction. 

Dr.  Ellsworth  Euot  has  been  elected  one  of  the 
Trustees  of  the  College  of  Physicians  and  Surgeons, 
vice  Dr.  Benj.  Ogden,  deceased. 

Jambs  R  Wood,  M.D. — We  take  pleasure  in  announc- 
ing that  the  degree  of  LL.D.  has  lately  been  conferred 
upon  Dr.  Wood  by  the  Genesee  College. 

Dr.  Charles  E.  Morgan,  of  this  city,  died  suddenly 
August  4.  We  will  give  an  obituary  notice  of  the  de- 
ceased in  our  next 

New  York  Hospital. — Dr.  James  W.  McLane  has 
been  elected  one  of  the  attending  physicians  to  the  New 
York  Hospital,  vice  Dr.  Thomas  B.  Dash,  resigned. 

Senboa  Co.  Mbdical  Societt.  —  The  anniversary 
meeting  of  the  Seneca  County  Medical  Society  was 
held  at  the  Eagle  Hotel,  in  Waterloo,  on  Wednesday, 
July  10th.  The  President  of  the  Society,  Prof.  Bolter, 
of  Ovid,  delivered  an  interesting  address.  The  election 
of  officers  for  the  ensuing  year  resulted  as  follows: — 
Prendenty  Dr.  O.  S.  Patterson,  Waterloo;  Vioe-Presi- 
dmU,  James  Flood,  Lodi;  Secretary,  S.  R.  Welles, 
Waterloo;  Treasurer.  E.  J.  Schoonraaker,  Tyre :  Cen- 
ears,  W.  W.  Wheeler,  Farmer  Village;  A.  Emens, 
Fayette;  J.  Dunn,  Lodi. 

Thx  Dkath  or  Sir  William  Lawrence,  Bart.,  F.RS. 
— The  London  Telegraph  announces  the  death  of  this 
distinguished  surgeon,  at  his  residence,  Whitehall  Place, 
on  the  5th  instant  The  deceased  was  bom  at  Ciren- 
cester, on  the  16th  of  July,  1783,  and  was,  therefore, 
eighty-four  years  old  at  die  time  of  his  death.  He 
received  a  preliminary  education  at  a  classical  school 
near  Gloucester,  and  was  afterwards  i^prenticed  to  die 
cdebrated  Abemethy.  So  decided  was  his  zeal  in  ana- 
tomical pursuits,  that  before  three  years  of  his  appren. 


ticeship  had  expired  he  was  appointed  Demonstrator  of 
Anatomy  at  St.  Bartholomew's  Hospital  He  finished 
his  professional  education,  and  became  a  member  of  the 
Royal  College  of  Surgeons  on  the  6th  of  September, 
1805;  was  appointed  Assistant  Surgeon  to  St.  Bartholo- 
mew's Hospital  in  March,  1813,  and  succeeded  to  one 
of  the  principal  surgeoncies  in  May,  1824.  He  had 
previously  been  chosen  one  of  the  Professors  of  Ana- 
tomy and  Surgery  to  the  College  of  Surgeons,  and 
delivered  the  lectures  there  for  four  years.  For  several 
years  Mr.  Lawrence  lectured  on  surgery  at  different 
medical  schools,  his  celebrated  lectures  on  Physiology, 
Zoology,  and  Natural  History  of  Man  giving  r^ae  to  the 
charge  of  materialism,  as  well  as  being  the  subject  of 
severe  criticism.  The  Governors  of  the  Boyal  Hospi- 
tals at  Bethlehem  and  Bridewell  requested  the  author 
either  to  resign  his  appointment  as  surgeon  of  those  in- 
stitutions or  to  retract  his  convictions.  In  compliance 
with  this  demand  he  wrote  a  long  letter  expressing 
regret  at  having  pven  utterance  to  the  pernicious  doc- 
trines contained  in  the  lectures,  the  published  copies  of 
which  he  afterwards  sold  to  a  London  publisher  for  ex- 
portation to  this  country.  In  1826  the  deceased  made 
himself  conspicuous  in  his  opposition  to  the  Council  of 
the  Royal  College  of  Surgeons,  although  two  years  sub- 
sequently he  became  a  member  of  the  same  Council, 
having  been  elected  to  fill  a  vacancy  occasioned  by  the 
death  of  Sir  P.  M'Gregor,  and  in  1840  was  promoted  to 
a  seat  in  the  Court  of  Examiners.  Sir  William  Law- 
rence, who  was  a  member  of  many  learned  and  scien- 
tific societies,  both  at  home  and  abroad,  had  obtained 
the  highest  honors  which  can  fall  to  the  lot  of  a  surgeon. 
In  addition  to  those  already  mentioned,  be  had  been 
twice  elected  a  President  of  the  Royal  College  of  Sur- 
geons, viz.  in  1846,  and  again  in  1855.  On  the  pass- 
ing or  the  Medical  Act,  and  the  institution  of  a  Council 
of  Medical  Educati i>nand  Registration,  Sir  William  was 
nominated  by  the  Crown  a  member  of  that  body.  He 
wks  the  senior  sergeant-surgeon  of  the  Queen,  and  only 
a  few  months  since  was  created  a  baronet.  By  his  de- 
cease there  is  a  vacancy  in  the  Council  of  the  College 
of  Surgeons.  The  deceased  Baronet  leaves  a  son,  who 
is  a  member  of  the  College  of  Surgeons,  and  medical 
officer  in  the  Queen's  Indian  army,  as  well  as  two 
daughters. 


THE  CHOLERA. 

In  Europe. — The  official  accounts  of  the  cholera  hi 
Sicily,  dated  Palermo,  the  29th  of  June  and  the  4th  of 
July,  report  as  follows :  In  the  province  of  Girgenii. 
from  the  18th  to  the  27th  of  June,  2,573  attacks  and 
1,371  deaths;  Caltanisetta,  from  the  17th  to  the  27th, 
1,305  attacks  and  762  deaths;  Trapani,  firom  the  19th 
to  the  27th,  17  attacks  and  13  deaths;  Catania^  from 
the  23a  to  the  28th,  107  attacks  and  55  deaths.  For 
the  week  ending  July  4,  for  the  provinces  of  Catania, 
Caltanisetta,  Girgetti,  and  Trapani,  the  attacks  were 
2,383  and  the  deaths  1,421.  Palermo  and  Messina 
enjoy  perfect  health,  and  both  have  established  cordons 
against  infected  districts. 

In  the  United  States. — The  cholera  appears  to  have 
manifested  itself  decidedly  among  the  troops  at  Fort 
Larned  and  Dod^e,  and  still  prevails  at  Fort  Harker,  all 
of  whiciiare  stations  upon  the  great  "plains,'*  or  prairies 
of  the  West,  and  designed  more  particularly  as  defenoes 
against  Indian  depredations.  Exchanges  say  "it  is 
raging  fearfully  in  Ellsworth,  Kansas,  the  average  mor- 
tauty  being  ten  a  day.  The  place  is  ahnost  completely 
deserted.'* 

A  telegram  has  also  been  lately  received>at  tJie  War 

digitized  by  Google 


288 


THE  MEDICAL  RECORD. 


Department  from  Fort  Leavenworth,  Kanisas.  announc- 
ing the  death  of  Lieut.-Colonel  George  M.  McGill, 
Assistant  Surgeon  United  States  Army,  by  cholera, 
near  old  Fort  Lyon,  CJolorado  Territory,  on  the  20th 
ult  The  telegram  also  stated  that  two  companies  of 
the  Thirty-eighth  United  States  Infantry  passed  old 
Fort  Lyon  on  the  22d  ult.,  and  reported  having  had 
twenty  cases  of  cholera  and  seven  deaths  up  to  that  time. 

Another  account  states  that  "seven  cases  occurred 
in  one  family  at  Salina,  Ejmsas,  which  resulted  in  three 
deaths." 

In  the  lower  grounds  of  the  Mississippi  "Valley,  par- 
ticularly in  the  region  of  broken  lev^  and  neglected 
agricultural  interests,  the  pestilence  has  likewise  reared 
its  head.  The  same  is  true  of  Arkansas,  the  planta- 
tions in  the  vicinity  of  Pine  Bluff,  Des  Arc,  and  Helena 
having  been  sorely  visited.  A  planter  at  the  latter 
place  lost  twenty-five  hands  in  one  week.  The  mor- 
tality from  the  disease  at  Memphis,  Tenn.,  at  one  time 
reached  as  high  as  fifty  per  day,  but  has  since  visibly 
declined. 

In  our  own  city  there  have  been  no  importations 
from  abroad  alt!K)ugh  a  few  cases  have  been  returned 
to  the  Health  Board,  not  all  of  which,  however,  were 
regarded  as  authentic. 

MAnoHHKim's  Operatiok  for  Fistula  nr  Akc— ^ 
The  method  of  operating  is  as  follows : — ^The  patient  is 
placed  upon  the  side  in  which  the  fistula  is  located, 
while  an  assistant  elevates  the  opposite  buttock.  One 
of  the  extremities  of  a  wire  is  passed  into  the  external 
orifice  of  the  fistula,  and  brought  out  with  the  finger  of 
the  surgeon,  previously  introduced  by  the  rectum.  The 
two  extremities  of  the  wire  are  then  attached  to  the 
two  branches  of  the  ^croweur^  and  by  a  i«^id  turning  of 
the  screw  the  tissues  are  quickly  bound  and  crushed  by 
pressure.  The  dressing  used  consists  simply  of  charpie 
saturated  in  a  solution  ofnhenic  acid  (one  part  in  a 
hundred)  repeated  once  daily. — i\r.  0,  Medical  and  Sur- 
giccd  JaumaL    Biehmond  Medical  JottmalL 

M.  NAlatok  has  recently  been  named  a  member  of 
the  Institute,  and  has  also  i^eceived  frt>m  the  hands  of 
the  Prince  Imperial  of  France,  his  distinjguished  patient, 
the  insignia  of  Grand  Officer  of  the  Legion  of  Honor. 
X)n  the  latter  occasion  he  merely  called  upon  the  Prince 
at  St.  Cloud,  to  pay  him  his  usual  visit,  when  his  young 
patient  said  to  hmi.  "  Wait  a  little,  doctor,  I  have  some- 
thing to  give  you.'*  He  then  presented  the  cross  and 
ribbon  to  the  surgeon,  saying,  "  It  is  not  quite  new,  as 
my  father  has  worn  it  for  some  time.'*  M.  N61aton 
immediately  drove  to  the  Tuiieries  to  thank  the  Em- 
peror. E^  Migesty  confirmed  the  welcome  iauctf  and 
added,  '*  I  shall  never  forget,  doctor,  the  care  whidi  my 
son  has  received  firom  you."  It  womd  seem  impossible 
to  confer  a  signal  &vor  with  greater  delicaoy  and  grace. 
M.  Rayer,  formerly  Dean  of  the  Faculty,  is  the  only 
other  member  of  the  medical  community  m  France  who 
baa- been  invested  with  this  high  honor. 

TsAiNiNa  THB  YouHO. — ^Lct  us  here  for  a  moment 
linger  on  the  question,  what  would  happen  to  a  young 
horse  if  we  were  to  work  him  in  a  cart  as  soon  as  he 
was  one  year  old,  or  if  we  attempted  to  train  a  puppy 
as  soon  as  it  could  see.  The  result  would  certainly  be 
more  likely  to  produce  death  than  a  vigorous  adult  age. 
In  like  manner^  the  "forced"  intellect  soon  dies  out, 
and  if  the  prodiffy  of  the  youthful  nurseiy  survives  to 
be  a  man,  he  is  inostly  the  biggest  fool  of  the  family — 
while  he,  who  trom  oeing  the  greatest  dunce  was  let 
idone  whUe  young,  derelopes  into  the  sensible,  thou^ht- 
fhl,  and  plodding  man. — J)&.  Immam.  London  Medical 
Mrror. 


Photographs  or  thi  Presidents  akd  Aotino  Pbi- 
sn>ENTS  or  THE  American  Medical  Association. — It 
will  be  recollected  by  our  readers  that  at  the  last  meeting 
of  the  American  Medical  Association,  Prof.  Alden  March, 
of  Albany,  presented  to  the  association  a  photograph  of 
all  the  presidents  of  that  body,  which  he  had  taken 
great  pains  to  collect.  We  liave  recently  received  a 
complete  set  of  the  above,  twenty-one  in  all,  which 
have  been  admirably  reproduced  by  Messrs.  Jeffers  A 
McDonald,  of  619  Broadway,  Albany.  We  are  dad  to 
learn  that  Prof  March  having  generously  supplied  them 
with  the  negatives,  they  are  enabled  to  supply  the  pro- 
fession at  a  moderate  price.  The  collection  is  an  ex- 
ceedingly valuable  one,  as  many  of  those  representative 
men  have  passed  away.  The  likenesses  are  truthf^il 
and  well  executed. 

Is  Mt  Consultino  Phtsioian  a  Gentleman? — Dr. 
U.  R  Milner,  of  Jefferson  City,  La.,  in  a  communication 
to  the  Soti^em  Journal  of  Mediocd  Sciences  "on  the 
Professional  Manners  of  Physicians,"  makes  the  follow- 
ing remark,  which,  unfortunately  for  the  profession,  is 
a  well  deserved  renection  upon  me  character  of  many  a 
consulting  physician.  "  It  is  a  bane  of  the  profession, 
and  a  fact  attested  by  the  experience  or  observation  of 
%very  member  of  it,  that  at  tfiis  day  consultation,  which 
is  a  most  valuable  auxiliary  to  successful  practice,  and 
when  properly  conducted  and  appreciated,  an  invaluable 
boon  to  afflicted  man,  is  made,  eieht  times  out  of  ten, 
the  opportunity  of  one  party  or  the  other  to  injure  the 
other  either  by  insinoation  of  some  sort  or  by  downright 
slander.  What  manners  I  And  what  is  the  effect? 
Consultations  are  shunned  and  i^ored,  and  a  general 
distrust  is  engendered.  If  a  high-toned,  honorable 
gentleman  and  doctor  is  forced  to  have  constiltation, 
and  some  one  is  proposed  and  preferred  by  the  indivi- 
dual or  familv  whom  be  does  not  know,  the  first  ques- 
tion he  asks  himself  is,  *  Is  he  a  gentleman  ? ' " 

CoNSANoiTiNBous  Marriagss. — ^Dr.  Robert  Newman, 
of  this  city,  having  been  i^pointed  at  the  late  meeting 
of  the  **  Medical  Society  of  the  State  of  New  York,^ 
upon  a  Committee  to  investigate  and  report  upon  the 
result  of  consanguineous  marriages,  asks  of  his  profes- 
sional brethren  answers  to  the  following  questions,  which 
ma^  be  transmitted  to  him,  118,  West  Houston  streetL 
before  November  next:  Name  ^itial)  and  age  of 
husband,  nativity,  age  when  married,  constitu- 
tion, health,  deformities,  peculiar  diathesis,  health  of 
his  family,  hereditary  diseases,  deformities,  <Stc.,  Name 
(initials)  and  age  of  wife,  nativity,  age  when  marri- 
ed, constitution^  health,  deformities,  peculiar  diathesia, 
health  of  her  family,  hereditary  diseases,  deformities, 
&C.  How  are  thej^jBrties  relatea  to  each  other?  How 
long  married?  How  many  children,  or  sterility? 
Abortions ;  cauSe ;  how  many,  and  at  what  period  ? 
Children  died,  at  what  ages  and  from  what  duseasee  ? 
The  constitution,  age  and  present  health  of  living 
children,  deformities,  mental  conditions,  idiocy,  cretin- 
ism, deaJ^  mute,  blind,  epilepsy,  albinism,  insane,  d(c, 
Remarks  and  other  information. 

It  will  be  seen  that  these  questions  are  very  com- 
prehensive in  their  scope,  and  as  answer  accurately 
given  will  help  to  dear  up  itianv  unsettled  points  we 
ope  an  who  are  able  to  ffive  him  any  inmrmation, 
especially  those  residing  in  mis  State,  will  do  so  in  the 
assurance  that  the  material  fiimi^ed  will  be  prop- 
eriy  used. 

A  New  Item  nr  a  Bill. — One  charge  in  a  lawyer^ 
bill  against  a  client  was,  "  For  waking  up  In  the  ni^t 
and  thinking  of  your  business — ^five  dollfurs."  H^w 
man^  such  items  could  with  etpxal  propriety  find  their 
w^  into  the  bills  of  the  physician? 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


28Q 


©riginal   Communitafwng. 

SOME  CONSIDERATIONS 

IN  REGARD   TO   TDE 

TREATMENT  OF  HIP-JOINT  DISEAS^,. 
By  CHARLES  F.  TAYLOB,  M.D., 

OP  HBW  TOBK. 

The  question  is  often  asked  me,  "  What  is  your  ex- 
pedience in  the  use  of  the  splint  in  hip-joint  disease  ?  " 
**  Do  you  find  the  results  as  satisfactory  as  we  have 
been  led  to  expect  by  those  who  have  been  the  chief 
advocates  of  the  counter-extension  plan  of  treatment?  " 
Thesse  questions  not  only  evince  a  disappointment  in 
practice  with  the  splint,  but  imply  a  doubt  as  to  the 
principles  of  treatment  Not  long  ago  an  eminent 
surgeon  who  has  had  abundant  opportunities  for  witness- 
ing the  results  of  the  splint  treatment  as  practised  by 
a  prominent  advocate  expressed  to  me  his  entire  dis- 
belief in  its  efficacy. 

My  own  experience  with  this  mode  of  treatment 
having  been  entirely  satisfactory,  I  propose  to  give 
gome  reasons  (as  they  appear  to  me)  for  the  frequent 
failures  in  its  use,  together  with  my  Own  method  of 
procedure. 

I  believe  that  the  majority  of  failures  in  the  use  of  the 
counter-extension  splint  are  owing  to  the  inefficiency 
of  the  instrument  employe:!,  and  to  aprac'ical  disregard 
of  the  true  end  to  be  sought  by  its  use. 

An  apparatus,  like  a  remedy,  should  be  the  embodi- 
ment of  an  idea.  In  the  making  up  of  a  prescription, 
or  the  construction  of  an  appiratu*?,  every  element 
should  contribute  to  the  completeness  of  the  whole. 
We  may  have  antagonistic  mechanical  forces  as  well  as 
incompatibles  in  dru^s.  In  proposing  any  medical 
means  we  should  ask  ourselves— 1st.  "What  is  the 
ultimate  object  to  be  accomplished  ?  "  2d.  "  What  are 
the  simplest  means  of  accomplishing  the  object  ?  "  3d. 
**  What  are  the  elements  whsch  contribute  towards  the 
end  sought?"  4th.  "What  are  the  elements  which 
may  interfere  with  that  end,  or  which  may  be  incom- 
patible with  it?" 

We  must  correctly  answer  these  questions  before  we 
can  reach  general  success  in  a  proposed  treatment. 

Let  us  analyze  the  objects  to  be  secured  by  the 
counter-extension  splint. 

Dr.  H.  G.  Davis  first  devised  "the  splint"  The 
object  was  counter-extension  with  locomotion. 

Simple  counter-extension  had  been  used  before. 
Locomotion  would  secure  for  the  patient  fresh  air, 
exercise,  appetite,  digestion,  health,  provided  the  splint 
were  sufficient  to  arrest  the  disease.  In  Dr.  Davis's  hands 
we  will  say  it  has  been  thus  efficient.  But  his  instru- 
ment contained  several  elements  incompatible  with  the 
main  object  sought— efficient  counter-extension — and 
which  interfered  with  its  success  in  hands  not  accus- 
tomed to  overcoming  the  difficulties  inherent  in  the 
apparatus. 

In  the  old  splint  the  ligaturing  of  the  thigh  by  the 
perineal  str&p  made  it  always  difficult,  and  often  impos- 
sible for  the  patient  to  bear  sufficient  force  to  accomplish 
the  purpose  m  view.  This  was  partially  remedied,  how- 
ever, bv  the  cross-piece  and  joint  proposed  by  me,  and 
which  have  been  universally  adopted. 

Again,  "continued  elasiic  extension"  contains  an 
almost  fatal  element  ^^JElasHc*'  (India-rubber  "elas- 
tic ")  extension  is  incompatible  with  muscular  extension. 
If  the  muscles  overcome  resistance  they  are  not  ex- 
tended. If  the  resistance  is  so  great  that  the  muscles 
are  obhged  to  yield,  then  the  extension  is  not  "  elastic  " 


to  the  muscles,  whatever  it  might  be  to  a  greater  force. 
"  Elastic  "  extension  applied  to  muscles  is  an  absurdity. 
Either  the  resistance  is  so  great  that  it  requires  more 
than  the  force  of  the  muscles  to  cause  it  to  exhibit  its 
elasticity  when  it  is  not  elastic  to  the  force  the  muscles 
possess,  or  the  elasticity  of  the  rubber  yields  and  the 
actital  resistance  is  made  by  the  webbing  surrounding 
the  rubber.  In  either  case  the  actual  resistance  is  non- 
elastic.  But  even  if  elastic  resistance  were  not  incom- 
palible  with  muscular  extension,  it  would  be  rendered 
so  by  the  incompetency  of  the  matei  ial  used.  India- 
rubber  has  no  definite  resisting  force  except  under  com- 
pression and  equable  temperature.  But  India-rubber 
strings  incorporated  in  webbing  become  softened  and 
attenuated  by  the  heat  of  the  body,  and  do  not  re?ain 
for  many  minutes  the  resistance  they  had  when  applied. 
It  is  its  wonderful  facility  for  becoming  stretched-out 
and  utterly  useless  which  makes  success  of  compara- 
tively easy  attainment  with  the  use  of  rubber.  So 
much  for  "  elastic  extension  "  in  overcoming  muscular 
action.  In  regard  to  its  effect  upon  the  diseased  joint 
it  is  even  m6re  ineffective  for  good. 

The  splint  is  used  in  preference  to  confinement  with 
the  weight  and  pulley,  on  the  theory  that  it  gives  equal 
protection  and  immunity  to  the  joint  with  the  advan- 
tage of  fresh  air  and  exercise.  But  how  can  it  protect 
the  joint  if  the  extension  be  elastic  ?  Whenever  the 
force  of  progression  happens  to  be  for  the  moment 
greater,  then  the  extension  suddenly  yields  and  ceases 
to  afford  protection  at  the  very  time  when  it  is  most 
needed.  Hence  the  joint  is  liable  to  successive  concus- 
sions with  the  varying  force  thrown  upon  the  unequal 
resistance. 

Here,  also,  the  only  salvation  is  the  fact  that  the 
rubber  straps  soon  stretch  out  and  become,  in  effect, 
inelastic. 

The  simple  truth  is  that  muscles  yield  readily  to 
firm,  unyielding  resistance,  and  this  only  should  be  used 
to  overcome  their  action. 

Thus  much  for  some  of  the  elements  operating  at  the 
pelvic  end  of  the  splint. 

The  lower  end  is  attached  by  adhesive  straps.  I  will 
not  discuss  the  plan  of  making  tract  on  from  the  foot, 
because  I  cannot  see  how  such  a  plan  could  be  seriously 
adopted.    Its  inefficiency  most  be  apparent 

Shall  motion  be  allowed  at  the  knee — in  other 
words,  shall  the  instrument  reach  to  the  knee,  or  to 
the  ankle?  In  1860,  before  1  had  ever  treated  a  case 
of  hip  disease,  my  attention  was  called  to  the  subject  in 
consequence  of  the  discussions  going  on  at  the  time. 
I  then  devised  the  short  instrument,  which  has  since, 
for  some  unaccountable  reason,  been  labelled  with  Dr. 
Lewis  A.  Sayre's  name.  Inferring  that  the  length  of 
the  instrument,  with  the  preventing  of  motion  at  the 
knee,  was  for  the  purpose  of  securing  greater  room  for 
applying  the  adhesive  straps,  I  reasoned  that  more 
surface  could  be  found  inside  the  thigh  than  below  the 
knee,  with  the  apparent  advantage  of  allowing  free 
motion  at  the  knee.  A  cut  of  this  apparatus  was  pub- 
lished in  the  Medical  Times  of  July  20,  1861. 

My  first  case  satisfied  me  that  my  reasoning  in 
regard  to  it  was  fallacious.  In  tlie  first  place,  experi- 
ence proves  that  there  are  decided  advantages,  with  no 
important  disadvantages,  in  preventing  motion  at  the 
knee.  Primarily  it  is  an  advantage  (when  counter-ex- 
tension is  complete,  but  not  otherwise),  to  cause  the 
motion  of  progression  to  be  at  the  hip  instead  of  the 
knee,  as  it  would  be  if  the  latter  were  not  confined. 
Again,  it  is  utterly  impossible  to  keep  on  the  adhesive 
straps  while  the  muscles  of  the  thigh — an  inverted  cone 
itsefr— are  altematelv  shrinking  and  swelling  beneath 
them  in  moving  the  leg.     The  straps  will  slip  off.  t 

Digitized  by  ^ J.*^^ 


290 


THE  MEDICAL  RECORD. 


Dr.  Prince  says  it  is  a  "  beautiful  little  instrument ;  '* 
and  so  it  is ;  but  it  is  good  for  nothing,  being  practi- 
cally inefficient  except  with  an  amount  of  attention 
seldom  given  any  case.  I  did  cure  one  case  with  it, 
but  I  saw  my  patient  daily  for  months,  and  the  waste 
of  adhesive  plaster  was  enormous. 

Another  serious  objection  to  the  short  instrument  is, 
that  it  is  impossible  to  secure  so  good  extension  of  the 
thigh  upon  the  pelvis :  that  is,  the  flexor  muscles  can* 
not  be  so  well  extended  as  they  can  be  with  the  long 
splint.  But  even  with  the  long  splint  we  have  this 
disadvantage,  viz.  that  the  adhesive  straps  will  yield, 
relax,  and  slide  more  or  less,  requiring  constant  watch- 
ing and  re-adjustment  of  tiie  apparatus;  and  this  is 
particularly  the  case  where  the  patient  is  allowed  to 
walk  about. 

In  such  circumstances  the  adhesive  straps  must  not 
only  keep  up  extension,  but  are  forced  at  each  step  to 
bear  the  weight  of  the  body  in  addition.  A  slight 
relaxing  of  these  straps  taking  place,  there  is  no  more 
extension ;  and  as  they  always  do  relax  or  slide  more 
or  less,  let  me  ask  here,  what  becomes  of  the  theory 
that  the  head  of  the  femur  is  partially  *'  drawn  out "  of 
the  acetabulum  ?  Is  the  rehef  derived  fi  om  the  splint  in 
consequence  of  this  alleged  fact?  What  with  the 
relaxing  of  the  adhesive  straps  and  the  "  elastic "  ex- 
tension, we  should  have  a  continual  churning  motion  in 
the  socket  which  would  not  be  very  favorable,  one 
would  tliink,  to  the  diseased  joint  I 

Employing  more  force  in  these  cases  than  practi- 
tioners generally  do,  I  am  yet  incredulous  about  the 
alleged  "  drawing  out/''  of  the  head  of  the  bone.  I  do 
not  believe  it  occurs,  or  ought  to  occur,  nor  do  I  beUeve 
that  it  would  be  anything  but  harmful  if  it  did  occur. 

The  sole  object  of  counter-extension  is  to  destroy  the 
tonicity  of  the  muscles  about  the  hip-joint.  This  destruc- 
tion of  tonicity  gives  relief  and  motion,  and  is  all  we 
can  do  by  mechanical  means  for  this  disease.  If  we 
can  do  it,  and  still  allow  the  patient  fresh  air  and 
exercise,  so  much  the  better.  And  this  should  be  our 
aim,  and  until  we  have  fully  accomplished  it,  we  have 
not  realized  the  benefit  of  counter-extension  treatment 
at  all.  If  a  splint  or  weight  be  applied  it  may  assist  in 
keeping  the  limb  steady  and  quiet,  and  in  that  way  the 
patient  may  improve ;  but  the  improvement  is  due  to 
the  cbnfinement  and  protection  from  motion,  rather 
t!r.n  to  counter-extension  and  motion,  which  latter  are 
the  two  sources  of  benefit  when  counter-extension  is 
efficient.  I  repeat,  the  muscular  tonicity  must  be 
temporarily  destroyed.  The  counter-extension  must  be 
carried  to  that  point. 

And  here  we  have  a  certain  guide  as  to  the  amount 
of  force  to  be  used  and  the  extent  to  which  it  is  to  be 
canied.  When  we  have  destroyed  tonicity,  our  chief 
labor  is  done.  Afterwards  we  need  only  use  force 
enough  (which  will  be  relatively  small)  to  keep  up  the 
flaccid  condition  of  the  muscles  till  the  disease  sub- 
sides. We  might  even  temporarily  dispense  with  the 
splint  altogether,  except  that  when  the  extension  is 
entirely  suspended  the  muscles  quickly  recover  their 
tonicity;  and,  besides,  the  weight  of  tae  1  ody  would 
not  be  supported  in  locomotion  if  the  splint,  or  some 
form  of  crutch,  were  not  used.  This  explains  how  a 
case  may  progress  favorably  with  the  unequal  exten- 
sion which  is  inevitable  with  the  splint,  provided  the 
muscles  have  first  been  relaxed  by  diminishing  their 
tonicity.  In  such  cases  we  do  not  have  those  contrac- 
tions which  are  apt  to  follow  (even  when  they  are 
prevented  from  accompanying)  the  active  stage  of  the 
disease.  It  may  be,  and  generally  is,  followed  by 
weakness  of  the  muscles  about  the  joint,  which  may 
require  special  treatment  to  restore  their  tonicity.    This 


is  a  sacrifice  we  must  make  to  the  greater  good  of 
arresting  the  diseased  action  in  the  joint.  On  the 
other  hand,  if  contractions  accompany  or  follow  the 
disease,  we  may  be  sure  that  our  counter-extension 
has  been  inefficient,  and  therefore  worthless  as  such ; 
and  that  the  improvement,  if  any,  is  due  to  the  quiet 
fixation  of  the  joint,  which  the  splint  has  been  a  con- 
venient means  of  accomplishing.  And  I  suspect  this 
is  very  often  the  case  in  the  use  of  both  splint  and 
pulley. 

I  have  mentioned  as  one  serious  objection  to  the 
short  splint,  the  irapossibiUty  of  acting  adequately  on 
the  flexor  muscles.  Both  long  and  short  splints  pos- 
sess a  grave  fault,  in  the  impossibility  of  a<?ting  on  the 
adductor  muscles.  In  fact,  the  position  of  botti  on  the 
outside  of  the  leg  rather  favors  adduction  of  the  leg, 
and  there  certainly  is  no  possible  way  of  specially  ex- 
tending the  adductor  muscles,  the  ones  most  particu- 
larly influenced  by  contractions.  They  can  simply 
extend  in  the  direction  of  the  thigh,  acting  with  equal 
force  on  the  already  extended,  as  well  as  contracted, 
musclea  They  do  not  sufficiently  tend  to  correct 
deformity  after  it  has  begun ;  hence  a  great  deal  of  force 
used  is  wasted,  from  the  sheer  impossibility  of  actually 
antagonizing  a  contracted  muscle. 

Now,  if  we  could  bring  our  force  to  act  directly  on 
the  contracted  muscles  (the  adductors,  for  instance),  a 
relatively  small  amount  of  force  would  overcome  them, 
and  t'e  point  would  be  gained  at  once,^  for  the  other 
muscles  are  already  extended  by  their  position.  Hence 
I  have  used  for  several  years  an  apparatus  with  two 
perineal  bands.  The  "cross  piece  at  the  top  is 
carried  nearly  around  the  pelvis  to  the  opposite  side,  so 
that  it  becomes  a  hip-ftaTwi.  The  steel  is  extended 
far  enough  for  fastening  to  it  the  perineal  strap— about 
three-fourths  of  the  circumference  of  the  hips — and 
terminated  by  a  leatMer  str«p.  Sometimes  there  is  an 
abduction  screw  at  the  joint,  between  the  hip  band  and 
splint,  but  experience  proves  that  all  the  motion 
required  can  be  secured  by  regulating  the  perineal 
straps.  Tightening  the  opposite  strap  would  or  course 
abduct  the  thigh  and  act  directly  on  the  adductor 
muscles.  By  thus  having  every  action  of  the  joint 
under  control  of  the  instrument,  we  are  enabled  to 
accomplish  a  definite  purpose  and  secure  better  results 
with  less  force. 

There  is  another  great  advantage  in  having  two  peri- 
neal straps.  The  danger  of  abrasion  of  the  skin  is 
diminished  more  than  one-half,  and  if  it  should  become 
sore  we  can  loosen,  or  even  take  off,  the  strap  of  one 
side,  the  action  of  the  instrument  being  temporarily 
kept  up  by  the  other  strap.  We  thus  add  to  our 
resources  against  accidents. 

This  arrangement  of  double  perineal  straps  (anJ,  when 
necessary,  abduction  screw)  seems  to  make  the  upper 
end  of  the  ephnt  very  satisfactory,  if  not  perfect  in  its 
action,  for  it  enables  us  to  realize  without  delay  or  in- 
direction the  object  of  the  treatment — the  reduction  and 
often  temporary  destruction  of  muscular  tonicity, 
especially  of  Hie  muscles  most  contracted.  But  there  is 
still  the  difficulty  oi  keeping  up  sufficient  uniformity  of 
extensi4)n,  especially  with  active  patients,  after  the  sub- 
sidence of  the  acute  symptoms. 

In  spite  of  the  utmost  care  there  will  be  motion  at 
the  lower  end  of  the  splint,  and  a  tearing  loose  of  the 
adhesive  straps  at  the  bottom,  which,  with  the  frequent 
want  of  care  on  the  part  of  the  patient's  attendants, 
after  improvement  seems  to  be  assured,  causes  a 
liability*  to  too  much  concussion  in  the  joint,  and  a 
regainmg  of  tonicity  of  the  muscles  and  thus  hindrance 
to  the  most  favorable  progress  of  the  case.  Still  there 
is  not  so  often  actual  recurrence  of  tl^e  disea?e^  once 

Digitized  by  VjOOQ IC 


THE  MEDICAL  RECORD. 


291 


subdued,  as  prolonged  recovery  with  chronic  irritability 
in  the  joint,  as  shown  by  lingering  tendency  to  rontrae- 
tioM  of  the  muscles.  While  the  patient  is  quiet,  there 
is  not  the  least  difficulty  in  accomplishing  all  that  is 
desired  with  the  splint  just  described.  Only  when  the 
patient  throws  his  weight  upon  the  splint  in  walking 
do  we  find  the  adhesive  straps  insufficient  to  re<ist  for 
any  length  of  time  the  severe  and  unequal  strain  thus 
thrown  upon  them. 

In  other  cases,  as  disease  of  the  knee  and  ankle,  and  dis- 
location of  the  hip-joint,  I  have  been  in  the  habit  of  using 
what  may  be  called  the  expectant  treatment  A  simple 
apparatus  is  made,  attached  to  the  shoe  and  extcndmg 
to  the  perineum,  where  it  terminates  in  a  well  padded 
crutch,  turned  outward  so  as  to  rest  under  the  ischium. 
The  apparatus  is  made  a  little  longer  than  the  leg — with 
a  contrivance  for  extending  when  needed — so  that  in 
standing  or  walking  the  heel  never  reaches  the  ground, 
and  of  course  the  whole  weight  of  the  body  rests  on 
the  instrument.  Tlie  patient  then  has  motion  of  the 
joint,  but  no  weight  is  thrown  upon  it.  The  result  of 
this  protectine^,  ezpectani  treatment,  has  been  so  satis- 
factory, that  It  suggested  the  idea  of  incorporating  it 
with  the  counter-extension  hip-joint  splint.  The  result 
is  shown  in  the  accompanying  figure.     The  splint  is 


extended  to  the  bottom  of  the  foot  and  turned  under 
it,  from  which  position  extension  is  made.  Adhesive 
straps  are  applied  to  hoik  sides  of  the  whole  leg,  in 
the  usual  manner,  the  inside  strap  terminating  in 
a  buckle  (a)  and  the  outside  strap  terminating  in  a 
short  piece  of  webbing,  which  is  passed  through  a  slit 
in  the  apparatus,  thence  under  the  foot  through  an- 
other slit  (c)  at  the  end  of  the  foot  piece,  and  buckled 
to  the  inside  strap  just  above  the  internal  malleolus. 
Thus  extension  is  made  from  the  bottom  of  the  foot. 
Thus,  also,  when  the  patient  attempts  to  walk  it  is  the 


instrument  which  strikes  the  ground  and  sustains  his 
weight,  without  in  the  least  increasing  the  strain  on  the 
adhesive  straps.  In  fact  it  is  an  ever  present  crutch, 
allowing  motion  of  the  joint,  but  not  allowing  weight 
to  be  borne  on  it.  Extension  is  kept  up  continually, 
more  surface  is  allowed  for  the  adhesive  straps,  and 
only  the  legitimate  strain  is  ever  thrown  upon  them — 
that  which  antagonizes  muscular  action — but  never  the 
weight  of  the  body.  There  is  one  other  advantage 
which  this  instrument  has  over  others.  Usually  we 
have  to  depend  much  on  the  care  and  judgment 
of  others — the  patient's  parents,  friends,  and  nurses. 
With  the  splint  terminating  in  the  middle  of  the  leg 
there  is  no  definite  point  where  it  should  be,  and 
hence  no  guide  to  the  eye  or  definite  indication  by 
which  inexperienced  persons  can  know  if  the  apparatus 
is  properly  acting.  Hence  the  difficulty  of  getting  the 
most  careful  directions  carried  out.  But  by  the  crutch 
and  extension  splint  combined,  the  patient  himself 
knows  at  once  if  the  instrument  is  acting  or  not.  The 
least  slipping  or  relaxing  of  the  straps  makes  it  longer 
under  his  foot,  and  impedes  his  walking,  and  he  desires 
it  readjusted.  But  even  if  it  were  not  actually  extend- 
ing the  hip — and  after  the  tonicity  of  the  muscles  is 
cnce  overcome,  it  often  need  not — the  patient  is 
entirely  safe  from  the  pressure  of  weight  and  concussion 
in  the  joint  He  waits,  but  the  leg  hangs  suspended. 
Indeed,  many  have  advised,  as  I  sometimes  have  when 
circumstances  were  such  that  nothing  better  could  be 
done — patients  to  wear  a  thick  sole  on  the  foot  of  the 
weU  leg  and  use  crutches,  letting  the  lame  leg  han^'. 
The  only  difficulty  is  in  carrying  the  plan  into  practice 
with  sufficient  perseverance  and  uniformity.  If  the 
crutch  can  be  attached  to  the  leg  as  in  this  instrument, 
p.nd  concealed  from  view,  and  always  ready  with  its  pro- 
tection, the  results  of  the  expectant  treatment  might  be 
better. 

One  word  about  applying  adhesive  straps.  I  have 
seen  several  legs  irretrievably  spoiled  by  applying  the 
straps  on  the  leg  only,  neglecting  to  include  the  thigh. 
This  has  generally  been  done  where  the  treatment  had 
been  by  the  weight  and  pulley.  Force  enough  to  relax 
the  powerful  muscles  abt)ut  the  hip-joint  must  be  liable 
to  pull  asunder  the  weaker  ones  at  the  knee  and  ankle, 
if  traction  be  made  only  froup  the  foot  or  leg.  I  have 
seen  great  injury  resiilt  from  such  thoughtlessness,  tlie 
patients  recovering  from  the  hip  disease  only  to  find 
themselves  crippled  for  life  with  knees  so  weakened  as 
to  be  wholly  umible  to  sustain  them.  Under  all 
circumstances  the  straps  ought  to  embrace  as  much  of 
the  thi^h  as  possible.  Let  no  one  understand  me  as 
intimating  that  with  the  best  appliances  disease  of  the 
hip-joint  is  easy  to  cure,  or  to  treat.  Not  so.  Success 
is  only  to  be  obtained — I  mean  tlie  best  success,  which 
is  the  only  result  we  ought  to  be  satisfied  with — by 
diligence,  care,  and  perseverance. 

A  perfect  splint,  even  if  that  were  attainable,  is. 
not  enough.  There  is  no  magic  in  surgical  apparatus, 
let  them  be  never  so  cunningly  devised.  They 
should  have  a  function  corresponding  to  our  idea  of  the 
requirements  of  the  case.  Unless  we  dIUgently  attend 
to  httle  details,  we  c;mnot  expect  the  best  results. 
Succeas  is  generally  in  the  ratio  of  our  eflforts  to  se- 
cure it 

•  » • 

Intestinal  Absorption. — According  to  Letzerich  ( Vir- 
chow's  ArchiVj  xxxvii.  232),  fat  and  albumen*  are  not 
absorbed  by  the  epithelium  of  the  intestine,  but  by  va- 
cuoles between  the  epithelial  cells,  which  lead  directly 
from  the  intestine  into  the  lacteab.  Fat  in  the  epi- 
theUum  he  considers  pathological,  and  generally  due  to 
excess  of  fat  in  the  food.  f^  r^r^r^]r> 

Digitized  by  VjOOQIC 


292 


THE  MEDICAL  RECORD. 


THE  PROTECTIVE  USE  OF  QUININE. 
By  STEPHEN  ROGERS,  M.  D. 

KKVr  TORK. 

It  must  have  been  brought  home  to  the  appreciation  of 
meat  people,  who  have  devoted  their  time  and  brains  to 
the  investigation  of  any  Bubject^  that  popular  errors 
relating  to  lb  at  subject, — ^and  bavmg  their  origin  in  the 
published  conclusions  of  unqualified  observers,  or  ob- 
servers of  too  limited  experience — are  most  obstinate 
things  to  overcome.  Tlie  practical  confusion  which 
one  witnesses  in  the  popular,  as  well  as  the  profes- 
sional mind,  resulting  tiom  these  publications,  is  often 
vexatious  and  disheartening  to  the  studious  investiga- 
tor and  author. 

These  reflections  were  again  called  forth  by  the  peru- 
sal of  an  extract  from  the  Nashville  Journal  of  Mediane 
and  Surgery^  published  in  the  Record  of  July  15. 
under  the  title  of  "  Quinine  as  a  preventive  of  malarial 
fever." 

As  that  extract  contains  unwarrantable  statements, 
is  too  indefinite  and  confused  to  serve  as  a  guide  to 
either  practitioner  or  layman,  and  is  therefore,  in  my 
opinion,  a  dangerous  piece  of  medical  literature.  I 
oflfer  you  the  following  extract  from  my  memoir  upon 
the  uses  and  virtues  of  quinine,  published  in  the  Trans- 
actions of  Medical  Society  of  the  State  of  New  York  for 
1862.  I  therein  treat  of  the  uses  of  quinine  in  mias- 
matic disease  in  the  following  order,  viz.  first,  its  pro- 
tective uses ;  that  is,  to  protect  from  miasmatic  infec- 
tion. Second,  its  preventive  uses ;  that  is,  to  prevent 
paroxysms  oi  miasmatic  disease  after  infection  has 
taken  place.  Third,  its  curative  uses ;  that  is,  to  cure 
miasmatic  disease  during  the  paroxysm.  As  your  pub- 
1  shed  extract  from  Dr.  White's  report  involves  the 
principles  set  forth  in  my  first  subdivision,  I  send  you 
that  portion  only  which  reads  in  substance  as  follows : 

Among  the  first,  if  not  the  first  danger  the  emigrant 
is  exposed  to  on  his  arrival  in  a  miasmatic  locality,  is 
that  attending  the  fever  known  by  the  various  names, 
lemittent,  bilious  remittent,  climatorial,  acclimating, 
climatic,  and,  as  I  prefer,  yJr*/  miasmatic  fever. 

Consequently,  the  first,  the  invariable,  and  the  in- 
evitable mquiry  is,  what  can  be  done  to  avoid  it?  And 
eminently  proper  are  such  inquiries,  for,  with  com- 
paratively rare  exceptions,  the  paioxysms  of  this  first 
miasmatic  fever  are  by  far  the  most  severe  and  imme- 
diately dangerous  of  any  the  individual  will  ever  suffer 
however  long  he  may  remain  in  the  unhealthy  region. 

This  is  ihe  fever  which,  both  in  the  West  and  in  the 
East  Indies,  in  Africa  and  in  tropical  America,  has 
given  the  terrible  character  to  tropical  fevers  which  is 
prety  universally  entertained.  It  is  of  paramount  im- 
portance then  for  the  recently  arrived  resident  to  adopt 
all  possible  means  to  escape  this  particularly  dangerous 
first  attack.  But  the  query  aiises,  as  he  is  to  become  a 
permanent  resident,  will  he  not  sooner  or  later  certainly 
suffer  his  first  and  severe  type  of  fever  ? 

The  law  relating  to  this  first  miasmatic  fever,  is 
similar  to,  or  identical  with  that  observed  by  yellow 
fever,  viz.  the.longer  one  resides  in  the  locality  where 
it  is  suffered,  the  less  liable  he  becomes  to  it,  so  that 
while  in  the  case  of  yellow  fever  he  may  escape  it 
altogether,  in  miasmatic  disease,  though  he  may  at 
a  later  date  suffer  mild  paroxysms  often,  yet  tlie  first 
violent  climatorial  attack  he  escapes  altogether. 

In  both  cases  a  species  of  toleration  of  the  surround- 
ing influences  is  acquired,  their  poisonous  impression 
upon  the  sensorium  is  lessened ;  so  that  in  the  one 
ca?e  the  disease  is  escaped  altogether,  and  in  the  other 
the  intense  and  destructive  character  of  Uie  paroxysms 


of  the  early  attacks  is  not  witnessed,  except  in  rare 
cases. 

This  fact  was  stated  by  Dr.  James  Johnson,  to  be  the 
result  also  of  a  continuous  high  temperature ;  and  he 
attempted  to  employ  this  opinion  in  explanation  of  the 
fact  tnat  Europeans  do  not  suffer  yellow  fever  in  the 
East  Indies,  they  becoming  "  seasoned,"  as  he  termed 
it,  by  the  long  sea  voyage  in  the  tropics. 

Recorded  experience,  however,  destroys  this  wgu- 
ment  of  Dr.  Johnson.  I  am  acquainted  with  the  feet 
that  persons  who  have  crossed  the  tropics  twice  on 
the  voyage  out,  and  cruised  for  months  in  the  tropical 
zone,  have  siill  taken  yellow  fever  when  exposed  in 
infected  localities  on  the  Paciflc  coast  of  this  continent. 

In  miasmatic  poison,  time,  as  well  as  infected  locality, 
is  also  requisite  for  this  acclimating  process.  How  is 
it  to  be  secured  in  necessary  amount  and  with  any 
degree  of  certainty  ?  I  do  not  hesitate  to  reply,  thaX 
it  can  be  done  by  the  proper  employment  <  f  quinine. 

Let  us  not  fall  into  the  delusion,  however,  of  sup- 
posing that  this  is  an  invariably  necessary  agent ;  for 
it  is  a  fact,  that  time,  toleration  of  the  poison,  and 
acclimation,  are  not  infrequently  secured  without  any 
aid  from  the  medical  art.  Some  favoring  circum- 
stances, such  as  removal  from  the  infected  locality 
during  hours  of  sleep  j  or  short  periods  of  exposure  at 
long  intervals ;  or  some  peculiar  resisting  force  of  con- 
stitution, may  carry  one  along  for  months,  and  thus 
secure  him  a  mild  miasmatic  attack.  But  quinine,  when 
given  in  doses  sufficiently  large  to  interfere  i\dth  the 
depressing  influences  of  the  miasmatic  poison,  will 
undoubtedly  protract  the  period  between  the  first 
exposure  and  the  development  of  the  first  paroxysm  bo 
much,  as  to  secure  the  constitutional  change  required 
for  tne  modification  of  the  febrile  symptoms.  High 
authorities  have  promulgated  very  confused  ideas  upon 
this  very  point. 

For  example,  the  United  States  Sanitary  Commission 
have  adopted  the  doctrine,  that  if  quinine  have  not  the 
effect  of  arresting  the  paroxysms,  '*  it  will  always  render 
the  disease  milder."  Now^  I  believe  it  does  so  in  an 
indirect  way  only,  that  is,  by  giving  the  exposed 
person  time  for  acchmation,  as  above  explained.  I 
have  never  had  reason  to  believe  that  the  simple 
introduction  of  quinine  into  the  system  daily  for  an 
indefinite  time,  is  followed  by  any  such  modiffcation  of 
the  febrile  paroxysms  necessarily. 

Were  this  the  case,  persons  dosed  with  tin's  drug 
for  a  time  before  ^eir  exposure  to  the  miasmatic 
poison,  would  have  a  mild  form  of  the  fever  whether 
they  continued  to  take  it  after  the  exposure  commenced 
or  not. 

I  have  no  knowledge  of  any  experimental  observa- 
tions which  tend  to  establish  any  such  doctrine  as  thww 

My  experience  in  this  matter  has  thoroughly  con- 
vinced me,  that  the  law  is,  that  the  longer  the  quinine 
taken  enables  the  person  to  escape  the  first  miasmatic 
fever,  the  more  will  its  paroxysms  be  modified,  and  the 
milder  will  the  attack  become.  The  converse  of  this 
would  be,  that  whatever  the  quantity  of  quinine  taken, 
should  the  fever  notwithstanding  come  on  early,  no 
such  amelioration  of  its  character  will  be  experienced ; 
but  it  will  be  in  every  respect  a  true  acclimatmg  fever. 

So  uniformly  did  it  result,  that  the  person  who— by 
reason  of  any  of  the  favoiing  circumstances  herein 
enumerated — passed  a  month  or  two  in  miasmatic 
exposure  before  suffering  his  first  attack,  had  it  in  a 
more  or  less  modified  form,  that  when  I  saw  a  person 
newly  arrived  in  the'  country,  passing  thirty  or  forty 
days'  exposure  without  symptoms  of  fever.  I  could  pre- 
dict with  almost  absolute  certainty  that  wnen  his  fever 
did  come,  it  would  be  in  a  mild  formr^  T 

__  _,v:.oogle 


THE  MEDICAL  RECORD. 


203 


Now,  the  indefinite  protection  of  the  person  from 
miasmatic  infection,  and  of  course  the  power  to  post- 
pone in  like  manner  the  first  attack  of  fever,  is  unques- 
tionably possessed  by  quinine,  and  this  is  what  should 
be  termed  its  protective  action.  I  now  come  to  the 
inquiry  as  to  the  amount  of  the  medicine  required  to 
effect  this  result.  My  experience  with  quinine  in  the 
treatment  of  the  developed  miasmatic  disease  had 
tanght  me  that  doses  too  small  to  produce  a  sensible 
impression  upon  the  nervous  system,  could  not  be 
reliei  upon  to  prevent  the  paroxysms.  Why  then 
should  such  small  doses  be  expected  to  prevent  infec- 
tion ?  I  could  never  see  any  reason  for  such  an  expec- 
tation, and  therefore  I  applied  the  same  principle  to  the 
protection  from  infection,  that  I  had  been  accustomed 
to  employ  in  the  prevention  of  paroxysms.  Hence, 
whether  administered  for  the  one  object  or  the  other,  a 
seasible  impression  should  be  produced,  and  for  the 
purpose  of  protecting  from  infection  this  impression 
should  be  continuously  kept  up  during  the  hours  of 
exposure. 

Appreciable  signs  of  the  action  of  the  drug  are  pro- 
duced by  from  three  to  six  grains.  My  usual  first  dose 
wa?  four  to  five  grains,  and  increased  or  diminished  as 
seemed  requisite  in  each  case.  I  ascertained  that  once 
in  about  twelve  hours  was  sufficiently  frequent  to 
repeat  the  dose  as  a  rule,  though  some  eliminate  the 
drug  completely  in  about  eight  hours ;  and,  therefore, 
such  persons  should  take  their  dose  ouce  in  eight 
hour?.* 

Now,  infection  having  been  avoided  by  this  continu- 
ois  impression  of  quinine  during  the  exposure,  there 
seemed  to  me  no  reason  for  continuing  its  administration 
after  the  exposure  ceased,  and  accordingly  I  so  in- 
structed the  patients.  The  result  was  a  uniform  ex- 
emption from  infection.  The  experiments  whose  results 
led  me  to  these  conclusions,  thou^^  extending  over  a 
number  of  years,  would  have  been  less  conclusive  had 
not  an  occasional  self-willed  person  declined  to  take  the 
protective  dose,  on  the  ground  that  well  people  require 
no  medicine.  I  will  mention  but  a  single  case  in  illus- 
tration. A  ve?sel  arrived  in  the  port  of  Aspinwall  with 
a  perfectly  fresh  crew,  that  being  their  first  voyage  to 
that  harbor.  Among  them  were  three  persons  who 
refused  to  take  the  prescribed  quinine.  After  remain- 
ing at  the  wharf  about  three  weeks,  the  vessel  sailed. 
These  three  persons,  and  these  only,  were  taken  ill  of 
fever  on  their  way  to  New  York.  All  the  rest  of  the 
crew  had  uninterrupted  good  health.  So  many  similar 
cases  occurred  within  my  observation  during  my  resi- 
dence there,  that  I  was  compelled  to  accept  the  results 
witnessed  as  the  effects  of  the  measures  adopted,  and 
not  mere  coincidences.  I  did  so,  too,  with  a  full  under- 
standing of  the  behavior  of  miasmatic  poison  upon  a 
?romi8Cuous  population.  I  knew  it  to  be  possible,  for 
had  often  witnessed  its  demonstration,  that  some  may 
expose  themselves  for  weeks  to  miasmatic  exhalations 
and  yet  go  away  perfectly  well  and  remain  so,  without 
ever  taking  a  grain  of  quinine  or  other  medicine.  On 
the  other  hand,  I  had  seen  persons  seriously  infected  by 
a  few  hours'  exposure  only.  While  I  am  ready  to 
admit  that  many  of  the  persons  to  whom  I  gave  the 
quinine  would  probably  have  escaped  the  fever  without 
it,  I  fully  believe  that  all  of  those  obatinate  ones  who 
refused  to  take  it^  and  suffered  fever,  would  have  been 
protected  by  it 

This  fact  of  the  great  difference  in  susceptibility  to 


*  For  farther  phjr«iologle»l  Informallon  upon  the  point  of  the  dara- 
tl«n  of  th«  lnflaeoe«>  of  quinine,  I  refer  the  reader  to  a  Report  of  the 
retails  nf  experimente,  by  Dr.  Bence  JoDo^  published  In  the  Rioobd  of 
Bept.  IS,  1861;  and  to  m/  Letter  relation  >o  the  Mine,  pnbliabed  la  the 
&wraj>«rOetlft,186«. 


miasmatic  poison  so  frequently  seen,  is  not  sufficiently 
considered  oy  most  writers  upon  the  uses  of  quinine,  in 
making  up  the  conclusions  to  which  they  have  arrived. 
For  example,  the  Sanitary  Commission  publishes  the 
story,  that  seventy-seven  persons  went  on  an  excursion 
up  a  river  in  Africa,  and  leaves  us  to  infer  that  they  were 
gone  about  twenty-four  hours.  The^  all  took  a  dose  of 
quinine  when  they  started,  and  earned  another  dose  to 
take  at  night,  except  one  of  the  party.  This  one  was  the 
only  one  of  the  whole  seventy  and  seven  men  who  suf- 
fered fever  subsequently.  Now,  I  do  not  deny  that  this 
man  may  have  been  infected  during  that  exposure,  but  if 
so,  he  certainly  was  a  remarkably  susceptible  subject.  In 
my  belief,  it  is  scarcely  probable  that  another  one  of  the 
whole  party  would  have  suffered  from  so  slight  an  ex- 
posure, had  they  taken  no  quinine.  The  inference, 
therefore,  that  the  other  seventy-six  men  were  pro- 
tected by  the  quinine  they  took  is  by  no  means  deduci- 
ble. 

Also  the  following  notable  sample  of  the  extraordinary 
delusions  that  even  physicians  are  occasionally  led  into. 
Thirty-two  officers  and  men  were  exposed  in  the  Rio 
^Ponga  for  two  days  and  two  nio;hts.  They  took  four 
grains  of  quinine  daily  during  the  time.  Four  of  the 
party  subsequently  suffered  fever.  On  another  occa- 
sion a  party  of  thirty-four  were  similarly  exposed  for 
seven  or  eight  days,  taking  a  dose  of  quinine  every  other 
day  only,  during  the  time.  Seventeen,  or  just  half 
of  this  party^  subsequently  had  severe  remittent  fever , 
notwithstandmg  their  dose  of  quinine  on  alternate  day.^ 
while  twelve  and  a  half  per  cent,  of  the  former  party  fell 
sick  after  two  days*  exposure,  though  they  took  a  daily 
dose. 

No  one  with  any  knowledge  of  the  natural  history  of 
miasmatic  disease  as  manifested  in  the  human  subject 
can  regard  this  account  as  affording  the  least  evidence 
that  the  quinine  given  exercised  any  influence  one  way 
or  the  other.  It  is  not  at  all  probable  that  one  of  the 
whole  party  was  protected  by  the  medicine  he  took. 
The  result  is  certainly  much  worse  than  the  former 
similar  Chagres  exposure  of  so  many  thousands  of  our 
countrymen  who  took  no  medicine  whatever.  The  old 
Isthmus  transit  used  to  occupy  from  one  to  four  days, 
yet  the  persons  who  contracted  the  fever  during  it,  never 
amounted  to  twelve  and  a  half  per  cent.  Obvious 
therefore  as  it  is  to  me,  that  the  quinine  given  in  the 
cases  here  alluded  to  was  nearly  totally  useless,  my 
surprise  at  the  conclusion  to  which  the  author  of  the 
report  comes  may  be  understood.  He  says,  "  it  is  not 
to  be  presumed  that  quinine  will  prevent  the  occurrence 
of  fever  in  every  case,  but  in  a  sufficient  number  to  be  of 
the  utmost  benefit,  and  the  fever  occurring  in  those 
who  have  employed  it  as  a  prophylactic  is  sure  to  be 
of  little  moment.  Yet  this  reporter  has  just  stated  that 
fifty  per  cent,  of  his  cases  had  severe  remittent  fever  after 
exposure  of  one  week. 

These  histories  simply  demonstrate  what  I  have 
already  declared  to  be  the  truth,  viz.,  that  there  is  a 
great  difference  in  the  matter  or  susceptibility  to  the 
impressions  of  miasm  manifest  in  different  individuals — 
some  resisting  them  many  days,  as  we  see  in  the  case 
of  the  thirty-four  men,  half  of  whom  only  became  in- 
fected and  Buffered  disease  from  a  seven  or  eight  day 
exposure.  Others  became  thus  inf<^cted  in  a  day  or 
two,  and  in  a  few  rare  cases  I  believe  that  a  few  hours' 
exposure  will  seriously  infect  them. 

I  need  not  urge  the  importance  of  a  due  consideration 
of  all  of  these  facts,  in  estimating  the  effect  of  the 
quinine  administered  in  any  given  case — how  much 
credit  should  be  awarded  to  the  drug,  how  much  to 
fortuitous  or  sought  circumstances,  and  how  much  to 
the  unaided  vis  medicatrix  naturce,      r^  r^r^r^Ar^ 


294 


THE  MEDICAL  RECORD. 


I  believe  that  this  point  was  weighed  with  due  care 
di^ring  the  investigations  which  convinced  me  that 
quinine  wiU  protect  from  miasmatic  infection.  This 
power  conceded  to  it,  then  very  naturally  arises  the 
query — How  long  mdywe  rdyupon  its  protective  powers  f 
This  is  a  more  difficult  question  to  answer  than  the  un- 
initiated, and  even  than  some  of  those  who  have  written 
upon  quinine,  seem  to  suppose.  Few  persons  will 
submit  to  an  interminable  drugging,  practised,  as  it 
must  be,  in  an  experiment  of  this  character,  while  the 
subject  is  in  perfect  hea'lh,  and  on  this  account,  chiefly, 
I  have  never  been  able  to  form  a  definite  opinion  in 
reply.  But  whatever  the  limit  may  be,  I  am  convinced 
that  we  may  rely  upon  it  with  confidence,  for  any 
period  within  sixty  days,  and  this  is  long  enough  for 
any  practical  purpose.  The  various  published  reports 
touching  the  permanency  of  the  influence  of  quinine, 
nearly  all  refer  to  its  action  as  a  preventive  of  paroxysms, 
and  not  as  a  protective  from  mfection.  Of  this  class 
was  a  case  quoted  by  the  Sanitary  Commission,  wherein 
a  period  of  one  hundred  and  forty  days  seemed  to  make 
no  difference  in  the  action  of  the  drug.  Though  quoted 
as  evidence  of  its  permanent  power,  this  case  is  worth-, 
less  upon  the  point  in  question.  This  protective  power  is 
of  the  utmost  utility  to  the  transient  resident  who  may 
desire  to  get  off  without  carrying  with  him  the  poison- 
ous impression  which  will  eventually  develop  into 
disease.  To  this  end,  where  the  residence  is  not  to  ex- 
tend beyond  sixty  days,  I  reconmiend  that  a  continu- 
ous influence  of  the  quinine  be  kept  up  during  the 
whole  time,  if  the  exoosure  is  constant,  but  to  be 
omitted  during  any  penod  that  the  person  may  be  re- 
moved from  the  miasmatic  atmosphere.  "Where  the 
residence  is  to  be  longer,  I  can  see  no  useful  purpose  in 
continuing  to  administer  the  medicine  longer  than  about 
thirty  days,  because,  as  we  have  seen,  a  residence  of 
thirtjr  days  and  upwards  in  the  locality,  will  have  so 
modified  the  constitution  that  his  febrile  attacks  will  be 
of  mild  type,  should  they  not  be  prevented  by  appro- 
priate treatment,  a  very  practicable  thing  to  do. 
Whether,  to  secure  this  result,  it  is  necessary  to  give 
sufficient  quinine  to  constantly  produce  signs  of  its 
action  or  not,  I  am  by  no  means  certain.  But  as,  short 
of  this  evident  effect,  there  is  clearly  much  doubt  as  to 
whether  the  medicine  is  exercising  any  influence  or 
not,  I  think  it  a  safe  error,  if  error  at  all,  to  be  thus  far 
certain,  and  I  therefore  so  recommend. 

Summary :  When  the  person  is  thrown  into  miasm, 
give  him  at  once  three'to  five  grains  of  quinine — accord- 
ing to  the  effect — and  repeat  the  dose  once  in  twelve 
hours  during  the  whole  period  of  exposure,  up  to  about 
thirty  days  in  the  permanent  resident,  and  to  sixty 
days  if  the  person  is  not  to  remain  longei*  than  that  in 
the  impure  atmosphere,  and  where  there  are  peculiar 
reasons  for  desiring  him  to  avoid  subsequent  miasmatic 
disease.  It  should  not  be  lost  sight  of,  that  cases  often 
occur  wherein  it  will  be  necessary  to  repeat  the  dose 
once  in  eight  hours  in  order  to  maintain  the  required 
influence  of  the  medicine,  the  signs  of  which  are  to  be 
carefully  watched  and  maintained  in  all  cases. 

When  exposure  ceases  the  medicine  is  to  be  at  once 
suspended. 

The  following  additional  deductions  from  the  general 
summary  of  that  memoir,  may  appear  to  you  of  sufficient 
interest  to  merit  republication,  viz.  That  removal  from 
a  miasmatic  atmosphere  for  any  twelve  hours,  especially 
during  a  night,  is  quite  equivalent  as  a  protective  to  one 
dose  of  quinine — it  may  be  much  more  economical,  and 
when  practicable,  is  by  far  the  most  desirable  protec- 
tive meafiure. 

That  in  all  cases  where  this  measure  can  be  daily 
practised,  it  will  unquestionably  preserve  the  suscepti- 


bilities of  the  brain  to  the  action  of  the  medicine,  for  an 
indefinite  and  probably  long  period,  and  will  thus  serve 
indirectly  as  a  most  efficient  protective. 

That  when  continuous  exposure  is  inevitable,  there  is 
no  safety  in  attempting  to  protect  from  infection  by  the 
use  of  quinine  for  a  longer  time  than  two  months,  and 
as  a  general  rule  it  is  not  advisable  for  longer  than  one 
month. 

That  ceasing  its  administration  at  the  end  of  the  first 
month,  by  the  time  the  infection  takes  place  and  the 
premonitions  wjpear,  the  susceptibilities  to  the  medi- 
cine will  have  become  so  restored,  that  it  will  be  prac- 
ticable, generally,  to  prevent  the  paroxysms  for  long 
periods  of  time. 

That  by  an  observance  of  these  principles,  and  by 
avoiding  the  causes  of  other  diseases,  most  men,  of  even 
ordinary  constitutions,  can  be  kept  in  miasmatic  locali- 
ties for  years  in  an  efficient  state  of  health. 

N.  Y.,  882  West  Thtrtj-fourth  street 

INTRA  LARYNGEAL  SURGERY, 

AND  TOPICAL  MEDICATION   OF  THE  UPPER   AIB- 
PAS8AOE8. 

By  J.  SOLIS  COHEN,  M.D., 

OP  PHILADKLPmA. 

No.  1. 

Professor  Czermak.  the  ingenious  founder  of  laryn- 
goscopy, though  not  nimself  a  practising  physician  at  the 
time,  soon  recognized  the  fact  that  the  lary  ng08cop>e  could 
be  utilized  for  far  more  important  purposes  than  that 
of  the  diagnosis  of  laryngeal  disease ;  and  using  his 
mirror  as  a  *'  guide  to  the  operating  hand,"  he  boldly 
plunged  a  sound  into  the  interior  of  a  patient's  laiynz, 
and  demonstrated  a  safe  practice  for  the  method  of 
intra-laryngeal  surgery,  with  visual  confirmation  of 
results.  Herein,  no  one  can  claim  participation  in  his 
honors. 

It  is  now  practicable  to  apply  local  treatment  to  the 
upper  air-passages,  in  many  mstances,  with  as  mucli 
precision  as  to  tne  inner  surface  of  the  cheeks  or  nos- 
trils, and  the  ingenuity  of  operators  and  cutlers  has 
adapted  to  the  purpose  instruments  of  such  configura- 
tion and  mechanism,  as  permits  of  the  performance  of 
many  dehcaie  surgical  operations,  in  the  removal  of 
neoplasms  especially,  under  a  great  variety  of  form  and 
seat  of  disease. 

The  employment  of  the  laryngeal  mirror  for  pur- 
poses of  diagnosis,  is  an  art  comparatively  easy  of 
acquisition  ;  but  operations  within  the  larynx  and 
trachea  by  its  aid,  require  considerable  practice,  if  not 
a  certain  amount  of  peculiar  adaptation  in  addition. 

Certain  general  manoeuvres  are  necessary  for  the 
proper  introduction  of  every  instrument,  from  a  blunt 
probe  to  an  exposed  bistoury.  The  plan  which  the 
writer  has  fbund  most  useful  in  instructing  his  pupils, 
is  to  begin  by  holding  the  mirror  over  a  plane  surface, 
as  for  instance,  the  page  before  us ;  the  paper  repre- 
senting the  plane  of  the  upper  surface  of  the  larynx, 
and  the  mirror  being  held  an  inch  or  more  aboTe  it,  at 
an  inclination  of  about  45^  Then  the  student  is 
directed,  with  the  other  hand,  to  take  an  ordinary 
probe,  and  keeping  his  attention  upon  the  image  of  the 
spot  he  designs  touching,  to  carry  the  probe  towards 
the  mirror  until  it  is  nearly  in  contact,  and  then  to 
move  it  gently  until  a  distinct  view  is  obtained  of  its 
point,  when,  without  losing  sight  of  the  end  of  the 
probe,  it  is  to  be  directed  towards  the  image  of  the 
spot  selected,  and  to  be  slowly  carried  to  it  A  little 
practice  will  soon  render  him  familiar  with  the  direc- 


igitized  by 


Google 


THE  MEDICAL  RECORD. 


295 


lion  necessary  to  be  given  to  the  probe  to  secure  the 
desired  movement.  After  this  has  been  repeated 
sufficiently  to  familiarize  the  student  with  the  proper 
method  of  following  the  reflex  of  his  movements,  so  as 
to  carry  his  instrument  at  will  to  the  right  or  the  left, 
in  front  or  behind,  the  straight  probe  is  changed  for  a 
curved  one,  such  as  would  be  suitable  for  introduction 
into  the  larynx,  and  the  same  exercises  are  repeated,  a 
second  person  after  a  while  designating  the  points 
which  the  student  is  to  endeavor  to  touch.  A  triangu- 
lar pasteboard  tube  of  the  size  of  the  larynx,  with  cer- 
tain marks  upon  its  inner  surface,  is  then  substituted 
for  the  sheet  of  paper  or  printed  page,  and  the  mirror 
is  then  held  above  it,  so  aa  to  reflect  the  image  of  the 
interior,  and  the  exercises  are  repeated.  The  difficulty 
of  toucning  a  desired  spot  is  now  rather  g;reater  than 
before,  and  the  student  learns  to  raise  the  handle  of  his 
injitrument,  if  he  wishes  to  touch  the  anterior  surface 
of  the  tube,  and  to  depress  it  in  order  to  carry  the 
point  of  his  instrument  towards  the  posterior  portion  of 
the  tube,  as  also  the  proper  movement  to  the  one  side 
or  the  other. 

After  this,  a  papier-machd  model  of  a  larynx  is  em- 
ployed as  a  means  of  exercise,  and,  finally,  the  method 
introduced  by  Tobold,  which  is  to  mount  a  recently 
excised  larynx  with  the  tongue,  soft  palate,  etc.,  upon 
the  rod  supporting  a  skull,  with  the  jaws  separated,  the 
oesophagus  being  fastened  round  the  rod.  If  a  recent 
larynx  cannot  be  obtained,  a  wet  preparation,  or  an 
artificial  one  is  substituted. 

Aft'ir  a  certain  degree  of  facility  has  been  acquired 
in  this  way,  it  is  necessary  to  learn  how  to  manage  the 
mirror  and  operating  instrument  at  the  same  time  with 
artificial  light ;  and  this  is  best  done  by  suspending  the 
model,  or  the  mounted  skull,  within  a  box,  with  a 
small  opening  to  represent  the  open  mouth  just  in  front 
and  above  the  larynx,  or  model ;  then  the  light  is  to 
be  thrown  in'o  the  interior  through  the  opening,  and 
the  manipulation  proceeded  with  as  before. 

After  the  student  has  acquired  CuUsiderable  facility  in 
placing  the  point  of  his  instrument  upon  any  desired 
spot,  recognized  solely  by  reflection  in  the  mirror,  it 
will  require  a  great  deal  of  patience  and  of  practice  to 
enable  him  to  accomplish  the  same  result  upon  a  patient, 
in  whom  nervousness  and  the  natural  irritability  of  the 
rtructurcs  willcau^e  more  or  less  movement  of  the  parts, 
whose  reflex  must  be  followed  promptly  and  witn  ac- 
curacy in  order  to  ensure  precision  of  movement.  The 
results  that  reward  perseverance  seem  all  but  incredible 
to  tho?e  who  are  not  familiar  with  the  subject,  or  im- 
pressed in  its  favor. 

The  principal  rule  to  be  observed  in  these  manipula- 
tions, be  they  what  they  may,  is  to  carry  the  instru- 
ment well  towards  the  mirror,  until  its  point  is  visible  in 
the  image,  and  not  to  1  se  sight  of  the  point  during 
the  operation.  Very  often  the  instrument  will  have  to 
be  withdrawn  again  and  again  before  a  favorable  onpor- 
lunity  is  presented  for  carrying  it  home ;  but  witn  in- 
creasad  practice,  the  expert  soon  becomes  able  to  suc- 
ceed at  almost  every  attempt 

We  can,  in  this  way,  not  only  make  local  applications 
of  a  general  nature,  such  as  swabbing,  syringing,  etc. ; 
but  circumscribed  ulcers  can  be  cauterized ;  abscesses 
opened;  tumors  ligated^  excised,  or  twisted  off;  gran- 
ulations scarified ;  individual  muscles  galvanized ;  every- 
thing except  dissection ;  and  this  without  comprom- 
ising the  integrity  of  the  healthy  structures,  any  more 
than  occurs  under  ordinary  circumstances. 

The  instrument  which  it  is  proposed  to  place  within 
the  larynx,  must  be  formed  with  a  proper  curve  or 
angle.  The  angle  most  generally  serviceable  is  one  of 
112^,  bat  if  it  be  a  little  greater  or  a  little  less,  it  will 


make  no  material  difference.  An  angular  instrument 
may  be  employed,  if  desired,  but  will  occupy  more 
space  in  the  throat  than  if  curved,  and  thus  at  times 
may  be  less  serviceable.  The  laryngeal  portion  may  be 
from  an  inch  and  a  half  to  three  inches  in  length,  and 
the  handle  or  stem  from  six  to  eight  inches.  Under 
certain  circumstances,  the  ordinary  form  of  the  instru- 
ment may  be  conveniently  departed  from,  in  conse- 
quence 01  peculiar  conformation  of  larynx,  or  where  it 
is  intended  to  operate  upon  the  anterior  or  posterior 
wall  of  the  tube ;  in  the  former  instance,  the  angle  naay 
be  more  acute,  and  in  the  latter  more  obtuse ;  otherwise, 
the  necessary  depression  or  elevation  of  the  hand,  in 
order  to  reach  the  desired  spot,  will  require  the  posses- 
sion of  a  greater  amount  of  skill 

The  best  method  of  managing  the  tongue,  is  for  the 
patient  to  extrude  it  as  far  as  possible,  and  then  to  hold 
the  tip  himself  between  his  thumb  and  forefinger,  so  as 
to  arrest  the  involuntary  backward  movement  when  an 
instrument  is  passed  within  the  mouth,  a  cloth  being 
interposed  between  the  tip  of  the  tongue  and  the  fin- 
gers to  prevent  its  slipping.  Patients  soon  learn  to 
hold  the  tongue  properly  and  quietly,  without  graspmg 
it  If  it  is  absolutely  necessary  to  employ  a  tongue 
depressor,  an  instrument  should  be  selected  which  will 
reach  well  back  to  the  base  of  the  tongue,  which  is 
then  to  be  forcibly  depressed  and  drawn  forwards,  and 
the  management  of  the  tongue  depressor  should  be  en- 
trusted to  the  patient  The  less  paraphernalia  employed, 
however,  the  better.  Tongue  depressors,  head  rest', 
and  laryngeal  ^'Jixateurs  "—instruments  attached  to  the 
patient's  head,  or  to  his  jaws,  and  provided  with  a  fork, 
which  is  to  hold  the  laryngeal  mirror  in  position— all 
produce  more  or  less  restraint  on  the  part  of  the  patient 
or  operator,  and  their  use  is  therefore  to  be  avoided 
unless  imperatively  needed,  an  emergency  which  is, 
happily,  of  rare  occurrence.  When  a  patient  is  unable 
to  maintain  his  head  in  a  proper  position  without  ex- 
traneous support,  the  best  rest  for  it  is  the  breast  of  a 
friend,  or  that  of  an  assistant,  who  should  place  one 
hand  upon  the  forehead.  The  writer  sometimes  em- 
ploys Tobold's  head  rest,  when  an  assistant  is  not 
within  call.  If  the  tongue  is  very  fleshy  or  very  un- 
ruly, a  depressor  may  become  indispensable.  It  is 
difficult  t6  conceive  of  any  case  in  which  an  instrument 
for  holding  the  laryngeal  mirror  in  position  can  be 
judiciously  employed,  for  it  would  become  spattered  by 
cough,  etc.,  necessitating  frequent  readjustment,  which 
would  prove  exceedingly  irksome  and  vexatious.  If 
the  operator  require  the  u?e  of  both  hands  for  instru- 
mental purposes,  the  mirror  can  be  managed  by  an 
assistant,  or  in  many  cases,  and  what  would  be  far  pref- 
erable, bv  the  patient  himself,  who  can  oft^n  be  taught 
to  keep  the  mirror  in  position  after  it  has  been  properly 
placed  by  the  operator;  and  indeed  some  patients  have 
learned  by  practice  during  protracted  treatment,  to  in- 
troduce the  mirror  themselves,  and  place  it  at  once  in 
the  desired  position. 

Light,  patient,  tongue,  etc.,  being  in  proper  adjust- 
ment, the  mirror  is  introduced  with  the  left  hand,  if  the 
operation  is  to  be  performed  with  the  right,  or  vice 
vm'sdj  and  with  the  other  hand  the  instrument  is  to  be 
pa<^sed  well  back  into  the  pharynx  and  close  to  the 
mirror,  until  its  point  can  be  clearly  discerned  in  the 
mirror,  and  avoidmg  con  tact  with  any  of  the  structures'; 
then,  with  the  image  in  the  laryngeal  mirror,  as  "  the 
guide  to  the  operating  hand,"  the  point  of  the  instru- 
ment is  to  be  directed  towards  the  desired  spot,  and  ,• 
following  the  reflex,  to  be  carried  there  promptly  and 
quietly.  The  instrument  should  be  taken  in  hana  as  if 
it  were  a  pen,  not  as  if  it  were  a  cart- whip,  as  too 
many  are  apt  to  hold  it^  and  the  fingers  being  extended 


296 


THE  MEDICAL  RECORD. 


on  the  wrist,  the  laryngeal  portion  is  to  be  carried  over 
the  tongue,  until  its  approach  is  seen  in  the  mirror.  It 
is  not  always,  even  after  long  practice,  that  the  actual 
COD  tact  of  the  instrument  with  the  diseased  spot  can 
be  seen  in  the  mirror,  for  usually,  and  perhaps  always, 
at  a  first  application,  spasmodic  action  ensues  at  the 
moment  of  contact;  and  very  often  the  instrument^  if 
not  promptly  withdrawn,  will  be  caught  by  the  epi- 
glottis or  by  the  base  of  the  tongue,  an  occurrence 
which  it  is  desirable  to  be  able  to  avoid,  although  under 
certain  circumstances,  as  when  a  general  application  is 
being  made  by  means  of  a  moistened  sponge,  the  action 
may  be  advantageous,  inasmuch  as  it  compresses  the 
sponge,  and  thereby  secures  the  discharge  of  its  fluid. 
Under  these  circumstances,  the  character  of  the  contact 
is  to  be  determined  by  the  impression  conveyed  to  the 
finger  by  the  end  of  the  instrument  As  soon  as  prac- 
ticable, which  is  as  soon  as  the  spasmodic  action  induced 
by  the  operation  ceases,  the  parts  are  to  be  reexamined 
in  the  ordinary  manner,  in  order  to  judge  of  the  success 
of  the  application,  as  well  as  to  determine  the  necessity 
for  its  repetition  in  case  of  failure. 

Patients  soon  become  accustomed  to  the  momentary 
contact  of  a  foreign  body  against  the  laryngeal  mucous 
membrane,  but  at  the  earlier  interviews  the  distress  is 
often  extreme ;  there  is  a  great  deal  of  spasm,  with  chok- 
ing sensation  and  expectoration,  while  the  sense  of  con- 
striction and  dread  of  suffocation  sometimes  remain 
for  several  minutes.  It  is  the  same  as  when  a  foreign 
body  has  been  removed  from  the  conjunctival  mucous 
membrane,  the  sensation  of  its  presence  remains  for 
some  time;  and,  from  a  similar  cause,  patients  will 
"  feel  the  sponge  in  the  throat "  after  its  withdrawal, 
and  this  will  keep  up  the  feeling  of  impending  suffoca- 
tion, so  that  they  will  sometimes  throw  themselves 
from  side  to  side,  walk  about  the  room,  approach  the 
window  to  get  a  breath  of  air,  etc.,  and  occasionally 
exhibit  an  amount  of  distress  piteous  to  witness.  With 
each  repetition,  however,  the  sensibility  of  the  parts 
decreases,  until,  after  a  while,  the  application  will  be 
followed  by  a  mere  clearing  of  the  throat  In  the 
earlier  appUcations,  too,  the  effect  will  be  to  induce 
active  congestion  of  the  parts  with  increased  secretion, 
which  will  be  followed  by  a  sense  of  roughness,  dry- 
ness, or  burning,  in  greater  or  less  degree,  continuing 
from  fifteen  minutes  to  several  hours.  As  the  applica- 
tions are  repeated,  these  effects,  too,  gradually  diminish 
in  intensity.  The  swallowing  of  cold  water  will  often 
materially  alleviate  this  distress,  when  it  is  severe ;  and 
if  it  continues  for  some  time,  the  inhalation  of  an  ano- 
dyne solution  or  vapor  will  overcome  the  irritation. 

Very  often  a  skilful  operator  can  succeed  in  making 
a  successful  application  at  the  first  interview  with  his 
patient,  but  with  those  who  are  less  practised,  and  in 
all  cases  of  extreme  irritabiUty  of  structures,  a  certain 
amount  of  preparatory  manipulation  becomes  requisite. 
The  plans  recommended  in  the  writer's  recent  articles 
on  laryngoscopy,  see  Vol  /.,  p,  359  (to  which  he  may 
add  that  the  hypodermic  injections  of  anodyne  solu- 
tions has  not  produced  very  satisfactory  results),  may 
be  employed.  The  best  method  is  the  contact  of  some 
extraneous  body.  I  often  show  a  patient  how  to  pass 
an  instrument  into  his  own  larynx,  a  probang  with  a 
small  sponge  attached,  for  instance,  and  direct  him  to 
moisten  a  sponge  with  water,  and  insert  it  into  the 
larynx  two  or  three  times  a  day,  until  the  contact  of 
the  instrument  can  be  borne  without  flinching.  This 
practice  is  necessary  at  times,  preparatory  to  the  em- 
ployment of  cutting  instruments ;  less  so  when  cauteri- 
sation or  general  applications  are  to  be  instituted. 
Very  of\ien  the  epiglottis  is  more  irritable  than  the  in- 
tenor  of  the  larynx,  and  to  overcome  this  the  best  plan 


is  for  the  operator  to  pass  his  finger  behind  the  patient's 
epiglottis,  and  pull  it  forward  several  times,  and  then 
to  teach  the  patient  how  to  perform  the  manoeuvre  him- 
self, and  direct  him  to  repeat  it  occasionaUy  at  intervals 
during  the  day.  Then  he  may  be  provided  with  an 
extension  thimble,  with  a  good,  broad,  blunt  end,  and 
insert  that  several  times  a  da^.  When  the  epiglottis  is 
very  much  depressed,  the  patient  must  pull  it  forward 
frequently,  so  as  to  induce  it  to  assume  a  more  erect  posi- 
tion. A  patient  can  be  taught  to  raise  the  epiglottis  with 
one  fore-nnger,  and  then  to  pass  a  sponge  probang  along 
the  back  of  the  finger  down  into  the  larynx.  By  this, 
or  some  similar  method,  the  sensibility  of  the  part  will 
be  gradually  subdued,  and  it  is  surprising  sometimes 
how  soon  uie  irritability  is  overcome.  And  here  we 
are  led  to  an  important  practical  observation,  which  is, 
that  a  patient  who  has  been  suffering  a  long  time  with 
severe  disease,  even  when  of  nervous  temperament, 
will  leam  to  control  his  sensations  promptly,  while  one 
whose  trouble  is  trivial  or  imaginary,  will  require  longer 
tuition  and  preliminary  manipulation.  Again,  it  wiU 
be  noticed,  that  a  patient  who  may  be  exceedingly- 
docile,  and  may  codperate  well  with  bis  physician 
during  the  earUer  interviews,  will  sometimes  become 
less  tolerant  of  manipulation  as  relief  is  being  obtained. 

Where  obstinate  depression  of  the  epi^ottis  pre- 
cludes the  convenient  introduction  of  an  instrument,  it 
will  have  to  be  forcibly  raised  by  means  of  properly  curv- 
ed forceps,  hooks,  or  pincettes,  of  which  that  of  Von- 
Bruns  (described  at  page  349,  Vol.  /.,  of  Thb  Medical 
Reoord)  is  the  best 

Certain  precautions  are  necessary  to  success  in  limit- 
ing a  local  application  to  certain  portions  of  structures, 
and  in  order  to  gain  access  to  others ;  and  for  this  pur- 
pose we  avail  ourselves  of  the  physiological  effect  of 
voluntary  movement.  Thus,  if  we  want  to  medicate 
the  floor  of  the  glottis,  or  prevent  any  of  the  material 
used  firom  entering  the  trachea  and  lower  laryngeal 
cavity,  we  direct  the  patient  to  emit  a  vocal  sound, 
which  of  course  closes  the  glottis;  if,  on  the  contrary, 
we  desire  the  instrument  to  enter  the  lower  laryngeal 
cavity,  or  penetrate  into  the  trachea,  we  direct  a  deep 
inspiraticm  to  be  taken  which  opens  the  glottis  and 
permits  the  passage  of  the  instrument  between  its  lips; 
if  we  wish  to  make  an  appUcation  to  the  laryngeal 
surface  of  the  epiglottis,  or  to  the  anterior  portion  of 
the  vocal  cords,  ventricular  bands,  etc ,  we  direct  the 
forcible  extension  of  the  tongue,  and  the  utterance  of  a 
high  note  or  an  ironical  laugh,  in  order  to  expose  these 
structures  more  fully ;  if  we  wish  to  touch  a  spot  upon 
the  lingual  face  of  the  epiglottis,  or  in  the  glolto- 
epiglottic  sinuses,  or  upon  the  base  of  the  'tongue,  we 
allow  the  base  of  the  tongue  to  remain  in  a  more  na- 
tural position,  or  cause  it  to  he  protruded  in  such  a 
way  as  will  not  raise  the  epiglottis  to  its  erect  posi- 
tion, etc.  Then,  again,  the  preliminary  movements  of 
retching,  swallowing,  coughing,  etc ,  will  raise  the 
entire  laryni,  and  bring  the  structures  within  nearer 
reach  of  an  instrument 

With  these  general  remarks,  we  are  able  to  enter 
upon  the  special  consideration  of  our  subject. 

AoASSiz  AND  American  Archjeologt. — It  is  rumored 
that  Professor  Agassiz  and  the  senior  class  of  Harvard 
University  contemplate  a  visit  to  southern  Ohio,  for 
the  purpose  of  a  scientific  investigation  of  the  antiqui* 
ties— tumuli,  fortifications,  and  other  remains— of  an 
extinct  race,  in  which  it  so  greatly  abounds. 

CoKStTMPTiON  OF  CONFECTIONERY  IN  Paeis. — Accord- 
ing to  the  Parisian  Chamber  of  Commerce  about  eleven 
mSlions  of  francs  were  spent  in  bonb.ns  last  year. 


THE  MEDICAL  RECORD. 


297 


ANAPHRODISIA. 

TB1N8LATED  FBOM  THS  FHENOH  OF  M.  AMBROISE  TARDIEN 
DS  l'hOPITAL  la  ROBOISIfiRE,  PARIS. 

By  WM.  mason  TURNER,  M.D. 

PHILABKLPHIA. 

Thi  name  Anaphrodisia  has  been  giyen  to  the  inertia 
of  the  genital  organs,  and  to  the  eneryation  or  the 
abolition  of  the  genital  functions. 

It  is  not  necessary  to  confound  anaphrodisia  with 
impotence  (mgerUfie)  and  sterility  (opWte).  which  in 
men  and  women  indicate  a  total  impossibility  of  the 
perfect  accomplishment  of  the  generative  act  and  the 
reproduction  of  the  species.  Anaphrodisia  is  simply 
one  of  the  forms— one  of  the  sub-divisions  of  impo- 
tence. This  can,  in  fact,  depend  as  well  on  a  mechani- 
cal difficulty  in  the  emission  of  the  sperm,  or  on  a  de- 
fective ejaculation ;  and  in  women,  on  a  faulty  organic 
cooformation,  or  on  a  menstrtial  derangement,  as  on  an 
irritable  nervous  atony,  and  on  a  deficiency  in  the  gener- 
ative power. 

Anaphrodifiia  in  man  is  ordinarily  characterized  by 
its  slowness,  defect  in  energy,  and  later  by  the  absolute 
impossibility  of  erection  of  the  penis,  accompanied  in 
the  beginning  by  premature  emissions,  which  are  pro- 
voked by  the  sligntest  attempt  at  coitus.  The  sper- 
matic secretion,  and  oflener  still  the  venereal  desires  and 
exhilarations  which  are  its  prelude,  gradually  diminish, 
and  finally  become  null  Among  I'emiJes,  anaphrodisia 
is  infinitely  more  rare,  and  is  very  difficult  to  determine, 
on  account  of  a  somewhat  passive  rdle  to  which  the  sex 
is  often  reduced.  For  the  rest,  it  consists  in  a  particu- 
lar insensibility,  a  veritable  atony  of  the  genital  organs, 
and  an  ab^ence^  more  or  less  complete,  of  the  needs  and 
pfeatures  of  animal  love. 

Ani^hrodiBta  affords  a  great  number  of  varieties,  in 
regard  to  its  march  and  the  causes  which  produce  it. 
Without  referring  to  that  which  results  phyBiologically 
from  increasing  age,  and  which  can  otherwise  be  retarded 
or  advanced  by  special  circumstances  inherent  to  the 
constitution,  anaphrodisia  can  be  in  some  degree  c<m- 
gmtalj  and  dependent  upon  an  original  constitutional 
noe.  Subjects  who  are  infected,  have  generally  a  pecu- 
liar physiognomy.  Their  natures  are  effeminate^  lym- 
phatic ;  their  forms  rounded,  sometimes  amounting  to 
embonpaifii;  the  capillary  syatem  is  meagre,  or  wholly 
wanting,  especially  in  the  neighborhood  of  the  sexual 
organs;  the  voice  is  shrill  and  piercing,  the  genitals  are 
but  slightly  developed,  resembling  atrophy ;  in  women 
the  breasts  are  scarcely  formed,  and  the  menstrual  flux 
scanty ;  the  character,  apathetic  and  without  energy. 

In  other  cases,  anaphrodisia  is  CLcquired  and  prema- 
turely determined  by  venereal  excesses  commenced 
before  age,  and  which  have  early  enfeebled  the  genera- 
tive system  and  the  entire  constitution  by  onanism. 
Sometimes,  on  the  contrary,  by  an  absolute  abstinence, 
and  a  default  in  the  rightful  use  of  the  genital  organs, 
or  again  by  an  excessive  and  habitual  tension  of  mind 
by  exclusive  pre-occupations,  which  lead  in  their  train 
to  ideas  of  ambition,  to  speculations  in  money,  and  to 
devotion  to  science. 

Finally,  ans^brodisia  can  be  simply  transient,  and  be 
produced  by  a  too  great  abuse  of  the  pleasures  of  love, 
by  the  enfeebled  state  which  follows  a  serious  illness  of 
long  duration,  by  the  accidental  and  immoderate  use  of 
spirituous  liquors,  drunkenness,  and  the  excesses  of  the 
table.  It  likewise  is  due  to  certain  moral  impressions, 
which,  by  a  singular  contrast,  instantaneously  paralyze 
every  tpeciee  of  genital  power  in  men.  Such  are, 
especially,  excessive  keenness  of  desire,  timidity,  dis- 


trust of  one's  self,  and  an  unforeseen  distraction  in  the 
act  of  coitus. 

That  which  we  have  spoken  implies  exclusively  to 
essential  anaphrodisia;  and  we  ought  to  add  that  this 
affection  is  often  nothing  more  than  a  symptom  which 
is  observed  at  the  beginning  of  brain  derangements,  in 
diseases  of  the  spinal  marrow,  and  in  paraplegias,  of 
which  it  is  one  of  the  first  and  best  premonitory  signs. 
It  is  met  with  likewise  in  diabetes,  in  different  cachexias, 
in  severe  leucorrhoeas,  in  certain  rebellious  gastralgias, 
and  in  asphyxia  from  the  fumes  of  charcoal,  afler  each 
of  which  it  lasts  for  a  certain  time. 

The  treatment  of  anaphrodisia  is  necessarily  subordi- 
nated to  the  different  causes  which  we  have  enumerated. 
If  it  be  oflen  bevond  the  resources  of  our  art,  as  when, 
for  example,  it  is  congenital,  or  when  indicated  by  an 
anticipated  old  age.  it  is  not  always  the  same,  in  cases 
where  the  atony  oi  the  ^nital  organs  is  recent,  or  where 
the  disease  is  attributable  to  a  cause  which  can  be  effica- 
ciously combated.  A  tonic  regimen,  cold  affusions, 
lotions,  or  douches  followed  by  firictions  on  the  vertebral 
column,  on  the  organs  themselves;  and  sulphuretted 
mineral  waters,  are  Uie  means  which  guarantee  most  suc- 
cess. It  is  best  likewise  to  add  t^e  preparations  of  nux 
vomica,  the  action  of  which  (continued  with  prudence) 
produces  often  the  most  brilliant  results  {Trousseau). 
We  must  count  less  on  cantharides,  phosphorus,  and  the 
numerous  aphrodisiac  remedies,  which  are  so  dangerous, 
and  generally  so  little  to  be  relied  on,  that  their  em- 
ployment cannot  be  sustained. 


Original  €tctuxts. 


EXTIRPATION  OF  THE  UTERUS  BY  MIS- 
TAKE  FOR  OVARIAN  TUMOR: 

BKINO  REMARKS  MADE    UPON    THE    PRKSEKTATIOM    OF    THE 
BPBCIIIBir  TO  TOE  K.  T.   PATHOLOOICAL  SOCIETY, 

JUNE  27,  1867. 
Bt  E.   KRACKOWIZER,  M.D. 

Mr.  President — This  is  the  body  of  a  uterus,  in  the 
walls  of  which  is  imbedded  a  large  fibroma,  which  was 
removed  by  mistake  for  an  ovarian  tumor ;  at  least  I 
ought  to  say  that  I  only  became  aware  that  it  was  a 
uterine  tumor  when  it  was  too  late  to  arrest  the  opera- 
tion. 

The  woman  from  whom  it  was  taken  was  forty-eight 
years  of  age.  She  had  been  delivered  when  she  was 
twenty  years  of  age  of  a  healthy  child,  and  from  that 
time  Mie  menstruated  regularly.  She  did  not  marry, 
howeverj  until  she  was  thirty-five  years  old,  and  was 
without  issue  for  four  years,  when  her  husband  died  of 
consumption.  She  remained  a  widow  three  years,  and 
married  again  eight  years  ago,  no  children,  however, 
being  born.  She  was  always  in  most  excellent  health, 
and  menstruated  regularly  up  to  the  time  of  the  opera- 
tion. About  two  years  ago  she  felt  that  her  health 
be^n  to  get  somewhat  impaired;  she  could  not  de- 
scnbe  in  what  manner,  save  that  she  did  not  have  her 
previous  vigor  and  activity,  and  that  her  appetite  be- 
came impaired,  and  that  it  seemed  to  her  more  difficult 
to  attend  to  the  duties  of  her  household  than  heretofore. 
One  year  ago  a  swelling  in  the  lower  part  of  the  abdo- 
men appeared;  it  did  not  increase,  however,  to  any 
considerable  degree,  or  with  any  marked  rapidity,  and 
its  presence  only  occasioned  her  uneasiness. 

I  saw  her  for  the  first  tune  about  six  weeks  ago,  and 

made  an  examination  into  her  case.    The  tumor,  which 

was  about  the  size  of  a  child's  head  two  years  old,  was 

digitized  by ^ „      ^_ 


298 


THE  MEDICAL  RECORD. 


felt  occupying  the  lower  part  of  the  abdomen.  It  was 
smooth,  elastic,  painless  on  pressure,  and  movable  from 
side  to  side.  On  making  a  vaginal  examination,  it  was 
found  that  the  mass  bore  down  behind  the  symphysis 
pubis,  and  had  crowded  the  uterus  backward.  The  os 
was  felt  on  the  posterior  part  of  the  tumor.  A  uterine 
sound  entered  with  great  facility  to  the  depth  of  two 
inches  and  a  half  behind  the  tumor.  When  the  sound 
was  grasped  by  one  hand  and  the  tumor  held  with  the 
other,  it  seemed  to  move  independently;  I  therefore 
concluded  that  I  had  a  simple  ovarian  tumor  to  deal 
with,  and  that  the  uterus  was  normal  and  unconnected 
with  it.  I  supposed  that  the  pedicle  was  a  pretty  short 
one.    No  examination  per  rectum  was  made. 

The  condition  of  things  was  explained  to  the  woman. 
After  stating  to  her  the  chances  which  she  had  if  the 
tumor  were  left  alone,  or  if  the  operation  were  under- 
taken, and  after  sufficient  time  had  been  given  her  for 
deliberation,  she  most  decidedly  preferred  to  have  a 
radical  operation  undertaken.  I  then  called  in  Dr. 
Kammerer,  to  get  his  advice  in  the  matter.  He  made 
an  examination,  and  corroborated  my  opinion  in  everjr 
respect,  except  that  he  thought  that  the  tumor  origi- 
nated from  the  left  side,  while  I  was  of  the  opinion 
that  it  came  from  the  right  sido. 

The  day  before  yesterday  the  operation  was  made. 
After  chloroform  was  administered,  an  incision  was 
made  midway  between  the  umbilicus  and  symphysis 
pubis  to  the  extent  of  four  inches,  and  tlie  tumor  was 
presented.  I  must  state  that  at  the  previous  examina- 
tions, never  having  felt  any  fluctuation,  I  was  of  the 
opinion  that  the  walls  of  the  cyst  were  very  thick. 
When  the  peritoneal  cavity  was  opened  sufficiently  wide 
so  as  to  mtroduce  the  hand,  it  was  found  that  the 
omentum  was  adherent  in  several  spots  on  the  surface 
of  the  tumor.  On  the  left  side  a  band  was  detected, 
with  a  somewhat  cylindrical  yielding  mass  in  it,  which 
seemed  to  be  the  dilated  Fallopian  tube  of  the  left  side. 
On  bringing  the  hand  between  the  promontory  and  the 
tumor,  the  mass  was  found  to  be  connected  most  inti- 
mately with  the  cervix  uterL  Before  that  was  done, 
however,  a  trocar  was  plunged  into  the  mass,  and  on 
introducing  the  trocar  I  became  aware  that  I  had  to 
deal  with  a  solid  tumor,  as  no  fluid  escaptd  and  the  end 
of  the  trocar  was  firmly  held  fast.  A  great  deal  of 
venous  oozing  took  place  from  this  spot,  between  the 
promontory  of  the  sacrum  and  posterior  aspect  of  the 
tumor  I  could  feel  plainly  the  left  ovary,  and  I  could 
also  ascertain  that  the  mass  was  a  continuation  of  the 
cervix  uteri.  The  uterine  sound  was  passed  to  the 
depth  of  two  inches  and  a  half;  it  was  also  evident 
that  the  tumor  was  springing  from  the  lower  portion  of 
the  body  of  the  uterus,  which  a  little  above  the  inner 
OS  was  swelling  out  rapidly  into  a  globular  tumor. 

The  question  then  arose,  whether  it  was  better  to 
desist  from  the  operation  or  go  on.  In  rapidly  can- 
vassing the  chances  which  this  poor  woman  had,  and 
which  were  very  slim  indeed,  it  was  thought  best  to 
proceed.  Inasmuch  as  the  tumor  had  been  wounded 
and  hsemorrhage  had  occurred,  the  risk  of  peritonitis 
was  very  great:  and,  further,  if  it  were  possible  that 
peritonitis  would  not  follow,  the  wound  itself  would 
give  her  no  more  chance  if  the  mass  were  allowed  to 
remain  than  if  it  were  taken  away.  I  therefore  deter- 
mined to  remove  the  whole  mass.  I  ligated  both  Fal- 
lopian tube^  and  of  course  part  of  the  broad  ligament, 
and  after  the  ligation  of  these  bands,  and  when  the 
tumor  became  more  movable,  I  lifted  it  out  of  the  ab- 
dominal cavity,  pulling  it  well  up  above  the  symphysis 
pubis,  so  that  the  neck  of  the  tumor  could  be  seen  and 
felt.  I  then  carried  the  chain  of  the  ^craseur  around  it, 
and  proceeded  very  slowly  to  close  it.     I  was  Mlj 


three-quarters  of  an  hour  in  accomplishing  this,  in  the 
fear  that  by  proceeding  more  rapidly  haemorrhage  might 
ensue.  After  the  chain  had  worked  through  the  rest 
of  the  womb,  that  is,  the  cervix  being  stifl  upon  the 
stretch  above  the  symphysis,  no  haemorrhage  was  visi- 
ble, but  as  soon  as  the  stump  was  fairly  liberated  the 
whole  field  of  the  operation  was  deluged  with  blood. 
The  stump  was  again  grasped  with  the  forceps,  and 
both  uterine  arteries  were  secured,  but  the  uterine 
veins,  as  well  as  several  sinuses  in  the  cervix  itseU^ 
continued  to  pour  forth  blood,  and  these  with  great 
difficulty  were  at  length  secured.  For  greater  security 
against  accident,  a  silver  wire  was  then  twisted  around 
the  end  of  the  stump,  and  the  ends  brought  out  of  the 
wound. 

The  loss  of  blood  was  considerable,  but  the  pulse  did 
not  indicate  an  an«mic  condition  of  the  body. 

The  operation  took  fully  two  hours  and  a  half.  The 
wound  was  closed  with  five  silver-wire  sutures.  A 
hypodermic  injection  of  Magendie's  solution  was  then 
administered,  and,  as  the  result,  she  slept  quieUy  an 
hour,  after  which  she  awoke.  I  saw  her  about  seven 
o'clock  in  the  evening,  and  she  was  then  in  a  tolerably 
comfortable  condition.  There  was,  however,  a  good 
deal  of  tenderness  on  the  right  side  of  the  umbilicus  on 
the  slightest  touch,  otherwise  the  abdomen  was  not 
tender.  Four  drops  of  Magendie's  solution  were  given 
every  hour  during  the  night.  After  midnight  she  be- 
came restless  and  commenced  to  vomit.  She  vomited 
several  times  after  I  saw  her  next  morning,  about  seven 
o'clock.  It  was  then  very  evident  that  peritonitis  was 
extending  rapidly.  I  made  a  hypodermic  injection 
again,  and  during  my  absence  large  doses  of  Magendie 
were  given.  About  one  o'clock  in  the  afternoon  she 
was  in  a  sinking  condition,  there  being  no  pulse  at  the 
wrists,  and  at  four  o'clock  she  died. 

No  post-mortem  examination  was  made^  and  I  do 
not  believe  that  had  it  been  done  much  more  h'ght 
would  have  been  thrown  on  the  case,  so  short  a  period 
of  «time  having  elapsed  from  the  operation  to  the 
death. 

On  introducing  a  catheter  or  sound  into  the  cavity 
of  the  womb,  it  will  be  seen  that  the  uterine  canal 
reaches  up  a  good  deal  higher  than  at  the  original  ex- 
amination. If  I  had  not  had  my  mind  preoccupied 
with  the  existence  of  an  ovarian  tumor,  and  if^  on  ac- 
count of  some  obstacle,  the  probe  had  not  been  arrested 
at  just  the  depth  of  two  and  a  half  inches,  I  should  have 
been  prevented  from  making  this  deplorable  mistake. 
I  suppose  that  the  sound  was  arrested  by  some  projec- 
tion into  the  cavity  of  the  uterus,  and  possibly  I  did 
not  make  effort  enough  to  get  it  beyond  that  point. 

The  specimen  has  been  incised  by  a  longitudinal  cut, 
and  it  will  be  seen  that  a  large  fibroma  is  embedded  in 
the  walls  of  the  uterus,  and  that  this  mass  has  nothing 
to  do  with  the  cavity  itself 

I  must  mention  that  in  the  progress  of  the  operation, 
when  the  chain  of  the  ^raseur  was  tightened,  the 
centre  of  the  mass  seemed  to  be  occupied  by  a  hard, 
irregular  mass,  and  that  there  was  a  loeseness  of  the 
investing  walls  noticeable.  In  a  similar  case,  if  I 
should  be  caught  in  such  a  tight  place,  I  would  firom 
such  a  symptom  be  led  to  modify  the  operation ;  that 
is,  instead  of  removing  the  uterus,  and  giving  the 
patient  an  almost  infinitesimal  chance,  I  would  incise 
the  walls  of  the  tumor  and  enucleate  the  mass.  He- 
morrhage would  have  occurred,  but  it  would  not  have 
been  difficult  to  secure  the  bleeding  points  as  they  in 
turn  showed  themselves.  A  very  loose  pouch  would, 
of  course,  remain,  but  that  to  a  great  extent  could  be 
resected,  and  the  edges  in  apposiuon  secured  by  sutures. 
The  mistake  that  I  made  in  supposing  that  the  tumor 


THE  MEDICAL  RECORD. 


299 


was  naoT^le  independently  from  the  uterus  is  explained 
bj  the  fact  that  the  womb,  just  at  a  distance  of  two 
and  a  half  inches  from  the  os  externum  expanding  rapidly 
to  a  globular  mass,  would  rock  from  one  side  to  the  other 
when  moved  by  the  hands  through  the  abdominal 
walls,  as  it  were,  on  the  extremity  of  the  uterine  sound 
introduced  to  the  depth  of  normal  length  of  a  healthy 
uterus  without  imparting  this  motion  to  the  sound 
itself. 


|Jr0)grjess  of  illrtical  Science. 

Erqot  in  SpoTTEn  Fbter. — A  well-marked  case  of 
cerebro-spinal  meningitis,  which  resulted  in  complete 
recovery,  after  running  a  course  of  164  da3rs,  is  reported 
in  the  Boston  Medical  and  Surgical  Journal,  July  ISth, 
1867,  in  the  treatment  of  which  ergot  seemed  to  have 
more  influence  in  controlling  the  symptoms  directly  re- 
ferred to  the  nervous  centres  than  any  other  remedy 
employed.  The  wine  was  used  in  doses  ranging  from 
20  to  40  minims  three  or  four  times  daily. 

ExTIRPATrON   OF  NaIL  OF   ThUMB   ITNDEB  ANESTHESIA 

BT  Cold. — Dr.  John  Parsons,  of  Mt.  Pleasant,  Kansas, 
reports  the  following  case  in  which  local  anaesthesia 
was  produced  by  the  mixture  of  snow  and  salt: 

"  Mrs.  B.,  who  had  been  treated  by  charlatans  with 
salves,  etc.,  for  the  past  four  months,  without  any  bene- 
fit, lately  applied  for  treatment,  and  I  decided  to  remove 
the  partly  detached  naU  of  the  right  thumb.  As  she 
dreaded  the  pain  of  the  operation,  and  also  taking  chlo- 
roform and  ether,  I  concluded  to  try  freezing  with  snow 
and  salt.  In  two  minutes,  the  thumb  being  insensible 
to  pain,  I  quickly  extirpated  the  nail.  The  thumb  was 
then  thawed  in  water,  and  then  simply  dressed.  Seven 
days  after  the  operation  it  was  healing  rapidly,  and  a 
new  nail  had  appeared." — Am,  Jour,  Med,  Sciences, 

Bromide  of  Potassiuh  in  Puerperal  Conyulsions. — 
The  following  interesting  case  is  reported  in  the  Am. 
Journal  of  Med,  Sciences,  by  Dr.  Chas.  C.  Shoyer,  of 
Learenworth,  Kansas.  He  thinks  it  the  first  in  which 
the  bromide  of  potassium  has  been  used  in  the  treat- 
ment of  puerperal  convulsions,  and  asks  that  the  drug 
may  have  a  further  trial. 

Mrs.  H.,  aged  18,  primipara,  was  seized  April  30th, 
with  a  severe  gastric  pain,  which  Dr.  S.  at  his  first  visit 
thought  was  caused  by  the  inception  of  labor;  at  a 
second  visit,  however,  the  true  seat  was  recognized, 
and  it  was  easily  controlled  by  small  doses  of  morphia 
with  CO.  spts.  lavender.  During  the  night  she  vomited 
and  had  two  stools  from  a  half  ounce  of  oL  ricini ;  she 
had  a  craving  appetite,  and  ate  largely  of  meat,  bread, 
etc.,  swallowing  without  mastication,  as  the  event 
proved;  this  continued  throughout  the  night,  and  in 
the  morning  of  May  Ist,  she  got  up  at  7  a.m.,  for  the 
purpose  of  eating  again,  but  fell  to  the  floor  fainting ; 
upon  being  placed  in  bed  she  had  a  series  of  violent  con- 
vulsions. When  seen  at  eight  o'clock  she  was  strongly 
convulsed,  breathing  stertorously,  pupils  insensible  to 
light,  teetn  firmly  fixed,  and  fi*otning  at  the  mouth. 

Five  drops  of  ol.  tiglii  were  given  in  the  course  of  an 
hour  without  any  effect.  Chloroform  was  found  to 
quiet  the  convulsions  only  during  its  administration. 
Dr.  S.  having  ascertained  that  the  child  was  dead,  now 
punctured  the  membranes,  with  a  view  to  inducing 
labor.  In  a  short  time  she  began  to  vomit,  throwing 
up  large  pieces  of  bread,  meat,  and  other  food.  She 
now  became  quiet  for  a  short  time,  during  which  a  pur- 
gative mixture  was  exhibited,  which  was  followed  by 
three  copious  evacuations,  voided  in  the  bed,  the  patient 
being  unconscious.    After  this  she  was  quiet  for  nearly 


three  hours,  but  the  pains  of  labor  setting  in  about  6 
P.M.,  she  had  several  convulsions  in  rapid  succession. 
Upon  consultation  it  was  determined  to  give  the  bro- 
mide of  potassium  in  fiileen  grain  doses  hourly,  and  to 
be  governed  by  its  effects.  From  the  time  of  its  first 
administration  to  the  end  of  labor,  a  period  of  21i  hours, 
she  did  not  have  another  convulsion.  The  bromide  was 
given  five  hours  successively,  and  then  at  greater  inter- 
vals, as  the  Btertor  had  ceased,  and  she  was  somnolent ; 
towards  the  end  of  labor  the  intervals  were  four  hours. 
The  child  was  born  at  2J  p.m.  of  the  2d,  was  about 
8^  months  old,  and  had  been  some  days  dead,  as  the 
epidermis  was  peeling.  She  took  in  all  2^  drachms  of 
bromide  during  19^  hours.  She  remained  somnolent 
until  the  morning  of  the  3d,  and  then  awakened  as 
from  a  prolonged  slumber,  having  no  recollection  of  the 
past,  not  even  that  she  had  given  birth  to  a  child.  A 
specimen  of  urine  was  examined  30  hours  afler  confine- 
ment, and  found  free  from  albumen. 

The  Ophthalmoscope  Axn  the  Physician. — Dr.  J.  V. 
Solomon,  of  Birmingham,  in  a  late  issue  of  the  British 
Medical  Journal,  makes  the  following  remarks : 

I  find  all  impediment  to  focussing  of  the  fundus  to 
be  at  once  overcome  if  the  student  suspend  the  power 
of  accommodation  of  his  right  eye  by  the  application 
of  a  four-grain  solution  of  atropia  (British  Pharmaco- 
'pceia)  half  an  hour  before  making  his  ophthalmoscopic 
examination. 

This  being  done,  and  the  iris  of  the  patient  fully  di- 
lated, he  has  on'y.  after  having  observed  the  usual  rules 
laid  down  in  opnthalmic  works,  to  gently  move  his 
head  a  httle  backward  or  forward,  as  the  case  may  be, 
and  a  complete  picture  of  the  optic  nerve  and  its  sur- 
roundincs  starts  into  view. 

The  physician  will  do  well  to  select  a  case  of  extreme 
short  sight,  atrophy  of  the  optic  nerve,  or  a  light  blue 
normal  eye,  for  his  first  experiment,  and  continue  his 
observations  every  day.  By  the  time  the  action  of 
the  atropia  has  subsided,  he  will,  if  endowed  with  good 
vision  and  some  manual  tact,  find  himself  master  of  a 
step  in  ophthiJmic  investigation  which  had  hitherto 
been  considered  by  him  as  insurmountable. 

Unusually  Rapio  Action  of  the  Heart. — Dr.  Rich- 
ard Payne  Cotton  reports  a  case  in  the  British  Medical 
Journcu  of  unusual  n^idity  in  the  hearts  action.  The 
patient  was  a  tailor.  42  years  of  age,  who  from  time  to 
time  had  been  suoject  to  paroxysms  of  palpitation. 
These  were  in  each  case  preceded  by  loss  of  appetite, 
acidity,  and  disordered  stomach,  with  constipation,  the 
rapid  action  of  the  heart  following  immediately  upon 
a  sensation  of  faintness  and  short  breathing.  When 
called  to  see  the  patient  in  one  of  these  attacks,  the 
physician  found  him  anxious,  but  not  otherwise  serious- 
ly distressed;  his  breathing  was  short,  hurried,  and 
irregular,  varying  from  thirty  to  forty  in  a  minute. 
The  pulse  was  too  rapid  to  be  depended  on ;  but  the 
beating  of  the  heart  was  distinct,  regular,  free  from 
murmur,  and  two  hundred  and  thirty-two  per  minute. 
Immediately  over  the  semilunar  valves  both  sounds 
could  be  clearly  distinguished,  scarcely  differing  from 
each  other,  and  closely  resembling  the  peculiar  "  tic- 
tao "  beats  of  the  foetal  heart ;  but  in  every  other  part 
of  the  cardiac  region  a  single  and  abrupt  sound  only 
could  be  heard.  No  valvular  murmur  could  anywhere 
be  detected,  neither  was  there  any  visible  pulsation  in 
any  of  the  larger  arteries ;  but  the  jugular  veins,  as  well 
as  the  larger  veins  at  the  bend  of  the  arms,  could  be 
distinctiy  seen  to  pulsate.  Subsequently  the  sphygmo- 
graph  was  employed,  and  the  tracings,  which  were  re- 
markably regular,  representing  mere  ripples,  proved  the 
pulsations  at  that  time  to  equal  220  per  minute.  The 
digitized  by  ^ „      ^_ 


800 


THE  MEDICAL  RECORD. 


attack  passed  off,  as  did  all  previous  ones,  suddenly.  The 
treatment  consisted  first  io  the  use  of  antacids  and 
stimulants,  during  the  action  of  which  a  considerable 
quantity  of  tape-worm  was  expelled.  Afler  a  short 
time  the  tincture  of  digitaL's  was  given  in  doses  from  10 
to  15  minims  three  times  a  day;  and  it  was  during 
the  use  of  this  medicine  that  the  heart  returned  to  its 
normal  pulsation — ^that  of  70  per  minute.  Notwith- 
standing the  immense  rapidity  of  the  action  of  the  heart 
during  the  paroxysms,  the  patient  was  not  considered  at 
any  time  in  danger.  In  conclusion  the  reporter  re- 
marks:— "In  the  case  before  us,  either  one  of  two  con- 
ditions may  have  existed.  The  presence  of  the  tape- 
worm may  have  produced  a  reflex  irritation  of  the 
heart  itself;  or  the  acidity  and  dyspepsia  under  which 
the  patient  invariably  suffered  at  the  period  of  his  at- 
tacks may,  by  giving  rise  to  an  abnormal  condition  of 
the  blood,  have  provoked  the  heart  to  its  rapid  and 
premature  contractions;  and  it  is  even  possible  that 
these  two  conditions  may  have  coexisted.  I  will  not, 
however,  insist  upon  such  an  explanation ;  but,  in  the 
absence  of  even  the  slightest  indication  of  brain  or 
spinal  affection,  or  indeed,  of  any  unusual  amount  of 
general  nervous  sensibility  in  our  patient,  I  am  at  a 
loss  for  any  other." 

Aids  to  Digestion. — Dr.  Marcet,  in  a  pamphlet  "  On 
a  new  process  for  preparing  meat  for  weak  stomachs^ 
recommends  the  use  of  hydrochloric  acid  and  pepsin 
as  solvents  for  the  cooked  flesh  previous  to  being  taken 
for  food.  He  is  of  the  opinion  that  by  this  means 
many  irritable  stomachs  could  be  enabl^  to  dispose  of 
a  certain  amount  of  animal  food  which  under  other  cir- 
cumstances could  not  be  digested  at  all.  He  gives 
careful  directions  for  preparing  the  food. 

Phenio  Aom  for  CABrea — Phenio  acid  is  strongly 
recomniended  in  dental  caries  by  two  French  dentists, 
MM.  Prest  and  Victor.  They  assert  that  they  can 
obtain  a  cure  in  nine  cases  out  of  ten,  without  resort- 
ing to  extraction. 

Action  of  StrLPHURXTTED  Hvdrogsk  on  the  Blood. — 
Herren  Klaufimann  and  Rosenthal  confirm  the  obser- 
vations on  the  action  of  sulphuretted  hydrogen  gas 
upon  the  blood,  already  made  by  Herr  Hoppe  Segfer. 
They  say  that  the  toxication  of  sulphuretted  hydrogen 
is  simply  asphyxia.  In  cases  of  poisoning  by  this  gas, 
the  treatment  is  to  introduce  oxygen  into  the  blood  by 
artificial  respiration,  and  there  is  hope  of  recovery  as 
long  as  the  heart  acts.— ^rcAwy^r  Anatomte, 

Cervical  Ribs.— L.  Stieda,  of  Dorpat>  d^escribes  the 
case  of  a  woman,  aged  30,  in  whom  a  pair  of  cervical 
ribs  sprang  from  the  seventh  cervical  vertebra.  Ex- 
cept tnat  the  left  cervical  rib  was  ossified  to  its  verte- 
bra, whilst  the  right  was  articulated  to  it  by  a  movable 
joint,  both  ribs  closely  resembled  each  other.  In  each 
a  head,  neck,  tubercle,  and  body  were  found ;  the  an- 
terior end  of  the  body  was  pointed  and  connected  by 
a  ligament  to  a  plate  of  cartilage  attached  to  the  anterior 
end  of  the  first  thoracic  rib.  The  subclavian  arteries 
had  been  removed,  so  that  Stieda  could  not  determine 
their  relations.  The  thoracic  vertebra  and  ribs,  and 
the  lumbar  vertebras,  were  normal  in  number.  The  pa- 
per concludes  with  a  brief  historical  account  of  the 
cases  previously  recorded. —  Virchow's  Archives,  1866, 
and  British  Med.  Jour. 

Broadbsnt^s  Treatment  of  Cancer  bt  the  Injection 
OF  Aoetio  AciD.—Recent  trials  of  the  method  of  Dr. 
Broadbent  in  the  treatment  of  cancerous  tumors  by  the 
injection  into  their  substance  of  acetic  acid,  in  the  Can- 
cer Hospital^  have  resulted  negatively.  The  tumors,  in- 
stead of  ahnvelling  in  size,  have  been  found  to  enlarge, 


and  to  take  an  inflammatory  action.  In  one  or  two  in- 
stan^  in  which  the  method  has  been  employed  in  this 
cit^the  same  unpleasant  effects  ensued. 

•^  Opium  in  Thebapeutios. — The  practice  of  physicians 
in  America  and  in  Great  Britain,  if  not  elsewhere,  has 
changed  very  much  in  regard  to  the  use  of  opium  in 
fevers  and  some  other  forms  of  disease,  within  the  last 
twenty  or  thirty  years.  Some  remarks  of  Dr.  AUbutt 
on  this  subject,  in  Banking's  Ahstraci,  referring  to  the 
use  of  this  remedy  in  the  Leeds  (Eng.)  Fever  Hospital, 
so  entirely  accord  with  the  results  of  our  own  experi- 
ence, that  we  take  the  liberty  of  commending  them  to 
such  of  our  readers  as  may  still  entertain  somethmg  of 
the  old  prejudice :  "  One  year  ago,"  says  Dr.  Allbutt,  "  I 
looked  upon  opium  in  fever  with  much  suspicion,  pant- 
ing its  occasional  value  alone,  and  greatly  restrictmg  its 
use.  Gradually  my  fear  of  the  restlessness  overpowered 
my  fear  of  the  opium,  and  I  have  now  ceased  to  regard 
the  latter  with  any  great  i^prehension.  Continually  I 
have  witnessed  the  terrible  havoc  which  a  night's  toss- 
ing makes  in  a  little  reserve  of  strength.  Two  such 
nights  reduce  it  to  a  most  precarious  level,  and  few  pa- 
tients outlive  three.  On  the  other  hand,  though  I  and 
my  assistants  have  been  for  six  months  giving  morphia 
at  all  stages  of  the  fever  to  combat  sleeplessness,  I  have 
never  yet  seen  mischief  result.  I  have  never  seen  the 
power  of  taking  food  suspended  by  it,  or  the  oppessioa 
increased.  On  the  contrary,  I  have  continually  seen 
with  pleasure  how,  on  the  morning  after  opium  has 
brought  sleep,  even  during  the  first  few  days  of  the  dis- 
ease, the  tongue  has  become  moister,  the  headache  less, 
and  the  countenance  more  open.  The  sleep  of  an  opiate 
is  better  than  no  sleep.  Camphor  is  also  a  great  favorite 
of  ours.  We  find,  on  the  whole,  that  no  medicine 
equals  it  in  the  low  delirium  often  connected  with  fee- 
ble heart  We  combine  it  with  opium  in  low  delirium 
accompanied  widi  sleeples-ness.  Perhaps,  however,  the 
most  striking  in  its  immediate  effects,  of  all  the  medi- 
cines which  we  have  used,  is  that  which  we  familiarij 
call  Graves*  Medicine.  The  combination  of  antimonj 
and  opium  in  the  wild  delirium  of  fever  is  advised  by 
Graves  in  a  well-known  passage  of  the  Clinical  Medi- 
cine, and  a  marvellous  one  it  is.  Half  a  grain  of  mor- 
phia, with  one-third  or  half  a  grain  of  tartar  emetic, 
with  repetition  of  half  the  dose  if  necessary,  will  bring 
quietness  and  sleep  to  a  patient  who,  an  nour  or  two 
before,  was  a  raging  maniac."  We  do  not  exactfy" 
agree  with  Dr.  A.  3iat  the  power  of  taking  food  is 
never  suspended  by  the  remedy.  But  this  is  a  small 
matter.  The  distinction  between  the  grades  of  delirium 
is  important,  the  combination  with  camphor  being* 
adapted  to  the  low  form,  and  the  antimony  to  the  wild 
and  sthenic  form. — Pacific  Med.  and  Surg.  Joumai, 

Beef  Curing  bt  Ybnous  Injection  is  practised  by  a 
firm  at  Corpus  Christi,  Texa«,  according  to  report,  with 
perfect  success.  The  blood  is  withdrawn  by  tapping 
the  right  ventricle  of  the  heart,  the  animal  having  been 
stunned;  after  which  the  veins  are  forcibly  injected 
with  brine,  through  a  hose,  the  nozzle  of  which  is  tightly 
inserted  in  an  orifice  in  the  left  ventricle,  while  the  ori- 
fice in  the  right  ventricle  is  closed.  AJler  filling,  the 
right  ventricle  is  opened,  and  allowed,  under  a  continued 
pressure  of  brine,  to  run  clear  of  the  remaining  blood. 
On  making  an  incision  at  any  point  in  the  carcass,  the 
brine  spirts  out  the  same  as  blood  from  the  living  ani- 
mal only  with  greater  force.  Even  the  hide  is  per- 
fectly salted,  and  the -carcass  can  be  kept  or  transported 
whole  as  it  stands,  or  skinned,  cut  up,  and  packed,  with 
perfect  safety  firom  ddcomposiUon. — St  Louis  Med^ 
Reporter^  ^  t 

Digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


301 


The  Medical  Record. 

^  Stmi-9Iont^ts  foiirnal  of  ^I^^^inne  Bnb  Sntgets. 
Gborge  F.  Shrady,  M.D.,  Editor. 


PablislMd  on  th0 1st  and  Iflt^of  each  Month,  Ij 
WILLIAM  WOOD  A  CO.,  «1  Walkbr  Sticbkt,  New  Tobk, 


FOREIGN  AGENCIES, 


LovDOH— Tbubitrb  k  Co. 

PaBX«— BOUABOB   XT  ClB. 


LBtPfttO^B.  HBBtfAlflf. 

Bio  Jamubo— Stbpubma  t  Oa. 


Ne'W   Yorlt,   September  1,  1867'. 

THE  TRUE  NOBILITY  OF  THE  MEDICAL 
'  PROFESSION. 
A  DiSTiNGUiSHKD  professoF  once  said,  that  'Mf  all  the 
medicine  in  the  world  (with  a  few  exceptions)  were 
cast  into  the  sea,  it  would  be  the  better  for  mankind 
and  the  worse  for  the  fishes."  His  other  utterances 
abo  on  matters  pertaining  to  medical  practice,  sparkling 
though  thej  be  with  wit  and  brilliant  with  antithesis', 
can  hardlj  be  said  to  be  orthodox,  for  having  thus  fre- 
quently made  out  his  brethren  as  fools  or  hypocrites, 
our  autocrat  says  that  he  has  looked  in  vain  for  a 
wicked  physician  to  serve  as  a  character  in  a  story. 
Here  again  we  should  be  glad  if  in  our  kaleidoscope 
riew  of  the  great  and  good  among  us,  there  were  not 
obtruded  the  dark  shapeless  bodies  of  those  who  dis- 
honor us  by  evil  practices,  covered  up  with  the  usual 
cult  about  the  nobility  of  the  profession.  This  cant  is,  in- 
deed, a  very  common  thing  with  us.  If  we  were  to 
believe  the  words  of  physicians  themselves,  as  uttered 
in  valedictory  addresses,  obituary  notices,  editorials  in 
medical  journals,  our  profess' on  ennobles  all  upon  whom 
its  mantle  falls.  That  there  may  be  an  intrinsic  nobil- 
ity in  our  calling,  we  are  ready  to  admit;  yet  the  nobil- 
ity consists  not  so  much  in  the  nature  of  the  work 
among  the  sick  and  suffering,  as  in  the  manner  in  which 
that  work  is  done.  There  are  some  aspects  of  our  pro- 
fession in  which  it  is  a  trade,  and  an  honest  one  too, 
entitled  to  all  the  respect  given  a  skilful  and  honest 
worker  in  any  chosen  calling,  but  no  more.  For  in- 
stance, all-night  attendance  upon  a  very  sick  patient, 
with  a  handsome  fee  looming  up  in  the  future,  may  or 
may  not  be  a  philanthropic  act,  only  so  far  as  the  actu- 
ating principle  be  founded  on  a  correct  motive.  In 
other  words,  much  depends  on  the  spirit  with  which 
the  work  is  done.  Mutual  admiration  on  the  part  of 
physicians,  it  seems  to  us,  is  a  little  overdone.  We 
are  not  accustomed  to  hear  the  men  of  other  profes- 
aona  indiscriminately  laud  their  calling.  Since  we 
have  voluntarily  chosen  our  work,  this  laudation  of  the 
profession  by  implication  praises  us.  As  after  all  we 
get  our  living,  in  most  instances,  by  it,  and  avow- 
edly practise  it  for  money,  this  sort  of  excessive  talk 


about  philanthropy  seems  in  doubtful  taste.  Let  us  set 
about  to  reform  the  profession.  Let  us  discountenance 
the  evil  practices,  which  in  so  many  instances  spring 
from  their  toleration,  by  those  who  should  be  the  very 
ones  to  exemplify  the  nobility  of  the  profession  of 
medicine. 

"  A  stream  cannot  rise  higher  than  its  fountain,"  and 
until  our  medical  schools  make  some  inquiries  as  to  the 
moral  and  mental  qualifications  of  the  candidates  for 
matriculation  and  graduation,  the  medical  profession 
will  be  far  from  being  in  that  fanciful  condition  which 
cannot  furnish  a  wicked  character  for  a  novel.  As  we 
have  often  said  in  these  columns,  impliedly  at  all  events, 
there  is  no  qualification  now  required  to  enter  a  med- 
ical college,  exbept  the  pecuniary  ability  to  pay  one 
hundred  and  forty  dollars  per  annum.  On  graduating, 
no  questions  whatever  need  be  ItgaUy  asked,  except 
"  have  you  paid  for  your  tickets,  studied  three  years, 
and  passed  your  examination  ? "  Asa  result  of  this 
beautiful  and  noble  system,  is  it  any  wonder  that  some 
men  who  graduate  at  respectable  colleges,  immediately 
rush  into  all  sorts  of  deluding  practices,  among  which 
that  of  homoeopathy  may  be  mentioned  ?  In  such  a 
condition  of  the  market — where  the  demand  for  charac- 
ter, much  less  for  reputation,  is  so  slight,  can  we  com- 
plain that  the  supply  is  in  proportion  ?  We  intend 
never  to  leave  this  subject,  until  reform  has  begun  at  the 
head  of  our  profession — until  medical  schools  cease  to 
display  so  largely  the  money-making  object,  which,  in 
the  end,  cannot  but  tend,  by  the  number  of  unworthy 
ones  admitted  to  our  ranks,  to  lower  so  materially  that 
high  standard  of  excellence  for  which  we  are  all  natur- 
ally eager.  While  therefore,  we  may  be  reminded  that 
"it  is  an  evil  bird  which  fouls  its  own  nest,"  at  the  same 
time,  without  even  challenging  for  admiration  the  acts 
of  the  truly  noble  men  in  the  profession,  we  may  be 
consoled  with  the  reflection  that  the  memory  of  the 
great  army  of  Esculapian  soldiers,  whose  names  shall 
ever  be  honored  so  long  as  science  has  its  votaries  or 
truth  its  disciples,  presents  themes  broad  and  ample 
enough  in  scope,  for  the  most  craving  eulogist.  Let  us 
ask  then,  in  view  of  the  indiscriminate  laudation  which 
is  heaped  upon  our  calling  by  medical  men  themselves, 
how  can  we  do  otherwise  than  raise  the  notes  of  warn- 
ing, lest  our  junior  practitioners  hug  the  delusive  idea 
that  an  entrance  into  the  profession  has  of  itself  en- 
nobled them. 

Individual  self-sacrificing  work,  not  alone  for  a  liv- 
ing, but  for  the  luxury  of  doing  good,  done  in  the  same 
spirit  for  both  rich  and  poor,  and  purity  of  life  and  heart, 
— these  will  ennoble  us.  But  when  we  practise  in  this 
way,  let  us  leave  our  encomiums  to  others. 

The  organization  of  a  medico-legal  society  in  this 
city  is  a  feature  worthy  of  notice.  Its  members  be- 
long to  the  medical  and  legal  professions,  and  its  object 
is  the  discussion  of  all  matters  pertaining  to  forensic 
medicine.     That  the  workings  of  such  a  society  cannoi 


302 


THE  MEDICAL  RECORD. 


but  be  productive  of  benefit  to  both  parties,  no  ono 
can  doubt..  A  vast  loss  of  time  in  court^  an  amicable 
instead  of  the  usual  rancorous  feeling  between  the 
lawyer  and  his  medical  witness,  and  the  elimination  of 
many  practical  truths,  must  result  from  a  free  discus- 
sion between  the  gentlemen  of  the  two  professions  on 
a  proper  subject  of  inquiry.  The  plan  of  the  society 
embraces  the  selection  and  discussion  of  a  certain  sub- 
ject at  each  meeting. 

As  one  great  source  of  knowledge  in  legal  medicine 
is  from  the  examination  of  dead  bodies,  it  further  pro- 
vides that  every  medical  member  shall  use  his  best  efforts 
to  increase  the  practice,  in  his  profession,  of  making  such 
examinations,  and  stand  pledged  at  all  times  to  conduct 
an  autopsy  for  any  physician  who  may  request  such 
service.  A  report  to  the  society  is  required  from  the 
member  making  such  an  examination,  and,  if  possible, 
its  illustration  by  diseased  or  injured  parts  taken  from 
the  body. 

We  should  be  glad  to  hear  of  similar  organizations 
elsewhere. 


The  new  Quarantine  Station  at  West  Bank,  in  the 
Lower  Bay,  has  not  reached  that  state  of  forwardness, 
which,  when  the  contract  was  awarded,  the  public  had 
a  right  to  expect  It  will  be  remembered  that  the 
works  were  to  cover  an  area  of  about  two  acres,  and 
were  to  be  constructed  of  solid  hewn  timber  bound  in  a 
species  of  net  or  lattice-work,  and"  that  these  cribs  were 
to  rise  some  eight  or  ten  feet  above  high- water  mark. 
The  two  cribs  now  in  position  have  withstood  the  un- 
usually violent  winds  and  seas  of  last  winter  and  spring, 
and  are  thought  by  experts,  proof  against  tests  still 
more  severe.  Mr.  Swift  has,  however,  failed  in  mak- 
ing the  requisite  progress  within  the  time  specified  in 
his  contract,  since  the  superincumbent  structure  is  not 
yet  aM  above  high-water  mark,  and  until  such  be  the 
case,  the  Commissioners  of  Quarantine  decline  to  pay 
down  any  instalments  in  liquidation  of  expenses  thus 
far  incurred. 

— ^  »    WW 

We  would  call  the  attention  of  those  of  our  brethren 
who  may  be  interested  in  the  progress  of  pharmacy  to 
the  coming  meeting  of  ihe  American  Pharmaceutical 
Association  in  the  University  Building,  on  the  10th 
instant. 

We  have  every  reason  to  believe  that  the  matters  to 
be  discussed  will  be  of  paramount  interest,  not  only  to 
the  pharmaceutist  but  to  the  medical  practitioner.  A 
new  feature  will  be  introduced  in  the  shape  of  "  an  ex- 
hibition of  objects  relating  to  pharmacy,"  which  will  bo 
open  for  inspection  for  four  days,  dating  from  the  open- 
ing of  the  session.  For  the  sake  of  utiUzation  the 
Association  have  adopted  a  programme,  which  calls  for 
the  following  articles : 

(1.)  Chemical  apparatus,  including  those  for  pharma- 
ceutical processes.  This  includes  apparatus  and  utensils 
for  evaporation,  distillation,  percolation,  filtration,  etc., 
and  analytical  apparatus  of  all  kinds. 


(2.)  Microscopes,  microscopical  apparatus  and  objects. 

(3.)  Apparatus  used  for  remedial  purposes,  as  gal- 
vanic and  electro-magnetic  machines,  enemas,  surgical 
appliances,  etc. 

(4.)  Glassware,  adapted  for  the  wants  of  the  apothe- 
cary. 

(5.)  Scales  and  weights,  for  chemical  and  store  pur- 


(6.)  India-rubber  goods,  for  pharmaceutical,  chemi- 
cal, or  remedial  purposes. 

(7.)  Improved  dispensing  appliances,  as  bottles,  boxes 
for  pills  and  powders,  labels,  protection  against  mistakes 
by  pharmaceutist  or  patient,  etc. 

(8.)  Medicines  newly  introduced  or  proposed  for  use. 

(9.)  Mineral  waters  and  apparatus,  mcluding  natural 
and  artificial  medicinal  waters,  and  apparatus  for  mak- 
ing and  dispensing  them. 

(10.)  Specimens  of  chemicals,  drugs,  pharmaceutical 
preparations,  as  also  botanical  specimens. 

(11.)  Illustrations  of  adulterations,  and  the  means  of 
detecting  them. 

(12.)  Improved  dietetic  preparations. 

(13.)  Books  relating  to  pharmacy  or  collateral  sciences. 

(14.)  Historical  relics  having  an  interest  in  connec- 
tion with  pharmacy  or  its  cultivators,  as  portraits,  pho- 
tographs, autographs,  etc. 

(15.)  Any  improvements  in  branches  connected  with 
pharmacy,  not  included  in  above. 


Eejjorta  0f  Saciettes* 


NEW  YORK  PATHOLOGICAL  SOCIETY. 

Stateo  Meeting,  May  24, 1867. 
(Continued  from  page  284.) 

OAKGRENE  OP  LEG  BY  EMBOLUS,  AMPUTATION  BTO. 

Dr.  Sands  presented  an  amputated  leg  on  behalf  of 
his  colleague.  Dr.  Gouley.  He  gave  the  following 
description  of  the  case. 

A  consultation  was  held  yesterday  aflemoon  at 
Bellevue  Hospital  upon  the  case  of  a  woman  who  was 
71  years  of  age,  and  who  had  been  in  the  hospital  aboat 
five  weeks.  A  very  few  points  in  the  history  of  her  case 
were  ascertained  by  the  House  Surgeon ;  and  it  appears 
that  just  about  seven  weeks  ago,  she,  then  being  in  what 
she  considered  good  health,  was  seized  with  a  violent 
pain  in  the  calf  of  the  left  leg.  This  pain  extended 
down  the  leg,  and  continued  with  considerable  severity 
for  several  c&ys.  On  the  third  day  following  this  attack 
of  pain,  a  dark  colored  spot  was  noticed  ou  the  top  of 
the  foot,  just  below  the  instep.  At  that  time,  according 
to  her  statement,  the  toes  were  not  discolored ;  the  dis- 
coloration, however,  spread  with  some  rapidity  towards 
the  toes,  tmtil  idl  of  them  were  impUcated,  and  also  ex- 
tended very  gradually  over  the  ankle  and  up  the  leg ; 
and  it  was  only  ten  days  ago  that  the  mortification 
ceased  to  extend,  and  that  a  line  of  demarcation  became 
apparent.  Tliis  line  of  demarcation  was  nearly  circular 
about  the  limb,  and  was  situated  about  four  inches  below 
the  line  of  the  knee-joint.  It  was  suspected  .that  this 
woman  labored  under  heart  disease,  and  the  attending 
surgeon,  Dr.  Gk>uley,  thought  that  he  had  satisfied  him- 
self that  there  was  some  disease  of  the  aortic  valves. 
His  observation  was  not  verified,  however,  by  any  of 
the  gentlemen  who  examined  this  patient  in  consulta- 
tion. 

The  question  arose  as  to  the  propriety  of  an  open^- 
tion,  and  also  as  to  the  cause  of  this  mortification, 
which  it  was  thought  did  not  exactly  correspond  witi 

Digitized  by  ^ ^  _        \ 


THE  MEDICAL  RECORD. 


the  description  of  gangrena  senilis.  The  opinion  was 
pretty  generally  expressed  that  ihe  mortification  might 
depend  upon  the  presence  of  a  plug  in  the  principal 
vessel  of  the  leg,  and  the  reason  why  this  opinion  was 
expressed  was  that  the  disease  began  of  a  sudden.  In 
regard  to  the  operation,  wo  were  not  entirely  agreed, 
but  the  preponderating  opinion  being  in  favor  of  imme- 
diate amputation,  it  was  performed  by  Dr.  Gk)uley.  The 
operation  was  performed  through  the  knee-joint  The 
knife  was  swept  around  the  leg  below  the  joint, 
making  an  ordinary  circular  flap,  and  I  was  quite  sur- 
prised to  see  how  well  the  stump  was  covered. 

After  the  removal  of  the  limb,  the  most  interesting 
part  of  the  specimen  centred  itself  in  the  examination 
of  the  yessels.  A  very  curious  phenomenon  was 
noticed  at  the  time  of  the  operation,  as  no  vessel  bled 
sufficiently  to  require  the  ligature.  The  poplite^  artery 
and  vein  stood  out  prominently,  and  were  seen  to  be 
filled  with  a  recent  dark  red  coagulum.  Other  ves- 
sels were  seen  plugged  in  the  same  way.  Dr.  Grou- 
ley  has  examined  the  specimen  somewhat  hastily.  The 
vessels  were,  as  I  have  said,  plugged  at  the  level  of  the 
section  made  by  the  amputation,  the  proof  of  which  is 
seen  in  the  presence  of  plugs  in  the  distal  extremities 
of  these  vessels.  This  coagulum,  in  the  case  of  the 
artery,  extends  down  it  for  about  an  inch  and  a  half; 
and  there,  just  at  about  the  point  where  the  popliteal 
should  bifurcate,  the  artery  is  very  much  distended, 
apparently  bv  the  presence  of  a  globular  plug  of  fibrine 
of  a  yellowish-red  color,  distinguishing  it  in  color  from 
the  dark  red  coagulum  which  occupies  the  vessel  above. 
The  arterial'  coats,  so  far  as  I  can  judge  by  superficial 
examination,  are  diseased ;  they  contain  patches  of 
atheroma,  and  appear  to  be  somewhat  ossified.  Where 
the  embolus  is  found,  all  the  arteries  above  the  occlusion 
are  healthy,  and  for  several  inches  below  the  arteries 
are  pervious,  and  do  not  contain  coagula.  This  plug 
is  pretty  closely  adherent  to  the  inner  surface  of  the 
popliteal  a:  tery. 

Now  it  struck  me  as  possible  that  this  might  not  be 
an  embolus  from  another  part,  but  a  coagulation  in  the 
distended  aneurism  of  the  artery.  I  think  that  the  argu- 
ment against  it  is  that  the  color  is  different.  I  should,  alter 
all,  regard  the  specimen  as  one  of  senile  gangrene,  caused 
by  the  occlusion  of  the  vessel  by  a  clot  which  has  been 
lodged  in  that  particular  locality  from  some  other  por- 
tion of  the  body. 

Dr.  Markoe  was  inclined  to  the  belief  that  Dr. 
Gouley's  case  was  one  of  obstructive  gangrene,  from  the 
fact  that  it  commenced  so  suddenly,  not  at  the  toes, 
but  upon  the  dorsum,  and  that  in  less  than  five  weeks 
the  gangrene  had  spread  above  the  middle  of  the  leg, 
DO  line  of  demarcation  having  formed,  as  usual,  in  the 
middle  of  the  leg. 

Dr.  Newman  remarked  that  the  result  would  show 
whether  the  diagnosis  was  right  or  not;  if  it  were  due 
to  embolus  the  patient  would  get  well,  if  to  senile 
gangrene  the  patient  would  mevitably  die.  This 
opinion  was  aflerwards  endorsed  by  Dr.  Markoe. 

ABNORMAL  POSITION  OF  THE  7£STICLS. 

Dr.  Sands  lasly  presented  a  testicle  which  he  had 
removed  under  the  following  circumstances :  He  was 
consulted  in  July  last,  by  a  lad,  seventeen  years  of  age, 
with  reference  to  a  swelling  in  the  left  half  of  the  per- 
ineum, which  he  knew  had  been  there  for  seven  or 
eight  years,  and  which*  recently  had  given  him  trouble 
in  riding  on  horseback.  The  patient  was  aware  of  the 
nature  of  the  swelling,  and  his  mind  was  much  depres- 
sed in  consequence,  and  suffering  besides  from  semi- 
nal  emission,    he    desired  very    much   to  have  the 


part  removed,      j 
that  it  was  due 
in  the  region  of  tl 

side  of  the  media.. , ^ ^ 

between  the  posterior  margin  of  the  scrotum  and  the 
anterior  margin  of  the  anus.  It  had  some  mobility, 
and  could  be  moved  an  inch  laterally  to  the  right  or  left, 
and  two  or  three  inches  up  towards  the  inguinal  canal ; 
but  on  ceasing  the  pressure  it  would  resume  its  former 
position.  The  operation  was  undertaken  in  the  hope 
of  being  able  to  replace  the  testicle.  The  first  incision 
through  the  perineum  penetrated  the  sac  of  the  tunica 
vaginaUs,  and  exposed  the  organ.  It  was  then  found 
that  the  serous  sac  was  very  limited  in  extent,  or  rather 
very  narrow,  it  being  just  large  enough  to  admit  tlie 
forefinger,  and  ran  up  along  the  spermatic  cord,  which 
was  lodged  closely  in  the  fold  between  the  scrotum  and 
thigh,  and  ran  up  three  inches  and  there  terminated. 
From*  the  circumstances  of  the  case  the  operation  of 
replacement  was  considered  impracticable,  and  the  organ 
was  accordingly  extirpated.  The  testicle  was  well 
developed,  being  only  about  one-half  of  its  usual  size, 
and  the  structure  was  perfect.  The  wound  healed  per- 
fectly, and  the  seminal  emissions  ceased. 

Dr.  Sands  remarked  that,  on  consulting  authorities,  • 
he  had  found  that  this  particular  abnormal  position  of 
the  testicle  was  rare.  In  an  article  upon  the  subject  in 
TodcTs  CyclopcediGj  it  is  stated  that  John  Hunter  first 
drew  the  attention  of  the  profession  to  the  subject,  and 
that  he  saw  two  cases.  No  description  of  them,  how- 
ever, is  given.  Later,  it  is  stated  in  the  same  article, 
that  two  cases  came  under  the  observation  of  Ricord, 
In  one  of  these  the  testicle  was  inflamed  as  the  sequence 
of  gonorrhoea,  and  he  was  about  to  open  what  he 
thought  to  be  an  absces?,  when  he  discovered  it  on 
examination  to  be  a  testicle.  Two  were  also  stated  to 
have  been  seen  by  Vidal  (de  Cassis).  The  curious  fact 
was,  that  they  were  two  brothers,  similarly  affected. 
A  seventh  case  has  been  spoken  of  in  one  of  the  British 
journals,  as  having  been  seen  and  operated  upon  by 
Mr.  Partridge.  The  operation  of  replacement  was  first 
attempted,  but  failing  to  do  so,  the  organ  was  removed. 
Another  case  was  alluded  to  in  Holmes'  Surgery,  in  an 
article  by  Mr.  Humphrey.  He  speaks  of  having  seen  a 
testicle,  not  in  the  perineum,  but  in  the  angle  between 
the  thigh  and  scrotum;  and  he  speaks  of  it  in  reference 
to  the  question,  whether  it  had  traversed  the  scrotum 
or  not.  In  that  instance  he  found  that  the  cord  passed 
directly  upward.  Finally,  a  case  has  been  noticed  by 
a  German  surgeon,  Zeiss,  who,  in  an  attempt  to  perform 
lithotomy  by  the  left  lateral  incision,  came  across  the 
testicle  in  that  locality,  and  changed  his  incision  to.  the 
opposite  side. 

The  Society  then  adjourned. 


The  Embalmed  Body  op  the  late  Emperor  Maxi- 
milian.— **  In  regard  to  the  body  of  MaximDian  "  says  a 
Herald  correspondent,  writing  from  the  city  or  Mexico 
under  date  July  29th,  ult,  "it  was  embalmed  by  Dr. 
Ribadaneira,  Medical  Inspector  of  the  Army  of  North- 
ern  Mexico,  on  the  staff  of  General  Bscobedo.  After 
the  embalment  it  was  taken  to  the  chapel  of  the  Con- 
vent of  the  Capuchin  Nuns,  where  it  lay  a  few  days 
ago  under  a  guard  awaiting  to  be  claimed  by  some 
competent  and  authorised  person.  It  is  stated  that 
the  doctor  has  a  claim  upon  the  corpse  for  $10,000  or 
$20,000,  professional  fee  for  services,  and  that  it  is  held 
for  this  fee.  The  coffin  is  an  ordinary  affair,  the  face 
of  the  corpse  covered  with  glass.  The  body  is  poorly 
dressed,  and  imperfectly  embahned."    (^Q(^(jTp 


904 


THE   MEDICAL   RECORD. 


Corte«ponlreiTce. 


MEDICAL  MATTERS  IN  PARIS. 

(From  our  own  Correspondent.) 
To  TUB  Editob  or  thb  Mbdical  Beoobd. 
Sir— At  the  l&stsSance  of  the  Academy  of  Medicine  the 
discussion  on  tracheotomy  was  continued,  and  M.  Peter 
made  quite  a  discourse  on  the  subject^  describing  the  prac- 
tical difficulties  in  the  way  of  the  operation,  and  suggest- 
ing means  of  overcoming  them.  Ainong  the  principal,  is 
the  small  size  of  the  trachea  in  young  children.  The 
operator  is  liable,  in  making  an  incision  with  the  bis- 
toury directed  perpendicularly  to  the  windpipe,  to 
pass  completely  through  that  organ  to  the  oesopnagua. 
Again,  the  index-finger  used  to  hold  the  trachea  in 
place,  frequently  pushes  it  to  one  side,  so  that  the  in- 
cision is  made  to  the  right  or  left  of  the  mediae  line. 
This  would  be  of  small  consequence  if  the  trachea  was 
steadily  maintained  in  the  first  position,  but  too  often 
the  finger  slips,  the  trachea  returns  to  the  middle  of 
the  throat,  and  the  incision  is  concealed  from  view. 
These  difficulties  are  more  formidable  as  the  child  is 
.  younger,  but  M.  Peter  thinks  that  the  age  alone  never 
offijrs  a  formal  contra-indication,  since  it  is  well  in  case 
of  need  to  operate  on  the  smallest  child,  and  give  it  a 
chance  for  lite  at  a  moment  that  all  others  are  lost. 

M.  Peter  considers,  however,  that  tracheotomy  is 
never  necessary,  and  therefore  never  advisable,  except 
in  cases  of  pseudo-membranous  croup,  and  believing 
that  pseudo-membranous  angina  invariably  accompanies 
this  disease,  he  abstains  from  the  operation  whenever 
he  cannot  nnd  false  membranes  in  the  pharynx.  The 
extension  of  the  membranes  to  the  bronchial  tubes  is, 
however,  of  course  a  circumstance  of  unfavorable  omen 
for  the  operation.  It  is  often  difficult  to  diagnose  this 
complication.  M.  Moutard  Martin  signalizes  pale  as- 
phyxia as  an  excellent  sign.  M.  Peter  adds,  an  un- 
usual frequence  of  the  respiratory  movements,  whose 
rapidity  is  slackened  in  simple  laryngeal  croup.  When- 
ever there  are  more  than  fifty  inspirations  a  minute, 
there  is  good  reason  to  suspect  a  pseudo- membranous 
bronchitis. 

Subsequent  to  the  operation,  the  practitioner  pos- 
sesses another  sign  of  this  formidable  complication. 
When  the  canula  left  in  the  tracheal  wound  does  not 
become  filled  with  mucosities,  when  at  the  end  of  twelve 
hours  it  is  still  dry,  there  is  too  good  reason  to  believe 
that  the  mucous  surface  of  the  bronchial  tubes  is  cov- 
ered with  false  membranes  which  effectually  prevent 
secretion. 

M.  Peter  declares  that  pseudo-membranous  bron- 
chitis is  quite  frequent,  occurring,  in  his  experience,  52 
times  in  105  fatal  cases. 

Pneumonia  coincident  with  the  croup  does  not  ab- 
solutely forbid  the  operation.  M.  GnsoUe  observes, 
that  his  first  successful  case  of  tracheotomy  was  em- 
barrassed by  this  complication.  M.  Nelaton  had  been 
called  upon  to  operate,  but  recognizing  the  concomit- 
ant pulmonary  lesion,  refused.  M.  Grisolle  then  as- 
sumed all  the  responsibility,  and  operated  himself— 
the  child  recovered. 

M.  Archambaud  had  obtained  21  cures  among  67 
operations,  including  two  upon  adults.  The  most  of 
these  cases  had  alreadv  reached  the  last  period  when 
the  operation  was  performed,  the  patients  sometimes 
being  completely  insensible.  Among  53  operations 
made  under  such  circumstances,  17  had  succeeded,  and 
among  12  cases  treated  at  an  earlier  stage  of  the  dis- 
ease, 4  were  saved.  The  proportion  therefore  is  about 
he  same. 


M.  Peter  assumes  as  contra-indications,  an  excessive 
waxy  pallor,  ganglionic  engorgement,  extreme  puffi'iess 
of  the  neck,  which  is  neither  oedema  nor  emphysema, 
all  signs  of  general  intoxication. 

Cases  of  stridulons  laryndtis  are  successfully  treated 
by  M.  Peter  with  steam.  The  child  is  surrounded  by 
half-a-dozen  basins  filled  with  boiling  water,  so  that  the 
respiratory  organs  may  be  incessantly  bathed  in  the 
humid  atmospnere;  the  croupal  symptoms  generally 
subside  in  about  an  hour. 

The  month  of  June  has  been  unfavorable  for  the  per- 
formance of  tracheot«»my,  since  out  of  eight  operations^ 
divided  equally  between  the  Children's  Ho4>ital  and 
H6pital  St.  Eugenie,  six  have  proved  fatal 

APPRECIATION  OF  MEDICAL  CONSTITITTIONS. 

This  observation  enters  into  a  report,  presented  by 
Mr.  Besnier  to  the  Academy  of  Medicine,  on  the  medi- 
cal constitution  for  June.  An  effort  is  being  made  just 
now  to  collect  materials  for  a  rigorous  appreciation  of 
"  medical  constitutions."  The  value  of  such  an  apprecia- 
tion cannot  be  too  highly  estimated,  when  it  is  remem- 
bered how  largely  this  condition  enters  as  an  element 
into  the  effect  of  medical  treatment  There  can  be  no 
question^  that  the  reputation  of  a  large  number  of  methods 
and  medicines  has  been  made  by  the  fact  that  they  were 
administered  at  a  moment  when  the  disease  had  as- 
sumed a  benign  type,  and  tended  of  its  own  accord  to 
a  favorable  issue.  During  this  month  of  June,  nearly 
all  the  cases  of  typhoid  fever  in  the  hospitals  have  re- 
covered. There  has  not  been  less,  but  rather  more  of 
the  disease  than  usual,  and  the  first  stages  have  frequent- 
ly opened  with  considerable  severity,  but  any  danger- 
ous symptoms  have  quickly  abated,  and  the  course  of 
the  malady  has  been  equally  satisfactory  under  any 
treatment  This  reminds  me  of  an  amusing  anecdote 
related  by  Dr.  Maximin  Legrand  in  the  feuilleton  of 
the  Union  Midiccde:  One  day.  the  gargan  de  service, 
employed  in  the  wards  of  Mr.  iouquier,  appeared  with 
two  black  eyes,  and  his  face  covered  with  bruises. 
"  What  is  the  matter  with  you,  my  man  ?  '*  inquired 
M.  Fouquier,  always  kind  and  polite.  *'  I  have  been 
fighting  with  M.  Bouillaud's  tn/Srmter,  and  he  is  better 
done  for  than  I  am."  "  You  were  very  wrong ;  what 
were  you  fighting  about?  "  '*  Because  he  insisted  that 
it  is  always  necessary  to  bleed  in  typhoid  fever  I** 
The  gravity  of  the  phy^cian  was  not  proof  against 
this  unexpected  reply. 

When  it  i9  remembered  that  M.  Bouillaud  is  the 
author  of  the  famous  system  of  bleeding  in  pneumonia 
twice  a  day,  coup  sur  coup^  and  extends  his  sanguinary 
propensities  to  typhoid  fever  also,  the  belligerent  enthusi- 
asm of  bis  humble  subordmate  may  be  easily  explained 

THE  ADMINISTRATION  OF  MERCURT  IN  SYPHILIS. 

At  the  Imperial  Society  of  Surgeons,  the  discussions 
Still  turn  upon  the  question  of  the  administration  of 
mercury  in  syphilis,  a  question  that  seems  subject  to 
periodical  agitation.  The  most  conspicuous  part  of  the 
debate  has  been  that  sustained  by  M.  Despres,  whose 
views  have  been  entirely  special,  "  so  special,"  observes 
Dr.  Reveillant,  "  that  he  remained  entirely  alone  in  his 
opinion."  For  M.  De?pr&  is  radical  enough  to  deny 
any  efficacy  to  mercury  whatever,  in  the  disease  in 
which  it  has  for  so  long  been  considered  the  sheet- 
anchor.  He  is  resolved  never  to  administer  the  bane- 
ful drug  either  in  primary,  or  secondary,  or  tertiary  ^- 
philis.  Theoreticallv,  he  bases  his  principles  upon  the 
idea,  that  the  malady  is  already  so  exhausting  to  the 
patient,  that  the  debilitating  effects  of  mercury  can 
work  him  nothing  but  iniury.  Practically  M  Despres 
appeals  to  the  result  of  his  experience  in  the  H6pitai 
Leourcine,  among  234  patients,  of  whom  some  werQ 
digitized  by  ^ „      ^_ 


THE  MEDICAL  RECORD. 


305 


subjected  to  the  claasical  treatment,  others  to  a  course 
of  tonics.  Among  the  first,  a  percentage  of  28  for 
100  returned  after  more  or  less  time  to  the  hospital  for 
fresh  treatment  of  the  disease,  while  in  the  second  class 
the  returns  were  only  10  for  a  hundred.  M.  Despr^ 
declares,  rather  fancifully,  that  the  physician  should 
endearor  to  restore  his  patient  to  a  "  life  of  infancy," 
regulating  his  food,  sleep,  and  exercise,  building  up  his 
shattered  constitution,  and  that  nature  would  eliminate 
the  poison.  "  We  cannot  believe  that  a  purely  empiri- 
cal medicine  can  be  a  contra-poison  against  syphilis^  or 
that  there  is  any  sense  in  employing  a  drug  that  exists 
in  the  blood  like  foreign  matter,  which  does  not  assimi- 
late with  a* single  fluid,  and  wnich,  even  in  exercising 
a  certain  perturbating  and  deleterious  efiect  on  the 
economy,  neither  solicits  nor  suspends  the  regular  exer- 
cise of  a  single  function." 

The  only  points  of  importance  in  M.  Despres*  remarks, 
are  the  statistics,  and  their  value  is  vigorously  contested 
by  M.  Depaul  He  observes  that  the  comparison  be 
tween  the  two  modes  of  treatment  was  not  sufficiently 
extended,  and  moreover,  that  the  basis  of  comparison 
was  fallacious,  since  a  number  of  the  patients  who  bad 
been  treated  by  expectation,  probably  absented  them- 
selves from  the  clinique,  not  because  they  were  cured, 
bat  because  they  were  disgusted  with  the  treatmenL 
Nothing  exasperates  a  hospital  patient  so  much  as  the 
suspicion  Uiat  nothing  is  being  done  for  him.  He  main- 
tained that  this  expectant  system  was  extremely  dan- 
gerous, since  the  most  serious  destruction  of  tissue,  such 
as  the  perforation  of  the  palatine  vault,  might  take  place 
while  the  physician  was  watching  with  folded  hands. 
M.  Depaul  laid  especial  stress  on  the  efficacy  of  mercury 
adminii^tered  for  syphilis  contracted  during  pregnancy, 
when,  he  declares,  it  uniformly  prevents  abortion,  in 
recent  cases. 

A  case  that  recently  occurred  in  the  service  of  M. 
H€rard  at  Laribaissiere,  which  I  had  an  opportunity  of 
observing  myself)  is  in  entire  accordance  with  this  asser- 
tion. The  subject  was  a  woman  of  about  85,  in  the 
third  month  of  pregnancy.  Several  years  previous  she 
had  been  treated  at  Lourcine  for  primary  syphilis,  and 
two  years  ago  had  bee»i  an  inmate  of  Laribaiasi^re  for 
syphilitic  angina.  Each  time  she  had  completely  re- 
covered, and  it  was  impossible  to  ascertain  whether  the 
renewal  of  the  disease  was  a  manifestation  of  the  orig- 
inal malady,  or  the  result  of  a  new  infection.  At  the 
moment  of  her  entrance,  in  June,  the  patient  presented  an 
eruption  of  syphilitic  erythema,  copper-colored  blotches 
disseminated  over  the  entire  body;  a  small  tumor  on 
the  right  frontal  bosse,  with  broad  base,  but  slight  ele- 
vation, but  the  seat  of  lancinating  pains  exasperated 
It  night,  and  which  extended  also  to  the  temples  and 
the  ears:  a  gray  ulcerated  fissure  at  the  left  commissure 
of  the  lips ;  a  grayish  plague  mugueux  on  the  right  labium 
majus  of  the  vulva.  Fine  subcrepitant  r&les  could  be 
beard  at  the  summit  of  the  left  lung.  A  cough  had  ex- 
isted for  several  months,  but  the  patient  professed  to 
have  been  perfectly  free  from  syphilitic  accidents  at  the 
commencement  of  her  pregnancy.  She  was  ordered  a 
piU  of  corroaive  sublimate  containing  five  centigrammes, 
to  be  taken  every  evening.  This  was  the  11th  of  June. 
On  the  12th,  in  addition  she  commenced  to  take  25 
centigrammes  of  iodide  of  potassium  every  morning. 
By  the  19th  the  pains  in  the  head  had  entirely  ceased, 
and  the  eruption  had  begun  to  fiede.  By  July  11th  tlie 
tamor  had  almost  disappeared,  as  also  the  plaque  mu- 
pmiXf  and  the  eruption  was  entirely  gone.  The  fissure 
of  the  lips  was  also  healed,  and  the  patient  left  the  hos- 
pital on  the  16th  of  July  in  a  perfectly  satisfactory  con- 
dition (the  cough  also  was  din^inished),  both  as  regards 
her  general  health  and  the  march  of  the  pregnancy. 


The  treatment  was  continued  uninterruptedly  during 
the  first  month ;  after  that,  the  sublimate  was  suppressed, 
and  the  iodide  alone  continued. 

MM.  Gu^rin,  Perrin,  Vemeuil,  and  Velpeau,  also 
took  up  arms  in  defence  of  mercury.  They  nearly  all 
insistea  upon  a  prolonged  treatment,  not  less  than  two 
yearSy  as  absolutely  necessary  to  radical  cures.  M. 
Gu€nn  therefore  disapproves  of  large  doses.  He  prefers 
the  protiodide  associated  with  opium,  but  in  case  that  is 
supported  with  difficulty,  he  has  recourse  to  fumiga- 
tions with  cinnabar.  He  does  not  believe  that  inunc- 
tions alone  are  sufficient,  while  they  have  the  incon- 
venience of  producing  sahvataon  more  speedily  than 
other  methods  of  admmistration.  M.  Perrin,  with  an 
experience  of  470  cases,  treated  at  Val  de  Grace,  dis- 
believes that  mercury  administered  in  primary  syphi- 
lis can  prevent  the  regular  evolution  of  the  disease,  and 
therefore  confines  himself  to  local  cauterizations,  and 
only  commences  general  treatment  with  the  appearance 
of  secondary  symptoms.  He  is  careful  to  administer 
chlorate  of  potassacoincidently  with  the  mercury  in  any 
form.  He  acknowledges  that  no  treatment  is  infallible 
against  relapses,  but  that  the  physician  is  simply  called 
upon  to  be  persevering,  and  reapply  the  treatment  at 
each  outbreak  until  he  has  mastered  the  disease. 

M.  Vemeuil  and  Velpeau  believe  in  the  beneficial 
effects  of  mercury  at  all  periods  of  the  disease,  and  the 
former  declares  that  salivation  is  an  imaginary  phantom. 
Syphilis  rwoy  exhaust  itself  spontaneously,  but  such  cases 
are  rare,  and  generally  the  patients  are  exhausted  first 

The  only  person  who  in  any  way  sustained  the  views 
of  Desprds  was  M.  St  Gkrmain,  who,  while  professing  to 
believe  that  mercury  does  render  some  indefinite  ser- 
vice in  syphiUs,  d^-lares  at  the  same  time  that  he  con- 
siders it  as  useless  against  chancre,  that  he  has  a  "cer- 
tain tendency  not  to  administer  it  in  secondary  syphilis," 
and  that  he  always  combats  tertiary  symptoms  by  iodide 
of  potassium. 

It  appears,  therefore,  that  not  much  new  light  has  yet 
been  thrown  on  this  important  subject  by  the  debate. 
The  society  is  waiting  to  hear  the  opinion  of  M.  Diday, 
pupil  of  Ricord,  whose  voice  would  naturally  have  much 
influence. 

More  original  views  were  presented  in  a  recent  dis- 
cussion at  Lyons,  on  the  same  subjectj  where  several  of 
the  members  maintained  that  it  was  unnecessary  to 
spend  much  time  or  thought  upon  the  cure  of  patients 
who  had  faUen  a  prey  to  the  disease  in  consequence  of 
misconduct,  and  that  especially  such  patients  should 
never  receive  the  benefit  of  gratuitous  treatment. 

VESICO-VAGINAL   FISTULA   TREATED    BY  THE    AMERICAN 
METHOD. 

M.  Courty,  Professor  at  Montpellier,  publishes  an  ac- 
count of  six  cases  of  vesico-vaginal  fistula,  successfully 
operated  by  the  "  American  method."  The  BuUeHn  of 
Therapeutics  publishes  the  details  of  two  that  presented 
unusual  difficulties.  In  one,  the  fistula,  five  centimetres 
long,  dated  from  four  jrears,  the  urethra  was  oblit- 
erated, and  vagino-pubic  adhesions  existed.  There 
was  also  a  hernia  of  the  bladder.  Owing  to  the  ad- 
hesions, the  operation  was  exceedingly  difficult,  the 
haemorrhage  abundant,  and  the  lips  of  the  wound  did  not 
completely  close.  Afler  a  second  operation,  however, 
performed  upon  the  gaping  part  of  the  suture^adhesion 
was  effected,  and  a  radical  cure  completed.  The  treat- 
ment lasted  four  months.  In  the  second  case,  the  pa* 
tient,  a  woman  28  years  old,  ^^  alreadv  been  ope- 
rated upon  unsuccessfully,  and  a  cicatricial  tissue,  hard 
and  thioc,  bordered  the  edges  of  the  fistula,  which  waa 
eight  millimetres  long.  In  this  case  also,  two  opera* 
tions  were  necessary,  f^  r^r^r^\r> 

Digitized  by  VjOOQ  Ic 


806 


THE  MEDICAL  RECORD. 


M.  Courty  only  revives  the  borders  of  the  fistula, 
at  the  expense  of  the  vaginal  mucous  membrane,  care- 
fully avoiding  the  vesical.  For  the  deep  sutures  he 
uses  Startin*s  needles,  and  for  the  superficial,  Sims'.  He 
leaves  a  sound  constantly  in  the  urethra,  and  by  means 
of  a  canula  pushed  to  the  bottom  of  the  vagina,  has  the 
(?avity  washed  out  twice  a  day  with  a  lotion  to  prevent 
Suppuration.  The  wires  are  withdrawn  between  the 
fifth  and  tenth  days. 

MISTAKE   BETWEEN   AN   OVARIAN  AND   RENAL   CYST. 

The  Gazette  Hehdomadaire  quotes  a  case  of  a  mistake 
made  between  an  ovarian  and  renal  cyst  by  the  dis- 
tinguished Dr.  Wells  of  London.  A  woman  of  43  years 
presented  herself  at  his  hospital,  to  be  treated  for  an 
abdominal  tumor,  that  two  experienced  physicians  had 
already  pronounced  to  be  an  ovarian  cyst.  They  had 
refused  to  operate,  however,  because  «  loop  of  intestine 
was  recognized  as  passing  in  front  of  the  tumor.  On 
the  4th  of  August,  when  Mr.  Wells  first  saw  the  pa- 
tient, the  tumor  had  risen  to  the  epigastrium,  and  the 
patient  seemed  threatened  with  suffocation.  He  punc- 
tured the  cyst  to  her  immediate  relief,  and  the  tumor 
and  dull  percussion  sound  entirely  disappeared.  Two 
months  later,  the  woman  returned  to  the  hospital,  with 
the  tumor  again  filling  all  the  abdomen.  On  the  left  of 
the  umbilicus  was  recognized  a  hard  band,  which  was 
supposed  by  some  to  be  a  loop  of  intestine,  by  others 
the  Fallopian  tube.  The  menstruation  was  regular ;  the 
urine  contained  mucus  and  epithelium,  but  no  albumen. 
The  abdomen  was  largely  opened  in  the  median  line. 
The  incision  of  the  peritoneum  revealed  passing  in  front 
of  the  cyst,  the  transverse  and  descendmg  colon,  inti- 
mately adhering  to  the  abdominal  walls  and  also  to  the 
cyst ;  16  pints  of  gray  purulent  liquid  were  withdrawn 
from  the  cavity.  The  destruction  of  the  adhesions  re- 
vealed a  second  cyst,  which  yielded  two  pints  of  clear 
liquid.  Finally,  since  it  was  impossible  to  destroy  the 
deep  adhesions,  the  cyst  was  left  in  place  and  the  wound 
closed.  The  patient  succumbed  the  next  morning.  At 
the  autopsy  the  following  state  of  things  was  manifest : 
Four  pints  of  sanguinolent  serum  and  of  coagula  were 
effused  in  the  peritoneum.  The  uterus  and  ovaj^es  were 
perfectly  healthy.  The  right  kidney  was  hypertrophied, 
and  much  softened,  a  calculus  of  40  centigrammes  was 
found  in  the  calix.  The  left  kidney  was  converted  into 
a  cyst  more  voluminous  than  the  head  of  a  foetus,  con- 
taining a  single  cavity  divided  by  bridles,  and  whose 
walls  were  formed  by  the  renal  capsule.  The  paren- 
chyma had  completely  degenerated  and  atrophied. 

A  precisely  analogous  case  occurred  here  the  other 
day,  at  La  r iti^,  in  the  ward  of  M.  Belrier.  The  pa- 
tient was  48  years  old,  and  feeble,  and  on  this  ac^count 
it  was  decided  that  ovariotomy  was  unadvisable,  al- 
though an  ovarian  cyst  was  aingnosed  without  any 
hesitation.  Tapping  was  followed  by  the  complete  col- 
lapse of  the  tumor,  which,  however,  resumed  its  ori- 
ginal dimensions  in  two  or  three  weeks.  At  the  time 
of  the  patient's  death,  two  or  three  weeks  after  the 
operation,  the  cyst  contained  several  quarts  of  liquid, 
and  occupied  all  of  one  side  of  the  abdomen,  fi:om  the 
iliac  fossa  to  the  hypochondrium.  At  the  post-mortem, 
this  tumor  was  found  to  be  an  enormous  cyst  of  the 
kidney,  whose  entire  parenchyma  was  destroyed,  and 
only  the  capsule  left,  lined  by  a  serous  membrane  of 
new  formation,  but  or  sufficient  secreting  power  to  re- 
produce the  entire  volume  of  liquid  in  the  course  of  two 
or  three  weeks. 

Mr.  Wells  has  profited  by  his  mistake  to  make  a 
more  careful  study  of  the  points  of  diagnosis  between 
renal  and  ovarian  cysts,  and  has  published  some  most 
valuable  reflections.  The  diagnosis,  he  says,  should  be 
based  on  the  following  circumstances : 


1st.  Whenever  a  bridle  of  intestine  is  recognized  as 
passing  in  fi-ont  of  the  cyst,  it  is  almost  certainly  renal, 
since  the  ovarian  cysts  push  the  entire  intestinal  mass 
of  it  against  the  vertebral  column. 

2nd.  The  ascending  colon  would  be  found  on  the  in- 
ternal side  of  the  right  kidney ;  the  left  is  crossed  from 
above  downwards  by  the  descending. 

3rd.  The  urine,  which  should  be  subjected  to  a  mi- 
croscopic examination,  nearly  always  contains  mucus, 
epithelium,  pus  or  albumen,  in  cases  of  renal  tumors, 
whilst  liie  menstruation  is  not  disturbed  as  it  is  in  ovarian 
disease.  (This  latter  circumstance  evidently  cannot  be 
relied  upon  in  the  numerous  instances  where  the  tumor 
is  developed  after  the  menopause.) 

4th.  The  bridle,  on  percussion,  is  found  to  be  con- 
tracted like  a  cord,  and  is  mobile. 

5th.  In  the  case  of  ovarian  cysts,  the  liquid  often  es- 
capes by  the  Fallopian  tube,  aiter  adhesions  have  been 
contracted,  while  in  renal  cysts  the  way  of  escape  is  by 
the  ureter  and  bladder. 

6th.  Renal  tumors  appear  first  in  the  hypochondria, 
and  develop  downwards ;  ovarian  in  the  iliac  fossa,  and 
pass  upwards. 

Mr.  Wells  concludes  that  henceforth  no  one  need 
make  a  mistake  between  the  two  diseases. 

CAKOER  OF  THE   KIDNEY,  BTO. 

While  speaking  about  renal  tumors,  I  must  mention 
a  highly  interesting  case  at  present  in  the  service  of  M. 
H^rard,  at  Laribaissi^re,  where  an  inverse  mistake  in 
the  diagnosis  was  induced  by  the  ambiguity  of  the 
symptoms.  The  subject,  a  woman  of  about  38,  entered 
the  ward  the  31st  of  March,  presenting  an  abdominnl 
tumor  that  occupied  the  left  iliac  fossa,  and  extended 
in  front  to  the  umbilicus,  and  behind  to  the  spine.  A 
smaller  tumor  was  situated  in  a  precisely  similar  man- 
ner at  the  right  side.  The  patient  had  begun  to  suffer 
five  montha  before  her  entrance,  with  severe  pains  in 
the  renal  and  dorsal  regions,  which  were  presently 
followed  by  the  development  of  the  left  tumor,  which 
rapidly  increased  to  its  present  size.  The  disease  had 
attacked  the  right  side  about  a  month  ago.  The  an- 
terior border  of  the  tumor  could  be  felt  distinctly  in 
front ;  behind  the  hmits  were  more  vague.  Clear  per- 
cussion sound  was  obtained  between  the  dulness  of  the 
tumor,  and  that  proper  to  the  spleen.  Also,  the  mass 
did  not  continue  into  the  inguinal  region,  or  pass  the 
median  line,  so  that  the  idea  of  an  ovarian  disease  was 
set  aside.  The  position  at  the  left  of  the  principal  mass 
put  the  liver  out  of  the  question,  and  the  appearance  of 
a  similar  tumor  in  the  right  renal  region  indicated  that 
a  symmetrical  organ  was  invaded.  Everything,  there- 
fore, led  to  the  belief  that  the  disease  occupied  the  kid- 
ney, a  belief  (as  I  hasten  to  say)  that  so  far  nothing  has 
contradicted.  But  the  tumor  presented  quite  distinct 
fluctuation.  The  complexion  of  the  patient,  though 
pale  and  chalky,  had  no  tmt  of  special  cachexia,  and  the 
diagnosis  of  renal  dropsy  (hydronephroae)  was  pro- 
nounced. A  surgeon  in  consultation  agreed  in  this 
opinion,  and  tapped  the  tumor.  There  issued,  neither 
urine  nor  serous  fluid,  but  a  small  quantity  of  juice, 
which,  both  to  the  naked  eye  and  the  microscope,  was 
evidently  cancerous.  The  greater  part  of  the  tumor 
was,  after  all,  solid. 

The  patient  is  still  alive,  and  her  condition  is  liable 
to  great  variations.  For  a  long  time  after  her  entrance 
to  the  hospital  she  suffered  almost  continually  from 
pain,  which,  finally,  seemed  to  be  relieved  by  subcuta- 
neous injections  of  morphine.  A  week  ago  she  was  a 
great  deal  better,  sat  up,  embroidered,  felt  quite  at  her 
ease,  but  a  relapse  has  just  occurred,  ana  she  is  now  about 
in  the  same  state  as  when  she  entered.  During  the 
first  weeks  the  tumor  seemed  to  increase,  but  for  th© 


THE  MEDICAL  RECORD. 


307 


last  six  weeks  it  has  beea  quite  stationary.  Since  the 
tappinj^  (which  did  not  materially  diminish  the  size  of 
the  tumor),  the  sensation  of  fluctuation  has  disappeared, 
and  now  the  surface  of  the  mass  is  more  uneven,  ihoupfh 
never  Iiard,  or  distinctly  bosselated.  The  cancer  is  evi- 
dently an  encephaloma. 

CaXTRAOTIBILITT   OF  HCSOULAB  FIBRE. 

Before  closing  my  chronicle,  I  must  tell  you  of  some 
singular  experiments  that  have  just  been  made  by  M. 
Bouget  upon  the  contractibility  of  muscular  fibre.  M. 
Rou«:et  commenced  his  researches  on  the  subject,  by 
the  study  of  the  style  of  the  vorticellus,  where  the  mus- 
cle consists  of  a  single  fibre.  This  is  elongated  during 
life,  but  under  the  influence  of  excitants,  or  after  the 
deatli  of  the  animal,  the  spiral  returns  brusquely  on 
itself,  and  is  shortened  four-fifths,  being  transformed 
into  a  spiral  spring,  pressed  closely  together.  Experi- 
menting subsequently  upon  living  animals,  Rouget 
fonnd  that  everything  that  interfered  with  the  nutrition 
of  the  muscles,  made  them  contract.  If  the  main  artery 
of  a  limb  were  tied,  if  galvanic  excitement  was  con- 
tinued incessantly,  if  the  muscles  were  subjected  to  a  con- 
tinually increasing  heat  or  to  cold,  the  result  was  always 
the  same,  they  contracted.  When  the  contractions  were 
too  frequent,  the  myographion  showed  that  the  trans- 
verse lines  repeatedly  approached  each  other,  could 
no  longer  separate,  but  remained,  as  it  were,  agglutina- 
ted. Kouget  declares  that  the  primitive  muscular  fibre 
i3  constituted  by  an  elastic  fibre  twisted  in  a  spiral,  and 
that  the  transverse  lines  mark  the  curves  of  this  t^piral, 
and  not  the  segmentations  of  a  straight  bundle  of  fibrillar 
elements,  as  usually  maintained.  The  state  of  repose, 
the  normal  state  of  this  spiral,  is  that  of  the  approxi- 
mation of  its  lings,  which  appears  to  the  eye  as  the 
contraction  of  the  muscle.  Tlie  lengthening  is  the  really 
active  process,  and  can  only  occur  during  the  vigor  of 
life.  The  cadaveric  rigidity  of  muscles  is  precisely  the 
same  phenomenon  as  that  occurring  when  their  vitality 
has  been  exhausted  by  heat  or  cold,  or  starved  out  by 
lack  of  food.  When  a  muscular  fibre  shortens,  it  does 
H)  in  virtue  of  its  own  elasticity,  which  triumphs  over 
the  vital  force  developed  in  the  act  of  nutrition.  This 
or  any  other  force  that  excites  motion  in  the  muscles, 
tt  the  moment  that  it  ceases  to  act,  is  transformed  inte 
teat,  and  hence  the  rise  of  temperature  observed  in 
muscles  entering  into  a  state  of  contraction. 

Muscles  do  not  contract  in  successive  undulations  or 
shocks,  except  at  the  beginning  of  the  action  of  an  ex- 
ternal excitant^  or  when  they  are  exhausted  by  fatigue. 
Contracted  muscles  seen  under  a  microscope,  are  found 
to  be  perfectly  motionless.  When  they  contract  by  the 
win,  tliere  are  no  undulations  even  at  the  beginning  of  the 
period. 

The  influence  of  this  theory,  which  reverses  the 
passive  and  active  sides  of  muscular  movement,  upon 
tetanus,  chorea,  and  all  diseases  of  muscular  activity,  is 
e«ily  perceived.  But  M.  Rouget  as  yet  attempts  no 
pathological  applications. 

Ua  joli  mot^  as  the  French  say,  in  conclusion.  You 
*re  familiar  with  the  name  of  Charcot,  I  suppose,  and 
of  his  intimacy  with  the  distinguished  surgeon,  Vulpian. 
The  two  have  so  often  published  together,  that  their 
names  are  inextricably  associated  to  the  public  ear. 
The  other  day  a  friend  of  Charcot's  observed : 
^  *'  Charcot  has  been  made  happy  this  morning.  He 
i«  tlie  father  of  a  son." 

"  What,"  exclaimed  a  bystander,  "  Charcot  and  Vul- 
^  ?  "  But  it  was  explained  that  this  time  it  was 
Charcot,  tout  uuL 

THX  ORIGIN  OF  MODERN  ANJLSTHESIA. 

I  have  not  yet  finished,  for  I  must  mention  the  com- 


pliment paid  by  the  Gazette  Hehdomadaire  to  the  Medical 
Kecord,  as  ^'  the  most  serious  medical  journal  in  the 
United  States.'*  When  the  Record  ascribes  the  first 
(chronological)  honor  of  chloroform  to  Dr.  Wells,  the 
Gazette  thinks  that  the  question  is  settled* 

^  ^ P.   C.   M. 

JOTTINGS  OF  A  MONTH  ABROAD. 

To  THE  Editor  of  tiib  Medical  Becobd. 

Dear  Doctor — Seven  weeks  ago  I  was  with  you  in 
your  sanctum  in  Walker  Street,  as  little  dreaming  of  a 
trip  to  Europe  as  of  journeying  to  the  moon ;  to-day 
finds  me  on  board  the  St.  Laurent,  bound  from  Havre 
to  New  York.  Summoned  by  cable-despateh  to  a  sick 
relative  at  Rome,  I  left  home  at  a  few  hours'  notice, 
reached  the  "  eternal  city  "  in  seventeen  days,  and,  with 
my  invalid  in  charge,  came,  by  easy  stages,  once  more 
to  ship-board.  With  only  four  to  five  weeks  abroad, 
and  with  another  and  paramount  obiect  of  attention  on 
hand,  you  may  well  suppose  that  I  have  had  but  Httle 
time  to  devote  to  medical  study  and  observation,  and 
that  I  cannot  have  much  to  tell  you  and  your  readers. 
Still  my  visit  has  not  been  entirely  sterile,  and,  after 
fifteen  years'  absence  from  Europe,  it  has  afforded  me 
almost  as  much  pleasure  as  would  be  enjoyed  by  a 
novice.  Perhaps  a  few  jottings  by  the  way  may  be 
worth  Recordiwg,  even  in  a  somewhat  desultory  manner. 

I  had  not  before  appreciated  the  danger  incurred  by 
pleasure-seekers  in  Italy,  especially  during  the  spring 
and  summer.  The  relative  referred  to  left  home,  ap- 
parently in  good  health,  in  the  month  of  March,  and 
made  the  tour  of  Italy  with  the  usual  labor  of  sight- 
seeing; and  any  one  who  has  tried  it  knows  how  ex- 
hausting this  is.  On  the  eve  of  leaving  Rome  he  was 
seized  with  fever,  from  which  he  had  partially  recovered, 
when  a  haemoptysis  took  place,  and  auscultation  of  the 
lungs  showed  that  tubercles,  which  had  probably  existed 
before  in  a  latent  state,  had  been  still  further  developed. 
He  was  sent  to  the  Alban  Hills,  in  the  neighborhood  of 
Rome,  but  even  there  the  climate  was  so  depressing 
that  he  was  daily  losing  ground,  until  my  arrival  enabled 
him  to  be  brought  to  a  cooler  and  more  healthy  region. 
Nor  has  this  been  an  isolated  case  this  season.  Two 
very  similar  ones  have  come  to  my  knowledge,  both 
happening  to  American  travellers,  one  of  which  has  al- 
ready terminated  fatally,  and  the  other  is  likely  to  do 
so.  Dr.  J.  Henry  Bennet,  in  his  "Winter  in  the 
South  of  Europe,"  p.  11)5,  says:  "  Rome  is  a  winter  re- 
sidence for  healthy  tourists,  not  for  invalids;  malaria 
reigns  there,  more  or  less,  all  the  year.  Every  winter 
it  makes  victims,  even  among  the  healthy,  and  the  med- 
ical practitioners  who  have  been  settled  there  for  years 
say  that  malarial  fever  complicates,  more  or  less,  nearly 
every  form  of  disease,  slight  or  severe,  that  occurs,  even 
during  the  winter  montha"  These  facte  should  be  borne 
in  mind  by  physicians  when  advising  patients  with  re- 
gard to  a  foreign  tour. 

I  had  hoped  to  be  able  to  go  northward  fi'om  Rome 
and  see  something  of  medical  matters  in  the  north  of 
Italy,  and  possibly  in  Germany.  I  wanted  especially  to 
see  'in  Florence  *  Galligo,  the  author  of  a  most  able  work 
on  venereal  diseases,  and  Professor  Pellizari,  who  first 
established  beyond  dispute  the  inoculability  of  syphilitic 
blood;  to  become  personally  acqusinted  witi  Drs. 
Tamburini  and  Ricordi,  in  Milan,  and  to  visit  the  Hos- 
pital Maggiore,  where  the  latter  is  fast  making  for  him- 
self a  name  by  his  studies  in  syphilography.  The  bright 
sters  in  Germany  are  too  well  known  to  require  enume- 
ration. My  patient,  however,  was  too  ill  to  bear  the 
fatigue  of  travelling  by  land,  and  so  I  was  compelled  to 
turn  my  back  upon  all  these  anticipated  pleasures,  aod 


S08 


THE  MEDICAL  RECORD. 


even  upon  the  magnificent  fete  of  the  '*  eighteenth  cen- 
tenary of  St.  Peter  "  about  to  be  celebrated  at  Rome,  and 
start  for  Paris,  vid  Civita  Vecchia  and  Marseilles. 

The  loss  was  in  a  good  measure  compensated  for  by 
the  opportunity  thus  afforded  of  passing  two  days  at 
Lyons  on  the  way.  It  is  not  often  that  one  has  a  cnance 
to  visit  a  place  so  remote  from  the  larger  medical  centres, 
although  the  desire  to  see  such  men  as  Diday  and  Rollet, 
and  others  of  the  famous  medical  school  of  Lyons,  would 
make  one  put  up  with  many  inconveniences  to  accom- 
plish it.  ' 

I  visited  the  Hospice  de  T Antiquaill**  in  company  with 
the  surgeon  in -chief,  Dr.  Gailleton,  who  kindly  pointed 
out  the  cases  of  interest,  among  which  were  several  in- 
stances of  the  communication  of  syphilis  among  glass- 
blowers,  through  the  medium  of  the  mouth-tube  used  in 
common  by  a  number  of  men  belonging  to  one  set.  The 
frequency  of  this  occurrence  has  induced  the  authorities 
to  adopt  certain  preventive  regulations.  Cases  of  go- 
norrhoea! rheumatism  were  also  unusually  numerous  in 
the  wards,  and  several  of  them  in  women. 

This  hospital  is  admirably  situated  upon  the  heights 
of  Fourvi^res,  several  hundred  feet  above  the  city,  and 
commanding  a  view  of  Mont  Blanc,  at  a  distance  of 
ninety  miles.  It  is  the  only  institution  of  the  kind  at 
Lyons  into  which  venereal  cases  are  admitted,  and  hence 
it  affords  nn  admirable  opportunity  for  the  study  of  this 
class  of  diseases.  Aside  from  its  lunatic  department  it 
has  three  divisions,  one  devoted  to  the  skin  diseases  of 
children,  one  to  venereal  diseases  of  men,  and  a  third  to 
venereal  diseases  among  women.  Each  surgeon  takes 
these  three  divisions  in  order,  devoting  six  years  to 
each,  and  at  the  dose  of  his  eighteen  years  of  service 
resigns.  This  is  a  bad  arrangement  on  one  account, 
since  it  leaves  some  men  like  Rollet  and  Diday,  still  in 
the  prime  of  life,  without  a  public  field  for  observation 
or  instruction. 

Personal  interviews  with  the  two  physicians  just 
named  were  most  agreeable.  Diday  I  should  judge  to 
be  about  fifty-four  years  of  age.  He  looks  not  unlike 
our  friend,  Dr.  A.  C.  Post,  and  has  all  the  activity  and 
vivacity  of  the  latter.  He  was  much  interested  to  know 
whether  anything  was  doing  in  America  with  regard  to 
the  prophylaxis  of  venereal,  a  subject  which  at  present 
is  engaging  renewed  attention  both  in  France  and  Eng- 
land. A  novel  and  rather  questionable  idea  advanced 
by  Diday  is  the  parasitic  origin  of  all  venereal  diseases, 
including  gonorrnoea.  His  argument  is  this :  It  is  the 
prerogative  of  organized  beings  to  produce  their  like  ; 
venereal  and  other  contagious  diseases  reproduce  them- 
selves, and  hence  must  be  of  parasitic  origin.  Diday 
expects  that  this  view  will  yet  be  confirmed  by  the 
microscope.* 

I  was  particularly  struck  with  the  fine  appearance 
and  affable  manners  of  the  handsome  RoUet,  a  younger 
man  than  Diday,  but  who  is  entitled  to  rank  among 
the  first  syphilographers  of  the  present  day.  Surely.  I 
know  of  no  one  who  has  contributed  more  to  syphilo- 
graphy  than  he  during  the  last  ten  or  twelve  years. 

At  the  invitation  of  these  gentlemen  I  was  present  at 
a  meeting  of  the  Academy  of  Medicine  of  Lyons,  where 
I  found  an  assemblage  of  some  thirty  to  forty  physicians 
and  surgeons,  seated  round  an  immense  table,  under  the 
presidency  of  Dr.  Bouchacourt,  and  occupied  with  a  dis- 
cussion upon  the  contagiousness  of  cholera,  carried  on 
in  a  scientific  spirit  which  might  serve  as  an  example 
to  some  of  our  medical  societies.  It  was  amusing,  how- 
ever, to  observe  how  severe  a  Frenchman  can  be  in  de- 
bate, and  yet  how  parliamentary  in  his  language. 

*  A  letter  from  my  friend.  Dr.  J.  H.  Salisbury,  of  Cleveland,  Ohio, 
»«««lved  since  my  return  home,  intimates  that  be  has  already  aecom- 
t»uahed  something  In  this  direction* 


Arriving  in  Paris  a  few  days  afterwards,  of  course  I 
made  it  one  of  my  first  objects  to  see  Ricord,  the  Nestor 
of  the  syphilitic  world,  and  one  of  the  few  bright  lights 
of  twenty  years  ago  still  remaining.  I  was  told  that  I 
should  be  likely  to  find  him  the  least  occupied  at  about 
eleven  o'clock  in  the  evening,  when  his  office  hours, 
which  commenced  at  four  in  the  afternoon,  were  nearly 
over.  Calling  at  this  hour,  however,  I  found  his  waiting- 
room  still  filled  with  patients,  and  he  afterwards  told  roe 
that  he  was  rarely  through  before  twelve  or  one  o'clock. 
Ricord  has  ''  aged,"  as  an  Englishman  would  say,  s'nce 
sixteen  years  ago,  but  his  activity  and  endurance  may 
be  inferred  from  the  amounti  of  work  of  which  he  is  still 
capable.  If  any  medical  man  ever  had  reason  to  be 
satisfied  with  the  well-merited  honors  that  all  confer 
upon  him  in  his  green  old  age,  it  is  certainly  he.  There 
was  no  time  to  talk  over  with  him  any  of  the  mooted 
questions  of  syphilis,  but  there  is  no  doubt  (and  my 
friend.  Dr.  Atlee,  of  Philadelphia,  will  please  notice  the 
fact)  that  Ricord  now  admits  in  full  the  recent  doctrines 
upon  venereal  diseases,  including  the  duality  of  virus, 
the  contagiousness  of  the  secretions  of  secondary  lesions 
and  the  blood,  and  also  vaccinal  syphilis.  Such  was  the 
universal  testimony  of  his  fiiends  in  Paris,  and  I  after- 
wards heard  the  same  from  Mr.  Acton,  in  London,  who 
had  recently  spent  several  days  with  Ricord,  and  had 
freely  converred  with  him  upon  these  topics.  It  may- 
be, as  I  judge  from  what  I  heard,  that  this  surrender 
was  somewhat  reluctantly  forced  upon  him  at  an  age 
when  he  felt  he  had  not  the  time  or  opportunity  to  pro- 
long the  contest,  but  the  fact  remains  the  same.  I  was 
told  in  Paris  that  he  still  refused  to  admit  the  possibility 
of  vaccinal  syphilis,  but  Mr.  Acton  informed  me  that  he 
now  yields  even  this. 

The  most  prominent  among  the  younger  men  at  Pars 
who  devote  themselves  to  the  specialty  of  venereal  dis- 
eases, and  the  one  most  likely  to  succeed  Ricord  in  his 
position  so  far  as  any  one  can,  is  probably  Foumier, 
the  popil  and  ardent  admirer  of  Ricord,  and  the  editor 
and  annotator  of  Ricord's  Lemons  sur  U  Chancre,  I  had 
the  pleasure  of  accompanying  Foumier  through  his 
wards  at  the  H6tel  Dieu,  and  listening  to  an  admiraWe 
lecture  from  him  upon  renal  paraplegia,  which  was 
illustrated  by  a  case  in  his  service.  He  is  the  author 
of  various  articles  relating  to  venereal  in  the  Nouveau 
DicUonnaire  de  Mid,  et  de  Chirurgie  prattques,  now  in 
course  of  publication  by  J.  B.  Bailliere.  These  articles 
are  not  only  an  excellent  resum^  of  the  subject — the 
best  that  I  am  acquainted  with — but  contain  much 
original  matter,  and  will  probably  at  some  future  time 
be  incorporated  in  book  form. 

From  Fournier's  lecture-room  I  went  into  Maison- 
neuve's  wards,  where  I  found  him  making  bis  visit  and 
surrounded  by  a  crowd  of  students.  On  being  intro- 
duced to  him  he  stopped  to  compliment  the  success  of 
American  surgery,  and  among  several  instances,  men- 
tioned the  remarkable  results  obtained  in  ovariotomy 
as  compared  with  the  results  of  the  operation  in  Paris. 
I  suggested  that  the  atmosphere  of  Wpitals  was  pe- 
culiarly unfavorable  to  this  operation,  but  I  soon  found 
that  I  had  touched  him  in  a  tender  spot,  for  he  imme- 
diately began  a  lecture  lasting  at  least  twenty  minutet. 
in  which  he  attempted  to  show  that  atmospheric  and 
local  influences  have  nothing  whatever  to  do  with  the 
success  or  faUure  of  any  operation,  and  that  everything 
depends  upon  the  skill  of  the  surgeon  I  "  When  we 
know  how  to  operate  in  cases  of  ovariotomy  as  well  as 
American  surgeons,"  said  he,  "  we  shall  have  equally  as 
good  results.'"  One  of  the  internes  whispered  to  me 
that  this  was  a  favorite  idea  of  Maisonneuve,  and  that 
I  had  better  not  reply  to  his  arguments  if  I  wanted  to 
see  anything  of  his  service,  since  he  would  keep  on 

__  _,  __>ogre 


THE  MEDICAL  RECORD. 


809 


talking  all  day.    Maisonneuve  is. as  fond  of  using  the 
icr<uevr  and  his  urethrotome  as  ever. 

Upon  callinjr  lo  see  M.  Clerc,  I  found  him  an  older 
man  than  I  had  anticipated,  but  probably  not  over  45 ; 
of  most  a^eeable  manners,  and,  with  an  American  wife, 
wdl  posted  in  American  aflfairs  both  civil  and  medical. 
Clerc  is  too  well  known  for  what  he  has  done  in  syphi- 
lograpby  to  render  it  necessary  for  me  to  siiy  anything 
on  Uiis  score.  He  is  now  correcting  the  proofs  of  the 
second  fasciculus  of  his  work  upon  venereal  diseases.  I 
accompanied  him  in  his  visit  to  the  wards  of  St  Lazare, 
devoted  to  the  prostitutes  of  Paris — ^a  privilege  rarely 
accorded  even  to  medical  men,  and  was  struck  with  his 
skill  in  diagnosis.  I  wish  I  had  time  to  describe  some 
of  the  interesting  cases  there  seen.  I  may  mention  en 
pa^ant  that  he  does  not  believe  in  the  chancre  mixte, 
out  this  might  perhaps  have  been  anticipated  from  his 
peculiar  ideas  as  to  the  relationship  of  the  chancroid 
au'i  the  true  chancre. 

I  have  found  the  lost  Pleiad  1  Bassereau  **  still  lives," 
the  author  of  the  most  logical  essay  upon  venereal  ever 
written;  the  man  who  first  stirred  up  all  this  hubbub 
about  unity  and  duality;  who  ruthlessly  *Sent  flying" 
our  early  ideas  as  to  the  influence  of  idiosyncrasy  upon 
the  development  of  the  syphilitic  germ,  and  who  vnU 
ever  be  known  and  thanked  for  having  done  it  I  For  years 
it  has  been  a  mystery  to  me  what  had  become  of  this 
man.  Nothing  further  appeared  from  his  pen.  His 
name  was  nowhere  seen  in  the  reports  of  the  meetings 
of  various  medical  societies,  at  which  the  results  of  his 
labors  were  discussed.  I  am  afraid  to  say  how  many 
students,  just  returned  from  Par  s,  I  have  questioned 
the  last  ten  years  as  to  what  had  become  of  Bassereau, 
and  have  usually  received  a  cold  douche  in  the  reply — 
"  Never  heard  of  him ! "  The  fact  is,  to  speak  poetically, 
Ba58creau's  peisonality  appeared,  like  a  meteor;  his 
work  remained,  a  fixed  star  I 

Having  been  born  a  Yankee,  I  can  now  make  a 
"guess"  towards  a  solution  of  the  mystery,  and  one 
which  I  think  is  not  far  from  the  truth.  Even  Parisian 
society  is  not  quite  ft  ee  from  the  prejudice  that  it  is 
somewhat  infra  dig,  for  a  medical  man  to  make  a 
specialty  of  venereal  diseases.  Bassereau,  a  man  of 
unusually  refined  tastes  and  sensitive  feelings,  published 
a  book  which  reviewed  the  whole  ground  of  venereal 
diseases,  and  contained  the  germ  of  almost  a  complete 
revolution  in  the  prevailing  views  upon  the  subject;  and 
he  instinctively  gave  it  the  modest  title  of  "  A  Treatise 
upon  Skin  Diseases  symptomatic  of  Syphilis  1 "  Vain 
subterfuge.  Imagine  his  horror  at  finding  he  was  ap- 
preciated, and  that  in  spite  of  himself  he  had  become 
venereaUy  famous  I  What  wonder  that  he  should  have 
shur.  himself  within  his  elegant  apartments  in  the  Rue 
de  Toumon,  and  found  consolation  in  the  beautiful  paint- 
ings with  which  his  taste  for  art  has  adorned  the  walls! 
Seriously  speaking,  however,  Bassereau  never  in- 
tended to  make  a  specialty  of  venereal  Circumstances 
led  him  to  investigate  certain  points  connected  with 
it.  This  he  did  witli  tlie  genius  innate  in  him, 
and  he  discovered  a  truth  which  he  gave  to  the  world. 
This  done,  his  work  was  accomplished.  His  book  was 
eomplete  in  it8c?lf,  requiring  neither  emendation  nor 
addition.  The  fact  which  it  was  intended  to  prove 
was  generally  accepted.  The  purpose  he  had  in  view 
was  lulfiUed  I     He  had  finished  a  good  work  I 

The  reputation,  however,  which  his  book  gave  him, 
has  been  the  source  of  no  little  consultation  practice  in 
venereal  cases,  so  that  his  interest  in  tlie  subject  has 
been  kept  up,  and  I  was  glad  to  hear  from  him  that  he 
had  already  written  a  complete  treatise  upon  the  pa- 
thology and  treatment  of  venereal  diseases,  which  he 
should  publish  "  by  and  by." 


I  did  not  see  Auzias-Turenne,  who  is  still  living  in 
Paris,  as  firm  a  believer  as  ever  in  syphilization,  which, 
however,  is  about  defunct^  both  in  France  and  Engknd ; 
in  the  latter  country  especially  so,  since  Boeck^s  mani- 
fest failure  during  his  recent  visit  there.  It  is  said  that 
Auzias-Turenne  si  ill  practises  his  inoculations  upon 
patients  in  a  quiet  way,  but  that  they  (the  pa  ients)  aie 
nrst  obliged  to  sign  a  paper  stating  that  the  treatment 
was  undertaken  at  their  express  wish,  so  that  he  may  be 
protected  against  any  legal  process. 

But  this  letter  is  already  much  longer  than  I  intended, 
and  I  have  left  myself  scarcely  any  time  or  space  to 
speak  of  London,  where,  however,  I  was  only  able  to 
remain  some  three  or  four  days,  and  to  do  little  more 
than  visit  the  Lock  Hospital,  and  to  call  upon  two  of 
the  most  noted  syphilographers,  Mr.  Acton  and  Mr, 
De  Meric.  The  latter  conducts  the  venereal  depart- 
ment of  the  London  Lancet  with  great  ability,  and  is 
well  known  from  his  Lettsomian  lectures,  and  other 
contributions  on  the  subject  of  venereal. 

Upon  the  continent,  the  modern  views  of  venereal 
pathology,  the  duality  of  virus,  the  contagiousness  of 
secondary  lesions,  etc.,  are  almost  universally  adopted. 
The  same  cannot,  I  think,  be  said  of  English  surgeons, 
many  of  whom,  especially  among  the  older  men,  still 
adhere  to  the  old  doctrines.  Mr.  Acton,  for  instance,  in 
his  green  old  age,  is  still  firm  in  the  faith  of  twenty 
years  ago ;  but  this  splendid  specimen  of  a  "  fine  old 
English  gentleman "  (in  the  fullest  sense  of  the  word) 
acknowledges  that  the  time  for  him  to  undertake 
renewed  investigation  is  past.  He  said  to  me :  ''  What 
can  I  say  about  all  this  muddle  that  you  have  got 
venereal  diseases  into  ?  One  of  you  says  one  tihing,  and 
another,  another.  My  days  for  professional  work  are. 
over.  I  have  no  hospital  for  observation  and  experi- 
ment I  only  spend  my  mornings  in  town,  and  the 
rest  of  my  time  I  am  on  my  farm,  in  which  I  am  most 
interested.  You  talk  about  the  contagiousness  of 
secondary  lesions,  but  I  don't  see  such  cases.  If  you 
ask  me  my  opinion,  I  can  only  reply,  *  Ricord  says  he 
believes  it.'  Why  doesn't  some  young  man  take  hold 
of  these  matters,  and  clear  them  up  ?  " 

Notwithstanding  this  partial  retirement  from  active 
life,  Mr.  Acton  is  deeply  interested  in  the  movement 
for  the  prevention  of  venereal  diseases  which  is  now 
going  on  in  England,  and  he  has  recently  visited  Paris 
for  the  purpose  of  examining  anew  the  working  of  the 
system  there  in  vogue.  It  is  probably  known  to  many 
readers  of  the  Record,  that  the  parliament  of  Great 
Britain  has  already  passed  an  act  which  went  into 
operation  in  December,  1864,  and  was  entitled  the 
*'  Contagious  Diseases  Prevention  Act."  The  object  of 
this  act  was  the  prevention  of  venereal  diseases  in  the 
army  and  navy,  and  its  operation  holds  good  only  for 
such  towns  an  are  military  or  naval  stations.  Its  gene- 
ral features  are  that  the  police  of  such  towns  have  the 
power  of  causing  any  common  prostitutes  to  be  ^ken 
to  a  dispensary  to  be  examined  as  to  their  state  of 
health,  and,  if  diseased,  of  enforcing  their  stay  in  gov- 
ernment hospitals  nntil  cured.  Already  this  law  has 
caused  a  verj'  considerable  diminution  of  venereal  dis- 
ease in  the  army  and  navy,  and  also  among  the  civil 
inhabitants  of  these  towns;  and  it  is  recommended  by 
the  committee  of  the  Harveian  Society  of  London,  Xo 
which  the  matter  was  referred,  that  the  same  regula- 
tions be  introduced  in  London  and  other  large  towns. 
Even  now  London  has  a  Lock  Hospital  for  both  male 
and  female  patients,  which  has  been  in  existence  for 
more  than  a  century  I  Is  it  not  time  that  some  provision 
for  this  purpose  were  made  in  America  ?  But  this  sub- 
ject, as  well  as  an  account  of  my  visit  to  the  Lock  Hos- 
pital%  must  be  deferred  to  another  occaaion.  |/-^(-yT/> 


310 


THE  MEDICAL  KECORD. 


I  will  only  add  one  word  with  regard  to  the  endos- 
cope, which  does  not  appear  to  be  used  to  any  extent 
either  in  Paris  or  London,  and  is  regarded  as  of  very 
little  practical  value,  while  a  catheter  still  has  an  ei/e  to 
it,  or  while  the  surgeon  who  is  entitled  to  use  a  ure- 
thral instrument,  whether  a  sound  or  a  catheter,  has  an 
"  eye  in  tue  end  of  his  finger." 

Yours  truly,  F.  J.  Bumstead. 


THE  SANITARY  CONDITION  OF  CHICAGO 
(From  cub  Specul  Corrb8POndent.) 

To  THB  EoiTOB  or  THi  Medicai  Secokd. 

Sir — Favored  by  a  season  remarkably  conducive  to 
health,  and  cared  for  by  an  energetic  Board  of  Health, 
our  city  has  enjoyed  a  degree  of  immunity  from  disease, 
which  has  never  been  surpassed  since  the  colonization 
of  the  north-west  territory.  The  weather  has  been 
singularly  fine,  with  very  little  of  that  excessive  heat 
which  often  renders  the  summer  months  so  enervating 
in  the  prairie-land.  Thunder-showers  have  been  in- 
frequent; yet  there  has  been  no  drought  to  parch  the 
soil.  Above  all  there  has  been  almost  none  of  that 
steaming,  sultry,  equatorial  weather,  which  last  year 
was  so  lavorable  to  the  propagation  of  miasmatic  dis- 
eases. Our  new  Board  of  Health  has  displayed  com- 
mendable vigor.  Under  their  administration,  the  long- 
forgotten  voice  of  the  scavenger  has  been  again  heard 
in  the  streets.  The  gutters  and  sewers  were  thorough- 
ly cleaned,  and  the  alleys  were  purged  of  manure  at  an 
early  date  in  the  spring.  The  bodies  of  nine  thousand 
eight  hundred  and  thirty-nine  dead  dogs  were  deported 
from  the  city,  and  of  nuisances  a  host  without  number 
were  thoroughly  abated. 

For  the  first  time  in  its  existence,  Chicago  has  been 
presentably  clean,  much  to  the  astonishment  of  the  inno- 
cent civilian  who  had  never  experienced  the  good  effects 
of  a  little  military  energy  and  dispatch  in  the  adminis- 
tration of  public  affairs.  In  fact,  the  city  is  as  clean  as 
it  can  be  so  long  p.s  the  great  work  of  providing  sewer- 
age, pavement,  and  water,  has  not  yet  reached  a  point 
where  it  can  be  adequate  to  the  supply  of  our  increas- 
ing population.  The  present  condition  of  our  water- 
supply  affords  a  marked  example  of  the  difficulties  with 
which  a  growing  community  must  contend.  Placed  in 
<;ommunication,  by  a  magnificent  tunnel,  with  an  inex- 
haustible reservoir  of  the  purest  and  most  delicious 
water  that  has  ever  been  carried  to  any  city,  we  have 
actually  known  suffering  dming  the  past  season  for 
want  of  that  element;  and  another  month  will  pass 
before  the  conapletiou  of  the  new  pumps  will  afford  a 
sufficient  supply. 

"Shall  we  nave  cholera  this  year?"  is  the  great 
question  which  is  now  upon  the  lips  of  every  one.  In 
spite  of  a  considerable  increase  of  population,  the  mor- 
tality of  1867  has  been  much  less  than  during  the  cor- 
responding months  of  1866.  During  the  month  of  July, 
the  usual  increase  of  bowel  complaints  has  been  re- 
marked. There  has  been  a  more  than  conmion  tendency 
to  dysentery.  And  it  cannot  be  denied  that  rice-water 
stools,  with  vomiting,  cramps,  and  suppression  of  urine, 
have  been  occasionally  encountered  by  some  of  our 
most  experienced  diagnosticians.  The  Board  of  Health, 
while  refiising  to  name  these  as  cases  of  Asiatic  cholera^ 
takes  pains  to  deal  with  them  as  if  they  were  such. 
There  can  be  no  doubt  that  the  germs  of  the  disease  ex- 
ist in  Chicago,  but  whether  they  will  slumber  innocuous, 
or  whether  they  shall  yet  be  awakened  to  direful  activi- 
ty, your  correspondent  does  not  venture  to  predict 

The  handsome  new  building  of  Rush  Medical  College 
is  rapidly  approaching  completion.    In  magnitude,  ele- 


gance, and  convenience,  it  is  said  to  excel  every  other 
Medical  College  building  in  the  United  States.  Were 
it  only  possible  now  to  lay  aside  all  fear  of  competition 
with  the  University  of  Michigan,  adjusting  the  fees  to 
a  rational  standard,  and  bringing  the  course  of  teaching 
into  conformity  with  the  requirements  of  an  enlightened 
age,  nothing  could  restra'n  this  rejuvenated  institution 
from  its  natural  position  in  the  foremost  rank  of  Ameri- 
can colleges.  As  soon  as  the  conflict  with  brick  and 
mortar  is  ended,  it  is  to  be  hoped  that  the  representa- 
tive men  of  old  Rush  may  be  found  ready  to  join  hands 
with  those  who  would  have  our  colleges  express  rather 
thf>n  retard  the  progress  of  medical  science. 

The  place  of  the  lamented  Amerman  in  the  surgical 
staff  of  the  County  Hospital,  has  been  filled  by  the  elec- 
tion of  Dr.  Edwin  Powell,  of  this  city.  Dr.  P.  is  the 
nephew  and  successor  of  the  celebrated  Professor  Brain- 
erd.  He  served  with  great  disunction  in  the  medical 
staff  of  the  army  during  the  late  war.  He  has  since 
been  connected  with  Ru<h  Medical  College,  as  Demon- 
strator of  Anatomy,  and  more  recently  as  Professor  of 
Military  Surgery,  a  position  which  he  resigned  to  ac- 
cept the  appointment  of  surgeon  to  the  County  Hospi- 
tal. To  this  place  he  brings  first  class  abiUty,  and  a 
reputation  second  to  no  other  in  Chicago. 

M. 
Chicago,  Augati  15, 1867. 


LUXATION  OF  TUE  ULNA. 

To  THB  EdITOB  of  THB  MsDICAL  BkCOHD. 

Sir — In  your  issue  of  August  1st,  there  appeared  a  com- 
munication from  Dr.  Stephen  Rogers,  in  which  is  given 
a  lucid  description  of  "  a  very  rare  accident,"  and  its 
treatment  under  Dr.  Rogers's  direction  at  the  Demilt 
Dispensary. 

There  appear,  also,  in  various  parts  of  this  article, 
remarks  which  reflect  rather  severely  upon  the  previous 
treatment  of  the  case  in  question  in  this  institution.  I 
deem  this  not  only  undeserved,  but  also  unjust.  I  was 
present  when  the  patient  first  applied  at  this  office  for 
treatment ;  I  heard  the  diagnosis  as  given  by  the  sur- 
geon taking  charge  of  the  case ;  I  witnessed  the  reduc- 
tion of  the  dislocation  and  the  application  of  the  splint, 
and  also  myself,  on  two  different  occasions,  examined 
the  affected  joint  and  questioned  the  patient  as  to  her 
ailment.  I  feel,  therefore,  that  it  becomes  my  duty  to 
state  to  the  profession  my  knowledge  of  the  case,  and 
to  correct  any  wrong  impression  that  may  have  been 
received  upon  reading  the  remarks  of  Dr.  Rollers. 

The  patient  is  represented  to  be  an  *'  Irish  domestic." 
Personally,  I  mention  her  inability  to  serve  in  such  a 
capacity,  and  especially  to  perform  the  severe  duty  of 
wringing  clothes,  which  is  stated  to  be  the  cause  of  the 
dislocation.  She  is  sadly  deformed — a  lateral  curvature 
of  the  ppine  so  distorting  the  trunk  that  the  ribs  of  the 
right  side  rest  upon  the  crest  of  the  ilium.  Her  general 
appearance  would  also  indicate  that  she  was  not  capable 
of  undergoing  any  hard  labor. 

There  is  one  point  upon  which  Dr.  R.  is  evidently 
very  greatly  mistaken.  To  quote  from  his  letter — "  Not 
satisfied  with  her  progress  towards  recovery,  the  patient^ 
after  waiting  many  days,  finally  came  to  the  Dispen- 
sary.*' Dr.  R  also  states  that  the  patient  "  presented 
herself  at  the  Demilt  Dispensary  on  the  19th  of  June, 
1867."  Our  books  will  show  that  her  first  appearance 
here  was  on  the  15th  of  the  same  month,  or  just  f<mr 
days  before  she  applied  at  the  dispensary. 

The  didocation  was  reduced,  and  the  splint  applied 
on  the  morning  of  the  16th  of  June.  The  patient  was 
then  ordered  to  report  the  next  morning.     This  she 


THE  MEDICAL  RECORD. 


8U 


foiled  to  do,  and  nothing  has  been  seen  of  her  at  this 
institution  since  the  application  of  the  splint. 

When  the  patient  fii*st  made  application  for  treatment 
she  was  particularly  questioned  regarding  the  cause  of 
the  dislocation.  In  reply  to  all  queries  she  said,  "  it 
came  on,  and  I  do  not  know  any  cause  lor  it."  The 
surgeon  who  was  examining  the  joint  then  turned,  and^ 
in  a  jocular  manner,  remarked  to  myself  and  some  med- 
ical students  wlio  were  present,  "  this,  then,  must  bo  a 
case  of  spontaneous  dislocation  of  the  ulna."  It  was 
further  remarked,  that  injuries  of  a  similar  natuie  had 
not  nnfrequently  been  presented  for  treatment  at  this 
institution. 

In  another  part  of  his  letter,  Dr.  R.  states  ^hat  he 
"  restored  the  bones  to  their  nornal  position,  but  with- 
out snapping,  sudden  slipping,  or  other  usual  phenomena 
of  the  return  of  dislocated  bones  to  articular  cavities." 
Precisely  the  same  circumstance  was  observed  when 
the  d  slocation  was  reduced  at  this  office.  There  was 
no  difficulty  of  retaining  the  bones  in  position — no 
Seeming  tendency  to  a  recurrence  of  the  dislocation, 
and  the  normal  relation  of  the  hand  and  forearm  was 
perfectly  restored  when  the  patient  left  this  institution. 

What  tampering  may  have  been  done  by  tlie  patient 
herself,  or  her  friends,  during  the  three  days  that  elupsed 
K^tween  the  time  of  the  application  of  the  splint  and 
the  presentation  of  the  case  at  the  dispensary,  I  know 
not  But  it  is  probable  that  the  dressings  were  re- 
moved, and  on  that  account  she  may  have  ft^lt  a  disin- 
clination to  return  to  the  institution,  where,  duiing  the 
time  the  case  was  under  treatment,  I  am  satisfied  all 
was  done  that  could  be  accomplished  by  the  most  skilful 
surgery. 

Respectfully  yours, 

Newton  M.  Shaffer,  M.D., 

Assistant  Resident  Surgeon. 

I^ST.TinriOIf  FOB  RUPTURKD  AND  vRIPFLKD, 

N.  Y.,  August  15, 1867. 


GOOD   AIR. 
To  TiiB  Rditoii  op  tub  Medical  Record. 

Dear  Sir — But  for  the  circumstance  that  the  Medi- 
cal Record  is  much  more  generally  distributed  than 
the  *'  Transactions  of  the  Academy  of  Med  cine,"  I 
would  not  trouble  you  to  state  that  in  your  notice  oi 
my  paper  on  The  Economy  of  Human  Life^  in  your  last 
number,  I  am  incorrectly  reported  as  maintaining — 
"tlwt  proper  food  was  much  mure  important  than  good 
air.  Or  the  most  salubrious  surroundings." — While  I  do 
think,  and  endeavored  to  show  in  my  paper,  that  insul- 
ficient  food  in  cliild-bed  is  a  fruitful  source  of  ill  health 
to  rnotlier:*,  an«l  that  poor  and  insufficient  food  is  a 
Craitlul  source  of  mortality  among  infants  and  children, 
I  ain,  neverthele^,  far  from  maintaining  that  anything 
id  Or  can  be  more  important  to  heaMi  than  good  air. 

Truly  your-j, 
A.  N.  Bell. 

BlOOKLTN,  Aug.  19, 18«7. 


New  Uses  of  Mica. — Mica  coated  with  a  silver  film 
is  now  used  in  this  country  for  large  reflectors.  Pus- 
cher  of  Nuremberg  hflCs  suggested  the  employment  of 
ftlTered  mica  for  covering  curved  surfaces,  the  flexibi- 
lity of  mica  giving  it  great  advantages  over  glass.  Af- 
ter being  heated,  mica  loses  most  of  its  flexibdity,  but 
it  then  makes  a  beautiful  material  for  inlaying  work. 
A  pretty  eflfect  is  obtained  by  scattering  sm3l  frag- 
naents  of  mica  on  freshly  poured  sheets  of  gelatine,  and 
viroislung  it  with  a  dark  solution  of  gelatine.  Finely 
ground  mica  mixed  with  a  solution  of  gum  arable  may 
be  used  for  a  silver  ink. 


(Dbituarg. 


CHARLES  E.  MORGAN,  M.D., 

HEW  TOKK. 

Died,  on  August  4th,  1867,  Charles  E.  Morgan,  M.D., 
in  the  34th  year  of  his  age,  of  acute  diarrhoea  and 
hfiemorrhage  of  the  bowels,  after  an  illness  of  ^^^  days. 

In  Dr.  Morgan,  the  profession  loses  one  of  its  most 
cultivated  and  abie  members.  His  studious  habits,  and 
h  s  enthusiastic  devotion  to  scnence,  occasion  a  profound 
regret  that  his  Ule  was  so  shoit. 

His  career  as  a  scholar  must  have  commenced  very 
early,  as  we  hear  of  his  prosecuting  the  study  of  min- 
eralogy at  eleven  years  of  age,  under  the  care  of  the  late 
Dr.  Francis  Hawkes,  and  of  tiie  production  of  a  work 
on  natural  philosophy  at  the  age  of  seventeen.  In  1854 
he  graduated  at  Columbia  College,  and  in  1857  received 
the  degree  of  Doctor  of  Medicine  at  the  College  of 
Physicians  and  Surgeons.  He  then  spent  seven  years 
in  Europe  in  the  study  of  medicine  and  the  collateral 
sciences,  under  such  men  as  Bernard,  Robin  Le  Compte, 
Virchow,  DuBois-Reymond,  and  Hoppeseiler. 

He  returned  in  J 864,  and  few  were  better  fitted  for 
their  Ufe-work  than  he. 

Since  his  return  he  has  been  engaged  in  the  practice 
of  his  profession,  giving  special  attention  to  diseases  of 
the  skin,  on  which  he  has  frequently  lectured ;  and 
during  the  last  two  years  he  has  occupied  a  chair  on 
diseases  of  the  skin  at  the  Northern  Dispensary,  which, 
we  may  aflirm,  was  never  more  honorably  fiUed. 

Within  this  time  he  had  completed  a  work  entitled 
"  Electro-Physiology  and  Electro-Therapeutics,  includ- 
ing an  Account  of  the  Electric  Fishes,"  which  is  in 
press,  and  for  which  he  traced  on  the  blocks  most  of  the 
cuts.  Undoubtedly  his  book  will  do  much  towards  giving 
electricity  its  proper  importance  in  the  practice  of  med- 
icine, which  it  certainly  has  not  enjoyed  heretofore. 
To  illustrate  the  quiet  confidence  the  Doctor  entertained 
of  the  thoroughness  of  his  work,  it  may  be  worth 
remarking  that  about  a  year  since  he  was  urged  to 
complete  his  book,  as  it  had  been  a  long  time  in  course 
of  preparation,  in  fear  that  some  one  else  might  pubhsh  a 
similar  work  in  advance  of  his ;  to  which  he  replied : 
"  I  have  no  fear  of  that ;  there  are  many  points  con- 
sidered in  my  book  which  no  one  else  will  think  of." 
The  statement  was  so  thoroughly  founded  in  fact  as 
not  to  be  in  the  least  degree  immodest. 

He  had  contributed  somewhat  to  the  medical  journals, 
and  had  read  by  invitation  an  article  on  diseases  of  the 
skin  before  the  Medical  Journal  Association,  a  few 
months  since,  which  appeared  some  time  since  in  our 
columns. 

He  had  many  projects  on  foot,  and  seemed  to  feel  that 
his  mission  pointed  towards  original  investigations  in 
medicine,  more  especially  to  physiology,  as  he  could 
devote  most  of  his  time  to  such  matters,  not  being  under 
the  necessity  of  practising  medicine  for  a  livelihood. 
He  was  not  a  member  of  any  medical  association, 
and  although  proposed  for  the  American  Microscopical 
Society,  he  had  not  joined  it.  He  seemed  to  enter- 
tain an'idea,  which  had  too  much  foundation  in  fact. 
that  some  of  the  older  medical  societies  had  reachea 
their  fussQiferous  stage  of  development,  and  should 
give  place  to  younger  institutions.  In  fact,  he  had 
made  efforts  to  found  a  new  society,  which,  unfortun- 
ately, had  not  been  crowned  with  success. 

It  was  a  rule  with  our  lamented  brother  "to  do 
whatever  his  hands  found  to  do  with  his  miffht,"  never 
thinking  that  aught  worth  do  ng  at  all  should  be  done 
!e8S  than  thoroughly  well.    As  a  microscopist  he  hardkr 

Digitize.  „, iOglC 


812 


THE  MEDICAL  RECORD. 


had  a  superior  in  this  country.  Although  an  excellent 
linguist,  speaking  four  or  five  different  languages,  he 
was  perhaps  more  able  in  mathematics  and  the  physical 
sciences,  of  which  he  was  especially  fond.  He  added 
to  all  these  acquirements  a  good  knowledge  of  painting. 

If  he  had  any  mental  fault,  it  was  perhaps  in  over- 
burdening a  subject  with  information — presenting  more 
facts  than  could  be  well  managed,  in  his  great  desire 
to  treat  things  exhaustively ;  but  as  this  is  an  error  on 
the  safe  side,  and  as  age  would  have  corrected  the  ten- 
dency, we  could  not  but  be  lenient  towards  it. 

It  may  not  be  amiss  to  state  that  although  he  was 
ambitious  to  achieve  for  the  sake  of  the  good,  he  was 
much  stimulated  in  his  work  b^  the  pleasure  a  kind  and 
indulgent  mother,  his  sole  surviving  parent,  experienced 
in  his  successes. 

Towards  his  professional  brethren,  he  ever  maintained 
B  courteous  and  modest  bearing,  wnich  never  asserted 
superiority  to  the  humblest  member;  ever  ready  to 
assist  any  who  loved  the  science  to  which  he  had 
devoted  his  life,  and  tempering  all  his  actions  with  the 
gentle  grace  of  the  Christian.  Let  us  feel  certain  that 
he  has  received  the  plaudit,  "Well  done,  good  and 
faithfiil  servant." 

His  funeral  was  attended  by  the  medical  staff  of  the 
Northern  Dispensary,  at  St.  Bartholomew's  Protestant 
Episcopal  Church,  of  which  he  had  for  years  been  a  con- 
sistent member.  After  which,  a  meeting  was  held  by  the 
physicians,  and  resolutions  of  sympathy  and  condolence 
passed,  which  were  sent  to  his  family,  and  ordered  to 
be  printed. 


Itetu  |)ubltcation0. 


Books  and  Pahphtbts  Received. 

A  Treatise  on  Human  Physiology,  Designed  for  the 
Use  op  Students  and  Practitionebs  op  Medicine.  By 
John  C.  Dalton,  M.D.,  Prof,  of  Physiology  and  Micros- 
copic Anatomy,  in  the  College  of  Physicians  and  Surgeons, 
etc.,  etc.    Philadelphia:  H.  0.  Lea.     1B67. 

A  Treatise  on  Emotional  Disorders  op  the  Sympathetic 
Nervous  System  op  Nerves.  By  Wiluam  Murray, 
M.D.,  M.R.C.P.,  London,  etc.  New  York:  A.  Simpson  & 
Ck).     1867. 

Thirty-hrst  Annual  Announcement  op  the  Medioal  De- 
partment op  UNivBRsrrY  op  Louisville.    1867. 

Ninth  Annual  Announcement  op  the  Chicago  Medical 
College. 

Nineteenth  Annual  Catalogue  and  Report  op  the  New 
England  Female  College.    Boston.    1867. 

Transactions  op  the  Medical  Society  op  the  State  op 
Kansas,  for  1867.J 

Medical  Communications  to  Massachusetts  Medical  So- 
ciety.   Vol  XI.,  No.  1.,  for  1867.    Boston.    Ib67. 

iHeliical  Jtema  ar(b  ll^tus. 

College  op  Physicians  and  SuRGEONa — Dr.  Bum- 
stead  has  resigned  the  post  of  Lecturer  upon  Materia 
Medica  at  the  College  of  Physicians  and  Surgeons,  and 
Dr.  James  W.  McLane  has  been  appointed  in  his  place. 

Dr.  Bumstead  has  accepted  the  appointment  of  Pro- 
fessor of  Venereal  Diseases  at  the  same  College. 

The  British  Medical  Association,  during  the  past 
month,  held  their  annual  conference  in  Dublin,  Dr. 
Stokes,  Begius  Professor  of  Physic  in  the  University  of 
Dublin,  and  President  of  the  King's  and  Queen's  College 
of  Physicians,  being  the  presiding  officer.  The  arrange- 


ments for  the  scientific  portion  of  the  business  were 
more  complete  than  on  any  former  occasion.  Trinity 
College  and  the  Colleges  of  Surgeons  and  Physicians 
conferred  degrees  on  the  most  distinguished  guests.  An 
invitation  to  hold  the  next  annual  conference  at  Oxford 
was  accepted,  and  Professor  Cleland  nominated  as  presi- 
dent. In  the  opening  address  on  "Medicine."  Sir 
Dominick  Carrigan  impressed  the  necessity  for  greater 
stringency  in  registration  laws,  and  censured  the  facility 
with  which  diplomas  could  be  purchased  in  the  United 
States  and  in  Germany. 

Muster  out  op  Surgeons,  U.  S.  V. — The  following 
surgeops  of  the  United  States  Volunteers,  who  have 
been  on  duty  in  the  Bureau  of  Refugees.  Freedraen, 
etc.,  are  ordered  to  be  honorably  mustered  out  of  the 
United  States  service : — J.  J.  De  Lamater,  A.  C.  Swartz- 
welder,  W.  R  Dewitt,  M.  K.  Hogan,  Charles  J.  Kipp, 
J.  W.  Applegate,  and  Patrick  &!enan.  Dr.  Robert 
Fletcher,  Surcjeon,  United  States  Volunteers,  is  also 
ordered  to  be  honorably  mustered  out  The  order  leavt  s 
but  one  surgeon,  U.  S.  V.,  in  service.  The  few  vacan- 
cies existing  in  the  regular  corps  will  probably  soon  be 
filled.  ' 

The  American  Pharmaceutical  Association  will 
hold  its  annual  meeting  at  the  University  Building  in 
this  city,  September  lOlh,  1867. 

Death  of  Dr.  J.  Mason  Warren  op  Boston.— Dr. 
Warren  died  of  internal  cancer  complicated  with  intus- 
susception, August  19th,  in  the  56th  year  of  his  age. 

Report  op  the  Examination  of  Vessels  arriving  at 
New  York. — There  has  been  compiled  at  the  statisti- 
cal bureau  of  the  Treasury  Department  an  abstract  of 
the  report  of  the  examinations  of  vessels  having  on 
board  passsengers  other  than  cabin  passengers,  which 
have  arrived  at  the  port  of  New  York  during  the 
month  of  June,  1867,  from  which  it  appears  that  the 
total  number  of  vessels  examined  was  eighty-six,  of 
which  forty-two  were  steamships  and  the  remainder 
sail  ng  vessels.  The  average  length  of  the  steamship  voy- 
ages was  thirteen  and  two-third  days,  and  of  the  sail- 
ing vessels  thirty -nine  days.  The  total  number  of  pas- 
sengers brought  was  39,078,  of  which  22,822  were 
males ;  6,566  were  under  eight  years  of  age.  The  to- 
tal number  of  deaths  was  117  males  and  59  females. 
Of  the  entire  number  84  were  under  eight  years  of 
age.  The  abstract  states  the  mortality  of  the  adults 
was  not  unusual,  but  that  of  the  children  calls  for  in- 
vestigation, being  nearly  one  and  one-third  per  cent  of 
the  whole  number  brought  over.  A  number  of  the 
vessels  brought  more  steerage  passengers  than  the  law 
permits^  and  in  several  instances  they  were  reported 
lor  prosecution.  A  report  concerning  the  Hamburg 
ship  John  Barti*am,  shows  that  nineteen  deaths  occur- 
red, of  which  six  were  children,  and  that  they  were 
caused  by  bad  water  and  food,  and  want  of  care  and 
attention. 

MBTEREOGRAPn. — Among  the  objects  of  great  inter- 
est to  scientists  in  the  Paris  Eitposition  were  the  dia- 
grams made  by  the  instrument  invented  by  Father 
Secchi  of  the  College  of  Rome,  for  registering  auto- 
matically the  changes  in  the  temperature,  pressure, 
moisture,  and  the  motion  of  the  atmosphere. 

Yellow  Fever  in  Texas. — The  epidemic  of  yellow 
fever  which  has  been  raging  in  Indianola  and  Lavacca, 
TezaSj  according  to  the  latest  advices  of  the  secular 
press  IS  now  on  the  decline. 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


313 


Original   Communicati0ita. 

INTRA-LARYNGEAL  SURGERY. 
By  J.  SOLIS  COHEN,  M.D., 

or  rHILABBLPBIA. 

No.  IL 

THE  APPLIOATION  OF  SOLUTIONS  TO  THE  UPPER  iJR-PAS- 
SA0E8. 

Local  applications  to  the  throat  are  most  freqjuently 
made  in  the  form  of  solution.  They  are  applied  by 
metns  of  a  mop,  sponge,  or  sofl  brush ;  or  by  means  of 
a  syringe,  or  doucne ;  or  broken  up  into  a  fine  mist  bj 
means  of  the  nebulizer.  The  first  of  these  methods  is 
that  most  generally  employed,  the  sponge  being  used 
more  frequently  than  the  mop  or  the  brush.  If  a  brush 
is  employed,  it  should  be  one  formed  of  a  good  quality 
of  camel's  hair,  or  badger's  hair,  and  should  be  well 
made.  Brushes,  made  of  glass,  are  occasionally  employ- 
ed with  corrosive  solutions,  but  there  is  always  danger 
of  the  occurrence  of  injury  or  embarrassment  from  the 
detachment  of  some  of  the  glass  filaments,  an  occur- 
rence, howevw,  which  is  said  to  be  infirequent  I  have 
never  used  these,  preferring  to  have  a  good  camel's-hair 
pencil  destroyed,  to  running  any  risks  with  such  brittle 
material 

The  most  suitable  substance  for  the  application  of  so- 
lutions in  the  great  majority  of  cases,  is  a  small  piece  of 
soft  surgical  sponge  of  the  finest  quality.  It  must  be 
strong  enough  to  resist  a  good  deal  of  tension  without 
tearing,  in  order  to  avoid  liability  of  its  being  caught 
and  torn  off,  so  as  to  cause  mischief  When  large  sur- 
^ces  are  to  be  washed  over,  a  long-haired  brush,  the 
hair  of  which  may  extend  an  inch  or  an  inch  and  a 
half  from  the  quiU  portion,  and  squeezed  at  the  free 
end,  will  be  more  suitable  than  the  sponge,  especially 
when  the  parts  are  very  sensitive  and  the  friction  of  the 
sponge  would  produce  more  irritation.  Where  a  small 
circumscribed  spot  is  to  be  touched,  a  delicate  fine-hair 
pencil  answers  the  purpose.  For  a  general  application, 
if  a  hair  pencil  be  employed,  it  should  be  large  enough 
to  take  up  firom  five  to  fifteen  minims  of  fluid.  If  a 
decided  contact  with  a  diseased  surface  is  desired,  such 
a  contact  as  is  produced  by  moderate  pressure,  a  sponge 
will  be  the  most  advanta^ous,  as  it  will  better  allow  of 
pressure;  and  if  it  is  mtended  that  the  application 
should  force  a  portion  of  the  fluid  out  upon  the  dis- 
eased surface,  the  object  will  be  better  accomplished 
with  the  sponge,  as  it  can  be  made  to  absorb  a  larger 
quantity  of  fluid  than  can  be  taken  up  by  the  brush. 
In  oert^  cases,  a  mop,  made  by  unravelling  portions 
of  a  strip  of  linen,  will  be  the  most  convenient  medium 
of  application. 

Whatever  material  be  employed,  care  must  be  taken 
to  see  that  it  is  firmly  secured  to  a  staff,  so  there  will  be 
no  chance  of  its  becoming  separated,  and  this  is  espe- 
cially to  be  guarded  against  when  the  interior  of  the 
larynx  is  to  oe  operated  upon.  A  stout  piece  of  whale- 
bone, about  the  thickness  of  a  writing-quilL  and  of  the 
proper  length  and  shape,  forms  the  most  ordinary  stem, 
and  is  very  convenient  A  stout  wire  of  silver,  or  Ger- 
man silver,  firmly  secured  in  a  wooden  or  other  handle 
is  also  often  used,  and  is  perhaps  preferable  to  the 
whalebone  on  account  of  its  greater  rigidity,  besides 
irhich  the  shwe  of  the  carve  can  be  readily  altered  to 
meet  varying  indications.  The  whalebone  staff  can  be 
bent  to  any  desired  shape  by  first  dipping  it  into  boil- 
ing water  and  allowing  it  to  remain  there  a  few  mo- 
ments; if  it  is  allowed  to  remain  in  the  hot  water  too 


long,  it  will  become  too  flexible,  and  curl  round  like  a 
piece  of  tape;  should  this  occur,  it  may  be  hardened 
again  by  immersion  in  cold  water.  If  the  stem  to  be 
used  be  of  hard  vulcanized  rubber,  it  can  be  given  the 
desired  curve  by  previous  immersion  in  hot  water,  or 
by  holding  it  over  a  flame  for  a  few  minutes.  A  bit  of 
sponge  may  be  fastened  to  the  probang  in  several  ways ; 
by  sewing  it  on  through  holes  drilled  through  the  ex- 
tremity of  the  stem,  or  by  tightly  winding  a  thread 
round  and  round  it,  in  which  case,  the  extremity  had  bet- 
ter be  a  little  bulbou;?.  The  plan  which  I  prefer,  is  to  have 
three  grooves  cut  round  and  round  near  the  extremity 
of  the  stem,  and  to  wrap  around  the  sponge  iron  wire 
forced  into  the  grooves,  which  forms  a  very  secure  at- 
tachment, less  Hable  to  become  acted  upon  by  the  cor- 
rosive solutions  than  threads  of  cotton  or  silk,  and 
thus  allow  the  sponge  to  be  pulled  off.  A  brush  may 
be  firmly  attached  to  a  stem,  by  dipping  the  quill  por- 
tion, which  should  first  be  cut  down  so  as  to  be  no 
longer  than  is  absolutely  necessary,  into  hot  water  until 
it  becomes  moistened  into  pliability;  then,  while  in 
this  condition,  it  is  to  be  placed  upon  the  stem  and 
tightly  bound  into  the  grooves  by  thread  or  wire. 

Another  method  of  employing  a  brush  or  a  sponge, 
is  to  use  a  staff  terminatmg  in  a  two-bladed  forceps, 
serrated  and  furnished  with  prongs,  so  as  to  hold  on 
firmly  to  the  brush  or  sponge,  the  grasp  upon  which 
is  tightened  by  a  ring  screwing  over  the  forceps,  or 
compressing  the  blades  by  a  strong  bayonet-catcn.  If 
desirable,  this  stem  can  be  made  flexible  so  as  to  avoid 
injury  to  the  patient  when  making  an  involuntary 
movement  at  tne  moment  the  instrument  is  within 
the  larynx,  and  also  to  facilitate  pushing  it  on  through 
the  glottis  against  a  patient*s  resistance.  Another  plan 
is  to  seize  t  e  sponge  between  the  blades  of  a  pair  of 
laryngeal  forceps  with  a  spring-catch  in  closing,  so  as 
to  prevent  separation  of  the  blades  while  the  iostru- 
ment  is  in  use.  I  am  in  the  habit  of  employing  a  deli- 
cately made,  properly  curved  spring  forceps,  acting  in 
the  same  manner  as  the  artery  spring  forceps,  in  which 
compression  of  the  handle  sepa- 
rates the  blades  which  are  tightly 
pressed  together  by  the  recoil  of 
the  springy  holding  the  brush  or 
sponee  with  a  firm  grasp;  and 
which  can  be  held  between  the 
thumb  and  fingers  exactly  in  the 
same  manner  as  if  it  were  a 
sound  or  probang.  If  it  is  deem- 
ed desirable  to  employ  a  more 
delicate  sensation  of  touch  than 
can  be  conveyed  by  an  instru- 
ment held  between  the  thumb 
and  finders,  the  staff,  which 
should  then  be  much  shorter, 
may  be  screwed  on  to  a  thimble 
fittmg  the  forefinger  as  in  Fig.  1, 
which  will  thus  convey  the  tac- 
tile sense  with  more  distinctnesa 
When  the  sponge  is  not  attached, 
the  instrument  becomes  a  sound. 
Dr.  Elsberg,  of  New  York,  has 
adapted  for  the  same  purpose,  a 
spring-riuK  for  the  terminal  pha- 
lanx of  we  forefinger,  hke  the 
ring  to  which  the  conjunctival 
scarificator  is  sometimes  attach- 
ed ;  to  this  ring  is  ri vetted  a  stem 
composed  of  two  pieces  of  watch-spring  bent  to  the 
proper  shape,  the  extremities  of  which  are  forked  by 
havmg  a  V-shaped  piece  cut  out^  so  as  to  present 
two  sets  of  prongs,  which  are  bent  at  a  right  angle 


Vio.1. 


814 


THE  MEDICAL  RECOBD. 


towards  each  other,  so  as  to  grasp  the  sponge  when 
placed  between  them;  a  slide  passing  round  the 
two  springs,  and  a  jam  sliding  between  them  keep  the 
teeth  firmly  fixed  in  the  sponge.  This  instrument  is  flex- 
ible enough,  and  readily  coram unicates  the  sensation  of 
touch  to  the  finger.  Sponge-holders  are  preferable  to 
to  any  sort  of  probang.  because  they  admit  of  ready  re- 
moval, and  removal  or  bits  of  sponge ;  so  that  the  same 
piece  need  not  be  used  twice,  even  upon  the  same 
mdividuaL 

The  size  of  the  sponge  will  vary  according  to  the  use 
to  which  it  is  to  be  put  j  for  circumscribed  applications 
it  should  be  no  larger  than  absolutely  necessary ;  for 
general  application,  and  where  it  is  intended  to  press 
some  of  the  fluid  out  of  the  sponge,  it  should  be  much 
larger;  if  it  is  to  be  passed  hetween  the  lips  of  the 
glottis,  it  should  not  be  larger  than  a  good-si»&d  pistol- 
bullet,  and  should  be  somewhat  egg-shaped,  so  as  to 
&cilitate  its  passage.  Every  time  a  sponge  is  to  be 
used,  it  shouW  be  pullei  upon,  to  see  that  it  is  firmly 
attached  to  the  stem  or  holder;  before  use,  it  should  be 
dipped  into  plain  water,  and  after  becoming  saturated 
should  be  squeezed  dry,  so  that  it  will  absorb  plenty 
of  the  medicated  solution  when  dipped  into  it.  Before 
making  an  application  it  is  well  to  press  against  the 
parts  a  soft  Dit  of  sponge  from  which  plain  water  has 
just  been  squeezed,  in  order  to  remove  from  tiie  sur&ce 
any  secretions  or  deposit,  and  thus  secure  more  thor- 
ough contact  of  the  remedy  to  the  diseased  structures. 
In  cases  of  ulcerations  in  chronic  laryngitis,  especially 
of  the  scrofulous  and  syphilitic  varieties^  where  there 
is  considerable  dysphagia,  the  difierence  m  result  from 
attention  to  this  particular,  and  neglect  of  it,  will  be 
fouqd  very  marked. 

No  special  rules  are  necessary  to  be  given  for  the 
application  of  a  sponge  or  hair-pencil  to  the  portions  of 
the  throat  anterior  to  the  larynx ;  they  can  be  readily 
exposed  and  swabbed.  Care  should  be  taken  to  make 
the  application  as  swiftly  and  gently  as  is  consistent 
with  thoroughness ;  there  is  little  to  be  gained  from  the 
employment  of  force ;  a  little  manipulation  will  soon 
accustom  the  parts  to  the  presence  of  a  foreign  sub- 
stance. 

For  making  applications  to  the  lingual  surface  of  the 
epiglottis,  its  boraer,  some  portions  of  its  laryngeal  sur- 
fece,  the  upper  portion  of  the  laryngeal  aperture,  and 
the  mucous  membrane  covering  the  carti^ges  of  San- 
torini,  it  is  not  always  necessary  to  employ  the  laryn- 
goscope. If  a  well-constructed  tongue-depressor  be 
employed,  of  such  shape  as  described  in  a  previous 
article  (see  the  Medical  Record,  Vol  I,  p.  348),  it  will 
often  be  ioiind  practicable  to  force  down  the  base  of  the 
tongue  in  such  a  manner  as  to  expose  a  considerable 
portion  of  the  epiglottis,  and  not  infrequently  its  entire 
Ungual  surface.  This  requires  a  little  knack,  perhaps, 
in  the  handling  of  the  depressor,  but  is  yeiy  readily 
acquired.  The  instruction  I  give  my  pupils  is,  "Press 
the  base  of  the  tongue  downwards  and  forwards  as  if 
you  were  going  to  force  it  out  under  the  chin.  The 
patient  should  ait  opposite  a  good  light,  natural  or  arti- 
ficial, direct  or  reflex,  so  that  when  the  mouth  is  well 
opened  the  fauces  are  well  exposed;  and  the  operator 
should  stand  in  such  a  manner  as  to  look  down  upon 
the  pharynx  from  above,  not  to  look  into  the  mouth 
horizontally;  then  the  tongue-depressor  is  to  be  applied 
so  that  a  firm  hold  is  taken  on  the  base  of  the  organ, 
and  the  effect  is  to  be  made  again  and  again  to  depress 
the  tongue  sufficiently;  as  long  as  each  attempt  ex(>oses 
more  and  more  of  the  posterior  phaiyngeal  wall,  it  is 
safe  to  continue  the  manipulation,  and  finally  the  crest 
of  the  epi^ottis  will  be  seen  behind  the  tdngue,  and 
^ipeated  efforts  may  expose  its  entire  glossal  surface. 


If  this  method  be  unsuccessful,  the  epiglottis  may  be 
touched  or  titillated  with  the  extremity  of  the  tongue- 
depressor,  which  will  induce  reflex  movements  of  chok- 
ing, so  as  to  raise  the  larynx,  and  then  the  larynx  can 
be  raised  sufficiently,  sometimes,  to  expose  a  large  por- 
tion of  the  aditus  laryngis.  While  this  manoeuvre  is 
being  accomplished  with  one  hand,  the  proper  applica- 
tion can  be  made  with  the  other  to  any  morbid  appear- 
ance. The  same  manoeuvre  suffices  mr  making  appli- 
cations to  ulcere,  or  olher  morbid  appearances  upon  the 
pharynx,  which  may  have  been  discovered  upon  laryn- 
goscopic  examination.  Where  morbid  processes  cannot 
be  exposed  in  this  way,  it  will  beoome  necessary,  of 
course,  to  haye  recourse  to  the  principle  of  reflexion. 
For  a  general  application  to  the  mterior  of  the  larynx 
or  trachea,  recourse  to  the  laryngoscope  is  not  abso- 
lutely necessary,  though  more  s&  than  the  method 
introduced  with  so  much  success  by  the  late  Dr.  Horaoe 
Green,  of  New  York. 

Before  making  any  effort  to  introduce  «n  instrument 
within  the  cavity  of  the  larynx,  however,  it  is  exceed- 
ingly desirable  to  become  familiar  with  the  exact  posi- 
tion occupied  by  the  epiglottis,  for  this  vaJve  is  sometimes 
quite  erect,  and  at  oUiei-s  very  much  depressed  :  in- 
deed, it  is  a  matter  of  question  m  certain  medi<»l  circles 
whether  a  physician  is  at  all  justified  in  making  an 
attempt  to  pass  an  instrument  into  the  laryngeal  cavity 
without  previously  satisfying  himself  of  the  normal  po- 
sition of  his  patient's  epiglottis.  Where  a  laryngoscope 
is  at  hand,  the  point  m  question  can  be  very  readily 
determined ;  where  such  an  instrument  is  not  of  conve- 
nient access,  the  attempt  should  be  made  to  expose  the 
epiglottis  by  the  method  described  aboye ;  should  this 
fail,  the  forefinger  of  the  operator,  or  a  strong  bent  probe 
should  be  employed  a?*  a  lever  to  keep  down  the  base  of 
the  tongue,  and  if  not  successful  with  the  tongue  re- 
tained within  the  mouth,  the  same  means  may  be  tried 
with  the  tongue  extended,  care  being  taken  to  interpose 
something  between  the  lower  teeth  and  the  tongue,  so 
as  to  prevent  injury  to  the  organ  from  {^eesure  on  the 
incisors.  Shoidd  this  method  fisul,  the  forefinger  should 
be  passed  along  the  base  of  the  tongue  until  it  reaches 
the  epiglottis,  which  will  be  easily  recognised  by  the 
touch,  with  which  sense  its  position  can  be  determined 
also.  In  such  cases  the  epiglottis  may  be  pulled  for- 
ward by  the  forefinger  of  one  hand,  which  can  be  used 
as  a  guide  for  the  passage  of  an  instrument,  oyer  tlie 
finger  and  epiriottis  into  the  larynx;  and  tins  method 
is  often  the  omy  one  at  all  practicable  in  making  appli- 
cations to  the  larynx  of  the  child,  in  wMch  cases  the 
mouth  may  be  Icept  open  by  a  mouth-distender  or 
speculum;  or  the  precaution  should  be  taken  to  oro- 
tect  the  forefinger  and  hand  by  a  towel  or  handkerdiief 
from  impleasant  impressions  of  the  little  one^s  teeth. 

The  readiest  method  to  pass  the  probang  into  the 
larynx  without  the  use  of  tne  laryngoscope,  is  as  fol- 
lows : — First,  determine  the  position  of  the  epiglottis  in 
the  manner  described,  or  any  other  manner;  then  de« 
press  the  tongue  with  a  strong  tongue-depressor;  if  it 
exposes  the  epiglottis,  so  much  the  better ;  as  the  pa- 
tient takes  an  inspiration  pass  the  instrument  in  the 
middle  Hne  until  its  point  has  passed  behind  the  posi- 
tion assumed  by  the  epiglottis ;  then  telHng  the  patient  to 
make  a  prolonged  soimd  of  the  diphthong  os,  depress  the 
base  of  the  tongue  by  a  movement  which  diall  drag  it 
forwards  at  the  same  time,  and  sink  the  point  of  the 
probang  downwards  and  forwards  by  a  vertical  more- 
ment  of  the  wrist,  which  shall  bring  the  back  of  the 
band  all  but  in  contact  with  the  patient's  face.  If  it  is 
intended  to  pass  the  glottis,  the  patient  must  be  directed 
to  take  an  ins{>irataon  at  the  moment  the  probang  enters 
the  larynx;  tms  opens  the  glottn,  and  penmts &e  ^m- 


THE  MEDICAL  RECORD. 


315 


sagA  of  the  instrament.     The  moment  the  instrument 
baa  entered  the  larjnz,  spasm  takes  place,  the  epiglot- 
tis shuts  down  like  a  trap-door  upon  the  foreign  lx>dy, 
and  the  patient  feels  and  exhibits  the  symptoms  of  im- 
pending suffocation.     In  withdrawing  the  instrument, 
the  resiBtanoe  of  the  epiglottis  is  fdt ;  and  if  it  has 
passed  die  gk>ttis  the  resistance  of  its  lips  will  be  pre- 
Tioudy  distinguished.    The  sense  of  constriction  usually 
described  as  proof  of  entrance,  and  ascribed  to  the  spas- 
modic closure  of  the  glottis  in  withdrawing  the  instru- 
menty  i^  usually  due  to  the  prt^ssure  of  uie  epiglottis 
upon  it,  as  I  hare  repeatedly  verified  with  the  laryngo- 
scope, during  my   own  manipulations.    The  di'^tress 
caused  by  the  first  passage  of  the  glottis  by  a  probang 
isof^n  extreme  in  degree,  the  sense  of  soffocation 
remaining  for  some  time ;  but  it  becomes  less  and  less 
at  each  succeeding  application,  until  erentually  nothing 
ensues  but  a  slight  paroxysm  of  congh,  sometimes  a 
mere  dearing  of  the  throat    If  the  ^ottis  has  been 
passed,  and  it  is  desired  to  swab  the  trachea,  a  single 
motion  down  the  tube  and  out  again  is  all  that  is  requi- 
site; to  move  the  probang  up  and  dov^n  two  or  three 
tames,  as  if  the  wmdpipe  were  a  "  chimney  flue  '*  re- 
quiring cleansing,  is  a  procedure  as  unnecessary  as  it  is 
inelegant.    In  persons  with  thin  necks,  the  passage  of 
the  sponge  down  the  trachea  can  be  seen  through  the 
integument    The  right  bronchus  has  been  swabbed  in 
in  this  way  by  Dr.  Horace*  Green,  and  others,  and  even 
a  tube  has  been  passed  into  this  bronchus  for  the  pur- 
pose of  throwing  in  an  injec- 
^^^  tion.    I  have  never  had  occa- 
j^T  sion  to  make  an  attempt  of  this 

^r  kind,  but   I    have  repeatedly 

/m  reached  the  biAircation  of  the 

Im  trachea  of  a  lady  who  was  re- 

\^.  lieved   by    this    method  of  a 

ohronio  laryngo-tracheitis,  said 
to  be  of  nearly  forty  years'  dura- 
tion. , 

Tlie  substances  most  frequent- 
ly applied  by  the  sponge,mop,  or 
bru^  are  solutions  of  nitrate 
of  silver,  sulphate  of  zinc,  sul- 
phate of  copper,  chloride  of  zinc, 
tannic  acid,  persulphate  of  iron, 
etc. ;  the  nitrate  of  silver  being 
employed  most  frequently.  The 
method  of  treatment  is  appli- 
cable to  cases  of  chronic  laryngi- 
tis, follicular  and  ulcerative ;  U- 
ryngo-traeheitis;  pseudo-mem- 
branous laryngitis  ;  syphihtio 
affection*!  of  these  parts,  etc.  In 
withdrawing  the  sponge,  the 
tongue  and  pharynx  are  often 
touched  involuntarily,  and  this 
excess  of  fluid  may  be  removed 
in-part  by  gargling  with  suitable 
articles,  such  as  salt  and  water 
after  nitrate  of  silver,  milk  and 
water  afler  iodine,  etc. 

In  cases  of  limited  ukera- 
tions,  moist  excrescences,  etc., 
where  the  ap|>lication  is  to  be  limited  to  the  points 
diseaeed,  they  are  to  be  made  with  the  aid  of  the  laryn- 
goeoope.  If  a  mere  momentary  contact  is  required,  a 
irery  fine  bair-pencil  may  be  employed ;  if  longer  con- 
tact 18  requisite,  it  should  be  made  with  a  small  piece  of 
sponge,  no  larger  than  is  absolutely  necessary,  fastened 
ia  aa  appropriate  sponge-holder.  The  hair-pencil  is 
BM>re  apt  to  permit  a  drop  of  fluid  to  fall  from  it,  and  this 
Bi^  drop  into  the  larynx  before  the  application  is  made. 


Fie.  s. 


r 


Another  method  of  applying  liquids  to  these  struc- 
tures is  by  means  of  the  syringe.  The  so-called  catarrh- 
syringe,  manufactured  by  the  Hard-Rubber  Company, 
may  be  employed  for  this  purpose,  but  the  barrel  is  so 
large  as  often  to  obstruct  the  view.  The  most  conve- 
nient instrument  is  the  syringe  of  Tobold,  Fig.  2,  the 
nozzle  of  which  is  of  hard  rubber,  with  a  silver  tip  per- 
forated by  several  holes  to  permit  of  the  better  distribu- 
tion of  the  fluid.  The  barrel  is  of  glass,  and  if  desired, 
the  piston-rod  can  be  graduated  so  as  to  permit  of 
great  accuracy  in  the  amount  of  S'^lution  to  be  em- 
ployed, if  this  point  be  deemed  of  consequence.  The 
rings  on  the  barrel  are  for  the  first  and  second  fingers; 
the  ring  on  the  piston-rod  for  the  thumb.  Its  manner 
of  employment  is  obvious.  This  instrument  is  some- 
times made  with  a  larynjreal  mirror  in  the  curve,  and 
the  contents  are  prmected  from  several  apertures,  which 
open  on  the  rim  of  the  mirror.  A  somewhat  similar 
combination  of  laryngoscope  and  syringe  has  been 
devised  by  Binz.  Torek's  syringe  is  similar  to  Tobpld's, 
but  the  nozzle  bus  but  a  single  aperture,  over  which  a 
bit  of  sponge  is  tied.  It  is  used  in  the  same  manner; 
but  by  merely  dipping  the  sponge  into  a  solution  with- 
out drawing  up  any  of  the  fluid  by  the  piston,  it  can  be 
used  as  a  probang. 

For  the  administration  of  a  douche  into  the  larynx, 
etc.,  in  the  form  of  a  very  fine  spray,  and  which  shall 
irritate  the  parts  less  than  an  injection  from  a  syringe, 
the  best  instrument  which  has 
been  devised  is  the  laryngeal 
douche  of  Q-ibb  (Fig.  3),  which 
consists  of  a  silver  tul3e,  with  the 
proper  laryngeal  curve,  to  the 
nree  extremity  of  which  there  is 
screwed  on  a  platinum  bulb, 
perforated  with  a  number  of 
openings  so  fine  that  they  cannot 
be  seen  without  the  aid  of  a 
lens;  the  straight  end  of  the  tube 
is  fastened  by  silver  wire  with- 
in the  neck  of  a  little  rubber  ball 
The  instrument  13  charged  by 
dipping  the  bulb  into  the  solu- 
tion while  the  ball  is  compressed, 
and  then  releasing  the  ball  untu 
a  sufficient  quantity  has  been 
drawn  into  the  tube.  In  em- 
ploying the  instrument,  it  is  held 
by  the  neck  of  thfe  ball,  between 
the  middle  phalanges  of  the  first  ^ 
and  second  fingers^  the  ball  of  die^ 
thnmb  being  applied  to  the  base 
of  the  ball,  and  when  it  has  been 
placed  in  position  it  is  discharged 
by  compressing  the  b^  with  the 
thumb.  The  spray  produced  is 
as  finely  divided  as  that  made  by 
the  various  nebulizers  in  use,  for 
purposes  of  preparing  solutions 
for  inhalation,  and  the  contact  of 
the  spray  produces  loss  spasm 
than  any  otner  method  of  medi- 
cation. It  is  admirably  adapted 
ri«.  8.  to  making  a  general  application 

to  the  larynx  or  trachea,  espe- 
cially valuable  when  the  structures  are  very  sensitive  or 
irritable,  and  contact  with  the  sponge  or  brush  would 
induce  piun,  and  it  can  therefore  be  employed  when  the 
use  of  the  sponge  would  be  impracticable. 

These  syringes  and  douches  can  be  employed  for 
introducing  solutions  into  the  larynx,  when  the  depres- 
sion of  the  epigiottis  is  so  great  as  to  preclude  admission 

Digitized  by ^ ^_ 


816 


THE  MEDICAL  RECORD. 


to  a  sponge  or  hair-pencil.  The  method  of  treatment 
is  applicable  to  cases  of  general  inflammation,  acute  or 
chronic ;  to  alterations  of  structure ;  inflammatory  affec- 
tions of  the  vocal  cords  and  pseudo-membranous  laryn- 
fitis.  Dr.  Gibb,  in  the  last  edition  (London,  1864),  of 
is  work  on  Diseases  of  the  Throat  and  Windpipe,  states, 
p.  232,  that  he  has  recently  employed  the  spray  of  a 
solution  of  nitrate  of  s  Iver  (thirty  grains  to  the  ounce), 
as  an  injection  into  the  larynx  and  trachea  in  croup, 
and  the  severity  of  the  symptoms  were  so  speedily  dimi- 
nished that  he  almost  doubted  whether  the  disease  was 
actually  croup  I  yet  all  the  well-marked  symptoms  were- 
present. 

By  causing  the  patient  to  utter  a  vocal  sound  at  the 
moment  of  projVctmg  the  fluid  from  the  instrument,  we 
avoid  its  entrance  into  the  trachea  in  affections  of  the 
vocal  cords  and  parts  above  them.  I  have  frequently 
succeeded  in  overcoming  paralysis  of  the  muscles,  mov- 
ing the  vocal  cords  in  that  form  of  aphonia,  known  as 
frinctional,  by  means  of  an  apphcation  of  the  spray  of 
sulphuric  ether  from  the  laryngeal  douche ;  and  I  have 
also  employed  for  this  purpose  solutions  of  iodine, 
nitrate  of  silver,  and  astringents,  with  satisfactory 
results,  as  have  also  followed  the  use  of  the  same  reme- 
dies applied  by  the  sponge.  The  mechanical  eflfect  of 
the  sponge  or  the  douche  has  doubtless  had  much  to  do 
with  the  effect,  though  some  amount  of  credit  must  be 
allowed  to  the  stimulus  which  was  employed  with  them. 
When  ether  is  used  with  a  douche  of  this  kind,  or  with 
a  syringe  made  from  vulcanite,  the  solvent  action  of 
ether  upon  rubber  must  not  be  forgotten,  and  eventual 
destruction  of  the  rubber  portion  of  the  instrument 
must  be  expected. 

Another  method  of  applying  a  douche  to  the  larynx 
is  by  means  of  some  modification  of  the  Beigson  insuf- 
flator used  for  the  nebulization  of  liquids.  These  tubes 
are  so  arranged  as  to  be  readily  introduced  within  the 
larynx,  where  the  distribution  of  the  nebula  takes 
place ;  or  they  are  so  constructed  that  they  can  be  held 
over  the  laryngeal  entrance,  and  the  spray  be  propelled 
into  the  larynx  without  contact  of  the  instrument  with 
that  tube.  One  of  the  best  instruments  of  the  latter 
kind,  and  one  which  can  be  used  by  those  who  would 
be  unable  to  pass  an  instrument  into  the  larynx,  is  the 
spray-producer  of  Maunders  (see  illustration.  Medical 
Keoord,  Vol.  i.,  p.  219).  This  instrument  consists  of  an 
India-rubber  ball,  perforated  at  its  base,  so  as  to  admit 
of  instantaneous  refilment  of  air  when  emptied ;  an 
upper  or  air-tube  communicates  horizontally  with  the 
ball,  and  terminates  at  its  other  extremity  in  a  capillary 
^opening,  turned  downwards  just  far  enough  to  cover 
the  capillary  extremity  of  a  second  tube  running  under 
the  first  one ;  this  lower  tube  at  its  other  end  does  not 
communicate  with  the  ball,  but  dips  down  into  a  small 
vial,  which  slides  upon  a  pin  fastened  to  the  upper 
tube.  In  using  the  instrument  the  vial  is  partially  filled 
with  the  solution  to  lie  employed  j  the  instrument  held 
mpch  as  the  laryngeal  douche,  between  the  first  and 
other  fingers,  is  passed  into  the  mouth,  until  its  point 
all  but  reaches  the  posterior  wall  of  the  pharynx,  and 
then  the  ball  is  compressed  by  the  thumb,  which  forces 
the  air  to  escape  through  the  upper  tube,  while,  in  pass- 
ing, the  capillary  aperture  of  the  lower  tube  creates  a 
yacnum,  forcing  the  liquid  to  issue  from  the  Httle 
reservoir,  and,  as  it  escapes,  this  liquid  is  propelled 
downwards,  in  the  form  of  spray.  By  altering  the 
direction  or  the  capillary  extremities  of  these  tubes, 
the  spray  may  be  forced  in  any  desired  direction.  I 
notice  that  many  of  these  instruments,  as  the  laryngeal 
douche  and  spray-producer,  as  well  as  the  insuflaator,  to 
be  described  subsequently,  are  furnished  with  an  egg- 
shaped  rubber  ball,  simihu:  to  those  in  certain  forms  d' 


anal  syringes.  These  balls  have  to  be  held  in  the  palm 
of  the  hand,  and  then  compressed  by  closing  the  hand 
upon  them,  a  motion  which  invariably  disturbs  the 
position  of  the  point  of  the  instrument  to  a  considera- 
ble extent^  and  necessitates  a  very  awkward  manner  of 
introducing  the  instrument.  The  shaped  ball  I  employ 
is  seen  in  Fig.  3,  in  connection  with  Q-ibb's  laryngeal 
douche. 

Still  another  method  of  introducing  solutions  is  that 
of  Von  Bruns,  who  uses  a  properly  curved  tube,  drawn 
at  one  end  to  a  fine  aperture ;  to  the  other  en(^  a  piece 
of  rubber  tubing  is  attached.  The  fluid  is  drawn  up  by 
suction  with  the  mouth,  and  discharged  by  blowing 
through  the  tubing,  an  inelegant  method  of  procedure. 

All  these  instruments  are  improvements  upon  the 
method  of  Trousseau  and  BeUoct,  who  employed  an 
anal  syringe  for  this  purpose,  and  of  Erichsen,  who 
also  invented  a  laryngeal  syringe. 

By  turning  these  instruments  round,  or  upside  dovm, 
as  it  were,  and  altering  the  curve  if  necessary,  they 


become  converted  into   naso-r 


S3rringes,  or 


douches,  for  the  treatment  of  affections  of  the  posterior 
nares  and  naso-pharyngeal  space. 

In  using  corrosive  solutions,  as  of  nitrate  of  silver, 
acid  nitrate  of  mercury,  etc.,  the  portion  of  the  instru- 
ment with  which  the  material  comes  in  contact  should 
be  of  gold,  platinum,  glass,  or  vulcanite. 

Solutions  adapted  to  the  treatment  of  chronic  affec- 
tions of  the  upper  air-passages  should  be  strong ;  lor 
instance— of  nitrate  of  silver,  grs.  40,  120  to  the  ounqe 
of  water;  sulphates  of  copper  and  zinc,  grs.  30,  80  to 
the  ounce ;  chromic  acid,  grs.  40,  120  to  the  ounce,  etc 
Weaker  solutions  are  not  of  much  service.  If  a  stronger 
application  is  required,  the  sponge  may  be  moistened, 
and  then  rubbed  upon  the  salt,  so  as  to  secure  a  veiy 
concentrated  solution.  For  syphilitic  affections,  the 
best  local  application  is  a  solution  of  the  acid  nitrate  of 
mercury,  one  part  to  from  five  to  twenty  of  water, 
according  to  the  indications.  Where  an  application  is 
made,  a  second  application  is  not  usually  necessary 
until  all  beneficial  aAion  from  the  first  has  ceased, 
which  may  be  one,  two,  or  three  days,  or  longer,  ac- 
cording to  circumstances, 

A  NEW  MODE  OF  TREATING 

UMBILICAL  HERNIA  OF  INFANTS. 

Bt  a,  G.  field,  M.D., 

IOWA. 

In  the  treatment  of  a  case  of  umbiUcal  hernia  in  an 
infant,  some  time  since,  I  experienced  but  little  benefit 
from  the  usual  appliances,  and  finally  resorted  to  the 
use  of  adhesive  strips  only,  with  which  a  radical  cure 
was  effected. 

Since  then,  the  plan  has  been  adopted  with  success 
in  the  treatment  of  other  cases,  and  its  simplicity  may 
justify  its  publicity,  and  induce  others  to  give  it  a  trial 
It  is  basea  upon  the  as.<«umption  that  there  are  two 
indications  to  be  met :  the  support  of  the  parietes  of 
the  abdomen,  and  the  production  of  a  plastic  exuda- 
tion at  the  point  of  injury. 

Two  strips  of  adhesive  plaster  of  sufficient  length 
are  to  be  applied  to  the  abdomen,  each  reaching  from 
the  crest  of  the  ilium  on  one  side  to  the  hypochon- 
drium  on  the  other,  botii  crossing  over  the  umbilicus. 
In  the  apphcation  of  each,  the  umbOicus  is  to  be 
pressed  well  down  by  tiie  finger  of  the  surgeon,  while 
the  strip  of  plaster,  one  end  of  which  having  been  pre- 
viously attached,  is  drawn  firmly  over  it,  and  secured, 
so  as  to  cause  an  inward  fold  of  the  integtunent  at  the 
point  of  injury,  thus  closing  the  ap^rt^re,  And  at  the 

digitized  by  VjOOQ IC 


THE  MEDICAL  RECORD. 


81Y 


8&me  time  constituting  apoc?  of  the  corrugated  tissues 
of  the  abdominal  wall  • 

By  re-i^plying  the  strips  when  they  became  loosen- 
ed, and  continuing  the  treatment  a  few  weeks,  radical 
cures  resulted. 


ON  SOME  OF  THE  INDICATIONS 

rOETHB 

USE  OF  THE  EUSTACHIAN  CATHETER. 
By  0.  D.  POMEROr,  M.D., 

NBW   TORIC 

There  seems  to  be  a  wide-spread  prejudice  against  the 
use  of  the  Eustachian  catheter,  especially  amongst  gen- 
eral practitioners.  In  looking  oyer  works  on  the  dis- 
eases of  the  ear,  much  will  be  found  in  condemnation 
of  this  practice ;  even  if  it  is  admitted  to  be  occasionally 
justifiable,  the  dangers  from  its  use  are  so  dilated  upon, 
as  to  frighten  any  but  the  boldest  from  attempting 
catheterization. 

More  frequently  is  this  the  case  with  English  writers ; 
and  American  physicians,  regarding  them  with  greater 
fiivor  perhaps,  are  especially  in  danger  of  adopting  such 
erroneous  notions. 

The  Continental  surgeons,  however,  almost  unani- 
mouslv  favor  its  use. 

Perhaps  one  cause  of  this  wide-spread  fear  of  cathe- 
terization has  arisen  from  two  cases,  supposed  to  have 
been  killed  by  its  use  in  London,  more  than  twenty 
years  since,  and  reported  by  Turnbull,  of  which  Mr. 
Troltsch  remarks :  **  It  is  hard  to  see,  from  the  published 
account  of  the  autopsy,  how  the  accident  occurred." 
In  spite  of  this,  however,  it  has  been  quoted  in  almost 
every  book  on  the  subject  since.  Two  cases  by  Troltsch, 
and  one  by  Pitcher,  have  been  recorded,  in  which 
emphysema,  more  or  less  extensive,  has  resulted  from 
the  use  of  the  catheter;  the  air  being  again  absorbed, 
without  serious  consequences.  Occasionally  laceration 
of  the  mucous  membrane  and  moderate  haemorrhage 
have  resulted. 

I  have  not  heard  of  a  case  from  any  surgeon  in  this 
country,  in  which  mischief  has  been  done  by  the 
catheter  when  judiciously  used.  In  fact,  American 
surgeons  have  in  public  assemblages  declared  that  they 
have  been  prejudiced  against  the  use  of  the  catheter, 
but  employ  it  much  more  frequently  now  than  for- 
merly I  My  own  experience  in  the  matter  ma^  have 
been  sufficient  to  give  me  a  prejudice  for  or  against  its 
use.  I  have  never  met  with  a  single  untoward  acci- 
dent; occasionally  a  little  pain  has  been  caused,  or  the 
most  trifling  hssmorrhage.  In  the  case  of  children,  it 
will  be  somewhat  more  difficult.  My  own  practice  is 
to  hold  the  child's  head  firmly  between  the  knees,  when, 
in  spite  of  struggles  and  cries,  we  may  succeed  in  its 
introduction-  (The  best  mode  of  introducing  the  cathe- 
ter is  Kramer's,  described  in  Troltsch's  work  on  the 
ear,  translated  by  Dr.  Roosa.)  Politzer's  apparatus  has 
superseded  the  catheter  in  a  great  number  of  cases,  and 
when  it  succeeds,  of  course  catheterization  is  unjusti- 
fiable. Mtny  times  a  patient  presents  himself  with 
only  one  ear  affected ;  ttie  tube  may  be  so  impervious 
as  "not  to  allow  an  interchange  of  air  between  the 
throat  and  cavity  of  the  tympanum ;  you  very  properly 
try  inflation  bv  the  Politzer  apparatus  and  succeed — at 
the  expense  oi  injuriously  inflating  the  well  ear,  or  you 
do  not  succeed  at  all,  and  must  eventually  use  the 
catheter  J  you  wish  to  inject  medicated  vapors  or  gases, 
and  the  injection  goes  into  the  well  ear  more  than  into 
the  diseased  one,  most  likely  doing  mischief;  you  will 
not  then  hesitate  to  use  the  catheter.  Again,  Sir 
Astley  Cooper  is  reported  by  Sir  William  Wilde  to 


have  said,  "  Whenever  the  patient  is  himself  able  to 
inflate  the  tympanum,  never  use  any  artificial  means  to 
do  so ;  it  is  unnecessary,  and  may  be  injurious." 

Within  a  few  days  I  have  observed  a  case  which  dis- 
proves this  proposition.  The  patient  was  somewhat 
deaf  in  both  ears  from  myringitis  and  inflammation  of 
the  cavity  of  the  tympanum,  with  partial  closure  of  the 
tubes,  worse  in  the  lefl,,  to  which  treatment  was  princi- 
pally directed.  He  could  inflate  both  tympani  easily, 
although  that  was  not  the  case  at  first,  by  holding  his 
nose  and  making  a  forced  expiration ;  still  there  was 
no  improvement  in  the  hearing  of  the  left.  I  then  tried 
the  Politzer,  which  forced  in  the  air  much  more  strongly, 
so  much  so  as  to  cause  momentary  pain  and  deafness  to 
the  right  ear,  without  improvement  in  the  other ;  I  then 
tried  tiie  catheter  in  the  left,  and  by  vigorous  pumping 
of  air  through  it,  succeeded  in  much  improving  the 
hearing.  The  membrane  had,  by  the  inflammatory 
thickening,  become  so  rigid  and  immovable  as  not  to 
be  pressed  into  a  normal  position  (it  having  become 
sunken  by  the  disease),  except  by  the  catheter. 

A  new  method  of  treating  diseases  of  the  cavity  of 
the  ear  by  means  of  a  medicated  spray,  in  the  same 
manner  as  in  inflammations  of  mucous  membranes 
elsewhere,  has  been  devised,  and  to  accomplish  this,  the 
spray  catheter  must  be  used;  so  we  infer  that  any 
person  practising  aural  surgery,  with  anything  like 
thoroughness,  must  needs  use  the  catheter,  if  not  fre- 
quently, occasionally,  and  I  am  confident  that  every 
man  capable  of  using  this  instrument  with  even  a  mod- 
erate amount  of  skill,  must  coincide  with  this. 

Ilep0rta  of  iS^oapitaie. 

BELLEVUE    HOSPITAL. 

POLYPUS  OP  TEX  REOTUM. 

By  D.  MoLEAN  FORMAN,  M.D., 

H0U8B  817BOBOH. 

Polypus  of  the  rectum,  although  a  somewhat  rare 
disease,  is  an  important  one  to  be  acquainted  with,  in- 
asmuch as  it  often  produces  most  severe  symptoms,  and 
at  the  same  time  is  easily  remedied. 

The  most  simple  form  in  which  a  polypus  is  seen,  is 
where  there  are  one  or  more  short  processes,  as  it  were, 
of  the  mucous  membrane  standing  out  prominently  in 
the  cavity  of  the  rectum.  These  bodies  are  usually 
situated  in  the  cavity  of  the  rectum  above  the  internal 
sphincter,  produce  little  uneasiness,  cAuse  very  httle 
inconvenience,  and  therefore  do  not  demand  the  atten- 
tion of  the  surgeon. 

A  form  of  polypus  very  rarely  met  with  is  where  the 
growth  is  warty,  composed  of  an  ago^regation  of  small 
lobes  arranged  upon  a  peduncle,  just  like  a  bunch  of 
grapes,  and  upon  microscopical  examination  being 
chiefly  or  entirely  epithelial 

The  vascular  polypus  is,  perhaps,  of  most  frequent 
occurrence;  it  is  cluefly  met  with  in  young  children. 
The  tumor  varies  in  size  from  a  cherry  to  a  pea ;  is  of 
a  bright  color;  its  structure  is  fibro-cellular  and  emi- 
nently vascular.  It  is  usually  situated  within  a  short 
distance  of  the  anus.  The  symptoms  which  this  form 
of  the  disease  produces  is  the  prolapse  of  the  tumor 
when  the  patient  evacuates  his  bowels,  and  haemor- 
rhage of  a  more  or  less  profuse  character.  The  occur- 
rence of  this  loss  of  blood  in  a  child  should  lead  to  a 
careful  examination  of  the  rectum,  for  if  the  tumor 
be  seated  high  up  it  will  recede  afier  evacuation  of  the 
bowels,  and  thus  escape  observation.    It  is  necessary, 


318 


THE  MEDICAL  RECORD, 


therefore,  to  make  the  examination  immediately  after 
the  eyacuatioD  of  the  rectnm  by  medicine  or  an  enema. 

OASB  or  POLTPI  or  THB  BEOTUM. 

Wm.  H J  «t  16  years,  was  admitted  to  Belle- 

vue  Hospital,  July  22,  1867.  The  patient  is  a  pale, 
anaemic,  sickly-looking  boy,  has  an  anesmic  cardiac 
mnrmur^dema  of  both  lower  extremities,  and  is  very 
weak.  Urine  healthy.  Be  states  that  he  has  been 
troubled  with  a  protrusion  of  the  bowel  when  he  goes 
to  stool  ever  since  he  was  a  little  boy.  At  times  he 
has  profuse  haemorrhage  from  the  bowels  and  is  greatly 
prostrated  thereby.  He  complains  of  pain  in  his  back, 
and  says  he  has  a  good  deal  of  pain  about  the  anus 
when  he  evacuates  his  bowels.  Soon  after  admission 
an  enema  was  administered,  and  he  was  directed  to 
force  down  all  the  rectum  he  could.  Upon  examining 
him  after  the  enema,  there  was  found  to  be  a  flesh- 
colored  mass  about  the  size  of  a  man's  fist  presenting 
very  much  the  appearance,  except  in  color,  of  the  head 
of  a  cauliflower,  protruding  from  the  anus.  Upon  ex- 
amination, this  mass  was  found  to  be  composed  of  thei 
mucous  membrane  of  the  rectum,  and  several  hundred 
polypi,  varying  in  size  fi'om  a  pea  to  a  very  large  bean, 
attached  to  the  mucous  membrane  by  small  pedides,  the 
interspaces  beii)g  filled  with  a  gelatinous  mucus.  Upon 
removing  several  of  the  smallest  ones  for  examination, 
they  were  found  to  be  extremely  vascular,  and  in  tex- 
ture fibro-cellu!ar.  Upon  introducing  the  finger  in  the 
rectum,  apparently  healthy  mucous  membrane  could  be 
felt  above  the  polvpi  about  an  inch  above  the  ^hineter. 
This  mass  of  polypi  and  mucous  membrane  protrude 
from  the  anus  every  time  the  boy  has  a  passage  from  his 
bowels,  and  fi^uently  bleed  when  he  walks  about, 
but  are  easily  reduced  by  himself,  several  oimces  of 
bloody  mucus  escaping  after  each  reduction. 

Treatfnent. — Good  nourishing  diet;  syrup  ferriiodidi 
and  quinine. 

July  31. — Patient  is  suffering  a  good  deal  from  his 
disease,  and  his  general  condition  is  now  extremely  bad 
and  becoming  worse  every  day.  To-d  ly,  the  patient  being 
seen  by  several  of  the  attending  surgeons.  Dr.  Sands, 
at  thdr  approval,  ligated  the  mass  by  passhig  several 
strong  ligatures  through  it  near  the  junction  of  the 
healthy  and  diseased  mucous  membrane,  tying  them 
tight  so  as  to  strangulate  it.  After  the  whole  mass  had 
been  included  in  the  ligatures,  most  of  the  polypi  were  re- 
moved with  the  scissors  and  the  rest  returned  within 
the  anus.  Augtat  1. — ^The  operation  has  been  followed 
by  a  good  deal  of  constitutional  disturbance.  Pulse  140 
to  160,  and  very  weak.  Skin  hot  and  dry.  Tongue  a 
little  dry  and  furred.  Gomplaibs  of  pain  about  the 
anus.  He  is  kept  moderately  under  the  influence  of 
stimulants  and  opium.  Aug.  2. — There  is  but  little 
change  in  his  condition ;  he  has  vomited  several  times 
during  the  day.  Aug,  3. — The  patient  is  better  to* 
day.  Has  no  evidences  of  peritonitis.  Bowels  moved 
three  times  last  night ;  none  of  the  polypi  were  voided 
in  the  stools.  Still  complains  greatly  of  soreness  about 
the  anus.  Avg,  14. — Patient  has  improved  daily, 
several  of  the  ligatures  having  come  away,  and  to-day 
several  polypi  were  passed  with  the  contents  of  the 
rectum.  Aug.  23. — ^Upon  introducing  the  finger  in 
the  reotum,  one  large  and  several  small  polypi  can  be 
felt,  but  they  give  him  no  trouble,  and  he  is  unable  to 
protrude  them.  He  has  had  no  more  hemorrhages 
since  the  operation.  There  is  no  evidence  of  a  stricture 
of  the  rectum.  His  health  is  ereatly  improved,  and  at 
his  request  he  was  to-day  discharged  fix>m  the  hospital 
and  went  to  his  home  in  the  country. 


©riginal  Cecture«» 


ON  ABSCESS. 
Bt  ALFRED  C.  POST,  M.D., 

PBOFI880B  OP  stnoiMt  m  mrrVKitiTT  mnnoAi.  oollms. 

Gentlemen — The  subject  of  my  lecture  to-day  is  ab- 
scess. This  term  is  used  to  denote  a  circumscribed 
collection  of  purulent  matter  in  a  cyst  or  sac,  which  is 
produced  by  inflammHtion.  It  occurs  most  frequently 
in  parts  which  abound  in  cellular  tis'^ue.  The  inflamed 
part  first  becomes  infiltrated  with  fibrine  or  liquor  san- 
guinis, and  then  in  the  midst  of  its  substance  a  small 
cavity  is  excavated  by  ulcerative  absorption,  and  the 
cavity  so  formed  is  filled  with  pus.  By  progressive 
ulceration^  the  cavity  becomes  gradually  enlarged,  and 
the  quMUtity  of  contained  pus  is  increased  in  Sie  same 
proportion.  The  ulceration  involves  chiefly  the  wall  of 
the  abscess  which  is  nearest  to  the  external  surface  of 
the  body,  or  to  some  mucous  canal  which  lies  in  its 
neighborhood ;  and  in  this  manner  the  cavity  of  the  ab- 
scess approaches  nearer  and  nearer  to  the  surface,  until 
finally,  when  left  to  itself,  it  cischarges  its  contents, 
when  its  opposite  walls  become  approximated,  and  ulti- 
mately united  with  each  other,  chiefly  by  the  process 
of  granulation.  Abwesses  are  often  attended  with, 
marked  embarrassment  of  the  functions  of  important 
organs,  and  with  serious  disturbance  of  the  general 
health.  In  many  instances  they  endanger  the  life  of 
the  patient  The  danger  of  abscesses  depends  upon  a 
variety  of  circumstances. 

I.  Their  size.  A  very  large  abscess  is  dangerous,  on 
account  of  the  large  amount  of  irritation  which  attends 
its  formation,  of  the  exhaustion  occasioned  by  the  pro- 
fuse discharge,  and  of  the  tax  upon  the  vital  powers 
resulting  from  the  extensive  destruction  of  tissues. 

II.  Their  number.  Yery  numerous  small  abscesses 
are  attended  with  great  irritation,  and  lead  to  exhaustion 
of  the  vital  powers.  This  is  illustrated  by  the  irritation 
and  exhaustion  attending  a  severe  attack  of  small-pox. 

m.  Their  situation.  When  an  absce^  is  situated  in 
a  vital  organ,  it  greatly  embarrasses  the  fijnction  of  the 
organ  in  which  it  is  located,  and  produces  a  corre- 
sponding amount  of  constitutional  disturbance.  When 
it  is  so  situated  as  to  interfere  with  the  ingress  <»r  egress 
of  the  contents  of  a  mucous  canal,  the  degree  of  dan- 
ger will  be  in  proportion  to  the  importance  of  the  func- 
tion which  it  impedes.  If  it  encroach  upon  the  respiratory 
tube,  it  will  give  rise  to  urgent  and  distressing  dyspnoea, 
bringing  the  life  of  the  patient  into  the  mo6t  imminent 
peril.  This  source  of  danger  is  illustrated  by  retro- 
pharyngeal abscesses,  by  cynanche  cellularis,  and  by 
purulent  collections  in  the  walls  of  the  larynx  or  trachea. 
An  abscess  pressing  upon  the  oesophagus  may  so  inter- 
fere with  the  function  of  deglutition  as  to  expose  the 
patient  to  the  danger  of  death  by  inanition.  A  fatal 
case  of  this  kind  occurred  under  my  observation  a  num- 
ber of  years  since.  An  obstinate  obstruction  of  the 
OBSophaffus  near  its  entrance  into  the  stomach,  rendered 
deglutition  impossible,  and  a  short  time  before  the  death 
of  the  patient,  there  was  a  copious  discharge  of  pa*, 
which  was  regurgitated  from  the  oesophagus  through 
the  mouth. 

An  abscess  compressing  a  portion  of  the  intestinal 
canal  may  occasion  fatal  obstrucion  of  the  bowels.  And, 
in  like  manner,  an  abscess  in  the  vicinity  of  the  urethra 
may  give  rise  to  retention  of  urine,  and  if  relief  be  not 
speedily  afforded,  a  fatal  event  may  follow.  When  an 
abscess  is  so  situated  that  its  progress  towards  the  sur- 
face is  greatly  impeded  by  the  extreme  density  of  th^ 


THE  MEDICAL  RECORD, 


819 


tissues  which  corer  it,  as  where  it  occurs  beneath  a 
fibrous  membrane,  its  progress  is  attended  with  great 
pain  and  constitutional  disturbance.  In  such  cases,  the 
mteerity  of  the  organ  involved  in  the  disease  is  threat- 
ened, and  even  the  life  of  the  patient  may  be  imperilled. 
lY.  The  state  of  the  general  health.  When  an  ab- 
scess occurs  in  a  person  whose  general  health  was  pre- 
viously impaired  by  great  privations,  or  by  severe 
illnesa,  or  by  vicious  habits,  the  danger  is  greativ  in- 
creased by  the  unfavorable  condition  so  induced.  Under 
such  circumstances,  the  walls  of  the  abscess  sometimes 
present  a  gangrenous  character. 

V.  The  existence  of  a  persistent  source  of  irritation, 
counteracting  the  reparative  efforts  of  the  system.  This 
source  of  embarrassment  and  of  danger  is  represented 
by  the  presence  of  foreign  bodies,  of  diseased  none,  and 
ol*  dead  tissues. 

YL  An  impure  state  of  the  atmosphere  in  the  place 
where  the  patient  is  treated,  as  in  the  wards  of  a 
crowded  or  lU-ventilated  hospital,  in  the  filthy  habita- 
tions of  the  poor,  etc. 

Abscesses  are  divided  into  two  classes,  viz.  acute  and 
chronic.  An  acute  abscess  is  one  which  passes  rapidly 
through  its  several  stages,  the  reparative  process  often 
being  completed  within  three  weeks  ft*om  the  com- 
mencement of  the  dis^^ase.  Its  formation  is  attended 
with  active  inflammation,  with  severe  pains,  and  burn- 
ing heat  and  throbbing,  and  with  more  or  less  febrile 
excitement  When  the  matter  has  been  evacuated, 
the  inflammatory  symptoms  rapidly  subside,  and  the 
process  of  reparation  is  speedily  completed. 

A  chronic  abscess  is  angering  in  its  progress,  and 
almost  indefinire  in  its  duration,  continuing  for  months, 
or  even  for  years.  It  is  for  the  most  part  attended 
with  little  or  no  pain,  the  temperature  of  the  part  is 
scarcely  elevated  above  the  normal  standard,  and  there 
is  often  no  febrile  disturbance.  When  fever  exists,  it 
is  apt  to  present  the  hectic  type.  After  the  matter  has 
been  evacuated,  there  is  often  little  or  no  tendency  to 
reparative  action,  the  cavity,  in  some  cases,  remaining 
undiminished  in  size,  giving  rise  to  a  profuse  and  long- 
eontinned  purulent  discharge ;  and,  in  other  cases,  con- 
tracting to  a  sinus  or  fistula,  which  is  strongly  indi^osed 
to  heaL  It  often  occurs,  after  the  opening  of  a  chronic 
abscess,  that  the  matter  contained  in  it  undergoes  a 
(^emical  change,  by  which  it  becomes  acrid  and  irritat- 
ing, contaminating  the  blood,  and  giving  rise  to  irrita- 
tive fever,  by  which  the  life  of  the  patient  is  imperilled. 
Chronic  abscesses  are  often  attended  with  a  diseased 
condition  of  tlie  bones  and  articulations,  or  with  the 
presence  of  foreign  bodies,  which  keep  up  persistent 
irritation. 

In  the  treatment  of  acute  abscess,  in  its  early  stage, 
the  aim  of  the  practitioner  diould  be  to  moderate  tne 
lorce  of  the  existing  inflammation.  The  means  em- 
ployed for  this  purpose  will  vary  according  to  the  con- 
stitutional condition  of  the  patient,  and  the  activity  of 
the  inflammatory  disease.  When  the  inflammation  is 
Motive,  with  a  firm  resisting*  pulse,  and  well-marked  in* 
flanamatorj  fever,  and  when  the  patient  is  young  and 
has  a  vigorous  constitution,  general  or  local  blood- 
Wtting,  purging,  antimonials,  and  other  depressing 
agents  may  be  resorted  to.  When  the  patient  is  old, 
&eb'e,  or  of  broken-down  constitution,  a  supporting 
treat  m^ent  will  be  indicated. 

During  the  forming  stage  of  abscess,  warm  fomenta^ 
tions  or  emoIUent  cauplaHms  may  be  applied  with  ad- 
vmatMfe,  These  applications  relieve  in  some  degree  the 
Bufifenngs  of  the  patient,  and  they  favor  the  approach 
of  matter  to  the  surfbce  of  the  body.  It  is  dtoirable.  in 
general,  during  the  progress  of  an  acute  abscess^  tnat 
the   patient  should  abstain  from  active  exercise.    In 


most  cases,  the  horizontal  posture  should  be  maintained. 
When  suppuration  has  occurred  to  such  a  degree  that 
fluctuation  is  distinctly  perceptible,  an  opening  should 
be  made  for  the  evacuation  of  the  matter.  In  many 
instances,  the  patient  has  an  instinctive  aversion  to  the 
use  of  cutting  instruments,  and  stronscly  objects  to  the 
opening  of  the  abscess.  It  becomes  then  an  important 
question  to  decide  whether  the  objections  of  the  patient 
snail  be  positively  overruled,  and  an  artificial  opening 
shall  be  made,  or  whether  the  opening  of  the  abscess 
shall  be  left  to  the  more  tardy  operation  of  nature. 
When  the  abscess  is  of  moderate  size,  and  involves  only 
the  skin  and  the  subcutaneous  cellular  tissue,  it  may  be 
safely  left  to  itself.  A  spontaneous  cure  will  ultimately 
take  place,  and  the  only  bad  consequence  will  be  that 
the  patient  will  suffer  more  pain  than  he  would  have 
done,  if  an  artificial  opening  had  been  made.  But 
there  are  many  circumstances  under  which  it  is  the  im- 
perative duty  of  the  medical  attendant  to  insist  peremp- 
torily on  incising  the  wall  of  the  abscess,  and  evacuating 
its  contents  at  an  early  period.  The  early  opening  of 
an  abscess  should  always  be  resorted  to  when  the  swell- 
ing embarrasses  an  important  function,  especially  the 
function  of  a  vital  organ.  When  an  abscess,  for  exam- 
ple, occupies  the  posterior  wall  of  the  pharynx,  and 
encroaches  upon  the  entrance  of  the  larynx,  so  as  to 
embarrass  respiration,  no  time  should  be  lost  in  making 
a  fi'ee  incimon,  and  giving  issue  to  the  matter.  The 
same  remark  apphes  to  collections  of  purulent  matter 
by  the  side  of  the  larynx  or  trachea,  or  pressing  upon 
the  oesophagus.  In  that  formidable  disease,  cynanche 
cellularis,  in  which  the  cellular  tissue  of  the  neck  is  in- 
flamed, and  suppuration  is  threatened,  the  patient 
should  be  watched  with  the  utmost  care,  as  it  is  uncer- 
tain at  what  point  fluctuation  may  first  be  detected, 
within  the  buccal  cavity,  in  the  fauce?,  or  beneath  the 
base  of  the  jaw,  and  an  incision  should  be  made  at  the 
earliest  practicable  period,  to  guard  against  the  danger 
of  suffocation. 

When  an  abscess  obstructs  the  urethra,  the  rectum, 
or  any  portion  of  the  intestinal  canal,  it  is  important 
that  an  early  opening  should  be  made  to  evacuate  the 
matter,  and  to  relieve  the  obstruction. 

Abscesses  in  the  immediate  vicinity  of  the  thoracic 
or  peritoneal  cavities,  or  of  the  articulations,  should 
always  be  promptly  opened,  as  there  is  great  danger  of 
the  extension  of  inflammation  to  the  serous  or  syno- 
vial membranes,  or  of  the  bursting  of  the  abscess  into 
the  adjacent  cavities. 

Abscesses  encroaching  upon  the  eye,  the  ear,  or  any 
other  important  and  sensitive  organ,  should  be  opened  at 
an  early  period,  for  the  relief  of  the  intense  pain  to  which 
they  give  rise,  and  for  the  preservation  of  the  important 
fimction  whose  integrity  is  jeoparded.  An  intra-orbital 
abscess  is  not  only  excessively  painful,  but  it  subjects 
the  patient  to  imminent  danger  of  loss  of  vision.  The 
safety  of  the  patient  depends  on  the  early  evacuation 
of  the  contents  of  the  abscess.  In  like  manner,  the 
small  abscesses  which  occur  in  the  walls  of  the  meatus 
auditorius  extemus,  near  the  bottom  of  the  concha, 
give  rise  to  the  most  agonizing  pain,  which  can  only  be 
relieved  by  a  free  incision.  Thi-*  indsion  should  be 
made  very  early,  even  before  the  pus  is  fully  elaborat- 
ed. It  sometimes  happens  that  two  abscesses  occur  in 
the  same  ear,  and  that  the  deeper  one  is  concealed  from 
view  by  that  which  is  more  superficial.  A  few  years 
ago,  I  was  called  one  evening  to  see  two  patients  in 
one  house,  a  gentleman  and  a  lady,  who,  by  a  curious 
coincidence,  were  both  suffering  from  abscess  of  the 
external  meatus.  I  made  an  incision  into  the  abscess 
in  the  gentleman's  ear,  and  he  told  me  afterwards  that 
he  felt  strongly  inclined  to  knock  ma^own,  the  pun 

Digitized  by  VjOO^  ^  _ 


320 


THE  MEDICAL  BECORD. 


of  the  incision  being  of  so  ezcruciftting  a  character. 
But  in  a  few  moments  complete  relief  followed.  I 
made  a  similar  incision  into  the  abscess  in  the  lady's 
ear,  and,  to  my  surprise,  little  or  no  relief  was  aflforded. 
I  was  obliged  to  make  a  free  use  of  anodynes  to  dimin- 
ish the  intensity  of  the  pain.  I  at  once  expressed  the 
opinion  that  there  was  a  deeper  abscess  which  could 
not  then  be  brought  into  view.  This  opinion  was  veri- 
fied in  the  course  of  two  or  three  days,  when  the  swell- 
ing occasioned  by  the  superficial  abscess  had  subsided. 

When  an  abscess  occurs  at  a  great  depth  from  the 
surface,  when  it  occurs  beneath  a  muscle,  or  a  fibrous 
membrane,  or  other  dense  and  resisting  tissues,  it  is  very 
important  not  only  that  an  early  opening  should  be  made, 
but  that  the  incision  should  be  sufficiently  fi-ee  to  give 
a  ready  outlet  to  the  matter,  and  fiilly  to  relieve  the 
tension  of  the  inflamed  parts.  It  is  not  uncommon  to 
meet  with  deep  collections  of  purulent  matter,  in  firont 
of  the  tragus,  over  the  temporo-maxillarj^  articulation, 
or  behind  the  concha  in  the  mastoid  region,  constitut- 
ing what  have  been  termed  pre-atiricular  or  post-auri- 
cuiar  abscesses.  These  purulent  collections  are  attend- 
ed with  agonizing  pain,  and  with  great  constitutional 
disturbance,  and  they  not  only  threaten  the  integrity 
of  the  organ  of  hearing,  but  they  bring  the  life  of  the 
patient  into  jeopardy.  A  free  and  deep  incision  is 
the  sheet-anchor  of  safety  to  the  patient 

When  an  abscess  iovolves  a  secreting  gland,  as  the 
mammary,  parotid,  etc.,  the  early  evacuation  of  the 
matter  is  important,  as  the  most  efficient  means,  not 
only  of  relieving  pain  and  constitutional  irritation, 
but  of  preventing  extensive  disorganization  of  the 
glandular  substimce. 

In  all  cases  in  which  the  progress  of  an  abscess  gives 
rise  to  severe  pain,  or  to  great  constitutional  disturb- 
ance, an  incision  for  the  evacuation  of  the  matter  con- 
stitutes the  most  prompt  and  available  means  of 
relief. 

When  an  abscess  presents  a  gan^enous  character, 
being  attended  with  rapid  disintegration  of  tissues,  and 
emitting  an  offisnsive  odor,  a  free  incision  is  important 
to  the  safety  of  the  patient.  If  it  be  omitted,  there  is 
reason  to  apprehend  extensive  destruction  of  the  ad- 
jacent tissues,  and  contamination  of  the  blood  by  the 
noxious  fluids  contained  within  the  abscess. 

The  manner  of  opening  an  acute  abscess  varies  some- 
what according  to  its  situation,  its  depth,  and  the 
density  of  the  investing  tissues.  Under  ordinary  cir- 
cumstances, when  the  walls  of  an  abscess  are  of 
moderate  thickness  and  density,  the  most  convenient 
method  is  to  insert  the  point  or  a  sharp  bistoury  into 
the  cavity  of  the  abscess,  and  to  bring  it  out  through 
the  skin  at  the  distance  of  half  an  inch,  an  inch,  or 
more,  from  the  point  of  entrance,  and  to  complete  the 
incision  by  carrying  the  knife  onward  in  the  same  di- 
rection. The  point  selected  for  opening  the  abscess 
should  be  where  fluctuation  is  most  distinct,  or  at  a 
point  where,  in  the  ordinary  position  of  the  patient,  the 
matter  will  be  mo$t  readily  drained  off.  In  the  case  of 
a  large  abscess,  it  will  be  often  necessary  to  make  one 
or  more  counter-openings  at  convenient  points,  to 
secure  a  more  effectual  drainage  of  the  matter.  These 
counter-openings  may  be  made  after  the  lapse  of  vari- 
able intervals  of  time,  as  the  necessitv  for  them  may 
become  manifest.  The  best  point  for  making  the 
coimter-opening  may  be  determined  by  introducmg  a 
long  probe  through  the  original  opening,  until  it  ap- 
proaches the  surface  at  a  depending  part  oi  the  abscess. 
After  the  opening  has  been  made,  it  will  often  be  ad- 
visable to  insert  a  tent  of  lint,  wnich  may  be  left  in 
place  for  several  days,  until  the  opening  has  become 
established.    When  an  abscess  is  quite  deep,  and  when 


its  walls  are  of  considerable  density,  it  may  be  difficult 
to  transfix  the  cavity  so  as  to  bring  out  the  point  of 
the  knife.  In  such  cases,  after  the  bistoury  has  entered 
the  cavity,  the  opening  may  be  enlarged  by  raising  the 
heel  of  the  instrument,  and  ripping  up  the  integument 
When  the  opening  is  made  in  this  manner,  it  is  more 
painful  than  by  the  former  method.  When  an  abscess 
18  confined  by  a  very  dense  fibrous  membrane,  it  may 
be  opened  by  making  a  fi^e  incision  with  a  scalpel 
directly  upon  its  face.  In  certain  obscure  abscesses  in 
the  posterior  wall  of  the  abdomen,  it  will  be  advisable 
to  make  a  caiitious  dissection^  layer  by  layer,  down  to 
a  point  where  fluctuation  can  be  detected,  in  the  man- 
ner recommended  by  Prof.  Willard  Parker. 

When  a  deep-seated  abscess  is  covered  by  an  expan- 
sion of  muscular  fibres,  the  incision  by  which  the  ab- 
scess is  opened  should  cross  the  direction  of  the  fibres 
of  the  muscle ;  otherwise  the  purulent  matter  will  not 
escape.  If  the  opening  be  of  insufficient  size,  and  there 
be  any  good  reason  why  it  should  not  be  enlarged,  the 
escape  of  matter  may  be  facilitated  by  the  introduction 
of  a  canala.  After  the  opening  of  an  acute  abscess,  it 
is  not  generally  advisable  to  make  pressure  to  accelerate 
the  flow  of  the  matter.  If  the  opening  be  sufficiently 
free,  the  matter  will  escape  as  rapidly  as  the  walls  of 
the  cavity  will  accommodate  themselves  to  the  diminish- 
ed quantity  of  its  contents.  Pressure  will  occasion  un- 
necessary pain,  and  when  the  pressure  is  removed,  the 
walls  of  the  cavity  will  expand,  and  air  will  be  forced 
in  by  atmospheric  pressure :  the  air  so  introduced  will 
act  chemicaUy  on  the  matter  as  it  is  secreted,  causing 
it  to  assume  an  acrid  and  irritating  character. 

For  two  or  three  days  after  the  opening  of  an  acute 
abscess,  emollient  poultices  may  generally  be  appl  ed 
with  advantage.  But  the  long  continuance  of  such  ap- 
plications has  a  tendency  to  increase  and  to  prolong  the 
suppuration,  and  to  retard  the  healing  process.  As 
soon  as  the  inflammation  has  lost  its  active  character, 
a  pledget  of  lint  spread  with  cerate  or  ba8ili(5on 
ointment  may  be  laid  over  the  opening;  over  this  may  be 

E laced  a  linen  or  muslin  compress,  to  be  kept  in  place 
y  a  roller  bandage  appHed  with  a  moderate  degree  of 
firmness.  The  dressings  should  be  renewed  once  or 
twice  a  day,  according  to  the  quantity  of  the  discharge. 
When  there  is  copious  suf)puration,  the  stiength  of  the 
patient  should  be  maintained  by  generous  diet,  and,  if 
necessary,  by  tonics  and  stimulants. 

The  treatment  of  chronic  abscesses  differs,  in  many 
respects,  from  that  of  acute  abscesses.  The  constitu- 
tional treatment  is  mainly  directed  to  invigorate  the 
general  health,  to  promote  healthy  secretions,  and  to 
restore  to  their  normal  condition  any  functions  which 
may  be  disordered.  When  the  local  inflammation  at- 
tendmg  the  formation  of  the  abscess  is  somewhat  active 
in  its  character,  moderate  local  depletion  will  often  be 
of  service.  Revulsion  by  the  skin,  or  by  the  aliment- 
ary canal,  will  also,  in  inany  oases,  exert  a  beneficial 
influence.  Small  cnronic  abscesses  about  the  neck  or 
face  of  a  young  female  should  be  carefully  treated  with 
reference  to  the  avoidance  of  an  unseemly  cicatrix. 
The  incision  should  be  small,  and  should  correspond 
in  direction  with  the  natural  folds  of  the  skin.  Gentle 
pressure  should  be  made  to  force  out  the  contents  of 
the  cavity.  This  is  especially  necessary  in  scrofiilous 
abscesses,  in  which  the  matter  contained  is  like  a  mix- 
ture of  curds  and  whey.  After  the  abscess  has  been 
evacuated,  a  compress  of  lint  should  be  laid  over  it, 
and  should  be  kept  in  place  by  strips  of  adhesive 
plaster. 

Large  chronic  abscesses,  like  those  which  so  fre- 
quently originate  in  the  region  of  the  psoas  muscle, 
require  to  be  treated  with  great  caution,  as  they  ex- 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


321 


pose  ihe  life  of  the  patient  to  hnminent  danger.  The 
question  has  often  been  discussed,  and  it  has  given  rise 
to  no  Kttle  anxiety  in  the  minds  of  surgeons,  whether 
these  abscesses  should  be  evacuated  by  art,  or  whether 
the  opening  should  be  left  to  nature.  When  the 
opening  has  occurred,  whether  it  has  taken  place  spon- 
taneously, or  has  been  the  result  of  artificial  interfer- 
ence, there  is  often  a  decided  aggravation  of  the  con- 
stitutional symptoms.  Irritative  fever,  with  anorexia 
and  nausea,  and  great  prostration  of  the  vital  powers, 
are  very  apt  to  ensue.  The  liability  to  the  occurrence 
of  these  symptoms  has  produced  in*  the  minds  of  many 
snrgeons  a  reluctance  to  make  an  artificial  opening. 
I  am  myself  inclined  to  the  opinion,  that  in  most  of 
these  cases  it  is  best  for  the  patient  that  the  surgeon 
should  make  a  puncture  or  incision  for  the  evacuation 
of  the  matter.  It  should  not  in  ordinary  cases 
be  made  until  the  matter  has  approached  sufficiently  near 
to  the  surface  to  produce  distinct  fluctuation.  It  may 
then  be  expedient,  when  the  abscess  is  very  large,  and 
the  vital  powers  have  begun  to  flag,  to  make  a  small 
puncture,  and  to  allow  half  or  two-thirds  of  the  con- 
tents of  the  abscess  to  escape  without  external  pressure ; 
and  then  to  cover  the  wound  with  adhesive  plaster, 
and  apply  a  compress  and  bandage.  After  a  week  or 
two,  another  puncture  may  be  made,  and  the  rest  of 
the  matter  evacuated,  after  which  a  compress  and 
bandage  may  be  applied  as  before.  When  the  abscess 
is  of  moderate  size,  and  when  the  general  h'^alth  of 
the  patient  has  not  l>een  much  impaired,  a  more  free 
opening  may  be  made  at  once^  and  the  whole  contents 
of  the  abscess  evacuated.  In  either  case,  if  the  pus 
assume  an  offensive  and  acrid  character,  and  there 
be  svmptoms  of  irritative  fever,  a  very  free  incision 
should  be  made,  and  the  cavity  of  the  absce^  should 
be  thoroughly  cleansed,  J)y  injecting  it  with  Oastile 
soap  and  water  by  means  of  Davidson's  syrinee  or 
some  other  suitable  instrument  This  injection  should 
be  repeated  once  a  day,  or  oflener  if  necessary.  A 
compress  and  bandage  should  then  be  appUed  to  keep 
the  walls  of  the  abscess  as  nearly  as  possible  in  con- 
tact The  strength  of  the  patient  should  be  maintained 
by  appropriate  diet,  with  the  judicious  use  of  tonics  and 
stimulants.  When  the  cavity  of  the  abscess  has  con- 
tracted to  the  dimensions  of  a  sinus,  stimulating  in- 
jections may  be  often  used  with  advantage.  For  this 
purpose,  the  surgeon  may  use  the  liquor  sodce  chlori- 
natte,  diluted  with  eight  parts  of  water,  or  sulphate  of 
copper,  three  to  five  grains  to  the  ounce,  or  sulphate  of 
sine  of  the  same  strength.  These  injections  may  be 
repeated  daily,  or  at  intervals  of  two  or  three  days. 
"Wien  chronic  abscesses  have  remained  very  long  un- 
healed, it  will  be  well  to  examine  if  there  be  dead  bone, 
or  some  foreign  body  keeping  up  the  irritation.  The 
removal  of  such  foreign  matenal  will  often  be  followed 
by  the  speedy  closure  of  the  abscess.  When  there  is 
no  such  cause  of  irritation,  the  application  of  a  large 
blister  over  the  surface  will  sometimes  lead  to  a  very 
fitvorable  change.  I  have  recently  used  this  remedy 
in  an  exceedingly  obstinate  case,  with  most  signal  ad- 
vantage. 

^  <  ^  

LiTNATic  Asylum  for  Connecticut. — The  new  lunatic 
asjrlum  for  the  State  of  Connecticut  now  established  at 
Middletown,  has  been  donated  230  acres  by  the  State 
and  city  authorities  for  the  purpose. 

Theodore  Rnvri,  Professor  of  Ophthalmology  in 
Leipsic,  died  in  that  city  from  apoplexy  on  the  ^d  of 
June.  He  was  67  years  old ;  had  held  his  position  in 
the  Leipsic  University  for  five  years.  He  was  the  well- 
known  author  of  a  text- book  on  ophthalmology. 


|)r00wa«  of  ittelrital  Science. 

New  Method  of  Treating  Yellow  Fever. — ^Dr. 
Alexander  Piddes,  F.R.C.S.B.,  of  Jamaica,  W.  I.,  pro- 
fesses to  have  saved  more  than  the  usual  number  ot 
patients  afflicted  with  yellow  fever,  by  the  following 
method  of  treatment :  He  administers  at  the  beginning 
of  Uie  disease  a  full  dose  of  castor-oil,  carefiiUy  discard- 
ing calomel  and  quinine,  as  not  only  useless  but  inju- 
rious ;  this  he  Tollows  up  with  the  alkaline  sulphites, 
giving  the  preference  to  the  bisulphite  of  soda  as  being 
tasteless,  and  not  likely  to  offend  the  stomach.  The 
dose  of  this  agent  as  employed  by  Dr.  Fiddes,  is  twenty 
grains  every  two  or  three  hours  in  a  glass  of  water. 
As  adjuvants,  he  uses  iced  sheets  to  envelop  the 
body  when  the  skin  is  hot  and  dry,  or  an  occasional 
vapor-bath  when  the  sur&ce  is  dry  merely  without  be- 
ing hot 

SuLPfflTE  OP  Soda  in  the  Treatment  op  Erysipelas. 
— Dr.  Addinell  Hewson  says  he  has  obtained  results 
from  the  use  of  sulphite  of  soda  in  the  IocmI  treatment 
of  erysipelas,  which  have  been  to  him  both  interesting 
and  suiyrising.  In  extensive  trial  of  the  remedy,  both 
in  hospital  and  private  practice,  he  has  never  seen  it 
fail,  when  thoroughly  applied  before  the  deep  planes  of 
cellular  tissue  had  been  invaded  by  the  disease.  Before 
such  parts  had  become  affc-cted.  a  solution  of  ten  grains 
of  thw  salt  to  the  ounce  of  water,  when  thoroughly  ap- 
plied on  lint  all  over  the  surface  affected,  and  to  a  con- 
siderable distance  beyond  it,  and  covered  with  oiled 
silk  to  prevent  the  evaporation  of  the  solution,  had  not 
only  produced  a  decided  bleaching  effect  on  the  discolored 
suiface  in  every  such  instance,  in  the  first  twenty-four 
hours  of  its  use,  but  had  invariably  destroyed  all  traces 
of  the  disease  in  forty-eight  hours  from  its  first  applica- 
tion. The  effect  was  the  same,  whether  the  application 
was  made  in  the  traumatic  or  idiopathic  form  of  the 
disease.  He  has  thus  cured  twenty-seven  cases,  seven 
of  which  were  of  idiopathic  erysipelas.  Even  in  the 
cases  where  the  deep  planes  of  cellular  tissue  were  in- 
volved, as  well  as  the  surface,  the  disease  on  the  surface 
was  always  apparently  affected  by  the  application.  It 
was  mo»t  positively  bleached  in  all  instances,  and  in 
many  was  evidently  destroyed,  within  the  period  above 
stated,  even  while  that  in  the  deeper  part  proceeded  to 
suppuration. — !Pr(m».  Col,  Fhy».y  PhUaddpkia, 

Menorrhagia  and  Menorrhagio  Pain  Treated  Suo- 

OESSFULLT  BY  THE  SpINAL  APPLICATION  OF  HoT  WaTER. 

Dr.  John  Chapman,  in  the  Medical  Mirror,  speaks  of  the 
local  application  of  hot  water  in  relieving  the  distress  of 
menorrhagia.  He  reports  a  case  in  whicn  water,  heated 
to  120®  F.,  was  applied  along  the  lower  third  of  the 

?>ine,  and  kept  there  until  the  water  became  cooled, 
he  result  of  the  first  application  was  a  wonderfully 
rapid  and  great  relief  to  the  patient's  back,  and  the  flow 
was  to  a  great  extent  restrained.  The  flow  had  quite 
ceased,  after  seven  applications  of  the  water,  at  the  end 
of  the  fifth  day,  and  had  been  so  lessened  in  quantity, 
that  but  little  more  blood  was  lost  during,  the  four  days 
after  the  treatment  began  than  was  lost  during  the 

Erevious  eighteen  hours.  Moreover,  the  patient  found 
erself  very  much  better  and  stronger  than  during  her 
previous  periods.  Dr.  Chapman  highly  reconmiends 
this  treatment. 

Prevention  of  Purulent  Absorption  bt  Ergotinb, 
— It  ^)pear8,  from  the  observations  of  M.  Labat,  a  phy- 
sician of  Bordeaux,  that  the  administration  of  ergotine 
idFter  amputation  is  attended  with  the  most  beneficial 
results.  The  ergotine  is  given  afke&^e  amputatio*^ 
digitized  by  VjC  _      ^_ 


822 


THE  MEDICAL  RECORD. 


and  each  day  up  to  the  dayr  when  the  ligatuies  oorae 
away,  the  medinm  dose  being  ftx)in  five  to  six  grains. 
M.  Labat's  memoir  on  the  subject,  presented  to  the 
Society  de  Chinirgie,  records  fourteen  cases  tJreated  in 
this  WKy,— 'Medical  limes  and  QasMe. 

Amblyopia  Produobd  bt  Tobacco-Smokwo. — M. 
Viordin  has  reported  three  cases  of  amblyopia  caused 
by  smoking.  In  the  treatment  of  these  cases  the  quan- 
tity of  tobacco  smoked  wes  reduced,  under  the  direction 
of  M.  Viordin,  and  the  sight  was  restored  in  the  course 
of  a  few  weeks.— i/WtcoT  Times  and  Oazette, 

ChORIA  TrSATED  bt  BlOHABDSOir's  ApPARATUit — ^An 

interesting  case  in  which  chorea  was  successfully  treated 
by  ft^ezing  the  skin  over  the  spinal  cord  has  lately  been 
recorded  in  the  OateUe  Behdomadaire,  and  tends  to  some 
ex  rent  to  support  Uie  ice  theory  of  Dr.  Chapman.  A 
Mttle  g'rl,  about  seven  years  cSd,  was  attacked  with 
chorea,  and  presented  herself  to  Dr.  Lubelski,  who, 
having  tried  in  vain  the  usual  tonic  and  antispasmodic 
remeoies,  determined  to  produce  anaesthesia  of  the 
spinal  cord,  by  means  of  etfier  spray.  The  instrument 
used  was  the  variety  of  Kchardson's  apparatus  used  by 
dentists,  and  whi(;h  has  a  double  nozzle.  It  was  appUed 
to  both  sides  of  Uie  spinal  cord,  and  the  ether  spray  was 
forced  upon  the  surface  for  three  or  four  minutes,  the 
operation  being  twice  repeated.  The  result  was  that 
au  the  abnormal  movements  ceased,  and  the  natural 
powers  of  motion  were  restored. — Lancet. 

Common  Salt  for  Wounds. — A  French  writer  speaks 
in  term?  of  the  highest  commendation  of  chloride  of 
sodium  in  the  treatment  of  wounds  and  ulcers.  The  first 
efiect  on  a  foetid  wound  he  says  is  to  destroy  the  odor  im- 
mediately. Another  immediate  phenomenon  observed 
is  the  pinkish  hue  which  it  gives  the  decomposed  san- 
guineous, blackish  liquids  in  the  wound.  At  the  same 
time  ^ere  is  felt  a  peculiar  sensation  of  cold  and  prick- 
ling, which  may  even  become  slightly  painful  The 
suppuration  diminishes  rapidly,  and  in  the  changes  in 
it  nas  a  happy  efibct  on  the  system,  the  appetite  im- 
proving and  the  strength  returning.  Four  hundred 
oases  of  wounds  thus  treated  are  reported.  There  was 
neither  erysipelas,  nor  tetanus,  nor  no^ital  ganffrene  in 
any  one.^ough  the  hygienic  condition  of  the  hospital 
was  bad.  In  only  one  case  was  there  pyemia.  The 
solution  first  apphed  was  in  the  strength  of  one  drachm 
to  a  pint  of  water.  After  using  this  a  few  days,  a  con- 
centrated solution  was  employed.  In  fistulous  cases  the 
solution  was  injected  into  the  sinusee^ — jPaa^  MMcal 
and  Surgical  Joumak 

PoMPsn. — One  of  the  latest  discoveries  reported  fit>m 
the  excavations,  is  that  of  a  bronze  vase  hermetically 
sealed,  and  containing  a  considerable  quantity  of  water, 
which  was  pronounced  clear,  firesh,  and  remarkably  soft 
after  its  repose  of  1800  years. — Richmond  Med.  Joumdk 

Lime  Inhalations  in  P8cin>o-MEMBRANou9  CKotrr. — 
Dr.  B.  B.  Wilson,  in  the  Medical  and  Swgical  Reporter, 
■peaks  very  highly  of  lime  inhalations,  and  gives  some 
instances  in  which  the  curative  efiect  of  the  remedy  was 
most  marked  and  decided.  Owing  to  the  difficulty  in 
inducing  children  to  use  the  inhaler,  he  ''  frequenUy  ex- 
temporizes a  vapor-bath,  by  throwing  a  lai^  blanket 
over  the  child's  head  and  shoulders,  as  well  as  over  the 
sofa  upon  which  it  reclined,  and  including  also  within 
its  circimiference  a  pitcher,  in  which  a  small  lump  of 
quicklime  was  being  rapidly  slaked  by  means  of  boiling 
water.  In  this  way  the  air  surrounding  the  child's  body, 
as  well  as  that  respired,  was  highly  charged  with  the 
vapor  of  lime-water.  This  process  was  repeated  every 
hour,  or  every  half  hour,  when  the  breathing  seemed 


more  than  usually  hurried  and  difficult  The  immediate 
efiect  upon  the  patient  seemed  to  be  soothing,  the  most 
urgent  dyspnoea  being  relieved,  and  the  httle  sufferer 
ahnoet  always  becoming  quieter  and  falling  into  a  light 
sleep  under  its  use." 

Nasal  Hjocorrhacm.— Dr.  Heard,  in  the  Oaeette  dn 
ffdpitavx,  says  he  never  fails  to  stop  the  most  obstinate 
epistaxis  by  a  simple  process  of  compression  of  the  nos- 
trils. Being  subject  in  early  li&  to  epistaxis,  he  found 
the  h»morrbage  come  from  a  part  of  the  septum  within 
roa^  of  the  ends  of  the  finffecs.  By  compressing  the 
alas  upon  the  septum,  the  bleeding  generally  ceased 
within  five  minutes.  Even  the  hemorrhages  of  typhoid 
fever,  or  those  occurring  with  organic  disease  of  the 
heart,  have  been  usually  checked  without  losing  a  tear 
spoonful  of  blood. — Boston  Med  and  Surgical  Journal 

Causes  op  Deaf-Dumbness.— Dr.  Peet,  Principal  of 
the  New  York  Institution  for  the  Instruction  of  the 
Deaf  and  Dumb,  has  recently  published  statistics  from 
which  he  deduces  the  striking  conclusion  that  in  Europe, 
generally,  the  chances  of  the  birth  of  a  deaf-mute 
child  are  more  than  twice  as  great  as  in  the  United 
States,  or  615  in  a  million  thete,  against  278  in  a  mil- 
lion here ;  while  the  chances  of  the  loss  of  hearing  after 
birth  are  in  Europe,  except  in  Grermany^  much  less  than 
in  the  United  States,  to  wit,  154  in  a  million  there,  and 
222  in  a  million  here.  Such  statistical  results  as  these 
form  the  data  from  which  we  must  study  the  cause  of 
deaf-dumbness.  The  striking  contrast  between  the  Old 
World  and  the  New  may  be  owing,  in  part,  to  climate  - 
in  part  to  the  severe  outnioor  labors  imposed  on 
women  of  the  laboring  dasses  in  many  countries  of 
Europe ;  in  part  to  idiosyncrasies  of  race.  The  Euro- 
pean returns  which  show  such  a  preponderance  of  con- 
genital cases,  are  chiefly  from  countries  where  the  bulk 
of  the  population  is  of  the  Celtic  and  Latin  races.  We 
have  very  few  such  returns  from  European  populations 
of  the  Anglo-Saxon  and  Teutonic  races,  and  most  of 
those  we  have  agree  with  the  American  returns  hi  pre- 
senting a  large  proportion  of  accidental  cases.  The 
causes  of  congemtal  deafness  are  as  yet  but  very  im- 
perfectly understood.  When  deafness  is  the  apparent 
result  of  a  known  disease,  or  accident,  it  is  comnara- 
tively  easy  to  judge  widi  probability  of  the  mode  of 
operation :  but  in  most  cases  of  congenital  deafness  we 
are  left  wnolly  in  the  dark,  even  as  to  the  condition  of 
the  organs  of  hearing.  They  are  too  deeply  seated  for 
more  than  a  very  superficial  examination  in  life,  and 
opportunities  for  dissection  of  subjects  known  to  have 
been  deaf-mutes  rarely  occur. 

The  remote  causes  that  have  been,  with  most  proba- 
bility, assigned  for  congenital  deaf-dumbness  are  the 
following : 

1.  Unequal  ages  of  the  parents,  eq>ecially  where  the 
mother  is  older  than  the  father,  or  advanced  age  of 
either  parent,  especially  of  the  mother. 

2.  lU  health  and  feebleness  of  constitution  in  one  ot 
both  parents,  especially  where  there  is  a  hereditary  ten- 
dency to  scrofula. 

3.  Impairment-  of  the  psosreative  power,  especially 
in  the  father,  through  early  dissipation  or  bad  habits, 

4.  Intermarriages  of  blood  relations. 

5.  Causes  operating  during  gestation,  through  the 
excited  imagination  or  nervous  sensibility  of  the  mo- 
ther. 

6.  Ill  health  of  the  mother  during  gestation,  orpl^s- 
ioal  accident  during  that  period. 

7.  Intemperance  in  one  or  both  parents  about  the 
time  of  conception. 

8.  The  influence  of  unhealthy  occupations,  bad  wa* 

Digitized  by  ^ „       ^_ 


THE  MEDICAL  RECORD, 


323 


ter,  iDferior  diet^  or  damp  dwellings  of  the  pArents,  on 
their  offspring. 

9.  Direct  hereditary  transmission. 

All  these  pritnary  causes,  it  will  be  aeen  are^  mtUa- 
tm  mutandis,  as  i^plicable  to  other  con^^nital  mfirmi- 
ticB  as  to  deaf-dumboeaa.  A  defectiye  bridge  gives  way 
at  itd  weakest  point ;  and  where  there  is  no  specially 
weak  point,  the  point  of  fracture  may  be  determined  by 
alight  causes.  ^  it  seems  there  are  &milies  in  which 
the  weak  point  of  the  constitution  is  the  apparatus  of 
h^jing ;  but  in  many  oases  the  tendency  to  deafness, 
rather  than  to  idiocy,  blindness,  lameness,  or  some 
other  infirmity,  was  biassed  by  causes  that  often  baffle 
research,  because  they  seem  so  slight  that  they  elude 
attention. 

Pethisis  m  BAHBADO^s.—Ththisls  is  a  disease  that 
has  been  supposed  hardly  t  >  exist  in  the  tropics,  but 
obserrations  of  late  years  seem  to  say  that  such  is  far 
from  being  the  case.  In  the  island  or  fiarbadoes  it  is 
much  more  common  than  formerly,  and  quite  so  amongst 
the  negroes.  Since  the  abolition  of  slavery,  the  diet  of 
the  blacks  has  probably  been  less  nutritious  than  when 
they  were  not  obliged  to  provide  for  themselves,  con- 
gistinj?  now  chieQy  of  Indian-meal,  sweet  potatoes,  and 
flying-fish — ^which  last  delicious  fish  is  taken  in  immense 
numbers  around  the  island ;  -and  to  this  cause  the  increase 
of  disease  seems  to  be  attributed,  though  the  eenend  ap- 
pearance of  the  blacks  struck  me  as  quite  heaJthy.  And 
1  would  remark  that  the  number  of  mulattoes,  in  whom 
we  generally  find  a  greater  tendency  to  tubercular 
afiectlonfi  than  in  the  pure  negroes,  appeared  to  me  to  be 
gmaH  I  saw  several  cases  of  phthisis  at  the  hospital, 
and  was  told  that  when  patients  come  to  the  island  with 
this  disease  no  marked  benefit  is  experienced,  though 
the  dimate,  if  a  tropical  one  could  have  any  effect, 
seems  to  be  all  that  could  be  desired.  Scrofulous  glands 
and  disease  of  the  joints  are  also  common,  but  tuber- 
cular meningitis  is  very  rare. — Db.  J.  B.  S.  Jackson, 
BoiUm  Med,  and  Surg.  Jour, 

BcTRNS  OR  Scalds. — ^The  following  is  one  of  the  beet 
apphcatioos  we  know  of  in  cases  of  bnms  or  scalds, 
more  especially  where  a  large  surface  is  denuded  of  the 
cuticle : — Take  a  drachm  of  finely  powdered  alum,  and 
mix  thorouffbly  with  the  white  of  two  eggs  and  one 
teacupful  of  &esh  lard  ;  spread  on  a  cloth,  and  apply  to 
the  parts  burned.  It  gives  almost  instant  reUef  from 
pain,  and,  by  excluding  the  air,  prevents  excessive  in- 
tiammatory  action.  The  application  should  be  changed 
at  least  once  a  day. — 8l,  LouU  Med.  Reporter. 

MoirraLT  Period  or  IirFseuNDmr. — Dr.  Avrord.  a 
phrsician  of  Bochelle,  has  publiahed  a  work  entitled 
**  6eneration  and  the  Duration  of  Pregnaocv  in  the 
'Human  Race,"  in  which  he  has  arrived  at  the  allowing 
ooncluaions  :-— 1.  The  cycle  of  generative  functions  lasts 
38  days.  It  is  divided  into  three  periods  of  unequal 
kngth,  which  the  author  calls  menarrhagiCy  generative, 
and  kgpnotie.  2.  Menstruation  returns  normally  every 
28  days,  starting  from  the  accession  of  the  courses.  Its 
doration  b  indefinite.  3.  A  certain  time  elapses,  most 
frequently,  and  perhaps  always,  between  the  end  of  the 
courses  and  the  beginning  of  the  generative  period  ;  this 
time  the  author  calls  the  mUrj^riodic  phase.  4.  The 
generative  period  always  ends  the  14th  day  after  the 
beginning  of  the  courses.  5.  It  has  been  shown  by  an 
observation  of  fifteen  years,  and  resting  to-day  upon 
thousands  of  facts,  with  proof  and  counter-proof,  that 
woman  is  physiologically  barren  during  fourteen  days  in 
twenty-eight — that  is  to  say,  after  the  fourteenth  day, 
commencing  with  the  appearance  of  the  courses,  till  the 
end  of  the  allowing  penod,      M.  Avraid  does  not  ad- 


mit the  possibility  of  impregnation  during  the  period  of 
the  menseS)  and  maintains  that  parturition  is  effected 
always  two  hundred  and  seventy  days  after  impregna- 
tion.— Jour,  de  Mid.  et  de  Chir.  New  Orleans  Med.  and 
Surg.  Joumcd. 

A  Casi  OF  DisLOOATToir  of  Tzhur. — ^Dr.  G.  W. 
Topping,  of  Dewitt,  sends  to  the  Eeview  the  account  of 
a  ease  of  "  probable  disloeation  of  the  bead  of  the 
femur  into  the  great  sciatic  notch,  and  reduction  by  ma- 
nipulation before  the  diagnosis  had  been  satisfactorily 
e^ttblished."  A  boy  had  frdlen  from  a  sleigh,  had  been 
caught  by  the  right  foot,  and  dragged  for  a  considerable 
distance  on  the  ground.  A  superficial  examination 
revealed  symptoms  of  dislocation  of  right  femur,  upward 
and  backward.  He  was  unable  to  stand  upon  his  right 
foot,  or  move  it  outward  or  fbrward.  Standing  upon 
the  left  foot,  the  right  great  toe  rested  on  the  left  os 
oalcis.  The  right  heel  was  lifted  slightly  from  the  floor, 
and  the  corresponding  t^igh  closely  hugged  its  neighbor. 
The  boy  referred  the  pain  to  a  poii^  ^low  the  knee, 
and  the  doctor  flexed  the  thigh  upon  the  body  at  a 
right  angle.  Taking  hold  of  -the  knee  with  one  hand, 
and  the  ankle  with  the  other,  he  then  rotated  the  limb 
outward.  The  patient  complained  but  little  during  this 
process,  and  no  sudden  snap  indicated  the  reduction  of 
the  dislocation  ;  but  all  symptoms  of  injury,  except  a 
slight  stiffness  of  the  muscles,  suddenly  vamshed,  and 
the  boy,  who  a  moment  before  was  not  able  to  bear  his 
weight  on  the  limb,  could  now  walk  without  difficulty. 
Dr.  Topping  considers  the  lesion  to  have  been  a  disloca- 
tion of  the  head  of  the  femur  into  the  great  sciatic 
notch. — Deiroit  Rev.  of  Med,  and  Pharmacy . 

Case  of  Bromine  Poisonino. — Samuel  P.  Duffield^ 
Ph.  D.,  in  the  Detroit  Review  of  Medicine  and  Phar^ 
macy^  gives  the  following  successful  treatment  ofpoison- 
ing  by  bromine  inhalation.  The  corrosive  action  of  the 
bromine  was  such  that  the  glottis  had  closed  with  a 
spasm,  and  did  not  yield  willingly.  The  patient  was 
brougnt  near  to  a  steam-pipe,  the  mouth  held  open,  and 
the  steam  thrown  from  some  distance,  so  as  not  to  bum 
him,  into  his  mouth  and  over  the  face.  It  had  the  de- 
sired effect,  and  the  patient  was  subsequently  sent 
home.  The  steam  inhalations  were  continued  for  some 
time,  and  the  patient  recovered.  The  attention  of  the 
profession  is  particularly  called  to  the  great  value  of 
steam  inhalations  in  cases  of  poisoning  by  corrosive 
vapors. 

