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CANADA 

MEDICAL  AND  SURGICAL 

MEDICAL  AND  SURGICAL  SCIENCE 

EDITED     BY 

GEORGE  B.  FENWIOK,  M.D. 

IBQEBV,  MoQiLL  UnIVKBSITT  ; 
HoHTtKAL  nENEBAL  HogrmL 

"VOL.    "VII. 


^ontrral : 

iraiNTBD  AND  PUBLISHED  BY  THE  fiAZETTB  PRINTINa  COMPANY. 
1819. 


c    ^- 


INDEX  TO  VOL.  VII. 


Abnor 
Abvrli 

Tits 
^^ 

orale  Rectu 
m  of  Ibe  I 
ed   by   the 

■% 

Ac»W 
A  huge 

raly«« 

.■'."■.i.-i,i„: 

ir 

Aneuri 

"r.!»-<,«7: 

Aneun 

m    uf    the 

Subolavian  u,d 

der 

riat"!,"!}: 

7; 

BelEiulo 
BelH 

breatment  of  la- 
'(Sses'of  Intei^ 

on  cues  of  Ura- 

'7 

Bullet  wDund  of  the 

skiill 

Cases  in  SuisicaJ    Practice,  by  Mr. 

JonaCban  llulchinaon .'^ 

Caaea  treated  with  TheiDo-CautBre, 


_r.  Roddi™        

CaoHOtion  of  Septicemia  3T>i 

CaiiHs  and  ours  of  InHOmnift H5 

Caustic  Alcohol! zzi 

Orebml  Locallutioa  and  Ampnta- 

ti™  of  EilramiUea 37 

CeuatioD  of  Epilapiia  flU  and  ultl- 

Uhlurai  Hydrate '.'.'.. '.lll'.'.'.ias'i S«& 

ChloThydrate  of  Pilocarpine  in  Op- 

thalmic  Praotioe I<^> 

" Ih  Catnphor ....  2a(l 


Coi 


^(ihnheitu'e    Theory  of  TumouT>.~- 

"-"-  "-'--'Continued) St 

>r   ChlurDfonn   and 

Kidney..':    :] 


Murpbi-    

Cuiisenital  absence  of 

CoDgenilsl  Inituinal  Hernia 

Coulnittion    of   KiRfat   Side   of 

Chest.    A  OinicHl  Lecture. 

Dr.R.P.  Howard 

Copaiba  in  C^rrbojiB  and  Jaundice 


PlQE 

OORBEBPONDENCE  ; 

Letter  from  London.  By  Geo.  Ross, 

I*t''"jj'  f™  i^'riii '  bV  Geo.'  Ross*.   '* 

Lettiir'f™  "Gdinbu^h''"B;' J!    * 

lietlerlromDr.  0  Leary 331 

Proceedings  of  the  Medioo-Chirur-  / 

aieal  Society  of  Montreal,  Hay  / 
loth  and  MaySOth,  Dr.  Edwards,  ' 
SecreUry    jffi 

Cystitis  by  Contagion '. 557 

Deaf-Mutum... see 

Deacnption  of  the  Conjoined  Twins. 

,      By  Dr.  MaoCallum 97 

Diagnueb  and  Treatment  of  Abdo- 
minal Tttmouis    39 

Dislocation  of  the  Hip 529 

[luncan,  U.  C,  M.D..  L.R.C,a..  Edin., 
?f  t.^"  j"^  Sound  for  examining 
the  Bladder 302 

EllIKIRIAl: ; 

Yellow  Fever  in  the  South 93 

Marke  of  Murderous  Violence n 

the  Bones  in  Pernicious  Aoiemia. .    95 

The  RBcognition    of  Culaniai  De- 
Colonial  Degrees :.'.*.'  237 

Dinner  to  Dr.  Andrew  Clark     24U 

The  PrasB  as  an  Educator 285 

TrommerKjtractof  Malt 288 

Canada  Vine  Uruwers'  Association   SSI 

Medical  Items        2SS 

Coroner's  Inquests 329 

Letter  from  Dr.  O'Leary    331 

Pond  8  Improved  Snhygmogrmih  ..  33S 
The  Registration  of  Uritish  Qualifi- 

Aecident  to  Dr.  Henry  Howaid '.'.'..  3*1 

A merioan  Health  Pruners 38Z 

Medical  Items  of  News 3S4 

McOill   University  Proceedings   of 

Convocation  433 

College  of  Physicians  ind  Surgeons 

ofOntario....  .     ..; 476 

A  Private  Hospital 479 

Medical  Items 48O 

Mctures  from  Parisian  UospitalB  . .  480 

Warner's  Pills  of  Quinine 524 

Registration  of  Colonial  Degrees.. .  KS 

Estraetof  Malt ^7 W 

Medical  Item.    Dr.  Chs.  H.  Murray  52» 

profession  of  Medicine  &  Surgery 
mProTincaof  Queheo- 670 


243593 


CbdiuIb  Mudioal  AiSMiBtion 6 

A  Pen  wont  recmmending S 

Med  ioul  Items - i 

EdwnrOa,  Oliver  C.  M.D.  P^iemui 
tmd  Death,  rollowinc  the  eutljnc 

Enterotomr  ,-■- 

GrgaliiiiDBSUe  of  UUrioeBbruid.  -  S 

Etythema  NodtHnm 

Kitrophy  of  tbe  HeHrt 1 

FenwI<ik.O.E,,M.D.  OueofUiBlu- 
catioD  of  the  Hip  Joint S 

FiDWlek,  Oeotxe  S.,  H.  D.  Ra- 
movai  of  end  uf  Jteetum  fur 
Bpithilioma  I 

Feniriok.  i9.  R,  M.D.  Valediutury 
AddreutotheQraijDMediD  Med- 
idne  uid  Surier>-.  MoUill  Uni- 
VBisily S 

Five  Fatal  Ciue>  of  Cirrhojiti  uf  the 
Ijver,  Willi  Autopaiei.  By  Geo. 
R™b,A.M.,M.D 3 

Formulary.  Goat  Speoiflc I 

Fraoture  ot  the  Patella  PleDin  Pueu- 
monia  and  Thrombons  of  Ful- 
monaiy  Artery,     fir   Rndf er  .. .  i 

Fuolunii  in  Chronio  Nephritia  and 
ItTOply  S 

Uhji^biib  a[    the   Lnog  treated  by 

Qaa  in  Perittmeal  Cavity  reiieved  by 
Puncture 5 

Uutro-Klytrotomy  i 

General  Trefttmanl  of  tbe  Ineiuia. 
Dr.Howard  t 

Oun  Shot  Wound  of  the  Brain,  Case 
of  Reeovery  rrom 1 

HiLrmletnieBB  of  DrcuL  in  the  Blnul   -  1 

Head,  Henry  U..M.  D.,  on  Aneurism 

of  tbe  InnomiiiiLte  Artsrv  cured 

by  tbe  Uolhod  of  lufnell 

HijairriL  Rkfobtb; 

Ounshot  Injury  ofFeinoral  Artery 

C»e  of  Dislocition  of  itae  Femur 
into  the  Foiameu  Ovali,  under 
Dr.Reddy 

Case  of  Acute  Tubercnloais,  undar 
Or.   Keddy.      Reported    by   Dr. 

Case  'or^AneuriBm'nf'the'iiio^ie 
Aorta,  under  Dr.  Reddy.  Re- 
ported by  W.  R.  Satberland.  Eiq. 

Cue  of  Pysmia,  under  Dr.  Wil- 
kins.    Hepoited  by  James  Bell. 

Puerpsial  Balajnpsia.  under  Dr. 
HacCatlnm.  Reported  by  Mr. 
W.  R.  Sutherland! 1 

LaryuRBsl  Dinbthoria— Traeheotu- 
my— Reeovery.  Under  Dr.  Roil- 
diek.  Reported  by  B.  N.  Vino- 
ben,  M.D 1 

Comminuted  Fruture  of  the  Fifth 
Cervieal  Verlebrw,  under  D». 
Roddick.     Reported    by    James 


Ball,  A 


Cue< 


r  StranpJaCi 


Oblim 


■  In«- 


Cnse  of  Ounehot  Wonnd  of  the 
brain— Recorery.  UnderUr.  Fen- 
wtok.  Reported  by  Mr.  H.  W. 
Lloyd  25* 

Tumour  litnated  over  tbe  Parotid 
Gland  removed  by  Dr.  Fenwiok. 
Reported  bv  Mr.  ThamiM  Gny-  S33 

Case  of  Diphtheria— Sodden  Death. 
Under  the  care  of  fir.  Rou.  Rs- 
iwrted  bv  Mr.  Imrie 3P6 

ULSeoDH   DeKeneration    of    Lddr — 

Dr.     Ross.      Reported    l>y    Mr. 

tjutherlojid  'jm 

ComiiDUnd   Comminuted    Frauture 

Dr.  RcJdSck.  Reported'  by  Mr. 
J.A.  MoArtbur 3» 

Case  of  Malignant  BpulU— nartiul 
removal  of  ^Ih  Superior  Haiil- 
lull  under  Dr.  Kuddick.  Reported       , 
by  Mr.  H.  B.  Gray 380 

Compound  Fracture  of  RodlUB  aud 

^  Ulna,  treated  ADtlseptiaally.  un- 
der Dr.  Roddick.  Reparled  by 
W.  H.  Bnrland.M-D    303 

Uiuera'  Pbtliiiri«.  under  Dr.  Oiler. 
Reported  by  Mr.  Bankin  Dawson.  452 

Acute  Bricht't  Uiieaw  In  a  Child, 
under  Dr.  Oiler.  Reported  by 
Mr.  Andrew  Hendenon 4SS 

Strangulated  Obliyue  Inguinal  Her- 
nia Operation— Death.  CnderDr. 
Fenwiok.  Reported  by  A.  W. 
lHirio,M.D 48S 

Aphasia  with  riKht-sided  hemiple- 

liiider  Dr.  Outer.    Reported  by 

D.  Mignault,  B.A iS3 

Acute  Rheumatism,  treated  by 
SsliDylaie  of  tjudn.  under  Dr. 
Osier.  Reported  by  B.  K.  Mac- 
Keuiie.B.  A  «« 

Howard.  Henry,   M.  D.,  M.  R.O.S., 

Eng.,  Preaidenlial  Address  de- 
livered before  the  Medioo-Cbi- 
mriicul  Society  of  Montreal lEfl 

IlowaH.  Henry,  M-D..  M.R.O.S., 
Bur.,  Responsibility,  Crime  and 
Innanitv 34T 

Ho»iiH.  Henry.  M.D.,  M,H.O.S.. 
Eni..  on  the  Ueneiol  Treatment 

Huward,°R.  p' u'.'a.',''i.a.ci8^, 
Edin.,  Uinioal  Lseture  On  a  Oise 
iif  ooiitraetioD  ot  [be  right  side  uf 
the  Cheat. Ml 

ButabiiiHoa.  J.  A.,  M.D.,  CM.,  Case 
of  Partial  PtoeentaPnevi* SO 

Hypudermic  Inieetion  of  Dhluroronn    33 

llypodermio  ilqjeotlaii  (of  Diolyaed 
Iron  in  Chloroiiii 235 

Idioniilbio    Mydriasis  Itreated   with 

Infandl'TDimhMoranmmer  ■''-''."  S3 
Influence  of  Syphilis  on  the  cuntM  of 

Woundi    12! 

Intercaiwl  Dislocation MS 

Intermittent  Favei— Ita.  BeU 631 

Intermlninaual  Spinal  Hnmorrhages 

simulodnt  Poison  by  StiyohiJne.  )I66 
IntHtin^  Obstruetion  and  Death ....  464 
Intravenoua  InjeeCiDD  of  Auimoii'*  .'  G13 


iDtTodactoiT  AddrcBs  U  ths  Dpeniiig 
of  the  Mediosl  Ssmjod,  McOm 
DuiceraUy.    By  Dr.  Roddiok  . . . .  14 

lodtds  of  Patassium  in  aiaall  doiea 
iDpenuMntromJCiaft    Z3 

lodofomi  u  ■  local  soiesthetie  Zl 

lodororm  in  Ulaadutar  SneUiwra  ...    18 

Jmbotmndi   S 

UwTKidi  ia  tha  AlbumiiiDru  ol 
Pregoancy 37 

iMite  Dosea  of  Belladonna  in  iDtes- 
tioM  Obstrootion 23 

Ij«»lu«  of  the  FemomL  ArWn 18 

LitDotomr  —  Removal  of  enlarged 
middle  Lobe  of  the  ProaUte 
Qlsod. a 

HuCallam.  D.  C.  H.D..  M.R..C.8.E. 
DawiiptioD  of  tha  Conjoined 
Twina(wilh  plate)     S 

Macdonald,  J.  W.,  M.D..  H.RC.8., 
Eos.,  Traehealomy  in  lAryngeal 
Diphtheria  , a 

HacDonnell.  Rioharj,  B.A.,  H.D., 
H.ILG.S.,EiiB.  Tbrea  Cues  of 
Ualianant  Disease 

Haltine 

Hsmmaiy  Abscsag.  by  Dr  Shephi 

Medical  Tans'  in  Qennaiiy 

HoiemenU  or  the  Eyelids  

Neerotu  nitboat  Soppuratioa    . 

Nephritic  AbacQ&ii 

New    Method    of    Compreisinv 

Iliao  Artery 

Nitrite  of  Amyl  in  Ague   

Notes  on  Military  SurEery.    By  cur- 

geoQ  J.  Lewtas,  H.B. 5C 

Notes  on  Sewer  Gai— PoisuoiDg  by  . .  31 

(Edemaof  the  Feet  iaTyphaid  Fever  ti 

Ophthdmoseonia  apiieanuiceg  in  Ta- 

bercntar  Menincitis- 5i 

On  InsobitiaB  und  Keftige ration ..  ■■■  Ti 

On  Lisleri^m.    By  Dr.  Roddiek 21 

On  the  abortive  treatment  of  Syphilis  1 
Onihe  treatment ot  Diphtheria  ....21 
On  the  treatment  uf  Diseases  of  the 

&lon 31 

On  Uleerition  of  the  Fmnum  Un-  , 

Os!e1?^ni..^M^?M,R;c!p.;  Lond.',  '' 
Cohnheim'sTheoiTofTumauni..  3S 
Osier.  Wm..  M.D..  M.R.C.P.,  Lond., 

Theory ot Tumoun  (continued)..  Ji 

Paracentesb  Abdominis  by  gradual 

drainage  with  a  single  oanula —    f 
Partial  IMacenla  Pnevta.    L)r.   Ilat- 

Feculiaritie's  *  in  "  Might '  SweatB*  ol 

Phthisinl K 

Personal - 11 

Pbtliiais  and  its  Vsi^eties,  a  Lecture. 

by  Dr.  Andrew  Clarke  .-..'. 13 

Pilocarpin  in  Children's  Diseases...  Z£ 
Popliteal  Aneurism   treated  by   Es- 

msrch'ij  Bandage  2( 

Prevention  of  Relapses  in  Typhoid 

Presidential  Address,  delivered  bo- 
forc  the  Hedico-Ctdrurgical  So- 
ciety of  Montreal. by  Dr.  Homnl  1£ 


Paok. 

itus  Vulva 377 

asis 89 

Psoriasis  VuWria 90 

"  smia  and  Death  following  the  out- 
re Anomaly— A  Sincle  Kidney 475 

__jmarkable  Operation  512 

Remedies  for  Mas^tis  Puerperalis, 
ind  Eicoriatidand  Fissured  Nip- 
Dies  38 

LovaJ  of  the  Astragalus \SB 

loval  of  the  end  of  the  Rectum 
.'or  Epithelioma,  bv  Dr.  Fenwick.  100 
Responsibility    and    Irresponsibility 
m  Crime  and  Insanity.    By  Dr. 

Huward M7 

iport  uf  a  Case  o(  Malignant 
Cholera ■ 134 

REvrKWH  AHD  NoTJClB  OF  BoUKS  : 

A  Mnnnal  of  Operative  Surgery. 
By  L.  A.8timaou,B.A..H.D....    20 

Fowns'  Manual  of  Chemistry.  By 
Henry  Watts,  B.A.,F.R.S 21 

Nervous  Diseases,  their  Descrip- 
(ion  and  Treatment.  By  Allan 
McLaneHami1ton,M.D... 22 

Transactions  of  the  American  Oy- 
nscolosical  Society.    Vol.  2 24 

Transactions  uf  the  Medical  As- 
sociation of  Georgia  tor  ISTS   ....    70 

The  Throat  and  its  Diseases.  By 
Lenox  Browne,  F.R.C.S.E 74 

Analiomy— Descriptive  and  Sur- 
gical.   ByllenryUray.F.K.8. ...    7H 

The  Physicians'  visiting  List  tor 
1879 118 

Elementary  Quantitative  Analysis. 
By  Alexander  Classen 118 

A  tinlde  to  the  Pnuitiool  Examina- 
tion of  Urine,  By  James  Tyson, 
M.D 119 

The  Anta«onia[u  of  Therapentio 
AgenU.  ByCMiloerFotboivill, 
MTD .' "...'ISO 

A  Clioioal  Hislnrr  of  (he  Medical 
andSurgical  Dlaease«  of  Women. 
By  Robert  Bomos.  M.D.... m 

Transactions  of  the  Pathologiual 
Society  of  Philadelphia.    Vol.  7  108 

A  Treatise  on  the  ^icni-e  imd 
Ptw-tioe  of  Midwifery.  Uy  W.  :<. 
Playfair.  M.D.,  P.R.I5.P  170 

KlemcDiaiiy  QoaatltalivF  An;iKi>ii. 
By  Alexander  Clanon ITl 

The  Uniiioic  Conftitueots  ■A'  Plaiile 
pLod  Vuuelable  gubstaucctt.  By 
l.r.  It.  Wittrtein      m 

(J)-.'lii|.ifJiu  nf  the  Praolieo  oFHed- 
K'ri.L-.    Von Tlumsiren.   Vol.XVH2ie 

"II  lient  and  Pain.  By  John  llil- 
Um.F,H.S 221 

Cyclopedia  of  [he  Praclic^e  <ii  Meiii- 
cine.    Vol.  XHI 222 

Tha  Principles  and  Prautm,.  ..ISiir 
■ery-  Vol.  L  By  IJ.  Iliiv,..- 
Agnew,  M.D..  L.L.D 258 

Practical  Sui^err,  inuludiUK   Sui- 

S'cal    UresKing    and    Bandaeiiie, 
yj.  EwingMear«.MD Dii 

The  Patliological  Anatuoir  of  the 

Ear.    By  if.  Sehwartie,  M.D  . . . .  2S3 
Essentials  uf  Ohemietry.    By  R.  A. 
Withans,  A.M..  M.D Xa 


A  Pnotittl  TmtisB  on  tbe  Medioul 

•nil  KnnrloftJ  Uxea  of  ElecIriDit;. 

Bk  Un,  Board  sod  RocknelJ 31S 

l«u  or  Wolfbl.  Blood  Bnllting  and 

t.uDi    Dliicus.     By   Hnrui    Do- 

Ml,M.i> 320 

tllMua  uf  ibo  BlBddar  and  Uretb  m 

la  Wommi.  By  4.  C,  Skene.  M.I).  321 
HiuidkI  of  Plirnml  DiumDiiii.    By 

Fruab  DtUfleld,  MId 3:22 

A  PnciiMl  Muiuol  uf  iJia  Dbwteas 

ur  ClilldrBU.  with  a  Punnulary.    __ 

Br.  K.  ICJIIa.  M.D 3SS 

Indux  Uedimiii.    Dn.  Billinga  and 

MetohBr 324 

A  Maimal  of  the  PrBotias  of  Sat- 

tsry.  ByThanuu Bryant. K.R.US.  3t» 
'riiB  Frliisjiilee  and  Practice  ufSnr- 

!m.7i'..   ..I"..." f.."",'.. ..''.' 364 

Uaneial   Suiiiital    Fatbolotiy   and 

Tfasn>]>«ulii».   By  Ur.  Theu.  Bill- 

n>tL 36.5 

Looturei  <in   Uib   Lodsliiutiua   of 

DIhhuu  of  the  Brain.  ByOhnroot  409 
Leolnroa  on  Brlghl'i  Diaeiue  of  Iho 

Kldneyi.    Ibr  J.  M.  Oharuul 410 

PhnlaloiriiMl  TlieraiWDtioa.    A  now 

ThMry.   By  Thomas  W.  Poole. 

M.D 411 

Tba  •Nalional   Diaptnwtory.     By 

6Ui\iii.od  UaiBoh 456 

Cliniiial  IiwtnrBii  od  Diaewcu  ■>«- 

cullar  to   Womaa.      By    Lombe 

Atthill    4^'>- 

Hedloal  OhemittTy.  lacludinic  ttie 

Ontliues  of  Otgania  mid  Palhu- 

lofical  ChemUtiy.    ByC.  Uilbort 

Wheeler 4SS 

Healtth  PrlniBn,  No.  I.    Eieraije 

imd  TndBing.    By  W.  B.  Uraeo- 

flold,  M.I> *SH 

Auwrluiui  Health  Primeis.    Hcii.r- 

inB  luid  how  tu  beep  it-    By  Clu. 

H.Bntnett,  M.D  460 

Clininal  IiwtiBc  on  Disaiaes  of  the 

Uver.  By  Dr.  F.  Theod.  Frericba  4UI 
Atl*»  of  Human    AaatoiDy— Part 

111.     By  lUckniaon  J.  (loodlnc. 

F.R.S 463 

Tablets  of  AitBtooiy  and  PhyniDlocy. 

I^TbomM  Cooke,  F.B-U.S 462 

Ctoal 4«S 

An  Inlrodnotion  to  PatfaoIoET  and 

Morbid    Anatumy.      By    T.    H. 

Green,  M.D. 46S 

A'PnctiiwI  Treatise   uu  Siuviniil 

DiacnOBia.      By   A.   L.   Kanney, 

A.M.,  M.D  49H 

Modem  eureioulTherapeutioi.    By 

(1.  H.  Naobeya.  A.M.,  H.U HM 

TrentlBe   on    BiHsaeB   of   Infancy 

and  Ohildhoud.  J,  L.  6uiilh.M.i>.  SOU 
aini«il  Dlacnoaii.    BdiledbyJiu. 

RnUylon.M.D n)3 

Kpltomr  of  Skin  Diieaiea.  By  Til- 
bury. Pux,  H.D.,  F.R.C.P -Wi 

QuI4e  to  the  QualiUtiTo  and  Qun.n- 

tiUtire  Andyein  or  thu  Urine.  Dr. 

CNeubauerandDr.J.VngBl....  tM 
Guido  to  ThenpBUtii39  and  Maleria 

Medloa.  RobL  FWquhanon.M,  [).  W 
Pmotieal  Manual  of  iIib  Di^•8lueB  ol 

Children.    Edward  Ellis.  M.D..      ^VJ 


Koddiok,  Tboa.  G..  M.D.  Cnaet  treat-         ~ 
Bdwitb  tbB Theruia.Caat£r<i  ...-  21 

Roddiek,TbuniasG.,M.D.  InCnxino- 
'toiy  Leoturs  at  tbB  OpBQinK  ut 
Ibe  MedlDol  Sesiion  McdiU  Cni- 

Raddi^,%boiiaB'  0.1  M-'lir  On  't'l^ 

torlim a 

RodcBT,  Tho«.  A.,  M.D.,  on  a  Cue  *f 

IVnatare  uf  tbo  Patella  Thitunbo- 
sis  of  PulinonaTT  Artery  44T 

Rura,  GeoTEB,  A.M.,  M.D.  Hvefotftl 
CasBs  uf  arrfaoiie  ot  the  Lirer, 
with  Antoprisi 38 

RniiturBd  Perieardiiun.  Fractured 
Pelvis  and  Kuptnred  Uratbra. ...  11 

aalioylals  of  Soda  in  Rbeumatism    ■  36 

SBW«ll.Jiia.A..H.D..uu  Iba  Core  oi 

.Aneorlxm  by  Tnlnotl'i  method  .- 

Shepherd,  F.  J-  M.O.,  on  HammarT    ' 

AbscetB S! 

Slonoaia  of  Pulmunary  Artery 1' 

Striflture  of  the  Rectum  treated  by 

InciBion .41- 

StryobniainNoetomalEnarBaia  ....  IW 

Snlphate  uf  Uuluine -    ft 

SuiEieal  Treatment  uf  Bronehoeele- .     °* 

Tape  Worm  in  Cuonmbera 

Tapping  the  Lungs  in  Phthisis  

ThsComJnKDuliiu>uftheA(icoaebear    16 
Tbe    Dilatable    Tampon    to    arrest 
H«mon-hiwe  after  Lilholomy  .-     « 

..jB  Odour  of  Sanctity  W 

Tbe  Past  and  Present—BBforB  am' 
Atler  the  Introdaction  uf  thk. 
Antiseptio  Method  in  SuTKery  . . .  2M 

Tbo  Patbolagy  uf  Rodent  IJIbbf ifli 

Tbu  Physiolngicnt   and  Therapeutic 

Aelion  of  Jaborandi 177 

Tberaiieutiu  Value  of  Crulnn  Chloral  K~ 
The  Royal  Mediual  and  Chirunrleal 
SoBlety  Thyrotomy   in  oblitera- 
tion uf  Iiaiynx 2 

TheSt«maeb  Bandage  in  Aisltes J— 

Tbe Suigloal Treatment  of  Lapoi...  £7B 
Tbo  Treatment  of  Aoote  Obstruotion 

of  tbo  Bowel* 37 

Tbo  Treatment  otPhagedonioUleers.  T 
Tbe  Use  of  Btwrine  in  Qlanoonia . . , .  50 
The  Uie  of  Bntotin Typhoid  Feier..  IT 
Three  Catea  of  Maliitnant  Dlieaie. 

Dr.  HacDonnell 48 

Tight  StrietnrBB of  tbe  Urethra  ....  la 
Treatment  of  Diarrhneii  by  Ozlda  of 

Zioe a 

Treatment  of  Diphtheria 23 

TrBatmeut  of    Henralraa  by  Hypo- 

dermiornieolioneuTBrgot.. 23 

TrBBtmenttol   Mierua   with  Sodium 

Ethyhito     23 

Treatmeut  iir  P^ori.isi*'    ....   - 8 

Trenhfif ■  ^..f..  \-.y,Ar- 33 

Tt«ui"t.  ■'    "  ■    i'''         .  ";    viripMi 

Vmi,  n 

TreiiJ MP...       r,,aa  uf 

"'caics'o'f"..:...'.'!...."*..,.™.,  '..  IS 
Trnoheoiaiuy    in    iMrynceal    Dipfa- 
theriiu     By.  J.  W.  MaoDonald, 
M,D,,M,|t.(.;.S 21 

Traoifuiioii II 


INDEX. 


Vll 


Page 

JawnAtie  Tetanus 561 

TorpeDtine  as  an   External  Appli- 

cetion  in  Small  Pox 48 

Two  Gases  of  Urethral  Fever.    Dr. 

Jas.  Bell 49 

Tee  of  Piloearpine  in  Children's 
Diseases 552 

Urticaria  as  a  Consequence  of  the 
use  of  Sodium  SiUcylate 326 

Uterine  Hemorrhage    •...    47 


Paok 
Valedictory  Address  to  the  Gradu- 
ates in   Medicine  and  Surgery, 
McGill  University.    By  Dr.  Fen- 
wick  385 

Vienna  Letter » 536 

Warner's  Pills  of  Quinine 524 

When    shall    the  Lying-in  Woman 

get  up? 564 

Wound  of  the  Brain  by  a  Pistol  Shot, 

Recovery  from  254 


LIST  OF  CONTRIBUTORS  TO  VOL.  VII. 


-♦- 


Bill,  .Iambs,  M.D. 

BlTRLAND,  W.  H.,  M.D. 

Clark,  Andrew,  M.D.,F.R.C.P.,Lond. 

Dawson,  Rankin,  Esq.,  B.A. 

Duncan,  Gk).  C,  M.D.,  L.B.C.S.,  Ed. 

Edwards,  A.  C,  M.D.,  M.R.C.8.,  E. 

FiNWiOK,  Gborgb  E.,  M.D. 

Gray,  Thos.,  EHtj. 

Hkad,  Henry,  H.,  M.D. 

Hbndirbon,  a.  W.,  Esq. 

Howard,  Henry,  M.D.,  M.B.C.S.,  E. 

Howard,  R.  P.,  M.D.,  L.R.C.S.,  Edin. 

HUTCHINSOH,  J.  A.,  M.D. 

Imrw,  a.  W.,  M.D. 

Lloyd,  H.  W.,  Esq. 

MacDonnbll,   Richard,  B.A.,  AID., 
M.R.C.S.,  Eng. 


MoArthdr,  J.  A.,  Esq. 

McCallum,  D.  C,  M.D.,  M.R.C.S.,  E. 

McDonald,  J.  W.,  M.D.,  M.R.C.8,  E. 

McKrnzib,  B.  E.,  B.A. 

MiGNAULT,  D.,  B.A. 

OsLiR,  William,  M.D.,  M.R.C.P.,  L. 

Roddick,  Thomas  G.,  M.D. 

Rodger,  Thos.  A.,  M.D. 

Ross,  George,  A.M.,  M.D. 

Sewell,  0.  A.,  M.D.,  L.R.C.S.,  Edin. 

Shepherd,  P.  J.,  M.D.,  M.B.C.S.,  Eng. 

Stewart,  J.,  M.D. 

Sutherland,  W.  S.,  M.D. 

Tremain,  L.,  M.D. 

Vineberg,  H.  N.,  M.D. 


CAN"  ADA 

Medical  &  Surgical  Journal 

AUGUST,  1878. 

PYJIMIA  AND  DEATH  FOLLOWING  THE  CUTTING 

OF  A  CORN. 

BY  OLIVER  C.  EDWARDS,  M.  D. 
(Read  before  the  Medico-chinirgical  Society  of  Montreal,  May  Slst,  1878.) 

On  Wednesday,  March  6th,  I  was  called  to  see  S.  S.,  a  young 
nian  aged  19,  residmg  in  Prince  street.     On  enquiry  the  fol- 
lowing facts  were  given  me  of  his  previous  history.     He  had 
had  an  attack  of  pneumonia  three  years  prior  to  his  present 
illness,  otherwise  he  had  enjoyed  excellent  health.    He  was  one 
of  a  family  of  thirteen,  two  of  whom  had  died  in  ipfancy. 
father  and  mother  are  living.    He  had  been  engaged  as  a 
printer  for  five  years,  and  for  the  past  two  years  of  that  time 
has  been  working  in  a  well-ventilated  oflBce  in  this  city.     The 
house  m  which  he  was  lodging  was  comparatively  comfortable 
snd  neat,  but  the  street  is  low-lying,  and  the  dnunage  defective. 
He  had  lost  much  sleep  during  the  winter,  from  an  over  indul- 
gence in  dancing,  often  dancing  all  night — this  taking  place  on 
&n  average  two  nights  a  week.     Three  days  before  his  present 
illness  he  danced  all  night  in  a  very  warm  room,  and  perspiring 
freely.    He  slept  for  about  half  an  hour  in  his  damp  clothes, 
and  then  went  to  his  work  at  the  usual  hour.    I  was  also 
informed  that  on  February  27th,  while  in  the  act  of  shaving 
down  a  com  on  the  little  toe  of  the  right  foot,  with  a  razor,  he 
accidently  cut  too  deep,  and  the  wound  bled  somewhat  freely. 
Having  bound  up  the  toe  he  went  about  his  work  as  usual.   On 
Saturday,  March  2nd,  he  complained  of  pain  in  the  toe,  and 
noticed  it  somewhat  inflamed.    On  the  following  day  the  pain 

NO.  LXXIII.  1 


2  CANADA    MEDICAL    AND    8CIEGICAL    JCIUBSAL. 

was  more  acute,  and  the  inflammation  had  extended  up  the  foot 
for  a  distance  of  tliree  incliea.  It  waa  bIbo  noticed  that  a  few 
drops  of  pua  had  formed  around  the  com  on  the  little  toe.  A 
bread  and  water  poultice  was  applied  and  the  pus  discharged. 
The  pain  was  so  acute  on  the  evening  of  that  day,  that  having 
gone  to  a  friend's  house  he  was  obliged  to  he  assisted  back  to 
his  home.  He  also  fell  a  slight  pain  extending  up  the  inner 
aide  of  the  leg  and  thigh. 

On  Monday  March  the  4tU  the  painful  sensations  lad  ceaeed 
entirely  in  the  right  leg,  and  the  inflammation  had  entirely 
passed  away  from  the  foot,  but  he  now  experienced  a  very  acute 
pain  in  his  left  hip  and  joint.  Fever  came  on  during  the  day 
and  perspiration,  which  became  very  profuse  at  night-time,  but 
no  chills. 

On  Wednesday,  March  the  6th,  I  saw  him  for  the  first  time. . 
Found  him  lying  on  bis  right  side,  which  position  he  had  retain-  | 
ed  for  the  past  two  days,  the  left  leg  somewhat  flexed — face 
expressive  of  much  anxiety,  and  complained  of  great  pain  in  the 
left  hip-joint,  the  character  of  which  he  described  as  "  like  the  i 
beating  of  a  bkeltsmith'B  hammer."  There  was  no  swelling 
about  the  joint,  but  it  was  tender  to  the  touch.  He  compltuned 
also  of  a  slight  pain  in  the  popliteal  region  of  the  same  leg. 
Pulse,  100  ;  temperature  100  2-5''.    Tongue  coated  but  moist. 

Knowing  that  the  patient  had,  two  nights  before  his  iHnesB, 
exposed  himself  to  cold  by  dancing,  perspiring  freely,  and  after- 
ward sleeping  in  his  wet   clothes,  and  thinking  that  the  slight 
accident  in  cutting  the  com  on  th'e  little  toe  was  a  mere  coinci- 
dence, I  at  first  judged  this  to  be  a  case  of  inflammatory  rheu- 
matism, of  a  kind  which  is  sometimes  present,  the  pain  confined 
to  one  joint,  no  appearance  of  swelling,  and  the  pain  moffl   , 
excruciating.     Accordingly,  I  administeTcd  at  the  first  visit  a  j 
hypodermic  injection  of  morphia,  and  put  him  on  the  salicylate 
of  soda,  20  grs,  every  three  hours,  powder  of  morphia  to  be  . 
given  at  stated  intervals,  and  ordered  hot  applications  to  the 
joint,  and  nourishing  liquid  diet. 

March  1th. — Perspired  very  profusely  during  the  previous   \ 
night,  his  bed-clothea  and  shirt  saturated.     Appears,  however, 


PY-ffiMIA — BY  DB.   EDWARDS.  3 

more  comfortable,  pain  is  considerably  relieved,  but  the  tempera- 
ture is  no  lower. 

Sth. — Temperature  101^  ;  pulse  104.  Though  the  medicine 
is  given  carefully  and  regularly  there  is  no  diminution  in  the 
temperature,  but  the  opposite.  His  sleep  is  very  much 
disturbed.  During  the  following  week  the  symptoms  continued 
much  the  same.  Having  had  misgivings  on  my  mind  that  pos- 
sibly the  trouble  in  the  joint  might  l>e  of  Pyaemic  origin  I  had 
each  day  made  careful  enquiry  for  any  history  of  rigors,  and 
had  closely  examined  the  painful  part  for  any  evidence  of  an 
abscess,  but  could  detect  none. 

12^A.— Temperature  101  2-5^.  Pulse  110^.  Retains  the 
same  position  on  his  right  side,  and  cannot  bear  to  be  placed  in 
any  other  position.  His  sleep  is  exceedingly  restless  and  deli- 
rium is  present,  but  not  constantly. 

ISth. — Morning  temperature,  101  2-5^.  Pulse  116.  Even- 
ing temperature  102  2-5'*. 

15^A.— Morning  temperature  102  1-5^  Evening  103  2-5^. 
JHis  bladder  is  excessively  irritable ;  scarcely  able  to  retain 
even  a  few  drops  of  urine, 

16th. — Had  during  the  night  very  severe  bleeding  at  the 
nose.  He  has,  however,  been  often  subject  to  this  before.  Pa- 
tient is  evidently  much  worse  to-day.  Face  expressive  of  the 
greatest  anxiety.  Pulse  128  and  very  irregular.  Tempera- 
ture in  the  morning  103  1-3®.  Tongue  dry  and  clammy.  I  or- 
dered brandy,  a  half  ounqe  every  three  hours,  and  substituted 
quinine  in  the  place  of  the  salicylate  of  soda.  Dr.  Fenwick 
saw  him  in  consultation  ^ith  me  and  regarded  the  case  as  one 
of  pyaemia.  There  was  not  however,  as  yet,  the  slightest  evi- 
dence of  pus.  The  pain  in  the  hip  joint  is  very  severe  ;  the 
opiate  has  lost  its  power  though  administered  in  increasing 
doses  from  the  beginning.  He  also  complains  of-  great  pain 
and  tenderness  over  the  scrotum.  The  quinine  was  directed 
to  be  given — 5  gr.  dose  three  times  a  day.  Temperature  that 
evening  104° 

nth, — Morning  temperature  102  2-5^.  A  rash  not  unlike 
measles  is  now  present  on  the  back  and  forehead.     The  perspi- 


4  rANAHA    MKrirrAL    AND   SrUOlCAT.    JOCHNAL. 

ntiiftui  have  continued  from  the  first  very  profusely,  especially 
At  nij(Iit  time.  Has  qIko  complained  of  a  feeling  of  coldnees, 
Ifiit  liM  hover  liad  anything  like  a  chill.  Pulse  to-day  is  firmer. 
A  \m>\  furn  liu  f'lrincd  on  rij^ht  hip.  Continued  much  the  same 
'm  t)i«  ISth  and  lOth.  lias  attacks  of  epistaris  each  night, 
wlilohihuiveTor,  aru  controlled  by  snuffing  up  a  solution  of  iron, 
"n  t)i«  It^th,  the  IowoIm  moved  three  times,  a  little  more  liquid 
tluifi  riHtiiral.  Up  to  this  date  there  had  heen  a  decided  ten- 
'Uitiry  b)  cniitipation. 

IfM/t,  —From  the  fact  tlirut  circumstances  prevented  his  being 
[<ro|wrly  iiiiriiod,  he  was  to-day  removed  to  the  General  Hoepi- 
t«l,  and  placed  under  Dr.  Fenwick'a  care,  to  whom  I  am  in- 
(l«lit«d  for  the  facte  of  the  case  up  to  the  time  of  his  death, 
whioyi  t^jok  place  ten  days  after  admission.  On  the  second  day 
afhir  liijt  ailmiNMon,  a  swelling  of  considerable  size  was  seen 
itvar  iho  xacrum,  corresponding  with  the  part  where  he  had  suf- 
fornd  fliK^h  acute  pain.  This  abscess  was  'o^iened.  At  this  stage 
i/f  thii  diMOM  tlic  patient  was  placed  lying  on  his  belly,  owing  to 
Uio  groat  pain  in  his  hack  and  the  bed  aore  on  his  right  liip. 

WMtihK  progrcMHed  rapidly :  he  was  delirious  during  the 
'iilglit,  unil  there  wan  a  tendency  to  picking  at  the  bed-clothes. 
A  toooiul  abncenn  fornied  in  tlie  vicinity  of  the  hip-joint,  which 
wan  oi>enoil  and  discharged  freely.  The  day  following,  (April 
the  iMt),  ho  died,  ( <  nfurtvmately  a  post  mortem  examination 
VIM  not  afforded,  as  the  body  was  removed  to  Belleville  before 
Kuch  invfiiligatwn  ii'an  poggUile. 

It  u  a  matter  of  interest  to  notice  such  a  formidable  disease 
at,  Pyemia,  arising  fVom  such  a  slight  cause.  Certainly  it  is  a 
diieaae  to  be  dreaded  iti  all  major  operations,  but  how  very  un- 
usual to  see  it  follow  the  presence  of  a  few  drops  of  pent-up 
pua  in  such  a  superficial  place  and  from  such  a  email  accident 
OB  cutting  a  small  corn  too  deeply.  In  looking  into  tlie  subject 
I  find  that  pyromia  in  private  practice  and  from  slight  causes 
was  made  the  subject  of  the  inaugural  address  by  Mr.  Prescott 
Hewitt,  at  the  Clinical  Society  of  London,  in  1874.  It  may  be 
of  interest  in  coimection  with  the  present  paper  to  cite  some  of 
the  cases  whiuh  Mr.  Hewitt  roporte : 


I 


VYMMIA — BY   DR.   EDWARDS.  5 

"  A  hale  old  gentleman  close  upon  80,  who  had  long  enjoyed 
excellent  health,  had  a  small  warty  growth  on  the  skin  just  over 
the  tendon  Achilles.  This  was  removed,  as  it  chafed  him  in 
walking.  After  laying  up  for  a  few  days  and  the  trifling  wound 
was  all  but  healed,  he  was  allowed  to  go  about  a  little,  but 
being  of  active  habits,  he  one  day  took  a  longer  walk  than  usual. 
This  was  followed  by  some  slight  inflammation  of  the  skin, 
which,  however,  soon  subsided.  He  was  on  the  eve  of  return- 
ing to  his  usual  avocation,  when  rigors  and  sweatings  appeared. 
Then  came  an  immense,  deep-seated  abscess  in  the  thigh,  under 
the  constant  drain  of  which  he  ultimately  sank." 

In  another  case,  the  removal  of  a  small  sebaceous  cyst  of 
the  scalp  was  followed  by  erysipelas,  pyaemia  and  death. 

Another  case  of  a  gentleman  residing  in  the  country,  sup- 
posed to  be  suflering  from  acute  inflammatory  rheumatism  in 
both  ankle  joints,  but  which  proved  to  be  pyaemic  abscesses* 
Here  the  cause  was  suppuration  about  the  tonsils.  This 
patient  at  that  time  recovered,  but  four  years  later  he  died  of 
pyaemia,  following  the  removal  of  a  small  warty  growth  from 
the  scrotum. 

Another  interesting  case  was  that  of  a  young  woman  who 
had  run  a  needle  into  the  fleshy  part  of  the  leg.  It  was  after- 
wards removed,  and  nothing  more  was  thought  about  it  till 
a  few  days  later,  when  the  spot  became  painful.  A  tiny 
abscess  formed  which  was  attended  to,  but  she  shortly  after  had 
rigors  and  profuse'  sweatings.  She  ultimately  recovered,  but 
was  five  months  confined  to  her  bed. 

Other  cases  equally  interesting  are  recorded,  as  from  the 
pulling  of  a  tooth,  or  resulting  from  periostitis  of  the  tarsal 
bones,  from  being  tripped  up  in  the  street ;  also,  cases  follow- 
ing or  associated  with  gonorrhoea. 

In  the  case  presented  to  the  Society  this  evening,  there  was 
an  absence  of  all  rigors,  which  is  one  of  the  distinctive  evi- 
dences of  the  disease.  He  complained  of  being  chilly,  espe- 
cially at  mght-time,  but  he  never  had  a  distinct  rigor.  There 
was  the  absence  also  of  much  fluctuation  in  the  temperature, 
which  is  so  markedly  present  in  pyaemia.    The  morning  and 


6  CANADA   MEDICAL    AND    SHROICAL   JOURNAL. 

evening  temperature  ran  a  pretty  definite  course.  It  is  worthy 
of  note  that  many  cases  of  pycemia  in  its  early  stages  have- 
been  mistaken,  as  was  the  present  one,  for  Inflammatory  Rheu- 
matism. In  the  Patftoloffiaal  Tfansactio7t»  Vol.  13,  page  189. 
Dr.  Bristowe,  of  St,  Thomas'  Hospital,  makes  this  remark  in  a 
report  of  five  cases  of  pyreraia,  the  result  of  necrosis,  which 
had  been  mistaken  for  inflammatory  rheumatism  : 

"  The  patient  is  attacked,  not  necessarily  as  the  result  of  ac- 
cident, with  slight  rheumatic  pains  in  the  course  of  one  of  the 
bones.  The  disease  at  first  mild,  soon  becomes  severe ;  swell- 
ing and  tenderness  soon  manifest  themselves  more  or  less  obsti- 
nately.- The  aspect  of  the  patient  is  that  of  a  person  suffering 
from  inflammatory  fever.  Soon,  however,  in  a  large  propor- 
tion of  the  cases,  symptoms  bearing  a  superficial  resemblance 
to  those  of  typhus,  typhoid  or  even  delirium  tremens,  set  in. 
pysemia  has  become  cfitablished,  and  the  patient  rapidly  sink^." 

In  connection  with  the  treatment  of  this  most  formidable  dis- 
ease, there  is  a  statement  made  hy  Mr.  Durham,  of  (Juy's 
Hospital  in  the  Lancet  of  March  7th,  1874,  and  coming  from  so 
eminent  a  surgeon,  it  certainly  merits  our  attention.  He  says  : 

"  Of  late  years,  whenever  I  have  the  slightest  indication  of 
the  symptoms  setting  in,  I  have  immediately  given  large  doses 
of  quinine ;  and  in  cases  in  which  pytemic  symptoms  have 
been  well  established,  and  which  I  have  no  doubt  would  have 
gone  on  to  fatal  termination,  I  have  also  given  large  doses  of 
quinine,  and  in  some  cases  the  most  satisfactory  results  have 
been  obtained.  I  have  seen  over  and  over  again,  a  patient 
with  a  dry.  red,  glazed,  brown-furred  tongue,  with  a  rapid  pulse 
and  high  temperature,  having  had-  a  rigor  a  short  time  previ- 
ously, with  evidence  of  suppuration  occurring  in  one  part  or 
another.  I  have,  in  such  a  case,  given  a  drachm  of  quinine, 
and  repeated  it  in  three  or  four  hours,  and  the  next  day  have 
seen  the  patient  in  a  totally  iifierent  condition — the  tempera- 
ture down,  the  pulse  lower,  tongue  clean  and  moist,  and  the 
patient  expressing  himself  as  well." 

While  the  true  nature  of  Ihe  toxic  matter  that  gives  rise  to 
the  blood-poisoning  in  Pytemia,  its  origin  and  mode  of  opera- 


ANEURISM  OP  THE  INNOMINATE  ARTERY — BY  DR.  HEAD.  7 

tion  are  not  fully  known,  and  while  it  manifests  itself  more  fre- 
quently in  the  surgical  department  of  Hospital  practice,  but,  seen 
also  in  private  practice,  it  is  interesting  to  observe  that  we  may 
have  it  present  without  any  traumatic  cause,  following  some  ex- 
hausting disease,  notably  typhus,  and  in  some  cases  of  typhoid 
fever ;  and  we  may  also  have  it  attendant  on  some  of  the  most 
simple  accidents  in  daily  life — the  running  of  a  splinter  into  the 
toe,  or  the  prick  of  a  needle,  as  among  the  cases  recorded  by 
Mr.  Prescott  Hewitt,  or  such  a  simple  thing  as  the  cutting  of 
a  com,  the  notes  of  which  I  have  had  the  honor  of  presenting 
to  the  Society  this  evening. 

ANEURISM  OF  THE  INNOMINATE  ARTERY  CURED 
BY  THE  METHOD  OF  TUFNELL.* 

BY  HENRY  H.  HEAD,  M.D. 

To  the  Editor  of  the  Canada  Medical  and  Surgical  Journal. 

Quebec,  June  24th,  1878. 

Sir, — I  herewith  send  you  the  report  of  a  case  of  Aneurism 
of  the  Innominata,  treated  by  Dr.  Head  of  Dublin,  on  the  plan 
suggested  by  Mr.  Joliffe  Tufnell,  also  of  Dublin.  This  report 
was  kindly  forwarded  to  me  by  the  latter  gentleman,  and  as  it  is 
to  my  knowledge  that  several  other  cases  of  internal  aneurism 
have  been  treated  in  an  equally  successful  manner  by  the  same 
method,  I  think  it  due  to  humanity  and  the  spread  of  science , 
that  the  knowledge  of  Mr.  Tufihell's  treatment,  at  once  so  suc- 
cessful, and  yet  so  simple,  should  be  extended  as  far  as  possible. 

You  will  therefore  oblige  xne  much  by  giving  the  report  an 
insertion  in  your  valuable  journal. 

James  A.  Sewell,  M.D., 

Dtan^  Medical  FaetUty  Lau<U  University. 

The  case  which  I  wbh  to  present  to  the  Society  is  one  of  an 
aneurismal  sac  that  had  undergone  cure  by  the  process  upon 
which  so  much  stress  has  been  laid  by  Mr.  Tufnell  —  viz., 

*  Bead  before  the  Dublin  Pathological  Society,  January  20,  1878. 


1 


conBolidation,  by  auccessive  dcpoBits  of  fibrin.  The  previoua 
history  of  the  case  is  short.  In  July  last,  the  gentleman,  who 
was  leaving  Ireland,  came  to  thank  me  for  my  long  attendance 
upon  him,  two  years  before,  for  a  stomach  affection.  I  had  not 
seen  him  for  those  two  years,  and  he  told  mo  that,  during  that 
time  he  had  suffered  from  intense  neuralgia  in  the  back  and 
flhoulder,  along  the  back  of  the  neck,  and  in  the  back  of  the 
head.  For  this  he  had  been  treated  in  various  ways,  and  he 
had  used  large  hypodermic  injections  of  morphia,  which  gave 
him  a  good*deal  of  relief;  but,  after  some  time  he  was  obliged 
to  give  them  up,  from  the  intense  itchiness  of  akin  which  they 
caused.  lie  then  appeared  to  be  well,  and  had  not  suffered 
much  from  neuralgia  for  some  time.  lie  was  a  Presbyterian 
chaplain  in  the  army,  and  was  going  over  to  take  charge  of  troops 
at  Shorncliffe,  in  England.  He  mentioned  to  me  that  he  had  a 
little  mark  on  his  chest,  beneath  the  right  collar  bone — a  dusky 
spot,  about  the  size  of  a  fi.ve-shilling  piece,  as  if  he  had  got  a 
bruise,  and  asked  me  to  look  at  it.  Upon  examining  it,  I 
detected  a  distinct  pulsation  underneath,  and  came  to  the  con- 
clusion that  ho  had  a  thoracic  aneurism.  But  for  the  pulsation, 
however,  it  would  have  been  impossible  to  detect  an  aneurism. 
There  was  no  sign  of  pressure — no  murmur,  no  difficulty  of  ; 
deglutition,  no  dilatation  or  irregularity  of  any  vessel  There  was 
no  sign  of  interference  with  either  recurrent  nerve,  and  his 
voice  was  natural.  The  impulse  of  the  aneurism  was,  if  any- 
thmg  slightly  in  advance  of  the  heart's  impulse,  as  if  the 
commencement  of  the  contraction  of  the  lieart  acted  upon  the 
aneurism  before  the  apex  of  the  heart  struck  the  walls.  This  I 
have  observed  in  two  instances  of  aneurism  of  the  aorta.  There 
was  DO  double  impulse,  and  no  murmur  or  bruit.  He  com- 
plained of  little  or  no  pain,  except  a  burning  sensation.  I  told 
him  that  I  thought  he  was  not  fit  for  duty,  and  explamed  to  him, 
to  a  certain  extent,  the  uature  of  his  illness — that  an  effort 
should  be  made  to  cure  him  ;  and  I  suggested  a  consultation 
with  Mr.  I'u&ell,  who  concurred  in  my  diagnosis  that  it  was  an 
aneurbm,  and  most  probahly  of  the  arteria  innominata.  As  I 
conadered  that  this  gentleman  was  likely  to  be  benefited  by  the 


ANEURISM  OF  THE  INNOMINATE  ARTERY — BY  DR.  HEAD.  9 

treatment  which  Mr.  Tufnell  has  so  ably  advocated,  we  explain- 
ed to  him  the  nature  of  the  treatment.     He  said  that  he  would 
be  glad  to  adopt  it.    He  assumed  the  recumbent  position  the 
last  week  in  July,  and  continued  it  until  the  middle  of  October. 
I  had  to  leave  town  myself  at  the  beginning  of  August,  and  Mr. 
Tufaiell  was  then  kind  enough  to  take  charge  of  the  case.    The 
patient  took  little  or  no  medicine,  and  we  did  not  give  him  any 
iodide  of  potassium ;  but  when  he  was  under  my  sole  care,  and  I 
occasionally  when  his  heart  beat  a  little  fast,  he  got  small  doses  I 
of  aconite,  which  reduced  the  frequency  of  the  pulse  a  good  deal. 
The  principal  treatment  consisted  simply  of  the  horizontal  pos- 
ture, absolute  rest,  and  a  minimum  of  liquids,  his  food  consisting 
a8  much  as  possible  of  solids,  so  as  to  diminish  the  quantity  of 
blood,  and  at  the  same  time  keep  up  its  healthy  condition.     He  \ 
bore  his  confinement  very  well ;  but,  in  the  beginning  of  October, 
he  began  to  show  signs  of  great  restlessness,  and  I  thought  it  ^ 
better  not  to  confine  him  any  longer.     He  began  to  get  up,  and ' 
gradually  to  go  out ;  but  became  sleepless,  and  got  into  a  state 
of  great  mental  depression,  fearing  that  he  would  be  put  on  half 
pay,  and  that  he  would  be  arrested  for  debts  which  really  he 
did  not  owe.     Mr.  Tufnell  and  I  now  advised  him  to  apply  for 
^ditional  leave  of  absence,  thinking  that  the  aneurism  being 
sow  very  much  consolidated,  a  little  more  rest  might  enable  him 
to  go  back  to  his  duty.  He  applied  for  additional  leave,  and  on 
the  very  day  before    the  occurrence  of  the  unfortunate   act 
which  terminated  his  life,  went  before  a  medical  board ;  the 
leave  of  absence  recommended  was  granted,  but'of  this  he  could 
not  be  made  aware,  as  the  proceedings  are  private.     He  was 
now  advised  to  go  to  the  country  for  change  of  scene,  and  his 
friends  were  taking  him  there,  when,  at  the  Railway  Station  at 
Kingsbridge,  he  became  suddenly  excited,  ran  away  from  them, 
and  threw  himself  over  the  wall,  which  is  twenty-four  feet  in 
depth,  into  the  Liffey.     He  was  not  killed  by  the  fall,  but  the 
water  in  the  river  was  shallow  at  the  time,  and  he  was  immersed 
in  the  mud.  From  this  he  ^as  extricated  as  speedily  as  possible, 
and  taken  to  Dr.  Steevens'  Hospital,  and  after  lying  there  for 
about  two  hours,  he  died.     I  did  not  see  him  myself,  but  was 


10  CANADA    MEIlirAL    AND   SmfllCAl,   JorBSAL, 

informed  that  no  impulse  could  be  detected  over  tlie  aorta,  but 
he  got  a  violent  cough,  which  was  characteristic  of  pressure. 
The  Coroner  directed  a  limited  port  viortem  examination  to  be 
made,  which  gave  tlie  opportunity  of  ascertaining  exactly  the 
Bite  of  the  aneurism  and  the  result.  While  undergoing  treat- 
ment Mr.  Tufnell  and  I  came  to  the  conclusion  that  the  aneu- 
rism had  undergone  a  great  deal  of  consolidation,  although  to 
what  extent  exactly  we  could  not  tell,  because  there  was  still  a 
strong  impulse.  It,  however,  gave  tlie  impression  of  a  solid 
tumour  striking  against  the  sternum,  and  we  could  not  feel  anyi 
signs  of  lateral  dilatation  whatever.  The  centre  of  the  impulaej 
was  about  the  edge  of  the  sternum,  between  the  cartilages  or 
the  first  and  second  ribs,  extending  about  an  inch  and  a  half  in 
each  direction  ;  and  there  was  also  marked  duhiess  on  percusJ 
sion.  The  heart  was  slightly  displaced  and  pushed  downwardsj 
the  apex  beating  between  the  sixth  and  seventh  ribs,  a  goodi 
deal  to  the  left  of  the  nipple  and  over  a  considerable  surface :] 
and  there  was  also  some  amount  of  dulness  on  percussion  over 
the  region  of  the  heart.  We  came  to  the  conclusion  that  the 
heart  was  slightly  enlarged .  Upon  inspection  by  '•fHio  cadetfris, , 
a  solid  tumour  was  found,  occupying  the  entire  mediastinum, 
and  firmly  attached  to  the  under-surface  of  the  sternum  and  the 
cartilages  of  the  first  and  second  ribs.  A  portion  of  the  sac  of 
the  aneurism  being  adherent  to  the  under-surface  of  the  bones, 
it  was  supposed  at  first  that  the  shock  of  falling  twenty-four 
feet  had  burst  the  sac  of  the  aneurism,  but  it  was  found  that 
there  had  been  no  rujiture  whatever,  nor  were  there  any  signs 
of  extravasation  of  blood.  The  heart  itself  was  covered  with 
fat,  and  to  some  degree  enlarged,  flat,  and  flabby.  On  opening 
the  left  side  of  the  heart  the  wall  was  found  to  be  very  thin  and 
tiie  cavity  a  good  deal  dilated ;  but  the  valves  were  perfect, — 
when  we  opened  the  aorta,  we  found  it  very  much  dilated  and  ) 
altered  by  atheroma  in  a  marked  degree,  with  dilatation  almost  I 
amounting  to  true  aneurism.  Upon  slitting  up  the  aorta,  we 
found  that  the  original  aneurism  occupied  almost  the  entire  of  I 
the  arteria  innominata.  At  the  back  of  it  the  vessels  were 
jervious — namely,  the  subclavian  and  the  carotid  on  the  right.   , 


4 


i 


HOSI'lTAI,    RFl'OKTS. 


