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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. 

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'fi 



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



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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 

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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 
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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. 



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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 



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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 



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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- 



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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 

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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. 

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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 
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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. 



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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 



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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 



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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 



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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 



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THE MEDICAL RECORD. 



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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 

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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- 

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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- 

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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- 



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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 

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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 woorv m d 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 
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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 

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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^ 
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82 



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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. ^^ ^ 

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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 

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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 

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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 
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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. 

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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 
m ea su re, 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* 
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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. — 

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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. 



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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% 



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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- 
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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 
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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 
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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 ^^ ^ 

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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 

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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 t mcio m $ nU 

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THE MEDICAL RECORD. 40 



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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. 



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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 



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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 

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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 



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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 



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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. 



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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, 



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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 

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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 
transatla n tic 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- 



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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^^ 
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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, 



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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. 

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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- 
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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, 



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€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 

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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 



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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 

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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 

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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. 



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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 

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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- 

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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, 

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"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* 



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^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 
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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^ ♦ \ 

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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.*' 



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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->. 

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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. 

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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. 

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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 

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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 

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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 

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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. 

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 O oWVULfllVl 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 e xe e ooi Te 
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- 
w togical 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, 



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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. 



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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 



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(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. 



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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 
co mfi itts 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 
esta hl i flh 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. 

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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 

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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 

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*'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 : 

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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 

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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> 

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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 
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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- 
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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 

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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 

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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 



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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." 



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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 s