Occlusion  of  the  Ob  Uteri. — ^Mr.  Mellor  read  notes 
before  the  Manchester  Medical  Society,  of  a  case 
of  occlusion  of  the  os  uteri  during  labor.  The  pa- 
tient, affed  21,  was  a  primipara,  and  was  at  her  fuM 
time.  On  his  arrival,  there  were  no  urgent  symptoms^ 
and  he  left  again  shortly.  He  was  soon  sent  for  hur- 
riedly. Severe  expulsive  pains  had  been  going  on  for 
sonoe  time.  The  external  organs  were  in  a  state  of  re- 
laxation, and  deUvery  seemed  at  hand.  But,  on  exan^ 
ination,  not  a  trace  of  the  cervix  nor  of  the  os  could  be 
detected.  The  posterior  wall  of  the  vagina  and  the  cer- 
vix were  quite  continuous  with  each  oUier;  as  if  agglu- 
tinated together.  A  careful  examination  was  then  iniade 
wifh  a  speculum,  but  nothing  like  the  os  could  be  seen. 
Mr.  Robertson  also  saw  the  caae;  and  it  was  determined 
to  make  an  opening  into  the  uterus.  This  was  done  in 
the  presumable  site  nf  the  os  with  a  scalpel :  and,  after  a 
while,  as  no  dilatation  took  place,  a  curved  oistoury  was 
inserted,  and  the  incision  was  prolonged  anteriorly  and 
posteriorly.  A  great  quantity  of  meconium  escaped. 
The  occiput  speedily  came  through,  and  all  went  on 
weU.  The  labor  lasted  six  hours,  and  the  recovery 
waa  nninterrupted.    There  had  previogsly  not  been  a 


Digitized  by  LjOO^. 


324 


THE  MEDICAL  RECORD. 


trace  of  uterine  affection,  and  menstruation  was  always 
healthily  performed.  Dr.  Thorburn  made  some  remarks 
on  such  cases,  and  quoted  Mattei,  who  had  reported 
forty-two  cases,  not  all  primiparae,  and  who  considered 
that,  in  the  majority,  the  occlusion  was  owing  to  simple 
organization  of  the  cervical  plug  of  lymph,  and  not  to 
inflammation. — British  Med,  Jaitr. 

Death  trom  Swallowing  two  Ounces  of  Chloro- 
form.—Dr.  D  W.  Stormont,  of  Topeka,  Kansas,  reports 
{Leavenworth  Medical  Herald)  a  case  of  suicide  by  the 
internal  administration  of  chloroform.  The  patient  was 
twenty-six  years  of  age  and  in  good  health  at  the  time. 
He  swallowed  two  ounces  of  undiluted  chloroform  at  a 
single  draught  In  three  minute-*  after  he  had  laid  him- 
self composedly  down,  he  could  with  difficulty  be  aroused 
from  the  stupor  into  which  he  was  rapidly  sinking ;  and 
though  he  could  not  spealc,  he  indicated  that  he  had  se- 
vere pr.in  in  the  region  of  the  stomach.  In  five  minutes 
he  was  entirely  unconscious  and  breathing  stertorously. 
He  died  in  just  one  hour  after  taking  the  draught  Med- 
ical assistance  frop  some  cause  did  not  arrive  until  a 
few  minutes  before  he  died,  and  nothing  was  done  to 
counteract  the  effects  of  rhe  poison.  At  the  post-mor- 
tem examination,  the  surface  generally  was  livid ;  the 
face,  neck,  chest,  and  nails  very  much  so.  Bloody  froth 
was  issuing  from  the  mouth  and  nostrils.  On  opening 
the  chest,  both  lungs  were  found  to  be  dark  externally, 
and  fully  ^distended.  They  were  uniformly  congested 
with  dark,  liquid  blood,  and  the  posterior  portions  were 
perfectly  engorged  with  it  Both  sides  of  the  heart 
were  nearly  full  of  black,  uncoagulated  blood;  the 
liver  and  spleen  both  normal  externally,  but  somewhat 
softened,  and  filled  with  dark,  liquid  blood.  The  oeso- 
phagus was  congested.  The  stomach,  at  the  cardiac 
end,  and  along  the  greater  curvature,  and  half  way  up 
each  side,  was  discolored  externally,  dotted  over  with 
ecchymosed-lookm^  patches,  giving  it  a  mottled  ap- 
pearance. It  con  tamed  two  or  three  ounces  of  a  light- 
colored  Uquid,  which  had  a  slight  odor  of  chloroform. 
At  the  cardiac  end,  internally,  and  along  the  bottom 
nearly  to  the  pyloric  end,  the  mucous  membrane  was 
of  a  dark-red  color,  softened,  and  easily  peeled  off  with 
the  thumb-nail.  Up  the  sides  it  was  of  a  brighter  red, 
speckled  appearance,  and  not  softened.  The  intestines 
were  healthy.  Circumstances  prevented  the  extension  of 
the  examination,  which  is  much  to  be  regretted.  The 
reporter  of  the  case  closes  with  the  following  remarks : — 
"  Recoveries  are  recorded  from  drinking  two  ounces,  or 
even  more,  of  chloroform,  but  active  measures  were 
nsed — as  the  stomach-pump,  emetics,  stimulants,  inter- 
nal and  external  artificial  respiration,  galvanism,  etc 
As  an  internal  stimulant,  the  spirits  of  ammonia,  or  the 
carbonate  of  ammonia,  is  the  best  Very  dangerous 
symptoms  have  been  produced  by  half  an  ounce,  and 
death  has  been  caused  by  one  ounce.  Dr.  StilW  says : 
*  When  death  has  been  produced  by  ihe  internal  use  of 
chloroform,  its  local  irritant  action  has  evidently  been 
the  chief  cause  of  the  fatal  result*  In  this  case,  death 
followed  too  soon  to  have  been  produced  in  this  way. 
It  was  more  probably  caused  by  the  action  of  the  poi- 
son on  the  blood  and  the  cerebro-spinal  system,  as  in 
prolonged  inhalation  of  the  vapor.  A  peculiarity  of 
this  case  is  the  shortness  of  the  time  between  taking 
the  chloroform  and  death,  as  compared  with  other  fetid 
cases  reported." 

Slouohino  produced  bt  Local  Anjesthesia. — ^We 
examined,  a  few  days  since,  in  the  Middlesex  Hospital, 
a  young  woman  whose  case  is  of  no  little  importance  in 
reference  to  the  question  of  local  as  affainst  general 
antesthesia  for  operations.  Mr.  Lawson  had  diagnosed 
the  existence  of  an  abscess  behind  the  patient's  breast, 


and  as  the  pus  was  very  deep  (under  the  pectoral 
muscle),  the  refHgerator  was  used,  paraffine  ether  be- 
ing employed.  Congelation  was  rapidly  produced,  and 
kept  up  for  a  few  minutes.  The  result  has  been,  that 
a  portion  of  skin,  about  an  inch  by  three-quarters  of 
an  inch,  over  the  upper  part  of  the  breast,  had  sloughed, 
and  its  healing  will  necessarily  be  attended  by  an  un- 
seemly scar.  The  patient  is  a  maid-servant ;  were  she 
unfortunately  a  lady,  the  undress  of  the  modern  ball- 
room would  be  impracticable  without  revealing  such  a 
blemish  as  might  seriously  damage  her  value  in  the 
matrimonial  market.  The  case  is  certainly  exceptional ; 
but  the  circumstance  is  worth  remembering  when  ex- 
posed parta  of  the  body  are  to  be  operated  upon.— 
Lancet 

New  Mode  of  Treating  Fracture  of  Lower  Jaw. — 
Dr.  Benj.  H.  Riggs,  of  Sehna,  Ala.,  reports  in  the 
Southern  Journal  of  Medical  Sciences  for  May,  1867,  a 
case  of  compound  fracture  of  the  inferior  maxilla,  occur- 
ring in  an  adult,  in  the  treatment  of  which  he  claims 
that  he  made  use  of  a  new  method.  The  po'nt  of  frac- 
ture was  "  immediately  to  the  right  of  the  symphysis, 
and  through  the  socket  of  the  right  central  incisor,  the 
outer  half  of  that  tooth  being  exposed  to  view ;  the 
right  fragment  was  very  much  drawn  inwards;  the 
gum  was  freely  severed  at  the  seat  of  fracture."  A 
pasteboard  splint  and  Barton's  bandage  was  first  applied, 
and  the  patient  put  upon  his  good  behavior.  This 
method  proved  unsuccessfiil,  for  ihe  patient  took  the 
liberty  of  neglecting  the  doctor's  instructions  as  to  rest 
and  method  of  eating,  so  that  at  the  end  of  six  weeki 
there  was  found  a  nstula  under  the  chin,  but  no  evi- 
dence of  an  attempt  at  union  of  the  bones.  Dr.  Riggs 
then  determined  to  use  some  mechanical  appliance 
within  the  mouth,  and  obtained  the  assistance  « f  Dr. 
S.  G.  Todd,  a  dentist,  who  took  an  impression  in  soft 
wax,  formed  from  it  a  plaster  cast,  and  upon  this  con- 
structed a  silver  band,  which  was  "  made  to  fit  every 
inequality  of  the  teeth,  completely  encircling  the  first 
nine ;  it  was  not  quite  as  wide  as  the  teeth  were  long, 
and  did  not  interfere  with  the  closure  of  the  mouth. 
An  intercommunicating  portion  extended  from  the  fix)nt 
arm  of  the  band  to  the  posterior,  at  the  seat  of  fiiictupe." 
This  appliance  was  found  to  maintain  exact  coaptation 
of  the  bones.  A  tin  fracture-box,  which  was  soon  dis- 
carded as  cunjbersome  and  unnecessary,  and  a  two- 
tailed  bandage,  completed  the  apparatus.  Under  this 
treatment  the  fistula  closed  at  onoe,  and  the  case  seemed 
to  progress  favorably  for  some  weeks ;  but  at  the  end 
of  that  time  it  was  found  necessary  to  remove  the  right 
central  incisor,  which,  being  at  the  seat  of  fracture,  had 
acted  as  a  foreign  body.  It  was  then  seen  that  there 
had  been  no  attempt  at  bone  formation.  The  band  was 
now  shortened  and  readjusted,  after  which  the  fiatuk 
again  cloped,  and  the  case  progressed  favorably  to  the 
end  of  the  treatment  At  the  end  of  six  weeks  from 
the  extraction  of  the  tooth  the  apparatus  was  removed, 
and  the  patient  discharged,  although  on  account  of  the 
anaemic  condition  of  his  system,  osseous  union  was  noft 
yet  perfect 

Curare  in  Epilepsy. — Dr.  Benedikt  informs  the  Vi- 
enna Medical  Society  that  the  subcutaneous  injection 
of  curare  has  a  favorable  influence  over  epileptic  dis- 
eases. A  man,  20  years  of  age,  had  had  epilepsy  since 
he  was  9  years  old.  During  five  months  he  was  nib- 
jected  to  curare  ii^ections  in  hospital  For  the  last 
fifteen  months  he  has  had  no  return  of  the  fits.  Four 
similar  cases,  equally  successfiil,  were  related  by  Dr. 
Benedikt  The  injections  were  used  three  times  a  week, 
under  the  skin  in  the  neck,  an  eighth  of  a  grain  being 
used  at  each  operation. — British  Medical  Journal 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


825 


The  Medical  Eecord, 

%,  Sesd-Pont^ls  lonmal  of  |9lebkhtt  mtb  Sntgers* 
Gboege  F.  Shbady,  M.D.,  Editor. 

Pnbllshod  on  tk*  1st  and  IflttofMoh  Month,  bf 
WrULIAM  WOOD  A  CO.,  «1  Walkie  Stmit,  N«w  Yoek. 

FOREIGN  AGENCIES, 


Loin»ov— Tbubw RB  k  Co. 
Pab»— Bumahgk  kt  Cib. 


Lbipsto—B.  Hbrmann. 

Bio  Jambibo— STBPUBim  t  Ca. 


New   Y6p1c.   September  16.  ISe*^. 

HOSPITAL  EXPERIENCE. 
The  facilities  for  study,  experiment,  and  observation, 
afforded  in  connection  with  extensive  hospital  practice, 
are  MI7  appreciated  by  medical  men ;  as  evinced  not 
only  by  the  laborious  exertions  necessarily  made  to  ob- 
tain appointments  upon  the  medical  staffs  of  public  in- 
stitutions, but  also,  and  perhaps  in  greater  degree,  by 
the  tenacity  with  which  positions  are  retained  by  the 
successful  candidates.  Too  few  of  those  who  enjoy 
hospital  privileges  think  of  availing  themselves  of  their 
«upenor  advantages  for  a  few  years  merely,  and  then 
gracefully  retiring  to  welcome  a  successor.  Profes- 
sional pride,  or  professional  capital,  whether  it  take  the 
form  of  fame  as  a  teacher,  or  fame  as  a  practitioner, 
creates  a  desire  fo  make,  for  the  time  being,  the  most 
out  of  an  appointment,  and  then  induces  a  habit  to  hold 
on  to  it  as  long  as  possible — until  infirmity  suggests 
the  policy  of  withdrawal,  or  the  charms  of  a  preferable 
position  woo  its  reluctant  worshipper  to  the  embrace 
of  a  heavier  responsibility. 

Inseparable  from  the  charge  of  a  large  number  of 
sick,  are  duties  and  personal  sacrifices  which  are  ardu- 
ous and  onerous;  the  services  requisite  for  the  fulfil- 
ment of  which  are  recompensed  by  no  pecuniary  equiv- 
alent; nevertheless,  well  as  this  is  understood,  new 
Aspirants  for  duties  and  responsibilities  press  forward 
their  claims  to  gratuitous  employment,  whenever  there 
is  wafted  from  the  medical  staff  of  a  hospital  the 
slightest  suspicion  of  the  shadow  of  a  vacancy. 

Some  der^ire  the  position  to  be  enabled  to  study ; 
others  require  it  to  be  enabled  to  teach ;  a  few  think  it 
necessary  to  the  establishment  of  their  reputation  or 
standing. 

The  advantages  of  a  position  in  a  hospital  are  very 
great 

Practical  experience  is  necessary  to  success  in  the 
treatment  of  disease.  The  most  briUiant  theories  of  cure 
must  withstand  the  test  of  bedside  criticism  before  they 
can  be  relied  upon,  and  this  has  been  the  case  from  the 
earliest  dates  of  the  professional  record,  whatever  the 
disease,  whatever  the  therapy ;  results  differ  from  ex- 
pectations §0  often  and  so  constantly,  that  the  action  of 


new  remedies  cannot  be  depended  upon,  until  confirmed 
again  and  again  by  repeated  observation. 

The  practice  of  medicine,  as  ordinarily  pursued  by  the 
family  practitioner,  does  not  often  afford  opportunities 
ample  enough  or  precise  enough  for  the  prompt  deter- 
mination of  the  value  of  asserted  discoveries  in  thera- 
peutics ;  the  physician  who  is  constantly  employed  in 
the  exercise  of  his  profession,  seldom  has  time  for  the 
systematic  prosecution  of  his  investigations,  and  if  he 
has  plenty  of  time  for  methodical  observation,  his  op- 
portunities for  availing  himself  of  it  are  apt  to  be  less 
frequent.  Then  again,  in  private  practice  it  is  extremely 
difficult  to  control  patient,  nurse,  attendants,  medicine, 
diet,  social  intercourse,  and  so  on,  sufficiently  to  judge 
correctly  of  the  individual  influence  of  special  modifi- 
cations of  treatment  unaffected  by  interference  from 
extraneous  circumstances.  Implicit  compliance  with 
all  the  instructions  of  the  physician  is  rarely  encoun- 
tered in  private  practice ;  the  medicine  ordered  for  the 
patient  may  be  administered  with  scrupulous  exacti- 
tude by  the  conscientious  nurse,  but  indiscretions  of 
diet,  of  social  intercourse,  etc.,  are  often  indulged  in 
without  telling  the  doctor,  especially  in  cases  where 
danger  to  life  has  not  excited  the  fears  of  the  patient 
and  his  friends,  to  the  detriment  of  any  investigation  in 
therapeutics  by  the  physician.  Effects  are  thus  en- 
countered, which  may  or  may  not  be  the  result  of  the 
ascribed  cause,  and  therefore,  in  order  to  estimate  dis" 
cemingly  the  value  of  each  disturbing  element,  inves- 
tigation is  necessarily  prolonged,  suspended,  and  again 
renewed  as  opportunities  offer,  until  sufficient  evidence 
is  collected  to  justify  the  adoption  of  ultimate  conclu- 
sions. Thus,  in  important  cases,  experience  at  the 
bedside  in  private  practice  is  accumulated  slowly  and 
with  great  labor. 

In  a  well-regulated  hospital — and  every  hospital 
should  be  well  regulated — the  surroundings  are  differ- 
ent ;  discipline  is  essential  to  the  preservation  of  order, 
and  patient  and  nurse,  apothecary  and  cook,  medi- 
cine and  drink,  are  undef  the  control  of  the  physician ; 
such  food  and  medicine  as  he  prescribes,  and  such  only, 
is  administered  to  the  patients ;  no  officious  interference 
by  nurse  or  relative  is  permitted  or  dreaded  ;  the  tem- 
perature of  the  ward,  the  degree  and  character  of  ven- 
tilation, the  access  of  visitors  to  the  bedside — all  this 
is  regulated  in  accordance  with  the  instructions  of  the 
physician ;  intelligent  professional  assistants  watch  the 
course  of  the  disease,  note  important  changes  and  re- 
sults in  the  absence  of  the  principal  attendant,  examine 
the  secretions  and  excretions,  and  bring  into  requisi- 
tion all  the  appliances  of  differential  diagnosis,  at  hand 
at  the  moment  needed;  observations  are  made  at 
stated  intervals,  and  recorded  for  the  examination  of 
the  principal;  fact  is  accumulated  after  fact,  until, 
eventually  at  the  close  of  the  case,  a  distinct  and  com- 
plete record  has  been  made  of  all  important  features, 
with  due  allowance  for  every  disturbing  element  in  its 
management    The  simultaneous  presenc^f  a  number 

_,gitized  by  Google 


826 


THE  MEDICAL  RECORD. 


ef  similar  cases,  as  often  occura  in  the  wards  of  a  large 
establishment,  oflfer  facilities  for  bedside  comparison 
which  cannot  be  made  where  patients  reside  apart^ 
and  which  are  invaluable  in  the  study  of  the  progress 
of  disease  and  its  cure.  And  at  the  fatal  termination 
of  an  obscure  or  severe  case,  the  opportunity  for  post- 
mortem examination  under  the  most  favorable  circum- 
stances, as  to  time  of  day,  and  conveniences  of  a  special 
apartment  for  that  purpose,  are  of  the  utmost  utility  ; 
carefhl  drawings  can  be  made  of  morbid  appearances, 
for  future  study  and  reference,  spedmens  preserved  for 
minute  examination  and  comparison,  etc.,  etc. 

Thus  in  hospital  practice  tolerably  reliable  results  ^m 
almost  always  be  secured  as  to  the  history  of  disease 
or  the  effect  of  treatment.  Observation  alone,  how- 
ever, is  but  of  limited  benefit ;  the  advantage  is  confined 
4o  the  observer  and  those  with  whom  he  is  in  im- 
mediate professional  intercourse,  and  to  the  observer 
hiniself  it  is  of  but  limited  advantage  unless  the  obser- 
vations made  are  recorded  at  the  time  of  occurrence. 
Facts  are  to  be  accumulated  at  the  bedside  ;  they  are  to 
be  considered,  pondered  on,  collated,  and  compared 
wiUi  fects  previously  accumulated  in  the  study.  The 
conclusions  of  one  who  adopts  this  plan  will  be  far 
different  from  what  he  would  arrive  at  from  depend- 
ence upon  memory  alone,  for  it  has  been  acknowledf^ed 
by  writers  that  the  impressions  made  upon  the  mind 
by  recollections  of  experience  do  not  sdways  confirm 
^e  recorded  results  of  statistics. 

Hence  the  importance,  in  hospital  practice,  of  care- 
fully recording  experience  which  is  new,  or  which  will 
bear  upon  doubtful  or  disputed  points  in  medicme; 
but  such  records  should  not  remain  buried  in  the  case- 
book of  the  hospital,  or  the  professional  note-book  of 
the  physician ;  they  should  be  announced  for  the  bene- 
fit of  those  who  have  not  access  to  the  wards  of  a  hos- 
pital, and  who  in  great  measure  depend  upon  hospital 
men  to  verify  assertions  and  determine  mooted  points 
in  therapeutics.  The  membere  of  a  hospital  medical 
staff  are  looked  upoi^^  by  the  itmk  and  file  of  the  pro- 
fession, as  leaders  in  the  investigation  of  disease,  ther- 
apy, and  pathology,  and  it  is  a  duty  they  owe  to  their 
1m8  prominent  brethren  to  teH  them  what  they  have 
learned,  or  what  they  have  discovered  in  their  hospital 
experience. 

Abroad,  it  has  been  customary  for  the  staff  of  a  hos- 
pital to  publish  its  hospital  reports  periodically,  com- 
prised of  papers  on  special  subjects  of  interest,  care- 
fbMy  prepared,  incorporating  the  results  of  their  obser- 
vation and  experience,  with  the  collated  record  df  the 
sentiments  and  conclusions  of  others  in  this  country. 
The  coming  year  will  inaugurate  a  similar  system  in 
two  of  our  most  prominent  hospitals — BeTlevue  Hos- 
pital, of  New  York,  and  Pennsylvania  Hospital,  of 
Philadelphia,  establishments  which  present  as  good 
material  in  character  of  cases,  and  acquirements  of  at- 
tendants, for  valuable  papers  as  any  similar  establish- 
ments elsewhere.    In  calling  attention  to  this  impor- 


tant and  praiseworthy  movement,  we  would  urge  the 
adoption  of  a  similar  plan  upon  every  hospital  staff  in 
the  country.  To  such  we  would  say,  publish  whatever 
occurs  of  interest  or  instruction  in  the  institutions  un- 
der your  charge,  whether  it  form  a  thin  pamphlet  or  a 
bulky  volume ;  if  you  cannot  find  a  publisher  with  suf- 
ficient enterprise  to  print  it,  ask  the  institution  receiv<- 
ing  the  benefit  of  your  gmtoitous  services,*  to  ac- 
knowledge their  obligation  -to  the  profession  by  the 
periodical  appropriation  of  a  sum  sufficient  to  cover  the 
expense  of  publication.  We  need  in  this  country  more 
new  woi^  practical,  suited  to  the  ^dimate,  the  people, 
and  the  style  of  practice.  Clinical  reports  of  hospitals 
afe  always  welcomed ;  they  present  in  succinct  furm  the 
views  and  results  of  the  day;  they  are'  passing  events, 
and  are  always  welcomed,  and  therefore  they  form  a 
prominent  portion  of  the  contents  of  our  medical  jour- 
nals. Summaries  of  sets  of  cases  treated  alike,  or  treated 
differently,  collected  with  care,  will  doubtless  prove 
equally  acceptable  in  the  form  of  yearly  Hospital  Re- 
ports, and  we  anticipate  that  the  annuals  of  Beilevue 
and  of  Pennsylvania  Hospital,  will  meet  with  a  cordial 
reception  firom  the  profession  at  large,  not  the  less 
agreeable  beeause  it  will  be  a  new  form  of  medical 
literature. 

Inestimable,  however,  as  are  the  advantages  of  hos- 
pital experience,  and  much  as  we  should  value  their 
published  record,  we  must  be  careful  not  to  over-esti- 
mate their  value.  Apart  flrom  the  humaneness  of  at- 
tending upon  those  sick  compelled  in  their  extremity 
to  accept  the  kind  offices  of  strangers,  the  main  object 
of  hospital  practice  is  to  furnish  general  practitioners 
with  a  reliable  source  of  estimate  of  the  value  of  vari- 
ous therapeutic  agencies  offered  for  their  adoption,  that 
they  may  make  use  of  the  results  in  the  ordinary  prac- 
tice of  their  professioa  We  are  too  apt  to  take  these  re- 
sults and  apply  them  just  as  they  are.  This  is  an  error. 
In  studying  and  comparing  hospital  reports,  we  must 
not  forget  that  they  are  results  obtained  under  hospi- 
tal regime^  and  that  they  will  become  modified  when 
we  put  them  to  practice.  We  must  remember  that 
disease  is  resisted  with  more  routine  in  the  ward  of  a 
hospital,  than  in  the  private  chamber  of  the  sick ;  and 
that  there  exists,  too,  a  modifying  in^uence  in  the  social 
position  and  relations  of  the  invalid  at  his  own  house, 
and  the  patient  in  a  public  institution ;  and  in  institu- 
tions altogether  eleemosynary,  there  is  a  still  greater 
difference  in  this  respect  These,  and  similar  consider- 
ations, modify  the  condition  of  the  patient  essentially, 
and  thus  both  directly  and  indirectly  influence  the 
course  of  the  disease  and  the  result  of  therapeutic  in- 
terference. Under  certain  circumstances,  therefore,  we 
shall  anticipate  the  success  in  the  treatment  of  certain 
diseases  to  be  greater  in  the  hospital  than  it  will  be  in 
the  private  residence ;  and  under  other  circumstances, 
the  reverse  will  be  the  case.  A  striking  example,  for 
instance,  of  the  great  difference  in  the  result  <^  treat- 
ment of  the  same  disease  as  it  is  encountered  in  the 
digitized  by  Google 


THE  MEDICAL  RBCORIX 


83t 


faospital,  and  as  met  with  in  private  practice,  is  afforded 
ns  in  typhus  fever.  The  same  physician  will  be  success- 
ful with  his  typhus  patients  in  hospital  at  the  same 
time  that  he  is  losing  them  in  his  private  practice ;  and 
the  latter  class  of  patients  will  too,  as  a  usual  thing, 
belong  to  a  better  dass  of  society,  and  yet  the  success 
of  treatment  will  predominate  with  the  poorer  class. 
Why  are  the  results  not  constant,  even  under  the  most 
fiTorable  ciromnstaooes  of  worldly  resooroes  ?  Because 
in  the  one  case  we  can  do  much  to  improve  the  hygi- 
enic condition  of  the  patients,  in  providing  better  diet^ 
better  clothing,  better  air,  and  the  system  responds  to 
the  assistance ;  on  the  other  hand,  the  private  patient 
occupies  well-ventilated  apartments,  lives  in  a  healthy 
Iccality,  possesses  ample  chaoge  of  linen  and  bedding ; 
is  Bopplied  with  the  most  desirable  articles  of  diet^  and 
yet  the  means  are  inefiEknent  here,  which  have  sufficed 
in  the  hospital,  because  we  cannot  improve  his  hygienic 
condition ;  or,  if  the  private  patient  be  not  of  the  bet- 
ter class,  and  lives  in  confined  localities,  with  restricted 
diet,  limited  change  of  clothing,  we  cannot  improve  Ms 
hygienic  condition  to  the  same  extent  as  if  he  were  in 
hospital,  and  hence  the  success  of  remedial  agents  will, 
in  each  instance,  be  less  certain*  The  same  process  of 
reaaoning  can  be  carried  out  in  other  diseases,  and  es- 
pecially in  the  ti-eatment  of  surgical  diseases,  to  show 
that  in  guiding  ourselves  by  the  results  of  study,  ex- 
periment, and  observation,  as  recorded  in  hospital  re- 
ports, it  is  necessary  to  exercise  a  oectain  unount  of 
discretion  in  applying  to  private  practice  these  results 
of  hospital  experience. 


We  hare  doleful  accounts  of  the  prevalence  of  the  yel- 
bw  fever  upon  our  Qnlf  coast  In  GkJveston,  Texas, 
where,  according  to  the  views  of  the  physicians  therC) 
the  disease  was  not  introduced  but  germinated,  the  type 
has  been  particularly  malignant  A  despatch  fVom  this 
city,  received  by  the  U.  S.  Secretary  of  the  Treasury 
during  the  present  month,  states  that  the  fever  is  ''  fatal 
beyond  precedent  Out  of  twenty-six  officers  con- 
nected with  the  Custom-House,  only  three  are  fit  for 
duty.  The  remainder  are  either  sick  or  dead."  The 
victims  in  general  are  foreigners,  who  constitute  a  very 
important  element  in  the  population.  The  Commandant 
ef  the  Fifth  District  ((General  Griffin)  reports  to  his  su- 
periors under  date  Sept  3,  that  "  there  is  not  an  army 
flntgeon  in  or  around  Galveston  fit  fbr  dut^,  and  that 
the  regular  medical  practitioners  of  that  city  have  more 
than  they  can  possibly  attend  to." 

The  scourge  appears  to  be  stiU  under  oontrol  at  Indi- 
ttoh,  Lavacca,  and  Victoria— but  not  so  at  Corpus 
Christi  or  New  Orleans,  at  which  last,  according  to  the 
declaration  of  the  Health  Board  on  the  3rd  insL,  it  is 
now  epidemic,  but  of  mild  type.  Accomits  from  the 
West  Indies  are  somewhat  more  ftiirorable,  partieidarly 
in  the  case  of  the  more  important  towns — ^but  from 
every  quarter  there  comes  the  gratifying  intelligence 
that  the  members  of  our  profession  are  laboring  maur 


fully  to  stay  the  pestilence,  in  a  spirit  that  is  as  seliP- 
sacrificing  as  it  is  commendable. 

The  cholera  also  seems  to  have  gained  a  new  impetus 
in  certain  parts  of  Hurope.  The  iJnited  States  Consul  a5 
Palermo,  Italy,  reports  that  "  On  the  31st  of  July,  up  te 
the  time  of  the  matUng  of  my  last  despatch,  there  had 
only  taken  place  six  or  seven  cases  of  cholera,  but  be-* 
fore  the  day  was  over  tiiey  ran  up  to  twenty-nine  cases.' 
On  the  1st  of  August  it  went  up  suddenly  to  two  huu*- 
dred  and  eighty  cases,  and  it  has  kept  thus  up  to  date; 
averaging  from  two  hundred  and  fifty  to  three  hundted 
cases  daily.  The  lower  classes,  as  usual,  are  the  greatest 
sufferers ;  but  it  has,  however,  spread  among  the  middle 
and  even  the  upper  classes.  It  b  of  a  more  violent  and 
fatal  nature  than  last  M,  for  hardly  one-third  of  the  at- 
tacked have  so  &r  got  over  it  The  entire  population 
is  panic-struck;  the  greater  part  of  the  wealthy  families 
have  escaped  to  the  Continent,  the  middle  class  have  left 
the  city  and  are  staying  in  the  villas  and  in  the  subui^s; 
and  many  of  the  laboring  classes  have  gone  up  to  the 
mountains  and  pitched  tents  in  the  open  fields.  The 
city  has  a  very  mournful  aspect,  and  business  is  almost 
entirely  suspended." 

In  the  Calabrias,  and  Sicily,  and  a  few  of  the  north- 
em  provinces,  the  people  add  to  their  sufferings  the 
dread  of  poison,  wMch  they  believed  to  be  administered 
through  several  malevolent  agencies.  Indeed,  We  learil 
from  the  Qazette  de  France  that,  "On  rumors  of  cholera 
at  Naples  thepopi^iace  rashed  in  a  mass  to  the  abode 
of  a  fortune-teller  called  the  Sibyl,  massacred  her,  and 
cut  her  into  morsels." 

The  same  paper  adds  in  this  connection :  "  The 
authorities  have  suspended  the  march  of  troops,  fairsi 
and  even  the  examination  of  students.  At  Napks  all 
ships  coming  from  Leghorn  are  placed  under  quarafl** 
tine." 

A  letter  from  the  Basilicata  to  ihe  Avenir  of  Naples 
states  ^*  that  the  cholera  is  making  terrible  ravages  in 
several  communes  of  that  province.  In  that  of  Migli*« 
onico,  of  which  the  population  does  not  exceed  fiv© 
thousand  souls,  the  number  of  deaths  daily  amounts  to 
fh>m  fifty  to  sixty.  Some  families  have  been  entiitely 
destroyed."  The  disease  has  likewise  appeared  in  War* 
saw  and  in  Danzick,  and,  if  we  credit  the  secular  print^ 
"as  a  fearful  epidemic." 

In  our  own  far  wesrt^  tip  to  the  date  of  our  present 
writing,  the  number  of  victims  has  not  yet  perceptibly 
declined — the  Indian  Territory,  south  of  Kansas,  having 
been  sorely  visited^  and  the  population  of  Fort  Gibson 
having  lost  fbUy  thirtyi'-eeVen  per  cent  of  their  whota 
number,  From  the  otiier  infected  military  stations  we 
have  little  if  any  news,  which  we  trust  may  be  regarded 
as  a  symptom  indioating  a  fair  condition  of  the  pubHc 
health. 

The  coming  of  cool  weather  brings  with  it  a  disposi- 
tion for  renewal  of  work  in  medical  circles.  The  di^ 
ferent  societies  wluch  have  been  enjoving  a  vacation 

Digitized  by  VjOO^  ^  _ 


328 


THE  MEDICAL  RECORD. 


have  resumed  their  sessions,  and  the  preliminary  lec- 
tures in  the  medical  schools  haTe  been  commenced. 
The  number  of  medical  gentlemen  who  hare  been 
recruiting  their  wasted  energies  upon  their  farms  and 
country  seats  have  returned  with  renewed  vigor  to 
practise  their  art,  and  everything  points  towards  the 
possibility  of  a  winter  of  more  than  ordinary  activity 
in  the  medical  line.  The  meetings  of  the  societies  are 
well  attended,  and  an  interest  is  manifested  in  their  pro- 
ceedings which  is  as  gratifying  as  it  is  encouraging.  The 
students  are  beginning  to  assemble  from  different  quar- 
ters, and  the  prospects  of  good  classes  on  the  part  of  the 
colleges  are  as  promising  as  they  have  been  at  any  time 
heretofore. 


A  Practical  Guide  to  the  Study  of  the  Diseases  op 'the 
Ete;  their  Medical  and  Surgical  Treatment  By  Hbmrt 
W.  Williams,  M.iJ.,  Ophtbdaiio  Surgeon  to  the  City 
Hospital,  eta,  etc  Boston :  TiOKiroB  A  Fields.  1867. 
pp.  421. 

Some  time  since  we  noticed  the  essay*  on  "  Becent 
advances  in  Ophthalmic  Science,"  by  this  author. 

The  work  now  before  us  is  a  second  edition,  and  con- 
tains as  an  appendix  the  essay  above  mentioned. 

*'  In  offering  this  treatise  to  the  profession,  and  to 
those  who  are  about  to  enter  it,  the  author  does  not 
assume  to  set  forth  all  which  is  known  in  respect  to 
diaeases  of  the  eye." 

The  idea  seems  to  be  to  give  the  student  a  general 
knowledge  of  eye  diseases,  "  and  to  allow  him  to  con- 
sult other  works  at  his  leisure,  should  he  wish  for  com- 
plete information  regarding  them." 

It  does  not  seem  to  us  that  this  is  the  correct  aim  in 
writing  a  monograph.  Text-books  for  students  on  gen- 
eral subjects  are  the  proper  places  to  set  forth  general 
ideas  of  diseases.  A  practising  physician  who  consults 
a  work  on  a  special  class  of  diseases,  expects  to  find  in 
it  a  full  account  of  the  pathology,  treatment,  etc.,  which 
may  be  of  use  to  him  in  the  case  that  he  is  looking  up. 
He  does  not  wish  "  to  consult  other  works  at  his  lei- 
sure." Besides,  we  do  not  remember  to  have  seen  refer- 
ence to  a  single  author  in  the  whole  book,  so  where 
shall  the  general  practitioner  find,  in  other  works,  what 
he  fails  to  find  in  this  ? 

The  gr^-at  advances  in  ophthalmic  science  that  have 
been  made  within  the  last  few  years,  and  the  failure  of 
works  on  practice  of  surgery  to  keep  pace  with  this  ad- 
vance, do  to  some  extent  render  necessary  such  a  work 
as  the  present. 

It  is  a  very  readable  book,  and  by  its  pemsal  the 
physician  will  gain  a  very  good  idea  of  what  can  be 
accomplished  by  a  skilled  ocuhst^  if  he  does  not  himself 
learn  exactly  how  to  treat  eye  diseases. 

Throughout  the  work  are  various  practical  suggestions 
that  are  very  useful,  and  which  are  original  with  Dr. 
Williams,  who,  besides  beiug  a  careful  student  and  com- 
piler, has  that  rare  qualific^ition,  in  a  medical  man,  of 
having  an  original  turn  of  mind,  which  does  not  take 
all  the  accepted  notions  for  granted.  His  modification 
of  Bowman's  probes  for  the  treatment  of  lachrymal  ob- 
struction seems  to  be  a  valuable  improvement  They 
are  "  made  with  bulbous  extremities,"  and  "  with  the 
third  of  the  probe  nearest  the  end  much  more  slender 
than  the  remaining  portion,"  They  are  made  on  the 
■wne  principle  as  certain  bougies  for  urethral  stricture. 


While  speaking  of  the  treatment  of  diseases  of  the 
cornea,  Dr.  Williams  uses  this  expression :  ^^  If  he  act  as 
a  mere  specialist,  and  attempt  to  gain  his  object  by  local 
remedies  alone,  nis  best  endeavors  will  be  baffled,"  etc., 
and  '^  constitutional  remedies  are  of  quite  as  much  im- 
portance as  any  local  applications."  Some  oculists  seem 
to  ignore  all  constitutional  participation  when  treating 
their  eye  cases.  It  seems  to  us  that  the  use  of  tonic 
remedies,  and  attention  to  the  general  health,  are  quite 
as  important,  if  not  more  so,  than  local  applications,  in 
the  treatment  of  ulcers  of  the  cornea,  phlyctenular  kera- 
titis, etc. 

And  in  syphilitic  iritis  the  exclusion  of  preparations 
of  mercury,  and  the  entire  reliance  on  atropine,  seems  at 
least  injudicious.  Adhesions  of  the  pupillary  margin  are 
not  the  only  evil  results  of  the  syphilitic  poison ;  and  the 
mere  fact  of  a  physician  being  a  apecialist  gives  him  no 
right  to  let  his  patient  suffer  from  any  trouble  not  im- 
mediately in  his  line,  while  under  his  care.  Therefore 
we  think  that  Dr.  Williams  hardly  puts  the  case  strong 
enoQgh  when  he  says,  "Where  interstitial  comeitis 
exists  as  a  complication,  the  use  of  mercurials  niay  be 
admissible."    We  should  say  indispensable. 

The  article  on  "  inflammation  of  the  meibomian  and 
ciliary  glands,"  is  one  of  the  best  that  we  have  seen  on 
the  subject.  It  will  repay  careful  study.  By  carefVilly 
carrying  out  the  plan  of  treatment  here  described,  al- 
most aU  cases  of  the  disease  in  question  prove  curable. 

The  appendix  would  doubtless  be  as  new  to  many 
physicians  now  as  when  it  first  appeared,  and  it  is  well 
worth  a  careful  reading.  The  part  on  the  ophthalmo- 
scope, and  the  accompanying  plates,  give  an  excellent 
and  simple  explanation  of  that  instrument  and  its  use, 
as  we  have  already  noticed  in  our  review  of  it,  when 
issued  as  a  separate  work.  The  book  as  a  whole  is  a 
valuable  one,  an4  creditable  to  its  distinguished  author, 
although  we  are  constrained  to  repeat  that  a  "  guide " 
should  be  a  little  more  minute,  and  a  bibliography 
which  would  only  take  up  little  space,  would  greatly 
enhance  its  value.  We  commend  the  beautiful  typog- 
raphy and  paper  and  binding  to  the  attention  of  the 
New  York  and  Philadelphia  publishers. 

KOTES    OW   THE    ORIGIN,  PREVENTION,   AND    TREATMENT  OP 

Ablatio  Cholera.  By  John  C  Peters,  M.D.  2d  Edition 
with  an  Appendix.  N.  Y. :  D.  Van  Kostrand,  1867. 
12mo.,  pp.  200. 
This  excellent  and  very  readable  work  of  Dr.  Peters 
has  advanced  to  a  second  edition,  and  we  are  pleased  to 
notice  the  fact  as  an  evidence  of  the  appreciation  with 
which  the  profession  regards  the  labors  of  the  author. 
Our  readers  are  already  acquainted  with  the  intrinsio 
merits  of  this  hroehuref  and  we  again  take  occasion  to 
commend  it  to  their  careM  perus^  and  study,  as  a  wgrk 
singulariy  complete  in  all  those  facts  pertaining  to  chol- 
era which  the  recent  investigations  of  the  ablest  minds 
in  the  profession  have  given  us. 

The  Medical  Register  of  the  Crrr  of  New  York  and 
YiciNiTT,  to  which  is  also  added  a  nearly  complete  list  of 
the  members  of  the  Medical  Societies  of  the  State  of  New 
York  for  the  jear  oommencinfc  JuDe  1,  1867.     Published 
under  the  supervision  of  the  New  York  Medico-Historical 
Society.    John  Sheadt,  M.D.,  Editor.    New  York :  N.  Y. 
PRINTINO  CJo.,  1867. 
This  very  welcome  annual  comes  to  us  much  enlarged, 
compared  with  its  predecessors,  and  under  the  charge 
of  a  new  editor.    Although  somewhat  delayed  in  its 
publication  on  account  of  the  many  additions  whieh 
were  thought  necessary  to  be  made,  the  p:  ofession  will 
doubtless  be  unwilling  to  find  fault  witn  the  circum- 
stance in  view  of  the  remarkable  completeness  of  the 
work.    As  it  now  stands  it  may  beconsidered  the  per- 

^igitized  by  LjOO^^_ 


THE  MEDICAL  RECORD. 


329 


fectf'oD  of  a  Register.  No  pains  liave  been  seemingly 
spared  to  make  it  in  every  respect  a  reliable  book  for 
reference  on  all  matters  pertaining  to  medical  matters  in 
the  city  of  New  York  and  vicinity.  The  list  of  prac- 
tising i>hysicians  is  as  complete  as  the  utmost  care  in 
canvassing  the  districts  could  po$^ibly  make  it,  while  the 
office  hours  of  all  are  accurately  and  reliably  given. 
This  latter  feature  alone  is  sufficient  to  recommend  for 
the  little  volume  a  place  upon  the  table  not  only  of 
every  practitioner  in  the  city  and  vicinity,  but  of  those 
throughout  the  adjoining  States  who  may  have  occa- 
sion to  send  their  patients  to  the  city  for  purposes  of 
consultation.  By  being  reliably  informed  as  to  the 
time  when  the  physician  to  whom  his  patient  is  to  be 
sent  can  be  found  in  his  ofi&ce,  much  time,  trouble,  and 
annoyance  are  saved. 

It  would  be  impossible  to  give  in  detail  aU  the  medi- 
cal matters  of  interest  which  are  referred  to  in  this  vol- 
wne ;  but  suffice  it  to  ^ay  that  we  have  presented  to  us 
an  account  of  all  the  medical  societies,  medical  institu- 
tions, ho^itals,  dispensaries,  throughout  the  city,  while 
all  the  officers  of  the  county  societies  are  given,  and  all 
the  members  of  the  same.  The  list  of  nurses,  artifi- 
cers in  medical  appliances,  and  instruments,  and  of 
regular  educated  dentists  will  serve  as  a  guide  to  those 
who  may  be  in  need  of  recommendations. 

The  obituary  notices  are  fulL  and  are  written  with 
that  ease,  elegance,  and  taste  which,  even  independent 
of  the  interest  that  may  be  taken  in  the  subjects  of  the 
tkett  hes,  will  command  for  them  a  wide  reading. 

We  have  not  deemed  it  out  of  place  in  these  col- 
umns thus  to  allude  to  the  work  before  us.  Al- 
though the  editor  is  known  to  our  readers  as  a 
valu^  contributor  to  our  columns,  it  is  no  reason  in 
itself  why  any  outside  emanations  from  his  pen  should 
not  receive  the  same  notice  as  would  those  of  a  stran- 
ger, and  entitle  us  to  the  privilege  of  praising  or  con- 
d  mning  his  efibrts  in  absolute  accordance  with  an  im- 
partial judgment.  This  part  of  our  task  we  have  en- 
deavored faithfully  and  conscientiouslv  to  fulfil,  and  lay 
down  the  volume  with  our  unquaHfied  approbation. 

Thk  Mikbral  Waters  of  the  United  States  and  Oakada; 
WITH  A  Map  and  Plates,  and  General  Directions  for 
Reacbiho  Mineral  Spbikos.    By  J.  J.  Moorman,  M.D., 
Kesident  Phvaician  at  the  White  Sulphur,  Lecturer  oo 
i^natomy  and  Physiology,  Roanoke  College,  Ya.,  ela,  eta 
Baltimore:  Kbllt  and  Pibt,  1867.    12ido.,  pp.  507. 
As  the  work  is  written  for  the  public,  it  cannot  be  ex- 
pected to  serve  the  purposes  of  a  scientific  treatise.    It 
IS  true  there  is  not  a  HtUe,  in  a  general  sense,  that  ma^ 
be  of  value  to  the  physician  in  reference  to  the  locah- 
ties  and  properties  of  the  difierent  Spring  waters,  but 
further  than  thi/«  the  book  is  seemingly  written  more  to 
•muse  than  instruct,  and  will  doubtless  serve  its  purpose 
in  filling  up  a  gap  in  what  the  author  chooses  to  call 
"Spring  hterature."    The  work  is  decently  printed^  and 
his  scattered  through  its  pages  several  indifferent  htho- 
graphic  representations  of  the  different  Springs  and 
theu*  surroundings. 

Essentials  of  the  Principles  and  Practice  of  Medicine: 
A  Handt  Book  for  Students  and  PRAcnnoNERa  By 
Henry  Hartshorne,  M.D.,  Prof,  of  Hygiene  in  the  Uni- 
versity  of  Pennsylvania,  Auxiliary  Faculty  of  Medicine, 
eta,  eto.  Philadelphia:  HenrtCLia,  1867.  12mo.,  pp. 
417. 

The  work  before  us  is  stated  to  be  "an  unambitious 
effort  to  make  useful  the  experience  of  twenty  years  of 
private  and  hospital  medical  practice,  with  its  attendant 
study  and  reflection;"  and  so  well  has  the  author 
accomplished  his  object  that  we  cannot  refi^n,  despite 
our  prc^judice  against  handy  books  in  general,  from 


pronouncing  it  a  remarkable  success.  The  arrangement 
of  the  subjects  is  most  judicious  and  unexceptionable,  and 
the  manner  in  which  he  treats  of  the  "  essentials  **  ot 
medicine  is  in  the  highest  degree  satisfactory  to  the 
reader. 

The  work  is  divided  into  two  parts,  the  first  referring 
to  the  Principles  of  Medicine,  under  which  heading 
General  Pathology,  Semeiology,  General  Therapeutics, 
and  Nosology  are  discussed ;  and  the  second,  under  the 
caption  of  Special  Pathology  and  Practice,  gives  us  an 
insight  into  the  functional,  systemic,  and  organic  affec- 
tions, with  their  dif^oses,  prognoses,  treatment,  etc. 
Then  follows  a  list  of  formula  which  the  experience  of 
the  author  has  approved  of  in  the  different  ailments,  and 
lastly,  a  general  mdex. 

The  introduction  to  the  work  gives  us,  in  a  remarka- 
bly concise  and  comprehensive  manner,  an  exhaustive 
history  of  the  different  systems  of  medicine  that  have 
prevailed,  and  altogether,  stamps  Dr.  Hartshorne  as  a 
scholar  of  no  ordinary  pretensions.  The  main  part  of 
the  work  is  of  a  decidedly  practical  character,  and  the 
effort  to  condense  every  essential  point  in  the  smallest 
possible  space  gjjes  a  value  to  the  book  that  is  decid- 
edly pecufiar.  We  must  not  be  considered  as  recom- 
mencing the  work  for  more  than  it  really  Is,  a  simple 
record  of  the  experience  of  a  thinking  and  practical 
man,  one  who  has  given  ample  evidence  that  he  under- 
stands what  the  title  of  his  little  book  implies.  We 
have  perused  it  diligently,  and  we  hope  impartially,  and 
lay  it  down  with  naught  but  commendation. 


Keporta  of  Sacicttes. 


NEW  YORK  PATHOLOGICAL  SOCIETY. 

Stated  Meeting,  June  27,  1867. 

Dr.  H.  B.  Sands,  President,  in  the  Chair. 

report  or  committee  on  dr.  ocjtter's  specimen. 

Dr.  Rogers,  as  one  of  the  committee  appointed  at  the 
previous  meeting  to  report  upon  Dr.  Cutter's  specimen 
of  diseased  spleen,  offered  the  following: 

The  undersigned  member  of  the  committee  of  two, 
appointed  by  the  President  of  the  New  York  Pathol  og- 
icw  Society,  to  examine  and  report  upon  the  true  char- 
acter of  certain  specimens  presented  to  the  Society  at 
its  meetmg  of  the  12th  of  June,  inst.  by  Dr.  Cutter,  at 
t^e  request  of  the  other  member.  Dr.  Cutter,  has  ex- 
amined the  specimens,  and  reports  that,  after  repeated 
and  careful  examinations  of  the  specimens  furnished 
him  by  Dr.  Cutter,  from  both  the  stomach  and  uteru^ 
he  failed  to  discover  any  evidences  of  any  kind  of 
cancerous  disease. 

Even  the  physical  character  of  the  specimens  fur- 
nished did  not  present  anything  abnormal.  He  wishes 
to  be  understood  as  making  this  report  upon  the  ma- 
terial furnished  him  only,  without  even  supposing  that 
they  were  well  selected  and  representative  specimens 
of  the  idleged  diseased  stmcture.  In  relation  to  the 
cyst  found  attached  to,  or  developed  from  the  ^leen, 
he  found  it  to  be  a  pure  specimen  of  cholesteatoma. 

The  members  of  the  Society  who  saw  the  specimen, 
will  appreciate  l^e  following  as  a  graphic  description 
of  its  appearance  to  the  naked  eye ;  and  your  reporter 
testifies  to  its  faithfulness^  in  respect  to  the  microscopic 
appearances.  It  occurs  in  Mr.  Paget*s  lecture  on  what 
he  terms  "  Compound  or  Proliferous  Cysts,"  at  p.  393, 
and  reads  as  follows : 

"  In  the  opposite  extreme  to  these  cysts,  in  which  the 
cuticuUff  proouct  is  most  perfect,  we  nnd-4^  innumer- 

^Ic 


igitized  by  VjOOQIC 


880 


THE  MEDICAL  RECOBD. 


able  variety  of  contents,  of  buff-  and  ochre-yellow, 
and  brownish  materials,  that  seem  to  consist  mainly  of 
degenerate  cuticle  mingled  with  sebaceous  secretions. 
The  microscope  finds  in  them  a  confused  mass  of 
withered  scales,  of  granular  fatty  matter,  clustered  and 
floating  free,  of  cholesterine  crystals,  and  of  earthy 
matter  in  free  molecules,  or  inclosed  within  the  cells  or 
scales,  and  all  these  may  be  floating  in  a  turbid  liquid, 
or  retained  in  some  soft  tenacious  mas?,  or  clustered  in 
hard,  nodular,  and  pointed  masses,  projecting  like  stalac- 
tites from  the  old  cyst- walls." 

Nor  in  this  character  does  it  appear  to  be  a  unique 
specimen.    Dr.  Gross,  in  speaking  of  cysts  affecting  the 

3)Ieen,  remarks  that  they  may  contain  a  clear  limpid 
uid  like  spring  water,  in  other  cases  they  may  be  oc* 
cupied  by  a  sort  of  meliceric,  atheromatous  (which 
means  composed  more  or  less  largely  of  cholesterine 
crystals),  or  steatomatous  substances. 

In  conclusion  your  reporter  begs  leave  to  state,  that 
while  he  declares  that  the  portions  of  this  cyst  and 
contents  submitted  to  him.  were  purely  cholesteatoma, 
he  does  not  deny  that  tne  cyst  may  have  possessed 
other  constituents,  of  a  cancerous  character.  Mr.  Cur- 
ling cites  several  examples  of  cholesteatoma  associated 
with  malignant  disease  in  the  same  tumor  or  person, 
and  one  case  of  this  form  of  disease  in  a  testis,  with 
which  enchondroma  and  encephaloma  were  combined. 

UBUTABT  OALOClil,  VtOt 

Dr.  Post  exhibited  a  urinary  calculus  which  resembled 
very  much  the  charms  said  to  have  been  worn  by 
the  Homan  ladies,  beinfi^  representations  of  the  penis 
with  the  scrotum  attadied.  It  was  removed  by  the 
lateral  operation  of  lithotomy  from  a  boy  13  years  of 
age,  who  had  complained  of  B3rmptom8  of  stone  in  the 
bkdder  ever  since  he  could  recollect.  The  stone  was 
readily  detected  on  sounding,  the  sound  emitted  by  the 
steel  instrument  indicating  it  to  be  of  a  light  and  porous 
nature.  On  introducing  the  forceps,  the  stone  was 
seized  by  its  small  extremity,  causing  it  to  be  broken, 
the  larger  portion  being  afterward  removed.  The 
operation  was  performed  at  2  o'clock  on  the  Wednes- 
day previous,  and  at  9  o'clock  in  the  evening,  having  a  de- 
sire to  urinate,  the  patient  passed  a  large  quantity  of 
urine  tinged  with  blood.  Since  then  he  has  had  d^ree 
discharges  a  day  by  the  natural  passage.  The  first  even- 
ing afler  the  operation  the  pulse  was  130,  attended  with 
some  febrile  heat;  it  however  soon  subsided,  and  on  the 
Monday  following  his  pulse  was  80,  and  he  was  able  to 
get  about  the  room  quite  comfortably.  The  calculus 
weighed  107  grains,  was  li  inches  in  length,  f  of  an 
inch  in  breadth  at  the  larger  extremity,  and  ^  at  the 
smaller  extremity.  A  small  portion  was  analyzed  by 
Dr.  Wm.  B.  Lewis,  and  was  found  to  be  composed 
chiefly  of  phosphate  of  lime,  with  a  small  trace  of  the 
triple  phosphate^  and  carbonate  of  lime. 

He  also  exhibited  a  calculus,  salivary  in  character, 
temoved  from  the  Wharton's  duct  of  a  pittient  60  years 
•f  age.  This  body  had  existed  under  the  tongue  for  7 
or  8  years,  but  had  given  no  trouble  until  a  month  ago, 
when  great  difficulty  of  mastication  was  the  result  of  its 
presence.  When  it  was  extracted  it  was  found  to  have 
f- remarkable  prominence  at  one  end  and  was  marked 
by  tapering  at  the  other.  It  weighea  28  grains,  was  i 
•f  an  inch  in  length,  and  i  an  inch  in  breadth  at  its 
broadest  portion. 

Db.  Bauer  exhibited  a  Specimen  of  aneurism  of  the 
arch  of  the  aorta,  for  the  purpose  of  affording  the  junior 
members  present  an  opportunity  of  viewing  a  typical 
case.  It  waa  situated  on  the  imterior  portion  of  the 
arch,  and  by  its  prsssme  gradually  absorbed  the  car- 


tilages and  ribs,  as  yfeU  as  a  portion  of  the  sternum  in 
its  neighborhood. 

EXTIRPATION   OF  INTRA-tTTERlKB  nSROtTS  TUMOR. 

He  next  presented  an  intra-uterine  fibrous  tumor 
which  he  had  removed  by  operation  that  morning* 
The  diagnosis  of  the  case  had  been  made  5  years  ago. 
The  patient  was  49  years  of  age  and  had  four  chOdren, 
the  youngest  being  12  years  old.  Four  years  ago  Dr. 
Bauer  was  called  to  attend  her  for  hsemorrhage  of  the 
uterus,  and  on  examining  her  carefully  he  discovered  an 
intra-uterine  tumor,  pr<K)ably  fibrous.  Dilatation  waa 
commenced,  as  it  was  necessary  to  do  so  in  order  to 
treat  the  symptom  of  bleeding.  The  treatment  of  di« 
latation  was  carried  on  to  that  extent  that  at  the  end 
of  a  year  afterwards  he  could  introduce  his  three  fin- 
gers, and  allow  the  tumor  to  come  out.  Soon  af^r- 
wards  the  patient^  formerly  a  resident  of  Brooklyn,  had 
removed  to  this  city.  She  went  on  occasionally  having 
her  attacks  until  she  beg^  to  suffer  frona  an  extremely 
foetid  discharge,  and  having  sent  to  a  neighboring  phy- 
sician, and  he  having  pronounced  the  case  one  of  oancer, 
she  became  very  much  alarmed,  and  sent  for  her  old 
attendant.  Dr.  &iQer,  on  examination,  found  the  tumor 
protruding  though  the  os,  and  also  discovered  that  its 
foetid  odor  was  due  to  ulceration  and  sloughing  of  its 
lower  portion.  The  only  resource  was  the  operation 
of  enucleation,  which  was  done  without  the  slightest 
difficulty.  It  seemed  to  be  attached  directly  to  the 
mucous'  membrane^  no  distinct  pedicle  being  discover- 
able. On  microscopical  examination  it  was  umnd  to  be 
purely  fibroid  in  character. 

Dr.  Weir,  after  exhibiting  a  specimen  for  a  candidate, 
presented  several  specimens  of  the  distoma  bepatica^ 
which  he  had  accidentally  met  with  in  the  rectum  o[  a 
patient  upon  whom  he  was  operating  for  extravasatwn 
of  urine.  The  patient  statea  to  him  that  he  had  been 
in  the  habit  of  passing  them  for  several  years.  His  life 
was  terminated  by  diarrhoea.  No  post-mortem  ex- 
amination was  made. 

PENDULOUS  ATOPOSE  TUMOR. 

Dr.  Satre  exhibited  an  adipose  tumor  removed  by 
operation  firom  the  outer  portion  of  the  right  davicle 
of  a  woman,  35  years  of  age,  who,  strange  to  say,  bad 
carried  it  for  8  years  without  tin.  operation.  She 
was  brought  to  the  hospital  on  account  of  haemorrbage 
occasioned  by  ulceration  into  a  large  vein  upon  its  sur- 
face. It  weighed  1  pound  and  9  ounces,  and  there 
were  9  large  veins  found  upon  its  sur&ce,  and  one  large 
artery  through  its  substance. 

He  also  presented  a  tumor  of  the  same  character 
which  he  had  some  time  before  removed  fVom  the  upper 
and  inner  portion  of  the  right  thigh,  which  had  su<m  s 
long  pedicle  that  it  had  been  diagnosticated  by  some 
who  saw  it  as  pediculated  fibrous  tumor. 

Dr.  Markoe  remarked  that  tlielast  tumor  had  pedicu- 
lated on  account  of  its  weight,  while  there  evidently  (M 
not  exist  such  an  attachment  from  the  commencement 
as  would  have  been  the  case  in  the  pediculated  tumor. 

REPORT  or  committee  ok  dr.  finkell's  case  of  n«Tti- 

uterine  tumors  CAUSING  DimOULT  LABOR. 

Dr.  Rogers  then  offered  the  fbllowing  report  of  the 
committee  to  examine  into  the  condition  of  the  intrs- 
abdominal  tumors  in  the  foetus  presented  at  the  previous 
meeting  bv  Dr.  Finnell. 

The  undersigned  committee,  appointed  by  the  PrK 
sident  of  the  New  York  Pathologioal  Society  at  tli» 
meeting  of  12th  June,  1867,  to  examine  and  to  rewat 
upon  the  true  character  of  the  two  tumors  presented  by 
Dr.  Finnell  at  that  meeting,  re^ectfully  report^  tM 

Digitized  by  V^jOO^  ^  _ 


THE  MEDICAL  RECORD. 


331 


the  required  examination  has  been  instituted,  and  the 
following  result  aniyed  at : 

The  committee  would  first,  however,  beg  leave  to 
premise,  tliat  the  history  of  tne  specimens  as  given  by 
Dr.  Finnell  at  the  time  of  presenting  them,  having  in- 
cluded tlie  statement  that  all  of  the  viscera  of  the  ven- 
tral cavity  were  present^  and  in  a  healthy  condition,  and 
that  it  was  a  male  foetus  whose  testes  were  not  sought 
for,  nor  examined,  and  consequently  not  known  to  be 
present,  had,  as  the  Society  will  recollect,  dirt  cted  the 
attention  of  some  of  its  members  to  the  foetal  testes, 
a^  the  starting-point  of  the  enormous  tumors— enormous 
when  compared  to  the  healthy  foetal  gland.  The  ab- 
sence of  any  report  relating  to  the  testes  of  the  foetus, 
was  indeed  the  chief  cause  of  the  necessity  for  the  for- 
mation of  the  committee.  For  with  a  perfectly  healthy 
condition  of  the  abdominal  viscera  of  a  male  foetus, 
and  the  existence  of  two  exactly  similar  tumors,  per- 
fect duplicates  of  each  other,  occupying  the  two 
lateral  regions  of  the  cavity,  and  each  provided  with  a 
rimilar  duct  or  vessel,  this  mass  could  scarcely  be 
regarded  as  anything  else  than  diseased  testicle,  had 
no  testicles  been  found  elsewhere. 

In  the  absence  of  this  important  evidence,  the  com- 
mittee were  forced  to  resort  to  histological  proofs  in 
the  formation  of  a  conclusion  as  to  the  character  of  the 
growths.  The  form  of  the  growth  is  that  well  known 
in  pathology  as  fihro-cysHc.  The  cysts  are  of  all  pos- 
sible sizes  from  an  almost  imperceptible  vesicle  to  the 
quarter  or  an  inch  in  diameter,  and,  as  we  believe,  are 
hned  by  a  delicate  membrane,  possessed  of  tesseiated 
epithelium.  At  least  this  is  the  fact  with  the  cysts 
larce  enou;?h  for  examination. 

On  carefully  dissecting  the  tumors,  each  one  is  found 
to  have  a  duct  or  vess  1,  of  sufl&cient  size  to  admit  a 
common  probe.  The  microscope  shows  that  this  duct 
or  vessel  is  lined  by  an  epithelium  of  the  columnar 
vaiiety.  Tracing  it  deeper  into  the  substance  of  the 
tumor,  this  duct  is  found  to  be  an  outlet  from  a  kind  of 
sinus  extending  in  the  direction  of  the  long  axis  of  the 
tumors  for  about  half  its  length.  This  sinus  has  sever- 
al communicating,  or  tributary  ducts  leading  into  it 
from  various  parts  of  the  tumor,  and  is  precisely  similar- 
Ij  located  and  provided  in  the  two,  and  possesses  the 
same  variety  of  epithelium  as  the  duct.  Besides  this 
duct,  each  tumor  has  a  vessel  of  very  small  size,  pos- 
sessing all  the  characteristics  of  an  artery,  leading  into 
its  substance,  another  having  the  appearance  of  a  small 
▼ein,  and  lined  with  scaly  epithehum,  and  between 
these  two  vessels  is  also  found  a  nerve  branch  accom- 
panying the  vessels  in  their  distributions.  Under  the 
microscope,  the  nuclei  of  the  neuralemma  of  this  nerve 
twig  are  very  distinctly  visible,  and  render  its  nervous 
character  unequivocal  These  three  are  united  in  one 
pedicle  or  cord,  and  are  located  at  a  slight  distance  ft-om 
the  large  duct.  Now  as  this  is  precisely  the  histologi- 
cal description  of  the  spermatic  cord  and  the  epididy- 
nial  portion  of  the  spermatic  duct  and  of  nothing  else, 
farther  proof  in  support  of  the  belief  that  these  tumors 
tre  examples  of  fibro-cystic  disease  of  the  foetal  testes 
does  not  appear  necessary  to  the  committee.  Desiring, 
however,  to  leave  no  point  uninvestigated,  the  following 
extract  from  Mr.  Paget's  lecture  on  fibro-cystic  tumprs, 
will  explain  why  tne  committee  extended  its  micro- 
scopic examinations.  He  says :  "  We  fimd  examples  of 
fibrous  tumors  thic^y  beset  with  numerous  well-de- 
fined and  lined  cysts.  This  appears  to  be  the  nature  of 
the  *  hydatid  testis'  described  by  Sir  Astley  Cooper. 
The  specimens  that  I  have  seen  of  it  make  me  think 
&at  it  is  essentially  a  fibrous  tumor  in  the  ietticUf  with 
Cyst  formation  in  the  tumor.  For,  upon  or  around  the 
tumor,  the  seminal  tubes  or  theur  remains  may  be  traced 


outspread  in  a  thin  layer,  and  without  difficulty  separ- 
able, and  the  substance  of  the  tumor  is  a  distinct  mass 
of  common  fibrous  tissue,  with  a  variable  number  of 
imbedded  cysts,  filled  with  pellucid  serous  or  viscid 
contents."  The  committee  hardly  expected  to  find  any 
such  layer  of  seminal  tubes  over  this  tumor — the  size 
of,  and  very  nearly  the  shape  of  half  of  the  fully  devel- 
oped foetal  brain — ^for  the  foetal  testis,  which  is  about 
as  large  as  a  medium-sized  pea,  spread  out  to  that  degree, 
could  with  difficulty  be  detected.  But  in  the  hope  that  it 
might  have  been  difierently  disposed  of;  we  commenced 
the  microscopic  examinations  of  various  portions  of 
the  substance  of  the  mass,  and  very  soon  found  un- 
doubted fragments,  of  both  the  straight  and  the  convolut- 
ed seminal  tubes,  lined  with  their  characteristic  ceZLSb 
The  whole  tumor  contains  vast  numbers  of  epiudle- 
shaped  nucleated  fibro-plastic  cells,  and  exudation  cor- 
puscles, and  in  some  regions  much  mingled  with  these 
seminal  cells.  These  fragments  of  the  testis  seem  scat- 
tered over  a  great  part  of  the  tumor,  for  we  have  de- 
tected them  in  portions  taken  from  widely  distsint  parts. 
The  locality  of  these  fragmentarv  portions  of  the  testis 
is  generally  marked  by  a  slightly  yellow  tinge  of  the 
substance  of  the  tumor,  and  a  less  cystic  character  of 
the  point  thus  tinged  These  fragments  are  mostly  lo- 
cated near  the  s  »urces  of  the  vessels  or  ducts  we  have 
described  as  tributary  to  the  longitudinal  sinus  of  the 
tumor,  and  can  with  great  certAinty  be  pointed  out. 
All  doubt,  therefore^  in  the  minds  of  the  committee,  &s 
to  the  testicular  origin  of  the  tumors,  has  been  removed. 
But  as  to  the  precise  pathology  of  the  tumors,  the  com- 
mittee see  difficulty  in  demonstrating  that  the  disease 
was  originally  of  the  fibro-areola  tissues  of  the  testia 
or  of  the  cell- tubes,  that  is,  whether  it  was  a  pure  fibro- 
cystic disease,  or  whether  it  was  in  part  a  gh^dular  tu- 
mor of  the  testis.  If  it  be  in  part  what  is  known  as  a 
"  glandular  proliferous  cyst,"  distinguished  by  the  pres- 
ence throughout  its  substance  of  structure  exactly  sim-  , 
ilar  to  that  of  the  gland  upon  which  it  is  developed, 
it  can  be  so  only  to  a  small  degree,  for  large  portions 
of  the  tumor  are  devoid  of  such  structure.  The  com- 
mittee thereupon  incline  to  the  opinion  that  it  is  a  pure 
fibro-cystic  disease  in  the  testis  of  the  foetiM. 

The  committee  entertain  the  theory,  that  the  part 
of  the  duct  present  in  the  specimen,  corresponds  to  the 
epididymis,  and  represents  that  part  of  the  seminal 
duct  in  a  straightened  and  dilated  condition. 

This  view  receives  the  confirmation  of  the  best  autho- 
rities upon  the  minute  anatomy  of  the  testis  and  its 
ducts;  the  epididymis  being,  according  to  them,  the 
only  portion  of  the  seminal  passage  lined  by  columnar 
epithelium. 

The  longitudinal  sinus  represents  the  rete-testis  in 
a  dilated  state,  forming  an  irre^lar  but  common  canal : 
and  the  tributary  ducts  opening  intO'it  are  the  diseased 
and  dilated  vasa  recta  of  the  original  testis. 

In  conclusion,  the  committee  would  add,  that  it  has 
been  unable  to  obtain  any  information  of  the  record 
of  a  similar  case  of  foetal  disease,  and  that  thereupon, 
so  far  as  it  knows  to  the  contrary,  this  is  an  umque 
case  in  pathological  history. 

Stephen  Kooers. 

F.  C.  FlWNBLL. 

£.  Kraokowizeb. 

Executive  Session. 

Minutes  of  previous  meeting  read  and  approved. 
Dr.  G.  H.  Wynkoop  was  elected  a  member. 
On  motion,  the  Sv/ciety  adjourned  until  the  second 
Wednesday  in  September. 

^^•'''"^'-  Digitized  by  Google 


832 


THE  MEDICAL  RECORD. 


€ontepor(tftncL 


"THE  UTERINE  ELEMENT  .IN  PRACTICE" 
AGAIN. 

To  THS  Eduoe  of  tbb  Msdioal  Biooed. 

Sib — In  some  of  the  operations  now  undertaken  with 
the  uterus,  is  there  not  some  danger  of  doing  harm,  eyen 
endangering  life  ?  Can  it  be  slit  up,  have  its  cervix 
dilated  with  sponge-tents,  injections  thrown  into  its 
cavity,  etc.,  without  any  nazard,  if  discrimination  and 
caution  be  not  exercised  ?  As  bearing"  on  this  point,  I 
quote  a  statement  in  the  American  Medical  Journal  in  a 
notice  of  the  Transactions  of  the  Obstetrical  Society  of 
London :  *'  Dr.  R.  Greenhalgh  presented  a  paper  on 
mechanical  dysmenorrhoea,  in  which  he  states  tnat  he 
had  operated  upon  nearly  three  hundred  cases  of  this 
affection,  with  but  few  and  slight  casualties.  In  one 
there  was  rather  profuse  haemorrhage,  for  which  plug- 
ging was  had  recourse  to.  In  about  five  others  pelvic 
cellulitis  ensued,  a  casualty  which  is  by  no  means  un- 
frequent  after  the  use  of  sponge-tenta  In  one  perito- 
nitis WAS  set  up,  and  terminated  fatally."  Are  such  in- 
cidental casualties,  resulting  in  one  case  in  death,  not  to 
be  taken  into  the  account  ?  Should  they  not  admonish 
to  the  practice  of  some  caution?  Should  they  not 
hinder  young  practitioners  from  plunging  headlong  into 
uterine  practice  ?  There  is  no  part  of  the  physician's 
business  that  requires  more  accurate  discrimination,  and 
the  specialty  of  the  treatment  of  female  diseases  ought 
notw  therefore,  to  be  entered  upon  at  the  beginning,  but 
it  snould  be  a  gradual  outgrowth  fi-om  a  general  prac- 
tice, gathering  up  its  stores  of  diagnosis  in  the  course  of 
long  years.  This  being  so,  it  is  not  wonderful  that  we 
have  occasiof  al  revelations  of  great  blunders  in  the 
diagnosis  and  practice  of  newly-fledged  practitioners  in 
female  diseases.  I  have  known  one,  who  flourished 
largely  with  the  speculum,  to  mistake  a  head  for  a  breech 
presentation,  when  the  head  could  be  distinctly  felt 
passing  down  through  the  well-opened  os  uteri,  show- 
mg  that  his  touch  was  not  well  educated — ^however  it 
might  be  with  his  sight — and  I  have  known  another  to 
diagnose  grave  disease  of  the  uterus  and  prescribe 
accordingly,  when  the  occurrence  of  abortion,  before 
the  remedies  were  applied,  retealed  the  true  nature  of 
the  case.  Other  mistakes  could  be  cited,  but  these  wi'l 
sufl&ce.  I  remark,  in  passing,  that  the  errors  committed 
from  lack  of  experience  in  those  who  undertake  early  in 
their  practice  to  foist  up  a  reputation  for  the  treatment 
of  female  diseases  are  undoubtedly  frequent,  for  the  few 
that  accidentally  come  to  light  must  be  a  small  portion 
of  those  which  actually  occur. 

I  have  spoken  in  a  previous  article  of  the  common- 
ness of  the  error  of  supposing  ulceration  of  the  os  uteri 
to  exist  when  it  does  not.  I  have  no  doubt  that  quacks 
and  demi-quacks  (of  whom  we  have  many  in  our  ranks) 
often  call  the  slightest  patch  of  redness  an  ulcer,  or  even 
pretend  that  one  exists  where  there  is  not  the  shadow 
of  disease  to  be  seen  on  the  organ.  In  this  latter  case 
the  patient  may  appear  to  be  cured  by  the  local  appli- 
cation, and  may  give  the  doctor  great  praise  for  having 
found  out  just  what  the  matter  is,  as  it  is  expressed,  and 
for  knowing  just  what  tb  do.  And  yet  it  is  the  general 
remedies  that  have,  of  course,  effected  the  cure,  while 
he  may  have  merely  pretended  to  apply  the  nitrate  of 
silver,  or^  if  he  has  really  applied  itj  his  light  touches 
have  inflicted  no  damage  that  is  not  readily  recovered 
from  by  the  membrane.  Indeed,  I  have  no  doubt  that 
even  when  there  is  considerable  of  that  lesion  which  I 
have  spoken  of  as  being  by  far  more  commonly  found 
on  the  OS  uteri  than  any  other,  general  treatment  alone 


may  often  succeed  without  any  local  application-— that 
it  often  did  before  the  speculum  was  introduced  into 
practice,  though  it  w  very  certain  that  judicious  local 
treatment  may  be  of  essential  service  in  such  cases.  To 
attribute  all  or  most  of  the  symptoms  to  this  lesion 
where  it  exists^  as  is  often  done,  is  a  great  error.  In 
most  cases  it  is  a  small  part  of  tiie  mfficulty,  and  in 
many  it  is  one  of  those  local  ailments  that  have  their 
origin  in  a  general  condition.  I  will  quote  here  what 
Guerin  says  of  the  symptoms  attributed  to  the  so-called 
ulceration : 

'*  As  the  human  mind  has  a  great  tendency  to  assign 
effects  to  causes  which  it  can  readily  appreciate,  tiie 

f)ains  which  women  so  fi  equently  experience  in  their 
oins  and  abdomen  have  generally  been  attributed  to 
ulceration  of  the  uterine  nook.  This  ulceration  answers 
to  all — pains  of  the  stomach,  of  the  kidneys,  dyspepsia, 
hysteria,  nervous  affections  of  all  sorts — everything  is 
explained  by  excoriation  of  the  uterine  neck.  Alier 
having  examined  many  thousands  of  women,  I  think 
myself  right  in  affirming — 

"  Fir$t.  That  these  ulcerations  cannot  cause  the  pains 
which  have  been  attributed  to  them. 

"  Second,  That  these  pains  are  caused,  in  a  very  large 
majority  of  cases,  by  phlegmonous  inflammation  of  the 
large  ligament^  by  an  ovaritis,  a  pelvic  peritonitis,  or  by 
a  hsematocele,  or  finally  by  an  intestinal  lesion  to 
which  the  physician  gives  no  ferther  thought  when  he 
has  discovered  an  mceration,  however  Eu^ght,  of  the 
neck." 

I  remark,  in  passing,  that  it  is  doubtful  whether  the 
symptoms  mentioned  are  as  firequently  to  be  attributed 
to  these  local  diseases  as  Giierin  states-^ very  often  they 
are  either  functional  or  nervous  results,  dependent, 
sometimes,  undoubtedly,  upon  a  morbid  general  condi- 
tion, which  must  be  relieved  by  general  remedies. 

Guerin  thinks  that  the  useftilness  of  the  speculum  has 
been  vastly  overrated,  while  that  of  the  touch  has  been 
as  much  undervalued,  of  late  years,  in  the  investigation 
of  the  diseases  of  ihe  uterus.  If  the  question  were  be- 
tween not  using  the  speculum  at  all  and  using  i  as  ex- 
cessively as  many  do,  I  am  free  to  say  that  the  former 
is  preferable— in  other  words,  I  believe  that  those  who 
rely  upon  the  symptoms,  together  with  what  they  can 
discover  by  the  touch,  when  that  is  necessary,  really 
make  out,  m  the  great  majority  of  cases,  a  more  correct 
diagnosis  than  those  who  make  so  very  much  of  the 
diseases  of  the  uterus,  and  especially  of  its  os,  and  use 
the  speculum  with  great  freedom.  While  the  latter 
think,  generally,  altogether  too  much  of  the  local  dis- 
ease, and  perhaps  sometimes  find  such  disease  when  it 
has  no  real  existence ;  the  former,  though  indeed  fail- 
ing, sometimes,  to  appreciate  truly  what  is  local,  will, 
with  few  exceptions,  meet  properly  the  necessities  of 
the  case.  It  is  these  exceptional  cases  that  the  specu- 
lum is  needed  to  take  care  of  fully.  Practically  the 
use  of  the  speculum  is  required  in  some  cases  besides 
these,  for  disease  of  the  os  may  be  occasionally  suspected 
where  it  does  not  really  exist;  but  allowing  all  proper 
latitude  for  its  use  as  a  means  of  investigation,  it  need 
not  be  frequently  employed. 

There  is  one  item  in  the  practice  of  some  who  have 
so  frequently  found  ulceration  of  the  os  uteri,  that  de- 
serves a  slight  notice.  It  has  been  common  to  enjoin 
rest  upon  the  bed  for  some  time  aftier  applying  the 
nitrate  of  silver.  I  have  never  found  this  necessary  in 
any  cases  where  I  have  applied  it,  that  is,  on  account 
of  its  application,  though  it  may  have  been  sometime* 
necessary  for  other  reasons.  But  the  expedient  certainly 
gives  importance  to  the  local  treatment  in  the  eyes  <if 
uie  patient,  and  is  quite  a  usefiil  part  of  the  programn&e 
with  the  cunning  and  quackish  phjrsidan^    j  ) 

Digitized  by  VjOOQIC  j 

1 


THE  MEDICAL  RECORD. 


ddd 


Far  be  it  from  me  to  undervalue  recent  researches  in 
uterine  patholof^y,  and  the  multiform  coutrivaDces  for  in- 
TesUgating  and  treating  diseases  of  the  uterus.  At  the 
same  time  I  must  say  that  while  with  many  most 
flagrant  abuAes  exist  in  connection  with  their  treatment 
—often  actually  quackish — even  with  the  best  there  is 
apt  to  be  too  much  made  of  local  disease,  and  not 
enough  of  that  which  is  general.  It  is  precisely  as  it 
has  been  with  various  local  diseases  from  time  to  time 
— for  example,  to  take  a  recent  instance,  what  has  been 
called  the  clergyman's  sore-throat,  &n.  error  which  has 
had  its  day  and  is  now  fast  passing  away. 

The  practice  of  the  abuses  which  I  have  noticed  in 
the  treatment  of  female  diseases  is  doing  much  harm  in 
various  ways.  It  hinders  from  proper  investigation, 
some  being  so  disgusted  with  Balbirnie,  and  his  succes- 
sion of  apostles  of  the  speculum,  that  they  will  not 
use  the  instrument  at  all.  It  encumbers  our  journals 
and  other  records  of  the  profession  with  false  facts. 
Not  only  the  statements  of  those  who  stoop  to  quackery, 
but  those  of  men  who  have  exclusive  and  one-sided 
views,  mislead  the  profession  and  embarrass  its  investi- 
gations. And  beyond  all  this,  it  brings  discredit  on  the 
profession,  and  gives  currency  to  that  miserable  delu- 
sion, the  necessity  of  having  female  practitioners  to  be 
demoted  especially  to  the  care  of  female  diseases.  The 
honorable  and  high-minded  physician  never  need  to 
offend  A  true  delicacy  in  using  si\  necessary  means  for 
the  investigation  and  treatment  of  disease,  but  unneces- 
sary measures  may  so  offend,  and  their  influence  is 
wider  than  in  the  particular  cases  in  which  they  are 
used,  and  tends  to  mar  the  standing  of  the  whole  pro- 
fession, and  pat  it  into  a  false  position.  i' 


ANOTHER  NEW  POST-MORTEM  NEEDLE. 

To  TBS  EDROB  or  TBI  M XDIOAL  BSOOBD. 

Sm — ^In  the  "  Rboord,"  of  July  15th,  a  post-mortem 
needle  is  described  and  illustrated,  which,  while  supply- 
ing a  more  available  means  than  the  ordinary  needle 
for  the  purpose,  is  yet  surpassed  by  an  invention  that  I 
beg  leave  to  describe,  and  which  I  have  found  invalu- 
able where  many  autopsies  were  to  be  made,  and  time 
predoua 

It  is  the  invention  of  an  Irishman,  the  most  wonder- 
fully ingenious  man  I  think  I  have  ever  met,  but  whose 
devotion  to  rum  blasted  every  project,  and  brought  him 
from  Uie  outset  b^low  the  chance  of  fame.  Among 
his  thousand  inventions,  he  had.  devised  a  sewing- 
machine  for  his  wife,  which  was  used  in  his  home  long 
before  the  possibility  of  such  a  machine  had  been 
demonstrated  by  a  more  energetic  inventor,  to  the 
public  What  his  real  name  was,  I  cannot  say ;  but  at 
the  time  of  hia  invention  of  the  post-mortem  needle, 
he  had  fallen  to  be  plain  dead-bouse  man  at  Flatbush 
Hospital;  and^  to  show  how  revoltingly  debased  the 
appetite  for  hquor  may  become,  he  would  drink  the 
ilcobol  fr^om  our  choicest  pathological  specimens^  and 
fill  up  the  jara  with  water — but  to  the  needle : 

The  instrument  has  a  straight  firm  handle  with  a 
needle  fastened  into  it  like  an  awl.  curved  near  the  end 
and  perforated  at  the  extremity  like  the  one  referred  to 
in  the  "  Bboosd  "  of  the  16th  inst  A  common  spool, 
holding  Uie  thread,  is  so  placed  uoon  the  needle  m  its 
long  axis  near  the  handle  as  to  eaaUy  revolve  and  cause 
the  thread  to  unwind  when  necessary.  The  free  extre- 
mity of  the  thread  is  passed  through  the  eye  of  the 
needle,  forming  a  loop. 

The  operation  of  the  instrument  is  simple — it  is  passed 
through  botli  eiges  of  the  out,  the  loop  of  thread  is  then 
caoght  between  the  thumb  And  finger,  drawn  onward, 


the  needle  withdrawn  as  vrith  an  aneurism  needle ;  the 
handle,  needle,  and  spool  are  then  passed  through  the 
loop  and  drawn  tightly.    The  result  is  a  lock-stitch. 

The  instrument  ha<s  never,  so  far  as  I  am  aware,  been 
presented  to  the  profession ;  but  it  is  so  simple,  so 
efficient,  and  may  so  readily  be  made,  that  it  wifi  com- 
mend itself  A  more  delicate  needle  would  be  a 
valuable  addition  to  a  pocket-case  for  ordinary  wounds 
Yours  truly, 

E.  HOLDEN,  M.D. 
100  Orange  Street,  Newark,  K  J. 


©bttuarg* 


ALFRED  AEMAND  LOUIS  MARIE 
VELPEAU, 


DE 


or  PABia, 


Whose  death  was  announced  by  an  Atlantic  cable  tele- 
gram as  having  occurred  Aug.  23,  ult.,  was  born  May  18, 
1793,  at  Br^e  in  the  department  of  Inde  et  Noir. 
The  son  of  a  poor,  easy-going,  kind-hearted  blacksmith, 
who  had  destmed  him  for  the  same  trade,  iiis  advantages 
for  even  a  rudimentary  education  were  quite  Umited— 
so  much  so,  indeed,  that  he  learned  to  read  from  three 
books,  which  constituted  his  father's  library.  These, 
which  at  the  age  of  ten  years  he  could  recite  verhaMmy 
were  a  treatise  of  BxppocraieB^he  Rustk  Mason^  and 
the  Poor  People's  Physician,  Having  thus  thoroughly 
mastered  their  contents,  he  began  to  practice  writing, 
and  soon  became  proficient  enough  in  arithmetic  to  keep 
lus  father's  small  score& 

About  this  time  a  curate  who  had  been  sent  to 
Br^che,  opened  a  school  for  gratuitous  instruction,  at 
which  the  most  attentive  and  eager  student  was  our 
eminent  surgeon  of  the  future.  Tne  death  of  this  pre- 
ceptor, at  the  end  of  only  a  four  months'  residence, 
again  interrupted  his  plans.  In  his  sixteenth  year, 
however,  he  was  befriended  by  a  physician  from  a  dis- 
tant village,  who  procured  for  him  the  privilege  of  pros- 
ecuting his  studies  in  the  family  of  a  we  ilthy  gentle- 
man. This  mine,  it  is  needless  to  say,  was  well  worked, 
r  Having  taken  up  his  residence  at  Tours,  a  populous 
town  some  eight  leagues  distant  from  his  burtbplaoe, 
he  became,  after  only  fifteen  months  of  study,  the  en- 
vied possessor  of  the  diploma  of  "  Officier  de  Saute,** 
and  soon  after  "  Interne  of  the  Hospital.  These  hon- 
ors he  attained  while  practising  the  most  rigid  economy, 
Uvine,  says  one  authority,  "  on  a  scanty  supply  of  coarse 
bread  and  cheese,  sent  to  him  once  a  week  by  his 
thoughtful  mother."  He  subsequently  became  first-as- 
sistant to  Monsieur  Bretonneau,  surgeon  of  the  hospital 
at  Tours,  attending  to  his  private  patients  and  occasion- 
ally collecting  a  well-earned  odd  fee  on  his  own  account, 
— all  of  which  brought  him  into  notice,  and  indirectly 
added  to  the  income  of  two  hundred  francs  allowed  by 
the  hospital  to  servitors  of  his  grade. 

An  affair  of  the  heart,  however,  in  which  a  fickle  maid 
played  an  important  part,  provoked  him  to  abandon 
Toiurs  for  Paris,  suppHed  only  with  a  loan  of  ten  Napo- 
leons and  a  letter  from  his  finend.  Monsieur  Bretonneao, 
to  the  excellent  Dr.  Jules  Oloquet  Here,  studying,  fol- 
lowing the  hospitals,  and  still  fighting  hand-to-hund 
with  his  old  enemy,  povertv,  he  was  advised  by  Dr. 
Oloquet,  whom  he  soon  numbered  among  his  friends,  to 
ti^e  his  chance  at  the  public  Oonoours,  an  institution 
which  looked  for  only  one  qualification  in  a  candidate^ 
ability  to  stand  tlie  test  of  its  examination.  In  this 
way  he  won  his  position  in  the  Hospital  St.  Louis, 
where  he  remained  three  years.    He  is  next  found  tke 

digitized  by  ^ JIC 


984 


THE  MEDICAL  BBCORD. 


private  assistant  of  Monsieur  Bongon,  surffeon  to  the 
Duke  de  Berry.  The  Concoure  now  awarded  him  still 
another  honor,  that  of  "  Aide  d*Anatomie  "  to  the  fac- 
ulty. In  May,  1823,  he  graduated,  and  in  the  following 
year  was  appointed  "  Professor  Agr^g^.'*  A  surgeon 
of  the  Bureau  Central  in  1828.  h^  still  found  means  for 
constant  improvement,  and  although  an  acknowledged 
chief,  the  impartial  Concours  refused  him  the  chair  of 
"External  Pathology/*  which  he  so  obstinately  contest- 
ed. In  1830,  the  Concours  returned  three  names  for  the 
Obstetrical  Chair  as  equal  in  merit— Moreau,  Dubois,  and 
Velpeau,  the  first  of  whom  was  chosen.  In  h's  last 
contest,  which  was  in  1836,  he  won  the  chair  of  Clinical 
Surgery. 

Velpeau  was  a  member  of  most  of  the  scientific  bod- 
ies witii  which  Paris  abounds,  and  in  1859  attained  the 
dignity  of  "  Commandant  in  the  Legioo  of  Honor.'*  A 
judicious  operator,  a  voluminous  writer,  a  lucid  lecturer, 
and  an  indef  itigable  student,  he  well  deserved  the  title 
given  him  by  one  of  his  admirers,  of  "  King  of  Sur- 
geons."   He  died  of  nephritis. 

MICHAEL  PAKADAr,  D.O.L.,  P.R.S., 

OF  LONIXW. 

Prof.  Faradat,  the  eminent  English  chemist  and  natu- 
ral philosopher,  who  died  in  London,  England,  August 
27,  1867,  was  bom  in  Surrey,  England,  September  22, 
1791.  His  father  being  a  working  smith,  tne  deceased 
was  unable  to  obtain  oUier  than  the  most  ordinary  edu-^ 
cation  at  a  common  day-schooL  When  a  lad  of  thirteen 
years,  he  was  apprenticed  to  a  London  bookbinder,  and 
kaving,  through  his  position,  the  means  of  obtaining 
sever^  scientific  works,  he  studied  them  carefully,  and 
by  the  assistance  of  a  treatise  on  electricity,  was  en- 
aoled  to  construct  his  first  electrical  macmne  with  a 
glass  phial  Subsequently,  through  the  kindoe$«  of  a 
member  of  the  Royal  Institution,  Mr.  Faraday  obtained 
permission  to  attend  the  last  four  lectures  of  Sir  Hum- 
phrey Davy,  in  1812.  He  afterwards  sent  to  the  kind- 
hearted  pmla<K>plier  a  copy  of  the  notes  h  e  had  taken, 
and  requested  his  assistance  to  enable  him  to  "escape 
from  trade,  and  to  enter  into  the  service  of  science.'* 
Sir  Humphrey,  after  asoertaining  the  ability  of  the  ap- 
plicant, promptly  complied  with  his  request^  and  made 
him  his  chemical  assistant  at  the  Royal  Institution.  The 
deceai^ed  subsequently  travelled  throughout  Europe  as 
the  assistant  and  amanuensis  of  his  patron,  and  on  his 
return  to  England  resumed  his  position  at  the  Royal 
Institution.  The  progress  of  Mr.  Faraday  was  now 
rapid  and  succeesfuL  In  1820  he  discovered  tiie  chlo- 
rides of  carbon ;  in  1821  the  mutual  rotation  of  a  mag- 
netic jpole  and  an  electric  current,  and  m  1823  his  exer* 
tions  led  on  to  the  condensation  of  the  gases.  In  1833 
he  became  the  Professor  of  the  new  chair  of  chemistry 
at  the  Royal  Institution,  a  position  he  ever  after  held. 
The  honors  which  his  own  and  foreign  governments 
and  institutions  bestowed  upon  him  for  bis  services  to 
science  were  numerous.  He  was  a  Commander  of  the 
Legion  of  Honor,  Knight  of  the  Prussian  Order  of  Merit, 
Fellow  of  the  Royal  Societj,  Doctor  of  Civil  Laws,  one 
of  the  eight  foreign  Associates  of  the  Imperial  Acade- 
my of  Sciences  at  Paris,  besides  being  a  member  of 
many  learned  and  scientific  bodies  in  Europe  and  Ame- 
rica.   

Dr.  JAMES  JACKSON, 

or  BOSTON,  MMM. 

The  Bo?ton  papers  announce  the  death  of  this  physician 
as  having  occurred  August  27th,  at  the  age  of  ninety 
years.     Dr.  Jackson  was  a  native  of  Newburyport^ 


Mass.,  where  he  was  bom  on  October  3,  1777.  Iq 
1796  he  graduated  at  Harvard  College,  and  in  1802  was 
admitted  to  the  Massachusetts  Medical  Society.  He 
soon  won  a  high  position  in  hia  profes.<^ion,  and  in  1812 
became  Professor  of  the  Theory  and  Practice  of  Medi- 
cine in  the  Harvard  Medical  School,  which  positioQ  he 
held  for  twenty-four  years.  He  was  also  one  of  the 
founders  and  physicians  of  the  Massaohusetta  General 
Hospital,  and  was  elected  President  of  the  Medical  So- 
ciety several  times.  About  eighteen  montlis  ago  bis 
faculties  suddenly  failed,  and  thenceforward  his  physical 

Cowers  gradually  declined.    His  death  appeared  to  have 
een  caused  more  firom  old  age  than  firom  any  local  dis- 


J.  MASON  WARRBSN^,  M.D., 

or  B06TO1I,  UAm. 

Dr.  J.  Mason  Warren  died  at  his  residence  in  Boston, 
of  cancer  of  the  bowels,  Aug.  20.  Thua^  another  briehl 
light  in  American  surgery  has  been  extinguished.  Dr. 
Warren's  family  is  well  Imown  in  the  medical  history 
of  New  England.  The  names  of  his  father.  Dr.  John 
Collins  Warren,  and  of  his  grandfather.  Dr.  John  War- 
ren, will  always  be  associated  with  tnat  of  Mott,  as 
pioneers  in  the  surgical  field  of  America.  With  the 
rich  inheritance  of  his  name,  and,  in  our  opinion,  with 
more  ability  than  his  father  or  grandfather,  though  with 
less  sternness  of  character,  and  less  desire  to  attain  no- 
toriety, Dr.  J.  Mason  Warren  acquired  a  large  surgical 
practice,  and  was  imdoubtedly  looked  upon  as  the 
greatest  surgical  authority  by  the  publio  of  New  Eng- 
land and  the  British  Provinces. 

It  was  the  writer's  good  fortune  to  have  served  under 
Warren  at  the  Massaohuaetto  Geaeral  Hospital  and  in 
later  years  to  have  met  him  often  as  a  friend.  Pleasant 
is  the  memory  of  those  days  passed  in  intercourse  with 
Townsend,  Heyward,  Bigekw,  Sam.  Parkman,  and 
Warren,  of  whom  only  Townsend  and  Bigelow  still 
remain.  Where  else  could  be  found  a  surgical  corps  of 
such  genial,  honorable  men,  and  such  Me  enthusiasts 
in  their  profession  ?  Each  nad  his  peculiar  traits^  each 
his  special  excellencies. 

To  us  internes^  or  "  pupils,"  as  the  Trustees  of  the 
Mass.  GeviL  Hospital  have  unwisely  dubbed  the  house 
staff  of  that  institution,  Warren's/orfc  was  t'le  conscien- 
tious care,  and  the  assiduous  attention  which  he  deroted 
to  every  patient  who  came  under  his  charge.  Others 
could  operate  with  more  apparent  boldness,  and  with 
greater  coolness  than  he.  before  a  serious  operation  he 
would  vent  his  nervous  excitement  by  walking  up  and 
down  the  amphitheatre  aside.  His  hand  might  tremble 
as  he  took  the  knife ;  but  once  the  operation  commeno- 
ed,  all  signs  of  agitation  ceased  *  then  no  fingers  were 
steadier  than  his,  no  greater  skill  and  delicacy  of  mani- 
pulation could  be  shown.  But  it  was  jftar  excellence  after 
the  operation  that  Warren  won  our  admiration  by  his 
rare  combination  of  the  physician  with  the  surgeon. 
Early  and  late,  if  circumstances  required,  and  at  the 
sacrifice  of  private  practice,  he  would  visit  the  ho^ital 
and  watch  over  his  patient.  The  minutest  detail  receiv- 
ed attention.  Every  contingency  was  provided  for. 
The  richv-st  man  on  Beacon  street  could  have  received 
no  greater  care.  It  is  hardly  necessary  to  add,  that  he 
thus  endeared  himself  to  every  patient^  and  commanded 
the  esteem  of  his  assistants.  His  success  as  an  ogenUx 
was  also  dependent  in  a  great  measure  i4>on  this  fact 

In  all  our  dealings  wit£  him  as  internes,  Mason  War- 
ren was  always  the  same — ^kind,  considerate,  gentle- 
manly, at  the  same  time  that  he  was  exacting  m  the 
rigid  performance  of  our  duties ;  not  from  the  policy 
which  might  lead  some  "  visiting  surgeons  '*  to  mend 


Digitized  by 


tin^  surgeons    U 

Google 


TfflE  MEDICAL  RECORD. 


885 


th«ir  ways,  but  from  the  kindly  nature  bom  in  him. 
His  intimate  friend  and  fellow-Btadent,  Br.  Oliver  Wen- 
dell Holmes,  in  a  touching  tribute  to  his  memory,  sudi 
as  Hobnes  only  could  write,  says,  that  in  all  their  inter- 
eourse  be  never  knew  of  an  unkiod  or  harsh  word  be- 
tween Warren  and  his  associates. 

With  less  modesty  and  leas  of  a  retiring  disposition, 
ind  with  more  desire  for  fame,  Warren  might  have 
secared  a  wider  reputation,  to  which  he  was  frilly  en- 
titled. His  contributions  to  surgery  were  chiefly  re- 
ports of  cases,  published  in  the  current  medical  litera- 
ture of  the  day.  He,  however,  lived  to  complete  a 
most  elegant  work,  which  will  remain  a  monument  to 
his  memory  and  an  honor  to  American  surgery,  entitled 
"Surgical  Observations^  with  Cases,*'  and  bearing  the 
date  of  1867. 

We  liave  lost  in  Warren  a  skilfrd  surgeon,  a  true 
friend,  a  noble  and  upright  man.  B. 

PE.  JOHN  HART, 

^W  Wmw  TOKK. 

At  a  regular  meeting  of  the  ^^  East  River  Medical 
Anociation  of  the  City  of  New  York,"  held  September 
3,  1867,  the  following  preamble  and  resolution  were 
BDinimoasly  adopted  : 

Wkereatf  It  has  pleased  the  Almighty  Ruler  of  the 
Universe  to  remore  from  our  midst  Cootor  John  Hart^ 
a  valued  friend  and  asMoiate;  and 

Wherecis,  In  the  loes  of  one  so  intimately  connected 
with  the  East  River  Medioal  Association,  and  so  promi- 
nently and  honorably  identified  with  its  existence  and 
tims,  it  becomes  us  as  members  of  the  Association,  to 
give  an  earnest  expression  of  our  sreat  sorrow  in  this 
ontoward  bereavement;  therefore,  be  it 

Ee9ohedf  That  as  a  conscientious  practitioner  of  medi- 
eine— as  a  genial  friend— as  a  zealous  member  of  this 
Association  (of  whith  he  was  one  of  the  originators)— 
m  an  exemplary  and  Mthful  presiding  officer — ^hischar^ 
icter  has  ooinmanded  our  respect^  and  his  memory  will 
always  be  cherished. 

Resolved^  That  a  oopy  of  the  foregoing  be  published  in 
the  medical  journals  oi  this  city. 

Truman  Nichols,  M.D., 

R.  J.  O'SULLTVAN.   M.D., 

Wm.  Newman,  M.D., 

Committee. 

XUm  |)ubltcatton0. 


Books  ano  Pamphlvfs  Riohvxd. 

Kicbo-Ohemistbt  of  Poisons,  Inolddikq  thsib  Phtsiologt, 
Pathological  %»d  Legal  Relations;  adapted  to  the  use 
of  the  Mediod  Jurist,  Physician,  and  general  Gherofst  By 
Thbo.  G.  Wormlbt,  M.D.,  ProC  of  Chemistry  and  Toxicol- 
ogy in  Starling  Medical  College,  and  of  Natural  Sciences  in 
the  Capital  University  of  Columbus,  Ofaia  With  seventy- 
eight  illustrations  on  steel  New  York :  BaiHidre  Bros. 
W67.     8vo.,  pp.  e«8. 

Chimistet.  By  William  Thomas  Brande,  D.C.L.,  F.RS., 
L  ft  E.,  of  Her  Majesty^s  Mint,  and  Alfred  Swaine  Tat- 
UOVL,  M.D.,  F.R.S.,  Fellow  of  the  Royal  College  Physicians 
of  London.  9d  American  edition,  thoroughly  revised. 
Philadelphia:  H.  0.  Lea.     1867.    Bvo.,  pp.  764. 

Klkxents  of  Medioal  Cbexistbt.  By  B.  Howard  Rand, 
Prot  of  Chemistry  in  JeSerson  Medioal  College.  Philadel- 
phia: T.  Elwood,  Zell  k  Co.    1867.    12mo.,  pp.  899. 

ThB  PHTSKOLQeT  07  HaN,  DbSIONBD  TO  RePBUSBNT  THB  EX- 
ISTING State  or  Physiological  Soienob  ab  Applied  to 
THE  Functions  op  thb  Human  Body.  By  Austin  Flint, 
Jr.,  M.D.,  ProC  of  Physiology  in  Bellevue  Hospital  Medi- 


eal  College,  N.  Y.  Alimentation,  Digestion,  Absorption, 
Lymph,  and  Chyle.  New  York :  D.  Appleton  ft  Co.  186T. 
8vo.,  pp.  556. 

Physician's  Visftino  List  fob  1868.  Philadelphia :  Lind- 
say &  Blakiston. 

Injuries  or  the  Eye,  Orbit  and  Eyelidg,  Their  IiiMBDUTa 
AND  Remote  Effects.  By  George  Lawson,  F.R.C.S.t 
Eng.,  Assistant  Surgeon  to  the  Royal  London  Ophthalmio 
Hospital,  'Moorfields,  etc.  Philadelphia:  H.  C.  Lea. 
1867.     12mo,  pp.  408, 


Mttsxcoi  3ttm9  anlr  Xtms. 


pewonal. 

Professor  Ag^assiE  is  superintending  the  illustrations 
for  his  "  Journey  to  Brazil,"  the  work  being  ail  written 
and  in  the  printer's  hands. 

Surgeon  P.  G.  S.  Ten  Broeck  has  been  ordered  to 
Fort  Preble,  Maine,  to  relieve  Assistant  Surgeon  F.  Le 
B.  Monroe. 

Prop.  Hyrtl,  of  Vienna,  received  a  gold  medal  at 
the  last  Paris  Exhibition  for  his  anatomical  prepara^ 
tions,  and  Prof.  Trichmann,  of  Cracow,  the  bronze  for 
the  same.  Dr.  Politzer,  of  Vienna^  received  an  "  honor- 
able mention.*' 

Australian  Liechbs  are  just  now  threatening  to 
compete  with  those  of  the  Swedish  and  Hungariaa 
variety.  They  are  principally  collected  in  and  near  the 
Murray  river,  and  it  is  said  tnat  sometimes  250,000  are 
shipped  by  a  single  stoamer  for  the  English  market. 

The  Ohbmioal  News  and  Joifrkal  of  Physical 
Science. — ^Meshre.  Townsend  &  Adams,  of  this  city, 
have  undertaken  to  republish  in  this  country  this  wefl- 
known  aud  highly  esteemed  British  periodical.  It  is  to 
be  issued  in  monthly  parts  instead  of  being,  as  is  the 
original,  a  weekly  issue.  It  is,  typographically  ^>eak- 
ing,  well  executed.  The  enterprise  of  the  publishers 
deserves  substantial  support 

Gilding  by  Amalgamation. — M.  Dufresne,  of  Paris, 
has  introduced  a  new  process  for  gilding.  He  first 
covers  the  article  to  be  gilded  by  decomposing  a  basic 
salt  of  mercury,  by  means  of  a  galvanic  battery,  then 
precipitates  gola  by  the  same  means  upon  it,  and  lastly 
covers  the  article  with  another  deposit  of  mercury. 
The  article  is  then  heated  in  a  furnace  until  the  mer- 
cury passes  off  as  a  vapor,  when  the  coating  of  gold  is 
found  adhering  to  every  part  of  the  surface.  If  the 
volatilization  of  the  mercury  is  carried  on  in  a  dose 
fiirnace,  there  will  be  no  danger  to  the  workmen. 

The  New  York  Citt  D^driatb  Asylum. — The  build- 
ing about  to  be  erected  by  the  Ck>mmissioners  of  Public 
Charities  and  Correction  upon  Ward's  Island,  N.  Y., 
for  ihe  reclamation  <^  drunkards,  will  be  of  brick  in  the 
medis&Yid  style  of  arehitecture,  with  Mansard  roof 
and  ventilating  tun^ts.  In  its  construction  the  pa- 
vilion pLm  will  be  adopted — the  pavilions  to  be  eaok 
39  feet  vride  by  121  feet  long,  «nd  the  corridors  17  ieet 
wide  by  68  feet  long. 

The  expenditures,  with  a  view  to  ensure  the  modem 
improvements  in  the  matter  of  ventilation,  heating, 
wash-rooms,  water-doeets,  baths,  etc.,  will  be  on  a  lib- 
eral soale. 

A  New  Method  of  Prbberviho  the  Diad.— Th««  is 
now  on  exhibition  at  the  Now  York  Morgue  tbe  body 
of  a  drowned  man  supposed  to  have  been  in  the  water 
for  three  days  prior  to  itg  recovery,  and  whidi  is  1^^^ 

digitized  by  ^: _^lC 


886 


THE  MEDICAL  RECORD. 


subjected  to  an  experimental  preservatioQ.  It  is  in- 
dosed  in  a  metallic  case,  made  perfectlj  air-tight,  and, 
as  yet,  although  forty  days  have  elapsed  since  the  com- 
mencement of  the  experiment,  shows  no  signs  of  de- 
compohitioD.  This  result  is  obtained  by  forcing  the 
air  irom  the  case  and  supplying  its  place  with  a  cer- 
tain gas,  which  the  discoverer,  we  regret  to  state,  is 
inclined  to  keep  secret.  He  even  expresses  the  beHef 
that  the  body  in  course  of  time  will  become  as  hard  as 
stone. 

Professor  Pollin,  the  distinguished  Surgeon  and 
Oculist,  who  died  in  Paris  lately,  was  forty-three  years 
of  age. 

A  NEW  Hospital  (pavilion)  is  to  be  built  in  Berlin. 

Dr.  Mradows,  of  London,  has  been  elected  an 
honorary  member  of  the  Obstetrical  Society  of  Berlin. 

Dr.  Raole,  Assistant  Professor  in  the  Paris  Univer- 
sity, is  dead.  He  was  so  poor,  although  a  famous 
author,  that  the  cost  of  his  burial  was  paid  by  his  col- 
leagues. 

TflE  Cattle  Plague  has  appeared  in  the  province  of 
Old  Castile,  in  Spain. 

The  Percentage  of  Deaths  in  thi  Hospitals  at 
Hong-Kong  is  quoted  at  thirty-three  and  a  hal£  This 
is  said  to  arise  ft  om  the  fact  that  Chinamen  are  only 
brought  to  the  hospital  by  their  friends  when  in  a 
dying  condition.  Some  place  those  who  are  dying  out 
ot  doors,  in  order  to  save  the  cost  of  burial,  when  they 
are  picked  up  and  carried  to  the  hospital  by  the  poUce. 

The  Exhaustion  of  the  Native  Population  of  the 
Sandwich  Islands,  which  has  been  going  on  for  a  great 
number  of  years,  seems  to  be  accelerated  of  late.  Dur- 
ing the  last  six  years  there  has  been  a  decrease  of 
over  9,000.  The  death  rate  among  the  natives  is  now 
about  1,500  a  year  over  the  births ;  and  with  an  in- 
creasing ratio,  this  decimation  will  work  the  extinc- 
tion of  the  race  in  a  quarter  of  a  century.  European, 
but  more  especially  Californian  enterprise,  already 
sways  the  development  and  the  institutions  of  these 
islands,  and  the  proximity  and  unequalled  energy  of 
our  Pacific  States  mu^t  inevitably  draw  them  at  no  dis- 
tant day  under  the  protection,  if  not  the  possession,  of 
the  Union. 

New  Base  for  Artificial  Teeth. — ^Dr.  G.  F.  J.  Col- 
burn,  of  Newark,  N.  J.^  has  invented  a  substitute  for 
rubber  in  dentistry,  which  promises  to  be  of  much  value 
to  the  profession.  It  is  in  reality  a  cement  of  which 
mineral  asbestos  is  one  of  the  ingredients.  Asbestos  is 
a  very  peculiar  substance.  It  is  exceedingly  light,  and 
so  very  fibrous  in  its  nature  that  it  may  be  spun  and 
woven  like  cloth,  in  which  condition  it  resists  fire,  wa- 
ter, and  many  of  the  acids  with  complete  success.  Tak- 
ing advantage  of  these  natural  qualities.  Dr.  Colbum 
has^  by  long  study,  discovered  additional  substances, 
which,  when  uniteo,  form  an  artificial  base  that  posses- 
ses remarkable  toughness,  adherence,  strength,  and 
lightness.  The  ease  and  freedom  with  which  it  can  be 
moulded  is  a  strong  recommendation.  It  can  be  readily 
applied  to  gold,  plalinum,  and  other  plates.  We  have 
see. I  some  full  sets  of  teeth  on  aluminum  plates  that 
were  trul^  beautiful.  This  new  base  contains  no  in- 
gredients injurious  to  the  health  of  the  mouth  or  system. 
It  is  not  affected  by  acid  secretions,  is  free  from  all  taste, 
and  is  inodorous. — ScierUtfic  American, 

Remarkable  Preservation  of  Bebf. — Some  beef 
which  was  deposited  in  tins  beneath  aheap  of  stones  in 
Spitzbergen.  by  Capt  Parry,  in  1827,  was  recentiy  dis- 
covered, ana  a  portion  was  cooked  and  eaten  at  a  sup- 
per in  Stockholm,  after  being  preserved  for  forty  years. 


A  New  Method  of  Vitriftino  the  Surface  of  Irou 
has  recently  been  introduced  in  Paris.  Instead  of 
covering  the  surface  of  the  iron,  according  to  the  usual 
method,  with  a  very  fusible  glass  in  powder  and  then 
bringing  the  iion  to  a  red  heat^  the  materials  of  the 
glass  are  laid  upon  the  iroo,  which  is  heated  until  per- 
^ct  vitrification  takes  place.  The  consequence  is  that 
the  iron  becomes  oxidized,  and  combining  with  the 
silicic  acid,  the  iron  and  glass  form  one  substance.  The 
coating  may  be  as  thick  as  desired,  but  it  is  found  in 
practice  that  a  thick  coat  of  glass  soon  breaks  away, 
while  a  thin  one  lasts  for  a  long  time.  The  method  is 
being  applied  or  tried  upon  armor  plates  for  ships. 

The  Legion  of  Honor. — ^It  is  calculated  that  64,000 
persons  wear  decorations  of  the  Legion  of  Honor. 
What  chance  is  there  for  being  distinguished  in  such  a 
crowd  ? 

Decoction  of  Sage  nr  Profuse  Sweating. — ^M.  Vio- 
NARD,  of  Nantes,  after  the  manner  of  Van  Swieten,  has 
successfully  employed  decoction  of  sage  for  the  relief  of 
proftise  sweating.  In  the  case  of  a  man  twenty-five 
years  of  age,  who  had  sufiered,  from  time  to  time,  du^ 
ing  many  years  from  attacks  of  this  kind,  the  remedy 
proved  efifectual.  The  sweating  began  suddenly  between 
two  and  three  o'clock  in  the  moi  ning  all  over  the  body  and 
was  so  profuse  as  to  completely  saturate  the  bed-elothes, 
and  to  a  considerable  extent  the  mattress  also.  I  n  conse- 
quence of  the  regularity  of  the  attacks,  sulphate  of  quinia 
was  tried  as  an  antiperiodic,  but  unavailingly ;  the  per- 
spiration regulariy  reappeared,  and  without  any  apparent 
pathologicu  cause.  At  length  M.  Vignard  prescribed 
the  following  preparation :  Take  of  chopped  sage  leaves 
a  large  teaspoonful  {une  forte  prwde) ;  of  water,  six 
fluid  ounces.  Boil  the  sage  for  a  minute  or  two  in  the 
water ;  let  it  stand  to  co^  then  filter  and  sweeten  to 
taste.  From  that  time  the  perspiration  ceased  when- 
ever the  decoction  was  taken,  but  reappeared  when  it 
was  omitted.  M.  Vignard  suggested  the  use  of  iim 
remedy  in  the  colliquative  sweating  of  phthisi& — 
Joufn.  de  Med,  de  Nantes, 

To  Beautify  the  Teeth. — ^Dissolve  two  ounce««  of 
borax  in  three  pounds  of  boiling  water,  and  before  it  is 
cold  add  one  teaspoonful  of  the  spirits  of  camphor,  and 
bottle  for  use.  A  tablespoonful  of  this  mixture,  mixed 
with  an  equal  quantity  of  tepid  water,  and  applied 
daily  with  a  sott  brush,  preserves  and  beautifies  the 
teeth,  extirpates  all  tartarous  adhesion,  arrests  decay, 
induces  a  healthy  action  of  the  gums,  and  makes  the 
teeth  pearly  white. — Ex, 

A  Cheap  Glass-Cutter. — ^The  DruggieU^  Circular 
gives  the  following  description  of  a  cheap  glass-cutter: 
— Take  an  old  tbree-comered  file,  hei^  it  red  hot^  and 
plunge  it  into  a  previously  prep^ared  mixture,  of  equal 
parts  of  snow  and  salt,  stirring  it  about  so  as  to  co<h  it 
as  quickly  as  possible.  Then  grind  the  point  on  a  wet 
stone,  preserving  the  three  sides  as  neariy  as  possible, 
and  it  is  ready  for  use.  Lay  the  glass  to  be  cut  on  a 
periectly  smooth  surface,  apply  a  thin  flexible  rule,  and 
draw  the  point  of  the  file  quickly  over  the  glass.  A  litttle 
practice  will  teach  one  how  hard  to  bear  on  without 
fracturing  the  glass.  To  insure  success  it  is  needftd  to 
notch  the  edges  of  the  glass  at  the  extremities  of  the 
scratch.  The  file  can  be  reground  when  it  becomes  dulL 
Such  an  instrument  will  doubtless  be  found  serviceable 
for  cutting  glass  in  the  laboratory,  and  may  be  used  ^ 
as  a  good  substitute  for  the  diamond,  and  all  ordinary 
purposes. 

STunEHTS  nr  Germany. — ^There  are  about  2,600 
students  of  medicine  in  Germany,  exclusive  of  Austiift 
and  Bohemia. 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


837 


©rigmol   Communicotioits. 


SEA-SICKNESS. 

0BSERTATI0N3  AND  DBDUOTIONS   FROM   PERSONAL    EXPERI- 
ENCE. 

Bt  WK  mason  turner,  M.D., 

PHILADELPHIA. 

An  article  by  Dr.  Armand,  in  the  Gazette  Mtdicale  de 
ParU,  suggested  the  following  remarks : 

A  good  deal  has  been  written  on  this  complaint, 
which  for  several  reasons  we  might  designate  as  singu- 
lar. For  many  years  it  has  been  noticed  The  naxisea 
navigaiium  of  the  Latins,  the  mal  de  mer  of  the  French, 
the  seekrankheii  of  the  Germans,  and  the  mareo  of  the 
Spaniards,  all  correspond  to  our  sea-sieknesSy  and  has 
been  written  of  in  as  many  tongues  as  above  given. 
The  grand  point  which  has  been  discussed,  and  which 
is  at  issue  now,  concerns  the  cau^e  of  the  affection.  The 
answer  seems  ready  enough  to  any  question  of  this  na- 
ture. It  appears  very  natural  to  say  that  the  cause  of 
sea-sickness  is — the  «ea,  of  course  1  There  is  truth  in 
the  answer,  of  a  verity ;  and  yet  that  answer  may  be 
forced  to  mean  almost  anything;  for  instance,  that  (1) 
seargickness  is  occasioned  by  the  sight  of  the  sea;  (2) 
by  the  pectdiar  odor  arising  from  the  sea- water;  (3)  by 
the  ccilmness  of  the  sea;  (4)  by  the  pitching  of  the  sea ; 
(5)  by  the  rolling  of  the  sea,  and  bo  on,  ad  infinitum,  or 
ad  nauseam,  at  least.  On  many  of  these  circumstances, 
or  peculiarities,  it  has  indeed  been  contended,  depends 
the  true  cause  of  the  sea-sickness.  The  distressing 
phenomena  of  the  complaint  are  known  either  by  ex- 
perience, by  eighty  or  bv  hearsay,  to  almost  every  one. 
It  is  useless  to  say  anything  on  that  head.  It  has  been 
known,  in  some  instances,  to  produce  death  by  its  vio- 
lence, by  occasioning  haematemesis,  by  rupturitig  aneu- 
risms, and  by  producing  abortion  in  casas  of  advanced 
gestation ;  of  course,  the  fatal  results  here  being  the 
effect  of  the  violent  effort  to  vomit,  and  the  collateral 
forces  called  thus  into  action.  The  cause,  however,  as 
I  have  mentioned  above,  is  chiefly  deserving  of  inter- 
est, as  it  regards  sea-sickness.  It  has  been  stated  as 
different  by  a  dozen  different  authors.  At  one  time  it 
was  thought  to  be  the  specific  odor  arising  from  salt 
water,  or  an  absence  of  the  peculiar  ahnosphere  which 
floats  over  the  land.  Again,  for  a  long  time,  it  was 
considered  t)  be  the  unnatural  motion  imparted  to  the 
viscera  of  the  abdomen  and  to  the  stomach,  occasioning 
them  to  rub  against  each  other,  thus  producing  the  nau- 
sea. Again,  it  has  been  contended  that  it  is  owing  to 
an  improper  or  irregular  circulation,  which  leaves  the 
brain  badly  irrigated.  The  grand  nerve-centre  being 
thus  deranged,  the  stomach,  by  the  intimate  relation  it 
sustains  to  it,  is  secondarily  affected  through  the  sym- 
pathetic system,  and  we  have  the  result— nausea  and 
vomiting;  Some  have  explained  sea-sickness  by  com- 
paring tbe  fluids  in  the  body,  bo  far  as  ascent  and  de- 
scent are  concerned,  to  the  mercurial  column  of  the 
barometer,  ia.,  that  the  body  being  unnaturally  placed 
— thrown  or  tossed  about^  as  is  the  case  in  swinging^ — 
the  blood  has  an  unwonted  tendency  to  the  brain,  on 
which  it  presses,  impairing  its  functions;  then,  second- 
arily, the  stomach  partakes  of  the  derangement,  and 
we  have  nausea  and  vomiting.  Yet^  again^  it  has  been 
argued  that  perverted  visiony  occasioned  by  unusual  im- 
IH-essions  produced  on  the  brain  through  the  retina  (I 
mean  through  or  by  means  of  the  retina  as  the  medium), 
is  the  true  caose  of  sea-sickness.  Dr.  Armand  espouses 
this  view  m  U^.    It  was  that  feature  in  his  article 


which  arrested  my  attention,  and  made  me  at  once 
condemn  his  position  as  untenable.  Such  I  can  readily 
prove  it  to  be.    To  this,  however,  I  will  come  anon. 

So  fiu*  as  regards  the  odor  theory,  very  little  need  be 
said.  We  have  undeniable  facts  to  prove  this  cannot  be 
the  cause.  Some  of  our  fishermen  who  live  on  Gape 
Cod  have  their  houses  so  near  the  waves  of  old  ocean, 
that  the  spray  dashes  into  the  doora  Here  we  have 
every  odor  from  the  sea  which  it  is  possible  to  have ; 
saline  incrustations  cover  everything,  and  the  atmos- 
phere is  what  might  be  termed  excessifoeiy  marine. 
What  effect  is  visible  in  the  inhabitants ?  Nausea  and 
sea-sickness  ?    No  1  rosy  cheeks  and  hardy  frames. 

There  is  truth,  however,  in  the  theory  of  the  unnatu- 
ral motion  imparted  to  the  abdominal  viscera;  and,  hke- 
wise,  in  regard  to  the  opinion  that  sea-sickness  is 
occasioned  by  an  inequality  of  the  circulation  which 
leaves  the  brain  impoverished.  The  barometric-mer- 
cuiy-column  solution  is  not  now  generally  received,, 
and  for  good  reasons.  How  could  the  theory  prove 
true  in  practice,  in  regard  to  persons  who  occupied  a 
horizontal  position  throughout  the  voyage,  in  which 
case  the  blood  pressure  on  the  brain  amounts  to  noth- 
ing, or  almost  nothing  ? 

It  is  with  Dr.  Armand's  view,  however,  that  I  have 
particularly  to  deal,  that  of  tracing  sea-sickness  simply 
to  perverted  vision.  For  the  sake  of  doing  him  full  jus- 
tice, I  quote  the  Doctor's  words :  "  In  some  people  it 
(sea-sickness)  is  produced  if  they  look  out  of  a  carriage 
at  the  sides  of  the  road  and  vxxtch  the  trees,  apparently 
in  rapid  motion." 

I  have  italicized  the  words/*  look  "  andj"  watch  "  to 
call  attention  'Xo  the  fact  that  the  Doctor  has  the  vision 
intimately  concerned.  Again :  "  All  these  circum- 
stances, itiduding  sailing,  have  this  in  common,  that 
they  give  rise  to  an  interference  with  the  laws  of  per- 
spective, produce  perversion  of  vision,  cerebttd  fatigue, 
and  a  whole  series  of  sympathetic  phenomena,  reacting 
from  the  brain  upon  the  stomach  and  the  entire  organ- 
ism. A  proof  that  the  fatigue  of  the  eye  is,  in  tnese 
cases,  the  chief  cause  of  the  peculiar  feeling  is,  that  after 
having  waltzed,  the  most  certain  means  of  getting  rid 
of  vertigo  is  to  shut  the  eyes  for  an  instant;  while  on 
board  ship  a  pretty  sure  means  of  avoiding  sea-sickness 
is  to  looK  steadily  on  one  point;  a  better  still  is  to  lie 
down  and  dose  the  eyes,^* 

The  italics  in  the  entire  quotation  are  mine.  From 
the  extracts  given,  the  Doctor's  views  are  manifest.  His 
grounds  can  be  soon  rendered  untenable.  I  have,  my- 
self seen  considerable  experience  on  the  Atlantic,  Medi- 
terranean, and  in  St,  Gkorge's  Channel  During  my  voy- 
agings  I  have  experienced  weather  such  as  old  scdts  say 
they  never  saw  before,  and  never  desire  to  see  again. 
In  storm  or  calm  I  paid  a  strict  attention .  to  sea-sick- 
ness, endeavoring  to  determine  on  some  particular  and 
certain  cause  for  it.  I  am  pretty  welt  prepared  to  speak 
of  it,  both  from  observation  and  experience. 

In  May^  1859, 1  sailed  as  surgeon  in  the  American 
packet  ship  "  Admiral,*'  from  Havre  in  France,  to  New 
York.  During  the  voyage  I  took  especial  pains  to  note 
the  amount,  the  degree,  and  i^parent  cause  of  the  sea- 
sickness, of  which  there  was  much  throughout  the  pas- 
sage, and  to  observe,  particularly,  the  peculiar  state  of 
the  patient,  as  regarded  the  respiratory  organs,  digestive 
apparatus,  etc.  From  summing  up  in  my  note-book 
I  learned  the  following  when  I  arrived  in  New  York. 
Ist.  That,  in  the  calmest  weather,  so  far  as  the  «ea  was 
concerned,  no  matter  how  great  our  rate  of  speed  (and 
we  frequently  had  fine  breezes,  while  the  sea  was 
smooth)  there  toas  less  seatr^ickness,  showing  that  im- 
pressions made  on  the  corpora  quadrigemina  through 
the  medium  of  vision,  by  passage  through  the  water, 

digitized  by  ^ ~  ^^ 


338 


THE  MEDICAL  RECORD. 


bad  no  effect  2d.  That  the  worst  sickness,  and  most 
of  it.  we  had  when  the  ship  was  laying-to,  against  head- 
winds and  head-seas,  and  when  she  was  alternately 
pitching  in  the  chops  and  rolling  in  the  troughs  of  the 
sea.  This  was  when  we  were  motionless,  so  far  as  re- 
garded onward  progress,  and  our  only  motion  was  an 
undecided,  reluctant,  very  slow  drifting  to  leeward, 
attaining,  perhaps,  the  rate  of  a  quarter  of  a  mile  in  an 
lour,  a  speed  which  would  not  "pervert  '*  the  "  vision  " 
by  auy  means,  and  could  not,  fur  the  poor  emigrants 
were  nuddled  together  in  the  "'tween-decks"  of  the 
ship,  below  water-line,  where  at  mid-day  the  apartment 
is  as  dark  as  atmidnignt.  The  vision  could  not  be  per- 
verted in  this  case,  and  could  not  have  occasioned  the 
sea-sickness,  3d.  Again,  iu  perfect  cnlms,  as  regards 
the  winds,  when  the  ship  did  not  even  have  steerage- 
way  on,  when  a  long,  sullen,  lazy  roll  was  on  the  sea, 
the  remnants  of  a  late  gale,  sea-sickness  was  ever  on 
the  increase,  though  not  so  bad  as  in  a  chopped  sea,  as 
noticed  above.  This  was  the  case  when  we  were  cross- 
ing the  grand  banks  of  Newfoundland.  Sometimes,  in 
this  latitude,  the  breeze  died  away  so  completely  that 
we  fished.  The  vision  was  not  perverted  here,  no  more 
than  when  we  stand  on  the  beach  at  Cape  May  or  at 
Newport.  4th.  In  regard  to  the  patients,  I  observed 
that  those  most  affected  had  crammed  to  siufeiting 
their  geterally  healthy  stomachs  with  every  kind  of 
food  before  coming  aboard.  This  point  was  particu- 
larly noted.  Again,  those  persons  who,  presuming  on 
the  strength  of  their  stomachs  on  land,  had  dared  to  go 
to  sea  on  such  presumption,  were  most  often  and  speed- 
ily laid  low.  On  the  other  hand,  those  whose  digestion 
was  bad  on  land  and  on  sea,  who  had  been  suffering  for 
some  time  with  liver  or  general  dyspeptic  complaints, 
were  most  exempt  from  the  malady.  From  this  it 
might  be  inferred,  generally,  that  those  who  were  in 
ill  health  were  least  Sable  to  sea-sickness,  by  reason  of 
the  akeady  unsusceptible  state  of  the  stomach,  hver,  or 
brain,  the  latter  perhaps  primarily  This  leads,  very 
naturally,  to  what  I  consider  the  most  tenable  reasons 
given  for  a  certain  train  of  circumstances  causing  sea- 
sickness.   I  will  defer  this,  however,  yet  a  moment 

In  refutation  of  Dr.  A  rmand's  propositions  or  conclu- 
sions concerning  perversion  of  vision  causing  sea-sick- 
ness, I  have  brought  illustrations  au  contraire.  Firs*, 
in  observation  (1),  where  swift  passage  through  water, 
in  calm  seas,  with  eood  winds,  produced  the  least  bad 
effect;  and  secondly,  in  observation  (2),  when  in  a 
heavy  gale,  chopped  sea,  and  vessel  laying-to,  when  all 
the  emigrants  were  below  and  out  of  sight  of  every- 
thing; in  other  words,  where  vision  was  not  called  into 
play  at  all,  there  was  most  sea-sickness.  More  than 
that — and  I  am  indeed  thankful  to  be  able  to  report  this 
particular  point — there  was  a  man  aboard  the  "  Admiral " 
who  was  entirely  blind,  having  a  bard  cataract  in  one 
eye,  and  comeai  opaqueness  complete  in  the  other;  a 
man  who  had  not  seen  for  twenty  years — ^who  could 
not  tell  day  from  night — yet  that  man  was  violently 
sea- sick  for  thirty- eight  days ;  in  fact,  from  the  time  we 
left  the  "  Channel "  until  we  made  Sandy  Hook.  "  Per- 
verted vision  "  with  a  vengeance  I  Again,  how  can  it 
be  possible  that  perverted  vision  could  have  occasioned 
sea-sickness  in  one  who  kept  the  state-room  and  the 
bed  from  port  to  port  ?  I  hold  just  such  a  case  now  in 
my  memory.  A  lady,  on  the  French  steamer  "  Meandre," 
was  sea-sick  from  the  time  she  left  Marseilles  until  she 
landed  at  Alexandria,  in  Egypt.  Yet  she  never  stirred 
from  her  state-room,  which  was  below  the  saloon-deck, 
and  where  there  was  no  light  scarcely,  which  she 
avoided  altogether  by  closing  the  dead-light  and  fore- 
going the  use  of  the  lamp.  So  much,  then,  for  Dr.  Ar- 
m^xA'^  fatigue  of  the  eye  and  perverted  vision^  which  to  a 


blind  man  and  to  a  woman  shut  up  in  what  might  be 
termed  a  "  black-hole,"  is  somewhat  out  of  the  ordinary 
path  of  logic. 

From  careful  observation,  I  attribute  sea-sickness 
simply  and  entirely  to  the  peculiar  motion  of  the  ship, 
which  motion  affects,  by  deficient  circulation,  chiefly 
both  brain  and  stomach — ^it  matters  not  which  first 
Moreover,  I  think  it  attacks  especially  persons  of  a 
healthy  organization,  the  more  so  where  the  viscera,  as 
the  stomach,  hds  just  been  imposed  upon,  and  tampered 
with.  Generally  speaking,  we  must  conclude  that  the 
stomach  is  primarily  affected  by  the  unwonted  motion, 
and  that  the  dizziness,  headache,  etc.,  are  secondary 
and  dependent.  We  all  know  when  we  strike  a  person 
over  the  epigastrium,  the  blow  will  occasion  vertigo, 
and  sometimes  complete  unconsciousness.  If  we  strike 
the  same  person  a  blow  on  the  head,  vomiting  ensues 
as  in  concussion.  This  shows  an  intimate  relationship,' 
or,  as  a  Frenchman  has  said,  the  existence  of  two  brains. 

It  is  very  true  that  waltzing,  and  riding  backwards 
in  a  carriage,  will  frequently  produce  in  certain  persons 
a  nausea,  approximating  to  sea-sickness.  I  think  both 
are  due  to  the  same  cause.  In  waltzing  there  is  a 
wheeling  around,  an  unnatural  motion  wnich  throws 
the  brain  and  other  viscera  into  abnormal  positions, 
hence  the  effect  In  this  case  it  cannot  be  denied  that 
the  confused  blending  of  so  many  objects  hurriedly  and 
promiscuously  together  on  the  retina  tends  to  increase 
this  feeling.  But  at  sea  these  objects  are  not  present 
to  blend  together;  there  is  nothing  outside  the  ship 
save  the  Umitless  sky  and  water,  a  stray  blackfish,  an 
occasional  swarm  of  Mother  Carey's  chickens,  and  a 
solitary  gull  1  As  to  riding  backwards^  I  speak  this 
much  from  experience :  When  shut  up  m  a  close  car- 
riage and  jolted  over  a  rough  road,  I  am  sick  at  the 
stomach — virtually  «ea-sick,  and  it  matters  not  whether 
I  look  out  of  the  carriage  window,  or  keep  my  eyes 
closed.  This  effect  is  not  produced  when  I  am  on  a 
smooth  road.  Many  times  have  I  rolled  in  a  carriage 
over  the  gravelled  drives  in  the  Bois  de  Boulogne,  near 
Paris,  and,  although  going  backwards^  I  never  expe- 
rienced any  sickness  at  the  stomach,  it  might  well  be 
asked  here,  if  vision  is  at  fault  in  riding  backwards  in  a 
carriage,  why  is  it  that  persons  are  less  apt  to  be  sick 
in  an  open  cariiage,  where  vision  is  not  obstructed? 
Why,  again,  is  it  mat  those  who  are  made  sick  by  rid- 
ing backwards  in  a  carriage  are  never,  or  seldom  at 
least,  affected,  when  riding  backwards  in  a  rail-car.  I 
am  an  individual  example  as  regards  this  point  also.  I 
have  travelled  backwards  in  American,  French,  English, 
German,  Italian,  Swiss,  Austrian,  and  Egyptian  rail- 
cars,  where  one-half  of  the  passengers,  from  the  peculiar 
construction  of  the  carriages^  must  riae  backwards ;  yet 
I  never  saw,  in  this  experience,  a  case  of  perverted 
vision,  with  its  consequent  nausea.  We  never  hear  of 
a  person  being  sea-sicK  on  a  river  steamer.  Who  was 
ever  thus  affected  when  steaming  up  the  Hudson  or 
down  the  Mississippi?  Yet  the  vision  has  certainly 
every  inducement  to  become  confrised.  We  often  see 
the  sailor  made  sick  when  he  first  goes  ashore  from  a 
long  cruise.  He  is  accustomed  to  tread  his  decks,  to 
the  ceaseless  roU  of  the  octan.  On  land  he  forgets  this 
peculiar  (his  customary)  mode  of  perambulation ;  he 
raises  his  foot  and  lists  to  port  and  starboard,  to  wind- 
ward and  leeward,  expecting,  frotn  habit,  to  be  met 
half-way,  but  he  misses  stays  and  is  soon  abeam-ends, 
for  the  ground  is  a  fixture.  Vision  is  not  here  at  fault, 
but  the  man  is  sick^  and  we  know  why.  As  regards  the 
cure  of  sea-sickness,  little  can  be  done.  The  different 
viscera  must  he  JiahiiiuUed  to  their  unnatural  motion  and 
to  the  inequaUties  of  circulation  thus  produced.  A 
good  plan  is  to  wear  a  broad  bandage  tightly  around 

Digitized  by ^ ^_ 


THE  MEDICAL  RECORD. 


339 


the  abdomen  and  stomach,  and  try  to  ^' tough  o?/*"  the 
sickness  by  braving  the  weather,  and  in  storm  or  shine 
keeping  the  deck  and  learning  to  walk  it.  Lying  down 
amidships  relieves  sea-sicknes?.  So  far  as  remedies 
(medical)  are  concerned,  calomel,  citric  acid,  the  fluid 
extract  of  valerian,  and  the  oxalate  of  cerium  have 
been  recommended. 

The  advantages  resulting  from  sea-sickness  are  posi- 
tive and  negative.  Sometimes  the  agonizing  efforts  to 
relieve  the  stomach  occasion,  as  remarked  before,  a 
haematemesis,  and  fatal  results  have  occurred  in  ad- 
vanced pregnancy.  Moderately,  however,  sea-sickness 
acts  beneficially  by  exciting  the  liver  to  more  vigorous 
action,  and  by  causing  the  stomach  to  eject  surplus  bile. 
More  than  that,  it  eventually  tones  the  appetite  and 
leaves  the  bowels  in  a  ^ood  condition  by  the  increased 
peristaltic  movement  imparted.  As  Dr.  Chapman,  I 
think,  was  accustomed  to  say,  "It  shakes  up  the  gall 
bladder,  and  clears  the  ship  fore  and  aft." 

I  hope  my  remarks  as  regards  this  theory  of  per- 
verted vision  may  not  appear  egotistical,  nor  do  I  plead 
guilty  to  the  charge  of  hypercriticism.  My  remarks  are 
based  on  the  teachings  of  the  great  master— experience. 

CLINICAL  PAPERS  ON  EAR  DISEASE. 
By  D.  B.  St.  JOHN  ROOSA,  M.D., 

PKOFBSeOK  in  THE  UVIYEBSXTT  MBDIOAL  OOLLBOB. 
Na   I. — INSPISSATED  CERUMEN. 

It  is  intended,  in  the  papers  which  are  proposed  under 
ihe  above  title,  to  present  some  of  the  practical  results  of 
an  experience  in  ear  diseases,  reaching  over  quite  a  large 
numt'cr  of  cases,  in  such  a  way  that  they  may  be  useuil 
as  a  guide  to  those  who  see  comparatively  hltle  of  the 
dise&^ics  of  this  organ. 

Among    the   laity,    and    even    in    the    profession, 
hardening   of  the   ear-wax   is   regarded    as   quite   a 
common  and  harmless  affection.     All  forms  of  deaf- 
ness are  ascribed  to  this  cause,  and  the  first  treatment 
that  many  ear  patients  receive,  is  a  vigorous  syringing, 
to  see  "  if  the  wax  be  not  hardened,"  and  this  oft«n 
without  any  preliminary  examination.    Impacted  ceru- 
men is  indeed  quite  a  common  occurrence,  but  it  is  by 
no  means  as  simple  an  affair  as  has  been  generally  sup- 
posed.   I  do  not  mean  by  this,  that  it  is  anything  more, 
ts  a  general  thing,  than  a  local  affection,  but  as  such,  it 
mav  produce  results  very  detrimental  to  the  function 
of  hearing.    It  hardly  seems  to  occur  more  fi-equently 
in  persons  with  a  soft  skin  than  others,  as  has  been 
suggested  by  some  authors,  for  among  tJie    patients 
whom  I  have  seen,  careful  examination  has  failed  to 
delect  any  such  origin.    Persons  with  a  dry  and  harsh 
skin  have  as  oflen  come  to  me  with  impacted  cerumen, 
as  the  opposite  class.     A  frequent  cause  is  the  too  care- 
ftd  washing  of  the  auditory  canals  with  soap  and  water, 
which  some  over-clean  persons  delight  in  doing.     This 
rinsing  oat  the  canal  plugs  the  natural  yellow  wax, 
which  is  on  its  way  out,  down   to  the  bottom  of  the 
canal,  and  being  continued  morning  after  morning,  at 
last  fills  np  the  ear,  and  when  the  drum  is  once  tairly 
covered,  and  pressed  upon,  and  twt  till  ihen^  deaftie:*s 
results.    It  is  somewhat  remarkable  how  long  persons 
may  have  the  ears  plugged  up  with  hard  wax  without 
being  aware  of  it.     On  examining  patients  who  present 
themselves  with  impacted  wax,  only  causing  deafness 
on  one  side,  we  will  nearly  always  find  the  same  con- 
dition of  things  as  to  the  wax,  in  the  other  ear.    If  the 
oemmen  be  very  black  and  hard,  and  if  i^  comes  out  in 
one  lar^e  pltu^,  we  may  conclude  that  it  has  been  there 
for  jeara.    X  recall  two  cases  m  which,  from  definite 


accounts,  we  could  safely  conclude  that  five  years  had 
elapsed  since  the  deafiiess  occurred.  In  both  of 
these  cases  the  hearing  became  normal  after  the  wax 
was  removed.  Impacted  wax  sometimes  causes  serious 
inflammation  of  the  canal  and  drum.  In  one  case,  that 
of  a  young  lady,  suppuration  of  the  drum  resulted  from 
hardened  wax  pressing  upon  it,  and  the  wax  was 
removed  spontaneously  like  a  shot  from  a  pistol,  and,  as 
was  stated,  with  almost  as  loud  a  report  This  evacua- 
tion was  preceded  by  the  most  intense  pain.  The  re- 
moval of  a  plug  three- fourths  of  an  inch  long  from  the 
other  auditory  canal,  and  which  was  wedged  in  very 
tightly,  saved  the  patient  from  the  inflammation  whicn 
was  so  troublesome  on  the  other  side.  In  another  case 
still  under  treatment,  what  was  supposed  to  be  on  first 
examination  a  plain  case  of  inspissated  cerumen,  was 
found,  afler  removal  of  the  wax,  to  be  one  of  inflamma-' 
tion  of  the  integument  which  lines  the  canal  The 
removal  of  the  hardened  wax  was,  as  it  were,  only  the 
removal  of  a  huge  scab  from  an  ulcerating  surface.  I 
have  seen  other  cases  like  this. 

Inspissated  cerumen  causes  many  symptoms.  The 
prominent  ones  are : — 

1.  Sudden  deafness. 

2.  Tinnitus  aurium. 

3.  Vertigo. 

4.  Earache. 

Of  course  an  examination  is  the  only  method  of  clear- 
ing up  the  diagnosis.  This  exarnination  should  be  under- 
taken with  the  ear  mirror  (or  otoscope,  properly  called), 
and  not  with  the  syringe.  In  other  words,  it  should  be 
ocular  and  not  tactile.  The  trouble  can  hardly  be  con- 
founded with  any  other  affection.  Wax  which  presses 
upon  the  drum  is  almost  always  black,  not  yellow,  and 
nearly  fills  the  canal  No  decided  prognosis  can  be 
given  from  seeing  the  wax,  as  to  whether  its  removal 
will  restore  the  hearing.  Hardened  cerumen  very  often 
forms  over  a  perforated  or  ulcerated  membrana  tympani, 
and  is  then  of  course  only  a  small  part  of  the  disease. 
It  often  results  also  from  the  dropping  of  oils  into  the  ear 
for  some  therapeutical  end  seldom  attained.  The  origi- 
nal disease  for  which  the  oils  were  used  was  then  prob- 
ably an  affection  of  the  cavity  of  the  tympanum. 

The  habit  of  examining  the  ear  in  all  cases  with  head 
sjrraptoms,  will  sometimes  assist  materially  in  clearing 
up  a  diagnosis.  I  once  cured  a  man  from  the  effects  of 
a  supposed  sun-stroke,  by  removing  inspissated  cerumen, 
who  nad  been  treated  for  two  months  in  a  hospital  for 
cerebral  disease. 

Patients  who  have  once  had  impacted  wax,  are  apt  to 
suffer  again  fi*om  the  same  cause,  at  least  I  have  seen 
qnite  a  large  proportion  of  cases  in  persons  who  have 
been  affected  in  the  same  way  before.  Such  may  be  ad- 
vised to  have  their  ears  syringed  with  a  solution  of  bi- 
carbonate of  soda  and  water,  about  once  in  two  months. 
The  removal  of  the  hardened  mass  is  very  often  a  tedious 
affair.  I  once  spent  an  hour  a  day  for  a  week  in  remov- 
ing a  ma«s  from  the  ear  of  a  lady  patient,  in  the  in- 
terim the  best  solvents,  such  as  soda,  were  used.  With 
previous  soaking  the  canal  with  a  warm  solution  of  soda, 
say  a  drachm  to  the  half  pint,  ten  minutes  will  generally 
suffice  to  remove  the  mass.  A  good  india-rubber  syr- 
inge, holding  at  least  four  ounces,  should  be  used,  and 
the  auditory  c:mal  well  straightened  by  holding  up  the 
auricle  with  the  left  hand,  at  the  same  time  syringing 
with  the  right  The  glass  syringes  are  of  no  use.  The 
stream  sent  in  should  be  vigorous  but  steady,  and  care 
taken  not  to  imeot  it  with  such  force  as  to  cause  pain 
or  dizziness.  There  should  never  be  anv  pain  caused  in 
syringing  the  ear  for  any  purpose.  Where  pain  is  pro- 
duced, syringing  will  do  narm.  A  thin  bowl  is  held 
under  the  ear  by  the  patient.    No  asssistanc  is  needed. 


340 


THE  MEDICAL  RECORD. 


No  towel  need  be  placed  on  the  patient's  neck,   for 
with  careful  manipulation  no  water  will  be  spilled. 

The  ear  may  contain  an  astonishingly  great  quantity  of 
hardened  ear  wax,  and  an  examination  should  be  made 
very  frequently  during  the  course  of  the  syringing  to 
determine  when  it  is  all  removed.  No  after-treatment 
is  necessary.  If,  however,  sounds  are  oppressive,  as 
they  often  are,  after  the  removal  of  large  quantities  X)f 
ear  wax,  a  Uttle  cotton  may  be  worn  in  the  meatus  for 
a  day  or  two.  The  membrana  tympani  always  appears 
reddened  immediately  after  the  removal  of  the  cerumen, 
and  then  dulL  It  will  be  some  days  before  it  regains 
its  normal  translucency.  If  the  hearing  be  not  improved 
immediately  on  removing  the  wax,  the  middle  ear  should 
be  inflated  by  Politzer's  method.  The  drum  is  some- 
times sunken  in  temporarily,  and  one  or  two  passages 
of  air  through  the  eustachian  tube  will  restore  its  posi- 
tion as  well  as  the  hearing. 

Professor  Gross  recommends  the  use  of  a  pick  for  the 
removal  of  impacted  wax.  This  does  very  well  as  an 
aid  where  the  wax  is  very  hard.  If  it  be  used,  the  sur- 
geon should  have  a  mirror  on  his  forehead,  and  never 
Eut  the  pick  in  the  canal,  unless  he  can  see  just  what 
e  is  doing.  Painful  and  even  destructive  inflamma- 
tion may  be  caused  by  this  mining  out  process.  The 
general  practitioner,  to  whom  ear  cases  come  in  only  a 
small  proportion  in  his  daily  rounds,  bad  much  better 
rely  on  the  use  of  a  syringe  and  warm  water  where  pos- 
sible, having  previously  moistened  the  canal  with  a 
warmed  solution  of  soda,  zinc,  sulph.,  or  with  glycerine 
and  water,  sweet  oil,  etc.  Inspissated  cerumen  rarely 
occurs  in  children.  I  suppose  there  is  no  difference  in 
the  Uability  of  the  sexes,  and  I  know  of  no  well- 
established  proximate  cause,  except  ,the  one  given 
in  the  beginning  of  this  article,  i.e.,  packing  the 
meatus  by  the  frequent  pouring  in  of  water.  Yet 
we  might  say  that  it  is  common  for  hardened  wax  to 
collect  about  a  foreign  body  in  the  ear,  such  as  a  raisin, 
introduced  originally  to  relieve  earache,  a  cherry-pit, 
etc.,  but  here  the  inspissated  cerutaen  is  only  a  concomi- 
tant. It  is  hardly  to  be  credited,  although  forn^erly 
generally  believed,  that  a  diathesis  has  anything  to  do 
with  it,  or  that  there  is  any  disease  of  the  ceruminous 
glands.  The  cause  is  probably  in  one  way  or  another 
mechanical — that  is,  there  is  some  interference  with  the 
normal  and  daily  removal  of  the  secretion. 


HERPES  CIRCINATUS  AND  FAVUS  FROM 
ACHORION  IN  THE  MOUSE 

Bt  R.  CRESSON  stiles,  M.D. 

Two  specimens  have  accidentally  fallen  under  mj  ob- 
servation, within  a  few  years,  of  mice  infected  with  a 
vegetable  parasite  which  had  destroyed  the  scalp,  bUnd- 
ed  the  eyes,  and  covered  the  head  with  whitish  friable 
masses  of  fungus.  Such  specimens  (similar  at  least  in 
general  appearance)  I  find,  on  inquiry,  are  not  rare. 

Under  the  microscope  the  fungus  in  question  presents 
the  characters  of  Achorion  Schoenleioi ;  its  elements  are 
merely  smaller,  or  less  luxuriant  than  those  taken  &om 
a  crust  of  favus  on  the  human  scalp. 

Recently  I  inoculated  a  spot  on  my  forearm,  as  in 
va(icination,  with  a  fragment  of  the  liftvus-crust  of  a 
mouse,  and  in  ten  days,  when  I  had  supposed  the  inoc- 
ulation a  failure,  a  ring  of  herpes  circinatus  made  its 
i^peanmoe,  of  a  quarter  of  an  inch  in  diameter,  around 
the  point  of  inoculation.  The  ring  of  vesicles  continued 
to  enlarge  until  it  reached  an  inch  in  diameter,  the  en- 
cdosed  area  regaining  the  natural  appearance  of  the  skin. 
Under  the  microscope,  however,  its  epidermic  scales  were 


found  increased  in  sise;  many  of  them  containing  a 
formidable  nucleus  and  nucleolus  as  in  chronic  eczema. 

Attached  to  the  scales  of  epidermis  were  spore-bearing 
filaments  and  spores,  the  latter  rapidly  multiplying  by 
gemmation.  The  circle  of  vesicles  was  composed  of  nu- 
ilute  acuminated  elevations  of  the  cuticle,  filled  with  a 
clear  lymph  containing  cytoid  corpuscles  only.  At 
their  base  were  found  filaments  of  mycelium,  but  no 
spores.  The  vesicles  are,  without  doubt,  produced  by 
the  irritation  of  these  filaments  as  they  extend  in  the 
(so-called)  rete  mucosum. 

A  single  application  of  an  emulsion  of  the  strongest 
carbolic  acid  (from  deliquescent  crystals),  with  an  equal 
quantity  of  water,  caused  the  whole  disk  to  come  off  in 
a  single  scale  or  crust,  in  about  a  week,  and  the  disease 
did  not  reappear. 

Finding  the  results  of  this  inoculation  so  readily  con- 
trolled, I  repeated  the  experiment  on  two  of  my  medical 
friends,  who  were  sufficiently  interested  in  the  matter 
to  be  willing  to  lend  themselves  to  its  fisher  investiga- 
tion. In  both  the  period  of  incubation  wsb  ten  days. 
On  one  no  herpes  appeared,  but  instead,  the  h»r  follides 
became  the  seat  of  pomgo  favosa.    On  the  other,  her- 

Ees  circinatus  first  appeared ;  but  after  the  herpetic  ring 
ad  reached  an  inch  in  diameter,  pits  of  porrigo  favosa 
occupied  its  area,  a  hair  passing  through  the  centre  of 
each.  The  whole  area  was  elevated,  congested,  and  its 
epidermis  abounded  in  the  filaments  and  spores  of  the 
parasite. 

The  results  of  this  last  inoculation  gradually  disap- 
peared under  the  frequent  application  of  carbohc  acicL 

In  connection  with  the  pathology  of  favus,  the  re- 
searches of  Schoenlein,  Gruby,  Remak,  Lebert,  Bennett, 
Bazin,  and  Robin  possess  an  interest  inseparable  from 
successful  endeavors  to  trace  the  mode  of  action  of  a 
palpable,  material  cause  in  the  production  of  a  disease, 
the  nature  of  which  had  long  been  the  subject  of  sur- 
mises and  theories  only.  In  experiments  on  the  inocu- 
lation of  the  achorion  from  fkvus  in  man,  fitvus  only,  as 
far  as  I  am  aware,  has  been  produced ;  and  it  has  not 
been  suspected  that  herpes  circinatus  and  porngo  fa- 
vosa were  but  different  modes  of  growth  and  activity 
of  the  same  living  germs.  Yet  favus  has  often  been 
seen  to  follow  herpes,  and  the  coincidence  of  the  two 
diseases  in  the  same  person  is  quite  common. 

Recently  Tilbury  Fox  has  published  an  account  of  ex* 
periments  on  the  production  of  herpes  circinatus  from 
favus  in  the  cat.  The  souroe  of  favus  in  the  cat  is 
most  probably  the  same  disease  in  the  mouse.  The 
pulverulent  crust  of  favus  in  the  mouse  scatters  its 
fragments  on  the  slightest  touch,  and  articles  of  clothing 
are  thus  liable  to  the  infection,  and  readily  transmit  it 
to  man. 

The  value  of  carbolic  acid  in  destroyinfi^  a  parasite  so 
tenacious  of  vitality,  is  an  indication  of  the  importance 
of  this  agent  as  a  parasiticide  and  disinfectant. 

DELIRIUM    TREMENS    SUCCESSFULLY 
TREATED  WITH  COFFEE. 

Br  WM.  R.  WHITEHEAD,  M.D., 

MSW  TORK. 

Recently,  in  a  case  of  delirium  tremens,  I  observed  a 
peculiarly  marked  tranquillizing  effect  caused  by  strong 
coffee,  and  which  produced  prolonged  and  refi^^ing 
sleep,  after  the  usual  remedies  had  proved  ineffectual 

Mr.  C,  a  merchant,  visiting  New  York  on  business,  who 
had  been  drinking  very  hard  for  several  days,  was  taken 
vnth  delirium*  tremens  on  the  13th  of  last  March.  His 
friends  stated  that  they  believed  this  to  be  his  first  at- 
tack.   He  was  seen  by  a  physician  on  the  15th,  but  did 


THE  MEDICAL  RECJORD. 


341 


not  receive  further  medical  attention  until  the  night  of 
the  17th,  when  I  was  called  to  see  hira.  He  exhibited  the 
usual  Pjmptoms,  with  the  exception  of  a  remarkable 
absence  of  muscular  twitching  on  feeling  the  pulse.  His 
hallucinatious  were  at  times  very  amusing ;  he  was  not 
disposed  to  be  violent,  but  was  quite  tractable  and  easily 
controlled  by  his  attendants.  A  mixture,  containing 
about  a  drachm  of  chloroform  to  the  dose,  was  pre- 
scribed to  be  taken  every  few  hours. 

The  next  morning  he  was  more  quiet,  having  slept 
about  two  hours  during  the  night,  and  for  the  first  time 
since  his  illness.  The  condition  of  his  bowels,  his  urin- 
ary and  other  secretions,  were  carefully  observed.  His 
tongue  was  large,  white,  and  moist.  Some  pills  of 
opium  were  substituted  for  a  mixture  containing  chlo- 
roform and  tincture  of  hops,  ordered  early  in  the  day. 
A  small  quantity  of  ale  was  permitted,  and  some  be6f- 
tea  and  chicken-brot'i  ordered.  At  night  he  was  very 
restless ;  his  pulse  at  one  time  could  not  be  felt ;  his  ex- 
tremities became  cold  and  respiration  labored : — ^I  gave 
him  half  a  glass  of  whiskey. 

On  the  morning  of  the  19th  I  was  told  that  he  slept  an 
hour  or  two  soon  after  drinking  the  whiskey  ;  his  skin 
was  jaundiced,  and  he  was  costive.  Twelve  grains  of 
blue  mass  were  prescribed,  which  failed  to  produce  the 
desired  effect.  At  night  eight  grains  of  calorael  were 
given,  lo  be  followed  in  the  morning  by  a  clyster.  He 
vomited  several  times  during  the  day,  but  retained  the 
nourishment  which  he  had  taken. 

On  the  20th  his  bowels  were  slightly  relieved,  his  skin 
was  moist,  and  pulse  good.  I  prescribed  sulphate  of 
morphia  in  half-grain  doses ;  he  became  quite  restless 
daring  the  day. 

The  next  day  there  was  no  sensible  abatement  of  the 
restlessnes-*,  and  he  was  not  free  for  any  length  of 
time  from  ludicrous  or  disquieting  hallucinations.  At 
no  time,  however,  was  he  violent,  nor  did  he  manifest 
great  fright.  The  sulphate  of  morphia  was  repeated ; 
he  took  some  nourishment;  his  bowels  were  moved 
with  a  clyster.  Complaining  of  soreness  in  the  stomach  ; 
B  blister  was  placed  on  the  epigastrium. 

On  the  22d,  at  the  morning  visit,  being  satisfied  tftat 
the  morphia  had  failed  to  afford  relief;  bromide  of  po- 
tassium was  given,  twenty  grains  at  a  dose,  every  two 
hours,  in  a  suitable  mixture.  At  the  third  dose  he  be- 
came more  restless  and  excted  than  he  had  previously 
been.  The  bromide  was  discontinued,  and  three  sub- 
cutaneous injections  of  Magendie's  solution  of  morphia 
were  made,  of  thirty  drops  each,  at  an  interval  of  one 
hour  between  each  injection.  They  failed  to  produce 
the  slightest  apparent  effect  He  drank  half  a  ^lass  of 
whiskey,  which  seemed  to  quiet  him  considerably. 
He  took  frequently  during  the  day  Tourtelot's  beef- 
essence  with  much  reUsh. 

On  the  morning  of  the  23d  I  was  told  that  after  drink- 
ing the  whiskey  he  slept  three  hours,  but  I  found  him 
quite  restless.  Bromide  of  potassium  was  prescribed 
in  drachm  doses,  of  which  he  took  two,  each  at  an  in- 
terral  of  two  hours.  At  half-past  four  p.m.,  he  was  much 
more  quiet  He  asked  for  a  cup  of  coffee,  which  he 
drank  very  gratefully,  and  at  the  same  time  eat  a  small 
piece  of  bread.  Ninety  grains  of  bromide  of  potassium 
weie  ordered  at  a  dose,  in  which  doses  I  was  reli- 
able informed  it  had  been  recently  given  successfully 
in  deUrium  tremens  at  the  New  York  hospital : — 
Daring  the  night  two  doses  of  the  bromide  were  ad- 
ministered. His  urine  was  abundant  and  clear; 
pnlse  strong  and  fulL  He  slept  about  an  hour  that 
niprht.  The  next  day  his  bowels  were  slightly  moved 
with  a  clyster.  The  bromide  of  potassium  was  repeated 
twice,  in  doses  of  ninety  grains,  and  produced  at  the 
second  dose  some  anadsthesia  of  t^e  skin. 


On  the  25th  Professor  Willard  Parker  saw  him 
with  me,  and  observed  the  same  absence  of  mus- 
cular twitching  to  which  I  have  already  alluded. 
It  was  decided  that  the  patient  should  have  his  body 
and  limbs  well  rubbed  alter  being  washed ;  that  he  should 
be  permitted  to  have  a  cup  of  coffee,  and  as  much 
nourishment  as  he  could  be  induced  to  take.  At  night 
a  hot  whiskey  toddy  was  to  be  given  to  him,  to  be 
succeeded  by  mhalations  of  ether,  but  the  ether  was  not 
given. 

At  the  morning  visit  the  next  day  I  found  that  he 
had  not  slept  during  the  night,  and  was  very  rest- 
leas.  The  toddy  seemed  at  first,  as  his  nurse  informed 
me,  to  make  hira  more  quiet;  but  he  soon  became  much 
more  restless  after  than  before  taking  it.  Chloroform, 
opium,  brandy,  and  bromide  of  potassium  had  been  each 
unsuccessfully  essayed ;  the  last  of  these  substances  in 
such  doses  as  thoroughly  to  test  its  action.  One  prom- 
inent idea,  however,  governed  my  course  throughout 
the  treatment— it  was  properly  to  nourish  the  patient. 
I  regarded  the  alcohol  as  a  poison  to  be  eliminated,  but 
considered  that  the  equilibrium  of  the  nervous  system 
should  be  gradually  reestablished  by  suitable  stimulants. 
Only  temporary  benefit  resulted  from  the  remedies  used ; 
and  if  at  times  they  failed  to  produce  any  appreciable 
good,  they,  on  the  contrary,  once  or  twice  seemed  to  be 
productive  of  harm.  When  quiet,  and  sleep  did  not 
immediately  follow  the  use  of  brandy,  the  restlessness 
was  much  increased.  Morphia  appeared  to  be  positively 
injurious.  The  bromide  of  potassium,  in  doses  oftwenty 
grains,  greatly  excited  the  patient ;  increased  to  drachm 
doses,  and  then  to  doses  of  one  drach  and  a  half  each, 
made  him  a  little  more  quiet  I  was  not  encouraged, 
however,  to  contmue  any  longer  these  remedies,  but 
disposed  to  discontinue  further  medical  treatment,  and 
rely  upon  the  gradual  assimilation  of  concentrated  and 
nutritious  food,  to  allay  the  nervous  excitement,  and 
produce  sufficient  recuperative  sleep. 

The  patient  had  several  days  before  expressed  a  wish 
for  coffee,  which  he  seemed  to  relish.  It  now  occurred 
to  me  that  coffee,  acting  as  a  food,  containing  nitrogen- 
ous principles,  and  also  as  a  special  nervous  stimulant, 
miirht  in  this  case,  by  its  peculiar  action,  it  given  in 
sufficient  quantities,  produce  a  quieting  effoct  and  in- 
duce deep.  Consequently  coffee  was  tried ;  and  the 
issue  of  the  experiment  proved  to  be  successful. 

At  two  o'clock  P.M.  about  a  pint  of  very  strong  coffee 
was  prescribed,  with  a  little  cream,  enough  to  make 
it  palatable  for  him ;  and  a  broiled  steak  ordered,  a  part 
of  which  he  eat  At  eight  o'clock  p.m.  I  found  that  he 
had  slept  four  hours.  He  drank  again  a  large  cup  of 
coffee,  and  took  fifteen  grains  of  blue  ma^s. 

On  the  27th,  at  the  morning  visit,  I  found  that  he  had 
slept  nearly  all  night,  but  was  then  restless.  His  bowels 
had  been  moved,  and  hid  general  condition  was  very 
much  improved.  Very  strong  coffee  was  again  pre- 
scribed, and  at  half-past  twelve  o'clock  p.m.  I  found  him 
asleep.  After  this  the  coffee  was  repeated  a  few  times ; 
he  continued  to  improve,  and  soonrecovered. 

Probably  this  nervous  stimulant,  by  imparting  an  in- 
creased tone  of  a  peculiar  character,  to  the  general  sys- 
tem, reestablishea  its  equilibrium  and  caused  sleep, 
when  other  stimulants,  acting  in  a  different  manner, 
failed  to  produce  this  result  This,  however,  is  merely 
a  conjecture,  and  may  possibly  be  explained  by  others 
in  a  more  satisfactory  manner. 

88  Futh  ATKinrR,  New  Toek. 


Creosote    for    BuRNa — ^A    correspondent    highly 
extols  creosote  as  an  external  anodyne  for  burns. 


342 


THE  MEDICAL  RECORD. 


Ut\^orts  of  ^00pital»* 


JEFFERSON  MEDICAL  COLLEGE, 

OF  PHILADELPmA. 

Surgical  Clinics  of  Prof.  Gross. 


CATARACT. 


Oct.  27,  1866.— Mrs.  Catharine  H r,  »t  47.    One 

eye  of  this  patient  was  operated  oq  a  year  agr,  and 
there  still  remains  in  it  a  portion  of  the  capsule  of  the 
crystalline  lens,  presenting  a  dense,  white,  chalky  ap- 
pearance, as  observed  through  the  dilated  pupil.  There 
13  some  amount  of  vision.  In  the  other  eye  there  is  a 
cataract  of  the  crystalline  lens  and  its  capsule,  which 
has  existed  about  eighteen  months.  The  general  health 
of  the  patient  is  good ;  she  has  no  diabetes.  Three  of 
her  brothers  have  gone  blind  with  cataract. 

Occasionally  as  many  as  five  or  six  members  of  the 
same  family  suffer  from  the  disease,  showing  that  there 
is  a  hereditary  or  family  proclivity  to  the  affection, 
though  this  is,  of  course,  uncommon. 

Cataract  is  an  opacity  of  the  crystalline  lens  and  its 
capsule,  or  of  the  crystalline  lens  alone,  or  of  its  capsule 
alone.  It  presents  itself  in  various  forms  or  degrees. 
"When  the  opacity  pervades  the  entire  crystalline  lens 
and  its  capsule,  we  say  the  cataract  is  complete  or  ma- 
ture; it  is  imperfect  when  the  reverse  is  the  case, — 
when  there  is  a  portion  of  the  crystalline  lens,  or  of  its 
capsule,  or  of  both,  in  a  state  of  transparency  or  partial 
transparency.  Cataract  is  liable  to  occur  at  all  periods 
of  life ;  it  is  sometimes  an  intra-uterine  affection,  the 
disease  taking  place  before  birth,  during  gestation ;  or 
it  may  take  place  soon  after  birth ;  it  is  uncommon  in 
children  and  in  very  young  person?,  being  met  with 
most  fi-equently  after  the  age  of  fifty,  and  from  that  on 
to  sixty-five  or  seventy  years.  It  generally  comes  on 
without  any  assignable  cause,  and  is  developed  gradu- 
ally, not  suddenly ;  but  there  is  occasionally  an  exception 
to  the  rule,  as  in  a  case  which  occurred  to  the  speaker 
many  years  ago  in  the  Louisville  Hospital,  wliere  a 
man's  eye  became  cataractous  in  the  course  of  twenty- 
four  hours. 

The  disease  is  liable  to  occur  in  both  sexes,  but  is 
moi  e  common  in  males  than  in  females,  in  all  probabil- 
ity growing  out  of  the  usual  difference  of  their  daily  em- 
ploy menta  It  is  liable  to  occur  in  persons  of  all  ranks 
and  of  all  pursuits ;  it  is  said  that  persons  who  use  the 
eye  a  great  deal  for  minute  vision  are  more  liable  to 
suffer  from  it  than  othei  s,  but  it  is  not  deterujined  that 
this  is  the  fact.  It  was  formerly  said  that  blacksmiths 
were  exempt. 

The  disease  is  a  painless  one ;  the  loss  of  sight  is  gf  ad- 
ual,  and,  when  there  is  no  complication  attending  the 
case,  there  is  still  a  cei  tain  degree  of  vision  when  the 
pupu  is  dilated,  as  in  cloudy  states  of  the  weather,  or 
in  daylight  when  the  pupil  has  been  dilated  with  atro- 
pia^  belladonna,  stramonium,  or  some  narcotic  of  this 
kmd.  Under  these  circumstances  the  rays  of  light  pass 
between  the  margins  of  the  iris  and  the  retina  so  as  to 

E reduce  a  certain  amount  of  vision.     When  there  is  ad- 
erence  to  the  mar^^ind  of  the  iris,  the  rays  cannot  pen- 
etrate and  the  patient  is  completely  blind. 

The  opacity  of  the  cataract  generally  begins  from  the 
radius  to  the  circumference.  Simultaneously  the  opacity 
begins  in  the  capsule  and  the  lens,  and  begins  usually  in 
the  posterior  portion.  When  the  opacity  is  in  progress 
we  can  discern  it  very  readily  by  looking  through  the 
pupil,  especially  if  previously  dilated,  as  a  httle  speck  of 
a  wUitiih,  or  slightly  yellowish,  or  drab-colored  aspect. 


This  enlarges,  gradually  increases,  and  when  the  cata- 
ract IS  complete  there  is  no  difficulty  at  all  in  regard  to 
the  diagnosis.  Sometimes,  but  very  reprehensibly, 
opacity  of  the  cornea  is  mistaken  for  cataract,  but  this 
is  the  result  of  inflammation,  and  should  be  duly  recog- 
nize^l.  Cataract  is  an  opaque  body  lying  behind  the 
pupil  directly  in  the  centre  of  the  eye.  When  there  are 
adhesions  of  the  iris  to  the  lens,  or  when  the  pupil  has 
been  diminished  in  consequence  of  inflammation,  and 
opacity  of  the  cornea  coexists  with  these  adhesions, 
then  the  diagnosis  may  be  very  difl&cult  indeed.  Under 
all  eircumstances  the  proper  plan  is  to  dilate  the  pupil 
by  the  application  of  atropia,  the  proximate  principle  or 
alkaloid  of  belladonna.  From  one-third  to  half  a  grain 
dissolved  in  half  an  ounce  of  water  will  be  of  sufficient 
strength  for  the  purpose,  and  a  few  drops  of  this  solu- 
tion put  in  contact  with  the  cornea  and  conjunctiva  will 
dilate  the  pupil.  The  head  should  be  thrown  back,  the 
eyelid  opened  to  expose  fully  the  surface  of  the  ball  of 
the  eye,  and  then  five  or  six  drops  of  the  solution  should 
be  put  in  contact  with  the  organ,  and  if  the  process  be 
repeated  several  times  in  the  twenty-four  hours,  free  di- 
latation will  be  the  result,  which  will  continue  for  several 
consecutive  days.  It  dilates  the  pupil  to  the  very  ut- 
most, paralyzing  it  for  the  time  being.  Instead  of  drop- 
ping the  solution  into  the  eye,  it  may  be  applied  by  rub- 
bing the  solution  on  the  eyehds  and  eyebrow.  We  no 
longer  use  the  belladonna  as  formerly,  the  atropia  being 
more  reliable,  prompt,  and  efficacious. 

When  the  pupil  has  been  dilated  we  look  at  the  cata- 
ract, and  tlie  diagnosis  is  sufficiently  plain. 

There  are  ditlerent  operations  in  vogue  for  the  re- 
moval of  cataract.  When  the  cataract  is  soft,  when  the 
disease  is  of  recent  standing,  or  occurs  in  a  very  young 
person,  the  operation  adapted  to  its  relief  is  comminu- 
tion by  means  of  the  needle,  or  a  very  delicate  knife  in- 
troduced into  its  substance,  passing  the  instrument  about 
in  different  directions  and  breakiug  up  the  lens  and  its 
capsule,  hashing  it  as  it  were,  and  subjecting  the  fi"ag- 
mems  to  the  action  of  the  aqueous  humor  of  the  eye,  or 
the  absorbents  of  the  eye,  if  you  please,  for  it  is  a  disputed 
pd5nt  if  the  aqueous  humor,  weighing  only  five  grains — 
a  few  drops  of  liquid — has  any  solvent  powers  or  not. 
All  we  know  is  that  when  the  cataract  is  carefully- 
broken  up  in  this  way,  and  the  resulting  inflammation  is 
properly  kept  in  check,  solution  takes  place,  the  firag- 
ments  gradually  disappear,  leaving  the  aqueous  humor 
perfectly  clear  and  limpid  for  the  transmission  of  the 
rays  of  light. 

A  soft  cataract  is  usually  distinguished  by  its  large 
size  and  pecuhar  whitish  or  bluish  appearance. 

When  the  cataract  occurs  in  a  person  of  advanced 
life,  is  of  long  standing,  comparatively  small,  of  a  yel- 
lowish or  drab-colored  appearance,  then  we  assume  that 
it  is  hard,  and  that  the  operation  of  comminution  is  not 
adapted  to  it,  for  we  cannot  break  it  up  with  a  needle 
or  comparatively  sharp  knife.    It  must  be  extracted. 

Formerly,  indeed  until  within  the  last  few  years,  an 
operation  called  depression  or  couching  was  very  much 
in  vogue.  This  operation  consists  simply  in  inti  oduciug 
a  delicate  needle  into  the  eye,  and  displacing  the  cata- 
ract or  opaque  body  by  throwing  it  out  of  the  axis  of 
vision  and  burying  it  in  the  vitreous  humor  of  the  eye, 
depressing,  couching  it,  or  laying  it  down  as  it  were. 
This  operation  has  become  obsolete,  and  very  justly  so, 
because  it  has  been  found  from  long  experience  that  this 
opaque  body,  the  crystalline  lens  with  its  capsule,  will 
remain  here  for  years  undissolved,  unaffected  by  the  vit- 
reous htimor  of  the  eye ;  not  only  this,  but  it  will  dis- 
solve the  vitreous  humor  of  the  eye  itself,  by  its  pres- 
sure, by  the  inflammation  which  it  produces ;  and  it  will 
graduidly  sink  down  to  the  lower  pait  of  the  «ye  so  as 


THE  MEDICAL  RECORD. 


343 


to  pre?s  upon  the  retina,  and  in  this  manner  produce  an 
amount  of  inflammation  which  will  be  rapidly  followed 
by  an  irretrievable  loss  of  sight. 

There  is  another  operation  in  connection  with  soft 
cataract,  consisting  in  lineal  extraction,  devised  by  Qib- 
8on,  of  England,  in  1811,  subsequently  modified  by  some 
German  surgeons  and  revived  aflerw«irds  in  England. 
It  conjsiats  in  making  a  small  incision,  not  more  than 
about  two  and  a  half  Tines  in  extent,  that  is  about  one- 
fifth  or  one-sixth  of  an  inch,  througn  the  lower  part  of 
the  cornea,  and  then  scooping  out  the  lens  a^ong  with 
its  capsule.  This  is  called  linear  extraction,  because  of 
the  delicacy  of  the  incision.  It  is  adapted  only  to  soft 
catar  ict,  not  to  hard.  The  old  operation  consists  in 
making  a  large  free  incision  into  the  cornea,  either  in 
the  upper  or  lower  portion  of  its  extent  as  the  case  may 
be,  the  lower  incision  being  usually  preferred,  and  very 
justly  so.  The  incision  includes  fully  one-half  of  the 
circumference  of  ^e  cornea.  It  is  done  with  a  delicate 
knife,  and  the  next  step  consists  in  lacerating  the  cap- 
sule of  the  lens ;  inthe  next  place  pressing  out  or  hook- 
ing out  the  opaque  body,  the  crystalline  lens.  This  is 
called  the  operation  of  extraction,  and  when  properly 
performed  affords  vision  at  once.  The  patient  has  to 
run  the  risk  attendant  on  the  resulting  mflammation, 
which  may  be  so  great  as  to  prevent  union  of  the  wound 
in  the  cornea,  and  lead  to  gangrene  or  sloughing  or  de- 
struction of  the  eye,  as  has  happened  in  thousands  of 
instances.  It  is  adapted  only  to  cases  of  hard  cataract, 
and  the  eye  should  be  rather  prominent  than  otherwise ; 
if  it  is  sunken  back  in  its  socket  it  is  not  as  favorable  for 
extraction ;  nor  i^  it  well  adapted  where  there  is  unu- 
sual flatness  of  the  cornea,  which  should  be  convex, 
prominent,  in  order  to  justify  this  kind  of  interference ; 
still,  this  is  not  an  insuperable  objection.  Then  there 
should  be  a  perfect  formation  of  the  pupil;  it  should  be 
dilatable,  not  necessarily  dilated ;  there  should  be  no  ad- 
hesions at  all,  no  disease  in  the  iris — otherwise  the 
ease  is  not  adapted  for  extraction. 

The  op<Tation  proposed  to  be  performe'1  in  the  present 
instance  consists  in  lacerating  the  capsule,  and  those 
portions  of  the  lens  which  can  be  brought  under  the  in- 
fluence of  the  needle.  The  cataract  appears  to  be  a  soft 
one,  or  very  nearly  soft,  though  there  may  be  a  little 
nucleus  in  the  centre.  The  operation  is  easy,  the  ma- 
nipulations simple,  and  it  is  not  painful.  It  is  not  neces- 
sary to  administer  chloroform,  as  is  done  when  the  op- 
eration of  extraction  is  performed,  when  we  want 
perfect  control  over  the  eye  as  well  as  over  the  body. 
The  patient  may  sit  up  or  lie  down,  as  is  most  conve- 
nient, though  it  is  preferable  that  the  patient  sit  up  with. 
the  head  reclining  against  the  breast  of  an  assistant. 
The  upper  eyelid  should  be  held  out  of  the  way  by 
the  index-finger  uf  the  assistant,  the  lid  being  caught 
between  the  soft  portion  and  the  nail ;  the  lower  lid  is 
depre?sed  by  the  mdex-finger  of  the  surgeon;  then  the 
delicate  needle,  held  in  the  other  hand  as  a  writing-pen, 
i»  introduced  and  the  cataract  comminuted: 

SEBACEOUS  TUMOR  OF  KECK  AND  SHOULDER. 

Oct.  27,  1866.— Lizzie  R o,  «t  22.    This  patient 

had  a  tumor  of  fourteen  or  fifteen  years'  standing  upon 
the  back  part  of  the  neck  and  shoulder.  The  skin  was 
not  particularly  discolored,  being  but  a  shade  or  two 
more  red  than  the  parts  around,  owing  to  the  pressure 
of  tiie  tumor  on  the  skin  and  the  consequent  congestion 
of  the  vessels  in  that  part.  It  was  movable  and  pain- 
less. 

There  are  various  tumors  h'able  to  form  in  this  situa- 
tion ;  some  formed  from  preexisting  tissues,  others  not. 
We  have  the  fibroid  tumor,  a  structure  composed  of 


fibres  crossing  each  other  in  every  direction,  and  impart- 
ing a  firmness  to  the  tumor  unlike  that  found  in  any 
other  portion  of  the  body  except  cartilage,  tendon,  and 
bone;  a  tumor  liable  to  become  developed  in  many 
portions  of  the  body,  more  particularly  the  uterus.  In 
the  case  before  us,  the  tumor  is  comparatively  soft,  there- 
fore we  exclude  from  our  diagnosis  the  idea  that  it  is  one 
of  those  cla^s  of  tumors  fibroid  or  fibrous  in  character. 
In  the  next  place,  is  it  a  cartilaorinous.  or  fibro-cartilag- 
inous,  or  bony  tumor?  Of  course  if  it  is  too  soft  to  be 
fibrous,  it  cannot  be  any  of  these.  It  is  not  a  wen-like 
excrescence,  as  occasionally  occurs  in  various  parts  of 
the  body,  CFpecially  the  head  and  the  face ;  so  we  exclude 
that  from  our  diagnosis.  It  is  not  a  nerve  tumor  or  a 
neuroma,  because  it  i**  free  from  pain  and  it  is  situated 
very  superficially ;  besides,  it  is  much  larger  than  a  nerve 
tumor  would  be  in  this  situation.  The  nerve  tumor  oc- 
casionally acquires  a  large  bulk,  the  size  of  a  man's  head, 
when  it  occurs  in  connection  with  the  large  nervous 
trunks.  It  is  not  a  cystic  or  an  encysted  tumor;  it  is 
not  as  distinctly  elastic  as  if  it  contained  a  watery  or 
sanguinolent  fluid.  It  is  not  a  hydatid  tumor,  for  it  is 
exceedingly  uncommon  to  find  such  a  tumor  under  the 
skin,  and  then  it  is  remarkably  elastic,  fluctuating  dis- 
tinctly under  pressure.  This  tumor  has  a  semi-elastic 
feeling,  bordering  on  the  doughy,  difficult  to  describe. 

Insertion  of  an  exploring  needle,  however,  demon- 
strated that  this  tumor  was  sebaceous  or  encysted. 
It  was  larger  than  the  sebaceous  tumor  is  usually 
found,  and  it  is  rare  that  a  sebaceous  tumor  is  found  in 
this  situation;  hence  the  liability^to  a  mistake  in  diag- 
nosis. 

On  removal,  the  cyst  of  the  tumor  was  much  shrunken, 
its  contents  resembling  spoiled  tallow  or  lard. 

This  is  therefore  a  tumor  which  had  its  origin  in  a  pre- 
existing tissue,  and  is  not  a  new  formation,  having  been 
developed  from  a  sebaceous  gland,  follicle,  or  crypt. 
The  inspissated  secretion  which  becomes  pent  up  does 
not  remain  an  innoxious  fluid,  but  from  long  retention 
may  become  excessively  offensive  in  consequence  of  the 
presence  of  a  large  quantity  of  sebaceous  acid.  Some- 
tiifaes  we  find  it  partly  fluid  and  partly  solid ;  now  and 
then  cases  occur  in  which  hairs  are  found  among  the 
contents,  especially  in  the  congenital  form  of  the  seba- 
ceous tumor,  such  as  developed  under  the  eyebrow,  eye- 
lid, forehead,  and  various  portions  of  ^the  scalp.  They 
are  frequently  seen  with  numerous  hairs  in  the  interior 
of  the  cyst,  evidently  retained  during  the  progress  of 
development 

The  cyst  is  nothing  but  the  wall  of  the  sebaceous 
crypt  or  follicle  in  a  state  of  hypertrophy  in  consequence 
of  long-continued  interstitial  deposits;  retention  of  the 
fluid  produces  irritation,  provokes  a  flux  of  blood  and 
nerve  fluid  to  the  part,  and  thus  the  wall  of  the  crypt 
becomes  greatly  enlarged,  and  in  some  cases,  when  the 
tumor  is  very  old,  a  portion  of  the  cyst  degenerates  into 
fibro-cartilage,  or  into  cartilage,  and  orcasionally,  though 
very  rarely,  into  bonv  substance.  Thus  this  tumor  is 
simply  an  unnatural  development  of  a  preexisting 
structure,  fi-equently  so  small  it  cannot  be  perceived  by 
the  naked  eye.  but  capable,  during  the  progress  of  its  de- 
velopment, ot  aasuming  the  volume  of  a  hen's  egg  or  an 
orange.  This  tumor  does  not  take  on  malignant  action, 
but  m  consequence  of  long-continued  pressure,  or  the 
pressure  of  the  dress  on  any  part  of  the  body  where  the 
tumor  may  exist,  ulceration  is  liable  to  take  place,  and 
then  a  very  unpleasant  sore  may  be  produced,  causing 
pain,  ^nd  hieing  the  seat  of  a  constantly  offensive  or  fetid 
discharge. 

The  only  remedy  is  excision,  and  every  particle  of  the 
cyst  must  be  removed ;  if  the  slightest  atom  is  left  be- 
hind, it  becomes  the  nucleus  of  a  new  formation. 


344 


THE  MEDICAL  RECORD. 


Iljtp0rt»  of  Strcietws. 


NEW  YORK  ACADEMY  OF  MEDICINE. 

Called  Meeting,  September  18,  1867. 
Dr.  Alfred  C.  Post,  President,  in  the  Chair. 

THE   QUESTION  OF  AID  FOR  THE   YELLOW-FEVER  SUFFERERS 
AT   THE   SOUTH. 

Dr.  Chamberlain,  in  explanation  of  the  objects  of  the 
meeting,  read  the  following : 

301  MoTT  Street,         ) 
New  York,  Sept.  14,  1867.  J 
Sir  :  At  a  meeting  of  the  Executive  Committee  ap- 
pointed at  a  general  meeting  of  citizens  held  on  Fri- 
day, the  13th  inst.,  to  devise  means  for  administering 
to  tne  wants  of  the  sufferers  from  yellow-fever,  it  was 
Resolvedy  That,  in  the  judgment  of  this  Committee,  it 
is  desirable  that  tlie  subject  of  ways  and  means  to  aid 
the  sufferers  from  yellow-fever  in  the  Southern  cities 
should  be  taken  into  special  consideration  by  the  New 
York  Academy  of  Medicine,  the  Kings  County  Medi- 
cal Society,  and  other  sitiiilar  associations :  and  inas- 
much as  hundreds  who  now  need  our  charitable  relief 
daily  become  victims  of  this  terrible  scourge,  prompt 
action  is  necessary. 

Very  re^^pectfully,  your  obedient  servant,  • 

John  Browne^  Secretary. 
A.  C.  Post,  M.D.,  President  of  the  New  Y  ork  Academy 
of  Medicine. 

Dr.  Hamilton,  after'  adverting  briefly  to  the  destitu- 
tion of  the  South,  and  the  urgent  want  of  experienced 
nurses,  gave  it  as  his  opinion  that  the  epidemic  would 
spread,  and  that  its  final  arrest  could  not  be  expected 
before  the  accession  of  frost,  which  in  the  Gulf  States 
occurs  about  the  middle  or  latter  part  of  October.  He 
said  the  medical  profession,  through  its  various  organi- 
zations, was  capable  of  wielding  a  power  which  bad 
not  yet  been  exerted,  and  which  might  well  be  put 
forth  in  a  cai^se  like  this.  It  was  not  expected  that 
members  of  the  Academy  would  contribute  largely, 
because  in  many  instances  they  were  not  able  to  do  to  ; 
but  they  could  do  much  towards  arousing  a  public  feel- 
ing that  would  carry  material  aid  to  the  sufferers.  He 
then  moved  the  following,  which  were  unanimously 
adopted : 

Resolved^  That  the  President  of  the  Academy,  Dr. 
Alfred  C.  Post,  with  the  Council  of  the  Academy, 
constitute  a  Medical  Jlelief  Committee,  who  shall  be 
authorized  to  receive  and  distribute  such  funds  as  may, 
for  the  purposes  specified,  be  handed  to  them,  and  that 
they  be  authorized  al.^o  to  adopt  such  further  measures 
for  the  relief  of  the  sick  at  the  South  as  they  shall  deem 
proper  and  fit. 

Resolved,  That  we  recommend  to  all  American  medi- 
cal organizations,  especially  in  the  Slates  not  suffering 
from  the  present  epidemic,  to  take  similar  action  as 
speedily  as  possible.  The  President  and  Council  of  this 
Academy  will  take  charge  of  such  funds  as  may  be  for- 
warded from  other  medical  societies ;  or  they  may  send 
their  contributions  direct  to  the  President  of  the  How- 
ard Association  at  New  Orleans,  which  Association  will 
distribute  the  same  to  other  branches  in  other  cities  in 
such  manner  as  may  be  required. 

the  perils  and  the  devotion  of  the  army  medical 

STAFF. 

Dr.  Chamberlain  read  a  letter  from  Dr.  E.  Harris, 
calling  attention  to  the  devotion  of  the  army  surgeons 


in  the  South,  many  of  whom  have  died  at  their  posts 
during  the  prevailing  pestilence,  and  offered  the  follow- 
ing resolutions,  which  were  adopted  unanimously : 

Resolved,  That  this  Academv  sends  its  greeting  of 
sympathy  and  cheer  to  our  professional  brethren  of  the 
fever-itricken  South;  that  it  recognizes  with  admira- 
tion their  heroic  and  unselfish  devotion  to  the  profes- 
sion and  humanity ;  that  in  the  swelling  list  of  those 
who  have  not  feared  to  die,  and  in  the  uiualtering  ranks 
of  those  who  live  to  labor  in  this  good  cause,  the  pro- 
fession and  the  world  are  again  (SUed  to  witness  that 
the  true  physician  braves  penl  and  gives  his  life  when- 
ever necessary  in  ministering  to  the  sick. 

Resolved,  That  we  endorse  and  respond  to  their  call 
for  all  personal  and  material  aid  needed  for  the  most 
complete  medical  care  of  the  sick. 

The  Academy  then  adjourned. 


EAST  RIVER  MEDICAL  ASSOCIATION. 

Stated  Meetino,  August  6,  1867. 
Dr.  Yerranus  Morse,  President,  in  the  Chair. 

AMENDMENTS  OF  THE  CONSTITUTION  AND  BT-LAWS. 

Dr.  Weisse  proposed  several  amendments  to  the  Con- 
stitution and  By-Laws,  the  chief  of  which  related  to  the 
division  of  the  organization  into  sections.  These  were 
as  follows :  Surgical  Anatomy,  Pathology,  and  Prac- 
tice, P.  D.  Weisse,  Chairman  ;  Visceral  Anatomy, 
Physiology,  Pathology,  and  the  Practice  of  Medicine, 
Alexander  W.  Stein,  Chairman  ;  Obstetrics  and  Gyn»- 
colo^,  M.  S.  Buttles,  Chairman ;  Therapeutics  and 
Medical  Jurisprudence,  Truman  Nichols,  Chairman ; 
Hygiene.  Climatology,  Meteorology,  and  Vital  Statis- 
tics, William  F.  Thoms,  Chairman, 

DECEASED   MEMBER& 

Dr.  Thoms  announced  the  decease  of  Drs.  Philip 
O'Reilly  and  Edward  KeUy  Hogan.  The  following 
committee,  at  the  conclusion  of  eulogistic  remarks  by 
several  members  of  the  Association,  were  appointed  to 
draft  resolutions  expressive  of  the  sense  of  the  meet- 
ing:— Drs.  W.  F.  Thoms.  John  Burke,  and  John  Pur- 
cell  ;  and  Drs.  Henry  E.  McCartin,  E.  J.  Hogan,  and 
James  J.  Purcell.  On  motion,  the  following  were 
appointed  a  special  committee  on  visitation  of  sick 
members: — Drs.  William  Newman,  Truman  Nichols, 
John  Bmrke,  Richard  J.  O'Sullivan,  and  Henry  E. 
Crampton. 

THE   PRESENT   STATE   OF  KNOWLEDGE  REGARDINQ   ZTMOTIO 
DISEASES. 

Dr.  Skiff,  in  a  paper  which  he  had  prepared,  briefly- 
reviewed  the  substantial  advances  made  in  our  under- 
standing those  diseases  which  nosologists  had  dasaed 
under  the  head  of  zymotic 

He  maintained  that  zymotic  disease  depended  for  its 
cause  on  either  virus^  miasm,  or  venom,  the  first-men- 
tioned of  which  would  constitute  the  agent  for  the 
transmission  of  contagious  diseases,  e,g.,  variola,  which 
by  virtue  of  the  impalpable  miasm  diffused  through  the 
air  or  inherent  in  the  fomites,  was  also  an  infectious 
malady.  Miasm,  or  the  second  morbific  principle,  is 
that  unknown,  ina{^r«:ciable  emanation,  exposure  to 
which  produces  a  specific  disease.  To  illustrate,  the 
same  miasm  will  not  produce,  in  different  individuals, 
typhus  fever,  yellow-fever,  and  cholera.  Venom  dif- 
fers fi'om  both  virus  and  mia^m ;  it  is  a  physiological 
secretion  foimd  in  the  so-calied  venomous  insects  and 
reptiles. 

He  then  alluded  to  the  so-called  .infiintile  diseases. 
Digitizer  „^ ^_ 


THE  MEDICAL  RECORD. 


345 


which  claimed  so  lar^  a  share  of  the  attention  of  kKi- 
manitarians  and  medical  philosophers. 

After  commenting  upon  ventilation  and  cleanliness 
as  being  the  most  positive  of  prophylactics,  he  passed 
to  the  consideration  of  disinfectants,  which  for  conve' 
nience  of  study  were  classed  under  tnree  heads : 

1.  Chemical  disinfectants. 

2.  Absorbents. 

3.  Antiseptics. 

In  the  employment  of  all  the  practical  applications 
of  our  art,  we  must  as  nearly  as  may  be,  conform  to  the 
sanitary  processes  of  nature,  whose  principal  hygienic 
operations  were  mainly  oxidation,  difliision,  and  dilu- 
tion. AU  these  we  may  imitate,  but  only  to  a  Hmited 
extent. 

Keepm^  in  mind  that  all  other  means  are  but  subsi- 
diary to  thorough  ventilation  and  removjd  of  organic 
matters,  the  most  eflfectual  method  of  purifying  the  air 
and  destroying  the  virus  or  infection  of  disease  is  by 
the  evolution  «f  certain  gases,  such  as  ozone,  chlorine, 
hyponitrous,  nitrous,  and  sulphurous. 

Ozone  may  be  hberated  by  placing  a  stick  of  phos- 
phoras  on  an  ordinary  tea-plate,  with  sufficient  water 
poured  upon  it  to  immerse  two-thirds  or  three-fourths 
of  it,  according  to  the  size  or  the  volumetric  capacity  of 
currents  of  air  circulating  through  the  room.  Tiie  evo- 
lution of  this  agent  may  be  instantly  suspended  by 
covering  the  phosphorus  entirely  with  water. 

The  next  article  in  importance  in  point  of  practical 
efficiency  is 

CTWortnc,  which  is  less  objectionable  than  the  preced- 
ing, from  the  fact  that  there  is  less  danger  of  mis- 
management.   The  Uberation  of  the  gas  is  more  gradual 
and  more  controllable.    The  formula  used  in  the  U.  S. 
army  hospitals  is  an  excellent  one,  and  is  as  follows : 
18  parts  common  salt,  finely  ground, 
15     "     binoxide  manganese,  finelv  pulverized. 
Mix,  and  place  in  a  flask,  and  pour  on  it  the  following 
mixture,  completely  cooled : 

45  parts  of  concentrated  sulphuric  acid, 
21         "     water.    Shake  the  flask. 

Bromine  is  very  efficient ;  it  evaporates  spontaneously 
when  the  bottle  conUdning  it  is  uncorked,  and  soon 
deodorizes  the  infected  room.  But  being  difficult  to 
manage,  and  expensive,  it  is  less  used  than  others. 

Nitrous  acid  acts  very  powerfully  on  organic  matters, 
but  being  very  irritating  to  the  respiratory  organs,  it 
it  should  only  be  used  in  the  chamber  after  vacation  by 
the  patient,  which  of  course  is  not  always  practicable. 
It  may  be  evolved  by  placing  nitrate  of  potash  in  sul- 
phuric acid,  or  by  placing  a  bit  of  copper  in  nitric  acid, 
diluted  witn  water. 

Sulphurous  acidy  readily  obtained  by  burning  sulphur, 
acts  very  powerfully  on  organic  matter  by  oxidation, 
especially  destroying  animal  contagion  and  miasms, 
but  is  also  irreepirable,  except  in  limited  quantities. 

The  agents  just  mentionea  are  deodorizant^,  and  anti- 
septic as  well  as  true  disinfectants,  by  virtu^  of  their 
oxidizing  properiies. 

Absorbents, — ^The  most  available,  as  well  as  the  most 
economical,  of  the  second  class  of  disinfectants  is  char- 
coal 

This  may  be  used  very  efficiently  in  covering  over 
the  surface  of  the  contents  of  a  privy-sink  or  cesspool ; 
or  it  may  be  very  beneficially  mixed  with  lime  unslaked 
— in  the  proportions  of  one  of  charcoal  to  two  of  lime. 
The*e  two  agents  more  completely  cover  the  whole 
ground  in  the  matter  of  general  disinfectants  than  any 
of  the  others. 

In  disinfecting  old  dwellinors,  as  has  already  appeared 
in  the  instructions  of  the  Health  Board,  the  smoke  of 
a  wood  fire   is  an  ever-ready  expedient.    Dry  lime 


sprinkled  on  moist  or  oleaginous  surfeoes  has  also  re- 
paid the  experimenter  with  the  most  beneficial  results. 
Of  the  anttsepticsy  the  metallic  salts  are  the  most  use- 
ful as  deodorants.     Among  these  may  be  mentioned — 

1.  Solution  of  nitrate  of  lead  (  3  j.  salt  to  |  j.  water). 

2.  Solution  of  the  chloride  of  zinc. 

3.  Solution  of  the  sulphate  of  copper. 

4.  The  salts  of  iron — the  protosulphate  and  the 
protochloride.  The  salts  of  iron  are  very  prompt  in 
controlling  ammoniacal,  sulphuretted,  and  other  noxious 
effluvia ;  hence  very  useful  and  convenient  in  deodor- 
izing evacuations  by  vomiting  or  by  stool. 

5.  Permanganate  of  potassa—one  of  the  most  useful 
and  efficient  of  the  class,  has  but  one  drawback,  to  wit, 
expensiveness. 

It  is  particularly  efficacious  in  topical  applications,  in 
dressing  wounds,  old  ulcers,  and  the  Uka  To  purify  in-  • 
fected  apartments,  cloths  saturated  in  a  strong  solution 
of  the  permanganate  may  be  suspended. 

Another  very  useful  purpose  for  which  a  solution  of 
the  permanganate  may  be  employed,  is  the  purification 
of  water.  Drop  small  quantities  into  the  water  until 
the  beautiful  tinge  of  the  permanganate  begins  to  ap- 
pear. Shake  well,  and  deodorization  immediately  takes 
place,  and  water  which  otherwise  would  be  very  offen- 
sive from  decaying  animal  or  vegetable  matters,  may  be- 
come wholesome,  tastelea^,  and  drinkable,  and  the  effect 
of  the  necessary  amount  of  permanganate  is  to  render 
the  water  tonic  in  its  effects,  and  not  in  the  least  objec- 
tionable. 

5.  Garbolates. — Creosote,  carbolic  acid,  and  coal-tar 
are  each  very  effective  as  antiseptics,  and  not  only  ar- 
rest the  putrefactive  process,  but  as  long  as  it  is  in  the 
pabulum  subject  to  change,  it  prevents  the  recurrence 
of  putrefaction.  But  owing  to  the  fiict  that  they  are 
easily  decomposed  through  chemical  reactions,  th^ 
effects  are  somewhat  limited. 

Their  offensive  smell  renders  them  objectionable  to 
some  extent  in  dwellings,  but  they  are  very  valuable  in 
disinfecting  sewers,  drains,  privies,  stables,  and  the  like. 
Coal-tar  may  be  used  for  chamber  vessels  by  mixinsr 
equal  parts  of  coal-tar,  alcohol,  and  soft-soap— a  small 
quantity  only  is  required. 

Heat. — For  the  purpose  of  disinfecting  clothing,  mer- 
chandise, or  fomites  or  any  kind,  a  temperature  of  250" 
may  be  employed  with  entire  success,  without  any  dan- 
ger of  injuring  the  color  or  the  value  of  the  finest  tex- 
tures. Rooms  or  ovens  may  thus  be  heated  for  the 
effectual  disinfection  of  goods,  clothing,  etc.,  which  have 
arrived  at  quarantine  from  an  infected  port 

But  assuming  as  correct  the  theory  that  the  so-called 
zymotic  diseases  owe  their  origin  to  a  catalytic  change 
in  the  blood  set  up  by  the  introduction  of  an  extrane- 
ous substance,  the  question  most  pertinent  that  now 
presents  itself  is — after  the  blood  poison  has  entered 
the  circulation,  what  are  the  indications  for  treatment  f 

1st  Neutralization  of  the  poison ;  and  2d.  Elimina- 
tion. 

Under  the  ^neral  expression  neutralization,  it  is 
proper  to  mention,  are  included  the  different  processes 
which  may  occur  to  put  a  period  to  the  influence  of  the 
poison — whether  it  be  by  combining  with  the  nervous 
element,  and  forming  a  compound  on  which  the  poison 
is  incapable  of  producing  an  effect — as  is  supposed  is 
the  case  in  the  result  of  giving  arsenic  and  quinine  in 

Xe,  or  by  the  use  of  agents  which  will  render  the 
>d,  or  that  part  which  is  affected  by  the  poison,  un- 
fermentable ;  or  by  the  direct  effect  of  oxidation  by 
union  of  the  poison  with  the  remedy. 

In  the  treatment  of  some  forms  of  the  contagious  dis- 
eases, such  as  syphilis,  gonorrhoea,  puerperal  fever,  and 
erysipelas,  the  disease  undoubtedly  may_^be^ aborted  by 


846 


THE  MEDICAL  RECORD. 


burning  out  the  virus  previous  to  its  extending  from  a 
local  to  a  constitutional  disease.  In  the  case  of  puerperal 
fever  or  erysipelas,  the  nidus  is  so  subtle  that  the  initial 
point  for  abortive  treatment  must  be  carried  back  a  step 
further,  and"  the  physician  or  nurse  should  thoroughly 
wash  his  hands,  instruments,  etc.,  in  a  solution  of  per- 
manganate of  potassa,  creosote  water,  or  some  effica- 
cious disinfectant. 

In  case  of  infectious  diseases,  if  there  be  a  class  of 
remedies  by  oxidizing  the  poison  or  rendering  unfer- 
men table  its  pabulum,  their  general  appHcation  would 
indeed  be  a  forward  step. 

That  there  are  such  a  class  of  remedies  has  been 
claimed  by  Dr.  Giovanni  Polli,  in  his  often-quoted  com- 
munications to  the  Koyal  Institute  of  Lombardy,  at 
Milan. 

Results  so  far  seem  to  favor  his  theory,  since  pycemia 
sepiicmmia^  and  all  the  class  of  fevers  with  putridity  and 
purulent  absorption,  such  as  hospital  fever,  and  puer- 
peral fever,  anatomical  inoculation,  etc.,  have  been 
treated  by  the  alkaline  sulphites  with  advantage. 

Miasmatic  fevers  are  treated  with  the  sulphite  of 
magnesia  with  great  efficacy. 

Numerous  reports  are  given  of  their  value  in  the 
exanthemata  and  typhus  fever. 

The  g-eneral  results  reported  are  to  the  effect  that 
they  mitigate  the  intensity  of  the  febrile  exanthem, 
render  the  confluent  and  malignant  forms  more  benig- 
nant, shorten  the  course  of  the  milder  forms,  and  in  all 
cases  accelerate  convalescence. 

Dr.  Polli  does  not  state  that  they  will  prove  available 
in  curing  cholera  and  plague,  but  thinks  they,  will  prove 
highly  useful  as  prophylactics. 

The  plan  of  Dr.  Polli  has  to  recommend  it  that  it  is 
rational,  and  as  the  sulphites  are  innoxious  in  their 
effects,  it  is  to  be  hoped  that  the  profession  in  this 
country  will  give  it  a  thorough  trial. 

It  appears  that  in  order  to  get  the  curative  effect  of 
these  medicines,  it  is  best  to  saturate  the  system.  For 
rapid  sa'uration  the  sulphite  is  better  than  the  hypo- 
sulphite. 

Of  the  sulphite  of  soda,  four  or  five  drachms  a  day,  dis- 
solved in  water,  is  the  minimum  dose.  But  for  the 
prophylactic  effect  the  hyposulphite  is  preferable. 

Miminaiion. — ^In  taking  general  ground  as  to  whether 
or  not  the  eHminative  treatment  is  to  be  adopted  in  the 
treatment  of  zymotic  disease,  it  cannot  but  be  granted 
that  the  indication  exists,  if  we  accept  the  fact  of  the 
blood  containing  an  extraneous  poison. 

It  must  certainly  be  conceded  that  throughout  the 
whole  class  of  zymotics  there  is  running  through  each 
particular  disease  a  similarity  that  links  the  whole 
together,  exclusive  of  the  similarity  of  the  causes. 

There  is  a  prodromic,  incubative  period  common  to 
all,  during  which  there  comes  on  constitiftional  dis- 
turbance, which  is  fever.  Then,  after  the  acme  of  the 
disease  has  been  reached,  "  when  the  leaven  has  leav- 
ened the  whole  lump,"  there  is  seemingly  an  effort  of 
nature  to  cast  out  the  materies  morbi  which  has  caused 
the  disturbance.  The  increased  activity  in  the  exanthe- 
mata is  exhibited  in  the  skin ;  in  plague  in  the  glands. 
In  typhoid  fever  the  glands  of  the  intestines  are  chiefly 
implicated,  whilst  in  cholera  and  dysentery  congestion 
of  the  abdominal  viscera  is  presehf. 

But  because  there  is  an  indication  that  nature  points 
towards  the  open  door  of  any -particular  emunctory,  it 
is  not  to  say  that  all  the  treatment  should  tend  to  stimu- 
late activity  in  that  direction.  On  the  contrary,  in  some 
instances  it  is  eminently  proper  to  make  a  diversion  in 
favor  of  an  already  overburcfened  organ. 

The  paper  concluded  with  remarks  upon  the  thera- 
peutics of  cholera,  m  which  it  was  maintained  that 


opijites,  alteratives,  and  astringents  were  Really  elimi* 
native  agents,  which  gradually  directed  the  poison  to 
the  different  emunctories.  ^ 

The  Association  then  adjourned,    -.ft 

progress  of  McVical  Scieitce* 

The  Suboert  of  the  Arteries  has  been  signally 
stamped  by  the  progreasive  conservatism  of  the  day — 
thus  far  testimony  inclines  against  the  knife.  Of  17 
published  cases  of  aneurisms  and  wounds  of  arteries,  8 
were  treated  by  ligature,  of  whom  6  recovered  and  2 
died ;  9  were  treated  by  compression  direct  or  digital, 
and  indirect  or  by  tourniquet— aZZ  recovered. — MecL 
Record  {May  1.);  Lancet^  i  1 :  i.  9. ;  MecL  Times  S 
Gazette,  Mch,  30,  jp.  335 ;  Am,  Journal  Med,  ScienoeSy 
vci.,  pp,  402-500  ;  Ann.  Univers,  cxcix,  p,  351.  BrO, 
Med,  Journal,  Mch,  16  ;  Lancet  i.  4  \  Gaz,  des  H6p,y 
Nos.  25,  36;  Petersburg  Med.  Ztesch.,  voL  xii,  No.  213, 
p.  137. 

The  Therapeutical  Advantage  op  Position  in  thb 
Treatment  of  Shook. — The  following  case  is  presented 
in  the  Chicago  MedicalJournal,  by  Hiram  Wanzer.  M.D. : 
March  16th,  J.  T.,  set.  9  years,  had  fallen  through 
a  hatchway,  alighting  upon  his  nead,  and  was  taken 
home  in  a  state  of  profound  insensibility.  There  was 
scarcely  any  pulse  when  I  arrived,  and  the  heart's 
action  was  nearly  suspended ;  there  was  general  pallor 
of  the  countenance  and  coldness  of  the  extremities, 
every  symptom  indicating  fearly  dissolution.  I  imme- 
diately raised  the  body  and  legs  to  an  angle  of  45**,  and 
in  less  than  16  minutes,  quite  a  full  pulse  returned  at 
the  wrist;  the  action  of  the  heart  was  stronojer,  and 
the  glow  returned  to  the  cheeks,  showing  that  the 
capillary  circulation  was  being  established.  He  was 
now  placed  in  the  recumbent  posture  to  remove  his 
clothing  and  examine  his  body  for  injuries,  and  in  a 
moment  the  blood  forsook  the  wrist,  and  the  heart's 
action  was  again  more  imperceptible.  I  thought  he 
was  gone.  I  placed  him  instantly  in  the  former  poa- 
tion,  and  in  less  than  five  minutes  the  pulse  retume<^, 
and  the  heart  began  to  beat  with  renewed  vigor,  and 
the  brain  responded  to  its  acccustomed  stimuli.  The 
rationale  of  the  treatment — the  blood  returned  to  the 
capillaries,  and  the  machinery  of  life,  temporarily  sus- 
pended, was  again  set  in  motion.  He  remained  m  this 
position  thirty  minutes  longer,  when  he  was  placed  in 
the  recumbent  posture.  Cold  applications  were  applied 
to  the  head,  and  hot  epithems  to  the  feet,  and  an 
enema  of  whiskey,  |  ss.  with  gum  camphor  gr.  v.  was 
gi  ven«  This  measure  assisted  in  completing  the  reaction. 
His  convalescence  was  exceedingly  rapid,  but  he  was 
speechless  24  hours. 

Htpoderkic  Injections  in  Puerperal  Convulsions. — 
Dr.  V.  H.  Taliaferro  in  the  AUanta  Medical  and  Sur- 
gical  Jo^rnaly  speaks  in  praise  of  hypodermic  injections 
of  morphia  in  a  case  of  puerperal  convulsions  occurring 
in  his  practice.  The  convulsions  had  lasted  sevend 
hours,  and  the  head  was  well  impacted  in  the  inferior 
strait  On  his  arrival  at  the  bedside,  chloroform  was 
immediately  given,  but  did  not  control  the  convulsions 
until  after  she  had  been  bled  from  the  arm,  Neariy 
three  hours  elapsed  before  the  child  was  dehvered  widi 
forceps.  The  patient  was  at  this  time  in  an  "  alarosin^ 
condition  from  profound  coma  and  great  prostration. 
A  grain  of  morphia  was  now  administered  by  hypo- 
dermic injection,  and  the  patient  left  until  the  following 
evening,  when  the  operation  was  repeated.  On  the 
following  morning  the  patient  was  but  little  improved* 
The  injectiops  were  repeated  as  on  the  previous  days. 


THE  MEDICAL  RECORD. 


847 


morning  and  evening.  On  the  third  afternoon  the 
morphia  was  discootinued,  and  the  patient  aronsed, 
sat  up  in  bed,  and  spoke  to  her  attendants.  From 
this  time  the  recovery  was  rapid.  Dr.  Taliaferro 
thinks  the  **  recovery  of  the  woman  mainly  due  to 
the  hypodermic  administration  of  the  morphia,  where- 
by a  sufficient  narcotism  was  induced  immediately  fol- 
lowing delivery,  and  kept  up  until  reaction  had  quietly 
and  firmly  established  itself,  avoiding  thereby  the  vio- 
lent reaction  which  would  in  all  reasonable  probability 
have  ensued,  and  resulted  in  the  most  active  inflamma- 
tion, establishing  itself  most  likely,  in  the  peritoneum, 
the  uterus,  or  both." 

Imperforate  Anus  w  the  Hog. — J.  M.  Johnson, 
M.D.,  relates,  on  the  authority  of  Oapt.  McDaniel  of 
Atlanta,  Qtk,  a  very  curious  circumstance,  which  can  be 
verified  by  a  number  of  witnescjes.  Mr.  John  E.  Gad- 
sey,  of  Franklin,  Tenn.,  raised  a  male  hog  to  be  eighteen 
months  old  with  imperforate  anus.  The  animal  was 
always  fat,  and  in  every  particular,  except  the  one 
mentioned,  properly  developed.  Afler  retaining  his 
food  for  a  certain  length  of  time,  feeding  as  other  hogs, 
vomiting  would  ensue,  and  then,  with  an  appetite  as 
keen  as  ever,  he  would  go  to  his  meals  again.  He  was 
killed  at  the  age  of  eighteen  months,  was  thoroughly 
iat,  and  to  all  appearances  in  peifec^  health. — AUanta 
Medical  a/nd  Sttrgical  Journal 

EXPERHINCE    IN    THE    TREATMENT    OF    ChOLERA. — In    a 

communication  to  the  Cincinnati  Lancet  and  Observer ^  Dr. 
S.  S.  Todd,  of  Kansas  City,  advocates  the  use  of  can- 
tharides  in  connection  with  dilute  sulphuric  acid.  He 
says :  "  From  a  desire  to  have  the  plan  thoroughly  tested, 
I  give  my  practice  in  a  limited  number  of  cases  with 
the  results : 

"  First,  ten  grains  of  mass  hydrarg.  and  a  large  plas- 
ter of  cer.  cantharides,  apphed  early  over  the  stomach 
and  bowels ;  to  be  removed  before  vesication  if  the 
symptoms  abate.  It  is  designed  that  the  active  princi- 
ple of  the  fly  shall  be  absorbed.  Second,  the  following 
mixture :  5  •  Tr.  cantharid.  3  ij.,  acid,  sulph.  dilut., 
syr.  tolutani,  aa  |  j.,  tr.  opii  3  ij.  M.  For  an  adult,  two 
teaspoonfuls  of  the  mixture  in  a  wine-glassful  of  water 
every  half  hour  or  hour.  If  rejected  by  the  stomach, 
repeat  at  cnce  until  retained.  When  the  more  alarming 
symptoms  abate,  administer  more  sparingly.  This  is 
intended  for  use  prior  to  collapse,  and  as  soon  as 
diarrhoea  or  vomiting  first  occurs,  and  immediately  fol- 
lowing the  mercurial  For  collapse,  the  same,  except 
that  me  tincture  of  opium  is  omitted,  and  the  dose 
increased  to  three  teaspoonfuls.  One  of  the  most  re- 
markable and  invariable  effects  is  the  immediate  cessa- 
tion of  cramps,  if  they  have  been  present.  The  pulse, 
too,  is  increased  in  fulness,  and  the  heat  of  the  body 
augmented.  This  is  often  seen  temporarily  in  those 
who  are  beyond  recovery.  How  fer  these  results  are 
due  to  the  sulphuric  acid,  I  am  unable  to  say,  as  I  have 
not  used  the  cantharides  except  in  conjunction  with  the 
remedies  named.  No  alcoholic  stimulant  is  allowed, 
and  cold  water  is  given  by  the  teaspoon  only.  The  ex- 
tremities are  kept  warm  with  a  dry  heat  They  should 
be  kept  well  covered  and  no  rubbing  allowed.  The 
patient  should  take  the  bed  on  the  appearance  of  the 
first  symptoms,  and  the  most  absolute  quiet  of  the 
patient  and  surroundings  should  be  preserved.  If  the 
case  is  dangerous,  he  should  not  even  be  allowed  to 
turn  over  in  bed,  and  should  be  prevented  from  getting 
up  to  have  his  evacuations,  and  urged  to  restrain  them 
•8  long  as  po&sible.  The  first  dose  of  the  medicine  is 
usually  rejected,  but  if  it  is  repeated  immediately,  it  will 
be  retained.  Strangury  is  rare,  and  if  produced,  U 
easily  removed  by  a  dose  of  morphia.    From  the  I3th 


of  August,  to  the  1st  of  November,  1866, 1  had  twenty- 
three  cases  under  my  exclusive  care,  and  all  of  them 
were  subjected  to  the  foregoing  treataeut,  with  slight 
variations.  In  no  case  was  the  blister  omitted,  and  all 
had  the  tincture  of  cantharides  and  dilute  sulphuric 
acid  in  very  nearly  the  proportions  giveni  Of  these  23 
cases,  16  recovered  and  7  died.  Of  the  cases  of  recovery, 
6  were  of  mild  character,  attended  with  vomiting  or 
purging,  or  both  ;    7  were   of  a  severer   type,   and 

Eartially  collapsed,  while  3  were  completely  ecl- 
ipsed. In  none  of  the  cases  was  there  consecutive 
fever.  Most  of  the  cases  were  seen  and  treated  early.  In 
one  case  only  had  the  disease  existed  over  ten  or  twelve 
hours,  and  in  this  case  complete  collapse  came  on  shortly 
afler  my  first  visit.  This  patient  was  able  to  leave  his 
bed  in  five  or  six  days.  I  do  not  hesitate  to  express 
the  opinion  that  a  majority  of  the  fatal  cases  might  have 
been  saved  by  the  medication  de!»cribed,  had  they  been 
timely  treated.  Comparing  this  treatment  with  that  I 
saw  adopted  in  1849-50,  when  calomel  and  opium 
were  the  remedies  chiefly  relied  on,  I  am  impressed 
with  the  belief  that  we  are  rapidly  tending  to  the  point 
when  cholera  shall  be  shorn  of  half  its  terrors." 

Dr.  Todd  also  calls  att«niion  to  the  use  and  probable 
value  of  the  dilute  sulphuric  acid  as  a  prophylaotic  in 
epidemic  cholera.  A  fluid-drachm  in  a  wine-glassful 
of  water,  before  breakfast  and  before  retiring  at  night,  is 
suflScient  He  and  a  large  number  of  others  have  used 
it  with  complete  satis^tion.  Many  of  the  parties 
were  exposed  for  several  consecutive  days  as  nurses, 
and  none  of  them  took  the  disease. 

Obstruction  of  the  Bowels  from  Accumulation  of 
Cotton  Yarn. — Dr.  0.  T.  Gardner  reported  (Boston 
Med,  and  Surg,  Jour.)  to  the  Providence  Medical  Asso- 
ciation, a  Case  of  the  above.  The  patient  was  a  female, 
aged  26  years,  a  weaver  by  occupation.  When  Dr. 
Gardner  first  saw  the  patient,  she  had  symptoms  of  en- 
teritis, pains  and  tenderness  of  the  abdomen,  accompa- 
nied by  vomiting.  Bowels  constipated,  nights  sleepless. 
In  the  emesis,  he  discovered  a  small  quantity  of  cotton 
yam.  On  inquiry,  he  learned  that  the  patient,  during 
the  past  six  months,  had  been  in  the  habit  of  chewing 
cotton  yam  and  swallowing  it.  To  relieve  the  pain, 
he  injected  sulphate  of  morphia,  hypodermically ;  this 
was  followed  by  castor-oil,  producing  copious  evacua- 
tions of  the  bowels,  and  revealing  the  cause  of  her  ill- 
ness, in  the  shape  of  some  half-pound  of  cotton  yam. 
Dr.  G.  exhibited  a  portion  of  the  yarn.  The  health  of 
the  patient  previous  to  this  illness  had  been  good,  the 
catamenia  being  regular;  and  she  had  no  morbid  pro- 
pensities in  relation  to  eating. 

Puncture  of  Bladder  per  Rectum.— Recovery. — 
Dr.  B.  F.  Hart,  of  Marietta,  Ohio,  in  a  private  letter  to 
a  friend,  reports  a  case  of  successful  puncturing  of  a 
distended  bladder,  after  all  the  ordinary  means  had  been 
resorted  to.  The  operation  was  performed  per  rectum 
by  means  of  a  trocar  and  canula.  The  cause  of  disten- 
sion was  an  impassable  stricture. 

Ligature  of  Subclavian  Artery.  —  The  left  sub- 
clavian artery  was  ligated,  November  14,  1866,  by  Dr, 
T.  G.  Morton,  Philadelphia,  for  spontaneous  aneurism  of 
the  axillary.  The  patient  recovered  and  was  discharged 
on  the  li5th  day,  after  having  survived  an  unusual 
number  of  secondary  complications,  including  twelve 
hfiemorrhages  from  collateral  vessels,  which  brought  him 
three  times  to  death's  door,  and,  at  la^t.  sphacelation  of 
nearly  the  whole  arm.  The  ligature  of  the  subclavian 
was  placed  upon  its  second  portion,  the  wound  healed 
perfectly,  and  the  ligature  came  away  oji^  the  eighteenth 
day. — Am,  Journal  of  Med,  Sciences,  ^jQO^ 


348 


THE  MEDICAL  RECORD. 


Bromide  of  Potassium  in  Affbctions  of  the  Testes. 
— Dr.  Bedford  Brown,  of  Washington,  D.  €►,  has,  for 
ten  years  past,  found  the  bromide  of  potassium  Tery 
useful  in  diseases  of  the  entire  genito-urinary  system, 
especially  in  affections  of  the  ovary  and  testis.  The 
earliest  effect  which  he  has  noticed  is  a  positive  dimi- 
nution of  pain,  and  relief  to  annoying  phenomena  at- 
tendant. He  thinks  that  this  sedative  power  is  dis- 
played even  in  cases  in  which  no  more  decidedly  curative 
effect  is  produced.  For  the  state  thus  induced  he  sug- 
gests the  term  brominmn. — Am,  Jour,  of  Med,  Sciencet. 

Solvents  for  Cholesterine,  Etc. — In  an  interesting 
and  important  article  in  the  last  number  of  the  American 
Journal  of  the  Medical  Sciences,  Dr.  T.  H.  Buckler,  of 
Baltimore,  relates  his  experience  with  chloroform  and 
succinate  of  the  peroxide  of  iron  as  solvents  for  choles- 
terine and  cholesteric  fat ;  he  has  invariably  found  them 
successful  The  chloroform  is  used  in  teaspoonful  doses 
everv  hour  during  the  existence  of  acute  pain  produced 
by  the  impaction  of  calculi  in  the  duct  of  the  gall  blad- 
der, and  after  each  meal,  when  the  urgent  symptoms 
have  subsided.  But  although,  both  on  account  of  its 
solvent  and  its  anaesthetic  powers,  chloroform  was  found 
by  far  the  best  remedy  for  the  acute  symptoms,  it  had 
no  efficacy  to  prevent  the  formation  of  other  stones. 
Considering  that  the  difficulty  of  dissolving  cholesteiine 
depends  upon  the  small  amount  of  oxygen  which  it 
contain^  it  was  thought  that  substances  containing 
oxygen  in  large  proportion  would  be  most  Ukely  suc- 
ceiiully  to  combat  the  cholesteric  tendency.  With 
this  in  view,  the  peroxide  of  iron  and  succinic  acid  were 
selected,  and  from  them  Dr.  Stewart,  the  chemist,  of 
Baltimore,   prepared    the  hydrated  succinate  of  the 

?eroxide  of  iron.  This  nibstance,  when  taken  in  about 
5  grain  doses  af\er  each  meal  for  more  than  six  months, 
had  the  effect  of  preventing  the  accumulation  of  biliary 
calculi  It  is  also  stated  tbit  this  salt  may  be  used  witn 
advantage  by  persons  having  a  tendency  to  obesity,  or 
where  there  seems  a  probability  that  fatty  degeneration 
is  invading  the  heart  or  other  organs.  Dr.  Buckler  con- 
siders it  important  that  this  succinate  should  be  pr^ 
pared  in  the  hydrous  state,  and  kept  constantly  m  a 
water  bath,  as,  if  dried,  it  does  not  dissolve  in  water. 

Operation  for  Belief  of  Artifioial  Antts. — Dr. 
Kinlock,  of  South  Carolina,  reports  in  the  American 
Journal  of  Medical  Sciences  a  case  of  artificial  anus, 
from  ^nshot  wound,  in  which  seven  months  after  the 
reception  of  the  injury,  during  which  time  the  function 
of  the  lower  portion  of  intestine  had  been  suspended, 
he  succeeded  in  uniting  the  upper  and  lower  portions, 
and  converting  the  artificial  anus  into  fascal  fistula,  by 
which  means  the  patient  was  rescued  fi'om  approaching 
death  by  starvation.  The  condition  of  the  parts  was 
such  that  it  was  necessary  to  lay  open  the  peritoneal 
cavity  and  break  up  the  adhesions  already  formed.  The 
results  were  not  all  that  had  been  expected,  but  were 
sufficiently  beneficent  to  serve  as  an  argument  against 
the  practice  of  abandoning  intestinal  lesions  to  nature. 
Three  years  after  the  operation  the  patient  weighed 
over  200  pounds,  and  could  ride  half  a  day,  or  wtuk  a 
mile  without  resting. 

Index  of  Physical  Endurance.— Dr.  Ruschenbfer- 
ger,  of  the  Navy,  concludes  that  the  length  of  the 
cerebro-spinal  axis,  measured  from  the  perineum  to  the 
vertex,  affords  a  better  index  of  physical  efficiency  than 
the  ^  total  height  of  a  man.  Adverting  to  a  paper  in 
which  Dr.  B.  A  Gk>uld  states  that  the  "  tall  men  did 
not  wear  as  well  as  the  shorter,"  he  remarks :  "  Obser- 
vation has  led  me  to  conjecture  that,  as  a  rule,  men  of 
average  height,  made  up  of  a  long  trunk  and  compara- 
tively short  lower  extremities,  possess  greater  power 


to  endure  with  impunity  great  labor  and  exposure 
to  vicissitudes  of  all  kinds  than  men  who  have  com- 
paratively long  lower  limbs  and  short  trunks.  A  long 
and  otherwise  fully  developed  trunk  affords  more  space 
for  the  accommodation  of  organs  essential  to  life  than 
one  of  smaller  dimensions.  The  size  of  the  contained 
organs  is  proportionate  to  the  capacity  of  the  cavities 
provided  for  them;  and  it  may  be  assumed  that  all 
things  being  equal,  the  size  of  an  organ  is  a  measure  of 
its  power. — Am.  Journal  of  Med,  Sciences. 

Cerqiro-Sftnal  Meningitis. — ^In  an  analysis  of  one 
hundred  and  sixty-one  cases  of  cerebro-spinal  menin- 
gitis, which  occurred  at  the  Philadelphia  Hospital 
during  the  winter  of  1866  and  1867,  Dr.  Githens  makes 
the  f(^owing  statements : 

The  patients  ranged  from  eight  to  sixty-eight  years 
of  age,  and  with  few  exceptions  were  intemperate  and 
irregular  in  Uieir  habits ;  they  lived  in  filthy  neighbor- 
hoods, in  crowded  tenements,  and  frequently  in  under- 
ground apartments.  The  disease  showed  no  signs  of 
contagiousness,  the  cases  being  confined  to  no  particular 
part  of  the  house ;  two  cases  rarely  came  successively 
from  the  same  ward.  About  a  week  oi  prodromata 
generally  preceded  the  attack;  there  were  muscular 
pains,  general  sorenesSj  tenderness  of  the  surface,  so 
that  a  touch  became  pamful ;  nausea  and  bilious  vomit- 
ing, but  little  or  no  disturbance  of  the  bowels.  The 
eruption,  which  was  one  of  the  symptoms  generalljr 
ushering  in  the  real  onset  of  disease,  was  not  at  all  uni- 
form in  character,  while  thirty-seven  out  of  ninety-eight 
cases  had  no  eruption  at  alL  The  peculiar  expression  of 
countenance,  the  depressed  comers  of  the  mouth,  the 
wild,  staring,  watchml  gaze  of  protruded  eyes,  and  the 
congested  conjunctiva,  were  characteristic.  Thirst  as 
insatiable  as  in  cholera  wasmarked  and  persistent.  The 
temperature  was  lower  than  is  recorded  of  any  other 
typhoid  disease,  ranging  from  100®  to  105®.  The  dura- 
tion, including  prodromata,  was  in  many  cases  from 
twenty  to  thirty  days.  Death  occurred  in  a  little  over 
26  per  cent,  of  the  cases  treated.  Carbuncles  and  boils 
were  fi^quent  sequelae ;  deafiiess,  more  or  less  marked, 
resulted  in  sixteen  cases. — Am.  Journal  of  Med,  Sciences, 

Elephantiasis  Grscoruh;  both  Common  Carotids 
Tied. — Dr.  J.  M.  Camochan  reports  to  the  Am.  Journal 
of  Med,  Sciences  a  case  of  the  above  disease,  which  had 
invaded  the  skin  and  subjacent  tissues  of  the  face  and 
neck,  spreading  from  a  small  pimple  below  the  right 
comer  of  the  mouth,  until,  at  the  end  of  fourteen  years, 
the  parts  presented  the  appearances  characteristic  of 
leontiasis;  sight,  hearing,  and  smell  were  gone,  from 
obstruction,  and  taste  and  sensation  were  blunted.  In 
the  early  course  of  the  malady  excision  of  the  individual 
tubercles  as  they  appeared,  and  later,  constitutional 
treatment  had  been  tried  without  essential  benefit.  In 
November,  1868,  the  right  common  carotid  wasligated, 
and  the  operation  caused  so  great  a  diminution  in  the 
size  of  the  morbid  growth  that  sight  and  hearing  were 
restored.  At  the  end  of  six  months,  the  disease  ap- 
pearing to  be  stationary,  the  left  common  trunk  waSx 
tied.  This  caused  a  siill  further  improvement,  whidi 
continued  until  the  fall  of  1860,  when  the  curative 
process  was  apparently  passive.  During  the  next  six 
years  various  secondary  operations  were  performed  for 
the  removal  of  nodular  masses  which  had  either  ap- 
peared since  the  operations,  or  not  shrunken  equauy 
with  the  surrounding  parts,  until,  in  December  of  1866, 
it  could  be  noted  that  there  was  no  disposition  in  the 
disease  to  extend,  but,  on  the  contrary,  to  inrther 
diminish ;  the  senses  were  perfect,  the  operation  of  the 
brain  unimpaired,  the  general  health  excellent,  the  spirits 
good,  and  the  patient  a  useful  member  of  her  househc^d. 


THE  MEDICAL  RECORD. 


849 


The  Medical  Eeoord. 

^  J$emi-3[ont^l3  |(mnml  of  ptbidne  Bnb  Snrgers* 
GsoBGB  F.  Shbjldt,  SLD.,  Editob. 

PabUshed  on  th«  1ft  and  15th  of  each  Month,  hf 
WILLIAM  WOOD  ^  CO.,  61  Walxbb  Stbvbt,  Nkw  Tobk. 

FOBSIGIf  AGENOIES, 


LoKDOK— Trurhkb  h  Co. 

PaBO— BoSftABDB   BT  ClB. 


Lbipsic^B.  Hbrmakn. 

Bio  Jaitxibo— BTBPHBNfi  t  Oa. 


Nevr   York.   October  1.  1867. 

MEDICAL  CLLQUISM. 
T«E  strong  tendency  to  aggregation  which  is  mani- 
fested by  similar  particles  is  a  prime  fact  among  the 
phenomena  of  the  material  universe.  Star-dost  will  not 
lie  in  nebulous  maases,  but  ever  resolves  itself  into  sep- 
arate suns,  each  one,  doubtless,  with  its  attendant  plan- 
ets circling  through  infinite  space.  To  the  same  law 
the  rock-ribbed  earth  is  found  obedient,  as  the  orderly 
stratification  of  its  crust  bears  witness;  and  when  to  in- 
am'mate  matter  the  higher  principle  of  life  is  introduced, 
the  uniform  activity  of  corresponding  forces  becomes 
«till  more  apparent.  The  terse  old  saw  concerning  birds 
of  similar  p'umage  has  lost  ncme  of  its  truth.  With  the 
affinities  which  group  individuals  of  the  human  race,  all 
are  familiar.  Regarding  the  custom  of  the  angelic  hosts 
it  may  not  be  prudent  to  inquire,  but  there  is  high 
authority  for  the  belief  that  even  "devil  with  devil 
damn'd  firm  concord  holds." 

With  such  an  array  of  facts  from  the  order  of^  nature 
ever  before  their  attentive  eyes,  it  might  be  supposed 
that  the  members  of  the  medical  profession  would  con- 
stitute the  most  harmonious  brotherhood  imagini^le. 
Animated  by  the  spirit  which  community  of  pursuits 
should  engender,  the  noble  army  of  doctors  might  not 
unreasonably  be  expected  to  present  the  charming  spec- 
tacle of  a  body  pf  philanthropists,  cordially  cooperating 
for  the  good  of  humanity  and  of— each  other.  Strict 
regard  for  scientific  accuracy,  however,  compels  us  to 
conclude  that  we  are  yet  far  from  realizing  so  happy  a 
picture.  Close  inspection  shows  the  mass  of  physicians 
divided  into  little  societies,  clubs,  or  cliques.  The  mem- 
bers of  tliese  fraternities  are  held  together  either  by  sen- 
timents of  mutual  admiration,  by  a  show  of  scientific 
seal,  or  with  shame  be  it  said,  by  disappointment  and 
jealousy.  Men  of  oongeni^  temper  are  instinct- 
ively drawn  into  contact.  Some  one,  of  perhi^s  more 
than  average  ability,  f(Mm8  the  nucleolus  of  the  happy 
band.  Mirror-like  he  reflects  the  compliments  of  his 
friends,  who  in  turn  are  too  polished  to  absorb  sueh 
comfortable  radiations.  All  is  light  and  warmth  in  these 
pleasant  circles.    It  is  the  old  story  of  the  oak  and  the 


ivy — ^fair  to  the  eye,  and  without  reproach  till  perchance 
the  venerable  trunk  has  surrendered  life  and  substance, 
when  the  whole  growth,  late  so  leafy  and  graceful,  falls 
suddenly  to  earth,  a  most  pitiable  ruin.  All  this,  how- 
ever, is  harmless  enough.  The  tie  of  friendship  is  as 
sacred  and  as  wcurthy  of  honor  when  it  unites  the  mem- 
bers of  our  profession  as  when  it  draws  together  any 
other  harmonious  eouls.  It  is  only  when  mutual  esteem 
degenerates  into  mutual  flattery,  begetting  exduslveness 
and  contempt  for  outsiders,  that  such  association  degen^ 
erates  into  cliquery.  ^ 

Upon  the  solid  foundations  of  the  medical  schools^ 
are  usually  based  cliques  of  a  scientific  sort  Here  are 
gathered  the  high-priests  of  the  profession,  so  many  at 
least  as  can  gain  admission  to  the  ranks  of  the  faculties, 
and  around  them  duster  a  swarm  of  neophytes  ready 
alike  to  fill  the  air  with  a  hum  of  applause  at  the  dicta 
of  their  ohie&,  or  to  fly  in  the  faces  of  all  who  would 
doubt  the  prowess  of  their  champions.  Very  worthy 
and  very  useful  bodies  are  these,  so  long  as  they  are 
content  to  "improve  each  shining  hour;"'  but  when 
rivalry  or  o^^sition  stirs  the  hive,  alas!  for  defenceless 
humanity  I 

It  is  in  this  connection  that  we  feel  constrained  to 
remark  upon  certain  practices  which  are  in  vogue 
among  the  members  of  these  corporations.  The  rivalry 
of  the  schools  excites  their  officers  to  every  possible 
efibrt  for  the  attraction  of  students,  not  merely  by  the 
quality  of  the  instruction  imparted,  but  by  the  hope  of 
assistance  and  advancement  after  graduation.  For  these 
hopes  the  younger  men  are  expected  to  lend  their 
backs  as  stepping  stones  for  the  progress  of  their  master, 
whose  personal  ambition  is  afler  all  the  main-spring 
which  sets  in  motion  so  many  wheels  of  selfishness. 
With  all  this,  however,  fault  could  not  be  found,  were 
not  the  most  unwarrantable  methods  of  advancement, 
copied  from  the  lowest  forms  of  political  trickery,  too 
often  adopted  by  men  whose  position  and  renown  should 
place  them  above  all  that  is  dishonorable.  It  is  impos- 
sible to  convict  these  offenders;  for  such  Is  the  organizar 
tion  of  the  cliques  in  which  they  move,  that  upon  no 
individual  member  can  be  charged  the  responsibility  for 
any  given  act. 

Another  flagrant  abuse  of  the  principle  of  association 
is  shown  by  the  fiict  that  in  oonsequence  of  these  cliques 
it  has  become  well-nigh  impossible  for  any  one  outside 
of  the  number  of  their  favorites  to  obtain  a  position  in  our 
hospitals  and  colleges.  Scientific  attainments  weigh  but 
lightly  against  the  influence  of  a  well-organized  club. 
When  a  vacancy  occbrs  on  the  staff  of  a  hospital  or  in 
the  faculty  of  a  college,  it  does  not  seem  so  much  a 
question  of  intellectual  fitness  which  first  arises  con- 
cerning the  candidate,  as  the  nature  of  his  connections 
and  the  degree  of  his  availabiUty.  Who  are  his  patrons  ? 
What  wiU  he  do  for  me?  These  are  the  questions 
which  occupy  too  much  the  minds  of  those  who 
have  a  voice  in  the  matter.  In  this  way  our  college  &o- 
ulties  and  hospital  boardd  become  the^s^ost  exdusive 
•digitized  by  VjOO^^_ 


850 


THE  MEDICAL  RECORD. 


bodies,  of  whose  members  too  many  will  stick  at  noth- 
ing for  the  gratification  of  their  own  selfishness.  This 
is  one  of  the  evils  which  recoil  upon  the  malefactor,  for 
no  one  can  be  at  the  same  time  a  college  professor,  a 
physician  or  surgeon  to  three  or  four  hospitals,  and  the 
master  of  a  large  practice,  without  losing  ground  as  i^ 
man  of  science.  This  overreaching  ambition  renders 
the  lives  of  some  of  our  ablest  men  almost  useless  to  the 
profession,  and  hinders  the  accomplishment  of  anything 
which  may  serve  in  future  as  a  monument  to  their 
memory.  Could  a  tithe  of  the  time  which  these  gentle- 
men now  spend  in  racing  fit)m  one  operating  theatre  to 
another  be  occupied  with  careful  study  and  collation  of 
their  cases,  how  much  more  enduring  would  be  their 
own  reputation — ^how  much  more  instructive  the  med- 
ical literature  of  their  day  I 

Basest  of  all  the  cliques  are  those  which  have  for  their 
object  money.  Science,  honor,  the  esteem  of  then-  fel- 
lows, all  go  for  naught  with  men  who  for  gold  or  for 
the  hope  of  gold  are  willing  to  enter  the  organized 
cliques  into  which  quackery  subdivides.  Lamentable, 
indeed,  is  the  spectacle  presented  by  the  young  man 
who  at  the  outset  of  his  professional  career,  destitute  of 
principle,  and  only  ambitious  for  pecuniary  success, 
stands  balancing  with  all  his  feelers  in  motion,  seeking 
admission  to  some  little  association  which  shall  bear 
him  easily  on  to  fortune.  To  become  the  satellite  of 
some  great  man,  or  a  noisy  member  of  a  mutual  admi- 
ration club,  or  the  appendage  of  even  a  political  party 
which  may  have  fevors  to  bestow,  these  are  his  first 
objects  of  desire.  Failing  here,  the  unscrupulous  for- 
tune-hunter consents  to  discuss  homoeopathy,  eclecti- 
cism, whatever  disreputable  thing  may  promise  most 
Surely  and  rapidly  downward  tends  the  course  of  the 
adventurer,  no  matter  how  fair  the  mask  with  which 
he  seeks  to  captivate  the  eyes  of  the  world.  When  shall 
the  noble  title  of  physician  be  no  more  defiled  by  these 
carrion-crows  of  the  profession  ? 

Do  these  facts  seem  to  contradict  the  law  of  nature? 
On  the  contrary,  they  exhibit  exact  conformity  with  that 
law.  Like  seeks  like,  and  congeniality  will  govern  the 
association  of  the  best  of  men.  It  is  only  the  abuse  of 
what  is  in  itself  good  that  gives  occasion  to  the  com- 
plaints which  are  rife.  Physicians  are  but  men ;  and 
while  they  continue  to  be  animated  by  the  motives 
which  influence  the  mass  of  mankind,  it  is  useless  to  ex- 
pect greater  unanimity.  Only  when  the  spirit  of  the 
golden  rule  shall  become  alike  the  guiiJe  of  the  philoso- 
pher and  the  peasant ;  when  the  lion  shall  lie  down  with 
the  lamb,  and  doctors  cease  to  disagree^  will  cliques  and 
all  their  attendant  evils  be  known  no  more. 


During  the  past  fortnight,  Mr.  T.  Spencer  Wells,  of  Lon- 
don, has  paid  a  visit  to  this  country,  and  it  should  be  a 
cause  for  congratulation  among  American  physicians 
that  he  carries  with  him  such  a  high  opinion  of  our 
professional  character,  and  our  institutions.    During  his 


sojourn,  at  first  in  Canada,  and  afterwards  in  Philadel- 
phia^  New  York,  and  Boston,  every  professional  courtesy 
has  been  extended  to  him,  to  which  his  enviable  repu- 
tation as  one  of  the  most  celebrated  operators  of  the 
age  entitle  him.  The  letter  from  our  correspondent  in 
Philadelphia  gives  us  a  graphic  account  of  his  doings 
in  that  city,  and  his  reception  there.  It  is  needless  to 
say  that  our  own  city  was  not  behindhand  in  tendering 
professional  courtesies  to  the  great  ovariotomist.  While 
here,  he  was  the  guest  of  Prof.  B.  Fordyce  Barker, 
who  kindly  invited  his  professional  brethren  to  meet 
Mr.  Wells  at  the  Mott  Memorial  Library,  and  the  large 
number  in  attendance  on  that  evening  must  have  shown 
the  distinguished  foreigner  that  his  services  in  the  cause 
of  science  had  been  duly  and  appreciatingly  recognized. 
With  a  taste  that  is  in  every  respect  to  be  commended, 
the  gatheriug  was  a  purely  social  one,  and  everything 
was  done  to  make  the  evening  pass  pleasantly  and  pro- 
fitably, not  omitting  the  elegant  supper  provided  for 
the  occasion.  The  selection  of  the  building  was  a  good 
one,  and  was  singularly  appropriate  as  honoring  the 
name  of  one  of  our  illustrious  dead,  by  the  presence  in 
the  Memorial  rooms  of  one  who  has  written  the  most 
touching  and  chaste  obituary  of  Dr.  Mott  which  has 
ever  emanated  fi*om  the  transatlantic  press.  It  is  per- 
haps needless  to  call  to  the  mind  of  many  of  our  read- 
ers that  the  memoir  referred  to  was  the  one  penned  for 
the  columns  of  the  Medical  Times  &  Gazette^  of  London. 
The  occasion  was  a  rare  one,  and  was  seemingly  as 
pleasant  to  the  guest  as  to  the  rest  of  the  company. 

The  day  following,  in  company  with  Dr.  Emmet,  he 
visited  the  new  Woman's  Hospital,  just  opened,  and  the 
New  York  Hospital  in  company  with  Dr.  C.  M.  Allin, 
one  of  the  visiting  surgeons.  By  special  invitation  the 
succeeding  day,  he  offered  some  remarks  upon  the  sub- 
ject of  ovariotomy,  to  a  large  and  appreciative  audience, 
who  were  at  the  same  time  delighted  with  his  easy  and 
elegant  delivery,  and  edified  by  his  practical  and  com- 
mon-sense observations.  The  substance  of  his  remarks 
will  be  found  in  the  letter  firom  Philadelphia.  Starting, 
afler  this  short  stay,  for  Boston,  he  remained  in  that 
city  for  a  few  days,  and  departed  last  Wednesday  for  his 
home. 

During  his  lecture  at  Bellevue,  in  speaking  of  the 
character  of  our  physicians,  and  of  the  means  which 
they  had  at  their  command  for  the  study  of  disease,  he 
made  the  remark  that  British  physicians  should  now 
think  as  much  of  coming  to  this  couutry,  and  making 
themselves  acquainted  with  what  was  being  done  here, 
as  we  formerly  did  of  taking  a  trip  to  Great  Britain. 
This,  coming  from  such  a  source,  is  full  of  significance, 
and  should  encourage  us  to  profit  still  more  from  the 
means  so  abundantly  placed  before  us.  He  can  be  as- 
sured, in  turn,  that  he  carries  with  him  the  esteem  and 
admiration  of  his  American  cousins.  It  is  a  pleasing 
task  to  record  such  interchange  of  courtesies,  and  we 
hope  to  be  able  soon  to  have  another  occasion  to  per- 
form a  similar  one.  ^<^  t 

Digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


351 


H^mms. 


The  Principles  and  Practice  op  Disinpeotion.  By 
Roberts  Bartholow,  M.D.  Cincianati,  1867.  12mo,  pp. 
111. 

This  is  a  very  useful  manual  on  the  subject  of  which  it 
treats,  and  i^  in  a  form  very  convenient  for  use.  The 
author,  in  his  first  chapter,  speaks  of  the  substances  on 
which  disinfectants  are  intended  to  act ;  which  he  di- 
vides into  two  classes:  1.  Those  developed  in  the 
process  of  putrefactive  decomposition  of  animal  and 
vegetable  matter ;  and  2.  That  peculiar  organic 
matter  to  which  we  apply  the  terms  virus,  materiea 
fnarbij  morbi6c  matter,  diseased  germinal  matter,  eta 
It  is  assumed  with  great  probability,  contrair  to 
the  theory  of  Liebig,  that  rMUeries  marhi  is  living 
matkr.  If  so,  the  zymotic  theory  must  be  abandoned, 
together  with  the  nomenclature  founded  on  the  doc- 
trine of  A  ferment,  Discoveiyand  science  seem  rapidly 
tending  in  this  direction.  We  never  were  fully  per- 
suaded of  the  truth  of  Liebig's  theory  of  fermentation 
in  living  bodies.  Our  townsman.  Prof.  Paine,  has  well- 
nigh  exploded  all  this.  Prof.  Beale  now  comes  in  to 
declare  the  theory  "not  only  unreasonable  in  it- 
self, but  as  obstructing  the  progress  of  knowledge." 
What  then  ?  Are  we  prepared  to  embrace  a  theory 
of  disease  based  entirely  on  microscopic  researches? 
QhsU  we  believe  Dr.  !Beale  and  others  when  they 
assure  us  that  the  power  of  growth  and  the  pro- 
duction of  tissue  depend  upon  minute  masses  of  "germi- 
nal matter,"  and  that  there  is  no  distinction,  chemical, 
phvsical,  or  microscopical,  between  the  normal  germi- 
nal matter  employed  in  building  up  tissue,  and  the 
abnormal  or  diseased  germinal  matter  which  excites 
the  phenomena  of  disease  ?  We  are  not  about  to  dis- 
pute this  point ;  if  a  microscopist  claims  to  see  what 
no  one  else  has  ever  seen,  or  not  to  see  differences  ac- 
knowledged by  all  others  to  exist,  we  think,  instead  of 
taking  his  statements  as  truth,  it  is  better  to  wait  for 
further  observations  and  developments.  We  are  in  no 
hurry  on  these  theoretic  points,  we  can  afford  to  wait; 
and  we  think  it  by  far  the  safer  course  to  adopt.  It  is 
becoming  quite  too  common  to  overlook  the  vital  en- 
dowments, and  vital  properties.  On  Dr.  Beale's  theory 
we  don't  see  why  all  diseases  should  not  be  communi- 
cable, for,  if  the  degraded  germinal  matter,  which  is 
contained  in  discharges  from  the  lungs,  skin,  and  intes- 
tinal canal,  fall  into  suitable  soil,  they  will  grow  and 
multiply,  and  thus  propagate  these  diseases,  and  as  the 
atmosphere  is  said  to  be  filled  with  all  manner  of  diseases, 
the  germs  of  vibrio^  cactericBj  and  monads  of  the  ani- 
mal kingdom,  and  spores  of  fungi,  mycodermsy  and 
mueedines  of  the  vegetable  kingdom,  pus  cells  in  hos- 
pitals, and  cholem  cells  wherever  this  disease  prevails, 
the  theory  of  disinfection  becomes  simphfied,  so  that, 
instead  of  confining  our  attention  to  destroying  noxious 
gises,  and  the  volatile  produots  of  putrefactive  decompo- 
rition,  we  must  especially  seek  to  attack  and  destroy  these 
«Ks,  the  virus  of  disease,  the  materies  morhi.  We  must 
direct  our  attention  to  diseased  germincd  matter,  Fotd 
odors  are  nothing,  except  as  they  lower  the  vital  forces, 
the  power  of  resisting  and  throwing  off  disease;  in 
other  words,  preventing  the  action  of  this  morbid  cel- 
lular growth — disease-producing  matter.  Where 
must  our  disinfectants  be  applied  in  order  to  be  effi- 
cient? Evidently,  where  the  diseased  matter  is. 
In  cholera,  to  the  choleraic  discharges ;  in  small-pox, 
scarlatina,  etc.,  to  the  air  in  which  the  germinal  cellular 
matter  floats. 
Chapter  11.  treats  of  the  "  Mode  of  Action  of  Disvnfect- 


cmisJ^  In  this  we  discover  nothing  new.  The  author 
first  describes  the  agents  that  chemically  destroy  the 
noxious  compound.  Second,  Those  that  airest  chemical 
change,  antiseptics.  Third,  Agents  that  physically 
restrain  the  noxious  compound.  Under  the  first  class 
he  ranks  heat,  ozone,  chlorine,  hromine,  iodine,  nitrous 
add,  sulphurous  acid,  and  the  chlorides  and  sulpTiates  of 
mineral  bases.  Of  these  heat  is  considered  the  most 
powerful,  and  may  be  assigned  to  each  of  the  three 
classes. 

Chapter  III.  treats  of  the  ^^Application  of  Disinfect-' 
ants,^^  under  the  following  heads,  viz. :  "  Disinfection  of 
air,"  "  disinfection  of  solids  and  liquids,"  "  of  water,*' 
"of  the  discharges  of  the  sick,"  "of  cesspools,"  "of 
clothing,  bedding,  etc.,"  "public  disinfection,"  "pur- 
chase of  disinfectants^  etc."  To  these  is  added  a  notice 
of  recent  papers  on  disinfectants.  Altogether  the  work 
is  creditable  to  the  well-known  talents  and  industry  (^ 
the  author,  and  we  would  strongly  recommend  it  as 
the  best  manual  on  the  subject  yet  issued  from  the 
press. 


C(rrtc«p0ttl>ena* 


MEDICAL  MATTERS  IN  PARIS. 
(from  our  owh  oorbbbpondext.) 

Paris,  August  19,  1867. 
To  TiiB  Editor  or  tbb  Mxdioal  Bkcosd. 

Sir — The  School  of  Medicine  held  its  annual  closing 
ceremonies  on  the  14th.  M.  B^ier  pronounced  an  elo- 
quent eulogy  upon  Rostan.  On  the  17th  the  amphi- 
Uieatre  of  the  !Ecole  was  aga'n  filled  to  celebrate  the 
opening  of  the  IntemationiQ  Medical  Congress,  where 
seven  hundred  physicians  from  aU  parts  of  the  world^ 
representing  nearly  all  the  celebrated  physicians  living, 
had  gathered  together. 

THE  INTERNATIONAL  MEDICAL  OONORESS. 

The  hemicircle  was  draped  with  the  flags  of  all 
nations.  The  eagle  of  Prussia  floated  in  the  midst  of 
the  colors  of  France,  and  the  Turkish  crescent  frater- 
nised with  the  banner  of  England.  M.  Bouillaud  pre- 
sided, supported  on  the  right  by  M.  Gavarret,  on  the 
left  by  M.  Tardieu,  and  pronounced  an  eloquent  addresi^ 
whose  feeling  was  responded  to  by  every  member  of 
the  great  assembly.  When  the  illustrious  professor 
said.  "  I  cannot  contemplate  this  scene  without  being 
profoundly  moved ;  I  feel  my  feeble  powers  fail  to  ex- 
press the  just  sentiment  of  the  occasion,"  aU  the  audi- 
ence replied  by  bravos  the  most  sympathetic;  and 
when  the  orator  concluded,  "  Let  us  rise  to  salute  these 
entwined  flags,  and  than  unite  our  hands  as  they  are 
united,  in  sign  of  complete  and  cordial  fraternization," 
Um  enthusiasm  was  at  its  height,  and  the  amphitheatre 
resounded  with  a  thunder  of  applause. 

But  alasl  having  been  at  its  height,  it  was  all  the 
more  liable  to  fall.  The  day  was  very  hot,  and  the  old 
amphitheatre  was  constructed  for  other  purposes  than 
those  of  ventilation.  The  question  of  the  day  wm 
tuberculization ;  and  after  the  reading  of  the  fiirst  me- 
moir, the  audience  began  to  reflect,  to  calculate  that 
many  more  were  to  follow,  that  they  were  "  in  "  for 
three  or  four  hours  at  least.  People  grew  restless^  and 
anxious.  Presently  every  one  was  electrified  with  a 
voice,  whose  timbre,  entirely  exotic,  pierced  right 
through  the  decorum  of  the.  assembly. 

"  M.  President,  is  it  permitted  to  ask  a  question  ?  " 

"Certainly;  speak." 

"  I  am  a  stranger:  I  am  a  physician  from  Holland, 
Digitizeu„, O^" 


352 


THE  MEDICAL  RECORD. 


and  as  a  Hollander  I  have  been  myited  to  assist  at  ^e 
International  Congress,  but  I  find  I  have  made  some 
mistake ;  for  in  my  opinion  this  is  no  ooneress,  but  a 
class,  a  school-room,  where  some  doctors  nave  come 
together  to  admire  each  other,  and  hold  themselves  up 
for  admiration.'* 

Literally,  that  is  what  the  honest  Dutchman  said. 
He  spoke  with  all  the  traditional  phlegm  at'  his  race ; 
he  scanned  each  word,  and  the  ironical  syllables  fell 
into  the  midst  of  the  "  band  of  brothers  "  like  so  many 
bomb-shells.  Of  course  there  was  confusion,  and  calls 
to  order ;  then,  finally,  the  reading  of  the  papers  on 
tabercnlization  was  resumed. 

The  other  questions  that  will  occupy  the  Congress 
are  as  follows : 

Second  Session, — Continuation  of  the  discussion  on 
tuberculosis.  Discussion  on  the  influence  of  climates, 
races,  and  different  social  conditions  upon  menstruation 
in  diverse  countries. 

Third  Session. — On  the  constitutional  accidents  whidi 
occasion  death  after  surgical  operations. 

Fourth  Session, — Is  it  possible  to  propose  to  different 
governments  efficacious  measures  to  restrain  the  propa- 
gation of  venereal  diseases  ? 

Mfth  Session, — On  the  acdimatation  of  the  races  of 
Europe  in  warm  countries. 

Sixth  Session, — On  the  influence  of  alimentation  upon 
thejproduction  of  certain  diseases  in  different  countries. 

(The  memoirs  announced  upon  this  question  all  relate 

And  in  the  same  stance  will  be  developed  some 
considerations  upon  entozoa. 

This  programme  promises  well,  some  of  the  topics 
being  of  extreme  interest  and  importance,  and  only 
capable  of  being  studied  in  the  li^ht  of  the  experience 
of  physicians  of  many  nationalities.  All  the  medical 
world  that  is  not  at  the  congress  has  gone  into  the 
country,  whither  we  will  follow  them,  and  collect  some 
gleanings  from  the  rich  harvest  of  the  provincial  socie- 
ties, which  in  intelligence  and  learning  are  not  inferior 
to  tiose  of  Paris. 

THE  OONtAQION  OF  CHOLERA^ 

The  Imperial  Society  of  Medicine  at  Lyons,  in  the 
stance  of  the  15th  of  July,  listened  to  a  dissertation 
bjr  M.  Rodet,  upon  the  capital  question  of  the  conta- 
gion of  the  cnolera.  M.  Rodet,  who  occupies  a  middle 
ground  between  the  non-contagionists  and  the  conta- 
gionists,  commenced  by  citing  a  certain  number  of  facts 
that  had  been  adduced  by  each  party  in  proof  of  its 
theoiT.  On  the  side  of  the  first,  four.  In  1835,  the 
vessel  Ville  de  Marseille  was  stationed  two  or  three 
miles  fi*om  Toulon,  where  the  cholera  was  then  raging, 
and  the  crew  had  frequent  intercourse  with  the  infect- 
ed city,  yet  not  a  person  took  the  disease.  In  1831, 
limong  a  hundred  nurses  and  aftendants  upon  cholera 
patients  in  the  hospital  at  Cairo,  not  a  single  person 
took  the  cholera;  eighty  nurses  in  the  hospitol  of  Mon- 
aoorah  have  enjoyed  the  same  immunity;  and  among 
sixty  at  the  hospital  at  Damiette,  only  one  took  the 
diolera.  Again,  at  the  Hospital  of  the  Dey  at  Algiers, 
the  inamunity  of  the  persons  attached  to  the  cholera 
wards  was  so  great  in  1865,  that  one  might  have  sup- 
pcKsed  them  to  be  asylums  of  refuge.  Finally,  in  the 
Military  Hospital  of  Constantinople,  1,488  cholera  pa- 
tients were  received  from  the  27th  of  January,  1855,  to 
the  31st  January,  1856,  of  whom  658  died.  Their 
clothes  and  linen  were  washed  by  the  hospital  attend- 
ants; the  privies  exhaled,  from  time  to  time  fetid 
emanations,  which  sjjread  throughout  Uie  hospital,  and 
even  beyond  its  precincts ;  yet  in  spite  of  so  many  con- 
ditions Bnvorable  to  contagion,  the  disease  was  not  com- 


municated to  any  other  patient,  or  to  any  of  the  per- 
sons attached  to  the  wards. 

It  is  noticeable,  however,  in  connection  with  the  first 
case  cited,  at  Toulon,  that  although  the  crew  of  the 
VUle  de  Marseille  was  so  remarkably  spared,  twelve 
phjrsicians  succumbed  to  the  epidemia  In  1865,  there 
perished  in  the  same  city  six  physicians,  two  apothe- 
caries, ten  nurses  at  the  marine,  and  five  at  the  military' 
hospital,  in  all  twenty-three  persons  connected  with  the 
care  of  the  cholera  patients. 

In  these  cases,  however,  the  non-contagionists  may 
still  urge,  that  the  victims  were  at  the  same  time  ex- 
posed to  epidemic  influence,  so  that  it  is  impossible  to 
tell  what  share  contagion  had  in  the  infliction  of  t^ 
disease.  This  argument  does  not  hold  in  regard  to 
seven  other  cases  quoted  by  M.  Rodet,  occurring  during 
various  epidemics,  and  one  related  in  detail  by  M.  Peti- 
teau,  that  he  observed  last  September.  In  aU  these 
cases  the  infection  seemed  to  be  directly  transmitted  by 
persons  going  from  an  infected  to  a  healthy  locality, 
was  first  communicated  to  persons  with  whom  they 
came  directly  into  contact,  and  thence  from  individual 
to  individual,  over  a  certain  radius,  after  which  the 
morbid  influence  seemed  to  be  extinguished.  In  only 
one  case  was  a  wide-spread  epidemic  excited.  In  five 
of  these  eight  cases  the  disease  was  imported  by  people 
who  had  visited  the  in^ted  locality,  merely  during  a 
few  hours  or  days,  and  were  attacked  shortly  after  their 
return  home,  communicating  the  disease  to  those  who 
nursed  them.  In  M.  Petiteau's  case  the  attendants  on 
the  patient  escaped,  but  after  his  death  a  drunken  com- 
rade, who  persisted  in  passing  all  night  by  his  corpee, 
embracing  it,  and  conmiitting  a  thousand  extravagances, 
was  speedily  smitten.  Twelve  cases  followed  this  in- 
fection, of  which  six  died.  In  the  cases  cited  by  Rodet 
for  the  first,  only  the  son  and  husband  of  the  original 
patient  died,  while  she  recovered,  and  the  disease  went 
no  further.  In  the  second  instance,  only  the  mother  of 
the  patient  was  carried  off,  while  he  recovered.  In  the 
third,  fourteen  persons  perished  out  of  a  population  of 
130  inhabitants.  In  the  fourth,  there  were  thirty-one 
deaths  in  thirty-four  days.  The  other  three  instances  of 
infection  mentioned  by  Rodet  were  occasioned  by  the 
flight  of  persons  from  places  where  they  had  lived,  fiwr 
some  time  during  the  prevalence  of  the  epidemic,  into 
healthy  localities.  In  the  first  case,  a  general  epidemic 
was  lighted  up.  In  the  second,  all  the  members  of  a 
femily  living  in  different  houses  were  successively  at- 
tacked. In  the  third,  twenty-seven  persons  were 
attacked,  of  whom  twelve  succumbed. 

M.  Rodet,  although  attaching  full  importance  to  these 
facts,  as  proof  of  the  communicability  of  cholera  by 
direct  contagion,  is  careful  to  point  out  that  such  influ- 
ence cannot  explain  all  the  bizarre  phenomena  of  epi- 
demics, and  that  it  is  necessary  to  admit,  over  and  above 
the  focus  of  infection,  a  general  cause  which  hovers 
over  all  the  individuals  placed  in  this  focus,  an  epidemic 
cause,  a  quid  divinum  or  igno^m  as  has  been  so  often 
repeated. 

The  Medical  Gazette  of  Algiers  reviews  a  recent  work 
by  M.  Jules  Girette,  where  this  question  of  the  epi- 
demic influence  is  treated  on  the  largest  scale.  This 
writer,  by  the  very  title  of  his  work.  Civilization  and 
the  Cholera,  betrays  that  his  views  are  liable  to  be  all 
rather  biassed  by  the  idea  that  belief  in  contagion  must 
tend  to  barbarize  nations,  and  hence  ought  to  be  dis- 
countenanced on  moral  grounds.  It  is  rather  unfortu- 
nate that  this  initial  bias  should  be  so  perceptible,  for  it 
somewhat  tends  to  shake  the  reader's  confidence  in  the 
complete  impartiality  of  the  author's  statements.  Yet 
various  circumstances  pointed  out,  concerning  the 
march  of  the  epidemic  of  1866,  along  the  shores  of  the 


THE  MEDICAL  RECORD. 


353 


Mediterranean,  seem  certainly  difficult  to  reconcile 
with  the  theory  of  the  perfect  efficacy  of  quarantine. 
"  Greece  and  Sicily  isolated  themselves  completely,  and 
escaped  the  cholera.  But  so  also  did  Corsica,  which 
continued  to  communicate  freely  with  the  infected 
cities  of  Nice  and  Livoume,  and  only  subjected  vessels 
coming  from  Marseilles,  where  the  epidemic  was  at  its 
height)  to  a  quarantine  of  tiiree  days.  Salonica  and 
Vdo,  unexpectedly  exposed  to  the  contagion,  after  a 
prolonged  quarantine,  nevertheless  escaped.  Neither 
Samsoum,  nor  Gatoum,  nor  Doargas,  nor  Varma  were 
attacked  by  the  cholera,  although  they  were  constantly 
visited  by  emigrant  vessels.  It  scarcely  touched  Tre- 
bisond,  traversed  by  hosts  of  fiigitives  en  route  for 
Persia.  Yet  all  these  ports  had  no  other  defence  than 
a  quarantine  of  from  three  to  five  days.  At  Malta, 
Bey  rout,  Dardanelles,  and  Odessa,  the  epidemic  was 
communicated  to  the  city  by  the  lazaretto  that  pro- 
fessed to  protect  it.  At  Constantinople,  a  Turkish  fri- 
Site  evaded  the  quarantine,  and  imported  the  disease, 
ajorca,  surrounded  by  a  cardan  $(mUaire^  attributed 
the  cholera  by  which  it  was  decimated,  to  some  secret 
fraudulent  importation,  since  no  other  cause  could  be 
discovered.  The  same  with  Alicant.  At  Enos  the 
epidemic  raged,  and  could  be  explained  by  no  suspected 
communication.  Trieste,  spared  up  to  the  28th  of  Sep- 
tember, and  believing  itself  secure  behind  a  model  laza- 
retto, awoke  to  find  the  cholera  within  its  walK 
Southampton,  finely  open  to  arrivals  from  Alexandria, 
did  not  register  its  firat  death  from  cholera  until  the 
25th  of  September,  nearly  at  the  same  time  as  Triefete, 
and  two  months  after  Marseilles." 

M.  Girette,  however,  takes  great  pains  to  trace  the 
march  of  the  epidemic  of  1865,  from  its  cradle,  among 
the  hordes  of  pilgrims  to  Egypt.  M.  Jobert,  however, 
sanitary  physician  on  board  the  Arethusa,  who  reviews 
the  book,  lays  much  more  stress  than  the  author  upon 
the  fact  that  some  new  and  peculiar  atmospheric  con- 
ditions, or  epidemic  capacitor,  must  have  prevailed  at 
Egypt  during  that  year,  since  every  year  the  pilgrims 
were  in  the  habit  of  having  the  cholera  at  He<^az,  but 
it  was  not  communicated  beyond  their  own  camp.  M. 
Jobert  quotes  with  especial  emphasis  the  description 
given  from  personal  observation  by  M.  Girette,  of  the 
state  of  things  at  the  temple  of  Withoba,  at  Punder- 
poor,  where  men  and  women  were  crowded  together 
by  thousands,  in  a  narrow  court,  awaitmg  their  turn  to 
enter  the  temple.  Inside  the  Httle  stone  temple  the 
same,  and  worse;  the  emanations  from  the  bodies  of 
the  worshippers  condensed  upon  the  statue  of  the  god, 
and  the  moisture  was  regarded  as  a  miraculous  sweat  1 
The  resident  physician  at  Pimderpoor  believes  that  the 
first  origin  of  the  cholera  is  probably  at  this  celebrated 
ahrine. 

To  return  for  a  moment  to  M.  Rodet  He  speaks 
hopefully  of  the  good  effects  of  the  treatment  suggested 
by  Dr.  Burg,  and  in  1866  experimented  by  M.  Lisle, 
physician  at  the  Insane  Asylum  at  Marseilles.  Upon 
the  appearance  of  the  epidemic  in  the  asylum,  M.  Lisle 
had  at  first  endeavored  to  combat  its  ravages  by  the 
ordinary  method  of  diffiisible  stimulants.  He  lost  twelve 
patients  out  of  fourteen,  a  number  much  greater  than  the 
ordinary  average,  and  whose  excess  is  to  be  attributed 
to  the  much  feebler  resistance  to  the  disease  offered  by 
the  insane.  Finally  the  servant  of  M.  Lisle  was  at- 
tacked; he  employed  the  same  treatment,  and  with 
Sual  lack  of  success,  for  at  the  end  of  twenty -four  hours 
hope  seemed  to  be  lost  In  this  extremity  he  resolved 
to  try  Dr.  Burg's  prescription,  apd  considerably  to  his 
surprise  the  woman  recovered.  He  then  applied  the 
same  treatment  to  the  remaining  patients  in  the  wards, 
and  the  results  surpassed  his  expectations.    Among 


twenty-six  men  he  obtained  twenty-one  recoveries,  and 
among  six  women  (including  his  servant),  four;  in  all, 
twenty-five  cures  among  thirty-two  cases. 

The  following  is  the  formula  for  the  remedy  that  ob- 
tained such  unlooked-f(»'  success : 

Dissolve  five  per  cent,  of  sulphate  of  copper  in  150 
grammes  (about  five  ounces)  of  distilled  water;  and  add 
to  this  150  grammes  of  sugared  water,  together  with  10 
drops  of  Sydenham's  laudanum. 

A  CASE  OF  OSTEOBfALACIA. 

At  the  Society  of  Medical  Sciences  at  Lyons,  was  re- 
cently presented  by  M.  Vdrard,  a  most  interesting  case 
of  osteomalacia.  The  patient,  as  usual,  a  woman,  was 
thirty  years  old,  and  had  been  the  victim  of  the  disease 
for  ten  years  at  the  time  of  her  death,  which  occurred 
in  an  attempt  at  child-birth.  I  have  been  unable  to 
find  the  details  of  the  case  as  related  by  M.  V^rard, 
having  only  at  hand  a  subsequent  report  upon  the  case, 
made  b^  Dr.  Berne,  surgeon  at  La  Oharit^  at  Lyons. 

In  this  report  is  only  noticed,  that  the  commencement 
of  the  disease  had  been  characterized  by  sharp  pains, 
which  had  been  supposed  to  be  rheumatismal ;  that  the 
pregnancy  had,  as  usual^  greatly  accelerated  the  march  of 
the  disease ;  that  the  diseased  bones  presented  were  all 
highly  porous ;  that  in  the  spongy  tissue,  the  osseous 
trabeculse  had  become  rare,  or  had  disappeared;  the 
medullary  spaces  had  united  together,  and  in  the  hol- 
low bones  contributed  to  enlarge  the  medullary  canal ; 
that  even  in  the  cortical  compact  substance,  the  vascular 
canals  were  enlarged,  and  formed  areolse,  which  uniting 
transformed  it  into  a  spongy  tissue  of  large  network ; 
which  indeed  was  so  general  that  the  compact  tissue 
had  almost  disappeared,  and  there  only  remained  the 
superficial  layer,  which,  moreover,  was  infiltered  by  a 
yellow,  fatty,  medullary  substance;  that,  besides,  in 
the  parts  of  the  osseous  system  which  were  the  most 
altered,  were  discovered  numerous  oelb  resembling  pus 
globules. 

This  last  fact  seems  to  confirm  the  opinion  of  Virchow, 
who  ascribes  osteomalacia  to  a  "parenchymatous  inflam- 
mation, the  immediate  consequences  of. which  are  only  an 
interstitial  exudation,  but  the  remote  result  is  the  de* 
struction  of  the  osseous  tissue. 

A  chemical  analysis  of  the  bones  was  made,  princi- 
pally with  a  view  of  searching  for  lactic  acid,  and  thus 
indirectly  testing  the  theory*  that  ascribes  the  resorption 
of  the  lime  salts  to  the  presence  of  this  agent.  It  was 
impossible  to  find  lactic  acid  in  the  fi^e  state,  for  at  the 
time  the  analysis  was  made,  the  bones  had  already  sub- 
mitted to  maceration  for  several  days  in  water  saturated 
with  marine  salt,  and  the  acid,  if  present,  would  neces- 
sarily be  dissolved.  But  some  lactates  might  still  be 
lef^.  To  settle  the  question,  the  ashes  of  the  calcined 
bones  were  treated  with  water,  thus  losing  a  consider- 
able portion  of  their  weight  (0*42  gr.  out  of  0-99  gr. 
for  the  spongy  substance,  and  0*23  gr.  out  of  1  '73  gr. 
for  the  compact).  The  filtrated  substances,  precipitated 
with  nitrate  of  silver,  gave  0*20  chloride  of  sodium  in  the 
first  case,  and  0*10  in  the  second.  Remained  0*22  and 
0*13  of  residue,  in  which,  if  anywhere,  the  lactates  were 
contained.  In  this  residue,  dissolved  in  distilled  water, 
the  presence  of  an  organic  acid  was  presently  proved 
by  the  addition  of  a  few  drop  of  nitric  acid,  then  lime- 
water,  which  formed  a  precipitate,  proving  that  the  nitrio 
acid  had  found  material  to  convert  into  oxalic  acid, 
which  produced  an  oxalate  with  the  lime.  Further  ex- 
amination showed  that  the  solution  did  not  precipitate 
with  baryta-water,  had  no  action  upon  lime-water  until 
it  had  been  treated  with  nitric  acid,  and  gave  a  white 


«  Of  MM.  Marehaad,  0.  Schmidt,  aad  Otto 

digitized  by 


C^ogle 


354 


THE  MEDICAL  RECORD. 


precipitate  with  concentrated  acetate  of  zinc,  whence 
the  presence  of  lactic  acid  was  conclusively  proved. 

The  usual  disproportion  between  the  organic  and  in- 
organic materials  or  the  bones  was  also  shown  by  the 
analysis.  The  proportion  in  100  of  the  inorganic  mat- 
ter instead  of  being  64,  the  normal  figure  for  compact 
bone,  was  41,  and  in  the  spongy  substance  not  more 
than  18. 

The  proportion  between  the  carbonates  and  phos- 
phates remained  the  same,  the  former  being  one-tenth 
the  weight  of  the  latter. 

M.  Verard  very  justly  re^tted  that  no  experiments 
had  been  made  to  asoertam  whether,  in  spite  of  the 
narrowness  of  the  basin,  the  head  of  a  foetus  could  not 
have  been  made  to  pass,  in  virtue  of  the  softness  of  the 
bones.  The  antero-posterior  diameter  of  the  inferior 
strait  only  measured  from  a  centimetre  and  a  half  to 
two  centimetres ;  but  the  bones  were  so  soft,  that  the 
first  placed  in  the  pelvic  cavity  easily  forced  a  place  for 
itself.  Dr.  Berne  thought  that  in  a  similar  case,  at  a 
moment  of  accouchement,  before  the  obstetrician  should 
address  himself  to  the  cesarean  operation,  he  should  se- 
riously consider  whether  the  pelvic  basin  were  not  sus- 
ceptible of  enlargement  by  dint  of  pressure.  In  the 
case  in  question,  I  am  unfortunately  unable  to  tell  what 
was  actually  done. 

THE  FUNCTION  OF  THE  VASCULAR  GLANDS. 

At  a  recent  stance  of  the  Academy  of  Medicine  in 
Belgium,  Dr.  Foisson  read  a  paper,  propounding  a  the- 
ory on  the  function  of  the  vascular  glands,  that  seems 
to  me  much  the  most  ingenious  and  complete  of  any 
that  has  ever  been  advanced  concerning  them.  This 
theory  carries  out  the  suggestion  made  by  Broussais, 
who  assigned  to  the  spleen  the  fimction  of  deviating 
the  blood  from  the  stomach ;  so  the  thymus  and  thy- 
roid, a  similar  r6Ie  for  the  respiratory  organs.  This 
idea,  however,  being  based  upon  no  serious  proof;  passed 
unperceived.  But  M.  Foisson  has  greatly  enlarged  and 
strengthened  it  in  his  essay,  of  which  I  shall  endeayor 
to  give  you  an  idea.  * 

The  general  theory  of  derivation  is  the  followingt 
All  organs  submitted  to  alternations  of  action  and  re- 
pose, require  a  greater  amount  of  blood  during  the  first 
than  the  second  period.  The  variations  thus  necessi- 
tated in  their  circulation,  are  effected  by  an  agency  in- 
dependent of  the  general  circulation,  namely,  the  ap- 
propriate vascular  glands,  that  act  by  driving  the  blood 
away  from  the  organs  wnen  they  have  no  need  of  it. 

The  only  organs  in  adult  life,  engaged  intermittently 
in  active  functions,  are  the  musdeS^  stomach,  brain,  and 
uterus. 

The  muscles,  when  acting  separately,  mutually  derive 
the  blood  fi*om  one  another,  and  when  they  act  all  to- 
gether, the  heart  quickens  its  action,  and  sends  the  ex- 
cess of  blood  required.  Their  variations,  therefore, 
depend  directly  on  the  general  circulation,  and  they  have 
no  need  of  special  apparatus. 

But  the  stomach  is  essentially  intermittent  in  its  ac- 
tivity. The  secretion  of  gastric  juice  evidently  demands 
a  large  amount  of  blood,  to  judge  from  the  size  of  tiie 
arteries  distributed  to  its  walls.  During  the  intervals 
of  digestion,  these  arteries  are  tortuous,  and  compara^ 
tively  little  blood  passes  through  them.  The  blood  from 
the  coeliac  axis  being  mainly  distributed  by  the  splenic 
artery  to  the  spleen,  the  tortuousneas  of  this  splenic 
artery  may  be  supposed  to  be  unfolded  at  an  opposite 
time  fi-om  that  m  which  the  gastric  arteries  grow 
straight 

The  thyroid  gland  is  the  derivative  reservoir  for  the 
blood  going  to  the  brain.  This  blood  arrives  at  the 
*-hyroid  from  the  superior  thyroidien  given  off  firom  the 


internal  carotid — ^and  the  inferior  thyroidien,  that  springs 
from  the  subclavian  dose  by  the  origin  of  the  vertebral, 
so  that  by  a  double  route  the  circulation  of  the  thyroid 
can  affect  that  of  the  encephalon.  In  virtue  of  that 
same  connection,  between  the  thyroid  and  the  brain,  do 
persons  affected  with  goitre  so  often  become  cretins; 
the  exaggerated  development  of  the  thyroid  interferes 
with  the  nutrition  to  the  brain,  and  the  more  important 
organ  is  actually  starved  out  by  the  fi^ud  of  the  less, 
which  seizes  its  supplies  en  route.  Finally,  for  the  ute- 
rus, the  mammary  glands  perform  the  office  of  deriva^ 
tion,  and,  after  parturition,  when  the  uterus  must  retract, 
and  has  no  fiirtner  need  of  the  expensive  nourishment 
upon  which  it  has  subsisted  during  pregnancy,  the  epi- 
gastric arteries,  prepared  for  the  task  by  the  develop- 
ment they  have  experienced  durinj^  the  last  months  of 
this  period,  intercept  the  supplv  of  blood  going  to  the 
uterus,  and  convey  it  to  the  glands,  by  means  of  their 
anastomoses  with  the  mammary  arterie&  Among  ani- 
mals in  whom  the  mammary  glands  are  abdominal,  the 
epigastric  artery  supplies  tiiem  directly.  To  this  ex- 
tremely suggestive  mterpretation  of  the  well-known 
facts  of  the  case,  one  dimculty  may  be  addressed.  If 
the  extra  nutrition  of  the  uterus  and  mammary  glands 
is  carried  on  at  alternate  periods,  how  does  it  happen 
that  the  glands  increase  during  pregnancy  ?  This  fact, 
however,  is  really  provided  for  by  the  theory  which 
admits  that  the  satellite  organs  do  increase  coincidently 
with  their  principals,  if  only  for  the  sake  of  being  at 
hand,  and  in  good  condition,  to  receive  the  brunt  of  their 
circulation  when  the  functions  of  the  principal  organ  is 
intermittent ;  but  that  in  addition  to  this  parallelism  of 
development,  comes  the  alternative,  or  contrast,  at  the 
moment  when  the  principal  organ  subsides  into  inac- 
tivity, and  the  satellite  starts  into  full  activity. 

For  explanation  of  the  office  of  the  thymus  gland 
and  supra-renal  capsules,  the  theory  is  identical,  but 
applied  as  it  were  in  an  inverted  fashion  as  respects 
chronological  order.  The  lun^  and  kidneys  do  not 
function  at  all*  during  foetal  life,  and  hence  have  need 
of  only  so  much  nutritive  fluid  as  is  required  for  their 
growth.  But  as  they  begin  to  act  at  the  very  moment 
of  birth,  the  new  supplies  necessary  for  the  mainte- 
nance of  their  functions  must  be  stored  up  close  at 
hand,  ready  to  be  turned  into  their  future  channels. 
For  this  purpose  the  thymus  gland  and  supra-renal 
capsules  are  contrived.  The  blood  during  foetal  life  is 
directed  towards  them,  as  it  were  next  door,  but  at 
the  moment  of  birth  the  current  is  turned  into  the 
neighboring  arteries,  and  from  that  moment  the  foetal 
organs  begm  to  waste  and  gradually  disappear. 

The  thyroid  gland  also,  though  in  action  throughout 
life,  is  much  required  during  infancy,  since  the  brain 
at  that  period,  as  far  as  regards  its  intellectual  func- 
tions, is  in  a  quiescent  or  at  lea«?t  passive  state,  conse- 
quently the  thyroid  gland  of  children  is  proportion- 
ately nmch  larger  than  in  adults. 

M.  Foisson  refers  to  the  characteristics  common  to 
the  structure  of  all  the  vascular  glands,  as  tending  to 
confirm  his  theory.  Huschke  and  Kolliker  agree  in 
recognizing  in  all  these  organs  the  existence  of: 

1.  A  foundation  system  of  trabeculae,  serving  for  a 
support  to  the  vessels. 

2.  Vesicular  cavities  occupying  the  interstices  lefl  be- 
tween the  trabeculse. 

3.  The  presence  in  the  cavities  of  a  Hquid  charged 
with  globules,  and  the  absence  of  any  efferent  canal 
Nothing  in  this  structure  suggests  the  idea  of  a  secre- 


•  This  U  th«  remark  of  the  author.  Bat  I  beUere  It  Ib  not  strlctl/ 
correct  for  the  kidneys,  since  the  bladder  is  fg^nd  to  coni^  nrlne 
befbre  birth. 


Digitized  by 


t  found  to  coniMn  n 

Google 


THE  MEDICAL  RECORD. 


355 


tion  appropriated  to  the  perfeotionment  of  the  blood  or 
Ivmpn,  while  it  is  on  the  contrary  marvellouslj  adapted 
for  the  purposes  of  derivation.^ 

The  entire  theory  is  resumed  in  the  following  pro- 
positions : 

1.  All  the  organs  of  the  economy  consume  during 
the  periods  of  their  activity  an  amount  of  blood  more 
considerable  than  that  required  in  repose. 

2.  In  the  normal  state,  the  heart  sends  at  each  mo- 
ment the  same  quantity  of  blood  in  every  branch  of 
the  arterial  tree. 

3.  The  blood  which  arrives  at  organs  in  excess  during 
their  period  of  repose,  is  received  by  special  organs 
called  derivators, 

4.  The  function  of  derivation  may  be  performed  with- 
out the  intervention  of  an  organ  exclusively  devoted 
to  the  task,  as  in  the  case  of  the  mammary  glands. 

6.  Every  organ  whose  function  is  intermittent,  pos- 
lesses  an  apparatus  for  derivation. 

6.  Derivation  is  not  only  arteria],  but  sometimes  ve- 
nous, as  when  the  spleen  receives  the  trop  plein  front 
the  portal  vein,  or  the  thyroid,  during  muscular  exer- 
tion, from  the  engorged  jugulars. 

7.  Derivation  is  a  complementary  function  of  the  cir- 
culation, and  necessary  to  a  regular  distribution  of  the 
materials  of  nutrition  and  secretion.  At  the  same  time 
it  is  not  absolutely  essential  to  life,  so  that  in  the  lower 
animals  any  of  the  vascular  glands  may  be  extirpated 
with  impunity. 

8.  Derivation  is  explained  by  the  following  law  of 
physics :  When  a  pipe  traversed  by  a  fluid  is  divided 
mto  two  branches,  that  of  the  two  in  which  the  cur- 
rent is  the  most  rapid  receives  a  greater  quantity  of 
liquid  than  the  other. 

.  This  theory  is  so  perfectly  captivating  to  me,  that 
as  yet  I  have  not  been  able  to  imagine  any  serious  ob- 
jection to  its  soundness.  Perhaps  you  or  your  readers 
may  be  more  critical,  and  I  submit  it  to  your  judgment. 

UNION  BY  FIRST  INTENTION  AFTER  LITHOTOMT. 

Professor  Bouisson,  of  Montpellier,  is  at  present  writ- 
ing a  series  of  articles  in  the  MantpeUier  Medicale^  upon 
union  of  the  wound  by  first  intention  after  the  opera- 
tion of  lithotomy.  The  Professor  not  merely  beUeves 
this  to  be  possible,  and  in  his  first  paper  adduces  four 
cases  in  proof  of  his  assertion,  but  engages  to  show  how 
this  very  desirable  result  can  be  secured.  Of  these  four 
cases,  the  first  was  that  of  a  young  man  who  had  been 
treated  for  some  time  with  elastic  bougies,  in  the  hope 
of  sufficiently  dilating  the  urethra  to  admit  of  the  ope- 
ration of  lithotrity.  All  at  once,  however,  the  patient 
became  unquiet  and  irritable ;  an  obstinate  spasmodic 
condition  of  the  canal  joined  itself  to  the  organic  re- 
traction, and  forced  the  surgeon  to  abandon  all  hope 
of  crushing  the  calculus,  and  an  operation  for  lithotomy 
was  decided  upon.  Owing  to  the  presumed  smallness 
of  the  stone,  the  median  incision  was  selected.  The 
operation  was  performed  on  the  16th  of  December,  and 
encountered  no  serious  difficultie?.  An  incision  of  three 
centimetres  practised  on  the  median  line  of  the  peri- 
neum easily  attained  the  urethra.  After  division  of  the 
cutaneous  and  cellular  layers,  the  membranous  portion 
being  directly  divided,  the  length  of  the  left  edge  of  the 
catheter  which  had  been  introduced  in  the  urinary 
canal  to  serve  as  a  guide,  a  lithutome  was  introduced, 
the  catheter  withdrawn,  the  finger,  gorget,  and  forceps 
saccessively  introduced  into  tne  bladder,  and  the  cal- 
culus seized  and  extracted. 

Tbe  calcVdus  was  spheroidal,  with  irre^lar  surface,  so 
compact  and  hard  that  tbe  operation  of  hthotrity  would 
have  beeen  very  difficult.  A  vesical  injection  terminated 
(he  operation,  which  had  been  performed  with  the  as- 


sistance of  chloroform.  The  knees  of  the  patient  were 
then  drawn  together,  and  maintained  in  an  elevated 
position  by  a  cushion  placed  underneath  ;  a  calming  and 
diffusible  draught  was  administered;  the  day  passed 
without  fever  or  vesical  pain;  the  patient  vomited 
twice;  in  the  evening  a  little  urine  escaped  by  the 
natural  passage.  The  next  day  reddish  urine  was 
passed  naturally,  also  a  very  smaU  amount  escaped  at 
the  wound,  whose  anpearance  was  good.  During  the 
two  following  days  also  the  local  and  general  phenom- 
ena were  satisfactory ;  the  urine  nearly  entirely  passed 
by  the  urethra.  The  wound  closed  without  suppura- 
tion, and  by  the  eighth  day  was  completely  cicatrized 
hy  first  intention.    The  cure  was  permanent 

In  the  second  operation  performed  by  M.  Bouisson, 
the  patient  was  sixty-four  years  old,  and  Uie  bladder  con- 
tained six  calcuh  and  was  completely  paralyzed.  After 
the  operatiouj  whose  details  I  will  not  repeat,  the  per- 
sistent retention  of  urine,  which  did  not  even  escape 
by  the  wound,  rendered  it  necessary  to  leave  a  sound 
permanently  in  the  bladder,  for  the  accumulation  caused 
much  pain  and  suffering  to  the  patient  By  this  means 
also  the  urine  was  completely  turned  away  from  the 
wound,  a  circumstance  which  undoubtedly  favored  its 
union,  which  was  effected  in  six  days,  by  first  inten- 
tion, without  any  trace  of  inflammation  or  infiltration. 
In  this  case  also  the  median  incision  had  been  prac- 
tised. Tbe  third,  the  same  form  of  the  operation.  The 
subiect  was  sixteen  years  old ;  tbe  calculus,  though  hard 
and  voluminous,  was  ovoid,  and  presented  itself  to  the 
forceps  by  its  most  favorable  diameter,  so  that  it  was 
extracted  without  difficulty.  After  the  operation,  the 
adduction  of  the  thighs  was  secured  by  means  of  an 
apparatus,  so  that  the  lips  of  the  wound  were  brought 
in  contact,  and  the  dorsal  decubitus  strictly  enjoined. 
The  first  day  only  theurine  escaped  by  the  wound ;  after 
that  ihe  patient  was  able  to  urinate  voluntarily.  Even 
after  the  subsidence  of  the  swelling  around  the  lips  of 
the  wound,  which  might  at  first  have  opposed  the  es- 
cape of  the  urine,  that  liquid  continued  to  traverse  the 
natural  passages,  and  owing  to  this  fortunate  circum- 
stance the  wound  was  cicatrized  by  the  sixth  day. 
Neither  infiltration,  nor  ecchymosis,  nor  suppura- 
tion supervened,  and  the  cicatrix  remained  perfectly 
solid.  The  fourth  operation,  with  the  medio-lateral  in- 
cibion,  was  performed  on  a  child  of  six  years  old,  who 
had  suffered  from  painful  micturition  from  the  age  of 
two  years.  In  this  case  the  first  sounding  had  failed 
to  discover  the  calculus,  and  although  that  was  dis- 
tinctly perceived  at  the  second  examination,  it  seemed 
again  to  disappear  at  the  moment  of  the  operation.  Nev- 
ertheleps,  M.  Bouisson  made  the  incision.  The  poste- 
rior radius  of  the  prostate  gland  seemed  so  short,  in 
consequence  of  the  flattening  of  this  organ,  that,  hav- 
ing practised  tbe  median  section  of  the  skin  as  far  as 
the  urethra^  M.  Bouisson  judged  it  prudent  to  incline 
the  lithotome  in  the  direction  of  tiie  oblique  radius  of 
the  prostate,  in  order  to  avoid  the  rectum,  and  to  limit 
this  oblique  section  to  the  gland,  so  that  the  incision 
represented  a  broken  line  wnose  first  part  was  straight, 
and  the  second  oblique.  This  opening,  more  than  suf- 
ficient for  the  extraction  of  the  calculus,  gave  issue  to 
a  certain  quantity  of  urine,  which  carried  the  stone 
along  with  it  into  the  very  grasp  of  the  forcepa  The 
calculus  was  the  volume  and  shape  of  an  olive ;  mam- 
millated,  reddish-yellow,  and  composed  of  uric  acid. 
The  whole  operation  only  occupied  three  minutes  from 
the  moment  of  the  incision  to  the  extraction  of  the 
stone. 

In  oonsequenee  of  the  inclination  of  the  lithotome, 
a  branch  of  the  perineal  artery  had  been  divided,  giv- 
ing rise  to  considerable  haemorrhage,  an  accident  that 


856 


THR  MEDICAL  RECORD. 


had  been  entirely  ayoided  in  the  other  operations.  The 
hcemorrhage  was  arrested  by  torsion  of  the  vessel,  bnt 
returned  some  honrs  after  me  operation,  to  be  finally 
vanquished  by  compression  and  the  application  of  ice. 
This  was  the  only  notable  effect  of  the  operation.  The 
urine  esoapecP  by  the  wound  during  the  evening  and 
in  the  night ;  but  after  the  first  day  the  passage  of  nrine 
ceased  to  be  continual,  and  came  under  the  infinenoe 
of  vesical  contraction.  Towards  the  end  of  this  day  a 
part  of  the  urine  passed  by  the  urethra,  and  from  the 
fourth  day  no  more  escaped  from  the  wound,  which 
united  without  suppuration,  and  without  the  occur- 
rence of  either  sanguine  or  urinary  infiltration.  By 
the  eighth  day  the  cicatrization  was  complete. 

All  these  cures  were  obtained  by  the  perineal  ope- 
ration. M.  Bouisson  thinks  that  such  happy  results 
could  rarely  be  achieved  when  the  hypogastric  incision 
wa<*  practised.  In  succeeding  papers  he  hopes  to  de- 
velop further  views  suggested  by  the  interesting  ob- 
servations of  which  I  have  related  the  summary. 

NEW  APPARATUS  FOR  IRRIOATION  OF  THE  lYl. 

Dr.  Amable  Cade,  of  S^nt  And^l,  also  makes  a 
communication  to  the  MontpeUier  MSdicate^  concerning 
a  new  apparatus  devised  by  himself  for  securing  con- 
tinual irrigation  of  the  eye  after  the  operation  &r  cat- 
aract.   This  is  composed  : 

1.  Of  a  hemispherical  reservoir,  of  a  capacity  of  nearly 
a  quart,  with  an  opening  at  the  top,  and  capable  of  be- 
ing suspended  over  the  head  of  the  patient. 

2.  Two  supra-ocular  recipients,  of  lozenge  shape, 
each  furnished  with  two  Uttle  handles,  destined  either 
to  fix  the  apparatus  before  the  eves  by  the  aid  of  a  cir- 
cular band,  or  to  keep  in  place  the  two  recipients  when 
both  eyes  have  been  operated  the  same  day.  Their 
posterior  side  is  made  of  gold-beater's  skin,  which 
ought  to  be  placed  in  immediate  contact  withi  the  closed 
eyelids. 

3.  Two  tubes,  communicating  between  the  reservoir 
and  the  recipients.  These  tubes  are  furnished  with 
screw  joints,  which  permit  the  suppression  of  one  of 
the  recipients  when  only  one  eye  is  operated. 

^  4.  Little  pieces  of  sponge  loosely  introduced  in  the 
communicatmg  tubes,  to  prevent  the  passage  of  the 
water,  except  drop  by  drop,  every  second  in  ordinary 
cases.  These  sponges  may  be  removed  in  case  of  im- 
minent danger  from  violent  inflammation,  when  a  rapid 
current  of  cold  water  is  needed. 

5.  Two  discharging  tubes,  a  yard  and  a  half  in 
length,  destined  to  conduct  the  irrigating  fluid  from 
the  recipients  to  a  vase  placed  by  the  bedside. 

By  means  of  this  apparatus,  JDr.  Cade  has  already 
performed  eight  operations  for  cataract  with  the  most 
complete  success,  in  some  cases  warding  off  a  com- 
mencing phlegmonous  inflammation,  that  threatened  to 
become  a  terrible  complication.  P.  C.  M. 


Opkratiox  for  Auteflexion  of  UxKRua — Dr.  J.  C. 
Kott,  of  Baltimore,  suggests  a  modification  of  Dr.  Sims's 
operation  for  the  relief  of  dysmenorrhoea  dependent  on 
anteflexion  of  the  uterus.  After  making  the  bilateral 
incisions  through  the  neck,  he  allows  the  hook  to  re- 
main in  the  anieriar  lip  while  the  posterior  is  cut  off 
by  curved  scissors.  By  this  expedient  the  canal  of  the 
neck  is  kept  open,  and  after  the  internal  posterior  lon- 
^tudinal  incision  the  sponge-tent  is  at  once  and  easily 
introduced.  Any  vessels  divided  should  be  immediately 
ligated.  He  suggests  also  an  alteration  in  the  tents, 
by  which  they  are  rexjdered  firmer,  more  cleanly,  and 
^ore  rapidly  effective.— iiw.  Journal  Med.  Sciences. 


MEDICAL  MATTERS  IN  PHILADELPHIA. 

[fROK  our  special  C0fiBSBP(»a>BNT.] 

VISIT  OP  T.  BPBNCER  WELLS,  OF  LONDON,  TO  THE  CLINIC  OF 

THE  JEFFERSON  MEDIOAL  COLLEGE, 

Airp  SVMABKS  BT  VHAT  OBHTLSMAH  ifBOlX 

OVARIAN  TUMORS. 

To  THE  EdITOB  of  TBI  MlDIOAL  EbCOBD. 

Sir — ^With  the  approach  of  autumnal  dianges,  greater 
activity  is  being  exhibited  in  our  medical  circles.  The 
summer  months,  not  very  warm,  have  been  marked  by 
a  most  unusual  deluge  of  rain,  which  has  kept  the 
streets  of  our  city  comparatively  dean,  despite  me  ne- 
glect of  "contractors,"  and  as  a  consequence  conserved 
the  health  of  our  inhabitants.  Such  a  healthy  season 
as  the  summer  just  past  has  been,  has  not  been  known 
here  for  years ;  some  ffo  so  far  as  to  say  that  there 
never  has  been  such  a  healthy  season.  The  mortality 
imports  have  shown  a  marked  decrease  in  the  proportion 
of  deaths  as  compared  with  the  years  more  immediately 

E receding,  notwithstanding  an  evident  increase  of  P<^"* 
ition.  Vernal  comfdaints  have  not  been  near  as  fre- 
quent as  usual,  nor  have  there  been  the  usual  proportion 
of  protracted  illnesses.  Bilious  remittent  fever,  bron- 
chitis, and  pneumonia  seem  to  have  been  the  most  fre- 
quent disorders,  and  this  has  been  the  result  of  hospital 
as  well  as  of  private  practice.  A  number  of  physicians 
have  remarked  this  season  a  greater  amount  of  periodi- 
city in  disease  generallv  this  season,  as  if  a  malanal 
element  pervaded  the  locality,  and  as  a  consequence 
there  has  been  more  frequent  occasions  for  the  exhibi- 
tions of  quinine  in  addition  to  other  treatment.  Aa  a 
consequence  of  the  mildness  oi  the  temi)erature  there 
have  been  remarkably  few  cases  of  insolation  during  the 
summer. 

The  Colleges  are  open  again,  finishing  their  summer 
courses,  and  are  well  attended  by  the  "  spring  "  classes, 
as  well  as  by  a  sprinkling  of  first-course  men,  who  are 
slowly  arriving. 

Most  of  the  medical  societies  have  resumed  their 
meetings,  and  are  preparing  for  energetic  and  instructive 
employment  for  the  winter.  Medical  publishers,  too, 
are  getting  ready  to  offer  a  valuable  file  of  literature  the 
coming  season.  The  enterprising  firm  of  Lindsay  & 
Blakiston  are  issuing  from  their  press  an  exceedingly 
valuable  catalogue  of  new  books  and  republications. 
Of  these  are  just  out — "  Harris's  Dictionary  of  Dentil 
Surgery,"  a  work  which  has  been  out  of  print  for  four 
or  five  years,  and  a  republication  of  the  **  Biennial  Ret- 
rospect of  Medicine,  Surgery,  and  their  allied  Sciences," 
for  the  New  Sydenham  Society,  1867,  edited  by  Pow- 
ers, Anstie,  Holmes,  and  other  well-known  authorities.* 
They  have  also  nearly  ready,  and  shortly  to  be  issued^ 
a  work  on  "Epidemic  Meningitis,  or  Cerebro-Spinal 
Meningitis,"  from  the  pen  of  Dr.  Alfred  Still6,  Profea- 
sor  of  the  Practice  of  Medicine  in  the  University  of 
Pennsylvania ;  one  from  the  pen  of  Dr.  J.  Solib  Coben, 
of  this  city,  on  "  Inhalation :  its  Therapeutics  and  Prac- 
tice ;"  a  new  edition  of  "  Diseases  and  Accidents  inci- 
dent to  Women;"  Hufelsaid  on  "Prolonging  Life;" 
Tail's  "  Operative  Dentistry  "  etc ;  and  they  are  pre- 
paring, with  a  great  deal  or  care,  the  first  volume  of 
"  Reports  of  Cases  and  Clinical  Lectures,"  by  the  Medi- 
cal and  Surgical  Btak  of  the  Pennsylvania  Hospital, 
with  papers  from  the  pens  of  Drs.  Ckrhard,  Levi<^ 
Meigs,  Da  Costa,  Hewson,  Morton,  Hunt,  and  Agnew. 
This  work  is  to  be  abundantly  illustrated,  and  to  be 
issued  ^X)ut  New  Year,  in  the  highest  style  of  the  art 
The  volume  is  looked  for  with  peculiar  eagerness  by 
our  city  practitionersj  who  all  feel  attached  to  the  old 
Digitized  by  ^ „       ^  _ 


THE  Medical  record. 


867 


mstttatioD,  the  memory  of  whose  hard  benches  inyolun- 
tarily  calls  the  palm  to  the  breech,  and  will  doubtless  be 
hailed  with  equal  pleasure  by  all  who  have  frequented 
the  old  amphitheatre. 

The  great  event  of  the  week  has  been  the  visit  of  Dr. 
Spbnosb  WellS)  the  British  ovariotomist,  to  the  chnic  of 
Jefferson  College,  on  Saturday  last,  and  his  remarks  to 
the  class  in  connection  with  the  diagnosis  of  an  abdom- 
inal tumor  which  was  examined  by  him  upon  the 
occasion.  The  brothers  Atlie  were  present  with  the 
distinguished  guest,  who  had  just  witnessed  an  opera- 
tion of  ovariotomy  by  Dr.  Washington  L.  Atles,  of 
this  city,  who  has  performed  the  operation  more  than 
one  hundred  and  sixty  times.  Prof.  Gross,  in  introduc- 
ing these  gentlemen  to  his  class,  took  care,  in  comment- 
ing upon  the  operation  of  ovariotomy,  to  allude  to  its 
American  origin,  and  to  substantiate  the  claims  of  Dr. 
John  Atlxs,  of  Lancaster,  Pa.,  who  wa^  present,  as  the 
fir^t  surgeon  who  had  ever  performed  the  operation  of 
removing  both  ovaries  upon  the  same  occasion  *  this 
patient  was  operated  upon  in  1843,  and  is  still  livmg. 

After  attending  to  a  lew  urgent  cases  to  whom  prom- 
ise had  been  made  to  attend  to  them  that  day.  Prof 
Gross  yielded  the  balance  of  the  hour  to  Dr.  Wells. 
who  tlien  proceeded  to  examine  the  patient,  who  haa 
been  provided  for  that  purpose.  Tnis  was  a  negro 
woman,  sst.  43,  widowed,  and  who  bad  carried  an  abdom- 
inal tumor  for  fourteen^eara.  The  patient  was  placed  in 
the  recumbent  position,  with  the  head  and  snoulders 
devated,  the  tumor  being  uncovered  throughout  its 
entire  extent  without  exposure  of  any  other  part  of  the 
person.  Dr.  Wells  stated  that  it  was  his  usual  plan  to 
expose  the  tumor  in  this  way  and  secure  a  good  view 
of  it,  before  asking  any  leading  questions  from  the  pa- 
tient^ and  he  thereby  avoided  loss  of  time  which  might 
be  occupied  in  the  recital  of  unnecessary  history,  and 
elicited  information  on  such  points  only  as  might  be  per- 
tinent to  the  case.  It  was  an  interesting  fact  in  con- 
nection, that  he  had  never  met  with  a  case  of  ovarian 
tumor  in  the  negro,  though  he  had  seen  one  in  a  Creole 
who  had  come  from  New  Orleans  and  in  a  mulatto 
woman  from  Jamaica^  This  infrequency  might  he  ac- 
counted for  by  the  limited  number  of  black  people  in 
the  British  Islands,  though  his  friend  Dr.  Washington 
L.  Atlee,  of  Philadelphia,  who  was  present,  and  whose  ex- 
perience in  ovarian  tumors  was  equalled  by  no  other 
American  surgeon,  informed  him  that  fibroid  tumors  of 
the  uterus  were  much  more  apt  to  be  met  with  than 
ovarian  tumors  in  the  negro  race.  The  fact  of  the  pa- 
tient being  a  negro  would  in  a  measure  deprive  him  of 
one  of  his  aids  to  diagnosis,  on  which  he  placed  consider- 
able importanoe.  He  referred  to  the  complexion  of  the 
patient  Whenever  a  lady  with  an  enlarged  abdomen 
presented  herself  in  his  consulting  apartments,  the  first 
thing  he  did  was  to  notice  her  complexion,*  if  this  was 
healthy  or  florid  he  always  suspected  he  had  a  tumor 
oonnected  with  the  uterus  to  deal  with,  but  if  it  were 
pallid,  yellowish,  or  waxy,  his  mind  instantly  reverted 
to  the  probability  of  the  tumor  being  ovarian.  Emacia- 
tion too  was  more  generally  apt  to  be  associated  with 
ovarian  tumors,  and  in  the  patient  about  to  be  examined 
there  is  a  general  appearance  of  health  which  would  not 
lead  to  suspicion  of  tne  existence  of  serious  disease  were 
it  not  for  tne  presence  of  the  abdominal  enlargement. 
After  gaining  a  general  idea  firom  the  appearance  of  the 
tumor  in  a  state  of  resL  he  then  proceeded  to  a  physical 
examination ;  and  the  first  step  is  to  measure  the  tumor 
by  means  of  the  tape-measure ;  the  first  measurement  is 
tiiken  round  the  body  at  the  level  ^f  the  lunbilious;  the 
aeoond  is  a  vertical  measurement  in  front  and  is  taken 
ip  two  steps,  one  being  from  the  edge .  or  the  ensiform 
cartilage  to  the  umbilicus,  and  the  other  from  the  um- 


bilicus to  the  pubic  i^mphysis,  which  shows  whether 
the  tumor  occupy  more  of  the  upper  or  more  of  the 
lower  portion  of  the  abdomen ;  next,  an  obh'que  mea- 
surement would  be  taken  fitun  each  superior  spinous 
process  of  the  ilium  to  the  umbilicus,  demonstrating 
whether  the  tumor  occupied  a  position  more  to  the  right 
or  to  the  lefl^  and  was  therefore  more  likely  to  be  con- 
nected with  one  ovary  than^  the  other.  The  measure- 
ments being  concluded,  his  next  step  in  the  examination 
is  palpation  of  the  tumor,  to  judge  of  the  sense  of  resis- 
tance, of  the  existence  of  fluctuation,  of  the  nature  of 
such  fluctuation  if  present^  and  of  the  size,  consistence, 
and  surrounding  attachments  of  the  tumor.  If  by 
slightly  filliping  the  abdomen,  distinct  evidences  of  fluc- 
tuation follow,  'as  shown  by  the  movement  of  a  wave 
of  liquid  beneath  the  integument,  readily  distinguished 
by  the  eye,  even  at  a  considerable  distance,  as  occurred 
in  the  instance  under  examination,  then  he  inferred  that 
the  water  thus  seen  was  not  contained  in  a  cyst,  for  the 
walls  of  a  cyst  are  too  firm  to  permit  of  the  production 
of  such  distinct  rippliog,  and  his  conclusion  would  be 
that  the  fluid  was  immediately  beneath  the  abdominal 
integument,  that  is  to  say,  free  in  the  peritoneal  sac, 
and  therefore  suirounding  the  tumor.  The  next  step  in 
the  examination  is  to  determine  the  boundaries  of  the 
tumor,  and  these  could  be  marked  out  by  pressing  the 
walls  of  the  abdomen  in  with  the  ends  of  the  fingers 
until  the  edge  of  the  tiunor  was  felt,  and  then  carrying 
the  fingers  around  the  tumor  and  thus  determining  its 
contour.  Then  succussion  was  performed  on  each  side 
of  the  tumor,  first  with  one  hand  and  then,  with  the 
other,  to  determine  the  existence  of  any  fluid  within  it 
which  would  be  signalled  if  present  by  the  transmission 
through  the  mass  of  a  sense  of  fluctuation  from  one 
hand  to  the  other.  In  the  instance  under  examination 
no  such  sense  of  fluctuation  within  the  waUs  of  the  tumor 
could  be  perceived.  The  next  thing  was  to  lifb  up  the 
tumor  through  the  abdominal  walls,  to  get  an  idea 
of  its  weight,  density,  and  amoimt  of  attachment  to 
surrounding  structures.  In  the  present  instance  the 
tomor  could  be  Ul'ted  fieely  m  every  dirtction. 
showing  that  there  were  no  serious  attadiments,  and 
the  abd(Hninal  walls  could  be  readily  Ufled  from  the 
mass,  and  without  producing  any  tension  upon  the  um- 
bilicus, showing  that  there  were  no  adhesions  in  this 
direction.  Then,  be  proceeded  to  pass  the  fingers  around 
the  edges  of  the  tumor  and  under  them,  so  as  to  judge 
of  the  integrity  of  outline  of  the  mass ;  and  in  the  pres- 
ent case  he  distinguished  here  and  there  small  out- 
growths of  the  size  of  a  marble  or  walnut,  particulariy 
at  the  lower  portion  of  the  tumor  as  it  approached  the 
pelvis.  The  existence  of  these  nodulations  is  extremely 
rare  in  cases  of  ovarian  tumor,but,they  are  not  uncommon 
in  fibroid  tumors  of  the  uterus.  This  circumstance,  the 
fact  of  the  patient^s  appearance  denotive  of  compara- 
tive health,  together  with  the  absence  of  oedema  of  the 
lower  extremities,  would  lead  him  to  the  inference  that 
the  case  tmder  examination  was  one  of  fibroid  of  the 
uterus,  and  not  of  ovariant  umor.  Afiirther  method  of 
continuing  the  diagnosis  consisted  in  auscultating  the  tu- 
mor. In  fibroid  tumors  of  the  uterus  there  can  almost 
always  be  detected  a  vascular  murmur,  sometimes  much 
like  the  murmur  heard  through  the  placenta,  which  is 
not  heard  in  ovarian  tumors.  Applying  ^e  stethoscope 
in  the  present  instance,  no  such  decided  vascular  mur- 
mur could  be  heard,  but  there  was  a  distinct  sense  of 
propulsion  communicated  to  the  ear,  and  synchronous 
with  the  pulscj  which  was  due  to  the  transmission 
through  the  tumor  of  the  pulsations  of  the  abdominal 
aorta.  A  vaginal  examination  was  then  made,  rt;sulting 
confirmatively  with  the  diagnosis  arrived  at  by  externai 
examination  of  the  tumon    This  was^nferred,  princi* 


igitized  by  LjOOQIC 


858 


THE  MEDICAL  RECORD. 


pally  because  the  cervix  of  the  uterus  was  beyond  the 
reach  of  the  finger.  When  there  exists  a  fibroid  tumor 
of  the  uteruSf  the  enlargement  of  the  fundus  carries  the 
neck  of  the  womb  up  out  of  the  pelvis,  and  a  vaginal 
examinalion,  as  in  the  present  case,  is  apt  to  reveal  an 
empty  pelvis.  This  is  not  usually  the  case  in  ovarian 
tumor,  though  sometimes  under  such  circumstances  the 
neck  may  be  beyond  reach,  but  usually  a  portion  of  the 
ovarian  tumor  may  be  felt  as  a  fluctuating  mass  between 
the  cervix  and  the  bladder,  or  between  the  cervix  and 
the  rectum.  Still  another  aid  to  diagnosis  exists  in  the 
introduction  of  the  uterine  sound.  If  the  sound  can  be 
passed  several  inches  into  the  organ,  it  is  confirmative  of 
enlargement  of  the  uterus,  but  often  when  such  en- 
largement exists,  the  sound  cannot  be  introduced  in 
consequence  of  the  tortuousness  of  the  canal  of  the 
cervix;  and  therefore  the  negative  evidence  afforded 
from  the  sound  is  not  to  be  always  taken  into  consider- 
ation as  proof  of  non-enlargement  of  the  uterus. 

Having  determined  the  diagnosis,  the  question  arises 
as  to  the  treatment.  In  a  case  like  the  present  it  must 
be  palliative,  upon  general  principles  to  meet  indications 
as  they  call  for  interference.  Extirpation  of  such  a  tu- 
mor is  sometimes  performed,  but  the  results  are  emi- 
nently unfavorable.  Five  such  operations  had  been  per- 
formed by  the  lecturer,  but  they  had  terminated  fatelly 
in  every  instance,  probably  because,  in  some  degree 
they  were  not  cases  favorable  for  surgical  interference. 
The  operation  has,  however,  proved  successful  occa- 
sionally, but  not  as  a  rule.  He  would  not,  therefore, 
advise  the  removal  of  a  fibroid  tumor  of  the  uterus 
unless  the  life  of  the  patient  were  in  imminent  peril 
from  impaction  of  the  rectum  or  other  cause,  and  opera^ 
tive  interference  presented  the  only  chance  of  relief. 

Dr.  Wells  then  proceeded  to  exhibit  the  instruments 
he  had  devised  for  drawing  off  the  contents  of  an  ovarian 
cyst  previous  to  its  removal,  and  for  securing  the  pedicle 
afterwards.  He  had  found  an  inconvenience  in  the 
use  of  the  ordinary  trocar  and  canula  fi-om  the  escape 
of  fluid  between  tiie  walls  of  the  cyst  and  the  canula 
during  the  interval  between  the  puncture  and  the  with- 
drawal of  the  trocar.  This  he  believes  he  avoids  by  the 
use  of  a  hollow  trocar,  permitting  the  escape  of  the  fluid 
from  the  very  instant  of  puncture.  The  instrument 
presented  ia  of  large  size,  probably  admitting  the  end  of 
the  finger,  and  protrudes  beyond  a  canula  in  the  shape 
of  the  nib  of  a  large  quill-pen.  As  soon  as  the  instru- 
ment has  been  plunged  into  the  cyst,  and  while  the  fluid 
has  already  begun  to  esci^e,  the  trocar  can  be  with- 
drawn within  the  canula.  avoiding  the  chance  of  subse- 
quent injury.  The  canula  is  encircled  by  two  semicir- 
cular, three-pronged  vulsella^  which  are  intended  to  seize 
upon  the  waUs  of  the  xyst,  so  that  they  can  be  with- 
drawn fi'om  the  abdomen  during  the  evacuation  of 
their  contents.  To  facilitate  this  evacuation,  and  to 
avoid  the  nuise  or  other  embarrassment  which  occasion- 
ally produces  an  unpleasant  effect  during  the  draining  of 
the  fluid,  he  has  attached  to  his  canula  a  long  rubber 
tubing  of  large  size ;  the  tube  consists  of  two  layers  of 
india-rubber,  enclosing  a  spiral  wire  which  keeps  the 
tube  pervious.  His  clamps  for  securing  the  pedicle  con- 
sist of  two  stout  parallel  curved  plates  of  steel,  serrated 
on  their  opposing  surfaces  and  admitting  of  very  great 
compression  by  means  of  screws  on  the  outside ;  they 
have  movable  handles  which  can  be  withdrawn  after 
the  pedicle  has  been  secured,  and  their  curved  form  ren- 
ders the  walls  of  the  abdomen  more  tolerant  of  their 
pressure  during  the  separation  of  the  pedicle.  Where 
the  pedicle  is  too  short  to  be  secured  in  this  way,  he 
employs  another  instrument  composed  of  two  metallic 
blades  shielded  beneath  with  ivory  to  prevent  the  pas- 
sage of  heat  to  the  tissues  between  which  the  pedicle  is 


grasped,  and  then  all  that  portion  which  protrudes  be- 
yond the  instrument  is  seared  off  with  the  hot  iron,  the 
abdomen  being  protected  from  contact  with  l^e  cantery 
by  a  vertical  shield  attached  to  one  of  the  blades  of  the 
instrument  After  all  the  tissue  above  the  level  of  the 
instrument  has  been  destroyed,  the  blades  are  gently 
separated  to  avoid  tearing  the  attachments  which  have 
adhered  to  the  instrument  during  the  cauterization  ;  as 
the  blades  are  separated,  any  hasmorrhage  that  occurs  is 
immediately  controlled  by  ligature ;  and  finally  the  pedi- 
cle is  allowed  to  become  retracted  within  the  peritoneal 
cavity,  and  the  incision  in  the  integument  is  closed. 

Dr.  Wells  stated  that  he  had  performed  the  operation 
of  ovariotomy  in  all  228  times,  and  with  the  following 
result :  of  the  first  hundred  cases,  66  recovered  and 
34  died ;  of  the  second  hundred,  72  recovered  and  28 
died;  and  of  the  last  twenty-eight  cases,  2i  recovered 
and  4  died;  in  all  162  recoveries  and  66  deaths,  or  a 
general  mortality  of  a  little  more  than  twenty-nine  per 
cent.  He  had  removed  both  ovaries  in  seven  cases,  four 
of  which  recovered  and  three  died. 

With  regard  to  the  mortality  of  the  operation,  Dr. 
Wells  did  not  consider  it  greater  than  in  other  se- 
rious surgical  operations,  such  as  amputation  at  the 
hip,  ligation  of  the  iliac  artery,  the  operation  for  strai^gu- 
lated  hernia,  and  the  like ;  l>eside3  which  it  must  not  be 
forgotten  that  the  operation  is  one  of  recent  origin,  and 
that  there  is  not  therefore  in  thi^epartment  of  surgery 
that  acciunulation  of  experience  which  serves  as  a  guide 
in  other  operations.  He  believes,  too,  that  as  surgeons 
become  more  familiar  with  the  proper  selection  of  cases, 
the  mortality  would  gradually  decrease  in  accordance 
with  previous  experience  in  the  history  of  surgical  opera- 
tions; while  here,  as  elsewhere,  a  certain  number  of 
operations  are  performed  at  the  urgent  solicitation  of  the 
patient,  even  against  the  judgment  of  the  operator.  He 
alluded  to  mistakes  likely  to  occur  in  the  diagnosis  of  ova- 
rian tumor,  embarrassments  which  present  themselves 
unexpectedly  during  the  progress  of  the  operation,  and 
occasionally  preventing  its  completion ;  but  he  did  not 
think  these  mistakes  were  more  frequent  than  mistakes 
which  sometimes  occur  in  all  branches  of  surgery, 
despite  the  exercise  of  the  greatest  care  and  judgment^ 
and  he  instanced  the  circumstance  of  lithotomy  having 
been  occasionally  performed  without  the  discovery  of  a 
calculus,  the  puncturing  of  an  aneurism  instead  of  an 
abscess,  as  parallel  cases  to  those  in  which  a  fibroid  or 
other  tumor  has  been  mistaken  for  an  ovarian  cyst,  and 
thus  led  to  an  operation  which  should  not  have  been 
undertaken ;  but  ne  firmly  believed  that  as  science  ad- 
vanced, these  mistakes  would  gradually  become  less 
firequent,  and  be  eventually  expunged  from  the  history 
of  ovariotomy. 

The  above  resume  firom  memory  will  enable  your 
readers  to  judge  of  the  practical  manner  in  which  the 
subject  was  handled,  ana  your  correspondent  only  re- 
grets that  he  did  not  take  notes,  so  as  to  have  given  a 
more  extended  report  for  your  lecture  column ;  but  the 
fact  is  that  he  became  so  interested  in  the  gentleman's 
manner  that  he  forgot  all  about  notes. 

Yours  truly, 

C.J. 

PmLAOBLPHiA,  Bept  16, 1667. 

Still  akothir  Alkaloid  of  Opium. — Messrs.  T.  and 
H.  Smith,  of  London,  have  found  a  new  alkaloid  in 
opium,  to  which  they  have  given  the  name  of  Crvp- 
topid.  These  chemists,  however,  obtained  only  five 
ounces  of  the  muriaie  o/eryptopia  from  out  of  four  tons 
of  opium.  The  primary  form  of  the  crystals  is  a 
hexagonal  prism.    The  chemical  formula  is  as  follows : 

cr^o*N. 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


859 


A  QUESTION  OF  PRIORITY. 

To  THl  BdROB  OF  TBB  MkDXOAL  RkOOBO. 

Ik  your  issue  of  Sept  1,  1867,  is  an  article  on  the 
treatment  of  hip-joint  disease,  by  Dr.  Chas.  F.  Taylor, 
which  contains  a  sentence  which  deserves  a  comment. 
Dr.  Taylor  says,  "  In  i860,  before  I  had  ever  treated  a 
case  of  hip-disease,  my  attention  was  called  to  the  sub- 
ject, in  consequence  of  the  discussions  going  on  at  the 
time.  I  then  devised  the  short  instrument,  which  has 
since^  for  some  unaccountable  reason,  been  labelled  with 
Dr.  Lewis  A.  Sayre*s  name.** 

This  gentleman  made  the  same  charge  in  the  Ameri-' 
can  Medical  TItmb,  of  July  20.  1861,  and  which  I 
corrected  in  the  following  number,  of  July  27,  1861. 
by  the  letter  of  Dr.  Erskine  Mason,  stating  that  I  haa 
used  the  short  splint  in  Bellevue  Hospital  in  Sept., 
1860,  up  to  which  time  Dr.  Taylor  now  states  in  his 
last  paper  he  had  never  treated  a  case  of  hip-disease. 

Why  he  repeats  this  error,  which  he  has  once  ad- 
mitted and  apologized  for,  I  leave  for  himself  to  ex- 
plain. 

The  foUowing  is  from  the  American  Medical  Times  of 
July  27,  1861,  and  speaks  for  itself; 

"  CORRICTIOK. 

"  lb  the  Editor  of  the  American  Medical  Times  : 

"  795  Broadway,  New  York,  July  24,  1861. 
"Sir — In  your  issue  of  July  20th,  in  an  article  on 
'Improved  Splint  for  counter-extension  in  Morbus 
CJoxarius,  by  Dr.  Charles  F.  Taylor,*  in  which  he  states 
that  he  constructed  an  instrument  in  the  latter  part  of 
last  year,  with  a  branch  passing  from  the  external 
splint  over  just  above  the  knee,  to  the  inside  of  the 
thigh,  etc.,  and  in  the  concluding  paragraph  of  his  arti- 
cle, afler  claiming  various  improvements,  etc.,  says :  '  I 
am  forced  to  do  this  from  the  fact  that  the  Medical 
T^mes^  in  its  issue  of  June  29th,  had  an  instrument 
figured  as  the  improvement  of  Dr.  Sayre,  which  the 
reader  cannot  have  failed  to  notice,  is,  so  far  as  the  con- 
tn?ance  for  receiving  the  adhesive  strap  firom  the  inside 
of  the  thigh,  substantiaUy  identical  with  the  one  here 
described.  This  improvement  was  first  shown  by  me 
to  Dr.  Sayre  after  I  had  used  it  several  months,  and  he 
has  adopted  it  without  giving  me  proper  credit.* 

"  Dr.  Taylor  first  showed  me  his  instrument  about 
the  1st  of  February,  1861,  whereas  it  will  be  observed, 
by  the  following  correspondence,  that  my  instrument 
was  exhibited  at  Bellevue  Hospital  at  the  time  of  my 
lecture  on  Hip-Disease,  in  December,  1860,  and  I  had 
constructed  it  some  time  previous,  at  the  suggestion  of 
Dr.  Mason. 

**As  the  lecture  was  not  published  until  June  29, 
1861f  it  is  possible  that  Dr.  Taylor  fell  into  his  error  by 
not  observing  the  date  of  its  deHvery.* 

"  I  called  upon  Dr.  Taylor  as  soon  as  I  had  read  his 
article,  knowing  that  he  would  correct  the  error,  as 
toon  as  it  was  explained  to  him,  but  finding  him  absent 
from  the  city^  and  that  he  would  not  return  for  some 
weeks,  I  have  deemed  it  but  justice  to  myself  to  correct 
this  false  statement. 

"  *  795  Broadway,  July  22,  1861. 
'* '  Dr.  Mason,  House  Surgeon,  Bellevue  Hospital : 

"  *  Deab  Sm — Will  you  be  kind  enough  to  give  me 
the  date  of  the  oase  of  Morbus  Ooxarius,  in  Dr.  Crane's 
wards,  and  for  which  you  suggested  to  me  to  alter 


*^*  It  If  btd  proper  that  we  shoold  itate  that  the  lecture  of  Dr.  Sayre 
kaa  been  in  our  poeeeielon  since  the  earlj  part  of  Janaarr,  and  that  Hi 
M^bBeation  waa  deli^ed  by  a  preeeora  of  matter.— i^.  Jjmt.  Jf9d, 


my  instrument  so  as  to  make  extension  firom  above  the 
knee  only,  and  also  the  date  of  my  lecture  on  that  sub- 
ject, in  which  I  exhibited  the  improved  instrument. 
"  *  Respecttully  yours,  etc., 

"*  Lewis  A.  Sayre.* 

" '  Bellevue  Hospital,  July  23,  1861. 
" '  Dr.  Satre  :  Dear  Sir — ^The  time  I  first  made  the 
suggestion  to  you  to  make  the  extension  firom  above 
the  knee  in  your  apparatus,  for  the  treatment  of  hip- 
disease,  was  about  the  middle  of  September,  1860. 

"  *  Tne  apparatuSjthus  modified,  you  showed  to  your 
class  at  Bellevue  Hospital  the  middle  of  December, 
1860.  "  '  Yours  respectfully, 

" '  Erskine  Mason, 
"  *  House  Surgeon.* 
"  Further  comment  is  unnecessary. 
"  You  will  obUge  me  by  giving  this  an  insertion  in 
your  next  issue. 

"  Respectfully,  your  obedient  servant, 
"  I^wis  A.  Satre.** 

Some  weeks  after  the  publication  of  this  correction. 

Dr.  Taylor,  on  his  return  to  the  city,  called  at  my  office, 

and  apologized  for  the  error,  and  regretting  the  injus- 

^tice  he  had  done  me,  promised  to  publish  a  correction. 

For  some  reason  or  another  this  promise  has  obvi- 
ously never  been  fulfilled. 

By  reference  to  the  dates,  in  the  two  articles  of  D»*. 
Taylor,  in  one  of  which  he  states  that  he  constructed 
his  instrument  in  the  latter  part  of  I860:  and  in  the 
other  that  he  had  used  it  several  months  before  he 
showed  it  to  me,  would  certainly  place  the  time  of  my 
seeing  his  instrument  some  months  after  January,  at 
which  time,  as  will  be  seen  by  the  note  of  the  Editor 
of  the  Medical  Times  ray  lecture  was  in  the  hands  of 
the  printer:  and  the  instrument  had  been  used  some 
months  before. 

Yours  respectfully. 

Lewis  A.  Satre,  M.D. 

8S5  FiRH  AvsNUS,  Nxw  Yobk,  Sept.  5, 186T. 

ACTIVE    VENTILATION. 

A  NEW  METHOD. 
To  THB  EonoB  or  tbm  Mxdioh.  Bxoord. 

Sir — On  a  close  morning,  an  apartmjent  where  several 
persons  have  slept  may  be  opened  to  the  fiillest  extent 
of  all  the  windows  and  doors,  and  yet  so  slow  is  the  at- 
mospheric diffusion  that,  on  entering  such  a  room  several 
hours  later,  you  would  at  once  say  "  this  air  is  unfit  for 
respuration.** 

Wind-sails  are  often  of  great  service  in  driving  out  the 
stagnant  air  from  between  the  decks  of  vessels,  but  these 
are  as  dependent  upon  the  wind  as  are  the  vessels  them- 
selves, but  in  the  exceedingly  simple  method  which  I 
am  about  to  propose  we  actually  raise  the  wind  by 
which  we  effect  the  good  result. 

It  is  by  gently  swinging  all  the  doors  hack  and/or^  upon 
their  hinges.  The  thoroughness  of  this  method  may  be 
demonstrated  by  placing  a  feather  in  a  distant  part  of 
the  room,  and  if  you  please,  under  or  behind  some 
piece  of  furniture  where  you  would  least  expect  it  to  feel 
the  influence  of  your  fan;  afier  one  minute  s  effort,  look 
for  the  feather.  Again,  shut  all  the  doors  but  one,  and 
as  you  move  that  one  observe  that  the  distant  windows 
of  the  apartment  "  rattle,'*  and  the  curtains  swing  syn- 
chronously with  your  own  efforts.  This  method  of 
ventilation  seems  especially  valuable  for  all  sleeping 
rooms,  for  tenement-houses,  basements,  clothes  presses, 
closets,  or  any  other  places  where  the  atmosphere  is 
not  readily  changed   by  draughts  or^^^irrents.  jlts 

Digitized  by  VjOOQ IC 


860 


THE  MEDICAL  RECORD. 


advantages  are  too  obvious  for  serious  argument,  but 
the  process  is  so  exceedingly  simple  that  it  will  be  neg- 
lected and  forgotten.  Were  it  some  great  thing,  at- 
tended with  parade  and  expense,  we  might  hope  for  its 
general  adoption.  But  for  this  consideration  I  would 
hardly  say  of  my  own  thought  that  T  regard  it  as  an 
important  practicid  hygienic  suggestion  which  (mght  to 
increase  the  longevity  of  our  race.  The  idea  may  have 
occurred  to  others  — ^'twere  strange  if  it  has  not — ^but  I 
would  make  it  the  property  of  every  man,  the  custom 
of  every  family,  a  blessing  to  every  age. 

Truly  yours,  J.  H.  Hobabt  Buroi,  M.D. 

60  CoCRT  Strekt,  BBOOKL-qr,  N.T. 

Um  |)ublicatum0* 

Books  jlsd  Pahphlbtb  BBomvsD. 

A  Dictionary  of  Medical  Terminology,  Dental  Surgery 
and  the  Collateral  Soibnobb,  by  Chafin  A.  Harris, 
M.D„  D.D.a,  Prof:  of  the  Principles  of  Dental  Surgery  in 
the  Baltimore  College,  etc.,  eta  Third  edition  carefully  re- 
vised and  enlarged  by  Ferdinand  J.  S.  Gorgas,  M.D. 
D.D.S.,  Prod  of  Dental  Surgery,  Baltimore  College. 
Philadelphia.     Lindsay  ft  Blakiston,  1867. 

A  Biennial  Retrospect  op  Medicinb,  Surgery,  and  theuP 
ALUED  Sciences,  edited  by  Mr.  H.  Power,  Dr.  Anstie, 
Mr.  Holmes,  Mr.  Thomas  Windsor,  Dr.  Barnes  and  Dr. 
C.  Hilton  Fagob,  for  the  New  Sydenham  Society.  Phil- 
adelphia:   lindsay  ft  Blakiston,  1867. 

Is  rr  I  ?  A  Book  for  every  man.  By  Horatio  R  Storer, 
M.  D.,  of  Boston,  Vice-President  of  the  American  Medica^ 
Assodation.    Boston :  Lee  &  Shepard,  1867. 


Dr.  H.  Knapp,  Professor  of  Ophthalmology  in  the 
University  of  Heidelberg,  is  now  on  a  visit  to  this 
country.  He  is  one  of  the  well-known  authorities  on 
eye  disease  in  Germany,  and  strangelv  enough,  expresses 
the  same  opinion  concerning  the  facilities  for  medical 
study  in  this  country  as  does  Spencer  Wells,  quoted  in 
another  place.  We  take  pleasure  in  stating  that  the 
distinguished  professor  intends  at  some  future  time  to 
give  us  a  practical  article  for  our  columns^  on  a  subject 
Cv/unected  with  his  specialty. 

Dr.  B.  a.  Olimbnts,  Surgeon,  U.  S.  A,  according  to 
the  official  accounts,  is  slowly  recovering  from  an  attack 
of  yellow  fever,  contracted  in  the  line  of  duty  at  New 
Orleans,  La. 

Death  of  Prof.  Robert  Watts. — At  the  moment  of 
going  to  press  we  are  informed  of  the  death  of  our  cher- 
ished friend,  Dr.  Robert  Watts,  Professor  of  Anatomy 
in  the  College  of  Physicians  and  Surgeons,  in  this  city. 
This  event,  which  we  announce  with  no  ordinaiy  feel- 
ings of  sorrow,  occurred  at  Paris,  France,  on  the  Btk 
ultimo.  An  obituary  notice  of  the  deceased  wifl  appear 
in  our  next  issue. 

Deaths  among  XJ.  S.  A.  Surceon?  ik  The  ltne  of 
DUTY. — Nine  surgeons  in  the  United  States  service  have 
died  during  the  past  month  in  the  cholera  and  yellow 
fever  localities  of  the  West  and  Southwest  This  is 
more  than  the  usual  mortality  in  that  branch  of  the  ser- 
vice for  an  entire  year. 

A  New  Parisian  Sensation. — ^Paris  is  just  now  in 
the  enjoyment  of  a  new  sensation  in  the  person  of  the 
Zouave  Jacob  (trombone-placer),  who  cura  the  paraly- 
tic, the  blind,  and  the  bed-ndden  generally,  by  a  few 
energetically  spoken  phrases*  He  comes  to  Paris  late 
in  the  afternoon,  after  giving  a  sitting  of  oon^ultatioDS 


at  Versailles.  The  most  remarkable  part  of  the  miracles 
wrought  by  him  is  the  circumstance  that  he  receives 
no  fees,  and  cures  without  even  the  pretence  of  infini- 
tesimal doses.  Jacob  is  a  general  practitioner,  and 
claims  to  be  equally  at  home  in  every  department  of 
medicine. 

The  Mother  the  Best  Nurse. — ^The  authorities  at 
Munich  for  some  years  past  have  required  that  in  aU 
cases  of  children  dymg  in  their  first  year,  the  parents 
should  declare  whether  or  not  the  infant  had  been 
suckled  by  the  mother.  A  statistical  table  of  the  last 
two  years  shows  that  out  of  100  deceased  88  were  not 
so  brought  up. 

Mortality  from  Scarlatina  in  England. — ^Tbe 
average  amount  of  scarlet  fever  that  constantly  exists 
in  England  may  be  estimated  fix)m  the  fact  that  in  the 
twenty-one  years  from  1838-42,  and  1847-62,  the 
deaths  numbered  910.720,  or  14,796  annually.  In  fact 
scarlet  fever  is  nearly  as  fatal  as  the  entire  class  of 
fevers  summed  up  by  the  Registrar-General  under  the 
generic  term  "  typhus."  In  1863  the  total  deaths  fix)m 
scarlet  fever  were  30,475,  or  148  per  100,000  popula- 
tion. The  annual  average  death-rate  from  this  malady 
in  London  during  the  twenty-six  years  ending  1862 
was  83  per  100,000  population.  The  mortality  ranged 
from  32  in  1841  to  174  in  1863.  In  the  quinquennium, 
1839-43,  the  yearly  average  was  78 ;  in  that  of  1844- 
48,  it  rose  to  88;  in  that  of  1859-63  it  increased  to 
115;  the  death-rate  of  1863  being  174,  or  more  than 
double  the  average  of  the  twenty-six  years.  1838-64. 