It 


Those  OD  the  left  were  also  perfect ;  but  the  descending  aorta 
WM  very  atheromatous ;  and  at  a  distance  nf  between  three  or  four 
inches,  there  was  another  small  aneuiism,  the  size  of  a  walnut. 
This  we  could  not  diagnose  during  life  ;  bnt  it,  too,  waa  all  but 
filled  up  with  libriii.  The  principal  interest  in  the  case  lies  in 
the  manner  in  which  the  aneurism  wis  cured.  The  layers  of 
fibrin  were  very  firm,  and  closely  laminated,  the  layers  of  it 
being  almost  as  thin  as  sheets  of  paper  spread  one  over  the  other. 
It  is  a  most  interesting  example  of  what  may  be  done  by  the 
absolute  rest  and  other  items  of  treatment  advocated  by 
Mr.  Tnfneil  —  in  fact,  this  aneurism  waa  cured.  This  case 
ought  almost  to  have  been  Mr.  Tufnell's,  fot'he  had  more  to  say 
to  the  treatment ;  but  as  the  patient  vraa  mine  at  the  first  and 
the  last,  I  have  laid  the  case  before  the  society.  The  age  of 
the  patient  was  fifty-six. 

Dr.  Bookev  said  that  the  lungs  were  congested,  and  had  a 
good  deal  of  frothy  fluid  in  them,  such  as  is  met  with  in  the  lungs 
of  a  person  who  has  been  drowned.  The  patient,  who  waa  a  heavy 
man,  sixteen  stone  weight,  had  fallen  twenty-four  feet,  and  was 
found  lying  on  his  face.  He  died  within  two  hours  after  he  was 
received  into  the  hospital,  and  breathed,  it  was  stated,  all  the 
time  he  was  there. 


tCAL  AHD  Surgical  Casks  Oc< 
Montreal  Gem 
I 


^ospiial  J^cfiorts. 


ihot  Injury  of  Femoral  Artery — lAgature.     Under  the 
eare  of  Dr.  Wilkins. 

(From  Not«e  tAkcn  liy  Dr.  I!:  rlibd,  AsHislaijt  House  Surgeon.) 
McC,  set.  22,  was  admitted  into  the  Montreal  General 
utal  9th  August,  1877,  under  the  care  of  Dr.  Wilkina,  suf- 
fering Irom  the  effects  of  a  bullet  wound  in  the  right  thigh. 
The  accident  occurred  in  this  way  :  Patient  had  a  revolver  at 
fhll  cock  in  his'hand,  which  he  was  about  to  place  in  his  coat 
pocket,  but  before  doing  so  forgot  to  let  down  the  cock,  and  the 
trigger  caught  in  the  side  of  the  pocket,  causing  the  charge  to- 


13     .  CANADA  MEDICAL   AND   SURGICAL    JOURNAL. 

explode,  the  ball  entering  the  right  thigh  about  2^  inches  below 
the  anterior  aaperior  spinous  process,  taking  a  course  downwards 
and  inwards,  becoming  superficial  in  the  inner  aspect  of  the 
thigh  about  five  inches  below  the  crutch,  where  it  was  easily 
extracted  bj  a  small  incision. 

Patient  is  one  of  a  family  of  six,  all  of  whom  are  healthy 
except  one  slater,  who  is  subject  to  rheumatism.  Father  and 
mother  both  hving.  Has  followed  the  trade  of  tinsmith  for 
several  years ;  has  never  been  intemperate,  and  has  enjoyed 
good  health.  Height  5  ft.  7  in.;  weight  about  133  lbs.  On 
examining  heart,  a  systolic  basic  murmur  can  be  heard.  The 
copious  hemorrhage  which  took  place  immediately  after  the 
accident  had  stopped  before  his  arrival  in  hospital,  and  as  there 
was  almost  no  bleeding  then,  nothing  further  was  done  than  to 
apply  ice  over  the  track  of  the  wound.  The  case  seemed  to 
do  well  until  a  couple  of  days  after  (11th  Aug.),  when  swelling 
waa  perceived  over  the  femoral  artery  as  well  as  to  its  inner 
side.  Upon  palpation  pulsation  was  distinctly  felt,  accompanied 
by  a  thrill.  Asacultation  revealed  a  moderately  loud  bruit  No 
pulsation  could  be  felt  in  popliteal  artery,  but  there  was  pulsa- 
tion in  a  small  artery  lying  somewhat  posterior  to  the  usual 
situation  of.thc  posterior  tibial.  The  leg  retained  its  normal 
temperature. 

These  conditions  revealed  what  we  were  before  doubtful  of — 
that  b,  that  an  artery  was  injured  and  that  a  traumatic  aneui^ 
ism  was  forming. 

The  next  two  days  (Aug,  12  and  13)  the  swelling  continued 
to  increase  and  the  temperature  commenced  to  rise,  reaching 
on  the  evening  of  August  13,  102°. 2.  The  injured  leg  over 
affected  part  was  three  inches  more  in  circumference  than  the 
left  leg. 

As  it  was  decided  (Aug.  14)  to  cut  down  upon  the  injured 
vessel  and  tie,  the  patient  was  etherized,  and  after  completely 
emptying  the  leg  of  blood  by  elevating  it  and  applying  a  roller, 
Esmarch's  elastic  ligature  was  firmly  applied  to  the  highest 
point  of  the  leg,  part  of  the  ligature  encircling  the  pelvis.  Dr, 
Wilkins  now  made  a  free  incision,  about  four  inches  in  length 


HOSPITAL    REPORTS.  13 

oyer  the  course  of  the  femoral  artery,  the  centre  of  the  incision 
being  a  little  above  the  lower  angle  of  Scarpa's  triangle,  and 
corresponding  with  the  point  of  intersection  of  two  lines,  one 
drawn  over  the  course  of  the  femoral  artery,  and  the  other  over 
the  track  of  the  bullet.  The  sartorius  having  been  pushed  aside 
and  some  further  dissections  made,  the  sheath  of  the  vessel 
was  brought  into  view,  when  it  was  discovered  that  the  bullet 
had  perforated  the  femoral  artery,  about  1|  inches  below  the 
origin  of  the  profunda.  Th^  artery  was  not  completely  severed ; 
about  three-quarters  of  its  circumference  was  carried  away, 
leaving  a  rent  about  two-thirds  of  an  inch  long ;  the  distal  end 
was  first  tied,  a  second  ligature  was  also  applied  to  the  cardiac 
end  as  close  as  possible  to  the  rent,  and  the  vessel  cut  between 
the  two  ligatures,  this  last  fixed  ligature  was  for  the  purpose  of 
preventing  retraction  and  to  manipulate  this  end  of  the  artery, 
as  it  required  further  dissection  to  enable  it  to  be  firmly  tied. 
A  large  quantity  of  coagula  and  decolorized  fibrin  were  turned 
out  of  the  aneurismal  cavity,  which  was  to  the  inner  side  of  the 
artery  extending  upwards  to  Poupart's  ligament.  The  distal 
cut  end  of  the  artery  was  now  suflSciently  bared  and  firmly  tied 
with  silk,  and  the  cavity  formed  by  the  aneurism  washed  out  with 
carbolic  lotion.  The  edges  of  the  wound  were  brought  together 
by  means  of  wire  suture  and  a  free  opening  left  at  the  lower  end 
of  the  wound,  a  drainage  tube  inserted  and  carbolic  oil  dressing 
.  applied.  Patient  was  immediately  put  under  the  influence  of 
opium ;  watch  was  constantly  kept  up  for  a  few  days  by  his 
bedside  to  guard  against  haemorrhage. 

Temperature  continued  to  rise  for  a  couple  of  days  after  the 
operation,  when  (Aug.  16)  it  reached  105^.2.  For  the  first 
time  he  now  (Aug.  16)  complained  of  pain  in  his  right  foot ; 
on  the  following  day  this  pain  was  limited  to  that  portion  of  the 
foot  immediately  behind  and  below  the  right  internal  malleolus, 
over  which,  on  the  17th,  a  bulla  commenced  to  form.  On  the 
19th  this  bulla  was  filled  with  a  dark  fluid,  and  the  lymphatics 
leading  from  it  were  inflamed.  It  continued  to  increase  in  size 
until  the  21st  August,  when  it  burst,  bringing  into  view  a  large 
slough  beneath,  portions  of  which  separated  on  the  24th,  leav- 


14  CANADA  MEIUCAL   AND   BtlROlCAL    JOUBNAI.. 

ing  healthy  granulations  beneath  ;  other  portiona  ol  the  alough 
separated  on  the  27th  August,  hut  the  la«t  of  the  alough  did  not 
«ome  away  until  two  days  eubsequently  (August  29). 

On  the  2tith  August,  seventeen  days  after  the  accident,  he 
complained  for  the  first  time  of  his  toes  being  tender  ;  three 
days  later  (29th)  there  was  considerable  Bwelling  and  fluctua- 
tion over  the  metatarsal  bone  of  the  great  toe.  This  was  opened, 
irhen  a  large  quantity  of  pus  escaped,  and  the  metatarso 
phalangeal  joiot  was  found  to  be  involved.  This  joint  continued 
discharging  more  or  leas  every  day  until  the  10th  Oct.,  when 
Dr.  Wilkins  decided  to  resect  the  joint,  but  after  laying  bare 
the  heads  of  the  bones,  the  metatarsal  bone  was  found  to  be  dis- 
eased BO  very  far  up  it  was  necessary  to  amputate  the  toe  close 
to  the  tarao-metatarsal  articulation,  after  which  the  patient  did 
well  without  a  single  bad  symptom. 

During  the  course  of  his  confiuement  to  bed  two  sloughs  were 
produced  by  pressure  on  the  inside  of  the  foot,  the  integument 
over  the  outer  malleolus  ^ving  way  August  26,  and  that  over 
the  outer  edge  of  the  base  of  the  fifth  metatarsal  bone  on  the 
15th  of  September. 

On  the  second  day  after  the  operation  (Aug.  16)  symptoms 
of  septicsemia  made  their  appearance ;  profuse  perspiration 
with  high  temperature,  vouaiting  and  diarrhcea.  His  tempera- 
ture, which  commenced  to  rise  two  days  before  the  operation, 
reached  105". 2  on  the  second  day  after,  and  kept  moderately 
high  (103"  to  104')  for  about  six  weeks  subsequently,  occa- 
sionally falling  three  degrees,  sometimes  a  little  more,  after  the 
administration  of  a  twenty-grain  dose  of  quinine.  Stimulants 
were  freely  administered  ;  for  one  period  of  forty-eight  hours 
he  I'ad  continuously  one  ounce  of  brandy  every  two  hours. 
Besides  aiding  the  quinine  in  bringbg  down  the  temperature, 
it  materially  lessened  the  frequency  of  the  pulse,  which  had 
reached  148°  on  August  17. 

The  de.structiou  of  the  great  toe  joint  bo  long  after  the  acci- 
dent I  consider  to  have  been  due  entirely  to  embolism  :  the 
femoral  was  tied  bo  close  to  the  origin  of  the  profunda  (about 
an  inch  from  origin)  that  the  cardiac  end  of  the  thrombus  is 


HOSPITAL    REPORTS.  15 

ilely  to  have  projected,  in  the  form  of  a  cone,  a  little  beyond 
the  opening  of  the  profunda,  and  thus  permitted  one  or  more 
small  portions  of  the  plug  being  detaolied  from  it  and  carried 

Ptli  the  current  until  arrested  in  the  sraal!  blood  vessels  of  this 
nt  where  suppurative  processes  were  set  up. 
Mf  of  Dinlocation  of  the  Femur  into  thf  Foramen  Oiiale. 
Under  care  of  Dr.  Reddy.  Reported  by  James  Bell, 
M.D.,  Assistant  Ilouse  Surt;eon,  M.  G,  Hospital. 
W.  S,,  a  medium-aized,  well-built  and  healthy  Englishman, 
40  years  of  age,  was  admitted  to  Dr.  Reddy's  wards  on  the 
23rd  of  June  last,  having  received  an  injury  to  his  left  hip  the 
evening  before.  Ho  was  wresthng  with  a  friend  and  threw  him, 
and  the  latter  while  down  grappled  him  by  the  legs  and  brought 
him  to  the  ground,  at  the  same  time  rolling  over  him.  He  felt 
something  give  way  in  the  fall,  and  he  had  to  be  assisted  to  his 
feet.  On  admission  he  was  suffering  great  pain,  especially  over 
the  adductor  muscles  of  the  thigh  near  Pouparfs  ligament. 
The  body  was  bent  forward  in  attempting  to  walk,  and  in  the 
recumbent  position  the  thigh  was  Bemifle-xed  on  the  abdomen. 
The  whole  limb  was  abducted  and  the  foot  everted.  Tliere  was 
also  considerable  apparent  lengtiiening  of  the  limb.  The  but- 
tock was  much  flattened,  and  the  gluteal  fold  absent.  The  tro- 
cbanten  could  be  felt  at  the  bottom  of  a  deep  depression  over 
the  outer  side  of  the  thigh.  There  was  preternatural  fulness  of 
the  anterior  and  inner  portions  of  the  upper  third  of  the  thigh, 
and  in  this  situation  even  shgbt  pressure  was  very  painful. 
Brgaiit'i  Line  measured  3J  inches  on  the  left  side  and  2i  on 
the  right,  and  the  left  leg  was  half  an  inch  longer  than  the  right 
The  patient  was  chloroformed  and  Lrs,  Keddy  and  Fenwick 
proceeded  to  reduce  the  dislocation  by  the  rotatory  method. 
The  first  attempt  threw  the  bone  into  the  ischieatic  notch.  It 
was  easily  thrown  back  again  into  the  foramen  ovale,  and  a 
second  attempt  was  made  with  a  similar  result.  On  the  third 
attempt  it  sUpped  into  its  place  without  difficulty.  The  patient'a 
:gs  were  bound  together  and  ice  applied  to  the  joint.  There  was 
rosiderable  swelhng  for  a  few  days  and  his  temperature  rose  a 


IC, 


L   MEIIICAI-    AMD   SCROICAL    JOUBNAt.. 


little.  It  ranged  for  three  or  four  daj3  between  99"^  F.  and 
101"  and  then  became  normal.  The  ice-bags  were  removed 
in  three  or  four  days  and  tlie  bandages  at  the  end  of  a  week. 
The  patient  was  kept  in  bed  for  two  weeks.  lie  was  finally 
discharged  on  the  1 3th  of  Julv,  feeling  quite  well  and  able  to 
■walk  -with  the  aid  of  a  stick . 


eorrespondence. 

London,  July  11, 1878. 

7^  l/u  Editor  qf  the  C'imava  Medicil  a.<<d  Sl-roioal  Jdl'iisai.: 

Dear  Sir. — At  Edinburgh,  from  the  great  and  long  standing 
reputation  of  its  University,  there  is  always  found  much  to 
repay  any  medical  visitor.  Yet  at  the  present  time  one  cannot 
but  be  struck  with  the  absence  of  any  who  stand  as  Syme, 
Simpson  and  others  stood,  head  and  shoulders  above  all  the  rest. 
London  men  taunt  their  northern  friends  by  telling  them  that 
every  good  man  there  naturally  comes  to  London.  ■  That  is 
certainly  true ;  but  the  retort  which  has  been  thrown  back  has 
equal  justice,  vii!.,  that  when  a  London  school  is  in  want  of  a 
teacher  it  ia  very  often  to  Edinburgh  that  they  look  to  find  the 
man. 

Of  course  one  cannot  speak  of  Edinburgh  without  being  led 
to  speak  of  Liaterism.  My  impression  so  far  is  that  the  last  12 
months  does  not  appear  to  have  made  any  ehan'ie  in  the  posi- 
tion of  the  germ-doctrine.  I  don't  think  the  full  antiseptic 
teaching  and  treatment  can  be  said  to  be  gaining  ground,  and 
it  will  apparently  be  a  long  time  before  this  matter  can  be  de- 
finitely settled.  The  opponents  of  Listerism  are  not  confined 
to  such  men  as  Spence,  who  have  grown  grey  in  the  practice  of 
now-called  old-fashioned  surgery,  and  who  obstinately  refuse  for 
a  moment  to  entertain  the  idea  of  such  radical  changes  in  pro- 
cedure, but  number  amongst  them  young  men,  active,  keen 
and  earnest,  who  have  had  ample  opportunities  of  studying 
both,  and  who  will  asseverate  and  maintain  and  shew  cases  to 
prove  that  as  good  results  can  be  obtained  one  way  as  the  other, 
provided  always  it  be  in  the  same  hands  and  e({ually  carefully 


I 


rORRESPONDKMCR,  It 

&nd  skilfully  managed.  Even  in  Edinburgh  itself  there  are  but 
a  few  who  may  be  called  enthusiastic  and  thorough  antiseptic 
men.  Of  these  probably  Chiene  ia  the  chief.  Many  others,  such 
as  Mr.  Jas.  Bell,  for  inatance,  use  a  thoroughly  antiseptic  treair 
r  ment  in  certain  cases,  but  object  to  its  employment  in  many 
others  of  a  similar  class. 

The  new  Royal  Infirmary  at  Edinburgh  is  appi'oaehing  com- 
pletion. It  is  an  immense  structure,  built  of  stone,  on  the  most 
approved  modem  pavilion-plan,  and  covering  several  acres  of 
ground.  It  will  surely  be  much  appreciated  by  the  members 
of  the  schools  and  by  the  public.  No  stranger  can  help  being 
struck  with  the  antiquated  and  wretched  condition  of  the  pre- 
sent building,  seeing  that  it  is  the  t«aching  field  of  the  largest 
schools  in  Great  Britain. 

Nerve-stretching  in  sciatica  continues  to  be  practiced  there  to 
a  limited  extent.  Some  of  the  reaulte  from  it  are  brilliant  but  in 
other  cases  it  has  <|uite  failed,  and  as  yet  there  is  no  positive 
means  of  distinguishing  between  those  which  are  amenable  to  this 
ft  treatment  and  those  which  are  not.  I  saw  one  case  there  sup- 
P  posed  to  have  been  cured  but  in  whom  it  had  speedily  returned. 
There  is  a  considerable  number  of  Canadian  graduates  and 
student.'^  here  at  present.  St.  Thomas'  Hospital  is  their  favorite 
resort.  Dr.  Murchison  still  continues  his  summer  clinics  twice  a 
week.  There  are  alwaya  to  be  found  in  his  words  an  admirable 
selection  of  severe  and  important  medical  cases.  From  the 
severity  of  the  cases  admitted  also  autopsies  are  frequent. 
Here  probably  more  than  at  any  other  school  arc  the  students 
of  the  class  diligently  and  systematically  instructed  by  the  bed- 
side and  made  to  take  a  continually  active  part  in  the  diagnosis 
of  all  new  cases.  Owing  of  couree  to  Dr.  Murchison 'a  great 
reputation  in  connection  with  diseaaea  of  the  liver  and  allied 
organs,  great  numbers  of  rare  and  interesting  varieties  of 
abdominal  complaints  are  constantly  to  be  seen.  For  instance, 
within  two  days  of  each  other,  I  saw  two  very  parallel  caaea  of 
encephaloid  of  the  testicle  combined  with  secondary  disease  in 
the  poBt-peritoneal  glands,  and  one  of  thene  in  a  monorehid, 
where  the  disease  first  attacked  the  undeacended  gland. 


18  CANADA  MEDICAL    AND 

The  recent  conversazione  of  the  Royal  College  of  Phyaici: 
which  is  always  one  of  the  features  of  the  s 
remarkable  for  the  number  of  new  scientific  iuatrumcnta  which 
will  probably  soon  in  various  ways  come  into  use  in  medical 
practice,  viz.,  improved  sphygmographs,  the  microphone,  and 
the  phonograph.  You  are  aware  that  Sir  Henry  Thompson  haa 
already  made  some  noise  about  the  employment  of  the  micro- 
phone for  the  detection  of  stone.  It  is  complained  that  the 
sound  of  the  "click"  reached  the  Times  office  as  soon  as  it 
did  the  eara  of  the  bystanders  !  As  an  example  of  the  way  in 
which  the  phonograph  may  possibly  be  useful,  I  miglit  mention 
the  suggestion  which  I  heard  made  by  a  well-known  alienist  the 
other  day  to  cause  a  patient  atJ'ectcd  with  general  paralysis  or 
other  forms  of  nervous  speech  derangement,  to  rej^ater  his 
peculiarities  of  accent  by  this  instrument,  and  thus  by  setting 
the  clock-work  in  motion,  every  one  of  the  modifications,  &c., 
would  be  most  accurately  reproduced  at  any  time,  and  could 
thus  be  used  for  purposes  of  illustration  or  comparisoa 

Lymphadenoma  is  a  disease  attiactiug  a  good  deal  of  atten- 
tion. Cases  here  appear  to  be  tolerably  numerous,  but  tltere 
certainly  appears  to  be  much  wanting  a  good  description  of  the 
points  of  difi'erential  diagnosis  between  this  disease  and  strumous 
enlargement  of  the  cervical  glands.  There  is  a  case  however, 
of  an  undoubted  character  under  Dr.  Bristowe  bi  St.  Thomas' 
hospital,  where  the  glandular  enlargements  are  vei-y  f;eneral ; 
there  is  enormous  enlargement  of  both  sides  of  the  neck  press- 
ing deeply  against  the  pharynx  and  upper  part  of  the  larynx. 
Tracheotomy  has  been  performed  for  a  month  with  great  comfort 
to  the  patient.  He  wears  an  elastic  rubber  trachea-tube,  which 
is  only  removed  once  a  week,  and  seems  to  answer  e.'stremely  well, 

I  had  the  pleasure  of  heajing  Professor  Burden  Sanderson's 
Harveian  oration.  It  was  made  much  more  interesting  than  one 
might  have  expected.  He  left  the  ordinary  ground  of  following 
the  course  of  ilajvey,  as  an  investigator,  and  tried  to  impress 
upon  his  audience,  especially  addressmg  the  younger  portion, 
the  advisability  of  devotmg  themselves  earnestly  and  continu- 
ously without  hope  of  any  immediate  reward,  to  the  investigar 


I 


CORRESPONDENCE.  19 

the  medical  problems  of  the  day,  and  to  the  obaervation 
of  nature  with  strict  records  of  facta  obtiuncd.  He  particularly 
inaiated  upon  the  necessity  of  aiich  men  travelling.  He  believed 
it  to  be  too  much  the  custom  at  present  to  be  confined  to  the  Lon- 
don schools,  but  he  considered  it  juet  aa  requisite  in  the  present 
liay  to  spend  some  years  in  foreign  countries  for  all  men  devoting 
themselves  to  original  inveatigations,  as  it  was  for  Harvey  to 
have  8|)ent  five  years  at  Padua  after  he  had  completed  a  full 
curriculum  in  London  and  obtained  the  English  degrees. 

Sayre's  plaster  of  paria  bandages  have  become  so  popular 
anee  hia  demonatratiooe  in  this  couatry  that  anything  connected 
with  that  subject  can  hardly  fail  to  interest  your  readers.  The 
torgeons  of  the  National  OrthopEedie  Hospital  have  been  experi- 
TQenting  with  a  new  substance  which  they  are  hopeful  will 
supersede  the  heavy  plaster.  The  composition  is  a  patent,  and 
the  exact  composition  not  known.  Sheets  of  this  material, 
whicb  ia  a  kind  of  felt  impregnated  vrith  certiun  gums  and  resins, 
are  made  into  a  cylindrical  form.  Measurements  of  the  patient 
are  made  and  from  this  a  block  tike  a  shoemaker's  last  is  fitted 
«st  to  approximate  to  the  patient's  size  and  outline.  A  portion 
of  the  sheet  is  blocked  on  this  and  sent  to  the  operator.  When 
the  patient  ia  slung,  the  felt  bodice  is  siraplv  heated  over 
a  gas-stove,  when  it  becomes  perfectly  pliable  and  can  be 
smootblj  adapted  to  the  body.  It  sets  quite  hard  in  two  or 
three  minutes.  It  is  then  lac*ed  up  in  front.  The  advantages 
of  course  are  lightness,  cleanliness,  and  the  fact  that  it  can  be 
removed  as  often  as  desired  without  any  ill-effect  whatever. 
I  saw  two  cases  treated  with  it  and  was  pleased  with  the  working 
of  the  material.  The  objections  to  it  are  too  obvious  to  require 
mentioning. 

Too  will  be  pleased  to  hear  that  the  small  volume  of  Patholo- 
gical Reports  lately  issued  from  the  Montreal  General  Hospital 
has  been  exli-emely  well  received  by  those  best  competent  to 
jmlge  of  its  scientific  merits.  I  have  heard  it  in  some  quarters 
very  highly  complimented.  Having  now  attended  several  of 
the  best  autopsy-rooms  in  London.  I  have  not  yet  found  one  in 
which  the  post-mortem  examinations  are  conducted  as  well  or 
»»  aystematically  aa  they  are  in  our  own  General  Hospital. 

G.  R. 


CANADA   MEIHrAL   AND    StlBOtOAL   JODRNAL. 


a^uiews  and  Notices  of  Boohs. 

A  Manual  of  Operative  Stirgerif.     By  Lewis  A.  StimsoNi 
B,A.,  (Yale)M.D.,  Surgeon  to  the  Presbyterian  Hospital, 
Professor  of  Pathological  Anatomy  in  the  Medical  Faculty 
of  the  University  of  New  York.     With  332  illustrations, 
8vo.,  pp.  477.    Philadelphia  :  Henry  C.  Lea,  1878.  Mon- 
treal :  DawBon  Brothers,  St.  James  Street. 
In  the  preparation  of  this  manual  tlie  author  has  endeavoured 
to  render  it  complete  as  regards  the  details  of  the  descriptions 
of  operations,  to  meet  the  wants  of  the  surgeon  and  also  the 
student  of  medicine  and  surgery,  taking  care  however  not  to 
over-burthen  his  work  with  minuteness  of  detail  in  non-essentials. 
Still,  where  he  deemed  it  necessary,  he  has  not  hesitated  to  de- 
scribe very  fully  the  method  of  performance  of  operations  end 
the  anatomical  relation  of  parts.     He  divides  the  work  into 
seven  parts.     In  part  I.  we  liave  considered  the  accessories  of 
an  operation,  such  as  aniesthetics,  means  of  arresting  hsemorrh- 
age,  treatment  of  surgical  wounds,  the  suture  and  bandages. 
Part  II.  is  devoted  to  the  ligature  of  arteries.     Part  III.  to 
amputations.    Part  IV.  to  excision  of  joints  and  hones.     In 
part  V.  is  considered  neurotomy  and  tenotomy.     Part  VI.  treats 
of  plastic  operations  about  the  face ;  and  in  part  VII.  we  Lave 
considered  special  operations.   Fully  half  of  the  book  is  devoted 
to  this  part,  and  we  have  the  subject  discussed  in  nine  chapters. 
In  the  first  chapter  is  given  operations  on  the  eye  and  its 
appendages.     Then  we   have  operations  on  the  ear  and  its 
appendages ;  on  the  mouth  and  pharynx ;  on  the  neck  ;  on  the 
thorax  :  on  the  abdominal  wall,  stomach  and  intestines  ;  on  the 
genito-urinary  organs  of  the  male  ;  the  same  of  the  female :  and 
finally  a  description  of  miaeellaneous  operations.     These  latter 
consist  of  splenotomy,  subcutaneous  osteotomy,  erectile  tumours, 
birth-mark,  weh-fingers,  cicatricial  flexion  of  phalanges  and  in- 
growing toe  nails.     The  type  is  clear  and  well  impressed ;  the 
illustrations  are  all  that  can  be  desired.     Every  department  is 
fully  illustrated  by  engravings,  which  will  he  found  of  incalcola- 


I 


REVIEWS  AND  NOTICES  OF  BOOKS.  21 

lie  use  to  the  sargeon.  The  description  of  each  operation  is 
concise  and  clear.  We  commend  this  work  to  our  readers ;  in 
many  respects  it  is  superior  to  Joseph  Bell's  little  work  on  the 
same  subject,  and  which  for  years  past  has  been  the  familiar 
guide  to  the  student  in  following  a  course  of  operative  surgery. 


FowneB*  Manual  of  Chemistrt/,  Theoretical  an^  Practical. 
Revised  and  corrected.  By  Henry  Watts,  B.A.,  F.R.S. 
Editor  of  the  Journal  of  the  Chemical  Society.  A  new 
American,  from  the  twelfth  English  Edition.  Edited  by 
Robert  Brydgbs,  M.D.,  &c.,  with  177  illustrations;  8vo., 
pp.  1027.  Philadelphia :  Henry  C.  Lea,  1878.  Montreal : 
Dawson  Brothers,  St.  James  Street. 

Fownes'  Elements  of  Chemistry  has  been  a  favourite  text 
book  for  many  years.  The  work  is  designed  to  give  the  student 
a  general  outline  of  the  principles  of  chemistry  and  serve  as  an 
introduction  to  the  larger  and  more  voluminous  works  on  this 
science,  and  furthermore  to  fit  him  for  the  perusal  of  original 
memoirs,  which,  together  with  practical  work  in  the  laboratory, 
can  alone  lead  to  a  real  acquaintance  with  the  spirit  of  research, 
and  the  wonderful  resources  of  chemical  science.  The  first 
three  editions  were  brought  out  by  the  author,  or  nearly  so,  as 
the  third  edition  was  nearly  completed  before  his  death  in  1849. 
At  the  commencement  of  the  following  year  the  third  edition 
appeared  edited  by  the  late  Dr.  Bence  Jones.  The  six  follow- 
ing editions  came  out  under  the  conjoint  editorship  of  Dr.  Bence 
Jones  and  Dr.  Hofmann.  The  tenth  edition  in  1868,  was  pub- 
lished by  Dr.  Bence  Jones,  and  the  present  edition  by  Mr. 
Henry  Watts.  These  gentlemen  found  it  necessary  to  make 
considerable  alterations  and  additions  in  almost  6very  part  of 
the  work  in  consequence  of  the  numerous  changes  which  had 
taken  place  in  chemical  knowledge.  The  chapter  on  General 
Principles  of  Chemical  Philosophy  was  re-written.  Considerable 
additions  to  the  description  of  the  metals  were  made  and  the 
greater  part  of  Organic  Chemistry  was  re-written,  and  in  the 
4ast  English  edition  a  vast  amount  of  new  matter  was  added,  so 


22  CA.tAlfA   MEDICAL   AVD    SCBOICAL   JOUBNAL. 

that  it  was  deemed  desirable  to  lUvide  the  work  mto  two  volomeeT 
the  first  including  chemical  pb^dcs  and  inorganic  cheimstry, 
and  the  second  being  devoted  to  organic  chemistry.  In  previous 
editions  there  ia  to  be  found  a  portion  devoted  to  phyaolo^eal 
chemistry,  incIuiUng  a  description  of  the  tissues  and  fluids  of 
the  animal  body,  and  also  a  description  of  the  functions  of  nutri- 
tion and  respiration.  In  the  present  edition  however  thb  part 
has  boen  omitted,  in  consequence  of  this  department  of  chemistry 
having  become  so  extensive  aa  to  demand  consideration  in  a 
Boparato  work. 

In  this  the  American  edition,  the  publishers  announce  that 
in  reprinting  the  work  "  by  the  use  of  a  small  but  exceedingly 
clear  type,  it  has  been  compressed  intiD  one  volume."  This 
however  has  not  been  done  at  the  expense  of  any  portion  of  the 
work,  and  the  American  editor  has  confined  any  additions  he 
may  have  found  advisable  to  make  to  the  narrowest  compass. 

Wo  feel  convinced  that  it  ie  alone  necessary  to  announce  this 
work  to  ensure  a  large  demand,  as  it  is  one  of  the  best  manuals 
iHued  from  the  press,  and  has  always  been  a  favourite  text 
book. 


Nurviim   Diseates,   their  Description   and    Treatnwnt.  —  By 
Allan  McLane  Hamilton,  M.D.,  Fellow  of  the  New 
York  Academy  of  Medicine,  Attending  Physician  at  the 
Epileptic  and  Paralytic  Hospital,  Blackwell'a  Island,  New 
York,  with  fifty-three  illustrations;  8vo.,  pp.512.     Phila- 
delphia: Henry  C,  Lea,  1878.     Montreal:  Dawson  Bro- 
thers, St.  James  Street, 
The  autlior  informs  us  in   his  preface  that  it  has  been  his 
object  to  produce  a  concise  and  practical  book,  and  he  also  de- 
clares that  he  will  be  amply  rewarded  for  this  self-imposed  task 
should  he  at  any  time  be  made  aware  that  the  diagnosis  and 
treatment  of  nervous  diseases  has  been  simplified  through  his 
means,     llie  subject  of  insanity  has  not  been  gone  into,  as  he 
believes  that  it  demands  a  more  careful  and  extended  notice 
than  could  be  accorded  to  it  in  a  work  of  this  size  ;  cerebro 


HETIEWa  AND   NOTICES  OF   nOOKS. 


23 


spinal  meningitia  is  however  discussed,  although  many  authori- 
ties regard  it  as  not  belonging,  strictly  speaking,  to  nervous 
disorders.  Von  Ziemmsen  in  hia  eyclopiedia  classifies  it  among 
the  acute  infectious  diseases,  and  many  other  authors  place  it 
among  the  fevers.  It  can,  however,  in  a  work  of  this  nature, 
be  very  properly  considered.-  The  work  commences  by  an  in- 
troduction in  which  will  be  found  in  the  first  part  hints  as  to  the 
method  of  examination  and  study  of  cases,  and  also  the  proper 
method  of  conducting  an  autopsy,  and  microscopical  examina 
tiona. 

In  the  second  part  is  mentioned  instruments  used  as  ^ds  to 
the  diagnosis  and  treatment  of  nervous  diseases ;  such  as  the 
thermometer,  the  sesthesiometer,  the  dynamometer,  and  the 
ophthalmoscope.  These  are  all  essentia!  aids  to  the  diagnosis 
of  these  affections ;  and  in  the  treatment  we  have  electrical 
apparatus,  the  hypodermic  syringe,  ice  bags  of  varioiu  designs, 
and  cauteries.  The  rest  of  the  book  is  divided  into  eighteen 
chapters ;  die  opening  chapter  being  devoted  to  disease  of  the 
cerebral  meninges.  Chapters  ii.  to  vi.  inclusive  are  given  to  the 
discussion  of  diseases  of  the  cerebrum  and  cefebellum.  In 
chapter  vii.  diseases  of  the  spina!  meninges  are  considered,  then 
the  ensuing  four  chapters  are  devoted  to  diseases  of  the  spinal 
cord.  There  is  a  chapter  on^  bulbar  paralysis,  then  follow  two 
chapters  on  what  the  author  classifies  under  the  beading  of 
cerebro  spinal  diseases,  these  consisting  of  cerebro  spinal  men- 
engitia,  cerebro  spinal  sclerosis,  alcoholism,  hydrophobia,  hysteria, 
hystero-epilepsy,  catalepsy,  chorea  paralysis  agitans  and  esoph- 
^almic  gMtrc.  The  remaining  four  chapters  are  on  diseases 
of  the  peripheral  nerves. 

At  the  end  of  the  volume  there  are  formulre  for  various  mix- 
tares,  pills,  powders,  hypodermic  injections,  inhalations,  lotions 
and  unguents.  This  book  containa  a  large  amount  of  material 
which  is  not  to  be  found  elsewhere  ;  the  style  is  very  clear  and 
readable,  am!  the  teaching  sound.  No  physician  ought  to  he 
without  a  copy  of  tliis  work.  The  author  has  had  ample  oppor- 
tunity in  connection  with  the  epileptic  hospital  on  Biafikwell's 
Island,  as  also  with  the  ontnloor  department  of  the  New  York 


24 


CANADA   MEDICAL    AND   HUEGICAL   JOURNAL 


Hospital,  and  has  apparently  fully  utiiiaed  the  material  at  his 
disposal.  The  work  appears  to  be  a  very  important  and  useful 
addition  to  the  literature  of  this  subject,  which  was  prior  to  the 
appearance  of  this  volume  rather  meagre. 


Tramactions  of  the  Ameriean  Oynacological  Society.  Vol.  2. 
For  the  year  1877.  8vo.,  pp.  672,  with  index  of  Gynce- 
colo^cal  and  Obstetrical  literature  of  all  countries,  frord 
July  1st  1876*,  to  January  1st  1877,  pp.  25.  Boston : 
Houghton,  Osgood  k  Co.,  Cambridge.  The  Riverside 
Press,  1878. 

This  ia  the  second  volume  of  Transactions  of  the  American 
Gynoecological  Society,  and  consists  of  a  series  of  papers  sub- 
mitted to  the  Society  at  its  second  Annual  Meeting,  held  in 
May,  1877.  It  has  taken  a  httle  over  a  year  to  bring  out  this 
volume — perhaps  a  little  tardy,  but  what  has  been  done  is  well 
done.  The  volume  is  got  up  in  the  same  style  as  Its  predecessor, 
in  good  readable  type,  on  fully  toued  paper,  and  illustrated 
throughout  with  chromo-Iithographs  and  heliotypes  of  excellent 
finish.  From  an  introductory  note  by  Dr.  Chadwick,  the  sec- 
retary of  the  Society,  we  learn  that  it  is  the  intention  to  publish 
in  each  succeeding  volume,  an  index  for  the  year  to  the  GytMB- 
cological  and  Obstetric  Literature  of  all  Countries.  This  volume 
contiuns  such  an  i&dex,  extending  from  the  let  July  1876,  to 
the  lat  January  1877.  It  has  been  prepared  with  the  coopera- 
tiou  of  Dr.  J,  S.  Billings,  of  the  I^atioual  Medical  Library  at 
Washington  ;  this  will  add  greatly  to  the  value  of  the  work,  and 
if  kept  up  from  year  to  year  will  render  the  work  indispensable 
in  the  hbrary  of  the  scientific  student.  After  Ibta  of  honorary 
fetlowa  and  ordinary  fellows,  and  minutes  of  the  proceedings  of 
the  second  annual  meeting,  the  real  interest  in  the  volume  opens 
with  ihe  annual  address  on  medical  Gynixcology  by  the  presi- 
dent. Dr.  Fordyee  Barker.  In  a  few  introductory  remarks, 
he  points  to  the  advisability  of  the  careful  dLstribution  of  foreign 
honorary  fellowships,  observing  that  llie  society  should  adopt 
"  the  wise  policy  of  8electin.g  a  very  small  number  from  thoee 


\ 


BEVIEWS  AND   NOTICES   OF   BOOKS.  25 

only  who  have  done  so  much  for  the  literature  and  science  of 
our  branch  of  the  profession,  as  to  make  their  election  an  ex- 
pression of  the  highest  respect  which  this  society  can  evince  "  ; 
and  as  regards  honorary  fellowships  from  amongst  his  own 
countrymen  he  suggests  the  expediency  of  selection  only  from 
amongst  those  who  "  have  won  the  honour  by  good  service  in 
the  society."  Certainly  if  these  suggestions  are  fully  carried 
out  they  will  do  much  to  elevate  the  character  and  standing  of 
the  society,  for,  as  he  truly  observes,  "  honours  cheapened  by 
being  made  conmion,  are  but  lightly  esteemed." 

This  excellent  address  is  followed  by  one  from  the  pen  of  Dr. 
James  R.  Chadwick,  of  Boston,  on  the  functions  of  the  anal 
sphincters,  so  called,  and  the  art  of  defecation ;  in  this  we  have 
described  the  physiological  action  of  the  sphincters,  the  author 
recognising  after  Hyrtl  the  sphincter  ani  tertius.  This  paper  is 
very  interesting  and  leads  to  practical  deductions,  of  which  the 
following  are  a  summary :  That  in  the  introduction  of  a  bougie 
into  the  rectum  it  is  an  error  to  imagine  that  a  straight  bougie 
ought  not  to  meet  with  any  natural  obstruction.  2nd.  '^  As  the 
anteri9r  half  of  the  inferior  detrusor  is  just  below  the  level  of 
the  bottom  of  Douglas's  pouch,  it  seems  probable  that  the  point 
at  which  inter-peritoneal  abscesses  are  most  likely  to  perforate 
the  rectum  is  just  above  this  constricting  fold,"  and  3rd.  '^  As 
the  superior  detrusor  is  shown  to  be  forced  down  into  the  canal 
during  defecation  by  the  action  of  the  abdominal  muscles,  the 
suggestion  presents  itself  that  this  part  of  the  rectum  is  the  one 
that  first  emerges  in  cases  of  prolapsus  of  the  rectum."  This 
article  is  illustrated  by  two  heliotype  plates. 

Dr.  John  Byrne,  of  Brooklyn,  N.  Y.,  gives  a  practical  paper 
on  amputation  and  excision  of  the  cervix  uteri,  their  indications 
and  methods.  The  term  excision  he  restricts  to  the  removal  of 
comparatively  small  portions  of  the  cervix  in  contradistinction 
to  the  term  amputation,  by  which  he  would  imply  the  entire  re- 
moval of  an  hypertrophied  or  diseased  cervix.  In  speaking  of 
the  means  used  for  the  amputation  or  excision  of  the  cervix,  the 
author  shows  a  decided  preference  to  the  use  of  the  galvanic 
cautery  ;  seven  cases  are  reported  with  encouraging  success ; 


26 


ADA    MEDICAL   AND    StrRlilCAL    JOrRNAL. 


an  interesting  discussion  on  this  paper  follows,  and  we  have  the 
opinion  of  Dr.  Scott,  of  the  Women's  Hospital,  San  Francisco, 
Dr.  Byford,  of  Chicago,  Dr.  Goodell,  of  PWIadelphia,  and  Dr. 
Nocggerath,  of  New  York. 

We  next  have  a  report  on  the  corpus  Inteum,  from  the  pen 
of  Dr.  John  C.  Dalton,  of  New  York.  It  appears  that  at  the 
meeting  of  the  society,  held  in  1876,  Dr.  Daltoo  was  invited  to 
prepare  a  report  on  this  subject,  and  through  the  cooperation  of 
a  number  of  medical  fricnda  he  obtained  in  good  condition 
thirty-two  pairs  of  ovaries,  at  various  periods  after  menstruation, 
and  after  delivery  the  first  ten  cases  reported,  illustrated  the 
growth  and  retrogression  of  the  corpus  luteum  as  connected 
with  the  menstrua!  period.  Then  we  have  the  record  of  six 
cases  in  which  the  condition  of  the  ovaries  is  described  after 
menstruation  had  been  suspended  for  several  months  or  years. 
Those  cases,  the  author  informs  us,  serve  to  illustrate  the  nega- 
tive history  of  the  corpus  luteum  in  its  relations  with  menstrua- 
tion. The  ensuing  five  cases  illustrate  certain  irregularities  and 
_  marked  deviations  in  the  corpus  luteum  of  menstruation,  and 
the  remaining  cases  illustrate  the  apjwarance  of  the  corpus 
luteum  of  pregnancy  and  after  delivery ;  this  paper  is  illustrated 
with  twelve  coloured  lithographs. 

Dr.  G.  H.  Bixhy,  of  Boston,  gives  a  translation  of  a  paper 
by  Dr.  Otto  Spiegelberg,  on  the  pathology  and  treatment  of 
puerperal  eclampria.  This  is  followed  by  a  paper  on  dilatation 
of  the  cerWx  uteri  for  the  arrest  of  hiemorrhage,  by  Dr.  G,  H. 
Lyman,  of  Boston.  There  are  three  short  papers,  one  by  Dr. 
Skene,  on  the  principles  of  gyncecological  surgery  applied  in 
obstetric  operations,  another,  researches  on  the  mucous  mem- 
brane of  the  uterus,  by  Dr.  Engelmann,  and  a  third  on  the 
necessity  of  caution  in  the  use  of  chloroform  during  laborir,  by 
Dr.  W.  T.  Luak.  In  this  paper  the  author  assigns  five  reasons 
why  chloroform  is  objection  able.  Ist.  If  carried  to  complete 
loss  of  consciousness,  it  sometimes  weakens  uterine  action,  or ' 
may  suspend  it  altogether.  This  may  possibly  follow,  but  we 
should  think  it  exceptional.  Uterine  action  may,  as  a  first 
efi'ect,  be  weakened,  but  we  cannot  call  to  mind  any  case  where 


I 


REVIEWS  AND    SOTICEB   OF   BOOKS.  ^1 

it  has  boen  totally  auspended  during  the  parturient  act.  In  the 
third  proposition  the  author  denies  that  patients  in  labour  enjoy 
any  absolute  immunity  from  the  pernicious  effects  of  chloroform. 
Fourthly,  the  author  holds  that  the  antesthetic  ought  not  to  be 
given  in  the  third  stage,  as  he  remarks,  the  relative  safety  of 
chloroform  in  parturition  ceases  with  the  birth  of  the  child.  In 
this  we  fully  agree.  The  chief  objection  to  our  mJhd  to  the  use 
of  chloroform,  is  a  decided  tendency  to  post  partum  haemorrhage 
aa  following  its  employment.  It  appears  to  influence  injuriously 
the  contractile  power  or  tone  of  the  muscle  of  the  uterus,  and 
in  onr  experience  post  partum  hremorrhage  is  very  apt  to  follow 
'm  ose. 

This  fact  was  long  since  pointed  out,  and  in  all  cases  in  which 
chloroform  has  been  freely  administered,  the  aocoucheur  should 
always  use  more  than  ordinary  precautions  against  this  result 
which  is  BO  apt  to  follow,  as  undoubtedly  the  anieathetic  tends  to 
jirodace  nterine  relaxation. 

The  next  paper  is  by  Dr.  Van  de  Warker,  on  the  present 
status  of  the  intra  uterine  stem  in  the  treatment  of  flexions  of 
the  uterus.  This  paper  is  fully  discussed,  the  discussion  being 
participated  in  by  all  the  leading  gynoecologists  present.  A 
case  of  vaginal  ovariotomy  ia  reported  by  Dr.  Goodell.  This  is 
ft^owed  by  a  paper  from  Dr.  Robert  Battej,  entitled,  "  la 
there  a  proper  field  for  Battey'a  operation  ?  "  As  our  readers 
sre  aware,  Dr.  Battey  proposes  the  removal  of  the  ovaries  while 
still  functionally  active,  as  a  means  of  relieving  certain  condi- 
tions, and  he  offers  the  following  propositions :  He  would  prac- 
tice removal  of  the  ovaries — 1st.  "  In  those  cases  of  absence  of 
the  uterus,  in  which  life  is  endangered  or  health  destroyed  by 
reason  of  the  deficiency."  2iid.  "  In  cases  when  the  uterine 
cavi^  or  vaginal  canal  has  been  obliterated  and  cannot  be 
restored  by  surgical  means.  If  grave  symptoms  are  present, 
[he  removal  of  the  ovaries  becomes  a  last  and  only  resort,  and 
may  be  hopefully  invoked  in  the  case."  3rd,  "  In  cases  of  in- 
sanity or  confirmed  epilepsy,  dependent  on  uterine  or  ovarian 
diseaae,"  4th.  "  In  cases  of  long  protracted  physical  and 
mental  soflering,  dependent  on  monthly  nervous  and  vascular 


28 


CANADA  MBDICAI,    AND    SURGICAL   JOUBNAL. 


perturbations  which  have  resisted  all  other  means  of  cure." 
We  cannot  believe  that  this  operation  will  ever  become  a  recog- 
nised surgical  procedure.  In  the  discussion  which  follows  this 
paper,  the  general  feeling  appears  adverse  to  the  adoption  of 
this  as  a  recognised  and  justifiable  operation. 

Dr.  Paul  F.  Mund^  gives  an  excellent  paper  on  "the  value  of 
electrolysis  in  tbe  treatment  of  ovarian  tumours."  The  conclu- 
sions he  arrives  at  are  as  follows  :  1.  Unquestionably  a  num- 
ber of  cases  of  ovarian  tumours  reported  on  reliable  authority' 
have  been  completely  cured  or  permanently  improved  by  electro- 
lysis. 2.  It  is  equally  unijuestionable  that  in  a  number  of  cases  ^ 
the  electrolysis  was  followed  by  dangerous  and  even  fatal  results. 
3.  Further,  six  cases  out  of  fifty-one  received  neither  benefit 
nor  injury  from  tbe  treatment,  and  four  were  only  temporarily 
improved.  4,  The  lack  of  accurate  reports  of  tbe  anatomical 
character  of  the  cyst  in  the  cases  collected,  prevents  any  definite  1 
conclusion  as  to  whether  monocysta  or  polycysts  are  more  or  leas  ' 
amenable  to  electrolysis,  or  unfavourably  affected  by  it.  5.  How 
the  cures  were  effected  is  a  matter  still  open  to  investigation. 
6.  Notwithstanding  these  undoubted  cures  the  percentage  of 
successes  (.55  per  cent.)  compares  unfavourably  with  that  of  ovar- 
iotomy. Spencer  Wells  had  78  per  cent.,  and  in  187(1  a 
as  91  per  cent,  of  recoveries.  7.  Judging  partly  from  these  ' 
statistics,  and  partly  from  general  considerations,  it  would  seem 
that  electrolysis  can  In  no  wise  supplant  ovariotomy,  and  that 
to  try  electrical  experiments  with  patients  whose  tumours  and 
oonstitution  are  in  every  way  prepared  for  the  radical  operation, 
looks  very  like  trifling  with  their  hvea. 

Notwithstanding  these  conclusions,  baaed  on  a  most  careful 
analysis  of  all  the  cases  no  far  published,  we  cannot  altogether 
-agree  with  Dr.  Mundi^,  as  it  must  be  admitted  that  the  number 
of  cases  in  which  the  electrolytic  treatment  has  been  practised 
do  not  bear  comparison  with  those  in  which  ovariotomy  has  been  i 
followed.     Electrolysis  in  ovarian  cysts  is  yet  in  the  very  outset  I 
of  its  career,  and   we  cannot  but  believe  that  it  has  a  bright  I 
future,  and  that  in  the  hands  of  scientific  and  hsnest  men  it   | 
will  yet  bo  found  a  [jowerful  means  for  good. 


i 

i 

I 


hevibws  and  notices  op  books.  29 

There  is  an  excellent  paper  by  Dr.  Emmet,  of  New  York,  on 
congenital  absence  and  accidental  atresia  of  the  vagina.  Dr. 
Giddings  reports  a  case  of  sarcoma  of  the  kidney  in  a  negro 
child ;  this  is  illustrated.  Dr.  Parvin  gives  a  supplementary 
report  of  a  case  of  xenomenia,  which  was  published  in  the  first 
volume  of  the  transactions  ;  this  is  accompanied  with  two  helio- 
types,  Dr,  Engelmann  writes  a  paper  on  the  hystero-neurosis, 
with  especial  reference  to  the  menstrual  hystero-neurosis  of  the 
stomaclt  The  volume  proper  closes  with  an  obituary  sketch,  by 
Dr.  Lyman,  of  the  late  Charles  Edward  Buckingham  ;  this  is 
accompanied  with  an  excellent  likeness  of  Dr.  Buckingham,  who 
was  one  of  the  original  fellows  of  the  society.  There  is  also 
published  a  number  of  supplementary  papers,  presented  to  the 
council  by  the  candidates  elected  to  fellowship  of  the  American 
Gyncecological  Society  at  its  second  annual  meeting  in  1877. 
These  consist  of  cases  illustrating  important  points  connected 
with  the  operation  of  ovariotomy,  by  Dr.  Kimball,  of  Lowell, 
Mass.  The  radical  treatment  of  dysmenorhcea  and  sterility  by 
Dr.  Elwood  Wilson,  of  Philadelphia.  Dr.  Wardale  West's  views 
of  rotation,  by  Dr.  John  P.  Reynolds,  of  Boston.  Vascular 
tomours  of  the  female  urethra,  by  Dr.  A.  Reeves  Jackson,  of 
Chicago.  The  simple  varieties  of  perineal  laceration,  by  Dr. 
Thaddeus  A.  Reamy,  of  Cincinnati.  On  Lying-in  institutions, 
especially  those  in  New  York,  by  Dr.  H.  J.  Garrigues,  of 
Brooklyn,  N. Y.  The  menstrual  cycle,  by  Dr.  John  Goodman,  of 
liouisville,  and  also  an  appendix  to  Dr.  John  Byrne's  paper  on 
amputations  and  excisions  of  the  cervix  uteri. 

We,  have  thus  far,  we  hope  without  prolixity,  endeavoured  to 
give  our  readers  some  conception  of  the  contents  of  this  excel- 
lent volume  ;  it  is  a  credit  to  the  society  from  which  it  emanates, 
and  we  believe  it  will  be  hailed  with  satisfaction  by  the  profes- 
sion generally. 


CANADA  MEDICAL    AND   80R0ICAL   JODKNAL, 


aSxtracfs  from  ■Kritish  and  foreign  Jaurnals. 

UnJCH  olherwiic  staled  the  incilalioni  ire  made  tpeciaDy  (oi  ihii  jDumil. 

Iiithotomy.— Acase  of  Lithotomy,  in  which  an  enlarg- 
ed middle  lobe  of  the  prostnte  gland  waa  accidentally  removed. 
By  Chablbs  Wiluaus,  F.R,C.S.,  Aasiatant  Surgeon  to  the 
Norfolk  and  Norwich  Iloapital. — The  specimen  which  I  have  the 
pleasure  to  exhibit  to  you  represents  an  enlarged  middle  lobe  of 
the  prostate  gland,  accidentally  removed  from  a  gentleman  on 
whom  I  performed  the  operation  of  lithotomy. 

The  patient  waa  a  tall  thin  man,  aged  72,  living  about  ten 
miles  from  Norwich.  He  had  had  symptoms  of  stone  in  the 
bladder  for  upwards  of  twelve  months.  A  few  months  before  I 
visited  him,  he  had  passed  on  one  or  two  occasions,  a  large 
quantity  of  blood  in  his  urine.  Of  late  he  had  suffered  much 
from  the  presence  of  the  atone.  He  had  been  greatly  disturbed 
during  the  night  and  had  become  low-spirited.  His  urine  waa 
found  to  be  (juite  healthy  and  free  from  albumen.  His  feet 
were  in  no  wise  oedematous ;  and  he  could  eat  freely.  There  was 
a  loud  systolic  bruit  heard  over  an  extended  area  of  the  cheat 
giving  rise  to  no  inconvenience.  Five  yeara  previously  ho  frac- 
tured the  neck  of  the  right  thigh-bone  ;  ankylosis  of  the  hip- 
joint  resulted  from  the  injury,  and  he  now  walks  with  a  perfectly 
straight  and  atifi*,  and  shortened,  limb. 

On  July  6th,  with  the  assistance  of  Messrs.  Morton,  surgeons, 
of  Aylaham  (under  whose  care  the  patient  had  been),  I  perform- 
ed the  usual  lateral  operation,  and  removed  a  single  stone,  of 
an  oval  flattened  shape,  weighing  five  drachms,  of  uric  acid 
formation.  An  enlarged  middle  lobe  of  the  prostate  became 
engaged  between  the  blades  of  the  hthotomy-forcepa.  anterior 
to  the  hinge,  and  was  unconscioiialy  torn  off  and  came  away  with 
the  stone.  There  was  free  arterial  hfemorrhage  from  a  deeply 
seated  vessel,  which  was  without  much  difficulty  seen  and 
secured  by  ligature.    A  tube  was  placed  in  the  wound. 

On  visiting  the  patient  next  day  I  found  him  easy  and  com- 
fortable.    There  had  been  do  sickness ;  he  had  slept  fairly  well ; 


1 


BRITISH   AND    POREIOM    JOUBNALS.  31 

■  pulse  64.  The  wound  looked  well ;  the  urine  waa  clear,  and 
drop]Hng  freely  from  the  tube  and  abundant  in  quantity.  On 
ihe  ninth  day,  he  paaaed  the  whole  of  his  urine  through  the 
penis,  and  the  wound  waa  healing  rapidly.  Three  weoka  later, 
I  found  him  in  excellent  health,  and  the  wound  perfectly  healed. 
He  aeldom  found  it  necessary  to  micturate  more  tlian  once  dur- 
ing the  night 
Remarkb. — This  case  presents  some  points  of  much  intereet, 

1.  The  presence  of  a  loud  systolic  bruit  Is  not  a  pleasant  sign 
in  connection  with  the  administration  of  chloroform,  of  which 
my  patient  inhaled  from  four  to  five  drachms,  and  from  which 
lie  suffered  not  the  slightest  inconvenience,  either  during  the 
operation  or  subsequently. 

2.  The  fracture  of  the  neck  of  the  right  oa  femoris  had  re- 
sulted in  ankylosis  of  the  joint.  The  limb  was  immovably  fixed 
iu  the  straight  position  ;  therefore  it  could  not  be  tied  up  in 
ordinary  lithotomy  fashion,  but  waa  held  by  an  assistant  in  a 
sirught  direction  over  my  left  shoulder.  This  rendered  the 
performance  of  the  operation  somewhat  less  easy  than  usual. 
The  parte  forming  the  perineum  were  lax  instead  of  being  tense, 
and  m  order  not  to  wound  the  rectum,  which  was  large  and 
9accid,  I  passed  my  left  forefinger  inta  the  bowel,  and  retained 
it  until  the  point  of  the  knife  was  lodged  in  the  groove  of  the 
Btafi";  and,  by  directing  the  edge  of  the  knife  very  obliquely 
outwards,  the  rectum  escaped  injury — an  event  which,  in  all 
probability,  would  have  occurred  had  not  these  precautions  been 
adopted.  If  such  an  accident  had  happened,  taking  into 
account  the  age  of  the  patient,  I  fear  the  termination  of  the 
case  would  have  been  unfavorable, 

3.  The  removal  of  a  large  portion  of  the  middle  lobe  of  the 
prostate,  though  quite  accidental,  waa  attendant  with  a  happy 
result.  The  man  was  relieved  of  a  trouble  which,  sooner  or 
later,  would  have  been  a  source  of  grievous  annoyance  to  him. 