The  census  of  1860  shows  that  the  total  number  of 
deaths  from  scarlatina  in  the  United  States  in  that  year 
was  26,393. 

New  York  Medico-Leoal  Society. — This  society  is 
now  in  active  operation,  and  we  shall  endeavor  fh>m 
time  to  time  to  keep  our  readers  informed  of  its  doings. 
Dr.  Wooster  Beach,  Jr.,  is  the  President,  and  Dr.  Leo 
is  the  Secretary. 

The  Traffic  in  Coooulus  Imdious. — 60,000  pounds 
of  oooculus  indicus  were  imported  from  India  to  Eng^d 
last  year— a  sufficient  quantity  to  drug  120,000  tons  of 
beer. 

Sulphate  of  Soda  as  a  Remedy  for  Maoulji  of 
the  Cornea. — Dr.  De  Lnca  reports  to  the  French 
Academy  of  Sciences  that  sulphate  of  soda,  which  has 
the  property  of  maintaining  the  fibrin  of  the  blood  in  a 
fluid  state,  may  be  used  with  success  in  removing  these 
spots.  The  best  method  of  using  it  is  to  reduce  the 
salt  to  a  fine  powder,  and  drop  a  pinch  of  it  into  the 
eye  of  the  patient  wlule  in  a  horizontal  posture — the 
salt  is  soon  dissolved  in  the  liquids  of  the  eye. 

Bekr  versus  Bread. — ^The  amount  of  nutriment  con- 
tained in  beer  is  generally  greatly  over-estimated.  Lei- 
big  asserts  that  in  1,460  quarts  of  the  best  Bavarian 
beer  there  is  exactly  the  nourishment  of  an  ordinary 
two  and  a  half  pound  loaf  of  bread.  This  beer  is  about 
on  a  par  with  our  best  American  beer.  Instead  of  being 
a  condensation  of  the  nutriment  contained  in  the  grain 
in  just  so  far  as  the  liquid  has  undergone  fermentation 
the  nourishment  has  disappeared. 

Support  Medical  Journals. — No  man  can  fulfil  the 
mission  of  a  doctor  uiiless  he  takes  a  good  medical 
journal,  and  it  is  useless  to  cry  poverty.  The  best  in- 
vestment a  practitioner  can  maJce— one  that  insures  him 
bread,  meat  and  clothea^is  not  six,  but  fifty  dollars* 
worth  of  good  medical  journals.  If  a  man  practisM 
without  this  sort  of  communion  with  his  brethr^i 
throughout  the  world  he  deserves  to  be  poor.  Surely 
the  oommunity  in  which  he  lives  has  a  right  to  keep  him 
so. — Southern  Journal  Afedical  Soience. 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


361 


©rigmol   Commumcati0n«* 

CASES  OP 
i^    ORGANIC  AND  REFLEX  PARALYSIS 

TREATED  BY  ELECTRICITY. 

By  a.  D.  ROCKWELL,  M.D., 

AND 

GEO.  M.  BEARD,  M.D., 
ucnrsxB  oa  ihebtoub  disbabu  nr  ths  mnynarrr  medical  oollkqs 

OF  XKW  TOSK. 

I. 

In  all  the  eras  of  medical  history  the  treatment  of  the 
variouB  forms  of  paralysis  has  been  at  once  the  oppro- 
brium of  science  and  the  glory  of  empiricism.  It  is 
more  eminently  time  of  this  disease  than  of  almost  any 
other  with  which  humanilgr  suffers,  that  while  there  are 
thousands  of  cases  that  defy  the  combined  skill  and  ex- 
perience of  the  faculty,  there  is  yet  no  system  of  treat- 
ment so  fantastic  and  absurd  as  not  to  be  able  in  certain 
instances  to  perform  absolute  and  apparently  marvellous 
cures.  There  are  few  practitioners  of  large  experience 
who  have  not  known  of  cases  of  paralysis  that  have 
been  to  all  human  seeming  permanently  restored  by 
practices  that  are  abhorrent  to  science  and  reason,  and 
that,  too,  at  the  hands  of  those  who  were  as  igno- 
rant of  the  rationale  of  tlieir  own  treatment  as  thev  were 
of  the  pathology  of  the  disease.  The  causes  of  this  dis- 
crepancy between  the  experience  of  science  and  charla- 
tanism are  not  difficult  of  explanation. 

Ist.  The  obscure  pathology  of  the  different  forms  of 
paralysis. 

The  causation  and  nature  of  most  of  the  diseases  of 
the  nervous  system  are  even  yet  environed  by  darkness 
rather  than  by  light,  notwithstanding  the  faithful  labors 
and  brilliant  discoveries  of  a  host  of  able  microscopists 
and  pathologists.  Prior  to  the  last  half  century,  all 
that  was  known  to  the  profession  of  the  pathology  of 
paralytic  affections  was  too  vague  and  erroneous  to  be 
any  guide  either  in  diagnosis  or  therapeutics ;  and  even 
in  our  day,  in  spite  of  the  splendid  researches  of  Rom- 
berg, Trousseau,  Leroy  d'  Etiolles,  Duchenne,  Flourens, 
and  Srown-S^uard,  there  are  comparatively  few  among 
general  practitioners  who  even  attempt  a  systematic  diag- 
nosis between  paralysis  dependent  on  myelitis  or  other 
organic  affections  of  the  central  nervous  system,  and 
those  which  are  due  to  reflex  action  or  to  ansemia.  This 
question  of  differential  diagnosis  that  presents  itself  with 
every  case  of  paraplegia,  and  is  of  such  vital  moment 
both  for  the  prognosis  and  therapeutics,  is  either  not 
raised  at  all  or  is  ansveered  without  logical  investigation 
or  reflection.  The  direct  and  inevitable  consequence  of 
this  uncertain  pathology  is  primarily  to  make  tne  treat- 
ment of  paralysis  almost  entirely  empirical,  and  ulti- 
niately  to  throw  discredit  on  all  measures  of  active  in- 
terference, even  in  cases  that  proper  investigation  would 
show  to  be  entirely  curable. 

Charlatans  have  busily  occupied  the  field  thus  left 
open  by  the  ignorance  and  discouragement  of  science, 
and  have  oftentimes  surprised  themselves  and  their  pa^ 
tients  by  speedy  and  astonishing  results. 

2d.  The  helplessness  and  suffering  caused  by  paral- 
ysiSy  and  the  hngering  character  of  many  of  its  phases, 
beget  the  desire  and  the  opportunity  on  the  part  of  the 
patient  to  test  many  styles  of  practice  that  are  repug- 
nant to  sense  or  philosophy. 

A  patient  who  is  stricken  down  in  the  prime  of  man- 
hood by  this  mysterious  chronic  disorder,  and  who  (as 


is  so  often  the  case)  is  counselled  by  his  family  physician 
to  wait  for  nature  and  time,  can  hardly  be  censured  for 
grasping  at  anything  that  offers  the  faintest  hope  of  re- 
lief. We  cannot  wonder  that  such  unfortunates  are 
ready  to  $ow  beside  all  waters,  even  though  they  find 
neither  satisfaction  nor  reward. 

3d.  The  very  recklessness,  ignorance,  and  greediness 
of  quacks  have  driven  them  to  successiul  experiments 
that  the  conscientious  and  honorable  would  hardly  dare 
attempt. 

The  spirit  of  Paracelsus  and  Sir  John  Long  still  lives, 
and  amid  a  thousand  blunderings  it  now  and  then  stum- 
bles on  some  path  that  leads  to  usefulness. 

We  would  not  be  understood  as  underrating  the  sys- 
tematic and  patient  investigations  of  a  number  of  able 
minds,  who  for  the  past  few  years  have  labored  specially 
in  this  department,  and  have  contributed  so  much  that  is 
of  practical  service  in  the  treatment  of  paralysis  as  well 
as  in  the  study  of  its  pathology.  Chiefly  among  these 
recent  observers  is  0.  E.  Brown-S^quard,*  whose  writ- 
ings on  diseases  of  the  nervous  system,  for  originality 
and  boldness  of  thought,  and  for  clearness  and  compact- 
ness of  style,  have  few  equals  in  scientific  literature. 
But  the  conclusions  at  which  he  arrives,  and  which  he 
so  lucidly  presents,  are,  to  say  the  least,  not  indisputa- 
ble. The  variety  of  fact^  that  he  has  collated  are  indeed 
of  immense  service  to  the  student  of  diseases  of  tlie 
nervous  system,  as  a  guide  by  which  to  estimate  obser- 
vations that  shall  be  made  by  future  experimenters ; 
though  it  may  well  be  questioned  whether  all  his  bril- 
liant generalizations  will  stand  the  test  of  the  combined 
experience  of  ihe  explorers  that  are  to  come. 

His  leading  ideas  m  regard  to  the  pathology  of  para- 
plegia, are  clearly  set  forth  in  the  following  propositions : 

ist.  That  there  is  a  form  of  paralysis  of  the  lower 
limbs,  entirely  distinct  from  all  others,  as  proved  by  its 
mode  of  production,  by  morbid  anatomy,  by  its  symp- 
toms, and  by  the  influence  of  a  certain  mode  of  treat- 
ment ;  and  that  this  form  of  paralysis  fully  deserves  the 
name  of  reflex  paraplegia* 

2d.  That  the  reflex  paraplegia  may  be  caused  by  the 
most  various  irritations  ot  the  skin,  the  mucous  and 
serous  membranes,  the  abdominal  or  thoracic  viscera,  as 
\^11  as  of  the  genital  organs,  or  the  trunk  of  the  spinal 
neives. 

3d.  That  most  cases  of  paraplegia  can  be  placed  in 
two  groups,  entirely  different  one  from  the  other,  ac- 
cording to  t!ie  existence  or  the  absence  of  symptoms  of 
irritation  of  the  motor,  sensitive,  and  vaso-motor  nerve 
fibres. 

4th.  That  most  of  the  therapeutical  means  to  be  em- 
ployed in  paraplegia  are  also  to  be  grouped  in  two  cate- 
gories, one  of  which  is  fitted  to  t£ose  cases  in  which 
there  are  symptoms  of  irritation,  and  the  other  to  those 
cases  in  which  these  symptoms  do  not  exist.f 

The  "  therapeutical  means  "  referred  to  in  the  last 
pYoposition  are  as  follows : 

In  reflex  paralysis. — 1st.  Means  of  diminishing  the 
external  irritation  that  causes  the  paraplegia — viz.,  local 
applications  of  belladonna,  or  of  opium,  or  of  both  com- 
bined. 2d.  Means  of  improving  the  nutrition  of  the 
spinal  cord — viz.,  strychnine,  sulphuret  of  potash, 
sleeping  on  the  back  with  the  nead  and  legs  elevated, 
applications  of  cold  and  heat  to  the  spine,  revulsives, 
**  galvanism. "  3d.  Means  of  preventing  the  iU  effects 
of  rest  in  the  paralyzed  nerves  and  musdes — viz.,  "gal- 
vanism "  and  shampooing. 

Paralysis  due  to  myelitis^  or  (q  some  cangesHve  or  m- 


•  Oonne  of  Lectorei  on  the  Physiology  and  Pathology  of  the  Cen- 
tral Nervoiu  Sjitem.  t 
t  Lectorea  on  PanOyilB  of  Lower  Extremities,  p.  Iia  i  O  Q I  ^ 


362 


THE  MEDICAL  RECORD. 


flammatory  condition  of  (he  spinal  cord  or  its  membranes. 
— Ist.  Means  for  diminishing  the  congestion  of  the  spinal 
cord— viz.,  sleeping^  with  the  arms  and  legs  on  a  lower 
level  than  the  spme,  hot  and  cold  applications,  dry 
cupping,  revukives,  belladonna  and  ergot  of  rye.  2(1 
Means  to  prevent  the  formation  of  sloughs,  or  to 
cure  them  when  fonned,  and  to  prevent  other  alter- 
ations of  nutrition  in  the  paralyzed  parts — ^viz.,  pounded 
ice  and  poultices,  shampooing,  warm  foot-baths,  the 
flesh-brush  and  galvanism,  remedies  for  anynepnritis 
or  cystitis  that  may  occur,  laxatives  for  the  bowels, 
3d.  Tonics— cod- Uver  oil^  iron,  ale,  and  nutritious  food.* 

We  have  been  thus  minute  in  presenting  the  teach- 
ings of  Brown-S^quard  for  the  following  reasons : 

Isl  Because,  whatever  exceptions  may  be  taken  to  his 
generdizations,  he  is  indisputably  and  justly  regarded 
as  one  of  our  highest  authorities  on  the  diseases  of  which 
he  treats.  The  relative  position  that  has  been  thus  ac- 
corded to  him,  in  this  country  at  least,  has  been  mainly 
due  to  the  fact  that  his  opinions  on  these  somewhat  ab- 
struse subjects,  whether  firmly  grounded  or  not,  are 
stated  with  a  clearness,  a  positiveness,  and  an  authority 
that  can  but  command  attention.  2d.  Because,  in  our 
view  (although,  as  will  be  explained  further  on,  we  are 
not  prepared  to  endorse  all  of  his  statements  in  regard 
to  reflex  paralysis),  his  system  of  therapeutics  for  aM  re- 
he  vable  paralytic  affections,  is  at  once  catholic,  scientific 
and  comprehensive,  since  it  is  based  on  a  differential 
pathological  diagnosis,  and  practically  includes  the  best 
results  of  daring  quackery — the  movement  cure,  rubbing, 
and  galvanism — as  well  as  the  judicious  administration  of 
remedies.  3d.  Because,  as  we  shall  endeavor  to  show  by 
theory,  by  general  experience,  and  more  especially  by 
detailed  exhibition  of  cases,  these  indications  for  tiie 
treatment  of  the  nervous  forms  of  curable  paralysis  are 
more  fully  met  by  general  electrization  f  with  the  faradaic 
current  in  conjunction  with  localized  electrization — 
either  with  the  faradaic,  or,  in  some  cases,  with  the 
galvanic  current — than  by  any  other  one  system  that 
has  yet  been  proposed 

In  regard  to  general  electrization  with  the  faradaic 
current,  we  speak  only  from  our  own  experiments  on 
ourselves  and  on  the  living  subject,  and  firom  a  consid- 
erable experience  with  a  variety  of  diseases,  since  we 
were  the  nrst  to  call  the  attention  of  the  profession  to 
this  method  of  treatment. 

So  far  as  merely  localized  electrization  with  the  &r»- 
daic  or  galvanic  current  is  concerned,  our  experienoe 
was  in  the  main  anticipated,  and  has  been  corroborated 
by  Duchennej,  Tripier,  and  Seller  in  France;  by  Proft. 
Remak  and  Ziemssen,  and  by  Dre.  Kosenthal,  Meyer, 
Benedict,  Erdman,  and  Bastings  in  (Germany :  by  Dr. 
Althaus  of  London,  and  by  Drs.  Gkuratt,  Weir,  Mitchell, 
and  W.  A.  Hammond  of  our  own  country.  We  claim 
that  general  electrization  with  the  faradaic  current  is  a 
general  tonic  and  corrective  of  very  great  efficacy,  and 
that  as  such  it  fulfils  the  following  specific  indications: 

1st.  To  strengthen  and  soothe  irritable  and  painful 
nerves  or  crgans. 

2d.  To  prevent  atrophy  and  fatty  degeneration  that 
may  result  from  too  long  disuse  of  paralyzed  nerves  and 
muscles. 

3d.  To  equalize  the  circulation ;  to  bring  the  blood 
to  cold  parts,  and  vice  versa^  to  diminish  congestion. 

4th.  To  prevent  the  formation  of  ulcers  in  paralyzod 
partA,  and  to  hasten  their  cure  when  formed. 

5th.  'to  produce  general  tonic  effects  in  the  whole 
system,  by  correcting  the  deranged  organs  of  assimila- 

*  Lecture!  on  Paralyile  of  Lower  BxtremltleB,  pamim. 

T  For  explanation  of  this  and  other  terms  emploTed  In  electro-tlien- 
IK**!!^,^*  reader  b  referred  to  our  recentl/  puWished  treatlae  on  the 
Medical  Use  of  Electridty. 


tion,  and  stimulating  all  the  various  processes  of  waste 
and  repair.  Tht-se  constitutional  tonic  effects  of  general 
electrization  are  demonstrated  in  the  same  manner, 
as  from  the  internal  administration  of  tonics — travel- 
line,  sea-bathing,  riding — ^viz.,  by  increase  of  appetite, 
making  the  sleep  more  refireshmg,  relieving  nervous 
and  inflammatory  pains,  regulating  the  bowefe,  improv- 
ing the  circulation,  the  color  of  the  cheeks,  the  muscular 
development,  and  t^e  touiememble  of  the  individuaL 

For  proof  of  these  statements  we  refer  to  our  treatise 
already  published,  and  to^  the  details  of  cases  that  are  to 
accompany  these  articles.  The  power  of  electrization 
(whether  with  the  galvanic  or  fiu^aic  current)  to 
soothe  irritated  and  painful  nerves  or  organs,  is  so  very 
easy  of  demonstration,  that  we  wonder  that  it  is  not 
more  generally  appreciated  by  the  profession.  Acute 
neuralgias  are  ofien  instantaneously  reheved  by  the  ap- 
plication of  a  fine  current^  directly  over  and  dong  the 
painful  nerves.  For  aching  eyes  and  irritable  tlwoats 
and  urethras,  no  anodyne  is  at  once  so  efficacious  and 
so  harmless.  The  harmlessness  of  electrization,  used  in 
this  way,  gives  it  in  many  cases  a  manifest  advantage 
over  hypodermic  injections,  or  the  internal  use  of  opiates. 

Were  electrization  only  useful  in  neuralgia,  it  would 
deserve  far  more  attention  from  men  of  science  than  it 
has  yet  received. 

It  will  be  observed  that  the  effects  here  claimed  for 
electrization  are  substantially  those  that,  according  to 
the  theories  of  Brown-S^quard,  are  desired  in  the  various 
forms  of  paralysis.  That  the  most  important  indication 
of  all,  viz.,  the  equalization  of  the  circulation,  is  excel- 
lently met  by  electrization,  we  have  repeatedly  and 
daily  demonstrated  in  our  own  practice  and  on  our  own 
persons,  and  in  the  presence  of  various  members  of  the 
medical  profession. 

If  the  bulb  of  a  thermometer  be  applied  to  a  limb,  in 
which  the  circulation  is  normal,  or  is  deficient,  just  be- 
fore and  just  after  electrization,  it  will  be  found  that 
there  is  oftentimes  a  very  perceptible  rise  in  the  tem- 
perature ;  and  vice  versa^  electrization  of  inQamed  joints 
or  other  parts,  reduces  the  temperature,  dissipates  tbe 
redness,  reUeves  the  pain,  and  diminishes  the  sweUing, 
thus  ameliorating  all  the  symptoms  of  inflammation. 

This  last  effect  is  best  secured  by  a  very  fine  induced 
current,  gent'y  applied  with  the  moistened  hand. 

Although  electnzarion  in  active  inflammation  is  con- 
trary to  most  of  the  teachings  of  the  past,  yet  this  is 
only  another  evidence  of  tiie  irresistible  tendency  of 
the  human  mind  to  accept  the  dictate  of  leadership  with- 
out doubt  or  question*  The  antiphlogistic  efi^ts  of 
general  electrization  are  much  more  decided  than  when 
the  applications  are  merely  loca],  for  the  reason  that, 
by  the  former  method,  the  great  83rmpathetic  and  the 
entire  system  are  affected,  and  then  react  on  the  diseased 
part.  We  are  continually  demonstrating  the  antiphlogis- 
tic effects  of  electrization  in  inflammations  of  the  con- 
junctiva, the  nasal  passages,  pharynx,  laiynx,  bronchi, 
the  urethra  (the  acute  and  passive  stages  of  gonorrhoea), 
and  in  inflamed  ioints. 

Now,  although  the  bone  is  comparatively  a  poor  con- 
ductor, yet  the  articulations  of  the  spinal  column  wiU 
not  wholly  prevent  the  influence  of^  the  electric  cur- 
rent ;  but  the  cord  is,  probably,  chiefly  affected  by  the 
impression  it  receives  from  the  electrized  periphery. 

If  injurious  irritation  of  sensitive  nerves  operate  di- 
rectly on  the  central  nervous  system,  as  rightly  claimed 
by  Brown-S^quard,  then  certamly  there  is  a  fair  proba- 
bility that  tonic  and  corrective  impressions  of  ^e  peri- 
phery ma^  operate  favorably  upon  the  same  system. 
This  question  will  be  discussed  more  in  detail  mrther 
on. 

In  this  connection  it  may  be  wen-io  state  that  all 
Digitized  by  VjC  _      ^_ 


THE  MEDICAL  RECORD. 


863 


the  results  that  we  have  here  or  elsewhere  claimed  for 
general  electrization,  can  be  secured  in  all  their  fulness 
and  variety  by  any  or  all  who  will  bring  to  the  investi- 
gation the  requisite  energy,  enthusiasm,  patience,  and 
earnest  love  of  truth.  It  is,  perhaps,  too  much  to  be 
expected  that  our  older  practitioners  will  find  it  possi- 
ble, amid  their  heavy  responsibilities,  to  pursue  a  de- 
partment that  demands  so  much  time  and  special  expe- 
rience as  the  scientific  study  of  electro-therapeutics ; 
bat  for  younger  men,  who  have  health  and  oppor- 
innity,  the  field  thus  opened  for  the  energetic  and 
persevering  is  too  rich  in  promise  of  usefulness  to  be 
any  longer  passed  by.  Since  we  first  formally  called 
the  attention  of  the  profession  to  the  tonic  effects  of 
general  electrization  with  the  faradaic  current,  we  have 
been  gratified  to  leam  that  others  in  different  parts  of 
the  country  have  commenced  to  experiment  with  this 
method  of  treatment,  and  some  of  these  have  already 
met  with  sufficient  success  to  more  than  corroborate  all 
that  has  been  claimed  for  it 

tl4  BtOADW  AT. 


ox  THE  PREVENTION  AND  TREATMENT 
OF  SCARLATINA. 

By  N.  L.  north,  M.D., 

BBOOKLTir,  N.  T. 

I  WAS  greatly  pleased  on  reading  in  the  last  number  of 
the  N.  Y.  Medical  Journal  an  article  by  Dr.  C.  C.  Lee, 
*'0n  the  Internal  Use  of  Chlorine  Water  in  Anginose 
Scarlatina,"  as  it  so  exactly  accords  with  my  own  ex- 
perience of  the  last  few  years,  as  also  with  the  recorded 
experience  of  so  many  English  physicians  for  the  past 
five  or  ten  years,  as  may  be  seen  by  looking  over  the 
files  of  Braithwaite  for  the  time.  Mr.  E.  JT  Blyth,  in 
18G3,  and  again  in  1864,  particularly  calls  the  attention 
of  the  profession  to  tliis  treatment  in  the  following 
language :  "  Let  me  urge  my  medical  brethren  to  give 
a  full  and  fair  trial  to  my  remedy,  relying  implicitly  on 
it  ....  I  see  no  reason  why  every  one  using 
this  remedy  fiiHy,  should  not  be  blessed  with  the  same 
success  that  I  have  been,  during  many  years  that  I  have 
used  this  specific  in  an  active  and  extensive  practice." 

The  formula  given  by  Mr.  Blvth  is  (except  that  there 
are  ten  instead  of  eight  grs.  of  chlorate  of  potash)  the 
same  as  that  given  hj  Dr.  Lee,  and  the  same  also  as 
may  be  found  in  "  Watson*s  Practice  of  Physic."    In 
£act  the  remedy  is  not  a  new  one,  or  not  an  uncommon 
one,  and  yet  1  believe  it  might  with  great  good  effect 
be  more  middy  known  and  more  generally  used.    Any 
practitioner  who  will  try  the  remedy  need  not  long  be 
in  doubt  as  to  its  great  value  in  anginose  scarlatina. 
I  myself  had  the  honor,  in  August  or  September,  1864. 
of  reading  a  paper  on  scarlatina  before  the  ''  Medical 
Association  of  the  E.  D.  of  Brooklyn,"  wherein  I  particu- 
larly urged  upon  my  medical  brethren  the  use  of  the 
hyposulphite  of  soda  as  a  prophylactic,  and  as  a  gen- 
eral remedy  in  scarlatina,  and  the  "  chlorine  mixture  " 
in  the  anginose  or  diphtheritic  variety.  I  also  give  it  and 
urge  its  use  in  pure  diphtheria  as  a  remedy  of  far  greater 
power  than  any  other  I  have  ever  used.  I  speak  of  the 
remedy  as  a  "  chlorine  mixture,"  for  it  is  evidently  not 
a  simple  *'  chlorine  water,"  but  a  mixture  of  pure  chlo- 
rine 'with  the  chloric  and  hydrochloric  acids,  and  is  to 
most  people  pleasant  to  the  taste,  while  the  '^  chlorine 
water  "   of  the  Pharmacopoeia  is  very  disagreeable  to 
the  taste,  and,  according  to  my  experience,  of  far  less 
value  in  scarlatina  anginosa  or  diphtheria,  than  the  c'nlo- 
line  mixture  which  Ihave  prepared  as  follows : 

Pat  tea  grains  of  the  chlorate  of  potash,  finely  levi- 


gated, in  a  pint  bottle ;  cork  it ;  add  one  drachm  of  hy- 
drochloric acid;  in  a  minute  or  so  add  an  ounce  of 
water,  and  shake ;  to  dissolve  the  vapor,  let  it  stand  a 
short  time ;  then  add  more  and  more  water  at  intervals 
until  the  bottle  is  filled. 

I  direct  my  apothecaries  to  be  in  no  haste  in  the  pre- 
paration of  the  mixture,  but  to  prepare  it  beforehand, 
and  add  the  water  ounce  by  ounce,  and  allow  suflScient 
time  between  each  addition  for  the  absorption  of  the 
vapoV  or  gases.  I  find  physicians  are  in  the  habit  of 
using  ehllrate  of  potAsh  and  hydrochloric  acid  witti 
water — writing  extemporaneous  prescriptions  therefor 
— in  very  much  larger  quantities  of  the  acid  and  potas. 
chlor.,  yet  with  nothing  like  the  effect;  and  1  have 

X'n  and  again  surprised  them  with  the  strength  and 
iency  of  my  chlorine  mixture  made  after  the  formula 
of  Dr.  Blyth  above  given.  I  find  it  again  very  neces- 
sary to  know  my  apothecary ;  as,  with  our  model  arrange- 
ment of  learned  apothecaries,  I  find  it  very  difficult  to 
"  heat  it  into  the  head  "  of  more  than  about  one  in  fifty 
that  the  ma>nner  of  compounding  medicines  is,  many- 
times,  of  as  much  importance  as  the  matter  of  which 
they  are  compounded. 

As  to  the  dose  of  the  chlorine  mixture,  I  give,  accord- 
ing to  the  age  and  condition  of  the  patient,  from  a  tea- 
spoonful  to  two  tablespoonfiils,  diluted  with  pure  water, 
at  intervals  of  from  one  to  eight  hours.  Much  larger 
doees  may,  and  have  been  given,  but  I  find  these  doses 
large  enough,  and  much  prefer  giving  small  quantities 
fi-equently,  to  larger  doses  at  longer  intervals ;  as  it 
seems  to  me  its  action  is  more  antiseptic  and  disinfect- 
ant than  otherwise,  and  the  more  continuous  its  appli- 
cation to  the  seat  of  the  disease,  the  better  for  the  pa- 
tient 

The  N.  Y,  Medical  Journal  published  a  short  com- 
munication from  myself,  in  March,  1866,  in  which  I  ad- 
vocated the  use  as  prophylactic  for,  as  well  as  a  remedy 
in.  scarlet  fever,  of  hyposulphite  of  soda,  and  the  chlorine 
mixture  in  the  anginose  variety.  Dr  Blyth  recommends 
the  chlorine  mixture  alone  for  the  same  purpose.  I 
wish  here  to  add  to  what  I  said  in  the  communication 
mentioned,  that  I  still  believe  the  hyposulphite  of  soda 
to  be  a  prophylactic  of  more  power  than  anything  ever 
yet  used,  and  that  its  apparent  failure  is  explainable  in 
the  fact  that  the  profession  is  looking  for  some  spe- 
cific (as  vaccination  for  small-pox)  for  scarlatina,  and 
have  given  this  medicine,  as  they  have  others,  with  that 
idea  uppermost.  Now  if  the  ground  be  taken  that  the 
medicine  acts  as  an  antiseptic-  and  disinfectant,  we  shall 
not  give  it  for  a  few  days,  and  think  we  have  obtained 
its  preventive  effect  upon  the  system,  but  we  shall 
administer  it  to  the  well  children  as  a  prophylactic  dur- 
ing the  whole  time  of  their  exposure. 

In  March,  1867,  the  Metropolitan  Board  of  Health 
(so  the  newspapers  informed  us)  passed  a  resolution  in- 
cluding scarlet-fever,  measles,  diphtheria,  etc.,  in  their 
category  of  "  contagious  diseases.  I  did  hope  at  the 
time  that  some  recommendation  might  emanate  from,  or 
that  some  order  would  be  issued  by  the  Honorable  Board, 
requiring  the  systematic  use  of  disinfectants  and  prophy- 
lactics in  these  diseases,  if  any  could  be  sufficiently  reUed 
upon  to  warrant  a  trial ;  but  I  was  doomed  to  disappoint- 
ment, as  I  heard  nothing  more  of  the  resolution  until 
Jum  (about  the  time  it  usually  takes,  by  the  way,  for  a 
resolution  or  order  of  the  Metropolitan  Board  of  Health 
to  be  promulgated,  or  carried  into  effect  in  this  far-off 
region  of  the  Eastern  District  of  Brooklyn),  when  I  was 
ofiicially  informed  that  said  resolution  had  been  passed. 
That  official  document  also  contained  the  following : 
"  Physicians,  when  reporting  cases  of  contagious  dis- 
eases, are  requested  to  state  whether  an^  action  on  the 
part  of  the  Board  of  Health  is^needed  in^consequencg 


364 


THE  MEDICAL  RECORD. 


of  the  condition  or  surroundings  of  the  patient"  I, 
for  one,  did  not  know  what  they  meant,  as  they  had  not 
stated  what  action  they  proposed  to  take  in  such  cases ; 
and  I  was  glad  to  find  in  the  report  of  tlie  proceedings 
of  the  "  East  River  Medical  Association  "  that  that  so- 
ciety had  appointed  a  committee  to  inquire  of  the 
Board  of  Healdi  what  they  did  mean,  or  what  they 
proposed  to  do.  Yet  I  was  again  disappointed  in  the 
answer;  as  I  had  hoped,  as  I  before  stated,  that  some 
definite  action  would  be  taken  which  would  result  in 
some  useful  statistics.  I  desire  to  add  one  word  in  regard 
to  the  use  of  the  chlorine  mixture  and  the  hyposulphite 
of  soda,  particularly  in  scarlatina  and  diphtheria.  It 
seems  to  me  these  medicines  should  not  be  depended 
upon  to  the  exdugion  of  tonics,  iron,  eta  ;  for  if  they 
act  only  as  antiseptic,  and  if  they  are  curative  only 
through  removing  or  destroying  the  poison  which  is 
the  cause  o^  and  which  is  generated  by  the  disease, 
and  if  either  or  both  to  any  extent  act  as  a  prophylac- 
tic, by  destroying  the  commimicated  poison  previous  to 
its  development  of  the  disease  in  the  exposed  person, 
then  of  course  in  actual  disease  the  necessity  of  toning 
up  the  system  and  striving  to  repair  the  damage  done, 
should  by  no  means  be  lost  sight  of.  I  have,  for  in- 
stance, given  the  chlorine  mixture  in  severe  cases  of 
diphtheria^  and  destroyed  the  whole  of  a  bad  membrane 
in  from  twenty-four  to  forty -eight  hours,  and  in  twelve 
hours  more  have  found  my  patient  as  bad  as  at  the 
fii-st,  and  of  course  thought  it  necessary  to  redouble  my 
efforts  to  cure.  I  have  again,  in  just  as  severe  cases, 
given  the  mixture,  and  immediately  followed  by,  or 
alternated  with,  the  tr.  ferri  sesquichloridi,  and  other 
tonics,  and  have  had  the  satisfaction,  not  only  of  seeing 
the  &uces  clear  up  and  resume  the  healthy  state,  but 
find  the  whole  system  of  my  patient  rallymg  to  a  nor- 
mal state,  and  thus  preventing  a  return  of  the  diseased 
condition. 
Bbookltn,  N.  T.,  September,  IT,  186T. 


dDrtginal  €tctuus. 


ON  YELLOW  FEVER. 

DEUVERED  SEPT.   23,  1867,  AT  BELLSVUE  HOSPITAL,   N«  T. 

By  warren  stone,  M.D., 

PROrBSBOB  or  etTRGKBT  IK  TBM  im>IOAL  DXPABmXMT  OF  TH8 

vKir KBsm  OF  LounxAVA,  ma 

Yellow  fever  is  a  disease  which  everybody  seems  to 
understand,  yet  few  agree  upon  its  exact  nature  and 
character.  It  is  a  disease  simply  peculiar  to  the  South, 
to  certain  warm  regions.  The  exact  laws  that  govern 
it  we  have  not  been  able  to  define.  Many  observa- 
tions have  been  made  as  to  the  temperature  necessary 
to  the  existence  of  this  disease,  and  certain  theories  have 
been  iu  favor  for  a  length  of  time ;  but  all  arbitrary 
rules  have  been  set  aside,  examples  having  occurred  to 
falsify  them.  Yellow  fever  is  simply  and  purely  a  dis- 
ease that  can  exist  only  in  warm  chmates.  It  is  mdoced 
by  a  peculiar  poison,  totally  intangible,  and  distinct 
from  any  of  the  known  causes  of  disease.  There  is  no 
combination  of  filth — no  combination  of  circumstances, 
calculated  to  deteriorate  health  and  excite  typhuft  or 
typhoid,  or  fevers  of  a  low  grade,  that  have  anythhig 
to  do  with  the  generation  of  this  disease.  This  is  a 
remarkable  fact,  not  generally  understood ;  the  filth  of 
cities  does  not  generate  yellow  fever,  though  it  has  the 
same  influence  upon  it  as  upon  other  diseases,  by  im- 
pwring  the  vigor  of  the  system,  and  rendering  it  more 
susceptible  to  morbid  agents — but  that  is  alL  Sanitary 
measures  are  imporlantj  and  I  would  not  say  anything 


to  deter  people  from  insisting  on  cleanUness  in  cities ; 
but  some  Federal  officers  took  credit  to  themselves  for 
keeping  yellow  fever  out  of  New  Orleans  during  its 
occupatiotL  It  is  a  notorious  &ct  that  the  dty  was  not 
cleaner  than  usual  during  that  time,  but  the  conditions 
were  more  favorable;  the  weather  was  cooler  and 
pleasanter,  and  there  was  less  rain  than  usual  The 
principal  thoroughfares  may  have  been  a  little  more 
clean,  but  the  suburbs  and  surroundings  were  as  finiitful 
sources  of  disease  as  ever.  There  was  no  material  dif- 
ference. We  had  had  six  successive  years  of  exemption 
in  other  times,  and  that  when  there  was  no  quarantine 
whatever.  The  fever  fixes  upon  the  healthiest  locations 
with  as  much  virulence  as  upon  the  low  regions.  Back 
on  the  Magnolia  Ridges,  looked  upon  as  the  most 
healthful  region  on  the  earth,  it  has  prevailed  with 
great  severity.  Indeed,  it  is  generally  more  destructive 
in  the  country,  when  it  occurs  there,  than  in  cities. 
But  the  character  of  the  disease  has  been  sufficiently 
written  upon,  and  I  will  confine  myself  to  a  few  points 
in  dispute. 

I.  As  to  its  etiology.  There  is  great  dispute  upon  a 
subject  one  would  suppose  might  be  reduced  to  a  mat- 
ter of  fact,  viz. :  whether  it  is  imported  or  of  local  ori- 
p^n.  The  epidemic  influence  is  certainly  not  imported 
in  ships ;  it  is  waited  through  the  atmosphere  and  takes 
a  wide  range,  confining  itself  to  no  little  narrow  place. 
It  seems  as  if  it  came  in  one  grand  wave,  and  went  * 
round  in  cycles.  We  have  exemption  for  several  years. 
It  generallv  appears  first  on  the  islands  and  in  the  ports 
of  the  Gulf.  If  it  is  late  in  the  season  we  do  not  get  it 
in  New  Orleans  that  year,  but  next  year  that  atmos- 
phere or  influence  reaches  us  with  a  good  deal  of  cer- 
tainty. In  1851  it  commenced  in  Brazil  and  on  the 
Rio,  and  progressed  regularly  northward,  taking  the 
West  India  isUnds  in  1852,  and  reaching  New  Oneans 
in  1853,  when  it  was  of  the  same  character,  virulence, 
and  severity  that  characterized  it  in  the  places  it  had 
previously  visited.  It  ran  from  one  city  to  another,  and 
along  the  Atlantic  ports  for  several  years.  In  1855  it 
reached  Memphis,  and  many  of  the  interior  towns  suf- 
fered severely.  This  year  its  history  is  worth  noticin|^. 
We  had  had  in  New  Orleans  sporadic  cases,  with  evi- 
dently no  intensity  of  the  poison.  This  was  eariy  in 
June.  When  an  epidemic  has  visited  New  Orleans  it 
has  generally  appeal  at  two  points,  above  and  below 
the  city,  where  shipping  mostly  lay,  and  where  there 
was  the  greatest  congregation  of  subjects  calculated  to 
take  the  disease,  owing  to  bad  living  and  want  of  ventila- 
tion and  proper  dormitorie&  It  usuallv  starts  from  ike 
river  and  goes  backward,  attacking  all  who  are  in  the 
vicinity.  This  year  it  did  not  begin  thus;  but  cases 
occurred  here  and  there  irregularly  in  all  sections  of  the 
city,  not  being  intense  enough  anywhere  to  affect  all 
who  were  exposed.  At  the  same  time,  the  weather 
was  such  as  favors  the  development  of  yellow  fever — 
frequent  rains  followed  by  a  hot  sun.  These  rains  fre- 
quently occurred  two  or  three  times  a  day— not  sweep- 
ing rains,  but  enough  to  keep  everything  damp,  so  that 
one's  boots  became  mouldy  while  he  was  asleep  at  night 
This  weather  lasted  the  whole  of  June  and  July,  yet 
the  fever  did  not  increase  at  all,  and  everybody  felt, 
therefore,  that  there  would  be  no  epidemic ;  for  I  should 
remark  another  thing:  when  yellow  fever  once  com- 
mences as  an  epidemic,  it  goes  on  by  a  regular  grade, — 
one  case  to-day,  two  to-morrow,  four  the  next  day,  and 
so  on  until  it  reaches  its  height,  and  then  it  declines 
pretty  much  in  the  same  ratio.  This  year,  up  to  the 
time  I  am  speaking  o^  there  had  been  nothing  of  the 
kind ;  but  after  this  state  of  things  had  continu  ed  soma 
time,  yellow  fever  appeared  on  t£e  Gulf  ooast^  coming 
from  the  direction  of  Mexico.    The 'disease^was  evi- 


THE  MEDICAL  RECORD. 


865 


dently  of  a  more  severe  character,  and  I  remarked  to 
some  one  that  there  was  an  epidemic  influence  which  I 
was  pretty  sure  would  reach  us.  The  fever  seized  on 
Indianola,  Texas,  and,  taking  other  town&  on  its  way, 
broke  out  at  length  in  great  severity  in  New  Iberia,  a 
village  about  a  hundred  miles  west  of  New  Orleans. 
/  It  was  the  more  severe  there  because  there  had  been  an 
accession  to  the  population,  in  consequence  of  recent 
drowning  out  by  overflows. 

Just  a  day  or  two  before  I  came  away  the  fever  had 
reached  New  Orleans ;  and  though  the  weather  was  un- 
&vorab]e  to  the  disease,  it  nevertheless  increased  stead- 
ily from  nine  cases  a  week  to  as  many  in  a  single  day. 
It  is  &iij  therefore,  to  infer  that  the  epidemic  which 
started  in  Texas,  on  the  Gulf  coast,  swept  on  and 
reached  us,  and  really  was  the  epidemic  we  are  no^ 
sofiering  from.  This  is  the  general  character  of  the  dis- 
ease, though  occasionally  it  will  fix  upon  a  place,  run 
its  course,  and  not  extend  further;  but  that  is  not  usual. 
It  seems  to  be  some  influence  like  influenza,  which 
sweeps  along,  affecting  almost  every  one  within  its 
reach. 

II.  The  question  of  the  contagiousness  of  yellow 
fever  is  an  important  one,  and  ought  to  be  settled.  It 
was  entirely  conceded  that  it  was  non-contagious  until 
1853,  when  the  disease  swept  over  the  land  with  such 
violence  that  everybody  thought  they  could  see  how  it 
was  carried.  Medical  men  diSer  upon  the  subject;  but 
it  is  important  to  decide  the  question,  for  many  reasons, 
especially  with  regard  to  quarantine,  and  to  the  sufifer> 
ing  persons  themselves.  Under  the  view  that  it  is 
contagious,  those  who  are  seized  are  liable  to  be 
neglected  bv  all  but  their  nearest  relatives,  and  even 
they  attend  them  with  reluctance.  I  am  perfectly 
conyinced,  beyond  all  doubt  or  hesitation,  that  person- 
ally it  is  not  contagious.  I  know  that  it  is  not  What- 
ever is  contagious  ought  to  be  tan^ble;  there  ought 
not  to  be  any  dispute  about  it  A  disease  that  is  con- 
tagioao  once  is  always  contagious.  Yellow  fever  is  the 
same  thing  in  every  place  where  it  occurs;  it  is  a 
specific  disease,  and  the  same  subject  has  it  but  once, 
and  does  not  lose  his  acclimation,  no  matter  where  he 
goes  or  how  long  he  remains  away;  but  there  are  some 
traditional  points  of  belief  on  this  subject,  and  the 
human  understanding  is  very  hard  to  convince  in  such 
cases.  We  have,  however,  abundant  opportunities  of 
proving  that  persons  never  lose  their  acclimation,  and 
never  have  the  disease  but  once.  There  are  of  course 
occasional  exceptions  to  this  rule,  as  to  all  others. 
Small-pox  is  said  to  occur  a  second  time,  though  I  have 
never  seen  it  myself  If  yellow  fever  is  contagious,  as 
contagionists  contend,  it  should  be  extremely  so,  so 
that  there  could  be  no  doubt  of  it.  They  cite  far- 
fetched instances  in  proof  of  its  contagiousness,  but 
isolated  cases  prove  nothing.  I  have  witnessed  the 
disease  on  a  large^  scale,  and  could  not  have  failed 
to  observe  it.  I  do  not  claim  to  have  been  a  close 
observer ;  but  I  have  been  an  honest  (Ae,  and  have 
endeavored  to  avoid  theorizing.  It  is  too  common  to 
form  an  opinion  or  theory,  and  then  hunt  for  facts  to 
verify  it  I  endeavored  to  have  no  opinion  beyond 
what  was  to  be  inferred  from  the  facts  before  me.  The 
first  opportunities  I  had  were  in  the  Charity  Hospital 
of  New  Orleans,  in  my  first  season  there,  in  1833.  I 
had  arrived  after  being  shipwrecked,  and  having  lost 
almost  everything.  I  found  it  difficult  to  c^et  any  place. 
I  was  merely  assistant  in  the  Charity  Hospital  The 
epidemic  was  very  severe  for  the  number  or  the  popu- 
lation]. The  fever  commenced  in  the  usual  manner, 
toward  the  river,  and  spread  backward  gradually, 
street  by  street  The  Charity  Hospital  was  then  back 
on  the  confines  of  the  swamp.    You  could  shoot  duck. 


fix)m  the  walla  The  fever  did  not  really  prevail  there. 
The  poor  inhabitant",  living  in  little  cheap  houses  in  the 
vicinity  of  the  hospital,  escaped  the  yellow  fever,  and 
none  except  the  male  portion,  who  worked  in  other 
parts  of  the  city,  were  affected  by  the  disease.  This  I 
was  aware  of  from  having  attended  them  personally. 
It  would  appear  that  the  hospital  itself  was  not  the 
seat  of  this  poisonous  influence.  The  hospital,  there- 
fore, and  those  who  stayed  in  the  hospital,  were  more 
exempt  from  fever  than  those  outside.  The  hospital 
became  crowded,  because  there  were  so  many  strangers 
in  the  city  who  had  no  firiends,  that  the  directors  gave 
orders  to  receive  all  who  came.  The  accommodation 
was  inadequate.  The  servants  were  sick,  and  none 
could  be  hired.  The  consequence  was  that  the  hospital 
became  filthy ;  the  passages  were  often  filled  up  with 
bedsacks  covered  with  excrement,  black  vomit,  etc. 
So  much  of  this  filth  accumulated  that  it  generated  a 
low  house  fever  of  a  peculiar  character,  something  like 
jail  fever,  the  patient  having  a  dry  black  tongue,  with 
Bordes  on  the  teeth,  and  falling  into  a  dull  lethargic 
Qondition,  from  which,  however,  they  recovered  rapidly 
under  the  use  of  stimulants.  People,  therefore,  actually 
became  sick  from  the  filth  of  yellow  fever,  ana  escaped 
yellow  fever  itself,  simply  because  the  hospital  was 
situated  at  a  point  where  the  atmospheric  influence  did 
not  prevail  I  was  there  all  the  time,  and  did  not  take 
the  fever  until  the  28th  September.  I  was  with  the 
fever;  I  dissected  everything  (I  handled  the  corpses, 
and  had  lifted  out  ten  bodies  tlie  day  I  was  taken)  in 
order  to  discover  if  possible  some  facts  that  would 
suggest  proper  remedies,  for  the  disease  was  treated 
abdominably.  In  1853  three  hundred  cases  of  yellow 
fever  were  treated,  in  the  Charity  Hospital  and  in  my 
infirmary  back  of  the  city,  by  some  ten  or  twelve 
sisters  of  charity,  all  of  whom  were  unacclimated.  Yet 
these  sisters  were  the  last  persons  in  the  house  to  take 
the  fever,  simply  becaus  *  the  atmospheric  influence  did 
not  prevail  there.  In  1847  I  had  two  young  men  as 
assistant  house  surgeons  in  the  hospital  with  yellow 
fever,  and  they  were  the  two  last  cases  that  took  the 
disease,  though  they  had  been  over  it  all  the  time.  At 
the  time  they  took  it  there  were  no  other  cases  in  the 
hospital  In  1853  and  1854  there  was  one  nurse  in  the 
Charity  Hospital  who  lived  there  during  the  whole 
time,  and  did  not  go  out  In  the  winter  of  1854  he  left 
the  hospital  for  other  purposes;  and  in  1855  he  was 
one  of  the  first  cases  brought  in  with  yellow  fever,  and 
died  with  black  vomit  That  is  only  an  isolated  case,  but 
I  merely  mention  it  In  1859  a  ship  came  in  from  a 
German  port  with  three  hundred  emigrants  on  board, 
of  the  better  class,  and  yeDow  fever  among  them.  They 
had  sailed  on  the  south  side  of  Cuba  and  got  the 
disease  away  out  at  sea,  where  it  would  be  difficult  to 
quarantine  it.  They  had  been  becalmed  in  that  hot 
region.  Some  forty  of  these  subjects  were  brought  to 
Charity  Hospital  and  placed  indiscriminately  along  with 
numbers  of  other  unacclimated  persons.  The  disease 
ran  its  course,  and  a  large  number  of  the  forty  died,  but 
not  a  solitary  case  took  it  in  the  house.  These  are 
instances  which  occur  on  a  large  scale.  Nobody  will 
pretend  to  say  you  can  place  forty  cases  of  the  mis- 
named Irish  typhus,  or  ship  fever,  among  other  patients 
without  some  of  the  others  taking  iL  though  that 
disease  requires  some  little  exposure.  They  would  get 
•  it  with  us,  but  the  disease  would  not  stay  with  u? ;  it 
soon  ran  out,  and  was  not  disposed  to  spread  as  it  does 
in  northern  cities.  But  we  have  instances  continually 
in  New  Orleans  to  prove  the  non-contagiousness  of 
yellow  fever.  In  tlie  beginning  of  epidemics,  when  • 
the  disease  is  located  in  the  lower  part  of  the  city, 
cases  occur  of  men  taking  the  fever,  ai|d  being  brought 
digitized  by ^ „      ^_ 


366 


THE  MEDICAL  RECORD. 


away  and  treated  in  healthy  parts  of  the  city.  In  such 
cases  nobody  takes  the  disease  from  these  persons.  In 
1B56  and  1857  yellow  fever  occurred  in  the  city,  and 
was  strictly  confined  to  about  six  squares ;  and  though 
the  poison  was  evidently  potent,  there  were  no  cases 
outside.  They  were  very  anxious  to  prove  that  it  was 
imported,  but  these  casts  had  had  no  connection  what- 
ever with  anything  that  came  into  the  port.  It 
originated  there.  Forty  cases,  I  think,  were  brought 
to  Charity  Hospital,  and  I  traced  them  all  to  this 
region.  It  was  my  habit  to  find  out  whence  each 
case  came,  and  all  these  cases  could  be  traced  directly  to 
this  region,  limited  to  six  squares.  Nobody  else  took 
it  from  the  cases  brought  us,  nor  did  any  new  points  of 
infection  occur.  But  it  is  strange  how  easily  the 
human  mind  is  convinced  upon  a  subject  when  it  wants 
to  be  convinced.  After  the  epidemic  of  1853  I  went 
into  the  country,  and  thought  I  would  make  inquiries 
from  the  common  people  who  had  no  prejudices.  I 
found  them  about  equally  divided,  each  having  made 
up  his  opinion  from  what  he  had  seen.  One  had  had  a 
case  brought  into  his  house,  and  nobody  took  the  fever 
from  it;  but  he  had  seen  cases  where  overseers  had 
gone  back  of  the  plantations  to  escape  it,  and  had 
there  taken  it.  There  was  one  favorite  instance  cited 
among  them,  of  a  family  living  in  the  "  Piney  Woods," 
of  six  men,  the  father  and  five  sons.  One  got  the 
fever,  and  all  took  it  from  him,  and  all  died.  I  did  not 
take  any  pains  to  argue  with  them,  for  you  will  find 
the  most  diflScult  people  to  argue  with  are  those  who 
do  not  know  anything  about  the  subject.  I  finally 
asked  an  intelligent  man,  "Pray,  where  did  the  first 
one  get  it  ?"  Said  he :  "  The  first  one  had  gone  to  the 
banks  of  the  river,  and  was  standing  on  the  high  bluff 
when  a  steamboat,  having  yellow  fever  on  board, 
passed  up,  and  he  took  it."  Now,  I  visited  the  place, 
and  the  spot  where  he  stood  was  three-quarters  of  a 
mile  from  where  the  steamboat  passed  him  in  going  up ; 
80  if  he  took  it  in  that  way,  it  would  argue  conttigion 
beyond  all  doubt.  But  many  persons  make  up  Uieir 
minds  from  instances  just  as  far-fetched  as  this.  I 
mention  these  circumstances,  which  have  convinced  me 
that  yellow  fever  is  not  personally  contagious.  How 
far  its  atmosphere  may  go,  or  how  much  atmosphere 
bottled  up  or  carried  in  a  ship  may  contain  poison 
enough  to  give  it  to  a  person  who  may  be  so  unlucky 
as  to  breathe  it,  I  cannot  say.  I  have  (bought  a  ship 
might  become  charged,  and,  with  the  hatches  closed, 
might  contain  enough  poison  to  communicate  it  by 
inhalation.  This  is  not  an  unreasonable  supposition, 
but  I  do  know  that  the  fever  patients  them-elves,  and 
the  filth  that  accumulates  around  them,  do  not  generate 
the  di^ase.  So  far  as  the  theory  of  its  being  carried  by 
ships  is  concerned,  it  would  be  well  to  inquire  into  the 
condition  of  ships  coming  from  infected  ports ;  but  in 
case  of  its  being  communicated  that  way,  it  is  certain 
that  it  would  go  no  fiirther  than  the  individuals  who 
went  on  board  that  ship  and  breathed  that  atmosphere. 
HI.  The  disease  itself  varies  in  the  manner  of  its  at- 
tack. The  most  favorable  attacks  are  those  where  it  is 
ushered  in  at  once  with  marked  and  prominent  symp- 
toms ;  where  the  patient  is  taken  with  rigor  (not  a 
violent  chill),  followed  immediately  by  pains  in  the 
limbs,  bdfck  and  head^  with  reaction,  heat  of  the  skin, 
and  fever.  But  in  a  great  many  of  the  cases  the  attack 
is  insidious,  accompanied  by  a  kind  of  energy  which 
enables  the  patient  to  be  up,  though  he  has  a  little  rigor 
and  aching  in  the  limbs.  He  keeps  about  a  day  or  two  : 
but  the  disease  is  making  its  progress  in  the  blood  all 
the  time,  so  that  when  a  physician  comes  the  pati<  nt 
says  he  has  been  sick  two  hours,  when  he  has  really 
been  sick  two  days.    While  the  patient  is  moving  about, 


the  poison  causes  more  fearftil  ravages  upon  the  system 
than  when  he  is  quiet ;  and  that  is  why  those  cases  are 
more  favorable  where  the  disease  is  ushered  in  briskly 
at  once.  Tfee  physician  is  more  likely  to  see  them  at 
the  beginning,  and  the  patient  is  more  likely  to  adopt 
proper  measures.  That  is  the  reason  the  disease  is  so 
troublesome  now.  A  large  proportion  of  the  cases  oc- 
cur among  strangers,  who  have  nobody  to  coerce  or 
take  care  of  them,  or  direct  them.  Many  of  the  cases, 
as  virulent  as  they  would  appear  to  you,  are  mild, 
though  the  mild  cases  are  just  as  sure  to  kill  as  any 
others ;  and  almost  all  will  prove  fatal  unless  the  patient 
is  managed  properly  and  kept  quiet.  Take  a  plain 
common  case — that  is  ushered  in  at  once  with  rigor,  and 
pains  in  back,  head,  and  Umbs.  There  is  sometimes 
^80  capillary  engorgement,  particularly  noticeable  in 
the  eye,  though  it  is  not  that  conjunctival  engorgement 
frequently  seen,  but  a  redness  of  the  vessels  of  the  eye 
which  is  not  seen  in  any  other  fever :  and  in  the  same 
proportion  will  you  also  see  a  pecuuar  redness  of  the 
skin.  That,  however,  cannot  be  said  to  be  character- 
istic ;  but  you  otlen  see  it  If  the  patient  is  placed  in 
bed  and  under  favorable  circumstances,  he  is  disposed 
to  go  into  a  sweat,  as  after  a  common  chill  of  inter- 
mittent. This  affords  some  relief,  but  not  much.  The 
pains  continue,  and  if  the  case  is  a  favorable  one,  the 
sweating  will  go  on  until  that  and  the  heat  subside  to- 
gether, provided  the  patient  is  kept  perfectly  quiet. 
Then,  if  he  is  nourished,  he  will  rally  and  suffer  no  more 
than  the  one  paroxysm.  Three  days  is  the  most  com- 
mon period.  In  the  course  of  the  third  day  the  fever 
leaves,  and  the  patient  is  then  in  a  favorable  condition. 
It  is  then  essential  to  nourish  him.  He  ought  not  even 
to  raLse  his  head  from  the  pillow  until  his  blood  has 
been  renewed.  The  effect  of  this  poison,  whatever  it 
is,  is  such  upon  the  blood  that  it  alxost destroys  it;  and 
if  the  patient  is  allowed  to  get  up,  a  faintness  comes 
over  him,  perhaps  accompanied  by  nausea,  and  some- 
times, the  whole  process  of  the  disease  is  renewed. 
With  faintness,  and  a  loathing  for  food,  the  patient  gen- 
erally dies  with  great  certainty,  when  he  would  be 
perfectly  safe  if  kept  quiet  and  nourished.  This  is  the 
course  of  favorable  cases. 

IV.  The  treatment  of  such  cases  is  simple.  With  re- 
gard to  purgatives,  they  do  not  want  them.  There  is 
too  much  disposition  to  purge  patients.  If  the  pa- 
tient has  been  eating  recently,  and  has  ingesta  on  the 
stomach,  it  may  be  desirable  to  evacuate  it  from  fear  of 
fermentation,  and  consequent  irritation.  A  little  oil 
will  act  easily,  and  be  effective,  if  taken  four  or  five 
hours  after  meals.  If  the  bowels  are  constipated,  a 
simple  injection,  to  evacuate  the  lower  bowel,  is  all  that 
can  be  useful  Then  let  the  patient  alone,  and  never  let 
him  get  out  of  bed  until  he  has  been  thoroughly 
nouriSied.  If  I  see  them  in  the  beginning  of  a  case 
that  is  ushered  in  suddenly,  as  soon  as  there  is  any  per- 
spiration I  give  a  frill  dose  of  quinine,  The  effect  is 
remarkable.  There  is  no  doubt  about  its  value  at  this 
time.  It  quiets  all  those  pains  as  completely  as  in  a 
ca?e  of  neuralgia:  it  checks  the  rigor  and  promotes 
perspiration,  and  ii  you  manage  them  carefully  they  will 
go  on  sweating,  and  there  will  be  no  return  of  the  fever. 
I  used  sometimes  to  give  a  smaller  dose  of  quinine 
next  day.  I  do  nothing  else,  but  regulate  the  drinks. 
There  is  nothing  more  to  be  done.  There  is  no  pathol- 
ogy visible :  there  is  no  organic  disease ;  nothing  to  be 
found  by  tne  dissecting-knife.  There  is  simply  this 
condition  of  blood,  whicn  is  shown  later  by  discoloration 
of  the  skin.  The  pains  in  the  head  and  back  induce 
many  to  make  ice  applications.  I  do  not  think  they  do 
any  good,  but  on  the  contrary  a  good  deal  of  harm.  If 
you  once  make  the  application,  and  it  is  left  off  for  a 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


867 


moment,  reaction  comes  on,  and  the  pain  is  intense. 
If  you  do  not  put  ice  on  at  all,  the  patients  complain 
very  liitle.    My  patients  very  seldom  complain  of  pain. 
Once  having  applied  ice,  you  must  keep  it  constantly 
there  during  the  whole  course  of  the  disease,  and  even 
afterward,  and  I  believe  they  suffer  a  great  deal  less  if 
you  do  not  use  it  at  alL    Cups  have  been  very  much 
used  at  times.     Some  men  wno  adopted  this  plan  of 
treatment  made  quite  a  handsome  fortune  during  the 
yellow  fever  season.    Everybody  had  to  be  cupped,  on 
the  stomach,  back,  and  behind  the  mastoid  processes. 
There  is  no  advantage  in  losing  blood  unless  the  patient 
is  plethoric;  then  he  may  have  a  little  surplus  blood 
taken,  perhaps  with  advantage.    As  for  applications  of 
mustard,  I  6nd  the  less  the  patient  is  disturbed  the 
better ;  but  sometimes  a  sinapism  over  the  back  relieves 
them  in  a  remarkable  degree.    You  can  reapply  it  as 
often  as  you  please.    The  same  application  to  die  back 
of  the  neck  will  relieve  the  pain  there,  and  is  almost 
always  more  or  less  valuable.     The  matter  of  nausea  is 
of  the  first  importance.     Until  they  are  nourished  they 
cannot  ^et  up  wiih  safetjr,  even  though  they  have  had 
a  very  hght  attack.    I  give  any  nourishing  drink  they 
can  take  oHen  during  the  disease ;  and  they  will  bear 
stimulants  in  almost  any  stage,  if  they  crave  them. 
There  is  a  peculiarity  in  the  stomach  of  the  yellow  fever 
patient:  he  will  retain  anything  he  Ukes,  and  reject 
almost  anything  that  is  unpleasant.     I  would  not  incul- 
cate the  idea  that  they  need  stimulants  during  the  dis- 
ease, but  it  may  be  given  w:hile  the  fc  ver  is  on ;  and  you 
will  find  the  local  symptoms  are  not  aggravated  by  stim- 
ulants when  the  general  condition  requires  them.    Those 
who  have  been  accustomed  to  stimulants  will  some- 
tiraes  take  them  while  they  have  fever.     I  usually  allow 
just  what  they  crave ;  and  they  will  take  brandy  when 
they  have  fever,  and  the  skin  wiU  become  moist  under 
it,  and  the  pulse  slower ;  though  I  should  remark  that 
the  pulse  is  not  generally  very  frequent,  and  seems  to 
have  a  good  deal  of  force.    There  is  generally  some 
uniformity  of  the  taste  in  craving  stimulants.     Some 
years  they  generally  crave  malt  Uquor,  as  good  Scotch 
ale;  other  years  champagne,  and  other  seasons  brandy; 
and  it  can  always  be  administered,  even  during  fever, 
if  there  is  a  sinking   condition  with  disposition   to 
K^.    After   the   fever  has  subsided,  you   can  give 
i&m  malt  liquor.    I  prefer  it  if  the  patient  likes  it. 
Then  they  wUl  very  soon  rally,  and  any  solid  animal 
food   or  oV  er  proper  nourishment  may  be  given.    If 
the  patient,  from  any-  cause,  is  not  inclined  to  take 
nourishment,  it  is  always  advisable  to  give  it  by  injec- 
tion.    The  rectum  will  absorb  it    I  have  fed  cases  in 
this  way,  and  they  have  rallied.     Any  way  to  get  nutri- 
ment  into    the    system.    If  you  do  not  administer 
nourishment  in  time,  the  patient  will  loath  it^  and  you 
-Will  then  find  it  difficult  to  nourish  him  it  all.    It  does 
not  take  much  to  answer  the  purpose ;  convalescence  is 
rapid,  and  they  wUl  soon  get  up  and  go  about  their 
busine-8.     This  is  only  in  the  favorable  cases.    In  pa- 
tients who  knock  about  and  are  imprudent,  the  fever 
-wSi  run  five  or  six  days,  the  skin  becomes  dry  and  hot, 
and  it  is  useless  to  attempt  to  promote  perspiration.     I 
would   remark  that   the  sweating  is  often  overdone. 
Patients  are   kept    sweating  under  blankets  in   hot 
•weather  until  it  oppresses  them.    You  may  carry  a 
proper  course  of  treatment  to  excess.    The  idea  is  to 
keep  the  patient  covered  and  perspiring  without  carry- 
ing it  to  excess;  but  if  you  pass  this  stage,  and  the  hot 
Bthse  comes  on,  this  will  run  five  days :  the  patient  will 
ffeel  perfectly  well,  and  then  there  will  come  on  a  re- 
lapse, and  black  vomit  follows.    Some  use  cold  baths ; 
but  the  less  the  patient  is  disturbed  the  better,  so  I 
prefer  sponging  quietly.    There  is  a  singular  sense  of 


exhaustion,  and  I  always  consult  the  patients  with  re- 
gard to  the  use  of  water.  The  patient  will  generally 
convalesce  in  the  same  manner  when  the  disease  ter- 
minates on  the  third  day ;  but  you  have  to  watch  care- 
fully, for  you  can  sometimes  anticipate  symptoms,  and 
give  medicine  for  what  is  going  to  be. 

You  will  perhaps  observe  the  patient  becoming  rest- 
less, and  he  will  tell  you  he  has  a  little  burning  in  his 
stomach,  and  then  you  know  that  he  is  progressing  tow- 
ard black  vomit.  Muriatic  acid  is  about  to  be  formed  in 
the  stomach,  and  you  may  anticipate  it.  The  best 
remedy  I  have  found  to  be  small  quantities  of  bicar- 
bonate of  soda  and  morphia — about  one-fourth  of  a 
grain  of  the  latter  in  a  four-ounce  mixture  with  a  little 
soda,  of  which  mixture  teaspoonful  doses  may  be  given. 
It  is  remarkable  how  susceptible  they  are  to  opium,  and 
by  the  soda  the  acid  is  neutralized.  In  the  way  oi  nu- 
triment, beef-tea,  either  by  the  stomach  or  by  iniection, 
is  of  great  value.  If  you  can  wear  the  patient  through 
this  stage  he  wifl  ^et  well,  while  he  would  die  with  per- 
fect certain tt  but  for  these  Uttle  things.  It  is  the  judi- 
cious use  of  \ittle  things  that  saves  him.  People  gen- 
erally think  it  is  a  mighty  disease,  and  wants  mighty 
medicines  —  great  things  to  tear  them  all  to  pieces. 
When  I  firstwent  to  New  Orleans,  sixty  grains  of  calo- 
mel was  the  ordinary  dose ;  and  they  often  liked  to  give 
more.  Some  used  to  carry  it  in  their  pockets,  and  hav- 
ing given  as  much  as  they  dared,  they  colored  it  with 
charcoal ;  but  it  was  calomel  to  tne  end,  and  it  was  re- 
markable that  some  of  the  patients  got  wcllj  tool 
Another  feature  of  the  disease  is,  that  when  it  is  ush- 
ered in  with  rigor  the  patient  is  a  Uttle  delirious.  That 
is  not  significant  in  the  fever,  but  shows  a  degree  of 
enervation  if  it  comes  on  later.  It  is  one  of  the  condi- 
tions yon  should  anticipate.  The  patient  may  discover 
a  disposition  to  this  aberration,  which  you  may  treat  by 
a  simple  anodyne  and  stimulant,  and  thus  prevent  sub- 
sequent delirium.  When  it  once  sets  in  it  is  like  mania 
a  potu,  and  is  unmanageable ;  the  patient  exhausts  him- 
self if  you  do  not  give  anything,  and  if  you  do,  he  goes 
into  coma  and  dies;  so  you  must  observe  the  symp- 
toms in  season.  It  is  that  nice  observation  which  ena- 
bles one  to  take  advantage  of  little  things  and  prevent 
serious  mischief.  I  look  upon  a  patient  with  yellow 
fever  as  a  perfectly  irresponsible  being ;  he  talks  to  you 
reasonably,  but  he  is  a  crazy  man;  he  is  completely 
perverted:  he  will  get  up ;  he  will  say  he  has  no  fever; 
he  will  talk  quite  rationally,  except  that  he  is  a  little 
more  susceptible,  and  disposed  to  be  argiunentative,  and 
it  is  difficult  to  make  him  obey.  It  is  for  that  reason 
the  disease  is  so  destructive  now,  and  always  among 
strangers.  It  is  strange  what  a  difference  there  is  in 
favor  of  a  patient  in  a  family  wh-  re  there  is  a  sensible 
matron  to  take  care  of  him.  Ten  such  cases  will  give 
less  trouble  than  one  elsewhere.  She  sees  the  begin- 
ning of  the  disease,  and  prevents  patients  from  going 
out  till  your  next  visit,  when  she  tells  you  quietly  there 
is  another  case.  Yellow  fever  patients  are  apt  to  labor 
under  a  misapprehension  as  to  themselves.  There  is  a 
sort  of  exhilaration  that  gives  them  a  don't-care  feel- 
ing ;  they  are  sure  to  think  they  have  some  important 
business  to  attend  to  and  must  go  out,  but  they  cannot 
tell  you  what  it  ii  if  you  ask  them.  That  is  one  cause 
of  the  fatality  of  tlie  disease.  It  works  upon  the  sys- 
iAjfx  with  much  more  severity  while  the  patient  is 
knocking  about.  1  have  met  them  walking  on  the 
sunny  side  of  the  street  buttoned  up  to  keep  warm. 
They  perhaps  get  chilled,  and  are  picked  up  in  a  stu- 
por. They  cannot  be  advised  or  restrained.  This  is 
true  of  those  who  have  been  staying  there  on  purpose 
to  become  acclimated.  They  feel  so  well  after  the  fever 
subsides,  that  they  cannot  be  induced  tp-^tay  in  bed  I 
Digitized  by  VjOOQIC 


368 


THE  MEDICAL  RECORD. 


have  known  the  fever,  under  quinine,  to  disappear  in 
twentj-four  hours.  But  if  they  get  up,  having  taken, 
perhaps,  fifteen  or  twenty  grains  of  quinine,  they  can- 
not walk  across  the  floor;  But  will  faint  and  fall,  if  the 
fever  has  gone.  Yet  you  will  find  great  difficulty  in 
keeping  ?uch  a  one  in  bed.  Of  course,  those  left  to 
themselves  will  get  up,  have  a  relapse,  and  die  in  the  end 

There  is  little  more  to  be  said  in  regard  to  treatment. 
Purffing  is  to  be  avoided,  though  it  is  remarkable  how 
much  violent  treatment  patients  will  bear.  If  they  have 
a  fair  chance  otherwise,  two  out  of  three  will  get  well 
under  very  harsh  treatment.  I  took  occasion  when  I 
had  command  of  a  hospital  to  make  a  comparison.  We 
had  about  six  visiting  physicians  in  the  house,  and  all 
had  some  favorite  mode  of  treatment — all  more  or  less 
perturbating  and  active.  Each  one  boflsl^  of  Ms  suc- 
cess. I,  having  charge,  ordered  that  patients  should  be 
sent  in  rotation  with  the  utmost  strictness,  so  that  each 
physician  should  have  about  an  equal  number  of  good 
and  bad  cases.  I  happened  to  have  four  wards  myself, 
and  at  the  end  of  the  month  I  found  by  the  report  that 
the  several  physicians  had  results  just  about  the  same, 
once  in  a  while  a  case  or  two  being  in  favor  of  one  or 
another ;  whatever  perturbating  treatment  was  used,  it 
made  no  difference,  but  there  wa^  a  difference  of  ten  per 
cent,  in  favor  of  letting  them  alone,  and  simply  manag- 
ing them  on  the  principles  I  have  mentioned  to  you. 
Any  one  would  like^  in  a  case  of  life  and  death,  to  have 
the  ten  per  cent  advantage.  I  should  mention  that  cases 
were  sent  to  my  ward  the  same  as  to  the  others,  and  I 
had  no  object  but  to  get  at  the  facts.  There  is  a  curi- 
ous disposition  in  people  to  think  they  are  getting  the 
fever  when  they  are  not,  and  when  they  do  get  it  they 
will  not  believe  it,  and  will  commit  imprudences  that 
favor  the  progress  of  the  poison.  I  should  say  further 
of  the  use  of  quinine,  that  I  have  never  known  any  one 
to  use  it  as  it  should  be  used.  I  never  give  it  but  at 
the  outset  of  the  disease,  just  as  the  rigor  has  passed 
off,  and  the  fact  that  it  relieves  pain  shows  it  to  oe  use- 
ful It  promotes  perspiration,  and  prolongs  the  sweat- 
ing stage.  A  larger  number  of  cases  under  quinine 
will  terminate  the  hot  and  sweating  stages  togeUier,  so 
that  you  resolve  it  into  one  paroxysm,  and  that  a  short 
one,  and  less  likely  to  return.  Without  quinine  the 
fever  is  more  likely  to  return  and  render  the  case  dazf- 
gerous. 

I  cannot  insist  too  much,  in  conclusion,  on  the  total 
rresponsibihtjr  of  the  patient,  and  the  great  importance 
of  keeping  him  quiet  by  gentle  means,  and  without 
rendering  him  impatient.  Force  would  only  do  mis- 
chief. I  recollect  the  captain  of  a  ship  (and  they  are 
generally  a  litUe  imperious),  who  was  my  patient,  and 
was  doing  wonderfully  well  one  nij?ht  when  I  left  him, 
but  who,  on  my  vi  it  next  day,  had  defied  the  nurse  and 
driven  her  out  of  the  room.  He  was  then  beginning 
to  gulp,  and  was  going  rapidly  toward  black  vomit  I 
took  him  by  the  shoulder,  laid  him  down,  and  told  him 
seriously  I  would  cut  his  throat  if  he  turned  right  or 
left  before  I  returned.  He  was  alarmed,  obeyed  me, 
and  got  well,  and  used  aft>erward  to  laugh  over  it,  say- 
ing he  was  firmly  impressed  with  the  idea  that  I  would 
really  do  as  I  threaten-  d  if  he  disobeyed.  This  shows 
the  peculiar  condition  of  the  mind,  for  he  could  con- 
verse rationally  at  the  time. 

I  will  only  add  that  nothing  is  to  be  gained  by  deple- 
tion, and  that  I  have  had  cases  where  the  bowels  w^e 
unmoved  for  six  days,  and  that  yet  did  well.  It  is  bet- 
ter to  avoid  all  causes  of  exhaustion,  even  that  attend- 
ant on  the  use  of  the  bedpan. 

Velpeau's  last  words:  II  faut  toujours  travaiOwr^ 
VM»  amw. 


llq)0rt»  0f  S0ctctit«* 


NEW  YORK  ACADEMY  OF  MEDICINE. 

Stated  Meeting,  October  2, 1867. 

Dr.  Henrt  D.  Bitlklby,  Vice-President,  in  the  Chair. 

TSA-TSIN,  or  THB  RHTN008A  BXOAVATA,  AS  AN 
■MHENAGOOUS. 

Dr.  Prince  presented  a  very  interesting  report  con- 
cerning the  above  agent,  in  the  coarse  of  which  he 
recited  fifty-five  cases  in  which  the  drug  had  been  ex- 
hibited. Twenty-six  of  these  occurred  in  his  own 
practice.  He  proved  that  this  Chinese  remedy  had 
attracted  the  attention  of  some  of  the  profession  in  Eng- 
land some  sixteen  years  ago,  but  since  then,  strangely 
enough,  had  fallen  into  disuse,  so  that  now  it  was  gen- 
erally regarded  as  a  discovery.  It  had  also  been  em- 
ployed by  German  physicivi^.  The  Doctor  exhibited 
a  specimen  of  the  article  furnished  by  its  importer,  Mr. 
Albert  Dung ;  this  was  in  a  coarse-grained  powder,  of 
an  olive-green  hue,  and  the  form  best  adapted  for  its 
exhibition  he  found  to  be  a  decoction  of  a  strength  re- 
presenting from  3  j.  to  3  iij.  of  the  powder. 

The  article  was  entirely  harmless,  was  not  an  abor- 
tive, but  acted  as  a  sedative  upon  the  uterine  ^stem, 
and  proved  its  specific  action  by  increasing  the  men- 
strual flow. 

The  experience  of  all  the  gentlemen,  however,  who 
had  tested  this  agent  was  not  uniform,  nor  as  satisfiic- 
tory  as  that  of  the  rej)orter. 

Dr.  Chamberlain  yave  the  details  of  three  cases — in 
one  of  which  he  had  meffectually  exhibited  3  i^.  for  five 
days — in  the  other  two  the  results  were  negative. 

Dr.  Hubbard  had  hardly  given  this  emmenagogue  a 
fair  trial ;  but  in  his  solitary  instance  had  employed  3  iv. 
prepared  after  Mr.  Dung's  directions,  and  with  no  more 
success  than  the  last  speaker. 

Dr.  Prince,  in  reply  to  a  query  by  Dr.  Bulkley,  had 
found  that  the  samples  had  varied  in  strength  and  ex- 
cellence. 

Dr.  Harris,  in  view  of  the  fact  a;  stated  by  Dr. 
Prince,  that  no  chemical  analysis  had  as  yet  been  made, 
oflTered  the  following,  which  was  unanimously  adopted : 

Reaolvedj  that  Dr.  E.  R.  Squibb,  of  Brooklyn,  be  re- 
quested to  examine  this  drug,  and  that  he  report  to  this 
Academy  at  his  earliest  convenience. 

He  thought  that  the  alkaloid  of  Tsa-Tsin,  if  it  had 
any,  might  possibly  be  discovered  in  this  way,  and  with 
it  the  profession  might  experiment  more  satisfactorily. 

Aft^r  a  recital  by  Dr.  Harris  of  certain  remarkable 
cases  of  anomalous  fever  which  had  occurred  in  the 
vicinity  of  this  city,  and  which  are  now  being  investi- 
gated, the  Academy  adjourned. 

MEDICAL  SOCIETY  OF  THE  COUNTY  OF 

NEW  YORK. 

Stated  Meeting,  Sept.  2,  1867. 

Dr.  Samuel  T.  Hubbard,  President,  in  the  Chair. 

THE  public  health. 

Dr.  Dunster,  as  Secretary  of  the  Committee  on  Dis- 
ease?, read  the  report,  which  embraced  a  period  of 
thirteen  weeks,  ending  August  24th,  ult.  The  average 
weekly  mortality  (51$  during  this  time  was  less  than 
the  corresponding  weeks  of  the  previous  year,  and 
exhibited  an  actual  decrease  of  sixty-four  deaths.  This 
was  accounted  for  by  the  absence  of  any  epidemic,  and 
the  favorable  meteorological  and  sanitary  condition  of 
the  city. 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


869 


Tbe  zymotic  diseases  constituted  in  June  twenty-nine 
per  cent,  in  July  forty-two  per  cent,  and  in  Augpist 
forty-seven  per  cent  of  the  entire  mortality — ^in  this 
class,  diarrhosal  diseases  were  the  most  destructive. 
During  this  period,  however,  cholera  claimed  only  eight- 
een victims,  aeainst  834  of  the  previous  year.  Scarlatina 
and  rubeola  have  been  quite  prevalent,  the  mortality 
from  the  latter  disease  averaging  during  the  entire  sum- 
mer twenty  per  week. 

The  tubercular  diseases  show  the  unfavorable  effect 
of  extreme  and  prolonged  heat — since  in  August  the 
death-rate  was  equal  to  a  figure  attained  during  the  in- 
clement weather  of  Februarv  and  March.  On  ue  other 
hand,  the  mortality  ascribable  to  pneumonia  and  bron- 
chitis had  inversely  declined. 

During  the  thirteen  weeks,  237  inches  of  rain  fell, 
which,  as  it  washed  away  vast  amoimts  of  filth,  ex- 
erted a  beneficial  effect  This,  however,  would  not  have 
been  the  case  if  the  city  had  an  absorbing  and  retentive 
surfiice  soil  in  lieu  of  an  extended  and  perfect  drainage. 

PAPEBS  READ. 

Dr.  Notes  read  a  paper  entitled  "  Recent  Modifica- 
tions of  the  Operation  for  Cataract,  and  their  Results." 
This  was  statistical  in  character,  and  contrasted  the 
different  results  as  obtained  by  the  ancient  and  by  the 
modem  methods.  He  clearly  proved  that  the  recent 
plana  of  treatment  were  much  the  more  successfiil. 

Dr.  Thoms  followed  with  a  plan  for  the  registration 
of  atmospheric  changes,  adapted  to  the  exhibition  of 
their  influence  upon  disease  and  mortality. 

THE  ANNUAL  OOEXATIOV. 

The  President  announced  that  the  next  meeting  of 
the  Society  would  be  its  anniversary,  on  which  occasion 
the  annual  election  would  be  held.  He  also  stated  that 
the  annual  collation,  which  embraced  within  its  plan 
a  general  reunion  of  the  profession,  would  be  haa  on 
or  about  that  time,  and  appointed  the  following  gentle- 
men a  committee  of  arrangements  to  carry  out  the 
purposes  of  the  Society :  Drs.  Wm.  B.  Bibbins,  Ells- 
worth Eh'ot,  James  L.  Brown,  Jerome  0.  Smi^  John 
Shrady,  H.  M.  Brush,  Wm,  B.  Lewis,  and  Wm.  T. 
White. 

The  Society  then  adjourned. 


EAST  RIVER  MEDICAL  ASSOCIATION. 

Stated  Meitino,  Sept.  3,  1867. 
Dr.  Yerranus  Morse,  President,  in  the  Chair. 

THE  DECEASE  OF  DR.  JOHN  HART. 

Dr.  T.  Nichols  reported  resolu  ions  of  condolence  upon 
the  decease  of  Dr.  John  Hart,  a  former  President  of  the 
Association,  which  were  ordered  to  be  published  in  the 
medical  journals  of  this  city. 

Dr.  Morse  ^)oke  in  eulogistic  terms  of  the  deceased, 
and  gare  an  account  of  his  last  ilness,  together  with 
many  incidents  of  his  life. 

UNAUTHORIZED  REPETITION  OF  PHTSI0IAN8*  PRESORIPTTONS. 

Db.  John  Shradt  presented  the  following,  which  was 
adopted : 

JtUmjlvtdy  that  in  view  of  the  meeting  of  the  American 
Pharmaceutical  A>«ociation  on  the  loSi  inst.^  it  is  emi- 
meaUy  proper  that  the  action  of  this  Association  reg^oxl- 
ing  the  unauthorized  use  of  physicians*  prescriptions  by 
apothecaries  be  referred  to  the  former  body. 

GRADUATES   OF    AMERICAN    MEDICAL    COLLEGES,   AND    THI 
GERMAN  80CIBTT  OF  NIW  TORK. 

De.  Brices  introduced  the  following,  which  were 
also  adopted : 


Whereas^  it  has  been  represented  that  the  (German 
Society  of  the  City  of  New  York  have  resolved  that  no 
graduate  of  an  American  Medical  CoUe^  shall  be  ap- 
pointed to  the  position  of  District  Physician,  therefore 
be  it 

Eeiohed,  that  the  Association,  through  their  commit- 
tee, ask  for  information  on  said  subject,  and  respectfully 
request  the  reasons  for  said  action.  Committee,  Drs. 
Brekes,  Weisse,  and  Blume. 

Dr.  Weisse  then  read  the  report  of  the  Surgical  Sec- 
tion, in  which  he  gave  an  interesting  and  condensed 
summary  of  the  progress  of  that  department  of  science 
for  several  months  past. 

DIFFICULTIES  IN  DUGNOSIS  OF  ABDOMINAL  TUMORS. 

Dr.  0*SuLLrvAN  read  a  paper  with  the  above  caption. 
He  warned  against  a  too  great  haste  in  diagnosis,  espe- 
cially with  reference  to  tumors  in  suspicious  localities, 
and  recited  an  instance  where  a  popliteal  aneurism  was 
laid  open  instead  of  an  abcess.  This  necessitated  im- 
mediate amputation,  death  ensuing  in  a  few  days. 
^  In  regard  to  the  abdomen,  notwithstanding  the  pub- 
lication of  manv  interesting  cases  implicating  some  par- 
ticular organ  of  the  cavity,  he  was  somewhat  astoDished 
that  the  question  in  its  general  bearings  had  never  been 
discussed.  A  notable  exception,  however,  exists  in  the 
case  of  the  American  Medical  Associaiion  (see  Medical 
Record,  vol  ii.,  p.  i30),  who  have  deputized  a  committee 
to  investigate  the  subject.  For  the  putpoae  of  more 
fully  illustrating  his  views,  he  related 

A  OABB    OF  OAROINOMA  OF  THE  UVSR  OF    SIX  MONTHS* 
STANDING. 

Some  years  ago  he  was  consulted  by  S.  P.,  a  native 
of  Canton,  China,  who  first  came  to  America  in  1816,  in 
the  capacity  of  ship's  steward  or  cook.  For  the  past 
sixteen  years  of  his  life,  however,  he  kept  a  Chinese 
sailor  boarding-house  in  Cherry  street. 

He  was  married  twice ;  by  his  first  wife  he  had  no 
issue,  by  the  second  three  children,  all  of  whom  are 
living.  He  enjoyed,  for  a  considerable  time  previous  to 
his  last  illness,  excellent  health.  Some  eighteen  years 
since,  whilst  on  a  voyage  from  New  Orleans  to  this  port, 
he  met  with  an  accident  which  caused  a  severe  contu- 
sion of  the  right  side ;  owing  to  which,  on  his  arrival 
here,  he  entered  the  hospital,  where  he  remained  sev- 
eral weeks. 

.According  to  the  rather  general  custom  of  his  coun- 
trjnuen,  he  was  an  inveterate  opium  smoker,  but  during 
his  last  illness  he  practised  this  rather  moderately.  In 
other  respects,  the  history  of  the  patient,  owing  to  his 
imperfect  knowledge  of  our  language,  is  neces^urily  in- 
complete. 

When  he  first  consulted  Dr.  O'Sullivnn,  he  referred 
his  trouble  mainly  to  the  region  of  the  stomach,  where 
there  was  a  very  strong  pulsation ;  he  aLu)  complained 
of  pain  in  the  chest,  being  unable,  however,  to  focalize 
it.  He  also  suffered  fix>m  C4*nstipation,  which  had  be- 
come habitual  in  its  character.  A  careful  examination 
of  the  lungs  and  heart  revealed  nothing  abnormal 
Still  pursuing  his  investigations,  he  discovered  a  large 
tumor  in  the  epigastric  region,  below  the  diaphragm, 
and  in  a  line  with  the  transverse  colon. . 

It  presented  a  nodulated  appearance,  and  its  extent, 
he  fancied,  could  be  quite  readily  traced.  Auscultation 
ehcited  no  thrill  or  otiier  symptoms  of  aneurism.  Per- 
ci^on  elicited  dulness  over  the  entire  extent  of  the 
tumor.  The  usual  symptoms  of  carcinopia  were  ab- 
sent. It  then  occurred  to  him  that  it  might  be  a 
f»cal  accumulation;  this  seemed  the  most  probable  the- 
ory fix)m  the  history  of  the  case,  the  position  of  the  tu- 
mor, and  its  painle<(S  character.  This  idea,  also,  after  a 
&ir  trial,  he  was  reluctantly  obliged  to  reject. 

Digitized  by  VjOOQIC 


BIO 


THE  MEDICAL  RECORD. 


On  examination  of  the  tumor,  after  an  interval  of 
several  weeks,  during  which  the  patient  had  omitted  to 
call  at  his  office,  he  found  that  it  had  increased  some- 
what in  size,  also  that  it  was  a  little  tender  on  pressure ; 
in  other  respects  the  symptoms  had  undergone  no 
change.  After  a  careful  examination  by  a  physician  of 
eminence,  whom  he  had  called  in  consultation,  the  lat- 
ter inclined  to  the  belief  that  it  was  a  faecal  tumor,  but 
stated  his  opinion  with  some  reservations,  and  advised 
saline  cathartics,  to  be  followed  by  injections,  etc. 

Free  movements  of  the  bowels,  without  any  appre- 
ciable effect  on  the  tumor,  were  the  only  result  As 
this  plan  of  treatment  only  debilitated,  it  was,  with  the 
consent  of  the  consulting  physician,  suspended.  The 
patient  was  frequently  seen  during  the  month,  during 
which  time  he  complained  of  very  littie  pain  in  the 
tumor,  and  scarcely  any  irritation  of  the  stomach;  he 
could  retain  his  food  very  well,  though  his  appetite  was 
somewhat  fickle ;  occasionaDy,  too,  the  loss  of  sleep 
troubled  him  very  much.  To  meet  this  indication,  he 
prescribed  a  pill  of  camphor  and  hyoscyamus,  which  for 
a  time  seemed  to  reheve  him  ;  he  was  also  taking  at 
tiiis  time  a  bitter  (fluid  ext  quassise),  and  locally  he 
had  applied  a  belladonna  plaster,  etc.  A  messenger, 
who  came  with  an  urgent  solicitation  at  11  pjc  a 
month  after,  stated  that  the  patient  had  been  injured  in 
a  mSUe  at  their  house  a  short  time  previously.  On 
arrival,  Dr.  O'S.  found  him  suffering  much  pain,  kneel- 
ing in  bed  and  resting  on  his  face  and  hands,  which 
Eosition,  with  much  difficulty,  he  succeeded  in  getting 
im  to  change.  He  then  ascertained  that  his  Chinese 
patient,  whilst  in  the  act  of  leaving  his  room,  in  a  fit  of 
anger  was  pulled  back  by  an  excited  female  relative, 
who  seized  him  by  the  waist^  and  thus  made  direot 
pressure  on  the  tumor.  From  thenceforward  he  con* 
tinned  t6  complain  constantly  of  pain,  his  stomach, 
however,  behaving  as  well  as  usual  About  this  time 
a  surgeon  of  eminence,  now  deceased,  saw  him,  and 
pronounced  in  favor  of  an  aneurism,  although  he  con- 
fessed that  the  symptoms  were  not  as  well  defined 
as  usual  He  advised  a  continuance  of  the  same 
line  of  treatment.  The  pain  and  uneasiness  in 
the  region  of  the  tumor,  however,  seemed  to  have 
increased;  and  the  patient,  a  little  despondent,  and 
naturally  enough  anxious  for  a  change  of  remedies, 
desired  further  counsel.  Accordingly,  Dr.  E.  R.  Peastee 
was  called ;  and,  after  a  thorough  examination  of  the 
case,  very  decidedly  excluded  aneurism.  He  thought  it 
probable  that  the  growth,  whatever  it  was,  was  at- 
tached to  the  left  lobe  of  the  liver ;  as  to  its  character,  he 
could  not  determine.  This  opinion  was  also  expres^d 
by  the  late  Dr.  Sinclair,  who  saw  the  patient  a  few 
weeks  before.  The  patient  continued  in  this  condition 
some  days,  feeling  pretty  comfortable,  being  able  to 
walk  about  his  room,  and  seemingly  not  sufifering 
much  firom  debility  or  loss  of  flesh,  having  even  cone 
to  Brooklyn  on  a  visit  to  some  friends  for  a  couple  of 
days.  His  daughter  stated  to  me  that  he  would  have 
remained  some  time  longer,  but  for  the  want  of  his 
opium  pipe.  He  finally  diedf  in  a  semi-comatose  state ; 
and  three  and  a  half  hours  after  death.  Dr.  O'Sullivan, 
assisted  by  the  late  Dr.  D.  S.  Conant,  made  the  autopsv. 
After  opening  the  abdomen,  the  peritoneum  on  tne 
upper  part  of  its  cavity  was  found  in  a  state  of  great 
congestion,  and  considerable  ecchymosig  existed  in  the 
epigastric  region.  The  large  tumor  wtiich  had  caused 
so  much  diversity  of  opinion  previous  to  death, was  found 
to  be  connected  with  the  left  lobe  of  the  hver ;  turning 
ju^t  below  the  mass,  the  transverse  colon  crossed  the 
abdomen,  whilst,  resting  upon  the  lower  projecting  por- 
tion of  toe  growth,  the  pylorus  and  duodenum  crossed 
in  the  direction  of  the  mass,  which  was  readily  dissected 


up  from  the  aorta,  and  removed  with  a  portion  of  the 
pancreas,  which  was  adherent  to  its  lower  border,  by 
making  a  section  of  the  liver  through  the  longitudinal 
Assure.  The  abdominal  aorta  was  then  dissected  out 
from  below  the  bifurcation  to  the  middle  of  the  thoracic 
aorta,  and  found  to  be  almost  perfectiy  healthy.  The 
accompanying  specimen  he  brought  away,  not  without 
the  consent  of  m  concerned,  but  amid  the  howling  of 
the  excited  Chinese.  Specimens  of  the  contents  of  the 
lower  cystic  and  divided  portions  of  the  preparation, 
have  been  examined  by  Professor  Flint,  Jr.,  and  found 
to  be  composed  of  cancer  cells,  free  nuclei,  &tty 
globules,  and  granular  matter,  as  were  shown  in  the 
accompanying  diagram. 

Afler  some  debate  upon  the  paper,  the  Assooiation 
adjourned. 


|)r00r«a  of  iSftcMcal  Qcxtnct. 


New  Mbthod  of  Preserving  Flesh. — Dr.  Bnmetti, 
of  Padua,  has  discovered  a  new  method  for  preserving 
flesh,  for  which  he  has  been  awarded  a  gold  medal  at 
the  International  Exhibition.  The  following  descrip- 
tion of  the  process  is  given  by  the  Paris  Correspondent 
of  the  N,  Y,  Tirnes  :^The  process  of  Dr.  Brunetti 
comprises  several  operations,  viz. :  1,  the  washing  of 
the  piece  to  be  preserved ;  2,  the  degraissage,  or  eating 
away  of  the  fatty  matter;  3,i;he  tanning;  and  4,  the 
desiccation.  1.  To  wash  the  piece,  M.  Brunetti  passes 
a  current  of  pure  water  through  the  blood-vessels  and 
the  various  excretory  canals,  and  then  he  washes  the 
water  out  by  a  current  of  alcohol.  2.  For  destroying 
the  &t  he  follows  the  alcohol  with  ether,  which  he 
pushes,  of  course,  through  the  same  blood-vessels  and 
excretory  ducts ;  this  part  of  the  operation  lasts  some 
hours.  The  ether  penetrates  the  interstices  of  the  flesh, 
and  dissolves  all  the  fat.  The  piece,  at  this  point  of  the 
process,  may  be  preserved  any  length  of  tune  desired, 
plunged  in  ether,  before  proceeding  to  the  final  opera- 
tions. 3.  For  the  tanning  process,  M.Bninetti  dissolves 
tannin  in  boiHng  distilled  water,  and  then,  after  wash- 
ing the  ether  out  of  the  vessels  with  distilled  water,  he 
throws  this  solution  in.  4.  For  the  drying  process,  Dr. 
Brunetti  places  the  pieces  in  a  vase  with  a  double  bot- 
tom filled  with  boiling  water,  and  he  fills  the  places  of 
the  preceding  liquids  with  warm,  dry  air.  By  the  aid 
of  a  reservoir,  in  which  air  is  compressed  to  about  two 
atmospheres,  and  which  communicates  by  a  stop-cock 
and  a  system  of  tubes,  first  to  a  vase  containing  chloride 
of  calcium,  then  with  another  heated,  then  with  the 
vessels  and  excretory  ducts  of  the  anatomical  piece  in 
course  of  preparation,  he  establishes  a  gaseous  current 
which  expels  in  a  very  littie  time  all  Sie  fluids.  The 
operation  is  now  finished.  The  piece  remains  supple, 
li^ht,  preserves  its  size,  its  normal  relations,  its  solid 
histolo^cal  elements,  for  there  are  no  longer  any  fluids 
in  it.  It  may  be  handled  without  fear,  and  will  last 
indefinitely.  The  discovery  is  a  magnificent  one,  and 
the  sooner  medical  schools  are  provided  with  full  cabi- 
nets of  natural  and  pathological  pieces  the  better. 

Trsatmbkt  of  Scrofulosis. — Dr.  T.  Balman  (Ixmoef^ 
proposes  a  treatment  for  scrofulous  disease  of  the  ex- 
ternal lymphatic  glands  which  consists  in  the  local  ap- 
plication of  pledgets  of  lint  soaked  in  iodine.  If  the 
disease  be  chronic,  pencil  with  argent,  nitr.  every  five 
or  six  days.  When  abscess  forms,  open  at  once,  apply- 
lint,  and  paint  with  iodine. 

The  gauss  of  RAcmns. — ^Dr.  Dick,  in  a  communica- 
tion to  the  Pathological  Society,  London,  proves  rachitis 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


sn 


to  be  a  disease  of  mal-nutrition  of  bone.  He  experi- 
mented on  puppies — taking  certain  ones  of  the  litter 
from  the  mother's  breast,  and  raising  them  by  hand ;  in 
these  he  produced  the  disease  artificially,  while  the 
nurslings  were  exempt. 

A  Question  regarding  Nutriment. — Dr.  Thudichum 
asserts  that  Liebig's  extract  of  meat  lacks  the  essential 
properties  of  nutriment.  It  contains  the  elements  re- 
quired in  very  small  proportion,  and  in  an  oxydized 
state,  and  is  simply  a  stimulant,  a  strong  beef-tea  when 
prepared  for  swallowing.  Of  the  twenty-five  per  cent 
solid  substance  contained  in  meat,  four- fifths  are  insolu- 
ble in  water,  or  become  so  by  boiling,  allowing  only 
one-fifth  of  the  solid  parts,  or  five  percent,  of  the  whole, 
to  be  saved  in  the  extract  He  thinks  that,  after  eggs, 
the  nearest  substitute  for  meat  is  Indian-corn  ana  other 
kinds  of  seeds,  beans,  peas,  etc.,  when  grown  in  south- 
em  climates.  Northern  grown  beans  are  not  approved, 
and  this  kind  of  food  always  requires  peculiarly  oarefdl 
preparation  to  be  digestible.  Vegetable  food  requires 
much  digestion,  and  its  use  demands  and  creates  an 
increase  of  ihe  stomach,  which  is  visible  in  well-fed 
vegetarians. 

Fish  Biscuit. — Professor  Rosing,  of  Asa,  France,  has 
invented  a  process  of  making  flour  fi*om  a  species  of 
sea-fish,  which  he  forms  into  biscuit,  thereby  providing 
a  very  nutritious  and  compact  article  of  food.  These 
biscuit  are  four  times  as  rich  in  albuminoid  substances 
as  beef,  four  and  a  half  times  as  freah  codfish,  and  six- 
teen times  as  fresh  milk. 

"Weaning — A  writer  on  this  subject,  in  a  communica- 
tion to  the  Boston  Medical  and  Surgical  Journal^  says : 
"The  best  average  I  can  make,  gives  almost  elevefi 
months  as  the  approved  term  for  lactation.  But  eleven 
months  is  a  longer  period  than  I  would  have,  as  a  rule, 
in  the  present  state  of  society.  Children  weaned  at 
nine  months  do  as  well  as  those  weaned  at  eleven 
months,  for  aught  I  have  discovered,  and  three  months 
will,  in  many  instances,  be  added  to  it  from  a  variety 
of  causes ;  and  if  a  longer  term  than  nine  months  is 
named,  just  as  much  will  be  added  to  that,  and  lactation 
win  be  prolonged  to  a  very  doubtful  period. 

"  I  suggest  nine  months — not  as  prefigured  by  gesta- 
tion, or  anything  else,  but  simply  as  a  reasonable  term 
for  nursing.  In  support  of  a  shortened  term  of  lacta- 
tion, I  have  an  impression,  strong  enough  to  influence 
me  a  good  deal,  that  children  nursed  beyond  a  year — 
above  all,  for  two  years — are  not  likely  to  do  as  well  as 
those  weaned  earlier  •  and  that  scrofulous  or  puny  chil- 
dren are  not  benefited  by  an  extended  term  of  nursing, 
especially  of  their  own  mothers :  and,  on  the  other 
hand,  that  mothers  are  generally  benefited  by  a  brief 
term  of  lactation. 

**  The  advancement  of  the  teeth  is  generally  made  an 
item  in  deciding  the  question  of  weaning.  The  age  for 
the  development  of  the  canine  teeth — the  most  dreaded 
period  of  dentition — is  about  the  eighteenth  month  ;  and 
to  wait  for  the  appearance  of  those  teeth,  would  be  to 
establish  an  unreasonable  term  of  lactation. 

"On  this  point  of  the  importance  of  the  develop- 
ment of  the  teeth,  writers  are  very  indefinite ;  and  each 
writer  who  does  specify  what  teeth  he  would  have  the 
child  exhibit  at  the  time  of  weaning,  states  that  chiidren 
usually  show  the  specified  teeth  at  about  the  age  he 
hag  named  as  the  fit  time  to  stop  lactation ;  so  that  in 
fi»l  the  cutting  of  the  teeth  comes  to  be  a  part  of  a. 
cautious  theory,  but  is  in  reality  of  very  little  conse- 
qnence  in  deciding  whether  a  child  shoiidd  be  weaned 
or  not" 

On  the  question  of  the  season  of  the  year  when  a 


child  should  be  weaned,  the  same  writer  says :  "  The 
suggestions  of  Dr.  Dewees,  which  divide  the  year  into 
a  convenient,  an  inconvenient,  and  an  improper  season, 
were  based  on  a  large  and  careful  observation,  and  are 
well  worth  remembering.  If  we  look,  however,  for  a 
formula  on  the  season,  we  shall  hardly  find  anything 
more  concise  than  the  words  *  either  after  the  warm 
season  has  passed,  or  before  it  has  commenced.  Of  the 
two  I  prefer  the  former.'  I  will  only  add  for  myself, 
that  (so  strong  is  my  conviction  that  much  nursing  is 
not  welcome  by  the  mothers  of  this  day),  I  would  not 
hesitate  to  wean  in  the  spring.  If  a  child  is  nine 
months  old  early  in  May,  I  would  advise  that  it  be 
weaned,  unless  its  mother  exhibit  uncommon  capacities 
as  a  nurse.  But  each  case  of  weaning,  like  each  case 
of  sickness,  is  to  be  considered  and  managed  by  itself, 
and  not  to  be  disposed  of  in  rigid  accordance  with  any 
fixed  rules  or  maxims.'* 

Persistent  Eclampsia;  Forced  Delivery  Accom- 
plished BY  Bilateral  Incision  of  the  Cervix  Uteri, 
— ^Wm.  P.  Holt,  M.D.,  in  the  Southern  Medical  Journal 
relates  the  history  of  a  case  to  which  he  was  called, 
where  the  patient  was  '*  a  primipara  aged  19,  stout,  ro- 
bust, and  very  plethoric."  She  had  had  "grinding 
pains"  for  several  hours.  An  examination  revealed 
the  OS  high  up,  undilated  and  rigid.  Had  had  great  fiil- 
ness  about  the  head  for  three  weeks,  and  the  limbs  were 
oedematous.  Four  hours  after  the  first  examination, 
the  OS  was  found  in  the  same  position  and  condition. 
Convulsions  came  on  soon  after,  which  were  modified, 
but  not  controlled,  by  chloroform.  The  convulsions  still 
continuing,  it  was  decided  to  take  blood  from  the  arm, 
which  was  done  copiously ;  but  the  convulsions  again 
recurring,  it  was  decided  to  make  a  bilateral  incision 
of  the  cervix  uteri  with  the  probe-pointed  bistoury, 
forcibly  dilating  with  the  finger.  A  hook  was  then 
iiitroduced,  the  foetus  caught  in  the  groin  (it  being  a 
breech  nresentation)  and  delivered.  The  after-birth 
soon  (^e  away  entire,  and  the  patient  made'  a  good 
rewjiTOry. 

^^reatment  or  Opium  Poisoning  by  a  New  Method, 
BY  A.  Le  B.  Munroe,  M.D. — ^A  lady  had  taken  two 
ounces  of  laudanum,  from  the  effects  of  which  she  was 
In  a  state  of  profound  coma.  Emetics  were  used,  and 
afterward  the  stomach-pump  was  applied,  and  the  stom- 
ach thoroughly  worked  out,  which  produced  no  ame- 
lioration of  the  symptoms. 

The  following  treatment  was  then  instituted :  "  The 

Eatient  was  placed  upon  her  back  on  the  floor,  with 
er  head  elevated  a  httle  upon  a  folded  sheet,  the 
clothes  slipped  down  below  the  waist,  leaving  the 
chest  entirely  bare.  A  pail  and  a  pitcher  of  cold  water 
were  then  brought  in.  The  pitcher  was  then  raised  to 
the  ceiling,  eight  or  nine  feet  from  the  floor,  and  the 
water  allowed  to  fall  in  a  small  stream  upon  the  epigas- 
trium. By  the  time  the  first  pailful  wa^  exhausted,  the 
breathing  had  become  a  little  more  frequent  and  equa- 
ble, and  the  stertor  less.  The  second  pailful  was  brought 
in,  and  soon,  to  my  great  joy,  I  could  see  that  the  deathly 
pallor  of  the  face  was  being  lighted  up  by  the  flow  of 
the  vital  current  from  the  heart ;  a  blush,  barely  percep- 
tible at  first,  gradually  and  steadily  spread  over  the  be* 
fore  pale  and  expreesionless  features,  until  it  warmed 
into  the  full  glow  of  life  and  health.  By  degrees  other 
manifestations  of  returning  life  appeared.  She  began 
to  make  efforts  to  move  awajr  fix)m  the  pouiing  stream, 
weak  at  first,  but  increasing  m  strength,  until  she  could 
turn  partly  over  and  interpose  the  hands  to  break  the 
force  of  the  stream.  At  length,  after  about  three  pail- 
fiils  of  water  had  been  used,  her  struggles  to  escape  trom 
what  was  now  evidently  torture,  we^»^  quite  severe ; 

Digitized  by  VjOO^  ^  _ 


872 


THIT  MEDICAL  RECORD. 


and  about  this  time,  to  our  infinite  satisfaoticm,  she  be- 
^n  to  beg  for  quarter  in  long-drawn,  drowsy  syllables, 
increasing  in  energy  and  forcl^e,  until  they  were  uttered 
in  a  tone  and  manner  which  evinced  a  considerable  de- 
gree of  passion,  and  even  anger,  at  the  strange  and  even 
cruel  treatment  to  which  she  was  subjected.  But  even 
now  she  would  fall  asleep  immediately  if  let  alone. 
Having  continued  it  as  long  as  we  thought  necessary, 
we  desisted,  and  rubbed  her  dry  with  warm  cloths. 
We  then  raised  her  up  and  walked  her  about  the  room 
for  an  hour  or  more,  resting  at  intervals.  She  recov- 
ered without  any  permanent  ill  effect. 

'^I  believe  this  treatment  will  be  more  effective  in  the 
cure  of  extreme  cases  of  opium  poisoning  than  anything 
else.|||  Doubtless  it  would  be  just  as  effective  in  poiaon- 
iiig  by  other  narcotics,  and  possibly  in  some  cases  of 
suspended  animation." — Boston  Medical  and  Stirgioal 
Journal, 

Group  TREATsn  bt  SuLPHtiB. — The  BriHsh  Medical 
Jowmal^  quoting  trom  the  Gazette  Med,  de  Paris,  states 
that  M.  Lagonterie,  from  observing  the  effects  of  sul- 
phur on  the  oidium  on  vines,  has  been  led  to  administer 
it  in  several  cases  of  croup.  He  mixes  a  teaspoonful  in 
a  glass  of  water,  and  gives  the  mixture  in  teaspoonfbl 
doses  every  hour.  The  effect  he  describes  as  wonder- 
ful. The  disease,  in  effect,  is  cured  in  two  days,  the 
only  symptom  remaining  being  a  cough,  arising  from 
the  presence  of  loose  particles  of  fsXee  membrane  in  the 
tracnea.  Mous.  Lagonterie  says  he  has  followed  this 
plan  in  seven  cases,  all  being  severe,  especially  the  last^ 
the  patient  being  cyanotic,  with  protruding,  rolling  eyes, 
and  noisy  respiration. 

Hydatids  or  the  Uterus.— Dr.  W.  H.  Grimes,  in  the 
.  Leavenworth  Herald,  states  that  he  attended  a  patient 
where  there  were  expelled  fix>m  the  uterus  fourteen 
pounds  of  hydatids.  "The  woman  was  a  good  deal 
exhausted  by  protracted  suffering  and  subsequent  luem- 
orrhage ;  this  condition,  however,  was  soon  relieved  by 
cold  application,  and  repeated  doses  of  tannic  add  and 
morphine.  She  rapidly  recovered,  and  has  had  no  fur- 
ther trouble  from  the  disease." 

Leprosy. — Surgeon  0.  Macnamara,  of  the  Calcutta 
Hospital,  draws  the  following  conclusions  in  regard  to 
this  disease  :  1st.  Leprosy  is  very  common  among  the 
natives,  about  one  in  ten  being  affected  byit,  and  it  is 
probably  on  the  increase.  2d.  It  is  much  m  ore  common 
among  the  pure  natives  than  among  other  tribes  which 
have  become  degraded  by  intermarriage  with  them,  and 
it  is  very  rare  among  Europeans.  3a.  It  is  hereditary 
and  inoculable,  but  not  propagated  by  simple  contact,  or 
through  the  air,  or  by  sexual  intercourse  or  other  means. 
4th.  It  has  no  connection  with  syphilis,  and  was  preva- 
lent in  India  centuries  before  that  disease  whs  kiiown. 
5th.  It  is  probably  curable  in  its  premonitory  stages^ 
but  in  the  anaesthetic  or  tubercular  form  it  is  without 
remedy.  No  provision  having  been  made  by  tiie  In- 
dian government  for  the  care  of  lepers,  much  remains 
to  be  learned  regarding  the  treatment  6th.  A  proper 
regard  for  cleanliness  and  other  hygienic  considerations 
seems  amply  sufficient  to  prevent  the  disease. — Pacific 
Medical  cmd  Surgical  Journal, 

Grindbua  nr  Asthma. — Since  our  former  notice  of 
this  plant  in  asthma,  we  have  testimony  firom  various 
sources  which  settles  the  question  of  its  value.  It  appears 
to  have  been  uniformly  palliative,  if  not  preventive,  ^the 
paroxysms  in  the  cases  treated  by  it.  Its  action  seenos 
to  be  antispasmodic  and  expectorant  In  the  case  before 
referred  to.  in  which  the  relief  was  so  well  marked,  it 
lost  its  effects  measurably  after  use  for  six  months, 
though  the  paroxysms  have  never  been  as  violent  since 


as  before  the  use  of  grindelia.  We  may  mention  here, 
that  the  best  treatment  known  to  us  for  true  qiasmodic 
asthma  is  the  hypodermic  ii\jection  of  moq)hia.  The 
paroxysm  is  invariably  relieved  by  the  injection,  and,  in 
a  large  proportion  of  cases,  does  not  return  for  weeb  or 
months.  One-fourth  to  one-half  a  grain  is  the  proper 
quantity.  With  this  remedy  we  approach  an  asthmatio 
patient  in  the  hope  of  giving  him  prompt  and  efficient 
relief.  We  usually  inject  it  in  the  exrcL—Paeifio  Medical 
and  Surgical  Journal, 

Cannabis  as  an  Antidote  for  Strychnia.— The 
Chicago  Medical  Eacammer  reports  the  case  of  a  man 
who  swallowed  five  grains  of  strychnia,  and  was  seen 
nearly  four  hour&aftc^ard,  when  he  had  frequent  and 
severe  spasms,  with  rigidity  of  muscles,  and  inability  to 
move  the  Hmbs,-  pulse  130.  Adrachmof  the  tinotareof 
cannabis  was  given,  and  another  in  five  minutes;  then 
two  similar  doses  at  intervals  of  ten  minutes,  and  two 
doses  at  intervals  of  fifteen  minutes,  with  rapid  amelio- 
ration of  the  symptoms.  The  next  drachm  was  given 
in  an  hour  and  a  hal^  after  which  it  was  alternated  with 
camphor,  as  the  symptoms  demanded.  The  patient  re- 
covered with  uninterrupted  convalescence,  i^r  forty- 
eight  hours. 

The  Extraordinart  Deuoact  of  the  Spectrum  nn 
in  determining  the  presence  of  certain  metals  is  well 
known  to  scientific  men.  Bunsen  and  Kirchhoff  intimate 
that  it  is  possible  to  recognise  in  this  way  the  sixhr- 
thousandth  part  of  a  grain  of  potassa  or  baryta,  the 
one-millionth  of  a  grain  of  lime  or  stronda,  the  sixty- 
millionth  of  a  grain  of  lithia,  and  the  one  hundred  and 
sixty-millionth  of  a  grain  of  soda.  Dr.  Letheby,  the 
distinguished  London  chemist,  has  detected  by  these 
means,  the  presence  of  blood  in  the  stains  on  linen 
which  had  lain  by  for  seventeen  years. — Paq^  Medi- 
cal and  Surgical  Journal, 

Tannin  as  a  H jocostatio. — Dr.  J.  M.  Lii^ey,  in  tbs 
Leavenworth  Herald,  thus  speaks  (A  tannin :  "  A  man, 
54  years  of  age,  was  presented  to  me  with  gangrene  or 
the  foot  The  line  of  deman^on  was  wdl  formed, 
just  above  the  ankle.  I  amputated  the  1^  at  the  middle 
third.  The  arteries  were  easily  secured,  and  no  arterial 
blood  was  lost,  but  the  venous  heomorrhage  was  con- 
siderable, and  soon  increased  to  fiightful  proportions, 
althoufirh  several  of  the  larger  veins  were  secured.  I 
sprinkled  tannin  over  the  surface  of  the  wound,  and 
the  hsemorrhage  was  immediately  and  permanently 
arrested." 

Separation  op  Tin  and  Arsenic. — ^Professor  Woh- 
ler's  method  is  based  on  the  solubility  of  sulphide  of 
arsenic  in  bisulphate  of  potash,  which  does  not  dissolve 
the  tin.  The  mass,  after  being  oxidized  by  nitric  add, 
is  allowed  to  digest  with  sulphur  and  caustic  potash  tiU 
the  solution  is  complete.  The  liq^uid,  after  being  treated 
by  sulphurous  acid  in  excess,  is  allowed  to  rest  for 
some  time^  and  is  then  evaporated  until  all  the  sul- 
phurous acid  is  driven  off.  The  sulphide  of  tin  is  then 
removed  by  filtration,  and  wa^ed  with  a  strong  solu- 
tion of  common  salt,  which  may  be  removed  from  the 
precipitate  by  an  acid  solution  of  acetate  of  ammonia. 
The  sulphide  of  tin  is  converted  into  the  oxide  of  tm 
b^  roasting  in  contact  with  air.  Arsenic  may  be  pre- 
cipitated from  the  arsenious  acid  contained  in  the  liquid 
by  a  current  of  sulphuretted  hydrogen. 


Treatment  of  Burn& — The  treatment  Ibr  this 
of  affections  in  St  Thomas*  Hospital.  London,  is  to 
whitewash  the  parts  with  a  paste  of  wniting  and  Tin- 
egar.  The  crust  is  left  on  until  it  falls  off,  when  s  renew- 
al^of  the  appUcation,  if  necessary,  ig^niade. 

Google 


Digitized  by  ^ 


THI  MEDICAL  RECORD. 


873 


The  Medical  Eecx)rd. 

^  JStnd-Stontblg  Imtmal  of  Ptbtcnu  mb  Shoitti. 
Georgb  F.  Shradt,  ILD.9  Bditob. 

PablialMd  on  the  Ut  aad  IMi  of  Mflh  Bftonth,  br 
WILLIAM  WOOD  A  00^  #1  Walkbx  Bnutn,  Nbw  Yobk. 


WOREIBN  A&SKCIS& 


Loif  DOH— TSUBITRB  k  CO. 
pABSft— BuBBAHttB  IT  OlB. 


LBfPBio— Bk  HBBHAmr. 

Bio  Jamboo— Stbphbhb  t  Oa. 


Now   Yorlc.   October  lO.  UBSr. 

THE  LATE  INTERNATIONAL  MEDICAL 
CONGRESS. 
It  seems  that  the  grand  international  medical  re- 
onion  at  Paris  failed  to  respond  by  substantial  results 
to  the  zealous  anticipations  of  many  of  its  warmest 
friends.  Such  might  have  been  presaged  from  a  knowl- 
edge of  the  traditional  rontinism  of  certain  leading 
spirits  of  the  French  school,  and  from  the  intellectual 
Tassalage  which  restricted  the  free  interchange  of  ideas, 
and  community  of  thought  within  such  limits  as  traced 
by  the  organizers  of  this  universal  medical  convention. 
The  conception  of  assembling  the  medical  celebrities  of 
an  parts  of  the  world — each  to  contribute  his  share  of 
knowledge  and  experience,  and  offer  it  as  a  voluntary 
homage  of  his  nation,  and  as  an  individual  expression 
of  charitable  feeling  and  disinterested  philanthropy — 
was  the  prompting  of  generous  and  noble  impulses,  and 
elicited  the  commendations  and  hearty  support  of  the 
medical  profession  generally.  The  medical  representa- 
tives of  the  different  nationalities  met  in  the.enlivening 
capital  of  France,  regaled  by  the  brilliancy  and  magnifi- 
cence of  the  gay  city,  fitvorably  impressed  and  most 
indulgently  disposed  to  justify  to  a  moderate  degree 
the  gratification  of  a  certain  vanity  so  characteristic  of 
Frenchmen,  which  at  times  is  not  displeasing,  because 
attended  with  so  much  good  feeling.  But  lo  I  Bouil- 
laad,  the  President  of  the  Congress,  at  its  inaugnradon 
informs  the  assembly  that  "  France  is  Paris,  and  that 
Paris  is  the  World,"  and  thus  unmistakably  exhibits 
the  true  motives  which  actuated  the  organisation  of  the 
grand  Congress.  The  President  utters  an  expression 
of  conceit  which  shows  that  none  are  welcome  who 
are  not  convinced  of  the  insuflBciency  of  their  own 
offerings,  and  humble  enthusiastic  admirers  of  certain 
F^nch  declaimers,  who,  having  selected  their  own  pro- 
gramme, chosen  their  own  subjects  for  discussion,  may 
very  naturally  be  expected  to  eclipse  the  foreigners, 
most  of  whom  probably  are  but  in^nerfectly  acquainted 
with  the  French  language. 

Our  Paris  correspondent  has  Mthfully  exposed  the 
proceedings  of  the  Congress,  which  will  be  read  with 


interest  Impartis^ty  requires  that  we  should  adjudge 
a  just  meed  of  praise  for  the  benefits  resulting  from  the 
discussion  of  those  subjects  which  occupied  the  atten- 
tion of  the  Congress,  although  regretting  as  we  do  that 
the  organization  was  so  imperfect)  disappointing  the 
hopes  of  many  of  its  well-wishers,  both  among  French- 
men and  foreigners. 

One  of  the  questions  which  appears  to  have  received 
most  attention  was,  the  several  complications  occurring 
after  surgical  operations,  and  which  so  frequentiiy  cause 
death.  The  subjects  of  tuberculosis,  of  syphilis,  and  of 
syphilization,  called  forth  animated  discussions.  Men- 
struation and  the  preservation  of  anatomical  specimens, 
although  important  subjects,  engaged  the  attention  of 
the  convention,  to  the  exclusion  of  other  and  more 
weighty  matters.  At  the  first  meeting,  Br.  Van  Lohe, 
of  Holland,  expressed,  in  energetic  and  sensible  terms, 
his  disapprobation  of  transforming  the  International 
Medical  Congress  into  a  school  of  medicine,  where  were 
pronounced  learned  dissertations,  affording  no  instmc- 
tion  to  any  one,  but  serving  merely  to  display  the 
mutual  admiration  of  certain  members.  President 
BouiUaud,  in  calling  the  refractory  member  to  order, 
discovered  the  sentiments  of  a  large  portion  of  the 
assembly,  and  which  were  manifested  by  its  hearty 
approval  of  the  intrepidity  of  the  honest  Dutchman. 
It  was  fortunate  that  there  were  some  who,  if  they  did 
not  fully  represent  the  medical  celebrities  of  their 
respective  countries,  might  at  least  enter  a  protest 
against  the  proceedings  of  the  assembly.  No  idea  can 
be  formed,  ftom  a  review  of  the  deliberations  of  this 
learned  body,  either  of  the  importance  of  oor  own 
country,  or  of  its  claims  to  a  proper  and  merited 
distinction.  The  same,  with  rare  exceptions,  may  be 
said  of  other  countries.  These  remarks  ate  not  prompted 
by  a  spirit  of  detraction ;  on  the  contrary,  the  recollec- 
tion of  the  great  and  valuable  advances  in  medical 
dcience  made  in  France  will  cause  us  always  justly  to 
esteem  the  names  of  those  great  men  like  Bichat,  whose 
giant  intellect  in  a  few  years  regenerated  the  medical 
science  ;  Laennec,  who  discovered  and  developed  aus- 
cultation; or  who,  like  Dupuytren,  gave  a  practical 
value  and  brilliancy  to  surgery,  and  which  reflected  the 
highest  honor  on  the  profession. 

These,  and  a  host  of  other  great  men  who  have 
added  lustre  to  the  French  school,  have  passed  firom  the 
stage  of  life;  and  some  have  but  quite  recently,  like  the 
last  fi^tUing  leaves  of  autumn,  seemed  to  drop  all  at  once : 
Malgaigne,  Trousseau,  Civiale,  Yelpeau,  Rostan,  Bayer^ 
have  gone  to  their  last  homes,  and  left  but  t>»e  relic  of 
the  past,  the  President  of  the  International  Medical 
Congress,  M.  BouiUaud. 

The  excellence  to  which  the  French  have  attained  in 
their  physiological,  pathological,  and  chemical  research- 
es, have  rendered  them  eminently  distinguished,  and 
caused  them  to  be  accepted  as  the  leaders  in  medical 
science.  Frenchmen  have  been  for  a  long  time,  to  a 
very  considerable  extent,  the  elaborators  of  the  important 
digitized  by  ^ „      ^_ 


374 


THE  MEDICAL  RECORD. 


problems  which  have  engaged  the  minds  of  medical 
men ;  they  have  been  large  contributors  to  our  science ; 
but  not  the  only  ones.  With  the  march  of  intellect  and 
the  extension  of  civilization ;  with  the  astonishing 
enterprise  displayed  in  all  the  departments  of  industry 
^roughout  the  world,  and  especially  on  this  Western 
Continent,  an  influence  has  been  exercised  upon  the 
progress  of  medicine  commensurate  with  the  general 
development  of  intelligence,  and  the  multiplied  comforts 
And  conveniences  of  life.  The  medical  profession  of 
this  country  is  in  a  position  to  be  a  large  contributor  of 
valuable  knowledge  to  any  international  medical  con- 
gress ;  and  if  the  organizers  of  the  Paris  Congress  failed 
to  recognize  this  fact,  others  have  not  French  sur- 
geons now  adopt  our  American  operation  for  ovariotomy, 
And  Frenchmen  pay  a  tribute  of  respect  in  many  ways 
to  our  countrymen.  Our  ambulances  are  esteemed  th« 
best  at  the  Paris  Exhibition ;  our  sewing  and  reaping 
machines,  with  other  appliances  of  industry,  which  are 
the  real  exponents  of  a  true  civilization,  have  been 
adopted  by  the  French,  and  the  Imperial  GhjvernmeDt 
supplies  its  navies  from  our  iron-clads.  Well  might  the 
International  Medical  Gongre^  have  anticipated  impor- 
tant advantages  from  a  better  acquaintance  with  the 
progress  of  medical  science  in  this  country,  suggestive, 
At  least,  if  not  fruitful  in  brilliant  scientific  results. 

DiTBiNa  the  threatened  cholera  epidemic,  we  heard 
much  through  the  secular,  as  well  as  the  medical  press, 
of  the  praiseworthy  sanitary  labors  of  our  Board  of 
Health.  Disinfection  and  purification,  zymotic  diseases, 
contagion  through  the  moisture  of  the  earth,  wece 
terms  well  set  forth  in  exhaustive  reports,  famed  for 
verbosity  as  weU  as  for  zeal  in  the  sanitary  reform  of 
our  metropolis. 

But  if  all  the  rumors  which  reach  us  have  a  tithe  of 
truth  in  them,  some  of  our  health  authorities  are  rest- 
ing with  their  laurels  won,  while  nuisances  in  the  way 
of  filthy  gutters,  excrements  thrown  into  the  public 
streets,  are  left  to  breed  fever  and  death,  with  no  sani- 
tary mspector  "  to  molest  or  make  afraid."  Policemen 
say  that  remonstrances  are  made  in  vain,  and  citizens  in- 
form us  that  in  individual  instances  respectful  com- 
plaints have  not  even  been  noticed. 

Seriously,  gentlemen  of  the  Board  of  Health,  every 
oomj^int  of  a  respectable  citizen  deserves  a  careful  in- 
vestigation, and,  if  possible,  the  nuisance  should  be 
promptly  abated.  Inspectors  have  other  duties  than 
to  draw  their  pay  and  wear  their  badges.  The  city  of 
New  York  deserves  a  little  more  sanitary  inspection 
than  that  involved  in  carefully  prepared  reports  and 
statistical  tables.  There  are  crying  evils  in  the  city, 
which  the  capable  medical  men  engaged  as  inspectors 
should  daily  report  until  they  are  abated.  After  a  great 
struggle,  some  of  our  first  medical  men  have  been 
placed  on  a  Board  of  Health,  a  band  of  well-educated 
inq)ectors  selected,  but,  in  some  instances,  they  pay  no 
more  attention  to  honest  complaints,  they  see  no  more 


nuisances  in  their  sessions  and  rounds,  than  did  the 
former  company  of  liquor  dealers  who  did  our  sanitary 
inspection. 

The  intentions  of  the  Board  are  doubtless  good 
enough,  but  it  strikes  us  that  its  heretofore  fair  record 
is  liable  to  be  serioudy  damaged  in  the  eyes  of  its 
firmest  upholders  by  the  apathy  into  which  it  has 
seemingly  so  lately  fallen.  Eternal  vigilance  is  no  less 
the  price  of  liberty  than  of  health,  and  we  fear  that 
our  Health  Board  needs  the  monition. 

We  regret  being  compelled  to  notice  a  severe  attack 
of  publicity  which  one  of  the  professors  in  a  medical 
college  of  this  city  has  recently  been  subjected  to,  in 
the  columns  of  the  Evening  Mail  of  October  7.  We 
are  willing,  for  the  sake  of  the  dignity  of  the  profession 
which  he  represents,  and  for  the  respectability  of  the 
number  of  institutions  with  which  he  is  connected,  to 
strain  our  charity,  by  presuming  that  he  is  entirely  in- 
nocent of  any  comphcity  with  such  a  flagrant  breach  of 
good  taste  and  medical  etiquette.  J[f  oujr  presumptions 
are  well  founded,  and  we  sincerely  hope  they  are,  who 
among  the  profession  can  be  consideif  d  safe  from  penny- 
a-liners  in  search  of  items  ^  who  can  rest  assured  that, 
at  some  future  date,  the  number  of  his  surgical  opera- 
tions may  not  only  be  peddled  to  the  community,  but 
that  the  very  privacy  of  his  home  be  invaded,  letting 
alone  the  recital  of  many  other  details,  the  bare  perusal 
of  which  in  print  would  be  calculated  to  bring  the  blush 
to  his  cheek  ?  But  if  there  is  no  escape,  let  us  prepare 
ourselves  for  the  worst. 

^^  »  ^ 
Thb  yellow  fever  at  the  SouUi  still  prevails  to  an 
alarming  extent,  especially  in  New  Orleans  and  in  the 
interior  towns  of  Texas.  In  the  former  place  the  mor- 
tality has  been  terrible,  the  number  of  vicitims  to  the 
disease,  up  to  the  first  of  October,  being  estimated  at 
the  enormous  number  of  seventeen  hundred  and  seventy- 
six.  At  Galveston  and  Corpus  Ohristi,  the  fever,  by 
all  accounts,  has  spent  itself,  there  remaining  only  a 
few  scattered  cases;  but  in  tiie  towns  of  Lagrange, 
Himtsville,  Hempstead,  Mellican,  AUeyton,  and  Nava- 
sola,  in  Texas,  it  is  still  at  its  height.  At  Hempstead 
and  AUeyton  all  the  physicians  are  dead,  and  ,at  M^'- 
can  during  the  past  month  the  mortality  has  been  folly 
seventy  per  oent  The  different  Howard  associations 
are  doing  their  work  in  a  manner  that  reflects  credit 
upon  their  name,  and  the  physicians  are  nobly  striving 
with  all  their  energies  and  skill  to  stay  the  progress 
of  the  dreadful  enemy.  The  associations  referred  to 
hold  regular  daily  sessions,  and  the  amount  of  labor 
that  they  perform  may  be  in  a  manner  apppreciated  when, 
on  the  authority  of  the  K  0,  7\me$  of  the  26th  inst, 
we  state  that  twenty-five  hundred  cases  have  been  on 
the  relief  books  at  one  time,  and  that^  on  an  average, 
over  seventy  cases  have  been  reported  during  eadi  day. 
It  is  estimated  that  the  "  Howards"  of  New  Orieans 
alone  will  have  to  spend  seventy-five  thousand  doDais 

digitized  by  LjOO^^_ 


THE  MEDICAL  RECORD. 


375 


before  the  season  is  over.  In  view  of  this  fact  the 
amount  of  pecuniary  aid  that  is  needed  will  be  apparent 
to  aU.  We  are,  however,  pleased  to  hear  that  money 
is  being  subscribed  with  a  liberal  hand  for  those  locali- 
ties where  it  is  so  much  needed,  and  given  in  the  hands 
of  those  who  use  it  so  wisely.  In  this  connection  we 
may  mention  particularly  that  the  N.  T.  Academy  of 
Medicine  recently  forwarded  the  sum  of  thirteen  hun- 
dred dollars  to  the  Orescent  City,  and  that  the  Medical 
Society  of  Richmond  Co.,  N.  Y.,  has  arranged  to  send 
out  two  of  their  number  to  aid  their  worn-out  brethren. 
It  is  hoped  that  the  coming  frost  may  soon  put  an  end 
to  the  scourge,  and  that  the  stricken  localities  may 
q>eedlly  be  released  from  that  appalling  gloom  which  has 
hung  over  them  for  such  an  unusually  long  period. 

In  view  of  the  painful  interest  now  taken  in  the 
origin^d  spread  of  the  epidemic,  we  have  thought  it 
advisable  to  publish  in  the  present  issue  a  verbatim  re- 
port of  the  very  interesting  lecture  on  yellow  fever 
recently  delivered  in  this  city  by  Prof.  Stone  of  New 
Orleans. 

A  Trbatisb  on  Human  Phtsioloot,  designed  for  the 
Use  of  Students  and  Practitioners  of  Medicine.  By  John 
C.  Dalton,  M.D.,  Professor  of  Physiology  and  Mioroecopic 
Anatomy  in  the  College  of  Physicians  and  Surgeons,  etc., 
etc.  Fourth  Edition,  Revised  and  Enlarged,  with  274 
Illustrations.  Philadelphia:  Henry  C.  Lea.  1867.  8m 
pp.  678. 

Prof.  Dalton's  work  has  such  a  well-established  repu- 
tation that  it  does  not  stand  in  need  of  any  recom- 
mendation. Ever  since  its  first  appearance,  it  has  be- 
oome  the  highest  authority  in  the  English  language ; 
and  that  it  is  able  to  maintain  the  enviable  position 
which  it  has  taken,  the  rapid  exhaustion  of  the  differ- 
ent successive  editions  is  sufficient  evidence. 

The  present  edition,  which  is  the  fourth,  has  been 
thoroughly  revised  and  enlarged  by  the  incorporation 
of  all  the  many  important  advances  which  have  lately 
been  made  in  this  rapidly-progressing  science. 
Injuries  or  the  Eye,  ORBrr,  and  Bykltds,  their  Treatment 

and  Remote  Effects.     By  Gbo.  Lawson,  F.R.C.8.,  Eng. 

AasAsL  Surgeon  to  the  Royal  London  Ophthalmic  Hoepitid, 

Moorfields,  and  to  the  Middlesex  Hospital ;  Late  Assist  Sur- 

rn.  Rifle  Brigade.    With  numerous  Ulustratiooa.    Phila. : 
a  Lea.     1867.     ISmo,  pp.  408. 

The  welcome  which  this  book  has  received  across  the 
Atlantic,  has  induced  its  republication  in  this  country, 
•nd  that  it  will  be  equally  well  received  by  us,  there 
can  hardlv  be  a  doubt  The  work  comprises  a  collec- 
tion of  all  the  more  important  and  ft-equent  injuries  of 
the  eye,  selected  evidently  with  great  care,  most  of 
ihem  being  typical  in  character.  All  the  different  im- 
portant operations  for  the  removal  of  deformities  and 
the  like,  occasioned  by  injuries,  are  succinctly  de- 
Bcribed,  and  most  of  them  elaborately  illustrated.  Al- 
though evidently  intended  for  the  ^edalist,  the  work 
will  be  found  of  special  value  to  the  practical  surgeon, 
to  whom  ample  directions  are  given  for  the  performance 
of  roost,  if  not  all,  the  necessary  operations.  Very 
many  of  the  cases  are  unique  in  character,  and  all  are 
mtereating,  and  as  a  majority  of  them  make  their  first 
appearance  in  print,  a  special  practical  value  is  thereby 
ffiven  to  the  work.  Every  one  who  consults  this 
brochure  will  arrive  at  the  conclusioa  that  the  author 


has  performed  a  very  usefiil  task  excellently  well,  and 
has  spared  no  pains  to  dish  up  for  his  readers  a  pleasing 
variety  of  cases,  each  of  which  has  its  own  practical 
value.  The  numerous  well-executed  illustrations  serve 
to  add  to  the  interest  of  the  work,  as  well  as  I  he  addi- 
tion in  the  latter  part  of  the  volume  of  the  test  types 
of  Jaeger,  of  Berlin 

Diagram  Showing  the  Effects  op  the  Meteorological 
Influences  on  Mortality  in  the  City  of  New  York, 
1866.  Arranged  by  Wm.  Faulds  Thoms,  M.D.,  Physician 
to  the  N.  Y.  Dispensary,  Surgeon  to  the  Eastern  Dispen- 
sary, eta     Wm.  Wood  A  Co.     1867. 

This  chart,  with  a  surface  of  only  one  and  a  half  square 
feet,  represents  a  deal  of  careful  compilation,  and  ad- 
dressed as  it  is  to  the  eye,  conveys  to  the  mind  at  a 
glance  the  various  relations  to  each  other  of  rates  of 
mortality  and  temperature  as  influenced  by  barome- 
trical bearings  and  points  of  humidity.  The  perpen- 
dicular lines  divide  the  diagram  into  months  and  weeks, 
while  the  horizontal  are  used  as  a  scale  for  mortaUty, 
temperature,  etc  The  waved  lines,  stars,  and  figures^ 
indicate  the  variutions  in  the  meteorological  influences 
and  their  effects  on  the  mortality.  For  example,  the 
record  for  the  week  ending  July  31st  (29th  week), 
shows  the  interesting  fact  that  the  mortahty  rate  is 
greatly  increased  when  high  temperature  is  combined 
with  low  mean  humidity.  We  find,  too,  that  during 
the  cholera  epidemic  the  barometer  was  relatively 
lower  than  usual;  that  westerlv  winds,  and  vernal  rains, 
barring  perhaps  the  element  of  coincidence,  slightly  in- 
creased the  oeath  returns.  During  autumn,  however, 
falls  of  rain  appear  to  exert  quite  a  contrary  effect 
Deaths,  too,  are  less  fi*equent  when  the  thermometer 
ranges  between  60°  and  70°  Fahrenheit,  the  barometer 
being  at  30.00  inches,  and  the  mean  humidity  between 
60°  and  70°  (taking  the  point  of  saturation  at  100). 

A  noticeable  feature  about  the  plan  of  arrangement  is 
the  facility  of  comparison  between  any  given  year, 
month,  or  week,  thus  making  the  science  of  meteorol- 
ology  thoroughly  practical. 

The  Medical  Use  op  ELBOTRiorrr,  with  special  reference  to 
General  Blectrizatiou,  as  a  Tonic  in  Neuralgia,  Rheuma- 
tism, Dyspepsia,  Chorea,  Paralysis,  and  other  affections 
.  associated  with  Debility.  By  Geo.  M.  Bsard,  M  D.,  and  A. 
D.  Rockwell,  M,D.  New  York :  Wm.  Wood  &  Co.  12ino^ 
■pp.  66. 
This  book  has  appeared  in  substance  in  our  columns 
durinff  the  past  tew  months.  We  assume,  howeve^ 
that  wis  constitutes  no  valid  objection  to  our  notice  or 
it,  as  independent  reviewera  The  subject  is  an  inter- 
esting one,  not  only  as  regards  the  agent  employed, 
but  as  to  the  diseases  treated.  Looking  back  at  the 
long  but  not  glorious  career  which  '*  electricity  in  the 
cure  of  disease  "  has  seen,  we  are  not  inclined  to  envy 
our  authors,  in  their  attempts  to  rescue  it  firom  the 
ways  of  quackery,  into  which  it  seemed  to  have  almost 
hopelessly  fallen.  Yet  Doctors  Beard  and  Rockwell 
seem  to  appreciate  their  position  as  pioneers,  as  an  ex- 
tract from  page  12  will  show:  "It  is  the  duty,  and 
should  be  the  delight,  of  scientific  men,  to  wrest  the 
medical  employment  of  electricity  from  the  bands  of 
these  selfish  harpies,  and  accord  to  it  that  honor  to 
which  its  merits  justly  entitle  it"  This  misuse  of  val- 
uable assistances  in  diagnosis  and  cure,  is  a  common 
thing  with  us,  where  medical  men  may  be  easily  super- 
ficially educated,  and  where  they  are  very  often  readv 
to  tlu-ow  distrust  and  reproach  upon  a  subject  which 
they  do  not  understand.  The  only  way  to  drive  out 
quacks  is  to  educate  the  profession  on  every  point,  up 
to  the  possible  results  from  any  agent  in  cure,  minute 
investigation,  or  aid  in  diagnosis. 


Digitized  by 


Google 


376 


THE  MEDICAL  RECORD. 


If  this  little  book  opens  the  eyes  of  the  profession  to 
what  electricity  is,  the  peripatetic  and  self-oonstitated 
professors  of  magnetism  wiU  soon  find  their  occupation 
gone. 

There  is  an  "explanation  of  terms"  in  the  be- 
ginning, which  clears  away  some  of  the  fogs^inees  about 
the  subject  of  "  galvanic  battery,  the  quantity,  inten- 
sion, or  tension  of  electricity,  galyanization,  &radaiza- 
tion.  the  ascending  and  descending  current,"  etc.  We 
think,  however,  that  our  authors  would  have  done 
better  had  they  lefl  faradization  as  Duchenne  gave  It 
to  us;  simply  because,  whether  properly  used  or  not,  it 
has  been  generally  employed,  and  medical  men  do  well, 
88  a  rule,  to  leave  etymology  alone ;  but  this  is  a  small 
matter. 

The  causes  of  the  ill  success  of  physicians  in  using 
electricity  are  very  graphically  given.  The  gist  of  it  is, 
that  physicians,  often  like  the  laity,  expect  means  oi 
cure  to  act  in  a  muiiculous  sort  of  a  way,  and  not  as 
the  result  of  their  careful  and  conscientious  use,  in  the 
hands  or  under  the  immediate  observation  of  the  medi- 
cal attendant  We  have  had  so  much  experience  in* 
combating  this  kind  of  an  unexpressed  but  entertained 
opinion,  among  our  medical  brethren,  in  another  field, 
that  it  is  with  warm  feelings  we  see  the  principle 
that  it  is  not  the  means  used,  but  the  way  of  using 
them,  which  does  the  good,  so  clearly  stated  as  in  this 
hrochtfre. 

The  hand  is  preferred  as  an  electrode.  '*No  in- 
strument that  human  skill  shall  devise  can  ever  equal 
the  hand  in  flexibihty  and  power  of  adaptation." 

Although  the  cases  related  ti^e  up  quite  a  large  por- 
tion of  the  book,  we  are  by  no  means  indined  to  regard 
them  as  the  most  valuable  part  of  it;  but  so  far  as  they 
gro,  they  seem  to  show  that  whatever  general  electrira- 
tion  may  do,  it  avails  much  as  a  tonie.  Carefully  and 
thoroug^y  employed,  it  will  undoubtedly  save  mudi 
drugdng,  and  reheve  cases  whidi  must  else  go  un- 
benefited. 

In  the  rapid  sketch  of  the  book  which  the  state  of 
our  columns  makes  necessary,  we  can  say  no  more  than 
that  it  seems  to  be  the  entering  wedge  toward  the 
more  thorough  laying  open  of  the  important  subject  of 
which  it  treats.  We  trust  that  before  many  years,  the 
authors  will  give  the  profession  the  Airther  benefit  of 
their  studies  and  practice.  We  are  fully  aware  of  the 
valuable  contributions  of  Professor  Wm.  A.  Hammond 
to  onr  ther^eutical  knowledge  of  electricity ;  but  the 
book  of  which  we  have  been  speaking  is  so  obviously 
differet^t  in  its  scope  from  their  reoord  of  investigations, 
that  we  attempt  no  comparison. 

The  authors  are  among  the  first,  if  not  the  very  first, 
to  caU  attention  to  the  tonic  properties  of  general  elec- 
trization. If  they  never  do  anythine  more,  they  have 
done  a  great  work,  opened  a  large  field  which  is  yet  to 
be  oarenilly  cultivated. 


Thb  cbime  of  nrrAvnoiDE  is  increasing  in  France ;  and 
on  this  account  the  juries  who  are  called  upon  to  deal 
with  these  offences  have  recently  found  their  verdicts 
unaocompanied  with  any  allusion  to  mitigating  circum- 
stances. Thus  at  the  assizes  of  the  Gironde  a  young 
woman  of  25  has  been  condemned  to  five  years*  impria- 
onmen^  with  hard  labor,  for  throwing  her  new-Wa 
infant  into  the  river ;  and  another  woman  has  been 
sentenced  to  eight  years'  penal  servitude  at  Strasbujrg 
for  disposing  of  her  child  down  a  water-closet  At  the 
Msises  of  Saiftne-et-Loire  a  girl  of  18  was  committed  to 
prison,  with  hard  labw  for  seven  years,  for  burying  her 
child  alive. 


€ottt9por(iftntt. 


THE  INTERNATIONAL  MEDICAL 
CONGRESS. 


To  TBI  Edrob  or  i 


I  Medicai.  Rioobd. 


Paris,  Sept  9. 
Sm — ^Now  that  tiie  international  Medical  Congress  has 
come  to  an  end,  it  may  not  be  inappropriate  to  review 
its  proceedings,  and  endeavor  to  form  an  estimate  of  ita 
results. 

This  task  cannot  fail  to  disi^point.  It  is  acknowl- 
edged on  all  hands  that  the  Congress  was  ill-organised, 
the  programme  arranged  without  sufficient  tact,  and  the 
legitimate  aims  of  the  discussions  almost  entirely  lost 
sight  of  Evidently  the  great  advantage  to  be  gained 
by  the  discussions  of  an  assemblv  of  physicians  fix)m 
all  parts  of  the  world  would  be,  that  the  contingent  of 
information  fiimished  by  each  should  represent  some- 
thins^  peculiar  to  his  country  or  school  Data,  often 
Eainfully  gleaned  firom  the  records  of  traveller.'*,  would 
e  collected  in  abundance  by  medical  observers  resident 
on  the  spot,  and  offered  to  enrich  the  common  treasure. 
Moreover,  celebrated  men,  who  had  hitherto  talked  to 
each  other  across  seas,  and  through  the  medium  of 
books,  would  meet  face  to  face,  would  familiariy  con- 
verse with  each  other  on  the  mighty  labors  by  which 
their  names,  their  fatherland,  had  been  rendered  illns- 
trious,  and  derive  mutual  refreshment  from  the  rare 
intercourse. 

AU  this  I  say  might  have  been  expected.  But  the 
expectation  has  been  very  imperfectly  fulfilled.  In 
the  first  place  only  inadequate  provision  was  made  in 
different  countries  to  send  such  men  as  should  most 
justly  represent  the  actual  condition  of  national  science. 
There  should  have  been  official  delegates  &om  the  prin- 
cipal universities,  who  should  have  been  distinguished 
from  the  crowd  of  mediocrities  who  might  choose  to 
attend,  but  who  should  not  be  mistaken  K>r  such  repre- 
sentatives. From  lack  of  such  precaution,  a  multitude 
of  opinions  were  advanced  which  were  entirely  undeserv- 
ing the  sanction  of  so  solemn  an  occasion  as  this  pro- 
fessed to  be.  Any  one  could  speak,  and  any  one  did 
speak:  and,  as  a  rule,  the  more  distinguished  visitors 
held  tiieir  tongues. 

Not  a  word  from  Virchow  or  (Jraefe,  who  were  both 
present;  not  a  word  from  Bennett  or  Simpson.  In- 
deed only  two  Englishmen  are  on  record  as  having 
spoken,  and  not  a  single  American.  The  debases  were 
chiefly  maintained  by  the  French  and  Italians.  This 
was  probably  in  part  owing  to  the  very  imperfect 
knowledge  of  French  that  prevails  among  us  Anglo- 
Saxons,  especially  the  Americans,  and  whidi,  as  I  uAve 
had  quite  frequent  occasion  to  observe,  seriously  inter- 
feres with  the  benefit  they  are  able  to  derive  from  a 
few  months*  visit  to  Paris.  But  the  silence  also  re- 
sulted, in  all  probability,  from  the  fact  that  few  had 
prepared  themselves  for  a  sufficiently  long  time  in  ad- 
vance ;  as  a  consequence,  the  topics  for  discussion  were 
developed  in  the  most  unequal  and  irregular  manner. 
The  mmute  anatomy  of  tuberculosis  occupied  two  or 
three  sessions,  in  which  nearly  all  the  speakers  were 
French,  who  revived  old  disputes  without  reporting 
any  researches  made  especially  for  the  Congress.  On 
the  other  hand,  the  three  questions  that  seemed  most 
peculiarly  adapted  for  international  discussion — the  in- 
fluence of  various  climates  upon  menstruation;  tho 
problem  of  acclimation ;  and  the  influence  of  alimei^- 
tation — were  only  touched  upon  in  the  most  cursorj 
manner.    As  a  whole,  there&re,  the  Ck>ngre^a  oannoi 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


B11 


he  said  to  have  arrived  at  any  valuable  result  Never- 
theless, two  of  the  discussioDS— on  the  treatment  neces- 
sary to  prevent  purulent  infection  afler  surgical  opera- 
tion?, and  on  measures  to  be  recommended  to  the  gov- 
ernments of  various  countries  to  arrest  the  spread  of 
syphilitic  diseases — were  exceedingly  interesting;  and  m 
ab  the  sSanceSj  various  topics  were  incidental^  devel- 
oped that  are  quite  worth  recording.  I  shall  endeavor 
to  mention  some  of  the  principal,  beginning  with  those 
which  occupied  the  least  time  and  attention. 

The  communications  made  on  the  subject  of  alimen- 
tatioD  were,  in  accordance  with  the  programme,  all 
written  in  rderence  to  pellagra.  M.  Bouchut  has 
found  on  grains  of  wheat  spoiled  by  the  damp,  a  fungus 
very  simikr  to  that  found  in  the  same  circumstances  on 
the  maize,  to  the  consumption  of  which  pellagra  is  gen- 
erally attributed.  He  proposes  to  name  mis  fungus 
apariaorvum  tHHcL  To  obtain  it  it  is  only  necessary 
to  place  some  wheat  in  ajar,  and  keep  it  damp. 

M.  Demaria  believes  that  pellagra  is  not  dependent 
on  an  accidental  poisoning,  but  is  a  constitutional  neuro- 
sIb,  dependent  on  hereditary  influences  and  poor  food. 

The  communications  of  M.  Dropsy,  of  Cracovia,  con- 
cerning the  Polish  Jews,  and  Mr.  Kingston  on  the 
Anglo-Canadians,  presented  in  the  course  of  the  dis- 
cussion on  tuberculosis,  touch  on  a  subject  of  more 
widely  spread  interest  than  the  poison  of  the  maize. 
Each  tends  to  prove  the  enormous  influence  of  animal 
food  upon  the  preservation  of  health,  especially  from 
the  raviufes  of  phthisis.  At  Cracovia,  the  peasants  are 
all  healthy  and  robust,  living  much  upon  animal  food. 
The  Jews  scarcely  spend  more  than  two  sous  a  day  for 
their  nourishment,  and  never  eat  meat  Consumption 
makes  such  ravages  among  them  that  the  race  threatens 
to  die  out  In  the  same  way  in  Canada,  the  French 
Canadians,  who  eat  meat  in  excess,  often  three  or  four 
times  a  day,  are  declared  by  Mr.  Kingston  (an  English- 
man)VD  be  a  superb  race  of  people ;  while  their  English 
neighbors,  who  live  much  more  soberly,  are  infinitely 
more  subject  to  tuberculous  disease. 

The  question  of  acclimation  was  as  much  restricted 
88  that  of  the  influence  of  food,  being  limited  to  the 
investigation  of  the  conditions  necessary  for  acclimat- 
ing Europeans  in  warm  countries.  M.  Simonot  read 
an  interestuig  memoir  on  the  subject  For  him  the 
difficulty  did  not  arise  from  the  heat  of  the  climate, 
but  the  poisonous  influence  of  miasm.  Wherever  that 
cou'd  not  be  destroyed,  it  was  useless  to  expect  to 
make  permanent  homes  for  white  families. 

M.  Lombard,  not  adhering  strictly  to  the  question, 
communicated  the  result  of  researches  on  the  laws  of 
mortality  in  Eur(^,  according  to  atmospheric  in- 
fluences. According  to  these,  winter  and  spring  is  the 
most  sickly  season  mr  all  the  north  and  centre  of  Eu- 
rope, while  the  southern  countries  enjoy  their  excess  of 
mortality  in  summer  and  autumn.  In  Europe,  miasm 
still  continues  to  be  one  of  the  most  powerful  agents 
influencing  mortality,  and  it  is  an  agent  which  in  this 
country  it  is  in  the  power  of  man  to  remove. 

A  number  of  carefully  prepared  memoirs  on  the  ques- 
tion of  menstruation  were  communicated ;  but,  as  most 
of  them  consisted  mainly  of  statistical  tables,  they  could 
not  be  read.  The  stati:}tics  that  were  read,  by  M.  Lag- 
neau  and  M.  Joulin,  accord  very  well  with  the  estab- 
lished law,  in  virtue  of  which  menstruation  is  known 
to  be  precocious  in  warm  cUmates,  and  retarded  in  cold. 
In  Bnglish  India,  the  average  age  for  the  establishment 
of  puberty  is  twelve  years  and  six  months.  In  Nor- 
way, sixteen  years  and  four  months.  The  supposed 
dirorences  between  difierent  cities  of  France  is  shown 
to  be  trifling,  Marseilles  being  only  six  months  earUer 
than  Paris. 


Mr.  Bobert  Cowie  has  made  some  curious  researches 
upon  menstruation  in  the  Shetland  Islands,  and  its  con- 
nection with  longevity.  In  this  locality  the  menses 
are  established  at  the  same  a^e  as  in  weat  Britain, 
while  the  mSnopauaey  instead  of  occurring  at  forty-five 
or  forty-six  years,  is  deferred  to  a  period  varying  from 
forty-eight  to  fifty-four  years,  fifty-one  bein^  the  aver- 
age. In  connection  with  this,  Mr.  Cowie  notices  a  con- 
siderable difierence  in  the  rate  of  mortality,  as  shown 
by  the  following  table : 

Shetland  Islandi.  Scotland, 

Above  70  years  =  33.55  per  100.  18.25  per  100. 

'*     80     "      =  20.00      "  7.05      " 

tt     90     "     =    5  03      "  1.00      '^ 

From  95  to  106  years  =  2.68  per  100.        0.29      " 

The  discussion  on  tuberculosis  was  divided  into  three 
parts,  severally  referring  to  its  pathological  anatomy, 
its  prevalence  in  different  climates,  and  its  treatment 
Of  these,  the  first  received  much  the  most  attention, 
not  because  of  its  superior  importance,  but  because  it 
happens  to  be  extremely  d  la  mode  at  the  moment, 
and  more  speakers  had  something  to  say  on  it  The 
debates  touched  on  the  following  questions :  First,  the 
specificity  of  the  tubercle;  second,  its  identity  with 
the  products  of  inflammation ;  third,  the  precise  seat  of 
the  granular  deposit ;  fourth,  the  relation  of  the  yellow 
degeneration  to  the  gray  or  crude  tubercle ;  fifw,  and 
finally,  two  or  three  peculiar  and  rather  bizarre  opinions 
were  advanced  which  had  no  relation  with  any  of  these 
points. 

The  question  of  the  specificity  of  the  tubercular 
deposit  may  be  variously  reg^Etrded.  A  special  anatomi- 
cal element  may  be  sought,  as  characteristic  of  tuber- 
cle, but  such  an  attempt  was  universally  pronounced 
to  be  chimerical.  On  the  roecific  character  of  the 
tuberculous  product,  either  the  gray  or  the  cheesy 
may  be  attacked  or  defended,  together  or  separately. 
Such  a  combat  occurred,  and  was  marked  by  a  diverfdty 
of  arguments,  in  support  of  a  diversity  of  theories. 
Professor  Crocq  of  Brussels,  and  M.  Lebert,  assimilate 
completely  the  tuberculous  process  to  the  inflammatory. 
M.  Crocq  began  by  declaring  that  the  cellules  of  the 
gray  granulation  could  be  compared  to  nothing  but  the 
cellules  of  the  lymph  and  lymphatic  glands,  toe  white 
globules  of  the  blood,  of  mucus,  and  of  pus ;  in  other 
words,  leucocytes,  among  which  he  did  not  hesitate  to 
class  ihem.  In  the  granulations,  these  leucocytes  are 
distinguished  from  pus,  chiefly  by  the  absence  of  inter- 
cellul^  substance;  are  smaU,  because  bathed  by  no 
liquid,  and  have  only  a  sin^e  nucleus,  on  account  of 
their  low  vitality.  These  leucocytes  arise  from  the 
epithelial  ceUs,  or  those  of  the  connective  tissue,  and 
submit  ultimately  to  fatty  degeneration,  etc. 

The  phenomena  successively  exhibited  in  the  forma- 
tion of  these  leucocytes,  are  identical  with  those  of  the 
cellular  elements  of  inflamed  tissues.  When  an  orgui 
is  examined  in  which  tubercles  are  developing,  it  is 
found  strewn  with  vascular  patches.  Sometimes  the 
centre  is  already  consistent  and  elastic  and  at  this 
centre  the  tubercle  is  gradually  formed  oy  exudation, 
since  vasculariization  and  repletion  of  the  tissues  by 
matters  destined  to  be  exuded,  is  common  to  inflam- 
mation and  tubercular  formation.  Moreover,  in  inflam- 
mation the  cellular  elements  absorb  new  material,  swell, 
become  opaque,  and  finally  give  birth  to  new  genera- 
tions of  cells  similar  to  the  leucocytes.  These,  either 
in  the  tubercle  or  inflammation,  have  four  destinations. 
First,  they  are  destroyed,  and  their  materials  re- 
absorbed; second,  they  are  transformed  into  new 
connective  cells;  third,  they  svrim  in  an  intercellular 
Hquid,  and  constitute  pus ;  fourth,  they  undergo  the 
fatty  degeneration. 


Digitized  by 


Google 


873 


THE  MSDICAL  RECORD. 


It  resultB  from  these  considerations  (concludes  M. 
Crocq),  that  tuberculization  is  by  no  means  a  specific 
disease,  recognizing  a  vice  of  the  blood  for  cause,  but 
an  affection  of  the  same  order  as  inflammations,  and 
should  be  combated,  like  other  phlegmasias,  by  anti- 
phlogistics  and  revulsives. 

Lebert's  views  are  substantially  the  same,  but  are 
based  on  inferences  derived  from  certain  experiments 
made  upon  animals  by  injections  of  various  substances 
under  the  skin.  In  eleven  instances  were  used  the 
products  of  chronic  pneumonia,  chronic  adenitis  ap- 
parently tuberculous,  and  tuberculous  granulations  of 
the  lungs;  two  experiments  with  injections  of  pus; 
nine,  the  products  of  expectoration  and  of  pulmonary 
caverns;  ten  injections  of  charcoal  or  mercury  were 
made  into  the  jugular  vein. 

The  charcoal  produced  little  emboli,  followed  by  cellu- 
lar hyperplasma,  little  granulations,  and  even  multiplica- 
tion of  the  epilheliid  cells  and  those  of  the  connective 
tissue.  The  mercury  provoked,  besides,  an  inflammation 
of  the  vessels ;  here  also,  however,  cellular  hyper- 
plasma, in  the  form  of  little  granulations,  and.  when  the 
irritation  had  reached  a  high  degree,  formation  of  solid 
inflammatory  foci  which  ultimately  suppurated  and  pro- 
duced cavema 

The  inoculation  of  morbid  products  excited  a  more 
severe  local  irritation,  and  also  numerous  granulations 
in  different  organs. 

Hence,  for  Lebert,  the  tubercle  strictly  resembling 
the  granulation  thus  artificially  created,  is  a  product 
eminently  hyperplastic,  and  cannot  be  classed  with 
accidental  products  properly  so  called. 

After  this  exposition  of  the  pure  inflammatory 
doctrine  of  tuberculization,  H^rard  and  Cornil  rushed  to 
the  defence  of  their  theory,  which  may  be  called  rnodi^ 
fied  inflammatory.  For  them,  the  gray  granulation  is 
the  only  characteristic  lesion  of  tuberculosis  which 
excites  au  inflammation,  whose  degeneration  consti- 
tutes the  so-called  cheesy  tubercle.  Neither  of  these 
champions  undertook  the  task  of  rebutting  the  -views  of 
Grocq  or  Lebert,  but  each  addressed  himself  to  that 
side  of  the  doctrine  which  touched  tipon,  and  was 
contradicted  by,  that  of  M.  Villemain.  This  physican 
has  recently  made  some  remarkable  experiments  on 
the  inoculation  of  tubercle,  and  has  succeeded  in  thus 
conveying  the  disease  to  rabbits.  So  far,  his  experi- 
ments tended  to  confirm  <at  least  without  the  critt* 
cism  afforded  by  those  of  Lebert)  the  doctrine  of  the 
specificitv  of  the  tubercular  deposit.  But,  proceeding 
further,  he  professes  to  have  obtained  gray  granula- 
tions, after  inoculation  with  die  yellow  cheesy  matter. 
In  consequence  of  this,  he  renounced  the  views  he  had 

{>reviously  held  in  regard  to  that  substance,  and,  no 
onger  believing  it  to  be  a  secondary  inflammation,  he 
concluded  it  to  be  a  more  advanced  stage  of  the  crude 
tubercle,  thus  returning  frunkly  to  the  ideas  of  Laennec 
Hdrard  replied  that  this  cheesy  pneumonia  (pneti- 
m&nie  cas^evse)  might  be  sufficiently  stamped  with 
the  character  of  the  granulation  by  which  it  was 
caused,  to  serve  as  material  for  infection;  but  such 
did  not  prove  that  it  was  identical  with  the  granulation 
which  could  often  be  found  in  its  midst,  little  changed. 

M.  Cornil  attacked  Villemain  on  another  point, 
namely,  in  regard  to  the  seat  of  the  granulation. 
Villemain,  in  a  memoir  of  some  length,  read  at  the  first 
session  of  the  Congress,  declared  that  the  greater  num- 
ber of  granulations  occupy  the  air-vesicles,  herein 
again  coinciding  with  Laennec.  At  tiie  beginning  of  his 
researches,  he  had  considered  the  contents  of  the 
alveoli  as  a  product  belonging  to  the  pulmonary 
epithelium,  and  distinct  from  the  granulation,  which  is 
the  view  actually  held  by  H^rard  and  OomiL    But 


subsequently,  M.  Villemain  became  convinced  that  the 
membrane  of  separation  between  the  alveoli  was  not 
homogeneous,  but  contained  a  special  element  identical 
in  structure  with  the  connective  tissue.  In  this  tissue 
were  deposited  the  greater  number  of  the  granulations. 
He  considers  the  existence  of  an  epithelial  layer  at  the 
internal  surfiu^e  of  the  alveoli  to  be  extremely  proble- 
matical 

Hence,  he  does  not  believe  that  the  elements  consti- 
tuting the  catarrhal  or  cheesy  pneumonia  are  derived 
from  epithelial  cells,  but  from  the  nucleated  cells  of  the 
membrane  separating  the  alveoli.  Being  much  crowded, 
these  cells  sometimes  assume  plane  surfaces  from 
pressure,  so  as  to  resemble  epithelium;  but  they  are 
never  soldered  together. 

M.  Villemain  admits  that  the  initial  stages  of  tubercle 
resemble  those  of  inflammation,  inasmucn  as  the  two 
external  zones  of  the  three  that  constitute  a  tubercu- 
lous nodosity,  represent  cells  in  different  stages  of 
development;  but  the  two  processes  are  to  be  dis- 
tinguished by  the  terminations,  which  for  inflammation 
is  pus,  for  tuberde  fatty  degeneration.  The  similarity 
between  the  anatomical  elements  of  these  two  states  is, 
as  M.  Villemain  justly  thinks,  no  reason  for  identifying 
them. 

M.  Cornil  denied  point-blank  that  the  tubercle  was 
developed  anywhere  but  in  the  lymphatic  or  ad- 
ventitious tunic  of  the  blood-vessels,  especially  at  their 
bifiurcation.  This  phenomenon  (in  tuoerculization  of 
the  pia  mater)  is  accompanied  by  two  others:  1st. 
The  multiplication  of  similar  elements  in  the  connective 
tissue  of  the  pia  mater  which  surrounds  the  diseased 
vessel ;  2d.  The  coa^ation  of  the  blood,  and  the  retro- 
grade metamorphosis  of  the  fibrine  and  blood-globules. 

ComU  admits  that  in  the  lungs  there  is  a  development 
of  elements  in  the  interalveolar  membrane.  But,  besides, 
he  insists  that  the  large  pavement  cells,  perfectly  free, 
measuring  0.015,  are  really  epithelial,  and  cannot  be  con- 
founded with  the  elements  of  the  connective  tissue, 
which  are  small,  0.004,  agglutinated,  intimately  united 
by  a  homogeneous  and  granular  substance.  The  first 
constitute  Hie  tuberculous  pneumonia;  the  second 
the  granulation. 

A  Hungarian  physician.  Dr.  Bakody,  warmly  sup- 
ported the  views  of  Cornil  He  moreover  suggested 
that  the  tubercle  developed  especially  in  the  summit  of 
the  lungs,  because  there  the  respiratory  movements  are 
less  extensive,  and  the  lungs  cannot  readily  reject  the 
mass  of  cells  which  form  in  the  alveoli  in  consequence  of 
inflammatory  irritation. 

The  question  concerning  tuberculization  in  different 
countries  and  circumstances  was  then  taken  up.  M. 
Marmisse  read  a  memoir  upon  the  influence  of  this  dis- 
ease on  the  mortality  at  Bordeaux.  The  influence  of 
hygienic  conditions  is  indicated  bv  terribly  eloquent 
figures  Among  1,000  poor  people  registered  at  the 
Bureau  de  Bknfaisance,  626  die  of  phthisis,  while  the 
rich  classes  only  yielded  a  tribute  of  87  on  1,000  to  this 
formidable  disease. 

J  have  already  quoted  M.  Dropsy's  remarks  on  the 
Jews  in  Poland,  and  Mr.  Kingston  s  on  the  English  in 
Canada.  Dr.  Horaan,  of  Christiania^  read  a  memoir  on 
the  disease  in  Norway,  and  its  distnbution  in  different 
sections  of  tlie  country.  The  proportion  of  deaths  from 
tuberculous  diseases  in  Norway  is  about  162  in  1,000. 
The  variations  in  different  districts  are  from  79  to  226 
per  1,000.  Sometimes  a  great  difference  is  observed 
between  two  neijjfhboring  districts,  which  cannot,  then, 
be  referred  to  difference  of  climate.  Dr.  Homan  in- 
vokes syphilis  as  a  powerful  ^nt  to  explain  this  differ- 
ence. The  capital  question  of  the  treatment  of  phthisis 
received  no  new  light 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


379 


I  must  not  forget  to  mention,  among  the  opinions  in- 
dependently broached,  that  of  M.  Empis,  who  invents 
a  new  disease  called  granuLiCy  distinct  from  tuberculosis ; 
and  of  a  physician  whose  name  escapes  me,  who  de- 
clares the  cause  of  tubercle  to  be  excessive  pressure  in 
the  blood-vessels,  whereby  the  colloid  matters  in  the 
blood  are  exuded  in  the  form  of  granulations. 

The  second  great  question,  on  the  prevention  of  ac- 
cidents after  surgical  operations,  was  developed  with 
much  animation.  Two  principal  opinions  obtained : 
one  the  perfect  efficacy  of  local  treatment,  the  otlier  the 
importance  of  minute  constitutional  care. 

One  of  the  most  interesting  memoirs  read  in  support 
of  the  first  theory  was  that  of  Professor  Bourgade,  of 
Clermont-Ferrand,  on  the  employment  of  perchloride  of 
iron.  The  capital  fact  from  which  the  Professor  reasons 
is  the  different  effect  produced  by  wounds  made  with  a 
bistoury  or  with  caustic.  The  latter  are  habitually  in- 
nocuous ;  the  former  often  followed  by  serious  accidents 
of  infection.  Some  surgeons  have  sought  on  this  ac- 
count to  substitute  the  caustic  for  the  bistoury ;  but  that 
is  impossible  in  a  large  number  of  cases,  and  the  bistoury 
will  always  remain  the  surgical  instrument  par  exc4- 
lence.  The  problem  is,  therefore,  to  reduce  the  wound 
made  by  it  to  the  same  conditions  as  that  produced  by 
the  caustic.  This,  according  to  M.  Bourgade,  is  accom- 
plished by  means  of  the  perchloride  of  iron,  which  com- 
bines intimately  with  the  tissues,  and  forms  over  the 
wound  a  kind  of  magma  solid  and  adherent,  a  species  of 
plastic  cuirass,  which  resembles  both  a  coagulum  and  an 
eschar,  which  becomes  hard  and  resistant,  and  only  be- 
gins to  separate  by  suppuration,  the  sixth,  eighth,  or 
tenth  day  after  the  operation.  The  following  is  the 
method  lor  its  application:  When  the  operation  is  fin- 
ished, and  the  arteries  suitably  tied,  the  wound  should 
be  washed  and  dried  with  the  greatest  care :  and  when 
the  flow  of  blood  is  well  arrested,  the  whole  surface  is 
covered  with  lint  saturated  in  a  solution  of  perchloride 
of  iron  at  thirty  degrees.  It  is  essential  that  all  parts 
of  the  wound,  bones,  muscles,  cellular  tissue,  etc., 
receive  the  direct  action  of  the  liquid.  The  wnole  is 
covered  with  moistened  lint 

When  the  tampons  of  lint  fall,  they  show  a  blackish 
surface,  covered  with  a  thin  eschar,  which  gradually  de- 
taches itself,  reveaUng  a  pink  wound  in  very  good  con- 
dition, already  covered  with  fleshy  granulations. 
•  This  method,  of  course,  is  only  adapted  to  wounds 
uniting  by  second  intention;  but,  in  M.  Bourgade*s 
opinion,  that  is  the  only  union  possible  in  hospitals. 
Several  surgeons  ex|N«ssed  the  opinion  that  the  attempt 
to  obtain  union  by  first  intention  was  rapidly  being 
abandoned.  The  perchloride  has  been  applied  in  95 
operations,  all  followed  with  success. 

The  accidents  that  are  guarded  against  by  the  per- 
chloride are  more  especially  purulent  and  putrid  infec- 
tion, phlebitis,  angeioleuciiis,  osteomyelitis,  and  consecu- 
tive haemorrhages. 

The  perchloride  is  supposed  to  act  by  a  light  cauteri- 
sation of  the  bleedinff  surfaces,  and  by  effecting  a  solid 
coagulation  even  in  the  interior  of  the  veins.  There  re- 
sults an  adhesive  and  obliterating  phlebitis,  which  pre- 
vents the  suppurative  phlebitis,  and  opposes  the  absorp- 
tion of  morbid  elements. 

M.  Barbosa,  delegate  from  the  Portugal  government, 
real  some  extracts  from  an  important  statistical  me- 
moir on  the  operations  practised  for  the  last  twelve 
years  in  the  hospital  St.  Joseph,  at  Lisbon.  They  were 
quite  favorable — only  69  deaths  among  243  ampu- 
tations of  Umbs;  among  these,  62  amputations  of 
the  thigh,  which  gave  29  deaths. 

M.  Barbosa  lays  great  stress  upon  the  good  hygienic 
conditions  of  the  wards,  ventilation,  and  cleanliness. 


He  adopts  the  circular  method  for  amputation,  and  al- 
ways dresses  the  wound  with  lint  dipped  in  alcohol 
saturated  with  camphor,  an  ancient  custom  in  Portugal. 

Professor  Gosselin  followed  Barbosa  in  attaclnng 
much  more  importance  to  these  circumstances  of  hy- 
giene t^an  to  the  local  dressing.  He  takes  especial 
pains  with  the  morale  of  his  patients,  endeavoring  gradu- 
ally to  accustom  them  to  the  idea  of  the  operation,  al- 
lowing them,  whenever  it  be  possible,  to  name  the  day, 
always  securing  them  from  pain  by  the  use  of  chloro- 
form, etc  He  is  also  careful  to  remove  the  patient  as 
far  as  possible  from  cases  of  erysipelas,  etc.,  which,  un- 
fortunately at  La  Piti^,  cannot  always  be  very  far.  Af- 
ter the  operation,  he  is  especially  careful  to  avoid  doing 
anything  to  cause  pain.  Never  places  any  apparatus  on 
the  stump  which  will  render  it  necessary  to  lower  or 
raise  it ;  does  not  attempt  to  draw  together  the  edges 
of  the  wound,  and  rejects  the  use  of  alcohol  in  the 
dressing  to  avoid  pain ;  places  the  patients  on  a  me- 
chanical bed.  which  allows  them  to  be  moved  without 
suffering.  By  these  precautions,  out  of  48  amputations 
he  succeeded  in  saving  29  patients,  a  mortality  of  39  on 
100.  Of  the  19  deatos,  10  only  were  by  purulent  in- 
fection. 

As  an  instance  of  the  disastrous  influence  of  moral 
shock,  M.  Gosselin  cites  the  case  of  a  patient  who  was 
doing  well,  when  he  heard  that  his  wife  had  become  in- 
sane and  was  at  the  Salpetridre.  Very  soon  afterward 
he  began  to  shiver,  and  fell  a  victim  to  purulent  infec- 
tion. 

M.  Vemeuil,  the  distinguished  surgeon  at  Lariboia- 
si^re,  especially  occupied  himself  with  the  consideration 
of  the  previous  health  of  the  patient  The  influence  of 
diseases,  manifest  or  latent,  of  the  kidneys  and  lungs, 
of  drunkenness,  miasm,  etc.,  is  constantly  proved  by 
the  unfortunate  results  of  the  best  conducted  operations. 
M.  Vemeuil  thinks  that  erysipelas  more  fi-equently  oc- 
curs in  individuals  with  Uie  herpetic  or  arthritic  dia- 
thesis. 

M.  Labat  attached  less  importance  to  previous  or  co- 
incident diseases,  and  agreed  with  M.  Bourgade  in  the 
attention  needed  for  the  local  conditions  of  the  wound. 
He  lays  down  several  rules  as  follows : 

1.  Never  attempt  to  obtain  immediate  union  except 
when  tiie  wound  is  shallow,  the  texture  of  the  tissues 
uniform,  the  opposed  surfaces  can  be  maintained  in  con- 
tact as  well  as  the  edges,  and  the  tissues  have  not  been 
too  profoundly  bruised. 

2.  Carefully  avoid  all  conditions  which  may  lead  to 
the  alteration  of  the  fluids,  and  their  sojourn  near  the 
mouths  of  the  veins. 

3.  Favor  the  draining  of  fluids  by  a  tube  or  other 
means,  establishing  a  canal  from  one  end  of  the  wound 
to  the  other. 

4.  Avoid  the  employment  of  all  irritating  substances, 
especially  in  regions  abundantly  provided  with  lym- 
phatics. 

6.  In  anfractuous  wounds,  fill  up  the  anfractuosities 
with  lint,  so  as  to  avoid  the  accumulation  of  fluids. 

6.  Preserve  the  limb  as  immovable  as  possible,  and 
avoid  too  frequent  dressings. 

7.  Abstain  absolutely  from  the  application  of  pure 
water  on  the  wound ;  always  use  alcohol 

8.  Whenever  there  is  reason  to  fear  purulent  absorp- 
tion, give  ergotine  in  the  dose  of  two  to  three  grammes 
from  the  first  day,  and  continue  as  long  as  the  danger 
lasts,  usually  ten  or  twelve  days. 

A  distinguished  professor  from  Home,  M.  Mazzoni, 
pointed  out  the  necessity  of  isolating  the  surgical  wards 
from  those  containing  fever  or  tuberculous  patients,  a 
precaution  hardly  ever  adopted  in  French  hospitals ; 
but  at  Naples,  Professor  Palasciano  did  not  hesitate  to 


Digitized  by 


Google 


980 


THE  MEDICAL  RECORD. 


tender  bis  resignation  when  the  attempt  was  made  to 
approach  a  fever  ward  near  that  of  his  operated  patients. 
M.  Mazzoni  asserted  the  comparatiTe  immnnity  of  the 
Italian  hospitals,  even  the  maternities,  from  erysipelas 
and  puerperal  fever,  in  all  cases  except  where  the  usual 
precautions  to  exclude  patients  affected  with  fevers  or 
other  contagious  diseases,  or  wit^  taberoolosis,  are  for 
some  reason  neglected. 

Mr.  Meric,  of  London,  also  claimed  for  the  EngUsh 
hospitals  the  merit  of  great  attention  to  this  point,  and 
ascribed  to  it  much  of  the  superior  success  of  English 
surgeons  in  ovariotomy. 

But  sometimes  the  most  lively  debates  of  the  entire 
Congress  were  excited  by  the  question  of  syphilis,  and 
its  means  of  prevention  by  legal  measures.  With  the 
exception  of  Dr.  Drysdale  of  London,  and  one  other 
physician  who  wished  to  oppose  moral  education  to  the 
extension  of  the  frightfol  evil,  it  was  everywhere  as- 
sumed that  the  only  efficacious  measures  consisted  in 
strict  surveillance  over  prostitutes.  In  proof  of  the 
results  obtained  by  this  means,  several  members  read 
elaborate  memoirs.  The  first  was  sent  by  M.  Wleminckx 
of  Brussels,  who  pronounces  that  to  be  the  best  regu- 
lated of  cities  in  this  respect.  All  the  registered  public 
women  are  examined  every  three  days,  and  punished 
if  they  fail  to  present  themselves  for  examination.  Upon 
the  slightest  suspicion  of  disease  they  are  sent  to  the 
hospitu.  All  physicians  are  forbidden  to  treat  prosti- 
tutes at  their  houses.  Rewards  are  offered  to  such  wo- 
men as  present  themselves  regularly  for  examination. 
By  iheans  of  these  precautions,  M.  Wleminckx  asserts 
that  the  number  of  syphilitic  diseases  has  very  consider- 
ably abated,  and  secondary  and  tertiary  affections  have 
Dearly  disappeared. 

In  addition  to  these  measures  applied  to  women,  iii 
military  hospitals  all  syphilitic  patients  are  rewarded  if 
they  will  denounce  the  person  from  whom  they  have 
contracted  the  disease. 

M.  Crocq,  also  from  Belgium,  observed  that  these 
measures,  so  efficacious  in  the  great  cities,  were  neglect- 
ed in  small  villages,  which  served  as  places  of  refuge  for 
clandestine  prostitution,  and  were  indestructible  foci 
of  syphilis. 

M.  Rollet,  in  the  name  of  the  Imperial  Society  of 
Medicine  at  Lyons,  advocated  not  omj  surveillance  oT 
the  women,  but  of  all  men  in  situations  where  their 
conduct  could  be  controlled^  as  soldiers,  sailors,  ete. 
In  view  especially  of  the  temble  accidents  recently  oc- 
curring at  a  large  glass  factory,  where  the  workmen 
being  compelled  to  applv  their  mouths  successively  to 
the  same  tube,  nearly  all  contracted  the  disease  from 
one  whose  mouth  was  the  seat  of  syphilitic  ulceration, 
M.  Rollet  recommends  the  extension  of  this  surveillance 
to  the  glass-blowers  also. 

M.  ffuchon  made  a  report  of  the  measures  actually 
enforced  in  the  French  navy.  Every  sailor  or  soldier 
is  submitted  to  an  examination,  previously  to  the  arri- 
val of  the  vessel  in  port,  and  none  are  permitted  to  go 
on  shore  without  a  certificate  of  perfect  health.    Same 

Precautions  before  leaves  of  absence  are  granted, 
'hanks  to  this  incessant  surveillance,  which  uthough 
of  ancient  date  has  been  especially  vigorous  since  1830, 
the  navy  department  has  greatly  diminished  the 
number  of  syphilitic  patients  admitted  into  the  hos- 
pitals. At  Brest,  where  the  hospital  formerly  alwavs 
contained  three  hundred  beds  of  such  patients,  the 
number  has  diminished  to  one  hundred. 

M.  Le  Fort  presented  some  statistics  concerning  the 
actual  state  of  prostitution  in  Paris.  The  total  number 
of  registered  prostitutes  is  3,851,  of  which  1,306  are 
distributed  amon^  one  hundred  and  sixty-five  houses 
—the  rest  are  isolated.    The  amount  of  clandestine 


prostitution  is  enormous,  but  cannot  be  estimated. 
All  soldiers  treated  for  the  disease  are  compelled  to  re- 
veal its  source,  and  the  police  pursue  the  woman.  A 
certain  number  of  girls  are  arrested  every  day  for  clan- 
destine prostitution ;  among  13,818  of  this  category, 
3,728  were  found  to  be  diseased,  1,131  were  sent  to  St. 
Lazare,  7,217  reclaimed  as  minors  by  thenr  fiunilies  (!)> 
1,649  only  were  registered. 

In  six  years,  504,000  examinations  have  been  made 
with  the  speculum  upon  prostitutes,  and  3,720  conta^ 
^ous  diseases  have  been  thus  discovered.  This  number 
IS  small  in  comparison  to  the  number  of  examinations, 
but  considerable  in  proportion  to  the  number  of  prosti- 
tutes registered. 

In  spite  of  all  this  surveillance,  as  Mr.  Drysdale  of 
London  remarked,  syphilis  is  not  less  frequent  in  Paris 
than  London,  where  prostitution  receives  no  sanction 
from  authoritative  surveillance. 

The  question  that  really  excited  the  Congress  almost 
to  a  flame,  was  that  of  the  possibility  of  preventing 
svphilis  by  inoculation.  It  is  unnecessary  to  record 
the  debate  in  which  M.  Ricord  quite  overbore  M.  Au<» 
zias-Turenne,  who  enthusiastically  advocated  such  in- 
oculation. Several  very  disastrous  and  even  fatal  di^^ 
eases  were  reported  by  those  who  adhered  to  Ricord's 
doctrine,  as  the  consequence  of  inoculation  with  the 
hard  chancre.     The  discussion  had  no  especial  result. 

Complementary  sessions  were  held  from  time  to 
time  in  the  evening,  in  which  various  interesting  sub- 
jects were  suggested  or  debated.  I  have  already  over- 
passed my  space,  but  must  mention  two  cOnmiunications 
of  real  curiositv. 

The  first  is  tie  exposition,  by  M.  Bnmetti,  of  a  new 
method  for  preserving  anatomical  pieces.  His  prepara- 
tions have  been  on  exhibition  at  the  Exposition,  but 
the  process  hitherto  has  been  kept  secret.  In  an  even- 
ing session,  however,  M.  Bnmetti  revealed  it;  and,  as 
I  know  from  personal  examination  of  his  preparations, 
the  results  are  so  admirable,  that  every  one  should  be 
acquainted  with  the  method. 

Several  operations  are  included  j  the  washing  of  the 
piece,  fi^eing  it  from  fat,  its  tannmg  and  desiccation. 

To  wash  the  piece,  M.  Bnmetti  passes  a  current  of 
pure  water  through  the  blood-vessels  and  excreting 
canals ;  then  alcohol  to  expel'  the  water. 

Then  ether  is  made  to  replace  the  alcohol  in  order  to 
dissolve  the  fat;  this  process  requires  several  hours. 
The  ether  penetrates  everywhere,  and  everywhere  ac- 
complishes its  work  thoroughly.  At  this  point,  the 
Eieoe  plunged  in  ether  can  bepi'eserved  indefinitely 
efore  proceeding  to  further  operations. 

Then  tannin  is  dissolved  in  boiling  distilled  water,  and 
this  solution  is  passf^d  into  the  blood-vessels,  etc.,  after 
the  ether  has  been  driven  out  by  a  current  of  distilled 
water. 

Then  the  piece  is  dried  by  being  placed  in  a  vase  with 
a  double  bottom,  and  containing  between  the  two,  boil- 
ing water.  By  means  of  a  reservoir  where  the  air  is 
compressed  to  about  two  atmospheres,  and  which  com- 
municates by  a  stopcock  and  a  system  of  tubes,  first 
with  a  vessel  containing  chloride  of  Ume,  then  witJi  an- 
other empty  and  heated^  then  with  the  vessels  and  ex- 
creting canals  of  the  piece,  M.  Bnmetti  establishes  a 
gaseous  current  which  expels  all  the  liquids.  The  op- 
eration is  then  finished,  and  the  piece  remains  supple, 
light,  with  its  natural  size  and  relations,  and  all  its  solid 
histological  elements.  The  most  perfect  microscopic 
slices  mav  be  made  from  the  preparation. 

Th6x>tnerinventioiL  which  is  too  good,  or  at  least  too 
strikf(ng,  to  be  passea  by  in  silence,  is  an  instrument 
for  Somatoscopy.  This  was  presented  by  M.  Millot,  of 
Russia,  and  is  dedgncd  to  illuminate  the  cavities  of  tiue 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


381 


body,  so  as  to  render  them  traDSparent  to  the  eye. 
The  apparatus  is  composed  of  a  glass  tube  containing  a 
platinQm  wire  curled  up  on  itself,  and  communicating 
by  copper  stems  with  the  two  poles  of  an  electric  battery. 
When  the  current  is  passed,  the  platinum  wire  grows 
glowing  white,  and  emits  an  intense  lights  This  tube 
introduced  into  the  stomach,  vagina,  or  rectum  of  the 
oadayer,  has  enabled  the  obseryer  to  see  by  transparence 
the  walls  of  the  abdomen.  M.  Mi  Hot  noiade  some  ex- 
periments upon  animals  before  the  Congress,  but  so  fiEur 
he  has  had  no  opportunity  to  test  his  apparatus  on  the 
Hviiig  subject  He  hopes,  however,  by  its  means  to 
bring  great  assistance  to  the  diagnosis  of  tumors  of 
the  ovary,  and  even  adherence?,  and  also  of  calculi 
and  tumors  of  the  bladder.  P.  G.  M. 


THE  ADMINISTRATION 'OF  CHLOROFORM 
BY  THE  VAPORIZER. 

To  nnt  Editob  or  tub  Mkdioal  Reoord. 

Sib — Permit  me  respectfully  to  submit  to  the  consid- 
eration of  your  readers  a  few  remarks  on  chloroform, 
and  a  new  method  of  administering  it  as  an  anesthetic. 

The  ordinary  way  of  giving  chloroform  as  an  anaes- 
thetic is  objectioni3t>le  on  account  of  the  deleterious 
effects  of  the  carbonized  air  formed  within  the  inhaler 
by  the  respiration  of  the  patient  An  absorption  of  the 
carbonic  acid  gas  into  the  system,  either  alone  or  with 
chloroform,  causes  various  degrees  of  toxicological 
effects.  Tnese  do  not  always  depend  on  the  quantity  of 
the  poison  thus  taken  :  but  are  much  owing  to  the  con- 
dition the  poison  finas,  that  nerve  power  which  ever 
shows  its  resistance  to  all  agents  that  are  enemies  to 
the  integrity  of  the  body.  In  this  tozico-physiologictd 
straggle,  so  to  speak,  either  the  one  or  toe  other  will 
triumph,  resulting  either  in  the  death  or  recovery  of  the 
patient.  If  our  premises  are  correct,  we  have  a  clue  of 
the  causes  of  death  from  the  effects  of  chloroform,  in 
cases  where  no  known  disease  exist  in  the  patient^  that 
are  considered  incompatible  with  the  condition  of 
chloroformic  ansssthesia. 

To  lessen  danger  in  giving  chloroform  by  inhalation,  I 
have  lately  used  the  spray  in  such  a  way  that  the  vapor 
is  received  into  the  lungs  highly  oxygenated  with  at- 
mo^^eric  air.  This  is  accomplished  by  the  use  of  an 
elastic  air-pump,  attached  to  a  dental  spray  instrument 
The  spray  of  chloroform  is  forced  into  an  inhaler,  which 
is  a  cone  made  of  a  towel,  giving  it  firmness,  and  in  a 
measure  making  it  impermeable  to  vapor  bv  pinning 
several  layers  of  writing-paper  around  it  The  inhaler 
with  this  arrangement  is  put  over  the  patient's  nose 
and  mouth,  and  as  the  spray  is  pumped  into  it,  it  is 
reoeiTed  by  inhalation.  The  action  of  the  sprav  may 
correspond  to  each  inspiration  of  the  lungs.  By  this 
methcxi  of  administering  chloroform  but  little  is  required, 
and  its  effects  are  highly  satisfactory.  I  am  firmly 
impressed  with  the  belief,  that  this  mode  of  etherizing 
patienta  is  accompanied  with  no  more  danger  than 
there  is  in  the  use  of  the  nitrous  oxide  gas. 

On  the  13th  day  of  August,  1867,  I  extirpated,  at 
Cozsackie,  New  York,  a  mammary  cancerous  tumor 
from  Miss  S.  J.  S.  My  assistants  were  Drs.  Williams, 
Spoor,  and  Jackson.  The  patient  was  of  plethoric 
habit  and  was  prepared  for  tne  operation  by  aperients 
and  low  diet  Twenty  minutes  before  administering 
the  spray  we  gave  her  an  ounce  of  brandy.  The  anaes- 
thetic given  in  the  case  was  a  mixture  of  equal  parts  of 
chloroform  and  sulphuric  ether.  The  patient,  in  a  few 
minutes,  was  gradually  and  promptly  brought  under  its 
fun  influence.  Ttie  operation  was  completed,  and 
Sims*  sutures  inserted  as  the  patient  merged  into  con- 


sciousness. The  amount  of  chloroform  used  in  :his  case 
was  one  teaspoonful,  or  one  tablespoonful  of  the  mix- 
ture. The  effects  of  the  anesthesia  were  of  short  dura- 
tion, and  the  wound  healed  almost  by  the  fibrst  intention. 
G.  P.  Haohinbero,  M.D. 

HuDtoif,  N.T^  Sept  1«,  18«T. 

THE  LIQUOR  ZINCI  CHLORIDI  IN  GONOR- 
RH(EA. 

To  nn  Editob  of  the  BIkdioal  Bioovd. 
Dear  Sir — My  attention  was  called  this  morning  to 
the  following  paragraph  in  Dr.  Bumstead's  work  on 
venereal  diseases :  **  The  chloride  of  zinc  is  a  powerful 
caustic  and  irritant^  which  fulfils,  although  in  a  much 
less  perfect  manner,  the  same  indications  as  nitrate  of 
silver,  and  may.  therefore,  be  used  under  simikur  cir- 
cumstances." "It  is  a  favorite  injection  with  some 
practitioners,  especially  with  my  venerable  friend  Dr. 
J.  P.  Batchelder  who  employs  a  very  strong  solution 
in  all  stages  or  gonorrhoea,  and  states  that  but  few 
cases  resist  more  than  a  week.  Dr.  B.  dissolves  3  ij  of 
the  chloride  in  3  iij  of  water,  and  directs  the  patient  to 
commence  with  three  drops  of  the  mixture  to  a  table* 
spoonful  of  water,  and  inject  thrf  e  times  a  day  j  to  add 
a  drop  at  a  time  (rarely  exceeding  eight  drops)  until  a 
smarting  sensation  is  produced,  and  then  graaually  to 
diminii^h  the  strength  until  the  discharge  disappears." 
This  paragraph  contains  a  most  singular  mistake  or 
misunderstanding  in  regard  to  my  use  of  the  chloride 
of  zinc  in  gonorrhoea.  I  do  not  in  fact  recollect  ever 
having  j^escribed  it  in  any  case  whatever,  except  as  a 
caustic  m  cancerous  affections.  My  injection  in  gonor- 
rhoea is  simply  six  drops  of  the  liquor  zinci  chluridi  to 
an  ounce  of  water — the  injection  to  be  made  three 
times  a  day,  the  strength  of  the  injection  to  be 
regulated  by  the  effect  produced,  a  slight  uneasiness 
only  being  desirable.  The  discharge  usually  disappears 
in  the  course  of  three  or  four  days.  I  generally,  now- 
ever,  advise  the  patient  to  inject  cold  water  as  he  did 
the  injection  proper  for  several  days.  The  cure  is 
usually  accomplished  in  five  or  six  days  from  the  com- 
mencement of  the  treatment;  and  I  may  add  that 
patients  treated  in  this  way  are  rarelv  affected  with 
chordee,  and  seldom  require  any  internal  reme(^» 

J.  P.  Batchkldsr. 
New  Tobk,  Sept  SS,  1867. 

THE  DISCOVERER  OF  AN./ESTHESIA. 

To  TBI  Bditob  of  nn  Mbqioal  Rbcobd^ 

Sir — A  recent  article  in  the  Medical  Record,  on  the 
discoverer  of  ansesthesia,  does  not  seem  to  me  to  reach 
the  true  point  at  issue ;  and  much  of  the  discussion  of 
the  respective  claims  of  Drs  Morton,  WeUs,  and  Jack- 
son, is  irrelevant,  from  failure  to  understand  just  what 
those  claims  are.  Knowing  Dr.  Morton  well  and  what 
he  does  claim,  from  personal  conversation,  I  ask  your 
indulgence  of  a  limited  space  in  reply. 

Dr.  Morton  does  not  claim  to  be  the  discoverer  of 
sulphuric  ether,  or  of  the  principle  of  anaesthesia — 
nor  does  Dr.  Wells.  Local  and  general  anaesthesia  {ana 
without,  and  aisihesis,  feeling,  or  consciousness),  has 
been  known  for  centuries,  and  signifies  in  its  profes- 
sional appUcation  a  condition  in  which  operations  may 
be  borne  without  pain  or  consciousness  of  suffering ; 
it  refers  to  a  class  of  i^nts  by  which  pa'n  is  reh'eved, 
and  susceptibility  to  it  suspended;  thus  opium  and 
other  narcotics,  cold  locally  applied  or  in  its  general 
effects,  alcohol  to  the  extent  of  complete  insensibility, 
have  all  been  long  employed  for  anaesthetic  purposes. 


382 


THE  MEDICAL  RECORD. 


nitrous  oxide  gas  was  long  known  to  the  profession, 
and  its  peculiar  properties  vaguely  understood ;  but  it 
is  granted  by  aU  familiar  with  the  discussion,  that  Dr. 
Wells  was  the  first  to  make  a  practical  application  of 
its  ancestheiic  property  in  the  extraction  of  teeth — and 
the  honor  let  none  take  from  him — but  here  he  stops ; 
a  bint,  taken  from  the  accidental  injury  of  Mr.  Cooley 
while  under  its  influence,  suggests  the  idea  of  extracting 
teeth  without  pain ;  the  experiment  succeeds,  and  since 
tlien  has  been  constantly  employed.  This  is  not  the  dis- 
covery of  nitrous  oxide — ^nor  is  it  the  discovery  of 
ansesthesia  I  Mr.  Colton  employed  it  long  before — it 
is  the  practical  application  of  the  gas,  as  a  feasible 
agent,  by  means  of  which  teeth  may  be  extracted  with- 
out pain ;  beyond  that  it  has  never  been  carried.  Its 
effects  are  too  fugitive  to  admit  of  severe  surgical  opera- 
tions under  its  influence ;  here  was  the  fault — and  here 
Dr.  Morton  introduces  sulphuric  ether,  having  tried  it 
upon  himself  and  others,  claiming  for  it  what  could  not 
be  claimed  for  nitrous  oxide  p*,  or  any  other  known 
agent,  the  power  of  inducing  msensibility  long  enough 
to  admit  of  severe  surgical  manipulations. 

Dr.  Wells  did  not  discover  nitrous  oxide — but  he 
did  conceive  the  idea  of  its  employment  as  an  anaes- 
thetic. Dr.  Morton  did  not  discover  sulphuric  ether — 
but  he  did  discover,  by  long  experimentation-  properties 
which  others  knew  nothing  of,  and  giving  them  to  the 
world,  became  one  of  its  grand  benefactors. 

Great  discoveries  are  not  stumbled  upon  often ; 
patient  thought,  long  and  close  investigation  and  exper- 
iment, are  the  price  of  any  really  valuable  advance 
in  science  or  art  Obstacles  constantly  present  them- 
selves, and  deter  many.  It  is  only  he  who  has  greater 
&ith,  and,  seeing  the  clue,  follows  it  out  in  all  its  intri- 
cacies to  the  ultimate  result,  who  is  the  victor.  Hints 
are  caught  from  others  unconscious  of  their  value ;  but 
to  the  patient  investigator  they  are  as  parts  wanting  in 
a  chain,  and  seen,  are  at  once  seized  and  worked  in 
in  their  own  proper  place,  and  lo !  the  chain  of  induc- 
tion is  complete.  Now,  what  was  wanted  previous  to 
the  discovery  claimed  by  Dr.  Morton  was,  an  agent  safe 
in  its  effects,  and  which  would  suspend  consciousness 
long  enough  to  admit  of  surgicd  operations.  Did 
nitrous  oxide  gas  meet  this  want  ?  It  was  simply  an 
advance  by  which  trivial  operations  could  be  performed. 
It  is  asserted  that  Dr.  Morton  previously  obtamed  what- 
ever he  knew  of  the  practicability  of  ansssthesia  from 
Dr.  Wells.  Dr.  Morton  denies  this;  but  grant  it  as 
relating  to  ansesthesia  by  nitrous  oxide,  did  Dr.  Wells 
originate  or  develop  the  principle  ?  It  was  known  long 
before ;  and  if  it  is  said  by  way  of  detraction  from  Dr. 
M.  that  he  owes  the  idea  to  Dr.  Wells,  just  as  true  is 
it  that  Jie  owes  the  idea  to  the  accidental  administration 
of  the  gas  in  his  presence.  The  test  of  the  real  value 
of  an  article  is  its  practical  application  to  real  wants. 
The  gas  never  met  them,  and  has  never  been  claimed 
as  really  valuable  in  general  surgeir.  Franklin  drew 
the  lightning  from  the  clouds — is  he  entitled  to  the 
credit  of  the  discovery  of  the  electric  telegraph  ?  No 
more  is  Dr.  Wells  to  the  honor  of  this  magnificent  dis- 
covery. Recognizing  a  want  never  yet  met ;  grasping 
isolated  facts  and  arranging  them  in  their  proper  rela- 
tions ;  seizing  hints  here  and  there,  by  patient  thought 
and  bold  experiment,  Dr.  Morton  announced  to  the 
world  the  discovery  of  anaesthesia  by  an  agent  harm- 
less in  its  proper  careful  use,  and  adapted  to  the  wants 
of  the  surgeon.  Struggling  against  incredulity  and  pre- 
judice, he  forced  it  upon  obstinate  unbelief;  he  com- 
battea  dogmatic  opposition  in  this  countnr  and  in 
Europe  from  the  profession,  the  pulpit,  and  the  press  ; 
and  at  last,  when  a  reluctant  assent  was  given  to  its 
worth,  and  this  changed  into  grand  eulogy  of  its  im- 


mense value,  his  claim  is  for  the  first  time  disputed. 
The  "  Report"  of  Hon.  Truman  Smith  is  easiy  ex- 
plained when  it  is  understood  that  he  is  trustee  K>r  the 
Wells  estate,  and  so  is  rather  a  special  plea  than  an 
impartial  scientific  document.  Scarcely  a  medical  so- 
ciety in  this  country  but  has  already  accorded  to  Dr. 
Morton  the  honor  which  he  claims;  and  while  perhaps, 
at  this  late  day,  no  new  facts  may  be  adduced,  yet  a 
careful  consideration  of  those  already  presented  can 
scarcely  fail  to  establish  his  claim  in  the  minds  of  the 
profession  throught»ut  the  country. 

I  am,  sir,  truly  yours, 

J.  W.  Lawton,  M.D. 

Stsaouu,  N.  Y.,  Sept  4, 1867. 


A  CASE  OF  ELEPHANTIASIS  ARABUM. 

To  TBI  Editok  or  thb  Mbdioal  Bsoobd. 

Sir — ^As  cases  of  Lymphangitis  Chronica^  or  EtephanU- 
asis  ArabuTTij  are  proverbially  rare,  particularly  among 
the  German  element  of  our  population ;  and  as  the 
subjoined  case  presents  one  or  two  points  of  interest^ 
the  same  is  respectfully  tendered  for  publication : 

Catherine  M: ,  aged  forty-three  years,  wife  of  a 

street-sweeper,  presented  herself  on  the  19th  of  June, 
1886,  at  the  surgical  department  of  the  German  Dispen- 
sary. Her  frame  seemed  fragile^  her  countenance  cadav- 
erous ;  when,  upon  being  questioned  regarding  her  mal- 
ady, two  legs  of  enormous  proportions  were  exhibited, 
the  lefl  one  especially  being  huge  and  unwieldy. 

The  disea£e  commenced,  without  any  assignable  cause, 
twelve  years  ago.  Its  growth  was  slow,  but  steady, 
for  two  years,  when  an  invasion  of  the  tissues  of  the 
right  leg  commenced.  After  the  lapse  of  four  years 
from  the  first  manifestations  of  the  disease,  it  remamed 
stationary.  The  following  appearance  was  then  pre- 
sented : 

From  knee  to  ankle-joint  a  smooth  mass  of  tisBQe. 
divided  into  three  large  swellings,  or  tumors,  separated 
by  excoriations  and  fissures.  On  the  outer  circumfer- 
ence of  the  first  tumor  was  a  flat,  granulating  sore, 
which,  however,  was  gangrenous  posteriorly. 

The  dimensions  were  as  follows:  circumference  at 
knee,  12}  inches ;  at  knee,  above  pateUa,  14}  inches ; 
of  the  first  tumor,  25  inches;  of  the  second,  located  at 
the  middle  third  of  the  tibia,  24  inches;  of  the  third, 
near  the  ankle-joint,  15  inches. 

Difiiculty  of  locomotion,  and  consequent  abstinence 
from  many  enjoyments,  were  the  only  inconveniences 
for  a  long  period. 

During  the  month  of  November  however,  erysipelas^ 
with  subsequent  ulcerations,  and  several  profuse  haem- 
orrhages occurred,  the  latter  having  caused  the  debil- 
itated condition  already  mentioned. 

As  the  results  which  are  obtained  through  operative 
proceedings  are  very  unfavorable,  and  as  her  aosemic 
cachectic  condition  contra-indicated  any  surreal  pro- 
cedure, recourse  was  had  to  the  expectant  method. 

Accordingly,  Dr.  L.  Voss,  who  then  officiated,  di- 
rected the  gangrenous  sore  to  be  dressed  with  a  solution 
of  permanganate  of  potassa,  and  exhibited  large  doses 
of  iron  internally. 

These,  with  absolute  rest^  horizontal  posture  of  botii 
limbs,  methodical  compression,  and  the  most  nutritious 
diet,  constituted  the  course  of  treatment. 

In  March,  1867,  she  reappeared  at  the  Di^>ensajry, 
when  a  few  folds  of  hypertrophied  skin  were  the  only 
remaining  traces  of  a  former  hideous  disease. 

Yours  truly,        ^    Davp  Brbub,  ILD. 

Niw  YoiM,  Sept.  28, 1991,    ^^^^^^  byS^C   ^  ■      ^^ 


THE  MEDICAL  RECORD. 


396 


THE  RUSH  MEDICAL  COLLEGE,  CHICAGO. 

To  rns  Editob  or  teb  Msdioal  Bsqobd. 

Sra — ^Yesterday  was  a  proud  day  in  the  annals  of  medi- 
cine. The  twenty-fifth  annual  course  of  lectures  by  the 
Faculty^  of  Rush  Medical  College  was  opened  in  the 
splendid  edifice  which  has  just  been  completed  for  the 
institution.  The  lower  lecture-room  was  crowded  by 
the  alumni,  the  students,  and  members  of  the  pro- 
fession, who  were  assembled  at  eight  o'clock  in  the  even- 
ing, to  hear  the  introductory  address.  It  was  the  larg- 
est gathering  of  medical  men  that  has  ever  been  seen 
in  the  Western  States.  Upon  the  platform  were  the 
members  of  the  Faculty,  the  Mayor  of  the  city,  and  a 
number  of  distinguished  citizens.  One  only  who  should 
have  been  present,  was  invisible — the  founder  of  the 
college,  the  famous  teacher  whom  envious  death  had 
snatdied  too  early  from  the  scene  of  his  triumphs. 

Alter  the  usual  formal  prayer  and  discourse  of  sweet 
music,  the  President  of  Uie  College,  Prof.  Blaney,  pro- 
nounced an  inaugural  address,  which  had  for  its  subject, 
"  The  past  History  of  Rush  Medical  College." 

These  interesting  reminiscences  were  followed  with 
an  appropriate  speech  of  congratulation  by  the  Hon. 
J.  B.  Rice,  Mayor  of  the  city.  The  new  professor 
of  surgery,  Moses  Gunn,  M.D.,  was  then  introduced 
to  the  audience,  and  proceeded  to  open  the  course  of 
lectures  with  an  address  well  calculated  to  excite  the 
attention  and  the  attachment  of  his  future  auditors. 
After  this  conclusion  of  the  hterary  exercises  of  the 
eTening,  Professor  Blaney  invited  the  guests  of  iJie 
school  to  an  entertainment  which  was  served  in  the 
q>acioa&  dissecting-room.  Everything  was  conducted 
with  perfect  good  taste,  and  there  was  nothing  that 
oould  mar  the  harmony  of  an  occasion  which  can  never 
be  forgotten  by  the  delighted  assembly. 

Rush  Medi<^  C<{llege  has  now  attamed  its  majority. 
Poasessing  the  finest  building  in  the  United  States,  its 
exterior  attractions  alone  are  sufficient  to  insure  per- 
manent prosperity.  The  new  structure,  which  was  last 
night  so  happily  dedicated,  is  built  of  brick,  with  an  in- 
terior &cing  of  white  concrete  instead  of  plaster.  It 
has  a  front  of  sixty  feet  on  Dearborn  street^  by  seventy- 
two  on  Indiana  street,  and  its  height  is  sixty-six  feet. 
The  old  building,  which  measures  thirty-two  feet  by 
seventy,  is  immediately  adjoining,  and  communicates 
with  the  new.  In  this  edifice  are  the  chemical  labora- 
tory and  the  dissecting-room.  The  lecture-rooms  fill 
the  whole  length  and  breadth  of  the  new  bnilding.  The 
lower  lecture-room  presents  an  appearance  similar  to 
that  of  the  amphitheatre  of  the  College  of  Physicians 
and  Surgeons^  N.  Y.  It  is,  however,  much  larger,  and  the 
semidroular  tiers  of  seats  rise  upon  the  panoptic  curve 
— a  great  improvement.  The  ceiling  is  supported  at  an 
elevation  of  twenty-six  feet,  by  four  massive  iron  pil- 
lars, light  and  air  are  fireely  admitted  throueh  win- 
dows wluch  pierce  three  of  the  walls  at  the  levd  of  the 
highest  row  of  seats.  Above  this  splendid  room  is  the 
anatomical  theatre,  with  its  seats  lor  seven  hundred 
students.  Lighted  through  the  dome  from  an  elevation 
of  fif^  feet  above  the  professorial  arena,  the  dim  vast- 
ness  of  its  depths,  as  seen  last  evening,  was  well  calculated 
to  create  a  profound  impression  upon  the  minds  of  the 
students  who^  for  the  first  time,  were  entering  the  pre- 
cincts of  Alma  MaUr,  Besides  these  spacious  theatres, 
the  building  contains  a  quiz-rooni,  sixteen  feet  by  thirty ; 
the  dissecting-room,  thirty-eij^ht  feet  by  eighty:  a 
mmeam,  a  laboratory,  rooms  tor  the  professors,  a  ois- 
pensary,  the  hall  of  the  College  of  Pharmacy,  a  hospital 
ward,  the  janitor's  room,  and  a  cellar  for  the  prepara- 
tion of  anatomical  subjects.    The  edifioe  is  heated  by 


steam,  and  contains,  as  we  are  told,  every  appliance  to 

make  it  the  most  perfect  medical  college  huilaing  in  the 

world.    All  this  upon  a  site  which  forty  years  ago  was 

a  howling  Indian  camp-ground.    It  is  wondertul  I 

M. 
Chicago,  October  8,  18<t7. 


Vim  |JublteatUrn«. 


Books  Aim  Pamphlets  Rbceiyed. 

Epidbhio  Mbninoitis  ;  ob  Oebbbbo-Spinal  MENiNOins.  By 
Alprkd  STiLLi,  M.D.,  Professor  of  Theory  and  Practice  of 
Medicine,  and  of  dinioal  Medicine,  University  of  Penosyl- 
vania,  etc.  PhUadelpbia :  Lindsay  k  Blakiston,  1867. 
8vo.,  pp.  178. 

Hufbland's  Abt  ov  Pbolonoiko  Lifb.  Edited  by  EB4SHns 
Wilson,  F.B.S.  Philadelphia:  Lindsay  k  Blakiston, 
1367. 

Tbansaotioks  or  the  Axbbioan  Medical  Assoclltion. 
Yd.  18.    1867. 

Oatalooue  of  thb  Suboical  Sbotion  of  the  UinTBD 
States  Abht  Medical  Musbuk.  Prepared  under  the 
direction  of  the  Surgeon-General,  U.S.  A.,  by  Alfred 
WooDHULL,  Assistant  Surgeon  and  Brevet  Major,  U-SwA. 

Catalogue  of  the  Medical  Section  U.S.A.  Medical  Mu- 
seum. Prepared  under  the  direction  of  the  Surgeon-G^en- 
eral,  U.S. A.,  by  Brevet  Lieut-Colonel  J.  J.  Woodward, 
Assistant  Surgeon,  U.S.  A,  in  charge  of  the  Medical  and 
Microscopical  Sections  of  the  Museum. 

Studies  in  Pathology  and  Therapeutics.  By  Saicubl 
Hbnry  Dickson,  MD.,  LL.D.,  Professor  of  Practice  of 
Physic  in  Jefferson  Medical  College,  eta,  eta,  Philadelphia. 
New  York:  Wm.  Wood  <fc  Co.,  1867. 

ittcWcol  3tem»  anlr  VLma. 


personal. 

Dr  Adam  Frank,  of  Philadelphia^  has  been  appointed 
an  assistant  surgeon  in  the  navy. 

Surgeon  James  MoClblan  has  been  ordered  to  the 
naval  rendezvous  at  Philadelphia. 

Surgeon  G.  S.  Olebourne  has  been  ordered  to  the 
apprentice-ship  Saratoga. 

Drs.  Frank  H.  Hamilton,  Elisha  Harris,  T.  Gkillard 
Thomas,  Theodore  Walser,  and  A.  Nelson  BeU,  have 
been  appointed  the  Executive  Committee  at  a  recent 
meeting  of  physicians,  and  have  in  charge  matters 
relating  to  the  relief  of  the  Southern  yellow-fever  suf- 
ferers. 


GOODTBAR  VBB8US  THB  DbNTAL  YuLOAITITB  CoMPANT. 

— ^An  important  patent  case  in  Baltimore,  of  GK)odyear 
against  the  Dental  Vulcanite  Company,  which  was 
argued  last  spring,  has  just  been  decided  in  &vor  of 
Gk)odyear. 

New  Works.— ProC  Geo.  T.  Elliot  of  this  city,  is 
engaged  upon  a  work  on  Clinical  Obstetrics,  to  be 
issued  shortly  hy  the  Appletons;  and  Prof.  C.  A.  Lee, 
of  Peekskill,  New  York,  is  similarly  occupied  with  a 
work  on  Practical  Therapeutics. 

N.  Y.  County  M!edioal  Society. — At  the  anniversary 
meeting,  held  October  7th,  the  following  officers  were 
elected  for  the  ensuing  year :  Dr.  B.  R.  Peaslee,  Presi- 
dent; John  T.  Kennedy,  Vice-President;  Ellsworth 
Siiot,  Secretary;  and  Whl  R  Bibbins,  Treasurer. 

The  latb  Dr.  Charles  E.  Morgan. — At  a  meeting 
of  the  Physicians  and  Surgeons  of  the  Northern  Di^>en- 
sary,  convened  on  Tuesday  evening,  Aug.  6,  1867,  to 


884 


THE  MEDICAL  RECORD. 


express  their  sentiments  upon  the  sudden  death  of  thei^^ 
esteemed  and  beloved  associate,  Dr.  Charles  £.  Mor- 
gan, the  following  preamble  and  resolutions  were  unan- 
imoasly  adopted : 

Whereas  J  It  has  pleased  Almighty  Qtod.  to  remove  from 
our  midst  an  intelligent,  earnest,  and  Christian  gentle- 
man; therefore, 

Resolved,  That  as  physicians  of  this  institution  we  feel 
the  loss  of  one  of  the  most  worthy,  efficient,  and  bril- 
liant members  of  its  medical  staff;  as  his  associates,  we 
feel  that  one  is  lost  to  us  whose  talents,  rare  medical  at- 
tainments, habits  of  patient  study,  and  earnest  devotion 
to  his  profession,  gave  promise  oi  a  most  brilliant  and 
Buccesimil  career ;  as  friends,  we  sorrow  that  we  shall  no 
more  on  earth  associate  with  one  whose  many  good 
qualities  had  endeared  him  to  us  alL 

Resolved,  That  we  will  ever  cherish  his  memory,  and 
emulate  his  example. 

ResoVued,  That  a  copy  of  these  resolutions  be  sent  to 
the  family  of  the  deceased  as  an  evidence  of  our  sincere, 
heartfelt  sympathy  in  their  deep  affliction,  and  that  they 
be  published  m  the  Medical  Record,  and  the  Nem  York 
DuMy  Times, 

EvKRARDUS  B.  Warner,  M.D., 
Saml.  B.  Ward,  M.D., 
B.  F.  Dawson,  M.D., 

Committee, 

(We  regret  to  say  that  the  above  preamble  and  reso- 
lutions were  sent  \^  us  at  such  a  late  date,  that  we  have 
been  unable  to  find  a  place  for  them  before. — [Ed^ 

Medical  Sooiett  of  Hudson  County,  New  Jersey. 
— ^The  regular  monthly  meeting  of  this  society  was  held 
at  Jersey  City,  September  6th,  Eight  members  were 
present. 

On  motion,  the  Chairman  appointed  a  committee  of 
three  members  to  take  into  consideration  the  laws  of 
the  State  regulating  the  practice  of  medicine,  and  in- 
quire whether  any  statute  exists  for  the  protection  of 
the  public  against  ignorant  pretenders  and  unqualified 
practitioners  of  medicine  and  surgery. 

The  Secretary  was  requested  to  have  notices  of  meet- 
ings published  in  the  Jersey  City  and  Hoboken  papers, 
and  send  a  synopsis  of  the  proceedings  of  each  meeting 
to  the  editors  of  the  Medical  Record  of  New  York, 
and  the  Medical  and  Surgical  Reporter  of  Philadel- 
phia.   E.  W.  Buck,  M.D.,  Secretary. 

The  Late  Dr.  Taooart. — At  a  special  meeting  of  the 
Hudson  County  Medical  Society,  held  at  the  office  of 
Dr.  Varick,  in  Jersey  City,  on  the  16th  inst.,  the  fol- 
lowing resolutions  were  adopted : 

Whereas,  It  has  pleased  Almighty  God  to  remove 
from  our  midst  our  worthy  brother.  Dr.  Charles  Tag- 
gart)  who  for  many  years  was  associated  with  us  a  mem- 
ber of  our  Society,  therefore  be  it 

Resolved,  That  tnis  mournful  event  has  deprived  us 
of  one  whose  honorable  and  generous  character  had 
won  our  esteem,  and  that  while  we  mourn  our  loss,  we 
bow  in  humble  submission  to  the  will  of  Gk)d. 

Resolved,  That  a  copy  of  these  resolutions  be  pub- 
lished in  the  Medical  Keoord  of  New  York,  the  Medi- 
cal and  Surgical  Reporter  of  Philadelphia,  and  the  pa- 
pers of  Jersey  City. 

T.  R.  Varick,  M.D., 
E,  W.  Buck,  M.D., 

M.  A.  Miller,  M.D., 

Cormnitiee, 

The  Yellow  Fever  in  1853  and  1867.— The  yellow 
fever  in  1853  gradually  increased  from  the  week  ending 
July  25  untQ  the  week  ending  August  25,  when  the 
deaths  ran  up  from  21  to  1»614.  The  next  week,  end- 
ing August  28,  the  number  of  deaths  by  yellow  fever 


was  1,486,  and  the  decline  then  was  gradual,  until  the 
disease  wa^  declared  no  longer  epidemic  on  the  13th  of 
October.  The  greatest  number  of  yellow  fever  deaths 
then  in  any  one  day  was  315,  August  21.  In  1867  the 
disease  has  certainly  assumed  a  much  milder  form. 
Taken  in  its  earliest  stages,  and  promptly,  judiciously, 
and  carefrilly  treated,  a .  great  majority  of  .the  patients 
recover.  The  number  of  deaths  for  the  week  ending 
August  31  was  126.  The  number  for  the  week  ending 
yesterday  morning  was  212.  The  highest  number  in 
any  one  day  this  year  is  44.  The  next  day  the  deaths 
declined  to  30,  and  yesterday  increased  again  to  43. 
The  disease  has,  we  believe,  reached  its  climax.  It 
will  we  have  no  doubt,  gradually  recede  from  this  lame 
to  tne  close  of  the  season.  The  lesson  of  the  yellow 
fever  deaths  this  year  should  be  engraven  deeply  on 
the  public  mind.  It  is  chiefly  owing  to  the  neglect  of 
such  thorou^  and  effective  sanitiiry  measures  as  were 
adopted  by  General  Butler  in  1862.  The  late  city  go- 
vernment shamefully  neglected  their  duty  to  protect 
the  public  health.  They  embarrassed  the  cit^  finances 
to  such  an  extent  that  the  present  city  administration 
is  crippled,  and  unable  to  do  what  ought  to  be  done  to 
cleanse  the  city.  The  canals  are  abominably  filthy,  the 
draining  machines  are  nearly  worthless,  the  contractors 
to  keep  the  streets  clean  neglected  their  duty,  and  hence 
the  result  There  would  nave  been  no  yellow  fever 
deaths,  or  but  few,  if  prudence  had  been  regarded  in 
the  sanitary  management  of  the  city. — N,  0,  R^pvUh' 
lican, 

A  Move  in  the  Bight  Direction. — At  a  recent  meet- 
ing of  the  Presbytery  of  Troy,  held  in  Glen's  Falls^ 
New  York.  Elder  John  Lambert,  M.D.,  of  Salem,  of- 
fered the  rollowing  preamble  and  resolutions,  which, 
after  free  discussion,  were  passed  unanimously  : 

Whereas,  It  appears,  from  recent  publications  by  some 
of  the  most  distinguished  physicians  and  statisticians  of 
our  country,  and  from  articles  in  both  reUgious  and  sec- 
ular papers,  that  the  prevention  and  destruction  of 
human  life  is  one  of  the  common  sins  of  our  age  and 
country  ;  and  whereas  many  of  our  leading  journals  are 
in  the  habit  of  giving  a  prominent  place  to  advertise- 
ments proposing  to  assist  in  committing  such  crimes ; 
therefore 

Resolved,  1.  That  this  Presbytery  express  their  de- 
cided conviction  of  the  great  criminality  of  such  pro- 
ceedings, and  of  all  other  means  contributing  to  like 
fearful  results. 

2.  That  our  Church  members,  and  the  families  con- 
nected with  us,  should  avoid  patronizing  and  encour- 
aging journals  that  admit  these  immoral  advertisements 
to  their  columns. 

New  York  Medical  Gazette. — The  two  first  numbers 
of  this  new  weekly  are  very  creditably  made  up,  the 
articles  being  as  varied  and  as  lengthy  as  the  sise  of  the 
journal  will  admit.  The  editorial  management  has 
been  confided  to  Leroy  Milton  Yale,  M.D.,  who  will 
doubtless  be  found  to  be  the  right  man  in  the  ri^ht 
place^  and  will,  vnth  his  well-known  energy  coupled  with 
his  hterary  ability,  do  everything  to  make  the  journal 
attractive  to  the  general  practitioner.  We  oordiaUj 
extend  to  this  new  candidate  for  &vor  a  welcome  to 
our  exchange  list,  and  trust  tliat  it  may  rapidly  earn  for 
itself  an  enviable  position  in  the  current  medical  litera- 
ture of  our  country. 

The  Memory  of  the  Late  Professor  Trousseau  is 
to  be  revered  by  the  Parisian  Academy  of  Medicine, 
by  his  marble  bust  which  it  is  proposed  to  place  in 
their  HalL  M.  Lasegue  has  issued  an  appeal  for  ^mds 
to  the  pupils  and  friends  of  the  eminent  deceased,  for 
the  purpose  of  carrying  out  this  object 


THE  MEDICAL  RECORD. 


885 


©rightol   Cottrmunicattona* 


INTRA-LARYNGEAL    SURGERY. 
By  J.  SOUS  COHEN,  M.D., 

or  PBILAOKLPHIA. 

No.  in. 

THE  EMPLOYMENT  OF  SOLUTIONS  IN  THE  FORM  OF  NEBULA 
OR  SPRAY. 

In  the  topical  treatment  of  affections  of  the  throat 
and  upper  air-passages,  applications  are  sometimes 
requisite  which  shall  produce  more  prolonged  contact 
with  the  diseased  structures  than  the  local  applicatioDS 
already  described;  sometimes  as  the  chief  mode  of 
treatment,  sometimes  as  an  adjuvant  to  other  local 
treatment,  and  sometimes  for  the  purpose  of  allaying 
the  pain  of  disease,  or  the  pain  produced  by  other 
local  applications.  The  method  most  fully  accomplish- 
ing this  purpose  is  the  employment  of  solutions  broken 
up  into  a  finely  diffused  spray  or  nebula,  projected  upon 
the  parts,  or  directed  there  by  means  or  the  voluntary 
mspiratory  effort  of  the  patient  The  principles  in- 
Tolved  in  the  production  of  the  nebula,  it  is  presumed, 
are  familiar  to  the  readers  of  the  Medical  Record,  and 
need  not,  therefore,  be  submitted  to  explanation  here. 
A  number  of  instruments  employed  for  the  purpose 
are  depicted  and  described  at  pages  169  and  170  in 
VoL  I.  of  this  Journal,  to  which  the  reader  is  referred. 
The  form  most  frequently  employed,  and  this  on  ac- 
count of  its  low  price  and  fiwality  of  manipulation,  is 
the  Bergson  apparatus  with  the  hand  bellows  of  vt, 
Andrew  Clarke,  of  London  (Fig.  6,  Vol  I.,  p.  170). 
The  spray  from  this  instrument  is  propelled  with  a 
considerable  degree  of  force,  and  it  is  therefore  more 
particularly  applicable  to  employment  in  affections  of 
the  nares,  mouth,  pharynx,  epiglottis,  and  npper  por- 
i  tions  of  the  larynx ;  and  but  little  effort  of  inspiration 
beyond  that  of  ordinary  breathing  is  necessary  to  pro- 
duce the  effect  of  drawing  the  current  in  upon  the  dis- 
eased surfaces.  When  the  nebula  is  to  be  made  to 
pass  the  dottis,  the  instrument  of  Mathieu  (Fig.  1,  p. 
169,  VoL  I.)  is  much  more  suitable,  as  the  spray  from 
it  is  more  diffused,  the  particles  being  mereljr  suspended 
in  the  air,  and  therefore  more  ant  to  be  carried  inward 
by  the  current  of  inspiration.  These  instruments  must 
either  be  set  in  action  by  the  patient  or  by  an  attend- 
anty  and  the  pumping  soon  becomes  irk^iSme,  so  that 
they  can  be  employed  only  for  a  few  minutes  with- 
out inducing  fatigue;  their  usefulness  thus  becoming 
impaired  to  a  certain  degree.  When,  therefore,  a  rather 
prolonged  application  is  required,  it  will  be  found  more 
convenient  to  employ  an  apparatus  in  which  the  steam 
from  boiling  water  b  employed  as  the  nebulizing  force, 
instead  of  comprised  air  as  in  the  instruments  just  re- 
ferred to.  Siegle's  apparatus,  or  any  of  its  modifica- 
tions, answers  Uie  purpose  of  preventing  fatigue,  because 
the  nebuiization  is  produced  without  muscular  effort  on 
the  part  of  the  patient  or  his  assistant^  and  can  therefore 
be  kept  up  for  as  long  a  period  as  may  be  desirable. 
The  trifling  amount  of  steam  which  becomes  mingled 
Tvith  the  spray,  can  hardly  dilute  it  injuriously,  and  will 
sometimes  be  of  great  advantage  by  raising  the  tem- 
perature of  the  spray.  With  an  apparatus  working  by 
compressed  air,  the  temperature  of  the  nebula  wm  be 
cold,  unless  a  solution  in  hot  water  be  employed,  or 
the  apparatus,  at  the  moment  of  its  employment^  be 
placed  in  a  vessel  containing  warm  water.  Steam  ap- 
paratuses of  this  kind  are  depicted  in  figures  3  and  4, 


page  170,  of  VoL  L  In  most  of  the  various  modifica- 
tions of  Siegle's  steam  hydrokomion,  as  also  in  the 
original  instrument  as  invented  by  him,  the  horizontal 
tube  from  which  the  steam  emerges  is  bent  before 
entering  the  boiler,  so  as  to  dip  down  into  itfix}m  above; 
and  in  using  these  we  find,  every  now  and  then,  es- 
pecially soon  after  the  apparatus  is  set  in  action,  that 
the  steam  condenses  at  this  elbow  in  the  horizontal 
tube,  and  as  this  is  driven  forward  by  the  escape  of 
the  steam  stiU  forming  behind  it,  it  spurts  out  the  hot 
water  with  some  force,  sometimes  projecting  it  into 
the  face  or  eyes  of  a  patient  with  very  uncomfortable 
results,  and  occasion^y  creating  an  mdisposition  to 
further  continuance  of  the  process.  This  can  in  great 
measure  be  avoided  by  having  the  horizontal  tube  pass 
directly  into  the  boiler  fi:t)m  the  side,  close  to  the  top, 
and  thus  avoiding  the  curve  which  the  steam  strikes 
in  its  ascent,  ^nie  ascending  steam  now  strikes  the 
top  of  the  boiler,  and  condenses  there  without  impeding 
the  escu>e  through  the  horizontal  tube  of  the  appwatus. 
This  is  tne  form  of  instrument  that  the  writer  is  in  the 


_1 


habit  of  employing ;  with  tubes  of  a  duck-bill  form, 
which  pemuts  of  their  being  introduced  within  a 
mouth  speculum,  and  thus  avoiding  considerable  loss 
of  spray.  The  tube  passes  into  the  boiler  through 
a  cork,  which  would  readUy  be  blown  out  by  an 
excess  of  steam,  thus  doing  away  with  the  necessity 
for  any  special  safety-valve  to  prevent  explosion  of 
the  boiler.  With  this  modification,  the  apparatus,  as 
depicted  in  the  above  figure,  is  essentially  the  appa- 
ratus of  Siegle,  having  his  original  arrangement  of 
a  lamp  with  a  screw  for  raising  and  lowering  the  wick 
so  as  to  regulate  the  evolution  of  the  steam.  A  small 
lamp  beneath  the  medicine  glass  can  be  used  to  heat 
the  solution,  when  desirable  to  increase  the  temperature 
of  the  nebula.  A  mouth  speculum  is  used  to  protect 
the  teeth,  tongue,  roof  of  the  mouth,  etc. ;  and  the  tube 
entering  the  fannel  extremity  of  the  speoulum,  thefaoe 
and  clothing  are  thereby  protected  from  the  spray,  a 
very  desirable  precaution  in  the  administration  of  solu- 
tions containing  nitrate  of  silver,  or  other  discoloring 
articles.  The  condensed  fiuid,  as  it  fiows  out  of  the 
funnel  extremity  of  the  speculum,  can  be  directed  into 
an  ajppropriate  receptacle  so  as  to  protect  the  clothing 
and  riimi  ture.  The  instrument,  with  all  its  appurtenances, 
can  be  obtained  firom  Mr.  GbucRio,  the  prominent  sur- 
gical-instrument maker  of  Philadelphia. 

Any  article  of  the  materia  medica,  soluble  in  wattf , 
or  in  weak  alcohol,  is  suitable  for  employment  by  tUs 
process.  Oils,  and  solutions  in  glycerine  have  also 
been  employed,  but  in  such  cases  the  apertures  of  the 
distribuUng  tubes  must  be  larger  than  sufllce  for 
Digitized  by  ^ „       ^_ 


886 


THE  MEDICAL  RECORD. 


watery  or  Alcoholic  solutions.  This  method  is  much 
superior  to  that  of  gargles,  because,  by  the  minute  sub- 
diyision  of  the  particles  of  the  fluid,  and  their  divergence 
in  exit,  more  complete  contact  with  the  structures  is 
secured,  as  well  as  a  more  continuous  effect  Their 
snpericmty  to  gargles  is  readily  shown,  for  it  is  impos- 
sible to  gargle  in  such  a  manner  that  the  fluid  shall 
come  in  contact  with  the  posterior  wall  of  the  pharynx 
without  a  voluntary  attempt  at  swallowing  at  the 
moment  of  garg^g,  which,  at  the  best,  but  secures  an 
imperfect  and  limited  contact.  One  can  prove  this  by 
gargling  with  some  colored  solution,  such  as  of  indigo 
or  anilme,  and  then  examining  the  effect  before  a 
looking-glass.  He  will  find  the  roof  of  the  mouth, 
tongue,  and  soft  palate  covered  with  the  color  em- 
ployed, but  not  the  deeper  structures.  Besides,  in 
those  diseases  accompanied  with  acute  inflammation  of 
the  fauces  and  pharynx,  gargling  is  often  impracticable 
on  account  of  the  pain  produced  by  the  effort,  and 
sometimes  on  account  of  the  difficulty  of  opening  the 
mouth  to  a  suflicient  extent  With  the  nebiuizer, 
however,  we  can  direct  the  spray  into  the  mouth  when 
it  cannot  be  widely  opened,  and  secure  contact  of  the 
solution  with  the  affected  surfaces  without  any  other 
cooperation  on  the  part  of  the  patient,  than  such  as 
simply  opening  his  mouth  to  prevent  the  ingress  of  the 
spray. 

These  applications  may  be  used  in  many  affections 
of  the  throat  and  upper  air-paasages.  In  coryta,  the 
spray  can  be  readily  inspired  into  the  nostrils  by  simply 
giving  the  head  a  suitable  inclination.  The  remedies 
which  have  been  found  most  applicable  to  this  disease 
are  muriate  of  ammonia,  to  induce  free  secretion  in 
dry  snuffles,  and  alum  to  repress  the  profuse  discharge 
of  rhinorrhoea,  as  also,  by  its  antiseptic  qualities,  to  coun- 
teract fetor  when  present.  ^ 

In  acute  ir\flammations  of  iAe  pharynx  and  fauces^ 
remedies  appHed  in  this  manner  are  of  great  value. 
Alum  and  tannin  are  the  articles  most  frequently  em-i 
ployed;  alum,  perhaps,  being  indicated  in  the  greater 
number  of  in^tances.  The  solution  of  alum  may  vary 
in  strength,  from  five  to  twenty  grains  to  the  ounce  of 
water,  and  may  be  employed  frequently  during  the  day. 
When  much  pain  is  present,  some  narcotic,  as  the  ex- 
tract of  opium,  from  a  quarter  of  a  grain  to  a  grain, 
ma^  be  advantageously  added  to  the  ounce  of  the  so- 
lution of  akun.  Recent  inflammations  of  the  tonsOs, 
especially  in  persons  subject  to  frequent  attacks  of  ton- 
silitis,  can  sometimes  be  rigidly  subdued  by  the  appli- 
cation of  a  nebulized  solution  of  alum,  five  or  ten  trains 
to  the  ounce  of  water,  repeated  every  hour  or  two  hours 
until  the  desired  effect  has  been  produced.  Sulphate  of 
copper,  in  the  proportion  of  horn  five  to  twenty  grains 
to  the  ounce,  has  been  used  with  similar  results. 

In  the  acute  inflammation  of  these  structures  ac- 
companjing  the  exanthemata,  as  in  the  anginoee  varietv 
of  scarlet  fever,  we  have  in  these  applications  an  ad- 
mirable method  of  afibrding  relief  to  local  suffering, 
moderating  the  degree  of  inflammation,  and  cleansing  the 
parts  of  aocumulating  exudation. 

In  the  exudations  accompanying  diphtheria  and  pseu- 
do-m^nbranons  croup,  we  have  a  means  of  making  local 
apidications  in  cases  where  the  employment  of  any 
other  method  would  be  impracticable.  Strong  solu- 
tions of  tannin  have  been  employed  for  this  purpose 
in  the  St  ikig^nie  Hdpital  defl  Enfants,  with  success  ; 
chlorate  of  potassa,  bromide  of  potassium,  and  other 
remedies  of  tms  class,  have  been  variously  recommended ; 
hot  water  broken  up  by  nebuhzation,  and  breathed  in 
upon  the  parfc^  is  a  most  invaluable  remedy;  but  the 
remedy  now  iwuonable,  and  a  good  one  it  is,  is  the 
lime-water,  which,  as  demonstrated  by  Kiichenmeister, 


and  confirmed  by  Biermer,  Forster,  and  others,  has  a 
peculiarly  solvent  effect  upon  diphtheritic  deposits 
which  have  been  expectorated  or  detached  from  the  mu- 
cous membrane ;  though  it  is  by  no  means  certain  that 
this  solvent  effect  can  be  depended  upon  while  the  de- 

Sosit  is  in  situ,  for  it  has  been  demonstrated  by  Dr. 
>a  Costa,  in  at  least  two  instances,  that  the  local  applica- 
tion of  lime  water  had  no  visible  effect  upou  the  diphthe- 
ritic deposits  against  which  the  spray  was  directed  with 
great  care  by  himself 

In  these  cases,  it  is  not  unlikely  that  the  beneficial 
effects  attributed  solely  to  the  lime,  are  in  great  measure 
due  to  the  warm  water  with  which  it  is  combined,  for 
the  instructions  are  to  administer  the  lime  inhalations 
hot  to  secure  the  best  results.  In  these  and  similar 
cases,  the  employment  of  warm  water  alone,  apart 
from  its  soothmg  effect  as  a  fomentation  applied  to  the 
parts,  as  to  an  inflammation  on  the  surface  of  the  body, 
by  supplying  moisture,  prevents,  or  at  least  retards,  the 
congelation  of  the  diphtheritic  exudation,  and  in  this 
manner  conduces  to  facility  of  detachment  and  expec- 
toration. 

In  (Bronte  inflammtUionB  of  the  pharynx  and  fauces. 
the  remedy  which  seems  to  have  produced  most  general 
benefit  is  tannin,  in  the  proportion  of  from  one  to  ten 
grains  to  the  ounce  of  water.  In  these  cases  the  ap- 
plications need  not  exceed  two  or  three  a  day.  Occi- 
sionally  a  weak  solution  of  sulphate  of  zinc,  a  grain  or 
two .  to  two  or  more  ounces  of  water,  will  produce  a 
more  satisfiMJtory  r^ult  than  the  tannin.  In  obstinate 
cases,  especially  when  they  have  been  of  long  standing, 
weak  solutions  of  iodine,  such  as  five  or  ten  drops  of 
the  tincture,  or  twenty  to  thirty  drops  of  Lugol's  solu- 
tion to  the  ounce  of  water,  perseveringly  continued, 
will  gradually  establish  an  idterant  influence  which  will 
eventuate  satisfactorily ;  especially  will  this  be  the  case 
when  there  has  been  glandular  involvement  of  the 
follicles,  tonsils,  or  Ivmphatics. 

There  is  a  form  of  dry  pharyngitis,  pharyngitis  sicca^ 
which  often  causes  a  CTcat  deal  of  distress,  producing 
attempts  at  clearing  the  throat  which  afford  no  relief 
and  sometimes  accompanied  with  intolerable  burning ; 
in  such  cases  advantage  may  be  expected  from  the  use 
of  a  nebulized  solution  of  the  muriate  of  ammonia,  from 
two  to  ten  grains  to  the  ounce  of  water,  and  resorted  to 
two  or  three  times  in  the  twenty-four  hours. 

I  have  seen  a  few  cases  of  chronic  inflammataon  of  the 
fauces  produced  by  exposure  in  the  fire-rooms  of  engine 
works,  in  which  the  application  of  the  spray  of  warm 
water,  or  a  warmed  infusion  of  wild  cherry  bark,  has 
afforded  a  great  deal  of  rehef  during  the  period  of  ex- 
posure. 

Solutions  of  the  nitrate  of  silver,  firom  a  quarter  of  a 
grain  to  a  grain  or  two  to  the  ounce  of  water,  have 
been  recommended,  employed  in  this  manner,  in  ohronic 
pharyngitis. 

Syphilitic  angina  has  been  successfiiUy  treated  by  the 
application  of  a  solution  of  corrosive  sublimate,  one  or 
two  grains  to  the  ounce  of  water. 

In  acute  laryngitis  the  inhalation  of  a  nebulized  solu- 
tion of  distilled  water,  sometimes  containing  from  two 
to  ten  grains  of  common  salt  to  the  ounce,  has  been 
found  of  great  service.  Alum,  tannin,  muriate  of  am- 
monia, sulphate  of  zinc,  the  mineral  acids,  hare  all  been 
recommended  in  this  complaint :  with  the  addition  of  a 
little  narcotic  for  the  purpose  or  subduing  pain.  Warm 
water  alone  will  oflen  afiord  a  grateful  feeling  of  relicC 

In  chronic  laryngitis^  whether  existing  as  a  distinct 
affection,  or  connected  with  tuberculosis,  alum,  tannin, 
chlorate  of  potassa,  the  salts  of  iron,  iodine,  and  weak  so- 
lutions of  nitrate  of  silver,  have  been  recommended  by 
various   authorities.      The  writer's   experience    leacla 


THE  MEDICAL  RECORD. 


887 


him  to  prefer  local  applications  b^  means  of  the  sponge 
or  mop,  as  more  directly  beneficial,  and  especially  so 
in  cases  where  ulceration  has  occurred;  though  the 
Ytrious  astringent,  alterative,  and  protective  inhalations 
are  often  to  be  advantageously  employed  in  addition. 

In  cedema  of  the  larynx  inhalations  of  a  strong  solu- 
tion of  tannin,  frequently  repeated,  have  been  warmly 
recommended  by  Trousseau,  who  relates  two  cases  in 
his  CUnique  MSdicaie,  In  two  instances  under  the 
writer's  care  prompt  relief  followed  the  employment  of 
an  opiate  solution,  which,  in  the  first  case,  had  been  ad- 
ministered for  the  purpose  of  subduing  local  distress 
preparatory  to  the  employment  of  scarification. 

In  the  recommendation  of  the  above  ipeasures  for  the 
local  treatment  of  affections  of  the  throat  and  upper  air- 
passages,  it  is  not  to  be  understood  that  general  treat- 
ment, the  regulation  of  diet,  and  so  on,  are  not  to  re- 
ceive as  muen  attention  in  the  management  of  disease  as 
if  the  local  measures  were  not  resorted  to.  All  that  is 
clainied,  and  this  much  is  claimed,  is,  that  affections  of 
these  structures  can  be  treated  much  more  successfiiUy 
by  the  employment  of  these  methods  of  local  medication, 
in  addition  to  systemic  treatment^  than  by  reliance  upon 
general  medication  alone. 


A  CASK  OF 

COMPLETE  LATERAL  LUXATION  OF  THE 

RADIUS  AND  ULNA  OUTWARDS. 

By  THEODORE  R.  VARIOK,  M.D., 

nnSKT  OITT,  v.  J. 

Qio.  Enight,  83t.  0  years,  was  thrown  violenlly  from  a 
waffon  while  in  rapid  motion,  striking  on  his  head  and 
back,  with  his  left  arm  behind  him  in  a  state  of  flexion. 
He  was  brought  to  my  office  on  the  3Ist  of  August, 
186/,  within  ten  minutes  after  the  receipt  of  the  injury, 
and,  consequently,  in  the  most  favorable  condition  for 
manipulation!  no  swelling  of  the  soft  parts  having  yet 
occuned.  The  forearm  was  in  a  state  of  semi-flexion, 
supported  by  the  hand  of  the  opposite  side,  the  ulna 
lying  to  the  outer  side  of  the  external  condyle,  with 
dight  posterior  projection  of  the  olecranon.  The  ole- 
cranon, ooronoia  process,  and  greater  sigmoid  cavity 
coald  be  distinctly  defined,  and  the  head  of  the  radius 
in  its  normal  attachment,  could  be  felt  rotating  subcu- 
taneously  on  pronating  and  supinating  the  forearm, 
free  motion  of  the  forearm  in  every  direction  was  pres- 
ent, giving  the  impression  of  being  attached  to  the  arm 
solely  by  the  soft  parts.  The  projection  of  the  internal 
condyle  was  out  of  all  proportion  to  what  is  seen  in  cases 
of  incomplete  luxation.  The  trochlea,  coronoid  depres- 
sion, and  the  olecranon  depression  were  distinctly  re- 
cognized. Complete  dislocation  of  the  ulna  outwards 
-wta  diagnosed,  which  diagnosis  was  corroborated  by 
my  fiiend,  Dr.  B.  A.  Watson,  who  was  present  and  as- 
sisted in  me  reduction. 

The  patient  was  placed  fiilly  under  the  influence  of 
ether,  and  moderate  extension,  oombined  with  lateral 
pressure,  effected  the  reduction  without  difficulty.  The 
subsequent  treatment  consisted  of  rest  and  oold  irriga- 
tion for  a  few  daysy  followed  by  passive  motion  of  the 
pftrts,  whidi  resulted  in  perfect  recovery.  The  amount 
of  inflammation  which  followed  the  injury  was  exceed- 
jug^j  fllieht,  due  unquestionably  to  the  prompt  reduc- 
tion of  Uie  luxation. 

The  exceeding  rarity  of  accidents  of  this  land  renders 
tine  case  one  of  more  than  ordinary  interest.  So  rare 
jtre  they  that  Sir  Astley  Cooper  doubted  the  possibility 
Off  ihax  oocunring,  and  writes  as  follows :  "  With  respect 


to  lateral  luxations,  they  are  always  incomplete,  and 
easily  discovered.*'  Gross's  scepticism  is  expressed  in  the 
foUowing  words :  *'  Lateral  dislocation  of  the  elbow- 
joint,  besides  being  exceedingly  rare,  can  scarcely  occur 
in  any  other  than  an  incomplete  form,  and  as  a  conse- 
quence of  severe  injury  extensively  implicating  the  soft 
parts." — System  of  Surgery,  vol  il,  p.  70. 

Errichsen's  testimony  is,  '^  complete  lateral  dislo- 
cation of  the  bones  of  the  forearm  being  exceedingly 
rare." — Science  and  Art  of  Surgery,  p.  264. 

According  to  Cbelius,  '^  The  lateral  dislocation  may 
be  either  complete  or  incomplete ;  that  outwards  is  more 
firequent  than  that  inwards." 

"  In  complete  lateral  dislocation  the  projection  of  the 
fore  and  upper  arm  are  much  more  decided  than 
in  the  incomplete,  and  on  account  of  the  great  tearing 
of  the  soft  parts,  the  forearm  is  movable  in  every  di- 
rection."— /%atem  of  Surgery,  vol  il,  p.  229. 

Hamilton  writes  as  follows :  "  The  large  minority  of 
outward  dislocations  of  the  forearm  are  incomplete; 
indeed,  only  nine  examples  of  a  complete  dislocation 
have  been  collected  by  Denuc^,  including  two  seen  by 
himself.  Malgaigne  has  since  added  two  more,  making 
in  all  eleven  cases.  All  these  examples  have  occurred 
in  the  practice  of  French  surgeons.  So  far  as  I  am 
able  to  discover,  no  American  or  En^flish  surgeon  has 
ever  reported  a  single  example." — JP)'ac,  and  Dishca' 
tione,  3d  edition,  p.  601. 

Nelaton  has  also  reported  one,  making  in  all  thirteen 
recorded  cases  of  the  accident ;  which  may  be  summed 
up  as  follows:  Denuc^,  nine  c^ses;  Malgaigne,  two; 
Nelaton,  one ;  Varick,  one ;  total,  thirteen. 


CASE  OF  DIABETES  MELLITUS  FOLLOWING 

INJURY  OF  THE  BRAIN. 

By  DK  McCLINTOCK, 

MOSBXB,  X.  T. 

I  WAS  called,  February  18,  1?67,  to  see  A.  P.,  twenty 
years  of  age.  from  whom  I  obtained  the  following  his- 
tory :  In  February,  1866,  while  felling  timber  in  the 
woods,  he  received  a  blow  on  the  head  from  a  filing 
branch.  He  was  removed  to  the  bouse,  and  two  cred- 
itable physicians  were  called  to  attend  him.  They  dis- 
covered a  longitudinal  fracture  of  the  occipital  and  the 
parietal  bones,  crossing  the  left  lambdoidal  suti^e.  The 
trephine  was  used,  and  a  disc  of  bone  with  some  spicula 
removed.  One  month  later  the  bowels  became  consti- 
pated, and  tiie  flow  of  urine  increased. 

When  first  seen  by  me  he  was  much  emaciated;  suf- 
fered intensely  fi-om  thirst;  appetite  voracious;  skin 
harsh  and  dry;  tongue  clean,  red,  and  tender ;  pulse  forty- 
eight;  weight  one  hundrea  and  eight  pounds,  showing 
a  K)ss  of  twenty-two  pounds  since  the  injury  was  re- 
ceived. He  was  voiding  |wo  hundred  and  fifty  fluid 
ounces  of  limpid  urine  daily,  sp.  gr.  1028,  showing  su- 
pir  by  all  the  tests.  He  complained  of  no  pain  in  the 
head  or  elsewhere. 

The  bone  seemed  nearly  replaced;  a  slight  open 
wound  remained,  from  which  oozed  a  drop  of  healthy 
pus.  He  had  a  httle  cough,  which  he  referred  to  the 
throat  or  larynx. 

He  was  placed  for  one  month  on  a  non-saccharine 
diet,  with  morphia,  ipecac,  and  cod-Uver  oiL 

At  the  end  of  this  time  the  urine  was  decreased  one- 
third,  sp.  gr.  1024,  and  the  thirst  and  distressing  symp- 
toms much  mitigated.  Tmct.  nuc.  voul  (gtt.  &  daily) 
was  soon  added.  At  the  end  of  the  next  month,  sp. 
gr.  had  Men  to  1019,  while  the  quantity  was  reduc<Mi 
to  ninety-six  flmd  ounoes.  Bowels  still  very  alu^^fish ; 


388 


THE  MEDICAL  RECORD. 


other  symptoms  much  relieved;  strength  increased,  bat 
weight  one  hundred  and  five  pounds.  Treatment  con- 
tinued, with  steam  bath  daily. 

In  August  last,  the  cough  increased  with  some  ex- 
pectoration, and,  on  examination,  the  lungs  gave  une- 
quivocal evidence  of  tubercle,  extensively  difiused. 
From  this  time  the  course  was  aownward.  Emaciation 
increased,  with  harassing  cough,  oedema  of  extremities, 
and  deatii  occurred  October  Ist,  eight  months  fi-om  the 
time  I  saw  him,  and  nineteen  from  date  of  injury. 

For  comment,  allow  me  to  quote: 

"  Again,  since  continued  irritation  of  the  bnun  at  the 
origin  of  the  pneumogastric  nerves  will  make  the  urine 
saccharine,  the  cause  of  diabetes  in  the  human  subject 
may  reasonably  be  placed,  in  some  instances,  within  the 
skull ;  and  we  may  understand  how  diseases  or  injuries 
of  the  brain,  or  even  mental  disquiet  or  dejection  ope- 
rating through  the  brain,  may  produce  it ' — See  page 
1008,  Watson's  Practice  of  Pkyste. 

"  Bearing  in  mind  the  name  and  distribution  of  the 
pneumogastric  nerve^  may  we  not  indulge  the  conjec- 
ture that  disease  or  iiyury  of  the  brain,  near  the  origin 
of  that  nerve,  may  directly  afiect  the  function  of  the 
stomach,  and  thus  prevent  its  digestive  power — or  the 
functions  of  the  lungs,  and  thus  inteifere  with  the 
chemical  destruction  of  sugar  in  those  organs.  This 
last  notion  might  seem  to  receive  support  from  the  fre- 
quent association  of  disease  of  the  lungs  with  saccha- 
nne  urine.*' — Op,  cit  ante. 


©rtginal  €tttuxte. 


LECTUBES  UPON  THE 

PHYSICAL  EXPLORATION  OF  THE  AB- 
DOMEN, 

DBLITlfiBID  (OCT.,  1897)  IN  THE  PBELIHINABT  CX)UB8B  AT 

THB  MSDIOAL  DEPABTMENT  OF  THE  UNIVEBSlTY 

OF  NEW  TOBK, 

By  ALFEED  L.  LOOMIS,  M.D., 

PBOFBSOK  OF  IH8T1TUTM  AX1>  PKACTIOB  OW  XSDIOUnB. 

Leotubb  I. 

Intboduction. — Topography  of  the  Abdomen—  Contents 
of  the  Various  Megions — Abdominal  Inspection,  Pal- 
pation^  Percussion^  and  AusevUaUon — Diseased  Con- 

^    diUons  of  the  Peritoneum,  Stomach,  and  IniestiMs. 

Gentlimen — ^There  are  difficulties  in  the  physical  ex- 
ploration of  the  abdomen  which  are  not  met  with  in 
similar  examinations  of  the  thorax. 

iF7r«^— Thoracio  diseases  involve  in  their  diagnosis 
the  examination  of  only  one  of  two  organs,  or  their 
appendages;  while  an  abdomiilal  affection  may  require 
for  its  diagnosis  the  examination  of  ten  or  twelve  or- 
gans. Thus,  a  tumor  on  the  left  side  of  the  abdomen 
may  be  either  an  enlarged  mesenterio  gland,  or  it  may 
be  connected  with  the  stomach,  spleen,  kidneys,  ova- 
ries, or  uterus;  or  it  may  be  a  hernia,  an  abscess,  a 
hydatid  cyst,  an  aneurism,  or,  lastly,  only  a  lump  of 


Second, — ^The  action  of  the  thorado  organs  is  r^^ular 
and  rhythmical,  and  their  contents  unvarying;  while 
the  action  of  the  abdominal  viscera  is  often  irregular 
and  intermittent.  An  abdommal  organ  may  also  at  one 
time  be  greatly  distended  with  contents,  and  80<m  afier 
be  empty;  when  filled,  its  contents  may  be  soUd,  fluid, 


or  gaseous,  or  all  these  together.  The  lungs  and  heart 
contain  respectively  the  saine  quantities  of  air  and 
blood  during  every  five  minutes  of  ordinary  life,  but 
the  stomach  and  bladder  can  never  remain  long  in  one 
condition,  either  full  or  empty. 

Third, — The  abdominal  organs  are  packed  loosely  in 
a  cavity  with  loose  walls.  Ttey,  therefore,  can  be  in- 
creased or  decreased  in  size  so  as  to  alter  whoUy  their 
relations  to  their  fellow  organs, — thus  the  uterus,  usu- 
ally the  smallest,  will,  in  fmfilling  its  natural  function, 
become  much  the  largest  of  all,  until  it  crowds  even  the 
thoracic  organs;  moreover,  in  disease  a  single  ovaiy 
may  swell  into  a  sac  which  will  fill  entirely  the  abdom- 
inal cavity.  These  constitute  the  chief  difficulties  in 
the  physical  examination  of  the  abdomen,  and  they 
must  always  throw  a  certain  degree  of  doubt  upon  all 
physical  diagnosis  directed  to  this  part  of  (he  body. 

To  facilitate  our  examinations,  and  to  render  our  in- 
ferences more  certain^  it  is  well  to  divide  the  abdomen 
into  regions,  by  jpassing  imaginary  planes  through  the 
body.  The  divimons  which  have  been  proposed  by 
different  observers  vary  somewhat  The  following, 
which  very  nearly  correspond  to  those  proposed  by  Dr. 
Bright^  will,  I  think,  be  found  most  useful : 

Tnus,  the  abdomen  may  be  divided  into  three  general 
regions — ^the  epigastric,  the  umbilical,  and  the  hypo- 
gastric. 

The  epigastric  is  bounded  above  by  the  dii^hragm, 
below  by  a  horizontal  i^ane  passing  through  the  an- 
terior extremities  of  the  tenth  rib  on  either  side.  In  a 
well-formed  chest  the  cartilage  of  the  tenth  rib  on 
either  sideoflEers  a  projection  at  its  lower  convex  border, 
which  can  be  felt  without  difficulty ;  a  horizontal  plane 
carried  backward  through  these  points  will  pass  be- 
tween the  bodies  of  the  first  and  second  lumbar  rer- 
tebr».  This  region  is  subdivided  into  the  right  and  left 
hypochondria,  which  correspond  to  the  qnoes  inclosed 
by  the  false  ribs. 

The  umbUieal  region  is  bounded  above  by  the  lower 
boundary  of  the  epigastric,  and  below  by  a  horisontal 
plane  passing  through  the  anterior  superior  spinous 
processes  of  the  ilia;  this  plane,  if  earned  backward, 
will  pass  between  the  second  and  third  sacral  opines. 

The  hypogastric  re^on  is  bo*jmded  above  by  the  lower 
boundary  df  the  umbilical  region,  bekrw  in  the  centre 
by  the  upper  margin  of  the  pubes,  on  ei^ier  side  by 
Foupart*s  ligaments.  This  region  occupies  the  whole 
cavity  of  the  true  pelvis.  The  umbitoJ  and  hypogas^ 
trie  reeions  have  each  three  subdivisions  made  by  two 
verticu  planes  passing  backwards  through  the  spinous 
processes  of  the  pubes  and  the  points  on  the  tentii  ribs 
already  alluded  to.  The  subdivisions  of  the  umbilical 
reffion  thus  produced  are  termed  the  central  or  urnhH^ 
icM,  and  the  lateral  or  the  right  and  l^  ktmbar.  The 
subdivisions  of  the  hypogastric  thus  produced  consist  of 
the  middle  or  pubic,  and  the  lateral,  or  right  and  2^ 
inguinal. 

The  organs  contained  in  these  regions  in  health  are 
as  follows  (the  situation  of  these  or^s  is  very  per- 
fectiy  ^own  in  the  diagram  on  pi^  od8,  Qray's  Anat- 
omy) :  The  epigastric  region  contdns  the  whole  of  the 
left  and  a  part  of  the  ri^t  lobe  of  the  liver,  the  gafi 
bladder,  the  pyloric  orifice  of  the  stomach,  the  com- 
mencement of  the  duodenum,  a  porticm  of  the  colon, 
the  pancreas,  the  aorta,  and  the  coeliac  artery. 

The  right  hypochondria  contains  neariy  the  whole  of 
the  right  lobe  of  the  liver,  the  anffle  of  the  ascen^ng 
colon,  the  greater  part  of  the  duodenum,  the  renal  cap- 
sule, and  the  upper  portion  of  the  right  kidney. 

The  left  hypodiondria  contains  the  rounded  cardiac 
portion  of  the  stomach  at  aH  times,  and  a  very  laige 
portion  of  the  organ  whra  „dlstended^th<>  )aftjangie  6f 


THE  MEDICAL  RECORD. 


389 


tlie  colon,  the  spleen,  and>a  small  portion  of  the  left  kid- 
ney with  its  renal  capsule. 

The  umbUical  region  is  chiefly  oconpied  by  a  portion 
of  the  arch  of  the  colon,  the  omentum,  and  the  small 
intestines.  It  contains  likewise  the  mesentery  and  its 
glands,  the  aorta,  and  the  vena  cava. 

The  right  lumbar  region  contains  the  caecum  (chiefly 
lodged  in  the  iliac  foss»),  the  ascending  colon,  the  lower 
and  middle  portion  of  the  kidney,  and  a  portion  of  the 
ureter. 

T?ie  left  lunibar  region  is  occupied  by  the  descending 
colon,  the  sigmoid  flexure  of  the  colon,  the  left  kidney, 
and  the  ureter.  The  small  intestines  likewise  occupy 
the  lumbar  region  on  either  side. 

The  pubic  or  hypogastric  region  contains  in  children 
the  urinary  bladder,  with  pcMrtions  of  the  ureter,  also  in 
adults  if  they  be  distended,  the  convolutions  of  the 
small  intestines,  and  in  the  female,  the  uterus  and  its 
appendages. 

The  right  ingumcA  region  contains  the  "  oul-de-sao  "  of 
the  caput  ooli,  Uie  vermiform  process,  and  the  iliac  vessels. 

The  leA  inguinal  region  a  part  of  the  sifpioid  flexure 
of  the  colon,  and  the  iliao  vessels  of  that  side. 

The  meikode  employed  in  the  physical  examination 
of  the  abdomen,  with  the  exception  of  succussion,  are 
similar  to  those  practised  in  exploration  of  the  thorax ; 
but  they  differ  in  their  relative  importance.  In  thora- 
cic examinations,  auscultation  is  the  most  important 
method,  while  in  abdominal  examinations  ausoultatfon 
is  only  employed  in  determining  the  existence  of  aneu- 
risms and  of  pregnancy. 

Percussion  and  palpation  are  the  means  by  which  we 
gain  the  most  useftd  information  conoeming  the  con- 
tents of  the  abdominal  cavity. 

Before  considering  the  ogns  which  indicate  the 
changes  that  occur  in  the  different  affections  of  the  ab- 
dominal organs,  I  will  briefly  notice  the  different 
methods  of  exploratioD. 

Inspection, — ^By  it  we  note  alterations  in  the  shape 
and  movements  of  the  abdomen.  It  is  most  satisfiio- 
torily  performed  with  the  patient  lying  on  the  back, 
with  the  thighs  dightly  flexed.  In  healin,  the  abdomen 
is  of  an  oval  form,  marked  by  elevations  and  depres- 
sions corref^nding  to  the  abdominal  muscles,  the 
umbilicus,  and  in  some  degree  by  the  form  of  the  sub- 
jacent viscera ;  it  is  larger  relatively  to  the  sise  of  the 
chestL  in  children  than  in  adults,  more  rotund  and 
broaaer  inferiorly  in  females  than  in  males. 

Alterations  in  its  shape  due  to  diseasey  we  find  to  con- 
sist :  First,  in  enlargementj  which  may  be  general  and 
symmetrical,  as  in  ascites ;  or  partial  and  irregular,  from 
tumors,* hypertrophy  of  organs,  as  the  Hver  or  spleen; 
or  from  tympanitic  distension  of  portions  of  the  intes- 
tine by  gas,  as  of  the  colon  in  typhoid  fever.  Second, 
it  may  be  retraetedj  as  in  extreme  emaciation,  and  in 
several  forms  of  cerebral  disease ;  especially  is  this  no- 
ticeable in  the  tubercular  meningitis  of  children. 

The  normal  movements  of  the  abdominal  walls  are' 
connected  with  the  respiration,  so  that  they  have  a  cer- 
tain relation  to  the  movements  of  the  chest  walls,  being 
often  increased  when  the  latter  are  arrested,  and  vice 
versd.  Thus,  abdominal  movements  are  increased  in 
pleurisy,  pneumonia,  pericarditis,  etc.,  but  decreased  or 
wholly  suspended  when  disease  causes  abdominal  pain, 
tA  in  peritonitia 

Not  unfrequently,  when  inspecting  the  abdomen,  a 
distinct  pulsation  will  be  visible  in  the  epigastric  region, 
which  frequently  is  mistaken  for  aneurism.  The  super- 
ficial abdominal  veins  are  also  at  times  visibly  enlarged, 
indicating  an  obstruction  to  the  current  of  blood,  either 
in  the  portal  system  (as  in  cirrhosis),  or  in  the  vena  cava. 

Mensuration  is  mainly  useful  in  determining  the  exact 


increase  or  decrease  of  abdominal  dropsies,  visceral 
enlargements,  and  tumors.  It  is  performed  by  means 
of  a  graduated  tape. 

Palpation, — This  method  of  exploration  often  fur- 
nishes us  with  the  most  important  information.  Jt  may 
be  performed  with  the  tips  of  the  fingers,  with  the 
whole  hand,  or  with  both  hands,  and  the  pressure  may 
be  slight  or  forcible,  continuous  or  alternate.  In  order 
to  obtain  the  greatest  amount  of  information  by  palpa^ 
tion,  the  patient  should  be  placed  in  a  horizontal  posi- 
tion, with  the  head  slightly  raised  and  the  thighs  flexed ; 
sometimes  it  is  necessary  to  place  him  in  a  standing 
position  or  leaning  forward.  By  pdlpaiion  we  can  d^ 
termine  the  size  and  position  of  the  viscera,  the  exist- 
ence of  tumors  or  swellings,  whether  they  are  super- 
ficial or  deep,  large  or  small,  hard  or  spft,  smooth  or 
nodulated,  movable  or  fixed,  solid  or  fluid,  and  whether 
or  not  they  possess  a  motion  of  their  own.  We  can 
also  ascertain  if  tenderness  exist  in  any  portion  of  the 
abdominal  cavity,  and  if  pain  is  increased  or  relieved  by 
firm  pressure. 

In  the  performance  of  abdominal  percussion,  the  pa- 
tient should  be  placed  in  the  same  position  as  for  pal- 
pation, and  the  percussion  should  be  for  the  most  part 
mediate.  In  exploring  ^e  abdomen  by  means  of  per^ 
cussion.  Dr.  Bennett  directs  that  the  pleximeter  (the 
finger  being  the  best)  should  first  be  placed  immediatdy 
below  the  xij^id  cartila^,  pressed  firmly  down  and 
carried  along  the  median  line  towards  the  pubes,  strik- 
ing it  all  the  way.  now  forcibly,  now  gcpUy.  The  dif- 
ferent tones  whicn  the  stonuum.  colon,  and  small  intes- 
tines furnish  will  be  distinctlv  neard.  The  percussion 
should  then  be  made  laterally,  alternately  to  the  one 
side  and  then  to  the  other,  untu  the  whole  surface  is 
percussed.  In  this  manner  the  different  percussion 
sounds  of  the  stomach,  lar^e  intestines,  small  mtestioes, 
and  the  solid  viscera,  will  be  readily  distinguished. 
Thus,  the  percussion  sound  ehcited  over  a  healthy  ab- 
domen may  be  duQj  flat,  or  fympanitie.  Over  the  cen- 
tral portion  of  the  hver,  spleen,  and  kidneys^  the  p^xsus- 
sion  sound  is  flat ;  over  that  portion  of  eitner  of  these 
organs  where  they  overlap  the  intestines  or  stomach  it 
is  duU,  with  a  tympanitic  equality.  Over  the  stomach 
and  intestines  it  is  tympanitic,  more  so  over  the  former 
than  the  latter.  When  fluid  occupies  the  abdoniinal 
cavity,  over  the  fluid  the  percussion  sound  will  be  flat. 
A  distended  bladder  or  uterus,  an  enlarged  liver,  spleen, 
kidney,  or  mesenteric  gland,  ovarian,  aneurismad,  and 
other  tumors,  are  recognized  and  their  limits  deter- 
mined by  the  unnatural  and  increased  area  of  the  per- 
cussion flatness;  while  on  the  other  hand,  gaseous  dis- 
tension of  the  stomach  or  intestines  is  recognized  by  the 
in<H*ea8ed  area  of  tympanitic  percussion. 

In  the  physical  exploration  of  the  abdomen,  ausculta- 
tion is  onlv  of  service,  as  I  have  already  said,  in  the 
diaffnosis  of  aneurisms,  and  in  detecting  the  pulsations 
of  the  foetal  heart,  and  the  utero-placental  murmur  in 
the  pr^^nant  state.  Our  examinations  of  the  abdominal 
viscera  are  sometimes  interfered  with  and  rendered  un- 
certain, by  changes  that  occur  in  the  abdominal  walls. 
Generally  the  aMominal  walls  are  sufficiently  thin,  sofb, 
and  movable  for  us  to  determine  with  considerable  ac- 
coraoy  the  situation  and  condition  of  the  subjacent 
organs;  i^  however,  everything  is  masked  by  layer 
upon  laver  of  fat,  as  in  some  cases  of  obesity,  all  ab- 
dominal examinations  wiU  be  unsatis&ctory.  An 
oedematous  condition  of  the  abdominal  walls,  as  in 
"  Bright's  disease,"  may  also  prevent  us  from  ascertain- 
ing the  condition  of  the  viscera.  When  this  occurs,  the 
surface  of  the  abdomen  presents  a  smooth,  even,  shining, 
waxy  appearance,  and  pits  on  firm  pressure.  Superfl- 
cial  (ibscess  of  the  abdominal  walls  also  occurs  occasion- 


890 


THE  MEDICAL  RECORD. 


ally,  which  interferes  greatly  with  the  exploration  of 
the  abdominal  cavity.  You  can  recognize  tneee  by  the 
circumscribed  bulging,  by  tenderness  on  slight  pressure, 
by  the  redness  of  the  surface,  and  by  the  characteristic 
fluctuation  of  a  superficial  abscess.  The  abdominal 
muscles  also  are  sometimes  abnormally  deyeloped^  or 
unnaturally  rigid,  as  in  tetanus,  rheumatic  inflammation, 
and  in  the  early  stage  of  peritonitis;  this  somewhat 
interferes  with  our  examinations. 

DISEJUSED  CONDITION   OF  TDE  PERITONKUM. 

Under  this  head  may  be  included  the  various  results 
of  inflammatory  action,  ascites,  etc.  They  all  give  rise 
to  more  or  less  abdominal  enlargement 

BjirupeeUonwe  recognize  in  acute  peritonitis  either 
a  diminution  or  an  entire  suspension  of  abdominal  res- 
piration, the  breathing  becoming  entirely  thoracic.  The 
abdomen  enlarges,  becomes  unnaturally  tympanitic,  and 
there  is  marl^  tenderness  on  firm  pressure.  The 
comparative  result  of  ^rm  and  dight  pressure  is  one  of 
the  strong  diagnostic  marks  of  peritoneal  inflammation. 

Chrome  periionitiM  is  ahnost  alwajrs  connected  with 
tubercular  deposits  in  the  substance  and  on  Uie  fi*ee 
surface  of  the  peritoneum,  and  in  addition  to  the  tym- 
panitio  distension  of  the  abdomen,  and  the  tenderness 
on  firm  pressure  noticed  in  acute  peritonitis,  fluid  ac- 
cumulations take  place  in  the  peritoneal  cavity. 

AviU»  is  a  collection  of  fluid  from  any  cause  in  the 
peritoneal  cavity. 

On  inspection  we  always  find  the  abdomen  um/armlt/ 
enlarged,  and  its  movements  during  respiration  are 
either  suspended,  or  limited  to  the  epigastric  region. 
The  superadal  abdominal  veins,  if  the  ascites  depends 
upon  disease  of  the  liver,  will  often  be  found  enlat'ged. 

If  the  palmar  surface  of  the  hand  be  applied  to  the 
side  of  the  abdomen  at  the  level  of  the  fluid,  and  light 
percussion  be  performed  on  the  opposite  side,  a  sense  of 
fluctuation  will  be  communicated  to  the  hand. 

Fercttssion  gives  flatness  at  the  lower  and  most  de- 
pending portion  of  the  abdomen,  while  at  the  upper 
portion  aoove  the  level  of  the  fluid,  there  is  a  drum-like 
tympanitic  resonance.  When  the  patient  is  in  the  erect 
pc^tion^  the  tympanitic  resonance  is  confined  to  the 
epi^astnum  and  upper  portion  of  the  umbiHcal  region. 
If  m  a  recumbent  position,  the  tympanitic  resonance 
will  extend  into  the  hypogastrium ;  if  plac^  on  either 
side,  ^e  lumbar  region  of  the  opposite  side  becomes 
tympanitia  Other  abnormal  changes  that  occur  in  the 
paitoneum  are  connected  with  deposits  that  may  be 
classed  under  the  head  of  abdominal  tumors. 

In  considering  the  physical  signs  which  indicate  ab^ 
normal  changes  in  the  different  abdominal  organs^  I  will 
commence  with  those  of  the  stomach.  When  this  viscoa 
is  empty,  or  not  distended  with  gas  or  food,  there  is  on 
inspecHon  no  visiUe  prominence  to  indicate  its  position, 
nor  doesfxilpa^ion  fiimish  us  any  information  as  to  its 
condition. 

PercuMion  gives  a  metsllio  or  tympanitic  resonance, 
which  enablet  us  to  distinguish  it  from  the  surrounding 
viscera.  The  line  of  dulness  which  markes  tlie  lower 
border  of  the  liver,  and  the  inner  border  of  the  spleen, 
determines  the  upper  and  lateral  boundaries  of  the 
stomach ;  to  ascertain  the  lower  border,  percuss  gently 
downward  ftom  this  line  of  dulness  until  a  slight 
change  in  the  percussion  sound  indicates  that  we  have 
reached  the  transverse  colon.  The  cardiac  orifice  or  ex- 
tremity of  the  organ  is  situated  opposite  the  inner  bor- 
der of  the  seventh  rib.  At  a  point  a  Utile  below  tiie 
lower  border  of  the  Hver,  within  a  line  dravm  from  the 
right  nipple  to  the  umbilicus,  the  pyloric  orifice  of  tiie 
organ  is  situated.  TSie  lower  margm  of  the  great  "  cul- 
de-sac  "  is  found  generally  near  tl^  umHhcas. 


Diminution  in  the  size  of  the  stomach  cannot  be  re- 
cognized by  phvsical  exploration.  An  increase  in  size 
or  distension  or  the  stomach  may  occur  firom  an  accu- 
mulation of  gas,  from  large  quantities  of  fluids  or  solids 
taken  into  the  stomach,  or  it  may  be  enlarged  within 
circumscribed  spaces  firom  cancerous  deposits  in  its 
walls. 

Gaseous  or  tympanitic  distension  of  the  stomach  is 
recognized  by  an  increase  in  the  area  of  the  character- 
istic tympanitic  resonance  of  the  organ.  A  distended 
condition  of  the  stomach  from  food  or  drink  is  recog- 
nized by  an  absence  of  the  normal  resonance,  and  by  a 
continuation  of  the  dull  percussion  of  the  liver  and 
spleen  downwards  to  the  umbilicus.  A  moderate 
amount  of  fluid  or  solid  in  the  stomach  can  be  deter- 
mined by  a  limited  area  of  dulness  corresponding  to 
the  normal  situation  of  the  "  cul-de-sac  "  of^  the  organ. 

Cancsr  of  the  stomach  most  frequently  has  its  seat  at 
the  pyloric  extremity  of  the  organ,  but  m  whatever  por- 
tion of  the  organ  it  may  be  developed  it  can  be  recog- 
nized by  circumscribed  dulness  on  percussion,  where  m 
health  (when  the  stomach  is  empty)  we  should  have 
tympanitic  resonance.  The  percussion  dubiess  elicited 
over  the  cancerous  mass^  however,  has  a  hollow  char- 
acter which  is  readily  distinguished  from  the  flat  per- 
cussion sound  of  a  BoUd  organ. 

By  palpation,  a  nodulated  mass  is  readily  detected 
oorresponding  to  the  area  of  percussion  dulness,  which 
is  movable,  easily  graspedjand  readily  separated  firom 
the  surrounding  viscera.  These  signs,  taken  in  connec- 
tion with  the  attendant  symptoms,  are  almost  always 
sufficient  for  a  positive  diagnosis. 

Intestines, — ^in  a  normal  condition  the  large  intestines 
fhmish  a  more  amphoric  percussion  sound  than  the 
stomach.  When,  however,  they  are  filled  with  fluid  or 
solid  accumulati<His,  the  situation  of  these  accumulations 
can  be  marked  out  on  the  surface  by  the  dulness  on 
percussion.  As  the^e  most  firequently  collect  in  the 
descending  colon,  the  percussion  sound  over  this  portion 
is  usually  less  resonant  than  over  the  ascending  or 
transverse  colon.  According  to  Dr.  Bennett^  in  a  prac- 
tical point  of  view  it  is  often  useful  to  determine 
whether  a  purgation  by  the  mouth  or  an  enema  is 
likely  to  open  the  bowels  most  rapidly.  If  there  is 
duhieas  in  the  left  iliac  fossa,  in  the  track  of  the  descend- 
ing colon,  that  portion  of  the  intestine  must  be  full  of 
fieces,  and  an  enema  is  indicated.  If,  on  the  other  hand, 
the  sound  in  the  left  iliac  fossa  is  tympanitic,  and  the 
right  dull,  an  enema  is  of  little  service,  as  it  will  not 
extend  to  the  cecum,  and  purgatives  by  the  mouth 
are  indicated.  Sometimes  the  whole  colon,  or  the 
transverse  portion,  or,  what  is  more  common,*the  sig- 
moid flexure  of  the  large  intestine,  becomes  distended 
with  fiscal  accumulations,  giving  rise  to  circumscribed 
abdominal  enlargement,  and  to  flatness  on  percussion 
over  that  portion  of  the  abdomen  which  corre^[>onds  to 
the  situation  of  the  intestine.  (Care  must  be  taken  not 
to  confound  this  condition  with  an  enlarged  liver,  spleen, 
tumor,  etc.)  The  percussion  soimd  over  the  small  in- 
testines, unless  they  are  distended  with  gas,  is  higher 
E itched  and  less  amphoric  than  that  of  the  surrounding 
irge  intestines. 


A  Cholera  Medal. — ^A  decree  of  the  King  of  Italy 
orders  that  a  medal  shall  be  struck  in  bronze,  silver,  and 
gold,  to  be  conferred  on  such  persons  as  shall  have  ren- 
dered signal  service  during  the  prevalence  of  cholera  or 
any  other  grave  epidemic.  It  will  have  on  one  side  the 
head  of  the  kinp,  and  on  the  other  a  crown  of  oak,  with 
a  legend  importing  that  it  is  a  recompense  for  services 
in  connection  with  the  public  healthr^^  t 

digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


391 


|Pr00rf0«  0f  iHelrttal  Science. 

lODlNB    AS   AN   INJECTION. — REMOVAL    OP   THE    StAINS 

PBODUCED  THEREBY. — One  of  the  great  objections  to 
the  use  of  iodine  as  an  injection  beineits  disposition  to 
stain  the  linen,  Dr.  Percy  Boulton,  of  Harewood  square 
(London),  calls  the  attention  of  the  profession  to  the 
fact  that  all  such  stains  can  be  prevented  by  the  addi* 
tion  of  carbolic  acid,  which  not  only  renders  the  iodine 
colorless,  but  at  the  same  time  acts  as  an  antiseptic. 
He  recommends  the  following  compound  :  Of  com- 
pound tincture  of  iodine,  one  drachm ;  solution  of  car- 
bolic acid,  six  drops  (as  sold  in  the  shops) ;  water,  six 
ounces.  I  have  found  this  particularly  useful,  applied 
by  means  of  the  spray-producer  to  the  mucous  mem- 
brane of  the  nose  in  chronic  ozena,  when  it  would  have 
been  impossible  to  use  tincture  of  iodine  alone  in  solu- 
tion, owing  to  the  staining  of  the  face,  and  also  of  the 
pocket-handkerchief  when  used  subsequently.  The 
offensive  odor  in  this  case  was  at  once  removed,  and  a 
sense  of  cleanliness  imparted  which  had  not  been  ex- 
perienced by  the  patient  for  a  long  time  before. 

Over-Eating  as  a  Risk  to  Lipe  in  Operations. — 
Over-eating  is  not  commonly  supposed  to  lead  to 
any  such  risks  of  life  as  over-drinking  does;  yet  I 
believe  that  you  will  find  in  operative  surgery,  that 
among  the  habits  that  increase  the  risks  of  life,  this  may 
stand  not  far  from  drunkenness,  especially  if  the  over- 
eating is  of  meat  and  other  nitrogenous  foods.  I  am 
led  to  believe  this  from  several  cases  that  I  have 
observed,  and  I  think  that  there  are  large  evidences  of 
it  You  know  that  the  general  results  of  operations  in 
provincial  hospitals  tell  of  a  smaller  mortality  than 
in  the  hospitals  of  London  and  the  largest  towns.  The 
difference  is  commonly  ascribed  to  differences  in  the 
purity  of  the  air,  and  other  advantages  of  that  kind,  in 
the  comparatively  rural  districts.  I  believe  that  much 
more  of  it  is  due  to  the  differences  of  habits  in  the 
several  classes  of  patients.  The  diSerences  are  man v ; 
but  one  of  the  chief  of  them  is  that  the  poor  in  the 
agricultural  districts  eat  far  less  meat  than  those  in 
liu^  towns  do,  and  are  by  comparison  less  fed,  though 
probably  not  worse  fed,  and  you  may  frequently 
observe  that  patients  who  come  to  us  from  agricul- 
tural distaicts  Dear  operations  in  all  respects  better  than 
Londoners  who  are  submitted  to  the  same  proceed- 
ings. Of  course  many  things  concur  to  make  the 
differences  of  constitution  between  a  town  and  a 
country  population;  but  I  am  satisBed  that  among 
these  things  a  very  potent  influence  is  exercised  by 
the  difference  of  diet;  and  the  differences  that  we  may 
thus  see  are  strongly  illustrated  by  what  one  hears  of  the 
results  of  operations  upon  the  natives  of  India  and 
other  Eastern  countries,  whose  diet  is  almost  exclu- 
sively vegetable.  Almost  any  amount  of  injury  may  be 
inflicted  on  them,  and  not  be  followed  by  the  destruc- 
tive mischiefs  which  occur  in  Europeans  under  the 
same  circumstacnces.  They  are  defective,  it  is  said,  in 
healing  power;  but  they  recover  with  comparative 
certainty,  however  slowly,  from  operations  of  the 
greatest  magnitude.  A  common  expression  about 
them  is,  "You  can't  kill  them."-^AMES  Paget,  F.R.S., 
London  Lancet, 

A  New  Glycerine. — To  obtain  this  compound  M. 
Edmone  Sichel  employs  four  parts  (by  weight)  of 
yelk  of  egg,  and  five  parts  of  glycerine,  which  he  mixes 
simply  in  a  mortar.  It  has  the  consistence  of  liquid 
honey,  and  is  unctuous  like  the  fatty  substances,  over 
which  it  has  the  advantage  of  being  easily  removed  by 
water.    It  is  unalterable,  a  specimen  having  been  lefc 


exposed  to  the  air  for  three  years  with  impunity.  Ap- 
plied to  the  skin,  it  forms  on  the  surface  a  varnish  which 
protects  it  from  contact  with  the  air.  These  properties 
render  it  serviceable  for  broken  surfaces  of  all  kinds, 
particularly  for  lumps,  erysipelas,  and  cutaneous  affec- 
tions, in  which  it  soothes  the  itching,  and  also  for  sore 
nipples :  its  harmlessness  preventing,  in  the  latter  case, 
any  interruption  of  suckling. — Am,  Jour.  Pharm. 

To  Prevent  Pittino  in  Small-Pox.— Dr.  C.  Black 
(Lancef)  claims  that  the  complete  exclusion  of  light  from 
the  room  in  which  small-pox  patients  are  confined,  to- 
gether with  the  application  oi  hog*s  lard  to  the  face  to 
guard  it  from  contact  with  the  oxygen  of  the  air,  will 
effectually  prevent  pitting. 

'  The  Cause  of  the  Activitt  of  Animal  Poisons. — 
Prof.  George  B.  Halfor(L,  of  the  ITiiiversity  of  Mel- 
bourne, has  discovered  that  in  the  case  of  the  victim  of 
the  bite  of  the  cobra  di  capella,  molecules  or  living 
"germinal"  matter  are  thrown  into  the  blood  and 
speedily  grow  into  cells.  These  cells  multiply  so 
rapidly  that  in  a  few  hours  millions  upon  milHons  are 
produced  at  the  expense  of  the  oxygen  absorbed  into 
the  blood  during  respiration;  and  hence  the  gradual 
decrease  and  ultimate  extinction  of  combustion  and 
chemical  change  in  every  other  part  of  the  body, 
followed  by  coldness,  sleepiness,  insensibility,  slow 
breathing,  and  death.  The  cells  which  thus  render  in 
so  short  a  time  the  blood  unfit  to  support  life,  are 
circular  in  diameter,  on  the  average  of  one  seventeen- 
hundredth  of  an  inch.  They  contain  a  nearly-round 
nucleus  of  one  two- thousand-eight-hundredth  of  an 
inch  in  breadth,  which,  when  fiirther  magnified,  is  seen 
to  contain  oiher  still  more  minute  spherules  of  living 
"germinal"  matter.  In  addition  to  this,  the  apphcation 
of  magenta  reveals  a  minute  colored  spot  at  some  part 
of  the  circumference  of  the  cell.  This,  besides  its  size, 
serves  to  distinguish  it  from  the  white  pus  or  lymph- 
corpuscle.  The  professor  adds  to  his  account  of  the 
action  of  this  powerful  poison  that  he  has  many  reasons 
for  believing  that  the  materies  morhi  of  cholera  is  a 
nearly  allied  animal  poison. 

NrmiTE  OF  Amyl  in  Angina  Pectoris. — Dr.  T.  Lander 
Brunton  (Lancet)  gives  some  very  interesting  results  of 
the  treatment  of  that  distressing  complaint,  angina 
pectoris,  by  this  new  compound.  He  was  first  im- 
pressed with  its  value  as  a  therapeutic  agent  after 
witnessing  some  experiments  with  it  by  Dr.  Arthur 
Gamgee,  of  Edinburgh.  The  effect  of  its  administration 
seemed  to  be  the  lessening  of  the  arterial  tension  and 
the  induction  of  capillary  congestion  ;  this,  together 
with  the  assertion  of  Dr.  B.  W.  Richardson,  that  while 
under  its  influence  there  was  a  paralvsis  of  the  nerves 
firom  the  periphery  inwards,  as  well  as  the  fact  pro- 
pounded by  Outhrie  (Jour,  of  Chem.  Soc.,  1859)  that  it 
was  of  utility  as  a  resusdtative  agent  in  drowning,  suffo- 
cation, and  prolonged  fainting,  led  him  to  use  it  in  a  case 
of  obstinate  anginal  pain,  which  lasted  in  paroxysms 
for  an  hour  to  an  hour  and  a  hal^  and  recurred  every 
night 

In  reference  to  its  action  in  this  and  other  cases  he 
says : — 

"  On  pouring  from  five  to  ten  drops  of  the  nitrite  on 
a  cloth  and  giving  it  to  the  patient  to  inhale,  the  phy- 
siobgical  action  took  place  in  firom  thirty  to  sixty 
seconds ;  and  simultaneoosly  with  the  flushing  of  the 
face  the  pain  completely  disappeared,  and  generally  did 
not  return  tUl  its  wonted  time  next  night  Occasionally 
it  began  to  return  about  five  minutes  after  its  first 
disappearance ;  but  on  giving  a  few  drops  more  it  again 
disappeared,  and  did  not  return.  On  a  few  occasions  I 
have  found  that  while  the  pain  disappeared  firom  every 


302 


THE  MEDICAL  RECORD. 


other  part  of  the  chest,  it  remained  persistent  at  a  spot 
about  two  inches  to  the  inside  of  the  right  nipple,  and 
the  action  of  the  remedy  had  to  be  kept  np  for  several 
minutes  before  this  completely  subsided.  In  almost  all 
the  other  cases  in  whicn  I  haye  given  it,  as  well  as  in 
those  in  which  it  has  been  tried  by  my  friends,  the 
pain  has  at  once  completely  disappeared.  In  cases  of 
aneurism,  where  the  pain  was  constant,  inhalation  of 
the  nitrite  gave  no  reUe^  but  where  it  was  spasmodic 
or  subject  to  occasional  exacerbations  it  either  com- 
pletely removed  or  greatly  relieved  it.  It  may  be  as 
well  to  note  that  in  tSiose  cases  in  which  it  &iled,  small 
bleedings  were  likewise  useless. 

"  From  observations  during  the  attack,  and  from  an 
examination  of  numerous  sphygmographic  tracings 
taken  while  the  patients  were  free  from  pain,  while  it 
was  coming  on,  at  its  height^  passing  off  under  the 
influence  of  amyl,  and  agam  completely  gone,  I  find 
that  when  the  attack  comes  on  gradually  the  pulse 
becomes  smaller,  and  the  arterial  tension  greater  as  the 
pain  increases  in  severity.  During  the  attack  the 
breathing  is  quick,  the  pidse  small  and  rapid,  and  the 
arterial  tension  hi^h,  owing,  I  believe,  to  contraction 
of  the  systemic  capillaries.  As  the  nitrite  is  iohaJed  the 
pulse  becomes  slower  and  ftdler,  the  tension  diminished, 
and  the  breathing  less  hurried.  On  those  occasions 
when  the  pain  returned  after  an  interval  of  a  few 
minutes,  the  pulse,  though  showing  nttie  tension, 
remained  small  in  volume,  and  not  tm  the  volume  as 
well  as  tension  of  the  pulse  became  normal,  did  I  feel 
sure  that  the  pain  would  not  return. 

"  As  patients  who  suffer  from  angina  are  ^t  to  become 
plethonc,  and  greater  relaxation  of  the  vessels  is  then 
required^  before  the  tension  is  sufficiently  lowered,  I 
think  it  is  advisable  to  take  away  a  few  ounces  of 
blood  every  few  weeks.  When  the  remedy  is  used  for 
a  long  time,  the  dose  requires  to  be  increased  before 
the  effect  is  produced.  A  less  quantity  is  sufficient 
when  it  is  used  with  a  cone  of  blotting-paper,  as 
recommended  by  Dr.  Richardson,  than  when  it  is 
poured  on  a  large  dotL  From  its  power  of  paralysing 
both  nerves  and  muscles,  Dr.  Richardson  thinks  it  maj 
prove  useful  in  tetanus ;  and  I  believe  that,  by  relaxing 
the  spasm  of  the  bronchial  tubes^  it  might  be  very 
beneficial  in  spasmodic  asthma.  I  have  tried  it  in  a 
case  of  epilep^,  but  the  duration  of  the  fit  seemed  little 
affected  by  it.  It  produces  relief  in  some  kinds  of 
headache,  and  in  one  of  neuralgia  of  the  scalp  it  relieved 
the  severe  shooting  pain,  though  an  achmg  feeling 
still  remained." 

SiNoiTLAR  Case  of  Abscess  in  the  Situatiok  or  Fem- 
oral Hernia,  Containino  Air.  By  P.  D.  Lentb, 
M.D.,  of  Cold  Spring,  N.  Y.-— Miss  G— ,  ^d  54,  usuallv 
enjoying  good  health,  was  att.acked  soddenly,  Marcn 
22j  1867,  while  coughing  moderately,  with  severe 
pam  or  "  cramp  '*  in  the  hypogastrium,  which  continued 
to  occur  in  paroxysms,  notwithstanding  hot  fomenta- 
tions, etc.  Patient  had  had  similar  attacks,  at  long 
intervals,  for  several  years,  always  produced  by  cough- 
ing, and  she  could  arrest  the  action  of  the  diaphragm  to 
avoid  actinff  painfiilly  on  the  abdominal  viscera.  The 
pain  seemea  to  her  to  be  connected  with  the  bladder, 
and  to  induce  a  disposition  to  pass  water  frequently. 
There  was  also  some  bearing-down  pain,  and  anodynes 
were  prescribed  per  rectum.  The  anodynes  occasioned 
some  nausea,  which  had  not  existed  before,  and  the 
bowels  had  been  regular.  The  next  day  the  pulse  was 
100.  She  had  less  strangury  pain,  but  complained  of 
pain  across  the  abdomen,  at  the  level  of  the  umbilicus, 
and  extending  to  the  spine,  of  a  boring  character ;  also 
of  a  pain  along  the  lower  part  of  the  back,  especially 


in  attempting  to  assume  a  sitting  posture.  No  dis- 
tension of  abdomen,  and  no  pain  on  pressure.  On 
thorough  examination,  a  tumor  was  observed  in  the 
right  groin,  below  Poupart's  ligament.  Patient  says  it 
appeared  suddenly  some  years  ago,  and  has  never  given 
''  the  least  uneasiness ;"  is  oval  in  shape,  its  long  dia- 
meter parallel  with  Poupart's  ligament,  somewhat 
larger  than  a  pigeon's  egg,  movable,  and  not  painful  on 
firm  pressure.  There  was  no  appearance  of  the  neck 
of  a  hernia  above  the  ligament^  and  no  pain  on  pressure 
in  that  locality.  Simple  enemas  were  ordered,  and 
anodynes.  March  Slst. — The  enema  acted  well  The 
tumor  was  sore  after  the  manipulation,  but  patient  up 
and  about  the  room.  In  the  evening  bad  a  recurrence 
of  pain.  April  3d. — Pain  still  confined  to  the  region  of 
umbilicus  mainly,  extending  to  the  spine,  aggravated 
by  sitting  up.  Has  also  some  bearing  down  and 
tenesmus.  Bowels  move  regularly  and  without  pain, 
and  no  nausea.  Tumor  much  inflamed,  and  the  indu- 
ration extending  to  surrounding  areolar  tissue,  but  not 
above  Poupart's  ligament.  No  paiu  on  pressure  over 
any  part  of  the  abdomen*  Pulse  good  :  ordered  cata-' 
plasms  and  anodynes.  April  10th.----dtili  obliged  to  use 
anodyne  enemata.  No  nausea,  and  bowels  move 
daily.  Inflammation  of  timior  increased,  and  extends 
several  inches  around  the  femoral  ring.  For  some  days 
it  has  been  softening,  and  fluctuation  distinct  Has  a 
peculiar  feel,  different  from  an  ordinary  abscess  in  a 
"  ripe  *'  condition.  Determined  to  lay  open  the  abscess, 
and  having  an  idea  of  possible  connection  with  hernia, 
first  punctured  with  an  exploring  knife,  the  withdrawal 
of  which  was  followed  by  a  dight  puff  of  gas  of  an 
odor  unmistakably  /cecal,  A  probe  being  introduced, 
another  puff  followed.  On  entering  the  abscess  with  the 
scalpel,  a  gush  of  fetid  gas  was  followed  by  several 
ounces  of  dark,  unhealthy  pus,  but  no  feculent  matter. 
The  finger,  introduced  into  the  cavity,  could  be  passed 
in  various  directions,  but  did  not  enter  the  abdominal 
cavity.  May  23d. — Great  relief  followed  the  evacuation 
of  the  contents  of  the  abscess,  though  the  pains  con- 
tinued for  several  days ;  is  now  quite  well,  and  moves 
about  the  house.  The  wound  is  not  quite  healed.  Was 
this  a  suppurating  gland  or  a  hernia  ?  If  the  latter,  it 
might  possibly  be  an  instance  of  protruaon  through  the 
thyroid  foramen,  and  if  a  hernia,  it  must  have  been  of 
the  caecum,  since  there  was  never  any  constipation.  If 
it  was  a  hernia,  would  there  not  have  been  disturbance 
of  the  functions  of  the  abdomen,  and  other  symptoms 
than  the  boring  pain  across  the  abdomen  ?  There  was 
no  appearance  of  gangrene  about  the  abscess. — H.  T. 
Medicm  Journal, 

A  Convenient  H^smostatic.  By  A.  P.  Mebrill 
M.D. — A  combination  of  elixir  of  vitriol  and  tannic 
acid  has  been  recommended  for  this  purpose,  but  I  was 
not  aware  of  its  value  until,  in  1857, 1  accompanied  a 
patient  to  the  office  of  the  late  Dr.  Horace  Green,  to 
obtain  the  benefit  of  his  skill  as  a  specialist  in  diseases 
of  the  throat.  The  tonsils,  although  not  enlarged,  the 
doctor  thought  in  a  morbid  condition,  and  be  pared  a 
thin  slice  fi-om  the  surface  of  each.  Only  a  little  bleed- 
ing followed  during  the  day,  but  at  two  o'clock  that 
night  his  wife  discovered  that  his  pillow  was  bloody, 
and  called  me  from  my  bed  in  the  same  hotel.  I  found 
his  pulse  feeble,  breathing  labored,  and  strength  greatly 
prostrated ;  and  he  soon  vomited  a  large  quantity  of 
Wood  which  had  been  swallowed.  I  could  see  the  pul- 
sations of  a  bleeding  arterv  in  one  of  the  tonsils,  and 
there  was  an  oozing  of  blood  from  the  cut  sur&ces. 
Having  no  other  remedy  at  hand,  I  made  a  mixture  of 
elixir  of  vitriol  and  tannic  acid,  and  applying  freely,  the 
hsemorrhage  was  immediately  and  permanently  arrested. 
digitized  by "^ ^_ 


THE  MEDICAL  RECORD. 


898 


Since  that  time  I  have  used  this  mixture  ii\  yaribus  in- 
ternal and  external  htemorrhages,  and  with  uniform 
success.  I  am  now  inclined  to  the  opinion,  that  what- 
erer  can  be  effected  in  sudi  cases,  and  even  in  diarrhoda, 
by  astrin^nts,  maybe  done  by  this  remedy*  and  in 
emergencies  it  is  more  likely  to  be  found  witnin  con- 
yenient  reach  thui  most  other  remedies  of  this  class. 
A  touch  of  the  tongue  with  this  combination,  made  in 
the  strength  of  a  saturated  solution,  will  convince  any 
one  of  its  powerful  astringency. 

KOBERLK  ON  THE  AMPUTATION  OF  THE  FTERUS.-Thc  GOZ. 

de$  BopitauXy  No.70,1866,reports  according  to  theAfneri- 
can  Medical  Tme$^  January,  1866  (?)  and  Qaz.  Hebdom,^ 
No.  11,  1866,  that  operative  surgery  now  undertakes 
procedures  which  were  formerly  held  to  be  impracticable. 
This  is  true  of  ovariotomy  ana  the  extirpation  of  the 
uterus  by  the  abdominal  walls.  The  latter  operation 
18  laid  to  have  been  first  performed  by  Clay,  an  American, 
in  1847,  and  that  then  it  was  performed  by  several 
foreign  surgeons,  and  in  France  oy  Eoberle.  The  last 
ooeration  was  by  Storer,  of  Boston,  in  September,  1865. 
(Dr.  Storer*s  case  is  fiumliar  to  our  readers ;  he  having 
removed  the  entire  uterus,  on  account  of  an  enormous 
fibrous  tumor  weighing  thirty-seven  pounds.)  Up  to 
this  time  there  have  been  twenty-four  extirpations  of 
the  uterus  and  both  ovaries ;  of  the  former  seventeen 
two  recovered;  of  the  latter  seven  four  recovered. 

Eoberle  remarked  that  the  above  account  was  incor- 
rect. The  first  extirpation  of  the  uterus  was  performed 
by  Heath  in  Manchester,  England,  and  the  first  one  with 
a  successfcd  result  by  Bumham  of  Lowell,  Massachusetts, 
in  1853.  The  known  number  of  operations,  with  or 
without  removal  of  both  ovaries,  is  forty-two,  with  eight 
cures  and  thirty-four  deaths,  that  is,  one  cure  in  every 
five  cases. 

The  extirpation  of  the  uterus  is  a  much  more  grave 
and  difficult  operation  than  that  of  the  ovaries.  The 
most  of  the  operations  have  been  performed  on  account 
of  errors  in  diagnosis.  More  than  a  third  of  the  cases 
bled  to  exhaustion  during  the  operation  or  soon  after. 
Bumham  had  performed  the  operation  most  frequently : 
nine  times,  and  twice  with  success.  Xoberle  had  had 
two  fevoraole  results  in  five  cases.  The  deaths  were 
from  haemorrhage.  In  the  first  case  a  yein  which  was 
not  ligated  caused  a  fatal  oozing,  much  blood  having 
already  been  lost  during  the  operation.  In  the  second 
case  a  ligature  sh'pped  off  during  the  operation,  and  a 
fearful  temorrhage  quickly  destroyed  life.  In  the  third 
case  the  operation  was  very  difficult,  on  account  of  ad- 
hesions over  the  entire  surface,  and  complication  with 
ascites.  In  this  case  Nelaton  nad  previously  diagnos- 
ticated an  ovarian  cyst,  and  had  made  injections  of 
iodine  to  the  right  and  left  of  the  tumor,  in  the  abdomi- 
nal cavity  (Bauohbolde),  and  had  thus  caused  the  gefie- 
ral  adhesions.  The  ovaries  were  found  healthy  and 
not  removed. 

The  operation  lasted   nearly  three  hours,  and  was 
aooompanied  by  severe  haemorrhage.    The  first  suc- 
cessful result  occurred  in  1863.    The  two  ovaries,  the 
atems,  and  a  fibroid  weighing  seven  kilogrammes  (more 
than  fifteen  pounds)  were  removed.    This  patient  is  still 
alive  and  welL    The  second  was  reported  in  the  Qaz, 
Med.y  Straaabourg^  1866,  No.  5,  at  the  same  time  with 
ft  fiavorable  result  in  a  case  of  polypus  with  an  irredu- 
cible inversion  of  the  uterus.    The  operation  took  place 
March  6, 1866.    The  inversion  was  twentj-six  centime- 
tres   long  (about  eight  and  two-third  mches).      The 
puncture  of  the  tumor,  which  was  considered  an  ova- 
rian growth,  had  no  result.    Then  Eoberle  recognized  it 
as  the  fibrous  tumor, which  was  developed  from  the  right 
superior  wall  of  the  uterus.   The  broaa  uterine  ligament 


on  the  right  side  was'  twice  ligated  and  then  divided 
between  me  Hgatures.  An  iron  wire  loop  was  then 
firmly  secured  around  the  upper  part  (in  der  Hohe)  of 
the  neds  of  the  womb,  the  left  ovary  and  tube  (Fallo- 
pian) seized  with  it,  and  the  tumor  cut  off  some  centi- 
metres above  the  wire.  It  weighed  five  kilogrammes 
(more  than  ten  pounds).  The  ovaries  were  healthy. 
The  wound  united  without  any  peculiar  applications, 
the  lower  angle  being  left  open.  The  ligature  of  the 
uterus  fell  off  with  the  dead  stump  in  ten  days. 

The  patient  recovered  without  any  accident,  except 
that  some  months  after  an  abscess  opened  in  the  rec- 
tum.   Since  then  she  has  been  perfectly  well 

Besides  the  abdominal  incision  for  the  purpose  of  ex- 
tirpation of  the  uterus  in  fibroid  tumors,  gastrotomy 
has  been  performed  twenty  times,  in  order  to  Ugate  or 
enucleate  pediculated  fibroid  tumors,  and  eight  times 
with  success.  In  fourteen  other  cases  ^he  operation 
was  not  completed,  and  of  these,  there  were  nve  fatal 
results.  — K  Kohmt,  Documents  pour  aervir  d  Vhistoire 
de  V extirpation  de$  tumeura  ftbreuses  de  la  matrice  par  la 
miihode  8tu  perirenne.  Paris,  1865.  MoTiatsachriJffur 
Oeburtshunas.  Band  27, 5  HeA  from  Oaz,  des  H^pUatm. 
No.  72, 1866. 

On    THB    SUBOUTANBOITS    INJECTION    OF    QuiNINB    IN 

Oases  of  Malarial  Nbi^ralgia,  by  E.  0.  Sbgitin,  M.D., 
Resident  Physician  New  York  Hospital. — Several  cases 
are  related  from  the  hospital  case-book,  illustrating 
"  the  effect  of  quinine  injected  hypodermically  over  ihQ 
seat  of  neuralgias  due  to  blood-poisoning  by  malaria." 
An  such  cases  had  previously*  been  treated  by  quinine 
and  iron  internally,  with  blisters  over  the  affected  part 
This  treatment  was  not  satisfactory;  the  usual  term 
of  hospital  residence  being  from  ihree  weeks  to  three 
months.  Dr.  W.  H.  Draper  directed,  in  the  first  case 
related,  the  injection  of  quinine.  "  In  four  days  the 
pain  was  relieved,  and  in  four  more  the  cure  was  com- 
plete and  permanent ;  the  case  having  previously  been 
under  treatment  five  weeks  without  benefit."  The  fol- 
lowing is  the  formula  used :  Quin.  sulph.,  grs.  Ix. :  acid. 
8ulph.dil.  gtt  zL;  aqu»  dist  |  j. ;  mix,and  make  a  solution, 
filtering  with  care.  xxxv.  minims  are  equal  to  four 
grains  of  quinine.  "  The  injections  were  given  in  the 
following  manner :  A  fold  of  skin  being  tiScen  up,  and 
firmly  held  between  the  thumb  and  finger,  the  point  of 
the  syringe  was  introduced  at  the  top  of  the  fold, 
where  a  partial  anesthesia  had  been  produced  by  the 
pressure ;  the  needle  being  put  in  its  full  length,  the 
solution  was  forced  in  gradually,  as  the  needle  was 
withdrawn,  so  as  to  throw  the  liquid  as  much  as  possi- 
ble into  the  track  of  the  wound,  and  to  cause  the  least 
rupture  of  the  surrounding  connective  tissue.  After 
removing  the  syringe,  a  Uttle  circular  friction  was  used 
to  assist  absorption.  The  immediate  effect  of  the  injeo- 
tion  is  a  pretty  severe  burning  pMU  felt  in  the  part, 
dae,  probably,  to  the  acid  and  irritating  property  of  the 
solution.  The  therapeutic  effect  of  the  medication 
shows  itself  in  the  arrest  of  the  pain  and  hypersosthesia, 
followed,  in  some  instances,  by  slight,  though  distmct 
local  anaesthesia.  No  abscesses  or  other  unpleasant 
symptoms  have  followed  the  seventy-eight  injections 
used  in  the  cases  mentioned."  The  modus  operandi 
may  be  said  to  be  three-fold.  1st  By  absorption  of 
the  drug,  whereby  it  obtains  its  specific  effect  tending  to 
the  removal  of  the  cause  of  the  neuralgia.  2d.  By  direct 
therapeutic  action  of  the  quinia  upon  the  nerves  and 
cellular  elements  of  the  parts  affected.  3d.  By  pres- 
sure; a  purely  mechani(»l  effect  of  considerable  im- 
portance, due  to  the  large  quantity  of  fluid  used,  and  to 
the  amount  of  exudation  thrown  out  Of  the  six  cases 
related,  the  subjects  were  all  seamen  firom  Southern 


304 


THE  MEDICAL  RECORD. 


poitB,  and  all  had  the  malarial  cachexia,  haTing  had 
remittent  or  intermittent  fever  before  the  coming  on  of 
the  pain.  In  none  of  the  cases  was  the  pain  intermit- 
tent, nor  was  it  of  the  same  intensity  during  the  twenty- 
four  hours,  being  usually  more  distinct  in  uie  afternoon. 
The  internal  administration  of  iron  and  cinchona  was 
used  in  connection  with  and  for  some  time  after  the 
injections  were  discontinued. 

Raw  Flesh  and  Brandt  in  the  Treatment  of 
Phthisis. — 1.  The  exhibition  of  raw  beef  and  mutton, 
and  of  alcohol,  in  doses  yaryiog  according  to  circum- 
stances, arrests  the  progress  of  pulmonary  phthisis  and 
other  consumptive  diseases.  Under  the  influence  of 
this  mode  of  treatment,  strength  is  restored,  the  coun- 
tenance recovers  its  animation,  appetite  returns,  and 
the  patient  gains  in  flesh  and  weight.  In  a  month,  or 
even  in  three  weeks,  in  several  cases,  the  body  gained 
four,  six,  eight,  and  even  as  much  as  twelve  pounds. 
2.  This  general  improvement  of  the  system,  aided  by 
appropriate  treatment  of  the  leading  symptoms,  checlcs 
the  hectic  fever^  diarrhoea,  and  night-sweats.  3.  When 
these  complications  have  yielded,  amendment  of  the  local 
condition  of  the  lungs,  or  other  diseased  organs^  sets  in, 
and  the  advance  of  cicatrization  can  be  ascertained  by 
percussion  and  auscultation.  4.  The  efficacy  of  the  treat- 
ment is  not  equal  in  all  stages'  of  the  disease.  In  the 
third  stage,  the  improvement  in  general  is  confined  to 
a  prolongation  of  life,  the  inevitable  issue  being  merely 
postponed.  In  the  second  stage  only  can  the  treats 
ment  be  said  to  be  curative,  provided  all  the  necessary 
precautions  are  strictly  attended  to.  Of  all  atrophic 
diseases  in  which  the  treatment  is  applicable,  that  in 
which  the  greatest  measure  of  benefit  is  obtainable  is 
puhnonary  tuberculosis,  in  all  its  stages.  It  is  also 
highly  beneficial  in  every  form  of  anaemia,  whether 
resulting  from  hiemorrlu^  or  spermatorrhoea ;  at  the 
conclusion  of  acute  affections,  especially  typhus  and 
tjrphoid  fevers,  in  the. last  stage  of  leucaamia,  albumi- 
nuria, and  diabetes ;  it  is  also  frequently  successful  in 
pyaemia,  paludal  cachexia,  chronic  nervous  fever,  and  in 
general  in  all  protracted  morbid  conditions  in  which 
repair  is  obviously  unequal  to  the  expenditure  of  the 
system.— Jbttr.  of  Prod,  Med,  <k  Swrg. 

PoisoNiNo  BT  Strychnine;  Recovery  after  TAKiwa 
Three  Grains. — ^Mr.  W.  H.  Folker  reports  in  a  recent 
number  of  the  Lancet^  a  case  of  the  above.  The  patient 
took  three  grains  of  the  alkaloid  for  suicidal  purposes. 
The  first  spasm  came  on  in  three-quarters  of  an 
hour.  The  severest  paroxysm  occurred  in  an  hour 
and  fifly  minutes.  The  spasms  ceased  in  twelve  hours. 
The  face  was  calm,  and  free  fi:om  the  risus  sardonicus 
of  ordinary  tetanus.  The  intellect  was  clear  through- 
out, althoug'h  screaming  was  present,  together  wiUi 
a  dread  of  oeing  touched — similar  to  that  witnessed 
in  hydrophobia.  Touching,  and  the  effort  of  swal- 
lowing, directly  produced  a  spasm.  The  spasrts 
were  very  irregular  in  their  oceurrence.  Chloroform 
was  apparently  the  remedy  which  brought  about  the 
good  result.  In  this  respect  the  case  bears  a  striking 
analogy  to  the  one  reported  in  our  columns  (March  1, 
1867)  by  Dr.  Hamilton,  of  Chardon. 

Blotttno  Paper  as  a  Drbssino. — Dr.  Boser  (SchmicWs 
Jahrbucher)  recommends  blotting-paper  as  a  very  cheap 
and  serviceable  surgical  dressing.  It  is  to  be  apphed 
either  in  broad  pieces  or  in  separate  layers  so  placed  in 
reference  to  each  other  that  Uie  edge  of  each  leaf  is  di- 
rected toward  the  pus  to  be  al:»orl^d. 

Starch  Injections  nr  IJRBTHRrns.— M.  Luc  (RecueU 
de$  MhnoiresdeMed.  etde  CWrurflr.  MKteirw)  uses  with 
great  success  a  tolerably  thick  solution  of  starch  in  caaefl 


of  acute  urethritia  He  says :  "  It  never  produces  pain, 
and  avoids  strictures." 

EXAHINATION  OF  THE  EXTERNAL  AUDITORY  PaSSAQB. — 

In  the  interesting  article  from  my  friend  Dr.  Shaw,  on 
this  subject,  in  your  journal  for  May  30th,  occurs  the 
following  sentence:  "From  the  great  uncertainty 
which  attends  the  weather,  recourse  must  be  had  to 
artificial  light,  which  will  be  found  an  efficient  substi- 
tute "  (that  is  for  ordinary  daylieht  or  sunlight).  One 
of  the  great  advantages  whicn  ttie  method  oi  illumina- 
tion of  V  on  Troltscl^  of  which  Dr.  Shaw  justly  speaks 
so  highly,  is,  as  it  peems  to  me,  the  fact  that  we  are 
never  obliged  to  substitute  lamp  or  gaslight  for  ordinary 
daylight,  even  if  the  weather  be  doudy  or  stormy.  1 
have  never  as  yet  seen  the  daylight  which  was  not  suffi- 
cient to  fully  illuminate  the  auditory  canal  and  membrana 
timpani,  when  reflected  by  the  conoave  mirror.  Be- 
lieving, aa  I  do,  that  the  introduction  of  this  simple 
means  of  examiuation  has  done  more  for  the  advance  of 
our  knowledge  in  ear  disease  than  any  one  suggestion 
ever  made  in  this  province,  I  am  induced  to  ask  you  to 
insert  this  as  an  addendum  to  an  article  which  has  done 
a  real  service  to  the  profession^  If  I  am  correct  in  my 
views  of  the  adaptability  of  the  mirror  to  any  weather, 
cloudy  or  pleasant,  its  use  becomes  still  more  pimple. — 
2>.  B.  SL  John  Rooea^  Bost.  Med.  S  Surg,  Jour. 

Case  or  Papillary  QROvmt  in  the  Armpit  ;  Curx  bt 
THE  Electrolytic  Method. — ^A  lady  presented  herself^ 
Nov.  21,  1866,  on  account  of  a  small  papillary  and 
highly  vascular  growth,  which  had  first  appeared  ia  the 
right  axilla,  since  the  commencement  of  1865,  and  had 
somewhat  rapidly  increased  in  size  during  the  last  few 
months.  It  was  one-third  of  an  inch  long,  and  one- 
fourth  of  an  inch  wide  in  its  widest  part  I  introduced 
a  needle  connected  with  fifteen  oells  of  the  battery 
into  the  base  of  the  tumor,  and  allowed  the  current  to 
pass  for  three  minutes.  No  chloroform  or  ether  spray 
was  used.  The  current  had  not  acted  many  seconds, 
when  a  peculiar  change  was  observed  in  the  tumor, 
which  lost  its  flesh  color,  and  i^peared  quite  white,  aa 
if  it  had  been  firozen.  When  the  needle  was  with- 
drawn, circulation  in  the  tumor  had  evidently  quite 
ceased.  There  was  scarcely  any  pain  during  the  opera- 
tion, and  none  at  all  afterwards,  nor  was  any  blood  lost 
Nov.  23. — Tumor  entirelv  shrivelled  up,  looking  like 
a  thin  brown  leaf  just  adhering  to  the  skin.  The  ope- 
ration, therefore,  was  not  repeated.  Dec. — ^The  eschar 
fell  off  about  a  week  after  the  operation.  There  is 
now  no  sign  that  there  ever  was  a  tumor,  no  scar,  nor 
even  redness  of  the  skin  perceptible. — Dr.  Jtdiua  AU- 
haus  in  ihe  Brit,  Med,  Joum. 

Death  from  Cblorovorm  on  its  Third  AnimnBTRA- 
TioN. — Assistant-Surgeon  H.  A.  Du  Bois,  U.S. A.,  in 
the  2^.  Y.  Med,  Joumalj  communicates  a  report  of  a 
case  of  death  by  chloroform  in  a  patient  about  thirty- 
five  years  old,  suffering  from  scrofulous  disease  of  ihe 
testicle.  The  testicle  on  the  first  examination  was 
found  considerably  enlarged ;  an  incision  gave  exit 
to  a  quantity  of  pus,  and  after  treatment  for  Bome 
time,  a  fungous  growth  was  removed,  together  with  a 
greater  part  of  the  testicle,  by  Syme's  operation.  The 
wound  soon  healed,  and  the  patient  was  discharged 
cured.  It  required  two  ounces  of  chloroform  to  bring 
him  under  its  full  influence.  He  struggled  violently, 
and  had  a  number  of  tonic  epe&ms.  In  three  months 
he  again  presented  himself,  the  other  testicle  having 
ti^en  on  the  disease,  and  after  treatment  for  some 
time,  it  was  removed.  About  a  half  ounce  of  chloro- 
form was  used  on  this  occasion,  the  patient  coming  un- 
der its  influence  with  little  difficulty.    The  wound 


THE  MEDICAL  RECORD. 


805 


healed  to  a  great  extent,  though  at  the  end  of  two  or 
three  weeks  one  of  the  ligatures  still  remained  firmly 
held.  So  much  pain  was  induced  by  the  attempt  to  re- 
move it,  that  chlorofonn  was  again  resorted  to.  About  a 
drachm  was  put  on  a  small  towel,  loosely  folded  in 
the  form  of  a  cone,  and  with  the  apex  well  opened,  I 
proceeded  to  put  him  under  its  iufluence.  He  stated 
that  he  was  coming  under  its  influence  easily,  and  that 
he  hoped  he  would  not  cause  as  much  trouble  as  before. 
He  breathed  well,  and  appeared  to  be  rapidly  becoming 
affected.  The  second  sta^  coming  on,  he  threw  his 
arms  about,  so  that  it  required  an  assistant  to  hold  him, 
though  not  to  the  extent  tha^  one  frequently  sees :  the 
breathing  suddenly  becoming  stertorous,  the  chloroform, 
which  had  been  renewed  to  the  extent  of  one  fluid- 
drachm,  was  discontinued.  The  patient  lay  on  the  bed, 
and  I  watched  attentively  the  moment  when  the  eye- 
lids would  show,  by  their  relaxed  condition,  that  the 
patient  was  sufficiently  under  the  influence  of  the  an«> 
assthetic  to  perform  the  trifling  operation  required.  The 
stertor  was  followed  by  a  spasm,  causing  the  body  to 
assume  the  condition  oi  opismotonoa,  and  to  slide  down 
in  the  bed,  the  face  assuming  a  peculiar  expression, 
which  alarmed  and  caused  me  to  throw  water  on  the 
fiioe  and  abdomen.  The  limbs  now  became  relaxed, 
the  epasm  havinff  ceased,  and  haviag  lasted  about  half 
a  minute.  The  breathing  was  gasping,  and  he  inspired 
at  long  intervals.  I  seized  the  tongue,  and  drew  it  out 
of  the  mouth,  and  commenced  artificial  respiration ; 
sent  for  ammonia,  hot  water,  and  a  magneto-electric 
machine,  while  I  examined  the  hearty  which  was 
beating  but  feebly.  Anmionia  was  applied  to  the  nos- 
trils, cold  water  to  the  chest  and  fiice,  and  hot  to  the 
abdomen.  In  the  hope  of  restoring  the  breathing,  ar- 
tificial respiration  was  kept  up,  and  a  strong  current  of 
electricity  was  passed  through  the  heart,  through  the 
throaty  and  through  the  length  of  the  spinal  cord.  After 
a  few  gasping  respirations,  death  took  place.  The 
means  of  resoscitation  were  kept  up  for  some  time 
after  life  had  ceased,  but  without  any  effect  Death 
took  place  in  from  five  to  seven  minutes  after  the  com- 
mencement of  the  administration  of  the  chloroform. 
The  chlorofonn  used  was  that  prepared  by  Squibb. 
The  quality  of  the  chloroform  was  tested,  but  no  impu- 
rity was  detected.  An  autopsy,  four  hours  after  death, 
revealed  a  slight  accumulation  of  fiit  over  the  pericar- 
dium and  on  the  surface  of  the  hearty  an  effusion  of 
serum  in  the  pericardium,  heart  structure  firm,  a  few 
hardened  tubercles  at  the  apices  of  the  lungs.  At  the 
apex  of  the  left  a  well-marked  cicatrix,  the  kidne3rs 
congested,  nkeasuring  seven  inches  in  length  by  four  in 
width,  spleen  greatly  enlarged,  and  the  hver  of  normal 
consistence,  and  slightlj  increased  in  size.  The  sper- 
matic cord  was  diseased  for  about  two  inches,  and  the 
ligature  was  nearly  ulcerated  through.  Considerable 
fluid  was  efinsed  between  the  dura  and  pia  mater,  and 
arachnoid*  The  cause  of  death  could  probably  be  ex- 
plained by  the  condition  of  the  kidneys.  Patient  had 
lost  flesh  from  the  commencement  of  the  disease,  had 
frequently  complained  of  pain  in  the  region  of  the 
ki^eys,  and  at  tlie  time  of  the  second  admission  was 
fiofiermg  from  break-bone  fever.  Perhaps  the  chloro- 
form acting  upon  the  blood,  already  overcharged  with 
excrementitious  matter,  may  have  produced  the  con- 
vulsion and  caused  the  efiusion,  which  may  have  been 
the  cause  of  the  cessation  of  the  heart's  action ;  though 
it  is  possible  that  the  overloaded  blood,  when  charged 
with  chloroform,  acted  so  as  to  cause  paralysis  of  the 
heart 

The  UjiBiLiOAt  Souptle  ;  Dr.  A.  Charrier,  Paris  (^Gfa- 
uUt  d€8  HdpUaux). — ^The  phenomenon  named  umbilical 


souffle,  though  rare,  occurs  more  fi*equently  than  is  gen- 
erally supposed.  It  is  in  practice  a  premonitory  symp- 
tom of  very  flreat  importance.  It  indicates  compression 
of  the  umbmcal  cord,  and  consequently,  an  impeded 
utero-foetal  circulation.  The  umbilical  souffle  may  be 
intermittent  or  persistent  Intermittence  diminishes 
the  seriousness  of  the  prognosis.  Permanence  of  the 
souffle  increases  the  gravity  of  the  prognosis,  particu- 
larly if  alternate,  and  acceleration  of  the  cardiac  beats 
comes  on,  and  afterwards  violent  movements  of  the  fce- 
tus,  followed  by  a  diminution  both  in  the  rhythm  and  in 
the  number  of  the  foetal  pulsations.  When  such  symp- 
toms occur,  it  is  evident  that  the  death  of  the  foetus  is 
imminent.  When  the  souffle  is  intermittent,  it  is  the 
duty  of  the  practitioner  to  abstain  from  action  and  wait; 
but  he  should  watch  attentively,  by  auscultation,  the  ute- 
ro-foatal  circulation .  If  the  souffle  be  persistent,  and  the 
phenomena  of  slow  action,  and  acceleration  of  the  car- 
diac pulsations  of  the  foetus,  etc,  are  presented,  the  prac- 
titioner should  step  in  and  induce  premature  labor.  The 
umbilical  souffle  is  frequently  produced  by  an  accidental 
shortening  of  the  cord.  The  accidental  shortening  of 
the  funis  is  in  direct  relation  to  its  length ;  for  the  lon^r 
the  umbilical  cord,  the  greater  is  its  chance  of  becoming 
twisted  round  one  or  more  parts  of  the  foetus,  and  so 
giving  rise  to  disorders  just  mentioned.  Accidental 
or  natural  shortening  of  the  cord  may  be  dan^rous  in 
the  last  stage  of  labor  by  this  sign  :  an  inversion  of  the 
fundus  of  the  womb  at  the  time  of  each  pain,  which  in- 
version is  reduced  spontaneously  after  the  cessation  of 
the  uterine  contraction.  The  anatomical  proof  of  this 
complete  inversion  of  the  uterus  may  be  found  in  the 
premature  separation  of  the  placenta  at  its  central  part, 
in  the  presence  of  recent  dots  behind  this  organ,  and  in 
the  rapid  expulsion  of  the  after-birth  into  the  vagina 
almost  immediately  after  the  passage  of  the  child. — 
Eidf'  Yearly  Abstract. 

Milk  as  a  Cardiac  Sedative. — ^Dr.  Pecholier  avers 
that  under  the  influence  of  a  milk  diet,  which  he  enjoins 
in  the  obstructive  diseases  of  the  heart,  the  impulse  of 
the  heart  dimmishes,  together  with  the  palpitation,  and 
the  congested  condition  of  the  face,  the  brain,  and  the 
lungs.  The  patient  experiences  unexpected  improve- 
ment, and  he  thinks  that  by  the  adoption  of  this  plan 
life  may  be  prolonged. 

Forecasts  of  Weather. — ^There  are  strong  grounds 
for  believing  that  the  barometer  may  yet  be  made 
available  in  giving*  premonitions  of  stormd:  Q-.  W. 
Hough,  Director  of  the  Dudley  Observatory  at  Albany, 
stated,  at  the  last  meeting  of  uie  American  Association 
for  the  Advancement  of  Science,  that  the  observations 
made  during  the  past  year  with  his  self-recording 
barometer  confirmed  the  opinion  advanced  by  him  at  a 
previous  meeting  that  the  barometric  oohtmn  is  restless 
during  a  storm  which  may  not  be  within  several  hun- 
dred miles  of  the  instrument  The  number  of  minute 
oscillations  of  the  colunm,  taken  in  connection  with  the 
movement  apparent  to  the  eye,  will  indicate  the  com- 
parative seventy  of  the  storm.  It  is  probable  that  one 
hundred  similar  instruments,  properly  distributed  across 
our  continent,  would  record  the  atmospheric  changes 
with  such  minuteness  that  new  and  important  generali- 
zations might  be  arrived  at 

A  SnfpLB  Method  or  pROTEonNo  Water  from  the 
AonoN  OF  Lead  Pipe. — DingWs  Polyiechnisehes  Jour- 
ndl  publishes  a  simple  method,  brought  forward  by  Dr. 
Schwars,  of  Breelau,  for  preventing  the  poisonous  mflu- 
ence  of  lead  pipes  on  water,  by  forming,  on  the  inside 
surface  of  the  pipes,  an  insoluble  sulphuret  of  lead, 
which  has  proved  so  effective  that,  after  simple  distilla- 


896 


THE  MEDICAL  RECORD. 


Uon,  no  trace  of  lead  can  be  detected  in  water  which 
has  remained  in  the  pipes  for  a  long  time.  The  opera- 
tion,  which  is  a  very  simple  one,  consists  in  filling  the 
pipes  with  a  warm  and  concentrated  solution  of  sul- 
phuret  of  potassium  or  sodium ;  the  solution  is  left  in 
contact  wiui  the  lead  for  about  fifteen  minutes.  Com- 
monly, a  solution  of  sulphur  in  caustic  soda  will  answer 
the  purpose,  and  produce,  practically,  the  same  results. 
It  is  known  that  sulphuret  of  lead  is  the  most  insoluble 
of  all  compounds  of  lead,  and  nature  itself  presents  an 
example  which  justifies  the  theory  of  Dr.  Schwarz, 
since  water  extracted  from  the  mine  of  Galena  does  not 
contain  lead,  a  fact  which  has  often  occasioned  surprise. 
— Journal  of  Applied .  Chemistry, 

Nbw  Method  of  Treating  Abscess. — Mr.  Joseph 
Lister,  F.K.S.,  Prof  of  Surgery  in  University  of  Glasgow, 
has  sent  a  communication  to  the  Lancei  in  which  he 
describes  a  new  method  for  treating  abscess,  by  which 
he  cldms  more  than  ordinary  good  results.  His  pro- 
cess is  based  upon  the  exclusion  of  those  atmospheric 
germs  which  are  supposed  to  keep  up  by  their  decom- 
position the  pyogenic  acid.  The  mode  in  which  this  is 
accomplished  is  as  follows : 

A  solution  of  one  part  of  crystallized  carbolic  aoid  in 
four  parts  of  boiled  Imseed  oil  having  been  prepared,  a 
piece  of  rag  from  four  to  six  inches  square  is  dipped  in 
the  oiljr  mixture,  and  laid  upon  the  skin  where  Sie  in- 
cision IS  to  be  made.  The  lower  edge  of  the  rag  being 
then  raised,  while  the  upper  edge  is  kept  firom  dipping 
by  an  assistant,  a  common  scalpel  or  bistoury  dipped  in 
tne  oil  is  plunged  into  the  cavity  of  the  abscess,  and  an 
opening  about  three-quarters  of  an  inch  in  length  is 
made,  and  the  instant  the  knife  is  withdrawn  the  rag  is 
dropped  upon  the  skin  as  an  antiseptic  curtain,  beneath 
which  the  pus  flows  out  into  a  vessel  placed  to  receive 
it  The  cavity  of  the  abscess  is  firmly  pressed,  so  as  to 
force  out  all  existing  pus  as  nearly  as  may  be  (the  old 
fear  of  doing  mischief  by  rough  treatment  of  the  pyo- 
genic membrane  being  quite  Sl-founded) ;  and  if  there 
be  much  oozing  of  blood,  or  if  there  be  a  considerable 
thickness  of  parts  between  the  abscess  and  the  surface, 
a  piece  of  lint  dipped  in  the  antiseptic  oil  is  introducea 
into  the  incision  to  check  bleeding  and  prevent  primary 
adhesion,  which  is  otherwise  very  i^t  to  occur.  The 
introduction  of  the  lint  is  effected  as  rapidly  as  may  be, 
and  under  the  protection  of  the  antiseptic  rag.  Thus  the 
evacuation  of  the  original  contents  is  accomplished  with 
perfect  security  against  the  introduction  of  hving  germs. 
This,  however,  would  be  of  no  avail  unless  an  antiseptic 
dressing  could  be  appHed  that  would  effectually  prevent 
the  decomposition  of  the  stream  of  pus  constantly  flow- 
ing out  beneath  it  After  numerous  disappointments, 
I  have  succeeded  with  the  following,  which  may  be  re- 
lied upon  as  absolutely  trustworthy.  About  six  tea- 
spoonfuls  of  the  above-mentioned  solution  of  carbolic 
acid  in  Hnseed  oil  are  mixed  up  with  common  whii- 
ing  (carbonate  of  lime)  to  the  consistence  of  a  firm 
paste,  which  is  in  fiust  glazier's  putty  with  the  addition 
of  a  little  carbolic  acid.  This  is  spread  upon  a  piece  of 
sheet  block  tin  about  six  inches  square ;  or  common  tin- 
foil will  answer  equally  well  if  strengthened  with  ad- 
hesive plaster  to  prevent  it  from  tearing,  and  in  some 
situations  it  is  preferable,  from  its  adapting  itself  more 
readily  to  the  shape  of  the  part  affected.  The  putty 
forms  a  layer  about  a  quarter  of  an  inch  thick ;  it  may 
be  spread  with  a  table-knife,  or  pressed  out  with  the 
hand,  a  towel  beinff  temporarily  mterposed  to  prevent 
the  putty  firom  sticking  to  the  hand  or  soiling  the  coat- 
deeve.  The  tin  thus  spread  with  putty  is  pUced  upon 
the  skin  so  that  the  middle  of  it  corresponds  to  the  po- 
sition of  the  incision,  the  antiseptic  rag  used  in  openmg 


the  abscess  being  removed  the  instant  before.  The  tin 
is  then  fixed  securely  by  adhesive  plaster,  the  lowest 
edge  being  left  free  for  ihe  escape  of  the  discharge  into 
a  folded  towel  placed  over  it  and  secured  by  a  bandage. 
This  dressing  has  the  following  advantages :  The  tin 
prevents  the  evaporation  of  the  carbolic  acid,  which  es- 
capes readily  through  any  organic  tissue  such  as  ofled 
silk  or  gutta-percha.  The  putty  contains  the  carbolic 
acid  just  sufficiently  dilutea  to  prevent  its  excoriating 
the  skin,  while  its  substance  serves  as  a  reservoir  of 
the  acid  during  the  intervals  between  the  dressii^. 
Its  oily  nature  and  tenacity  prevent  it  from  being 
washed  away  by  the  discharge,  which  all  oozes  out  be- 
neath it  as  fast  as  it  escapes  from  the  incision ;  while 
the  extent  of  the  surface  of  the  putty  renders  it  se- 
curely antiseptic.  Lastly,  the  putty  is  a  cleanly  appli- 
cation, and  gives  the  surgeon  very  little  trouble;  a 
supply  being  daily  made  by  some  convalescent  in  a 
hospital,  or  in  private  practice  by  the  nurse  or  a  friend 
of  uie  patient;  or  a  larger  quantity  may  be  made  at 
once,  and  kept  in  a  tin  canister.  The  dressing  is 
changed,  as  a  general  rule,  once  in  twent}r-four  hoars; 
but  if  the  abscess  be  a  very  large  one,  it  is  pmdent  to 
see  the  patient  twelve  hours  mer  it  has  been  opened, 
when,  if  the  towel  should  be  much  stained  with  dis- 
charge, the  dressing  i^ould  be  changed,  to  avoid  sub- 
jecting its  antiseptic  virtues  to  too  severe  a  test  But 
i^r  the  first  twenty-four  hours,  a  single  daily  dressing 
is  sufficient  The  changing  of  the  dressing  must  be 
methodically  done,  as  follows :  A  second  similar  piece 
of  tin  having  been  spread  with  the  putty,  a  piece  of  rag 
is  dipped  in  the  oilv  solution,  and  placed  on  the  incision 
the  moment  the  nrst  tin  is  removed.  This  guards 
against  the  possibility  of  mischief  occurring  during  the 
cleansing  of  the  skin  with  a  dry  cloth  and  pressing  out 
any  discharge  which  may  exist  in  the  cavity.  If  a  plug 
of  lint  was  introduced  when  the  abscess  was  opened,  it 
is  removed  under  cover  of  the  antiseptic  rag,  which  is 
taken  off  at  the  moment  when  the  new  tin  is  to  be  ap- 
plied. The  same  process  is  continued  daily  t£Q  the  sinus 
closes. 


IiOMOEViTT  IN  Emolanu. — ^Amouff  the  deaths  regis- 
tered in  Eneland  in  the  year  1865.  mere  were  twenty- 
one  men  and  sixty -eight  women  above  a  hundred  years 
old,  viz. :  five  men  and  twenty-fi^^e  women,  aged  one 
hundred ;  four  men  and  fifteen  women,  aged  one  hun- 
dred and  one ;  five  men  and  eleven  women,  aged  one 
hundred  and  two ;  three  men  and  four  women,  aged  one 
hundred  and  three;  one  man  and  seven  women,  aged 
one  hundred  and  four;  two  men  and  four  women,  aged 
one  hundred  and  five ;  one  woman,  aged  one  hundred 
and  six ;  one  man  and  one  woman,  aged  one  hundred 
and  ten. 

Population  of  the  Earth. — ^In  the  first  vohme  of 
Dr.  Behm*s  "  (Geographical  Annual '*  lately  published  at 
Grotha,  there  is  an  interesting  article  on  the  population 
of  the  earth.  This  was  estimated  by  Busching  in  1787 
at  1,000,000,000,  by  Pabri  and  Stem  in  1800  at  900,000, 
000,  by  Horschelmann  in  1833  at  872,000,000,  by  Diete- 
rici  in  1858  at  1^88,000,000,  and  by  Kolb  in  18^5  at 
]  ,220,000,000.  Dr.  Behm  estimates  it  at  1,350,000,000, 
thus  distributed:  Europe,  285,000,000;  Asia,  796,600k, 
000;  Australia  and  Polynesia,  3,850,000;  Alnea,  188, 
000 ;  and  America,  74,500,000.  At  the  same  time  be 
acknowledges  that  it  is  impossible  to  arrive  at  anything 
more  than  an  approximate  notion  of  the  population  in 
Asia  and  Africa,  there  being  no  census  or  other  accurate 
means  of  ascertaining  the  numW  of  inhj^itants   in 

those  continents.  .       ,,    i     r^r^i 

„ igitized  by  Vji^V^k  ^  _ 


THE  MEDICAL  RECORD. 


897 


The  Medical  Eecx)rd. 

GKORaB  P.  Shrady,  M.D.,  Editor. 


PnbUahfMl  on  tlM  1st  and  Idth  of  Moh  IConth,  tyf 
WILLIAM  WOOD  4s  00^  61  Walub  Bnanv  Nkw  Tobk. 


FOBEIGN  AOSKOIB& 


LovDOH— Tr'viuibb  k  Co. 

PaU*— BOSSAVOK  XT  Cll. 


Lbipsio—B.  HBBMAinr. 

Bio  jANsnto—SntPincNfl  t  Oa. 


New  Yorlu  NovexzLber  !•  1867. 

MEDICAL  PBOPHETS. 

There  is  nothing  so  encouraging  to  the  physician  as 
the  absolute  confidence  of  his  patient.  The  thought 
that  his  actions  are  approved  by  the  one  who  has  en- 
trusted life  to  his  hands  serres  to  assuage,  in  a  degree 
which  nothing  else  can,  the  many  anxieties  and  per- 
plexities to  which  every  practitioner  is  more  or  less  a 
prey.  There  is  in  such  an  understanding  a  mutual 
shkmng  of  a  responability,  which  is  enconragiog  to  both 
pardeS)  and  enables  each  to  perform  to  infinite  good  ad- 
vantage his  duty  to  the  other. 

This  blind  belief  in  the  skill  and  understanding  of  the 
physician  is  not  so  strong  as  it  has  been ;  but  this  is 
not  so  much  due  to  the  patient  as  to  the  physician. 
The  former  does  not  of  choice  barter  the  comforts  of 
such  a  faith  in  the  wonderful  properties  of  drugs,  and  in 
the  immaculate  opinions  of  the  doctor,  for  the  present 
fashionable  and  hollow  gratification  of  sneering  at  medi- 
cine as  an  uncertain  science.  To  very  many  the  mere 
sommoningof  a  physician  means  recovery;  and  his 
presence  in  the  sick-chamber  has  not  inaptly  been 
likened  in  effect  to  that  of  a  ministering  angel. 

But  these,  alas  I  are  getting  to  be  in  the  minority. 
We  have  no  hesitation  in  saying  that  one  of  the  main 
reasons  for  this  has  reference  to  the  propensity  among 
ns  of  making  ourselves  almost  prophets.  We  are  not 
content  to  trust  to  nature  and  our  remedies,  but  are 
constantly  accustoming  ourselves  to  indulge  in  un- 
reasonable and  thoughtless  conjectures  as  to  the  issue 
of  the  disease,  and  most  generally,  in  nine  cases  out  of 
ten,  stultifying  ourselves  in  the  eyes  of  our  patients  by 
a  false  prognosia  Nothing,  in  our  opinion,  tends  more 
certainly  to  destroy  the  confidence  of  a  patient  in  his 
medical  adviser,  than  to  have  it  become  apparent  that 
sudi  a  mistake  has  been  made.  Among  physicians 
the  reasons  are  in  the  main  obvious  enough ;  but  to 
outsiders,  who  have  not  sufficient  knowledge  of  the 
laws  of  disease,  and  their  disposition  to  an  ofttimes 
treacherous  modification,  there  is  no  excuse,  save  that 
which  refers  to  culpable  ignoranee.  How  often  we 
have  had  occasion  to  hear  that  such  and  such  an  indi- 


vidual, apparently  in  perfect  health,  had  been  con- 
demned to  speedy  death  years  before  by  his  physician ; 
and  how  often  we  have  thought  that  the  disagreeable 
reflection  which  is  thereby  cast  upon  the  skill  of  our 
brother  might  have  been  prevented  by  more  caution  on 
his  part  There  is  hardly  a  community  that  can  be 
found  in  which  some  such  story  of  this  kind  concerning 
a  practitioner  is  not  afloat.  The  error  lies  more  in  con- 
demning our  patients  too  soon  to  death  than  in  prom- 
ising them  a  cure.  We  are  not,  in  truth,  sufficiently 
well  acquainted  with  the  curative  power  of  Nature  to 
enable  us  fairly  to  appreciate  it.  An  old  practitioner  once 
gave  us  the  advice  never  to  deliver  a  child  to  death 
until  the  breath  had  actually  left  the  body,  for  truly  did 
he  say  that  care  and  patience  might  fan  the  slightest 
spark  of  animation  into  a  blaze  of  reaction.  Every 
practitioner  in  midwifery  can  attest  the  truth  of  this 
from  the  moment  the  child  becomes  an  independent 
being ;  and  it  is  only  because  many  of  us  forget  that 
the  vital  principle  in  a  child  of  two  years  of  age  is 
strong  as  it  was  at  birth  that  we  are  so  ready  to  givj 
unfavorable  prognoses  in  such  cases. 

Virtually,  the  same  facts  may  apply  to  the  constitu- 
tional stamina  of  different  cases ;  for  in  very  many  we 
find  most  astonishing  recoveries  taking  place  in  the  very 
face  of  death  itself,  and  in  contradiction  tp  all  the  legit- 
imate relations  between  cause  and  effect  How  oft«n 
have  such  cases  actually  rallied  under  the  very  hand  of 
the  one  who  had  already  cut  the  sufferer  loose  from 
every  human  hope  I  If,  in  such  an  instance,  the  physician 
has  given  a  cautious  prognosis,  he  gains  the  credit  of  a 
remarkable  cure ;  but  if  otherwise,  he  is  not  only  cheated 
of  his  just  meed  of  praise  for  the  proper  management 
of  the  case,  but  is  called  an  ignoramus  besidea 

Another  foolish  practice  is  that  of  predicting  the  time 
of  death.  It  is  a  temptation  into  which  many  have 
fallen,  and  the  majority  have  had  reason  to  be  diagrined 
at  many  an  inexplicable  mistake. 

We  recollect  a  case  in  point,  in  which  a  female  was 
shot,  and  the  ball  having  entered  a  vital  part^  the  patient 
was  allowed  only  an  hour  to  live.  The  public  took  a 
great  interest  in  the  unfortunate  victim ;  and,  to  satisfjr 
the  cravings  for  news,  bulletins  appeared  daily  for  a 
month  or  more,  predicting  an  almost  hourly  death, 
until  many  of  the  secular  papers  were  forced  to  com- 
ment upon  the  vahie  of  an  opinion  so  obviously  faulty. 
Finally,  a  long  time  after,  the  patient  did  actually 
die,  but  evidently  not  for  the  reason  that  the  doctor 
said  she  must 

If  we  perchiCnce  make  a  wrong  diagnoms,  the  mistake 
is  by  no  means  so  apparent  to  our  patient;  but  let  U8 
by  any  miscalculation  surrender  to  death  a  sufferer  who 
is  determined  to  live  despite  our  decision,  and  we  give 
to  the  laymen  an  incontestable  and  glaring  proof  of  our 
ignorance — a  something  which  to  them  cannot  be 
exj^ned  away  by  any  of  the  subtieties  of  medical 
logic. 

The  constant  occurrence  of  these  mistakes  dumld 
"■" '  O' 


808 


THE  MEDICAL  RECORD. 


teach  us  the  all-important  lesson,  to  be  on  our  guard  mv 
giving  any  prognosis,  but  leave,  as  we  have  a  right  to 
do,  a  loophole  through  which  we  can  save  the  integrity 
of  our  opinion.  When  we  consider^  how  impossible  it 
is  to  foretell  death  in  the  vast  majority  of  instances,  it 
IS  surprising  to  find  how  physicians  will  hazard  their 
reputations  a3  skilful  observers,  by  predicting  the 
result  in  such  positive  terms. 

It  is  natural  for  the  patient's  friends  to  be  anxious  in 
regard  to  the  result  of  the  case  of  the  sick  one,  but 
they  cannot,  in  reason,  ask  for  anything  more  than  an 
opinion.  The  physician  can  give  this  in  a  sufficiently 
qualified  way,  not  only  to  satisfy  his  questioner,  but  pro- 
tect himself  in  case  the  result  be  such  as  had  not  been 
anticipated.  But  the  trouble  with  most  of  us  who 
have  not  been  unfortunate  enough  to  make  any  mistake 
in  prognosis  is,  in  the  ecstasy  of  a  presumably  cor- 
rect diagnosis,  to  rush,  by  way  of  bolstering  it  up,  at 
once  into  a  prognosis  which  is  too  apt  to  be  unqualifi- 
edly pro  or  con. 

Every  one  who  has  been  long  in  practice  has  proved 
to  himself  the  great  uncertainty  of  death  as  weU  as  of 
life,  and  has  learned  to  make  his  calculations  accord- 
ingly. The  very  useful  lesson  to  be  learned  is  that  of 
never  surrendering  the  patient  to  death  with  folded 
hands,  but  standing  by  his  bedside  as  a  fiutbful  minis- 
ter to  the  last,  hoping  that,  if  a  cure  cannot  be  ef- 
fected, the  malady  may  be  at  lea^t  mitigated  in  the 
severity  of  its  symptoms,  and  the  coming  of  death  re- 
tarded. In  the  present  state  of  our  science  it  is,  to  say 
the  least,  hazardous  for  any  medical  man  to  give  up  his 
case  as  absolutely  hopeless,  and  allow  any  assertion  to 
overreach  the  bounds  of  probability.  Aside  fi*om  the 
capriciousness  of  nature,  and  the  modifying  effects  of 
different  constitutions,  idiosyncrasies,  and  other  no  less 
important  conditions,  the  chances  are  that  a  mistake  in 
diagnosis  may  be  made  which,  as  the  foundation  of  all 
prognoses,  would  render  the  latter  valueless.  Another 
reason  is,  we  do  not  study  the  approach  of  death  enough. 

The  haste  to  give  up  a  case  iu  despair  explains  in 
one  way  the  success  of  the  charlatans,  who  are  ever 
ready  to  seize  upon  the  so-called  desperate  ones  and 
make  capital  of  them.  If,  under  such  circumstances,  a 
mistake  is  made,  as  is  too  apt  to  be  the  case,  and  the 
patient  gets  well,  it  is  of  course  due  to  the  remarkably 
curative  powers  of  the  quack's  nostrum. 


As  probably  nearly  every  member  of  our  profession  has 
read  the  Code  of  Medical  Ethics  adopted  by  the  Amer- 
ican Medical  Association,  and  having  read,  could  not 
weU  avoid  being  impressed  vnth  the  lightness  of  its 
burdens,  we  presume  it  will  be  unnecessary  to  state 
that  its  edict  is  a  sermon  against  the  recognition  of 
quackery  in  any  and  every  form.  There  is  no  attempt 
whatever  to  conceal  its  animosity  toward  all  unmanly 
subterfuges,  and  none  to  entrap  the  unwary — ^its  lan- 
^ige  is  told  simple,  unmistakable  -it  confers  certain 


immunities,  and  demands  certain  conditions  in  return. 
No  man  is  dragooned  into  obedience  to  its  laws — the 
act  must  be  voluntary,  and  the  step  taken  with  circum- 
spection. We  are  led  to  make  these  remarks  in  view 
of  a  recent  episode  in  the  proceedings  of  the  N.  Y. 
Academy  of  Medicine,  which  the  public  press  is  deter- 
mined shall  pass  into  history. 

The  facts  are  these :  One  of  its  fellows  was  arraigned 
for  violating  the  code,  in  that  he  had  held  repeated  con- 
sultations with  "  a  homceopathic  physician,  so  called." 
The  charge  was  admitted,  but  sought  to  be  extenuated 
on  the  ground  of  ignorance  regarding  the  professional 
heresies  of  one  of  the  parties  in  question.  The  plea 
failed,  and  the  Academy  adopted  the  recommendation 
of  its  committee  on  ethics,  that  the  delinquent  be  sus- 
pended from  membership  for  an  indefinite  peripd;  at 
the  same  time  intimating  that  after  due  penitence  and 
recantation,  he  woulA  be  restored  to  former  privileges. 
The  case  being  lost^  and  the  verdict  esteemed  "  a  bless- 
ing in  disguise,"  the  determination  ''to  die  game"  was 
neither  surprising  nor  unnatural.  The  kind  intentions 
of  the  committee  being  thus  thwarted,  assumed  the 
character  of  a  misapprehended  mercy,  and  the  victim, 
by  the  aid  of  the  secular  press,  has  since  been  adver- 
tised into  the  seventh  heaven  of  martyrdom. 

"  He  has  been  kicked  out  of  the  Academy,"  says  the 
Tribune.  ''  His  parchment  is  of  no  more  use  to  him 
now  than  if  he  had  cut  it  out  of  a  drum-head.  What- 
ever may  have  been  his  services  to  the  sick  and  suffer- 
ing during  his  twenty-three  years'  practice,  whatever 
his  accuracy  in  diagnosis,  his  skill  in  prescription,  his 
faithfulness  to  duty,  his  succeiu,  his  reputation,  his  gen- 
eral standing  among  phyadans — ^there  is  no  doubt 
about  him  now ;  he  is  a  pariah  and  an  outcast  He 
need  not  expect  any  more  fees.  He  may  take 
down  his  sign  and  sell  his  gig.  Patients  are  warned 
to  keep  awav  from  him,  and,  to  use  the  language  of 
one  of^  the  'regular'  gentlemen  who  have  brought 
upon  him  this  dreadful  doom,  he  is  probably  at  the 
present  moment '  wandering  Mone '  in  this  great  city 
and  dying  *  a  living  death.' " 

The  spectacle  is  a  moving  one,  and  slightly  melo- 
dramatic, but  there  is  a  painful  impression  of  bhie  fire, 
the  first  miuxlerer,  and  the  slow  music 

Meanwhile,  too,  the  Academy,  after  these  terrible  on- 
slaughts, is  be^ning  to  recover  its  self-possession, 
and  to  become  accustomed  to  its  bereavement;  the 
victim  of  persecution  has  had  the  advantage  of  first- 
class  notices  in  the  Tlmei  and  JHbuney  some  bad 
rhetoric  has  been  expended,  and  all  the  parties  are  to 
be  supposed  as  being  very  well  pleased  with  the  de- 
nouement 


Cub  attention  has  been  called  to  an  oversight  of  oar 
ovm  in  a  recent  report  of  the  lecture  by  Dr.  Warren 
Stone  on  yellow  fever.  By  mistake  of  the  reporter 
the  lecture  is  represented  as  having  been  delivered 
in  Bellevue  Hospital  instead  of  Bellevue  Hoq)i(aI 
Medical  College.  We  make  the  correction  with  pleas- 
ure, particularly  since  we  are  also  indebte^^  ^^^  P^^ 
Digitized  by ' 


Ddebted  to  the 


THE  MEDICAL  RECORD. 


899 


lie  spirit  of  this  flourishing  college  for  the  very  accept- 
able lecture  of  T.  Spencer  Wells. 


The  diflferent  medical  colleges  have  regularly  inaugu- 
rated their  winter  courses,  and  the  attendanca  of  students 
is  generally  as  large  as  it  has  ever  been  heretofore,  and 
there  is,  besides,  a  reasonable  prospect  of  an  increase. 
All  oor  schools  are  well  managed,  and  richly  deserve 
encouraging  patronage. 


Hejirrrtg  of  ^oclttxte. 


N.  Y.  PATHOLOGICAL  SOCIETY. 

Stated  MsixiNa,  Skpteicber  11, 1867. 
Dr.  Wm.  B.  Bibbiks,  Ohaibman  pro  iwn. 

CANCBROUS  DISEASE  OF  THE  SIGMOID  FLEXURE. 

Dr.  Satrb  exhibited  a  specimen  of  which  he  gave  the 
following  account  : 

On  the  7th  of  July,  I  was  called  al^ut  one  o'clock  at 
night,  by  Dr.  Davis  of  this  city,  to  see  a  patient  in  19th 
stree^  who  was  said  to  be  suffering  from  obstinate  con- 
8tipation,  with  the  request  that  I  &onld  bring  some  in- 
jecting instruments.  The  man  was  46  years  of  tLge^ 
remarkably  stout  and  healthy-looking,  and  weighing 
about  two  hundred  and  fifty  pounds.  He  stated  that 
being  an  sctive  business  man,  ne  had  enjoyed  remark- 
ably good  health,  not  having  been  laid  up  with  sickness 
for  twenty  years  past.  I  found  his  abdomen  distended 
to  its  utnoost  capacity,  and  the  patient  making  all  the 
time  ine£Eectual  efforts  at  stooL  This  was  Tue^y,  and 
he  had  liad  no  passage  since  the  Saturdav  previous, 
when,  as  lie  stated,  be  had  his  usual  difficulty  at  stool 
which  he  had  suffered  from  for  a  year  past,  consisting 
in  the  necessity  for  an  injection.  During  this  latter 
period,  however,  he  had  never  been  so  troubled  as  to 
seek  for  medical  advice.  The  physician  had  been  trying 
to  ffet  a  passage  through  him  for  the  past  two  days,  but 
wiUiout  success.  By  exploring  his  anus  with  the  fin- 
ger I  oould  find  no  obstrucUon,  but  on  passing  up  a  flex- 
ible rectal  bougie  for  eight  or  nine  inches,  I  came  across 
a  positive  stricture,  which  was  so  firm  that  I  could  not 
penetrate  it  at  all.  The  abdomen  was  very  much  dis- 
tended, and  he  being  vary  fot  withal,  it  was  some  time 
befbre  I  could  satisfy  myself  of  the  existence  of  a  tumor 
in  the  situation  of  the  sigmoid  flexure.  Havins;  settled 
upon  this  diagnosis,  I  stated  that  there  was  no  hope  for 
him,  and  that  he  most  certainly  must  die  very  soon. 
He  received  the  intelligence  very  composedly,  and  died 
at  the  end  of  twenty-rour  hours  after. 

On  making  a  post-mortem  examination,  twenty-four 
hours  after  death,  the  colon  was  found  immensely 
distended,  in  some  places  being  as  large  round  as  a  man  s 
arm.  There  was  uo  enteritis  present,  neither  was  there 
any  general  peritonitis  to  be  met  with.  At  the  sigmoid 
flexure  a  hardened  mass  was  discovered,  which  was  im- 
pervious to  water  fit^m  above  and  below.  On  removing 
the  mass  subsequently,  it  was  found  to  block  up  the 

tat  so  completely  as  to  barely  admit  the  passage  of  a 
ne  probe.  The  tumor  was  scirrhous-cancer,  and  it  was 
very  remarkable  that  a  disease  so  extensive  as  this  has 
been,  as  is  seen  by  the  specimen,  could  have  existed 
without  pain,  or  any  serious  inconvenience,  until  within 
a  fbw  days  of  his  death. 


PUXRPKRAL  OOKVULSIOKS  OCCASIONED  BT  ALLOWING  PLA- 
CENTA TO  REMAIN  TOO  LONG  IN  UTERO— A  HOMGEOPATmO 
MISTAKE. 

Dr.  Satrb  next  presented  a  specimen  which  he  said 
was  interesting,  not  strictly  in  a  pathological  point 
of  view,  but  in  connection  more  particularly  with  the 
circumstances  which  brought  it  to  light 

At  the  last  meeting  of  flie  society.  June  27,  he  was 
suddenly  called  away  by  a  gentleman^  who  met 
him  at  the  door,  with  the  statement  that  his  (the  mes- 
senger's^ daughter  was  dying,  and  that  ne  snould  im- 
mediately repair  to  the  house.  On  the  way  thither  he 
stated  that  his  daughter  had  been  confined  the  evening 

before  at  five  o'clock,  and  was  attended  by  Dr. ^ — 

of  this  city,  a  prominent  homoeopath,  who,  afler  having 
delivered  her  of  a  fine  healthy  boy,  had  left  the  house 
with  an  assurance  to  the  patient  and  her  friends  that 
everything  was  all  right  In  the  course  of  a  few  hours 
afterwards,  the  homoeopath  was  summoned  in  great 
haste  to  find  his  patient  in  a  convulsion.  He  then 
called  in  another  distinguished  homoeopath  in  consulta- 
tion. They  together  were  with  the  patient  most  of  the 
day,  during  which  time  she  had  frequent  convulsions. 
Finally,  at  nine  o'clock  in  the  evening,  they  stated  that 
it  was  impossible  for  her  to  survive,  and  a  clergyman 
was  accordingly  sent  for.  As  Dr.  Sayre  entered  the 
house,  the  mother  of  the  patient  came  down  to  state  that 
the  two  homoeopaths  had  just  left,  and  that  a  marked 
change  had  come  over  her  daughter,  that  the  medi- 
cine was  beginning  to  act,  and  that  they  thought  that 
there  was  just  one  chance  in  a  thousand  for  recovery, 
and  begged  that  Dr.  S.  should  not  see  her  for  fear 
that  any  change  of  treatment  might  be  positively 
fatal.  The  father  accordingly  apologized,  and  Dr.  8. 
was  about  leaving,  when  a  servant  came  down  to 

say  that    Mrs.  A '   was  in  a  fit    Dr.  Sayre  was 

then  requested  to  see  the  patient,  and  found  her  in 
a  severe  convulsion ;  her  tongue  was  protruded  fit)m  her 
mouth,  covered  with  bloody  firoth  which  issued  also 
firom  the  nostrils^  while  her  face  was  black.  Girdling  her 
arms  and  legs  with  handkerchief,  and  hy  sudden  twitehea 
producing  a  shock  on  her  nervous  system^  and  by  artificial 
respiration  he  succeeded  in  restoring  the  arculation,  which 
had  nearly  ceased.  He  then  proceeded  to  examine  the 
uterus.  He  found  tlie  os  largely  dilated,  and  then  felt 
what  he  supposed  to  be  a  dot  of  blood,  but  on  passing 
his  hand  up  into  the  cavity  of  the  organ,  he  found  that 
the  mass  was  too  large  to  be  taken  away  without  dan- 
ger firom  hiemorrhage,  and  accordingly  administered 
ergot  to  expedite  matters.  As  the  result,  the  mass  was 
removed,  wnich  proved  to  be  the  placenta  entire,  with 
the  exception  of  a  small  piece  that  had  been  torn  off 
with  the  cord. 

In  conclusion,  he  stated  that  he  thought  that  it  was 
bis  duty  to  repwort  the  case  as  he  had  done,  in  order 
to  expose  to  the  community  a  fair  sample  of  homoeo- 
paUiic  practice. 

In  answer  to  a  question  from  Dr.  Eliot,  he  stated 
that  no  other  cause  for  the  convulsions  than  tne  placenta 
in  utero  was  found  in  the  case  cited,  there  being  no 
ursemic  poisonine  discoverable.  The  patient  subse- 
quently recovered. 

Dr.  Rogers  believed  with  Dr.  Sayre  that  the  result 
of  the  case  proved  conclusively  the  cause  of  the  con- 
vulsions. 

Dr.  Post,  in  reference  to  Dr.  Sayre's  first  case  of 
cancer  of  sigmoid  flexure,  remarked  that  he  had  a 
bmtiier  who  died  at  the  age  of  twenty-nine  years,  who 
had  no  passage  fix>m  the  bowels  for  a  period  of  nearly 

Digitized  by  VjOOQ IC 


400 


THE  MEDICAL  RECORD. 


nrFLAlOCATION  OF  THE  COLON  AKD    OTHER    CONSEQUEM0E8 
OF  JLBTIFIOIAL  NURSlNa. 

Dr.  Lewis  Smith  exhibited  a  specimen  of  inflamma- 
tion of  colon  removed  from  the  body  of  an  infant  who 
died  at  the  SLge  of  one  year  and  six  months.  This  his- 
tory was  briefly  told :  The  child  was  brought  up  by 
hand,  and  as  is  usually  the  case  with  such  children,  when 
the  summer  commenced  it  began  to  be  affected  with 
looseness  of  the  bowels.  The  diarrhoea  lasted  through 
the  months  of  July  and  August,  and  towards  the  last 
it  was  accompanied  with  the  usual  symptoms  of  pro- 
gressive emaciation.  About  two  vreeks  before  the 
death  of  the  child  it  became  very  drowsy,  and  vomiting, 
which  before  had  only  been  occasional  now  became 
pQore  frequent  Death  occurred  from  the  comatose  state 
in  part,  but  mostly  from  exhaustion.  At  the  time  of 
death  the  emaciation  was  not  marked.  The  evac- 
uations during  the  sickness,  according  to  the  state- 
ment of  the  physician  in  attendance,  were  of  a  brown- 
ish or  yellowish-brown  color.  There  was  never  any 
discharge  of  blood. 

On  making  the  post-mortem  examination  the  stomach 
was  found  in  its  normal  state,  the  small  intestine  exhib- 
iting here  and  there  evidences  of  slight  vascularity, 
but  the  mucous  membrane  of  the  large  intestine  was 
foundremarkably  thickened,  roughened,  and  congested, 
as  in  colitis  of  the  adult.  This  condition  of  things  ex- 
tended over  the  entire  mucous  membrane  of  that  por- 
tion of  the  intestinal  canaL  There  were  no  ulcera- 
tions. 

On  opening  the  thoracic  cavity  both  lungs  could  be 
fully  inflated,  with  the  exception  of  a  little  nodule  on 
the  posterior  aspect  of  the  lower  lobe  of  the  right  lung. 
The  left  lung  could  also  be  readily  inflated,  with  the 
exception  of  the  tongue-like  process  of  the  upper  lobe 
and  the  lower  margin  of  the  inferior  lobe.  On  exami- 
nation of  these  parts.  Dr.  S.  was  of  the  opinion  that 
their  conditions  were  not  due  to  pneumonia,  but  to  a 
state  of  protracted  collapse  of  the  lung,  continuing  so 
long  that  it  was  impossible  with  the  utmost  force  to  in- 
flate them. 

On  account  of  the  prolonged  drowsiness,  it  was  of  in- 
terest to  ascertain  the  condition  of  the  brain  and  me- 
nin^a  That  organ  was  normal  in  appearance,  but  the 
cavity  of  the  arachnoid  contained  about  four  or  five 
ounces  of  serum.  There  was  also  considerable  effused 
fluid  found  in  the  lateral  ventricles.  The  sinuses  con- 
tained more  than  the  usual  number  of  clots,  most  of 
which  were  soft  and  redj  while  a  few  were  white  and 
quite  firm,  thereby  giving  evidence  of  their  ante- 
mortem  formation. 

Dr.  Smith,  in  conclusion,  remarked  that  there  were 
several  pointa  of  interest  m  this  case.  The  first  had 
reference  to  the  existence  of  such  intense  colitis  and 
reotiUs,  without  any  evacuation  of  blood.  He  believed 
that  in  the  colitis  of  the  young  infant  this  was  not  un- 
common ;  in  fact,  Bouchout  affirmed  that  dysentery  was 
very  rare  in  the  young  infant.  The  collapsed  condition 
of  tne  lungs  at  different  points  was  another  object  of 
interest;  and  lastly,  the  condition  of  the  brain  being 
that  of  spurious  hydrocephalus,  deserved  to  be  noteo. 
In  answer  to  a  auestipn  trom  Dr.  Rogers,  he  remarked 
that  the  fontanelles  were  depressed,  as  was  commonly 
the  case  in  all  similar  instances  in  very  young  children. 

Dr.  Rogers  asked  if  the  remark  of  Dr.  Smith,  in  re- 
gard to  the  fi^quency  with  which  children  brought  up 
by  hand  suffer  from  diarrhoea  in  the  summer  months, 
was  amply  borne  out  by  facta 

Dr.  Smith  thought  that  as  far  as  city  children  were 
ooncemed,  it  was. 

Dr.  Eliot  remarked  that  there  was  one  reason  why 


it  should  be  so,  from  the  fact  that  the  milk  was  most 
apt  to  spoil  in  hot  weather. 

Dr.  Bibbins  stated  that  among  the  lower  classes  the 
statement  of  Dr.  Smith  was  especially  true. 

RUPTITRE  OF  AORTA,  PERICARDIUM,  AKB  PLIX7RA. 

Dr.  Delafield  exhibited  a  specimen  of  heart  and  an- 
nexa,  taken  from  the  body  of  a  woman  who  was 
found  dead  in  the  street  She  was  af^^arentlv  forty- 
five  years  of  age,  rather  fitt  than  otherwise,  and  various 
parts  of  her  body  and  limbs  were  covered  with  bruises. 
There  were  no  marks  of  violence  about  the  head.  No 
history  was  obtainable.  On  opening  the  chest  the  left 
pleural  cavity  was  found  filled  with  partially  clotted 
blood.  On  {he  anterior  surface  of  uie  pericardium 
there  was  a  long  rent  through  it^  extending  frt>m  the 
base  ahnost  to  the  apex  of  the  sac ;  and  on  examining 
the  heart  itself,  there  was  foimd  in  the  aorta,  just  above 
the  insertion  of  the  aortic  valves,  a  transverse  rapture 
through  all  the  coats  of  the  vessel,  surrounding  which 
were  several  patches  of  atheroma.  There  were  no 
changes  in  any  other  organs  save  the  kidneys,  the  left 
one  being  loaded  with  small-sized  cysts,  and  the  right 
being  in  an  advanced  stage  of  fatty  degeneration. 
The  cause  of  death  was,  of  course,  a  rupture  of  the 
aorta,  the  blood  eecai^^  first  into  the  penowdium,  and 
thence  through  the  slit  in  that  sac  mto  the  pleural 
cavity  of  that  side. 

ORAHULAR  KIDNBTS,  ETC. 

Dr.  Fiknell  exhibited  a  pair  of  small  granular  kid- 
neys taken  from  the  body  of  a  patient  of  Dr.  Ghkrrish, 
twenty  yean  of  age.  She  had  been  under  the  oare  of 
that  gentleman  two  months  previous  to  death.  She 
presented  during  that  period  the  usual  symptoms  of 
Bright's  disease,  severe  headaches,  vomitmgs,  oedema 
of  tne  face  and  extremities,  etc  Her  vision  at  times 
was  so  much  disturbed  by  &tty  defeneration  of  the 
retina,  that  she  could  scarcely  see  at  afi.  The  attending 
physician  stated  that  the  day  before  her  death  she  was 
seised  with  a  violent  pain  in  the  left  side,  attended 
with  cough  and  dyspnoea.  The  diagnosis  of  pleuro- 
pneumonia was  made  and  confirmed  by  Pro£  Clark, 
who  saw  the  patient  in  oonsnltadon.  She  gradnaUj 
sank,  and  died  the  next  morning. 

The  strange  thing  about  the  case  was  that  at  the 
autopsy  no  special  lesion  to  account  for  death  wm 
found  in  the  chest,  and  instead  of  plenro-pnenmonia, 
there  was  a  simple  osdema  of  both  lungs. 

A  MUSEUM  OF  PATHOLOOT. 

Dr.  FnnrBLL  presented  a  second  specimen  on  behalf 
of  Dr.  Leo,  which  also  consisted  (^  a  pair  of  granular 
kidneys.  These  were  removed  from  a  man  thirty  yean 
0^  age,  who,  being  a  driver  on  one  of  the  city  cars,  was 
severely  beaten  by  some  rowdier  and  died  the  follow- 
ing morning  in  Bellevue  Hospital. 

The  post-mortem  examination  revealed  snch  exten- 
sive disease  in  difierent  parts  of  the  body,  that  it  be- 
came an  interesting  question  whether  the  oeating  was 
the  direct  cause  of  death  or  not  There  was  cirrhosis  of 
the  liver,  tubercles  in  the  lungs,  granular  disease  of  the 
kidneys,  and  extensive  extravasation  of  blood  upon  the 
surface  of  the  brain,  which  had  evidently  found  its 
way  through  the  substance  of  the  organ  into  the  lateral 
ventricles.  There  were  also  present  evidences  of  secon- 
dary syphilis.  He  had  been  a  very  hard  drinker  be- 
sides. Dr.  F.  thought  it  remarkable  that  a  man  with 
so  much  disease  could  be  enabled  to  follow  such  an  ac» 
tive  occupation.  He  was  of  the  opinion  that  death 
was  caused  by  apoplexy^  whioh  had  probably  oome  on 
independent  of  tne  injunes.  ^<^  t        ^ 

digitized  by  VjOOQIC  ' 


THE  MEDICAL  RECORD. 


401 


OUNSHOT  WOXTKD  OF  HEART  AND  XJVER. 

A  third  specimen  was  also  exhibited  by  the  same 
gentleman,  on  behalf  of  Dr.  Wooster  Beach,  Jr.  It 
consisted  of  a  gunshot  wound  of  the  hearty  taken  from 
a  man  who  was  accidedtaUr  shot  in  the  pistol  gallery 
of  Barnum's  Museum,  while  in  a  stoopmg  position 
fixing  the  target  The  ball  entered  to  the  right  of  the 
spine,  fracturmg  the  eleventh  rib,  passed  through  the 
hver,  thence  through  the  right  ventricle  at  its  lower 
portion,  struck  the  sternum,  and  was  lost.  He  walked 
twentj-five  feet,  and  then  fell  dead. 

He  next  presented  a  fourth  specimen  on  behalf  of 
Dr.  Stirling.  It  consisted  of  the  aorta  with  its  prin- 
cipal branches,  on  the  internal  surfaces  of  which  ar- 
teries were  abundant  deposits  of  atheroma.  The 
remarkable  circumstance  was  that  the  degeneration  of 
the  coats  was  principally  confined  to  the  posterior  as- 
pect of  the  vessels. 

sofTjuriNa  OF  thi  brain — obstinatb  constipation. 

He  also  exhibited,  on  behalf  of  the  same  gentleman, 
a  specimen  taken  from  a  man  sixty-five  years  of  age, 
who  6.Ye  years  before  death  became  afflicted  with  sof- 
t«iing  of  the  brain,  as  eylDced  by  a  tottering  gait  and 
feeble  intellectual  powers      The  softening  increased 

Eadually,  attended  by  paralysis,  which  was  more  or 
»  extensive  in  different  parts  of  the  body.  During 
the  latter  period  of  his  illness  he  suffered  from  diarrhoea, 
which  would  alternate  with  long  continued  and  obsti- 
nate constipation.  At  one  time  he  was  seventeen  days 
without  an  evacuation,  at  another  twenty-one,  jmd  at 
another  thirty-five  days.  There  was  no  obstruction  of 
the  gut  to  account  for  this.  On  examining  the  body 
after  death  the  transverse  and  descending  colon  were 
loaded  with  large  hardened  masses  of  fboes,  which 
being  previously  felt  through  the  abdominal  walis,  gave 
the  impression  of  internal  tumors. 

In  answer  to  a  question,  Dr.  Stirling  remarked  that 
the  patient  was  an  active  business  man,  was  in  the 
habit  of  working  his  brain  severely  at  times,  and  that 
during  the  thirty-five  days  of  constipation  he  had  no 
stercoraceous  vomiting. 

fibro-oabtilaoinous  tumors  of  ear. 

Dr.  Post  exhibited  afibro-oartilaginous  tumor^  which 
was  remarkable  on  account  of  its  seat,  he  havmff  re* 
moved  it  from  the  helix  of  the  ear  of  a  muJAtto, 
seven  years  old.  It  had  been  growing  for  three  years. 
There  did  not  seem  to  be  any  apparent  cause  for  its 
^pearance  in  that  locality. 

Dr.  Satre  remarked  that  some  years  ago  he  had 
presented  to  the  Society  two  such  tumors,  removed 
mm  the  same  positions  from  two  different  mulatto  girls, 
caused  in  both  mstances  by  puncturing  the  ear  for  ear- 
rings. 

The  Society  then  adjourned. 


Statbd  MBBTnra,  Sxptrmbir  25,  1867. 
Dr.  a  0.  Post,  Chairman  pro  tern, 

Db.  Finnell  presented  the  uterus  and  appendages  of 
a  woman  twenty-five  years  of  age,  who  died  as  there- 
suit  of  faUopian  pregnancy.  The  patient  was  seen  six 
hours  after  having  been  seized  with  violent  abdominal 
pains,  and  when  she  was  evidently  in  a  dying  condition. 
Her  menstruation  had  been  irregular,  the  last  catamenia 
having  occurred  only  two  weeks  before,  which  circum- 
stance mided  the  doctor  in  making  a  diagnosis.  She 
(Med  twelve  hours  after  the  attack.  At  the  autopsy  the 
abdomen  was  found  moderately  filled  with  blood,  about 


five  pints  in  aH  The  left  Fallopian  tube  was  the  seat  of 
two  enlargements ;  one,  the  smaller,  nearest  the  uterus, 
was  found  ruptured  on  its  proximal  side ;  the  other, 
larger,  was  situated  in  the  fimbriated  extremity,  which 
was  filled  with  apparently  nothing  more  than  a  mass  of 
coagulum.  The  left  ovary  contained  a  corpus  luteum 
of  recent  formation.  The  uterus  itself  was  but  slightly 
enlarged.  The  patient  had  but  one  child  five  years  be- 
fore. 

OUNSHOT  WOUND  OR  FRACTURE  OF  THS  BODT  OF  THE 
SECOND  LUMBAR  VERTEBRA. 

Dr.  Hamilton  presented  a  conical  rifle  ball  which  he 
removed  from  a  patient  on  the  18th  of  the  present 
month  at  Bellevue  Hospital.    The  case  was  as  follows : 

WlUiam  Madden  (enhsted  as  William  McMahdn)^  pri- 
vate 20th  Conn.,  pet  24,  was  wounded  in  battle,  March 
16,  1866,  at  Averysborough,  N.  C,  the  ball  entering 
on  the  left  side,  a  little  above  the  crest  of  the  ilium,  and 
about  four  inches  from  the  spine,  and  passing  across 
deep  and  nearly  horizontally  to  the  right  side,  where  it 
lodged.  There  was  no  evidence  that  any  of  the  viscera 
of  the  abdomen  were  wounded.  He  fell  immediatelv, 
and  Was  carried  to  the  rear,  being  unable  to  walk. 
There  was  no  immediate  paralysis  of  the  bladder,  but 
three  days  later  a  paralysis  of  the  bladder  existed  to 
that  degree  that  it  became  necessary  to  employ  the 
catheter,  and  the  urine  had  to  be  drawn  for  seven  con- 
secutive days.  He  was  placed  upon  a  water  bed  after 
a  time,  on  account  of  bed  sores.  At  the  end  of  six 
months  the  baU  was  felt  about  four  inches  from  the 
spine  on  the  right  side,  but  no  attempt  was  made  to  re- 
move it,  probably  because  the  diagnosis  was  not  suffi- 
ciently positive.  About  one  year  from  the  time  of  in- 
jury he  began  to  walk  upon  crutches;  and  about  this 
tnne  also,  a  small  piece  of  bone  escaped  by  the  wound 
of  entrance,  contsuning  a  fragment  of  lead.  Several 
other  very  small  pieces  escaped  at  other  times.  Three 
weeks  ago,  the  position  of  the  ball  changed,  falling 
lower  down,  so  as  to  rest  almost  upon  the  crest  of  the 
ilium. 

His  condition  before  the  operation,  as  stated  by  Dr. 
Hamilton,  was  briefly  as  follows :  He  was  considerably^ 
emaciate4  hut  well  enough  to  walk  about  The  spi- 
nous processes  of  the  first,  second,  and  third  lumbar  ver- 
tebres  were  unusually  prominent^  describing  a  curve 
backwards,  such  as  we  see  in  caries  of  the  spme.  They 
were  fixed  in  this  position ;  and  the  patient  believes 
that  no  change  in  their  form  has  taken  place  during  the 
last  two  years.  The  wound  of  entrance  was  still  open, 
and  there  were  three  other  sinuses  opening  in  the  nght 
groin,  which  evidently  communicated  with  the  first- 
named  sinua  The  bowels  were  tumid,  tympanitic,  and 
constipated.  In  making  water  there  was  often  some 
delay,  and  generally  some  effort  required  to  start  it. 

The  ball  could  be  distinctly  felt  in  the  situation  before 
described. 

The  patient  was  placed  under  the  influence  of  ether, 
and  the  ball  exposed  by  a  long  and  deep  incision.  It 
was  easily  removed  by  Dr.  Hamilton,  assisted  by  Dr. 
Pinkney,  of  the  Bellevue  Dispensary.  He  is  now  again 
walking  about,  and  the  discharge  has  much  dimini^ed. 

The  ball  is  flattened  upon  one  side  of  its  base,  and  at 
this  point  some  small  fragments  of  bone  are  embedded  in 
its  substance. 

There  are  two  points  of  interest  in  this  qase.  Ftrtij 
that  although  the  body  of  the  vertebra  was  hit,  there 
was  no  immediate  paral3r8is  of  the  bladder — ^the  paral- 
ysis of  the  bladder  taking  place  three  days  later,  and 
no  doubt  as  a  consequence  of  the  inflammation  which 
ensued.  Second,  The  case  is  of  interest  in  that  he  has 
a  &ir  prospect  of  complete  xeoovery.    It  is  quite  cer- 


402 


THE  MEDICAL  RECORD. 


tain  that  the  lesion  of  the  spine  has  been  completely 
repaired  long  since ;  and  Uiere  is  every  reason  to  be- 
lieve tliat  nothing  but  the  presence  of  the  ball  has  per- 
petuated the  sinus. 

In  the  Surgeon-G^enerars  report,  Circular  No.  6,  one 
hundred  and  eighty-seven  examples  of  gunshot  frac- 
ture of  the  vertebrae  are  reported,  of  which  one  hun- 
dred and  eighty  died,  and  of  the  seven  which  recovered 
not  one  was  a  fracture  of  the  body  of  a  vertebra. 
There  are  collected  in  the  Military  Museum  at  Washing- 
ton, sixty-six  specimens  of  gun&ot  lesions  of  the  spine 
and  cord. 

It  is  certainly  very  rare  that  patients  recover  after 
these  accidents ;  but  it  must  not  be  ^  forgotten  that  one 
anatomical  circumstance  gives  the  patient  some  addi- 
tional chances  when  any  of  the  vertebrae  below  the 
first  iimibar  are  hit  in  the  adult. 

In  the  child,  at  birth,  the  spinal  cord  extends  as  low 
down  as  the  third  lumbar  vertebra,  but  in  the  adult  no 
lower  than  the  top  of  the  second ;  here  it  terminates  in 
a  leash  of  nerves,  which  are  firmer  than  the  cord,  and  lying 
side  by  side  in  a  common  sheath,  they  slide  upon  each 
other,  and  do  not  probably  suffer  so  often  from  concus- 
sion or  compression.  Mr.  Alexander  Shaw,  to  whom 
we  are  indebted  for  this  explanation,  has  seen  four  ex- 
amples of  fracture  of  lumbar  vertebrae  below  the 
second,  unaccompanied  by  any  degree  of  paralysis,  and 
whieh  were  followed  by  speedy  recovery. 

Dr.  Hamilton  called  attention  to  the  fact  that  in  this 
case  the  ball  could  not  have  struck  the  body  very  super- 
ficially, as  in  that  case  it  must  have  wounded  the  vena 
cava,  or  the  aorta,  and  it  was  probably  an  example  in 
which  the  ball  penetrated  the  centre  of  the  side  of  the 
vertebra,  making  perhaps  a  round  hole,  of  which  sev- 
eral examples  have  been  reported  from  time  to  time,  or 
it  may  have  passed  in  a  deep  groove,  made  on  the  an- 
terior surface  of  the  body  of  the  vertebra.* 

Db.  Post  referred  to  a  case  that  came  under  his  no- 
tice at  the  Chesapeake  Hospital,  Fortress  Monroe,  in 
which  a  ball,  after  having  traversed  the  soft  tissues  for 
a  distance  of  nine  inches,  was  very  much  flattened. 
The  explanation  for  this  seemingly  extraordinary  cir- 
cumstance was,  that  the  misfflle  had,  previous  to  enter- 
ing the  body  of  the  patient^  been  flattened  by  striking 
against  a  tree. 

0ARIE8    OF    THE   TARBUB. 

Db.  Kceqlcb  exhibited  a  specimen  of  extensive 
caries  of  the  tarsal  bones,  necessitating  amputation 
of  the  leg.  The  disease  took  its  ongpn  from  an 
injury  to  the  foot  occasioned  by  a  misstep  mto  a  hole,  a 
year  ago,  since  which  time  it  gradually  extended  until 
it  involved  all  the  small  bones  of  the  ankle  in  destruc- 
tion. Shortly  after  caries  declared  itself^  a  small  portion 
of  the  OS  calcis,  as  well  as  of  the  astragalus,  was  re- 
moved with  a  view  to  arrest  the  progress  of  tne  disease, 
but  the  result  was  very  unsatisfactory.  There  was  a 
time  when  amputation  at  the  ankle  would  have  been 
practicable,  but  the  patient  refused  then  to  have  the  op- 
eration performed,  but  subsequently,  on  account  of  the 
severe  pain  which  the  progress  5f  the  disease  occasioned, 
he  gladly  consented  to  have  the  limb  removed  higher 
up.  This  operation  was  successful,  and  from  last  ac- 
counts the  promises  for  recovery  were  good. 

AN  INTSBESTINO   CASE  OF  ANEUBISM. 

Db.  0.  H  Smith  exhibited  a  specimen  of  aneurism, 
of  which  he  gave  the  following  account : 

*  At  the  next  meeting  of  the  Sodetv*  October  9, 1M7,  the  pfttlent 
was  himself  broTigbt  Into  the  presence  of  the  members  and  examined, 
the  dlapiosls,  as  to  the  scftt  and  character  of  theinjiuy,  being  fully 
eonnnned  by  all  who  were  present. 


The  patient  was  a  seafaring  man,  forty-five  years  of 
age,  who  enjoyed  good  health  up  to  a\year  ago,  when 
he  commenced  to  have  pain  in  his  chest,  attended  with 
cough  and  some  dyspnoea.  This  condition  of  things 
increased,  and  at  the  end  of  seven  or  eight  months  from 
his  first  attack  I  saw  him.  H«  had  previously  been  un- 
der the  charge  of  another  physician,  and  Professor 
Clark  had  seen  him  in  consultation.  Dr.  Clark  on  his  first 
visit  was  unable  to  say  what  he  thought  was  the  matter, 
but  on  the  second  visit  he  said  that  tnpre  was  some  en- 
largement of  some  of  the  vessels  of  the  thorax,  mean- 
ing aneurism.  He  advised  tincture  of  aconite,  evidently 
to  control  the  heart*s  action.  The  physician  had  ex- 
hausted all  his  energies  upon  the  case,  and  he  being 
discouraged,  I  was  requested  to  take  charge  of  the 
patient.  I  found  that  he  could  lie  only  on  his  back,  in- 
clining a  litde  to  the  right,  bolstered  up  with  pillow?. 
Any  effort  on  his  part  waa  sure  to  increase  bis  difficulty 
in  breathing,  and  even  the  mere  swallowing  of  food 
would  at  times  give  rise  to  paroxysms  of  dyspnoea 
which  were  quite  suffocative  in  character.  He  pre- 
sented very  much  ihe  appearance  of  aperson  in  a  per- 
petual paroxysm  of  severe  asthma.  His  pulse  in  both 
wrists  waa  soil  and  natural  and  there  was  no  increased 
pulsation  in  the  arteries  oif  the  neck.  On  examining 
his  chest  nothing  could  be  heard  beyond  the  asthmatic 
breathing  over  every  part  of  his  thorax,  and  the 
dyspnoea  was  so  great  that  he  could  not  hold  his 
l^ath  that  I  might  have  an  opportunity  to  listen  to 
the  heart  sounds.  The  case  looked  to  me  like  obstruc- 
tion of  the  trachea  either  from  within  or  without 
There  was  no  dulness  over  any  part  of  the  chest,  but 
Dr.  Clark  had  said  it  was  aneurism,  and  I  must  accept 
the  diagnosis  although  I  could  not  see  it.  In  the  course 
of  eight  days  after  I  saw  him  he  sank  and  died. 

The  autopsy  was  made  twelve  hours  after  death. 
The  hmgs  were  found  to  be  healthy.  The  trachea  and 
surrounding  parts  were  divided  high  up,  with  a  view 
of  turninff  out  the  whole  viscera,  when  it  was  dis- 
covered that  the  aorta  was  firmly  aidherent  to  the  s{)inal 
column.  The  parts  were  then  more  carefully  examined 
in  siiu.  when  it  was  observ9d  that  the  descending  aorta, 
fi:t)m  the  left  subclavian  down,  was  occupied  by  an  an- 
eurism about  six  inches  long.  The  aorta  was  then  for- 
cibly torn  from  its  attachments  to  the  spinal  column, 
when  it  was  discovered  that  there  was  a  groove  along 
the  spinal  column  upon  its  anterior  surface ;  this  groove 
was  one-half  or  three-fourths  of  an  inch  in  width, 
and  from  two  to  three  inches  in  length.  The  aorta  was 
attached  to  the  spinal  colunm  on  either  side  of  this 
groove,  the  posterior  wall  of  the  artery  having  been 
obliterated  by  friction,  or  pressure  of  some  kind.  As 
this  tumor  .was  torn  out,  two  large,  firm,  fibrinous  clots 
were  taken  from  it.  These  two  clots  occupied  the  an- 
terior portion  of  the  vessel,  while  the  current  of  blood 
circulated  behind,  in  the  groove  referred  to.  On  fur- 
ther examination  it  was  discovered  that  the  ascending 
aorta,  from  the  heart  up  to  within  half  an  inch  of  the 
innominata,  was  very  much  dilated  and  funnel-shaped. 
The  descending  aorta  showed  evidences  of  atheroma, 
and  particularly  upon  ^e  posterior  aspect  of  the  vessel 
In  tne  ascending  aorta  tnere  were  no  signs  of  athe- 
romatous deposit.  The  arch  of  the  aorta,  from  the  in- 
nominata to  the  left  subclavian,  was  normal,  which  ex- 
plains why  there  was  no  abnormal  pulsation  in  the 
vessels  of  the  neck,  or  of  their  branches.  The  oesoph- 
agus lay  upon  the  right  border  of  the  ppinal  column 
firom  the  arch  of  the  aorta  down,  and  the  trachea  rested 
upon  the  oesophagus.  The  trachea  passed  under  the 
arch  of  the  aorta,  and  the  left  bronchus  passed  over 
this  tumor.  The  continual  pressure  of  the  tumor  upon 
that  left  bronchus  would  explain  thegconstant  difficulty 

digitized  by  VjC  „      ^_ 


TEDE  MEDICAL  RECORD. 


403 


of  breathing.  The  patient  died  of  asphyxia  as  io  chil- 
dren with  membranous  croup. 

Dr.  Booebs  moved  that  a  committee  be  appointed  to 
report  on  the  specimen  presented  that  evening  by  Dr. 
Finnell^  which  motion  being  carried,  a  committee  of  two, 
consisting  of  Drs.  Rogers  and  Finnell,  was  named. 

The  Society  then  adjourned. 

THE  NEW  YORK  MEDICO-LEGAL  SOCIETY. 

Stated  Meetino,  Octobeb  8,  1867. 

Db.  Thohas  0.  FiMNBLL,  PRESIDENT,  iu  the  Ghaif. 

THE  METHOD  TO  BE  ADOPTED  IK  AUTOPSIES. 

The  points  of  discussion  were  taken  up  in  the  following 
order:  notes,  instruments,  the  surroundings  of  the 
body,  the  autopsy  with  the  necessary  concomitants  of 
external  inspection,  examination  of  the  head,  thorax 
and  abdomen,  spine  and  limbs. 

For  notes,  it  was  recommended  that  paper  with  print- 
ed heads  be  used  referring  to  the  information  required. 
Time  of  commencing  must  always  be  stated. 

The  instruments  snould  be  as  few  as  possible.  Those 
generally  employed  were  recommended,  excepting  the 
mallet  and  chisel  The  best  needle  is  the  ordinary  sail- 
maker's  needle,  sold  at  a  trifling  cost  at  all  hardware 
stores.    Its  edges  should  be  ground  sharp. 

In  criminal  cases,  the  various  objects  near  the  body 
should  be  examined  with  great  care  and  their  position 
entered  in  the  notes.  Too  great  caution  cannot  be 
exercised. 

In  the  external  examination,  the  body  should  be 
Tiewed  from  head  to  foot.  Sugillation,  and  all  other 
marks  must  be  noted.  The  position  of  the  limbs 
must  be  carefully  observed ;  also  the  amount  of  decom- 
position and  abdominal  swelling.  The  location  of  the 
marks,  etc.,  must  be  described  by  actual  measurement. 

In  opening  the  head,  the  use  of  the  mallet  and  chisel 
was  objected  to  by  some,  as  a  fracture  of  the  skull  mieht 
result  m)m  their  employment,  where  none  existed  be- 
fore. To  retain  (he  skull- cap  in  place,  Dr.  Finnell's 
method  of  driving  French  naus  far  enough  into  the  di- 
ploS  of  the  stationary  portion  at  the  occipital  bone  to 
nold  securely,  then  bending  them  so  as  to  prevent  the 
movable  portion  from  sliding  backwards,  was  explained ; 
and  also  Dr.  W.  Beach's  plan,  consisting  of  a  wire  bent 
into  loops,  opening  in  contrary  directions,  in  which  the 
upper  and  lower  cut  sections  were  placed  and  held 
in  position.  Both  these  contrivances  were  intended 
to  >nold  the  bone  in  place,  and  prevent  the  unsightly 
mark  in  the  forehead,  where  the  edges  do  not  approxi- 
mate. A  method  to  accomplish  the  same  object  was 
used  by  Dr.  J.  Beach.  The  line  taken  by  the  saw  an- 
teriorly, ran  just  over  the  forehead,  the  mark  being  hid 
by  the  nair. 

To  inspect  the  chest  and  abdomen,  an  indsion  from 
behind  the  symphysis  of  the  maxillary  bone  to  the  sym- 
physis pubis,  was  advocated,  allowing  the  tongue,  and 
contents  of  the  neck  and  thorax,  to  be  turned  out  The 
disfigurement  caused  by  this  mode  was  thought 
sufficient,  by  some  members,  to  prevent  its  general 
adoption.  To  lessen  the  flow  of  blood  in  taking  out  the 
heart,  placing  ligatures  on  the  cavee  was  suggested. 
Dr.  Finnell  illustrated  his  method  of  opening  the  heart, 
by  which  both  sides  of  the  organ  were  completely 
exposed.  A  number  of  valuable  practical  suggestions 
in  this  branch  of  the  subject  were  made,  but  our  space 
will  not  admit  of  further  detail 

LoKDOK  Mud.— Thirteen  per  cent,  of  the  mud  in  Lon- 
don is  said  to  be  abraded  uron. 


CorregponUence* 


THE   QUESTION   OF  PRIORITY. 

To  THs  Kditob  of  thb  Msdioal  Bboobo. 

Sib— In  the  absence  in  Europe  of  my  partner,  Dr. 
Charles  F.  Taylor,  will  you  allow  me  a  small  space  in 
the  Record  for  the  publication  of  a  few  words  in  regard 
to  the  "question  of  priority"  between  Drs.  Sayre  and 
Taylor,  as  to  the  invention  and  use  of  a  short  q)lint  in 
the  treatment  of  hip-disease  ? 

If  I  understand  the  matter,  Dr.  Sayre  hns  raised  a 
false  issue,  both  in  his  letter  of  July  24,  1861,  pub- 
lished in  the  American  Medical  7lme»,  and  in  the  one 
just  published  in  the  last  number  of  the  Record. 

I  understand  Dr.  Taylor's  claim  to  be  this,  viz. :  That 
he  (Dr.  T.)  first  devised  and  used  a  splint  with  a  cross- 
piece  and  joint  at  the  top,  and  with  a  branch  to  take  the 
adhesive  straps  from  the  inside  of  the  thigh.  These 
peculiarities,  which  constitute  the  distinctive  features 
of  that  splint.  Dr.  Sayre  has  adopted ;  the  instrument 
has  been  labelled  as  "Sayre's,"  and,  if  we  mistake  not. 
Dr.  S.  has  figured  it  in  a  published  article  as  his  own. 

As  to  Dr.  Taylor  having  "  promised  to  publish  a  cor- 
rection" of  his  "error  "  I  can  safely  leave  it  for  him 
(Dr.  T.)  to  explain,  on  his  return  from  abroad. 
Respectfully  yours, 

W.  E.  Vermilte. 

1808  BnMdway,  Oct  4, 1887. 


tleni  3n0ttuTneitt0. 


EUSTACHIAN  CATHETER  HOLDER. 
Br  0.  D.  POMEROY,  M.D., 
nwToix. 
The  aocompanyinff  cut  represents  an  instrument 
holding  the  eustachian  catheter  in  position,  which  may 
involve  some  principles  of  construction  not  often  ob- 
served. 


for 


The  band  passing  around  the  head  and  fastening  the 
instrument  to  the  forehead,  is  made  of  leather,  instead 
of  elastic  material,  to  hold  more  firmly,  as  any  giving 
is  contra-indicated.  The  clamp  which  holds  the  cathe- 
ter by  means  of  a  small  thumb  screw,  passes  vertically 
through  a  round  aperture  in  a  small  post,  placed  at 
right  angles  to  the  forehead  plate  Tor  iron),  which 
allows  it  to  slide  up  and  down  througn*a  circular  aper- 
ture, which  permits  the  clamp  to  revolve  upon  its  axis ; 
the  whole  fastened  by  a  screw  at  the  top  of  the  post 
Within  tiie  iron  plate  the  post  is  fastened  with  a  pivot- 
like arrangement  which  aJlows  the  damp  to  be  moved 
from  one  nostril  to  the  other.  r^  ^^  ^-^  ^T  ^ 

digitized  by  VjOOQ  Ic 


4M 


THE  MEDICAL  RECORD. 


In  the  cut  the  clamp  is  pushed  so  fiir  up  as  to  be 
above  the  level  of  the  catheter.  When  adjusted^  we 
have  only  to  loosen  the  screw  in  the  forehead  piece, 
and  allow  it  to  drop  down  sufficiently  to  catch  the 
catheter,  when  both  screws  are  tightened.  The 
advantage  of  this  instrument  over  some  others  is — ^the 
ball  and  socket-joint  at  the  forehead,  which  is  easily 
worn  out,  and  does  never  bold  the  catheter  so  as  to 
perfectly  prevent  any  antero-posterior  movements,  is 
here  dispensed  with,  and  the  lateral  pivot-Uke  move- 
ment wnich  allows  the  clamp  to  swing  to  either  nostril 
without  any  screw  adjustment,  is  peculiar  to  this  in- 
strument alone,  as  far  as  I  know. 

Some  object  to  the  use  of  the  catheter-holder  in  toto ; 
but  when  we  reflect  on  the  ease  with  which  the  cathe- 
ter is  displaced,  and  the  attendant  pain,  the  necessitat- 
ing an  extra  hand  for  its  management  (unless  the  ope- 
rator is  very  skilful),  and  the  difficulty  of  introducing 
the  bougie  through  a  movable  catheter,  it  seems  to  me 
its  value  must  be  conceded. 


©bituarg* 


PROFESSOR  ROBERT  WATTS,  M.D. 

NBW  YORK. 

RoBKRT  Wattb,  M.D.,  the  widely  known  Professor  of 
Anatomy  in  the  College  of  Physicians  and  Surgeons, 
N.  Y.,  whose  death  occurred  at  Paris,  Sept^oaber  8tb, 
was  bom  August  31, 1812,  upon  what  is  now  the  site 
of  St  John's  College^  Fordham,  Westchester  county, 
N.  Y.  Having  graduated  from  Columbia  College,  N.  Y., 
in  1831,  he  be)2:an  his  medical  studies  in  the  office  of 
Professor  Willard  Parker,  the  while  attending  the 
schools  in  Pittsfield,  Mass.,  and  Woodstock,  Y t.  Sub- 
sequently, however,  he  became  the  pupil  of  Professor 
Alexander  H.  Steyens  in  New  York,  and  finally  re- 
ceived his  diploma  from  the  College  of  Physicians  and 
Surgeons,  in  1836. 

Dr.  Watts  early  evinced  a  preference  for  the  study 
of  anatomy ;  and  the  proficiency  which  was  the  natural 
result  of  his  zeal,  well  qualified  him  while  yet  a  student 
for  the  duties  of  assistant  to  his  preceptor,  then  Pro- 
fessor of  Anatomy  at  the  Woodstock  College.  After  four 
gears'  service  as  Anatomical  Professor  at  these  Eastern 
mstitutions,  he  accepted,  in  1839,  a  corresponding  ap- 
pointment in  the  College  of  Phvsicians  and  Surgeons, 
and  fi*om  that  date  conunenced  his  residence  in  our 
city.  A  resignation  of  his  former  positions  in  1841 
enabled  him  to  devote  himself  more  closely  to  the  in- 
stitution, of  whose  faculty  he  was  at  the  time  of  his 
decease  the  oldest  member. 

In  1844,  Dr.  Watts,  together  with  several  other 
prominent  physicians,  took  an  active  part  in  the  foun- 
dation of  the  N.  Y.  Fathological  Society^  of  which  for 
several  years  he  was  tibe  President  He  was  also  a^ 
Fellow  of  the  K  Y.  Academy^of  Medicine,  and  a  mem- 
ber of  the  N.  Y.  Medical  and  Sumcal  Society,  as  well 
as  the  Society  for  the  Relief  of  Widows  and  Orphans 
of  Medical  Men,  and  the  N.  Y.  Medical  Journal  Associ- 
ation. 

The  health  of  Professor  Watts,  which  as  a  rule  was 
rather  delicate,  at  length  became  so  much  impaired  at 
the  close  of  the  last  collegiate  session,  that,  in  accord- 
ance with  the  advice  of  an  intimate  professional  fiiend, 
who  had  detected  tuberculous  disease  of  the  lungs,  he 
concluded  to  test  the  advantage  of  a  sea-voyage.  Dur- 
ing the  latter  part  of  May,  therefore,  in  company  with 
his  wife,  he  set  sail  for  England,  Finding  the  climate 
of  that  region  but  ill  adapted  to  his  neeids,  he  sought 


the  more  genial  weather  (^  the  Continent.  Here  again 
he  was  disappointed,  for  his  disease  steadily  progressed, 
and  while  in  raris^n  August  30th,  pneumo-thorax  sud- 
denly occurred.  Under  this  he  rapidly  sank,  closing 
his  pure  and  gentle  life  with  the  crowning  graces  of 
Christian  suomiBsion  and  patience,  regretted  by 
*'  troops  of  friends,"  and  respected  by  all 

His  remains  were  brought  home,  and  after  the  funeral 
services  held  at  the  church  of  the  Asoension.  October 
18,  ult,  were  placed  in  the  vault  of  St  Mark's  P.  R 
Church. 


Um  l^ubltcationd. 


Books  and  Fasifhlets  Received. 

Injubies  of  th»  Btb,  Orbtt,  and  Etbuds^  thbib  nncEDi* 
ATB  and  eemotb  XFrBOTB.  By  Gsa  Lawson,  F.R.C.S., 
Bog.,  AsBistant  Surgeon  to  the  Boyal  London  Ophthalmic 
Ho^tal,  Moorflelds,  and  to  the  Middlesex  Hospital;  late 
Assistant  Surgeon  Rifle  Brigade.  London;  Longmans^ 
Green  4  Ca    IS^I. -^Ik-om  (he  Avihor.) 

ClBOULAB   Na  7,  WaB  DePASTMERT,  BUBffEOV-QKXS&AlM 

Office,  Washington,  D.a,  July  1,  1867.  A  Report  on 
AmpuUtions  at  the  Hip  Joint,  in  Military  Suigvy. 

Inhalation,  its  Thebapeotiob  and  Practice.  A  Treatise 
on  the  Inhalation  of  Gases,  Vapors,  Nebulized  Ruida,  and 
Powders,  including  a  description  of  the  iq[>paratu8  employ- 
ed, and  a  record  of  numerous  experiments,  eta,  etc.  By 
J.  SOLis  Cohen,  M.D.  Philadelphia:  Lindsay  4(  Blakis- 
ton.    1867. 

A  Contbibution  to  the  Histobt  of  the  Hip-Jonrr  Opera- 
tions performed  during  the  late  Civil  War  ;  being 
the  SUtistics  of  20  cases  of  Amputations  and  13  Reseo- 
tioDs  at  this  articulation  in  the  Southern  Service.  By 
Paul  P.  Eve,  M.D.,  Prof  of  Surgery  in  the  University  of 
Nashville,  Tenn. 

Transactions  op  the  Medical  Soceett  of  the  State  of 
Pennsylvania,  at  its  18th  Annual  Session.  Fourth  Se- 
ries.   Part  TIL    Phila.     1867. 

Synopsis  of  a  Course  of  Lectures  on  Materia  Mkdica 
and  Pharhacy,  Delivered  in  the  University  of  Pennsyl- 
vania ;  with  five  lectures  on  the  Modus  Operandi  of  Medi- 
cines. By  Joseph  Carson,  M.D.  Fourth  edition  revised. 
Phila. :   H.  C.  Lea.    1867. 

The  Practice  op  Medicine  and  Surgery  applied  T9  the 
Diseases  and  Accidents  incident  to  Women.  By  Wm. 
H.  Byford,  A.m.,  M.D.,  Prof,  of  Obstetrics  and  Diseases  of 
Women  and  Children,  Chicago  Medical  College.  Phila. : 
Lindsay  ft  Blakiston.     1867. 

Headaches,  Their  Causes  and  their  Curb.  By  Henry 
G.  Wright,  M.D.,  P.R.C.aL.,  LAA.,  eta  From  the  Fourth 
London  Edition.    Phila. :    Lindsay  &  Blakiston.     1867. 


MtVitoi  Jtcm«  anlr  Urns. 


New  York  State  Woman's  Hospital. — The  first 
portion,  or  one  of  the  four  quadrangular  pavilions  of 
the  New  York  State  Woman's  Hospital,  situate  at  the 
comer  of  Fiftieth  street  and  Fourth  avenue,  was  opened 
October  10th  with  very  interesting  exercises.  The  at- 
tendance of  ladies  was  unusually  l^ge^  and  comprised  a 
goodly  number  of  those  who  are  known  throughout  the 
city  for  their  philanthropic  works. 

The  Hon.  James  W.  Beekman,  Preddent  of  the  Board 
of  Governors,  presided. 

After  prayer  by  Rev.  C.  D.  Foss,  and  a  brief  address 
by  Mr.  IBeekman,  in  which  a  history  of  the  inetitution 
was  successfully  reviewed,  an  address  was  delivered  by 


THE  MEDIOAL  RECORD. 


405 


hi 


Dr.  Barker,  who  said  he  was  the  only  physicifto  now 
Hying  in  the  city  who  was  thoroughly  acquainted  with 
the  early  history  of  ^e  institution.  He  knew  the  zeal 
with  which  the  profession  welcomed  the  discovery  that 
a  surgical  disease  of  the  most  distressing  character, 
which  the  resources  of  art  had  heretofore  failed  to 
reach,  was  now  by  the  genius  and  skill  of  Dr.  Sims 
radically  cured  by  one  or  more  operations.  It  was  evi- 
dent soon  after  this  discovery  was  made,  that  a  special 
hospital  was  necessary  to  render  available  its  benefits 
to  a  Jgreat  majority  of  those  requiring  the  operation. 
The  Woman's  Hospital  Association  was  founded  in 
February,  1855,  with  a  Board  of  Manaffers  consisting  of 
thirty-four  ladiea  It  is  the  work  of  woman  for  the 
benefi  t  of  woman.  The  hospital  was  opened  on  the  4th 
of  May,  1855,  with  forty  beds,  and  during  the  twelve 
^ears  that  have  elapsed  siQce  that  time  over  400  cases 
lave  been  cured  of  the  most  loathsome  infirmity  that 
woman  is  ever  called  upon  to  bear,  by  which  she  is  de- 
barred from  all  society,  and  made  a  burden  to  herself, 
and  an  infirmity  which  before  was,  as  a  rule,  incurable. 
Within  twelve  years  too,  1,219  cases  have  been  dis- 
charged, cured  or  greatly  relieved.  New  York  City 
could  point  with  proud  satisfaction  to  the  institu- 
tions which  she  now  possesses  for  the  relief  of  human 
suflfering.  The  speaker  here  made  mention  of  the  vari- 
ous charitable  medical  institutions  in  the  city,  and 
spoke  of  the  advantages  they  offered  to  the  public.  In 
again  refening  to  the  New  York  State  Woman's  Hos- 
pital, he  said  that  not  many  years  hence  this  beaytiful 
edifice,  which  may  now  be  said  to  be  on  the  outskirts 
of  the  city,  will  be  near  the  centre  of  a  most  prosper- 
ous and  wealthy  population.  Who  could  estimate  the 
incalculable  amount  of  reUef  to  human  suffering  which 
this  institution  is  destined  to  afford — the  number  of 
desolate  and  loathsome  wives,  or  wretched  and  helpless 
mothers,  who  will  be  restored  to  health  and  hi^piness? 
Dr.  Barker  next  paid  a  feeling  compliment  to  the 
surgeon  in  charge  of  the  institute,  and  ended  his  ad- 
dreas  with  an  expression  of  confidence  in  the  success  of 
the  good  work  thus  begun. 

Rev.  Dr.  Adams  next  addressed  the  meeting.  He 
said  he  never  envied  Dr.  Sims,  but  he  did  rejoice  in  the 
thought  of  the  deep  delight  which  Dr.  Sims  and  his 
associates  must  have  felt  in  the  marveUoos  success 
which  attended  their  efforts. 

Short  addresses  were  also  made  by  Dr.  Afred  0. 
Post  and  Bev.  Dr.  Duryea,  after  whidi  prayer  was 
offered  by  Rev.  Dr.  Adaoos.  The  exercises  were  closed 
with  silking  and  the  benediction. 

The  edifice  is  on  the  French  pavilion  plan,  and  when 
oompleted  will  consist  of  a  prmcipal  building  on  the 
OMitre  of  the  flat,  and  connected  with  four  pavilions 
built  in  quadrangular  form  by  a  series  of  corrid(M^ 
The  style  is  that  known  as  the  Lombardo-ItaHan.  The 
exterior  material  of  the  walls  is  Philadelphia  pressed 
briokj  with  a  basement  dressing  of  cut  stone.  The 
building  will  be  covered  in  with  a  Mansard  roof  of  omah 
mental  slate,  with  ornamental  ridge  ornaments. 

The  main  building  is  160  feet  in  length  by  40  in 
Iweadth.  The  first  floor,  intended  for  private  paying 
patients,  contains  reception-rooms  and  sleeping  apart- 
ments, fitted  up  with  every  requisite  for  comfort  and 
convenience.  The  upper  floors  are  devoted  to  sick 
wards,  and  are  supplied  with  ample  accommodations  in 
the  way  of  cloeetia,  bath-rooms,  etc.  On  the  third 
story  is  the  operating-room,  which  is  overlooked  by  a 
gallery  intended  for  medi<»l  students.  An  devator, 
worked  by  the  engine  of  the  laundry,  siq[>plies  dualities 
for  ascending  to  and  descending  from  the  upper  por- 
tions of  the  edifice.  Adjoining  the  main  building  is  the 
laoodry.    la  the  basement  are  located  two  power&d 


steam  boilers  and  a  steam  pump  for  heating  purposes. 
On  the  upper  floor  are  the  washing-machines,  capable 
of  washing  2,000  pieces  per  diem,  an  elaborate  mangling- 
machine,  and  the  drying-room. 

The  State  appropriated  $50,000  toward  the  erection 
of  the  institution,  and  the  city  donated  the  site,  and 
will  in  fnture  have  the  right  to  nominate,  free  of  charge, 
to  one-fourth  of  the  beds  in  the  institution. 

Thougjh  the  institution  will  be  m  part  self-supportinfir, 
yet  it  will  in  great  part  depend  upon  voluntaiy  contn- 
butions.  Its  predecessor,  the  Woman's  Hospital  Asso- 
ciation, numbered  among  its  patients  ladies  who  came 
from  Europe  for  treatment  # 

Officibs  of  the  Medico-Lboal  Society. — ^At  the 
late  election  the  R>llowing  were  elected  officers  of  the 
Medico-Legal  Society :  Dr.  Thomas  0.  Finnell,  Presi- 
dent ;  Dr.  Robert  Newman,  Vice-President*  Dr.  Simeon 
N.  Leo,  Secretary;  and  Dr.  Augustus  Wolufarth,  Trea- 
surer. 

Thi  ZouAvi  Jacob.— The  Paris  correspondent  of 
the  N.  T,  World,  afier  discoursing  somewhat  at 
length  upon  the  achievements  of  the  miracle-working 
Zouave,  says :  '*  General  Forey  was  treated  by  Jacob 
after  his  usual  fashion—that  is,  by  a  simple  word  of  com- 
mand— 'Walk,  because  I  say  you  can  walk.*  But 
the  General  himself  has  been  too  long  accustomed  to 
command  to  submit  to  the  authority  of  a  mere  soldier, 
even  if  his  palsied  limbs  were  not  past  remedy.  Jacob 
says  that  his  failure  in  the  General's  case,  and  in  many 
others,  is  not  his  fault;  that  he  does  not  know  ^e 
source  of  his  power — ^pretend  to  discuss  it,  he  only 
knows  that  he  fi*equently  brings  relief  when  other 
remedies  faU,  and  that  he  is  wiUing  to  make  use  of  his 
^fl  whenever  he  is  asked.  If  he  succeeds  he  is  happy, 
if  he  fails  he  can  only  regret  it  While  Jacob's  star  was 
at  its  zenith,  some  new  evidence  of  his  miraculous  power 
Was  published  almost  every  da^ ;  now  that  it  is  on  the 
wane,  there  is  abundance  of'^  testimony  against  the 
authenticity  of  his  cures.  A  story  is  told  of  a  priest 
who,  deprived  of  si^t  through  a  paralysis  of  the  optic 
nerve,  called  upon  the  Zouave.  *  Take  off  your  spec- 
tacles,' said  Jacob,  ''and  look  me  in  the  face.  You  can 
seel'  *No.'  "But  I  say  yes.'  *Well,  then,  yes.' 
And  the  ecclesiastic  retired,  to  the  great  astonishment 
of  the  crowd.  *  Your  sight  is  improved,  then  ? '  said  a 
friend  to  him  as  he  was  passing.  '  Not  in  the  least' 
'  But  please  to  expkin.*  *  Why,  the  fact  is  I  did  not 
wish  to  appear  more  stupid  than  the  rest.' " 

MlDIOAL  SOOIBTY  OF  THE    OoUMTY  OF  NeW  YoBK. — 

SiXTT-SEOOin>  AmnvBBSABT. — Tim  ancient  society, 
which  now  numbers  upwards  of  250  members,  celebrat- 
ed its  sixty-second  anniversanr,  on  the  21st  ult,  at  the 
new  Music  Hall,  comer  of  Houston  and  Mott  streets, 
with  a  eoUation — nominally  such — but,  in  its  appoint- 
ments and  enjoyableness,  really  a  dinner.  The  affair 
was  decidedly  a  success;  the  reunion  of  the  profession 
being  both  cordial  and  general  Speeches  were  made 
by  Drs.  Wm.  W  Reese,  President  of  the  Medical  Socie- 
ty of  the  County  of  Kings;  0.  L.  Mitchell,  a  delegate 
from  that  societv  to  the  State  Medical  Society ;  Edmund 
S.  P.  Arnold,  President  of  the  Medical  Society  of  the 
County  of  Westchester;  P.  Stewart,  of  Peekskill;  J. 
Foster  Jenkins,  of  Yonkers;  Eleasar  Parraelee,  Presi- 
dent of  the  College  of  Dentistry ;  Alfred  0.  Post,  Presi- 
dent of  the  New  York  Academy  of  Medicine ;  James 
Knight,  of  the  New  York  Society  for  the  Relief  of  the 
Ruptured  and  Crippled;  Professor  Wm.  Detmold,  Dr. 
John  P.  Garrish,  and  Dr.  Ellsworth  Eliot  Excellent 
music  enlivened  the  programme,  and  after  "  Auld  Lang 
Syne,"  by  the  whole  company,  the  guests  reluctantly 
diqpened  at  a  kte  hour.  /^^  t 

Digitized  by  VjOOQIC 


406 


THE  MEDICAL  RECORD. 


The  New  Colored  Orphan  Asylum. — At  the  corner  of 
143d  street  and  Tenth  avenue,  a  new  colored  orphan 
asylum,  to  replace  the  building  destroyed  during  the 
draft  riots,  is  being  erected.  The  style  will  be  extreme- 
ly simple,  but  the  building  will  be  very  commodious 
and  extensive.  The  dimensions  of  the  main  structure, 
which  is  to  be  built  with  all  the  modem  improvements, 
are  to  be  234  by  100  feet 

The  new  Infants*  Hospital  of  Randall's  Island. — 
It  is  proposed  to  build  a  new  Infants'  Hospital  on  Ban- 
dairs  Island.  The  building  will  cost  from  $100,000  to 
$150,000.  The  plans  are  now  in  the  hands  of  Mr.  Ben- 
wick,  the  architect,  for  his  report. 

The  Institution  for  the  Blind  in  this  city  has  one 
hundred  and  twenty-two  students,  half  of  whom 
are  females. 

The  new  Offices  of  the  Oommissionbrs  of  Chasities 
AND  Correction. — The  site  of  new  offices  for  the  De- 
partment has  been  secured  on  the  north-west  comer 
of  Third  avenue  and  Eleventh  street  for  $62,500 — 771 
feet  by  100  feet  in  dimensions.  The  rooms  on  Bond 
street  now  rented  by  the  Conmiissionershave  long  been 
ill  suited  for  the  purposes  designed. 

The  relative^  proportion  or  the  Medical  to  the 
Legal  Praotitionbrs  in  England  and  Prussia. — 
According  to  a  statistical  article  in  an  English  paper, 
the  numl^r  of  lawyers  in  England  is  just  about  equal 
to  the  number  of  doctors,  but  in  Pmssiathe  doctors  are 
nearly  four  tjmes  as  numerous  as  the  lawyers. 

The  Opening  of  the  Colleges. — ^The  College  of  Phy- 
sidans  and  Surgeons  inaugurated  their  regmar  season 
by  the  usual  exercises,  October  14th,  ult  Dr.  H.  B. 
Sands,  who  succeeds  to  the  chair  of  Anatomy,  deliv- 
ered tlie  address,  in  which  he  alluded  in  a  touching  n^an- 
ner  to  the  many  virtues  of  Professor  Watts,  the  &te  in- 
cumbent, and  the  Bellevue  Hospital  Medical  College 
commenced  its  course  with  an  interesting  address  by 
Prof.  Prank  H.  Hamilton. 

The  University  Medical  College  also  formally  opened 
their  fSall  and  winter  course  on  the  same  evenmg,  Pro- 
fessor A.  L.  Loomts  delivering  an  entertaining  discourse 
upon  the  "  Progress  of  Medical  Science.*'  The  New 
York  College  of  v eterinary  Surgeons  have  likewise  en- 
tered upon  their  duties.  Professor  F.  D.  Weisse  address- 
ed the  niends  of  the  institution  assembled  by  invitation 
at  the  rooms  of  the  New  York  EEistorical  Society,  Octo- 
ber 2.  He  urged  in  warm  terms  the  importance  of  a 
more  thorough  and  extended  knowledge  of  veterinary 
science.  The  New  York  College  of  Dentistry  commenced 
their  session  October  16.  Dr.  J.  Smith  Dod^e  delivered 
the  introductory  address  at  the  CoUege  in  FifUi  avenue, 
near  twenty-second  street. 

Dr.  John  Betts  MoEwen,  of  this  city,  died  October 
7  ult.,  of  rupture  of  the  heart  consequent  upon  fatty 
defeneration,  a^ed  59  ye^  He  was  a  graduate  of  th^ 
College  of  Physicians  and^Surgeons,  clasd  1831. 

A  New  Work. — Darwin,  whose  "  Origin  of  the  Spe- 
cies "  created  somewhat  of  a  sensation  in  the  scientific 
world,  has  a  new  book  in  press,  entitled,  "  The  Varia- 
tion or  Animals  and  Plants  under  Domestication."  The 
work,  which  will  elucidate  the  principles  of  inheritance, 
reversion,  crossing,  interbreeding,  and  selection,  will  be 
published  by  Murray,  of  Londoo,  and  will  consist  of 
two  octavo  volumes. 

Bars  Modesty. — A  gentleman  who « refuses  to  have 
his  name  published,  has  donated  to  the  Birmingham 
(England)  General  Hospital  $50,000. 

Opium  Eating  in  England. —  Dr.  Hawkins,  of 
Xing's  Lynn,  tells  the  readers  of  the  Medical  Journal 


that  half  the  opium  imported  into  England  is  consumed 
in  Lincolnshire  and  Norfolk.  One  Lynn  chemist  sells 
200  pounds,  another  140  pounds  a  year  of  solid  opium, 
besides  five  or  six  gallons  of  laudanum,  and  five  or  six 
gallons  of  "  Oodfrev's  Elixir  "  (a  pint  of  laudanum  in 
every  three  gallons)  a  week.  People  will  be  startled  to 
hear  of  drawers  full  of  half-drachm  packets  of  opium, 
of  which  many  customers  take  three  a  day.  A  farmer 
came  in  to  get  some  ffood  laudanum.  "  How  many 
drops?"  asked  the  chemist.  "Drops?"  was  the 
reply :  "  give  me  an  ovmce  and  a  hal£"  The  chemist 
looked  at  him,  saw  he  was  in  the  habit  of  taking  it,  and 
grave  him  the  dose.  He  drank  it  ofl^  returned  twice  in 
the  day  for  the  same  quantity,  and  took  home  a  half- 

Eint  bottleful  with  him  when  he  left  market  The 
abitis  no  new  one.  The  present  writer  can  vouch 
for  its  existence  in  and  around  Spauldin^and  even 
across  in  Leicestershire  a  dozen  years  affo.  The  excuses 
would  be  obvious— deficient  food  with  the  poor,  ague 
and  "rheumatiz."  needing  an  anodyne,  with  others. 
But  it  is  a  growing  habit,  and  Dr.  Hawkins  speaks 
very  strongly  of  its  pernicious  effects  in  poisoning  the 
blood.  To  It  he  attributes  the  excessive  infant  mor- 
tality in  the  district,  and  the  "  miserable,  feeble,  brown- 
ish-yellowish countenances  so  striking  among  many  of 
the  inhabitants."  In  fact,  he  thinks  its  effects  on  the 
system  almost  as  bad  as  tnose  of  syphilis,  and  calls  for 
some  interference  to  discourage  what  is  becoming  a 
cause  of  wide-spread  degeneracy  in  the  breed. — Im- 
perial Review. 

Multiplioitt  of  Ohinibb  Bbmbdhs. — The  great 
strength  of  Ohinese  medicine  lies  in  the  multitude  of 
their  remedies.  Their  materia-medica  is  as  large  as 
ours.  It  consists  of  a  vast  accumulation  of  materialB 
that,  age  after  age,  empirics  have  said  were  good  for  this 
and  good  for  that  Of  such  facts  their  b(x>ks  consist. 
They  are  characterized  by  a  vast  predominance  of  vege> 
table  matters.  As  a  sdence  they  know  nothing  of 
botany ;  but  as  far  as  acquaintance  with  the  characteris- 
tics of  the  plants  goes,  their  growth,  and  properties  when 
used  as  medicines,  they  are  exceedingly  well  versed.  I 
mi^ht  say  with  safety,  that  every  plant  that  grows  in 
China  has  been  studied  with  a  view  to  its  medional  qua- 
lities, and,  no  doubt,  they  are  in  possession  of  valuable 
&cts  that  will  in  time  be  made  useful  in  other  countries : 
and  I  might  say  also,  that  they  are  about  as  successful 
in  the  treatment  of  diseases  as  physicians  in  other  ooun- 
tries.  Next  to  vegetable  remedies  are  animal  products 
in  their  practice.  Some  of  them  are  exceedin^y  dis- 
gusting in  their  implication  to  the  human  system.  The 
more  outlandish  the  animal  the  better  is  the  medicine. 
The  medicine  taken  firom  a  sluuk,  for  instance,  is  con- 
sidered more  powerful  than  that  obtained  from  a  better 
disposed  fish;  and  the  blood  of  a  lion  or  tiger  is  more 
cheerful  as  a  medicine  than  the  blood  of  less  ferocious 
animala.  The  blood  of  a  tiger  would  be  given  to  a  man 
\vho  needed  a  little  more  of  the  tifi;er  in  his  composition ; 
and  the  blood  of  a  Uon  would  be  given  to  one  who 
needed  a  general  rousing  up  of  his  powers.  A  dass  of 
medicines  which  we  haye  not  touched  as  yet.  is  the 
poisonous  substances  of  animals  and  insects.  They  do 
not  know  how  to  extract  the  poisons,  bat  they  cut  off 
the  stinging  portions  of  insects,  scorpions,  and  sudi  like, 
which  are  prized  very  highly,  and  apply  them  in  various 
ways.  Some  of  them  prove  yery  powerful  and  prompt 
in  their  action.  They  do  not  deal  very  extensivdy  m 
mineral  substances,  arguing  that  as  but  few  of  the 
mineral  substanoes  are  embrs^ed  in  the  human  organiza- 
tion, it  would  not  be  prq>er  to  infuse  such  substances  into 
the  system.  Mercury  and  iron  are  about  the  only 
minerals  they  use,  which  they  employ-ui  various  fbrtna, 
digitized  by  VjC  „      ^_ 


THE  MEDICAL  RECORD. 


407 


mercury  extensively,  in  something  like  our  blue  pill, 
and  some  resembling  calomel — ^Db.  Wilbt,  Oinn,  Lancet 
and  Ohs&rver. 

HuDsoH  County,  K  J.,  Medical  Sooiett. — ^This  So- 
ciety held  its  reffuLar  monthly  meeting  on  Oct.  Ist^  nine 
of  the  members  being  present. 

The  committee  appomted  at  the  last  meeting  to  ex- 
amine and  report  upon  existing  laws  of  the  State 
with  reference  to  the  practice  of  medicine,  made  their 
report  recommending  that  the  subject  be  urged  upon 
the  attention  of  the  State  Society  at  its  next  annual 
meetixig. 

Dr.  Culver  related  the  history  of  a  singular  and  fatal 
case  of  choleraic  dysentery,  supposed  to  iSive  originated 
from  the  noxious  gases  generated  by  an  animal  in  a 
state  of  decomposition.  Dr.  Varick  reported  a  very 
rare  case  of  complete  lateral  dislocation  of  the  elbow- 
joint.  Dr.  Chabert  exhibited  a  specimen  of  tssnia  lata 
eleveh  feet  in  length,  entire,  expelled  from  a  patient  by 
the  use  of  three  capsules  or  Dipple's  animal  oil 

The  Salt  Springs  of  Nbw  Yobk  produce  nearly 
7,000,000  bushels  of  salt  per  year. 

Cinnabar  in  California. — ^An  exceedingly  rich  bed 
of  cinnabar  has  been  discovered  about  four  miles  south 
of  San  Jose,  Cal  There  is  a  solid  ledge  about  twelve 
feet  wide  and  eight  feet  thick,  between  walls  of  rock, 
which  grows  richer  as  the  excavation  proceeds. 

Thx  so-called  Natural  Soap  of  Missourl — ^Natural 
soap,  it  is  again  announced,  has  been  discovered  in  Mis- 
souriy  some  sixty  miles  from  St  Louis.  What  has  been 
really  found  is  probably  **  fuller's  earth,"  a  variety  of 
day  which,  from  its  unctuous  touch,  might  easily  be 
mistaken  for  soap. 

Ths  Dangers  of  Boat  Racing. — The  Lancet  thus 
speaks  of  *^  The  Dangers  of  Boat  Racing" :  Few  laymen 
Lave  the  slightest  idea  of  the  dangers  to  which  a  supreme 
physical  struggle,  like  the  finish  of  a  University  boat- 
race,  subjects  organisms  ♦  ♦  ♦  ♦  ♦ 
♦  ♦  We  sincerely  trust  that  the  fine  young  fellows, 
whose  exertions  at  the  race  have  incidentally  occasioned 
our  remarks,  will  sustain  no  lasting  harm  firom  their 
eflbrts ;  but  we  think  it  our  duty  to  inform  them,  and 
the  whole  race  of  crack  oarsmen,  of  the  almost  inerit- 
able  consequences  which  would  arise  from  even  a  few 
repetitions  of  such  a  performance.  It  unfortunately 
hs^pens  that  the  experience  of  medical  men  in  this 
matter  has  never  been  published  in  a  complete  and  com- 
pendious form ;  but  there  are  few  Lonaon  physicians 
who  have  not  met  with  lamentable  illustrations  of  the 
mischief  done  in  this  way.  The  tremendous  respira- 
tory efforts  which  a  fatigued  man  must  make  when  he 
pats  on  such  a  series  of  sp\irts  as  those  which  Cam- 
bridge made,  very  often  produce  rupture  of  the  air-cells 
of  the  lung,  and  a  dangerous  permanent  emphysema. 
The  furious  action  of  the  heart  may  cause  rupture  of  a 
Talre,  and  very  frequently  does  cause  cardiac  dilatation, 
with  or  without  hypertrophy,  and  lastly,  the  enormous 
blood  pressure  in  the  vessels  is  not  uncommonly  the 
cause  of  aneurism.  Exact  statistics  are  wanting  on  the 
subject  of  these  maladies  as  thus  produced,  nor  can  we 
say  accurately  to  what  extent  they  shorten  life ;  but  it 
is  certain  that  men  who  have  committed  great  excesses 
in  taxing  their  powers  by  boat-racing  when  voung, 
frequentlv  do  not  survive  to  old  age.  We  have  known 
of  seTeral  deaths  from  fatty  and  dilated  hearty  quite  in 
early  middle  life,  which  were  directly  traceable  to  this 
cause.  The  dangers  incidental  to  the  process  of  train- 
ing, and  the  climax  for  which  it  is  the  preparation,  are 
best  avoided  by  the  selection  of  men  of  sound  phyn^ue. 


by  a  gradual  education  for  the  contest,  and  by  the 
avoidance  of  an  abrupt  subsequent  transition  to  ordi- 
nary habits  of  life. 

Thb  Humboldt  Medical  Archives. — The  firtt  num- 
ber comes  to  us  in  a  very  creditable  shape,  and  contains 
original  communications,  an  interesting  lecture  by  Profl 
Hammer,  editorials  and  news.  It  is  under  the  editorial 
charge  oi  Drs.  A.  Hammer  and  M.  A.  Fallen,  they  hav- 
ing ror  co-editors  the  faculty  of  the  Humboldt  Medical 
College,  St  Louis.  Although  emanating  from  the  said 
college,  the  intention  is  to  make  it  cosmopoUtan,  but 
this  is  not  made  as  apparent  as  it  might  be  if  an  elabor- 
ateljr  written  editorial  notice  of  the  advantages  of  the 
institution  were  omitted. 

Work  on  Miutart  Surgery. — The  Oaxette  Mi^di" 
caie,  of  Paris,  speak9  well  of  a  work  called  "Military 
Surgerjr  in  Prance  and  America,*'  by  M.  Ooze,  and 
which,  it  seems,  exhibits  a  comparison  very  favorable  to 
the  American  military  surgical  appliances,  and  of  the 
sanitary  department  generally  of  the  17.  S.  government. 

American  Ambulances. — The  Paris  correspondent  of 
the  London  Medical  Timee  and  Gazette^  and  also  that  of 
the  lUustrated  News,  calls  the  American  ambulances 
the  best  in  the  Exhibition,  and  the  one  exhibited  by 
Dr.  Benjamin  Howard,  of  New  York,  the  most  perfect 
of  them  all  The  "  Times  and  Ghizette  "  correspondent, 
deems  it  a  matter  of  regret  that  Dr.  Howard  s  ambu- 
lance was  not  known  until  nearly  the  close  of  the  war. 

A  Medical  Cannibal. — The  Liverpool  Post^  of  the 
16th  Sept,  announces  the  extraordinary  fact  of  a  med- 
ical assistant  actually  cooking  and  dining  off  of  a  corpse. 
This  disgusting  affair  took  |Mace  at  St  Thomas's  Hos- 
pital, London.  As  a  just  punishment  for  such  an  out- 
rage upon  common  decency,  the  medical  authorities 
have  publicly  dismissed  the  would-be  cannibal  in  disgrace. 

Another  Death  prom  Chloroform.-— Deaths  from 
chloroform  are  now  getting  to  be  so  common  that  it  re- 
quires a  faithful  chronicler  to  keep  track  of  theuL  The 
present  case  occurred  (so  says  the  Liverpool  Post)  at 
the  Northern  Hospital,  Liverpool,  on  the  11th  of  Sept 
The  operation  to  be  performed  was  that  of  straightening 
an  anchylosed  knee,  the  result  of  a  fracture  received 
some  time  previously.  The  junior  house-surgeon  fMr. 
Trubshaw)  administered  chloroform  bv  means  of  Skin- 
ner's inhaler,  using  about  four  or  nve  drachms,  and 
tbinking  that  the  deceased  would  not  inhale  more  than 
half  that  quantity.  Deceased  exhibited  alarming  symp- 
toms towards  the  close  of  the  operation,  and  artificial 
means  were  employed  to  sustam  respiration,  but  he 
expired  shortly  aiterwards.  The  chloroform,  it  ap- 
peared from  the  evidence,  was  carefuUjf  administered, 
and  eyery  precaution  used  to  prevent  misadventure.  A 
post-mortem  examination  of  the  body  was  made  by  Dr. 
Wollaston,  senior  house-surgeon  at  the  hospital,  and  his 
^opinion  was  that  death  resulted  from  syncope  induced 
by  chloroform.  He  added  that  the  medical  gentlemen 
present  at  the  operation  were  satisfied  with  the  manner 
in  wluch  the  chloroform  had  been  administered.  Ver- 
dict, "Died  from  misadventure,  from  the  administra- 
tion of  chloroform,  during  an  operation."  The  jurv 
added,  that  no  blame  was  attachable  to  any  of  the  med- 
ical gentlemen,  and  that  the  chloroform  had  been  ad- 
ministered wim  caution.  The  patient  was  fifteen  years 
of  age. 

A  Permanent  Anjbsthetio  Wanted. — A  reward  of 
$10,000  has  been  offered  by  an  English  gentleman, 
through  the  chairman  of  the  London  Hospital,  to  any  per- 
son who  shall  have  discovered  by  July  1, 1868,  any  means 
by  which  in  all,  or  nearly  all  cases,  pain  can  be  both 


408 


THE  MEDICAL  RECX)RD. 


permanently  and  completely  extinguished,  as  it  ean  now 
be  extinguished  for  a  short  time. 

LoyGBviTT  OF  Brun  Workers. — Reasoning  from 
Analogy  aod  from  the  facts  of  biography,  it  would  seem 
that  uiose  who  are  endowed  wiui  unusual  intellectual 
powers  can  work  harder  and  longer,  all  things  being 
equal,  than  the  rank  and  file  of  humanity.  The  law  is 
that  great  intellects  are  incased  in  sturdy,  powerful 
frames,  and  the  occasional  existence  of  monstrosities 
serves  but  to  establish  ihe  rule.  The  number  of  really 
great  men  of  history  is  comparatively  so  small  that  it  is 
impossible  to  fully  substantiate  this  theory  by  staUstioal 
facts,  but  if  we  take  the  record  of  biography  from  the 
earliest  time  to  the  present  as  our  guide,  it  would  seem 
to  be  very  clear  that  intellectual  giants  are  capable  of 
undergoing  severer  brain  labor,  with  far  better  prospects 
of  longevity,  than  men  of  mere  ordinary  abHity.  I  nave 
taken  the  pains  to  go  through  the  cydopsedia,  and  to 
note  down  the  ages  of  one  htMdred  of  the  greatest  men 
of  history,  those  who  have  created  epo<£s,  and  have 
been  the  leaders  of  the  world's  thought  in  literature, 
art,  sdenoe,  and  statesmanship,  and  i  have  found  that 
the  average  age  of  these  was  much  higher  than  that  of 
literary  and  professional  men  generally:  nay,  even 
much  Wher  than  that  of  clergymen,  the  longest  livers 
of  alL  This  list,  which  covers  a  period  of  many  centu- 
ries, contains  such  names  as  Qoetne,  Coleridge,  JJessing, 
Beranger,  Wordsworth,  Voltaire,  Hume,  Milton, 
8hakeq>eare,  Dante,  and  Irving^  amon^  men  of  letters ; 
Baphael,  Michael  Angelo,  and  Keynolds,  among  paint- 
ers ;  Malebranche,  Locke,  Leibnitk  Kant,  Hobbes,  and 
Hamilton,  among  modem  philosopners ;  and  Socrates, 
Aristotle,  Plato,  Cicero,  among  the  ancients ;  Harvey, 
Cuvier,  Buffon,  Galileo,  Humboldt,  Newton,  Jenner, 
and  Faraday,  among  men  of  science*  Napoleon,  Marl- 
borough, Washington,  Mettemich,  Richelieu,  Burke. 
Webster,  Calhoun,  and  Clay,  among  warriors  ana 
statesmen;  and  Calvin,  Luther,  Elnox,  Butler,  Paley, 
and  Edwards,  among  theologians.  No  one  will  deny 
that  these  and  simil«^  names  fairly  represent  the  giants 
of  history.— Geo.  M,  Beard,  M.D^  in  '^ Hours  at  Mome,'' 

Death  /bom  Ohlorodtke. — On  Saturday  last  consi- 
derable excitement  was  created  in  the  town  of  Haries- 
ton  by  the  report  that  a  woman  named  Elisabe^ 
Saunders  had  been  poisoned  by  chlorodyne.  The 
deceased  has  for  several  years  been  in  the  employ  of 
Mr.  Thomas  S.  Stanton^f  Mendham,  who  supplied 
this  town  vrit^  milk.  While  on  her  round  witn  the 
milk  on  Saturday  morning,  she  called  on  Mrs.  Arnold, 
and  as  she  complained  to  her  that  she  was  sufiering 
from  diarrhoea,  Mrs.  Arnold  gave  her  a  dose  of  chloro- 
dyne, which  had  as  she  thought  been  prepared  for  her 
son,  but  which  it  turned  out  was  undiluted.  On  discor- 
ering  her  mistake,  Mrs.  Arnold  sent  for  Saunders,  and 

gave  her  some  antimony  as  an  antidote.  She  was, 
owerer,  left  to  go  on  her  way,  and  not  returning  home 
at  her  usual  time,  inquiry  was  made  for  her,  and  sIm 
was  found,  between  10  and  11  o'clock,  in  a  water- 
closet  in  the  town,  in  a  state  oi  unconsciousness. 
Medical  attendance  was  called  in,  and  every  attention 
was  shown  her,  but  she  never  rallied,  aod  only  lingered 
till  10  o'clock  at  night  An  inquest  was  held  on 
Monday  morning,  when  a  verdict  of  "Accidental  death 
from  an  overdose  of  dilorodyne"  was  returned. — Lon- 
don New$, 

ExTENsivB  Examination  op  thn  Em. — ^A  oorioos 
work  has  been  published  at  Breslan  latdly  by  Dr.  Her- 
mann Cohn,  givmg  the  result  of  an  examination  of  the 
eves  of  10,060  school  obikfara.  The  proportion  of 
short-sighted  childrm  was  17'1  per  cent,  or  1,730 
among  10,060.    No  TOkge  children  w>ere  found  to  be 


short-fflghted  until  they  had  been  some  time  at  school 
— at  least  half  a  year.  Dr.  Cohn  attributes  ^e  evil  in  a 
great  measure  to  the  bad  construction  of  sdiool  benches, 
which  force  the  children  to  read  with  their  books  dose 
before  their  eyes  and  with  their  heads  held  downwards. 
The  obstinate  adherence  to  the  ancient  Gk)thic  character 
in  printing  and  writing,  to  which  Englishmen  are  gener- 
ally inclined  to  attribute  the  prevailing  near-sighted- 
ness of  Gkrmans,  is  not  alluded  to  by  Dr.  Cohn. 

SinoiDES  IN  England. — The  Begistrar-General  has 
published  a  curious  return  of  the  number  of  suicides  in 
jSngland  during  the  eight  years  from  1858  to  1866. 
They  average  1,300  annually,  and  to  every  minion  of 
the  populauon  run  thus  in  each  successive  year:  66, 
64, 70, 68, 65, 66,  64  and  67.  Hanging  has  always  been 
the  death  generally  adopted  by  suicides,  28  out  of  the 
ratio  of  67  per  million  suicides  falling  under  this  head. 
After  hangmg  follow  cutting,  stabbing  or  drowning^ 
poisoning,  and  by  firearms.  The  ratio  of  suicides  per 
million  of  the  respective  populations  in  1864,  was  110  in 
Fraooe,  64  in  England,  45  m  Belgium,  30  in  Italy,  and 
15  in  Spain. 

Ths  Wabhinoton  XJnivsrsitt — ^A  Niw  School  or 
Mbdioini. — A  new  medical  institution  under  the  above 
name,  having  a  corps  of  professors  second,  perh^>s,  to 
that  of  no  other  institution  in  the  country,  is  about 
being  established  in  Baltimore,  tmder  auspices  whk^ 
lead  to  the  assurance  of  its  permanent  success.  There  is 
no  doubt  that  Baltimore,  regarded  as  a  (kvorable  point 
for  education  generally,  may  find  abundant  support  for 
more  than  one  medical  school,  and  with  that  idea  this 
project  has  been  commenced. 

The  regular  sessions  of  Washin^n  University  will 
begin  annually  on  the  first  Tuesday  in  October,  and 
continue  for  five  months.  A  summer  course  of  lectures, 
beginning  on.  the  first  Monday  in  April  and  concluding 
on  the  luit  day  of  July  of  each  year,  will  be  delivered 
by  the  adjunct  faculty.  The  ttculty  consists  of  the 
following  professors :  Bev.  Thomas  E.  Bond,  MJ)., 
President ;  Q.  C.  M.  Roberts,  M.D.,  Emeritus  Professor 
of  Obstetrics^  and  Diseases  of  Women  and  Children : 
0.  L.  Ford,  M.D.,  Professor  of  Descriptive  and  Surj^cal 
Anatomy  ^  J.  P.  Logan,  MIX,  Professor  of  the  Principles 
and  Practice  of  Medicine ;  Harvey  L.  Byrd,  MD.,  Pro- 
fessor of  Obstetrics ;  Martin  P.  Scott,  M.D.,  Professor  of 
the  Diseases  of  Women  and  Children ;  Edward  Warren, 
MD.,  Professor  of  Uie  Principles  and  Practice  of  Sur- 
gery ;  John  F.  Monmonier,  M.D^  Professor  of  Physi- 
ology and  General  Pathology ;  J.  J.  Moorman,  MJD^ 
Professor  of  Medical  Jurisprudence  and  Hygiene :  Joseph 
E.  Cl^ett,  M.D.,  Professor  of  Materia  Meaica  and 
Therapeutics;  Clarence  Morfit,  M.D.,  Professor  of 
Medical  Chemistry  and  Pharmacy ;  John  N.  Monnomier, 
M.D.,  Demonstrator  of  Anatomy. 

The  faculty  have  obtained  an  eligible  location  for  the 
holding  of  lectures  and  diniques  in  the  large  building 
comer  of  Calvett  and  Saratoga  streets  where,  during 
the  session,  dailv  classes  will  be  held.  It  is  intended  by 
the  fiioulty  to  obtain  apermanent  location  at  an  eariy 
day.  Added  to  the  University  is  a  free  dispensary, 
recentiy  opened  at  the  University  building,  at  whiui 
all  persons  desiring  medicine  or  surjpcal  attention  are 
treated  daily,  between  the  hours  of  12  if.  and  1  p.h. 
Daring  these  hours  both  professional  services  sod 
medicmes  are  fiimiahed  gratuitously.  The  foHowiug 
are  the  suigeons  and  physicians  of  the  dispensary: 
Surgeons — Vto&,  Edward  Warren  and  C.  h.  Ford. 
Physieinns  Profa  Josq)h  P.  I'CJmi,  Harvey  L.  Byrd, 
John  F.  Monnomier,  Jos^h  E.  Qagett,  and  Martin  P. 
Scott  ^  T 

Digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


409 


©rigiitol   Communtcati0n«* 

O^ES  OF 

REFLEX    AND    ORGANIC    PARALYSIS 

TREATED  BY  ELECTRICITY. 

By  A.  D.  ROCKWELL,  M.D., 

AND 

GEORGE   M.    BEARD,    M.D., 

LlOTVKtfS  ON  nSTOUS  DUBAflSB  IN  THK  UNIVSHSITT  MBOICAL    OOLLCO* 
OF  MBW  TOME. 

FACIAL  PARALTSI8  TREATED  BT  THE  OALVANIO  OURRENT. 

Case  I. — Mbs  P.,  a  stout,  vigorous  young  lady  of 
fifteen,  was  sent  to  us  by  Dr.  F.  Elliott  to  be  treated 
for  paralysis  of  the  seventh  pair,  on  the  left  side, 
caused  by  exposure  to  a  draught  of  air  two  months 
previous.  The  paralytic  symptoms  came  on  suddenly 
and  in  full  force  immediately  afler  the  exposure,  and  at 
first  she  experienced  considerable  difficulty  in  speaking. 

She  gradually  became  so  accustomed  to  the  abnormal 
condition  of  her  lips  and  face  that  she  was  able  to  con- 
verse almost  as  clearly  as  before ;  but  the  improvement 
in  the  condition  of  the  paralyzed  muscles  was  very 
slow,  and  at  the  time  she  came  to  us  the  affection 
speared  to  be  almost  stationary.  At  the  time  she 
received  the  first  application  at  our  hands  (Aug.  1, 
1862),  she  presented  most  of  the  usual  symptoms  of 
paralysis  of  the  seventh  pair. 

Her  mouth  was  drawn  over  towards  the  healthy  pide 
GO  violently  as  to  produce  considerable  deformity  when 
she  laughed  or  conversed,  and  even  when  she  smiled. 
When  she  attempted  to  frown,  the  left  brow  remained 
as  smooth  as  that  of  a  child. 

Her  left  eye  rolled  up,  and  when  she  attempted  to 
dose  it,  the  lids  would  not  approach  nearer  than  one- 
quarter  of  an  inch  to  each  other.  A  powerful  Faradaic 
current,  localized  in  the  affected  muscles,  produced  very 
feeble  or  imperfect  contractions;  while  on  the  sound  side, 
a  very  mild  current  applied  with  the  hand,  produced 
active  contractions  of  all  the  principal  muscles.  The 
patient  was  so  well  in  all  other  respects,  that  we 
decided  to  use  only  partial  or  localized  electrization 
over  all  the  muscles  on  the  left  side  of  the  face.  Two 
vigorous  applications  made  in  this  way,  one  electrode 
being  placed  firmly  below  the  ear,  and  the  other  passed 
over  the  ramifications  of  the  seventh  pair  as  well  as  over 
the  individual  muscles,  did  not  seem  to  increase  to  any 
appreciable  extent  the  electro-muscular  contractility, 
and  accordingly  we  resolved  to  adopt  an  entirely  dif- 
ferent method  of  warfare. 

The  next  time  we  localized  the  galvanic  stream 
through  the  left  side  of  the  face,  and  with  most  charm- 
ing results.  Contractions  of  the  paralyzed  muscles 
were  at  once  produced  that  were  as  vigorous  and  as 
natural  as  those  caused  by  the  Faradaic  current  on 
the  healthy  side. 

The  patient  began  at  once  to  improve,  and  after  ten 
visits,  distributed  over  a  period  of  six  weeks,  she  was 
dismissed  as  approximately  cured.  There  still  remained 
some  deficiency  of  action  of  the  muscles  concerned  in 
frowning  and  in  winking,  but  the  expression  of  her 
fiM^,  both  in  repose  and  in  conversation,  was  normal 
The  very  little  that  remains,  nature  ought  to  accom- 
plish unaided.    The  interesting  points  are  as  follows : 

First. — Ths  galvanic  current  produced  contractions^ 
and  wrought  a  cure,  when  the  induced  or  Faradaic  utterly 
failed.  This  important  fact  with  regard  to  the  galvanic 
<mrrent,  viz.,  its  power  of  causing  contractions  in  paralyz- 
ed muscles  that  do  not  appear  to  be  affected  by  the  Fara- 
daic was  first  pointed  out  by  the  late  Prof.  Remak,  of 
Beiiin,  whoae  original  and  able  researches  in  electro- 


therapeutics* really  made  him  the  father  of  a  distinct 
school  of  electricians  in  Germany,  as  Duehenne  has 
long  been  in  France.  Though  the  ideas  advanced  by 
Remak  were  at  first  scouted  and  despised  by  the  pro- 
fession, as,  indeed,  has  ever  been  the  case  with  all 
original  suggestions  in  science,  and  although  his  own 
impetuosity  and  extravagance  hurried  him  into  general- 
izations that  could  not  have  stood  the  test  of  investiga- 
tion, yet  his  leading  idea  in  regard  to  the  superiority  of 
the  galvanic  over  the  Faradaic  current,  in  some  forms 
of  paralysis,  is  now  as  fully  established  as  any  feet  of 
science  among  those  who  are  practically  femiliar  with 
electro-therapeutics. 

These  observations  of  Hemak  have  recently  been 
confirmed  in  a  very  striking  manner  by  Prof  Ziemssen,t 
of  Berlin,  by  Schulz,  Meyer.J  Baierlacher,  Neumann, 
and  Hammond.  As  a  rule,  the  benefit  received  in*  such 
cases  is  proportioned  to  the  extent  of  the  musciUar 
contractions  that  can  be  produced.  The  current,  eitht,T 
the  Faradaic  or  the  gtuvanic,  acts  as  a  heal  tonie^ 
bringing  into  action  the  diseased  muscular  fibres,  in- 
creasing •  the  local  processes  of  waste  and  repair,  im- 
proving the  circulation,  and  consequently  making  the 
parts  permanently  warmer  and  stronger.  These  results 
we  have  observed  very  markedly  in  a  number  of  cases 
of  infantile  paralysis,  under  the  influence  of  general 
electrization  with  the  Faradaic  current 

Second. — The  paralyzed  muscles  were  at  first  brought 
to  contraction  by  a  galvanic  stream  of  small  quantity, 
but  of  considerable  intensity,  that  had  no  effect  whatever 
on  the  muscles  of  the  healthy  side.  As  the  patient  im- 
proved, however,  it  became  necessary  to  use  a  stronger 
galvanic  stream  in  order  to  produce  the  contractions. 
Towards  the  close  of  the  treatment,  the  muscles  of  the 
paralyzed  side  began  to  respond  to  the  Faradaic  current. 
These  apparent  inconsistencies  had  also  been  previously 
observed  by  a  number  of  the  German  electricians 
already  mentioned.  The  late  P.  Victor  Bazire§  has  re- 
corded an  experience  almost  precisely  similar.  It  docs 
not  follow  from  these  facts  that  the  relative  value  of  the 
two  currents  is  entirely  undecided.  On  the  other  hand, 
it  may  well  be  qiiestioned  whether  we  do  not  know 
nearly  as  much  of  the  indications  of  their  use  and  the 
rationale  of  the  operation  of  their  currents,  as  of  any  of 
the  internal  remedies  that  are  styled  specifics.  In 
general  electrization  for  the  purpose  of  producing  a 
constitutional  tonic  influence,  in  partial  electrization 
with  a  view  to  calmative  or  absorbent  effects,  and  for 
most  cases  of  localized  electrization,  we  use  tiie  Fara- 
daic current. 

On  the  other  hand,  for  those  exceptional  cases  of 
paralysis  where  the  Faradaic  current  will  not  produce 
contractions,  and  also  when  it  is  desired  to  affect  the 
retina,  we  use  the  ealvanic.| 

Third.— Although  the  galvanic  current  applied  to  the 
face  caused  intense  flashes  of  light,  affecting  the  retina 
by  reflex  action,  as  is  always  the  case  when  it  touches 
any  part  supplied  by  the  fifth  pair,  it  yet  was  in  no  way 
injurious  to  tne  eye. 

Long  ago,  Duehenne  recorded  a  case  of  permanent 
blindness  resulting  fi-om  over-excitation  of  the  retina 
through  a  strong  galvanic  stream  applied  to  the  face. 
The  patient  reported  that  the  whole  room  seemed  to 
be  in  a  blaze,  and  immediately  afterwards  she  became 
blind  on  the  side  to  which  the  current  had  been  ap- 

*  Ueber  Method.  ElectrUlning  OelUhintor  MatkeliL    Berlin,  1860. 

t  Die  EleoUioat  In  der  Medldo.    Berlin,  IBM. 

±  Die  Electriciit  In  Ihrer  Anwendang  aaf  Prao.  Med.     Berlin.  1861. 

I  Notes  to  TnmBktlon  of  Trooweau's  Lectures  on  Ollnloal  Medicine, 
Vwt  II.,  p.  881. 

I  The  galvanic  ftream  appeaiB  In  some  instances  to  cause  absorp- 
tion more  rapidly  than  the  Faradaic.  For  its  nse  in  ttie  form  of  gal> 
▼ano-cantery,  vide  Althaos  on  Tumors  and  other  Bnrgioal  DIsoMfi. 
London,1867.  /^ 


Digitized  by  ^ 


410 


THE  MEDICAL  RECORD. 


plied.  This  sad  experience  of  Duchenne  has  had^  the 
effect  of  deterring  the  electricians  of  France,  England, 
and  America,  from  using  the  galyanic  stream  of  any 
strength  to  the  parts  supplied  by  the  fifth  pair.  But, 
with  all  deference  to  those  who  differ  fi-om  us,  we 
cannot  regard  this  fear  as  well  grounded.  One  case,  if 
anything,  proves  but  little  in  science,  and  there  is  at 
least  reason  for  suspecting  that  the  unfortunate  pa- 
tient of  Duchenne  was  at  the  time  affected  by  some 
weakness  of  the  retina  or  other  parts  of  the  eye  that 
prepared  ^ler  for  the  final  catastrophe. 

Certain  it  is  that  the  accident  has  never  been  re- 
peated, 8o  far  as  we  know,  by  any  of  the  recent  ex- 
perimenters in  this  department  On  the  other  hand, 
very  mady  of  the  German  electricians  use  the  galvanic 
streanvj  oftentimes  firom  a  large  number  of  elements, 
in  vjU^ous  affections  of  the  face,  and  witiiout  injury. 
Fo>  ourselves,  we  never  hesitate  to  employ  the  g«5- 
v^nic  current  of  any  strength  so  long  as  benefit  may 
be  received.  More  than  that*,  we  have  tested  the 
/^  stream  from  a  large  number  of  elements,  on  our  own 
faces,  in  order  to  experience  its  physiological  effects  on 
^  the  salivary  secretion,  sense  of  taste,  and  always  with- 
out injury.  It  may,  indeed,  cause  a  slight  headache, 
dizziness,  or  drowsiness ;  but  so  may  the  Faradaic  cur- 
rent, when  used  in  excess  or  without  proper  caution. 
But  facial  paralysis  may  often  be  relieved  by  the  Fara- 
daic current  alone. 

PARTIAL  PARALTSIS  OF  THE  RIGHT  SinB  OP  THE   PACE,  WITH 
CONTRAOTIOlf  dP  MtTSCLES,  FOLLOWIWO  NEURALGIA. 

Casb  II. — ^Miss  J.,  aged  forty,  came  to  us  in  the  early 
part  of  September  of  the  present  vear,  to  be  treated 
for  a  facial  paralysis  of  a  peculiar  character.  Her  face 
was  drawn  to  the  right  side,  so  that  her  features  were 
very  much  distorted.  We  at  first  supposed,  and  very 
naturally,  that  the  case  was  one  of  paralysis  of  the 
seventh  pair  of  the  left  side,  but  a  more  careful  exa- 
mination led  us  to  modify  our  diagnosis. 

Her  history  was  as  follows :  Several  years  previous, 
while  occupied  in  day  and  night  attendance  at  the  bed- 
side of  a  sick  fi-iend,  she  was  suddenly  attacked  with 
severe  facial  neuralgia  of  the  nriit  side,  that  continued 
to  annoy  her  for  two  months.  The  disease  Uien  abated, 
^  but  since  that  time  she  has  been  firequently  harassed  by 
persistent  numbness  in  the  right  arm  and  hand. 

On  localizing  a  strong  Faradaic  current  through  the 
muscles  of  the  lefi  side  of  the  face,  powerful  contrac- 
tion^ were  excited.  On  the  right  side  no  such  effect 
could  be  produced. 

Furthermore,  her  right  eye  was  nearly  closed,  owing 
to  a  partial  ptosis,  and  while  she  could  easily  frown  and 
corrugate  the  left  brow,  the  right  was  entirely  smooth 
and  expressionless.  It  was  very  evident,  both  from 
the  history  of  the  case  and  firom  symptoms  at  the  time, 
that  the  rigki  side  was  paralyzed,  and  not  the  left,  as  at 
first  appeared,  and  that  the  face  was  drawn  towards  the 
right  by  the  contractions  of  the  miucles  following  the 
parcUysis. 

The  lamented  Trousseau,  whose  lectures  on  clinical 
medicine  are  unrivalled,  not  only  for  their  originality  and 
suggestiveness,  but  also  for  clearness  and  fairness  of  state- 
ment, as  well  as  for  elegance  and  beauty  of  style,  has  de- 
scribed this  condition  so  accurately»that  we  quote  his 
own  language  as  it  appears  in  the  translation  of  Bazire.* 

After  relating  the  symptoms  of  a  patient  suffering  from 
paralysis^  he  says :  "  If  left  facial  paralysis  was  thought  of 
at  first  sight,  the  depression  of  the  lower  lid,  and  the  less 
marked  e:roansion  of  the  nostril  on  the  right  side,  were 
already  sufficient  to  cause  a  modification  of  the  diagnosis. 
Bat  when  the  patient  attempted  to  move  that  side 

♦  Lettiipes  on  Clinical  Medicine,  Part  H.,  p.  822. 


of  her  face  there  could  no  longer  be  any  hesitation,  and 
it  became  manifest  that  it  was  the  right  side  which 
was  affected.  When  she  spoke,  and  still  more  when 
she  laughed,  her  face  was  pulled  with  force  to  the  left, 
the  upper  lip  and  the  ala  nasi  on  that  side  going  oblique- 
ly upwards,  and  the  labial  commissure  being  drawn 
with  considerable  energy  upwards  and  outwards. 
When  she  attempted  to  blow,  her  left  cheek  swelled, 
and  her  mouth  remained  closed  on  that  side,  whilst  her 
right  cheek  was  flaccid  and  her  mouth  opened  out  a 
little  on  that  side.  Besides,  she  could  not  shut  her 
right  eye,  however  much  she  tried." 

In  this  case  we  used  only  the  Faradaic  current,  lo- 
calizing the  electricity  as  nearly  as  possible  along  the 
course  of  the  portio  dura  and  ite  ramifications.  To  ac* 
complish  this  the  small  positive  electrode  was  pressed 
firmly  under  the  right  auricle,  near  the  point  where  the 
nerve  emerges  from  the  temporal  bone,  while  the  negi^ 
tive  was  moved  along  its  various  terminal  branches. 

No  particular  results  were  obtained  from  the  first 
application,  but  during  the  second  visit  slight  contrac- 
tions were  produced  on  the  right  side,  and  jt  was  then 
noticed  that  the  eyelid  did  not  fall  so  low  as  before. 

In  the  course  of  a  few  days  the  patient  again  vinted 
us,  when  the  improvement  was  quite  marked.  Th^e 
was  considerable  relaxation  of  the  contracted  muscles^ 
and  the  electro-muscular  contractility  was  readily  dem- 
onstrated. At  the  fourth  visit,  which  occurred  about 
two  weeks  from  the  commencement  of  treatment^  the 
ptosis  was  hardly  noticeable,  and  the  power  of  corru- 
gating the  occipito-frontolis  on  the  right  side  was  perfects 
There  still  remained,  however,  some  distortion  of  the 
features,  owing  to  the  obstinate  nature  of  the  muscular 
contractions,  and,  although  she  subsequently  received 
quite  a  number  of  applications,  the  contraction  waa  not 
so  entirely  dissipated  as  were  all  the  other  symptoms. 
But  the  amelioration  was  so  complete  that  the  distor- 
tion was  little  noticed,  and  ceased  to  give  her  any  coit- 
siderable  annoyance. 

Case  III.,  in  its  manifestations,  was  similar  to  the  first 
case,  not  only  as  to  its  causation,  but  also  in  many  of  its 
symptoms.  Its  principal  interest  is  derived  from  the 
fact  that  the  Faradaic  current  caused  contractions  of 
considerable  power  in  the  muscles  of  the  affected  side, 
while  in  the  other  case  the  galvanic  stream  alone  caused 
the  muscles  to  respond  to  any«  extent  We  made  use 
of  the  Faradaic  current  on  four  different  occasions, 
with  the  effect  of  benefiting  the  paralysis  and  markedly 
lessening  the  consequent  distortion  of  the  features. 

About  this  time  (three  months  previous  to  the  date 
of  this  article)  she  was  confined,  and,  as  her  home  is 
some  distance  from  the  city,  we  have  not  seen  her 
since.  By  direct  information,  however,  we  leam  that 
her  paralysis  remains  the  same  as  when  we  last  saw 
her.  There  is  every  reason  to  believe  that  an  approxi- 
mate cure  would.be  effected  by  a  few  more  applications. 

Case  IV.— Mr.  M.  was  brought  to  us  by  Dr.  Cockroft 
to  be  treated  for  paralysis  of  both  sides  of  face.  In  the 
month  of  March,  1862,  during  the  retreat  of  the  Con- 
federate army  from  Kentucky,  this  gentleman,  s^er 
prolonged  exposure  to  cold  and  wet,  was  attacked  with 
facial  neuralgia.  Previously  he  had  been  so  unfortu- 
nate as  to  contract  syphilis,  which  had  passed  into  the 
secondary  stage ;  but  for  several  years  he  had  been,  to 
all  appearances,  entirely  fi-ee  fi-om  the  disease.  This 
attack  of  neuralgia  was  followed  by  partial  paralysis  of 
the  right  side  of  the  face.  The  neuralgia  persisted 
until  July,  but  the  paralysis  has  continued  constant 
until  the  present  time.  In  January,  1866,  he  had  a  re- 
newal of  tlie  neuralgia,  which  this  time  attacked  the 
left  side  of  the  face.  It  was  of  mi  intermittent  type, 
and  o&  the  25th  of  March,  without  a  premooitory  eymp^ 
digitized  by  ^ „      ^_ 


THE  MEDICAL  RECORD. 


.  411 


torn,  and  when  he  was  entirely  free  from  pain,  the  lefk 
side  of  the  face  became  completely  paralyzed.  He 
gradually  lost  the  sense  of  hearing,  and  in  two  weeks 
was  absolutely  deaf.  When  brought  to  us  for  treat- 
ment he  was  suffering  from  paralysis  of  the  whole  face. 

He  was  unable  to  close  either  eyelid,  could  neither  ele- 
vate the  eyebrows  nor  frown.  He  had  but  little  control 
over  the  mouth,  and,  as  a  consequence,  his  speech  was 
very  imperfect.  "  The  motionless  face  assumed  a  pecu- 
liar aspect,  and  looked  like  a  hfbless  mask,  on  which 
the  impressions  of  the  soul  were  no  longer  expressed 
but  by  changes  of  color.'*  We  had  but  little  hope  of 
benefit' ng  him,  nor  were  we  disappointed ;  for  after  a 
month  of  faithful  and  hopeful  perseverance  on  the  part  of 
the  patient,  not  the  slightest  improvement  was  observed. 
For  a  little  time  after  an  application  he  seemed  to  possess 
more  control  over  the  muscles  of  the  eye  and  mouth,  and 
his  articulation  was  evidently  more  distinct.  Dr.  Devalue 
gives,  after  Marshall  Hall,  the  following  test,  by  which  it 
may  be  ascertained  whether  the  cause  of  double  facial 
paralysis  is  seated  in  the  brain  or  in  the  course  of  the 
nerves :  In  the  former  case  the  conducting  power  of 
the  nerve-trunks  is  retained  for  an  indefinite  period. 
8o  that  by  galvanizing  the  trunk  and  the  principal 
branches  of  the  facial  nerves,  all  the  muscles  supplied 
by  them  are  thrown  into  contraction,  as  if  the  muscles 
themselves  are  being  galvanized,  whilst,  when  the  para- 
lyzing cause  is  in  the  course  of  the  nerves,  they  very 
easily  lose  their  conducting  power. 

Moreover,  if  reflex  movements  be  seen  in  the  para- 
lyzed muscles,  it  will  be  a  sure  evidence  that  the  cause 
of  the  paralysis  is  in  the  nerve  centres. 

If  the  above  test  can  be  relied  upon,  and  we  are  in- 
clined to  think  that  experience  will  prove  it  to  be  of  creat 
yalue,  the  seat  of  the  trouble  in  the  case  under  consider- 
ation was  evidently  in  the  course  of  the  nerves.  The 
strongest  current  that  we  were  able  to  induce  caused 
no  contraction  of  any  of  the  muscles  of  the  face,  and 
reflex  movement  was  entirely  absent.  We  had  no  op- 
portunity to  use  the  galvanic  stream,  much  to  our  re- 
gret, since  the  case  first  related  in  this  article  proves 
that  it  is  often  of  service  when  the  Earadaic  current  is 
tiseless. 

In  this  connection  it  may  be  proper  to  say  a  word  in 
regard  to  the  general  indications  that  call  for  electriza- 
tion in  the  various  forms  of  paralysis. 

It  seems  all  the  more  important  that  we  should  make 
this  explanation,  from  the  fact  that  physicians  who  in 
many  particulars  are  well  informed  and  even  advanced, 
appear  to  forget  that  paralysis  is  merely  a  symptom  of 
some  disturbance  in  the  central  nerve  system  or  at 
some  point  of  the  nervous  connection. 

It  needs  then  no  demonstration  to  show  that  the  cura- 
bilitj^  of  any  ffiven'case  of  paralysis,  whether  it  be  hemi- 
plegia, paraplegia,  or  facial,  must  depend  on  the  cause. 
According  to  our  experience  with  electrization  in  paral- 
ysis, the  following  points  seem  to  be  pretty  clearly 
established  : 

1st.  In  hemipleda,  paraplegia,  and  glosso-lar3mgeal* 
paralysis  (glosso-pharyngo-labialist),  dependent  on  per- 
sistent, irritating,  centrd  lesions^  such  as  softening  of 
the  brain,  active  tumors,  local'  mjuries,  and  the  like, 
electrization  in  any  form  is  sometimes  contraindicated, 
or  at  least  is  of  no  positive  value.  It  has  been  observed 
that  patients  affected  with  softening  of  the  brain  are 
very  apt  to  suffer  for  a  time  after  an  application  with  a 
kind  of  quivering  or  tremor  that  is  almost  diagnostic. t 

2d.  In  paralysis  dependent  on  lesions  that  are  not 

i» 
*  Tronsseaa^B  Lectures  on  Clinlcftl  Medicine, 
t  Die  Elektretkerapie.    Dr.  Moriz  Rosenthal. 
X  Under  this  elAuse  mar  properly  be  iadtcated  ^  FlrocresslYe  Loco- 
motor ataxia  ;'^  perhaps  also  the  *'  senile  trembUng^  of  Troosseaa. 


persistent,  either  galvanization  or  Faradaization  are 
usually  of  great  benefit,  and  even  though  absolute 
cures  are  not  always  obtained,  yet  the  process  of  fatty 
degeneration  of  the  muscles  may  often  be  retarded  and 
arrested,  and  in  the  majority  of  cases  the  power  of  mo- 
tion and  tactile  sense  can  be  greatly  increased.  These 
pleasant  results  are  very  markedly  observed  after  per- 
severing electrization  of  cases  of  infantile  paralysis. 
But  in  all  that  we  attempt  for  such  long-standing  affec- 
tions of  the  nerve  centres,  we  should  ever  Keep  in 
mind  the  emphatic  words  of  Trousseau :  ^y"  Chronic 
diseases  demand  chronic  treatment."  ■' 

3d.  Paralyses  that  are  not  dependent  on  ally  form  of 
central  lesion,  such  as  are  variously  termed  reflex,  peri- 
pheral, functional,  anemic,  or  hysterical ;  also  those  of  a 
traumatic  origin,  or  those  which  are  due  to  exposure  to 
cold,  recent  cases  of  lead  palsy,  and  the  mysterious 
affection  termed  "  writers'  cramp,"  are  very  often  abso- 
lutely and  permanently  curable  by  judicious,  practical, 
and  continuous  electrization. 

More  than  this,  such  cases,  if  taken  early,  are  some- 
times cured  or  relieved  as  promptly  and  as  rapidly  as  any 
other  class  of  affections  with  which  we  have  to  do.  The 
conviction  is  every  week  being  more  and  more  forced 
upon  us  that,  were  such  kind  of  paralytics  submitted  to 
proper  electrization  at  once  after  the  symptoms  appear, 
the  number  of  cripples  would  be  greatly  diminished. 

In  the  course  of  these  articles  we  shall  present 
cases  illustrative  of  nearly  all  these  different  tjpes 
of  paralysis,  and  shall  detail  the  method,  and  results 
of  treatment  by  Galvanization  and  Faradaization  in 
these  three  classes  :  Firsty  those  that  received  no  bene- 
fit whatever,  or  in  which  electrization  was  contraindi- 
cated. SecondlVj  those  that  were  temporarily  or  per- 
manentiy  benefited.  Thirdly^  those  that  were  abso- 
lutely or  permanently  cured. 

But  although  this  series  of  articles  is  to  be  mainly  oc- 
cupied with  paralytic  symptoms,  we  shall  be  very  sorry 
to  give  the  impression  tiiat  paralysis  is  the  only  or,  in- 
deed, the  most  important  affection  for  which  electriza- 
tion is  indicated.  In  conversation  with  our  friends  in 
the  profession  the  inquiry  is  continually  made  as  to  what 
we  can  do  for  paralysis ;  but  great  surprise  is  expressed 
when  we  reply  that  our  most  interesting  and  most  uni- 
form successes  are  with  an  entirehr  different  class  of 
nervous  affections,  and  even  with  inflammatory  state& 

We  cannot  therefore  too  often  repeat,  in  all  our  writ- 
ings and  teachings,  that  general  electrization  with  the 
Faradaic  current,  using  the  hand  as  an  electrode,  is  a 
tonic  of  wide  and  varied  efficacy,  and  meets  with  the 
most  constant  and  permanent  success  (though  of  course 
with  many  failures)  iu  cases  of  rheumatism,  neuralgia^ 
dyspepsia,  chorea,  dysmenorrboea^  amenorrhcea,  ana 
other  affections  associated  with  general  debility  that  for 
some  cause  refuse  to  yield  to  ordinary  remedies. 

Localized  electrizationj  such  as  has  been  universally 
adopted  by  the  European  electricians,  has  indeed  been 
essayed  in  a  number  of  diseases,  but  is  chiefly  indicated 
in,  and  is  now  used  by,  all  advanced  students  of  nervous 
diseases,  for  the  different  forms  of  paralysis.  On  the 
other  hand,  general  electrizatumy  which  is  the  method 
that  we  have  introduced  to  the  profession,  differs  from 
this  as  widely  in  its  indications  and  effects  as  it  does  in 
the  rationale  of  its  performance. 

It  is  not  electricity  in  the  abstract,  but  electrization 
in  the  conorete  that  cures  diseases  The  effects  of  elec- 
tricity on  the  human  body  depend  entirely  on  tite  manner 
in  which  it  is  generated  and  the  method  by  which  it  is 
employed,  and  no  observation  in  electro-then^uties  is 
worth  anything  that  does  not  express  distinctly  whether 
the  galvanic  or  Faradaic  currents  are  used,  and  whether 
the  electrization  be  localized,  partial,  or  general 


412 


THE  MEDICAL  RECORD. 


RUPTURE  OF  THE  HEART. 

BEINa  BEMABKS  MADB  AT  A  MEBTINa  OF  THE  PATHOLO- 
GICAL BOCIETT,  OCTOBER  ».  1867. 

By  W.  B.  LEWIS,  KD., 

ITBW  rOBK.  T 

On  the  9th  of  October,  at  the  request  of  a  member,  I 
presented  to  the  N.  Y.  Pathological  Society  the  heart  of 
a  physi6ian  of  this  city  who  died  in  his  sixtieth  year, 
after  an^illnes8  of  about  ten  hours,  of  rupture  conse- 
quent upfcn  fatty  degeneration  of  the  heart. 

On  thejteaturday  previous  the  doctor  was  in  his  usual 
health.  On  Sunday  morning  he  arose,  but  having  a 
headache  and  feeling  out  of  sorts,  went  back  to  bed. 
Durinflf  the  day,  which  was  passed  quietly,  he  took  some 
light  food,  and  at  tea-time  joined  the  family  and 
seetaed  much  better.  About  nine  p.m.,  while  writing 
some  letters,  he  was  seized  with  a  severe  pain  in  the 
Stomach.  It  passed  off  in  a  few  minutes,  so  that  he 
•  wrote  again,  but  it  soon  returned,  and  was  then  felt  in 
the  back  also,  between  the  shoulders.  The  agony  became 
intense,  and  was  not  relieved,  although  fomentations 
and  sinapisms  were  applied,  and  opium  and  chloroform 
were  taken  internally.  He  was  sure  he  had  stricture  of 
the  stomach,  and  to  overcome  this  would  rise  from 
the  bed  and  provoke  vomiting  by  drinking  warm 
water  freely,  and  then  lie  down  and  strain  like  a 
woman  in  labor.  Although  he  was  fully  conscious  of 
the  influence  of  the  medicines  taken,  the  pain  con- 
tinued without  abatement  until  an  early  hour  in  the 
morning,  when  he  slept  for  a  few  minutes  while  sitting 
in  a  warm  bath.  About  half-past  seven  a.m.  he  arose 
and  renewed  his  efforts  to  remove  the  difficulty  by 
vomiting.  To  accomplish  this  he  passed  his  fingers  as 
far  as  possible  into  his  throat,  and  strained  frightfully. 
As  soon  as  he  was  again  upon  the  bed  he  said,  "  Some- 
thing has  given  way ;  there  will  be  a  change  soon."  He 
died  a  few  minutes  after  this,  breathing  most  quietly  to 
the  last 

Several  times  since  last  January  he  had  suffered  in  a 
similar  manner,  but  less  severely  and  for  a  shorter 
period,  and  on  each  occasion  had  gradually  found  relief. 

The  post-mortem  examination  was  made  early  on 
Wednesday  mornine.  The  body  was  then  very  thoroughly 
chilled  and  stiffened  by  the  ice  with  which  it  had  been 
surrounded.  The  subcutaneous  layer  of  adipose  was 
more  than  an  inch  in  thickness,  and  that  beneath  the 
peritoneum  more  than  one-quarter  of  an  inch.  The 
lungs  appeared  normal.  A  quantity  of  blood-stained 
serum  escaped  from  a  wound  in  the  pericardium,  pro- 
duced while  removing  the  sternum.  The  abdominal  or- 
gans, except  a  small  portion  of  the  hver,  were  hidden 
beneath  a  mass  of  fat.  The  great  omentum  was 
strangely  loaded,  being  not  less  than  an  inch  and 
a  half  thick  at  its  junction  with  the  transverse  colon. 
The  stomach  was  entirely  normal,  presenting  no 
thickening  or  other  change  at  any  part  of  its  walls,  ex- 
cept that  in  the  fundus  there  was  a  slight  blackish  stain 
upon  the  mucous  membrane.  It  contained  about  an 
ounce  of  a  thick,  greenish  fluid,  such  as  is  found  during 
the  later  stages  of  digestion.  The  liver  was  engorged 
with  blood,  and  evidently  fatty  ;  the  mottling  produced 
by  intra-lobular  congestion  being  quite  marked.  The 
gall-bladder  was  full  of  bile,  a  little  thinner  and  lighter  in 
color  than  usual ;  no  concretion  was  found  in  it  or  its 
duct.  Upon  slitting  up  the  pericardium  an  irregular 
laceration  of  the  wwls  of  the  heart,  three-fourths  of  an 
inch  long,  was  at  once  noticed,  situated  about  midway, 
from  above  downwards,  and  a  Uttle  to  the  left  of  the 
inter-ventricular  septum.  The  visceral  pericardium, 
however,  was  torn  only  at  two  points,  the  larger  of 


which  would  admit  the  end  of  a  large-sized  probe. 
Placing  the  finger  upon  this  portion  it  could  be  easily 
depressed,  showing  that  the  walls  were  very  thin  and 
much  softened  beneath.  The  pericardium  contained 
some  loosely  clotted,  dark  blood,  not  having  the  arterial 
hue,  nor  by  any  means  forming  a  cast  of  the  sac. 

Upon  opening  the  right  ventricle  it  was  found  firmly 
contracted.  No  lesion  of  either  valves  or  cavities  was 
found  upon  this  side.  On  the  left  side,  in  the  sinuses  of 
the  semilunar  valves,  were  whitish,  slightly  elevated 
spots  of  atheroma  in  an  early  stage.  Near  the  apex  of 
the  ventricle,  anteriorly  and  to  the  right,  was  an  extensive 
transverse  laceration,  rather  more  than  an  inch  in  length, 
the  columnse  appearing  discolored  and  ragged  upon  its 
edges.  The  new  cavity  thus  produced  was  evidently 
not  made  at  one  time,  as  it  connected  with  at  least 
two  sinuses  which  coula  be  traced  upwards  towards  the 
base  of  the  organ  beneath  the  pericardium  and  fat^ 
One  of  these  opened  into  the  right  ventricle  through  one 
of  the  venae  thebesii,  near  the  origin  of  the  pulmonary 
artery,  and  upon  the  right  surface  of  the  septum.  A 
pecuUarity  of  this  rent  was  that  it  was  of  the  transverse 
variety,  which  numbers  about  one-fourth  of  the  re- 
corded cases,  the  majority  being  parallel  with  the  fibres 
of  the  heart.  There  were  two  other  partial  ruptures,  one 
to  the  left,  and  another  below  this  fotal  one ;  it  seemed 
that  either  of  these  might  in  time  have  caused  death. 
The  tissue  of  the  organ  was  of  a  duller  shade  than  is  nor- 
mal, and  remarkably  friable,  more  so  than  the  liver  in 
this  case. 

A  small  portion  clipped  from  the  neighborhood  of 
one  of  these  partial  ruptures  was  examined  microscop- 
ically. Much  the  greater  number  of  the  fibres  were 
CTanular,  semi-opaque,  and  either  devoid  of)  or  but 
faintly  showing  their  striae ;  some  had  a  column  of  more 
or  less  irregular  fat  globules  occupying  their  centres ; 
some,  though  few,  were  transparent,  and  presented  the 
strise  clearly.  Numerous  free  oil  globules  of  various  sizes 
were  seen  floating  in  the  field.  Tne  granular  particles 
were  not  resolved  into  globules  by  a  power  of  five 
hundred  diameters,  although  it  was  supposed  that  such 
was  their  real  form. 

Allow  me  to  call  attention  to  the  location  of  the 
greatest  and  most  constant  pain  in  the  epigastrium. 
This  obscured  the  diagnosis,  and  has  remained  in  a  meas- 
ure unexplained,  to  some  at  least,  by  the  autopsy. 
I  have  recently  learned  of  a  similar  case  in  which, 
after  a  few  hours  of  ffreat  agony,  also  referred  to  the  epi- 
gastrium, and  thought  to  be  due  to  biliary  calculus,  the 
Eatient  died  of  rupture  of  the  left  ventricle  of  the 
eart 


LIGATION  OP  THE 

SUBCLAVIAN  ARTERY  FOR  ANEURISM 

OF  THE  HUMERAL  AND  BONY  TUMOR. 

Br  E.  P.  BENNETT,  M.D., 

OAKBITRT,  OT. 

Ligation  of  this  artery  is  not  so  rare  or  so  difficult  as 
to  excite  any  particular  interest,  but  there  were  some 
circumstances  attending  this  case  which,  perhaps,  make 
it  worth  recording.  The  patient  was  a  hatter,  of  good 
habits  and  constitution,  about  thirty  years  of  age. 
Some  two  or  three  years  ago  he  perceived  a  small 
tumor  on  the  inner  side  of  the  humerus,  near  the  axilla. 
It  increased  slowly  in  size  until  about  the  6rst  of  July, 
when  he  requested  my  opinion  in  regard  to  its  nature 
and  treatment.  Upon  examination  I  found  a  rough, 
sharp  tumor,  in  shape  like  a  cock's  comb,  about  two 
inches  long,  and  three-fourths  of  an  ineh  wide,  ^s  it 

digitized  by  VjOOQ IC 


THE  MEDICAL  RECORD. 


413 


produced  but  little  inconvenience,  I  advised  him  to  let 
It  remain  and  watch  its  progress.  He  returned  in  about 
a  week,  and  said  that  while  engaged  in  moving,  the 
tumor  had  suddenly  increased  in  size,  and  was  exceed- 
ingly painful.  Upon  examination  I  could  with  diflS- 
culty  feel  the  bony  projection,  as  it  was  covered  and 
obscured  by  a  large  pulsating  tumor  the  sizQ  of  a  large 
orange.  Tliere  was  a  brachial  aneurism  situated  near 
the  axilla,  the  artery  having  probably  ulcerated  from  the 
pressure  of  the  bony  projection.  I  immediately,  with 
the  aid  of  my  son,  Dr.  W.  0.  Bennett,  and  Dr.  A.  0. 
Benedict,  of  Bethel,  proceeded  to  tie  the  subclavian  after 
its  passage  throug^h  the  scaleni.  The  pulsation,  which 
before  was  excessive,  immediately  ceased  after  tighten- 
ing the  ligature,  and  never  returned ;  the  tumor  soon  be- 
coming soft  and  flaccid.  The  ligature  came  away  on  the 
twenty-fourth  day,  and  he  has  done  remarkably  well. 
He  has  now  returned  to  his  ordinary  labor,  that  of  a 
hat-finisher,  and  is  able  to  perform  an  ordinary  day's 
labor ;  the  temperature  of  the  arm  is  natural,  but  no 
pulsation  has  yet  returned  in  either  of  the  arteries  at 
the  vvrist.  More  than  this,  as  yet  no  increase  of  the 
bony  tumor  has  occurred.  SuflBcient  time,  however,  has 
not  yet  elapsed  to  ascertain  definitely  what  effect  the 
ligation  of  the  artery  will  have  upon  its  growth.  If  it 
continues  to  grow,  I  shall  cut  down  upon  and  remove  it 
wifh  a  longitudinal  portion  of  the  shaft  of  the  bone  from 
whichjit  proceed^  which  will,  in  all  probabiHtv,  entirely 
eradicate  the  difficulty.  I  removed  a  similar  tumor 
from  the  arm  of  a  gentleman  now  living  in  Middletown, 
N.  Y.,  with  gouee  and  chisel,  taking  away  about  half 
of  the  bone,  with  entire  success. 


MEDICAL  DEPARTMENT  OF  THE  UNIVER- 
SITY OF  PENNSYLVANIA. 
MEDICAL  CLINIC  OF  PROF.  CARSON. 

FhiladelphUs  Oct.  19, 1867. 

Flatulency. — The  patient,  a  married  female,  about 
thirty  years  of  age,  has  been  subject  to  flatulency  for  a 
period  of  fifteen  years.  The  character  of  the  complaint 
m  the  patient  is  the  emission  of  wind,  or  of  certain  gases 
from  the  stomach,  sufficiently  loud  to  drown  the  lectur- 
er's voice,  these  emissions  occurring  about  every  half 
minute.  She  has  no  feeling  of  discomfort,  although  she 
does  not  feel  so  well  in  the  eveniug  as  in  the  afternoon. 
Has  no  difi&culty  in  breathing,  does  not  suffer  from  head- 
ache ;  sometimes  feels  an  oppression  about  the  heart ; 
no  palpitation  in  going  up  stairs ;  pulse  strong  and  reg- 
ular, but  not  rapid — beats  eighteen  to  the  quarter; 
rhythm  of  the  heart  perfect ;  the  impulse  is  very  mod- 
erate, the  two  sounds  are  perfectly  perceptible ;  nothing 
is  the  matter  tlien  with  her  heart  There  is  a  perceptible 
gurgling  from  her  alimentary  canal  extending  all  the 
way  up  into  her  thorax.  The  sounds  of  respiration  are 
thus  rendered  indistinct.  She  became  pregnant  in  the 
spring,  but  from  derangement  of  the  alimentary  canal 
was  unable  to  go  through  the  full  terra  and  miscarried. 
There  is  no  perturbation  of  the  nervous  system. 

From  a  peculiar  condition  of  the  alimentary  canal  in 
nervous  cases,  this  secretion  of  air  generally  comes  on 
all  at  once,  and  it  is  said  to  be  connected  with  disturb- 
ance of  the  ganglionic  system.  In  some  cases  irritation 
about  the  centre  of  the  spine  will  induce  this  secretion 
of  wind,  if  it  is  secretion,  which  the  lecturer  doubts, 
because  the  canal  does  not  secrete  gas,  the  presence  of 
which  ia  much  more  likely  to  be  due  to  some  decompo- 


sition. The  manner  in  which  the  gas  is  formed,  how- 
ever, is  a  disputed  point  There  is  no  perceptible  odor 
from  this  emission,  though  it  may  nevertheless  be  hy- 
drogen gas,  which  is  sometimes  generated  in  the  ali- 
mentary canal ;  still,  it  may  be  some  other  matter. 

This  case  appears  to  be  a  pure  specimen  of  reflex  ac- 
tion, producing  a  generation  of  gas  in  the  alimentary 
canal,  come  from  whatever  cause  it  may.  There  is  a 
distension  of  the  stomach,  and  the  diaphragm  so  presses 
upon  it  as  to  bring  up  the  gas  by  eructation ;  so  that  it 
may  be  looked  upon  to  a  certain  extent  es  nervous. 
The  lecturer  said  that  he  had  always  found  it  advisable 
under  this  condition  of  things,  when  there  was  a  tendency 
to  a  secretion  of  gas,  if  it  be  secreted,  to  use  the  tere- 
binthinates,  for  example  spirits  of  turpentine,  and  at  the 
same  time  to  keep  the  bowels  regular  and  in  a  soluble 
condition,  for  which  he  found  nothmg  better  than  a  warm 
cathartic ;  sometimes  asafoetida  is  of  great  assistance — 
it  is  a  nervine.  The  patient  was  ordered,  upon  going  to 
bed,  a  couple  of  piUs,  each  containing  a  grain  of  rhubarb, 
a  grain  of  aloes,  two  grains  of  powdered  asafoetida,  a 
grain  of  soap,  and  half  a  drop  of  some  essential  oil;  and 
to  take  three  times  during  the  day  five  drops  of  spirits 
of  turpentine  in  emulsion  with  gum  and  sugar. 


Uep0rt«  0f  Societies^ 


NEW  YORK  PATHOLOGICAL  SOCIETY. 

Stated  Meetino,  October  8,  1867. 

Dr.  a.  C.  Post,  Chairman  pro  tern, 

OBDEMA   OF  THROAT  AND   TONSILLAR  OUNOREIION. 

Dr.  Satre  exhibited  a  specimen,  and  gave  the  his- 
tory of  it  as  follows :  On  Sunday  a  week  ago  I  was 
called  in  great  haste  to  a  lady  who  was  supposed  to  be 
suffocating  with  diphtheria.  I  found  the  patient,  eet. 
60,  sitting  up  in  bed  with  all  the  symptoms  of  impend- 
ing suffocation — her  expression  was  anxious,  and  her 
respiratory  efforts  were  painfully  difficult.  Upon  exam- 
ining her  throat  no  evidences  of  diphtheritic  deposit 
could  be  discovered,  but  there  was  to  be  seen  an 
oedematous  condition  of  the  tonsils,  the  epiglottis,  and 
of  the  foFsa  beside  the  epiglottis.  Fearing,  from  the 
urgency  of  her  symptoms,  that  strangulation  might 
ensue  from  any  delay,  I  immediately  slit  open  the 
oedematous  membrane  with  a  bistoury,  and,  m  doing 
so,  felt  the  blade  strike  upon  a  roughened  hard  sub- 
stance. My  first  impression  was  that  this  material  was 
a  piece  of  oyster-shell.  An  abundant  discharge  of 
thick  ropy  mucus  followed  the  incision,  and  there  was 
immediate  relief  of  all  the  urgent  symptoms.  By  fish- 
ing in  the  throat  with  a  forceps,  the  foreign  body  could 
be  distinctly  felt,  but  not  having  a  curve  to  the  instru- 
ment to  enable  a  grasp  to  be  taken  of  it,  it  was  re- 
moved by  means  of  a  bent  probe.  On  examination  it 
proves  to  be  a  concretion  evidently  formed  in  one  of 
the  follicles  of  the  tonsil.  It  lay  upon  the  left  side  of  the 
epiglottis  in  the  fossa  between  the  columns  of  the  ton- 
sH.  There  was  no  tonj'illitis  at  the  time,  but  whether 
there  was  any  before  I  am  not  able  to  say.  In  answer 
to  some  questions  from  the  members  he  stated  that 
severe  dyspnoea  had  existed  for  eight  hours  previous  to 
his  having  seen  her,  and  that  she  had  been  sent  down 
from  Yorkyille  by  her  physician,  who  had  supposed  her 
suffering  from  diphtheria.  The  extent  of  the  incision 
could  not  be  stated,  as,  for  obvious  reasons,  it  was  made 
in  a  great  hurry.  The  oedema  was  mostly  upon  the 
left  side  of  the  throat 
Dr.  Rogers,  who  kindly  examined'^eL  concretion, 


oncre 


4U 


THE  MEa)ICAL  RECORD. 


makes  the  following  report : — The  specimen  is-  one 
whose  exterior  appearance  is  very  well  described  by 
Dr.  Gross  in  his  Elements  of  Pathological  Anatomy. 
When  speaking  of  earthy  concretions  in  the  tonsils,  he 
says,  "  they  usually  have  a  white,  greyish,  or  light- 
brownish  color,  a  spherical  figure,  and  a  finely  tubercu- 
lated  surface."  I  presume  these  difierent  shades  of 
color  result  from  the  different  proportions  of  animal 
substances  composing  the  concretions.  This  one  is 
quite  dark  on  account  of  the  large  amoimt  of  ani- 
mal substance  it  contains.  It  is  composed  of  carbon- 
ate of  lime  mostly,  apd  dissolves  in  the  acids  with  effer- 
vescence, leaving  an  abundant  residuum  of  dark-brown 
animal  matter,  which,  upon  examination  by  the  micro- 
scope, is  found  to  be  composed  of  a  mass  of  ill-defined 
cells  or  corpuscles,  or  both,  intermingled  with  a  few 
pavement  epithelial  scales.  I  have  little  doubt  that  this 
animal  debns  is  composed  of  follicular  epithelial  scales, 
altered  pus  and  mucous  corpuscles,  as  well  as  an  occa- 
sional pavement  scale,  from  the  adjacent  mucous  mem- 
brane. The  stone  is  undoubtedly  a  concretion  in  one 
of  the  follicles  of  the  tonsils,  the  result  of  old  folliculi- 
tis. 

Dr.  Jaoobi  did  not  understand  the  connection 
which  existed  between  the  oedema  and  the  presence  of 
the  foreign  body.  He  had  met  with  some  cases,  and 
read  of  many  more,  in  which  foreign  bodies  of  the  same 
description  in  the  throat  produced  distressing  symptoms, 
but  in  none  of  these  was  there  any  oedema  of  the 
glottis. 

CARIES  OP  HEAD  OP  PEMITR  WITH  EXSECTION, 

Dr.  Satre  presented  a  second  specimen,  consisting  of 
caries  of  the  head  of  the  femur  with  some  portions  of 
the  acetabulum,  which  he  removed  by  excision  that 
day  from  a  child  six  years  of  age.  Eighteen  months 
ago,  having  been  previously  in  good  liealth  and  of 
healthy  parents,  the  patient  fell  from  a  swing  some 
seven  or  eight  feet,  striking  upon  the  feet.  This  acci- 
dent was  followed  almost  immediately  by  a  sharp  in- 
flammation of  the  hip-joint,  resulting  at  first  in  consid- 
erable lameness.  At  the  end  of  three  or  four  months 
afterwards  the  patient  was  able  to  walk  about,  but 
never  entirely  recovered  the  use  of  the  limb.  The 
child  last  fall  was  brought  to  Dr.  Sayre's  office,  but  he 
being  absent  firom  the  city  the  case  was  treated  by 
other  surgeons  until  he  returned.  The  day  but  one 
before  he  operated.  There  was  such  extreme  abduc- 
tion of  the  thigh  of  one  side  that  the  knee  lay  behind 
the  lower  third  of  the  femur  of  the  opposite  side. 
There  was  an  opening  near  the  posterior  spinous  pro- 
cess of  the  ilium,  and  another  just  behind  and  below 
the  trochanter  major.  On  carefiil  examination  under 
chloroform  by  pressure  and  rotation  no  crepitus  could 
be  detected.  If  the  evidences  of  the  existence  of  this 
condition  were  the  only  ones  that  could  settle  the  ques- 
tion of  destructive  disease  in  the  joint,  the  operation 
would  not  have  been  performed;  but  notwithstanding 
the  absence  of  this  important  sign  Dr.  Sayre  concluded 
firom  the  position  of  the  limb  that  there  was  a  destruc- 
tion of  the  head  of  the  bone. 

The  incision  was,  as  usual,  slightly  curved,  and  the 
head  of  the  femur  was  sawn  off  just  below  the  trochan- 
ter. On  removing  the  diseased  mass,  the  head  of  the 
femur  was  entirely  gone  and  its  place  occupied  by  a 
pulpy,  elastic,  and  pinkish  looking  substance  resembling 
lnd[ia-rubber  in  consistence.  The  child  was  dressed  up 
in  the  ordinary  way  by  Bonnet*s  wire  breeches.  Al- 
though the  bone  was  soft  at  the  point  of  section  the 
periosteum  was  intact  below,  and  Dr.  Sayre  thought 
that  the  chances  for  recovery  were  good.  He  recog- 
nized the  softened  condition  at  the  time,  but  it  being 


the  opinion  of  the  gentlemen  present  that  a  section  at 
the  point  would  be  low  enough,  he  acquiesced  and  per- 
formed the  operation  accordingly.  The  treatment  by 
elastic  extension  had  not  been  tried  by  the  surgeons 
having  previous  charge  of  the  case,  otherwise  the  opera- 
tion in  his  opinion  would  doubtless  have  been  uncalled 
for. 

In  conclusion,  he  stated  that  it  had  now  been  nearly 
two  years  since  ne  had  presented  any  specimen  of  ex- 
section  of  the  femur,  since  which  time  he  had  removed 
three  with  a  good  result,  and  one  where  death  ensued. 
This  made  in  all  twenty-three  cases,  with  only  six 
deaths. 

RUPTURE  OP  THE  HEART. 

Dr.  Lewis  presented  a  specimen  of  rupture  of  heart 
(vide  page  412). 

Dr.  Hamilton  stated  that  in  1860  he  made  mi 
autopsy  of  a  gentleman  who  died  of  a  rupture  of  the 
left  ventricle.  The  patient  was  sixty  years  of  age,  and  of 
a  robust  constitution.  He  saw  him  twenty-four  hours 
before  his  dissolution,  when  he  was  suffering  from  ir- 
regular and  feeble  action  of  the  heart,  and  with  a  pain 
which  he  located  chiefly  in  the  epigastrium  and  some- 
what upon  the  left  side.  The  pain  was  suTOOsed  to  be 
due  to  some  disturbance  of  the  stomach  of  which  the 
action  of  the  heart  was  merely  sympathetic,  more  espe- 
cially as  he  had  been  accustomed  to  such  attacks  pre- 
viously ;  in  fact,  he  had  suffered  from  a  similar  one  on 
the  very  day  Dr.  Hamilton  first  saw  him,  but  not  quite 
so  severe  as  the  one  referred  to.  From  this  last  attaok 
he  never  recoyered.  A  post-mortem  examinaiion  was 
made,  and,  as  far  as  he  could  remember,  the  heart  seemed 
to  have  undergone  fatty  degeneration.  There  was  a 
fissure  near  the  apex  of  the  left  ventricle.  The  walls 
of  the  heart  were  very  much  thinned.  The  rent  was  a 
very  small  one,  and  but  three  ounces  of  blood  were 
fi^und  in  the  pericardium. 

Dr.  Eliot,  who  had  attended  the  medical  gentleman 
whose  case  was  reported  by  Dr.  Lewis,  stated  that  the 
deceased  had  repeatedly  suffered  from  similar  attacks  of 
pain,  which  he  had  been  accustomed  to  refer  to  stricture 
of  the  stomach,  and  when  warned  of  their  appearance 
would  take  some  blue  mass  and  be  relieved.  He  was 
also  in  the  habit  of  inducing  emesis  by  thrusting  his 
finger  into  his  throat,  with  the  idea  thereby  of  relaxing 
the  stricture.  So  much  had  he  practised  this  manoeuvre 
that  at  times  he  would  almost  insert  his  whole  hand 
into  his  throat.  He  did  not  commence  to  ail  until 
Sunday,  when  he  was  compelled  to  stay  in  bed  until 
evening,  and  then  arose  and  wrote  a  couple  of  letters. 
Shortly  after  this  he  was  taken  with  the  pain,  which 
was  so  severe  that  he  was  forced  to  brace  himself  with 
his  back  against  the  door  for  relief,  which,  however,  did 
not  come,  and  he  then  went  upstairs  to  bed.  The  re- 
maining portion  of  the  history  was  already  known. 

POIBONINO  BT  LAUDANUM. 

Dr.  Finnell  exhibited  the  uterus  and  appendages  of  a 
young  lady  who  had  been  poisoned  by  an  overdose  of 
laudanum.  She  had  eaten  a  very  hearty  dinner  in  the 
evening  about  six,  and  two  hours  after,  while  suffering 
from  some  pain,  it  is  not  known  where,  she  took  some 
laudanum  from  a  bottle  which  had  been  standing  for  a 
long  time  without  a  cork.  The  quantity  taken  was  not 
known,  neither  was  the  strength  of  the  tincture  ascer- 
tained. She  retired  about  ten  o'clock  in  a  stupid  condi- 
tion, and  in  the  middle  of  the  night  her  aunt,  who  was 
sleeping  with  her,  became  alarmed  at  her  heavy  snoring, 
and  miSe  some  ineffectual  efforts  to  arouse  her.  The 
alarm  was  given,  but  all  endeavors  to^j^psusdtate  her 

Digitized  by  VjC  -^       ^  ^ 


THE  MEDICAL  RECORD. 


415 


were  nnayailing,  and  she  died  at  five  o'clock  the  fol- 
lowing morning. 

The  autopsy  was  made  twelve  hours  after  death.  The 
stomach  contained  part  of  the  meal  taken  the  evening 
before,  and  there  was  a  strong  odor  of  laudanum  per- 
ceptible when  the  organ  was  opened.  Although  the 
deceased  menstruated  a  week  before  her  death  no  recent 
corpus  luteum  was  discovered.  The  uterus  was  in- 
tensely congested  on  its  internal  surface,  and  the  os  and 
cervix  were  plugged  with  a  thick  mucus. 

EXTENSIVE   EXTRAVASATION   OF    URINE. 

Dr.  Buck  presented  a  specimen  of  a  bladder  and  ure- 
thra taken  from  a  roan  thirty-seven  years  of  age,  who  was 
admitted  on  the  afternoon  of  the  Thursday  before  into 
St.  Luke's  Ho8|MtaL  He  was  represented  to  be  a  hard 
drinker,  and  was  in  a  condition  verging  on  collapse  from 
extensive  extravasation  of  urine.  The  antecedents  of 
his  case  were  very  imperfectly  related.  It  was  repre- 
sented that  a  swelling,  to  be  presently  described,  had 
existed  for  three  days.  The  scrotum  was  distended 
almost  to  the  size  of  a  foetal  head,  was  shining  and  tense. 
The  penis  was  swollen  and  oedematous,  not  tense,  and 
the  pubes  was  distended,  and  the  flanks  above  and  on 
a  Une  with  Poupart's  ligament  were  very  considerably 
swollen  and  elevated.  This  condition  was  particularly 
niarked  on  the  right  side.  The  surfaces  of  these  swell- 
ings were  mottled  and  had  a  hard  appearance,  and 
when  pressure  was  made  the  patient  made  decided 
complaints  of  pain.  Fluctuation  could  be  felt  in  the 
right  iliac  region.  The  perineum  was  also  distended 
and  tense. 

The  first  step  in  the  performance  of  an  operation  for 
the  relief  of  the  patient  was  the  making  of  a  free  inci- 
sion along  the  raphe  of  the  scrotum  for  two- thirds  of  its 
distance,  splitting  it  to  the  depth  of  two  inches,  and  carry- 
ing the  incision  back  along  perhaps  half  the  extent  of 
the  perineum.  This  passed  through  infiltrated  tissues 
of  a  greyish  aspect,  and  the  incision  far  back  towards 
the  perineum  arrived  in  a  cavity,  which  was  found  to 
spread  extensively  and  give  escape  to  a  very  foetid  dis- 
charge. An  incision  was  also  made  in  the  right  iliac 
region  over  the  most  prominent  portion  of  the  swelling, 
and  from  that  a  very  considerable  discharge  of  bloody, 
watery  fluid  took  place.  The  tissues  exposed  by  this 
incision  were  dark,  and  evidently  in  a  condition  verging 
on  gangrene. 

The  patient  hiccoughed  occasionally ;  his  countenance 
was  of  an  ashy  hue,  and  his  whole  aspect,  as  well  as 
condition  of  ptdse,  was  that  of  impending  collapse.  He 
was  also  represented  to  have  vomited  previously. 

No  attempt  was  made  to  relieve  the  bladder  at  that 
time ;  in  &ct,  it  was  thought  best  not  for  the  present  to 
proceed  any  further.  Every  means  was  used  to  sus- 
tain his  strength,  and  it  was  hardly  suspected  that  he 
could  survive  the  night.  But  next  forenoon  he  was 
still  alive,  and  reaction  to  a  certain  extent  had  taken 
place ;  the  hands  were  of  the  natural  warmth,  and  the 
pulse  was  a  shade  better.  The  scrotum  had  very  con- 
siderably collapsed  from  the  drainage,  which  was  also 
the  case  with  the  flanks,  particularly  the  right 

At  this  time  it  was  thought  proper  to  make  an  eflfort 
to  introduce  a  catheter.  The  swollen  condition  of  the 
prepuce,  however,  prevented  the  meatus  from  being 
brought  into  view.  After  repeated  attempts  to  strike 
the  meatus  with  the  catheter  without  success,  the 
prepuce  was  laid  open  throughout  its  whole  dorsal 
portion.  It  was  then  discovered  that  a  tight  stricture 
existed  about  three  inches  from  the  meatus.  A  No. 
2  bougie  could  be  tightly  engaged  in  the  constricting 
band.  To  get  through  it  the  following  expedient  was 
resorted  to:    A  No.  1  bougie  was   engaged  in   the 


stricture^  and  the  free  end  of  the  instrument  cut  off. 
The  perns  being  held  straight  and  a  little  stretched,  the 
canufa  of  a  small  trocar  was  passed  over  the  bougie 
until  it  rested  upon  the  anterior  surface  of  the  stricture. 
The  bougie  was  next  withdrawn  and  in  its  place  an 
appropriate  trocar  was  placed,  which  was  thrust  against 
and  into  the  stricture.  This  permitted  the  bougie  to  be 
passed  through  the  stricture,  but  not  far  into  the  urethra. 
An  attempt  was  then  made  to  introduce  Hok's  instru- 
ment, when  it  was  found  that  by  a  little  moderate 
pressure  it  could  be  advanced  pretty  well  into  the 
stricture,  at  least  sufficiently  to  arrive  at  the  remotest 
part  of  its  dilating  portion.  The  dilator  was  then  passed 
and  thrust  home,  and  upon  withdrawing  it  it  was  found 
that  a  Holt's  instrument  closed  could  be  passed  suffi- 
ciently far  to  be  engaged  into  the  neck  of  the  bladder. 
A  larger  sized  instrument  was  next  passed  home,  result- 
ing in  the  further  ru]l)ture  of  the  stricture.  This  per- 
mitted the  entrance  of  a  tapering  No.  10  bougie  into 
the  bladder,  and  aflerward'^  of  a  good-sized  catheter, 
when  eipht  or  ten  ounces  of  urine  were  drawn  off.  The 
urine  being  clear  and  free  from  any  admixture,  it  seemed 
fair  to  infer  that  the  bladder  was  not  suffering  from  any 
catarrh  or  other  form  of  inflammation. 

The  catheter  was  lefl  in,  with  directions  to  draw  off 
the  water  at  stated  intervals,  and  the  general  treatment 
was  continued.  He  was  admitted  on  Thursday,  and 
survived  until  five  o'clock  Sunday  aflernoon. 

The  specimen  showed  that  the  interior  of  the  blad- 
der was  free  from  disease,  except  the  thickening  of  its 
coats,  which  condition  would  naturally  coexist  with  a 
stricture  taxing  the  muscular  power  of  the  viscus. 
The  anterior  Umit  of  the  membranous  portion  was  the 
situation  of  the  opening  through  which  the  extravasa- 
tion took  place.  This  was  large  enough  to  admit  of 
the  introduction  of  a  No.  6  or  7  catheter.  The  exter- 
nal incision  had  communicated  with  the  cavity  imme- 
diately external  to  this.  The  laceration  of  the  urethra 
occupied  about  the  space  of  an  inch,  and  extended  into 
and  exposed  the  tissue  external  to  the  urethnk  There 
was  no  appearance  of  any  stricture  posterior  to  this. 

The  question  in  connection  with  this  rupture  sug- 
gested itself,  whether  this  extravasation  had  been  pre- 
ceded by  an  abscess  communicating  with  or  opening 
into  the  urethra,  of  limited  dimensions,  and  whether  the 
rupture  of  the  walls  took  place  when  the  extensive  ex- 
travasation occurred.  In  reference  to  the  probability 
of  this  condition  of  things,  he  cited  an  instance  of  simi- 
lar cases  that  were  occasionally  admitted  to  hospital& 
Patients  with  old  and  tight  strictures  will  occasionally 
call  attention  to  a  lump  in  the  crotch.  On  examination, 
a  deep,  hard,  circumscribed  swelling  will  be  found 
situated  a  little  to  one  side  of  the  median  line  em- 
bracing the  urethra.  The  skin  will  be  movable  over  it, 
and  perhaps  not,  and  perhaps  the  prominence  cannot  be 
recognized.  On  handling  the  parts,  however,  a  firm 
hard  tumor  is  discovered.  An  exploration  of  the  ure- 
thra shows  a  stricture  at  the  level  of  this  tumor.  That 
swelling  is  evidently  an  abscess.  Fluctuation  cannot 
be  felt  in  it  at  first,  but  its  progress  is  this :  The  con- 
stant action  of  the  vis  a  tergo  of  the  urine  crowds  the 
excretion  into  this  abscess,  at  first  small,  and  keeps  up 
a  constant  irritation  there  tending  to  enlarge  it.  As  it 
enlarges  it  produces  adhesions,  until  the  integument 
becomes  involved  and  an  external  opening  is  estab- 
lished. But  in  the  progress  of  this  abscess  towards  the 
surface,  an  ulcerative  process  may  be  going  on  inter- 
nally, and  may  even  get  the  start  of  the  pointing  ex- 
ternally and  establish  a  communication  direct  with  the 
neighboring  cellular  tissue,  which  will  in  some  instances 
extend  so  that  it  may  even  infiltrate  the  walla  of  the 

^^^  Digitized  by  VjOOQIC 


416 


THE  MEDICAL  RECORD. 


In  the  present  instance  it  was  Dr.  Buck's  opinion 
that  ihe  latter  condition  obtained.  Jn  conclusion,  he 
recommended  that  such  tumors,  when  found  in  con- 
nection with  strictures,  should  immediately  be  freely 
incised  in  aoticipation  of  trouble  that  was  otherwise 
sure  to  come. 

POST-MORTEM   LESIONS  IN   FOUNDLINGS. 

Dr.  Lewis  Smith  exhibited  specimens  which  illus- 
trated some  of  the  post-mortem  lesions  that  were  to  be 
met  with  in  foundlings.  He  remarked  that  a  compara- 
tively small  proportion  of  foundlings  live  beyond  six  or 
eight  months.  They  come  in  charge  of  the  city  at  the 
age  of  about  a  week,  and  are  placed  in  an  institution, 
and  there,  with  all  the  possible  care  that  can  be  given 
them,  they  soon  begin  to  waste  away,  diarrhoea  soon 
occurring,  and  continuing  until  the  close  of  life.  In 
many  of  these  cases  there  is  \  dry  cough,  while  in 
others,  during  the  last  day  or  two,  symptoms  of  hydro- 
cephalic disease  manifest  themselves.  In  that  latter 
condition  the  infant  becomes,  of  course,  stupid,  and 
passes  into  a  state  of  collapse,  the  cause  evidently  being 
referrible  to  inanition. 

He  presented  the  brains  of  two  infants  who  had  died 
under  these  circumstances ;  and  the  large  and  small  in- 
testines of  two  o there. 

In  connection  with  the  general  post-mortem  appear- 
ances of  these  cases,  he  remarked  that  usually  there 
were  evidences  of  intestinal  inflammation,  in  the  shape 
of  injection  and  thickening  of  the  mucous  membrane 
of  the  colon.  Sometimes  this  amounted  to  mere  arbo- 
rescence,  and  sometimes  it  was  a  matter  of  doubt 
whether  it  was  simple  congestion  or  not. 

In  the  minority  of  cases  there  were  no  evidences  of 
intestinal  inflammation,  the  mucous  membrane  being 
pale,  and  the  follicles  and  Peyer's  patches  being  tome- 
what  raised.  The  child  then  dies  of  anon-inflammatory 
diarrhoea.  In  the  majority  of  cases  there  are  signs  of 
ulceration  of  the  solitary  ibllicles. 

The  condition  of  the  lung  was  one  of  considerable 
in  teres  tj  and  corresponded  with  that  described  by 
writers  as  pneumonia  induced  by  inanition — an  ad- 
vanced stage  of  hypostatic  congestion  caused  by  mere 
feebleness  of  the  circulation.  He  remarked  that  for 
some  time  past  he  had  given  considerable  attention  to 
this  state  of  the  lung,  and  had  come  to  the  conclusion 
that  in  many  instances  actual  pneumonia  was  caused  by 
the  presence  of  this  accumulated  blood  acting  as  an 
irritant. 

The  brains  of  those  who  died  with  hydrocephalic 
symptoms  were  usually  conge&ted  at  post-mortem  ex- 
amination. 

In  the  lungs  exhibited  there  was  at  one  spot  well- 
marked  gangrene.  This  state  of  things  the  speaker 
had  repeatedly  noticed  before,  and  was  inclined  to  be- 
lieve that  it  was  the  result  of  general  inanition,  which 
was  invited  to  that  locality  by  the  extreme  feebleness 
of  the  circulation  through  a  hypostatically  congested 
part.  There  was  no  foetor  of  the  breath  noticed  in  this 
case.    • 

Dr.  Jacobi  could  not  understand  why  gangrene 
should  be  so  localized,  and  yet  dependent  upon  a  gen- 
eral cause,  and  expressed  the  opinion  that  in  all  such 
cases  Some  tangible  mechanical  obstruciion  must  exist 
to  explain  it. 

Dr.  Bibbins  believed  that  the  great  mortality  of 
foundlings  was  mainly  due  to  the  insufficient  supply  of 
fresh  air  to  the  wards  and  rooms  which  they  occupied. 

In  answer  to  a  question,  Dr.  Smith  remarked  that  the 
percentage  of  foundlings  with  gangrene  of  the  lungs  was 
about  one  per  cent. 

The  Society  then  adjourned. 


EAST  RIVER  MEDICAL  ASSOCIATION. 

Stated  Meeting,  October  1,  1867. 

Dr.  V.  Morse,  President,  in  the  Chair. 

THE   endoscope   AS  AN   AID   IN  THE   DIAGNOSIS  AND  TREAT- 
MENT OF  GRANULAR  URETHRITIS   AND  STRICTURE. 

Dr.  Stein  having  read  the  report  of  the  section  on  dis- 
eases of  the  urinary  organs,  made  a  few  remarks  ex- 
planatory of  the  endoscope,  which  he  exhibited.  He 
alluded  to  the  fact  that  gonorrhoea,  or  acute  urethritis,  in 
passing  to  the  chronic  stage,  extends  from  the  anterior 
to  the  deeper  portions  of  the  urethra,  usually  localizing 
itself  at  the  bulbo-membranous  region.  The  symptoms 
which  indicate  this  period  of  the  disease  are  well  de- 
fined and  always  recognized ;  but  the  exact  pathological 
condition  of  the  urethral  mucous  membrane  was  the 
province  of  the  endoscope  to  reveal,  for  by  its  aid  we 
are  enabled  to  explore  the  urethral  canal,  and  have 
presented  in  an  unmistakable  manner  the  true  lesions  of 
this  affection. 

As  the  tube  of  the  instrument  approaches  the  seat  of 
disease,  we  observe  an  abnormal  redness,  which  grad- 
ually increases,  and  becomes  most  marked  at  the  bulbo- 
membranous  region ;  at  this  point  its  surface  appears 
unequal :  these  inequalities  increase  in  size  and  number, 
and  finally  form  deep-red  rounded  eminences  or  ^anu- 
lations,  which  impressively  resemble  the  granulations  of 
granular  conjunctivitis.  This  condition  being  accepted 
as  constituting  the  affection  familiarly  known  as  gUet^  is 
now  more  properly  called  granular  urethritis.  If  these 
granulations  are  neglected  they  will  sooner  or  later  in- 
evitably lead  to  the  formation  of  organic  stricture ;  but 
if  timely  discovered,  direct  topical  applications  through 
the  tube  of  the  endoscope  or  sol.  argenti  nitratis  (xx. 
to  XXX.  grs.  to  aq.  |  i.)  will  remove  them,  and  restore 
a  healthy  condition  to  the  mucous  membrane. 

In  impassable  organic  stricture  the  endoscope  enables 
us  accurately  to  appreciate  its  anterior  configuration  and 
the  exact  position  of  its  orifice,  so  that  in  case  of  re- 
tention of  urine  we  can  afford  relief  by  introducing  a 
small  catheter,  and  obviate,  perhaps,  the  necessity  of 
perineal  section  or  puncture  of  the  bladder.  Further- 
more, in  the  operation  of  internal  urethrotomy  we  have 
the  eye  as  a  guide,  and  can  better  Umit  our  incision  to 
the  indurated  and  strictured'part,  than  by  any  other 
means. 

The  field  of  labor  of  the  endoscope  is  not  confined 
to  the  urethra  alone ;  Desormeaux  has  lucidly  demon- 
strated its  utility  in  the  examinations  and  treatment  of 
the  diseases  of  the  mucous  membrane  of  the  bladder, 
cavity  of  the  neck  and  body  of  the  uterus,  ovarian  cysts, 
upper  part  of  rectum,  and  also  in  discovering  the  pres- 
ence of  foreign  bodies  in  deep  wounds. 

The  want  of  interest  manifested  in  the  endoscope, 
considering  that  its  value  is  relatively  equal  to  the 
speculum,  laryngoscope,  and  ophthalmoscope,  by  many 
of  the  profession,  is  not  a  little  sorprisng. 

Dr.  0.  J.  Ward  coincided  with  Dr.  Stein's  views,  but 
thought  that  the  value  of  the  endoscope  would  be  still 
farther  enhanced  if  some  means  might  be  devised  to 
keep  the  transparent  orifice  of  the  tube  from  being 
obscured  by  the  blood  which  followed  its  introduction. 
He  had  seen  it  introduced  in  two  instances,  and  at  each 
occasion  this  constituted  quite  an  annoyance. 

Dr.  Buttles  had  for  some  time  been  in  the  habit  of 
using  a  hollow  glass  tube,  whose  walls  were  strong 
enough  to  obviate  any  danger  from  fracture,  into  whicm 
he  directed  the  light  reflected  fix)m  the  mirror  in  ordi- 
nary use  by  aural  surgeons.  In  this  way  he  obtained  a 
pretty  accurate  idea  of  the  condition  of  the  urethra^  and 
made  his  topical  appUcatious  accordingly.  ^^^1^ 


THE  MEDICAL  RECORD. 


417 


Dr.  Stein  had  no  doubt  but  that  this  plan  answered 
well  enough  in  certain  cases,  particularly  where  the 
lesion  occupied  the  ordinary  site ;  still  he  thought  that 
the  endoscope  was  better  adapted  to  a  wider  range  of 
investigation. 

In  reply  to  a  question,  he  thought  that  the  addition 
of  a  few  grains  of  camphor  to  the  oil  increased  the  bril- 
liancy and  whiteness  of  the  Hght.  Dr.  Bumstead's 
formula  was  pulv.  gum  camphor,  gr?.  xv. ;  kerosene  oil, 
I  i. ;  sol 7.  Dr.  Andrews  in  the  Chicago  Med,  Exam- 
iner extols  the  magnesium  light.  He  would  also  state 
that  Dr.  Weir  of  this  city  had  made  a  very  ingenious 
modification  of  Desormeaux's  instrument,  which  might 
be  seen  at  Mr.  Tiemann's  establishment  in  this  city. 

The  meeting  then  adjourned. 


MEDICAL  SOCIETY  OF  THE  EASTERN 

DISTRICT  OF  BROOKLYN. 

Stated  Meeting,  September  19,  1867. 

diabetes  mellitus. 

Dr.  Wieber  read  a  paper  on  Diabetes  Mellitus,  of  which 
the  following  is  an  abstract : — 

He  first  referred  to  a  case  of  diabetes  which,  at  the 
time  of  writinsr,  had  been  twenty  months  under  his 
observation.  The  patient,  a  girl  aged  seven  years,  had 
complained  for  several  weeks  before  medical  advice  was 
summoned ;  at  this  period,  January,  1866,  the  case  pre- 
sented all  the  symptoms  of  diabetes.  The  urine,  which 
was  discharged  in  large  quantities,  bore  a  specific 
g^vity  of  1040,  and  when  examined  by  different  tests 
proved  to  contain  a  large  amount  of  grape  sugar.  The 
patient  was  put  upon  animal  food,  and  the  only  medi- 
cine prescribed  was  **  artificial  Vichy  water,"  of  which 
from  one  to  two  pints  were  taken  per  diem.  Under 
this  treatment  the  patient  gradually  improved,  the  thirst 
became  less  urgent,  and  the  sugar  in  the  urine  dimin- 
ished. At  interval^  amylaceous  food  was  allowed,  and 
wine  given  in  small  quantities.  After  six  months  of 
this  treatment  there  was  scarcely  a  trace  of  sugar  in  the 
urine,  the  patient  had  always  a  good  appetite,  and  had 
gained  strength.  A  few  months  after,  this  sugar  again 
made  its  appearance  in  the  urine,  but  the  patient's  suf- 
ferings were  slight.  She  drnnk  less  than  before,  and 
the  discharge  of  urine  diminished-  At  present,  having 
been  twenty  months  under  treatment,  the  girl  is  at- 
tending school,  and  considered  well  by  her  parents; 
but  the  urine,  which  has  a  specific  gravity  of  1020,  con- 
tains sugar,  which  shows  that  the  disease  is  still  going 
on.  During  the  whole  time  of  treatment  no  medicine 
other  than  the  Vichy- water  has  been  given  the  patient. 

Dr.  Wieber  presented  to  the  Society  specimens  of 
chemically  pure  grape  sugar  made  by  himself  from  the 
urine  of  his  patient ;  he  also  showed,  by  different  tests, 
the  sugar  in  fresh  urine  from  his  patient,  of  which  the 
following  are  the  simplest  and  best.  First — Take  about 
fifteen  or  twenty  drops  of  urine  diluted  with  four  or  five 
cubic  centimetres  of  water,  and  about  one-half  C.  C.  liq. 
potassa  caustic  (or  liq.  soda  caustic),  and  then,  by  drops, 
a  very  dilute  solution  sulphate  of  copper  j^  should  there 
be  sugar  in  the  urine  the  precipitate  by  agitation  will 
dissolve,  forming  a  clear  blue  Uquid ;  without  agitation 
the  blue  liquid  has  to  be  heated  near  to  the  boiling 
point,  at  which  a  red  or  yellow  precipitate  of  suboxide 
of  copper  will  appear.  Caution  is  here  necessary  lest 
too  much  of  the  copper  solution  be  used.  Another 
portion  of  urine  may  be  treated  in  the  same  way,  with 
the  exception  of  heating  it ;  in  the  course  of  twenty- 
four  hours'  precipitation  will  take  place  if  sugar  is  pre- 
sent. 


This  second  test  is  important,  and  never  to  be  omit- 
ted, as  other  abnormal  ingredients  of  the  urine  will 
cause  a  reduction  of  copper  when  subjected  to  heat  in 
this  way. — (Trommer's  test.) 

Second — Take  a  small  quantity  of  urine  in  a  narrow 
test  tube,  add  a  solution  of  caustic  potassa.  and  heat  the 
upper  part  of  the  liauid ;  when,  if  sugar  be  present,  it 
will  become  of  a  yellowish  brown  color. — (Moore.) 

Third — Take  equal  parts  of  urine  and  solution  car- 
bonate soda  (made  of  one  part  carb.  soda  to  three  of 
water),  add  a  small  quantity  of  nitrate  of  bismuth; 
apply  heat  for  some  minutes,  after  which  the  bismuth 
turns  to  a  gray  or  black  color,  according  to  the  quantity 
of  sugar  present. — (Boettches.) 

Another  sure  method  of  testing  diabetic  urine  is  by 
the  decomposition  of  sugar  into  alcohol  and  carbonic 
acid,  by  adding  yeast  to  the  urine. 

Referring  to  different  theories  of  diabetes  mellitus, 
Dr.  Wieber  quoted  from  Prof.  T.  Vogel — ^Diseases  in 
Urinary  Organs.  However  the  organization  of  sugar 
may  be  explained,  to  cause  mellituria,  sugar  must  be 
accumulated  in  the  blood  and  is  dissolved  in  the  serum, 
which  in  patients  suffering  from  diabetes  mellitus  has  a 
higher  specific  gravity  (1033  instead  of  1029). 

This  concentrated  blood  serum  is  absorbing,  according 
to  the  law  of  endosmosis,  the  water  from  the  hquids 
of  the  parenchyma  as  well  as  from  water  taken  with 
the  food  and  drink.  In  consequence  of  this  the 
blood-vessels  are  overcharged  ;  a  plethora  takes  place, 
which  causes  a  higher  degree  of  pressure  in  the  vascular 
system,  especially  in  the  kidneys,  resulting  in  polyuria. 
By  this  theory  the  thirst,  dry  skin,  and  other  symptoms 
of  diabetes  mellitus  are  easily  explained. 

The  duration  of  diabetes  mellitus  is  very  variable. 
Prof.  Griesinger,  of  Berlin,  recorded  one  hundred  cases, 
ranging  as  follows : — 

Less  than  a  quarter  of  a  year,  1 ;  quarter  to  one-half, 
2 ;  one-half  to  one,  13 ;  one  to  two,  39 ;  two  to  three, 
20 ;  three  to  four,  7 ;  four  to  five,  2;  five  to  six,  1 ;  six 
to  seven,  2 ;  seven  to  eight,  1. 

Twelve  cases  were  uncertain.  Griesinger  found  that 
from  two  hundred  and  twenty-five  cases,  seventy-six  per 
cent,  were  males,  and  twenty-four  per  cent,  females. 
Considering  the  age,  there  were  under 

Ten  years,  6  cases:  ten  to  twenty,  36:  twenty  to 
thirty,  46 ;  thirty  to  forty,  60 ;  forty  to  fifty,  36;  fifty 
to  sixty,  14 ;  sixty  to  seventy,  7 ;  seventy  to  eighty,  1. 
According  to  Griesinger's  collection  of  post-mortem 
examinations  of  sixty-four  cases,  there  were  forty-three 
per  cent,  complicated  with  tuberculosis  pulmonalis,  and 
thirty-two  cases  were  kidney  diseases,  viz. — hyperaemia, 
6 ;  enlargement,  7 ;  abscess,  3 ;  Brignt's  d^pease,  17. 
On  motion,  the  Society  then  adjourned. 

MEDICAL  SOCIETY  OF  THE  COUNTY  OF 

NEW  YORK. 

STATEn  Mbeting,  Nov.  3,  1867. 

Dr.  Edmund  R.  Peaslee,  PsEsmENT,  in  the  Chair. 

SimMART  OF  THE  PBESIDSNt'S  ADDRESS. 

Dr.  Peaslee  delivered  the  inaugural  address,  the 
subject  of  which  was  ^'  The  Aims  and  Qualifi- 
cations which  Conduce  to  Render  Man  an  Orna- 
ment to  the  Medical  Profession.'*  After  refer- 
ring to  the  veneration  paid  to  the  science  of  medi« 
cine  by  the  ancients,  ne  invited  attention  to  the 
qualities  that  were  essential  to  make  a  phvsician  an  aid 
to  his  fellow  mortal  and  an  ornament  to  tie  profession. 
The  first  requisite  was  a  sound,  thorough  education 
before  entering  into  practice.  He  then  instanced  some 
of  the  evil  results  which  followed  the  efibrts  of  young 


418 


THE  MEDICAL  RECORD. 


men  who  practised  medicine  without  first  gaining  a 
knowledge  of  the  studies  which  should  precede  that 
course.  A  study  of  anatomy  should  precede  physio- 
logy, and  that  of  both,  pathology.  He  next  alluded  to 
the  brief  time  allowed  iu  some  colleges  for  the  graduat- 
ing of  students,  and  characterized  the  system  as  one 
that  did  great  injustice  to  the  students  and  the  publia 
He  also  showed  the  importance  that  a  physician  in 
practice  should  keep  himself  fiilly  informed,  by  read- 
mg,  of  the  new  principles  developed  in  medicine,  and 
took  the  ground  that  a  physician  should  not  allow  any 
other  occupation  to  interfere  with  his  profession.  H!e 
recited  numerous  instances  to  proye  that  many  physi- 
cians, whose  names  are  eminent  in  history,  and  whose 
practice  was  exceedingly  laborious,  found  ample  time  to 
read  and  write  medical  works.  A  physician  could  not 
expect  to  gain  eminence  at  once,  and  young  men  need 
not  despair  of  achieving  feme.  It  took  Harvey  thirty- 
six  years  to  perfect  his  system  of  the  "  Circulation  of 
the  Blood."  Neither  did  advanced  age  disqualify  men 
from  engaging  in  active  business  pursuits,  and  it  would 
not  do  for  a  physician  to  rely  wholly  upon  his  experi- 
ence. There  was  always  something  to  learn,  and 
practice  did  not  necessarily  give  experience.  Another 
requisite  to  the  success  of  the  physician  was  piety. 
The  speaker  closed  his  address  with  an  appeal  to  lus 
hearers  to  observe  those  qualities  which  tend  to  make 
the  profession  useful  and  eminent. 

Dr.  Roosa  then  read  a  paper  entitled,  ''  Remarks  on 
the  Diagnosis  and  Treatment  of  Diseases  of  the  Ear." 

Dr.  Griscom  followed  with  a  description  of  a  new 
form  of  Family  Record. 

The  Society  then  adjourned. 


l^xoQctss  Of  iittrttcal  0c«nce* 


The  Treatment  op  Contracted  Muscles  and  Ten- 
dons.— The  treatment  of  contracted  muscles  and  ten- 
dons, as  advised  by  Dr.  H.  Q-.  Davis,  of  this  city,  in  his 
work  on  Conservative  Surgery^  is  based  upon  the  good 
effects  of  a  state  of  constant  tension.  The  author  main- 
tains that  whenever  any  circumstance  shortens  the  rel- 
ative distance  between  the  points  of  origin  and  inser- 
tion of  any  muscle  or  tendon,  there  is  an  absence  of 
the  natural  stimulus  to  the  normal  nourishment  of  the 
parts ;  that,  in  other  words,  no  more  of  the  nutritive  ele- 
ment is  effused  than  is  barely  requisite  to  maintain  such 
tissues  in  their  shortened  condition.  If,  under  these 
circunastances,  extension  is  employed  by  the  elastic  me- 
thod, the  Antracted  tissues  are  kept  constantly  upon 
the  stretch,  and  are  gradually  elongated  to  their  normal 
dimensions.  As  a  consequence  of  this  continuous  ten- 
sion of  the  fibres,  the  supply  of  nourishment  is  propor- 
tionately increased,  so  that  eventually,  by  the  constant 
supply  of  new  material,  the  parts  actually  grow  to  their 
natural  length  and  original  strength.  His  observations 
with  reference  to  this  point  have,  he  assures  us,  been 
amply  and  satisfactorily  proved  as  the  result  of  fifteen 
years  9f  experience. 

The  advantage  of  elastic  extension  over  other  methods 
consists  in  the  fact  that  it  is  constantly, kept  up,  and 
that,  as  the  muscles  or  tendons  give  way  to  the  force 
exerted  upon  them,  there  is  always  enough  power 
of  extension  in  reserve  to  keep  up  the  action  and  follow 
up  the  good  effects.  This  continuous  tension  stimulates 
the  deposit  of  new  mateiial,  so  that  the  growth  of  such 
shortened  tissues  is  more  rapid  than  under  ordinary 
circumstances.  As  extension  is  ordinarily  kept  up  by  in- 
elastic bands,  the  force  is  constantly  liable  to  be  reduced 
by  the  relaxations  of  the  appliances,  which  must,  in  a 


longer  or  shorter  time,  yield  to  the  stretching  to  which 
tliey  are  subjected.  This  principle  can  be  satisfactorilj 
applied  to  all  cases  in  which  it  is  necessary  to  overcome 
undue  contraction  of  the  soft  parts  from  any  cause  save 
actual  organic  interruption  of  nerve  power ;  such,  for 
instance,  as  in  deformities  attendant  upon  contractions 
after  inflammations  of  the  joints,  upon  the  different 
varieties  of  talipes,  upon  the  deformitie3  after  fractures 
and  old  dislocations,  and  even  upon  the  retraction  of 
the  integuments  a^r  bums.  In  the  latter  case  the 
strain  is  put  upon  the  surrounding  skin  by  means  of 
adhesive  plaster  in  opposite  directions  to  the  contracting 
forces  in  the  ciatrices.  The  general  plan  of  treatment 
has  to  be  modified  in  accordance  with  the  special  indi^ 
cations  that  may  be  present  in  each  case,  constantly 
calling  the  ingenuity  of  the  surgeon  into  play.  H!e 
does  not  consider  division  of  the  tendons  as  at  all  ne- 
cessary for  the  accomplishment  of  permanent  elongation 
of  contracted  parts,  and  affirms  that  continuous  elastic 
extension,  intelligently  employed,  is  all-sufficient  to 
overcome  the  most  obstinate  contraction. 

In  many  cases  where  muscles  are  firmly  contracted, 
and  antagonistic  ones,  by  constant  stretching,  by  de- 
rangement of  nerve  force  and  deprivation  of  proper 
nourishment,  are  paralyzed,  he  assists  nature  by  supply- 
ing by  means  of  india-rubber  webbing  an  artificial  muscle 
on  the  paralyzed  side.  By  this  means  the  contracted 
muscle  is  not  only  elongated,  but  its  antagonist  is  pro- 
portionately shortened,  and  in  both  instances  the  power 
of  muscular  co-ordination  is  regulated  by  an  equal  distri- 
bution of  nerve  power. 

Again,  in  order  to  exercise  more  power  upon  the  con- 
tracted muscles,  he  employs  pressure  upon  their  bellies; 
at  the  same  time  makes  use  of  the  elastic  extension 
besides.  This  is  accomplished  by  employing  two  sets  of 
adhesive  plasters,  so  arranged  fan-fashion,  one  strip  over- 
lapping the  other,  that  they  will  cross  each  other  over 
the  beUy  of  the  muscle.  To  the  smaller  extremities  of 
each  one  of  these  sets  is  sewn  a  piece  of  elastic  webbing 
to  which  the  extending  force  is  attached.  If  it  is  desired, 
for  instance,  to  make  extension  by  this  means  upon  the 
extensors  of  the  thigh,  strips  of  plaster  are  applied  firom 
below  upwards  diagonally  across  the  front  of  the  thigh, 
first  upon  one  side  and  then  upon  the  other,  the  sets 
crossing  each  other  at  acute  angles  in  the  median  line  <^ 
the  limb.  A  firm  roller  is  applied  over  the  whole  to  keep 
the  plasters  in  position,  while,  to  the  ends  of  the  strips 
as  they  lap  upon  each  other,  on  both  sides  of  the  loiee 
strong  webbing  is  sewn  for  the  purpose  of  connecting 
with  the  elastic  extension  below.  Extension  being  ap- 
plied, the  extensor  muscles  are  not  only  put  upon  toe 
stretch,  but  the  diagonal  position  to  the  two  sets  of  plas- 
ters by  virtue  of  the  direction  of  the  strain,  compresses 
the  bellies  of  these  muscles  besides.  This  plan  of  treat- 
ing muscles  is  not  only  applicable  to  cases  of  joint-dis* 
ease  and  the  like,  but  may  be  advantageously  employed 
in  cases  of  fracture  in  which  the  powerful  action  of  a 
certain  set  of  muscles  obstinately  tends  to  keep  up  a  con- 
stant separation  of  the  two  fragments.  In  attaching 
the  elastic  webbine  to  the  soil  parts  the  ordinary  ad- 
hesive plaster  carefully  and  smoothly  applied  is  always 
used,  and  is  in  turn  maintained  in  its  position  by  nicely 
adjusted  bandages. 

Next  to  a  fair  share  of  mechanical  ingenuity  in  the 
use  of  this  method  of  extension,  success  is  only  gained 
by  the  exercise  of  much  patience  and  firmness  on  the 
part  of  the  attendant,  so  that  a  constant  stretching  of  the 
p>art8  day  and  night  be  kept  up  for  weeks.  Intermis- 
.sions  in  such  a  course,  if  allowed  to  occur  either  by  ne- 
glect, design,  or  discouragement,  are  attended  with  the 
loss  of  much  more  ground  than  at  first  would  be  expect- 
ed, owing  to  opportunities  thus  granted  to  the  contrMt- 


THE  MEDICAL  RECORD. 


41» 


ed  tissaes  to  recorer  in  some  degree  the  streDgth  of 
liabit 

As  an  evidence  of  the  good  effects  of  this  method  of 
extension,  Dr.  Davis  asserts  its  power  to  relieve  the  pain 
which  is  sometimes  such  a  distressing  accompanimeDt 
to  some  forms  of  muscular  contractions.  He  believes 
that  the  contraction  of  the  muscles  around  diseased 
joints  is  first  produced  by  an  effort  of  the  will  to  hold 
the  parts  motionless  and  in  as  comfortable  a  position  as 
possible,  and  Uiat  the  muscles  getting  into  the  habit  of 
contraction,  the  exercise  of  the  will  is  no  longer  neces- 
sarj  to  keep  up  the  contraction. 

A  Fracture  of  the  Cranium,  with  penetration  of 
a  bony  spiculum  into  the  brain  and  loss  of  brain  sub- 
stance, is  recorded  in  the  Gaz,  des  Hop,^  the  remarka- 
ble feature  of  which  was  recovery  within  six  weeks. 

The  Arrest  op  Hjbicorrhaoe  bt  Acupressure  (if 
we  may  judge  by  the  tenor  of  several  articles  in  the 
Medical  Times  and  OazeUe,  the  Lancet  and  in  special 
treatises)  is  steadily  growing  in  favor.  It  is  claimed  for 
this  method  that  it  is  not  only  an  efficient  hssmostatic, 
but  that  it  accelerates  the  heatinr  of  wounds,  and  that 
"  tmion  by  the  first  intention  has  been  repeatedly 
effected  in  stumps  of  the  thigh  without  a  drop  of  pus  / 

The  experience  of  our  own  surgeons  is  rather  ad- 
verse to  t£is  mode  of  treatment,  it  having  been  found 
in  several  instances  that  a  suppurating  tract  had  been 
established  by  the  needle. 

The  Sttptio  Collodium  composed  of  tannin,  alcohol, 
ether,  and  gun  cotton,  is  highly  extolled  by  Dr.  B.  W. 
Richardson,  in  the  Med.  Times  and  Gazette^  as  favoring 
"  union  by  the  first  intention." 

The  Extirpation  of  'Njbyi  by  Eihjoleatioh. — An  ar- 
ticle ''on  the  enucleation  of  nsevus"  appears  in  the 
Brit,  Med.  Journal.  This  advance  in  treatment  is  the 
result  of  Mr.  Faget's  investigations.  He  demonstrated 
the  existence  of  a  distinct  sac  in  these  cases,  and  upon 
this  &ct  is  based  the  above-mentioned  curative  pro- 
cedure. 

SoAMPOomo  TN  Sprains. — ^M.  Beringer  Ferand  {BuU. 
de  Ther.)  advocates  shampooing  in  the  case  of  sprains. 
He  advises  the  attendant  to  be^in  with  gentle  passes 
and  movements,  to  be  gradually  increased  in  force. 
Cold  lotions  and  rest  should  follow.  The  manipula- 
tions should  always  be  towards  the  body. 

Applications  for  Garbukolbs  after  Incisions  and 
Ivdolent  Ulcers. — A  solution  of  permanganate  of 
potash  (  3  88.- 1  j.)  is  strongly  advised  as  a  dressing  after 
tiie  incision  of  carbuncles,  and  as  application  to  ulcers. 
—Dr.  Leavitt,  Am>.  Jonm.  Med.  Sciences. 

Another  writer  (Dr.  D.  A.  Morse,  Med.  and  Surg. 
Reporter)  prefers  the  claims  of  the  following  application 
in  indolent  ulcers,  where  the  tissues  are  dark  and  in- 
durated. B . — Plumbi  subaoet,  7  parts ;  pulv.  opii,  1 
part;  hydrarg.  submur.,  2  parts.  He  claims  that  it 
relieves  pain,  mduces  a  healthy  appearance,  etc 

Period  of  the  Growth  of  Man. — Prof.  B.  A. 
Gould,  firom  statistics  derived  ifrom  the  register  of  two 
and  a  half  millions  of  men  in  the  United  States  Army, 
has  brought  out  the  fact  that  men  attain  their  maxi- 
mum stature  much  later  than  is  generally  supjposed. 
This  takes  places  commonly  at  29  or  80  years  of  age ; 
b«t  there  are  frequent  instances  of  growth  until  35^  not 
very  noticeable — ^a  yearly  gain  of  a  tenth  of  an  inch, 
perhaps — still  a  growth.  Afler  35,  the  stature  subsides 
m  similar  proportions,  partly  perhaps  from  the  conden- 
sation of  the  cartilages,  partly  because  of  the  change 
occurring  m  the  angle  of  the  hip  bone.    The  age  for 


maximum  stature  comes  earliest  to  the  tallest  men.  as 
if  it  were  the  necessity  of  unusual  development.  For* 
eigners  were  shorter  than  men  of  native  birth.  The 
height  of  men  seemed  to  depend  on  the  place  of  enlist- 
ment. A  Massachusetts  man  enlisting  in  Iowa  was  an 
inch  taller  than  if  he  had  stayed  at  home.  As  we  go 
west,  men  grow  taller.  One  man  measured  more  than 
6  feet  10  inches.  Out  of  1,000,000,  there  were  6,000 
who  measured  more  than  6  feet  4  inches  j  but  men  of 
such  stature  do  not  wear  welL  In  Maine,  men  reached 
their  greatest  height  at  27 ;  in  New  Hampshire,  at  35 ; 
in  Massachusetts,  at  29 ;  in  New  Jersey,  at  31,  The 
tallest  men,  of  69  inches,  come  from  Iowa.  Maine,  Ver- 
mont, Ohio,  Indiana,  Minnesota,  and  Missouri,  give  us 
men  a  little  over  68 ;  and  the  average  of  all  shows  the 
Americans  to  be  "a  very  tall  people.** 

Magnetism  not  Resident  upon  the  Surfaces  of 
Bodies. — In  a  discussion  on  this  subject,  before  the 
British  Association,  Sir  William  Thompson  took  excep- 
tion to  the  remark  that  magnetism,  like  electricity,  dis- 
tributes itself  upon  the  surface  of  bodies.  The  same 
statement  had  been  made  by  authors  of  repute;  but  it 
only  added  proof  to  the  fact  that  in  many  popular 
books  there  were  statements  not  merely  false  in  theory, 
but  false  as  being  in  direct  opposition  to  facts  published 
many  years  ago.  Harlow,  in  experimentin|j  with  bars 
of  iron,  found,  long  ago,  that  the  magnetic  influence 
was  not  discoverable.  His  experiments  were  not  care- 
fully made,  yet  he  rashly  stepped  to  the  conclusion 
that  magnetism  resides  at  the  surface ;  and,  although  it 
was  soon  proved  incorrect  by  a  celelDrated  mathema- 
tician, this  statement  has  been  the  fruitful  parent  of 
many  fallacies. 

The  most  Frequent  Seat  of  Urethral  Stricture, 
— M.  H.  Follett  {Archives  Giniraks  de  Mldicine,  April, 
1867 ;  GasteUe  Behdom.  April  12,  1867)  believes  that 
organic  strictures  of  the  bulbo-membranous  region, 
though  pronounced  to  be  frequent,  are  rare.  He  pub- 
lishes six  cases  of  organic  stricture,  of  which  one  alone 
occupied  the  bulbo-membranous  region,  while  the  re- 
mainder occupied  the  spongy  part. 

The  Treatment  of  Hydrocele  of  the  Cord. — M. 
de  Luci  (Gaz.  des  HSp.)  reports  a  case  of  encysted 
hydrocele  of  the  cord  cured  by  alcoholic  injectiona. 

The  Radical  Cure  of  Varicocele. — ^Maisonneuve 
(Edinburgh  Med.  Jour.)  recommends  coagulating  injec- 
tions of  the  perchloride  of  iron  for  the  radical  cure  of 
varicocele. 

A  Simple  Remedy  for  Polypi  of  the  Nares, — ^Dr, 
T.  Bryant  (London  Lancet)  treats  mucous  polypi  of  the 
nares  wiUi  tannin  used  as  a  snuff. 

SucoEBSFUL  Closure  of  an  Artificial  Anus. — ^Dr.  J. 
B.  Graves  (Med.  and  Surg.  Reporter)  furnishes  a  unique 
history  of  a  case  of  strangulated  hernia.  Operation  was 
performed,  and  followed  by  an  artificial  anu?.  In  due 
time  this  was  closed  by  Dapuytren*s  method.  Twelve 
years  afler,  the  patient  reports  herself  in  perfect  health ; 
she  can  feel  the  transit  of  fiecal  matter  along  the  gut  at 
the  point  where  the  artiBcial  anus  was,  and  can  even 
assist  its  passage  by  manipulation. 

A  Rare  Result  of  Catheterism. — ^M.  Foucher  (Hdp, 
St  LouiSj  Gazette  des  Hdp.)  publishes  a  case  where 
catheterism  was  followed  by  orchitis,  suppuration  and 
elimination  of  the  tissues  of  the  testicle,  peritonitis,  and 
death.  The  points  of  interest  are:  (1)  An  example 
of  suppurative  orchitis  with  elimination  of  the  semin- 
iferous substance.  (*2)  The  transmission  of  inflamma- 
tion from  the  testicle  and  epididymis  to  the  cord,  then 
to  a  hernial  sac,  and,  finally,  to  the  peiitpneum. 

digitized  by  VjOOQIC 


480 


THE  MEDICAL  RECORD. 


A  Unique  Affection  of  a  Nerve  i8  reported  in  the 
Trans,  of  the  Med,  Chirurg,  Soc.j  London  (vol.  xlix.  p. 
29).  "  An  arterio-venoua  cyst  was  found  in  the  poplit- 
eal nerve,"  af^er  amputation  of  the  thigh. 

Infusion  of  Coffee  in  Strangulated  Hernia. — The 
administration  of  infusion  of  coffee  ( |  iij.  freshly 
roasted  and  ground  coffee,  to  five  cups  of  boiling  water) 
induced  spontaneous  reduction  in  a  case  of  strangulated 
hernia  which  had  been  doomed  to  operation. — Dr.  A. 
BuRiLLON.  BuU.  de  Thirap,^  IxxiL,  p.  82,  Jan.  30,  Lan- 
cet, Mar.  16.     Half  Yearly  Abst,  xlv. ' 

Treatment  of  Qonorrhcea. — Dr.  Dyes  (Schmidfs 
Jahrbucherj  No.  2,  1867)  says :  "  Copaiba,  it  is  known, 
does  harm  at  the  commencement  of  gonorrhoea ;  it  does 
but  little  good  eSter  the  inflammatory  stage  has  passed 
off.  It  is  almost  incredible  how  practitioners,  who 
throughout  the  whole  course  of  gonorrhoea  order  ab- 
stinence from  everything  likely  to  cause  irritation,  can, 
in  direct  opposition  to  this,  prescribe  a  medicine  so 
irritating  to  iho  kidneys  andunnary  passages  as  balsam 
of  copaiba."  His  treatment  consists  in  subduing  inflam- 
mation of  the  urethral  mucous  membrane  by  soothing, 
mucilaginous,  and  cooling  medicine,  combined  with  a 
spare  diet  and  rest,  and  directly  «dler  the  removal  of 
this  inflammatory  condition,  an  injection  of  zinci  sulph. 
is  applied  to  the  urethra. 

M.  Luc,  in  the  Brit  Med,  Joxtmal,  March  23^  recom- 
mends a  tolerably  thick  solution  of  starch  m  acute 
urethritis.  '^  It  never  produces  pain,  and  avoids  stric- 
tures." 

Pepsin  in  the  Vomitino  of  Pregnancy. — ^A  number 
of  French  physicians  declare  the  efficacy  of  pepsin  in 
the  vomiting  of  pregnancy.  It  should  be  ^en  in  the 
dose  of  eight  or  ten  grains,  before  eating.  Hydrochlo- 
ric acid  is  also  recommended  as  equally  efficient — 
thirty  to  sixty  drops  to  be  taken  daily,  properly  diluted. 
Strychnia,  we  thiuk,  is  not  inferior  to  either,  the  twen- 
tieth to  the  twelfth  of  a  grain  three  times  a  day. — 
Pacific  Med.  and  Surg,  Jour, 

Batio  of  Deaths  from  Inhalation  of  Chloroform. — 
Edmund  Andrews,  M.D.,  in  a  letter  to  the  Chicago 
Med,  Enquirer,  states  that  he  has  been  at  some  pains 
to  discover  the  ratio  of  deaths  from  the  inhalation  of 
chloroform.  The  surgeons  of  London  do  not  seem 
to  be  frilly  aware  of  the  real  mortaUt^  attending  its 
administration,  Mr.  Simon  even  expressing  the  opinion 
that  it  is  safer  to  take  chloroform  than  to  take  a  ride 
in  a  railroad  car.  Fibres  have  been  collected  from 
fourteen  hospitals  in  Liverpool  and  London.  Reliable 
accounts  of  chloroform  being  administered  83,069  times 
were  obtained,  and  of  these  24  proved  fatal,  or  1  in 
3,461.  A  railroad  in  active  business  with  a  mortality 
Hke  this  would  kill  from  600  to  3,000  passengers 
every  year.  Dr.  Andrews  advises  the  use  of  ether, 
reserving  chloroform  for  those  who  do  not  come  under 
the  influence  of  ether.  Possibly  the  tetrachloride  of 
carbon  may  prove  to  have  the  eafety  of  ether  and  the 
promptness  of  chloroform.  The  statistics  above  given 
were  gathered  from  surgical  cases,  and  are  of  no  value 
in  testing  its  safety  in  obstetric  practice. 

Enlargement  of  the  Colon. — Dr.  Wm.  Sewitt,  in 
the  Chicago  Medical  Journal,  relates  the  history  of  a 
case  to  which  he  was  called  to  reheve  a  patient  who 
bad  not  had  an  evacuation  of  the  bowels  for  three 
weeks.  During  this  time  the  patient  had  been  in  the 
hands  of  a  spiritual  doctor  who  said  he  was  suffering 
from  "  tvindy  dropsy,''  The  patient  was  suffering  from 
intense  pain  in  the  abdomen,  with  frequent  desire  to 
expel  flatus  from  the  rectum,  which  he  could  only 
accomplish  by  placing  himself  upon  his  head  and  hands 


in  a  peri)endicular  position.  The  abdomen  was  enor* 
mously  distended,  and  so  tense  that  it  was  impoesible 
to  find  the  outline  of  any  of  the  abdominal  organs. 
Since  a  similar  attack  about  nine  years  before,  he  bad 
had  a  torpor  of  the  bowels,  having  an  evacuation  once 
in  eight  or  ten  days.  An  examinaiion  per  anum 
revealed  what  seemed  an  enormous  tumor,  filling  the 
entire  pelvic  cavity,  with  a  resemblance  to  a  child's 
head  at  term.  The  rectum  appeared  normal.  He  had 
taken  powerful  cathartics,  ana  copious  enemata  were 
ordered,  but  in  attempting  to  use  them  they  did  not 
pass  beyond  the  rectum,  and  flowed  immediately  back. 
A  long  rectum-tube  was  t'len  used,  but  could  not  be 
carried  ftirther  than  the  upper  portion  of  the  rectum, 
when  it  would  fold  upon  itself,  snowing  obstruction  at 
the  sigmoid  flexure.  Laxatives  were  afterwards  used, 
but  to  no  effect,  except  occasionalljr  to  expel  some 
flatus.  He  continued  in  this  condition  for  about  a 
week,  when  he  was  suddenly  seized  with  an  excru- 
ciating pain  in  the  abdomen,  and  in  a  few  hours 
expired.  An  autopsy  revealed  the  peritoneal  cavity 
enormously  distended  with  gas,  and  a  large  quantity  of 
ftecal  matter,  of  the  consistence  of  batter,  was  extravasa- 
ted  into  it,  showing  that  perforation  had  taken  place — the 
immediate  cause  of  death.  The  perforation  was  at 
several  points  of  the  colon.  The  ascending  and  descend- 
ing colon  appeared  like  two  immense  cylinders  lying 
side  by  side,  extending  from  the  epigastrium  to  the  pelvis, 
being  about  five  and  a  half  inches  m  diameter,  and  fiUea 
with  soft  faecal  matter.  The  two  cylinders  were  folded 
upon  themselves,  filling  the  entire  surface  of  the  ab- 
dominal cavity.  The  sigmoid  flexure  was  about  the 
same  diameter,  and  what  was  supposed  to  be  the 
tumor  filling  the  pelvic  cavity  was  the  sigmoid  flexure 
distended  with  fiecal  matter  and  folded  upon  itself 
giving  Hie  firm  and  rounded  shape  of  a  pelvic  tumor,  ana 
pressed  so  firmly  upon  the  upper  portion  of  the  rectum 
as  to  prevent  all  passage  of  Isecal  matter  into  it  The 
colon  was  very  much  thickened,  and  completely  filled 
with  faecal  matter  of  the  consistence  of  batter,  containing 
over  a  large  wooden  pailftil,  besides  what  had  paaied 
through  the  perforations  into  the  peritoneal  cavity. 

Venomous  Bites. — ^By  J.  T.  Newman,  M.D. — A  man 
was  bitten  on  the  right  tendo  achillis  by  a  rattlesnake, 
and  was  found  three  hours  after  suffering  the  most 
excruciating  agonies.  The  right  side  was  swollen  all 
the  way  from  the  heel  to  the  shoulder,  pulse  varying 
from  130  to  145,  the  respiration  from  36  to  40,  and  he 
also  foamed  at  the  mouth,  gnashed  his  teeth,  and 
violent  spasms  would  ensue.  Thirty  ^ins  of  morphia 
and  a  gallon  of  brandy  were  ordered.  He  was  given  five 
grains  of  the  former  and  eight  ounces  of  the  latter.  The 
swelling  was  rapidly  covering  the  entire  body.  At  the 
end  of  an  hour  from  the  time  the  first  dose  was  eivai, 
the  same  dose  was  repeated,  and  also  a  poultice  of  stra- 
monium leaves  was  applied.  It  could  now  be  plainly 
seen  that  the  spasms  were  subsiding.  The  brandy 
was  then  given  in  doses  of  four  ouncts  every  fifteen 
minutes.  This  treatment  was  kept  up  for  six  hours, 
changing  the  poultices  every  half  hour.  At  the  end  of 
that  time  he  fell  into  a  sleep  lasting  four  hours.  The 
swelling  now  commenced  to  subside.  When  he  awoke 
the  same  dose  of  morphia  as  first  given  was  repeated. 
Two  ounces  of  aq.  ammoniae  were  mixed  with  an  equal 
amount  of  brand v,  and  after  two  doses  of  this  mixture 
he  slept  several  hours.  Within  as  many  hours  he  had 
taken  thirty  grains  of  morphia,  a  gallon  of  brandy,  and 
four  ounces  of  ammonia.  'Except  at  the  part  bitten,  the 
swelling  had  almost  subsided.  It  exuded  a  greenish 
fluid,  which  may  or  may  not  have  been  the  virus.  The 
patient  recovered. — Chicago  Medical  Journal 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


421 


The  Medical  Kecord. 

3-  Stmi-Pontfelg  |imnml  of  Pftbidnt  mib  Snrgerg. 
George  F.  Shradt,  M.D.,  Editor. 

Pobluhed  on  the  Ut  and  15th  of  each  Month,  bf 
WILLIAM  WOOD  A  00.,  «1  Walmbb  SroraBT,  Niw  Towc. 


FORBIGN  AGSKOIES, 


LoinK>K— Tkubrsb  k  Co. 

PAUB^BoeSAKOB  XT  Ou. 


LKIP8I0 — B.   HbRM ANN. 

ElO  JaMBIXO— STBPUBNi  T  Ca. 


NTew   York.   November   15.  1867. 


CONCERNING-  PRESCRIPTIONS. 
It  has  become  of  late  a  fashionable  practice  with  the 
apothecaries  to  sneer  at  the  qualifications  of  physi- 
cians its  prescribers.  At  first  sight  we  might  explain 
this  on  the  supposition  that  they  are  too  zealous  in 
urging  the  claims  of  their  specialty,  and  too  fearful  of 
the  possibility  of  their  calling  being  left  out  in  the  cold. 
It  is  perfectly  natural  for  any  class  of  individuals  to 
have  the  interests  of  their  trade  or  profession  dearest 
to  their  hearts,  and  so  far  as  this  is  an  element  in  their 
dissatisfaction  we  must  stand  ready  to  excuse  them. 
But  that  is  only  in  part  the  cause,  for  their  reflections 
upon  our  knowledge  of  and  interest  in  pharmacy  are 
made  appallingly  apparent  when  we  calmly  examine 
the  questioa 

There  in  no  disguising  the  fact  that  the  majority  of  us 
merit,  to  no  small  extent,  all  the  aspersions  which  the 
pharmaceutists  heap  upon  us,  and  that  to  the  respective 
charges  of  carelessness  and  ignorance  we  have  to  put  in 
the  plea  of  guilty. 

The  first  of  these  charges  is  not  diflBcult  to  prove.    If 
any  one  has  gratified  a  curiosity  to  fathom  the  myste- 
ries of  the  doctors*  hand- writing,  as  seen  in  the  books 
of  our  apothecaries,  he  must  be  struck  at  first  sight  with 
itB  illegibility.    The  page  of  such  a  volume  spread  out 
before  him,  looks  more  like  one  covered  with  the  cabal- 
istic tracings  of  some  astrologist,  than  the  production 
of  the  enUghtened  professional  man  of  the  nineteenth 
century.    If  he  has  the  time  and  patience  to  decipher 
some  names,  and  guess  at  the  rest,  as  he  must  of  neces- 
sity be  forced  to  do,  he  will  come  to  another  conclusion : 
that  the  doctor  is  withal  rather  an  ingenious  letter- 
former,  as  well  as  an  accomplished  abbreviator  of  sym- 
bols.    This  gratification  of  the  inventive  faculty  would 
be  innocent,  even  praiseworthy,  if  it  were  diverted  in 
a  somewhat  different  channel,  where  mistakes  in  guess- 
ing and  lack  of  a  special  genius  in  appreciating  are  not 
apt  to  be  attended  with  disagreeable,  if  not  dangerous 
results.     When  he  assumes  that  the  apothecary  is  a 
mere  person  to  obey  absolutely  his  directions,  and  that 
the  patient  is  supposed  to  take  with  unquestioned  con- 
fidence the  different  powerful  articles  that  may  be 


written  for,  he  should  at  least  he  careful  that  his  mean- 
ing is  clearly  understood.  We  have  no  right  to  throw 
any  extra  responsibility  upon  the  compounder  of  our 
receipts ;  and  it  is  more  than  we  have  reason  to  expect 
that  he  can  always  hit  the  mark,  notwithstanding  the 
almost  constant  practice  to  which  his  cleverness  is  sub- 
jected. 

The  carelessness  in,  writing  is  in  fact  one  of  the  main 
complaints  which  the  compounders  have  against  us ;  it 
is  justly  the  crying  evil  of  the  prescription-counter, 
and  there  is  every  reason  why  we  should  cause  it 
at  once  to  cease  One  of  these  gentlemen  told 
us  that  he  actually  dreaded  to  receive  some  of  the 
prescriptions  written  by  many  of  his  bad-writing 
patrons,  as  with  most  of  them  he  had  to  waste  much 
valuable  time  in  deciphering,  and  then  not  unfrequently 
was  compelled  to  keep  the  patient  waiting  while  he 
despatched  his  errand-boy,  that  he  might  obtain  from 
the  writer  himself  a  translation  of  the  important  docu- 
ment. This,  too,  was  ofl times  exceedingly  difficult  when 
the  tracings  were  over  an  hour  or  two  old.  In  this 
connection  he  informed  us  of  instances  in  which  the 
lives  of  patients  were  actually  saved  by  the  adoption 
of  such  a  course.  Is  it  not  fair  then  to  conclude  that 
he,  in  common  with  the  rest  of  his  fraternity,  had  just 
cause  for  complaint  ?  These  were  the  gentlemen  who 
were  in  the  habit  of  scrawling  the  receipts  with  very 
hard  lead  pencils  on  the  ends  of  brown  wrapping 
paper  and  the  leaves  of  old  books,  and  who  did  not 
seem  to  think  that  the  apothecary  had  the  right  to  ask 
anything  more  of  them. 

The  only  explanation  why  this  abuse  has  not  been 
remedied  is  perhaps  to  be  found  in  the  very  small  amount 
of  trouble  and  slight  increase  of  care  required  on  the 
part  of  the  writer.  If  physicians  generally  would  take  as 
much  pains  in  writing  their  prescriptions  as  in  figur- 
ing the  items  in  their  bills,  no  one  could  fail  to  under- 
stand what  was  meant 

There  is  no  necessity,  however,  of  enlarging  upon  this 
particular  point,  but  we  will  call  the  attention  of  those 
interested  to  other  faults  in  prescription-writing.  The 
first  has  reference  to  the  lack  of  a  sufficient  knowledge 
of  pharmacy  to  enable  us  at  all  times  to  make  scientific 
prescriptions.  The  majority  of  us  are  constantly  commit- 
ting these  mistakes,  and  are  day  by  day  laying  ourselves 
open  to  the  deservedly  severe  ridicule  of  our  druggists* 
The  foundation  of  all  this  ignorance  rests  upon  a  defec- 
tive medical  education,  such  as  is  carried  on  in  most  of 
our  medical  schools.  The  only  practical  familiarity 
which  tlie  students  receive  of  the  reactions  of  any  phar- 
maceutical article  is  the  writing  of  it  in  a  lecture  note- 
book, while  the  only  remembrance  is  centred  in  some 
bottle  containing  the  specimen  which  has  been  passed 
around  the  class.  The  whole  study  of  materia  medica, 
as  generally  carried  on,  is  a  mere  effort  of  memory ; 
and  it  is  not  remarkable  to  find  that  the  different  reac- 
tions, modes  of  combination,  etc.,  are  occasionally  for- 
gotten.   The  fact  that  oiu:  best  prescribera  are  those 

Digitized  by  VjjOOQIC 


422 


THE  MEDICAL  MECORD. 


who  have  some  time  during  their  pupilage  been  at 
work  in  the  prescription  department  of  some  shop, 
should  not  have  its  significance  lost  upon  those  who 
still  have  opportunities  for  simili^  improvement.  It  is 
only  the  occupation  of  some  such  position  in  earlier 
professional  life  that  can  safely  secure  the  practitioner 
against  the  repeated  occurrence  of  numerous  ridiculous 
and  annoying  blunders. 

But  there  is  another  point  connected  with  prescrip- 
tion writing  which  deserves  at  this  time  a  passing 
notice,  and  that  has  reference  not  only  to  the  correct- 
ness of  the  compounds  to  be  employed,  but  to  their 
elegance  and  inviting  taste.  This  is  truly  an  art  by 
itseli^  and  when  once  mastered  is  of  incalculable  value 
to  any  one  who  is  called  upon  to  treat  such  as  are  tor- 
mented with  tastes  that  are  fastidious.  The  great  objec- 
tion which  many  homoeopathic  patients  have  against  our 
system  of  practice  is  the  administration  of  our  nauseous 
draughts.  We  cannot  quarrel  with  these  people  for 
any  dislike  they  may  entertain  towards  many  of  our 
disagreeably  tasting  drugs ;  but  we  should  endeavor,  by 
skilful  combinations,  by  the  judicious  use  of  the  active 
principles  and  the  employment  of  concentrated  medi- 
cines, to  do  away  with  the  necessity  for  complaint. 
The  practitioner  who  can  contrive  to  give  a  small  dose 
which  shall  equal  in  power  a  larger  one,  and  at  the 
same  time  divest  it  of  any  objectionable  taste,  will  cer- 
tainly be  preferred  to  his  less  thoughtful  brother. 

There  is  another  light  in  which  this  matter  of  refinement 
in  prescriptions  can  be  viewed,  and  that  is  the  increased 
tolerance  of  those  remedies  which  are  made  more  or  less 
agreeable  to  the  palate.  Quinine,  cod-liver  oil,  many 
of  the  preparations  of  iron,  and  a  host  of  others  too 
numerous  to  mention,  can  be  administered  for  long 
periods  when  properly  combined  with  aromatics,  and 
the  like,  when  without  them  the  stomach  of  a  feeble 
patient  might  be  constantly  nauseated.  If  more  care 
were  taken  to  render  palatable  the  remedies  prescribed 
to  children,  there  would  be  less  repugnance  on  their 
part  to  the  very  name  of  medicine.  Let  a  child  take  a 
grain  of  quinine  in  a  simple  solution,  and  let  the  nurse 
choke  it  down  his  outraged  throat  by  dint  of  holding 
the  little  one's  nose,  and  by  other  little  tricks  which  these 
tender-hearted  females  know  so  well,  and  a  prejudice 
against  anything  in  the  shape  of  medicine  is  formed 
which  it  requires  years  to  eradicate.  The  same  may 
virtually  be  said  of  those  of  less  tender  years,  who  will, 
despite  their  best  intentions,  enter  their  natural  protest 
against  a  nauseous  compound. 

Many  of  us  do  not  appreciate  the  importance  of  pala- 
table mixtures,  and  not  a  few  refuse  to  believe  that 
pharmacy  is  incapable  of  dressing  up  the  most  noxious 
agents  in  the  guise  of  agreeable  and  even  tasty  com- 
pounds. There  is  nothing  in  science  that  forbids  its 
association  with  refinement ;  in  fact  the  customs  of  the 
present  day  demand  that  they  should  be  inseparable,  and 
the  physician  who  takes  the  hint  can  find  no  more  dif- 
ficulty in  keeping  his  patients  in  good  humor,  in  pre- 


venting the  formation  of  wry  faces,  and  in  saving  his 
medicines  many  hard  names,  than  he  has  in  the  majority 
of  cases  in  curing  the  sufferers  of  their  maladies. 

The  remarks  concerning  the  remissness  of  the  Board  of 
Health  which  we  have  recently  made,  we  are  happy  to 
inform  our  readers  were  founded  upon  a  misapprehen- 
sion of  the  facts  of  the  case.  Since  writing  them,  we 
have  received  a  letter  from  Dr.  Dalton,  the  Sanitary 
Superintendent,  which  presents  us  with  an  official  state- 
ment of  the  doings  of  that  Board,  and  which  most 
efiectually  explains  away  the  reasons  for  our  strictures. 
We  are  informed  that  the  Board  is  rtill  doing  its  whole 
work,  that  the  sanitary  inspectors  are  as  faithful  «i  the 
performance  of  their  duties  as  ever,  and  that  the 
reports  referring  to  the  existence  of  unabated  nuisances^ 
although  founded  on  fact,  are  really  unavoidable,  inas- 
much as  it  has  been  found  impossible,  on  account  of  the 
immense  number  of  complaints  on  hand,  to  attend  to 
them  with  that  despatch  that  is  desirable.  We  are  glad 
to  hear  this,  and  to  be  assured  that  we  have  been  in 
error  in  supposing  that  the  delays  were  due  to  any 
dereliction  on  the  part  of  the  inspectors,  but  rather  to 
circumstances  over  which  the  Board  itself  has  no  con- 
trol. We  shall  soon  take  occasion  to  refer  more  in  de- 
tail to  the  workings  of  this  body,  and  to  the  obstacles 
which  oppose  its  praiseworthy  efforts. 

We  have  been  compelled,  on  account  of  a  press  of  ma- 
terial, to  defer  to  the  next  niunber  an  interesting  lecture 
by  Prof.  Loomis,  and  an  elaborate  and  finished  article 
by  Prof  Joseph  Jones,  of  Nashville. 


Eeoie»0  aiilr  VLotxcts  of  Book». 


The  PHTsroLOGY  and  Pathology  op  the  Mixa  By 
Henry  MAimsLEY,  M.D.,  Lond.  D.  Appleton  <£;  Co.,  44S 
Broadway,  N.  Y.  1867.  8vo.,  pp.  442. 
This  very  important  work  treats  of  mental  phenomena 
from  a  physiological,  rather  than  a  metaphysical  point 
of  view,  and  brings  the  many  instructive  instances  pre- 
sented oy  the  unsound  mind  to  bear  upon  the  obscure 
problems  of  mental  science.  The  physiology  and  pathol- 
ogy of  the  mind  have,  indeed,  been  too  lone  di- 
vorced :  and  it  is  thne  some  effort  should  be  made  to 
reconcile  these  two  branches  of  science.  Metaphysical 
writers  have  gone  on  treating  mental  diseases  as  pure 
abstractions,  as  having  no  connection  with  the  organi- 
zation, as  if.  in  short,  they  belonged  to  a  science  which 
;  is  enth^ly  distinct  from  that  which  is  concerned  with 
the  sound  mind.  To  the  medical  profession,  chi^y,  be* 
longs  the  great  credit  of  exploring  and  discovering  the 
physical  conditions  of  mental  function,  and  the  relation 
of  the  phenomena  of  the  sound  and  the  unsound  mind. 
Notwitnostanding  the  great  advance  that  has  been  made 
in  modem  times  in  the  science  of  mind,  some  of  our 
teachers  of  mental  philosophy  still  inculcate  the  absurd 
doctrine,  that  we  are  acquainted  with  mind  and  body 
as  two  distinct  and  separate  entities,  as  if  they  were 
separate  subjects  of  investigation ;  either  not  connected 
at  all,  or  only  in  a  very  remote  and  unimportant  de- 
gree. Our  <dergy,  who  generldly  found  their  moral  and 
spiritual  inculcations  on  the  same  false  basiSy  Are  often 

Digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


42S 


horrified  at  the  sinfulness  of  a  sleepy  congregation,  who 
are  breathing  an  atmosphere  containing  fifty  per  cent,  of 
carbonic  acia.  They  talk  of  the  faculties  and  disposi- 
tions of  the  mind  ^without  the  slightest  apprehension 
apparently,  that  they  are  in  close  connection  with  the 
body.  A  perusal  of  the  memoirs  of  Edwards,  Payson, 
and  other  celebrated  divines,  who  speak  of  their 
yarying  moods,  dispositions,  and  feelings,  as  wholly 
influenced  by  supernatural  and  never  by  physical  in- 
fluences, must  satisfy  every  person  of  the  general  truth 
of  this  remark. 

How  often  must  the  fact  be  enforced,  that  the  human 
mind,  as  it  exists  in  this  world,  cannot,  by  itsdf^  become 
an  object  of  philosophical  investigation ;  that,  placed  in 
a  material  world,  it  cannot  act,  or  be  acted  on,  but 
through  the  medium  of  an  organic  apparatus?  The 
physician  sees  the  most  abundant  proof  on  every  hand, 
that  the  state  of  the  physical  organs  exerts  a  com- 
manding influence  over  the  mental  manifestations,  and 
he  needs  no  argument  but  daily  observation  to  satisfy 
him  that  no  system  of  mental  philosophy  is  entitled  to 
consideration  which  overlooks  or  denies  their  influence, 
and  treats  the  thinking  principle  as  a  disembodied  spirit. 
We  must  take  man  as  he  exists  in  this  world,  and  care- 
fully investigate  the  laws  which  regulate  the  connection 
between  the  organs  and  the  mind,  not  expecting  to  dis- 
cover the  essence  of  either,  or  the  manner  in  which 
they  are  united. 

'Hiis  work  of  Dr.  Maudsley  is  unquestionably  one  of 
the  ablest  and  most  important  on  the  subjects  of  which 
it  treats  that  has  ever  appeared,  and  does  infinite  credit 
to  his  philosophical  acumen  and  accurate  observation. 
No  one  has  ever  more  successfully  exhibited  the  dis- 
cordant results  of  metaphysical,  physiological,  and 
pathological  studies  of  mind,  or  demonstrated  more 
satisfactorily  the  uselessness  of  an  exclusive  method, 
or  the  pressing  need  of  combined  action,  and  of  a  more 
philosophical  mode  of  proceeding.  The  work  consists 
of  two  parts;  the  first  part,  resting  on  the  physiolo- 
grical  method  of  inquiry  into  mental  phenomena,  treats 
under  nine  different  chapters  of  "  The  Method  of  the 
Study  of  Mind ;"  of  "  The  Mind  and  the  Nervous  Sys- 
tem;" of  ''The  Spinal  Cord  and  Reflex  Action;"  of 
•*  The  Sensory  Centres  and  Sensation ;"  of  **  The  Su- 
preme Cerebral  Centres  and  Ideation ;"  "On  Emo- 
tion ;"  "  On  Volition ;"  "  On  Actuation ;''  and  «  On 
Memory  and  Imagination."  One  hundred  and  ninety- 
four  pa^es  are  devoted  to  the  discussion  of  these  sub- 
jects. Many  of  the  views  presented  are  similar  to  those 
laid  down  in  the  recent  writings  of  Herbert  Spencer, 
Dr.  Laycock.  and  Dr.  Carpenter,  and  with  which  the 
readers  of  tne  Rboobo  are  doubtless  more  or  less  fa- 
miliar. 

Our  limits,  however,  much  to  our  regret,  oblige  us  to 
pass  on  to  the  second  part  of  the  work,  which  treats 
of  the  pathology  of  mind^  under  the  following  heads  : 
**  On  the  Causes  of  Insanity  ;'*  "  On  the  Insanity  of 
Early  Life  ;"  "  On  the  Varieties  of  Insanity ;"  "  On 
the  Pathology  of  Insanity ;"  "On  the  Diagnosis  of  In- 
sani^ ;"  "  On  the  Prognosis  of  Insanity ;"  and  "  On 
the  Treatment  of  Insanity." 

In  regard  to  the  alleged  ca%t»e9  of  insanity,  we  have. 
-with  the  author,  always  considered  them  as  so  vague  ana 
general,  as  to  render  it  extremely  difficult  to  ascertain, 
-with  any  precision,  what  thev  really  are.  The  uncer- 
tainty springs  from  the  fact,  that  in  a  great  majority  of 
caaes  there  is  a  concurrence  of  conditions,  and  not 
o>ne  single  effective  cause.  All  the  conditions  which 
coBspire  to  the  production  of  an  effect  are  alike  causes, 
alike  a^nts ;  and  therefbre,  all  the  conditions,  whether 
in  the  individual  or  in  the  circmnstances  in  wnich  he  is 
placed,  which  in  a  givea  ease  eooperate  in  the  pro- 


duction of  disease,  must  alike  be  regarded  as  causes. 
Hence,  we  have  looked  upon  the  assigned  causes  of  in* 
sanity,  as  contained  in  the  annual  reports  of  our  super* 
intendents  of  Insane  Asylums,  as  not  only  worthless,  but 
worse  than  that,  false  and  deceptive.  They  would 
have  us  believe,  forsooth,  that  a  patient  has  become  in- 
sane from  grief,  from  anxiety,  vanity,  ambition,  religi- 
ous excitement,  despair,  etc.,  as  if  these,  frequently 
only  the  early  symptoms  of  mental  disease,  were  its 
true  and  real  causes  I  The  iact  is,  that  the  causation  of 
insanity  may  often  extend  over  a  lifetime,  and  its 
germs  are  latent  in  the  very  foundations  of  the  diar- 
acter,  the  final  outbreak  being  perhaps  only  the  ex* 
plosion  of  a  long  train  of  antecedent  preparationa 
There  are  successive  links  of  causation,  sometimes  trace- 
able, sometimes  not,  as  the  inevitable  consequence  of 
certain  antecedents;  it  is  palpably  absurd  to  assign 
mental  derangement  to  the  influence  of  any  single 
cause.  It  is  common  to  treat  of  the  causes  of  insanity 
as  physical  and  moral,  but  it  is  manifestly  impossible  to 
discriminate  them  with  any  tolerable  exactness.  The 
truth  is.  that  everj  moral  cause  operates  through  the 
physical  changes  which  it  produces,  and  in  the  great 
majority  of  cases  in  which  the  cause  is  considered  as 
moral,  there  is  something  in  the  physical  constitution 
by  the  cooperation  of  which  the  result  has  been  brought 
about 

Our  author  notices  one  fact  which  deserves  serious 
consideration,  and  which  is  as  applicable  to  our  own 
country  as  to  Great  Britain,  and  that  is,  the  large  in* 
crease  of  late  years  in  the  number  of  the  insane  who 
have  come  under  care  and  observation.  He  quotes  the 
Reports  of  the  Lunacy  Commissioners  to  show  that,  on 
the  1st  of  January,  1849,  there  were  14,560  patientg  in 
the  hospitals,  asylums,  and  licensed  houses  of  England 
and  Wales ;  that  six  years  afterwards,  on  the  1st  of 
January,  1855,  there  were  20,493  insane;  that  ten 
years  afterwards,  on  the  1st  January,  1865,  there  were 
29,425  insane  under  certificates ;  and  that  on  the  1st 
January,  1866,  the  number  had  risen  to  30,869 ;  thus 
showing  a  steady  increase  of  about  1,000  a  year,  in  the 
insane  population  of  England  and  Wales,  for  the  last 
17  years ;  an  increase  far  more  than  proportionate  to 
the  population.  From  the  best  statistics  we  can  gather, 
the  same  disproportionate  increase  of  the  insane  is  true 
as  regards  the  United  States ;  though  something  may 
be  due  to  the  large  number  of  cases  formerly  un- 
reported, but  which  more  stringent  legislation  has 
brought  under  observation,  and  to  the  larger  number  of 
insane,  especially  of  the  pauper  class,  who  are  now 
sent  to  asylums ;  and  lastly  to  the  prolongation  of  life 
in  those  who  have  been  brought  under  proper  care. 
Perhaps,  also,  more  people  are  now  thought  to  be  mad 
than  was  formerly  the  case.  Besides^  our  asylums  have 
become  so  palatial,  so  desirable  as  elegant  and  commo- 
dious residences,  that  they  are  not  only  resorted  to  bj 
those  who  are  not  insane,  but  continue  to  be  the  abodes 
of  many  after  they  have  recovered,  as  the  most  eligible 
resorts  anywhere  to  be  found.  In  fact,  fewer  persons 
proportionately,  are  now  discharged  from  our  asylums, 
either  by  death,  or  by  being  thought  to  have  recovered, 
than  formerly ;  hence,  one  reason  for  the  increase  in 
the  number  of  our  insane  hospitals. 

Passing  over  the  intermediate  subjects,  for  the  con- 
sideration of  which  we  have  no  space  left  in  our 
columns,  we  come,  lastly,  to  the  treatment  of  insanity, 
in  all  respects,  perhaps,  the  most  important  branch  of 
the  subject. 

We  affree  with  our  author,  that  in  no  other  disease 
are  the  difficulties  of  treatment  so  great  as  they  are  in 
insanity— difficulties,  not  only  appertaining  to  the  na^ 
ture  of  an  obscure  disease,  b«t  mcreased  and  multiplied 


424 


THE  MEDICAL  RECORD. 


by  the  social  prejudices  connected  with  it ;  by  the  fre- 
quent concealment  and  misrepresentation  on  the  part 
of  the  friends  of  a  patient  j  but,  also,  by  the  imsatis- 
factory  character  and  management  of  institutions  espe- 
cially established  for  the  reception  of  insane  persons, 
and  the  tendency  of  recent  lunacy  legislation  (we  refer 
particularly  to  the  legislation  of  our  own  countrjr), 
which  has  overlooked  the  great  class  of  the  chronic  in- 
sane, now  inmates  of  jails  and  alms-houses,  and  pro- 
vided only  for  acute  and  recent  cases.  We  may  say  of 
many  of  our  States,  as  of  England,  the  land  is  being 
covered  with  overcrowded  asylums,  to  which  it  is  de- 
signed that  the  great  mass  of  the  lunatic  population  shall 
be  consigned,  irrespective  of  circumstances  or  conditions, 
where  they  may  be  kept  safely  imprisoned  and  secluded 
from  the  public  eye,  lest  the  tender  sensibilities  of  friends 
and  relations  may  be  hurt,  or  their  feelings  disturb- 
ed. Once  there,  it  would  seem  that  the  whole  object 
was  accomplished,  for  there  is  little  if  any  inquiry 
ever  made,  whether  all  is  done  that  can  be  to  secure 
the  best  medical  treatment  of  those  who  are  curable,  or 
the  p^atest  comfort  of  those  who  are  incurable.  The 
persistence  with  which  the  superintendents  of  our  in- 
sane asylums  have  recently  opposed  the  separation  of 
acute  and  curable  cases  from  the  chronic  and  for  the 
most  part  incurable  cases,  shows,  we  regret  to  say,  a 
determination  to  resist  all  innovation,  however  desir- 
tbhy  and  however  beneficial  to  the  insane  it  may  prom- 
ise to  be,  and  however  supported  by  experience, 
reason,  or  weight  of  authority.  Very  slight  observa- 
tion must  satisfy  us  that  there  is  at  this  time,  and  in 
our  country,  a  public  jealousy  of  asylums  and  those 
who  superintend  them,  which  vnll  require  a  wise  and 
cautious  management  to  overcome.  The  cruelties  of 
former  years  yet  live  in  the  public  memory;  and 
though  to  be  rid,  at  any  cost,  of  the  oflfending  presence 
of  the  insane,  may  satisfy  the  false  views  and  perverted 
feelings  of  some,  yet  there  is  an  enlightened  public 
conscience,  and  a  right  moral  feeling  regarding  this  un- 
fortunate class,  which  will  hold  those  who  have  charge 
of  them  to  a  strict  personal  responsibility.  To  be 
called  a  lunatic,  is  too  often  equivalent  to  being  cut  off 
socially  from  all  humanity,  and  those  in  charge  of  asy- 
lums are  strongly  tempted  to  be  Satisfied  if  they  render 
their  establishments  secure  prisons  and  lock-ups.  In- 
discriminate sequestration  seems  to  embody  all  require- 
ments ;  and  all  treatment,  moral  and  physical,  ends  in 
proper  classification  I  Untold  evils  have  arisen  from 
the  assumption,  that  because  a  man  is  disturbed  in  his 
intellect,  he  must,  therefore,  be  shut  up  in  an  asylum ; 
whereas  the  true  principle  to  guide  our  practice  should 
be,  that  no  one,  sane  or  insane^  should  ever  he  entirely 
deprived  of  his  Uberty,  unless  for  his  own  protecUon^  or 
for  the  protection  of  society.  We  therefore  fully  agree 
with  our  author  in  saying  that,  instead  of  acting  on  the 
general  principle  of  confining  the  insane  in  asylums, 
and  making  the  particular  exceptions,  we  ought  to  act 
on  the  general  principle  of  depriving  no  one  of  his 
liberty,  and  of  then  making  the  numerous  exceptions 
which  will  undoubtedly  be  necessary  in  the  cases  of 
insane  persons,  as  in  the  cases  of  criminals.  We  con- 
fine the  insane,  not  as  criminals,  in  order  to  punish  or  re- 
form, but  to  cure  them,  and  to  protect  themselves  and 
society  against  their  violence.  Now,  no  one  will  deny 
that  tiiere  are  many  chronic  and  incurably  insane  per- 
sons, neither  dangerous  to  themselves  nor  others,  and 
who  are  able,  and  would  be  benefited  by  some  light 
bodily  labor,  who  are  at  present  closely  c  nfined  in  our 
lunatic  asylums,  and  who  ought,  by  every  consideration 
of  expediency  and  humanity,  to  be  at  large.  We  deny 
the  assumption,  so  persistently  acted  upon,  that  it  is  no 
inhumaaity  to  keep  them  shut  up  as  long  as  they  are 


insane.  Our  humane  legislation  in  New  York,  it  is 
true,  causes  their  removal  from  our  State  asylum  if  not 
benefited  or  cured  at  the  end  of  a  year,  to  those  well 
managed,  philanthropic  institutions,  ^unty  poor-houses 
and  jails,  where  they  genei'ally  remain  till  death  steps 
in  to  put  an  end  to  their  sufferings !  But  in  our  other 
asylums  they  seem  to  be  kept  because  they  have  been 
once  put  in — ^properly,  necessarily,  or  not ;  sometimes, 
we  fear,  because  it  is  thought  their  existence  should 
not  be  known  to  the  world ;  and  often  to  save  trouble, 
care,  or  expense !  If  the  principle  of  non-restraint  in 
asylums  is  so  admirable  and  beneficial  as  all  attest  it  to 
be,  how  vastly  more  beneficial  would  be  the  abolition 
of  the  restraint  of  asylums  themselves,  as  in  Belgium  ? 
Such  is  the  sage  suggestion  of  Dr.  Maudsley. 

In  the  statements  and  principles  above  laid  down,  we 
have  only  followed  in  the  steps  of  our  author,  who  has 
given  every  one  of  them  the  sanction  of  his  authority. 

It  is  not  proposed  by  Dr.  M.  to  leave  the  insane  not 
in  asylums  witnout  proper  care  and  control,  but  to  have 
them  provided  for  in  private  families,  as  in  Scotland 
and  Belgium.  No  one  can  properly  appreciate  the 
strength  of  the  passion  for  liberty  which  there  is  in  the 
human  breast,  even  in  the  insane ;  and  "  there  is  no 
one,"  says  our  author,  **  who  would  not  infinitely  pre* 
fer  a  garret  or  a  cellar  for  lodgings,  with  bread  and  water 
only  for  food,  than  to  be  clo3ied  in  purple  and  fine 
linen  and  to  fare  sumptuously  as  a  prisoner  every  day.*' 
A  slight  intercourse  with  the  insane  in  hospitals  must 
satisfy  one  that  all  the  comforts  they  have  in  their  cap- 
tivity, including  games  and  so-called  amusements,  are 
but  a  miserable  compensation  for  their  entire  loss  of 
liberty. 

Dr.  M.,  it  is  to  be  recollected,  has  himself  been  a  su- 
perintendent of  an  insane  asylum,  and  spe^s  from 
ample  experience  of  many  years.  He  thinks  the  dis- 
comforts of  these  institutions,  even  the  best,  are  not 
sufficiently  considered  ;  apart  from  the  imprisonment — 
especially  the  associations  which  the  insane  experience 
in  an  asylum  where  all  sorts  and  conditions  of  madness 
are  congregated  together,  harrowing  scenes  of  which 
they  are  unwilling  witnesses,  the  vulgar  tyranny  of 
ignorant  attendants,  which  is  unavoidable  in  large  asy- 
lums, and  the  thousand  other  unpreventable  miseries  of 
asylum  life — Dr.  M.  thinks  that  the  superintendents  of 
asylums  are  apt  to  be  blinded  to  the  demerits  of  the 
system,  and  in  the  pride  of  success  of  organization, 
classification,  etc.,  to  overlook  the  numerous  evils  in- 
separably connected  with  it. 

The  system  of  placing  the  pauper  insane  in  private 
families  in  Scotland  has  been  tried  for  several  years 
past,  as  shown  by  the  reports  of  the  Scotch  Deputy 
Commissioners  in  Lunacy,  and  has  proved  very  success- 
ful. A  few  years  ago,  it  is  stated!,  their  persons  were 
in  a  wretched  state,  neglected  and  ill-treated  in  many 
cases,  but  that  now  all  this  is  changed ;  that  by  the 
powerful  agency  of  official  instruction  and  inspection, 
systematically  exercised,  all  who  have  to  do  with  them 
have  been  penetrated  with  more  enlightened  views, 
and  the  condition  of  their  charges  has  accordingly  been 
immensely  improved,  and  now  leaves  little  or  nothing 
to  be  desired ;  and  what  has  been  done  in  Scotland  can  be 
done  here.  Besides,  the  experience  of  the  Scotch  Lunacy 
Board  shows  that  many  pauper  patients  are  well  taken 
care  of  in  private  dwellings  at  less  than  one-half  what 
the  cost  would  be  in  a  county  asylum.  The  condition 
of  the  numerous  insane  Chancery  patients  in  England, 
who  live  in  private  houses,  is  said  to  be  eminently  satis- 
factory, much  more  so  than  it  could  be  in  the  best  asy- 
lum, and  the  same  is  said  to  be  true  of  many  other 
single  patients  living  in  private  families ;  especially  in| 
the  villi^  of  Hanwell  and  its  neighborhood. 

digitized  by  ^ O"  J 


THE  MEDICAL  RECORD. 


425 


In  conclusion,  Dr.  M.  is  persuaded  that  future  pro- 
gress in  the  improvement  of  the  treatment  of  the  in- 
sane lies  in  the  direction  of  lessening  their  sequestra- 
tion and  increasing  their  liberty.  Sfany  chronic  in- 
sane, incurable  ana  harmless,  will  be  allowed  to  spend 
the  remaining  days  of  their  sorrowful  pilgrimage  in 
private  families,  having  the  comforts  of  family  life,  and 
the  priceless ,  blessing  of  the  utmost  freedom  that  is 
compatible  with  their  proper  care.  The  one  great  im- 
pediment to  this  reform  at  present  undoubtedly  lies  in 
the  public  ignorance,  the  increasing  fear,  arfd  the  selfish 
avoidance  of  insanity.  When  knowledge  is  gradually 
made  to  take  the  place  of  ignorance,  and  familiarity 
banishes  the  horror  bred  of  ignorance,  then  will  a 
kindly  feeling  of  sympathy  for  the  insane  unite  with  a 
just  recognition  of  their  own  interests,  on  the  part  of 
those  who  receive  them  into  their  bouses,  to  secure  for 
them  proper  accommodation  and  good  treatment ;  then 
alfio  will  asylums,  instead  of  being  vast  receptacles  for 
the  concealment  and  safe-keeping  of  lunatics,  acquire 
more  and  more  the  character  of  hospitals  for  the  insane, 
while  those  who  superintend  them,  being  able  to  give 
more  time  and  attention  to  the  scientific  study  of  in- 
sanity, and  to  the  means  of  its  treatment,  will  no  longer 
be  open  to  the  reproach  of  forgetting  their  character  as 
physicians,  and  degenerating  into  mere  house-stewards, 
&rmers,  or  secretaries. 

The  Physician's  Visiting  List  for  1868.  Phila  :  Lind- 
say <fe  BlakistOD. 

This  convenient  pocket  companion  at  once  commends 
itself  to  our  notice  for  its  simplicity  of  arrangement. 
The  publishers  have  exhibited  admirable  judgment  in 
the  omission  of  various  details,  which  tend  to  encum- 
ber rather  than  add  to  the  value  of  vade-mecums  of 
this  kind. 

Elements  op  Mbdical  Chemistry.  By  B.  Howard  Rakd, 
Prot  Chemistry  in  Jeflferaoa  Medical  College.  Phila.  : 
T.  Ell  wood  Zell  A  Co.     1866.     Pp.  399. 

The  volume  before  us  is  a  "  multum  in  parvo,"  and 
well  adapted  for  the  needs  of  the  medical  student. 
The  definitions  are  models  of  pith  and  brevity,  and  the 
book  as  a  whole  meets  with  our  approval^  especially 
for  the  happy  manner  in  which  general  prmciples  of 
chemistry,  as  applied  to  medicine,  are  discussed. 

Uicbo-Chbmistry  op  Poisons,  including  their  Physiological, 
Pathological,  and  Legal  Relations,  adapted  to  the  use  of 
the  Medical  Jurist,  Physician,  and  General  Chemist.    By 
Thbo.  a.  WoRMLEY,  M.D.,  Prof.  of  Chemistry  and  Toxi- 
cology iu  Starling  Medical  College,  and  of  Natural  Sciences 
in  Capital  University,  Columbus,  0.     With  78  Illustrations 
upon  SteeL     New  York :  Baillidre  Bros.     1867.    Pp.668. 
Thb  title  of  the  work  will  give  our  readers  a  fair  idea 
of  its  contents,  but  as  to  tne  nature  of  these  contents 
it  becomes  our  duty  to  speak.    The  volume  is  of  such 
a  size,  and  the  subjects  treated  of  so  numerous,  that  we 
cannot  in  the  space  allotted  us  give  it  a  full  review. 
Yet  we  hope  that  in  this  nece^arily  brief  notice  we 
ahall  do  it  that  justice  which  its  intrinsic  merit  de- 
serves. 

The  subject  of  poisons  will  always  be  an  interesting 
one  to  medical  men,  and  any  work  that  is  specially  cal- 
culated to  unravel  the  mysteries  which  hang  over  the 
commission  of  the  most  atrocious  of  all  crimes,  should 
be  and  will  be  held  in  special  esteem  as  a  positive  and 
important  addition  to  our  already  too  scanty  know- 
ledge of  toxicology.  The  unly  popular  works  that  we 
have  heretofore  had  upon  this  particular  department  of 
medical  science  have  been  those  of  Taylor  and  Chris- 
tiaon,  which  are  both  excellent  of  their  kind,  but  so 
far  do  they  fall  short  of  the  treatise  in  question,  as  re- 


gards its  particular  design,  that  hereafter  it  must  be 
considered  the  authority  in  the  English  lansruage.  With 
an  industry  that  has  been  unt'ring,  and  a  perseverance 
truly  remarkable,  the  author  gives  us  in  this  volume  the 
results  of  the  most  elaborate  and  careful  investigations 
into  the  nature  of  most  of  the  known  poisons,  bringing  to 
his  aid  the  microscope  to  help  him  beyond  the  sphere  of 
the  mere  analyst,  thus  enabling  him  to  discover  the 
existence  of  poison  in  the  100,000th  part  of  a  grain. 
While  he  gives  to  us  all  that  has  heretofore  been  known 
practically  concerning  the  detection  of  poisons,  mineral 
and  vegetable,  he  has  added  many  other  original  inves- 
tigations which,  considering  the  care  that  has  been 
tiien  in  carrying  them  out,  give  them  an  immense 
value,  and  stamp  them  rightly  with  the  unquestionable 
reliabihty  of  scientific  accuracy.  At  first  the  author 
tells  us  that  his  idea  was  merely  to  present  the  results 
of  his  studies  in  the  micro-chemistry  of  poisons  proper, 
but  wisely  reconsidering  his  original  intention,  he  has 
given  bes'des  a  more  or  less  complete  treatise  upon  toxi- 
cology proper,  embodying  under  each  appropriate  head, 
the  symptoms,  treatment,  post-mortem  appearances,  and 
reactions  of  the  different  poisons. 

In  the  appendix  we  have  some  seventy-eight  superb 
illustrations  upon  steel,  of  the  microscopical  appearance 
of  different  toxic  agents.  These  were  faithfully  traced 
by  the  skilful  hand  of  his  wife,  who,  for  the  sake  of 
doing  her  part  of  the  work,  studiously  set  about  to 
master  the  art  of  steel  engraving.  In  point  of  artistic 
finish  and  minuteness  of  detail,  we  have  never  seen  any- 
thing to  equal  these  truly  beautiful  plates,  the  excellen- 
ces of  most  of  which  are  only  appreciable  with  the 
aid  of  a  magnifying  lens.  As  a  reward  for  the  faithful 
performance  of  such  a  task,  the  author  has,  with  sin- 
gular good  taste,  dedicated  the  work  to  her  to  whom 
he  owes  so  mucn.  In  addition  to  this,  there  is  a  valu- 
able tabular  statement  of  the  reactions  of  the  different 
poisonous  alkaloids. 

The  great  value  which  this  work  will  possess  to  the 
medical  jurist,  the  toxicologist,  the  general  chemist,  and 
the  lawyer,  will  be  the  knowledge  that  it  has  been  pre- 
pared by  a  most  earnest  worker,  an  accurate  observer, 
a  practical  chemist,  and  a  skilful  microscopist,  for  such, 
at  least,  we  have  reason  to  judge  him  to  be  after  a 
careful  study  of  his  masterly  work. 

Chemistry.  By  William  Thomas  Bbandb,  D.C.L.,  P.R.S., 
L.  &  E.,  of  her  Majesty's  Mint,  Member  of  the  Senate  of 
the  University  of  London,  etc.,  eta ;  and  Alfred  Swaine 
Taylor,  M.D.,  F.R.S.,  Fellow  of  the  Royal  College  of 
Physicians  of  London,  and  Professor  of  Chemistry  and 
Medical  Jurisprudence  in  Guy's  Hospital.  2d  American 
Edition,  thoiooghly  Revised.  Phila. :  H.  C.  Lea.  1867. 
8vo.,  pp.  764. 

There  are  so  many  excellent  works  on  chemistry 
now  before  the  pubhc,  that  it  is  hard  to  say  which  one 
of  them  has  most  claims  for  favor.  The  one  before  us, 
which  is  the  joint  labor  of  two  of  the  greatest  minds  in 
Great  Britain,  can  most  certainly  demand  for  itself 
the  highest  rank  in  the  special  department  of  which 
it  treats.  Although  a  work  of  large  size,  being  an 
octavo  of  over  seven  hundred  pages,  it  is  filled  with 
such  subjects  as  are  useful  to  the  student  of  every- 
day chemistry,  or  to  the  practical  man  who  measures 
the  utility  of  every  scientific  fact  in  proportion  to  its 
capability  of  being  demonstrated.  In  other  words,  it 
is  calculated  in  our  opinion  to  give  to  the  medical  man 
the  broadest  possible  ground-work  for  the  study  of 
chemistry,  and  the  application  of  its  great  truths  to  the 
every-day  necessities  of  practical  life.  Nothing  more 
is  attempted,  and  nothing  more  is  needed,  in  a  woric 
specially  designed  for  medical  practitioners  and  stu- 


42e 


THE  MEDICAL  RECORD. 


dents.  The  very  rare  substonces  which  are  only  met 
with  in  the  laboratory  of  the  professor  or  the  cabinet 
of  the  amateur,  are  wisely  ruled  out,  and  their  places 
occupied  by  accounts  of  more  useful,  because  more 
common  substances.  The  work  has  been  thoroughly 
revised  by  ProC  Taylor,  upon  whom,  by  the  recent 
death  of  his  colleague,  the  whole  labor  has  necessarily 
fallen.  The  old  systems  of  nomenclature  are  adopted, 
and  eyerything  is  done  in  the  work  to  make  the  road, 
difficult  in  all  cases  to  the  acquisition  of  true  know- 
ledge, as  easy  and  as  gradual  as  possible. 

A  Tbeatisb  on  Emotional  Disorders  op  the  Sympathetic 
System  op  Nerves.  By  William  Muriuy,  M.D.,  M.R.C.P., 
Lend.,  Physician  to  the  Dispensary,  eta,  etc  New  York : 
A.  Simpson  <b  Oa  1867.  8vo.,  pp.  96. 
The  subject  treated  of  by  our  author  is  rather  a  novel 
one,  and  he  deserves,  at  least,  the  thanks  of  inedical 
practitioners  in  general  for  dressing  up  old  facts  in  new 
garbs,  and  explaining  by  a  very  plausible  theory  the 
relations  of  mind  to  matter.  He  charges,  with  a  fair 
show  of  reason,  most  of  the  mischief  in  the  shape  of 
morbid  emotions,  to  the  agency  of  the  great  sympa- 
thetic. His  remarks  upon  me  influence  of  emotion  in 
producing  disease  on  the  one  hand,  and  as  the  result  of 
disease  on  the  other,  are  not,  it  is  true,  very  new,  but 
they  are  of  so  practical  a  character,  and  the  facts  are  so 
suggestive  and  significant,  that  the  author,  it  seems  to 
us,  has  been  fully  justified  in  writing  such  a  book.  His 
stvle  is  concise,  pleasant  and  firank,  while  the  number 
of  illustrative  cases  that  are  scattered  through  the  hro- 
chure  seems  to  impress  indelibly  upon  the  minds  of  his 
readers  the  facts  he  wishes  to  bring  out.  We  are  sorry, 
however,  to  see  this  otherwise  excellent  book  marred  by 
such  a  number  of  typographical  errors,  showing  inex- 
cusable carelessness  in  proof-reading. 


€ontspov^tnct. 


THE  LIQUOR  ZINCI  CHLORIDI  IN  GONOR- 
RHCEA. 

To  THB  Editob  or  THX  Mkdioal  Bsoobd. 

Dear  Sir — I  am  not  quite  sure  that  I  understand  the 
ground  upon  which  my  good  firiend,  Dr.  Batchelder, 
takes  me  to  task  in  your  issue  of  October  16,  in  a  com- 
munication with  the  above  heading.  It  cannot  be  for 
the  reason  that  I  have  called  the  chloride  of  zinc  a 
caustic,  since  it  is  commonly  so  regarded,  and  not  to 
call  it  so  might  even  be  looked  upon  as  "  singular."  I 
suppose,  therefore,  that  Dr.  B.  refers  to  my  statement 
as  to  the  strength  of  the  solution  of  this  agent  which 
he  is  in  the  habit  of  using  in  the  treatment  o£ 
gonorrhoea,  especially  as  I  could  never  understand 
how  his  patients  always  got  well  under  so  strong  an 
injection  as  he  employs,  while  mine  often  could  not 
bear  it  at  alL  Since  this  matter  (not  puriform,  but 
merely  serous)  i$  not  personal  either  to  the  Doc- 
tor or  myself— for  I  could  never  have  any  personal 
difficulty  with  a  man  whom  to  know  is  to  honor  and 
respect — and  since  there  are  one  or  two  points  of  prac- 
tical interest  involved,  you  will  perhaps  allow  me 
•pace  for  a  brief  reply. 

The  statement  in  my  work  on  Venereal  Diseases,  to 
which  Dr.  Batchelder  takes  exception,  is  the  following  : 
"  Dr.  Batchelder  dissolves  3  ij.  of  the  chloride  (of  zinc) 
in  3  iii.  of  water,  and  directs  the  patient  to  commence 
with  three  drops  of  the  mixture  to  a  tablespoonful  of 
water,  and  inject  three  times  a  day ;  to  add  a  drop  at  a 
time  (rarely  exoeedioig  eight  drops)  until  a  smarting 


sensation  is  produced,  and  then  gradually  to  diminish 
the  strength  until  the  discharge  disappears."  This 
statement,  my  fi-iend  says,  is  "  a  most  singular  mistake 
or  misunderstanding  in  regard  to  my  (his)  use  of  the 
chloride  of  zinc" 

Now,  you  know,  one  naturally  does  not  like  to  be 
accused  -of  mistake  or  misunderstanding  when  one 
knows  he  is  right;  so  you  will  pardon  my  saying  that 
the  above  statement  was  written  down  one  evening, 
some  ten  years  ago,  directly  after  I  heard  it  from  Dr* 
B.'s  own  lips,  at  a  meeting  of  the  New  York  Medical 
Association,  when,  with  pleasure  and  profit,  we  younger 
members  used  to  listen  to  the  results  of  his  mature  ex- 
perience. This  very  note  is  now  before  me,  includii^ 
Dr.  B.'8  remarks  upon  the  treatment  of  bubo  by  his 
favorite  remedy,  compressed  sponge,  and  of  sw^led 
testicle  by  an  emetic  of  tartarized  antimony  and  the 
local  application  of  mercurial  ointment 

But,  fi-om  fear  that  some  will-o'-the-wisp  might 
have  transmogrified  my  notes  during  the  ten  years  they 
have  been  lying  on  my  shelf,  I  have  to-day  borrowed 
the  volume  of  records  of  the  New  York  Medical  Asso- 
ciation, from  the  present  Secretary,  my  friend  Dr.  A. 
E.  M.  Purdy,  and  I  find  there  abundant  testimony 
that  my  estimate  of  the  strength  of  the  solution  em- 
ployed by  Dr.  B.  is,  if  anything,  below  the  average 
statement  made  by  himself  in  several  communications 
to  the  society.  Thus,  at  the  session  of  February  11, 
1856,  when  the  treatment  of  gonorrhoea  was  under  dis- 
cussion. Dr.  B.  is 'reported  by  the  Secretary,  Dr. 
Learning,  as  saying  that  "  he  uses  the  chloride  of  ainc 
and  distilled  water  equal  parts,  and  eight  (8)  drops  of 
this  solution  to  an  ounce  of  water"  as  an  injection. 

But  this  evidence  is  superfluous,  since  Dr.  B.  confirms 
my  statement  in  the  very  communication  to  your  jour^ 
nal  in  which  he  calls  me  to  account;  with  tiiis  excep- 
tion, that  the  injection  he  now  uses,  viz.,  six  drops  of 
the  liq.  zinci  chloridi  to  the  ounce  of  water,  is  one- 
tenth  stronger  than  the  one  I  quoted! 

Several  years  ago,  at  my  request.  Prof.  P.  W.  Bed- 
ford, of  the  College  of  Pharmacy,  made  a  careful  esti- 
mate of  the  specific  gravity  and  number  of  grains  of 
the  chloride  in  each  fluid  drachm  of  the  lici.  zinci  chlo- 
ridi, for  ^e  purpose  of  fecilating  the  writing  of  pre- 
scriptions for  dilutions  of  this  fluid.  The  same  gentle- 
m'ln  has  made  a  similar  examination  of  a  solution  of 
two  drachms  of  the  cldoride  of  zinc  in  three  dradime 
of  water,  and  the  following  are  the  comparative  re- 
sults: 

"  The  liq.  zinci  chloridi,  as  sold  by  Dr.  Sonibb,  has 
the  sp.  gr.  1.56.  A  fluid  drachm  weighs  eighty-eight 
and  one-half  grains,  and  contains  forty-four  grains  of 
anhydrous  chloride  of  zinc.  Drops  are  totaUy  unr^ 
UahUj  and  may  vary  fix)m  one  hundred  and  fifty  to  fifty- 
eight  to  the  fluid  drachm ;  but  it  is  safe  to  estimate  them 
on  the  average  at  sixty-four  (the  result  of  tw«ity 
trials).  Hence  six  minims  or  six  drops  may  be  calcu- 
lated to  contain  four  and  four-tenths  grains. 

"  Again,  if  two  drachms  of  chloride  of  zinc  be  dis- 
solved in  three  drachms  of  water,  we  shall  have  a  so- 
lution measuring  three  and  three-fourths  fluid  drachma^ 
with  a  sp.  gr.  of  1.41.  Each  fluid  drachm  weighs 
eighty  grains,  and  contains  forty  grains,  or  every  six 
drops  four  grains,  of  anhydrous  chloride  of  zinc.  Henee 
this  solution  is  one-tenth  weaker  than  the  liq.  xinci 
chloridi." 

When,  therefore,  my  venerable  friend  says  that  bit 
"  injection  in  gonorrhoea  is  simply  six  drops  of  the  liqiiar 
zinci  chloridi  to  an  ounce  of  water,"  he  simply  sa^  that 
his  injection  is  one-tenth  stronger  than  if  he  used  thre* 
drops  of  a  solution  consisting  of  zinci  chloridi  3  ij.  and 
aquas  3  iij.,  to  half  an  ounce  of  water.  Q.  £.  D. 
Digitized  by  VjOO^  ^  _ 


THE  MEDICAL  RECORD. 


427 


Mr.  Milton,  who  appears  to  have  tested  the  efficacy 
of  various  caustics  and  astringents  in  the  treat- 
ment of  gonorrhoea  with  a  great  deal  of  care, 
assigns  to  the  chloride  of  zinc  a  position  inferior 
to  that  of  the  sulphate  and  acetate;  and  such, 
as  a  general  rule,  has  been  my  own  experi- 
ence, although  in  some  exceptional  cases  the  chloride 
win  succeed  when  the  sulphate  and  acetate  fail.  I  have 
not  usually  been  able,  however,  to  use  so  strong  a  solu- 
tion as  that  recommended  by  Dr.  Batchelder. 

In  closing,  I  would  merely  call  attention  to  the  un- 
certainty and  inaccuracy  of  prescribiqg  drops  instead 
of  minims. 

Tery  truly  yours, 

F.  J.  BUUSTIAD. 
1«  West  Twenty-third  street,  Oct.  22, 1867. 


THE  COLLEGE  COMMENCEMENTS,  PHILA- 
DELPHIA.— THE  PHYSICIANS  AND  APO- 
THECARIES. 

(from  our  own  correspondent.) 
To  m  Editob  or  rmt  IIxdioal  Rboobd. 

Sm — On  Monday,  14th  ult,  the  sessions  began  in  the 
medical  colleges  of  this  city.  At  noon  the  introductory 
at  the  University  of  Pennsylvania  was  delivered  l^ 
Prof.  Lbidt  in  a  brief,  practical  address,  detailing  the 
method  of  tuition  pursued  at  the  institution,  and  giving 
the  students  some  excellent  suggestions  as  to  the  manner 
of  study.  The  importance  of  attendance  upon  clinical 
instruction  was  pointed  out,  and  the  advantages  of  an 
acquaintance  with  French  and  German  were  promi- 
nently set  forth.  At  half-past  seven  in  the  evening,  the 
general  introductory  at  the  Jefferson  Medical  College 
was  delivered  by  Prof.  Gross.  This  was  anything  but 
a  brief  address,  but  the  subject  selected  was  one  so  ex- 
tensive as  to  preclude  the  possibility  of  brevity  in  doing 
it  justice.  The  changes  which  had  taken  place  in  prac- 
tice, and  the  improvements  which  had  been  made  in  the 
science  and  art  of  medicine  sinoe  the  lecturer's  first  en- 
trance into  the  profession,  and  embracing  a  period  of 
forty  years,  was  the  main  subject  presented.  The 
audience  upon  each  occasion  was  very  large,  and  at  the 
more  convenient  evening  hour  the  room  was  literally 
packed,  numbers  standing  at  the  entrance  for  whom  there 
was  no  accommodation  inside.  It  is  impossible  to  judge 
from  the  attendance  upon  an  introductory  of  the  num- 
ber of  students  present  in  regular  attendance,  as  mem- 
bers of  both  classes  attend  indiscriminately,  as  well  as 
graduates  and  friends  of  the  institution.  It  is  believed, 
however,  that  the  classes  are  fully  equal  to  the  numbers 
of  last  year. 

The  subject  of  the  reciprocal  duties  between  phjrsicians 
and  apothecaries  was  discussed  at  several  meetings  of  one 
of  our  medical  societies,  previous  to  their  annual  ad- 
journment over  the  summer  months,  and  it  is  again  re- 
ceiving considerable  attention.     Many  giievances,  on 
the  part  of  a  certain  class  of  apothecaries  in  this  city, 
have  been  gradual ly.accumillating  for  years,  until  at 
length  physicians  are  compelled  to  concert  some  mea- 
sures or  relief  for  their  own  protection.    An  indisposition 
to  move  actively  in  the  affair,  and  a  dislike  to  be  the  first 
one  to  make  the  movement,  has  long  held  each  one 
back,  but  the  matter  is  now  being  discussed  in  earnest, 
and  it  is  to  be  hoped  that  the  result  will  be  satisfactory. 
It  is  not  only  that  apothecaries'  stores  have  become,  m 
.  m«nj  instances,  degraded  into  confectionery,  stationery, 
perfumery,  and  dram  shops,  but  that  the  proprietors  of 
these  establishments  are  taking  upon  themselves  certain 
functions  of  the  physician  which  were  not  surrendered 
to  them  when  he  abandoned  the  preparation  of  his  own 


prescriptions.  Such  are,  prescribing  for  the  sick  and 
thereby  diverting  from  the  physician  a  portion  of  his 
livelihood ;  the  substitution  of  one  ingredient  for  ano- 
ther in  putting  up  prescriptions ;  the  criticism  of  pre- 
scriptions before  patients ;  the  appropriation  of  the  for- 
mula of  a  physician,  and  the  vending  of  the  remedy, 
either  privately  or  by  advertisement,  as  a  proprietary 
medicine.  These,  and  other  abuses,  as  the  exposal  for 
sale  of  such  remedies;  the  renewal  of  prescriptions 
against  the  wish  of  the  prescriber;  the  recommendation 
of  one  physician  to  the  detriment  of  another  who  is  in 
attendance  upon  the  cas%  eta,  are  calling  for  some 
method  which  shall  remedy  the  evils  complained  oC 
One  plan  strongly  nrced,  is  to  patronize  only  such  apo- 
thecaries as  restrict  their  business  to  the  compounding 
of  prescriptions  and  sale  of  drugs.  There  are  a  number 
of  trustworthy  pharmaceutists  who  are  at  present  cona- 
pelled,  by  the  press  of  competition,  to  offer  for  sale  certaiu 
family  medicines,  and  perhaps  otherwise  transgiess  their 
proper  limits,  who,  if  assured  of  the  support  of  practi- 
tioners, are  willing  at  once  to  abandon  wl  the  practices 
complained  of.  It  is  therefore  recommended  by  some 
physicians  that  such  concerted  action  be  made  general, 
and  that  every  prescribing  apothecary  be  prosecuted  for 
practising  without  a  Ucense,  and  that  all  apothecaries 
vending  secret  remedies  or  quack  medicines  be  declared 
unworthyof  confidence  in  the  compounding  of  prescrip- 
tions. Whether  anything  will  be  done  remains  to  be 
seen.  Physicians  have  it  in  their  power  to  correct  these 
abuses  if  they  will  act  together,  and  the  best  method  of 
doing  so  is  to  make  up  their  minds  to  direct  their  pa- 
tients to  such  pharmaceutists  only  as  confine  themselves 
to  a  legitimate  prescription  business.  Should  any  action 
be  takeu  by  the  society  which  is  now  agitating  the 
matter,  they  will  doubtless  invite  the  cooperation  of  the 
other  medical  societies  and  the  profession  at  large  in  the 
city.  If  anything  definite  is  determined  upon  I  will  in- 
form your  readers  of  it.  unless,  indeed,  some  objection 
to  publicity  be  made,  which  is  not  unlikely  to  occur. 
Yours  truly,  C.  J. 

Philadelphia,  Nor.  1, 1867. 


CREASOTE  FOR  BURNS. 

To  THB  Editor  or  thb  Medical  Bsoobp. 

Sir — We  are  surprised  to  find  creasote  as  an  applica- 
tion for  bums  referred  to  in  several  of  the  journals  as  a 
new  thing.  It  has,  for  several  years,  been  so  generally 
and  successfully  used  in  this  city,  both  in  hospital  and 
private  practice,  that  we  supposed  its  value  was  more 
extensively  known.  If  we  were  mistaken,  let  ns  add  our 
testimony  to  its  merit.  We  dilute  the  creasote  with 
water  till  the  mixture  has  but  slight  milkiness  remain- 
ing; or,  to  be  more  exact,  Q.  Creasoti  3iij.;  aquas 
font.  Oj.,  M.  In  dressing  bums  it  is  of  great  importance 
to  the  patient's  comfort  that  the  strips  of  old  linen  or 
cotton,  by  means  of  which  the  application  is  made, 
should  not  be  m<»e  than  two  inches  wide—- that  they 
may  be  renewed  successively  without  disturbing  a  large 
surface  at  onoe.    Yours  truly, 

J.  H.  HoBABT  Burgs. 

60  Court  Street,  Brooklyn. 

A  Theory  regardino  thr  Cause  of  Phosphores- 
cence.— A  French  savant  has  propounded  the  theory 
that  pho^horescence  is  due  to  the  emission  of  light 
previously  absorbed.  He  finds  that  porous  substances 
that  have  been  exposed  to  light  have  a  decomposing 
action  on  salts  of  silver,  when  placed  in  contact  with 
them  in  the  dark.  ^<^  j 

Digitized  by  VjOOQIC 


428 


THE  MEDICAL  RECORD. 


Utw  3mtxnmtrdsi. 


A    NEW  PESSARY. 
By  M.  S.  buttles,  M.D., 

ADJUNCT  TO  CnAIB  OF  OB8TETRI0S,  AWD  PRKLIITTXART  LKOTTTRSR  Olf 
OTM JBOOLOOY,  IN  UNIVKRSITT  MBDIOAL  OOLLROB,  HRW  TORK. 

In  the  Medical  Record  of  August  1,  1867,  mention 
is  made  of  a  pessary  exhibited  by  me  at  a  meeting  of 
the  East  River  Medical  Association. 

Since  then  I  have  been  so^equently  interrogated  by 
members  of  the  profession  (some  having  very  erroneous 
and  almost  ludicrous  ideas)  in  regard  to  its  use,  that  I 
have  thought  it  best  to  make  known,  in  a  few  words, 
some  of  the  advantages  of  this  instrument,  with  direc- 
tions when  and  how  it  is  to  be  used.  In  the  first  place 
we  wish  to  state  that  we  do  not  make  the  subject  of 
pessaries  our  hobby,  and  ride  it  to  death ;  but  that  they 
are  sometimes  of  use,  no  enlightened  physician  will 
pretend  to  deny. 

Recognizing  the  principle  that  the  utenis  is  mainly 
supported  by  the  vagina  and  muscular  tissues  of  the 
pelvis,  it  is  easy  to  see  why  a  foreign  body  introduced 
into  the  vagpna  ought  to  be  supported  in  the  same  way. 
The  uterus  is  a  cone  with  the  apex  down:  the  contrac- 
tility of  muscular  tissue  and  coaptation  or  the  soft  parts 
tend  to  slide  the  uterus  up  in  the  pelvic  cavity ;  should 
the  base  of  the  cone  be  placed  down,  the  same  cause 
would  very  soon  force  the  organ  into  the  external 
world. 

It  is  upon  this  principle  that  we  have  constructed  the 
"conical  pessary.  It  is  made  of  hard  rubber,  and 
may  be  bent  to  any  curve  by  simply  oiling  and  passing 
through  a  flame  until  it  becomes  softened. 


Fio.  1. 


Fio.  8. 


The  accompanying  cuts  will  convey  an  idea  of  its 
shape  better  than  I  can  explain.  Figure  1  represents  a 
front  view,  whi'e  figure  2  shows  its  relation  to  the  uterus 
in  cases  or  prolapsus,  retroversion,  and  retroflexion,  the 
base  being  m  the  posterior  vaginal  cul-de-sac.  In  cases 
of  anterior  displacements,  the  base  of  the  instrument 
should  be  placed  anterior  to  the  cervix  uteri,  and  in  all 
cases  the  apex  should  float  loosely  in  the  vagina  (some- 
times being  visible  at  the  vulva)  so  as  to  participate  in 
the  downward  movement  of  the  uterus  when  the  pa- 
tient coughs  or  strains. 

It  is  a  great  mistake  to  attempt  the  support  of  the 
uterus  by  a  dead  pressure,  especially  if  there  exists  the 
least  inflammation  or  irritability  of  the  organ.  There 
is  nothing  like  nature's  support — the  soft  parts. 

We  have  been  informed  of  a  case  where  the  instru- 
ment was  introduced  with  benefit  by  placing  the  apex 
in  the  posterior  ctd-desac.  and  the  base  against  the  in- 
ner surface  of  the  ascending  rami  of  the^pubes.  This 
vas  done  by  a  very  highly  educated  physician  of  this 


city,  who  has  attained  considerable  eminence  as  a  gyn^s- 
cologist,  and  one  for  whose  judgment  we  have  the  most 
profound  respect 

If  the  instrument  is  introduced  in  tliis  way  it  doeg 
not  act  on  the  principle  upon  which  it  was  constructed, 
and  falls  short  of  what  is  designed. 

What  we  claim  for  this  pessary  is,  that  it  brings  into 
play  the  natural  supports  of  the  ut  jrus,  and  can  be  worn 
by  the  patient  when  other  instruments  cannot ;  that  it 
is  more  efieotual  in  keeping  the  organ  in  situ;  that 
where  congestion  and  irritability  exist  as  the  result  of 
displacements,  it  is  not  always  necessary  to  treat  the 
uterus  before  introducing  it,  and  removing  the  cause. 

It  may  be  used  with  great  benefit  in  the  anterior 
displacements;  but  experience  shows  that  it  is  more 
effectual  in  cases  of  prolapsus,  and  eminently  so  in  pos- 
terior displacements. 

In  justice  to  our  friend.  Dr.  James  E.  Steel,  we  will 
state,  that  while  conversing  with  him,  some  two  years 
ago,  we  gained  an  idea  which  contributed  in  a  measure 
to  the  result  of  this  invention. 


Um  ipubltcationa. 


The  Physician's  Handbook  fob  1868.  By  William  Elmeb, 
M.D.  N.  Y.:  W.  A.  Townsend  &  Adams,  1863. 

Hysteria,  bto.  Six  Lectures  delivered  to  the  Students  of  St. 

Bartholomew's  Hospital,  1866.  By  F.  C.  Skky,  F.RS.,  Era 

N.  Y.:  A.  Simpson  &  Co.,  1867. 
Lbcturbs  on   Diseases  of  Wombn.    By  Charles  West, 

M.D..  Fellow  Royal  College  of   Physiciann,  eic    Third 

American  from  third  and  revised  English  Edition.    Phila* 

delphia:  K  C.  Lea,  1867. 


^eliical  3tem«  anli  Urns. 


Address  before  Alumni  of  University. — Professor 
George  T.  Elliot  will  deliver  an  address  before  the 
Alumni  of  the  Medical  Department  of  the  University, 
on  Friday  evening  the  22d  inst,  at  8  o'clock,  in  the 
large  chapel  of  the  University  on  Washington  square. 
The  profession  generally  are  invited. 

The  "  Howard  Ambulance.'* — A  recent  letter  from 
Baron  Larrey  announces  the  awarding  of  the  silver 
medal  to  Dr.  Benjamin  Howard,  of  this  city,  by  a  unan- 
imous vote  of  the  International  Ooimcil,  and  requests 
drawings  and  descriptions,  which  may  be  laid  before  the 
Academy  and  the  Army  Medical  Boards  by  the  Inspeo 
tor-in-Ohief  of  the  Medical  Deparment  of  the  armies  of 
France. 

Long  Island  Collsqe  Hospital. — Prof.  Jos.  C.  Hutch- 
ison has  resigned  the  chair  of  Surgery,  and  Prof.  E.  N. 
Chapman  that  of  Obstetrics,  in  the  Long  Island  College 
Hospital. 

Surgeons  to  the  Queen. — Sir  W.  Fergusson  has  re- 
cently been  appointed  Sergeant  Surgeon  to  the  Queen, 
and  Mr.  Paget,  Sergeant  Surgeon  extraordinary. 

Assistant-Surgeon  Jajies  M.  Flint,  U.  S.  N.,  has 
been  detached  from  the  Pensacola,  and  is  waiting  orders. 

Dr.  Marion  Sims  has  been  honored  by  the  King  of 
Italy  with  the  title  and  insignia  of  Knight  of  the  Order 
of  St.  Maurice  and  St.  Lazarus.  He  is  now  also  Com- 
mander first-class  of  the  Order  of  Isabella  la  Catholique. 

Dr.  Alfred  0.  Treat  has  sailed  from  New  York  via 
California  as  missionary-physician  to  Pekin,  China. 

Dr.  Levi  Folsom  died  in  this  city,  October  25,  ult, 
aged  sixty-four  years,  ten  month&^^d  twelT^e  days. 

Digitized  by  VjOOQ  IC 


THE  MEDICAL  RECORD. 


429 


Recent  Appointments  in  the  U.  S.  Akmt  Medical 
Department. — Drs.  Samuel  H.  Orton,  A.  B.  Campbell, 
John  N.  Randall,  W.  J.  Wilson  Jenkins,  A.  FitzgerdJ, 
Peter  MofiFat,  Charles  Styer,  Joseph  H.  T.  King,  Joseph 
K.  Corson,  Alfred  Delano,  W.  H.  H.  Michler,  Daniel 
Weisel,  and  Peter  J.  A.  Cleary. 

Dr.  D.  Tilden  Brown  has  been  appointed  Professor 
of  Psychological  Medicine  and  Medical  Jurisprudence 
in  the  College  of  Physicians  and  Surgeons  in  this  city. 
Dr.  Thomas  N.  Q-ettt.  Brevet  Lieut.-Colonel, 
IT.  S.  A.,  Post  Surgeon  at  Fort  McHenry,  Md.,  died, 
aged  about  fifty  years,  on  Oct  30th,  ult^  His  original 
commission  as  Asst-Surgeon  bears  date  Nov.  23,  1849. 
Until  within  a  short  time  since,  Dr.  Getty  filled  the 
position  of  Medical  Director  of  the  Department  of  the 
South. 

Dr.  E.  M.  Shaw,  also  of  the  army,  was  killed  in  an 
attack  by  Indians  upon  a  stage  near  Soda  Lake,  Ari- 
zona^ October  17th,  ult. 

Dr.  John  M'Greoor,  late  surgeon  in  a  Connecticut 
regiment,  and  recently  of  Thompson,  Connecticut,  was 
thrown  from  his  carriage  on  the  afternoon  of  Nov.  4th, 
nit.,  on  Dyer  Street,  Providence,  R.  I.,  in  consequence 
of  a  collision  with  a  freight  car  drawn  by  horses.  He 
was  run  over,  and  sustained  a  comminuted  fracture  of 
the  left  arm,  which  necessitated  amputation  at  the 
shoulder-joint.  He  died  within  three  hours  after  the 
accident. 

Death  or  John  D.  Murphy,  Passed  Asst.-Surgeon, 
U.S  JN. — A  telegram  has  been  received,  announcing  the 
deathofPa<5sedAsst. -Surgeon  John  D.  Murphy,  U.S.N., 
at  Pensacola,  Pla.,  of  yellow  fever.  Surgeon  Murphy 
entered  the  United  States  service  November  5,  1861, 
and  was  promoted  to  Passed  Asst.-Surgeon,  January  24, 
1862,  being  at  the  time  of  his  death  the  first  for  pro- 
motion to  full  Surgeon.  During  the  war.  Dr.  Murphy 
saw  much  active  service,  being  present  at  the  following 
engagements :  Passage  of  Forts  Jackson  and  St.  Philip 
and  capture  of  the  Ohalmette  batteries  below  New  Or- 
leans, April,  1862 ;  first  attack  on  Vicksburg,  June  28, 
1862 ;  encounter  with  the  rebel  ram  Arkansas^  July  15, 
1862 ;  siege  and  capture  of  Port  Hudson,  during 
which  Dr.  Murphy  was  on  shore  with  the  battery  of 
nine  inch  guns  from  the  Richmond  ;  skirmish  at  Missis- 
sippi City,  March  8, 1862 ;  both  attacks  on  Fort  Fisher, 
nT  C.  Dr.  Murphy  was  ordered  from  the  naval  hos- 
pital, N.  Y.,  in  the  early  part  of  the  present  year  to 
duty  at  Pensacola,  where  his  duties  nave  for  a  long 
time  compelled  him  to  battle  with  the  epidemic  to 
which  he  finally  succumbed.  Dr.  Murphy  stood  well 
in  his  profession,  and  his  death  will  be  deeply  felt  by 
his  friends  and  the  service  generally. — Army  and  Navy 
Journal,  Nov.  2.     [Dr.  M.  died  Oct.  23d  ult.— Ed.] 

The  New  German  Hospital  now  being  built  in 
Seventy-sixth  street,  this  city,  has  realized  quite  a 
handsome  sum — the  proceeds  of  a  vocal  and  instrumental 
concert  at  Woshington  Hall,  Morrisania,  N.  Y.  This 
institution  is  still  somewhat  crippled  for  means,  and 
eminently  deserves  a  recognition  of  its  claims  upon  the 
public. 

Ports  Declared  Infected. — The  MetropoUtan  Board 
of  Health  has  adopted  a  form  of  proclamation  de- 
claring the  following  Southern  ports  infected  until  Nov. 
21st:  Galveston,  Lavacca,  Corpus  Christi,  Indianola, 
New  Orleans,  Mobile,  Key  West,  Pensacola,  and  St. 
Augustine. 

Disappearance  of  the  Cholera  from  Palermo. — 
Our  Consul  at  Palermo,  under  date  of  October  1,  says : 
The  cholera  epidemic  has  entirely  ceased  in  this 
to'vrDf  there  having  been  no  new  cases  since  the  22d  of 


September  last  For  the  past  six  days  the  health  offi- 
cers have  issued  clean  bills  of  health.  The  actual  num  - 
her  of  deaths  during  the  epidemic,  as  well  as  I  have 
been  able  to  ascertain,  was  4,776  in  the  city  proper, 
and  some  700  or  800  in  the  neighboring  villages.  Busi- 
ness is  slowly  reviving. 

Darwin's  Theory  or  the  Animal  Scale. — Professor 
Bischoflf,  of  Munich,  has  recently  received  numerous 
skulls  of  orang-outang,  chimpanzee,  and  gorilla,  and 
comes  to  the  conclusion  that  Darwin  has  failed  to 
prove  the  ascent  of  man  from  the  monkey. 

A  LmERAL  Londoner. — A  wealthy  Londoner,  name 
not  mentioned,  has  given  £250,000  for  the  erection  of 
a  convalescent  hospital  in  London. 

Doctors  Connected  with  the  Public  Pres^  — 
Twenty-five  doctors,  all  of  whom  have  some  time 
practised  medicine,  are  at  present  responsibly  connected 
with  the  New  York  press. 

Population  of  Great  Britain. — ^Q-reat  Britain  now 
contains  thirty  millions  of  people,  an  increase  of 
two  and  a  half  millions  since  1852,  and  during  the 
time  she  has  furnished  three  millions  of  emigrants 
to  this  country,  Australia,  and  other  parts  of  the  globe. 
During  the  last  fifteen  years,  Ireland  has  decreased  in 
population  nearly  eight  hundred  thousand. 

Among  oi;r  French  exchanges  is  a  new  medical  jour- 
nal which  has  recently  appeared  at  Paris,  and  is  edited 
by  Professor  Piorry.  This  new  medical  periodical  bears 
the  name  of  the  Evinement  MMcal,  and  is  decidedly 
an  event  in  the  scientific  periodical  literature  of  the 
day.  Professor  Piorry  has  at  present  attained  to  an  ad- 
vanced age  in  years  and  in  the  memory  of  the  profes- 
sion. His  skilled  diagnosis  in  the  clinical  wards  of  his 
hospital,  his  lucid  expositions  of  obscurely  revealed 
symptoms  of  the  most  perplexing  forms  of  disease,  have 
rendered  him  preeminently  distinguished  as  a  diagnos- 
tician. His  name  will  live  in  history  associated  with 
the  names  of  Auenbrugger  and  Corvisart,  and  as  hav- 
ing contributed  largely  in  practical  benefits  to  our 
knowledge  of  the  pathology  of  the  interior  organs  of 
the  body.  We  sincerely  and  most  cordially  greet  the 
appearance  of  this  new  journal  The  learned  professor 
is  a  candidate  for  one  of  the  vacant  places  left  by  the 
death  of  Rayer  and  Velpeau.  Bonne  chance  ^  Tauteur 
de  "  Dieu,  I'Ame  et  la  Nature." 

New  York  Society  for  the  Relief  or  the  Ruptured 
and  Crippled. — During  the  month  of  August  last,  five 
lots  of  ground  (125  by  100  feet)  have  been  purchased,  on 
the  northwest  corner  of  Lexington  avenue  and  Forty- 
second  street,  for  the  purpose  of  erecting  thereon  a  hospi- 
tal for  the  sui^cal  treatment,  and  education  whilst  under 
treatment,  of  crippled  children — many  of  whom  will  be 
detained  three  or  more  years  for  cure.  There  will  also 
be  a  department  for  the  treatment  of  out-patients,  fur- 
nishing them  with  surgico-mechanical  appliances,  and 
keeping  the  apparatus  in  repair  whilst  under  treatment. 
All  this  will  be  free  of  charge  to  the  indigent ;  and  to 
those  able  to  pay,  a  charge  will  be  made  to  meet  tJheir 
circumstances  when  so  desired.  The  amount  received 
from  patients  is  handed  to  the  Treasurer  of  the  Society, 
and  contributes  to  the  support  of  the  Institution. 

In  our  present  very  limited  sphere  the  labors  have 
been  as  follows : 

The  number  of  patients  treated  the  first  year  was 
828 ;  the  second  year  965,  showing  an  increase  of  six- 
teen per  cent. ;  the  third  year  the  patients  numbered 
1,489,  or  an  increase  of  fifty-four  per  cent,  j  and  during 
the  fourth  year,  ending  May  1st,  there  were  1,684  cases, 
which  is  equivalent  to  thirteen  per  cent ;  ai^d  the  whale 

digitized  by  VjOOQ IC 


430 


THE  MEDICAL  RECORD. 


number  who  had  received  the  benefits  of  the  Institu- 
tion up  to  that  period  was  4,966. 

These  figures  are  important  amd  significant  They 
show,  that  as  the  Society  grew  in  public  knowledge  and 
fkvor,  there  was  a  large  and  rapid  increase  of  cases.  In 
the  fourth  year,  however,  the  increase  was  only  thirteen 
per  cent,  over  the  preceding.  This  was  not  owing  to 
a  paucity  of  cases,  for  of  these  there  was  a  steady  in- 
crease, but  to  the  Society's  inability  to  receive  or  treat 
a  greater  number  without  enlarged  means  and  accom- 
modations.— Exiractfrom  Remarks  ofDr,  James  Knight 
at  the  CoUation  of  the  iV.  F.  County  Medical  Society. 

Death  Statistios  of  the  Sexes. — In  a  paper  by 
Mr.  W.  L.  Sargant,  on  the  vital  statistics  of  Birming- 
ham and  seven  other  large  towns  in  England,  results 
are  arrived  at  different  in  some  respects  from  those 
commonly  received.  Thus,  whilst  admitting  that  there 
are  more  male  deaths  on  the  whole  than  female,  the  au- 
thor states  that  "  in  the  first  five  years  of  life  there  is  a 
large  excess  of  male  deaths ;  that  firom  five  to  ten  years 
of  age  the  male  excess  is  very  small ;  that  from  ten  to 
fifteen  the  male  excess  is  decided,  but  at  fifteen  the  tide 
turns,  and  until  twenty  the  female  deaths  are  largely  in 
excess ;  that  from  twenty  to  thirty-five  the  male  and 
fen^e  deaths  are  equal ;  and  then  after  thbty-five,  the 
male  deaths  are  again  in  excess.  Mr.  Sargant  adds  in 
a  note  the  '^  siuKulu*  fact"  obtained  from  Mr.  Makeham, 
who  is  such  high  authority  in  vital  statistics,  "that 
among  the  males  of  the  upper  classes,  from  the  age  of 
sixteen  to  that  of  twenty-three,  the  annual  rate  of 
m  *rtality  rises  rapidly  from  about  eight  to  a  maximum 
of  fifteen  per  thousand,  after  which  it  gradually  dimin- 
ishes." It  cannot  but  be  desirable  and  interesting  to 
ascertain  the  cause  or  causes  of  this  state  of  things. 

To  THE  G-ENBBOUS  MeMBBBS  OF  THE  PROFESSION. — ^Dr. 

Mong-Shaw-Loo,  a  native  of  India^  who  has  been  in 
this  country  nearly  ten  years,  obtaining  an  education, 
and  is  now  a  graduate  of  Lewisbtire  College,  Pa.,  ana 
of  a  medical  college  in  Cleveland,  Onio,  where  he  was 
a  student  of  Dr.  Gustav  C.  B.  Weber,  is  about  return- 
ing to  his  native  land.  Any  of  our  readers  who  have 
books  or  surgical  instruments,  or  apparatus,  that  they 
can  dispense  with,  would  do  a  worthy  act  to  a  worthy 
man  by  forwarding  them  to  this  office  [116  S.  Seventh 
street].  Dr.  Mong-Shaw-Loo  will  need  them  in  im- 
parting instruction  to  others  in  India,  where  the  field 
IS  extensive  and  the  laborers  are  few. — PhUa,  Med,  and 
Surg.  Reporter. 

ASSKIMMENTS  IK  THE  IT.  S.  ArMT  MeDIOAL  DEPART- 
MENT.— A  special  order  has  been  issued  from  the  War 
Department,  direoting  the  following  newly-appointed 
Assistaiit-Surgeons  to  report  for  duty  as  hereinafter 
indicated:  A.  B.  Campbell  and  J.  H.  T.  King,  to  the 
Medical  Director,  D€j)artment  of  Dakota ;  Daniel  Wei- 
sel,  to  the  commanding  officer  of  Fort  McHenry,  Mary- 
land ;  P.  0.  A.  Cleary,  to  the  Medical  Director,  Depart- 
ment of  the  Cumberland;  W.  H.  H.  Michler,  to  the 
Superintendent  of  West  Point,  New  York,  tempora- 
rily ;  John  N.  Bandall,  J.  E.  Corson,  and  Alfred  Dela- 
ney,  to  the  Post  Surgeon  of  the  principal  recroiting 
depots  Fort  Columbus,  New  York  harbor. 

Officers  of  the  East  River  Medical  Assooiatioit. — 
The  following  were  elected  at  the  Anniversary  Meeting 
of  the  above  Association :  President,  Dr.  John  Burke ; 
Vice-Presidents,  Drs.  William  Newman  and  Robert  A. 
Barry ;  Secretary,  Dr.  William  J.  Purcell ;  and  Treasu- 
rer, Dr.  Truman  Nichols. 

Yellow  Fever  in  New  Orleans,  La. — The  New 
Orleans  Board  of  Health,  Nov.  5th,  ultimo,  after  pacing 
a  high  tribute  to  the  Howard  Association  in  recognition 


of  their  disinterested  services,  declared  yellow  fever  no 
longer  an  epidemic  The  total  number  of  deaths  up  to 
above  date  was  3,006. 

Consultations  with  Homobopathists. — The  articles 
which  have  appeared  in  the  New  York  papers  lately  on 
this  topic,  forcibly  illustrate  how  littie  the  public  un- 
derstand the  motives  which  induce  medical  societies  to 
oppose  such  a  practice.  One  journal,  which  is  always 
loud  in  its  claims  to  liberality  and  fairness,  tells  us  we 
do  not  understand  our  position — that  such  opposition  i» 
unphilosophical.    Let  us  see  how  this  charge  stands. 

If  Mr.  Field,  when  he  wished  to  lay  the  Atlantic 
cable,  had  called  to  his  aid  the  spiritual  media  who 
claim  to  be  able  to  move  matter  without  human  agency, 
and  asked  their  advice  and  assistance  in  the  matter, 
would  he  have  been  a  philosopher  or  a  fool?  If  the 
surgeons  in  India  were  to  solicit  in  their  cases  the 
powers  of  the  school  of  native  doctors,  who  cure  ex- 
clusively by  charms  and  amulets — the  Saat,  we  believe 
thev  are  called  ^would  they  be  acting  in  an  eminently 
philosophical  manner  ?  Yet  these  latter  unquestionably 
are  well  educated,  and  tolerablv  successful ;  and  very 
intelligent  and  honest  folks  nave  impHcit  faith  is 
'^  physical  manifestations."  To  act  philosophici^,  m 
simply  to  act  in  accordance  with  common  sense.  There 
would  be  no  sense  or  honesty  either  in  advising  witb 
a  person  as  to  hanging  a  charm  around  the  necak  of  a 
man,  when  we  believe  it  will  have  no  effect  at  all— or, 
if  any,  merely  through  his  faith  in  it.  To  do  so  would 
be  to  encourage  an  error  or  a  deceit. 

Just  so  with  the  infinitesimal  doses.  We  firmly  be* 
lieve  they  are  all  inert.  To  consult,  therefore,  which 
of  them  to  give,  is  hypocrisy  or  knaverjr — no  mode- 
rately honest  man  would  do  it;  one  who  is  openly  disr 
honest  has  no  business  in  a  reputable  medical  society. 
If  any  beUeve  the  doses  are  not  inert,  and  yet  cannot 
subscribe  to  the  ^'  Law  of  the  Similars,"  such  consulta- 
tions are  equally  vain,  and  equally  unphilosophioaL 
The  wonder  is,  why  any  can  be  found  in  either  camp 
to  court  such  foolish  and  aimless  interviews. — PkStk 
Med.  and  Surg.  Reporter. 

The  Cholera  at  the  IT.  S.  Naval  RsKDEZvoua^ 
NEAR  PmLADELPHiA,  has  happily  been  brought  under 
control  The  type  was  pronounced  virulent,  and  the 
sick  men  were  transferred  firom  the  Potomac^  the  re- 
ceiving ship  on  board  of  which  it  first  iq)peared,  to  the 
double-ender  SassacuSj  wliich  was  converted  into  a 
hospital  ship.  The  first  death  occurred  on  board  the 
former  ship,  which  is  now  dismantled  and  undergoing 
purification,  October  19th,  ult.  Surgeons  Lowber, 
King,  Wales,  Nelson,  and  Denby,  Past  Assist -Surgeon 
Hutchinson,  and  Assist-Sur^eons  Drennan.  Frank,  and 
Hawks,  were  on  duty  durmg  the  prevalence  of  the 
malady. 

BiRTSB  IN  Vienna. — According  to  the  statistics  of  last 
vear,  the  illegitimate  births  in  Vienna  exceeded  the 
legitimate  by  one  thousand. 

Arrfval  or  ImciGRANTS  AT  Tins  Port. — The  state- 
ment of  the  Commissioners  of  Emigration  shows  that 
during  the  year  ending  October  30,  1867,  208y428 
immigrants  arrived  at  this  port. 

Suicides. — The  London  Athenccum  directs  attention 
to  the  Registrar-Gkneral's  curious  return  of  ihe  number 
of  suicides  in  England  during  the  eight  years  from  1858 
to  1865.  They  average  1,300  annually,  and  to  every 
million  of  the  population  run  thus  in  each  successrre 
year:  66,  64,  70,  68,  66,  66,  64  and  67.  Hanging  has 
always  been  Uie  death  generally  adopted  bv  suicides, 
28  out  of  the  ratio  of  67  per  million  suicides  fiJling  under 
digitized  by ^ ^_ 


THE  MEDICAL  RECORD. 


481 


this  head.  After  hanging  follow  catting,  stabbinjg  or 
drowning,  poisoning  and  by  firearms.  The  ratio  of 
suicides  per  million  of  the  respective  population  in  1864 
was  110  in  France,  64  in  England,  46  in  Belgium,  30  in 
Italy,  and  15  in  Spain. 

Singular  SuPERSTrrioK  rar  England. — "G^oing  into 
a  neighbor's  house  in  Madely,  one  day  last  week,  I 
found  one  of  the  children  suffering  from  severe  cough, 
and  expressed  my  opinion  that  it  was  a  case  in  which 
medical  assistance  should  be  obtained.  The  father  of 
the  boy  agreed  that  it  was  very  bad,  but  said  that  before 
calling  in  a  doctor  he  intended  to  try  a  cure  that  he  had 
long  used  in  similar  cases,  and  never  found  to  fail  On 
being  pressed  to  communicate  the  prescription,  he 
gravely  informed  me  that  the  charm  consisted  in  cutting 
a  few  hairs  from  the  part  of  the  patient's  head  where  it 
joins  the  neck,  placing  them  between  two  thin  slices  of 
bread  and  butter,  and  giving  them  to  a  dog.  If  the 
sandwich  took  no  effect  on  the  animal  the  patient  would 
recover;  but  if  the  dog  sickened  the  case  was  critical, 
and  a  doctor  should  be  called  in  forthwith." — PaU  MaM 
Qazette  Correspondent. 

PoMONiNO  BY  Phosphorus.  —  M.  Dybkowsky,  in  a 
recent  memoir,  states  that  the  poisonous  action  of 
phoephorufl  is  entirely  due  to  the  formation  of  phoepho- 
retted  hydrogen  gas,  which,  in  passing  into  the  blootl, 
rapidly  combines  with  the  oxygen  present.  Hence 
that  death  from  phosphorus  is  nearly  he  concludes 
equivalent  to  deatn  by  asphyxia. — Med,  and  Surg,  Ee- 
porter. 

Making  Sea-Sand  PRODUorrvE. — Another  experiment 
has  been  made  in  England  to  ascertain  the  effect  of 
sewage  manure  upon  sea-sand,  which,  according  to 
Liebig,  would  never  yield  a  crop.  The  metropolitan 
sewage  company  became  tenants  of  ten  acres  of  land  at 
Barkmg,  upon  which  bricks  had  been  made.  On  one 
acre  of  the  ten,  4,000  loads  of  the  MapUn  sands  were 
spread  to  the  depth  of  two  feet.  On  this  grass  and 
wheat  were  sown,  with  an  admixture  of  the  sewage, 
and  the  result  was  a  healthy  and  productive  crop.  This 
year  the  whole  of  the  ten  acres,  for  which  the  company 
paid  £1  an  acre,  is  all  laid  down  in  grass,  and  has  been 
re-let  to  a  London  dairyman  at  £18  lOs.  the  acre,  the 
eompany  supplying  their  tenant  with  sewage  to  the 
amount  of  508.  per  acre. — N,  Y,  Evening  Post, 

A  Medical  Examination  in  Ireland. — ^A  contributor 
who  has  himself  been  one  of  the  fortunate  candidates, 
sends  us  the  following  interesting  item : 

**The  examination  for  the  diploma  of  the  Royal 
OoHege  of  Surgeons  in  Ireland  is  looked  forward  to  by 
the  students  of  the  Dublin  Medical  Schools  as  an  ordeal 
demanding  from  the  candidate  not  only  an  intimate 
acquaintance  with  professional  subjects,  but  a  consid- 
erable amount  of  fortitude  and  self  possession  for  the 
occasion.  Before  he  can  present  himself  for  the  final 
examination,  the  student  is  arraigned  before  the  Court  of 
Examiners  in  classics,  in  order  to  satisfy  the  College  that 
he  has  received  a  suitable  preliminary  education ;  but  this 
step  may  be  taken  at  any  sta^  of  his  professional  studies. 
Having  attended  the  prescribed  courses  of  lectures  and 
sessions  of  hospital  practice,  he  makes  application  for 
*  letters  testimonial,'  and  when  his  turn  has  come  round 
be  presents  himselif  in  the  building  of  the  college  to 
await  the  pleasure  of  the  Court  of  Examiners  Things 
have  changed  in  some  minor  respects  since  my  time, 
apart  from  the  well-known  addition  of  practical  demon- 
strations in  anatomy  and  surgery,  and  the  answers  in 
Kvriting  now  required  fix)m  candidates.  But  I  will 
briefly  describe  the  scene  as  it  presented  itself  to  me 
some,  six  years  ago. 


"  Arriving  at  the  outer  door,  under  escort  of  Drs. 
John  Morgan  and  E.  D.  Mapother,  the  celebrated 
grinders,  both  now  professors  of  the  college,  with  a  few 
friends  who  had  already  been  through  the  mill,  and  a 
posse  comiiaius  of  future  candidates,  the  applicant  was 
received  by  the  venerable  John  Evans,  the  veteran 
college  porter,  who  eyed  him  with  an  anxious  glance, 
possibly  having  some  connection  with  the  usual  fee  on 
delivery  of  the  diploma.  After  a  short  interval,  occu- 
pied by  the  assembling  of  the  court,  a  bell  was  heard  to 
sound,  and  Mr.  Evans,  presenting  himself  at  the  door 
of  the  examination-hall,  received  the  order,  *  Bring  in 
the  candidate,*  and  the  latter  was  ushered  in  by  the 
obsequious  John,  who  pushed  the  chair  well  in  under 
him  at  the  table,  lest  in  his  trepidation  he  should  lose 
his  balance,  and  supplied  him  with  a  glass  of  water  to 
reUeve  any  vocal  agitation  which  might  arise. 

'^  The  candidate  now  found  himself  seated  at  a  large 
round  table.  Opposite  to  him  he  observed  Mr.  Richard 
G-.  H.  Butcher,  of  resection  celebrity.  President  of  the 
Court  of  Examiners,  with  a  member  of  the  council  of 
the  college,  and  three  other  examiners  on  each  side  to 
complete  the  circle.  These  all  retained  their  respective 
positions  during  the  examination,  and  to  each  of  the 
examiners  he  was  required  to  give  answers  distinctly 
audible  to  the  rest.  Fortunately,  the  remaining  audi- 
ence, consisting  of  such  licentiates  of  the  college  as 
chose  to  attend,  was  seated  behind  the  candidate^  on 
tiers  of  benches  at  the  end  of  the  hall  nearer  the  en- 
trance. He  was  then  examined  in  succession  by  each 
member  of  the  court,  the  examination  continuing  for 
one  hour  on  each  of  two  successive  days. 

"  Among  the  most  trying  features  of  the  ordeal  was 
the  exhibition  by  Dr.  Jerome  Morgan  of  what  poor  old 
Arthur  Mitchell  used  to  call  the  **  arcana  medicamento- 
rum,"  consisting  of  specimens  of  the  materia  medica,  the 
name,  history,  habitat,  and  properties  of  each  of  which 
were  in  turn  demanded ;  and  the  goed  Doctor  seemed 
well  pleased  when  the  fortunate  aspirant  accurately 
discriminated  between  carefully  crystallized  specimens 
of  Epsom  salts,  sulphate  of  zinc,  and  oxalic  acid,  and 
pronounced  certain  small  flakes  to  consist  of  the  inspis- 
sated juice  of  the  momordica  elaterium,  ecbalium  agreste 
or  squirting  cucumber,  aixv^  oypio^  of  Hippocrates,  com- 
momy  found  growing  wild  among  the  rubbish  in  villa- 
ges of  Greece  and  the  Archipelago,  the  specimen  being 
recognized  by  the  impress  of  the  linen  on  which  the 
feculsa  are  dried.  Various  were  the  questions  pro- 
ponnded  in  anatomy,  physiology,  practice  of  medicine, 
and  operative  surgery ;  and  Mr.  Michael  Harry  Staple- 
ton  (better  known  to  students  as  *  Baron  Lerrey,*  a 
sobriquet  probably  derived  from  his  undisguised  admi- 
ration of  that  still  more  eminent  surgeon),  inquired 
into  the  nature  and  treatment  of  common  sprains,  the 
different  varieties  of  aneurism  and  epilepsy,  vainly 
endeavoring  to  *take  a  fall  out  of  the  candidate  by 
suggesting  horse  exercise  as  a  prophylactic  in  the  latter 


**  Towards  the  close  of  the  second  sSance,  the  candidate 
was  accosted  by  the  still  small  voice  of  Mr.  Butcher, 
requesting  him  in  amiable  accents  to  *  write  a  prescrip- 
tion for  a  purgative  mixture  and  read  it,*  which  done 
he  retired  to  the  hbrary,  or  more  frequently  just  outside 
the  door  of  the  hall,  to  await  the  result,  which  was 
finally  communicated  by  John  Evans  in  the  shape  of  a 
pieoe  of  paper  containing  the  words,  *  The  court  is — 
satisfied,*  with  an  ominous  blank  for  the  addition  of 
^not,'  which  fi-equentiy,  alas  I  in  less  fortunate  instances, 
appeared  in  half-dried  ink  hke  the  signature  of  the 
President,  the  remainder  having  been  prepared  before- 
hand. The  decision  was  arrived  at  by  ballot  of  the 
examiners,  and  Scorn  it  there  was  no  appeal,  no  alterna*- 
Digitized  by  ^ j\^ 


432 


THE  MEDICAL  RECORD. 


tive  but  to  return  to  his  studies  for  the  space  of  six 
months.  The  final  ceremony  cons'sted  in  making  and 
subscribing  to  the  following  declaration :  *  I,  A.  B.,  do 
solemnly  and  sincerely  declare  and  promise,  that  I  will 
observe  and  be  obedient  to  the  statutes,  by-laws,  and 
ordinances  of  the  Royal  College  of  Surgeons  in  Ireland, 
and  that  I  will,  to  the  utmost  of  my  power,  endeavor 
to  promote  the  reputation,  honor,  and  dignity  of  the 
said  college.' 

**  There  are,  in  Dublin,  several  schools  of  medicine 
and  surgery,  and  although  some  of  them  are  under  the 
direction  of  the  authorities  of  the  diflferent  colleges,  the 
professors  are  ineligible  to  the  office  of  examiners. 
There  are  four  coUepres  empowered  to  grant  degrees  or 
diplomas,  viz.,  the  University  of  Dublin  (Trinity  Col- 
lege), the  Queen's  University,  which  has  no  school  in 
Dublin,  but  holds  its  examinations  at  the  vice-regal 
castle,  the  Royal  College  of  Surgeons,  and  the  King 
and  Queen's  College  of  Physicians,  which  has  a  kind  of 

?ai*tner8hip  ••chool  in  connection  with  Trinity  College, 
'here  are,  besides,  several  unchartered  schools,  which 
have  no  direct  connection  with  any  examining  body, 
in  which  students  are  prepared  for  the  different  exami- 
nations.'* 

Mental  Labor  and  Phtsical  Exertion. — It  may 
be  possible,  at  some  future  stage  of  scientific  inquiry, 
to  compute  the  comparative  amount  of  oxidation  in  the 
brain  during  severe  mental  labour.  Even  now,  from 
obvious  facts,  we  must  pronounce  it  to  be  a  very  con- 
siderable fraction  of  the  entire  work  done  in  the  system. 
The  privation  of  the  other  interests  during  mental 
exertion  is  so  apparent,  so  extensive,  that  if  the  exer- 
tion should  happen  to  be  long  continued  a  liberal  atone- 
ment has  to  be  made  in  order  to  stave  off"  general 
insolvency.  Mental  excess  counts  as  largely  as  mus- 
cular excess  in  the  diversion  of  power  :  it  would  be 
competent  to  suppose  either  the  one  or  the  other  reduc- 
ing the  remaimng  forces  of  the  system  to  one-half  of 
their  proper  amount.  In  both  cases  the  work  of  resto- 
ration must  be  on  the  same  simple  plan  of  redressing 
the  inequality  by  allowing  more  than  the  average  flow 
of  bluod  to  the  impoverished  organs,  for  a  length  of 
time  corresponding  to  the  period  when  their  nourish- 
ment has  been  too  small  It  is  in  this  consideration 
that  we  seem  to  have  the  reasonable,  I  may  say  the 
arithmetical,  basis  of  the  constitutional  treatment  of 
chronic  disease.  We  repay  the  debt  to  nature  by 
allowing  the  weakened  organ  to  be  better  nourished 
and  less  taxed,  according  to  the  degradation  it  has 
undergone  by  the  opposite  line  of  treatment  In  a 
large  class  of  diseases  we  have  obviously  a  species  of 
insolvency,  to  be  dealt  with  according  to  the  sound 
method  of  readjusdn?  the  relations  of  expenditure  and 
income.  And,  if  such  be  the  true  theory,  it  seems  to 
follow  that  medication  is  only  an  inferior  adjunct. 
Drugs,  even  in  the  happiest  application,  can  but  guide 
and  favor  the  restorative  process;  just  as  the  stirring 
of  a  fire  may  make  it  bum,  provided  there  be  the 
needful  fiiel.  There  is  thus  a  definite,  a' though  not 
numerically  stateable  relation,  between  the  total  of  the 
physico-mental  forces  and  the  totAl  of  the  purely 
{>hy8ical  processes.  The  grand  aggregate  of  the  oxida- 
tion of  the  system  includes  both ;  and,  the  more  the 
force  taken  up  by  one,  the  less  is  left  to  the  other. 
Such  is  the  statement  of  the  correlation  of  mind  to  the 
other  forces  of  nature.  We  do  not  deal  with  pure 
mind — ^mind  in  the  abstract ;  we  have  no  experience  of 
an  entity  of  that  description.  We  deal  with  a  compound 
or  two-sided  phenomenon — omental  on  one  side,  phy- 
sical on  the  other  ;  there  is  a  definite  correspondence 
in  degree,  although  a  difference  of  nature,  between  the  , 


two  sides ;  and  the  physical  side  is  itself  in  full  correla- 
tion with  the  recognized  physical  forces  of  the  world. — 
MacmiUan's  Magazine  for  September. 

The  Nervous  Telegraph. — A  French  savan  has 
likened  the  quickness  of  volition  in  an  animal  to  the 
telegraph.  He  tells  his  class :  When  a  whale  is  har- 
pooned, the  nerve  affected  instantly  telegraphs  to  the 
creature's  brain,  "  Harpoon  in  tail ;"  upon  which  the 
brain  telegraphs  back,  ''Jerk  tail  and  upset  boat" 
What  a  wonderful  thing  is  science  I 

Exercise  and  its  Effects. — Mr.  Archibald  Macliren, 
in  a  volume  entitled  "  Training,  in  Theory  and  Prac- 
tice," speaks  of  the  immediate  effects  of  exercise  on  the 
muscles  most  actively  engaged  at  the  time.  He  found 
the  law  of  development  strongly  demonstrated  in  a 
long  pedestrian  tour,  exiendmg  over  nearly  four 
months,  in  which  the  average  per  day  on  foot  exceeded 
nine  hours,  and  usually  witti  a  knapsack  weighing 
twelve  pounds.  During  this  time  the  chest  fell  fi^om 
41  to  39^  inches  in  circumference;  the  upper  arm 
from  14i  to  13^ ;  the  lower  arm  remaining  unchanged 
at  12^^  inches.  The  lower  limbs,  on  the  contrary,  were 
greatly  increased — ^the  calf  of  the  leg  passing  from  16  to 
17i  inches;  and  the  thigh  from  23i  to  25  inches. 
Often  recorded  examples  to  the  same  purport  are  seen 
in  the  great  development  of  the  legs  of  dancers  and  the 
arms  of  a  blacksmith,  eta 

Effect  of  the  Absence  of  Sound  upon  thb  Mdtd 
AND  Sense  of  Hearing. — Dr.  H.  RaDs  Smith,  of  Louis- 
ville, Ky.,  in  the  course  of  certain  investigations,  has 
established  the  truth  of  the  theory  that  the  permanent 
denizens  of  the  Mammoth  Cave  are  not  only  without  a 
trace  of  the  optic  nerve,  but  are  also  destitute  of  the 
sense  of  hearing.  Dr.  Smith  at  one  time  penetrated 
about  four  miles  into  the  interior  of  the  cave,  and 
some  four  hundred  feet  below  the  surface  of  the  eartL 
The  effect  upon  him  of  the  solitude  and  total  absence  of 
sound,  he  states,  was  very  distressing,  and  almost  in- 
supportable, resulting  in  a  very  perceptible,  although 
temporary,  defection  of  hearing  and  aberration  of  mind. 
This  explains  the  fact  why  persons  lost  in  the  cave  for 
one,  two,  or  three  days,  have  always  been  found,  when 
rescued,  in  a  state  of  temporary  insanity.  The  mind 
and  special  senses,  deprived  of  their  natural  pabuhzm 
and  stimulus,  gradually  become  weakened,  paralysed, 
atrophied,  and  finally,  as  far  as  external  manifestations 
are  concerned,  nearly,  if  not  quite,  extinct.  These  in- 
vestigations may  afford  some  clue  to  the  cause  of 
cretinism  in  the  deep  gorges  of  the  Alps. 

The  Abuse  of  Physical  Exercise. — The  WestminMter 
Oazettej  in  the  course  of  a  declamation  against  too 
much  physical  exercise,  sensibly  observes:  "Thoee 
who  have  gone  through  the  severest  training  become 
in  the  end  dull,  listless,  and  stupid,  subject  to  numerous 
diseases,  and  in  many  instances  the  ultimate  victims  of 
gluttony  aud  drunkenness.  Their  unnatural  vicor 
seldom  lasts  more  than  five  years.  It  was  especiwly 
remarked  by  the  Greeks  that  no  one  who  in  boyhood 
won  the  prize  at  the  Olympic  games  ever  distinguished 
himself  afterwards.  The  three  years  immediately  pre- 
ceding seventeen  arc  years  of  great  mental  development^ 
and  nature  cannot  at  the  same  time  endure  any  severe 
taxing  of  the  physical  constitution.  Prudence,  theft>- 
fore,  especially  at  this  critical  period  of  life,  must  ever 
go  hand  in  hand  with  vigor,  for  the  evils  of  ezoess  crat- 
weigh  by  far  the  evils  of  deficiency." 

SrpmLis  Contracted  from  Cigar  Stumps. — Twocsset 
of  syphilis  contracted  by  chewing  cigar  stumps  picked 
up  m  the  streets,  have  been  reported  in  a  recent  nxim- 
ber  of  the  CHorndU  ItaUano  deUelfaUtdie  Venmre, 

Digitized  by  VjC  -^       ^  _ 


THE  MEDICAL  RECORD. 


433 


€)ri0inal   Communrcotona* 

VESICO-VAGINAL  AND  RECTO-VAGINAL 

FISTULES. 

By  NATHAN  BOZEMAN,  M:D., 

NEW  TOKK. 

A  Vesico- Vaginal  and  a  Recto- Vaginal  FUhiU  in  the 
same  case;  the  former  of  Enormous  Dimensions^ 
through  which  the  Fundus  of  the  Bladder  protruded^ 
and  made  its  appearance  eostemaUy  in  the  form  of  a 
large  Fleshy  Ihmor,  with  both  Ureters  opening  upon  its 
surface — The  Rectal  Fistule,  also  of  large  size,  com- 
pluxUed  in  the  lower  edge  with  a  broad,  hard,  and  un- 
yielding band,  closed  at  one  operation  with  our  Button 
Suture,  by  virtue  of  its  protective  power  against  the 
uncorUrolUd  and  poisonous  Urine  flowing  into  the  Va- 
gina all  the  while  from  the  Ureters — The  Vesical  open- 
ing treated  by  transverse  or  horizontal  obliteration  of 
the  Vagina,  done  at  one  operation  with  the  Button 
Suture — First  successful  operation  of  the  kind  on 
record — Remarks, 

In  the  great  republic  of  science  no  one  has  the  impe- 
rial right  to  authority,  it  matters  not  what  may  be  the 
character  of  his  investigations,  further  than  his  superior 
opportunities,  judgment,  skilL  and  success  make  him 
so.  The  bare  assertion  of  a  thing,  without  the  neces- 
sary proo^  at  this  advanced  stage  of  medical  science, 
fails  to  give  satisfaction,  and  cannot  be  accepted  by  the 
truly  scientific  physician  and  surgeon.  ^ 

A  fair  and  honest  report  of  cases,  therefore,  I  have 
always  thought  was  the  only  way  of  doing  one*s  self 
fall  justice,  and  enabling  others  to  arrive  at  satisfactory 
conclusions  regarding  the  results  of  any  particular 
branch  of  practice.  So,  in  1853,  when  I  first  turned 
my  attention  to  the  treatment  of  some  of  the  injuries 
incident  to  parturition,  I  determined  to  put  upon  record 
every  case  that  presented  itself  to  me,  whether  success- 
fully treated  or  not,  believing  that  I  would  thereby 
make  my  experience,  as  far  as  it  went,  available,  and 
thus  enable  other  colaborers  in  the  same  field  to  profit 
by  my  mistakes  as  well  as  my  successes ;  the  only  true 
way,  I  conceive,  of  subserving  the  great  ends  of  science. 

As  to  the  correctness  of  my  course,  no  one,  I  pre- 
sume, will  gainsay ;  and  when  it  is  recollected  that 
almost  every  one  of  the  injuries  of  which  we  are  speak- 
ing possesses  distinct  peculiarities,  and  calls  for  a  partic- 
ular modification  of  treatment,  the  importance  of  the 
matter  becomes  at  once  strikingly  manifest,  and  the 
duty  of  the  surgeon  clearly  indicated. 

My  first  case  of  vesico-vaginal  fistule,  cured  by  the 
clamp  suture  (long  since  abandoned  by  its  author,  and 
now  seldom  resorted  to  by  any  one,  I  believe),  was  pub- 
lished in  the  New  Orleans  Medical  and  Surgical  Jour- 
nal, for  May,  1854.  My  second  case,  also  cured  by  the 
damp  suture,  was  published  in  the  Southern  Medical 
and  SurgicH  Journal,  for  August,  1855.  My  other 
cases,  thirty-nine  in  number,  treated  with  our  button 
9uiure,  were  published  in  the  Louisville  (Ky.)  Review, 
for  May,  1856;  North  American  Medico- Chir.  Review, 
for  July  and  November,  1857 ;  Edinburgh  Medical  Jour- 
nal, and  Glasgow  Medical  Journal  for  Oct  1858 ;  Gazette 
des  IlApitauoB  for  Jan.  4th  and  6th,  1859;  New  Orleans 
Medical  and  Surgical  Journal,  for  January,  March,  and 
May,  1860,  making  in  all  forty -one  cases,  and  ranging 
through  a  period  of  about  seven  jreai-s. 

At  the  date  of  my  Inst  report,  m  1860, 1  can  say,  and 
with  some  littie  pride  too,  that  my  number  of  recorded 
cases  exceeded  that  of  any  surgeon  either  in  this  coun- 


try or  Europe.  Even  at  this  writing^  no  other  surgeon 
in  this  country  has  published,  that  I  am  aware  of,  an 
equal  number ;  and  it  has  only  been  exceeded  in  Great 
Britain  by  Mr.  Isaac  Baker  Brown,  whose  entire  num- 
ber about  equals  mine,  reported  and  unreported. 

By  reference  to  my  cases,  some  of  them  will  be 
found  of  the  greatest  interest,  I  think,  as  denot- 
ing important  improvements  in  the  treatment  of  cer- 
tain classes  of  fistules,  aside  from  the  revolution  that 
was  effected  almost  at  the  very  outset,  by  the  inaugura- 
tion of  a  new  form  of  suture,  I  may  mention,  first. 
Hie  paring  and  suturizing  of  the  cervix  uteri.  This  had 
been  done  previously,  it  is  true,  by  Jobert  (de  Lam- 
balle),  but  the  precedence  was  unknown  to  me  at  the 
time  of  my  first  operation  in  1855 ;  secondly,  a  new  and 
successfiil  plan  or  treating  rents  of  the  urethra;  thirdly, 
t?ie  making  of  the  uterus  subservient  to  the  closure  cf  large 
fistulous  openings,  by  hauling  it  down  and  attaching  it  to 
the  anterior  border  of  the  fistule,  thus  superseding  the 
necessity  of  a  resort  to  M.  Jobert's  dangerous  and  un- 
successful procedure,  d^AiUopJastie  par  glissement  ou  par 
locomotion,  the  only  plan  then  practised  in  such  cases 
by  surgeons  generally ;  fourthly,  a  successful  plan  of  dis- 
engaging or  extricating  the  cervix  uteri  from  the  bladder 
when  incarcerated  in  the  latter  organ,  as  sometimes  hap- 
pens, and  at  the  same  time  closing  the  fistulous  opening^ 
thus  giving  the  menstrual  flow  its  natural  outlet,  a  pro- 
cedure in  which  I  claim  priority,  and  so  far  as  my  read- 
ing extends  there  are  no  other  cases,  except  my  own,  to  be 
found  upon  record,  treated  according  to  my  method  or 
otherwise;  fifthly,  transverse  or  horizontal  obliteration 
of  the  vagina  in  a  class  of  cases  where  the  loss  of  tissue 
has  been  so  great  as  utterly  to  preclude  the  possibility  of 
closure  of  the  fistulous  opening  in  the  usual  way. 

The  grounds  upon  which  1  claim  priority  in  the  latter 
operation  will  appear  and  be  better  understood  from 
my  remarks  in  connection  with  the  narration  of  the  fol- 
lowing interesting  case,  whose  p  culiaritiea  occasioned 
the  adoption  of  the  novel  proceaure.  With  this  cnse  I 
resume  the  publication  of  my  reports,  which  will  be 
continued  in  the  Beoord  until  completed. 

Case  XLII.— J.  F..  colored,  eet.  19,  entered  my  pri- 
vate hospital  Jan.  1,  1859,  laboring  under  the  extensive 
and  complicated  injuries  above  stated;  of  medium  sta- 
ture, well  formed,  and  healthy  looking.  About  the 
age  of  sixteen  was  confined  with  her  first  child,  at  full 
term ;  labor  was  short  and  unattended  with  difficulty ; 
the  result  being  satisfactory  as  regarded  both  mother 
and  child.  Eighteen  months  afterwards  was  confined 
with  her  second  cliild:  labor  lasting  this  time  about 
forty-eight  hours;  child  still-born.  No  instruments 
were  used,  a  midwife  being  the  attendant. 