I  witnessed  the  same  accident  in  &  ease  operated  on  by  Mr. 
Cadge.  In  the  forceps,  between  the  stone  and  the  blades,  there 
came  away  three  masses,  which  were  apparently  fibrous  out^ 
growths  of  the  prostate,  and  which  weighed  one  drachm  two 


I 


32  CANADA   MEDICAL   AJfD   SliBOICAL  JOPRNAT., 

HCruplea.  In  two  months  the  wound  had  healed,  and  the  patient 
was  strong  and  well.  Mr.  Cadge  remarks  :  "  It  has  happened 
to  m^  twice  before  to  remove  small  fibrous  tmcoura  of  the  pros- 
tate gland  during  the  operation  of  lithotomy,  and  apparently 
without  harm  to  the  patient."  {Trangaetion»  of  the  London 
Pathological  Societt/,  vol.  xiii,  1862.)  And  he  gives  the  exper- 
ience of  an  expert  modern  lithotomist  on  this  subject,  who  says : 
"  It  has  occurred  to  me,  eight  or  ten  times,  to  bring  away  por- 
tions of  the  prostate  and  without  noticeable  injury  to  the  patient. 
In  more  than  one  instance,  it  was  the  prominent  front  lobe  that 
got  between  the  handles,  anterior  to  the  binge,  and  was  torn  off 
entire  ;  and  although  I  have  never  known  unpleasant  results  to 
the  patient,  and  that  sometimes  he  has  been  benetited  in  after- 
life, by  having  got  rid  of  an  useless  impediment  to  a  natural 
function,  I  would  not  willingly  that  such  an  occurrence  should 
happen,  and  I  try  to  avoid  it  by  turning  the  blade  of  the  forceps 
to  the  lower  angle  of  the  wound  as  I  leave  the  bladder :  but 
when  it  does  occur,  I  lay  no  account  by  it." — British  Mrd. 
Journal. 


I 


Congenital  Absence  of  One  Kidney.— 

In  the  current  number    of    Virchow's   ArcMv,  Dr.   Beumer 

has  collected  from  various  sources  forty-eight  cases  of  this 
interesting  malformation.  In  forty-ibur  cases  it  was  entirely 
absent,  and  in  the  other  four  rudimentary.  It  was  as  often 
absent  on  one  side  as  on  the  other.  It  was  of  more  frefjuent 
occurrence  in  the  male  than  the  female.  In  most  cases  in  which 
the  kidney  was  absent  the  supra-renal  body  was  present ;  in  two ' 
cases  it  was  enlarged,  in  five  cases  it  was  absent.  In  thirteen 
cases  an  arrest  of  development  of  the  seicual  organs  was  observed. 

The  remaining  kidney  was  in  all  cases  enlarged  and  increased 
in  size  and  weight,  and  a  corresponding  development  of  the  ves- 
sels and  ureter. 

This  is  a  fresh  and  striking  proof  of  the  completeness  with 
which  the  one  kidney  can  carry  on  the  fiinctions  of  two  without 
suffering  degeneration  in  consequence  of  the  incieased  work. — 
Mtdical  Journal,  N.  Y. 


^ 


BRiTIgH   AND   FOREIGN   JOl^NALS.  Ai 

The  InfontUe  Diarrboea  of  Summer.— 

At  a  recent  meeting  of  the  New  York  Academy  «1'  Medicine 

i^Med.  Record,  May  2.5, 1S7S),  Dr.  J.  Lewis  Smith  contributed 

I  a  very  interestiDg  paper  on  this  subject.     As  regards  its  treat- 

I  xoent,  he  said  he  helieved  that  there  were  but  very  few  remedies 

P  frora  wliich  it  was  necessary  to  select,  and  for  his  own  part  he 

scarcely  ever  employed  more  than  two,  viz.,  opium  and  bismuth, 

before  the  hydrocephaloid  stage  was  reached,  and  these  he 

considered  better  than  all  others.     The  administration  of  the 

large  doses  of  bismuth  now  employed  is  of  but  recent  origin, 

bat  has  been  followed  by  the  best  results.     In  ordinary  cases 

it  should  be  given  in  doses  of  ten  or  twelve  grains,  and  it  may 

be  advantageously  combined  with  the  compound  powder  of  chalk 

with  opium  (which  contains  one  grain  of  opium  in  forty),  or 

else  with  ordinary  Dover's  powder.     For  general  use,  however, 

I  it  i«  perhaps  better  to  give  the  bismuth  in  suspension,  and  the 

\  following  prescription  will  be  found  a  very  admirable  one : — 

R..  Tmci.  opii  deodoratse gtt.  xvj. 

Bismuth,  subnitratis iij. 

Syrupi flss. 

Aquze fjiss. 

Dose,  a  teaspoonful  for  a  child  of  one  year. 

Dr.  Smith  said  that  he  had  been  much  more  succeesfiil  since 
he  had  employed  opium  and  bismuth  in  this  way  than  before, 
when  he  would  often  try  a  long  list  of  remedies  in  succession, 
tnd  not  find  good  results  from  any.  Such  a  combination  as  the 
ftbove  is  retained  on  the  stomach,  and  has  the  effect  of  both  an 
tntieeptic  and  an  astringent.  No  preparatory  treatment  is 
fieccBsary,  unless  it  is  found  that  some  irritating  article  of  food 
hg£  been  taken ;  but  moat  of  the  caees  are  considerably  ad- 
vanced when  the  physician  is  called  in,  and  any  such  source  of 
tfouble  has  long  since  been  gotten  rid  of. 

.\lmoBt  all  cases  of  entcro-colitis  need  stimnli^B.  and  brandy 
ie  ibe  best  form  in  which  it  can  be  given.  Of  course,  the  amount 
sfaould  vary  according  to  the  ago,  and  Dr.  Smith  is  in  the  habit 

NO.  LXXIU.  3 


AND    SrRniCAL   JOUHNAI.. 


34  CANADA   MELII 

of  giving  three  drops  for  everj  month  of  the  child's  age  {when 
under  one  year)  every  two  or  three  hours. 

When  the  hydrocepbaloid  stage  of  the  diseftse  is  reached,  the 
opium  should  be  withdrawn  or  given  very  cautiously  ;  but  the 
hismuth  may  be  continued  aa  before.  At  tbia  period,  howeverj 
we  must  depend  principally  on  tonics  and  astringents,  and  one 
of  the  most  useful  agents  that  can  he  employed  is  the  liquor 
ferri  nitratis.  The  following  prescription  will  prove  of  great 
service ; — 

H .  Tinct.  calumbae f3  ij. 

Liq.  ferri  nitratis gtt.  xviij. 

Syrupi f^ij. 

M. 


At  the  same  time  the  stimulus  should  be  kept  up  aa  before. 

Finally,  the  kind  of  diet  used  is  of  the  utmost  importance. 
If  the  child  ia  under  one  year  old  it  should  at'  once  be  removed 
to  the  country,  or  a  wet-nurse  should  be  provided  for  it,  as  no 
artificial  food  is  reliable.  If  both  of  these  are  impossible,  the 
best  cow's  milk  should  be  prepared  in  such  a  way  as  to  resemble 
healthy  human  milk  as  much  as  possible.  -  The  milk  should  be 
allowed  to  stand  for  some  time,  and  then  only  the  upper  third  of 
it  employed.  In  this  way  the  larger  part  of  the  sugar  and 
butter  will  be  obtained,  while  the  indigestible  casein  (which 
settles  to  the  bottom)  will  be  avoided.  As  regards  farinaceous 
preparations  for  children  under  six  months  old,  Dr  Smith  prefers 
Mellin's  Liebig's  food,  which  also  has  the  endorsement  of  such 
authorities  as  Eustace  Smith  and  Tanner.  Its  taste  is  quite 
sweet  from  the  dextrine  and  glucose  which  it  contains,  while  it 
ia  almost  entirely  free  from  starch.  When  added  to  cow's  milk, 
it  makes  as  good  a  substitute  for  mother's  milk  aa  has  as  yet 
been  obtained.  After  the  age  of  six  months  infants  can  digest 
a  certain  amount  of  starchy  food,  and  then  Robinson's  prepared 
barley  may  be  used  with  advantage,  if  it  is  sufficiently  boiled. 
As  a  rule,  however.  Dr.  Smith  prefers  Bidge's  food,  which  is 
highly  recommended  by  Steiner,  of  Germany.    Dr.  Smith  for- 


BRITISH  AND   FORErON  JOURNALS.  35 

merly  used  to  employ  Nestl^'s  food,  but  has  been  obliged  to 
give  it  up,  when  the  bowels  are  affected,  on  account  of  its 
laxative  effect.  In  cases  of  habitual  constipation  in  young 
in&nts,  which  is  often  a  very  perplexing  condition  to  the  prac- 
titioner, he  has  found  it  of  very  great  service. — Monthly  Abstraet. 

Siirgrical  Treatment  of  Broncliocele.'— 

Professor  Bilroth  has  found  that  the  injection  of  iodine  is  not 
as  dangerous  as  was  supposed.  In  some  individuals  a  \iolent 
reaction  occurs,  in  others,  there  is  none.  His  method  is  as 
follows  :  He  injects  first  from  one-third  to  one-half  of  the  so- 
called  Pravaz  syringeful  of  undiluted  tincture  of  iodine,  and,  if 
this  is  well  borne,  in  five  or  six  days  he  makes  a  second  injec 
tion  of  one  half  or  a  whole  syringeful,  repeating  this  twice  a 
week.  If  the  patient  becomes  thin,  the  treatment  should  be 
immediately  stopped,  as  the  emaciation  may  go  on  to  an  import- 
ant degree.  It  should  also  be  stopped  if  haemoptysis  appears. 
In  general,  the  injections  are  well  borne,  and  exert  remarkable 
influence.  They  may  be  tried  when  suffocative  symptoms  have 
appeared,  if  the  patient  is  kept  under  constant  inspection  ;  and 
even  in  cases  about  to  be  operated  upon,  their  employment  has 
been  followed  by  recovery.  It  is  essential  that  the  iodine  be 
injected  well  into  the  substance  of  the  bronchocele,  which  may 
be  done  rapidly,  the  pain  at  the  most  continuing  for  five  or  ten 
minutes,  and  requiring  cold  applications,  while  in  many  cases  it 
18  entirely  absent. 

In  cystic  bronchocele  he  usually  injects  half  an  ounce  of  tinc- 
iure  of  iodine,  afl«r  having  allowed  the  cyst  to  empty  itself 
through  a  canula.  The  puncture  is  sealed  up,  and  on  the  third 
day  there  is  great  swelling  and  accumulation  of  gas ;  from  this 
moment  absorption  begins  slowly,  lasting  about  a  year.  In 
thirty-four  cases  treated  in  this  way  he  had  twenty-nine  recov- 
eries. The  iodine  is  supposed  to  exert  an  alterative  action 
upon  the  cells  lining  the  cyst,  and  tlms  prevents  further  secre- 
tion. He  has  also  tried  incision  with  drainage,  and  stitching 
the  wall  of  the  sac  to  the  skin.  Three  out  of  twelve  treated 
in  this  way  died  however.     Of  thirty-seven  cases  of  extirpa- 


CANADA   MEDICAL   1 


ItjROlCAL    JOIJRNAL. 


tion,  twenty-four  recovered.  He  finds  the  cwtilageB  of  the  tra- 
chea so  thinned  by  pressure  that  they  become  easily  compressi- 
ble, ami  hence  several  sudden  deaths  have  takeo  place  from 
swelling  of  the  parts,  giving  rise  to  suffocation.  The  mortality 
in  a  scries  of  ninety-four  cases  waa  eighteen,  or  about  nineteen 
per  cent.  A  case  of  goitre  succeasfally  treated  by  one  subcu- 
taneous injection  of  ergot  was  reported  at  the  recent  meeting 
of  the  American  Medical  Association.  — Botton  Medical  <md 
SvrtjicHl  Journal, 

Aneurism  of  SubclaTian  and  Axillary 
Artery — Treated  by  Rest  and  Restricted  Diet. — At  a  late 
meeting  of  the  Clinical  Society  of  London  {Lancet,  March  16, 
1878),  Mr.  HtiLKE  read  the  notes  of  such  a  ease.  The  patient, 
a  French-polisher,  aged  thirty-six,  but  much  older  in  appearance, 
addicted  to  drink,  after  suffering  from  pains  in  the  left  shoulder 
and  arm,  supposed  to  be  rheumatic,  during  two  months,  became 
aware  of  a  swelling  at  the  root  of  hia  neck  on  the  left  aide,  for 
vhich  he  went  into  King's  College  Hospital.  Dissatisfied  with 
what  was  there  done  for  him,  he  left  that  hospital,  and  five 
months  after  the  beginning  of  his  illness  entered  the  Middlesex 
Hospital,  28th  March,  1877.  At  this  time  he  had  a  large 
aneurismal  tumour  filling  the  axilla  and  implicating  also  the 
third,  second,  and  presumably,  to  some  extent,  also  the  first  part 
of  the  left  subclavian  artery  ;  and  he  suffered  great  pain  down 
the  ai'm  and  over  the  shoulder-blade.  He  waa  kept  in  bed,  and 
enjoined  to  keep  perfectly  atill — not  even  to  sit  up  or  to  move 
off  the  bed  for  any  purpose,  and  he  waa  put  on  a  very  limited 
non-stimulating  diet.  This  was  followed  by  rapid  mitigation  of 
the  pain,  by  decrease  of  the  aneurism  and  its  obstruction  by 
clot.  He  was  discharged  for  disorderly  conduct  in  June,  at 
which  time  the  axillary  portion  of  the  sac  had  shrunken  to  the 
size  of  an  acorn,  and  was  quite  impervious,  and  the  cervical 
part  was  very  small,  and  felt  very  firm.  It  was  thought  that  a, 
slight  pulsation  of  this  part  might  be  communicated.  He  after- 
wards entered  Charing-cross  Hospital,  where,  Mr.  Hulke  learned, 
doubts  were  entertained  of  the  nature  of  the  affection.    This 


BRITISH  AND   PORWGN  JOTTENALS.  37 

Mr,  Hulke  took  to  be  confirmatory  of  the  permanence  of  the 
consolidation  and  occurrence  of  a  cure.  The  encouragement 
the  case  afforded  for  the  trial  of  a  modified  Valsalva's  method 
in  aneurism,  where  the  ordinary  direct  surgical  methods  were 
not  applicable,  induced  Mr.  Hulke  to  submit  the  case  to  the 
consideration  of  the  Clinical  Society. — Monthly  Abstract. 

Cerebral  Localization  and  Amputation 

of  Extremities* — a  case  of  amputation  of  the  right 
thigh  at  the  age  of  nineteen,  followed  by  atrophy  of  the  fold 
passing  from  the  second  left  frontal  convolution  to  the  anterior 
marginal  one,  is  reported  by  Drs.  Le  Double  and  Violet,  of 
Tours.  The  patient  died  of  tubercular  pleurisy  thirty-one 
years  after  the  operation.  The  general  appearance  of  the 
brain  upon  autopsy,  was  found  to  be  symmetrical  with  equal 
lobes,  with  exception  of  a  very  evident  depression  of  the  mem- 
branes in  front  of  the  anterior  marginal  convolution,  which 
became  more  apparent  on  the  removal  of  these  envelopes.  The 
left  anterior  marginal  convolution  had  the  same  volume  as  the 
right,^  but  t^e  fold  passing  from  it  to  the  second  convolution 
presented  all  the  usual  phenomena  of  atrophy.  As  the  case 
was  one  bearing  upon  the  disputed  issue  of  cerebral  localization, 
the  reporters  took  the  trouble  to  locate  analogous  cases,  of 
which  they  found  seven  on  record.  In  the  first,  amputation  of 
the  left  arm  had  been  foUoi^ed,  in  the  course  of  five  years,  by 
atrophy  of  the  superior  portion  of  the  ascending  convolution  of 
the  paracental  lobule.  In  the  second,  amputation  of  the  thigh 
had  involved  atrophy  of  a  cerebral  lobe  and  corresponding 
mar^nal  convolutions,  in  the  course  of  thirty  years.  In  the 
tliird,  amputation  of  the  thigh  having  been  performed,  the 
patient  died  nine  months  later  of  purulent  infection,  and  no 
atrophy  had  yet  taken  place.  M.  Luys  reported  three  cases  of 
his  own  to  the  Academy  of  Medicine,  France,  in  October,  1877, 
in  which  amputation  of  the  leg  had  been  followed  by  atrophy  of 
an  ascending  frontal  convolution.  The  seventh  case  was  one  of 
arrested  development  of  the  leg,  reported  by  M.  Laudouze,  in 
which  the  atrophy  involved  the  superior  part  of  the  ascending 


dH  CANAUA   MBriCAL    AND   SUBIIOAL   JflURNAI.. 

parietal  convolution.  Analysis  of  these  cases  ahowa  that  the 
lesion  occupied  a  point  near  the  motor  centre  proposed  for  the 
leg  by  Curville,  Duret,  and  Ferrier,  in  only  one  of  them. — 
iV.  Y.  Mediod  RfvU'iP. 

Remedies  for  Ma.stitis  Puerperalls  and 
£zooriated  or  Fissured  Nipples.— For  Ma^ 

titis  :   R  Linseed  oil,  f  jiv  ;   Hydrate  chloral,  3  ss. 

Powder  the  chloral  very  fine,  then  mix  it  thoroughly  with  the 
oil.  Apply,  apread  thickly,  on  a  piece  of  soft  woollen  flannel,  a 
little  larger  than  necessary  to  cover  the  breast,  with  a  cenkal 
opening  through  which  the  nipple  may  protrude. 

Apply  as  warm  as  can  be  borne,  and  keep  warm  whilst  it 
remainfi  applied,  by  warm  sacks  of  chamomile  flowers  or  hops. 
The  plaster  should  be  renewed  every  four  to  six  hours,  until  all 
pain,  swelling  and  induration  are  relieved. 

For  excoriated  or  fissured  nipples : 

R,  Powdered  nutgalla,  5  j,  Oil  peppermint,  gtt.  x. 
Comp-  tinct.  opium,  q.  s.  to  make  a  thick  paste. 

Apply  a  small  portion  juat  after  the  child  nurses,  each  time. 
Just  before  the  child  nurses,  the  nipple  should  be  gently  cleansed 
with  a  soft  sponge,  and  warm  tar-soap  suds, — Dr.  Q.  C.  Smith 
in  Pacific  Medical  and  Surgical  Journal. 

Hypodeitoic  Injections  of  Gtilorofomi. 

— Tlieae  injections  have  beeu  highly  recommended  by  eminent 
physicians  as  a  substitute  for  morphine.  It  is  claimed  that  they 
are  piunless,  that  they  relieve  pain  rapidly  and  for  several 
hours,  and  that  they  are  entirely  innocuous,  being  followed  by 
neither  local  nor  general  symptoms.  Dr,  Jochheim,  of  Darm- 
stadt, however,  reports  a  case  in  which  the  injection  of  only  ten 
drops  of  chloroform,  which  is  only  one  half  what  is  frequently 
administered,  was  followed  by  severe  local  disturbances.  Five 
hours  an«r  the  injection  a  violent  local  inllammation  set  in,  and 
in  twenty-four  hours  a  bard,  black  slo-jgh  had  formed,  which 
waa  not  caat  off  by  suppuration  until  six  weeks  afterwards, — 
Allg.  Med.  Vent.  Zeit.— Medical  Review,  N.   ¥. 


BRITISH  AND   FOREIGN  JOURNALS.  39 

On  the  Diagnosis  and  Surg^ical  Treat- 
ment of  Abdominal  Tumours.— Bj  T.  Spencer 
Wells,  F.R.C.S.—[Ab8tra€t']—The  first  lecture  was  delivered 
on  Monday,  June  10th,  at  4  p.m.  The  lecturer  entered  at 
considerable  length  into  the  mode  of  examining  patients  with 
abdominal  tumours,  describing  in  detail  the  methods  of  external, 
btemal,  and  combined  examination,  and  showed  his  form  of 
note-book  for  recording  cases.  He  described  the  mode  of  dis- 
tinguishing collections  of  fluid  in  the  abdominal  cavity  from 
the  collections  in  cysts,  and  illustrated,  from  preparations  in  the 
museum,  ovarian,  renal,  and  hydatid  cysts. 

We  give  the  following  remarks  on  combined  internal  and 
external  examination  of  the  abdomen  and  pelvis  : — 

'*  With  the  thumb  in  the  rectum  and  the  forefinger  in  the 
vagina  we  can  often  get  an  accurate  notion  of  what  may  be 
contained  in  Douglas's  pouch ;  or>  on  the  other  hand,  if  the 
thumb  is  on  the  cervix  uteri  and  the  forefinger  in  the  rectum,  it 
is  quite  easy  to  feel  a  considerable  part  of  the  uterus,  even  to 
the  fundus,  and  t^  get  a  notion  of  its  size  and  form,  or  of  any- 
thing attached  to  its  exterior,  either  in  front,  behind,  or  at  the 
fundus. 

^^  Simon,  of  Heidelberg,  laid  great  stress  on  the  combined 
examination  of  the  bladder  and  uterus  after  dilatation  of  the 
ureUira,  believing  that  this  was  not  only  useful  in  completing 
diagnosis  of  disease  of  the  bladder  itself,  but  also  for  examining 
growths  in  the  vesico-uterine  pouch,  tumours  on  the  anterior 
surface  of  the  uterus,  or  on  either  side  of  the  pelvis,  where 
they  extend  forwards.  Combined  examination  between  the 
-walls  of  the  abdomen  and  the  bladder  may  occasionally  become 
necessary.  In  some  forms  of  uterine  disease  combined  exami- 
nation may  be  assisted  by  previous  dilatation  of  the  neck  of 
the  uterus  with  a  sponge  tent;  and  in  other  cases,  where 
examination  by  rectum  alone,  or  combination  of  rectal  and 
external  examination,  may  be  insdfficient,  as  in  inversion  of  the 
uterus  or  cogenital  absence  of  this  organ,  combined  examination 
by  bladder  and  rectum,  either  by  finger  in  rectum  or  sound  in 
the  bladder,  or  finger  in  bladder  after  dilatation  of  urethra, 


40  CANADA   MEDICAL    AND   SURGICAL    JOL'BSAL. 

gives  all  the  information  reqaired  ;   but  thia  Beldom  can  be 
neeeBsarj,  except  in  cases  of  atresia  of  the  vagina. 

"  As  Hegar  has  pointed  out,  if  the  thumb  of  one  hand  in  the 
vagina  fixea  the  vaginal  portion  of  the  cervix  uteri,  the  index 
finger  of  the  same  hand  in  the  rectum  can  not  only  feel  the 
posterior  surface  of  the  uterus  distinctly,  but  can  follow  the 
saoro-uterine  ligaments ;  while,  if  the  other  hand  presses  the 
abdominal  wall  backwards  towards  the  sacrum,  a  very  accurate 
idea  can  be  obtained  of  the  relations  of  all  the  pelvic  organs. 
The  uterus  can  be  moved  in  various  directions,  and  anything  ' 
between  it  and  the  bladder  or  rectum  is  distinctly  felt,  supposing 
of  courae  no  extraordinary  amount  of  fat  in  the  abduminal  wall, 
nor  any  peculiar  rigidity  in  the  va^na,  mterferc.  Flexions  of 
the  uterus  are  thus  very  accurately  recognised,  and  often 
replaced  easily. 

"  These  examinations  must  be  carried  on,  sometimes  with  the 
patient  on  her  back,  sometinaes  on  her  side,  and  sometimes  in 
both  positions,  and  occasionally  in  the  knee  and  elbow  position, 
with  the  shoulders  low,  a  change  of  position  of  the  organs 
giving  information  otherwise  unattainable. 

"  Simon  lays  great  stress  on  the  fact  that  when  a  patient  ift 
deeply  narcotised  the  whole  hand  may  be  passed  into  the  rectum". 
I  have  done  this  occasionally,  hut  have  not  obtained  much 
additional  information  than  is  given  by  one  or  two  fingers. 

"  Hegar  deserves  the  credit  of  introducing  a  method  of  ex- 
amination which,  in  some  cases,  is  really  of  very  j^reat  value. 
He  fixes  the  vagina!  portion  of  the  cervix  uteri  by  a  pair  of 
long  hooked  forceps,  by  whichthe  uterus  may  be  ran  downwards 
or  on  either  side.  The  same  object  may  be  obtained  more 
safely  by  one  of  Marion  Sims's  hooks,  and  there  can  be  no  better 
method  of  clearing  up  doubts  about  the  size  and  position  of  the 
uterus,  its  connexion  with  neighbouring  organs,  and  e3))eciall}r 
its  relation  with  abdominal  and  pelvic  tumours. 

"  I  need  not  say  that  this  must  be  done  with  due  care ;  that 
no  forcible  traction  upon  the  uterus  must  be  exercised,  and  that 
eteadjmg  the  organ  will  often  be  found  quite  enough, 

t  uterus  thus  fixed  and  gentle  traction  made 


BRITISH   AND   FOREIGN   JOURNALS.  41 

npen  it  with  one  hand,  and  one  or  two  fingers  of  the  other  hand 
are  passed  into  the  rectum,  the  posterior  surface  and  sides  of 
the  uterus  are  felt,  and,  if  necessary,  the  finger  may  be  carried 
over  the  fundus.  Sometimes  the  forceps  or  hook  may  be  given 
to  an  assistant,  while  one  or  two  fingers  of  one  hand  in  the 
rectum  and  the  other  on  the  abdominal  wall  effect  a  combined 
examination  of  the  most  complete  character.  The  connexion 
of  die  abdominal  tumours  with  the  pelvic  organs  may  be  very 
accurately  made  out.  A  slight  pull  on  the  uterus  may  be 
sufficient  to  clear  up  any  doubts  as  to  the  connexion  between 
the  uterus  and  the  tumour,  while  the  pedicle  or  membranous 
adhesiiHis  with  the  rectum  may  be  made  tense  and  felt. 

"  Supposing  a  tumour  is  partially  or  entirely  in  the  pelvis, 
in  more  or  less  close  apposition  with  the  uterus,  by  drawing  the 
uterus  downwards  or  forwards  on  to  one  or  other  side,  the 
examining  fingers  in  the  rectum  may  follow  the  outlines  of  the 
tutnour  and  notice  how  its  movements  are  affected  by  the  move- 
ments of  the  uterus,  or  if  it  may  be  seperated  from  the  uterus. 
It  is  by  no  means  unfrequent  that  you  can  separate  the  uterus 
from  a  tumour  where  previously  there  had  seemed  to  be  intimate 
connexion,  or  union  apparently  inseparable.  The  assistant 
drawing  down  the  uterus  or  to  one  side,  with  two  fingers  in  the 
rectum  and  the  other  hand  over  the  abdomen,  pushing  up  the 
tumour,  we  may  often  get  an  idea  of  the  length  of  the  pedicle, 
and  in  reference  to  uterine  fibroids  information  as  to  the  possi- 
bility of  removing  them.  You  find  out  the  length  and  thickness 
of  the  cervix,  whether  it  is  fixed  or  movable,  and  whether  it  is 
involved  in  the  new  growth.  You  pull,  as  it  were,  the  neck  of 
the  uterus  out  of  the  mass  which  in  a  measure  involved  it,  and 
this  shows  the  tumour  to  be  a  growth  which  may  be  removed.'* 

The  lecturer  then  described  the  chemical  character  of  the 
fluids  removed  by  tapping  in  ascites  and  in  ovarian  cysts,  re- 
serving the  microscopical  characters  for  the  second  lecture. 

In  the  second  lecture,  delivered  on  Wednesday,  June  12th, 
Mr.  Wells  described  the  microscopical  elements  found  in  ovarian 
fluids,  dwelling  especially  on  Drysdale's  granular  ovarian  cell, 
and  on  certain  groups  of  large  pear-shaped  vacuolating  celk 


42  CANADA   MEIIICAF-    AND   SURnK 

observed  in  peritoneal  fluid  in  cases  of  cancer  of  omentum  and 
ovary.  The  remainder  of  the  lecture  was  occupied  by  the 
demonstration  of  specimona  from  the  museum,  to  illustrate  the 
diagnosis  of  different  forma  of  multilocular,  dermoid,  and  solid 
ovarian  tumours  from  the  various  abdominal  tumours  for  whioh 
they  may  be  mistaken.  Very  interesting  specimens  of  splenio 
tumours  removed  during  life  by  the  lecturer  were  shown,  large 
tumours  of  the  kidney  and  liver,  a  large  gall-bladder  with  thick 
walls,  hydatids  of  the  omeotum,  aortic  aneurisms,  false  cysts 
formed  by  adhesions  the  result  of  chronic  peritonitis,  numeroua 
specimens  of  intra-abdominal  cancer,  extra-uterine  pregnancy, 
and  tumours  of  the  abdominal  wall.  The  very  rich  collection  of 
uterine  tumours  in  the  mu&eum  was  reserved  for  the  last  lecture 
of  the  course. —  The  Lanctt. 

Idiopathic  Mydriasis,  treated  ^rith 
Eserine.— A.  Stasford  Morton,  in  the  Brirhk  Medical 
Journal,  observes ;  Mr.  Bonton'a  caee  of  Idiopathic  Mydriasis, 
treated  with  Eserine,  recorded  in  the  Journal  of  July  13th,  ia 
interesting,  as  showing  the  immediate  and  beneficial  effect  of 
sulphate  of  eserine,  where  Calabar  bean  discs  and  solution  of 
extract  of  Calabar  bean  had  been  employed  without  any  result. 
I  presume,  where  it  is  stated  that  "  the  patient  was  suffering 
from  great  pain  in  the  left  eye,  occasioned  (as  was  at  once 
apparent)  by  dilatation  of  the  pupil,"  it  is  meant  that  the  p^a 
and  dilatation  were  produced  by  the  same  cause  ;  and  whatever 
this  may  have  been,  I  should  be  very  glad  if  Mr.  Benton  would 
give  us  any  further  information  as  to  how  he  arrived  at  the 
conclusions  that  "  the  impairment  of  vision  was  due  solely  to 
the  dilated  pupil ;"'  and  that  "  there  was  no  loss  of  accommoda- 
tion, as  the  patient  could  see  to  read  i]uite  plainly  through  ft 
pinhole  aperture  in  a  piece  of  card  held  close  to  the  eye  ;"  for 
the  following  cases,  which  have  come  under  my  observation, 
would  seem  to  show  that  a  patient,  having  mydriasis,  without 
loss  of  accommodation,  may  read  small  type  even  without  a 
pinhole  aperture ;  and  further,  that  a  patient,  with  combined. 
mydriasis  and  suspension  of  accommodation,  may  even  read 
brilliant  type  through  a  small  aperture. 


BRITISH  AND   FOREIGN   JOURNALS.  43 

Case  I.  was  a  joung  lady,  not  in  the  least  myopic,  who,  after 
complete  dilatation  of  the  pupils  had  been  produced  by  a  very 
weak  application  of  atropine,  could  read  small  type  up  to  within 
five  or  six  inches  of  her  eyes,  and  who  declared  that  her  vision 
was  not  at  all  affected  by  the  mydriasis. 

Case  U.  was  a  youth  at  the  Moorfields  Hospital,  who  had 
applied  a  strong  solution  of  atropine  (four  grains  to  one  ounce), 
thrice  daily,  for  more  than  a  week  ;  and,  though  he  omitted  it 
for  two  days,  he  had  put  in  five  or  six  drops  on  the  morning 
the  following  note  was  taken :  He  was  emmetropic,  and  could 
see  well  in  the  distance,  though  the  largest  type  he  could  read 
at  about  sixteen  inches  was  J.  16,  but  on  holding  a  pinhole 
aperture  close  to  his  eye,  he  was  able  to  read  easily  Jager  I 
{brilliant  type). 

I  have  tried  other  cases  with  similar  results  ;  but  as  my  notes 
have  already  taken  up  more  space  than  I  intended,  I  will 
not  go  into  details  about  them ;  and  will  simply  remark  that,  till 
we  have  further  particulars,  it  appears,  from  the  observation 
made  by  Mr.  Benton  on  May  19th,  that  '^  distant  objects  could 
alone  be  discerned  "  even  though  the  patient  could  read  quite 
plainly  through  a  pinhole  aperture,  there  is  still  left  the  possi- 
bility, if  not  probability,  of  the  further  element  of  loss  of 
accommodation  in  this  interesting  case. 

Tbe  Stomacli  Bandagre  in  Ascites.— Mr. 

S.  Mackenzie  urges  the  value  of  firm  bandaging  in  dropsy  of 
the  abdomen.  He  gives  a  case  in  the  British  Medical  Jour- 
nalj  from  which  we  quote  the  portion  referring  to  his  treat- 
ment. 

March  30tA. — The  abdomen  now  measured  thirty-six  inches ; 
its  summit  was  about  three-quarters  of  an  inch  above  the  level 
of  the  sternum,  and  it  was  flat  on  the  surface.  The  edge  of 
the  liver  could  now  be  felt  three  inches  below  the  point  of  the 
jdphiod  cartilage.  No  irregularities  could  be  felt  on  the  surface 
of  the  liver. 

May  \lth, — The  condition  of  the  patient  appeared  station- 
JU7.     There  was  still  a  considerable  amount  of  fluid  in  the  peri- 


44  CANADA  MEDICAL   AND   SURGICAL   JOURNAL. 

toneal  cavity.  She  passed  about  forty  ounces  of  urine  in  the 
course  of  the  twenty-four  hours.  Z%e  abdomen  was  ordered 
to  be  tightly  bound  with  a  flannel  bandage,  so  as  to  exercise 
pressure. 

June  4th. — When  the  bandage  was  first  applied  to  the  abdo- 
men, the  pressure  caused  a  feeling  of  sickness,  but  soon  tlie 
patient  bore  it  without  discomfort ;  in  fact,  it  appeared  to  afford 
her  relief.  The  measurement  around  the  abdomen,  at  the  level 
of  the  umbilicus,  was  now  thirty-three  inches.  She  passed 
about  thirty  to  forty  ounces  of  urine  daily,  and  did  not  perspire 
much.  I  now  ordered  a  properly  made  abdominal  support  to 
be  constructed  for  her  by  the  instrument  maker.  It  was 
arranged  with  straps,  so  that  it  could  be  tightened  to  a  very 
considerable  degree. 

June  29th. — The  patient  expressed  herself,  and  appeared  to 
be,  in  good  general  health,  but  she  was  still  much  wasted.  The 
abdomen  looked  much  smaller,  and  measured  thirty-one  and  a 
half  inches  at  the  level  of  the  umbilicus.  There  was  pseudo 
fluctuation  on  percussion,  but  it  did  not  convey  the  impression 
of  being  due  to  fluid.  The  liver  could  be  felt  in  the  same  situ- 
ation as  before.  Its  surface  was  smooth,  its  edge  firm,  sharp 
and  regular.  The  spleen  was  not  to  be  felt  in  the  abdomen. 
Its  dullness  reached  the  seventh  rib  in  the  axillary  line.  She 
passed,  6n  an  average,  fifty  to  sixty  ounces  of  normal  urine 
daily.  She  ate  and  slept  well.  She  was  now  alloTved  to  get 
up,  but  was  directed  to  continue  wearing  the  abdominal  sup- 
port. The  latter,  owing  to  the  diminution  of  the  size  of  the 
abdomen,  had  required  to  be  altered.  After  being  up  in  the  ward 
for  a  few  days,  the  patient  was  allowed  to  go  into  the  garden  ; 
and  there  then  being  no  reaccumulation  of  flmd  in  the  abdomen, 
she  was  made  an  out-patient.  This  was  in  July,  1875.  The 
patient  has  been  continually  under  my  observation  from  then 
until  now.  She  has  had  no  recurrence  of  the  ascites.  Her 
general  condition  of  health  is  feeble,  but  she  is  able  to  do  her 
household  work  and  earn  her  living.  Unusual  exertion  causes 
slight  oedema  of  the  feet.  She  has  never  had  albuminuria. — 
Med.  and  Siirgieal  Reporter. 


BRITISH  AND  FOREIGN  JOURNALS.  45 

The  Coming  Duties  of  the  Accoucheur. 

— Prof.  Gaillard  Thomas,  lecturing  on  a  case  of  neglected  pro- 
lapsus uteri,  makes  (^New  York  Medical  Record^  Dec.  22)  the 
following  observation  : — "  The  time  is  not  distant  when  confine- 
ment cases  will  be  treated  very  differently  from  what  they  are 
at  the  present  day.   This  is  a  subject  of  the  utmost  importance. 
There  is  the  most  urgent  need  of  a  radical  change  in  the  prac- 
tice of  the  majority  of  the  profession,  and  the  time  is  ripe  for  the 
appearance  of  a  stirring  and  able  paper  on  the  *  Proper  Man- 
agement of  Natural  Labour,'  which  will  awaken  medical  men  to 
a  sense  of  their  duty  in  obstetrical  cases.   The  physician  should 
be  expected  and  required  to  visit  his  patient  from  time  to  time 
dl  through  her  pregnancy,  in  order  to  see  that  everything  is 
progressing  favourably  for  a  successful  delivery,  and  to  remove,  if 
possible,  any  condition  (as  albuminuria,  for  instance)  which  is 
likely  to  interfere  with  this ;  and  I  am  fully  convinced  that  it 
will  not  be  long  before  the  accoucheur  who  does  not  pursue  this 
plan  will  be  held  culpable.     Again,  he  will  be  held  equally 
culpable  if  he  discharge  his  patient  at  the  ninth  day,  or  at  the 
€nd  of  a  fortnight,  without  making  a  physical  examination,  to 
ascertain  that  the  parts  have  sustained  no  ii\jury  from  the  strain 
and  pressure  of  parturition,  and  that  the  process  of  restoration 
to  the  normal  condition  is  going  on  satisfactorily.     A  little  at- 
tention paid  at  that  time  will  often  prevent  the  most  serious 
consequences  in  the  future.    If  the  physician  had  made  such 
an  examination  in  the  case,  and  had  found  the  cervix  lacerated, 
be  might  have  waited  a  month,  and  then,  ascertaining  that 
trouble  was  resulting'  from  it,  he  should  have  sewn  it  up,  and 
also  restored  the  perineal  body  wiich  had  given  away.    ♦    *    ♦ 
All  this  could  have  been  readily  done  in  the  second  month  after 
delivery,  and  it  would  certainly  have  been  a  great  deal  better 
to  do  it  than  to  wait  thirteen  years  before  undertaking  the 
operation.     It  is  true  that  this  woman  has  suffered  compara- 
tively little  pain  and  inconvenience  in  consequence  of  the  neg- 
lect of  her  physician,  but  this  is  a  very  rare  exception  to  the 
general  rule ;  and,  as  I  said  before,  the  time  is  not  far  distant 
when  the  medical  man  will  be  held  responsible  for  allowing  such 


41!  CANADA   MEDICAL    AND    SUROICAI.   JOVHS.' L, 

a  condition  to  continue  without  interlering  to  pre\  ent  the  evil 
results  BO  Bure  to  follow  from  it." — Med.   IHmfg  and  Gazette, 

On  the  Combined  Use  of  Cbloroform 

and  Morphia.— Prefesaor  Kcenig,  in  a  communication 
to  tlio  i'entratbliitt  fur  Chirurffie,  (No.  39, 1877),  says  he  has 
combined  the  hypodermic  adminiatration  of  morphia  with  that 
of  chloroform  in  a  large  mimher  of  caeea,  with  very  favorable 
reaultx.  It  in  seldom  necL'ssavy  to  give  more  than  one  or  at 
moat  two  centigrammea  (one-sixth  to  one-third  grain). 

The  indications  for  the  use  of  morphia  during  chloroform- 
narcosis  are  twofold  :  1.  Jlotor  diaturbancea  occurring  betbre 
or  during  chloroform-inhalation  unless  these  are  very  transitory :  ■ 
2,  Operations  of  such  a  nature  that  the  chloroform-narcoeis 
cannot  be  maintained  throughout,  and  especially  towards  the 
end.  Among  the  latter  may  be  particularly  mentioned  opera- 
tions upon  the  eye,  plastic  operations,  extirpation  of  tumours 
from  the  Boft  parts  of  the  face.  The  object  of  using  morphia 
is  to  induce  analgesia  over  and  above  the  chloroform-narcoeis, 
and  alao  that  this  narcosis  should  not  be  pushed  so  far.  As 
regards  any  danger  which  nay  he  connected  with  the  combinsr 
tion  of  narcotics,  Kcenig  esteems  this  lightly.  He  says  that 
out  of  seven  thousand  cases  in  which  he  has  used  chloroform, 
none  have  died  from  it,  and  many  of  these  took  morphia  also. 
—London  Med.  Record,  F<b.  15, 1S78. 

Abbrtive  Treatment  of  Furnucnlos.— 

Dr.  licveu  observed  at  the  Petersburg  Medical  Society  lPeter»- 
fntrt/  ilfd.  Woch.,  Dec.  20)  ihat  all  niMes  of  treatment  hitherto 
tried  (such  as  early  incision,  cauterizing,  and  cold  or  .warm 
applications)  have  failed  to  arrest  the  further  development  of 
(urunculus  that  has  once  commenced.  The  following  procedure, 
however,  brings  it  to  a  stand :  A  burning,  pricking,  itching 
suddenly  occurring  in  a  normal  portion  of  the  skin,  announces 
the  commencement  of  the  development  of  the  funincnlus,  utd 
oo  the  same  day  a  small  and  quite  superficial  mduradon  can  b* 
Mt  at  Ae  spot     If  the  skia  be  now  saperfidaliy  scraped  with 


BftlTISn  AND    FOREIGN   JOURNALS.  47 

a  small  knife,  so  that  a  drop  or  two  of  blood  may  be  pressed 
through  the  epidermis,  no  fumnculus  will  be  developed.  This 
result  would  seem  to  show  that  the  affection  originates  in  the 
uppermost  layer  of  the  corium,  and  perhaps  in  the  capillaries 
of  the  papillae,  and  not,  as  hitherto  received,  in  ihe  subcutaneous 
connective  tissue,  with  succeeding  necrosis  of  the  corium  and 
epidermis.  Disturbance  of  the  digestive  organs  (frequently 
diarrhoea)  always  precedes  or  accompanies  furunculus ;  but  a 
]dethoric  or  decrepit  constitution  is  no  necessary  condition,  as  it 
may  occur  in  one  that  is  quite  normal. — Med.  Times  and 
Oazette. 

Sulphaito  of  Quinine. — A  property  of  Sulphate  of 
Quinine  not  well  knowa — This  property  consists  in  the  modifi- 
cation it  causes  on  suppurating  surfaces  when  it  is  applied 
locally.    The  injection  of  a  solution  of  60  centigrammes  of  sul- 
phate of  quinine  in  60  to  100  grammes  of  distilled  water  is 
very  advantageous  in  the  treatment  of  empyema.     The  same 
injection  is  efficacious  in  gonorrhoea,  and  an  ointment  of  sulphate 
of  quinine    exercises  a    cicatrizing    action    on    wounds  and 
<^uroDic  ulcers.     The  injections  of  quinine  have  the  same  action 
on  suppurating  cavities  and  fistulous  tracts. — Q-azetta  Medica 
ioUana, 

Vterine  HeniOn*]ia»^e* — In  a  recent  discussion 
*t  the  Obstetrical  Society  of  London  on  the  value  of  injection 
rf  diloride  of  iron  in  uterine  hemorrhage.  Dr.  Robert  Barnes 
wid  the  point  of  the  syringe  should  be  carried  to  the  fundus. 
^  could  only  be  insured  by  introducing  the  hand  into  the 
nterus.    Clots  should  be  removed  before  injection.     One  to  four 

• 

^  &  good  strength,  but  a  stronger  solution  might  be  used  if 
i^^cessary,  but  it  should  not  be  escharotic.  This  means  of  arrest- 
^  hemorrhage  had  stood  the  test  of  experience,  and  had  saved 
1^7  lives.  The  test  for  its  use  is  the  possibility  of  exciting 
Keflex  action.  Where  this  cannot  be  done,  use  perchloride  of 
^n.— ifed.  Times  and  Gazette. 


48  CANADA   MEDICAL   AND 

The  Dilatable  Tampon  to  arrest  Hsb- 
morrhagre  after  Idthotomy.— Dr.  C.  F.  Maon- 

DER,  in  the  lir'Uhh  Meiliaal  Journal,  remarks  :  Having  to 
perform  lateral  lithotomy  out  of  town  a  short  time  since,  on  a 
patient  aixty-five  yeara  of  age,  widi  a  large  prostate  and  deep 
perinseum,  I  provided  myself  with  one  of  Mr.  Buokaton 
Browne's  instruments.  The  operation  was  performed  on  a 
curved  staff,  and  the  patient  was  soon  comfortably  in  bed. 
After  a  ehort  time  a  little  bleeding  occurred  ;  and  as  I  had  to 
return  to  London,  I  introduced  the  tampon  and  stopped  it.  On« 
of  my  dressers,  Mr.  W.  Wliitford,  remained  m  charge,  with 
the  acquiescence  of  Dr.  VVolston,  the  medical  attendant.  On 
visiting  this  gentleman  in  the  evenmg,  eight  hours  subsequently 
to  the  operation,  I  found  him  very  comfortable  indeed ;  no 
bleeding,  and  the  urine  floiving  freely  through  the  tube.  At 
6  A.M.,  Mr.  Whitford  allowed  the  tampon  to  collapse  ;  and  at 
9  A.M.  I  removed  the  instrument.  The  patient  made  an 
terrupted  recovery. 

Should  the  tampon  become  somewhat  flaccid  too  aoon,  as  it 
may  do  by  an  insidious  escape  of  air,  it  can  be  readily  refilled. 
Certainly  I  shall  never  perform  lateral  lithotomy  without  hav- 
ing me  of  these  instruments  at  hand, 

Turpentine  as  an  external  application 
in  Small-Pox.— Ur,  Farr,  of  Lamboth,  ascribes  great 

value  to  turpentine  as  an  external  application  in  small-pox.  He 
claims  that  it  at  once  relieves  any  smarting  or  irritation,  effect- 
ually corrects  the  unpleasant  odor  given  off  in  the  more  confluent 
form  of  the  disease,  and  aeems  in  a  marked  degree  to  arrest 
pustulation,  thereby  modifying  and  sometimes  entirely  preventing 
pitting.  In  consequence  of  its  powerful  antiseptic  and  diaio- 
fectant  properties,  it  tenda,  moreover,  to  prevent  the  spread  of 
the  infection.  Mr.  Fai-r  uses  it  in  tlie  proportion  of  one  part  of' 
rectified  spirits  of  turpentine  to  three  or  four  of  olive  oil,  and' 
applies  it  night  and  morning  by  means  of  a  feather, — The 
cet,  May  11th. 


CANADA 


Medical  &  Surgical  Journal 


SEPTEMBER,  1878. 


anginal  eommunications* 


TWO  CASES  OF  URETHRAL  FEVER, 
By  James  Bell,  M.  D. 

Assistant    House    Surgeon    Montreal    General    Hospital. 
(Read  before  the  Medico-Chinirgical  Society,  June  21st,  1878.) 

The  subject  of  my  paper, '  Urethral  Fever,'  is  well  illustrated 
by  two  cases  which  occurred  in  the  Hospital  last  winter.  They 
were  both  in  Dr.  Roddick's  wards.  The  first  is  that  of  a  sailor, 
George  Ives,  who  was  admitted  for  stricture  of  the  Urethra  on 
the  23rd  of  October,  '77.  He  was  a  large,  well-built,  muscular 
young  Englishman,  24  years  of  age.  His  family  history  was 
obscure.  The  only  reliable  fact  that  could  be  ascertained  was 
ftat^his  mother  died  of  some  wasting  disease — probably 
Riilusis.  He  had  been  at  sea  since  he  was  12  years  of  age 
tod  had  always  been  healthy.  He  had  gonorrhoea  6  years  ago 
tod  was  treated  by  his  Captain  with  injections,  and  recovered 
HI  a  month  without  having  any  of  the  ordinary  complications 
or  sequels  of  gonorrhoea,  af^rchitis,  bubo,  or  stricture.  He 
bad  no  difficulty  in  micturition  after  this  attack.  About  2  years 
*go  he  contracted  gonorrhoea  again.  It  lasted  six  months,  and 
^hen  his  ship  arrived  in  New  York  he  consulted  a  doctor,  under 
▼hose  treatment  he  rapidly  recovered.  The  treatment  con- 
sisted in  injections  and  the  administration  of  capsules — probably 
^  copaiba.  About  nine  months  ago  he  noticed  that  in  mic- 
^riiion  the  stream  was  very  small  and  often  irregular  and 
twisted  at  the  meatus,  and  he  had  sometimes  to  strain  a  good 

NO.  LXXIV.  4 


50  CANADA   MEIJICAt.    AND   SUmHCAL   JOCBNAL. 

deal  to  evacuate  hia  bladder.  These  difficulties  gradually 
iDcreaacd,  and  once  ataea  he  had  complete  retention  for  three 
days,  and  was  ultimately  relieved  by  s.  comrade  by  means  of  a 
gum  elastic  catheter.  On  his  last  voyage  he  had  complete 
retention  again ;  this  was  about  three  weeks  before  admission. 
He  was  relieved  and  ena-bled  to  evacuate  his  bladder  on  this 
occasion  by  means  of  a  hct  hip  bath.  On  examining  his  penis, 
he  was  found  to  have  a  bridge  of  tissue  extending  across  the 
meatus  near  its  upper  part  On  the  27th  October,  this  band 
was  divided  and  the  urethra  was  explored  with  Lifter's  Metallic 
Sound,  and  a  firm  tight  atricture  was  discovered  in  the  usual 
situation — about  the  junction  of  the  spongy  and  membranous  por- 
tions of  the  urethra.  An  instrument  was  not  passed  through 
the  stricture, — in  fact,  this  feat  was  scarcely  attempted.  Thi^ 
was  about  half-past  three  in  the  afternoon.  A  smaU  piece  ol 
gum-elastic  catheter  was  tied  into  the  meatus  where  the  smal 
band  had  been  severed.  About  two  o'clock  next  morning  b 
had  a  severe  rigor.  His  temperature,  unfortunately,  was  nql 
taken  until  seven  in  the  morning.  It  was  then  103"  F.  H« 
iraa  ordered  tr.  aconiti,  m.  v  liq.  ammon.  acet,  ^  ss.  4  q.  h.  QS 
had  also  some  diarrhoea  which  was  easily  checked  by  the  use  cli 
bismuth.  His  temperature  reached  104.8  in  the  ev 
and  he  was  given  twenty  grains  of  quinine.  His  urine  was  no! 
measured,  but  he  passed  a  fair  quantity  which  was  very  hi^ 
colored  and  deposited  a  la,rge  amount  of  lithates.  It  coutaJoaj 
no  albumen.  He  was  very  dull  and  drowsy  and  complied  (| 
head-ache  and  a  feeling  of  restlessness  and  anxiety.  He  na 
DOW  thoroughly  examined,  but  no  organic  disease  could  b* 
discovered, 

Oct.  30th. — Still  flushed  and  feverish,  great  head-ache  t 
restlessness.     Is   somewhat   delirious   at   night  and  can  wit] 
diflEculty  be  kept  in  bed.     Tongue  coated  and  dry.     He 
ordered  chloral   and   bromide   of    potash   at  night,  which,  i 
moderate  doses,  had  little  effect  upon  him. 

Oct  SlBt. — Has  difficulty  in  micturition  ;  has  to  stand  up  t| 
evacuate  his  bladder.  He  passed  70  oz.  of  urine  in  twen^ 
four  hours.    The  urine  now  contains  two  or  three  per  cent,  i 


URETHRAL   FEVER. — BY  DR.  BELL.  51 

albumen  and  deposits  a  small  quantity  of  pus ;  it  deposits  a 
large  quantity  of  lithates  on  standing.  Diarrhoea  set  in  again 
kt  was  easily  checked. 

Nov.  9th. — Fever  continues ;  little  change  in  symptoms, 
except  that  prostration  is  greater.  He  is  restless  and  delirious 
at  night.  He  was  ordered  a  chloral  draught  at  night  again, 
but  it  had  no  effect  on  him  ;  he  has  now  considerable  tenderness 
on  the  right  side  of  the  abdomen  and  in  the  right  loin.  Up  to 
this  time  we  had  considered  this  a  case  of  urethral  fever,  but 
the  continued  high  temperature,  which  so  far  had  been  pretty 
^golar ;  the  increasing  prostration  and  delirium  at  night ;  the 
tenderness  on  the  right  side  of  the  abdomen  and  the  diarrhoea, 
and  the  general  severity  of  the  case,  began  to  make  us  suspect 
ftat  it  was  typhoid  fever,  in  spite  of  its  mode  of  onset  and 
several  other  circumstances  which  were  opposed  to  that 
^liagnosis.  He  was  accordingly  transferred  to  the  medical 
vards  in  charge  of  Dr.  Ross,  who  examined  him  carefully,  and 
gave  it  as  his  opinion  that  he  had  not  typhoid  fever,  but  from 
the  position  of  the  tenderness  in  the  abdomen,  which  was  over 
the  right  kidney  and  along  the  right  ureter,  and  the  presence 
of  the  slight  amount  of  pus  in  the  urine  which  persisted  without 
toy  appreciable  variation  from  day  to  day,  he  thought  that  he 
Iwid  probably  some  organic  disease  of  the  right  kidney  ;  he 
found  all  his  other  organs  healthy.  He  remained  in  the  medical 
irards  under  Dr.  Ross's  care  until  the  30th  of  November.  For 
*l>out  two  weeks  there  was  but  little  change  in  his  symptoms, 
W  his  temperature  was  very  erratic — the  difference  botween 
themommgand  evening  temperatures  being  sometimes  as  much 
^  8^^  F.  He  then  began  to  improve,  and  on  the  30th  Novem- 
'^f  he  was  re-transferred  to  the  surgical  wards,  but  nothing 
more  was  done  for  his  stricture,  and  on  the  10th  of  December 
ke  was  discharged. 

The  second  case  was  from  the  country — a  married  man,  30 
jears  of  age,  of  Irish  descent,  large  and  well-built.  He  was 
admitted  on  the  5th  of  November,  '77,  for  stricture  of  the 
^ethra.  He  has  no  history  of  constitutional  disease  ;  was 
always  very  healthy ;   never  had  rheumatism  or  any  disease 


52        CANADA  MEDICAL  AND  SURGICAL  JOUBNAL. 

• 

that  ]io  can  remember.  lie  attributes  his  strictare,  which  he- 
Mays  ho  has  had  all  his  life,  to  riding  bare-backed  when  a  boj^ 
havin/;;  received  several  slight  injuries  in  that  way.  He  had 
gonorrhoea  sixteen  years  ago,  which  aggravated  his  stricture  a 
good  deal.  His  stricture  began  to  trouble  him  seriously  about 
seven  years  ago,  when  he  consulted  a  doctor,  who  passed  a 
catheter  for  him.  He  believes  that  it  never  entered  his  bladder. 
Ho  then  consulted  another  doctor,  who  passed  a  No.  3,  and  be 
felt  "  all  right "  for  twelve  months  afterwards.  He  was  then 
obliged  to  consult  another  medical  man,  who  passed  bougies, 
which  gave  only  temporary  relief.  He  has  had  trouble  ever 
since  in  micturition,  especially  in  spring  and  fall.  Two  years 
ago  ho  was  in  the  hospital  under  the  care  of  Drs.  Reddy  and 
Wilkins,  who  ruptured  his  stricture  with  Thompson's  Divtdsor. 
Ho  left  the  hospital  soon  after,  and  had  no  difficulty  for  a  year 
and  n-half  afterwards.  He  had  no  instruments  passed  after 
leaving  the  hospital.  During  the  last  six  months  he  has  fre- 
((uently  boon  unable  to  evacuate  his  bladder,  and  on  these 
oooasiona  was  roliovod  by  the  late  Dr.  Cline,  who  passed  a  No. 
♦1  silver  instrument.  He  never  had  complete  retention  until 
six  moitths  agt>,  when  ho  first  consulted  Dr.  Cline ;  he  never 
sufforiHl  fivm  chills  or  fever  in  any  of  these  manipulations — 
tior  at  anv  other  time.  He  was  admitted  about  10  o'clock  in 
the  morning  of  the  oth  of  November,  '7S  :  at  2  p.m.,  four  hours 
after\\ar\ls,  l>r»  KinWiok  explored  the  uretlira  and  discovered 
a  tight  eartilaginous  and  somewhat  elastic  stricture  at  the 
jwuotiouof  the  :^|vngy  and  membianous  portions  of  the  urethra. 
He  mavle  twv\  or  thret^  un^fiwocvssful  but  not  at  all  forcible 
attempts^  to  j\*iss  a  oathoter  into  the  bladder ;  no  blood  was 
drawn,  a\u\  thert*  vas  no  reason  to  ?ur»rv>^  that  even  an 
abra*\o\^  of  the  tuxioou^  wombrano  had  Ivon  x^rvxiuced.  About 
V,;ilt*'iv^st  four,  i>\o  hvn\r^  at'^or  the  oivra::.^n,  ho  had  a  severe 
v*.i;>T,  auvl  hi*  tom\vraturv'^  ran  up  to  10;>'^  F :  he  perspired 
v*,vfu5^^iv  and  was  xorv  iw^tle**.  Ouriu::  the  :uyr.:  he  had  two 
?i;ic^t  ohiV;*  ;  V,o  xViv,vu^:i\s\l  N>f  «^wrv^  hoAdsio>.t\  a-i  could  not 
!^\s^5\     No\t  u*onv.^\>;  at  U  a^n*.,  he  h*vX  a::,^:I.er  serer^  rigor. 


URETHRAL   FEVER. — BY  DR.   BELL.  53 

fifteen  grains  of  quinine.     At  4  p.m.  he  had  another  chill,  and 

a  temperature  of  101^  F.     At  2  o'clock  next  morning  he  had 

another  chill  less  severe,  and  his  temperature  rose  to  103°  F. ; 

he  had  still  another  slight  chill  in  the  afternoon.     His  urine, 

unfortunately,  was  not  measured  during  the  first  twenty-four 

hours  after  the  operation.    He  passed  some  urine,  however — I 

don't  know  how  much ;   but  it  was  dense,  high-colored,  and 

contained  no  aJbimien,    He  was  very  restless,  complained  of 

severe  head-ache,  and  flept  none  at  all  for  three  days  during 

this  attack.     His  tongue  was  coated  and  he  had  no  appetite. 