Patient  thinks  she  did  not  pas^s  any  urine  during  labor, 
and  believes  that  her  suffering  was  greatly  increased 
from  tiiis  circumstance;  t-ays  that  her  urine  began  to 
dribble  from  her  as  soon  as  labor  was  completed,  and 
from  that  time  to  the  present  moment  has  never  been 
able  to  pass  it  in  the  natural  way.  The  preneral  health 
to  all  appearances  is  good,  far  better  than  could  have 
been  expected  under  the  circumstance^ 

Eocaminaiion, — The  patient,  on  being  placed  upon  hr  r 
knees  and  elbows  bef  )re  a  s:rong  liirht,  was  found  to 
have  a  sufficiently  capacious  pe!vi>*,  the  labia  majora 
were  thickened  and  excoriated,  and  between  ihem  pro- 
truded the  fundus  of  the  bladder,  in  the  form  of  n  large 
fleshy  tumor,  as  large  as  a  medium-sized  orange,  with 
both  ureters  plainly  visible  upon  its  surface.  Ckntle 
pressure  with  the  ends  of  the  fingers  upwards  and  hack- 
wards,  upon  this  extruded  portion  of  the  bladder,  car- 
ried the  fundus  ihrou^h  the  immense  chastn  in  the  an- 
terior wall  of  the  vagina  to  its  normal  position.  The 
intiroduction  now  of  the  lever  speculufl^  brought  fully 

le 


Digitized  by  VjOOQ 


434 


THE  MEDICAL  RECORD. 


into  view  a  fistulous  opening,  with  metes  and  hounds 
truly  appalliog.  In  the  sloughing  process  I  found  that 
nearly  all  of  the  infra  vaginal  portion  of  the  cervix  uteri, 
the  basfond  and  trigone  of  the  bladder,  and  nearly  one- 
half  of  the  urethra  had  been  carried  away,  thus  pre- 
senting an  example  of  a  fistule  belonging  to  both  my 
fourth  and  fifth  classes*  which  I  had  never  observed 
before. 

The  borders  of  this  opening,  as  well  as  the  stump 
of  the  cervix  uteri,  had  the  appearance  of  being 
healthy^  there  being  no  abrasions,  as  are  commonly  seen 
in  injuries  of  this  nature  far  less  serious.  A  striking 
feature,  however,  was  their  immobility ;  no  movement 
of  its  sides  or  depression  of  the  uterus  could  be  effected, 
thus  precluding  the  possibility  of  any  compensation 
for  loss  of  tissue  by  hauling  the  uterus  down,  as  I  had 
always  been  able  to  do  before  in  the  largest  sized  fis- 
tulous openings.t  Another  feature  of  the  anterior 
border  is  worthy  of  note — viz.,  the  partial  exposure  of 
the  pubic  arch ;  the  bones  could  be  traced  with  the 
finger  half  or  three-quarters  of  an  inch  on  either  side 
of  the  symphysis  pubis.  I  next  had  the  patient  to 
turn  upon  her  back,  in  order  to  explore  the  posterior 
wall  of  the  vagina,  having  already  perceived  indications 
of  a  recto-vaginal  fisitde.  The  introduction  of  the  specu- 
lum at  once  disclosed  the  situation  and  nature  of  this 
additional,  and,  I  may  say,  very  grave  and  serious  in- 
jury, complicating  as  it  did  the  one  which  we  have  just 
described  of  such  formidable  proportions.  It  was  situa- 
ted about  two  and  a-half  inches  from  the  anus,  and  was 
oval  in  diape,  with  its  long  axis  extending  directly  across 
the  redo-va^^inal  septum.  Its  lower  border  was  in- 
volved in  a  broad,  hard,  and  somewhat  unyielding  band, 
which  extended  entirely  across  the  posterior  wall  of  the 
vagina.  This  band  I  found  to  influence  very  materially 
the  mobility  of  the  edges  of  the  fistule.  and  there  was 
a  doubt  in  my  mind  at  the  time  as  to  wneiher  their  ap- 
proximation could  be  effected,  even  with  the  best 
course  of  preparatory  treatment  that  could  be  insti- 
tuted. 

Treatment — Here  I  must  be  allowed  to  quote  my 
own  remarks  from  the  New  Orleans  Medical  arid 
SurgicalJoumalj  for  January,  1860.  Upon  resuming 
the  publication  of  my  cases  in  that  journal,  these  re- 
marks were  called  forth  by  the  peculiarities  of  this 
particular  case,  and  the  treatment  that  was  adopted  for 
its  successM  management,  May,  1859.  I  am  thus  par- 
ticular in  stating  the  precise  dates  of  treatment  and 
publication  of  remarks,  as  the  question  of  priority  of 
operation  will  be  discussed  hereafter : 

"  Several  of  the  cases  that  I  am  now  about  to  report 
are  of  unusual  interest ;  one,  perhaps,  the  most  remark- 
able on  record.  This  was  a  case  of  both  vesico- vaginal 
and  recto-vaginal  fistules,  and  from  its  peculiarities  oc- 
casioneJ  the  maugu ration  of  a  new  and  successful  plan 
of  treatment  never  before  adopted,  that  I  am  aware  of, 
and  one  to  be  re;?arded  of  the  greatest  practical  utility. 

"  The  unyielding  nature  of  the  posterior  septum 
could  not  be  overcome  by  any  plan  of  treatment.  This, 
therefore,  left  fte  with  no  other  alternative  than  the 
obturation  of  the  vagina  at  the  vulva^  according  to  the 
method  of  Vidal  (de  Cassis).  In  addition,  now,  to  the 
ordinary  objections  to  the  above  procedure,  there  was 
one  in  the  present  instance,  that  at  first  appeared  in- 
surmountable ;  namely,  the  existence  of  the  recto-va- 
ginal fistule.  With  this  reraaininp:,  not  only  the  urine 
and  catamenia,  but  the  faeces,  would  have  been  turned 
in*o  one  common  receptacle,  with  no  other  outlet  than 
the  urethra.    For  the  latter  to  become  dissolved  in  the 


*  See  ITorih  Amerloan  Mid.  CMr.  Bwiew  tot  Julr,  1897. 
t  Op,  di. 


Other  two  excretions,  and  be  dischaiged  with  them, 
would  have  been  next  to  impossible.  M.  Vidal*s  opera- 
tion, therefore,  was  out  of  the  question,  unless  the 
recto-vaginal  opening  could  first  be  dosed ;  and  to  the 
success  of  this  there  appeared  one  very  preat  obstacle, 
namely,  the  uncontroued  urine.  This,  in  almost  any 
position  of  the  patient,  would  necessarily  come  more  or 
less  in  contact  with  the  raw  edges  of  the  fistule  when 
brought  together,  and  by  its  irritating  effect  have  pre- 
vented their  union.  Relying,  however,  upon  the  protec- 
tive power  of  our  button,  as  shown  on  former  occasions 
in  the  management  of  double  and  triple  veeico-vaginal 
fistules,  I  resolved  to  hazard  an  attempt  at  least  to 
place  our  patient  in  a  condition  for  obturation  of  the 
vagina,  which,  however  partial  the  relief  promised, 
seemed  to  be  called  for  under  the  circumstances.  I  say 
partial  relief  because  it  is  well  known  that  closure  of 
the  vagina,  as  directed  by  M.  Vidal,  leaves  the  patient 
with  no  control  over  the  urine,  to  say  nothing  of  the  ill 
consequences  arising  from  the  more  or  less  stagnation 
of  this  fluid  and  the  catamenia  at  the  lower  part  of  the. 
vagina.  To  prevent  the  latter  result,  therefore,  it  re- 
quired that  these  excretions  shoiild  always  be  fi-eely 
and  completely  discharged,  whether  involimtarily  or 
not.  This,  in  my  judgment,  could  be  effected  in  no 
other  way  than  by  attaching  the  posterior  to  the  ante- 
rior wall  of  the  vagina  just  helow  the  vesical  extremity  of 
the  urethra^  thus  placing  our  line  of  cicatrization  hori- 
zontally and  far  above  the  perpendicular  one  of  M. 
Vidalj  just  within  the  meatus  urinarius,^  Therefore, 
after  closing  the  recto-vaginal  opening,  if  possible,  I 
determined  to  put  into  practice  this  new  procedure. 
Accordingly,  I  went  to  work,  and  to  my  great  aston- 
ishment the  rectal  opening  was  closed  at  our  first  trial 
It  remained  now  for  me  to  see  what  could  be  realized 
by  the  procedure  above  proposed." 

The  operation  consisted  simply  in  paring  off  the 
mucous  membrane  across  the  anterior  wall  of  the  vagina 
up  to  the  very  brink,  so  to  speak,  of  the  chasm  already 
described.  In  a  similar  manner  the  mucous  membrane 
was  pared  off  around  and  across  the  posterior  vaginal 
wall,  just  opposite,  and  to  a  corresponding  extent  The 
denuded  surface  all  around  averaged  in  width  half  to 
three-quarters  of  an  inch. 

This  stage  of  the  operation  being  completed,  eight, 
silver-wire  sutures  were  next  introduced  and  adjusted 
in  the  usual  manner,  which  brought  the  two  raw  sur- 
faces of  the  opposing  walls  of  the  vagina  in  perfect  ap- 
position. A  button  then  of  the*  ordinary  shape,  one 
mch  and  three-quarters  in  length,  with  holes  to  corre- 
spond to  the  number  of  sutures,  was  next  slid  down 
upon  the  approximated  parts,  and  then  secured  by  com- 
pressing a  perforated  shot  upon  the  two  ends  of  each 
wire.  A  catheter  was  now  lodged  in  the  urethra,  and 
the  patient  placed  in  bed.  In  the  after  treatment  no 
other  attention  was  called  for  than  that  required  in  an  or- 
dinary case  of  vesico-vaginal  fistule.  Suture  apparatus 
removed  on  the  ninth  day. 

"  Suffice  it  to  say,  our  first  operation  was  attended 
with  entire  success,  and  our  patient,  contrary  to  the 
most  sanguine  hope,  had  almost  complete  control  over 
her  urine.  I  say  almost  complete,  because  she  retains 
and  passes  it  at  will,  dribbling  only  taking  place  from 
the  urethra  occasionally  when  she  goes  too  long  with- 
out emptying  the  bladder.  She  keeps  perfectly  dry  at 
night,  not  requiring  to  get  up  at  all,  and  during  the  day, 
when  walking  about,  she  can  sometimes  go  three  or 
four  hours  without  any  dribbling. 

"  When  I  performed  this  operation,  I  did  not  for  a 
moment  suppose  that  our  patient  would  regain,  to  any 
extent,  the  power  of  controlling  her  urine,  if  ever  so 
successful    The  most  that  1  hoped  for  was  a  meclianical 


THE  MEDICAL  llECORD. 


485 


obstruction  to  its  flow  while  the  patient  was  in  the  re- 
cumbent posture,  thus  enabling  her  to  lie  dry  at  night. 
The  result,  however,  has  proved  most  conclusively  that 
the  vagina,  thus  occladed,  secures  to  the  patient  the 
power  of  retaining  and  passing  her  urine  at  will,  as 
thouirh  the  fistulous  opening  itself  were  closed. 

**  This  operation,  therefore,  cannot  be  regarded  other- 
wi!?e  than  as  a  great  triumph.  It  enables  us  now  to 
manage  a  class  of  cases,  if  not  as  satisfactorily  as  we 
could  desire,  certainly  upon  scientific  principles,  and 
with  results  never  heretofore  attained,  as  far  as  my  in- 
formation extends.  Vidal*8  operation,  nowever  success- 
fiilly  performed,  must,  from  the  very  nature  of  thinjis, 
always  be  attended  with  an  involuntary  flow  of  urine 
upon  leaving  the  recumbent  posture,  and  therewith  a 
downward  pressure  or  unpleasant  feeling  at  the  lower 
extremity  of  the  vagina,  caused  by  the  accumulation  of 
urine  and  the  catamenia  constantly  going  on  there." 

Remarka. — The  result  in  this  case,  as  regards  both 
the  recto- vaginal  fistule  and  the  transverse  or  horizontal 
obliteration  of  the  vagina^  must  strike  every  one.  under 
the  circumstancesj  as  being  satirsfactory  in  the  highest 
degree.  Somethmg  over  eight  years  having  now 
elapsed  since  this  operation  was  done,  I  have  only  to 
say  my  views  have  undergone  no  change,  as  to  the  im- 
portance of  the  procedure  and  its  superior  advantages 
over  M.  Vidal's  method. 

Recent  and  further  examination  into  the  literature  of 
the  subject  satisfies  me  that  my  claims  to  priority  in  the 
operation  of  which  we  are  speaking  were  jus^,  at  the 
time  I  fircst  called  the  attention  of  the  profession  to  it  in 
the  journal  already  referred  to.  Neither  in  this  country, 
Prance,  Q-reat  Britain,  nor  Ireland,  had  there  been  at 
the  period  named  a  successful  operation  of  the  kind ; 
and  even  now,  the  records  of  the  profession  in  Uie 
countries  named,  so  far  as  my  reading  extends,  do  not 
afford  another  authenticated  example. 

In  Germany,  it  is  true.  Prof.  Simon,  of  Rostock,  a 
few  months  before  I  performed  my  operation,  proposed 
prec'sely  the  same  procadure,*  cross  obliteration  of  the 
vagina  (queren  obliteration  der  scheide),  and  had  actually 
performed  the  operation  twice,  though  without  any  suc- 
cesa  We  have,  therefore,  no  proof  of  his  having  ever 
effected  a  cure  by  his  procedure  prior  to  the  date  of 
mv  paper.  But  when  we  know  the  kind  of  cases  in 
which  Prof.  Simon  first  proposed  his  operation,  there 
will  not  be  found  such  a  willingness,  I  imagine,  to 
award  him  the  credit  he  might  otherwise  have  been 
entitled  to.  He  tells  us  that  the  case  which  8uggest?d 
this  novel  procedure  to  him  was  one  in  which  tlie  vap^na 
was  almost  in  a  normal  state,  and  the  fistulous  openin<r 
80  small  as  only  to  admit  the  end  ol'  the  fin^fer,  but  it 
WIS  deeply  situated  in  the  vagina  and  difficult  to  approach. 
These  were  the  circumstance  =»,  after  severed  attempts  to 
close  the  small  fistule,  we  are  told,  which  called  forth 
the  above  expedient,  and  which  fortunately  proved 
equally  unsuccessful.  I  say  fortunately,  because  it  was 
truly  S'>  to  both  patient  and  reputation  of  surgeon,  for 
the  latter  tells  us  afterwards  he  succeeded  in  closinp:  the 
same  fistule  and  discharged  the  patient  cured,  a  result  to 
her  infinitely  preferable  to  that  of  an  obliterated  vagina, 
and  certainly  more  in  accordance  with  corre<rt  prin- 
ciples of  surgery,  all  must  admit.  As  appears  from  the 
date  of  Simon's  article  quoted,  he  did  not.  publish  his 
vieWM  until  two  years  after  mine  appeared,  but  he  makes 
no  mention  whatever  of  my  ca-e  ov  operation.  T  slioild 
be  disposed  to  attribute  this  oversight  or  nejorlect  to  the 
fa^t  of  his  having  not  seen  my  papers,  but  the  p  dnable 
iojostice  is  made  manifest  by  his  resjrt  to  my  pbn  of 


•  Ueber  (Ua  Op«r«tloii  der  Bluen-SchddMflstela  daroh  die  Dlniege 


suture,  and  in  the  very  case  too  upon  which  he  first 
tried  transverse  obliteration  of  the  vagina,  and  failed. 

I  will  defer  eaying  more  at  the  present  time  in  con- 
nection with  this  important  operation,  as  I  hope  to  be 
able  soon  to  present  mv  views  upon  it  in  a  different 
form,  and  with  suitable  illustrations. 

FifTB  Atuuk  Hotkl. 

ACUTE  INFLAMMATION  OF  PSOAS 

MAGNUS  MUSCLE. 

Bt  J.  W.  GBOSVENOR,  M.D., 

rROTlDnOC,  B.  I. 

Acute  inflammation  of  the  psoas  magnus  muscle  is  a  very 
rare  disease.  In  searching  medical  literature  I  find  only 
a  single  case  reported  in  detail,  and  th  t  by  Dr.  0.  W . 
Parsons,  of  this  city,  in  the  Boston  Medical  and  Surgi^ 
eal  Journal  of  September  10,  1861.  A  case  is  men- 
tioned by  Prof  Gross  in  the  1866  edition  of  his  surgery. 
On  page  594,  he  s  lys,  *'  An  instance  has  been  reported 
of  a  young  man  who  died  from  rupture  of  the  p5«oas 
muscle,  death  having  been  preceded  by  severe  inflam- 
mation and  (infiltration  of  pus.*' 

In  a  letter  to  Dr.  A  nth  my,  of  this  city.  Prof  Gross 
regret?  his  inability  to  refer  to  the  particu  ar  case.  Prof. 
Willard  Parker  infoims  me  by  letter  that  he  has  the 
notes  of  two  unpublished  cases  which  have  occurred  in 
his  practice.     I  hope  we  may  soon  see  them  in  print. 

The  following  case  has  lately  come  under  my  obser- 
vation. 

Lemuel  Grosvennr  Perry,  a  student,  nineteen  years 
of  age,  strong  and  healthy  irom  birth,  while  playing 
ball,  on  Jnne  27,  1867,  felt  something  "give  way'*  in 
his  right  side.  • 

Soon  after  returning  home  on  the  same  day,  he  wag 
taken  sick  with  vomiting  and  quite  a  sharp  puin  in  the 
right  lumbar  rep  ion.  Tongue  was  slightly  furred, 
bowels  constipated,  pulse  full  and  about  ninety  per 
minute.        ^ 

A  cathartic  of  magnesia  in  combination  with  charcoal 
acted  promptly,  by  whi  h  t^^e  nain  wn«»  considerably 
relieved  and  the  vomiting  entirely.  On  the  morning  of 
June  29t!),  patient  had  quite  a  severe  ciiill.  For  the 
lour  or  five  days  following  there  was  but  little  change 
in  the  symptoms — pul  e  f  lir,  and  about  eighty  per 
minute,  tongue  sliprhfly  brown  and  mol<t  stomach  un- 
comfortaVe,  t^ent'enry  to  diarrhoea,  t^e  pain  in  the  ripht 
lumbar  region  conf  inuinir,  though  not  seveie.  July  4th, 
a  swellng  and  har  Iness  were  observed  over  the  seat  of 
the  pain.  It  was  circumscribed,  and  covered  a  space  of 
about  four  squa -e  inches,  its  centre  being  on  a  vertical 
level  with  the  anterior  Fuperior  spinous  process  of  the 
the  ilium.  For  two  or  three  Hays  it  became  a  little 
more  prominent,  and  then  r«^ma'n»^d  in  statu  quo. 

Patient  found  urination  dfficult  without  sranding. 
He  couM  not  fully  extend  his  right  1-  g,  kept  the  right 
thigh  flexed  on  the  abdomen,  anr^  rotated  outwards, 
moved  from  sid?  to  side  in  bed  with  difliculty  and  pnin; 
wh-n  on  hi^  feet  a^snmed  a  stooping  posture,  with  the 
bodv  inclined  toward?*  the  right  silo.  Abdomen  not 
swollen,  and  rot  tender  on  pr.^^^snre,  except  in  Hght 
lumbar  and  right  iliac  regions  F  om  about  the  4th  to 
he  12th,  patient  was  eonifortJibly  J^ick,  was  able  to  get  up 
without  as  'stance  every  dav,  his  pul^»*  fai^,  the  general 
sytrpt)ins  biinor  the  Fame  as  duting  the  few  days  pre- 
vious 'o  the  appear  n*e  of  the  sw tiling.  At  3  a.m  of 
the  121  h,  he  was  s  ized  wih  a  severe  pain  at  d  excevive 
vorni  itiir  of  a  g  «  e  is'i-looking  material ;  cold,  clamny 
per«n'ra'ion  f«  lowed,  pulse  l)ceatre  very  rapid  and 
fee'  le.  Vomiting  coH'nned  with  Fight  ab,'t?ment  till 
de  ith  at  6i-  o'c'o  :k  p.m.  of  the  same  day^--^  t 

__  _,v:.oogle 


436 


THE  MEDICAL  RECORD. 


Treatment  previous  to  the  sinking  stage,  on  July 
12th,  consisted  of  a  cathartic  at  the  outset  of  the  disease, 
as  already  mentioned,  injections  of  starch  and  laudanum 
to  control  the  diarrhoea,  anodynes  sufficient  to  relieve 
pain  and  procure  rest  and  sleep  at  night,  animal  broths 
and  some  fruits,  occasionally  brandy  and  water.  The 
tumor  was  painted  with  tincture  iodine  for  several  days, 
and  leeches  applied  to  it  on  the  11th.  In  the  stage  of 
collapse  treatment  consisted  in  morphia  injected  hypo- 
dermically,  and  iced  champagne,  to  which  were  added 
a  few  drops  of  chloroform.  During  his  sickness  the 
patient,  who  was  under  the  medical  care  of  his  father 
Dr.  Perry,  was  seen  by  Drs.  Peckham  and  Parsons,  of 
the  city,  and  Dr.  Clapp,  of  Pawtucket. 

Autopsy  by  Dr.  Mason,  seventy-two  hours  after 
death.  Greater  omentum  slightly  adherent  to  small  in- 
testine<«,  which  were  considerab'y  congested.  Lower 
part  of  ascending  colon  and  appendix  vermiformis  ad- 
herent to  abdominal  wall.  A  few  fibres  of  psoas  mag- 
nus  muscle  were  rou^h  and  broken  down,  and  the  muscle 
itself  dissected  up  sJong  its  posterior  surface,  and  the 
peritoneum  separated  from  its  anterior  surface.  The 
anterior  crural  nerve  running  along  the  outer  border  of 
the  muscle  was  separated  from  all  attachments  for  a 
distance  of  six  inches.  About  three  pints  of  purulent 
fluid  in  peritoneal  cavity.  The  rupture  of  the  pentoneum 
was  apparently  between  the  stomach  and  liver.  Right 
kidney  healthy.    No  diseased  bone  discovered. 

Undoubtedly  inflammation  commenced  at  that  part 
of  the  psoas  magnus  muscle  where  the  fibres  were 
broken  down,  an  abscess  followed,  and  pus  as  it  was 
formed  burrowed  under  the  muscle,  dissected  up  the 
peritoneum,  and  finally  burst  into  the  peritoneal  cavity 
on  the  morning  of  July  12th,  at  the  time  when  the  alarm- 
ing change  in  the  symptoms  occurred. 

I  have  seen  no  account  of  this  disease  in  the  English 
language.  In  Copland's  Medical  Dictionary  occurs  an 
article  on  inflammation  and  suppuration  of  the  psoas 
muscles.  The  author  mentions  psoitis  as  one  of  its 
synonymes,  but  he  evidently  refers  to  ^aoBa  abscess, 
which  is  a  chronic,  not  an  actUe  disease.  The  only  article 
on  this  subject  wpich  I  have  seen  is  in  the  Dictionnaire 
de  Medicine,  vol.  xxvi,  under  the  heading  Psoite. 
The  rarity  of  the  disease,  and  the  meagre  amount  of 
literature  upon  it,  may  justify  me  in  presenting  a  resum^ 
of  this  article. 

Causes  of  Psoitis, — Fails,  blows  on  lumbar  region 
and  pelvis,  violent  movement  of  body  backwards  and 
forwards  on  lower  extremities ;  raising  heavy  weights ; 
very  severe  exercise.  Ferrus,  the  author  of  the  article, 
thinks  rheumatism  has  a  great  influence  on  the  develop- 
ment of  the  disease. 

Symptoms. — Pain  in  lumbar  re^on,  which  soon  ex- 
tends to  groin  and  thigh — usually  intolerable,  rarely  al- 
most nothing.  Extension  and  flexion  of  thigh  greatly 
increases  the  pain.  Walking  difficult  or  impossible. 
If  patient  waits  trunk  is  strongly  inclined  forwards. 
Engorgement  of  inguinal  glands.  As  disease  progresses 
pain  becomes  severer,  and  lower  extremity  of  affected 
aide  is  constantly  flexed  and  sUghtly  turned  outwards. 
An  attempt  at  extension  or  rotation  gives  excessive 
pain.  This  position  of  the  limb  is  ordinarily  the  most 
characteristic  sign  of  psoitis.  Sometimes  there  is  numb- 
ness in  the  Umb.  Fever  declares  itself,  digestive  organs 
become  deranged ;  sometimes  nausea  and  vomiting  occur, 
often  diarrhoea,  rarely  constipation ;  urine  is  sometimes 
purulent,  sometimes  colored  with  blood.  At  last  in  the 
groin  or  lumbar  region  appears  a  tumor  more  or  less 
extensive,  fluctuating,  not  changing  color  of  skin,  not 
painful  on  pressure,  drawing  back  mto  interior  of  ab- 
donen.  In  this  tumor,  whether  it  opens  spontaneously 
or  is  opened  by  an  instrument,  is  found  more  or  less  pus. 


Hectic  fever  follows,  pulse  becomes  small  and  frequent ; 
a  cough  appears,  colliquative  diarrhoea  supervenes, 
and  the  patient  dies  of  marasmus. 

Pathological  Anatomy. — The  muscle  is  found  in  three 
conditions.  First,  it  is  entirely  preserved,  but  softened, 
in  color  like  the  lees  of  wine,  infiltrated  with  black 
blood,  and  easily  torn.  Secondly,  vestiges  of  the  muscle 
remain,  of  the  consistency  of  pulp,  blackish  in  color,  and 
of  a  disagreeable  odor.  Thirdly,  the  muscle  is  com- 
pletely destroyed  by  suppuration. 

The  secretion  is  not  pure  pus,  but  a  mixture  of  pus 
and  muscular  fibres  not  entirely  broken  down.  Usually 
suppuration  extends  outwards  towards  the  surface,  but 
Ettmaller  and  Withmore  have  each  reported  a  case  in 
which  the  purulent  matter  found  its  way  into  the  intes- 
tine and  appeared  in  the  evacuations.  These  two  patients 
died,  and  the  autopsies  revealed  a  communication  be- 
tween the  abscess  and  colon  in  both  cases.  Sometimes 
the  secretion  follows  the  psoas  and  iliacus  muscles  as  far 
as  their  insertion  into  the  lesser  trochanter,  and  infiltrates 
the  muscles  surrounding  the  coxo-femoral  articulation. 

Diagnosis. — The  symptom  which  may  be  considered 
pathognomonic  is  flexion  of  the  lower  extremity  upon 
the  trunk  in  the  direction  of  the  fibres  of  the  psoas 
muscle. 

This  sign,  taken  in  connection  with  the  acute  pain 
caused  by  rotating  the  limb,  will  enable  us  to  make  out 
a  diagnosis  in  a  large  majority  of  cases.  Sometimes  a 
dia^osis  is  very  difficult.  From  abscess  due  to  a  change 
in  lumbar  vertebras  it  may  be  distingtushed  by  the 
rapidity  of  its  course,  by  absence  of  deformity  in  ver- 
tebral column,  by  the  impossibility  of  extending  the  leg 
and  of  easily  executing  the  movement  of  rotation. 
Nephritis,  although  resembling  psoitis  in  the  seat  of  the 
pain,  differs  from  it  in  not  preventing  the  movements  of 
extension  and  rotation  of  the  limb.  In  hernia  the  ab- 
sence of  fluctuation  in  the  tumor,  digestive  troubles,  and 
absence  of  lumbar  pain,  exclude  the  existence  of  psoitis. 
SomTetimes  there  is  great  difficulty  in  diagnosticating 
between  coxalgia  and  psoitis.  In  the  latter  as  in  the 
former,  the  pain  extends  along  the  thigh  and  sometimes 
as  far  as  the  knee,  and  also  there  is  sometimes  the  same 
difficulty  of  rotation  in  one  as  in  the  other.  Still,  the 
principal  seat  of  the  pain  at  the  outset  of  the  disease 
being  in  the  lumbar  region  in  psoitis,  and  in  coxalgia  in 
the  external  iliac  fossa,  will  usually  prevent  any  mistake. 
(From  abscess  of  the  appendix  vermiformis  and  from 
iliac  abscess  I  think  psoitis  may  be  distinguished  by  the 
peculiar  position  of  the  limb  in  the  latter,  viz.  flexed 
upon  the  abdomen  and  rotated  outwards.) 

Prognosis. — Psoitis  is  a  very  grave  disease.  Dr.  Kyll 
thinks  the  prognosis  very  favorable,  all  his  five  patients 
having  recovered,  and  yet  he  admits  that  he  is  not  quite 
sure  whether  the  seat  of  the  disease  was  in  the  psoas 
muscle,  the  lumbar  vertebrae,  or  the  pelvic  cellular  tissue. 
Psoitis  does  sometimes  terminate  in  recovery,  as  is 
shown  by  a  case  reported  by  La  Motte.  Fluctuation 
was  felt  deeply  jdong  the  vertebras  and  loins  between  the 
last  rib  and  ilium.  A  large  incision  was  made,  and  six 
pounds  of  pus  extracted.  After  five  months  the  patient 
recovered.  There  was  some  doubt,  however,  as  to  the 
nature  of  the  disease.  (Prof.  Willard  Parker  informs 
me  that  the  two  cases  which  have  come  under  his  ob- 
servation recovered.)  In  the  collections  of  pus  which 
form  in  the  pelvic  cavity  the  bursting  of  the  abscess 
into  the  intestines  is  considered  favorable,  but  in  psoitis 
such  an  event  is  considered  unfavorable,  as  is  shown 
by  the  two  cases  already  mentioned. 

Treatment. — As  soon  as  the  patient  complains  of  pun 
along  the  track  of  the  psoas  muscle,  and  other  circum- 
stances enable  us  to  predict  inflammation,  general  bleed- 
ing is  recommended,  repeated  applications  of  leeches 
"■" '  O' 


THE  MEDICAL  RECORD. 


437 


and  cupe  to  the  loins  and  groin,  fomentations,  frictions 
with  mercury,  ammonia,  iodine,  etc.  Finally,  blisters 
and  cauteries  may  be  employed.  If  suppuration  takes 
place,  the  painful  parts  should  be  covered  with  warm 
poultices;  and  constipation  should  be  relieved  by  a  pur- 
gative or  laxative.  If  the  abscess  points  at  the  sur- 
fiice,  it  should  be  opened. 

CASE  OP  POISONING  BY 

ALCOHOLIC  EXTRACT  OF  BELLADONNA. 

Bt  H.  a  DUBOIS,  M.D., 

ABSmxm  SCBGBOX,  U.S.  A. 

As  the  following  case  presents  several  points  of  in- 
terest^ I  transmit  it  with  but  few  comments : 

December  28,  1866,  feeling  indisposed,  I  ordered  for 
myself:  Sulph.  Quin^  grs.  v. :  ext  coloc.  co.,  grs.  x. ;  pil. 
mass,  hyd.,  v. :  M.  FL  piL  No.  iv. 

I  received  tne  four  piUs,  two  of  which  I  at  once  took, 
and  soon  afler  retired  (about  eleven  p.m).  I  slept  but  little, 
but  was  not  very  restive,  and  did  not  observe  anything 
peculiar  in  my  sensation^)  until  near  eight  a.m.  the  follow- 
ing mominsr,  when,  on  putting  my  foot  to  the  floor^  I 
came  near  losing  my  balance,  and  staggered  for  some  dis- 
tance across  the  room,  unable  to  support  myself  steadily, 
or  regulate  the  movements  of  my  legs.  Dressing  with 
much  difficulty,  I  managed  to  reach  the  surgery,  where, 
seating  myself,  I  commenced  prescribing  for  the  sick. 
I  now,  for  the  first  time,  found  that  I  was  unable  to 
read  the  names  on  the  sick  report,  the  page  appearing 
perfectly  blank.  Up  to  this  time  I  had  not  been  able  to 
control  my  thoughts.  On  rising,  I  remember  that  I  had 
a  faint  idea  that  something  was  wrong,  but  was  unable 
to  say  what ;  the  acts  in  putting  on  my  clothes  were 
performed  nearly  involuntarily,  the  prominent  idea 
being  the  necessity  I  was  under  of  being  punctual  at 
my  post  at  sick  calL  Not  seeing  any  names  on  the  sick 
report,  I  asked  the  steward  ihe  reason,  and  then  dis- 
covered that  I  could  not  control  the  movements  of  my 
tongue.  I  managed,  however,  to  make  myself  under- 
8to<Ml,  and  was  informed  that  the  names  were  there. 
I  remember  that  then,  by  a  strong  impulse,  I  collected 
my  thoughts  to  endeavor  to  ascertain  the  cause  of  my 
disability.  The  first  thought  which  presented  itself  was 
that  I  was  drunk,  but  thid  I  rejected,  as  I  could  not 
remember  having  drunk  any  intoxicating  liquor  the 
preceding  day.  Sext,  I  ran  over  my  actions  the  even- 
ing before,  and  I  recalled  the  two  pills  I  had  taken, 
recollected  their  composition  with  difficulty,  and  the 
thought  then  struck  me  that  as  the  extract  of  culo- 
cynth  and  extract  of  belladonna  were  both  put  up 
in  pots  much  alike,  one  had  been  mistaken  for  the 
other.  I  remember  that  I  recalled  the  amount  that  I 
had  probably  taken,  and  determined  that  I  would  pre- 
scribe for  the  sick,  if  I  could  neither  see,  speak  dis- 
tinctly, nor  stand  steadily,  before  I  retired  to  my  room. 
I  ordered  the  steward  to  caU  the  names  out,  and  when 
the  first  man  came  up  I  could  see  his  outUne,  but  could 
not  recognize  his  features.  I,  however,  remembered 
his  name  and  what  should  be  the  matter  with  him,  and 
having  his  last  prescription  read  out  I  continued  it, 
afraid  to  trust  myself  in  prescribing.  In  this  way,  with 
few  changes,  and  then  careful  to  use  the  simplest  of 
medicines,  I  saw,  or  rather  did  not  see,  some  thirty 
sick,  for  each  of  whom  I  prescribed,  or  continued  his 
former  prescription. 

I  then  returned  to  my  room  with  a  brain  whirling,  a 
dull,  heavy  pain  in  the  back  of  the  head,  and  my  mmd 
^wandering  from  time  to  time.  I  recollect  distinctly 
trying  to  collect  mv  thoughts,  and  using  the  utmost 
exertions  of  my  will  to  keep  them  fixed,  so  as  to  try  to 


remember  the  smallest  fatal  dose  of  the  extract  of  bella- 
donna, and  to  recall  all  the  symptoms  of  poisoning  from 
that  drug,  and  their  proper  treatment.  I  came  to  the 
conclusion  that  I  would  treat  myself  on  general  prin- 
ciples. I  had  some  strong  coffee  brought  and  put  before 
me,  and  drank  cupfiil  after  cupfiil  I  sent  for  whiskey, 
and  mixing  it  with  the  coffee,  I  continued  its  use, 
taking  also,  during  the  day,  several  half-grain  pills  of 
morpnise  sulph. 

This  treatment  relieved  the  giddiness.  I  found  my 
mind  ceased  to  wander,  and  though  a  vague  feeling — ^a 
feeling  of  vacuity— of  a  lack  of  something,  still  con- 
tinued, together  with  a  severe  nain  in  the  back  of  the 
head  whenever  I  tried  to  thinlc,  I  felt  better.  I  now 
tried  to  examine  my  eyes  in  a  glass,  but  could  only  see 
a  general  outline.  However,  by  going  across  to  the 
other  side  of  the  room  and  looking  at  the  glass,  I  man- 
aged to  discover  that  my  pupils  had  expanded  so  that  I 
could  see  no  iris.  As  1  now  look  back  to  this  period, 
everything — my  thoughts  and  actions — all  seem  vague 
and  misty  *  though  I  remember  them,  and  that  distinctly, 
still  the  thoughts  seemed  to  have  formed  themselves 
under  the  power  of  a  strong  effort  of  the  will,  and  that 
the  least  relaxed,  the  thought  would  escape.  So  too, 
with  my  actions.  In  walking,  I  can  remember  that  on 
fixing  one  foot  on  the  ground,  it  required  an  effort  of 
the  will  to  raise  the  other,  and  much  judgment  in  so 
placing  it  that  the  body's  centre  of  gravity  was  pre- 
served. My  arms  and  legs — but  the  latter  not  to  the 
same  extent — felt  numb  and  cold  to  my  touch.  With 
great  difficulty  I  held  anything  in  my  hands.  By  noon, 
or  four  hours  since  I  first  noticed  the  effects  of  the  poison, 
I  was  able  to  visit  and  prescribe  for  some  twenty  pa- 
tients in  hospital,  but  returned  greatly  exhausted  This 
state  continued  all  the  afternoon  and  evening,  and  I 
passed  a  sleepless  night;  my  mind  wandering,  and 
vague  and  misty  visions  presenting  themselves.  Fur 
two  days  my  vision  continued  much  impaired,  and  then 
it  gradually  became  normal  as  the  pupils  resiuned  their 
usual  si^. 

While  my  vision  was  most  impaired,  I  noticed  objects 
nearly  as  well  as  ever  a  mile  or  two  out  on  the  prairie, 
though  if  I  looked  attentively,  the  effort  became  ex- 
ceedingly painfuL  The  action  of  the  brain  slowly 
became  normal.  Exertion  of  any  kind — even  the  read- 
ing of  the  simplest  book-— caused  intense  fatigue,  and  a 
dull  heavy  pain  in  the  back  of  the  head.  These  symp- 
toms, together  with  great  lassitude,  continued  for 
between  two  and  three  weeks.  There  are  a  few  symp- 
toms that  I  have  neglected  to  mention.  Colicky  pains, 
and  dryness  of  mouth  and  throat  presented  themselves 
on  the  second. day.  The  dejections  for  several  days 
were  dark  colored,  and  extremely  offensive,  and  the 
ur'ne  was  voided  frequently  and  in  large  quantities. 
Some  days  after  these  symptoms,  I  notio^  on  my  hand 
a  large  red  blotch,  which  disappeared  on  pressure,  and 
which  in  the  course  of  a  week  faded,  leaving  the  skin 
rough.  For  two  months  I  felt  lassitude,  and  but  little 
mental  exertion  was  required  to  bring  back  the  pecuUar 
feeling  in  the  head. 

I  have  described  this  case  with  minuteness,  as  its 
chief  point  of  interest  seems  to  me  to  reside  in  the 
control  the  will  appears  to  have  had  over  the  cerebrum, 
constantly  bringing  the  mind  under  contarol,  and  holding 
it  to  its  work ;  and  in  the  remembrance  of  things,  and 
theur  appearance,  seen  with  a  brain  and  through  optic 
nerves  poisoned  with  belladonna. 

In  conclusion,  I  will  only  add  that  the  amount  of 
poison  taken  was  five  graina  The  preparation  used 
was  Squibb's  ale.  ext,  and,  as  I  had  supposed,  it  had 
been  used  for  the  ext.  coloc.  co.  by  the  soldier  whom 
I  had  been  compelled  to  nse  as  a  steward^  ^ 

Digitized  by  VjOOQ  IC 


438 


THE  MEDICAL  RECORD. 


©ttginal  Cetture«. 


LECTURES  UPON  THE 

PHYSICAL    EXPLORATION    OF   THE 

ABDOMEN. 

DBLrVKRED  W  THB  PBELTMIN^RT  OOURSB  AT  THE   MEDICAL 
DEPARTMENT  OF  THB   UNIVERSITY   OF  NEW  YORK. 

By  ALFRED  L.  LOOMIS,  M.D.^ 

rBorsasom  or  institutbs  akd  pbaotios  of  ifXDionnL 
Lecture  II. 

physical  signs  of    DISEASED    CONDITIONS  OP    THE    LIYBB 
AND  8PLEE.V. 

Gentlemen — I  will  endeavor  this  morning  to  detnil 
to  you  the  phvsical  signs  by  which  we  determine  tiie 
changes  that  take  place  in  the  liver  and  spleen  during 
the  progress  of  disease.  I  will  commence  with  the 
LIVER :  Our  diagnosis  in  any  case  of  hepatic  disease 
rests  mainly  on  the  size,  form,  and  position  of  the  liver, 
as  determined  by  percussion  and  palpation.  The  first 
step  then  in  studying  the  physical  signs  indicative  of 
disease  of  this  organ  is  to  become  familiar  with  its 
normal  boundaries.  In  its  healthy  state,  the  right  lobe  of 
the  liver  occupies  the  right  hypochondrium,  lying  com- 
pletely in  the  hollow  formed  by  the  diaphragm,  rarely 
descending  below  the  free  border  of  the  rib?,  or  ex- 
tending upwards  above  the  fifth  Intercostal  space ;  the  left 
lobe  reaches  across  the  median  line  to  the  space  below 
the  ensifurm  cartilage. 
The  upper  boundary  of  the  organ  is  determined  by 

Sercussing  with  moderate  force  from  the  right  nipple 
ownwards  until  the  flatness  of  the  percussion  sound 
indicates  that  a  solid  organ  has  been  reached ;  draw  a 
line  at  this  point.  Then  percuss  downwards  from  the 
axilla,  and  from  a  point  a  little  to  the  right  of  the  me- 
dian line  in  front,  in  the  same  manner,  until  the  same 
change  occurs  in  the  percussion  sound ;  a  line  drawn 
through  the  points  which  mark  these  changes  in  the 
percussion  sound,  determines  the  upper  boundary  of  the 
liver,  and  it  will  be  found'  generally  to  correspond  to 
the  base  of  the  ensiform  cartilage  6n  the  median  line 
in  front ;  to  the  fil\h  intercostal  space  on  the  line  of 
the  right  nipple ;  to  the  seventh  rib  in  the  axillary  re- 
gion, and  to  the  ninth  rib  in  the  dorsal  region.  The 
lower  boundary  of  the  organ  is  determined  by  percuss- 
ing downwards  from  the  Sne  of  flatness  already  deter- 
mined, and  noting  the  points  where  the  tympanitic 
sound  of  the  stomach  and  large  intestine  occuris,  which 
will  generally  be  found  to  correspond  anteriorly  with 
the  free  border  of  the  ribs,  and  to  a  point  three  inches 
below  the  ens'form  cartilage  on  the  median  line ;  later- 
ally in  the  axillatjr  region  to  the  tenth  intercostal 
space*  and  postenorly  in  the  dorsal  region  to  the 
twelfih  rib.  The  flatness  of  the  left  lobe  usualbr  reaches 
two  inches  to  the  lei't  of  the  median  line.  The  whole 
margin  of  the  liver  (except  where  it  comes  in  contact 
vvith  the  apex  of  the  heart  through  the  medium  of  the 
diaphragm)  may  thus  be  determined  and  marked  out  on 
the  surface.  The  vertical  measurements  will  be  found 
very  nearly  as  follows :  three  inches  on  the  right  of 
the  rnedian  line  in  front,  four  inches  on  a  line  with 
the  right  nipple,  four  and  one-half  inches  in  the  axil- 
lary region,  and  four  inches  posteriorly  in  the  dorsal 
region.  The  smooth  edge  of  the  lower  margin  of  the 
liver  in  health  (especially  in  thin  subjects)  can  be  dis- 
tinctly felt  underneath  the  free  b'^rder  of  the  ribs. 

The  healthy  liver  in  its  normal  position  evidently  in- 
fluences very  little  the  percussion  sound  over  the  lower 


half  of  the  abdomen,  which  (as  has  already  been  stated), 
when  the  organs  there  situated  are  normal  and  empty, 
yields  tympanitic  resonance  from  immediately  below 
the  margin  of  the  ribs  to  the  pubes;  if)  therefore,  the 
percussion  sound  is  dull  over  any  portion  of  this  space, 
and  the  dulness  is  uninterrupted  to  the  margin  of  the 
ribs  on  the  right  side,  we  have  good  reason  for  believing 
that  the  liver  is  the  organ  diseased. 

The  normal  laundarie$  of  the  liver  already  defined 
may  be  great'y  altered  w  ithout  any  abnormal  change 
occurring  in  the  organ  itself  These  normal  changes, 
unless  remembered,  may  lead  to  errors  in  diagnosis. 
Thus  congenital  ma'formations  may  give  rise  to  an  in- 
crease in  the  area  of  hepatic  dulness ;  an  accurate  his- 
tory of  the  patient,  however,  will  keep  us  from  error  in 
such  cases. 

In  examination  of  children,  it  should  also  be  remem- 
bered that  the  liver  is  proportionally  larger  than  in 
adults. 

The  practice  of  tight-lacing  may  cause  displacements 
and  malformation  of  the  liver,  and  thus  give  rise  to  ap- 
parent hepatic  enlargements.  The  marks  which  this 
practice  leaves  on  the  chest  wall  will  be  sufficient  to 
attract  our  attention,  and  so  prevent  mistake. 

Diseases  of  the  thoracic  organs,  and  abnormal  condi- 
tions of  the  other  abdominal  viscera,  sometimes  cause 
displacement  of  the  liver,  simulating  vei-y  closely  hepat- 
ic enlargement ;  these  we  will  consider  under  the 
head  of  differential  diagnosis  of  the  diseases  of  the  liver. 

Variations  in  the  size  of  the  liver  in  hepatic  diseases. — 
Variations  in  the  size  of  the  liver  occur  in  almost  every 
disease  to  which  it  is  subject  It  is  increased  in  size  in 
faiiy  liver,  in  wawy  liver ,  in  hydatid  tumor,  in  ahs<x9s  of 
liver  J  in  congestion,  in  acute  hepatitis,  in  ohsirudion  of  the 
bile  ducts  J  and  in  cancer. 

It  is  diminished  in  size  in  cirrhosis,  and  in  eicuis 
atrophy. 

Enlargements  of  the  liver  were  divided  by  Dr. 
Bright  into  smooth  and  irregular.  Dr.  Murchesson  has 
divided  them  into  painless  and  painful  enlargements. 
Both  of  these  divisions,  it  seems  to  me,  have  their  ob- 
jections, and  in  giving  the  physical  signs  of  the  various 
diseases  accompanied  by  enlargement  of  the  organ,  it 
is  hardly  practicable  to  adopt  either  of  them  exclu- 
sively. 

Fatty  Liver. — In  fatty  degeneration  of  the  liver 
the  organ  is  imiformly  enlarged ;  there  are  no  circum- 
scribed bulgings  ;  its  normal  shape  is  unaltered ;  there 
is  no  expansion  of  the  lower  ribs,  it  never  gives  rise  to 
ascites,  and  it  is  not  attended  bv  anv  visible  enlarge- 
ment of  the  superficial  veins.  In  palpation  below  the 
margin  of  the  ribs  on  the  right  side,  and  in  the  epigas- 
trium, a  soft  cushion-like  enlargement  is  readily  detect- 
ed, extendingnotunfiequently  as  low  as  the  umbilicus; 
its  outer  surface  is  smooth,  and  its  lower  margin  is 
rounded  and  not  well  defined;  it  is  never  tender  on 
pressure.  On  percussion  there  is  flatna«s  over  the  sur- 
foce  of  the  abdomen,  corresponding  to  the  enlargement 

Waxy  Liver, — In  waxy  or  amyloid  degeneration,  the 
organ  undergoes  greater  enlargement  than  in  fklty  de- 
generation ;  it  often  becomes  so  large  as  to  fill  the  whole 
abdominal  cavity;  its  growth  is  slow,  usually  extending 
over  a  period  of  two  or  three  years.  The  enlargement 
is  uniform,  and  the  area  of  hepatic  dulness  is  conse- 
quently increased  on  percussion  in  every  direction, 
more  however  in  firont  than  behind  There  is  often  on 
inspection  a  visible  tumor  below  the  margin  of  the  ribs, 
but  there  is  no  bulging  of  the  ribs  themselves.  On 
palpation,  the  portion  of  the  organ  below  the  ribs  is 
dense,  firm,  and  resistant,  the  outer  surface  is  smooth, 
the  lower  margin  is  sharp  and  well  defined.  Pain  and 
tenderness  are  rarely  present,  so  that4he  porticp  of  the 
digitized  by  LjOOgle 


THE  MEDICAL  RECORD. 


4391 


organ  below  the  ribs  (as  in  fatty  degeneration)  can  be 
manipulated  without  giving  the  patient  any  incon- 
Tenience.  When  excessive,  it  is  almost  always  accom- 
panied by  ascites. 

Hydakd  Tamor  of  the  Liver, — ^Hydatid  cysts, 
when  small  or  deep-seated,  cannot  be  detected  by  phys- 
ical examination;  but  large  and  superficially  seated 
hydatid  cysts  are  recoj^ized  by  abnormal  increase  in 
the  area  of  hepatic  dulness,  the  outline  of  the  dulness 
being  irregular,  and  by  the  globular  form  of  the  en- 
largement on  the  surface  of  the  organ.  Sometimes 
^ese  cysts  are  so  large  as  to  cause  the  organ  to  fill  a 
large  portion  of  the  abdominal  and  right  pleural  cavity ; 
the  natural  form  of  the  organ  is  greatly  altered,  the 
enlargement  taking  place  more  in  one  direction  than  in 
another.  Sometimes  percussion  over  a  large  hydatid 
cyst  will  give  rise  to  a  characteristic  vibration  (known 
as  hydatid  firemitus) ;  this  vibration  is  produced  by  the 
collision  of  the  smaller  cysts  that  are  contained  in  a 
large  one.  A  hydatid  liver  encroaching  on  the  thoracic 
^Nice  gives  rise  to  flatness  on  percussion,  and  absence 
of  respiratory  sound,  from  the  base  of  the  chest  up- 
wards as  far  as  the  tumor  extends,  the  upper  boundary 
of  the  flatness  being  arched.  It  is  distinguished  firom 
pleuritic  effusion  in  that  a  change  in  the  position  of  the 
body  does  not  change  the  line  of  percussion  dulness. 
On  palpation  sometimes  the  enlarged  portion  below  the 
ribs  has  an  elastic  or  even  fluctuating  feel,  and  if  a  large 
cyst  be  near  the  surface  it  may  give  rise  to  a  sense  of 
fluctuation;  the  surface  over  these  enlargements  is 
smooth,  and  the  organ  is  not  tender  on  pressure,  and  its 
growth  is  slow. 

Abscess  of  the  Liver. — When  hepatic  abscesses  exist, 
from  whatever  cause,  it  depends  entirely  upon  their  sit- 
uation, whether  an  external  tumor  is  produced  or  not ; 
if  the  abscess  occupies  the  posterior  portion  of  the  right 
lobe,  the  liver  is  pushed  down  so  that  its  margin  is 
perceptible  below  the  free  border  of  the  ribs,  and  the 
flatness  on  the  right  side  posteriorly  extends  higher 
than  natural.  When  an  abscess  is  superficial  and  is 
pointing  externally,  a  distinct  tumor  is  felt  below  the 
ribs ;  the  situation  of  the  tumor  varies  according  as  the 
right  or  left  lobe  is  affected,  and  there  is  always  more 
or  less  bulging  of  the  ribs  if  the  right  lobe  is  affected. 
A  tumor  arising  from  such  a  cause  is  easily  traced  as 
connected  with  the  liver,  of  which  it  evidently  forms  a 
part,  the  flatness  on  percussion  being  continuous. 
Sometimes  the  organ  is  enormously  enlarged,  its  free 
border  extending  below  the  umbilicus,  the  surface  of 
the  enlargement  being  smooth,  and  excessivtly  tender  on 
pressure.  The  sensation  to  the  examiner  on  making 
light  pressure  will  be  soft  and  fluctuating,  or  that  of 
elastic  tenderness.  In  some  rare  instances,  abscesses 
produce  an  uneven  or  lobulated  condition  of  the  sur- 
face ;  under  guch  circumstances,  it  may  be  mistaken  for 
cancer,  unless  the  rational  svmptoms  and  history  of  the 
case  be  included  in  the  elements  of  diagnosis.  The 
enlargement  goes  on  rapidly ;  with  a  correct  history  of 
the  case  the  diagnosis  is  easily  made. 

Congestion  of  the  Liver, — ^The  most  simple  form  of 
hepatic  enlargement  is  that  which  results  from  con^s- 
tion.  When  the  liver  is  thus  loaded  with  blood,  a  slight 
Iblness  is  perceptible  on  the  right  side.  On  palpntion 
the  space  immediately  below  the  ribs  is  occupieci  by  a 
smooth,  hard,  resi'tting  enlargement,  corresponding  to 
the  natural  shape  of  the  liver,  which  is  not  usually  ten- 
der to  pressure,  and  there  is  no  well  defined  tumor. 
On  percussion  a  flat  sound  is  elicited  an  inch  or  two  be- 
low the  margin  of  ribs  on  the  right  side. 

Obstruction  of  the  Bile-<tucts, — A  similar  enlargement 
of  the  liver  to  the  one  just  noticed  occurs  when,  from 
any  caose,  there  is  obstruction  in  the  biUary  ducts,  and 


an  accumulation  of  bile  takes  place  in  the  liver.  Some- 
times when  this  ocotirs,  in  addition  to  the  general  en- 
largement detected  by  the  slight  uniform  increase  in 
the  normal  area  of  hepatic  dulness,  a  globular  projec- 
tion is  detected  at  a  point  corresponding  to  the  trans- 
verse fissure  of  the  liver,  with  the  elastic  feel  of  deep- 
seated  fluid ;  this  tumor  is  the  distended  gall-bladder. 

Aciite  Hepatitis, — The  physical  signs  of  acute  hepatitis 
do  not  differ  materially  from  those  of  simple  congestion, 
except  in  the  excessive  pain  that  exists  on  pressure 
over  that  portion  of  the  organ  which  descends  below 
the  ribs. 

Cancer  of  the  Liver. — In  most  cases  of  cancer,  the 
diagnosis  is  easily  made  by  the  physical  signs. 

un  percussion^  the  area  of  the  hepatic  dulness  is 
always  increased,  sometimes  extremely  so ;  the  organ  is 
found  to  occupy  the  greater  portion  of  the  epigastrium, 
extending  beyond  the  median  line  to  the  left  hypo- 
chondrium  (pushing  the  diaphragm  upwards),  and  often 
descending  below  Uie  ribs  to  the  crest  of  the  ilium. 

On  palpation^  irregular  nodules  of  various  sizes  are 
distinctly  felt  through  the  abdominal  walls,  projecting 
from  the  surface  of  that  portion  of  the  enlarged  organ 
which  is  below  the  free  border  of  the  ribs;  these  promi- 
nences are  usually  harder  than  the  surrounding  hepatic 
tissue,  and  there  is  more  or  less  tenderness  on  pressure 
over  them.  Cancer  of  the  liver  may  or  may  not  be 
accompanied  by  ascites.  Occasionally  the  surface  of 
the  liver  in  cancer  is  perfectly  smooth,  and  in  such  cases 
you  will  be  unable  to  detect  the  disease  by  the  physical 
signs. 

DirmnvMon  in  the  Size  of  the  Liver, — The  liver  is  dimin- 
ished in  size  in  cirrhosis,  and  in  acute  atrophy. 

Cirrhosis  of  the  Liver, — In  fully  developed  cases  of 
cirrhosis  of  the  liver,  the  organ  is  always  diminished  in 
size,  and  there  is  more  or  less  abdominal  dropsy.  The 
only  evidence  of  this  disease  furnished  by  inspection,  is 
a  visible  enlargement  of  the  superficial  veins. 

Percussion. — The  area  of  the  normal  hepatic  flatneas 
is  diminished^  and  its  limits  are  determined  as  follows : 
If  the  abdominal  cavity  is  distended  with  dropsical  ac- 
cumulation, the  patient  should  be  placed  partly  on  the 
left  side,  so  that  the  fluid  will  gravitate  from  the  hepatic 
region  ;  the  percussion  flatness  then,  instead  of  extend- 
ing to  the  free  border  of  the  ribs,  will  often  give  place 
to  tympanitic  resonance  an  inch  or  more  above  their 
free  margin,  and  instead,  also,  of  extending  across  the 
median  line  into  the  left  hypochondrium,  will  rarely 
reach  that  line,  while  the  vertical  measurement  of 
hepatic  dulness,  on  a  line  with  the  right  nipple,  often 
does  not  exceed  two  and  a  half  inches. 

Palpation. — ^By  firm  pressure  with  the  ends  of  the 
fingers  upwards^  httle  nodules  will  often  be  felt  on  the 
under  surface  of  the  organ.  Sometimes,  when  the  dis- 
tension of  the  abdomen  from  the  dropsical  accumulation 
has  been  very  great,  we  can  get  no  information  by 
palpation  until  after  the  performance  of  paracentesis. 

Atrophy  of  the  Liver. --The  only  physical  sign  of 
atrophy  of  Uie  liver  is  progressive  diminution  in  the 
size  of  the  organ  as  ascertained  by  percussion,  its  surface 
remaining  smooth,  the  diminution  not  being  accom- 
panied with  ascites. 

Differential  Diagnosis  of  Diseases  of  the  Liver. — ^The 
sources  which  may  lead  to  error  in  the  conclusion  that 
the  liver  is  the  seat  of  disease  when  ii  is  not,  are — first, 
accumulations  in  the  ascending  and  transverse  colon ; 
diseases  with  enlargement  of  the  right  kidney ;  diseases 
of  the  stomach ;  displacement  of  the  liver  by  disease  in 
the  right  side  of  the  chest ;  enlargement  of  the  spleen ; 
tumors  of  the  omentum,  and  ovarian  tumors. 

FcBccU  Accumulations, — To  distinguish  these  accumu- 
lations from  enlargement  of  the  liver  by^ physical  ex- 
Digitized  by  \sjOO^  ^  _ 


440 


THE  MEDICAL  RECORD. 


amination  is  always  difficult  and  sometimes  impossible ; 
they  give  rise  to  a  distinct  tumor  bi  low  the  border  of 
the  ribs^  which,  by  percussion  and  palpation,  seems  to 
be  contmuous  and  connected  with  the  liver.  The  dif- 
fen-ntial  diagnosis  can  only  be  made  afler  making  trial 
of  remedies  which,  by  acting  freely  on  the  bowels,  re- 
move the  accumulation  and  cause  the  disappearance  of 
the  supposed  hepatic  enlargement. 

Disease  of  the  Right  Kidney, — The  right  kidney  Fome- 
times  enlarges  in  such  a  inanner  as  to  present  itself  as  a 
tumor,  extending  from  the  under  suiface  of  the  right 
lobe  of  the  liver.  If  it  has  attained  considerable  size,  it 
may  therefore  seem  to  be  continuous  wiih  the  liver  as 
a  growth  from  its  substance.  It  may  be  distinguished 
from  the  liver  by  carefully  examinins:  its  relation  to  the 
ribs;  as  the  patient  lies  on  his  back,  the  enlargement, 
instead  of  passing  up  under  the  ribs,  slips  down,  so  as 
to  allow  the  finger  to  pass  verticaUy  between  the  tumor 
and  ribs. 

Disease  of  the  StomcuiK — The  only  disease  of  the 
stomach  which  we  are  likely  to  confound  with  en- 
largement of  the  liver  is  cancer.  It  can,  however, 
usually  be  readily  distinguished  from  it  by  the  tympan- 
itic quality  of  the  percussion  sound  over  the  cancerous 
mass,  and  by  the  mobility  of  the  supposed  enlargement. 

Displacements  of  the  liver  downwards  from  extensive 
pleuritic  effusion  and  from  pneumothorax  are  recognized 
by  the  piesence  of  the  physical  signs  which  indicate 
these  thoracic  diseases. 

Enlargement  of  the  spleen^  and  ovarian  tumors,  are 
distinguished  from  enlargements  of  the  Uver  by  the  shape 
of  the  tumor,  and  by  the  continuous  and  increasing 
flatness  of  the  percussion  sound  as  we  pass  towards  the 
normal  position  of  these  organs. 

Spleen. — The  spleen,  from  the  obscurity  which  in- 
volves its  natural  function,  so  that  its  affections  usually 
give  rise  to  but  negative  general  symptoms,  and  from 
its  comparatively  isolated  situation,  often  presents 
greater  difficulties  in  the  diagnosis  of  its  morbid  con- 
ditions than  is  the  case  with  any  other  abdominal  organ. 
In  health  this  organ  occupies  the  upper  portion  of  the  left 
hypochondriac  region,  its  lower  border  touches  the  lefl 
kidney,  while  its  convex  surface  occupies  the  concavity 
of  the  diaphragm.  It  is  bounded  superficially,  above, 
by  the  lower  border  of  the  ninth  rib,  anteriorly  by  the 
stomach  and  colon,  and  inferiorly  by  the  free  margin  of 
the  tibs.  It  is  about  four  inches  long  and  three  inches 
wide.  In  its  healthy  condition,  inspection  and  palpa- 
tion furnish  only  negative  results. 

Percussion. — To  determine  the  boundaries  of  the  epleen 
by  percussion,  it  is  necessary  that  the  patient  should 
lie  on  the  right  .^^ide.  Its  anterior  border  is  readily  de- 
termined by  the  tympanitic  resonance  of  the  stomach 
and  intestines.  Posteriorly,  where  the  organ  comes  in 
contact  with  the  kidney,  it  is  difficult  and  oft«n  impos- 
sible to  determine  its  boundary.  Its  superior  border 
corresponds  to  the  line  which  marks  the  change  from 
flatness  to  pulmonary  resonance.  The  inferior  is  known 
by  the  tympanitic  resonance  of  the  intestine. 

In  disease  the  spleen  may  be  increased  or  diminished 
in  size.  We  are  rarely,  if  ever,  able  to  recognize 
atrophy  of  the  spleen  during  lile.  In  most  cases  of 
splenic  disease  there  is  neither  pain  nor  tenderness. 
The  only  reliable  physical  signs  of  disease  of  the  organ 
are  connected  with  iis  enlargements.  The  tumor  pro- 
duced by  the  enlargement  of  the  organ  can  scared}^  be 
overlooked.  Its  diaracteristics  are  a  smooth,  oblong, 
solid  heap,  felt  immediately  beneath  the  integuments, 
extending  from  under  the  ribs  on  the  left  side,  a  little 
bc^hiiid  the  origin  of  the  cartilages,  often  advancing  to 
the  median  line  in  one  direction,  and  descending  to  the 
crest  of  the  ilium  in  the  other,  filling  the  left  lumbar 


region  at  its  upper  part  This  tumor  is  unially  movable, 
rounded  at  its  upper  portion,  and  presenting  an  edge 
more  or  less  sharp  in  fi-ont,  where  it  is  often  notched 
and  fissured.  According  to  Dr.  Bright,  the  principal 
tumors  which  may  be  mistaken  for  an  enlarged  spleen 
are — chronic  abscess  of  the  integuments,  cancer  of  the 
stomach,  enlargement  of  the  left  lobe  of  the  liver,  dis- 
eased omentum,  fecid  accumulation  in  the  colon,  disease 
of  the  left  kidney,  and  ovarian  disease. 

Chronic  ahscess  of  the  integument  sometimes  occurs 
precisely  in  the  situation  of  an  enlarged  spleen,  but  it  is 
easily  distinguishable  fi*om  it  bv  the  superficial  charac- 
ter of  the  swelling,  and  by  its  being  too  soft  to  belong 
to  an  internal  viscus. 

Cancerous  deposit  in  the  cardiac  extremity  of  the 
stomach  sometimes  gives  rise  to  a  tumor  which,  from 
its  being  deeper  than  the  abdominal  walls,  and  descend- 
ing from  the  margin  of  the  ribs,  might  be  mistaken  for 
an  enlarged  spleen.  One  of  the  best  marks  will  be 
found  in  the  sound  elicited  by  fcrcible  percussion,  which, 
when  the  stomach  is  diseased,  has  more  or  less  of  a 
tympanitic  resonance,  while  the  tumor  is  harder  to  the 
feel  than  an  enlarged  spleen. 

Enlarged  left  Me  of  ^  liver  is  easily  distinguished 
froni  enlarged  spleen,  for  the  mar^n  of  the  tumor  can 
be  traced  runnmg  towards  the  nght,  and  not  towards 
the  left  as  is  the  case  with  enlarged  spleen. 

Cancerous  and  tuberculous  enlargements  of  the  omen" 
turn  are  distinguished  from  an  enlarged  spleen  by  the 
fact  that  they  extend  across  the  abdomen  and  cannot 
be  traced  backwards ;  they  do  not  descend  from  be- 
neath the  ribs,  and  are  rough,  hard,  and  uneven. 

FcBcal  accumulation  in  the  intestine  is  a  source  of 
very  great  difficulty  in  this  diagnosis,  for  when  it  takes 
place  in  the  descending  colon,  at  the  sigmoid  flexure, 
the  enlargement  assumes  very  nearly  the  siruation  of 
an  enlarged  spleen,  and  is  scarcely  to  be  distinguished 
from  it  except  by  its  peculiar  feet,  by  its  history,  and 
by  the  result  of  cathartics ;  nor  must  one  without  the 
most  persevering  employment  of  purgatives  and 
emetics,  conclude  that  the  mtestines  have  been  emptied. 

The  kidney  sometimes  enlarges  towards  the  left  hypo- 
chondrium,  and  \  resents  a  tumor  very  ncM-ly  in  the  situa- 
tion of  an  enlarged  spleen ;  but  by  tracing  it  back  towards 
the  loins,  we  shall  find  that  its  chief  bulk  is  situated 
much  farther  back,  and  that  it  is  much  more  fixed,  so 
that  if  the  patient  is  placed  on  his  hands  and  knees 
it  does  not  fall  forward.  By  observing  the  rules  (which 
I  shall  give  you  at  my  next  lecture)  for  the  diagnoeos  of 
ovarian  tumors,  you  will  easily  distinguish  them  from 
enlarged  spleen. 


The  ErrKCT  of  Musio  on  the  Insane. — Dr.  Boyd,  in 
his  nineteenth  report  on  the  Somerset  Lunatic  Asylum, 
determines  affirmatively  the  vexed  question  of  the  pro- 
piiety  of  amusements  for  the  insane,  and  of  the  effect 
of  music  on  the  insane.  He  writes :  "  For  a  belief  in 
the  wonderfully  soothing  effects  of  music  on  the  insane 
we  have  the  authority  of  Holy  Writ^  in  the  case  of  King 
Saul ;  and  the  Greeks  and  Romans  were  eq^ually  aware 
with  the  Jews  of  its  power.  In  modem  tunes  the  ef- 
fect which  the  *  Ranz  de  Vaches  *  produces  on  the  Swiss, 
and  the  '  Reel  of  Tullochgorum  *  on  the  Highlanders,  is 
well  known.  Music  is  said  by  Esquirol  to  act  upon  the 
physical  system  by  producing  ^ntle  shocks  upon  the 
nerves,  quickening  the  circulation.  It  acts  upon  the 
mind  in  fixing  the  attention  by  mild  impressions,  and  in 
exciting  the  imagination  by  agreeable  recollections.  It 
is  a  vuuable  remedial  agent,  particularly  in  cun vales* 
cence." — British  Medical  Jowmal,  ^^  j 

digitized  by  LjOOgle 


THE  MEDICAL  BECOBD. 


441 


|>r00«««  0f  MtVxtai  Science. 

Prevkntion  of  Sickness  from  Chloroform.  —  A 
writer  in  the  British  Medical  Journal  believes  that  a 
few  drops  of  chloroform  in  water,  given  as  a  drink  to 
patients  previous  to  their  being  anaesthetized,  effectually 
counteracts  the  tendency  to  vomit,  which  is  so  annoy- 
ing an  accompaniment  to  most  operations.  The  remedy 
has  at  least  tne  claim  of  simplicity,  and  deserves  to  be 
tried. 

New  Method  of  Expbllimq  TiSNiA. — Dr.  Lartet 
(Oatstte  MidicaHe  de  Paris)  has  tried  with  success  the 
following  method :  He  gives  in  one  dose  20  grammes  of 
ether,  followed  two  hours  aHerwards  by  30  grammes  of 
castor  oil  "  The  worm  is  discharged  without  causing 
pain,  entire  or  almost  so,  and  always  with  the  cephalic 
end  intacf 

Alcohol  unkeoessart  in  the  Treatment  of  Inebri- 
ates — Dr.  Day,  Superintendent  of  the  New  York  State 
Inebriate  Asylum  at  Bingham  ton,  says  in  a  recent  let- 
ter: "During  the  last  ten  years  I  have  had  under  my 
care  over  two  thousand  five  hundred  cases  of  inebriety, 
in  all  its  various  forms  and  conditions.  More  than  four 
hundred  of  these  had  delirium  in  its  various  stages.  In 
the  first  years  of  my  connection  with  the  asylum  for 
the  treatment  of  their  cases,  I  embraced  ^  common 
error  that  liquor  could  not  with  safety  be  entirely  with- 
drawn from  the  habitual  diinker.  After  two  or  three 
years  of  observation,  I  found  this  was  an  error.  ♦  *  ♦ 
I  found,  on  trial,  that  my  patients  did  much  better  by 
withdrawing  alcohol  altogether,  never  allowing  even 
alcoholic  tinctures  of  any  kind  to  be  given.  Since  I 
have  been  connected  with  this  institution  (about  five 
months)  I  do  not  think  I  have  given  one  drop  of  alco- 
hol in  any  shape  to  a  patient.  *  *  *  A  man  may 
habitually  drink  his  quart  of  liquor  or  more  per  day,  as 
most  habitual  drinkers  do.  Confine  such  a  man  in  some 
place  and  put  him  upon  an  allowance  of  one  half  his 
usual  quantity,  and  he  will  suffer  more  than  he  will 
to  cut  him  off  entirely.  I  have  tried  this  in  a  lar^e 
number  of  cases,  and  mive  satisfied  myself  fi^om  actual 
observation.** 

Solvents  for  Cholbsterine. — Dr.  Buckler,  of  Balti- 
more, was  consulted  by  a  lady,  who  had  always  enjoyed 
good  health  up  to  the  time  of  an  attack  of  pain  in  the 
right  hypochondrium,  amounting  at  times  to  positive 
anguish.  An  examination  revealed  an  irregular  indurat- 
ed tumor,  felt  through  the  walls  of  the  abdomen,  and 
directly  over  the  inferior  margin  of  the  liver.  The 
tumor  was  finally  decided  to  be  a  distended  gall-bladder 
filled  with  biliary  calculi.  A  teaspoonful  of  chloroform 
was  given  by  the  stomach  every  hour  while  the  pain 
lasted,  and  a  teaspoonful  after  each  meal  for  five  days 
longer,  when  the  tumor  described  entirely  8ubside<l, 
affording  unmistakable  evidence  that  the  gall  stones, 
none  of  which  were  found  in  the  stools,  had  entirely 
dissolved  by  the  use  of  the  chloroform.  An  attack  of  the 
same  nature  as  the  former  one  coming  on  three  months 
af^er,  chloroform  was  again  used,  with  the  same  re- 
sult as  before.  It  being  desirable  to  administer  some 
agent  capable  of  controlling  the  cholesterine  diathesi^ 
succinic  acid  and  peroxide  of  iron  were  prescribed  as 
follows :  3  Hydrated  succinate  of  peroxide  of  iron, 
I  i?8.;  water,  |  visa. ;  and  of  this  a  teaspoonfiil  afer 
each  meal.  The  patient  took  of  this  six  months  with 
no  recurrence  of  tne  attack,  and  has  continued  to  enjoy 
excellent  health.  Three  other  cases  treated  with  chloro- 
form were  promptly  relieved. — Am,  Journal  of  AM, 
Science, 


On  the  Internal  Use  of  Chlorine  Water  in  Scar* 
LATiNA  Anginosa.— By  C.  C.Lee,  M.D.,  of  Philadelphia. 
— During  an  epidemic  of  scarlatina  in  Blockly  Hospital, 
Philadelphia,  the  ordinary  treatment  seeming  incapable 
of  arrest mg  the  anginose  symptoms,  although  the  epi- 
demic was  not  characterized  by  a  specially  malignant 
type,  and  the  mortality  in  the  first  stage  was  rapidly 
increasing,  attention  was  called  to  the  efficiency  of 
chlorine  water  in  this  condition.  Eight  severe  cases— 
of  twenty-three  then  on  hand — ^were  placed  upon  this 
treatment  exclusively,  as  far  as  medication  was  con- 
cerned, milk  punch,  beef  tea,  etc.,  being  continued  as 
usual  The  result  of  this  change  after  the  first  twenty- 
four  hours  was  most  gratifying,  for  a  marked  improve- 
ment was  perceptible  m  all  the  cases,  without  exc  ption. 
The  amelioration  was  first  observed  in  the  throat,  where 
the  sloughing  tendency  was  rapidlv  arrested,  and  in  the 
diminished  inclination  to  coma,  while  the  febrile  symp- 
toms and  the  eruption  ran  their  course.  All  the  eight 
recovered.  Of  the  fifteen  treated  in  the  usual  way. 
four  died  during  the  acute  stage,  and  in  two  dropsical 
symptoms  intervened  during  a  protracted  convalescence, 
to  which  they  ultimately  succumbed,  leaving  nine 
recoveries.  In  a  subsequent  epidemic,  of  twenty- 
one  cases,  twelve  were  selected  at  random,  and  treated 
with  chlorine  water,  while  the  remainder  were  treated 
in  the  ordinary  wav.  Of  the  former,  two,  whose  symp-' 
toms  were  typhoid  and  mali^ant,  died  on  the  third 
day,  without  an  effort  at  reaction,  while  the  remaining 
ten  made  an  excellent  recovery.  Of  the  latter,  two 
died  on  the  fourth  and  fifth  day,  with  typhoid  symp- 
toms :  one  on  the  tenth  day ;  two  of  kidney  affection ; 
and  tne  remainder  recovered  rapidly.  As  is  seen,  the 
ratio  of  recoveries  was  almost  two  to  one  in  favor  of 
the  chlorine  treatment,  and  the  cases  were  selected 
without  reference  to  the  severity  of  the  symptoms :  in- 
deed, the  only  two  cases  of  malignant  scarlet  fever  that 
occurred,  were  included  in  this  class ;  but  the  chlorine 
was  quite  powerless  in  arresting  their  progress.  The 
chlorine  water  was  used  in  several  other  cases,  and  the 
result  was  as  gratifying  as  in  the  previous  ones  related. 
— iV.  T.  Med.  Journal, 

Tapeworm  Treated  wrrn  PirMPKiN  Seeds. — Dr.  S. 
A.  Williams  relates  the  following  history :  A  boy,  six 
years  old,  had  been  troubled  for  about  a  year  with  tape- 
worm, segments  of  which  had  been  frequently  seen  in 
his  fseces.  He  had  been  treated  with  pink  root,  calo- 
mel, etc.,  but  to  no  purpose.  He  was  directed  to  take 
fifteen  drops  of  turpentine,  in  the  form  of  an  emulsion, 
tliree  times  daily,  for  a  week,  and  ailerwards  that  two 
ounces  of  the  kernels  of  pumpkin  seeds  be  thoroughly 
ground  up  with  sugar  to  a  fine  pulp,  and  sufficient  mint 
water  added  to  make  an  emubion  of  twelve  fluid 
ounces.  This  was  taken  in  the  morning,  between  six 
and  seven,  in  divided  doses,  upon  an  empty  stomach. 
At  nine  a.m.  two  tablespoonfms  of  castor  oil  were 
given,  and  at  eleven  a.m.  the  usurper  rapidly  beat  a  re- 
treat before  the  advancing  foe,  and  twenty-one  feet> 
head  and  shoulders^  were  carefully  bottled  up;  since 
which  time  the  boy  has  rapidly  gained  in  health  and 
spirits. — Chicago  Med.  Examiner, 

Burns. — ^The  profession  is  indebted  to  Dr.  Gross  for 
the  introduction  of  white  lead  and  linseed  oU  in  the 
treatment  of  bumo.  It  is  one  of  the  very  best  applica- 
tions that  can  be  used ;  effectually  excluding  tne  air, 
and  being  always  grateful  to  the  patient  In  all  cases, 
no  matter  whether  merely  the  skin  or  the  deeper 
structures  are  involved,  white  lead  rubbed  up  with  lin- 
seed oil  to  the  consistence  of  paste  or  paint,  and  placed 
on  with  a  brush,  will  be  found  productive  of  great  re- 
lief   There  does  not  appear  to  be  anT-«isk  fiom  the 

digitized  by' 


442 


THE  MEDICAL  RSCOKD. 


ooostitatiooal  influence  of  the  lead,  though  it  has  been 
suggested,  to  counteract  anj  tendency  of  this  kind,  that 
the  patient  should  occasionally  take  a  little  sulphate  of 
magnesia. — Dr,  Affnew,  in  the  Medical  and  Surgical  Bd- 
porter, 

Sea-Sicknkss. — ^Dr.  E.  Andrews,  in  a  letter  to  the 
Chicago  Med,  Examiner,  states  that  persons  subject  to 
sea-sickness  oflen  take  a  voyage  with  entire  comfort 
after  taking  the  following  prescription:  Ten  grains  of 
bine  mass  the  night  before  embarking ;  follow  it  the 
next  morning  with  a  brisk  cathartic  of  Seidlitz  powder. 
A  voyage  at  sea  is  almost  always  constipating  in  its 
effects,  and  a  repetition  of  the  medicine  once  or  twice 
on  the  passage  may  be  necessary. 

A  New  ANJtSTHBTio. — ^Dr.  S.  P.  Yandell,  Jr.,  alludes 
to  a  new  anaesthetic,  the  properties  of  which  have  been 
lately  investigated  by  Dr.  Smith,  of  London.  He  has 
administered  tetrachtoride  of  carbon  with  happy  results 
in  a  variety  of  cases.  It  is  inhaled,  at  intervals,  to  the 
extent  of  a  drachm,  and  though  the  effect  is  transient, 
he  has  seen  relief  follow  its  use  in  headache,  dysmenor- 
rhcea,  chronic  metritis,  and  hay  fever,  tie  has  also 
used  it  in  labor,  and  found  it  a  safe  and  valuable  means 
of  mitigating  the  pains,  without  apparently  hindering 
the  natural  efforts.  In  some  cases  of  labor,  it  induces 
a  quiet  sleep,  and  removes  for  a  time  the  efforts  of  ex- 
haustion or  the  nervous  system.  In  many  respects, 
Dr.  Smith  deems  it  preferable  to  chloroform — quite  as 
safe,  j)leasanter  to  inhale,  and  producing  the  effect  de- 
sired in  smaller  quantities. — Atlanta  Med,  and  Surg, 
Journal, 

Removal  of  Stone  from  Female  Bladder  bt  Di- 
latation— Dr.  W.  B.  McGnvran  was  consulted  by  a  pa^ 
tient,  who  for  two  years  previously  had  suffered  from 
stone  in  the  bladder.  An  operation  being  determined 
upon,  the  patient  was  put  under  the  influence  of  chloro- 
form, a  sponge  tent  removed  from  the  urethra  intro- 
duced about  an  hour  previously,  and  the  Kttle  finger  pass- 
ed into  the  bladder  to  be  reassured  as  to  its  size.  The 
index  finger  was  then  substituted  for  the  little  finger, 
and  by  steady  and  continued  pressure  the  urethra  was 
dilated  sufiBlciently  to  introduce  a  pair  of  forceps  and 
seize  the  stones.  After  three  trials,  with  the  index 
finger  in  the  vagina  behind  the  stone,  it  was  removed. 
There  was  but  little  laceration  of  tne  parts,  and  the 
patient  recovered  perfectly.  The  stone  measured  one 
and  a  quarter  inches  in  length  by  seven-eighths  of  an 
inch  in  diameter,  and  weighed  one  hundred  and  fifty- 
six  grains. —  Western  Journal  of  Medicine, 

Several  Bbooveries  from  Tetanus^  have  been  re- 
cently put  on  record.  Tobacco-juice  applied  to  the 
wound  (one  case) ;  Fleming's  tinct.  aconiti  (two  cases, 
a  mare  and  a  boy);  acid,  hydrocy.  dil.  (one  case,  a 
horse) ;  and  the  extract  of  calabar  bean  (two  cases)  j 
were  the  agents  employed. — Edinburgh  Med,  Journal, 
The  Veterinarian^  Braitkwaite,  voL  liv. 

The  Relative  Advantages  of  Lithotomt  bt  the  Me- 
DLiN  akd  the  Lateral  Methods. — Dr.  Thomas  Markoe 
has  a  very  interesting  article  in  the  New  TorJe  Medical 
Journal  for  AJmiI,  1867,  on  Median  Lithotomy,  with  a 
report  of  twenty-three  successful  cases. 

He  believes  that  the  advantages  which  the  operation 
presents  are — 1st.  The  incision  being  in  the  median  line 
of  the  body,  does  not  encounter  any  large  vessels,  and 
must  therefore  be  less  liable  to  hfiemorrhage  than  the 
lateral  or  bilateral  operation.  2d.  The  incision  being  in 
the  median  line,  and  not  reaching  as  far  back  as  the 
vera  montanum,  cannot  injure  the  seminal  ducts,  and 
therefore  produce  emasculation.    3d.  With  the  finger 


in  the  rectum,  the  course  of  the  knife  can  be  most  pre- 
cisely appreciated,  and  ordinary  caution  only  is  neces- 
sary to  avoid  wounding  the  gut  in  the  first  plunge  of 
the  knife.  4th.  There  is  no  danger  that  the  incision 
may  fail  to  reach  the  bladder.  5tn.  The  deep  perineal 
fascia  not  being  invaded  by  the  knife,  deep  infiltration 
of  urine  cannot  occur.  6th.  The  prostate,  not  having 
been  divided,  retains  its  sphincter  power,  and  the  unne 
does  not  flow  fi-om  the  bladder  except  at  the  will  of  the 
patient 

Mr.  Holmes  Coote  (Lancet,  Feb.  2),  who  advocates 
the  lateral  method,  hokis  that,  in  the  unfortunate  cases, 
the  causes  of  death  depend  but  little  on  the  casualties 
attending  the  operation.  They  proceed  from  the  all- 
pervading  influence  of  morbid  changes  in  important 
parts,  such  as  the  kidney,  and  upon  the  organism 
generally.  The  median  operation  has  been  tried  at 
St.  Bartholomew's  in  various  ways,  but  none  had  ap- 
peared to  him  to  possess  any  claim  to  superiority  over 
the  lateral  operation.  The  operation  of  lithotrity  is  best 
suited  for  calculi  of  medium  size,  occurring  in  persons 
otherwise  healthy,  in  middle  or  advanced  life. 

Mr.  W.  F.  Teevan  (Brit  and  Foreign  Med.  Chir,  Re- 
view, Jan.  1867),  arrives  at  the  following  conclusions : 
1.  When  lateral  lithotomy  is  performed,  the  stone 
ought  always  to  be  cut  out,  and  not  torn  out.  2.  That 
the  median  operation  is  not  justifiable  for  the  extraction 
of  calculi  which  are  upwards  of  half  an  inch  in  diame- 
ter ;  for  if  Ihch  sized  stones  be  removed  by  that  pro- 
cess, obliteration  of  the  orifices  of  the  ejaculatory  ducts 
and  permanent  impotence  will  result 

PoisoNiNO  BT  A  Bbe-stino. — Dr.  William  O'Doniel, 
of  Marion^  Greorgia,  was  called  at  10  a.m.  to  see  a  gen- 
tleman of  feeble  constitution,  who,  about  half  an  hour 
previously,  had  been  stung  by  a  bee  on  the  ri^t  ear. 
The  sting  was  immediately  removed,  after  whioh  the 
patient  was  troubled  with  nausea  and  occasional  emesis^ 
which  continued  to  grow  woise.  After  careful  exam- 
ination, found  patient  irrational,  heart's  action  mudi 
enfeebled,  breathing  exceedingly  difficult  and  stertorous 
profuse  flow  of  saliva,  face  considerably  swollen,  body 
partially  covered  with  dark  spots,  extremities  cold  Or- 
dered sinapisms  to  extremities,  morphia  one-quarter 
gr,  brandy  and  water  |7ro  re  nata.  In  an  hour  the 
patient  could  speak  rationally,  and  complained  of  a  most 
excruciating  pain  in  the  epigastric  region,  chilly  sen- 
sation, burning  in  fauces,  and  incessant  nausea.  By  4 
P.M.  patient  was  up,  but  much  exhausted,  and  recov- 
ered completely. — AUanta  Med,  Si  Surjf,  Jour, 

PoisoNiNo  BT  AoETio  AoiD. — ^A  csso  of  this  rare  ac- 
cident recently  occurred  to  a  man  forty  years  of  age,  who 
according  to  accounts,  took,  while  intoxicated,  two  or 
three  ounces  at  a  single  draught  for  suicidal  purposes. 
The  patient  was  shortly  afterwards  admitted  to  Guy'a 
Hospital 

The  foUowinff  is  an  abstract  of  the  lengthy  case: 
Within  the  first  hour  the  symptoms  were  slight  col- 
li^pse  and  laryngeal  obstruction,  which  was  so  severe 
as  to  lead  to  cessation  of  respiration,  but  was  at  once 
relieved  by  tracheotomy.  The  lips  and  tongue  were 
not  at  all  charred  or  inflamed.  Some  six  hours  subse- 
quently reaction  was  complete ;  there  was  inability  to 
swallow,  with  great  thirst  On  the  following  day  the 
patient  could  swallow  liquids,  but  had  pain  at  die  feucea^ 
and  considerable  salivation.  On  the  tliird  day  the  tra- 
cheotomy tube  was  taken  out,  without  any  subsequent 
impediment  to  respiration.  No  symptoms  of  gastric^ 
pulmonary,  or  cardiac  disturbance  arose.  Indeed,  di- 
vesting tie  case  of  the  laryngeal  complication  (which, 
perhaps,  would  not  have  arisen  had  the  man  been  sober 
when  swallowing  the  acid),  we  find  the  symptoms  were 

digitized  by  VjC  „      ^_ 


THE  MEDICAL  RECORD. 


449 


smply  slight  collapse,  an  inability  to  swallow  during 
one  day,  and  thirst  and  salivation ;  but  it  must  be  borne 
in  mind  that  the  result  was  in  all  likelihood  modified  by 
the  earl^  and  copious  administration  of  magnesia  sus- 
pended m  water. — Lancet, 

Imooolations  07  MsLANOTio  Matter. — ^M.  Goujon  hus 
lately  succeeded  in  producing  melanotic  deposits  in 
rabbits  by  inoculating  the  matter  taken  from  a  tumor 
of  that  nature  removed  from  the  axilla  of  a  patient.  If 
subsequent  experiments  confirm  the  results  obtained 
by  M.  Qoujon,  a  reconsideration  of  our  views  as  to 
malignant  growths  will  become  necessary. 

A  New  Strpno. — An  exchange  says  that  the  per- 
chloride  of  iron  combined  with  collodion  is  a  good  nse- 
mostatic  for  wounds,  the  bite  of  leeches,  etc.  To  pre- 
pare it,  one  part  of  crystallized  perchloride  of  iron  is 
mixed  with  six  parts  of  collodion.  The  perchloride  of 
iron  should  be  added  gradually  and  carefully,  to  prevent 
the  evolution  of  excessive  heat,  which  injures  the  collo- 
dion. The  composition,  when  well  made,  is  of  a  yel- 
lowish red  color,  perfectly  limpid,  and  produces  on  the 
^in  a  yeUow  pellide  which  retains  great  elasticity. 

Fermented  Mare's  Milk  ik  rns  Treatment  of 
Phthisis. — At  a  late  sitting  of  the  French  Academy  of 
Medicine,  Dr.  Stahlberg,  physician  to  the  factories  of 
Sorga  in  the  Oural,  read  a  paper  on  the  eflScacy  of  JcoO' 
miff,  or  fermented  mare*s  milk,  in  the  treatment  of 
pulmonary  diseases.  Its  good  effects  can  only  be  ex- 
plained by  its  producing  a  diminution  in  the  secretion 
of  the  mucous  membranes  or  a  better  nourishment. 

Chloroform  in  Obstetrics. — Sir  J.  Y.  Simpson  gave 
as  his  opinion,  at  a  meeting  of  the  Obstetrical  Section  of 
the  British  Medical  Association,  that  chloroform  never 
caa^d  convnldions,  puerperal  mania^  hfemorrhage,  or 
delay  of  labor.  '*  He  gave  it  as  soon  as  weariness  from 
pain  occurred,  during  a  pain,  and  always  with  the 
patient  in  a  recumbent  position.'* 

The  Cause  of  Osteomalacia. — ^M.  Driven,  after  sev- 
eral analyses,  has  concluded  that  in  osteomalacia  the 
presence  of  lactic  acid  and  the  lactates  in  the  bones,  bv 
acting  as  solvents  of  the  phosphates  and  carbonates,  is 
the  cause  of  the  softening. 

Ingrowing  Toe-Nail. — Dr.  Bailey  (Leavenworth  Medi- 
cal Journal)  having  observed  that  the  pressure  of  the  sec- 
ond toe  against,  and  rather  beneath,  the  great  toe,  is  the 
source  of  the  whole  trouble,  has  devised  a  bandage  for 
the  relief  of  the  difficulty.  He  takes  "  a  piece  of  strong 
muslin,  about  one  inch  wide  and  just  long  enough  to 
make  two  loops  (by  sewing),  one  large  enough  to  slip 
over  the  great  toe.  and  the  other  to  slip  over  the  third  toe 
and  bring  them  clope  together,  letting  the  second  toe 
rest  over  or  above  the  bandage."  In  this  way  he  gets 
the  pressure  required  to  crowd  the  soft  parts  away 
from  the  nail,  and  at  the  same  time  removes  the  pres- 
Bare  which  caused  the  disease.  This  bandage  may  be 
easily  worn,  even  when  the  boots  or  shoes  are  ordi- 
narily tight 

Foreign  Body  nf  the  Urethra. — ^Dr.  Charles  "Waah- 
bume,  House-Surgeon  N.  Y.  Hospital  (Medical  Gazette)^ 
recently  extracted,  in  the  case  of  a  patient  with  a  stric- 
ture just  under  the  pubic  arch,  about  one  and  a  half 
inches  of  a  No.  6  elastic  bougie,  which  was  broken  off 
beyond  the  stricture,  after  having  been  introduced  with 
difficulty  by  another  physician.  Dr.  W.  resorted  to  the 
following  ingenious  device :  "  The  patient  was  etherized, 
and  a  strong  needle  passed  through  the  walls  of  the 
urethra  from  below  and  behind  the  stricture  into  the 
fragment  of  the  bougie,  which  was  moved  along  the 
urethra,  and  after  a  little  difficulty  through  the  stricture. 


to  a  point  where  it  could  be  reached  by  a  polypus  for- 
ceps introduced  through  the  meatus."  No  bad  symp- 
toms followed,  and  alter  the  patient's  discharge  from 
hospital,  dilatation  was  resumed. 

Wounds  produced  bt  the  Ghabsepot  Projbotilb. — 
Dr.  Sarazin,  of  Strasburg,  has  made  some  experiments 
on  a  corpse  at  close  quarters,  with  the  following  re- 
sults :  Ist.  The  diameter  of  the  orifioe  made  by  th% 
bullet  entering  the  body,  is  not  sensibly  larger  than  thai 
of  the  projectile.  2d.  The  diameter  of  the  orifice  by 
which  the  bullet  leaves  the  body,  is  from  seven  to  thir- 
teen times  larger  than  that  of  tne  prciectile.  3d.  The 
arteries  and  veins  a^e  cut  transversely,  retracted  and 
gaping;  the  muscles  torn  and  reduced  to  a  pulp.  4th. 
The  bones  are  smashed  in  a  manner  out  of  all  proportion 
with  the  dimensions  of  the  projectile.  To  sum  up,  the 
wounding  effects  present  a  remarkable  intensity,  and  it 
is  well  to  note  that  the  balls,  after  passing  through  the 
body,  pierced  two  one-inch  planks  and  buried  them- 
selves deeply  in  the  wall  behind. 

ASOITBS   DEPENDENT    ON  HePATIO   LeSION;   OPERATION 

OF  Paracentesis  twice  performed:  followed  bt  Per- 
rroNins ; — Cure. — Dr.  de  Faria,  Professor  of  Olinical 
Medicine,  reports  the  following  case : 

Jos^,  African,  bachelor,  twenty  years  of  ape,  free,  a 
stone-cutter  by  trade,  and  an  inhabitant  of  the  parish 
of  San  Pedro  Velho,  on  the  11th  of  March  of  the  cur- 
rent year,  entered  the  Infirmary  of  San  Francis  during 
my  term  of  service.  On  examining  the  patient  I  re- 
marked a  general  condition  denoting  a  progressing  ca- 
chexia ;  on  exploring  the  belly  an  enormous  swelling 
was  discovered,  on  percussing  which  I  determined  great 
peritoneal  involvement  and  complication.  I  likewise 
detected  in  the  right  hypochondriac  region  a  firm  hard 
body  sufficiently  well  pronounced,  where^  though  with 
great  difficulty,  I  determined  bv  palpation  the  li^er 
much  augmented  in  volume,  and  extending  far  above 
the  borders  of  the  false  ribs.  Respiration  was  not  suf- 
ficiently accelerated  in  the  vertices  of  the  lungs,  and  was 
quite  indistinct  at  the  bases,  where  marked  signs  of  vesi- 
cular congestion  were  apparent.  The  heart  showed  noth- 
ing abnormal  in  its  action,  save  an  unwonted  celerity 
in  its  rhythm,  and  an  unusual  soft  sighing  near  its  base, 
dependent  no  doubt  on  an  alteration  in  the  blood.  The  in- 
fenor  extremities  were  oedematous;  the  pulse  was  weak 
and  frec[uent  I  instituted  at  once  drftstio  purgatives 
and  decided  diuretics ;  and  directed  a  dietetic  regimen, 
graduated  to  suit  his  failing  digestive  powers — such  as 
chicken,  bread,  and  a  small  quantity  of  wine  for  din- 
ner. The  enormous  enlargement  increased  so  rapidly 
as  to  become  pdinute  b^  minute  a  horrible  inconve- 
nience to  the  poor  man,  unpeding  ordinary  repose,  and 
absolutely  forbidding  sleep ;  and  his  countenance  por- 
trayed so  much  suffering  and  anguish  that  I  determined 
to  perform  the  operation  of  paracentesis.  For  the  rea- 
sons given  above,  I  performed  the  operation  as  soon 
as  the  day  following  his  entrance  into  the  hospital  A 
very  large  quantity  of  a  peculiar  serum  was  evacuated. 
Afterwards  I  continued,  during  my  month  of  service, 
my  therapeutical  remedies  without  stint ;  yet  notwith- 
standing all  I  could  do,  the  liquid  reproduced  so  rap- 
idly that  on  the  19th  day  of  my  month,  a  new  punc- 
ture was  necessitated;  and  on  the  20th  day  unequi- 
vocal signs  of  acute  peritonitis  appeared.  I  forth- 
with commenced  to  combat  this  with  calomel  in  small 
doses,  and  opium,  with  mercurial  frictions,  etc.  The 
inflammation  subsided  after  a  few  days,  and  from 
that  date  I  began  to  administer  (he  perchloride  of 
iron,  in  conjunction  with  a  mild  diuretic  and  sudo- 
rific, composed  of  cream  of  tartar,  nitre,  and  the  alco- 
holic extract  of  aconite.    From  that  date  nntil  the  day 


Ui 


THE  MEDICAL  BECORD. 


of  bis  departure,  well  and  sound,  I  continoed  this 
treatment;  having,  however,  to  these  therapeutical 
means  added  a  generous  reparative  diet — Chueia  Med" 
tea  da  Bahia^  10th  June^  1867. 

EpILBPBT    CONJOIKEn  WITH    COKGBNITAL  PhTMOSIS. — 

Congenital  phymosis  has  been  observed  in  eleven  of 
twenty-five  consecutive  male  cases  of  epilepsy  admit- 
ted at  the  infirmary.  That  such  a  frequent  complica- 
tion should  hitherto  have  remained  unnoticed  can  ooly 
be  explained  by  the  circumstance  that  epileptic  patients 
seldoDi  come  under  the  eye  of  the  surgeon,  and  that 
physicians  usually  neglect  to  examine  the  sexual  or- 
gans. The  effects  of  congenital  phymosis  on  the  sys- 
tem are  usually  disregarded,  although  there  can  be  lit- 
tle doubt  that  this  maltbrraation  has  a  consitierable 
pathological  importance.  There  is  always  an  accumu- 
lation of  serum  oetween  the  nrepuce  and  the  glans  in 
such  cases,  and  herpes  and  balanitis  may  be  the  conse- 
quence. This  irritation  often  leads  to  great  sexuiu  ex- 
citement about  the  period  of  puberty,  and  to  mastur- 
bation, with  all  its  consequent  evil  effects;  frequent 
emissions  of  semen  at  night  may  also  be  traced  to  the 
same  cause.  A  variety  of  cerebral  symptoms  may  then 
be  induced,  such  as  pain  in  the  head,  giddiness,  noises 
in  the  ears,  eructations,  sickness,  etc.,  which,  where 
they  depend  only  on  this  condition,  may  be  entirely 
removed  by  circumcision.  Whether  actual  epileptic  fits 
are  ever  the  result  of  phymosis,  seems  doubtful ;  yet  the 
propriety  of  operation  in  cases  of  that  kind  cannot  be 
questioned,  as  aU  sources  of  inflammation  should,  on 
principle,  be  removed  in  convulsive  disorders.  Several  of 
these  cases  which  were  admitted  at  the  Infirmary,  have 
been  operated  on  by  Mr.  Solly  and  Mr.  Spencer  Wells. 
In  no  instance,  however,  have  the  fits  ceased  immedi- 
ately, consequent  upon  the  operation,  so  that  a  relation 
as  between  cause  and  effect  could  not  have  existed  be- 
tween phymosis  and  epilepsy.  Yet,  Dr.  Althaus  said, 
it  generally  seemed  as  if  the  convulsive  disorder,  after 
circumcision  in  such  cases,  yielded  more  readily  to  the 
remedy  employed  than  it  did  before. — London  Lancet, 

Hermbtio  Seal. — A  mixture  of  gelatine  and  glyce- 
rine is  liquid  while  hot^  but  on  cooling  it  becomes  solid, 
retaining  considerable  elasticity  and  toughness.  The 
neck  of  a  bottle  dipped  into  this  melted  compound  is 
covered  with  an  air-tight  cap,  which  can  be  made  as 
thick  as  desired  by  repeating  the  operation. 

Preserving  Sulphuretted  Hydrogen  ih  Solutiok. — 
At  the  last  meeting  of  the  Pharmaceutical  Society  of 
Paris,  M.  Lepage  brought  forward  a  process  which  he 
has  adopted  for  preserving  solutions  of  sul[»huretted 
hydrogen.  Instead  of  using  water  alouB,  he  saturates 
a  mixture  of  equal  parts  of  pure  glycerine  and  water 
with  sulphuretted  hydrogen  gas,  and  uses  it  in  the  or- 
dinary way.  None  of  the  reactions  are  in  the  least 
interiered  with,  while  the  solution  possesses  almost  per- 
fect stability.  The  dilute  glycerine  dissolves  less  gas 
than  distilled  water  will ;  representing  the  solubility  in 
water  by  100,  that  in  glycerine  will  be  60. — Chemical 
News, 

Artificial  Milk. — Liebig  recommends  the  following 
"Alimentary  Prepration  for  replacing  Human  Milk 
for  Children : "  A  mixture  is  made  of  15  grammes  of 
wheaten  flour,  15  grammes  of  ground  maltv  6  grammes 
of  bicarbonate  of  potash,  30  grammes  or  water,  and 
160  grammes  of  milk  are  then  added.  The  whole  is 
then  heated,  and  then  stirred  continually  until  the  mix- 
ture begins  to  thicken.  It  is  then  taken  off  the  fire, 
and  stirred  all  the  while.  After  five  minutes  it  is  boiled, 
and  then  strained  through  a  fine  sieve.  The  ground 
malt  necessary  for  the  preparation  is  easily  furnished  j 


from  bariey  malt,  obtuned  at  any  brewery.  It  can 
be  ground  in  a  common  coffee  grinder,  and  then  passed 
through  a  sieve.  If  this  preparation  is  well  made,  it 
is  as  sweet  as  the  natural  milk :  it  is  fluid  enough,  and 
keeps  for  twenty-four  hours.  In  Germany  the  use  of 
this  food  is  very  extensive,  and  its  nutritive  qualities 
are  found  to  be  excellent.  It  has  a  slight  taste  of  flour 
or  malt,  to  which  children  get  accustomed — in  fact  they 
soon  prefer  it  to  other  fcof — Chemical  News. 

Glycerine  in  the  Arts. — A  German  chemist,  nanaed 
Pusher,  of  Nuremberg,  reported  to  the  Trades  Union 
of  that  place  that  he  had  met  with  CTcat  success  in 
using  glycerine  together  with  glue.  While  generally, 
after  the  drying  of  glue,  the  thing  to  which  it  is  i^ 
plied  is  liable  to  break,  tear,  or  spring  off,  if  a  quan- 
tity of  glycerine  equal  to  a  quarter  of  the  quantity  of 
glue  be  mixed  with  it,  that  defect  will  entirely  disap- 
pear. Pusher  also  makes  use  of  this  glue  as  lining  for 
leather,  for  making  globe  firames,  and  for  smoothing 
parchment  and  chaUc  paper.  He  also  uses  it  for  pol- 
ishing, mixing  wax  with  the  glycerine,  and  using  it 
as  an  underground  for  laying  on  aniline  red  color.  The 
red  was  found  to  excel  all  others  in  which  glycenoe 
was  not  used.  The  glycerine  has  also  some  properties 
in  common  with  India-rubber,  for  it  will  blot  out  pen- 
cil marks  from  paper,  so  as  to  leave  no  mai  k  whatever. 
A  paste  made  of  starch,  glycerine,  and  gypsum,  will 
maintain  its  plasticity  and  iwlhesiveness  longer  than  any 
other  known  cement,  and  does  therefore  recommend 
itself  for  cementing  chemical  instruments  and  appara- 
tus used  by  pharmacists.— */bumai  of  Applied  ChemiB- 
try. 

Chemical  Calculus. — Sir  Benj.  0.  Brodie,  Professor 
of  Chemistry  in  the  University  of  Oxford,  in  a  lecture 
"  On  the  mode  of  representation  afforded  by  chemical 
calculus  as  contrasted  with  the  Atomic  Theory,"  as- 
sumes as  his  unit  that  portion  of  ponderable  matter 
which  at  the  melting  point  of  ice  and  at  a  pressure  of 
760  millimetres  of  mercury,  occupies  a  space  of  1,000 
cubic  centimetres.  To  denote  units  of  chemical  sub- 
stancesj  he  uses  Greek  letters  as  symbo's,  and  in  such  a 
manner  as  to  indicate  that  nitrogen,  phosphorus, 
chlorine,  bromine,  iodine,  and  several  other  so-called 
elementary  substances,  are  compounds  conuiuing  hy- 
drogen, in  combination  with  unknown  elements.  It  is 
claimed  that  this  system  shows  there  are  three,  and 
perhaps  four,  fundamentally  distinct  classes  of  elemen- 
tal bodies;  the  first  maybe  represented  by  hydrogen 
and  mercury ;  the  second  by  oxygen  and  sulphur ;  the 
third  by  nitrogen  and  cMorine.  The  only  novelty  in 
this  classification  is  the  grouping  together  of  elements 
of  widely  differing  *' atonucity."  What  advantages 
may  be  gained  by  assuming  that  substances  not  yet 
decomposed  are  compounds,  and  using  symbols  of 
volumetric  units  as  a  more  mathematical  form  of  ex- 
pression, the  author  has  not  yet  satbfactorily  shown. 

Effects  of  Alcohol  on  the  System. — Dr.  N.  S. 
Davis  {Chicago  Medical  Examiner)^  in  a  series  of  ^hyg- 
mographic  observations  in  regard  to  the  above,  has  con- 
cluded, in  the  first  place,  that  tlie  presence  of  alcohol 
in  the  blood  diminishes  the  rapidity  of  nutrition  and 
disintegration,  upon  which  depend  the  functions  of 
elimination,  calorification,  and  innervation.  In  other 
words,  alcohol  is  a  po  itrve  organic  sedative  instead  of  a 
diffusive  stimulant  In  the  second  place,  the  alcohol  it- 
self acts  in  the  system  exclusively  as  a  foreign  sub- 
stance, and  as  such  is  ultimately  excreted  or  eliminated 
without  chemical  change. 

A  Double  Femoral  Artery  coiqplicated  an  opera- 
tion for  ligation — the  second  case  on  record — at  the 
Richmond  Hospital,  London.  ^^  j 

digitized  by  VjOOQ IC 


THE  MEDICAL  RECORD. 


446 


The  Medical  Eecord. 

^  Semx-Poni^IS  |ounraI  of  SPfebkhte  Bitb  S^nrgerj. 
Gbobob  F.  Shradt,  M.D.,  Editob. 

PabUch«d  on  th*  lit  and  15thof  Moh  Month,  bf 
WILLIAM  WOOD  it  CO.,  11  Walks*  Stkset,  Nkw  Yobk. 

FORXION  AOEIfClXS, 


Lo«i>OK— Tbubvib  k  Co. 

PaBII— Bo0SAJf«B  R  ClB. 


ILkIFSIO— B.  HBRMAHir. 
Bio  Jakbibo—Stbpubms  t  Ca. 


Ne-w  York.   IDeoeznber   2,  1867. 


MEDICAL  AUTHORSHIP. 

"  A  GOOD  book,"  says  Milton,  in  his  beautiful  essay  on 
the  Liberty  of  Unlicensed  Printing,  "  is  the  life-blood 
of  a  master-spirit,  embalmed  and  treasured  up  on  pur- 
pose to  a  life  beyond  life." 

It  is  imfortunate  for  the  cause  of  science  that  more 
of  the  pure  and  noble  ambition  that  inspired  the  great 
poet  to  labor  over  a  decade  of  years  on  the  epic  that 
has  immortalized  his  name,  is  not  felt  by  the  skilful 
and  laborious  medical  profession  of  America.  It  is 
unfortunate  that,  amid  the  rush  and  din  of  a  growing 
republic,  even  our  men  of  science  have  been  forced  to 
labor  so  much  for  the  meat  that  perisheth,  and  have 
sought  so  little  the  bright,  though  distant,  rewards  of 
fame. 

It  is  unfortimate  for  the  progress  of  the  American 
profession  it^lf,  that,  amid  the  first  material  develop- 
ment of  the  nation,  they,  have  thus  been  compelled  to  mi- 
nister so  exclusively  to  the  needs  of  the  living,  that  little 
time  or  strength  Has  been  left  to  appeal  to,  or  to  seek 
for  glory  from  generations  yet  unborn. 

But  this  national  exigency,  at  least  in  the  Eastern 
part  of  the  country,  has  in  a  measure  passed  away,  and 
the  forty  thousand  physicians  of  America  are  no  longer 
without  excuse,  if  either  a  love  of  duty  or  a  love  of 
fiune  does  not  inspire  them  to  erect  a  higher  and  severer 
standard  of  medical  literature. 

We  have  passed  through  a  stage  of  our  material 
growth ;  we  have  levelled  the  forests,  built  our  houses, 
and  opened  our  highways ;  we  are  sure  of  bread  for 
ourselves,  we  are  sure  of  it  for  our  children ;  and,  if  we 
can  turn  awhile  from  the  race  for  wealth,  we  may  be- 
queathe to  the  hereafcer  something  purer,  richer,  and 
more  enduring  than  mere  physical  comforts. 

To  speak  plainly,  the  day  has  come  when  the  profes- 
sion should  labor  less  for  money  and  more  for  science. 
We  should  cease  to  be  mere  mechanics,  working  only 
for  hire,  and  should  rise  to  the  level  of  scientific 
thought^  philosophy,  and  authorship.  We  cannot  do 
this  without  sacrificing  a  few  pieces  of  silver.  But  is  a 
man  worthy  of  the  profession  who  will  not  risk  this 


much  ?  '^  Science  is  a  harsh  mistress,"  said  Sir  Humphry 
Davy,  when  the  youthful  Faraday  asked  to  be  his  assist- 
ant. "  She  gives  but  small  pecuniary  rewards.  Con- 
sider well  before  you  leave  your  prospect  of  wealth  as 
a  merchant  for  the  poverty  that  awaits  the  servants  of 
science." 

Faraday  left  his  store,  however,  and  entered  the 
laboratory,  and  created  an  era  in  the  history  of  civiliza- 
tion. This  is  the  spirit,  this  the  enthusiasm  that  inspires 
us  in  this  land  far  too  little. 

To  raise  the  standard  of  medical  authorship  is  a  duty 
every  right-minded  physician  owes  to  himself. 

A  distinguished  medical  professor,  whose  works  have 
long  been  standard  on  both  sides  of  the  Atlantic,  once 
said  to  us  that  ho  never  felt  that  he  '[  really  knew  any 
subject  until  he  had  written  upon  it."  The  oft-cited 
words  of  Bacon,  "  Writing  makes  an  exact  man,"  are 
preSminently  true  of  all  scientific  attainments.  We 
can  never  thoroughly  know  any  subject  until  we  have 
first  thoroughly  learned  our  ignorance  of  it ;  and  one 
of  the  very  best  ways  to  gain  a  measure  of  our  own 
ignorance  is  to  attempt  to  teach  others. 

We  speak  advisedly  when  we  say  that  any  young 
man  who  carefully  and  studiously  writes  or  lectures  on 
any  department  of  science,  will  make  greater  progress 
in  five  years  than  another  man  of  equal  ability  can  do  in 
twenty- five  years  without  the  use  of  his  voice  or  pen. 

Our  ideal  of  medical  rhetoric  is  most  criminally  low. 
It  seems  to  be  a  common  impression,  even  among  those 
whose  education  should  have  taught  them  better,  that 
the  detaihng  and  representation  of  cases,  and  all  sci- 
entific writing  generally,  is  wholly  a  mechanical  per- 
formance, and  requires  no  special  rhetorical  training  or 
study.  The  error  is  a  most  serious  one,  and  makea 
itself  felt  in  the  hideous  compositions  that  load  the 
tables  of  every  editor  of  a  medical  journal. 

We  have  a  right  to  speak  plainly  here.  There  is  not 
a  medical  college  that  does  not  have  one  or  more  pro- 
fessors who  ignoranily  teach  erroneous  styles  of  gram- 
mar and  rhetoric ;  there  is  not  a  class  that  graduates 
from  any  of  these  institutions  one  quarter  of  whose 
membera  can  prepare  a  paper  on  any  subject  that  shall 
be,  both  in  thought  and  style,  a  credit  to  themselves  and 
to  the  cause  of  science ;  there  is  not  a  medical  journal 
that  is  not  forced  to  publish  articles  that  must  be  revised, 
sentence  by  sentence,  before  they  appear  in  print;  there 
is  not  a  medical  society  whose  members  are  not  more 
or  less  oppressed  by  difiuse  and  shambling  addresses. 

The  effect  of  the  almost  universal  prevalence  of  a  low 
standard  *uf  our  medical  writing  and  speaking  haa 
recoiled  banefully  on  the  estimation  in  which  the  pro- 
fession are  held  by  the  community.  The  impression 
prevails,  even  among  the  educated  classes,  that  medi- 
cine is  an  art  and  not  a  science,  and  that  its  disciples 
are  mechanics,  and  cannot  bo  scholars.  The  ranks  of 
the  profession  are  swelled  by  a  great  army  of  Ishmaelitea^ 
who,  wandering  over  tlie  earth,  by  some  luck  or  chance 
happen  to  stumble  into  'Moctoring,",  and  who  feel 
Digitized  by ^ ^_ 


446 


TEffi  MEDICAL  RECORD. 


about  as  much  scientific  enthusiasm  as  do  the  Patricks 
who  lay  the  pavement,  or  the  "  bulls  and  bears  "  in  Wall 
street. 

Our  literary  institutions  send  to  our  medical  schools, 
with  a  few  slight  exceptions,  those  whom  they  en- 
dured or  hated,  rather  than  those  whom  they  loyed  and 
honored ;  the  fools  and  the  drones,  rather  than  the  gen- 
tlemen and  the  scholars;  the  leaves  that  have  been 
shaken  off  before  the  maturity  of  graduating  was 
reached,  rather  than  the  fairest  and  best  of  their  per- 
fectly riper  fruit 

There  are,  indeed,  already  in  the  profession — and  we 
are  glad  to  see  that  each  year  is  adding  to  their  num- 
ber— a  few  of  as  true,  as  pure,  as  noble  and  aspiring 
souls  as  ever  connected  themselves  with  any  cause,  but 
as  yet  they  are  hardly  enough  to  leaven  the  great  mass 
of  ignorance  and  mediocrity. 

We  received  the  other  day  from  a  very  faithful,  ear- 
nest gentleman  in  the  profession,  an  article  on  a  subject 
of  great  interest,  which  included  some  exceedingly  in- 
teresting observations,  but  which  contained  so  much 
that  was  irrelevant,  and  was  prepared  throughout  in 
such  utter  defiance  of  the  laws  of  grammar  and  rhe- 
toric, that  we  were  compelled  to  return  it  to  ito  autjior, 
with  the  request  that  it  should  be  entirely  remodelled. 

Whoever  says  that  scientific  writing  is  a  very  easy 
or  indifferent  matter,  is  either  a  genius  or  a  fooL  In 
the  accurate  observation  of  causes,  symptom?,  and  re- 
sults of  di<fease,  in  making  the  philosophical  deductions 
horn  established  facts,  by  rejecting  the  irrelevant  and 
considering  what  are  essentiid;  and  in  presenting  these 
hctB  and  conclusions  In  a  style  at  once  pimple,  clear, 
and  interesting,  there  is  room  for  the  display  of  the  best 
Acuities  of  observation  and  judgment,  and  as  wide  a 
range  for  the  exercise  of  rhetorical  genius  and  ability 
as  in  any  other  form  of  literary  composition. 

"Genius,"  says  Ruskin,  "seizes  right  hold  of  the 
heart  of  a  subject."  The  same  is  true  of  nil  with  cul- 
tivated talent  Ability  in  composition  does  not  come 
by  accident  It  does  not  come  by  genius  unless  it  be 
accompanied  with  patient  industry.  It  does  not  come 
by  academical  or  collegiate  education.  It  comes  by  the 
patient  study  of  the  best  models  by  faithfnl  and  repeated 
practice.  Indeed,  success  in  this,  as  in  other  fields  of 
effort,  comes  through  repeated  failures. 

Furthermore — ^authorship  is  a  duty  that  physicians 
owe  to  their  profession.  The  obligations  that  all 
practitioners  owe  to  science  are  greater  than  they  can 
ever  repay,  however  sincere  may  be  their  gratitude. 
It  is  through  a  long  line  of  authors  that  we  have  in- 
herited all  that  we  know  in  the  yarioos  departments  of 
medicine  and  surgery.  It  is  to  medical  authors  that  we 
are  indebted  for  the  garnering  up  and  treasuring  of  the 
accumulated  experience  of  more  than  twenty  centuries. 
It  is  by  the  teachings  of  medical  authors  that  many  of 
the  best  discoveries  and  improvements  of  science  have 
been  suggested  and  inspired.  It  is,  in  a  word,  by 
authorship,  more  than  by  anything  else,  that  the  prac- 


tice of  our  day  is  more  rational,  more  discriminating, 
and  more  successful  than  that  of  Hippocrates  and 
Qalen. 

While  it  is  true  that  very  much  is  published  in  our 
journals  that  ought  never  to  see  the  light,  it  is  still 
more  true  that  much  valuable  experience  is  lost  to  the 
world,  perhaps  for  ever,  for  want  of  a  trifling  amount  of 
literary  ability  and  enthusiasm  on  the  part  of  the  ob- 
server. A  great  deal  that  is  rich  and  suggestive  in 
medical  practice  dies  in  the  various  circuits  of  oor 
country  practitioners,  and  is  buried  with  them  in  the 
same  grave. 

To  record  this  experience,  and  to  transmit  it  to  tho 
future,  is  not  a  matter  of  choice.  It  becomes  a  solemn 
and  itnperative  duty.  The  hour  a  graduate  receives  his 
diploma  and  enters  the  ranks  of  the  profession,  that 
hour  he  consecrates  himself  to  science ;  and  so  long  as 
he  continues  in  her  service  he  is  bound  at  leas(t  to  obey 
her  one  great  command :  "  Go  and  teach  what  you  learn 
to  every  member  of  your  own  profession."  The  sweet- 
est, purest,  noblest  things  in  the  profession  of 
modern  times,  and  that  which  redeems  its  many  bicker- 
ings and-  envy  lags,  its  occasional  bigotry  and  narrow- 
ness, is  the  universal  esprit  de  corps  that  makes  the 
discoveries  and  experience  of  the  individual  the  com- 
mon property  of  all.  The  feeling  with  every  pioneer 
is,  "  This  is  not  my  invention,  these  are  not  my  experi- 
ments ;  they  are  the  property  of  Science,  and  I  am  to 
bring  them  as  grateful  offerings  into  her  temple.** 

But  there  are  those  who  may  not  be  influenced  by 
appeals  to  love  of  duty.  For  these  we  must  descend 
to  a  lower  level,  and,  with  the  old  Romans,  plead  with 
them  to  do  right,  for  the  love  of  glory.  Amid  the 
harassments  and  drudgery  of  daily  practtee  can  there 
be  anything  more  sustaining  than  the  reflection  that  we 
are  toiling  not  alone  for  this  little  circle  of  patients 
about  us,  but  for  the  misery  and  distress  everywhere; 
not  for  the  brief  day  of  our  personal  activity,  but  per- 
haps for  all  coming  time. 

This  may  be  a  lofly  ideal,  and  few  there  are  who 
shall  attain  unto  it  But  there  is  a  world  of  wisdom 
in  the  advice  that  Dr.  Dwight  loved  to  give,  ^Am 
kighj  for  you  will  be  sure  to  come  short  of  your  aim.** 

But  we  descend  to  a  still  lower  level,  and  appeal  to 
necessity.  It  is  only  by  writing  that  young  men  of  our 
time  can  hope  to  rise  to  high  position.  It  is  fast  becom- 
ing true  of  America,  a^  it  has  long  been  true  of  Conti- 
nental Europe,  that  only  authors  can  become  authori- 
ties. "  What  has  he  written  ? "  is  the  question  first 
asked  of  a  candidate  for  a  professorship  in  Berlin,  Paria^ 
or  Vienna.  With  us  it  has  been  the  custom  to  inquire, 
"What  influence  can  he  bring?  who  are  his  bankers? 
what  IB  his  income-tax  ?  ** 

But  we  are  happy  to  say  that  a  new  era  is  com- 
mencing to  dawn  on  the  science  of  America.  The 
time  will  soon  be  past  when  any  roan  can  be  bolstered 
up  into  scientiflc  greatness,  and  held  there  by  friendly 
props  and  stays.  The  time  will/SDon  be  Dist  when 
Digitized  by' 


'CoS^_ 


THE  MEDICAL  RECORD. 


441 


the  professional  standing  of  any  man  will  be  solely  or 
chiefly  estimated  by  the  carriages  he  drives,  the  dress 
of  the  patients  that  crowd  his  waiting-rooms,  or  even 
by  his  mere  mechanical  skilL 

The  time  is  already  past  when  any  man  can  hope  to 
rise  to  be  authority  in  any  department  of  medical  sci- 
ence through  any  royal  road  of  social  influence,  poli- 
tical manipulations,  or  even  of  personal  charms. "  Those 
who  are  to  be  the  leaders  and  guides  of  medical  science 
for  the  coming  generation  must  earn  their  position  by 
persistent,  original  investigation,  and  by  faithfiilly  record- 
ing their  experience  in  the  permanent  hterature  of  the 
day. 

It  is  the  pen  and  not  the  lancet^  the  scholar  and  not 
the  mechanic,  that  is  to  guide  and  shape  the  scientific 
future  of  America. 

The  attendance  of  students  at  our  colleges  is  not,  on 
the  whole,  so  large  as  was  at  first  anticipated,  and  thus 
far  there  is  no  increase  over  last  year.  What  we  lack, 
however,  in  quantity,  is  amply  compensated  for  in 
quality,  and  the  various  institutions  have  reason  to  con- 
gratulate themselves  upon  the  fact  that  so  large  a  num- 
ber of  well-informed  and  properly-prepared  students 
have  enrolled  themselves  as  matriculants.  We  have 
reason  to  hope  that  eventually  the  medical  student  of 
old  will  be  effectually  and  permanently  replaced  by  his 
more  accomplished  and  perhaps  more  civilized  brother. 
The  time  is  even  now  at  hand  when  it  is  next  to  im- 
possible to  distinguish  any  student  of  medicine  from  an 
accomplished  and  well-bred  gentleman ;  the  proverbial 
cane  is  going  out  of  fashion,  the  straggling  locks  have 
been  shorn,  and  all  the  other  eccentricities  of  the  by- 
gone "  Sawbones  "  have  ceased  to  be.  We  have  reason 
to  believe,  in  spite  of  this  change,  that  our  students 
will  work  as  hard  and  progress  as  rapidly  as  they  did 
formerly. 

A  PLAN  fbr  instruction  in  special  departments  of  med- 
icine is  about  being  inaugurated  in  Boston,  which,  if 
fully  carried  out,  will  doubtless  be  productive  of  much 
good  in  extending  the  Umits  of  medical  education.  The 
idea  is  to  furnish  young  graduates  and  practitioners  op- 
portunities for  perfecting  that  knowledge  of  the  healing 
art  which  the  rapid  advancements  in  science  have  placed 
beyond  the  ordinary  college  curriculum.  On  general 
principles,  there  is  every  reason  why  the  project  should 
meet  with  success,  and  we  should  like  to  see  similar 
institutions  in  all  our  large  cities. 

The  profession  in  this  country  should  commence 
to  develop  its  resources  more  than  it  has  heretofore 
done,  and  endeavor  to  prove  in  a  practical  manner  that 
it  is  not  always  necessary  to  go  abroad  in  order  to  fami- 
liarise ourselves  with  the  higher  walks  of  the  healing  art. 
Bat  aaide  from  the  gratification  of  a  natural  and  com- 
mendable pride  in  this  matter,  the  teachers  have  another 
responsibility  to  discharge,  that  of  ministering  to  the 
wanta  and  requirements  of  those  who  are  unable  to 


spend  any  time  abroad,  and  who,  if  they  were,  are  too 
imperfectly  acquainted  with  the  French  and  German  to 
render  such  a  sojourn  profitable  or  edifying. 

The  school  in  question  has  a  good  faculty,  the  ma- 
jority of  its  members  being  men  of  distinction  in  the 
different  departments  which  they  are  to  teach. 


EeotetDd  antr  Uotxcts  of  ^ooks. 


Thb  Phtsiologt  of  Man  :  Designed  to  Reprbsbkt  thb  Ex- 
iSTiNQ  Statb  op  Phtsiologioal  Sciekob  as  Appued  to 
THB  Functions  op  the  Human  Body.  By  Austin  Flint, 
Jr.,  M.D.,  Prof,  of  Physiology  and  Microscopy  iu  the  Belle- 
vue  Hospital  Medical  College,  N.  Y.;  and  in  the  Long 
Iftland  College  Hospital,  eta,  etc.  Alimentation,  Digestion, 
Absorption,  Lymph,  and  Chyle.  New  York:  D.  Apple- 
ton  A  Co.     1867.    bvo.,  pp.  546. 

A  uttlb  over  a  year  ago  we  took  occasion  to  notice 
somewhat  in  detail  the  contents  of  the  first  volume  of 
a  series  upon  the  Physiology  of  Man,  by  Prof.  Flinty  Jr. 
We  are  now  called  upon  to  bring  before  our  readers  a 
cursory  review  of  the  contents  of  a  second  volume,  and 
reiterate  our  satisfaction  at  the  manner  in  which  the 
task  which  he  has  taken  upon  himself  has  been  per- 
formed. The  intention  of  the  author  is  to  furnish  at 
such  intervals  as  are  consistent  with  careful  study  and 
investi^tion,  four  volumes  upon  the  different  depart- 
ments in  physiology  and,  it  possible,  to  make  each 
part  complete  in  itself.  The  first  volume  treated  of  the 
blood,  circulation,  and  respiration,  and  was  well  calcu- 
lated, by  the  manner  in  which  the  subject  was  dealt 
with,  to  prepare  the  profession  for  a  just  appreciation  of 
the  second  of  the  series  now  before  us. 

The  subjects  of  alimentation,  digestion,  and  absorp- 
tion, have  necessarily  an  interest  attached  to  them  com^ 
mensurate  with  the  importance  of  their  functions  in  the 
preservation  of  animal  Hfe ;  but,  strange  to  say,  works 
on  physiology  generally,  have  not  been  accustomed  to 
give  them  that  promlpence  and  detail  of  treatment  which 
all  practising  physicians  acknowledt^e  they  deserve.  For 
the  present  efforts  of  our  author  in  supplying  this  de-* 
fidency,  his  professional  brethren  must  necessarily  be 
under  obligations.  The  different  subjects  are  handled 
with  care,  discretion,  and  ability ;  while  the  amount  of 
study  which  has  been  required  to  personally  acquaint 
himself,  as  he  claims  to  have  done,  with  all  the  numer- 
ous authorities  mentioned  throughout  the  work  is  diffi- 
cult to  estimate.  Such  a  course  for  a  practical  teacher 
and  author  cannot  be  too  highly  commended,  and  must 
of  necessity  add  that  weight  to  his  statements,  and  give 
that  force  to  his  conclusions^  which  nothing  short  of  a 
rightful  determination  to  do  his  duty  could.  But  not  only 
have  the  older  authorities  been  carefullv  perused,  but 
recent  writers  have  been  studied,  and  all  the  late  and 
most  important  discoveries  are  brought  up  to  date. 

The  first  section  of  the  work,  treating  or  alimentation, 
is  very  complete  and  svstematic.  The  remarks  upon 
hunger  and  thirst  are  full  of  suggestive  and  practical 
facta^  and  cannot  fail  to  interest  the  reader.  The  de- 
scription of  the  proximate  principles,  of  course  inevit- 
able, will  perhaps  be  read  more  than  chapters  on  those 
subjects  ordinarily  are,  on  account  of  the  many  well 
digested  ideas  concerning  their  physiological  actions 
which  are  plentifully  sprinkled  throughout  the  text 
The  relations  of  the  different  alimentary  Fubstances  to 
each  other,  their  proper  mode  of  preparation,  and  their 
relative  value,  are  fully  presented.  The  account  of  the 
cereal  grains  in  Chapter  IIL  is  elaborately^  given,  while 

digitized  by  LjOO^^_ 


448 


THE  MEDICAL  RECORD. 


the  remarks  upon  the  diDFerent  beverages  in  Chapter 
IV.  give  evidence  of  much  careful  analysis  and  studi- 
ous elaboration.  His  views  upon  the  different  stimu- 
lants are  eminently  sound,  and  in  keeping  with  those 
advanced  by  most  of  the  leading  anthoiities.  Alcohol, 
then,  is  not  considered  as  an  aliment  in  a  physiologiciu 
sense*,  ite  principal  effect  upon  the  economy  being  the 
production  of  a  certain  amount  of  nervous  exaltation, 
which  passes  off  as  the  article  is  eliminated,  together 
with  the  diminution  of  exhaled  carbonic  acid  gas,  and 
the  discharge  of  other  excrementit'ous  materials,  the 
principal  among  which  is  urea.  The  argument  to 
prove  that  alcohol  does  not  increase  iJie  capacity  to 
endure  severe  and  protracted  bodily  exei-tion,  is  not  as 
specious  as  it  might  be  made  by  a  less  absolute  reliance 
upon  the  testimony  of  Dr.  Hayes,  of  the  Arctic  explor- 
ing expedition.  But  while  one  may  find  fault  with  the 
line  of  argument,  the  conclusions  of  the  author  will  be 
accepted  on  grounds  already  well  established. 

The  physiology  of  digestion  is  considered  under  the 
appropriate  headings  of  salivary,  gastric,  pancreatic,  bili- 
ary, and  intestinal.  While  tachsubjtnjt  is  treated  al- 
most exhaustively,  and  all  the  important  experiments 
recited  and  commented  upon,  no  new  conclusions  as 
to  the  functions  of  either  of  the  foregoing  secretions 
have  been  arrived  at;  the  saliva  converts  starch  into 
sugar;  the  gastric  juice  (togetlier  with  its  accompanying 
acidity,  due,  as  the  author  thinks,  to  free  lactic  acid) 
digests  the  albuminoid  substances;  the  pancreas  takes 
care  of  the  fats ;  the  intestinal  juices  help  along  the  sa- 
liva in  the  conversion  of  the  starch  j  the  bile,  though 
acknowledged  to  be  a  secretion  of  vital  importance,  is 
stiU,  as  regards  its  function,  wrapped  in  tantalizing 
mystery. 

The  consideration  of  digestion  from  a  mechanical 
point  of  view  is  very  complete  and  satisfactory,  and 
especially  is  this  the  case  with  the  remarks  upon  dcprlu- 
tition  and  the  movements  of  the  stomach.  In  the  latter 
connection  we  cannot  forbear  our  hearty  commenda- 
tion of  the  manner  in  which  the  function  of  vomiting  is 
handled.  The  interesting  and  valuable  experiments 
which  are  detailed,  are  conclusive.  In  them  we  learn 
that  the  diaphragm  is  the  prinipal  agent  in  vomiting, 
and  that  this  muscle  is  aided  by  the  abdominal  muscles, 
the  muscular  coats  of  the  stomach  being  at  the  time 
relaxed.  These  facts  have  been  long  ago  established 
to  the  satisfaction  of  physiologist*,  but  we  do  not  recol- 
lect to  have  seen  them  so  succinctly  and  comprehensively 
put  before. 

Absorption  is  most  elaborately  discussed,  and  although 
many  facts  of  value  are  given,  they  are  hardly  sufficient 
to  divest  the  article  of  tediousness.  But  this  is,  after  all, 
nothing  more  than  the  general  reader  expects  from  an 
enthusiastic  physiologist. 

The  book  as  a  whole  is  an  admirable  one,  and  is 
even  a  decided  improvement  upon  the  first.  The  inter- 
esting fv^ature  of  the  work  is  a  recital  of  typical  experi- 
mants,  which  are  timely  and  judiciously  introduced  to 
impress  the  facts  upon  the  mind  of  the  reader.  H  is 
printed  in  elegant  style,  and  may  be  considered  a  model 
in  the  typographical  line. 

Manual  Comprssstok  in  Aneurism. — ^Mr.  Thomas 
Bryan ty  of  London  (Lancet) j  has  succeeded  in  curing 
a  large  aneurism  of  the  popliteal  artery  by  manufu 
pressure,  in  twenty-four  hours. 

The  SocrBTY  for  the  Prevention  of  Orubltt  to 
Animals  (London),  has  voted  the  sum  of  twenty-five 
pounds  to  the  Richardson  testimonial  fiind,  in  consider- 
ation of  his  discovery  of  the  method  of  producing  local 
ansBsthesia. 


Uepnrts  of  S0cictie«. 


NEW  YORK  PATHOLOGICAL  SOCIETY. 

Stated  Meeting,  Oct.  23,  1867. 
Dr.  H.  B.  Sands,  President,  m  the  Chair. 
Dr.  a.  Clark  presented  a  specimen  of  tumor  of  the 
brain  for  the  sake  of  bringing  out  some  points  connected 
with  diagnoj^is.  The  chief  features  of  the  case  he  then 
read  as  reported  by  Dr.  C.  Young,  the  House  Physician 
of  Belle vue  Hospital 

SOME  points  connected  WITH  THE  DIAGNOSIS  OF   TUMOR 
OF  THE  BRAIN. 

Elizabeth  Lambert^  aet  33,  a  native  of  Wales,  widowed, 
admitted  July  25,  1867.  When  admitted,  patient  wag 
in  a  very  exhausted  condition,  and  had  to  be  carried  to 
a  ward.  She  stated  that  she  had  lived  for  some  time 
in  Charleston,  and  had  been  attacked  at  different  times 
by  the  miasmatic  fevers  which  prevail  there.  She 
gave  a  history  of  tubercular  family  taint  She  had  had 
several  children,  had  never  contracted  chancre,  and 
gave  no  history  of  secondary  syphilis.  She  had  re- 
cently been  discharged  from  Charity  Hospital,  where 
she  said  she  had  been  treated  for  phthisis.  Patient  said 
that  she  had  been  subject  to  violent  headaches  for  tho 
past  fifteen  years,  but  that  her  general  health  had  been 
good  till  last  Christma.<9,  when  she  contracted  a  cold,  and 
stifiCc^red  from  dyspnoea,  palpitation  of  the  heart,  and 
spitting  of  blood.  She  had  no  cough.  She  had  suffered 
from  night-sweats,  had  lost  flesh  and  strengUi. 

At  time  of  admission  she  complained  of  nothing  but 
weakness.  Face  pale,  pupils  natural,  pulse  feeble  and 
rapid.  On  percussion  there  was  slight  comparative 
dulness  on  right  side.  On  auscultation  nothing  abnor- 
mal was  discoverable  beyond  feeble  respiratory  murmur 
and  prolonged  expiration  on  both  sides.  No  increase 
of  vocal  resonancf .  Heart  sounds  were  healthy.  No 
disease  of  liver  or  spleen  could  be  diagnosticated,  urine 
normal  Shortly  after  admission  she  began  to  com- 
plain of  severe  neuralgic  pains  in  the  head,  more  espe- 
cially on  the  left  side  and  at  the  back.  This  was  treated 
with  quinine  in  large  doses,  when  she  recovered  suffi- 
ciently to  be  up  and  "  go  out  on  pass."  Her  improve- 
ment continued  for  about  three  weeks.  About  October 
1st,  she  again  began  to  suffer  with  the  pain.  There  was 
ptosis  of  left  eyelid,  and  there  was  a  slight  ecchymosis 
of  the  integument  around  it.  The  pupil  was  somewhat 
dilated  and  did  not  respond  to  light  There  was  some 
tenderness  of  the  supra-orbital  nerve.  There  was  no 
facial  paralysis,  and  ibe  tongue  was  protruded  in  the 
median  line.  The  right  eye  was  natural.  She  com- 
plained of  a  terrible  pain  also  at  back  of  her  head.  For 
about  ten  days  previous  to  death  she  had  occasional 
vomiting.  The  bowels  had  to  be  moved  by  medicine. 
The  pulse  was  slow,  sixty-four,  and  regular.  The  pain 
did  not  yield  as  before  to  quinine,  and  she  was  at  last  put 
on  large  doses  of  iron,  with  iodide  of  potassium  in  large 
doses,  on  suspicion  of  there  being  a  cerebral  tumor.  She 
died  October  22. 

Autopsy  thirty  hours  after  death. — Rigor  mortis 
well  marked.  The  calvarium  was  removed,  and  the 
dura  mater  found  to  be  adherent  on  the  left  side, 
posteriorly.  It  was  carefully  removed,  when  there  was 
found  a  lurge  tumor  adherent  to  dura  mater,  hard,  and 
occupying  a  deep  depression  in  the  left  hemisphere  of 
brain.  Tne  brain-matter  was  so  much  softened  that  it 
could  not  be  removed,  and  the  exact  relations  were 
thus  destroyed.  The  lungs  were  found  to  present  the 
appearances  of  subpleural  emphysema.  Aorta  was 
slightly  atberomatou?,  as  it  is  given  off  from  heart 
Heart  healthy ;  liver,  kidneys  and  s^en  healthy. 

Digitized  by  VjOOQ IC 


THE  MEDICAL  RECORD. 


449 


The  main  point  in  the  case  being  pain  on  the  left  side 
and  at  the  back  of  the  head,  Dr.  Clark  had  remarked  to 
the  House  Physician,  at  the  t  me  his  attention  was  first 
drawn  to  the  patient,  that  the  cause  of  the  symptom 
was  to  be  referred  either  to  the  existence  of  miasmatic 
neuralgia^  or  to  a  tumor  of  the  brain  probably  syphiliiic 
in  character.  He  was  then  informed  that  the  patient 
had  previously  been  an  inmate  of  Bellevue,  and  had 
be^n  treated  by  quinine  for  neuralgia,  and  that  ghe  had 
shortly  after  gone  out  relieved;  and  she  being  re- 
admitted with  the  same  pain  on  the  1st  of  October,  the 
doctor  was  inclined  to  take  the  vi.  w  that  it  was  mias- 
matic, and  he  held  to  that  opinion  until  his  faith  in  it 
was  shaken  a  few  days  before  her  death.  The  death 
was  sudden,  occurring  on  the  22d  inst.,  and  nobody 
knew  the  precise  circumstances  attending  it 

On  bein^  informed  of  her  death,  the  professor  was 
much  surprised,  as  he  bad  seen  her  the  day  before  with 
her  intellect  clear  and  motor  power  good,  she  having  at 
that  time  no  evidences  of  oi  ganic  disease  of  the  brain. 
When,  however,  he  was  told  that  shortly  before  her 
decease  there  was  noticed  a  little  ptosis  of  the  left 
eye,  with  some  ecchymosis,  he  was  forced  to  change  his 
view  of  the  case,  and  pronounce  the  cause  of  death  as 
tumor  of  the  brain. 

On  making  a  post-mortem  examinatioil^a  tumor  was 
found  growing  out  from  the  dura  mater,  and  pressing 
into  the  substance  of  the  brain  at  the  posterior  extrem- 
ity of  the  posterior  lobe  of  the  cerebrum.  The  hole 
into  which  the  tumor  was  imbedded  was  large  enough 
to  receive  half  a  hen's  egg.  Although  there  was  con- 
siderable softening  in  the  neighboring  brain  substance, 
there  was  none  at  that  precise  point. 

The  pulse  was  slow  during  the  latter  part  of  her  life ; 
at  sixty,  and  perhaps  rarely  above  that  Her  mode  of 
death,  however,  was  a  point  to  which  he  wished  to  call 
the  attention  of  the  Society,  in  tiie  hope  of  obtaining  some 
eznlanation  for  the  association  of  the  symptoms  refer- 
rible  to  tlie  left  eye,  with  the  tumor  on  the  brain.  In  a 
word,  how  could  a  tumor  in  this  locality  produce  a  con- 
traction of  the  pupil,  ptosis,  and  ecch}mo8is  of  the  eye 
referred  to?    The  other  eye  was  reported  sound. 

As  to  the  nature  of  the  tumor,  as  no  microscopical 
examination  had  as  yet  been  made  of  it,  nothing  but 
conjecture  could  be  offered.  It  might  be  of  tuberculous 
or  fibrous  character. 

Dr  Flint  asked  if  the  softening  was  in  any  proximity 
to  the  origin  of  the  third  pair  of  nerves. 

Dr.  Hamilton  did  not  think  it  was  necessary,  in  order 
to  make- out  a  distinct  connection  between  cause  and 
effect,  to  suppose  that  the  origins  of  the  nerves  in  ques- 
tion were  involved,  and  referred  to  some  observations 
recently  made  by  Brown-S^quard,  in  which  it  was 
proved,  that  nerves  more  or  less  remote  from  the  seat 
of  brain-disense  were  affected,  and  this  without  any 
cause  that  could  be  explained  on  the  score  of  nervous 
commnnication,  save  reflex  action. 

Dr.  Jaoobi  thought  that  the  sudden  death  might  be 
explained  on  the  supposition  of  the  existence  of  centric 
apoplexy,  as  he  noticed  that  the  brain  had  not  been  cut 
intb. 

Dr.  Clark  remarked  that  it  was  designed  not  to  ex- 
amine the  brain  farther  until  it  had  been  exhibited  to 
the  Society, 

Dr.  Jacobi  also  suggested  that  some  explanation  of 
the  direct  cause  of  death  might  be  found  in  the  upper 
part  of  the  spinal  cord. 

Dr.  Clark  stated  that  the  case,  to  his  mind,  was  one 
which,  so  (iir  as  it  was  investigated,  could  give  no 
clue  for  the  formation  of  a  correct  diagnosis  before 
death. 

Db.  Jacobi  thought  that  this  diffictdty  was  Increased  | 


by  a  knowledge  of  the  fact  that  the  paralysis  of  the 
levator  oculi,  and  of  the  radiating  fibres  of  the  iris, 
weie  respectively  due  to  different  causes. 

In  answer  to  a  question  from  Dr.  Flint,  Dr.  Clark 
stated  that  the  heart  was  not  fatty. 

Dr.  Hamilton,  in  reference  to  the  question  of  sudden 
death,  reminded  the  Society  of  some  observations  made 
by  Dr.  Flint  some  years  ago,  bearing  upon  effusion  into 
the  arachnoid  of  the  four£  ventricle  as  the  cause. 

Dr.  Flint  remarked,  that  since  the  time  those  obser- 
vations were  published,  he  had  reason  to  reject  them  as 
without  value,  more  especially  as  subsequently  the  sub- 
ject of  uraemia  had  been  studied. 

BIRTH  OF  OHILD  A  TEAR  AFTER  OVARIOTOMT. 

Dr.  Cutter,  in  rising  to  exhibit  some  serum  removed 
from  an  ovarian  cyst,  took  occasion  to  refer  to  a  case 
of  a  lady  twenty-four  years  of  age,  fix)m  whom  he  had 
removed  a  year  before  a  multilocular  tumor  of  the  left 
ovary.  She  made  a  very  rapd  recovery,  and  on  the 
8th  of  October  was  delivered  of  a  healthy  female  child 
without  difficulty.  He  knew  of  but  few  cases  where 
pregnancy  followed  after  such  an  operation,  and  none 
m  which  it  had  occurred  so  soon  after.  Mr.  Spencer 
Wells,  out  of  228  cases,  had  met  with  only  eight  or  ten 
pregnancies. 

The  serum  presented  was  removed  from  the  left  ovary 
of  a  lady  thirty-four  years  of  age.  The  tumor  had  been 
growing  for  ten  years,  during  which  time  she  had  two 
children,  and  was  now  pregnant  with  the  third ;  at  the 
time  of  the  tapping  she  was  quite  large,  and  the  amount 
of  fluid  withdrawn  was  seventy  pounds.  She  suffered 
no  inconvenience  from  the  tapping,  although  she  had 
commenced  to  refill  rapicQy.  As  she  was  advanced 
seven  months,  the  question  arose  as  to  whether  it  was 
best  to  induce  miscarriage  or  allow  the  case  to  go  on. 

EPtTLIS  OF  UPPER  JAW. 

He  also  exhibited  an  epulis  of  the  upper  jaw  removed 
from  a  female.  The  growth,  when  it  nrst  made  its  ap- 
pearance, resembled,  by  all  accounts,  a  collection  of 
sprouting  granulations,  due,  as  the  patient  behoved,  to 
the  irritation  of  wearing  a  badly  fitted  set  of  teeth.  In 
the  course  of  three  months  it  grew  to  a  considerable 
size  and  became  pedunculated.  It  was  removed  in  the 
usual  way  by  the  saw  and  gouge,  the  attendant  hsemor- 
rhage  being  controlled  by  the  persulphate  of  iron.  The 
tumor  was  examined  microscopically,  and  no  traces  of 
malignancy  were  found,  notwithstanding  that  tlie  gross 
appearances  of  the  mass  were  at  least  suspicious. 

INTFRSSTINO  experiments  WITH  TJ0ATURE8. 

Dr.  B.  Howard  exhibited  three  specimens  of  liga- 
tion of  the  carotid  arteries  in  the  sheep,  by  different 
ligatures  and  in  different  manners,  and  made,  in  con- 
nection therewith,  the  following  remarks: 

A  patient  came  to  me  witii  an  axillary  aneurism, 
and  as  immediate  compression  was,  under  the  circum- 
stances, impracticable,  I  thought  of  no  other  method  of 
treatment  save  that  of  ligation  of  the  subclavian.  The 
condition  of  the  artery,  I  apprehended,  would  not  allow 
of  ligation  in  the  ordinary  manner,  by  the  silk  hgature, 
and  I  thought  if  ligation  were  to  be  performed  at  alL  it 
must  be  by  the  metallic  ligature.  We  know  that  it  is  as 
generally  accepted  as  taught,  that  the  metallic  ligature 
takes  up  its  residence  qnietly  wherever  it  is  placed. 
Before  proceeding,  however,  to  perform  such  an  opera- 
tion, I  thought  it  would  be  better  to  confirm  these 
teachings  first  by  experiment 

I  accordingly  obtained  a  very  strong  sheep,  and 

appMed  a  silver-wire  ligature  to  the  common  carotid, 

and  fastened  it  by  twisting  it  very  tightly.      Fijty- 

six  days  afterwards,  I  cut  down  thpotsgh  the  cioa- 

^igitized  by  VjOOk^- 


450 


THE  MEa)ICAL  RECORD. 


ifiXy  and  found  that  the  collateral  circulation  which 
was  established  was  very  complete,  and  that  the  capil- 
lary circulation  was  not  great;  so  that  by  making 
the  section,  which  was,  by  the  by,  a  vivisection,  there 
was  very  little  haemorrhage.  On  coming  down  to  the 
point  of  ligation,  I  was  very  much  astonished  to  find 
what  appeared  to  be  a  good-sized  aneurism.  I  con- 
cluded, altliough  I  could  detect  no  pulsation,  that  it 
was  a  dissecting  aneurism ;  the  ligature  having  perhaps 
caused  ulceration  of  the  middle  and  internal  coats  of 
th;  vessel.  I  removed  it,  and  on  section  I  was 
rather  surprised  to  find  what  you  here  Bee — that  this 
sac  was  an  abscess  full  of  inspissated  pu^  the  pus 
having  been  in  larger  Quantity  than  when  I  removed 
the  tumor,  aa  is  manifested  by  the  plications  of  the 
pyogenic  membrane.  Ic  occupied  a  space  of  about 
four  lines  on  either  side  of  ligature,  beyond  which 
points  the  plugs  were  intact  for  about  seven  lines.  In 
the  centre  of  this  abscess  lay  this  ligature,  with  the 
middle  and  lining  coats  of  the  artery  completely 
aloughed  away  and  detached. 

Here  is  another  specimen  removed  from  a  pretty 
strong  sheep.  I  applied  a  leaden  ligature  this  time, 
and  bad  it  rather  large,  in  order  to  avoid  its  cutting 
through.  I  tied  it  tightly,  and,  apprehensive  that  the 
sharp  twisted  ends  might  possibly  produce  some  me- 
chanical irritation,  I  sought  to  avoid  it  by  securing  the 
ends  with  perforated  shot^  they  then  beiog  cut  off 
smoothly.  Twenty-six  days  afterwards,  I  cut  down 
through  the  cicatrix,  when  instantly  a  pellet  of  pus 
appeared  in  the  incision,  as  if  propelled  from  behind. 
I  made  another  incision,  when  the  ligature  and  shot 
immediately  followed  it.  As  I  proceeded  towards  the 
original  site  of  the  ligation,  the  hemorrhage  was  ex- 
ceedingly great — ^almost  equal  to  that  produced  by  dis- 
secting through  erectile  tissue.  I  ligated  above  and 
below,  and  then  removed  this  portion  with  the  abscess 
which  I  present  There  had  been  a  good  deal  of 
inflammation  around  the  artery,  and  there  was  con- 
siderable fibrinous  material  effused  in  the  neighborhood. 
When  preparing  this  specimen,  I  came  to  a  point  which 
I  thought  was  no  part  of  the  tumor,  but  was  misled; 
for,  by  continued  clipping  with  a  scissors,  I  came  down 
to  a  part  which  was  exceedingly  dense,  and,  cutting 
that,  a  little  opening  was  revealed,  through  which  a 
piece  of  whalebone  has  been  passed,  and  through 
which  the  ligature  had  ulcerated  its  way  to  the  surface. 
On  making  a  longitudinal  section  of  this  artery,  I  found 
it  perferitly  occluded,  and  well  plugged  on  its  cardiac 
and  distal  aspect  Between  the  proximal  end  of  the 
distal  plug  and  the  distal  end  of  the  oardiao  plug,  was 
apparently  an  abscess  containing  about  a  drachm  and  a 
half  of  sero-purulent  fluid ;  otherwise,  the  clot  was  per- 
fect The  points  of  interest  in  this  specimen  are  the 
great  amount  of  irritation  and  inflammatory  action  that 
occurred  about  this  metjmic  ligature,  and  that  through 
the  consequent  excesiive  deposit  of  fibrine  the  liga- 
ture, shot  and  all,  had  worked  its  way,  arriving  nearly 
at  the  cicatrix  of  the  integument 

I  iniagined  that  perhaps  the  kind  of  ligature  was 
not  the  only  consideration  which  should  claim  atten- 
tion, and  I  obtained  another  sheep,  to  the  common 
carotid  of  which  I  applied  a  silver-wire  ligature,  tying 
it  incompletely  after  the  manner  of  the  silk  ligature ; 
but  I  was  very  careful  to  tie  it  loosely.  I  tied  it  tight 
enough  only  to  diminish  the  canal  of  the  artery  to  a  con- 
siderable degree,  but  avoided,  as  nearly  as  I  could  judge, 
a  complete  closure. 

On  cutting  down  afterwards  upon  the  cicatrix,  I 
could  scarcely  discover  whereaboats  the  ligature  had 
been  applied,  so  small  was  the  amount'  of  irritition  it 
liad  produced.    The  plug  in  this  case  was  more  perfect 


than  in  either  of  the  preceding  cases.  There  was  no  ab- 
scess^ the  fibrinous  deposit  being  just  sufficient  to  cover 
the  ligature.  There  waSj  on  making  the  section,  just  a 
drop  of  something  in  which  my  friend  Dr.  Rogers,  who 
has  examined  several  specimens  for  me,  thought  he 
found  one  or  two  globules  of  a  doubtful  nature.  At 
all  events,  the  inflammatory  action  was  exceedingly 
slight,  only  enough  to  be  serviceable.  The  result,  so 
far  as  occlusion,  extent,  and  firmness  of  the  plug  are 
concerned,  is  very  much  better  than  in  either  of  the 
other  cases. 

I  am  very  unwilling,  at  present,  to  make  any  deduc- 
tions from  fiiese  expenments.  They  form  only  a  small 
part  of  a  series  which  I  have  in  progress,  each  with  a 
different  ligature  applied  in  a  different  manner.  So  far 
as  these  experiments  go,  other  things  being  equal,  it 
seems  to  be  demonstrated,  1st,  thai  the  mdalUc  ligature 
does  not  always  reside  quietly  where  it  is  pla^d.  The 
last  experiment  demonstrates,  2d,  that  it  is  not  always 
necessary  for  complete  occlusion  of  the  artery  to  tie  Vie 
ligature  so  tightly  as  to  divide  the  middle  and  internal 
coats.  3d.  The  last  experiment  is  very  suggestive, 
that  a  silver-wire  ligature  applied  so  loosely  as  to  pro- 
duce no  lesion  of  the  artery,  nor  even  to  completely 
arrest  the  circulation,  may  suffice  for  the  cure  of  aneur- 
ism, when  ai^Mjrdinary  ligature  would  be  rendered  in- 
expedient by  xhe  condition  of  the  arterial  coats. 

Dr.  Hamilton  thought  that  such  experiments  as 
those  detailed  by  Dr.  Howard  were  particularly  called 
for  at  this  time.  A  great  many  trids,  it  is  true,  had 
been  made  with  the  ligature,  but  none  as  yet  to  test 
the  relative  value  of  the  different  kinds,  more  especially 
of  the  metallic.  It  was  not  strictly  correct  that  the 
plan  of  applying  the  ligature  for  rupture  of  the  middle 
and  internal  coats  was  absolutely  necessary  to  success, 
as  there  were  instances  in  which  the  old  flat  ligature 
accomplished  occlusion  without  any  such  injury  to  the 
interior  of  the  vessel.  He  was,  however,  much  inter- 
ested in  knowing  whether  the  metallic  ligature  had  the 
additional  advantage  which  was  usually  claimed  for  it 
over  the  silk.  He  was  not  fully  convinced  aa  to  how 
much  the  sloughing  was  due  to  the  different  kinds  of 
ligature,  and  to  the  different  means  that  were  taken  in 
tying  them  to  guard  against  undue  irritation.  He  ex- 
pressed a  hope  that  the  doctor  would  Heave  the  points 
of  his  ligatures,  in  future  experiments,  entirely  without 
the  wound. 

Dr.  Bozeman,  by  invitation,  referred  to  a  case  in 
which  a  ligature  was  applied,  as  in  the  third  experiment 
of  Dr.  Howard,  upon  a  human  subject.  About  three 
months  ago  he  was  called  upon  to  apply *a  ligature  to 
the  carotid  for  aneurism  of  the  temporo-maxillary  artery. 
The  ligature  was  applied  with  the  same  view  as  in  the 
experiment  referred  to,  and  tied  precisely  as  Dr.  How- 
ard had  applied  his,  the  idea  being  to  effect  complete 
apposition  without  rupture  of  the  internal  coats  of  the 
artery.  The  wound  was  closed  in  the  ordinary  way, 
and  there  was  union  by  the  first  intention. 

In  answer  to  a  question  from  Dr.  Hamilton,  he 
stated  that  he  attributed  the  small  amount  of  irritation 
which  followed  not  so  much  to  the  ligature  as  to  the 
manner  in  which  it  had  been  applied. 

In  this  connection  he  referred  to  some  experiments 
upon  dogs  which  had  been  performed  some  forty  years 
ago  by  Dr.  Leverty  of  Mobile.  Twelve  or  fifteen  liga- 
tions had  been  performed  upon  the  carotid — silver,  gold, 
leaden,  silk,  grass,  and  hair  ligatures  bad  been  used.  He 
thought  that  in  every  instance  in  which  the  metaUio 
ligatures  were  used  they  had  become  ent'rely  encysted, 
there  having  been  not  a  single  instance  of  separation, 
and  the  occhided  portions  of  the  artery  having  been  in 
firom  three  to  six  montlis  reduced  to  a  cord. 


Digitized  by 


Google 


THE  JTEDICAL  RECORD. 


451 


Dr.  Howard  wished  to  state  that  experiment  No.  3 
differed  essentially  from  the  case  related  by  Dr.  Boze- 
man  in  this,  that  the  canal  was  only  diminished,  not 
closed,  as  in  the  patient  referred  to. 

Dr.  Post  thought  that  it  had  been  the  general  im- 
pression among  surgeons,  that  since  the  small  ligatures 
came  into  use,  and  were  so  tied  as  to  rupture  the  inter- 
nal and  middle  coats,  there  was  less  danger  than 
formerly  from  secondary  haemorrhage.  The  idea  was  to 
couit  union  of  the  ruptured  surfaces  of  the  coats  before 
the  ligature  should  have  a  chance  to  ulcerate  through. 

Dr.  Howard  remarked  that  this  principle  was  true 
with  regard  to  the  divided  ends  of  arteries  as  in  stumps, 
but  when  the  ligatures  were  applied  in  the  continuity 
of  the  vessel,  as  in  the  treatment  for  aneurism,  they 
were  liable  to  ulcerate  their  way  prematurely  through, 
and  give  rise  to  subsequent  haemorrhage. 

Dr.  Markok  thought  that  two  surgical  questions  were 
involved  in  these  experiments — the  one  had  reference 
to  the  occlusion  of  the  artery  and  the  com'ng  away  uf 
the  ligature,  the  other  to  the  obliteration  of  the  vessel 
and  allowing  the  ligature  to  become  encysted.  In  the 
former  case  it  seemed  necessary  that  the  process  should 
be  a  rapid  one  by  the  rupture  of  the  coats,  while  in  the 
latter  it  was  no  question  of  time  whatever,  all  that 
seemed  necessary  being  the  approximation  of  the  op- 
posed internal  coats,  leaving  the  obliteration  to  go  on 
gradually.  « 

Dr.  Peaslee  considered  that  the  degree  of  tightness 
of  the  ligature  was  the  question  at  the  very  foundation 
of  the  inquiry.  It  had  long  ago  been  settled  by  Dr. 
Knight,  of  New  Haven,  that  an  artery  Hke  the  femoral 
could  be  occluded  by  digital  compression  kept  up  con- 
tinuously for  forty-eight  hours.  This,  of  course,  proved 
that  rupture  of  the  arterial  coats  was  not  absolutely 
necessary  to  secure  such  an  end.  He  believed  that  the 
degree  of  tightness  of  the  ligatures  alone  produced  the 
dough,  and  it  mattered  not  what  kind  of  material  com- 
posed the  thread,  the  silver  wire  being  no  more  innocu- 
ous in  that  respect  than  the  silk  cord. 

Dr.  Sands,  in  this  connection,  referred  to  an  operation 
^rformed  by  one  of  the  surgeons  of  the  New  York 
Hospita'.  The  case  was  one  of  popliteal  aneurism, 
for  which  the  femoral  artery  was  to  be  ligated.  The 
vessel  was  exposed  in  the  usual  way,  when  the  thread 
was  passed  around  it,  and  the  ends  passed  through  two 
perforations  of  the  skin  apart  from  the  original  incision, 
and  tied  over  a  roll  of  lint.  The  wound  was  then 
closed.  He  did  not  remember  the  details  of  the  subse- 
quent treatment,  but  he  knew  that  very  soon  after  the 
operation  the  patient  had  pretty  severe  inflammation, 
that  the  pressure  had  to  be  let  up,  that  the  pulsation  re- 
turned in  the  tumor,  and  that  the  final  result  was  the 
death  of  the  patient  from  diffuse  cellular  inflammation. 

In  reply  to  a  question  by  Dr.  Howard,  if  Dr.  Boze- 
man  or  any  member  present  was  aware  of  any  record 
of  the  same  kind  of  experiments  as  those  presented, 
Dr.  Bozeman  replied  he  was  not  aware  of  any  except 
those  he  had  stated. 

Dr.  Markob  referred  to  a  case  of  ligation  of  sub- 
clavian for  aneurism  reported  by  Mr.  Porter,  of  London. 
The  ligature  was  tied  over  a  probe  outside  of  the  wound. 
At  the  end  of  fifty-six  hours  the  patient  was  doing 
well 

The  Society  then  adjourned. 


Dr.  GinLLAV,  who  was  lately  called  in  by  Nnpoleon, 
declined  any  fee,  saying  that  ''the  honor  was  sufficient 
for  him."  However,  $2,000  were  sent  to  him ;  but  he 
mode  a  present  of  the  whole  amount  to  the  Academy 
of  Medicine. 


NEW  YORK  ACADEMY  OF  MEDICINE. 

Stated  Mxetino,  Novbmbbr  6,  1867. 
Dr.  Alfred  C.  Post,  Prksidemt,  in  the  Chair. 

STATISnOAL  MEDICINE. 

Dr.  Thoms  read  a  paper  upon  the  above  subject,  ac- 
companied with  a  large  number  of  diagrams,  plans  of 
inquiry,  etc.,  which,  as  compilations,  exhibited  no  little 
care  and  labor.  He  dwelt  at  lengih  upon  the  represen- 
tative value  of  figures  as  expressive  of  exact  knowl- 
edge, and  urged  the  necessity  of  care  in  the  collection 
of  our  iudividual  facts.  These  became  important  when 
grouped  together,  particularly  since  statistics  were  sup- 
posea  to  advance  fiom  facts  to  conclusions.  The  state- 
ments of  a  general  observer  were  n.t  of  course  entitled 
to  as  much  credence  as  those  of  him  who  was  prepared 
to  corroborate  every  assertion  with  a  fact  ready  at 
hand. 

He  thought  that  the  subject  was  really  more  important 
than  generally  supposed,  as  honestly  compiled  statistics 
constituted  the  very  foundation  of  science,  and  that 
every  figure  was  endowed  with  a  certain  power  of  its 
own,  even  more  significant  than  a  printed  page.  The 
doctor  also  insisted  that  the  study j  a!thou<;h  at  fiist 
somewhat  barren  of  interest,  led  us  into  correct  habits 
of  thought,  and  taught  a  proper  discrimination  in  re- 
gard to  the  relative  bearing  of  one  fact  upon  another. 

Dr.  BiBBiNS,  as  indicative  of  the  importance  attached 
to  the  subject  by  "  the  Medical  Society  of  the  State  of 
New  York,"  referred  to  the  teims  of  "the  Brirsmade 
Prize,"  which  at  the  last  session  of  the  Society  was 
awarded  to  Dr.  Franklin  Hough.  This  called  for  a  plan 
adapted  for  the  tabulation  of  hospital  reports,  records  of 
practice,  etc.  He  could  not  but  compliment  Dr.  Thoms 
upon  his  efforts  to  awaken  the  professi'  n  to  the  im- 
portance of  the  subject,  appreciated  perhaps  only  by 
those  who  were  called  upon  to  tabulate  a  great  many 
facts,  whose  value  was  cniefly  numerical.  The  obstet- 
rical wards  of  any  of  our  large  hospitals  furnished  an 
example  <  f  the  necessity  of  properly  arranged  tables, 
by  suggesting  to  the  investigator  "  what  to  observe.* 
These  tables,  as  economizers  of  labor,  would  prove  a 
virtual  boon  to  the  profession,  particularly  to  that  por- 
tion, who,  from  the  pressure  of  private  practice  and 
public  duties,  were  compelled  to  note  their  tacts  on  the 
instant  In  London  this  was  reduced  to  a  system.  He 
remembered,  too,  having  admired  several  years  ago,  cer- 
tain tables  prepared  in  France.  He  was  well  aware 
that  in  the  hospitals  the  young  men  would  be  likely  to 
oppose  the  innovation,  but  when  convinced  of  its  labor- 
saving  and  time-economizing  capacity,  they  would 
gladly  second  the  endeavors  of  their  superiors  to  test 
the  measure. 

He  would  also  call  attention  to  the  importance  at- 
tached by  all  readers  of  the  secular  papers  to  the  data 
published  by  the  Health  Board.  Dr.  B.  then  concluded 
with  a  tribute  to  the  author  of  the  paper,  as  being  en- 
titled to  congratulation  for  havmg  presented  the  subject 
in  so  practical  a  form. 

Dr.  Herzoo,  while  appreciating  the  efforts  of  Dr. 
Thoms,  could  not  but  regret  that  he  had  omitted  from 
his  plan  all  reference  to  condition  of  the  soil  and  atmos- 
pheric influences.  He  deemed  no  plan  perfect  which 
did  not  provide  for  such  observation,  and  would  embrace 
every  opportunity  to  urge  upon  his  brethren  the  neces- 
sity of  this,  especially  in  the  study  of  zymotic  diseasea 

Dr.  HARRra  remarked  upon  the  significant  value  of 
natural  phenomena,  and  alluded  to  the  labors  of  Petten- 
koffer.  He  also  referred  to  the  very  exhaustive  manneT 
in  which  the  subject  of  moisture  in  the  soil  had  been 
studied  at  Munich  and  Berlm,  but  as  a  whole,  he 


462 


THE  MEDICAL  RECORD. 


thought  that  temperature  changes  did  not  exert  as 
much  influence  as  was  generally  supposed. 

He  agreed  with  Dr.  Thorns,  that  we  should  accurate- 
ly state  and  analyze  our  fiicts,  and  concluded  with  some 
remarks  upon  the  advanta;?es  to  he  gained  by  a  greater 
attention  to  detail  in  the  Oiling  up  of  the  death 
certificates,  according  to  the  form  pre?cribed  by  the 
Health  Board.  He  thought  that  the  chief  obstacle  to 
accurate  observation  in  these  cases  consisted  in  not  ap- 
preciating the  relationship  between  the  disease  and  the 
sequel®.  Not  phthisis,  for  instance,  but  pneumonia,  an 
intercurrent  complication,  might  terminate  the  life  of  the 
patient.  Bright's  disease  of  the  kidneys  and  diphtheria 
mifi;ht  destroy,  while  the  exanthematous  poison  was 
still  in  force. 

kinoslet's  portable  oas  blow-pipb. 

Dr.  Post  exhibited  a  blow-pipe,  invented  by  Pro£ 
Norman  W.  Kingsley,  of  the  New  York  College  of 
Dentistry,  which  possessed  the  advantage  of  being 
worked  by  a  thumb-pipe  regulating  the  supply  of  gas 
and  the  volume  of  the  flame.  It  was  also  capable  of 
turning  the  flame  in  any  direction,  while  one  hand  was 
free  to  control  the  object  held ;  the  flexible  tube  which 
constituted  a  part  of  the  apparatus  could  be  attached  to 
any  «is-pipe  or  burner,  while  the  current  of  air  was 
supplied  by  the  mouth,  a  bellows,  or  in  fact  any  power 
for  such  purpose. 

Dr.  Post  regarded  the  invention  as  especially  ser- 
viecable  in  heating  cauteries,  in  which  case  a  small 
flame  can  be  directed  upon  a  given  point  of  the  metal 
eniployed. 

In  reply  to  a  query  of  Dr.  Budd's,  concerning  the 
relative  merits  of  thia  apparatus  and  the  ordinary  blast- 
lamp,  he  was  of  opinion  that  the  former  had  the  ad- 
vantages of  simplicity,  convenience,  and  a  greater  range 
of  appiicaiion. 

A  TRIBUTE  TO  THE  MEIfORT  OP  THE  HEROES  OF  THE  U.  8.  ARMT 
AND  NAV7  MEDICAL  DEPARTMENTS. 

Dr.  Harris  prefaced  the  following  resolutions  with  a 
tribute  to  the  zeal  and  self-forgetfulness  of  the  surgeons 
of  the  army  and  navy  during  the  prevalence  of  the 
cholera  and  yellow  fever  epidemics. 

Resolved^  That  this  Academy  view  with  peculiar 
satisfaction  the  honorable  record  of  constant  and 
heroic  devotion  to  professional  duty  by  the  medical 
officers  in  the  U.  S.  Army  and  Navy  at  all  the  stitions 
where  yellow  fever  prevailed  durinsr  the  present  season. 

Raolved,  That  to  the  memory  ot  the  medical  officers 
and  other  physicians  who  have  sacrificed  their  lives  at 
posts  of  duty  in  the  infected  districL^,  this  Academy 
hereby  orders  ths  names  of  these,  our  lamented  breth- 
ren, to  be  publicly  read  before  it  at  its  anniversary 
meeting,  to  the  end  that  the  same  may  be  entered  upon 
the  records  in  connection  with  these  resolutions. 

Hesolved,  That  these  resolutions  be  published  in  the 
medical  journals  of  this  city.    Carried. 

A   GOYERNMEKTAL  INQUIRT  INTO  THE   CAUSES  OF  THE  LATE 
TSLLOW  FEVER  EPmEMIO. 

Dr.  Herzoq  presented  the  following,  with  the  request 
that  th?y  be  tabled  until  the  next  session  of  the  Acad- 
emy, since  the  lateness  of  the  hour  precluded  dis- 
cussion. 

WhereaSj  From  the  earliest  history  of  the  country, 
the  maritime  regions  of  the  Southern  States  have  been 
visited  by  epidemic  yellow  fever,  which  on  some  occa- 
siooa  has  been  as  destructive  to  liie  and  to  commerce  as 
any  epidemic  recorded  in  history,  and 

Whereas,  The  essential  nature  of  this  disease,  the 
question  of  its  endemic  or  epidemic  character,  the  laws 


of  its  origin  and  propagation,  and  the  measures  proper 
for  its  prevention,  have  never  been  investigated  by  the 
methods  of  modern  science,  and 

Whereas^  The  Scientific  Commission  for  the  investiga- 
tion of  Asiatic  cholera,  organized  by  the  Bavarian 
Government,  has  attained  such  results  in  exact  knowl- 
edge as  have  brought  that  disease  in  great  degree  under 
sanitary  control    Therefore 

Eesolvedj  That  the  Academy  of  Medicine  will  use  its 
influence  and  solicit  that  of  similar  scientific  bodies  in 
aid  of  the  appropriation  by  Congress  of  a  sufficient  sum, 
and  the  appointment  of  a  commi-sion  to  consist  of  men 
qualified  in  every  department  of  natural  science  in- 
volved in  such  inquiry,  to  whom  this  subject  shall  be 
referred  for  investigation  and  report 

The  Academy  then  adjourned. 


€ontspor(btnce. 


THE  QUESTION  OF  PRIORITY. 

To  Tiu  Editob  of  TaB  Mkdical  Eboobd. 
Sir— In  your  number  of  October  16th,  Dr.  W.  E.  Ver- 
milye  asks  for  the  insertion  of  a  "  few  words  in  relation 
to  the  question  of  priority  between  myself  and  Dr. 
Taylor,  in  relation  to  the  construction  and  use  of  the 
short  splint  in  hip  diseifces." 

This  subject  was  so  completely  settled  by  my  first 
letter  in  the  Medical  Times  of  1861,  and  reprinted  in 
the  Record  of  October  1,  1867,  and  the  dates  therein 
given,  that  I  confess  myself  somewhat  surprised  at  the 
remarks  he  makes. 

He  says,  "  If  I  understand  the  matter,"  thereby  ad- 
mitting the  doubt  whether  he  does  understand  it  or 
not^  "  Dr.  Sayre  has  raised  &  false  issue,  both  in  bis  letter 
of  July,  1861,  and  in  the  one  recently  published." 

It  certainly  is  very  remarkable  that  this  false  issue  • 
was  not  discovered  for  seven  years  either  by  Dr.  Taylor 
or  Dr.  Vermilye,  as  it  has  been  published  extensively 
to  the  profession,  and  applied  in  public  at  Bellevue  Hos- 
pital with  a  cross-piece  and  joint  at  the  top,  and  with  a 
branch  to  take  the  adhesive  straps  froni  the  inside  of  the 
thigh,  in  December,  1860,  some  months  before  Dr.  Tay- 
lor constructed  his  instrument,  and  which,  he  says  m 
his  paper,  he  showed  to  me  in  Februarv,  1861. 

The  instrument  is  labelled  "  Sayre*s  '^'  by  tlie  instru- 
ment-maker, in  order  to  distinguish  it  from  others.  As 
this  whole  matter  is,  however,  a  mere  question  of 
dates,  which  Dr.  Mason's  letter  settles  so  completely, 
I  hope  I  shall  be  spared  from  again  coming  before  the 
profession  on  this  subject. 

Lewis  A,  Satrb,  M.D. 

Since  the  above  has  been  in  type,  Dr.  Sayre  has 
received  the  following  note,  which  will  speak  for  it- 
self: 

Not.  18, 1867. 

Prof.  L.  A.  Satre. 

Dear  Sir — In  answer  to  your  inquiries  I  beg  to 
state,  that  in  December,  1860,  I  made  a  short  splint 
for  the  Commissioners  of  Public  Charities  and  Correc- 
tions. I  also  made  one  about  that  time,  or  before,  I 
believe,  for  a  poor  patient  of  yours  in  the  Tenth  ave- 
nue, near  60th  street,  New  York.  I  have  no  entry  of 
the  latter  case  in  my  books,  as  I  did  not  charge  for  the 
splint.  Both  of  these  splints  had  a  branch  to  take  the 
plaster  from  the  inside  of  the  thigh,  and  also  a  short 
cross-piece  to  go  partially  around  the  pelvis,  and  con- 
nected with  the  splint  by  a  ball  and  socket  joints 

I  should  have  written  to  you  earlier,  but  it  was  neces- 
sary for  me  to  see  Dr.  E.  Mason,  to  be  sure  of  the  date 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


453 


that  these  splints  were  made.  You  may  perhaps  re- 
member that  the  doctor  was  your  assistant  m  Bellevue 
Hospital  in  the  fall  of  1860. 

I  am  very  respectfully, 

THE  WASHINGTON  XJNIVERSITT. 

To  m  Editor  of  m  Mkdicax.  Bbooro. 
SiR«*Ia  your  issue  for  this  month  there  is  a  notice  of 
Washington  University,  in  which  my  name,  by  some 
mean?,  has  been  printed  C.  L.  Ford.  I  should  proba- 
bly not  have  noticed  the  error  had  not  Dr.  C.  L.  Ford, 
of  Ann  Arbor,  Michigan,  addressed  a  communication  to 
Rev.  Dr.  Bond,  President  of  the  College,  which  would 
indicate  that  he  thought  the  person  alluded  to  was  him- 
Belf— since  he  is  of  the  impression  that  the  faculty  has 
been  but  recently  organized,  and  the  College  not  yet  in 
operation.  Very  respectfully,  eta, 

^  A.  J.  Foard,  M.D 

Prof.  Anatomy,  and  Dean  Washington  Univ. 

4T  LtBEKTT  ST.,  COR.  LeXtKOTOK, 

Baltimokk,  Not.  20,  l867. 

IletB  3n«triiment«. 


DR.  D.  H.  GOODWILLIE'S  INHALER. 
Wk  present  a  description  of  a  simple,  safe,  efl&cient, 
and  economical  apparatus  for  the  administration  of  all 


This  inhaling  apparatus,  manufactured  by  Tiemann 
&  Co.  of  this  city,  consists  of  a  face  piece  (C),  con- 
nected with  it  a  faucet  (A)  which  contains  the  inhala- 
tion-valve (Pig.  2,  h)  for  the  passage  of  the  vapor,  and 
exhalation-valve  (/)  for  the  escape  of  the  expired 
breath,  and  a  fresh  air-passage  (^),  with  an  index  to 
show  the  amount  of  vapor  and  air  being  inhaled  at  any 
time  during  the  administration.  The  inhaler  is  con- 
nected by  a  flexible  tube  to  the  bottle  (a)  containing  a 
sponge,  and  half  filled  with  the  aniesthetic  fluid  to  be 
used.  Air  is  admitted  by  a  tube  (h)  to  the  centre  of 
the  sponge,  to  evaporize  the  fluid  on  the  upper  half  of 
it  during  the  inhalation.  The  inhalation-valve  and  air- 
passar;e  are  of  the  same  caliber,  and  divided  by  the  index 
into  five  parts.  The  revolution  of  the  faucet  over  the 
inhalation- valve  and  air-passage  controls  the  inhalation 
of  vapor  and  air.  Figure  1  on  the  index  shows  the 
minimum  amount  of  vapor,  and  4  the  maximum 
amount.  The  fifth  part  is  always  fi^sh  air.  Revolving 
the  faucet  from  1  to  4  increases  the  vapor  and  decreases 
the  a'r.  4  to  1,  vice  vtrsA.  All  the  vapor  can  be  shut 
off  and  fresh  air  admitted  without  removing  the  inhaler 
from  the  face.  For  example,  let  the  faucet  be  revolved 
to  2  on  the  index,  then  two  parts  of  vapor  and  three 
parts  air  are  inhaled.  The  gradual  inhalation  accus- 
toms the  air-passages  to  the  vapor,  and  thus  produces 
less  spasm  or  the  epiglottis,  coughing,  strugglmg,  and 
sickness,  and  narcotism  is  quietly  produced  and  easilv 
maintained.  By  this  apparatus  the  administrator  has  full 
knowledge  and  control  of  the  vapor  inhaled.  A  great 
saving  of  chloroform  or  ether  is  effected,  as  the  vapor 
from  the  bottle  passes  direct  to  the  lungs,  and  is  mixed 
with  air  at  the  will  of  the  administrator  by  the  faucet. 

This  apparatus  can  be  applied  to  the  inhalation  of  all 
the  anaesthetics  and  medicated  vapors. 


(Dbituarg* 


the  anaesthetics  and  medicated  vapors,  invented  by  Dr. 
D.  H.  Gh)odwillie  of  tliis  city. 


PROFESSOR  WORTHINGTON  HOOKER,  M.D., 

The  profession  throughout  the  country  has  been  called 
upon  to  mourn  the  untimely  removal  by  death  of  one  of 
its  most  widely  known,  cherished,  and  active  members. 
Engaged  in  the  practice  of  his  profession  for  a  period  of 
forty  years,  and  winning  by  his  literary  talents  a  repu- 
tation in  early  professional  life,  he  became  identified 
with  two  generations.  His  life  affords  an  illustration  of 
what  any  physician  can  make  himself  by  arduous  labor 
and  fidelity  of  purpose.  Although  practising  the  art 
which  he  loved  so  well  up  to  his  death,  he  always 
found  time  and  opportunity  to  devote  himself  to  the 
fascinations  of  literature,  both  within  and  beyond  the 
pale  of  his  profession.  No  one  in  our  ranks  has  enjoyed 
a  success  in  the  circulation  of  publications  greater  than 
his.  This  is  particularly  the  case  with  several  minor 
works  upon  scientific  matters,  designed  for  schools  and 
colleges,  among  which  may  be  mentioned,  "  The  Child's 
Book  of  Nature,"  and  his  •'  Physiology  for  Colleges  and 
Schoo's."  Both  of  these  have  been  extensively  adopted 
by  the  various  institutions  of  learning  throughout  New 
England.  His  first  work  waa  entitled,  "  The  Physician 
and  Patient,"  and  so  well  was  it  written,  that  he  laid  by 
it  the  foundation-stone  for  an  enviable  literary  reputa- 
tion. His  contributions  to  Jhe  medical  journals  were 
varied,  practical,  and  valuable,  and  on  two  different  oc- 
casions he  was  awarded  a  prize  for  medical  essays  by 
the  American  Medical  Association.  He  was  every- 
where distinguished  for  his  affable  and  generous  nature, 
and  raised  for  himself  hosts  of  friends  whose  hearts  are 
now  painfully  sad  over  his  departure.^^-^  t 

Digitized  by  VjOOQ  IC 


454 


THE  MEDICAL  RECORD. 


Born  ia  Springfield,  Mass.,  in  the  year  1805,  he  was 
sixty-two  yeara  of  age  at  the  time  of  his  death.  He 
graduated  at  Yale  in  the  class  of  1^25.  In  the  same 
class  were  President  North  of  Hirailton  College,  Gov- 
ernor Ford  of  Ohio,  Chief  Justice  Thoma'*  Slidell  of 
the  Supreme  Court  of  Louisiana,  Hons.  George  W. 
Woodruff,  Thcvnas  H.  Bond,  William  B.  Bristol,  Abijah 
Oatlin,  and  Dr.  N.  B.  Ives.  He  commenced  the  study 
of  mediciiie  in  the  Hnrvard  Medical  School  immediately 
ader  graduation,  and,  upoa  the  conclusion  of  his 
studies,  in  1828,  he  established  himself  in  pnictice  in 
Norwich,  Conn.,  where  he  remained  until  1852,  when 
he  led  lor  New  Haven  to  accept  the  Professorship  of 
Theory  and  Practice  in  Yale  College.  He  continued  in 
connection  with  that  institution  until  his  death,  dis- 
tinguishing himself  as  a  teacher  and  an  advocate  for 
the  elevation  of  the  standai  d  of  medical  education.  The 
interest  whi-h  he  took  in  this  latter  subject  manifested 
itself  in  many  praiseworthy  efforts  before  the  American 
Medical  Association,  and  caused  him  to  be  looked  to  as 
one  of  the  radical  pioneers  in  the  advancement  of  the 
interests  of  the  brotherhood. 

In  1830  he  married  Miss  Mary  IngersolL  of  Spring- 
field, who  died  shortly  before  he  left  Norwich.  Subse- 
quently he  united  himself  to  a  daughter  of  the  late  Gov- 
ernor Edwards^  who  survives  him. 

Added  to  his  other  graces  was  the  exalted  one  of 
a  consistent  Christian,  he  being  for  many  years  a  prom- 
inent and  zealous  member  of  the  Congregational  de- 
nominatio!),  and  an  active  worker  in  the  Sunday-school 
department. 

In  his  decease  a  vacant  place  is  left  in  our  ranks 
which  cannot  be  easily  filled,  but  h.*  has  led  us  an  ex- 
ample by  which  all  can  profit,  and  we  net  d  hope  for 
nothing  better  than  that  our  last  end  may  be  like  his.  His 
eloquent  tongue  is  sLLnt,  his  accomplished  pen  is  atr^-st, 
but  his  ennobling  record  lives  after  him,  and  his  mem- 
ory will  be  kept  green  by  the  thousand i  he  has  in- 
structei  and  bef'riende  1. 


tlctu  |)ubltcatiDnd* 


Books  akd  Pamphlets  Received. 

Report  op  Prooeedinos  of  the  Association  of  Medical 
supkrintexdbnts  of  american  institutions  for  the 
Insane.    1B67. 

TuEN  AND  Now:  A  Discoorse  Introductory  to  the  Forty-third 
Course  of  Lectures  in  tlie  Jeflrer?»(>n  if«^iiical  Colle^  of 
riiiladelphia.  By  S.  D.  Gross,  M.D.,  Professor  of  Princi- 
ples and  Practice  of  Surgery. 

Water:  A  Medical  Essny  by  Samukl  W.  Francis,  M.D., 
Physician  to  Northern  Digpen.sary,  New  York. 

Photographs  of  Diseases  op  tub  Skin,  taken  from  Life. 
Nos.  3,  4.  Series  I.  By  H.  F.  Damon,  A.M.,  M.D.  Bos- 
ton:  James  Campbell,  I8rt7. 

Mechanical  TflERAPEurics:  A  Practical  Treatise  on  Surgi- 
cal Apparatus,  AppliiincoH.  and  Kk'meniarv  OperatioiiR, 
etc,  etc  By  Philip  S.  Wales,  M.D,  U.S.N.  Piiiladel- 
phia:  11.  C.  Lea,  1867. 

On  Diseases  of  the  Lungs  and  Atr  Passages,  their  Pa- 
tholojry.  Piiyflical  Diagno!<w,  >»ympioms,  and  Treatmeitt. 
By  II.* W.  P'ULLER,  M  l>.  CaiiUib.,  etc,  etc.  From  the  Sec- 
ond and  Revised  London  Edition.  Philadelphia :  H.  C. 
Lea,  18<a. 

A  Treatise  o.v  Therapeutics  and  Pharmacoi^ogy,  eta  By 
Gkoiioe  B  Wood,  M.D.,  Presi'lcnt  of  the  America:i  Philo- 
Rnpiiit>al  S«K?iely.  elc.  etc.  Third  Edition.  In  2  vols. 
Philadelphia:  J.  B.  Lipplncott  <fe  Co.,  18G8. 

A  Treattse  on  the  Cause  op  Kxii\usted  Vitality,  or 
Ab*isefi  of  the  Sexual  Fiinetinn.  By  R.  P.  Miller,  M  D.. 
Physician  if>  the  llyKif^nic  iMKtitiito  and  Tu'*ki8h  Baths^ 
etc,  etc.    New  York:  J.  A.  Gray  k  Green,  1867. 


iXitimi  3tem«  avib  Urns. 


The  Late  Prof.  Robert  Watts,  M.D. —  Wheretu,  it 
has  pleased  an  All-wise  Providence  to  take  from  the 
scene  of  his  earthly  labors  one  of  the  oldest  and  best 
beloved  members  of  this  Society,  Dr.  Robebt  Watts; 
therefore, 

Besolvidj  That  in  the  death  of  our  late  aeaociate  we 
deplore  the  loss  of  a  sigacious  physician,  a  genial  com- 
panion, and  a  true  friend. 

Resolved^  That  in  this  Society,  where  for  so  many 
years  he  found  the  most  grateful  recreation  from  thie 
labors  of  an  arduous  prac  ice,  we  cannot  cherish  too 
warmly  the  memory  of  his  ever-welcome  presenoe. 

Resolved,  That  to  the  profession,  as  well  as  to  this 
Society  and  his  many  friends,  the  exalted  character  of 
Dr.  Watts  as  a  man,  his  ability  and  self-sacrific'n?  de- 
votion as  a  physician,  and  his  noble  qualities  of  hearty 
will  ever  make  him  an  example  worthy  of  emulation 
and  regard. 

Resolved,  That  a  copy  of  these  resolutions  be  trans- 
mitted to  the  family  of  the  deceased,  and  that  they  be 
published  in  the  medical  joum  ils  of  this  city. 

T.  M.  Markoe,  M.D.,  President 
Foster  Swift,  M.D.,  Secretary. 

At  a  meeting  of  the  Students  of  the  College  of  Phy- 
.^icians  and  Surpreons,  held  in  the  Hall  of  the  College, 
October  18,  1867,  the  following  preamble  and  resolu- 
tious  were  adopted : 

Whereas,  We  the  Students  of  the  College  of  Physicians 
and  Surgeons,  have  heard  with  sincere  regret  of  the 
death  of  our  Professor  of  Anatomy,  Dr.  Robert  Watts^ 
and 

Whereas,  We  ever  found  in  him  an  able  and  efficient 
instructor,  a  true  and  sympathizing  friend ;  therefore, 
be  it 

Resolved,  That,  while  we  would  ever  reoognjjse  the 
will  of  an  All- wise  Providence,  we  deplore  the  death 
of  one  so  eminently  qualified  by  rare  mental  attain- 
ments, and  by  the  naturally  pleasant  traits  of  his  charao- 
(er,  for  the  position,  the  duties  of  which  ho  so  long  and 
faithfully  performed. 

Resolved  J  That  we  tender  our  heartfelt  sympathy  to 
the  family  of  the  deceased,  and  would  comfort  them 
with  the  assurance  that  he  has  lefl  behind  him  many 
endearing  fruits  of  a  useful  and  well-spent  life. 

Resolved  ,  That  as  a  tribute  of  respect  to  the  memory 
of  our  late  professor,  we,  as  a  class,  attend  his  funeral 
and  wenr  a  badge  of  mourning:  for  thirty  days. 

Resolved,  That  a  copy  of  these  resolutions  be  sent  to 
the  family,  and  also  that  they  be  published  in  two  of 
the  New  York  daily  papers  and  in  two  of  the  leading 
medical  journals  of  the  United  States. 
Frank  W.  Rockwell,     ^ 
John  J.  Prenoergast,      >   CommiUes, 
WiLLARD  Parker,  Jr.,     ) 


Dr.  Carter,  an  eminent  physician  of  Charlottesville, 
Va.,  died  on  Thursday,  November  7,  of  apoplexy,  in 
the  seventy-sixth  year  of  his  age.  Dr.  Carter  p[nuin- 
atei  in  Philadelphia,  in  1812,  and  settled  in  Charlottes- 
\ille  in  1824.  He  had  been  a  practising  physician  for 
filly-live  year?,  and  was  beloved  wherever  known  for  his 
many  amiable  qualities. 

A  Premium  for  an  Essay  on  Croup. — The  Emperor 
Napoleon,  having  lost  a  nephew  by  croup,  offers  % 
premium  of  12,000  francs  for  the  best  essay  on  thftt 

disease. 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


455 


Poisoned  by  Myrbane. — An  inquiry  was  held  by  Mr. 
John  Humphreys,  the  Middlesex  coroner,  at  the  ]31ack 
Horse  tavern,  Kingsland-road,  into  the  death  of  the 
wife  of  a  tradesman  living  at  64  Kingsland-road. 
Her  name  was  Elizabeth  Masham,  aged  sixty-four 
years.  On  the  27th  ult.  she  went  on  a  visit  to  Mr. 
and  Mrs.  Eipple.  While  there  she  was  seized  with 
spasms,  and  went  to  a  cupboard,  and  drank  what  she 
tnoueht  was  brandy.  She  had  made  a  mistake,  and 
drank  some  myrbane.  Mrs.  Kipple  said  that  the  smell 
was  sickening.  Mr.  John  Masham  stated  that  when 
he  found  that  his  wife  had  been  poisoned  he  placed  a 
quarter  of  a  teaspoonful  of  the  liquid  into  his  mouth. 
His  face  began  to  glow,  and  his  sight  became  confused. 
He  then  spat  it  out.  For  three  days  after  he  was  dizzy. 
Dr.  Hoskins  proved  that  the  deceased  expired  on  Wed- 
nesday, from  the  effects  of  poisoning  by  myrbane.  She 
was  insensible  for  three  days  before  her  death.  The 
coroner  said  that  the  present  was  the  third  case  of  myr- 
bane poisoning  on  record.  Both  the  other  cases  had 
come  under  his  notice.  One  of  Uiem  was  that  of  a 
young  man,  who  swallowed  some  of  the  poison  while 
sucking  a  syphon  to  make  it  run.  That  occurred  at  a 
chemical  factory.  The  other  death  arose  from  a  man 
spilling  a  carboy  filled  with  it  over  his  clothes.  In  order 
to  dry  them  he  lay  down  in  front  of  a  fire,  and  the 
poisonous  vapor  killed  him.  He  was  found  dead. 
Myrbane  was  quite  a  new  poison,  and  it  had  been  acci- 
dentally discovered  by  a  chemist,  who  was  making  the 
magenta  color  out  of  coal-tar.  It  was  used  to  scent 
oils  and  to  give  a  flavor  to  cakes.  Cheap  pastrycooks 
bought  it  at  63.  to  8s.  a  pound,  and  used  it  instead  of  bit- 
ter almonds,  which  cost  12s.  a  pound.  Three  drops  of 
it  in  a  pound  cake  would  not  do  damage.  The  jury 
returned  a  verdict,  "  That  tlie  deceased  was  accidentally 
poisoned  by  myrbane.'' — London  News, 

Dr.  Ejirl  TnnRscH,  Professor  at  Erlangen,  son-in- 
law  of  the  celebrated  chemist,  J.  von  Liebig,  has  ac- 
cepted the  call  as  Professor  of  Surgery  and  Director  of 
the  Sure^ical  Clinic  at  Leipsic,  in  the  place  of  Gunther, 
deceased. 

PaorESSOR  Lteberkuhk  has  been  called  to  the  chair 
of  Anatomy  at  the  University  of  Marburg. 

Dr.  Ignaz  Ritter  v.  Nadherny  died  in  Vienna  on 
the  6th  of  August,  in  the  eightieth  year  of  liis  age,  after  a 
li'e  of  active  and  earnest  labor  devoted  to  the  honor  of 
his  profession  and  the  good  of  his  fellow  men.  He  com- 
menced public  life  more  than  fifty  years  ago  as  Pro- 
fessor of  Medical  Jurisprudence  in  Prague,  was  after- 
wards elevated  to  various  positions  of  official  trust  in  Bo- 
hemia^ and  finally  made  chief  of  the  medical  branch  of  the 
department  of  Public  Instruction.  His  labors  for  the 
public  hygiene  of  Bohemia  were  stupendous;  his  efforts 
on  behalf  of  the  charitable  institutions  of  Prague  un- 
remitting; while  two  generations  of  physicians  looked 
up  with  reverential  love  and  awe  to  their  patriarch  and 
nestor,  Nadherny.  He  was  untieing  in  his  labors  of 
love  for  a  suffering  humanity ;  no  work  was  too  hard, 
no  sacrifice  too  great  for  him.  Three  monarchs  of 
Europe  recognized  his  services  by  elevating  him  to  the 
rank  of  Knight,  and  conferring  on  him  titles,  decorations, 
and  testimonials  of  every  description;  while  in  the 
hearts  of  the  people  he  has  built  himself  a  monument  of 
everlasting  gratitude. — AUgemeine  Wiener  Zeitung, 

Dr.  Edmund  Rose  of  Berlin  succeeds  Billroth  as 
Professor  of  Surgenr  and  Director  of  the  Surgical  Clinic 
at  Zurich,   Switzerland. 

The  Treatment  of  Infantile  Paralysis. — At  the 
regular  meeting  of  the  Paris  Academy  of  Medicine  held 
on  the  17th  of  September,  M.  Bouvier  presented  from 


Dr.  C.  P.  Taylor,  of  New  York,  a  work  entitled  Ivfan- 
tile  Paralysis  and  its  Attendant  Deformities.  At  the 
same  time  he  showed  to  the  Academy  two  forms  of 
apparatus,  from  Dr.  Taylor,  one  for  the  treatment  of 
Pott's  disease  and  the  other  for  coxalgia. 

"The  apparatus  which  I  have  the  honor  to  present 
to  the  Academy,"  said  M.  Bouvier,  "  has  been  on  exhi- 
bition in  the  American  section  of  the  Exposition.  It 
differs  essentially,  as  may  be  seen,  from  those  which 
are  ordinarily  employed  in  the  treatment  of  Pott's  dis- 
ease. It  combines  all  the  advantages  of  horizontal  po- 
sition, while,  at  the  same  time,  it  gives  the  patient  ex- 
ercise and  fresh  air.  With  this  apparatus  Dr.  Taylor 
endeavors  to  protect  the  diseased  vertebrae,  as  is  done 
in  the  dorsal  decubitus  without  the  aid  of  the  instru- 
ment. Like  a  bed  securely  attached  to  the  dorsal 
region,  the  instrument  exercises  on  the' vertebral  column 
an  equable  pressure,  as  would  result  from  the  patient's 
weight  when  in  bed.  This  force  is  uniformly  antero- 
posterior. 

"  The  apparatus  is  a  simple  lever,  which  raises  the 
superior  part  of  the  vertebral  column,  by  using  the 
transverse  processes  as  the  fulcrum;  so  that,  whilst 
pressure  on  the  articulations  of  the  transverse  processes 
IS  safely  increased,  the  pressure  on  the  bodies  of  the 
diseased  vertebrae  is  considerably  diminished.  The  in- 
strument is  hinged,  and  acts  like  a  supplementary  ver- 
tebral column.  Its  arrangement  enables  one  to  appre- 
ciate exactly  and  to  modify  the  degree  of  force  em- 
ployed, and  to  render  the  treatment  constantly  and 
regularly  progressive.  It  also  assists  the  contractions  of 
the  spinal  muscles.  The  ability  of  the  patient  to  be  in 
the  open  air,  while  the  seat  of  disease  is  protected 
against  all  shock — this  constitutes  the  superiority  of 
this  mode  of  treatment. 

"  The  other  apparatus  is  designed  for  counter-exten- 
sion in  coxalgia.  The  idea  of  counter-extension  origi- 
nated with  Dr.  Davis  (of  New  York),  but  this  instru- 
ment is  nevertheless  the  inveniion  of  Dr.  Taylor.  It  con- 
sists, 1st,  of  a  belt,  provided  with  two  straps,"  which  em- 
brace the  perineum,  producing  extension  from  above ; 
2d,  of  a  long  extensible  Sjlint,  received  under  the  foot 
by  a  Strap,  which  is  a  continuation  of  the  adhesive 
straps  applied  to  each  side  of  the  thigh  and  around  the 
limb ;  this  strap  produces  counter-extension. 

"  Elongation  is  accomplished  by  means  of  a  lateral 
screw.  Not  only  the  muscular  tonicity  is  overcome, 
and  the  articulation  preserved  from  pressure  or  shock, 
but  during  locomotion  the  weight  of  the  body  is  sus- 
tained by  the  i^3trument,  because  the  body  rests  on 
the  straps  which  embrace  the  perineum. 

*'  The  result  of  Dr.  Taylor's  experience  shows  that 
when  the  tonicity  of  the  muscles  of  the  hip  is  com- 
pletely overcome,  and  the  parts  are  guarded  from 
pressure  and  shock,  locomotion  is  not  only  free  from 
danger,  but,  on  the  contrary,  very  advantageous,  be- 
cause the  patient  can  thus  profit  by  the  potent  measures 
which  hygiene  places  at  our  disposal" — Gaz.  dea  Hopt- 
tavx. 

The  Present  Raid  on  the  Uterus. — ^The  following 
extract  from  the  address  of  Dr.  W.  D.  Buck,  before  the 
New  Hampshire  Medical  Society,  is  copied  from  the 
St.  Louis  Medical  Reporter :  "  The  uterus  is  a  harmless, 
inoffensive  little  organ,  stowed  away  in  a  quiet  little 
place.  Simply  a  muscular  organ,  having  no  function 
to  perform  save  at  certain  periods  of  life,  but  furnish- 
ing a  capital  field  for  surgical  operations,  and  is  now- 
a-days  subject  to  all  sorts  of  barbarity  from  surgeons 
anxious  for  notoriety.  Had  dame  Nature  foreseen 
thi',  she  would  have  made  it  iron-clad.  What  with 
burning  and  cauterizing,  cutting  and  ^slashing,  and  split- 


456 


THE  MEDICAL  RECORD. 


ting,  and  skewering,  and  pessaryinff,  the  old  fiiflhioned 
womb  will  cease  to  exbt,  except  in  history.  The  Trans- 
actiona  of  the  National  Medical  Association  for  1864 
has  figured  123  different  kinds  of  pessaries,  embracing 
every  variety,  from  a  simple  plug  to  a  patent  thresh- 
ing machine,  which  can  only  be  worn  with  the  largest 
hoops.  They  look  like  the  drawing  of  turbine  water- 
wheels,  or  a  leaf  from  a  work  on  Entomology.  Pes- 
saries, I  suppose,  are  sometimes  useful,  but  there  are 
m  »re  than  there  is  necessity  for.  I  do  think  this  fill- 
ing up  the  vagina  with  such  traps,  making  a  Chinese 
toy-shop  of  it,  is  outrageous.  Hippocrates  said  he  never 
would  recommend  a  pessary  to  procure  abortion,  nay, 
he  swore  he  never  would.  Were  he  alive  now  he 
would  never  recommend  one  at  all  If  there  were 
fewer  abortions  there  would  be  fewer  pessaries,  and  if 
there  were  fewer  pessaiies  there  would  be  fewer  abor- 
tions. Our  grandmothers  never  knew  they  had  wombs, 
onl^  as  they  were  reminded  of  it  by  a  healthy  foetus; 
which,  by  the  by,  they  always  held  on  to.  Now-a-days 
even  our  young  women  must  have  their  wombs  shoved 
up,  and  if  a  baby  accidentally  gets  in  by  the  side  of  the 
machinery,  and  finds  a  lodgment  in  the  uterus,  it  may, 
perchance,  have  a  knitting-needle  stuck  in  its  eyes  be- 
fore it  has  any.  It  is  the  easiest  thing  in  the  world  to 
introduce  a  speculum,  and  pretend  to  discover  ulcera- 
tion of  the  05,  and  subject  a  patient  to  this  revolting 
manipulation  once  or  twice  a  week,  when  there  is,  iu 
fact,  nothing  the  matter.  By  some  practitioners,  all  dis- 
eases which  occur  in  the  female  ai*e  attributed  to  the 
uterus.  In  this  class  are  especially  to  be  included  all 
such  as  make  of  the  abnormal  conditions  of  the  uterus 
a  specialty." 

A  Magkbtio  Bullet  Probe. — Mr.  Sylvande  Wilde 
has  invented  an  instrument  for  extracting  bullets  in 
wounds,  which  has  been  aptly  called  a  sensitive  artifi- 
cial finger^  for  its  action  d^ends  on  the  actual  presence 
of  the  bullet  sought  for.  It  consists  of  two  insulated 
steel  wire^  which  are  connected  with  an  electro-mag- 
net and  a  bell,  so  arranged  that  the  electric  circuit  wul 
pass  through  the  two  wires  whenever  they  are  connect- 
ed by  contact  with  the  same  piece  of  me!al,  whicli  will 
form  a  part  uf  the  conductor.  The  points  of  the  probe 
are  sheathed  in  a  sliding-tube  when  introduced  into  the 
wound,  and  are  not  uncovered  u-til  the  supposed  bul- 
let is  felt.  The  forceps  have  curved  points,  and  are 
not  pallets  or  spoons.  When  the  ends  of  ine  probe 
are  uncovered,  on  touching  the  bullet,  the  latter  com- 
pletes an  electric  circuit,  which  sets  in  motion  a  mag- 
net, and  by  its  attraction  compels  the  forceps  to  gra-^p 
the  bullet ;  it  is  then  ready  to  be  drawn  out 

Humoral  pATnoLoav  aoain  in  the  Asoendant. — ^It  is 
a  remarkable  fact  that  the  humoral  theory  in  pathology, 
which  dates  back  as  far  as  Hippocrates,  and  which  was 
of  course  founded  only  upon  bold  speculaton,  is  now 
emerging  by  the  aid  of  science  from  the  almort  univer- 
sal contempt  into  which  it  had  s  nk,  and  becoming  a  re- 
ceived dogma.  We  now  depend  upon  the  different 
emunctorie;*,  and  do  not  attempt  to  extinguish  the  dis- 
ease at  the  hazard  of  life.  In  a  word,  we  '*  soo^.he  and 
8  istain,"  as  Dr.  Flint  with  a  beauriful  conciseness  ex- 
presses ir,  while  the  process  of  purifi.*ation  is  in  pro- 
gress. As  defendants  of  the  expectant  school,  we  now 
fortify  the  system  to  prepare  it  against  the  a^i'^aults  of 
an  ill-conditioned  militia  mustered  in  for  an  emergency. 
— Private  Letter, 

The  Female  Doctor  Question  Abroad. — Mmf».  Sour- 
kof  has  just  received  the  djjcree  of  Doctor  of  Medicine 
from  the  University  of  Ziric^  She  is  Russian  by  birth. 
and  studied  at  St.  Petersburg  with  great  credit  until 


the  Russian  government  forbade  the  conferring  of  de- 
grees in  medicine  upon  women. 

An  Extensive  Hospital. — An  exchange  states,  on  the 
authori^  of  Dr.  Nathan  R.  Smith,  of  Baltimore,  Md., 
who  has  recently  returned  from  Europe,  that  the  city 
of  Milan  can  boast  of  the  most  magrnificent  hospital  in 
all  Europe.    It  contains  2,500  beds. 

The  Colors  op  Soap-Bitbbles.— At  the  late  meeting 
of  the  British  Association  for  the  Advancement  of 
Science,  Sir  David  Brewster  read  a  paper  on  this  sub- 
ject)  from  which  it  appears  that  be  had  been  led  to  make 
some  new  investigations  as  to  the  cause  of  colors  of 
soap-bubbles,  after  he  had  repeated  the  beautiful  exper- 
iments of  Professor  Plateau,  "  On  the  Equilibrium  of  a 
Liquid  Mass  without  Gravity."  In  these  cases  the 
colors  of  soap-bubbles  were  presented  to  him  upon 
soap-BIm?,  plane,  convex  and  concave;  but  the  changes 
of  form  which  they  underwent,  and  their  motions  upon 
the  film  itself  were  incompanble  with  the  common 
theory  of  their  formation.  Afler  describing  various 
phenomena  emittetl  by  the  ordinary  soap-bubble,  and 
also  with  the  bubble  having  its  fi'm  toughened  by  a 
mixture  of  glycerine,  Sir  David  remarked  that  his  ex- 
periments were  sufficient  to  establish  the  almost  incred- 
ible truth  that  the  colors  of  the  soap-bubble  are  not 
produced  by  the  thickness  of  the  film  itself,  but  by  the 
secretion  from  it  of  a  new  substance  flowing  over  the 
film  and  expanding,  under  the  influence  of  gravity 
^d  molecular  forces,  into  colored  groups  of  various 
shapes,  and  returning  spontaneously,  when  not  returned 
forcibly,  into  the  parent  films. 

At  the  conclusion  of  tiie  paper,  Sir  William  Thom- 
son remarked  that  the  mechanical  questions  involved 
in  the  seemingly  simple  operation  of  blowing  soap  bub- 
bles were  the  greatest  enigmas  to  s<uentific  men.  The 
extraordinary  expansion  and  adhesion  combined  in  the 
vapor  spheres  were  well  worthy  of  the  fullest  inyesti- 
gation. 

OpHTnALMrO  AND   AuRAL    MrDICINE  AND  ScTROERT. — 

John  p.  Garris!i,  M.D.,  will  deliver  his  introductory  to 
a  course  of  lectures  on  Ophthalmic  and  Aural  Medidoe 
and  Surgery,  at  the  Cosmopolitan  Ho^ital  rooms,  No. 
65  West  Thirty-fourth  street,  corner  of  Broadway,  on 
Thursday  evening,  December  5th,  at  eight  oVlodc 
The  profession  and  students  of  medicine  are  invitcKl  to 
attend. 

Birth  and  Death  Rate  of  the  World. — Stat's^dans 
have  calculated  that  if  the  population  of  the  worid 
amounts  to  between  twelve  hundred  and  thirteen  hun- 
dred million  persons,  the  number  of  deaths  in  a  year 
would  be  about  thirty-two  millions.  Assuming  the 
correctness  of  tiiis  calculation,  tlio  deaths  each  day 
would  be  nearly  88,000 ;  3,600  per  hour ;  60  per  min- 
ute ;  and  thu^  every  second  would  carry  into  eternity 
one  human  l.fe  from  one  part  of  the  world  or  another. 
But  reproduction  asserts  its  superior  power;  for,  on 
calculating  the  probable  annunl  birUis  on  the  gl'*be, 
the  result  shows  that  whereas  60  persons  die  per  min- 
ute, 70  children  are  bom,  and  thus  the  increase  uf  the 
population  is  kept  up. — Lancet, 

TnE  Sapphires  of  Montana. — Tlie  Montana  people  are 
conj»raiiilatin;r  the:nselvos  over  ihe  discovery  of  genu- 
ine sapphires  in  t'lat  territory.  The  precious  stones  t'onnd 
on  El  D  >r;ido  Bar  ar»  fatnil  arly  known  in  that  !02aU*y 
by  the  name  of  '*  Collins'  dia*nonds,"  and  are  said  to  be 
quite  plentiful  and  eanily  procured. 

New  York  Evr  and  Ear  Infirmary.  —  Dr.  P.  J. 
Bumstead  has  resigned  his  position  as  Surgeon  to  this 
institution. 

Digitized  by  VjOOQ  IC  ' 


THE  MEDICAL  RECORD. 


467 


©riginal   Commumcati0it«. 


EXPERIMENTS   ILLUSTRATING 

THE  DIRECT  ACTION  OF 

HYDROCYANIC  ACID  UPON  THE 
MEDULLA  OBLONGATA. 

Bt  JOSEPH  JONES,  M.D. 

pBoraaoB  or  phtsioloqt  amd  patholoot  ik  thb  msdioal  dkpabt- 

MSNT  or  THE  VNITKBaiTT  Or  KASHVILLB,  AXD  HXALTU  OVnOKB,  CITT 
or  HABHTUXI. 

BvuMARr.—Mcperiment  1.  Effects  of  Pncssic  Acid  ad- 
ministered hy  the  Mouth. — Experiment  2.  Brain  of 
AUigator  exposed,  and  Prussk  Acid  applied. — Experi- 
ment 3.  Prussic  Acid  applied  to  Spinal  Cord  in  tail  of 
young  Alligator. — Experiment  4.  Prussic  Acid  applied 
to  Spinal  Cord,  midway  between  Anterior  and  Posteri- 
or Extremities — Experiment  5.  Poison  applied  to  Spinal 
Marrow,  midway  between  Anterior  Extremities  and 
hose  of  Brain  — Ecperiments  6,  7, 8,  and  9.  Prussic 
Acid  applied  to  Medtdfa  Oblongata, 

The  following  ten  experiments  were  performed  in 
the  monUi  of  April,  1862,  at  Montevideo,  Liberty  Co., 
Georgia. 

A  solution  of  prussic  acid  was  freshly  prepared,  of 
a  strength  equal  to  that  of  the  fresh  Acidum  Hydrocy- 
anicum  Dilutum,  U.  3.  P. 

For  these  experiments  I  selected  ten  young  alligators 
(Alligator  Mississippiensis)  of  the  same  oge,  and  from 
the  same  nest. 

Effects  of  Prussic  Acid  administered  hy  the  Mouth. 
Experiment  1. — Poured  a  solution  of  prussic  acid,  in 
amount  about  f  3  ss.,  down  the  mouth  and  throat  of  a 
small  young  alligator.  The  reptile  was  only  six  inches 
in  length,  and  had  not  left  the  egg-shell  more  than  a 
week  or  ten  days. 

In  three  and  a  half  minutes  the  alligator  manifested 
signs  of  the  action  of  the  poison,  in  its  staggering  gait 
and  convulsive  movements ;  in  twelve  minutes,  gap- 
ing and  struggling  violently,  with  spasmodic  move- 
ments of  the  muscles ;  in  fifleen  minutes,  breathes  only 
occasionally  (once  every  two  or  three  minutes),  and 
then  in  a  spasmodic  manner,  lies  indifferently  upon  the 
back  or  belly,  and  cannot  walk;  sixteen  minutes  after 
the  first  Implication  of  the  poic'on,  and  one  minute  after 
the  last  observation,  all  motions  appear  to  have  ceased ; 
when  thrown  into  cold  water,  however,  it  appears  to 
be  aroQsed  by  the  shock,  and  makes  several  attempts  to 
swim  and  turn  on  its  side;  these  motions  ceased  in  a 
few  minutes,  and  when  turned  over  on  its  back  in  the 
water,  it  remained  so,  whilst  an  alligator  whoi^  cere- 
brum had  been  exposed,  and  touched  with  the  same 
solution  of  prussic  acid,  remained  vigorous  and  strong. 

Twenty-six  minutes  (ten  minutes  a  ter  the  preceding 
observation),  lies  as  if  dead,  without  any  motion,  ex- 
cept^ every  two  or  three  minutes,  a  spasmodic,  feeble, 
respiratory  effort;  mechanical  stimuli  produced  but  a 
dight  tremulous  motion  of  the  muscles,  whilst  irritation 
of  the  muscles  of  the  alligator  wbose  cerebrum  had 
been  exposed  and  treated  with  hydrocyanic  acid,  in- 
duced vigorous  respiratory  motions;  in  thirty  minutes 
(four  minutes  after  the  last  observati(m),  all  external 
signs  of  life  have  vanished,  and  the  animal  appears  to 
be  dead. 

Thirty  minutes  after  the  application  of  the  poison, 
the  thorax  was  opened  and  the  heart  exposed;  auricles 
and  ventrides  greatly  distended  with  blood,  beating 
slowly  and  spasmodically  forty  times  per  mmute;  fifty- 


two  minutes  (twenty-two  minutes  after  the  last  obser- 
vation), action  of  heart,  twenty-six  per  minute ;  one 
hundred  and  twelve  minutes  (sixty  minutes  after  the 
last  observation),  action  of  heart  twenty-six  per  min- 
ute; one  hundred  and  eighty  minutes  (sixty-eight 
minutes  after  last  observation),  no  signs  of  life  in  the 
muscular  system;  mechanical  stimuli  fail  to  produoe 
contractions;  heart  still  acts  in  a  slow,  spasmodic  man- 
ner; the  blood  presents  a  brownish  purplish  color; 
auricles  and  ventricle  still  engorged  with  dark  blood ; 
action  of  heart,  twenty  per  minute. 

Two  hundred  and  fifly-eight  minutes  (seventy-eight 
minutes  after  the  last  observation),  pulsations  of  the 
heart  still  continue,  they  are  however  s'ower  and  more 
irregular  and  spasmodic,  tl  e  rhythm  ot  its  action  has 
been  destroyed;  the  auricles  act  continuously  about 
ten  times  per  minute,  the  ventricle  not  so  often.  The 
action  of  the  heart  continued  to  grow  slower  and 
slower  until  it  finally  ceased.  The  exact  time  was  not 
noted. 

Prussic  Acid  appUsd  to  Brain  of  AUigator,  Experi- 
ment 2. — Removed  the  superior  plate  of  the  craniimi 
of  a  small  alUgator  (six  inches  in  length),  and  exposed 
the  superior  surface  of  the  cerebrum  without  wounding 
tlie  large  veins  and  arteries.  The  membranes  were 
carefully  removed  from  both  hemispheres,  so  as  not  to 
injure  the  great  central  vessels  running  between  the 
hemispheres  and  the  cerebellum. 

The  sur&ce  thus  exposed  was  moistened  with  the 
solution  of  prussic  acid. 

Four  minutes  after  the  direct  application  of  the  poison 
to  the  surface  of  the  cerebiimi,  no  signs  of  the  action 
of  the  hydrocyanic  acid ;  t^e  surface  of  the  brain  was 
wounded,  and  the  poison  again  implied.  In  eleven 
minutes  (seven  minutes  after  the  last  observation),  the 
effects  are  beginning  to  be  manifest,  in  a  decrease  of 
activity  and  life  in  tlie  muscular  motions:  the  reptile  is 
still  able  to  crawl  about,  aiid  to  make  the  sounds 
usually  emitted  by  young  alligators.  The  blood  oozing 
from  the  wounded  surface  of  the  brain  presents  a 
brilliant  crimson  color. 

In  fi^^en  minutes  (four  minutes  after  the  last  obser- 
vation), motions  spasmodic,  gasps  for  breath,  and  emits 
quick,  spasm .'>dic  sounds,  like  an  imperfect  bark  *  these 
spasmodic  motions  ceased  in  a  few  moments.  Tne  rep- 
tile crawled  off  and  attempted  to  bite  the  finder  when 
placed  before  its  head,  and  when  thrown  mto  cold 
water  it  swam  rapidly.  The  effects  of  the  poison  ap- 
pear to  be  due  chiefly  to  its  absorption  by  the  blood- 
vessels of  the  brain,  and  its  distribution  to  other  por- 
tions of  Uie  nervous  system,  and  not  to  a  direct  action 
upon  the  nervous  structures  constituting  the  cere- 
brum. 

The  poison  was  again  applied  to  the  exposed  surface 
of  the  cerebrum,  and  its  structures  were  again  injured 
so  that  the  poison  might  come  in  immediate  contact 
with  the  nervous  elements.  Twenty-four  minutes  after 
the  first  application,  still  able  to  swim,  but  evidently 
losing  power :  the  respiration  is  slow,  spasmodic,  and 
iiTegular.  In  the  bst  application,  the  nervous  struc- 
tures were  more  extensively  injured,  and  the  poison 
more  effectually  applied. 

The  forces  gradually  declined,  and  thirty-six  minutes 
after  the  first  apphcation  (twelve  minutes  after  the  last 
observation)  the  alligator  has  so  far  lost  voluntary  mo- 
tion that,  when  thrown  into  cold  water,  it  remains  indif- 
ferently upon  the  back  or  belly,  as  it  may  be  placed ; 
stilt  breathing,  but  the  respiration  is  very  ^w  and 
spasmodic. 

The  heart  was  next  exposed;  the  act  of  cutting 
through  the  muscles  to  expose  the  heart  caused  con- 
tractions of  the  Tsrious  muscles  of  the  thofax  and  fore- 
^igitized  by ^ ^_ 


458 


THE  MEDICAL  RECOKD. 


limbs ;  action  of  heart  tbirty-eight  per  minute,  more 
regular  and  active  than  the  heart  of  the  alligator  in  the 
preceding  experiment,  auricles  and  ventricle  filled  with 
crimson  blood ;  forty- two  minutes,  action  of  heart  thirty- 
eight. 

One  hundred  and  sixty-eight  minutes  after  firut  ap- 
plication of  poison  to  cerebrum  (one  hundred  and 
twenty-six  minutes  afler  last  observation),  the  reptile 
has  greatly  recovered,  and  is  attempting  to  walk ;  htart 
beating  with  considerable  regularity  and  force. 

Tiie  remaining  coverings  of  the  superior  and  poste- 
rior parts  of  the  cerebrum,  especially  those  portions  of 
the  dura  mater  and  arachnoid  which  dip  down  between 
the  hemispheres,  and  between  the  cerebrum  and  cere- 
bellum, were  removed.  Considerable  haemorrhage  en- 
sued from  the  large  blood-vessels ;  tliis  was  wiped  care- 
fully away,  and  the  prussic  acid  again  applied  to  the 
surface  of  the  brain,  reaching  the  cerebellum  (neces- 
sarily from  the  anatomical  relations  of  the  membranes 
removed  and  the  large  blood-vessels  cut),  and  perhaps 
also  in  small  quantities  the  meduUa  oblongata  and  spinal 
cord.  ^ 

The  poison  acted  almost  immediately,  producing  te- 
tanic spasms,  followed  by  cessation  of  respiration  and 
loss  of  muscular  power. 

One  hundred  and  seventy-eight  minutes  after  the  first 
application,  and  ten  minutes  after  the  last,  the  action  of 
the  heart  was  twenty-four  per  minute ;  two  hundred 
and  fifty-eight  minutes  (ninety  minutes  after  the  last 
observation),  muscles  still  respond  slightly  to  mechani- 
cal stimuli ;  heart  still  acts  ten  times  per  minute  spas- 
modically. Since  the  loss  of  blood  from  the  blood- 
vessels of  the  brain,  the  heart  is  not  so  filled  with 
blood,  and  continued  to  diminish  in  the  size  and  in  the 
frequency  of  action,  until  it  ceased  ia  about  an  hour 
after  the  last  observation.  The  precise  time  of  the  ces- 
sation of  its  action  was  not  noted. 

Prussic  Acid  applied  to  Spinal  Marrow.  Experiment 
3.  —  Exposed  the  spinal  cord  in  the  tail  of  a  young 
alligator  for  half  an  inch,  commencing  just  below  the 
junction  of  the  hind  K^gs,  and  applied  the  solution  of 
prussic  acid  used  in  the  preceding  experiment^  to  the 
surface  of  the  spinal  cordj  immediate  contraction  of 
the  muscles  and  cries  of  pain  followed  the  application  ; 
these,  however,  soon  subsided  and  the  animal  became 
quiet.  No  special  effect  was  produced  upon  the  respi- 
ratory acts,  except  to  render  them  fuller  and  somewhat 
labored. 

Two  minutes  after  the  poison  was  again  applied  and 
produced  similar  results — contractions  and  cries  of  pain, 
and  full  laborious  respiration.  As  often  as  applied  to 
the  spinal  cord,  it  produced  these  effects — they  are, 
however,  evidently  becoming  less  marked-  Eight  min- 
utes after  the  first  application,  when  thrown  into  cold 
water,  the  reptile  swims ;  ten  minutes  after  (two  min- 
utes after  last  observation),  spasmodic  attempts  at  respi- 
ration, gapings  of  the  mouth  and  throat,  and  spasmodic 
attempts  to  crawl;  twenty-five  minutes,  limbs  spasmed, 
muscular  powers  feeble,  Ues  in  partial  stupor.  In  thirty 
minutes  after  the  first  application  of  the  poison,  all  ex- 
ternal signs  of  life  are  extinct;  when  the  thorax  was 
opened,  however,  a  convulsive  mo*  ion  of  the  respiratory 
muscles  ensued,  inflating  still  farther  the  lungs.  Heart 
acting  regularly,  contracted,  and  not  engorged  with 
blood;  the  absence  of  the  usual  large  amount  of  blood 
in  the  cavities  of  the  heart  in  poisoning  vnth  hydrocy- 
anic acid,  appears  to  be  referable  to  the  loss  of  blood 
which  ensued  from  the  tail,  which  was  considerable. 
Action  of  heart,  thirty-two  per  minute. 

One  hundred  minutes  after  the  first  appUcation  of 
the  poison  the  heart  ceased  to  beat 

PrvMi4  Add  applied  to  Spirud  Marrow.    Bcperiment 


4. . —  Exposed  the  spinal  cord  of  a  young  alligator 
naidway  between  the  anterior  and  posterior  extremi- 
ties, and  applied  prussic  acid  of  the  same  strength  as  in 
the  preceding  experiments :  spasmodic  contractions  and 
motions  of  the  muscles  ana  limbs  were  almost  immedi- 
ately excited.  The  respiration  still  continued,  notwith- 
standing several  repetitions  of  the  poison.  Eighteen 
minutes  after  the  application  respiration  still  continues; 
twenty-two  minutes,  still  breathes  slowly,  althou^  the 
mu^c^es  respond  but  little  to  mechanical  excitements ; 
at  the  end  of  forty-two  miputes  all  external  signs  of 
life  were  gone.  Heart  still  acting  fifty  times  per 
minute. 

Prustic  Acid  applied  to  Spinal  Marrow.  Experimenib, 
— Exposed  the  spinal  cord  of  a  young  alligator,  midway 
between  the  fore-legs  and  base  of  brain,  and  applied 
prussic  acid — tetanic  spasms  of  the  voluntary  muscles 
followed,  without  the  arrest  of  respiration.  FL'teen 
minutes  after  the  application  of  the  poison,  still  breathes 
and  attempts  to  swim  when  thrown  into  water;  swims 
with  the  hind,  but  not  with  the  fore-legs,  and  appears 
to  have  lost  much  of  the  power  of  the  fore-legs.  In  fifty-  " 
tw^o  minutes  all  external  signs  of  life  have  become  ex- 
tinct. Heart  exposed,  still  acting  thirty-two  times  in 
the  minute. 

Prussic  Acid  applied  to  Brain  and  Medulla  Oblongata, 
Experiment  6. — ^Exposed  the  cerebrum,  cerebellum, 
medulla  oblongata,  and  superior  portion  of  the  spinal 
cord  of  a  young  aUigator  (Alligator  Mississippiensis) — 
considerable  blood  was  lost  during  the  removal  of  the 
walls  of  the  cranium  and  vertebrae,  the  animal  appeared 
exhausted,  and  the  nervous  muscular  actions  appeared 
to  be  influenced  by  the  loss  of  blood  and  the  violence 
inflicted  upon  the  membranes  of  the  brain  and  spinal 
cord ;  the  motions  of  the  animal  were  rendered  some- 
what irregular  and  spasmodic.  A  solution  of  prussic 
acid  of  the  same  strength  as  that  employed  in  the  pre- 
ceding experiments,  was  applied  to  the  nervous  struc- 
tures exposed,  without  however  taking  the  precaution 
to  wipe  away  the  blood,  which  was  continually  oozing 
from  the  divided  vessels.  No  immediate  effect  was 
produced,  and  eight  minutes  afterwards  the  alligator 
was  still  able  to  swim  with  precision  and  vigor  when 
thrown  into  water.  After  removing  the  animal  from 
the  water,  the  nervous  structures  were  carefully  wiped 
dry,  thus  removing  all  the  blood  and  water,  and  the  poison 
was  then  applied  immediately  to  the  exposed  surfaces. 
This  last  appUcation  appeared  to  have  a  more  immediate 
and  decided  effect  than  the  previous  one,  and  in  one  min- 
ute spasms  with  convulsive  cries  were  excited.  Fifteen 
minutes  after  the  first  application,  and  seven  minutes 
after  the  second  application,  respiration  was  irregular,  < 
not  more  than  two  or  three  times  per  minute,  and 
mechanical  stimuli  caused  but  little  effect  upon  the 
voluntary  muscles — when  thrown  into  the  water,  the 
animal  lies  indifferently  upon  the  back  or  belly.  In  ft 
few  minutes  more,  all  volimtary  muscular  motions 
ceased  entirely.  When  the  heart  was  exposed,  it  was 
beating  regularly,  and  did  not  present  the  engorged  ap- 
pearance of  the  heart  of  the  alngator  into  whose  mouth 
and  stomach  the  poison  had  been  introduced  (Ex.  1). 

In  the  present  case  the  action  of  the  poison  produced 
a  powerful  contraction  of  the  respiratory  musoles,  and 
complete  expulsion  of  the  air  contained  in  the  lungs. 

In  one  hundred  and  thirty-five  minutes  firom  the  first 
appUcation,  the  heart  had  ceased  to  beat;  artificaal 
respiration  and  infiation  of  the  collapsed  lungs  restored 
the  action  of  the  heart  During  the  process  of  artificial 
respiration  there  was  a  partial  restoration  of  the  irrita- 
bility of  the  muscles.  At  the  end  of  two  hundred  and 
fifteen  minutes  aU  action  in  the  heart  bad  ceased.  The 
more  early  extinotion  of  the  powers  of  the  hearty  in 
Digitized  by  ^ „      ^_ 


THE  MEDICAL  RECORD. 


459 


this  experiment  than  in  the  first,  was  due  in  great 
measure  to  the  loss  of  blood. 

Prutsic  Add  applied  to  Medulla  Oblongata.  Experi- 
merU  7. — Exposed  the  brain  and  medulla  oblongata  of 
a  small  alligator,  and  afcer  wiping  off  the  blood  carefully 
applied  the  soludon  of  prussic  acid  to  these  parts — in 
lesis  than  a  minute,  in  fact  almost  immediately,  violent 
convulsive  movements  were  excited,  violent  expiration 
of  air  from  the  lungs,  and  death  in  a  few  moments.  The 
lungs  remained  permanenUy  collapsed  and  the  respira- 
tory muscles  contracted.  The  collapsed  contracted  ap- 
pearance of  the  thor&x  and  abdomen  was  in  striking 
contrast  to  the  inflated  body  of  the  alligator  killed  in 
the  fir>t  experiment  by  the  internal  administration  of 
the  poison. 

Thorax  opened  one  hundred  and  twenty  minutes  after 
the  application  of  the  poison  ;  heart  had  ceased  to  pulsate. 
Inflation  of  the  lungs  was  followed  by  a  renewal  of  the 
action  of  the  heart  The  cessation  of  the  acUon  of  the 
heart,  in  the  two  last  experiment*?,  sooner  than  in  the 
two  first  experiments,  was  due  to  the  collapsed  state  of 
the  lungSj  and  the  greater  loss  of  blood  in  the  latter.  In 
the  two  nrst  experiments  the  lungs  remained  inflated, 
and  there  had  not  been  any  loss  of  blood  in  the  first 
reptile  experimented  on,  and  in  the  second  none  for  some 
time  after  the  commencement  of  the  experiment 

In  the  present  (7th)  experiment,  the  muscles  responded 
to  mechanical  stimuli  after  the  institution  of  artificial 
respiration.  At  the  expiration  of  two  hundred  and  ten 
minutes,  all  action  in  the  heart  had  ceased.  On  account 
of  the  loss  of  blood,  the  heart  presented  a  pale  appear- 
ance, contracted,  and  with  but  little  blood  in  its  cavities. 
Prussic  Add  applied  io  MeduUa  Oblongata,  Experi- 
ment 8. — Exposed  the  medulla  oblongata  of  a  small 
alligator,  and  applied  directly  to  the  nervous  structures 
the  solution  of  pnisisic  acid ;  convulsions,  suspension  of 
respiration,  and  apparent  death  followed  almost  imme- 
diar<»ly. 

The  air  was  driven  forcibly  out  of  the  lungs,  and  the 
respiratory  and  abdominal  muscles  remained  contracted 
so  as  to  present  a  contracted  appearance  of  the  chest 
and  abdomen.  The  heart  exposed  one  hundred  and 
twenty  minutes  after  the  application  of  the  poison,  had 
ceased  to  beat ;  it  contained  little  or  no  blocni,  and  was 
pale  and  contracted.  Inflation  of  the  lun^s  restored  its 
action.  Two  hundred  and  ten  minutes  alter  the  applica- 
tion of  the  poison,  the  action  of  the  heart  had  ceased. 

Prussic  Add  applied  to  AfeduUa  Oblongata.  Experi- 
ment 9. — Exposed  the  medulla  oblongata  of  a  young 
alligator  and  applied  prussic  acid — the  effect  was  almost 
immediate;  in  one  minute  the  respiration  wa^  arrested, 
and  the  respiratory  muscles  permanently  contracted. 
The  eyes  winked,  and  the  mouth  gaped  for  some  eight 
minutes,  and  even  long  after  the  eyes  and  mouth  ceased 
to  move  of  themselves,  the  eyes  would  wink,  and  the 
muscles  of  the  jaw  would  contract  when  pinched. 
Thirty  minutes  after  the  action  of' the  poison,  the  heart 
was  exposed — lungs  contracted,  the  act  of  cutting  excited 
contractions  in  the  respiratory  muscles — heart  acting 
f  jrty-four  times  per  minute  regularly. 

It  is  worthy  of  note  in  these  experiments,  that  the 
lungs  were  collapsed,  and  the  respiratory  muscles 
forcibly  and  permanently  contracted  only  when  the 
poison  was  applied  to  the  medulla  oblongata. 

Prussic  Add  applied  io  Medulla  Oblongata,  Eaoperi- 
ment  10  — Removed  all  the  skin  over  the  cranium  and 
spinal  column  of  a  young  alligator  and  applied  prussic 
acid  of  the  same  strength  as  that  used  in  the  preceding 
experiment  At  the  end  of  seven  minutes  the  reptile 
still  shows  signs  of  great  activity,  being  able  both  to 
swim  and  wa^k ;  at  the  end  of  eighteen  minutes  after 
the  application  of  the  poison,  although  manifesting  its 


effects  in  loss  of  power  and  irregular  movements,  stiU 
it  swam  with  vigor  and  precision  when  thrown  into 
water.  The  bony  wall  was  then  removed,  the  medulla 
oblongata  exposed,  and  the  poison  applied  directly  to  its 
surface  :  the  effect  was  evident  in  a  few  seconds,  and 
whilst  there  were  no  well  marked  tetanic  spasms,  still 
the  respiration  ceased,  as  well  as  all  voluntary  motions. 
When  mechanical  stimuli  were  applied,  reflex  actions  of 
the  extremities  indicated  the  existence  of  nervous  and 
muscular  irritability. 

Heart  exposed  ninely-five  minutes  afterwards ;  its  ac- 
tion was  a  mere  tremor. 

From  these  eocperiments  we  conclude  that  prussic  acid 
ads  primarily^  direcUy^  and  chiefly  upon  the  medulla  ob- 
longata and  spinal  cord;  and  that  its  ability  to  produce 
sudden  death  is  dependent  upon  its  action  upon  the  medulla 
oblongata. 

Derangements  in  the  relations  of  the  medulla  oblon- 
gata and  spinal  cord  to  the  muscular  system  generally, 
and  especially  to  the  respiratorjr  system,  are  the  first 
phenomena  manifested  in  the  action  of  prussic  acid. 

When  absorbed  firom  a  raw  surface,  or  from  the 
stomach  and  bowels,  these  phenomena  are  manifested, 
as  well  as  upon  the  direct  application  of  the  poison 
to  the  medulla  oblongata,  but  more  slowly.  In  warm- 
blooded animals  death  takes  place  idmost  imme- 
diately after  the  administration  or  inhalation  of  the 
poison  ;  still,  when  taken  by  the  mouth,  a  sufficient  time 
always  elapses  for  the  absorption  of  the  poison  and  its 
distribution  to  the  great  nervous  centres.  As  soon  as 
the  poison  in  the  blood  reaches  the  medulla  oblongata 
and  spinal  cord,  convulsive  motions  are  excited,  and  if 
the  impression  be  sufficiently  intense  there  is  an  imme- 
diate arrest  of  the  action  of  the  ganglionic  cells  presiding 
over  the  respiratory  process,  and  immediate  death  fol- 
lows. 

In  the  young  alligator  the  cartilaginous  walls  of  the 
cerebro-spinal  nervous  system  can  readily  be  removed 
by  the  knife,  and  we  are  thus  enabled  to  apply  the 
poison  to  successive  portions  of  the  nervous  system,  and 
thus  demonstrate  tlie  immediate  and  direct  action  of  the 
poison  upon  that  portion  of  the  cerebro-spinal  nervous 
system  wliich  presides  over  respiration  and  the  reflex 
actions. 

Prussic  acid,  as  we  have  satisfactorily  demonstrated 
by  numerous  experiments,  acts  also  upon  the  blood,  and 
upon  the  muscular  fibres  and  the  sympathetic  nervous 
system ;  but,  as  has  been  conclusively  demonstrated  by 
the  experiments  just  recorded,  the  most  marked  phe- 
nomena, and  those  disturbances  of  the  respiration  which 
induce  death,  are  due  to  the  direct  action  of  the  poison 
upon  the  medulla  oblongata. 


English  Beer  a  Cause  op  Gout. — ^According  to  M. 
Charcot,  who  has  been  lecturing  on  the  subject  at  La 
Salpetri^re,  notwithstanding  the  drunken  habits  of  the 
lower  classes  in  Russia,  Poland,  Sweden,  and  Denmark, 
gout  is  almost  unknown  among  them.  In  Ireland,  and 
Scotland  also,  where  whiskey  is  the  national  drink,  gout 
is  little  k-nown.  Porter  and  sweet  cider  are  accused 
vehemently ;  and  Dr.  Ball,  a  distinguished  agrege  of  the 
French  hospitals,  and  a  naturalized  Englishman,  analyzes 
carefully,  for  the  benefit  of  French  savans,  our  English 
beer;  deRcribin^r  porter  as  highly  colored,  poor  in  alco- 
hol deprived  of  sugar,  disposed  to  acid  fermentation, 
and,  owing  to  the  torrefaction  of  the  grain,  contaiaing 
a  principle  which  is,  perhaps,  not  foreign  to  its  effects 
in  the  production  of  disease.  This  is  the  fatal  cause  of 
English  gout,  according  to  these  gentlemen.  Gout, 
however,  prevails  most  in  this  country  amongst  the 
dasses  who  never  drink  porter,  C^  r^r^r-An^ 

digitized  by  VjOOQ  IC 


460 


THE  MEDICAL  RECORD. 


CLINICAL  PAPERS  ON  EAR  DISEASE. 
Bt  D,  B.  St.  JOHN   ROOSA,  M.D., 

rKorusos  in  ths  vkitusitt  midical  oollkgk. 
NO.   n. — FURUNCLBS  IH  THE  EXTKBNAL  AUDITORY   OAKAL. 

Perhaps  the  simplest  and  best  classification  of  inflam- 
mations of  the  external  auditory  canal,  is  that  of  VoH 
Troltsch.  He  divides  these  inflammations  into  circum- 
scribed and  diffuse. 

By  circumscribed  inflammation  occurring  in  tliis  part 
we  mean  simply  furuncles  in  the  passage.  They  generally 
arise  in  connection  "v^ith  the  existence  of  furuncles  in 
other  parts  of  the  body,  and  are,  like  them,  very  painful. 
They  also  produce  deafness  by  mechanically  closing  the 
canal.  Tinnitus  aurium— noise  in  the  ears — a  symptom 
which  is  apt  to  be  very  troublesome  in  almost  all  other 
ear  affections,  is  not  generally  present  when  furuncular 
inflammation  exists.  It  may  be,  however,  afler  the  pus 
from  the  boil  has  been  evacuated,  and  some  of  it  perhaps 
remains  in  the  canal  and  presses  upon  the  membrana 
tympani  and  through  it  upon  the  ossicula  auditus  and 
auditory  nerve.  The  reason  that  the  tinnitus  is  absent 
in  the  early  stages,  is  of  course  the  fact,  that  there  is  no 
pressure  exerted  upon  the  drum  by  a  circumsmbed 
swelling  of  the  canaL 

There  will  be  no  difficulty  in  the  diagnosis,  if  the  ear 
be  examined  by  means  of  the  mirror  or  otoscope,  and 
reflecied  daylight  or  sunlight  One  or  more  circum- 
scribed swellings  are  found  in  the  caliber  of  the  canaL 
Their  usual  situation  is  a  point  near  the  tragus^  on 
the  anterior  wall,  and  we  may  have  two  or  more  at  a 
time. 

The  proper  treatment  is  to  make  an  incision  at  as  early 
a  period  as  possible,  and  then  to  continuously  apply 
warm  water,  giving  tne  ear  an  uninterrupted  warm  bath, 
as  it  were.  It  makes  no  difference  whether  pus  or 
blood  be  eva()iated  by  the  incision.  The  relief  following 
is  generally  immediate  in  either  case. 

The  incision  is  best  made  with  a  sharp-pointed  curved 
bistoury,  cutting  from  below  upwards,  and  not  with  a 
scalpel  down  upon  it,  as  the  books  usually  advise.  The 
incision  can  be  made  more  quickly,  and  does  not  cause 
so  much  pain,  as  when  made  with  the  scalpel  The  ear 
should  be  syringed  with  warm  water  after  the  hsmor- 
rkige  has  ceased. 

After  the  furuncle  is  opened,  and  the  pain  caused  by 
it  has  disappeared,  it  is  well  to  smear  the  passage  with 
some  ointment,  in  order  to  hasten  the  softening  of  the 
indurated  tissue  surrounding  the  furuncle,  but  as  long 
as  pain  continues  the  use  of  warm  water  snould  be  per- 
sisted in.  Steam  may  also  be  allowed  to  pass  into  the 
ear  fiom  any  sort  of  a  vessel. 

Leeches  do  not  seem  to  do  the  same  amount  of  good 
in  furuncular  inflammation  as  in  the  diffuse  form. 

The  vapor  of  chloroform  has  been  highly  spoken  of, 
allowing  it  to  pass  into  the  auditory  canal,  but  I  do  not 
know  mudi  of  it  by  experience,  having  been  generally 
satisfied  with  the  method  of  treatment  above  indi- 
cated. 

We  shall  probably  not  be  done  with  the  case  when 
one  furuncle  has  been  evacuated,  and  has  healed :  just 
as  in  other  parts  of  the  body,  one  boil  is  apt  to  follow 
another  in  rapid  succession. 

This  brings  us  to  consider  the  cause  of  this  affection. 
I  do  not  think  I  ever  saw  a  furuncular  inflammation  of 
the  external  auditory  canal  in  a  patient  who  was  in 
other  respects  in  a  physiological  condition.  It  seems 
to  be  the  evidence  of  a  wrong  state  of  tbe  system  of  some 
kind. 

Furuncles  arc  very  apt  to  occur  in  anaemic  persons. 
I  have  seen  several  cases  where  they  were  troublesomo 


after  parturition,  daring  which  the  system  had  been  mndi 
exhausted,  and  perhaps  the  patient  had  not  been  under 
the  most  judicious  management  as  regards  the  diet. 
When  iron  was  adnunistered,  and  nourishing  diet  sab- 
stituted  for  slops,  the  boils  ceased  to  recur.  Last  winter 
I  saw  cases  in  young  ladies  who  were  s^alous  attendants 
upon  the  Oermcm,  and  who  spent  large  portions  of  the 
night  in  the  ball-room,  for  quite  long  periods.  They 
were  not  particularly  amemic,  but  they  nad  no  proper 
appetite,  and  were  evidently  suffering  from  the  effeoto 
of  an  imprc^r  mode  of  life. 

Regular  hours,  regular  times  for  eating,  ezerciae 
in  ^e  daytime,  soon  reh'eved  these  cases,  but 
those  who  would  persist  in  their  dissipations  did  not 
recover  until  the  season  was  over.  In  one  case  there 
were  also  hordeoli  or  styes,  which  are  generally  regarded 
as  evidences  of  malnutrition. 

It  will  be  seen  from  this,  that  the  local  treatm^it  is 
by  far  the  lesser  part  of  our  labor  in  these  cases  of  cir- 
cumscribed inflammation  of  the  auditory  canal.  We 
should  be  very  carelul  to  inquire  as  to  the  i^>petite,  ex- 
ercise, mode  of  life,  and  spec^ficaUy  correct  anything 
which  may  be  out  of  the  way.  It  will  not  be  enough 
to  give  general  directions,  such  as  "  You  most  take  ex- 
ercise and  live  weiy*  but  the  amount  and  kind  of  exer- 
cise should  be  indicated,  ihe  time  of  eating,  variety  of 
food,  etc. ;  at  the  same  time  some  one  of  the  preparations 
of  iron  will  generally  be  indicated. 

The  ear  should  be  kept  fh)m  the  influence  of  odd 
air,  when  the  patient  is  out  of  doors,  by  cotton,  or 
an  ear-lap :  but  the  habit  of  thus  protecting  the  ears  in 
the  open  clear  air,  where  there  is  no  draughty  should  be 
abandoned  when  the  ear  is  w^L 


VESICAL  CALCULUS. 

PASSAGE   or   A   STONE   THREE-FOURTHS   OF  AK  INCH  IK  CIR- 

OUMFEREKCE,  THROUGH  TEE   URETHRA   OF  A  BOT   TWO 

YEARS   OLD. 

By  WM.  MASON  TURNER,  M.D. 

PBILADELPmA. 

The  case  which  I  beg  leave  here  to  report,  occurred  in 
my  practice  several  years  ago,  in  the  city  of  Peters- 
burg, Virginia.  It  was  given  very  briefly  in  the  Ftr- 
ginia  and  Maryland  Medical  Jottmal.  As  it  is  an  inter- 
esting case,  I  am  induced  to  lay  it  once  again  before  the 
profession.  On  the  29th  of  Au^t,  I860, 1  was  sent 
for  in  haste,  to  see  a  child,  suffering,  as  the  messenger 
informed  me,  from  retention  of  urine.  The  case  had 
been  seen  by  a  brother  physician,  who  sent  word  that  I 
should  bring  a  catheter.  I  found,  for  my  patient,  a  hand- 
some littie  boy  (colored)  just  twenty-seven  months  old. 
The  attending  physician,  baffled  in  his  attempts  to  give 
relief,  and,  moreover,  called  away  to  another  case,  turned 
the  little  patient  over  to  me.  He  was  lying  on  his  back, 
moaning  most  piteously,  his  countenance  betraying 
acute  suffering.  The  pulse  was  both  frequent  and  quick, 
ranging  in  strokes  from  120  to  136  per  minute. 

Before  proceeding  to  explore  the  region  of  tbe  blad- 
der, I  was  led  to  examine  the  chest,  by  acdd^ntally 
laying  my  hand  over  the  right  lung,  and  feeling  a  de- 
cided vibratory  thrilL  On  auscultation  I  detected  a 
pneumonia  in  tbe  upper  lobes  of  both  lungs,  and  in  the 
second  stage ;  as  bronchial  respiration,  brondiophony ,  and 
dulness  on  percussion  were  well  marked.  Upon  in- 
quiry I  learned  that  the  child  had  been  sick  a  month 
previous,  with  measles,  and  having  taken  cold  when 
recovering,  had  been  complaining  more  or  less  since 
that  time. 

The  bladder,  to  whidi  I  then  tnrnedrmT  atteolion,  was 
digitized  by  VjOO^^_ 


THE  MEDICAL  RECORD. 


401 


enormously  distended,  protruding  and  hanging  over  the 
pubic  aroh,  resembling  in  miniature  somewhat  tkependu- 
hug  6e%  of  pregnant  women.  The  epidermis  in  the 
neighborhood  of  the  bladder  was  red  and  shining,  and  I 
feared  the  formation  of  an  artificial  opening.  The  penis 
was  muoh  enlarged,  and  seemed  to  be  infiltrated  with 
vine.  This  was  not  the  case,  however,  as  subsequent 
examination  proyed.  To  add  to  the  difficulties  of  the 
case,  there  was  present  a  congenital  phymosis,  rendered 
ten  times  more  rigid  in  its  contraction  by  the  swollen 
condition  of  the  penis.  It  was  a  difficult  task  which  I 
then  set  to  work  to  perform,  that  of  drawing  away  the 
urine  of  a  boy,  twenty-eeven  months  old,  under  circum- 
stances of  such  pain  to  the  little  fellow,  and  of  such 
disadvantage  to  myself.  The  swollen  and  phymosed 
condition  of  the  penis,  and  the  great  nervous  irritability 
present  in  the  patient,  rendered  it  almost  impossible  to 
make  even  an  attempt  with  the  catheter.  At  the 
slightest  touch  the  child  would  shriek  and  scream,  until 
I  actually  thought  the  strained  bladder  would  rupture 
before  the  violent  muscular  contractions  would  relax. 
Finally,  after  much  patience  and  considerable  manosu- 
▼ering,  my  only  assistant  being  an  old  lady,  who  man- 
aged to  hold  the  child's  hands,  I  succeeded  in  passing  a 
small  catheter  through  the  hard,  pursed-up  ring  of  3ie 
phymosis,  and  as  fortune  decreed  it,  into  the  urethra. 
This/ea<  I  was  compelled  to  perform  several  times,  for 
the  frantic  effisrts  of  the  child  dislodged  the  catheter  and 
made  my  labor  abortive.  However,  I  placed  my  knees 
upon  the  lower  extremities  of  the  child,  and  in  this  posi- 
tion succeeded  in  passing  the  instrument  once  more  into 
the  urethra.  Moving  it  slowly  and  cautiously  onward, 
I  soon  had  the  satisfaction  of  reaching  the  bladder, 
which  I  knew  by  tiie  sudden  gush  of  the  pent-up  urine 
Uirough  the  catheter.  At  the  neck  of  Uie  blmider  I 
noticed  a  slip^ht  griUy  feel  as  the  catheter  glided  along; 
it  was  transient,  however,  and  I  thought  nothing  of  it, 
attributing  it  to  the  ring  of  a  cartilaginous  stricture, 
which  I  have  no  doubt  existed.  The  boy  was  imme- 
diately reheved,  and  fell  asleep,  while  the  urine,  an  enor- 
mous quantity,  was  flowing.  That  night  I  prescribed 
simply  cold  cloths  to  the  penis.  The  next  morning  I 
called  to  see  the  boy,  and  found  him  much  refreshed 
and  improved  by  a  good  night's  rest  The  belly  over 
the  bladder  had  lost  the  prominent,  huSety  appearance 
of  the  previous  evening,  and  had  assumed  somewhat 
more  its  natural  proportions ;  yet  it  was  still  very  tender. 
The  penis  still  possessed  its  look  of  infiltration,  and  re- 
seml^ed  a  lump  of  translucent  jelly.  The  boy  had  only 
once  voided  his  water,  and  that  in  a  very  unsatiefactory 
manner,  screaming  at  the  top  of  his  voice  when  the 
urine  reached  the  urethral  canal,  and  refusing  most 
positively  to  make  fiirther  effort  The  result  was,  on 
my  arrival,  he  was  again  unable  to  urinate.  Once 
again  my  little  catheter  was  brought  into  requisition 
with  success.  I  thought,  perhaps,  the  rigidity  of  the 
phymosis  occasioned  to  a  certain  extent,  at  least,  the 
difficulty  in  micturition,  and  I  determined  to  operate 
for  it  at  once.  The  operation  was  over  in  a  few 
seconds,  and  I  then  saw  that  the  retention  was  in  no 
wise  connected  with  the  phymosis.  Passing  the  catheter 
into  the  empty  bladder,  for  the  purpose  of  exploration, 
I  detected  the  same  griUtf  feel  which  I  had  remarked 
the  previous  evening.  There  was  no  mistaking  the 
pecuhar  sensation,  the  touch  was  decisive ;  there  was  a 
foreign  body  occasioning  all  this  troubia  In  withdraw- 
ing Uie  catheter,  which  I  had  used  as  a  sound,  I  felt  an 
opposing  substance,  and  then  with  my  thumb  and  fore- 
fimrer  detected  an  irregularly  rounded  tubercle  in  the 
urethra.  After  several  introductions  of  the  catheter,  the 
tone  was  successfully  hooked  in  the  fenestra  of  the  in- 
tmment,  and  was  cautiously,  slowly,  drawn  forward  to- 


wards the  meatus  extemu$.  Here  I  was  beset  by  much 
difficulty.  I  dared  not  split  the  urethra,  and  yet  it  was 
extremely  difficult  to  get  a  hold  on  the  stone,  which 
showed  a  constant  tendency  to  retrocede.  After  much 
patience,  however,  and  considerable  manipulation,  the 
c<uu8  belli  was  drawn  near  the  external  orifice,  and  neatly 
extracted  with  a  thin  pair  of  dressing  forceps.  The  boy 
came  near  swooning,  but  soon  revived. 

A  further  examination,  using  the  catheter  as  a  sound, 
revealed,  as  I  had  already  suspected,  another  calculu.-* 
in  tiie  bkdder.  Lithogenesis  was  hereditary,  it  seemed, 
and  yet  the  family  record  did  not  substantiate  the 
opinion.  The  following  are  the  dimensions  of  the  stone : 
length,  five-eighths,  and  circumference,  three-quarters 
of  an  inch;  weight,  forty- two  grains;  shape,  semi- 
conoidal  and  semi-cylindrical,  the  presenting  end  cor- 
responding to  the  apex  of  the  cone.  An  analysis  de- 
termined it  to  be  oxalate  of  lime. 

Owing  to  the  irruption  of  the  recent  war,  I  was  un- 
able to  follow  up  this  case,  but  will  simply  mention 
that  just  before  hostilities  began  I  was  again  called  to 
the  little  patient,  and  succeeded  in  getting  away,  by 
the  same  means  as  employed  in  the  first  case,  another 
calculus,  but  much  smaller  than  the  first  extracted.  The 
noticeable  feature  in  this  case  is,  that  a  stone  of  such 
remarkable  size  did  pass  through  the  urethra  of  a  chUd 
two  yean  of  age. 


©riginal  Cetture«. 


ADDRESS  TO  THE 

ALUMNI  OF  THE  UNIVERSITY   MEDICAL 

COLLEGE,  N.  Y. 

By  Prof.  GEORGE  T.  ELLIOT,  M.D. 

Fellow  Alumni  of  the  University  Medical  College — 
The  unexected  honor  of  addressing  you  this  evening, 
at  the  first  formal  meeting  of  the  Alumni,  has  been 
awarded  to  me  by  the  committee,  representing  the  in- 
terests of  2,631  of  our  number,  in  sucn  a  manner  that  it 
could  not  be  declined ;  and  it  has  been  accepted  in  the 
spirit  which  prompted  the  offer.  As  a  native  of  this 
city  •  a  graduate  of  the  literary  department  of  Colum- 
bia College ;  a  doctor  of  medicine  of  this  University ; 
a  lecturer  lor  several  years  in  the  College  of  Physicians 
and  Surgeons  ;  and  as  one  of  the  founders  and  profes- 
sors in  the  Bellevue  Hospital  Medical  College,  I  repre- 
sent alike  those  affectionate  reminiscences  which  have 
called  us  together  this  evening,  as  well  as  that  solidarity 
of  purpose,  interest,  and  responsibility  in  which  all 
these  colleges  are  embraced. 

The  history  of  the  past  has  shown  that  the  prosperity 
of  one  enhances  the  prosperity  of  all,  and  the  brightest 
hopes  for  the  future  success  of  medical  teaching  in  this 
metropolis  grow  out  of  the  harmony  of  feeling,  the 
concert  of  action,  and  the  honorable  emulation  by 
which  they  are  distinguished. 

The  inevitable  centralizati<m  of  interests,  which  is  be- 
gotten by  the  laws  of  trade  and  the  natural  advantages 
of  New  York,  had  foreshadowed  the  commercial  pre- 
eminence of  this  city  before  its  wondrous  development 
has  astonished  the  world.  While  the  electric  telegraph, 
pondered  over  by  Pro£  Morse  in  one  of  the  rooms  in 
this  building,  has  so  concentrated  the  facilities  for  busi- 
ness operations,  as  of  necessity  to  develop  the  future 
of  New  York  beyond  all  possible  anticipation.  Those 
long  lines  of  telegraphic  wire  are  the  nerves  of  com- 
mercial life,  the  various  cities  of  the  country  are  the 
ganglia,  but  here  is  the  busy  brain  of  commerce  wbioh 


462 


THE  MEDICAL  RECORD. 


coordinates  and  directs  the  Tast  ramifications  of  its 
monetary  relations. 

Such  commercial  supremacy  ^iwarfe,  of  necessity,  the 
relative  status  of  literary  and  educational  enterprises, 
while,  in  reality,  favoring  their  development  in  every 
possible  way.  The  great  rewards  of  professional  and 
literary  life  in  this  country  are  to  be  found  in  this  city; 
and  hence  the  ranks  of  ambitious  men  are  steadily  re- 
cruited from  all  the  States  by  those  who  have  the  nerve 
and  the  capacity  to  enter  the  arena  and  compete  for  the 
highest  prizes.  The  great  hospitals  of  every  country 
are  found  in  its  principal  city. 

There  can,  therefore,  be  no  doubt  of  the  eventual  su- 
premacy of  New  York  as  the  great  centre  of  medical 
education  in  this  country,  even  if  the  astonishing  pro- 
gress of  the  last  few  years  had  not  confirmed  the  antici- 
pation. It  is  to  the  medical  department  of  the  University 
that  the  honor  is  due  of  first  practically  developing  the 
claims  of  New  York  to  be  the  chief  medical  school  of 
t'jis  country ;  although  the  medical  department  of  Co- 
lumbia College  and  Kutgers  College  must  for  ever  share 
the  honor  of  laboring  as  pioneers  in  the  field. 

The  experience  in  teaching,  and  the  brilliant  reputa- 
tion of  the  founders  of  this  college,  turned  the  tide  of 
students  to  thb  city,  made  its  advantages  known  to  the 
South  and  West,  and  attracted  larger  classes  to  their 
lectures  than  had  ever  been  seen  in  New  York. 

In  the  twenty-seven  years  which  have  elapsed  since 
its  organization  many  changes  have  occurred  in  its 
Faculty,  while  some,  full  of  years  and  honors,  have 

Massed  away  from  among  us,  and  rest  from  their  labors, 
t  is  a  fitting  time  to  recall  some  of  those  personal  re- 
miniscences which  are  shared  by  so  many  of  my  audi- 
ence, and  it  is  to  ba  hoped  that  the  subsequent  annual 
addresses  to  the  Alumni  of  this  college  may  gradually 
supply  those  data,  interesting  at  the  time  to  those 
who  can  confirm  their  accuracy,  and  furnishing  the 
most  valuable  materials  for  the  biographer  and  the  his- 
torian. 

When  I  first  matriculated  in  this  college  in  October, 
1845,  the  lectures  were  delivered  in  the  Stuyvesant 
Institute  on  Broadway,  opposite  Bond  street,  which 
belonged  to  the  Faculty,  and  was  subsequently  sold  by 
them  afler  they  had  erected  the  splendid  building, 
recently  destroyed  by  fire,  in  East  Fourteenth  street, 
between  Third  avenue  and  Irving  place.  At  this  time 
the  prosperity  of  the  college  was  at  its  height,  the  spa- 
cious lecture-rooms  were  thronged  with  students  from 
all  parts  of  the  country,  but  especially  from  the  South 
and  West  The  Faculty,  flushed  with  succes?,  full  of 
ardor,  experienced,  energetic,  in  the  prime  of  manhood, 
and  well-knit  together,  presented  in  the  highest  degree 
the  cohesion,  the  discipline,  the  vigor,  and  the  enthusi- 
asm which  represent  the  essentia  conditions  for  the 
prosperity  of  a  college. 

Of  all  the  names  which  challengd  my  attention,  it  is 
ris^ht  that  the  first  place  should  be  given  to  that  of 
Valentine  Mott,  then  Professor  of  Surgery,  and  more 
widely  known  in  this  country  and  to  th.e  world  than 
any  American  physician  has  ever  been  before  or  since. 
To  lecture  on  Surgery  was  for  Mott  a  labor  of  love, 
never  completely  relinquished  to  the  close  of  his  long 
life.  His  image  rises  clearly  before  me  as  he  alighted 
from  the  large  old-fa?hioned  gig  in  which  he  then  pre- 
ferred to  drive ;  clad  in  spotless  glossy  blacky  without  a 
crease  or  grain  of  dust,  he  passed  wi(h  his  pleasant 
smile  and  slightly  bowed  form  through  the  throng  of 
admiring  students  to  his  private  room. 

Although  a  fluent  lecturer,  Mott  was  rarely  eloquent, 
and  never  sought  to  charm  his  audience  by  any  grace 
of  oratorical  display.  Student?  and  physicians  went  to 
see  and  hear  the  self-reliant  man  who  had  devised  so 


many  bold  and  original  surgical  procedures,  and  was 
so  renowned  for  the  delicacy,  the  skill,  and  the  success  of 
his  operations.  In  the  gentle,  placid,  smiling  face  before 
them  they  beheld  the  surgical  pioneer  who  had  left  so 
few  of  the  great  operations  on  the  human  body  to  be  orig- 
inated by  others.  As  secure  in  his  knowledge  of  relative 
anatomy  as  the  manner  in  the  fidelity  of  his  compass, 
Mott  had  passed  boldlv  on  from  one  triumph  to  another, 
had  made  the  crooked  ways  straight,  and  illumined  the 
path  for  all  to  follow.  His  devotion  to  the  studjf  of  sur^ 
gicfll  anatomy  was  such,  that  to  the  dose  of  his  active 
life  he  rarely  undertook  an  operation  of  difficulty  with- 
out  previous  reference  to  the  cadaver. 

These  minute  precautions  with  which  he  guarded  his 
operations  against  every  avertable  cause  of  failure,  the 
intensity  of  his  devotion  to  delicacy  and  sucoeas  in  his 
manipulations,  were  the  foundation  of  his  great  renown, 
and  distinguished  every  thought  and  act  of  his  surgical 
career.  To  him  each  step  of  an  operation  always  in- 
volved a  solemn  responsibility,  though  be  might  have 
discharged  the  same  dutv  an  incredible  number  of  times, 
before ;  and  such  was  his  enthusiasm,  that  the  hgatures 
which  he  had  applied  to  the  great  arteries  were  care- 
fully preserved,  and  even  shown  to  his  successive 
classes.  They  were  as  hallowed  to  him  as  the  trusty 
weapon  which  the  successful  soldier  bears  back  from 
the  well-contested  field. 

These  qualities  distinguished  him  as  a  lecturer,  but 
detracted  from  his  success.  A  feeling  was  left  in  the 
minds  of  many  students  that  these  operations  might 
fall  to  their  lot>  but  couW  only  be  properly  performed 
by  such  a  man  as  Mott,  separated  from  them  by  impas- 
sable barriers.  And  thus  the  very  vastness  of  his 
knowledge  of  the  subject,  and  his  extreme  desire  to 
impart  aU  those  details  which  had  served  him  so  well  in 
such  trying  and  unforeseen  emergencies,  somewhat  ob- 
scured the  student's  perception  of  those  few  indispens- 
able indications  whicn  alone  he  was  fitted  to  compre- 
hend. 

"  Ah,"  said  the  late  Professor  Gilman  to  me,  "  I  wish 
that  I  had  not  been  prevented  by  circumstances  froni 
delivering  a  course  of  lectures  on  a  certain  subject; 
they  would  have  been  better  than  any  that  I  have 
ever  given.**  And  when  I  asked  him  why,  he  replied, 
"  Because  I  would  not  have  been  embarrassed  by  any 
knowledge  of  the  subject.*'  But  the  very  wealth  of 
illustration  and  detail  in  Mott's  lectures  which  em- 
barrassed the  young  student,  made  them  of  pricelees 
value  to  the  practitioner,  and  to  him  who  had  grappled 
with  similar  difficulties. 

How  many  living  men  there  are  who  can  endorse 
the  statement  made  by  the  President  of  the  C5ollege  of 
Physicians  and  Surgeons  at  the  formal  meeting  of  the 
Academy,  held  afler  the  death  of  Dr.  Mott  I  "  I  never 
met  Dr.  Mott  in  any  case,"  said  Dr.  Delafield,  "  without 
learning  some  fact  of  practical  value.** 

According  to  an  old  Chinese  proverb,  "  Tall  towers 
are  known  by  the  shadows  which  they  cast,  and  great 
men  by  their  calumniators."  Nor  was  Mott  an  excep- 
tion to  the  law.  But  their  voices  are  hushed  in  the 
presence  of  the  grave ;  and  while  impotent  during  his 
long  life  to  deprive  him  of  his  iust  meed  of  honor, 
they  have  for  ever  ceased  their  objections  to  his  rank 
as  the  greatest  sui^on  that  America  has  ever  pro- 
duced. 

In  1850,  Dr.  Mott*s  health  began  to  fidl,  and  for  a 
second  time  he  restored  its  tone  by  a  visit  to  Europe. 
His  place  was  filled  by  Prof.  S.  D.  Gross,  now  the  soo- 
cessor  of  Matter,  in  the  Jefferson  Medical  College  of 
Philadelphia. 

Dr.  Gross's  resignation  from  the  University  led  to  tiie 
appointment  of  Dr.  Alfred  0.  Po«trto  the  vacant  chair. 
digitized  by  V^jOO^^_ 


THE  MEDICAL  RECORD. 


463 


The  nephew  of  Dr.  Wright  Post,  whom  Dr.  Mott  vene- 
rated as  the  leading  surgeon  of  his  day,  long  a  surgeon 
to  the  New  York  City  Hospital,  an  untiring  student,  he 
now  fills,  witii  honor  to  himself  and  to  the  College,  the 
chair  which  is  identified  with  the  lives  of  the  leading 
sargeons  of  the  country. 

After  his  return  fi-om  Europe,  Dr.  Mott  accepted  the 
proffered  rank  of  Emeritus  Professor  of  Surgery  in  the 
College  of  Physicians  and  Surgeons,  but  subsequently 
resigned  that  position  to  take  the  same  rank  and  title 
in  the  University,  which  he  held  to  the  day  of  his 
death. 

Granville  Sharp  Pattison  was  one  of  the  founders  of 
the  College,  and  Professor  of  Anatomy  when  I  was 
a  student  The  first  idea  of  the  establishment  of  this 
school  was  developed  in  his  mind  by  a  desire  to  settle 
in  New  York.  He  came  fi-om  Philadelphia  to  lay  his 
plans  before  Dr.  John  W.  Draper,  who,  more  than  an^ 
other  man,  has  shaped  and  directed  the  policy  of  this 
College  from  the  hour  when  he  consented  to  undertake 
its  organization. 

Pattison  was  no  ordinary  lecturer.  His  strongly 
marked  individuality  stood  out  in  bold  relief  in  what- 
ever surroundings  he  might  be  placed  by  duty  or  incli- 
nation. His  finely  marked  oval  face,  his  commanding 
forehead,  the  quiet  grace  of  his  movements,  the  calm 
equipoise  of  manner  which  marked  the  man  of  the 
world,  at  home  in  the  best  bred  circles,  and  fitted  to 
shine  in  any  society,  all  conspired  to  enhance  that  pecu- 
liar charm  which  tne  audience  felt  before  a  word  had 
yet  been  uttered. 

He  needed  all  these  and  other  qualities  to  supply  the 
deficient  voice  and  defective  articulation  which  marred 
his  elocution.  It  often  happens,  however,  that  the 
physical  defects  of  a  man  of  marked  ability  enlist  the 
sympathy  of  his  admirers,  blunt  the  sharp  edge  of  crit- 
icism, and  form  an  additional  bond  of  endearment 
Without  these  drawbacks.  Pattison  would  have  been  a 
great  orator ;  in  spite  of  them  he  succeeded  in  teaching 
anatomy  so  clearly,  and  in  a  manner  so  attractive  to 
the  student,  that  it  will  always  be  difficult  to  find  his 
superior. 

One  secret  of  his  success  is  to  be  sought  in  the  strik- 
ing contrast  of  his  style  to  that  of  Mott  The  professor 
of  surgery  and  the  professor  of  anatomy  in  a  medical 
school,  teach  the  same  subjects  in  their  different  rela- 
tions, and  often  meet  on  common  ground.  Perhaps 
Dr.  Pattison  was  not  unaware  of  the  relief  which  it 
gave  to  the  student  when  he  taught  the  surgical  anat- 
omy of  the  neck,  or  of  hernia,  in  simple  graphic  lan- 
gua^,  which  penetrated  like  a  sunbeam  into  the  cloud- 
iest intellect;  or  when  stripping  the  subject  of  all  the 
refinements  and  minutia  with  which  it  had  been  draped 
by  the  great  surgeon,  he  pointed  with  that  ardor,  that 
demonstration  of  warm  sympathetic  feeling  for  the 
student  of  which  he  was  supremely  master,  to  the 
simple  anatomical  details,  the  clear  cardinal  facts,  which 
alone  they  need  remember,  and  on  which  alone  they 
miRht  rely. 

It  was  formerly  the  custom  to  open  the  session  by  a 
week  of  introductory  lectures— one  evening  being  al- 
lotted to  each  chair — and  I  well  remember  the  impres- 
sion which  Dr.  Pattison  made  on  one  of  these  occasions. 
These  addresses  were  prepared  with  care,  read  from  the 
manuscript^  and  requested  for  publication  by  the  class. 
When  the  time  came  for  Dr.  Pattison's  address,  the 
amphitheatre  was  lighted  up  instead  of  the  lower  lec- 
ture-room, and  thronged  with  students.  The  doctor 
made  his  appearance  in  full  evening  dress,  with  blue 
drens  coat  and  pumps.  Using  no  notes,  commencing  in 
a  low  tone  of  voice,  in  his  peculiar  enunciation,  strug- 
gling with  his  lisp,  and  the  difiScuIty  that  he  experienced 


in  pronouncing  the  letter  r,  he  proceeded  to  show  that 
an  exact  knowledge  of  anatomy  was  indispensable  to 
the  trustworthy  practitioner.  The  hushed  silence  with 
which  his  remarks  were  received  showed  the  sympathy 
of  the  audience  for  the  difficult  articulation,  and  their 
confidence  in  the  power  of  the  man.  But  as  he  un- 
folded his  argument,  and  dilated  with  his  theme,  his 
voice  rose,  the  listless  unimpassioned  manner  was  lost 
in  the  eagerness  and  ardor  or  the  earnest  advocate ;  all 
the  fiery  energy  of  his  nature,  the  reminiscences  of 
years  of  heart-inspired  teaching  were  fused  in  the  glow- 
ing words  which  brightened  tbe  beaming  faces  of  the 
class,  until,  at  last,  uncovering  a  superb  dissection  of 
the  surgical  anatomy  of  the  neck,  he  pointed  with  fin- 
gers trembling  with  excitement  to  the  relations  of  the 
vital  parts  to  each  other  in  illustration  of  his  method  of 
teachmg,  and  concluding  amid  storms  of  applause,  he 
left  indelibly  impressed  on  the  mind  of  every  student 
that  it  was  hopeless  to  seek  for  a  more  trusty  guide. 
His  was  the  skill — 

*'  To  breathe  the  enlivening  spirit,  and  to  fix 
The  generous  impulse  in  the  glowing  breast.*' 

After  Dr.  Pattison's  death,  his  place  was  filled  by  Dr. 
William  H.  Van  Bureu,  whose  large  surgical  experience 
in  army  and  civil  hospitals,  as  well  as  his  singulariy 
clear  and  remarkably  well  illustrated  demonstrations, 
lent  the  greatest  interest  to  his  lectures. 

The  identification  of  Professor  Van  Buren  with  the 
United  States  Sanitary  Commission  during  the  Civil 
War,  has  associated  his  name  for  ever  with  our  national 
history ;  and  the  official  history  of  the  commission  has 
recorded  the  following  testimony  of  his  colleagues  to 
the  value  of  his  services. 

"  Dr.  Van  Buren  was  one  of  the  members  of  the 
commission  to  whom  it  was  indebted  for  services  in 
the  eariy  period  of  its  history,  which,  when  viewed  by 
the  light  of  experience,  it  would  seem  impossible  to 
have  dispensed  with.  To  his  eminent  professional  repu- 
tation, which  had  done  so  much  to  secure  a  respectful 
hearing  of  the  claims  of  the  commission  at  the  outset, 
he  joined  a  calm  and  sober  judgment,  not  only  of  what 
ought  to  be  done,  but  of  what,  with  proper  effort,  could 
be  done.  His  former  connection  with  the  medical  staff 
giving  him  a  thorough  knowledge  of  the  defects  of  the 
system,  gave  also  a  practical  value  to  his  suggestions  of 
the  remedy  which  it  was  impossible  to  over-estiraate. 
The  commission  did  not  hesitate  to  follow  implicitly 
hb  counsel  in  all  his  suggestions  of  reform  measures, 
and  the  wisdom  and  propnety  of  his  advice  have  been 
fully  confirmed  by  the  experience  of  its  whole  history." 

Dr.  Darling,  who  had  long  since  resigned  his  posi- 
tion as  Demonstrator,  and  devoted  himself  with  ardor  to 
professional  studies  abroad,  a  Fellow,  by  examination, 
of  the  Royal  College  of  Surgeons  of  IJondon,  has  ac- 
cepted the  post  made  vacant  by  Prof.  Van  Buren's 
resignation,  and  stands  a  living  link  between  the  mem- 
ories of  the  early  college  days  and  the  active  duties  of 
the  present 

The  chair  of  Throry  and  Practice  has  witnessed 
many  changes,  and  has  been  filled  by  many  of  the 
ablest  men  in  the  country.  The  emphatic  Revere,  tho 
scholarly  Saml.  H.  Dickson,  the  classic  Bartlett,  the  learn- 
ed Meredith  Clymer,  who  served  with  distinction  as 
surgeon  in  the  late  war,  the  practical  and  clear-headed 
John  A.  Swett,  who  has  left  in  his  work  on  Practice 
the  proof  of  his  great  ability,  that  graceful,  apt^  and 
finished  clinical  teacher,  Dr.  John  T.  Metcalfe,  have 
successively  discharged  the  responsibilities  of  a  post 
now  filled  by  Dr.  Alfred  L.  Loomis,  who  has  laid  in 
the  Bellevue  and  Charity  Hospitals  the  foundations  of 

his  success,  C^ d-\r\n]o 

Digitized  by  VjOOQ  IC 


464 


THE  MEDICAL  RECORD. 


The  department  of  Materia  Medica  has  always 
been  identified  with  Dr.  Marty n  Paine,  whose  volum- 
inous works  attest  the  studious  habits  and  the  earnest 
convictions  which  have  distinguished  his  long  career. 
The  days  have  gone  when  Dr.  Payne  used  to  canter  to 
the  college  on  his  mettlesome  black  horse ;  but  though 
bowed  by  the  weight  of  years,  and  led  by  advancing 
age  to  withdraw  from  active  duty  in  favor  of  Professor 
Thompson,  neither  his  intellectud  forces,  nor  his  inter- 
est in  the  college,  are  in  any  way  abated. 

With  the  obstetrical  chair,  the  name  of  Gunning  S. 
Bedford  has  been  associated  from  the  beginning.  The 
remarkable  success  which  has  attended  the  publication 
of  his  lectures,  and  of  his  college  clinic,  the  rapid  ex- 
haustion of  successive  editions,  the  translation  of  his 
works  into  foreign  languages,  the  approbation  of  re- 
viewers and  of  students,  attest  the  ability  which  marked 
his  teachings.  Retiring  from  the  schools,  he  has  thus 
left  a  perpetual  legacy  in  the  published  results  of  all 
his  studies.  In  his  successor.  Dr.  Chas.  A.  Budd,  the 
alumni  recognize  one  to  whom  the  interests  of  the 
chair  are  worthilv  confided,  and  who  has  added  to  its 
attractions  by  the  assignment  of  Dr.  Jacobi  to  the 
children's  clinic. 

Dr.  John  W.  Draper,  now  Emeritus  Professor  of 
Chemistry  and  of  Physiology,  has  been  the  executive 
officer  and  guiding  spirit  of  the  school.  Earnest  but 
calm  as  a  lecturer,  remarkable  for  the  aptness  and  pro- 
fusion of  his  illustrations,  the  concentrated  manner, 
the  simplicity  of  style,  and  distinctness  of  argument, 
never  suggested  a  thought  of  that  exceeding  grace  of 
language  and  brilliancy  of  metaphor  which  rendered 
Prof.  Draper's  introductory  and  valedictory  addresses 
so  remarkable,  and  which  found  a  congenial  theme  in 
his  eulogy  on  Pattison.  The  magnetic  influence  of  Dr. 
Draper  as  a  lecturer  is  felt  in  the  sentiment  of  reserved 
force  with  which  he  penetrates  an  audience,  in  the  pos- 
session of  such  qualities  as  are  displayed  in  his  wonder- 
fiU  work  on  the  History  of  the  Intellectual  Develop- 
men  of  Europe,  and  in  his  remarkable  history  of  the 
Civil  War  in  America.  Each  of  these  might  justly 
claim  the  labor  of  a  life;  but  his  studies  have  been 
prosecuted  while  giving  two  distinct  courses  of  lec- 
tures, writing  an  elaborate  work  on  Physiology,  a  text- 
book on  Chemistry,  contributing  original  views  to  our 
knowledge  of  the  laws  of  light  and  their  relations  to 
the  development  of  plants;  and,  among  other  valuable 
discoveries,  originating  the  application  of  the  process 
of  Daguerre  to  the  taking  of  portraits  from  life. 

He  thus  stands  a  pioneer  in  one  of  the  most  valuable 
inventions  of  the  age,  identified  with  the  science  and 
the  literature  of  his  time,  an  ornament  to  the  University, 
and  the  pride  of  the  AlumnL 

Although  no  longer  actively  connected  with  the 
school  as  a  teacher,  hd  has  the  happiness  of  seeing  the 
chairs  of  Chemistry  and  Physiology,  made  vacant  by  his 
resignation,  ably  filled  by  his  two  sons. 

It  is  as  though  an  elevated  type  of  fissiparous  germ- 
ination had  demonstrated  alike  the  exceuence  of  the 
stock  and  the  vigor  of  the  parent  germ. 

The  University  Medical  College  enjoys  the  honor  of 
having  inaugurated  the  era  of  clinical  teaching  in  this 
city.  The  dinio  of  Dr.  Mott  has  now  expanded  into 
those  of  Prof.  Post,  of  Prof.  Q^uley,  who  brought  to  the 
Army  of  the  Potomac  the  operative  skill  obtained  in 
Bellevue,  of  Prof.  Roosa  cultivating  his  specialty  with  ar- 
dor ;  and  while  it  awakened  a  short-sighted  and  mistaken 
opposition  in  the  time  of  its  founders,  it  was  the  first 
of  those  organizations  which  have  since  been  developed 
in  the  colleges  of  the  city.  Although  clinical  instruc- 
tion was  previoudy  given,  to  a  certain  extent,  in  the 
New  York  Hospital  to  those  who  had  paid  an  extrava- 


gant price  for  a  ticket  of  admission,  neither  the  inter- 
est felt  by  the  staff  in  the  subject,  nor  the  accommoda- 
tions then  existing  in  that  hospital,  or  in  the  small 
theatre  subsequenUy  opened  in  Bellevue,  sufficed  for 
the  necessities  of  the  student. 

The  method  of  clinical  instruction  inaugurated  in 
surgery  by  Prof.  Mott,  and  in  obstetrics  by  Prof.  Bed- 
ford, bridged  over  the  period  of  time  which  elwsed 
between  5ie  former  comparative  indifference  to  bed- 
side teaching  as  an  educational  necessity,  to  the  present, 
when  our  college  clinics  are  beginning  to  yield  in  at- 
traction to  the  superior  advantages  of  our  large  hos- 
pitals, in  which  a  spirit  of  honorable  emulation  has 
arisen  already,  productive  of  surprising  results,  and 
prophetic  of  incalculable  benefit  for  the  future. 

And  now,  fellow  Alumni,  that  I  have  embodied  in 
this  retrospect  some  of  the  reminiscences  of  the  past, 
and  some  of  the  claims  of  Alma  Mater  to  an  exalted 
rank  among  the  medical  institutions  of  our  country — 
let  me  ask  how  has  it  fared  with  you  in  the  battle  of 
life? 

Many  of  our  number  are  at  rest.  Some  have  &llen 
on  the  field  of  battle,  or  have  succumbed  to  the  pesti- 
lence. Many  have  revived  their  college  associations 
and  their  friendships,  after  their  arduous  dqties  had 
been  discharged  to  the  wounded  of  both  contending 
armies.  Many  have  shrunk  from  ^e  responsibilities 
and  heart-aches  which  weigh  upon  the  physician,  and 
have  sought  in  lighter  duties  a  calmer  and  less  heated 
life.  Some  have  died  in  the  very  bud  of  promise,  to 
whom  the  touching  words  of  Newton  are  as  applicable 
as  they  were  to  the  young  astronomer  Cotes.  "  Ah  1 " 
said  the  unselfish  Newton,  "if  Cotes  had  lived,  we 
should  have  learned  something."  Others  may  be 
found  in  the  very  van  of  progress,  cherishing  the  best 
interests  of  our  profession,  and  a  bright  example  to  us 
all. 

The  vicissitudes  of  life  have  left  their  impress  on  ua. 
Where  are  the  light  hearts,  and  the  buoyant  spirits 
which  thrilled  our  pulses  when  we  ascended  this  plat- 
form, and  touched  the  long  coveted  diploma? 

Bheu  fugctceSj  Posiume^  Postume^  l<ibuntur  anni/ 
The  resistless  waves  of  time  bear  us  onward  on  the  tide 
of  advancing  years.  We  follow  those  who  have  gone 
before.  Soon  we  shall  feel  that  last  regret  that  we  had 
not  done  more  and  better  in  our  day  and  generation, 
and  then — 

"  Dust  to  dust,  ashes  to  ashes." 

Were  we  wise  when  we  became  physicians  ?  Are 
those  wise  who  recruit  our  ranks?  I  fear  that  many  a 
heavy  sigh  proclaims  the  disappointed  hope.  The  rosy 
atmosphere  of  youth  has  ^one,  the  shadows  deepen,  the 
naked  stony  realities  of  life  encotnpass  our  steps.  We 
have  our  fits  of  gloom  and  disappointment.  We  are 
condemned  to  struggle  against  that  immutable  law  of 
death,  to  which  we  must  ourselves  succumb. 

Our  consolation  may  be  found  in  watching  thoee  en- 
gaged in  other  intellectual  pursuits,  if  the  gathered  ex- 
perience of  our  bedside  lives  has  not  already  taught  us 
the  vanity  and  weariness  of  human  endeavor.  "For 
in  much  wisdom  is  much  grief;  and  he  that  increaseth 
knowledge  increaseth  sorrow." 

Where  in  the  range  of  intellectual  exertion  can  men 
find  respite  from  care,  or  fi^eedom  firom  disappointment  ? 
Where  is  the  field  of  study  in  which  the  physician  can- 
not glean  some  scattered  facts  to  stimulate  his  efforts 
and  reward  his  labor  ? 

Manhood  has  its  ideal  as  well  as  youth.  When  the 
rude  shock  of  the  world  has  dispelled  our  first  and 
brightest  illusions,  when  the  mirage  has  gone,  the  oasis 
vanished,  and  the  illimitable  desert  stretches  its  long 
waste  before  us,  then  all  the  noblest  qualities  of  ourna- 


THB  MEDICAL  RECORD. 


465 


tare  whioh  slumbered  t}iroup:h  the  long  peaceful  years 
of  ease,  stir  themselves  within  ns  and  nerve  us  to 
the  task.  Courage  and  ambition  sustain  the  drooping . 
hope,  patience  supports  the  steps,  and  fancy  paints 
the  reward  of  enduring  effort  Far  above  the  trudging 
feet^  the  busy  brain  remembers,  plans,  devises,  untu 
agam  the  arid  scene  is  colored  by  the  glow  of  manly  re- 
Bolution,  sUiving  for  the  same  ideal,  though  stripped  of 
the  chimeras  of  youth.  Disappointments  no  longer  dis- 
courage, &ilures  serve  as  fresh  incentives,  whuo  true 
wisdom  crowns  the  gathered  treasures  of  the  intellect 
with  the  insignia  of  humility. 

In  this  spirit  we  recognize  in  all  our  trials  the  purify- 
ing disciphne  of  life.  To  grow  wiser  is  no  longer  all. 
To  grow  better  is  the  thought  which  slowly  blends  it- 
self with  our  purpose,  and  graces  the  rugged  sur&ce  of 
resolve  as  the  clingmg  ivy  clasps  the  soUd  stone  in  its 
close  embrace. 

And  so,  turning  more  and  more  from  the  material  to 
the  spiritual,  we  find  that  the  greatest  love  must  come 
from  the  greatest  knowledge,  and  thus  the  imperfect 
intellectual  capabilities  evolved  from  our  being,  though 
failing  in  so  many  efforts,  take  at  last  their  highest  and 
securest  hold  on  faith  in  the  omniscient  Lord  and  Giver 
of  life. 

Survey  the  broad  converging  avenues  which  lead  to 
intellectual  distinction,  and  note  how  the  physician  can 
gather  instruction  and  consolation  from  the  lives  of  all 
who  toil  therein. 

Mark  the  astronomer  through  the  long  and  weary 
watches  of  the  nig;ht,  patiently  augmenting  the  grow- 
ing record  of  hli  observations.  Compare  him  with  the 
immensity  of  the  worlds  which  he  studies.  A  mere 
atom,  a  mathematical  point  with  neither  length,  breadth, 
nor  thickness,  standing  on  the  thin  crust  above  the  ever 
blasin?  fires  .which  we  call  the  solid  earth,  he  ha^  at- 
tuned his  mind  to  the  harmony  of  the  spheres,  and  has 
extended  his  knowledge  of  the  boundless  limits  of  the 
universe  by  apparatus  of  wondrous  mechanism,  so  that 
now  machinery  does  his  bidding,  and  records  the  results 
of  hi3  vigils  with  a  precision  and  accuracy  to  which 
man  himself  could  never  attain.  Privileged  to  read  the 
laws  which  determine  the  majestic  march  of  the 
heavenly  bodies,  the  astronomer  foretells  Uie  arrival 
within  his  sphere  of  vision  of  worlds  unknown  to  him 
nntil  their  perturbing  influences  had  heralded  their  ap- 
proach. Interpreter  of  the  oldest  and  proudest  of  the 
fair  daughters  of  science,  he  reads  the  separate  characters 
of  nebulous  masses,  and  recognizes  in  their  immensity  a 
stupendous  aggregation  of  separate  planets.  The 
glory  of  all  earthly  pageants  pales  before  the  grandeur 
and  solemnity  of  the  scenes  displayed  by  the  aid  of  a 
few  well  constructed  lenses.  Copernicus,  Galileo,  Kep- 
ler, Newton,  Herschel  have  passed  within  the  veil. 
The  fable  of  Prometheus  has  been  realized,  and  the 
heavenly  light  streams  through  countless  telescopes  from 
regions  dars  to  the  unaided  eye,  and  illumines  the  soul. 

But  consider  that  among  all  the  countless  numbers 
of  gifted  men  who  have  labored  in  this  the  most  ancient 
domain  of  science,  how  very  few  there  are  who  have 
advanced  its  limita  Consider  their  anxieties,  their  dis- 
appointmeiits,  and  even  their  persecutions,  and  you  will 
see  that  no  achromatic  lenses  can  be  contrived  to  shut 
out  the  gloom  of  discontent — '^For  man  is  born  to 
trouble  as  the  sparks  fly  upward.** 

The  microscope  of  the  physician,  planned  in  obedience 
to  the  same  laws  of  light  which  govern  the  construction 
of  the  telescope,  discloses  unimagined  marvels  worthy 
of  comparison  with  the  revelations  of  the  astronomer. 
He  finds  in  the  infinitely  small,  as  the  -  astronomer 
finds  in  the  infinitely  great|  wondrous  types  of  beauty, 
and  infinite  illustrations  of  that  obedience  to  law,  so 


grandly  ilhistrated  in  the  movements  of  the  heavenly 
bodies.  The  hairs  of  the  head  have  been  nnmbered, 
but  such  labor  bears  no  relation  to  that  which  has 
gradually  resolved  the  tissues  of  the  body  into  their  ul- 
Smate  elements,  and  traced  them  through  their  predesti- 
nal  transformations ;  which  has  found  such  startling  evi- 
dences <^  design  in  the  ultimate  capillary  vessels  ^  dif- 
ferent organs  J  which  has  disclosed  those  serried  ranks 
of  ciliated  epithelium,  with  their  sleepless  vibrations, 
lining  certain  recesses  of  the  body;  which  has  classi- 
fied ue  infusoria,  recognized  them  in  impalpable  grains 
of  microscopic  dust,  and  shown  in  their  migration  and 
development  another  evidence  of  that  grand  subordina- 
tion to  law,  set  like  the  seal  of  the  Creator  on  all  his 
works;  which  has  detected  in  the  excrementitious 
parts  of  man  and  birds  those  sparkling  crystals  shedding 
a  flood  of  light  on  the  treatment  of  disease,  and  those 
shells  of  transcendent  beauty,  baffling  the  engraver's 
art;  which  has  unravelled  the  coverings  of  the  ovule, 
defined  the  laws  of  its  growth,  and  disclosed  in  the  seg- 
mentation of  the  vitellus  the  first  of  those  wondrous 
changes  in  the  progressive  and  uniform  development  of 
foetal  life. 

And,  as  the  astronomer  finds  that  the  elaborate  inves- 
tigations of  ages  only  serve  as  starting-points  for  new 
discoveries  which  astound  his  intellect,  and  make  him 
feel  with  Newton  that  he  has  merely  gathered  pebbles 
on  the  sea-shore  of  knowledge ;  as  he  recojpizes  in  the 
"  sweet  influences  of  the  Pleiades  *'  the  ^rces  which 
overthrow  his  heliocentric  theories,  and  direct  a^ain 
his  hopeless  labors  in  search  of  the  unattainable ;  so  does 
the  microscopist  recognize  in  the  teeming  myriads  of 
unseen  hfe,  within,  beneath,  and  around  us — in 
the  mechanism  of  their  organization,  so  minute 
that  years  of  patient  study  are  demanded  for  a 
few  of  its  component  parts,  so  perfect  that  the  inventive 
mind  of  man  hails  with  gladness  in  these  models  unsur- 
passable illustrations  of  the  adaptation  of  means  to  ends 
— evidences  of  the  inexhaustibihty  of  his  researches,  and 
of  that  power  which  holds  the  earth  in  the  hollow  of 
his  hand,  and  has  known  all  things  from  tlie  beginning. 

What  creations  of  man  are  more  enduring,  and  more 
distinctive  of  his  preeminence,  than  the  varied  types  of 
architecture?  Prom  generation  to  generation,  they 
symbolize  the  religious  aspirations  of  peoples  and  the 
ambitious  hopes  of  kings.  Lost  languages  are  graven 
on  their  walb,  and  buried  for  centuries  in  oblivion, 
until,  after  the  lapse  of  ages,  the  Rosetta  stone  is  found 
and  the  dead  past  speaks  to  the  living  present.  For 
thousands  of  years  they  bid  defiance  to  natural  laws  of 
decay.  Empires  crumble,  nations  become  extinct,  seas 
and  rivers  change  their  barriers,  the  name  and  memory 
of  architect  ana  builder  are  gone  for  ever — but  still 
the  solid  structure  stands. 

But  the  physician  recognizes  in  the  long  bones  of  the 
human  skeleton  that  union  of  strength  with  lightness 
which  has  done  so  much  for  architecture,  and  sees  in 
the  mechanism  of  the  pelvis  that  combination  of  the 
principle  of  the  arch  and  the  suspension  bridge  with 
which  the  greatest  triumphs  of  engineering  have  been 
achieved.  Pursuing  his  researches  through  the  realms 
of  nature,  he  finds  in  the  nests  and  homes  of  animals  a 
perfection  of  adaptability  and  contrivance  which  chal- 
lenge our  lasting  admiration  while  they  humiliate  our 
pride. 

How  touching  are  those  discoveries  of  facts  illustra- 
tive of  domestic  lifij  which  the  enduring  pyramids  trans- 
mit more  surely  than  the  proud  memory  of  their  found- 
ers I  In  a  leisure  moment  the  humble  laborer  toiling 
with  a  hundred  thousand  of  his  fellows  on  the  slowly 
rising  structure,  scratches  on  the  sides  of  a  stone  the 
name  of  the  reigning  Pharaoh.    The  pyramid  is  finish- 


igitized  by 


466 


THE  MEDICAL  RECORD. 


ed.  Pharaoh  and  people  sleep  with  their  fathers.  The 
name  of  the  king  has  lapsed  trom  the  memory  of  tradi- 
tion, but  the  careless  record  of  the  poor  workman  trans- 
mits throagh  thousands  of  years  that  name  of  his  su- 
preme master  which  the  stately  pyramid  had  failed  to 
guard. 

From  the  legended  tonib  the  mummy  is  at  last  borne 
to  countries  of  which  the  existence  was  not  even  sur- 
mised in  its  lifetime.  Strange  forms  and  faces  watch 
with  mingled  curiosity  and  interest  the  unwrapping  of 
the  successive  covers,  but  when  there  falls  from  the  shriv- 
elled armpit  the  flower  which  has  been  pressed  there 
through  centuries,  the  unmistakable  token  of  a  last  affec- 
tionate thought  rolls  back  the  buried  ages,  and  the  electric 
spark  of  sympathy  flashes  from  the  unseen  past  into 
the  Uving  heart 

Customs  and  languages  may  disappear,  the  form  of 
men  may  change  with  me  influence  of  climate  and  mode 
of  life — but  the  same  tear  falls  from  the  mourning  eye  to- 
day which  bedewed  the  mummy  of  the  Pharaoh-^ 
through  all  recorded  time  the  human  heart  thrills  to  the 
same  human  emotions. 

They  slumber  in  all  their  vitality  through  centuries 
of  time,  but  at  the  fitting  moment  their  talismanic  in- 
fluence is  felt.  The  buried  grain  of  wheat  from  ^e 
Egyptian  tomb  ripens  at  last  into  the  golden  harvest  of 
another  hemisphere ;  the  symbols  of  joy  and  sorrow  en- 
graven on  stones  long  hidden  in  Egyptian  and  Assyrian 
sands,  touch  the  same  chords  of  feeling  now,  and  pro- 
claim the  brotherhood  of  man. 

How  wonderful  are  the  contributions  of  the  literature 
of  the  past  to  the  physician  of  to-day  I  The  dead  and 
buried  lan^ages  yield  to  him  their  hoarded  treasures  of 
wisdom.  He  sees  in  the  experience  of  ages  the  expanded 
experience  of  a  life.  With  all  the  stupendous  achieve- 
ments of  science  he  finds  in  the  aphorisms  of  the  fathers 
of  medicine  the  barriers  which  limit  his  progress  to-day. 
**  Vita  brevis,  ars  longa,  occasio  prseceps,  experimentum 
periculosum,  judicium  difficile."  Gknerations  of  scien- 
tific men  have  iefl  the  proud  record  of  their  discoveries 
as  starting-points  foi  the  enthusiasm  and  the  genius  of 
their  followers,  but,  as  the  boundaries  extend,  new  and 
more  fruitfiil  fields  for  observation  widen  the  horizon. 
"  Plus  on  s'^^ve,  plus  I'horizon  8*^tend."  The  strivings 
of  science  for  unattainable  knowledge  illustrate  the 
startling  mathematical  law  that  a  thing  may  be  infinitely 
greater  than  a  thing  infinitely  great. 

Philologists  have  at  last  unlocked  for  us  the  sacred 
books  of  the  Hindoos,  and  the  physician  finds  in  the 
Sanscrit  of  thousands  of  years  ago,  in  the  record  of  those 
laws  which  govern  the  development  of  the  offspring  of 
mixed  races,  the  same  results  which  our  experience  in 
the  South  has  taught  Let  us  hope  that  the  prophetic 
words  of  the  wise  old  Hindoos  may  not  apply  to  u& 
"  Every  country,"  they  say,  **  in  which  the  purity  of  type 
is  defaced  by  admixture  of  races  is  soon  destroyed  with 
its  inhabitants." 

The  artist  steeps  his  senses  in  types  of  beauty,  and 
harmonizing  all  their  attributes  in  the  rich  tints  of  his 
poetic  fancy,  the  result  is  shown  in  "  the  statue  which 
enchants  the  world,"  or  in  the  mellowed  splendor  of  the 
canvas  before  which  generations  bow  in  hopeless 
emulation. 

The  physician  deals  with  life  itself.  The  wasted  form, 
the  pallid  haggard  face,  the  sunken  suffering  eye  lie 
beCbre  him  on  their  couch  of  pain.  The  feeble  cry  of 
infancy,  and  the  stifled  anguish  of  maturer  years  echo 
within  his  heart.  See  in  the  results  of  his  labor  the 
wondrous  change.  The  parched  lips  are  wreathed  with 
smiles,  the  sparkling  eye,  the  rounded  outUnes,  the  rich 
blood  which  mantles  in  the  cheek  and  warms  the 
swelling  heart,  the  merry  peals  of  laughter  surely  de- 


monstrate the  advancing  power  of  his  art  The  writhing 
limbs,  contorted  with  pain,  relax  themselves,  and  bathed 
in  refreshing  sleep  acknowledge  in  graceful  attitudes 
the  magic  power  of  an  anaesthetic.  The  gibbering 
soulless  lace  of  the  insane  is  lighted  up  again  by  the 
dawn  of  returning  reason,  and  transformation  more 
wonderfiil  than  that  of  the  fabled  Memnon,  bursts  forth 
in  songs  of  praise. 

And  thus,  amid  all  the  cares  of  life,  the  true  physician 
finds  his  consolation  in  the  contemplation  of  nis  ideal, 
and  in  his  warm  intellectual  sympathy  with  all  students 
of  nature's  laws.  No  mere  routinist,  deserving  the 
sarcasm  of  Voltaire,  and  pouring  drugs  of  which  he 
knows  little  into  a  body  of  which  he  knows  less ;  but, 
humbly  recognizing  the  limitations  of  all  knowledge,  he 
shares  this  humiliation  with  all  earnest  seekers  after 
truth,  and  points  serenely  to  the  past  in  evidence  of  the 
progress  of  the  present 


|)r0jgrf ««  of  MtVxcai  Science. 


Process  for  PRonucmd  Htdrogek. — ^M.  Heurtebise 
describes  in  a  late  number  of  V Invention  an  economi- 
cal method  of  obtaining  hydrogen  gas.  He  places  char- 
coal in  a  retort  and  raises  it  to  a  red  heat ;  then  passes 
over  it  a  stream  of  carbonic  acid,  thus  forming  car- 
bonic oxide.  Into  another  red  hot  retort  he  passes  a 
current  of  steam  and  the  gaseous  contents  of  the  first 
retort^  and  the  products  in  the  second  retort,  resulting 
from  the  decomposition  of  steam,  are  carbonic  acid  ana 
hydrogen  gases,  which  are  separated,  and  the  carbonic 
acid  is  again  used  in  the  first  retort.  The  interesting 
process,  described  as  new  in  the  French  journal,  has 
been  long  used  in  America,  particularly  by  those  ex- 
perimenters who  have  aimed  at  mixing  nfbre  hydrogen 
with  the  large  class  of  hydrocarbons  which  are  very 
rich  in  carbon,  and  therefore  liable,  from  imperfect 
combustion,  to  give  off  fine  particles  of  unconsumed 
carbon  in  the  form  of  smoke. 

Tansy  in  Epistaxis. — ^Dr.  C.  P.  Uhle  {Medical  and 
Surgical  Reporter)  has  tested  quite  thoroughly  the  vir- 
tues of  the  tanacetum  vtdgare  as  a  remedy  in  epistaxis. 
An  accidental  application  of  a  tansy  leaf  to  the  part 
while  a  student,  completely  controlled  the  hsemorrhage 
in  his  own  person,  and  has  never  since  failed  in  his 
hands.  In  some  instances  the  simple  aroma  of  the 
plant  proved  sufficient 

The  BioHLORinE  of  Methylene,  the  discovery  of  which 
is  attributed  to  Dr.  Richardson,  of  London,  is  claimed  to 
differ  from  chloroform  in  the  rapidity  with  which  it  pro- 
duces aneesthesia,  in  the  prolonged  insensibility  which 
results  from  its  inhalation,  and  in  the  facility  with  which 
complete  anaesthesia  may  be  reestablished  by  the  recep- 
tion of  a  very  small  quantity  of  the  vapor  when  the  effect 
begins  to  diminish.  There  is  said  to  be  no  secondary 
excitement  in  the  action  of  this  agent,  no  convulsive 
movements  and  no  vomiting.  The  patients  upon  whom 
experiments  were  made  with  the  bichloride  of  methylene 
glided  softly  into  complete  unconsciousness,  and  after 
continuing  under  its  influence  for  periods  varying  firom 
half  to  three-quarters  of  an  hour,  with  very  slight  var- 
iation of  pulse  or  breathing,  recovered  their  conscious- 
ness as  quietly  as  they  had  lost  it, 

Nature  and  Mods  of  Propagation  op  Phthisis. — 
Dr.  William  Budd  (Laneei)  expresses  a  conviction  that 
phthisis  is  a  true  zymotic  disease,  of  specific  nature,  never 
originating  spontaneously,  and  perpetuated  solely  by 
the  law  of  continuous  succession,  and  that  the  tuber- 
culous matter  itself  is  or  includes  th^.^ecific  morbific 

Digitized  by  VjC  „^^^^^_ 


THE  MEQICAL  RECORD. 


467 


matter  of  the  disease,  and  constitutes  the  material  bj 
which  phthisis  is  propagated  from  one  person  to  another. 

EXPERDCENTS  WITH  BhOMIDE   OF  POTASSITTM. — ^MeSSFB. 

Eulenburg  and  Gutmann  have  stated,  before  the  Acad- 
emy of  Medicine  of  Paris,  that  doses  of  from  thirty  to 
sixty  grains,  either  by  the  stomach  or  injected  under 
the  skm,  kUl  a  rabbit  in  from  ten  to  forty  minutes. 
Smaller  doses  momentarily  disturb  the  action  of  the 
heart,  and  paralyze  the  power  of  moving  and  feeling, 
causing  a  &w  antecedent  shivers.  On  a  post-mortem 
examination  of  the  animals,  vm  change,  but  some  con- 
.  g^tion  of  internal  oreana  is  found.  With  frogs,  a  sub- 
cutaneous injection  of  one  grain  to  two  causes,  after  ten 
or  fifteen  minutes,  lou  of  movement,  reflex  action  and 
feeling,  with  arrest  of  respiration,  weakening  and  in- 
frequency  of  cardiac  ventricular  action,  retardation  of 
peripheral  circulation,  and  lastly,  complete  diastolic 
arrest  of  the  heart's  action.  These  effects  are  attributed 
by  Messrs.  Eulenburg  and  Gutmann,  not  to  the 
bromine,  but  to  the  potassium. — Lancet 

Subcutaneous  Incision  in  Carbunolb. — "I  have 
had  several  opportunities  of  seeing,  at  the  H6pital  St. 
•  Louis,  in  the  service  of  M.  Gu^rin,  cases  of  anthrax, 
more  or  less  grave,  treated  by  his  method  of  subcu- 
taneous incision.  This  proceedioe  counts  many  parti- 
sans among  us.  It  consists  in  plunging  in  the  centre 
of  the  anthrax  a  straight  bistoury,  which  is  immediately 
insinuated  on  the  fiat  under  the  skin  beyond  the  limits 
of  the  swollen  part ;  and,  as  soon  as  the  limit  is  passed, 
the  cutting  edge  of  the  instrument  is  turned  towards 
the  deeper  parts,  to  incise  them  from  the  circumference 
to  the  centre,  till  the  sensation  felt  indicates  that  resist- 
ance is  overcome.  This  first  incision  only  indicating 
one  radiu3  of  the  diseased  surface,  three  others  are 
made  which  converge  towards  it  to  the  point  at  which 
the  bistoury  was  introduced.  When  the  integuments 
ofifer  a  mortified  points  or  an  orifice,  it  can  be  used  for 
introducing  the  instrument,  without  its  being  necessary 
to  divide  the  skin  to  however  slight  an  extent.  The 
success  of  this  operation,  says  Dr.  Gu^rin,  seems  to  solve 
the  question  of  the  seat  of  anthrax ;  for,  if  it  be  practised 
at  the  outset  of  the  malady,  it  arrests  the  march  of  it, 
and  opposes  the  mortification  of  the  skin.  Often  the 
cellular  tissue  suppurates,  and  is  eliminated  under  the 
form  of  a  '  core ; '  while  the  skin  pres.*nts  no  alteration. 
The  subcutaneous  incision  of  anthrax  has  the  special 
advantage  of  relieving  the  patients  from  the  liability  to 
erysipelas  and  to  purulent  infection.  Besides,  this 
means  is  not  very  painful ;  for  it  spares  the  skin,  which 
is  of  all  the  tissues  that  of  which  the  incision  produces 
the  most  pain.  Finally,  it  does  not  give  rise  to  a  de- 
formed cicatrix — a  consideration  which  is  not  to  be  dis- 
dained when  the  anthrax  is  seated  on  the  face  or  any 
other  uncovered  part  of  the  body.  After  the  incision, 
emollient  poultices  are  applied;  and  in  all  cases  the 
cure  occurs  more  quickly  than  by  any  other  treatment" 
I^aris  Cor,  British  Med,  Journal, 

DiAOxosis  OF  Polypus  Nasi.— Obstruction  to  the  nasal 
passages,  due  to  a  thickened  condition  of  the  mucous 
membrane  lining  the  cavity,  is  without  doubt  one  of 
the  commonest  sources  of  error  in  the  diagnosis  of  nasal 
polypus ;  for  the  lower  turbinated  bone,  covered  with 
Its  thickened  mucous  membrane,  is  a  prominent  object 
in  the  nostril  of  a  patient  suffering  from  this  disease,  and 
an  obstruction  to  the  passage  is  at  the  same  time  a 
marked  complication  of  its  presence.  The  practitioner 
is  thus  too  often  misled  into  the  idea  that  a  nasal 
polypus  b  the  cause  of  all  the  symptoma  The  external 
^pearancc!*,  however,  of  the  parts  involved  in  these 
two  conditions  are  so  different  that  such  an  error  of 
diagnosis  should  not  be  made;  for  the  nasal  polypus 


has  usually  a  transparent,  pale,  succulent  aspect^  whilst 
the  mucous  membrane  covering  the  turbinated  bone  is 
of  a  dull,  congested,  and  more  solid  nature.  It  is  also 
to  be  observed,  on  examination,  that  the  mucous  mem- 
brane covering  the  turbinated  bone  is  continuous  with 
the  same  membrane  covering  the  nostril.  This  latter 
fact  is  readily  seen,  and,  in  doubtful  cases,  is  sufficient 
to  make  the  diagnosis  clear. — Thomas  Bbtant,  F.R.G.S., 
Lancet 

Does  thb  LnnsB  form  Suoab  ? — ^The  glycogenic  func- 
tion of  the  liver,  as  it  has  been  termed,  which  was  re- 
garded a  few  years  ago  as  a  weU  established  point  in  phy- 
siology, has  been  called  in  question,  lateljr,  by  means  of  ^ 
sundiy  experiments  going  to  show  that  it  is  not  pro- 
duced in  tnat  organ  until  after  death,  and  that  its  pro- 
duction is  due  to  a  kind  of  fermentation  which  can  only 
take  place  in  stagnant  blood.  Such,  at  least,  is  the 
claim  made  by  Pro£  Scbiff,  of  Pisa,  as  stated  in  a  letter 
from  that  city,  written  by  a  correspondent  of  the  Etch- 
mond  Med,  Jour,  The  Professor  round  that  a  ligature 
drawn  tighUy  for  forty  minutes  around  the  thigh  of  a 
rabbit  produced  a  flow  of  sugary  urine  lasting  twelve 
hours,  and  that  pressure  with  the  finger  upon  the  ab- 
dominal blood-vessels  of  a  rabbit  for  five  or  eight  min- 
utes produced  the  same  effect,  which  lasted  upwards  of 
two  hours.  His  theory  of  diabetes  b  that  the  sugar  re- 
sults firom  a  ferment  in  the  blood  which  has  not  the 
power  to  act  in  the  normal  condition  of  the  body,  but 
which  ia  enabled  to  operate  when  the  circulation  in  the 
Uver  and  other  parts  is  interfered  with  by  paralysis  of 
the  vaso-motor  nerves  which  supply  the  blood-vessels. 
The  therapeutic  indication  derived  from  this  theory  is 
to  prevent  or  annul  the  evolution  of  the  ferment  in  the 
blood  of  a  diabetic  patient  This,  it  is  suggested,  might 
be  attempted  by  the  sulphites  and  hyposulphites  of  Polli 
and  others.  Diabetes,  according  to  this  view,  becomes 
a  zymotic  disease.  Whether  we  have  gained  much  in 
the  treatment  of  it,  through  the  indefatigable  labors  of 
modem  physiologists,  is  a  question.  We  mav,  at  least, 
felicitate  ourselves  that,  sooner  or  later,  these  labors  will 
be  broupjht  to  a  useful  bearing  on  practice.  By  such 
thorough  and  laborious  researches  as  distinguish  the  age 
in  which  we  live,  truth  must  be  developed.  Though 
the  harvest  be  long  delayed,  yet  it  must  come  in  the 
course  of  events.  As  the  matter  now  stands,  we  are 
not  aware  that  the  treatment  claimed  to  be  "rational " 
can  demonstrate  its  superiority  in  practice  to  that  which 
is  purely  empirical — Pacific  Med,  and  Surg.  Jour, 

Danger  ATTENDma  Ete-w ashes  containing  Prepa- 
rations OF  Lead.— From  practical  observations  made 
at  the  Hospital  of  St.  Sauveur  at  Lille,  upon  the  evil 
effects  of  collyria  containing  acetate  of  lead,  quite  fre- 
quently employed  as  an  astringent  in  light  cases  of  oph- 
thalmia, a  precipitate  of  lead  was  observed  upon  the 
cornea,  a  layer  of  chloride  of  lead,  which  renders  it 
dim,  and  forms  erosions  upon  it  by  destroying  its  epithe- 
lium. Vessels  are  developed  upon  the  cornea,  as  it  were, 
to  resist  this  morbid  process,  and  the  precipitate,  afler  its 
disappearance,  leaves  behind  it  an  ulceration  of  the  cor- 
nea and  pannus,  which  it  is  very  oflen  very  difficult  to 
remove — ^in  fact,  a  greater  evil  than  that  it  was  first  in- 
tended to  remedy.  The  sight  of  the  right  eye  was  thus 
completely  lost  in  a  case  for  whom  the  following  coUyri- 
um  had  been  prescribed:  Subacet  lead,  3  ss. ;  Sydenham's 
laudanum,  gtt  xx. ;  dist.  water,  |  v.  M.  This  is  barely 
useful  in  some  cases  of  pannus;  and  even  blennorrhagio 
inoculation,  instituted  in  Belgium,  seems  preferable  in 
these  cases  ;  in  proof  of  which  several  cases  have  been 
published  in  this  ^*  Revue."  It  is  thus  safer  to  erase  it 
entirely  from  the  list  of  eye-washes, — Canada  Med 
Joumcd,  r-^  T 

Digitized  by  VjOOQ  IC 


4^8 


THE  MBDICAL.  REOOBD. 


SbPARAZIOH  of  EnPHTBBS  OF  IX>WIB  KND  OF  HuMIB- 

us.~Mr.  Sobert  W.  Smith,  RKCaL,  in  an  address 
upon  Surgery  delivered  before  the  British  Medical  As- 
sociation at  its  late  meeting  in  Ireland,  thus  remarks 
upon  the  diagnosis  of  this  form  of  separation : 

**  The  symptoms  winch  belong  to  it,  in  common  with, 
fracture  above  the  condyles,  are  the  following :  Short- 
eniDg,  crepitus,  the  removal  of  the  deformity  by  exten- 
sion, and  its  tendency  to  recur  when  the  extending 
force  is  relaxed ;  the  presence  of  an  osseous  tumor  in 
front  of  the  ioint;  the  increase  in  the  antero-posterior 
diameter  of  the  elbow.  It  differs  from  the  supracondy- 
loid  fracture  in  the  greater  transverse  breadth  and  regu- 
lar convex  outline  of  the  anterior  tumor ;  in  the  exis- 
tence of  two  tumors  posteriorly;  in  the  loss  of  the 
normal  relation  of  the  olecrauon  to  the  condyles.  It 
resembles  dislocation  of  both  bones  of  the  forearm 
backwards  in  the  foUowing  particulars :  The  transverse 
diameter  of  the  anterior  tumor  is  the  same  in  each 
case;  so  also  is  the  antOTo-posterior  breadth  of  the 
elbow;  in  both  the  olecranon  ascends  above  the  con- 
dyles, the  Hmb  is  shortened,  and  two  osseous  promi- 
nences can  be  distinguished  posteriorly.  It  differs, 
however,  from  luxation  in  the  existence  of  crepi- 
tus, in  the  tendency  of  the  deformity  to  recur,  and  in 
the  circumstances  of  the  anterior  tumor  beii^^  desti- 
tute of  trochlea  and  capitulum,  and  the  two  posterior 
tumors  being  nearly  on  the  same  level" 

Ephidbosis  Oritivtjl — Dr.  McCall  Anderson,  at  the 
meeting  of  the  British  Medical  Association,  related  a 
case  of  the  so-called  bloody  sweat  The  patient  was  a 
lady  fifteen  years  of  age,  who,  in  connection  with  defeo- 
tive  and  irregular  menstruation  (she  commenced  men- 
struating at  the  age  of  eight)  suffered  from  attacks  of 
hsemorrhage  from  the  skin  from  oval  or  round  er3rthema- 
tous  patches  situated  symmetrically  on  the  face,  arms, 
chest,  and  legs.  The  outbreaks  occurred  veiy  suddenl  v, 
generally  without  premonition.  The  patient  would 
know  however  at  once  of  an  attack  bv  a  peculiar  sen- 
sation, and  when  the  part  would  be  immediately  ex- 
posed the  cuticle  appeared  to  have  melted  away,  and  a 
"  complete  dew  of  blood,"  was  detected.  With  the  ex- 
ception of  the  menstrual  derangement  and  the  cuta- 
neous phenomeniL  tins  young  lady  appeared  to  be  in 
perfect  health.  The  general  tonic  course  was  pursued, 
with  stimulating  hip  baths  at  the  menstrual  epochs, 
and  afterwards  with  Fowler's  solution.  She  eventually 
entirely  recovered. 

CoRBinSRATIOKS    SuoaBSTBD    BT   THB   STin>T   OF   OnS 

HuimBxn  Cases  of  Stonb  in  the  Bladdbb  of  thb 
Adult  Rsokntlt  Opbratsd  on.  Bt  Sir  Henbt 
Thompson. — ^The  cases  were  not  selected,  but  were 
simply  those  which  had  occurred  in  the  author's 
motioe  during  the  last  three  years  and  a  hal£ 
Not  a  single  case  implying  was  refused  operation; 
that,  in  the  worst  cases,  being  the  only  chance  of 
life.  They  were  all  adults^  the  children's  cases 
being  omitted.  The  foUowing  facts  were  noted. 
Of  &e  100  cases,  84,  or  about  four^fiflhs  of  the  total 
number,  were  operated  on  by  lithotnty  and  16  by  lith- 
otomy. The  mean  age  of  the  84  lithotnty  cases  was 
62^  years ;  among  them  were  no  less  than  21  ca«ies  of 
70  years  and  upwards,  2  being  upwards  of  80  years  of 
age.  Among  these  84  cases  there  were  only  4  fatal 
cases.  The  hthotomy  cases,  16  in  number,  had  a  mean 
age  of  63i  years.  The  youngest  was  42,  the  oldest 
was  80  years ;  6  were  above  70  years  of  age,  indudinf 
1  each  of  77,  78,  and  80  years ;  6  cases  were  fatal  Of 
the  entire  100  oases  of  operation  upon  unseleoled  pa- 
iientsL  having  a  mean  age  of  62|>  years,  and  submitted 
*o  either  lithotrity  or  lithotomy,  there  were  90  recov- 


eries and  10  deaths.  These  cases  most  be  considered 
as  less  promising  oases  than  the  product  of  any  given 
district  Four  propositions  were  deduced  from  the 
facts  stated.  1.  Lithotrity  is  the  most  successful  oper- 
ation for  at  least  four-fifths  of  all  cases  of  stone  in  the 
adult  which  come  under  the  surgeon's  notice  at  the 
present  time,  a  statement  which  is  more  definitely  ex- 
pressed in  the  fact  that  the  rate  of  mortality  for  such 
cases  in  this  series  is  barely  five  per  cent.  2.  Lithotrity 
can  be  thus  successful  only  when  it  is  performed  on  a 
definite  system  in  accordance  with  certain  practical 
rules  which  experience  has  determined,  and  which  can 
be  laid  down.  3.  Cases  of  calculus,  in  which  one  of  the 
two  operations,  lithotrity  or  lithotomy,  ought  not  to  be 
performed,  are  excessively  rare.  4.  By  exercising  an 
ordinary  degree  of  vigilance  for  adult  patients  suffering 
from  symptoms  of  urinary  disorder,  every  case  of  calcu- 
lus may  be  discovered  in  an  early  stage,  may  be  success- 
fully treated  by  lithotrity,  and,  consequently,  the  oper- 
ation of  cutting  for  stone  may  be  rendered  obsolete,  or 
applicable  only  for  some  very  exceptional  example 
which  has  been  developed  as  the  result  of  extreme 
neglect  or  ignorance. — BriiWh  Medical  Journal 

AouTB  BHuncATisM  BT  Strufits  Calois. — ^I^.  0.  E. 
Buckingham  (Botion  MeeUecd  and  Surgical  Jowmal) 
speaks  highly  of  the  beneficial  effects  attending  the  ad- 
ministration of  this  medicine  in  acute  rheumatism.  He 
has  used  it  in  doses  as  large  as  forty-five  drops  everj 
two  hours,  but  generally  thirty  drops  have  been  suflS- 
dent  He  cautions  against  its  use  m  the  form  of  a  pill, 
or  dissolved  in  water,  and  prefers  milk  as  the  vehide. 
He  has  never  found  alkaline  urine  to  result  from  its 
use,  no  matter  how  large  or  fre<]^uent  the  dose.  He 
prefers  to  have  it  made  of  eausUc  hme.  *^  The  best  for- 
mula," says  he,  "would  be  to  mix  two  ounces  of 
lime  unslaked  and  eight  ounces  of  sugar  together  in 
the  mortar,  and  pour  over  the  mixture  a  wine  pint  of 
boiling  water.  Add  boiling  water  enough  to  make  up 
the  pint,  and  filter.  By  the  use  of  boiling  water,  the 
operation  is  more  rapid  and  the  formation  of  lumps  is 
avoided." 

Splanchnosoopt. — If  one  holds  an  egg  before  a  bright 
light,  it  is  seen  to  be  translucent  If  a  bright  light  were 
introduced  into  the  stomach,  we  could  obtain  a  toler- 
ably fair  view  of  its  anterior  and  lateral  parieties,  by  a 
similar  property  of  translucency.  Impossible  as  this 
demonstration.would  seem  to  be,  it  has  been  success- 
fully performed  by  M.  MiUiot,  of  Paris.  He  introduces 
into  tiie  stomach  glass  tubes  of  small  calibre,  containing 
two  platinum  wires,  connected  with  the  electrodes  of  a 
powerful  battery — ^the  apparatus  of  Middedorpf  he  pre- 
fers— and  thus  kindles  an  intense  light  in  the  cavity. 
Tumors  in  the  abdominal  walls  can  thus  be  demonstrat- 
ed, indurations  and  ulcerations  detected,  and,  indeed, 
to  what  extent  diagnosis  may  not  be  facilitated,  it  were 
premature  to  say.  Certainly  the  idea  is  novel  and 
worth  considering. 

The  Influence  of  STRioniRB  of  the  Pulmonart  Ab- 
TBRT  ON  the  Formatton  OF  TuBiBCLE. — M.  Lcbcrt,  the 
eminent  Professor  of  Breslau^  in  a  paper  sent  to  the 
Academy  of  Medicine  of  Pans,  comes  to  the  conclu- 
sion that  the  stricture  above  named,  at  the  origin  of 
the  vessel,  has  a  tendency  to  produce  an  extensive  and 
progressive  tuberculosis,  the  characters  of  which  may 
be  dinically  and  pathologically  ascertained. 

N-Bvi  BY  NiTBio  Aoro.— Mr.  Thomas  Smith,  F.R,C.8., 
in  some  dinical  papers  on  the  sur^^ery  of  childhood, 
recommends  the  application  of  nitnc  add  to  nievi  in 
preference  to  any  otner  caustic,  or  t<MJ3e  knifew  j 

digitized  by  VjOOQIC 


THE  MEDICAL  RECORD. 


409 


The  Medical  Kecx3RD. 

^  j$tmi-P0nt^  Immml  of  Ptbichu  snb  Stttgeis. 
Georgs  F.  Shradt,  M.D.,  EDnoR. 


PnbUiriwd  on  th0 1st  and  15th  of  each  Month,  bj 
WILLIAM  WOOD  St  CO.,61  Walksb  Stur,  New  Tobk. 


rOItEIQS  AQBKCIS&, 

Loirooir— Tbubxxb  k  Co.  I     LaiPSio— B.  Hiemanh. 

PABis—BossAXOa  R  Cis.  I     Rio  Jakxibo— frrspBiiis  t  Oa. 


N*e"W  YorlE.  IDeoember  16,  1S6*7. 


THE  PROPOSED  CHANGES  IN  OUR  COLLEGE 
SYSTEM. 

A  ciroular  has  tecentiy  been  addressed  to  the  Tari- 
ous  Colleges,  asking  for  a  concerted  action  on  their 
part  upon  the  several  propositions  offered  bj  the  late 
Teachers'  Convention  in  Cincinnati  The  committee 
that  represents  this  association,  having  a  more  or  less 
permanent  character,  are  perfectly  competent  to  present 
the  matter  officially  before  the  different  Medical  Schools, 
and  in  that  light  diis  last  appeal  for  reform  should  un- 
doubtedly be  viewed. 

They  take  for  their  basis  of  action  the  resolutions 
passed  not  only  by  the  Convention  but  by  the  Ameri- 
can Medical  Association ;  and  as  our  readers  are  already 
fiuniliar  with  that  document  in  detail,  it  is  unnecessary 
here  to  do  more  than  give  an  outline  of  the  scheme. 
In  brie^  then,  the  changes  proposed  may  be  summed  up 
under  four  heads :  First^  a  positive  standard  of  prelimi- 
Bary  education ;  secondly,  a  longer  time  in  which  to 
acquire  a  knowledge  of  the  various  branches  of  Medi- 
cal Science  and  Practice;  thirdly,  a  systematic  and 
succeasive  order  of  studies  for  the  student ;  and  lastly, 
a  certain  amount  of  direct  clinical  instruction  in  a  pub- 
lic hospital,  as  part  of  the  senior  course. 

We  have  from  time  to  time  taken  occasion,  in  our  dis- 
cussion of  various  matters  connected  with  Medical  Edu- 
cation, to  urge  the  adoption  of  the  suggestions  therein 
contained,  severally  and  collectively,  and  to  endorse  in 
toio  the  action  of  that  body.  We  have  Apt  only  been 
of  this  opinion,  but  have  been  ready  to  go  a  step  or  two 
fkrther  in  upholding  measures  that,  under  the  present 
system,  would  seem  almost  impracticable.  But  this  is 
by  the  way. 

The  objects  of  the  circular  which  is  before  us  are  not 
only  intended  to  explain  away  many  of  the  arguments 
which  have  seemingly  been  brought  forward  by  some 
of  the  schools  against  the  resolutions  referred  to,  but 
also  to  fix  a  period  to  the  present  system  of  medical  in- 
Btmction.  Its  first  intention  has  been,  to  our  way  of 
thinking,  well  carried  out,  and  we  have  only  to  hope 
that  its  second  object  will  be  also  attained  in  an  equally 
satisfiustory  manner. 


In  reference  to  the  question  of  preliminary  educa- 
tion we  have  fully  expressed  our  views^  and  the  plan 
which  we  took  occasion  to  si^gest  was  the  examina- 
tion of  the  stud^its  by  some  competent  persons  other 
than  the  ftumlty,  ih  order  tiiat  no  plea  that  any  un&ir- 
ness  of  partiality  could  be  brought  fi>rward.  This  at 
the  time  we  bdieved  was  practicaUe,  and  we  are  still  of 
the  same  opinion.  There  may  be  some  other  means 
adopted  to  insure  this  end,  but  this  matters  not,  so  long 
as  the  spirit  of  the  resolution  is  carried  out.  The  com- 
mittee have,  with  some  show  of  policy,  merely  presented 
the  necessity  for  the  adoption  of  some  feasible  means 
without  suggesting  anything  definite.  This  is  hardly 
the  wisest  course  that  could  be  pursued,  inasmuch  as 
it  is  advisable  to  form  as  a  responsible  body  a  distinct 
platform  upon  which  all  points  at  issue  must  be  directly 
settled.  A  failure  to  distinctly  define  the  manner  in 
which  these  preliminary  examinations  should  be  eaiv 
ried  on  may  still  leave  the  whole  question  open,  a  prey 
to  misconceptions  and  to  the  temptation  of  practically 
ignoring  the  su1:)3ect  altogether. 

Oil  the  other  proposed  changes  the  committee  Is  more 
to  the  point  In  regard  to  the  increase  in  the  memr 
bers  of  each  college  faculty  good  reasons  are  given. 
The  contemplation  is  to  give  four  lectures  per  day  to 
each  class  throughout  the  whole  collie  term  of  six 
months.  We  cannot  see  how  this  can  be  objected  to  by 
any  faculty.  The  necessary  increase  of  their  members 
will  so  divide  the  labor  as  that  each  one  can  perform 
his  duty  to  himself  and  to  the  students.  To  t)ie  sup- 
posed decrease  in  the  income  of  each  professor  by  the 
adoption  of  this  course  the  committee  have  offered  a 
satisfactory  and  conclusive  answer.  The  increase  in  the 
faculty  they  assert  is  amply  compensated  for  pecuni- 
arily by  the  requirement  that  each  student  shall  pay 
full  fees  for  three  courses  of  lectures  instead  of  two. 
With  this  the  teachers  can  find  no  fault,  and  the  student 
will  not  be  liable  to  demur,  especially  when  no  c^ioice 
is  left  him  in  order  that  he  may  be  sure  of  his  diploma 
in  the  end.  The  increased  expense  for  the  whole  term 
will  not  be  felt  any  more  for  the  third  year  than  for  the 
two  previous  ones,  while  in  the  «id  the  increased  outlay 
on  his  part  brings  him  a  richer  premium  in  the  allow- 
ance of  extra  time  to  benefit  by  the  instruction  which 
he  receives. 

The  section  referring  to  the  branches  to  be  taught 
during  each  term  vras  simply  {or  the  purpose  of  naming 
a  definite  course  to  be  pursued  by  each  o^ge,  so  that 
sudi  a  uniformity  in  the  general  sjrstem  might  be  ob- 
tained as  would  allow  students  of  different  classes  to 
transfer  themselves  to  different  coUeges  without  occa- 
sioning confusion. 

In  order  to  obviate  embarrasBment  in  making  the 
change  from  the  present  system  of  college  instruction 
to  the  one  proposed,  the  ocMsimittee  prudenUy  soggest 
^'  that  all  students  who  have  so  nearly  completed  their 
period  of  study  at  the  time  fixed  for  making  the  change 
that  an  attendance  on  an  additional  course  would  ren- 
^igitized  by ^ ^_ 


470 


THE  MEDICAL  RECORI>. 


der  them  etigible  to  graduation,  shoald  be  allowed  to 
complete  their  course  by  attending  the^Senior  depart- 
ment undef  the  new  arrangement ;  while  all  who  are 
in  the  first  half  of  their  period  of  study  should  be  sub- 
ject to  the  new  arrangement  in  full."  This  proposition 
is  an  eminently  proper  and  practical  one,  and  sRould  ef- 
fectually do  away  with  the  principal  obstacle  to  the 
speedy  carrying  out  of  the  new  plan. 

The  time  set  for  the  inauguration  of  these  changes 
is  during  the  winter  term  of  1868-9,  and  it  strikes  us 
that  there  is  ample  opportunity  offered  to  all  the  col- 
leges to  discuss  the  matter  by  answers  to  the  following 
questions  by  the  committee: 

1st  Do  your  faculty,  together  with  the  governing  au- 
thority of  your  College,  approve  of  the  several  propo- 
sitions as  a  whole  ? 

2d.  If  you  do  not  approve  of  the  plan  of  revision  as 
a  whole,  what  changes  would  you  suggest? 

3d.  If  you  approve  of  the  plan  as  a  whole,  or  of  all 
its  essential  features,  will  your  College  be  ready  to 
adopt  it  practically,  and  issue  your  Annual  Announce- 
ment for  the  College  term  of  1868-9,  in  accordance 
therewith ;  provided  all  the  principal  Medical  Colleges 
in  this  country  (or  at  least  those  in  the  cities  of  Boston, 
New  York,  Philadelphia,  Baltimore,  Richmond,  Charles- 
ton, New  Orleans,  Louisville,  Cincinnati,  St.  Louis, 
Chicago,  Buffalo,  and  Albany)  will  agree  to  do  the 
same  at  the  same  time  ? 

These  answers  are  to  be  addressed  to  the  Chairman, 
Dr.  N.  S.  Davis,  of  Chicago.  We  hope  that  every 
respectable  Medical  College  in  the  land  will  consider 
it  a  bounden  duty  to  give  the  subjects  referred  to  the 
fullest  consideration,  and  be  prepared  when  the  time 
comes  to  agree,  if  not  entirely  upon  the  plan  as  set  forth, 
at  least  sufficiently  so  to  Insure  that  uniformity  of  action 
which  shall  crowd  out  every  element  but  honorable 
competition  and  an  earnest  desire  to  raise  the  standard 
of  Medical  Education. 

There  is  no  reason  why  a  response  should  not  be  re- 
ceived from  every  College  by  the  committee  before  the 
first  of  March  next,  when  opportunities  would  be  given 
to  call  another  Convention  of  Medical  Teachers,  and 
have  a  report  presented  to  them  in  due  form. 


What  general  practitioner  returning  from  an  obstetric 
call,  after  having  spent  with  his  patient  many  weary 
hours,  has  not  felt  that  it  would  have  been  an  incalcu- 
lable relief  to  him  to  have  shifted  the  case  upon  some 
other  one  ?  There  is  no  department  in  medicine  where 
so  much  time  is  spent  which  is  so  little  recompensed 
as  in  obstetrics;  and,  in  view  of  that  fact,  the  phy- 
sician has  often  rightly  wished  for  some  substitute  who 
might  be  competent  to  care  for  all  his  ordinary  cases. 

The  persons  to  whom  we  naturally  look  for  a  per- 
formance of  this  part  of  the  practitioner's  duties  are 
•operly  educated  midwives.    It  is  well  known  that 
plan  of  confiding  obstetric  cases,  when  of  simple 


character,  entirely  to  such  females  has  been  for  a  long 
time,  and  still  is,  in  successfiil  operation  in  Europe ;  in 
fact,  many  of  our  German  and  French  brethren  who 
are  practising  in  this  country  are  in  the  habit  of  entrust- 
ing all  their  cases  to  them  with  the  most  satisfactory 
results.  The  midwives  referred  to  are  in  general  ex- 
ceedingly trustworthy,  and  being  educated  to  send  for 
the  physician  whenever  any  other  part  than  the  head 
of  the  child  presents,  they  are  not  Hkely,  unless  design- 
edly, through  presumption  of  knowledge,  to  blunder 
by  incompetent  interference. 

We  are  confident  that  such  a  system  might  be  in- 
augurated in  this  country,  and  we  are  equally  sure  that 
if  it  were,  the  profession  generally  would  give  it  their 
hearty  support.  A  good  plan  would  be  to  form  a  cor- 
poration in  connection  with  some  hospital,  whidi 
should  be  legally  qualified  to  give  the  suitable  instruc- 
tion to  well  reconmiended  applicants,  as  the  necessities 
of  the  case  require,  and  also  to  issue  licenses  whidi 
would  be  held  in  the  light  of  diplomas  for  practice  in 
this  particular  department  and  at  a  particular  time; 
beyond  that  it  is  not  necessary  that  we  should  go.  If 
a  well  organized  corps  of  obstetric  lecturers  were  es- 
tablished, and  regular  lectures  upon  the  duties  of  at- 
tendants upon  natural  labor  delivered,  it  would  be  cal- 
culated to  turn  the  tide  of  female  medical  education  ints 
a  more  natural,  useful,  legitimate,  and  profitable  chan- 
nel. 

We  are  pleased  to  learn  that  the  fi-iends  of  Dt,  W. 
Marsden  of  Quebec,  the  well  known  sanitarian,  con- 
template presenting  him  with  a  handsome  testimonial 
in  order  to  show- their  appreciation  of  his  energy  and 
ability  in  connection  with  the  establishment  and  im- 
provement of  quarantine  regulations.  Such  a  mark  of 
favor,  which  could  not  be  more  worthily  bestowed, 
points  with  significance  to  the  probability  of  the  iq)- 
pointment  of  the  distinguished  gentleman  as  chief  of 
the  Sanitary  Bureau  of  the  Federal  Kingdom. 

In  obedience  to  an  implied  promise  to  further  discuss 
the  matter  of  recipes  duplicated  without  proper  author* 
ity,  we  now  deem  it  expedient  to  recpr  to  the  subject. 

We  have  already  expressed  our  views  upon  the 
moral  aspects  of  the  question — and  here  we  use  the 
adjective  in  its  broadest  sense — and,  at  the  same  time, 
without  any  attempt  to  forestall  the  judgment  of  the 
profession,  we  more  than  intimated  that  the  prescrip- 
tion belonged  to  the  physician  in  fee  simple.  Since 
then,  through  the  kindness  of  Dr.  0*Sullivan,  who  has 
been  prominently  identified  with  the  movement,  we 
are  enabled  to  lay  before  our  readers  what  is  technicaDy 
known  as  a  "  legal  opinion." 

First, — The  prescription  is  a  direction  from  the  phy- 
sician to  some  druggist  to  put  up  for  and  prepare  lor  a 
patient*H  use,  a  certain  medicine.  When  the  druggist 
performs  this  act  and  files  away  the  prescripUon,  bebja 
no  right  to  again  put  up  or  prepare  medicine  from  thAi 
prescription,  unless  he  docs  so  h^  the  order  of  tbe 
Digitized  by  VjjOOQIC 


THE  MEDICAL  RECORD; 


411 


pLydoian  who  originally  gave  it.  He  has  no  more 
ri^ht  to  do  so  than  a  merchant  would  have  to  deliver 
on  a  written  order  for  one  barrel  of  flour  sundry  bar- 
rels, after  the  one  oalled  for  was  delivered. 

A.  more  important  feature  is,  however,  involved  in 
the  matter  of  phvsidans*  prescriptions  being  duplicated 
by  a  druggist^  without  the  physician's  authority  or  in- 
struction, which  is  that  the  medicine  so  duplicated  may 
be  entirely  unsuited  to  the  patient's  changed  condition 
of  health,  which  the  druggist  has  no  opportunity  of 
knowing.  No  one  is  capable  of  judging  in  such  matter 
but  the  attending  physician.  The  druggist  that  dupli- 
cates a  physician's  prescriptions,  without  the  physician's 
orders,  commits  a  crime  against  society,  inasmuch  as  he 
permits  medicine  to  leave  his  store  which  may  cause 
the  death  of  the  person  to  whom  it  is  administered. 

Second. — ^Medical  societies  have  a  right  to  prescribe 
and  establish  a  rule  for  the  government  of  druggists  in 
such  matters,  which  no  doubt  druggists  would  carefully 
observe.  This  would  save  the  medical  profession  from 
many  charges  of  mal-practice,  and  many  persons  from 
the  injuries  resulting  from  the  continued  use  of  a  medi- 
cine not  advised  or  prescribed  by  a  physician. 

Vitoittos  onlr  Uotkts  of  f^ooks. 

Clixical  Lectdres  o»  the  Principles  and  Practice  of 
MiBDiciNB.  By  John  Hughes  Bennett,  M.D.,  F.R.S.E., 
Profeaaor  of  the  Institutes  of  Medicine,  and  Senior  Pro- 
fessor of  Clioical  Medicine  in  the  University  of  Edinburgh, 
etc,  etc.  Fifth  American  from  the  Fourth  London  Edition. 
With  five  hundred  and  thirty-seven  illustrations  on  wood. 

'•  New  York:  William  Wood  &  Co.,  61  Walker  street 
pp.  1022. 

W«  remember  what  a  treat  we  enjoyed  as  a  student 
when  we  took  up  Watson's  Praclice  of  Physic,  and 
read  it  through  in  course.  It  was  an  oasis  in  the  desert 
of  slipshod  and  dry  medical  literature,  which  invigorated 
the  young  traveller  along  the  pathway  of  medical 
knowled^  for  many  a  waste  beyond.  Here  is  another 
book  which  must  give  to  the  student  the  same  relief 
that  did  the  classic  work  of  Sir  Thomas  Watson.  It 
has  been  ac^udged  superfluous  to  speak  for  books  that 
pass  through  such  numerous  editions  as  the  one  before 
us— they  speak  for  themselves.  Yet.  when  an  author  so 
eminent  as  John  Hughes  Bennett  takes  the  pains  which 
have  been  here  taken  to  keep  his  works  abreast  with  the 
most  advanced  state  of  medical  knowledge,  it  demands 
more  than  a  passing  recognition.  The  sections  have 
nearly  all  been  retouched,  and  the  peculiar,  and,  we  be- 
lieve,  very  generally  accepted  views  of  the  author  have 
received  new  explanation  and  veriQcation.  Dr.  Ben- 
nett's mode  of  conducting  a  clinical  course  must  cer- 
tainly commend  itself,  as  it  has  already  to  the  students 
of  the  former  editions,  to  those  who  study  the  present 
one.  The  only  wonder  is  that  in  the  United  States, 
where  we  have  such  advantages  for  clinical  instruction, 
'we  do  not  make  better  use  of  them.  Too  many  of  our 
colleges  are  pleased  when  the  physician  or  surgeon 
in  charge  makes  a  great  impression  on  the  wondering 
stadent)  but  fails  to  give  him  any  instruction.  This  is 
the  fault  of  our  system^  and  not  of  our  teachers. 

Students  in  our  hospitals  should  hear  and  see  more  for 
themselves,  and  be  questioned  by  the  clinical  lecturers. 
Any  one  who  has  seen  the  method  of  clinical  instruc- 
tion as  it  obtains  in  the  wards  of  Oppolzer  and  Skoda, 
in  Vienna,  must  draw  painful  comparisons  when  he 
risita  those. of  our  eminent  teachers;  but,  let  it  be  re- 
membered, the  comparison  is  not  between  the  teachers, 
bat  the  methods^  for  our  instructors  are  certainly  as  able 


and  interesting  as  those  abroad.  Private  instruction  in 
New  York  is  doing  the  work  that  ought  to  be  done  in 
the  chnical  wards  before  the  whole  class  or  sectiona 
of  it. 

In  the  part  of  the  work  on  the  examination  of  the 
patient,  the  physician  will  fin^  an  account  of  the  use  of 
the  laryngoscope,  illustrated  by  wood  engravings,  which 
make  every  special  book  on  this  subject  merely  a  lux- 
ury ;  and  so  with  the  microscope.  Velpeau's  note  in 
the  second  section,  showing  by  statistics  that  morbid 
growths  may  be  removed  and  allow  the  patient  immu- 
nity for  years,  is  valuable  as  giving  a  fixed  standing- 
point  where  so  much  is  mere  quicksands  of  conjecture. 
Dr.  Bennett  concludes  from  the  facts  he  presents, 
^^  that  the  possibility  of  permanently  eradicating  cancer 
may  now  be  considered  to  have  been  incontestably 
demonstrated.'' 

The  theory  of  change  of  type  receives  new  attacks 
from  our  author,  and  his  views  are  sustained  with  in- 
terest and  vigor.  He  regards  it  as  "  altogether  falla- 
cious, and  entirely  opposed  to  all  the  data  which  his- 
tology, physiology,  and  pathology  have  accumulated  in 
modern  times."  The  "  inquiry  into  our  present  means 
of  treatment,**  on  page  320,  subdivided  into  the  three 
heads  of  Dietetics,  Hygienica.  and  Materia  Medica,  will 
be  found  a  very  scientific  and  sensible  discussion  of  the 
means  at  our  hands  in  combating  disease.  The  second 
part  of  the  subject  is,  perhaps,  the  one  in  which  even 
our  wisest  practitioners  must  often  fail  In  the  case  of 
office  consultations  especially,  the  inquiries  are  not  mi- 
nute enough  as  to  the  mode  of  life— eating,  exercise, 
sleeping,  hours  of  the  patients,  etc 

We  are  tempted  to  linger  over  our  notice  of  this  book, 
already  so  well  known,  from  the  mere  gratification  of 
pointing  out  some  of  its  excellences.  The  student  or 
medical  man  who  has  not  already  profited  by  its  com- 
plete and  interesting  presentation  of  dinical  medicine, 
which  is  in  fS&ct  the  whole  of  medicine,  will  find  in  the 
letter-press,  as  well  as  the  numerous  ana  beautiful  wood- 
cuts of  this  work,  a  guide  with  almost  the  fulness  of  a 
cyclopaedia,  without  any  of  its  dryness.  Even  the 
^'  Ethics  of  Medicine  '*  receive  the  consideration  of  our 
author,  and  an  eloouent  page  is  devoted  to  "  the  sense 
of  duty  and  moral  obligation  "  with  which  a  medical 
man  should  be  imbued. 

We  have  thus  spoken  of  this  book,  as  if  it  were  a  new 
and  unknown  one,  but  this  is  somewhat  necessary  when 
we  consider  the  new  recruits  which  our  ranks  are  con- 
stantly receiving,  and  who  need  advice  in  the  mass  of 
medical  literature  presented  to  their  bewildered  choice. 

The  American  publishers  have  brought  out  the  work 
in  an  excellent  manner. 

Inhalation  :  Its  Thebapkutios  and  Praotiok.  By  J.  So  lis 
Cohen,  M.D.  8vo^  pp.  806.  Philadelphia:  Lindsay  &> 
BlakistOD,  186t. 
Whbn  a  certain  divine  was  asked  why  it  was  that  he 
allowed  the  choir  to  sing  such  lively  airs  in  his  church, 
he  replied,  *^  The  devU  hashadihe  best  tunes  long  enough; 
it  is  time  now  that  the  Lord  should  have  his  share." 

The  last  decade  has  witnessed  a  vigorous  and  organ- 
ized determination  on  the  part  of  scientific  men  to 
wrest  the  employment  of  a  number  of  usefiil  therapeu- 
tical agents  from  the  hands  of  ignorant  and  unscrupu- 
lous outsiders,  and  to  consecrate  them  to  the  service  of 
truth  and  humanity.  The  feeling  is  every  year  growing 
stronger,  both  in  Europe  and  America^  that  the  quacks 
have  had  some  of  our  best  remedies  long  enough,  and 
that  it  is  time  that  science  should  have  her  share.  It  is 
to  the  influenoe  of  this  spirit  among  the  more  advanced 
men  in  the  profession  that  we  owe  the  valuable  contri- 
butions that  have  recently  been  made  to  the  Tery 


472 


THE  MEDICAL  RECORD. 


ImportaDtcpeouJ  departmenta,  of  gynecology,  the  vene- 
real, ophthalmoloj^,  aural  surgery,  the  moTement  core, 
•lectro-therapeutics,  and  the  system  of  treatment  by 
inhalationa 

This  work  of  Dr.  Cohen  is  one  of  the  many  protests 
that  have  recently  been  issued  against  the  sinnd  neglect 
•f  therapeutics,  that  has  been  bo  fashionable  among  our 
leaders  m  science.  It  is,  at  least,  an  attempt  to  find 
out  *'  a  more  excellent  way  "  of  treating  a  variety  of 
affections  that  have  hitherto  been  regarded  as  obstinate 
or  incurable.  Although  the  work  is  mainly  a  collection 
of  observations  gathered  from  a  variety  of  sources,  and 
although  the  conclusions  arrived  at,  on  many  points, 
are  very  indefinite  or  unsatisfactory ;  yet  ic  will  be,  on 
the  whole,  of  great  aervioe  to  every  student  of  thera- 
peutics, and  must  be  regarded  as  the  most  valuable 
contribution  that  has  yet  been  made  on  the  subject  of 
inhalations. 

To  the  observations  of  other  practitioners,  in  Europe 
ftnd  America,  Dr.  Ooben  has  added  the  results  of  ms 
own  experience ;  and  although  his  bias  in  favor  of 
inhalation  is  decidedlj  stronger  than  our  own,  he  has 
yet  presented  the  subject  with  scientific  faime88,and  we 
shall  await  with  interest  the  result  of  bis  future  studies. 

The  plan  of  the  work  is  as  follows :  Part  I.  Inhala- 
tion of  nebulized  fluids.  Part  II.  Inhalation  of  medicated 
airs,  gases,  and  vapors.  Part  IH  Inhalation  of  powders. 

The  following  facts  seem  to  be  established : 

1.  That  nebulized  fluids,  and  also  powders,  penetrate 
into  the  respiratory  passagea 

2.  That  for  quite  a  wide  range  of  diseases  of  the 
respiratory  passages,  inhalations  are  often  of  very 
appreciable  service  as  adjuvants. ' 

3.  That  considerable  further  experience  is  necessary 
to  settle  many  doubtful  questions,  both  in  regard  to  the 
utility  and  the  method  of  employment  of  inhalations. 

The  record  of  the  experiments  made  with  the  inhala- 
tion of  oxygen  is  of  especial  interest  and  very  suggest- 
ive. The  plan  and  arrangement  of  the  work  are  excellent 
and  jclear,  but  in  his  stvle  of  composition  the  author 
sometimes  lays  himself  open  to  criticism.  Science 
should  always  be  presented  in  short  sentences.  In- 
volved, tortuous,  and  unbdanced  paragraphs,  especially 
in  the  summing  up  of  conclusions,  are  ver^  apt  to  mis- 
lead and  dishearten.  A  few  short,  decisive  sentences 
will  not  only  be  more  readily  understood,  but  wiU  also 
be  much  longer  remembered. 

In  the  pursuit  of  his  special  department  of  Laryngo- 
logy, the  author  will  have  abundant  opportunity  to  make 
fbrther  experiments  with  inhalations,  that  will,  we  doubt 
not  be  of^  great  value  to  science. 

Our  limits  will  not  permit  us  to  describe  the  work  in 
greater  detail,  and  we  can  only  recommend  it  to  all  who 
are  desirous  of  experimenting  with  this  very  pleasing 
branch  of  therapeutics^ 

iKJums  OF  Ets,  Obbit  and  Eteuds;  thsib  Iioisdiatb 
AND  Rbmotb  BFfKCTa  Bv  Geo.  Lawson,  F.R.C.S^  Eng. 
Assistant  Surgeon  to  the  Royal  Loudon  Ophthalmic  Hos- 
pital; late  Assist  Surgeon  of  Rifle  Brigade.  London: 
Longmans,  Green  &  Co.    1867 ;  12mo,  pp.  430. 

Wb  have  received  from  the  author  the  original  edition 
of  this  highly  practical  work.  In  a  preceding  number 
W8  took  occasion  to  commend  it  to  the  attention  of 
every  practical  surgeon,  and  now  weme  the  present  fa- 
Torable  opportunity  afibrded  us,  while  acknowledging 
the  receipt  of  the  London  edition,  to  reiterate  thia  good 
<^inion,  and  at  the  same  time  to  refer  to  the  very 
superior  stjle  in  which  it  is  issued  by  the  publishers. 
Our  Amencan  reprints  are  nominally  cheaper,  but  our 
^glidi  oousint  are  still  our  masters  in  the  typographic 
\  artw 


H^porte  0f  00ctctie». 


NEW  YORK  ACADEMY   OP  MEDICINE- 

Statid  MxBTfiio,  Nov.  20, 1867, 
Dr.  Henrt  D.  Bulklet,  Tice-President,  in  the  Chair. 

RESULTS  or  DR.  QUIMBT'S  MEmOD  OF  TREATDIO  CLIJB- 

PEvr. 

Dr.  Quiicbt,  of  Jersey  City,  by  courtesy  of  the 
Academy,  exhibited  two  patients  who  had  been  sub- 
jected to  his  mode  of  treatment  for  club-feet  by  adhe- 
sive straps  (see  Medical  Record,  Vd.  L  p.  554JL  One 
of  the  little  girls  employed  her  feet  without  any  embar- 
rassment; while  in  the  case  of  the  youngest,  still  an 
infant  in  arms,  he  contrasted  tbe  difference  between  ao 
original  cast  and  the  present  condition. 

treatment  or  dislooated  clavicle  bt  same  method. 

The  doctor  also  exhibited  a  patient  in  whom  a  dislo- 
cated clavicle  at  the  acromial  end  was  confined  in 
position  by  a*  similar  use  of  the  adhesive  strap,  along 
with  compresses  at  the  salient  |)oints  of  the  injured 
shoulder.  The  adhesive  band  passing  around  the  dioul- 
der  and  elbow,  admirably  answered  the  purpose  of  im- 
mobilitv. 

Dr.  Finnell  adverted  to  the  rarity  of  this  disloca- 
tion. 

Dr.  Quimby  claimed  that  there  could  be  no  question 
as  to  his  diagnosis,  which  had  been  verified  by  Profl 
Post  He  stated  that  the  patient  had  sustained  the  in- 
jury as  a  result  of  direct  violence  applied  to  the  shoul- 
der by  a  fall  from  a  horse.  He  wm  prepared  to  cite 
another  instance  of  the  sape  injury  which  had  been 
received  by  a  person  engaged  in  house-moving.  The 
lesion,  he  thought,  was  quite  easy  of  detection  by  reaaon 
of  the  prominence  of  the  points  in  question. 

Dr.  G-arrish  thought  that  in  the  case  of  club-feet,  the 
application  of  tbe  adhesive  strap  might  be  made  tniiii*- 
diatdy  afUr  hirth^  and  related  a  case  in  his  own  experi- 
ence, where  he  successfuUv  carried  out  this  plan.  F6r 
his  own  part)  he  could  see  but  few  contra-indications  to 
a  general  adoption  of  this  as  a  rule ;  he  had  also  failed 
to  find  any  very  serious  objections  to  the  uae  of  Scai^ 
pa's  shoe. 

Dr.  Quimbt  said  that  in  tbe  case  of  weak,  scrofoloos 
children,  in  whom  the  tendo-achillis  had  been  divided 
at  the  usual  time,  and  that,  too,  by  experts,  the  condi- 
tion known  as  ''  weak  ankle  "  was  not  infrequent. 

DEATH  or  PROr.  HOOKER. 

Dr.  Chamberlain  read  a  communication  fi-om  Dr. 
John  O.  Adams,  announcing  the  death  of  Prof.  Worth- 
ington  Hooker,  of  Tale  College,  which  occurred  from 
typhoid  fever,  November  6.  The  usual  condolatory 
resolutions  were  then  passed. 

After  an  informal  debate  upon  a  question  of  roedicd 
ethics,  which  was  ruled  out  oi  order,  the  Academy  ad- 
journed. 

Stated  Meeting,  December  4,  1867. 
Dr.  AxrRED  C.  Post,  Prestoeiit,  in  the  Chan*. 

THE  QUESTION  Or  BLOOD-LETTINa 

Dr.  Post,  by  previous  arrangement,  opened  the  £•- 
cussion  upon  the  subject  of  blood-letting.  After  alhid- 
ing  to  the  antiquity  of  the  practice — ^it  having  been  m 
vogue  among  the  Egyptians,  Assyrians^  and  other  di- 
tions,  and  resorted  to  by  Polydorus  soon  after  tbe  naf*  ^ 


THE  MEDICAL  RECORD. 


iff 


•f  Troy,  not  to  mention  the  endorsement  of  Hippocrates, 
•r  ita  rank  as  a  remedial  agent  all  through  the  period  of 
Roman  civilization — he  remarked  euhstantially  as  fol- 
k>W8 :  Notwithstanding  its  loss  of  reputation,  partly 
eaused  by  an  abuse  of  its  power,  he  contended  that 
reneaection  was  a  remedy  of  real  value,  and  in  many 
cases  was  indispensable — in  other  words,  that  it  short- 
ened the  progress  of  disease,  and  increased  the  prospect 
of  cure. 

Itfi  effect  upon  the  circulation  was  well  marked,  as 
evidenced  by  a  decrease  in  the  frequency  of  the  pulse, 
a  lowering  of  the  animal  heat,  and  a  diminution  in  the 
volunte  of  the  artery.  To  use  a  conventional  phrase, 
"  the  pulse  rises,"  it  becomes  fuller,  and  the  patient 
very  often  experiences  relief  at  once.  The  effect  of 
opening  a  vein  is  beautifully  illustrated  in  peritoneal  in- 
flammation, for  here  the  pulse  being  '^  skmU,"  an  in- 
crease in  force  is  more  readily  detected. 

The  doctor  t  ouc^ht  that  in  acute  inflammations  and  in 
active  determinations  of  blood  to  important  or^ns,  the 
blood-letting  plan  of  treatment  was  of  substantial  value. 
It  relieved  local  pain.  Among  the  other  effects  he  al- 
luded to  free  and  copious  perspiration,  a  tendency  to 
syncope,  nausea,  emesis,  and  sometimes  convulsions. 

It  might  be  judiciously  employed  from  infancy  to  old 
age,  although  in  the  first  mentioned  stage  of  life  its  ap- 
plication, perhaps  for  no  very  cogent  reasons,  was  limit- 
ed to  the  use  ot  leeches.  In  advanced  age  great  caution 
is  required,  but  for  the  benefit  of  the  over-timid  he 
cited  two  recorded  cases — one  that  of  a  man  aged 
eighty-seven  bled  twice  in  one  day,  and  another  aged 
^^fiT^^Ji  bl^d  nine  times  for  pneumonia — these  in  proof 
that  even  under  this  adverse  condition  it  was  not  so 
destructive  to  life  after  all.  The  case  of  the  late  Dr. 
Cheesman  fwho  died  in  -1862,  aged  seventy-five  years, 
Ed.],  as  related  by  Dr.  Alonzo  Clark,  was  also  to  be 
remembered  in  this  connection,  since  he  was  evidently 
benefited  by  a  copious  bleeding. 

Dr.  Post,  to  fortify  his  position,  then  related  the 
following  cases,  given  in  brief  as  below : 

Case  1. — A  gentleman,  rct.  40,  low  in  stature,  pleth- 
oric, with  a  short  neck  and  much  devoted  to  commer- 
cial pursuits,  during  the  extreme  heat  of  a  summer  sev- 
eral years  ago,  was  seized  with  coma,  convulsions,  etc. 
Wh3n  seen  professionally,  the  bloodvessels  of  his  face 
were  found  turgid  with  blood,  and  his  whole  condition 
naturally  suggested  venesection,  which  was  accordingly 
performed.  A  copious  bleeding  restored  him  to  con- 
pciouanes*,  and  probably  to  society.  He, afterward  had 
like  attacks,  the  second  one  during  the  extreme  cold  of 
the  next  winter,  which  were  subdued  by  the  same 
means ;  but  finally,  after  these  repeated  onsets  apparent- 
ly excited  by  extreme  ranges  of  temperature,  he  died 
of  apoplexy. 

Case  2. — A  young  clergyman,  in  the  course  of  a  plat- 
form speech,  reeled  and  fell.  Having  a  flushed  face, 
full  pulse,  and  great  confusion  of  mind,  he  was  bled, 
with  marked  and  complete  relief. 

Case  3. — A  woman,  eet.  40,  small  and  slender,  with 
a  pulse  of  inconsiderable  force  but  not  remarkably  com- 
pressible, being  seised  with  a  severe  cephalalgia*  refer- 
rible  to  the  frontal  region,  sent  for  him.  He  adminis- 
tered the  usual  remedies,  revulsives,  cold  afibsion  to 
head,  cathartics,  but  without  benefits  The  patient  then 
suggested  bleeding,  which  Dr.  P.  had  not  before  enter- 
tained, owing  ta  its  apparent  contra-indication.  Her 
solicitation  .was  backed  by  the  assurance  that  previous 
bleedings  m  similar  attacks  had  alwavs  afforded  relief. 
The  loss  of  something  over  a  pint  of  blood  from  the  arm 
verified  her  statement.  He  was  subsequently  called, 
say  three  or  four  times  at  long  intervals,  and  each  time 
the  patient  was  bled  with  the  same  result.    After  sev- 


eral years  also  he  was  summoned  at  night  to  her  bed- 
side— ehe  was  in  a  state  of  stupor,  had  a  wild  look,  was 
unable  to  speak,  but  significanUy  pointed  to  her  elbow. 
A  full  bleeding  brought  relief,  and  since  then  she  has 
enjoyed  comparative  immunity  from  attack. 

Case  4^ — A  little  over  a  score  of  years  ago,  befwe 
ur»mia  was  a  recogDized  disease,  he  (Dr.  P.)  was  called 
to  a  lady  with  full  habit  in  the  eighth  month  of  preg^ 
nancy;  she  had  a  vertigo^  which  merged  into  part  ml 
loss  of  consciousness;  her  pupils  were  dilated,  her  face 
flushed  and  somewhat  oedematous ;  in  fact,  he  was  now 
pretty  well  satisfied  that  she  was  ^^uramie.'*  But  be 
that  as  it  may,  a  bandage  applied  to  her  arm,  as  pre- 
liminary to  venesection,  caused  fainting;  still  he  felt^  ' 
that  notwithstanding  the  syncope,  this  was  the  course 
to  be  adopted.  Dr.  Delafield  as  consulting  physician 
strongly  endorsed  this  view,  and  as  a  result  of  their 
deliberation  the  patient  lost  one  quart  of  bloo^  with  re- 
nooval  of  symptoms.  The  patient  was  in  due  time  de- 
livered of  a  boy,  who  is  now  a  husband  and  father. 
Here  he  thought  that  the  Iwicet  might  be  credited  with 
two  lives. 

Cass  5. — A  lady,  set  31  or  32,  removing  from  the 
country  to  the  city,  in  the  last  month  of  her  pregnancy, 
with  no  attendant  engaged,  sent  for  him.  He  found 
her  with  anasarca,  countenance  pale,  waxy,  and  oede- 
matous. With  a  view  of  unloading  the  cellular 
tissue,  he  gave  a  hydragogue  cathartic,  and  finding  no 
symptoms  of  labor,  he  left.  On  the  next  day,  however, 
she  was  taken  in  travail ;  there  being  great  nudity  of 
the  OS  uteri  but  little  progress  was  made ;  besides,  she 
complained  of  a  persistent  pain  between  her  eyebrows. 
Fearing  ureemic  convulsions,  he  bled  her  freely,  when 
the  headache  ceased,  the  us  uteri  relaxed,  and  the  pa- 
tient, after  a  natural  labor,  made  a  complete  recovery. 

The  doctor  also  held  to  the  view  that  even  in  chronio 
affections  the  lancet  was  not  always  to  be  avoided. 

He  instanced  the  case  of  a  young  widow  once  un- 
der treatment  by  him  for  a  severe  pain  in  the  right 
hypochondriac  region,  along  with  an  intense  jaundice. 
Begarding  the  case  as  either  one  of  impacted  cidculus  or 
as  a  spasm  of  the  biliary  duct,  he  resorted  to  full  anes- 
thesia, with  temporary  benefit,  which  he  prolonged  by 
anodynes.  The  attacks  were  quite  firequent.  FinaUr 
she  passed  into  the  hands  of  the  late  Dr.  B'chard  i, 
Hoffman,  by  whom  she  was  bled  with  marked  benefit. 

Another  case  adduced  was  that  of  a  patient  in  the 
New  York  Hospital  who  was  suffering  from  a  somewhat 
intractable  iritis.  This  was  several  years  ago.  This 
patient,  when  first  seen  by  him,  had  lost  no  blood  during 
the  early  stage,  his  gums  had  been  touched,  he  com- 
plained of  pain  and  impaired  vision^  his  pupil  was  ir- 
regular, etc.,  etc.  Having  a  firm  resisting  pulse,  he  was 
bled  by  the  house  surgeon  under  his  (Dr.  P.*8)  direc- 
tion. The  inflammation  then  began  to  pass  away  very 
rapidly. 

Dr.  P.,  in  concluding  his  remarks,  cited  the  case  of 
strangulated  hernia  at  the  New  York  Hospital  upon 
which  he  had  called  the  usual  consultation  of  his  colleag- 
ues preliminary  to  an  operation.  In  the  interim,  how- 
ever, he  directed  the  hard,  tense,  and  tender  tumor  to  be 
covered  with  leeches,  when  spontaneous  reduction  took 
pUoe.  He  also  referred  to  the  benefits  of  the  local  ab- 
straction of  blood  by  leeches  in  the  case  of  acute  pneu- 
monia in  the  very  voung  suljoct,  and  ii^  pneumonia 
generally  when  no  depressing  influence  was  at  work. 
JSleeding  during  the  first  twelve  or  twenty^four  hours  of 
puerperal  peritonitis,  and  by  this  he  meant  the  spo- 
radic variety  occurring  in  nrivato  not  public  practice,  he 
also  regarded  as  beneGoial,  notwithstanding  the  sinall 
pulse  and  the  first  difficulty  to  get  a  flow  of  blood. 

Dr.  Axdsrson  referred  to  the  Ghang04A  professional 

Digitized  by  VjC  „       ^_ 


474 


THE  MEDICAL  RECORD. 


opinion  regarding  this  matter,  which  would  be  more 
obvious  by  contrasting  a  period  twenty-five  or  twenty- 
six  ^ears  ago  with  the  present  time.  He  remembered 
bavmgread  the  work  of  Dr.  Armstrong  on  fevers,  which 
very  strongly  impressed  him.  Venesection  in  this  treatise 
was  much  praised,  and  it  had  occurred  to  him  that  fol- 
lowing up  the  bleeding  with  anodynes  would  be  emi- 
nently philosophical.  While  of  this  way  of  thinking  a 
gentleman,  "  a  full  and  hearty  liver,"  sent  for  him.  The 
patient  had  great  respiratory  oppression,  but  no  pneu- 
monia— ^bleeding  at  once  relieved  him.  In  the  case  of 
Dr.  Cheesman  it  would  be  proper  to  note,  that  notwith- 
standing the  very  happy  result,  much  more  blood  was 
lo3t  than  was  originally  intended,  since  the  slipping  off 
of  the  bandage  allowed  the  bed  to  become  quite  well 
ensanguined  before  the  discovery  was  made. 

Dr.  Woodhull  reminded  the  Academy  of  the  case 
of  Dr.  Francis,  deceased,  who  was  bled  to  about  the 
amount  of  eighteen  ounces  for  the  relief  of  laryngitis. 

Dr.  Foster  also  reverted  to  the  lime  when  bleeding 
was  usual  He  was  quite  certain  that  he  had  cut  short 
the  progress  of  an  acute  pneumonia,  some  three,  four, 
or  five  days,  by  the  openmg  of  a  vein  and  a  reliance 
upon  diluent  drinks.  In  those  cases  where  bleeding  was 
omitted — for,  even  in  those  days,  all  did  not  bleed — he 
inclined  to  the  view  that  the  percentage  of  recovery 
was  less.  He  had  himself  lost  two  pounds  of  blood 
for  a  pleurisy,  and  with  immediate  relie£  The  doctor 
then  described  a  fever  of  congestive  character  which 
prevailed  in  1837,  in  a  country  village,  previous  to  his 
taking  up  his  residence  in  this  city.  In  these  cases, 
venesection  evidently  was  of  benefit. 

Dr.  G-arrish  thought  that  discrimination  in  the  use 
of  the  lancet  was  necessary — that  in  certain  cases  it 
was  absolutely  essential,  while  in  others  its  effect  could 
not  but  be  pernicious.  He  regarded  depletion  in  acute 
inflammation  of  the  eye  as  a  remedy  of  great  value. 

Dr.  Peter  Van  Burkn  remembered  having  himself 
been  bled  by  a  distinguished  physician  of  Albany,  now 
deceased,  twice  in  a  short  interval,  for  a  threatened  in- 
flammatory disturbance.  A  low  fever,  of  a  typhoid 
character,  proved  that  the  operation  was  uncalled  for. 

At  the  beginning  of  his  professional  career,  it  was 
thought  impossible  to  initiate  the  treatment  of  pleuritis 
without  a  resort  to  blood-letting.  In  such  cases,  the 
respiration  did  certainly  become  quite  free.  He  also 
alluded  to  the  benefit  accruing  from  venesection  in  two 
cases  of  puerperal  convulsions,  before  the  days  of  chlo- 
roform. 

Dr.  Worster  gave  in  his  testimony  regarding  the 
application  of  leeches  between  the  dioulder-blades — 
especially  in  the  case  of  young  children  suffering  from 
pneumonia  of  a  grave  type.  He  was  in  every  sense 
well  pleased  with  the  result 

Dr.  Satrb  was  cognizant  of  a  case  where  leeches 
were  applied  between  the  shoulders,  and  the  child  in 
consequence  died.  This  had  made  a  strong  impression 
on  him.  Oiled  silk  jackets,  poultices,  etc.,  he  regarded 
as  much  safer  and  more  serviceable. 

Cases  requiring  prompt  bleeding  he  regarded  as  quite 
rare.  He  did  not  wisli  to  be  understood  as  saying 
they  never  occurred,  since  he  had  himself  carried  a 
lancet  in  his  vest  pocKet  for  fifteen  years  and  had  used 
it  three  times. 

A  broad  distinction  existed  between  local  depletion 
and  ihe  abstraction  of  blood  from  the  general  circula- 
tion. The  effects  were  quite  different  For  his  own 
{>art,  he  could  not  see  why  girdling  the  arm  and  the 
eg  on  tht  opposite  side  for  ten  or  fifteen  minutes  at  a 
time,  and  then  alternate  with  the  opposite  limbs,  should 
not,  by  the  withdrawal  of  a  certain  amount  of  blood 
'W>m  the  general  circulation,  answer  the  object  of  the 


practitioner  much  better,  and  with  less  risk.  For,  in 
these  instances,  the  blood  is  not  lost^  but  temporarily 
withdrawn — its  mission  to  nourish  and  repair  has  only 
been  suspended. 

The  change  in  our  modes  of  treatment,  he  remarked, 
was  due,  not  to  popular  prejudice,  but  to  the  increased 
information  of  medical  men.  The  starvation  and  the 
lancet  phm  had  gone  out  of  date — all  were  beginning 
to  believe  more  in  good  food  and  good  air. 

Dr.  Woodhull  would  hesitate  to  bleed  except  in 
sudden  apoplexy.  Some  twenty-five  years  ago,  it  was 
quite  difficult  to  get  women  to  do  without  being  bled 
once  a  year.  He  had,  however,  converted  some  over 
to  his  views,  and  they  had  invariably  admitted  that 
their  health  had  improved  after  the  discontinuance  of 
the  practice. 

As  regarded  puerperal  eclampsia,  he  guarded  agwnst 
it  by  careful  watching  of  his  patients  previous  to 
their  accouchement.  A  few  fortnightly  visits  would 
often  save  much  vexation  and  anxiety. 

Dr.  W.  was  of  opinion  that  in  discussing  these  and 
kindred  subjects  we  did  not  keep  sufficiently  well  in 
view,  the  difference  between  patients  in  the  country 
and  those  in  the  city. 

Dr.  Richards,  after  a  few  remarks  by  Dr.  Van  Buren 
concerning  a  change  of  type  in  disease,  asked  whether 
it  might  not  be  a  change  of  opinion,  and  for  the  pur- 
pose of  giving  the  junior  members  of  the  Academy  an 
opportunity  of  expressing  their  views,  he  moved  that 
the  discussion  be  resumed  at  the  first  opportunity. 

Da  Grisoom,  in  seconding  the  motion,  remarked  that 
the  very  important  element  of  physical  and  chemical 
changes  as  aJBecting  the  character  and  condition  of  the 
bloo^  had  been  entirely  lost  sight  of  during  the  dis- 
cussion of  the  evening. 

The  motion  prevailed  and  the  Academy  adjourned. 


NEW  YORK  MEDICO-LEGAL  SOCIETY. 

Stated  Mketino,  Got.  22,  1867. 

Dr.  T.  C.  Fiknell,  President,  in  the  Chair. 

DUTIES  OF  A  MEDICAL  WITNESS  IN  CASES  OF  MAL-PRAOTICR. 

Dr.  James  J.  O'Dea,  in  continuation  of  the  discussion 
upon  the  above  subject^  offered  the  following  re- 
marks: 

He  recommended  in  the  first  place,  that  when  a  physi- 
cian is  asked  to  give  testimony  in  a  case  involving  the 
reputation  of  a  fellow  practitioner,  he  should  consider 
the  following  questions :  Does  my  education  (taking  the 
word  in  its  broadest  sense)  quaiijy  me  to  p<iS9  judgrment 
in  such  a  ease  f  Am  I  si^jficiently  unbiassed  to  be  Me  to 
give  a  fair ,  unprejudiced  testimony  f  Conceding  his  sat- 
isfaction as  to  his  qualifications  in  this  respect,  he  an- 
swers these  two  questions  in  the  affirmative*  he  might 
then  proceed  to  give  the  disputed  subject  nis  serious 
and  cardul  attention,  pursuing  the  following  order :  He 
should  examine  accurately  the  facts  upon  which  his 
opinion  is  to  be  based,  cautiously  abstiunm^  from  a  con- 
clusion until  every  relevant  point  is  investigated,  ques- 
tioned, and  found  reliable.  Now,  this  is  the  test  of  "  a 
competent  witness."  In  the  performance  of  this  duty, 
if  not  before,  the  value  of  the  preliminary  questions 
already  mentioned,  will  become  evident.  It  will  then 
appear  that  not  every  man  has  the  requisite  patience, 
judicial  quaUty*of  mind,  or  logical  training  in  weighine 
the  value  of  evidence,  in  separating  what  is  essential 
from  what  is  non-essential,  what  is  reliable  from  what 
is  unreliable. 

As  a  digression,  he  might  refer  te-the  fact  that  veiy 
digitized  by  LjOOV^_ 


THE  MEDICAL  RECORD. 


47& 


often  there  are  at  least  two  opposing  medical  witnesses 
in  trials  having  a  medico-legal  beariog,  and  sometimes 
each  so  identilies  himself  with  the  cause  of  the  side  on 
which  he  is  engaged,  that,  in  the  witness-stand,  the 
medical  evidence  is  contradictory  to  an  astonishing  de- 
gree. Why  is  this?  Some  explanation  is  not  difficult. 
Each  has  considered  his  own  side  of  the  question,  and 
that  only.  Neither  gets  possession  of  the  facts  com- 
mon to  both  sides.  Neither  starts  from  a  common 
ground.  They  have  either  never  consulted  together. 
or  the  consultation  has  been  held  in  that  formal  and 
ridiculous  manner  out  of  which  nothing  comes,  and 
which,  even  in  the  ceremonious  old  days  of  three-cor» 
nered  hats  and  powdered  wigs,  was  made  the  theme  of 
many  a  jest  by  caricaturists  and  satirists. 

But  to  return,  let  us  suppose  a  case  in  reference  to 
the  more  inmiediate  subject  in  hand.  Take  the  simplest. 
A  surgeon  is  sued  for  shortening  of  a  leg,  the  result 
of  fracture  of  the  thigh  bone.  What  is  the  duty  of  the 
medical  expert  in  approaching  such  a  question  ?  First, 
he  would  repeat,  he  should  decide  on  his  oum  compe- 
tency. After  that,  he  may  examine  the  history  of  the 
injury,  its  nature,  the  period  at  which  the  surgeon  was 
called  in,  the  ihode  of  treatment  adopted,  the  care  and 
conduct  of  the  surgeon  in  his  dealing  with  the  case,  and 
equally,  the  conduct  of  the  patient  during  treatment. 
He  will  take  his  measurements  of  the  limb,  comparing 
the  shortening  with  what  he  has  witnessed  in  his  own 
experience,  and  learned  from  that  of  others.  He  will 
do  all  this  that  he  may  be  able  to  give  an  intelligent  an- 
swer to  questions  such  as  the  following:  Was  the  limb 
properly  treated  ?  Was  the  conduct  of  the  surgeon  in 
relation  to  his  patient  such  as  to  lead  to  the  conviction 
that  he  used  all  necessary  and  usual  precautions  to  in- 
sure as  sound  a  limb  as  the  circumstances  permitted  ? 
He  did  not  say  these  are  the  questions  that  will  be 
asked  upon  the  stand,  he  did  but  think  they  contained 
about  the  pith  of  the  whole  matter. 

Now  let  us  place  our  medical  expert  in  the  witness- 
stand  and  ask  ourselves  what  are  his  duties  there. 
They  are  many,  including  those  to  science,  to  himself, 
and  to  the  physician  whose  reputation  is  on  trial.  In 
respect  to  science,  he  stands  in  the  relation  of  an  ad- 
vised and  independent  exponent  of  its  most  modem, 
most  advanced  ideas.  One  of  the  most  important  of 
hia  duties  is  to  be  independent  and  unbiassed.  No  mat- 
ter on  what  side  he  may  be  engaged,  he  should  strive, 
above  all  else,  never  to  be  a  partisan.  He  should  be 
calm  and  self-possessed.  Few  men  of  any  profession 
enter  a  witness-stand  without  a  degree  of  nervousness 
varying  according  to  individual  temperament.  Some 
can  easily  subdue  this,  others  partly,  and  again  others 
not  at  all  These  last  should  avoid  such  a  position.  A 
good  deal  that  is  wise  has  already  been  said  during  the 
progress  of  this  discussion  on  the  best  way  to  answer 
the  questions  of  counsel ;  so,  leaving  this  part  of  the  sub- 
jectw  he  will  conclude  by  offering  a  few  words  on  the 
duties  to  the  accused  practitioner.  He  should  have  the 
full  benefit  of  every  doubt.  The  medical  expert  should 
shield  him  and  defend  him  by  every  means  in  his  power 
consistent  with  truth  and  a  beneficent  justice.  It  is  a 
good  rule  to  adopt — and  so  far  as  he  had  considered  the 
matter,  it  admits  of  no  exception — ^never  to  pronounce 
an  opinion  adverse  to  the  treatment  of  a  case  unless  it 
displays  some  fault  which  can  only  be  attributed  to 
gross  and  culpable  neglect.  That  one  physician  should 
condemn  another  for  "an  error  of  judgment,"  is  so  pe- 
dantic, so  ultra-dogmatic,  as  to  seem  almost  incredible 
if  irequent  experience  did  not  teach  otherwise. 

After  Pome  ftirther  discussion  on  the  part  of  the  Soci- 
ety, and  a  hberal  interchange  of  individual  opinion,  the 
Society  adjourned. 


NEW  YORK  PATHOLOGICAL  SOCIETY. 

Stated  Meitino,  Nov.  13,  1867. 

Dr.  H.  B.  Sands,  President,  in  the  Chair. 

REMOVAL  OF  STONE  BY  DILATATION. 

Dr.  Hamilton  presented  the  bladder,  urethra,  with  the 
left  ureter  and  kidney  attached,  etc.,  taken  from  a  wom- 
aiLof  whose  case  he  presented  the  following  history : 

Harriet  James,  a  mulatto,  aged  thirty-nine  years, 
born  in  Virginia,  was  admitted  to  Charity  Hospital, 
Blackwell's  Island,  August  21,  1867,  suffering  with 
a  stone  in  the  bladder.  She  was  a  married  wom- 
an, and  had  borne  seven  children.  She  had  been 
blind  from  early  infancy.  During  the  last  four  years 
she  bAd  passea  several  calculi,  some  of  which  were  of 
the  site  of  an,  almond.  At  the  time  of  her  admission 
she  was  laboring  under  chronic  cystitis,  and  suffered 
great  pain,  accompanied  with  an  almost  constant  desire 
to  urinate.  The  stone  was  felt  with  the  sound,  press- 
ing snugly  against  the  neck  of  the  bladder.  It  could 
also  be  felt  distinctly  with  the  fingers  through  the  walls 
of  the  vagina. 

Sept.  6,  1867,  in  presence  of  a  number  of  medical 
gentlemen  and  students,  I  removed  the  stone  by  the 
method  of  dilatation.  Bapid  dilatation  was  made 
rather  than  slow  dilation,  as  has  usually  been  prac- 
tised and  recommended,  because  the  irritability  of  the 
bladder  and  urethra  was  such  that  they  would  not 
have  tolerated  the  presence  of  an  instrument  or  of  any 
foreign  substance  for  any  length  of  time. 

The  patient  having  been  placed  under  the  influence 
of  ether,  I  introduced  a  Weiss'  female  urethral  dilator, 
and  in  about  five  minutes  opened  the  blades  nearly  one 
inch.  I  then  closed  and  withdrew  the  dilator,  and 
introduced  successively  several  sizes  of  gold  and  hollow 
india-rubber  bougies.  The  last  had  a  diameter  of  just 
one  inch.  Withdrawing  this,  I  now  introduced  the  fore- 
finger of  my  right  hand  easily,  and  felt  the  stone.  With  - 
drawing  my  finger,  I  carried  in  a  medium-sized  lithot- 
omy forceps,  and  seized  the  stone ;  but  it  was  so  brit- 
tle that  it  crumbled  under  the  pressure  of  the  instru- 
ment, and  I  brought  out  only  a  portion.  I  removed  a 
few  other  firagments  with  the  forceps,  and  the  remain- 
der I  washed  out  with  warm  water,  thrown  in  with  a 
large  syringe.  With  my  finger  I  could  now  feel  the 
whole  interior  of  the  bladder,  and  I  found  that  no  par- 
ticles were  left. 

During  the  operation  a  few  drachms  of  blood  escaped 
from  the  lacerated  mucous  membrane  of  the  urethra. 
I  could  also  feel  the  urethra  contract  sensibly,  but  not 
suddenly  or  spasmodically,  upon  my  finger.  The  patient 
was  then  returned  to  bed. 

During  several  weeks  preceding  the  operation  she 
had  been  kept  constantly  under  the  influence  of  opiates, 
I  was  informed,  to  appease  her  suffering.  These  it  was 
found  necessary  to  continue,  as  the  pain  in  the  bladder 
had  not  much  subsided  after  the  removal  of  the  stone. 
It  was  remarked,  however,  that  she  retained  her  urine 
after  the  operation  as  well  as  she  had  done  before ;  that 
is,  she  was  able  to  hold  it  an  hour  or  more,  and  then 
the  desire  to  urinate  became  so  great  that  she  was  com- 
pelled to  rise  and  evacuate  the  bladder.  In  rising  no 
water  escaped  until  she  sat  upon  the  vessel,  nor  did 
any  urine  escape  involuntarily  in  bed,  until  a  few  days 
before  death.  Injections  of  morphine  and  of  nitrate  of 
silver  were  employed  to  allay  the  irritability  of  the 
bladder,  but  to  no  purpose. 

On  the  20th  of  September  a  diarrhoea  commenced, 
which  passed  soon  into  dysentery,  and  this  continued 
until  she  died.  Her  death  took  place  October  2,  1867, 
about  one  month  after  the  operation  was  made. 


476 


THE  MEDICAL  RECORD. 


Auiop$y, — ^The  ureters  and  the  pelves  of  tiie  kidneys 
were  greatly  dilated,  and  were  filled  with  pus  and 
urine.  The  walls  of  the  bladder  were  greatly  thickened, 
and  the  inner  surface  was  lined  with  masses  of  lymph, 
arranged  in  laminae,  with  portions  hanging  in  shreds. 
The  urethra  remained  dilated  sufficiently  to  admit  read- 
ily the  forefinger,  but  it  was  not  as  dilatable  as  at  the 
time  of  the  operation. 

Dr.  Hamilton,  in  connection  with  the  case,  remarked 
that  he  had  operated  for  lithotomy  fire  times  success- 
fully, but  that  this  was  the  only  one  in  which  dilata- 
tion had  been  employed.  He  was  of  course  unable  to 
draw  from  it  any  conclnsions  as  to  the  adnsability  of 
the  hitter  method.  He  was  not  sure  bat  that  she  held 
her  water  in  some  measure  because  of  the  swelling, 
but  he  was  confident  that  the  circular  fibres  were  not 
paralyzed ;  the  fact,  however,  that  it  was  still  dilatable 
after  death  did  not  rule  out  the  possibility  of  her  having 
incontinence  afterward,  in  case  she  had  lived.  The 
(act  that  the  chronic  cystitis  was  not  relieved  by  the 
operation  was  a  recommendation  for  an  incision  into 
the  viscns.  He  reminded  the  members  that  Dr.  Emmet 
had  recently  advocated  the  creation  of  a  vesico-vajnnal 
fistula,  in  cases  of  chronic  cystitis,  the  idea  being  to 
relieve  the  bladder  by  an  incision  mto  its  walls.  The 
subsequent  olosore  of  the  fistula  was  comparatively  a 
small  matter. 

In  answer  to  a  question  from  Dr.  Van  Buren,  he 
stated  that  there  was  no  particular  change  after  the 
operation,  save  a  slight  amelioration  of  the  bladder 
symptoms,  and  that  as  far  as  any  evidences  of  pyelitis 
were  concerned,  there  was  nothing  found. 

Dr.  Vak  Bubek  remarked  that  the  failure  of  the 
operation  to  relieve  the  inflammation  of  the  bladder 
suggested  to  his  mind  the  possibility  of  the  existence  of 
pyelitis,  and  purulent  urine  coming  down  from  the  kid- 
neys into  the  bladder,  thus  keeping  up  an  irritation 
independent  of  the  stone. 

Dr.  Sands  remarked  that  a  few  years  ago  he  re- 
moved a  stone  from  a  pregnant  woman.  She  had  symp- 
toms of  stone  for  several  months  only,  and  at  the  time 
he  was  consulted  she  was  suffering  from  symptoms  of 
very  severe  cystitis.  The  tenesmus  of  the  bladder  was 
almost  constant,  and  the  discharge  of  purulent  urine, 
loaded  with  phosphates,  was  very  profuse.  The  ques- 
tion came  up  as  to  the  expediency  of  performing  the 
operation  at  once,  when  it  was  decided  in  the  amrmi^ 
tive,  and  the  stone  was  removed  in  accordance  with  the 
suggestion  of  Dr.  Smmet  The  incision  was  made 
through  the  vagina^  and  the  calculus  extracted  with  very 
little  trouble.  The  stone  was  a  little  over  an  inc^  in  its 
longest  diameter.  He  was  satisfied  that^  at  the  time  of 
the  operation,  the  coats  of  the  bladder  were  somewhat 
altered.  The  vesico-vaginal  fistula  was  immediately 
afterward  closed  by  six  silver  sutures,  which  were  re- 
moved on  the  eighth  day.  The  cystitis  was  arrested  at 
once,  and  all  vesical  tenesmus  ceased.  She  was  ailer- 
ward  oonfined,  in  due  time,  and  everything  went  on 
well 

Dr.  Jaoobi  a^ced  Dr.  Hamilton  if  the  membrane  lining 
the  bladder,  in  his  case,  was  of  recent  origin. 

Db.  Hamiltoh  believed  that  it  was  both  recent  and 
oR 

Dr.  Jaook  remarked  tiiat^  if  it  could  be  settled  that  it 
was  of  recent  date,  it  might  be  assumed  tiiat  tiie  deposit 
was  tiiie  result  of  a  diphtheritic  exudation,  which  might 
have  had  a  significant  relation  to  the  dysentery  from 
which  the  patient  suffered. 


TaioHiHiAais.— Two  deaths  from  Trichiniasis 
been  reported  in  St  Louis. 


have 


Corre«ponl>tttce. 


MEDICAL  MATTERS  IN  PARIS. 

(from  our  own  correspondent.) 

To  TUB  Editoa  or  THX  Mboioal  Beookd. 

Sir — To-day  celebrates  the  closure  of  the  Exposition ; 
to-morrow  will  witness  the  reopening  of  the  Ecole  de 
M^ecine,  and  the  beginning  of  the  long  medical  year. 

In  Paris,  the  ceremonies  of  the  year  are  reserved  for 
its  close  as  in  Italy,  while  in  England,  as  in  Spain  and 
Portugal,  whatever  solemnities  are  deemed  ntting  to 
dignify  the  old  critical  days  of  the  scholastic  season  are 
observed  at  the  moment  of  its  recommencement. 
L'  Union  MidicdU,  of  Pars,  in  reviewing  the  celebra- 
tions held  at  the  different  schools,  greatly  commends 
the  simplicity  of  the  English,  who  qoietly  assemble  at 
the  numerous  "  head-oentres "  of  instruction,  listen  to 
a  regulation  address,  and  immediately  set  to  work  at 
their  studies ;  whereas^  in  Madrid  and  Lisbon  the  a£Ekir 
is  made  a  state  occasion^  honored  by  tiie  presence  of 
the  king  and  highest  public  functionaries.  It  is  pomp 
vtrsui  utility,  says  Dr.  Simplice,  and  the  contrast  is 
manifest  even  in  the  themes  chosen  by  the  professors 
Tor  the  address.  That  of  Mr.  Qraily  Hewitt,  for  ex- 
ample, at  the  University  College  in  London,  was  en- 
titled, "The  Therapeutic  UUlity  of  Alimentation," 
while  the  discourse  of  Professor  Alonzo  at  Madrid  was 
devoted  to  an  elaborate  exposition  of  "  The  Benefits  of 
Instruction." 

In  Italy,  the  illustrious  Professor  Tommasi  cele- 
brated the  close  of  the  year  of  official  instruction  by  a 
retrospective  review  of  the  most  important  clinical  facts 
that  have  presented  themselves  to  his  observation  since 
its  commencement.  M.  Tommasi  energetically  insists  on 
the  sufficiency  of  clinical  study  to  meet  its  own  legitimate 
ends,  and  protests  against  the  prevailing  tendency  to 
accept  the  ideas  of  Chomel  and  degrade  it  into  a  simple 
stepping-stone  for  pathological  anatomy.  "  Clinical 
study  alone  has  established  the  causal  relations  between 
articular  rheumatism  and  endocarditis,  between  alcohol- 
ism and  arthritis  on  one  side,  and  endo-arteritis  on  the 
other,  between  different  species  of  constitutional  infec- 
tion and  an  increase  in  the  volume  of  the  spleen,  be- 
tween syphilis  and  certain  special  neoplasias  of  the 
connective  tissue,  between  scarlatina  and  croupal  inflam- 
mation of  the  pharynx  and  kidneys." 

You  remember  that  Continental  physicians  (not  in- 
eluding,  however,  the  French)  are  agreed  to  denominate 
all  inflammations  attended  with  fibrinous  exudation 
croupaL 

EPILEPSY    DEPENDIKO    UPON    PREMATURE    OSSIFICATION    OF 
THE  CRANIAL  SUTURES. 

Among  other  interesting  facts  quoted  from  his  clinic, 
Tommasi  signalizes  a  case  of  epilepsy  in  a  child,  depend- 
ant upon  premature  ossification  of  the  craninl  sutures, 
especially  the  spino-occipital.  This  cause  of  epilepsy 
has  been  specially  signalized  by  Virchow.  In  Tom- 
masi's  case,  the  disease  was  greatly  ameliorated  by  the 
use  of  nitrate  of  silver,  but  it  is  difficult  to  imagine  why. 

CONOERNINQ  PTISANS. 

The  use  of  ptisans  is  so  widely  spread  in  France, 
where  cold-water  drinking  is  considered  at  once  an 
imbecility  and  a  crime,  that  their  selection  becomes  a 
matter  of  considerable  importance.  M.  Miquel  (de 
Tours)  has  just  publi^ed  some  suggestions  on  the 
drinks  most  suitable  in  typhoid  fever  that  might  be  not 
altogether  useless  at  home.  He  proscribes  all  amylaceous 


THE  MBDIOAL  llECORD. 


with  yellow  and  slate-colored  spots,  as 
the  title  of  gastritis. 

ABSENIO  IN  CEREBRAL  OOKOESTIONB. 

Therapeutics  does  not  constitute  at  present  the  most 
fashionfJ^le  subject  of  meditation  m  the  medical 
world)  so  much  the  more,  therefore,  do  I  glean  studi- 
ously all  indications  of  experiment  in  this  direction.  M. 
Lisle  has  just  read  a  note  before  the  Academy  on  the 
advantages  of  arsenic  in  the  treatment  of  intercurrent 
cerebral  conation  among  the  iDsaoe.  M.  Lisle  con- 
siders hallucmations  to  be,  not  a  symptom,  but  a  com- 
plication of  insanity,  and  always  dependent  upon  con- 
gestion, consequently  always  to  be  treated  by  arseni- 
ous  acid.  He  claims  to  have  cured  131  patients  out  of 
193  by  the  use  of  this  medicament,  and  to  have  markedlv 
ameliorated  the  condition  of  twenty-nine  others.  If 
the  facts  cited  by  M.  Lisle  are  trustworthy  (and  there 
is  no  reason  to  suppose  they  are  not)  they  are  in  strik- 
ing opposition  with  his  theory.  According  to  the  ana- 
logy of  its  action  in  all  oUier  cases,  arsenious  acid 
should  be  considered  as  an  eminent  tonic  of  nutrition, 
regulating  the  life  of  the  capillaries,  perhi^,  in  several 
ways,  but  by  no  means  tending  to  disgorge  them  of  un- 
seemly congestion.  At  the  hospital  Beatyon,  M.  Mon- 
tard  Martin  told  me  that  he  employed  arsenious  acid 
with  considerable  success  against  cholera  in  the  last 
epidemic,  and  there  seemed  reason  to  suppose  that  the 
capillary  circulation  of  the  surface  was  restored  or 
stimulated  by  this  potent  drug  in  a  manner  to  relieve 
the  deadly  visceral  congestion.  Moreover,  as  tiie  editor 
of  the  MontpeUier  MidicaU  remarks,  it  is  far  from  proved 
that  hallucinations  are  connected  with  congestion  of  the 
brain,  a  condition  not  indicated  merely  by  some  redne?s 
of  the  fece  and  brilliancy  of  the  eyes.  According  to  the 
ideas  of  Luys  in  his  recent  brilliant  researches  into  the 
minute  anatomy  of  the  cerebro-spinal  system,  hallucina- 
tions occur  when  the  thalami  optici,  instead  of  simply  re- 
ceiving impressions  from  without  and  irradiating  them 
to  the  periphery,  set  up  an  independent  action,  and 
originate  impressions  in  the  recesses  of  their  own  struc- 
ture. This  might  occur  whether  they  were  excited 
by  congestion  or  their  normal  functions  perturbed  by 
ansemia. 

For  those  who  have  not  read  M.  Luys'  book,  it  may 
be  necessary  to  explain  that  man^  of  ms  views  <m  the 
structure  of  the  brain  are  quite  onginal.  The  particular 
theory  to  which  I  have  just  referred  rests  on  another, 
purely  anatomic,  namely,  that  all  sensitive  fibres  pro- 
ceedmg  from  the  posterior  and  lateral  columns  of  the 
spinal  cord,  are  destined  to  terminate  in  the  thalami 
optici,  which  constitutes  the  first  receptacle  and  halt- 
ing place  for  impressions  received  firom  the  world  with- 
out. Here  the  crude  impressions  are  elaborated  and 
ultimately  radiated  to  the  vesicular  matter  of  the  con- 
volutions along  the  converging  white  fibres  that  ap- 
parently proc^  from  the  surface  to  the  base  of  the 
brain.  These  are  not,  as  generally  affirmed,  the  mere 
continoation  of  the  fibres  from  the  cord,  but  new  ones, 
deriving  their  origin  from  the  thaUmi  optici  them- 
selves. 

THE  OHARACTIRS  OF  CEREBRAL    SOFTENINO. 

In  this  connection  it  is  natural  to  mention  the  essay 
in  the  Archives  de  AfSdecinej  written  by  Proust,  on  soft- 
ening of  the  brain.  The  dominant  idea  resulting  from  the 
researches  of  this  distinguished  young  physician,  is  the 
separation  of  BodeningiramoUissement)  l)oth  from  en- 
cephalitis and  h»morrhage.  Encephiditis  determines 
a  neoplasia,  or  is  equivalent  to  it,  precisely  as  inflam- 
mation generally  involves  the  idea  of  exudation. 

Hemorrhage  usually  results  from  the  rupture  of  a 
digitized  by ^ ,  _      ^_ 


and  sugared  mucilaginous  drinks,  especially  those  con- 
taining vegetable  acids,  and  all  fermentable  preparations, 
on  the  ground  that  they  increase  the  secretion  of  bile, 
and  the  confluence  of  the  intestinal  eruption.  Therefore, 
instead  of  lemonade,  currant  jelly,  gum  and  barley 
water,  M.  Maquel  recommends  infusions  of  linden  and 
orange  leaves^  chamomile  and  mignonette ;  also  water 
flavored  with  a  few  drops  of  coffee,  tea,  brandy,  or  rum. 
In  preparing  rice  water,  mixed  with  decoctions  of 
poppy  heads,  the  physician  of  Tours  directs  that  the 
rice  be  not  added  to  the  decoction  ready^  made,  but  onlv 
allowed  to  remain  in  contact  with  it  long  enough 
for  the  water  to  extract  the  astringent  principle  of  its 
rind. 

DYSPEPSIA  AND  rrS  TREATMENT. 

M.  Malherbe.  of  Nantes,  publishes  some  reflections 
on  a  subject  calculated  to  interest  the  inmost  heart  of 
every  Aiierican — on  the  treatment,  namely,  of  dys- 
pepsia. Considering  that,  in  our  favored  land^  all 
the  blessings  of  liberty  are  impotent  to  save  us  firom 
the  grasp  of  this  foul  fiend,  and  that  nearly  every  one 
of  us  has  either  had  dyspepsia,  or  actually  suffers 
from  it,  or  is  destined  to  suffer  in  the  future ;  no  sug- 
gestions on  the  subject  can  afford  to  be  lostw  M.  M^- 
berbe  strongly  recommends  the  use  of  pure  hydro- 
chloric acid  in  all  cases  of  the  atonic  form  of  the  disease. 
He  considers  this  substance  to  act  as  a  stimulating 
tonic,  which  facilitates  stomachal  digestion  by  assisting 
to  dissolve  albuminous  substances;  by  regulating  the 
secretion  of  gastric  juice ;  by  remedying  constipation  in 
virtue  of  an  exciting  action  on  the  intestine ;  finally, 
by  a  tonic  action  on  the  general  economy.  In  various 
cachexias,  even  advanced  tuberculosis,  this  medicine  is 
found  to  render  good  service.  X  have  myself  had  an 
opportunity  of  testing  the  truth  of  this  observation, 
especially  at  Lariboissi^re,  in  the  wards  of  M.  H^rard. 
He  is  enabled,  by  means  of  this  acid,  to  greatly  relieve 
the  various  dyspeptic  symptoms  (among  which  frequent 
vomiting  is  not  the  least  painful)  which  torment  the 
last  days  of  his  numerous  consumptive  patients. 

It  is  recommended  to  associate  wine  of  quinquina, 
calumba,  or  rhubarb,  and  some  preparation  of  opium 
with  the  hydrochloric  acid.    The  following  is  the  for- 
mula employed  at  the  Hotel  Dieu  of  Nantes : 
Wine  of  Quinquina  .  .  .  100  grms. 

Syrup  Thebaic 30      " 

Pure  Hydrochlor.  Acid  .      1      ** 
Mix. 

The  dose  is  fi*om  two  to  six  teaspoonfnls  a  day.  To 
relieve  the  gastral^c  pain  to  which  man^  dyfqseptics 
are  martyrs,  M.  Miqael  suggests  the  administration  of 
a  concentrated  opiate,  combined  with  a  bitter,  which 
serves  to  correct  its  injurious  effects.  The  following  is 
his  formula : 

Syrup  of  Bitter  Orange  Peel,   jf 

"         Morphine >   aaq.s. 

«         Ether ) 

Mix. 

Where  the  pain  comes  on  principally  before  eating,  it 
is  advisable  to  administer  a  narcotic  or  etherized  draught 
about  a  quarter  of  an  hour  before  meals.  It  is  M. 
H^rard's  practice  to  give  his  patients  ten  drops  of 
Sydenham  laudanum  immediately  before,  and  one  grm. 
of  pepsine  immediately  after  eating.  This  treatment 
entirely  relieved  the  pain,  and  stopi^  the  vomiting  in 
the  case  of  a  woman,  who  subsequently  died  from  the 
effects  of  a  diarrhoea  maintained  by  deep  tuberculous 
ulcerations  of  the  intestines,  and  with  whom  the 
mncous  membrane  of  the  stomach  presented  the  signs 
of  such    an  intense   arborescent    ixyection,    mingled 


478 


THE  MEDICAL  RECORD. 


capillary  aneorism.  But  ramoWsaement  is  a  necrobiosis, 
essentially  the  same  as  gangrene  of  the  limbs,  and  its 
phenomena  only  differ  because  the  tissues  involved  are 
withdrawn  from  the  action  of  the  air.  M.  Proust,  how- 
ever, reserves  the  name  necrobiosis  for  a  molecular  de- 
struction of  tissue,  and  to  its  destruction  en  tnoMe  as* 
signs  the  term  necrosis. 

The  death  of  the  cerebral  substance  depends  upon 
obstruction  of  the  capillary  circulation,  however  caused, 
whether  by  a  thrombus,  an  embolus,  stricture  of  the 
cerebral  arteries,  fatty  degeneration  of  the  capillaries, 
thrombus  and  phlebitis  of  the  sinus,  etc.  In  these 
cases,  there  may  be  produced  either  a  condition  of 
anaemia  or  of  hypersemia.  If  an  obstacle  to  the  cir- 
culation be  situated  in  the  sinus,  there  is  always  hyper- 
fi&mia ;  obstacle  in  the  capillaries  occasions  rather  ane- 
mia. The  first  produces  the  red,  the  second  the  white 
softening.  Hyperaemia  of  the  parts  surrounding  tlie 
focus  of  softening  is  easily  explained  by  the  collateral 
fluxion  in  branches  of  the  vessel  whose  tension  has 
been  increased  by  the  obstacle  to  the  circulation.  Hy- 
persemia  of  the  centre  of  the  infarctus  is  more  difficult 
to  account  for,  and  M.  Proust  only  suggests-with  some 
hesitation,  that  it  may  be  due  to  some  action  on  the 
part  of  the  vaso-motor  nerves,  or  the  result  of  a  func- 
tional alteration  of  the  capillaries. 

The  white  coloration  is  rarely  observed,  but  occurs 
occasionalty  in  cases  of  general  cachexia,  as  in  the  case 
of  cancerous  patients. 

The  red  coloration  may  be  uniform,  and  is  then 
more  marked  at  the  periphery;  or  spotted,  and  then 
results  from  little  haemorrhages  aridng  from  the  rupture 
of  a  great  number  of  capillaries. 

Diminution  of  the  consistence  of  the  part  is  appreci- 
able from  the  second  day.  The  tissue  has  a  trembling 
jellv-form  appearance.  Then  the  part  becomes  tume- 
fiedf,  it  is  softer,  the  furrows  separating,  the  convolu- 
tions di<»appear,  and  by  the  third  or  fourth  day  it  has 
become  reduced  to  a  diffluent  paste. 

The  first  phenomenon  detected  by  the  microscope  is 
the  appearance  of  fatty  granulations  in  filtering  the 
tissue.  These  have  been  observed  at  the  end  of  twenty- 
two  hours  by  Charcot,  and  thirty-six  hours  by  Prevost 
and  Cotard.  Then  granular  bodies  succeed  to  these 
fatty  granulations  and  accompany  them.  According  to 
Bouchard  these  granular  bodies  consist  of  agglomera- 
tions of  fatty  granulations. 

Transformations  speedily  take  place,  corresponding 
to  what  has  been  described  under  the  name  of  chronic 
softening,  plagues  jawiu,  cellular  infiltration.  The  col- 
oring matter  of  the  blood  transudes  through  the  walls 
of  the  capillaries;  that  already  extravasated  becomes 
converted  into  yellow  granular  amorphous  masses,  or 
else  into  reddish  oblique  rhomboidal  crystals,  the  hse- 
matoidine  of  Virchow. 

Later,  a  neoplastic  effort  sets  up,  and  a  tendency  to 
cicatrization  appears;  the  pia  mater  contracts  adhe- 
sions with  the  bottom  of  the  excavation  that  has  been 
fbrmed  by  resorption  of  disorganized  tissue,  and  across 
this  excavation  are  extendi  laminas  of  connective 
tissue.  The  tissue  surrounding  the  softened  part  be- 
comes slightly  indurated  in  virtue  of  a  proliferation  of 
nuclei  and  cells.  This  last  is  analogous  to  the  forma- 
tion of  an  eliminating  membrane  around  a  patch  of 
gangrene  in  a  limb. 

Provost  and  Cotard,  under  the  direction  of  Yulpian, 
have  made  a  number  of  experiments  on  the  produc- 
tion '  of  foci  of  ramoUiMement  by  injection  into  the  ar- 
teries of  powder  of  lyconodium  or  tobacco.  They  suc- 
ceeded in  simultaneously  provoking  infarctus  in  the 
brain  the  spleen,  and  the  kichieys,  were  able  to  observe 


the  apparition  of  fatty  granulations  and  granular  bodies, 
and  determine  the  formation  of  plaques  Jaunes, 

Although  the  opinions  have  been  refuted  which  at- 
tached softening  to  inflammation,  on  account  of  a  mis- 
taken idea  that  the  yellow  degeneration  consisted  of  pus, 
Proust  admits  that  certain  analogies  exist  between  the 
two  afifections,  especially  in  the  formation  of  the  zone 
of  proliferation.  Further,  that  it  is  impossible  to  say 
that  haemorrhage  and  softening  exercise  no  mutual 
influence  on  each  other;  on  the  contrary,  the  first 
tends  to  destroy  the  tissue  directly,  and  to  cut  off  ite 
nutrition,  or,  on  the  other  hand,  tiie  second,  by  with- 
drawing from  the  capillary  walls  their  normid  support, 
predisposes  them  to  yield  to  the  pressure  of  the  blood. 

The  influence  of  atheroma  upon  the  production  of 
haemorrhage  is  of  course  unquestionable.  1  had  an 
opportunity  of  observing  a  remarkable  illustration  in 
an  autopsy  recently  performed  at  La  Charity.  The 
aorta  was  atheromatous  from  its  base  to  a  point  below 
the  cross;  the  carotids  were  sprinkled  with  athe- 
romatous patches,  but  arrived  at  the  brain,  the  inter- 
nal carotid  showed  complete  degeneration.  The  same 
was  true  of  the  branches  of  the  basilar  artery.  In 
this  brain^  sections  in  any  direction  revealed  a  punc- 
tuated injection  caused  by  rupture  of  the  capillaries, 
and  in  the  middle  lobe  of  each  side,  adjoining  the 
thalami  optioi,  existed  a  pmall  focus  of  haemorrhage. 
Truly  yours, 

P.  C.  M. 

PAmn,  KoT.  •,  1667. 

THE  NECESSITY  OP  EXECUTIVE  SESSIONS 
FOR  THE  DISCUSSION  OF  ETHICAL  POINTS. 

To  THS  SOITOB  or  TBB  Mbdioal  Bboobi). 

Sir— As  I  have  always  noticed  that  whenever  a  point 
involving  personal  notoriety  is  likely  to  be  discussed 
before  the  **  Academy,"  the  would-be  martyr  takes  the 
precaution  to  come  duly  supplied  with  reporters  repre- 
senting the  secular  press,  would  it  not  be  well  to  en- 
force the  rule  of  exclusion  by  at  once  going  into  Ex- 
ecutive Session?  We  have  already  had  two  rather 
singular  coincidences  of  the  presence  of  reporters  firora 
a  paper  or  two  of  known  animosity  to  the  Academy, 
when  it  was  desirable  that  an  appeal  to  the  public 
should  not  be  lost  for  the  want  of  a  medium  of  com- 
munication or  a  sensational  rhodomontade.  How 
should  these  representatives  of  the  press  be  present 
then,  and  never  before  or  since?  Simply,  because 
when  one  desires  to  play  the  Spartan,  with  his  back  to 
the  rock,  he  is  determined  that  his  pluck  shall  somehow 
or  other  be  appreciated.  Yours  truly, 

a. 

Nbw  Yobs,  December  2, 186T. 


Um  Smtxmitnta. 


THE  UTERINE  APPLICATOR. 

Bt  F.  B.  LAWSON,  M.D., 

or  XKW  tobk. 

Tms  object  of  this  paper  is  to  furnish  the  medical  pro- 
fession with  a  description  of  an  instrument,  devif^d  by 
myself,  for  applying  caustic  and  astringent  solutions  to 
concealed  mucous  surfaces. 

I  will  not  question  here  the  propriety  or  impropriety 
of  this  mode  of  treatment  in  a  certain  class  of  diseases 
a£fectmg  these  surfaces,  for  I  am  sadsfied  that  this  in- 
teresting point  is  already  decided ;  it  is  the  manner  of 
applying  Uiem  that  should  engage  our  attention. 


THE  MEDICAL  RECORD. 


479 


^  ia 

//  ^® 

//  siz 


By  the  usud  methods,  we  all,  no  doubt,  have  ezpe- 
rieDced  many  difficulties,  exposed  the  patient  to  many 
dangers,  and  often  failed  in  obtaining  good  results,  sim- 
ply because  the  surfaces  were  unevenly  touched — too 
eererely  cauterized,  or  not  cauterized  at  all.  To  obviate 
these  difficulties,  and  to  enable  me  to  apply  these  prepare 
ations  to  the  proper  surfaces,  I  was  induced  to  adopt 
this  new  meUiod,  and  the  results,  so  far  as  I  have  pro- 
greased,  have  been  remarkably  favorable.  It  gives  me 
perfect  command  of  the  caustic,  which  can  be  used  of  any 
strength ;  enables  me  to  apply  solutions  evenly  and  thor- 
oughly to  any  surface,  as  the  laryngeal,  pharyngeal,  and 
the  eustachian  tube,,  to  the  mucous  membrane  of  the 
male  and  female  urethra;  and  even  to  that  of  the 
n terns,  which,  by  the  usual  methods,  is  frequently  in- 
arjcessible,  unle?8  the  parts  are  previously  dilated. 

This  instrument,  which 
have  denominated    a 
_,,    M  jgm^  caustic  applicator^  has   a 

^^S-^      jT  nozzle,  Fig.  1,  A,  which 

is  a  conicS,  flexible  sil- 
ver or  platinum  tube,  the 
size  at  its  bulbous  extre- 
1/  mity  of  a  No.  2  bougie, 

I  at  its  base  of  a  No.  3,  is 

11  7i  inches  in  length,  and 

It  is  attached  to  a  glass  sy- 

\l  ringe,  B.     The  piston  of 

//  this    syringe    works  by 

//  means  of  a  screw  through 

the  nut  G,  which  is  at- 
tached or  not  to  the 
cap  as  the  operator  may 
choose,  but  m  other  re- 
spects it  is  like  the  im- 
proved subcutaneous  sy- 
ringe, except  that  the 
metal  below  the  plunger 
is  of  pure  silver. 

The  steps  necessary  to 
prepare  the  instrument 
for  use  are  these : 

1.  The  syringe  is  to  be 
completely  filled  with 
whatever  solution  is  re- 
quired, and  the  liquid 
tbrced  to  the  end  of  the 
tube. 

2.  A  piece  of  cotton, 
more  or  less,  according 
to  circumstances,  is  to  be 
carefully  and  securely 
wound  round  the  end  of 
the  nozzle,  so  as  to  form 
a  bulb  (see  Fig.  2),  which 
mnst  be  thoroughly  wet 
in  warm  water  immedi- 
ately before  being  used. 

3.  The  nozzle  is  to  be 
bent  to  suit  the  part  on 
which  the  operation  is  to 
be  performed. 

To  use  the  instrument, 
however,  after  being  thus  prepared,  some  little  dex- 
terity is  necessary,  which  is  soon  acquired  by  prac- 
tice. The  cotton  bulb  is  now  applied  to  the  part  to 
be  cauterized,  a  quantity  of  fluid  sufficient  to  saturate 
it  is  to  be  injected,  when  it  can  be  used  as  a  swab, 
and  should  be  moved  from  within  outwards.  The 
piston  at  the  time  of  injecting  the  cotton  should  work 
through  the  nut  (Fig.  1,  C)  attached  to  the  cap^  and 
by  observing  this  precaution,  the  operator,  with   a 


Uttle  experience,  and  with  the  assistance  of  the  gauge, 
can  use  whatever  quantity  of  fluid  he  desires. 

This  instrument  possesses  numerous  advantages,  iht 
most  important  of  which  are  these : 

1.  It  gives  the  operator  perfect  command  of  whatever 
preparation  he  wishes  to  apply, 

2.  It  permits  of  these  applications  being  made  to  sur- 
faces that  are  for  the  most  part  not  readily  accessible  by 
the  ordinary  means. 

3.  The  nozzle  being  flexible,  it  is  appropriate  for  all 
concealed  mucous  surfaces,  and  therefore  it  does  the 
work  of  many  instruments. 

4.  It  applies  clean  caustic  on  a  clean  swab,  and  cau- 
terizes the  precise  spot  affected  thoroughly  and  evenly, 
and  removes  all  coagulable  materials. 

I  have  used  this  instrument  in  the  pharynx,  for 
which  it  is  peculiarly  appropriate :  in  the  uterus,  where 
I  employ  it  frequently,  and  for  which  organ  it  was 
originally  intended;  in  the  male  urethra,  in  cases  of 
gonorrhoea  and  gleet,  and  in  all  with  ease,  safety,  and 
decided  benefit. 

I  trust  that  the  profession  will  find  this  instrument  as 
useful  and  valuable,  or  more  so,  than  is  here  claimed. 
In  some  future  issue  I  may  present  details  of  a  few 
cases  of  uterine  disease  treated  by  this  applicator. 

87  Wist  Tbibtt-fibst  arssxT. 


Mtixcoi  3Um9  mi  Urns. 


The  Transactions  of  the  American  Medical  Associ- 
ation, Vol.  XVIII.,  may  be  obtained  of  Dr.  H.  D. 
Bulkley,  42  East  Twenty-second  street,  bj  those  sub- 
scribers who  have  not  yet  been  supplied.  Non-sub- 
scribers are  also  entitled  to  be  furnished  at  the  usual 
rate  of  $5.00.  We  trust  that  everjr  practitioner  of 
medicine  will  feel  it  his  duty  to  sustam  the  enterprise, 
and  thus  relieve  the  embarrassments  of  the  Publishing 
Committee. 

The  Late  Professor  Robert  Watts,  M.D. — At  a 
meeting  of  the  Trustees  of  the  College  of  Physicians 
and  Surgeons  in  the  city  of  New  York^  held  1 8th  of 
November,  the  registrar  having  communicated  the  de- 
cease of  Robert  Watts,  M.D.,  late  Professor  of  Anatomy 
in  the  College,  on  the  8th  day  of  September  last,  in  the 
city  of  Paris,  the  following  resolutions  were  unani- 
mously passed : 

JResolvedy  That  by  the  decease  of  Professor  Watts  the 
College  has  sustained  a  loss  of  one  of  its  most  accom- 
plished and  successful  teachers,  whose  untiring  zeal  and 
devotedness  to  its  interests  have  largely  contributed  to 
its  steadily  advancing  prosperity.  For  nearly  thirty 
years  Dr.  Watts  had  occupied  the  chair  of  Anatomy, 
and  taught  this  most  important  branch  of  medicd  sci- 
ence with  acknowledged  ability  and  success,  and  to 
the  great  advantage  of  the  numerous  classes  of  students 
who  have  attended  upon  his  instructions. 

Resolved,  That  this  Board  not  only  desire  to  com- 
memorate the  loss  sustained  by  the  College,  but  also  to 
express  their  deep  sense  of  the  excellence  of  Dr.  Watts* 
character,  and  the  heartfelt  sorrow  they  experience  in 
this  bereavement. 

Resolved,  That  a  copy  of  these  resohitione^  duly  an- 
thenticatea  by  the  signatures  of  the  president  and 
registrar,  be  communicated  to  the  family  of  the  de- 
ceased, with  the  assurance  of  the  sympathy  of  this 
Board  in  the  affliction  they  have  sustained. 

Resolved^  furthermore,  uiat  these  resolutions  be  pub- 
lished in  the  medical  journals  of  the  city. 

GuBDOK  Buck,  Registrar, 
Edward  JhiUkJixust^  PregidenL 

digitized  by  VjjOOQIC  * 


480 


THE  MEDICAL  RECORD. 


Death  from  C^loboform. — A,  death  firom  ohloro- 
form  is  reported  in  Chicago.  The  cause  is  referred  to 
simple  asphyxia  from  t£d  toxic  effects  of  the  article, 
although  portions  of  cracker,  of  which  the  patient  had 
partaken  i^ortlj  before  the  administration  of  the  an»s- 
thetic,  were  found  in  one  of  the  bronchial  tubes.  The 
chloroform  was  pure,  and  but  an  ounce  was  adminis- 
tered. Every  means  to  restore  the  patient  was  resorted 
to  without  avail 

A  Doctor's  Bill  in  the  Rbion  op  William  III. — 
In  the  diary  of  Sir  Thomas  Eokeby,  justice  in  the  Court 
of  Common  Pleas  in  the  reign  of  William  III.,  just  pub- 
lished, occurs  the  worthy  valetudinarian's  doctor's  biH 
for  only  two  months,  October  and  November,  1697 : — 
''  Purging  pills,  23. ;  leeches,  6d. ;  aperitive  ingredients. 
Is.  6d. ;  hystericke  water,  28. ;  a  purging  bolus.  Is.  6d ; 
purging  pills,  Is. ;  Gascan  powder,  4s. ;  vermifuge  pills, 
a  box,  3^.  4d. ;  a  purging  bolu?.  Is.  6d ;  purging  pills^ 
Is. ;  cephalick  drops,  2s.  6d. ;  an  hysterick  julep,  3s.  6d. ; 
hysterick  pills,  85,  6s.  8d. ;  a  vomitive  potion,  2s.  6d. ;  a 
stomaltick  cordial,  2s. ;  a  cordial  potion,  Is.  8d. ;  vomit- 
ive salts,  3  doses.  Is.  6d.^-  the  hysterick  julep,  3s.  6d.; 
Mithridate,  la. ;  the  vomitive  potion,  2s.  6d. ;  vomitive 
salts.  Is.  6d. ;  the  hysterick  pills,  68.  8d. ;  the  hysterick 
julep,  38.  6d  ;  sal-armoniac,  64— 2Z.  178.  lOd."  Spite  of 
this  drenchiug,  to  which  he  had  to  subject  himself^  he 
lived  to  the  age  of  67. — Brituh  Medical  JoumdL 

Scotch  Mitnificekoe.  —  Subscriptions,  varying  in 
amount  from  25Z.  to  the  lar^e  sum  of  5,0002.  continue  to 
be  paid  in  for  the  new  buildings  on  Gilmore  Hill,  for 
the  University  of  Glasgow  and  Hospital,  and  the  total 
already  amounts  to  the  enormous  sum  of  101,6001 
19s.  2dL—BriUah  Medical  JowmaL. 

Db.  D.  S.  Young  has  been  appointed  to  the  Chair  of 
Surgery  in  the  Cincinnati  Medical  College. 

Dr.  E.  S.  Connor  accepts  the  Chair  of  Medical  Chem- 
istry in  ihe  Medical  College  of  Ohio,  vice  Dr.  Roberts 
Bat  tholow,  resigned. 

Dr.  Hbnry  p.  Sartwbll,  eminent  in  scientific  circles, 
died  at  Penn  Tan,  N.  Y.,  Nov.  16th  ult. 

Colonel  Warrkk  Webster,  Surgeon  United  States 
Army,  has  been  relieved  from  the  Army  Medical  Board, 
in  New  York  city,  and  assigned  to  duty  as  the  Medical 
Director  of  the  Military  District  of  Texas.  Colonel 
Webster  had  charge  of  David's  Island  Hospital  during 
the  war,  and  earned  a  high  reputation  for  the  order, 
d  scipline,  and  general  good  management  of  the  impor- 
tant post. 

M.  Nelaton  has  resigned  his  chair  as  Professor  of 
Clinical  Surgery.  The  reason  assigned  is,  that,  in  ad- 
dition to  his  previously  immense  practice,  the  recent 
death  of  Jobert  de  Lamballe  and  Yelpeau  has  put  upon 
him  a  large  amount  of  work.  We  have  heard  M.  Ni- 
ton's professional  income,  from  private  practice,  his  po- 
sitions as  surgeon  to  the  Emperor  and  professor  agr^d, 
estimated  at  $126,000  per  anntmi.  It  is  said  that  the 
anatomist,  Sapp^y,  will  succeed  hiin  in  the  clinical 
chair. — Medical  Gazette. 

Thb  Scarcttt  of  DissEcnNQ  Material  in  London  is 
the  cause  of  much  complaint  on  the  pjirt  of  medical 
teachers  and  students.  It  is  supposed  to  be  due  to  the 
suppression  of  the  remuneration  which  was  formerly 
bestowed  upon  undertakers  for  the  increased  trouble  of 
delivering  over  the  bodies  to  the  proper  authorities. 

Thb  Srgond  Volukb  of  thb  Sanitart  Commission's 
publications,  edited  by  Prof.  A.  Flint,  is  in  press.  It 
treats  upon  medical  topics  connected  with  the  late  civil 
war. 


SuRGBON  H.  F.  MoSherrt,  U.  S.  N.,  died  at  sea^  Oc- 
tober 1st  ult,  on  board  the  U.  S.  Steamer  Wyoming, 
and  was  buried  at  Singapore  October  3.  He  entered 
the  service  June  23,  1860,  and  was  promoted  to  sur- 
ceon  September  22,  1863.  In  the  early  paH  of  18<}4, 
he  was  on  dutv  at  the  Naval  Hospit^  Memphis,  Tenn., 
but  was  detached  and  ordered  to  the  Dacotak^  after- 
ward serving  in  the  North  Atlantic  Squadron.  He  was 
ordered  to  the  Wyoming  March  18,  1865,  and  at  the 
time  of  his  death  was  a  passenger,  condemned  by  a 
medical  survey. 

The  pRrzE  Essay  on  Physical  Lonoetity — ^by  Ameri- 
can Popular  Life  Insurance  Company.  This  company 
offered  some  time  since  a  prize  of  $500  for  the  best 
essay  upon  this  subject  Two  communications  of  the 
number  presented  were  so  meritorious,  and  it  was  so 
hard  to  decide  the  question  of  superiority,  that  a  prize 
was  given  to  each.  The  successful  authors  were  Dr.  J. 
H.  Cfriscom,  of  New  York,  and  Dr.  J.  V.  C.  Smith,  of 
Boston. 

A  GiEtANDMOTHER  AT  Twenty-bioht. — An  old  practi- 
tioner who  is  giving  the  reminiscences  of  his  medical 
experience  in  the  Gazette  Medieale  de  Lyon,  enumerates 
among  them  the  case  of  a  young  girl  in  his  vicinity, 
who  became  the  mother  of  a  healthy  child  at  the  i^  of 
fourteen.  The  child  was  a  girl,  and  in  her  turn  became 
a  mother  at  fourteen  years  of  age.  The  young  grand- 
mother, he  says,  is  still  hard  at  work  in  her  village,  and 
is  very  proud  of  her  title  to  a  unique  fame  as  a  grand- 
mamma at  twenty-eight 

Sir  William  Lawrence. — The  council  of  the  CoUegje 
of  Surgeons  have  resolved  to  purchase  a  bust  of  their 
late  colleague,  Sir  William  Lawrence,  to  be  added  to 
their  collection  of  Surgical  celebrities  which  ornaments 
the  hall  and  staircase  of  the  college. 

Triohiniasts  in  Berlin.— Trichiniasis  has  appeared  in 
Berlin ;  seventy  cases  have  been  already  reported,  of 
which  two  have  proved  fatal. 

The  Weight  of  Trichinji. — ^Professor  M.  Weissner, 
of  Vienna,  has  computed,  that  it  must  take  thirty-five 
millions  of  trichinae  to  equal  the  weight  of  one  drachm. 

A  Painful  AocmBNT. — Dr.  Weber,  Professor  of  Sur- 
gery at  Heidelberg,  and  two  of  his  assistants,  recently 
died  of  diphtheria  under  the  following  circumstances : 

It  was  necessary  to  perform  tracheotomy  in  a  case 
of  diphtheria ;  and  in  the  course  of  the  procedure  a  dot 
of  blood  got  into  the  trachea.  M.  Weber  attempted  to 
extract  it  by  suction  in  the  absence  of  a  proper  instru- 
ment, and,  failing  to  do  so,  his  two  assistants  also  at- 
tempted. All  three  of  them  died  within  six  days  of 
each  other  I 

Miasmatic  Fevers  treated,  by  Chloroform  inter- 
nally.— Dr.  Geo.  F.  Brickbtt  of  Chicago  {Chicago 
Medical  Journal)  gives  some  interesting  results  attend- 
ant upon  the  administration  of  chloroform  internally. 
He  was  led  to  make  use  of  the  article  on  the  recom- 
mendations of  Pro£  Merrill,  of  this  city.  Six  oases  of 
cure  by  this  a^nt  are  recorded.  The  dose  was  a  fluid 
drachm,  and  m  every  instance  the  patient,  instead  x>f 
having  a  chill,  went  quietly  to  sleep. 

Dr.  Roberts  Bartholow  has  been  appointed  Pro- 
fessor of  Materia  Medica  and  Therapeutios  in  the  Medi- 
cal College  of  ^io. 

M.  Claudb  Bernard  has  been  raised  to  the  rank  of 
Commander  of  the  Legion  of  Honor. 

Dr.  Robert  Jessop,  formerly  of  Ireland,  died  at  Mount 
Erie,  111,  October  30,  in  the  67th  ve^  of  his  age. 

Digitized  by  VjC  _       ^_ 


THE  MEDICAL  RECORD. 


481 


©rigtnal  C0mmumtatt0n0^ 


SPRING  AND  SELF-RETAINING  SPECULUM. 
Bt  NATHAN  BOZEMAN,  M.D., 

mew  TOBK. 

The  TAgina,  as  a  membranous  canal,  may  properly  be 
said  to  represent  a  truncated  cone  with  the  base  turned 
upward  and  the  apex  downward,  correspondiog  with 
its  mouth. 

The  general  outline  of  the  organ,  as  viewed  in  its 
natural  condition,  is  such  as  would  result  from  bringing 
the  two  opposing  walls  of  the  cone  together,  the  cer- 
vix uteri  being  encircled  by  it  at  the  centre  of  its  base, 
and  its  mouth  closed  by  the  falling  together  of  the  la- 
bia majora. 

The  line,  therefore,  formed  by  the  anterior  and  pos- 
terior walls  of  the  organ  coming  together  is  transverse, 
while  that  formed  by  the  opposing  surfaces  of  the  la- 
bia is  antero-posterior,  being  at  ri^t  angles. 

Now  the  most  natural  indications  for  the  dilatation 
of  this  canal  with  the  peculiarities  named  would  appear 
to  be,  first,  separation  of  the  labia,  and,  second,  the  two 
opposing  walls  of  the  collapsed  cone,  so  to  speak.  This, 
scarcely  need  I  say,  is  the  view  generally  taken  of  the 
relationship  of  these  parts,  and  .the  usual  practice  is 
based  upon  it  of  bringing  within  the  field  of  observa- 
tion the  cervix  uteri  and  the  two  vaginal  walls. 

This  plan  of  antero-posterior  dilatation  of  the  vagina, 
it  matters  not  what  form  of  speculum  is  used,  I  con- 
ceive to  be  a  popular  error,  and  it  is  wholly  at  variance 
with  the  true  anatomical  relationship  of  the  parts.  I 
shall  presently  attempt  to  explain  more  fully  my  mean- 
ing in  our  description  of  a  new  form  of  speculum^  which 
I  have  the  pleasure  of  presenting  now  to  the  notice  of 
the  profession.  The  principle  of  construction,  as  well 
as  principle  of  action  of  this  new  instrument,  will  be 
found  to  differ  from  all  others  heretofore  in  use  in  sev- 
eral respects,  which  I  shall  explain  farther  on.  SuflBce 
it  to  say,  one  of  the  very  essential  differences  is  in  what 
might  be  termed  the  working  point  of  the  instrument, 
that  portion  which  is  applied  to  the  resistance.  The 
blades  of  our  instrument  are  introduced  between  the 
opposing  walls  of  the  vagina  edgewise,  instead  of  flat- 
wise as  formerly ;  and  the  dilatation  is  effected  trans- 
versely or  horizontally,  as  will  be  better  understood 
when  we  come  to  explain  the  principle  of  action.  The 
same  instrument  applies  to  the  dilatation  of  the  vulva 
as  well  OS  the  vaginal  canal;  thus  giring  us  at  one 
glance  a  view  of  the  parts  from  the  mons  veneris  to  the 
cervix  uteri  in  front,  and  behind,  nearly  the  whole  of 
the  posterior  wall  of  the  vagina — any  and  every  point 
within  this  extensive  range  being  accessible  for  opera- 
tive purposes. 

The  dilatation  thus  effected  is  so  regulated  that  the 
labia  and  the  two  extremities  of  the  vagina  are  put 
upon  the  stretch  only  to  the  extent  desired,  which  is  in 
strict  accordance  with  the  anatomical  conformation  of 
the  prnrts,  this  being  of  such  a  nature  as  to  make  the  in- 
strument sdf'$vMaming^  one  of  its  peculiarities ;  another 
being  dasHciiy  of  flexure.  This  principle  of  elasticity 
has  never  before  been  embodied  in  any  form  of  specu- 
lum that  I  am  aware  of,  and  its  utility  and  importance, 
in  my  judgment,  cannot  be  too  highly  estimated.  In- 
stead of  tlie  hard,  inflexible  blade  rormerly  used,  touch- 
ing only  at  one  or  two  points  soft  and  delicate  struc- 
tores,  we  have  now  the  sofl,  elastic  spring  adapting  it- 


self to  all  the  points  of  resistance  with  a  uniformity  to 
be  attained  in  no  other  way. 

The  indications  for  complete  dilatation  of  the  vagina 
and  vulva  I  conceive  to  be  four : 

1st  Elevation  of  the  perinaum. 

2d.  Elevation  and  support  of  the  upper  part  of  the 
posterior  wall  of  the  vagina. 

3d.  Transverse  dilatation  of  the  labia  majora  and  the 
mouth  of  the  vagina. 

4:th.  Distension  and  steadiness  of  the  upper  part  of 
the  anterior  wall  of  the  vagina,  the  vesico-vaginal  sep- 
tum. 

Now  these  are  the  indications  to  be  fulfilled,  accord- 
ing to  my  judgment,  independent  of  any  and  all  efforts 
of  the  patient  to  the  contrary;  and  any  instrument, 
whether  ielf-retaining  or  not,  that  does  not  meet  these 
ends,  must  be  regarded  as  incomplete.  With  my  instru- 
ment I  claim  the  accomplishment  of  all,  the  falfiXment 
of  the  third  and  fourth  indications  being  an  advance 
beyond  all  other  methods,  to  say  nothing  of  the  self- 
retaining  quality  of  the  instrument,  which  it  must  be 
admitted  is  based  upon  more  correct  principles  than  any 
plan  heretofore  presented  to  the  notice  of  the  pro- 
fession. 

As  regards  the  position  of  the  patient  I  propose  a  few 
remarks  before  entering  upon  the  description  of  our  in- 
strument, as  I  consider  this  of  no  little  consequence 
in  certain  operations,  especially  those  upon  the  anterior 
wall  of  the  vagina. 

While  our  speculum  is  equally  well  adapted  to  all 
positions,  I  prefer  in  the  description  and  application  of 
it  to  consider  the  patient  resting  upon  her  knees  and 
breast,  the  body  forming  a  right  angle  with  the  thighs, 
and  the  thighs  a  right  angle  with  the  legs.  This  posi- 
tion I  now  prefer  to  all  others,  and  with  propriety  it 
may  be  termed  the  right-angle  position  upon  the  knees. 

In  no  other  position,  according  to  my  judgment, 
whether  chloroform  be  used  or  not,  can  the  patient  be 
made  so  easy,  comfortable,  and  secure,  and  without  the 
aid  of  assistants.  When  folded  up  it  is  compact,  light, 
and  portable,  and  weighs  only  eleven  pounds.  It  ex- 
ceeds twelve  inches  in  height,  only  on  one  side,  the 
depth  and  width  being  twelve  by  eif^hteen  inches.  I 
hope  before  long  to  be  able  to  publish  a  description  of 
this  thoracic  rest  or  support. 

We  have  come  now  to  the  most  difficult  part  of  our 
task,  a  description  of  this  speculum. 

Fig.  1  (half  size)  represents  a  front  quarter  view  of 
the  instrument,  expanded  as  when  introduced  for  use. 

The  general  features  of  it  as  shown,  are  outstretched 
arms,  expanded  wings,  rolling  surfaces,  standing  and 
projecting  arche?,  broad,  contracted,  narrow  and  rounded 
points;  and  the  thumb-screw  arrangement  indicates  that 
the  whole  is  moved  by  a  system  of  leverage. 

The  proportions  of  the  instrument  are,  I  think,  in  har- 
mony, and  the  construction  will  be  found  to  be  in  strict 
accordance  with  well-known  geometrical  principles.  It 
may  be  said  to  be  composed  of  two  simple,  similar  bent 
steel  levers,  about  8^  inches  in  length,  rounded  and  flat- 
tened at  certain  points,  havincf  elasticity  of  flexure,  and 
connected  at  one  extremity  by  a  pivot  joint  G,  around 
which  they  revolve  horizontally. 

For  description,  therefore,  as  is  most  naturally  sug- 
gested from  its  general  outlnte,  it  may  properly  be  divided 
into  the  foot  and  heel,  including  thumb-screw  and  short 
levers,  and  into  the  legs,  body,  wings,  neck,  and  arms  or 
blades,  as  indicated  by  Figs.  1,  2,  3,  4,  and  5. 

The  description  of  the  foot  and  heel  we  will  defer  until 
we  come  to  study  the  principle  of  action. 

I  shall  consider  B  the  centre  of  the  instmment ;  the 
plumb  Ime  U,  droj^ed  from  it,  the  balancing-po:n^. 


482 


THE  MEDICAL  RECORD. 


The  legs  where  they  leave  the  heel  E  and  e  are 
r^undedj  a  quarter  of  an  inch  in  thickness,  and  for  a 
short  distance  ascend  almost  perpendicularly,  inclining 
slightly  forward  and  inward.  In  the  next  part  of  their 
course  they  hecome  gradually  more  and  more  flattened, 
extending  now  almost  directly  forward,  only  inclin- 
ing slightly  outward. 

The  line  U  indicates!  their  imion  with  the  body. 
Their  length  is  two  inches  and  three-eighths.  This  part  of 
the  instrument  applies  to  the  purpose  of  dilating  the 
vulva  or  labia  majora.  The  lower  part  of  the  legs  falls  just 
within  the  fold  formed  by  the  inner  part  of  the  thigh 
and  the  labia,  while  the  upper  portion  passes  between 
the  latter  about  the  commencement  of  the  nympbse,  and 


point.  This  arch  is  four  and  a  half  inches  in  length,  con- 
nected in  its  middle  by  a  hinge  joint  0,  and  about  tiiree- 
quarters  of  an  inch  in  width.  It  should  be  made  of 
steel,  and  so  thin  between  the  joint  and  extremities 
as  to  allow  of  easy  bending  in  the  opening  and  shutting 
of  the  arms.  There  are  two  holes  near  each  end,  with 
slits  in  upper  ed^  to  encircle  the  narrow  neck  of 
the  rivet  when  m  use.  This  arch  may  be  used  or 
not,  as  circumstances  may  require,  it  being  easily 
slipped  off  or  on.  When  used  it  is  intended  to  elevate 
and  support  the  upper  part  of  Uie  posterior  wall  of 
the  vagina,  it  being  the  fulfilment  of  our  second  in- 
dication. It  is  easUy  elevated  or  depressed  with  the 
finger,  and  when  in  position  stands   about   one  inch 


thus  reaches  the  mouth  of  the  vagina,  which  corresponds 
exactly  with  the  plumb  line  IT,  the  balancing-point. 

The  body  is  included  between  the  two  lines  U  and  Q, 
and  is  somewhat  quadrangular  in  shape,  rounding 
on  its  outer  surface  and  hollowed  out  on  the  inner  side 
to  the  same  extent  as  the  upper  part  of  the  leg  and  the 
wing  standing  upon  its  upper  edge,  as  indicated  by  the 
line  B  Q.  This  part  of  the  instrument  is  applied  directly 
to  the  transverse  dilatation  of  the  mouth  of  the 
vagina.  The  wing  is  of  a  peculiar  shape,  and  for  the 
sake  of  description  may  be  divided  into  the  lower  and 
inner  portion  and  the  upper  and  outer  portion.  The  first 
part  presents  a  rounded  surfiice  firom  right  to  left,  and 
up  toward  the  projecting  angles  R  r  looks  almost  di- 
rectly forward.  These  projecting  arches  are  about  three- 
quarters  of  an  inch  wide,  and  at  the  angles  are  about 
three-quarters  of  an  inch  above  a  line  drawn  across  from 
centre  to  centre.  This  part  of  the  wing,  witli  its  fellow 
of  the  opposite  side,  gives  support  to  the  perinffium,which 
lies  across  from  one  to  the  other,  just  as  the  bridge 
spans  the  stream.  The  upper  and  outer  portion  of  the 
wing  looks  forward  and  outward,  and  is  intended  to  sup- 
port the  buttock.  The  neck  between  the  two  plumb  lines 
Q,  L,  is  about  half  an  inch  in  length  and  width,  and  as 
shown  is  the  most  contracted  part  of  the  arms.  This 
point  comes  just  within  the  mouth  of  the  vaeina,  and 
consequently  prevents  painful  stretching  of  uie  parts 
here  in  the  expansion  of  the  blades. 

The  arms  or  blades  forqi  the  widest  part  of  the  in- 
strument, and  are  intended  to  distend  and  steady  t^e 
vcsico-vaginal  septum.  They  are  thin,  spoon-shaped, 
about  two  inches  and  three-eighths  in  length,  and  at  M 
one  and  a  half  inches  wide.  On  the  middle  of  this  line  is 
seen  the  countersunk  head  of  the  rivet  wUch  passes 
througjh  here  and  gives  support  on  the  inside  to  the  ex- 
tremiUea  of  the  arch  N  n,  connecting  the  blades  at  this 


above  the  edges  of  the  blades,  and  on  a  plane  slightly 
above  that  of  the  projecting  angles  of  the  wings 
R  r.  Nearly  the  whole  of  the  instrument,  as  will  be 
seen  by  reference  to  the  figure,  is  included  within  the 
legs  of  the  right-angled  triangle  EEC,  only  the 
foot,  legs,  and  wings  being  outside.  The  circle  D  R  Q 
S  has  Its  centre  at  B,  the  centre  of  the  instrument, 
with  a  radius  of  one  inch  and  a  quarter,  the  length 
of  the  line  of  union  between  the  root  of  the  wing 
and  the  body.  This  circle,  as  is  seen,  includes  nearly 
the  whole  of  the  wing,  the  body,  and  a  large  part  of 
the  leg.  This  angle  and  centre  of  circle,  I  sliould  observe, 
are  important  points  to  be  borne  in  mind  in  the 
manufacture  of  the  instrument.  They  should  be  pre- 
served in  all  case 4,  it  matters  not  what  change  may 
be  found  necessary  as  regards  proportions. 

The  instrument,  when  set  upon  a  table,  has  its  foot 
flat  upon  the  surface,  touching  nowhere  else  excepting 
at  the  point  near  the  endS  of  the  blades^  as  indi- 
cated by  the  base  line  of  the  angle  E  0,  which  meas- 
ures four  inches  and  three-quarters.  The  leg  E  B 
measures  two  inches  and  three-quarters,  and  C^  four 
inches  and  a  half. 

From  centre  B  to  corresponding  point  of  opposite 
side,  the  distance  is  two  inches  and  a  quarter.  Between 
tips  of  wings  D  d,  four  inches  and  a  quarter.  Between 
commencement  of  neck  Q,  three  inches.  Between 
blades  at  M,  measuring  from  outside  to  outside,  four 
inches.  Between  points  measured  in  the  same  way, 
three  inches  and  a  halfl 

The  instrument  is  to  be  made  of  steel,  electro-plated, 
as  light  as  is  consistent  with  the  strength  required, 
there  being  certain  points,  of  course,  where  this  is  an 
important  feature ;  for  example,  the  foot  and  heel  of  the 
instrument. 

The  fHatiUciiy  oi  flexure,  it  should4>e  bomejin  mind, 

"^  _;__  _.v:.oogle 


THE  MEDICAL  RECORD. 


483 


extends  only  from  the  heel  to  the  extremities  of  the 
blades,  increasing  of  coarse  in  extent  as  the  latter 
points  are  approached.  The  limit  of  elasticity  at  the 
points  of  the  blades  should  not  exceed  three-quarters 
of  an  inch  under  any  amount  of  resistance  here,  and 
this  should  be  borne  in  mind  in  tempering  the  instru- 
ment, otherwise  the  limit  might  be  exceeded,  and  the 
usefblness  of  the  instrument  thereby  endangered. 

Fig  2  represents  the  instrument  closed,  ready  for  in- 
troduction or  withdrawal     It  being  collapsed,  so  to 


be  conceived,  and  answers^  in  the  most  satisfactory 
manner,  the  purpose  for  which  it  is  here  intended. 

In  studying  the  law  offerees,  there  are  several  import- 
ant points  always  to  be  borne  in  mind,  whether  applied 
to  the  rudest  lever  or  pulley,  or  to  the  most  complex 
piece  of  machinery.  As  Vieae  points  are  or  are  not 
understood,  depends  success  or  failure. 

Professor  Silliman,*  who  is  authority  in  matters  of  this 

.  sort,  says :  "  To  determine  a  force  with  precision,  we 

must  consider  three  things :  Ist.  The  point  of  applica- 


fflpeak,  every  point  of  the  opposing  sides  is  brought  into 
closer  relationship.  The  elevated  arch  standing  above 
the  edges  of  the  arms  or  blades,  as  seen  in  the  first 
view,  is  now  folded  within  them,  the  upper  part  of  it 
resting  beneath  the  hugging  arches,  R  r. 

In  this  view  of  the  instrument,  there  are  three  di- 
Tisions  made  by  the  two  plumb  lines  U  and  Q,  which 
are  important  as  directing  attention  to  the  uses  of  the 
respective  portions.  The  leg,  for  example,  included 
witnin  the  first  division,  performs  the  part  of  separating 
the  labia  jnajora.  The  wings  and  body  of  the  second 
division  elevate  the  periiMSum;  and  open  the  moulh  of 
ike  vagina^  to  the  utmost  limit  transversely.  The  arms 
or  blades  of  t^e  third  division  unfold  and  steculy  the 
vegieo'Vaginal  $epium^  or  upper  part  of  the  anterior  wall 
of  the  vagina,  and  at  the  same  time  give  support  to  the 
two  extremities  of  the  arch  which  spans  the  space  be- 
tween them,  and  receives  upon  its  top  the  faUing  pos- 
terior wall  of  the  vagina. 

The  thumb-screw  K  is  seen  reversed  to  its  fullest 
extent,  and  the  two  short  levers  quietly  folded  within 
the  foot  of  the  instrument,  the  point  P  being  now  in 
close  proximity  to  the  pivot  G. 

We  come  now  to  a  consideration  of  the  principle  of 
the  instrument,  and  I  will  state  in  the  outset,  as  thus 
applied  it  is  new  and  original  with  myself,  it  never 
bAving  been  applied  before,  that  I  am  aware  of,  by  any 
one,  to  the  purposes  of  a  speculum. 

The  principle  itself,  however,  is  an  old  one,  as  re- 
gards its  application  to  other  purposes.  It  will  be 
familiar  to  those  who  may  have  seen  a  certain  kind  of 
cotton  press  in  the  Southern  States,  in  which  it  is  em- 
ployed, though  with  a  more  extensive  system  of  lever- 
age than  I  have  here.  I  got  the  idea  myself  from  seeing 
the  above  application ;  and  the  credit  I  am  entitled  to  is 
the  modificauon  which^I  have  made  of  it^  to  suit  the  pur- 
poses of  a  idf-retaining  speculum,  the  prmciple  of  which 
we  wUl  now  attempt  to  describe.  This  principle,  as 
here  applied,  I  have  no  hesitancy  in  saying,  forms  one 
of  the  most  beautiful  illustrations  of  the  parallelogram 
of  forces  as  producing  curvilinear, motion  that  could 


tion.  2d.  The  direction.  3d.  The  intensity  or  energy 
with  which  the  force  acts." 

Inattention  to  one  or  more  of  these  rules  has,  I  am 
satisfied,  caused  the  failure  of  all  previous  e£forts  at  get- 
ting? up  a  setf-retaining  ntectdum^  to  fulfil  all  the  indi- 
cations previously  named.  I  am  ft-ee  to  confess  myself 
that  I  fiuled  in  many  of  my  efibrts  from  this  very  cause. 

My  greatest  error  I  now  conceive  to  have  been  in 
the  point  selected  for  the  application  of  force.  Had  I 
the  time  and  space,  it  might  be  interesting  to  show  how 
I  labored  to  extricate  myself  from  this  difficulty ;  but 
as  it  is,  I  shall  be  content  for  the  present  with  saying 
that  this  instrument,  as  here  exhibited,  is  not  the 
work  of  a  day,  or  a  week,  or  a  month,  but  years  of  patient 
thought  and  repeated  disappointments. 

Let  us  now  turn  our  attention  to  the  diagram,  ilg.  3, 
which  is  also  a  half-size  front  view  of  what  I  nave 
Fig.  8. 


denominated  the  foot  of  the  instrument,  here  re- 
presented closed  and  expanded,  with  both  legs  cut  off 
at  the  heel  E  and  E. 

The  two  sides  E  A  G  together  form,  as  is  seen,  al- 
most a  semi-circle,  with  a  radius  of  one  and  a  quarter 
inches.  In  the  middle,  where  they  unite,  is  the  pivot- 
joint  G,  and  here  is  the  point  of  our  application  of 
force. 

These  arms  are  inflexible,  somewhat  round,  and  almost 
of  uniform  thickness,  not  exceeding  a  quarter  of  an  inch 


*  Prindples, 


L^^niTby  Google 


484 


THE  MEDICAL  RECOBD. 


anywhere,  excepting  at  the  pivot  and  endsi  where  thej 
swell  out  a  little,  to  give  additioaal  strength. 

Witldn  these  arms  is  situated  our  plan  of  leverage 
for  opening  and  shutting  the  instrument  This  con- 
sists of  a  double-threaded  thumb-screw  K,  about  one 
inch  and  three-quarters  in  length,  and  three-eighths  of 
an  inch  in  thickness, with  an  open  wheel  on  the  outer  end, 
one  inch  and  an  eighth  in  diameter ;  and  of  two  shorty 
stout  levers,  one  and  a  quarter  inches  long.  These  lat- 
ter are  connected  at  one  extremity  by  a  joint  at  the  heel 
E  and  E,  two  and  a  half  inches  from  the  pivot  G-.  At 
the  other  extremity  they  are  connected  together  by  a 
joint  at  P.  Bising  above,  three-eighths  of  an  inch,  is  to 
be  seen  the  connecting  screw  of  this  joint,  expanded, 
and  perforated  to  receive  the  extremUy  of  the  thumb- 
screw, upon  the  extremity  of  which,  on  the  outside,  is 
placed  a  small  tap.  In  the  same  manner  the  thumb- 
screw passes  through  the  connecting  pivot-screw  G, 
which  is  the  nut,  the  former  being  free  to  move  both 
forward  and  backward. 

Let  the  two  lines  now  on  each  side,  A  D  and  P  D, 
represent  the  instrument  closed,  A  /  and  P  /  com- 
pleting the  rectangle  or  square.  (An  error  in  the  cut ; 
it  should  be  a  small  /.)  The  diagonal  P  A  will  then 
represent  the  situation  and  relationship  of  the  two  short 
levers  previously  described. 

To  open  or  expand  these  arms  now  to  the  Ihll  ex- 
tent, we  have,  as  would  appear,  two  forces,  A  P  and  A 
P,  acting  at  an  oblique  angle,  a  very  great  mechanical 
disadvantage,  as  will  be  readily  understood,  for  "  when 
a  force  acts  upon  a  bodpr  at  any  other  than  a  right 
ande,  a  part  of  its  effect  is  lost" 

,  The  difficulty,  however,  is  overcome  and  the  acoom- 
plLdunent  of.  our  purpose  rendered  easy  by  resolving 
each  of  these  oblique  forces  into  two,  P  /  and  A/ 
one  parallel  and  the  other  perpendicular  to  the  point  to 
be  moved.  This  is  effected  by  revolving  the  thumb- 
screw K  until  it  assumes  the  position  of  G  F,  and  the 
short  levers  that  of  E  F  and  E  P.  The  latter  together 
now  form  a  straight  line — a  relationship  that  places  the 
whole  instrument  in  a  state  of  equilibrium ;  the  weight 
of  the  two  sides,beiog  equal,is  exactly  counterpoised  at  F. 
Complete  now  the  parallelogiam  E  H  G,  and  we  have 
the  diagonal  G  B,  the  resultant  of  the  two  components 
thus  applied,  which  give  us  the  di^on^  or  oblique 
relationship  of  the  arms  of  the  instrument  which  is  here 
so  beautifully  carried  out  In  this  resolution  of  forces, 
therefore,  our  power  is  seen  to  pass  through  the  arc  of 
a  circle  which  is  the  diagonal  of  the  small  parallelogram 
A  c,  E  Xy  the  distance  A  E  being  three-eighths  of  an 
inch.  As  it  is  wiih  the  seat  of  power  so  it  is  with  every 
other  part  of  the  instrument  to  the  extremity  of  its 
blades,  which,  with  varying  radii,  pass  tlirough  the  arc 
of  a  circle  the  length  as  wefl  as  the  velocity  of  which 
increases  with  the  distance  from  the  pivot  Gk 

For  instance,  at  the  centre  or  balancing-point  of  the 
instrument  U,  Fig.  1,  corresponding  to  the  mouth  of 
the  vagina  and  about  one  inch  from  the  seat  of  power, 
we  have  the  arc  increased  from  three-eighths  to  half 
an  inch,  with  a  total  expansion  of  the  arms  at  this 
point  of  two  and  a  half  inches.  And  at  the  extremity 
of  the  blades,  a  distance  of  about  five  inches  from  the 
same  point,  the  arc  is  increased  to  one  and  a  half  inches, 
priving  us  a  space  between  the  o|^osing  blades  of  three 
mches  for  operative  purposes. 

At  the  two  points  named  the  Hmit  of  expansion  of 
the  blades  corresponds  exactly  with  the  limit  of  the 
dilatation  of  the  mouth  of  the  vagina,  and  its  upper  ex- 
tremity, which  alone  is  sufficient  to  explain  the  selfstii' 
ttUning  and  self-retaining  feature  of  the  instrument 

In  the  application  of  our  power  then  to  the  thumb- 
screw K,  the  position  of  it  is  most  advantageous  for 


producing  its  maximuni  eiOEect  in  collapsing  or  carrying 
the  two  short  levers  from  their  oblique  relatiopship  to 
that  of  right  angles  with  the  point  acted  upon,  thus 
affording  an  example  of  increased  power  with  increased 
resistance.  The  instrument  with  the  ab^ve  ^stem  of 
leverage  may  properly  be  said  to  represent  n  douUe 
bent  tevtTy  the  most  familiar  example  of  which  is 
the  fire-iong$.  Unlike  these,  however,  it  has  the 
power  applied  on  the  inside  instead  of  the  out^de. 
Alike,  though,  in  the  important  respect  of  having  the 
power  applied  between  the  fiilcrum  and  the  weight  or 
resistance,  distingoishing  both  at  once  as  levers  of  the 
third  class. 

This  instrument  I  shall  call  a  spring  and  self-retaining 
speculum,  as  is  most  naturally  suggested  from  these  two 
distinguishing  qualities  of  it. 

I  think  I  may  justly  claim  for  this  speculum  origi- 
nality in : 

1st.  The  system  of  leverage  employed,  possessing  as 
it  does  regulated  and  increased  power,  reduced  to  the 
smallest  possible  compass^  and  far  away  from  the  mouth 
of  the  vagina^  thus  allowing  the  freest  and  widest  range 
of  manipulation  with  instruments,  compatible  with  the 
nature  of  these  parts. 

2d.  Transverae  action  of  the  instrument,  with  uni- 
formly varying  movement  of  the  working-point,  ex- 
tending from  the  heel  to  the  point  of  the  blades,  thus 
making  the  lateral  walls  of  the  vagina  the  seat  of 
pressure  instead  of  the  anterior  and  posterior,  as  for- 
merly. 

3d.  Complete  exposure,  at  the  same  time,  for  opera- 
tive purposes  of  the  vulva,  both  walls  of  the  vaginaL 
and  tiie  cervix  uteri,  with  the  two  polished  surfaces  of 
the  arms  of  the  instrument  standing  upon  the  sides, 
the  most  favorable  position  in  which  they  could  be 
placed  to  secure  the  greatest  amount  of  renected  light 

4th.  Elasticity  of  the  working-poin^  of  the  instru- 
ment. 

6th.  Being  self-retaining  in  the  fullest  sense  of  the 
word. 

6th.  Being  equaUy  apphcaUe  in  its  use  to  all  posi- 
tions of  tJie  patient  ^ 

7th.  Allowing  all  operations  to  be  done  without  the 
aid  of  assistants,  or  exposure  ©f  the  person  of  tlie  i»- 
tient,  further  than  the  parts  immediately  brought  within 
the  field  of  observation  by  the  expansion  of  the  arms 
of  the  instrument. 

All  of  these  points,  I  am  safe  in  saying,  admit  of  the 
clearest  demonstraticm. 

Rernarhs, — Having  now  completed  the  description 
of  our  spring  and  sdf-reiaming  specilum,  it  remains 
for  us  to  offer  a  few  additional  remarks  upon  its  appli- 
cation in  practice,  and  the  circumstances  under  wbidi 
it  was  first  done;  for  it  \a  reasonable  to  conclude  that 
the  question  will  be  asked,  where  is  the  proof  of  all 
the  advantages  which  have  been  portrayed  at  such 
length? 

The  only  proof  I  propose  to  offer,  and  I  think  this 
conclusive,  is  the  application  of  the  instrument  in  a 
single  case,  the  very  one  to  which  it  was  adapted  in 
completing  it  as  here  shown.  This  case  being  an  ex- 
treme one,  as  wiU  apjpear,  has  the  advantage,  I  think, 
of  rendering  the  proof  convincing  to  the  praotical  mind, 
and  lessens  the  necessity,  I  conceive,  of  additional  cor- 
roborative testimony  to  satisfy  even  the  most  skeptical. 
The  case  referred  to  was  one  of  vesico-vagjnal  fistule 
occurring  in  a  very  stout,  fleshy  woman,  weighing  up- 
wards of  two  hundred  pounds.  Early  in  October  lit 
she  was  admitted  into  that  admirably  conducted  in- 
stitution under  itie  direction  of  the  Sisters  of  the 
Hoboken  St.  Mary's  Hospital,  where  my  patients  are 

now  received,  ^ C^  r^r\i 

Digitized  by  VjOOk^  ^  _ 


THE  MBMCAL  RECORD. 


485 


The  fistule  was  of  six  or  eight  months*  standing; 
small,  not  larger  than  a  pin*8  head,  and  occupied  what 
we  would  ordinarily  term  a  favorahle  position,  heing 
some  three  inches  above  the  meaiuB  nrinaritiSj  and  near 
the  edge  of  the  septum,  upon  the  left  side. 

The  peculiarity  and  difficulties  of  the  case  were  these : 
Anteversion  of  the  uterus;  a  oonyoluted  or  folded 
condition  of  the  two  opposing  walls  of  the  yagina, 
which  was  of  immense  size ;  and  a  pleated  condition  of 
the  edges  of  the  fistule,  and  the  parts  immediately  sur- 
rounding it 

Assisted  by  Drs.  Pinnell  Connolly,  Lynch,  Metcalfe, 
and  several  other  medical  gentlemen  of  New  York. 
and  Dr.  Chobert^  of  Hoboken,  I  undertook  my  usual 
operation,  the  patient  resting  upon  her  knees  and 
elbows.  My  fourth  size  of  the  lever  ppeculuro,  with  a 
blade  four  inches  long,  one  and  a  half  inches  wide  at 
the  iieel,  and  one  and  three-quarter  inches  near  the 
point,  was  employed ;  and  although  of  such  large  size, 
this  instrument,  with  spatulas  and  depressors,  brought 
to  bear  from  various  points  by  assistants,  afforded  us 
only  an  imperfect  view  of  the  very  small  fistule.  The 
upper  part  of  the  posterior  wall  of  the  vagina  came 
down  in  such  immense  folds  over  the  end  of  the  instru- 
ment, met  bpr  the  same  folded  and  protruded  condition 
of  the  anterior  wall,  under  violent  and  almost  continu- 
ous expulsive  efforts,  that  it  became  quite  impossible  to 
commence  the  process  of  paring  the  edges  of  the  fistule, 
and  to  complete  it  in  a  regular  manner.  This  stage  of 
the  operation,  however,  was  gone  through  with  after  the 
length  of  time  indicated,  only  to  be  followed  by  a  still 
greater  difficulty  and  delay  in  the  next — the  introduction 
of  our  sutures — only  three  being  called  for.  The  patient, 
at  this  stage  of  the  operation,  was  placed  upon  her  side 
and  chloroformed,  which,  however,  afforded  us  no  re- 
lief from  the  surrounding  difficulties. 

Suffice  it  to  say,  the  operation,  after  three  hours,  with 
five  or  six  assistants,  was  finished,  though  in  the  most 
aosatisfactory  manner  it  had  ever  been  my  misfortune 
to  encounter  before. 

Now,  after  all  our  labor  and  annoyance,  I  felt  that  a 
failure  was  inevitable,  and  so  expressed  myself  to  the 
gentlemen  present.  The  removal  of  our  suture  appa- 
ratus on  the  eighth  day  proved  too  truly  the  correctness 
of  our  misgivings  as  to  the  final  result.  There  was  a 
total  failure. 

With  a  full  understanding  now  of  the  difficulties  of 
the  case,  and  seeing  the  result  of  the  extraordinary 
efforts  which  had  been  made  in  this  operation,  I  con- 
templated, I  firankly  confess,  another  operation  with 
dread  and  ill  forebodings. 

I  determined,  however,  that  I  would  not  undertake 
another  until  I  could  devise  some  plan  of  securing  the 
patient  effiectually  in  the  right- angle  position  upon  the 
knees,  which  I  had  had  in  contemplation  for  several 
years ;  and,  if  possible,  to  complete  my  new  speculum, 
belieying  that  no  better  case  could  be  found  to  test  its 
merits.  Accordingly,  I  drew  a  plan  of  my  thoraeic  rest, 
alluded  to  in  Uie  former  part  of  this  paper,  and  placed  it 
in  the  hands  of  a  carpenter,  who  had  it  ready  for  use 
in  five  or  six  days. 

As  to  the  speculum^  this  was  not  so  easily  completed, 
as  it  invdved  a  radical  change  in  m^  original  plan, 
arinng  from  a  fundamental  error  in  its  construction, 
which  I  had  not  discovered  until  this  particular  juncture. 
An  explanation  of  this  change  would  necessarily  re- 
quire a  description  of  the  instrument  and  all  the  altera- 
tions made  in  it  fix>m  the  beginning,  which  would  far 
exceed  the  limits  assigned  to  these  remarks  in  the 
oatset. 

On  the  20th  of  November  it  was  so  near  completed 
AS  to  enable  us  to  use  it 


The  patient  was  now  placed  in  ou/new  position,  and 
thus  secured  upon  the  thoracic  rest.  The  position  was 
now  found  to  be  admirable,  and  the  confinement  of  the 
patient  perfect 

Chloroform  was  next  administered,  and  our  specu- 
lum, as  here  shown  and  described,  was  introduced  and 
expanded  to  the  f\illest  extent  A  reference  to  the 
limit  pointed  out  on  a  former  page  will  ^ve  some  idea 
of  the  enormous  size  of  the  vagina.  In  short,  the  dila- 
tation of  the  vagina,  regarding  all  the  indications  which 
we  have  pointed  out,  was  most  complete  and  satisfac- 
tory. The  insigniffcant  fistule  which  we  had  labored 
so  hard  to  bring  into  view  a  few  weeks  before  and 
failed,  now  showed  its^in  its  follest  dimensions,  steady 
and  inunovable,  even  in  the  very  face  of  the  most  vio- 
lent expulsive  efforts  of  the  patient  from  bearing  down 
and  vomiting,  before  which  we  stood  almost  powerless 
and  helpless  in  the  previous  operation,  with  every  as- 
sistant that  could  be  employed. 

I  now  viewed  the  parts  of  operative  procedure  for 
the  first  time  with  a  leeling  of  certainty  as  to  the  re- 
sult At  my  leisure  I  began  the  operation,  and  quietly 
completed  it  by  my  ordinary  method,  without  the  aid 
of  an  assistant,  further  than  to  wash  q>onges  and  give 
chloroform. 

In  twenty-five  minutes  our  patient  was  removed 
from  the  table  and  placed  in  bed,  totally  unconscious  of 
what  had  been  done.  Ten  minutes  of  this  time,  I 
should  observe,  were  lost  in  consequence  of  a  little 
hs&morrhage  which  had  to  be  controlled  before  intro- 
ducing our  sutures. 

Thus  was  achieved,  I  conceive,  the  greatest  triumph 
of  our  professional  life. 

The  above  operation  was  done  in  the  presence  of 
Drs.  Thomas  C.  Finnell,  Thomas  S.  Bahan.  Joseph  S. 
Crane,  of  New  York,  and  Dr.  Chobert,  of  Hoboken,  all 
of  whom  expressed  their  entire  satisfaction  at  the 
result. 

To  Dr.  ^nnell  I  am  under  many  obligations  for  hav- 
ing so  opportunely  placed  under  my  charge  the  above 
patient,  so  well  adapted  to  the  completion  of  our  in- 
strument Without  such  an  opportunity  our  success 
might  have  been  deferred  many  months  longer.  There 
are  also  due  Dr.  Chobert  many  thanks  for  his  kind  atten- 
tion to  the  patient  during  the  aflier  treatment 

The  result  in  this  case,  however  satisfactory  it  may 
be  viewed  in  the  iniportant  respects  mentioned,  merits 
additional  interest,  I  t])ink,  from  the  fact  that  the  in- 
strument actually  employed  in  the  case,  and  from  which 
these  drawings  have  been  made,  was  completed  by  my 
own  hands  in  gutta  percTia,  aKeet  lead,  and  ir<m  wire. 
To  Messrs.  €^eo.  Tiemann  a  Co.,  67  Chatham  street^ 
however,  I  am  under  great  obligations  as  regards  the 
foot,  leverage,  and  legs  of  the  instrument,  and  the  many 
changes  and  alterations  made  from  time  to  time  in  or- 
der to  reach  this  stage  of  completion.  They  placed  at 
my  disposal  an  experienced  and  finished  workman, 
who  made  and  put  together  almost  every  part  of  the 
instrument  above  named  under  my  own  supervision. 
Without  this  very  great  advantage  I  never  could  have 
gone  through  with  the  work  even  to  this  extent 

As  regarasthe  ultimate  success  of  this  instrument 
fi"om  what  we  have  seen  thus  far  in  its  application  I 
think  I  can  very  confidently  recommend  it  to  the  gen- 
eral ]:mu^itioner  as  well  as  the  surgeon,  as  likely  to  give 
satisfaction  in  all  cases  where  a  speculum  requires  to  be 
used. 

That  a  diminution  of  the  size  of  the  instrument  shown 
here  will  have  to  be  made  to  suit  the  majority  of  cases 
I  am  oonvinoed.  This  is  an  extra  large  size.  A  me- 
dium size,  I  think,  will  cover  four-fifths  of  all  cases ; 
one  smaller  size,  and  a  larger  one,  such  as  here  shown, 
"■" '  O' 


486 


THE  MEDICAL  RECOiq). 


covering  the  other  fifth  of  the  casea  In  this  last  class 
we  include  such  cases  as  the  one  above  detailed,  and  all 
cases  with  shortening  of  the  vagina  resulting  from  in- 
jury of  its  wa^  or  otherwise.  As  soon  as  we  can  de- 
termine properly  the  alterations  necessary  to  be  made 
in  the  proportions  of  this  instmment,  in  order  to  reach 
the  other  two  sizes^  we  will  have  them  made. 

The  instrument,  when  completed  in  steel  and  electro- 
plate^ as  designed,  wiU  not,  I  am  satisfied,  exceed 
the  weight  of  tnis  our  original  pattern,  which  is  only 
eight  ounces,  being  two  ounces  less  than  the  ordinary 
lever  speculum. 

I    FiRH  AVJEAUl  UOTBL. 

CASE  OF 

ANuEMIA  AND  DYSMENOREHCEA  TREATED 

BY  GENERAL  ELECTRIZATION. 

Bt  GEO.  M.  BEAED,  M,D., 

LECTUBXB  ON  NXBV0U8  DIBBASKS  IK  TUS  UmnrSBSITT  OF  XBW  YOBS, 
AMD 

A.  D.  ROCKWELL,  M.D., 

or  Haw  YORK. 

In  our  recent  papers  before  the  Academy  of  Medicine 
and  the  Medical  Society  of  the  County  of  New  York 
we  stated  the  principle  on  which  we  employ  general 
electrization  in  certain  uterine  symptoms,  and  also 
detailed  a  number  of  cases  illustrative  of  the  powerfiil 
constitutional  tonic  efifectsof  this  method  of  treatment 
in  amenorrhcea^  dysmenorrhcea^  menorrhagia,etc.,  asso- 
ciated with  general  debility,  and  not  dependent  on  in- 
curable organic  disease. 

The  CTcat  mistake  that  we  are  all  liable  to  make  in 
our  study  of  the  therapeutical  uses  of  electrization  is  the 
confoundinff  of  aymfioms  with  diseaaes. 

In  regard  to  the  mdications  for  general  electrization, 
the  question  to  be  asked  is  not  whether  it  be  good  for 
this  or  for  that  affection,  but  whether  in  any  case  of 
disease  (no  matter  what  its  name  may  be)  we  desire  a 
powerful  constitutional  ionic  impression. 

Whether  the  tonic  influence  that  is  received  from 
general  electrization  succeed  in  curing  or  relieving  the 
special  symptoms,  associated  with  the  general  debility, 
will  depend  on  the  constitution  of  the  patient,  and  on 
the  thoroughness  and  persistence  of  the  treatment. 

In  all  tne  painful  afiections  of  the  female  genital 
system,  where  electrization  is  indicated,  temporary  relief 
is  usually  afforded  by  an  application  of  but  a  few  mo- 
ments in  duration ;  but  permanent  cure  or  dissipation 
of  the  symptoms  is  only  achieved  by  thorough  and  per- 
sistent treatment^  studiously  varied  and  adapted  to  each 
individual  case. 

We  have  sometimes  succeeded  by  general  electriza- 
tion where  internal  tonics  and  localized  electrization  have 
failed.  It  is  needless  to  say  that  we  sometimes  meet 
with  obstinate  and  obscure  cases  of  uterine  disorder 
that  are  as  rebelliona  to  general  electrization  as  to  all 
other  systems  of  treatment. 

We  have  thus  far  met  with  the  best  and  most  uni- 
form success  in  the  treatment  of  dysmenorrhoea,  especi- 
allyof  the  neuralgic  variety,  and  in  chlorosis. 

With  amenorrhoea  ihe  results  are  as  various  as  are 
the  causes  that  produce  it. 

In  mere  temporary  suppression,  the  menses  are  some- 
times brought  on  by  one  or  two  applications ;  but  in 
long-standing  amenorrhoea  we  can  hope  for  abiding  re- 
sults only  firom  a  persevering  oourse  or  treatment  con- 
tinued for  several  weeks. 

According  to  our  experience  the  tonic  effects  of  general 


electrization  are  as  permanent  as  those  which  are  ob- 
tained from  the  use  of  iron,  bark,  strychnine,  cold 
bathing,  and  other  tonic  influences  that  we  are  all  ac- 
customed to  prescribe. 

The  following  case,  which  has  not  before  been  pub- 
lished, is  t3rpical  of  a  ntunber  in  which  we  have  obtamed 
similar  or  approximative  results. 

Case.-— Miss  D.,  aged  21,  came  to  this  dty  from  Au- 
burn, to  be  treated  for  the  variety  of  dysmenorrhoea 
termed  neuralgic.  The  treatment  by  ordinary  internal 
medication  was  continued  some  two  months^  but  as  the 
neuralgic  pain  seemed  to  be  but  little  relieved,  and  as 
her  general  condition  did  not  improve^  she  was  induced 
to  try  the  effects  of  general  electrization,  before  return- 
ing to  her  home.  IShe  commenced  to  menstruate  at 
irregular  intervals  when  about  fifteen  years  of  age,  and 
from  the  first  had  suffered  more  or  less  at  each  men- 
strual period.  Her  general  health  began  to  fail  tome 
three  years  before  she  visited  this  city  for  treatment, 
and  when  she  came  under  our  observation  she  pre- 
sented the  following  symptoms: 

She  was  decidedly  ansemic,  and  the  general  ap- 
pearance of  lassitude  and  discouragement  which  she 
presented  at  once  betrayed  the  disturbance  of  her  vital 
forces.  While  in  many  instances  of  neuralgic  dysmen- 
orrhoea the  pain  seems  to  be  confined  solely  to  those 
nerves  that  supply  the  sexual  organs,  in  this  case  the 
disorder  extended  to  the  whole  system.  The  constant 
recurrence  and  terrible  paroxysms  of  pain  from  which  she 
suffered  rendered  life  a  burden.  Even  in  the  interven- 
ing time,  anticipation  of  the  agony  that  she  again  must 
so  soon  undergo,  caused  her  to  suffer  fix)m  great  depres- 
sion and  melancholy. 

In  addition  to  these  distressing  pains  she  suffered  from 
profuse  menorrhagia^  so  that  what  little  strength  she 
regained  after  her  sickness,  was  almost  immtdiately 
lost  on  the  return  of  the  catamenia.  Her  bowels  had  been 
for  a  long  time  obstinately  constipated,  and  unless  this 
state  were  frequently  relieved  by  aperients  she  was 
annoy  ed  by  considerable  vertigo  and  headache.  She  be- 
gan to  despair  of  ever  obtaining  relief.  She  received  the 
first  application  of  general  electrization  in  November, 
1866.  A  very  mild  and  fine  current  was  used,  and  tiie 
application  was  extended  from  the  neck,  down  the 
spine,  and  over  the  vital  or^^ans. 

Although  she  was  submitted  to  the  influence  of  the 
current  for  but  five  minutes,  yet  during  the  application 
she  showed  symptoms  of  faininess,  and  on  the  following 
day  she  suffered  from  considerable  soreness  and  nervous 
prostration.  She  visited  us  on  three  different  occasions 
when  her  courses  appeared,  and  were  as  long  continued 
and  attended  veith  as  great  loss  of  blood  as  before. 
There  was,  however,  considerable  amelioration  of  pain. 
Before  the  cessation  of  the  flow,  we  renewed  the  opera- 
tions, and  continued  the  treatment  uninterruptedly 
for  nearly  four  weeks.  She  received  an  application 
every  other  day,  and  was  soon  able  to  bear  a  current  of 
ordinary  intensity.  The  improvement  in  her  general 
condition  was  exceedingly  rapid.  The  capricious  appe- 
tite became  less  exacting  and  the  constipated  bowels 
more  regular.  Alter  a  very  few  applications  had  been 
given  and  the  tonic  influence  of  electrization  began  to 
manifest  itself,  she  appeared  a  different  person  bSth  as 
to  mind  and  body.  When  her  menses  again  appeared 
she  suffered  but  litUe  more  pain  than  is  usual,  and  the 
general  neural^c  distress  was  quite  wanting. 

The  menormagia,  which  before  wa8<  sudi  a  promi- 
nent and  debilitating  symptom,  was  now  so  slight  as 
scarcely  to  deserve  the  name.  She  received  subse- 
quently three  more  applications,  when  she  returned  to 
her  home.  We  were  of  course  anxious  to  know  if  this 
fevorable  state  of  things  continued,  and  have  been 


THE  MEDICAL  RECORD. 


487 


gratified  to  learn  by  direct  information  that  since  she 
discontinued  treatment  Uiere  has  been  no  return  of  any 
prominent  distressing  symptouar.  She  lias,  moreover, 
continued  to  improve  in  her  general  condition,  until 
she  is  now  in  quite  robust  health. 

914  BkOADWAT. 


©riginal  Cectiire«* 


LECTURES  ON  TUMORS: 

bboro  portion  of  the  course  ok  surgert  at  the  jetfer- 

son  medical  college,  philadelphia. 

Session  1867-8. 

By  S.  D.  gross,  M.D.,  LL.D., 

PROFESSOR  OF  BUBOEBT. 
(Reported  expressly  for  the  Mboical  Beoobd.) 

L 
Tms  is  a  subject  of  great  importance,  for  there  is  no 
commonity  in  which  tumors  do  not  constantly  present 
themselves  in  some  form  or  other,  or  in  some  part  of 
the  body  or  other.  It  is  well  therefore  that  the  phy- 
sician should  have  a  geneifal  knowledge  at  all  events  of 
this  class  of  formations.  They  are  liable  to  occur  in  all 
organs  and  tissues  of  the  body,  almost  without  exception, 
just  precisely  as  wounds,  just  precisely  as  inflammation. 

A  tumor  may  be  defined  to  be  an  enlargement  of  a 
part,  of  a  tissue,  or  of  an  organ,  the  result  of  abnormal 
deposit.  This  abnormal  deposit  may  be  a  superaddition, 
it  may  be  a  new  product  or  it  may  be  precisely  similar 
to  that  which  is  naturally  going  on  under  all  circum- 
stances of  health  in  the  tissues,  organs,  or  structures  of 
the  human  body.  Some  of  these  formations  are  benign  ; 
others  are  mciignani.  The  benign  tumors  may  be  of 
new  formation,  the  result  of  new  deposit,  or  simply  the 
result  of  inflammatory  irritation,  or  super-nutntion — 
hyper-nutrition,  if  you  please  so  to  consider  it 

The  malignant  K>rmations  are,  so  far  as  we  are  ac- 
quainted with  them,  alway^s  the  results  of  deposits  of  new 
character;  they  are  additions  to  the  preexisting  tissues. 

The  number  of  malignant  formations  is  comparatively 
small:  we  have,  in  the  first  place,  seirrhus;  secondly, 
eneepnaloid;  thirdly,  melanosis;  fourthly,  eoUoid;  and 
lastly,  epUheltoma;  —  five  malignant,  heterologous  or 
cancerous  formations ;  those  which  destroy  the  part  in 
which  they  occur,  and  ultimately,  if  the^  are  allowed  to 
pursue  their  course,  also  the  life  of  the  individual;  they 
are  therefore  called  malignant. 

The  benign^  innocuous,  or  harmless  formations — 
those  which  do  not  assume  a  malignant  character— are 
much  more  numerous,  twice,  if  not  more  than  twice,  as 
numerous  as  the  malignant;  and  a  great  many  of  them 
are  simply  the  result  of  hypertrophy,  or  a  supemutrition. 
or  the  addition  of  a  material  which  is  naturally  deposited 
in  the  tissues  organs,  or  structures  of  the  body. 

There  are  few  situations  in  which  tumors,  benign  or 
malignant,  may  not  arise;  if  there  is  any  exception  at 
all,  it  is  the  aponeuroses,  the  fibrous  structures  as  they 
are  called,  and  the  tendons,  the  ligaments,  and  the  blood- 
vessels ;  but  it  is  questionable  whether  even  these  are 
not  occasionally  the  seat  of  both  of  these  formations. 

Tumors  are  liable  to  occur  in  the  external  portions  of 
the  body  as  well  as  in  the  internal  organs. 

The  consistence  of  a  tumor  varies  according  to  its 
nature^  according  to  the  character  of  the  affected  organ, 
according  to  its  age,  and  other  circumstances.  Thus,  a 
tumor  may,  in  the  first  instance,  be  fluid ;  by  and  bv  it 
may  become  more  or  less  solid ;  ultimately  perhaps  entire- 
ly solid :  or,  instead  of  this,  the  tumor  may  be  fluid  from 
its  commencement^  and  continue  in  this  condition  dur- 


ing the  remainder  of  its  existence,  no  matter  how  pro- 
tracted this  may  be :  or  a  tumor  may  be  partly  fluid  and 
partly  solid,  and  this  may  be  in  different  portions  of  its 
extent,  and  another  part  may  be  semi-fluid,  or  semi- 
solid, depending  upon  circumstances.  In  the  earlier 
stages  of  their  existence,  tumors,  as  a  general  principle, 
are  softer  than  in  their  advanced  stages,  because  as  the 
period  of  their  duration  continues  they  acquire  a  greater 
degree  of  solidity. 

Tumors  vary  very  much  in  their  volume  ;  thus  there 
may  be  a  tumor  not  larger  than  a  millet  seed,  or  a  small 
pea,  or  a  cherry;  and,  on  the  other  hand,  it  may 
be  as  large  almost  as  the  body  upon  which  it  grows. 
The  late  Dr.  Francis,  of  New  York,  reported  many  years 
ago  a  case  of  fibrous  tumor  of  the  uterus  which  weighed 
one  hundred  and  four  or  five  pounds.  Elephantiasis  of 
the  scrotum  sometimes  acquires  an  enormous  bulk ;  cases 
are  on  record  of  tumors  of  this  kind  weighing  upward 
of  one  hundred  and  fifty  pounds.  I  have  myself  re- 
peatedly drawn  off  water  firom  ovarian  cysts  amounting 
to  upward  of  ten  gallons,  in  one  instance  twelve  gal- 
lons ;  and  stiU  lar^r  quantities  have  been  drawn  off  from 
a  cyst  of  this  kind.  These  remarks  will  give  you  an 
idea  of  the  size  a  tumor  may  acquire. 

The  form  of  a  tumor  varies  in  different  cases ;  in  some 
it  is  perfectly  round,  in  others  conical,  in  others  pyri- 
form,  in  others  exceedingly  irregular,  and  in  many  in- 
stances we  find  that  it  is  nodulated,  or  marked  by  ele- 
vations and  depressions. 

The  shape  of  the  tumor  is  very  much  influenced  by 
the  struoture  in  which  it  occurs,  much  more  than  by  its 
nature ;  if  there  is  much  pressure  exerted  on  the  tumor, 
its  tendency  will  be  to  flattening,  in  consequence  of 
the  resistance  afforded  by  the  tissues  among  or  in  whioV 
it  is  situated.  If  there  is  no  compression  exerted  upon 
the  tumor  it  may  grow  to  any  bulk  and  acquire  any  con- 
figuration or  conformation. 

They  may  be  simple  or  mvUtbcular,  that  is,  they  may 
consist  of  single  cysts  or  of  several  cysts ;  large  tumors 
are  often  composed  of  series  of  similar  masses  united 
together  by  fibrous  or  fibrous  and  cellular  tissue. 

The  color  of  a  tumor  varies  according  to  circum- 
stances, a  matter  of  comparatively  little  consequence  in 
the  consideration  of  the  history  of  such  a  growth.  It 
is  only  when  a  tumor  is  external,  or  grows  in  any 
of  the  mucous  outlets  of  the  body,  as  the  nose,  throat, 
anus,  vagina^  or  lower  extremity  of  the  uterus,  that  we 
can  observe  the  color,  and  in  that  way  deduce  important 
conclusions  in  reference  to  the  nature  of  the  affection. 
Thus  when  I  look  into  a  person's  nose,  and  find  that  it 
is  filled  with  a  tumor  having  a  whitish,  greenish,  or 
gelatinous  appearance,  much  like  that  of  an  ordinary 
oyster,  I  make  up  my  mind  at  once  that  I  have  to  deal 
with  a  tumor  which  is  benign,  innocuous,  or  harmless  in 
its  character ;  if,  on  the  other  hand,  the  tumor  is  very 
vascular,  red,  or  of  a  bluish  or  livid  aspect^  then  I  make 
up  my  mind  that  it  is  of  a  very  different  character,  that  it 
is  fibroid;  and  if  it  is  very  vascular,  scarlet  in  its  com- 
plexion, liable  to  bleed,  and  growing  very  rapidly, 
then  I  make  up  my  mind  that  I  have  to  deal  with  ah 
encephaloid  tumor,  or  a  tumor  of  a  malignant  character. 
So  in  regard  to  these  growths  as  they  occur  in  the  vagina 
or  the  uterus.  Color,  therefore^  is  of  importance  when 
the  tumor  is  exposed  to  view. 

The  mdbiUty  of  a  tumor  varies  in  different  cases. 
Some  tumors  are  movable  during  the  whole  period  of 
tiieir  existence,  fi*om  their  commencement  to  their 
termination,  as,  for  example,  when  they  are  situated 
superficially.  Thus  a  sebaceous  tumor  of  the  scalp  can 
be  readily  moved  about  in  different  directions ;  so  in 
regard  to  some  other  tumors,  as  the  fatty,  especially 
when  pendulous.    But  there  are  other  tumors  whidb 


488 


THE  MEDICAL  RECORD, 


hftve  firm  adhesions  and  are  immoTable,  and  cannot  be 
pushed  about  from  one  point  to  another;  and  this  is 
the  case  frequently  from  their  very  commencement,  and 
they  80  continue  during  the  whole  of  their  connection 
with  the  parts  in  which  they  are  developed.  As  a 
general  rule,  it  is  a  good  sign  when  there  is  a  certain 
degree  of  mobility  in  a  tumor.  A  tumor  coimected 
with  a  bone  is  generally  immorably  fixed.  A  malig- 
nant tumor,  at  a  comparatively  early  period  of  its 
growth,  forvM  adhesiom  in  the  surrounding  structures, 
as  is  seen  in  cancer  of  the  mammary  gland.  Here, 
during  the  progress  of  the  affection,  lymph  is  poured 
out  between  the  affected  gland  and  the  surrounding 
structures,  by  which  the  parts  become  firmly  united 
together,  so  that  when  we  perform  an  operation  for  its 
extirpation,  we  are  obliged  to  use  the  knife  extensively 
in  order  to  effect  tlie  detachment  So  also  in  tumors  of 
benign  character  when  they  are  developed  among  the 
muscles,  or  when  they  are  situated  comparatiyely  super- 
ficially ;  the  pressure  on  the  surrounding  parts  excites 
inflanmiation,  lymph  is  poured  out,  and  strong  adhesions 
are  formed.  Again,  a  part  may  be  bound  down  merely 
by  the  tension  of  the  muscles,  ^neuroses,  tendons,  and 
other  structures,  without  any  aid  whatever  from  plasma, 
lymph,  or  fibrin. 

The  amsibility  of  tumors  varies  according  to  circum- 
stances. The  beni^  growth  is  rarely  attended  with  any 
Bensibility  unless  it  compresses  an  important  nerve. 
Then  there  may  be  pain,  which  may  be  stationary  or 
constant;  there  may  be  numbness  in  the  parts  around 
and  beyond  the  seat  of  the  tumor,  owing  to  compression 
of  the  nerves  and  the  imperfect  transmission  of  the  nerve- 
fluid.  Generally  such  tumors  are  firee  from  pain,  or  if  there 
be  pain,  it  is  comparatively  slight ;  whereas  in  malignant 
tumors,  especially  in  scirrhua,  there  is  usually  pain  at  a 
very  early  stage,  and  pain  which  goes  on  gradually  in- 
creasing in  severity  until  at  length  it  becomes  distressing, 
depriving  the  patient  of  appetite  and  sleep,  and  requiring 
anodynes  for  its  relief. 

The  rtlations  which  tumors  hear  to  ihe  surrounding 
structures  are  worthy  of  consideration.  Every  tumor 
must  have  a  habitation,  a  residence.  It  is  developed  at 
a  particular  point,  and,  as  it  increases  in  size,  it  gradually 
encroaches  on  tihe  surrounding  structures,  until  at 
length  it  has  not  room  enough  for  its  development, 
and  then  must  produce  more  or  less  serious  effects  upon 
^e  adjacent  parts  as  well  as  on  the  system  at  la^. 
In  consequence  of  this  pre8su^e,  as  well  as  the  ^G£i 
life  of  some  of  these  tumors,  we  find  that  there  is  a 
tendency  to  ulceration  and  to  elimination. 

The  benign  tumors  generally  retain  their  vitality 
unimpaired  lor  a  considerable  length  of  time,  frequently 
for  many  years.  In  many  oases,  espedally  in  the  malig- 
nant formations,  ulceration  takes  place  at  a  comparative^ 
early  period^  in  consequence  of  the  pressure  on  the 
tumor  exercised  by  the  supenaoent  structures,  and  in 
consequence  also  of  its  peeuhar  organization ;  and  in 
this  way  an  open  sore  is  formed,  pecuuar  in  its  character, 
attended  with  a  peculiar  discharge,  attended  with  a 
peculiar  pain. 

Occasionally  there  is  important  involvement  of  the 
lymphatic  ganglions  around.  This  is  the  case  some- 
times in  the  benign  tumors,  but  comparatively  seldom ; 
whereas  in  the  mahgnant  formations,  as  scirrhus,  me- 
lanosis, etc.,  the  lymphatic  gangUons  usually  become 
affected  in  a  comparatively  short  time.  The  nearest 
lymphatic  ganglions  always  suffer  in  this  way ;  thus,  in 
canoer  of  the  penis,  the  lymphatic  ganglions  of  the 
l^oin  become  involved ;  in  cancer  of  the  lip,  those  of  tlie 
jaw  and  the  chin;  in  cancer  of  the  mammary  gland,  the 
lymphatic  ganglions  of  the  axilla  are  invaded;  all  this 
as  a  necessary  result^  as  it  were,  of  a  contamimtted  con- 


dition of  these  structures  from  the  preexisting  disease 
in  the  neighboring  organ,  tissue,  or  structure. 

As  already  mentioned,  I  make  two  great  distincdona 
of  tumors  or  morbid  growths:  the  hen^  and  the  maUg- 
nant;  the  malignant  are  also  known  \mder  the  name 
of  the  heterologous,  heteroclite,  or  heteromorphous  form- 
ations. 

BKNIGV  TUlfOBS. 

Commencing  with  the  more  simple  benign,  innocu- 
ous, or  harmless  tumors,  we  have; — 

In  the  first  place,  the  hypertrophic  tumor,  the  result 
of  hvpertrophy  or  supemutrition,  a  sort  of  outgrowth 
of  the  natural  tissue,  structure,  or  organ,  where  the 
formation  occurs; — 

In  the  second  place,  there  is  what  may  be  called  the 
vascular  tumor,  composed  essentially  of  Teasels  in  a 
state  of  enlargement  and  morbid  alteration ; — 

In  the  third  place,  there  is  the  adipose  or  fatty  tumor, 
nothing  but  a  hypertrophic  condition  of  the  natural 
adipose  or  &tty  tissue,  the  tissue  which  occurs  in  such 
great  abundance  in  certain  individuals  in  different  parts 
of  the  body; — 

In  the  fourth  place,  we  have  what  is  called  the  horm^ 
tumor,  or  the  corneous  tumor,  a  tumor  resemUing  the 
horn  of  some  of  the  inferior  animals,  as,  for  example, 
the  goat; — 

In  the  ffdh  place,  we  have  the  fibroid  tumor,  or  the 
fibrous  tumor  as  it  is  not  unfrequentfy  called,  a  tumor 
composed  essentially  of  a  substance  resembling  some  of 
the  pre^isting  normal  or  natural  tissues,  as,  wr  exam- 
ple, the  sclerotic  coat  of  the  eye,  the  dura  mater,  the 
pericardium,  the  proper  coat  of  the  testicle,  the  aponeu- 
roses, periosteum,  etc.,  composed  essentially  of  fibrous 
tissue: — 

In  the  sixth  place,  we  have  the  cariHagisums  tumor, 
so  called  from  the  resemblance  which  it  bears  to  the 
cartilaginous  tissue,  composed  of  a  gristly  texture,  firmer 
than  the  fibroid  tumor,  less  firm  than  the  bony  tumor — 
the  enchondromatous  tumor  as  it  is  sometimes  denom- 
inated ; — 

Then,  in  the  seventh  place,  we  have  the  osseous  tu- 
mor, the  bony  tumor,  a  tumor  resemUing  essentially  the 
natural  bony  tissue,  resembling  it  but  not  identical  with 
it,  as  you  observe  in  ihe  various  specimens  on  the 
table;— 

Then  we  have,  in  the  eighth  place,  the  eakareous  tu- 
nior,  or  earthy  tumor,  a  tumor  of  exceedingly  rare 
occurrence,  most  generally  found  in  connection  with  a 
degenerated  lymphatic  g^glion  of  the  neck,  groin,  or 
bronchial  tubes ;  or  in  the  uterus,  in  oonneotion  perlupe 
with  the  fibroid  or  fibro-cartilagioous  tumor  of  that 
orran  ;— 

We  have,  in  the  ninth  place,  the  neuromatous  tumor, 
a  tumor  developed  along  the  course  of  a  nerve,  com- 
posed of  an  expansion  of  the  nerve-fibre,  with  the  ad- 
dition of  a  large  quantity  of  the  fibrous  or  fibroid  ele- 
ment such  as  mat  which  liters  so  largely  into  the  com- 
position of  the  ordinary  fibroid  development  j — 

Tentbly,  we  have  the  cystic  tumor,  which  is  exceed- 
ingly common,  and  which  may  be  an  original  growth, 
or  it  may  simply  be  an  outgrowth  of  the  preSxisdng 
structure ; — 

Eleventhly,  we  have  the  hydaiic  tumcMr,  a  tumor  com- 
posed essentially  of  hydatids,  found  most  firequently  in 
the  liver  and  in  the  ovary ; — 

Twelflhly,  we  have  the  polypoid  tumor,  met  with 
chiefly  in  the  cavities  of  the  nose,  the  uterus,  vaginai 
larynx,  fauces,  ear,  urethra,  and  the  urinary  bladder,  in 
a  word,  in  the  mucous  outlets  of  the  body;  called 
polypoid  from  its  resanblance  to  a  pdyp; — 

And  in  the  last  place,  there  is  the  tnydoui  tumor,  ori^ 


TBE  MEDICAL  RECORD. 


460 


inaUy  described  hj  Lebert  and  Paget,  a  tumor  the  ex- 
ifitenoe  of  which  is  not  yet  fully  deteimined ;  my  con- 
Tiction  is,  judging  firom  the  history  of  this  deyelc^ment, 
and  from  what  I  have  seen  of  it,  that  it  is  nothing  but  a 
form  of  enoephaloid  tumor,  fungus  hematodes,  or  soft 
cancer,  and  consequentiy  a  malignant  formation.  We 
have,  therefore,  including  the  myeloid  tumor  of  Lebert 
and  Faget,  thirteen  distinct  growths  of  tiiis  kind. 

NO.  I. — HTPEBTBOPHIO  TtTMOBS. 

The  hypertrophic  tumor  is  simply  an  outgrowth  of  a 
preexisting  structure,  tissue,  or  organ;  it  is  simply,  in 
other  words,  hypertrophy  of  a  preexisting  part  the 
result  of  supemutrition,  of  overgrowth,  of  inordinate 
vascular  activity,  attended  with  deposit  of  plastic  mat- 
ter, and  the  organization  of  this  matter,  so  that,  at 
len^^h,  it  becomes  part  and  parcel  of  the  tissue  with 
which  it  is  incorporated.  I  can  give  you  a  good  idea  of 
this  form  of  tumor  by  referring  you  to  what  so  fre- 
quently occurs  in  enlargement  of  the  tonsils.  In  persons 
ojf  scrofulous  temperament  or  predisposition,  these  glands 
are  exceedingly  liable  to  become  enlarged,  expecially 
in  young  children  under  the  age  of  nine  or  ten;  the 
slightest  exposure  to  cold  will  bring  on  an  attadc  of 
tins  kind ;  and  when  the  enlargement  has  progressed  to 
some  extent,  then  this  being  the  weak  part  of  the 
body,  whenever  the  patient  takes  cold,  pr  is  laboring 
under  disorder  of  the  general  health,  however  induced, 
there  will  be  apt  to  be  an  increased  activity  in  these 
structures,  followed  by  augmentation  of  their  size.  Now 
these  organs  exist  in  the  natural  state,  and  we  account 
for  the  enlargement  by  supposing  that,  in  consequence 
of  the  irritation  or  inflammation  which  takes  place  from 
the  causes  mentioned,  there  is  an  increased  flow  of 
blood  to  them,  that  their  vessels  become  enlarged  in 
consequence  and  thus  carry  more  blood  than  in  the 
normal  state,  and  these  vessels,  under  the  influence  of 
this  irritation  or  inflammation,  or  both,  deposit  plasma, 
lymph,  or  fibrin,  in  larger  quantity  than  they  do  in  the 
natural  state  simply  for  the  purpose  of  nourishing  or 
keeping  up  the  growth  or  vitality  of  these  bodies ;  the 
fibrin  is  intimately  connected  with  the  process  of  nutri- 
tion, which,  under  such  ciroumstanoes,  is  simply  in 
a  state  of  perversion;  there  is  simply  an  increase 
of  it,  hypertrophy — and  hence  we  say  that  a  tumor 
of  this  kind  ia  a  "  hypertrophic"  tumor.  So  in  regard 
to  what  is  called  goitre,  bronchocele,  or  the  "Derby- 
shire neck."  It  is  an  enlargement  of  the  thyroid 
gland,  situated  at  the  sides  of  the  larynx  and  upper 
portions  of  the  trachea,  consisting  of  two  lobes  con- 
nected at  the  middle  line  by  what  is  called  the  isthmus 
of  the  gland.  What  the  precise  function  or  structure  of 
this  hodj  is,  has  not  been  determined ;  but  we  know 
that  it  is  liable  to  the  formation  of  a  tumor,  especially 
frequent  in  certain  regions  of  the  world,  as  the  moun- 
tainous regions  of  the  United  States,  of  Switzerland, 
Italy,  Germany,  France,  the  Indies,  China,  )&&,  from 
what  cause,  we  cannot  determine. 

We  have  another  instance  of  this  form  of  tumor,  in 
old  age,  in  enlargement  of  the  prostate  ^land.  Then  we 
have  elephantiasis  of  the  scrotum,  consisting  of  hyper- 
trophy of  the  skin  and  subcutaneous  cellular  tissue. 
Cases  of  this  Idnd  are  on  record  where  the  tumor 
weighed  respectively  one  hundred  and  twenty,  and  one 
hundred  and  sixty  or  sixty-five  pounds,  all  due  to  an 
outgrowth  of  the  skin  and  subcutaneous  cellular  tissue. 

For  the  relief  of  these  tumors,  the  surgeon  must  call 
into  requisition  sorbefacient  remedies,  locally  applied 
and  administered  internally ;  when  these  fail,  the  organ 
must  be  retrenched,  or,  if  need  be,  excised,  an  operation 
which  is,  however,  generaUy  impracticable.  Such,  in  a 
-ew  words,  are  the  principles  of  treatment. 


HSit^oxts  of  i^ospitaia. 


NOTES  OF  HOSPITAL  PEACTICK 

By  H.  D.  BULKLEY,  M.D., 

msioiAii  or  Hsw  tosk  bobpral. 

Thb  Medical  Department  of  the  New  York  Hospital 
has  furnished  dunng  the  month  of  October  a  variety  of 
interesting  and  instructive  cases,  scmie  of  which  are 
thought  worthy  of  record. 

The  different  forms  and  varieties  of  malarial  disease 
have  formed  a  large  share  of  the  whole  number  of  oases, 
though  not  so  numerous  nor  so  severe  as  during  some 
past  years.  There  have  been  fewer  of  those  severe  oases 
of  congestive  fever  which  are  idways  so  alarming,  and 
a  much  smaller  number  of  cases  of  that  form  of  cachexia 
produced  by  the  malarial  poison,  so  characteristic  of 
the  effects  of  its  protracted  influence,  and  fewer  cases  of 
visceral  enlargements  firom  this  cause  than  were  so  com* 
mon  in  past  years.  Whether  this  is  to  be  attributed 
to  the  smaller  number  of  sailors  engaged  in  the  Southern 
trade  than  formerly,  or  whether  they  remain  a  shorter 
time  on  shore,  or  whether  prophylactic  means  are  more 
generally  used,  it  is  difficult  to  say. 

But  two  cases  of  the  congestive  form  of  malarial 
fever  have  occurred  during  the  month,  and  these  not ' 
of  the  most  severe  form.  Both  yielded  to  quinine,  at 
first  by  hypodermic  injection,  and  afterward  by  mouth. 
This  mode  of  using  quinine  is  now  the  rule  of  the 
house,  not  only  in  such  cases,  but  in  simple  intermittents, 
both  quotidian  and  tertian;  and  it  is  seldom  that  it 
fails  to  prevent  a  paroxysm  afl«r  entering  the  hospital, 
if  there  is  sufficient  time  for  its  action.  Two  injections 
of  four  grams  each,  with  an  interval  of  two  hours  be- 
tween &em,  are  usually  sufficient  for  this  purpose. 
Quinine  is  then  given  by  the  mouth  to  prevent  their 
return.  This  mode  of  treating  different  forms  of  mala- 
rious diseases  has  proved  both  eQective  and  econom- 
ical. Not  the  slightest  unpleasant  result  has  occurred 
in  its  use  except  in  one  instance,  when  an  abscess  formed, 
which  caused  but  little  trouble. 

Not  a  single  case  of  uncomplicated  malarial  disease  has 
proved  fatal  during  the  month,  and  it  is  rare  that  pa- 
tients with  intermittents  have  had  more  than  the 
second  paroxysm  afler  entering  the  hospital ;  and  while 
it  is  true  that  the  cases,  as  a  whole,  have  been  less  se- 
vere than  during  former  years,  it  is  no  less  true  that 
much  of  this  success  during  this  as  well  as  the  past 
season  may  fairly  be  attributed  to  the  hvpodermic  use 
of  quinine,  first  introduced  into  use  in  this  hospital  by 
my  colleague.  Dr.  G.  M.  Smith.  Instances  have  occurred 
in  whidi  it  was  necessary  to  administer  these  befbre 
the  patient  was  taken  from  the  carriage,  to  enable  hhn 
to  be  brou^t  safely  into  the  ward,  and  perhaps  again 
on  his  way  into  the  ward.  Preparations  are  made  to  ad« 
minister  quinia  in  solution  in  sulphuric  ether,  as  lately 
recommended,  but  no  trial  of  this  form  of  giving  it  was 
made  before  tne  close  of  the  month. 

Atropia  and  morphia  are  also  constantly  introduced 
in  the  same  way  in  appropriate  cases,  and  vntbout  any 
inconvenience  during  the  present  montL 

OHRONIO   DTSBNTKRT. 

Three  cases  of  chronic  dysentery  and  two  of  acute  were 
treated  with  large  doses  of  ipecac,  and  with  good  results. 
The  first  case  was  that  of  a  man  thirty-nine  years 
of  age,  who  had  contracted  the  disease  in  the  East  In- 
dies about  two  years  previously^nd  who  had  been  in 
the  hospital  over  eight  months.  He  averaged  about  eight 
or  nine  bloody  stools  in  twenty ^our^hours.  He  took 
Digitized  by  VjOOk  ^  _ 


400 


THE  MEDICAL  RECORD. 


seyen  boluses  of  ipecac,  consisting  of  ten  grains  each,  tak- 
ing three  daily,  and  at  the  end  of  eight  or  ten  days 
had  one  or  two  evacuations  each  day,  fkcal  and  without 
blood.  The  secon^  a  man.  thirty  years  of  age,  first  had 
dysentery  in  India  about  fourteen  months  ago,  and 
when  treated  in  this  way,  was  haying  twelve  to  fifteen 
dysenteric  stools  a  day.  He  took  ten  grains  of  ipecac 
three  times  a  day,  for  ten  days,  and  soon  had  only  one 
or  two  fsBcal  and  natural  passages  every  twenty-four 
hours.  This  man  had  at  the  same  time  albuminuria.  There 
was  some  oedema  of  the  lower  extremities.  His  urine 
contained  no  albumen  at  the  time,  though  some  had 
previously  been  found  in  it ;  but  the  microscope  showed 
hyaline  casts  and  kidney  epithelium,  and  oxalates.  After 
passing  stools  of  this  character  some  days,  he  had  a 
characteristic  cla^-colored  stooL  He  then  took  two 
more  boluses,  which  had  the 'effect  the  first  twenty-four 
hours  of  producing  a. free  bilious  stool,  and  a  few  days 
afterward  he  was  only  passing  one  natural  stool  daily. 
The  third  case  of  this  group  was  a  man  thirty-six  years 
of  age,  who  contracted  the  disease  in  China  eighteen 
months  before,  and  who  was  having  twelve  or  more 
bloody  and  mucous  stools  in  twenty-four  hours.  He 
took  four  doses  of  ipecac  of  ten  grains  each,  and  in  a 
few  days  was  passing  one  or  two  healthy  stools  in 
twenty-four  hours.  All  these  cases  had  been  some  time 
under  treatment,  and  had  taken  a  variety  of  remedies 
without  any  permanent  benefit 

The  first  of  the  patients  with  acute  dysentery  was  a 
man  of  thirty  years  of  age,  pale  and  somewhat  cachectic, 
who  had  been  suffering  with  the  disease  about  three 
weeks  before  admission,  and  had  about  five  oc  six  pas- 
sages daily,  either  mucous  or  bloody,  or  isecal,  more  or 
less  mingled  with  blood.  He  had  taken  calomel  and 
opium  at  first,  followed  by  opium  alone,  but  with  only 
temporary  benefit.  After  several  relapses  he  took  four 
of  the  doses,  containing  ten  grains  each,  of  ipecac,  and 
was  completely  relieved  in  a  few  da3rs,  and  left  the 
hospital  at  the  end  of  sixteen  days,  entirely  well. 

The  second  case  of  acute  dpentery  was  that  of  a 
man  who  had  bloody  stools,  mingled  with  fsecal  matter, 
who  took  two  of  the  boluses,  with  the  effect  of  pro- 
ducing free  bilious  discharges,  and  with  entire  relief. 

A  sixth  patient,  who  took  large  doses  of  ipecac,  was 
a  man  who  had  been  in  the  hospital  nearly  four  monliiB, 
who  was  suffering  under  rather  copious  liquid  stools, 
nearly  natural  in  color,  three  or  four  in  twenty  hours, 
which  were  suspected  to  be  tubercular  in  their  charac- 
ter. In  this  case  the  result  was  negative,  as  might 
perhaps  have  been  anticipated  from  the  nature  of  the 
case.  He  took  three  boluses  in  the  course  of  one  day, 
and  two  on  the  following  day.  He  vomited  a  little  the 
first  night,  but  not  afterward.  The  first  effect  was  an 
increase  of  the  quantity  and  firequency  of  the  discbarges, 
with  a  decided  bilious  tinge,  amounting  to  ten  or  twelve 
stools  in  the  twenty-four  hours.  The  stools  then 
resumed  their  previous  character,  and  their  usual  fi-e- 
quency.  This  mode  of  treatment  was  then  discontin- 
ued, on  the  supposition  that  this  was  not  a  case  in 
which  it  promised  success. 

It  is  perhaps  worthy  of  notice,  in  passing,  that  the 
first  of  these  patients  on  the  list,  the  man  who  had  con- 
tracted dysentery  in  India  two  years  previously,  had 
distinct  attacks  of  rheumatism  whenever  the  dysentery 
was  alleviated,  and  that  this  alternation  between  these 
diseases  had  attracted  his  own  attention,  and  led  him  to 
speak  of  it  This  corresponds  with  the  observations  of 
some  of  the  older  writers,  who  considered  them  as 
analogous  diseases,  and  both  owing  to  a  similar  disor- 
dered state  of  the  blood.  This  was  the  view  entertained 
by  Akenside,  in  his  Commentary  on  Dysentery,  who 
called  this  disease  a  rheumatism  of  the  intestines,  and 


said  that  rheumatism  and  dysentery  made  firequent 
transitions  from  one  to  the  other.  I  cannot  recall, 
however,  any  other  instance  of  such  a  relation  between 
them,  nor  is  it  mentioned  by  writers  generally. 

Ipecac  given  in  these  doses  usually  vomits  two  or 
three  times  very  fi'eely,  after  whicn  it  is  tolerated 
by  the  stomach.  The  first  of  these  patients  only 
vomited  after  the  first  bolus;  the  second,  the  one 
with  Bright's  disease,  vomited  for  two  or  three  days 
after  the  last  bolus  was  taken;  the  third  vomited 
but  very  little,  and  only  afl»r  the  first  bolus.  The 
fourth  patient  (the  first  with  subacute  dysentery)  vom- 
ited only  aft«r  the  first  bolus;  no  note  of  the  second 
(acute)  case  was  taken  on  this  point 

A  mustard  poultice  was  generally  applied  over  the 
epigastric  region  for  about  fifteen  minutes  each  time 
before  a  bolus  was  given,  but  not  always.  Laudanum 
was  not  given  in  any  case  before  the  exhibition  of  the 
ipecac,  as  recommended  by  Surgeon  Docker,  of  Bengal, 
who  was  the  first  to  bring  this  practice  into  notice, 
more  especially  in  acute  dysentery.  This  gentleman 
gave  much  larger  doses  of  ipecac,  sometimes  as  much  as 
a  drachm  and  a  half  at  a  time. 

No  sweating  was  produced  by  this  mode  of  treatment 
in  either  of  these  cases. 

The  action  of  ipecac  given  in  this  way  is  decidedly 
cholagogue,  its  exhibition  being  soon  followed  by  an 
abundant  discharge  of  bile  from  the  bowels,  generally 
with  a  considerable  quantity  of  fascal  matter,  and  a  re- 
lief of  the  tenesnms  and  of  all  irritation ;  and  it  is  doubt- 
less to  this  action  on  the  liver,  and  the  free  flow  of  bUe 
which  results  from  it^  that  its  beneficial  effects  on  the 
disease  are  to  be  attributed. 

During  the  months  of  September  and  October,  1861, 
I  treated  three  cases  of  chronic  dysentery  and  one  case 
of  chronic  diarrhoea  with  large  doses  of  ipecac,  and  with 
such  good  results  that  I  was  induced  to  bring  them 
before  the  New  York  County  Medical  Society,  in  a 
paper  which  was  afterward  published  in  the  fourth  vol- 
ume of  the  American  Medical  Times.  Of  these  cases, 
the  disease  had  lasted  in  one  three  months,  in  a  secona 
five  months,  in  a  third  four  months,  and  in  a  fourth 
some  months,  without  stating  the  exact  tune.  The  first 
of  these  patients  was  having  fifteen  to  twenty  stools  in 
twenty-four  hours  at  times :  the  second,  eleven  or  twelve 
stools  during  the  same  penod;  and  the  third^  sometimes 
as  many  as  twenty,  and  seldom  less  than  eight  or  ten. 
The  number  of  stools  in  the  fourth  was  not  noted.  The 
stools  became  nearly  or  quite  natural,  in  the  first  case, 
at  the  end  of  eight  or  ten  days ;  in  the  second,  at  the 
end  of  eight  days;  the  third  was  in  full  convalescence 
ix^  the  course  of  a  week.  In  the  fourth  case,  so  great  a 
change  was  caused  by  a  single  dose  of  ten  grains  of 
ipecac,  which  produced  neither  nausea  nor  vomiting,  that 
the  patient  left  the  hospital  in  a  few  days,  after  having 
been  there  under  treatment  for  some  months. 

Dr^  McKidd  reports  a  case  in  the  Edinburgh  Medical 
Journal  for  July,  1861,  in  which  a  diarrhoea  which  had 
lasted  ten  years  was  almost  entirely  checked  by  the  end 
of  the  first  week  by  doses  of  twenty  grains  of  ipecac 
(reduced  in  a  few  days  to  ten  grains)  every  twelve 
hours;  and  it  was  this  report  which  led  to  the  trial  of 
it  in  the  preceding  cases. 

Three  cases  of  albuminuria  were  treated  during  the 
month  with  the  bichloride  of  mercury,  and  with  satis- 
factory results.  One  of  these  was  a  boy  about  sixteen 
years  of  age,  who  had  been  suffering  from  the  disease 
two  or  three  yeairs,  who  had  never  had  scarlet  fever, 
and  whose  disease  could  only  be  traced  to  exposure  to  al- 
ternations of  temperature,  and  to  damp  and  wet  weather. 
He  had  granular  and  hyaline  casts  in  his  urine,  and  his 
body  and  limbs  were  much  distended  with  fluid.    The 


THE  MEDICAL  RECORD. 


491 


dropsical  effusion  had  subsided  very  much,  his  general 
condition  was  much  improved,  and  when  the  urine 
was  examined  near  the  end  of  the  month,  no  casta  were 
found  in  it  In  a  second  case,  in  which  granular  casts 
were  found,  this  remedy  was  also  found  useM.  The 
third  case  was  that  of  a  stout,  well-developed  man,  who 
entered  the  hospital  about  the  middle  of  the  month,  who 
was  very  much  swollen,  and  whose  urine  contained  a 
great  abundance  of  albumen,  and  microscopical  signs  of 
an  acute  attack,  and  whose  attack  was  airectly  pro- 
duced by  exposure  to  cold  and  wet.  He  was  decidedly 
improving  under  the  use  of  this  remedy  when  he  was 
discharged  by  request  The  hot  vapor  bath  had  also 
been  used  in  his  case,  but  without  marked  effect  The 
dose  of  bichloride  used  in  all  the  cases  was  one  thirty- 
second  part  of  a  grain,  in  the  compound  tincture  of 
gentian. 

One  case  of  chorea,  of  a  rather  mild  form,  in  a  boy 
about  fourteen  years  of  age,  which  had  existed  about 
two  years,  was  treated  with  the  bromide  of  potassium, 
in  doses  first  of  ten,  and  afterward  of  fifteen,  increased 
to  twenty  grains,  three  times  a  day,  but  with  litde  if 
any  perceptible  effect  on  the  disease. 

Kheumatism  in  its  different  varieties  and  forms 
was  fully  represented  in  the  wards  during  the  month, 
and  there  were  a  few  cases  of  typhoid  fever ;  and,  as 
usual,  some  cases  of  delirium  tremens — but  we  do  not 
propose  to  extend  our  paper  by  remarks  on  these.  The 
whole  number  of  patients  imder  treatment  during  the 
month  was  219,  and  the  total  number  of  deaths,  8, 
or  a  little  less  than  4  per  cent 
Kiw  YoBK.  NoTember,  18d7. 


Pr0fir«0  0f  iEelrttol  9it\tnct. 


Gentian  Boot  as  a  Dilator. — Professor  Winckel  in 
I(pstock  recommends  (Deutsche  Klinik,  1867)  the  radix 
gentianse  rubr»  as  a  new,  simple,  and  cheap  means  of 
dilatation  for  surgical  and  gynecological  purposes.  His 
attention  was  first  directed  thereto  by  an  article  of  John 
Jacob  Haeberlj  published  in  1834,  in  which  the  author 
states  that  havu^  operated  for  atresia  uteri  and  desiring 
to  keep  open  the  orifice  made  by  the  trocar,  he  intro- 
duced a  good,  firm  plug  of  radix  gendansB,  and  that  on 
the  following  day  he  found  no  small  difficulty  in  with- 
drawing the  same,  which  had  increased  to  twice  its 
former  size.  According  to  Dr.  Winckers  observations 
'  the  gentian  root  has  the  foUowing  advantages  over 
laminaria:  Ist  Its  cheapness,  the  ease  with  which  it 
can  be  obtained,  and  the  &ct  that  the  physician  can  so 
easily  cut  plugs  and  bougies  of  any  size  to  suit  his  re- 
quirements. 2d.  Its  somewhat  sinaller  power  of  ab- 
sorption, as  compared  with  laminaria,  is  compensated 
by  our  being  able  to  obtain  larger  pieces  of  it  (one 
and  one-half  to  two  inches  in  diameter)  so  that  it 
can  be  used  for  the  dilatation  of  openings  already  too 
large  for  laminaria.  3d.  The  fact  of  its  remaining  free 
fiwn  smell  constitutes  an  immense  advantage,  for  even 
laminaria,  though  in  a  much  less  degree  than  sponge- 
tents,  often  becomes  quite  foetid. 

The  radix  gentianse  may  therefore  be  used  with 
special  advantage  in  strictures  of  the  vulva,  vagina,  and 
uterus;  for  tamponing  the  uterus  in  smaller  htemoi'- 
rhages^  for  the  induction  of  abortion,  for  dilatation  i^er 
operations  for  atresia  of  the  genital  organ?.  Whether 
it  is  also  apphcable  to  stricture  of  the  urethra,  to  affec- 
tions of  the  lachr3rmal  ducts,  etc.,  remains  to  be  seen. — 
AU.  Med.  aZig.  IBff! .--Memorahaien. 

BXMOVAL  or    THE  SOAPULA,   HaLF  OF  TDI  ClAVIGLB, 

AND  THE  Whole  Arm;   Death  on  the  Third  Dat. — 


Sir  William  Fergusson  lately  performed  this  operation 
upon  a  patient  in  King's  College,  London,  it  being  some- 
what similar  to  the  one  done  by  him  two  years  ago,  and 
reported  in  our  columns,  this  making  the  second  one  of 
the  kind  performed  in  London.  The  following  aoooont 
of  the  case  is  taken  from  the  London  Lancet : 

Josiah  B ,  aeed  forty,  married,  late  of  Queens 

land.  New  South  Wales,  was  admitted  into  the  hospital 
on  tne  seventh  of  October  last,  with  a  loxwe  osteo-sar- 
comatous  tumor,  involving  the  left  scapula,  shoulder- 
joint,  and  adjacent  parts.  Two  years  ago  he  feU  on  the 
left  shoulder  and  cut  it  open  against  a  sharp  edge  of 
wood.  The  wound  healed  in  a  fortnight,  leaving  a 
cicatrix,  which  is  now  visible.  Two  months  afterward 
he  noticed  that  the  shoulder  was  becoming  painful; 
and,  in  three  months,  that  a  tumor  was  appearing.  It 
increased  rapidly  for  six  months.  He  went  to  Sydney, 
where  he  was  advised  to  come  to  England  The  size  of 
the  tumor  remained  stationary  from  the  time  of  his 
visit  to  Sidney  till  two  months  ago,  since  which  time 
it  has  again  increased  rapidly.  He  has  had  a  numbing 
pain  in  the  shoulder  ever  since  the  commencement 
This  pain  has  been  worse  of  late.  He  has  always  en- 
joyed robust  health.  He  says  that  his  father  died  after 
the  removal  of  a  tumor  from  the  back.  He  is  to  all  ap- 
pearances a  strong  man ;  and,  with  the  exception  of  the 
tumor,  in  a  good  state  of  health.  There  is  a  large  tu- 
mor in  the  left  scapular  region.  It  is  smooth,  in  parts 
very  hard,  giving  a  bony  sensation.  The  skin  is  freely 
movable  over  it,  and  perfectly  free  from  disease.  It 
moves  easily  with  the  scapula ;  but  is  immovable  in  its 
deep  attachments.  It  occupies  the  whole  of  the  space 
behmd  the  scapula,  and  takes  three  palms  of  the  hand 
to  cover  it  It  also  projects  downwiu^i  into  the  axilla. 
Here  it  is  very  hard,  and  the  covering  of  sldn  is  thinner 
than  elsewhere.  The  growth  goes  forward  under  the 
clavicle,  but  does  not  go  above  it  into  the  clavicular  re- 
gion of  the  neck.  The  subclavian  can  be  readily  com- 
pressed against  the  first  rib.  The  arm  is  freely  movable 
backward  and  forward,  going  with  the  scapula,  but  it 
cannot  be  directly  abducted. 

The  foUowinji^  were  the  chief  steps  of  the  operatioiL 
which  was  bnUiantly  performed  before  a  crowded 
theatre.  The  patient,  under  the  influence  of  chloroform, 
was  placed  on  nis  right  side,  well  over  to  the  right  edge  o  f 
the  table.  Mr.  W<kk1  compressed  ^e  subclavian  artery. 
Mr.  Henry  Smith  assisted  on  the  right  and  Mr.  Trevor, 
the  house-surgeon,  on  the  left  side.  Sir  William  stood 
on  the  right  side.  The  first  incision  was  over  the  outer 
third  of  me  clavicle,  which  was  sawn  through ;  then  a 
long,  sweeping  cut  firom  this  point,  curving  down  in 
fi*ont  of  the  shoidder,  round  the  arm,  over  the  deltoid, 
to  the  inferior  angl^  of  the  scapula.  The  shoulder-joint 
was  found  to  be  involved,  the  humerus  being  almost 
immovable.  The  flaps  were  then  dissected  off  nom  the 
sd^ula,  and  the  muscles  divided  along  the  upper  and 
ventral  borders  of  this  bone,  which,  with  the  arm,  was 
well  tilted  forward,  and  the  knife  carried  round  with  a 
circular  sweep  to  tiie  clavicle,  whence  the  incision  had 
first  started — ^the  important  vessels  and  nerves  being 
divided,  so  to  speak,  by  the  last  cut.  The  flaps  were 
then  sponged,  and  the  main  vessel  and  others  secured. 
Mr.  yfo<A  had  the  subclavian  so  well  under  control  that 
there  was  no  bleeding  fiK)m  it,  and  very  little  fit)m  the 
smaller  arteries;  the  man  lost  but  six  ounces  of  blooa 
at  most  Some  spicula  of  bone  were  dissected  from 
the  posterior  flap,  and  a  pieoe  sawn  fr<Hn  the  outer  end 
of  the  davide,  which  was  too  long.  The  flaps,  which 
were  abundant  were  brought  together  by  sutures,  and 
water-dressing  and  strappmg  implied.  The  man  was 
under  the  influence  of  chloroform  during  the  whole  of 
the  operation,  but  seemed  to  feel  a  shpck  when  the 


Digitized  by  LjOO^. 


492 


THE  MEDICAL  RECOER 


main  ressels  tod  nerves  were  divided.  The  tumor, 
whidi  was  of  an  osteo-sarcomatous  nature,  was  sent  to 
the  Bm$i  College  of  Surgeons.  The  patient  expired  at 
the  end  of  the  third  day,  from  the  combined  effects  of 
the  shock  of  the  operation,  and  the  existence  of  fatty 
heart,  fatty  kidney,  and  fktty  liver. 

Fraotitsbs  at  th£  Hip*  thx  Nature  of  txb  Lebioit, 
jjn>  ITS  Tbbatmxnt. — Bjl  H.  G.  Davis,  in  an  interesting 
•chapter  on  fractures  (Cofuervatwe  8wrgtry\  takes 
occasion  to  refer  to  the  characters  of  intra  and  extra 
capsular  fractures.  Afler  alluding  to  the  strength  of 
the  neck  of  the  femur,  and  its  capability  of  bearing  any 
amount  of  weight  from  below  upward,  he  assets  that 
when  the  force  is  applied  in  the  opposite  direction  « 
strain  is  brought  upon  the  cervix  in  its  most  defenceless 
position.  This  is  accounted  for  by  the  degree  of  ob- 
liquity of  the  neck  of  the  bone,  and  the  direction  of  the 
eancelH  that  support  the  articulating  head.  One  set  of 
these  fibres,  arranged  in  the  form  of  a  cone,  with  the 
base  resting  upon  Sie  buttress  of  the  cervix,  run  upward 
toward  the  head  of  ihQ  bone,  in  the  direction  of  the 
Mne  of  the  pressure,  while  a  few  fibres  are  arranged  in 
a  similar  mannw  upon  the  upper  portion  of  the  neck, 
but  with  the  difference  that  toeir  base  is  toward  the 
head  of  the  bone.  The  intermediate  fibres  between 
these  two  cones  are  more  or  less  interlaced. 

It  is  this  direction  of  these  braces  of  support  to  the 
head  of  the  bone  that  mechanically  disposes  in  a  frac- 
ture a  portion  of  the  bone  to  spHt  in  a  more  or  less 
oblique  direction.  The  break  commences  upon  the 
upper  side,  and  extends  transvensely  until  it  reaches  a 
point  near  its  lower  surface,  where  the  resistance  will 
be  least  in  a  longitudinal  direction.  Hence  it  will  split 
in  a  wedge-shape,  the  ^>ex  of  which,  may  or  may  not 
extend  under  the  oapsular  ligament,  retaining  its  oon- 
nection  with  the  neck  of  the  bone,  through  both  the 
d^ular  H^ameut  and  the  periosteum.  When  the  force 
is  applied  m  an  opposite  direction  the  direction  of  the 
fracture  will  be  duOferent.  In  both  instances  the  frac- 
ture at  first  takes  place  transversely,  and  after  following 
such  a  course  through  the  greater  thickness  of  the  neck 
the  line  of  fi*acture  is  deflected  in  the  course  of  one  or 
other  of  the  oblique  fibres^  and  split  off,  so  to  speak. 
It  is  this  split  portion  which,  according  to  Br.  Davis, 
bears  such  an  important  rektion  to  tbe  proper  treat- 
ment of  fractures  at  the  hip-joint  If  the  parts  afrer 
such  icguries  are  handled  with  care,  and  the  surgeon  is 
not  over-anxious  to  get  crepitus,  the  necessary  con- 
necUoDS  of  this  wedge^sbapea  splinter  and  the  perios- 
teum will  be  preserved,  thus  augmenting  Uie  chances 
of  bony  union. 

In  support  of  this  view  he  not  oily  quotes  examples 
in  which  the  fracture  has  taken  this  course,  but  refers  to 
the  fact  that  in  a  large  number  of  cases  there  is  at  first 
but  a  sli^t  shortening  of  the  limb ;  that  occasionally  loco- 
motion IS  performed  for  some  days,  when  shortening 
takes  place  suddenly.  He  also  alludes  to  the  fact  that  it 
not  unfirequentdy  hi^pens  that  when  dight  ^ortening 
exists  at  first,  and  the  limb  is  manipukted,  extreme 
shortening  occurs,  and  crepitus  is  omv  then  secured. 
He  considers  it  best  to  ran  the  risk  of  making  a  cor- 
rect diagnosis  by  giving  the  patient  the  benefit  of  a 
doubt,  and  employing  the  continuous  elastic  extension. 
If  at  the  end  of  a  few  days  the  urgent  symptoms  sub- 
side, as  in  the  case  of  a  severe  bruise,  a  cautious  use  of 
the  injured  limb  ma^r  be  allowed,  while  the  treatment 
by  the  elastic  extension  is  equally  i^plicable  to  both. 
fie  is  willing  to  admit  that  bony  union  is  rather  a  for- 
lorn hope,  but  he  behoves  that  the  only  chances  that  it 
may  occur  are  centred  in  care  in  conducting  the  neces- 
sary examination  of  the  Hmb.    I^  however,  a  surgeon 


is  determined  to  get  crepitus  in  every  case  when  there 
ir  reason  to  suspect  that  the  continuity  of  the  bone  is 
not  absolutely  destroyed,  no  union  oi  the  parts  can 
necessarily  occur.  The  shaft  of  the  femur  is  drawn 
up  by  the  muscles,  and  when  a  reduction  is  attempted, 
the  lower  edge  of  the  trochanteric  portion  impinges 
against  that  ox  the  neck,  and  as  the  only  attachment  of 
the  head  and  neck  to  the  pelvis  is  by  the  round  liga- 
ment, they  rotate  u{>on  it,  thus  bringing  the  upper  outside 
portion  of  the  cervix,  and  perhaps  a  part  of  the  head, 
m  apposition  to  the  fractured  face  upon  the  shaft. 
Then  the  head  of  the  bone,  from  the  scanty  nourishment 
it  obtains  by  means  of  the  round  ligament,  soon  falls  a 
prey  to  absorption,  the  limb  becomes  permanently 
shortened,  and  the  patient  incurably  lamed. 

The  method  of  treatment  pursued  by  Dr.  Davis  in 
these  cases  is  similar  to  that  of  continuous  exten^on  by 
the  weight  and  pulley,  as  recommended  by  him  in  the 
treatment  of  morbus  coxarius ;  the  idea  being  to  keep 
the  parts  iu  their  natural  relations,  and  the  limb  in  its 
normal  length,  giving  nature  the  best  posdble  cliance. 

If  these  views  prove  to  be  xx)n*ect,  and  they  cer- 
tainly appear  reasonable,  Dr.  Davis  has,  in  a  portion  of 
the  cases  of  inter-capsular  fracture,  relieved  the  profes- 
sion from  what  has  heretofi)re  been  oonsidered  an  insur- 
mountable difficulty,  and  has  furnished  strong  evidence 
of  the  necessity  for  a  thorough  investigation  into  the 
'*•  mechanical  causes  operating  injuriously,  both  in  health 
and  disease."  ^ 

OnnPBfErr  for  PRUMTtrs  VuLViB. — 5«  "^^^^  (or  cam- 
phorated) lard,  60  grammes ;  citr.  oint  3  grammes.  M. 
Rub  a  small  piece  on  the  parts  while  in  bed.  Should 
the  pruritus  resist  this  topical  application,  analyze  the 
urine.  If  glucosuria  diiould  be  fi>und  to  exist,  add  to 
general  treatment  M.  Bouchardat's  unguent,  to  wit: 

3.  Potass,  carbon.  100  grammes;  tinct  benzoin, 
60  grammes.    M. 

M.  Adrian's  FoRinrtAB  for  tar  preparations  are,  viz. : 
EmuU.  of  Vegttahle  Tar. 

Q »   Choice  tar,        ...        10  grammes- 
Yellow  of  one  egg,  or       .        16       •* 
Water,     ....        75       " 


5.   Choice  tarj 


100  grammes. 
Gtycerined  Tar. 

15  grammes. 

16  " 


70 


Yellow  of  one  egg^  or 
Glycerine, 
(1  grain  equals  18  grammes.— En.) 

Spina  Buida. — ^Dr.  FAzstriLHE  ^of  Rieumes)  having  to 
deal,  in  the  case  of  a  new-4>om  child,  with  a  voluminous 
spina  bifida^  and  adherent  by  a  pedicle  of  three  cent- 
imetres in  diameter,  did  not  hesitate,  after  evacuating 
with  a  trocar  the  limpid  serodty  contained  in  the  tumor, 
to  excise  it,  following  the  surgical  method  of  M.  Dubourg 
(of  Marmande)  as  given  in  two  successful  cases,  reported 
in  the  Journal  de  Medicine  Praiiqtie.  In  ohronidiDg 
this  new  audacity  the  JbumaZ  rightly  recalls  the  reserve 
which  men  of  experience,  such  aa  MM.  Guersant  and 
Giraldes,  held  in  regard  to  curative  means  employed  in 
spina  Infida.  M.  Guersant  did  not  believe  at  all  m  the 
radical  cure  of  ihvi  affection ;  and  among  the  sequeliD 
to  the  operation,  M.  Giraldes  determined  among  other 
things  a  case  of  hydrocephalus. 

M  Fazeuilhe  is,  to  ^pearances,  too  confident  His 
example,  at  all  events,  should  not  be  followed  in  every 
casc^Za  JFiwiee  Meduxde,  Oct  16,  1867. 

Maissonnettve,  of  Paris,  recommends  for  die  radical 
cure  of  varicocele,  coagulating  ii^'ections  of  the  perchlor- 
ide  of  iron. 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


493 


The  Medical  Record. 

Gborgb  F,  Shrady,  M.D.,  Editoe. 


PnUislMd  on  the  Itt  and  I5th  of  6«oh  Month,  b7 
WILLIAM  WOOD  &  CO.,  61  Walkbb  Stust.  New  Yosx. 


FOREIGN  AQSNCIES. 

ft  Co. 
Paus— BouAHas  xt  Cib. 


LoiTDOVj—TBUBnB  k  Co.  I     Lkipsio^B.  Hkrmamm. 

I     Bio  Jauxibo— &nepuxNS  t  Oa. 


IQ'evr  ITork.  J'axitiary  1*  1868. 


"IS  HE  RELIABLE?" 

It  seems  strange,  at  first  sight,  that  as  the  whole  object 
of  scieQce  is  truth,  there  should  be  any  question  in 
regard  to  so-called  scientific  facts.  All  of  us  are,  how- 
ever,  aware  that  statements  intended  to  be  scientific 
are  constantlj  open  to  every  conceivable  doubt  as  to 
their  authenticity.  How  fashionable  has  it  become, 
-when  any  startling  assertion  is  made  by  a  professional 
brother,  for  one  to  ask  the  other,  "  Is  he  reliable  ?  " 

The  question  is  a  perfectly  natural  one,  for  it  is  neces- 
sitated by  the  circumstances  of  the  case.  Whatever 
may  be  the  implication  of  want  of  truth  on  the  part  of 
the  observer,  the  real  cause  for  doubt  rests  upon  the  con- 
viction that  the  assertions  are  too  apt  to  be  exaggerated, 
and  savor  of  a  one-ideaism.  The  majority  of  men  who 
engross  themselves  in  one  pursuit,  or  in  one  particular 
department  of  a  calling,  seem  incapable  of  resisting  the 
temptation  of  presuming  it  paramount  to  everything 
else.  They  get)  so  to  speak,  in  that  habit  of  mind  in 
which  their  imaginative  faculties  outgrow  their  reason 
and  common  sense;  and,  while  they  have  no  desire  to 
orerreach  the  truth,  seem  incapable  of  sticking  to  it. 
This  curious  psychological  state  is  strikingly  illustrated 
in  a  story  told  by  a  celebrated  humorous  writer. 

It  appears  that  a  traveller,  who  was  very  anxious  to 
take  a  stage  very  early  in  the  morning,  put  up  the 
night  before  at  a  roadside  tavern  near  the  station,  and 
left  instructions  with  the  porter  to  be  waked  in  time. 
He  then  retired  with  the  full  assurance  that  his  wishes 
TTOuld  be  complied  with,  and  settled  himself  for  a  com- 
fortable night's  rest.  But,  alas  I  in  the  still  small  hours 
he  was  aroused  by  an  ominous  whisper  through  his  key- 
hole, "  Mister,  the  stage  has  just  passed."  This  piece  of 
intelligence  was  sufilcient  to  expedite  his  toilet  in  an  as- 
tonishing manner ;  his  legs  were  thrust  into  his  pants, 
his  boots  were  stamped  on,  his  coat  quickly  found  its 
plaoe  upon  his  back,  and,  with  satchel  in  hand,  he  was 
soon  in  readines?,  along  with  his  informer,  for  some 
violent  exercise  in  the  effort  to  overtake  the  vehicle  at 
its  stopping-place.  Fences  were  cleared,  ditches 
leaped,  and,  by  dint  of  much  running,  the  station  was 
reached.    On  inquiry,  however,  it  was  discovered  that 


the  carriage  was  not  due  for  two  hours.  The  indignant 
traveller  turned  upon  his  companion,  and  charged  him 
with  the  perpetration  of  a  rather  serious  joke.  The  an- 
swer which  he  receive!  was :  "  Ybu  see,  Mister,  from 
thinking  of  the  coach,  from  expecting  it,  from  wish- 
ing for  it,  and  dreaming  on  it,  I  thought  I  heer'd  it  I  " 

There  is  no  difficulty  in  meeting  with  cases  parallel 
to  this  in  scientific  investigations ;  and  we  should  be  as 
ready  to  exercise  forgiveness  toward  such  observers,  as 
we  will  suppose,  "for  the  argument's  sake,"  was  the  vic- 
timized traveller  towards  his  guide.  If  any  individual 
coaxes  himself  to  believe  that  his  particular  method  of 
treatment  is  the  nt  pltu  tdtra  of  everything  that  is  desir- 
able, he  is  very  easily  tempted  to  conform  his  theory  to 
facts,  rather  than  the  facts  to  the  theory.  There  is  in  such 
persons  a  constant  tendency  to  exaggerate  every  ele- 
ment that  bolsters  up  their  views,  and  to  make  light  of 
every  other  circumstance  tending  to  refute  them.  They 
are  convinced  that  an  operation  by  a  particular  method 
must  succeed,  and  will  hardly  believe  that  their  expec- 
tations have  not  been  realized,  even  when  the  patient 
is  dead. 

The  power  of  the  imagination  over  other  feculties  is 
also  as  marked  as  it  is  subtle,  even  when  an  investi- 
gator shows  a  determination  to  guard  conscientiously 
against  every  source  of  error.  Every  medical  student 
knows  this  full  well  from  personal  experience,  especially 
in  the  study  of  those  branches  which  require  a  more 
than  ordinary  acuteness  of  perception.  We  need  not 
refer  here  to  more  than  two  of  these,  auscultation  and 
microscopy.  If  he  listens  for  a  particular  sound  in  the 
chest,  in  the  belief  that  it  is  there,  he  invariably  hears 
it,  though  it  may  be  entirely  absent.  Under  the  micro- 
scope he  makes  out  delicate  definitions,  which  cannot 
possibly  be  developed  by  the  lens  of  the  power  he  is 
using.  All  this,  it  is  well  known,  does  not  d^)end  en- 
tirely upon  a  want  of  sufficient  acuteness  in  hearing 
in  the  one  case,  or  of  focal  adaptation  in  the  other. 

But  there  is  another  class  of  observers  who  are  less 
conscientious,  and  who  are  not  only  chicken-hearted 
about  telling  the  plain  truth,  but  who  sometimes  wil- 
fully pervert  everything  to  meet  their  ends.  The  sup- 
position that  this  is  the  case,  is  the  only  rational  one 
for  explaining  the  many  discrepancies  and  glaring  un- 
truths that  are  scattered  throughout  their  works.  They 
claim  for  their  personal  experience  more  than  is  by  the 
greatest  stretch  of  imagination  their  due,  and  speak 
of  successes  which  are  to  every  reasoning  mind  simply 
impossible.  These  impostors  are  self-conceited  enough 
to  suppose  that  their  trickeries  are  not  transparent; 
and  there  is  no  consideration  of  justice  on  their  part 
that  will  tempt  them  to  mend  tiieir  ways. 

True  science,  deaUng  as  it  does  with  stubborn  facts, 
with  laws  that  are  unchangeable,  and  with  conclusions 
that  are  logically  irrevocable,  can  give  no  quarter  to 
speculations  however  ingenious  or  captivating^  and 
every  element  of  the  imagination  must  necessarily  be 
left  out.  We  admit,  that  in  order  to  folbw  the  tortu- 
Digitized  by  VjOO^  ^  _ 


494 


THE  MEDICAL  RECORD. 


osities  of  this  thorny  path,  much  sacrifice  of  mere  opin- 
ion is  neoessary,  many  pleasing  and  tempting  deductions 
must  be  overthrown,  and  everything  in  the  shape  of  a 
prejudice  for  or  against  any  particular  view  be  resolutely 
combated.  (When  so  much  is  required  of  the  would- 
be  votaries  to  this  shrine,  is  it  a  wonder  that  so  many 
grow  weary,  and  fall  out  by  the  way  ?  ) 

But  on  the  other  hand,  there  are  multitudes  of  honest 
workers  who  have  conquered  every  prejudice  for  this 
or  that  theory,  who  look  through  a  lens  without  a  single 
aberration,  and  who  are  willing  to  labor  for  the  fascina- 
tion of  discovering  truth  in  its  purity.  These  are  they 
who  are  ever  ready  to  report  unsuccessful  results,  errors 
in  diagnosis,  and  mistakes  of  every  kind ;  who,  in  the 
true  interests  of  science,  are  not  only  searching  afler 
pleasant  paths,  but  are  willing  to  point  out  the  pitfalls 
which  they  have  escaped  and  fallen  into.  Observations 
from  such  men  are  always  reliable,  and  their  deductions 
are  always  sound.  Their  cases  are  accurately  detailed, 
every  point  concerning  which  there  may  be  a  doubt  is 
clearly  presented,  and  nothing  is  left  to  be  desired  in 
the  way  of  completeness. 

It  is  preposterous  for  any  one  to  suppose  that  unless 
he  fairly  earns  a  reputation  for  reliabiUty  by  an  honest 
endeavor  to  adhere  to  simple  facts,  tmtinctured  by  pre- 
judice of  any  kind,  that  his  works  can  endure. 

The  following  out  of  this  principle  has  given  to  us 
every  illustrious  name  in  medicine.  Their  works  are 
handed  down  from  past  ages,  not  merely  as  curiosities 
in  literature,  but  because  of  the  manly  and  outspoken 
truths  which  they  contain,  truths  which  every  recent 
observation  serves  only  to  con6rm,  and  add  new  lustre 
to  the  fame  of  the  writer.  Some  of  the  descriptions  of  dis- 
ease by  the  ancient  authors  are,  in  fact,  so  accurate,  that 
a  literal  translation  of  (hem  would  serve  every  purpose 
at  the  present  day.  How  dangerous  would  it  have 
been  for  such  to  have  drawn  on  their  imaginations,  to 
have  perverted  facts  and  the  Uke,  when  an  army  of  un- 
compromising truth-seekers  were  waiting  to  prove  their 
statements  by  the  test-tube,  the  retort,  the  post-mor- 
tem knife,  and  the  microscope  I 

XTin)ER  Beports  of  Hospitals  we  propose,  in  addition 
to  accounts  of  important  cases,  shortly  to  present  a 
series  of  articles  descriptive  of  the  practice  of  the 
various  hospitals  of  New  Tork  in  the  more  common 
affections,  incorporating  such  clinical  teachings  of  the 
attending  physicians  and  surgeons  as  may  serve  to 
illustrate  the  subjects  treated.  We  hope  to  make  this 
department  of  the  Bscord  especially  valuable  to  those 
of  its  readers  who  have  not  the  opportunity  of  person- 
ally availing  themselves  of  the  immense  hospital  advan- 
tages our  city  affords. 

OwiKO  to  the  unusual  press  of  matter  we  have  been 
compelled  to  defer  the  pubUcation  of  several  original 
articles  of  singular  merit,  among  which  may  be  men- 
tioned one  by  Professor  Salisbury,  of  Cleveland,  Ohio, 


which  is  profusely  illustrated,  one  by  Dr.  Rogers  on 
an  important  subject,  and  an  interesting  report  of  a  case 
by  Dr.  Hachenberg,  of  Hudson. 

The  full  attendance  at  the  various  societies,  and  the 
great  amount  of  interest  manifested  in  the  discussion 
of  the  various  medical  topics,  are  very  significant  of  an 
increase  among  our  active  workers.  There  is  nothing 
that  conduces  so  surely  to  mutual  improvement  and 
an  increase  of  our  knowledge  than  such  associations,  and 
we  are  gratified  to  chronicle  the  fact  that  so  many  of 
them  are  so  well  patronized. 

Heoietuji  at(b  Utft\ct»  of  f^ooks. 


Catalogue  of  the  U.  8.  Abmt  Medicai.  Museum.    Prepared 

under  the  Direction  of  the  Burgeon-General,  U.  S.  Army. 

Washington:   Government  Printing  OflBce.     1866-7.   Pp. 

961. 
Surgeon-General  Barnes  deals  in  surprises,  and  of  the 
most  agreeable  kind.  The  very  modest  title  of  "Cat- 
alogue *'  conveys  but  a  faint  idea  of  the  interest  or  value 
inherent  in  the  closely-printed  and  profusely  illustrated 
volume  before  us.  It  is  indeed  something  more  than  a 
catalogue,  since  the  numbered  specimen  and  name  of 
contributor  is  invariably  accompanied  by  a  succinct  de- 
scription and  history,  calculated  to  satisfy  any  reasonable 
amount  of  curiosity  regarding  results.  As  a  careful 
compilation,  seeking  to  record  for  the  benefit  of  science 
duly  authenticated  facts,  it  is  a  monument  of  labor, 
destined  never  to  be  too  highly  appreciated.  The  for- 
tunate possessor  of  this  contribution  to  the  history  of 
the  late  contest  might  well  hesitate  to  exchange  po- 
sitions with  the  spectator  in  the  museum  itselfj  since 
he  is  able  to  command  at  his  convenience  the  studied 
details  and  the  wealth  of  facts  without  the  bewilder- 
ment of  artistic  embellishments  and  the  embarrassment 
regarding  the  point  of  commencement 

About  three-fourths  of  the  Catalogue,  as  was  to  have 
been  expected,  is  devoted  to  the  department  of  surgery. 
The  general  scope  of  this  grand  division  may  be  best 
gathered  from  the  following  summary  of  diseases  and  in- 
juries, as  given  in  the  table  of  contents:  (1)  Cranium ; 
(2)  Face;  (3)  Vertebrae  and  Cord;  (4)  Thoracic  Parietes; 
(6)  Shoulder-joint;  (6)  Shaft  of  Humerus:  (7)  Elbow- 
joint:  (8)  Shafts  of  Radius  and  Ulna;  (9)  Carpus;  aO) 
Hand;  (11)  Pelvis;  (12)  Hip-joint;  (13)  Shaft  of  Fe- 
mur; (14)  Knee-joint;  (15)  Shafts  of  Tibia  and  Fibula  ; 
(16)  Tarsus;  (17)  Foot;  (18)  Organs  of  Circulation; 
(19)  Organs  of  Reroiration;  (20)  Abdominal  Viscera, 
etc.;  (21)  Results  of  Operations  on  Soft  Tissues;  (22) 
InjuriestoSoft  Tissues  not  Viscera;  (23)Ervsipela8.  etc. ; 
(24)  Tumors;  (25)  Casts;  (26)  Photographs  and  Draw- 
ings; (27)  Weapons  and  Proiectiles;  (28)  Materia  Chi- 
rurgica;  (29)  Miscellaneous  Articles;  (30)  Lower  Ani- 
ma£;  Index  of  Contributors  and  Index  of  Specimens. 

Each  one  of  these  sections  is  properly  subdivided ; 
as,  for  example,  in  the  case  of  *•*  Injuries  and  Diseases  of 
the  Face,  including  the  Organs  of  Vision,  Smell,  and 
Taste,"  the  subject  is  treated  with  reference  to  gunshot 
injuries,  injuries  not  caused  by  gunshot^  and  diseases 
and  their  results.  These  gunshot  injuries  are  then 
classified  as  being  "  Of  the  Bones  of  the  Face,  not  in- 
cludrnff  the  Lower  Jaw;  Ofthe  Lower  Jaw;  Of  the  Eve 
and  of  the  Tongue."  Another  subdivision  finally  dis- 
poses of  the  "  Gunshot  Injuries  of  the  Bones  of  the  Face 
not  including  the  Lower-jaw,"  und^r  the  captions  of 

digitized  by  LjOO^^_ 


THE  MEDICAL  RECORD. 


495 


*  IVaciures  not  Primarily  Fatal ;  Fractures  without  Oper- 
aiiansy  Secondarily  Fatai;  Remits  of  OperaHons  ;  Restdta 
ofEKfoUations  ;  Fractures  and  Dislocations  indirectly  pro- 
duced which  are  not  in  ihemsdves  IhtaU^  We  have  se- 
lected the  above  at  random,  and,  as  the  reader  will  per- 
ceive, have  not  pursued  the  matter  down  to  the  neces- 
sary mmutisB ;  but  we  trust  that  enough  has  been  given 
to  mipart  an  idea  of  the  general  i>lan  of  the  work. 

To  Dr.  Alft-ed  A.  Woodhull,  Assistant  Surgeon  and 
Brevet  Major,  U.S.A.,  is  due  the  honor  of  having 
prepared  the  surgical  portion  of  the  Catalogue.  His 
descriptions  of  the  specimens  are  singularly  graphic, 
pithy,  and  exhaustive.  As  far  as  condensed  expression  is 
concerned  they  approach  the  suggestiveness  of  Scriptural 
texts.  And  when  we  consider  the  temptations  to  am- 
plify^ this  is  indeed  a  rare  merit 

When  we  say  that  Dr.  Woodward  has  grouped  the 
objects  of  interest  for  the  medical  department  of  the 
museum,  we  know  that  our  readers  wiU  be  well  assured 
of  the  ccmipleteness,  the  judgment^  and  the  taste  dis- 
played in  the  execution  of  his  onerous,  and,  as  we  sur- 
mise, pleasant  task.  An  accomplished  pathologist  and 
an  accurate  observer,  he  has  miade  the  most  of  his  op- 
portunity, and  reflected  no  little  lustre  upon  the  hard- 
working and  not  enough  appreciated  medical  depart- 
ment of  our  army.  Much  has  been  required,  but  more 
accomplished. 

The  Table  of  Contents  will  give  better  than  any  ex- 
tended critique,  an  idea  of  this  division  of  the  work. 
Chapter  L  (X^^ervous  System)  introduces  us  to  speci- 
mens illustrating  lesions,  etc.,  of  the  brainy  membranes 
of  the  brain,  pinecU  gland,  bloodvessels  o/encephahn  and 
spinal  cord.  Chapter  IL  (Organs  of  Circulation)  pre- 
sents OS  vnth  the  results  of  autopsies,  exhibiting  mor- 
bific changes  and  congenital  anomalies  of  the  heart 
arteries  a/nd  veins,  lymphatic  glands,  and  thyroid  gland. 
Chapter  HE.  (Respiratory  Organs)  is  rich  in  dissections 
of  tne  air^passages,  the  lungs,  and  pleurce.  Chapter  lY. 
(Digestive  Organs)  adds  not  a  little  to  our  knowledge 
of  Uie  diseases  of  the  mou^,  pharynx,  and  cesophagus, 
the  stomach,  intestinal  canal,  peritoneum,  and  omentum, 
liver,  pancreas,  and  spleen.  Chapter  V.  (Urino-genital 
Organs)  is  quite  suggestive.  It  is  subdivided  under  the 
head  of  kidneys,  suprarenal  capsule,  urinary  passages, 
and  bladder,  male  organs  of  generation,  female  organs 
of  generation,  sxlA  fatus.  Chapter  VL  (Organs  of  Loco- 
motion) is  disposed  of  under  two  sections — muscles  and 
fcLsda,  bones  and  joints.  Chapter  VII.  (Integument)  and 
Chapter  YIIL  (Anomalies  and  Monstrosities),  followed 
by  a  copious  index,  close  this  portion  of  the  Catalogue. 

The  embellishments  are  also  fine.  No.  98,  from  a 
specimen  just  above  the  ileo-coecal  valve,  exhibits  in  a 
very  artistic  manner,  the  appearance  of  the  ileum,  with 
enlarged  follicles,  etc.  Iho.  280,  taken  from  a  case 
diagnosticated  as  typhus,  points  out  '^  the  solitary  fol- 
licles, enlarged  to  size  of  small  shot,  and  projecting  as 
polypoid  tumors  from  surface  of  mucous  membrane ;  at 
the  apices  of  many  of  these  tumors  are  one  or  more  small 
points  of  ulceration."  No.  468  very  ably  and  elegantly 
reproduces  **A  portion-  of  descending  colon  con- 
siderably thickened,  and  presenting  numerous  follicular 
ulcers,  varying  in  size  from  mere  points  to  three  lines 
in  diameter; "  and  No.  224^  follicular  ulcers  of  the  colon, 
which  have  degenerated  into  "vast  eroding  excava- 
tions." These  complete  the  illustrations  of  the  medical 
section. 

Another  portion  of  this  magnificent  publication  is  de- 
voted to  an  enumeration  and  description  of  microscopi- 
cal ^ecimens.  This  department  has  been  very  wisely 
entrusted  to  Assistant  Surgeon  Edward  Curtis,  who  has 
achieved  an  enviable  reputation  for  indefatigability  and 
fidelity*    We  are  told  that  a  large  majority  of  the  speci- 


mens have  been  prepared  in  the  microscopical  depart- 
ment of  the  museum,  the  greater  part  by  Acting  As- 
sistant Surgeon  J.  0.  W.  Xennon,  U.  S.  Army;  the 
remainder  by  Assistant  Surgeon  Edward  Curtis,  U.  S. 
Army,  and  Hospital  Steward  E.  M.  Schaeffer,  U.  S. 
Army.  Professor  Joseph  Hyrtl,  of  Vienna,  Austria, 
is  also  represented  by  a  number  of  *'  opaque  fine  injec^ 
tions  in  various  colors  to  show  the  arrangement  of  the 
capillaries  in  the  different  structures  of  the  body." 
These  are  mounted  dry. 

The  microscopical  section  of  the  museum  is  conveni- 
ently subdivided ;  its  objects  for  inspection  being  classi- 
fied as  ''  Mounted  Preparations  for  the  Microscope ; " 
"  Photographic  Negatives  of  Microsconic  Objects,'  and 
"  Photo-micrographs  presented  to  the  Museum." 

To  say  that  the  wealth  of  the  museum  in  this  respect 
is  enormous,  would  give  but  a  fiunt  idea  of  the  extent 
or  completeness  of  the  collection.  Aside  from  the 
physiological  specimens,  which  are  derived  from  almost 
every  family  in  the  animal  scale,  pathological  anatomy 
may  here  be  advantageously  studied  by  its  most  enthu- 
siastic votaries. 

Photo-micrography  has  been  well  worked  up.  We 
have  illustrations  of  the  apparatus  and  descriptions  of 
the  process,  with  a  reason  for  every  step  taken,  which 
to  the  scientific  operator  cannot  be  otherwise  than  ex- 
ceedingly valuable.  Dr.  R.  L.  Maddox,  of  Southampton, 
England;  Pro£  Joseph Gkrlacb, of  Erlangen,Bavaria;  Dr. 
C.  F.  Crehore,  of  Boston,  Mass. ;  Mr.  J.  H.  Woodworth, 
of  Dublin,  Ireland,  and  a  few  others  are  credited  with 
specimens  presented. 

The  Catalogue,  as  a  whole,  well  assures  us  tiiat  the 
Surgeon-General  has  conscientiously  devoted  his  ener- 
gies to  the  task,  which  we  are  proud  to  say  we  have  every 
reason  to  believe  has  been  penormed  without  reluctance, 
and  entirely  in  Uie  interest  of  science.  The  work  of 
compilation,  attended  as  it  is  with  the  necessity  of  elim- 
ination and  condensation,  though  tedious  we  can  now 
very  readily  see  has  steadily  progressed,  and  that  the 
condemnatory  resolutions  introduced  before  the  Ameri- 
can Medical  Association  at  its  last  meeting  were,  to  say 
the  least,  injudicious,  if  not  an  unwarrantable  reflection 
upon  a  faithful  public  officer.  That  they  did  not  pre- 
vail was  due  to  the  appreciation  in  which  that  officer  is 
held  by  the  profession,  as  well  as  to  the  fact  that  of  the 
members  of  that  Convention,  not  a  few  were  content 
"  to  keep  their  souls  in  patience,"  well  satisfied  that  the 
future  would  vindicate  me  wisdom  of  the  order  denying 
promiscuous  reference  to  documents,  even  on  the  part 
of  authors  themselves. 

Tbaksaotions  of  the  Ahbrioan  Msdioal  Assooiatiok. 
Instituted  1847.    Vol  xviiL    Phila.:  1867.     8vo,  pp.  648. 

The  Transactions  for  the  present  year  is  filled  with 
interesting  and  practical  matter  for  the  profession  at 
large,  and  reflects  credit  upon  the  last  year's  doings  of 
this  representative  body.  Our  readers  have  already 
been  presented  with  a  fml  report  of  the  proceedings  iu 
Cincinnati,  so  that  there  is  no  need  for  our  referring  to 
the  contents  of  that  portion  of  the  volume  occupied  by 
them,  except  to  state  that  the  report  is  carefully 
drawn  up  by  the  permanent  secretary.  We  have, 
however,  more  to  do  with  the  many  elaborate  and 
well-written  papers  which  are  contained  in  it.  The 
address  by  the  president.  Dr.  H.  P.  Askew,  of  Delaware, 
is  a  bold  and  manly  expression  of  opinion  concerning  the 
present  status  of  our  art,  and  the  radical  methods  to  be 
adopted  to  raise  its  standard.  Dr.  Stephen  Rogers' 
paper  on  extra-uterine  foetation  has  contained  in  it 
some  original  views  in  reference  to  the  method  of  diag- 
nosticating its  existence,  as  well  as  the  treatment  of 
the  attendant  hffimorrhage.    He  asserts  in  substance 


496 


THE  MEDICAL  RECORD. 


that  colickji[)ains  in  the  hypogastric  region,  attended 
with  a  sanguinolent  discbarge  per  Taginara,  are  almost 
pathognomonic,  all  other  things  being  equal,  of  extra- 
uterine pregnancy ;  and  as  statistics  have  failed  to  prove 
to  him  that  a  single  case  of  haemorrhage  accompanying 
this-  condition  ever  recovered,  he  advises  abdominal 
section  and  the  securiug  of  the  vessel.  His  arguments 
in  support  of  this  latter  view  are  well  put,  and  deserve 
the  consideration  of  every  interested  party.  Dr.  Tay- 
lor's paper  on  heart  diseases  in  the  army  U  very  practi- 
cal in  its  character,  and  refers  principally  to  the  fre- 
quency with  which  dilatation  of  the  left  ventricle  is 
met  among  those  who  are  exposed  to  great  fatigue  and 
privation.  Dr.  Hamill's  report  on  the  medical  topog- 
raphy of  Illinois  is  a  valuable  statistical  contribution  to 
sanitary  science.  Its  extreme  length  will  perhaps  inter- 
fere with  a  general  reading.  Dr.  Hildreth*s  observa- 
tions on  the  application  of  belladonna  to  diseases  of  the 
cornea  will  be  read  with  interest  by  those  whose  prac- 
tice tends  towards  ophthalmology.  The  report  on  the 
use  of  plaster  of  Paris  bandages,  by  Dr.  J.  L.  Little,  is  a 
praiseworthy  attempt  to  bnng  to  the  notice  of  his 
brethren  a  very  useful  practice;  but,  as  our  readers 
are  already  acquainted,  in  a  measure,  with  the  genUe- 
man's  views,  we  pass  on.  Dr.  B.  Howard  contributes 
a  short  and  extremely  valuable  paper  upon  a  new 
method  of  treating  varicose  veins,  by  ligation  with 
silver  wire  in  the  first  place,  and  depletion  of  the 
ligated  vessels  in  the  second  place.  The  plan  is  a  com- 
mendable one,  and  deserves  a  trial.  The  report  of  the 
committee  on  ligation  of  the  subclavian,  by  Dr.  Parker, 

fives  evidence  of  much  research  and  careful  study, 
here  is  contained  in  it  a  tabulated  statement  of  one 
hundred  and  fifty-seven  cases ;  but  the  chief  value  of 
the  report  is  centred  in  the  conclusions  which  a  faith- 
ful study  of  the  statistics  of  the  operation  has  afforded. 
The  same  may  be  said  of  a  well  written  and  elaborated 
article  upon  the  hip-joint  operations  during  the  late 
civil  war,  by  Dr.  Paul  F.  Eve.  The  report  upon  the 
rank  of  the  naval  medical  staff  is  full  of  significant 
facts,  which  are  well  presented  and  conclusive  as  to  the 
necessity  of  radical  reforms  in  that  department  The 
report  on  American  medical  necrology,  we  are  sorry 
to  say.  is  b^  no  means  complete,  and  in  many  portions 
of  it  there  is  evidence  of  an  undue  haste  in  its  prepara- 
tion. The  report  on  medical  education  presents  no 
new  facts,  aside  from  those  already  referred  to  in  our 
columns^  when  discussing  the  subject.  Dr.  Post's  re- 
port on  medical  literature  is  well  and  tastefully  writ- 
ten, and  gives  all  the  desired  facts  with  a  charming  and 
commendable  conciseness.  Dr.  Isaac  Ray's  paper  on 
the  progress  of  knowledge  in  insanity  is  full  of  sound 
reasoning  and  useful  and  common-sense  suggestiona 
Lastly,  the  two  prize-essays^  by  Dr.  Black,  on  the 
cause  of  intermittent  and  remittent  fever,  and  by  Dr. 
Pallen  on  the  treatment  of  certain  uterine  abnormities, 
are  worthy  of  particular  mention  for  the  amount  of 
study  and  work  which  each  gives  evidence  of.  Dr. 
Black's  views  are  to  a  certain  extent  original,  and  the 
pliun  and  common-sense  arguments  which  he  urges 
m  their  support  will  strongly  appeal  to  the  judgment 
of  the  profession  for  widespread  adoption.  Dr.  Pallen 
has  also  given  us  many  interesting  tacts  bearing  upon 
his  subject^  but  his  plans  of  treatment  for  uterine  affec- 
tions can  hardly  be  reconmiended  for  safety.  The 
Western  women  may  be  proof  against  bad  results  from 
the  operations  which  he  proposes;  but  our  Eastern 
females  certainly  lack  much  of  that  necessary  stamina. 
The  meetings  of  the  different  sections  are  by  no 
means  represented  as  they  should  be.  In  them,  many 
oi  the  pf4>er8  referred  to  m  the  volume  were  fully  dis- 
cussed, yet  we  have  in  the  reports  of  their  respective 


secretaries  the  merest  mention  of  such  facta.  This 
should  not  be  so.  In  the  interest  of  the  section,  no 
gentleman  should  accept  the  office  of  secretary  with- 
out a  full  appreciation  of  t^  responsibility  attending 
it^  and  should  in  one  and  all  cases  be  prepared  to  give 
a  decently  full  report  of  the  remarks  made  thereat. 

The  treasurer,  in  his  annual  repor^  tells  us  that  the 
association  is  in  debt  Cor  the  publication  of  its  transac- 
tions. This  is  a  grave  reflection  upon  the  character  of 
the  body,  in  not  liberally  supporting  eveir  laudable 
effort  to  place  before  its  members  much  valuable 
material.  We  are  in  hopes  that  the  sale  of  the  present 
volume  may  exceed  its  predecessors  in  just  so  much  as 
it  does  in  hterary  and  scientific  merits 

Thb  Practice  op  Medicine  and  Subqert  appued  to  the 

Dl^ASBS  AND  ACCmENTS  INOIDBNT  TO  WOMBN.     By  Wll. 

EL  Bttord,  A.M.,  M.D.  Author  of  a  Treatise  on  Chronic 
iDfiammation  and  Displacements  of  the  Unimpregnated 
Uterus,  eta  Secood  edition,  enlarged.  Phila. :  Lindsay 
&  BlakistoD.     Svo.,  pp.  616. 

Pbof.  Bttord'b  book  may  safely  be  said  to  fill  a  gap 
in  a  most  important  department  of  the  healing  art^ 
The  treatise  is  as  complete  a  one  as  the  present  state  of 
our  science  will  admit  of  being  written,  and  not  only 
gives  us  the  cases  in  which  the  knife  is  to  be  called  ** 
into  requisition,  but  ftilly  discusses  all  those  uterine 
ailments  which  are  to  be  benefited  by  medical  treat- 
ment. In  this  latter  respect,  the  work  has  a  peculiar 
value  to  every  general  practitioner.  The  author  speaks 
from  experience,  evidently  with  the  sole  otject  or  pre- 
senting his  subject  in  a  strictly  impartial  and  scientific 
light  The  present  edition  is  much  enlarged  in  point  of 
matter  contained  in  the  work,  althoueh  the  volume  itself 
is  very  little,  if  any,  increased  in  bulk.  We  commend 
it  to  tne  diligent  study  of  every  practitioner  and  stu- 
dent, as  a  work  calculated  to  inculcate  sound  principles, 
and  lead  to  enlightened  practice. 

A  Biennial  Retrospect  of  Medicinh,  Sueoery,  and 
THEIR  Allied  Sciences.  Edited  by  Mr.  H.  Power,  Dr. 
Anstie,  Mr.  Holmes,  Mr.  Thomas  Windsor,  Db.  Barnbs» 
and  C.  Hilton  Faoob,  for  the  New  Sydenham  Society. 
Phila. :  Lindsay  k  Blakiston.     1867.    8vo.,  pp.  496. 

This  volume,  published  under  the  auspices  of  the 
New  Sydenham  Society,  now  makes  its  welcome  ap- 
pearance bi-annually  instead  of  yearly,  as  heretofore. 
It  is  the  most  carefully  prepared  retrospect  with  which 
we  are  acquainted.  Each  department  is  in  charge  of  a 
gentleman  of  reputation,  and  everything  is  done  to 
summarize,  in  a  very  readable  way,  all  the  more  impor- 
tant advances  in  medicine  over  the  globe.  It  is  hand* 
somely  bound  and  elegantly  printed. 

Hufeland's  Art  of  Prolonging  Life.  Edited  by  Eras- 
mus Wilson,  F.R.3.  Author  of  A  New  System  of  Human 
Anatomy,  eta  From  the  last  London  edition.  Philadel- 
phia:  Lindsay  A  Blakiston.    1867.    12mo.,  pp.  298. 

The  Art  of  Prolonging  Life  was  written  more  than 
half  a  century  ago,  by  Christopher  William  Hufeland, 
a  professor  of  medicine  in  the  university  of  Jena,  since 
wnich  time,  on  account  of  a  deserved  popularity,  it  has 
gone  through  several  German  editions.  As  early  as 
1794,  it  was  6rst  translated  into  English,  probably  by 
the  author  himself  Although  subsequent  English  trans- 
lations have  appeared  since  then,  none  could  conipare 
with  the  original  one  in  elegance  and  exactness.  Pro£ 
Wilson  has  recently  taken  upon  himself  the  task  of 
editing  the  first  translation,  and  adapting  it  to  the 
wants  of  the  present  generation,  and  has  been  emi- 
nently successful  in  the  endeavor. 

In  the  present  age  of  fast  living^^ch  a  work  as  the 

Digitized  by 


THE  MEDICAL  RECORD. 


497 


ftbove  has  a  novel  interest.  Founded  as  the  statements 
are  upon  facts,  they  appeal,  in  trumpet  tongues,  to  every 
man  of  common-sense.  No  one  who  reads  it  can  quar- 
rel -with  the  author's  intentions,  even  if  he  is  not 
prepared  to  accept  the  conclusions.  The  relations  of  the 
moral  to  the  physical  nature  are  philosophically  set  forth, 
and  the  wbole  forms  a  com^dete  though  short  treatise 
upon  the  several  fundamental  questions  relating  to  the 
prolongation  of  life.  He  maintains  that  the  duration  of 
life  in  a  being  will  be  proportioned  to  the  innate 
quantity  of  vital  power,  the  greater  or  less  firmness  of 
its  organs,  the  speedier  or  slower  consumption,  and 
perfect  or  imperfect  restoration.  When  all  these  con- 
ditions exist  and  are  preserved  by  a  reasonable  amount 
of  care  on  the  part  of  the  individual,  the  chances  for 
exceeding  the  three  score  years  and  ten  are  proportion- 
ately great  This  principle  of  preservation  is  one  that 
is,  however,  hard  to  follow  at  the  present  day,  as  we 
are  forced  by  all  the  external  circumstances  of  our  living 
to  think  faster,  work  with  more  rapidity,  and  worry 
more  over  the  chances  of  success  than  did  our  fore- 
fathers, and  in  proportion  as  we  increase  the  draught 
must  we  consume  the  fuel  Still,  a  happy  medium  can 
be  consistently  drawn  between  the  two  extremes,  and  by 
a  proper  observance  of  the  relations  of  the  physical  to 
the  moral  element  of  our  nature,  many  years  of  comfort 
and  happiness  may  be  added  to  our  lot  If  we  are 
determined  to  burn  our  fuel  rapidly,  let  us  allow  our 
vital  energies  to  become  recruited  by  rest  instead  of 
adding  to  them  the  additional  burden  which  unneces- 
sary exciting  excesses,  improperly  denominated  pleasur- 
able recreations,  impose.  The  foundation  of  a  pro- 
longed life  rests  in  tlie  possession  of  a  good  digestion 
and  a  consequent  excellent  appetite,  for  dl  those  who 
have  attained  a  great  age  possessed  these  quidities  to 
a  remarkable  degree,  and  retained  them  to  the  last  In 
nothing  do  the  present  generation  pay  more  severely 
the  penalty  of  civilization  than  in  tne  deprivation  of 
these  inestimable  blessings — a  fact  sufficient^  explained 
by  the  increased  mental  excitement  which  we  are  sub- 
jected to,  no  less  than  in  the  trickeries  of  fancy  cook- 
ing, and  the  great  tendency  of  the  teeth  to  premature 
decay. 

The  work  is  a  charming  one — ^the  style  is  plain  and 
unassuming,  but  is  enriched  by  the  soundest  pnilosophy 
and  the  broadest  common  sense.  The  anecdotes  of 
long-lived  celebrities  are  well  told,  and  no  one  can  read 
the  work  for  profit  without  gaining  from  it  much  that 
is  entertaining  and  amusing.  It  is  a  book  weU  calcu- 
lated to  win  iavor  with  the  profession  and  the  reading 
public. 

Utports  0f  ^otktxta. 


NEW  YORK  PATHOLOGICAL  SOCIETY. 

Stateo  Mbetino,  Nov.  27,  1867. 

Dr.  H.  B.  Sahds,  President,  in  the  Chair. 

RETENTION  OP  URINE  BY  IMPACTED  CALCULI  IN  URETHRA. 

Dr.  Cutter  stated  that,  two  weeks  before,  he  had 
been  summoned  to  Boonton,  N.  J.,  the  messenger 
bringing  the  intelligence  that  the  father  of  Dr.  Farran, 
of  that  place,  had  been  suffering  firom  retention  of  urine 
for  forty-eight  hours.  The  patient  was  seventy-three 
years  of  age,  and  weighed  nearly  two  hundred  and  filly 
pounds.  On  arriving  at  the  place,  Dr.  Farran  informed 
him  that  he  had  succeeded  in  introducing  the  catheter 
as  far  as  the  bulbous  portion  of  the  urethra,  but  could 
not  go  beyond  it.  A  large-sized  catheter  was  then  in- 
troduced, and  likewise  a  smaller  one,  but  the  point  re- 


ferred to  could  not  be  passed.  Going  back  again  to 
the  large  catheter,  and  the  fingers  supporting  the  scro- 
tum, a  hard  lump  was  detected  at  tne  seat  of  the  ob- 
struction. The  instrument  was  then  withdrawn  and  a 
dressing  forceps  introduced  into  the  urethra,  with  a 
view  of  grasping  the  foreign  body  and  removing  it. 
As  this  could  not  be  done,  perineal  section  was  proposed 
and  performed,  when  the  obstruction  was  found  to  be 
an  impacted  calculus  As  the  sound  could  not  be  passed 
beyond  the  obstruction,  the  stone  was  pressed  forward, 
and  was  then  cut  upon  and  removed.  The  operation 
was  attended  with  immediate  relief,  it  only  being  neces- 
sary to  use  the  catheter  once  afler  the  operation. 

The  calculus,  which  was  of  small  siae,  showed  three 
facets  upon  its  surface,  which  proved  the  existence  of 
two  others  in  the  bladder.  One  of  these  had  been  de- 
tectied  in  the  bladder  on  the  occasion  of  pasang  the 
catheter  after  the  completion  of  the  operation. 

Dr.  Markoe,  in  this  connection,  stated,  that  five  weeks 
ago  he  had  operated  during  his  clinic  upon  a  similar 
case  in  a  boy  six  and  a  half  years  old.  One  year  before 
he  saw  the  patient  j  he  came  home  from  school  com- 
plaining of  an  inabihty  to  pass  his  water.  A  physician 
was  caUed,  who  succeeded  with  difficulty  in  introducing 
the  catheter  and  drawing  off  the  urine.  This  retention 
recurred  ftom  time  to  time,  sometimes  allowing  but  a 
little  water  to  be  passed  voluntarily,  at  other  times  the 
stoppage  being  complete.  This  went  on  for  a  long 
time,  the  attending  pnysician  passing  a  catheter  when- 
ever the  urgency  of  the  symptoms  demanded  it. 

On  being  brought  to  the  clinic  a  steel  sound  was  in- 
troduced, when  an  obstruction  was  discovered  in  pre- 
cisely the  same  situation  as  in  Dr.  Cutter's  patient;  said 
obstruction  proving  to  be  dependent  upon  a  calculus. 
The  attention  being  then  directed  to  the  perineum,  and  a 
solid  body  being  felt  in  the  situation  referred  to,  and  it 
beine  of  an  oblong  shape,  the  doctor  ventured  to  predict 
that  it  was  occasioned  by  a  slate-pencil,  more  especially 
as  it  had  lodged  there  so  Ion?,  permitting  an  instrument 
to  pass  by  it  when  the  bladder  had  been  relieved. 

Perineal  section  was  performed,  and  a  rounded  calculus 
was  removed  instead  of  a  slate-pencil,  as  was  antici- 
pated. The  elongated,  hardened  mass  felt  through  the 
scrotum  was  found  due  to  the  deposit  of  fibrinous  ma- 
terial in  the  long  diameter  of  the  tumor.  The  case 
aflerwards  progressed  favorably,  the  patient  having  no 
more  trouble  in  iJie  passage  of  his  urine. 

In  answer  to  a  question  fi^m  Dr.  Van  Buren,  Dr. 
Cutter  stated  that  in  his  case  the  prostate  was  slightly 
enlarged. 

PROBABLE  gunshot  WOUND  OF  STOMACH. 

Dr.  Cutter  next  exhibited  a  specimen,  the  history  of 
which,  he  was  sorry  to  say,  was  not  complete.  It  was 
a  small  pistol  ball,  very  much  the  shape  of  a  Mini^  rifle 
ball,  removed  from  a  bo^  fifteen  years  of  age,  who  was 
accidentally  shot  by  his  father  five  years  ago.  The 
missile  entered  the  umbilical  region  over  the  centre  of 
the  large  pouch  of  the  stomach,  and  apparently  passed 
directly  tnrough  the  organ  and  lod^fd  in  the  back. 
As  the  case  belonged  to  Dr.  J.  F.  Ward,  of  New- 
ark, who  had  attended  the  case  for  a  very  long  period, 
he  was  unable  to  say  whether  there  had  been  vomiting 
or  purging  of  blood  after  the  accident  or  not. 

Dr.  Hamilton  thought  it  very  unsafe  to  record  such 
a  case,  with  such  an  imperfect  history  as  one  of  perfora- 
tion of  the  stomach  by  a  ball.  He  Uiought  that  it  was 
necessary,  in  order  to  establish  the  existence  of  such  a 
wound,  to  have  vomiting  of  blood,  or  a  discharge  of  it 
per  rectum,  or  the  existence  of  a  fistula  in  the  stomach 
itself,  and  the  discharge  of  its  contents  through  the 

Digitized  by  VjOOQIC 


498 


THE  MEDICAL  RECORD. 


Dr.  Howard  stated  that  he  had  met  -with. several 
flesh  wounds  produced  by  pistol  bullets  at  short  range, 
and  had  mvanablj  found  that  they  had  healed  by  first 
attention.  He  did  not  think  i  t  improbable  that  a  wound 
might  be  made  in  the  stomach  and  yet  cloee  with  equal 
rapidity,  leaving  hardly  a  vestige  of  its  course  after- 
wards. 

Dr.  Satre  stated  that  he  had  only  seen  one  case  of 
horta  fide  gunshot  wound  of  the  stomach,  and  that  was  m 
the  person  of  Beverly  Cole,  of  California.  In  that  in- 
stance there  was  vomiting  and  purging  of  blood,  and  a 
discharge  of  the  contents  of  the  stomach  through  the 
wound.  It  was  three  years  since  he  had  seen  the  case, 
and  the  patient  was  now  doing  well. 

Dr.  Hewit  remarked  that  the  case  referred  to  by  Dr. 
Sayre  had  been  under  his  immediate  care,  being  assist- 
ed by  Dr.  Valentine  Mott,  Jr.,  and  Dr.  C.  S.  Tripler, 
and  that  the  symptoms  were  as  Dr.  Sayre  bad  related 
them,  except  that  there  was  no  discharge  of  the  con- 
tents of  the  stomach  through  the  wound. 

Dr.  Satrb  stated  that  he  had  merely  reported  the 
symptoms  as  they  were  detailed  to  him  by  the  patient 
some  time  after  the  accident. 

cancerous  testicle. 

Dr.  Hewtf  presented  a  specimen  of  cancerous  testicle, 
of  which  the  following  is  a  nistory : 

On  the  7Lh  of  the  present  month  I  was  requested 
by  Dr.  Wright,  of  East  New  York,  to  see  a  case  of  sus- 
pected organic  disease  of  the  testicle,  in  the  person  of 
S.  M.  A.  F.  F.     The  following  history  was  elicited : 

The  patient  was  forty-six  years  of  age,  a  fiurmer  and 
fisherman  by  turns,  descended  from  a  healthy  and  long- 
lived  ancestry,  bom  and  raised  in  the  immediate  neigh- 
borhood, temperate,  frugal,  and  chaste. 

At  the  age  of  eleven  he  injured  the  right  testicle  in 
crossing  a  fence.  Slight  inflammation  followed,  and  the 
groin  remained  from  that  time  permanently  enlarged, 
and  sensibly  harder  than  its  fellow.  No  other  notice- 
able circumstance  was  observed.  At  twenty-two 
years  of  age  he  married  a  heaJtliy  woman,  and  had  a 
family  of  five  children.  Sixteen  years  ago  he  suffered  an 
accidental  bruise  of  the  affected  part,  and  it  began  to  in- 
crease slowly  in  size  and  hardness,  and  to  make  its  dis- 
eased condition  manifest  by  occasional  flashes  of  pain, 
and  the  irritation  and  inconvenience  of  its  weight  and 
bulk. 

He  continued,  however,  to  pursue  his  occupations. 
The  history  from  the  time  specified  indicates  progres- 
sive diminution  (but  not  abolition)  of  sexual  desire 
and  power,  and  at  a  recent  period  the  circumstance  of 
acute  pain  in  the  act  of  emission.  An  examination  re- 
vealed an  elastic,  symmetrical  enlargement  of  the  size 
of  an  ostrich  eggy  red,  tender,  and  painful,  with  the 
sound  testicle  firmly  compressed  against  the  left  exter- 
nal ring. 

Diagnosis — Hydrocele,  with  malignant  degeneration 
of  the  gland.    Advice,  extirpation. 

Accordingly,  on  the  12th  inst,  I  proceeded  to  the 
operation.  Ether  was  cleverly  administered  by  Mr.  L. 
P.  (J.  Gouley,  and  I  punctured  the  sac  and  drew  off 
about  half  a  pint  of  serum.  I  was  then  enabled  to  ex- 
amine the  orpin  more  carefully,  with  the  result  of  con- 
firming the  view  originally  taken,  and  immediately  pro- 
ceeded with  the  ablation. 

—  I  ^  

A  Case  op  Traumatic  Tetanus  suooessfullt  treated 
BY  THE  Orbeal  Bean  OF  Calabar,  is  reported  by  Mr. 
A.  Campbell,  L.R.C.S.,  Edinburgh,  in  a  recent  num- 
^  ber  of  the  Lancet.  One-eighth  of  a  grain  of  extract  was 
administered  every  half  hour  at  first,  and  the  result  of 
relaxing  the  contracted  muscles  was  soon  obtained. 


MEDICAL  SOCIETY  OF  THE  COUNTY  OF 

KEW  YORK. 

Stated  Meetiho,  December  2,  1867. 

Dr.  E.  R,  Peablee,  President,  in  the  Chair. 

REPEATED  PRESCRIPTIONS. 

The  following  preamble  and  resolutions,  reported  from 
the  Comitia  Minora,  were  adopted  unanimously : 

TTAereos,  The  attention  of  this  Society  has  been  called 
to  the  repetition  of  prescriptions,  containing  active  in- 
gredients, by  druggists,  without  the  written  order  of 
physicians;  and  whereas  serious  consequences  to  pa- 
tients are  liable  thus  to  ensue ;  therefore 

Eeaolved,  That  we  respectfully  request  the  druggists  of 
this  city  not  to  repeat  such  a  prescription  without  the 
written  order  of  the  phydician,  he  being  the  only  com- 
petent judge  of  the  propriety  or  necessity  of  such  re- 
newal 

Besolved,  That  a  copy  of  these  resolutions  be  sent  to 
the  druggists  in  this  city. 

MEDICAL  IKTELLIOENCE. 

Among  the  topics  embraced  in  the  report  of  the  Com- 
mittee on  Medical  Intelligence  were:  Dr.  Salisbury's 
article  i]^n  the  discovery  of  a  new  algoid  vegetation  in 
chancroid;  with  Diday's  view  that  all  venereal  diseases 
are  of  parasitic  origin.  The  report  of  a  committee  of  phy- 
sicians at  Florence,  that  syphiHs  cannot  be  communicat- 
ed to  animids ;  and  the  opposite  conclusion  maintained  in 
a  report  lately  presented  to  the  Paris  Society  of  Medi- 
cine. An  account  of  the  recent  investigations  concern- 
ing the  period  after  menstruation  during  which  con- 
ception is  possible;  of  a  new  operation  for  relief  of  deaf- 
ness, consisting  in  excidon  of  the  handle  of  the  malleus, 
by  tSie  aid  of  the  parabolic  otoscope;  and  of  the  trial  of 
acupressure  in  a  case  of  subclavian  aneurism. 

BISTORT  or  UTERINE  'PATHOLOGY. 

Dr.  T.  G.  Thomas  read  a  paper  ui)on  the  above  subject, 
of  which  we  give  no  abstract,  as  it  will  soon  be  pub- 
lished. 

Dr.  Peasleb  said  the  Society  was  under  deep  obliga- 
tion for  the  elaborate  essay  just  read,  and  he  hoped  to 
see  such  papers  presented  more  frequently.  Qur  practice 
must  be  based  upon  our  pathology ;  those  discussions 
are  most  truly  "practical"  which  give  us  comprehensive 
views  of  this ;  and  for  the  attainment  of  such  views 
historical  investigation  is  essential  Though  it  is  only 
within  the  last  twenty-five  years  that  uterine  pathology 
can  properly  be  said  to  have  existed,  yet  it  is  surely  of 
no  slight  import  to  know  that  the  speculum  was  in  use 
a  century  sgo.  He  would  allude  to  two  or  three  points 
in  the  pathology  and  practice  of  the  last  twenty-five 
years.  The  lecturer  had  mentioned  the  prominent 
theories  upon  the  subject,  and  he  would  refer  especially 
to  those  of  Bennett  and  Velpeau,  who  have  exerted  so 
powerful  an  influence  in  determining  the  present  form 
of  uterine  pathology.  The  former  maintained  that  the 
great  majonty  (87  per  cent)  of  displacements  are  due  to 
antecedervt  inflammation,  the  latter  that  in  ei|hteen 
cases  out  of  twenty  the  inflammation  is  caused  by  the 
displacement  Among  adherents  to  the  former,  caustic 
is  the  great  remedy,  while  Velpeau's  disciples  treat  al- 
most every  case  with  some  kind  of  mechanical  support 
Hence  we  had  two,  or  he  might  say  three,  r^resenta- 
tive  men  in  uterine  practice :  first^  Bennett,  with  bis 
caustic ;  second,  Hodge,  of  Philadelphia,  who  pushed 
Velpeau's  theory  to  its  limit,  and  often  used  supporters 
(as  he  directly  states)  even  where  no  displacement  was 
found ;  and  third,  Sims,  who,  taking  a  difierent  view 
still,  that  most  uterine  diseases  depend  upon  some  ob- 


THE  MEDICAL  RECORD. 


409 


struction  of  the  cervical  canal,  had  given  great  prom- 
inence to  operations  upon  the  cervix.  Doubtless  each 
of  these  views  required  modification,  though  each  had 
done  much  to  advance  true  science.  All  innovators  are 
apt  to  be  extremists,  yet  we  honor  them  none  the  less 
for  their  substantial  additions  to  our  knowledge.  We 
think  we  have  now  learned  the  particular  class  of  cases 
in  which  caustic  is  advisable,  and  we  reserve  it  for  such; 
while  to  mechanical  support  we  assign  its  own  province. 
Beyond  question  it  will  be  the  same  with  the  view  just 
now  most  fashionable,  and  the  time  will  come  when 
operations  upon  the  cervix  will  be  more  rarely  per- 
formed. 

NEW  YORK  ACADEMY  OP  MEDICINE. 

Stated  Mektino,  Dec.  18,  1867. 

Diu  Alfred  0.  Post,  President,  in  the  Chair. 

jlnkiversarv  discourse. 

Dr.  Stephen  Smith  delivered  the  Anniversaij  Dis- 
course, in  which  he  gave  a  resum^  of  the  condition  of 
surgery  in  the  metropolis,  extending  from  a  period  of 
some  two  hundred  years  ago,  to  about  the  beginning 
of  the  present  century.  The  discourse  was  interspersefti 
with  sketches  and  reminiscences  of  leading  practitioners, 
among  the  most  elaborate  of  which  was  a  memoir  of 
Dr.  John  Jones,  Professor  of  Surgery  in  King's  Col- 
lege, who  died  in  1791. 

A  copy  of  the  discourse  was  requested,  by  a  vote  of 
the  Academy,  for  publication. 

The  President  announced  that  the  Academy  would 
be  convened  on  the  succeeding  evening,  to  listen  to  a 

£aper  by  Professor  Horatio  R.    Storer,  of  Boston, 
[ass. 
The  Academy  then  a<^oumed. 

NEW  YORK  MEDICO-LEGAL  SOCIETY. 

Stated  Meetino,  Nov.  6,  1867. 

Dr.  T.  0.  FiNNELL,  President,  in  the  Chair. 

A  CASE  OF  PERITONITIS,   CAUSED  BT    LACERATION    OV 
UTERUS  BT  SOUND. 

Dr.  Newman  detailed  the  following  case :  A  medi- 
cal friend  was  summoned  on  Monday,  Oct.  27  th,  to 
attend  a  woman  four  and  a  half  months  pregnant,  who 
had  been  in  labor  thirty  hours.  She  attributed  her 
miscarriage  to  a  fright  got  by  collision  with  a  boy  on 
Broadway,  and  to  a  good  deal  of  walking  and  excite- 
ment in  Brooklyn.  When  he  arrived,  be  found  the  ex- 
ternal OS  dilated,  the  internal  constricted,  and  the  head 
of  the  foetus  presenting.  On  visiting  her  the  following 
dsy  at  four  o'clocl^  and  finding  no  progress  made,  while 
the  symptoms  indicated  increasing  debility,  he  inserted 
Barnes's  uterine  dilator.  But  this  proving  ineffectual, 
he  introduced  a  uterine  sound,  guided  and  protected  by 
his  index  finger,  with  which  he  separated  the  mem- 
branes, first  on  one  side,  and  then,  after  its  withdrawal 
and  rcintroduction  with  the  same  care,  on  the  other. 
By  six  o'clock  of  that  same  evening  a  dead  foetus  was 
born.  The  placenta  and  membranes  came  away  with- 
out difficulty ;  the  former  presenting  to  the  eye  the  ap- 
pearance of  fatty  degeneration.  Immediately  after  this 
she  was  seized  with  a  rigor,  and  the  next  day  had  the 
symptoms  of  violent  peritonitis,  which  terminated 
fatally  the  following  Saturday. 

Da,  Bahan  reported  the  result  of  the  autopsy  of  the 
above  case  held  the  day  following  death.  The  abdomi- 
nal cavity  presented  the  appearances  of  recent^  exten- 


sive, and  violent  peritonitis.  The  greater  omentum  wa® 
glued  to  the  intestines  beneath.  A  large  quantity  o 
sero-pus  weUed  up  from  behind  the  uterus,  which  organ, 
as  well  as  the  liver,  presented  on  its  surface  naany 
patches  of  recent  lymph.  The  uterine  cavity  contained 
some  broken  down  clots  of  blood,  and  the  external  os 
was  dark  purple,  and  slightly  ragged  at  one  angle. 

Dr.  FinneUi,  in  presenting  the  uterus  of  this  woman 
to  the  Society,  alluded  at*  some  length  to  its  points  of 
interest,  whether  viewed  pathologically  or  medico- 
legally.  But  paramount  over  all  was  the  existence  of 
an  abnormal  canal,  which  starting  from  the  cervix  quite 
near  tlje  internal  os,  terminated  very  soon  in&culdeBac 
in  the  uterine  muscular  waU.  It  was  large  enough  to 
admit  with  ease  the  passage  of  the  handle  of  a  scalpel, 
and,  in  his  opinion,  was  the  result  of  an  accident  which 
had  occurred  to  the  gentleman  in  the  introduction  of  the 
sound,  notwithstanding  the  care  and  circumspection 
used. 

Dr.  Lynch  doubted  that  a  probe-pointed  sound  used 
in  the  careful  and  gentle  manner  described,  could  be 
made  to  penetrate  the  tissues  of  a  uterus  so  healthy  as 
this  appeared  to  be. 

Dr.  John  Beaoh  supposed  the  sound  to  have  entered 
a  sinus,  from  which  shght  force  might  push  it  into  the 
uterine  wall.  He,  however,  doubted  the  relation  of 
cause  and  effect  between  the  wound  and  the  peritonitis, 
as  the  uterine  tissues  presented  no  evidences  of  inflam- 
mation. 

Dr.  Connolly  said  it  was  a  question  whether  this 
woman  had  not  been  tampered  with  by  an  abortionist 
previous  to  the  regular  physician^s  attendance,  and 
agreed  with  the  preceding  speaker,  that  the  relation 
between  the  wound  and  the  peritonitis  was  not  evident. 

Dr.  Wooster  Beach  said  his  experience  at  autopsies 
had  taught  him  that  inflammation  might  exist  in  a  re- 
mote part  of  theperitoneum,  and  yet  be  due  to  injury 
of  the  uterus.  He  was  not  prepared  to  ofler  an  ex- 
planation of  this  fact. 

Dr.  Stirling  alluded  to  the  woman's  surroundings, 
which,  taken  in  connection  with  the  ragged  condition  of 
the  external  os  uteri,  led  him  to  suppose  that  attempts 
had  been  made  to  induce  a  miscarriage,  previous  to  the 
regular's  attendance. 

Dr.  Newman  closed  the  discussion  by  stating  that  the 
instrument  used  in  this  case  was  the  uterine  sound  with 
a  blunt  end,  about  No.  7,  catheter  size.  He  called  the 
attention  of  the  Society  to  the  fact  that  in  the  present 
contracted  and  shrivelled  state  of  the  parts  the  diameter 
of  the  wound  is  much  Iwger  than  tiiat  of  the  soimd. 
How  much  larger,  then,  it  must  have  been  in  the  fresh 
condition  I  He  failed  to  discover  any  reasons  for  sup- 
posing it  to  have  been  made  by  a  sound. 

The  meeting  then  adjourned. 


K  Y.  MEDICAL  JOURNAL  ASSOCIATION. 

STATED  REUNION.  FRIDAT.  NOVEMBERS©,  1S6T. 

Dr.  Gurdon  Book,  PREsmsNT,  in  the  Chair. 

periodical  fevers. 

Dr.  Lerot  M.Yale  read  an  elaborate  resum^  of  the  recent 
contributions  to  the  literature  of  periodical  fevers.  Under 
their  setiology  and  pathology  were  given  the  views  of 
SaUsburv,  with  which  our  readers  are  doubtless  familiar ; 
of  Robm,  who  attributes  midarious  fevers,  as  well 
as  nearlv  all  zymotic  diseases,  to  the  vitiation  of 
the  blood,  by  a  rapidly  putre&ctive,  coagulable,  albumi- 
noid substance  to  be  found  in  all  miasmatic  air  (Sur  lea 
SumeurSf  p.  195  et  seq.) ;  and  of  De  Beaufort,  who 
bases  upon  this  theory  a  very  ingenious  paUiology  (Buf 


*500 


THE  MEDICAL  RECORD. 


Mn  CfhierdU  de  Thirapeutique^  Sept  30,  1867).  Un- 
der prophylaxis  and  treatment,  reference  was  made  to 
the  prophylactic  power  claimed  for  tobacco ;  to  the  new 
modes  of  administering  quinia,  hypodermically,  iatro- 
leptically,  and  by  inhalation ;  and  to  new  anti-periodics, 
among  which  chloroform  stands  preeminent  in  its 
power  of  bringing  on  reaction  from  pernicious  conges- 
tions. M.  Eulenberg*s  experiments  upon  the  modus 
operandi  of  quinia  were  mentioned.  He  concludes, 
though  the  value  of  his  results  is  questioned,  that  it  di- 
rectly destroys  muscular  irritability,  and  paralyzes  first 
the  reflex  nervous  centres  of  the  cord,  and  later  the 
cerebral  ganglia. 

The  discussion  which  followed  assumed  a  very  prac- 
tical character. 

Dr.  H.  S.  Hewitt  stated  that  he  had  used  quinia  as 
a  prophylactic  in  many  hundred  cases,  and  had  come 
to  regard  it  as  almost  infallible. 

Dr.  C.  C.  Leb  fully  endorsed  this  view.  He  referred  to 
an  instance  in  the  late  war,  where  a  body  of  eight  hun- 
dred and  fifty  men,  not  befwe  exposed,  were  suddenly 
compelled  to  encamp  in  a  malarious  region ;  seven  hun- 
dred of  them  were  put  under  a  prophylactic  regimen  of 
quinia,  and  of  these  but  four  or  five  were  attacked  by 
the  fever;  while  of  the  one  hundred  and  fifty  not  so 
treated,  only  twenty  or  thirty  escaped  it*  It  was  ob- 
served in  these  cases  that  this  agent  was  less  efficient 
for  the  control  of  the  disease,  when  once  established, 
than  for  its  prevention. 

Dr.  Austin  Flint  related  a  singular  efiect  of  large 
doses  of  quinia  in  a  case  of  violent  congestive  inter- 
mittent, which  he  had  seen  last  summer  in  consultation. 
During  the  paroxysm  several  doses  of  twenty  to  forty 
grains  were  given,  at  intervals  of  two  hours,  until  up- 
wards of  one  hundred  grains  had  been  taken  with  no 
evidence  of  cinchonism.  When  the  amount  of  one 
hundred  and  thirty  grains  was  i;eached,  there  suddenly 
occurred  total  blindness,  but  without  tinnitus  aurium 
or  other  of  the  usual  signs  of  over  action  of  the  drug. 
The  blindness  passed  off  in  a  few  hours,  and  the  par- 
oxysm, which  bad  threatened  to  be  fatal,  was  happily 
arrested. 

Dr.  Whfte  had  treated  a  case  in  which  ten  grains  of 
the  snlphate  produced  convulsions,  and  the  patient 
stated  that  he  had  been  similarly  affected  before.  The 
valerianate,  in  small  doses,  was  substituted  with  ^ood 
effect.  Dr.  W.  had  met  with  another  instance  <w  the 
kind.  He  said  that  the  surgeons  upon  the  Panama 
Railroad  had  given  a  lon^  and  faithful  trial  to  the  va- 
rious substitutes  for  quinia,  only  to  abandon  them  and 
return  to  the  sulphate  of  this  alkaloid  as  the  best  anti- 
periodic. 

Dr.  Garrish  had  been  using,  with  encouraging  re- 
sults, the  hyposulphite  of  soda  (gr.  x.-xx.  ter  in  die) 
in  four  cases  which  had  resisted  quinine  and  arsenic. 

NEW   SPLDTT  FOR  FRACTURE  OF  THE  THIGH. 

Dr.  Hewjlt  presented  a  new  splint  for  fractures  of  the 
thigh.  It  is  composed  of  metal ;  the  side-pieces,  which 
are  firmly  united  by  cross-bars,  are  hinged  at  the  knee, 
and  the  thigh  and  le^  portions  are  fixed  at  any  desired 
angle  by  means  of  a  simple  screw  appliance ;  extension  is 
made  from  the  foot  by  any  of  the  usual  methods  (screw, 
elastic  strap,  or  weight),  counter-extenaon  by  a  perinroal 
pad  attached  to  the  inner  side  of  the  splint,  and  by  a  pelvic 
band  attached  to  the  outer  ade ;  coapting  pads,  shaped 
to  fit  the  thigh,  are  fixed  at  any  point  by  screw  clamps 
which  play  along  fenestrae  in  tiie  side-pieces.  The 
thigh  is  to  be  left  without  bandaging.  Dr.  H.  claims 
for  this  splint  the  merits  of  simplicity,  lightness,  and 
firmness ;  openness,  giving  free  ventilation  to  the  limb, 
and  enabling  the  surgeon  to  detect  at  once  any  devia- 


tion of  the  fitigments  from  the  right  line ;  and,  as  its 
most  important  feature,  that  it  secures  such  perfect 
coaptation  as  to  reduce  to  the  minimum  the  force  of 
extension  and  counter-extension  required. 

Annual  Mebtiito,  Tuesday,  December  3,  1867. 
Dr.  Stephen  Smith,  Vice-President,  in  the  Chair. 

reports. 

The  report  of  the  Treasurer,  Dr.  S.  T.  Hubbard, 
showed  the  total  receipts  for  the  year  to  have  been 
$1834.32;  total  expenses^,  $2010.28;  but  by  ofiseUing 
the  bills  against  the  Association  by  the  amount  due  it, 
there  was  left  a  nominal  debt  of  $29.68.  The  Treasurer 
stated  that  the  expense  of  furnishing  the  new  rooms 
had  made  an  extra  draft  upon  the  funds,  during  the  past 
year,  such  as  would  not  soon  be  required  again ;  and  that 
m  his  opinion  the  current  regular  assessments  would  be 
ample  to  meet  all  demands  upon  the  treasury. 

The  Board  of  Direction  reported  the  condition  of  the 
Association  very  flourishing.  A  reserved  fund  had  been 
guaranteed,  to  meet  any  deficit  in  its  finances,  but  there 
had  been  no  occasion  to  draw  upon  it.  The  aodety 
was  larger  than  the  year  before,  numbering  at  present 
about  160  members.  Four  members  had  died  during 
the  year:  Drs.  S.  P.  White,  0.  E.  Morgan,  J.  B.  Mc- 
Ewen,  and  Robert  Watts.  The  hbrary  was  steadily  in- 
creasing in  value. 

The  Librarian.  Dr.  B.  S.  Thompson,  reported  that  at 
the  beginning  or  the  year  tiie  list  of  medical  periodicals 
regularly  taken  embraced  thirteen  American,  eight 
English,  twelve  German,  and  ten  French  journals.  Dur- 
ing the  year  eight  journals  had  been  added,  making  the 
number  now  received  fifty-one.  Donations  h^d  been 
received  of  one  hundred  and  twenty-eight  copies  of 
transactions,  monographs,  journals,  etc. ;  also  of  several 
photographs  and  engravings. 

OFncERS  elect. 

The  Association  proceeded  to  ballot  for  oflScers  for 
the  year.  Dr.  Stephen  Smith  declined  to  be  a  candi- 
date Ibr  reelection  as  Vice-President,  from,  inability  to 
be  regulariy  present  at  the  meetings,  and  Dr.  Hubbard 
declined  further  service  as  Treasurer.  With  these  ex- 
ceptions the  old  Board  was  reelected.  The  following 
are  the  oJBficers  chosen:  President,  Dr.  Gurdon  Buck; 
First  Vice-President,  Dr.  Isaac  E.  Taylor ;  Second  Vice- 
President,  Dr.  Samuel  T.  Hubbard ;  Recording  Secre- 
retwT,  Dr.  F.  A.  Burrall;  Corresponding  SecreUry, 
Dr.  Emil  Noeggerath ;  Treasurer,  Dr.  H.  P.  FwTiham ; 
Trustees,  to  serve  three  years,  Drs.  F.  H.  Hamilton,  F. 
J.  Burastead,  Austin  Flint,  Sen,,  Alfred  Underbill,  and 
A.  B.  Mott. 

• —  ^  >  ^       — 

EAST  RIVER  MEDICAL  ASSOCIATION. 

Stated  Meetino,  Nov.  5  th,  1867. 
Dr.  V.  Morse,  Presimnt,  in  the  Chair. 

A  CASE  of  TWIN-DELIVERT,  WITH   INTERVAL  OF  SIXTEEN 

hours. 

Dr.  O'SuLLfVAK  read  the  history  of  an  interesting  caie 
of  twin-delivery,  which  occurred  in  his  own  practice ; 
in  which  there  nad  been  an  interval  of  sixteen  hours 
between  the  birth  of  the  first  aud  second  child.  The 
point  of  interest  was  that  after  the  birth  of  the  firet 
child,  the  uterus  remwned  perfectly  inactive.  Hour 
idler  hour  passed  away,  imtil  at  last  it  was  determined 
to  wait  no  longer.  'Fearing  to  give  ergoL  lest  the 
presentation  should  prove  to  be  an  abnormal  one,  Dr. 
O'SuUivan  thought  seriously  of  deluFery  by  version. 
digitized  by  V^jOO^^_ 


THE  MEDICAL  RECORD. 


601 


On  introducing  the  band  into  the  yagina,  for  the  pur- 
pose of  making  a  thorough  exploration,  he  found  the 
pelvis  ample — the  head  of  the  foetus  rather  large,  but 
not  too  much  so  for  the  lateral  diameters,  and  presenting 
in  the  left  occipito-iliac-posterior  position. 

The  membranes  were  ruptured,  when  a  few  feeble 
pains  followed,  but  soon  ceased.  Ergot  was  then  given 
m  the  ordinary  manner,  with  the  desired  result;  the 
pains,  from  having  been  at  first  moderate,  soon  became 
satisfactorily  powerftd.  The  head  readily  engaged, 
the  occiput  rotating  posteriorly,  and  passmff  tJhough 
the  hollow  of  the  sacrum,  and  a  male  child  of  large  size, 
strong  and  healthy,  was  delivered.  The  placenta  was 
readily  detached  without  any  hsdmorrhage.  The  pa- 
tient made  a  good  getting  up.  The  interesting  point  in 
this  case  was  in  reference  mainly  to  the  long  interval 
of  time  which  had  elapsed  before  the  birth  of  the  second 
child,  it  being,  with  some  rare  exceptions,  probably  the 
longest  on  record,  in  which  the  result  to  both  mother 
and  child  was  so  favorable.  It  is  probable  that  the 
propriety  of  non-interference  in  this  case,  until  the 
uterus  resumed  its  action,  may  be  open  to  criticism, 
notwithstanding  that  no  untoward  symptoms  of  any 
kind  ensued  during  the  interval  With  now  nearly  ten 
years  additional  experience  in  obstetric  practice,  and  con- 
siderable in  the  use  of  the  forceps,  he  would  not  now  delay 
so  long  before  attempting  delivery ;  he  would  not  wait  at 
furthest  until  a  single  hour  had  elapsed.  If  it  were  a 
vertex  presentation,  and  had  engaged  sufficiently,  he 
would  use  the  forceps;  if  this  were  n:)t  feasible,  he  should 
then  turn  and  deliver.  Either  of  the  above  expedients 
he  deemed  preferable  t  >  the  use  of  ergot.  There  is, 
however,  very  respectable  authority  for  postponing  in- 
terference in  these  cases  unless  compelled  to  the  con- 
trary by  accidental  circumstances,  such  as  convulsions, 
h»morrhage,  etc.  There  are  several  instances  on  record, 
though  of  course  very  rare,  when  the  second  child  has 
been  retained  for  days  and  even  weeks. 

Db.  Abbott  asked  why  the  doctor  preferred  using 
forceps  in  such  oases  to  administering  ergot.  This 
question  gave  rise  to  an  animated  discussion,  which 
continued  until  a  late  hour,  when  it  was  finally  resulved 
to  make  ''Parturients"  the  subject  for  debate  at  the 
next  meeting. 


€otxespor(tftncL 


MEDICAL   MATTERS   IN   PARIS. 

(from  our  speolu.  correspondent.) 

To  TUB  KniToa  or  thb  Mxdioal  Bkoobd. 

CURI017S  NERVOUS  PHENOMENA. 

Sib — ^The*' sensation''  of  the  week  centres  around  the 
discussion  of  a  remarkable  circumstance  occurring  in 
the  wards  of  M.  Bichet  at  Hotel  Dieu.  On  the  23d 
of  October,  a  woman  entered  the  service,  who,  felling 
against  some  pieces  of  sheet  copper,  had  been  wounded 
Id  the  forearm  by  their  sharp  ed^,  in  such  a  manner 
that  the  radial  artery  and  median  nerve  had  been 
cooipler^ly  divided..  Notwithstanding  this  section, 
sensibility  remained  in  the  thumb,  index  and  middle 
finj^ers,  and  the  external  border  of  the  ring  finger,  all 
furnished  by  the  median  nerve;  moreover,  the  per- 
ipheric extremity  of  this  nerve  was  exquisitely  sensitive 
to  the  touch  of  the  pincers. 

The  fact  has  been  examined  and  acknowledged  by  a 
number  of  distinguished  physicians.  There  can  be  no 
doubt  that  the  median  was  completely  severed.  But  it 
IB  difficult  to  explain  a  phenomenon  so  contrary  to 


the  facts  which  form  the  basis  of  current  physiologi- 
cal theories,  according  to  which  the  peripheric  ex- 
tremity of  a  severed  motor  nerve  preserves  its  mo- 
tor power,  and  that  of  a  sensitive  nerve  loses  its  sensi- 
bility. Dr  Fort,  in  the  Union  Mddicale,  endeavors  to 
prove  tiiat  the  case  is'one  of  recurrent  sensibility,  like 
that  described  by  Bernard  as  existing  in  the  facial  nerve. 
Irritation  of  this  nerve  excites  pain,  on  account  of  its 
anastomoses  with  the  trigeminus.  In  the  same  way, 
says  Dr.  Fort,  we  must  infer  from  this  fact  itself  that 
the  radial  and  cubital  nerves  furnish  anastomoses  with 
the  median,  by  which  this  latter  is  enabled  to  preserve 
its  sensibility  even  after  section. 

This  argument  s  rather  past  factum.  Moreover,as  ob- 
served by  Dr.  Reveillant  in  the  QaxeUe  dee  Bdpitaux, 
there  is  no  analogy  between  the  coupling  of  a  sensitive 
and  motor  nerve  in  a  single  ** nervous  pair"  (as  in  the 
case  of  the  5th  and  the  7th)  and  this  supposed  anas- 
tomosis between  two  sensitive  nerves,  which  is  justi- 
fied by  no  precedent  whatever.  Dr.  Reveillant  main- 
tains, that  since  the  grand  palmar  nerve  is  more  deeply 
situated  than  the  median  at  the  wrist  on  the  level  of 
the  wound,  since  it  is  united  to  the  median  only  by  a 
loose  cellular  tissue  which  permits  great  mobility,  since 
the  median  was  torn,  instead  of  being  distinctly  cut^ 
and  the  wound  was  deepest  on  the  radial  boraer  of 
the  wrist — in  view  of  these  considerations  it  is  probable 
that  the  great  palmar  nerve  was  not  divided,  as  at  first 
supposed,  and  the  recurrent  sensibility  was  due  to  its 
presence  in  the  parts  furnished  by  the  median.  But 
this  explanation,  though  hypothetically  satisfactory  for 
the  sensibility  remainmg  in  the  hand^  renders  no  ac- 
count of  that  preserved  in  the  peripheric  extremity  of 
the  median,  since  the  palmar  branch  is  given  off  from 
this  latter  nerve  at  a  point  above  the  situation  of  the 
wound,  and  afterward  has  no  connection  with  the 
median.  Dr.  Bichet  has  not  yet  spoken.  His  detailed 
description  of  the  case  is  presently  expected,  and  may 
throw  light  on  this  vexed  question. 

EXPERIBfENTS   UPON  CRIMINALS. 

At  the  naval  medical  school  of  Brest,  M.  le  profes- 
seur  Duval  has  pursued  some  physiological  researches 
in  a  direction  that  continually  tends  to  become  re- 
stricted. If  the  humanitarian  tendencies  of  the  age 
prevail,  capital  punishment  will  be  abolished,  and  phy- 
siologists forever  deprived  of  the  bodies  of  criminals  as 
material  for  experiments.  In  view  of  this  unfortunate 
contingency,  all  experiments  actually  performed  are  in- 
vested with  a  double  interest,  on  account  of  the  pos- 
sibility that  they  may  be  the  last  permitted  in  civilized 
countries. 

The  following  is  a  resume  of  the  results  obUuned  by  M. 
Duval,  in  galvanization  of  the  different  apparatus  of  the 
bodies  of  criminals,  within  five  or  six  minutes  after  their 
execution. 

Nervous  System, — Galvanisation  of  the  motor  ocular 
nerve,  at  its  point  of  immersion  in  the  cavernous  sinus, 
caused  instant  contraction  of  the  dilated  pupil.  In 
two  subjects  reflex  movements  were  excited  by  a 
brusque  tap  on  the  hands  or  feet  The  contractions 
of  the  deltoid,  brachial,  biceps,  anterior  tibial  and  gastro- 
nervous  muscles  were  especially  evident  In  the  case 
of  a  slight  irritation  of  the  surface,  exciting  contraction 
of  the  subjacent  muscles,  the  action  was  evidently  reflex : 
where  a  smart  percussion  had  been  practised,  M.  Duval 
supposes  that  the  muscular  fibre  had  been  directly  ex- 
cited, independent  of  the  nerves.  This  experiment 
confirms  Schiff 's  refutation  of  the  theory  that  warm- 
blooded animals  oould  not  exhibit  reflex  movements 
after  decapitation. 

Digestive  Apparatus, — ^The  stomach  and  small  intestines 


502 


THE  MEDICAL  RECORD. 


continued  to  exhibit  peristaltic  movements  for  several 
miDutes.  The  stomach  was  filled  with  food,  and  in  the 
midst  of  digestion,  but  none  of  its  contents  escaped  at 
the  orifices  afier  removal  of  the  organ  firom  the  ab- 
domen, so  efficient  was  the  contraction  of  the  sphincters. 
A  remarkable  prominence  of  the  solitary  closed  folh'cles 
of  the  iUum  was  observed.  This  fact  is  interesting,  on 
account  of  a  theory  recently  proposed,  which  considers 
such  prominence  to  be  a  characteristic  lesion  of  cholera. 

Circulatory  Apparatus. — The  primitive  carotids  were 
divided,  and  their  extremities  were  seen  to  rise  at  re- 
gular intervals,  elongate  beyond  the  level  of  the  wound, 
and  then  subside ;  at  each  impulse  a  small  quantity  of 
frothy  vermilion  blood  escaped. 

On  the  same  two  subjects,  the  thorax  was  opened 
seven  minutes  after  death,  and  the  heart  found  to  be 
beating  within  the  pericardium.  Upon  incision  of  this 
membrane, ",.  the  following  succession  of  phenomena 
was  observed.  At  the  beginning  of  each  movement  the 
auricular  appendix  was  suddenly  raised,  and  distanced 
from  the  aorta,  then  fell  aa  abruptly  into  its  primitive 
position.  In  rising,  the  appendix  lengthened,  and  the 
indentures  of  the  circumferencese  parated  like  the  fingers 
of  an  outstretched  hand.  At  the  same  time  with  this 
erection  of  the  appendix,  occurred  an  expansion  of  the 
auricle,  as  if  it  were  distended  by  an  efflux  of  liquid. 
The  contraction  of  the  ventricules  followed  that  of  the 
auricles  in  less  than  the  fifth  of  a  second.  These  cavities 
were  shortened  in  all  their  diameters,  their  surface 
became  farrowed,  they  contracted  together  in  perfect 
synchronism. 

Aft«r  cessation  of  the  spontaneous  beatings  of  the 
heart,  the  movements  were  renewed  by  the  application 
of  galvanism,  first  to  the  organ  itself,  afterward  to  the 
spinal  cord. 

M.  Duval  found  that  a  moderate  degree  of  contrac- 
tUity  existed  in  the  walls  of  the  aorta,  which,  irritated 
by  the  insertion  of  a  finger,  were  found  to  slightly  press 

upon  it.  1       .      .        /.  1 

Respiraiory  Apparatus. — Upon  galvanization  of  the 
extemd  or  internal  intercostal  muscles,  or  of  both  to- 
gether, the  under  rib  was  raised  and  pushed  outward. 
Il  Duval  concludes  that  both  these  muscles,  concern- 
ing which,  from  the  time  of  Haller  and  Hamberger, 
there  has  been  so  much  discussion,  are  inspiratory.  M. 
Duchenne  (de  Boulogne)  impresses  this  feet  into  his 
service  to  prove  the  same  theory. 

ATROPHY  OP  MUS0LE8  OP  TRUNK  AND  LIMBS. 

I  am  not  sure  whether  I  have  mentioned  the  lecture 
delivered  by  Duchenne  upon  a  patient  in  the  wards  of 
M.  Bouillaud,  affected  with  atrophy  of  nearly  all  the 
external  muscles  of  the  trunk  and  limbs.  The  inter- 
costal muscles  were  entirely  wasted,  and  the  chest  is 
flattened  in  a  remarkable  manner.  The  respiration  is 
performed  by  the  diaphragm.  M.  Duchenne  remarked, 
that  Mnce  the  thorax  contracted,  as  in  expiration,  as 
soon  as  the  intercostal  muscles  became  poweneas,  it  was 
just  to  infer  that  in  health  they  antagonized  this  con- 
traction; that  is,  opposed  the  action  of  the  expiratory 
muscles.  It  seems  to  me  evident,  however,  that  the 
case  in  question  proved  that  they  exert«d  such  antag- 
onism in  virtue  of  their  tonicity,  not  at  all  on  account 
of  the  intermittent  contraction  during  inspiration.  The 
experiments  of  M.  Duval  are  no  more  conclusive,  for 
altnough  a  muscular  fibre  when  galvanized  should  ele- 
vate a  rib  to  which  its  fibres  were  attached,  we  are  not 
thence  to  infer  that  it  contracts  habituallv  during  life, 
or  therefore  that  it  directly  elevates  the  ribs  during  in- 
spiration. 

P.  C.  M. 


CONTRACTIONS  OF  THE  MUSCULAR  COATS 
OF  THE  STOMACH  IN  VOMITINa. 

To  niB  Editor  or  tub  Medical  Rbcobd. 
Sir — ^In  a  recent  review  (Medical  Record,  Dec  2, 1867) 
of  Ihe  ''  Physiology  of  Man^'  vol.  ti.,  by  Austin  Flin^ 
Jr.,  M.D..  "  we  leani,"  says  the  writer,  "  that  the  dia- 
phragm 13  the  principal  agent  in  vomitmg,  that  this 
muscle  is  aided  by  the  abdominal  muscles,  Uie  muscular 
coats  of  ihe  stomach  being  at  the  time  relaxed." 

We  present  the  following  facts,  not  only  as  a  contri- 
bution to  physiological  science,  but  m  our  reasons  for 
differing  largely  from  the  views  entertained  by  the  dis- 
tinguished author  on  the  subject  in  question. 

On  the  23d  of  April,  1858,  at  Lock,  Berlm,  Wayne 
Co.,  New  York,  while  performing  the  operation  of 
ovariotomy,  which  proved  success&l,  the  mdsion  ex- 
tending from  the  ensiform  cartilage  to  the  pubes,  and 
after  the  removal  of  two  large  tumors  weighing  nearly 
forty  pounds,  my  patient  began  to  vomit. 

Desirinff  to  settle  for  myself  the  physiological  ques- 
tion whether  the  muscular  coats  of  the  stomach  are 
mechanical  agents  in  vomiting,  I  introduced  my  hand 
into  the  abdomen,  and  placed  it  upon  the  stomach. 
That  organ  feU  and  acted  tike  a  living  thing j  its  coats  vfcre 
not  relcuced,  but  contracted  under  my  hand  at  each  of 
three  consecutive  retchings,  during  which  a  large  quan- 
tity of  food  was  ejected.  The  frequency  of  gastrotomy 
renders  it  probable  that  other  observers  may  confirm 
my  experience,  and  we  may  thus  establish  a  fMA  of 
vi^ue  to  science  and  of  interest  to  scientific  men. 
Very  respectfully, 

Xour  obedient  servant, 

Haiabd  C.  Potter,  M.D. 

OnrsTA,  December,  1867. 


Um  3n«trumeitt«^ 


A  POCKET-CASE  HYPODERMIC  SYRINGE. 
Br  D.  M.  STIMSON,  M.D. 
The  aocompan3ring  cut  represents  a  convenient  form  of 
hypodermic  syringe  to  be  carried  in  the  pocket-case. 

The  idea  which  is  here  carried  out  was  suggested  to 
me  two  years  ago  by  Dr.  G.  H.  Wynkoop,  of  this  dty. 


The  point,  inclosing  the  wire  cleaner,  fits  into  a  bel- 
low graduated  piston.  The  barrel  is  an  ordinary  silver 
tube,  the  size  <x  a  No.  10  catheter,  and  is  about  three 
inches  long. 


Um   publtcationd. 


Books  and  Pavphlets  RBosrvED. 

A  Practical  Tbeatisk  on  Diseases  op  CHnj)RiN.  Bj  D. 
Francis  Condib,  M.D.,  Fellow  of  the  College  of  Physi- 
cians, eta  6th  Edition.  Revised  and  enlarged.  Philadel- 
phia: H.  C.Lea.    1868. 

Observations  on  the  Nature  and  Treatment  or  PoiT- 
PUS  OF  THE  Ear.  By  Edward  E.  Clarke,  M.D.,  Profeesor 
of  Materia  Medica  in  Howard  University,  etc.,  eta  Pp.  7  L 

42nd  Annual  Report  of  the  Mass.  Chaeftable  Etb  and 
Ear  Infirmart.  .  For  the  Tear  ending  Sept  SOth,  1867. 
Boston.    1867. 

On  the  Signs  and  Diseases  of  Pbegnanct.  By  Thonas 
Hawkbs  Tanner,  M.D.,  F.Lw&,  eta  From  Second  tod 
Enlarged  London  Edition.  Philadelphia,  H.  G.  Lea.  1868. 


THE  MEDICAL  RECORD. 


608 


Mtbxcoi  3ttmsi  axitf  Uma. 


Dr.  LiTiNOSTONB  PROBABLY  Alitr. — ^Letters  received 
in  London  give  assoranoe  of  the  safety  of  Dr.  Liying- 
stone,  the  African  explorer,  who  was  reported  to  have 
been  killed  hj  the  natives.  In  April  last  he  was  in 
good  health  and  continuing  his  explorations. 

EuLOOT  OR  Prof.  Valentinr  Mott. — ^Pro£  Samuel  D. 
Gross^  of  Philadelphia,  Pa.,  pronounced  a  Eulory  on 
the  Life  and  Character  of  the  bte  Pro£  Valentine  Mott^ 
at  the  Bellevue  Hospital  Medical  College,  Dec.  14, 
1867.  The  travels  of  the  eminent  deceased,  his 
intercourse  with  the  distinguished  medical  and  surgical 
savants  in  Europe,  as  well  as  otiier  incidents  in  his 
eventful  career,  were  fully  discussed. 

Dr.  Vernois,  Physician  of  the  Hotel  Dieu,  has  re- 
signed his  position. 

Dr.  Barrbt. — ^We  regret  to  annoimce  the  death  of 
Dr.  Barrey,  Medical  Director  of  the  Insane  Asylum  at 
Bodez.  He  died  on  the  1st  of  October,  after  a  short 
and  painful  illness,  in  the  51st  year  of  his  age. 

ScnoiDi  or  a  Distinouishsd  Surgeon. — Dr.  Ludwig 
Lewinsky,  head  of  one  of  the  surgical  divisions  of  the 
(General  Hospital  at  Vienna,  was  found  dead  in  his 
quarters,  on  the  17th  of  October.  A  farewell  letter,  ad- 
dressed to  his  wife,  leaves  no  doubt  of  his  death  being 
the  result  of  his  own  deliberate  action.  He  had  been 
for  some  months  haunted  with  the  fear  of  becoming  in- 
sane, a  fear  which  received  some  substantial  basis  in 
the  iact  of  his  being  afiOicted,  during  this  period,  with 
occasional  fits  of  iTisomnia, 

An  autopsy,  conducted  by  the  celebrated  Rokitansky, 
discovered  unquestionable  evidences  of  poisoning  by 
cyanide  of  potassium.  There  was  also  lound  an  ab- 
normal tbicKcning  of  the  membranes  of  the  brain, 
sufficient  to  account  for  the  sleeplessness  referred  to, 
which  in  the  end  had  led  to  so  melancholy  a  result 

Tbiohinasis  and  its  nmcTS  upon  an  IJnbxlievbr. — 
At  a  recent  public  meeting,  while  ProfessorVirchow  was 
urging  upon  the  audience  the  necessity  of  microscopical 
examinations  of  all  meats  supposed  to  be  infected  wiUi 
trichina,  a  distinguished  veterinarian  arose  and  astonished 
every  one  present  with  the  announcement  that  the  ex- 
istence of  trichinasis  was  an  unfounded  illusion.  Con- 
siderable sensation  was  of  course  produced  in  conse- 
quence, when  one  of  the  gentlemen  present  challenged 
the  horse-doctor  to  eat  a  portion  of  the  meat  which  was 
said  to  contain  those  creatures.  The  challenge  was 
caught  up  by  the  assemblage,  and  amid  the  greatest 
enthusiasm,  the  valiant  opposer  of  science  was  forced 
to  partake,  immediately  after  which  he  left  the  room.  A 
few  days  after  the  veterinarian  was  helplessly  paralyzed 
in  his  bed,  and  was  willing  to  acknowledge  his  error. 

Surgical  Instruments  from  Pompeii. — M.  Scoutet- 
tin  has,  by  permission  of  the  Italian  Government, 
obtained  photographic  representations  of  the  different 
surgical  instruments  found  at  Herculaneum  and  at 
Pompeii.  There  are  more  than  three  hundred  of  these 
instruments,  but  only  about  sixty  of  dissimilar  kinds. 
Among  the  most  interesting  are  some  brass  catheters, 
similar  to  those  described  by  Galen,  the  curves  of  which 
are  better  than  many  of  the  sounds  and  catheters  made 
at  the  present  day,  and  a  probe  presented  by  Galen  to  a 
magistrate  named  Erastitrate,  and  which  seems  prefer- 
able, in  a  practical  point  of  view,  to  those  now  in  use. 

Medical  STATisnoa  or  the  U.  S.  Navt. — ^From  the 
report  of  the  Hon.  Gideon  Welles,  Secretary  of  the 
Navy  (Dec.  2. 1867),  we  extract  the  following: 


The  Chief  of  the  Bureau  of  Medicine  and  Surgery 
presents  not  onl^  the  usual  report  of  sickness  and  death 
m  the  navy  during  the  year,  but  gives  in  addition  in- 
teresting tables  showing  the  number  of  sick  of  each 
squadron  engaged  on  the  blockade  during  the  war,  to- 
gether with  the  total  of  each  disease  treated,  number 
of  deaths  on  the  blockade  during  the  rebellion,  propor- 
tion of  deaths  to  the  number  of  cases  treated,  and  the 
proportion  of  deaths  to  the  number  of  ship*B  company. 
The  summary  shows  that  from  the  commencement  of 
the  rebellion  to  the  30th  of  June,  1865,  there  were  un- 
der treatment  114^038  cases:  that  there  were  2,532 
deaths,  the  proportion  of  deaths  to  the  number  of  cases 
treatea  being  *0175.  At  the  close  of  the  year  1865 
there  remained  under  treatment  853  cases  ^  during  the 
year  1866  there  occurred  24,350  cases  ot  disease,  in- 
jury, etc.,  making  a  total  of  25,203  cases  treated  during 
the  year,  of  which  310  died ;  23,954  were  returned  to 
duty  or  discharged  the  service,  leaving  939  cases  under 
treatment  at  the  end  of  the  year  1866.  The  propor- 
tion of  cases  admitted  to  the  whole  number  of  persons 
in  the  service  was  about  1*46,  or  each  person  was  on 
the  sick  list  l^-^  times  during  the  year.  The  propor- 
tion of  deaths  to  the  whole  number  in  service  was  1)18; 
and  l^e  percentage  of  deaths  to  the  whole  number  of 
cases  treated  is  *012,  or  less  than  two  per  cent,  taking 
the  average  strength  of  the  navy^-oflScers,  seamen, 
marines,  engineer  service  and  coast  survey  included — 
for  the  year  1866,  to  be  17,193.  The  total  number  of 
deaths  Irom  all  causes,  reported  at  the  Navy  Depart- 
ment from  October  1,  1866,  to  September  30,  1867,  is 
395.  The  number  of  insane  of  the  navy  under  treat- 
ment in  the  government  asylum  near  Washington,  dur- 
ing the  year  ending  30th  September,  1867,  was  24 ; 
number  now  under  treatment,  18.  The  necessity  for 
enlarging  the  laboratory  accommodation  continues  to 
press  Itself  upon  the  attention  of  the  bureau,  and  esti- 
mates for  this  purpose  have  again  been  submitted. 

Dr.  Dixi  Crosby,  LL.D.,  who  succeeded  the  hite  Dr. 
Mussey  in  the  professorship  of  surgery  in  the  Dart- 
mouth Medical  School  in  1838,  proposes  to  retire  from 
active  connection  with  the  school  this  year.  He  will 
then  have  completed  his  thirtieth  course  of  lectures. 
Dr.  Crosby  is  the  only  member  of  the  medical  faculty 
of  1838  now  retaining  position  in  the  institution.  Dr. 
Oliver  W.  Holmes  was  then  professor  of  anatomy  and 
physiology,  and  the  Hon.  Joel  Parker,  LL.D.,  of  med- 
ical jurisprudence. 

M.  GU>88ELm,  Professor  of  Clinical  Surgery  (at  La 
Piti^^  has  been  appointed  Professor  of  Ciinicai  Sur- 
gery m  La  Charitd. 

New  Hospitau — ^The  city  of  Rochester,  in  thi»  State, 
has  a  new  hospital  which  is  evidently  a  credit  to  the 
conntnr.  It  is  complete  in  all  its  arrangements,  as  we 
judge  irom  the  account  of  it  in  "  The  HcSpUdl  Review,  a 
journal  devoted  to  the  interests  of  the  sick  and  suffer- 
ing at  the  Rochester  City  Hospital."  There  is  a  surgi- 
cal, medical,  lying-in,  and  eye  and  ear  department ;  at- 
tending physicians,  H.  W.  Dean^  M.D.,  U.  U.  Ely,  M.D., 
David  LitQe,  M.D. ;  surgeons.  M.  F.  Montgomary,  M.D., 
H.  H.  Langworthy,  M.D.,  John  F.  Whitbeck,  M.D. ; 
ophthalmic  and  aural  surgeon,  Charles  £.  Rider,  M.D. 

Population  of  France. — At  the  close  of  a  late  dis- 
cussion in  the  French  Academv,  on  the  growth  of  the 
population,  it  seems  conceded  that  while  the  population 
IS  increasmg  sensibly,  the  rate  is  graduallj^  diminishing. 

New  Orleans  an  Intsoted  Port. — ^A  recent  procla- 
mation of  the  Metropddtan  Board  of  Health  has  made 
New  Orleans  '^  an  imected  place  within  the  meaning  of 
the  Health  Laws  of  this  place."    Appropriate  qoaran- 


BOA 


THE  MEDICAL  BBCOED. 


tine  regulations  are  enjoined  in  respect  to  persons  and 
vessels  coming  from  thence,  cholera  still  existmg  there, 
which  are  to  continue  in  force  until  the  21st  day  of 
Februarj  of  the  ensuing  year,  at  noon. 

The  Question  of  Rank.— The  chiefs  of  the  Bnreaaz 
of  Medicine  and  Surgery,  of  Provisions  an4  Cloth- 
ing, and  of  Steam  Engineering,  bring  to  the  notice 
of  the  department  the  claims  of  their  respective  corps 
to  increased  rank.  It  is  urged  that  by  the  recent 
creation  of  the  several  grades  of  admiral,  of  com- 
modore, and  lieutenant  commander,  the  rank  of  the 
staff  corps  has,  in  effect,  been  reduced.  The  law 
now  provides  for  the  appointment  of  fleet  surgeons, 
fleet  paymasters,  and  fleet  engineers,  but  the  rank  is 
only  temporary,  ceasing  when  the  oflScer  is  detached 
from  fleet  duty.  I£  these  grades  were  made  permanent 
and  to  embrace  a  sufficient  number  for  the  service  re- 
quired of  the  officers  standing  at  the  head  of  their  re- 
spective lists,  and  the  rank  now  temporarily  given  to 
fleet  officers  and  to  the  other  grades  legalized,  it  is 
thought  that  the  staff  corps  would  be  generally  satis- 
fied. It  is  understood  that  they  propose  to  bnng  the 
matter  of  increased  rank  to  the  notice  of  Congress,  and 
such  legislation  as  may  seem  equitable  and  just  is  re- 
commeoded. 

Prbventino  Bailroad  Collisions. — A  correspondent 
of  the  Mechanics*  Magazine  proposes  a  plan  whereby 
every  train  on  a  track  shall  communicate  with  another, 
before  or  behind  it,  whenever  the  two  approach  within 
a  certain  distance.  Electricity  is  the  means  employed, 
the  engines  of  the  trains  carrying  batteries  one  wire 
from  which  connects  with  the  engine  bell,  the  other 
connecting  with  the  earth.  Light  insulated  supplemen- 
tal rails,  made  in  continuous  length  of  two  miles  each, 
are  laid  by  the  side  of  the  main  rail,  so  that  the  tire  of 
the  locomotive  wheel  runs  on  both.  As  long  as  two 
trains  are  not  at  the  same  time  on  one  length  of  con- 
ducting rail,  no  electric  current  can  pass  on  account  of 
the  break  joint,  but  as  soon  as  thev  come  within  this 
particular  distance  of  each  other  the  circuit  is  com- 
pleted and  both  bells  will  ring. — Scientific  American, 

N.  Y.  Medical  Journal  Associatio.v. — The  weekly 
Friday  evening  reunions  of  this  Association  were  re- 
sumed on  the  8th  of  November.  They  are  fully  at- 
tended, and  are  occasions  of  no  little  scientific  and  so- 
cial interest.  At  each  meeting  is  presented  a  resurad 
of  the  current  literature  of  some  special  subject,  pre- 
pared from  the  ample  resources  on  the  Society's  shelves, 
by  a  member  previously  appointed.  Original  papers 
are  frequently  read,  and  new  instruments  or  other  mat- 
ters of  professional  interest  brou.i^ht  to  the  notice  of  the 
meeting.  After  discussion  of  the  subjects  presented, 
the  Society  adjou^^ns  to  coffee  and  sandwiches,  and  the 
remainder  of  the  evening  is  devoted  to  social  converse. 
We  shall  furnish  our  readers  reports  of  such  papers  and 
discussious  as  may  be  of  special  interest. 

Blood  in  thb  Body. — The  amount  of  blood  in  an 
adult  is  nearly  thirty  pounds,  or  full  one-fifth  of  the 
entire  weight.  The  heart  is  six  inches  in  length  and 
four  inches  in  diameter,  and  beats  seventy  times  per 
minute,  4,200  timos  per  hour,  100,800  times  per  day, 
36,772,000  tunes  per  year,  2,565,440,000  in  three-score 
and  ten,  and  at  each  beat  two  and  a  half  ounces  of 
blood  are  thrown  out  of  it,  one  hundred  and  seventy- 
five  ounces  per  minute,  six  hundred  and  fifly-six  pounds 
per  hour,  seven  hundred  and  three-fourth  tons  per  day. 
All  the  blood  in  the  body  passes  through  the  heart  every 
three  minutes.— /St  Zouis  Medical  B^orter, 


Tobacco  and  Pickles. — If  Englishmwi  have  had  ex- 
aggerated ideas  about  the  tendency  towards  rotundity 
exhibited  by  all  Dutchmen,  they  have  by  no  means 
overrated  the  national  habit  of  smoking.  The  Dutch- 
man of  to-day  is  as  great  a  smoker  as  was  his  great- 
great-grandfather.  The  pipe  has,  however,  given  way 
to  the  cigar ;  and  the  meanest  laborer  indulges  himsel]^ 
often  when  at  work^  with  the  "  weed  "  which  oosts  him 
less  than  a  farthing.  Passengers  on  railways  smoke  as 
a  matter  of  c  )urse ;  and  the  guard,  as  he  passes  from 
carriage  to  carriage  to  examine  the  tickets,  does  not 
hesitate  to  rest  now  and  again  in  one  of  the  car- 
riages to  smoke  a  cigar  with  any  neighbor  or  acqusun- 
tance.  The  teeth  of  a  Dutchman  are  nearly  as  charac- 
teristic as  the  skin  of  an  Englishman  who  has  lived  for 
a  long  time  in  India ;  they  are  much  discolored,  and 
many  of  the  incisors  are  carious.  The  Odontological 
Society  will  find  the  best  specimens  of  discolored 
teeth  from  smoking  among  modem  Dutchmen.  The 
Dutchman's  partiality  for  pickles  is  peculiar,  yet  easily 
explained.  In  Rotterdam,  but  more  largely  in  Amster- 
dam, pickle-stalls  are  not  much  less  frequent  than  apple- 
stalls  in  London.  The  pickle-stall  seems  to  be,  with 
many  workmen,  the  half-way  house  between  the  Work- 
shop and  the  dining-room.  This  nation  of  confirmed 
smokers  abounds  in  dyspeptics;  and  the  poorer  classes 
give  their  clammed  palates  a  fillip  occasionally  with  the 
sour  and  acid  substances  sold  in  the  streets. — Britiah 
Med.  Jour. 

WEioBTr  OF  THE  HuMAN  Brain. — In  the  Archiv  fur 
Anihropologiej  Dr.  A.  Weisback  has  been  giving  sever- 
al articles  on  the  relative  weight  of  the  brains  of  the 
populations  of  the  Austrian  empire,  in  respect  to  the 
bodily  size,  age,  sex,  and  diseases.  Some  of  his  con- 
clusions are  as  follows :  "  Among  Germans  twenty  years 
of  age,  those  of  medium  height  have  the  largest  brains. 
With  increasing  size  the  cerebellum  increases,  while 
the  cerebrum  relatively  decreases.  In  chronic  sickness 
the  total  weight  of  the  brain  decreases,  but  the  decrease 
is  confined  to  the  cerebrum  and  the  pons,  the  cerebel- 
lum relatively  increasing.  The  total  weight  of  the 
brain,  and  the  actual  weiirht  of  the  cerebrum,  are  great- 
est at  about  the  age  of  thirty,  from  which  pt»riod  both 
steadily  decrease  until,  at  the  age  of  eighty,  ten  per 
cent,  is  lost.  The  pons  varolii  increases  to  the  fiftieth 
year,  aud  then  steadily  decreases,  sometimes  seventeen 
per  cent,  in  a  decade.  On  the  whole  the  female 
brain  is  smaller  than  the  male,  but  in  certain  races  this 
difference  is  confined  to  the  posterior,  in  others  to  the 
anterior  segment." 

Our  Black  Descendants. — At  a  meeting  of  anthro- 
pologists, which  had  also  an  international  character,  at 
Paris  lately,  M.  Quatrefages,  one  of  the  most  eminent 
French  savans^  raised  the  question  whether  the  first  in- 
habitants of  Burope  were  white  or  black.  M.  Quatre- 
fages thinks  that  the  whites  preceded  everywhere  the 
negroes,  who  descend  from  them.  The  principal  argu- 
ment which  he  invokes  in  favor  of  that  opinion  is  the 
following.  All  travellers  who  have  lived  in  countries 
where  only  the  negro  race  dwelt  have  remarked  that 
sometimes  children  were  born  of  paler  color,  less  dis- 
tant from  the  white  type.  This,  says  M.  Quatrefeges, 
is  to  be  explained  by  the  influence  of  white  ancestors, 
whose  type  reappears  exceptionally  amongst  their  negro 
descendants.  This  reappearance  of  the  ancestral  type 
is  what  is  called  atavism ;  "  and,  as  black  children  are 
never  fbund  amongst  the  white  races,  it  must  be  in- 
ferred that,  if  l^e  negroes  descend  from  the  whites^  the 
whites  do  not  descend  from  tha  negroes." — Britidi 
Medical  Journal. 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


506 


©rifiinal  Communications* 

EXTIRPATION  OF  A  UTERINE  TUMOR. 
By  a.  P.  HACKENBERa,  M.D., 

nUDBOK,  N.  Y. 

About  a  year  ago,  I  presented  to  the  New  York 
Pathological  Society  a  large  abdominal  tumor  I  removed 
from  a  Southern  lady,  then  residing  in  the  city  of  New 
York.  The  tumor  had  been  diagnosticated  as  ovarian, 
but  after  its  removal  it  was  ascertained  that  it  was 
uterine.  As  a  similar  case  has  occurred  in  the  practice 
of  Dr.  E.  Krackowizer,  recently  published  in  the  Med- 
ical Record,  I  have  thought  that  a  history  of  the  csuse 
under  my  management  might  not  only  prove  interesting, 
but  perhaps  tend  to  put  us  more  on  our  guard  in  making 
out  the  diagnosis  of  abdominal  tumors. 

The  patient  I  operated-  upon  was  forty-five  years  of 
age.  She  was  a  maiden  lady,  and  always  enjoyed  a  good 
degree  of  general  health ;  never  was  troubled  with  any 
menstrual  irregularities,  and  never  suffered  much  from 
immediate  uterine  disturbances,  or  even  through  their 
sympathetic  influences.  Three  years  previous  to  the  time 
of  the  operation,  her  general  health,  from  unknown  cau- 
ses, received  a  shock,  from  which  she  never  fairly  rallied. 
She,  however,  continued  to  perform  the  duties  of*  her 
vocation,  which  was  that  of  leaching.  About  a  year 
later  she  detected  an  abdominal  enlargement,  which 
gradually  increased  until  it  had  assumed  an  enor- 
mous size.  The  enlargement  at  first  occasioned  no 
special  inconvenience,  but  as  the  tumor  increased  in 
size,  exhaustion  and  dyspnoea  set  in,  and  the  patient 
became  extremely  anxious  for  surgical  aid.  She  was  a 
lady  of  rare  intelligence,  and  expressed  a  positiveness 
that  the  tumor  originated  within  the  left  ovarian 
region. 

My  first  examination  was  about  a  month  before  the 
operation,  having  only  seen  her  twice  during  that  time, 
and  she  then  informed  me  that  she  had  been  examined 
by  Professor  Eve.  and  other  surgeons  of  the  South,  and 
that  they  had  diagnosed  her  case  ovarian  tumor,  and  rec- 
ommended an  operation.  On  account  of  the  increase  of 
dyspnoea  as  the  tumor  enlarged,  the  patient  was  ex- 
tremely anxious  for  an  operation,  and  for  that  purpose 
came  to  New  York.  Owing  to  the  positiveness  of  the 
patient,  and  the  case  being  diagnosed  bv  some  of  the 
most  distinguished  surgeons  of  the  South,  I  must  con- 
fess I  was  not  strictly  critical  in  making  out  a  distinct 
and  unbiassed  diagnosis  of  my  own:  however,  I 
doubted  the  serous  character  of  the  enlargement.  I 
saw  her  again  on  the  day  of  the  operation,  and  she  was 
again  examined  by  Dr.  T.  H.  Hammond,  now  of  St. 
I^uis,  and  Drs.  John  Beach,  Hyslop,  Wohlforth,  and 
others  from  the  city  of  New  York.  They  likewise  con- 
sidered the  case  ovarian  tumor,  and  saw  no  objection 
to  an  operation.  The  tumor  was  of  an  enormous  size, 
and  weighing  probably,  in  pitu,  not  less  than  twenty- 
five  pounds,  and  occupied  almost  the  entire  pelvic  cav- 
ity, and  anterior  part  of  the  abdomen.  To  the  touch  it 
was  smooth  and  elastic,  and  painless  even  by  rude 
manipulations.  It  appeared  to  be  movable  to  a  limited 
degree.  On  making  an  examination,  as  it  was  expected, 
the  tumor  had  forced  itself  into  tne  cul-de-sac  of  the 
vagina,  crowding  the  uterus  against  the  sacrum.  The 
OS  was  under  the  manipulating  control  of  the  index 
finger,  and  was  overhung  by  the  broad  base  of  the 
tumor. 

The  uterine  sound  was  not  resorted  to,  in  making  out 
our  diagnosis,  for  the  following  reasons:  1st.  The 
patient  had  determined  upon*  running  the  risk  of  an 


operation,  and  objected  to  the  use  of  the  sound.  2d. 
We  did  not  deem  the  use  of  the  instrument  absolutely 
necessary,  as  the  removal  of  the  tumor  became  impera- 
tive, regardless  of  its  character,  whether  uterine  or 
ovarian.  3d.  Owing  to  its  large  size,  its  great  pressure 
on  the  uterus,  its  supposed  long  pedicle,  we  did  not 
think  that  the  sound  would  serve  us  to  make  out  a 
clear  case. 

Our  omission  in  using  this  valuable  instrument, 
therefore,  gives  us  not  much  regret.  Even  in  the  hands 
of  such  skilful  and  experienced  surgeons  as  Ba-ackowi- 
zer  and  Kammerer  it  has  deceived  them  in  rendering  jk 
correct  diagnosis  in  their  case  of  uterine  tumor. 

After  the  patient  had  taken  the  risk  of  the  operation 
fully  into  consideration,  and  still  decided  in  its  favor,  we 
carefully  prepared  her  for  it.  Before  she  was  taken  to 
the  operating  table,  an  ounce  of  brandy  was  given.  As 
she  lay  down  to  receive  the  chloroform  she  felt  some- 
what the  influence  of  the  spirits.  As  soon  as  she  was 
under  the  influence  of  the  ansesthetic  an  incision  was 
made  to  the  extent  of  about  six  inches,  between  the 
umbiUcus  and  symphysis  pubis.  With  rapid  dissection 
the  tumor  was  exposed. 

I  must  state  that  at  the  examination  of  the  tumor  I 
was  not  positive,  as  were  my  assistants,  that  we  had 
fluctuation,  and  expressed  the  idea  that  we  might  be 
deceived  bv  the  superabundance  of  adipose  tissue  con- 
nected with  the  walls  of  the  abdomen.  In  my  own 
mind  the  differential  diagnosis  of  the  case  was  between 
a  fibrous  uterine  and  fibrous  ovarian  tumor;  declining, 
however,  to  favor  the  latter.  Even  if  uterine,  I  con- 
sidered the  operation  not  necessarily  fatal,  and  therefore 
not  contra-indicated.  Dr.  J.  D.  B.  Stillman,  member  of 
the  New  York  Pathological  Society,  published  in  the 
New  York  Journal  of  Medicine  fir.  Herff^s  case  of 
fibrous  tumor  of  the  uterus,  which  he  successfully  re- 
moved by  abdominal  section.  The  case  had  been  diag- 
nosed ovarian  tumor.  The  patient  permanently  recov- 
ered. Dr.  Atlee,  of  Philadelphia,  performed  the  opera- 
tion twice  with  success. 

After  the  tumor  was  exposed,  it  was  found  that  the 
omentum  was  adherent  over  part  of  its  upper  anterior 
surface.  These  adhesions  were  gently  broken  away. 
Such  was  the  size  of  the  tumor  and  consequently  the 
pressure  from  within,  that  it  was  impossible  to  make 
out  the  relation  ihe  pedicle  held  with  the  uterus  or  the 
ovaries.  A  trocar  was  thrust  into  the  tumor,  and  in- 
stead of  serum  presenting  itself  through  the  canula,  we 
had  venous  blood,  with  a  tendency  to  flow  freely. 
I  therefore  quickly  removed  the  trocar  and  firmly 
plugged  up  the  bleeding  orifice  with  lint,  and  checked 
the  hemorrhage.  A  solid  tumor  had  now  revealed  it- 
self. On  the  surface,  it  was  freely  supplied  with  veins ; 
many  of  them  were  large  and  well  distended.  The 
crisis  of  the  operation  was  now  presented,  and  for  a 
moment  was  critical  in  the  extreme.  The  question  was 
not  whether  to  desist,  for  the  size  of  the  tumor,  the 
great  pressure  from  within,  on  a  now  tense  gaping 
wound,  made  it  impossible.  Therefore  I  quicUy  ex- 
tended the  abdominal  section  upward,  within  a  few 
inches  of  the  ensiform  cartilage;  so  as  to  enable  me  to 
dislodge  it  from  its  bed.  The  extirpation  was  then  only 
accomplished  by  hunting  out  the  smallest  end  of  the 
mass,  and  bringing  it  out  first;  so  as  to  have  the  body  of 
the  tumor  to  follow  like  a  wedge.  As  the  growth  was 
supported  by  two  assistants,  I  carried  the  chain  of  the 
^craseur  around  the  pedicle,  and  proceeded  quickly  to 
make  a  deep  indentation  into  it,  for  the  purpose  of  ap- 
plying a  strong  hgature.  I  say  this  was  done  quickly, 
m  order  to  economize  blood  by  cutting  short  instantt- 
neously  the  circulation  of  the  tumor.  After  the  liga- 
ture was  thus  applied,  the  chain  of  the  ^raseur  was 


506 


THE  MEDICAL  RECORD. 


carried  toward  its  base,  and  promptly  removed.  No 
lisemorrhage  followed.  The  operation  was  performed  in 
thirty  minutes. 

Alter  the  woimd  was  carefully  cleansed,  and  all  ooz- 
ing of  blood  discontinued,  we  closed  it  by  silver  sutures, 
one  of  them  holding  the  extreme  end  of  the  stimap. 

As  the  patient  emerged  from  the  influence  of  chloro- 
form the  sutures  were  mtroduced.  Brandy  and  half  a 
grain  of  acetate  of  morphine  were  administered  after  the 
operation;  and  the  patient  gradua'ly  passed  into  a 
favorable  reaction.  The  operation  was  performed  at 
1 1  o'clock,  A.M.,  and  when  I  saw  her  in  the  evening 
she  was  in  a  tolerably  comfortable  condition;  the 
next  day  symptoms  of  peritonitis  set  in,  accompanied 
with  constitutional  depression.  With  the  abdominal 
soreness,  the  pulse  was  small  and  very  quick  ;  the 
tongue  dry  and  coated  with  fresh  sordes.  She  was 
remarkably  quiet.  There  was  considerable  serous  ooz- 
ing from  the  wound ;  but  not  much  blood.  The  symp- 
toms of  peritonitis  increased  in  spite  of  the  remedies  we 
brought  to  bear  against  them,  until  the  morning  of  the 
third  day,  when  the  extreme  depression  terminated  in 
death.    JSo  post-mortem  examination  was  permitted. 

In  examining  further  into  some  of  the  symptoms  of 
this  remarkable  case,  it  appears  to  me  now  that  we  can 
trace  in  a  measure  their  true  character. 

That  the  menstrual  function  was  not  impaired  was 
quite  significant,  if  not  pathognomonic  in  the  case. 
Ovaries  being  free  of  disease,  with  good  systemic  blood, 
usually  perform  their  function  uninterruptedly;  but 
\%  here  cue  or  both  are  disea-ed  they  show  menstrual 
trouble.  Even  where  but  one  is  affected,  the  other 
through  sympathy  refuses  to  peifoim  its  office;  and 
their  disease  always  manifests  manifold  sympathetic 
troubles.  Uterine  degeneration,  pivrtly  under  revulsive 
influences,  but  more  owing  to  a  deterioration  of  the 
blood,  will  likewise  suspend  the  healthv  action  of  the 
ovaries;  but  no  ex-uterine  growth  will  have  the  same 
effect,  as  long  as  the  blood  is  left  with  its  normal  stand- 
ard of  fibre.  Therefore  the  insidious  manner  in  which 
the  disease  developed  itself,  and  tlie  little  disturbance  it 
caused  to  the  general  system,  even  after  the  tumor  had 
grown  to  a  considerable  size,  should  have  excited  our 
suspicion,  that  the  disease  was  neither  ovarian  nor  a 
malignant  degeneration  of  the  uterus.  In  either  case  the 
symptoms  would  have  been  more  ative. 

The  tumor  was  movable,  or  rather  floating,  as  uterine 
tumois  usuaUy  are.  In  Dr.  Krackowizer's  case  the 
mobility  of  the  tumor  was  in  such  a  degree,  that  in  the 
examination  of  the  case  there  was  no  agreement  from 
which  side  it  originated.  This  feature  alone  should 
awaken  suspicion  that  the  tumor  was  of  central  origin. 

As  a  means  to  make  out  our  diagnosis  in  this  disease, 
the  use  of  the  uterine  sound  is  not  to  be  neglected ;  but 
without  corroborating  symptoms  to  sustain  us,  what  in 
our  hands  it  might  reveal  should  be  received  with  a 
cautious  consideration. 

The  examination,  per  rectum,  is  of  the  greatest  im- 
portance, as  the  relative  position  of  morbid  growth, 
within  the  base  of  the  pelvic  cavity,  with  the  uterine 
organs  can  be  accurately  ascertained. 

In  uterine  tumors,  the  developing  symptoms  are 
peculiar.  They  are  the  play  of  physiology  more  than 
pathology;  being  somewhat  akin  to  those  of  gestation. 
They  manifest  themselves  not  only  by  characteristic 
sensations,  but  leave  more  or  less  a  print  on  the  os 
tincse,  the  mammary  gland,  the  stomach,  and  the  urin- 
ary secretions.  In  uterine  tumor  the  mammary  glands 
are  well  developed ;  in  ovarian  tumor  the  tendency  is  to 
atrophy  of  these  organs. 

In  uterine  lumor  there  is  not  the  tendency  of  the 
body  to  waste,  and  the  development  of  cachexia  chat 


there  is  in  ovarian  tumors  and  malignant  degeneration 
of  the  uterus.  Some  time  after"  the  first  stages  of  tl^e 
disease  have  passed  over,  for  a  period  of  several  months, 
there  is  a  tendency  to  obesity.  This  was  the  case  with 
my  patient 

In  the  advanced  stage  of  the  disease,  the  pain  is  like- 
wise characteristic.  It  is  like  bearing  a  heavy  weight, 
paroxysmally  manifesting  itself  in  catching,  quickening 
sensations.  It  is  hke  an  ill-defined  quickening  sensa- 
tion, common  in  gestation.  The  pain  in  the  back  is 
likewise  more  troublesome  in  this  disease  than  in  ova- 
rian tumor. 

In  uterine  tumor  the  uterus  is  more  or  less  in  an 
unusually  developed  state,  with  its  sensibility  exalted. 
Therefore  in  menstruation  there  is  more  or  less  either 
dysmenoiThoea  or  menorrhapia,  if  not  both.  This  isnot 
owing  to  any  morbid  condition  of  ti  e  ovaries,  but  sim- 
ply to  the  increased  sensibihty  of  the  uterus,  and  may 
be  so  slight  as  even  to  pass  the  special  notice  of  the 
patient,  her  mind  being  so  intently  occupied  with  the 
main  disease.  The  developed  condition  of  the  uterus 
can  but  be  detected  by  way  of  the  rectum. 

Although  dyspnoea  may  be  considerable  in  all  exces- 
sive growths  of  abdominal  tumors,  in  ovarian  tumors 
this  symptom  is  particularly  troublesome.  There  is 
even  a  marked  difference  in  this  symptcm  between 
fibrous  and  serous  tumors  of  the  same  kind,  the  latter 
causing  more  difficult  respiiation  than  the  former. 
These  differences  are  owing  to  the  more  rapid  enlaigc- 
ment  taking  place  in  the  hquid  tumors  than  those  that 
fire  solid.  And  paroxysmal  dyspnoea  may  be  accounted 
for,  by  the  sudden  chatiges  in  the  pressure  on  the 
diaphragm,  caused  either  by  gaseous  or  fsecal  accumu- 
lations whhin  certain  portions  of  the  alimentary  canal. 

THE  PATHOLOGY  OF  THE  URINARY  OR- 
GANS AND  OF  THEIR  SECRETION. 

BKING  A  REPORT  READ  BEFORE  THE 

NEW    YORK   MEDICAL   JOURNAL   ASSOCIA- 
TION, DEC.  13,  1867. 
By  W.  B.  LEWIS,  M.D. 

The  first  department  of  our  extensive  subject  is  illus- 
trated by  a  number  of  cases  collected  from  various 
sources.  After  these  are  presented  such  recent  obser- 
vations, as  were  deemed  of  interest  or  importance,  ujwn 
the  symptoms  and  treatment  of  those  diseases  of  which 
a  morbid  condition  of  the  uiine  is  pathognomonic;  then 
upon  some  newly  discovered  peculiarities  of  that  fluid 
in  general  diseases ;  and,  finally,  upon  certain  urinary 
sediments  and  the  source  of  urea. 

In  Beale's  Archives  for  April  of  this  year  is  mentioned 
a  case  of  phthisis,  in  which  a  fungus  was  found  in  the 
pelvis  of  the  left  kidney,  nearly  filling  it  vrith  a 
white  pultaceous  mass  adherent  to  the  apices  of 
many  of  the  pyramids.  On  detaching  this,  a  ragged 
and  somewhat  soflened  surface  of  a  yellowish-white 
color  was  left.  The  substance  of  the  pyramid  for  a 
varying  depth,  averaging  i  of  an  inch,  was  of  the  same 
whitish  color^  contrasting  strongly  with  the  dark  crim- 
son of  the  congested  tissue  around.  The  diseased  por- 
tions were  firm,  except  at  the  top,  and  much  resembled 
tubercle.  Two  or  three  of  the  pyramids  of  the  right 
kidney  were  similarly  aflfected  to  a  less  extent.  The 
rest  of  the  organs  appeared  healthy. 

The  pulpy  matter  proved  to  consist  of  the  sporules 
and  mycehum  of  a  microscopic  fungus,  apparently  a 
species  of  oidium,  which  is  fully  described  and  figured. 
It  resembles  the  penicilium  glaucum-in  outline.    There 

___.w:.oogTe 


THE  MEDICAL  RECORD. 


507  • 


was  no  sugar  in  the  urine  three  days  before  death,  and 
no  history  of  diabetes;  no  signs  of  a  similar  growth 
were  found  e'sewhere  in  the  body ;  hence  it  is  inferred 
tlzat  the  fungus  had  crept  up  the  urinary  tract  from 
aphthous  patches  which  may  have  existed  about  the 
orifice  of  the  urethra,  or  from  some  parasite  of  the 
skin. 

Dr.  Fleming  exhibited  to  the  Dublin  Pathological 
Society  specimens  illustrative  of  primary  cancer  of  the 
kidneys,  and  a  cancerous  tumor  of  the  prostate.  The 
patient,  sixty  yeara  of  age,  had  long  been  laboring  under 
urinary  disease  which  had  resulted  in  incontinence, 
attended  with  occasional  paroxysms  of  pain.  There 
was  a  larger  amount  of  fever  than  is  usual,  great  thirst, 
unsteady  pulse,  and  irregular  bowels,  without  tenesmus. 
Had  never  had  haematuria  A  small  amount  of  urine 
collected  was  acid  and  clear.  There  was  no  abdominal 
tumor,  and  no  stone.  There  was  a  slight  obstruction 
to  the  entrance  of  a  sound,  in  the  prostate,  giving  the 
sensation  of  a  nodulated  hardness. 

Death  occurred  in  a  fortnight.  Before  death  the  in- 
continence became  retention,  and  at  the  autopsy  the 
bladder  wae  dst ended  with  urine.  The  kidneys  were 
greatly  enlarged,  adherent  to  the  surrounding  parts, 
and  containing,  upon  the  surface,  and  throughout  their 
substance,  numerous  morbid  deposits  of  a  whitish-yel- 
low color,  of  various  sizes.  The  prostate  was  large, 
very  hard,  and  nodulated.  Section  showed  an  isolated 
tumor,  apparently  cystic. 

The  specimens  were  instructive  to  the  surgeon,  as 
showing  that  symptoms  in  many  diseases  of  these  organs 
were  treacherous:  that  all  the  suffering  will  be  referred 
in  some  cases  to  the  bladder,  while  in  others  all  the 
distinctive  symptoms  will  be  referred  to  the  region  of 
the  kidneys,  and  yet  vesical  calculus  alone  may  be  found 
to  occasion  local  lesions. 

Dr.  Cheever  reports  two  cases  of  supposed  peri- 
nephiitic  abscess,  which  occurred  in  the  Boston  City 
Hospital.  One,  an  anaemic  girl  of  seventeen,  in  whom 
the  menses  had  never  appeared,  had  suffered  for  three 
years  from  incontinence  of  urine,  but  was  otherwise 
moderately  healthy.  She  had  a  fluctuating  swelling, 
three  inches  in  diameter,  in  the  right  lumbar  region, 
without  redness,  and  but  little  tender.  This  had  been 
two  weeks  in  appearing.  No  weakness  of  legs,"  no 
evidence  of  hip  disease,  no  chills,  but  profuse  sweats 
within  the  fortnight  The  tumor  was  opened,  giving 
exit  to  a  considerable  quantity  of  laudable  pus,  free  from 
odor.  A  probe  passed  in  three  inches  perpendicularly. 
No  denu(fed  bone  felt ;  probe  strikes  an  elastic  wall 
Nothing  abnormal  in  the  urine.  Discharged,  nearly 
well,  in  a  month. 

The  other  patient,  an  Irish  domestic,  age  seventeen, 
was  of  healthy  parents.  Four  weeks  before  admission, 
after  wetting  her  feet,  the  menstrual  flow  ceased,  and 
she  had  trouble  in  micturition,  which  at  length  resulted 
in  complete  .incontinence.  No  dribbling,  however, 
while  recumbent.  During  night,  passed  water  five  or  six 
times,  owing  to  pain  at  meatus.  Pulse  90,  temperature 
100®,  bowels  costive,  tenderness  in  right  lumbar  region. 
Urine  orange,  acid,  101 7,  largely  albuminous.  A  large 
amount  of  pus,  but  no  casts  or  blood.  She  now  began 
to  have  si  ght  chills,  followed  by  pyrexia,  and  in  two 
months  had  fixed  pain  in  right  lumbar  region.  A 
troublesome  cough  set  in.  At  the  end  of  five  months 
deep  fluctuation  being  felt,  a  trochar  was  introduced, 
and  about  two  ounces  of  thick^  foetid  pus  discharged : 
that  last  appearing  was  curd-hke.  A  probe  entered 
three  inches,  reaching  a  soft,  elastic  wall  No  bone  felt 
any  where  J  no  evidence  of  spinal  disease  or  hip  trouble. 
Shortly  anerwards  there  was  more  pus  in  the  urine, 
but  less  paiD«    Finally,  signs  of  purulent  absorption 


appeared,  and  she  died  two  months  after  the  punc- 
ture. 

Dr.  Homans,  of  Boston,  reports  a  case  of  stricture 
with  perineal  fistula  and  large  calculi  in  the  pelvis  of 
each  kidney.  The  patient,  sixty -six  years,  began  to  have 
difliculty  m  micturition  six  years  ago.  From  that 
time  gradually  failing.  Urine  purulent^  ammoniacaJ, 
and  voided  with  pain.  A  year  ago  penneal  abscesses 
discharged  externally ;  in  two  months,  after  great  pain 
and  swelling  in  the  perinaeum,  the  urethra  ruptured, 
and  the  urine  escaped  through  a  fistula.  A  catheter  was 
finally  made  to  pass  the  stricture,  but  the  patient 
gradually  failed  and  died. 

Both  kidneys  were  found  to  contain  calculi  of  various 
sizes  and  shapes.  A  single  one  formed  a  complete  cast 
of  the  cavity  in  which  it  was  found — ^the  left  pelvis — 
and  resembled  some  coral  formations.  It  was  two  and 
a  half  inches  long  by  one  and  a  half  wide ;  weight,  one 
ounce.  Many  of  the  branches  were  cup-shaped,  artic- 
ulating with  portions  more  deeply  imbedded  in  the 
kidney,  or  receiving  the  papillae  of  the  pyramids.  In 
the  right  kidney  were  irregular  masses,  from  f  of  an 
inch  in  diameter,  downwards.  A  puruloid  fluid  filled 
the  surrounding  spaces.  No  pus  cells  were  found,  but 
many  oil  globules,  pranules,  and  crystals  of  triple  phos- 
phate. The  adjacent  renal  tissue  was  gangrenous.  The 
ureters  contained  the  same  offensive  fluid  and  calcareous 
debris.  Bladder  thickened,  mucous  membrane  dark 
green,  and  in  many  cases  cribriform.  The  same  fluid 
here.  Middle  lobe  of  prostate  enlarged,  but  gland  itself 
small,  size  of  large  filbert.  Just  anterior  to  membranous 
portion  a  fistula  and  sinus ;  the  stricture  probably  here. 
Stone  composed  of  urates,  carbonate  and  oxalate  of 
lime,  and  triple  phosphate. 

Mr.  Southam  records  three  cases  of  what  appears  to 
have  been  spontaneous  fracture  of  vesical  calculi  in  situ. 
Two  were  hard  and  compact,  of  uric  acid  and  oxalate 
of  lime,  and  had  evidently  been  broken  some  time  before 
their  removal.  Mechanical  violence  is  ehminated  as  a 
cause  of  fracture,  which  Mr.  Southam  attributes  to  the 
generation  of  gas  in  the  calculi  themselves,  either  from 
chemical  change  of  earthy  constituents  or  decomposition 
of  animal  mucus,  their  cement. 

Dr.  Homans,  of  Boston,  removed  a  small  calculus  from 
the  meatus  of  a  boy  of  four  years,  who  had  retenti6n 
for  twenty-four  hours.  The  phymosis  and  oedema 
were  so  marked  that  it  was  difl&cult  to  find  the  preputial 
orifice.  The  patient  was  in  great  pain,  with  a  hot  skin 
and  quick  pulse.  He  was  etherized,  the  prepuce  sit 
up,  and  a  calculus  about  one  and  a  half  Hues  in  diameter, 
with  facete,  was  found,  completely  occluding  the  meatus, 
and  tightly  imprisoned  by  the  swollen  prepuce.  Tie 
urine  began  dribbling  at  once  upon  its  removal,  but 
was  withdrawn  by  a  catheter,  to  the  amount  of  thirty- 
six  ounces,  with  entire  relief  to  the  patient.  The  stone 
was  of  urates  and  oxalate  of  lime. 

Dr.  Leon  Serbet,  Ai.se,  France,  has  used  ergot  in 
paralysis  of  the  bladder  with  success.  His  patient  was 
sixty-six  years  of  age,  and  had  been  suffering  from  in- 
continence of  urine  for  fifteen  years.  The  doctor  was 
called  on  account  of  paralysis  resulting  from  over-dis- 
tention  during  an  attack  of  retention  of  urine.  Ergot 
was  tried,  thirty  grains  during  the  day ;  no  effect.  At 
the  end  of  ten  days,  fifteen  grains  were  given  four  times 
daily  at  twenty  minute  intervals,  before  and  after  a  hip 
bath  in  the  morning.  From  this  time  he  could  urinate, 
and  was  cured  in  fittden  days.  Ergot  is  thought  to  cure 
paralysis  of  the  muscular  fibres  both  of  the  body  of  the 
bladder,  and  of  its  neck. 

Dr.  Abbotts  Smith  calls  attention  to  certain  moral 
and  dietetic  points  in  the  treatment  of  this  disease. 
The  bad  habit  of  not  getting  ou^  of  bed_jtojBmpty_the 


508 


THE  MEDICAL  RECORD. 


bladder  at  proper  intervals  should  be  counteracted. 
The  quantity  of  fluids  should  bo  moderated,  especially 
at  night.  This  constitutes  the  secret  of  the  "Diela 
Sicca."  This  plan  is  useless  when  enuresis  depends 
upon  organic  disease  of  the  parts.  Milk  is  recom- 
mended as  unstimulating  and  easy  to  digest.  Hot 
liquids  taken  as  drink,  especially  tea,  are  objectionable. 
Patients  should  be  cautioned  against  horseback  riding. 

Dr.  Butler,  of  Maryland,  relates  a  case  of  hor:*eshoe 
kidney,  in  which  the  organ  was  in  the  pelvis,  and  could 
be  felt  per  rectum.  Four  arteries  supplied  this  anomaly, 
a  single  large  trunk,  from  the  aorta  at  its  bifurcation, 
which  was  immediately  in  front  of  the  sacra  media,  two 
from  the  left,  and  one  from  the  right  internal  iliac. 

There  are  now  two  specimens  of  the  horseshoe  kid- 
ney in  the  museum  of  Charity  Hospital  at  least  one  in 
the  "Wood  Museum,  and  we  believe  one  in  that  of  the 
City  Hospital. 

Two  cases  of  movable  kidney  were  recently  men- 
tioned by  Mr.  Heckford,  in  the  Lancd,  The  right  was 
most  freely  movable  in  both,  and  in  one,  a  woman, 
could  be  pushed  on  to  the  vertebral  column. 

AddxBorCa  Disease  of  the  suprarenal  capsules  is  the 
subject  of  a  work  by  Dr.  Edward  Greenhow.  An 
analysis  of  196  cases  is  given,  with  every  item  of  possi- 
ble interest  connected  with  each  case.  The  object  is  to 
remove  the  doubts  which  many  have  entertained  as  to 
the  reality  of  this  disease,  in  order  that,  its  existence 
being  fully  recognized,  future  inquiry  may  with  more  as- 
surance be  directed  toward  the  investigation  of  its  causes. 
*  The  American  Journal  of  MedicaT  Sciences  contains 
two  reports  which  serve  a^  comments  upon  the  fore- 
going. In  one  case  there  was  extensive  disease  of  the 
capsules  without  the  slightest  discoloration  of  the  skin. 
The  left  was  enlarged,  and  the  right  from  two  to  three 
times  its  usual  size.  They  were  firm,  and  contained  a 
large  amount  of  opaque  tubercular-looking  matter, 
f  The  other  case  was  of  cancer  of  the  pelvic  viscera  in 
an  aged  female,  with  a  cancerous  nodule  one-half  inch 
in  diameter  upon  the  peritoneal  face  of  the  right  kid- 
ney. The  organs  were  otherwise  healthy.  The  supra- 
renal capsules  had  suffered  a  little  fatty  alteration,  such 
as  is  commonly  found  alter  middle  life;  otherwise 
normal.  There  was  intense  bronze  discoloration  over  a 
very  large  extent  of  surface,  Viirying  in  depth  of  tint ; 
very  deep  in  the  scar  of  a  blister. 

Albximinuria, — Fauvel  gives  the  name  Aphonia  Alhu- 
minurica  to  aphonia  depending  upon  oedema  glottidis, 
which  appears  in  incipient  Bright*s  disease.  Besides 
the  tense  swelling  of  the  mucous  membrane,  with  a  pale 
smooth  surface,  the  laryngoscope  shows  no  local  morbid 
process.  The  urine  is  found  albuminous. 
^  Professor  George  Johnson  writes  as  follows  upon  the 
treatment  of  IXarrhcea  and  Vomiting  in  Renal  Disease, 
From  the  British  Medical  Journal :  -^**  Bearing  in  mind 
that  the  vomited  matters  are  usually  .very  offensive,  if 
you  direct  to  take  copious  draughts  of  tepid  water  your 
patient  will  often  obtain  relief  by  the  speedy  expulsion 
of  foul  secretions,  and  the  thorough  washing  out  of  his 
stomach.  This  should  be  repeated  from  time  to  time. 
The  food  must  be  of  the  lightest  and  most  digestible 
kind."  He  recommends  hydrochloric  acid,  fifteen  or 
twenty  drops,  with  each  meal,  with  one-thirtieth  grain 
strychnia.  The  acid  neutralizes  the  ammonia  often 
thrown  off  abundantly.  Sometimes  vomiting  wiU  be 
relieved  by  a  purgative  enema,  or,  if  the  stomach  will 
bear  it,  the  compound  colocynth  pill  to  stimulate  the 
lower  bowel  Nutritive  enemata  are  of  use  to  support 
strength  when  vomiting  is  incessant. 