He  had  no  pain,  except  the  head-ache.     All  this  time  he  was 

confined  to  bed  and  on  milk  diet ;  there  was  no  vomiting  nor 

diarrhoea.     He   was  now  thoroughly  examined,  and  all  his 

organs  found  to  be  healthy  except  his  heart.    He  had  both  mitral 

^4  aortic  disease,  with  great  hypertrophy  of  the  left  ventricle. 

He  was  ordered  spts.  ether,  nit.  3ss.,  tr.  digitalis,  mv.  liq.  ammon. 

acet.  3ii  t.  L  d.     He  had  no  more  chills  aftef  the  7th,  and  by 

,    the  10th  his  temperature  was  normal  and  he  felt  quite  well. 

On  the  14th,  a  No.  5  gum-elastic  catheter  was  passed,  and  left 

in  the  urethra  for  two  hours ;  no  bad  results  followed.    This 

was  done  daily  for  the  next  three  dajs  without  any  chill  or  rise 

of  temperature.     On  the  20th,  at  his  urgent  solicitation,  he 

was  put  under  the  influence  of  chloroform  and  an  attempt  was 

Diadeto  pass  ThompsorCa  divuhor^  but  without  success.     A 

No.  5  gum-elastic  catheter  was   however  passed  and  imme- 

^tely  withdrawn ;  this  was  about  2  o'clock  in  the  afternoon. 

Next  morning  at  11  o'clock,  twenty-one  hours  after  the  opera- 

^n,he  had  a  chill  and  his  temperature  rose  to  103  3-5.    He 

was  given  quinine,  grs.  xx,  and  by  evening  his  temperature  was 

IWj;  next  morning  it  was  normal,  but  he  felt  impatient  and 

discouraged.     He  was  ordered  to  remain  in  bed  and  h^kve  a  hot 

%bath  night  and  morning.     Two   days  later,  business  diffi- 

"Culties  compelled  him  to  leave  hospital  and  return  to  the  country, 

^  I  have  not  heard  from  him  since. 

Now,  it  is  an  established  fact  in  pathology  that  operations 
of  any  magnitude  on  any  part  of  the  body,  are  followed  by 
febrile  reaction,  and  as  a  rule  this  reaction  is  in  direct  proper- 


54 


CANADA   MEDICAL   AND   St.'HGICAL    jnUHNAL. 


tion  to  the  magnitude  of  the  operation — or,  in  other  words.  t» 
the  amount  of  injury  done,  due  allowance  being  niado  of  cours* 
for  the  patient's  surroundinga,  &c.  Tliis  rule  does  not  hold, 
good  in  operationa  about  the  urethra  and  bladder,  where  the 
moat  trifling  operation  may  produce  alarming  or  even  fatd, 
results  ;  while  severe  operations,  such  as  lithotomy  and  lithotrity,, 
external  urethrotomy  sni  rupture  of  structure  by  divulsion^ 
are  seldom  followed  by  bad  symptoms  and  hardly  ever  by  the 
group  of  symptoms  constituting  the  disease  called  "  Urethral' 
fever."  This  disease  seems  to  follow  as  a  rule  the  simpler 
operations  on  the  urethra,  as  the  passage  of  a  catheter  or  tha 
gradual  dilatation  of  a  stricture,  and  though  it  may  occur  i 
any  patient,  those  who  haTe  diseased  kidneys  are  thought  to  b 
specially  liable  to  it ;  while  the  use  of  ansesthetics  seems  to 
afford  protection  against  it.  It  generally  sets  in  a  few  hoiirft 
after  the  operation,  and  it  varies  gi'catly  in  degree,  the  simples! 
consisting  of  a,  chill,  or  perhaps  two,  followed  by  e 
and  head-ache,  which  continues  for  twenty-four  or  thirty-a 
hours,  and  then  leaves  the  patient  as  well  as  before.  This  slight 
form  is  no  doubt  constantly  overlooked,  as  the  patient  i 
frequently  quite  well  by  the  time  of  the  surgeon's  next  visit. 

Secondly.  There  may  be  a  severe  rigor,  followed  by  higb 
fever,  great  restlessness  or  delirium,  and  in  a.  few  hours  by. 
profuse  perspiration.  The-se  chills  with  fever  and  sweating  may 
be  repeated  at  intervals  of  a  few  hours  for  several  d 
the  patient  recover  in  a  week  or  two  without  the  superventioflf 
of  other  more  alarming  symptoms  ;  or,  there  may  follow  & 
number  of  days  of  general  febrile  eseitfimcnt,  delirium  and 
prostration,  with  scanty  high-colored  urine,  perhaps  containing 
albumen,  diarrhcea,  ami  frequently  copious  perspirationa.T 
There  may  be  remissions  from  time  to  time.  To  this  class  botln 
the  cases  which  I  have  reported  belong, — the  second  case  hav* 
ing  a  series  of  chills  with  high  fever,  lasting  over  three  or  foaf 
days;  the  patient  in  the  first  case  suffering  from  continuot 
fever  for  weeks,  with  many  of  the  symptoms  enumerated  above, 
and  also  some  pus  in  his  urine,  which  I  believe  to  have  origioatei 
in  the  bladder. 


y-81^ 

light 


URETHRAL   FEVER. — BT  DR.  BELL.  55 

There  are  still  other  cases  in  which  Hie  operation  is  followed 
by  a  violent  rigor,  high  fever,  prostration,  alarm,  anxiety  and 
excitement,  violent  vomiting,  profuse  diarrhoea,  suppression  of 
urine,  and  death  from  ursemia. 

Knally,  true  pyaemia  and  septicaemia  may  follow  operations 
.on  the  urethra  and  bladder,  as  they  follow  operations  elsewhere, 
and  then  tliey  are  frequently  mistaken  for  urethral  fever,  which 
is  not  to  be  wondered  at  when  we  consider  the  similarity  of  the 
spdptoms  in  these  diseases.    Pyaemic  abscesses  are  found  post- 
mortem in  the  prostate,  the  liver,  kidneys,  joints,  &c.,  and  then 
these  cases  seem  to  support  the  view  that  urethral  fever  is 
essentially  a  form  of  pyaemi^i.    Without  going  into  the  discus- 
sion of  this  subject,  I  believe   that  urethral  fever  is  due  to 
nervous  shock,  and  that  clinically  it  is  not  always  discriminated 
from  septicaemia  and  pyaemia.     In  support  of  this  view  I  would 
simply  ask,  in  what  other  way  can  we  explain  its  rapid  onset  and 
different  degrees  of  severity  from  such  different  degrees  of  causa- 
itive  irritation,  or  how  can  we  call  those  symptoms  pyaemic  which 
set  in  two  or  three  hours  after  the  passage  of  a  gum-elastic  cath- 
eter which  can  scarcely  have  abraded  the  urethra,  and  before  the 
passage  of  urine  over  the  possibly  abraded  surface  can  have  left 
anyihingfor  absorption  by  it  ?    And,  again,  how  seldom  do  these 
syn^ptoms  occur  in  the  course  of  the  different  suppurative 
dweases  of  the  genito-urinary  tract  ?    With  reference  to  treat- 
Bient,  tiie  great  object  of  course  is  prevention,  for  when  once 
^^lished  medication  seems   to  have  little,  if  any,  effect. 
Knowing  as  we  do  that  patients   with  kidney  disease  are 
speciaDy  liable  to  it,  and  that  in  them  it  is  particularly  danger- 
^ns,  every  case  ought  to  be  carefully  examined  before  operation 
^  the  patient  placed  in  the  most  favorable  conditions.     Some 
surgeons  recommend  the  use  of  five-grain  doses  of  quinine,  two 
or  three  times  a  day,  for  several  days  before  the  operation, 
-^y  operation  about  the  urethra,  or  even  the  dilatation  of  a 
8tncture,  generally  causes  so  much  pain  that  anaesthetics  are 
ealled  for,  and  it  is  a  satisfaction  to  feel  that  in  using  them  you 
we  not  only  sparing  the  patient  the  pain  of  the  operation  but 
lessemng  its  risks.  Tr.  ferri.  perchlor,  in  ten  minim  doses,  three 


J    SURGICAL    JtJORNAL. 

times  daily,  liaa  been  used  aa  a  prophylactic,  and  Fleming's 
tr.  of  aconite  in  two  minim  doses  immediately  after  the  operation, 
has  beenjvery  liighly  spoken  of,  and  especially  by  Mr.  Harriaon, 
of  Liverpool,  who,  in  a  recent  clinical  lecture  (which  was  pub- 
liahed  in  the  Lancet  last  winter)  said  that  he  invariably  uaed 
it  and  that  he  had  found  it  almost  unfailing. 

Quinine  in  large  dosea  may  be  said  to  be  the  standard  remedy 
when  the  disease  has  been  established.  Diarrhoea,  vomiting 
and  suppression  of  urine,  &c.,  and  other  special  symptoms, 
must  of  course  receive  appropriate  treatment. 

CASE  OF  PARTIAL  PLACENTA  PRiEVIA. 

By  J.  A.  HUTCUINBON,  M.  J).,  C.  5L 

On  the  20th  of  August  last,  I  was  called  in  haste  to  attend 
H.  S:  ECt  33,  a  woman  living  on  Bonaventure  street,  who  wai 
said  to  be  bleeding  from  the  womb.  On  my  arrival  at  th< 
house,  I  found  a  rugged  French  woman,  seated  on  a  ch^r  ia^ 
weak  condition.  On  enquiry  she  told  me  that  she  had  had  eigh^ 
children  and  one  abortiou  at  the  third  month  of  pregnancy) 
that  she  was  now  in  the  seventh  month  of  gestation ;  that  hesi 
general  health  had  alwaya  been  good  ;  that  she  had  never  anj 
previous  basmorrhages,  or  felt  anything  unusual  during  her  pre^ 
sent  pregnancy ;  that  she  had  been  engaged  running  a  sewing-'; 
machine  during  the  day,  and  had  felt  slight  pains  in  tho 
abdominal  region :  and  that  about  two  hours  previous  to  my 
arrival,  she  experienced  a  severe  pain,  and  felt  that  blood  was 
escaping  from  the  vagina.  Slie  then  sent  for  her  husband  to 
come  and  bring  a  doctor,  and,  aa  previously  stated,  it  was  two 
hours  before  I  was  in  attendance.  She  had  remained  in  the 
chair  all  the  time,  being  afraid  to  move,  as  she  felt  that  the 
hsBmorrhago  was  still  continuing,  and  imagined  that  if  she 
attempted  to  lie  down,  th«  child  would  he  immediately  expelled. 
This  she  wished  to  avert  until  a  doctor  was  present.  I  at  once 
caused  her  to  lie  down,  an<l  found  that  her  clothes  were  saturated 
and  the  blood  had  coagulated  in  largo  clots.  Fortunately,  the 
hsemorrhago  was  easily  controlled,  and  on  a  vaginal  e.xamination 


PARTIAL  PLACENTA  PREVIA. — BY  DR.  HUTCHINSON.        57 

being  made,  the  os  was  found  to  be  dilated  to  the  size  of  a  penny- 
piece.     I  could  also  feel  the  boggy  and  unresisting  mass  of  the 
placenta,  which  was  at  first  mistaken  for  a  coagulum  of  blood. 
At  this  time  I  did  not  push  the  examination  further,  and  finding 
the  hemorrhage  had  subsided,  allowed  the  patient  to  rest  for  a 
time.     She  had  still  a  strong,  regular  pulse,  and  did  not  exhibit 
much  evidence  of  exhaustion.     The  labor  pains  occurred  at 
intervals,  but  were  not  at  all  severe.    The  child  was  still  alive, 
as  the  foetal  heart  could  be  heard,  and  with  greatest  distinct- 
ness on  the  right  side.  Made  another  examination,  and  diagnosed 
placenta  praevia,  as  what  I  had  previously  mistaken  for  blood 
dots  could  not  be  detached,  and  on  auscultation  the  uterine 
souffle  was  heard  with  greatest  distinctness  over  the  site  of  the 
OS.    Under  the  circumstances,  I  deemed  it  advisable  not  to 
temporize,  but  to  aid  nature  in  the  expulsion  of  the  child,  as  it 
^as  then  of  a  viable  age,  and,  at  any  rate,  this  occurrence 
seemed  inevitable.     With  this  end  in  view,  a  moderate  dose  of 
«rgot  was  administered,  which  was  hoped  to  serve  a  double 
purpose,  viz  :  to  increase  the  contraction  of  the  uteyus,  and  by 
pressing  the  head  of  the  child  against  the  placenta,  would  check 
the  escape  of  blood  ;  and,  also,  to  assist  in  the' expulsion  of  the 
child.    The  necessity  of  puncturing  the  membranes  was  happily 
avoided,  as  at  this  time  the  liquor  amnii  began  to  escape.      It 
^d  not  seem  to  flow  away  readily,  being,  1  think,  impeded  by 
^^  pressure   of  the   placenta.     At   every  pain  an  additional 
amount  would  be  evacuated,  and  would  be  accompanied  with 
clots  of  blood.     When  the  os  became  largely  dilated,  I  could 
pass  my  fingers  up  at  one  margin  of  the  placenta,  and  feel  the 
"Cad  of  the  foetus.     The  hemorrhage  continued,  though  not  to 
^  alarming  extent,  in  the  intervals  between  the  pains.    At  the 
^^•^t  examination,  found  a  hand  down  below  the  head  and  at 
^he  margin  of  the  os   not  covered  by  the  placenta.     This  I 
Pushed  up,  and,  at  the  same  time,  separated  the  attachment  of 
^he  placenta  from  around  the  margin  of  the  os.     A  strong  pain 
following,  the  head  came  down,  engaging  in  the  os,  and  the 
child  was  soon  after  born  in  the  second  position.  Unfortunately, 
Ae  child  showed  no  signs  of  life  and  could  not  be  resuscitated* 


68  CANADA   MEDICAL   AND    SCBOICAL    JOURNAL. 

Hemorrhage  did  not  follow  to  any  alarming  extent,  nor  any 
other  unfavorable  symptoms.  Her  pulse  continued  almost 
normal,  neither  did  she  exhibit  signs  of  exhaustion.  The  uterus 
contracted  to  the  cricket  ball  shape  and  feel,  having  expelled 
into  the  vagina  the  placenta,  which  had  to  be  removed  manually. 
The  ordinary  treatment  followed,  and  the  patient  soon  after 
resumed  her  usual  health. 

The  above  case  must  be  considered  as  resulting  unusually 
fortunately  to  the  mother,  when  we  consider  the  great  mortality 
attending  such  a  complication  of  pregnancy  as  placenta  pi-revia. 
The  death  of  the  fcetus  I  take  to  be  due  to  the  loss  of  the 
maternal  blood,  and  by  respiration  having  been  carried  oa 
during  labor  by  a  placenta  which  was  only  partially  attached. 
Its  death  would  also  be  hastened  by  its  being  premature. 

It  may  be  interesting  here  to  add  a  few  remarks  with  respect 
to  the  cause  of  this  abnornoal  placental  site.  The  older  writers 
believed  that  the  placenta  had  originally  been  situated  at  the 
fundus,  from  which  it  bad  accidentally  fallen  to  the  lower  par* 
of  the  uterus.  It  was  supposed  by  Tyler  Smith  to  depend  on< 
the  ovule  not  having  been  impregnated  until  it  had  reached  iha 
lower  part  of  the  uterine  cavity.  Others  think  that  an  abnormal 
size  or  unusual  shape  of  the  uterine  cavity  may  favor  the  descent 
of  the  impregnated  ovule.  This  opinion  is  supported  by  the 
fact  that  placenta  prrevia  generally  occurs  in  women  who  have 
borne  several  children.  The  cause  of  this  abnormality,  how- 
ever, is  still  an  open  queetion,  and  many  eminent  authorities 
consider  it  purely  accidental. 

The  source  of  the  hremorrhage  is  now  generally  admitted  by. 
authorities  to  be  from  the  lacerated  utero-placental  vessels.  In. 
Playfair's  system  of  midwifery,  the  following  anent  this  matter 
occurs :  "  Only  a  few  years  ago,  Sir  James  Simpson  advocated, 
with  his  usual  energy,  the  theory  sustained  by  his  predecessor. 
Dr.  Hamilton,  that  tlie  chief,  if  not  the  only  source  of 
haemorrhage,  was  the  detached  portion  of  the  placenta  itself. 
He  argued  that  the  blood  flowed  from  the  portion  of  tlie  placenta 
which  was  still  adherent  to  that  which  was  separated,  and 
escaped  from  the  surface  of  the  latter ;  and  on  thia  suppositioa 


PARWAL  PLACENTA  PREVIA. — ^BT  DR.  HUTCmNSON.         69 

he  based  Ms  practice  of  entirely  separating  the  placenta,  having 
obsemd  that,  in  many  cases  in  which  the  after-birth  had  been 
expeDed  before  the  child,  the  hemorrhage  had  ceased.    The^ 
fact  of  the  cessation  of  the  haemorrhage,  when  this  occurs,  is  not 
doubted ;  but  Simpson's  explanation  is  contested  by  most  modem 
writers,  prominent  among  whom  is  Dr.  Barnes,  who  has  devoted 
much  study  to  the  elucidation  of  the  subject.     He  points  out 
that  the  stoppage  of  the  haemorrhage  is  not  due  to  the  separation 
of  the  placenta,  but  to  the  preceding  or  accompanying  contrac- 
tion of  the  uterus,  which  seals  up  the  bleeding  vessels,  just  as 
it  does  in  other  forms  of  haemorrhage.     The  site  of  the  loss  was 
actually  demonstrated  by  the  late  Dr.  Mackenzie  in  a  series  of 
experiments,  in  which  he  "  partially  detached  the  placenta  ia 
pregnant  bitches,  and  found  that  the  blood  flowed  from  the  walls 
of  the  uterus,    and    not    from    th#  detached  surface  of  the 
placenta.     The  arrangement  of  the  large  venous  sinuses,  open- 
ing, as  they  do,  on  the  uterine  mucous  membrane,  favors  the 
escape  of  blood  when  they  are  torn  across ;  and  it  is  from  them, 
possibly  to  some  extent  also  from  the  uterine  arteries,  that  the 
blood  comes,  just  as  in  post-partum  haemorrhage,  when  the  whole,, 
instead  of  a  part,  of  a  placental  site  is  bared." 

The  cause  of  the  haemorrhage  is  viewed  differently  by  differ- 
ent authorities.  It  is  contended  by  some  that  it  is  due  to  a  loss 
of  proper  relation  between  the  placenta  and  the  uterus  where 
it  is  attached.  Dr.  Mathews  Duncan,  however,  maintains  that 
the  haemorrhages  are  accidental,  being  due  to  similar  causes  to 
those  which  give  rise  to  haemorrhages  when  the  placenta  is 
normally  placed  ;  the  abnormal  situation  of  the  placenta  render- 
ing the  causes  more  apt  to  operate. 

Montreal,  August,  1878. 

[The  Editor  of  this  Journal  does  not  hold  himself  responsible^ 
for  the  opinions  expressed  by  contributoi*8.] 


L   MEDICAL   AND    SURGICAL   JOTTENAL. 


I3^ospital  Reports. 


Case  of  Acutf  Tuhfrcuhaii. — Under  care  of  Dr.  Reddy. — 
Reported  by  James  Bell,  M.D.,  As3t.  House  Surgeon, 

J.  F.,  aged  40,  a  large,  well-built  Englishman,  was  admitted 
on  the  l<lth  of  May,  compl^ning  of  cough  and  pain  in  the 
chest.  Ilo  was  also  delirious  and  unable  to  give  any  reliable 
account  of  himself.  From  hia  friends  it  was  learned  that  he 
was  a  very  hard  drinker,  had  had  delirium  (remwis  several 
times,  and  had  also  had  several  attacks  of  acute  illness,  ivith 
long  symptoms.  The  nature  of  these  attacks  could  not  be 
determined.  He  was  a  machinist,  and,  when  sober,  a  hard-work- 
ing man.  About  four  weeks  prior  to  his  admission  to  hospital, 
he  had  been  drinking  very  hard,  and  was  obliged  to  give  up 
work.  He  became  somewhat  delirious,  especially  at  night.  This 
was  looked  upon  as  the  natural  result  of  hia  spree,  and  little 
attention  paid  to  it  for  some  days.  He  had  nothing  more  to 
drink,  but  remained  delirious  at  times,  and  was  very  despondent. 

About  four  or  five  days  before  his  admission  he  became  much 
worse,  was  feverish  and  compiainetl  of  cough  and  pain  in  his 
chest.  On  admission  his  temp,  was  103°  F.;  pulse,  108  ;  resp., 
30.  He  complained  of  a  good  deal  of  pain  in  the  chest,  but 
could  not  localize  it.  His  expectoration  was  viscid  and  rusty. 
He  was  given  chloral  grs.  xx,  poL  bromid.  3i,  as  he  was  deliri- 
ous  and  could  not  be  kept  in  bed.  He  was  (guieter  after  the 
draught,  but  did  not  sleep. 

Oa  examination,  there  was  found  to  be  dalness  on  percussion 
orer  upper  lobe  of  right  lung — dight  in  front,  but  more  muked 
behind.  ' 

There  were  dry  bronchial  rfiles  and  line,  moist  rales  to  be 
beard  a!I  over  both  lungs.  In  the  right  infra- clavicular  and 
scapular  regions  (the  dull  area)  there  was  tine  crepitation,  and 
the  breathing  almost  tubular  over  the  rest  of  the  long.  Roe 
crepitation  was  also  heard  over  a  limited  area  at  the  base  of  the 


HOSPITAL   ftEPORTS.  61 

^®ft  long,  in  the  infra-axillary  region.  Heart  nonnal.  Ordered 
*  ^3aixture  of  ammon.  carb.  and  liq.  ammon.  acet.,  and 
poultices  to  the  chest. 

^ext  morning  his  temperature  was  101^  F. ;  pulse,  104 ; 
resp.j  40  ;  physical  signs  unchanged.  Ordered  quinine,  grs,  xx,. 
^^  the  afternoon. 

JUay  Ibih. — Had  a  very  bad  night.     There  is  now  constant 

*ow  muttering  delirium.     Surface  is  very  livid.     Ordered  spts. 

®ther  CO.  mxx  3  q.  h.  and  brandy.     Little  change  in  physical 

Signs,  except  that  there  is  a  small  circumscribed  area  of  dulness 

at  base  of  left  lung,  near  axillary  margin ;  pulse,  140,  very 

feeble  ;  resp.,  40  ;  temp.  104®.     Ordered  quinine,  grs.  xx  (per 

^uin.,  as  he   refused  to   swallow  it.)    |Urine  high-colored, 

deposits  lithates  and  phosphates  on  standing ;  no  sugar  nor 

^bumen. 

May  IQih. — Condition  scarcely  changed  since  yesterday ; 
still  delirious ;  pupils  contracted  to  the  size  of  pin-heads. 
Ordered  another  dose  of  quinine  (grs.  xx). 

May  Vlih. — Had  a  very  restless  night,  and  is  evidently 
Sinking;  surface  is  very  livid,  and  urine  and  faeces  are  passed 
involuntarily.  He  remained  in  this  condition  during  the  day, 
*ttd  died  at  five  o'clock  next  morning.  The  temperature 
^'it'oughout  ranged  from  102®  to  104®  F.,  and  did  not  seem  to 
^  affected  by  the  large  doses  of  quinine. 

J^o%t  mortem. — Eight  hours  after  death.  Body  fairly  well- 
nourished.  No  rigidity.  On  opening  the  abdomen  extensive 
^^esions  are  found  between  the  visceral  and  parietal  layers  of 
tiie  peritoneum,  chiefly  connecting  the  omentum  transverse  colon 
^d  surface  of  the  liver.  The  coils  of  the  small  intestines  are 
6*^ed  ^together  by  soft  flaky  adhesions.  The  mesentery  and 
Peritoneal  covering  of  the  small  bowel  and  caecum  are  covered 
^th  numerous  small  firm  tubercles  varying  in  size  from  a  pin's 
li^ad  to  that  of  a  small  shot. 

Thorax. — Both  lungs  are  intimately  adherent  to  the  chest 
wall. 

•     Right  Lung. — Numerous  small  evident  tubercles  in  the  lung 
tissue  just  beneath  the  pleura ;  lower  lobe  is  covered  with  a  thi 


62  CANATM   MEDICAL  AND  SURGICAL  JOUBNAL. 

layer  of  old  pleuritic  membrane.  From  apex  to  base  the  long 
is  stuffed  with  small  grey  miliary  granulations.  At  the  apex 
they  are  not  so  abundant,  and  there  are  one  or  two  firm  nodules 
the  size  of  peas.  The  lung  is  more  or  less  crepitant  throughout, 
but  in  the  upper  lobe  there  is  a  good  deal  of  exudation  into  the 
air  cells  and  the  lung  barely  floats  in  water.  There  is  a  very 
small  cavity  in  apex. 

Left  Lung, — Crepitant  throughout,  though  the  lower  lobe  is 
firm,  heavy,  and  dark  rod  in  color ;  it  is  also  stuffed  with 
tubercles  from  apex  to  base.  There  are  no  nodules  nor 
cavities.  The  tubercles  are  disseminated,  not  arranged  in 
groups,  and  present  a  greyish,  semi-translucent  appearance. 

Heart. — About  two  ounces  of  clear  amber-colored  fluid  is 
found  in  the  pericardium.  Right  auricle  is  filled  with  a  dark 
clot ;  right  ventricle  also  contains  dark  grumous  clots. 

Left  Auricle  contains  a  dark  jelly-like  coagulum. 

Left  Ventricle  contains  a  small  black  clot ;  valves  and 
chambers  normal. 

Spleens — Soo  grammes.  Capsule  presents  a  spot  of  localized 
thickening.  On  section,  Spleen  pulp  is  of  good  consistence 
and  studded  with  iunnuierable  small  tubercles  the  size  of  pin- 
points, Tlu\Y  are  of  uniform  size  and  resemble  grains  of  sand 
they  are  sv*  exoesAively  small, 

Kidnej^s. — Let\^  :ioO  grammes.  Caj^sule  detaches  readily. 
Cortex  cv>arse  Kvkiug  on  si\»tion,  Malphigian  bodies  very  dis- 
tinct, Soatterevl  thn^ughout  the  substance  ar^  numerous  small 
tubercles.     A  small  bi\^wnish  calculus  found  in  one  calrx. 

ifiy/i.*  A'i^iMcy,— lSv>  grammes:  ap|varance  similar  to  that 
of  let't  kklnev.     It  v\>ii;ains  tubei\*le*  al$o, 

i.4i\r,— Firmlv  aahexx  ut  to  diajxho^^.  Xumeroos  tubercles 
iu  adhesk>us.     v^rg^u  ;^>:^  ;  un^  tubercW  m  substance. 

cC?/im;;  i*nc-.  a*»m««,-  IVriu^ue*!  ^r&ce  studded  with  mbercles. 
Mucvus  measbjNoie  al*>  iutVv^xJ ;  ik^  ulvvr*:x«u 

.fiy>4W  Mwi  Jf>WAi:v^,^:Ss»niul.  ^5^  tuSrrvIes  dissccT^»ed 
^uo\T«hexe. 


HOSPITAL   REPORTS.  63 

Case  of  Aneurism  of  the  Thoracic  Aorta. — Under  the  care  of 
Dr.  Reddy.    Reported  by  W.  R.  Sutherland. 

P.  P.,  aged  48,  of  Irish  descent,  unmarried  man,  of  medium 
height,  strong  and  muscular,  was  admitted  into  the  Montreal 
General  Hospital  on  the  19th  April,  1878,  complaining  of  short 
breath  and  constant  cough  (which  has  a  peculiar  ring),  with 
pain  in  right  shoulder,  side  of  neck  and  crown  of  the  head. 
Pain  is  much  aggravated  on  attempting  to  lie  down,  and  a  sense 
of  chokmg  comes  on  so  that  he  has  to  be  propped  up  in  bed. 

He  expectorates  large  quantities  of  thin,  frothy  mucous,  with 
purulent  patches  tlirough  it.  Dyspnoea  is  not  worse  after 
exertion ;  appetite  good  ;  voice  somewhat  hoarse. 

Family  history  obscure  ;  but,  as  far  as  can  be  made  out,  it  is 
good. 

He  has  never  had  syphilis,  nor  any  other  disease  of  any 
consequence.  Was  a  soldier  for  twelve  (12)  years,  during 
which  time  he  saw  active  service  and  endured  severe  hardships. 
Smce  his  discharge  from  the  army,  has  been  a  policeman, 
porter,  and,  for  the  past  ten  (10)  years,  caretaker  of  the 
armory.  Has  been  a  man  of  regular  habits,  and  enjoyed  good 
health  up  to  January,  1877,  when  he  was  first  troubled  with 
Diore  or  less  pain  in  the  right  shoulder  and  side  of  the  head. 
Cough  and  hoarseness  were  not  noticed  until  July,  1877. 

On  examination,  the  superficial  veins  of  the  front  of  the  chest 
^  seen  to  be  moderately  distended,  one  markedly  so,  running 
froni  left  axiUa  across  chest  to  stemo-clavicular  articulation. 
Breathing  is  almost  entirely  abdominal.  Visible  pulsations  in 
hoth  super-clavicular  regions  and  in  superficial  arteries. 

Pupils  are  equal. 

^^mration — During  inspiration  left  side  measures  18j'. 

"      expiration     "      "         "  18. 

"      inspiration  right  "         "  18J. 

«      expiration     **      "        "  18^. 

Palpation — ^Appreciable  impulse  over  first  bone  of  sternum. 
Percussion  gives  no  decided  dullness  along  upper  part  of  the 
chest,  except  a  shade  over  the  first  bone  of  the  sternum,  more 


.^AHA   SIEDICAL   AND 


jer-resonant  in  front 


marked  on  the  riglit  side.     Left  lung  1 
and  behind. 

AuseuUation. — YmA  res|nraUon  feeble  all  over  the  chest. 
Vocal  resonance  somewhat  increased  over  upper  part  of  chest. 
Loud  sonorous  rales  over  front  of  the  chest,  and  8trid\ilou8 
breathing  over  both  back  and  front  of  the  chest.  Double 
murmur  in  first  space  of  both  sides,  much  louder  on  the  right. 

Heart. — Point  of  maximum  pulsation  is  at  lat  space,  to  the 
right  of  the  sternum,  and  at  this  spot  there  is  a  double  sound, 
also  a  double  murmur,  transmitted  all  through  tlie  arch. 
Systolic  J  short,  soft  and  flowing.  Diastolic,  very  short  and  very 
soft-  Both  sounds  and  murmurs  are  less  distinct  at  2od  S|;)ace, 
audible  but  less  distinct  at  Srd,  also  audible  at  cnsiform  cartil- 
age. Liside  left  nipple  is  a  systolic  murmur,  followed  by  a 
clear  second  sound  without  a  murmur. 

Urine — Contains  no  sugar  nor  albumen  ;  sp.  gr.  1,014, 

April  21. — Condition  is  unchanged.  Is  taking  IJq.  morphia, 
~ii;  vin  ipecaCj  5' ;  syr,  pruni  virg.,  jiii;  aq.  adsvi; — dose, 
a  table-spoonful  three  times  a  day. 

Maj/  2. — Passed  a  bad  night ;  cough  was  very  distressing, 
being  hard  and  without  much  expectoratioa  The  pain  in  his 
head,  neck  and  shoulders  is  much  worse  on  damp  days. 

Maff  7, — Is  much  weaker,  and  not  as  well  as  usual,  though 
Ids  condition  is  apparently  imchauged.  Ilaa  been  ordered  a 
tonic  of  quinine  and  Iron. 

Mat/  29. — Up  to  tliis  time  there  was  no  change  to  be  noticed, 
except  tiiat  the  veins  are  more  distended  ;  visible  pulsation 
very  marked  over  right  sterno-clavic  articulation.  In  addition 
to  the  marked  impulse  over  the  upper  part  of  the  sternum,  a 
thrill  can  be  distinctly  felt.  Pain  is  less  severe  on  the  right 
side  of  the  head  and  neck,  but  he  cannot  raise  his  right  arm 
higher  than  on  a  level  with  his  shoulder  without  experiencing 
very  great  pain  of  a  lancinatmg  character  just  over  the  coraeoid 
process.     Cough  is  much  worse  and  sputamuco  purulent. 

June  4. — For  the  past  few  days  he  has  been  troubled  with 
rheumatic  pains  in  his  anklea.     Yesterday  afternoon,  had  a 


HOSPITAL   REPORTS.  65 

Tery  severe  attack  of  dyspnoea,  which  lasted  about  half  an 
hour.    Pulse  was  120  ;  temp.  100^. 

He  continued  to  suffer  from  dyspnoea  and  pain  in  the  chest, 
irhich  he  could  not  localize,  until  June  12th,  when  he  died  after 
^  prolonged  attack  of  orthopnoea. 

Autopsy ^  30  hours  after  death  : 

Body  that  of  a  medium-sized  man ;  rather  emaciated. 

On  opening  the  abdomen,  intestines  appear  normal. 

Thorax,  —  Lower  lobe  of  right  lung  adherent  at  lower 
part  bj  soft  recent  adhesions.  Further  up  there  is  a  plastic 
lymph,  non-adherent,  and  beyond  this,  intense  congestion  of  the 
pleura ;  the  surface  of  the  upper  half  of  the  upper  lobe  alone 
18  healthy.  The  upper  part  of  the  lung  is  compressed  by  about 
one  pint  of  turbid  serous  effusion.  The  lower  part  of  right 
lang,  especially  at  the  margins,  and  for  a  space  of  three  or  four 
inches,  is  in  a  state  of  pneumonic  consolidation — red  hepatisa- 
tion;  a  small  part  of  it  has  advanced  to  the  stage  of  grey 
liepatisation.  On  the  anterior  surface  there  is  an  abscess  about 
the  size  of  a  filbert,  apparently  arising  from  a  previous  broncho- 
pneumonia.   Upper  part  of  lung  fairly  healthy, 

^ft  Lang — Non-adherent ;  anterior  surface  healthy  ;•  post- 
eriorly hypostatic  congestion ;  apex  on  section  appears  acutely 
<Jongested — crepitant ;  on  pressure,  exudes  a  large  amount  of 
^Ay  serum. 

S^art — Weighs  330  grammes ;  substance  apparently  healthy, 
also  valves,  except  aortic,  which  appears  to  be  slightly  incom- 
petent. The  arch  of  the  aorta  is  dilated  and  lengthened  so  as 
w  form  a  large  fusiform  aneurism,  involving,  chiefly,  the  trans- 
verse  portion  of  the  arch. 

The  innominate  artery  is  dilated  througjiout  its  whole  length 
*^^  to  form  an  independent  aneurism  which  sits  upon  that 
lonned  by  the  arch.  The  right  subclavian  and  carotid  are 
S^^en  off  from  this  sac,  but  are  of  normal  size  and  appearance 
from  their  origin.  The  recurrent  laryngeal  nerves  were  not 
observed  in  the  dissection,  but  it  seems  probable  that  the  right 
^^  in  some  way  interfered  with  by  the  innominate  portion  of 
tte  aneurism. 

NO.  LXXIV.  5 


>   SLTIQICAI,   JOCBNAL. 


eorrespondence. 

Paris,  12th  Auguat,  1878^ 

Ta  llie  Editor  of  the  CiMini  Mbdioal  amd  Sdhqical  Jouhhil  ; 

Dear  Snt,  —The  annual  meeting  of  the  British  Medical 
Association,  jou  are  aware,  has  taken  place  thia  year  at  Bath, 
between  the  6th  and  9th  days  of  this  month.  Bath  is  one  of 
the  quietest  but  pleasanteat  of  towns  and  seems  admirably 
suited  for  meetings  of  that  kind.  It  is  not  ao  small  but  that 
ample  and  good  accommodation  can  bo  afforded  for  a  very 
considerable  number  of  visitors,  and  yet  not  so  large  but  thai 
all  shall  be  conveniently  situated  towards  the  rooms  and  place* 
of  meeting.  In  itself,  too,  the  good  old  city  has  much  to  ia 
terest  a  visitor,  medical  or  otherwise — Its  famous  Lot  springs^ 
in  which  old  Romans  bathod  and  forgot  their  ills,  are  still  seen 
boiling  and  steaming  aa  they  rise  above  the  ground — its  really  i 
beautifnl  buildings  which  surround  those  springs  and  afford  the- 
invalid  every  desirable  luxury  in  the  way  of  bathing — its  nobis 
cathedral,  where  the  Bishop  of  Bath  and  -Wells  opened  the^ 
meeting  by  an  eloquent  sermon  to  the  Association,  and  queer 
old  houses  of  almost  all  possible  dates,  carrying  you  back  to  the 
time  when  Dr.  Johnson  and  his  faithful  boy  came  to  the  baths 
for  the  good  of  their  conatitutiona  and  to  enjoy  the  society  of 
the  many  beauties  of  that  day  who  found  it  "  the  thing"  to  go 
there.  Bath  is  famous  for  its  antiquities,  and  chief  amongst 
those  of  great  interest  arc  a  large  number  of  Roman  altars  and 
other  remains  in  wonderful  preservation,  which  have  been  found 
here  in  all  directions,  and  have  been  preserved  in  the  local 
Antiquarian  Museun.  Jlembers  of  the  Association  and  Med- 
ical visitors  were  made  free  of  all  the  baths  during  the  meeting^; 
and  I  assure  you  the  swimming  baths,  the  cutidaria,  and  the 
draughts  of  the  ferated  water  were  fully  appreciated  by  % 
great  many. 

The  first  evening  was  chiefly  occupied  by  the  President's. 
address — Unfortunately,  this  year  that  official  was  a  Dr.  Fal- 


CORRESPONDENCE.  67 

coner,  a  local  practitioner,  and  he  had  devoted  nearly  the  whole 
of  his  paper  to  extolling  the  virtues  of  the  healing  spring  in 
which  it  is  incumbent  upon  every  true  Tathite  to  believe — ^it 
contained,  however,  nothing  new  or  of  any  general  interest. 
This  was  followed  on  the   succeeding  day  by  the  address  in 
Medicine,  by  Dr.  Goodridge,  Sanior  Physician  of  the  Royal 
United  Hospital,  Bath.   It  will,  I  daresay,  appear  better  in  print 
than  when  i  ead — the  delivery  having  been  painfully  defective. 
It  was,  however,  of  excellent  quality,  and  was  listened  to  with 
much  attention.     The  subject  selected  was  that  of  the  natural 
production  and  regulation  of  heat  in  the  human  body,  and  the 
pyrexial  state.    After  a  survey  of  the  various  theories  of  heat 
production,  it  was  readily  shown  how  little  is  really  yet  known 
of  the  true  physiology  of  this  subject,  and  a  portion  how  much 
less  of  the  vaiious  complex  processes  which  result  in  the  pro- 
duction of  the  pyrexial  stat3.     All  physicians  and  workers  in 
practical  medicine  were  exhorted  to  give  this  subject  all  the 
attention  its  great  importance  deserves.     Dr.  Goodridge  would 
look  hopefully  forward  to  the  time  when,  possessed  of  a  true 
fimdamental  knowledge  of  the  laws  governing  heat  production 
*nd  discharge,  we  shall  be  able  on  true  scientific  grounds  to 
remedy  with  a  degree  of  certainty  hitherto  undreamt  of,  those 
pyrexial  abnormalities  which  now  constitute  an  often  serious  part 
of  a  great  many  of  the  very  commonest  maladies  we  are  called 
ttpon  to  treat. 

The  same  afternoon  the  sections  opened  and  the  medical  one 
was  the  centra  of  attraction.  It  was  presided  over  by  Prof. 
Grainger  Stewart,  the  popular  Professor  of  Medicine  of  the 
Edmburgh  University.  His  opening  address  was  devoted  to  a 
discussion  of  certain  recent  observations  by  himself  and  others 
iipon  the  pathology  and  relationships  of  ceftain  of  the  forms  of 
Blight's  disease  which  have  caused  him  to  alter  or  modify  many 
of  his  pre-conceived  views  as  expressed  in  his  work  on  that 
subject. 

The  daily  programme  had  announced  that  a  discussion  upon 
obstruction  of  the  bowels  would  be  held  and  would  be  opened 
ty  Mr.  Jonathan  Hutchinson — It  was  thfe  which  had.  attracted 


68  CANADA    MEDICAL   AND    6UKOICAL    JOURNAL. 

80  many,  and  the  room  was  crowded  to  excess — nor  w 
disappointed. 

Uis  paper  was  a  most. able  and  exhaustive,  and  at  th 
time,  concise  exposition  of  his  views  on  most  of  the  many  very 
important  questions  which  so  often  arise  in  connection  with  this 
serious  trouble — it  will  well  repay  perusal.  Aa  regards  diag- 
nosis, he  especially  remaiked  upon  the  importance  of  bearing 
in  mind  the  great  similanty  between  an  acute  obstruction  and  a 
paralysis  of  the  bowel  caused  by  acute  peritonitis,  generally 
from  perforation.  Several  instances  of  the  mistake  were 
alluded  to.  Of  course,  the  practical  importance  of  this  pomt 
cannot  be  overrated.  Then,  with  refereuce  to  operation  in 
cases  of  impermeable  obstruction  where  all  other  mea^3  have 
failed,  Mr.  Hutchinson,  with  characteristic  caution,  tolls  us  that 
as  in  even  apparently  desperate  cases  be  has  seen  spontaneous 
recovery  take  place,  he  Ti'ould  never  consent  to  operate,  except 
where  the  diagnosis  could  really  be  satisfactorily  mado  out  and 
where  a  constricting  band  was  believed  to  be  the  cause.  In 
cases  of  intus-susception  ho  prefers  trusting  to  nature.  He 
strongly  condemned  the  practice  now  followed  by  many  of 
puncturing  the  abdomen  to  relieve  from  flatus,  aa  he  has  seen 
aevevo  peritonitis  from  the  fceca!  gaseous  exudations  from  the 
little  holes.  In  this  he  was  opposed  by  Dr.  Clifford  Allbutt 
and  others,  as  they  claim  that  samatimss  it  really  may  help  to 
cure,  and  that  puncture  is  not  dangerous  except  after  the 
abdomen  ha:*  been  opened  in  gastrotomy.  One  member,  whose 
piactice  lies  in  a  lead-working  district,  stated  that  ho  had  quite 
frequently  met  with  forms  of  lead  colic  strongly  resembling 
obstruction,  and  advocated  the  'Tijwrtance  of  excluding  this 
posable  origin  of  the  symptoms.  Dr.  Bi-oadbent  urged  the 
value  of  forming  a  diagnosis  as  early  as  possible  of  the  exact 
seat  of  the  obstruction,  as  then,  from  the  patient's  age  and  the 
other  circumstances  of  the  attack,  a  very  certtun  opinion  might 
oft«n  be  formed  of  the  real  nature  of  the  trouble.  He  also 
would  examine  every  such  case  by  the  rectum,  observing  that, 
although  no  tumor  may  be  felt,  yet  sometimes  other  information 
may  be  got,  as,  for  instance,  that  the  rectum  is  held  open  by  a 


CORRESPONDENCE.  69 

tumor  and  not  allowed  naturally  to  collapse.  Several  other 
papers  on  the  same  subject  and  illustrating  various  points,  were 
read  by  Drs.  Kerr,  J.  Kerrit,  and  others,  and  the  discussion 
was  sustained  and  animated. 

The  Surgical  section  was  presided  over  by  Mr.  Callender,  of 
St.  Bartholomew's,  who,  in  his  introductory  remarks,  dwelt 
chiefly  upon  the  necessity  of  relief  to  pain  in  encouraging  the 
healing  of  wounds.    All  that  this  eminent  surgeon  says  on  that 
pomt  and  every  other  with  the  same  end  in  view  is  worth  bear- 
ing in  mind,  because  it  is  notorious  that  his  results  are  said  to 
be  every  way  equal  to  those  of  Lister,  and  still  he  is  the  great 
unbeliever  in  antiseptics.    The  jealousy  of   the  London  sur- 
geons towards  Lister  crops  out  every  now  and  then.    Callender 
was  showing  a  splint  with  some  modifications — "  We,  of  Lon- 
doa"  he  said,  "  have  seen  fit  to  import  a  surgeon  from  Edin- 
burgh, whilst  they  of   Edinburgh  have  actually  imported  this 
splint.    We  thought  they  considered  that  no  good  thing  could 
come  out  of  London."     This  was  followed  by  the  reading  of 
papers  on  subjects  connected  with  stone  in  the  bladder — but 
not  having  attended,  I  am  not  able  to  give  you  any  further 
pirticulars,  but  I  did  not.  learn  that  anything  very  novel  con- 
cembg  the  operations  for  stone  had  been  developed. 

The  following  day,  however.  Surgery  came  to  the  front.  The 
address  had  been  entrusted  to  Mr.  Wheelhouse,  of  Leeds,  and 
be  certainly  did  not  fail  to  do  full  justice  to  the  subject  he  had 
^  band.  It  was  a  lively  and  interesting  review  of  the  progress 
rf  Surgery  during  the  50  years  of  the  writer's  own  experience. 
It  was  admirably  delivered,  and  at  times  the  reader's  enthusiasm 
^▼en  carried  him  into  eloquence.  Its  interest  was  greatly 
danced  by  the  numerous  examples  introduced,  in  which  he 
bad  himself  been  led  by  reasoning  upon  the  now  established 
principles  of  Surgery,  to  some  of  the  most  remarkable  and 
•itisfactory  results.  I  may  not  take  up  much  more  of  your 
space,  but  would  tefer  your  readers  to  the  address  itself.  One 
w  two  instances,  however,  may  be  mentioned  of  the  unusual 
procedures  to  which  Mr.  Wheelhouse  has  occasionally  had 
wsort.  For  example,  he  has  recently  had  under  his  care  a  man 


CANADA  SIEDIOAt  AN!)   SDROICAL    JOURNAL. 


70 

who,  througli  a  fall  upon  a  scathe,  bad  received  a 

the  baclc  of  the  thigh,  Lnjuring  aiso  the  aciaUc  nen^e.  The 
Bubsequent  cicatriaation  had  completed  the  destruction  ^of  the 
nerve's  function  by  pressure,  and  complete  paraljaia  was  the 
result.  This  paralysis  had  lasted  several  months,  and  the  nan  I 
came  to  the  hospital  for  the  purpose  of  having  the  limb  ampu-  i 
tated,  80  cumbersome  had  it  become.  This  surgeon,  however, 
determined  to  try  the  effect  of  exposing  the  ends  of  the  divided 
norvc  and  joining  them  together.  This  was  done,  and  the  result 
was  a  perfectly  good  limb,  with  (after  some  months)  free 
motion  and  sensation. 

Antiseptic  Surgery,  of  course  came  in  for  a  full  share  o 
attention,  Without  entering  into  any  tlieoretical  discussion^ 
Mr.  Wlieclhouse  contented  himself  simply  with  stating  his  belief 
that  hy  this  moans  results  could  be  att-cdncd  which  he  had  always 
failed  to  procure  boforc  its  introduction,  and  which,  indeed,  1 
boHovcd  to  be  still  impossible  without  it.  Reference  was  alsw 
made  to  iho  great  advantages  which  surgery  has  reaped  from 
Dioulafoy's  method  of  aspiration.  After  enumerating  many  of 
the  molndies  to  which  this  improved  means  of  removing  fiuifi 
ia  applicable  the  writer  made  some  further  suggestions  with 
reference  to  tlie  extension  of  its  use —especially  to  the  empty- 
ing of  largo  and  putrid  cavities  in  lungs  and  washing  them  out 
with  some  disinfectant  fluid.  (I  have  since  been  Informed  tl 
this  has  already  been  done  by  some  German  surgeons.) — G.  Bi 

Iftouicu's  and  Notices  of  Boohs. 

^ranmctiontof  th*  MeJtcal  AnociatitfM  of  Georgia.    Twen^ 

tiiaih  Annual  S«ssion,  held  at  Atlanta,  April  ITth,  18^ 

and    li)Ui,    187S.     Sro,    pp.  279.    Atlanta,  ' 

Jasibs  p.  Uameson  &  Co.,  187a 

This  is  simply  it-hat  its  title   indicates,  and  contains  niM 

matter  of  int«rcst.    llio   onler  of  arrangement  is  in  the  uso 

etylc  :   the  body  of  th«  t>ook,  which  Cvvi^ts  of  exactly  thii^ 

two  pages,  being  taken  up  vith  taUe  of  cooteats,  index  \ 

I,  hst  of  officers,  special  \         ' 


EEVIEWS  AND    NOTICES  OF  BOOKS.  71 

i^hich  a  daily  record  of  the  minutes  of  the  meetings  appears. 
Tbe  papers  which  have  been  selected  for  publication  are  next 
^ven  in  the  appendix.  As  an  introduction  we  have  the 
President's  address — this  is  followed  by  an  oration  in  which  the 
author,  Dr.  Burgess,  touches  upon  the  subject  of  unwise  medi- 
cal literature,  of  which  there  certainly  appears  to  be  a  super- 
abundance. Dr.  Dostor  next  reports  a  case  of  amputation  of  the 
leg  for  necrosis  of  the  tibia  ;  the  patient  recovers,  and,  as  the 
Dr.  naively  observes,  he  was  made  "  apparently  a  happy  man,'* 
after  thirty-four  years  of  suffering.  This  is  succeeded  by  a 
report  of  cases  from  Dr.  Walker,  and  also  a  paper  on  tuber- 
■cular  meningitis,  by  Dr.  Grimes. 

The  next  paper  is  on  Yellow  Fever,  its  history,  causes, 

nature,  pathology   and  treatment,  by  Dr.  J.  C.  Le  Hardy,  of 

Savannah.     This  is  a  very  important  paper,  and  one  that  will 

attract  much  interest  at  the  present  time,  as  yellow  fever  is 

aaid  to  be  epidemic  in  the  South  just  now.     The  paper  is  based 

on  the  experience  gained  by  the  author  during  the  epidemic  of 

1876,  through  which  the  city  of  Savannah  passed  during  the 

latter  part  of  the  summer  of  that  year.    In  the  history  of  the 

epidemic,  the  author  gives  a  description  of  the  sanitary  con- 

ttn  of  many  parts  of  the  city,  and  points  to  the  condition  of 

<iver-crowding  of  buildings  and  defective  drainage  to  which  he 

attributes  the  aggravation  of  the  disease  when  once  developed. 

He  says : — ^^  The  sections  of  the  city  principally  inhabited  by 

the  working  classes,  (white  and  black)  and  extending  on  the 

eastern  and  western  slopes  of  our  bluff,  were  in  their  usual 

etched  sanitary  condition.     The  streets  narrow,  running  east 

^i  west ;    the  houses  wooden,  small,  decaying,«built  in  tene- 

^^ents,  with  miserable  ventilation ;   the  yards  small,  with  high 

plank  fences,  and  filled  up  with  offal  of  all  sorts  ;  their  privy 

■faults  badly  closed  ;    stables,  pigeon  and  poultry  houses,  &c., 

*"  huddled  together — Here  was  a  picture  to  meet  the  eye  on 

«very  side,— such  a  combination  was  quite  sufficient  to  produce 

fflth  diseases ;  but  it  had  existed  for  years,  and  although  it  was 

^t  in  my  judgment,  an   efficient  cause  for  yellow  fever,  yet 

^ing  an  epidemic  it  could  aggrvate  its  ravages."    It  has  been 


72  CANADA  MEDIOAL  AND  SURGICAL  JOURNAL. 

said  that  cleanliness  is  next  to  Godliness,  for  in  verity  it  con- 
sists in  our  duty  towards  our  neighbour  and  ourselves.     We 
fear  tliat  Savannah  is  not  the   only  city  on  this  continent 
afflicted  with  squalor  and  neglect  of  sanitary  precautions  in 
the  construction  of  buildings  and  their  appurtenances.     We 
have  often  in  our  own  city  viewed  with  anxiety  and  regret  the 
system  of  over-crowding  of  buildings,  and  we  may  observe  that 
during  tlie  two  past  epidemics  of  cholera  that  afflicted  our  city,. 
although  the  disease  was  very  generally  distributed,  yet  it 
provoil  most  fatal  in  localities  where  sanitary  precautions  had. 
boon  neglected.    Such,  we  imagine,  is  the  experience  of  all 
obsorvors  not  only  in  reference  to  yellow  fever,  but  also  of 
every  plague  witli  which  the  human  family  has  been  afflicted 
siuco  the  time  of   Moses.    Dr.  WoodhuU,  U.  S.  Army,  who 
wwto  an  official  account  of  the  causes  of  the  epidemic  of  yellow 
fovor  attSavaunah  in  ISTl^  and  which  is  published  in  the  num- 
W  (or  Ju1t«  1S77«  American  Journal  of  the  Medical  Sciences^ 
r(iiiark;» : — ^"^  Fiwm  the  data  which  I  have  been  able  to  collect^ 
I  iKink  it  is  clear :  Fu^t^  that  ther^  is  no  evidence  of  importa- 
tioii  \>f  iho  wlK>w  ioT^r  p^HSon  in  this  epidemic ;  Second,  that 
if  it  wa;jt  im|x>rti^}«  ih>  system  of  <(uarantine  could  have  guarded 
a^u^t  it ;  Thinly  that  ihi^  ${Mre«d  and  rirulence  of  the  epidemic 
w^n^  cloi^^y  <o(uieotvs)  with  ;ur  and  ^m1  pcJlutioD^  whether  this 
foHuiioii  b^  <SMv»^i<Kt>Hi  »^  a  $ufteieiit  explanatioii  of  the  ori^ 
\>(  tW  dvw^a^  x\r  Ws^^^  • 

W  Uax\\y.  i^\  K»  i>ajvr.  ijt  it^^iue^i  to  tie  befief  tliat  so  far 
a;^  ^xamvaK  i*  N\>iHVrwsi^  tii<^  xviV>>r  tVx^r  «rni  can  originate 
^whsH^t  \^)\yna^^^«^^  A'^>N>^jrii  ^i;'?^^  t));to$6cQ  is  sdll  debatable, 
1^  y«NN^^vte>.>^J  x>;>i(^^>^  >;jt  Vv  ^^  YM^a^  tev«KXUM^  «q  the  sub- 
ji^^^^  >i^v  >^v^  w  t)^i  t)s^  a^ti^vrx  %V>  ;a^»^usx$  dat  a  lack  rf 
^N^liM^f  ^^^^\^A^^^M^*  >^C  A#^i?ax*>f  ti^  5i9weie.  aiMl  tend  to  its 
$^^^>^a>U  W  .i^sv*  ¥kM  ^sj^ja^si  u  a^^  a  &««•  vC  tie  disease. 
\>^  ^W  ys«^^^  V  >NS#^-,<^  -N  JUa  i^tt^  ani  » iwahaag  gases 
awA  ysvS>^^>^>Ji»^  >sSN^  >NJsjN*KV  .^e  v«NN^*^«^  wlVv  ie^w  t»ce — its 


BSVIEWS  AND  NOTICES  OF  BOOKS.  75 

constant,  and  we  would  have  yellow  fever  recurring  here  every 
summer,  under  the  influence  of  our  solar  heat,  which  varies 
.very  little  from  year  to  year."  Such  not  being  the  case  how- 
ever, the  author  infers  that  some  other  cause  must  be  looked 
for.  Such  cause  he  regards  as  miasmatic,  due  to  a  mild  winder 
succeeded  by  long-continued  oppressive  heat,  with  much  rain- 
fall, and  consequently  a  large  area  of  stagnant  water,  wet  soil^ 
which  would  give  rise  to  noxious  emanations  or  miasms,  called 
more  recently  contagium  vivum.  This  paper  throughout  is 
most  interesting,  as  in  it  the  various  destructive  epidemics 
which  occurred  in  1817, 1820, 1854  and  1876  are  compared. 
The  author  concludes  this  part  of  his  essay  with  a  clinical  table 
which  shows,  as  he  observes,  "  as  naught  but  figures  can,  the 
variations  of  the  pulse,  temperature,  relapses,  and  influence  of 
quinine  treatment,  all  of  which  sustain  me  in  classifying  yellow 
fever  as  a  malarial  disease." 

Dr.  James  B.  Baird  gives  an  excellent  paper  on  neuralgia, 
and  its  modem  therapeusis.  The  author's  conclusions  as  to 
cause  of  these  affections  is  that,  while  admitting  the  possibility 
of  iheir  bebg  variable,  that  in  this  country  at  least,  the  most 
frequent  cause  is  malaria.  The  malarial  origin  of  some  cases 
of  neuralgia  would  seem  to  be  undeniable,  but  the  most  severe, 
constant,  and  unrelievable  cases  of  neuralgia  which  we  have 
over  witnessed,  were  due  to  pressure  directly  on  the  nerves  by 
cancerous  growths.  The  next  paper  is  a  report  of  one  hun- 
^  and  thirty  operations  for  strabismus,  from  the  pen  of  Dr. 
A.  W.  Calhoun. 

Dr.  V.  H.  Taliaferro,  professor  of  obstetrics  in  the  Atlanta 
Medical  College,  gives  a  paper  on  "  the  application  of  pressure 
^  diseases  of  the  uterus," — this  is  followed  by  a  paper  on  the 
^  of  uterine  tents  ;  the  author.  Dr.  Goldsmith,  proposes  the 
P^4  of  the  dried  com  stalk  as  a  uterine  tent.  There  are 
*wo  reports  on  Surgery,  the  one  by  Dr,  A.  A.  Smith,  for  the 
^nd  congressional  district — the  other  for  the  fifth  congressional 
Strict,  by  Dr.  J.  T.  Johnson.  These  are  followed  by  a  paper 
®^the  soft  palate,  from  the  pen  of  Dr.  W.  A.  Love.  Dr. 
-^itner  suggests  tar  as  a  means  of  rendering  solid  bandages,. 