The  irritation  of  the  bowels  may  be  as  great  as  that 
of  the  stomach.  Tenesmus  may  sometimes  be  allayed 
hy  the  xery  guarded  use  of  opium^  the  effect  being 


carefully  watched,  as  there  is  great  danger  attending  its 
incautious  exhibition.  The  object  is  to  allay  irritation, 
not  to  close  a  safety  valve.  All  thi^  disturbance  will 
disappear  if  the  kidneys  can  be  made  to  act.  Besides 
the  usual  expedients,  as  counter-irritants,  diuretic^  boi- 
air  baths,  and  the  like,  he  highly  recommends  an  inc's- 
ion  into  each  Ic'X  when  there  is  much  anasarca.  The 
fluid  is  rapidly  drained  away,  the  vessels  unloaded,  con- 
gestion relieved,  and  so  a  more  copious  secretic  n.  The  re- 
sult of  his  experience  is  that  in  cases  not  complicated  with 
valvular  disease  of  the  heart,  inflammation  rarely  fol- 
lows puncturing  the  legs,  and  the  relief  which  follows 
the  operation  is  often  very  great. 

Olucosuria, — In  August,  1861,  G.  Meissner  announced 
his  discovery  of  a  true  sugar  in  muscle.  Dr.  Johannes 
Ranke  has  reinvestigated  the  subject,  and  fully  con- 
firms Meissner's  supposition.  The  following  proposi- 
tions are  considered  as  established  : 

Isf.  That  there  exists  a  true  feimentable  sugar  in 
muscle. 

2d.  That  the  Amount  of  this  sugar  is  increased  by 
muscular  action,  including  tetanization  caused  by  strych- 
nine or  electricity. 

3d.  That  the  liver  has  no  effect  in  causing  this  in- 
crease ;  for  the  sugar  is  proved  to  arise  in  the  muscle 
itself,  and  from  the  muscular  substance. 

M.  Colias,  alluding  to  this  fact,  and  the  other  that  the 
substances  required  for  the  ntitrition  of  the  organs  reach 
them  in  a  soluble  condition  and  are  fixed  by  Fome  sub- 
stance unknown,  advances  ihe  theory  that  phosphate 
of  lime  is  the  agent  in  question,  since  it  converts  >ugar 
into  the  nearly  insoluble  glucose,  thus  precipitating  and 
fixing  it  in  the  organs.  He  recommends  phosphoric 
acid  and  the  phosphates,  and  reprobates  forbidding 
bread.  On  the  strength  of  this  Mr.  Carey  Lea,  of  Phil- 
adelphia, suggests  that  by  parity  of  arguihent  the 
mineral  acids  and  alkahne  nitrates  might  serve  to  fix 
albumen  in  Bright's  disease!  M.  Guyot-Danecy  pro- 
poses to  employ  citrate  of  soda  as  the  fixing  substance 
in  diabetes.  The  citrate  is  substituted  for  the  car- 
bonate because  it  does  not  interfere  with  digestion. 
He  administers  from  one  to  two  drachms  at  a  dose, 
which  may  be  mixed  instead  of  salt  with  the  bread. 
With  its  use  starch  Ibod  ceases  to  be  objectionable.  He 
allegCvS  thttt  the  SDgar  disappears  from  the  urine  after 
the  exhibition  of  this  salt. 

Diabetic  Phthisis, — The  first  general  symptom  of  this 
rare  disease,  says  Dr  B.  W.  Richardson,  is  severe  hectic, 
the  hot  stage  of  which  is  extreme,  and  is  succeeded  by 
great  coldness  of  the  surface,  depression,  and  copious 
elimination  of  urine.  Dyspnoea  is  a  marked  symptom  ;  a 
hacking,  dry  cough,  is  common.  Haemoptysis,  properly 
speaking,  he  has  not  seen  ;  but  rusty  sputum  in  small 
quantities  is  frequent.  There  is  little  acute  thoracic 
pain,  but  great  oppression.  Wasting  is  extreme.  The 
physical  signs  are  marked.  Cavities  are  not  often 
found,  death  taking  place  too  early  to  allow  softening  to 
occur;  moreover  tne  diabetes  interferes  uiih  this 
process  by  removing  water. 

In  pronounced  cases  the  prognosis  is  inevitably  bad, 
and  generally  definite,  too,  as  to  time :  he  has  not  seen  a 
case  survive  four  months  after  the  tubercular  condition 
was  established.  From  six  to  ten  weeks  was  the  com- 
mon tei-m  after  hectic  began  to  recur  with  regularity.  In 
every  case  of  the  disease  he  had  seen,  there  had  been 
disease  of  the  base  of  the  brain.  In  one  case  there 
was  bone  pressing  upon  the  under  surface  of  the 
medulla  oblongata;  in  another,  softening  of  the  brain 
substance;  and  in  a  third,  disease  of  the  vessels,  with 
thickening  of  the  membranes,  and  old  adhesions.  One 
of  the  patients  had  recovered  fi  om  acute  meningitis,  to 
be  taken  immediately  with  diabetes?  T 


THE  MEDICAL  RECORD. 


509 


That  there  is  a  functional  and  an  organic  type  of 
diabetes ;  that  the  functional  is  largely  curable,  and  the 
organic  absolutely  incurable;  and  that  the  functional 
type  is  connected  with  a  false  digestion,  owing  to  a  tem- 
porary interference  with  nerve  action — these,  he  thinks, 
are  facts  which  every  scientific  physician  must  be  pre- 
pared to  accept. 

He  is  convinced  that  oxygen,  iodine,  or  chlorine,  with 
their  compounds,  do  ha^'m ;  they  increase  elimination  and 
reduce  accordingly.  He  discards  a  restricted  diet.  He 
sustains  the  warmth,  and  checks  the  waste  of  the  body 
by  opium  and  quinine ;  he  supports  by  good  food,  espe- 
cially the  animal  oib,  which  he  gives  as  the  Esquimaux 
take  it,  and  for  the  same  reason,  to  sustain  the  lost 
caloi  ic.  He  thinks  there  is  more  hope  in  this  than  in 
any  other  remedy,  us.d  by  the  half-pint  at  a  time.  Dr. 
Abbotts  Smith  says  that  no  remedy  in  the  materia 
medica  is  of  such  value  as  this.  It  has  a  tendency  to 
improve  the  blood  by  increasing  the  proportion  of  red 
corpuscles.  His  system  of  alimentation  is  exclusive  of 
the  starches. 

Dr.  H.  Bence  Jones  says  that  the  eflfect  of  dieting 
upon  this  disease  is  far  beyond  that  of  any  known 
remedy.  The  potassio- tartrate  of  iron  and  Griffith's 
mixture  are  recommended,  taken  with  some  gaseous 
mineral  water.  Vegetable  and  animal  oils  and  fkt  con- 
stitute important  remedies;  of  these,  cod-liver  oil 
and  cream  are  the  best.  A  man,  aged  twenty-four, 
was  admitted  into  8t.  George's  Hospital,  having  lost 
two  stone  during  eight  months.  He  passed  seven 
quarts  of  urine  daily.  He  remained  unaer  treatment 
a  month,  during  wliich  time  he  was  on  animal  diet  and 
cod -liver  oil.  He  began  with  half  an  ounce  daily,  and 
increased  gradually  up  to  eight  ounces.  The  urine  fell 
to  two  and  a  half  pints,  sp.  gr.  1030,  and  he  increased 
in  weight  from  eight  stone  eight  pounds. to  nine  stone 
one  pound. 

Mr.  Hare  speaks  most  highly  of  the  dietetic  method. 
By  perseverance,  he  reduced  the  sp.  gr.  in  one  case  to 
1007,  yet  there  was  a  trace  of  sugar  present.  This  is 
tlj^  lowest  sp.  gr.  on  record  in  which  Tsugar  has  been 
found. 

Prof.  Bouchardat  recommends  energetic  and  system- 
atic exercise,  coupled  with  a  diabetic  regimen.  Clarets 
are  allowed,  but  not  sparkling  wines. 

Sir  Henry  Marsh  advocates  the  frequent  use  of  the 
vapor  bath  and  muscular  exercise.  It  should  be  used 
not  occasionally,  but  daily,  for  weeks  or  months,  if 
necessary.  This  advice  is  founded  upon  the  good 
results  obtained  in  a  case  under  his  charge. 

Dr.  Ramskill  has  treated  some  casis  very  successfully 
with  a  mixture  containing  three  grain  doses  of  perman- 
ganate of  potash,  in  water,  and  with  increasing  doses  of 
extract  of  cannabis  indica,  in  pill,  beginning  with  a 
quarter  of  a  grain  three  times  a  day,  and  going  up  to 
three  grains. 

Dr.  Buttura,  French,  cured  a  ten  years'  diabetes  with 
a  seton  to  the  neck.  The  sugar  went  as  the  pus  came, 
and  the  patient  remained  well  eight  months  afker  the 
withdrawal  of  the  irritant. 

Beranger  Ferand  has  treated  two  cases  of  diabetes 
with  partially  favorable  result^,  with  tincture  of  iodine, 
five  to  fifteen  drops  of  the  French  preparation,  before 
each  meal.  In  two  other  cases  he  found  the  sugar  to 
diminish  by  large  inhalations  of  oxygen — twenty  quarts 
of  gas  night  and  morning.  He  does  not  think  this 
treatment  will  cure^  but  that  it  is  of  great  benefit. 

Prof.  J.  H.  Salisbury  appears  agaiu  as  a  discoverer  of 
the  zymotic  nature  of  disease.  This  time  it  is  rheuma- 
tism, which  malady  he  considers  four-fold,  as  character- 
ized by  the  presence  at  one  time  of  lithic  acid,  at 
another,  oxalic  acid  in  lime  combination,  or  cystine, 


of  phosphates.  The  characters  of  each  are  drawn  out 
at  some  length.  The  fvirmentative  part  is  taken  by 
an  oldial  cryptogam,  consisting  of  spores  and  filament^, 
which  are  found  in  the  blood  and  urine,  together  with 
the  offending  crystalline  substances  aforesaid.  The 
name  is  Zymotosis  translucens.  It  soon  becomes  invisi- 
ble when  placed  between  the  slides.  The  following 
directions  are  given :  "  The  blood  should  first  be  care- 
fully examined  under  the  microscope.  To  do  this  an  in- 
cision is  to  be  made  in  the  arm,  a  drop  of  blood  quickly 
pressed  out,  and  received  upon  the  slide.  This  should 
at  onco  be  covered  and  placed  under  the  instrument 
and  carefully  watched,  to  observe  the  manner  in  which 
the  red  discs  arrange  themselves,  and  the  condition  of 
the  colorless  corpuscles.  Very  soon,  amid  the  red 
discs  and  fibrin  cells  will  be  seen,  here  and  there,  masses 
of  minute  spores,  and  occasionally,  ropes  and  knots  of 
algoid  filaments.  Crystalline  matters  are  also  occasion- 
ally met  with."  The  characteristic  fungus  is  also  found 
in  the  urine.  How  it  differs  from  penicilium  glaucum 
is  not  stated.  The  treatment  is  certainly  "miir^bile 
dictu."  In  three  of  the  "  species  "  it  begins  with  four  dis- 
tinct prescription*',  one  containing  six  ingredients.  You 
look  in  vain,  however,  for  those  sovereign  anti-fermen- 
tatives,  the  sulphites '  of  soda  They  are  for  once  left 
out  in  the  cold.  To  enjoy  a  diet  of  raw  beefj  finely 
chopped  and  mixed  with  yolks  of  sofl-boiled  eggs  and 
cream,  with  other  food,  excluding,  however,  all  sweets 
and  acids;  to  be  pounded  thrice  daily  with  a  ball  of 
curled  hair,  attached  to  a  stick ;  to  be  blistered  or  for- 
tified with  tonics ;  to  have  warm  baths  occasionally,  and 
frictions  oflen.  and  finally  to  be  resigned  to  some  months, 
a  year,  of  tnis  interesting  ritual — are  some  of  the 
delights  of  the  rheumatic. 

M.  Bordier,  in  a  memoir  detailing  his  experience 
of  the  cholera  epidemic  of  1866,  refers  to  the  changes 
in  the  urine  before  and  during  reaction.  Be/ore  mis 
it  is  found  in  all  cholera  patients  to  be  albuminous. 
This  is  thought  to  be  due  to  a  parenchymatous  nephritis, 
such  as  occurs  in  scarlatina.  Heat  does  not  always 
reveal  the  albumen.  Nitric  acid,  however,  precipitates 
it,  but  besides  this  cloud  there  appears,  in  severe  cases,  a 
sediment  of  a  mahogany  color.  This  color  changes 
to  blue,  and  then  the  bottom  of  the  glass  is  covered 
with  a  layer  of  indigo-blue,  soluble  in  ether,  and  almost 
entirely  composed  of  pure  carbon.  During  reaction 
this  fluid  contains  double  the  normal  amount  of  urea, 
with  uric  acid,  substances  rich  in  oxygen.  Albumen 
is  still  present,  though  only  for  a  short  time  and  in 
small  quantity ;  but  sugar  now  appears.  The  thirst  is 
again  felt,  and  the  body  is  covered  with  boils.  Glu- 
cosuria  is  a  constant  symptom  in  reaction,  as  albumin- 
uria is  in  the  algid  state.  This  is  thought  to  be  due 
to  paralysis  of  the  vaso-motar  nerves,  which  charac- 
terizes this  period,  and  which  acts  upon  the  liver  as 
well  as  the  other  viscera,  and  causes  passive  dilatation 
of  the  blood-vessels. 

Ufinary  Sediments, — In  the  Lancei  for  Feb.,  1867,  is 
figured  a  tube  and  stand  for  the  more  expeditious  col- 
lection of  objects  for  microFCopic  examination.  It  re- 
sembles the  chemist's  burette,  but  is  furnished  with  a 
stop-cock  below.  We  have  used  a  burette  with  the 
German  spring  valve,  and  prefer  it,  with  a  short  point, 
to  the  English  arrangement. 

Dr.  D.  W.  Flora,  of  Chicago,  remarks  that  the  dumb- 
bell crystal  of  so-called  oxalate  of  lime  is  not  a  primary 
but  a  tertiary  form.  He  claims  that  they  are  a  modi- 
fication of  the  globular,  stellate  crystals  of  urate  of  soda, 
which  become  after  a  time  joined  two-and-two  by  an 
isthmus.  "  The  primary  form  is  acicular,  the  seconaary 
globular,  and  the  tertiary  the  famous  dumb-bell."  Dr. 
Flora  does  not  seem  to  be  aware  that^a  dumb-bell 

Digitized  by  VjOO^  ^  _ 


610 


THE  MEDICAL  RECORD. 


form  of  the  urate  of  soda  has  been  known  for  soiX'^ 
years,  and  is  Bgured  by  Hassal  in  his  work  on  the  urine. 
Six  kinds  of  dumb-bell  crystals  are  found  in  human 
urine,  and  a  seventh  in  that  of  the  horse,  carbonate  of 
lime.  Uric  acid,  phosphate  of  lime,  oxalate  of  lime, 
sulphate  of  potash,  and  the  urates  of  soda  and  of  potash, 
are  the  six  referred  to. 

The  tests  for  the  oxalate  are  liquor  potassae  and  acetic 
acid,  bolh  with  heat;  neither  has  any  effect.  If  Dr. 
Flora  had  made  use  of  these,  he  would  probably 
have  seen  his  dumb-bells  rapidly  dissolve;  the  best 
proof  that  they  were  not  oxalic.  We  have  proof  that 
the  oxalate  dumb-bell  is  a  primary  form  in  that  it  has 
been  found  in  hyaline  casts  of  the  tubules. 

Dr.  P.  Bateman,  in  the  Lanc:t  reports  a  case  in 
which  sarcinae  were,  at  intervab,  found  in  the  urine  of 
a  gentleman  suffering  from  dyspepsia  and  neuralgia.  He 
had  a  long-standing  stricture  of  the  membranous  por- 
tion; and  a  frequently -recurring  prostatic  irritation  had 
recently  been  relieved  by  the  passage  of  several  small 
prostatic  calculi.  This  affection  is  quite  rare,  and  no 
attempt  has  been  made  to  explain  its  origin.  Bennett 
has  seen  but  one  case.  Bea'e  mentions  a  few  in- 
stances ;  Neubauer  and  Vogel  only  allude  to  two  cases, 

"With  regard  to  the  8ource  of  muscular  energy  and 
its  relations  to  the  excretion  of  urea^  the  experiments 
of  Frankland,  Fick,  Wislicenus,  and  Parkes,  seem  to 
prove,  that  during  exercise  the  urea  is  diminished,  or 
but  slightly  increased,  and  that  muscular  power  is  not 
therefore  so  much  derived  from  oxidation  of  albumin- 
ous as  of  non-nitrogenous  material.  Hence  it  is  argued 
that  the  urea  cannot  be  taken  as  a  measure  of  the  force 
expended,  or  the  waste  occasioned.  Also  that  persons 
training  for  muscular  feats  should  not  live  upon  a  diet 
restricted  to  albuminous  substances.  The  experiments 
of  Dr.  Noyes  detailed  in  the  Am,  Journal  Med,  Sciences 
seem  to  prove  that  such  a  diet  will  increase  the  excre- 
tion of  urea  considerably,  part,  at  least,  of  the  increase 
indicating  the  excess  of  albuminous  ingesta. 

These  are  some  of  the  more  interesting  facts  and 
opinions,  relating  to  our  subject,  which  have  been  hur- 
riedly gleaned  from  a  large  number  of  foreign  and  do- 
mestic journals. 


RUPTURE  OF  VAGINA  DURING  LABOR. 

OniLD  PARTLY  AND  PLACEIH'A  ENTIRELY  WITHIN  THE  ABDOM- 
INAL CAVITY. — DELIVERY  BY  FORCEPS,  AND   RECOV- 
ERY OF  THE  PATIENT. — StTBSEQITENT  PREGNAN- 
CY,   AND   DELIVERY   OP    A    STILL-BORN 
CHILD   BY  INSTRUMENTS. 

By  T.  B,  STIRLING,  M.D., 

NEW  YORK. 

On  January  10, 1863,  my  services  were  required  in  the 

case  of  Mrs.  P ,  then  in  labor.     The  pains  were 

violent  and  ineffective.  The  cause  of  the  difficulty 
seemed  to  be  the  anteversion  of  the  uterus.  The  ab- 
dominal walls  were  very  pendulous,  extending  upon 
the  thigh  nearly  half  way  to  the  knee,  giving  the  tumor 
of  pregnancy  an  ovoid  shape,  much  elongated.  This 
prevented  the  head  from  engaging  in  the  superior  strait; 
examination  showed  that  it  could  not  be  reached  per 
yaginam.  The  pendent  tumor  was  raised  and  supported 
in  this  position,  so  as  to  bring  the  axis  of  the  uterus 
more  nearly  in  line  with  the  axjs  of  the  strait,  and  thus 
favor  the  passage  of  the  head.  The  labor  now  went 
rapidly  forward,  and  a  living  child  was  born  in  less 
than  an  hour. 

The  woman  was  of  tall,  spare  figure,  thirty-six  years 
of  age;  had  given  birth  to  six  children,  and  joined  to 


the  usual  household  labors  of  her  class,  the  occupation 
of  a  tailoress.  assisting  her  husband  in  the  common  liv- 
ing room,  wnich  was  also  the  workshop.  To  hard 
work,  ana  to  the  necessity  of  maintaining  a  sitting 
posture  when  at  work,  she  attributed  the  extreme  lax- 
ity of  the  abdominal  walls,  and  the  pendulosity  of  the 
tumor  of  pregnancy,  which  caused  the  difficulty  of  her 
labor. 

The  circumstances  of  this  case  had  passed  out  of 
mind  for  two  yeai-s  and  a  half,  when,  on  the  9th  of 
July,  1865,  my  services  were  again  desired,  but  being 
out  of  town,  I  did  not  see  the  patient  until  late.  On 
arriving  at  the  house,  I  was  informed  that  labor  pains 
had  commenced  at  12  m.,  recurring  every  half  hour, 
but  not  deemed  sufficiently  severe  to  require  assistance. 
About  5  P.M.,  while  she  was  sitting  on  a  chair,  the 
waters  broke,  without  a  pain.  At  7  p.m.  the  pains  be- 
came suddenly  so  violent,  that  she  alarmed  all  around 
her  by  her  unusual  and  agonizing  outcries.  So  con- 
tinuous, sharp,  and  forcible  were  they,  that  any  prepara- 
tion of  her  bed  or  person  for  the  exigencies  of  labor 
was  deemed  impossible.  At  the  time  of  my  arrival, 
9  P.M.,  the  pnins  had  nearly  ceased,  but  she  had  the  ap- 
pearance of  having  passed  through  great  excitement, 
and  her  expressions  concerning  her  sufferings  were  a 
little  wild  for  one  who  had  borne  six  children,  and 
was  habitually  self-restrained  and  reticent. 

A  hasty  examination  was  made,  and  the  finger  came 
promptly  in  contact  with  the  corrugated  scalp,  just 
within  the  vulva.  The  excessive  pendulosity  of  ihe 
abdominal  walls  was  noticed,  which  recalled  the  pre- 
vious confinement,  and  the  kind  of  assistance  then  ren- 
dered. A  tumor  over  the  pubes  was  faintly  noticed 
in  the  median  line,  with  the  apex  below  and  the  ba^e 
as  high  as  the  umbilicus.  The  true  significance  of  this 
was  not  appreciated  at  the  time,  but  the  idea  of  an  ab- 
normal tumor  obstructing  the  labor  occurred  to  my 
mind.  It  was  ascertained  by  examination  not  to  be 
distended  bladder.  Its  shape  was  more  like  a  uterus, 
after  delivery,  before  it  has  fully  contracted.  Nothing 
of  a  positive  character  being  determined,  the  examina- 
tion was  discontinued,  the  patient  complaining  of  p8m 
under  the  touch,  and  there  being  no  pressing  necessity 
of  pursuing  it  further.  The  labor  pains  had  now  en- 
tirely ceased.  The  attendant  female  was  directed  to 
support  the  pendent  abdomen,  as  had  been  done  in  the 
previous  labor,  and  traction  was  made  with  the  fingers, 
used  as  forceps.  Pains  were  feebly  excited  by  this 
means,  but  the  head  was  not  advanced. 

Taking  advantage  of  this  interval  of  rest,  the  patienl*s 
attendants  were  directed  to  make  her  bed  more  com- 
fortable, and  to  change  her  dress,  while  I  awaited  in 
the  other  room,  the  expected  early  renewal  of  the  pains 
of  labor.  The  patient  made  not  the  slightest  complaint, 
and  apparentlv  was  sleeping.  Thinking  the  pains  were 
delayed  too  long,  about  12  o'clock  an  examination 
was  made,  which  revealed  the  fact  that  the  head  had 
somewhat  receded.  The  tumor  over  the  pubes  was 
still  well  defined,  and  a  hard  projecting  point  was  felt 
just  above  the  umbilicus  and  a  little  to  the  left  of  it, 
very  near  the  surface.  Rupture  of  the  uterus  was  at 
once  suggested,  and  the  irregularity  of  the  abdominal 
walls  was  recognized  as  some  portion  of  the  lower  ex- 
tremity of  the  child.  The  countenance  of  the  patient 
was  quiet  and  not  indicative  of  exhaustion;  the  pulse 
rather  weak,  but  without  excitement  Q'he  foetal  heart 
could  not  be  heard.  Being  convinced  of  the  diagnosis 
of  rupture,  which  had  probably  taken  place  several 
hours  before,  and  there  being  nothing  in  the  condition 
of  the  woman  to  excite  immediate  apprehension,  I  lefl 
her  and  went  in  search  of  medical  aid.  Dr.  Thomas  P. 
Cook  came  to  my  assistance,  reaching  the  house  about 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


511 


3  1-2  A.M.  He  examined  the  case,  and  confirmed  my 
diagnosis.  He  also  was  of  opinion  that  the  moment 
of  jrupture  was  during  the  sudden  access  of  pain  de- 
scribed above  as  occurring  about  7  1-2  p  m. — an  hour 
and  a  half  before  I  reached  the  house.  Dr.  C.  gave 
chloroform,  and  the  child  was  withdrawn  by  me  with 
the  forceps  without  difficulty.  It  exhibited  no  signs 
of  life — the  ordinary  means  of  resuscitation  being  tried 
without  success.  The  appearance  of  the  child  mvored 
the  opinion  that  it  had  been  dead  some  hours. 

In  completing  the  delivery,  the  cord  was  followed 
through  the  rent  into  the  abdominal  cavity  by  the  left 
hand.  It  led,  by  turning  a  sharp  corner,  to  the  lowest 
part  of  the  sac  f  )rmed  by  the  pendent  abdominal  walls. 
Here  the  placenta  was  grasped  within  the  peritoneal 
cavity,  brought  up  through  the  rent  and  so  delivered. 
In  doing  so,  the  wllowing  points  were  noted.  .  The  os 
uteri  was  found  to  be  closed ;  the  rent  was  situated 
in  the  vaginal  space  behind  the  cervix;  the  promontory 
of  the  sacrum  presented  to  the  hand  in  passing  a  very 
sharp  angle ;  the  fundus  uteri  was  grasped  m  the  hollow  of 
the  hand  and  ascertained  to  be  unruptured ;  the  placenta 
was  small,  and  the  blood  squeezed  out  of  it,  as  a  sponge. 
The  delivery  being  completed,  Dr.  0.  examined  the 
rent  and  verified  the  fact  of  the  rupture  and  its  locality 
in  Douglass'  space.  In  applying  the  bandage,  the  laxity 
of  the  walls  was  made  very  apparent.  It  was  neces- 
sary to  direct  the  attendant  to  steady  the  sac  full  of  in- 
testines in  the  abdominal  space  like  a  bag  of  meal, 
while  the  binder  was  applied  very  loosely.  The  ab- 
dominal walls  formed  a  fold  over  the  pubes,  extending 
several  inches  downwards  on  the  thighs. 

No  hope  of  recovery  was  entertained  by  me,  Dr. 
C.  thinking  it  barely  possible.  Anodynes  and  stimulat- 
ing noutjshment  were  ordered.  The  patient  was  assidu- 
ously watched,  two  or  three  visits  bemg  made  each  day, 
but  some  difficulty  was  experienced  in  controlling  the 
sister,  who  officiated  as  nurse,  so  as  to  secure  the  proper 
administration  of  a  stimulating  regimen.  The  patient, 
however,  remained  quiet  and  free  from  pain  till  the 
fourth  day.  Then  tympanites  and  prostration  were  no- 
ticed, and  turpentine  stupes,  and  af&rwards  a  cataplasm, 
were  applied  over  the  entire  abdomen.  This  afforded 
temporary  relief,  but  on  the  sixth  day  the  lowest  de- 
gree of  prostration  was  reached  and  apprehension  was 
entertained  that  the  end  was  near.  But  under  vigorous 
stimulation,  she  rallied  and  recovered  from  this  condi- 
tion. On  the  ninth  day  an  attempt  was  made  to  re- 
lieve the  distressing  tympanites,  by  inserting  the  tube 
of  a  stomach-pump  far  up  the  rectum.  This  secured 
the  desired  passage  of  much  flatus,  but  next  morning 
she  had  a  profuse  diarrhoea,  with  pulse  at  106,  and  a 
distressing  palpitation  of  the  heart.  These  symptoms 
were  reheved  by  Tr.  Opii — gtt.  xxv.,  2dis  horis. 
On  the  twelfth  day,  at  a  point  about  three  inches  below 
the  umbilicus,  the  abdominal  walk  were  noticed  to  be 
exceedingly  thin,  and  a  nipple-shaped  protrusion  was 
forming.  The  fold  lying  over  the  pubes  was  red,  thick- 
ened, and  distended.  The  general  tympanites  became 
enormou5.  This  protrusion  proved  to  be  an  abscess, 
which  went  on  increasing  till  the  evening  of  the  four- 
teenth  day,  when  it  burst  externally,  discliarging  a  very 
large  quantity  (said  to  be  enough  to  till  a  wash  basin  once 
and  a  half  full)  of  thin,  greenish,  foetid  fluid.  This  wa3 
probably  made  up  of  the  putrid  products  of  peritonitis, 
the  meconium  of  the  child,  and  the  blood  that  escaped 
from  the  placenta  when  in  the  abdominal  cavity.  For 
three  days  before  the  bursting  of  the  abscess,  the  pulse 
kept  steadily  ^t  128 ;  the  great  prostration  reappeared 
and  dissolution  seemed  imminent  On  the  twelfth  day, 
the  first  digital  examination  was  attempted,  to  ascertain 
the  condition  of  the  rent,  and  a  hernial  tumor  was  dis- 


tjovered  filling  the  entire  vagina  to  the^  vulva ^  at 'first 
giving  the  impression  that  the  intestine  had  fallen 
through  the  rent. 

In  those  newly  discovered  complications  the  coun- 
sel of  Drs.  Cock,  Little,  and  McLeod  was  sought  in 
turn. \'.  .Many  examinations  were  made,  as  far  as  pos-i- 
ble,  without  the  speculum,  the  patient  refusing  to  per- 
^mit  its  use.  No  positive  opinion  of  the  character  or  the 
tumor  in  the  vagina  was  arrived  at,  but  the  impressions 
leftjonmy  own  mind  by  the  consultations  were  these.  The 
tumor  in  the  vagina  was  probably  entirely  omentum, 
altered  by  inflammation.  It  had  fallen  through  the  rent, 
completely  plugging  it  up,  and  preventing  the  exit  of 
the  'material  which  afterward  composed  the  contents 
of  the  abscess.  The  cavity  of  the  abscess  was  proba- 
bly confined  to  the  abdominal  walls,  but  communicated 
by  some  free  channel  with  the  peritoneal  cavity.  In 
the  vagina  the  rent  was  distinctly  traceable  all  around 
the  base  of  the  tumor,  to  which  the  edges  of  the  rent 
seemed  to  be  agglutinate«l.  The  elongated  slit  of  the  os ' 
uteri  was  readily  recognized  in  front  of  the  tumor,  and 
the  uterus  was,  alter  some  doubting,  agreed  to  be  not 
adherent  to  the  abscess  by  its  posterior  wall.  There 
had  been  a  sanious  discharge  from  the  vagina  on  the 
second  day  after  delivery,  probably  originating  in  the 
uterus,  but  the  great  discharge  constantly  expected  did 
not^make  its  appearance,  being  eflectually  stopped  by 
the  occlusion  of  the  peritoneal  cavity,  by  the  omentum 
protruding  through  the  rent. 

A  colpeurynter  pessary  was  placed  in  the  vagina  for 
a  few  diys,  farther  protrusion  of  the  viscera  being  ap- 
prehended. Both  the  abscess  and  the  vagina  were 
freely  syringed  every  day  by  the  deep  insertion  of  the 
vaginal  nozzle.  The  cavity  of  the  abscess  was  often 
swept  by  the  finger  in  course  of  examination,  the 
mouth  being  at  least  an  inch  and  a  half  in  diameter. 
Poultices  were  kept  constantly  applied  up  to  the  twenty- 
seventh  day,  when  Bals.  Peruv.  was  substituted.  The 
patient  rapidly  convalescsd  aft«r  the  breaking  of  the  ab- 
scess, experiencing  no  inconvenience  in  her  functions 
from  the  tumor  in  the  varina,  and  sat  up  for  the  first 
time  on  the  twenty-eighth  day. 

(Fifty-sixth  day) — Sept.  2d.  I  found  her  at  work, 
in  nearly  her  usual  health,  but  also  found  myself  in  dis- 
favor, because  she  had  recovered  in  spite  of  my  unfavor- 
able prognosis,  and  I  therefore  did  not  venture  to  pro- 
pose, as  I  much  desired,  an  examination  of  the  parts. 
On  June  9,  1867,  two  years  aftier,  I  called  again,  to  as- 
certain her  present  condition,  so  as  to  be  able  to  com- 
plete this  history,  and  was  much  astonished  to  learn  that 
she  had  been,  in  the  int.Tvening  period,  delivered  by 
instruments  of  a  still-bom  child.  I  appHed  to  the  gen- 
tleman who  officiated  on  that  occasion,  and  he  kindly 
furnished  me  with  a  detailed  statement  of  her  confine- 
ment, which  took  place  on  the  30th  Nov.,  1866.  He  had 
received  no  history  of  the  previous  labor  to  guide  him, 
as  it  was  designecuy  kept  from  him  by  the  parties.  He 
says  in  his  report,  that  the  pains  died  suddenly,  in 
about  an  hour  after  they  had  become  strong  and  forci- 
ble.  He  waited  three  quarters  of  an  hour,  and  then  he 
had  recourse  to  forceps,  becoming  convinced  that  the 
child  could  not  be  delivered  without  instruments. 

He  is  of  opinion  that  Mrs.  P can  be  delivered  of 

liv'ng  children,  but  only  with  instrnments  applied  early. 
The  grounds'of  this  opinion  are  not  stated.  The  death 
of  the  child  is  attributed  to  the  premature  separation 
of  the  placenta,  a  few  minutes  before  <  the  birth  of  the 
child.  The  abdominal  walls  did  not  strike  him  as  ab- 
normally large  or  lax.  No  cicatrice  or  tumor  was  re- 
marked. No  difficulty  in  coition  had  been  experienced 
by  the  husband,  and  the  possibility  of  conception  had 
been  fully  demonstrated.  •         ^^  j 

Digitized  by  VjOOQ  IC 


512 


THE  MEDICAL  RECORD. 


©rtginal  Cectute«* 


LECTURES  ON  TUMORS : 

betrg  portion  of  the  course  on  sttroery  at  toe  jeffer- 
son medical  college,  philadelphia. 
Session  1867-8. 
By  S.  D.  gross,  M.D.,  LL.D., 

PBOPESBOR  OP  SUBGEEY. 
;'.  (Reported  expressly  for  the  Mkdioal  Eboobp.) 

IL 

NO.  II. — TASCULAR  TUMORS. 

GoNCEHNiNo' these  I  have  little  to  say.  The  vascular 
tumor  is  an  uncommon  form  of  tumor,  comparatively 
speaking.  We  observe  it  most  frequently  as  a  mother- 
mark,  a  viscus  as  it  is  called,  a  little  speck  existing 
upon  the  skin,  generally  of  the  forehead,  or  of  the  nose, 
or  the  eyelid,  or  the  lip,  or  the  cheek ;  it  may  be,  the 
ear,  sometimes  the  neck,  sometimes  the  shoulder,  or  the 
trunk,  or  an  extremity ;  sometimes  several  of  them  oc- 
curring simultaneously  in  different  portions  of  the 
body;  sometimes  on  the  inner  surface  of  the  cheek 
in  connection  with  the  piucous  membrane.  The  best 
example  I  can  give  you  is  an  internal  h^emorrhoid  or 
pile,  the  result  of  frequent  straining,  producing  thus  a 
determination  of  blood  to  the  inferior  portion  of  the 
rectum,  followed  by  habitual  distension  of  the  capillary 
vessels  in  the  submucous  cellular  tissue,  as  well  as  in  the 
substance  of  the  mucous  membrane,  so  as  to  form 
a  tumor  l^e  size  of  a  common  marble,  or  a  pullet's 
egg ;  composed  essentially  of  a  congeries  of  capillary 
veins  or  arteries,  united  and  supported  by  cellular  tis- 
sue, bleeding  copiously  when  incised  or  excised.  A 
nsBvuB  may  be  composed  essentially  of  capillary  veins 
or  capillary  arteries;  or  it  may  be  composed  of  a 
combination  of  the  two,  the  one  or  the  other  usually 
predominating.  When  a  tumor  is  composed  of  veins 
its  color  will  be  purple,  or  modena,  or  livid;  when 
it  is  of  arterial  tissue,  it  will  be  scarlet,  and  there 
will,  at  the  same  time,  be  pulsation  synchronous  with 
the  contraction  of  the  left  ventricle  of  the  heart. 
Such  a  tumor  constitutes  what  was  originally  de- 
scribed by  John  Bell,  of  Edinburgh,  as  aneurism  by 
anastomosis.  When  consistir  g  bo3i  of  veins  and  ar- 
teries there  may  be  slight  pmsation,  or  an  absence  of 
pu'sation. 

Such  tumors  require  excision  when  they  are  situated 
favorably ;  or  instead,  you  may  transfix  the  base  of  the 
growth,  when  it  is  comparatively  sm&ll,  at  two  opposite 
points,  with  two  pins,  and  wrap  around  them  a  strong 
ligature  to  strangulate  the  affected  tissues,  performing 
the  operation  in  the  manner  you  have  seen  me  execute 
it  at  the  Clinic. 

m. — ADIPOSE   OR  PATTY  TUMORS. 

The  adipose  or  fatty  tumor  is  of  suflBciently  frequent 
occurrence.  It  consists  of  a  mass  of  fat  similar  to  that  in 
the  parts  around,  being  simply  an  outgrowth  of  the  nat- 
ural, pree^^isling  or  original  fat  Under  the  microscope 
it  is  found  to  be  composed  precisely  of  the  same  cells 
with  the  same  characteristics ;  chemically  it  consists  of 
the  same  constituents  precisely,  and  it  has  the  same 
properties  precisely  as  that  tissue.  Why  tit  should 
grow  into  a  tumor,  we  cannot  of  course  determine. 
A  tumor  of  this  kind  may  be  single  or  multiple.  In 
one  case  I  saw  upward  of  two  hundred  in  the  body 
of  the  same  individual,  a  medical  student  who  attended 
my  lectures  in  the  University  of  Louisville.  In  such 
numbers  they  are  -unusual.  Generully  the  tumor  is 
single,  situated  most  cdjnmonly  in  the  subcutaneous  cel- 


lular substance.  Sometimes  such  a  tumor  is  pendulous, 
hanging  off  from  the  body  in  a  mass  of  considerable 
size.  Generally  speaking,  it  has  no  very  disiinct  cap- 
sule ;  there  is  usually  a  slight  condensation  of  the  cel- 
lular tissue  around  it,  so  that  it  might  be  called  a  dis- 
tinct envelope.  Such  tumors  have  comparatively  few 
large  vessels ;  nevertheless  they  are  capable  of  acquir- 
ing a  large  bulk.  When  we  remove  such  a  tumor  we  do 
not  expect  much  haemorrhage,  for  the  vessels  distributed 
through  the  tumor  are  generally  very  smalL  It  has  its 
nerves  and  absorbents,  which  are  not  of  new  formation 
any  more  than  the  tumor  itself.  It  may  acquire  a  bulk 
of  twenty,  thirty,  forty,  or  even  seventy  pounds.  Dr. 
Bray,  of  Evansville,  Indiana,  removed  one  some  years 
ago,  weighing  forty  pounds;  and  Prof.  Leidy,  of  the 
University  of  Pennsylvania,  presented  me  with  a  sec- 
tion from  such  a  tumor  weighing  seventy  pounds,  re- 
moved from  the  cavity  of  the  abdomen  oi  a  man  after 
death.  Its  growth  is  slow,  a  number  of  years  usually 
elapsing  before  it  attains  any  considerable  bulk.  When 
subjected  to  frequent  or  constant  pressure,  as  when  it 
is  situated  on  the  shoulder,  it  may  take  on  ulcerative 
action ;  but  ordinarily  it  grows  on,  gradually  developing 
itself,  without  any  untoward  occurrence  of  this  kind. 
It  is  not  capable  of  assimiing  malignancy  under  any 
circumstances. 

The  proper  remedy  is  excision.  Nothing  else  has 
been  found  to  answer  the  purpose. 

I  need  not  call  your  attention  to  the  different  forms 
or  configurations  of  these  tumors.  In  the  groin  and 
neck  they  send  out  processes  in  different  directions, 
which  we  are  obliged  to  dig  out,  as  it  were,  during  the 
operation  of  extirpation. 

rV. — HORNY  TUMORS. 

The  horny  tumor,  or  horny  excrescence,  is  a  very  cu- 
rious formation,  apparently  entirely  epithelial  in  its 
character,  an  outgrowth  from  the  epidermis,  and  from 
the  sebaceous  follicles.  There  is  still  some  obscurity 
with  regard  to  the  origin  of  a  growth  of  this  kind,  but 
such  we  are  willing  to  believe  is  the  method  of  its 
development.  Tumors  of  this  kind  are  capable  of  ac- 
quiring considerable  dimensions.  There  are  records  of 
their  being  ten,  twelve,  fourteen,  and  sixteen  inches  in 
length,  and  of  proportionate  diameter;  sometimes  as  a 
single  horn,  at  other  times  multiple  with  ramifications 
precisely  like  the  horns  of  the  inferior  animals.  The 
color  is  usually  brownish,  from  exposure  of  the  part  to  the 
atmosphere;  and  if  a  section  is  made,  it  will  be  found  to 
be  longitudinally  laminated,  growing  in  that  way  by 
layers.  The  surface  is  frequently  rough,  imbricated,  or 
scaly.  It  is,  of  course,  entirely  insensible ;  it  has  no 
vessels  in  its  interior,  so  far  as  we  are  able  to  determine, 
but  its  base  is,  of  course,  more  or  less  vascular.  Chem- 
ically, it  is  found  to  be  composed  chiefly  of  albumen, 
with  phog)hate  of  hme  in  combination  with  some  sul- 
phates. Under  the  microscope,  it  is  seen  to  consist  of 
an  immense  number  of  exceedingly  minute  epithelial 
cells  of  various  shapes,  round,  oviil,  and  conical.  The 
most  common  situation  of  such  a  tumor  is  the  scalp, 
frequently  the  forehead,  sometimes  the  face,  some- 
times the  upper  or  lower  lip,  sometimes  the  shoulder, 
sometimes  the  extremities,  sometimes  the  buttock.  I 
show  you  one  I  removed  from  a  lady  now  nearly  ninety 
years  of  age  •  it  grew  from  the  side  a  short  distance 
below  the  left  mammary  gland,  and  she  has  another  one 
growing  in  the  right  axilla,  A  tumor  of  th-s  kind  has 
been  found  upon  the  penis  and  upon  the  vulva ;  in- 
deed, there  is  nardly  any  part  of  the  body  where  it  has 
not  at  times  been  found. 

The  proper  remedy  is  excision,  cutting  out  the  parts 
fi*om  wnich  it  has  sprouted. 


Digitized  by 


Google 


THE  MEDICAL   RECORD. 


613 


T. — ^FIBROID  TUMORS. 

The  fibroid  or  fibrous  tumor  consists  of  tissue  similar 
to  the  fibrous  tissue  in  the  natural  state.  It  is  composed 
of  fibres  or  threads  crossing  each  other  in  every  conceiv- 
able direction^  forming  thus  a  very  tough,  strong,  con- 
densed resisting  tissue,  grating  under  the  knife.  A 
tumor  of  this  kind  has  occasionally  a  distinct  capsule, 
but  generally  it  is  devoid  of  a  covering  of  this  kind ;  the 
cellular  tissue  around  it  is  always  more  or  less  condens- 
ed. The  tumor  is  provided  with  blood-vessels,  nerves, 
and  absorbents,  precisely  as  the  fatty  tumor,  and  these 
are  sometimes  of  new  formation;  at  other  times  derived 
from  the  surrounding  structures,  shooting  into  them,  as 
in  false  membrane  of  the  pleura  or  peritoneum.  Tumors 
of  this  kind  grow  slowly,  years  sometimes  elapsing  be- 
fore they  attain  considerable  volume  or  expansion.  By 
and  by  such  a  growth  will  take  on  an  increased  activity, 
and  then  develop  itself  with  great  rapidity.  It  is  capa- 
ble of  acquiring  a  large  bulk.  A  case  reported  by  the 
late  Dr.  Francis,  of  New  York,  connected  with  the 
uteru?,  weighed  105  pounds,  nearly  as  much  as  the 
woman  in  whom  it  was  developed. 

These  tumors  are  liable  to  occur  in  various  parts  of 
the  body ;  sometimes  under  the  skin,  sometimes  in  con- 
nection with  the  testes,  or  ovary,  or  uterus,  or  some 
other  internal  organ,  tne  periosteum,  the  interior  of 
a  jointy  etc.  The  largest  growths  of  tliis  kind  occur  in 
the  uterus,  either  in  the  interior  of  the  organ,  in  its 
wall,  or  upon  its  outer  surface. 

There  is  a  fibrous  or  fibroid  tumor  which  bears  the 
name  offibro-plastic.  This  tumor  is  simply  a  modifica- 
tion of  the  original  fibroid  tumor  as  described.  We 
have  an  illustration  of  this  variety  of  tumor  in  the 
keloid  growth,  or  crab-like  tumor.  It  contains  fibrous 
tissue  in  combination  with  plastic  tissue,  a  large  quan- 
tity of  fibrin  in  a  state  of  organization,  more  crisp  than 
the  fibroid  tissue,  not  as  tough. 

Now  and  then  we  meet  with  what  is  called  the  recur- 
ring fibroid  tumor y  a  very  singular  kind  of  growth.  A 
man  comes  with  a  fibroid  tumor  on  the  shoulder,  or  upon 
the  f  ice  or  back  of  the  neck,  if  you  please ;  this  tumor 
m^y  be  the  size  of  the  fist,  or  it  may  not  be  larger  than  a 
goose's  e^g  or  a  pullet's  e^^,  comparatively  small ;  it  may 
be  of  two  or  three  years*  standing ;  it  may  be  entirely 
free  from  pain,  with  no  discoloration  of  the  skin, 
nothing  at  all  showing  that  it  has  any  malignant  tend- 
ency. The  tumor  is  carefully  removed,  completely 
excised,  every  particle  being  disposed  of  in  this  way.  In 
the  course  of  twelve  or  eighteen  months,  or  two  or 
three  years,  as  the  case  may  be,  a  tumor  of  precisely  a 
similar  kind  will  arise  in  the  same  spot  from  which  the 
other  was  removed.  Such  a  tumor,  we  say,  is  a  re- 
curring fibroid  tumor.  A  second  tumor  of  this  kind 
may  be  carcinomatous,  that  form  known  as  encephaloid. 

In  the  removal  of  such  a  tumor  there  may  be 
a  good  deal  of  difficulty ;  it  may  be  deep  seated,  may 
send  ramifications  among  the  surrounding  structures  to 
a  considerable  extent ;  may  involve  the  muscles,  nerves, 
arteries,  and  veins,  so  that  a  nice  dissection  is  required. 
The  proper  remedy  is  excision ;  nothing  less. 

*      VI.— CARTILAOIKOUS  TUMORS. 

The  cartilaginous  or  enchondromatous  tumor,  or  the 
en  chondroma,  as  it  is  called  by  Muller  of  Berlin,  by 
whom  it  was  first  accurately  described,  stands  inter- 
mediate between  the  fibroid  and  the  bony  or  osseous 
tumor.  The  largest  tumor  of  this  kind  I  ever  saw  was 
in  a  young  man,  a  native  of  Massachusetts,  who  died  six 
weeks  after  visiting  this  city:  it  involved  the  right 
shoulder,  and  was  found  to  weigh  thirty-one  pounds ;  a 
mass  which  could  have  been  removed  very  realily,  as 


was  shown  by  Dr.  Jackson,  of  Boston,  had  an  operation 
been  performed  at  the  proper  perioo.  These  tumors 
occur  in  dififerent  portions  of  the  body,  most  generally 
in  connection  with  a  bone,  sometimes  in  the  intermus- 
cular cellular  tissue,  sometimes  in  the  ovaries,  uterus, 
mammary  gland,  or  other  organs  of  the  body.  They 
are  slow  in  formation,  non-mdignant  in  their  tendency, 
giving  rise  to  pain,  but  chiefly  incommoding  by  their 
weight  and  by  their  pressure;  so  far  as  we  are  able  to 
determine,  they  are  not  disposed  to  run  into  malignancy, 
or  to  de^^enerate  into  carcinoma.  A  tumor  of  this  kind 
frequently  contains  a  large  quantity  of  bony  matter,  es- 
pecially when  the  growth  is  of  long  standing,  when  it  is 
liable  to  degenerate  into  a  bony,  osseous,  or  a  cal- 
careous formation ;  but  in  its  earlier  stages  it  is  of  the 
appearance  of  cartilage  or  fibro-carlilage,  as  the  fibro- 
cartilage  of  the  nose  or  larynx.  As  it  increases  in 
age  it  becomes  more  hard,  firm,  and  resisting,  until  it 
degenerates  into  bony  substance.  Examined  with  the 
microscope,  we  find  it  is  composed,  like  all  the  other 
tumors,  of  cells  containing  nuclei  and  nucleoli  of  variable 
size ;  chemically  considered,  it  is  found  to  be  composed  of 
chondrin,  a  peculiar  form  of  jelly,  the  precise  character 
of  which  has  not  been  determined.  It  is  more  dense, 
firm,  and  resisting  than  the  fibroid  tumor;  less  so  than 
the  bony.  Tliere  is  no  distinct  cover  in  a  tumor  of  this 
kind,  but  the  cellular  tissue  which  lies  in  immediate 
contact  wfth  it  is  always  more  or  less  condensed;  but 
there  is  nothing  like  a  distinct  capsule  or  envelope,  ex- 
cept in  very  rare  cases.  Such  a  tumor  has  its  proper 
blood-vessels,  nerves,  and  absorbenta  The  blood-ves- 
sels are  never  of  large  dimensions ;  consequently,  when 
a  tumor  of  this  kind  is  cut  into,  it  does  not  emit  much 
of  this  fluid;  and  therefore,  when  it  is  extirpated,  pro- 
vided the  knife  is  kept  in  close  contact  with  its  peri- 
phery, there  will  be  very  little  hemorrhage,  even  if  the 
tumor  is  of  very  large  bulk. 

Such  a  tumor  is  not  amenable  to  the  absorbent 
vea^ls,  and  the  sooner  it  is  removed,  the  better  for  the 
part  and  system ;  if  it  be  developed  from  a  bone,  this 
must  be  removed  with  it. 

VII. — OSSEOUS  OR  BONY  TUMORS. 

Growing  from  the  posterior  portion  of  the  shaft  of  a 
thigh  bone  which  I  hold  in  my  hand,  is  a  ledge  of  bone,  a 
small  tumor,  very  narrow  and  thin,  having  almost  a 
sharp,  free  margin,  and  connected  with  the  bone  from 
which  it  grows.  This  is  an^  osseous  or  bony  tumor. 
Very  frequently  the  term  exostosis  is  applied  to  this  form 
of  tumor,  from  a  Q-reek  compound,  signifying  to  grow 
from  a  bone.  It  consists  of  precisely  the  same  mate- 
rial as  the  bone  from  which  it  grows.  A  tumor  like 
this  is  susceptible  of  acquiring  great  bulk,  as  in  one  of  the 
specimens  of  the  disease  of  the  thigh  bone  exhibited,  and 
sometioies  acquires  a  much  larger  development,  and 
when  this  is  the  case  it  is  easy  to  conceive  the  encroach- 
ment it  would  make  on  the  surrounding  structures.  It 
would  produce  great  pain  and  tenderness  in  the  part, 
leading  to  a  necessity  for  the  removal  of  the  tumor,  or  the 
amputation  of  the  limb.  I  show  you  an  hemispherical 
tumor  taken  fi^>m  the  posterior  part  of  the  skull  of  an 
elderly  subject,  who  had  carried  it  for  many  years.  It 
is  a  specimen  of  condensed  bony  tumor,  containing 
a  large  quantity  of  carbonate  and  phosphate  of  Ume. 
The  word  ivory  is  used  to  designate  this  form  of  tumor ; 
it  is  the  ebumized  variety  of  exostosis.  Tumors  of  this 
kind  are  of  slow  growth;  there  is  no  tendency  to 
malignancy ;  they  may  remain  latent  for  many  years. 
After  a  while  they  may  acquire  an  increased  activity, 
and  in  this  way  ultimately  attain  a  very  large  bulk. 

Such  a  tumor,  when  found  to  incommode  the  parts 
by  its  pressure,  its  interference  with  important  mnc- 


Digitized  by 


Google 


514 


THE  MEDICAL   RECORD. 


tions,  requires  removal;  and  in  some  cases,  as  when 
connected  with  an  extremity,  amputation  of  the  limb. 

VIII. — CALCAREOUS  TUMORS. 

The  calcareous  or  earthy  tumor  is  exceedingly  un- 
common. I  have  seen  but  very  few  cases  of  it^  and  I 
have  no  specimen  to  exhibit  to  you.  We  find  this  form 
of  tumor  occasionally  in  connection  with  the  lymphatic 
ganglions  of  the  neck  in  a  state  of  degeneration ;  'we 
find  them  occasionally  in  the  interior  of  the  uterus  and 
of  the  ovary,  consisting  of  calcareous  matter,  composed 
mainly  of  carbonate  and  phosphate  of  lime  arranged  in 
such  manner  as  to  be  exceedingly  brittle,  having  none 
of  the  osseous  tissue  properly  so  called.  This  form  of 
tumor  is  interesting  in  a  pathological  rather  than  in  a 
practical  point  of  view. 

IX. — ^NEUROMATOUS  TUMORS. 

The  nerve  tumor,  or  neuromatous  tumor,  or  simply 
the  neuroma,  presents  us  with  two  varieties,  the  neu- 
romatous tumor  proper,  and  the  subcutaneous  painful 
tubercle,  or  a  peculiar  form.  The  neuromatous  tumor  is 
connected  with  the  large  nervous  trunks,  as,  for  ex- 
ample, the  sciatic,  the  median,  and  the  radisd  and 
ulnar  nerves,  which  are  the  structures  more  particu- 
larly liable  to  suffer;  but  sometimes  we  find  them 
in  connection  with  the  smaller  nerves,  and  some- 
times in  large  numbers  in  the  sympathetic  system. 
Sometimes  they  are  solitary,  at  other  times  they  are 
multiple.  Dr.  Robert  Smith,  of  Dublin,  by  whom 
these  tumors  have  been  better  described  than  by 
any  one  else,  has  given  a  case  in  which  there  were 
upwards  of  one  thousand  found  along  the  course  of  the 
^eat  trisplanchnio  system  of  nerves.  There  would 
seem,  therefore,  to  be  occasionally  a  neuromatous 
diathesis.  This  tumor,  if  it  be  ci^efully  examined,  will 
be  found  to  exist  simply  in  an  expansion  of  the  nerve 
fibres^  which  are  spread  like  feathers,  or  the  ribs  of  a 
fan,  inclosing  a  large  quantity  of  fibroid  tissue,  a 
substance  similar  to  that  entering  into  the  composi- 
tion of  the  fibroid  tumor.  Under  the  microscope  it  is 
found  to  contain,  of  course,  cells  with  nuclei  and 
nucleoli  of  a  particular  character.  Tumors  of  this  kind 
are  capable  of  acquiring  considerable  bulk,  as  the  size 
of  the  fist,  or  a  small  head.  They  are  slow  in  their 
formation,  attended  with  more  or  less  pain,  and  more  or 
less  numbness  in  the  distal  portion  of  the  extremity, 
when  the  development  occurs  in  one  of  the  limbs. 

Tumors  of  this  description  should  be  allowed  to  re- 
main unmolested,  unless  they  are  productive  of  much 
pain  and  inconvenience,  when  we  are  obliged  to  in- 
terfere ;  the  proper  plan  being  tb  cut  down  upon  the 
tumor,  and  enucleate  it^  blowing  the  nerve  fibres  to 
retain,  if  possible,  their  integrity.  If  this  be  impracti- 
cable, we  do  not  hesitate  to  cut  out  the  tumor  as  we 
would  any  other,  exsecting  it  very  carefully,  dividing 
the  nerve  above  and  below  the  tumor,  a  procedure 
which  will  be  followed  by  a  loss  of  function  in  the 
distal  portion  of  the  limb,  and  may  lead  to  mortification, 
as  in  a  case  reported  by  Drs.  Dalton  and  Hoffman  of 
Ohio. 

The  other  variety  of  nerve  tumor  is  known  under 
the  name  of  the  SubctUaneous  Painful  Tubercle^  origin- 
ally described  by  Petit,  and  afterwards  more  distinctly 
by  Cheselden,  in  the  last  century.  You  observe  a  little 
spot  immediately  beneath  the  skin,  which  it  lifts  up,  as 
it  were.  It  is  connected  with  the  superficial  nerves 
which  run  immediately  beneath  the  skin.  This  tumor 
is  liable  to  occur  in  various  parts  of  the  body.  Itis  usu 
ally  considered  to  be  more  frequent  in  the  inferior  than 
in  the  superior  extremity,  but  such  is  not  the  result  of  my 
own  observation,  which  is,  that  it  is  found  most  frequent- 


ly about  the  upper  extremity  and  shoulder.  It  may  be 
single  or  multiple ;  sometimes  there  are  eight  or  ten,  or 
even  twenty,  in  the  same  individual.  It  is  always  pro- 
ductive of  exquisite  pain  of  a  neuralgic  character.  Even 
one  solitary  tumor  of  this  kind,  not  larger,  perhaps, 
than  a  pea,  a  filbert,  or  a  small  almond,  will  be  suffi- 
cient to  make  the  patient  perfectly  wretched  in  conse- 
quence of  the  severity  and  constancy  of  this  pain.  It 
is  sharp  and  shooting,  or  dull  and  heavy,  liable  to  be 
aggravated  by  changes  of  temperature,  and  other  causes. 
The  proper  remedy  is  excision. 

^    HXtpoxts  of  ^ospitais. 

NEW  YORK  HOSPITAL. 

FEMORAL  ANEURISM   CURED   BY  COMPRESSION. 

Service  of  Dr.  C.  M.  Allin.  House  Surgeon,  Dr. 
Charles  Washburn,  who  has  furnished  notes  of  the 
present  case,  which  will  be  followed  by  another  in 
which  the  same  treatment  was  employed. 

Peter  L ,  set.  19,  native  of  New  York,  burnisher, 

admitted  Aug.  13,  1867.  At  half-past  eight  o'clock,  on 
the  morning  of  admission,  the  patient  had  received  a 
stab  in  the  right  thigh,  the  incision  being  an  inch  and  a 
quarter  in  lengthy  mree  inches  below  Poupart's  liga- 
ment, parallel  with  the  femoral  artery,  and  almost 
directly  over  it.  At  the  time  of  the  accident,  profuse 
venous  hsemorrha^e  had  occurred,  but  ceased  sponta- 
neously. On  admission,  the  wouna  was  perfectly  clean, 
the  pulse  rather  feeble  and  accelerated,  the  skin  cool 
and  moist. 

The  patient  was  put  to  bed,  and  the  wound  left 
open  for  about  five  hours,  when,  no  haemorrhage 
appearing,  it  was  closed  with  sutures,  and  a  compress 
was  applied  over  it  with  moderate '  firmness.  At 
6.30  P.M.  the  haemorrhage  recurred.  On  removal  of 
the  compress  and  sutures,  the  limb  was  found  very 
much  swollen,  and  the  tissues  about  the  wound  were 
infiltrated  with  blood,  which  was  still  rapidly  welling 
up,  mostly  venous,  with  a  slight  arterial  admixture. 
The  wound  was  enlarged,  and  an  attempt  made  to  find 
the  bleeding  vessel,  but  unsuccessftilly.  The  femoral 
being  uninjured,  the  artery  wounded  was  probably  the 
deep  external  pudic.  A  conical  compress  was  placed 
in  the  wound,  and  completely  arrested  the  haemorrhage 
from  both  artery  and  vein.  It  was  held  in  position  by 
a  Signorini  tourniquet,  which  at  9  oVlock  the  next 
morning  was. removed,  leaving  the  compress  undis- 
turbed. Two  days  later  this  also  was  removed  ;  and 
the  wound,  now  beginning  to  discharge,  was  syringed 
out  with  liq.  sod»  chlor.,  its  edges  were  slightly 
approximated  by  adhesive  strips,  and  a  dressing  of  lint 
and  simple  cerate  was  applied. 

On  the  18th  the  wound  was  filling  up  with  healthy 
granulations.  Above  it,  and  to  the  inner  side,  was  to 
be  felt  a  decided  induration,  to  which  a  pulsation  was 
communicated.  On  the  20th  the  pulsation  was  more 
distinct,  the  hand  perceiving  a  lifting  sensation  with 
each  beat ;  and  a  single  systolic  hmii  could  be  heard. 
All  pulsation  was  arrested  by  compression  of  the 
femoral  at  the  brim  of  the  pelvia  The  tumor  was  xery 
much  diffused,  and  its  margins  were  not  well  defined. 
The  point  of  most  marked  pulsation  was  situated  2  J 
inches  below  Poupart's  ligament  and  li  inch  to  the 
inner  side  of  the  sartorius.  The  next  day,  the  limits 
of  the  tumor  were  becoming  sharper,  and  the  bruit 
was  more  distinct  Pressure  would  empty  the  sac, 
which  refilled  by  successive  pulsations.  The  thigh  was 
somewhat  increased  in  size,  but  no  part  of  the  limb 
was  cedematous.   The  patient  beginning  to  complain  of 


Digitized  by 


Google 


THE  MEDICAL   RECORD. 


616 


severe  neuralja;ic  pains  about  the  tumor  and  extending 
down  the  thigh,  a  hypodermic  injection  of  15  drops  of 
Magendie's  solution  was  administered  at  night — Aug. 
24th.  A  consultation  was  called  at  which  Drs.  AUin 
and  Krackowizer  were  present  The  tumor  was  still 
increasing  in  size,  was  now  quite  cuxjumscribed,  and 
about  3i  inches  in  diameter.  Circumference  of  thigh 
over  tumor  201^  inches,  that  of  opposite  thigh  at  same 
point  18  inches.  No  diminution  in  force  of  the  tibial 
arteries.  Inguinal  glands  enlarged  and  very  tender.  It 
was  decided  to  employ  compression  of  the  femoral  just 
below  Poupart's  ligament 

Aug.  25th. — Compression  was  commenced  at  4  p.m. 
A  Signorini  tourniquet  was  used,  modified  by  affixing 
a  broad  pad  to  the  lower  limb  of  the  instrument,  while 
the  upper  pad  was  made  quite  thick,  in  the  shape  of  an 
inverted  conic  frustum.  This  was  brought  down  so  as  but 
partially  to  occlude  the  artery,  leaving  pulsation  in  the 
tumor  barely  perceptible.  The  pressure  was  well  borne 
until  10  o'clock  that  evening,  when  the  patient  began  to 
have  CTcat  pain  at  the  point  of  compression,  though 
that  about  the  tumor  and  in  the  thigh  had  quite  dis- 
appeared. The  tourniquet  was  slightly  loosened,  and 
half  a  grain  of  morphi»  sulph.  exhibited  hypodermically. 
This  induced  a  sound  sleep,  during  which  the  instrument 
was  again  tightened.  The  patient  remained  comfort- 
able, and  the  pressure  was  steadily  maintained  until 
the  28th  producing  no  oedema,  or  change  of  tempera- 
ture in  the  limb.  The  chief  embarrassment  arose  from 
the  enlarged  and  tender  glands  just  below  the  point  of 
pressure.  The  wound  had  begun  to  cicatrize.  On 
remitting  the  pressure  the  pulsation  in  the  aneurism 
was  found  to  have  somewhat  diminished,  while  its 
walls  had  become  thickened  in  a  marked  degree. 
Pressure  was  renewed  so  as  almost  completely  to  stop 
pulsation  in  the  sac,  though  that  in  the  artery  below 
the  pad  was  still  distinct 

Aug.  29th. — At  5  P.M.  compression  was  removed, 
when  the  tumor  was  found  perfectly  consolidated,  and 
all  pulsation  in  it  had  ceased.  The  pulse  in  the  femoral 
retained  its  normal  force  and  freedom.  The  skin  under 
the  pad  was  uninjured.  The  apparatus  was  left  loosely 
in  place  until  next  morning,  30th,  when  it  was 
removed.  The  tumor  then  gave  to  the  fingers  a  sen- 
sation of  almost  stony  hardness.  The  thigh  at  this 
point  measured  20  inches.  The  patient  was  free  from 
pain,  and  very  comfortable ;  had  slept  well,  without  an 
anodyne,  since  the  28tih.  The  wound  had  nearly 
healed.  On  the  5th  of  September  the  patient  was  out 
of  bed ;  the  tumor  softening :  thigh  measuring  19 
inches.  The  case  progressed  favorably,  and  on  the 
lOth  September,  the  wound  having  fully  healed,  the 
patient  was  discharged  cured. 


Operations  upon  Patik.vts  with  Heart  Disease. — 
Mr.  Paget,  Lar^cet^  does  not  believe  that  operations 
upon  persons  with  heart  disease  are  on  the  whole  at- 
tended with  a  great  deal  of  danger,  and  he  affirms  that 
the  risk  of  chloroform  is  far  less  than  the  shock  of  the 
operation.  Mere  irregularity  of  the  pulse,  if  it  does  not 
depend  upon  valvular  disease  or  fatty  degeneration  of 
the  heart,  does  not  affijct  materially  the  chances  of 
recovery. 

Chlorate  of  Potash  Injections  in  Vesical  Catarrh. 
— ^Vesical  catarrh  of  a  year's  standing  has  been  cured 
(Southern  Jour,  Med,  Sciences)^  by  injecting  the  bladder 
daily  with  four  to  six  ounces  of  solution  of  chlorate  of 
potash,  one  drachm  to  eight  ounces  of  water,  retained 
naif  an  hour  to  an  hour.  The  patient  was  a  female, 
who  had  suffered  greatly  from  the  disease. 


• 

Influence  of  Operations  upon  the  Nervous. — Let 
me  tell  you  of  the  people  that  are  commonly  called 
"nervous."  I  do  not  refer  to  those  with  manifest 
disease  in  any  part  of  their  nervous  system,  but  to 
those  that  are  exceedingly  sensitive,  mobile,  and  excit- 
able, whether  in  their  sensitive  or  motor  organs — who 
are  very  emotional,  and  with  their  whole  cerebro-spinal 
nervous  system  altogether  tpo  alert.  You  will  find 
them  and  their  friends  always  apprehensive  of  the 
results  of  operations :  they  will  tell  you  that  they  are 
so  nervous  they  can  bear  no  shock ;  and  they  look  with 
the  greatest  apprehension  upon  the  infliction  of  any  in- 
jury. All  this  is  fallacious.  You  may  be  surprised  at 
observing  how  very  little  influence  upon  their  organic 
processes  this  excessive  vivacity  of  their  cerebro-spinal 
system  exercises.  -  Time  afcer  time  I  have  found  patients 
who  have  complained  of  agonies  in  their  wounds,  and  I 
do  not  doubt  have  felt  them,  but  whose  pulses  have 
been  unmoved.  They  have  nad  enormous  pain,  but 
no  fever,  no  single  sign  of  disturbance  of  their  general 
nutrition ;  they  have  had  spasmodic  movements  of 
their  limbs,  tremblings,  and  rigors,  but  no  mischief  has 
followed.  Besides,  the  same  mobility  of  mind  which 
makes  these  patients  very  fearful  before  an  operation, 
makes  them  hopeful  directly  after  it ;  and  amongst  all 
the  people  that  can  in  any  sense  be  called  invsJids,  I 
know  none  who  more  generally  pass  through  the  conse- 
quences of  operations  with  impunity  than  do  those  who 
are  commonly  called  nervous,  and  whose  nervousness 
consists,  if  I  may  use  the  expression,  in  too  great  a 
vivacity  of  their  whole  cerebro-spinal  system.— James 
Paget,  F.RS.,  Lancet. 

Incompatibtuty  of  Pot.  Iodio.  ano  Potass.  Chlorat. 
— This  is  an  important  point  in  practice,  for  in  syphilis, 
to  act  at  the  same  time  upon  the  ulceration  of  the  mouth 
and  the  general  malady,  chlorat.  potass,  and  pot.  iodid. 
are  firequently  given.  This  practice  is  dangerous,  as 
has  been  demonstrated  by  M.  V^ej  for  the  chlorate  of 
potash,  absorbed  simultaneously  with  the  iodide  of  po- 
tassium, may  part  with  its  oxygen,  and  transform  it 
into  the  iodate,  a  poisonous  agent.  The  recent  experi- 
ence of  M.  Melsens  proves  the  possibility  of  this  trans- 
formation. 

This  ought  to  suffice  to  prevent,  were  it  only  as  a 
precautionary  measure,  the  simultaneous  administra- 
tion of  the  chlorate  of  potash  and  the  iodide  of  potas- 
sium.—  Gazette  Mid,  de  Paris, 

Resections.— M.  Sedillot  has  written  a  letter  to  the 
Imperial  Society  of  Surgery,  on  the  regeneration  of 
bone.  It  is  too  long  for  quotation  entire,  but  of  great 
interest.  He  contradicts  the  two  principles  of  sub-peri- 
osteal  resection  in  the  following  terms : 

One,  to  which  Larghi  has  given  the  general  name  of 
sub-periosteal  resection,  is  founded  on  the  idea  that  the 
periosteum  detached  and  isolated  in  the  condition  of  a 
sheath  or  a  flap,  is  able  to  renew  or  reproduce  the  sub- 
jacent bone  from  which  it  is  stripped  or  raised. 

The  other  principle,  which  I  have  called  sub-periosteal 
gouging  or  scraping,  has  for  its  principle,  that  it  is  the 
periosteum,  ordy  when  attached  to  the  bone,  that  is  able 
to  renew  it;  and  that,  in  consequence,  the  bone  beneath 
the  periosteum  should  be  husbanded  and  preserved 
with  the  very  greatest  care. 

After  invoking  the  aid  of  the  Baconian  method  of 
research,  M.  Sedillot  quotes  numerous  series  of  experi- 
ments which,  in  his  opinion,  are  sufficient  to  prove  that 
the  periosteal  flaps,  if  completely  isolated  from  the  sub- 


Digitized  by 


Google 


516 


THE  MEDICAL  RECORD. 


jacent  bone,  are  unable  to  reproduce  it ;  **  and  that  the 
80-called  method  of  sub-periosteal  resection  is  founded 
on  a;  deplorable  illusion ; "  and  gives  his  opinion  that^ 
the  chief  use  of  preserving  the  periosteum  at  all,  is  to 
supply  a  mould  for  the  bony  matter  which  is  left  in  his 
method  of  periosteal  gouging,  and  which  really  repro- 
duces the  bone. — Ed,  Med.  Joum.j  Chzette  dea  Mdpi- 
tavaCj — Am,  Jour.  Med.  Sciences. 

Treatment  of  Croup. — In  a  memoir  addressed  to  the 
Academy  of  Sciences  at  Paris  on  the  subject  of  croup, 
Dr.  Abeille  sums  up  his  conclusions  concerning  this  dis- 
ease, as  follows : 

1st.  Croup  is  only  a  predominant  localization  of  a 
general  disease,  diphtheria,  and  only  in  some  exception- 
al cases  can  it  be  met  with  as  a  local  disease. 

2d.  Local  treatment  alone  is  powerless  to  arrest  croup, 
and  can  only  fulfil  an  indication,  which  is,  to  combat  its 
localization,  and  in  this  respect  such  a  mode  of  treatment 
is  very  proper,  providing  it  does  not  complicate  the  ex- 
isting symptoms ;  such,  however,  may  be  the  effect  of 
cauterizations  of  any  kind. 

3d.  Croup  often  kills  by  asphyxia;  it  terminates 
fatally  frequently  when  there  exists  a  pseudo-membran- 
ous affection  of  the  bronchial  tubes  and  lungs,  or  when 
there  is  a  general  infection  of  the  system,  which  may  in 
some  manner  be  compared  to  putrid  infection.  Tra- 
cheotomy, performed  solely  to  prevent  the  patient  dying 
from  asphyxia,  while  the  diphtheritic  exudation  may 
disappear  spontaneously,  or  be  removed  later  by  local 
or  general  treatment,  is  the  practice  generally  adopted 
at  the  present  time,  but  is  not  justified  either  by  results 
or  scientific  deductions.  The  results  officially  known 
during  a  period  of  six  years  and  a  half  at  the  hospital 
"  Sainte  Eugenie,"  and  which  should  not  differ  from 
those  of  other  hospitals  during  the  same  lapse  of  time, 
show  three  deaths  out  of  every  four  patients  upon 
whom  tracheotomy  was  practised.  During  the  time  of 
Rosen,  with  the  treatment  which  is  considered  detestable 
at  the  present  day,  the  mortality  did  not  exceed  a  third 
of  the  cases  operated,  and  if  we  add  to  the  cases  of 
croup  operated  at  the  "  Sainte  Eugenie,"  those  receiv- 
ing medical  treatment  only,  we  find  a  third  resulting  in 
death,  precisely  as  during  the  time  of  Rosen;  that  is  to 
say,  that,  as  a  eeneral  result,  tra<;heotomy  has  added 
nothing  favorable  to  the  treatment  of  this  disease  (Sta- 
tistics of  M.  Bourdillat  read  before  the  Society  of  the 
Hospitals,  26th  of  July). 

4th.  It  is  then  positively  proved  that  it  is  from  a  med- 
ical treatment,  capable  of  combating  the  disease  both 
in  its  general  and  local  predominant  manifestations,  that 
science  should  seek  to  arrest  the  progress  of  croup. 
This  treatment,  says  Dr.  Abeille,  from  our  own  efforts, 
which  were  crowned  with  success  in  exceptionally  bad 
cases,  and  for  a  stronger  reason  in  cases  less  serious  and 
relatively  benign,  may  be  summed  up  in  the  three  fol- 
lowing propositions,  two  of  which  are  currently  accept- 
ed in  practice,  and  the  third  one,  which  is  of  recent  in- 
troduction, is  the  inhalation  of  moist  vapors  of  the 
sulphide  of  mercury,  a  suitable  diet,  and  the  free  use  of 
emetics. — Gazette  MediccUe,  Nos.  37,  38  and  39. 

Iodine  Inoalation  in  DiPHTHERrA. — Mr.  J.  Waring 
Curran  (LanceC)  extols  the  inhalation  of  iodine  in  diph- 
theria, and  claims  for  it  the  property  of  arresting  the 
development  of  the  membrane.  He  thus  speaks  of  it« 
employment : 

The  formula  which  I  employ  for  inhalation  purposes 
is  the  same  as  that  formerly  used  by  Sir  Charles  Scud- 
amore  in  pulmonary  phthisis — viz. :  Iodine,  iodide  of 
potassium,  of  each  four  grains ;  alcohol,  four  drachms ; 
water,  four  ounces.  Of  this,  for  each  inhalation,  com- 
mencing, I  take  a  drachm ;  add  to  it  a  pint  of  vinegar 


infused  with  a  handful  of  dried  garden  sage,  placed  in 
a  common  inhaling  jar.  steadily  increasing  the  quantity 
of  iodine  solution  until  I  arrive  at  half  an  ounce  each 
inhalation.  The  circumstances  of  the  case,  the  age 
and  strength  of  the  patient,  and  the  severity  or  mild- 
ness of  the  attack,  guide  me  with  regard  to  the  num- 
ber of  inhalations,  and  the  time  occupied  by  each.  For 
an  ayerage  case,  occurring  in  a  healthy  patient,  I  would 
say  twelve  inhalations  at  least  per  diem,  with  eight  to 
twelve  minutes  (an  interval  allowed  to  rest)  for  each. 
The  loss  of  valuable  time  in  country  practice,  occasion- 
ally, will  not  permit  the  delay  of  sending  and  wailing 
for  an  apparatus ;  accordingly  not  unfrequently  I  have 
been  -compelled  to  make  my  inhalation  in  the  follow- 
ing manner:  Having  boiled  the  vinegar  and  sage, 
place  it  in  a  teapot  with  a  long  spout,  and  when  ihe 
patient  is  prepared  to  inhale,  add  the  iodine,  cover  the 
lid  of  the  vessel  with  a  cloth,  keep  up  the  temperature 
by  a  spirit-lamp  placed  underneath,  and  holding  the 
vQSSel  by  the  handle,  allow  the  patient  to  inhale  through 
the  spout.  Laryngeal  irritation  is  in  a  great  measure 
prevented  by  the  small  quantity  at  first  used,  through 
the  patient  becoming  gradually  accustomed  to  it. 

Prompt  Action  of  Turpentine  in  the  Treatment  op 
TiBNiA  Solium.  By  M.  A.  McCelland,  M.D.,  Knox- 
ville,  lU. — I  was  summoned  at  4  o'clock  p.  m.,  Nov.  19, 
to  see  a  patient,  at  the  depot,  who  was  in  a  "fit." 
Learned  from  the  bystanders  that  the  young  man  had 
fallen  suddenly  forward  on  his  face,  and  f  jr  a  few  min- 
utes had  severe  spasms,  with  frothing  at  the  mouth.  In 
the  fall  he  injured  his  nose  sufficiently  to  cause  consider- 
able haemorrhage.  Found  him  in  a  semi-stupor,  breath- 
ing easily,  pupils  responding  to  the  light.  In  a  few 
minutes  he  recovered  sufficiently  to  inform  me  that 
he  was  very  tired,  and  that  he  had  had  these  "  fits  " 
before.  By  this  time  his  father  had  arrived,  from  whom 
I  learned  that  the  patient  was  twenty  years  old,  and 
had  been  generally  healthy — ^had  usually  a  voracious 
appetite,  and  that  three  years  before  he  had  passed  a 
great  many  worms,  and  at  one  time  a  portion  of  what 
was  supposed  to  be  a  tape -worm  six  feet  long.  With 
this  evidence  I  diagnosed  the  case  "  epileptiform  con- 
vulsions," depending  on  Taenia.  While  lying  on  his 
back  the  hsemorrhage  from  the  nose  took  place  into  the 
throat  and  was  swallowed,  and,  as  it  was  causing  the 
patient  to  vomit,  I  deferred  treatment  till  morning.  At 
6  o'clock  A.  M.,  Nov.  20,  I  began  to  exhibit  table- 
spoonful  doses  of  5  Turpentine  |  j  v..  Mucilage  Gum 
Acacia  §  ij.,  Syr.  Simp.  |  ij.,  Ess.  Lemon  |  ss.,  every 
half  hour.  At  9  o'clock  a.  m.  saw  the  patient,  who  was 
tolerating  the  medicine  well,  and  ordered  two  table- 
spoonfuls  at  a  dose.  The  patient,  on  his  own  responsi- 
bility, made  it  three.  At  half-past  10  a.  m.,  he  came 
marching,  highly  elated,  to  the  office  with  the  parasite 
carefully  wrapped  up  in  a  paper.  The  worm  came  en 
masse.  Did  not  learn  from  patient  whether  it  showed 
signs  of  life  or  not.  The  neck  of  the  worm  was  tied  in 
several  knots,  which  I  feared  to  undo  lest  I  should 
break  it  Measured  carefully  it  gave  nine  feet,  whicli, 
with  the  six  feet  passed  three  years  before,  gave  an 
aggregate  of  fifteen  feet,  which  is  the  averaj?e  length. 
The  bowels  had  been  constipated  for  a  long  time.  The 
emulsion  caused  active  catharsis,  and  with  a  rapidity 
my  experience  would  not  have  led  me  to  anticipate. 
The  above  case  exemplifies  the  therapeutic  value  of 
Turpentine,  given  in  large  doses,  in  the  treatment  of 
Taenia.  The  only  ill  effijct  his  been  a  moderate 
strangury,  which  is  readily  yielding  to  flax-seed  tea. 

PoTSONiNO  BY  SuMACH. — Dr.  Bramau  (Med.  and  Surg, 
Reporter)  recommends  local  application  of  dry  calomel  or 
citrine  ointment  not  only  for  sumach  but  ivy  poisoning. 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


617 


The  Medical  EECx)Ra 

^  Jitmi-Pont^lB  |ournaI  of  SS^ebtctiu  anb  Surgerg. 
Gkobge  F.  Shradt,  M.D.,  Editor. 

Publiihod  on  the  Ut  and  Idth  of  each  Month,  bf 
WILLIAM  WOOD  &  CO.,  61  Walkks  Stbbet,  New  York. 

FOREIGN  AGENCIES. 


LOMDOM—TSDBXBB  k  Oo. 
PaBIS— BoeSAllQB   BT  ClB. 


Lripsio— B.  Hbbmahn. 

Bio  Janbibo— Stbpubmb  t  Ga. 


Nevr   York,   January   15,  1868. 


SPECIALISM  AND  GENERAL  MEDICINE. 
There  is  do  doubting  the  fact  that  the  study  of  spe- 
cial branches,  a3  now  carried  on,  is  rapidly  enlarging 
the  domain  of  medicine.  The  specialists,  so  called, 
despite  any  prejudices  that  jnay  exist  in  the  minds  of 
the  general  practitioner  concerning  temptations  to 
magnify  the  claims  of  respective  departments,  must  be 
considered  as  benefactors  of  their  craft.  As  such  they 
should  deserve  the  thanks  of  every  one  who  is  a  friend 
to  science  and  an  advocate  for  progress.  All  who  have 
watched  the  advances  which  specialism  has  made,  and 
have  noted  the  number  of  able  men  who  have  been 
coaxed  iuto  special  studies,  must  admit  that  its  claims 
to  respectable  recognition  are  pretty  well  established. 
There  have  been  very  few  who  would  be  wilUng  to 
deny  any  good  results  which  might  grow  out  of  the 
study  of  a  specialty :  the  difficulty,  however,  has  been 
to  settle  upon  the  proper  relations  which  should  be 
maintained  between  specialism  proper  and  general 
practice.  We  are  well  aware  that  extreme  sides  have 
been  taken  on  this  point,  and  that  the  present  unset- 
tled state  of  the  question  has  been  the  natural  result. 
The  general  conviction  which  forces  itself  upon  every 
one  who  has  examined  into  the  respective  merits  of  the 
case  is  that  the  whole  difficulty  rests  upon  the  want 
of  a  proper  understanding  between  the  two  parties. 
The  subject,  viewed  in  the  broad  light  of  common  sense, 
admits  of  an  examination,  the  results  of  which  can  be, 
mutually  satisfactory. 

The  respective  positions  of  general  practitioner  and 
specialist  are,  in  truth,  very  diffijrent  from  each  other. 
The  former  is  the  proper  medium  of  communication  be- 
tween the  people  and  the  profession ;  while  the  latter  is, 
strictly  speaking,  separated  from  the  people  by  the  pro- 
fession. To  the  practising  physician  the  general  public 
naturally  look  a»  the  only  one  who  is  supposed  to  be 
acquainted  with  their  ailments,  and  who  is  able  to  give 
suitable  advice.  The  specialist,  however,  depends  al- 
most solely  for  patronage  upon  the  recommendation 
vf  his  brother;  he  dares  not,  unless  he  wishes  to  dis- 
honor himself  and  his  caUing,  bring  himself  and  l^is 
qtiali6oations  more  directly  to  the  notice  of  his  patients. 
He  is  forced  to  throw  himself  wholly  on  the  generosity 


of  his  endorser,  and  it  is  of  the  utmost  importanca  that 
his  delicate  position  should  be  properly  appreciated  by 
all  parties  concerned.  A  specialist  becomes  such  after 
a  very  long  and  patient  study  of  a  particular  branch  in 
medicine,  and  if  at  the  end  he  is  not  privileged  to  enjoy 
the  fruits  of  his  labors  by  the  generous  countenance  of 
his  confreres  it  is  an  injustice  not  only  to  him  but  to  the 
science  of  medicine  at  large.  We  are,  perhaps,  ready  to 
say  that  the  specialist  is  an  extremist,  that  he  is  one  of 
a  class  who  see  only  one  subject  for  study,  and  that  his 
habits  of  thought  will  not  allow  him  to  travel  out- 
side of  the  path  which  he  has  marked  out.  Although 
this  may  be  true  of  some,  it  is  by  no  means  the  case  with 
the  majority;  the  true  specialist,  to  our  mind,  is  one  who 
is  well  enough  grounded  in  the  general  principles  of 
medicine  to  guard  him  against  such  an  error.  The 
determination  to  unravel  difficult  problems  and  to  work 
properly  in  a  good  cause  is  manifest  in  most  of  his  doings ; 
and  even  though  we  are  ever  ready  to  condemn  trans- 
cendentalism, we  should  be  equally  generous  to  overlook 
its  commission  in  the  surety  that  in  it  are  buried  many 
important,  valuable,  and  indi^spensable  truths,  which 
otherwise  would  never  have  been  elaborated. 

The  specialist  differs  from  the  ordinary  physician  in 
that  he  has  prepared  himself  from  practice  in  the  most 
difficult  cases  that  may  occur  in  a  particular  branch. 
This  difference  is  becoming  more  and  more  appreciable 
as  the  study  of  specialties  is  advancing  and  enlarging 
its  area.  It  is  preposterous  for  any  one  t'j  suppose,  how- 
ever powerful  may  be  his  intellect,  however  apt  at  gain- 
ing informal  ion,  however  skilful  as  a  manipulator,  that 
he  can  be  a  specialist  in  every  branch.  Even  the  most 
obstinate  opposer  of  specialism  will  not  be  prepared  to 
allow  the  possibility  of  such  a  state  of  things.  Some 
men,  it  is  true,  have  made  an  approach  toward  the  accom- 
plishment of  such  an  end,  but  it  has,  after  all,  been  only 
an  approach.  We  are  not  only  forced  to  acknowledge 
the  benefits  of  specialism  in  theory,  but  the  general 
practitioner  must  apply  the  theory  to  practice ;  he  must 
not  only  admit  that  specialism  is  necessary  to  the  ad- 
vance of  our  knowledge  in  different  directions,  but 
must  be  prepared  to  support  those  who  labor  in  the 
cause  of  its  advancement.  This  he  can  very  well  do  by 
taking  an  honest  view  of  the  position  of  things,  and 
can  thereby  advance  both  his  own  and  his  brother's  in- 
terest. 

We  are  not  as  yet  inclined  to  draw  a  line  of  rigid 
distinction  between  the  two  classes  of  practitioners,  but 
are  convinced  that  the  time  is  not  far  distant  when  the 
necessities  of  such  a  course  will  be  apparent  to  the  most 
conservative.  At  present  we  are  in  just  this  position,  and 
should  be  prepared  to  act  in  accordance  with  its  de- 
mands : — The  general  practitioner,  if  he  desires  to  be  a 
type  of  his  class,  a  model  family  physician,  so  to  speak, 
can  hardly  expect  to  be  much  of  a  specialist  in  any 
department  except^  perhaps,  midwifery.  He  must 
take  the  pains  to  fit  himself  for  all  the  ordinary  cases 

that   may  come    to  him;    and  thesapXN-o^rnaj^^ay 

igi  ize      y  ^ 


518 


THE  MEDICAL  RECORD. 


in  passing,  are  suflSciently  numerous  and  important  to 
engross  all  his  thoughts  and  direct  all  his  energies.  He 
can  certainly  make  himself  as  useful  in  such  a  line  of  duty, 
and  accomplish  as  much  good  as  can  the  specialist,  who 
has  a  smaller  and  perhaps  more  cultivated  field  to  work 
in.  General  medicine  overlaps  specialism  sufl&ciently 
far  to  gratify  the  ambition  of  any  ordinary  conscientious 
practitioner.  This  common  ground,  so  to  speak,  embraces 
the  elementary  departments  of  all  specialties,  and  is  as 
much  th«  province  of  one  class  as  the  other.  While 
tho  specialist  is  expected  to  be  thoroughly  grounded  in 
the  elementary  as  well  as  the  more  advanced  part  of 
his  branch,  the  physician  must  know  how  far  he  dare 
go  in  the  treatment  of  any  of  the  organs  now  specially 
studied  without  the  aid  and  a i vice  of  an  expert. 
His  position,  afier  all,  is  the  most  enviable  of  the  two ; 
he  has  more  variety  in  his  practice,  has  an  oppor- 
tunity, to  a  certain  extent,  to  avail  himself  of  the 
various  new  ideas  which  are  presented  to  him,  and  to 
choose  the  most  eminent  men  in  all  cpecial  departments 
for  couilseL  An  enthusiastic  specialist  has  likened  the 
profession  generally  to  the  rank  and  file,  while  he 
pleases  to  call  the  experts  the  leaders.  Can  we  not, 
however,  for  the  sake  of  an  illustration  of  our  idea,  turn 
the  tables?  If  we  begged  to  differ  with  him  in  his  par- 
ticular view  of  the  case,  we  would  liken  the  practitioner 
proper  to  the  general  who,  when  he  is  about  to  fight 
a  battle,  calls  around  him  his  staff,  counsels  with  them, 
and  combines  the  views  of  all  in  a  plan  of  his  own. 
-^^--♦--^ 

Thb  report  of  the  case  of  extirpation  of  the  uterus,  by 
Dr.  Hackenberg,  in  the  present  number,  will  be  of  in- 
terest to  our  readers,  not  only  in  itself  but  as  the  rep- 
resentative gf  a  class  of  very  important,  severe,  difficult, 
and  fatal  operations.  The  uterus  was  first  removed 
during  life  through  the  abdominal  walls,  twenty-one 
years  ago,  and  up  to  Sept.,  1865,  forty-two  cases  have 
been  recorded,  with  eight  cures.  Since  that  time  the 
list  of  operations  has  been  increased  by  six ;  one  by 
Wood,  of  Cincinnati,  one  by  Sands,  and  one  by  Krack- 
owizer,  of  this  city,  the  one  in  the  present  issue,  one 
by  Atlee,  reported  at  a  recent  meeting  of  the  N.  Y. 
Pathological  Society  by  Dr.  E.  Delafield,  and  one 
which  has  not  yet  been  published,  by  Weber,  of  Cleve- 
land. All  of  these  latter  terminated  disastrously,  so 
that  the  ratio  of  good  results  has  decreased  from  eight 
in  forty -two  to  eight  in  forty-eight.  This  is  indeed  a 
frightful  mortality,  and,  when  we  compare  the  results 
with  its  sister  operation,  ovariotomy,  there  is,  surgically 
speaking,  a  wide  gap  between  them. 

The  lesson  which  every  practitioner  should  be  willing 
to  learn  from  Dr.  Hackenberg*s  case  is  that  which  re- 
lates to  the  necessity  of  a  correct  diagnosis  to  begin 
with.  The  mistake  which  is  so  candidly  stated  has  not 
been  committed  by  him  alone,  but  by  many  others  who 
have  preceded  him.  Indeed,  the  mojority  of  the  opera- 
tions which  have  been  performed  have  been  based  upon 
just  such  an  error.     It  is  not  likely  that  the  same  thing 


will  occur  again  with  the  same  individual,  but  then  ex- 
perience should  be  a  wholesome  warning  to  others  to 
"make  assurance  doubly  sure"  before  trusting  the 
patient  to  the  meagre  chances  of  success  which  the  op- 
eration offers. 

^  t  ^ 

We  would  take  occasion  to  state  that  the  delay  in  the 
appearance  of  our  last  number  was  unavoidably  occa- 
sioned by  the  issue  of  an  extraordinarily  large  edition. 


Ueoietua  anlr  Uatxcte  of  Books. 


Synopsis  of  the  Course  op  Lectures  on  Materia  Medica 
AND  Pharmacy,  deuverkd  in  the  Universtty  of  Penn- 
sylvania, WITH  Five  Lectures  on  the  Modus  Oper- 
andi OP  MEDiciNEa  By  Joseph  Carson,  M.D.  Fourth 
edition,  revised.     Phila. :  H.  C.  Lea.     1867.    Pp.272. 

As  the  title  of  this  little  work  indicates,  it  is  a  mere 
synopsis  of  a  course  of  lectures  on  materia  medica^  de- 
lirered  at  the  University  of  Pennsylvania,  and  is  cal- 
culated almost  solely  for  the  use  of  the  students  of  that 
institution.  As  such  it  doubtless  subserves  its  purpose, 
but  there  are  too  many  points  referred  to  in  the  text, 
which  require  elucidation  in  the  lecture-room,  to  rec- 
ommend it  to  the  students  of  medicine  generally. 
There  are,  however,  contained  in  the  work  ^ve  excel- 
lent lectures  on  the  modus  operandi  of  medidnes, 
which,  by  themselves,  cannot  be  excelled  for  systematic 
arrangement  and  sound  reasoning. 

A  Dictionary  of  Medical  Terminology,  Dental  Sotkobbt, 
AND  THE  Collateral  Sciences,  by  Chapin  A.  Harris, 
M.D.,  D.D.S.,  Professor  of  the  Principles  of  Dental  Sur- 
gery in  the  Baltimore  Medical  College,  etc.    Third  ed  - 
tion.    Carefully  revised  and  enlarged  by  Ferdinand  J. 
S.  Gorgas,  M.D.,  D.D.8.,  Prof,  of  Dental  Surgery  in  the 
Baltimore  College,  and  Vice-President  of  the  Association 
of  the  C'lUeges  of  Dentistry.  PhiK :  Lindsay  <&  Blakiaton, 
1867.     8vo,  pp.  748. 
Owing  to  tlie  much  lamented  death  of  Prof.  Harris, 
his   dictionary  did  not  advance  to   a  new  edition  as 
rapidly  as  the  requirements   of  the  case  demanded. 
The  many  advances  in  dental  science,  which    have 
been  made  during  the  past  few  years,  have  rendered 
the  incorporation  of  many  new  terms  and  formuks 
absolutely  necessary  to  the  student  of  dentistry,  as  well 
as  to  the  dental  practitioner,  and  they  especially  will 
be  gratified  to  learn  that  the  task  of  the  present  editor 
has  been  conscientiously  and  satisfactorily  performed. 
Nearly  three  thousand  new  words  have  been  incorpo- 
rated into  this  edition,  besides  additions  and  corrections 
to  many  others.    A  noticeable  feature  of  the  present 
edition  is  the  mention  of  the  doses  of  the  more  promi- 
nent medicinal  substances.    As  a  work  for  reference  to 
those  studying  or  practising  dentistry,  it  is  in  our  opinion 
invaluable.     The  arrangement  and  concise  treatment  are 
everything  that  can  he  desired,  and  the  work  as  a 
whole  is  what  its  title  indicates.    It    is  beautifully 
prmted,  and,   as  far  as  we  can  be  able  to  say  from  a 
cursory  review  of  its  contents,  free  from  typographical 
errors. 

Photographs  op  Skin  Diseases,  taken  prom  Life,  under 

the  Superintendence  of  Howard  F.  Damon,  A.M.,  M.D., 

Fellow  of  Mass.  Medical  Society,  etc.,  etc,  etc.    Boston : 

1867. 

We  are  always  interested  in  every  attempt  to  elucidate, 

and  thus  faciUtate  the  study  of  any  branch  of  disease, 

and  more  especially  of  one  which  is  too  often  so  dis- 

Digitized  by  VjOOQIC 


\ 


THE  MEDICAI^RECORD. 


519 


couraging  to  the  busy  practitioner  as  that  of  cutaneous 
diseases;  and  therefore  welcome  this  enterprise  of  Dr. 
Damon,  the  first  ever  attempted  in  our  country,  to  press 
photography  into  this  service.  Colored  photographs 
aiKi  chromo-lithographs  have  dready  been  used  tor  this 
purpose ;  but  they  fail  in  giving  a  correct  idea  of  these 
affections,  unless  made  too  expensive  for  the  student 
Dr.  Damon,  therefore,  leaves  his  plates  uncolored,  and 
is  thus  able  to  give  a  more  eorrect  idea  of  the  form, 
arrangement,  etc.,  of  them. 

Dr.  D.  proposes  to  issue  these  photographs  in  four 
series,  each  to  consist  of  six  illustrations,  makmg  twenty- 
four  plates  in  all ;  and,  if  patronized  by  the  profession, 
to  continue  them  until  a  complete  atlas  of  these  diseases 
is  presented.  Two  plates  are  to  be  issued  each  month, 
the  series  to  be  completed  in  about  a  year.  They  have 
been  taken  by  artists  employed  for  the  purpose,  from 
selected  cases  under  his  observation  in  dispensary,  hos- 
pital, and  private  practice. 

The  first  two  plates  of  this  series,  which  we  have 
received,  represent  chronic  eczema  of  the  hand  and 
herpes  zoster,  and  are  fine  specimens  of  art;  and  we 
trust  that  the  enterprise  will  receive  the  encouragement 
which  it  merits. 

''Epidekio  Meningitis  or  Cebbbbo-Spinal  Meningitis." 
By  Alfred  Stilli^  M.D.,  Professor  of  the  Theory  and 
Practice  of  Medicine  and  of  Clioical  Medicine  in  the  Uni- 
versity of  PennsylvaQia,  etc.,  etc.  Lindsay  &  Blakiston, 
PhUadelphia.    Pp.  178. 

During  the  epidemic  of  cerebro-spinal  meningitis, 
which  has  existed  in  the  United  States  for  the  past  ten 
or  eleven  years,  so  much  has  appeared  in  the  different 
medical  journals  in  regard  to  its  nature,  treatment,  etc., 
that  there  seems  little  space  for  anything  very  new. 
In  accordance  with  this,  the  present  work  seems  rather 
a  resum^  of  what  has  been  said.  It  contains  nothing 
particularly  new ;  but  the  observations  and  opinions  of 
many  different  writers  are  broibgkt  together^  compared, 
and  criticised.  The  present  work  is  well  suited /or  those 
who  are  anxious  to  find  in  one  booh  all  that  has  been 
said  on  the  subject,  while  its  complete  bibliography  shows 
the  more  curious  reader  where  to  look  for  more  minute 
information. 

The  authors  consulted  are  American,  English,  Irish, 
French,  German,  etc. ;  and  reference  is  made  to  about 
all  of  the  epidemics  that  have  been  reported.  In  some 
places  the  author  seems  to  have  adopted  German  ideas, 
and  along  with  them  a  German  mode  of  expression. 
But  this  would  only  be  another  instance  of  the  difficulty 
of  separating  the  two ;  when  an  idea  has  been  fully  de- 
veloped in  German,  it  seems  to  rebel  against  being  clad 
in  pure  English. 

The  symptoms  furnished  by  the  nervous  system, 
organs  of  the  senses,  digestive  organs,  urinary  organs, 
pulse,  skin,  etc.,  are  separately  considered.  And  we 
are  very  happy  to  see  the  explanation  of  the  causes  of 
so  many  or  the  different  symptoms  given.  In  many 
medical  works  we  find  a  bare  enumeration  of  headache, 
deafness,  constipation,  etc.,  which  symptoms  taken  to- 
^Uier  are  said  to  form  a  disease.  But  no  explanation 
IS  given  why  the  symptoms  arise.  After  reading  over 
the  list,  we  must  carefully  study  out  for  ourselves  each 
component  of  the  disease.  It  is  so  generally  considered 
the  duty  of  the  physician  to  treat  symptoms  that  it  be- 
comes important  for  him  to  know  how  to  do  so.  This 
knowledge  can  only  be  certainly  acquired  bv  becoming 
acquaint^  with  the  cause.  For  instance,  while  in  scar- 
latina the  deafness  will  depend  on  the  throat-trouble  or 
an  extension  of  it,  in  cerebro-^-pinal  meningitis  '^  this 
symptom  appears  to  depend  chiefly  upon  the  pressure 
of  the  plastic  exudation  in  which  the  auditory  nerves 


ar6  embedded."  Of  course  if  treatment  were  directed 
to  this  symptom,  it  would  necessarily  be  different  in  the 
two  cases. 

Until  the  immediate  causes  of  all  the  symptoms  of  a 
disease  are  known,  we  cannot  expect  to  know  its  ulti- 
mate cause. 

The  cause  of  cerebro-spinal  meningitis  appears  in- 
volved in  as  great  obscurity  as  ever.  It  seems  deter- 
mined that  it  is  not  contagious.  But  while  this  negative 
point  is  settled,  there  seems  to  bo  nothing  new  on  the 
positive  side  oi  the  question. 

After  discussing  the  positive  diagnosis,  the  compara- 
tive diagnosis  between  this  disease  and  hysteria,  typhoid 
and  typhus  fevers,  is  extensively  argued. 

The  article  on  treatment  we  regard  as  very  practical 
and  sound ;  ice  to  the  scalp  during  the  continuance  of 
pain  in  the  head,  blisters  to  the  scalp  and  nape  of  the 
neck  are  recommended.  Alcoholic  stimulants  are  not 
to  be  used  until  required.  Opium  is  highly  spoken  of: 
"  Among  the  symptoms  which  it  was  particularly  in- 
tended to  relieve,  was  one  which  is  usually  thought 
to  be  increased  by  narcotics,  viz.,  coma."  Quinine  is 
considered  as  being  only  useful  as  a  tonic.  The  benefit 
of  mercury  is  doubted. 

This  essay  is  very  interesting,  as  containing  all  that 
is  at  present  known  of  this  very  curious  disease,  and 
will  prove  an  excellent  starting-point  for  future  obser- 
vations. 


tEleports  of  ^otxdlta. 


NEW  YORK  ACADEMY  OF  MEDICINE. 

Called  Meeting,  December  19,  1867. 

Dr.  Henry  D.  Bulkley,  Vice-President,  in  the  Chair. 

A  new  method  of  treating  the  ovarian  stump  after 
excision. 

Dr.    Horatio  R.   Storer,  of  Boston,  Mass.,   read    a 

Eaper  upon  the  above  subject,  in  the  course  of  which 
e  recited  the  case  of  a  patient,  a  lady  from  Columbia, 
Tenn.,  from  whom  he  had  removed  an  unilocular  cyst 
of  left  ovary,  in  Chelsea,  Mass.,  September  23,  1867. 
There  were  present,  Mr.  T.  Spencer  Wells,  of  London, 
Eng.,  Drs.  Kimball,  of  Lowell,  Lincoln,  of  Boston,  aud 
Wheeler,  of  Chelsea.  The  tumor,  with  its  contents — a 
straw-colored  albuminous  fluid — weighed  forty-three 
pounds.  A  portion  of  the  fluid,  however,  had  been 
allowed  to  escape  through  a  puncture  made  by  a  trocar 
with  a  tubing  attachment.  The  pedicle,  which  was 
about  the  size  of  the  thumb,  was  divided  by  the  scis- 
sors, after  the  application  of  Dr.  Storer's  clamp  shield.* 
When  the  clamp  was  relaxed,  but  one  artery  of  moder- 
ate size  required  ligation,  which  was  effected  by  iron 
wire.  The  walls  of  the  primary  incision  were  brought 
together  by  twenty  iron-wire  sutures ;  the  end  of  the 
pedicle  was  brought  between  the  inner  lips  of  the 
wound  at  its  lower  angle,  where  it  was  "  pocketed." 
"  Pocketing  the  pedicle,"  as  he  (Dr.  Storer)  proposes 
to  designate  it,  is  effected  by  passing  three  of  the 
stitches  through  the  pedicle  and  both  inner  edges  of 
the  abdominal  wound,  after  which  the  external  edges 
are  brought  together.  This  procedure  coaptates  the 
raw  surfaces  of  the  wound  with  the  raw  surface  of  the 
pedicle,  while  the  line  of  superficial  union  completely 
covers  over  the  whole. 

The  operation  was  performed  during  menstruation,  to 
which  fact  Dr.  Storer  especially  directed  attenti(^  as 
being  a  deviation  from   the    general   practice.    This 

*For  deacriptloD  of  this  Instnunsnt,  led  Medical  Rfisord^  toL  i,  p.  885. 


Digitized  by 


oo^. 


520 


THE  MEDICAL  RECORD. 


period,  he  did  not  think,  was  necessarily  dangerous. 
Furthermore,  the  shock  of  the  operation,  and  5ie  re- 
moval of  one  ovary  during  menstruation,  had  no  appre- 
ciable effect  upon  the  amount  of  the  catamenial  dis- 
charge. The  accepted  views  of  the  profession  in  regard 
to  the  essential  character  of  menstruation,  he  thought 
required  modification.  He  alluded  to  a  case  in  which 
he  had  succe^fully  removed  the  uterus  and  both 
ovaries,*  where  there  was  a  sanguineous  effusion 
eighteen  days  after  the  operation,  and  twenty-six  after 
the  last  catamenia.  The  lady  alluded  to.  he  would 
state  as  a  matter  of  some  interest,  was  still  in  perfect 
health. 

Dr.  Storer  also  gave  the  details  of  a  case  in  which  both 
ovaries  had  been  removed,  and  in  which  the  pedicle 
had  been  treated  somewhat  differently  from  the  usual 
method.  He  had,  instead  of  dividing  the  pedicle,  dis- 
sected away  from  the  encompasi^ing  masses  the  Fallo- 
pian tubes  throughout  their  entire  length.  The  peri- 
toneal wounds  were  closed  by  wires,  which  served  the 
purposes  of  b6th  ligatures  and  sutures :  five  of  these 
being  inserted  upon  one  of  the  tubes,  and  three  upon 
the  other.  This  patient,  who  made  a  very  good  re- 
covery, has  had,  since  the  operation,  quite  regularly  a 
sanguineous  discharge,  not  referable  to  any  disease  of 
the  uterus,  and  not  under  the  control  of  any  haemos- 
tatic. This,  too,  in  its  persistence,  is  quite  different 
from  the  hiemorrhagic  discharge  following  hard  upon  an 
ovarian  section. 

Another  notable  point  in  the  first  operation,  as  re- 
lated in  the  paper,  consisted  in  the  novel  way  of  treat- 
ing the  stump,  in  alluding  to  which  Dr.  Storer  main- 
tained that  the  knife  was  objectionable,  on  account  of 
the  hflemorrhage  so  apt  to  follow  an  incised  wound,  and 
the  liability  of  a  free  and  fatal  flow  from  the  slipping  of 
the  ligatures. 

The  ^raseuralso  had  its  disadvantages,  one  of  which 
was,  when  his  clamp  shield  was  not  applied,  that  of 
dragging  in  outlying  tissues,  and  thereby  increasing 
the" number  of  divided  vessels.  Besides,  too,  a  con- 
tused wound  is  apt  to  give  rise  to  a  more  profuse  sup- 
puration. 

The  cautery,  says  Mr.  Wells,  "would  almost  cer- 
tainly fail  to  stop  such  large  vessels  as  are  frequently 
met  with  in  a  pedicle."  Mr.  Baker  Brown's  testimony 
in  its  favor  is  to  be  received  with  due  allowance.  His 
own  method  of  dissecting  the  Fallopian  tubes  away 
from  the  diseased  mass,  as  practised  in  the  first  related 
case,  has  for  its  recommendation  :  ls^.  No  unnecessary 
division  of  vessels.  2d.  A  probable  primary  union  of 
the  cut  peritoneal  surfaces  along  the  Fallopian  tubes. 
3d.  The  avoidance  of  haemorrhage  ;  and  4th,  the  absence 
of  contact  between  any  general  peritoneal  surface,  and 
any  newly  divided  or  suppurative  tissue. 

In  this  way  the  serous  lips  of  a  peritoneal  wound 
may  be  approximated  and  mechanically  ma3e  to  close 
the  mouths  of  bleeding  vessels.  In  the  case  of  a  long 
pedicle,  the  second  method  is  usually  practicable.  The 
stump  should  be  "  pocketed."  When  short,  or  where 
there  is  practically  none  at  all,  the  stump  can  still  be 
"  capped."  Metallic  sutures  are  to  be  preferred.  Dr. 
Storer  then  took  up  the  topic  of  subsequent  treatment 
of  the  stump.  He  remarked  that  whether  the  stump 
was  intra-murdl  or  extra-mural,  there  were  certain 
serious  dangers  to  be  considered.  The  intra-mural 
attachment,  or  "  pocketing,"  was  intended  to  obviate 
these.  Mr.  Hutchinson,  when  he  brought  the  ex- 
tremity of  the  pedicle  outside  of  the  abdominal  wall, 
lesseni  the  mortality  very  much,  since  he  decreased 
the  Yisk  of  hsemorrhege,  of  peritonitis,  and  of  a  subse- 


•  Medical  Hectyrd,  toL  L,  p.  168. 


quent  haematocele,  from  reflux  of  the  catamenia  through 
the  divided  Fallopian  tubes — a  frequent  accident,  liable 
to  end  fatally.  He  allowed  that  the  external  method 
fwhether  by  clamp,  pins,  or  sutures)  is,  wh?re  the  pedicle 
is  long  enough,  far  superior  to  the  wholly  internal 
method.  But  he  agreed  with  Mr.  Wells  that  it  was 
not  yet  perfect,  and  quoted  from  that  ovariotomist 
several  objections. 

He  claimed  that  by  '* pocketing"  many  difficulties 
were  overcome,  as  for  example  the  most  favorable  con- 
dition for  primary  union  was  obtained  in  that  two  raw 
surfaces  were  brought  directly  together;  haemorrhs^, 
either  primary  or  secondary,  was  as  easily  prevented  as 
when  the  stump  was  external ;  there  was  no  infevitable 
foetid  discharge  from  the  stump;  when  there  had  been 
a  careful  adaptation  of  surfaces,  there  was  slight  risk 
of  exciting  suppuration  in  adjacent  tissues.  The  exist- 
ence of  an  infra-umbilical  uterine  outlet  for  the  cata- 
menial flux,  and  the  occurrence  of  an  intra-peritoneal 
haematocele,  were  rendered  impossible,  while  traction 
upon,  or  strangulation  of  intestine,  was  quite  unlikely 
to  happen. 

Af  er  an  allusion  to  certain  prospective  modifications 
in  some  of  the  minor  details  of  the  operation,  Dr.  Storer 
gave  as  a  reason  for  his  having  made  the  attachment  at 
so  high  a  point,  viz. :  midway  between  the  umbili- 
cus and  the  pubes — a  desire  to  provide  against  any  sub- 
sequent pregnancy  by  blowing  the  uterus  to  rise  to  a 
higher  point. 

Dr.  Storer,  during  the  reading  of  his  paper,  remarked 
ex  tempore  upon  Dr.  Krackowizer's  case  of  extirpation 
of  the  uterus  by  mistake  for  ovarian  tumor.*  He 
maintained  that  an  absolutely  certain  diagnosis  in  that 
case,  as  indeed  in  many  other  such,  was  not  only 
nearly  but  quite  impossible  of  attainment 

Dr.  Peaslee  said :  He  was  very  much  interested  in 
the  paper  read  Jby  Dr.  Storer,  wnich  he  considered  a 
progressive  one.  Dr.  Storer's  method  of  treating  the 
pedicle  in  ovariotomy  may  also  be  proved  by  experi- 
ence to  be  the  best  method.  But  up  to  the  present 
time  he,  Dr.  P.,  thought  the  best  way  to  treat  the  pedide 
is  to  tie  it  with  a  double  silk  ligature,  passed  through  its 
middle — each  half  of  the  ligature  inclosing  half  of  the 
pedicle — then  to  cut  the  ligature  close  to  the  pedicle,  and 
let  the  latter  remain  in  situ  in  the  abdominal  cavity. 
Thus  the  abdominal  incision  may  be  coupletely  closed  at 
once.  He  did  not  mean  to  say  he  would  adopt  this 
method  in  every  possible  case,  but  he  thought  it  alto- 
gether superior  to  any  other  of  all  the  methods  hitherto 
used  and  specified  by  Dr.  Storer.  In  patients,  however, 
hke  Dr.  Storer*s,  wiUi  a  monocystic  tumor,  without  adhe- 
sion, and  with  the  other  favorable  conditions  specified, 
Dr.  S.  would  probably  have  succeeded  in  nine  cases  out 
of  ten,  and  perhaps  nineteen  out  of  twenty,  which- 
soever of  the  commonly  approved  methods  of  treating 
the  pedicle  had  been  adopted.  The  operadon  itself  in 
such  cases  is  facile,  and  no  special  care  in  a^r  treat- 
ment is  required.  On  the  other  hand,  cases  of  poly- 
cystic tumors,  with  extensive  adhesions  and  .unfavor- 
able conditions  of  general  health,  will  too  often  prove 
unsuccessful,  however  the  pedicle  may  be  managed. 

Still,  the  management  or  the  pedicle  is  doubuess  an 
important  element  of  success,  or  the  contrary,  in  the 
less  desirable  cases,  and  deserves  consideration  in  every 
instance.  He  was  very  positive,  too,  that  the  success 
of  ovariotomy  had  been  greater  in  proportion  to  the 
number  of  cases,  when  the  pedicle  had  been  treated 
according  to  the  plan  recommended  by  himself.  Dr. 
Tyler  Smith,  who  operates  in  this  way,  saved  eleven  out 


*  vide  Medical  Record,  Sept.  1, 1867,  p.  S97. 

Digitized  by' 


Google 


THE  MEDICAL  RECORD. 


621 


of  fonrteen  patients;  while  Mr.  Bryant*  saved  only  ten 
out  of  his  first  nineteen  cases,  in  which,  with  four  ex- 
ceptions, the  pedicle  had  been  treated  by  other  methods, 
but  of  his  last  seven  cases  treated  in  the  way  he  was 
commending,  aU  recovered.  The  whole  numbc;  of  cases 
treated  thus  far  in  this  way  is,  however,  still  small,  com- 

£ared  with  those  treated  with  the  clamp,  and  by  the 
gaiure  (Clay*s  method)  left  hanging  out  through  the 
abdominal  incision — the  method  he  adopted  in  his  first 
operations,  and  which  he  still  preferred  to  all  others, 
except  the  one  he  now  advised. 

It  has  been  objected  to  the  method  which  he  pre- 
ferred, that  a  slough  of  the  stump  was  sure  to  occur  be- 
yond the  ligature,  and  that  this  decomposed  mass,  fall- 
ing into  the  peritoneal  cavity,  would  become  absorbed 
and  produce  septicaemia.  In  corroboration  of  this 
view,  Dr.  Routh's  experiment  of  placing  a  piece  of  flesh, 
while  still  fresh,  in  the  peritoneal  cavity  of  one  of  the 
lower  animals  is  cited ;  since  here,  it  will  be  remem- 
bered that  the  flesh  underwent  decomposition,  and 
produced  fever  of  a  low  type  from  absorption  of  the 
septic  fluid.  Mr.  Spencer  Wells,  indeed,  suggests  on 
this  belief  that  the  ligatures,  if  used  at  all,  had  better 
be  brought  out  through  the  abdominal  incisjon,  in 
order  to  draw  off  the  decomposed  fluid  in  the  perito- 
neal cavity  by  capillary  attraction. 

Now,  in  reply  to  this  objection.  Dr.  P.  would  say : 

1st.  No  symptoms  of  septicaemia,  and  no  fever  of  a 
low  type  had  occurred  in  the  cases  treated  as  he  had  re- 
commended; which  shows  that  no  such  sloughing  of  the 
pedicle,  as  is  invoked  by  the  opponents  of  this  method, 
takes  place.  It  may  possibly  occur  in  exceptional  cases; 
but  as  a  general  proposition,  he  must  infer  that  it  does 
not,  and  that  Dr.  Routh's  experiment  therefore  directly 
&vors  this  method,  instead  of  being  opposed  to  it. 

2d.  He  (Dr.  P.)  has  had  the  fact  demonstrated  in 
three  cases,  in  which  six  ligatures  were  applied,  that  no 
slough  of  the  extremity  of  the  pedicle  occurs.  Two  of 
the  patients  died  on  the  seventeenth  day,  and  the  third 
(not  his  own  case)  a  few  days  earUer.  Of  the  six 
masses  inclosed,  not  one  had  sloughed.  All  were  con- 
nected with  the  adjacent  surfaces  by  an  exudation 
which  had  maintained  their  vitality,  though  some  of 
them  were  now  completely  cut  oft*  by  the  ligatures ; 
and  neither  of  the  three  patients  had  had  any  symp- 
toms referable  to  the  pedicle  at  all 

He  knew  of  no  other  objection  of  any  weight  to  the 
method  he  proposed. 

On  the  other  hand,  this  procedure  admits  of  a  com- 
plete and  immediate  closure  of  the  abdominal  incision, 
which  is  of  course  expected  to  heal  by  first  intention. 
Besides,  the  ligature  is  the  surest  safeguard  against 
hcerrtorrhage  that  is  known,  and  the  one  always  adopted 
when  the  other  methods  fail  to  arrest  it.  He  had  seen 
not  a  few  instances  in  wliich  the  clamp,  the  actual  cau- 
tery, the  silkworm's  intestine,  or  the  silver  wire,  failed 
to  control  the  hemorrhage  from  the  pedicle,  and  it  was 
necessary  to  resort  to  the  ligature  at  last.  It  seemed 
to  him  in  all  these  cases  that  it  would  have  been  quite 
as  wise  if  it  had  been  used  at  first,  without  so  much 
manipulation  and  loss  of  time.  Any  means  of  arrest- 
ing hsemorrhage  Tnay  £iil;  but  he  had  applied,  and  seen 
applied,  not  less  than  forty  ligatures  to  pedicles  with- 
out the  occurrence  of  haemorrhnge  in  a  single  instance. 
And  in  those  cases  in  which  the  ligature  had  slipped  off 
of  the  pedicle,  only  a  single  Jigature  had  been  passed 
round  the  latter,  and  then  the  pedicle  also  had  sometimes 
been  cut  too  close  to  the  ligature. 

This  is  a  method  also  wiiich  may  be  applied  to  all 
cases,  and  is  the  only  one  for  very  short  pedicles  (un- 

*  Zondon  Lancet  for  Sugu9t^  t867t  p.  615. 


less  the  cautery  or  the  Ajraseur  be  preferred).  Ot 
course  the  method  of  Dr.  Glav  is  also  applicable  to  all 
cases;  but  he  supposed  that  if  the  ligature  is  to  be  used 
at  all,  none  would  prefer  to  have  the  ends  coming  out 
through  the  abdominal  incision,  provided  there  is  no 
sloughing  matter  to  be  brought  through  in  that  way,  and 
that  the  loops  remaining  behind  produce  no  mischief, 
as  is  known  to  be  the  fact.  Dr.  Peaslee  had  had 
septiceemla  occur  in  three  of  his  cases,  but  not  from 
any  agency  of  the  pedicle  in  either  instance.  These 
three  cases  recovered. 

On  the  contrary,  Dr.  Peaslee  regarded  the  fixing  the 
pedicle  in  contact  with  the  abdominal  walls  in  any 
way,  whether  by  sutures  or  the  clamp,  or  by  **  pocket- 
ing," as  proposed  by  Dr.  Storer,  as  very  objectionable. 
Fortunately  this  could  not  ba  done  if  the  pedicle  was 
very  short ;  but  the  probability  that  such  an  adhesion 
would  interfere  with  the  upward  development  of  a 
gravid  uterus  is  very  great,  although  parturition  has 
followed  in  a  few  such  instances.  And  Mr.  Wells  has 
reported  a  case  of  death  from  strangulation  of  the  in- 
testines by  the  band  thus  extending  across  the  perito- 
neal cavity.  Why  not  so  manage  the  pedicle  that  if  the 
patient  survives  the  operation  the  recovery  is  perfect  ? 

Still,  ovariotomy  is  an  operation  in  regard  to  which, 
more  than  any  other  perhaps,  we  should  guard  against 
exclusive  views.  Experience  will  perhaps  show  that 
one  method  of  treating  the  pedicle  is  better  in  one 
class  of  cases,  and  another  in  another  class.  Mean- 
while he  adheres  to  the  one  as  generally  best,  which 
he  thought  had  thus  far  succeeded  proportionally 
better  than  any  other ;  and  which  presents,  at  the  same 
time,certain  advantages  not  secured  by  the  maintenance 
of  the  pedicle  in  contact  with  the  abdominal  walls, 
and  avoids  the  inconveniences  also  which  that  method 
involves.  In  regard  to  the  other  points  in  ovariotomy 
also,  we  must  have  no  preconceived  notions  on  com- 
mencing the  particular  operation;  since  if  uncompli- 
cated it  is  one  of  the  simplest  and  easiest  of  surgical 
procedures,  while  in  the  most  difficult  cases  it  is  the 
most  formidable  operation  ever  attempted.  And  with 
the  exception  of  the  class  of  cases  already  mentioned 
as  strongly  promising  success,  no  one  can  tell  before 
opening  the  abdominal  cavitv  what  complications  he  is 
to  meet.  The  operation,  therefore,  should  always  be 
commence<l  as  an  explorative  procedure,  and  with  the 
understanding  on  the  part  of  the  patient  and  the  friends, 
that  it  may  fail  of  completion,  should  complications  be 
found  which  render  its  completion  the  more  dangerous 
course. 

In  regard  to  the  removal  of  fibro-cystic  tumors  of  the 
uterus.  Dr.  Peaslee  remarked  that  he  had  not  had  so 
much  experience  as  Dr.  Storer,  and  that  he  had  neither 
been  so  fortunate  nor  so  unfortunate.  He  had  removed 
two  such  tumors,  one  patient  dying  in  forty-eight 
hours  and  the  other  at  the  end  of  a  week.  The  lat- 
ter, however,  died  actually  of  gangrene  of  the  intestines, 
from  hernia  through  the  abdominal  incision,  produced 
by  violent  coughing;  the  post-mortem  showing  that 
she  would  doubtless  have  recovered  firom  the  operation 
so  far  as  the  uterus  and  its  appendages  were  concerned. 

In  regard  to  the  case  reported  bv  Dr.  Krackowizer 
of  mistake  in  diagnosi««,  Dr.  Peaslee  remarked  that 
he  thought  no  apology  was  required  for  it.  He  (Dr. 
Peaslee)  had  once  made  a  similar  mistake,  afler  availing 
himself  of  the  sound  and  all  other  recognized  methods, 
he  believed,  of  diagnosis;  and  he  or  any  one  else  might 
do  the  same  again,  he  thought.  No  physician  ever 
pretends  that  he  can  always  distinguish  with  certainty 
between  two  diseases,  even  when  on  the  surface  of  the 
body;  and  any  surgeon  who  expects  always  to  be 
able  to  decide  with  unerring  certaintvbetween  two  or 

digitized  by  Google 


522 


THE  MEDICAL  RECORD. 


more  kinds  of  tumors  in  the  abdominal  cavity,  will  not 
only  sometimes  find  himself*  deceived  if  lie  pronounces 
positively,  but  be  will  also  hold  np  to  non-medical 
men  a  standard  which  they  will  not  be  slow  to  turn  to 
tlie  disadvantage  of  the  profession  generally.  It  is  well 
to  understand,  and  also  to  admit  publicly  even,  that 
human  diagnosis  recognizes  such  a  thing  as  an  impossi- 
bility, and  always  will  do  so. 

Dr.  Emmet  staled  that  his  experience  in  ovariotomy 
had  been  limited  to  some  half-a-dozen  cases.  As  a  mat- 
ter of  safety,  he  had  been  unable  to  make  up  his  mind, 
in  either  of  these  cases,  to  drop  the  pedicle  back  within 
the  abdomen.  He  had  secured  the  pedicle  crowded 
down  in  the  lower  angle  of  the  wound,  not  with  a 
clamp,  but  inclilded  in  the  abdominal  sutures.  In  each 
he  had  carried  out  somewhat  the  same  idea  as  proposed 
by  Dr.  Storer,  with  a  view  of  covering  early  the 
Slump  of  the  pedicle.  That  he  had  been  in  the  habit, 
afcer  the  fourtii  day,  of  cutting  off  the  h'gature  around 
the  stump  and  gradually  removing  the  sutures,  includ- 
ing the  pedicle,  before  the  others,  so  as  to  draw  the 
edges^of  the  abdominal  wall  over  it.  That  this  plan 
was  a  safe  one,  as  the  peritoneum  united  rapidly  and 
firmly  after  twenty-four  hours ;  as  the  stump  was  not 
entirely  strangulated,  he  had  never  had  any  sloughing 
from  the  end.  He  was  also  convinced,  when  the  pedicle 
was  to  be  brought  out  of  the  lower  angle  of  the  wound, 
that  the  best  plan  to  be  adopted  in  regard  to  the  in- 
cision was  to  make  it  as  near  down  to  the  pubes  as  pos- 
sible, that  is,  so  far  as  was  consistent  with  safety.  In 
his  cases  no  pregnancy  had  occurred ;  but  he  knew  of 
one  instance,  in  Dr.  Sims*  practice,  where  the  pedicle 
was  included  in  the  lower  angle  of  the  abdominal  sec- 
tion, and  the  patient  had  borne  three  or  four  children 
since  without  any  difficulty,  from  this  plan  of  treating 
it. 

Dr.  Noeggerath,  after  reviewing  the  additions  to  our 
knowledge  of  this  subject,  called  attention  to  the  fact 
that  Dr.  B.  Stilling,  of  Cassel,  was  the  first  to  propose 
(in  1837),  the  extra-peritoneal  adjustment  of  the  pedicle. 
His  method  consisted  in  tying  the  pedicle  en  masse^ 
and  uniting  it  by  pins  with  the  raw  surfaces  of  the 
abdommal  wall,  leaving  the  section  above  the  ligature 
outside  in  contact  with  the  air ;  thus  effecting  only  a 
partial  union  between  the  same  and  the  integuments. 
Therefore  Dr.  Storer's  manner  of  treating  the  pedicle 
was  an  original  one  in  principle. 

Dr.  N.  could  not  with  Dr.  Peaslee  so  strongly  en- 
dorse the  intra-peritoneal  management  of  the  stump. 
There  were  some  rather  serious  objections  to  its  appli- 
cation, among  the  chief  of  which  was  the  unreliability 
of  the  ligature  against  the  occurrence  of  heemorrhage 
resulting  fi-om  the  shrinking  of  tisjsue^,  which  were 
quite  succulent  when  the  Ugature  was  applied.  In 
this  case  the  ligature  would  of  course  become  loosened 
and  no  longer  fulfil  its  office.  He  recalled  a  case  of 
his  own,  upon  which  he  had  operated  in  October, 
1866,  and  in  which  a  double  ligature,  as  tightly  drawn 
as  could  be,  became  loosened  in  a  few  hours  and  origi- 
nated an  alarming  hsemorrhage. 

Another  objection  to  Dr.  Peaslee's  method  consisted 
in  the  possibility  of  the  occurrence  of  sloughing  of  the 
stump  and  septic  peritonitis  from  this  cause.  This  acci- 
dent could  not  occur  when  the  cut  surface  is  being  sur- 
rounded by  an  exudation  of  lymph  from  that  part  of 
the  peritoneum  with  which  it  comes  in  immediate  con- 
tact. But  in  case  the  pedicle  should  happen  to  touch  a 
peritoneal  surface  of  low  vitality,  owing  to  continued 
pressure  from  the  cyst  or  to  repeated  attacks  of  sub- 
acute inflammation  during  an  earlier  stage  of  the  cystic 
development,  why,  then,  gangrene  is  very  apt  to  take 
place  around  the  portion  included  within  the  ligature. 


How  far  decomposition  might  go  on,  Dr.  N.  had  him- 
self seen  in  one  instance,  where  the  tissues  not  only 
above  but  hdow  the  Ugature  came  away  to  the  extent 
of  some  three-fourths  of  an  inch. 

To  Dr.  Storer's  enumeration  of  the  different  modes 
of  treating  the  stump,  two  might  be  added,  which  he 
would  proceed  to  mention.  The  first  of  these,  adopted 
by  Dr.  Koeberle  of  Strasburg,  consisted  in  severing  the 
pedicle  by  a  small  wire  ^raseur,  gradually  tightened 
during  a  period  of  several  days;  after  which  everything 
was  left  in  the  abdominal  cavity.  The  secretions  were 
then  washed  out  as  they  occurred. 

The  second  plan  was  a  proposition  of  Dr.  N.  himself, 
and  consisted  essentially  in  leading  the  pedicle  through 
Douglass'  space  into  the  vagina,  where  it  was  to  be 
secured.  Tnus  being  in  sight,  and  out  of  harm's  way, 
it  could  be  more  readily  commanded  in  case  of  emer- 
gency. In  recommendation  of  this,  it  was  to  be  borne 
in  mind  that  inflammation  as  well  as  lesions  following 
the  pelvic  section  of  the  peritoneum,  seemed  to  be 
borne  with  less  danger  than  those  of  other  peritoneal 
regions;  a  fact  fully  corroborated  as  well  by  the  general 
innocuity  of  perimetritic  inflammations  as  by  his  own 
experience,  since  he  had  operated  at  least  fourteen 
times,  either  by  the  trocar  or  the  knife,  for  drawing 
ovarian  cysts  through  the  vagina,  without  losing  a 
single  patient  from  the  effects  of  traumatic  inflammation. 

Dr.  Peaslee,  in  reply  to  Dr.  Noeggerath's  remark  re- 
specting the  increased  wnount  of  blood  in  the  pedicle 
after  the  application  of  the  ligature,  and  its  subsequent 
diminution,  thus  producing  a  shrinking  of  the  pedicle 
and  a  loosening,  and  perhaps  the  detachment  of  the 
ligature, — said  he  made  issue  witli  any  one  who  might 
make  that  assertion.  On  the  contrary,  there  being  no 
further  need  of  blood  circulating  through  the  artery  of  the 
pedicle,  there  was  very  little  pressure  of  blood  into  the 
pedicle.  So  true  is  tms,  that  in  one  of  S.  Wells'  cases, 
tliere  was  ho  bleeding  from  the  pedicle,  though  he 
removed  the  clamp  (it  produced  such  violent  symptoms 
from  dragging  on  the  uterus)  in  four  hours  after  it  had 
been  applied. 

In  regard  to  menstruation  occurring  after  both  ovaries 
had  been  removed,  as  in  the  cases  quoted  by  Dr.  Storer, 
Dr.  P.  would  say.  that  he  had  removed  both  ovaries  in 
three  cases,  and  the  patients  are  all  now  living.  Neither 
of  these  patients  has  menstruated  since  the^ operation. 
He  has  in  four  cases  seen  a  flow  of  blood  from  the  vagina 
for  three  or  four  days,  and  commencing  the  third  or 
fourth  day  after  the  operat'on.  But  he  considered  this 
as  merely  a  haemorrhage  occurring  in  consequence  of 
congestion  of  the  uterus  firom  the  operation,  and  hailed 
it  as  a  good  omen,  as  that  congestion  was  thus  spon- 
taneously relieved. 

Dr.  Storer  did  not  wish  to  be  understood  as  laying 
down  any  invariable  rules,  even  for  a  given  operative 
procedure,  since  too  many  probabilities  were  to  be  taken 
into  account.  But  he  did  desire  to  put  himself  on  re- 
cord as  one  who  was  very  strongly  in  favor  of  prepara- 
tory treatment,  in  the  case  of  all  abdominal  sections, 
beheving  it  to  be  much  more  rational  to  prevent 
than  to  remedy  shock.  He  would  prefer,  for  instance, 
to  give  stimulants  before  anaesthesia  rather  than  when 
danger  was  imminent.  So,  too,  owing  to  the  present 
accepted  practice  of  preparing  the  pregnant  woman 
for  her  ordeal  by  a  proper  attention  to  her  con- 
stitutional conditions,  .much  suffering  was  saved,  and 
not  a  few  dangers  averted.  By  preparatory  treat- 
ment in  the  cases  to  which  he  had  just  alluded,  he  de- 
sired to  be  understood  as  meaning  something  extending 
ever  a  reasonable  period  of  time.  He  bel.eved,  too,  that 
to  operate  was  one  thing,  but  to  conduct  the  case  after- 
ward quite  another — ^indeed  those  who  wearily  watch 


Digitized  by 


)  wno  wearily 

GooqI 


gie 


THE  MEDICAL  RECORD. 


523 


over  the  case,  as  he  has  himself  had  an  opportunity  of 
knowing,  are,  after  all,  entitled  to  the  greater  share  of 
credit  for  the  successful  issue. 

In  response  to  the  resolution  of  the  Academy,  asking 
for  a  copy  of  his  paper  for  publication.  Dr.  Storer  said 
that  the  same  would  appear  in  the  Ameriean  Journal  of 
Medical  Science^  for  January. 

Dr.  Anderson  did  not  think  that  this  fact  would  con- 
flict with  the  resolution. 

The  resolution  prevailed,  and  the  Academy  ad- 
journed. 


N.Y.  MEDICAL  JOURNAL  ASSOCIATION. 

Stated  Reunion,  Friday,  December  6,  1867. 

Dr.  Qurdon  Buck,  President,  in  the  Chair. 

new  views  of  phthisis  pulmoxalis. 

Dr.  L.  Weber  read  a  resumd  upon  this  subject,  in- 
troducing it  by  reference  to  a  monograph  by  Aug. 
Hedinger  on  "  The  Development  of  the  Doctrine  of 
Phthisis  Pulraonalis  and  Tuberculosis*'  (Tubinjren,  1864). 
Most  of  the  ancient  physicians  held,  with  Q-alen,  that 
pulmonary  phthisis  was  caused  only  by  a  slow  inflamma- 
tory process  leading  to  ulceration;  but  a  few,  following 
Aretseus,  added  as  a  cause  nodose  indurations  (^/wtta), 
by  whose  softening  and  suppuration  vomicae  were  pro- 
duced. The  doctrine  of  Galen  held  firm,  though  not 
quite  undisputed,  sway  down  to  the  time  of  Laennec, 
whose  theory,  by  its  simplicity,  at  once  gained  a  strong 
hold  upon  the  professional  mind,  which  it  has  until 
very  recently  maintained.  Laennec  identified  phthisis 
and  tuberculosis,  and  considered  tubercle  a  peculiar 
neoplasm,  anatomically  demonstrable  either  as  such  or 
in  its  products,  cheesy  metamorphosis  and  vomicas. 
From  this  point  of  view  phthisis  was  pronounced  wholly 
unmanageable,  whether  in  the  way  of  cure  or  of  prophy- 
laxis; yet  Laennec  himself,  with  Rokitansky  and  Le- 
ber t,  was  afterwards  forced  by  clinical  observation  to 
admit  that  spontaneous  recovery  was  possible.  Brous- 
sais,  sustained  by  Andral  and  Reinhardt,  while  still  ac- 
knowledging phthisis  and  tuberculosis  identical,  denied 
that  tubercle  was  a  pseudoplasm,  and  regarded  it  as  the 
result  of  a  slow  inflammation ;  thus  reverting  to  the 
position  of  Galen.  An  approach  to  a  more  satisfactory 
pathulogy  is  to  be  found  in  the  masterly  researches  of 
Virchow,  who  distinctly  separates  the  neoplasm  known 
as  miliary  tubercle  from  all  the  other  pathological  pro- 
ducts commonly  grouped  together  with  it  as  tuberculous. 
Already  we  begin  to  seo  the  fruits  of  his  labors  in  the 
admirable  manner  in  which  Felix  Niemeyer  and  others 
have  lately  handled  the  subject,  and  in  the  results  of 
an  improved  therapeusis  based  upon  a  sound  pathology. 
Under  the  pathology^  Dr.  Weber  drew  attention  to 
the  theory  of  Dr.  William  Budd  (which  we  have  ^ven 
elsewhere),  that  tubercle  is  a  true  zymotic  disease,  spe- 
cific in  character,  and,  like  other  diseases  of  this  class, 
is  perpetuated  only  by  the  law  of  continuous  succes- 
sion; that  the  deposits  of  tubercular  matter,  which  are 
of  the  mature  of  an  eruption,  either  constitute  or  include 
the  specific  poison,  and  are  the  means  of  propagating 
the  disease  from  person  to  person ;  and  that  there  is 
reason  to  hope  that,  by  means  of  proper  disinfectant*?, 
we  may  ultimately  be  able  to  banish  this  scourge  from 
the  community.  This  theory  is  the  less  likely  to  find 
general  favor  now  that  the  questions,  what  is  tubercle? 
and  what  its  relation  to  phthisis?  are  being  so  variously 
answered — experiments  on  animals  tending  to  show 
that  although  tubercle  may  be  reproduced  by  inocula- 
tion, yet  there  may  be  caused  identical  products  by 
other  inoculated  matters.     Opposed  to  Budd  stands  the 


school  of  Virchow  and  Niemeyer,  which  holds  that  the 
so-called  tuberculous  deposits  in  the  lungs  are  by  no 
means  of  uniform  origin,  but  may  arise  from  the  cheeky 
metamorphosis  of  many  substances ;  and  that  phthisis 
may  originate  as  well  from  pneumonic  or  other  de- 
posits, local  inflammation,  etc.,  as  from  miliary  tubercle. 
Of  the  views  of  Niemeyer,  as  given  by  the  reviewer 
firom  the  papers  of  Dr.  Ott,  in  the  Berliner  Wochen- 
schrift  (Nos.  1-7,  1867),  we  append  a  brief  summary, 
referring  the  reader  for  their  luller  development  to  a 
condensed  translation  of  Dr.  Ott's  work  by  Dr.  W.  T. 
Lusk,  in  the  New  York  Medical  Joumdly  December,  1867. 
The  idea,  held  since  Laennec,  that  pulmonary  phthisis 
is  due  to  diathesis  only,  must  be  given  up,  experience 
having  shown  that  all  causes  productive  of  bronchitis 
or  hypersemia  and  consrestion  of  the  lungs  may  also  lead 
to  it  It  may  exist  in  cases  where  not  a  tubercle  is  to 
be  found  anywhere  in  the  body,  and  is  then  commonly 
traceable  to  some  form  of  pneumonia — most  frequently 
the  chronic  catarrhal  But  direct  irritation  from  foreign 
bodies,  and  especially  from  coagulated  blood  retained 
in  the  bronchi  and  alveoli  after  haemoptysis,  may  have 
been  the  starting-point — this  leading  to  pneumonia, 
with  cheesy  metamorphosis  of  the  pneumonic  foci,  and 
this  again  to  phthisis. 

In  his  diagnosis  Niemeyer  distinguishes :  1.  cases  of 
phthisis  dependent  upon  pneumonic  processes ;  2.  those 
of  phthisis  with  complicating  tuberculosis ;  and  3.  those 
of  primary  tuberculosis.  In  all  these  classes  there  is  in- 
creased frequency  of  respiration,  but  in  the  purely 
tuberculous  form  this  will  be  imaccompanied  by  dul- 
ness  on  percussion  and  bronchial  breathing.  The  dura- 
tion of  the  cough  and  catarrh,  whether  long  preceding 
the  fever  and  emaciation  or  from  the  first  associated 
with  them,  is  of  great  import,  the  former  pointing  to  a 
pneumonic  process,  the  latter  to  a  tuberculous.  The 
character  of  the  sputa  may  indicate  much;  and  a 
phthisical  patient  whose  expectoration  shows  extensive 
destruction  of  lung-tissue,  may  be  in  less  danger  than 
another  who,  feverish,  weak,  and  pale,  coughs  up  only 
tough,  transparent  mucus.  Fever  is  a  constant  symp- 
tom of  both  the  pneumonic  and  the  tuberculous  forms, 
and  the  thermometer  is  as  indispensable  a  guide  in  this 
as  in  other  febrile  affections.  In  the  pneumonic  forms 
the  remissions  are  more  marked  than  in  those  compli- 
cated with  tubercle  or  primarily  dependent  upon  it. 
Attention  to  the  character  of  the  fever,  in  conjunction 
with  the  physical  signs,  will  enable  us  to  determine 
whether  the  disease  is  pursuing  the  comparatively  ipno- 
cent  course  of  chronic  pneumonia  and  its  sequelae, 
whether  a  firesh  inflammatory  process  is  being  set  up, 
or  whether  the  very  grave  complication  of  true  tubercu- 
losis has  supervened.  Chiefly  to  the  fever  are  due  the 
impoverishment  of  the  blood  and  the  loss  of  flesh,  and 
the  knowledge  of  this  should  greatly  influence  our  treat- 
ment. 

The  treatment  can  be  much  more  understandingly 
and  hopefully  pursued  when  we  know  that  it  is,  in 
most  cases,  not  with  a  true  neoplasm,  but  with  pneu- 
monic processes,  that  we  have  to  contend.  Where 
genuine  tubercle  is  present,  the  case  is  hopeless,  and  wc 
can  only  aim  at  palliation.  Persons  with  a  tendency 
to  either  phthisis  or  scrofulosis  demand  the  best  hygienic 
conditions,  and  of  these  the  most  indispensable  is  plenty 
of  fresh  air.  To  secure  this,  residence  in  a  warm  cli- 
mate during  winter  may  be  advisable.  The  diet  must 
be  abundant  anl  nutritious,  and  rich  either  in  fat  or  in 
fat-producing  elements.  Among  these  the  malt  extracts 
may  well  replace  cod-liver  oil  where  that  is  found  nau- 
seous. Sweet  grapes  have  commonly  a  happy  eff*ect. 
The  patient  should  be  warmly  clad  in  flannel  At 
the  onset  of  an  acute  alveolar  catarrh^he  should  be 

digitized  by  VjOOQIC 


624 


THE  MEDICAL  RECORD. 


sent  to  bed,  avoid  superfluous  coughing  and  talking, 
have  his  chest  covered  with  poultices,  and,  if  pleuritic 
pains  persist,  have  leeches  or  cups  applied.  This  simple 
treatment  will  save  many  a  man  from  the  establishment 
of  a  confirmed  phthisical  affection;  and  will  often  sur- 
prisingly arrest,  in  chronic  cases,  an  exacerbation  of  the 
disease,  shown  by  increase  of  the  fever.  Should  these 
means  fail,  resort  may  be  had  to  antiphlogistics,  of 
which  a  favoiiie  with  the  author  is  a  pill  of  quiniee 
sulph.  (gr.  1),  digitaUs  (gr.  ss.),  and  ext.  opii  (gr.  one- 
quai  ter),  four  times  daily. 

Other  modes  of  treatment,  which  have  lately  been 
recommended  from  various  sources,  were  next  passed 
in  review;  nnd  the  paper  closad  with  an  account  of 
the  experiments  of  Lebert,  Wyss,  Yillemin,  and  others, 
upon  the  inoculation  of  tubercle  and  other  neoplastic 
and  inflammatory  matters  from  man  to  animals.  The 
first  positive  results  were  reported  by  Villemin,  who, 
in  a  communication  to  the  Paris  Academy  of  Medicine, 
December  4,  1865,  and  aojain  November  15,  1866,  gave 
his  op'nion  that  tubercle  is  inoculable  and  specific. 
But  the  greatest  value  attaches  to  the  experiments  of 
Lebert  and  Wyss,  which  are  the  most  numerous  (the 
details  of  forty-five  are  published),  and  bear  the  closest 
scrutiny.  The  summary  of  Lebert's  conclusions  is 
given  in  his  own  words :  "  Should  we  be  asked,  Have 
you  produced  genuine  tubercle  by  inoculation?  we 
should  answer  by  a  counter-question :  What  is  genuine 
tubterc!e  ?  what  have  we  inoculated  ?  where  will  you 
draw  the  line  of ,  demarcation  between  inflammatory 
product  and  tubercle,  as  it  appears,  aside  from  the 
lungs,  in  the  peritoneum,  pleura,  adventitia  of  arteries, 
blood-vessels  of  the  liver,  connective  tissue,  etc.  ?  With 
us,  inflammation  exercises  a  predominating  influence 
over  the  whole  doctrine  of  tuberculosis — a  kind  of 
inflammation  which  will  develop  itself  the  more 
rapidly,  the  poorer  and  less  favorable  we  find  the  gen- 
eral nutrition  of  the  body  and  its  tissues,  and  the 
greater  the  absorption  of  pathological  products  and 
de;?enerated  matter  which  has  taken  place  in  addition 
to  it.  The  gray  tubercle  neither  shows  a  specific  cell 
nor  even  does  it  belong  to  a  peculiar  type  of  cells,  and 
the  same  must  be  said  of  the  pathological  products  of 
our  experiments ;  by  which,  as  well  as  by  the  nature  of 
so-called  true  tubercle,  it  is  shown  that  they  stand  very 
near  to  the  inflammatory  processes — nay,  are  most 
likely  the  products  of  inflammation." 

The  paper  being  before  the  meeting  for  discussion, 

Dr.  Notes  remarked,  in  connection  with  the  pathol- 
ogy of  tuberculosis,  that  until  quite  recently  the  tissues 
of  the  eye  had  been  supposed  free  from  liability  to 
tubercular  deposit;  but  lately,  in  several  instances, 
miliarjr  tubercle  had  been  detected,  duiing  life,  in  the 
choroid — doubtless  in  the  walls  of  its  blood-vessels. 
Dr.  Delafield  had  a  specimen  from  the  dead-house  illus- 
trating this.  Dr.  Noyes  desired  to  hear  the  views  of 
Professor  Flint  upon  the  subject  of  the  paper. 

Dr.  Flint  was  not  prepared  for  an  elaborate  discus- 
sion of  the  subject,  but  would  touch  upon  a  few  points. 
While  we  should  receive  with  great  respect  the  opinions 
of  a  writer  so  justly  distinguished  as  Niemeyer,  yet  con- 
clusions so  radical,  tending  completely  to  overturn  the 
views  long  held  by  pathologists,  should  not  be  hastilv 
adopted.  Many  of  them,  indeed,  seem  in  conflict  witn 
clinical  experience.  Confining  the  term  tubercle  to  the 
miliary  form  alone,  and  considering  the  deposits  ordi- 
narily called  tuberculous  as  the  products  of  chronic 
pneumonia,  Niemeyer  attributes  this  chronic  pneumo- 
nia to  an  antecedent  bronchitis,  gradually  extending  to 
the  alveoli.  Now  nothing  is  more  common  than  to  see 
a  patient  rather  suddenly  developing  marked  evidence 
of  tubercle,  where  previous  observation  has  failed  to 


discover  any  sign  of  pulmonary  inflam«iiation.  Affain, 
nothing  can  be  more  certain  than  that  bronchitis  (as 
we  apply  the  term,  to  bilateral  inflammation  of  the 
bronchi)  has  no  tendency  to  eventuate  in  tubercle; 
and  moreover,  a  tuberculous  patient  contracting  bron- 
chitis experiences,  as  a  rule,  no  aggravation  of  the 
tuberculosis.  The  doctrine  that  hyperaimia  of  the 
lungs  is  a  frequent  cause  of  tubercle,  contradicts  cxpe^ 
rience.  In  mitral  lesions  the  njecnanical  conditions 
necessitate  such  hyperjemia,  yet  it  may  be  considered 
well  established  that  persons  with  these  lesions  are 
less  subject  than  others  to  pulmonary  tuberculosis. 

Dr.  Elsberq  felt  that  the  Society  was  indebted  to 
Dr.  Weber  for  presenting  the  views  of  Niemeyer; 
which  well  deserve  our  study,  as  being  almost  the  onljr 
attempt  to  establish  upon  a  scientific  basis,  of  both  clini- 
cal observation  and  post-mortem  examinations,  the 
doctrine  which  down  to  the  time  of  Laennec  had  been 
the  prevailing  one,  and  whose  strong  hold  upon  the 
popular  mind  was  still  to  be  seen.  The  recognized 
superiority  of  Laennec's  methods  of  diagnosis  had 
greatly  contributed  to  give  an  influence  to  his  patl)ol- 
ogy  of  which  we  could  hardly  divest  ourselves.  But 
its  inconsistencies  must  be  acknowledged  at  least  as 
great,  and  its  failure  to  meet  the  facts  of  clinical  expe- 
rience as  glaring,  as  could  be  charged  upon  the  theory 
of  Niemeyer;  while  its  uniformly  grave  prognosis  could 
not  but  affect  unfavorably  our  therapeutic  efforts. 

Dr.  Whiteuead  commented  at  some  length  upon 
various  means  of  treatment.  He  thought  that  the  use  of 
iron  and  sulphur  should  be  very  guarded,  as  likely  to  in- 
crease the  fever.  The  influence  of  climate  was  unde- 
niable, but  might  be  greatly  modified  by  hygienic 
measures.  Sea  voyages  were  in  general  more  harmful 
than  beneficial.  Muscular  inertia  must  be  regarded  as 
favoring  the  development  of  the  disease ;  hence  exercise 
was  an  important  prophylactic. 

Dr.  Herzoq  explained  what  he  deemed  a  misappre- 
hension of  some  of  Niemeyer*s  views ;  and  wished  to 
call  attention  to  the  illustration  they  had  received  fix>m 
the  labors  of  Professor  Buhl,  one  of  the  ablest  observers 
in  Europe.  Buhl's  conclusions  are,  that  although  miliary 
tubercle  is  to  be  distinguished  from  the  direct  results  of 
pulmonary  congestion  and  of  bronchitic  and  pneumonic 
processes,  yet  these  often  bear  a  causative  reUtion  to  it. 
The  inflammatory  exudation,  by  its  mechanical  press- 
ure, 80  interferes  with  the  nutrition  of  tlie  tissues  as  to 
give  rise  to  those  forms  of  degeneration  which  may  re- 
sult directly  in  phthisis  and  secondarily  in  the  produc- 
tion of  time  tubercle.  With  the  pulmonary  infiltration 
is  almost  uniformly  associated  a  similar  condition  of  the 
mesenteric  glands,  which  again  seems  to  have  its  influ- 
ence upon  the  development  of  tuberculosis.  Dr.  Uer- 
zog  spoke  of  the  impossibility  of  diagnosing  simple 
miliary  tubercle  by  the  physical  signs,  and  of  the 
importance,  in  this  regard,  of  attention  to  the  form  of 
the  accompanying  fever,  as  pointed  out  by  Niemeyer. 

An  animated  discussion  ensued  among  Drs.  Flint, 
Lusk,  Elsberg,  Herzog,  Weber,  and  Post*  in  the  course 
of  which  Dr.  Fldjt  remarked  that  while  Niemeyer  re- 
gards tubercle  as  resulting,  in  a  considerable  number  of 
cases,  from  the  irritation  of  coSgulalett  after  haemoptysis, 
experience  has  conclusively  established  that  those  cases 
of  phthisis  attended  by  haemoptysis  are  the  ones  which 
generally  pursue  the  most  favorable  course. — Dr.  Poot 
strongly  endorsed  this  view,  and  related  the  case  of  a 
patient  who  had  been  subject  to  frequent  and  profuse 
haemorrhages  for  thirty  years. — Dr.  Lusk  understood 
Niemeyer  that  haemoptysis  mijrht  cause  phthisis,  which 
was  amenable  to  treatment,  but  not  true  tubercle. — Dr. 
Herzoo  and  Dr.  Weber  explained  that  it  was  active 
haemorrhage,  from  excitement,  exertion,  etc.,  which,  oo- 


THE  MEDICAL  RECORD. 


625 


currin:^  in  a  lung  previously  considered  sound,  might,  by 
the  direct  irritation  of  the  coagula  as  foreign  bodies, 
give  rise  to  abscess  or  chronic  pneumonia ;  and  these  to 
phthisis.  Dr.  Herzoo  could  understand  how  haemor- 
rhage occurring  in  the  course  of  the  disease,  from  the 
breaking  down  of  the  infiltrated  tissues,  might,  by  re- 
lieving the  vessels  from  pressure,  so  affect  the  circulation 
as  to  cause  improvement  in  the  patient's  condition.  But 
he  thought  it  might  lead  to  results  either  immediately 
fatal,  or  remotely  so  from  the  formation  of  abscesses,  etc. 

Dr.  Elsberq  desired  Dr.  Flint's  views  upon  the  doc- 
trine of  the  specific  nature  of  tubercle,  as  propounded 
by  La§nnec,  and  still  generally  accepted. 

Dr.  Flint  replied  that  some  of  La6nnec*s  ideas  were 
exploded,  as  that "  crude  "  tubercle  (miliary  granulations) 
always  precedes  and  constitutes  the  "  seeds  "  of  tuber- 
cle as  commonly  understood.  But  on  the  point  in  ques- 
tion he  must  incline  to  the  affirmative  Fide.  We  have 
here  a  disease  of  aspeciBc  character,  and  doubtless  depen- 
dent upon  a  specific  diathesis ;  differing  widely  from  acute 
pneumonia  in  its  manifestations,  aud  in  many  respects 
also  from  chronic  pneumonia.  Acute  pneumonia  com- 
monly attacks  the  lower  lobes  of  the  lungs,  tubercle 
the  apices ;  pneumonia,  both  acute  and  chronic,  is  com- 
monly unilateral,  tubercle  bilateral  The  formation  of 
abscesses  in  tuberculosis  is  exceedingly  rare. 


Stated  Reunion,  Friday,  December  13, 1867. 
Dr.  a.  C.  Post  in  the  Chair. 

A   NEW   INSTRUMENT  FOR  ARTERIAL   COMPRESSION. 

Dr.  Van  Gibson  read  a  paper  entitled,  "A  New 
Method  of  Arterial  Compression  by  Means  of  a  Section- 
al Ligature.*'  After  a  resum^  of  the  more  recent  modes 
employed  for  the  complete  or  partial  occlusion  of  arteries, 
he  described  an  invention  of  his  own,  designed  to  effect 
either  of  these  objects,  and  applicable  more  particularly 
to  arteries  in  their  continuity,  as  in  the  treatment  of 
aneurism.  The  apparatus,  as  exhibited,  consists  of  two 
small  silver  tubes,  each  having  a  shoulder  near  one  end, 
and  a  slight  curve  at  the  other.  The  size  of  the  curve 
should  correspond  with  that  of  the  artery  to  be  oper- 
ated upon,  80  that  when  the  two  curved  extremities  are 
passed  down  upon  opposite  sides  of  the  vessel,  they 
may  together  embrace  it  below.  A  piece  of  wire  and  a 
wedge  of  cork  complete  the  instrument.  To  apply  it, 
the  artery  having  been  exposed  and  the  wire  passed  be- 
neath it  by  an  aneurism  needle,  a  tube  is  slipped  over 
either  end  of  the  wire,  until  the  two  curved  ends  meet 
beneath  the  artery  ;  the  opposite  ends,  remaining  out- 
side the  wound,  are  then  approximated  until  the  desired 
degree  of  compression  is  attained,  when  they  are  fixed 
in  position  by  placing  the  wedge  between  them,  and 
winding  the  free  extremities  of  the  wire  around  the 
shoulders.  The  apparatus  is  made  immovable  by  adhe- 
sive strips,  or  by  a  strep  fastened  about  the  limb,  and 
provided  with  a  clamp  for  the  purpose.  In  place  of  the 
cork  wedge,  the  doctor  proposed  to  graduate  the  press- 
ure by  means  of  a  spiral  spring  and  a  screw.  The  wire 
does  not  touch  the  artery  after  the  tubes  are  applied, 
and  in  removal  it  may  be  drawn  out  while  the  tubes  are 
held  in  situ,  to  avoid  tLe  chance  of  laceration.  The  in- 
Tentor  claimed  for  his  instrument  facility  of  application 
and  removal,  and  ease  of  graduating  the  compression. 
He  gave  the  details  of  two  experiments  with  it,  and 
desired  to  see  it  further  tested. 

Dr.  Wm.  B.  Lewis  next  read  a  carefully  condensed 
resum^  of  what  has  lately  appeared  in  medical  literature 
upon  "  The  Pathology  of  the  Urinary  Organs,  and  of 
their  Secretion."  Some  discussion  followed  upon  the 
propriety  of  incising  or  puncturing  the  integument,  for 


the  relief  of  anasarca  in  Bright's  disease.  Dr.  Van 
Grieson  related  a  case  of  incision,  resulting  in  severe 
erysipelas.  Dr.  Sayre  was  always  accustomed  to  make 
numerous  small  punctures  with  a  tenotome,  which 
rapidly  drained  away  the  fluid,  and  rarely,  if  ever,  gave 
rise  to  erysipelas. 


NEW  YORK  PATHOLOGICiVL  SOCIETY. 

Stated  Meeting^  Nov.  27,  1867. 
Dr.  B.  H.  Sands,  President,  in  the  Chair. 

VALUABLE   EXPERIMENTS   ON   LIGATION    OF  ARTERIES. 

De.  Ben  J.  Howard  presented  a  series  of  specimens, 
stating,  that  as  he  had  six  recent  cases  to  exhibit,  he 
would  in  description  confine  h'mself  to  the  chief  points 
in  the  respective  cases,  and  would  endeavor  to  avoid  a 
repetition  of  anything  expressed  upon  the  same  subject 
upon  a  previous  occasion. 

The  history  of  the  first  specimen  I  present,  marked 
No.  5,  is  as  follows : — Desirous  of  observing  the  re- 
sult of  a  simple  apposition  of  the  internal  coats  of  an 
artery.  I  prepared  a  band  of  lead,  about  a  h'ne  in  width, 
smootned  all  sharp  edges,  and  polished  it  brightly ; 
its  length  was  such  that  when  doubled  upon  itself,  it 
suflBciently  exceeded  the  diameter  of  the  arlery  as  to 
allow  of  its  being  passed  around  the  vessel,  and  the 
two  ends  clamped  together,  without  any  mechanical  in- 
jury to  the  coats  of  the  vessel  I  apphed  this  Hgature 
in  the  manner  described,  to  the  rignt  common  carotid 
artery  of  a  sheep,  on  the  17th  of  October.  On  the  23d 
of  November,  being  thirty-seven  days  after  the  opera- 
tion, I  made  an  incision  in  the  line  of  the  cicatrix,  which 
was  well  healed,  when  I  found  close  beneath  the  sur- 
face, the  ligature  in  a  state  of  dryness,  and  waiting  to 
drop  from  the  cicatrix.  The  deposit  of  fibrine  is  seen  to 
have  been  quite  extensive,  forming  a  solid  mass  from  the 
artery  to  the  integument  Through  the  whole  extent  of 
this  will  be  observed  a  sinus  communicating  with  the 
place  where  the  ligature  was  found,  and  the  point  cf  its 
application. 

The  longitudinal  section  of  the  artery  shows  that  the 
occlusion  of  the  artery  by  fibrine  at  the  point  of  ligation, 
and  by  a  well-formed  plug  above  and  below  it,  is  perfect. 
The  hgature  appears  to  contain  in  its  embrace,  the  part 
of  the  artery  it  was  made  to  include. 

No.  6. — October  17.  I  applied  to  the  right  common 
carotid  of  another  sheep  a  lead-wire  ligature,  tying  it 
loosely,  diminishing  calibre  about  two-thirds.  Novem- 
ber 22d,  being  thirty-six  days  after,  I  found  this  cicatiix 
healed,  but  at  about  its  middle  a  small  fluctuating  tumor. 
On  making  an  incision  through  it  along  the  line  of  cica- 
trix, the  tumor  was  found  to  contain  about  a  drachm  of 
very  thick  pus,  in  which  I  found  the  ligature.  The  deposit 
of  fibrine  will  be  seen  to  be  greater  in  this  than  in  the  last 
specimen;  and  through  its  whole  extent,  from  its  point 
of  application  to  the  abscess,  the  ligature  had  ulcerated 
its  way.  It  is  very  interesting  to  observe  the  plug  of 
fibrine  which  is  clearly  shown  in  situ,  by  which  the 
whole  rear  track  of  the  ligature  has  been  closed  up  as 
it  advanced  toward  the  integument. 

The  longitudinal  section  shows,  as  do  others,  that  at 
the  point  of  ligation,  for  the  portion  of  artery  destroyed 
by  tne  ligature,  is  substituted  a  solid  mass  of  fibrine,  and 
that  the  artery  is  thus  perfectly  occluded,  as  well  as  by 
a  clot  above  and  below. 

No.  10. — October  31.  To  the  right  carotid  of  a  sheep 
I  applied  a  flat  silk  ligature  outside  its  sheath,  diminish- 
ing the  calibre  of  the  artery  barely  one-hal£  Novem- 
ber 23d,  being  twenty-three  days  after,  I  found  the  cic- 
atrix soundly  healed,  the  fibrous  deposit  smaller  than 


526 


THE  MEDICAL  RECORD. 


in  either  of  the  two  preceding  eases ;  and  you  will  ob- 
serve that  the  longitudinal  section  of  the  artery  reveals 
the  sanrie  dense  fibrine  substituted  for  the  canal  of  the 
artery  at  the  point  of  Ugation. 

There  is  no  sinus  or  trace  of  the  ligature  visible  in 
this  specimen,  as  there  was  in  the  other  ca^es.  But  we 
know  it  did  escape,  because  it  was  found  outside  the 
wound,  the  free  end  having  been  fastened  there  at  the 
time  of  ligation. 

No.  7. — My  object  in  the  case  now  before  us,  was  to 
observe  the  effect  upon  an  artery  of  a  simple  cessation  of 
function.  Accordingly,  October  31st,  I  applied  three 
silver- wire  ligatures,  the  second  being  about  twelve  lines 
above  the  first,  and  the  third  about  four  lines  above  the 
second. 

The  first  was  tied  with  little  less  than  the  average 
tightness  commonly  used  in  the  silk  ligature;  the 
second  broke  close  to  the  loop,  so  that  I  had  but 
to  cut  off  the  free  end;  the  third  I  tied  with  firm- 
ness, but  with  more  caution,  to  avoid  repetition  of  the 
accident  incident  to  the  second  ;  twenty-two  days  after 
I  vivisected  this  specimen,  the  cicatrix  was  not  firm, 
and  the  hsemorrhage  was  great.  It  will  be  seen  that 
the  calibre  of  the  arterial  canal,  between  the  ligatures, 
is  very  much  diminished,  and  is  occupied  toward  its 
centre  by  what  appears  to  be  an  organized  clot,  which, 
as  we  approach  the  points  of  ligation  on  either  hand, 
becomes  a  firm  plug  of  fibrine. 

The  history  of  the  disused  artery  is,  however,  of  but 
small  importance,  compared  with  that  of  the  ligatures 
as  here  observed. 

The  first  ligature  cannot  be  found.  The  second  is 
also  wanting ;  and  from  the  original  site  of  each  through- 
out the  fibrinous  mass,  toward  the  cicatrix,  you  will 
observe  an  open  sinus  through  which  they  have  been 
discharged.  The  third  Ugature,  applied  with  less  force, 
will  be  seen  lying  loosely  withm  the  artery  at  the 
internal  end  of  the  upper  sinus,  apparently  waiting  to  be 
extruded.  The  occlusion  about  each  ligated  point  is 
coniplete. 

No.  9. — This  is  the  right  carotid  of  a  sheep  which  I 
ligated  October  31.  The  ligature  was  of  silver  wire, 
the  same  as  that  used  in  the  last  specimen  exhibited. 
I  lied  it  by  a  single  flat  knot,  and  cut  off  the  ends 
closely.  I  applied  it  outside  the  sheath,  tying  loosely, 
and  diminisliing  the  calibre  of  the  artery  about  half  or 
two-thirds. 

November  23d,being  twenty-three  days  after  the  oper- 
ation, I  found  the  cicatrix  quite  sound.  The  vivisection 
was  accompanied  with  very  little  hsemorrhage,  and 
here  is  the  specimen.  There  is  but  little  deposition 
of  fibrine,  and  a  longitudinal  section  of  the  artery  re- 
veals the  ligature  in  situ,  as  applied;  the  looseness  of 
its  application  being  manifest  by  the  size  of  the  piece 
of  whalebone  passed  through  its  loop.  It  will  be  seen 
there  is  no  sign  of  suppuration  or  sloughing,  but  only 
^he  deposition  of  fibrine  for  the  envelopment  of  the 
ligature,  and  that  due  to  inflammation  following  the 
laceration  of  the  areolar  tissue  in  the  performance  of  the 
operation. 

Here  is  a  specimen  exhibiting  the  difference  between 
the  effect  of  the  "  surgeon's  "  or  flat  knot  and  the  ordi- 
nary knot,  upon  the  internal  and  middle  coats. 

In  neither  case  are  the  divided  edges  of  the  inner 
coats  in  apposition ;  in  the  former  case  you  will  observe, 
by  means  of  the  lens  which  I  will  pass  around  with  it, 
that  the  divided  ends  are  curled  upward,  their  flat  sur- 
faces forming  a  plane  representing  the  diameter  of  the 
artery,  at  right  angles  with  its  long  axis ;  they  are  there- 
fore not  in  apposition  with  each  other,  but  only  in 
Juxtaposition. 

The  ordinary  round  knot,  you  will  see,  has  produced  a 


puckering  and  partial  laceration  of  the  inner  coat?,  the 
plications  terminating  like  radii  in  the  centre  of  the 
transverse  section  exhibited. 

The  specimens  presented  exhibit  in  each  case  where  a 
loose  ligature  has  been  used,  whether  of  silver^  lead^  or 
siUcj  perfect  occlusion  of  the  arterial  canal. 

When  the  loose  ligature  has  consisted  of  lead  or  ofsUk, 
ulceration  and  suppuration  have  occurred^  with  exti^sion 
of  the  ligature  toward  the  surface. 

Equally  with  other  specimens  previously  presented, 
these  exhibit  that  every  tight  ligature  of  either  Jeind^  and 
every  loose  ligature  except  the  silver,  has  been  extruded  ; 
but  the  "  loose  silver  ligature  "  is  followed  by  obliteration, 
fibrinous  and  extensive,  with  exemption  from  sloughing, 
from  suppuration,  and  from  extrusion  of  ligature  com^ 
mon  to  every  case  of  other  lands  exhibited. 

Here  are  the  facts,  as  far  as  they  go.  The  theory  which 
after  a  sufficient  accumulation  may  be  woven  out  of  them, 
may  be  worthy  the  consideration  of  the  Society.  As  to 
the  causes  of  the  differences  in  the  results,  I  may  be  al- 
lowed to  suggest  that  the  questions  in  order  might  be : 

Ist.  The  ligature. — What  relation  exists  between  the 
different  qualities  of  the  different  ligatures,  and  the  dif- 
ference in  the  results  exhibited  respectively? 

2d.  Looseness. — ^In  the  absence  of  sudden  lesion  of 
the  artery,  and  of  sudden  complete  strangulation  of  the 
vasa  vasorum,  are  not  the  parts  better  able  to  perform 
the  new  task  suggested  and  assigned  to  them  ?         ^ 

Is  not  the  operation,  the  shock,  the  local  and  general 
disturbance  more  moderate,  than  in  the  case  of  a  tight 
ligature  ? 

Is  not  the  gradual  accommodation  of  the  collateral 
braachts  to  the  demand  instituted  on  the  application  of 
a  loose  ligature,  sufficient  to  account  for  the  absence  of 
the  great  oozing  common  only  to  all  the  vivisections 
made  in  the  region  of  a  recent  tight  ligation  ? 

POST-HORTEM   BIGESTION  OF  THE  STOMACH,  ETC. 

Dr.  Lewis  Smith  presented  specimens  of  stomach,  and 
remarked  upon  them  as  follows:  At  a  recent  meeting 
of  this  Society,  I  presented  a  lung  which  seemed 
to  be  gangrenous.  The  patient  from  whom  it  was 
taken  was  a  foundling,  who  died  at  about  the  age  of 
one  month.  It  will  be  recollected  that  the  poste- 
rior part  of  esfch  lung  in  this  specimen  presented  a 
dark  gray  color,  and  was  very  much  softened.  The 
finger  readily  penetrated  it,  and  in  pkices  the  lung  was 
so  decomposed  as  to  be  almost  diffluent.  Other  portions 
of  the  lungs  and  the  other  viscera  had  undergone  no 
perceptible  alteration.  I  was  not  present  at  the  post- 
mortem examination  in  this  case,  but  Dr.  Gk)uiniock, 
of  the  house  staff  of  Charity  Hospital,  who  made  the 
post-mortem  examination,  states  that  it  was  made  about 
twelve  hours  after  death. 

I  present,  this  evening,  two  other  specimens,  one 
which  I  have  preserved  since  the  commencement  of  the 
year,  the  other  obtained  at  a  recent  post-mortem  exam- 
ination. The  infants  from  whom  these  lungs  were 
taken,  were  also  foundlings,  dying  when  a  few  months 
ol(L  in  a  state  of  exhaustion. 

I  have,  from  time  to  time,  met  with  such  specimens, 
probably  as  many  as  ten,  in  the  course  of  six  or  eight 
years.  I  had  been  led  to  regard  these  lungs  as  proba- 
bly gangrenous,  chiefly  by  exclusion;  for  I  could  not 
see  what  el^  the  state  could  be.  At  the  close  of  the 
meeting  referred  to,  however,  a  gentleman  not  a  mem- 
ber of  the  Society,  a  foreigner^  suggested  that  what  re- 
sembled so  closely  gangrene  m  its  gross  appearance, 
might  be  the  result  of  post-mortem  digestion.  I  was 
sure  that  there  had  been  no  escape  of  the  gastric  juice 
directly  into  the  pleural  cavity,  but  the  explanation 
offered  was  that  it  passed  up  the  oesophagus  and  down 


THE  MEDICAL  RECORD. 


527 


the  trachea  and  bronchial  tubes  to  the  lungs,  by  the 
movements  to  which  the  body  was  subjected  in  carry- 
ing it  to  the  dead-house. 

The  reasons  for  believing  these  lungs  gangrenous  are 
mainly  those  afibrded  by  the  appearance.  Rilliet  and 
Barthez,  who  have  wiitten  exhaustively  on  this  disease, 
state  that  in  nearly  all  cases  which  they  have  met,  the 
patients  were  exhausted  by  previous  disease.  The  gan- 
grene was  secondary.  As  regards  the  etiology,  there- 
fore, these  cases  would  correspond  with  those  observed 
by  Rilliet  and  Barthez,  for  these  foundlings  were  in  a 
reduced  state. 

On  the  other  hand,  as  reasons  for  considering  these 
lungs  not  gangrenous,  may  be  stated  the  fact,  that  they 
did  not  have  the  fetid  odor,  nor  was  the  breatn  of  these 
children  fetid.  The  authors,  however,  from  whom  I 
have  quoted,  state  that  fetor  of  breath  is  not  usually 
present  in  cases  of  gangrene  of  the  lung  in  children. 
They  observed  it  in  only  five  cases  in  sixteen,  and  in 
only  three  was  it  marked  (tres  fitide).  It  would  seem, 
also,  that  the  lungs  which  I  have  presented  could  not 
be  gangrenous,  since  it  is  improbable  that  I  could  meet 
as  many  as  ten  specimens  of  gangrene  in  six  or  eight 
years,  and  all  under  the  age  of  one  year,  when  Rilliet 
and  Barthez  only  observed  sixteen,  ^l  over  the  age  of 
two  and  a  half  years.  Again,  the  affected  portions  were 
not  surrounded  by  solidiQed  or  inflamed  tissue,  as  they 
ordinarily  are  in  gangrene. 

In  order  to  determine  what  the  effect  of  the  gastric 
juice  would  be  on  the  lungs,  I  removed  the  stomach  and 
its  contents  from  an  infant  about  twelve  hours  after 
death,  and  placed  it  in  one  of  the  pleural  cavities.  It 
was  opened  so  as  to  allow  a  more  ready  escape  of  the 
gastric  juice.  The  stomach,  with  its  contents,  was  also 
added  Irom  another  child,  and  incisions  were  made  in 
the  lung,  so  as  to  facilitate  the  action  of  the  gastric 
juice.  After  twenty-four  hours  the  lung  was  examined, 
and  the  result  was  negative.  There  was  only  a  slight 
yellowish  staining  of  the  lung.  Dr.  Gouinlock,  of  the 
house  staff  of  Charity  Hospital,  repeated  the  experi- 
ment, with  also  a  negative  result. 

While  these  experiments  were  being  made,  we  exam- 
ined the  body  of  an  infant  who  died  of  entero-colitis, 
at  the  age  of  about  six  months.  The  evidences  of  inflam- 
mation of  the  colon  were  very  decided.  The  coats  of 
the  stomach  were  softened  throughout  their  whole  ex- 
tent, so  as  to  be  easily  torn,  but  were  not  perforated, 
although  the  mucous  membrane  seemed  to  be  almost 
wholly  dissolved,  so  as  to  present  a  gelatinous  appear- 
ance. The  stomach  had  a  brown  color,  and  was  per- 
haps half  filled  with  contents  of  the  usual  appearance. 
The  surface  of  the  left  lobe  of  the  liver  adjacent  to  the 
stomach  presented  the  same  brown  color,  which  was 
Superficial,  as  did  also  the  part  of  the  diaphragm  which 
lies  over  the  stomach,  and  also  the  surface  of  the  left 
lung  contiguous  to  the  diaphragm.  This  part  of  the 
diaphragm  was  also  softened  On  opening  Ine  cesopha- 
^8,  it  was  found  of  a  brownish  or  leaden  color,  from 
the  cardiac  orifice  to  the  distance  up  the  tube  of  about 
two  and  a  half  inches.  There  were  several  small 
ulcers,  apparently  involving  only  the  mucous  membrane 
in  thU  part  of  the  oesophagus,  while  the  upper  portion 
of  this  tube  was  healthy.  On  one  side,  all  the  coats  of 
the  oesophagus  presented  the  same  appearance,  and 
seemed  somewhat  softened,  but  without  perforation, 
and  the  surface  of  the  lung,  which  lay  against  the 
oesophagus,  was  also  browned,  and  apparently  eroded 
to  the  depth  of  one  or  two  lines.  There  had  evidently 
been  a  transudation  of  liquid  through  the  coats  of  the 
oesophagus,  as  well  as  those  of  the  stomach. 

The  color  of  the  lung  produced  by  the  transudation 
yras  somewhat  like  that  of  the  specimens  which  I  have 


presented,  but  not  so  dark.  These  observations  evi- 
dently do  not  indicate  positively  the  nature  of  the 
change  presented  by  the  lungs  which  I  have  presented. 
The  negative  result  of  the  experiments  proves  nothing, 
because  we  know  that  post-mortem  digestion  does 
sometimes  destroy  tissues.  I  have  myself  seen  the 
oesophagus  severed  from  the  stomach,  by  this  digestion, 
in  the  child,  and  some  time  ago  a  specimen  was  pre- 
sented to  the  London  Pathological  Society,  in  which 
the  gastric  iiiice  had  perforated  the  oesophagus,  and 
had  made  a  hole  in  the  left  lung.  There  are,  so  far  as 
I  can  see,  but  three  modes  of  explanation  of  the  ap- 
pearances which  these  limgs  present,  namely,  by  sup- 
posing that  the  affected  portions  are  gangrenous,  or 
that  they  have  undergone  post-mortem  cUgestion  or 
ordinary  post-mortem  decomposition.  The  arguments 
against  either  explanation  are  strong.  Those  in  refer- 
ence to  the  first  two  I  have  sufficiently  alluded  to. 
The  arguments  against  the  last  explanation,  that  of  post- 
mortem decomposition,  are  the  short  time  after  death 
(in  one  case  about  twelve  hours)  at  which  the  autop- 
sies were  made,  absence  of  putrid  odor,  absence  of  any 
evidences  of  decomposition  in  other  portions  of  the 
lungs  and  in  the  other  tissues.  For  these  reasons  I 
think  that  the  Society  will  agree  that  these  specimens 
are  somewhat  remarkable,  and  that  we  do  not  yet 
know  certainly  their  character. 


Corrc«iM>nlrjencje. 


MUSIC  IN  CHOREA. 

To  TiTB  Editor  of  tux  Mxdical  Bxcobd. 

Sir — In  your  issue  of  December  2d,  I  noticed  an 
extract  taken  from  the  British  Mediccd  Journal  on  the 
"  Effects  of  Music  on  the  Insane." 

It  reminds  me  of  a  case  of  Chorea  which  came  under 
my  care  several  years  ago.  It  was  a  very  interesting 
case,  notes  of  which  were  taken  with  a  view  to  their 
publication  at  some  convenient  time ;  but  they  have  been 
mislaid,  and  I  must  depend  solely  on  memory  for  the 
description.  As  it  appears  to  me,  it  corroborates  in  a 
measure  the  theories  expressed  in  the  extract  alluded 
to ;  and  opposes,  as  far  as  a  single  case  can,  the  views 
of  many  modem  pathologists,  that  Chorea  is  intimately 
associated  with,  or  allied  to  rheumatism,  hence,  prim- 
arily, a  blood  disease. 

The  case  occurred  in  1862.  The  subject,  a  young  lady 
about  seventeen  years  of  age,  of  ordinary  parentage, 
intelligent,  with  a  florid  complexion,  of  medium  stature, 
form  plump  and  rounded,  previously  healthy,  with  the 
exception  that  about  two  years  previous  she  had  Cho- 
rea of  ordinary  peverity,  which  was  treated  successfully 
with  Fowler's  Solution.    A  short  time  anterior  to  the 
1  present  attack,  I  prescribed  Fowler  s  Solution  for  a 
I  slight  eczema,  and  this  she  was  taking  when  she  began 
to  notice  slight  involuntary  movements  of  one  arm. 
This  fact  was  taken  as  fair  evidence  that,  as  this  remedy 
appeared  to  excercise  no  power  as  a  preventive,  it 
promised  little  or  nothing  as  a  specific,  which  by  many 
I  it  is  believed  to  be ;  therefore,  as  the  case  continued  to 
I  grow  worse,   the  arsenic  was  discontinued,  and  she 
was  advised  to  use  sulphate  of  zinc,  as  ordinarily  pre- 
!  scribed  for  Chorea.    No  amefioration  followed ;  on  the 
'  contrary,  the  convulsive  movementa  steadily  increased. 
Cohosh,  or  black  snake-root,  as  recommended  by  Prof. 
Wood  in  his  Practice  of  Medicine,  was  oruered,  the  zinc 
remedy  to  be  continued;  still  the  symptoms  steadily 
and  rapidly  increased  in  severity,  and  the  convulsive 
action  became  so  general  that  apparently  every  volun- 
tary muscle  of  the  whole  body  was  involved. 


528 


THE  MEDICAL  RECORD. 


Such  a  case  I  never  saw,  so  violently  was  she  thrown 
about  from  one  part  of  the  bed  to  another.  To  sit  or 
stand  was  utterly  impossible.  Even  her  bed  was  faith- 
fully guarded  to  prevent  her  being  precipitated  to  the 
floor.  One  remedy  after  another  was  resorted  to  until 
tonics,  antispasmodics,  anodynes,  stimulants,  eta,  were 
exhausted.  Still  the  scene  was  unchang^ed,  only  that 
the  uicture  was  more  and  more  horrible.  No  remissions 
for  sleep ;  no  repose  whatever.  Scarcely  was  there  a 
moment's  respite  to  receive  food.  Tongue  sore  firom  be- 
ing frequently  caught  between  the  teeth,  flesh  wasting, 
Umbs  discolored  and  swollen  by  repeated  bruises,  ex- 
haustion advancing  rapidly.  Days  passed  away — as 
many  as  ten  or  twelve — and  all  the  while  she  was  com- 
pletely conscious  of  her  anguish. 

An  officious  neighbor,  as  the  case  began  to  assume  a 
threatening  aspect,  suggested  a  trial  of  musie.  The 
suggestion  was,  however,  dismissed  with  scarcely  a  fa- 
vorable thought.  After  a  few  days,  the  remedy  was 
again  proposed,  and  by  this  time  I  had  learned  that  the 
notion  was  quite  prevalent  in  the  neighborhood  that 
music  was  a  valuable  agent  in  the  treatment  of  St. 
Vitus'  dance.  I  remarked  that  it  was  undoubtedly 
worthless,  and  especially  so  in  a  case  of  such  severity, 
and  supp<>sed  it  was  again  dismissed.  At  my  next  visit 
on  the  morning  following,  to  my  utter  astonishment,  I 
found  a  violinist  and  his  instrument  "on  hand,"  and  my 
patient  decidedly  more  quiet!  He  was  invited,  it  ap- 
peared, the  evening  previous,  and  taking  an  adjoining 
room,  he  played  at  intervals  some  piece  of  plaintive 
music,  the  effect  of  which,  as  it  was  described  by  the 
attendants,  was  truly  marvellous.  She  slept  a  little  before 
morning,  and  to  abbreviate  the  recital,  the  cure  was 
rapid  and  complete. 

In  conclusion,  allow  me  to  remark  that  I  have 
searched  my  limited  library,  and  find  no  allusion  to 
music  as  a  remedy  in  Chorea: — that  is,  a  remedy,  per  se, 
R^camier,  at  the  H6pital  des  Enfans  Malades,  at  Paris, 
has  long  practised  systematic  movements  of  the  affected 
muscles,  sometimes  accompanied  with  music. 

Crescent,  N.  Y.,  Dec.  18«7.  Sam'l  Peters,  M.D. 

TO  WHOM   DOES   THE  PRESCRIPTION 
OF  A  PHYSICIAN  BELONG? 

To  TUB  Editob  op  thx  Medical  Rbcobd. 
Thebb  seems  to  me  to  be  a  risk  of  so  great  a  fallacy  in 
your  position  in  regard  to  this  inquiry,  that  with  the 
greatest  desire  to  attend  to  my  own  business,  and  above 
all  to  avoid  controversy,  I  must  beg  of  you  to  go  over 
the  ground  afresh,  and  seek  for  more  information  on  the 
subject  before  considering  it  definitely  settled.  It  is  an 
important  subject*  and  one  which  threatens  to  widen 
the  breach  between  medicine  and  pharmacy ;  and  that 
interest  will  be  most  damaged  which  obtains  judgment 
in  its  favor  on  insufficient  grounds.  In  a  discussion  now 
of  some  years'  standing,  legal  opinions  have  been  pretty 
freely  quoted  on  both  sides,  with  the  efi*ect  upon  some 
of  us,  at  least,  of  leading  to  the  inference  that  such 
opinions  must  differ  as  much  in  value  as  in  the  position 
taken.  Therefore,  lest  some  of  us  should  fall  into  a 
grave  error  which  may  do  much  harm  in  a  direction 
where  mistakes  are  not  easily  corrected,  let  me  beg  of 
you  to  suspend  judgment  until  the  subject  is  more 
thoroughly  examiued  on  all  sides. 

By  the  action  of  a  neighboring  medical  society,  the 
subject  is  now  before  the  American  Pharmaceutical 
Association,  a  body  which,  fi*om  its  interest  in  the 
matter,  is  entitled  to  a  hearing,  and  the  undersigned 
proposes  presenting  his  views  on  the  subject  to  the  New 
York  State  Medici  Society,  at  its  approaching  annual 
session.    Very  respectfully  yours,  KiR.  Squibb. 


SSitVxttii  Jtcma  anl^  tletoa. 


New  York  Pathological  Society. — ^The  foUowing- 
officers  have  been  elected  for  ihe  ensuing  year :  Presi- 
dent, Dr.  W.  B.  Bibbins;  Vice-Presidents,  Drs.  T.  M. 
Markoe  and  L.  A.  Sayre  •  Secretary,  Dr.  Geo.  F.  Shrady ; 
Trea8urer,Dr.  W.  B.  Biboins. —  Committee  on  Admissions^ 
Drs.  Weir,  Whitehead,  Rogers,  Krakowizer,  and  Shrady. 
Committee  of  PubUcatwn^  Drs.  Shrady,  Eliot  and  Rogers. 

CESAREAN  Section. — ^We  have  received  from  Dr. 
Dibble  of  New  Haven  a  report  of  a  successful  case  of 
Cesarean  Section  performed  by  Dr.  Townsend  of  that 
city.    We  shall  publish  the  details  at  an  early  date. 

The  Missouri  Medical  Association  was  duly  resusci- 
tated on  the  12  th  of  December,  after  a  long  sleep  of  ten 
years,  and  has  inaugurated  some  wise  measures  relating 
to  the  future  prosperity  of  medicine  in  the  State.  A 
communication  from  the  St.  Louis  Medical  Society,  ask- 
ing of  the  Legislature  a  Board  of  Medical  Examiners  to 
be  appointed  by  the  Missouri  Association,  with  power  to 
grant  licenses,  was  adopted^  and  a  committee  appointed 
to  prepare  a  suitable  memorial.  They  also  endorsed  most 
emphatically  the  stand  taken  in  the  matter  of  medical 
education  by  the  recent  Convention  of  Medical  Teachers. 

Banquet  of  the  International  Medical  Congress. — 
The  day  of  the  banquet  had  been  intentionally  set  for 
about  the  middle  of  the  sitting  of  Congress,  in  order 
that  it  might  serve  as  an  interlude,  and  at  the  same 
time  bring  together  a  large  number  of  convivials.  So 
of  the  two  hundred  subscribers  not  one  failed  to  be 
present 

The  magnificent  hall  of  the  Grand-Hotel  did  not  ap- 
pear too  large  for  the  four  or  five  long  tables  stretched 
out  side  by  side.  As  seats  were  not  taken  until  half- 
past  eight,  there  was  ample  time  in  the  waiting-saloon 
for  each  one  to  get  acquainted ;  this  was  very  desirable, 
inasmuch  as  the  hall  of  the  Congress  was  not  favorable 
for  meetings,  or  for  presentations  or  hand-shaking.  M. 
Frerichs,  fluttering  with  ribbons  and  decorations,  and 
elegant  in  manners ;  and  M.  Virchow,  in  a  solid  suit  of 
black,  very  drv,  with  a  false  collar  cutting  his  ears,  were 
the  objects  of  Fpecial  curiosity.  The  dinner  was  ani- 
mated, brilliant,  Uvely ;  men  jovial  in  certain  quarters 
(on  M.  Ricord's  side,  it  was  said).  The  celebrated 
syphiloCTapher  was  seated  to  the  left  of  the  president, 
and  M.  Virchow  to  the  right.  With  the  dessert  came 
the  toasts.  M.  BouiUaud,  the  president,  opened ;  then 
followed  others^  Among  them  M.  Ricord  drank  to  the 
extinction  of  venereal  diseases,  and  the  suppression  of 
that  specialty.— G^aafctte  Hebdom.^  Aug.  30,  1867. 

Ueto   |)ubUcatiatt0. 

Books  and  Pamphlets  Received. 

On  the   Pathoix)gy  and  Treatment  op  Albuminuria. 

By  William  H.  Dicehnson,  M.D.  Cantab.   8va,  pp.  265. 

London :  Longman,  Qreen  k,  Oo. 
Pennsylvania  Hospital  Reports.    Vol.  1.  186a  Phila. : 

Lindsay  k  Blakiston. 
Plastics  :  a  New  CLAssinoATiON  and  a  brief  Exposhion 

OP  Plastio  Sukgbbt.    By  David  Prince,  M.D.,  Phila. : 

Liodsay  k  Blakiston.     1868. 
Diseases  op  the  Heart,  their  Diagnosis  and  Treat- 
ment.   By  David  Wooster,  BJ.D.,  San  Francisoo.   H.  H. 

Bancroa  &  Oo.     1867. 
Seventeenth  Annivbrsary  MEEnxG'qf  the  lUiuois  State 
KMedical^Society.     1867. 

digitized  by  ^ 


Mjn  ine  luiuou  c^ 

Google 


THE  MEDICAL  RECORD. 


529 


©rigiitol   Commumcatt0n«* 

A  BRIEF  DESCRIPTION  OF 

STELLINE,  STELLURINE,  CONCHOIDINE, 

AND  PIGMENTINE, 

WITH  SOME  OF  THE  PATHOLOOICAL  STATES  AND  CONDITIOKS 

CAUSED    BT  THEIR    rORMATIOK    AND    PRBSEXOI 

IN  THE  HUMAN  BODT. 

By  J.  H.  SALISBURY,  M.D. 

STELLINE. 

Stellins  is  a  pathological  product  formed  by  the 
parent  cells  in  the  human  body^  only  in  disease.  It 
may  be  formed  at  any  dven  tune,  by  one  class  of 
parent  cells  only,  or  by  aiL 

When  one  class  of  cells  becomes  so  disturbed  in  their 
functions  as  to  form  this  body,  this  condition,  if  not  re- 
moved, has  a  tendency  to  extend  to  the  other  classes  of 
parent  cells,  and  soon  the  entire  organism  is  under  its 
mflueuce. 

When  this  body  is  formed  in  the  system,  its  presence 
produces  a  greater  or  less  amount  of  irritation  or  dis- 
turbance, according  to  the  state  of  the  system,  the 
drinks  and  food  taken,  and  the  hardships  and  other 
baneful  influences  to  wnich  it  is  exposed.  Its  presence 
may  be  confined  for  a  while  to  either  the  blood  appara- 
tus, the  skin,  or  to  the  mucous  membranes. 

The  tendency  is  for  it  to  pervade  the  entire  organism, 
when  once  the  conditions  are  present  for  its  formation. 
Its  principal  formation,  however,  may  be  for  a  long 
time  confined  mainly  to  one  class  of  parent  cells. 

For  instance,  when  this  constitutional  diathesis  is 
present,  and  there  is  a  weakened  and  irritable  c  »ndition 
of  the  bronchial  membranes  from  any  cause,  this  body  is 
likely  to  be  formed  here  first,  and  continue  to  be  formed 
largely  in  this  locality  for  a  long  time,  producing,  per- 
haps, asthma  and  bronchial  catarrhs  in  their  various 
phaa^,  without  its  being  formed  to  any  great  extent  by 
parent  cells  in  other  parts  of  the  organism. 

It  may  be  formed  for  some  time  by  the  parent  cells 
of  the  blood  apparatus,  and  appear  but  in  small  quantity 
elsewhere.  It  may  be  formed  largely  by  either  the 
mucous  membranes  or  skin,  and  be  but  slightly  present 
in  other  parts  of  the  body.  The  tendency,  however,  is 
for  it,  when  once  established,  to  pervade  the  entire  or- 
ganism, and  to  be  discoverable  by  the  microscope  in  the 
blood,  and  all  the  secretions  and  excretions,  and  in  and 
on  all  free  surfaces  of  the  body.  Whether  found 
locally  or  generally  distributed,  the  treatment  is  mainly 
the  same,  which  should  in  all  cases  be  directed  to  the 
removal  of  the  cause. 

This  body  in  shape  is  sometimes  oval  and  flattened, 
but  almost  always  either  polyhedral  or  polygonal,  with 

a  peculiar  radiating  or 
A  stellated  fracture  in  the 
centre.  From  the  pecu- 
liar characteristic  fracture 
0  ^.       J.       I  have  given  this  body 

^  ©  (flPi  *^®  name  sUUine  (a).  Its 
^  yw^^  ^-^  composition  is  not  yet 
I  v^     /Q   f^      determined.  Its  presence 


produces  much  disturb- 
ance. If  formed  to  any 
great  extent  in  the  blood 
apparatus,  its  presence 
has  a  tendency  to  produce  languor,  fatigue,  restless- 
ness, irritabihty,  despondency,  wakefulness,  consti- 
pation, palpitation  of  the  heart  on  any  excitement. 


with  more  or  less  irregularity  of  beat;  dull  aches  and 
pains  in  the  cardiac  region  and  chest,  back  of  neck, 
small  of  the  back  and  head,  with  more  or  less  dizziness. 
In  reading,  the  lines  and  words  sometimes  run  to- 
gether. In  sewing,  the  head  becomes  bewildered.  Ob- 
jects seem  to  tremble  as  if  heated  air  were  rising  before 
the  eyes;  and  the  patient  reels  at  times  in  walking. 
The  muscles,  under  the  influence  of  exertion,  ache,  and 
become  soon  exhausted.  The  limbs  prickle,  and  manifest 
premonitory  symptoms  of  paralysis.  The  head  becomes 
at  times  numb,  constricted,  and  bewildered,  and  think- 
ing is  painful  and  difficult.  The  memory  is  impaired, 
and  the  mind  readily  gives  way  to  anxiety  and  trouble, 
and  frequently  indulges  in  melancholy  forebodings. 
Small  crosses  become  painfully  oppressive,  and  the 
patient  frequently  contemplates  suicide ;  but  is  fearful 
to  execute  his  thoughts,  though  he  sometimes  does. 

In  this  condition  some  part  of  the  body  may  become 
temporarily  paralyzed ;  and  in  persons  of  a  peculiar  sen- 
sitive nervous  system,  either  cataleptic  or  epileptic  par- 
oxysms may  result  If  stelline  is  being  formed  in  the 
skin  to  any  great  extent,  it  (the  skin)  becomes  often  dry 
and  furfuraceous,  though  sometimes,  especially  if  there  is 
derangement  of  the  pulmonary  apparatus,  or  a  rheumatic 
tendency,  the  skin  may  be  covered  with  a  cold,  clammy, 
sticky  sweat)  which  has  a  sour  smell  Under  such  con- 
ditions the  cuticle  will  be  found  full  of  algoid  spores 
and  filaments,  and  sometimes  filled  with  a  peculiar  fun- 
goid spore,  which  has  a  brilliant  nucleus.* 

If  this  body  is  formed  largely  by  the  mucous  mem- 
brane of  the  bronchi,  the  patient  will  be  troubled  with 
severe  bronchial  coughs,  and,  perhaps,  asthmatic  at- 
tacks; or,  perhaps,  under  certain  conditions,  be  afflicted 
with  " rose "  or  " hay  asthma"  This  is  purely  bron- 
chial gravel.  Such  cases  cannot  be  curea  without  re- 
moving the  cause. 

If  formed  largely  by  the  nasal  mucous  membranes, 
nasal  catarrh  of  an  obstinate  character  results,  which 
will  not  yield  till  the  cause  is  removed.  If  this  body 
is  being  formed  largely  by  the  mucous  membrane 
lining  the  uterus^  there  results  severe  uterine  catarrh, 
which  will  not  yield  permanently  till  the  cause  is  re- 
moved. 

If  this  body  is  being  formed  in  the  tubuli  seminiferi 
spermatorrhoea  is  the  certain  result.  As  the  little  plugs 
of  stelline  come  away^  they  produce  irritation,  and  ex- 
cite dreams  and  emissions.  It  is  useless  to  undertake 
to  cure  such  cases  without  removing  the  cause.  If  this 
body  is  being  formed  largely  by  the  mucous  membranes 
lining  the  urinary  organs,  more  or  le^s  irritability  of 
these  organs  will  result. 

The  formation  and  accumulation  of  stelline  in  the 
blood  apparatus,  simply,  with  the  abnormal  states  and 
conditions  arising  therefrom,  constitute  a  disease  which 
may  be  designated  by  the  name  steUinemia,  That 
arising  from  the  formation  and  accumulation  of  this 
body  throughout  the  system,  may,  for  Hke  reasons,  be 
called  steUystema. 

STELLURINE. 

This  is  a  patholo^cal  product,  formed  in  disease  by 
the  parent  cells.  It  may  occur  in  the  blood:  in  the 
epidermic  layer  of  the  sldn ;  in  the  urine  and  fasces ; 
in  the  discharge  in  uterine  catarrh;  in  "the  expec- 
toration; and  m  the  secretion  of  bronchial  and  nasal 
catarrhs.  Wherever  it  occurs  it  produces  irritation 
and  disturbance.  It  may  be  absent  or  occur  in  small  or 
large  quantity  in  the  blood ;  and  be  absent  or  occur  in 
small  or  large  quantityin  any  or  all  of  the  other  local- 
ities above  named.     Where  it  begins  to  be  formed  by 


*  Mikroa,  iris  (dalUbory). 


Digitized  by 


Google 


530 


THE  MEDICAL  RECORD. 


any  one  class  of  parent  celb,  the  tendency  is  for  the 
same  pathological  condition  to  extend  to  the  others; 
and  in  a  longer  or  shorter  period — according  to  the  ex- 
posures and  condition  of  the  system — it  becomes  a 
general  or  constitutional  trouble.  I  supposed  for  a  long 
time  that  this  body  was  cystine. 
The  crystals  are  usually  irregular  in  shape,  very  trans- 

Earent,  tender  and  friable,  and  highly  refractive.  They 
ave  a  remarkable  tendency  to  fracture  into  many  frag- 
ments, as  the  blood  cools  and  contracts  by  clotting, 
while  being  viewed  between  the  slides  of  the  mi- 
croscope. The  crystals,  on  the  least  pressure,  fre- 
quently fly  asunder  with  considerable  force,  scattering 
the  pieces  in  every  direction — ^lifce  glass  badly  annealed. 
The  fracture  is  more  or  less  conchoidal,  and  frequently 
starts  from  the  centre  of  th* crystal  and  radiates  in 
various  directions,  dividing  it  into  two,  three,  four,  or 
more  parts,  and  sometimes  into  as  many  as  fifty  or  one 
hundred  — minute,  sharp,  angular  figments  («,/,  g^  A, 

''*^-    e  f  g        K        i  k 


a 


ife»^ 


From  the  stellated  character  of  the  fracture  I  have 
given  to  this  body  the  name  ateHurine.  It  is  distin- 
guished from  stelHne  by  the  peculiar  shape  of  the  crystals. 
Stelline  has  like  it  a  tendency  to  fracture,  but  to  a  much 
less  degree. 

Cystme  differs  from  this  body  in  not  being  inclined  to 
fracture,  and  in  being  less  transparent,  refractive,  and 
friable. 

E,  /,  91  ^)  *  represent  crystals  of  stellurine  as  seen  in 
the  freshly  drawn  blood  before  and  after  fiticturing. 

This  body,  when  present  in  the  blood  to  any  great 
extent,  like  stelline,  produces  dizziness,  impairment  of 
memory,  despondency,  wandering  rheumatic  neuralgic 
pains  and  aches,  nerve  irritability,  sleeplessness,  and 
often  a  strange,  mixed-up,  "crazy  feeling"  (as  patients 
describe  it)  in  the  head.  The  head  feels  frequently  as 
if  a  band  were  drawn  tightly  around  it ;  objects  viewed, 
tremble  as  if  heated  air  were  rising  before  them ;  and 
occasionally  ttie  patient  reels  in  walking  as  if  intoxicated. 

The  heart  palpitates  on  excitement,  and  the  beat  be- 
comes sometimes  intermittent,  and  a  dull  uneasy  ache, 
with  occasional  sharp  transient  pains,occurs  in  the  cardiac 
region.  There  is  a  tendency  for  the  muscles  of  organic 
life  to  lose  partially  their  tonicity,  the  heart-beat  be- 
coming more  or  less  deraneed,  and  the  peristaltic  action 
of  the  bowels  impaired.  There  is  frequently  a  strange 
mixed-up  numb  reeling  about  the  head,  wiUi  prickling 
numb  sensations  in  the  extremities. 

The  voluntary  muscles  readily  tire  and  ache  when 
over-fatigued.  Such  persons,  under  the  proper  conditions, 
may  be  affected  with  nasal,  bronchial,  or  uterine  catarrhs, 
with  asthma,  "  hay"  or  "  rose  fever,"  with  one  form  of 
rheumatism,  with  cataleptic  or  epileptic  manifestations, 
with  urinary  or  seminal  disturbances,  with  strange 
hallucinations,  and  even  insanity,  and  sometimes  with 
more  or  less  extended  paralysis. 

Medical  writers  have  been  in  the  habit  of  viewing 
many  local  manifestations  of  disease  as  purely  locm 
diflBculties.  For  instance,  oxaluria,  cystinic  una,  phos- 
phuria,  etc.,  which  are  treated  as  local  troubles,  are. 
as  a  general   rule,  really  constitutional   pathological 


statfes — these  several  bodies  being  formed  in  the  blood, 
expectoration,  faeces,  etc.,  as  well  as  in  the  urine.  The 
presence,  as  a  general  rule,  of  any  abnormal  product,  in 
any  given  part  of  the  organism,  is  but  alocal  manifestation 
of  a  constitutional  pathological  formation,  which  will  be 
found  to  show  itself  sooner  or  later  to  a  greater  or  less 
extent  in  other  localities. 

Wherever  we  have  oxaluria,  cystinic  tucia,  phosph- 
uria,  stellin-uria,  steUurin-uria,  etc.,  we  have  also  oxale- 
mia,  cystinemia,  phosphemia,  stellinemia,  stellurine- 
mia,  etc.  This  whole  matter  will  be  more  ftilly  treated 
of  in  a  paper  on  this  subject  now  nearly  read^. 

The  formation  and  accumulation  of  stellunne  in  the 
blood  apparatus  simply,  with  the  pathological  states  and 
conditions  arising  therefrom,  constitute  a  disease  which 
may  be  designated  by  the  name  aieUurinemia.  That 
arising  from  we  formation  and  aocumulation  of  this  body 
throughout  the  organism,  may,  for  similar  reasons,  be 
named  stdlurystema. 

The  formation  and  accumulation  of  either  stelline  or 
stellurine,  or  both,  or  of  cystine,  oxalate  of  lime,  or  the 
phosphates,  in  the  blood  apparatus,  may,  under  the 
proper  conditions,  result  eventually  in  organic  disease 
of  tne  heart.  These  bodies  all  have  a  tendency  to  partially 
paralyze  the  muscles  of  organic  life.  The  muscular 
power  of  the  heart  at  first  becomes  weakened,  or  its 
muscular  tonicity  so  impaired,  that  any  considerable 
exertion  or  excitement,  physical  or  mental,  excites  the 
heart  to  increased  activity,  while  during  passive  con- 
ditions the  beat  is  usually  slow  and  irregular.  In  this 
state,  the  circulation  is  either  too  sluggish  or  over 
active.  The  heart  responds  to  every  little  excitement 
and  exertion  to  which  either  body  or  mind  is  exposed. 
Dull  aches  and  pains  are  frequently  felt  in  the  cardiac 
region.  The  heart  sounds  are  all  normal,  for  a  long 
time  after  the  disease  has  begun  to  insidiously  work  its 
sure  way.  To  the  unaided  senses,  there  appears  to  be 
no  organic  disturbance ;  hence  the  pathological  condition 
of  the  organ  is  supposed  to  be  sympathetic  or  functional 
Organic  changes  are,  however,  slowly  in  progress.  The 
lining  tissue  of  the  heart  and  large  vessels  leading  to  it, 
becomes  thinly  or  thickly  studded  with  minute  mi- 
croscopic granulations  or  eminences.  These,  as  they 
grow,  take  on  a  smaller  pedicle  and  a  larger  body. 
They  are  really  minute  thrombi,  made  up  of  fibrin,  in- 
closing minute  crystals  and  granules  of  the  bodies  before 
named.  These  bodies  are  the  specific  cause  of  the 
thrombi  The  thrombi  fi^quently  become  detached  and 
float,  as  emboli,  freely  in  the  blood  stream,  unless  so 
laree  as  to  be  checked  in  their  course  by  the  ci4)illariea 

The  formation  of  minute  thrombi  goes  on  step  by 
step,  till  by  and  by  the  heart  sounds  become  abnormal, 
when  no  one  doubts  the  presence  of  organic  disease.  It 
may  however  now,  perhaps,  be  too  late  to  repair  the 
damaffe  done,  or  even  to  check  the  progress  of  the 
pathological  conditions  and  formations  fUready  far  ad- 
vanced toward  a  fatal  issue ;  while  if  the  disease  had 
been  discovered  and  treated  earlier,  there  would  have 
been  but  little  difficulty  in  its  removal. 

Here  then  again  the  microscope  comes  in,  and  reveals 
to  us  with  certainty  the  cause  of  a  most  dreaded  and 
fatal  disease,  while  yet  it  is  in  a  stage  that  is  amenable 
to  treatment 

PIOMENTTNE. 

This  is  a  peculiar  brownish-yellow  color-        I 
ing  matter,  that  occurs  in  the  blood  in  all 
cases  where  pigmentary  matter    is  being 
deposited  in  an  unusual  degree — either  in 
spots  or  generally  over  the  surface — in  the  ^ 
under  layer  of  epidermic  cells.    It  occurs  in 
thin  plates,  or  laminae,  irregularly  fractured  in  vari- 
ous oirections,  as  represented  at  2.     Patients  hav- 


0 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


631 


ing  this  substance  forming  largely  have  a  peculiar 
brownish-yellow,  bronzed,  sickly  hue.  It  is  found 
in  larger  or  smaller  quantity,  according  to  the  extent 
and  depth  of  the  pathological  coloring.  In  such 
cases,  the  digestiye  apparatus  has  become  more  or  less 
deranged  —  usually  from  defective  alimentation  and 
exposures ;  and  thie  blood  is  found  generally  thin,  and 
its  histological  elements  more  or  less  broken  down — the 
blood  glands  performing  their  office  of  forming  blood 
imperfectly.  Iron,  quiDine,  iodide  potassium,  and  good 
healthy  ahmentation  are  valuable  means  for  removing 
this  disease. 

To  the  formation  and  accumulation  of  this  body  in 
the  blood  apparatus  and  the  resulting  local  and  systemic 
disturbances  1  have  given  the  name  pigmentemia. 

OONOHOIDINE. 

Conchoidine  is  a  peculiar  body,  found  only  occa- 
sionally in  the  blood.  It  is  usually — ^in  shape— of 
an  oval  or  circular  disc-like  form ;  more  or  less  flat- 
tened in  the  direction  of  the  shortest  diameter.  It 
occurs  almost  always  with  fractures  extending  from 
the  circumference  toward  the  centre. 

m,  n,  0,  and  s  represent  this  body  as  it  appears  in 
the  blood.    It  resembles  very  much  a  fat  globule,  so  far 


as  its  lustre  and  refracting  characters  are  concerned ; 
but,  unlike  it  it  fractures  into  fragments  which  pre- 
serve their  form.  These  broken  pieces  are  sometimes 
met  with  in  the  blood. 

Of  the  causes  which  produce  these  bodies,  or  of  their 
chemical  constitution,  or  of  the  pathological  conditions 
excited  by  their  presence,  but  little  has  as  yet  been 
determined.  They  occur  in  the  blood  —  usually — in 
connection  with  other  abnormal  insoluble  products. 
They  undoubtedly  give  rise  to  more  or  less  systemic 
disturbance.  To  the  group  of  abnormal  states  and  con- 
ditions excited  bv  the  presence  and  accumulation  of 
this  body  in  the  blood  apparatus  I  have,  for  present  con- 
venience, given  the  name  conchoidemia. 

REPORT  OF  THREE  OASES. 

Case  I. — 5,  c,  and  d  represent  emboli,  from  the  blood 
of  a  lady,  Mrs.  Q-.  D.,  or  Cleveland,  Ohio, who  has  been 
laboring  under  steUinemia  and  steUurinemia  for  several 
years.  About  eighteen  months  ago,  she  gave  birth  to  a 
child,  which  soon  died.  She  seemed  to  get  along  quite 
well  after  the  labor ;  but  as  soon  as  she  was  able  to 
get  up  and  move  about,  she  found  the  least  exertion 
fatigued  and  prostrated  her.  As  soon  as  she  assumed 
the  erect  position,  a  peculiar  mixed-up,  dizzy,  numb 
feeling  would  come  over  her,  and  she  would  nave  to 
lie  down.  Her  appetite  was  good,  and  she  kept  in 
good  flesh. 

About  six  months  after  the  labor^  she  came  into 
my  hands.    On  examining  her  case  I  found  she  was 


laboring  under  the  diseases  previously  named.  Her 
blood  contained  many  granules  and  crystals  of  stdline 
and  steUurine  (a,  e,  /,  ^,  A,  t.  A;),  and  also  many  emboli, 
—6,  c,  d — filled  with   crystals  and  granules  of  ateUine 


and  steUurine.  The  urine  also  contiuned  these  bodies 
in  large  quantity. 

She  had  been  under  treatment  for  ulceration  of 
womb,  and  softening  of  brain. 

On  examination,  found  her  womb  trouble  simply 
catarrhal  and  slignt,  and  there  were  no  evidences  of 
brain  softening. 

She  seemed  to  have  no  muscular  power  or  endur- 
ance. The  least  exertion  would  bring  on  an  ex- 
hausted, half-paralyzed  condition  of  the  whole  body, 
with  a  peculiar  mixed-up,  dizzy  feeling. 

The  heart  sounds  were  normal,  but  the  pulsations 
were  at  times  cjuite  weak  and  irregular.  Listening  to 
reading  or  talkmg  for  a  short  time  would  frequently 
tire  her,  the  same  as  physical  exertion,  and  would 
bring  on  sometimes  the  same  bewildering  sensations. 

Bowels  very  constipated  —  almost  paralyzed  —  and 
urine  high-colored,  scanty,  and  of  a  sp.  grav.  of 
1.030  and  upward. 

The  least  exertion  woidd  excite  the  flow  of  per- 
spiration; although  she  had  most  of  the  time,  when 
still,  sensations  of  chilliness  in  extremities  and  back, 
unless  kept  well  covered  and  in  a  warm  room. 

Placed  her  on  the  following  treatment : 

5.  Acid.  Sulph.  Aromat       .    .    .    |  iii. 

Quin.  Sulph. 3  ji. 

Aquas §11 

M. 
S.    Put  2   teaspoonfuls  in  half    a  pint   of  warm 
water  and  wash   the  body  and  limbs  all  over  every 
day,  and  wipe  dry  after. 

After  the  bath  to  be  pounded  all  over  with  a  hair 
ball  for  10  minutes,  and  rubbed  afterward  thoroughly 
with  the  bare  hand,  till  the  surface  **  was  in  a  glow.* 

Q.  Potass.  lodid.  ^ 3iv. 

Tr.  Cinchonae  con^ 5  v. 

Tr.  Ghentian.  comp xi. 

Wine  Oolchicum  (seeds)  .    .    -    3  i. 

S.  Take  a  teaspoonful  before  each  meal 

Q.Acid.  Hydrochlor.  dil    .     .    .    |iiL 
S.  Take  10  drops  in  a  glass  of  water,  10  minutes  after 
breakfast  and  dinner. 

^ .  Quin.  Sulph. 3  i. 

Fern  Lactat. 3  ss. 

Strychnin.  Hydrochlorate    .    .  gr.  i. 
Ext.  Gentian. 
Syrup,  &ft  q.  s. 
M.  Make  pills  40. 
S.  Take  a  pill  2  hours  after  each  meal 
B.  Pil.  Aloes  et  Myrrh.  )  ^^ 
U.  S.  D.— S.O.         ]^^ 
S.  Take  one  on  retiring. 
Avoid  all  sweets  and  organic  acids. 
To  eat  rare  beef,  milk,  the  yolks  of  eggs  soft  boiled, 
with  a  little  bread  and  potato. 

digitized  by  VjOOQIC 


532 


THE  MEDICAL  RECORD. 


During  a  portion  of  the  time  she  has  used  the 
nitro-rauriatic  acid  bath  in  place  of  the  one  before 
mentioned. 

Under  this  treatment  she  has  slowly  but  steadily 
improved.  She  is  still  under  treatment;  and  is  im- 
proving more  rapidly  than  at  any  previous  time. 

The  blood  and  secretions  are  almost  free  from  stel- 
line  and  steUurine.  As  these  bodies  become  less  and 
less,  her  strength  and  muscular  endurance  gradually 
improve. 

I  should  have  stated,  that  for  several  years  before 
the  labor,  she  had  a  tired  feeling  frequently,  with 
occasional  attacks  of  dizziness.  These  gradually  in- 
creased in  severity  and  frequency  up  to  the  time  of 
delivery. 

Case  II. — Mr.  E.  R.,  of  Maumee  City.  Age,  eighteen. 
Appetite,  appearance,  and  general  health  good.  Does 
not  know  when  to  stop  eating.  Eats  anything  set  be- 
fore him.  Has  a  severe  attack  of  steUurinemia  and  cofi" 
ehoidemia.  Has  lost  almost  entirely  his  will  power. 
This  almost  total  loss  of  will  extends  back  for  about 
twelve  months.  Previous  to  that  time — for  several 
years — ^he  was  troubled  with  fits  of  despondency  and 
bewildering  sensations  in  head.  Was  fearful  that  some- 
thing dreadful  would  happen  to  him.  Was,  however,  able 
to  attend  to  business  up  to  about  fourteen  months  since. 
He  came  under  my  care  in  September,  1867.  When  I 
first  saw  him,  he  was  in  the  condition  he  bad  been  for 
some  ten  months. 

He  perfectly  understood  all  that  was  said  to  him — 
would  smile  when  anything  laughable  occurred,  mem- 
ory good,  and  manifested  a  disposition  to  follow  direc- 
tions strictly,  but  was  unable  to  answer  questionB,  or 
even  to  say  yes  and  no,  unless  excited.  If  he  saw  a 
horse  runnmg  away,  or  cars  coming,  or  a  house  on  fire, 
he  could  talk  as  well  as  any  one,  apparently.  As  soon, 
however,  as  the  excitement  ceased,  his  will  power  left 
him,  and  with  it  the  power  of  speech.  If  directed  to 
go  across  the  room  and  get  a  book,  he  perhaps  would 
rise  from  his  chair,  and,  unless  told  to  go  ahead,  would 
stand  by  the  chair  till  he  was  directed  to  proceed  or 
sit  down.  Sometimes  he  would  get  half-way  across 
the  room,  and  stop  and  stand  still  tin  told  to  go  on.  In 
eating,  he  had  to  have  his  food  placed  on  his  plate,  and 
unless  told  to  proceed  at  every  mouthful,  he  would' stop 
and  sit  motionless  till  his  elbow  was  jogged,  or  his  wifi 
assisted  by  the  direction  of  a  second  party. 

On  examining  his  blood,  found  it  to  contain  numerous 
crystals  of  steUurine  («,  /,  ^,  A,  t,  k)  and  conchoidine, 
represented  at  o  and  8.  * 

His  blood  was  otherwise  quite  normal,  save  that  here 
and  there  were  small  emboH  (Je  and  *). 

Placed  him  on  the  following  treatment : — 

5 .  Potass.  Bromid 5  iss. 

Tr,  Cinchonse  comp 5  vL 

Tr.  Gentian,  comp 5  i 

Aquae  Camphor |  i 

Aquae  Menth.  Pip |  i. 

Wine  Oolchicum  (seeds) .  .  .   |  L 

S.  Take  a  teaspoonfiil  before  each  meal,  and  on  re- 
tiring. 

B .  Acid.  Hydrochlor.  dil.  .  .   |  iil 

S.  Take  10  drops  in  a  glass  of  water  after  breakfast 
and  dinner. 

5.  Acid.  Nitromuriat  dil.  ...   |  iv. 
Quinin.  Sulph 3  iL 

S.  Put  li  teaapoonmls  in  half  a  pint  of  warm  water, 
and  wash  the  body  and  limbs  all  over  every  night,  and 
wipe  dry  after. 

B.  Tr.  Iodine |iss. 

S.  Paint  on  each  side  along  the  whole  length  of  the 
flpine  every  other  morning. 


Avoid  sweets  and  organic  acids.  Live  on  rare  beef, 
oyster  soup,  the  yolks  of  soft-boiled  eg^  beef  tea, 
milk,  and  a  little  bread  and  potato.  Avoid  all  stimu- 
lants. 

Nov.  7th,  found  him  considerably  improved.  He 
could  answer  questions  part  of  the  time  by  using  a  little 
effort,  and  could  quite  readily  say  yes  and  no  when 
asked  direct  questions.    Continued  treatment. 

I  should  here  say  that  all  the  organs  of  the  body  ap- 
pear quite  healthy.  The  heart-beat  is  rather  weaker 
and  slower  than  normal.  In  his  habits  he  has  always 
been  very  correct- — is  intelligent  and  etricUy  moral — 
he  being  a  conscientious  member  of  church.  So  far  as 
I  can  learn  from  him  and  his  family,  and  discover  from 
my  own  observations,  he  is  not  troubled  with  seminal 
emissions.  • 

Case  III.— Mr.  A.  W.  P«  Cleveland,  Ohio.  Called 
on  me  in  October,  1866.  Has  always  been,  up  to  the 
period  of  this  trouble,  a  very  strong,  robust  man,  of 
remarkable  endiu*ance.  His  habits  of  life  active,  and 
labors  severe.  Age  forty-two.  Has  steUinemta  and 
oxakmia.  For  a  few  days  previous  to  his  first  visit  he 
had  been  laboring  under  temporary  aberration  of  mind. 
Was  perfectly  sane  when  I  first  saw  him ;  but  was  la- 
boring under  great  depression  of  spirits,  and  was  fear- 
ful he  was  becoming  insane.  His  family  were  making 
arrangements  to  take  him  to  the  asylum  at  Newburgh, 
but  at  my  sohcitation  desisted,  and  placed  him  in  my 
hands  for  medical  treatment.  On  working  up  his  case, 
found  it  to  be  one  of  sidlinemia  and  oxdlemia.  Blood 
filled  with  masses  of  granules  of  oxalate  of  Ume  and  a 
multitude  of  well-defined  crystals  of  stelline. 

Urine  loaded  with  crystals  of  oxalate  of  lime,  both 
dumb-bell  and  octohedral — also  contained  crystals  of 
stelline.    Sp.  grav.  1.030  to  1.035. 

He  also  had  severe  nasal  catarrh.  The  catarrhal  se- 
cretions were  filled  with  crystals  of  stelline,  oxalate  of 
Ume,  and  an  algoid  vegetation  (zymotosis  catarrhaJis), 
Bowels  constipated  and.  portal  system  congested. 
Heart  sounds  normal,  but  pulsations  slow  and  inter- 
mittent, or  irregular.  Great  want  of  tonicity  in  mus- 
cles of  organic  life ;  a  tendency  to  paralysis.  Had 
prickling,  numb  sensations  in  extremities,  and  a  diz2y, 
mixed-up,  confused  feeling  in  head,  with  partial  loss  of 
memory.  Sometimes  he  suffered  terribly  with  severe 
pains  in  front  part  of  head,  accompanied  by  a  feeling  of 
stricture,  as  if  the  head  were  in  a  vice. 

The  following  is  a  brief  but  graphic  description  of 
some  of  the  more  prominent  symptoms,  given  by  him- 
self:— 

"In  the  month  of  April,  1864,  my  health  fiiiled. 
The  first  intimation  I  had  that  anything  was  wrong 
with  me,  my  mind  failed  to  work ;  that  is,  I  could  not 
figure  correctly,  was  confused,  could  not  collect  my 
thoughts,  or  express  them  intelligently.  There  seemed 
to  be  a  heavy  weight  upon  my  head — a  heavy  pressure 
about  the  brain.  By  ceasing  to  labor,  would  be  better 
for  a  Httle  time ;  but  as  soon  as  I  commenced  again 
this  pressure  and  confusion  would  return,  and  with  it  a 
terrible  depression  of  spirits.  I  could  not  get  rid  of  the 
idea  that  everything  was  going  to  fail— country  and  all 
were  going  to  ruin.  I  changed  my  occupation,  hoping 
to  get  relief,  but  continued  to  grow  worse  until  the 
fall  of  1865.  At  this  time  I  would  have  speE^,  lasting 
several  weeks,  of  unceasing  pain  and  pressure  in  my 
head — ^not  sleeping  any  for  weeks  together — and  oc- 
casionally would  lose  myself,  or  not  be  conscious  what 
I  was  doing,  for  from  a  few  hours  to  two  or  three  days, 
and  would  sometimes  wander  off  At  such  times  my 
hands  and  feet  would  become  cold,  numb,  and  almost 
lifeless.  The  sensation  I  had  in  my  head  I  cannot  de- 
scribe better  than  to  say  it  was  hki^that  produced  by 

Digitized  by  VjOO^  ^  _ 


THE  MEDICAL  RECORD. 


533 


putting  the  head  into  a  vice,  and  continuing  the  tight- 
ening operation  until  sensation  ceased  (numb  and  dead). 
At  other  times  there  was  a  continual  noise  in  it,  and 
any  little  sudden  sound  would  alarm  me.  I  was  in  con- 
tinual fear,  and  could  not  tell  why.  Had  a  continual 
dread  of  seeing  any  one,  especially  if  I  had  to  conyerse 
with  him ;  for  it  seemed  to  me  impossible  to  arrange 
my  thoughts  and  express  them  in  words  so  as  to  be 
understood.  When  this  pressure  was  gone,  I  would 
feel  as  well  as  ever,  only  would  be  wei3c,  suflfering  so 
long  from  pain. 

"  In  the  fall  of  1865  I  commenced  taking  medicine 
ordered  by  Dr.  Salisbury,  and  in  four  weeks*  time  was 
able  to  resume  my  occupation,  and  was  able  to  follow 
it  through  the  winter.  Ceased  taking  medicine  and  did 
not  follow  the  doctor's  directions,  and  in  the  month  of 
May,  1866,  was  taken  worse  again,  and  continued  so 
through  the  summer.  Was  compelled  to  seek  medical 
advice  again  in  the  month  of  October.  Followed  his 
directions  to  the  letter  for  seven  months,  and  then,  wit^ 
the  doctor's  consent,  commenced  business  again,  which 
I  have  steadily  followed  since.  I  am  now  deling  per- 
fecdy  well.  A.  W.  P. 

**  July  25th,  1867." 

This  case  had  been  diagnosed,  previous  to  my  exami- 
nation, as  one  of  brain-softening.  Placed  him  on  the 
following  treatment: — 

3 .  Acid.  Nitromuriat  dil. .   5  vi. 
S.  Put  a  teaspoonful  in  half  a  pint  of  warm  water, 
and  wash  the  body  and  limbs  all  over  every  night,  and 
wipe  dry  after. 

8 .  Potass.  lodid. 3  visa. 

Tr.  Cinchona  comp.   .    .    |  v. 
Wine  Colchicum  (seeds)  .    |  i. 
Tr.  Gentian,  comp.    .  .  .    3  L 
S.  Take  a  teaspoonful  before  each  meal. 

3.  Tr.  Iodine |  iss. 

Camel's-hair  brush. 
S.  Paint  the  whole  length  of  the  spine  and  over  the 
heart  every  other  day. 

5.  Pil.  Hydrarg.  Prot-Iodid. 

i  gr.  sc. XXX. 

S.  Take  a  pill  two  hours  after  breakfast  and  dinner. 

Q .  Potass.  Acet |  ii. 

"      Nit I  ss. 

Spts.  Nit  dulc. I  i. 

Aq.  Menth.  Pip 5  ^il 

S.  Take  a  tablespoon^  in  a  glass  of  water  at  night 
on  retiring. 

Under  this  treatment,  after  the  first  two  weeks  he 
improved  rapidly.  After  about  four  weeks'  treatment, 
he  visited  Kelly*3  Island  and  ate  grapes  freely.  Re- 
mained a  week  or  ten  days  on  the  idand,  gaining  fifteen 
pounds  in  weight 

Saw  him  after  this  every  four  weeks.  Continued 
treatment  for  three  months,  when  he  thought  himself 
well  enough  to  stop  treatment,  which  he  did  against 
my  advice.  From  January  to  May,  1866,  he  remained 
quite  well,  and  engaged  in  active  business.  In  May  he 
wa3  again  taken  down,  and  confined  to  his  house  and 
bed  for  about  six  weeks.  His  symptoms  were  intense 
BuflTering  and  pressure  in  head,  producing  great  prostra- 
tion and  despondencv,  like  those  previously  described. 

The  last  of  June  he  came  again  for  treatment,  and 
went  to  work  taking  his  medicines  in  earnest  Re- 
mained two  weeks,  and  then  went  to  Kelly's  Island, 
where  he  remained  four  weeks,  improving  rapidly.  He 
then  returned  home  and  engaged  in  business.  In  No- 
vember following  gave  himself  up  to  treatment,  which 
he  has  pursued  faithfully  to  this  date,  July  25th,  1867. 


Calls  himself  well,  and  is  able  to  attend  to  any  kind  of 
business.  There  is,  however,  a  small  quantity  of  stel- 
line  and  oxalate  of  hme  in  the  blood  and  secretions, 
for  which  reason  he  still  continues  treatment 


ANOMALOUS  CASE  OP  LABOR. 
Bt  WILLIAM  J.  BURGE,  M.D., 

OF  ATomBON,  Kansas. 

On  the  morning  of  Dec.  13,  1^7, 1  was  called  in  con- 
sultation with  Dr.  J.  M.  Linley,  to  attend  Mrs.  W 

set.  about  forty,  in  her  eighth  confinement  She  had 
been  in  labor  since  noon  of  the  12tb,  soon  after  which 
time  another  physician  had  visited  her  and  detected 
prolapsus  of  the  funis,  and  one  of  the  feet  presenting. 
Owing  to  other  engagements,  he  declined  to  take  charge 
of  the  case,  and  directed  the  woman  to  send  for  some- 
body else.  At  midnight  she  commenced  flooding,  and 
sent  for  Dr.  Linley,  who  administered  free  doses  of 
ergot ;  and  by  the  ordinary  examination  discovered  the 
prolapsed  cord,  which  had  ceased  to  pulsate,  and  a  foot 
presenting.  There  were  no  pains  of  any  consequence, 
and  as  the  hssmorrhage  had  nearly  stopped.  Dr.  Linley 
waited  about  two  hours  for  the  action  of  the  ergot, 
giving  repeated  doses  of  the  fluid  extract  and  also  of  the 
powder. 

At  the  end  of  this  time  there  were  slight  pains, 
and  still  some  hssmorrhage,  and  I  was  sent  for  in  con- 
sultation. On  examination,  I  found  the  same  state  of 
things  above  mentioned ;  and  being  requested  to  try 
and  bring  down  the  other  foot,  I  introduced  my  hand 
and  satisfied  myself  that  the  left  foot  was  presenting.  I 
then  felt  a  portion  of  the  placenta,  and  m  close  prox- 
imity to  it  what  I  supposed  to  be  the  right  tuber  ischii, 
but  soon  recognised  as  the  head  (vertex). 

Dr.  Linley  then  examined,  and  assured  himself  of  the 
correctness  of  my  diagnosis  in  every  particular.  The 
woman  resisted  every  effort  to  change  the  position  of 
affairs.  We  concluded  to  put  her  under  chloroform  and 
endeavor  to  turn  and  deliver,  or  to  return  the  foot. 
There  was  much  delay  in  obtaining  the  consent  of  the 
family.  In  the  meantime  the  pains  came  on  mora 
actively,  and  a  second  examination  convinced  us  that 
the  head  and  foot  were  advancing  in  the  same  relative  po- 
sition, and  with  every  probability  of  becoming  impacted. 
Warning  the  friends  against  longer  delay,  and  getting 
permission  to  do  as  we  thought  best,  we  sent  for 
chloroform  and  instruments  necessary  for  extrac- 
tion. About  an  hour  passed  before  the  messenger  re- 
turned, and  during  that  time,  to  our  surprise  and  grati- 
fication, the  foot  and  placenta  gradually  receded,  the 
head  advanced,  and  spontaneous  delivery  was  effected 
without  an  untoward  ^mptom.  The  woman  had  a 
capacious  pelvis,  and  had  borne  seven  healthy  children^ 
This  child  was  well  developed,  but  was  sacrificed  by 
pressure  upon  the  cord. 

Cazeaux  relates  a  case  of  similar  presentation  (with 
the  exception  of  placenta  preevia)  in  which  embryotomy 
had  to  be  performed. 

AiB  AND  Water  Pads  fob  Fraoturbs. — Christopher 
S.  Jeaffreson,  M.RC.S.,  has  figured  in  the  Lancet  an 
apparatus  for  the  treatment  01  fractures,  which  is  not 
only  simple  and  efficient  but  cheap.  The  main  feature 
consists  in  the  use  of  air  and  water  pads  formed  of 
india-rubber  bags,  which  are  accurately  adapted  to  the 
insides  of  the  coaptation  splints.  The  great  advantage 
of  this  contrivance  is  the  establishment  of  well-regu- 
lated and  equable  pressure,  as  well  as  that  of  cleanli- 
ness, over  the  employment  of  the  ordinary  compresses. 


534 


THE  MEDICAL  RECORD. 


INHALATION  OP 

SPEAT  OF  TENCT.  FERRI  CHLORIDI  IN  TRAU- 
MATIC  PULMONARY  HBMORRHAGR 

By  GEO.  M.  STERNBERG,  M.D., 
Bsarrr  majos  ajto  AauertAVT  buboboh  u.  g.  ▲.,  fort  bilst,  SAnAi. 

The  following  case  presents  some  points  of  interest, 
and  illustrates  one  of  the  uses  of  Kichardson's  spray 
apparatus.  * 

Mr.  W.,  a  merchant,  aged  28,  while  attempting  to 
put  a  drunken  man  out  of  his  store,  received  a  stab  in 
the  neck,  inflicted  by  a  lonff,  narrow-bladed  butcher's 
knife.  The  knife  entered  the  neck  on  the  right  side 
two  and  one-half  inches  above  the  clavicle,  and  just  to 
the  right  of  the  common  carotid  artery,  cutting  the  an- 
terior jugular  vein,  and  passing  downward  and  back- 
ward into  the  lung. 

The  bleeding  from  the  vein  was  free,  but  a  bystander 
controlled  it  by  pressure  with  his  thumb,  and  it  did  not 
recur. 

Mr.  W.  at  once  commenced  coughing  and  expec- 
torating bright  red  bloody  filled  with  minute  bubbles  of 
air.  From  this  time  until  I  was  called  (about  eighteen 
hours)  he  continued  to  cough  up  every  few  minutes  a 
mouthful  of  blood. 

When  he  was  first  wounded  he  sent  for  a  hospital 
steward  of  the  army,  with  whom  he  was  acquainted. 
The  steward  probed  tl^e  wound,  and  stated  that  the 
oesophagus  was  wounded  I  presume  his  diagnosis  of 
the  case  was  founded  upon  the  facts  that  blood  came 
from  the  mouth,  and  that  any  attempt  to  swallow  the 
medicine  he  gave  produced  a  violent  paroxysm  of 
coughing.  The  steward  prescribed  tincr.  ergot  with 
a  view  of  controlling  the  haemorrhage,  and  injections  of 
beef  tea  and  brandy  to  keep  up  the  pulse.  As  the 
haemorrhage  continued  and  the  man  was  n^idly  becom- 
ing exhausted,  his  friends  became  alarmed  and  sent  for 
me.  After  seeing  the  case,  I  at  once  sent  for  my  I^ch- 
ardson's  spray  producer  and  some  tinct  ferri  chlor. 
The  distance  was  six  miles,  and  it  was  two  hours  be- 
fore my  messenger  returned.  In  the  meantime  Mr. 
W.  continued  to  cough  up  a  mouthful  of  blood  every 
few  minutes,  and  the  total  amount  during  the  two 
hours  could  not  have  been  less  than  sixteen  fluid  ounces. 
Perfect  rest  was  enjoined,  and  no  treatment  adopted 
until  the  spray  apparatus  arrived.  I  then  added  half 
ounce  tinct.  ferri  chlor.  to  five  ounces  of  water,  and 
placing  the  extremity  of  the  instrument  well  back  in 
the  mouth,  caused  the  spray  to  enter  the  lungs,  by 
pressing  the  bulb  at  eadi  inspiration.  This  was  con- 
tinued for  about  a  minute,  and  after  an  interval  of  five 
minutes  was  again  resumed  for  a  minute. 

The  haemorrhage  was  arrested  completely,  and  did 
not  recur.  About  twenty  minutes  after  a  hypodermic 
injection  of  morph.  sulph.  gr.  i  was  administered,  and 
in  a  very  short  time  the  patient  fell  into  a  quiet  sleep. 
I  remained  with  him  all  night  He  occasionally  woke 
up  for  a  moment  and  then  dropped  asleep  again.  The 
next  morning  he  commenced  to  cough  up  occasionally 
a  little  dark  clotted  blood,  evidently  a  part  of  the  clot 
formed  by  the  action  of  the  tinct.  ferri  chlor. 

Perfect  rest  was  enjoined,  and  injections  of  beef  tea 
and  brandy  were  administered  from  time  to  time  during 
the  next  twenty-four  hours.  The  following  day  he  was 
able  to  swallow  a  little  wine  and  beef  tea,  and  in  addi- 
tion to  the  small  clots  of  dark  blood,  a  little  muco-pus 
was  expectorated. 

He  continued  rapidly  to  improve,  the  external  wound 
healinff  by  first  intention,  and  there  being  no  inflamma- 
tion of  the  lung  beyond  the  immediate  vicinity  of  the  | 


wound.  He  is  now  (nine  days  after  the  injury)  able  to 
sit  up  in  his  bed,  and  attend  to  some  business.  ^ 

He  lost  his  voice  entirely  from  the  moment  he  was 
wounded,  and  has  not  yet  refined  it  He  can  only 
swallow  liquids,  in  small  quantities  at  a  time,  and  then 
by  an  effort  and  usin^  great  care,  as  there  is  a  disposi- 
tion for  them  to  pass  mto  the  larynx,  producing  violent 
paroxysms  of  coughing. 

These  phenomena  are  probably  due  to  section  of  the 
recurrent  laryngeal  nerve,  or  some  of  its  branches. 


©rtginol  itttntte. 


LECTURES  UPON 

THE 

PHYSICAL  EXPLORATION  OF  THE  ABDO- 
MEN. 

DHJVIRID  in  the  PRStlMIKART  COURSI  AT  THE  MEDICAL 
DEPARTMENT  OF  THE   UNTVERSITT  OF  NEW  YORK. 

Bt  ALFRED  L.  LOOMIS,  M.D., 

FBomflos  OF  us'iiTm-Ea  akv  pbactiob  or  mDioDrx. 

Lecture  III. 

Physical  Examination  of  the  KxdMys,  Bladder,  Uterus, 
and  Ovaries,  BtUes  for  Performing  Uterine  Ausad' 
iation. 

Gentlemen — This  morning  I  will  detail  to  you  as  briefly 
as  possible  rules  which  may  guide  you  in  physical  ex- 
aminations of  the  kidneys,  bls^der,  uterus,  and  ovaries. 
I  will  commence  with  the  kidneys.  The  kidneys,  as 
you  are  aware,  in  health  are  situated  in  the  lumbar  re- 
gions, in  the  space  corresponding  to  the  two  last  dorsal 
and  the  two  upper  lumbar  vertebrae ;  the  right  is  a  little 
lower  than  the  left.  Superficially,  they  extend  from 
the  eleventh  rib  to  the  os  ilii.  The  right  is  boimded 
above  by  the  posterior  and  inferior  portion  of  the  right 
lobe  of  the  liver:  below,  by  the  caecum;  anteriorly,  by 
the  ascending  colon ;  and  posteriorly,  by  the  spinid  col- 
umn. The  left  is  bounded  above  by  the  spleen,  anteri- 
orly and  inferiorly  by  the  colon,  and  posteriorly  by  the 
spinal  column. 

In  disease,  the  kidneys  may  be  increased  or  dimm- 
ished  in  size.  Atrophy  or  diminution  in  size  can  hardly 
be  determined  by  physical  examination,  so  that  enlarjjfe- 
ments  are  the  only  conditions  to  which  physical  explo- 
ration is  applicable.  The  kidneys  may  be  enlarged  from 
calculi,  pyelitis,  which  sometimes  converts  the  kidneys 
into  a  bag  of  pus,  cancerous  and  tubercular  deposits, 
hydatid  cysts,  and  simple  distension,  the  result  of  ob- 
struction of  a  ureter.  A  tumor  is  also  sometimes  de- 
veloped at  the  upper  border  of  a  kidney,  from  disease 
of  the  supra-renal  capsule. 

Inspedion  rarely  ramishes  any  evidence  of  enlarge- 
ment of  a  kidney.  And  not  unfrequently  after  exam- 
ining the  lumbar  regions  by  palpation  with  great  care, 
and  by  careful  comparison  of  the  two  sides,  we  are 
unable  to  recognize  any  change  in  the  size  of  these 
organs ;  but  as  soon  as  we  place  our  hand  anteriorly  and 
press  firmly  towards  the  normal  position  of  the  kidney, 
a  tumor  is  felt ;  then  by  pressing  the  tumor  backwards, 
our  other  hand  resting  on  the « lumbar  region  of  the 
same  side,  we  at  once  determine  that  this  tumor  has  its 
origin  in  the  kidney.  The  part  of  the  abdomen  in 
which  a  renal  tumor  is  felt  will  vary  according  to  the 
nature  of  the  disease,  and  the  portion  of  the  kidney  in- 
volved. 

Percussion, — ^In  percussing  the  kidneys^auscnltatoiy 
digitized  by  VjOO^^_ 


THE  MEDICAL  RECORD. 


535 


percussions  should  be  employed ;  the  patient  should  be 
placed  on  the  abdomen  and  chest,  which  position  will 
allow  fluid  accumulations  in  the  abdominal  cavity  to 
grayitate  forwards,  and  the  intestines  to  float  upwards. 
The  external  margin  of  the  kidneys  can  then  be  readily 
determined  by  the  tympanitic  note  of  the  intestines 
around  their  circumference,  except  where  they  are  in 
relation  with  vertebrse.  In  heaiwij  the  outlines  of  the 
renal  dulness  will  correspond  to  the  limits  already 
g^ven.  Any  enlargement  of  these  organs  will  cause  a 
corresponding  increase  in  tlie  area  of  renal  dulness; 
but  we  cannot  by  physical  examination  establish  the 
exact  nature  of  the  disease  to  which  the  increase  in  the 
organ  is  due. 

The  sources  of  error  in  the  diagnosis  of  enlargements 
of  the  kidneys  yary  according  as  the  right  or  left  kid- 
ney is  the  seat  of  disease. 

Enlargement  of  the  right  kidney  may  be  mistaken  for 
an  enlargement  of  the  right  lobe  of  the  liver,  for  cancer 
of  the  pyloric  orifice  of  the  stomach,  for  focal  distension 
of  the  colon,  and  for  enlargement  of  the  right  ovary. 
The  rules  for  distinguishing  it  from  each  of  these  have 
been  already  given  in  a  previous  lecture,  as  likewise  for 
distinguishing  enlargements  of  the  left  Kidney  from  en- 
largement of  the  spleen,  the  left  ovary,  and  from  fiecal 
distension  of  the  descending  colon. 

Bladder, — When  the  bladder  is  empty  its  position 
cannot  be  determined  by  physical  exploration;  it  can 
only  be  detected  when  it  is  distended,  and  rises  above 
the  pubes ;  when  this  is  the  case,  a  tumor  is  visible  in 
the  hypogastric  region,  which  on  palpation  is  smooth 
and  oval.  Its  circular  margin  is  easily  made  out  by 
observing  the  tympanitic  sound  of  the  intestines  on  the 
one  hand,  and  the  dull  sound  produced  by  the  bladder 
on  the  other.  In  infants,  the  bladder  is  not  as  deep  in 
the  pelvis  as  in  adults,  consequently  a  smaller  quan- 
tity of  urine  in  the  bladder  can  be  recognized.  A  dis- 
tended bladder  can  only  be  mistaken  in  the  female  for 
a  gravid  uterus,  or  a  uterine  tumor;  the  use  of  a  cath- 
eter removes  all  doubts. 

Uterus. — The  unimpregnated  uterus  in  its  normal 
state  is  situated  in  the  lower  part  of  the  hypogastrium, 
and  is  inaccessible  to  the  touch  (externally),  or  to  per- 
cussion ;  but  when  normaUy  developed  by  iinpregnation, 
or  abnormally  b^  disease,  palpation,  percussion,  and 
auscultation,  furnish  us  with  important  information. 

In  pregnancy,  at  the  end  of  the  second  month,  a  dull 
sound  on  percussion,  just  above  the  pubes,  indicates  the 
development  of  the  uterus:  later,  as  the  uterus  increases 
in  volume,  and  rises  into  tne  abdomen,  we  are  able,  by 
the  oval  tumor  felt  in  the  hypogastrium,  and  by  the 
circumscribed  area  of  dulness  corresponding  to  the 
situation  of  the  tumor,  to  establish  strong  presumptive 
evidencd  of  pregnancy.  The.  presumption  becomes 
strengthened  if  the  area  of  the  dulness  increases  with 
the  regularity  proper  to  gestation.  But  percussion*  and 
palpation  are  insufficient  to  determine  whether  the  de- 
velopment of  the  uterus  is  due  to  pregnancy,  or  to 
some  morbid  deposit  in  its  walls  or  cavity,  as  fibrous 
tumors,  etc. 

At  the  end  of  the  fifth  month,  the  evidence  furnished 
by  both  these  methods  is  inferior  to  auscultation. 

Rules  for  performing  Uterine  AuscidkUion. — The  pa- 
tient should  be  placed  on  her  back,  with  her  thighs 
lightly  flexed,  so  as  to  relax  the  abdominal  muscles ; 
sometimes  it  is  well  to  incline  the  body  from  one  side 
to  the  other,  or  forwards  so  as  to  withdraw  the  pres- 
sure of  the  uterus  from  the  pelvic  arteries.  The  abdo- 
men should  be  uncovered ;  as  the  sounds  to  be  examined 
are  of  slight  intensity,  and  very  circumscribed,  their 
study  demands  close  attention  and  perfect  silence.  The 
stethoscope  is  always  to  be  preferred,  and  the  uterine 


tumor  should  be  auscultated  successively  at  different 
points. 

After  the  fourth  month  of  gestation,  if  the  uterus 
contains  a  living  foetus,  we  may  hear  three  distinct 
sounds:  the  placental  bruity  which  is  evidently  con- 
nected with  the  circulation  of  the  mother;  the  fatal 
hearty  and  the  funic  souffle,  which  are  connected  with 
the  circulation  of  the  foetus. 

Placental  Bruit. — This  sound  is  wngle,  intermitting, 
and  in  character  is  a  combination  of  the  blowing  and 
hissing  sound :  it  increases  in  intensity  up  to  the  period 
of  labor.  It  is  believed  to  depend  upon  the  rapid  pas- 
sage of  blood  from  the  arteries  into  the  distended 
venous  sinuses.  It  is  synchronous  with  the  maternal 
pulse,  is  subject  to  the  same  variations,  and  is  always 
heard  before  the  pulsation  of  the  foetal  heart 

The  area  over  which  it  is  audible  varies.  In  some 
instances  it  is  limited  to  a  single  point,  in  others  it  is 
audible  over  a  surface  of  three  or  lour  inches,  and  in  a 
few  it  is  heard  over  the  whole  uterine  tumor;  al- 
though there  will  always  be  one  spot  of  greatest  inten- 
sity, corresponding  to  the  placental  attachment  It  is 
also  intensified  by  uterine  contractions. 

During  the  first  half  of  pregnancy,  it  is  usually  heard 
with  greatest  intensity  in  the  median  line,  a  little 
above  the  pubes ;  after  the  fifth  month  at  the  lateral 
and  inferior  borders  of  the  uterus,  and  next  in  order  of 
time  it  will  be  heard  at  the  fundus. 

This  sound  may  be  confounded  with  the  respiratory 
murmur  of  the  mother,  and  with  intestinal  murmurs ; 
these  murmurs,  however,  are  not  synchronous  with 
the  pulse  of  the  mother;  and  if  this  fact  is  remembered, 
there  will  be  Uttle  difficulty  in  disiinguishing  them.  As 
a  proof  of  pregnancy,  placental  bruit  is  not  positive,  as 
it  is  sometimes  heard  in  connection  with  uterine  and 
ovarian  tumors.  It  does  not  prove  that  the  foetus  is 
alive,  for  it  is  heard  for  a  time  after  its  death.  Its  neg- 
ative evidence  is  of  less  value ;  for  if  the  placenta  is 
attached  posteriorly,  we  may  not  be  able  to  hear  it, 
although  pregnancy  exist 

Funic  Souffle. — This  sound  is  usually  heard  at  a  point 
quite  remote  from  the  placental  bruit ;  it  is  short,  feeble, 
and  blowing  in  character,  and  corresponds  in  frequency 
with  the  loetal  pulsation.  It  is  supposed  to  depend 
upon  obstruction  to  the  transmission  of  blood  through 
the  umbilical  arteries,  as  fi-om  twisting  or  knotting  of 
the  fimis,  or  firom  external  pressure ;  it  is  not  a  constant 
nor  even  a  freauent  sound ;  xhe  conditions  which  pro- 
duce it  are  rar^y  met  with. 

Fceial  Heart  Sound. — This  sound  conskts  of  a  succes- 
sion of  short,  rapid,  double  pulsations,  varying  in  fre- 
quency fi-om  120  to  140  per  minute.  The  first  sound 
is  short,  feeble,  and  obscure,  while  the  second  (the  one 
we  usually  hear)  is  loud  and  distinct,  and  may  be 
heard  over  the  body  and  limbs  of  the  child.  This 
sound  has  been  aptly  compared  to  the  ticking  of  a 
watch  wrapped  in  a  napkin,  and  is  usually  first 
heard  at  the  middle  of  the  fourth  month.  The  fre- 
quency of  the  pulsatioEs  does  not  vary  with  the  age  of 
the  foetus.  The  extent  over  which  the  foetal  heart 
sound  is  audible  varies ;  usually  it  is  transmitted  over  a 
space  three  or  four  inches  square.  The  location  of  the 
sound  is  determined  by  the  position  of  the  foetus.  It 
has  been  stated  that  by  drawing  a  horizontal  line,  and 
dividing  the  uterus  into  two  equal  parts,  whenever 
the  maximum  of  intensity  of  the  sound  is  below  this 
line,  it  is  a  vertex  presentation;  when  above  it,  a 
breech ;  also  when  the  foetal  pulsations  are  heard  low 
down  in  front  on  the  left  side,  that  the  foetus  is  in  the 
first  position  (EL  0.  I.) ;  if  heard  below,  and  in  front 
on  the  right  side^  it  is  in  the  second  position  (L.  0. 1). 

Twin  pregnancy  may  sometimes  be  determined  i>y: 


536 


THE  MEDICAL  RECORD. 


the  presence  of  heart  sounds  beard  at  distant  points 
over  the  uterine  tumor,  and  by  the  absence  of  syn- 
chronism in  the  two  pulsations.  The  sources  of  decep- 
tion in  exploring  for  the  foetal  heart  sound  are  the 
liability  of  confounding  the  pulsations  of  the  iliac  or 
abdominal  arteries  of  the  mother  with  it ;  in  most  cases 
their  situation,  comparative  frequency,  and  absence  of 
double  pulsation,  will  determine  their  character.  But  a 
difficulty  will  sometimes  occur  in  discriminating  be- 
tween them  when  the  maternal  pulse  is  very  much  in- 
creased in  frequency,  and  the  foetal  diminished.  Under 
such  circumstances  we  must  be  guided  by  the  character 
of  the  sound ;  and  if  it  is  or  is  not  synchronous  with 
the  radial  pulse. 

Again,  in  the  early  stage  of  pregnancy,  the  intensity 
and  impulse  of  the  maternal  pulsation  may  render  the 
feeble  foetal  sound  inaudible ;  changing  the  position  of 
the  foetus,  and  thus  removing  the  pressure  of  the  uterine 
tumor  from  the  subadjacent  arteries,  will  obviate  this  dif- 
ficulty. During  labor  our  examination  should  be  made 
in  the  interval  between  uterine  contractions.  In  pro- 
tracted labors  auscultation  is  of  value  in  indicating  to 
us  the  time  for  manual  or  instrumental  interference,  in 
order  to  save  the  life  of  the  child.  The  indications  of 
danger  to  the  child  are  feebleness  or  excessive  fre- 
quency of  the  foetal  pulsation,  irregularity  in  its  rhythm, 
absence  of  the  second  sound,  its  complete  cessation 
during  uterine  contraction,  and  the  slowness  of  its  return 
in  the  interval ;  irregularity  and  feebleness  are  the  most 
threatening  to  the  life  of  the  child.  When  the  sound 
of  the  foetal  heart  is  heard,  it  is  always  a  proof  of  preg- 
nancy, but  its  absence  is  not  positive  evidence  that 
pregnancy  does  not  exist;  for  the  foetus  may  be  dead, 
and  in  some  rare  cases  the  sounds  may  exist  and  be 
quite  inaudible  for  a  time,  and  then  appear.  This  phe- 
nomenon is  not  easily  accounted  for. 

Tumors  of  the  uterus^  whether  developed  on  its  sur- 
face, in  its  walls,  or  within  its  cavity,  give  rise  to  en- 
largements of  the  organ,  which  cause  it  to  occupy  a 
position  corresponding  to  that  occupied  by  a  gravid 
uterus.  The  position  and  extent  of  these  enlargements 
are  determined  in  the  same  manner  as  we  determine 
the  size  and  position  of  the  uterus  in  pregnancy.  De- 
posits in  its  walls  or  on  its  surface  give  rise  to  nodules, 
which  feel  through  the  abdominal  walls  like  hard  balls, 
varying  in  size  and  shape,  seldom  occurring  singly. 
The  whole  mass  can  usuaUy  be  moved  from  one  side  to 
the  other.  The  connection  of  these  tumors  with  the 
uterus,  as  determined  bv  the  uterine  sound,  leaves  little 
doubt  as  to  their  true  character ;  and  by  this  means  we 
readily  distinguish  them  from  all  other  abdominal  tu- 
mors. 

Ovaries. — The  ovaries  in  a  normal  state  lie  in  the 

Eelvic  cavitv,  and  their  position  cannot  be  determined 
y  phvsical  exploration;  but  when  they  become  the 
seat  of  those  forms  of  disease  which  cause  their  enlarge- 
ment, and  have  attained  such  dimensions  that  there  is 
no  longer  room  for  them  in  the  pelvic  cavity,  they 
ascend  above  the  brim  of  the  pelvis,  and  occupy  more 
or  less  space  among  the  abdominal  organs.  As  they 
pass  out  of  the  pelvis  they  are  6rst  noticed  in  the  right 
or  left  inguinal  region,  according  as  the  right  or  led 
ovary  is  alected,  and  tney  are  then  recognized  as  ova- 
rian tumors.  Often,  before  these  ovarian  enlargements 
have  attained  sufficient  size  to  attract  the  attention  of 
the  patient^  they  will  have  reached  a  central  position  in 
the  abdominid  cavity.  They  are  of  more  frequent  oc- 
currence than  all  other  forms  of  abdominal  tumors,  and 
their  existence  is  determined  almost  exclusively  by  the 
physical  signs  which  they  furnish. 

Inspection, — In  the  early  part  of  their  development  an 
uneven  projection  or  prominence  of  one  part  of  the  ab- 


domen will  disclose  the  seat  of  the  tumor,  occupying 
usually  the  iliac  or  lumbar  region  of  one  side,  and  ex- 
tending upward  to  or  beyond  the  umbilicus ;  while  in 
more  advanced  cases  no  irregularity  will  be  visible,  but 
the  rounded  form  of  the  abdomen  (while  the  patient 
lies  on  her  back)  offers  a  strong  contrast  to  the  flat- 
tened oval  appearance  of  ascites,  or  the  central  rounded 
form  of  a  uterus  distended  by  pregnancy. 

PalpaHon. — Ovarian  tumore,  when  small,  have  a 
firm,  elastic  feel;  but  when  large,  they  are  soft  and 
fluctuating.  In  some  cases,  by  passing  tiie  band  gently 
over  the  abdomen,  the  extent  of  the  tumor  will  bd 
readily  appreciated.  At  other  times,  the  limits  of  the 
tumor  cannot  be  ascertained  by  gentle  palpation,  for  it 
occupies  the  whole  of  the  abdomen,  except  the  concav- 
ity of  the  diaphragm.  In  such  cases,  by  making  firm 
but  not  forcible  pressure  on  various  parts  of  the  abdo- 
men, we  often  detect  at  once  a  general  sense  of  fluctu- 
ation, and  ascertain  inequalities  which  neither  the  eye 
nor  tne  hand,  when  passed  gently  over  the  surface,  will 
enable  us  to  detect;  and  sometmies  if  the  abdomen  is 
not  tense,  we  can  feel  masses  which  convey  the  impres- 
sion of  more  or  less  flattened  or  spherical  bodies  at- 
tached to  the  inside  of  a  fluctuating  tumor.  In  some 
cases,  the  sense  of  fluctuation  is  very  indistinct;  in 
others  it  is  even  more  evident  than  fa  cases  of  extensive 
ascites. 

Percussion, — The  sound  elicited  on  percussion  is  flat 
over  that  portion  of  the  abdomen  where  the  tumor 
comes  in  contact  with  the  interior  surface  of  the  ab- 
dominal wall ;  while  at  the  side,  and  above  where  the 
intestines  have  been  pushed  aside  and  upwards  by  the 
tumor,  the  percussion  sound  will  be  tympanitic;  by 
this  change  in  the  percussion  sound  we  are  enabled  to 
mark  out  the  boundaries  of  the  tumor. 

Differential  Diagnosis,— OYwrian  tumors  may  be  con- 
founded in  their  diagnosis  with  uterine  enlargements  (as 
pregnancy,  fibroid  tumors  of  the  uterus,  etc.),  asctie*^ 
nySoUids  of  the  omentum^  foecal  accumidaiions  in  the  in- 
testinesj  and  enlargements  of  the  liver,  spleen,  and  kid- 
ney. 

They  are  distinguished  from  pregnancy  by  a  stetho- 
scopic  examination  of  the  tumor,  which  reveals  in  the 
one  case  the  sounds  of  the  foetal  hearty  and  in  the 
other  their  absence.  They  are  distinguished  from  ute- 
rine tumors  by  their  different  consistency,  by  the  dif- 
ference in  their  outline,  by  the  difference  in  tneir  con- 
nection and  relative  position  to  the  uterus,  and  by  the 
fact  that  in  uterine  tumors  the  cavity  of  the  uterus,  as 
determined  by  the  uterine  sound,  is  always  elongated. 
The  diagnosis  between  ovarian  and  abdominal  dropsy 
is  made:  Ist,  by  observing  the  difference  in  the  shape 
of  the  abdomen  when  the  patient  lies  on  her  back; 
ovarian  tumors  project  forward  in  the  centre,  while  in 
ascites  the  abdominal  enlargement  is  uniform.  2d.  In 
ovarian  tumors  the  percussion  sound  is  dull  as  high  aa 
the  tumor  extends,  while  at  the  same  time  there  will 
be  tymp  'uitic  resonance  in  the  most  depending  portion 
of  the  abdominal  cavity ;  in  ascites  the  most  depending 
portion  of  the  abdomen  is  always  flat,  the  percussion 
resonance  being  confined  to  the  epigastric  and  umbili- 
cal region.  3(L  In  ovarian  dropsy  the  relative  line  of 
flatness  and  resonance  is  not  altered  by  change  in  the 

g><*ition  of  the  patient,  which  is  not  the  case  in  aadtea. 
ydatids  of  the  omentum  form  a  class  of  tumors  whidi 
you  will  be  unable  by  physical  signs  to  distinguish  from 
ovarian  tumors.  The  fact,  however,  that  these  omental 
enlargements  are  first  noticed  above  the  umbilicus,  and 
gradually  enlarge  downwards,  while  ovarian  are  first 
noticed  low  down  in  the  abdomen,  and  gradually  en- 
large upwards,  will  in  most  casey^e  sufficient  for  a 
diagnosis.  Digitized  by  VjC  _      ^  _ 


THE  MEDICAL  RECORD. 


537 


Fascal  accumulations  in  the  large  intestines  may  be 
mistaken  for  oyarian  tumors ;  the  peculiar  feel  of  such 
tumors  (which  has  already  been  described)  will^  how- 
ever, enable  you  to  distinguish  them  from  ovarian  tu- 
mors. 


l&£)T0tt0  of  i^oepitais. 


BELLEVUE  HOSPIT^. 

FRACTURE    AT    THE    BASE     OF   THE 

BRAIN. 

SXTENSIVB     OEKTRIO    APOPLBXT;     ANOMALOUS     OOKDITION 
OF  PUPILS. 

Beported  bt  Cqarlis  S.  Bull,  M.D.,  Senior 
Assistant  Phtsioian. 

Sbstiok  of  Db.  MoCrxadt. 

Hknrt  de  Tour,  aged  sixty,  married,  a  native  of  Canada, 
and  by  occupation  an  engineer,  was  admitted  to  Ward 
14  of  the  Bellevue  Hospital,  Nov.  2, 1867,  at  10  a.m.  No 
history  or  facts  of  any  kind  were  brought  witii  the 
patient  relative  to  his  physical  condition.  He  had  been 
a  night-watchman  at  the  Academy  of  Mu<»ic,  and  was 
found,  early  in  the  morning  of  admission,  in  an  insensi- 
ble condition. 

On  admission,  the  patient  was  comatose ;  his  breathing 
was  stertorous,  his  pulse  116  in  the  minute,  and  yery 
feeble.  His  tongue  was  moist  and  slightly  coated,  and 
the  surface  of  the  body  was  cooL  The  right  pupil  was 
dilated,  the  left  ooe  contracted.  There  was  some 
oedema  of  the  lower  extremities;  and  this,  in  connection 
with  his  comatose  condition,  had  caused  him  to  be  sent 
to  the  medical  side  of  the  hospital,  as  a  case  of  ursemic 
coma. 

His  wife  stated  that  for  some  time  back  he  had  suf- 
fered from  nausea  and  vomiting,  uid  frontal  headache, 
and  she  gave  a  pretty  clear  history  of  Bright's  disease. 

About  a  year  ago  he  had  been  attacked  with  a  con- 
vulsion, from  which  he  soon  recovered,  and  he  had  had 
none  since. 

^  Over  the  right  temple  was  a  large  tumor,  about  the 
size  of  a  smaU  orange,  bluish-black  in  color,  and  hav- 
ing three  small  cuts  on  its  surface,  none  of  which  ex- 
tended through  the  integument  The  patient  was 
grinding  his  teeth,  and  euiibited  tonic  contraction  of 
tne  muscles  of  the  extremities. 

The  urine,  on  examination,  revealed  albumen  and 
hyaline,  and  granular  casts.  A  diagnosis  was  made  of 
coma  from  urssmic  poisoning,  and  olei  crotonis  gtt.  iij. 
w^ere  administered,  but  without  the  desired  result,  and 
the  dose  was  repeated.  The  hot-air  bath  was  then  tried, 
in  hopes  of  bringing  on  diaphoresis,  but  failed  utterly ; 
and  notwithstanding  all  the  means  employed  for  his 
relief,  the  patient  sank,  and  died  at  half-past  three 
P.M.  of  the  same  day,  the  stertorous  respiration  and 
coma  having  continued  until  the  last. 

Autopsy  eighteen  hours  after  death.  Bigor  mortis 
Tvell  marked.  On  cutting  into  the  tissues  of  the 
Bcalp,  they  were  found  to  be  infiltrated  with  blood. 
On  separating  the  scalp  from  the  pericranium,  a 
large  collection  of  coagulated  blood  was  found  beneath 
the  tendon  of  the  occi pi to-fron talis  muscle,  iust  under 
the  point  of  external  swelling.  The  temporal  and  occi- 
pital arteries  of  the  right  side  were  both  ruptured,  and 
their  lacerated  extremities  could  be  dissected  out  amid 
the  tissues  of  the  Scalp.  No  point  of  fracture  could  be 
detected  oyer  any  portion  of  the  vault  of  the  cranium. 

On  removing  the  calvarium,  the  dura  mater  was 


found  to  be  intensely  congested,  and  a  large  amount  of 
fluid  blood  was  found  between  this  membrane  and  the 
skulL  There  were  no  signs  of  inflammation  to  be  de- 
tected. There  was  also  considerable  blood  extravasated 
in  the  subarachnoid  space.  The  brain  was  very  much 
soflened,  so  as  to  be  removed  with  great  difficulty.  It 
was  very  much  congested,  and  from  the  amount  of 
blood  found  beneath  the  anterior  lobes  of  the  cerebrum, 
it  was  supposed  that  the  anterior  cerebral  arteries  had 
been  ruptured.  The  arteries  of  the  brain  were  to  all 
appearances  healthy,  no  atheroma  having  been  discov- 
ered. On  slicing  open  the  brain,  the  entire  right  hemi- 
sphere of  the  cerebrum  was  found  to  be  hollowed  out ; 
tne  brain  substance  apparently  goue,  as  no  trace  of  it 
could  be  found,  and  its  place  occupied  by  an  immense 
clot  of  blood,  filling  all  three  of  the  lobes.  A  smaller 
clot,  about  the  size  of  a  pigeon's  egg,  was  found  occu- 
pying the  anterior  lobe  of  the  left  hemisphere. 

An  examination  of  the  base  of  the  skull  revealed  a 
stellated  fracture  of  the  petrous  portion  of  the  right 
temporal  bone,  commencing  Just  over  the  internal  ear, 
and  extending  about  half  an  inch  in  various  directions; 
but  it  did  not  reach  across  the  median  line. 

The  contents  of  the  thorax  were  in  a  healthy  condition. 
The  abdominal  organs  were  normal,  with  the  exception  of 
the  kidneys.  These  were  of  the  small,  fibrous,  con- 
tracted variety,  weighing  but  five  ounces  together.  The 
cortical  portion  had  nearly  entirely  disappeared  in  both, 
and  the  left  one  contained  a  few  small  cysts. 

The  case  presents  several  points  of  interest,  which 
are  as  follows :  1st.  Prom  the  presence  of  the  clots,  both 
pupils  should  have  been  dilated,  whereas  the  left  one 
was  firmly  contracted.  2d.  Was  the  fracture  found  at 
the  base  of  the  skull  produced  by  a  fall  while  the 
patient  was  in  a  ursemic  convulsion,  or  was  it  the  result 
of  a  blow  ?  3d.  The  presence  of  a  fracture  at  the  base, 
while  no  lesion  could  be  found  in  the  vault 


pr0gre««  of  iEeWcal  ^cxenct. 


Finr-oWB  Gasis  of  Ovariotomy. — ^Thomas  Keith, 
F.RC.S.,  gives  in  a  recent  number  of  the  Lancet  a  tabu- 
lated statement  of  fifty-one  cases  of  ovariotomy  which 
he  has  performed,  of  which  the  following  is  a  summa- 
ry: 

Of  51  operations,  there  wevp  40  recoveries  and  11 
deaths.  The  average  duration  of  the  disease  was  a 
little  more  than  two  years,  and  28  had  been  tapped 
once  or  oflener  before  the  operation.  The  youngest  was 
16,  the  eldest  68  years  of  age ;  26  were  married,  25 
unmarried.  Under  22  and  above  52,  all  recovered. 
Of  16  above  45,  all  recovered  save  one.  Of  5  cases  in 
which  both  ovaries  were  removed,  4  recovered.  The 
average  weight  of  the  tumors  was  34  lbs. ;  that  of 
the  fatal  cases  42  lbs.  The  smallest  was  a  semi-solid 
mass  of  7  lbs.,  in  a  case  where  a  large  cyst  had  burst  a 
fortnight  before.  The  largest  was  upwards  of  120  lbs. 
A  great  part  of  it  had  to  be  dissected  out.  Its  re- 
moval was  the  most  formidable  proceeding  he  was  ever 
concerned  in,  and  it  is,  so  far  as  he  was  aware,  the  largest 
tumor  ever  removed  successfully  from  the  living 
body.  Adhesions,  if  not  in  the  pelvis,  do  not 
seem  to  him  to  influence  much  the  result  of  ova- 
riotomy. In  the  cases  of  single,  or  nearly  single,, 
unattached  cysts,  nothing  could  be  simpler  than  the- 
operation,  and  in  several  the  cicatrix  is  now  not  more- 
noticeable  than  the  umbilicus.  The  majority,  how- 
ever, were  extremely  severe  operations — m  not  a  few 
extending  over  two  hours :  and  the  recovery  of  many 
was  very  remarkable.     Only  three  were  absolutely 


538 


TBOE  MEDICAL  RECORD. 


unilocular  cysts.  In  9  cases  the  tumor  was  through- 
out Bemi-sohd.  All  of  these  recoyered  saye  one.  These 
tumors  were  cut  into  and  broken  up  by  the  hand, 
and  remoyed  through  as  small  an  incision  as  possible. 

BEMoyiNo  Particles  of  Foreign  Matter  from  Ete- 
— Dr.  E.  M.  Moore  recently  informed  me  of  a  method 
for  remoying  particles  of  foreign  matter  from  the  con- 
junctiyal  fold  m  cases  where  other  means  seem  insuffi- 
cient. It  consists  in  scarifying  the  lid  in  the  usual 
way,  then  closing  the  eye  and  allowing  the  blood  to  co- 
agulate and  entangle  the  irritating  substances  in  the 
clot.  When  the  latter  is  remoyed  it  brings  away  the 
foreign  particles  with  it.  This  process  was,  I  beueve, 
originated  and  frequently  practised  by  the  late  Dr. 
Munn,  who,  a  few  years  ago,  had  a  great  reputation  for 
skill  and  tact  in  the  management  of  eye  diseases. — ^Dr. 
C.  E.  Rider,  Rochester,  N.  T. 

Mental  Medicine. — ^At  the  meeting  of  the  Academy 
of  Medicine,  September  17,  1867  {Gaz,  Mehdam.),  Dr. 
Lisle  read  a  note  upon  the  treatment  of  cerebral  con- 
gestion and  hallucination  by  arf^nious  acid.  The  con- 
clusions of  his  paper  are  the  following :  "  The  insane 
often  present  symptoms  of  cerebral  congestion.  This  is 
always  the  case  with  those  laboring  under  hallucina- 
tions. Of  one  hundred  and  ninety -three  of  the  latter, 
treated  by  arsenious  acid,  one  hundred  and  thirty-one, 
or  sixty-seven  per  cent,  were  cured,  and  twenty-seyen 
experienced  a  marked  and  permanent  improyement 
Hallucination,  hitherto  considered  as  a  symptom  of  in- 
sanity, is  simply  a  complication  ne^ly  always  graye. 
It  is  the  most  characteristic  symptom  of  cerebral  con- 
gestion. Arsenious  acid  is  a  remedy  really  specific  in 
the  disease.  It  is  also  yery  useful  in  cases  of  paralysis, 
incoherency,  melancholia,  etc.,  free  from  hallucinations, 
but  presenting  the  evident  signs  of  cerebral  congestion. 
Arsenious  acid,  administered  with  prudence  and  watched 
with  care,  is  one  of  the  most  inofiensive  agents  of  the 
materia  medica.  The  dose  yaries  from  five  to  sixteen 
milligrammes  (one-thirteenth  to  one-quarter  grain)  ad- 
ministered three  times  a  day  at  the  beginning  of  each 
meal." 

Large  Aneurism  of  Femoral  Treated  SuocESsruLLT  bt 
Compression  op  the  Aorta. — Mr.  Geo.  Lawson  (Lancet) 
reports  a  case  of  the  above  which  occurred  at  the  Mid- 
dlesex Hospital.  The  patient  was  a  stableman,  thirty- 
six  years  of  age,  otherwise  in  good  health.  At  first  a 
Carte's  compressor  was  applied  to  the  femoral,  but  no 
cure  resulting  a  resort  was  had  to  the  compi*ession 
of  the  aorta  by  Lister's  compressor.  The  operation 
and  its  result  are  thus  described : 

On  October  10th,  at  three  o'clock  p.  m.  (the  bowels 
having  been  completely  emptied  by  an  enema),  the 
man  was  placed  thoroughly  under  the  influence  of  chlo- 
roform. A  Lister's  tourniquet  was  applied  over  the 
abdominal  aorta  just  above  the  umbilicus,  and  another 
tourniquet  was  placed  firmly  over  the  femoral  artery 
just  below  the  aneurism.  Mr.  Moore  took  charge  of 
the  tourniquet  over  the  aorta,  whilst  Mr.  Lawson  kept 
his  finger  on  the  artery  just  above  the  aneurism,  to  watch 
if  any  blood  passed  mto  the  tumor.  The  tourniquets 
were  kept  on  for  twenty-three  minutes;  only  once  at  the 
end  of  the  fourth  minute  did  a  wave  of  blood  pass  into 
the  sao  of  the  aneurism,  when  the  tourniquet  over  the 
aorta  was  at  once  tightened;  but  for  the  remaining 
nineteen  minutes  absolute  compression  of  the  vessd 
was  maintained,  and  no  blooa  entered  the  tumor. 
The  man  became  now  somewhat  collapsed,  and  began 
to  retch.  The  tourniquets  were  then  removed  and  the 
administration  of  the  chloroform  stopped.  The  pulsa- 
*ion3  in  the  tumor  were  diminished,  but  they  were 


perfectly  regular.  It  was,  however,  impossible  to  say 
whether  the  diminution  of  the  pulsations  were  not 
due  to  the  collated  state  of  the  patient  The  man 
was  returned  to  his  bed,  and  the  Carte's  compressor  re- 
adjusted over  the  artery.  When  the  effects  of  the 
chloroform  had  completely  passed  off*,  he  complained  of 
coldness  and  numbness  of  the  legs,  with  soreness  in  the 
belly.  At  seven  o'clock  in  the  evening,  finding  that  all 
pulsation  had  ceased  in  the  aneurism,  the  man  himself 
removed  the  compressor.  The  house-surgeon  was  at 
once  sent  for,  and  he  found  that  there  was  no  longer 
any  pulsation  in  the  tumor.  Since  that  time  the  maa 
has  continued  to  improve.  With  the  exception  of  some 
feeling  of  soreness  m  the  belly,  which  lasted  for  about 
Uiirty-six  hours,  the  patient  suffered  no  inconvenienoe 
from  the  treatment  October  17th. — The  aneurismal  sao 
is  now  felt  as  a  hard  oval  mass ;  the  artery  which  leads 
to  it  pulsates  strongly,  but  aU  impulse  ceases  at  the 
upper  edge  of  the  tumor. 

Treatment  op  Scarlatina,  by  Dr.  Dyes. — ^Accord- 
ing to  Dr.  Dyes,  the  course  of  scarlatina  depends  en- 
tirely upon  the  intensity  of  the  inflammation  of  the 
throat  accompanying  the  exanthema,  and  which,  being 
identical  with  diphtheritis,  requires  the  same  treatment 
as  does  the  latter.  He  reconmiends  chlorine  water 
as  the  only  effectual  means  to  the  end  desired,  and 
claims  to  have  had  abundant  opportunity  of  conyinc- 
ing  himself  thereof  in  one  hundred  and  sixty-three 
successful  cases  of  diphtheritis,  and  five  of  scarlatina, 
in  all  of  whidli  the  remedy  was  employed  within  the 
first  five  days  of  the  disease.  When  gangrene  had  com- 
menced, which  is  usually  on  the  sixth  or  seventh  day, 
the  results  were  less  favorable.  The  use  of  gargles  of 
borax,  alum,  etc.,  is  pronounced  utterly  valueless,  as 
also  the  administration  of  chlorate  of  potassa,  which, 
moreover,  is  always  given  in  far  too  small  doses.  The 
author  gives  children  under  three  years  old  the  chlorine 
water  diluted  with  one-third  its  bulk  of  water,  to  those 
between  three  and  seven  years  old  with  one  pari  in  four 
of  water,  and  above  the  a^  of  seven,  unadulterated. 
The  frequency  of  its  admmistration  depends  on  the 
stage  and  the  severity  of  the  disease.  During  the  first 
three  days  of  the  disease  he  gives  a  teaspoonful  three 
or  four  times  a  day ;  afterward,  according  to  circum- 
stances—every two  hours,  or  every  hour.  It  is  neces- 
sary to  guard  against  the  decomposition  of  tiie  chlorine 
water.  To  this  end  it  is  essential  that  the  dose  be 
swallowed  rapidly,  as  its  efficacy  is  otherwise  decidedly 
lessened ;  and  also,  that  no  other  drink  be  permitted 
for  some  little  time  after.  The  author  bases  the  tfficacy 
of  this  method  on  the  antiseptic  and  anti-miasmatio 
qualities  of  the  chlorine,  whereby  the  spores  of  a  pecu- 
liar species  of  plant  rrom  which  the  diphtheria  is 
developed,  are  aestroyed.  He  also  recommends  the 
taking  of  ^mall  doses  of  chlorine  water  daily,  as  a  pro- 
phylactic by  those  exposed  to  the  infection  of  scarlii- 
tint^.—Deutsche  Klinik,  1867,  No.  T.—Zeitschrift  Jur 
Medicin,  etc, 

CONOERNINO  the    PoSSIBILrrY    OP     GAJ^VANlZINa    THE 

Brain  and  Spinal  Cord  in  the  Human  Subject.  By 
Dr.  Erb.  (From  a  paper  read  before  the  Medical  Na- 
tural History  Association,  at  Heidelberg.) — One  of  the 
most  important  questions  concerning  the  application  of 
the  galvanic  current  to  therapeutical  purposes  is  that  of 
the  practicability  of  reaching  with  this  current  individ- 
ual portions  and  organs  of  the  body.  The  possibility 
of  thus  reaching  the  great  centres  of  the  nervous  sys- 
tem—  the  brain  and  spinal  cord  —  is  considered  by 
Remak,  Benedikt,  Brenner,  and  others,  as  a  matter  ol 
course ;  whereas,  Ziemssen,  in  the  last  edition  of  his 
work  on  Electro-Therapeutics,  declares  himself  deci- 


THE  MEDICAL   RECORD. 


539 


dedlj  of  opinion  that  these  nervous  centres  cannot 
be  reached  either  ij  constant  or  induced  currents 
through  any  appliances  at  present  employed  in  thera- 
peutics. 

As  the  settlement  of  this  question  is  one  of  no  little 
importance,  Dr.  Erb  undertook  a  careful  investigation 
of  the  same,  and  gives  us  the  following  results :  As  a 
test,  various  experiments  were  tried  on  the  dead  body, 
and  they  invariably  proved  that  on  application  to  the 
cranium  of  even  weak,  constant,  and  mduced  currents, 
these  spread  into  the  substance  of  the  brain  with  such 
force  as  distinctly  to  contract  the  muscles  of  the  frog's 
leg,  the  nerve  whereof  was  in  contact  with  the  brain. 
One  is  thus  led  to  the  conclusion  that  it  is  thoroughly 
practicable  to  reach  the  encephalon  through  the  cra- 
nium, with  the  appliances  at  present  employ^,  and  that 
in  such  cases  the  dizziness,  dea&ess,  distress,  and  faint- 
ness  induced,  are  to  be  re^rded  as  evidence  of  the  di- 
rect excitation  of  the  bram.  Induced  currents  pene- 
trate this  organ  with  equal  &cility,  but  produce  as 
trifling  effects  therein  as  they  do  on  the  retina,  and 
other  higher  nerves  of  sense.  In  the  spinal  cord, 
where  the  relations  of  the  superjacent  tissues  are  some- 
what different  from  those  of  the  head,  experiments  have 
given  the  same  result,  via.  that  by  the  ordinary  ap- 
plication of  the  electrodes  to  the  back,  a  constant  cur- 
rent penetrates  to  the  cord  itself.  Experiments  on  the 
living  body  leave  scarcely  room  for  doubt  that  by  the 
changing  or  interruption  of  these  currents  a  lively  ex- 
citement is  induced  in  the  nerves  lying  within  the 
spinal  canal,  and  that  thus  the  value  of  the  application 
of  electro-galvanic  currents  to  the  spinsd  cord  is  estab- 
lished. The  author  confirms  former  testimony  to  the 
effect  that  the  constant  galvanic  current  is  the  one  to 
be  preferred  in  treating  affections  of  the  great  nerve 
centres. — HMdherger  Jahrhucher  der  LiiercUur,  1867. 
Zeitschrift  der  MediciUj  etc,,  Leipzig. 

Citrate  of  Soda  in  Diabetes. — The  Journal  of  Med- 
ical Chemistry  calls  attention  to  a  fact,  which  if  confirm- 
ed, will  be  fruitful  of  the  most  important  consequences. 
We  refer  to  the  property  of  citrate  of  soda,  in  causing  to 
disappear  glucose  in  diabetic  urine.  This  indeed  ap- 
pears the  result,  fi-om  a  good  many  experiments  with 
the  salt.  It  was  administered  in  the  dose  of  from  4  to 
8  ^mmes  a  day,  mixed  with  the  food,  as  common  salt. 

What  is  its  mode  of  action  ?  It  possesses  this  ad- 
vantage over  the  carbonate  of  soda,  that  it  wUl  not 
interfere  with  the  digestive  functions,  and  it  furnishes 
in  a  more  efficacious  manner  the  alkaline  carbonate 
necessary  to  the  chemical  transformation  of  glucose. 
The  experiments  will  continue. — IJa  France  Medicate. 

Uraohus  Pervious  after  Birth. — Of  this  Dr.  G.  J. 
Townsend  relates  the  following  case  :  "  I  was  asked  to 
see  a  negro  child,  five  days  old,  and  was  told  that  he 
was  passing  his  water  through  his  belly.  The  urine 
bubbled  fireely  from  the  umbihcus  every  time  the  infant 
cried  or  made  any  great  exertion.  The  cord  had  sepa- 
rated normally,  and  ihe  child  was  in  every  otner 
respect  vigorous  and  healthy.  There  was  evidently 
ulceration  of  the  surface,  lefb  by  the  separation  of  the 
cord.  The  urethra  was  entirely  pervious.  The  ulcer- 
ated surface  was  freely  cauterized,  and  the  edges  of  the 
opening  were  brought  into  close  apposition,  and  kept 
there  by  a  strip  of  adhesive  plaster  firmly  applied  in  a 
longitudinal  direction.  This  was  still  further  secured 
by  a  compress  of  cord  covered  with  wash-leather,  and 
kept  in  ^sce  b^r  being  stitched  to  a  closely  fitting 
swathe.  The  patient  was  well  in  four  days,  when  the 
swathe  was  removed. — Boston  Med.  and  Surg.  Journal. 

Case  or  iNTBRMimNT  Obohitu. — ^Dr.  W.  H.  Morton 


reports  a  case  of  intermittent  fever,  to  which  he  was 
called,  and  which  yielded  readily  to  quinine.  In  about 
ten  days  was  again  called  to  see  the  same  patient^ 
who  had  accidentally  bruised  his  testes.  At  the  time 
of  the  visit  patient  complained  of  severe  pain  in  the 
left  testis.  The  organ  was  hot,  tender,  and  enormously 
swollen,  presenting  the  ordinary  symptoms  of  acute 
orchitis.  Hot  hop  fomentations  were  ordered,  the 
parts  were  kept  elevated,  and  morphia  was  administered 
to  quiet  the  pain.  On  the  following  morning  the 
patient  was  very  much  better,  but  the  same  symptoms 
returned  at  the  same  time  the  following  night,  suggest- 
ing an  intermittent  tendency.  He  was  ordered  qumin. 
suTph.  one  scruple,  to  be  tsken  during  the  intermission. 
The  patient  had  no  further  paroxysms,  and  speedily 
recovered. — N.  Y.  Med.  Journal, 

Treatment  or  Intermittsnt  Fever  bt  Chloroform 
internally. — Six  cases  of  intermittent  fever  are  report- 
ed by  Dr.  Bricket^  in  the  Chicago  Med.  Ikoaminerj  which 
were  treated  with  chloroform,  with  the  happiest  results. 
In  some  of  the  cases  quinine  had  been  administered,  but 
had  not  broken  up  the  chHls.  In  each  case  one  drachm 
of  chloroform  was  given,  with  the  immediate  effect  of 
giving  a  quiet  sleep  of  fi-om  1  to  2  hours,  and  no  further 
medication  became  necessary.  The  cases  in  which  the 
drug  was  given  were  all  uncomplicated,  and  the  result 
was  in  the  highest  degree  satisfactory.  Further  trial 
of  chloroform  in  this  disease  is  recommended. 

Chloroform  in  Pernicious  Fever. — ^In  the  Richmond 
Med.  Journal^  Dr.  S.  Eagon  says  :  "  My  attention  was 
first  directed  to  chloroform  achninistered  internally,  in 
1880,  by  Dr.  Fenner,  of  New  Orleans,  who  had,  prior 
to  that  period,  employed  it  with  very  gratifying  effects 
in  several  cases,  as  well  as  in  the  cold  stage  of  ordinary 
intermittents,  with  like  results.  Dr.  F.  says:  *From 
the  very  prompt  and  happy  effects  experienced  in  the 
limited  number  of  cases  in  which  I  have  seen  the 
remedy  exhibited^  I  am  inclined  to  regard  chloroform, 
internally  administered  in  the  dose  of  from  half  a 
drachm  to  a  drachm,  repeated  in  the  interval  of  16  or 
20  minutes,  as  possessing  more  potency  than  any  other 
article  of  the  materia  medica,  in  bringing  about  reaction 
from  the  finghtful  collapse  of  congestive  fever.'  Having 
practised  since  1860  in  a  highly  malarial  district,  ample 
opportunity  has  presented  itself  of  putting  to  the  test 
Dr.  F.*s  assertion  as  to  the  value  of  chloroform  in 
relievhig  the  paroxysm  of  intermittent  fever  in  the 
cold  stage,  and  I  am  happy  to  be  able  to  add,  that  in 
doing  so  I  have  had  occasion  to  feel  thankful  to  him 
for  his  valuable  suggestion.  The  different  medical 
journals  bear  testimony  to  the  value  of  chloroform  in 
intermittents  in  the  cold  stage.  My  own  experience 
accords  with  the  views  expressed  in  these  articles.  I 
regard  pernicious  and  intermittent  fever  as  differing  in 
degree  only,  and  not  in  kind.  Of  the  modus  operandi 
of  chloroform  in  relieving  the  cold  stage,  I  have  seen 
no  explanation.  It  seems  most  plausible  to  suppose 
that  a  powerfiilly  stimulating  impression  is  produced  on 
the  stomach  by  immediate  contact  of  tne  remedy, 
which  impression  is  rapidly  conveyed,  chiefly  through 
the  medium  of  the  nervous  system,  to  the  capillaries, 
exciting  in  this  system  of  vessels  remote  sympathy. 
As  to  the  prophylactic  or  antiperiodic  power  of  chlo- 
roform, in  intermittent  fever,  I  am  inclined  to  think  it 
possesses  no  greater  virtue  in  this  way  than  is  common 
to  all  narcotics." 

AouTB  Idiopathic  Glossths,  by  Dr.  J.  B.  Burnett, 
M.D.,  Bellevue  Hospital.^-A  patient  presented  himself 
at  the  hospital,  who  within  two  months  had  had  several 
returns  of  "  a  lump  in  the  left  side  of  the  throat"    A 


Digitized  by 


Google 


540 


THE  MEDICAL  RECORD. 


week  before  admission  he  attended  a  picnic,  at  which 
he  drank  freely  of  lager  beer.  During  the  night  he  slept 
in  a  draught  between  two  windows.  In  the  morning 
his  tODgue  was  greatly  swollen,  hot  and  painful,  and  his 
throat  sore,  so  that  he  could  scarcely  articulate  or 
swallow.  There  was  a  profuse  salivary  discharge 
during  the  day.  By  a^moon  the  tongue  almost  com- 
pletely filled  the  mouth,  and  greatly  impeded  respira- 
tion. The  pain  in  the  tongue  was  intense,  and  he  was 
feverish,  anxious,  and  restless.  When  admitted  he 
presented  the  following  sj^mptoms  :  tongue  swollen 
and  hard,  immoderate  action  of  the  salivary  glands, 
glands  beneath  the  jaw  indurated,  foetor  of  breaUi, 
pulse  nearly  normal,  skin  cool,  bowels  regular,  and 
urine  normal.  Treatment  was  garbles  of  potass,  chlorat.. 
ice  to  tongue,  and  saline  purgatives.  Diet,  milk  and 
beef  tea.  In  about  ten  days  patient  recovered  com- 
pletely.— Med.  and  Surg,  Reporter, 

Stbel  PmsE  Rnro  Impacted  w  Naso-Phartkokal 
Fossa  fob  Thirteen  Years  and  a  Half.— Dr.  William 
Hickman,  M.B.,  F.RC.S.,  relates  in  a  recent  number  of 
the  British  Medical  Journal,  an  interesting  example  of 
the  long  residence  of  a  foreign  body  in  this  cavity. 
The  child  was  two  years  old  when  the  accident  which 
resulted  in  the  introduction  of  the  ring  occurred. 
While  at  play  it  was  suddenly  seized  with  a  fit  of  chok- 
ing produced  by  the  ring  with  which  the  child  was  at 
the  time  nursed,  and  the  mother  thrust  her  finger  in 
the  throat,  and  after  having  felt  it  it  disappeared,  and 
she  supposed  it  had  been  swallowed.  The  patient  after- 
ward buffered  from  symptoms  of  polypus,  and  it  was 
only  after  the  time  referred  to  had  elapsed  that  the  egc- 
istence  of  this  foreign  body  was  made  out  by  a  careful 
examination  with  the  rhinoscope.  An  ineffectual  efiTort 
was  made  to  push  the  foreign  body  down  into  the 
mouth  by  means  of  an  instrument  introduced  through 
the  nostrils,  but  on  this  failing,  guided  by  the  history  of 
the  case  and  the  appearance  of  the  foreign  body,  the 
operator  made  a  hook  with  a  long  probe  bent  into  three 
curves,  and  passed  it  up  behind  the  palate ;  and  after 
some  time  and  considerable  trouble,  and  with  the  assist- 
ance of  the  forefinger  of  the  left  hand,  he  managed  to 
pass  the  hook  through  the  ring  and  bring  this  away  on 
the  probe.  The  ring  was  a  wide  steel  one  (completely 
blackened  and  rough  from  its  lengthy  sojourn),  which 
had  belonged  to  one  of  the  old-fashioned  long  purses; 
it  measured  nearly  three-fourths  of  an  inch  in  diameter, 
and  nearly  half  an  inch  in  width. 

Congenital  Obstruction  of  Urethra. — ^A  woman 
was  delivered  of  a  healthy-looking  boy,  on  June  13, 
and  next  morning  both  were  doing  well.  Meconium 
passing  freely.  By  evening,  child  had  had  no  uriniuy 
passage,  but  discharges  from  bowels  frequent  and  thin. 
Upon  examination,  found  the  external  meatus  urinarius 
closed,  as  though  it  had  united  by  adhesive  inflammation, 
but  no  distension  of  urethra.  The  external  orifiice  was 
opened  with  a  bistoury,  but  no  urinary  discharge.  The 
probe  was  introduced  about  four  lines,  and  found  ob- 
struction, through  which  it  was  forced.  The  probe 
was  passed  four  lines  further,  and  another  obstruction 
found,  which  required  considerable  force  to  pass.  Find- 
ing no  tumefaction  over  the  bladder,  it  was  concluded 
that  the  serum  had  passed  off"  by  the  bowels  without 
being  secreted  by  the  kidneys.  The  probe  was  carried 
through  still  another  obstruction  to  the  pubes.  The 
instrument  was  then  bent  and  passed,  as  was  thought^ 
into  the  bladder ;  but  no  urine  followed.  Next  morn- 
ing the  child  passed  urine  freely,  showing  t^at  the  ob- 
structions had  been  broken  down  the  night  before. 
Had  there  been  a  free  secretion  of  urine,  the  child  must 
have  suiFered,  and  perhaps  have  died  before  the  forty- 


eight  hours  expired,  for  it  had  been  born  that  long 
before  any  urine  was  passed.  The  active  condition  of 
the  child*s  bowels  had  prevented  the  secretion  of  urine. 
The  child  afterward  did  well,  and  had  no  difficulty  in 
urinating. 

An  Inquiry  into  the  EfTECTfl  of  Putreftiho  Or- 
OAinc  Substances  upon  Living  Animal  Organism. — 
Dr.  Schweninger,  of  Munich,  thus  sums  up  the  results 
of  injections  into  the  blood,  directly,  the  experiments 
bein^  made  upon  seven  dogs  and  twelve  rabbits :  "  1st, 
The  injection  of  putrid  fibrin  into  the  blood  creates  an 
increased  temperature — fever.  2d.  This  ejrmptom  ap- 
pears rapidly  after  the  injection,  yet  not  immediately, 
and  seems  sometimes  to  be  preceded  by  a  sinking  of 
the  temperature.  3d.  The  general  infection  is  apparent 
from  the  affection  of  the  intestines,  disturbed  nutrition, 
and  the  vehement  attack  upon  the  nervous  system, 
tremor,  vomiting,  and  great  depression.  4th.  The 
vehemence  of  the  effect  depends  on  the  quantity  of  the 
fluid  injected.  5th.  Smaller  animals  are  more  affected 
than  larger  ones.  6th.  The  concentration  and  state 
of  putre£ction  are  of  no  influence  on  the  mode  of  opera- 
tion of  the  injection.  7th.  The  effect  is  also  brought 
about  after  fluids  had  been  evaporated  to  dryness,' if 
the  experiment  is  made  with  the  redissolved  drv  sub- 
stance. 8th.  The  injection  of  filtered  putrid  liquids 
never  creates  metastases,  or  abscesses  in  the  different 
organs  of  tJie  body.  Experiments  with  putrid  gaseous 
emanations,  although  the  animals  were  confined  for 
several  weeks  in  rooms  highly  impregnated  with  the 
same,  produced  no  kind  of  morbid  affections.** 

"  It  we  compare  the  results  of  these  experiments  with 
those  arrived  at  by  Stick,  Panum,  and  Billroth,  by 
using  various  compound  vegetable  and  animal  putrefy- 
ing substances,  we  find  the  same  local  as  well  as  gen- 
eral changes,  and  the  conclusion  bears  the  highest 
probability  that  in  all  processes  of  putrefaction,  either 
an  identical  or  very  similar  active  principle  must  exist. 
It  is  satisfactorily  proven  that  products  of  the  termina- 
tion of  putrefaction,  such  as  ammonia,  sulphuretted 
hydrogen,  are  not  capable  of  producing  the  above- 
named  pathological  processes.  Two  hypotheses  only 
are  probable :  either  there  is  during  the  process  of  pu- 
trefaction one  definite  chemical  substance  formed— one 
specific  poison  of  putridity — or  else,  organic  substances 
in  a  state  of  putrefaction  possess  tJie  property,  not  yet 
satisfactorily  explained,  of  transferring  and  communicat- 
ing their  own  elementary  or  chemical  condition, 
resembling  fermentation,  to  other  bodies.  This  condi- 
tion consists  in  locomotion  or  separation  of  the  ele- 
mentary components. 

"  Neither  tne  degree  of  dilution,  nor  the  duration  of 
putrefaction,  makes  anv  difference  in  the  modus  op- 
erandi. Comparing  this  fact  with  the  first  of  our 
hypothesis,  it  would  follow  that  the  most  different  sub- 
stances would  create  the  same  chemical  combination, 
and  that  it  would  preserve  its  character  during  all  stages 
of  putrefaction,  an  hypothesis  which  is  contrary  to  the 
laws  of  chemistry  as  well  as  to  the  very  principle  of 
putre&ction.  We  must,  therefore,  adhere  to  the  doc- 
trine which  considers  putre&ction  as  a  process  anal- 
agous  to  fermentation,  according  to  which  putrefying 
substances  transfer  their  own  molecular  motion  to  sul^ 
stances  with  which  they  are  brought  in  contact,  caus- 
ing an  increased  formation  of  cells,  or  the  reduction  of 
the  higher  and  normal  organic  forms  to  pathological 
ones,  and  lower  chemical  compounds.  Very  appro- 
priately says  Helmholtz:  'Putrefaction  resembles  the 
process  of  life  in  the  sameness  of  the  substances  which 
they  both  occupy,  in  the  capability  of  propagation,  and 
the  identity  of  condition  by  which  eitner  is  preserved 
or  destroyed.* "  ^^  j 

Digitized  by  VjOOQ  IC 


THE  MEDICAL  RECORD. 


541 


The  Medical  Eecord. 

Geobgb  F.  ShbadY}  M.D.,  Editob. 


FubUthed  OBth*  1st  and  lAthof  MMh  Month,  by 
WILLIAM  WOOD  A  00.,  61  Walksb  STsakr,  Nsw  Tobx. 


FOBEIGN  AGEHrOIES. 


Lo]n>o«— Th'ubhvb  k  Co. 
Pajiu— BouAios  n  Cis. 


{Liipsio— B.  Hbbmank. 
Bio  Jambibo— Stbphbhb  t  Oju 


Now   Yorlc,   B^ebruaxry  1,  ISCS. 

THE  ANNUAL  REPORT  OF  THE  SURGEON- 
GENERAL. 
The  Annual  Report  of  the  Surgeon-General  for  1867 
presents  us  with  some  &cts  of  interest  in  connection 
with  the  mean  strength,  health,  and  death-rate  of  the 
army  up  to  the  1st  of  July  last,  hesides  giving  assur- 
ances of  the  amount  of  work  that  has  been  accomplished 
during  the  time  specified  towards  completing  the  med- 
ical and  surgical  history  of  the  late  war.  The  average 
annual  strength  of  white  troops  is  represented  at  forty- 
one  thousand  one  hundred  and  four,  and  that  of  the  col- 
ored troops  as  six  thousand  five  hundred  and  sixty-one. 
The  constant  sickness  rate  among  the  former  from  all 
causes  was  fifty-eight  per  thousand,  or  less  than  six  per 
cent,  and  the  mortality  about  four  per  cent. ;  while  in 
the  latter  the  sickness  was  rated  at  five  per  cent,  and 
the  mortality,  not  counting  deaths  firom  epidemic  chol- 
era, at  3.9  per  cent 

As  regards  the  medical  and  surgical  history  of  the 
war,  we  are  assured  officially  ihat  it  is  actively 
progressing.  The  immensity  of  the  work,  and  the 
amount  of  care  which  it  is  necessary  to  exercise  in 
order  to  give  it  absolute  reliability,  is  such  as  will  con- 
sume much  time.  Reports  are  being  rapidly  accumu- 
lated from  all  sources,  compiled,  condensed,  and  ar- 
ranged with  a  method  that  is  almost  perfection ;  and  if, 
at  the  end  of  each  succeeding  year,  the  same  good  ac- 
count of  labors  can  be  rendered,  the  progress  towards 
completion  must  be  rapid,  sure,  and  satis&ctory.  Al- 
ready we  are  beginning  to  have  foretastes  of  what  is  in 
store,  in  the  publication  of  a  catalogue  covering  thou- 
sands of  pages  of  imperial  quarto ;  of  a  sketch  of  the 
material  on  hand,  in  the  famous  Circular  No.  6 ;  and 
lastly  by  the  appearance  of  one  of  the  most  elaborate 
and  carefully  prepared  reports  on  amputations  at  the 
hip-joint  which  has  ever  appeared  in  any  language* 
This  latter  report,  giving  an  account  of  fifty-three  of 
these  amputations,  covers  eighty  quarto  pages,  and  the 
text  is  sprinkled  with  some  of  the  finest  executed 
chromo-Iithographs  that  have  ever  appeared  in  any  sci- 
entific work. 

We  are  pleased  to  learn  that  the  first  volume  of  the 


history  is  already  prepared^or  the  printer,  that  the  fol- 
lowing ones  will  be  issued  as  soon  as  practicable,  and 
that  all  the  necessary  expenses  for  carrying  on  the 
work  as  £u:  as  completed,  will  be  covered  by  the  appro- 
priation last  made  by  Congress.  The  profession,  espe- 
cially those  who  have  been  engaged  in  the  war, 
should  see  to  it  that  their  part  of  the  work  be  per- 
formed. Many  of  these  gentlemen  now  out  of  the  ser- 
vice are  no  longer  under  official  obUgations  to  the  de- 
partment J  but  as  men  of  science,  they  owe  it  to  them- 
selves and  humanity  to  complete  their  cases,  as  far  as 
they  may  be  able,  by  reports  of  such  of  the  ultimate  re- 
sults as  may  haye  transpired  within  the  past  two  or 
three  years.  A  great  deal  has  lately  been  done  in  this  line 
by  the  aid  of  Surgeon-Generals  of  the  different  States, 
and  by  pension  officers ;  but  there  are  still  vast  numbers 
of  interesting  operations  which  are  waiting  for  such  re- 
sults as  the  lapse  of  a  year  or  more  can  alone  furnish. 
The  citizen  surgeon  proper  should  also  take  sufficient 
interest  in  the  undertaking  to  furnish  the  results  of  the 
cases  of  such  discharged  soldiers  as  may  consult  him 
either  in  hospital  or  private  practice.  The  Surgeon- 
General  has  given  the  profession  ample  reasons  for  be- 
hoving him  in  earnest  as  regards  carrying  out  the  grand 
design ;  and  they  should  be  ready  and  willing  not  only 
to  endorse  his  endeavors  by  commendations,  but  second 
them  by  the  more  substantial  aid  referred  to. 


Wb  have  received  from  the  physicians"  and  surgeons 
who  have  attended  a  second  private  course  by  Pro£ 
H.  R.  Storer,  of  Boston,  some  resolutions  which  admit 
of  a  very  curious,  not  to  say  ludicrous  construction. 
They  commence  thus : 

"  WhertaSj  An  unjust  prejudice,  founded,  partly  on 
ignorance  and  professional  jealousy,  and  partly  on  a 
false  conservatism,  exists  in  the  minds  of  many  of  our 
profession,  against  those  who  give  special  attention  to 
the  diseases  of  women ;  and,  whei^eas^  many  of  these 
diseases  are  eitlier  altogether  ignored,  or  imperfectly 
treated  of,  in  our  text-books,  and  by  the  teachers  of 
medical  science  in  our  schools ;  and,  whereas.  Pro£ 
H.  R  Storer,  in  instituting  and  carrying  out,  as  he  has 
done,  a  plan  for  the  more  thorough  instruction  of  phy- 
sicians on  these  important  subjects,  and  in  taking  a  bold 
stand  as  a  Uterine  Specialist)  has  incurred  a  certain 
degree  of  misrepresentation  and  abuse  ;'* 

Therefore  it  is  resolved  that  the  pupils,  eleven  in  all,  are 
perfectly  satisfied  that  their  teacher  does  not  merit  any 
such  abuse  as  has  been  hei^d  upon  him  for  taking  such 
"  a  bold  stand  "  as  he  has;  that  he  is  everything  that  a 
specialist  should  be ;  and,  besides  being  thankful  for  the 
"  candor  and  impartiality  "  with  which  he  has  discussed 
the  subject,  they  intend  in  future  to  give  him  their 
earnest  and  hearty  support  The  question  naturally 
enough  comes  up  as  to  any  just  cause  which  these 
gentlemen  have  for  unanimously  adopting  these  resolu- 
tions. In  the  first  place,  we  are  not  aware  that  the 
professor  has  specially  incurred  the  enmity  of  his 
brethren  for  studying  uterine  diseases  any  more  than 


542 


THE  MEDICAL  RECORD. 


others  who  have  perhaps  labored  equally  hard  in  that 
particular  department  Secondly,  even  if  the  contrary 
were  true,  we  hardly  think  that  the  resolutions  of  a  few 
admiring  pupils  would  have  any  particular  weight  with 
the  profession  at  large,  as  they  cannot  of  necessity  be 
considered  an  impartial  jury.  The  whole  affair  seems 
to  be  a  yery  poor  excuse  on  the  part  of  the  members 
of  the  said  dass,  whose  names  and  residences  are  care- 
fully added,  to  advertise  themselves  at  their  teacher's 
expense.  It  is  of  course  very  gratifying  to  a  teacher 
to  secure  the  approval  of  his  students,  but  we  think 
that  the  latter  should  hardly  deem  it  necessary  to  request 
that  such  an  endorsement  should  be  considered  of 
sufficient  importance  to  be  sent  to  the  medical  press  for 
publication. 

It  is  to  be  hoped  that  Pro£  Storer,  if  he  has  it  in 
his  power,  will  in  future  strive  to  curb  the  enthusiasm 
of  his  pupils  to  the  extent  of  preventing  them  from 
begging  for  him  the  place  of  a  martyr. 


The  following  published  letter,  clipped  from  the  Armf/ 
and  Navy  Journal^  New  York,  December  28,  1867,  is 
commended  to  the  careful  consideration  of  every  gen- 
tleman who  contemplates  entering  the  Medical  Corps  of 
the  United  States  Navy : 

Naval  Lists. — To  ihe  Editor  of  the  Army  and  Navy 
Journal^ — Sir  : — It  is  about  time  to  notice  the  ridiculous 
way  in  which  lists  of  officers  of  naval  vessels  and  stations 
are  inserted  in  the  public  prints.  The  New  York  Eer- 
aid,  of  the  18th  instant,  has  a  list  of  officers  of  the 
Piscaiaqua^  in  which  the  line  officers  are  ignorantly  in- 
serted afler  the  "  fleet  and  general  staff.'*  The  impro- 
priety of  such  an  order  of  naval  precedence  is  manifest, 
and  cannot  be  defended  on  the  ground  that  in  lists  of 
Army  officers  the  field  and  staff  have  always  been 
placed  before  the  line.  An  army  rule  is  no  authority 
for  infHnging  a  naval  custom,  or  else.it  might  be  urged 
that  because  army  paymasters,  engineers,  etc.,  have 
always  had  rank  de  facto,  in  the  Navy  they  should  be 
styled  lieutenant-commanders  or  majors. 

Fortunately,  the  Navy  proper  is  not  so  democratic  as 
the  Army,  and  they  will  continue  to  jealously  guard 
their  titles  and  order  of  precedence  against  the  absurd 
pretensions  of  inferior  branches  of  the  service. 

HOKOR. 

The  assumption  of  superiority  claimed  by  the  line  offi- 
cers under  dH  circumstancea^  as  portrayed  in  "  Honor's  " 
communication,  exhibits  a  spirit  of  intolerance  and 
iUiberality  unworthy  of  the  age;  and  is  a  gratuitous 
indignity  not  only  to  the  medical  staff  of  the  navy,  but 
to  the  profession  throughout  the  country. 

It  appears  by  the  recent  elaborate  report  of  the  Bu- 
reau of  Medicine  and  Surgery,  that  there  are  at  present 
about  fifly  vacancies  in  the  Medical  Corps  of  the  Navy. 
When  it  is  known  that  Congress  has  omitted  to  recog- 
nise the  services  of  the  Staff  Corps  by  increase  of  rank 
and  pay,  while  it  has  created  four  additional  grades  to 
reward  the  line,  it  is  fair  to  presume  the  vacancies  will 

Tment  rather  than  diminish. 


Eeo«w«  aitir  tl0tiM«  of  60ok3* 

Transactions  op  the  Medical  Sooibtt  op  the  State  op 

Kansas,  fob  the  Ybab  1867. 
This  volume  contains  the  proceedings  of  the  Kansas 
State  Medical  Society^  at  its  third  annual  meeting,  held 
in  Leavenworth,  Ajftil  3d  and  4th,  1867,  with  a  list  of 
members,  the  address  of  the  president  C.  A.  Logan, 
M.D.,  of  Leavenworth,  and  a  number  orpapers,  incTud- 
inij  reports  of  committees  on  Sureery,  Otetetrics,  and 
Cbmatology ;  on  the  Application  of  Water,  and  its  effects 
as  a  local  agent,  by  J.  L.  Prentiss,  M.D. ;  on  DiphtheriiL 
by  J.  W.  Brock,  M.D. ;  on  Poisoning  by  Arsenic,  and 
on  Persulphate  of  Iron  as  an  Hemostatic,  by  Johii  W. 
Parsons,  M.D. :  Femoral  Hernia,  by  R.  Morris,  M.D. ; 
The  Malarial  M:iasm  pervading  Non-malarial  Diseases,  by 
Charles  C.  Shoyer,  M.D. ;  and  on  Infantile  or  Oblique 
Fracture  of  the  Vertebra,  by  W.  E.  Turner,  M.D. 

Dr.  Prentiss  applies  water  locally,  by  means  of  a 
narrow  tubing  of^nght  rubber  of  proper  length,  coiled 
in  the  form  of  a  lamp  mat  to  the  desired  dimensions 
and  retained  in  shape  1)V  means  of  light  cords,  one  end 
of  the  tube  extending  mm.  the  centre  of  the  coil  and 
dipping  into  a  pail  of  water,  the  other  end  extending 
from  ttie  periphery,  with  a  stop-cock  attached,  to  the 
waste-paiL 

The  cases  of  poisoning  by  arsenic  were  treated  sac- 
cessfully  by  vomiting,  by  sulphate  of  zinc  and  the  firee 
administration  of  the  subcarbonate  of  iron,  which  Dr. 
Parsons  beUeves  to  be  as  efficient  as  the  hydrated  per- 
oxide, mixed  with  water  as  thick  as  cream. 

Dr.  Charles  C.  Shoyer  finds  that  in  Leavenworth 
there  is  a  periodicity  complicating  non-malarial  diseases^ 
and  necessitating  the  exhibition  of  quinine. 

We  congratulate  the  members  of  the  profes^on  in 
Kansas  upon  their  enterprise,  and  trust  that  they  will 
not  &il  in  the  sphere  of  medical  organization. 

Mbdioal  Commxjnioationb  op  the  Massaohusbttb  Msni* 

OAL  Society.  VoL  XI.  No.  1.  1867. 
This  volume  contains  the  proceedings  of  the  Council- 
lors of  the  Socie^,  on  October  3,  1866,  February  6, 
1867,  and  June  4,  1867.  At  the  meeting,  on  the  read- 
ing of  a  letter  from  S.  Eliot,  Esq.,  on  the  part  of  the 
Tnistees  of  the  Massachusetts  General  Hospital,  re- 
questing an  expression  of  opinion  as  to  the  expediency 
of  admitting  females,  as  students,  to  visit  the  wards  of 
the  hospital,  afler  a  lull  debate  it  was 

Resolved^  That  in  the  opinion  of  the  Councillors  of  the 
Massachusetts  Medical  society,  it  is  inexpedient  to 
admit  females  as  students  to  our  State  medical  sdiooli 
and  hospitals.    49  yeas,  7  nays. 

Then  follow  the  proceedings  of  the  annual  meeting 
of  the  Society,  held  at  Boston,  June  4,  1867,  with  % 
list  of  officers  of  the  Society,  and  of  the  District  Medi- 
cal Societies,  and  a  catalogue  of  Fellows. 

Quite  a  number  of  papers  on  interesting  subjects 
were  read,  but  they  are  mentioned  only  by  titles  and 
authors.  Obituaries  of  eight  deceased  members  are 
printed  in  the  communications.  The  annual  address 
was  on  "  The  Duties  of  the  Medical  Profession,"  and 
was  delivered  by  the  orator  for  the  year,  Horace  P. 
Wakefield,  M.D.^  of  Reading.  It  is  a  very  animated 
address,  advocating  professional  intercourse  as  a  means 
of  preventing  disagreement  among  doctors,  raising  the 
standard  of  medical  education,  and  warning  the  com- 
munity against  the  errors  of  the  day.  such  as  the  resort 
to  criminal  abortion,  the  use  of  alcoholic  stimulants  as 
Deneficial  in  a  state  of  healtb,  and  holding  in  gratefiil 
remembrance  the  good  deeds  of  deceased  professionsl 
associates.  ^  t 

Digitized  by  VjOOQ  IC 


THE  MEDICAL  RECORD. 


543 


On  Ligation  of  thb  Funis.     By  A.  P.  A.  Kino,  M.D. 
Wftshington,  D.C.    8yo.,  pp.  8t. 

This  pamphlet  details  a  number  of  arguments  support- 
ed b^  clinical  records,  in  proof  of  the  proposition  that 
ligation  of  the  umbilical  cord  at  child-birth  is  unneces- 
sary, often  injurious,  and  occasionaUv  actually  fatal  to 
life.  We  shall  give  a  good  idea  of  the  plan  and  scope 
of  the  argument  by  quoting  the  author*s  conclusions,  as 
follows : 

"  Ist  That  ligation  of  the  umbilical  cord  in  the  hu- 
man infant  is  unnece$8artf.  This  for  the  following  rea- 
sons : 

"a.  Because  the  operation  is  not  required  at  the 
birth  of  any  other  animal. 

'^  6.  Because  the  imagined  necessity  for  it  (viz.  to  pre- 
vent hsemorrhage)  does  not  exist,  as  distinctly  appears 
fix>m  a  knowledge  of  the  formation  of  the  cord,  and  of 
the  structure  of  its  component  vessels;  as  well  as  from 
the  numerous  recorded  cases  in  which  no  ligature  was 
applied,  and  yet  no  fatal  bleeding  followed. 

"  c.  Because  to  ligate  for  cleanliness'  sake  is  super- 
fluous. 

"  d.  Because  it  is  unreasonable  to  attach  to  the  pro- 
cess of  reproduction  in  women  so  glaring  an  imperfec- 
tion, as  that  the  birth  of  a  single  child  cannot  be  safely 
completed  without  a  strand  of  thread  upon  the  limbih- 
oalcord. 

I*  2d.  That  ligation  of  the  umbilical  cord  at  child-birth 
is  in  many  cases  injvriatu.  This  for  the  following  rea- 
sons: 

'^  a.  Because,  as  shown  in  the  text,  it  may  justly  be 
considered  as  the  cause  of  $econdary  hcBmorrhage  from 
the  umbilicus. 

"  6.  Because  by  preventing  that  flow  of  blood  which 
should  naturally  take  place  from  the  umbilical  vein,  and 
thus  giving  rise  to  congestion  of  the  liver,  it  produces 
in/aniile  jaundice^  and  probably  also  causes  sclerema, 

"  c.  Because,  by  interfering  with  desiccation  of  the 
cord,  and  thus  preventing  its  separation,  it  gives  rise  to 
tilceraiion  of  the  navels  and,  as  a  not  unfrequent  occur- 
rence, erysipelaSf  fungoid  excrescence,  etc. 

'*  d.  Because,  by  maintaining  the  funial  vessels  in  a 
state  of  congestion  aod  distension  from  unnaturally  re- 
tained blood,  it  causes  the  ii^ammcUion  of  these  ves- 
sels, and  also  hinders  their  normal  ohltierationj  thus  lay- 
ing the  foundation  for  wnbiHcai  phlebitis^  erysipelas, 
jaundice,  pycemia,  eta 

"  e.  Because,  by  preventing  a  normal  escape  of  blood 
when  the  cord  is  divided,  and  thus  causing  hepatic  hy- 
peremia and  congestion  of  the  portal  circulation,  it 
may  lay  the  foundation  for  that  innumerable  list  of  fatal 
infantile  affections  which  so  often  appear  to  originate  in 
congestion  of  the  portal  blood-vessels. 

*^  dd.  That  certainly  in  some,  and  probably  in  not  a 
few,  the  operation  of  ugating  the  funis  has  been  directly 
&ta].    This  for  the  following  reasons : 

'*  a.  Because  numerous  cases  of  death,  in  which  the 
fatal  result  was  ascribed  to  ligation,  have  been  recorded 
by  the  highest  obstetrical  authorities. 

"  b.  Because,  it  can  be  seen  how  the  operation  in  the 
cases  of  still-born  children  maintains  the  right  ventri- 
cle in  a  state  of  distension  (otherwise  relieved  by  bleed- 
ing from  the  hypogastric  arteries),  and  thus  effectually 
prevents  the  renewal  of  the  heart  s  action  when  it  has 
stopped ;  or  renders  the  stoppage  complete  when  it  is 
about  to  cease. 

"  c  Because,  in  many  instances,  the  removal  of  the 
ligature  has  saved  the  life  of  the  infiuit^  wJien  aU  other 
remedies  had  failed." 

As  to  the  management  of  the  cord,  our  author  recom-  . 
mends  that  the  cord  be  divided  with  a  dull  pair  of  | 


blunt-pointed  pocket  scissors,  hacking  through  the 
cord,  not  at  one  cut,  but  by  a  sort  of  nibbling  process ; 
and  he  thinks  a  small  pocket  ecraseur  would  be  the  best 
instrument  for  the  purpose:  if  it  should  bleed  too 
much — an  occurrenoe  which  nas  not  yet  happened  to 
the  author — then  the  cut  end  may  be  scratched,  scraped, 
and  pinched  between  the  thumb-nail  and  end  of  the 
index  finger,  until  the  haemorrhage  is  controlled. 

The  author  objects  to  dressing  the  cord,  because  it 
interferes  with  the  process  of  desiccation,  thus  prolong- 
ing the  period  of  separation ;  and  ^ves  pain  (often  mis- 
tsfen  by  nurses  for  colic)  by  fixation  of  the  distal  end 
in  contraction,  and  thus  pulling  the  fUnis  from  the  navel. 
In  conclusion,  the  author  claims  that  "  the  advantages 
of  this  mode  of  management  are,  that  desiccation  and 
separation  take  place  rapidly ;  that  pain  to  the  child  is 
avoided ;  that  the  risk  of  ulceration,  inflammation,  and 
erysipelas  of  the  navel  is  lessened ;  and  last,  but  by  no 
means  least,  the  accoucheur  can  in  one  moment,  by 
simply  raising  the  skirt,  easily  examine  the  umbilicus 
at  every  visit,  without  at  all  incommoding  the  infant, 
or  even  waking  it,  if  asleep.  This  last  is  an  advantage 
which  every  obstetrician  who  has  witnessed  the  cries  of 
the  infant  when  undergoing  examination  of,  and  re- 
moval of  dressings  from  the  umbilicus,  must^  I  think, 
appreciate." 

We  are  unable,  at  present,  to  pass  judgment  upon 
the  argument  in  this  essay,  having  always  adherea  to 
the  time-honored  custom  of  ligation  and  dressing ;  but 
we  cheerfully  recommend  the  perusal  of  the  pamphlet^ 
and  will  leave  it  to  obstetricians  to  learn  if  they  have 
been  taking  unnecessary  measures  from  before  the  days 
of  Hippocrates.    Did  Eve  tie  Cain's  funis  ? 

Thb  Physicians*  Hand-Book  fob  1868.  By  Wtlujlu 
Elinbb,  M.D.  New  York:  W.  A.  Townsend  &  Adams. 
1868. 

This  hand-book  of  practice,  which  has  met  with  such 
a  favorable  reception  with  the  profession  in  many  parts 
of  the  country^  enters  upon  its  eleventh  year  of  exist- 
ence. Its  distmguisbing  feature,  as  many  of  our  read- 
ers are  aware,  is  the  detailing  of  the  symptoms  and 
treatment  of  tne  various  diseases  met  with  m  practice, 
combining  the  advantages  possessed  by  an  ordinary 
hand-book  of  medicine  with  those  of  a  record  of  prac- 
tice. As  far  as  it  may  serve  to  refresh  the  memories  of 
practitioners  who  may  be  called  to  difficult  cases  in  an 
emergency,  and  where  prompt  action  is  required  to  save 
life,  it  is  calculated  to  subserve  a  very  good  purpose. 
As  to  the  general  arrangement  of  the  rest  of  the 
work,  it  b  excellent  in  its  way,  but  for  our  own  uses 
we  should  prefer  one  which  could  be  commenced  at 
any  time  in  the  year. 


CoMTORT  FOR  TouNO  Anatomibts. — "  During  my  at- 
tendance at  the  Windmill  Street  school,  I  worked  hard 
in  the  dissecting  room,  and  learned  a  good  deal  of  anat- 
omy. If  I  did  so,  however,  it  must  be  owned  that  it  was 
rather  as  a  duty,  and  because  it  was  necessary  to  my 
future  undertakings,  than  because  I  had  any  particular 
taste  for  l^e  details  of  anatomical  study.  I  remember 
some  years  afterwards  dining  with  a  friend,  who  was  a 
craniologist,  at  the  Athenssum,  when  he  told  me  that  he 
saw  that  I  had  the  organ  of  constructiveness  much  de- 
veloped, and  that  this  explained  how  it  was  that  I  ex- 
celled in  the  use  of  my  hands,  and  was  an  excellent 
dissector.  There  was  never  a  greater  mistake.  I  was 
naturally  very  clumsy  in  the  use  of  my  hands,  and  it  was 
only  by  taking  great  pains  with  myself  that  I  became  at 
all  otherwise. — 8ir  BenJ,  Brodiiit  AyUtGidographu,^  _ 


544 


THE  MEDICAL  RECORD. 


Utpoxts  of  ^OtlttltS. 


NEW  YORK  PATHOLOGICAL  SOCIETY. 

Stated  Meeting,  ITov.  27,  1867. 

Dr.  B.  H.  Sands,  President,  in  the  Chair. 

Dr.  Ccttter  stated  that  since  the  last  meeting  he  had 
asked  Dr.  Ward  more  particularly  concerning  the  case 
of  supposed  gun-shot  wound  of  the  stomach,  and  that 
gentleman  informed  him  that  there  had  been  vomiting 
of  blood. 

He  then  presented  three  photographic  representa- 
tions of  skin  disease  for  which  he  was  indebted  to  Dr. 
Ward :  one  of  these  was  a  beautiful  sp  ^cimen  of  leprosy, 
and  the  other  two  were  cases  of  efephantiasis.  They 
were  taken  from  subjects  in  Hong-Kong. 

ezseotion  of  RADiua 

He  also  exhibited  a  portion  of  the  radius  which  he 
had  exsected  a  week  before  from  the  arm  of  the  daugh- 
ter of  a  physician  in  Newark.  The  patient  was  of  a 
scrofulous  habit,  and  had  been  afflicted  fot  a  number  of 
years.  Three  finders  of  her  left  hand  had  been  re- 
moved previously  lor  necrosis,  besides  two  or  three  oper- 
ations upon  ike  arm.  The  father  stated  that  after 
these  operations  there  had  never  been  any  effort  at  re- 
pair. He  preferred  in  consequence  of  this  to  have  the 
whole  enlarged  portion  of  the  bone  removed  along  with 
the  sequestrum.  The  incision  was  made  in  the  long  axis 
of  the  hmb,  and  the 'section  made  with  the  chain  saw. 
The  wound  healed  by  granulation. 

The  specimen  consisted  of  an  expansion  of  bone,  in 
the  centre  of  which  was  a  small  splinter  of  necrosed 
bone. 

Dr.  Krackowizer  asked  why  the  opening  in  the. in- 
volucrum  had  not  been  enlarged  and  the  sequestrum 
removed. 

Dr.  Cutter  remarked  that  the  patient's  lather  wished 
the  whole  removed. 

Dr.  Kraokowizer  believed,  inasmuch  as  the  seques- 
trum was  entirely  loose  in  the  cavity  of  the  involucrum 
that  the  necrotic  process  had  ceased — the  strongest 
possible  argument  in  favor  of  enlarging  the  opening  and 
removing  the  dead  bone. 

Dr.  Cutter  stated  that  he  should  have  preferred  to 
do  so,  but  was  overruled  by  the  patient's  father. 

the  effect  of  aouprbssure  on  arteries. 

Dr,  Hutchinson  exhibited  the  right  and  left  carotid 
arteries  of  a  sheep  that  had  been  cut  for  the  purpose  of 
ascertaining  the  method  of  closure  of  vessels  when 
acupressure  was  employed,  and  the  time  required  to 
effect  such  a  result.  The  first  vessel  was  cut  on  the  1st 
of  November,  the  other  on  the  13th ;  the  animal  being 
killed  yesterday,  and  both  arteries  removed. 

The  left  carotid  was  the  first  one  cut.  It  was  ex- 
posed, and  an  acupressure  needle  used  according  to^Simp- 
son's  fourth  method.  When  this  was  applied  to  the 
artery,  the  vessel  was  cut  above,  and  as  was  expected, 
there  was  haemorrhage  from  the  distal  end.  The  needle 
was  immediately  applied  to  that  side  of  the  artery,  with 
the  effect  of  at  once  controlling  the  haemorrhage.  The 
wound  was  then  brought  together  with  sutures.  At 
the  end  of  forty-one  hours,  both  ligatures  were  removed 
and  no  bleeding  followed. 

The  same  operation  was  done  on  the  opposite  side,  as 
already  stated,  on  the  13th,  and  the»  ligatures  were  like- 
wise removed  on  the  forty-first  day  with  a  like  results 
Dr.  H,  remarked  that  he  had  intended  to  have  removed 


them  earlier,  but  was  prevented  firom  so  doing  by  being 
called  awav  to  the  country. 

"In  looking  at  this  specimen,"  said  he,  'Mt  will  be 
observed  that  there  is  no  clot  in  the  left  carotid, 
either  on  the  distal  or  cardiac  side,  that  the  vessel  is 
completely  closed  at  its  mouth,  and  perhaps  a  little  con- 
tracted there.  On  making  an  examination,  I  found  the 
cellular  tissue  and  sheath  of  the  vessel  connected  very 
firmly  with  the  extremities  of  the  artery ;  the  nerve 
was  also  imbedded  in  the  mass;  the  vein  was  aggluti- 
nated, but  easily  separated.  On  the  opposite  side  the 
same  condition  existed.  It  will  be  seen  that  the  artery 
on  this  side  was  considerably  larger  than  on  the  left, 
for  the  reason  doubtless  that  the  latter  was  first  tied, 
and  there  was  in  consequence  a  greater  volume  of 
blood  in  the  other.  There  are  also  in  this  vessel  (right) 
two  clots  of  a  purplish  color ;  one  of  them  by  accurate 
measurement  was  five-eighths  of  an  inch,  the  other 
three-eighths  of  an  inch  m  length ;  one  of  these  was 
pyramidal  at  the  top,  the  other  was  not.  These  clota 
were  very  slightly  adherent  to  the  vessel  The  vessel 
has  been  laid  open  entirely  to  its  mouth,  which  appears 
to  be  occluded  by  organized  lymph." 

He  stated  that  the  first  experiment  that  he  per- 
formed with  acupressure  was  upon  the  dead  subject.  It 
was  made  by  amputating  the  thigh,  and  afterward  by 
introducing  the  nozzle  of  Davidson's  syringe  into  the 
conmion  iliac  artery.  A  strong  man  then  pumped  into 
the  vessel  with  sufficient  force  to  throw  a  stream 
through  the  severed  end  of  the  femoral  for  a  distance 
of  hve  feet  No  difficulty  was  found  in  arresting  this 
flow  by  the  application  of  the  acupressure  needle. 

Since  the  experiments  upon  the  sheep,  he  had  per- 
formed two  upon  the  hving  subject  One  of  these  was 
upon  a  little  girl  whose  leg  was  reamputaled.  The 
first  operation  was  necessitated  by  the  occurrence  of  a 
railroad  accident,  causing  a  compound  comminuted 
fracture  of  the  leg.  The  flaps,  however,  sloughed,  and 
the  bone  protruded.  The  second  operation  was  per- 
formed on  the  7th  of  November  by  Dr.  Enos,  with  whose 
permission  Dr.  Hutchinson  employed  acupressure. 
Four  needles  were  applied  in  this  case.  During  the 
amputation,  the  patient  suffered  very  much  from  the 
effects  of  ether,  and  the  vomiting  which  resulted  was 
kept  up  more  or  less  for  forty-eight  hours.  The  haem- 
orrhage was,  however,  entirely  arrested  by  acupressure. 
Soon  aft;er  she  was  put  to  bed.  a  Uttle  oozing  took 
place  after  a  vomiting  spell,  but  tnis  was  only  a  reddish 
serum.  The  stump  was  accurately  closed  with  silver 
sutures,  but,  on  account  of  tension  which  soon  after  oc- 
curred^ they  were  loosened  forty-eight  hours  after  the 
operation,  when  the  needles  were  also  removed.  There 
was  union  by  first  intention  throughout  the  whole  of 
the  wound,  except  about  half  an  inch  in  extent 

The  second  operation  was  performed  the  day  before 
the  meeting,  after  a  reamputation  of  the  foot  at  the 
tarso-metatarsal  articulation.  A  portion  of  the  foot 
was  amputated  some  months  ago ;  but  when  the  parts 
healed,  the  metatarsal  bone  of  the  little  toe  was  round 
to  project,  and  that  of  the  fourth  toe  bein^  also  lef^ 
caused  such  a  great  inconvenience  that  uie  second 
operation  had  to  be  performed 'by  removing  the  parts 
higher  up.  Five  needles  were  used,  and,  in  addition  to 
these,  persulphate  of  iron  had  to  be  applied  to  one  of 
the  sunaces  of  the  bones  which  broke  off  at  the  articu- 
lar surface.  It  was  also  necessary  to  apply  a  ligature 
next  to  the  bone,  and  one  was  accordingly  dipped  in 
carboUc  acid,  tied,  and  the  ends  cut  off  short.  The 
edges  of  the  wound  were  drawn  together  with  metallic 
sutures,  and  the  acupressure  needles  were  removed 
twenty-two  hours  after  the  operation.  In  removing 
the  last  needle,  which  w^  fix>m  the  dorsalis  pedis  artery, 


THE  MEDICAL  RECORD. 


545 


a  little  oozing  took  place,  but  it  was  only  for  a  moment. 
The  patient  at  the  tiibe  of  reporting  the  case  was  com- 
fortable, and  the  wound  looked  well. 

Dr.  Markoe  stated  that  in  conjunction  with  Br.  Yan 
Buren  he  had  made  two  operations  with  acupressure. 
In  both  instances  the  needles  were  left  in  for  three  days, 
not  knowing  at  the  time  that  they  could  be  taken  away 
earUer.  The  wou^iis  were  large  and  the  needle  oc- 
casioned considerable  stretching,  followed  in  both  cases 
by  inflammation  and  suppuration.  The  hsemorrhage  in 
both  was  promptly  arrested,  but  in  consequence  of 
the  irritation  of  the  needles  and  the  deformity  they  oc- 
casioned at  the  line  of  the  flap,  he  had  abandoned  their 
use.  These  operations  were  made  shortly  after  Prof. 
Simpson  first  proposed  his  method. 

A  QUBSnONABLI  TUMOR  OF  THE  JAW. 

,  Dr.  Krackowizer  presented  a  specimen  of  tumor  of 
the  jaw  which  he  had  removed  from  a  lady  35  years  of 
age.  It  was  situated  in  the  region  of  the  right  parotid. 
About  18  or  20  years  ago  the  patient,  while  still  unmar- 
ried, was  said  to  have  had  a  similar  tumor  of  smaller  size, 
which  the  iamily  physician  who  attended  her,  and  who 
also  assisted  in  this  operation,  removed.  That  gentleman 
said  that  he  had  good  reason  to  believe  that  there  had 
been  some  portion  of  the  tumor  left,  for  after  the  wound 
had  healed  the  disease  reappeared.  The  tumor,  how- 
ever, grew  very  gradually,  and  was  never  painful  so 
long  as  it  was  small.  It  was  lodged  between  the  mastoid 
process  and  the  ramus  of  the  maxilla,  and  only  by  its 
presence  occasioned  an  inconvenience  during  mastica- 
tion. But  when  it  increased  so  as  to  lift  itself  out  of 
the  sulcus  pain  began  to  show  itself,  and  the  annoyance 
of  its  presence  was  much  increased.  The  skin  overly- 
ing it  was  loose,  and  the  old  cicatrix  was  not  adherent 
It  was  removed  by  a  longitudinal  incision  without  any 
difficulty.  A  part  of  the  parotid  gland  immediately  in 
contact  with  it  seemed  to  be  atrophied  by  pressure. 

On  removal  it  appeared  to  be  made  up  of  nodules,  but 
principally  of  two  sets,  the  larger  being  lodged  behind 
the  ear,  the  other  in  front  These  nodules  seemed  to 
be  prolongations  of  the  substance  of  the  tumor.  It 
was  not  homogeneous  in  structure,  as  some  parts  were 
bard,  others  soft,  and  some  elastic. 