74 


UANAJ)A  HEDICAL  AND   SURGICAL    JOCBNAL. 


and  as  a  substitute  for  starch,  glue,  dextrine,  &c.  The  work  is 
concluded  with  a  report  of  an  obstinate  case  of  hiccough,  a 
report  on  necrology,  the  constitution  and  by-lawa  of  the  associ- 
ation and  the  roll  of  members.  Altogether,  this  is  a  very 
creditable  production,  and  the  Secretary,  Dr.  Baird,  to  whom 
we  preaumo  we  are  indebted  for  its  publication,  is  to  be 
congratulated  tor  its  respectable  appearance. 

The  Tliroat  and  its  Diseages.  With  one  hundred  typical 
illustrations  in  colour  and  fifty  wood  engravings  designed 
and  executed  by  the  author.  Ey  Lennox  Bbowke, 
F.  R.  C.  S.,  Edin. ;  Senior  Surgeon  to  the  Central  Londoa 
Throat  and  Ear  Hospital.  8vo,  pp.  351.  London: 
Ballieke,  Tindell  &  Cos,  1878. 

The  author  in  his  preface  states  that  this  book,  the  result  of 
eleven  years  of  work  devoted  to  diseases  of  the  throat,  is  offered 
as  a  practical  guide  to  the  diagnosis  and  treatment  of  those 
affections.  He  does  not  enter  into  pathological  questioDS,  but 
confines  his  remarks  to  whatever  can  aid  the  busy  practitioner 
in  carrying  through,  with  the  hope  of  success,  the  treatment  of 
affections  of  the  tliroaL  So  that  fiueslions  of  "  purely  patho- 
logical interest "  are  not  discussed  in  these  pages. 

The  attention  of  the  reader  is  in  the  main  directed  to  diseases 

L  ^  the  throat  which  have  been  brought  out  more  prominently 

;e  the  introduction  of  the  use  of  the  laryngeal  mirror.     By 

\  tiie  use  of   the  Laryngoscope   the  observer  has  the  means  of 

I  maldng  oat   with  accuracy  many   special  conditions  of   the 

]  larynx  and   trachea,  by  actually  seeing  with  his  eye  these 

parts,  which  otherwise  would  be  invisible  during  life.    Thus 

with  this  powerful  auxiliary  he   has  these  cavities  laid  open 

to  his  view,  and   it  alone  reqmres  careful  observatioD.  wiUi 

an  inteltigeoce   equal  to  knowing  what  is   observed,   to   en- 

aUe   ^  phystnan   to    form   an   accurate   diagnosis   and   to 

porodiet  resolte,  which  will  surely  follow,  althou^  no  indie* 

•titffis  oF  such  events  may   b«  present.     Thus,  for  instance, 

I  «  man  may  be  the  subject  of  tfawacic  anenri^a  eDcroaching  aa 


REVIEWS  AND   NOTICES   OP   BOOKS.  15 

trachea,  or  probably  almost  completely  blocking  up  one  of 
tie  bifurcations  of  the  trachea  ;  the  symptoms  may  be  obscure 
—not  suflScient  at  least  to  enable  the  practitioner  to  positively 
pronounce  the  preseuce  of  such  a  fatal  malady,  but  the  laryng- 
oscope would  in  all  likelihood  aid  him  in  making  out  the  pres- 
sure or  obstruction,  and  its  most  probable  cause. 

The  text  of  this  work  is  divided  into  seventeen  chapters ; 
the  first  three  are  taken  up  with  a  description  of  the  laryngo- 
scope and  how  to  use  it ;  the  anatomy  of  the  larynx  is  next 
dealt  with,  after  which  the  laryngoscopic  and  rhynoscopic 
images  are  described—  these  are  accompanied  by  several  excel- 
lent outline  engravings  on  wood.  Chapters  four  and  five  are 
devoted  to  the  semeiology  and  therapeutics  of  throat  diseases, 
after  which  the  diseases  of  the  pharynx  and  fauces,  the  uvula 
and  tonsils  are  discussed  in  chapters  six  and  seven.  Catarrh, 
naso-pharyngeal  and  posterior  nasal,  has  a  chapter  devoted  to 
itself.  Diphtheria  is  the  next  subject  taken  up  in  chapter  nine. 
On  the  question  of  general  treatment,  the  author  is  not  very 
pronounced.  He  remarks  that,  "  Many  general  remedies  have 
been  suggested,  and  some  have  been  vaunted  as  specifics,  but 
tiie  most  rational  and  satifactory  method  seems  to  be  that  of 
treating  symptoms  as  they  arise. *'  The  author  believes  that, 
"  locally  very  much  may  be  done  *' ;  as  long  as  the  disease  is 
confined  to  the  pharynx  he  believes  that  the  spray  or  brush 
Diay  be  of  great  service.  The  author  does  not  enter  into  the 
question  of  tracheotomy,  although  he  remarks  that  if  it  does 
Jiot  save  the  life  of  the  patient,  it  certainly  lessens  the  agony 
of  death.  We  certainly  think,  that  in  view  of  the  marked 
success  of  the  operation  in  this  very  fatal  malady,  where  the 
l^nx  is  implicated,  that  the  neglect  to  perform  the  operation 
^  to  be  condemned,  and  we  are  disappointed  to  find  in  a  work 
<«tensibly  devoted  to  the  practical  consideration  of  this  subject, 
that  it  is  dismissed  in  a  paragraph  of  some  six  lines.  This  work 
w  offered  as  a  practical  guide  to  the  diagnosis  and  treatment  of 
diseases  of  the  throat,  but  it  would  appear  that  the  author  has 
^ot  fully  made  up  his  mind,  at  least  on  this  most  important 
point  of  treatment,  and  the  sooner  he  does  so  the  better.     We 


:.  AKD   SUKGICAL   JOURNAL, 

do  not  believe  in  half  measures  in  surgery.  In  surgery,  as  in 
war,  action  to  be  successful  must  be  prompt,  decisive  and 
energetic,  with  a  full  knowledge  of  the  topography  of  the 
country,  and  a  careful  attention  to  ibe  rules  of  strategy-  It 
must  not  be  supposed,  hoivever,  that,  becanse  there  is  this  want 
of  decision  in  recom mending  the  operation  of  tracheotomy  in 
diphtheritic  laryngitis,  that  there  is  the  same  lack  of  practical 
instruction  throughout  the  volume.  There  are  a  few  points  in 
which  a  decided  opinion  might  bo  advantageously  given,  bu* 
we  presume  the  author  baa  not  actjuired  such  an  amount  of 
experience  as  to  give  him  that  necessary  self-reliance  which 
alone  is  looked  for  in  the  practical  man.  We  shall  hope  to  see 
a  decided  improvement  in  this  and  many  other  respects  in  a 
second  edition  of  this  work,  ftleanwhile,  we  may  remark  that 
there  is  much  instruction  to  bo  gained  from  these  pagop. 
and  the  coloured  lithographs  are  very  beautifully  executed 
and  very  truthful. 


Analomtf — Descriptive  and  Surgical.  By  IIesry  Gray, 
F.  R.  S.,  with  five  hundred  and  twenty-two  engravings  on 
wood,  with  an  introduction  on  general  anatomy  and 
development.  By  T.  Holmes,  M.  A.,  Cantab.  A  new 
American  from  the  eighth  and  enlarged  English  edition,  to 
which  is  added  Landmarks,  Medical  and  Surgical.  By 
LuTUER  HoLDEN,  F.RC.S.  Imp.  8vo,  pp.  983.  Plular 
delphia:  Hknhv  C.  Lea,  187t*. 

It  is  scarcely  necessary  to  draw  attention  to  this  well-known 
work,  except  to  announce  a  new  American  from  the  eighth  and 
enlarged  English  edition.  This  edition  has  been  passed  through 
the  press  by  Dr.  Richard  J.  Dunglison,  and  from  the  fact  that 
the  work  had  received  three  revisions  at  the  hands  of  tha 
English  editor,  Mr.  Timothy  Ilolmes,  since  the  issue  of  the 
previous  American  re-prmt,  no  further  additions  were  deemed 
necessary.  The  publisher  has  enhanced  the  value  of  this  book 
by  adding  to  it  at  the  end  of  the  volume  Ilolden's  Landmarks, 
Medical  and  Surreal ;    this  has  been  an  addition  of  some  45 


BRITISH  AND  FOREIGN  JOURNALS.  77 

pages  of  reading  matter.  Gray's  Anatomy  has  been  a  favourite 
with  students  and  practitioners  for  many  years,  and  this  edition 
has  lost  none  of  its  attractiveness.  It  is  the  same  valuable«and 
reliable  guide  brought  down  to  the  anatomical  knowledge  of 

the  day, 

Extracts  from  38ritish  and  Fori3ign  Journals. 

Unlen  otherwise  stated  the  translations  are  made  specially  for  this  Journal. 

The  Treatment  of  Phasedaanic  Ulcers— 

ByDr.  G.  E.  Weisfolg,  Virch.  Archives^  Yo\.  LXVI,  page 
311.— Among  the  many  therapeutical  problems  presented  by 
the  various  manifestations  of  syphilis,  the  treatment  of  phage- 
denic ulcers  is,  perhaps,  the  most  difficult. 

No  plan  of  treatment  hitherto  recommended  by  the  best 
authorities  suffices  to  alleviate,  much  less  to  arrest,  the  pain 
which  these  ulcers  give  rise  to. 

The  desire  to  afiFord  relief  in  this  terrible  disease,  has  led  to 
the  use  of  an  infinite  variety  of  local  remedies.  One  author 
has  even  extolled  the  use  of  the  actual  cautery.*  As  an  ofiset 
to  this  truly  barbarous  surgical  practice,  I  venture  to  publish 
the  result  of  treatment  in  nine  cases.  The  method  to  be 
described  was  so  successful,  that  I  think  it  deserves  to  take  pre- 
cedence of  all  others. 

No  matter  how  intense  the  pain  occasioned  by  a  phagedsenic 
^cer  may  be,  it  ceases  immediately  when  the  ulcer  is  exposed 
to  the  action  of  an  electro-magnetic  bath. 

If  the  sore  is  not  so  situated  that  it  can  be  immersed  in  the 
^ater,  the  faradization  may  be  applied  to  the  nerves  supplying 
this  part;  the  effect,  though  hot  so  strikingly  beneficial,  still 
^ces  to  render  the  condition  of  the  patient  comparatively 
comfortable. 

The  faradaic  bath  may  usually  be  applied  as  follows :  The 
sore  is  to  be  immersed  in  a  basin  of  warm  water,  to  the  bottom 

•  Horriflon.    Fiset  «  On  the  local  treatment  of  Venereal  Ulcers,"  in  the 
2fev  York  Eeeorder,  Oct.  16,  1874. 


78 


CANADA   MEDICAL   ANK   SUKOICAL   JorRNAL. 


of  which  one  electrode  ia  connected.  The  battery  being  80 
arranged  as  to  give  a  very  weak  current,  the  patient  applies 
one  finger  to  the  sponge  of  the  other  electrode ;  two  or  more 
fingers  may  be  placed  upon  the  sponge,  if  the  patient  does  not 
find  the  application  too  strong  to  be  borne  with  comfort. 

Faradization  of  the  nerves  leading  to  the  wound  may  be 
conducted  in  a  similar  manner  ;  the  parts  in  the  vicinity  of  the 
soro  being  stroked  with  the  sponge  of  one  electrode,  whilst  one 
or  more  fingers  are  placed  upon  the  other. 

Patienta  very  soon  learn  lo  manipulate  in  such  a  way  as  to 
avoid  painful  muscular  contractions  in  the  neighbourhood  of  the 
ulcer,  and  can  then  be  trusted  to  make  subsequent  applications 
for  themselves ;  in  the  intervals  the  sore  may  be  dressed  with 
oiled  lint.  The  pain  at  first  soon  recurs  after  each  faradization, 
and  for  a  few  days  the  patient  will  frequently  have  recourse  to 
the  use  of  the  battery ;  [but  the  period  of  relief  gi'adually 
becomes  longer  after  each  application,  and  at  the  end  of  eight 
or  ten  days  the  sore  is  not  more  painful  than  an  ordinary  non- 
specific ulcer. 

In  the  meantime  the  appearance  of  the  ulcer  has  not  under- 
gone any  corresjionding  improvement,  its  base  still  being  covered 
with  adherent  sloughs,  its  margins  raised  and  occupied  by  a 
brawny  infiltration,  although  the  excessive  sensibility  has 
entu-ely  disappeared.  At  this  stage  there  are  many  remedies 
which  will  act  beneficially,  but  of  these  the  nitrate  of  mercury 
deserves  the  preference.  It  may  be  used  in  the  form  of  an 
ointment,  eight  grains  to  the  ounce.  At  first  this  application 
causes  a  slight  smarting,  but  nndcr  its  iufluence  the  ulcer 
soon  cleans  rapidly,  its  raised  edges  sink,  and  the  healing  ■ 
process  makes  rapid  progress,  so  that  in  from  fifteen  to 
twenty  days  the  cure  is  completed.  Treated  in  this  way  a 
pbagedienic  ulcer  as  large  as  a  twenty-dollar  gold-piece  will 
heal  in  about  a  month.  A  phagedaenic  ulcer  is  more  difficult 
to  treat  when  a  patient  is  at  the  same  time  suffering  irom 
periosteal  pains,  for  in  these  cases  the  relief  afibrded  by 
the  faradaic  current  ia  not  so  complete.  Under  these  cir- 
cumstances injections  of  the  nitrate  of  mercury  are  extremely 


BRITISH  AND   FOREIGN   JOURNALS.  7^ 

serviceable.  They  are  less  harmful  than  injections  of  the 
perchloride  of  mercury,  do  not  cause  abscesses,  and  supply 
tie  system  with  a  much  larger  quantity  of  soluble  mercury, 
without  causmg  salivation,  than  can  be  done  in  any  other  way. 
For  the  relief  of  periosteal  pains  the  subcutaneous  injections  of 
nitrate  of  mercury  do  not  require  to  be  made  more  often  than 
once  in  fourteen  days.  They  wiU  usually  effect  a  cure  in  about 
two  months. 
The  formula  for  injection  is  as  follows  : 

ft  Hydrarg :   oxid :  nit :  crystall    .     .     .     gr.  viii. 
Aq  :  destill :.........  fl  3  xiv. 

Dispens  solutio  limpida. 

On  the  abortive  treatment  of  Syphilis 

—By  Dr.  Gustavb  E.  Weisfolg,  from  Virchow's  Archives, 
Vol.  LXIX,  1,  p.  143.-^The  author,  who  appears  to  think  the 
abortive  treatment  of  syphilis  is  quite  within  the  bounds  of 
possibility,  says  that  whoever  believes  at  all  in  the  eflScacy  of 
medicines  must  also  admit  that  we  have  only  to  find  a  suitable 
remedy  or  method  of  treatment  in  order  to  prevent  the  first 
local  manifestation  from  passing  on  to  a  general  or  constitutional 
affection.  In  support  of  this  proposition,  he  points  to  the  fact 
that  there  is  always  a  considerable  interval  between  the  appear- 
ance of  the  local  disease  and  the  symptoms  denoting  general 
infection,  and  maintains  that  during  the  interval  it  should  be 
posable  to  anticipate  and  prevent  the  process  of  general 
infection.  One  of  the  chief  diflSculties  to  be  overcome  is  to 
f<Min  a  correct  estimate  of  the  actual  value  of  any  course  of 
^tnaent  pursued  with  this  object  in  view,  since  several  years 
must  necessarily  elapse  before  any  decisive  results  can  be 
attained. 

Certain  it  is,  however,  that  those  remedies  which  are  known 
to  have  a  curative  effect  when  given  internally  for  constitutional 
syphilis,  do  not,  when  given  in  the  same  way,  possess  the  power 
rf  preventing  general  infection.  This  indicates  at  least  one 
Section  in  which  there  is  nothing  to  hope  for  from  the  abortive 
plan  of  treating  syphilis.     The  author  adheres  to  the  generally 


so  CAi(AI>A   MEMCAL   ASD   STIGICAL  JOUKXAL. 

accepted  doctrine  that  infection  takes  place  throagh  the  medinai 
of  the  Ijmpliaticfi — though  dotibts  as  to  the  correctness  of  this 
view  Iiave  recently  bocn  raised — and  lays  great  stress  on  thO' 
expcrimcnti  of  Broca.  The  latter  attempted  to  prevent  geoenl 
infuctioti  when  there  was  a  syphilitic  sore  on  the  penis  and 
awollini^  of  the  in;;uina!  glands,  by  incising  and  injecting 
tlicm  with  io'lino,  thus  setting  np  an  acute  inflammation  of  the 
glnndK  in  tuicstion. 

Ho  wan  lod  to  this  from  the  common  observation  that  sore* 
followed  by  Buppiirating  Imbo  seldom  give  rise  to  constitutional 
infection,  ami  ho  hopcil  to  attain  the  same  result  by  imitating 
nature,  Although  the  aittlior  finds  this  plan  of  treatment  u 
loHH  OS  an  abortive  meaaurc,  ho  maintains  that  the  principle  upoui 
which  it  is  founded  ia  correct,  on!y  it  is  esaential  to  be  before- 
hand witli  the  syi)iiilitic  poison  and  grapple  with  it  before  ti* 
general  lymphatic  «yst(!ra  ia  impregnated  by  it.  He,  in  fact, 
Rttaini  iho  object  wliioli  IJroca  had  in  view,  but  by  a  different 
method  of  trentmeiit.  Hie  author  directs  attention  to  the 
curious  foot,  that  the  watery  solution  of  nitrate  of  mercurt 
mentioned  in  the  previous  article,  mny  be  injected  under  th* 
•kin  of  ft  hcnltliy  part  without  even  setting  up  purulent  inflam- 
mntion,  hut  that  if  the  part  be  already  inflamed,  aiich  i 
iiycotion  invnrlaldy  prodticos  (in  aliscoss,  and  he  has  utilized 
Uiia  ppculinrity  of  netion  in  such  a  way  as  to  prevent  the  spresdt 
«)f  venereal  iwison  from  a  primary  sore  through  the  ingiund 
glands  to  the  system.  In  any  doubtful  case  he  injects  some  a 
Iho  Einlutiun  auboutanpously,  between  the  sore  and  6r3t  coi 
wltttiiMi  of  iii;;uiual  glands  Ukoly  to  bo  infected  by  it.  If  thei 
glands,  or  tl)0  lymi^ltaltca  leading  to  them,  are  not  already  ii 
an  iuAam«d  cotiditi«nt  no  ttbacflts  is  formed,  and  if  the  injectiai 
U  TVi>t^all^l  ev«ry  ten  or  tvtln  days  till  th«  primary  soie  i 
h««t#«l  awl  the  indurtitioB  hu  dis^ipeared,  constitatioi 
.  ^]r|iUlit  Mr»r  •MOM*. 

In  4)mw  cmm  IB  wioel^  m  Mcoaat  of  already  t 
['M>M— atiwi,  ahaewaw  li)nM4,ib«  paiMirts  stia  noma  fr« 
'  ftwi^ffkilb.  11t*aiitkir)iM|nwtfeiedtkHaborti««trMtee 
k  dNHK^  At  llM  fit*  ;«*r«,  ia  dw^j^^n  «•«»  af  isAMtted  « 


BRITISH  AND   FOREIGN  JOURNALS.  81 

niixed  chancres.  Of  these,  abscesses  formed  on  both  sides  in 
fourteen  cases,  on  only  one  side  in  six  cases.  The  final  result 
was  followed  up  in  twenty-eight  of  these  cases,  all  of  which 
remained  free  from  syphilis,  as  did  also  their  children. 

This  method  of  treatment  is  based,  according  to  the  author, 
upon  the  law  that  "  mercury  exercises  its  specific  action  as  an 
antisyphilitic  most  efifectually  when  it  comes  in  direct  contact 
with  the  chancre  poison  in  the  tissues  primarily  aficcted  :  "  and 
this  occurs  when  those  tissues  are  impregnated  with  mercury, 
which  contain  the  lymph  vessels  connecting  the  chancre  with 
the^eneral  lymphatic  system.  The  author  concludes  the 
articiM  by  earnestly  inviting  the  profession  to  give  the  proposed 
method  a  fair  trial. 

Paracentesis  Abdominis  by  gradual 
drainage  with  a  single  fine  Cannula.— ^ 

By  Reginald  Southey,  M.D.  Oxon.,  F.R.C.P.— The  unusual  re- 
lief of  the  distressing  symptom  of  anasarca  which  I  found  follow 
the  employment  of  fine  drainage-cannulas  encouraged  me  to 
employ  nearly  the  same  apparatus  in  the  treatment  of  ascites  ; 
and  now  that  my  experience  has  extended  over  a  fair  number 
of  cases,  enough  to  satisfy  me  that  this  mode  of  proceeding  is 
attended  by  no  extra  risks,  I  venture  to  lay  it  as  briefly  as  I 
can  before  the  profession,  « 

Apparatus. — ^The  trocar  and  bulb-headed  cannula  required 
for  the  purpose  of  gradually  drawing  off  ascitic  fluid,  by  the 
help  of  a  capillary  tube,  diflfers  very  little  from  that  employed 
ty  me  for  anasarcous  limbs.  Both  instruments  are  equally 
fine.  The  calibre  is  the  No,  1  exploring  trocar  of  the  surgeon.' 
One  long  needle-trocar,  measuring  an  inch  and  three  quarters 
in  length  from  hilt  to  point,  has  appeared  long  enough  for  all 
the  cases  hitherto  tapped  by  me.  Three  or  four  cannulas  of 
different  lengths,  adapted  to  the  thickness  from  fat  and  oedema 
of  different  abdominal  walls,  are  required.  The  cannulas  may 
be  perforated  with  as  many  as  six  or  eight  side  holes — the  more 
the  better,  so  that  their  strength  is  not  interfered  with  The 
mouth  end  of. each  cannula  should  be  armed  with  a  small  silver 

NO.  LXXIV.  6 


'f/i  KX%Xhh  MtVlCAL  AX»  SnunCAL  JOCKXAL. 

ihUs  or  nhUM,  Uf  fAfthte  zaj  risk  of  die  canunk  kead  snking 
Um/Mh  the  ifuHkce  ^>f  the  sldn  when  this  is  hi^j  oedematous ; 
HUflf  HiutifU}  M  it  may  seem  to  contrire  an  annatnre  which  may 
thus  Hficnrc  AtA  help  to  maintain  the  cannula  in  position,  I 
may  nay  that  I  have  not  yet  qcute  mastered  the  matter.    As  to 
the  htngtli  of  the  shield  or  cross-beam,  one  inch  appears  ample 
— '}«o«,  half  an  inch  each  side  of  the  cannula.    The  shield  may 
bo  roini«l  or  sqtiare  with  rounded  edges,  or,  as  I  have  had  mine 
nifulo,  an  elongated  plates,  one  inch  long  by  a  quarter  of  an 
Inch  hroa<l,  and  about  a  thirty-second  of  an  inch  thick.     Whe- 
ther tho  cannula  was  best  fixed  immovably  to  the  shield  or 
()th(U'wiHo,  was  the  next  point  to  decide.     It  was  found  that 
tho  nnuiovably  fixed  shield,  held  fast  by  two  strips  of  plaster, 
by  (tint  of  tho  niovomonta  of  the  abdominal  muscles  in  respira- 
tion oithor  worked  away  from  its  plaster  moorings  or  tended  to 
work  out  tho  cannula  end  from  tho  peritoneal  cavity.    Messrs. 
KiM'^UHon  thoroforo  contrived  a  shield  for  me  which  held,  but 
ullowod  tho  ounnulu  a  limited  play  in  every  direction,  and  m 
praotiov^  thi«  hu8  worked  admirably.     One  instrument  I  had 
n\ado  iW  tlioKO  particular  oases  in  which,  although  the  ascites 
\\\\^  hoon  ovn\HidorabU\  and  its  relief  urgent,  the  presence  either 
of  oanoorouj*  tvuuouw  iu  tho  abdominal  cavity  or  an  enlarged 
livor  lu\H  nn\doivd  a  Inml  and  pointed  bo<ly,  like  the  cannula 
o\uU  ubvutiu^  oti  tho  poritonoal  as|HH:t  of  tlie  abdominal  parietes, 
undOvHiraMo  ;  for  »;» tho  tluid  dnuns  away  the  abilomen  collapses 
and  tho  j^\viot\vi  jiiluk*  aud  larJ^^  softsjurfaoed  masses,  moved 
wp  anvl  dvnvu  by  tho  do$o\nit  of  llio  dia|>hragm«  might  be  torn 
<^ud  t\vttod  ^ii^^iu^t  tho  Ostuuula^  and  mavle  to  bleed.    To  meet 
tUi*  ov/AM\jiYUOY  ;i^  o^Muiul*  which  ttK►r>^lY  traversed  a  shieldfdate, 
*ud  N\A*  uot  tixvsi  ;i^i  ;i^lU  ariHNjit^i  bc^  adapted.    If  anything 

,V  ><'  <*\\<'*'*>^/Mx — THviAl  a*  thfe  iss  it  appears  to  me  firom 
v^\lvvN^^,^v  tivAl  th<^re  i*  a  r\jAt  awvl  a  wrv«i^  war  oi  inOK^udng 
iKo  vSAuv.uU.  )u$t<^vl  vNl  vxrixi^j  tho  ttvvar  ia  v^^ii^e  wrw&ii- 
vH^Ux'xv  \^  W  Nv\j4  K^  j^v^jv  tW  tvia5  *ic'w::wari5  scc^evtat 
tv^>fcai\U  ^i^*^  v^S.Nik  a*A  ^^  axvii  ^«iV.S\j:  ;i3e  caraiia  tcm 
^^%*^^i^  ^x^%ax>fe  ^  ;j^;wy5i«fc    T^  >»\H£3»i  2iiaie  is  5c  sS^t 


BRITISH  AND   FOREIGN  JOURNALS.  83 

that  one  can  afford  to  make  it  almost  anywhere,  but  from  pre- 
judice I  should  select  the  raphe  or  mesial  line  below  the  umbi- 
licus, and  about  midway  between  this  and  the  pubes.  Before 
operating,  I  always  insist  upon  my  house-physician  ascertaining 
that  the  bladder  is  empty. . 

I  append  one  case  of  ascites  from  cirrhosis  thus  treated,  but 
for  the  last  year  I  have  had  every  case  of  ascites — ^hepatic, 
•carcinomatous,  cardiac,  renal — which  has  fallen  under  my  care 
at  St.  Bartholomew's,  and  required  tapping,  tapped  in  this  way ; 
^nd  the  results  have  proved  suflSciently  satisfactory  for  me  to 
recommend  it  highly.     I  have  had  no  instance  of  peritonitis 
thus  provoked.    The  paracentesis,  instead  of  being  a  formidable 
operation,  is  nothing  more  than  the  prick  of  a  needle.     The 
ascitic  fluid  is  quite  sufficiently  evacuated  ;  it  is  also  removed 
gradually,  the  near  average  rate  of  its  removal  being  from  ten 
to  twenty  ounces  per  hour.   The  pressure  upon  the  diaphragm, 
the  intestines,  the  intra-abdominal  vessels,  and  the  walls  of  the 
abdomen,  is  slowly  but  steadily  relieved.     There  is  no  syncope 
provoked  and  no  necessity  for  swathing  the  patient  with  banda- 
ges, a  circumstance  in  the  old  method  of  performing  paracente- 
sis by  large  trocars  which  in  hot  weather  added  greatly  to  the 
patient's  distress.     Both  by  doctors  and  patients  this  mode  of 
performing  paracentesis  will,  I  think,  be  hailed  as  an  advance 
^n  clinical  medicine. 

William  H ,  aged  fifty-eight,  shoemaker,  was  admitted 

^toLuke  ward  on  March  12th,  1878,  for  extensive  ascites  and 
anasarca  of  his  legs.  The  abdomen  was  very  tense  ;  dyspnoea 
considerable  ;  some  cyanosis.  Urine  scanty,  high  coloured,  of 
"'gh  specific  gravity,  containing  no  albumen.  Heart's  apex 
heat  two  inches  outside  left  nipple  line  ;  systolic  murmur  loudest 
^t  apex  and  over  ventricle.  Pulse  very  irregular.  Breathing 
shallow  ;  some  oedema  of  both  bases  posteriorly,  with  bronchial 
fales.  Limit  of  liver  and  spleen  not  to  be  ascertained  by  reason 
<>f  the  ascites.  Up  to  ten  years  ago  he  had  had  good  health  ; 
then  had  first  attack  of  rheumatic  gout.  Was  admitted  into  the 
hospital  in  June,  1876,  for  dropsy  of  legs  and  abdomen,  and 


84  CANADA  MEDICAL   AND   SURGICAL   JOURNAL. 

was  discliarged  well,  and  again  for  a  recurrence  of  dropsy  about 
Christmas,  1876. 

The  man's  physiognomy,  his  habits  of  life,  and  the  manner  in 
which  his  present  dropsy  had  commenced,  the  abdomen  swelling 
before  tlie  legs,  led  me,  notwithstanding  the  cardiac  murmur, 
manifest  dilatation  of  both  ventricles;  and  irregular  heart's  ac- 
tion, to  attribute  his  dropsy  principally  to  cirrhosis  of  the  liver 
and  an  obstructed  portal  circulation. 

Paracentesis  abdominis  with  my  fine  trocar  and  fixed  shield 
was  iM>rformed  at  C  p.m.  on  March  13th.  In  twenty-one  hours, 
11,400  CO.  of  clear,  straw-coloureil  serum  had  been  evacuated 
by  the  capillary  tube.  Tlie  specific  gravity  of  the  ascitic  fluid 
w«o  10:iO  :  reaction  alkaline.  The  amount  of  fibrin  as  well  as 
of  albumen  in  it  very  considerable ;  the  former  manifesting  its 
presence  by  six^ntaueous  formation  of  a  slight  coagulum  in  the 
tluivi  The  tube  was  removed  during  the  night  of  the  14th- 
loth,  the  tluid  having  ceased  to  flow,  and  the  abdomen  being 
v\uite  tlaooi\L 

M^rch  ISth, — Condition  sm;^ariy  improved :  appetite  good ; 
funoiionjii  uv^rtual ;  uriue  ft,^w  abundant*  dear,  amber-coloured, 
alk^Uuo,  *p.  S^.  1024*  no  albusien :  breathing  quite  tranquil ; 
*Iwj^  >fcvU  ;  he;jirt*$  aiv\  *d*l  b^«3Lt?  two  inches  outside  left  nip- 
\^lo  ^vrjvudicuUr  >v:wwii  tcarrfi  and  fifth  ribs ;  action  still 
irrx^j^uUr ;  tir^5  s».^und  lou-.l  ind  rin^g,  bu:  attended  by  no 
muviuur  ;  li^vr  uuiuuViS^-y  vvtrtncced*  suialU  and  cirrhotio. 

'lV>fc;>i\K^  cuvl  of  Ayr**  tii<^  i?v.l:ciett  had  a,;xn  filled  onsider- 
A^^^  aikI  '.No  V^  Vc^au  ^.^  bo  ,\fd«fniatou;?  ouoe  more*  but  his 
A*o\v;i;o  a^kI  ;:vucrjt!  :Vvt>.h  wcr\*  :cherwt;se  fairly  good. 

\l\v  ^;1>  V*K'  .*i.s:cf^^or  ,^c  iMomea  and  !iia?rferencewith 
^^sv  vU\xvvu;  0.*  .>v^  ,vaviuH^*^i  ,U^:]i  dir^-i^jued  ieadi  by  dysp- 
'uw*.  l^\\4tv't^;  s;>.r\*H  ,i:^l  'rijrf.cvt  Hi*?  risculGicory  signs 
iviivU^^wl  viVvxvMvv  oi*  $x^t»c  iu-xi  :u  riji'ic  rlv?ura  prebaMe,  as 
.^\vv  s^sicMu*  oi  \*^cv  \\i:<  .\*  .Cv^  Aut^»  lVacr?u^»sb  again  per- 
A*j  tiivsv  tx  V;v\v\  t>c  *mV  ^vstidiuvHi  itt  di:rty-%hree  hours, 
xluiOi.;  ^iVv'A  ,»iuv^  v*vvtiiv-*Hic  Viuc^ ^\*\C*r  luid wer«  drawn otf; 

VH*  H\>i  ^  bb^  >MW^«^  ^^lit^^  «m&ccifal«J  and  &efing  so 


BRITISH  AND  FOREIGN  JOURNALS.  85 

TOl  that  there  was  no  object  in  Keeping  him  longer  in  bed.  On 
^ay  11th  he  was  discharged  at  his  own  request. 

Rmarh, — This  patient's  case  was  doubtless  a  highly  favour- 
able one  for  relief  by  tapping.     The  best  prognostic  feature  in 
any  case  of  hepatic  dropsy  is  a  stomach  that  still  maintains  di- 
'  gestive  powers.     In  treatment,  however,  this  mode  of  perform- 
ing paracentesis  leaves  nothing  to  be  desired ;  the  tuto^  citOy  et 
jucunde  are  sufficiently  fulfilled  by  it— The  Lancet. 

Causes  and  Cure  of  Insomnia.— Dr.  Sawyer 

observes  that  insomnia  is  one  of  the  commonest  complications 
and  consequences  of  a  vast  variety  of  morbid  states.     Pyrexia, 
physical  pain,  coughing,  dyspnoea  are  all  conditions  which  pre- 
vent or  shorten  sleep.     Such  insomnia ,  may,  for  the  most  part, 
he  controlled  either  by  the  exhibition  of  remedies  which  directly 
promote  sleep  (hypnotics),  or  by  the  adoption  of  measures 
which  combat  the  cause  of  the  insomnia,  by  reducing  fever,  by 
plliating  pain,  by  checking  cough,  or  by  relieving  cardiac  dis- 
turbance.   But  there  is  another  form  of  sleplessness,  which  may 
l)e  called  insomnia  per  se^  or  simple  inability  to  sleep,  for  which 
it  is  difficult  to  find  an  adequate  cause,  but  which  seems  to  de- 
pend upon  inability  on  the  part  of  the  brain  and  nervous  system 
generally  to  adapt  themselves  to  the  conditions  that  are  requi- 
site for  sleep.     It  is  more  common  in  the  upper  middle  class 
than  amongst  others,  and  especially  in  those  of  a  high  mental 
endowment.     There  are,  he  thinks,  three  varieties  of  this  form, 
psychic,  toxic  and  senile.    In  natural  sleep  the  brain  is  anaemic 
and  inactive,  hence  any  cause  that  prevents  due  repose  of  a 
^sufficient  nimiber  of  the  cerebral  cells,  or  sustains  cerebral  hy- 
peraemia,  will  prevent  sleep.     Examples  of  psychic  insomnia 
may  be  found  where  severe  and  sudden  emotional  shocks,  or 
prolonged  mental  strain  affect  men  of  nervous  temperament- 
The  patient  is  dull  and  listless,  the  eyes  wanting  in  vivacity, 
complexion  sallow,  head-ache  is  present  with  occasional  gid- 
diness and  disturbance  of  the  senses,  twitching  of  the  muscles. 
In  toxic  anaemia  the  cause  of  the  sleeplessness  acts  primarily 
oipOQ  the  vessels  of  the  brain,  giving  rise  to  some  degree  of  ar- 


8G 


CANADA   MEDICAL   AMD   SURGICAL    JOURNAL. 


terial  hypersemia.  The  external  poisons  thus  acting  are  tobac- 
co, alcohol,  tea  and  coffee,  the  internal  are  certain  effete  pro- 
ducts of  tissue  metamorphosis  Vfhich  accumulate  in  the  bodiea 
of  gouty  patients  or  of  those  whose  kidneys  act  deficiently. 
The  insomnia  of  these  cases  he  believes  to  be  due  to  the  main- 
tenance of  a  state  of  high  tension  in  the  cerebral  arteries.  In 
tlie  senile  form  of  insomnia  the  sleeplessness  is  due  to  senile 
degeneration  of  the  smaller  cerebral  arteries,  which  ara  phy- 
sically unable  to  adapt  themselves  to  the  condition  of  relative 
arterial  anaemia,  which  is  rerjuisite  for  healthy  sleep.  In  the 
treatment  of  insomnia,  soporifics  must  often  be  used.  Of  these, 
the  chief  are  chloral,  opium,  morphia,  the  bromides,  Indian 
hemp,  alcohol,  and  affusion  with  cold  water.  In  psychic  in- 
somnia, Dr.  Sawyer  prefers  chloral.  Change  of  air  and  scene 
and  rest  are  essential.  In  the  well  nourished,  bromide  of  po- 
tassium is  the  best  hypnotic,  in  30-60  grain  doses,  combined 
with  tincture  of  ergot,  or  of  digitalis.  Over-worked  men  are 
often  anEemic,  and  require  iron,  with  a  little  alcohol,  at  night. 
Exercise  may  generally  be  enjoined.  In  gouty  lithiasis,  with 
a  pulse  of  high  tension,  he  has  confidence  in  the  curative  eflectB 
of  colchicum,  supplemented  by  the  use  of  dilute  saline  purga- 
tives,, such  as  Pullna,  Friedrichshall,  Ilunyadi  Janos,  or  Ra- 
koczy  waters.  Senile  insomnia  is  very  obstinate,  but  perhaps 
in  the  bromides,  with  full  doses  of  hops  or  henbane,  we  have 
the  best  and  least  harmful  means  for  its  relief. — Lancet  and 
Hospital  Gazette,  N.  Y. 


Ne'w  method  of  compression  of  tbe 
lilac  artery  In  amputation  at  the  hip- 
joint.— Mr.  Richard  Davy,  of  the  Westminster  Hospital, 
remarks  that  in  all  severe  operations,  one  of  the  first  consider- 
ations of  the  surgeon  is  to  Bntici])ate  shock,  and  to  prevent  the 
loss  of  blood.  He  accordingly  permits  a  patient  to  have  a  glass 
of  wine  or  brandy  and  water  about  an  hour  before  the  opera- 
tion, with  a  result  that  partakes  more  of  a  sedative  than  of  a 
stimulant  character  ;  a]}preheu9ion  is  assured  ;  cardiac  tone  is 
gained ;  fitness  for  the  ordeal  is  exhibited.     The  American  sur- 


BRITISH  AND   FOREIGN  JOURNALS.  87 

geoDs  devised  pressure  on  the  aorta  for  haemostatic  ends  during 
amputations  high  up  towards  the  pelvis.     Lister  arranged  a 
horse-shoe  clamp  and  screw-pad  for  compressing  the  aorta  above 
the  umbilicus.     Dr.  Davy  saw  this  mechanism  employed  in 
Syme's  operation  on  gluteal  aneurism  in  1860,  and  in  1874  he 
drew  Mr.  Holmes'  attention,  who  was  then  lecturing  in  the 
College  of  Surgeons,  to  the  possibility  of  controlling  the  aorta, 
common  iliacs,  and  internal  iliacs,  by  pressure  through  the  rec- 
tal wall,  which  he  considers  a  less  serious  procedure  than  com- 
pression of  the  aorta  through  the  abdominal  wall.     Last  Janua- 
ry a  favorable  case  presented  itself  for  testing  the  value  of  the 
suggestion  in  a  boy  suffering  from  morbus  coxae,  and  requiring 
amputation  at  the  hip-joint.     In  the  performance  of  the  opera- 
tion the  right  leg  and  thigh  were  emptied  partially  of  blood  by 
Esmarch's  bandage,  chloroform  was  administered,  and  about 
one  ounce  of  sweet  oil  was  injected  into  the  empty  rectum.     A 
straight  lever  of  wood  (run  smooth  and  round  out  of  a  lathe) 
TO  introduced  per  rectum  ;  the  small  end  was  applied  over  the 
right  common  iliac  artery  between  the  bodies  of  the  lumbar  ver- 
tehrae  and  psoas  magnus  muscle  ;  the  projecting  part  of  the 
kver  ran  nearly  parallel  to  the  left  thigh.     Mr.  Bond  readily 
compressed  the  common  iliac  artery  by  elevating  the  projecting 
am  of  the  lever,  the  perin3eal  tissues  acting  as  a  fulcrum.     As 
the  lever  was  raised  or  depressed,  so  did  the  right  femoral  ar- 
tery cease  or  continue  to  pulsate.     The  left  femoral  was  undis- 
turbed, beating  with  regularity  throughout.     A  long  square 
anterior  flap  was  made  by  transfixion  over  the  joint,  the  muscles 
and  capsule  were  divided,  and  a  short  posterior  cut  severed  the 
limb.    The  arteries  were  tied,  sutures  inserted,  and  the  boy 
placed  in  bed.     About  a  wine-glassfull  of  blood  was  lost.     The 
hoy  recovered,  with  the  exception  of  one  or  two  small  sinuses. 
— 5nf.  Med.  Jour,  ^  Hospital  Gazette^  N.  Y, 

Enterotomy. — Dr.  Von  Langenbeck,  at  the  late  Con- 
gress of  the  Society  of  German  Surgeons,  showed  a  patient  on 
^hom  he  had  performed  enterotomy  last  May,  and  who  wore  an 
Indiarrubber  bladder  as  an  obturator  to  the  artificial  ai.us.    He 


iL. 


8S  CANADA  MEDICAL   AND   SUBOICAL   JOUKNAL, 

called  atteDtion  to  the  importance  of  providing  a  Buffieient  clos- 
ure for  ttie  new  opening.  In  a  case  of  colocomj,  performed 
on  a  child  for  absence  of  rectum,  and  which  was  in  otiier  res- 
pects successful,  death  had  occurred  from  prolapse  of  the  in- 
testine, in  consecjiience  of  the  want  of  a  proper  obturator. 

Dr.  Trendelenburg  (Rostock)  had  performed  enterotomy 
three  times,  and  considered  it  much  less  dangerous  than  colo- 
tomv,  in  consequence  of  the  injury  to  the  soft  parts  being  less. 
For  the  closure  of  the  fistula,  remaining  after  gastrotomy,  he 
recommended  a  drainago-tube  provided  with  a  stop-cock,  which 
could  be  fixed  securely  ia  a  perpendicular  direction  by  means 
of  a  ring  of  cork. 

Dr.  Czemy  (Ueidclberg)  thought  that,  independently  of 
the  connection  in  size  Lftween  the  prolapsed  portion  of  bowel 
and  the  opening,  the  proFapse  was  always  absent,  or  very  smaU, 
when  there  was  adhesion  of  the  serous  membrane  above  the 
opening. 

Dr.  Von  Irfingcnbcck  said,  in  order  to  prevent  misunder- 
standing, that  in  the  case  of  the  child  to  which  ho  had  referred 
he  had  not  performed  Ainussat's  operation,  but  had  opened  tiie 
flexure  of  the  colon.  He  had  made  the  opening  very  small, 
and  he  believed  that  the  prolapse  was  the  result  of  invagination. 
A  means  of  preventing  prolapso,  not  attended  with  danger,  but 
certain  in  action,  was  the  use  of  a  plug  to  be  inserted  in  the  in- 
testine. One  of  his  iiatJonls  had  fop  some  years  used  this  plan 
with  success.— ioHti.  Mfl  Itrcurd  jf-  JIois'p.  Gazdte,  N.  Y. 


Treatment  of  Ulcers  of  the  Leg:.— Dr. 

BccUov  ndvist-s  a  now  int'thoil  of  treating  ulcers  of  the  leg- 
First,  ihe  patient  must  romaiu  in  bod  twenty-four  hours,  so  that 
the  usual  oodcma  which  accoiujianics  ulceration  may  he  got  rid 
of.  During  this  period  tho  limb  should  he  wrapped  in  lint 
soaked  in  a  solution  of  carbolic  acid.  The  leg  should  then  be 
well  dried  and  the  bandagw  applied — this  bandage  must  be  of 
the  thinnest  possible  llucu  and  put  on  n  hot  plate  and  spread 
with  heated  ompUatruui  adlinii.  (^Enip.  Resina^).  This  jilaster 
goes  easily  through  tlio  thia  linen  bandage,  so  that  both  sides 


BRITISH  AND   FOREIGN  JOURNALS.  89 

are  equally  covered  with  the  mass.  The  bandage  is  then  ap- 
plied to  the  leg  from  below  up,  in  strips,  which  must  go  com- 
pletely round  the  leg,  and  the  upper  strip  overiap  the  under  by 
a  third  of  its  breadth.  It  is  important  that  the  strips  be  evenly 
applied  so  that  there  may  be  no  interference  with  the  circula- 
tion. After  the  application  of  the  bandage,  the  patient  must 
remain  some  hours  in  bed.  The  bandage  is  taken  off  after  four 
weeks,  and  during  the  night  succeeding,  the  limb  must  be  en- 
veloped in  lint  soaked  in  a  solution  of  carbolic  acid,  and  the  next 
morning  the  bandage  should  be  re-applied  in  the  same  way.  If 
there  is  a  foetid  discharge  which  escapes  from  under  the  bandage. 
Dr.  Becker  advises  over  the  emp.  adhaes.  should  be  applied  one 
of  Lister's  gauze  bandages  impregnated  with  carbolic  acid,  and  an 
ordinary  linen- roller  applied  over  all — this  last  bandage  should 
be  moistened  every  two  or  three  days  with  a  solution  of  car- 
bolic acid  in  spirits  of  wine  (20-100).  Dr.  Becker  claims  that 
this  method  of  treating  ulcers  is  superior  to  Lister's  or  Rever- 
din's. —  (^Berlin^  KUn,  Wochschr.  xiv,  1877),  quoted  in 
SchmidVs  Yahrbucher,  1878. 

[This  method  of  strapping  is  very  similar  to  that  advised  by 
Mr.  Baynton,  years  ago.  Dr.  Becker,  however,  evidently  is 
unacquainted  with  Baynton's  strapping.] 

Treatment  of  Psoriasis,— Prof.  Thiry  (Presse 

MM.^  xxiv,  1877),  employed  jaborandi  in  the  treatment  of  two 
cases  of  inveterate  psoriasis  in  young  persons.  In  one  case  of 
general  psoriasis  the  result  was  very  favorable, — in  the  other, 
f»soriasis  guttata,  the  cure  was  not  complete.  The  first  case 
was  cured  in  eight  weeks.  He  gave  the  jaborandi  in  the  form  of 
infusion,  in  doses  of  3i — 3ii  daily.  (Quoted  in  Schmidts 
Yahrlucher,  1878.) 

Psoriasis.— WuTZDORFF,  of  Berlin,  holds  the  opinion 
that  psoriasis  is  never  acquired  except  in  those  in  whom  the 
tendency  is  congenital,  and  whose  skin  is  irritated  from  various 
mechanical,  chemical  and  thermic  causes.  In  those  that  have 
the  tendency,  the  psoriasis  always  appears  in  some  part  of  the 


90 


k   3I£[>ICAL  AXD  9CBAICAL  JOCBKAL. 


■kin  that  is  irritated,  as  the  battocka  in  riders,  in  Bhoemnkert* 
on  inner  side  of    the    left  knee,   and  the  gluteal  region  in 
tailori— (Quoted  in   .SMmid('«    Yahrbueker,   No.  5,  1878.) 


Psoriasis  Vulgaris.— I>r.  E.  Poob  {Pra-jer  V 
teljahrtachrr)  declares  that  psoriasis  vulgaris  ia  a  constitntii 
aHection  and  is  the  manifestation  in  the  skin  of  malarial  fevwj 
He  calls  it  "  malarial  psoriasis,"  and  treats  it  with  rjuininej 
arsenic,  carbolic  acid,  &c.,  internally.  In  68  per  cent,  of  tha 
cases  tlio  parents  suffered  from  ague,  and  31  per  cent,  from 
lichenouH  eruptions.  In  most  of  the  eases  examined  (327)  he 
found  enlargement  of  the  spleen. — (Quoted  in  Centrallllatt  f 
Med.  Wmemeh,  1878.) 


Erythema  Nodosum  ((EluneO— Amor^  18- 

patients  examined  suffering  from  e.  nodosnm,  17  were  ivoraen 
and  1  wns  a  male ;  their  ages  varied  from  10  to  27  years, 
except  one,  who  was  .^4.  In  16  cases  the  eruption  was  dis- 
tinctly accompanied  by  fever.  The  prodromal  fever  usually 
lasts  from  two  to  eight  days,  and  seems  disproportionate  to  the 
local  oniption.  As  complications  we  find  pain  and  swelling  in 
the  joints,  as  in  rheumatism  ac.,  but  endocarditis  is  never  seen, 
*  *  •  *  While  0.  nodosum  is  harmless  in  healthy  persons 
with  no  hereditary  taint,  it  must  always  he  a  subject  of  alarm 
in  those  whoso  families  are  phthisical  and  who  themselves  are 
badly  nourished  ind  anpemic  individuals. — [DrenrfcHcr  jahr.  f. 
Nat.  llf.il., M'l.  Qaotcd'm  Centrallblattf.  Med.  Wlgmisekj 

Dh.  Svhtlin  (Ccntrallhlatt  f.  Med.  Wissenschr,  April,  "78) 
has  booa  oxperimcnting  with  guinea  pigs  on  the  eiScacy  ol 
atropine  in  epilepsy.  He  found  that  he  could  control  the  reflex 
spasm  of  epilepsy  (which  had  been  induced  in  guinea  pigs 
after  tlie  usual  manner)  by  small  doses  of  atropine  with  the 
^iroiUest  ease  ;  tho  dose  he  used  was  0,001, — 0,902.  He  has 
al  80  bad  good  results  with  his  own  patients  suffering  from 
epilepsy  ;  lie  uses  it  in  very  small  and  not  increasing  doses  O.OOtJ 
grftinm?,  in  the  form  of  pill. 


J 


I 


BRITISH  AND    FOREIGN  JOURNALS.  91 

Jaborandi. — Dr.  O.  Kahler  (Prager  Med,  Wissechr. 
1877)  recommends  jaborandi  in  cases  of  diabetes,  where  the 
digestion  is  in  good  condition.  It  rapidly  reduces  the  amount 
of  urine.  In  acute  bronchitis  and  chronic  dry  catarrh  he  has 
found  it  of  service,  and  also  in  parotitis  accompanying  severe 
infectious  diseases.  He  advises  its  use  in  mumps,  rheumatic 
affections,  neuralgia,  nephritis,  uroemia,  &c.,  and  in  chronic 
metallic  poisoning.  Kahler  uses  jaborandi  in  the  shape  of 
infusion,  and  says  its  use  is  contra  indicated  by  a  weak  heart. 

AtlietOSiS. — ^Dr.  OuLMONT  (Utude  clinique  sur  VAth^- 
tose  par  le  Dr.  P.  Oulmout,  Paris,  1878),  during  his  residence 
m  the  SalpetriSre  under  M.  Charcot,  had  the  opportunity  of 
studying  several  patients  aflSicted  with  athetosis,  an  affection  little 
known  as  yet,  and  of  which  the  name  even  was  until  lately  almost 
ignored  in  France.  The  history  of  athetosis  is  of  very  recent 
date  •  it  was  first  named  in  1871  by  Hammond  of  New  York,  who 
devoted  a  chapter  to  it  in  his  treatise  On  Diseases  of  the  Ner- 
vous System,  Some  years  before  Charcot  (1853)  and  Heisse 
(1860)  had  described  phenomena  analogous  to  those  defined 
by  Hammond ;  and,  since  the  labours  of  the  latter,  several 
other  observers  have  spoken  of  athetosis,  chiefly  in  America 
and  in  England. 

Athetosis  {athetos,  without  fixed  position)  is  characterized, 
according  to  Hammond,  by  "  the  impossibility  which  the  pa- 
"  tients  find  of  keeping  their  fingers  and  toes  in  any  desired 
"  position,  and  by  the  continual  movement  of  the  Bame." 

The  name  of  athetosis,  like  that  of  chorea,  says  M.  Oulmont, 
is  a  general  appellation,  comprising  varieties  which  are  very 
different  in  point  of  progress  and  symptomatology.  Athetosis 
may  be  unilateral  (hemi-athetosis)  or  double.  M.  Oulmont  has 
studied  both  forms  in  a  series  of  thirty-seven  clinical  observa- 
tions, from  which  he  has  drawn  the  following  conclusions : — 

1.  There  are,  in  what  is  described  under  the  name  of  athe- 
tosis, two  entirely  distinct  forms  which  must  be  completely 
separated ;  unilateral  or  hemiathetosis,  and  double  or  general 
athetosis.  2.  Hemiathetosis  consists  of  slow,  exaggerated, 
involuntary  movements,  limited  to  the  foot  and  hand  of  one 


02 


MEDICAL   AND   SURGICAL   JOUKSAL. 


side  of  the  body,  and  now  and  then  occupying  the  correspond- 
ing half  of  the  face  and  neck.  3.  To  the3e  movements  are 
generally  added  transitory  contractions  or  intermittent  spasna, 
which  are  simple  modifications  of  athetotic  movements,  a  sort- 
of  intermediate  stage  between  the  mobility  of  athetosis  and  the 
rigidity  of  post  hemiplegia  contraction.  Tbey  may  attack  all 
parts  of  the  upper  extremity,  but  in  the  lower  extremity  they 
rarely  pass  the  instep.  4.  The  movements  are  involuntary, 
little  modified  by  the  will,  and  often  exaggerated  by  it.  They 
persist  during  rest,  often  even  during  sleep,  at  least  to  the 
degree  of  fixing  the  liinb  in  an  abnormal  position.  5.  Hemia- 
thetoais  appears  nearly  always  on  the  paralyzed  side  during  the 
course  of  motor  hemiplegia.  6.  It  coincides,  in  the  great 
majority  of  cases,  with  more  or  less  complete  hemianiesthesia 
of  the  same  side.  7.  The  other  symptoms  which  may  aceom-- 
pany  it,  namely  permanent  contraction,  rigidity,  and  atrophy, 
with  laxity  of  the  articular  ligaments,  do  not  depend  on  th* 
athetosis,  but  on  the  hemiplegia  itself.  Articular  relaxation  ia 
particular  is  specially  marked.  8,  Hemiathetosis  resembleei 
''  bemichorea  ;  like  it,  it  is  the  symptom  of  a  cerebral  lesion  of' 
some  sort,  without  doubt  in  the  neighbourhood  of  the  lesion 
■which  produces  hemiohorea,  that  is  to  say,  the  fibres  in  front 
and  outside  of  the  sensory  bundles  at  the  lower  part  of  the 
corona  radiata  (of  Reil).  In  cases  where  motor  or  sensory 
hemiplegia,  or  both,  aro  absent,  it  may  be  admitted  that  there- 
ia  such  a  tendency  to  concentration,  that  it  attacks  the  atbetotio 
fasciculi  at  a  place  where  the  sensory  and  motor  bundles,. 
united  at  the  lower  part  of  the  internal  capsule,  are  already 
dissociated.  9.  llomiathetosia  and  liemichorea,  very  disUnot 
\-arieties  of  posthemiplegic  disorders,  may  be  united  by  various 
forma  of  actaal  tremblings,  transitional  states  in  which  the 
cliafactora  of  both  are  blended.  10.  Double  athetosis  presents 
the  same  clinical  aspecU  as  hcmiathetosis,  except  that  thft 
movements  exists  on  both  sides  of  the  body.  The  face  secmft 
to  bif  attaokod  more  constantly  and  more  severely  than  in  the 
uuilateral  form,  11.  It  is  not  accompanied  by  any  disorder  oC 
movement  or  of  eonsibility.  I'i.  Its  nature  is  unknown  ;  stir"" 
it  may  bo  admitted  that  there  is  between  it  and  hemiathetosii 
(he  same  relation  na  thero  ia  between  chorea  and  bemichorea^ 


CANADA 


tAxal  m&  ^nxt^xal  §mtmt 


Montreal,  September,  1878. 

YELLOW  FEVER. 

This  scourge  still  continues  to  infest  southern  cities,  and  it 
is  surmised  that  it  will  continue  until  the  frosts  of  winter  have 
set  in.  It  has  apparently  extended  farther  north  on  this  occas- 
sion  than  during  any  previous  epidemic.  This  is  accounted  for 
from  the  continued  rain  with  an  unusual  hot  term,  and  the 
disease  appears  to  have  been  aggravated  by  the  neglect  of  sani- 
tary precautions  such  as  eflScient  drainage  and  cleanliness. 
Dirt  and  neglect  of  sanitary  means  is  not  held  to  be  suflBcient 
to  generate  the  fever,  but  there  can  be  little  doubt  that  during 
the  prevalence  of  an  epidemic  it  will  greatly  add  to  its  viru- 
lence and  fatality.  We  read  of  whole  families  being  swept 
away  in  Grenada.  This  probably  is  somewhat  exaggerated,  as 
there  appears  to  be  a  panic  amongst  the  people  and  it  is  the 
fashion  now  a  days,  at  least  with  some  people,  to  deal  with 
inflation  even  in  our  miseries.  That  the  fever  is  bad  enough 
and  fatal  enough  is  sufficiently  evident  by  the  report  of  Dr. 
Woodworth,  of  Washington,  Surgeon-General  to  the  U.  S» 
Marine  Hospital  Service.  The  following  abstract  of  that  report 
we  take  from  the  Boston  Medical  and  SurgicalJournal : — 

New  Orleans — During  the  week  ending  30th  August,  1878, 
there  were  1,204  cases  of  yellow  fever  in  that  city,  of  whom 
333  died.  Since  the  outbreak  of  the  epidemic  there  have  been 
2,877  cases  with  867  deaths.  This  gives  an  average  of  a  little 
over  30  per  cent. 

Vickshurg. — It  is  estimated  that  there  have  been  from  the 
outbreak  of  the  epidemic  in  this  place  800  cases  of  yellow  fever 


M 


MEDICAL   AND    SURCiK 


with  185  deaths.     This 


:  23. 


.hi3  gives  a  percentage  of  over 
In  Memphis  the  death  rate  has  heen  high ;  during  the  week 
endmg  30th  August  there  were  721  cases  of  yellow  fever,  with 
a  mortality  of  241,  yielding  a  percentage  of  33.42. 

The  disease  appears  to  be  confined  to  the  line  of  the  Missis- 
sippi, although  cases  are  reported  in  Ciacinnati  and  Philadelphia. 
These  were  all  imported  cases  from  infected  places  south. 

No  reliable  information  or  official  reports  obtained  from 
Granada,  Canton,  Port  Gibson,  and  Port  Eads,  La. 


MARKS  OF  MURDEROUS  VIOLENCE. 

We  observe  by  a  recent  telegram  from  Quebec  that 
at  the  inquest  held  on  the  body  of  Joseph  Guonette,  found 
•  decapitated  on  the  railway  track  at  St  Henry,  a  verdict  of 
wilful  murder  has  been  rendered  against  some  party  or  parties 
unlioown.  The  circumstances  are  somewhat  peculiar.  Guen- 
ette  was  a  perfectly  sober  man  and  was  seen  late  in  the  evening 
of  the  night  of  the  supposed  accident.  He  had  evidently  been 
killed  by  a  stab  in  the  chest  which  had  implicated  the  heart. 
The  medical  gentlemen  who  examined  the  body  post  mortem 
gave  it  aa  their  opinion  that  life  was  e.xtinct  some  time  before 
his  head  was  severed  from  his  body  by  the  wheels  of  the  pass- 
ing train,  and  that  death  was  the  result  of  a  stab  in  the  chest 
wall  near  the  heart  inflicted  by  some  sharp  instrument.  The 
body  subsequently  had  been  placed  on  the  track  with  the  neck 
on  one  of  the  rails.  This  evidence  was  substantiated  by  the 
conductor,  who  examined  the  body  as  soon  as  the  train  was 
stopped.  It  was  almost  cold,  somewhat  rigid,  and  there  was 
very  little  blood  on  the  track.  The  matter  is  in  the  hands  of 
the  police. 

A  very  similar  case  is  reported  in  an  English  periodical 
■where  the  body  of  a  man  supposed  to  be  drowned  was  recov- 
ered from  the  Serpentine.  The  surgeon  who  gave  evidence  at 
the  inquest  testified  that  he  found  a  buUet-wound  o 
side  of  the  chest  which  Involved  the  heart  and  which 
ed  would  have  caused  spee'*"  death.    It  is  not  stated  howeT^ 


I 


MARKS   OP  MURDEROUS   VIOLENCE.  95 

whether  the  sigiis  of  death  by  drowning  were  absent.  Other 
evidence  went  to  show  that  the  deceased  had  shot  himself  while 
on  the  bridge  and  that  his  body  fell  into  the  river.  These 
cases  are  instructive  as  they  point  to  the  necessity  of  careful 
and  patient  investigation,  and  by  the  exercise  of  reason  the 
actual  nature  of  the  case  can  generally  be  arrived  at  with 
certainty.  Murder,  when  perpetrated,  can  very  rarely  be  so 
covered  up  as  to  obliterate  all  trace  of  the  crime.  And  it  is  as 
well  the  public  should  be  aware  that  the  profession  possesses 
sure  and  certain  signs,  unmistakeable,  reasonable,  and  convinc- 
ing, \>hich  will  bring  to  light  a  hideous  crime  of  this  nature 
even  though  there  may  be  no  corroborative  evidence,  which, 
however,  in  the  instances  above  referred  to  was  not  wanting. 

THE  BONES  IN  PERNICIOUS  ANEMIA. 

We  notice  that  reference  is  made  in  the  London  Lancet  of 
August  2nd,  to  some  observations  published  last  autumn  in  the 
"  Transactions  of  the  Canada  Medical  Association,' '  by  Pro- 
fessor William  Osier,  M.D.,  of  McGill  University,  in  reference 
to  the  condition  of  the  bones  and  marrow  in  Pernicious 
Anaemia,  as  well  as  to  other  remarks  on  the  same  subject, 
more  recently  published.  The  latter  we  have  not  seen,  but  the 
Lancet  does  not  accredit  the  source  from  whence  it  has  obtained 
the  information.  This  is  to  be  regretted,  as  it  is  due  to  the 
author,  as  well  as  to  the  readers  of  the  Lancet ^  to  give  them 
the  opportunity  of  seeing  the  entire  article,  and  not  a  mere 
abstract  of  observations  which  are  of  practical  importance,  and 
which  are  attracting  very  general  attention.  Dr.  Osier  has 
devoted  a  large  amount  of  time  to  these  inquiries,  and  so 
fer  as  he  has  gone  his  deductions  are  highly  interesting  and 
mstructive,  and  reflect  credit  on  his  persevering  industry. 

IMPORTANT  ANNOUNCEMENT. 

The  enterprising  book  publishing  house  of  William  Wood  & 

Co.,  27  Great  Jones  Street,  New  York,  have  undertaken  a 

sdieme  of  reproducing  books  of  foreign  authors  at  prices  far 

WW  anything  of  the  kind  heretofore  attempted.    We  can 


96  CANADA   MEItlCAL   AND   SURGICAI:.   JolTlSAI.. 

illustrate  the  reproductiou  of  Ziemssen'e  Cjclofa^dia  of  tlie 
Practice  of  Medicine,  now  near  its  completion,  and  we  must 
state  without  hesitation  that  in  our  opinion  the  reading  profes- 
sional public  owe  a  debt  of  gratitude  to  Messrs.  Wood  k  Co. 
for  having  carried  out  bo  successfully  this  great  enterprise. 

A  somewhat  similar  attempt  on  their  part  is  about  to  be 
inaugurated,  and  we  trust  their  laudable  eETorts  will  receive 
that  recognition  and  support'  which  they  dcerve  Indeed  the 
profession  is  offered  a  library  of  booki,  wluth  will  be  sold  to 
Bibscribers  only,  at  an  annnual  substnption  of  twelve  dollars. 

The  proposal  for  the  year  1879  i«  to  issue  twelve  volumes, 
"  Rest  and  pain,"  a  course  of  lectuie*  hy  John  Ililton,  F.R.S., 
and  which,  at  the  time  of  their  deln  ery,  attiacted  niucb  atten- 
tion. This  valuable  work  is  profusely  illustrated  witli  engrav- 
ings on  wood.  "Diseases  of  the  Intestines  and  Peritoneutn," 
being  articles  published  hy  Wardell,  Bristowe,  Begbie,  Thos.  B. 
Curling  and  Ransom.  These  papers  are  taken  from  Reynolds' 
System  of  Medicine,  and  will  form  a  volume  with  numerous 
illustrations.  A  third  edition  of  Ellis' ''  Practical  Manual  ot 
the  Diseases  of  Children,"  with  formulary.  Lawson  Tait's 
work  on  diseases  of  women.  "  A  Clinical  treatise  of  Diseases- 
of  the  Liver,"  by  Dr.  Fried.  Theod.  Frerichs,  translated  by 
Dr.  Murchison.  This  work  is  worth  all  tJie  money  asked  for  the 
12  volumes,  it  is  the  most  valuable  treatise  ever  written  on  thia 
subject,  and  will  be  published,  in  this  series,  in  three  volumes. 
"  In^'ant  Feeding  and  its  influence  on  life,"  hy  C.  H.  F.  Routh, 
M.D.,  third  edition.  The  remaining  four  volumes  are  not 
announced  as  Messrs.  Wood  desire  to  avail  themselves  of  what- 
ever may  appear  in  the  announcements  of  books  to  be  pub- 
lished in  1879,  which  are  usually  made  in  October.  We  trust 
our  readers  will  entertain  the  offer  of  the  publishers  and 
respond  freely  and  promptly,  as  it  is  very  important  tbat  all  who 
intend  to  subscribe  should  do  so  without  delay,  so  as  to  give  the 
publishers  some  idea  of  how  large  an  edition  will  be  rec^uired. 


•  #  • 


CANADA 


Medical  &  Surgical  Journal 


OCTOBER,  1878. 


Original  $ommunicaticms. 


A  DESCRIPTION    OF   THE    CONJOINED    TWINS, 

MARIE-ROSA  DROUIN. 

By  D.  C.  MacCallum,  M.D.,M.R.C.S  ,  Eng. 

'^fegsor  of  Midwifery  and  Diseases  of  Women  and  Children?  McGill  University. 

This  remarkable  specimen  of  the  fusion  in  part  of  the  bodies 
of  two  female  children  was  brought  to  Montreal  for  exhibition 
during  the  month  of  April,  1878.     It  was  exceedingly  diflScult 
to  make  a  thorough  examination  of  the  children,  as  the  mother 
was  strongly  opposed  to  having  them  handled  or  touched.     By 
frequent  visits,  and  by  obtaining  the  consent  of  the  mother  to 
see  the  children  whilst  she  was  washing  and  dressing  them,  I 
succeeded  in  making  out,  not  only  the  most  important  points 
.  relating  to  their  union,  but  also  in  obtaining  an  excellent  draw- 
ing, by  Hawksett,  of  the  appearances  which  they  present  anter- 
iorly and  potseriorly.     The  specimen  belongs  to  St.  Hilaire's 
class  of  Monstres  Doubles ;  VdimxWQ-Sysomien  ;  Genres-P^o- 
iyme  ;  to  Playfair's  division  of  Bicephalous  Monsters. 
The  children  lie  in  their  mother's  arms  much  as  they  are  repre- 
sented in  the  plate,  the  two  upper  separated  portions  being  about 
in  a  line  with  each  other,  and  each  forming  nearly  a  right  angle 
with  the  single  trunk.     The  one  to  the  left  of  the  observer, 
named  Maries  resembles  the  mother,  has  a  fairer  complexion,  is 

NO.   LXXV.  1 


98  CANADA  MtDIPAT.    AND 

more  strongly  developed  and  healthier  looking  than  her  sister 
Rota,  who  ia  smaller,  darker,  more  delicate-looking  and  resem- 
bles the  father.  They  arc  both  bright,  lively  and  intelligent- 
looking  children.  The  tvro  bodiea,  from  the  heads  as  far  as 
the  abdomen,  are  well  formed,  perfectly  developed,  and  in  a 
state  of  good  nutrition.  The  union  between  them  commences 
at  the  lower  part  of  the  thorax  of  each,  and  from  that  part 
downwards  they  present  the  appearance  of  one  female  child; 
that  is,  there  is  hut  one  abdomen  with  one  navel,  a  genital 
fissure  with  the  external  organs  of  generation  of  the  female,  and 
two  inferior  extremities.  The  6oating  ribs  are  distinct  in  each, 
as  is  also  the  ensiform  cartilage.  The  lateral  halves  of  the 
abdomen  and  the  inferior  extremities  correspond  in 
development  respectively  to  the  body  of  the  same  side ;  and  the 
same  remark  applies  to  the  labia  majora.  The  spinal  columns 
are  distinct  and  appear  to  meet  at  a  pelvis  common  to  both, 
although  the  fumon  of  the  cliildren  commences  at  some  distanco 
above  their  junction.  From  near  the  extremity  of  each  spine, 
a  fissure  extends  downwards  and  inwards,  meeting  its  fellow  of  ■ 
the  opposite  side  at  the  cleft  between  the  buttocks  near  the 
anus,  including  a  somewhat  elevated  soft  fleshy  mass,  tliicker 
below  than  above.  At  a  central  point  between  these  fissures, 
at  the  distance  of  two  and  a  half  invites  from  the  point  where 
the  vertebral  columns  meet,  and  Oiree  and  a  half  inehet  from 
the  anus  there  projects  a,  rudimentary  limb  with  a  very  mov- 
able attachment.  This  limb,  which  measures  jive  inchet 
length,  and  ia  provided  with  a  joint,  tapers  to  a  fine  point,  which 
is  furnished  with  a  distinct  nail.  It  is  very  sensitive  and  con- 
tracts strongly  when  slightly  irritated. 

The  respiratory  movements  are  not  synchronous,  nor  do 
the  pulsations  of  the  hearts  correspond — Marie's  heart  beating 
at  the  time  of  examination  128  per  minute ;  Rosa' 
The  sensation  of  hunger  is  not  always  telt  at  the  same 
time,  as  very  frequently  one  child  sleeps  while  the  other 
is  nursing.  When  one  child  cries  and  the  other  is  tranquil,  the. 
abdomen  on  the  side  of  the  crying  child  contracts  and  expands, 
and  the  limb  of  that  side  is  agitated,  while   the  corresponding 


TH«   CONJOINED   TWINS. — BY    DR.    MAOGi^LLnM.  99 

parts  of  the  opposite  side  are  at  rest.  There  is  slight  move- 
ment of  the  lateral  half  of  the  abdomen  on  the  side  of  the  quiet 
child,  but  this  is  evidently  communicated.  Precisely  the  same 
phenomena  are  observed  when  either  child  forces  during  a 
motion. 

From  these  observations  it  would  appear  that  the  spinal,  res- 
piratory, circulatory  and  digestive  systems  of  these  children  are 
quite  distinct  They  have  each  a  separate  diaphragm,  and  the 
abdominal  muscles  on  each  side  of  the  mesial  line,  and  the  limb 
of  that  side  are  supplied  with  blood  by  the  vessels  and  are 
under  the  control  of  the  nervous  system  of  the  corresponding 
child.  They  have  each  a  distinct  stomach  and  an  alimentary 
canal,  which  probably  opens  at  a  point  close  to  the  common 
anus.  It  would  follow  also  that  the  accessory  organs  of  the 
digestive  system  are  distinct  for  each  child. 

The  two  fissures  behmd  are  evidently  the  original  clefts 
between  the  buttocks  of  each  child,  one  buttock  remaining  in  its 
integrity,  whilst  the  other  in  a  rudimentary  condition  is  fused 
with  that  of  the  opposite  child,  forming  the  soft  fleshy  mass 
from  the  upper  part  of  which  the  rudimentary  limb  projects. 

These  children  are  the  products  of  a  second  gestation.  They 
were  bom  at  St.  Benoit,  county  of  Two  Mountains,  on  the  28th 
February,  1878.  The  mother,  a  fine  healthy  lookeng  woman, 
aged  26  years,  states  that  she  experienced  unusual  sensations 
in  the  womb  during  the  period  of  gestation,  and  that  towards 
its  close  the  abdomen  became  so  prominent  she  was  ashamed  to 
be  seen  by  her  friends.  The  weight  also  greatly  fatigued  her, 
and  the  movements  of  the  children  were  very  distressing. 
During  her  labour  she  was  attended  by  a  midwife.  It  lasted 
seven  hours,  commencing  at  1  a.m.  and  terminating  at  8  a.m. 
One  head  and  body  were  first  bom ;  this  was  shortly  followed 
by  the  lower  extremities,  and  immediately  after  the  second 
body  and  head  wQre  expelled. 


iCROICAL    JOIIRNAI,. 

REMOVAL  OF  THE  END   OF   THE    RECTUM    WITH 

THE  SPHINCTER  ANI  FOR  EPITHELIOMA. 

By  Georoe  E.  Fbnwtck,  M.D, 

PROFBBSOR  or   SlIRGEBT,   McGiLL    UnIVBRSITT. 

<R«dbe(otglhe  Mcdieo-ChirarEJciit  Sociilr  nlHonlnil.) 

The  operation  which  I  deaire  to  describe  to  the  Society  thb 
evening  ia  rather  novel  in  procedure,  ainifily  from  the  fact  that 
very  few  cases  are  met  with  in  which  it  may  be  considered 
suitable  ;  extirpation  or  amputation  of  the  rectum  or  rather  a 
portion  of  that  bowel  has  been  practiced  for  over  half  a  cen- 
tury. Liafranc  performed  it  as  early  as  1826,  and  claima  to 
have  reheved  six  out  of  nine  caaes.  Other  continental  Bur- 
geons have,  in  isolated  caaee,  removed  several  inches  of  the  end 
of  the  bowel  with  variable  success.  It  is  an  operation  which 
has  received  unqualified  condemnation  from  British  surgeons, 
but  I  am  under  the  impression  that  their  opinions  are  too  sweep- 
ing, as  in  my  awn  limited  experience  there  are  occasionally 
met  with  undoubted  cases  of  maUgnant  disease  of  tbe  end  of 
the  bowel  which  are  capable  of  safe  removal.  In  the  4th  vol. 
of  Holmes'  Surgery,  Mr.  Henry  Smith,  in  writing  on  this  3ul>- 
ject,  remarks:  "  Some  surgeons  were,  a  few  years  since,  in 
the  habit  of  performing  excision  of  the  lower  part  of  the  rectum 
when  affected  with  cancer  ;  but  this  proceeding  must  be  looked 
upon  both  as  barbarous  and  unscientific,  and  is  now  ha])pily 
exploded  from  the  catalogue  of  surgical  operations."  This  was 
the  opinion  of  Mr.  Smith  in  1870,  but  from  the  more  recent 
light  that  has  been  thrown  on  this  subject,  he  may  have  greatly 
modified  hia  views.  Mr.  Erichsen,  in  tlie  last  edition  of  his 
work  just  published,  remarks  (vol.  2,  page  680);  "  When  it 
(cancer)  occurs  as  a  primary  disease  it  ia  usually  in  the  form 
of  epithelioma  and  may  then  form  around  the  anus,  just  aa  it 
does  at  other  muco-cutaneous  appertures.  If  limited  and 
detected  in  the  early  stage  it  may  advantageously  be 
excised,  hut  at  a  more  advanced  period  of  the  disease  such  a 
practice  can  scarcely  be  adopted  with  any  prospect  of  aucceea, 
in  consequMH^e  of  the  impossibility  of  removing  the  whole  of 


I 


BSKOVAL  OF  END  OP  EKCTUM. — Bt  DE.  Pl^NWlClBt.  101 

the  structures  implicated."     Mr.  Allingham,  m  his  work,  holds 
much   the  same    opinion.     He   observes :    "  In  any  form   of 
cancer,  save  epithelioma,  I  do  not  think  excision  can  be  recom- 
mended." But  although  in  epithelioma  he  admits  the  possibility 
of  removal,  yet  only  then  when  very  limited.      I  may  remark 
here  that  it  is  seldom  that  the  surgeon  meets  with  a  suitable 
case  for  extirpation  in  cancer  of  the  rectum.     The  disease  does 
not  attract  early  attention  ;  a  certain  amount  of  discomfort  is 
experienced,  and  this  may  continue  for  months,  as  the  disease 
advances  slowly  and  insidiously.     The  patient  may  believe  he 
is  suffering  from  piles  and  may  resort  to  various  quack  reme- 
dies, or  he  may  consult  his  surgeon,  who  without  examination, 
pronounces  the  symptoms  present  as  due  to  piles,  and  gives  him 
an  ointment  of  tannic  acid  or  galls.     Hence  it  is  that  in  very 
many  cases  the  real  condition  of  the  parts  is  made  out  when  it 
is  too  late  to  resort  to  operative  measures  for  the  removal  of 
the  disease.      One  of  the  prominent  objections  to  the  operation 
is  the  danger  of  injury  to  the  peritoneum,  besides   which  in 
advanced  cases  the  parts  in  the  vicinity  become  so  infiltrated 
as  to  preclude  the  chance  of  removal. 

Continental  surgeons  have  adopted  this  measure  of  removal 
of  the  end  of  the  bowel,  and  we  read  of  the  variable  success  of 
Lisfranc,  Velpeau,  Billroth,  Volkman  and  others.  The  latter 
surgeon  does  not  attach  such  importamce  to  a  wound  of  the 
peritoneum  as  others,  as  his  system  of  treatment  is  simply  after 
the  manner  of  Lister,  and  if  the  peritoneum  is  opened  he  does 
not  hesitate  to  deal  with  it  much  in  the  same  manner  as  is  fol- 
lowed in  ovariotomy.  Volkman,  who  has  had  very  considerable 
experience  in  these  cases,  attaches  great  importance  to  free 
drainage,  and  he  holds  that  with  these  precautions  the  patient 
b  insured  against  the  dangers  of  diffuse  pelvic  cellulitis  which 
is  so  apt  to  spread  behind  the  fascia  and  result  in  fatal 
septicaemia  or  peritonitis.  He  states  that  he  has  seen  three 
permanent  cures,  by  the  early  removal  of  undoubted  cases  of 
cancer  of  the  rectum,  and  that  in  these  cases  the  disease  had 
not  returned  at  the  end  of  six,  five  and  three  years.  This,cer- 
tiunly,  is  very  encouraging,  and  has  led  him  to  believe  that 


102 


CANADA  HBDtOAI.  AND   BtmOICAI.   JOURNAL. 


cancer  invading  the  rectum  ie  less  liable  to  become  disseminated, 

and  hence  its  early  removal  will  greatlj  serve  to  protect  the 
patient  from  systemic  infection.  Quite  a  number  of  caseB  have 
recently  been  performed  in  New  York  by  variouB  operators,  and 
Dr.  Van  Euren  has,  in  a  recent  number  of  the  New  York  Medi- 
cal Record,  published  a  lecture  delivered  on  this  subject  with  a 
report  of  three  cases.  The  case  annexed  is  the  first  of  the  kind 
I  have  seen  which,  in  my  own  opinion,  was  suitable  for  the 
operation.  I  have  met  with  several  cases  of  cancer  of  the  rectum, 
and  have  performed  colotoiay  in  that  afieotion  on  several  occar 
aions,  not  as  a  curative  but  as  a  palliative  measure ;  but  the  case 
under  review,  notwithstamiing  the  patient's  great  age,  seemed 
to  be  one  suitable  for  extirpation,  which  operation  was  carried 
out  with  sueceas.     The  not^s  are  as  follows : 

July  22»rf,  1878,  I  was  requested  to  see  Mrs.  N,,  an  old 
lady  of  seventy  years,  who  was  reported  to  be  suffering  from 
dysentery.  She  was  a  liale  and  well  preserved  woman  and 
had  been  the  subject  of  procidentia  uteri  for  many  years. 
She  was  of  a  constipated  habit,  and  whenever  she  went 
to  stool  the  straining  was  so  great  that  the  uterus  and  bladder 
would  be  forced  out  and  had  remained  so  during  the  past  six 
weeks.  There  was  great  difGculty  in  relieving  her  bowels,  and 
for  the  last  week  or  ten  days,  I  was  informed,  she  had  a  dysen- 
tenc  attack,  passing  lii^uid  faeces  in  small  quantities,  but  very 
frequently,  mixed  with  blood  and  mucus.  The  tenesmus  was 
very  distrsssing,  and  there  existed  a  constant  feeling  of  fuUnesB 
and  distention.  There  was  also  a  burning,  dragging  (eehng, 
extending  up  the  course  of  the  bowel,  with  pain  over  the  sacrum 
and  down  the  thighs.  From  the  history  and  symptoms,  I  aup- 
, posed  that  the  bowel  was  filled  with  impacted  fjEces  which 
was  locally  keeping  up  the  irritatjon.  I  preacribed  a  dose  of 
castor  oil  This  operated  three  or  four  times  and  gave  much 
relief.  The  tenesmus,  boo'cver,  still  continued,  and  she  passed 
much  blood  and  mucus.  On  the  26th,  her  daughter  informed 
me  that  she  had  bleeding  piles  and  that  they  were  ulcerated. 
This  led  to  a  careful  inspecUou,  when  the  following  conditioD 
was  observed  : — 


1^  the  Ik 
^"  pted 


SKHOVAL  OF  INI)  OF  RECTUM. — BT  DR.  FBNWICK.  103 

^Gompletelyaurnmndmg  the  anus  was  a  fungus  mass,  ulcerated, 
itil]i  everted  and  ragged  edges,  presenting  much  the  same  ap- 
pearanee  as  is  seen  in  epithelioma  of  the  lips.  On  exploring 
-1^  Ijowel  with  the  finger,  I  found  that  the  disease  implicated 
boat  two  inches  of  the  anterior  wall ;  the  point  of  the  finger 
Wihed  abovo  the  diseased  mass ;  the  rugas  were  large,  corru- 
pted and  thickened,  but  the  mucous  mombrano  above  and 
aloag  the  posterior  wall  was  smooth  and  healthy  to  the  feel. 
There  could  be  no  doubt  as  to  the  nature  of  the  case,  and  1 
Me»ed  it  to  be  one  suitable  for  removal,  and  advised  the  per- 
fonoance  of  the  operation.  A  consul  tation  was  demanded  by  the 
frieniis,  and  I  met  Dra.  Howard  and  Drake  the  following  morning. 
Tbeae  gentlemen  coincided  with  me  in  tlie  nature  of  the  case, 
and  agreed  in  the  advisability  and  feaeibihty  of  the  removal  by 
™^   operation. 

^^H  Some  delay  followed  in  consequcDce  of  objections  ou  the  part 
^^R.of  some  members  of  her  family,  bat  finally  arrangements  were 
^^B  Concluded,  and  the  operation  performed  in  the  following  manner 
^^P  Ca  the  6th  of  August,  1878.  Dr.  Roddick  acted  as  my  direct 
^■^  UfOBtant,  the  other  gentlemen  above  named  were  present,  and 
^^■•Bsisted  with  their  counsel  and  advice. 

^^K    A  dose  of  castor  oil  had  been  given  the  evening  previous,  and 

^^BHie  lower  bowel  well  washed  out  with  an  enema.  £thor  having 

^^Mieen   adminigtered,  the  operation  commenced  by  luaking  an 

^^tflUiptical  incision  on  either  side  of  the  anus.  Cutting  wide  of  the 

^^K disease,  the  knife  sank  in  well  on  either  side  info  the  ischio-rectal 

^^  fosaa,  freely  exposing  the  levator  ani  muscle.    This  was  divided 

as  far  forward  as  was  deemed  advisable.  .There  was  no  chance 

of  saving  the  sphincter  ani,  as  it  appeared  to  he  engaged  in  the 

disease.     The  posterior  wall  of  the  vagina,  which  was  perfectly 

healthy,  was  readily  reflected,  and   the  bowel,  freed  from  its 

attachments,  was    easily  drawn  down.      All   bleeding  points 

were  immediately  secured  with  carbohzed  gut.      At  this  stage 

of  the  proceedings,  between  three  and  four  inches  of  the  end  oi 

the  rectum  was  hanging  out  of  the  wound,  and  I  proceeded  to 

te,  cutting  with  a  pair  of  scissors  directly  across  the  gut, 

lUy   above   the  diseased  mass.      Having  divided  ahoi^t  one 


104 


CANADA   MEDICAL   AHD   BVBOIOAL    JOUBNAL, 


quarter  of  the  entire  extent  of  the  bowel,  the  mouths  of  the 
veBsela,  both  pnudmal  and  distal,  were  tied,  and  then  the  entire 
thickness  of  the  bowel  was  stitched  to  the  healthy  skin.  A. 
second  slice  of  the  bowel  waa  then  made  and  treated  in  the 
same  manner,  and  so  on  until  the  entire  diseased  mass  was 
removed.  As  we  proceeded,  all  bleeding  points  were  secured, 
BO  that  the  amount  of  blood  lost  did  not  exceed  six  ounces.  In 
attaching  the  bowel  to  tbe  akin  on  either  side  deep  sutures  of 
silk  were  used,  and  where  there  was  anj  gaping  fine  carbolized 
cat-gut  sutures  were  introduced  between  those  of  ailk.  As  much 
skin  had  to  be  sacrificed,  it  vras  necesaary  to  close  the  wound 
posteriorly  approximating  the  edges  of  the  healthy  akin  on  either 
aide  of  the  wound,  and  passing  well  down,  two  large-«zed 
drainage  tubes  which  were  secured  in  position.  These 
were  with  difficulty  retained,  and  they  had  to  be  removed  ' 
on  the  following  day,  as  they  appeared  to  be  doing  no  good. 
After  closing  the  wound,  tbe  parts  were  covered  with  a  piece 
of  lint  soaked  in  carbolic  oil  and  supported  by  a  pad  of 
cotton  batting  with  a  firmly  applied  T  bandage.  To  avoid  all 
strtuning,  as  well  as  to  save  tbe  parts  from  injury,  the  urine 
waa  drawn  off  with  the  catheter ;  a  full  dose  of  morphia  by 
hypodermic  injection  was  given  at  night.  At  the  evening  visit 
the  patient  waa  perfectly  comfortable  ;  there  waa  no  atraining 
or  tenesmus,  and  she  complained  only  of  slight  soreness.  Her 
temperature  was  911"  F. 

Auffust  1th, — She  passed  a  good  night,  slept  weU  and  com-  i 
fortably,  the  urine  was  well  secreted,  healthy  in  appearance, 
and  had  been  removed  by  the  catheter  twice  during  the  night ; 
she  has  taken  milk  and  h^ef-tea  in  fair  quantity,  temperature, 
99* ;  pulse,  lUO ;  tongue  rather  furred,  and  she  suflera  from 
nausea,  in  all  likeliliood  due  to  the  ether.  The  dressing  was 
removed,  and  I  found  tliat  the  drainage  tubes  had  been  forced 
out  of  their  position  so  that  they  were  taken  away.  Tbe  wound 
was  bathed  wiiii  tepid  water,  thoroughly  cleansed  and  dressed 
tn  tlio  same  manner  as  above  described.  Tlie  case  progressed 
favorably.  Un  ttiu  tliini  day  the  bowels  moved  freely  without 
pun  ur  straininjj,  suppuration  waa  in  due  time  established,  and 


lUBMOYAL  OP  BND  OP  RECTUM. — BY  DR.  PENWICK.  105 

the  process  of  cicatrization  went  on  kindly.  The  stitches  were 
aU  removed  on  the  eighth  day  :  this  added  to  her  comfort,  as 
during  the  last  two  days  the  action  of  the  bowels  was  attended 
with  some  pain. 

Union  was  complete  by  the  twelfth  day.     There  was  no  ten- 
dency to  prolapsus  of  the    rectum  ;  the  uterus  and  bladder 
still  come  down  but  are  readily  returned,  in  this  respect  the 
patient  is  no  worse  off  than  before  the  operation.  At  the  present 
time,  September  27,  the  parts  are  in  a  very  satisfactory  state  ; 
there  is  inability  to  retain  the  faeces,  but  she  is  fully  aware 
when  the  bowels  are  going  to  act,  and  has  sufficient  warning  to 
enable  her  to  make  preparations  necessary  for  cleanliness.   She 
is  in  excellent  spirits,  is  able  to  go  about  the  house,  and  has 
rentored  out  for  a  drive  on  several  occasions.     She  has  greatly 
improved  in  appearance  and  in  condition,  and  expresses  the 
hope  of  soon  being  able  to  have  control  over  her  bowels.     The 
results  are  so  far  very  satisfactory,  and  add  one  more  case  to 
those  already  published  by  other  surgeons.     It  points  to  the 
necessity  for  an  early  examination  in  affections  of  the  rectum, 
a  role  insisted  on  by  all  practical  surgeons,  as  it  may  be  pre- 
sumed that  some  cases  at  least  are  permitted  to  advance  beyond 
die  reach  of  surgical  aid  by  the  neglect  of  *  a  careful  and 
thorough  examination  as  to  condition  in  cases  where  such  a 
serious  malady  may  be  suspected. 

I  have  on  a  former  occasion  reported  a  case  of  epithelioma  of 
the  rectum  in  a  young  girl  of  twelve  years,  but  in  this  case  the 
disease  extended  up  the  bowel  for  a  considerable  distance,  too 
far  to  permit  of  removal.  In  this  case  colotomy  was  performed 
as  a  palliative,  with  considerable  relief  to  the  distress  and 
misery  endured  by  the  sufferer  whenever  the  bowels  acted. 

Drs.  George  Ross,  and  William  Oslbr,  returned  to 
Canada  on  the  25th  ultimo,  after  a  three  months'  holiday  in 
Great  Britain  and  on  the*  continent.  Dr.  Robert  Craik,  has 
also  been  absent  in  Europe  since  last  July,  and  is  daily  expected 
to  return. 


CANABA    MEDICAL   AND   SURfllOAL   JOtJKNAL. 


hospital  a^porta. 


Ca$e  of  Pycemia. — Under  care  of  Dr.  WiLsras.  Reported 
by  Jahbs  Bell,  M,D.,  AsMstant  House  Surgeon. 
M.  C,  set.  23,  was  admitted  on  the  evening  of  August  21ati 
1878,  with  a  painful  swelling  on  the  left  antero-Iateral  aspeeV 
of  the  neck,  and  high  fever.  She  was  a  servant  girl  of  lesK 
than  medium  height,  stout  and  well  built.  She  was  bright  andJ 
intellijrent-looking,  but  with  very  prominent  eye-balls.  Her 
family  history  was  good  and  she  had  always  enjoyed  goOd 
health  until  five  years  ago,  when  she  began  to  suffer  from 
palpitation  of  the  heart,  and  noticed  an  enlargement  of  her  necl 
She  came  to  tlie  hospital,  and  was  found  to  have  all  the  cha 
acteristic  signs  and  symptoms  of  exophthalmic  goitre.  A  prom 
nent  cyst  in  the  letl  lobe  of  the  thyroid  gland  was  tapped,  after 
which  she  says  she  did  n»t  suffer  trom  palpitation  or  any  other 
symptoms  of  this  disease  for  two  years,  until  the  gland  again 
became  enlarged.  Two  years  ago  she  had  pneumonia  and  was 
treated  in  hospital.  She  menstruated  for  the  Brst  time  two 
years  ago  and  since  then  has  not  been  regular,  menstruating  at 
intervals  of  one,  two  or  tliree  months.  Her  present  illness 
began  five  days  before  aduiisaion  with  head-ache,  back-ache, 
pain  in  her  neck  and  fever.  Afler  the  first  day  of  her  ilbeas 
she  had  frequent  chills  and  was  very  restless,  not  being  able  to 
sleep  either  by  night  or  day.  On  admisMon.  her  temperature 
was  104^  F.,  face  Hushed,  breathing  hurried,  pulse  rapid  and 
iutornutting.  The  cye-baUs  were  very  prominent,  the  anterior 
aspect  of  tlie  nock  much  enlarged  and  painful,  and  towards  the 
left  side  extremely  tender.  Two  distinct  and  separate  cysts 
could  bo  easily  made  out — on©  at  the  extreme  left  of  the  gland 
very  tense  and  tender,  the  other  over  the  isthmus,  protty  full, 
but  not  at  all  tondor  on  presaorv.  She  complained  of  pun  in 
the  tumor  which  eztcndetl  down  the*  sti^mal  region.  AH  the 
othtn-  orgaiM  w«ni  hoftlthj.     She  did  not  sleep,  ant)  was  very 


HOSPITAL   REPORTS.  107 

readess^and  at  1  a.in.,  had  si  severe  chill,  which  lasted  half  an 
konr.  The  temperature  was  not  taken  after  this  chill.  At  1 
p.nL,  on  the  22nd,  she  had  another  severe  chUl,  followed  by  a 
temperature  of  105*^  F.  She  was  ordered  20  grains  of  quinine, 
to  be  taken  at  once,  and  an  application  consisting  of  equal  parts 
of fltiid  extract  of  belladonna  and  glycerine  to  be  applied  to  the 
tomor;  also  a  mixture  containing  liq.  anmion.  acet.  and  tinct. 
aconiti,  and  she  was  given  milk  diet.  The  pulse  wad  now 
pretty  regular  and  rapid  (124).  No  intermissions  in  the 
Ajthm  were  subsequently  noticed. 

August  23rd,  temperature  100^  in  the  morning  ;  pulse  120  ; 

neck  swollen  and  oedematous  on  left  side.     Left  parotid  gland 

enlarged  and  hard.     She  complains  of  sore  throat  and  severe 

pain  in  the  left  ear.      Ordered  a  linseed  meal  poultice  instead 

of  the  belladonna  application  to  the  neck,  and  tr.  digitalis  m.  iij. 

to  be  added  to  each  dose  of  the  febrifuge  mixture,  which  was 

giyen  every  four  hours  ;  she  had  also  twenty  grains  of  quinine. 

She  had  a  severe  chill  at  9.30  p.m.,  the  temperature  rising  to 

107^  F.     She  had  twenty  grains  of  chloral  at  night,  but  did 

not  sleep. 

August  24th,  temperature  100^  in  the  morning.  All  the 
symptoms  ahready  mentioned  are  more  marked,  especially  the 
swelling  and  oedema  of  the  neck.  The  painful  cyst  at  the  left 
extremity  of.  the  gland  was  aspirated  and  found  to  contain  pus, 
which  forced  its  way  out  drop  by  drop  from  the  puncture  made 
by  the  hypodermic  needle.  It  was  then  opened  with  a  scalpel, 
and  about  half  an  ounce  of  pus  escaped.  This  gave  consider- 
able relief,  and  the  evening  temperature  was  only  102*^  F ; 
pulse  100.  She  had  again  20  grams  of  quinine  in  the  afternoon. 
August  28th,  she  became  delirious  in  the  afternoon,  and  by 
10  p.m.  had  to  be  held  in  bed.  She  was  given  chloral  and 
bromide  of  potash  in  large  doses,  an  ice  cap  was  applied  to  the 
head  and  she  became  quiet ;  temperature  99|  in  the  morning 
and  101 J  in  the  evening.  She  perspired  profusely  during  the 
day  and  had  four  loose  feculant  stools.  She  had  no  chiUs 
after  the  23rd,  but  perspired  freely  and  had  two  or  three  stools 
daily  from  the  25th. 


108  CANADA   MEDICAL    A 

August  2yth,  still  delixious  but  quieter;  abscesfl  still  di9- 
cbargiug.  Both  parotids  much  swollen,  go  that  the  mouth  can 
hardly  be  opened.     Ordered  6  oz,  brandy  daily. 

August  30th.  Condition  scarcely  changed  for  the  last  two 
or  three  days.  Pulse  90  to  100  ;  tumi)erature  99J  to  102- 
Patient  restless  and  more  or  less  delirious  all  the  time.  Di^talis 
omitted. 

September  Sud.  Patient  seems  quite  rational  and  says  that 
she  feels  better.  Eap-acbe  quite  gone.  About  1  p.m.  she 
became  suddenly  quite  furious.  The  ice-cap,  which  had  been' 
removed  for  two  or  three  days,  was  now  re-applied  to  the  shavea 
aoalp,  Ordered  chloral  and  bromide  again.  No  symptoms  of 
brain  trouble  except  the  delirium.  The  delirium  persisted  and 
urine  and  feces  were  voided  in  the  bed.  At  9  p.m.  the  right  arm 
was  found  to  he  quite  paralyzed.  As  she  was  quite  unconsci- 
ous it  was  impossible  to  say  whether  there  was  any  paralysis  of 
the  legs  or  not 

September  3.  There  is  now  complete  paralysis  of  both  sensa- 
tion and  moUon  in  the  right  arm.  There  seems  to  be  paralysis 
of  motion  in  tlie  right  leg,  but  sensation  does  not  seem  to  be 
interferod  with.  There  are  frequent  spasmodic  movements  of 
the  left  arm  and  leg.  There  is  no  strabismus  nor  any  aSection 
of  the  pupila.  Patient  eviiiontly  mking  rapidly.  She  died  at  5 
p.m.,  the  temperature  being  107)  about  half  an  hour  before  death. 

Autopsy  19  hours  after  death. 

Body  that  of  a  modium-«ixed  young  woman  &irly  nourished. 

Very  slight   mammary   development     There  is   symmetrical 

I  Rwelling  in  the  region  of  the  thyroid,  on  the  left  side  of  which 

a  small   opening  discharging   on    pressure   creamy   pua. 

Her«  ia  also  ooosiderabln  exopfath&lmns.     On  opening,  abdo- 

Mn  organa  appear  healthy. 

Tkonat. — Pericardium  normal  and  contains  a  small  qusntitj 
\  of  dear  Krum. 

HmH. — £115  grms.  Substance  and  raWes  healthy.  The 
*"  rig^t  auricle  and  wntricW  contain  a  good  deal  of  friable  clot. 

7.wN^.— 11i«i*are  firm  adhenons  orer  a  considerable  portioa' 
of  both  Ittugs,  oipMUUf  Ik*  Mi      Longs  crepitant.     On 


HOSPITAL   REPORTS.  109 

pressure  they  exude  a  good  deal  of  frothy  serum.  Equally 
distributed  through  both  are  small  dark  .patches  (infarcts),  the 
largest  about  the  size  of  a  bean.  In  two  cr  three  places  there 
are  thromboses  of  the  pulmonary  arterial  branches,  the  vessels 
being  about  one-fifteenth  of  an  inch  in  diamater.  None  of  the 
infarcts  have  suppurated  or  softened.  The  lungs  are  light  in 
color  and  in  general  appearance  healthy. 

Uver. — 1080  grms.  On  section,  the  cut  surface  is  obscurely 
mottled,  but  no  definite  infarcts  are  to  be  seen.  Gall  bladder, 
moderately  fall. 

Spleen, — Rather  large  anc    firm.     Malphigian  bodies  very 
firm.    No  infarct. 
Pancreas  normal. 

Eidneys.SOO  grms.  each.  Capsules  not  adherent.  Numerous 
dark  patches  on  the  surface  of  both  organs   (infarcts).      The 
left  has  a  couple  of  small  abcesses,  each  about  the  size  of  a 
pea,  and  a  small  quantity  of  pus   in  the  pelvis,  apparently 
derived  from  one  of  these. 
Stomach  and  intestines  apparently  healthy. 
The  thyroid  gland  consists  chiefly  of  cysts  of  various  sizes, 
between   which  are  tracts  of  gland  tissue,  the  latter  almost 
entirely  confined   to  the  right  lobe  ;  a  large  sac  occupying 
nearly  all  the  left  lobe  of  the  gland,  and,  opening  externally, 
contains  a  small  amount  of  pus.     A  cyst  rather  larger  than  a 
pigeon's  egg  occupies  the  isthmus,  and  lies  upon  the  trachea. 
This  contains  sero-purulent  fluid.       The  right  lobe  contains 
numerous  cysts,  varying  in  size  from  a  pea  to  a  marble.     Some 
of  these  contain  clear  serum  and  others  caseous  matter.      The 
cellular  tissue  of  the  left  antero-lateral  region  of  the  neck, 
especially  that  between  the  deeper  muscles,  is  infiltrated  with 
pas.      The  left  parotid  gland  is  large  and  firm,  and  in  its  sub- 
stance  are  several  suppurating    cavities.     The  right  parotid 
is  very  much  swollen  and  hard,  but  is  not  suppurating. 

Brain. — 1280  grms.  The  superior  longitudinal,  straight  and 
right  lateral  sinuses,  with  the  superior  cerebral  veins  down  to 
their  finer  branches  are  filled  with  a  firm  black  clot,  in  which 
are  noticed  two  or  three  suppurating  points.     The  dura  and 


110  CANADA   HEWCAI.   AND   StIRGlOAL   JOITRNAL. 

pia  mater  are  much  congested,  and  the  surface  of  the  couvolt 

tions  very  red.     (The  brain  waa  not  dissected  when  fresh,  bu  A 
preserved  for  somo  time  in  nitric  acid  solution).     On  dissection  -, 
the  whole  interior  of  tlie  left  hemisphere  forming  the  roof   of 
the   lateral   ventricle  is    found   to  be  quite   soft  and   broken 
down.     A  smaller  spot  of  similarly  disorganized  cerebral  sub- 
stance is  found  in  the  centre  of  the  right  heuusphere.     Tias 
softening  is  probably  post  mortem,     A  black  clot,  fusiform  in 
shape  and  about  an  inch  long  by  half  an  inch  in  diameter,  ia 
found  extending  into  the  anterior  extremity  of  the  middle  froutal 
convolution  of  the  left  anterior  lobe  parallel  to  the  longitudinal 
fissure.     It  extends  into  the  brain  from  the   surface,  but  no 
definite  connection  with  any  of  the  vessels  can  be  made  out. 


Case  of  Puerperal  Edampgin. — Occuring  at  the  Universitj 
Lying-in  Hospital.  Under  care  of  Dr.  MacCallcm, 
Reported  by  &Ir,  W.  R.  Sutiiekland. 

Mary  Welsh,  iet.  20,  was  admitted  into  the  Universily 
Lying-in  Hospital  16tii  March,  1877,  pregnant  of  her  second 
child.  History  elicited  from  her  at  previous  confinement,  BeCi 
1875,  was  as  follows : 

She  is  well  built,  healthy  looking,  about  5  ft.  6  in.  ia 
height,  fair  complexion,  dark  hair,  and  rather  stout.  Hh 
always  enjoyed  good  health,  never  having  been  ill  since  hw 
childhood,  when  she  describes  having  a  fever.  At  times  of 
menstruation  she  is  always  unwell  for  a  long  time,  great 
quantity  of  discharge.  Since  gestation  commenced  has  sufiered. 
severe  headaches  and  occasional  dizziness. 

She  is  of  an  apparently  healthy  family,  but  says  her  motlior 
always  has  convulsions  at  time  of  labor. 

Smce  recovery  from  her  first  attack,  in  January,  1876,  she 
has  been  aniemic  and  suffering  from  Bright's  disease.  For  the 
last  week  she  has  complained  of  severe  headache,  pain  in  the 
stomach,  perversion  of  special  senses,  flashes  of  light  before, 
her  eyes,  momentary  blindness  and  ringing  in  the  earl. 
Menses  stopped  July  1876. 


HOSPITAL   REPOKTS.  Ill 

March  18tli,  Sunday,  at  8  p.m. — Oomplamed  of  blindness, 

and  sent  for  the  Matron,  who,  on  going  to  her  immediately, 

fbandherin  a  convulsion.     This  was  followed  by  drowsiness 

aid  partial  insensibility;   half  an  hour  afterwards  she  had 

another  convulsion.    I  saw  her  just  after  the  spasm  had  ceased, 

she  was  then  in  a  condition  of  deep  stupor,  but  could  be  roused 

by  a  loud  question,  and  complained  of  severe  headache.     We 

removed  her  to  the  Lying-in  Room.     I  then  drew  off  the  urine, 

it  was  very  high-colored,  contained  at  least  80   per  cent,  of 

albumen.    Pulse  120 ;  skin  moist  and  cool.     No  convulsions 

for  an  hour. 

At  11  p.m. — Dr.  MacGallum  visited  her  and  ordered  pulv. 

jalap  CO.,  to  be  given  at  once  ;   potass  bromide,  grs.  xx  every 

hour,  3rd  dose  to  be  intermitted   and   replaced  by  20  grs. 

chloral.     If  purgative  did  not  act  in  H  hrs.,  she  was  to  have 

an  enema.     Patient  was  now  in  complete  stupor.     Pulse  120. 

Foetal  heart  heard  very  loudly  about  an  inch  below  umbilicus  in 

median  line.     On  making  vaginal  examination,  found  os  uteri 

firmly  contracted,  uterus  high  up  almost  out  of  reach,  presenting 

part  could  not  be  felt  through  the  walls  of  uterus.    No  uterine 

contractions.     (Preceding  convulsions  lasted  about  1  minute 

each.) 

1  a.m. — 7th  fit  lasted  90",  followed  by  stertorous  breath- 
ing for  about  5  minutes. 

2  a.m. — 8th  fit,  very  severe.  No  action  of  the  bowels ; 
gave  an  enema ;  brought  away  a  small  amount  of  fsecal  matter. 
Head  rolling  from  side  to  side,  convulsive  twitching  of  eyelids, 
eye  balls  rolling,  pupils  much  dilated  but  respond  readily  to 
light.  Legs  and  arms  in  constant  motion.  From  this  time 
(2.30)  till  7  a.m.,  she  had  seven  more  convulsions,  long  and 
severe,  and  occurring  at  intervals  of  80  and  45".  Emptied 
the  bladder  only  about  3ss.  of  urine,  dark  in  color,  and  more 
albuminous  than  before. 

7  a.m. — 16th  fit,  lasted  1  minute  ;  pulse  130  ;  surface  warm 
but  somewhat  cyanosed ;  conjunctivae  insensitive  to  touch ; 
pupils  normal ;  irregular  spasmodic  jerking  of  body  and  limbs. 

7.15. — Lasted  one  minute,  followed  by  stertorous  breathing. 


112  CANADA   MEniCAL    AND   RtlKGICAL    JOURNAI,.       ^M 

7.30, — Same  in  character. 

7.40. — Lasted  one  minate  ;  fcetal  heart  cannot  now  be  heard. 

7.50. — An  attack  of  well  marked  opiathotonous  lasted  two 
minutes ;  tongue  swollen  and  protniding ;  no  clonic  epasms. 

8,15. — Lasted  80  ".  Face  and  upper  extremities  now  quite 
cynaotic.  Pulse  140  ;  weak,  can  hardly  be  counted  ;  awallowB. 
with  difficulty.  Loud  mucous  gurgles  in  trachea  and  pbamyx. 
Respiration  seemed  to  be  impeded  by  the  accumulation  of 
mucous ;  the  handle  of  a  spoon  was  inserted  crosswise  between' 
the  tooth  and  kept  there,  the  result  being  of  manifest  advantage. 

10.00  a.m. — Lasted  one  minute ;  less  rigidity.  Patient 
appeared  a  little  better.  Fit  preceded  by  spasmodic  contrac- 
tion of  recti  muscles. 

11.45. — Lasted  4.">  "  ;  omitted  regular  dose  of  chloral. 

1.40  p.m. — Very  severe:  lasted  two  minntes ;  gave  P.. 
Jalapse  co.  3i,  followed  by  an  enema  at  4.30  p.m.,  wbidi 
removed  a  large  amount  of  serous  fiecal  matter.  Has  taken 
beef-tea  freely  to-day. — Brandy  now  added. 

4.30. — Removed  ji  of  dark,  smoky-looking  urine — the  acco' 
mulation  of  three  hours.  Pulse  1.40  ;  respiration  moaning. 
Urine  aolidi&os  on  testing. 

5,00  p.m. — Uturine  contractions  noticed.  Os  dilated,  a 
of  half  a  dollar.  Labor  proceeded  regularly  ;  no  more  c 
vulaious.  Hreech  presentation.  2nd  dorso  posterior  or  4tJi 
position — child  delivered  easily.  Pains  strong  ;  scarcely  any 
intervals  between  them.  Delivery  occurred  at  8.00.  a,m.  TIm! 
medicine  was  discontinued  at  5  p,m.  Child — female — still 
bom,  wcigjil,  8  lbs. 

Placenta,  &dhoront,  but  easily  removed ;  uterus  well  conn 
tract«d,  nut  uneven. 

10,00  p.m.— Pulse  140 :  temperature  102"^. 

Very  restletu  throughout  die  ni^t  ;  difficult  at  times  to  kee|^ 
hor  in  Wd  from  the  t^isstng  alraut 

20A — V'rine  mom  abundant  this  a.m. ;  color  more  natural; 
only  20  per  cent.  allmmeiL     Pulse  1*20  ;  temperature  101°. 

Afteruiiou. — Patient  quiet — protrudes  tongue  when  asked  tft 
ikt  ao.    Tempertturo  101. 


HOan^TAL  REPORTS.  113 

21«^, — Quite  conscious ;  feels  very  sore.    Breasts  enlarging  ; 
is  aphioiiic ;  throat  sore,  cough,  headache. 
T.iO  p.m. — Temperature,  100 ;  feels  better  ;  pulse  120, 
Lochial  discharge  free. 

ii^rtd. — Pulse  120  ;  still   hoarse  ;  looks   well ;  is  very  low 
spirited.    Albumen  in  urine  about  10  per  cent. 

^^rd. — Pulse  100  ;  still  low  spirited  ;  has  had  general  head- 
ac1ie  and  amaurosis ;  at  times,  flashes  of  light ;  sees  things 
coloured  green,  red.  &c.  This  state  of  things  is  decreasing. 
Bowels  have  been  moved  two  or  three  times  each  day  siiyce 
delivery.  Hoarseness  less  marked.  Pharynx  rather  more 
sensitive,  though  it  can  still  be  freely  handled  without  produc- 
ing much  discomfort. 

2Sih. — Spirits  good ;  pulse  98.     Tongue  clean  and  moist. 
Eats  well.     Urine  still  contains  a  little  albumen. 
2Sth. — Recovered  voice  and  is  now  quite  convalescent. 

Laryngeal  Diphtheria. —  Tracheotomy.  —  Recovery,  —  Under 
Dr.  Roddick  — Reported  by  H.  N.  Vinebbrq,  M.D. 

L.  L.,  set.  6,  was  admitted  January  15th,  1878,  into  the 
wards  of  the  Montreal  General  Hospital,  with  symptoms  of 
laryngeal  diphtheria,  great  dyspnoea,  labored  breatliing,  base  of 
chest  retracted,  and  lips  and  finger  nails  quite  cyanotic.  On 
examination  the  tonsils  were  found  enlarged,  and  covered  with 
a  greyish-white  membrane,  which  extended  downwards  as  far  as 
the  naked  eye  could  see.  There  was  no  enlargement  of  the 
cervical  glands.  Three  days  before  admission  the  little  patient 
was  attacked  with  a  *'  sore  throat,"  but  croupal  symptoms  did 
not  set  in  until  forty-eight  hours  afterwards.  The  usual  treat- 
ment for  laryngeal  diphtheria  having  had  no  effect,  and  the 
symptoms  becoming  more  alarming,  the  medical  attendant  ad- 
vised the  parents  to  bring  the  child  to  the  Hospital,  with  a  view 
of  performing  tracheotomy.  Accordingly  the  child  was  admitted 
at  12,  noon,  and  very  shortly  after,  as  there  was  no  time  to 
lose,  Dr.  Roddick,  assisted  by  Dr.  Ross,  performed  tracheo- 
tomy, (the  high  operation)  in  the  ordinary  way.  The  opera- 
No.  Lxxy.  8 


CANADA    MSDIOAt    AND   SITRGICAL   JOORKAL. 


ist  as  tho) 


114 

taon  was  attended  with  scarcely  any  hreiDorrhage.  Just  a 
inciaion  was  being  made  into  the  trachea,  there  was  intena*. 
spasm  of  all  the  resjuratftry  muscles,  but  as  soon  as  the  trache- 
otomy tube  was  introduced,  the  spasm  passed  off,  and  quite  a 
mass  of  memhrane  was  brought  up  through  the  tube.  After  a 
few  powerful  expii-atory  efforts  the  breathing  became  much  i: 
proved,  and  within  an  hour  after  the  operation,  the  patient's 
lipB  and  finger-nails  regained  their  natural  colour.  CarbolizeJ 
lint  and  oiled  silk  was  introduced  between  the  rim  of  the  tube' 
and  the  edges  of  the  wound,  and  a  targe  woolen  cloud  was 
wrapped  around  tlie  patient's  neck.  He  waa  then  put  in  the' 
"  InfecUous  Ward."  Steam,  impregnated  with  carbolic  acid| 
was  kept  up  about  the  patient's  head,  and  he  was  ordered  to  be' 
given  salicylate  of  soda,  gra.  6.  in  solution,  every  three  hours 
plenty  of  milk  and  3  oz.  of  brandy. 

January  1 6(A. — Coughed  up  several  pieces  of  membrane  thig 
morning.  Carbolizcd  lint  removed,  and  nothing  but  oiled  silk 
intervening  between  the  tube  and  the  wound.  Wound  healthy 
looking.     Takes  plenty  of  nourishment. 

17(A. — Removed  the  tube  to-day  for  the  firet  time  since  the. 
operation.  After  cleaning  it,  it  was  re-introduced.  The  patient 
had  to  be  put  iin<ler  chloroform  at  ihe  time.  Cervical  glands 
slightly  swelled,  jioultices  to  be  applied  to  them.  Ordered  to- 
bum  Jss  of  sulphur  in  the  ward  every  two  hours.  Takes  plenty 
of  milk,  but  cannot  be  made  to  take  the  brandy.  To  have  beef 
tea  Tinct,  ferri  mur,  and  glycerine  in  ei^ual  parts  were  orderet 
to  be  applied  to  the  insido  of  the  tliroat,  but  the  nurse  found  t 
imposuble  to  carry  this  out. 

19lA. — H.1S  brought  up.  through  the  tube,  several  pieces  (^ 
nembrano.  Breathing  considerably  embarrassed  to-day,  and  it 
is  feared  the  disease  hnd  vxtended  downwards.  Removed  tube 
and  replaced  il  by  one  of  Trousseau's.  Considerable  redneai 
about  tlio  wound,  and  a  numWrof  small  white  vesications  near 
its  margin  Lcxd  lotion  to  be  applied.  .\t  4  p.m.  the  breath* 
ing  became  much  ea.<iier  afWr  bringing  up  a  small  piece  o 
membrane.  Moderate  discharge  of  a  purifomi  Said  throo^ 
dte  tube  over  ^oe  the  opera^ou. 


HOSPITAL  RBPOBTS.  115 

20<A.— Vesications  about  the  wound  are  extending.  Appear- 
ances suspicious  of  diphtheritic  action.  To  add  hydrocyanic 
acid  to  the  lead  lotion. 

21«^.— Removed  the  tube.     Patient  doing  well.     Tested  the 

power  of  breathing  in  the  natural  way,  by  closing  the  opening 

in  the  trachea  with  a  cork,  and  found  it  to  be  very  defective. 

Accordingly  after  the  tube  was  cleaned  it  was  re-introduced. 

Tincture  Ferri.  Mur.  in  small  doses  was  ordered,  but  the  patient 

could  not  be  made  to  take  it.     The  swelling  of  the  glands  has 

ahnost  entirely  disappeared.    The  white  vesicles  are  diminishing 

and  have  been  caused,  no  doubt,  by  the  glycerine  and  carbolic 

aciddressmg.  A  weaker  solution  to  be  used  hereafter.    Ordered 

lime  water  spray  through  the  tube.     Temperature  since  the 

operation  haa  ranged  from  100^  to  101 «  F.     Pulse  from  112 

to  140.     Respirations  from  24  to  36.     Pulse,  resp.  ratio  from 

3j-5tol. 

22nd. — Not  so  well  to-day.     Had  a  severe  fit  of  coughing 
early  this  morning. 

Breathing  somewhat  laboured.  Discharge  through  tube 
increased.  Does  not  take  his  nourishment  so  well.  Urine  is 
clear,  copious,  and  contains  albumen  (33  per  cent.)  for  the  first 
time,  it  having  been  tested  daily.  Tongue  is  coated  with  a 
heavy  white  fur,  a  few  coarse  bronchial  rales  heard  over  the 
chest.    Temperature  100^  F.  Pulse  112.    Respirations  30. 