Concerning  the  microscopical  appearances  of  the 
tumor  he  begged  leave  to  report  at  the  next  meeting. 
He  had  only  thus  far  examined  two  specimens,  but  in 
these  he  was  somewhat  disappointed  in  what  he  had 
found.  He  had  supposed  it  to  be  an  adenoid  tumor,  but 
on  microscopic  inspection  there  was  discovered  a  rich 
stroma  of  elastic  fibres,  in  the  interstices  of  which  were 
nests  of  cells,  the  latter  having  small  nuclei  They 
seemed  to  drop  out  of  their  places  very  easily,  and  flow 
in  larger  or  smaller  masses  over  the  field  of  vision.  But 
besides  these,  he  found  other  nests  of  different  sizes, 
which  were  composed  of  caudate  or  fusiform-shaped 
cells,  which  formed  themselves  into  layers. 

The  aspect  of  the  tumor,  as  well  as  its  history,  forbade 
the  conclusion  that  it  was  malignant :  still  the  micro- 
scope made  some  rather  significant  disclosures. 

KECR08I8     IN     FOPLOTAL      SPACE — NECESSITY     OF      SARLT 
PROBING,    ETC. 

He  next  exhibited  several  pieces  of  dead  bone  which 
had  been  removed  from  the  pophteal  space  of  a  boy 
10  years  of  age.  The  patient's  troubles  began  with  the 
symptoms  of  osteo-myelitis  about  the  middle  of  March. 
He  saw  him  in  consultation  about  the  first  week  in 
April  One  of  the  leading  surgeons  of  this  city  had  seen 
the  4)atient  in  consultation  before,  and  being  over-oon- 
servative,  had  declined  to  open  an  abscess  that  then 
existed.    When  Dr.  E.  saw  him  the  acute  symptoms 


had  passed  off,  and  he  found  the  knee-joint  intact,  the 
hamstring  muscles  shortened,  the  leg  semiflexed  on  the 
thigh,  and  the  lower  half  of  the  right  thigh  swollen, 
with  deep  fluctuation  evident  everywhere.  An  incision 
was  made  about  two  inches  above  the  upper  end  of  the 
patella,  and  a  Httle  to  the  inside,  where  fluctuation  was 
most  marked.  The  liquid  whicn  escaped  was  perfectly 
clear  serum,  except  a  few  shreds  of  coagulated  fibrine, 
and  some  accumulated  pus  globules.  The  finger  being 
introduced  into  the  opening,  could  be  swept  to  the  inner 
circumference  of  the  thigh  bone,  which  was  denuded  on 
its  internal  aspect,  near  and  above  the  knee-joint. 

The  boy  was  afterward  sent  into  the  country,  and 
returned  in  Sejptember.  There  were  then  two  separate 
sinuses  on  the  inside  of  the  knee-joint,  about  two  mches 
from  each  other.  The  probe  introduced  passed  outward 
and  posteriorly,  and  grated  against  dead  bone.  Bearing 
in  mind  the  condition  of  things  when  the  incision  had 
been  made,  he  determined,  in  order  to  get  easy  access 
to  the  dead  bone,  to  make  an  opening  between  the 
insertions  of  the  vastus  extemus  and  the  short  head  of 
the  biceps.  The  result  was  such  as  had  been  desired, 
and  the  four  pieces  of  bone  presented  were  removed 
without  difficulty.  The  necrosis  did  not  extend  into 
the  medullary  cavity,  but  seemed  to  confine  itself  to 
the  cortical  portion  of  the  bone. 

He  remarked  that  it  was  always  of  the  utmost  im- 
portance in  such  cases,  after  making  an  incisi<  n,  to  in- 
stitute a  thorough  examination  into  the  extent  and 
situation  of  the  denuded  bone.  In  this  case,  if  this  had 
not  been  done,  and  the  sinus  taken  as  a  guide  for  the 
operation,  the  route  for  the  pieces  of  dead  bone  would 
have  been  much  longer,  and  might  have  involved  some 
of  the  large  vessels  in  the  operation. 

NEW  YORK  MEDICOLEGAL  SOCIETY. 

Stated  Meeting^  January  7,  1868. 
Dr.  Thomas  0.  Finnell,  President,  in  the  Chair. 

APOPLEXY  or  THE  MEDULLA-OBLONOATA. 

Dr.  Terry  gave  the  details  of  an  autopsical  exami- 
nation, which  he  had  conducted  in  connection  with  Dr. 
John  beach,  with  a  view  of  ascertaining  the  cause  of 
death  in  a  diild,  five  days  old.  The  history  as  given 
by  the  mother  was,  that  the  child  after  crying  almost 
incessantly  for  two  days  became  <|uiet,  was  laid  to' rest 
at  10  P.M.,  and  found  dead  at  midnight  They  found 
the  abdominal  and  thoracic  viscera  healthy.  The  mem- 
branes of  the  brain  were  strongly  congested,  and  in  the 
ventricles  there  was  a  sanguineous  fluid.  They  were 
then  about  to  abandon  the  investigation,  when  it  was 
suggested  to  examine  the  base  of  the  brain,  but  without 
any  expectation  of  discovering  any  lesion.  The  brain 
was  accordingly  taken  out  and  very  carefully  opened. 
Dark  coagula  were  found  along  the  tnedtdla  oblongata, 
extending  fi-om  the  crura  cerebri  to  the  region  of  the 
third  or  fourth  cervical  vertebra.  The  clot  was  lying 
anterior,  under  the  dura  mater  and  external  to  the 
arachnoid  membrane.  He  mentioned  the  case  by  way 
of  illustrating  the  necessity  of  thorough  autopsical  ex- 
aminations, since  here  both  the  extreme  infancy  and  the 
absence  of  preceding  symptoms  scarcely  suggested  a 
suspicion  as  to  the  real  lesion. 

Dr.  John  Beach  was  well  satisfied  that  such  verdicts 
as  died  from  " contmWbfw,"  " suffbcationy"  ^* asphyxia" 
etc.,  were  merely  empirical,  and  expressed  no  scientific 
truth.  Still,  as  we  advanced  in  knowledge  these  ver- 
dicts would  of  necessity  be  gradually  replaced  by  others. 
But  we  could  not  expect  to  advance  the  interests  of 
our  science  by  hasty  or  slovenly  examinations  if hich 


546 


THE  MEDICAL  RECORD. 


too  often  confirmed  the  habit  of  jumping  at  conclusions 
not  at  all  warranted  by  the  facts. 

Dr.  Ohadsbt  recollected  a  child  only  thirteen  hours 
old,  who,  after  having  nursed  only  ^re  minutes  before, 
suddenly  died. 

Db.  Tebrt,  in  reply  to  a  question  of  Dr.  Wooster 
Beach,  said  that  the  spmal  cord  had  not  been  ex- 
amined. 

nXATH  FROM  XHB0LI7S  IH  THB  PULMONARY  ARTERT. 

Dr.  Tbrrt  related  a  case  of  sudden  death  in  a  man 
of  middle  a^e,  who  had  been  complaining  of  pain  in 
the  chest)  with  slight  difficulty  of  breathing,  extending 
over  a  period  of  two  weeks.  The  post-mortem  ex- 
amination revealed  very  slight  congestion  of  the 
lungs,  conjoined  with  a  general  hypostatic  condition  of 
the  whole  organ.  The  right  lunj^,  however,  he  noticed 
seemed  abnormally  firm  and  resihent,  without  being  ab- 
solutely diseased.  This  condition  of  things  induced 
him  to  look  more  closely  into  the  circulatory  system, 
when,  on  slitting  open  the  pulmonary  artery,  he  found 
a  large  embolus  extending  mto  the  lungs.  He  would 
inform  the  Society  that  the  cranium  had  been  duly  ex- 
amined, as  well  as  the  remaining  viscera,  and  had  been 
found  to  be  healthy. 

Dr.  R.  Newman  asked  whether  the  embolus  was  the 
real  or  immediate  cause  of  death. 

Dr.  Terry  said  that  there  were  in  the  heart  fibrinous 
clots  which  were  externally  red,  but  internally  of  a 
paler  color.    These  clots  were  decidedly  fibrinous. 

Dr.  Finhbll  said  that  this  question,  as  to  the  real 
cause  of  death  in  the  present  case,  was  scarcely  to  be 
regarded  as  certain,  very  few  of  us  are  accustomed  to 
examine  into  the  condition  of  the  arteries,  and,  of 
course,  a  comparison  of  experiences  could  not  be  ex- 
pected. 

Dr.  John  Beach  alluded  to  the  fact  that  this  man  had 
been  in  charge  of  a  physician  for  two  weeks,  and  was 
able  to  be  about  ,*  at  all  events,  his  case  ^d  not  seem  to 
be  regarded  as  critical 

MAY  OOMPRBSSION  07  THB  BRAIN  AND  A  CIRTAIN  AMOtTNT 
OF  INTELUOEKOE  CO-EXIST? 

Dr.  Woostbr  Beach  referred  to  the  case  of  a  man 
found  dead  in  his  cell  He  had  been  brought  into  the 
station  charged  with  bein^  intoxicated,  and  when 
questioned  by  the  captain  of  the  Precinct,  was  able  to 
retn^n  intelligible  answers.  According  to  the  testimony 
elicited  at  the  inquest,  he  had  left  ms  wife  compara- 
tively sober.  The  autopsy  demonstrated  the  fact  of  a 
somewhat  star-shaped  wound  of  the  scalp,  situate 
just  behind  and  above  the  ear,  with  an  indentation  of 
some  depth  at  the  junction  of  its  several  hmbs.  This 
did  not  lay  bare  the  skull,  although  the  existence  of  a 
fracture  involving  the  petrous  portion  of  the  temporal, 
the  parietal,  and  sphenoid  bones  was  demonstrated. 
There  was  likewise  found  a  dot  so  large,  that  it  de- 
pressed the  substance  of  the  brain  three-fourths  of  an 
incL  This  man  had  been  examined  and  sent  to  his 
cell  by  the  police  officials  without  there  being  a  sus- 
picion of  any  grave  injury,  much  less  does  there  seem 
to  have  been  any  attempt  on  their  part  to  discriminate 
between  intoxication  and  compression.  A  point  of 
some  medico-legal  interest  here  comes  up  for  consider- 
ation, Was  this  man  **  dubbed  f  "  For  his  own  part  he 
thought  that  it  was  probable  that  the  deceased  nad 
&llen  against  the  sharp  comer  of  a  stone  step,  as  the 
wound  from  a  dub  was  usutdly  in  a  straignt  line. 
Then,  again,  the  wound  was  evidentiy  auite  recent, 
since  the  victim  gave  a  coherent  account  of  himself. 

Dr.  O'Dea  suggested  tiiat  the  clot  might  have  been 
the  result  of  a  reactionary  hemorrhage. 


Dr.  JohH  Beach  cotdd  hardly  subscribe  to  the  opin- 
ion tb^t  the  dot  had  been  only  recentiy  formed,  and  re- 
lated a  case  in  illustration  of  the  amount  of  compression 
which  might  be  borne  by  the  brain,  without  interference 
with  its  function.  The  instance  in  question  was  that 
of  a  man  who  had  walked  continuously  from  Weehaw- 
ken  to  Avenue  A,  with  the  exception  of  the  time  con- 
sumed in  crossing  the  ferry,  and^then  lived  twelve 
hours  with  a  simiW  clot  on  his  brain.  In  this  case  the 
dura-mater  was  not  injured. 

Dr.  Stiruno  suggested  that  the  wound  might  possi- 
bly have  been  caused  by  a  thrust  with  the  butt-end  of 
a  club.  He  condemned  the  careless  examinations  of 
persons  found  in  the  streets,  and  thought  that  these  un- 
fortunates were  entitled  to  the  common  rights  of  hu- 
manity. Of  course,  he  would  not  say  that  such  exami- 
nations were  usual,  but  that  they  were  much  too  fi^ 
quent. 

causes  or  8T7DDEN  DEATH. 

Dr.  R.  Newman,  in  opening  the  discussion  upon  the 
causes  of  sudden  death,  said,  that  in  using  the  term 
"  sudden,'*  he  did  not  desire  to  be  understo^  as  mean- 
ing instantaneous,  but  that  he  would  start  with  the 
theory  that  a  few  nours  have  elapsed.  He  then  classified 
the  causes  under  the  following  general  heads: — 

Internal^  under  which  might  be  embraced  such  lesions 
as  have  been  caused  by  the  decay  of  parts,  such  as  the 
rupture  of  vessels  consequent  upon  atheromatous  de- 
posits. Familiar  examples  of  this  form  are  to  be  found 
m  aneurisms.  Besides  these  mijzht  be  cited  ruptures 
of  the  uterus,  hssmorrhages  within  the  thorax.  The 
heart  may  also  be  cited  as  being  frequentiy  at  fault,  the 
lesions  being  rupture  of  its  walls,  and  the  fatty  molecu- 
lar degeneration  of  Quain.  To  the  cranial  pavity  also 
many  a  death  is  referable :  being  caused  by  tlie  extra- 
vasation and  effusion  of  blood  at  base  of  the  brain,  etc 

JSxiemal  causes  comprise  external  violence,  the  ad- 
ministration of  poisons,  foreign  substances  within  tra- 
chea, suffix^tion  by  hanging  and  otherwise,  etc. ;  shock 
to  the  nervous  system,  par^ysis  of  an  important  nerve, 
piercing  of  the  medulla  oblongata,  as  practised  by  Ber- 
nard upon  the  lower  animals,  or  in  Cuba  in  the  ^*  gar- 
roting  of  malefactors ;  nervous  collapse  after  partu- 
rition, strokes  of  lightning,  which  last  he  supposed 
paralyzed  the  nerves  by  an  overdose  of  electricity. 

Dr.  FiNNEUi  added  another  cause,  the  rupture  of  the 
cord<B  tendinece,  which  allowed  the  valve  to  flap  back, 
and  act  as  an  oostruction. 

Dr.  H.  Baphael  also  alluded  to  another  cause,  which 
he  designated  as  from  exhaustion,  and  as  an  instance 
cited  the  case  of  a  patient  who,  having  advanced  to 
the  twenty-flrst  day  after  an  amputation  of  the  thigh 
through  its  middle,  fell  back  in  bed  dead. 

Dr.  O'Dea  stated  that  the  famous  Dr.  Pereira 
died  suddenly,  and  his  heart  was  found  to  have  been 
quite  flabby  and  soft  Dr.  Abercrombie,  of  London, 
had  also  died  from  a  fatty  heart. 

Dr.  Woostbr  Beach  was  of  opinion  that  this  cQn- 
dition  of  fatty  heart — which  term  he  used  in  its  ac- 
cepted professional  sense — ^was  after  all  quite  fre- 
quently a  mere  coincidence.  He  thought  that  when  no 
other  ostensible  cause  of  death  could  be  detected,  me- 
dical men  were  too  apt  to  betake  themselves  to  that 
phrase  as  a  refuge.  He  would  not  say  that  it  was  not 
a  cause,  but  that  statistics  put  the  number  of  deaths 
from  that  cause  at  a  figure  much  too  high. 

Dr.  Finnell  objected  to  Dr.  Beach  s  view,  as  not 
being  sufficientiy  specific. 

Dr.  Ohadsey  said  that  laboring  men,  when  they,  did 
die  from  any  cardiac  disease,  were  apt  to  fall  victims  to 
ossification  of  the  valves  while  the  mtempen^,  and 


THE  MEDICAL  RECORD. 


547 


those  able  to  lire  without  work,  died  from  '^  &ktty  de- 
generatioD." 

Dr.  Trrrt  Tentured  tl^e  theory  that  death  from  light- 
ning was  due  to  an  induced  opposite  electrical  con- 
dition of  the  body,  which  paralyzed  the  nerves. 

Dr.  J,  BsAOH  had  observed  that  the  unaodimated 
furnished  the  greatest  number  of  victims  to  sun-stroke. 
He  had  noticed,  too,  that  in  the  case  of  those  dead  from 
either  lightning  or  sun-stroke  there  was  a  ^purple  hue 
on  the  countenance,  and  a  great  tendency  to  decompo- 
sition, which  was  quite  rapid  in  progress.  This  con- 
dition of  things  he  attributed  to  the  great  congescion  of 
the  whole  capillary  system. 

The  meeting  then  adjourned,  with  the  understanding 
that  the  discussion  be  resumed  at  an  early  date. 

ALBANY  COUNTY  MEDICAL  SOCIETY. 

STATEn  Mestino,  Janitart  18,  1867. 

The  President,  Db.  R.  H.  Sabik,  in  the  Chair. 

Dr.  J.  S.  MosHBR  reported  a  case  of  poisoning  from 
Cieuta  Maeulata. 

Some  boys  Uving  just  south  of  Albany  were  out  in 
early  spring  digging  and  eating  roots  in  the  woods. 
Thev  were  taken  suddenly  and  seriously  sick,  and  one 
of  them  died ;  the  others  being  saved  probably  by  the 
prompt  and  efficient  treatment  of  Dr.  Wendell.  A 
specimen  of  the  root  was  brought  me  by  him,  and  it 
proved  to  be  the  Cieuta  MacukUa,  It  had  evidently 
been  mistaken  by  the  boys  for  the  fragrant  (hmorrhiza 
LongUtylis  (Sweet  Cicely).  It  is  one  of  the  most 
poisonous  plants  that  grow,  and,  unfortunately,  but  lit- 
tle known.  The  Shaker  packages  of  Conium  Macula- 
tum  are  labelled  Cieuta,  and  several  of  our  best  works 
on  materia  medica  make  no  distinction  between  the 
two  plants. 

The  Conium  Macnlatum,  or  Spotted  Hemlock,  is  com- 
mon, growing  by  roadsides,  and  is  familiar  to  all.  The 
genus  Cieuta  is  represented  in  this  country  by  two 
species,  the  C.  Maeulata,  or  Poison  Hemlock^  having  two 
or  three  tuberous  roots  as  large  as  the  little  finger,  and 
•  0.  Bulbifera.  The  C.  Virosa,  or  Water  Hemlock,  is  a 
European  species,  with  a  single  large  tuber,  sending 
out  a  number  of  rootlets,  and' has  been  long  imown  as 
one  of  the  most  deadly  poisons.  These  are  cerebro- 
spinal poisons,  acting  the  reverse  of  strychnine,  which 
has  been  suggested  as  an  antidote  for  them.  Tne  best 
treatment  seems  to  be  to  free  the  stomach  by  emetics, 
and  then  support  with  stimulants.  The  Order  Umbelli- 
ferse,  in  which  these  are  found,  also  furnishes  many  use- 
fril  plants.  It  is  most  widely  known  by  its  garden  and 
field  varieties.  The  caraway,  carrot,  parsnip,  and  celery, 
are  familiar  examples. 

From  the  ignorance  of  the  botanical  character  of 
these  plants  arises  also  ignorance  of  their  chemical  and 
toxicological  character.  There  is  much  ground  for  in- 
teresting investigation  in  these  plants.  I  have  several 
of  them  in  my  garden,  and  intend  to  become  better 
acquainted  with  their  properties.  The  terrible  char- 
acter of  the  cieuta,  and  the  complication  of  names 
which  confuse  it  with  conium,  so  common  in  medical 
use,  are  worth  o.ur  serious  attention. 

Dr.  Steveks  remarked  that  although  the  Cieuta  Ma- 
eulata and  C.  Bulbifera  are  natives  of  all  sections  of  our 
State,  they  are  not  veir  common,  and  hence  are  not 
generally  known  even  by  medical  men.  They  inhabit 
swampy  meadows  and  the  borders  of  marshes,  and  are 
usually  surrounded  by  tall  gra^^ses.  Both  species  have 
marked  characteristics,  and  if  once  recognized,  need 
never  afterwards  be  mistaken.  They  have  finely  divided  j 
leaves  and  white  flowers;  the  C.  Bulbifera  has  little  I 


bulbs  in  the  axils  of  the  leaves.  A  peculiarity  of  this 
order  is  that,  as  a  rule,  the  plants  growing  in  wet  places  - 
contain  an  acrid  narcotic  poison,  while  tnose  growing 
in  dry  places  are  harmless.  The  Cieuta  Maeulata 
and  .fithusa  (Fool's  Parsley)  we  examples  of  the  for- 
mer class;  the  carrot,  parsnip,  sweet  cicely,  and  cara- 
way, of  the  latter.  People  should  be  warned  to  avoid 
all  plants  growing  in  wet  places  and  which  have  urn- 
brella-like  inflorescence. 

Dr.  Stevens  reported  a  case  of  extrophy  of  the 
bladder  with  an  improved  instrument  for  its  relief. 
The  bladder  stood  out  upon  the  abdomen  like  a  large 
tumor,  raw  and  bleeding.  The  penis  was  a  little  more  than 
an  incn  long,  and  impeiforate,  and  the  ureters  opened  be- 
tween the  bladder  and  penis. 

Corre«jr0nlrtnoct. 


MEDICAL   MATTERS   IN   PARIS. 

(from     our     special     CORRESPONnENT.) 
To  THK  Eorros  or  tbb  Mxdioal  Bmosd. 

Sir — ^Before  the  Academy  of  Sciences,  M.  Sappey  pre- 
sented a  note  announcing  the  existence  of  nervi  xtervo- 
RUM,  or  nervous  filaments,  in  the  neurilemma  of  nervesy 
analogous  to  the  vascular  ramifications  in  the  coats  of 
blood-vessels.  The  distinguished  anatomist  has  fol- 
lowed these  filaments  as  far  as  the  sheaths  enveloping 
the  secondary  trunks  of  nerves,  but  they  are  never 
found  in  the  envelope  of  primitive  fascicules.  The  in- 
ternal envelope  of  the  optic  nerve  receives  no  nervous 
filament  The  external,  on  the  contrary,  receives  a 
number  firom  the  ciliary  nerves.  This  external  sheath 
is  also  remarkable  for  the  abundance  of  elastic  fibres 
which  enter  into  its  composition.  It  therefore  differs 
notably  fi-om  both  the  sclerotic  and  the  dura  mater, 
which  are  deficient  both  in  nervous  filaments  and  elastio 
fibres. 

THE  CURYATimB  OF  THE  8PINB  AND  THE  OSSIFICATION  OF 
THE  RIBS. 

M.  Sappey  is  the  Chef  des  Travaux  Anatomiques, 
and  has  just  reopened  his  popular  course  at  the  Ecole 
Pratique.  At  a  lecture  at  which  I  had  the  pleasure 
of  **  assisting "  the  other  day,  M.  Sappey  referred  to 
two  points  which  had  been  the  object  of  some  recent 
personal  researches,  and  may  not,  therefore,  be  well 
known  to  you.  One  was  an  explanation  of  tiie  curva- 
tures of  the  vertebral  column  by  the  obliquity,  in  the 
cervical  region,  of  the  intervertebral  disks,  in  tiie  dor- 
sal, of  the  bodies  of  the  vertebrae,  and  in  the  lumbar,  of 
both  bodies  and  disks.  Hirschfeld  had  attributed  these 
curvatures  to  the  action  of  the  yellow  ligament,  and 
declared  that  they  were  destroyed  by  its  section.  M. 
Sappey  had  repeated  the  experiment,  and  found  this 
assertion  incorrect — ^the  curvatures  persisting. 

The  other  point  referred  to  was  the  ossification  of  the 
ribs.  According  to  M.  Sappey,  the  ribs,  like  the  bones 
of  the  cranium  and  the  face,  pass  through  no  cartila- 
ginous stage,  but  a  thread  of  osseous  substance  is  found 
to  be  formed  directly  in  the  midst  of  the  original  '*  mu- 
cous" mass. 

THE  FUNCTION   OF  THE  VA80-M0T0R  NERVES. 

Drs.  Eulenbers  and  Landois  have  published  a 
series  of  articles  upon  the  fiinction  of  the  vaso- 
motor nerves,  and  upon  the  r61e  they  seem  to  play  in 
a  certain  intermittent  ophthalmia.  Gkiesinger  considers 
this  affection  to  be  a  form  of  latent  intermittent  fever, 
as  a  neuralgia  of  the  eye  more  or  less  severe,  accom- 


548 


THE  MEDICAL  RECORD. 


panied  by  congestion  more  or  less  intense.  It  is  nearly 
always  unilateral,  and  consists  in  an  intense  hyper- 
smia  of  the  eye,  with  photophobia,  suffusion,  contrac- 
tion of  the  pupil,  and  often  oedema  of  the  iris.  When 
the  disease  is  of  long  stan(}ing,  it  may  terminate  in 
chronic  ophthalmia,  or  in  atrophy  of  the  bulb.  Gbiesin- 
ger  considered  the  presence  of  neuralgia  essential  to 
characterize  this  form  of  ophthalmia,  but  Mannhardt  has 
reported  a  case  where  this  symptom  was  entirely 
wanting. 

A  man  thirty-six  years  old  was  suddenly  attacked  at 
nine  o'clock  in  the  morning  with  an  acute  catarrhal 
conjunctivitis.  Intense  redness  and  swelling  of  the 
palpebral  and  bulbar  conjunctiva,  abundant  flow  of 
tears  mixed  with  mucous  nocculi.  A  collyrium  of  ace- 
tate of  lead  was  ordered.  The  next  morninfi^  there  was 
no  trace  of  the  affection,  but  it  returned  wiUi  as  much 
intensity  as  ever  at  two  o'clock  in  the  afternoon.  The 
same  collyrium  was  employed,  and  the  inflammation 
again  disappeared,  to  reappear  the  fifth  dajr  between 
nine  and  two  o'clock.  Small  doses  of  quinine  were 
then  ordered.  An  access  of  moderate  intensity  occurred 
the  seventh  day,  but  from  the  ninth  the  disease  did  not 
return. 

It  may  therefore  be  admitted  that  the  vaso-motor 
filaments  of  the  trigeminus  may  be  affected  independ- 
ently of  the  sensitive  fibres,  and  that  intermittent  oph- 
thalmia may  exist  imcomplicated  by  neuralgia. 

OUBIOUS  PHENOMENA  PRESENTED  BY  PRDIITIVB  SYPHaiTIO 
INDURATIONS. 

In  the  Archives  of  Medicine  for  November,  M. 
Foumier,  a  distinguished  agr^g^  of  the  faculty,  has 
called  attention  to  certain  curious  phenomena  occasion- 
ally presented  by  primitive  syphilitic  indurations.  The 
first  and  most  interesting  is  an  ulceration  of  the  cica- 
trized chancre.  The  second  is  the  softening  of  the  cen- 
tral and  deep  portions  of  the  induration,  and  its  pro- 
gressive elimination  in  the  form  of  a  purulent  detritus. 
The  third  phenomenon  relates  to  the  production  of 
secondary  indurations,  resulting  fi-om  the  primitive  af- 
fection, and  occurring  in  the  neighborhood  of  the  initial 
chancre. 

In  the  first  case,  the  physician  may  have  had  to 
deal  with  a  chancre  which  has  accomplished  its  differ- 
ent phases  with  perfect  regularity,  and  has  cicatrized 
in  a  perfectly  satisfactory  and  apparently  definite  man- 
ner. Under  certain  circumstances  (of  which  an  un- 
usual abundance  of  the  induration  seems  the  most  char- 
acteristic) this  cicatrix  is  found  to  open^  ulcerate,  and 
.  erode  in  various  points ; — ^a  new  wound  is  thus  formed 
on  the  surCewe  of  the  induration,  which  sometimes  ex- 
cayates  its  entire  extent  M.  Fournier  has  observed 
this  secondary  ulceration  to  be  repeated  three  times  on 
the  same  base.  In  the  cases  in  question  the  rupture 
of  the  chancre  is  entirely  spontaneous. 

Although  in  the  greater  number  of  cases  the  ulcera- 
tion takes  place  on  chancres  in  which  the  induration  is 
excessive,  it  may  also  occur  when  this  is  of  only  medium 
intensity.  The  ulcer  is  formed  from  the  eighth  and  fif- 
teenth days  after  the  cicatrization.  Sometimes  it  is 
quite  superficial,  a  simple  erosion ;  sometimes  it  affects 
the  excavated  form.  A  sanguinolent  rather  than  puru- 
lent liquid  is  secreted  by  the  wound.  The  ulcer  gener- 
ally heals  with  remarkable  rapidity,  and,  although  some- 
times alarming  from  its  extensive  and  ragged  aspect,  it 
is  in  realitjr  benign.  Even  when  assuming  a  phage- 
denic form,  it  reafily  heals  with  only  an  application  of 
dry  lint. 

The  conversion  of  the  cicatrized  chancre  into  an  ab- 
Boess,  much  more  rarely  occurs  than  its  ulceration.  In 
this  case,  also,  the  cicatrix  has  been  regulwly  formed, 


and  the  induration  is  generally  excessive.  Presently  the 
centre  of  the  mass  is  felt  to  be  softened,  and  a  Uttle 
later  a  small  opening  is  discovered,  through  which  is 
eliminated  a  yellowish  sanguinolent  liquid,  puriform 
rather  than  purulent.  As  many  as  six  openings  have 
been  observed,  each  leading  by  a  curiously  formed  little 
passage  into  a  central  focus  of  softening.  The  integrity 
of  the  outer  layers  of  the  mass  is  preserved. 

It  is  evident  that  the  ulcer  and  the  abscess  are  really 
analogous  lesions,  each  producing  a  liquefaction  and 
consecutive  elimination  of  the  pathological  tissue  of  the 
induration.  May  not  the  exaggeration  of  this  latter, 
which  has  been  found  so  generi^ly  to  coincide  with  the 
lesions,  be  indirectly  their  cause,  on  account  of  opposing 
greater  difficulty  to  the  ordinary  process  of  absorp- 
tion? 

The  secondary  indurations  may  ulcerate,  and  assume 
the  aspect  of  primitive  hard  chancres.  M.  Fournier 
thinks  that  it  is  on  account  of  cases  of  this  kind  that 
Babington  had  been  led  to  maintain  that  syphilitic 
induration  preceded  ulceration.  An  opinion  that  M. 
Fournier  has  no  hesitation  in  pronouncing  erroneous, 
if  only  on  account  of  the  difficulty  of  diagnosis  between 
initial  chancre  and  herpes. 

OPERATION  FOR  NASO-PHARTNQKAL  POLYPUS. 

The  Gazette  dee  Hopitaux  contains  an  account  of  an 
interesting  operation  practised  at  the  Hotel  Dieu  of 
Clermont  Ferrand,  for  a  naso-pharyngeal  polypus.  The 
patient  was  a  boy  of  eighteen,  extremely  diminutive 
and  fragile.  The  polypus  had  apparently  existed  eigh- 
teen months.  The  right  cheek  was  but  slightly  de- 
formed, but  the  difficulty  of  speaking,  and  the  embar- 
rassment of  the  respiration,  forcing  the  patient  to  keep 
the  mouth  partially  open,  indicated  the  existence  of  a 
material  obstacle  to  the  entrance  of  air. 

The  soft  palate  was  pushed  forward  by  a  hard,  resist- 
ant, bright-red  tumor,  whose  lower  border  projected 
below  the  uvula,  its  adherent  edge  mounted  in  the 
pharynx.  The  nostril  of  the  same  side  was  obstructed 
by  a  fleshy  mass,  evidently  only  an  expansion  of  the 
guttural  tumor. 

The  finger,  introduced  between  the  cheek  and  the 
alveolar  arcade  of  the  upper  maxilla,  distinguished  a 
small  tubercle  which  corresponded  to  the  exterior 
tumor.  The  point  of  insertion  was  difficult  to  deter- 
mine ;  nevertheless  it  seemed  probable  that  the  tumor 
adhered  rather  to  the  pharynx  than  to  the  nasal  fossa. 

After  some  delays,  during  which  the  respiration  be- 
came more  and  more  embarrassed,  M.  Fleury  deter- 
mined to  afford  the  batient  the  only  chance  for  life  that 
remained,  by  practising  the  resection  of  a  portion  of  the 
maxilla,  and  thus  extracting  the  tumor.  The  patient 
being  under  the  influence  of  chloroform,  an  oblique  in- 
cision was  made  from  the  commissure  of  the  lips  to  the 
external  an^^le  of  the  orbit.  Only  one  artery  required 
ligature.  The  upper  flap  was  dissected  to  a  considera- 
ble distance,  then  a  chain  saw  introduced  by  means  of 
a  curved  needle  into  the  spheno-maxillary  clefl,  to  sep- 
arate the  maxilla  from  the  malar  bone.  The  second 
lateral  incisor  tooth  was  extracted^  and  the  cisaiUeSf 
introduced  into  the  mouth  and  nght  nostril,  easily 
divided  the  palatine  vault — a  section  practised  with 
scissors  separated  the  apophysis  of  the  maxilla ;  it  then 
was  only  nece^8ary  to  apply  the  blade  of  the  same  in- 
strument underneath  the  orbit  and  exercise  a  light 
pressure,  to  loosen  the  bone.  The  soft  parts  uniting  it 
to  the  subjacent  tissues  were  detached  with  curved 
scissors,  and  the  bone  then  easily  removed.  The  nasal 
fossa  and  zygomatic  cavity  were  thus  laid  open,  and 
the  opening,  though  smaller  than  if  the  maxilla  had 
been  entirely  removed,  was  sufficiently  large  to  give 
Digitize.  „, ^O" 


THE  MEDICAL  RECORD. 


049 


passage  to  the  tuipor,  and  the  risk  of  deformity  was  much 
less  than  would  have  been  incurred  by  the  other  opera- 
tion. The  polypus  being  discoYcred,  was  much  larger 
than  had  been  supposed,  since  it  occupied  the  cavities 
of  the  face.  As  much  as  practicable.  M.  Fleury  endeay- 
ored  to  enucleate  the  tumor.  The  pedicle  was  im- 
planted by  a  large  and  resistant  base  in  the  upper  part 
of  the  pharynx.  It  was  fortunately  but  slightly  vascu- 
lar,  and  the  slight  hsBmorrhage  following  its  division 
was  easily  arrested  by  the  cautery.  The  tumor  weighed 
112  grains,  and  was  nearly  entirely  fibrous. 

The  second  day  after  the  operation,  inflammation  of 
considerable  intensity  set  up  around  the  wound,  and 
destroyed  all  hope  of  union  by  first  intention.  The 
following  days  a  suspicious  odor  escaped  firom  the 
mouth  and  nostrils,  which  was  partially  neutralized  by 
lotions  of  chlorinated  soda.  The  patient  was  extremely 
feeble,  and  a  fatal  termination  was  dreaded.  However, 
after  some  days  of  uncertainty,  the  Ups  of  the  wound, 
which  had  opened^  assumed  a  better  appearance  and 
became  covered  with  healthy  granulations,  the  patient 
was  able  to  rise,  to  eat^  and  from  that  moment  the  con- 
valescence was  assu^d. 

The  inflammation  was  attributed  in  part  to  the  use 
of  the  actual  cautery.  The  wound  was  dressed  with 
lint  steeped  in  camphorated  alcohol 

This  IS  the  third  case  in  which  M.  Fleury  has  saved 
a  patient  from  inevitable  death,  by  boldly  venturing  on 
this  formidable  operation  on  the  maxilla. 

Among  the  clinics  recommenced  with  the  reopening 
of  the  year,  that  of  M.  Gossehn,  who  has  succeeded  the 
lamented  Velpeau  at  La  Charity,  is  not  the  least  inter- 
esting. The  inaugural  lesson  was  divided  into  three 
parts.  In  the  first  the  new  professor  paid  a  just  tribute 
to  the  memory  of  his  predecessor.  In  the  second,  he 
traced  a  rapid  sketch  of  the  history  of  this  famous  hos- 

eital,  founded  by  Marie  de'  Medici  260  years  ago. 
during  150  years  there  was  no  clinic,  and  the  names 
of  no  surgeons  have  come  down  to  us.  The  first  illus- 
trious clinician  of  the  Charity  was  Desault,  who  insti- 
tuted the  eoncours  for  the  position  of  assistant  sur- 
geon. Deschamps  was  the  first  who  obtained  this  title, 
and  also  the  first  who  availed  himself  in  his  scien- 
tific writings  of  observations  taken  among  his  hospital 
patients.  Until  then,  observations  had  always  been 
collected  from  the  writer's  private  clientele.  Of  all  the 
writings  of  Deschamps,  the  oest  known  are  his  "  Obser- 
vations on  the  Ligature  of  the  Principal  Arteries  of  the 
Extremities,  on  Account  of  Wounds  or  Aneurisms." 
Boy er  succeeded  Deschamps,  and  Roux  followed  Boyer ; 
finally  Velpeau  took  the  place  of  Roux,  when  the  latter 
succeeded  to  Dupuytren  at  Hotel  Dieu. 

The  third  part  of  the  lesson  was  devoted  to  two 
patients  in  the  wards,  one  with  a  fracture  of  the  wrist, 
the  other  with  an  encysted  encephaloid  tumor  at  the 
internal  and  lower  part  of  the  thigh.  Space  does  not 
permit  me  to  quote  at  length  M.  QosseUn's  remarks, 
further  than  that,  in  the  latter  case,  he  considered  that 
amputation  would  not  prevent  a  return  of  the  tumor, 
but  would  prolong  life.  p.  o.  m. 


CHLORODYNE. 

To  THi  Editor  or  ran  Mxdioal  Rbooro. 

SiR-^In  the  late  edition  of  Dr.  Aitken's  Practice  of 
Medicine  (1866),  Chlorodyne  is  several  times  recom- 
mended as  a  valuable  remedy^  and  a  formula  is  given 
on  p.  471,  vol  i,  which  is  said  to  be  "a  very  useful 
one." 

It  is  strange  that  a  compound  of  this  description 
should  have  obtained  the  sanction  of  physicians  in  the 


absence  of  any  authentic  or  officinal  directions  for  its 
prep|aration.  In  prescribing  it,  unless  the  nostrum  is 
specified,  the  practitioner  may  not  know  which  of  many 
compounds  will  be  furnished.  I  have  before  me  &ve 
different  formulas  for  Chlorodyne,  all  differing  in  re- 
spect to  ingredients  and  their  proportions:  and  not 
one  of  them  would  fiimish  a  good  imitation  of  the  Eng- 
lish nostrum. 

If  a  chloroform-anodyne  is  deemed  worthy  of  the 
place  it  now  holds  in  public  estimation^  it  should  have 
a  uniform  composition,  or  be  made  officmal,  in  order  to 
prevent  the  hazard  and  uncertainty  which  must  now  be 
incident  to  its  administration.  The  following  is  Dr. 
Aitken's  formula : 

ft.  Chloroform  £  3  iv ;  -fith.  Sulph.  f.  3  ii ;  Theraicae 
(Treacle)  f.  3  i ;  Mucila^Acacisa  t.  3  ii ;  Morph. 
Muriat.  gr.  viii ;  Acid.  jEydrocjranic.  dil.  (2  per 
cent)  3  li ;  01.  Menth.  Pip.  M.  iv  ad  vL  Msee 
bene. 

Further  directions  are  given  about  combining  the 
materials,  which  we  have  attempted  to  follow,  but,  on 
standing,  the  whole  of  the  ether  and  chloroform  separ- 
ate fi*om  the  "  constituent)"  so  that  the  formula  cannot 
be  considered  an  eligible  one. 

About  two  vears  a^o  the  writer  obtained  a  sample 
of  Dr.  Browne  s  genuine  chlorodyne  for  examination. 
It  was  of  a  dark  color,  with  an  oder  of  chloroform  and 
ether.  By  repeated  and  careful  tests  we  failed  to  dis- 
cover in  it  either  cannabis  or  hydrocyanic  acid.  (The 
same  result  was  obtained  by  Mr.  Chas.  Bullock  in  his 
examination  of  a  similar  article.)  The  "  constituent " 
was  found  to  be  molasses,  gum  Acacisu  and  ext  glycyr- 
rhiza.  It  contained  no  peppermint.  There  might  possi- 
bly have  been  a  small  quantity  of  capsicum,  but  the  pun- 
gent effects  of  this  and  chloroform  are  so  similar  that 
its  presence  may  be  considered  doubtful.  An  imita- 
tion, containing  only  chloroform,  morphia^  and  ether, 
resembles  "the  genuine"  in  sensible  properties  and 
operative  effects.  I  published,  accordingly,  the  follow- 
ing formula  for  Chlorodyne,  and  should  not  have 
thought  it  of  sufficient  consequence  to  refer  to  it  again, 
but  for  the  notice  taken  of  the  conipound  in  so  respect- 
able a  work  as  Aitken*s  Practice  ofMedicine.  The  fol- 
lowing is  an  imitation  of  Dr.  J.  CoUis  Browne's  Chlo- 
rodyne. 

Heat  molasses  in  a  water-bath,  and  remove  the 
scum  until  it  becomes  clear.  Mix  one  part  of  officinal 
mucilage  of  acacia  with  two  parts  of  tke  molasses,  to 
form  the  constituent. 

Dissolve  eight  gr.  sulphate  of  morphia  in  one  drachm 
and  a  half  of  water,  by  heat,  and  add  eight  gr.  powder- 
ed extract  of  liquorice.  To  this  solution  add  one  fluid 
drachm  of  cone,  sulphuric  ether.  Add  a  portion  of  the 
constituent,  and  two  fluid  drachms  of  chloroform,  and 
shake  the  mixture  then  add  enough  of  the  constituent 
to  make  one  fluid  ounce. 

Ten  minims,  or  twenty  drops^  contain  ^  gr.  of  the 
morphia  salf^  two  minims  and  a  half  or  ten  drops  of 
chloroform,  and  half  the  quantity  of  ether 

Chlorodyne  thus  prepared  resembles  the  nostrum  in 
pungency,^  color,  density,   and  other  properties.     If 
the  prescriber  wishes  to  administer  cannabis  or  hydro- 
cyanic acid,  they  may  be  added  extemporaneously. 
Truly  yours, 

W.  W.  Elt,  M.D. 

BocHnrxB,  N.  T.,  December,  18«T. 

Loss  OF  Memory  from  SvprnLis. — Dr.  Cerasi  {Medi- 
cal Journal^  Kome,  Italy),  in  a  case  of  flagging  intellect 
and  loss  of  memory  from  syphilis,  obtained  a  complete 
cure  in  two  months  and  a  half  by  the  use  of  mercurial 
firiction  and  iodide  of  potassium.  ^^-^  t 

digitized  by  VjOOQIC 


660 


THE  MEDICAL  RECORD. 


UTERINE  SURGERY. 

To  THB  EoiTOB  or  THB  Mbdioax  Bboobd. 

Sir — There  is  much  truth  and  some  error  in  the  as- 
saults now  being  frequently  made  upou  the  practice  and 
teachings  of  modern  uterine  surgenr.  In  our  efforts  to 
avoid  one  extreme,  let  us  be  careful  that  we  do  not  fall 
into  the  other,  and  especially  let  us  be  careful  not  to  be 
led  astray  by  the  influence  of  fashion  in  medicine. 
There  can  be  no  doubt  that  in  the  various  operations  for 
healing  breaches  of  continuity  in  the  genital  organs  of 
females,  great  good  has  been  accomplished;  but  it  is 
remarkable  that  what  have  within  a  few  years  been 
proclaiined  as  very  valuable  inventions  and  discoveries, 
should  so  soon  have  gone  out  of  use.  The  clamp  suture 
is  one  instance  of  this ;  and  atler  all  the  later  improve- 
menU,  it  may  now  well  be  doubted  whether  any  that 
have  been  employed  are  to  be  preferred  to  that  of  the 
waxed  silk,  so  long  in  use  in  surgical  operations.  Yes- 
ico -vaginal  fistules  were  long  ago  cured  bv  the  use  of 
this  suture,  the  wound  being  protected  from  mucous 
secretions  by  the  daily  appl^ation  of  nitrate  of  silver 
and  dry  calomel  Cauterizations  of  the  os  and  cervix, 
the  propriety  of  which  was  long  unquestioned^  are  now 
deemed  worse  than  useless  by  many  physicians,  who 
have  experimented  with  them  to  their  hearts'  content ; 
and  there  are  few  men  of  experience  who  approve  of 
slitting  up  the  neck  of  the  womb,  or  amputating  the  os, 
for  any  or  the  purposes  recommended.  The  pessary  has 
fallen  into  discredit,  not  only  by  its  multiplied  failures, 
but  by  reason  of  the  vast  variety  of  its  forms;  and  some 
are  now  reverting  to  the  ancient  notion,  that  prolapsus 
is  best  cured  bv  relieving  the  organ  of  its  engorgements. 
The  verdict  of  the  profession  must  soon  accord  with 
that  of  women  who  have  worn  pessaries — hard  sub- 
stances cannot  be  worn  in  the  vagina  without  inflicting 
injury.  The  use  of  the  specoilum  as  a  means  of  diag- 
nosis may  sometimes  be  proper ;  but  in  the  large  major- 
ity of  cases  a  digital  examination  is  more  satisfactory, 
and  the  speculum  will  be  resorted  to  very  rarely  ex- 
cept by  tyros  in  medicine. 

Yours  truly,  M. 


MtVicoi  3lttms  anlr  Urns. 


PERSONAL. 

Sureeon  J.  D.  Miller,  U.S.N^  has  been  detached 
from  duty  as  fleet  surgeon  of  the  iMorth  Atlantic  squad- 
ron and  placed  on  waiting  orders. 

Assistant  Surgeon  James  N.  Htde,  IJ.S.N.,  has  been 
ordered  to  the  Naval  Hospital,  Washington,  vice  Act- 
ing Passed  Assistant  Surgeon  D.  G.  Burleigh  detached, 
and  ordered  to  the  Purveyor. 

Acting  Assistant  Surgeon  Edward  T.  T.  Marsh  has 
been  placed  on  waiting  orders. 

Dr.  Jamks  Crane,  of  Brooklyn,  has  been  elected  Pre- 
sident of  the  Health  Board,  vice  Schults,  resigned. 

Dr.  Austin,  formerly  editor  of  the  Madras  A^^i^nopwm, 
and  a  writer  in  the  Saturday  Review^  has  been  ap- 
pointed special  correspondent  of  theTVmef  for  the  Abys- 
sinian Expedition. 

Dr.  Albert  Perohkent,  a  distinguished  physician  of 
Pittsburgh,  died  of  heart  disease,  Dec.  13. 


Death  of  Surgeon  Lewis  Taylor. — ^Intelligenoe  has 
been  received  at  the  Surgeon  Gkneral's  office  of  the 
death  of  Surgeon  Lewis  Taylor,  United  Slates*  Army, 
at  Fort  Wadsworth,  D^oU  Territory,  on  the  5th  of 
January. 


Medioal  SooiBTr,  County  or  New  York. — ^At  the 
next  stated  meeting  of  the  Medical  Society  of  the 
County  of  New  York  (February  3d)  Dr.  Fordyce 
Barker  will  read  a  paper  on  "  Abortion ; ''  and  Dr.  0.  G. 
Smith,  on  the  "  Paralysis  of  the  Insane."  Several 
members  have  promised  to  present  their  views  on 
these  subjects,  and  an  interesting  discussion  may  be 
expected.  * 

Northern  Dispensary. — ^The  41st  annual  meeting  of 
the  Trustees  of  the  Northern  Dispensary  was  held 
in  the  Board-room  of  that  Institution,  corner  of 
Waverley  Place  and  Christopher  street,  Hon.  Charles 
T.  Eirkland  in  ^e  chair.  The  secretary's  and  treasurer's 
reports  were  received  and  adopted.  These  documents 
show  that  the  receipts  from  all  souroes  during  the  past 
year,  including  balance  from  1866,  amounted  to  $6,999. 
41,  and  the  expenditures  to  $6,870.49.  The  total  num- 
ber of  persons  treated  by  the  institution  during  ths 
year  was  21,299,  of  whom  12,498  were  females  and 
8,801  males.  20,923  of  these  were  either  cured  or  re- 
Ueved,  and  the  balance  were  sent  to  hospital,  discharged, 
or  died.  There  remained  under  treatment,  Dea  31st^ 
1867,  33.  A  Board  of  Trustees  for  the  ensuing  year 
were  then  elected,  and  a  vote  of  thanks  offered  to  the 
chairman,  and  the  meeting  adjourned. 

Bellevue  Hospital. — The  following  are  the  statistics 
of  this  institution  for  the  year  just  ended : — Admissions^ 
5,805;  patients  in  hospital  on  the  1st  of  January,  1867, 
790 ;  total  number  treated  during  the  year,  6,595 ;  dis- 
charged from  hospital,  5.264;  deaths,  640;  in  hospital 
on  the  1st  of  January,  1868,  691.  The  ailments  of  the 
patients  were  as  follows : — Accidents  and  injuries,  1,507: 
obstetric  cases,  626;  infants  bom,  561;  cholera,  5:  all 
other  cases,  3,106.  The  deaths  were  from  the  follow- 
ing causes: — ^Injuries  and  accidents,  147;  cholera,  5; 
puerperal  fever,  9 ;  infants  bom  dead,  77 ;  Bright's  dis- 
ease, 113;  pulmonary  consumption,  146;  all  other 
causes,  143.  The  majority  of  the  patients  were  of 
foreign  birth;  only  1,799  native-born  citizens  having 
been  brought  to  the  hospital  for  treatment 

Cholera  at  Quarantine. — ^The  Hambui^  ship  Leib- 
nitz arrived  at  Quarantine,  Jan.  11  ult,  with  thirty-five 
cases  of  cholera  on  board,  one  hundred  and  five  deaths 
having  occurred  during  the  voyage  from  the  same  dis- 


MaiTARY  HosprrALS  for  the  Abyssinian  Exfsd^ 
Tioix. — "Immense  military  hospitals,"  according  to  the 
Nord  of  Brussels,  "are  being  organized  at  Alexandria, 
Cairo,  and  Suez;  that  of  Suez  aheady  contains  two 
thousand  beds." 

American  Journal  of  Obstetrics  and  DiBEAsn  or 
Women  and  Children  is  to  be  the  title  of  a  quarterly 
journal  shortly  to  be  issued  under  the  supervision  of  Dri 
Noeggerath  and  Dawson,  of  this  city.  The  subscrip- 
tion price  is  named  at  $3.00  per  annum. 

Average  Duration  of  Life  in  Italy. — The  director 
of  the  Italian  Life  Assurance  Society,  M.  W.  Rey,  has 
published  some  interesting  statistics  showing  the  aver- 
age duration  of  life  in  Italy  as  compared  with  that  in 
other  countries,  from  which  it  appears  that  the  mortality 
of  Italians  is  exceptionally  great  He  shows  that  in  Italy, 
22i  per  cent,  of  the  infant  population  die  yearly,  and  that, 
even  in  the  healthiest  distncts,  the  average  duration  of 
life  is  33.43  years  only,  while  in  France  it  is  3a33,  at 
Geneva,  42.02,  and  in  England,  39.31.  The  number  of 
births,  too,  is  relatively  much  smaller  in  Italy  than  in 
England  and  France. 

Dr.  B.  S.  Reilley,  Acting  Assistant  Surgeon,  U.  a  A^ 
died  of  yellow  fever  at  Rio  Grande  City,  Texas,  Sept. 
20,  1867. 

Digitized  by  VjOOQ  IC 


THE  MEDICAL  RECORD. 


551 


Lamentable  Death  raoM  CHLORoroRM. — A  young 
lady,  the  wife  of  a  lieiitenanlHX>Ionel  in  the  Confederate 
army,  died  recently  at  Gallatin  under  very  painftil 
circumstances.  Being  near  confinement,  and  sunering 
during  the  night  with  great  pain,  she  inhaled  somp  chlo- 
roform on  her  own  account.  She  laid  the  handkerchief 
upon  her  chin  and  fell  asleep.  In  the  morning  she  was 
found  dead.  This  circumstance  goes  to  prove  how 
dangerous  a  plaything  chloroform  is. 

The  ^ansas  Oolleob  of  Pharmaot  is  the  name  of  an 
association  of  enterprising  and  respectable  pharmaceu- 
tists of  Kansas. 

MioROsoopiG  Lense& — ^The  improvement  in  lenses  for 
the  microscope  began  in  reality  with  the  ^g  of  Powell 
&  Leland.  This  ^ass  gave  an  available  power  of  fi'om 
twelve  to  eighteen  hundred  diameters.  The  ^o  achro- 
matic lens,  with  a  focal  distance  of  ^  of  an  inch,  of 
the  same  makers,  followed.  At  present,  there  are  only 
two  of  these  objectives  in  the  Umted  States — one  at  the 
Army  Medical  Museum,  the  other  the  property  of 
Dr.  H.  W.  Atkinson,  of  New  York  City. 

Much,  however,  is  expected  from  a  ^  made  by 
W.  Wales,  of  Fort  Lee,  N.  J.,  which  an  exchange 
describes  as  beinj^  possessed  of  a  good  definition,  a  flat 
field,  and  as  giving  two  thousand  diameters  with 
ordinary  light  Its  focal  distance  is  ^  of  an  inch. 
Another  peculiarity  of  this  lens  is  that  it  can  be  used 
pot  only  as  an  ordinary  achromatic  lens,  but  also  as  an 
immersion-lens ;  and  as  an  "  immersion  it  has  an  extra 
large  angle  of  aperture. 

NlTMBER   OF  EiaORAMTS   WHO    HAVE  ARRIVED    IN  NeW 

York  durxno  past  Year. — Two  hundred  and  thirty- 
three  thousand  four  hundred  and  eighteen. 

Blood-Corpuscles  ik  CnLOROSia^M.  Duncan,  of  St. 
Petersburgh,  has  just  pointed  out  the  remarkable  fact 
that  the  blood-discs  of  chlorotic  persons  yield  up  their 
coloring  matter  more  easily  than  do  those  of  healthy 
subjects. 

Health  Board  STATisncs. — The  second  annual  re- 
port of  the  Metropolitan  Board  of  Health,  which  has  just 
been  published,  shows  that  during  the  year  ending  Sep- 
tember, 1867.  the  number  of  marriages  celebrated  in 
New  York  City  was  15,026^  and  in  Brooklyn  1,349, 
and  the  number  of  births  registered  in  New  York  City 
was  12,569,  and  in  Brooklyn  4,878.  The  deaths  in 
New  York  City  23,433,  and  in  Brooklyn  8,689. 

JuRARE  IN  VERBA  Magistri. — There  are  many  in  this 
country  who  are  wont  to  swear  by  the  words  of  for- 
eign masters;  who,  to  the  sound  advances  of  home 
growth,  yield  grudgingly  a  half-doubting  assent  until 
they  have  been  approved  abroad;  who,  to  the  utter- 
ances of  native  authors,  though  abundantly  sustained 
by  facts,  grant  but  a  tithe  of  the  weight  Aey  would 
concede  to  them  if  imported  from  Paris  or  London. 
We  know  perfectly  well  that  the  immense  hospitals  and 
extensive  libraries  of  Europe  have  given  our  transat- 
lantic teachers  the  start  of  us  in  observation,  erudition, 
and  scholasticism,  and  that  we  owe  them  a  debt  we 
have  but  just  begun  to  repay.  But  we  need  not,  on 
that  account,  forget  that,  for  practical  tactj  for  the 
power  of  seizing  the  essential  truth  while  sifting  out 
the  unimportant,  and  for  the  shrewd  interpretation  of 
fiu^ts,  the  American  mind  is  preeminent.  Let  us  learn 
to  appreciate  and  develop  our  originality.  By  the  side 
of  the  literary  excellence  of  the  Philadelphia,  and  of  the 
enterprise  of  the  New  York  School  of  Medicine,  we 
may  call  to  mind  that  the  wise  practical  counsels  of 
James  Jack«on ;  the  self-limitation  in  disease  of  Bige- 
low ;  the  teachings  of  Ware,  as,  for  instance,  upon  the 


different  kinds  of  so-called  croup,  and  the  treatment  of 
the  membranous  form  witiiout  perturbation,  and  also 
upon  the  injurious  effects  of  opium  in  delirium  tremens ; 
the  pathological  learning  of  John  B.  S.  Jackson ;  the 
bold,  yet  careful  and  successful  surgery  of  our  hospitals, 
associated  with  names  too  prominent  to  need  mention, 
recording,  among  other  things,  a  method  of  curing  ves- 
ico-vaginal  fistula,  quietly  practised  in  private  wards, 
which  anticipated  what  has  been  done  elsewhere;  the 
discovery  of  etherization,  caught  up  and  promulgated 
with  prompt  sagacity;  the  brilliant  and  authoritative 
physiology  of  Dalton,  transplanted  from  Boston ;  the 
treatment  of  syphilitic  iritis  without  mercury,  by  Wil- 
liams ;  the  judicious  recognition  of  the  sway  of  Nature 
in  disease,  not  preceded,  we  believe,  by  Forbes  in  his 
famous  articles  in  the  *'  British  and  Foreign ; "  all  these, 
and  much  more  which  might  be  mentioned^  are  as  val- 
uable as  though  they  emanated  fix>m  foreign  sources. 

The  war  has  emancipated  public  opinion  and  litera- 
ture from  subserviency  to  the  Old  World.  But  American 
physic  has  yet  to  declare  its  majority.  We  shall,  of 
course,  continue  to  examine  what  Europe  has  to  offer 
us,  but  should  see  it  through  our  own  spectacles. — Boa^ 
ton  Medical  and  Surgical  Journal, 

Report  of  Oommissiokerb  of  Ohabities  and  Corrso- 
TiON. — The  Commissioners  of  Charities  and  Public  Cor- 
rection, New  York,  report  90,816  persons  in  the  Insti- 
tutions during  1867.  Of  these,  47,646  were  in  the  City 
prisons;  2,311  in  the  Penitentiary  j  16,135  in  the  Work- 
house; 4,033  in  Almshouses;  90  m  the  Blind  Asylum; 
204  in  the  Hospital  for  Incurables ;  1,535  in  the  Infant 
Hospital;  6,573  in  Bellevue  Hospital;  6,855  in  Charity 
Hospital;  209  in  the  Small-pox  Hospital ;  320  in  the 
Fever  Hospital ;  1,441  in  the  Lunatic  Asylum:  153  in 
the  Epileptic  Hospital;  119  in  the  Paralytic  Hospital; 
2,040  in  the  Randall's  Island  Nurseries;  1^080  in  the 
Randall's  Island  Hospitals,  and  62  in  the  Idiot  Asylum. 

Estimated  ExpiKDiruRES  for  the  Suitort  of  Char* 
rriBs,  ETC.,  IN  THIS  City. — Among  the  estimated  items  of 
expenditure  for  the  maintenance  of  the  government  of 
this  county  for  1868,  are  the  following:  Metropolitan 
Board  of  Health  Fund,  $137,088;  Coroners*  Fees,  $26.- 
500 ;  Asylum  for  Idiots,  $660;  Children's  Aid  Society, 
$50,000;  Deaf  and  Dumb  Asylum,  $10,348;  Institution 
for  BUnd,$2,760 ;  New  York  Juvenile  Asylum,  $95,000  • 
New  York  State  Lunatic  Asylum,  $3,029;  Nursery  and 
Child's  Hospital,  $7,000. 

Abandoned  Infants. — One  thousand  seven  hundred 
and  twenty^three  infants^  who  had  been  thrown  awa^ 
bv  their  parents,  were  picked  up  in  the  streets  of  this 
city  last  year^  of  which  number  749  now  fill  the  chil- 
dren's nurseries  on  Randall's  Island. 

Phthisis  in  Peru. — On  the  sea-coast  of  Peru,  as  on 
that  of  the  Gulf  of  Mexico,  incipient  tubercular  phthi- 
sis is  one  of  the  commonest  of  pulmonary  affections. 
Prom  time  immemorial,  however,  it  has  been  known  to 
the  natives  that  a  removal  of  phthisical  patients,  even 
in  the  stage  of  well-marked  ulceration  and  cavities  in 
the  lungs,  to  the  inland  valley  of  Jauja,  at  a  height  of 
10,000  feet  above  the  sea,  was  followed  by  an  almost  in- 
variable suspension  of  the  disease — a  £Eict  which  is 
quite  corroborated  by  the  practice  of  physicians  at  the 
present  time.  From  the  statistics  of  Dr.  Fuentes,  of 
Lima,  published  in  1858,  it  appears  that  nearly  80  per 
cent  of  the  cases  of  phthisis  sent  to  the  Jauja  valley  are 
cured.  So  forcibly  has  this  fact  been  brought  before 
the  Peruvian  Oovemment,  that  it  has  established  in 
this  valley  a  military  hospital  for  consumptive  patients, 
and  especially  for  native  Indian  soldiers,  who,  in  the  ca- 
pital, are  singularly  prone  to  phthisis.    Indeed,  of  the 


Digitized  by 


Google 


552 


THE  MEDICAL  RECORD. 


whole  annual  mortality  of  Lima,  no  lees  than  twenty- 
two  and  twentv-nine  thirty-ninths  per  cent,  are  attri- 
buted by  Dr.  I^ientes  to  this  disease.  So  that,  as  Dr. 
Smith  remarks,  we  must  admit  that  the  Peruvian 
physicians  have  abundant  opportunity  of  testing  the 
Tarious  modes  of  treating  it;  and  the  unanimous 
opinion  at  which  they  have  arrived  as  to  it^  curability 
by  a  removal  of  the  patient  to  the  Jauja  valley,  leaves 
no  doubt  as  to  the  well-founded  nature  of  the  reputa- 
tion wliich  that  district  enjoys.  How  much  of  this  cu- 
rative power  maybe  due  to  the  moral  influence  exerted 
by  its  scenery  and  associations,  it  would  be  difficult  to 
say ;  but  a  nearer  approach  to  Elysian  felicity  than  the 
lives  which  its  population  are  described  as  leading,  it 
would  be  probably  impossible  to  find  in  any  less  favor- 
ed land.  The  harvest  being  home,  we  are  told,  the 
whole  rural  population  rest  from  their  agricultural 
labors  for  eignt  months  in  the  year,  which  they  give 
up  entirely  to  amusements  and  feasting,  trusting  to  the 
rain  of  heaven  during  the  other  four  months  of  the 
year  to  fertilize  their  land  and  yield  them  more  food 
than  they  require.  Surely  Dr.  Johnson  must  have  had 
this  valley  in  his  eye  when  he  wrote  his  pleasing  pction 
of  "  Rasselas,*'  for  no  other  of  which  we  have  ever 
heard  realizes  the  physical  conditions  under  which  the 
Prince  of  Abyssinia  sought  for  the  perfection  of  human 
happiness.  And  we  may  mention  for  the  benefit  of 
such  of  our  readers  who,  as  valetudinarians  or  philo- 
sophers, may  feel  an  interest  in  knowing  more  about 
this  charming  region  than  we  are  able  to  tell  them,  that 
if  the  project  of  running  regular  steamers  up  the  Ama- 
zon from  Parfi,  2,500  miles  from  its  mouth,  which  has 
jusr.  been  started  by  an  American  company,  becomes  an 
established  fact,  they  will  be  able  to  transport  them- 
selves into  it,  almost  without  changing  vessels,  after  a 
voyage  which,  though  long,  is  not  tedious  nor  debilitat- 
ing, and  which  wiU  carry  them  through  some  of  the 
most  magnificent  scenery  that  the  world  can  produce. 
— BrUish  (md  Foreign  Medico-  Chirurgical  Review, 

Thb  New  Grabs  which  has  made  its  appearance  in 
the  Southern  States  since  the  war,  is  called  Lespidoaa 
striata^  and  is  said  to  be  a  native  of  China  and  Japan. 
It  appears  to  be  a  dwarf  clover,  very  thick  set,  much 
relished  by  cattle,  and  is  a  complete  exterminator  of 
Bermuda,  joint,  sedge,  and  other  grasses.  It  was  not 
seen  before  the  war,  and  how  it  was  introduced  is  a 
mystery  among  planters  and  botanists. — Scien,  Amer, 

Statistics  of  the  British  Army. — A  correspondent 
of  the  London  Times  writes: — "Dr.  Bry den's  valuable 
tables,  showing  the  health  of  the  Bengal  Army,  English 
and  native,  and  of  the  prisons,  during  1866,  have  been 
shown  to  me.  The  death-rate  of  the  English  army 
was  only  20.11  per  1000,  while  it  was  32^  »n  the 
three  years  ending  1862, 23^  in  1863,  21  in  1864,  and 
2ii  in  1865.  There  has  been  a  similar  improvement 
in  the  rate  among  the  women  and  children.  In  1865 
it  was  42  per  thousand  women  and  83.15  per  thousand 
children.  Last  year  it  fell  to  25^  and  76  11  respective- 
ly. The  new  barracks  are  being  raised  all  over  the 
country." 

Mortality  AHOKa  Phtsioiaks  at  Q-alveston,  Texas. 
— ^Not  less  than  eight  practising  physicians  have  died  of 
yellow  fever  in  Houston,  Texas,  during  the  prevalence 
of  the  epidemic. 

To  Prevent -Metals  from  Ritstino. — Dip  the  article 
into  very  dilute  nitric  acid,  and  afterwards  immerse  it 
in  linseed  oil,  allowing  the  superfluous  portions  to  drain 
off.  "When  the  coating  of  oil  is  thoroughly  dry,  the^ 
article  will  be  ready  for  use,  and  thus  protected,  will 
remain  bright  for  years. 


Discourses  over  the  Tomb  of  Yelpeau  were  pro- 
nounced in  the  name  of  the  Institute  by  Nelaton,  in  the 
name  of  the  Academy  of  Medicine  by  Gosselin,  in  the 
name  of  the  Facultv  by  Richet,  in  the  name  of 
the  Administration  of  Public  Secours  by  Husson,  in 
the  name  of  the  Society  of  Surgery  by  Q-uyson,  and  in 
the  name  of  the  friends  of  the  deceased  by  Longet. 
Yelpeau  was  attended  most  faithfully  in  his  last  illness 
by  l^^elaton  and  Barth. — Gazette  Hebdom, 

Prooeedincw  A0AIN8T  A  SuBQEON. — ^A  member  of  the 
faculty,  who  assisted  at  a  notorious  and  fatal  duel  which 
took  place  at  Lisbon  some  months  ago,  was  proceeded 
against,  along  with  the  other  accomplices,  for  having 
attended  in  a  case  which  resulted  in  the  loss  of  a  life. 
The  accused,  who  was  a  military  surgeon,  proved  that 
he  was  compelled  to  do  the  service  by  order  of  the 
commandant  of  his  regiment,  and  that  he  was  not 
there  of  his  own  free  will.  He  was  discharged.  It 
appears  to  us  that  military  discipline  and  the  consci- 
ences of  medical  officers  should  be  in  accord. 

LuNATio  Asylums  in  Australia. — ^Two  new  lunatio 
asylums  are  about  being  established  in  Australia. 


tletu   l^ublicationd* 


Books  and  Pamphlets  Received. 
Treatise  on  the  Diseases  of  the  Ers,  including  the 
Anatomy  of  the  Organ.  By  Carl  Stbllwao  von 
Carion,  M.D.,  Professor  of  Ophthalmology  in  the  Imperial 
Royal  University  of  Vienna.  Translated  from  the  Third 
German  Edition,  and  Edited  by  Charles  E.  Hacelet, 
M.D.,  Surgeon  to  the  New  York  Eye  and  Bar  Infirmary, 
Physician  to  the  New  York  Hospital,  Fellow  of  the  New 
York  Academy  of  Medicine,  etc. ;  and  D.  B.  St.  John  Roosa, 
M.D.,  Clinical  Professor  of  the  Diseases  of  the  Eye  and  Ear 
in  the  Medical  Department  of  the  University  of  the  City  of 
New  York,  eta  With  an  Appendix  by  the  Editors.  Illus* 
trated  by  Ninety-six  Wood  Engravings  and  Eighteen 
Chromo-Lithographs.  New  York:  William  Wood  <k  Co. 
1868. 

The  Physician's  Daily  Pocket  Record.  Comprising  Visit- 
ing List,  Diary,  eta,  eta  By  a  W.  Butler,  M.D.  Phila- 
delphia: Office  of  Medical  and  Surgical  Reporter,  115 
South  Seventh  Street.     1868. 

Annual  Abstract  op  Therapeutics,  Materia  Medica, 
Pharmacy,  and  Toxicology  for  186T,  followed  by  an 
Original  Memoir  on  Gout,  Gravel,  and  Urinary  Calculi 
By  A.  Bouohardat,  Professor  of  Hygiene  to  the  Faculty  of 
Medicine,  Paris,  eta  Translated  and  edited  by  M.  J.  De 
Rossett,  M.D.,  Adjunct  to  the  Professor  of  Chemistry, 
University  of  Maryland,  eta  Philadelphia:  Lindsay  i 
Blakistoa     1868. 

The  Trbatkent  or  Diseases  of  the  Throat  and  Luxos 
BY  Inhalations,  eta  By  Emil  Sieglb,  M.D.  Trans- 
lated from  the  Second  German  Edition  by  S.  Nickles,  M.D. 
Cinn. :  R.  W.  CarroU  &,  Co.     1868. 

Pathological  Anatomy  op  the  Female  Sexual  Organs, 
by  Julius  M.  Klob,  M.D.,  Professor  at  the  University  of 
Vienna.  Translated  from  the  German  by  Joseph  Kam- 
MERBR,  M.D.,  Physician  to  the  German  Hospital  and  Dis- 
pensary, New  York ;  and  B.  F.  Dawson,  M.D.,  Assstant 
to  the  Chair  of  Obstetrics  in  the  College  of  Physicians  and 
Surgeons,  New  York.  New  York :  Moorhead,  Simpson 
k  Bond.     1868. 

Tenement  Houses,  their  ground  area,  cubic  feet  of  air 
space,  and  ventilation.  By  Wm.  F.  Thoms.  Surgeon  to  the 
Eastern  Dispensary,  eta    (Beprint)    Albany :  1867. 

ERKATtnc— Page  498,  line  28  from  bottom,  for  "  1  grain  eqnali  18 
grammes,"  read,  "  1  gramme  =  16,4M  grains,  troy.'* 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


553 


illeliicca  Societg  of  tlje  State  of 
ttetp  ^ork. 

SIXTY-FIRST  ANNIVERSARY. 


First  Day — morning  sission. 
The  Society  met,  pursaant  to  statute,  in  the  State  Geo- 
logical Rooms,  Albany,  at  11  a.m.  od  Tuesday,  Febru- 
ary 4,  1868. 

The  President,  Dr.  John  P.  Gray,  of  Utica,  called  the 
meeting  to  order,  when  there  being  no  clergyman  pres- 
ent, the  Society,  on  motion  of  Dr.  March,  proceeded  to 
regular  business. 

ADDRESS   OF   THE   PRESIDENT. 

'  Dr.  Gray  next  read  his  inaugural  address,  and  in 
compliance  with  the  by-law  on  the  subject,  gave  a 
sketch  of  the  progress  of  medicine  during  the  past  year. 
He  alluded  to  the  (act  that  two  new  medical  journals 
had  been  started  in  the  city  during  the  time  referred  to, 
the  Medical  Gazette  and  the  Quarterly  Journal  of  Psy^ 
chology^  and  in  pas-^ing  urged  the  members  to  sustain  all 
the  various  medical  periodicals  by  earnest  support,  both 
hterary  and  pecuniary.  In  alluding  to  the  subject  of 
medical  education,  he  deplored  the  low  grade  of  require- 
ments, and  the  non-existence  of  any  law  which  would 
compel  the  student  to  study  any  specified  time.  He  sug- 
gested the  propriety  of  recommending  to  the  legislature, 
not  only  the  passage  of  an  act  naming  some  particular 
time  for  study,  but  also  that  the  period  should  be  four 
full  years.  The  question  of  regulating  the  proper  sale 
of  dru;^  also  came  up  for  consideration,  and  some  legis- 
lation was  believed  to  be  necessary  to  accomplish  the  de- 
sired object.  Another  point  made  by  the  speaker  in  his 
elaborate,  well-timed,  and  able  address,  was  the  neces- 
sity of  clearing  awa^  the  stumbling-block  to  prosecu- 
tions for  abortions,  m  the  proper  understanding  of  the 
term  "quickening,"  it  being  desirable  to  make  aU  fully 
amenable  to  the  law  who  should  destroy  a  foetus  that 
was  viable. 

Dr.  Bissell,  of  Utica,  offered  the  following,  which 
was  adopted : — 

Beadvedj  That  the  President's  inaugural  address  be  referred 
to  a  committee  of  three,  to  examine  and  report  such  action 
thereou  as  may  be  deemed  necessary  on  the  part  of  the 
Society. 

Tlie  following  committees  were  next  appointed : — 

Bn8tne8H  Committee, — Dr.  E.  R.  Squibb,  of  Brooklyn ; 
Dr.  S.  O.  Vanderpoel,  of  Albany;  and  J.  Foster  Jen- 
kins, of  Yonkers. 

.  Cfommittee  on  OredenOala.—Brs.  Hyde,  P.  P.  Staats, 
and  W.  H.  BaUey. 

Committee  on  RecepUon, — ^Drs.  Alden  March,  Doo- 
little,  and  W.  B.  Bibbins. 

Committee  on  PreMenfa  Addren. — Drs.  Brinsmade, 
Banks,  and  Rochester. 

The  Rev.  John  F.  Peck,  at  this  stage  of  the  proceed- 
ingH,  apologized  to  the  Society  for  bus  absence  at  the 
time  of  the  opening  of  the  session,  having  been  de- 
tained some  distance  from  the  place  of  meeting  by  the 
sickness  of  some  of  his  parishioners. 

Dr.  James  H.  Armsbt  offered  the  following,  which 
was  carried : — 

ReMflfftd,  That  a  committee  of  three  be  appointed  to  in- 
yite  tiie  physicians  who  are  members  of  tba  CoDstitutiooal 
GoaveotioD  and  the  State  Legislature  to  participate  in  our 
deliberations  during  our  meeting. 

After  which  Drs.  Armsby,  Hall,  and  0.  White,  were 
appointed  as  said  committee. 


death   op   DRS.   JOHN   m'OALL  AND  NICHOL  H.  DERINO. 

Dr.  Bissell  said: — Mr.  President,  it  is  my  painful 
duty  to  announce  to  this  Society  the  death  of  two  of  its 
most  worthy  m  mbers  since  our  last  annual  meeting, 
Dr.  John  McCall  and  Dr.  Nichol  H.  Dering,  both  of  the 
city  of  Utica. 

Dr.  McCall  entered  the  medical  profession  in  1812  as 
an  assistant-surgeon  in  the  United  States  army,  at  the 
commencement  of  the  war  between  the  United  States 
and  Great  Britain.  Before  the  close  of  that  war  he 
was  appointed  a  regimental  surgeon,  and  served  his 
country  in  that  capacity  until  peace  was  restored  in 
1815,  with  honor  to  himself  and  the  best  good  to  the 
army.  After  an  honorable  discharge  from  the  service, 
he  commenced  the  practice  of  medicine  in  the  county 
of  Oneida,  where  he  soon  earned  for  himself  an  honor- 
able standing  in  the  profession  and  a  lucrative  practice, 
which  he  retained  until  stricken  down  by  the  palsy, 
resulting  in  his  death.  On  the  field  of  his  protracted 
labors  of  more  than  fifty  years,  he  was  permitted  to 
lay  down  his  life  surrounded  by  two  generations  of 
weeping  friends.  Dr.  McOall,  after  having  served  for 
four  years  as  a  delegate  from  tiie  Oneida  County  Medi- 
cal Society,  was  elected  a  permanent  member  of  the 
New  York  State  Medical  Society  in  1838,  just  thirty 
years  ago  *  therefore  at  the  time  of  his  death  he  was  one 
of  the  olaest  members  of  this  body.  Of  those  living 
who  wtre  present  when  he  became  a  permanent  mem- 
ber of  this  organization,  there  now  remain  but  Eliah 
T.  Foote,  of  Ifew  Haven,  elected  in  1827 ;  Dr.  Piatt 
Williams,  of  Alder  Creek,  Oneida  Co.,  elected  in  1828 ; 
Dr.  Edward  G.  Sudden,  of  New  York,  in  1831 ;  Dr. 
James McNaughton,  of  Albany,  in  the  same  year;  Dr. 
Joel  Foster,  of  New  York,  in  1832 ;  Dr.  John  P.  Mor- 
gan, of  St.  Louis,  Missouri,  in  1833. 

After  some  feeling  remarks  concerning  the  death  of 
Dr.  Dering,  he  offered  the  following  preamble  and  re- 
solutions, which  were  adopted : — 

WhereoM^  Tliis  Society  has  heard  with  profound  regret  the 
anoounoement  of  the  death  of  two  of  its  most  honored  mem- 
bers since  its  last  annual  seasion,  viz.,  Dr.  John  McCall,  and 
Dr.  Nicol  Dering,  both  of  the  city  of  Utica ;  therefore, 

Resolved^  That  in  the  death  of  our  distinguished  brother. 
Dr.  John  McCall,  who  for  thirty  years,  as  a  permanent  mem- 
ber of  this  Society,  faithfully  labored  for  its  advancement  and 
prosperity,  and  for  the  medical  profession  of  our  State,  and 
who  has  filled  with  honor  the  highest  office  in  the  giA;  of  the 
profession,  we  who  survive  him  are  called  upon  to  mourn  the 
loss  of  one  who  was  ever  faithful  and  devoted  to  the  cause  of 
medical  science,  and  the  improvement  of  the  medical  art,  a 
true  physician,  a  kind  and  generous  friend,  and  a  wise  and 
judicious  counsellor  in  all  that  pertained  to  the  sdence  and 
practice  of  medicine. 

Besoloed^  That  in  the  death  of  our  deceased  brother.  Dr. 
Nichol  H.  Dering,  of  Utica,  who  for  sixteen  jears  was  active 
and  devoted  as  a  permanent  member  of  the  New  York  State 
Medical  Society,  we  are  especially  called  on  to  lament  the  loss 
of  one  of  our  most  cherished  associates  and  brother  members, 
whose  long  life  had  been  devoted  to  the  promotion  of  the 
healing  art,  and  who  had  endeared  himself,  not  only  to  his 
medical  brethren,  but  to  all  who  enjoyed  his  friendship ;  and 
in  an  especial  manner  to  the  poor,  who  at  all  times  found  him 
both  willing  and  ready  to  minister  to  their  wants. 

Besolved,  That  Dr.  Ghas.  B.  Coventry,  of  Utica,  be  re- 
quested  to  prepare  a  memoir  of  the  late  Dr.  John  McCall,  and 
furnish  it  for  publication  in  the  next  volume  of  the  Transac- 
tions of  this  Society. 

Betolved^  That  Dr.  M.  M.  Bragg,  of  Utica,  be  requested  to 
prepare  a  memoir  of  the  late  Dr.  Nichol  U.  Dering,  for  pub- 
lication in  the  next  volume  ot  our  Transactions. 

Betoked,  That  the  secretary  furnish  copies  of  the  foregoing 
resolutions  to  the  respective  families  of  the  deceased. 
>  Prof.  Whttr,  of  Buffalo,  made  some  appropriate  re- 
marks in  regard  to  the  deceased  members. 


Digitized  by 


Google 


554 


THE  MEDICAL  RECORD. 


APFSAL  TO  THE   SOOIETT    BT  AN   EXPELLED   MEMBER    FROM 
A   OOXTNTY   SOOIETT. 

Dr.  Squibb,  as  Chairman  of  the  Business  Committee, 
presented  an  appeal  from  Dr.  N.  K.  Freeman,  of  West 
Farms,  Westchester  Co.,  from  a  decision  of  expulsion 
from  the  County  Society,  at  the  same  time  suggesting  that 
it  would  be  desirable  and  proper  to  refer  the  matter  to 
a  Committee  of  Censors,  who  should  report  their  de- 
cision to  the  Society  for  ultimate  action. 

The  propriety  of  this  measure  was  discussed,  and 
culminated  in  the  passage  of  the  following  resolution, 
offered  by  Dr.  Bissell— 

Resolved,  That  a  standing  committee  on  medical  ethics, 
to  consist  of  three  members,  be  annually  appointed,  to  whom 
all  papers,  resolutions,  and  other  matters  presented  to  the 
Society  for  consideration,  involving  questions  of  medical 
ethics,  shall  be  referred. 

Drs.  Brinsmadc,  Hyde,  and  Banks,  were  appointed  on 
the  aforesaid  committee. 

Dr.  Hun,  Chairman  of  the  Committee  on  the  Re- 
vision of  the  By-Laws,  read  an  elaborate  report,  which 
was  finally  referred  back,  with  instructions  to  report  a 
complete  set  of  by-laws  at  the  next  meeting,  and  have 
a  sufficient  number  of  the  same  printed  for  distribution 
at  the  commencement  of  the  next  annual  session. 

A  communication  was  next  read,  inviting  the  mem- 
bers to  an  entertainment  to  be  given  by  Drs.  March 
and  Armsby,  at  the  City  Hospital,  on  Wednesday  even- 
ing, at  9  o'clock. 

Reports  were  next  received  from  the  following  dele- 
gates to  sister  societies :  from  Dr.  H.  C.  Gray,  as  delegate 
to  the  New  Hampshire  State  Medical  Society;  and 
from  Dr.  Govan,  as  delegate  to  the  New  Jersey  State 
Medical  Society;  after  which  the  Society  adjourned,  to 
meet  at  3  p.m. 


First  Dat — afternoon  session. 

The  Society  met,  pursuant  to  adjournment,  at  3  p.m., 
and  was  called  to  order  by  the  President.  At  the  sug- 
gestion of  Dr.  Squibb  of  the  Business  Committee,  the 
minutes  of  the  meeting  were  to  be  read  eveiy  morning. 

The  President  announced  the  following  Nominating 
Committee :  Dr.  Jos.  C.  Hutchison,  Dr.  Geo.  J.  Fisher, 
Dr.  Thos.  Hun,  Dr.  F.  Burdick,  Dr.  D.  P.  Bissell,  Dr.  W. 
C.  Wey,  Dr.  W.  Af  anUus  Smith,  and  Dr.  C.  C.  Wyckoff. 

The  following  communication  was  received : 

State  of  New  York,  in  Assembly,  ) 
Albany,  Feb.  4^  1868.     J 

On  motion  of  Mr.  Jacobs : 

Besolved,  That  the  Special  Orders  for  Tuesday  and  Wednes- 
day evenings  of  this  week  be  set  aside,  that  no  sessions  be 
held  on  those  evenings ;  and  that  on  Wednesday  evening,  the 
use  of  the  Assembly  Chamber  be  allowed  to  the  State  Medi- 
cal Society. 

By  Order,  C.  W.  Armstrong, 

Clerk. 

Dr  Sqiheb,  from  Business  Committee,  announced 
the  reception  of  a  report  of  Dr.  Langworthy,  Health 
Officer  of  Rochester.  The  secretary  was  directed  to 
ask  .Dr.  Langworthy  to  make  an  abstract  for  the  Trans- 
actions. 

legal  enactments  to  regulate  practice  of  dentistry. 

On  motion,  Dr.  Wesoott,  dentist,  from  Syracuse,  was 
solicited  to  read  a  report  concerning  the  efforts  being 
made  to  obtain  legislation  upon  the  practice  of  dentistry. 
The  report  was  received,  and  the  following  preamble 
and  resolution,  offered  by  Dr.  Squibb,  was  adopted : 

Whereas^  The  Dental  profession  of  the  State  of  New  Tork 
(now  numbering  about  two  thousand  practitioners),  are  about 
to  petition  the  Legislature  of  the  State  for  such  legal  enact- 


ments as  will  tend  to  regulate  the  practice  of  dental  surgery, 
and  to  mark  some  distinction  between  the  meritorious  and 
skilful,  and  the  ignorant  pretender;  and  to  (dve  this  prof  ssion 
a  legal  recognition,  it  is  by  this,  the  Staie  Ifediccd  Society, 

jRcsolved,  That  this  movepnent  on  the  part  of  the  Dental 
profession  of  this  State,  to  procure  such  general  laws  for 
their  protection  as  now  pertain  to  the  Medical  profession, 
meets  with  our  hearty  approval,  and  that  we  hereby  join  la 
the  prayer  of  these  petitioners  for  this  purpose. 

the  sulphite  of  soda  and  glyoerinb. 

Dr.  John  H.  Q-risoom,  of  N.  Y.,  read  a  paper  entitled 
*'  Therapeutic  Value  of  Certain  Articles  of  the  Materia 
Medica  of  Recent  Introduction,"  in  which  he  treated 
more  particularly  of  the  uses  of  sulphite  of  soda  as  an 
mternal,  and  glycerine  as  an  external  remedy.  The 
former,  by  its  peculiar  antiseptic  property,  was  consid- 
ered by  him  as  one  of  the  most  valuable  alteratives, 
especially  in  those  cases  of  Junctional  dyspepsia,  where 
it  was  necessary  not  only  to  arrest  the  fermentative 
process,  but  also  to  furnish  an  alkali.  The  latter  sub- 
stance, in  consequence  of  its  affinity  for  the  watery 
elements  of  the  bloody  had,  according  to  his  observa- 
tions, a  marked  effect  m  melting  down  all  inflammatory 
indurations. 

The  paper  was,  on  motion,  referred  to  the  Pubhca- 
tion  Committee,  not  however  without  some  humorous, 
allusions  by  Dr.  Corliss  to  hobbyism  in  new  remedies 
generally. 

Dr.  Marsh  introduced  Prof.  Barker,  of  New  Haven, 
formerly  of  Albany.  Prof  Barker  gracefully  responded 
to  the  in  I  reduction.  Also  Chas.  L.  Ives,  of  New  Haven, 
who  also  addressed  the  Society ;  as  did  also  Drs.  Foster, 
of  Portland,  Maine,  and  Lewis  A.  Pendleton,  of  Maine. 

Dr.  Squibb  read  by  title  the  following  papers :  "  Meth- 
od in  Medicine,"  presented  by  the  Albany  Co.  Med. 
Society,  by  Dr.  Pomfret ;  contiimation  of  paper  on 
*'  Monstrosity,"  by  G.  J.  Fisher,  of  Sing  Sing  ;  all  of 
which  were  referred  to  the  Publishing  Committee. 

CONCERNING   MONSTROSITIES  AND  THE  N.   Y.   LEGISLATURE. 

Dr.  Corliss,  at  this  stage  of  the  proceedings,  remark- 
ed that  the  subject  of  "  Monstrosities,"  although  inter- 
esting in  its  way,  was  hardly  of  such  a  character  as  to 
warrant  its  continuous  publication.  He  was  of  the 
opinion  that  by  incurring  the  expenses  of  the  necessary 
woodcuts,  the  Society  might  run  the  risk  of  not  having 
the  legislature  issue  any  volume  the  ensuing  year. 

Dr.  Staats  favored  the  same  view. 

Dr.  Humphrey,  of  the  Assembly,  by  invitalnon,  re- 
marked upon  the  necessity  of  retrenching  the  expenses 
of  that  body  by  cutting  down  everything  in  the  shape 
of  papers,  in  the  Transactions,  to  the  smallest  possible 
compass.  He  acknowledged  that  he  loved  science  and 
progress,  and  endeavored  to  say  many  pretty  things 
concerning  the  good  that  the  State  Society  was  doin^, 
but  he  thought  that  the  extra  expense  of  a  few  wood-  ^ 
cuts  was  too  much  for  the  impoverished  legislature  of 
New  York  to  stand. 

Dr.  Bissell  was  inclined  to  differ  with  the  honorable 
gentleman  as  to  the  pecuniary  capability  of  the  legisla- 
ture^and  thought  that  the  Transactions  of  the  State 
Society  were  fully  as  valuable  as  any  of  the  lai^  num- 
ber of  other  documents  upon  which  money  was  so  lav- 
islily  spent 

Dr.  Fisher,  the  author  of  the  essay,  remarked  that 
he  had  taken  great  pains  to  carry  on  the  work  properly, 
and  in  order  to  follow  out  his  original  design,  he  had 
gone  to  no  Uttle  expense  of  time  and  money.  Al- 
though the  papers  were  very  near  completion  he  did 
not  object  to  stopping  where  he  was ;  in  fact,  he  felt 
that  a^r  what  had  been  said,  it  would  be  common 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


555 


courtesy  on  the  part  of  the  body  to  invite  him  to  pro- 
ceed, if  they  did  not  choose  to  endorse  the  remarks  of 
the  members  who  preceded  him.  He  also  alluded  to 
the  several  points  which  he  intended  to  bring  out,  and 
their  importance  in  a  practical  point  of  view. 

The  whole  subject  was  decided  to  be  out  of  order, 
and  consequently  no  definite  action  upon  it  was  taken 
at  this  time. 

The  Business  Committee  presented  the  following 
papers  by  title :  "  The  Habitual  Use  of  Alcoholic  Liq- 
uors on  the  Public  Health,"  by  W.  F.  Thorns ;  **  Effects 
of  the  Meteorological  Influences  on  Health,"  by  W.  F. 
Thoms-  "The  Chemistry.  Physiology,  and  Pathology 
of  the  Phosphates,"  by  Gerardus  H.  Wynkoop ;  "  Di- 
agnosis and  Treatment  of  Diseases  of  the  Ear,"  by  D. 
B.  St.  John  Roosa;  "  Abortion,"  by  Dr.  Fordyce  Barker, 
and  "  Illustrations  of  the  Report  of  a  Case  of  RemoviJ  of 
the  Entire  Scapula  for  Osteo  Sarcoma,"  by  Stephen 
Rogers.  They  were  all  referred  to  the  PubUshing 
Committee. 

Dr.  Newman  read  his  report  on  "  Con?anguineous 
Marriages,"  and  asked  to  have  the  committee  continu- 
ed.    Report  received  and  committee  continued. 

The  Society  then  adjourned  till  8  p.m. 

FiEST  Day — evening  session. 

The  Society  met  at  8  p.m.,  and  was  called  to  order  by 
■  the  President. 

Dr.  Squibb  presented  the  "Biographical  Sketch  of  Al- 
den  S.  Sprague,  M.D.,"  by  C.  C.  Wyckoff;  "  A  Report 
from  the  Madison  Co.  Med.  Society,  upon  some  of  the 
Diseases  of  that  County,"  by  Dr.  Saunders.  All  of 
which  were  referred  to  the  Publishing  Committee. 

Dr.  Garrish  read  his  report  on  "  Tsan-Tsi  or  Rhvn- 
chosa  Excavata  in  Amenorrhoea."  Referred  to  Publish- 
ing Committee. 

Dr.  Wolff  moved  to  lay  the  whole  subject  on  the 
table.    Lost. 

Dr.  Garrish  next  presented  a  specimen  of  an  ace- 
phalous monster. 

Dr.  Bates,  from  Columbia  Co.,  made  a  report  as 
delegate  to  the  Mass.  Med.  Society ;  after  which  the 
Society  adjourned  until  Wednesday,  9^  a.m. 


Second  Day — morning  session. 

The  meeting  was  caUed  to  order  by  the  President, 
Dr.  Gray,  when  the  Rev.  Mr.  Smart,  of  Albany,  offered 
a  prayer.  The  minutes  of  the  meetings  of  the  previous 
day  were  read  and  approved. 

Dr.  Cove.'H'rt,  of  Utica,  presented  a  memoir  of  the 
late  Dr.  John  McCall,  which  was  referred  to  the  com- 
mittee on  publication. 

THE  uses  of  the  SPHYGMOGRAPH. 

Dr.  S.  0.  Vakderpoel.  of  Albany,  exhibited,  by  re- 
quest, the  workings  of  the  sphygmograph.  He  stated 
that  Dr.  Hun,  of  Albany,  was  the  first  gentleman  who 
had  brought  the  instrument  to  this  country,  and  tl^it 
with  him  he  had  tested  its  extended  applicability  in  a 
large  number  of  ca^es.  After  stating  that  the  instru- 
ment was  destined  to  do  for  cardiac  disease  what  the 
stethoscope  had  done  for  chest  troubles,  he  described 
the  manner  in  which  the  pulse-waves  were  registered, 
and  the  significaince  of  the  tracings. 

Dr.  March  introduced  Dr.  Hitchcock,  a  delegate  from 
the  Massachusetts  State  Society. 

Dr.  Allaben,  of  Delaware  Co.,  read  a  report  of  a 
case  of  compound  fracture  of  the  leg,  which  had  occur- 
red in  that  county,  and  for  the  treatment  of  which  he 
had  been  sued  in  the  sum  of  $500  for  malpractice,  in  caus- 


ing mortification,  as  was  claimed,  by  tight  bandaging. 
The  facts  of  the  case,  as  they  appeared  in  the  report, 
were  adverse  to  such  a  decision.  His  object  in  present- 
ing the  case  to  the  Society  was  to  obtain  some  expres- 
sion of  opinion,  not  only  upon  this  case,  but  upon  sim- 
ilar ones.  The  report  was  referred  to  the  Committee  on 
PubUcation. 

On  motion  of  Dr.  Lee,  of  Peekskill,  the  whole  mat- 
ter was  referred  to  the  foDowing  committee  of  three : 
Drs.  Armsby,  Hutchison,  and  Wolcott. 

ANASTOMOSING   ANEURISM  OF  THE   ORBFT. 

Dr.  Armsbt  introduced  the  Rev.  Dr.  Hartwell,  who, 
a  year  before,  had  been  seized  with  an  inflammation  of 
the  left  eve,  terminating  in  a  slight  protrusion  of  the  eye- 
ball, which  had  gradually  been  increasing  until  the 
present.  The  tumor  was  strongly  pulsating  in  charac- 
ter, and  could  be  diminished  somewhat  by  pressure 
upon  the  carotid  of  that  side.  The  diagnosis  had  been 
that  of  ophthalmic  aneurism.  The  question  as  to  an 
operation  of  ligation  of  the  carotid  came  up,  and  would 
in  all  probability  have  been  performed,  had  not  an  aneu- 
rismal  varix  suddenly  made  its  appearance  upon  the 
prominence  of  the  left  shoulder.  The  patient*s  health  was 
beginning  to  break  down,  and  the  expression  of  opin- 
ion on  the  part  of  the  members  was  soUcited  as  to  the 
propriety  of  any  operative  interference. 

Dr.  March  gave  it  as  his  opinion  that  the  disease 
was  an  aneurism  by  anastomosis,  and  believed  with 
others  present  that  the  case  was  a  hopeless  one  for  sur- 
gical benefit 

Dr.  Quackenbush  read  the  Treasurer's  report,  show- 
ing a  balance  of  over  one  hundred  dollars  to  the  credit 
of  the  Society. 

holt's  INSTRUMENT  IN  STRICTURE. 

Dr.  Hutchison,  of  Brooklyn,  read  a  paper  on  the 
uses  of  Holt's  instrument  in  the  treatment  of  stricture, 
and  cited  some  illustrative  cases.  As  this  paper  will 
be  presented  to  our  readers  at  some  future  time,  we 
shall  not  here  make  an  abstract  of  it. 

Dr.  March  related  a  case  of  cancer  of  the  rectum, 
for  which  he  had  removed  two  inches  of  the  gut.  This 
case  will  also  probably  be  published  in  extenso  at  a 
future  time. 

report  of  committee  on  president's  inaugural. 

Dr.  Brinsmade,  as  Chairman  of  the  committee  on 
the  President's  Inaugural,  offered  the  following,  which 
were  unanimously  adopted : 

The  Committee  to  whom  so  much  of  the  President's 
address  was  referred  as  pertains  to  legislative  action, 
respectfully  report : 

First.  That  in  their  judgment,  laws  should  be  enacted, 
if  possible,  to  secure  proper  qualifications  and  restric- 
tions, on  the  part  of  those  to  whom  the  preparation, 
compounding,  and  sale  of  drugs  and  medicines  is  en- 
trusted. 

Second,  That  criminal  abortion  is  of  such  frequent 
occurrence,  and  is  so  Hghtly  regarded  by  the  commu- 
nity in  general,  that  its  wickedness  and  enormity,  and 
destructiveness  Co  health,  can  only  be  made  apparent  by 
the  united  expression  of  the  medical  profession ;  and 
that  it  is  the  sense  of  the  Medical  Society  of  the  State 
of  New  York,  that  the  words,  "  With  a  quick  child," 
in  chap.  22,  §  1,  quoted  in  the  address,  should  be  stricken 
out,  and  the  statute  thus  amended  made  to  cover  the 
whole  period  of  gestation. 

Third.  That  the  remarks  on  the  preliminary  education 
of  students,  and  on  t^eir  proper  medico-collegiate 
course,  are  most  fully  and  thoroughly  endorsed,  and 
tha^  til  legitimate  action  to  secure  the  same  is  mo^t 
earnestly  commended.  r^  ^^  ^-^  ^-r  T  ^ 

DigitizedbyVjOOQlC 


556 


THE  llEDICAL  RECORD. 


Fourth.  Without  further  specification,  the  committee 
advise  the  publication  and  wide  dissemination  of  the 
addres?,  as  presenting  the  sentiments  of  the  Society 
and  of  ihe  profession  at  large ;  and  Lasdy^  They  recom- 
mend the  appointment  of  a  local  committee  to  present, 
if  practicable,  tlie  necessary  documents  to  the  present 
Legislature  of  the  State  of  New  York,  to  procure  such 
legal  enactments  as  shall  accompUsh  the  end  desired — 
and  if  that  cannot  be  doue,  to  present  the  same  to  the 
next  Legislature  at  the  commencement  of  its  session. 

Tho.  C.  Brinsmadk, 
James  F.  Banks, 
Thos.  F.  Rochester. 
Dr.  Corliss  offered  his  report,  as  delegate  to  the 
Rhode  Island  and  Vermont  Medical  Societies. 

The  following  committee  on  the  above  resolutions 
of  Dr.  Brinsmade,  as  chairman  of  the  Committee  on 
President's  Inaugural,  was  announced:  Drs.  Brins- 
made, Banks,  and  Rochester. 

laOUOSCOPICAL   EXAMINATION  OF  DAMAGED  AND  VALUABLE 
PAPBRa. 

Dr.  E.  H.  Parker,  of  Poughkeepsie,  remarked  on 
the  use  of  the  microscope  in  detecting  alterations  in  val- 
uable papers.  The  remarks  were  based  upon  two  very 
interesting  cases  of  forgery,  to  which  the  doctor  had 
been  called  as  in  expert. 

The  first  was  one  in  which  it  was  an  alleged  promis- 
s  >ry  note,  signed  by  a  bhnd  man  who  had  deceased. 
The  gentleman  in  question  had  become  bUnd  by  cata- 
ract, but  was  nevertheless  in  the  habit  of  signing  all 
important  papers.  The  body  of  this  note  was  wriiteu 
by  a  different  hand,  in  blue  ink,  and  the  name  in  black 
ink.  The  question  came  up  a^j  to  whether  the  body  of 
the  said  note  was  written  before  that  of  the  signature 
or  not 

The  paper  fo'ded  end  to  end  across  the  middle.  Prints 
of  black  ink  were  transferred  fi*om  the  black  signature, 
and  were  found  on  the  opposite  side.  In  several  places 
the  blue  and  black  ink  of  the  dots  were  in  conjunction. 
It  was  impossible  to  tell  which  was  put  on  last,  till  a 
place  was  f  )und  where  the  bottom  of  a  letter  y  and  tip 
of  a  letter  h  came  together  over  a  dot,  and  showed  the 
bltie  ink  on  top. 

The  same  paper  read,  "  one  day  after  my  death  I 
promise  to  pay,"  etc.  It  showed  clearlv  under  the  mi- 
croscope that  it  had  been  written  *^one  year^^^  an 
erasure  having  been  made  and  day  written  in. 

The  other  paper  was  an  alleged  receipt  for  $2,000, 
paid  on  May  11th.  That  amount  had  been  paid  3fay 
iBt,  and  this  alleged  payment  was  denied  to  have  been 
made.  Examination  by  microscope  showed  that  the 
first  figure  1  of  the  date  was  in  ^otim-black  ink,  while 
the  second  and  the  rest  of  the  paper  were  in  Wuc-black 
ink.  Transfer  had  been  made  of  the  ftrowm-black  ink  to 
the  other  end  of  the  paper  by  folding,  showing  that  it 
was  put  on  last.  The  two  shades  of  black  show  only 
under  the  microscope ;  to  the  naked  eye  they  are  alike. 

Dr.  Squibb,  in  this  connexion,  referred  to  the  following 
case :  A  number  of  U.  S.  bonds  were  stolen  some  time 
since  from  a  party,  and  their  payment  stopped.  For  a 
long  period  nothing  could  be  discovered  in  relation  to 
them.  Finally,  however,  two  bonds  with  the  same 
numbers  were  found  in  Wall  Street,  and  it  occurred  to 
the  parties  concerned  that  one  of  these  must  be  of  the 
lot  that  had  been  stolen.  The  difficulty  was  to  decide 
which  was  the  genuine,  and  it  was  cleared  up  by  a 
microscopical  examination  of  the  ruled  lines  upon  which 
the  figures  were  written  in  red  ink.  The  magnifying 
glass  showed  the  tracings  of  the  old  figures  underneath 
the  new,  the  red  ink  of  the  former  having  been  ^le- 
viously  removed  by  a  chemical  proccSS. 


Dr.  R.  H.  Ward,  of  Troy,  next  read  a  very  lengthy 
paper  with  the  following  title :  '*  Allopathy ;  an  Inquiry 
into  the  relat  on  <>f  Sects  in  Medicine." 

Dr.  Coruss  related  a  case  of  ovarian  dropsy  which 
he  had  tapped  through  the  vagina. 

Dr.  Squibb,  in  behalf  of  the  Business  Committee, 
stated  that  information  had  been  received  from  Dr. 
Ives,  of  New  Haven,  that  Elial  T.  Foote,  a  permanent 
member  of  the  Society,  had  been  a  declared  charlatan 
for  many  years.  The  said  party  was  a  resident  of  New 
Haven,  and  had  done  much,  with  such  influence  as  he 
possessed,  to  damage  the  interests  of  the  profession  of 
that  place. 

A  motion  was  accordingly  made  to  drop  the  said 
name  fi'om  the  roll,  which,  after  much  discussion,  was 
carried. 

The  Society  then  adjourned  until  3i  p.  m. 

Second  Day— afternoon  session. 

The  Society  met  at  8|  p.m.,  agreeably  to  adjourn- 
ment. The  meeting  was  called  to  order  by  the  Presi- 
dent. 

Dr.  Cobb  moved  that  the  Society  request  the  Nomi- 
nating Committee  to  present  the  name  of  Dr.  CorUss  for 
uur  next  president.     This  was  lost 

Dr.  W.  White  made  his  report  as  delegate  to  the 
Maine  Medical  Society,  which  was  reftrred. 

Dr.  Squibb  presented  the  report  of  Dr.  A.  N.  Bell, 
from  Committee  on  Hygiene.     Keferred. 

A   WORM   IN   TBE   AORTA  (?). 

Dr.  Coates,  of  Batavia,  presented  a  portion  of 
the  arch  of  the  aorta  containing  a  lumbricoid  which 
was  discovered  in  that  artery  during  a  post-mprtem 
examination  of  a  soldier  in  the  Ladies'  Home  Hospital, 
of  New  York  city.  The  patient  had  died  in  1864  of 
pneumonia,  f<  Mowing  an  attack  of  measles.  On  attempt- 
ing to  remove  the  lungs  by  severing  the  vessels  at  their 
roots,  the  worm  referred  to  was  found  aUve  in  the 
cavity  of  the  aorta.  It  was  preserved  in  situ.  The 
gentleman,  Dr.  Tozier,  who  forwarded  the  specimen, 
not  having  sent  a  complete  history  of  the  case,  Dr.  C. 
was  unable  to  give  any  further  particulars. 

Dr.  Squibb  pertinently  remarked  at  this  juncture, 
that  in  all  probability  the  worm  had  accidentally  found 
its  way  into  the  interior  of  the  vessel  afler  the  death  of 
the  patient 

The  Business  Committee  read  by  title  a  paper  en- 
titled, "Removal  of  Encephaloid  Testicle,**  by  Dr. 
Ferris  Jacobs,  and  one  on  "  Cffical  Inflammation  and 
Ulceration  complicated  with  Diseased  Appendix,*'  which 
were  referred. 

CASE   OF  inverted   ACTION   OF   UTERUS. 

Dr.  Peter  P.  Staats,  of  Albany,  reported  a  case  of 
foot  presentation  which  was  accompanied  with  repeated 
and  forcible  recession  of  the  parts.  The  feet  were 
finally  dehvered,  when  a  large  retained  placenta  was 
found  at  the  fundus. 

Dr.  Squibb  suggested  that  the  placenta  in  that  situa- 
tion, acting  as  a  splint,  so  to  speak,  interfered  with  the 
action  of  the  uterine  fibres,  and  gave  a  chance  for  those 
below  to  press  the  lower  parts  of  the  child  upward. 

Dr.  Wm.  B.  Bibbins  offered  the  following  resolution : 

Resolved,  That  a  physician  of  this  State  will  not  be  received 
by  this  Society  as  an  invited  guest,  unless  he  is  either  a 
member  of  a  countv  medical  society,  or  a  member  of  the  New 
Tork  Academy  of  Medicine,  or  a  member  of  the  Faculty  of 
a  medical  College,  or  a  member  of  the  Legislature. 

Adopted. 

Dr.  WnrrE,  of  Buffalo,  offered  the  following,  which 
was  adopted : 


Digitized  by 


Google 


THE  MEDICAL  RECORD. 


667 


WhereoM^  Observations  have  been  made,  during  an  informal 
discussion  yesterday  in  this  Society,  questioning  the  propriety 
of  continuing  the  pubHcation  of  the  essay  of  Dr.  G.  J.  Fisher 
ou  "Compound  Monsters;"  and  Whereas,  Dr.  Fisher  in  his 
remarks  intimated  that  he  should  *'  feel  delicate  about  offer- 
ing to  the  Society  anything  further  on  the  subject. " 

Therefore  Besolved,  That  this  Society  recognizes  the  scien- 
tific value  of  this  essay,  and  earnestly  requests  Dr.  Fisher  to 
continue  his  monograph,  and  furnish  it  to  the  Committee  of 
Publication. 

Dr.  Bbadle  moved  the  foUowiog:  That  the  Committee 
on  Pharmacology  be  directed  to  report  to  this  Society 
the  name  of  a  member  to  supply  the  place  in  th:it  Com- 
miftee  of  Dr.  Townsend,  deceased.    Adopted. 

f)R.  Squibb  moved  that  the  Society  meet  Thursday 
morning,  at  9(  a.m. 

On  motion,  the  Society  adjourned,  to  meet  in  the 
Assembly  Chamber  at  8  o'clock,  to  hear  the  President's 
Address. 

The  Society  convened  in  the  Assembly  Chamber  at 
a  They  were  called  to  order  by  Dr.  Tefft,  Vice-Pre- 
sident; after  which  the  President,  Dr.  Gray,  deUvered 
his  annual  address. 

TuE  Annual  Address. 

The  subject  which  had  been  chosen  was  the  relation 
of  the  study  of  insanity  to  general  medicine.  After 
showing  that  insanity  was  properly  a  branch  of  general 
medical  science,  he  gave  an  historical  review  of  the 
progress  which  had  been  made  in  this  study ;  and  proved 
that  it  had  been  in  proportion  to  its  study  as  a  branch  of 
medicine  rather  than  of  mental  philosophy.  He  stated 
that  the  ancients  regarded  it  as  a  bodily  disease,  hence 
they  were  tolerably  correct  in  their  treatment ;  but 
during  the  middle  ages  it  fell  within  the  domain  of  phi- 
losophy, and  was  consequently  misunderstood.  In 
modem  times  its  progress  in  Europe  and  this  country 
had  been  due  to  the  investigations  of  medical  men 
taking  it  from  the  control  of  metaphysical  speculators. 
He  remarked  that  the  history  of  the  subject  showed 
that,  freed  from  the  above-noted  retarding  influences,  its 
progress  had  kept  pace  with  that  of  general  medicine, 
of  which  it  was  legitimately  a  part  Insanity  was  now 
recognized  as  a  physical  disease,  and  it  should  betiught 
as  such  in  medical  schools.  The  advantages  of  such 
teaching  were  then  dwelt  upon,  after  which  some  prac- 
tical hints  were  offered  as  to  how  such  a  plan  might  be 
carried  out 

The  Society  adjourned,  to  meet  at  9.30  a.m.  Thursday. 

It  was  moved  by  Dr.  Van  Dyke  that  the  thanks  of 
this  Society  be  tendered  to  Dr.  Gray  for  his  very  able 
and  interesting  address.    Adopted. 

After  the  adjournment,  the  members  assembled  at 
the  City  Hospital,  to  re.«pond  to  the  invitation  to  an 
entertainment  by  Drs.  March  and  Armsby.  Telling  ad- 
dresses were  made  by  Mr.  Bogart,  the  Hon.  Mr.  Brooks, 
and  others,  after  which  all  present  partook  of  a  bounte- 
ous and  elegant  supper. 


Third  Day — morninq  session. 
The  meeting  was  called  to  order  by  the  Pre^^ident, 
and  after  a  prayer  by  the  Rev.  Dr.  Reese,  of  Albany, 
the  minutes  of  the  previous  meeting  were  read  and  ap- 
proved. 

delegates  to   international  medical   00N0RE88. 

Dr.  Brinsmade,  on  behalf  of  the  Committee  of  Dele- 
gates to  the  International  Medical  Congress  at  Paris, 
made  the  following  report : — 

The  undersigned,  delegates  from  this  Society  to  the 
"  International  Medical  Congress"  held  at  Paris,  on  the 
16th  day  of  August,  1867,  respectfully  report : 


That  they  might  make  sure  of  being  duly  admitted 
to  the  Congress,  they  called,  on  the  15th  ol  August,  at 
the  office  of  the  Secretary,  M.  Jaccoud,  No.  4,  Rue 
Drouot,  with  the  certificates  of  their  appointment  by 
this  society,  and  after  s<fnding  up  cards  and  waiting  for 
some  time  in  the  ante-room,  we  were  informed  by  the 
female  concierge  that  M.  Jaccoud  was  engaged,  but 
that  we  might  record  our  names  in  a  little  book  lying 
upon  the  table,  and  take  a  green  "  carte  de  membre 
adherent"  on  which  were  the  names  of  the  President, 
M.  Bouiliaud,  and  the  Secretary,  M.  Jaccoud,  the  filling 
up  of  which  we  were  allowed  to  do  as  we  might  think 
proper. 

Inasmuch  as  our  credentials  were  not  required,  we 
of  course  reserved  them  for  future  use,  if  necessary. 
They  were  never  called  for,  or  examined  by  any  officer 
or  committee,  showing  to  iis  that  less  discrimination 
was  observed  in  order  to  give  character  and  distinction 
to  a  scientific  assembly  than  we  were  accustomed  to  in 
our  own  country.  The  card  informed  us  of  the  day  of 
the  first  s^nce^  but  neiUier  the  place  nor  hour  of 
meeting  was  designated.  After  not  a  little  inquiry  wo 
learned  that  the  place  was  the  great  Hall  of  the  "  Fac- 
ulty of  Medicine."  On  presenting  ourselves  at  the 
door,  no  cards  or  certificates  were  demanded,  and  we 
entered  with  the  crowd  to  find  seats  for  ourselves.  The 
bare  benches  of  the  amphitheatre  were  arranged  in  the 
usual  semicircular  manner,  without  any  support  for  the 
back ;  and  gentlemen  were  compelled  to  step  upon  them 
to  reach  the  forward  seats,  and  in  sitting  were  forced 
to  use  the  one  in  front  for  their  feet,  bringing  boots  and 
coat-skirts  in  disagreeable  proximity.  The  room  was 
indeed  a  large  one,  but  so  imperfectly  ventilated  that 
respiration  was  quite  difficult  after  remaining  a  few 
minutes.  The  dirty  and  uncomfortable  seats,  the  heat, 
and  the  irrespirable  atmosphere,  prevented  a  majority 
of  the  audience  from  remaining  during  any  entire 
session. 

It  did  seem  to  us  that  in  the  elegant  city  of  Paris 
plcasanter  accommodations  might  have  been  secured 
wherein  to  receive  invited  guests,  who  were  the  accred- 
ited representatives  of  governments  and  of  learned 
societies  from  dXi  parts  of  the  world.  Your  delegates 
deemed  themselves  honored  by  their  appointment  to  re- 
present so  large  a  society  from  so  large  a  State  as  that 
of  New  York,  equalling  in  population  and  size  several 
of  the  kingdoms  of  Europe;  and  confess  that  they  felt 
themselves,  in  virtue  of  their  office,  entitled  to  some 
consideration. 

But,  according  to  French  arrangements,  any  person 
having  accejis  to  the  ante-room  of  M.  Jaccoud  could 
avail  himself  of  all  the  privileges  procurable  by  the 
green  ticket 

About  the  6th  of  Jan.  last  your  delegates  received  * 
through  the  mail  a  ticket  which  seems  to  be  intended 
as  an  acknowledgment — perhaps  rather  tardy — that 
they  were  entitled  to  the  "  Carte  de  membre  adherent." 
A  large  proportion  of  the  audience  seemed  to  be  young 
men,  perhaps  young  physicians,  and  medical  students 
of  Paris  and  vicinity.  There  were  present,  however, 
adding  grace  and  dignity  to  the  assembly,  from  cities, 
towns,  and  schools  of  continental  Europe,  many  of  the 
most  distinguished  medical  men  of  the  world. 

Great  Britain  and  Ireland  sent  but  few,  scarcely  any, 
of  their  great  surgeons  and  physicians.  America  was 
represented  by  some  of  our  ablest  men. 

The  names  of  Virchow  of  Berlin,  Halla  of  Prague, 
De  M^ric  of  Brussels,  B^rard  of  Montpellier,  Baron 
Larry  and  Ricord  of  Paris  Fr^richs  of  Berlin,  Ernest 
Hart  of  London,  Sangalli  of  Pavia.  and  of  many  others 
of  equal  celebrity,  would  confer  honor  upon  any  con- 
gress. ^^ 


Digitized  by  VjOOQIC 


QV  C 

2k 


558 


THE  MEDICAL  REuOxviJ. 


It  was  announced  by  the  Secretary  that  on  Saturday 
evening,  Aug.  24th,  a  banquet  would  be  prepared  at 
"  Le  Grande  Hotel "  for  those  who  would  send  their 
names,  with  a  Napoleon,  to  the  Secretary.  About  two 
hundred  gentlemen  were  present  at  the  dinner — mem- 
bers of  the  Congress,  and  other  distinguished  physicians 
from  Paris  and  other  cities  on  the  Continent.  The 
dinner  was  as  at  "Tables  des  Hotes"  in  first-class 
hotels,  with  perhaps  a  few  more  courses,  and  a  greater 
variety  of  fipe  wines.  After  dinner  brief  speeches  were 
made  by  the  President,  M.  Bouillaud,  M.  ralasciano  of 
Naples,  M.  Teissier  of  Lyons,  M.  Jaccoud,  M.  Galligo 
of  Florence,  M.  Piorry,  M.  Ricord,  and  Mr.  Ernest  Hart 
of  London. 

Your  delegates  received  the  most  polite  attentions 
from  many  distinguished  members  of  the  profession  in 
Paris,  and,  although  they  feel  that  the  result  of  the 
meeting  has  not  been  as  useful  to  the  cause  of  medical 
science  as  was  anticipated,  nor  the  extension  of  acquaint- 
ance equal  to  what  was  hoped  for,  yet  many  pleasant 
associations  were  formed,  a  healthful,  vigorous,  and 
generous  emulation  was  excited,  a  wholesome  and  dig- 
nified "esprit  de  corps"  was  experienced ;  and  I  doubt 
not  most  of  us,  when  recalling  to  ourselves  the  many 
pleasant  and  intelligent  faces  we  have  seen,  the  cordial 
greetings  we  have  received,  the  evidences  of  ability  and 
zeal  manifested  by  medical  brethren  from  various  coun- 
tries, will  forget  the  uncomfortable  seats,  the  irrespira- 
biliiy  of  the  atmosphere  of  the  Hall,  and  will  be  willing 
to  make  liberal  allowance  for  differences  in  the  arrange- 
ments and  manner  of  conducting  scientific  associations 
and  social  reunions  in  different  countries,  and  will  re- 
member with  gratitude  the  originators  and  managers 
of  the  International  Medical  Congress,  and  this  Society, 
who  conferred  the  honor  and  gave  us  the  privilege  of 
representing  it  in  this  first  attempt  at  an  international 
assembly  of  men  who  do  honor  to  their  race  by  their 
benevolent  efforts,  and  with  whom  all  may  justly  feel 
pride  in  associating.  The  subjects  of  the  papers  which 
were  read  and  discussed  were  sodie  of  the  most  import- 
ant in  medical  science,  and  their  character  can  be  judged 
from  the  abstracts  which  have  been  published,  and  from 
the  great  ability  of  the  authors  and  speakers.  There 
was  much  talent  exhibited,  and  many  facts,  deductions, 
principles,  and  practices  were  broudit  out  which  will 
make  the  first  International  Medical  Congress  long 
memorable. 

It  would  be  useless  for  your  delegates  to  attempt 
anything  like  an  analysis  of  tbe  papers,  as  they  will 
doubtless  be  pubHshed  separately  or  together ;  and  such 
ample  notices  of  them  have  appeared  in  various  medical 
journals,  that  members  can  obtain  more  correct  views 
of  their  value  than  we  shall  be  able  to  present  in  this 
report;  and  we  simply  subjoin  the  programme,  giving 
the  subjects  in  the  order  of  their  consideration,  thinking 
it  may  be  useful  as  a  matter  of  reference. 
(Signed.) 

Thomas  C.  Brinsmade, 
Joseph  C.  Hutchison, 
Henry  S.  Downs. 

(Accompanying  this  report  are  the  documents  above 
referred  to.) 

REOiaTRATION  OF  BIRTHS  AND    HAHRUOES  IN  THE  STATE. 

Dr.  Lansing,  as  chairman  of  the  committee  to  pre- 
sent to  the  Legislature  the  subject  of  registration  of 
births  and  marriages  in  this  State,  etc.,  made  the  follow- 
ing report,  which  was  adopted  : 

The  committee  appointed  at  the  last  meeting  of  this 
Society,  to  present  to  the  Legislature  the  subject  of  the 
registration  of  births,  deaths,  and  marriages  in  this  State, 
and   to  solicit  the  passage  of  a  law  providing  for  a 


thorough  and  efificient  system  of  such  registration,  re- 
spectfully report  i^ 

That  a  hearing  was  granted  your  committee  by  the 
Judiciary  Committee,  both  of  the  Senate  and  Assembly 
of  1866-67,  and  the  subject  duly  brought  before  them, 
with  such  explanations  and  arguments  on  the  part  of 
your  committee  as  seemed  suitable  to  the  occasion. 
The  result  of  such  interviews  was  an  unfavorable  re- 
port on  the  part  of  the  committee  of  the  Senate,  who, 
while  conceding  the  importance  and  desirability  of  such 
a  law,  seemed  to  doubt  if  it  could  be  practically  carried 
out,  and  to  stum  Me  at  the  fact  of  the  present  existing 
law  on  the  subject,  which  remains  a  deiui  letter  on  the 
statute-book.  I 

The  committee  of  the  Assembly  noticed  the  subject 
favorably,  and  reported  a  bill  substantially  the  same  as 
the  one  containea  in  our  last  volume  of  Tran -actions, 
and  the  same  was  printed  and  placed  on  th&  files  of  the 
Assembly. 

Owing  to  the  multiplicity  of  other  business  before 
the  Assembly,  and  the  late  period  of  the  session  at 
which  it  was  brought  before  them,  the  matter  failed  of 
further  progress. 

The  next  step  of  your  committee  was  to  bring  the 
subject  before  the  governor,  and  a  suitable  memorial 
was  prepared  and  submitted  to  him,  with  the  expecta- 
tion that  he  would  communicate  the  same  to  the  Legis- 
lature at  its  present  session,  with  favorable  recommen- 
dations for  the  passage  of  some  such  law  as  is  desired  by 
this  Society. 

It  is  believed  that  in  such  expectation  your  commit- 
tee will  not  be  disappointed. 

Such  is  the  present  position  of  the  matter  in  charge 
of  your  committee. 

Its  final  success  in  the  Legislature  would  seem  to  de- 
pend upon  the  merits  of  the  measure  itself,  and  the 
exertions  of  its  friends. 

Eespectfiilly  submitted, 

T.  F.  Brinsmade, 
John  V.  Lansing, 

J.  S.  MOSHER, 

F.  B.  Hough. 

The  report  of  the  Nominating  Committee  was  re- 
ceived, and  on  motion,  it  was  adopted. 

It  was  then  moved  to  substitute  the  name  of  John  P. 
Garrish  for  permanent  member  in  the  first  district,  for 
that  of  J.  Marion  Sims.    Adopted. 

The  President,  according  to  the  action  of  the  Society, 
cast  a  ballot  in  favor  of  the  oflficers  named  by  the  Nom- 
inating Committee,  excepting  the  first  district,- for  which 
the  Society  balloted  separately,  with  the  result  of  the 
election  of  W.  B.  Bibbius  and  S.  D.  Hubbard. 

OFFICERS  ELECT  FOR   1868. 

The  following  is  the  report  of  the  Committee  of 
Nominations : — 

For  President — Dr.  J.  V.  P.  Quackenbush,  Albany. 
**    Vtce-Presideni— Dr.  James  P.  White. 
"    Secretary — William  H.  Bailey,  of  Albany. 
"    Treasurer — J.  V.  Lansing,  of  Albany. 
For  Censors  :  Southern  District — J.  P.  Jenkins,  of 
Yonkers:  Samuel  H.  Purdy,  of  New  York;  Edward 
R.    Squibb,   of  Brooklyn.      Eastern  District, — B.  P. 
Staats,   of  Albany;    T.   C.  Brinsmade,   of  Troy;    P. 
McNaughton.    of  Albany.    Middle  District. — M.    M. 
Bagg,  of  Utica;  C.  B.  Coventry,  of  Utica;  A.  F.  Doo- 
little,  of  Herkimer.     Western  Z>irtrtc/.— Sandford  East- 
man,  of  Buffalo;    Edward  Hall,  of  Auburn;    Alex. 
Thompson,  of  Aurora. 

For  Committbe  of  Correspondence. — ^The  present 
incumbents. 
For  Permanent   Members:   1st  district. — Wm.  B. 
digitized  by 


THE  MEDICAL  RECORD. 


559 


Bibbing,  Samuel  T.  Hubbard,  New  York.  2d  District. 
—Clark  A,  Nicholson ;  Lewis  H.  White,  of  FishkiH. 
Sd  District,— J,  V.  Lansing,  of  Albany ;  J.  R.  Boul- 
ware,  of  Albany.  4^  District, — John  P.  Shaver,  of 
Little  Falls ;  Isaac  J.  Buckbee,  Fonda.  6th  District — 
William  Russell,  of  Udca ;  Alonzo  Churcliill,  of  Utioa. 
eth  District— E,  G.  Crafts,  Binffhamton ;  E.  Odell,  Una- 
dilla,  7th  District,— H,  D.  fiidama,  Salinaj  H.  N. 
Eastman,  aeneva.  8^  District— John  F.  Whitbeck,  of 
Rochester  j  David  Little,  of  Rochester. 

Eligible  for  Permanent  Membership:  1st  District 
— Edward  H.  Janes,  of  New  York ;  George  F.  Shrady, 
New  York.  3rf  District,— P,  V.  S.  Pruyn,  of  Kinder- 
hook  ;  Wm.  Lamot,  of  Charlotteville ;  Jacob  S.  Mo- 
sher,  Albany  J  Wm.  H.  Craig,  Albany.  4th  District — 
Francis  Burdick;  Henry  H.  Greene,  of  Paine's  Hollow. 
5th  District — J.  K.  Leang;  Robert  Frazier,  of  Cam- 
den, eth  District — L.  Griffin,  Binghamton;  J.  W. 
Thompson,  Schuyler  Co. ;  J.  Dolson,  Bath.  7th  District, 
A.  W.  Marsh,  of  Pahnyra;  H.  C.  Hendricks,  of  McGraw- 
ville  ;  E.  J.  Schoonmaker,  of  Magee's  Comers.  8^  Dis- 
trict—M.  W.  Townsend,  of  Bergen ;  Charles  E.  Rider, 
Rochester;  JuUus  F.  Miner,  of  Buffalo. 

For  Honorary  Members. — ^N.  D.  Benedict,  Florida; 
Joseph  K.  Barnes,  Surgeon-General  U.  S.  A. :  Isaac 
Ray,  Providence,  R.  I.;  Thomas  8.  Kirkbride,  of  Phila- 
delphia. 

Eligible  for  Election  as  Honorary  Members. — 
Prof.  Stokes.  Dublin ;  Prof.  Rawdon  McNamara,  Dub- 
lin -Dr.  H.  C.  Lombard,  Geneva,  Switzerland ;  Dr.  T. 
R.  Varick,  Jersey  City,  N.  J. ;  Dr.  Wm.  Livingston,  St. 
John's,  N.B. ;  Sir  James  Y.  Simpson,  Edinburgh. 

For  Honorary  Degree  of  Dootob  of  I^^dicike. — 
Lewis  Post,  LodL 

Delegates  to  the  National  Quarantinb  Conven- 
tion.— ^Present  incumbents. 

Delegates  to  Connecticut  State  Medical  Society. 
— J.  C.  Hutchison,  Brooklyn ;  Philander  Stewart,  Peeks- 
kill  ;  E.  S.  F.  Arnold,  Yonkers ;  Arthur  S.  Wolff,  Platts- 
burgh. 

Delegates  to  Massachusetts  State  Medical  So- 
ciety.—J.  F.  Jenkins,  Yonkers;  H.  D.  Bulkley,  New 
York  city;  G.  J.  Fisher,  Sing  Sing;  Alden  March, 
Albany. 

Delegates  to  New  Jersey  State  Medioal  Society. 
— Ferris  Jacobs,  Delhi :  Samuel  Hart,  Brooklyn ;  Fred- 
eric Hyde,  Cortlandville;  Wm.  Govan,  Stony  Point. 
.  Delegates  to  New  Hampshirb  Medical  Society. — 
M.  R  Holbrook,  of  Poughkeepsie ;  Hiram  McNutt, 
Warrensburgh-  B.  R.  Peaslee,  New  York;  W.  B. 
Bibbins,  New  York. 

Delegates  to  the  Vermont  State  Medical  So- 
ciety.— Drs.  Francis  Burdick,  Johnstown ;  J.  G.  Orton, 
Binghamton ;  Thompson  Burton,  Fultonville. 

Delegates  to  Pennsylvania  Medical  Society. — 
Drs.  Caleb  Greene,  Homer;  W.  C.  Wey,  Elmira;  G«orge 
Burr,  Binghamton;  H.  C.  Stiles,  Brooklyn. 

Delegates  to  Ohio  State  Medical  Society. — Drs. 
C.  C.  Wyckoff,  Buffalo;  Sanford  Eastman,  Buffalo; 
Thos.  F.  Rochester,  Buffalo;  H.  W.  Dean,  Rochester; 
H.  H.  Langworthy,  Rochester. 

Delegates  to  Maine  Medical  Society. — Drs.  Ells- 
worth Eliot,  New  York ;  E.  L.  Beadle,  Poughkeepsie. 
Delegate  to  Rhode  Island  State  Medical  Society. 
Dr.  J.  H.  Burger,  Brooklyn. 

Delegates  to  American  Medical  Association. — 
The  present  incumbents,  leaving  out  H.  A.  Carrington, 
C.  S.  Wood,  Seth  Shore,  C.  M.  CrandaU;  eM  adding 
Wm.  Govan,  Stony  Point ;  Joseph  Bates,  J.  P.  White, 
Buffalo ;  H.  N.  Eastman,  Geneva ;  J.  F.  Jenkins,  Yon- 
kers ;  E.  S.  F.  Arnold,  Yonkers. 

Committee  on  Statistics. — Present  incumbents. 


Committee  on  Prize  Essays. — Present  incumbents. 

Committee  on  Publication  and  Revision  of  By- 
Laws. — Present  incumbents. 

Dr.  C.  a.  Lee  then  proposed  the  following  resolu- 
tions in  regard  to  an  amendment  of  the  By-Laws  to 
be  offered  for  consideration  at  the  next  meeting,  Feb- 
ruary, 1869 : 

1.  Resolved,  That  the  by-law  of  the  New  York  State 
Medical  Society,  requiring  the  President  and  Vice-President 
to  be  nominated  by  a  committee  appointed'by  the  President, 
is  hereby  repealed. 

2.  Resolvedy  That,  hereafter,  in  all  elections  for  officers,  the 
Presideut  and  Vice-President,  it  shall  be  done  by  ballot  by 
open  nomination  in  convention,  and  that  whoever  shall  re- 
ceive the  largest  number  of  votes,  shall  be  declared  elected. 

8.  The  election  shall  take  place  on  the  second  day  of  the 
meeting,  during  the  morning  session. 

After  considerable  discussion,  the  Resolutions  were 
laid  on  the  table,  with  the  understanding  that  they  be 
taken  uf)  and  considered  at  the  next  annual  meeting, 
the  President  elect  also  having  intimated  that  he  should 
call  the  attention  of  the  Society  to  the  subject,  in  his 
opening  address. 

Dr.  J.  Or,  Orton,  through  Dr.  Saunders,  offered  the 
following : 

Resolved^  That  the  Standing  Committee  on  Statistics  be  in- 
structed to  issue  a  suitable  circular  under  the  direction  of  the 
Publishing  Committee,  inviting  reports  from  the  profession  of 
any  epidemics  which  may  prevail  during  the  present  year  in 
this  Stata    Adopted. 

Dr.  Joseph  C.  Hutchison  offered  the  following : 

Resolvedj  That  the  chairman  of  the  delegates  from  this  So- 
ciety to  the  American  Medical  Association,  be  requested  to  pre- 
sent to  said  Association,  as  the  desire  of  the  Medical  Society 
of  the  State  of  New  York,  the  following  resolution,  aad  to 
urge  its  adoption : 

Resolved,  That  the  Faculties  of  the  several  Medical  Col- 
leges of  the  United  States  be  recommended  to  announce  ex- 
plicitly in  their  annual  commencement  circulars  and  adver- 
tisements, that  they  will  not  receive  certificates  of  time  of 
study  firom  irregular  practitioners,  and  that  they  will  not 
center  the  degree  upon  any  one  who  may  acknowledge  bis 
intention  to  practise  in  accordance  with  any  exclusive 
system.    Adopted. 

Business  Committee  read  by  title  the  following 
paper: 

Report  of  Cholera  at  Quarantine,  by  Dr.  John  Swin- 
burne, for  1867. 

Moved  that  the  Secretary  be  directed  to  advertise 
three  times  the  prizes  offered  by  this  Society  in  the 
medical  journals  of  this  State.     Carried. 

On  motion  of  Dr.  Bibbins,  a  vote  of  thanks  to  the 
State  Agricultural  Society  was  passed,  for  the  gratuitous 
use  of  the  Agricultural  Society  Hall  during  the  session 
of  the  Society.    Adopted. 

Business  Committee  read  by  title  Carbolic  Acid,  by  D. 
P.  BisselL  \ 

Dr.  Bissell  moved  that  the  thanks  of  this  Society  be   ^ 
tendered  the  Committee  of  Arrangements,  for  the  good 
accommodations  and  comfortable  arrangements  made 
for  this  Society.    Adopted. 

Resolved,  That  the  thanks  of  the  members  of  the  Medical 
Society  of  the  State  of  New  York  be  tendered  to  Drs.  Marsh 
and  Armsby,  for  the  kind  and  generous  hospitality  tendered 
to  them  at  the  Hospital  Buildmg  on  Wednesday  evening, 
March  5,  1868.    Adopted. 

Dr.  Brinsmade,  on  behalf  of  the  committee  appointed 
to  memorialize  the  Legislature,  asked  that  the  commit- 
tee be  continued.     Granted. 

Dr.  Squibb  offered  the  following,  which  was  adopted : 

Resolved,  That  the  thanks  of  the  Society  are  due,  and 
hereby  tendered,  to  the  President  and  other  officers  of  the 
present  annual  session.  „.^ ^ ^_ 


660 


THE  MEDICAL  RECORD. 


Resolved^  That  the  thanks  of  the  Society  are  tendered  to 
the  reporters  who  have  been  present,  and  have  reported  the 
transactions. 

Dr.  C.  a.  Lbb  raoved,  That  the  thanks  of  this  Society 
be  given  to  Dr.  E.  R.  Squibb,  for  the  very  able  manner 
in  which  he  has  performed  his  duties  as  Chairman  of 
the  Business  Committee.    Cam'ed. 

DOES  THE   NEGRO   HAVE   DELIRIUM  TREMENS? 

Dr.  B.  p.  Staats  stated  that  he  had  considerable  ex- 
perience in  the  treatment  of  delirium  tremens  in  the 
County  Penitentiary,  and  had  never  seen  one  case  in  a 
ncCTO.     He  asked  the  experience  of  members  present. 

Dr.  Briksmadb,  as  chairman  of  the  Committee  to  try 
the  case  of  Dr.  N.  K.  Freeman,  reported  progress,  and 
asked  that  the  Committee  be  instructed  to  report  at 
the  next  meeting.  The  request  after  a  little  discussion 
was  granted. 

The  Society  then  adjourned  to  the  first  Tuesday  in 
February,  1869. 

|)r0grf»6  0f  iEeliical  Science. 


CdBEBio  AoiD. — The  curative  power  of  cubebs  has 
been  found  to  reside  in  cubebic  acid,  a  crjstallizable 
constituent,  and  not  in  the  volatile  oil  or  resins.  From 
eight  to  thirty  grains  of  this  in  pill,  in  twenty-four  hours, 
completely  cured  three  out  of  five  patients  in  six  days. 
In  the  remaining  two  the  discharge  was  very  much 
diminished,  so  that  a  few  injections  removed  it. — Am, 
Jour.  Med.  Sciences, 

Ossified  Placenta. — Dr.  Galloway,  of  Canton,  Miss., 
has  met,  during  twenty  years,  with  eight  cases.  In 
every  case  the  child  was  well  developed,  and  the  mother 
convalesced  as  usual  He  makes  it  a  rule  to  inspect  the 
placenta  in  all  cases. — Am,  Jour.  Med.  Sciences. 

SuB-LUXATTON  of  bodv  of  stomum,  producing  a  depres- 
sion of  over  half  an  inch  at  the  lower  part  of  the  manu- 
brium, was  reduced  by  Dr.  M.  Forster,  of  Shomdale, 
Ontario  Co.,  as  follows :  He  threw  the  head  and  shoul- 
ders backward,  so  as  to  draw  the  clavicles  upward,  and 
produced  tension  of  the  pectoral  mu^les,  so  as  to  draw 
them  outward,  and  then  by  repeated  deep  inspirations 
succeeded  in  iorcing  the  manubrium  upward  and  out- 
ward.— Am.  Jour,  Med.  Sciences. 

Zymotic  Nature  of  Rheumatism. — Prof.  J.  H.  Salis- 
bury, of  Cleveland,  contributes  to  the  Am,  Jsur.  Med. 
Sciences  quite  a  long  article  upon  the  varieties  of  rheum- 
atism ana  their  treatment.  He  concludes  that  there  are 
four  principal  types,  which  he  names  from  the  substance 
found  in  abnormal  quantity  in  the  blood  and  secretions, 
and  excretions,  either  Uthic,  oxalic,  cystinic,  or  phos- 
phatic.  He  finds  uniformly  in  every  variety  in  blood 
and  urine,  and  even  upon  the  skin^  a  cryptogam,  which 
he  calls  Zymoioses  translucens^  consisting  of  very  minute 
spores  and  filaments,  which  are  higmy  refracting^  of 
faint  outline,  and  which  soon  become  nearly  invisible 
when  placed  between  the  slides.  The  following  direc- 
tions are  given  :  '*  Make  an  incision  in  the  arm ;  a  drop 
of  blood  quickly  pressed  out  and  received  upon  a  slide 
should  at  once  be  covered  with  thin  dass  and  watched  to 
observe  the  manner  in  which  the  red  discs  arrange  them- 
selves, aid  the  condition  of  Uie  coloriess  corpuscles. 
Verv  soon  little  gaps  will  appear  from  the  aggregation 
of  the  red  discs,  in  which  will  be  seen  colorless  cor- 
puscles (fibrin  cells)  more  or  less  aggregated,  and  here 
and  there  masses  of  minute  spores,  and  occasionally 
ropes  and  knots  of  algoid  filaments.  As  soon  as  the 
blood  becomes  quiet,  it  will  be  found  to  arrange  itself  to 


some  extent  in  ropy  rows  or  masses.  Crystalline  mat- 
ters are  also  occasionally  met  with.  The  characterisdo 
fungoid  is  also  found  in  the  urine,  which,  in  oxalic  and 
crystinic  rheumatism,  in  the  morning,  contains  the  cor- 
responding morbid  excretion.  The  treatment  of  each 
variety  is  detailed  at  some  length,  but  contains  no 
especially  new  features. 

Chloroform  in  Otalgia. — Dr.  C.  C.  Shoyer,  of 
Leavenworth,  Ka.,  relieves  earache  almost  immediately 
by  introducing  about  half  a  drachm  of  chloroform  into 
the  meatus  externu-'. — Am.  Jour.  Med.  Sciences. 

Prolonged  Gestation. — Dr.  P.  M.  Rivers,  of  Water- 
boro',  S.  C,  relates  a  case  in  which  a  hydrocephalic 
foetus  was  retained  in  utero  until  the  completion  of  the 
twelfth  month.  The  mother  was  troubled  with  abdom- 
inal pains  at  term,  but  these  subsided  after  three  days. 
— Am.  Jour.  Med.  Sciences. 

Muscle  Sugar. — In  August,  1861,  Q-.  Meissier  an- 
nounced his  discovery  of  a  true  su^ar  in  muscle.  Dr. 
J.  Rauke  has  reinvestigated  the  subject  and  fully  con- 
firms Meissier's  supposition.  The  following  propositions 
are  considered  as  established :  First  That  there  exists 
a  true  fermentable  sugar  in  muscle.  Second.  That  the 
amount  of  this  sugar  is  increased  by  muscular  action, 
including  tetanization  caused  by  strychnine  or  electricity. 
Third.  That  the  liver  has  no  effect  in  causing  thi-"  in- 
crease ;  for  the  sugar  is  proved  to  arise  in  the  muscle 
itself,  and  from  the  muscular  substance. — Am.  Jour. 
Med.  Sciences. 

Source  of  Muscular  Eneegt. — Profs.  Fick  and 
Wlslicenus  give  an  account  of  an  experiment  which 
seems  conclusively  to  show  the  error  of  Liebig's  theory 
that  muscular  power  is  derived  from  the  oxidation  of 
muscle,  and  the  truth  of  that  advanced  by  Bischoff  and 
Voit,  that  the  oxidation  of  hydro-carbonaceous  material 
is  the  source  of  that  power.  They  ascended  the  Faulhom, 
a  peak  of  the  Swiss  Alps ;  during  the  ascent,  for 
eighteen  hours  previous  and  six  hours  afler  it,  they  took 
hydro-carbonaceous  food  only,  and  it  was  found  that  the 
great  muscular  exertion  had  but  very  slightly  increased 
tlie  amount  of  urea  excreted,  and  that  during  ihe  six 
hours  after  the  ascent  even  less  urea  was  excreted  than 
before  starting.  Had  the  source  of  muscular  power 
been  the  oxidation  of  albuminous  material,  the  urea 
excreted  during  and  shortly  after  the  ascent  ought  to 
have  undergone  a  very  decided  increase.  Ihey  do 
not  deny  that  muscle  is  wa^^ted  to  some  extent 
during  contraction,  but  they  conclude  that  the  oxid- 
ation of  albuminous  substances  bears  a  very  small 
proportion  to  that  of  hydro-carbonaceous  material. 
Prof.  Parkes  has  recently  experimented  with  a  view 
of  ascertaining  the  correctness  of  these  conclusions, 
and  confirms  them  in  the  following  propositions: 
Firstly.  That  on  a  non-nitrogenous  diet  of  fat,  starch, 
and  sugar,  exercise  produces  a  slight  but  unimpor- 
tant increase  in  the  amount  of  nitrogen  excreted  both 
by  the  kidneys  and  the  intestines.  Secondly.  That 
during  the  period  of  actual  work,  the  amount  of  urea 
is  diminished,  proving  that  changes  take  place  which 
cause  either  a  retention  of  the  nitrogen  or  an  elimination 
by  another  channel  It  is  evident,  then,  that  the  quan- 
tity of  urea  excreted  cannot  be  taken  as  au  index  of  the 
amount  of  waste  which  tlie  tissues  have  suffered.  Thirdly. 
That  amount  of  force  expended  during  excretion  is  not 
merely  the  result  of  the  oxidation  of  the  muscular, 
nervou>5,^nd  other  nitrogenous  tissues  of  the  body, 
which  can,  in  fact,  represent  only  about  one-fifth  of  the 
entire  quantity,  but  that  inmost  important  share  in  its 
production  is  taken  by  the  non-nitrogenous  elements  of 
the  food,  previous  to  their  transformation  into  tissue. 


THE  MEDICAL  RECORD. 


661 


EzoRETioN  OF  Urba. — Dr.  L.  R  Noyes  has  communi- 
cated to  the  Am,  Jour.  Med.  Sciences  the  results  of  four 
weeks'  experiraentation,  to  discoYer  the  eflfects  of  food 
and  exercise  upon  the  excretion  of  urea.  The  subjects 
had  for  years  been  accustomed  to  an  almost  exclusively 
vegetable  diet.  He  concludes  that  the  urea  is  a  measure 
of  the  metamorphosis  of  the  tissues,  rather  than  of  sur- 
plus albuminous  matters  in  the  blood.  His  tables,  how- 
eyer,  seem  to  show  that  it  was  increased  by  both.  All 
four  subjects  lost  weight  during  a  week  of  animal  diet. 
The  quantity  of  urine  was  increased  twenty  per  cent 
The  sp.  gr.  rose  from  1,020  to  10,245  j  the  urea,  how- 
ever, rose  169  per  cent.  The  total  solids  rose  sixty-six 
percent  The  chlorides  varied  but  little.  The  urea, 
then,  was  the  substance  chiefly  affected  by.  the  change 
of  diet  A  vegetable  regimen  diminished  the  quantity 
of  urine  twenty-eight  per  cent  The  sp.  gr.  fell  frOm 
10,245  to  1,020.  The  total  sohds  diminished  forty-two 
per  cent  The  urea  fell  seventy-five  per  cent  All  the 
subjects  gained  in  weight  He  finds  that  during  exer- 
cise the  urea  excreted  is  proportioned  to  the  fatigue  ex- 
perienced. The  subject  who  exercised  most  was  accus- 
tomed to  long  walks,  and  suffered  no  fati^e.  His  urea 
was  diminished^  while  the  female,  who  took  the  least 
exercise,  was  most  fatigued  and  excreted  the  greatest 
additional  amount  Two  cups  of  strong  coffee  were 
'  taken  with  each  meal,  instead  of  water,  for  another 
week.  The  urea  increased  fourteen  per  cent.  No 
material  change  was  noticed  in  either  the  quantity,  the 
sp.  gr.,  or  the  total  solids.  Again,  the  twenty- four 
hours  were  divided  into  two  equal  portions,  in  each  of 
which  he  took  one  meal,  both  being  alike,  exercised, 
and  lay  upon  the  bed  the  same  number  of  hours ;  the 
only  difference  being  that  during  the  day  he  lay  awake, 
studying,  while  at  night  he  slept  The  quantity  of  urine 
during  the  day  was  very  nearly  double  that  during  the 
ni^ht  The  sp.  gr.  varied  from  two  to  five  degrees, 
being  lower  during  the  day.  The  total  soUds  of  the  day 
exceeded  those  of  the  night  by  seventy  per  cent  The 
reaction  of  the  night  urine  was  strongly  acid,  while  that 
of  the  day  was  distinctly  alkaline.  The  urea  during  the 
day  exceeded  that  of  the  night  by  thirty-one  per 
cent 

A  Useful  MoDinoATioK  of  th«  Catheter. — Dr.  T. 
Warden,  Lancet^  has  made  the  following  improvement 
in  the  construction  of  the  catheter,  which  specially 
adapts  itself  to  tlie  wants  of  those  patients  upon  whom 
the  instrument  has  to  be  used  while  they  are  confined  to 
their  beds.  From  the  lower  side  of  the  instrument, 
about  three  inches  from  the  extremity,  a  tube  is  led, 
having  about  the  same  curve  as  that  at  the  bent  end. 
The  catheter  now  presents  the  appearance  of  an  elon- 
gated letter  8»  'v^Hh  a  projecting  piece  at  the  angle  of 
uie  upper  curve.  This  part  is  impervious,  merely  serv- 
ing the  purpose  of  a  handle,  which  may  be  made  flat- 
tened if  desired ;  the  curved  portion,  which  points  down- 
wards, is  continuous  with  the  tube,  and  has  its  orifice 
closed  in  the  ordinary  way  with  a  wire  and  head.  By 
the  direction  of  this  part,  the  stream  can  be  safely 
directed  into  any  kind  of  vessel,  without  the  chance  of 
wetting  the  patient's  bed  or  the  hands  ot  the  operator. 

Granular  Detritus  of  Elements  in  Process  of 
Oadaverio  Alteration. — ^Another  very  important  par- 
ticularity which  anatomic  elements  present  in  propor- 
tion to  their  putrefaction,  is  their  reduction  into  mole- 
cular granulations,  very  fine,  grayish, very  numerous,  and 
gifled  with  very  active  Brownian  movement  The 
production  of  these  fine  granulations  is  a  phenomenon 
subsequent  to  that  of  the  exudation  of  sarcodique 
(fleshy)  drops  (or  gouts),  and  others,  described  above; 
it  does  not  show  itself  until  the  odor  of  putrefying  ani- 


mal substances  is  already  very  manifest  The  demi- 
solid,  anatomical  elements,  whatever  they  may  be,  fibres 
or  cellules,  if  they  are  homogeneous,  without  granu- 
lations, finally  become  finely  granulous,  in  a  uniform 
manner  throughout  their  whole  thickness.  At  the  same 
time,  the  contour  of  these  elements  becomes  pale, 
badly  determined,  and  the  delicate  molecular  granu- 
lations, floating  in  the  hquid,  become  more  and  more 
abundant  as  tnese  peculiarities  are  pronounced  more 
decisively. —  Charles  Rohin  in  La  France  MtdicaU,  OcL 
16,  1866. 

The  Treatment  of  Infantile  Diarrrcea. — Dr. 
Buiz  (Jour,  Pract,  Med,  and  Surg.)  expresses  the  fol- 
lowing opinions,  as  the  results  of  his  experience,  on  this 
subject :  **  1.  The  diarrhoea  of  spoon-fed  infants  gener- 
ally yields  to  the  addition  of  a  small  quantity  of  bicar- 
bonate of  soda  or  of  hme-water  to  the  milk.  2.  In 
summer-diarrhoea  supervening  without  any  tangible 
cause,  from  one-sixth  to  one-quarter  of  a  grain  of  calo- 
mel three  or  four  times  a  day,  associated  with  an  equal 
amount  of  ipecacuanha,  will  oflen  be  found  efficacious. 
If  the  indisposition  is  consequent  on  exposure  to 
cold,  minute  doses  of  opium  are  appropriate.  3. 
Chronic  diarrhoea  resulting  from  various  causes  may 
in  most  cases  be  checked  with  nitrate  of  silver,  one- 
sixth  of  a  grain  of  which  may  be  exhibited  without 
risk.  This  remedy  is  sometimes,  however,  rejected  by 
the  stomach,  and  should  then  be  replaced  by  tonics  and 
vegetable  astringents.  4.  Diarrhoea  combined  with 
anaemia  and  impaired  nutrition,  is  oflen  the  result  of  a 
state  of  decomposition  of  the  blood,  for  which  the  best 
remedy  is  the  proto-iodide  of  iron.  In  such  cases  bis- 
muth is  frequently  imavailing ;  whereas  in  doses  of  half 
a  drachm  three  times  a  day,  it  is  invariably  successful 
against  intestinal  relaxations  referable  to  tubercular 
ulceration.  The  causes  of  intestinal  catarrh  are,  how- 
ever, so  obscure,  that  in  many  instancts  the  treatment 
must  be  empirical." 

Prevention  of  Chloroform  Sickness. — It  seems 
that  the  plan  of  administering  a  few  drops  of  chloro- 
form in  water  to  prevent  sickness,  proposed  by  Mr. 
Chesshire,  has  been  tried  by  Mr.  J.  Vose  Solomon,  of 
the  Birmingham  Eye  Hospital,  and  others,  and  has  been 
abandoned.  He  says  (British  Medical  Journal) :  '^The 
results  of  this  practice,  as  observed  by  me  at  the  Bir- 
mingham Eye  Hospital,  may  be  briefly  summed  up  as 
follows :  Where  the  patient  had  not  been  specially  pre- 
pared for  the  inhalation,  the  whole  contents  of  the 
stomach  were  rejected;  where  the  precaution  of  allow- 
ing only  a  small  breakfast  of  tea  and  toast  at  an  early 
hour  in  the  morning  had  been  taken,  some  were  sick, 
and  some  were  exempt  from  that  troublesome  compli- 
cation. There  was  no  certainty.  The  prevention  of 
sickness  and  retching  during  and  aller  inhalation  of 
chloroform,  I  find  best  attained,  in  private  practice,  by 
obliging  the  patient  to  breakfast,  four  or  five  hours 
before  operation,  upon  the  lean  of  a  small,  well-cooked 
mutton  chop,  four  ounces  of  tea  or  cofi'ee,  and  a  bit  of 
toast.  In  persons  of  highly-nervous  temperament,  or 
whose  hearts  are  feeble,  the  administration  of  three 
ounces  of  hot  brandy  and  watet  twenty  minutes  prior 
to  commencement  of  inhalation,  facilitates  the  action  of 
the  anaesthetic,  prevents  gastric  disturbance,  and  insures 
satisfactory  cardiac  action.  If  the  patient  be  kept  en- 
tirely without  food,  or  permitted  to  take  only  a  cup  of 
tea  and  a  little  toast  for  the  early  morning  meal,  retch- 
ing of  distressing  urgency  has  been  frequently  observed. 
When  the  patient  is  much  excited  by  the  thought  of  the 
contemplated  surgical  procedure,  the  process  of  digestion 
becomes  arrested,  and  food  in  a  orudej^^ate  is  discharged 
byemoai..  _,gitizedbyCjOO^-_ 


562 


THE  MEDICAL  RECORD. 


Trbatmekt  or  Album  inoub  Nephritis. — This  refers  sim- 
plj  to  parenchymatous  nephritis,  and  the  treatment  is 
only  applicable  to  the  first  two  stages  of  the  complaint 
(congestion  and  exudation),  and  is  not  indicated  in  the 
third  (degeneration).  It  consists  in  the  administration  of 
iodide  of  potassium,  in  large,  increasing  doses :  give  two 
or  three  grammes  at  first,  then  increase  a  gramme,  every 
two  or  three  days.  A  daily  dose  has  thus  been  easily 
borne  of  from  fifteen  to  twenty  grammes.  In  conjunc- 
tion with  the  iodide  of  potassium  can  be  administered 
the  iodide  of  iron,  perchloride  of  iron,  tannin,  etc. — M. 
Crocq,  Medical  Congress, — Gazette  Hehdomadaire, 

Strokes  of  the  Heart  and  Pulse  reproduoed  bt 
Photography. — Dicrotism,  that  is  to  say,  the  double 
beat,  has  been  described  by  M.  Marey  as  a  normal  state 
of  the  pulse.  Before  the  invention  of  the  Sphymograph, 
it  could  not  be  determined  except  in  certain  patholog- 
ical cases,  as  the  precursor  of  hsemorrhages.  Our  photo- 
graphic apparatus  corroborates  the  assertion  of  my  wise 
brother,  but  at  the  same  time  settles  the  question  in  a 
much  more  definitive  manner.  It  demonstrates,  indeed, 
that  the  pulse  is  not  only  dicrotic  but  even  triple  in 
certain  cases,  and  that  after  mounting,  as  it  were,  at  a 
single  bound  to  the  summit  of  the  scale,  it  redescends 
by  three  successive  falls  to  the  inferior  level  Accord- 
ing to  my  observations,  already  numerous,  the  first 
undulation  corresponds  with  the  impulsion  of  the  left 
side  of  the  heart,  the  second  should  be  due  to  the  right 
side.  Now  the  third — is  it  due  to  the  elasticity  of  the 
arteries,  or  to  the  contraction  of  the  auricles?  That  is 
a  point  which  has  not  yet  been  demonstrated. — J£ 
Chas.  Oxanam  in  Gazette  Hebdom:  Sept  6,  1867. 

Idiopathic  Bubo  and  Secondary  Syphilis. — Ist. 
Bubo,  for  which  we  can  give  no  cause  {huhon  ^ernbUe\ 
cannot  be  explained  in  the  great  majority  of  cases  by 
the  simple  excitation  accompanying  coitus. 

2d.  It  should  be  considered  as  making  part  of  the 
array  of  venereal  symptoms,  under  the  same  title  as 
indurated  chancre,  soft  chancre,  blennorrhagia,  balanitis, 
warts,  etc. 

3d.  Facts,  most  scrupulouslv  noted,  will  not  allow  us 
to  doubt  that  it  can^  in  exceptional  cases,  be  followed  by 
constitutional  syphiUtic  taint. 

4th.  It  would  be  desirable  that  statistics  bearing  on 
a  great  number  of  cases  should  be  carefully  prepared, 
so  that  the  degree  of  frequency  of  unaccounted-for  bubo, 
and  the  cases  in  which  it  is  followed  by  secondary 
syphilis,  might  be  established. — Dr,  Bourguet,  of  Aim, — 
Medical  Confess, — Gazette  Midicale  de  Paris.  Oct,  26, 
1867. 

New  Operations  on  the  Eye. — ^M.  de  Graefe  took  oc- 
casion to  communicate  three  new  surgical  operations 
with  their  procedure. 

The  first  has  for  its  object  the  section  of  the  optic  nerve^ 
in  cases  of  remaining  subjective  luminous  sensation,  in 
{  particular  affections,  to  the  loss  of  the  eye,  and  the  oc- 
casion of  deep  troubles  in  the  life  of  the  patient. 

The  second  consists  in  the  partial  tenotomy  of  the  eZe- 
vator  of  the  vpper  eyelid,  in  Bandow*s  disease. 

TTie  third  concerns  the  most  recent  modifications 
practised  by  the  learned  professor  in  his  method  of 
linear  extraction  of  cataract.  This  modification  consists 
in  the  suppression  of  every  tractor  instrument  for  evac- 
uating the  crystalline.  Since  the  introduction  of  this 
modification,  the  number  of  cases  of  procidentia  of  the 
vitreous  body  has  been  diminished,  in  the  proportion  of 
from  U  m  100  to  3  m  100,— GazetU  Behdom:  Sept.  13, 
1867. 

Phthisis  among  the  Jews.— While  the  villagers  in 
^e  country  where  I  practise  are  generally  exempt  from 


phthisis,  the  Jews  are  very  much  subject  to  it,  so  much 
so  that  the  extinction  of  the  race  can  be  predicted  in  two 
or  three  generations.  Bad  food  seems  to  be  exclusively 
the  cause.  Meats  and  all  substantial  nourishment  are 
forbidden  fruit  for  them.  Thin,  emaciated,  pale,  they 
ever  present  the  aspect  of  the  "  Wandering  Jew."  And 
their  marriages  at  sixteen  or  eighteen  years  may.  like- 
wise contribute  to  this  extreme  mortality.  It  is  not 
climate  or  locahty  which  operates  in  this  case,  but  ali- 
mentation. For  the  most  part  remedies,  as  iodine,  iron, 
and  sulphur,  act  simply  and  only  by  developing  the  ap- 
petite. Garhc  seems  to  be  the  principal  nourishment 
of  the  Jews.  Baths  of  whey  (petit-lait),  much  employed 
in  Austrian  GaUicia,  in  Hungary  and  Bessarabia,  are  the 
most  efficacious  remedies. — M,  Dropsy^  Medical  Con- 
gress,—Gazette  Hehdom:  Aug.  30,  1867. 

""Holes  by  Bullets. — ^Bullets  which  penetrate  in  an 
earth  half  moist,  like  clay,  make  a  hole  larger  at  the  en- 
trance than  at  the  exit.  To  determine  this,  construct  a 
massive  fi*ame  of  timber  and  fill  it  in  for  five  or  six  yards 
with  clay.  In  firing  now  with  a  shot  No.  24,  the  hole 
presents  the  appearance  of  a  funnel,  having  a  diameter 
of  one  yard  and  thirty  centimetres  at  the  entrance,  and 
of  fifteen  centimetres  at  the  exit  This  effect  is  due  to 
the  transmission  or  not  of  motion,  by  the  air.  This  can 
be  proved  by  examining  a  section  of  either  of  the  orifices. 
It  is  always  composed  of  a  circle  with  small  concentric 
arcs,  showing  interruptions  darkened  by  the  sulphurous 
gases  carried  along  with  the  bullet  In  making  up  the 
total  of  these  elements,  we  find  exactly  the  length  of 
the  circumference  of  ihe  projectile.  The  effects  of 
communication  of  movement  are  moreover  more  ener- 
getic when  the  clay  is  somewhat  compressed.  All  the 
resistance  of  the  centre  to  the  penetration  is  repre- 
sented by  two  conditions — the  one  is  dependent  on  the 
swiftness,  the  other  is  proportional  to  the  square  of 
this  swiftness,  whence  we  deduce  the  equation  of  the 
curve  which  is  a  logarithm,  even  as  such  is  designated 
in  geometry.  When  we  turn  over  the  profile  impres- 
sions next  morning  we  can  determine  a  diminution  in 
the  length  of  all  the  diameters  obtained,  which  proves 
that  clay  is  gifted  with  a  certain  elasticity,  which  only 
shows  itself  at  the  end  of  a  certain  time. 

The  same  effects  have  been  observed  on  experiment- 
ing on  masonry,  but  they  are  less  appreciable. — Moni- 
teur.—From  La  France  Midkale^  October,  1867. 

Akeurisical  Tumors  of  Arteries. — It  seems  that  M. 
QosseUn  (of  late  appointed  as  professor  in  the  Surg. 
Clinic  of  la  Charite),  recently  laid  before  the  Academy 
of  Sciences  a  paper  on  Aneurismal  Tumors  of  Arteries. 
He  has  left  the  beaten  road,  and  takes  different  ground. 
In  this  relation,  la  France  MHicale  says : 

Contrary  to  the  old  practice,  the  new  surgeon  of  la 
ChariU  rejects  alike  the  ligation  of  the  branches  which 
nourish  the  tumor,  or  of  the  principal  trunks  of  one  or 
both  of  the  primitive  carotids,  for  example,  when  these 
tumors  have  their  seat  by  the  head,  as  is  often  the  case. 
He  has  the  same  views,  likewise,  in  regard  to  the  total 
ablation  of  the  tumor,  which  he  considers  as  dangerous^ 
and  which  indeed  is  only  applicable  in  season^xcept 
where  these  tumors  present  a  large  surface.  He  pre- 
fers to  all  these  different  means,  the  often-repeated  in- 
jection of  the  perchloride  of  iron,  thrown  even  into  the 
very  course  or  the  tumor.  Without  doubt  this  treat- 
ment has  its  inconvenienoes.  After  the  injections,  we 
may  see  now  and  then  small  ulcers,  very  exuberant  and 
rebellious,  showing  themselves,  by  which  a  quantity  of 
clots  escape — these  clots  due  to  contact  with  the  p«^^k»- 
ride— and  they  retard  for  a  long  time  the  case.  But 
the  final  resnlt  is  none  the  less  favorable. 

It  may  happen,  likewise,  thatphlegmasiay  induced  bj 


THE  MEDICAL  RECORD. 


563 


the  perchloride,  terminates  in  suppnration,  and  gives 
rise  to  consecutiye  hsQmorrhage.  In  such  an  event,  M. 
Gosselin  employs  the  actual  cautery,  as  much  with  a 
view  of  arresting  hsemorrhage,  as  to  complete  the  oblit- 
eration of  the  vascular  tumor,  and  his  success  has  de- 
cided that  he  was  right. — La  Ihince  Medieak.  Oct  16, 
1867. 

Evulsion  of  Arm  and  Scapula  by  Machinery. — Re- 
covery.—Dr.  Lowe,  of  the  West  Norfolk  and  Lynn 
Hospital,  publishes  (Lancet)  a  case  of  the  above  which 
is  an  example  of  an  operation  done  accidentally,  resem- 
bling that  recently  performed  by  Sir  William  Fergusson, 
and  reported  some  time  since  in  our  columns.  The 
patient,  set.  eighteen,  had  his  whole  upper  extremities 
drawn  into  the  carding-machine  of  a  flax-mill  and  torn 
to  pieces.  The  wound  was  closed  up  immediately 
after  the  man  was  rescued,  and  the  vessels  were  so 
much  torn  that  there  was  very  little  haemorrhage.  When 
admitted  into  the  hospital  he  was  in  a  state  of  collapse. 
The  wound  having  been  opened,  it  was  found  that  the 
entire  upper  extremity  had  been  torn  away,  and  the 
clavicle  exposed  over  its  outer  half.  The  skin  was 
divided  almost  as  evenly  as  by  a  knife,  and  formed 
good  anterior  and  posterior  flaps.  Over  the  breast  and 
side  of  the  face  the  surface  was  marked  with  lines  of 
scratches  caused  by  the  teeth  of  the  carding-machine. 
The  artery  and  nerves,  denuded  to  the  length  of  four 
inches,  were  found  lying  in  the  wound,  the  former  pul- 
sating strongly  to  within  a  quarter  of  an  inch  or  its 
extremity.  The  patient  was  put  under  the  influence  of 
chloroform,  when  Dr.  Lowe  separated  the  vessel  and 
ligatured  it,  cutting  off  its  exposed  part  as  well  as  that 
of  the  nerve-pkxus,  and  also  removed  about  the  outer 
third  of  the  clavicle.  The  wound  was  brought  together 
by  three  loose  sutures,  and  a  compress  and  bandage  ap- 
plied. The  patient  made  a  good  recovery,  and  was  m 
a  fit  condition  to  be  discharged  from  the  institution 
thirty-five  days  after  the  injury. 

Several  instances  of  a  similar  accident  are  on  record. 
In  some  cases  no  ligature  has  been  required.  This  was 
so  in  the  case  related  by  Belchier  ("Philosophical 
Transactions,"  voL  xl.),  and  in  one  by  James  (London 
Medical  Gazette^  vol.  v.).  Other  cases  in  which,  as  in 
Dr.  Lowe's,  the  subclavian  artery  was  tied,  will  be  found 
described  by  Scarnell  (The  Lancet^  1832,  p.  114),  and 
by  Cartwfight  (Boston  Medical  and  Surmccd  Journal^ 
1837).  There  is  also  a  case  of  Mr.  Lizars  mentioned  in 
Fergusson's  "  Practical  Surgery,"  as  well  as  reference 
to  others  described  by  Cheselden,  Carmichael,  King, 
and  Dorsay. 

The  Treatment  of  Syphilitic  Bubo. — A  recent  num- 
ber of  the  Lancet  gives  a  full  and  interesting  account  of 
the  treatment  of  syphilitic  bubo  in  the  out-patient  de- 
partoient  of  the  different  London  Hospitals.  The  fol- 
lowing may  be  considered  the  main  points  in  said  treat- 
ment: First,  rest;  second,  pressure,  if  it  will  be  toler- 
ated; third,  leeches;  fourth,  poultices,  when  suppura- 
tion is  inevitable;  fifth,  a  free  and  early  incision  to 
evacuate  the  contents  of  the  abscess;  sixth,  a  general 
anti-syphilitic  and  tonic  course. 

Oil  and  Soap  op  Qunrnvs. — ^M.  Flandrin  gives  the 
following  formula  for  oil  of  quinine  for  external  use, 
especially  for  children  who  refuse  to  take  it  by  the 
month.  Quinine,  according  to  M.  Flandrin,  is  soluble 
in  about  ten  parts  of  warm  and  fifteen  parts  of  cold 
oil  He  recommends  the  following  formula:  Pure 
quinine,  one  part;  oil  (freed  from  humidity),  fifteen 
parts.  Pestle  the  mixture  in  a  mortar  thoroughly; 
pour  the  whole  into  a  capsule  and  heat  it^  agitating 
gently  till  complete  solution  has  occurred.  Preserve 
in  a  dry  and  well-corked  bottle.    M.  Tripier  (Journal  de 


MSdeeine  el  de  Chirurgie),  a  medical  officer  of  the  army 
of  Africa,  recalls  the  services  which  soaps  of  the  alkaloids, 
including  quinine,  have  rendered  him  in  his  practice. 
He  gives  the  following  formula:  Stearine,  two  parts; 
sulphate  of  quinine,  one  part.  Warm  till  solution,  and 
add  a  little  lard  to  give  the  cons' stency  of  honey.  Rub 
this  into  the  armpits,  groin,  and  plantar  surfaces. 

Vaccination  Cicatrices  and  Revaocination.— Chas. 
E.  Buckingham,  on  this  subject,  contributes  the  follow- 
ing statements  to  the  Boston  Medical  and  Surgical 
Journal:  Ist  He  has  vaccinated  those  who  have 
never  been  vaccinated  before,  and  who  never  had  had 
variola,  with  failure  for  the  result  The  vaccination 
has  been  repeated  from  the  second  week  after  birth,  at 
various  intervals,  up  to  more  than  ten  times,  and  in 
one  case  over  twenty  times,  without  success ;  the  re- 
sult sometimes  being  a  little  soreness  of  the  skin,  some- 
times severe  soreness,  and  sometimes  without  any  ap- 
parent irritation  of  the  skin.  The  matter  used  has  been 
good,  if  the  fact  that  a  portion  of  the  same  was  used 
successfully  upon  other  arms  be  taken  as  evidence. 
2d.  He  has  been  led  to  question  whether  the  disease 
may  ift>t  have  taken  the  first  time  some  of  them  were 
vaccinated,  and  whether  they  may  not  have  vaccinia 
without  vesicles ;  as  many  believe  that  patients  have 
had  scarlatina  without  eruptions,  and  measles  without 
catarrh,  and  have  been  afterwards  exposed  without 
apparently  being  able  to  have  these  diseases.  There 
is  no  one  symptom  which  must  exist  in  every  case  of 
another  disease.  Why  not  in  vaccinia  ?  3d.  He  has 
seen  virus,  taken  from  the  same  arm  and  introduced 
into  two  others,  produce  in  the  one  case  the  most  per- 
fect, sound,  nmbiUcated  vesicle,  which,  without  sever- 
ity, went  through  its  regular  stages ;  and  in  the  other,  a 
state  of  general  constitutional  irritation,  ending  in  sup- 
puration, without  the  first  sign  of  vesicle.  4th.  He  has 
Known  two  cases  to  terminate  fatally.  In  one  of  these 
the  virus  did  its  work  as  well  as  in  other  cases.  5th.  He 
always  hesitates  more  about  vaccinating  an  adult  than  a 
child,  because  more  frequently  severe  symptoms  fol- 
low in  the  adult  than  in  the  child.  Gth.  He  has  fre- 
quently advised  against  revaocination,  because  of  the 
severe  symptoms  following.  7  th.  If  not  susceptible  of 
vaccinia,  the  thorough  introduc'ion  of  its  virus  into  one 
man*s  arm,  will  produce  no  efiect ;  if  introduced  into 
another  man's,  it  may  act  as  an  animal  poison,  and 
pyemia  may  follow.  8th.  It  is  not  improbable  that  the 
state  of  the  patient's  system  may  explain  many  of  the 
deaths  following  vaccination  in  rebel  prison**.  9th.  He 
has  seen  perfectly  normal-looking  vesicles  followed  bv 
cicatrices  both  large  and  "  small,  circular,  marked  with 
irradiations  and  indentations,"  and  then  afterward  re- 
duced to  *' miserable,  white,  flat  specks,"  and  has 
been  unable  to  produce,  in  the  possessors  of  these 
specks,  anything  but  sore  arms  and  headaches  by  re- 
vaccination.  10.  The  history  of  vaccination,  for  twenty 
years  past  in  foreign  armies,  is  not  enough  to  prove  the 
success,  or  necessity,  or  impropriety  or  revaocination, 
any  more  than  twenty  years  absence  of  spotted  fever 
from  Boston,  or  the  successful  result  of  quinine  treat- 
ment of  erysipelas  and  puerperal  fever  at  the  South 
Boston  Almshouse,  is  enough  to  prove  anything. 

Gunshot  Wound  of  the  Neck,  with  Injury   of 

Spinal  Cord. — Private  G was  found  the  morning 

after  a  battle  with  "  his  neck  broken."  He  was  carried 
a  quarter  of  a  mile  to  a  hospital,  where  he  remained  a 
few  days.  He  was,  after  a  few  days^  moved  some  dis- 
tance, to  secure  better  attention.  After  three  weeks  he 
was  again  moved  about  a  quarter  of  a  mile.  The  fifth 
day  after  the  wound  he  suffered  greatly,  complaining  of 
his  neck  and  boweb;  the  latter  being  extremely  pain- 


564 


THE  MEDICAL  RECORD. 


ful,  pulse  142,  extremities  cold,  and  excessively  rest- 
less. It  was  found  that  the  ball  bad  passed  tiirou^h  the 
neck,  and,  as  well  as  could  be  ascertained,  had  cut 
across  the  spinal  marrow.  He  lived  fifty-one  days,  and 
finally  succumbed,  from  dysenteric  symptoms,  attended 
with  extreme  and  persistent  nausea.  Before  the  de- 
velopment of  dysenteric  symptoms,  his  bowels  gave 
him  80  much  pain  that  spasms  and  tetanus  were 
thought  to  be  imminent  Voluntary  motion  was 
almost  entirely  lost ;  he  had  but  little  use  of  his  left 
hand.  His  evacuations  were  but  partially  under  his 
control.  On  the  fifty- first  day  he  ^ed.  An  examina- 
tion revealed  that  the  ball  had  passed  through  the 
lamina  of  the  fouiiih  cervical  vertebra,  severing  entirely 
the  lamina  attached  to  the  vertebra  from  the  spinal  por- 
tions, so  that  the  spinal  portions  of  the  bone  were  lying 
loose  in  the  half-formed  sac  around  the  injured  bone. 
The  sheath  of  the  spinal  marrow,  posteriorly,  was  cut 
across,  and  about  two-fifths  of  the  spinal  marrow  was 
severed.  The  internal  wound,  including  the  sheath  of 
the  cord,  was  filled  with  a  sanious,  offensive  pus,  tinged 
with  blood. — Atlanta  Medical  and  Surgical  JoumaL 

Diphtheria. — Dr.  Reuben  Searcy,  of  Alabama,  thus 
speaks  of  his  experience  in  the  treatment  of  this 
disease:  I  now  treat  it  wi  h  a  saturated  solution  of 
chlorate  of  potash,  acidulated  with  muriatic  acid ;  i.  «., 
100  grains  ot  the  potash,  in  four  ounces  of  water,  adding 
one  drachm  of  muriatic  acid.  To  a  child  of  ten  years 
old,  give  a  teaspoonful  every  two  hours,  in  sweetened 
water,  and  less  to  younger  children.  I  directed  two 
pieces  of  fat  bacon  to  be  sewed  to  a  piece  of  cloth,  and 
bound  to  the  neck  over  the  tonsils,  and  to  be  worn 
until  after  convalescence.  When  the  skin  is  hot  and 
dry,  rub  the  patient  all  over  with  a  piece  of  bacon  rind, 
then  wash  off  with  warm  water  and  soap.  This 
always  lessens  fever,  producing  sleep  and  perspiration. 
This  should  be  repeated  as  often  as  the  not  skin  re- 
quires. Gentle  aperients,  gruels,  teas,  etc.,  should  be 
directed,  but  an  active  purgative  or  emetic  should  never 
be  used. — Aiianta  Medical  and  Surgical  JoumaL 

The  Ligatubb  and  Mr.  Stme. — Mr.  Syme  has  bid 
adieu  to  the  use  of  the  ligature,  save  in  the  tying  of 
the  larger  arteries.  He  employs  torsion;  and  after 
this  operation  is  completed,  no  clears  out  the  wound, 
using  a  weak  solution  of  carbolic  acid  and  water  (one 
part  to  thirty),  and  covers  the  whole  over  with  a  paste 
containing  carbolic  acid,  chalk,  and  other  ingredients. 

Developmeitt  and  Treatment  op  Albctminuria. — 
W.  F.  M.,  a  correspondent,  thus  writes:  In  view  of  the 
notorious  inefl&cacy  of  our  treatment  of  BrighVs  dis- 
ease, I  thought  the  following  note  might  be  interestinpr. 
It  is  a  condensation  of  an  article  read  before  the  French 
Academic  Impdriale  de  M^ecine,  by  Prof  SemoU  of 
Naples,  and  is  the  coniplement  of  a  previous  memoir 
by  the  same  author.  In  his  previous  communication 
Prof.  Semola  developed  the  opinion  that  the  passage  of 
the  albumen  into  the  urine,  in  Bright's  disease,  was  the 
necessary  consequence  of  a  general  deficiency  of  nutri- 
tion by  which  the  albumen,  rendered  incapable  of  per- 
forming its  functions,  was  ehminated  by  the  kidneys  as 
a  substance  foreign  to  the  organism.  According  to 
this  theory,  the  alterations  of  these  organs  would  play 
only  a  secondary  r61e  in  the  development  of  the  disease; 
and  although  the  condition  of  the  kidneys  is  of  value 
in  prognosis,  Prof.  Semola  protests  affainst  the  ideas 
of  tiiose  who  pretend  to  explain  or  resolve  the  question 
by  purely  anatomical  deductions. 

One  diagnostic  sigu  distinguishing  organic  from  symp- 
tomatic albuminuria  is  furnished  by  the  quantity  of  the 
urea,  which  in  true  Bright's  disease  diminishes  with  the 
first  appearance  of  the  albumen,  and,  at  a  later  period, 


accumulates  in  the  blood.  The  same  is  true  of  the  sul- 
phates. Of  the  artificial  albuminurias,  that  produced 
by  the  suppression  of  the  cutaneous  functions  is  the  most 
like  Bright's  disease.  This  suppression  both  prevents 
the  oxidation  of  the  materials  introduced  into  the  sys- 
tem in  the  form  of  peptones  (the  products  of  the  diges- 
tion of  albumen),  and  causes  a  congestion  of  the  viscera, 
and  especially  of  the  kidneys. 

Thus,  according  to  this  author,  Bright's  disease  is  not 
the  result  of  a  primitive  anatomical  lesion  of  the  kid- 
neys, but  is  a  result  of  this  double  series  of  effects  which 
succeed  the  more  or  less  sudden  suppression  of  the 
functions  of  the  skin. 

The  aim  of  the  physician  should  be  to  reestablish 
these  functions,  and  thus  increase  the  oxidation  of  the 
peptones,  and  relieve  the  renal  congestion. 

Among  the  means  best  suited  to  this  purpose  are  the 
ordinary  sweatings,  or,  in  obstinate  cases,  hot-air  baths, 
always  followed  by  cool  or  cold  shower-baths;  prepara- 
tions of  arsenic,  and  inhalations  of  oxygen.  The  diet 
should  be  vegetable  or  starchy,  with  but  very  little  meat. 

Lithotomy — the  Bilateral  Operation  and  Double 
LiTHOTOME.— It  is  clear  to  my  mind  that  first,  the  anat- 
omy of  the  part;  second,  the  thing  to  be  accomplished 
(viz. :  the  extrnctintr  of  the  stone  of  large  or  small  siee, 
as  the  case  may  be);  and  third,  the  importance  of 
simplifying  as  much  as  possible  all  surgical  operations, 
forces  the  fact  upon  the  mind  of  every  operator  that 
the  bilateral  operation  is  the  one  to  make,  and  thai  the 
double  lithotome  is  the  instrument  with  which  to  make  it. 

As  every  operator  knows,  who  is  at  all  acquainted 
wifh  this  operation,  how  the  perineal  incisions  in  both 
methods  of^  operating  are  made,  it  is  only  necessary  to 
speak  of  the  m  >st  important  points  in  the  operation. 
It  is  an  admitted  fact  that  the  danger  of  cutting  the  in- 
ternal pubic  artery  consi>ts  i;i  lateralizing  too  much, 
while  that  of  wounding  the  rectum  is  in  not  lateralizing 
enough ;  now  this  being  the  fact  in  the  case,  it  is  cer- 
tainly apparent  to  the  mind  of  every  surgeon  that  as 
the  lithotome  regfulates  itself  as  to  the  amount  of  later- 
alization necessary,  there  cannot  be  so  much  danger  in 
the  hands  of  an  operator  of  dividing  the  pubic  artery  as 
there  would  be  by  using  the  bistoury,  and  by  simply 
depressing  the  handle  of  the  lithotome  and  withdrawing 
the  instrument  with  the  back  of  the  sheath  of  the  blades 
resting  in  the  groove  of  the  staffer  director,  which  should 
be  held  steadily  by  the  assistant,  closely  hugging  the 
symphysis  pubis,  so  as  to  draw  the  neck  of  the  bladder  as 
far  as  possible  from  the  rectum,  the  groove  in  the  director 
being  neld  on  a  line  parallel  with  the  raphe  of  the  perine- 
um. The  question  would  arise  in  the  mind  of  the  opera- 
tor, not  as  to  how  he  would  be  enabled  to  avoid  the  pubic 
arteries  and  rectum,  but  rather  by  operating  thus,  how 
is  it  possible  that  either  the  pubic  arteries  or  rectum 
could  be  injured ;  taking  care  of  course  not  to  set  the 
blades  of  the  lithotome  too  deep,  keeping  in  view  the 
fact  that  all  the  surgeon  wants  is  simply  a  hole  in  the 
bladder  large  enough  to  admit  the  end  of  the  index-finger, 
and  relying  upon  dilating  with  finger  and  blade  of  for- 
ceps for  extracting  stone,  in  the  event  the  size  of  stone 
should  require  it ;  and  failing  in  this  event  to  extract  it, 
then  always  bring  the  Uthotrite  to  your  aid  and  crush  it 
rather  than  risk  making  the  opening  any  larger. 

The  inexperienced  operator  will  be  astonished  to  find 
how  easily  and  to  what  extent  the  opening  in  the  bkd« 
der  can  be  dilated  by  the  finger,  or  by  simply  expanding 
the  blades  of  the  forceps;  and  after  the  stone  is  grasped 
by  the  forceps  he  will  be  equally  astonished  (o  find  how 
large  a  sized  stone  can  by  patience  and  manipulation  be 
wiUidrawn  from  a  very  small  opening. — Dr.  Benjamix 
Franklin,  NofhmUe  Journal  of  Medicine  and  Surgery. 


THE  MEDICAL  RECORD. 


565 


The  Medical  Kecord. 

Geobgb  F.  Shradt,  M.D.,  Editor. 


PablUbtd  <m  th«  1st  and  15thof  aaoh  Month,  tf 
WILLIAM  WOOD  4e  00^  <1  Walker  Stbsbt,  Niw  Toss. 


FOREIGN  AOEKCIK& 


LoinM>N~TsifBintB  k  Co. 
Paris— BoasAKOB  bt  Cib. 


LRIFSIO — B.  HbRM ANH. 

Bio  Jambiro— Strphbicm  t  Oa. 


Now   York,   B^ebruary   lO,  ISeS. 


THE  CLOSE  OF  OUR  SECOND  VOLUME. 
In  closing  the  second  volume  of  the  Medical  Record, 
we  take  the  opportunity  of  glancing  cursorily  at  the 
medical  events  which  have  occurred  during  the  past 
year.  Although  the  record  of  such  doings  as  interest 
medical  men  has  not  been  so  full  as  during  the  year 
before,  still  they  are  of  suflBcient  moment  to  merit  a 
retrospective  glance,  and  to  afford  us  an  opportunity  for 
some  congratulation. 

The  most  important  event  was  the  assembling  of  an 
International  Congress  at  Paris.  The  full  particulars  of 
this  meeting  have  been  already  placed  before  our  read- 
ers, and  the  opinion  as  to  its  success  has  been,  we  think, 
fully  and  impartially  expressed.  The  idea  of  having 
such  a  meeting  at  the  time  of  the  great  International 
Exhibition  was  a  good  one,  and  all  the  leading  medical 
minds  throughout  the  civilised  world  were  much  inter- 
ested in  its  success.  Its  failure  to  meet  the  require- 
ments for  which  it  was  instituted  was  not  due  so  much 
to  an  apathy  on  the  part  of  some  of  the  few  represen- 
tative men  of  other  countries,  and  their  indisposition 
to  be  present  at  its  sessions,  as  the  gross  mismanage- 
ment of  the  affair  by  those  of  the  committee  who  had 
the  matter  in  charge.  The  results  of  the  meeting,  how- 
ever, though  they  might  have  been,  for  obvious  reasons, 
more  gratifying  and  brilliant,  were,  nevertheless,  good 
enough  to  warrant,  under  different  auspices,  a  second 
undertaking  of  the  sort  In  fact  the  practical  value  of 
each  an  assemblage  of  scientific  *men  was  sufficiently 
apparent  to  make  this  congress  a  precursor  to  others, 
"which,  although  not  so  large,  were  at  least  more  suc- 
cessful. Among  the  latter  we  may  refer  to  the  confer- 
ence at  Weimar,  the  object  of  which  was  the  discussion 
of  the  prolific  subject  of  cholera. 

The  regular  national  medical  conventions  have  been 
"well  attended,  and  the  number  of  working  members 
has  so  much  increased,  that  a  new  interest  has  been  in- 
fused into  such  gatherings,  giving  them  a  character  with 
the  medical  public  which  they  were  far  from  possessing 
heretofore.  The  American  Medical  Association  has  well 
represented  itself  among  other  institutions  of  its  class; 
and  the  convention  of  medical  teachers  which  is  its 


legitimate  offspring,  has  been  such  a  success  in  the  har- 
mony of  its  workings,  as  well  as  in  the  influence  which 
it  is  calculated  to  exert  upon  the  cause  of  medical  edu- 
cation, that  a  similar  society  has  been  formed  in  Great 
Britain. 

Of  the  minor  societies,  we  are  enabled  to  say  much 
that  is  encouraging.  All  the  State  Conventions  which 
have  been  in  regular  operation  are  in  a  most  flourishing 
condition,  and  many  others  which  have  been  donnan* 
are  resuscitated,  while  the  medical  men  of  our  new 
States  and  Territories  are  equally  active  in  initiating 
suitable  measures  towards  following  the  example  of 
those  of  their  number  in  older  localities.  The  Ic^cal  so- 
cieties have  also  done  equally  well,  and  some  new  ones 
have  lately  been  organized,  which  promise  to  do  much 
good. 

The  publication  of  medical  works  has  been  reason- 
ably active ;  numerous  new  editions  have  been  issued, 
and  not  a  few  original  treatises  have  made  their  ap- 
pearance. Among  the  latter,  without  being  in  danger 
of  making  invidious  comparisons,  we  may  particularly 
mention  the  elaborate,  elegant,  and  useful  publication 
of  the  Catalogue  of  the  Army  Medical  Museum,  and 
the  comprehensive  report  embodied  in  Circular  No.  7, 
treating  upon  that  important  operation,  amputation  of 
the  hip.  Side  by  side  with  these  in  point  of  tjrpo- 
graphical  excellence  and  superb  illustrations,  can  rank 
the  work  on  the  Micro-chemistry  of  Poisons  by  Prof. 
T.  G.  Wormley,  of  Ohio.  There  are  others  which 
approach  these  in  value  of  contents  and  neatness  of 
form ;  but  the  ones  named  have  such  an  unquestionable 
claim  for  the  highest  rank,  that  we  think  we  have  a 
right  to  allude  particularly  to  them  in  the  light  of  model 
publications. 

Several  new  medical  journals  have  made  their  ap- 
pearance within  the  last  twelve  months,  and  as  far  as 
their  editorial  management  is  concerned,  they  seem  to 
be,  what  they  certainly  ought  to  be,  in  a  flourishing 
pecuniary  condition.  In  this  connection,  and  as  an 
earnest  of  the  appreciation  of  the  labors  of  medical 
editors,  we  have  the  gratification  of  saying,  notwith- 
standing the  ofl-repeated  predictions  of  many,  that  not 
a  single  one,  as  far  as  our  own  knowledge  goes,  has 
ceased  to  be. 

In  the  matter  of  progress  in  the  medical  sciences, 
there  has  been  but  little  done  in  comparison  with  for- 
mer years.  Perhaps  the  most  important  advance  in 
our  knowledge  which  has  been  made  refers  to  the 
views  recently  promulgated  in  regard  to  the  inoculabU- 
ity  of  tubercle.  The  experiments  of  Villemin,  Lebert, 
and  Simon,  have  been  of  exceeding  interest,  and  their 
results  have  furnished  us  with  some  rather  startling 
facts.  A  new  interest  is  now  manifested  in  the  study 
of  this  universally  prevalent  disease,  which  interest 
will  in  all  probability  be  intensified  when  the  zymotic 
theory,  broached  by  Dr.  William  Budd,  receives  its 
promised  exposition.  Beyond  these  additions  to  our 
knowledge,  there  has  been  nothing  more  done,  the 


566 


THE  MEDICAL  RECORD. 


workers  being  engaged  in  confirming  the  truth  or 
fallacy  of  many  of  those  discoveries  which  have  been 
brought  to  light  within  the  past  two  or  three  years. 
It  is  true  there  are  some  new  instruments  offered  us, 
but  for  the  most  part  they  are  important  modifications 
of  old  ones.  We  might  refer  in  passing  to  the  in- 
genious speculum  of  Bozeman  as  a  remarkable  addi- 
tion to  our  instruments  for  vaginal  examinations. 

Death  has  been  savagely  busy  with  the  members  of 
our  profession,  and  has  greedily  claimed  more  than  his 
usual  allotment  of  medical  men.  Among  the  honored 
names  which  live  now  in  the  past  we  mention  those  of 
Howard  Townsend,  Caspar  Wistar,  Benjamin  Ogden,  C. 
E.  Morgan,  Mason  Warren,  Robert  Watts,  and  Worth- 
ington  Hooker.  But  ours  has  not  been  the  only 
country  which  has  suffered  in  this  respect  England 
has  lost  its  Faraday,  Brinton,  Goodsir,  Lawrence,  Day, 
Warington,  and  Arnot;  and  Prance  has  been  called  to 
mourn  her  Jobert,  Velpeau,  Civiale,  Trousseau,  Roger, 
and  Flourens. 

With  the  exception  of  the  appearance  of  yellow 
fever  during  the  past  summer,  and  the  occasional  out- 
break of  a  few  scattered  cases  of  cholera,  the  people  of 
the  United  States  have  enjoyed  good  health.  In  fact 
the  same  may  be  said  of  most  of  the  portions  of  Europe. 
The  rinderpest  has  practically  ceased  to  be;  the  cholera 
did  not  scourge  them  as  heretofore ;  and  with  the  ex- 
ception of  the  appearance  of  the  epidemic  fever  in 
Ireland,  nothing  worthy  of  note  in  that  quarter  has 
occurred. 

It  is,  however,  useless  for  us  to  generalize  farther  on 
matters  which  are  to  be  found  in  detail  in  the  present 
volume;  and  in  closing  these  remarks,  may  we  express 
the  hop*  that  our  duties,  as  regards  making  this  journal 
a  medium  of  all  the  important  discoveries  in  medicine, 
surgery,  and  the  collateral  sciences,  have  been  satisfac- 
torily performed.  In  endeavoring  to  do  this,  we  have 
received  valuable  aid,  not  only  from  our  numerous  and 
talented  contributors,  but  from  the  following  members 
of  our  staff:  Drs.  Johw  Shkadt,  and  D.  B.  St.  John 
RoosA,  of  New  York ;  Dr.  J.  Sous  Cohen,  of  Philadelphia  ; 
and  Henry  M.  Lthah,  of  Chicago — whose  readiness  at 
all  times  and  under  all  circumstances  to  perform  onerous 
duties,  calls  from  us  our  most  heartfelt  thanks.  With 
the  same  staff,  and  vnth  an  extra  determination  to  in- 
crease the  usefulness  of  this  journal,  by  making  it  a 
faithful  and  trustworthy  chronicler  of  all  important 
medical  events,  we  enter  upon  the  third  volume. 

^  I  ^ 

The  meeting  of  the  State  Society  was  an  unusually 
large  one,  but  we  are  sorry  to  say  that  its  proceedings 
were  by  no  means  as  interesting  as  usual  Save  the 
addresses  of  the  retiring  President,  Db.  John  P.  Gray, 
and  the  presentation  of  a  very  few  rare  cases,  there 
was  nothing  to  redeem  the  duU  routine  of  society  busi- 
ness. One  or  two  of  the  papers  read  were  tedious  in 
the  extreme,  and  we  imagme  that  all  were  glad  when 
they  were  finished.    But  such  pertinacity  is  natural 


with  some,  and  their  enthusiasm  leads  them  so  far  be- 
yond the  pale  of  propriety,  that  they  are  rather  to  be 
pitied  than  blamed. 

Socially  considered,  the  meeting  was  an  immense 
success ;  and  as  the  result  of  the  kind  efforts  of  our 
brethren  in  Albany,  every  one  was  made  to  enjoy  him- 
self. The  entertainment  at  the  City  Hospital  by  Drs. 
March  and  Abmsby  was  an  elegant  affair,  and  reflected 
great  credit  upon  their  good  sense,  taste,  and  judgment. 

The  result  of  the  election  was  in  every  way  satisfac- 
tory to  all  the  members.  An  Association  with  such  an 
influence  and  with  such  a  standing  as  the  State  Society, 
should  always  exercise  the  greatest  care  in  the  choice 
of  its  chief  officers ;  and  it  is  pleasing  to  recollect  that 
for  year  after  year  only  representative  men  have  occu- 
pied the  posts  of  honor.  In  this  respect  the  coming 
year  will  be  as  those  that  have  passed.  Dr.  Quaoken- 
BUSH,  the  President  elect,  has  for  a  long  time  occupied 
not  only  a  prominent  position  in  the  profession  of  his 
city,  but  throughout  that  of  the  country;  and  now  re- 
ceives the  well-earned,  well-merited  honor  of  the  highest 
office  in  the  gift  of  his  brethren  of  the  State.  Dr. 
White,  of  Buffalo,  so  long  and  favorably  known  as  a 
gynaecologist,  has  received  the  office  of  Vice-President, 
which,  although  second  in  responsibility,  is  not  second 
in  honor  to  that  of  the  higher  office.  The  industrious 
and  efficient  Secretary,  Dr.  W.  H,  Bailey  of  Albany, 
has  been  wisely  retained  in  office.  The  position  is  the 
most  onerous  of  all  in  the  gift  of  the  Society,  and  requires 
its  holder  to  be  specially  qualified  for  it.  Dr.  Bailey 
has  given  ample  evidence  of  his  peculiar  fitness  for  the 
office,  and  his  re-election  affords  universal  satisfaction. 


Eeotetvs  antr  Uotxcts  jof  f^oohs. 


On  the  Pathology  and  Treatment  of  Albuminuria.  By 
Wiluam  H,  Dickinson,  M.D.,  eta  Longman,  Qreen  ft 
Ca    London,  1868.    8vo.,  pp.  265. 

There  is  no  branch  of  medicine  in  which  greater  pro- 
gress has  been  made  within  the  last  quarter  of  a  cen- 
tury than  that  of  renal  pathology ;  and  yet,  until  the 
time  of  Bright,  this  great  field  of  research  was  veiled  in 
primeval  obscurity.  Since  his  day,  Bostock,  Reese,  and 
Christison,  have  investigated,  with  marked  success,  the 
chemistn^  of  the  diseases  which  Bright  discovered; 
while  Wilks,  George  Johnson,  Roger,  Prout,  Bence 
Jones,  Harley^  Roberts,  and  others,  have  contributed 
greatly  by  their  patient  and  enlightened  labors  to  eluci- 
date the  pathology  and  indeed  the  entire  subject  of  renal 
affections. 

The  present  work  of  Dr.  Richardson  must  take  veiy 
high  rank  among  the  numeroiLs  treatises  devoted  to  this 
class  of  diseases;  for  it  in  an  appeal  to  observation 
rather  than  auUiority,  to  facts  rather  than  theory.  The 
different  chapters  are  devoted,  1st,  to  a  description  of 
the  healthy  kidney ;  2d,  to  albuminous  urine  and  fibrin- 
ous casts,  in  their  general  relation  to  the  pathology  of 
the  kidney ;  3d,  3ie  pathology  of  tubal  nephritis,  to- 
gether with  its  clinical  history,  causes,  and  treatment  • 
ttien  follow,  4th,  the  pathology,  causes,  symptoms,  ef- 
fects, and  treatment  of  granular  degeneration  j  5th,  the 
patholQgy  of  the  depurative  infiltration,  with  its  symp- 


THE  MEDICAL  RECORD. 


667 


toms,  clinical  history,  and  treatment;  6th,  comparison 
of  the  three  forms  of  renal  disease  which  are  produc- 
tive of  albuminuria ;  7th,  changes  of  the  blood  m  albu- 
minuria; 8th,  alcohol  as  a  cause  of  renal  disease;  9th, 
ohmate  in  relation  to  the  same.  All  these^  subjects  are 
graphically  and  beautifully  illustrated  by  colored  plates. 

The  description  of  the  healthy  structure  of  the  kid- 
ney requires  no  special  remark.  The  post-mortem  ap- 
pearances indicative  of  renal  disease  are  stated  to  be, 
Ist,  an  alteration  of  the  tubes  hj  the  accumulation  of 
their  contents.  They  may  be  widened,  perhi^M  irreg- 
ularly :  they  may  contain,  firsts  a  great  excess  of  epi- 
theUal  growth;  they  may  lose  their  epithelial  lining  and 
become  bare;  they  may  become  filled  with  fibrinous 
matter.  Secondly^  the  intertubular  fibrous  tissue  may 
be  increased,  particularly  near  the  sur&ce  of  the  organ ; 
which  may  be  detected  in  a  microscopic  section,  or  even 
by  the  naked  eye,  by  observing  whether  or  notthesur- 
£ice  of  the  organ  is  granular.  Thirdly ^  there  is  a  pecu- 
,liar  material,  which  is  recognized  by  the  "  amyloid " 
reaction  with  iodine,  which  starts  firom  the  blood-ves- 
sels and  infiltrates  ^e  whole  organ,  giving  it  the  ap- 
pearance described  as  waxy.  This  is  never  found 
except  as  the  result  of  a  peculiar  disease.  In  the  clas- 
sification of  renal  disease,  the  author  follows  an  anatom- 
ical division,  making  three  distinct  varieties,  viz. :  1st, 
disease  of  the  secreting  channels;  2d,  granular  degen- 
eration, or  the  contracted  granular  kidney  of  Bright ; 
3d,  the  waxy  or  amyloid  degeneration,  which  has  its 
origin  in  the  minute  blood-vessels,  resulting  in  an  infil- 
tration with  a  glassy  material,  poured  out  by  the  minute 
arteries,  in  consequence  of  which  the  organ  at  first 
assumes  a  whitish  or  anaomic  look,  increasing  in  hard- 
ness and  bulk,  till  at  length  it  presents  a  translucent 
or  "waxy"  aspect  The  grand  characteristic  of  the 
change  is  in  the  action  of  iodine,  which  imparts  to  the 
new  deposit  a  dark  brown  color,  unlike  the  yellow 
tint  which  the  healthy  parts  of  the  gland  receive  from 
the  same  reagent;  and  which  change  does  not  take 
place  in  any  other  form  of  renal  disease. 

The  presence  of  albumen  and  ca$t$  in  the  urine  is 
traced  to,  1st,  congestion ;  2d,  a  specific  change  in  the 
arteries,  which  renders  their  walls  unnaturally  pervious ; 
and  3d,  a  loss  by  the  secreting  tubes  of  their  epitheliid 
lining.  We  pass  over  the  "  pathology  "  and  "  chnical 
history  '*  of  "  tubal  nephritis,'*  to  speak  of  the  treat- 
ment. The  author  condemns  the  practice  of  general 
bleeding  in  this  disease,  as  recommended  by  Bri^t  and 
Christi<on,  though  he  thinks  moderate  cupping  fi-^m  the 
loins  may  sometimes  do  ^od,  but  especiidly  dry  cup- 
ping. He  condemns  purging  and  hot-vapor  baUis,  but 
speaks  favorably  of  the  very  free  use  of  pure  water  and 
the  infusion  or  digitalis,  for  the  purpose  of  increas- 
ing the  amount  of  urine.  After  the  acute  stage  is 
f)a88ed,  he  advises  the  use  of  perchloride  of  iron,  fol- 
owed  by  acetate  of  potash.  He  also  speaks  favorably 
of  combining  this  last-named  remedy  with  acetate  of 
iron,  or  bitartrate  of  potash  with  wine  of  iron ;  idso  the 
citrate  of  iron  and  qumine.  The  more  stimulating  diu- 
retics, as  nitre,  juniper,  and  squills,  are  to  be  resorted  to 
if  the  disease  assumes  a  chronic  form.  If  the  dropsy 
be  so  severe  as  to  call  for  mechanical  relief,  the  author 
advises  puncturing  with  needks  instead  of  the  lancet, 
as  less  Ukely  to  cause  erysipelatous  inflammation.  For 
the  treatment  of  head  symptoms,  he  recommends  smaU 
doses  of  opium,  chloroform,  active  aperients,  and  diu- 
retics, with  the  exception  of  cantbarides.  He  cautions 
against  the  use  of  mercurials,  even  in  small  doses.  In- 
^ammatory  complications  are  to  be  treated  in  such  a 
manner  as  not  to  interfere  with  the  management  of  the 
prinaary  disease. 

TlLxe  morbid  anatomy  of  grantdar  degeneration  of  the 


kidney  is  well  described  and  beautifully  illustrated  by 
the  colored  plates.  The  different  stages  of  the  disease 
are  accurately  traced  in  connection  with  the  causes  and 
symptoms;  and  especially  its  complications  with  heart- 
disease,  pregnancy,  blindness,  gout,  and  lead-poisoning, 
atheroma,  etc.  Among  the  accidents  of  the  disease, 
inflammatory  attacks,  hssmorrhagic  attacks,  urssmic 
poisoning,  etc.,  are  particularly  discussed.  The  chem- 
ical and  other  changes  in  the  urine  are  also  pointed  out. 
Every  form  of  the  disease  is  well  illustrated  by  cases. 
The  principal  points  of  treatment  in  this  disease  are 
attention  to  the  secretions  'of  the  skin,  which  must  be 
kept  active ;  the  patient  should  be  clothed  in  flannel, 
and  take  much  active  exercise ;  resort  at  regular  inter- 
vals, say  twice  a  week,  to  the  hot-air  or  Turkish  bath, 
or  the  vapor  bath,  which  are  most  useful  where  the 
urine  is  copious.  Besides  these  measures,  it  will  gen- 
erally be  necessary  to  give  iron :  the  citrate  or  acetate 
answers  the  purpose;^  with  which  the  acetate  of  ammo- 
nia or  acetate  of  potash  may  be  combined.  If  the 
urine  contain  blood,  the  sulphate  or  perchloride  of  iron 
may  be  used.  The  food  should  be  as  non-nitrogenous 
as  is  consistent  with  the  proper  nutrition  of  the  patient 
An  entire  abstinence  fi*om  animal  food  is  not  recom- 
mended. No  harm  has  been  observed  to  follow  the 
moderate  use  of  alcoholic  hquors,  as  gin  or  wine.  Beer 
is  to  be  forbidden  to  gouty  subjects.  The  dropsy  is  to 
be  treated  by  diuretics,  mixed  and  varied  until  a  suita- 
ble one  is  found,  Christison  recommends  a  combina- 
tion of  squills,  digitalis,  and  bitartrate  of  potassa.  The 
author  thinks  one  of  the  best  is  a  decoction  of  scopa- 
rium  taken  fireely.  If  oedema  resists  the  action  of 
such  remedies,  then  the  practitioner  must  resort  to  pur- 
gatives and  diaphoretics ;  as  the  compound  jalap  pow- 
der twice  a  week,  and  occasional  vapor  baths.  For  the 
treatment  of  stomach  symptoms,  nitric  and  hydrochloric 
acids  and  strychnia  are  recommended,  given  with  Col- 
ombo, or  some  other  mild  bitter.  Acids  are  oflen  useful 
For  vomiting  and  gastric  disturbances,  hydrocyanic 
acid,  creasote.  brandy,  and  soda-water,  ice,  etc.,  are  ad- 
vised as  wortny  of  trial 

There  are  some  important  statistical  statements  scat- 
tered throughout  the  work,  fit)m  which  we  gather  the 
following :  Of  thirty-nine  fatal  cases  of  tubal  nephritis, 
eighteen  had  hfematuria;  thirty-eight  oedema;  twenty 
ascites;  eleven hydrothorax ;  ten  ursemic  convulsions; 
ten  pneumonia;  nine  vomiting;  eight  bronchitis,  etc. 
As  to  duration  of  the  disease,  the  younger  the  patient, 
the  more  rapid  the  course  to  recovery  or  death.  Dur- 
ing childhood  the  majority  of  fatal  cases  terminate  dur- 
ing the  first  month,  many  within  the  first  week.  Few 
survive  the  third  month,  none  the  fifth.  After  the  age 
of  twenty,  no  deaths*  took  place  within  a  week,  few 
within  the  first  two  months.  The  greater  number  of 
cases  terminate  after  the  end  of  the  second  month,  be- 
fore that  of  the  sixth. 

In  forty  fatal  cases  under  sixteen,  pneumonia  was 
the  cause  of  death  in  fifteen ;  pleurisy  m  ten ;  ursemio 
convulsions  in  five ;  hydrothorax  in  three ;  peritonitis 
in  three;  and  vomiting  in  three.  Of  the  age  of  sixteen 
and  upward,  coma  or  convulsions  was  the  cause  of  death 
in  five;  inflammation  of  the  respiratory  organs  in  two; 
dropsy  in  four;  peritonitis  in  two.  The  urine  was 
greatly  diminished  in  quantity  iik  all  Granular  degen- 
eration is  almost  unknown  before  the  age  of  twenty. 
It  is  most  common  about  the  age  of  fifty.  Of  163  cases 
of  fatal  valvular  disease  of  the  heart,  twenty-nine  had 
the  kidneys  hard,  congested,  enlarged,  but  still  smooth. 
In  sixty-seven  the  kidneys  had  CTanukr  surfaces^  and 
more  or  less  contracted  cortices.  Vr.  Barclay  also  found 
twenty-eight  cases  of  granular  kidneys  in  seventy-nine 
cases  of  yalyular  disease  (Med.  Cbir.  Trans,  v.  31,  p.  196); 


568 


THE  MEDICAL    RECORD. 


no  other  form  of  renal  disease  has  any  dependence  upon 
changes  in  the  valyes.  The  disease  in  a  great  majority 
of  CHses  commences  in  the  heart  In  reference  to  preg- 
nancy as  a  cause  of  renal  disease,  in  consequence  of 
pressure  on  the  renal  veins  and  vena  cava,  to  which  at- 
tention was  first  called  by  Sir  J.  Simpson,  different 
writers  give  different  results  in  regard  to  the  presence 
of  albumen  in  the  urine.  Litzman  found  it  present  in 
thirty-seven  out  of  131  pregnant  or  lately  delivered  fe- 
males; of  which  twenty-six  were  primiparas.  Dr.  Blot 
detected  albumen  in  the  urine  of  forty-one  out  of  205 
pregnant  women;  most  of  them  cases  of  first  preg- 
nancy. It  is  well  known  that  pregnancy  often  occa- 
sions enough  renal  congestion  to  render  the  urine  albu- 
minous; causing  various  constitutional  symptoms,  as 
oedema,  disorders  of  vision,  convulsions,  headache,  etc. 
But  in  a  vast  majority  of  cases  after  delivery,  the  kid- 
neys return  to  their  normal  condition.  In  sixty-nine 
fatal  cases  of  granular  degeneration,  sixteen  were  de- 
pendent on  or  coincident  with  gout ;  thirty  per  cent,  of 
cases  are  dependent  on  lead-poisoning.  Oi  forty-two 
fatal  cases  in  men,  treated  by  the  author,  twenty-six 
had  distinct  granular  degeneration  of  the  kidneys ;  alco- 
hol affects  the  joints,  lead  the  kidne^a  In  250  cases  of 
the  disease,  the  liver  was  cirrhosed  m  thirty-seven.  In 
forty-eight  per  cent  there  is  cardiac  enlargement;  in 
fifty-two  per  cent  there  is  atheroma.  Hsemorrhagic 
attacks  are  oflen  consequent  on  this  disease.  Of  seventy- 
five  victims  of  apoplexy  examined  at  St  George's  Hos- 
pital, thirty-one  were  found  to  have  had  granular  de- 
generation of  the  kidneys.  In  another  series  of  cases. 
Dr.  Jones  (British  Med,  Jour.  1862)  found  in  thirty-six 
fatal  cases  of  apoplexy,  twenty-nine  in  which  the  kid- 
neys were  extensively  diseased.  In  twenty-four  the 
organs  were  small,  murd,  granular,  with  thin  cortical 
substances  diminished ;  so  Uiat  of  fatal  attacks  of  apo- 
plexy, one-half  at  least  are  preceded  by  granular  de- 
generation of  the  kidney.  The  renal  disease  induces 
the  cerebral  mischief.  But  we  are  to  consider  also  that 
the  coats  of  the  vessels  themselves  are  weakened  by 
atheroma;  while  the  force  of  the  left  ventricle  is  in- 
creased by  hypertrophy.  The  dimness  of  vision  in  this 
disease  is  owing  to  an  infiltration  of  the  retina  and 
optic  nerve  with  serum.  Usually  this  disease  destroys 
life  by  apoplexy,  or  some  inflammatory  affection ;  if  not, 
it  ends  in  ursemic  poisoning,  when  heietd  symptoms  are 
prominent,  as  coma  or  convulsions,  often  resembling 
narcotic  poisoning.  The  brain,  after  death,  is  found 
completely  anasmic.  Of  sixty-eight  fatal  cases  of  this 
granular  disease,  under  the  writer's  observation,  forty- 
nine  had  oedema;  twenty-four  bronchitis;  twenty- 
three  hydrothorax;  eighteen  ascites;  eleven  urtemic 
convulsions ;  fourteen  simple  coma ;  thirteen  other  head 
symptoms;  sixteen  pericarditis;  seven  pneumonia; 
seventeen  vomiting;  thirty-one  hypertrophy  of  the 
heart ;  fourteen  atheroma,  and  five  amaurosis. 

Our  space  will,  however,  not  allow  a  fiiUer  analysis 
of  the  contents  of  this  highly  valuable  work ;  we  think 
it  will  not  suffer  by  comparison  with  any  previous 
works  on  this  class  of  affections. 

A  Trbatiss  oir  Thbbapbotics  ahd  Pharmacology  or 
Materia  Mkdica.  By  Geo.  B.  Wood,  M  D.,  President  of 
the  American  Philofopbical  Society;  President  of  the 
College  of  Physicians,  of  Philadelphia ;  Emeritus  Profes 
Bor  of  the  Theory  and  Practice  of  Medicine  in  the  Uni- 
versity of  Pennsylvania,  etc.,  etc.  Third  Edition,  in  two 
volumea  Philadelphia:  J.  B.  Lippincott  &  Ca  1868. 
8vo.,  pp.  1800. 

It  seems  hardly  necessary  to  offer  a  favorable  opinion 
concerning  a  work  like  the  one  before  us,  in  its  third 
edition,  but  to  those  of  our  readers  who  may  have 


entered  the  profession  within  the  last  seven  years,  since 
which  time  the  second  edition  made  its  appearance,  a 
brief  notice  may  be  necessary. 

At  the  present  time,  when  fashions  in  medicine  lean 
towards  the  employment  of  a  very  few  and  pet 
remedies,  and  the  estimate  of  general  therapeutics  is  at 
such  a  low  ebb,  it  requires  no  small  amount  of  courage 
on  the  part  of  an  author  to  offer  to  the  profession  sudi 
a  treatise  as  Dr.  Wood's.  But  the  determination  to 
work  faithfully  in  this  much-neglected  branch,  and  the 
desire  to  do  his  part  in  presenting  his  subject  in  a  properly 
scientific  and  sound  philosophical  light,  has  surmounted 
all  other  obstacles.  If  the  difficulties  usually  in  the 
way  of  the  physician  acquiring  a  thorough  practical 
knowledge  of  the  action  of  medicines  and  of  their 
special  utses,  has  been  the  cause  of  ignorance  in  this  de- 
partment, they  are  now  virtually  removed  in  this 
masterly  treatise.  A  pecuhar  value  which  the  work 
has  consists  in  the  embodiment  of  the  author's  extensive 
and  valuable  experience  with  almost  every  article  al- 
luded to  in  the  volumes.  The  manner  of  treating  the 
various  subjects  leaves  nothing  to  be  desired.  Thoee 
which  are  of  most  importance  have  a  full  space  allotted 
them,  and  the  properties  of  the  articles,  physical  and 
chemical,  adulteratiot;s,  and  therapeutical  effects,  are 
admirably  and  truthfully  described.  The  action  of  the 
medicines  receives,  as  it  rightly  should,  especial  men- 
tion, and  the  reader  is  made  conscious  in  his  perusal 
that  he  is  the  recipient  of  views  which  are  marked 
with  the  conservatism  of  a  candid  teacher.  At  the  risk 
of  being  old-fashioned,  and  even  behind  the  age,  he  ujp- 
holds  the  virtues  of  those  remedies  which  years  ago  be 
proved  to  himself  possessed  a  practical  value;  at  the 
same  time,  with  all  the  ardor  of  a  youthful  mind,  be 
studies  the  effects  of  the  numerous  new  medicines  which 
have  lately  been  brought  to  notice.  We  would  gladly 
take  an  opportunity  to  remark  upon  the  merits  of  the 
work  in  extenso,  but  space  not  permitting,  we  have  to 
bring  our  rfiort  notice  to  a  close,  by  merely  enumeratiDg 
some  of  the  many  new  substances  which  are  added  to 
and  fully  discussed  in  the  present  edition: — Coca, 
nitrous  oxide,  antimoniated  nydrogen,  gelseminum, 
calabar  bean,  bromine  and  its  preparations,  lithia  and 
it*  compounds,  ozone,  peroxide  of  hydrogen,  perman- 
ganate of  potash,  and  sulphurous  acid,  and  the  sulphites 
with  carbolic  acid  in  their  antizymotic  relations. 

We  have  looked  over  the  book  carefully,  and  are  not 
aware  that  any  new  article  of  the  slightest  possible 
practical  utility  has  been  overlooked,  and  take  this  oc- 
casion to  congratulate  our  talented  and  scholarly  author 
for  such  a  faithful  performance  of  a  most  onerous  jet 
dutiful  task. 

The  author  of  the  volumes  before  us  has  well  re- 
deemed the  reputation  of  a  faithful  worker  which  lie 
has  enjoyed  for  so  many  years.  The  work  itself  is 
everything  that  can  be  asked  for  as  an  exponent  ot 
sound  views  and  calm  philosophioal  reasoning. 

Ueadaohes,  theib  Causbs  and  thbib  Cubs.  By  Hairy 
G.  Wright,  M.D.,  M.ILC.S.L..  L.S.A,  etc.  From  fourtli 
London  Edition.  Philadelphia;  Lindsay  &  Blakistoo, 
1867.     12mo,  pp.  154. 

This  work  gives  us,  in  a  clear  manner^  a  brief  descrij^ 
tion  of  all  the  different  marked  varieties  of  headaches, 
their  symptoms  and  treatment  The  varieties  are 
divided  into  those  of  childhood  and  youth,  of  a  lulttiie. 
depending  respectively  on  the  circulating,  digestive  ana 
nervous  systems,  gout  and  organic  disease ;  and  lastly 
of  old  age.  The  distinctions  between  the  different  kiocb 
of  pains  in  the  head  are  as  well  drawn  as  the  drciBii- 
stances  will  permit,  it  being  very  unfortunate  for  the 
purpose  of  a  positive  diagnosis  in  each  case  that  the 


THE  MEDICAL  RECORD. 


569 


^mptoms  of  one  variety  are  apt  to  run  into  the  other. 
Our  author  has,  however,  by  a  good  arrangement  of  his 
subject,  reduced  this  difficulty  to  a  minimum.  There  is 
an  appendix  of  formula,  fifty  in  number,  which  will  be 
found  very  useful  to  the  general  practitioner. 

The  Physicians*  Daily  Pocket  Record,  comprising  a 
YisitiDg  List,  Diary,  Daj-book  of  AocouDts.  etc.,  etc.,  etc. 
By  a  W.  Butler,  M.D.  Philadelphia:  Office  Medical 
and  Surgical  Reporter,  115  South  Seventh  street     1868. 

OuB  readers  are  already  so  wel  acquainted  with  the 
intrinsic  merits  of  this  Record,  that  it  is  unnecessary 
for  us  to  reiterate  the  opinion  which  we  took  occasion 
to  express  a  few  months  since. 

Chronic  Diseases  of  the  Larynx,  with  special  reference 
to  Laryngosoopic  Diagnosis  and  Local  Therapeutics.  By 
Dr.  Adblbbrt  Tobold,  Lecturer  in  the  University  of 
Berlin.  Translated  from  the  German,  and  Edited  by 
Georqb  M.  Beard,  A.M.,  M.D.,  Lecturer  in  the  University 
of  New  York.  "With  an  Introduction  on  the  History  and 
Art  of  T^aryngoecopy  and  Rhinoscopy,  Rhinitis,  Inhalations 
and  Electrization  applied  to  Diseases  of  the  Air  Passages, 
and  an  Appendix.  By  the  Editor.  Illustrated  with 
forty-four  wood  cuts.     8vo. 

Early  last  year,  soon  ader  its  publication  in  Berlin,  we 
received  a  copy  of  this  work  in  the  original,  and  have 
had  sufficient  time  to  iudge  of  its  merits.  Wo  were 
familiar  with  the  authors  Manual  of  Laryngoscopy 
published  in  Berlin  in  1863,  fi-om  which  the  Am- 
erican editor  of  the  present  work  has  largely  drawn 
in  the  prep  iration  of  the  volume  before  us,  so  as  to 
adapt  it  as  a  guide  to  the  use  of  the  laryngoscope,  and 
operative  procedure  under  its  reflecting  aid,  as  well 
as  an  exposition  of  the  diagnosis  and  treatment  of 
chronic  diseases  of  the  larynx,  as  modified  since  the 
use  of  the  laryngoscope. 

The  editor  begins  his  introduction  with  a  succinct 
and  correct  history  of  the  invention  and  early  applica- 
tions of  the  laryngoscope ;  follows  this  by  a  desciiption 
of  Tobold's  illuminating  apparatus,  which  we  know  from 
ample  experience  to  be  the  very  best  and  most  con- 
venient yet  devised ;  then  follows  with  brief  detailed 
rules  of  manipulation  for  purposes  of  diagnosis  and  the 
method  of  making  local  apphcations ;  proceeds  with  a 
description  of  the  art  of  rhinoscopy,  or  examination  of 
the  nasal  passages;  follows  this  with  an  entirely 
original  chapter  on  rhinitis :  a  chapter  on  inhalation ;  and 
concludes  with  an  original  chapter  on  electrization  in 
diseases  of  the  air  passages.  Then  follows  the  translar 
tion ;  after  which  appears  an  appendix  by  the  editor, 
describing  several  instrumental  appliances  not  treated 
of  by  Tobold,  and  concluding  with  a  description  of  the 
anatomy  of  the  pharynx,  uvula,  and  soft  palate.  Jt  will 
thus  be  seen  that  the  scope  of  the  entire  work  is  very 
comprehensive,  it  being  evidently  the  design  of  the 
editor  to  make  it  complete  as  a  single  treatise  on  laryn- 
goscopy and  laryngoscopal  medication  and  surgery. 

The  editor's  originalities  consist  in  the  chapters  on 
rhinitis  and  electricity.  With  electricity  we  have  not  had 
any  experience  to  justify  us  in  confirming  his  observa- 
tions or  in  dissenting  from  them ;  but  as  his  recent  efforts 
in  this  department  of  therapeutics  are  attracting  some 
attention,  we  are  willing  to  receive  his  observations 
with  regard  to  the  electrical  treatment  of  laryngeal 
affections  with  a  certain  degree  of  authority.  Rhinitis, 
or  naso-pharyngeal  catarrh,  or  rhinorrhoea,  as  it  has 
been  variously  termed,  he  attributes  in  the  main  to  con- 
finement in  over-heated  rooms,  and  to  smoking.  We 
hardly  think  smoking  a  prominent  predisposing  cause, 
as  it  is  not  usually  operative  in  the  female,  who  is  the 
subject  of  this  disease  nearly  as  frequently  as  the  male  ; 
nor  can  we  believe  that  smoking  is  as  often  the  cause 


of  laryngeal  complaints  as  is  the  opinion  of  many,  f«  r  in 
ordinary  smoking  the  smoke  is  not  received  into  the 
larynx,  and  when  such  an  inhalation  occurs  as  the  re- 
sult of  voluntary  effort,  the  experimenter  will  find  the 
immediate  effect  far  different  from  that  experienced  in 
the  ordinary  enjoyment  of  the  weed.  W%  agree  with 
Tobold  that  exposure  to  an  atmosphere  in  which  many 
are  smoking  is  directly  deleterious,  inasmuch  as  the 
smoke  being  diffused  in  the  atmosphere  gains  ready  in- 
gress to  the  air  i>assages.  Dr.  Beard  recommends  the 
employment  of  the  posterior  nasal  syringe  in  preference 
to  Thudicum*s  apparatus,  which  is  also  described,  a  point 
upon  which  our  own  experience  has  led  to  an  opposite 
conclusion.  The  best  remedy  for  cleansing  purposes, 
he  has  found  to  be  a  saturated  solution  of  chlorate  of 
potar^h  in  tepid  water,  failing  with  which  to  effect  a 
curative  process,  he  employs  mild  astringent  and  veiy 
weak  caustic  solutions.  The  article  on  inhalations  is 
merely  a  sketch  of  the  subject,  and  is  evidently  not  in- 
tended to  be  anything  more.  The  editor  speaics  in  the 
highest  terms  of  electrization  as  a  method  of  overcoming 
the  irritation  produced  by  caustic  applications  to  the 
larynx,  a  method  with  which  we  have  no  experience, 
and  for  which  we  have  not  as  yet  found  any  necessity. 
We  commend  this  portion  of  the  introduction  to  the 
notice  of  laryngoscopists,  for  it  presents  a  subject  which 
is  of  interest,  as  being  new,  and  doubtless  of  considerable 
value. 

Being  anxious  as  early  as  possible  to  bring  to  the 
notice  of  the  profession  an  English  version  of  this  ex- 
ceedingly valuable  treatise  on  chronic  diseases  of  the 
larynx,  and  familiarity  with  the  original  work  rendering 
its  repeiiisal  unnecessary,  we  have  not  critically  ex- 
amined the  translation,  which,  we  presume,  has  been 
rendered  with  fidelity  and  accuracy. 

Tobold  presents  the  subject  of  chronic  laryngitis  under 
the  division  of  simple,  ulcerative,  and  tuberculous ;  each 
of  which  subjects,  as  also  the  other  chronic  affections, 
he  treats  of  systematically  under  separate  headings  of 
anatomico-patliological  appearances,  symptoms  and 
causes,  fetiology,  lai  yngoscopic  dia^osis,  prognosis,  and 
treatment.  We  would  call  attention  to  his  insistanca 
upon  a  distinction  between  chronic  laryngitis  and  laryn- 
geal phthisis,  a  view  in  which  with  others  we  accord.  In 
making  local  applications,  Tobold  prefers  the  sponge  to 
the  hair  pencil  in  all  but  exceptional  cases  of  extremely 
limited  ulceration,  an  experience  with  which  we  coin- 
cide ;  and  he  attribotes,  in  many  instances,  beneficial 
results  from  the  mechanical  contact  of  the  sponge.  He 
gives  the  preference  as  a  local  remedy  in  general  to  ni- 
trate of  silver,  and  next  to  that,  to  tannin ;  and  is  by 
no  means  an  advocate  for  the  use  of  atomized  or  nebu- 
lized fluids.  In  the  local  treatment  of  laryngeal  phthisis, 
however,  he  gives  tannin  the  preference  over  nitrate  of 
silver. 

The  chapters  on  paralysis  of  the  muscles  of  the  larynx 
are  very  interesting.  He  describes,  and  depicts  diagram- 
matically,  five  different  forms  of  paralysis  productive  of 
whonia,  in  the  treatment  of  which  he  employs  local 
electrization,  not  only  after  the  admirable  nitro* laryngeal 
method  of  Mackenzie,  but  also  by  applymg  one  pole 
over  the  cervical  vertebra  and  the  other  over  the  course 
of  the  inferior  larvngeal  nerve  in  the  groove  between 
the  oesophagus  and  trachea.  In  hysterical  aphonia  he 
employs  the  electric  moxa  on  the  ^n  in  the  neighbor- 
hood of  the  larynx.  The  chapters  on  foreign  bodies  in 
the  larynx,  and  on  the  detection  and  removal  of 
neoplasms,  are  very  complete  and  explicit;  and  a  number 
of  instruments  devised  by  the  author  for  the  purpose  of 
surgical  interference  are  described  and  depicted,  the 
value  of  most  of  which  we  can  attest  fiom  personal  ex- 


penence. 


Digitized  by 


Gc 


570 


THE  MEDICAL  RECORD. 


There  are  chapters  in  the  work  on  the  histology  and 
physiology  of  the  larynx,  and  on  the  physiology  of 
voice.  In  treating  of  the  latter  subject,  but  two  regis- 
ters are  recognized,'  the  chest  and  falsetto,  the  head- 
register  being  designated  as  a  modification  of  the  falsetto. 
We  are  glad  of  the  opportunity  this  connection  gives  us 
to  call  the  attention  of  the  profession  to  the  researches  of 
a  lady  of  Philadelphia,  recently  of  Beriin,  who  has  lately 
made  teveral  discoveries  with  regard  to  the  physiology  of 
voice,  which  appear  to  show  conclusively  that  there  are 
five  separate  registers  of  the  voice ;  namely,  two  of  the 
chest,  two  of  the  falsetto,  and  one  of  the  head,  as  de- 
monstrable by  changes  in  the  form  of  the  glottis  recogni- 
zable in  the  transition,  by  reflection  in  the  laryngoscope. 
This  lady  has  also  demonstrated  as  the  result  of  numerous 
dissections,  that  the  cuneiform  cartilages  mentioned  in 
Wilson's  Anatomy,  are  the  chief  agents  m  the  production 
of  the  head  notes,  and  that  they  exist  much  more  fi*e- 
quently  in  the  female  larynx  than  in  the  male  larynx, 
and  that  this  accounts  for  the  inability  in  the  male  voice 
to  produce  th^  head  notes,  except  in  rare  instances.  The 
views  of  this  lady.  Madam  Seiler,  have  been  received 
and  endorsed  by  Helmholtz,  Du  Bois  Raymond.  Frerichs, 
and  others  of  high  European  authority ;  and  sne  was  an 
assistant  of  Helmholtz  in  many  of  his  recent  investiga- 
tions in  the  production  of  sound.  Mrs.  Seiler  has  now 
?a8sing  through  the  press  of  Messrs.  Lippincott  &  Co.,  of 
Philadelphia,  a  work  on  the  culture  of  the  human  voice, 
based  upon  ner  own  anatomical  investigations  and  ex- 
periments with  the  laryngoscope,  which  contains  chap- 
ters on 'the  physiological  and  physical  production  of 
vocal  sound,  of  exceeding  interest  to  physiologists  and 
laryngoscopists,  although  the  book  is  prepared  chiefly 
with  reference  to  the  art  of  cultivating  the  voice,  and 
is  therefore  not  intended  at  all  as  a  medical  work;  but 
to  the  physician  interested  in  the  subject  of  laryngo- 
scopy, and  the  physiology  of  the  voice,  we  recommend 
in  advance  of  its  publication  a  perusal  of  Mrs.  Seiler's 
forthcoming  volume. 

The  work  before  us  is  amplv  illustrated  by  wood-cuts, 
both  in  the  translation  and  in  the  additions  of  the 
editor ;  and  it  will  be  seen  from  our  remarks  that  we 
feel  indebted  to  Dr.  Beard  for  producing  this  monograph 
of  Tobold  in  the  vernacular,  as  well  as  for  enhancing  its 
value  to  the  general  practitioner  by  the  addition  of  mat- 
ter, original  and  selected,  which  should  render  it,  in  its 
present  form,  an  excellent  guide  for  the  study  and 
practice  of  laryngoscopy. 


^tports  of  gp0ctetie«» 


NEW  YORK    PATHOLOGICAL    SOCIETY. 

Stated  MMTma,  Nov.  27,  1867. 

Da  H.  B.  Sands,  President^  in  the  Chair. 

LITHOTOHT. 

Dr.  Krackowizeb  presented  a  stone  which  he  had 
removed  about  a  fortnight  ago  from  a  man,  sixty- 
two  years  of  age.  The  patient  came  to  this  country 
thirty  years  ago.  While  in  Q-ermanv  he  was  a  wine 
merchant,  and,  although  a  man  of  temperate  hab- 
its, he  was  obliged  to  take  considerable  quantities  of 
wine.  He  was^  however,  none  the  worse  for  it.  When 
he  came  to  this  country  he  engaged  in  the  clothing 
business,  and  became  a  man  of  excellent  habits.  The 
original  symptoms  of  stone  dated  back  nine  years.  He 
sometimes  was  free  from  them  for  half  a  year,  and  some- 
times longer  until  the  last  six  weeks,  when  he  was 
troubled  with  them  oftener,  the  urine  being  turbid,  and 
Bomelimes  bloody. 


On  introducing  the  sound,  the  stone  was  struck  im- 
mediately. After  having  satisfied  himself  as  to  its  pres- 
ence, the  doctor  tried  to  measure  its  size  by  drawing 
the  instrument  across  its  surface.  It  was  by  this  means 
made  out  to  be  an  inch  in  length. 

The  patient  being  very  fut,  the  finger  could  not  reach 
above  the  upper  border  of  the  prostate  gland.  Dr.  K. 
determined  to  perform  median  lithotomj',  the  opera- 
tion practised  many  times  by  Dr.  Markoe.  The  operar- 
tion  was  very  easy.  He  found  no  difficulty  at  all  in 
getting  into  the  bladder.  The  stone,  however,  could 
not  be  grasped  to  advantage  at  first,  and  after  repeated 
attempts  it  was  broken  and  removed  piecemeal.  The 
patient  was  treated  in  the  same  manner  as  laid  down 
by  Dr.  Markoe  in  his  paper  on  this  subject  in  the  N,  T, 
Medical  Journal.  Thirty-six  hours  after  the  operation 
the  patient  was  able  to  pass  a  good  deal  of  water 
through  the  natural  passage ;  after  four  or  five  days  it 
came  through  only  by  drops,  and  on  the  ninth  day, 
during  the  passage  of  two  ounces  of  urine,  only  eleven 
drops  escaped  through  the  wound.  On  the  eleventh 
day  all  the  water  was  passed  per  urethram. 

In  conclusion,  he  would  raerelv  state,  as  had  the 
originator  of  the  operation,  that  if  the  stone  be  too 
large  to  be  easily  extracted,  it  ought  to  be  broken 
and  taken  away  in  pieces.  In  this  instance  he  should 
have  followed  this  advice  if  it  had  not  been  broken  by 
the  instruments  in  the  first  efforts. 

The  stone  was  more  or  less  rounded,  was  covered 
with  warty  excrescences,  and  was  about  an  inch  and  a 
quarter  in  circumference.  It  was  probably  formed  of 
oxalate  of  Hme. 

EXTIRPATION  OF  UTERINE  TUMOR. 

Dr.  E.  Delafteld  presented  an  abdominal  tumor 
on  behalf  of  Dr.  Fetter. 

"  The  tumor  which  I  have  the  pleasure  of  presenting 
to  the  New  York  Pathological  Society,  was  removed 
from  the  person  of  Mrs.  T.,  of  this  city,  aged  fifty-nino 
years. 

"  It  was  removed  on  the  20th  of  this  month  by  Dr. 
Atlee,  of  Philadelphia. 

*'  The  exact  particulars  of  the  case  at  its  commence- 
ment I  am  not  able  to  give,  but  have  been  informed 
that  the  first  appearance  of  the  tumor  was  about  ten 
years  since. 

"  During  the  last  five  years  it  increased  very  rapidly 
in  size,  the  great  pressure  of  the  same  interfering  very 
much  with  the  respiratory  and  digestive  organa 

"  The  measurement  of  the  abdomen  at  its  largest  cir- 
cumference, previous  to  the  operation,  was  five  feet, 
and  from  the  sternum  to  the  umbilicus  twenty-one 
inches ;  from  thence  to  the  pubes,  fourteen  inches. 

**  Two  weeks  previous  to  the  operation  for  removal 
she  was  tapped,  and  sixty  pounds  of  fluid,  very  thick 
and  purulent,  were  drawn  ofl^  after  which  she  again 
filled  up  very  rapidly,  and  on  the  20th  of  the  monl^ 
fifty-two  pounds  more.  The  tumor  weighed  forty- 
eight  pounds,  making  the  weight  of  the  mass,  at  the 
time  of  removal,  one  hundred  pounds,  and,  with  the 
fluid  removed  two  weeks  previous,  one  hundred  and 
sixty  pounds.  The  fluid  drawn  off"  at  the  time  of  the 
operation  was  highly  offensive,  and  small  particles  of 
disorganized  matter  passed  through  the  opening. 

**  The  walls  of  the  uterus  were  adhering  at  every 
part  of  the  tumor,  and  it  seemed  as  if  it  would  be  im- 
possible to  separate  them. 

"  The  tumor  will  be  found  to  be  ovarian  arid  also 
fibrous  in  its  character,  and  the  uterus  and  both  ovaries 
were  involved  and  removed. 

"  For  twenty-four  hours  after  the  operation  the  pa- 
tient seemed  to  bo  very  comfortable;  there  was  no 


THE  MEDICAL  RECORD. 


671 


pain;  pulse  one  hundred  and  twenty;  after  which 
time  she  commenced  to  sink  very  rapidly  from  exhaus- 
tion, and  died  thirty-six  hours  after. 

"  Had  the  operation  been  performed  before  the  pa- 
tient lost  her  stamina,  I  think  she  would  in  all  proba- 
bility have  recovered." 

Dr.  Krackowizer  believed  that  the  tumor  was  purely 
a  uterine  one. 

Dr.  Bacc  thought  that  inasmuch  as  the  discharge  at 
the  second  tapping  was  purulent  and  oflfensive,  it 
should  have  been  an  argument  against  the  operation  ; 
and  the  foetid  discharge  at  the  earlier  part  of  the  oper- 
ation should  have  put  a  stop  to  the  proceeding. 

Dr.  Van  Borbm  cited  a  case  which  he  saw  with  Dr. 
James  Anderson  some  months  ago.  The  patient  was 
a  young  lady  who  had  an  enormous  collection  of  puru- 
lent fluid  in  the  cavity  of  the  abdomen.  This  was 
drawn  off  by  tapping  the  cyst.  The  tumor  was  after- 
ward removed  by  Dr.  Atlee,  and  he  believed  that  the 
result  was  fatal. 

Dr.  Cutter  remarked  that  the  patient  recovered. 

Dr.  Sayrk  stated  that  five  or  six  days  after  the  oper- 
ation the  patient  was  for  some  days  almost  in  articulo 
mortis,  but  eventually  she  entirely  recovered.  In  that 
case  there  was  a  discharge  of  pus  at  the  first  tapping. 

Dr.  Van  Bui^en  remanced  that  he  had  supposed  that 
the  case  had  proved  fatal,  as  at  the  last  account  which 
ho  had  of  it  the  patient  was  reported  as  rapidly 
sinking. 

Dr.  M^rkoe  stated  that  a  very  important  question 
came  up  in  this  connection,  viz.,  what  was  the  effect 
when  the  uterus  and  one  or  both  ovaries  were  removed  ? 

Dr.  Sands  remarked  that  the  only  experience  which 
he  had  had  was  centred  in  one  case  operated  upon  at 
the  New  York  Hospital  His  diagnosis  was  uterine  tu- 
mor, and  the  operation  was  undertaken  with  the  view 
of  removing  the  mass.  He  completed  the  operation 
with  great  difficulty,  owing  to  the  attachment  of  the 
tumor  in  the  cavity  of  the  pelvis.  The  case  proved 
fatal  a  few  minutes  after  the  operation.  In  that  in- 
stance the  uterus  and  one  ovary  was  removed.  The 
section  was  made  through  the  cervix  uteri,  and  not 
through  the  walls  of  the  vagina. 

Dr.  Bibbins  ref^srred  to  a  case  of  extirpation  of  the 
uterus  which  had  been  performed  in  1849  in  this  city. 
The  patient  in  that  instance  died  upon  the  table. 

SinOIDB  WITH  IIATOHSS. 

Dr.  Finnell  exhibited  a  stomach  removed  from  a 
young  female  who  destroyed  herself  by  a  unique  pro- 
cess. Being  crossed  in  some  love  matters,  she  made  a 
decoction  of  half  a  box  of  lucifer  matches  and  drank  it. 
She  died  at  the  end  of  six  hours. 

The  specimen,  for  which  he  was  indebted  to  Dr. 
Wooster  Bf  ach,  Jr.,  showed  a  mucous  membrane  cov- 
ered with  patches  of  intense  congestion  and  redness. 

OANOiB  or  oalvarium. 

Dr.  Loomis  presented  the  calvariura  of  a  German 
woman,  forty-eight  years  of  age,  who  died  in  Charity 
Hospital  on  the  4th  of  November.  She  had  been  an  in- 
mate of  the  institution  for  about  two  months  previous 
to  h^^r  decease.  Her  history  was  a  very  meagre  one, 
for  the  reason  that  she  was  not  considered  dangerously 
sick  until  two  days  before  her  death.  This,  in  fact,  was 
the  first  time  that  Dr.  Loomis  saw  her.  Previous  to 
this  she  was  supposed  to  be  suffering  from  chronic 
rheumatism.  She  was  complaining  of  pain  along  the 
right  arm  and  in  the  shoulder  and  saia  that  she  had 
suffered  from  it  for  the  last  foq^  or  B^^  years.  She  had 
been  in  Bellevue  twice  for  Ire^fcme^^y  *°^  ^^  ^^  ^* 
been  sent  fi-om  that  institution  */j  tho  Island.    The  pain 


was  more  particularly  located  by  her  in  the  muscles  of 
the  back  and  shoulder.  There  was  a  puffiness  about 
the  face  noticeable,  which  led  to  the  conjecture  that 
Bright's  kidney  was  present. 

On  questioning  her  more  closely,  she  remarked  that 
she  had  a  partial  loss  of  power  in  her  left  hand.  She 
had  only  noticed  it  the  day  before,  but  it  had  become 
so  rapidly  marked  that  at  the  examination  she  was 
hardly  able  to  raise  her  hand  to  her  head.  The  left  leg 
was  also  found  to  have  lost  sensation,  and  there  was 
also  a  decrease  in  temperature.  No  diagnosis  of  the 
case  was  then  made,  the  doctor  supposing  that  he  would 
have  an  opportunity  to  do  so  after  further  observation. 
In  the  mean  time  the  urine  was  directed  to  be  exam- 
ined. At  the  next  visit,  three  days  after,  he  found  that 
she  had  died  forty-eight  hours  fi*om  the  time  he  saw 
her ;  that  she  grew  rapidly  worse ;  that  the  paralysis 
increased,  commencing  in  the  right  arm  and  extending 
to  the  right  leg  and  other  parts  of  her  body  within  the 
next  twenty-four  hours.  She  died  quietly.  She  asked 
for  a  drink,  spoke  intelligently,  and  when  the  nurse  re- 
turned the  patient  was  dead. 

The  autopsy  was  made  in  the  absence  of  Dr.  Loomis. 
All  the  abdominal  and  all  the  thoracic  organs  were 
healthy  except  the  heart.  This  organ  was  the  seat  of 
ossification  of  the  coronary  artery.  There  were  also 
atheromatous  deposits  in  the  aorta  and  on  the  surface 
of  the  aortic  valves.  These,  however,  were  not  insuffi- 
cient. Some  hypertrophy  of  the  left  ventricle  was  also 
present,  which  together  with  the  aortic  lesion  was  ac- 
counted for  during  life  by  the  existence  of  the  usual 
physical  signs. 

On  removing  the  skull-cap  to  examine  the  brain,  the 
gentleman  engaged  with  the  saw  found  that  it  pene- 
trated different  portions  of  the  bone  with  a  great  deal 
of  ease ;  more  particularly  was  this  the  case  with  the 
occipital  This  softened  conditipn  was  explained  by  a 
mottled  deposit  of  a  new  material  in  different  parts  of 
the  bone ;  some  of  these  were  of  cartilaginous  hardness, 
others  of  muscular  consistency,  and  others  as  soft  as  jelly. 
This  change  was  confined  principally  to  the  occipital 
bone,  parietal  bones,  and  right  side  of  the  skull.  All  the 
other  bones  in  the  body  were  found  in  a  healthy  state ; 
neither  were  any  similar  deposits  found  in  any  of  the 
soft  parts ;  the  muscles,  however,  had  undergone  a  fatty 
degeneration. 

The  microscopical  characters  of  the  growths  were  sum- 
med up  as. follows:  fibrous  bands  crossing  polygonal- 
shaped  cells  from  the  ,-Vin>  to  f^,  of  an  inch  in  diame- 
ter, with  nuclei  and  nucleoli  These  cells  were  granu- 
lar, and  there  were  fi-ee  nuclei  everywhere  present. 
In  conclusion,  he  exhibited  a  drawing  of  the  micro- 
scopical appearances,  by  the  gentleman  who  had  made 
the  microscopical  examination  for  him. 

Dr.  Krackowizer  did  not  think  that  the  drawing 
was  a  fair  representation  of  bony  cancer,  but  it  seemed 
to  him  to  be  more  like  osteo-malacia. 

Dr.  Van  Bctrem,  in  this  connection,  referred  to  the 
case  of  a  man  who  had  come  under  his  observation,  and 
who  on  post-mortem  examination,  presented  a  skull  in 
a  similar  condition  to  Dr.  Loomis's  patient.  The  patient 
died  with  some  vague  cerebral  symptoms,  and  the 
bones  of  his  skull  were  found  inSltrated  in  places  to  the 
thickness  of  an  inch  or  more,  with  cheesy  cancerous 
material. 

Dr.  Terrt  exhibited  a  portion  of  epithelial  cancer, 
which  had  formed  in  the  cicatrix  of  a  tumor  of  similar 
character,  removed  two  and  a  half  months  before. 

THE  BrFBCTS  OF  STRICTURE. 

He  lastly  exhibited  the  bladder,  prostate,  and  portion 
of  the  ureuira  of  a  man  fifty-nine  years  of  age,  who  had  • 


612 


THE  MEDICAL  RECORD. 


gonorrhoea  twenty-five  years  ago,  followed  almost  im- 
mediately by  symptoms  of  stricture,  and  very  soon 
after  by  complete  retention  of  urine.  During  the 
greater  part  of  twenty-three  years  he  was  obliged  to 
have  the  catheter  passed.  In  October,  18G5,  when  Dr. 
Terry  first  saw  the  case,  he  commenced  with  a  number 
three  bougie,  and  gradually  increased  the  size  of  the 
stricture,  until  a  number  eight  could  be  admitted.  The 
patient  then  absented  himself  until  the  stricture  closed 
a^in,  when  he  returned.  This  he  did  three  or  four 
different  times,  when  the  same  process  of  dilatation  was 
resorted  to. 

The  patient  died  a  short  time  ago,  and  Dr.  Terry  ob- 
tained possession  of  the  specimen.  The  walls  of  the 
bladder  were  very  much  thickened  as  the  result  of 
chronic  cystitis.  The  stricture  in  the  spongy  tissue  was 
a  long  and  firm  one,  divided  into  two  sections,  and  at 
the  time  of  death  would  hardly  admit  a  number  four 
probe.    He  died  of  cystitis. 

Dr.  Post  thought  that  the  dilatation  could  have  been 
carried  on  still  further,  and  might  have  relieved  the 
patient  perhaps  permanently. 

Dr.  Terbv  remarked  that  he  would  have  persevered, 
but  the  patient  refused  to  bear  the  necessary  punish- 
ment. 

The  Society  then  adjourned. 


€oxttsifor(btnct. 


MEDICAL  MATTERS  IN  PARIS. 

(from     our     SPEaAL     COBPESPONDENT.) 
To  THB  Editor  of  tbm  Mbdtoal  Rboobd. 

Sir — You  will  remember,  no  doubt,  that  at  the  Inter- 
national Congress  the  theme  which  opened  the  debates, 
and  which  occupied  a  most  prominent  place  in  the  dis- 
cussions, was  the  apparently  exhausted  subject  of  tuber- 
culosis. M.  Villemin  has  just  offered  to  the  Academy 
the  treatise  of  which  his  remarks  at  the  Congress  were 
the  abstract,  the  exposition,  and  the  defence.  The  re- 
searches of  this  ingenious  experimentalist  have  led  him 
to  conclusions  differing  so  widely  from  those  generally 
adopted,  as  to  excite  the  curiosity,  applause,  or  indigna- 
tion of  eve^  defender  of  the  medical  faith.  Hence  the 
report  of  M.  C<»lin  on  Villemin's  book  has  been  fol- 
lowed by  an  able  and  lively  discussion  of  unexpected 
interest  in  connection  with  a  disease  which  had,  bo  to 
speak,  fallen  into  disuse,  and  whose  victims  were  re- 
^rded  as  useless  incumbrances  of  the  clinical  wards 
in  the  hospitals. 

mOQXJLABILlTr  or  TUBERCLE. 

The  novelty  of  Villemin*s  views  is  manifested  on 
three  important  points.  1st  Denying  the  existence  of 
epithelium  in  the  pulmonary  alveoli,  the  physician  of 
y&l-de-Grace  contradicts  Reinhardt's  assurance  that 
the  cheesy  masses  occupy  the  air-cells,  and  ascribes 
to  them  the  same  origin  and  seat  as  that  generally  ad- 
mitted for  the  gray  granulations,  viz.  the  connective 
tissue  between  the  alveoli,  and  around  the  blood-vessels. 
These  masses  are  the  result  of  fatty  degeneration  of 
the  plasmatic  elements  of  the  connective  tissue,  whose 
proliferation  has  given  rise  to  the  nuclei  and  smaU  cells 
characteristic  of  the  centre  of  the  gray  tubercle.  These 
last  elements  invariably  degenerate,  but  not  unfrequent- 
ly  the  large  connective  cells  on  the  periphery  of  the 
granulation  are  also  invaded  while  yet  undergoing  the 
process  of  multiplication.  In  this  respect,  therefore, 
Villemin  returns  sqiiarely  to  the  views  of  Laennec, 
who  regarded  the  cheesy  masses  as  soflened  tubercles. 


2d.  The  most  remarkable  part  of  the  Etudes  sur  la 
Tuberetdose  is  that  which  relates  to  the  experiments  on 
inoculation  of  tuberculous  matter,  some  of  whose  results 
were  submitted  to  ihe  Academy  in  1865.  Villemin  was 
induced  to  make  these  experiments,  by  observing  the 
histological  resemblance  of  the  elements  of  the  miliary 
tubercle  with  those  of  the  tubercle  of  syphilis  or  glan- 
ders. Since  they  were  specific  and  inoculable,  he  in- 
ferred that  the  gray  granulation  mij?ht  be  so  as  well. 
The  second  half  of  this  supposition  has  been  fully  con- 
firmed. An  immense  number  of  experiments  have  been 
performed  upon  rabbi t«,  by  inserting  into  the  subcu- 
taneous cellular  tissue  fragments  of  pulmonary  tubercles, 
and  in  nearly  all  cases  the  injection  was  followed  by 
an  eruption  of  miliary  granulations  in  the  lungs,  and 
by  the  constitutional  symptoms  of  tuberculosis,  to 
which,  after  awhile,  the  animals  succumbed. 

3d.  Upon  the  success  of  these  experiments,  the  first 
of  any  consequence  that  have  ever  been  made  in  th?s 
direction,  M.  Villemin  bases  an  entirely  new  theory  of 
tuberculosis.  He  claims  that  what  is  inoculable  must 
be  specific;  that  tuberculoas  belongs,  in  its  charac- 
ter of  specificity,  to  a  family  of  diseases,  depending  on 
the  substantial  introduction  into  the  system  of  a  pecu- 
liar animal  virus.  It  is,  in  short,  a  definite,  virulent^ 
contagious  disease,  hke  syphilis  and  glanders ;  and  the 
histological  similarity  between  the  tumors  in  the  three 
cases  is  justified,  so  to  speak,  by  their  fiamily  or  generic 
affinity. 

Now,  as  to  the  reality  of  the  results  obtained  by  M. 
Villemin  in  his  experiments,  there  can  be  no  doubt 
They  have  been  repeated  with  equal  success  by  M. 
Colin,  who  reports  the  new  treatise  to  the  Academy ; 
their  accuracy  is  acknowledged  by  M.  Comil,  from 
whose  party  Villemin  has  made  such  a  frightlul  seces- 
sion. Bouchard,  in  his  review  in  the  QazeUe  Hehdoma- 
daire,  and  Chauffard  and  Pidoux  in  their  speeches  at 
the  Academy,  all  admit  this  striking  and  unexpected 
discovery — viz.  tliat  tuberculosis,  anatomically  and  clin- 
ically characteristic,  may  be  communicated  to  rabbits 
and  guinea-pigs  by  inoculation  from  the  tubercles  of 
cattle  or  human  beings. 

But  the  inferences  adopted  by  M.  Villemin  are  ex- 
tremely contestable  and  contested,  as  M.  Chauffard  by 
an  anatomical,  M.  Pidoux  by  a  general  analysis,  success- 
fully disproved  the  pretended  virulence  of  the  tuber- 
cular deposit  Chauffard  points  out  that  inoculations  of 
specific  animal  poisons,  as  those  of  syphilis,  small-pox, 
hydrophobia,  etc.,  are  first  made  witM  fluids  containing 
no  morphological  elements  or  special  characteristics. 
But  Villemin's  favorite  experiments  consisted  in  grafting 
a  definite  structure  upon  the  organism.  When  this  struc- 
ture, sown  on  soil  rendered  congenial  by  the  presence 
of  lymphatics,  develops  itself  ar.d  excites  the  sur- 
rounding tissues  to  similar  proliferation,  it  does  so  in 
virtue  of  the  laws  of  development  of  tumors,  which, 
according  to  Virchow,  depend  on  the  foundation  of  a 
tissue  by  elements  coming  from  another  tissue. 

2d.  A  definite  period  of  incubation  is  essential  to 
the  process  of  virulent  inoculation;  afler  which  ap- 
pears local  trouble,  speedily  followed  by  general  symp- 
toms of  infection.  But  M.  Colin  shows  that  in  the  ex- 
periments there  is  no  such  incubation,  and  no  reproduc- 
tion of  the  tubercle  on  the  place  where  it  was  inocu- 
lated. The  tumefaction  observed  there  results  from 
the  resistance  offered  by  the  tubercle  to  the  dissolving 
action  of  altered  pus,  on  account  of  which  some  of  the 
matter  originally  introduced  may  often  be  found  on  the 
same  spot  six  weeks  afterwards.  M.  Pidoux  declares 
that  the  tubercle,  placed  at  the  base  of  the  scale  of 
heteroplastic  formations,  multiplexing  like  all  inferior 
organisms,  dying  speedily,  ana  infecting  Uie  locality 


THE  MEDICAL   RECORD. 


573 


"with  products  of  decomposition,  is  in  the  highest  de- 
gree incapable  of  the  incubating  force,  the  latent  and 
refractory  vitality  characteristic  of  vii  us. 

3  J.  The  gray  granulations  are  possessed  of  no  exclu- 
sive power  of  inaction,  ViUemin  himself  has  produced 
an  eruption  of  mihary  tubercles  by  inoculation  of  the 
cheesy  detritus,  and  even  admits  this  to  be  the  most 
favorable  for  the  experiment.  It  is  on  this  fact  that 
he  bases  the  revival  of  the  doctrine  of  identity  between 
the  cheesy  mass  and  the  crude  tubercle.  M.  CoUn 
•  has  successfully  inocula  ed  various  animals,  rabbits, 
guinea- pigs,  lambs,  calves,  and  dogs,  not  only  with 
the  cht'esy  deposit,  but  with  the  hard  cretaceous  tubercle 
from  the  lungs  of  oxen.  Clarck  has  succeeded  with 
ordinary  pus;  and  Empis  with  pus  from  puerperal 
peritonitis,  from  the  surface  of  Peyer's  patches  ulcerated 
in  typhoid  fever,  and  from  j«uppurating  fibrinous  pneu- 
monia. Finally,  Lebert  has  experimented  with  mineral 
substances,  as  mercury  and  carbon.  In  all  these  cases 
a  ciop  of  perfectly  characteristic  gray,  hard,  semi- 
tran<f)arent  tubercles  was  obtained  in  the  lungs  of  the 
animals  submitted  to  the  experiment.  It  is  impossible 
to  imagine  a  more  complete  demonstration  of  the 
common  and  non-specific  origin  of  the  crude  tuber- 
cle. 

4th.  M.  Colin,  in  his  report,  follows  s^ep  by  step  the 
consequences  of  the  inoculations,  and  shows  that  for  a 
long  time  they  are  purely  local  The  disease  is  com- 
municated, not  by  the  general  infection  of  the  whole 
sy  tern,  but  by  the  implantation  of  a  thorn,  whose 
irritation  gradually  extends  and  involves  the  lungs. 
The  focus  of  inoculation  is  presently  surrounded  by 
radiating  white  Unes,  formed  by  lymphatic  vessels  en- 
gorged with  foreign  matters.  The  ganglia  in  which 
these  vess  "h  terminate  engorge  themselves  also,  and 
become  filled  with  tubercular  granulations,  and  others 
in  their  turn.  The  ganglia  not  found  on  the  route 
traversed  by  the  morbid  ve.^^sels,  remain  perfectly  sound. 
From  the  lymphatic  system,  the  tuberculous  matter 
gain:^  the  Central  organs,  probably  by  the  route  of  the 
circulation,  and  is  thus  gradually  deposited  in  the  lungs, 
lirer,  spleen,  and  kidneys.  This  evolution  is  exactly 
that  of  the  gradual  propagation  of  a  local  evil,  not  the 
simultaneous  impregnation  of  the  entire  organism  by  a 
virulent  agent. 

Colin  is  so  impressed  by  this  local  character  of  the 
disease  artificially  produced,  that  he  jumps  to  the  con- 
clusion that  natural  phthisis  is  also  the  result  of  local 
mischief,  resulting  from  one  or  more  tubercles  that 
have  at  some  time  been  introduced  into  the  economy, 
and  after  remaining  latent  for  an  indefinite  period,  are 
suddenly  awakened  to  activity.  But  this  supposition 
is  entirely  gratuitous. 

5th.  M.  ridoux  dwells,  upon  Villemin*s  admission  that 
the  yellow  tuberculous  mutter  is  more  active  than  the 
gray  tubercle.  If  we  assume  (which,  as  we  shall  pre- 
sently see,  is  conceding  too  much)  that  this  cheesy 
deposit  be  in  fact  a  degeneration  of  the  tubercle,  a  strik- 
ing contra«it  becomes  apparent  between  the  tubercle  and 
vims.  This  is  more  active  in  its  first  stages  than  at  the 
period  of  its  degeneration. 

6th.  Pidoux  also  observes  that  the  similarity  be- 
twe.^n  the  histological  structure  of  the  tuberculous 
tumor  and  of  syphilis  and  glanders,  is  really  an  argu- 
ment against  the  virulent  character  of  the  first  af- 
fection. For  at  the  moment  that  the  other  two  dis- 
eases have  resulted  in  tumors,  they  have  cear^ed  to  be 
vuruleot,  and  have  passed  into  a  state  of  diathes  s.  In- 
oculation from  those  tumors  will  give  rise  to  neither 
glanders  nor  syphilis.  Hence  this  grand  foundation- 
stone  of  the  new  theory,  and  this  initial  observation  of 
M.  Villomin's  researches,  is  wrenched  from^  him,  and 


turned  most  ingeniously  into  a  powerful  argument 
against  his  cause. 

From  this  critique  it  appears  that  inoculation  of  tu- 
berculous or  other  matter  acts  on  the  lungs  (whither 
it  has  been  brought  by  the  blood,  and  arrested  by  the 
fine  network  of  capillaries),  by  irritation  of  the  plasmatic 
cells  of  the  connective  tissue.  These,  proliferating, 
give  rise  to  the  small  elements,  which,  closely  crowded 
together,  constitute  the  gray  tubercle.  The  process  is 
closely  analogous  to  the  proliferation  of  inflammation, 
which  also  results  in  the  formation  of  the  small  cells  ana 
nuclei  of  pus,  which  cannot  by  their  form  be  distin- 
guished from  those  of  the  crude  tubercle.  The  diffen»nce 
consists — first,  in  the  intercellular  substance,  liquid  in 
pus,  finely  granular  in  the  tubercle ;  second,  in  that 
the  fatty  degeneration  results  in  cheesy  masses  for  the 
tubercle,  while  the  pus  remains  liquid. 

In  all  cases  of  artificially  induced  disease  the  irritation 
comes,  of  course,  from  without,  and  may  be  called  local. 
This  may  occur  also,  as  Pidoux  observes,  in  acquired 
phthisis,  especially  in  that  of  miners  and  others  con- 
stantly expo>'ed  to  direct  irritiition  of  the  lungs.  But  in 
constitutional  and  hereditary  consumption  the  tuber- 
cular process  is  to  be  regarded  simply  as  the  final  stage 
to  wh.ch  all  irritative  processes  in  weakly  subjects  natu- 
rally tend  to  degenerate. 

"  The  impoverishment  of  the  field  of  nutrition  is  the 
first  condition  of  tuberculosis,"  says  Pidonx;  "the 
occurrence  of  some  irritation  the  second.  Nothing  is 
more  susceptible  of  irritation  than  weakness,  nothing  so 
ready  to  degenerate."  Agam  (for  I  quote  wilUngly 
from  this  able  and  brilliant  discourse  in  which  he  old 
colleague  of  Trousseau  so  well  justifies  his  reputation), 
"tuberculosis  is  the  constitutional  alteration,  the  cha- 
racteristic and  organic  heteroplasia  of  the  lymphatic  ap- 
paratus, the  fundamental  apparatus  of  nutrition.  This  is 
attacked  in  the  connective  tissue,  which  constitutes  its 
base.  When  this  tis^^ue  sustains  what  Hunter  calls  the 
stimulus  of  imperfection^  it  is  excited  to  proUferations, 
imperfect,  sickly,  of  an  extremely  ephemeral  vitality, 
bom  in  fact  but  to  die ;  such  is  the  tubercle." 

Chauffard  ingeniously  suggests  that  the  ease  with 
which  the  tubercle  may  be  inoculated  depends  precisely 
upon  the  poverty  of  its  organization.  The  fecundating 
tissue,  to  refer  again  to  Virchow's  idea  and  expression, 
would  need  to  make  less  eflfort  to  assimilate  another  to 
a  feebly  organized  structure,  than  to  one  complex,  rich, 
and  characteristic;  and  from  this  point  of  view  the  in- 
oculation of  tubercle  is  more  easily  comprehensible  than 
that  of  cancer. 

But  the  existence  of  an  internal  cause  for  tuberculosis, 
of  a  diathesis  and  of  hereditary  tendency,  is  denied  by 
M.  Yillemin,  and  it  is  this  denial  that  constitutes  the 
fame  of  his  heresy.  He  is  as  fi*ank  a  believer  in  the  con- 
tagious origin  of  phthisis  as  a  doctor  of  the  sixteenth 
century,  or  an  Italian  or  Spanish  peasant  of  the  present 
day.  For  him  reunions  of  consumptives  constitute  more 
deadly  foci  of  infection  than  cholera  hospitals,  and  the 
lives  of  the  patients  sent  to  Nice  and  Cannes  are  terribly 
shortened  by  the  atmosphere  impregnated  with  emana- 
tions from  the  reeking  lungs  of  their  fellow-sufferers. 

Upon  this  point  especially  does  M.  Pidoux  attack  the 
innovator.  He  charges  him,  not  unfairly,  with  having 
entirely  neglected  the  clinical  study  of  tuberculosis  in 
his  absorption  in  its  anatomical  pathology.  Examina- 
tion of  lungs  after  death  is  extremely  useful  as  a  means 
of  ascertaining  the  results  of  disease  and  many  of  its 
processes,  but  must  usually  be  incompetent  to  determioe 
its  cause.  And  it  is  glaringly  illogical  to  conclude  that 
because  in  a  given  case  a  disea^^e  has  been  artificially 
produced  by  inoculation  of  certain  substances  from 
without,   therefore  all  spontaneous  ca§^s  of  the  af- 

^igitized  by  Google 


674 


THE  MEDICAL  RECORD. 


fection  depended  on  the  same  mechanism.  As  well  argue 
that  capillary  bronchitis  could  only  be  caused  by  injec- 
tion of  snuflf  into  the  trachea. 

Yet  precisely  to  this  complexion  has  come  M.  Ville- 
min.  He  formally  denies  the  possibility  of  any  spou- 
taneons  alteration  of  the  organism,  and  insists  that  all 
disease  must  result  from  the  infliction  of  exterior  agents. 
Thus,  from  the  reformed  basis  of  phthisis,  he  dares 
attempt  the  reform  of  all  patholopy.  But,  as  Pidoux 
observes,  all  exterior  agents  would  be  without  eflfect 
were  it  not  for  a  suscepiibiUty  on  the  part  of  the  organ- 
ism to  be  affected,  which  capacity  itself  constitutes  a 
spontaneity  and  individuality. 

In  the  meantime  M.  Pidoux  is  far  from  claiming  for 
•phthisis  that  overwhelmingly  predestined  character  with 
which  it  is  popularly  associated.  He  admits  that  about 
one-sixth  of  ail  consumptive  patients  contract  the  dis- 
ease in  virtue  of  direct  hereditary  influence,  but  that 
many  others  are  predisposed  on  account  of  transformed 
hereditary  influence ;  arthritism,  herpetism,  syphihs,  or 
scrofula  in  the  parents,  tending  less  to  reproduce  them- 
selves in  the  children  than  to  occasion  pulmonary  tuber- 
culosis. 

Similarly,  phthisis  springs  up  in  the  wake  of  many 
diseases,  which  at  their  height  are  directly  antagonistic 
to  it  This  is  the  case  especially  with  arthritism,  whose 
remains  seem  as  it  were  to  enrich  the  soil  of  the  econo- 
my, and  prepare  it  for  phthisis.  Such  transformation 
takes  place  with  the  same  individual.  But  in  hereditary 
transmission  M.  Pidoux  announces  as  a  sufficiently  de- 
finite law,  the  progress  of  capital  or  initial  diseases,  first 
towards  mixed  diseases,  then  those  that  are  ultimate  or 
organic.  TJius  arthritism,  scrofula,  syphilis,  capital 
diseases,  change  into  herpetism,  neuroses,  neuralgias, 
catarrhs,  etc.,  or  mixed  diseases;  and  these  in  turn  de- 
generate into  organic  diseases,  as  tuberculosis,  cancer, 
epilepsy,  and  incurable  degenerations  of  the  nervous 
centres.  M.  Villemin  entirely  denies  any  connection 
between  scrofula  and  tuberculosis,  which  is  the  more 
singular  as  he  cannot  ignore  the  readiness  with  which 
the  lymphatic  glands  become  the  seat  of  cheesy  de- 
generations, such  as  he  identifies  with  tubercle.  It  is 
precisely  because  he  is  forced  to  admit  the  multiple 
origin  of  scrofula,  that  he  seeks  to  separate  it  from  tuber- 
culosis, of  which  the  specific  character  must  be  preserved 
at  all  hazards.  Pidoux,  fully  conceding  the  difference 
between  the  two  diseases,  justly  insists  on  their  ft-equent 
etiological  connections.  Scrofula  is  the  initial  chronic 
disease,  often  superficial,  curable,  and  not  an  organic 
malady,  although  capable  of  becoming  so.  Tuberculosis. 
and  especially  pulmonary  phthisis,  are  ultimate  ana 
organic  diseases,  too  often  the  final  stap;e  of  non-tuber- 
culous affection.  It  is  quite  as  necessary  for  scrofula  as 
for  arthritism  or  syphilis  to  degenerate  bef  re  it  gives 
.rise  to  tuberculosis ;  patients  with  scrofulous  ulcers  are 
not  consumptive,  but  lymphatic  constitutions,  deli- 
cate, nervous,  ** civilized,'*  fall  an  easy  prey  to  phthisis, 
often  because  of  their  escape  from  the  external  mani- 
festations of  the  disease. 

Finally,  it  is  unquestionable  that  a  number  of  persons 
untainted  by  hereditary  vice  of  constitution,  and  uninjur- 
ed by  previous  disease,  fall  victims  to  consumption  on 
account  of  exposure  to  cold,  to  want,  to  privations. 
Pidoux  seems  to  imply  that  in  these  cases  the  disease 
commences  in  bronchitis,  determining  proliferations  of 
alveolar  epithelium,  which  degenerates  into  cheesy 
masses,  which  ultimately  excite  a  crop  of  tubercles  by 
irritation  of  the  connective  tissue.  Pidoux,  therefore, 
fully  admits  the  German  distinction  between  pneumonic 
phthisis  and  granular  phthisis;  the  last  being  constitu- 
tional, the  first  accidental,  and  often  extremely  rapid. 
Bouchard  adheres  also  to  this  view,  and  sums  up  the 


differences  between  the  gray  tubercle  and  yellow  masses, 
which  nearly,  if  not  quite,  demonstrate  their  indepen- 
dence of  origin.  In  the  first  stages  of  the  **  cheesy 
pneumonia,"  as  the  yellow  masses  are  called  bjr  the  new- 
school  pathologists,  the  alveoli  are  found  partially  611ed 
with  large  pavement  cells,  which,  in  spite  of  M.  Ville- 
min*s  assertions,  reveal  their  epithelial  character  by 
being  more  or  less  soldered  together.  The  alveoli  also 
contain  serous  exudation.  On  the  contrary,  the  first 
stage  of  the  granulation  consists  of  a  mass  of  small  spheric 
cells,  0"",  008  in  diameter,  with  the  nucleus  filling  the  ' 
cavity  almost  completely,  closely  pressed  Against  each 
other.  This  mass  is  situated,  not  in  the  alveoli,  but  in 
the  connective  tissue  at  the  bifurcation  of  the  blood- 
vessels. In  the  second  stage  of  catarrhal  pneumonia 
the  liquid  is  absorbed,  the  anatomical  elements  accumu- 
late and  become  infiltrated  with  fet,  and  presently  the 
alveoli  are  rendered  entirely  impermeable  to  the  air,  and 
offer  on  section  a  smooth  level  surface  uniformly  gray 
and  homogeneous.  The  granulations  also  submit  to  the 
cheesy  degeneration,  but  for  a  long  time  retain  their 
form,  BO  that  different  zones  are  distinguishable  in  their 
mass. 

Villemin's  second  thesis,  therefore,  which  constitutes 
his  remarkable  discovery,  is  everywhere  confirmed,  and 
it  is  an  acquired  fact  that  it  is  possible  to  produce  pul- 
monary phthisis  artificially,  by  inoculation  with  tuber- 
cular deposit,  or  with  the  products  of  the  pneumonia 
accompanying,  determining,  or  deter ii»ined  by  that  de- 
posit. But  his  first  theory,  that  identifies  the  tubercle 
and  the  pneumonia,  and  his  third,  which  would  make  of 
phthisis  a  specific  virulent  disease,  seem  to  be  sufficient- 
ly refutable  and  refuted. 

I  only  mention  in  passing  the  theory  of  contagion,  for 
that  is  confessedly  based  on  no  clinical  facta,  but  those 
dubious  ones  that  have  already  done  service  for  this 
theory.  M.  Villemin  seems  to  infer  that  the  contagion 
of  phthisis  must  be  a  necessary  consequence  of  its  in- 
oculability.  But  this  is  evidently  a  strained  conclunon, 
since  the  conceivable  mode  of  transm  ssion  between 
human  beings  must  be  widely  different  from  that  prac- 
tised by  Villemin  on  his  rabbits.  The  hateful  practical 
consequences  of  this  doctrine  of  contagion  may  justify, 
perhaps,  a  partiality  for  M.  Pidoux's  vehement  denuncia- 
tion of  its  possibility.  I  have  ventured  to  devote  so 
much  space  to  this  discussion  (of  which  I  have  endea- 
vored to  render  the  substance,  but  have  been  unable  to 
transfer  the  zest  and  animation),  because  it  is  one  of  the 
most  important  that  has  taken  place  in  Paris  for  some 
time.  The  daily  urgent  practical  need  of  interest  in 
pulmonary  consumption  is  so  great  that  even  a  scientific 
vagary  that  should  rouse  the  flagging  attention  to  a  worn- 
out  theme,  would  be  of  value.  This  book  of  M.  Ville- 
min's,  however,  is  no  vagary  or  frivolity,  as  you  may 
judge  from  the  elaborate  report  that  has  been  made  of 
it  to  the  Academy,  and  firom  the  spirited  debate  to  whidi 
it  has  given  rise.  But,  in  spite  of  its  abiUty,  and  the 
great  interest  of  the  experimental  researches,  it  is  a 
reaction  in  a  sorrowful  direction.  All  hopes  of  curing 
phthisis  depend  upon  its  nature  as  a  general  dL-ease  of 
common  origin;  and  the  theory  which  tends  to  make  it 
specific  condemns  the  physician  to  inertia,  or  the  vain 
revival  of  forgotten  specific  antidotes.  It  is  with  pleasure, 
therefore,  that  I  find  that  M.  Villemin's  arguments  are 
less  sound  than  they  are  briUiant,  imposing,  and  endowed 
with  the  charm  of  novelty.  P.  C.  M. 

Pasib,  Janaarj  8,  1868. 


A  RusstAK  Female  Physician. — A  young  Russian 
lady  has  just  passed  her  examination  as  Doctor  <^ 
Medicine  at  the  University  of  Lubeck,     ^-^rsJo 


THE  JIEDICAL  RECORD. 


576 


DECOLORATION  OF  IODINE. 

To  TBS  Editor  of  ths  Midioal  Bscoud. 

Sir — During  some  experimenta  on  iodine,  I  recently 
discovered  a  fjict  to  which  I  desire  to  call  the  attention 
of  the  profession. 

It  has  long  been  a  desideratum  in  therapeutics  to  de- 
prive the  tr.  iodine,  a  remedy  of  so  much  value  in 
external  and  local  medication,  of  the  objectionable  stain 
which  it  leaves  on  the  skin  and  linen  of  the  patient 
The  latter  is  especially  complained  of  by  patients  for 
whom  this  substance  is  prescribed  as  lotion,  injection, 
or  liniment 

In  the  skin  department  of  the  Demilt  Dispensary, 
Dr.  Blnxome  was  (in  1866)  in  the  habit  of  using  tr. 
iodine,  decolorized  by  liq.  ammonis.  But  as  this  com- 
bination appeared  so  very  irritating  as  to  cause  children, 
to  whom  it  was  applied  for  herpes,  etc.,  to  scream  most 
violently,  Dr.  B.  concluded  to  abandon  its  use  rather 
than  inflict  unnecessary  pain  on  his  little  patients. 

Recently  (Nov.  1st)  your  journal  contained  a  notice 
of  the  decolorizing  property  of  carbolic  acid  on  iodine, 
discovered  by  Dr.  Percy  Boulton.  This  *'  carbolate  of 
iodine  "  is  highly  praised  in  a  letter  to  the  Journal  des 
Connaissances  MSdicales  as  an  antiseptic  and  stimulant, 
and  as  such  it  is  doubtless  a  valuable  agent.  But  in 
some  cases  the  carbolic  acid  might  be  contra-indicated. 

I  have  ascertained  that  the  hyposulphite  of  soda  has 
the  peculiar  effect  of  depriving  the  iodine  of  its  color, 
forming  a  perfectly  limpid  fluid,  which  does  not  form 
the  purple  iodide  of  starch  on  the  linen,  nor  produce 
the  yellow  discoloration  of  the  skin.  The  hyposulphite 
having  no  medicinal  effect  in  the  small  quantity  re- 
quired for  this  purpose,  the  tr.  iodine  suffers  no  addi- 
tion to  nor  detraction  from  its  therapeutic  properties. 

I  make  a  saturated  solution  of  the  hyposulphite  in 
water,  and  this  is  added  in  proportion  of  about  one- 
sixth  of  the  tr.  iodine.  The  latter  floats  upon  the 
former,  but  through  agitation  will  produce  a  beauti- 
fully clear  solution  with  the  properties  mentioned. 

The  solution  of  the  bisulphite  answers  the  same  pur- 
pose. 

If  we  desire  to  obtain  the  effect  of  the  imdiluted  tr. 
iodine,  we  need  only  dissolve  a  few  smi^ll  crystals  of  the 
hyposulphite,  or  a  little  of  the  powder  of  the  bisulphite 
in  the  tincture,  and  complete  decoloration  will  be  the 
result 

/        S.  Baruch,  M.D. 

OAJfDKsr,  8.  0,  Feb.  1, 1868. 


BROMIDE  OF  POTASSIUM  IN  FUNCTIONAL 
EPILEPSY. 

To  thb  EDnx>B  of  th»  Medical  Bkcobd. 

Sir, — I  take  this  occasion  to  report  the  following  case 
of  apparent  cure  of  epilepsy  by  bromide  of  potassium : — 
The  subject,  a  young  lady  about  twenty-five  years  of  age, 
applied  to  me  a  little  over  a  year  ago,  to  know  if  any- 
thing could  be  done  to  relieve  her  from  her  disease, 
which  she  stated  had  existed  for  several  years ;  the  fits 
occurring  every  two  or  three  weeks.  On  examination, 
no  cause  could  be  found  to  account  for  them,  and  I 
gave  her  but  very  little  encouragement  as  to  the  result 
of  treatment  Having  seen  accounts  of  the  action  of 
the  bromide  in  such  cases,  I  mentioned  it  to  her,  and 
she  concluded  to  try  it  She  has  done  so  from  that 
time  to  the  present,  and  the  result  has  been,  that  it  is 
now  one  year  since  she  has  had  an  attack  of  the  dis- 
ease. I  have  delayed  reporting  the  case  till  now, 
that  I  might  be  sure  that  the  remedy  was  producing 
the  effect    I  have  two  other  cases  of  epilepsy  under 


the  same  treatment,  and  when  they  have  been  treated 
long  enough  I  will  report  I  have  used  the  bromide  in 
several  cases  of  nervous  restlessness,  particularly  at 
night,  caused  by  uterine  disease,  and  have  derived 
much  benefit  from  it. 

The  formula  used  in  the  case  of  epilepsy  reported 
above  was  as  follows  : — 

5.      Pot  Bromid.       3  vl 
Ammo.  Bromid.  3  ij. 
'  Pot.  B.  Oarb.       grs.  xv. 
Tine.  Columbo    |  iss. 
Aqua  3  iij. 

Teaspoonful  three  times  daily  before  eating. 
I  am,  sir,  yours  respectfully, 

JosiAH  F.  Day,  M.D. 

Altrkd,  Maivb,  F«b.  1868. 


Um  3mtxiimtnt». 


A   NEW   SYRINGE   FOR   THE    TREAT- 
MENT  OF  GONORRHOEA. 

By  M.  S.  BUTTLES,  M.D., 

AOJtnrOT    TO    CHAIB    OF    OMTITEICS,    imTBBSITT    MSDXCAL   OOLUOV, 
MKW  TOKK. 

The  accompanying  cut  represents  a  syringe  made  for 
us,  about  two  years  ago,  by  Messrs.  Otto  &  Reynders, 
for  the  treatment  of  urethritis.  The  nozzle  of  the 
syringe  is  surrounded  by  two  prongs,  so  arranged  as 
to  admit  of  being  opened  by  means  of  a  ring  or  button. 
The  syringe  being  loaded  with  a  medicated  solution,  the 
nozzle  with  the  prongs  is  introduced  into  the  urethra. 
The  prongs  are  then  separated  by  means  of  the  ring,  so 
as  to  dilate  the  urethra,  or  rather  to  put  the  mucous 
membrane  on  the  stretch,  after  which  the  injection 
is  thrown  in,  thereby  washing  out  and  effectually 
touching  every  part  of  the  diseased  surface. 


By  the  use  of  this  syringe,  with  a  weak  injection,  we 
have  cured  more  than  a  score  of  obstinate  cases  of 


Digitized  by 


Google 


610 


THE  MEDICAL  RECORD. 


gonorrhoea  and  gleet,  which  bad  resisted  all  the  treat- 
ment our  ingenuity  could  suggest. 

We  would  recommend  this  instrument  to  the  pro- 
fession as  specially  applicable  in  chronic  cases,  in  which 
the  inflammation  burrows  in  the  folds  of  the  mucous 
membrane,  which  ordinary  injections  or  medicines 
(passing  out  through  the  urine)  do  not,  and  cannot 
reach. 

We  have  made  some  improvements  which  facilitate 
the  working  of  this  syringe  that  this  cut  does  not  rep- 
resent, but  which  we  doubt  not  every  intelligent 
physician  will  quickly  comprehend  when  he  comes  to 
practically  apply  one  of  the  improved  instruments. 


itteMcol  3tem0  anti  VLms. 


Prof.  Joseph  Jones,  of  Nashville. — We  are  pained 
to  hear  that  the  residence  of  Pro£  Jones  was  recently 
destroyed  by  fire,  together  with  many  of  his  most  val- 
uable manuscripts. 

Prof.  August  v.  Vooel. — We  notice,  in  recent  ex- 
changes, the  death  of  the  celebrated  German  Chemist, 
Prof.  August  v.  Vogel,  M.D.,  in  his  ninetieth  year,  up 
to  which  advanced  age  he  retained  the  fullest  vigor  of 
body  and  mind.  He  was  the  oldest  member  of  the 
Munich  Academy  of  Sciences,  and  was  particularly  distin- 
guished for  his  analyses  of  the  various  mineral  waters 
m  his  native  kingdom  of  Bavaria. 

Ohassepot  Wouwds. — Several  physicians,  who  parti- 
cipated in  the  late  Garibaldian  campaign,  express  them- 
selves as  follows  with  regard  to  the  etfects  of  the  new 
chassepot  gun.  The  multitude  of  missiles  which  can  be 
scattered  over  the  battle-field  in  the  course  of  a  few 
minutes,  by  means  of  this  fire-arm,  unquestionably  has 
the  effect  of  putting  a  laree  number  of  troops  hors  de 
combat;  but,  by  reason  of  the  small  size  of  the  projectile, 
the  number  of  fatal  ii^juries  is  very  small  in  proportion 
to  the  total  number  of  wounded. 

It  has  been  established,  on  observation  of  the  wound- 
ed at  Mentana  and  elsewhere,  that  the  Chassepot  bullet 
rarely  shatters  a  bone,  but,  in  the  large  majority  of  cases, 
passes  around  it.. — AUgemeine  Wiener  ZHtung, 

Circular  No.  6— Surgeon-General's  Office — Report 
ON  Cholera. — Dr.  Crane,  Assistant  Surgeon -(General  U. 
S.  A.,  has  presented  to  the  King  of  Prussia  a  comprehen- 
sive report  of  the  course  of  the  late  cholera  epidemic 
amongst  the  U.S.  troops.  This  admirable  work  has  created 
great  interest^  and  been  highly  appreciated  in  military 
medical  circles.  The  Ruasian  Minister  in  Washington 
has  received  instnictions  to  convey  the  thanks  of  the 
King  to  Assistant  Surgeon-General  Crane  for  this  valua- 
able  work. — AUgemeine  Med,  Centrat-ZeUung^  Berlin, 

Professor  Rokitauskt,  of  world-wide  reputation,  has 
recently  been  appointed  life-member  of  the  UerrenhauB, 
or  House  of  Lords,  of  Austria.  This  recognition  of  the 
merit  of  a  professional  brother  seems  to  excite  the  live- 
liest sentiments  of  satisfaction  in  the  German  medical 
world,  and  congratulatory  addresses  pour  in  on  every 
side  unto  the  newly  made  Peer. 

Prof.  Joseph  Grubbr. — At  a  late  session  of  the  Col- 
lege of  Professors  of  Vienna,  Prof  Hyrtl,  one  of  the 
first  celebrities  of  our  University,  proposea,  in  an  able 
written  address,  the  name  of  Dr.  Joseph  Gruber  as  ex- 
t       traordinary  Professor  of  Aural  Medicine  and  Surgery,  on 
fL     the  ground  of  the  high  literary  attainments  of  this 
phi  gentleman,  and  especifdly  of  the  great  value  of  his  late 
tiontwork  on  the  Membrana  Tympani.     Dr.  Gruber,  in  view 
Boaclf  his  valuable  services  to  the  public,  thousands  of 


whom,  every  year,  had  received  gratuitous  advice  from 
him  on  dbeases  of  the  ear  was  recently  appointed  at- 
tending surgeon  to  the  Imperial  General  Hospital — 
Wiener  Medidnisehe  Zeitung, 

Our  Great  Masters. — Dr.  B.  W.  Richardson,  of 
London,  in  the  course  of  an  address  on  Research  in 
Medicine^  delivered  to  the  Saint  Andrew's  Medical 
Graduates'  Association,  makes  the  following  eloquent 
allusion  to  the  lew  great  masters  in  piedicme : — •*  So 
great  is  this  limitation  that  the  twenty-three  centuries 
from  the  Father  of  Medicine  have  not  brought  twenty 
masters  who  at  this  moment  are  powerful  to  command. 
Hippocrates  still  holds  out  the  natural  history  of  dis- 
ease ;  Paulus  remains  the  foundation-stone  of  surgeir ; 
Paracelsus  keeps  the  crucible ;  Yesalius  as  yet  is  tiie 
anatomist ;  Harvey  still  has  his  hand  on  the  engine  of 
the  circulation ;  Willis  is  opening  the  skull-case  and 
unrolling  the  brain ;  Ma^o  continues  to  teach  that  there 
is  a  furnace  in  the  anunal  body  burning  by  the  air; 
Black  and  Priestley  tell  the  nature  of  the  combustion ; 
Haller  adds  physics  to  physic,  and  Boerhaave  scientific 
chemistry.  Pinel  puts  the  psychical  upon  the  physical ; 
John  Hunter  links  the  physiology  of  animals  inferior 
to  that  of  the  animal  superior ;  Jenner  stands  out  alone 
the  revealer  of  a  wholesome  remedy  ;  Humphry  Davy, 
escaping  from  his  nitrous  oxide  box,  and  exclaiming  to 
Dr.  Kinjflake,  *  Nothing  exists  but  thoughts,  the  uni- 
verse is  composed  of  impressions,  ideas,  pleasures,  and 
pains, '-^eads  the  beneficent  advance  of  those  who  have 
abolished  the  horror  of  the  surgeon's  knife ;  and  Laennec, 
pronouncing  a  diagnostic  on  such  safe  physical  basis  as 
to  leave  no  improvement  on  his  principles,  heads  the 
last  of  the 

"  *  Tongues  of  our  dead  not  lost, 
But  speaking  from  death's  frost 
Like  fiery  tongues  at  Pentecost.'  ** 

HTPonBRMic  Injections  of  Morphine,  t  >  the  number 
of  two  hundred  weekly,  are  employed  in  the  cancer 
wards  of  the  Middlesex  Hospital 

M.  Brunetti,  whose  method  for  tanning  anatomical 
preparations  has  recently  been  presented  to  our  readers, 
has  obtained  a  patent  for  the  same. 

Contributions  to  MEnioAL  Journals. — ^Dr.  T.  Parvin, 
the  accomplished  editor  of  the  Western  JoumeU  of 
Medicine,  in  remarking  up^n  our  recent  leader  on  Medical 
Authorship,  makes  the  following  pertinent  comment: 
— "  We  have  now  at  least  a  dozen  articles,  received 
within  six  months,  which  we  will  be  glad  to  publish 
when  time  occurs  for  revision.  Sometimes,  however, 
such  revision  costs  a  subscriber,  for  there  are  some  men 
who,  actuated  by  benevolence  or  love  of  small  notoriety, 
will  send  articles  abounding  in  the  grossest  violations  of 
orthography  and  syntax — violations  such  as  a  child  of 
ten  years,  who  has  been  properly  educated,  would  not 
make,  and  in  complicated  ana  involved  sentences;  and 
when  these  articles,  subjected  to  competent  medical 
revision,  are  rewritten  in  good  English  and  then 
published,  become  virtuously  indignant  and  *  stop  the 
Journal^  Publish  such  an  article  as  sent,  and  the  offence 
is  equally  great  or  greater,  and  at  the  same  time  you 
disgrace  your  periodical ;  decline  publishing,  and  the 
would-be  contributor  is  just  as  indignant,  and  thinks 
your  JourncU  is  a  poor  thing.  How  can  we  escape  Scylla 
without  running  against  Cnarybdis  ?  " 

AoKNowLBDOiiENT. — The  managers  of  the  Nursery 
and  Child's  Hospital  of  this  city  acknowledge  the  dona- 
tion of  five  thousand  dollars  firom  the  estate  of  the  lat« 
Channcey  Hose. 


Digitized  by 


Google 


CONTEIBUTOES  TO  VOLUME  11. 


Allin,  Dr.  C.  M.,  Surgeon  to  N.  Y.  Hospital. 

Atkinson,  Dr.  W.  B.,  Secretary  American  Medical  As- 
sociation, Pliiladelphia. 

Batohelder,  Dr.  J.  P.,  N.  Y. 

Beard,  Dr.  G.  M.,  N.  Y. 

Bedford,  Prof.  G.  S.,  N.  Y. 

Bell,  Dr.  A.  N.,  Brooklyn,  N.  Y. 

Bennett,  Dr.  E.  P.,  Danbury,  Conn. 

Bull,  C.  S.,  M.D.,  Senior  Assistant  Physician,  Belle vue 
Hospital. 

BozEMAN,  Dr.  K,  of  N.  Y.  (late  of  Montgomery,  Ala.) 

Bradley,  Dr.  E.,  N.  Y. 

Brekes,  Dr.  D.,  N.  Y. 

Buck,  Dr.  Gurdon,  Surgeon  to  N.  Y.  and  St.  Luke's 
Hospital,  N.  Y. 

Bulkley,  Dr.  Henry  D.,  Physician  to  New  York  Hos- 
pital, N.  Y. 

Bumstead,  Dr.  Freeh  an  J.,  N.  Y. 

BuRGE,  Dr.  J.  H.  H.,  Brooklyn,  N.  Y. 

BuROB,  Dr.  W.  T.,  Atkinson,  Kansas. 

BuRRALL,  Dr.  W.  P.,  N.  Y. 

Buttles,  Dr.  M.  S.,  N.  Y. 

Byford,  Dr.  W.  H.,  Prof.  Obstetrics,  Chicago  Medical 
College,  Chicago,  111. 

Caswell,  Dr.  E.  T.,  Providence,  Rhode  Island. 

Clark,  Dr.  Alonzo,  Prof.  Pathology  and  Practical 
Med.,  College  of  Physicians  and  Surgeons,  N.  Y. 

Cohen,  Dr.  J.  Solis,  of  Philadelphia. 

Cutter,  Dr.  J.  B.,  Newark,  N.  J. 

Da  Costa,  Dr.  J.  M.,  Lecturer  on  Clinical  Mediciii*  and 
Physician  to  Penn.  Hospital,  Phila. 

Dalton,  Dr.  J.  C,  Prof.  Physiological  and  Microscopic 
Anat,  College  Physicians  and  Surgeons,  N.  Y. 

Davis,  Dr.  H.  G.,  N.  Y. 

Dickson,  S.  H.,  M.D.,  Prof  Pract.  Physic,  Jefferson  Med. 
College,  Phila. 

DowELL,  Prof.  Greenville,  M.D.,  Editor  Galveston  Med- 
ical Joumaly  Texas. 

Draper,  Prof  John  C,  N.  Y.  University,  N.  Y. 

Draper,  Dr.  William  H.,  Physician  to  N.  Y.  and  St. 
Luke's  Hospital,  N.  Y. 

Dubois,  Dr.  H.  A.,  U.  S.  Army. 

Elliot,  Dr.  Georoe  T.,  Prof.  Obatet,  Bellevue  Hospital 
Medical  College. 

Ely,  W.  W.,  M.D.,  Rochester,  N.  Y. 


Estfif  ET,  Dr.  Thomas  Addis,  Surg,  to  State  Woman's  Hos- 
pital, N.  Y. 

Field,  Dr.  A.  G.,  Secretary  Iowa  State  Medical  Society, 
Des  Moines,  Iowa. 

Flint,  Dr.  Austin,  Prof  Practical  Medicine,  Bellevue 
Hospital  Medical  College,  N.  Y. 

Forman,  Dr.  D.  McLean,  House  Physician,  Bellevue 
Hospital,  N.  Y. 

Green,  Dr.  Willlam  Warren,  Prof  of  Surgery,  Berk- 
shire Medical  College. 

G^ODWiLLiE,  Prof  D.  H.,  N.Y.  College  of  Dentistry,  N.  Y. 

Gross,  Dr.  S.  D.,  Prof  of  Surgery,  Jefferson  Medical 
College,  Philadelphia. 

Grosvenor,  Dr.  J.  W.,  Providence,  R.  I. 

Hachenbero,  Dr.  G.  P.,  Hudson,  N.  Y. 

Hadden,  Dr.  Alexander,  House  Physician,  N.  R  Dis- 
pensary, N.  Y. 

Hamilton,  Dr.  Frank  H.,  Prof  Fract.  and  Dislocations, 
and  Military  Surgery,  Bellevue  Hospital  Medical 
College,  and  Long  Island  College  Hospital,  N.  Y. 

Herzoo,  Dr.  M.,  N.  Y. 

Hooker,  Prof  Worthington,  New  Haven. 

Hunter,  Dr.  James  B.,  N.  Y. 

Hutchison,  Dr.  Joseph  C,  late  Prof  of  Operative  Sur- 
gery, Long  Island  College  Hospital,  Brooklyn,  N.  Y. 

Krackowizer,  Dr.  E.,  Surgeon  to  N.  Y.  Hospital,  N.  Y. 

Lee,  Prof  Charles  A.,  M.D.,  Peekskill,  N.  Y. 

Lente,  Dr.  Frederick  D.,  Cold  Spring,  N.  Y. 

Lewis,  Dr.  W.  B.,  N.  Y. 

liOOMis,  A.  L.,  M.D.,  Prof  of  Theory  and  Practice  Med- 
icine, N.  Y.  University,  N.  Y. 

Lyman,  Dr.  Henry  M.,  late  Editor  Chicago MedkalJour- 
naif  etc.,  Chicago,  HI. 

Marsh,  K  J.,  M.D.,  U.  S.  Army. 

Maurt,  Dr.  R  B.,  Port  Gibson,  Miss,  late  House  Phy- 
sician, Bellevue  Hospital,  N.  Y. 

Merrill,  Dr.  A.  P.,  of  N.  Y. 

MoClellan,  Dr.  E.,  U.  S.  Army. 

Newman,  Dr.  William,  N.  Y. 

North,  Dr.  N.  L.,  Brooklyn,  N.  Y. 

NoYES,  Dr.  Henry  D.,  Surgeon  N.  Y.  Eye  Infirmary. 

Parker,  Willard,  M.D.,  Prof  of  Principles  and  Prac- 
tice Surgery,  College  of  Physicians  and  Surgeons, 
N.Y. 

Parsons,  Dr.  John,  Mount  Pleasant,  Kansas. 


Digitized  by 


Google 


fi>r<' 


Contributors  to  Medical  Itecordj  VoL  It. 


Parvin,  Prof.  Theophilus,  M.D.,  Editor  Western  Jour- 
wjX  of  Medicine^  etc. 

Peableb,  Prof.  Edmund  R.,  M.D.,  N.  Y. 

PoiiEROT,  Dr.  0.  D.,  N.  Y. 

Post,  Dr.  A.  C,  Prof.  Surgery,  University  Medical  Col- 
lege, N.  Y. 

PoTTEB,  Dr.  H.  A.,  Geneva,  N.  Y. 

QuiMBT,  Dr.  IsAAO,  Jersey  City,  N.  J. 

Richardson,  Dr.  J.  P.,  Union  Springs,  N.  Y. 

Roberts,  Dr.  A,  C,  N.  Y. 

Rockwell,  Dr.  A.  D.,  N.  Y. 

Rogers,  Dr.  Stephen,  N.  Y. 

RoosA,  Dr.  D.  B.  St.  John,  Clinical  Prof,  of  Diseases  of 
Eye  and  Ear,  University  Medical  College,  N.  Y. 

Salisbury,  Prof.  J.  H.,  M.D.,  Cleveland,  Ohio. 

Seguin,  Dr.  E.,  N.  Y. 

Shaw,  Dr.  H.  L.,  Boston,  Mass. 

Shrady,  Dr.  John,  Editor  of  N.  T.  Medical  Register. 

Smith,  Dr.  J.  Lewis,  Physician  to  Nursery  and  Child's 
Hospital,  etc.,  N.  Y. 

Smith,  Dr.  0.  H.,  N.  Y. 

Squibb,  Dr.  E.  R.',  Brooklyn,  N.  Y. 

Sternberg,  G.  M.,  M.D.,  U.  S.  Army. 

Stirling,  Dr.  T.  B.,  Resident  Physician,  N.  Y.  Lying-in 
Asylum,  N.  Y. 

Stiles,  Dr.  R  C,  Consulting  Physician,  Kings  Co.  Hos- 
pital, N.  Y. 

Storer,  Prof.  Horatio  Robinson,  M.D.,  of  Boston. 

Taylor,  Dr.  Charles  F.,  Resident  Surgeon,  N.  Y.  Or- 
thopoedic  Dispensary,  N.  Y. 

Thompson,  Dr.  W.  H.,  Phys.  to  Charity  Hospital,  N.  Y. 

Turner,  Dr.  William  Mason,  Phila. 

Varick,  Dr.  T.  R.,  Jersey  City,  N.  J. 


Vermilyb,  Dr.  W.  E.,  of  N.  Y. 

Voss,  Dr.  L.,  ofN.  Y. 

Whitehead,  Dr.  W.  R.,  M,D.  (Univ.  Paris),  late  ProC 

Clinical  Medicine,  N.  Y.  Medical  College,  N.  Y. 
Wells,  T.  Spencer,  London. 
Winslow,  Dr.  John,  N.  Y. 
Wood,  Prof.  James  R.,  M.D.,  Bellevue  Hospital  Medical 

College, 


Societies  and  Institutions  from  which  reports  have  been 
furnished, 

American  Medical  Assocution. 

American  Ophthalmolooioal  Society. 

Bellevue  Hospital,  N.  Y. 

Brooklyn  City  Hospital,  N.  Y. 

College  Physicians  and  Surgeons,  N.  Y. 

Charity  Hospital,  Black  well's  Island. 

East  Rtver  Medical  Association,  N.  Y. 

Jefferson  Medical  College,  Phila. 

Long  Island  College  Hospital,  Brooklyn,  N.  Y. 

Massachusetts  Medical  Society. 

Medical  Society  op  the  County  of  New  York. 

Medical  Society  of  the  State  of  New  York. 

Medical  Society  of  the  State  of  Pennsylvania. 

New  York  Academy  of  Medicine,  N.  Y. 

New  York  Hospital,  N.  Y. 

New  York  Medical  Journal  Association. 

New  York  Medico-Legal  Society. 

New  York  Pathological  Society,  N.  Y. 

Pennsylvania  Hospital,  Philadelphia. 

University  Medical  College. 


Digitized  by 


Google 


CONTENTS  OF  VOLUME  II. 


Abdombn,  physical  exploration  of,  388,  438,  534. 

Abdominal  tumors,  in  fcatus  complicating  labor,  298. 

Abortion,  remarks  on,  24,  37,  110,  158,  166,  384,  232,  240. 

Abscess,  lecture  on,  319. 

Acetic  acid,  poisoning  by,  442. 

Acromion,  fracture  of  the,  232. 

Acton,  W.,  review  of  work  by,  17. 

Adipose  tumor,  pendulous,  330. 

Aitken,  Dr.  W.,  review  of  work  by,  110. 

Albuminuria;  treatment  of,  564;  review  of  work  on,  566. 

Alcohol,  efiecls  on  public  health,  67, 113. 

Allen,  Prof.  J.  M.,  obituary  notice  o^  167. 

Amenorrhoea,  electricity  in,  99. 

American  Medioal  Association,  109. 121, 133, 158,  495. 

American  Ophthalmological  Society,  210. 

Amerman,  Dr.  GJeo.  K.,  obituary  notice  oC  237. 

Ammonia,  muriate  oi,  in  catarrhal  fevers,  213. 

Anaphrodisia,  remarks  on,  297. 

Anssathesia,  discoverer  of,  157,  381 ;  death  during,  by  cork 

in  throat,  96 ;  by  cold,  299. 
Anchylosis  of  knee-joint,  operations  for,  63. 
Anemia,  electricity  in,  486. 
Ankle-joint,  new  apparatus  for  extension  of,  35. 
Animals,  Society  for  Prevention  of  Cruelty  to,  86. 
Angina  Pectoris,  nitrate  of  amyl  in,  391. 
Anemia,  electricity  in,  99. 
Anus,  absence  of,  with  recto- vaginal  fistula,  223 ;  operation 

for  artificial,  348. 
Aorta,  aneurism  of,  112,  103. 

Appendix  vermiformisi  operation  for  abscess  of,  25,  169. 
Army ;  Medical  Bureau,  review  of  actions  ot,  189 ;  medical 

heroes  of,  452 ;  Potomac  medical  recollections,  39. 
Arsenic;  in  prostatitis,  227  ;  in  cerebral  congestions,  477. 
Arteria  innominata,  aneurism  of,  265. 
Arterial  compression,  now  instrument  for,  525. 
Ashhurst,  Dr.  John,  Jr.,  review  of  work  by,  HI. 
Asthma,  treatment  of,  179,  372. 
Atkinson,  Dr.  W.  B.,  dystocia,  42. 
Atresia  of  vagina,  Emmet's  operation  for,  85. 
Auditory  canal,  external,  furuncles  of,  460. 
Aural  catarrh,  treatment  of  acute  cases  of,  27. 
Autopsies,  how  to  carry  on,  403. 
Authorship,  medical,  445. 

B. 

Bartholow,  Dr.  R.,  review  of  work  by,  351. 

Batchelder,  Dr.  J.  P.,  liquor  chloridi  zinci  in  gonorrhoea,  381. 

Bauer,  Dr.  L.,  anchylosis  of  knee,  63. 

Beard,  Dr.  Geo.  M.,  medical  use  of  electricity,  1,  98, 148, 169, 

361,  409,  486;  review  of  work  by,  569. 
Bedford,  Prof.  G.  S.,  four  children  at  birth,  116. 
Belladonna,  poisoning  by,  437. 
Bellevue  Hospital  reports,  9,  226,  317,  537. 
Bennett,  Dr.  E.  P.,  ligature  of  subclavian,  412. 
Bennett,  Dr.  J.  H.,  review  of  work  by,  471. 
Biberine  in  uterine  disease,  7. 
Bladder,  hair-pin  in  the,  209. 
Blistering  as  a  method  of  treatment,  107. 
Blood  in  body,  504 ;  detection  of  stains  ot,  179 ;  —  letting, 

question  o(^  472. 
Bloody  sweat,  a  case  of,  468. 
BoNat-racing,  dangers  of,  407. 
Brain,  review  of  work  on,  39 ;  diabetes  following  injury  of, 

887 ;  inflammation  of,  161 ;  tumor  of,  163,^448 ;  weight 

of.  504 ;  workers,  longevity  ot,  408. 
Bread,  poisonous,  215. 
Bnmetti's  method  of  preserving  flesh,  370. 
Bone,  reproduction  o^  269. 


Bone,  rapid  exfoliation  o^  209. 

Bowman,  Dr.  John  E.,  review  of  work  by,  89. 

Bozeman,  Dr.  N.,  self-retaining  speculum,  481 ;  vesicovagi- 

nal  flstules,  433. 
Bright's  disease  and  ophthalmoscope,  135. 
Bromine,  poisoning,  case  of,  323. 
Buck,  Dr.  G.,  new  treatment  for  fracture  of  thigh,  49. 
Bumstead,  Dr.  F.  J.,  letter  from,  307,  427. 
Burge,  Dr.  J.  H.  H.,  operation  for  abscess  of  appendix  ver- 

miformis,  169;  letter  from,  360. 
Surge,  Dr.  W.  J.,  letter  from,  264 ;  anomalous  labor,  638. 
Bums,  treatment  of,  372,  441. 
Burrall,  Dr.  F.  A.,  excision  of  os  calcis,  171. 
Bullet  detectors,  new  and  ingenious,  262. 
Butler,  Dr.  S.  W.,  review  of  work  by,  39. 
Buttles,  Dr.  M.  S.,  a  new  pessary,  428. 
By  ford,  Dr.  W.  H.,  lectures  on  puerperal  convulsions,  8,  32 ; 

review  of  work  by,  496. 

0. 

Cesarean  section  on  a  cow,  148. 

Calculi  impacted  in  urethra,  497. 

Cancer  of  liver,  306;  kidney,  369;  sigmoid  flexure,  899; 
temperature  of  body  in,  58 ;  treatment  by  acetic  acid  in- 
jection, 69,  300. 

Cannabis  as  an  antidote  for  strychnia,  872. 

Carbolic  acid  putty  in  abscess,  396. 

Carbuncle,  subcutaneous  incision  in,  467. 

Caries,  dental,  causes  of  in  married  women,  69. 

Carson,  Prof.,  clinic  of,  418;  review  of  work  by,  618. 

Caswell,  Dr.  E.  T.,  aneurism  of  abdominal  aorta,  197; 
ovariotomy,  245. 

Catalogue  of  U.  S.  Army  Medical  Museum,  494. 

Cataract,  treatment  of,  342. 

Cerebral  softening,  characters  ot;  477. 

Chambers,  Dr.  T.  K.,  review  of  works  by,  87. 

Chancre,  diagnosis  of,  227. 

Chandler,  Dr.  T.  K,,  obituary  notices  o^  23,  95. 

Charity  Hospital  Reports,  200. 

Chassepot  projectile,  wounds  by,  448,  676. 

Chignons,  dangers  of,  106. 

Chilblains,  ointment  for,  180. 

Chinese  practice,  peculiarities  o^  120,  406. 

Chlorine  water  in  scarlet  fever,  363. 

Chlorodyne,  death  from,  408 ;  remarks  on,  649. 

Chloroform,  deaths  from,  137,  324,  894,  407,  420,  480 ;  re- 
marks on,  184,  219.  203,  381,  441.  661. 

Cholera,  remarks  on,  89,  139,  193,  279,  285,  287,  828,  847. 

Cholesterine,  solvents  for.  348,  441. 

Chorea,  electricity  in,  100 ;  music  in,  627. 

Civiale,  death  of,  264. 

Clark,  Dr.  A.,  tumor  of  the  brain,  448. 

Clavicle,  excision  and  regeneration  of,  84. 

Clitoridectomy,  71,  144'. 

Cod -liver  oil,  action  ot,  180. 

Ccoliao  axis,  aneurism  of,  233. 

Cohen,  Dr.  J.  Solis,  Laryngoscopy,  4,  29,  294,  313,  886 ;  let- 
ters from,  187,  234,  866,  427 ;  review  of  work  by,  471. 

Cofl<3e  in  delirium  tremens,  340. 

College  system,  proposed  changes  in,  469. 

Colon,  enlargement  of,  420. 

Conant.  Dr  D.  S.  anecdote  of,  71. 

Congestive  fever  in  the  South,  216. 

Conjunctiva,  syphilitic  affections  of,  267. 

Convention  of  medical  teachers,  23. 

Conyulsive  diseases,  temperature  of  body  in,  107. 

Creasote  in  bums,  427. 

Criminals,  experiments  on,  601. 

Croup,  treatment  o^  78,  304,  322,  372. 


Digitized  by 


Google 


580 


Contents  of  Volume  II. 


Davis,  Dr.  H.  G.,  extension  of  muscles  and  tendons,  418; 
fractures  of  hip,  492. 

Dalton,  Dr.  J.  C,  review  of  work  by,  375. 

Day,  Dr.  A.,  review  of  work  by,  17. 

Deaf-dumbnoss,  causes  of,  322. 

Delirium  tremens,  coffee  in,  840. 

Diabetes  raellitus ;  following  injury  of  brain,  387 ;  remarks 
on,  417. 

Death  statistics  of  the  sexes,  430. 

Dead,  a  new  method  for  preserving  the,  335,  870. 

Dickson,  Dr.  S.  H.,  on  scrofulosis,  56,  79,  102. 

Diphtheria,  treatment  of,  83. 

Disinfection,  review  of  work  on,  351. 

Draper,  Dr.  J.  C,  muscular  force,  247. 

Draper.  Dr.  W.  H.,  malignant  disease  of  dura  mater,  161. 

Drowning,  death  by,  227. 

Diphtheria,  clinical,  thermometry  in,  217. 

Dubois,  Dr.  H.  A.,  amputation  of  hip,  266 ;  poisoning  by  bel- 
ladonna, 437. 

Dura  mater,  malignant  disease  of,  161. 

Dying,  chloroform  to  the,  252. 

Dysentery,  chronic,  cases  of,  489. 

Dystocia,  discussion  on,  42. 

Dysraenorrhoea,  electricity  in,  486. 

Dyspepsia,  treatment  of,  477. 

E. 

Ear,  clinical  papers  on,  339,  460;  how  to  syringe  the,  179; 

a  new  syringe  for,  263. 
Earth,  population  of  the,  896. 
East  River  Medical  Association,   19,  67,  91,  104,  260,  344, 

369,415,500. 
Eating,  excess  in  as  risk  to  operations,  891. 
Eclampsia  and  incision  of  cervix  uteri,  371. 
Editorial  articles,  13,   37,   61,  85,  109,  133,   167,  181,  205, 

229,   258,   277,  301,  325,  849,  873,  397,  421,  445,  469, 

493,  517. 
P^lbow,  unusual  injury  to,  283. 

Electricity,  medical  use  o^  1,  98,  148,  169,  361,  409,  486. 
Elephantiasis  Arabum,  case  of,  382. 
Elliot,  Dr.  Geo.  T.,  lecture  to  Alumni  of  N.  Y.  University, 

461;  Turkish  baths,  117. 
Embolus  causing  gangrene  of  leg,  802. 
Eramenagogue,  a  new,  868. 
Emmet,  Dr.  T.  A.,  operation  for  atresia  of  vagina,  35 ;  new 

uterine  elevator,  115. 
Endoscope  and  its  uses,  416. 
Enlarged  testicles  in  abdomen  of  foetus    hindering    labor, 

258. 
Epilepsy,  with  premature  osaification  of  cranial  sutures,  477  ; 

bromide  of  potassium  in,  251. 
Epistaxis,  tansy  in,  466. 
Epidemic  contagion,  remarks  on,  168. 
Erysipelas,  treated  by  sulphate  of  soda,  321. 
Ether  versus  chloroform,  44. 
Eustachian  tube,  remarks  on  use  o^  317,  453. 
Extra-uterine  foetation,  treatment  o^  22. 
Eye,  dislocation  of  globe  of,  11 ;  fibro-plastic  tumor  of)  208 ; 

review  of  works  on,  828,  875. 


Fallopian  pregnancy,  cases  of,  207. 

Faraday,  Dr.  M.,  obituary  notice  of,  334. 

Favus  firom  achorion  in  the  mouse,  340. 

FemiUe  medical  education,  47,  92. 

Fevers,  catarrhal,  muriate  of  ammonia  in,  218 ;  periodical, 

remarks  on,  499 ;  spotted,  ergot  in,  299. 
Field,  Dr.  A.  G.,  treatment  of  umbilical  hernia,  816. 
Fistula  in  ano,  treatment  of,  249. 
Fistula,  vesico-vaginal,  treatment  of  in  Paris,  805. 
Flatulency,  remarks  on,  418. 
Flesh,  new  method  of  preserving,  870. 
Flint,  Dr.  A.,  cases  of  cardiac  disease,  104,  154. 
Four  children  at  a  birth,  115. 
Forman,  Dr.  D.  McLean,  polypus  of  rectum,  817. 


Foundlings,  post-mortem  lesions  in,  416. 

Fractures  of  thigh,  treatment  of,  49,  255 ;  hip,  nature  of, 

lesion  of,  492 ;  badly  united;  operation  for,  101. 
Funis,  postural  treatment  of  prolapse  of,  60;  ligation  of;  543. 

G. 

Garratt,  Dr.  A.  C,  review  of  work  by,  62. 

Gentian  root  as  a  dilator,  491. 

Glottis,  case  of  spasm  of,  140. 

Gronorrhoea,  treatment  of,  108. 

Gorilla,  anatomy  of  the,  240. 

Goodwillie,  Dr.  D.  H ,  a  new  inhaler,  468. 

Grosvenor,  Dr.  J.  W.,  inflammation  of  psoas  magnus,  435. 

Gross,  Dr.  S.  D.,  clinics  of,  82,  105,  249,  273,  342 ;  on  tumors, 

487,  512. 
Greene,  Dr.  W.  W.,  fibrous  tumors  of  uterus,  52  ;  removal  of 

deep  cervical  tumor,  173. 

H. 

Hachenberg,  Dr.  G.  P.,  chloroform  as  a  vaporizer,  881 ;  ex- 
tirpation of  uterus,  505. 

HsBmorrhagic  diathesis,  hereditary  tendency  to.  19. 

Hair,  blanching  of  the,  180. 

Hamilton,  Dr.  F.  H,  bullet  in  heart,  18;  lectures  by,  151, 
224. 

Hamilton,  Dr.  L.  A.,  strychnine  poisoning  treated  by  chloro- 
form, 28. 

Hare-lip,  lectures  on  operations  for,  151,  224. 

Hart,  Dr.  John,  obituary  notice  of,  836. 

Hartshome,  Dr.  H.,  review  of  work  by,  329. 

Heat,  as  a  resuscitating  agent,  10. 

Heart,  bullet  in  for  twenty  years,  1 8 ;  case  of  rupture  of, 
412  ;  wound  of,  232  ;  diseases  of;  104,  154,  299. 

Hieraorrhoids,  a  new  instrument  for,  215. 

Hepatic  abscess,  cases  of,  241. 

Hernia,  case  of  mesenteric.  111;  coffee  in,  420;  voroit'mg 
after  reduction  of,  260 ;  ether  spray  in,  228 ;  umbilical, 
treatment  of;  816. 

Herpes  circinnatus  from  achorion  in  mouse,  837. 

Heraog,  Dr.  M.,  causes  of  cholera,  198. 

Hip-joint;  disease,  treatment  of,  289;  amputation  o|;  266. 

Homoeopaths,  consultations  with,  480;  and  retained  pU- 
conta,  399. 

Hooker,  Dr.  Worthington,  obituary  notice  of,  453. 

Hospital  practice,  remarks  on,  206,  325,  489. 

**  House-maid's  knee,''  pathology  of;  210. 

How  does  a  young  physician  get  into  practice  ?  88. 

Howard,  Dr.  B.,  letter  from,  189 ;  on  ligatures,  449. 

Hudson,  Dr.  E.  D.,  Syme's  amputation  at  ankle-joint,  40. 

Human  life,  economy  of,  284. 

Hutchison,  Dr.  J.  C,  aneurism  of  arteria  innominata,  265. 

Hydrogen,  process  for  producing,  466. 

Hydrocyanic  acid,  experiments  with,  457. 

Hypodermic  syringe,  description  of  a  new,  502. 

I. 

Indigestions,  review  of  work  on,  87.      • 

Infanticide,  a  legal  question  regarding,  286. 

Infantile  paralysis,  review  of  work  on,  184. 

Inhalation,  review  of  work  on,  471. 

Inhaler,  a  new,  453. 

Insane,  effect  of  music  on  the,  440. 

International  Medical.Congress,  remarks  on,  851,  37S,  876, 557. 

Iodine,  removal  of  stains  produced  thereby,  391. 

Ireland,  medical  examination  in,  431. 

"Is  he  reliable?"  493. 


Jefferson  Medical  College  reports,  82,  105,  249,  273,  343. 

Jobert  (de  Lamballe),  obituary  notice  of;  190. 

Jones,  Dr.  Joseph,  experiments  with  hydrocyanic  add,  457, 


Kidneys,  malposition  of  the,  228. 

Digitized  by  VjOOQIC 


Contents  of  Volume  IL 


581 


Knee-joint,  amputation  at,  185,  258 ;  operation  for  anchy- 
losis of,  63 ;  repeated  resection  in,  84. 

Kraclfowizer,  Dr.  E.,  discharge  of  worms  per  urethram,  174  ; 
extirpation  of  uterus,  297. 


Lake  Michigan,  tunnel  under,  148. 

Lawton,  Dr.  J.  W.,  discoverer  of  anaesthesia,  882. 

Lawson,  Dr.  F.  B.,  uterine  applicator,  478. 

Lawson,  Dr.  Geo.,  review  of  work  by,  375. 

Laryngoscopy,  4,  29,  294.  313,  385,  569. 

Lawrence,  Sir  William,  death  of,  287. 

Lecture  term,  extension  of,  229. 

Letterman,  Dr.  J  ,  review  of  work  by,  39. 

Lente,  Dr.  F.  D,  new  method  for  facilitating  operation  for 

badly  united  fracture,  101. 
Leprosy,  case  of,  372 


Lewis,   Dr.  W.  B.,  rupture  of  the  heart,  412;  pathology  of    yv^}^'^^\ 

urinarv  or^n,.  506  »  F«         6/  ^J^p^n,  m  therapeutics,  300,  371. 


urmary  organs,  506. 

Ligatures,  remarks  on,  60,  449,  525. 

Lister,  Dr.  J.,  carbolic  acid  putty,  896. 

Lithotomy,  cases  of,  356,  468. 

Liver,  cancer  of,  266,  369 ;  rupture  of.  111;  tuberculous  dis- 
eases of,  232. 

Long  Island  College  Hospital  reports,  104,  154. 

Loomis,  Dr.  A.  L.,  physical  exploration  of  abdomen,  388, 
438,  634. 

Lower  jaw,  new  mode  of  treating  fracture  of,  324. 

Lunacy,  review  of  reports  on  in  France,  14. 

Lung,  treatment  of  haemorrhage  from,  534. 

Lyman,  Dr.  H.  M.,  letters  from,  68. 

M. 

Malarial  fever,  quinine  as  a  preventive,  228. 

Malpractice,  duties  of  a  medical  witness  in,  474. 

Mammary  gland  in  the  male,  231. 

Marsh,  Dr.  E.  J.,  Csesarean  section  by  a  cow,  148. 

Maudsley,  Dr.  H.,  review  of  work  by,  423. 

Maury,  Dr.  R.  B.,  hepatic  abscess,  241. 

Maxilla,  removal  of  osseous  tumor  from  superior,  145. 

Measles,  prophylaxis  of,  260. 

McClellan,  Dr.  E ,  chloroform  as  a  therapeutic  agent,  219. 

Medical;  advertising,  89,  95,  871 ;  cliquism,  849;  evidence 

in  law,  183 ;  schools,  examination  for,  181 ;  teachers' 

convention,  86,  130. 
Medical  Society;  of  County  of  New  York,  89,  112,  139,  368, 

417,  498;  of  State  of  New  York,  report  of,  553. 
Medicines,  our  knowledge  of,  44. 
Medico-legal  Society,  organization  oi,  301. 
Medulla  oblongata,  action  of  hydrocyanic  acid  on,  457. 
Meigs,  ProC  C.  D.,  review  of  work  by,  169. 
Meningeal  apoplexy  in  new-bom,  112. 
Menorrhagia,  tr^tment  of^  251,  821. 
Menstruation  in  the  male,  83. 
Mental  labor  and  physical  exertion,  432. 
Merrill,  Dr.  A.  P.,  biberine  iu  uterine  disease,  7. 
Methylene,  bichloride  of,  466. 
Metropolitan  Board  of  Health,  874. 
Mica,  new  uses  for,  311. 
Midwives,  a  call  for,  470. 
Milk,  breast,  prejudices  against,  180. 
Mind  review  of  book  on  physiology  and  pathology  of,  428. 
Mini^ball,  expectoration  oC  179. 
Monster,  anomalies  in  a,  283. 
Morbus  coxarius,  resection  of  femur  for,  17. 
Morgan,  Dr.  Cbas.  E.,  anatomy  and  physiology  of  skin,  73 ; 

obituary  notice  of,  311. 
Muscular  fibre,  contractility  of,  307. 
Muscular  force,  production  of,  247. 
Muscles,  contracted  treatment  of,  418. 
Myrbane,  poison  by,  455. 

N. 
Nerves,  emotional  disorders,  review  of  work  on,  426- 
New  York  Academy  of  Medicine  reports,  41,  95,  168,  183, 
284,  344,  368,  451,  472,  499,  619. 


New  York  Hospital  reports,  514. 
New  York  Medical  Journal  Association,  40,  499,  528. 
New  York  Medioo-legal  Society,  408,  474,  499,  545.   . 
New  York  Pathological  Society  reports,  17,  68,  88, 112,  185, 

160,   185,  207,  281,  256,  283,  302,  320,  299,  413,  448, 

475,  497,  525,  544,  670. 
Nitrous  oxide  as  an  aniesthetic,  77. 
Nursing,  artificial,  consequences  of)  400. 


Obstetrics,  review  of  work  on,  169. 

Old  folks,  number  of,  220. 

Ogden,  Dr.  Benj.,  obituary  notice  of,  215. 

Os  uteri,  case  of  occlusion  of,  323. 

Os  calcis,  case  of  excision  of,  171. 

Osteomyelitis,  case  of,  257. 

Ophthalmoscope  and  renal  disease,  135. 

Ophthalmological  Society,  review  of  transactions  of,  182. 


Operations,  over-eating  as  a  risk  in,  391. 
Our  therapeutics,  13. 

Ovariotomy,  cases  of,   70,  192,  207,  213,  231,  245,  268,  856, 
619. 


Paralysis,  electricity  in,  148,  361. 

Parker,  Dr.  Willard,  operation  for  abscess  of  appendix  verrai- 

formis,  26 ;  ligature  of  subclavian  artery,  97. 
Paris,  medical  matters  in,  212,  303,  851,  376,476,  501,  547, 

572. 
Patella,  treatment  of  fractures  of;  198,  221. 
Pericardium,  rupture  of)  400 ;  needle  in,  119. 
Philadelphia  County  Medical  Society,  42.  92,  165. 
Philadelphia,  medical  matters  in,  187,  234,  356,  427. 
Phthisis ;  in  Barbadoes,  828 ;  mode  of  propagating,  466 ;  raw 

flesh  in,  394. 
Phymosis,  congenital,  and  epilepsy,  444. 
Physician,  novel  mode  of  swindling  a,  212. 
Physical  exercise,  abuse  of,  432. 
Pinkney,  Dr.  H.,  artificial  anus,  228. 
Placenta,  retained,  homceopathic  treatment  of,  399. 
Pleurisy  in  infant,  19. 

Pneumonia,  cases  of  abscesses,  following,  226. 
Poisons,  animal,  causes  of  activity  of,  391 ;  review  of  work 

on,  425. 
Pomeroy,   Dr.   0.   D.,.  chloroform   in  suicide,    65;    use  of 

Eustachian  tube,  317;  Eustachian  catheter-holder,  408. 
Poor-houses,  condition  of  in  New  Jersey,  216. 
Post,  Dr.  A.  C,  morbid  affections  of  fingers  and  toes,  201 , 

abscess,  818. 
Post-mortem  needles,  new,  descriptions  of)  238,  833. 
Prescriptions,  remarks  on,  853,  421. 
Prescriptions  and  their  ownership,  261,  470. 
Prognosis,  uncertainties  o(  897. 
Prolapsus  uteri,  electricity  in,  169. 
Prostate,  inflammation  of,  arsenic  in,  227. 
Pruritus  pudendi,  remedy  for,  11,  492. 
Psoas  magnus  muscle,  acute  inflammation  of,  435. 
Puerperal  convulsions,  remarks  on,  8,  32,  252,  299. 

R. 

Rachitis,  treatment  of,  371. 

Radius  and  ulnb,  complete  lateral  luxation  outwards,  387. 

Railroad  collisions,  prevention  of,  504. 

Railway  injuries,  review  of  work  ou,  230. 

Recto-vaginal  fistules,  remarks  on,  433. 

Rectum,  glass  bottle  in,  262 ;  polypus  of;  317. 

Rhyncosa  excavata,  properties  of,  368. 

Richardson,  Dr.  Joseph  G.,  thermometry  in  diphtheria,  217. 

Roberts,  Dr.  W.  C,  epidemic  contagion,  165  ;  cholera,  89. 

Rockwell,  Dr.  A.  D.,  medical  use  of  electricity,  1,  98,  148, 

169,861,409,486. 
Rogers,  Dr.  S.,  extra-uterine  foetation,  22 ;  letter  from,  263 ; 

protective  use  of  quinine,  292. 
Roosa,  Dr.  D.  B.  St.  John,  clinical  papers  on  ear  diseasea, 

889,  460. 
Rubeola,  peculiar  form  of  eruption  in,  228, 


Digitized  by 


Google 


682 


CQrUents  of  Volume  11. 


Rash  Medical  (DoUoge,  Chicago,  383. 
S. 

Sacro-Ulac  junction,  caries  of,  88; 

Salisbury,  Dr.  J.  H.,  stelline,  629. 

Sayre,  Dr.  L.  A.,  letters  from.  359,  453. 

Scarlet  fever,  remarks  on,  91,  260,  868,  441. 

Scapula,  removal  of,  491. 

Schmid,  Dr.  H.  E.,  atomized  lime-water  in  croup,  78. 

Scfofulosis,  remarkH  on,  66,  79,  102,  870. 

Scrotum,  restoration  of  atter  sloughing,  269. 

Sea-sickness,  remarks  on.  337. 

Seguin,  Dp.  E.,  ether  vereus  chloroform,  44. 

Semilunar  valves,  rupture  of,  283. 

Sexes,  production  of  at  will,  24. 

Sexual  organs,  review  of  work  on,  17. 

Shaffer,  Dr.  N.  M.,  letter  from,  811. 

Shaw,  Dr.  H.  L.,  aural  catarrh,  27. 

Shock,  advantage  of  position  in,  846. 

Shoulder,  old  dislocations  of,  new  method  of  reducing,  235. 

Sigmoid  flexure,  cancer  of,  399. 

Skin,  some  points  in  the  anatomy  and  physiology  of  the,  73. 

Smith,  Dr.  J.  Lewis,  infantile  apoplexy,  112;  pleurisy  in  in- 
fant, 19. 

Smith,  Dr.  Nathan  R.,  review  of  work  by,  255. 

Societies,  publication  of  reports  o^  234. 

Sound,  effect  of  absence  of  on  mind  and  hearing,  482. 

South,  congestive  fever  in  the,  215. 

Speciahsm  and  general  medicine,  517. 

Speculum,  description  of  a  self-retaining,  481. 

Sphygmograpb,  cautions  in  regard  to  use  ofi  59. 

Spine,  review  of  work  on.  111. 

Splanchnoscopy,  remarks  on,  468. 

Spleen,  enlarged,  diagpnosis  of,  273. 

Spurious  vaccination,  review  of  work  on,  183. 

Stelline  and  stellurine,  529. 

Stiles,  Dr.  R.  C,  herpes  circinatus  from  achorion  in  mouse, 
340. 

Stirling,  Dr.  T.  B.,  rupture  of  vagina  in  labor,  510. 

Strabismus,  modlHcation  of,  the  operation  for,  11. 

Stricture,  effects  of,  571. 

Strychnine  poisoning  treated  by  chloroform,  22. 

Stomach-pump,  substitute  for  the,  192. 

Stomach,  probable  gunshot  wound  of,  497. 

Stone,  Dr.  Warren,  on  yellow  fever,  364, 

Suture,  new  form  o^  204. 

Sulphur  in  croup,  872. 

Sweating,  sage  tea  for,  336. 

Subclavian  aneurism,  case  ofj  233  ;  ligature  of,  97,  412. 

Syme's  amputation,  value  of,  40. 

Synovitis,  electricity  in,  148. 

Syphilis,  mercury  in,  804. 

Syphilographers,  incidents  concerning,  307. 

T. 

Taenia,  new  method  for  expelling,  441. 

Tannin  as  a  haemostatic,  372,  392. 

Taylor,  Dr.  0.  F.,  nitrous  oxide  as  an  aniesthetic,  77  ;  hip  dis- 
ease, 289. 

Teeth,  the  reason  for  caries  of,  171. 

Teeth,  artificial,  new  base  for,  336. 

Tendons,  contracted,  treatment  of,  418. 

Testicle,  abnormal  position  of  the,  803 ;  cancer  of)  207. 

Tetanus,  recoveries  from,  442. 

Therapeutics,  review  of  work  on,  568. 

Thigh,  new  splint  for  fracture  of,  600. 

Thorns,  Dr.,  alcohol,  or  fatality  of  cholera,  67 ;  hereditary  ten- 
dency to  haemorrhagic  diathesis,  19. 

Thomas,  Dr.  T.  G.,  uterine  pathology,  498. 

Tobold,  Dr.  A.,  review  of  work  by,  206. 

Toes,  lectures  on  certain  affections  oC  201. 

Tonsillar  concretion,  a  case  of,  413. 

Townsend,  Professor  Howard,  death  of,  46. 

Tricuspid,  direct  murmur.  259. 

Trichiniasis  and  its  effects  on  an  unbeliever,  608. 

Trichinosis,  nature  of,  88. 


Trichins,  weight  of,  480. 

Trousseau,  death  of,  264. 

Tsa-Tsin,  as  an  enunenagogue,  366. 

Tubercle,  inoculability  o^  108,  572. 

Tuberculosis,  lectures  on,  56,  79,  102. 

Tumors,  lectures  on,  487,  512;  abdominal,  difficulties  in  the 
diagnosis  of)  369;  electrolytic  treatment  of,  108;  re- 
moval of  deep  cervical,  173. 

Turkish  baths,  some  ideas  concerning  their  utility,  117. 

Turner,  Dr.  W.  Mason,  vesical  calculus,  460 ;  anapbrodisia, 
297;  sea-sickness,  337. 

Typhus  fever  treated  with  tea,  264. 

Typhoid  fever,  a  diagnostic  and  prognostic  sign  in,  156. 

U. 

Ulna,  luxation  of,  263,  310,  387. 

University  of  Pennsylvania,  reports  from,  418. 

University  of  Washington,  account  of,  408. 

Urea,  source  ofj  94. 

Urethra,  discharge  of  worm  through,  174. 

Urethritis,  starch  injections  in.  394. 

Urinary  calculi,  330 ;  organs,  pathology  of,  606. 

Urine,  extensive  diabetic,  examination  of,  180;  extravasation 

of  urine,  416. 
Uterine;  applicator,  478;  disease  at  conception,  259;  element 

in  practice,   205,   262,286,  332;  elevator,  a  new,  115; 

pathology,  history  of;  499 ;  pessary,  description  of  a  new, 

428. 
Uterus,  adventitious  growths  in,  78;  extirpation  of,  36,  297, 

898,  605 ;  fibrous  tumors  of,  62,  570 ;  laceration  of  by 

sound,  499 ;  present  raid  on  the,  455 ;  inverted  action 

of,  556. 
Uvula,  treatment  for  relaxed,  84. 


Vaccination  cicatrices  and  revaccination,  563. 
Vagina,  rupture  of,  during  labor,  610. 
Varick,  Dr.  T.  R.,  lateral  luxation  of  radius  and  ulna  out- 
ward, 387. 
Variola,  preventing  pitting  in,  891. 
Velpeau,  obituary  notice  of,  833. 
Ventilation,  active,  869. 
Ventricle,  left,  rupture  of,  185. 

Vermont  Medical  Society,  review  of  transactions  of,  159. 
Vesical  calculus,  case  of,  460. 
Vesico-intestinal  fistula,  208. 
Vesico-vaginal  fistula, <emark8  on,  433. 
Vinegar  to  detect  sulphuric  acid  in,  71. 
Volume  II.  of  Medical  Regobd,  close  of,  665. 

W. 

Warren,  Dr.  J.  M.,  obituary  notice  of,  334. 

Watts,  Dr.  Robt,  obituary  notice  of,  404,  454,  479. 

Weaning,  practical  remarks  on,  87 1. 

Wells,  Mr.  T.  Spencer,  visit  of,  360 ;  ovarian  tumors,  356. 

Wet-nursing,  mortality  attending,  61. 

White,  Dr.  F.  V.,  fracture  of  patella,  198,  221. 

Whitehead,  Dr.  W.  R,,  treatment  of  delirium  tremens,  840 ; 

osseous  tumor  of  jaw,  145. 
Wilson,  Dr.  G.,  restoration  of  scrotum  from  sloughing,  269. 
Wistar,  Dr.  Caspar,  obituary  notice  of,  119. 
Woman's  Hospital,  New  York,  account  of;  404. 
Wood,  Dr.  George  B.,  review  of  work  by.  668. 
Wood,  Dr.  James  R.,  reproduction  of  bone,  269. 
Wormley,  Dr.  Theo.  G.,  review  of  work  by,  425. 
Worms,  discharge  of  through  urethra,  174. 
Wright,  Dr.  H.  G.,  review  of  work  by,  668. 


Yellow  fever,  remarks  on,  321,  327,  364,  374. 


Zinc!  chloridi  liquor,  in  gonorrhoea,  881,  427. 

Zymotic  diseases,  present  state  of  knowledge  regarding,  344. 


igitized  by  VjC 


Digitized  by 


Google 


Digitized  by 


Google 


Digitized  by 


Google 


Digitized  by 


Google 


iitized  by 


Google 


Digitized  by 


Google