23r<i. — Passed  a  good  night,  and  is  much  better  to  day. — 
Changed  for  the  better  yesterday  evening.  On  removing  the 
tube  it  was  found  very  much  discoloured.  Tested  breathing, 
and  finding  it  still  defective,  the  tube  was  reintroduced.  Red- 
ness and  vesicles  about  wound  disappearing.  Takes  plenty  of 
milk,  but  will  not  take  stimulants  of  any  kind.  Urine  of  amber 
colour,  deposits  a  slight  sediment,  and  contains  25  per  cent, 
albumen.  Under  the  microscope  an  occasional  hyaline  cast, 
and  a  few  white  globules  are  seen.  Temperature  99.4°.  Pulse 
108 ;  respirations  30. 

25th — Yesterday  afternoon,  the  nurse  noticed  little  bits  of 
orange  coming  out  through  the  tube  after  the  patient  had  par- 
taken of  some.     Complains  oP  considerable  pain  on  swallowing* 


lie 


CANADA   MEDlOAl    AND   BUaOIOAL   JOURNAL. 


To-daj  the  nurse  noticed  some  egg  which  p»tient  had  eaten  come 
out  through  the  tube.  Otherwise  patient  is  doing  well. 
Percentage  of  albumen  in  urine  somewhat  less. 
2Sth. — Milk  and  food  taken  escapes  through  the  tube  freely. 
A  drink  of  milk  excites  a  fit  of  coughiug,  and  then  the  milk 
streams  out  through  the  tube.  Introduced  to-day  a  new  tube 
with  a  fenestrum  in  it.  Opening  of  tube  was  closed  by  a  cork, 
and  the  patient  breathed  through  the  natural  passages,  but  with 
great  difficulty,  for  about  15  seconds.  Urine  high  colonred. 
Albumen  almost  disappeared.  No  casts  to  be  seen  with  &e 
microscope. 

Temperature  suddenly  went  up  yesterday  evening, 
to  100"  F.     Pulse  124  ;  respirations  36. 

2U(A, — Ordered  to  be  fed  in  the  recumbent  posture,  and  it 
is  found  that  not  so  much  food  escapes  through  the  tube  in  thia 
way.  After  several  successful  trials  of  the  power  of  breathing, 
per  lias  naturalea,  the  tube  was  removed  and  left  out. 
Patient  speaks  now  more  distinctly,  but  still  in  a  whisper.  A 
rather  copious  eruption  of  varicella  cfime  out  to-day  all  over 
the  body,  explaining  the  sudden  rise  of  temperature.  Urine 
contains  about  25  per  cent,  albumen.  Temperature  101-2°  P. 
Pulse  125;  respirations  40. 

Febrnary  ls(, — About  4  p.m.  yesterday  patient  was  suddenly 
seitod  with  vomiting,  became  very  faint,  surface  and  extremities 
grew  cold,  the  breitthing  became  hurried,  and  the  face  livid. 
By  applying  warmth  to  the  body,  and  givmg  stimulanta  inter- 
nally, he  rallied  in  about  45  minalea. 

He  had  a  tolerably  f»r  night  after  diis  attack.     He 

veil  this  morning,  and  haa  had  a  S|tell  of  rapid  breathing,  (80 

per  minute),  again. 

'  2.00  p.m. — Breathes  nicely  now,  and  is  much  better.  As  the 

[  food  taken  by  mouth  still  ooutinues  to  escape  through  the  tub* 

I  in  considerable   i^iuuititiud,  cn«mau  of   beef-t«a  and  brandy 

[  every  four  hours  wen*  ohi*n'd  in  addition.     The  enemata 

■well  retained.    Has  soiut>  tot<.>ntion.     Has  only  passed  4  ouncet 

[  of  urine  during  the  last  twwnty-fuur  houra.  Ii  concains  about  10, 

^  per  coqU  of  nlbuioeu.  8oiue  of  th*  vftrioeUar  resides  are 


HOSPITAL  REPORTS.  117 

ating  while  others  are  coming  out.  Temperature  101®  F.  Pulse 

120.  Respirations  40.    From  this  time  until  complete  convales- 

cence*wa8  established,  the  temperature  was  normal  (98^  F.) 

Pulse  ranged  from  110  to  120,  and  the  respirations  from  36 
to  40. 

5ti."-Complams  of  pain  in  the  back  of  the  head,  and  for  the 
™  few  days  has  had  pain  in  the  lower  limbs,  and  some  numb- 
ness. cJtill  suflFers  from  some  retention.  Eruption  of  varicella 
•ws  disappeared.  Takes  food  by  mouth  much  better,  it  does  not 
excite  80  moch  coughing.  To  have  an  enemata  only  every  six 
lours.    Wound  healthy-looking. 

10^. — ^The  patient  is  doing  very  well,  no  more  food  passes 
through  the  opening  in  the  trachea.  Wound  doing  nicely,  and 
•is strapped  with  adhesive  plaster. 

Retention  has  passed  off,  urine  still  contains  a  small  per- 
centage of  albumen.  . 

18^. — ^Allowed  to  sit  up.     Wound  healing  nicely. 

25^. — Patient  was  taken  home  by  his  parents  to-day. 

SOth, — After  he  left  the  hospital  the  wound  healed  rapidly, 
but  for  a  long  time  the  little  fellow  suffered  from  a  hoarse  bark- 
ing cough,  which  was  much  worse  at  night.  Loud  rhonchi  were 
heard  over  the  root,  of  both  lungs  behind  during  this  time.  The 
voice  continued  husky  for  a  long  time  after  the  external  wound 
had  completely  closed.  For  the  first  four  weeks  after  he  left 
the  Hospital  he  improved  in  general  health  but  slowly,  but 
after  that  he  picked  up  wonderfully,  and  is  now  quite  fat  and 
•  well  in  every  respect 

This  adds  one  more  case  to  those  already  published  of  the 
success  attending  the  performance  of  tracheotomy  in  laryngeal 
Diphtheria.  The  case  was  most  urgent,  the  symptoms  at  the 
outset  were  severe  and  pronounced,  the  results  most  gratifying. 
As  it  is  the  rule  in  practice,  one  closely  followed  in  this  Hospital, 
to  open  the  trachea  whenever,  from  extension  of  the  disease, 
implicating  the  larynx,  the  life  of  the  patient  is  threatened, 
we  may  reasonably  hope  that  ere  long  other  successful  cases 
will^be  chronicled. 


.    MEDICAL    AND   STTlfllCAL    jnnRSAL. 


Ilsoiews  and  B:otices  of  JKoofes. 

Tfu  Phyneiann'  Vigiling  List  for  1879, — Twenty-eighth  year 
of  its  [fublication,  well  bound  in  leather,  with  tucks,  pocket 
and  pencil.     Philadelphia:  Lindsay  &  Blariston. 

We  have  received  a  copy  of  the  Physicians'  Visiting  List  for 
the  year  1879.  It  cornea  to  us  in  the  same  familiar  form  like 
an  old  fritnd  with  a  now  garment,  and  as  full  as  ever,  with  all 
the  requireraenta  needed  by  a  physician  in  a  work  of  this  kind. 

We  have  seen  many  other  somewhat  similar  lists,  but  this, 
"  The  Physicians'  Visiting  List  "  is  the  [larent  of  tbem  all,  we 
have  become  accustomed  to  its  use  and  could  ill  be  without  it. 
These  lists  can  be  had  of  any  bookseller  to  supply  space  for  25 » 
50, 75  or  100  patients  a  week.  The  book  ia  convenient  in  form, 
not  too  bulky,  and  in  every  respect  the  very  best  visiting  list 
published . 

Elementary  Quantitative  Anali/sin.  —  By  Alexander  Clas- 
sen, Professor  in  the  Royal  Polytechnic  School,  Aii  la- 
Chapelle.  Translated  with  additions  by  Edgar  F.  Smith, 
A.M.,  M.D.,  &c.,  kc,  with  thirty-six  illustiations.  8vo. 
pp.328.     Philadelphia.:  Henry  C.  Lea,  1878. 

We  hail  with  satisfaction  the  translation  of  this  little  work. 
We  have  been  acquainted  with  it  for  some  time  as  a  practical 
and  concise  guide,  and  we  believe  it  will  be  found  to  fill  an  im- 
portant niche  in  the  library  of  the  real  practical  chemist.  It  is 
a  compact  ant)  useful  manual  of  qnantitaiive  analysis.  Tlie 
author  has  sought  in  these  pages  to  illustrate  his  subject  by 
examples,  beginning  with  simple  determinations,  following  on 
with  a  number  of  alloys,  and  then  proceeding  to  the  analysis  of 
minerals  and  other  products  which  are  submitted  in  the  various 
departments  of  applied  chemistry.  It  is  sufficient  to  mention 
the  fact  that  this  book  has  been  adopted  as  a  class  book  in  nearly 
all  the  laboratories  of  continental  schools,  and  has  taken  rank  by 
the  side  of  larger  and  more  voluminous  works  on  this  subject, 


HBVTBWB   ANB    NOTICES   OF  BOOKS. 


11! 


and  even  in  Great  Britain  and  the  United  States,  it  has  been 
moet  favorably  received  as  a  thoroughly  reliable  guide.  This  13 
the  opinion  of  those  who  have  used  it  in  the  orij^nal  but  their 
work  will  be  greatly  facilitated,  at  least,  we  refer  to  English- 
speaking  students,  since  they  have  now  an  excellent  translation, 
and  one  whicli  haa  received  at  the  hands  of  the  translator  such 
additions  as  the  advance  of  scienti&c  facte  rendered  necessary. 

A  Ouide  to  the  Practical  Examination  of  Urine. — For  the 
use  of  Physicians  and  Students. — By  Jambs  Tyson,  M.D., 
Professor  of  General  Pathology,  &c.,  kc.  Second  edition, 
8vo.  pp.  172,     Philadelphia :  Lindsay  &  Blakiston,  78. 

In  this  the  second  edition  of  this  little  work,  the  author  has 
ciirefully  corrected  and  revised  it.  and  lias  incorporated  into  its 
pages  such  additional  facts  as  were  deemed  consistent  with  the 
original  purpose  in  its  publication.  This  has  been  done  without 
increasing  the  size  of  the  volume.  The  author  at  the  outset 
mentions  the  theory  of  Ludwig,  of  the  meth<id  of  secretion  of 
urine  He  then  mentions  the  reagents  and  appuratus  rer[nired 
for  quantitative  a^  well  as  approximate  analysis  The  selection  of 
a  specimen  of  urine  for  examination  is  then  referred  to,  and  in 
making  the  selection  the  neceasity  for  obtaining  a  part  of  the 
total  amount  of  urine  passed  in  the  twenty  four  hours  is  men- 
tioned. The  general  physical  and  chemical  characters  of  the 
urine  are  next  given.  He  then  passes  on  to  the  study  of  the 
diiTerent  constituents  of  urine  in  health  and  disease,  taking  up- 
first  the  organic  constituents  and  then  the  inorganic.  Urinary 
deposits  forms  the  subject  of  the  next  section,  the  closing  sec- 
tions being  on  the  differentia]  diagooais  of  renal  diseases,  and 
urinary  calculi.  The  directions  given  throughout  the  work  are 
clear  and  distinct.  Those  who  desire  more  elaborate  informa- 
tion on  the  chemistry  of  the  urine  will  have  to  consult  larger 
treadses  on  the  subject,  but  we  regard  this  little  work  as  con- 
taining all  that  is  really  essential  in  a  concise  form.  It  is  just 
such  a  treatise  as  the  busy  practitioner  will  find  of  the  greatest 
service,  and  we  can,  without  hesitation,  commend  it  to  our 
readers. 


CANADA    MZDICAL    AJ4D    SCROICAI.    JOraNAL. 


Thf  Antagonism  of  Therapeutic  Agentt  and  what  it  teaehet^M 
The  essay  to  which  was  awarded  the  FothergilliaD  Gold  I 
[cdal  of  the  Medical  Societ;  of  London  for  1878.  By  i 
f.  Miiner  Fother^ll,  M.D.  Edin.,  &c.,  &c.  8vo.  pp.  160.  f 
Philadelphia:  Henrt  C.  Lea,  1878. 

The  aathor  in  this  essay  gives  a  short  and  pithj  view  of  tli«l 
subject  of  the  antagonlBm  of  toxic  agents.     He  divides  tbel 

subject  into  two  departments,  experimental  and  practical.  That! 
is  he  gives  the  results  of  experiments  nhich  he  and  others  havel 
made  with  various  substances,  keeping  in  view  throughout  tbej 
work  the  practical  bearing  of  these  experiments. 

It  is  quite  recently  that  the  subject  has  demanded  attenti<Mi  1 
prominently.     Formerly    chemical    antidotes  were   those    only  I 
known,  or  those  giving  mechanical  results.     We  knew  that  a 
alkali  would  neutralize  an  acid.    That  tannin  in  any  form  would  I 
^^H  form  an  insoluble  compound  with  tartar  emetic,  and  that  sesqui- 

^^b  oxide  of  iron  would  throw   down  arsenic,  provided   it  was  in 

^^M  eufficient  quantity.     These  effects  were  observed  alone   when 

^^M  the  poison  was  in  the  ahmentary  canal  but  if  a  deleterious  sub- 

^^1  stance  had  entered  the  Mood  nothing  could  be  done,  but  wait 

^^1  patiently  with  the  hope  that  it  would  be  eliminated. 

^^H  This  little  work  consists  of  seven  chapters.    The  first  two  are 

^^M  described  as  being  upon   experimental   inquiry  and  practical 

^^B  inquiry,  the  one  being  a  continuation  of  the  other.     The  third 

^^M  chapter  treats  on  the  effects  of  drugs  on  the  nerve  centres. 

^H  Chapters  IV  and  V  are  on  the  action  of  drugs  on  tlte  circalation 

^H  and  on  the  respiration  respectively.    In  the  sixth  chapter  we 

^^1  are  taught  the  practical  use  of  a  knowledge  of  the  antagonism 

^^M  of  drugs,  in  cases  of  actual  poisoning.  And  in  the  last  chapter, 

^^1  we  have  a  concise  but  lucid  description  of  the  uses  of  a  know- 

^^H  ledge  of  antagonism  of  drugs  in  ordinary  practice.  This  U  really 

^^1  amost  interesting  little  work,  and  the  contents  should  be  familiar 

^^H  to  all,  as  its  practical  bearing  and  teaching  is  quite  indispenss- 

^^H  ble  to  the  physician  who  desires  to  follow  his  art  with  ordinary 

^^^  success. 


BIVIEW8  AND   NOTICES  OF   BOOKS.  l2l 

A  Clmeal  Hi9tory  of  the  Medcial  and  Surgical  Diseases  of 
Women. — By  Robert  Barnes,  M.D.,  Lond.,  Censor  of  the 
Royal  College  of  Physicians,  &c..  Obstetric  Physician 
and  Lecturer  on  Obstetrics  and  the  Diseases  of  Women  to 
the  St.  George's  Hospital.  Second  American  from  the 
second  London  edition,  with  181  illustrations.  8vo. 
pp.  784.  Philadelphia :  Henry  C.  Lea,  1878. 

The  first  edition  of  this'  work  appeared  in  1874,  but  since 

then  the  book  has  received  at  the  hands  of  the  author  a  thorough 

lerision,  by  which  he  states  that  many  changes  have  been  made  ; 

space  has  been  gained,  by  pruning  and  re-arrangement,  so  that 

additional  material  is  given  without  increasing  the  size  of  the 

the  volume.     A  new  chapter  on  the  relations  of  bladder  and 

bowel  disorders  to  aflfections  of  the  uterus  and  appendages  is 

to  be  found.     Many  new  illustrations  have  been  added,  and 

when  these  have  been  borrowed  from  other  works,  their  source 

is  duly  accredited. 

We  have  in  this  work  the  experience  gained  by  Dr.  Barnes 
after  years  of  patient  labour  and  study  as  a  practitioner,  teacher 
and  examiner,  what  he  has  himself  observed  he  has  had  faith- 
fully illustrated,  but  he  has  endeavored  to  correct  his  ovm 
observations  by  the  illustrations  of  others. 

The  work  is  divided  into  twenty-nine  chapters,  the  first  six 
being  introductory,  giving  the  anatomy  of  the  pelvic  organs. 
The  uterus  and  its  appendages,  Douglas'  Pouch,  the  axis  of 
movements  of  the  uterus,  changes  which  occur  during  menstru- 
ation.    The  conditions  indicating  a  necessity  for  local  examina- 
tion, constitutional  reaction,  disturbed  function,  such  as  amen- 
orrhcea,    menorrhagia,  dysmenorrhoea,    leucorrhoea,   irritable 
uterus,  irritable  ovary,  martodynia,  neuralgia,  such  as  spinal 
irritation,  paraplegia,  mental  derangement,  reflex  nervous  phen- 
omena, vomiting,  convulsions  and  epilepsy,  hysteria  vaginismus, 
sterility.     The  significance  of  symptoms  connected  with   the 
bladder,    peri-uterine    afiections,  ischuria  ;    cystitis ;    foreign 
material  found  in  the  bladder,  causing  an  irritable  condition 


122 


CANADA    MKDICAL    AND   8UE0ICAL   JOUKSAL. 


of  that  organ.     This  calls   to  mind  a  case  which  Ve  pabliahed  I 
in  the  last  number  or  this  journal  of  the  passage  of  hair  in  the  ( 
urine  in  a.  child.     On  this   [joint  the  author  observes  at  page 
132.    "  Hair,  fat  ami  teeth  may  find  their  way  into  the  bladder  J 
and  urine.     They  afford  conclusive  evidence  that  a  dermoid  I 
cyst  haa  contracted  adhesions  with  the  bladder,  and  oatabUahed  ] 
a  fistulous  communicatiiin."     This  bears  out  the  assumption  we  1 
made  in  respect  to  tlie   case  above  referred  to,  no  dermoid 
tissue  or  cyst  was  found  in  that  remarkable  cose,  and  therefore   j 
we  were  forced  to   look   for  some  other  to  account  for  ^e 
phenomenon. 

A  description  of  the  instruments  serving  for  diagnosis  and   j 
treatment  of  uterine  affections  ia  given  in  chapter  iv. 

The  various  methods  of  examination  are  described  in  chapter   I 
V.     The  pathuiogy  of  tho  ovaries.     The  history  of  menstrua- 
tion and  disorders  of  menstruation  are  next  treated  of  in  the 
Buocceeding  five  chapters.     Diseases  of   tho  ovaries,   absence 

Lot  the  ovary,  congenita!  disfilacements,  cysts  and  their  treat- 
ment, extra  uterine  gestation,  &c,,  are  deacribed  in  the  next 
six  chapters.  There  is  a  chapter  on  the  spinal  pathology  of 
the  uterua,  in  which  the  aathor  takes  a  rapid  view  of  congenital 
Abnormalities,  as  he  observes  this  is  necessary  before  entering 
upon  uterine  pathology  proper,  because,  these  conditions 
are  often  attended  with  disordered  function,  and  give  rise  to 
Bymptoms  which  are  extremely  puzzling  unless  these  special 
conditions  were  known  as  likely  to  exist.  This  chapter  is  illus- 
trated with  a  number  of  engravings  showing  various  abnormali- 
ties, such  as  a  uterus  strongly  developed  to  the  right,  probably 
a  specimen  of  important  development  toward  the  left  aide,  dou- 
ble or  biconate  uterus,  with  a  single  cervix  from  a  specimen  in 
the  museum  at  Guy's  Hospital,  another  of  double  uterus  and 
vagina  also  from  Guy's  Museum:  These  are  of  interest  from 
their  rarity.  The  next  cbapter  is  ou  thj  effects  of  labour  and 
lactation,  involution  in  defect  and  excess,  conditions  marked  by  - 
altered  vascularity,  metr'itis,  endometritis,  or  uterine  catarrh , 
with  intra-uterine  medication,  is  the  next  treated  upon.  Pelvic 
cellulitis,  pelvic  peritonitis,  and  intro-peritonitis  are  then  dis- 


BSVISW8  AND   NOTICES  OF   BOOKS.  123 

cnaaei :  blood  efiiisions  in  the  neighborhood  of  the  uterus,  with 
groups  of  cases  is  given  in  chapter  xxi. 

Displacements  of  the  uterus  forms  the  subject  of  the  next 
ch^r.    These  have  always  been  a  source  of  trouble  and 
difficulty  to  the  practitioner,  and  we  need  only  to  refer  to  the 
numerous  mechanical  contrivances  each  claiming  pre-eminence 
for  the  relief  of  uterine  displacements,  to   indicate   the   very 
unsatisfactory  practical  knowledge  we  possess  on  the  subject. 
The  author  alludes  to  the  fact  that  some  have  declared   that 
they  have  failed  to  recognize  displacements  of  the  uterus,  and 
therefore  they  refuse  to  believe  in  their  existence  ;  of  such  we 
can  only  say  they  must  be  obtuse  in  a  degree  surpassing  belief, 
as  it  is  impossible  to  fail  to  recognize  these  conditions,  if  a  care- 
fiJ  and  intelligent  examination  be  made.     With  regard  to  pes- 
saries, the  author  remarks  in  reference  to  tho  their  use,  that  a 
prolapsus  is  a  hernia,  and  a  pessary  a  tenis,  and  that  although 
surgeons  have  with  ingenuity  introduced  several  operations  for 
the  radical  cure  of  displacements,  yet "  pessaries  are  still  found 
necessary."  But  before  applying  them  he  points  to  the  necessity 
of  careful  examination  with  the  aid  of  the  sound,  so  as  to  ascer- 
tain the  presence  or  absence  of  adhesive  bands. 

The  author  gives  a  description  of  many  forms  of  pessary,  and 
refers  to  the  objectionable  features  of  some,  especially  Zwanck's 
instrument.  The  expanded  wings  of  this  instrument  are  apt  to 
produce  ulceration  of  the  vaginal  walls,  and  in  some  instances, 
the  author  states,  he  has  found  difficulty  in  removing  the  instru- 
ment as  it  had  become  incarcerated  by  union  of  granulation 
tissue,  and  contraction  of  the  ulcerated  surfaces.  Hodge's 
lever  pessary  is,  perhaps,  the  least  objectionable  of  all  forms  of 
uterine  support,  but  even  this  instrument  will  in  some  cases 
utterly  fail  of  giving  relief.  Thomas'  pessary,  which  is  a  modi- 
fication of  Hodge's  instrument,  is  often  of  great  use  in  extreme 
cases  of  prolapsus,  but  the  author  states  that  in  practice  he  has 
found  a  pessary  invented  by  Dr.  Scott,  of  Woodstock,  Canada 
West,  to  answer  the  purpose  far  better.  The  various  operations 
for  the  relief  of  prolapsus  uteri,  are  referred  to.  Versions  and 
flexures  /  of  the   womb  are   next  discussed,   and  the  various 


124  CANADA    UEDICAI.    AND   BtTROICAL    JOURNAL. 

methoda  of  treatmeEt  given.  Chapter  xxiv  is  dovotfed  te 
tumoura  of  the  uterus,  malignant  aad  benign,  their  structure) 
Beat,  ahajie,  densi(_y,  vnscularity,  the  law  of  growth,  fee,  aod' 
their  treatment.  He  i^oes  not  condemn,  nor  yet  speak  hops' 
fidly  of  the  removal  of  tumours  of  the  utenis  by  abdominal 
section,  either  alone  or  with  the  uterus,  and  he  remarks  that  tbf. 
time  has  not  yet  come  for  giving  a  confident  opinion ; 
"  present  there  is  little  ground  for  enthuaiaatic  advocacy  of  the" 
'■  practice."  That  for  the  present  the  queation  must  remun 
tuffjudice. 

Uterine  polypi,  tubercle,  and  cancer  of  the  uterus  are  next 
discussed,  and  the  last  two  chapters  are  devoted  to  diseases  of. 
the  vagina  and  of  the  vulva.  The  arrangements  of  the  subject*, 
discussed  are  pecuhnrly  his  own,  and  open  to  objection,  but 
the  subject  matter  is  particularly  readable.  We  commend  iia$\ 
vork  to  our  subscribers,  it  is  a  valuable  addition  to  the  liter»> 
ture  of  the  subject,  and  to  the  practical  man  will  be  found  an' 
invaluable  guide. 

Extracts  from  British  and  J'oreign  J0urnals. 


Ciroulatlon  of  the  Blood  in  the  Extre- 
mities.— Professor  Lister,  of  London,  on  the  influence  of 
pasition  on  the  circulation  of  the  blood  in  the  extremities,  lately 
ommunicated  to  the  Paris  Academy  of  Medicine  the  reaults  of 
his  personal  researches  on  this  important  subject.  In  the  ordi- 
nary operations  for  resection  of  the  wrist  joint  the  hemorrhage 
was  quite  abundant ;  and  with  a  view  to  remedy  the  eidl,  he 
raised  the  arm  to  be  operated  upon,  and  kept  it  elevated  for 
B3veral  minutes,  after  which  the  tourniquet  of  Petit  was  rapidly 
adjusted  so  as  to  arrest  the  circulation  in  it.  By  this  procedure 
the  arm  was  almost  completely  deprived  of  blood,  and  the  sur- 
geon allowed  the  double  advantage  of  being  able  to  avoid  the 
haemorrhage,  and  to  inspect  the  parts  with  care  and  precision. 
The  advantage  thus  obtained  seemed  sufficiently  important  to 
Professor  Lister  to  recommend  the  method  in  other  operations. 


BRITISH  AND   FOREIGN   JOURNALS.  125 

Towards  the  close  of  the  yaar  1873  he  explained  to  his 

students  the  value  of  this  method.     He  raised  one  of  his  arms 

l>erpendicularly,  while  the**  other  was  allowed  to  hang  at  his  side, 

to  shew  the  difierence  in  color  of  the  two  hands  placed  in  such 

different  positions.  The  reduction  in  temperature  which  occurred 

ia  the  elevated  hand  convinced  him  that  something  was  going  on 

^Uch  purely  mechanical  effects  could  not  explain,  and  that  the 

ditoinution  of  the  blood  pressure  within  the  vessels  was  due  to 

a  stimulus  of  the  vaso-motor  nerves  of  the  arm,  and  to  a  reflex 

contraction  of  the  muscular  fibres  of  the  arteries. 

Some  physiological  experiments  on  animals  have  confirmed 

the  author's  opinion ;  and  he  concludes  from  them  that  the  facts 

observed  cannot  be  explained  as  purely  mechanical  results  of  the 

dimmution  and  increase  in  the  blood  pressure  in  consequence  of 

the  change  in  position  of  the  limb.     The  arteries  are  but  little 

disposed  to  yield  to  an  increase  of  pressure  coining  from  within. 

Thus,  notwithstanding  the  powerful  force  with  which  the  blood 

is  propelled  by  the  cardiac  contractions,  their  diameter  may  be 

considered  constant  during  the  systolic  and  diastole.    M.  Lister 

made  the  following  experiment  before  the  Academy  :  applying 

an  elastic  band  on  a  limb  near  its  juncture  with  the  body,  after 

having  been  elevated  for  several  minutes,  it  was  observed  to 

remain  free  from  blood,  although  the  limb  was  allowed  to  hang 

down,    On  raising  the  limb  the  second  time  and  in  that  position 

removing  the  band,  it  rapidly  filled  with  blood,  notwithstanding 

the  fact  that  the  position  was  the  same  which  caused  the  blood 

to  leave  before  the  application  of  the  tourniquet. 

These  results  are  explained  thus  by  Prof.  Lister  :  After  the 
tissues  of  a  limb  have  been  deprived  of  blood,  for  a  certain  time, 
then  arises,  so  to  speak,  a  circulatory  want,  and  this  acts  as  a 
stimulus  to  relax  the  arteries  by  acting  through  the  vaso-motor 
in  the  same  manner  as  heat.  This  stimulus  of  the  circulatory 
want  causing  relaxation  of  the  arteries,  becomes  stronger  than 
the  stimulus  of  relaxation  of  the  veins  excited  by  gravity,  which, 
in  another  case,  would  cause  their  contraction. 

Another  experiment  consists  in  exciting  the  circulation  by  a 
few  minutes  running,  and  then  to  raise  the  arm  and  lower  it 


126  CANADA    UEDICAL    AND   SURGICAL   JfumNAL. 

after  a  few  moments.     Th.e  limb  is  seen  to  redden  and  congert 
exactly  as  it  does  after  the  cessation  of  cold  applications. 

In  order  to  prove  that  all  these  phenomena  depend  on  reflex 
action.  Prof.  Lister  remarks  that  if  the  course  of  them  was  purely 
mechanical  aTid  physical,  the  lower  part  of  au  artery  of  an  ela- 
vated  limb  would  enlarge,  because  there  would  be  a  reflux  rf 
blood  from  the  upper  part.  It  is  the  opposite  which  is  true, 
was  determined  by  the  Professor  in  exposing  the  inferior  portion 
of  the  femoral  artery  in  a  large  calf  very  near  the  abdomen. 
After  the  contraction  produced  by  the  operation  had  subsided, 
be  measured  the  exact  diameter  of  the  artery  externally  in 
different  positions  of  the  animal ;  and  the  results  obtained  con* 
firmed  his  theory. 

He  also  expl^ned  to  the  academy  the  results  of  an  ezperi^ 
meat  performed  on  a  horse.  With  the  aid  of  a  rope  and  pulley 
he  had  been  able  to  change  the  position  of  the  animal  so  that  at 
one  time  he  could  be  placed  upon  the  back  with  bis  feet  in  the 
air ;  at  another  on  the  aide,  his  limbs  in  the  horizontal  position ; 
and  at  another  be  allowed  to  regain  hia  feet.  The  metacarpal 
artery  was  exposed  in  its  iuferior  part,  and  on  elevating  the  limb, 
it  was  seen  to  be  without  pulsation  ;  and  the  wound  depnved  of! 
blood,  resembled  a  wound  in  a  cadaver.  The  diameter  of  the 
vessel  was  measured  with  a  pair  of  compasses.  When  the  leg; 
was  elevated  it  hardly  exceeded  that  of  the  aame  artery  dii,-ide(I 
and  emptied  of  its  contents,  while  in  the  horizontal  position,  and 
especially,  when  the  limb  had  hung  down,  its  enlargement  wM 
considerable.  In  calculating  the  internal  calibre  from  the  ex- 
ternal diameter  of  the  artery,  it  was  found  that  in  changing  the 
elevated  to  the  horizontal  position,  the  calibre  was  more  than' 
three  times  as  great,  and  in  allowing  the  limb  to  hang,  it  was 
Eux  limes  as  great. 

It  is  necessary  to  note  that  for  the  surgeon  there  is  no  appre- 
ciable difference  in  the  diamet«r  of  an  artery  between  the  systole 
and  diastole,  Morever  the  well-known  experiment  of  Holies, 
who  fixed  a  long  vertical  tube  in  the  carotid  of  a  horse  to  see 
how  high  the  blood  would  ascend  under  the  influence  of  the 
cardiac  impulse.     This  experiment  demonstrated  that  if  it  had 


BRITISH  ANDB<   OBEIQN  JOURNALS.  127 

only  to  resist  the  action  of  gravity,  it  would  ascend  to  a  height 
of  more  than  eight  feet,  or  more  than  twice  the  length  of  the 
limb. 

Prof.  Lister  closed  his  communication  by  pointing  out  some  of 
the  medical  and  surgical  applications  of  which  his  theory  is 
susceptible.  He  recalled  the  happy  results  of  raising  the  arm 
vi  the  treatment  of  epistaxis.  According  to  him  elevation  of 
the  arm  causes  a  reflex  contraction  of  the  arteries  in  the  upper 
extremities,  and  secondarily,  a  sympathetic  contraction  of  the 
arteries  of  the  face. — La  Tribune  Medicate, — The  Cincinnati 
Lancet  and  Clinic, 

The    Odor  of    Sanctity. -— Dr.   Hammond,  of 
New  York,  is  fully  persuaded  that  many  of  the  saints  of  the 
earlier  days  of  the  church  were  highly  odoriferous ;  and  this 
peculiar  quality  he  distinguishes  from  the  ill-smelling  savour, 
due  to  a  neglect  of  washing,  and  attributes  it  to  an  affection  of 
the  nervous  system.     Several   curious  instances  of  fragrant 
saintly  emanations  are  quoted.     When  the  blessed  Venturin 
of  Bergamos,  we  are  told  officiated   at  the  altar,  the  people 
struggled  to  get  a»near  as  possible  in  order  to  enjoy  the  perfume 
he  exhaled.     St.  Francis  de  Paul  gave  off  most  sensibly  a  deli- 
cious odor,  after  he  had  fasted  thirty-eight  or  forty  days,  and 
had  subjected  himself  to  frequent  disciplinary  inflictions.     The 
body  of  the  blessed  Liduine  emitted  a  delicious  redolence,  which 
was  sensible  not  only   to  smell  but  to  taste,  as  it  left  on  the 
tongue  and  palate  an  impression  like  that  of  chewing  camelia. 
Dr.  Hammond  refers  to  three  cases  which  have  fallen  under  his 
notice,  in  which  specific  odor  has  been  given  ofi"  from  the  body, 
as  a  result  of  affections  of  the  nervous  system.     In  the  first,  a 
young  married  lady,  of  strongly  hysterical  tendencies,  exhaled 
an  odor  of  violets,  which  perva<led  her  apartment,  and  was 
distinctly  perceptible  at  a  distance  of  several  feet  from  her. 
This  pleasant  fragrance  was  given  off  from  the  left  half  of  the 
chest  only,  where  the  perspiration  was  remarkably  increased, 
and  could  be  obtained  in  a  concentrated  form  by  collecting  the 
perspiration  in  a  cambric  handkerchief,  heating  this  with  four 


128  OANADA   SIEDICAL   AND   BUBGICAL    JOITRNAL. 

ounces  of  spirit,  and  distilling  over  one-fourth  of  the  spirit.  The 
distillate  was  strongly  impregnated  with  the  perfume  of  the 
violets,  which  was  converted  into  that  of  pine-apple  on  the 
addition  of  bicarbonate  of  soda.  It  is  assumed  that  this  per- 
fume was  dependent  upon  the  presence  of  butyric  ether  in  the 
perspiratioa  The  administration  of  the  salicylate  of  aoda  ulti- 
mately relieved  the  lady  of  the  violaceous  redolence,  which  she 
was  most  anxious  to  part  with.  In  the  second  case  a  pineapple 
odor  was  exhaled  with  insensible  perspiration  by  a  young  lady 
suffering  from  chorea.  La  the  third  case,  a  violaceous  odor 
was  emitted  by  a  hypochandriacal  gentleman.  Br.  Hammond 
has  known  unpleasant  odora  to  be  emitted  from  the  body  during 
emotional  excitement.  A  young  lady  suffering  from  sick  head- 
ache, smelt  of  Limburg  cheese.  At  present,  all  that  we  can 
say  is  that  the  peculiar  odora  referred  to  are  the  result  of  ner- 
vous ii&tarh&nce.— Michigan  Med.  News. 

Tig-ht  Strictures  of  tlie  Uretbra.— On  the 

use  of  Gouley's  tunnelled  instruments  in  the  treatment  of  tight 
strictures  of  the  urethra,  by  Reginald  Harrison,  F.R.S.,  (Sui> 
geon  to  the  Liverjwol  Royal  Infirmary)  at  the  last  meeting  of 
the  Lancashire  and  Cheshire  Branch,  I  advocated  the  more 
general  employment  of  Gouley'a  tunnelled  bougies  in  the 
treatment  of  tight  strictures  of  the  urethra.  I  have  recently 
had  under  treatment,  in  my  wards  at  the  Liverpool  Royal  In- 
firmary, three  cases  which  well  illustrate  the  observations  I  then 
made  as  to  the  great  service  these  instruments  were  capable  of 
rendering. 

'  Cash  I.— On  June  27th,  1878,  J.  P„  aged  27,  was  admitted 
suffering  from  stricture  of  several  years'  duration.  On  this, 
well  as  on  a  previous  ocwasion,  it  was  found  necessary  by  my 
house-surgeon,  Mr,  Hodgson,  to  tap  the  bladder  above  the  pubol 
with  the  aspirator.  This  gave  immediate  relief.  Two  days  after 
his  admission,  he  again  had  retention  whilst  I  happened  to  be  la 
the  infirmary.  I  succeeded  in  passing  one  of  the  finest  filiform 
bougies,  and  upon  this  u  tunnelled  catheter,  which  was  retainetl 
for  some  hours ;  from  this  date,  dilatation  upon  the  same  prin<a- 


ANTI    PflKEIKN   JOURNALS.  129 

pie  ivaa  gradoally  commeQced,  the  size  of  the  timiielled  rnstm- 
meot  being  increased  from  time  to  time,  until  a  numbar  9  ordi- 
nary bougie  passed  easily,  when  the  patieut  left  the  hospital. 

Case  II. — J.  W,,  aged  tiO,  wag  adoaittcd  nnder  mj  uare  on 

Jone  12th,  1878.    Thirty  years  preriously,  he  had  a  fall  on  hia 

pennsBQin,  rupturing  his  urethra,  for  which  perineal  section  was 

sncoessfuUy  performed  by  Dr.  Evans  of  Belper.  Unfortunately 

the  patient  does  not  appear  to  have  followed  up  the  treatment  of 

^^^  Ilia  own  case,  by  that  regular  introduction  of  bouses  which  in 

^^H  ill  esses  of  traumatic  stricture  is  absolutely  necessary,  and  oc- 

^^H  ea^onal  attacks  of  retention  was  the  natural  consequence.     As 

^^B  I  expected  I  found  a  very  tight  stricture,  which  would  only 

^^^B  idmit  a  filiform  bou^e.     Upon  this  a  tunnelled  b'ougie  was 

^^H  pasged,  and  dilatation  continued  until  a  Holt's  instrument  could 

^^^   be  introduced    On  several  subsequent  occasions,  I  passed  Ilolt'a 

I  instrument,  using  it  as  a  dilator  on   tlie  principle  of  a  glove- 

stretchei  ;  by  these  means  the  dimensions  of  the  urethra  were 

soon  enlarged,  and  the  patient  was  able  to  leave  the  Infirmary 

passing  urine  in  a  good  stream. 

Casb  m.— W.  J.,  aged  42,  was  admitted  on  July  5tli,  18T8, 
soffering  fi-om  retention  of  urine,  -wliich   bad  existed   almost 
I  completely  for  a  week,  it  having  been  found  irnpossible  to  pass 

a  catheter.  On  adraisaion,  I  could  only  get  into  the  bladder  the 
finest  filiform  bougie,  upon  which  a  catheter  was  f>assed  suffi- 
ciently large  to  allow  of  the  bladder  being  washed  out.  In  addi- 
tion to  the  cystitis,  there  was  a  large  suppurating  pouch 
behind  the  stricture,  with  extensive  kidney  disease.  The 
condition  of  this  patient  illustrated  the  consequences  which  may 
arise  where  a  stricture  of  the  urethra  is  allowed  to  remain 
nntroated.  He  gradually  sank  with  symjitoms  of  urjemia,  and 
died  on  July  14th.  A  po»l  moTtem  examination  showed  what 
had  been  predicted — viz.,  a  suppurating  pouch  behind  what  had 
been  a  very  tjght  and  extensive  stricture,  cystitis,  and  sujipitra- 
tive  nephritis. 

In  commenting  upon  my  remtrks,  Mr.  Lund  drew  attention 
to  an  objection  that  can  be  raised  to  the  use  of  these  instru- 
ments— viz.,  that,  on  passing  the  metallic  bougie  along  the 

NO.   LXXV.  9 


MEDICAL  ASD  SURGICAL 

whalebone  guide,  unless  care  be  taken,  tbe  bougie  ie  apt,  oa 
reaching  the  stricture,  to  double  upon  the  guide,  and  then,  if 
force  be 'exercised,  a  false  route  may  uninteuUonally  be  made. 
Short  of  failing  to  introduce  the  guide,  this  is  the  only  accident 
that  is  likoly  to  occur  in  the  use  of  these  instruments.  It  does 
not,  in  m;  opinion,  detract  from  their  efficacy,  inasmuch  as  I 
can  hardly  imagine  any  surgical  instrument  being  made  without 
requiring  in  its  use  that  skill  and  knowledge  which  can  only  be 
acquired  by  experience  and  observation.  I  admit  tbe  propriety 
of  Mr.  Lunda's  comment,  and  record  it  as  a  point  to  be  remem- 
bered when  using  these  inatruments. — British  Med.  Journal. 


Nephritic  Abscess.— (Nephritic  Abscess — opened 
by  lumbar  incision — great  relief— bronchitis — death.} — M.  J.,, 
aged  42,  was  admitted  into  Lydia  ward  on  November  28th, 
1877,  under  Mr.  Bryant's  care.  The  family  history  was  good, 
as  also  was  her  own.  She  had  had  small-fiox  and  scarlatina,  and 
was  accustomed  to  a  cough  every  winter,  with  expectoration,  but 
did  not  spit  blood.  She  was  a  married  woman,  and  the  mother 
of  eight  children,  seven  of  whom  were  living.  Her  last  child 
died  two  years  before  admission.  The  labour  was  long  lasting 
6'om  2  a.in.  on  Sunday  until  7  p,m.  the  next  day.  There  was 
haemorrhage  during  the  whole  time,  and  she  waa  unconscious  for 
suvoral  hours.  Instruments  were  used  to  e.xtract  the  child.  Her 
catamenia  since  that  time  had  been  very  irregular,  pale,  and 
extremely  small  in  quantity.  She  had  become  much  weaker, 
since  her  confinement.  Her  water  had  become  thick,  and  there 
was  also  much  pain  accompanying  micturition.  When  admitted, 
the  patjent  was  a  houlthy-looking  woman,  but  weak  and  rather 
,  Ou  examination  she  hid  no  noticeaMe  abdominal  enlarge- 
ment, except  a  slight  one  behind,  and  in  tlie  region  of  the  right 
kidney,  behind  which  then'  was  considerable  tenderness  on 
pressure.  Urine  normal  in  colour,  specific  gravity  1011,  albu- 
minous, having  a  large  deposit,  which  proved  to  be  nothing  but 
pus.  The  pus  was  tolerubly  pure,  and  was  not  mixed  witit 
mucua.    No  reukl  casts  were  Yisible  under  the  microscope. 


BRITISH  AND  POBEIGN  JOURNALS. 


131 


December  5th. — On  tolerably  firm  pressure,  half-way  between  - 
the  umbilicus  and  anterior  superior  spine  of  ilium,  a  not  very 
well  defined  lump  was  felt  extending  through  lo  the  lumbar 
region.  Pain  was  felt  at  the  anterior  end  of  the  lump  and  in 
the  lumbar  region.  The  litmp  could  be  moved  between  the 
fingers  placed  in  front  and  in  the  loin.  The  urine  was  abun- 
dantly loaded  with  pus.  the  proportion  of  which  had  been  in- 
creasing. The  amount  of  urine  had  been  decreasing  id  quantity. 
W. — A  glass  of  urine  was,  on  being  left  to  settle,  opaque 
with  pua  to  within  about  half  an  inch  of  the  top. 

7th, — Swelling  scarcely  so  apparent.  The  patient  had  ether 
administered,  and  Mr.  Bryant  made  an  oblique  incision  in  the 
lambar  region,  about  three  inches  long,  above  the  posterior  part 
of  the  crest  of  the  ilium,  at  the  juncture  of  the  lower  third  with 
the  middle  third  of  the  distance  between  it  and  the  last  rib. 
The  subperitoneal  fat  was  cut  down  upon,  and  a  directer  passed 
mto  the  kidney,  when  about  two  ounces  and  a  half  of  pus  were 
fl^'acuated.  Afterwards  the  finger  was  passed  into  the  wound, 
"*<i  Mr.  Bryant  considered  the  tinger  penetrated  into  the  pelvis 
°'  the  kidney.  The  cavity  was  then  washed  out  with  a  lotion 
•composed  of  three  drachma  of  the  compound  tincture  of  iodine 
'"*  a  pint  of  water,  a  drainage  tube  introduced  and  fixed  by 
'"^ane  of  a  silk  ligature,  and  the  wound  strapped  and  dressed, 
^t/i. — She  vomited  a  little  in  the  night,  but  did  not  sleep. 
**l®  thought  the  pjun  was  less  since  the  operation.  The  pus  in 
the  Urine  had  greatly  decreased.  The  wound  looked  well,  and 
there  was  very  httle  discharge. 

lOtA. — Pus  had  disappeared  from  the  urine  ;  there  was  slight 
•liscKarge  of  pus  from  wound. 

1 2£A, — She  felt  pretty  well ;  no  bad  symptoms  except  that 
"S''  temperature  was  a  litttle  high. 

l3eA. — Temperature  104'*.  She  had  great  retching,  without 
vrtniiting ;  bowels  very  much  relaxed  ;  one  pint  and  two  ounces 
"»  urine  were  excreted,  specific  gravity  1026. 

14M. — Patient  complained  of  burning  heat  over  the  abdom- 
'^^i  parities,  which  could  be  distinguished  easily  with  the  hand. 
Iwaperature  102*8*.  She  was  ordered  pil.  opii  iti  one-grwn 
dweB.    Urine  ten  ounces,  specific  gravity  1026. 


132  TASADA  MEDlfAt  ANP  8rB(lI0\L  JonHNAL, 

15(A.— Temperature  lOa-g". 

MMh. — She  was  much  worse  during  the  night,  breathing  with 
difficulty  ;  complained  of  great  pain  "in  side.  She  died  about 
noon. 

Post-mortem  by  Dr.  OoodJiart. — The  ascending  colon  and 
ciEcam  were  intimately  adherent  over  the  kidney  and  psoas 
muscle.  The  bowel  was  rather  contracteil.  The  supra-renal 
capsules  were  healthy,  but  the  right  was  somewhat  toujih,  em- 
bedded in  fibrous  tissue.  The  left  kidney  was  large  and  weighed 
about  nine  ounces,  white,  mottled,  and  contained  many  cysts. 
The  other  was  small  and  embedded  in  a  tough  mass  of  tissue  ; 
capsule  firmly  adherent  and  dense.  The  |ffllvis  opened  into  the 
abscess  deacribed.  Tliere  was  a  still  unopened  cyst  in  its  lower 
part.  The  ureter  was  evidently  dilated,  so  also  the  renal  cavity 
as  far  as  the  brim  oF  the  pelvis,  whore  it  became  matted  up  in 
a  thick  mass  of  fibrous  tissue  connected  with  the  right  ovary ; 
it  was  traced  along  and  found  pervious  to  this  part ;  then  for  an 
inch  it  was  lost,  being  damaged  in  extraction ;  belbw  the  missing 
part  it  was  again  pervious,  but  not  dilated.  There  was  no  broad 
ligament  on  this  side  nor  yet  on  the  other.  All  the  parts  were 
matted  up  together,  and  tha  ovaries  were  not  found  without 
difficulty.  The  uterus  was  healthy,  rather,  large,  and  transe- 
verse.  The  bladder  was  small,  its  mucous  membrane  red  and 
velvety,  and  in  a  state  of  subacute  cystitis.  Alt  the  mischief 
looked  like  some  old  inflammation  in  both  broad  ligaments,  lead- 
ing to  puckering  of  the  ureters,  and  so  to  renal  hydro- and  then 
to  pyo- nephrosis. — Medical  Times  and  Gazette. 

Acute  Ascending:  Paralysis.— M.  Degerinh 

has  announced  to  the  Acadi^mie  des  Sciences  the  observation 
of  changes  in  the  anterior  roots  of  the  spinal  nerves  in  cases 
in  which  a  careful,  naked  eye,  and  microscopic  e\aminaHon 
revealed  no  lesion  of  th'  spinal  chord.  The  method  of 
examination  employed  was  the  hardening  in  osmio  acid,  and 
examination  by  means  of  picrocarmin.  In  each  preparation  a 
number  of  nerve-tubules  presented  the  appearance  of  parenchy- 
matous  neurids,  fragmentation  of  the   myelin  in   drops  and 


I 


natnsB  and  foreiok  joitrnals.  133 

droplete,  an  mcreaae  in  the  protopiaem  of  each  inter-annular 
segment,  and  multiplication  of  tba  nuclei  of  the  sheath.  Id 
some  of  the  tubules  so  changed  the  axis-cylinder  had  entirely 
disapjjeared.  Most  of  the  nerve-tubules  presented  no  appre- 
ciable alteration.  The  same  appearauces  were  observed  in  each 
jwt  fif  the  chord.  A  similar  alteration  of  some  of  the  nerve- 
tubuleg  was  found  also  in  the  intra-muacular  nerves  of  the 
p>^yzed  ^mbs.  Attention  is  drami  to  the  point  without  much 
^eiglit  being  laid  upon  it,  and  its  relation  to  the  disease  may 
ftnnui  of  some  doubt  vhcn  we  consider  how  small  a  proportion 
fte  fe»  degenerated  tubules  bear  to  the  great  amount  of 
paraJrais. — Lancet. 

Cartilaginous    Defeneration    of    the 
Capsule  of  tlie  Spleen.— By  W.  F.  Mitrrai,  M.B., 

Ofliciatiiig   Civil  Surgeon,  (iya. — On  the  26th  April  last  the 

body  of  a  Hindoo,  age  about  00  years,  was  brought  to  Gya  for 

eiamination.     He  waa  said  to  have  fallen  mto   a   well.     In 

Duikin^  the  P.  M.  I  found  a  tendency  to  ossification  all  over 

the  body.     The  cartilages  of  the   ribs   had  become  ossihed ; 

there  was  commencing  uasification   of  the  coronary  arteries ; 

was  atheromatous  disease   of  the   mitral   valves,    with 

rtluckening   of  the   walla  of   the  left    ventricle  of  the  heart. 

^ut  the  peculiar  phenomenon  which  I  met  with  was  on  exam- 

ing  the  spleen,  when  I  found   the  whole  external  utirface  to 

ntt  of  a  cartilaginous  plate   about  J  inch  in   thickness. 

Qie  remaining  surface   of  the   spleen  was  normal,  and  the 

(nbstance  of  the   spleen,  except  for   some  slight  congestion. 

which  I  need  not  enumerate  showed  drowning  to  he  the 

'immediate-  caii.-4e  of  death,  but  I  thought  this  case  worth  sending 

to  your  journal,  as  I  do  not  remember  having  ever  heard  of  an 

exactly  similar  one, — Indian  Medical  Gazette. 

Cessation  of  Epileptic  Fits  -with  Ulti- 

mate  Cure.— Dv.  ^icn^LTZ  {  ncrlin  KUn.  IVocli.)  reportu 
a  case  of  epilepsy  occurring  in  a  sailor,  ISi  years  old,  formerly 
healthy,  who  for  a  month  had  suffered  from  epilepsy.  He  had 
a  fit   regularly  every   mid-day.      The   usual   remedies  were 


134  CANADA  MEDICAL  AND  StlRQIOAL  JOPRNAL. 

employed  without  the  least  Lenefit.  The  fit  was  preceded  by 
weariness  and  a  feeling  of  pressure  on  the  cheat,  and  was  followed 
by  several  hours  sleep.  By  the  administration  of  a  teaspoonful 
of  common  salt  before  the  time  for  the  fit,  it  was  warded  off 
for  a  week.  By  the  continuation  of  this  treatment  (a  teaspoonful 
of  common  salt  every  mid-day)  the  case  was  cured,  at  least, 
the  patient  at  the  time  of  publication  of  the  case  had  had  no  fit 
for  seven  weeks.—  [Quoted  in  Ventrallblattf  Med.  WiMmtch^ 

Report  of  a  Case  of  Mallirnant  Cholera 

— in  wiiich  thirty-two  grains  of  Chloral -Hydrate  were  hypoder- 
mically  injected :  recovery. — Augustus  R,  Hall,  M.  R.  C.  S., 
Eng.,  reports  the  following  case  in  the  British  MedicatJoumal: 
M.  M.,  the  wife  of  a  soldier,  a  very  spare  woman,  aged  30, 
the  mother  of  four  children,  was  carried  to  the  Female  Hospi- 
tal, Fortress  Gwalior,  about  three  o'clock  in  the  afternoon  of 
October  27th,  1877,  suffering  from  Cholera.  From  a  state- 
ment subsequently  made  by  herself,  it  appears  that  on  that  same 
L morning  she  was  feeling  well  till  after  breakfast.  About  11 
o'clock  she  felt  uncomfortable  and  oppressed,  and  laid  herself 
on  her  bed.  She  went  to  sleep,  and,  about  1  o'clock,  woke  up, 
and  found  that  copious  watery  evacuations  were  literally  flowing 
from  her,  and  saturating  her  bedding.  Vomiting  and  cramp 
soon  set  in,  and  her  husband  then  sent  for  a  dooly^  and  had  her 
conveyed  to  the  hospital.  On  admisBion  she  had  the  usual 
symptoms  of  well-marked  collapse.  The  akin  was  cold,  lips 
blue,  eyes  sunk,  tongue  and  breath  cold,  finger-ends  shrivelled, 
voice  sepulchral  ;  the  pulse  could  not  be  felt  at  the  wrist,  nor 
even  in  the  brachial  artery.  As  she  was  a  very  thin  woman,  it 
could  iiave  been  easily  felt  there  if  it  had  been  present.  There 
■were  cramps  in  the  hands  and  feet,  and  a  good  deal  of  vomit 
ing.  but  not  very  much  purging.  The  temperature  in  the  ax- 
illa was  95.2  degs,  Fahr.  On  examining  the  thorax  by  percus- 
sion, it  was  found  that  the  usual  area  of  cardiac  dulness  emitted 
a  resonant  sound.  On  apf>lication  of  the  stethoscope,  the  beat- 
ing of  the  heart  could  be  scarcely  heard,  and  at  times  seemed 
lost  ;  but  respiration  was  detected  over  the  part  of  the  chest 


BRtTIsn   AND  "PimEION    JOURNALS.  135 

Shortlj  after  admission,  one  Bcruple  of  chloral-hydrate,  dis- 
solved in  three  ouDces  of  water,  waa  given  by  the  mouth,  but 
iraa  rejected  ;  it  was  therefore  determined  to  adminiBter  that 
drug  Bubcntaneoualj  at  once.     At  4  o'clock  p.m.,  six  grains  of 
chloral,  dissolved  in  sixty  minims  of  water,  were  injected  into 
the  aabitance  of  the  left  deltoid  muscle  in  the  following  manner  : 
A.^  the  hypo.lermic  syringe  employed  held  only  twenty  minims, 
coutuniag  two  grains  of  chloral,  the  point  of  the  cannula  was 
pMBeil  through  the  skin  and  into  the  muscle  perpendicularly  for 
alwnt  the  depth  of  one  inch  ;  the  ayringe  was  then  emptied,  and 
the  cannula  was  withdrawn  until  its  point  reached  the  areolar  tia- 
sne,  but  was  not  withdrawn  througt  the  skin.      It  was  then 
Clirust  in  a  slanting  direction  at  about  an  angle  of  forty-five  de- 
grees into  another  portion  of  the  muscle.     The  cylinder  of  the 
cyringe  was  then  unscrewed,  filled  with  twenty  minims  of  the 
solntion,  screwed  on  to  the  cannula,  and  again  emptied.      The 
point  was  then  plunged  into  the  muscle  in  an  opposite  direction, 
aid  twenty  more  minims  injected.     By  these  means  sixty  drops 
of  the  solution  were  injected  into  three  different  portions  of  the 
muscle  with  only  one  puncture  through  the  skin,  thus  lessening 
the  chance  of  irritation  of  the  cutaneous  nerves.     These  details 
are  given  thus  minutely,  as  a  strict  attention  to  them  is  consid- 
ered a  very  essential  part  of  the  metliod  of  treatment  recom- 
mended. 

Observations  were  taken  with  the  clinical  thermometer  in  the 
axilla  every  twenty  minutes.  Half  an  hour  after  the  first  ope- 
ration, sixty  more  minims  of  the  solution  were  put  into  the  del- 
toid muscle  of  the  right  arm  in  the  manner  described  above. 
The  temperature  in  the  axilla  now  began  to  rise  steadily. — By 
6  o'clock,  eighteen  grains  of  chloral  in  180  minims  of  water  had 
been  injected  through  three  cutaneous  punctures,  and  the  ther- 
mometer registered  97. W  degs.  Fahr.  The  cramps  had  ceased 
hy  this  time,  and  the  vomiting  was  much  leas.  Some  serous 
evacuations  had  been  passed. — At  7  o'clock,  she  passed  a  small 
quantity  of  urine.  Four  grains  more  chloral  were  injected  into 
a  muscle,  the  left  pectoral. — At  8  o'clock,  tlic  temperature  was 
98  degB.  Fahr. — Soon  after  9  o'clock,  she  had  a  motion  of  serum 


136 


CANADA   HSDIOALr   AND   SPBaiOAL   JOUBNAL. 


slightly  tdnged  with  bile.  The  pulse  wae  now  felt  for  the  first 
time  in  the  brachial  orterj,  and  the  heart-sounds  were  louder. 
She  complfuned  of  intense  thirst  all  the  time,  for  which  she  had 
as  much  cold  water  to  drink  as  she  liked,  quite  irrespectively  of 
the  Fomiting  ;  at  Uiiies,  she  had  a  little  soda-water  for  a  change. 
On  a  few  occasions,  the  water  sbe  drank  was  slightly  acidulated 
with  dilute  aulj>huric  acid.  This  she  liked,  at  intervals,  as  she 
stud  "it  cleared  the  mouth". — At  10  o'clock,  the  teraperafcure 
fell  a  little,  being  recorded  at  97.8  degs.  Fahr.  ;  and,  shortly 
afterwards,  six  grains  more  chloral  were  injected  into  one  gluteal 
muscle.^ — At  midnight,  four  more  grains  were  injected  into  the 
other  gluteal  muscle  ;  so  that,  within  eight  hours,  she  had  thirty- 
two  grains  of  chloral  injected  altogether. 

At  4  o'clock  a.m.,  (Oct.  28th),  the  temperature  was  marked 
98,2  degs,  Fahr.,  and  she  had  some  sleep.  The  liquid  motions 
were  now  pretty  well  covered  by  bile. — At  7  o'clock  a.  m.,  the 
pulse  could  be  felt  in  the  radial  artery,  82  jier  minute  ;  respi- 
ration 20.  She  was  drowsy,  apparently  from  the  etfects  of  the 
cholar.  but  could  be  easily  roused,  and  answered  questions. 
The  voice  was  still  very  sepulchral  and  eyes  sunk  ;  tongue  and 
breath  not  so  cold.  She  was  drinking  water  continually,  moat 
of  which  she  retained.  The  temperature,  which  was  now  taken 
every  two  hours,  varied  between  97,4  and  98.2  degs.  Fahr. — 
At  1  o'clock  p.m  ,  she  passed  some  urine.  Liquid  bilious  stools 
were  repeatedly  passed  during  the  afternoon. — At  6:30  p.  m., 
she  said  she  would  like  "  a  good  sleep",  and  one  scruple  ot 
chloral  in  three  ounces  of  water,  and  some  syrup,  was  given  by 
the  mouth,  which  she  kept  dowa  She  had  2  hours'  sound  sleep. 
At  8:S0  pm.,  the  temperature  was  normal ;  she  had,  altogether, 
a  good  night.  The  urine  that  she  passed  was  tested,  and  found 
to  contain  a  quantity  of  albumen.  The  heart-sounds  had  gradu 
ally  became  normal. 

On  the  sixth  day  after  the  attack,  the  temperature  rose  to 
100.6  degs.  Fahr.,  but  never  higher,  so  that  she  can  hanlly  be 
said  to  have  had  any  secondary  fever.  Some  quinine,  however, 
in  five-grain  doses  was  given,  but  more  as  a  precautionary  mea- 
Bui-e.     Sbe  was  fed  with  plenty  of  milk,  chicken-broth,  and  beef- 


BRITISH   AND    POEEION  JOtrBNALS.  137 

tei,  vhsn  reactioo  was  established,  but  bad  no  stimulant  what- 
ever notil  3,  few  days  before  she  went  out  of  the  hospital  (on 
November  13th),  when  a  little  brandv  and  soda-wat-er  were  al- 
lowed. At  the  places  vfhere  the  injections  had  been  given,  there 
wa.t  a  little  auper6cial  redness  and  tenderness  for  u  few  days  ; 
but  some  mild  arnica  lotion  was  applied  to  the  skin,  and  no  furtho  r 
incoLteaience  resulted.  She  made  a  verjr  good  recovery ; 
aod,  mare  than  four  months  afterwards,  is  in  good  health,  and 
has  Bbwn  no  ill  effects  whatever  on  the  result  of  the  disease. 

KEHjiaKS. — Although  the  [larticulars  here  given  are  only 
tho^e  of  a  solitary  case,  atill  they  may  be  worth  publication  in 
the  pages  of  the  British  Medical  Journal.  At  all  events,  they 
apparently  show,  that  a  very  considerable  quantity  of  a  powor- 
fal  vascular  depressant,  like  chloral-hydrate,  can  be  introduced 
into  the  system  during  the  cold  stage  of  cholera  without  doing 
any  harm.  And  this,  taken  in  conjunction  with  the  fact  now 
generally  recoijQised,  that  alcoholic  stimulants  do  positive  injury 
in  that  stage,  may  give  some  indication  as  to  the  con-ect  princi- 
ple of  treatment  that  is  required. 

Without  going  into  the  different  symptoms  enumerated  above 
to  this  paper,  the  writer  desires  to  invite  particular  attention  to 
two  of  them,  viz.,  the  resonant  sound  emitted  by  the  usual  area 
of  canliac  dulness,  and  the  almost  total  absence  of  the  sounds 
of  the  heart,  and  ventures  to  give  the  following  attempt  at  an 
explanation  of  their  causation. 

From  personal  experience  of  an  attack  of  cholera,  the  wiiter 
feels  convinced  that  at  the  commencement  the  contractions  of 
the  heart  become  more  forcible,  the  calibre  of  the  arteries  be- 
ar, and  there  is  generally  increased  arterial  tension, 
robably  caused  by  excessive  stimiJation  of  the  vaso-motor  cen- 
As  the  cold  stage  becomes  intensified,  the  spasm  of  the 
icnlar  walls  of  the  heart  is  so  strong  that  there  is  almost  a 
mtinuous  systole,  the  diastole  not  being  allowed  to  take  place 
Jr  as  to  dilate  the  cavities  as  in  health.  It,  therefore,  occupies 
il  smaller  space  than  usual,  and  the  first  sound  is  only  faintly 
heard,  the  second  being  indiscernible.  Then,  the  whole  of  the 
arterial  muscular  fibres  being  also  in  a  state  of  contraction,  it 


AND   StTRGICAL    JOrRNAL,     ^^^B 

has  occurred  to  the  writer  that  the  heart  may  be  pulled  upwards 
aad  baukwardij  to  a  alight  extent  by  the  aorta,  thus  allowiog  a 
portion  of  tlie  lung  to  occupy  its  usaa!  position.  We  are  toti. 
by  minute  anatomists,  that  the  small  arteries  are  very  contrftct* 
ile,  and  that  the  large  ones  are  very  elastic,  but  possesses  littlfr 
coatractihty.  But  it  may  happen,  that  the  iatenae  stimutatioi^ 
to  which  the  aorta  is  thus  sapposed  to  be  subjected,  may  cauM 
it  to  contract  the  heart  in  the  manner  indicated.  The  hearij 
therefore,  may  be  so  contracted,  and  occupy  such  a  much 
smaller  space  than  normal,  that  a  portion  of  the  lung  may  get  ta 
front  of  it,  and  occasion  the  resonant  sound  heard  on  percussion. 
However,  whether  this  may  be  an  approach  to  the  truth  oi 
not,  the  fact  may  be  tested  repeatedly,  that,  in  deep  cholerj 
collapse,  the  heartrsounds  are  not  heard.  There  are,  in  ad 
dition,  the  cold  skin,  and  no  palae,  or  very  little,  felt  in  th< 
usual  localities.  Now  this  state  might  be  brought  about  if  th4 
heart  were  in  a  state  of  diastole  when  there  nrould  be  true  ayoi 
cope.  But  if  this  were  the  actual  condition  in  cholera,  it  i 
be  affirmed  that  alcohol  would  do  good  instead  of  harm  ;  as  it  is 
universally  admitted  that,  where  there  is  real  atony  of  the  heart, 
alcoholic  stimulants  produce  a  temporary  benefit.  But  if.  a 
supposed  here,  the  heart  be  in  a  condition  of  almost  continuous 
systole,  not  dilating  sufficiently  to  allow  much  blood  to  enter  its 
cavities  from  the  gorged  veins,  and  the  arteries  be  so  reduced 
in  diameter  aa  not  to  allow  that  little  blood  to  Sow  properly- 
through  them,  then  the  administration  of  alcohol  would,  it  a 
presumed,  do  hai-m,  which  ezperienoe  has  shown  to  be  the  case. 
Hence,  ajiparently,  a  state  of  pulselessness  mayjbe  produced  hj 
two  opposite  conditions  ;  in  one  of  which,  where  there  is  sya^ 
cope,  stimulants  do  good ;  in  the  other,  as  cholera  collapse,  thej 
do  absolute  harm. 

Turning  now  from  theory  to  practice,  there  are  a  few  point! 
which  must  be  attended  to  by  those  who  may  use  chloral  3ub> 
,  cutaneously  in  cholera.  The  strength  of  the  solution  employee 
may  be  laid  down  at  one  in  ten  ;  if  it  be  stronger  than  this, 
it  will  probably  cause  great  irritation,  ulceration,  or  eveo 
sloughing  (as  it  has  done  in  some  cases).      Besides,   if  the 


BRITISH  AND  FOREIQN  JOURNALS.  139 

specific  gravity  of  the  solution  be  too  high,  it  will  probably 
not  be  absorbed  as  it  ought  to  be. 

Then,  as  to  the  mode  of  injecting  :  it  is  most  strongly  recom- 
mended that  the  solution  should  be  put,  not  merely  under  the 
8kin,  but  into  the  substance  of  a  muscle.      In  cholera-collapse, 
where  the  skin  is  cold,  absorption  may  be  said  to  be  reduced  to 
aminimom,  and  the  drug  employed  may  lie  inert,  if  it  be  not 
introduced  as  deep  into  a  muscle  as  is  consistent  with  safety 
Mr.  Higginson,  lately  chief  surgeon  of  Kheri,  in  Oudh,  in  his 
report  of  cases  treated  by  him,  published  in  the  Supplement  to 
the  Q-azette  of  India^  February,  14th,  1874,  of  which  seventeen 
out  of  nineteen  recovered,  writes,  "  The  injections  were  made 
in  the  arms  and  thighs,  the  cannula  of  the  syringe  being  plunged 
pretty  deeply  into  the  flesh";  and,  in  a  letter  to  the  Indian 
Medical  Q-azette^  which  appeared  in  the  October  number  for 
1873,  he  writes,  '^  I  think  it  is  essentially  necessary  to  plunge 
the  cannula  deeply  into  the  flesh  ;  merely  inserting  its  point  un- 
derneath the  skin  will  not  do."     It  does  not  appear,  even  after 
this  advice,  that  this  precaution *has  been  taken  by  those  who 
have  useci  chloral  hypodermically. 

In  conclusion,  the  writer  emphatically  recommends  the  fol- 
lowing course  of  treatment  in  cholera.  *  When  premonitory 
diarrhoea  is  observed,  let  all  alkalies  and  opium  be  specially 
avoided,  as  well  as  alcohol.  Dilute  sulphuric  acid,  in  half  a 
drachm  to  drachm  doses,  in  a  bottle  of  gingerade  or  some  syrup 
and  water,  diluted  as  much  as  will  only  give  a  strong,  but  not 
diaagreeably  acid  flavour,  will  probably  be  found  the  best  thing 
to  take,  as  often  as  may  be  required. 

If  collapse  should  set  it,  or  the  patient  be  firsf^  seen  in  that 
stage,  inject  at  once.  Let  the  clinical  thermometer  determine 
the  amount  of  chloral  to  be  administered.  The  lower  the  read- 
ings, the  faster  the  injections.  It  may  be  yet  proved,  in  very 
severe  cases,  when  the.  temperature  is  down  nearly  to  90  degs. 
Fahr.,  that  as  miich  as  one  drachm  of  that  drug  may  be  neces- 
sary before  a  decided  effect  is  produced.  Take  frequent  obser- 
vations with  the  thermometer,  and  be  guided  by  it.  Give  the 
patient  plenty  of  cold  water  (no  ice)  to  drink.     Never  mind  if 


140 


CANADA   MEDICAL   AND   SURnJCAI.   JOURNAL. 


it  should  be  rejected  ;  it  relieves  the  great  thirst.  But  do  not, 
under  any  circumstance,  give  aoy  wiae,  spirits  or  opium.  We  | 
Bometimes  hear  of  the  sedative  action  of  opium  ;  hut,  perhaps, 
this  term  may  tend  to  mislead  as  to  its  real  therapeutic  effects*  1 
Poiaoiioiis  do^es  of  the  true  sedatives,  as  poiuted  out  manj  I 
years  ago  by  Dr.  Headland,  produce  death  by  syncope.  Opium  I 
causes  death  hy  coma  apnoea  It  is  a  stimulating  narcotic,  J 
according  to  Dr.  John  Harley. 

Should  reaction  be  established,  milk,  nourislung  soups  and  I 
broths,  and  afterwards  more  solid  food,  may  ho  constantly  given .( 
in  gradually  increasing  ijuantitieB.  Not  even  then  it  is  rccom-  ] 
mended  that  alcohol  be  prolilbited  until  convalescence  ia  assured. 

If  secondary  fever  should  manifest  itaelf,  then  quinine,  accord-  I 

ing  to  circumstances,  by  the  mouth,  or  hypodermic  ally,  if  the  I 

stomach  will  not  hear  it.     The  neutral  sulphate  is  now  always  I 

used  in  India  for  injections.     Again,  let  the  clinical  thennotna-  I 

_  ter  be  the  guide  ;  the  higher  the  body-heat,  the  more  qiunine.  | 

LTlie  writer  earnestly  begs  those  of  the  readers  of  this  paper 
vho  may  have  opportunities  to  carry  out  all  the  details  recom- 
mended above,  and  hopes,  in  spite  of  adverse  statements,  that 
the  treatment  ailvocated  may  be  attended  with  success.  At  all 
events,  he  trusts  that  these  remarks  may  be  the  means  of  in- 
ducing medical  men  to  give  the  method  a  complete  trial,  and 
that  rejjorts  tbat  may  be  published  before  long  may  settle  defin- 
itely the  question  whether  in  chloral-hydratfi  we  have,  or  have 
not,  a  remedy  of  efficacy  in  malignant  cholera. 
Fe 
bal 
ira 
urt 
ext 
the 


Ruptured  Pericardium  ;  Fractured 
Pelvis,  and  Ruptured  Urethra.— lUciiiei  the 

e  of  Dr.  Puzby) — R.  M.,  aged  forty-eight,  was  admitted  on 
Feb.  27th,  1878,  having  been  knocked  down  and  cmshed  by  a 
bale  of  cotton  striking  him  on  the  hack.  The  diagnosis  wna, 
fracture  of  both  pubic  bones,  with  rupture  of  membraneous 
urethra.  There  was  considerable  haemorrhage  frtim  urethra  ; 
extravasation  of  blood  slight.  He  complained  of  great  pain  in 
the  cardiac  region  :  and  had  an  incessant  painful  cough  and  a 
markedly  anxious  expression. 


BRITieH   AND    FriRf.ION   JorHNALS.  141 

A  broad  belt  was  firmly  applied  round  the  pelvis,  a  gum-elaatic 
catheter  was  tied  in  the  uretlira,  and  a  stimulating  expectorant 
mislnre  was  given. 

Furaweek  after  admission  there  was   oonaidbrablc   rise  of 
temperature.  '   Examination  showed  alight   pneumonia.      The 
patient  would  take  only  warm  fluids.  The  catheter  was  removed 
on  the  tjlh  March,  and   he  could  then  pass  water  without  diffi- 
cult;.   Temperature  became  quite  norma!  on  the  lOtb  March, 
Slid  continued  so  until  the  25th,  when  pleurisy  and  pericai-diiia 
developed;  and  be  died  on  the  27th,  a  month  after  admission. 
Nfcropfry. — Thorax :  There   waa    recent   pleurisy    in  both 
pIpilRE.     The  right  side  contained  six  ounces  of  serum,  the  left 
three  mmces,  and  there  were  effusion  of  lymph  over  a  large  ex- 
lent  of  both  lungs.     There  were  (edema  and  congestion  of  the 
lung.   The  pericardium  showed  evidence  of  a  rent  through  the 
whole  length  on  the  left  side.   The  state  of  parts  was  as  follows : 
Ou  removal  of  the  sternum  nothing  abnormal  was  noted,  hut  on 
Ifyiiig  to  raise  the  anterior  part  of  the  left  lung  from  the  peri- 
cardium,  it  was  found  to  be  adhei'ent  by  its  anterior  margin,  and 
^^  aateriorly  was  thinned  out  and  insinuated  around  and  behind  the 
^^L-ipei  of  the  heart.     These  adhesions  were  readily  broken  up  hy 
^^Btfae  finger,  and  then  entire  absence  of  pericardium  proper  from 
^y  the  left  side  of  heart  was  manifest,  and  tho  internal  surface  of 
^^  left  limg  acting  as  pericardium.     It  waa  now  seen  that  the  an- 
terior margin  of  the  left  lunghafl  adhered  to  the  retracted  right 
_      border  of  the  pericardial  rent ;  and  that  the  loft  aide  of  the 
_  ruptured  pericardium  appeared  as  a  band  three  <|uarterB  of  an 
*!icL  broad,  running  parallel  with   the  long  axis  of  the  body, 
behind  about  the  middle  part  of  the  heart,  and  presenting  a  free 
border.     The  [lortion  of  lung  pleura  in  contact  with  the  left  side 
Fof  the  heart  had  not  undergone  any  alteration  in  appearance. 
I  In  this  improvised  pericardium  there  was  over  an  ounce  of  tur- 
Plid  aerura,  and  there  waa  a  layer  of  recent  lymph  on  the  heart 
'  and  parietal  surfaces. — Abdomen :  There  was  fractui-e  of  both 
pubic  bones,  each  being  separated  into  three  pieces,  and  the 
pubic  part  of  actebellum  was  fractured  without  displacement 
Union  waa  iiretty  firm,  and  there  waa  a  large  amount  of  callus. 
llierc  was  separation  of  the  left  sacro-iliac  aynchondrosis,  with 
fracture  of  tho  left  ala  of  the  sacrum.    There  was  blackening  of 
all  the  parts  in  false  pelvis.  A  clot  lay  behind  the  posterior  wall 
— ^  the  membranous  urethra,"  and  there  was  evidence  of  alight 
lapture  in  the  posterior  wall.     The  kidneys  together  weighed 
'2  08. ;  the  liver  i  lb,,  and  waa  fatty. —  The  Lancet. 


Htflical  antl  ^ntgiwl  fotttnal. 


Montreal,  October,   i8 


THE  RECOGNITION  OF  COLONIAL  DEGREES. 

Legislation  in  Great  Britain  in  matters  medical  has  ao  far 
miacarried,  that  recognition  of  Foreign  and  Colonial  degreoa 
is  for  the  present  deferred.  To  thia  we  do  not  take  exception. 
While  we  believe  it  politic  tn  recognise  iegrees  hailing  from  the 
institutions  of  this  Dominion,  we  do  notre<;ard  it  as  so  urgently 
necesBarj  as  to  demand  immediate  action  without  due  and  care- 
ful consideration. 

We  have  heard  arguments  against  colonial  recognition,  urged 
with  the  utmost  narrow-mi  tidedness,  this,  in  a  great  measure, 
proceeding  from  an  absolute  ignorance  of  the  nature  and 
character  of  our  institutions,  sometimea  even  of  their  geogra- 
phical position. 

The  mistiness  which  exists  in  some  British  minds  touching  any- 
thing American  or  Canadian  is  very  surpassing.  Especially  ia 
this  the  case  in  the  present  day  when  the  means  of  transit  to 
and  fro  have  been  so  facilitated  that  a  man  can  run  over  the 
entire  continent  of  North  America,  almost  from  the  pole  to  the 
southernmost  pointof  the  Gulf  of  Mexico,  and  from  the  Atlantic 
to  the  Pacific,  and  return  to  his  native  Island  home,  in  a  sur- 
prisingly short  space  of  time,  without  much  fatigue,  and  at  com- 
paratively trifling  cost.    The  manners  and  customs  of  a  people, 


THX  REOOONITION  OF   COLONIAL   DECREES.  143 

and  the  character  of  their  educational  STstem  are  better  learnt 
by  personal  intercourse  than  bj  any  amount  of  book  lore. 

We  are  all  working  in  the  same  groove,  all  anxious  to  elevate 
the  standard  of  our  profession  for  the  benefit  of  the  human 
family,  but  we  doubt  much  if  this  result  will  follow  a  system- 
matic  abuse  and  misrepresentation  of  schools  and  colleges,  of 
which  fi^equently  the  self-imposed  authority  has  no  absolute 
knowledge.  It  is  painful  to  observe  the  repeated  gaucheries^ 
perpetrated  by  the  medical  press  and  by  contributors  in  the  way 
of  correspondents.  There  are  many  facts  connected  with 
Canadian  Universities  which  are  entirely  ignored,  whether 
unintentionally  or  with  a  direct  object  we  cannot  say. 

The  Canadian  Universities,  three  in  number,  in  this  Province, 
all  hold  Royal  charters,  and  the  privileges  granted  under  these 
charters  are  the  same  as  those  granted  to  the  Universities  of  the 
Mother  country.  Where  then  lies  the  difference  ?  The  preli- 
minary examinations  are  equally  stringent,  the  curriculum  of 
medical  study  is  the  same  as  that  in  British  Universities  and 
Colleges,  and  the  professional  examinations  are  a  literal  copy  of 
the  method  of  testing  the  candidate  followed  by  those  institu- 
tions. In  nearly  all  our  schools  the  professorial  chairs  are  hell 
by  British  Graduates.  But  to  add  to  the  security  of  the  public 
that  the  work  is  systemmatically  and  faithfully  performed,  the 
Provincial  Medical  Board  have  introduced,  under  act  of  our 
Local  Legislature,  a  method  of  visitation.  Two  members  of  the 
College  of  Physicians  and  Surgeons  of  the  Province  of  Quebec, 
are  appointed  by  the  Board  to  visit  and  attend  the  Medical 
examinations  of*  the  various  Universities,  Colleges  and  incorpor- 
ated medical  schools  of  the  Province,  and  who  shall  report  to 
the  Provincial  Medical  Board  upon  the  character  of  those 
examinations.  Those  visitors  or  assessors  cannot  be  chosen 
from  among  the  teachers  or  professors  of  any  of  the  Univer- 
sities, Colleges,  or  Medical  Schools.  Laxity  in  the  work  done, 
in  the  examination  of  candidates,  if  reported  on,  the  Provincial 
Medical  Board  has  the  power  to  refuse  registration  of  the  degree 
or  diploma  of  the  institution  so  reported  against,  until  such  a 
method  of  examination  shall  have  been  amended. 


144 


tAWADA    MKIUCAI.    ANB    StlBOICAI.   JOllBNAL. 


This  19  the  la' 


t  ewBts  in  thiB  I'rovince  and  as  it  i 

miniatered.  In  what  relative  position  do  the  inatitutions  of 
Great  Britain  stand  with  reference  to  this  law  ?  Graduates 
and  Licentiates  of  the  Universitiea  and  Colleges  of  Great  Brit- 
ain and  of  France  are  admitted  to  registration  on  what  their 
credentials  set  forth,  without  examination.  The  Act  is  so  far 
liberal  that,  although  it  compels  visitation  to  our  own  colonial 
schools,  it  accepts  in  good  faith  the  examinations  of  British  and 
French  sohools  without  question.  But,  although  this  is  the 
practical  working  of  this  local  act,  it  may  not  be  retained  in  its 
present  integrity.  There  is  a  growing  interest,  a  desire  to  have 
the  institutions  in  this  country  recognized  for  all  they  are  worth. 
We  should  be  sorry  to  have  to  chronicle  any  change  in  our 
law,  with  a  view  to  ignore  all  foreign  degrees — be  they  from 
Great  Britain  or  elsewhere.  Such  a  scheme  wai  proposed,  but 
did  not  carry ;  it  might  be  again  brought  up  and  become  the  lav 
of  the  land. 

It  should  be  remembered  that  in  all  matters  of  educational 
interest,  we  possess  the  right  of  legislating  for  ourselves.  W« 
should  be  very  sorry  to  see  any  such  system  of  esclusion 
adopted,  yet  it  must  be  confessed  that  nothing  is  more  likely  to 
follow,  if  a  good  lead  is  given  us,  the  cxchisiun  first  coming  from 
the  other  side.  Each  year  we  become  of  greater  importance 
on  the  world's  face,  because  we  are  a  growing  country,  with 
abundance  of  room  for  a  population  of  forty  times  our  present 
linut.  The  country  is  being  steadily  but  gradually  opened  up 
and  there  are  local  interests  at  stake  which  will  without  doubt 
in  time  attract  attention.  Our  youths  can  not  be  shut  out  from 
serving  their  country  or  fellow  man  in  any  capacity.  If,  through 
the  enterprise  of  Canadians,  hues  of  steamships  are  estahlished 
between  Canadian  ports  and  those  of  Great  Britain  or  any  other 
country,  it  would  bo  hard  indeed  to  refuse  service  to  a  young 
Canadian  surgeon,  simply  because  he  did  not  hold  a  British 
qualification.  Yet  this  has  been  done,  but  we  trust  will  never 
be  again  repeated. 


CANADA 


Medical  &  Surgical  Journal 


NOVEMBER,  1878. 
©riginal  eommunixjations. 

INTRODUCTORY   ADDRESS,  ON  BEHALF  OF  THE 
MEDICAL  FACULTY,  McGILL  UNIVERSITY, 

October  iBt,  1878. 
By  Thomas  G.  Roddick,  M.D., 

Pbofissob  of  Clinical  Subgebt. 

Gbcttlembn, — In  compliance  with  a  custom  honoured  by  time 
and  sanctioned  by  experience,  I  am  here  to-day  on  behalf  of  my 
colleagues  to  extend  a  warm  and  hearty  welcome  to  the  students 
of  this  Faculty  ;  and  at  the  same  time  to  offer  to  you  who  are 
beginning,  and  to  you  who  are  resuming  your  studies,  some  words 
of  advice  as  to  their  management.  To  many  of  the  latter  among 
you  the  "  introductory "  is  a  thrice-told  tale,  so  that  my 
remarks  will  be  directed  in  great  part  to  those  before  me  who 
are  about  to  enter  upon  the  study  of  medicine,  or  who,  at  all 
events,  occupy  these  seats  for  the  first  time. 

And  first  allow  me  to  congratulate  you  on  the  choice  of  a 
profession,  for,  while  it  is  one  of  the  most  laborious,  and  the  most 
self-sacrificing,  it  ranks  amongst  the  noblest,  the  most  important, 
and  at  the  same  time  the  most  interesting  of  all  the  occupations 
to  which  the  highest  human  endeavors  are  turned.  Although  you 
will  nevex,  from  the  pure  practice  of  medicine,  amass  the  enor- 
mpus  wealth  of  many  who  engage  in  trade,  still  a  fair  compe- 

NO.   LXXVI.  10 


146 


CANADA   UEDICAL    AND    BCRQICAIi   JOURNAL. 


tency  may  always  be  yours,  and  a  share  of  that  worldly 
distinction  of  which  all  are  more  or  less  ambitious.  You  have 
a  great  and  glorious  work  before  you,  namely,  to  relieve  suffer- 
ing, and  to  put  back  death, — and  see  to  it  that  you  prepare  your- 
self well  for  the  fight,  else  your  defeat  is  certain,  and  may  be 
moat  diaastrous.  When  it  is  coaaidored  what  dire  consequences 
may  follow  even  a  comparatively  trifling  error  in  the  practice  of 
medicine,  is  it  to  be  wondered  at  that  teachers  show  such  anxiety 
to  be  thoroughly  understood,  and  that  eicamlnera  often  appear 
BO  exacting?  They  feel,  and  moat  naturally  too,  the  grave  res- 
ponsibility of  their  re^^pective  positions  ;  and  between  them  and 
the  public  a  tacit  underatanding  exists,  regarding  the  qualifiDa- 
tions  of  those  who  are  to  minister  to  their  wants  when  laid  low 
by  accident  or  disease. 

You  are  fortunate  in  entering  upon  the  study  of  medicine  at 
this  time.  Medicine  is  advancing  with  gigantic  strides  in  every 
direction ;  connections  with  the  kindred  sciences  are  being 
made  daily,  new  lines  of  enquiry  are  being  opened  up,  and 
problems  hitherto  not  dreamt  of  are  pressing  forward  eagerly 
for  solution,  so  that  the  hum  of  a  busy  and  fruitful  activity  is 
pervading  all  its  ranks.  Medicine  ia  acknowledged  on  all  hands 
to  have  made  a  greater  advance  in  the  past  twenty  years  than 
in  the  century  before.  Men  representing  every  department  are 
now  busily  at  work.  Where  before  chemists  and  pbysiotogiate 
alone  occupied  the  dark  lanes  of  research,  we  now  find  the 
agents  of  pathology  and  therapeutics  pushing  eagerly  forward 
in  the  van,  and  with  the  aid  of  experiment,  wiping  out  old  and 
fusty  traditions.  The  latter,  especially,  which  has  been  well- 
likened  to  a  lazy  hoy  always  lagging  behind  his  fellows,  will  ere 
long  have  burst  the  rusty  bars  that  confine  him,  and  reach  that 
seat  in  the  science  of  medicine  that  has  been  vacant  so  long. 
Tou  may  plead,  and  with  some  reason,  too,  that  on  account  of 
these  advances,  the  work  in  store  for  you  will  be  greater  than 
that  required  of  your  predecessors.  That  ia  true,  but  only  in 
part,  for  whereaa  the  amount  of  ground  to  be  surveyed  is  now- 
Brdaya  greater  in  extent,  the  facility  and  accuracy  of  research 
have  more  than  proportionately  increased.     Wtat  would  your 


nrmoDXJCTORY  address. — ^by  dr.  roddick.  147 

predecessors  of  even  ten  years  ago,  not  have  given  for  a 
taste  of  the  opportunities  in  store  for  you  in  connection  with  the 
subject  of  physiology  alone  !  Whereas  they  had  to  be  content 
with  rough  plates  and  diagrams  in  the  elucidation  of  those  great 
functions  on  which  life  depends ;  these  will  be  made  clear  as 
noon-day  to  you  by  experiment,  and  by  the  use  of  the  micros- 
cope, and  other  physiological  apparatus. 

Your  curriculum,  certainly,  has  a  formidable  appearance, 

judging  from  tho  number  and  extent  of  the  subjects  it  contains, 

but  these  will  be  found  to  blend  or  dovetail  the  one  into  the 

other  so  intimately  that  after  a  time  the  work  becomes  less 

onerous  than  it  appears  at  the  first  glance.  The  business  before 

you  is  undoubtedly  great,  but  not  greater  than  may  be  eflfected 

with  pleasure  and  confidence.     As  you  will  doubtless  have 

gathered  from  the  annual  announcement  of  the  Faculty,  certain 

changes  have  been  made  in  the  programme  of  the  course,  to 

come  into  operation  this  session.  It  is  to  be  hoped  that  students 

will  fall  in  with  the  new  arrangement,  as,  in  the  words  of  the 

announcement,  by  means  of  it  "  a  certain  definite  amount  of 

work  must  be  accomplished  in  each  year,  and,  moreover,  an 

equitable  division  is  made  between  the  Primary  and  Final 

branches."     The  subjects  which  will  especially  engage  your 

attention  during  the  first  two  years  of  your  studentship  are 

Anatomy,  Physiology,  Materia  Medica,  and  Chemistry. 

Anatomy  should  remain  throughout  as  one  of  the  great  cen 
tral  subjects  of  your  medical  studies.  It  has  been  well  repre- 
sented as  the  keystone  of  the  arch,  touching  at  the  same  time 
both  halves  of  your  work — medicino  on  the  one  hand,  surgery  on 
the  other — and  sustaining  the  whole  superstructure  securely  in 
its  place.  You  will  learn  your  anatomy  from  lectures  delivered 
in  the  class-room,  and  from  the  Demonstrators  in  the  dissecting 
room,  but  in  truth  the  latter  is  the  place  where  you  get  a  really 
practical  knowledge  of  the  subject.  The  Professor  of  Anatomy 
teaches  you  where  the  various  structures  and  organs  of  the  body 
are  to  be  found,  and  their  relations,  &c., — in  the  dissecting- 
room  you  make  them  out  for  yourselves  and  handle  them.  Not 
the  least  part  of  dissecting,  by  the  way,  is  the  handling  of  the 


148 


CANADA   MEDICAt    AND    BCKOICAL    JOOBNAL. 


health;  tissues,  among  which  you  are  working,  as  then  you  are 
in  a  better  position,  later  on  in  the  course,  to  recognise  diseased 
structure  as  met  in  the  autopsy-room.  Do  the  work  faithfully. 
In  dissecting  a  muscle  be  not  satisfied  merely  with  seeing  its 
belly,  but  trace  it  to  its  origin  and  insertion,  and  verify  your 
observations  by  constant  reference  to  the  skeleton.  Combine  a 
little  surgery  with  your  anatomy.  Study  out  the  actions  of 
muscles,  so  that  you  may  be  able  to  appreciate  fractures,  their 
deformities,  the  means  by  which  they  are  produced,  and  the 
mechanism  by  which  they  might  be  overcome.  Make  out  for 
yourselves  where  the  main  arteries  can  be  tied  with  greatest 
ease,  and  you'  will  find  invariably  that  there  tlic  surgeon  also 
would  look  for  them,  in  big  endeavour  to  arrest  hsemorrhage  or 
close  up  a  diseased  vessel.  Study  the  various  regions  of  the 
body,  such  as  the  neck,  the  armpit,  the  groin,  the  ham,  &c. 
The  anatomy  of  the  joints — their  various  hollows  and  promi- 
nences— should  receive  your  special  attention.  Make  constant 
use  of  the  black-hoard,  and  if  you  have  any  taste  for  drawing 
by  all  means  cultivate  it.  Make  outline  sketches  of  your  dis- 
sections and  complete  them  at  your  leisure.  Every  stroke  of 
your  pencil  or  brush  will  help  to  fill  another  pigeon-hole  in  your 
memory.  There  can  be  no  doubt  that  a  careful  drawing  of  a 
well-prepared  dissection  will  save  hours  of  book  drudgery,  and 
must  lead  to  clear  and  accurate  ideas.  But  it  is  later  on  when 
you  come  to  deal  with  morbid  growths,  deformities,  &c.,  that 
this  accomplishment  will  be  found  of  the  greatest  service.  I 
may  appear  to  lay  unnecessary  stress  on  this  subject,  but  I  feel 
BO  strongly  regarding  it,  that  I  hope  the  day  may  come,  and 
soon  too,  when  there  will  he  a  teacher  of  drawing  and  painting  ■ 
in  connection  with  every  well-equipped  school  of  medicine. 

As  anatomy  is  the  keystone,  so  Physioiogyis  the  chief  cor: 
stone  of  rational  medicine.     It  is  now  generally  conceded  that'l 
there  can  never  be  a  great  physician  who  is  not  at  the  same  time  i 
a  good  physiologist.     Devote  much  of  your  time  theu  to  physic  • 
logical  research.      Save   up  your   pocket  money  and  buy  a 
microscope,  so  that  you   raay  be  enabled  to  work  up  at  your 
leisure  the  subjects  that  will  be  brought  before  you  from  time 


INTKOOUCTOHT   ADDRE88, — BY    DR.    EODDIOK,  149 

to  time  in  the  lecture-room  and  in  the  laboratory.  Never  loae 
an  opportunity  to  compare  diaeaaed  with  healthy  structurea,  for 
then  morbid  anatomy  will  be  receiving  its  juat  share  of  your 
attention. 

Chemistry,  theoretical  and  practical,  is  a  aubject  that  will 

interest  you  much,  although  its  area  is  now  ao  vast  that  it  is 

hardly   possible   for    the   student   to  obtain  a   knowledge  of 

the  whole.     It  will   be   found  indispensable  in  your  study  of 

Physiology  and  Materia  Medica,  in  tbe  momentous  questions  of 

Forensic  Medicine,  such  aa  the  detection  of  poisons,  &c ,  and  in 

the  examination  of  secretions  at  the  bedside.  I  would  earnesdy 

^^^  adnse  the  study  of  the  laws  of  light,  heat  and  electricity,  as 

^^^Ctliey  will  be  found  later  on  to  occupy  prominent  positions  in  tbe 

^^^■fereatment  and  diagnosis  of  disease.     The  importance  of  electri- 

^^^V])3ty  and  galvanism  as  therapeutic  agents  for  the  relief  of  pain, 

^^^BUid  the  restoration  of  use  and  feeling  to  paralyzed  parts,  ia  now 

^^^pBlly  recognized. 

^^"  Materia  Medica  with  its  important  department  of  Therapeu- 
tics will  also  demand  considerable  attention  at  your  hands.  It 
la  to  be  regretted  in  this  connection,  that  the  old  system  of 
Apprenticeship  has  passed  away,  as  then  materia  medica  was 
•nabibed  aa  it  were  insensibly  ;  by  constant  handling  one  got  to 
Know  the  colour,  taate.  smell,  and  a  hundred  other  qualities  of 
'*'~»a.g3.  It  is  to  be  hoped  that  the  present  requirements  of  the 
faculty  regarding  Practical  Pharmacy,  will  meet  with  an  earnest 
'^apODse  from  you  all.  Some  knowledge  of  Botany  and  Zoology 
*ill  be  demanded  by  our  esteemed  Principal,  but  wliile  a  fair 
*^^a  of  either  of  those  subjects  is  expected  of  you,  it  is  not 
^**airable  that  they  should  engage  ao  much  of  your  attention  aa 
***  <;xt:!ude  the  more  important,  and  purely  professional  work. 
^^ile  here  may  I  be  allowed  to  express  the  hope  that  as  the 
S^neml  education  of  the  student  of.  medicine  continues  to  ira- 
P**OvB  (and  the  improvement  baa  certainly  been  vast  within  the 
'*«l  few  years)  these  may  with  benefit  be  placed  in  the  list  of 
^^^lijects  for  preliminary  examination. 

By  following  the  course  thus  laid  out  for  you,  you  plant  deep 
***d  firm  a  scientific  ground-word    for  the  study  of  those 


150 


CANADA   MEDICAL    AND   SCRaiCAL   JOURNAl 


disorders  of  structure  and  function,  which  is  to  be  your  ultimate 
special  work.  It  should  be  one  of  your  ehiefest  aims  to 
combine  in  proper  proportion,  science  and  art.  It  would  be  a 
mistake  in  a  man  who  aspired  to  becoming  a  practical  physician 
to  devote  all  his  time  to  the  study  of  chemistry  or  physiology 
alone ;  but  the  abuse  of  a  thing  ia  no  argument  against  its 
proper  use,  and  it  will  invariably,  be  found  that  he  is  the  best 
practitioner  in  the  end  who  builds  on  such  a  foundation  as  the 
due  study  of  the  subjects  I  have  just  reviewed  alone  can  give. 
The  mere  practical  man  will  be  found  full  to  overflowing  of  false 
pathological  theories  which  often  form  the  basis  of  a  mischevious 
treatment. 

As  your  object  then  ia  not  to  become  anatomists,  physiologiste, 
or  chemists  alone,  but  physicians  and  surgeons,  your  nest  place 
is  the  wards  of  the  hospital — that  "  romantic  region,"  which 
will  be  found  to  have  its  charms  for  all — young  and  old.  Here 
your  faculty  of  observation  will  be  brought  fully  into  play — not 
that  restless  prying  curiosity  that  begets  disappointment  and 
disgust,  but  a  calm,  careful  searching  after  facts  that  only  habit 
can  engender.  "You  don't  know"  as  a  recent  novelist  has 
aptly  put  it,  "  that  you  are  forming  a  habit ;  you  take  each  act 
to  be  an  indindual  act,  whicb  you  may  perform  or  not  at  yonr 
wiU  ;  but  all  the  same  the  saccession  of  them  is  getting  you  into 
its  power ;  custom  gets  a  grip  of  your  ways  of  thinking  as  well 
as  your  ways  of  living  ;  the  habit  is  formed  and  it  does  not  cease 
its  hold  until  it  conducts  you  to  the  grave."  The  habit  of 
is  not  intuitive  then  ;  it  has  to  be  acquired.  The 
you  wU!  spend  your  time  most  profitably  in  the  out- 
n  of  the  hospital,  where  you  will  learn  what  a  wound 
to  dress  it ;  what  an  ulcer  is  and  the  various  methods 
of  treatment.  You  will  have  an  opportunity  here  also  of  studying 
the  commoner  forms  of  fracture,  and  the  application  of  dressings 
for  their  relief.  Occasionally  visit  the  Ophthalmic  room,  where 
under  the  present  able  management  there  is  much  to  be  learnt 
by  the  youngest  of  you  in  connection  with  the  diseases  of  the 
Eye  and  Ear.  Do  not  attemj't  too  much,  however.  The  medical 
coses  will  yet  only  puzilo  and  fmt  you,  so  that  I  should  advise 


younger 

patio  nt  r 
is  and  he 


mTBODUCTORT  ADDRESS. — BY    DR.   RODDICK.  151 

yon  to  avoid  them  until  you  are  better  qualified  to  appreciate 
them.  In  the  meantime  stick  to  those  things  that  you  can 
see  and  handle,  and  your  pleasure  and  satisfaction  will  be  great. 
Gentlemen  of  the  Graduating  Class,  I  would  remind  you  that 
the  days  of  your  studentship  are  rapidly  drawing  to  a  close  ; 
and  it  is  to  be  sincerely  hoped  that  you  will  make  the  utmost 
possible  use  of  your  opportunities  for  acquiring  that  practical 
knowledge  which  is  so  essential  to  your  future  success.  Let 
your  labour  be  well  directed,  and  then  the  least  gifted  among 
you  may  expect  reward.  Buxton  says  :  "  The  longer  I  live  the 
more  I  am  certain  that  the  great  difference  between  men, 
between  the  great  and  the  insignificant,  is  energy,  invincible 
determination,  an  honest  purpose  once  fixed,  and  then  death 
or  victory."  It  is  one  of  the  greatest  improvements  in  the 
medical  teaching  of  the  present  day,  that  practical  instruction 
is  carried  to  such  a  high  pitch.  This  is  not  done  to  the  exclusion 
or  detriment  of  systematic  teaching,  but  the  one  is  made  a 
help-mate  of  the  other.  Thus  the  facts  yon  gather  from,  the 
systematic  chairs  of  medicine,  surgery  and  obstetrics,  are  all 
more  or  less  capable  of  verification  and  illustration  at  the  bed- 
side. You  are  admonished  then  to  be  much  in  the  wards.  It  is 
there  ttiat  you  educate  your  senses  to  appreciate  the  signs  of 
disease.  Tou  cannot  too  soon  get  into  the  habit  of  examining 
patients  for  yourselves,  for  this  is  really  to  be  your  life's  work. 
Touch,  handle,  listen  wherever  you  can ;  see  everything  you 
can  see  with  your  own  eyes,  do  everything  you  can  do  with  your 
own  fingers.  In  a  word,  practice  the  habit  of  minute  method- 
ized observation.  Any  notes  you  may  have  to  make  should  be 
jotted  down  at  the  time  of  observation,  else  they  hourly  become 
of  less  value.  Record  your  observations  in  the  fewest  words, 
and  in  the  plainest  terms.  I  would  here  remark  that  while  it  is 
not  practicable  for  every  student  to  become  a  clinical  clerk,  the 
cases  are  in  a  manner  the  property  of  all,  so  that  all  are  en- 
couraged to  report,  and  the  clinical  teachers  will  be  ever  too 
happy  to  render  any  assistance  in  their  power.  Despise  nothing, 
however  insignificant,  that  can  in  any  way  improve  your  know- 
ledge.   It  is  a  mistake  too  often  made  to  run  after  sensational 


152 


^OAMADA  UEDIOAL  AWt)  StTBOIOAL  JOUftNAt. 


casea, — curiosities  which  are  seen  perhapa  once  or  twice  in  t 
course  of  along  practice.  The  patients  who  are  most  likely  to 
consult  you  in  your  early  days  of  practice,  will  in  the  majority 
of  instances  suffer  from  those  ailmenta,  which  perhapa  in  your 
student  days  yon  looked  upon  as  trivial  and  unworthy  of'yoar 
consideration.  "  It  is  only  an  absceaa,"  one  student  was  over- 
beard  to  say  to  another  with  regard  to  a  case  on  which  some- 
remarks  were  being  made,  and  which  he  did  not  condescend 
to  examine  with  the  others  of  the  class.  It  became  necessary 
in  a  very  short  time  after  to  examine  this  gentleman  for  his 
degree.  Among  the  cases  presented  by  the  clinical  professor 
was  one  identical  with  that  which  be  bad  ao  indignantly  spurned. 
He  iailed  to  make  it  out.  Its  only  an  abscess  said  the  examiner 
and  then  after  reminding  him  of  bia  indilFerence,  proceeded  to 
give  him  some  friendly  advice  on  the  aubject  of  "  little  things," 
which  I  happen  to  know  has  not  been  entirely  forgotten.  Even, 
if  it  be  only  an  abscess,  then,  gentlemen,  don't  despise  it.  I 
urge  you  to  be  open  to  receive  knowledge  by  every  avenue ; 
never  despise  any  method  of  inquiry,  however  minute  and  ap- 
parently unpractical,  which  may  throw  light  upon  the  nature  of 
disease  ;  every  appliance  or  new  mode  of  procedure  introduced 
with  a  view  to  making  diagnosis  more  exact,  should  at  any  rate 
receive  fair  play  at  your  hands.  When  medicines  are  prescribed 
note  accurately  their  actions,  for  in  this  department  we  are  all 
humble  observers.  The  actions  of  many  drugs  and  other  reme-i^ 
dial  agents,  are,  as  you  know,  very  imperfectly  understood. 
Professor  Rutherford  puts  it,  this  is  the  dei)artment  that  hangi 
fire,  and  so  retards  our  progress.  Note  especially  the  actionn 
of  those  new  remedies  which  are  now  on  their  trial.  Above  a 
things  I  would  entreat  you  during  your  practical  observatiouRl 
not  to  deceive  yourselves.  By  this  I  mean,  never  persuade 
yourselves  that  you  understand  or  see  what  really  you  do  not 
understand  or  do  not  see.  In  other  words  do  not  play  triclcs 
with  your  own  senses,  else?  intellectual  ruin  is  your  certain  fat« 
When  you  are  asked  to  see  your  stethoscope,  or  ophthalmoscopi 
.  never  deaat,  neTBr  be  BaUafied.  unlal  ' 


INTHODUCTOEV   ADDRGSB. — BT    DR.    BUDDICK.  153 

htve,  at  all  events,  made  out  aomething  of  the  nature  of  nhat 
you  hear  or  see.     Remember  what  Shakespeare  sajs  : — 

"  To  thine  own  Bcif  be  true  ; 
And  it  must  follow  an  the  night  the  day, 
ThoD  cao'Bt  not  then  be  false  to  Biij  man," 

In  order  that  the  scheme  of  practical  instruction  shall  be 
successful,  the  teacher  must  have  the  cordial  co-operation  of  all 
his  class.  Speaking  on  this  very  subject  tbat  prince  of  clinical 
teachers.  Dr.  Murchison,  makes  the  following  remarks,  and  these 
will  suffice  to  make  clear  my  meaning. 

■*  The  student  who  comes  forward  before  the  whole  class  is 
not  oaly  taught  himself,  but  he  himself  becomes  a  clinical  teacher. 
His  difficulties,  his  suggestions,  and  even  his  mistakes  become 
the  means  of  teaching  the  rest  of  the  class.  The  blunders  yOu 
make  show  you  how  to  avoid  them  for  the  future,  and  in  the 
meantime  famish  me  with  a  capital  opportunity  tor  clinical 
remarks. 

You  are  to  bear  in  mind  that  the  best  and  most  experienced 
Physicians  are  constantly  making  mistakes  in  examining  patients, 
uid  in  the  diagnosis  of  their  diseases. 

Although  a  mistake  sometimes  excites  a  smile  or  laugh,  the 
students  who  laugh  most  arc  usually  those  who  do  not  take  part 
in  the  examinations  themselves,  and  are  the  least  entitled  to 
laugh.  It  often  happens  tbat  they  who  make  the  most  mistakes 
at  Grst,  in  a  few  months  turn  out  to  be  the  most  expert 
observers." 

Let  us  help  one  another  then,  Gentlemen.  In  the  department 
of  Surgery,  for  instance,  we  are  now  especially  in  need  of 
all  the  assistance  you-  can  bring  hb  in  our  endeavour  to  carry 
out  that  system  of  treating  wounds  which  is  destined  to  super- 
cede all  other  methods.  The  originator  of  this  system  is  to-day 
but  a  humble  observer,  so  that  it  may  be  in  store  for  any  of  ua 
to  throw  tbat  additional  ray  of  light  which  alone  is  wanted  to 
perfect  that  stupendous  scheme,  in  the  consummation  of  which 
_  I  sincerely  believe  with  a  recent  American  writer,  tbat  the 

line  of  Joseph  Lister  is  destined  to  outrank  in  medicine  all 


k   UEDICAL    AND   atTHQIOAL   JOimNAL. 


164 

of  bis  century,  not  even  excepting  the  discoverer  of  ansesthesia. 

In  the  midst  of  your  anxiety  to  acquire  knowledge,  I  would 
aak  you  never  to  lose  sight  of  the  reapect  and  sympathy  due  to 
the  sick  and  afflicted.  Now  is  the  time  to  cultivate  that  tender- 
ness, not  only  of  touch  but  of  heart  that  marks  the  true  phyai- 
sician.  Remember  how  sensitive  are  the  feelings  often  of  those 
deprived  of  health,  and  how  much  pain  is  oftentimes  caused  to 
them  by  an  inconsiderate  word  or  deed.  Even  as  students  then, 
you  have  it  in  your  power  to  lay  under  contribution  the  afi'eo- 
tions  of  those  whom  accident  or  disease  has  for  the  time  brought 
in  your  way. 

When  human  skill  no  longer  avails,  and  death  terminates  your 
case  follow  it  to  the  autopsy-room,  and  compare  there  the  post- 
mortem appearances  with  the  clinical  observations  ycumay.have 
made.  It  is  impossible  in  our  day  to  over-estimate  the  value  of 
pathological  research,  and  I  am  happy  that  the  opportunity  here 
offers  to  state  bow  far  we  in  this  city  have  advanced  in  that 
department  of  medical  instruction.  We  have  it  from  one  whose 
opinion  we  all  value  highly,  "  That  there  is  no  autopsy-room  in 
London  in  which  the  post-mortem  examinations  are  so  well  or 
so  systematically  conducted  aa  they  are  in  our  General 
Hospital,'" 

Having  in  my  imperfect  way  taught  you  how  to  work,  the 
next  task,  which  you  might  with  all  fairness  impose  on  me, 
is  to  teach  you  how  to  rest.  One  method  by  which  you  can 
always  obtain  mental  repose  ia  to  vary  your  "  mental  diet." 
Prolonged  application  to  one  study  is  certain  to  weary  the 
brain,  as  one  set  of  muscles  become  tired  out  by  a  contlnuoua' 
strain.  You  will  often  find  great  relaxation  and  pleasure  in  the 
perusal  of  hooks  other  than  those  connected  with  your  profes- 
sional work.  It  is  said  of  the  great  diplomatic  chieftain.  Earl 
Beaconsfield,  that  after  a  severe  mental  strain  be  has  recourse 
to  the  reading  of  light  literature  as  a  recreation.  While  I  do 
not  advocate  novel  reading,  I  believe  there  are  many  novels 
which  might  be  read  with  profit  by  us  aU.    "  Every  kind  of 


I 


*  Letter  bom  Lgndoa. — Caj.  Mid.  Joduu. 


DttftODUCTORT  ADDRESS. — BT  DR.  RODDICK.  165 

literature,"  observes  a  thoughtful  writer,"  comes  into  play  some 
time  or  other ;  not  only  that  which  is  systematic  and  method- 
ized, but  that  which  is  fragmentary— even  the  odds  and  ends  : 
the  merest  rag  or  tag  of  information.''  The  exercises  connected 
with  your  Medical  Society,  which  I  would  strongly  advise  all 
students  to  join,  are  of  the  nature  of  a  recreation.     Take  a 
moderate  amount  of  physical  exercise  daily,  always  stopping 
short  of  fatigue.    The  body  as  well  as  the  mind  has  rights  which 
must  be  respected.     We  may  cheat  ourselves  but  we  cannot 
cheat  nature.     "  Because  she  lets  us  overdraw  our  accounst 
for  many  years,  we  fancy  the  accounts  are  not  kept,  but  depend 
upon  it  she  is  a  zealous  creditor,  who  is  sure  in  the  end  to  exact 
with  compound  interest  every  loan  she  makes  of  us ;  and  if  we 
continue  borrowing  for  work  the  hours  that  are  due    to  sleep, 
although  we  may  postpone  a  settlement  for  years,  the  final  and 
inevitable  result  will  be  physical  and  mental  bankruptcy." 

In  conclusion,  Gentlemen,  I  exhort  you  to  work  earnestly  and 
honestly ;  to  be  kind  and  charitable  one  to  another ;  and  to  be 
temperate  in  all  things. 

**  Come  wealth  or  want,  come  good  or  ill, 
Let  yonng  and  old  accept  their  part, 
And  bow  before  the  awful  Will, 
And  bear  it  with  an  honest  heart. 
Who  misses  or  who  wins  the  prise, 
Go  lose  or  conquer  as  you  can, 
But  if  you  fell  or  if  you  rise. 
Be  each,  pray  God,  a  Gentleman/' 


•:o:- 


156  CANADA   MEDICAt    AND   SDROIOAL   JOURNAL. 

PRESIDENTIAL    ADDRESS, 

DBLirEKED    BEFOBK 

THE    MONTREAL    \tED!CO-CHIRURGICAL    SOCIETY 

0.\  OCTOBBR  18tb.  IST8. 

Bt  Henbv  Howard,  M.D.,  M.R.C.S.,  E.no. 

MadluJ  AlteniUul  (a  the  Loii(U«  Painia  LanaCio  Aaylum.  P.Q. 

Gentlemen,  Confreres,  Members  op  the  Montreal 
MsDico-CaiBL'RGiCAL  SOCIETY, — It  is  bardlj  neceaaary  for  me 
to  assure  you  of  my  deep  gratitude  for  the  high  honour  you 
hftvo  oonferred  upon  me  in  electing  me  your  President  for  the 
ensuing  year.  Yea,  Sirs,  I  feel  it  to  be  a  very  great  honour, 
1  fopl  that  no  greater  could  be  conferred  upon  me  by  my 
confreres  than  that  of  placing  me  at  the  head  of  a  society  that 
18  recognised  as  representing  the  Medical  profession  of  this 
city,  and  indirectly,  the  profession  throughout  the  Dominion  of 
Canada: 

lint  while  I  feel  proud  of  the  honour  thus  conferred,  I  feel 
Bomewlint  humiliated  by  the  conviction,  that  I  have  been  chosen 
by  this  society,  not  hecaase  of  my  ability  or  talents ;  not 
beoiiuae  there  are  not  men  amongst  you  who  stand  head  and 
«buulilers  over  me  in  the  knowledge  of  medical  science  ;  but 
because  from  your  kindness  of  disposition,  your  truly  liberal 
spirit,  so  well  becoming  members  of  your  most  liberal  profession, 
you  thought  it  meet  to  pay  a  tribute  of  respect  to  so  old  a  mem- 
ber of  the  profession,  to  so  old  a  friend — for  many  of  you  I 
hnvp  known  from  early  childhood. 

Ours  is  a  profession  that  receives  but  few  honours  from  either 
hoi-oditary  Sovereigns,  or  the  sovereign  people,  for,  when  honors 
iir«  distributed,  very  few  fall  to  the  lot  of  medical  men.  I 
a|«ak  of  honours :  I  might  go  further  and  say  seldom  do  we 
ovtiii  meet  with  gratitude.  We  may  labour  mentally  and  phya- 
oally,  from  youth  to  old  age,  to  attain  the  knowledge  of  assuaging 
lutiii  and  suffering  in  others  ;  to  restore  to  health  the  aick  and 
d_viii«  Tiither  of  a  family,  or  the  mother  prostrate  with  disease ; 
we  may  by  our  tender,  watchful  care  and  skill,  dry  the  eyes  of 


\ 


PRESIDENTIAL  ADDRESS. — BT  DR.  HOWARD.  157 

the  heart-stricken  mother  by  restoring  to  her  tender  embrace 
the  child  that  she  hung  over  for  weeks,  hoping  against  hope  ; 
we  may  restore  the  raving  maniac  from  a  state  worse  than  death, 
to  be  again  clothed  in  his  right  mind.  We  may  burn  the  mid- 
night lamp,  and  literally  wear  out  our  lives  in  discovering  natural 
laws,  that  society  may  reap  the  benefit ;  all  these  things,  and 
much  more,  pay  we  do,  but  let  us  not  in  return  expect  any 
honour  from  society.  It  is  not  for  those  things  that  society  with 
a  generous,  I  might  almost  say,  with  an  insane,  impulse,  rushes 
forward  through  her  thousands  of  representatives  to  feast  "her 
heroes.  No,  gentlemen,  society's  heroes  perform  a  different 
sort  of  deeds,  are  a  different  stamp  of  men  than  those  to  be 
found  in  our  liberal  profession.  Therefore  it  is,  gentlemen,  as 
in  the  present  instance,  so  very  pleasant,  knowing  that  we  differ 
from  that  stamp  of  men,  to  receive  honour  from  men  who  give  it 
to  none  except  those  whom  they  believe  to  be  worthy  recipients, 
and  in  honouring  whom  they  honour  themselves ;  and  I  hope 
and  trust  that  this  kindly  and  liberal  spirit  which  prompted 
you  to  elect  me  as  your  President,  may  always  shine  out  clear 
and  brilliant  in  the  actions  of  the  members,  collectively  and 
individually,  of  the  Montreal  Medico-chirurgical  Society. 

Gentlemen,  the  first  notice  I  had  of  the  honour  you  had  con 
ferred  upon  me  was  given  me  by  my  friend  and  first  Lieutenant, 
your  Vice-President,  Dr,  Ross,  who,  after  congratulating  me 
and  witnessing  my  surprise,  brought  me  back  to  myself  by 
reminding  me  that  I  was  in  duty  bound  to  give  a  presidential 
address.  I  began  to  consider  what  I  would  say,  what  I  would 
talk  about.  I  thought  to  myself  it  will  be  no  time  to  speak  ot 
mental  science,  and  even  if  it  were,  I  am  afraid  that  I  have  from 
time  to  time  rather  bored  the  society  with  that  subject.  So  I 
made  up  my  mind  to  make  a  few  remarks  more  applicable  to  the 
time  and  circumstances.  It  has  been  a  matter  of  regret  and 
^rprise  to  me  to  see  how  seldom  our  regular  meetings  are 
attended,  with  some  honourable  exceptions,  by  the.  older  mem- 
bers of  tJbe  society.  It  is  hard  for  me  to  find  a  cause  for  this 
coldness.  Of  course,  I  can  only  judge  of  others  by  myself,  and 
as  for  me,  I  look  forward  to  our  regular  meetings  with  as  great 


158  CANADA   MBDIOAL   AND   SUROrOAL   JODKNAL. 

pleasure  as  the  young  man  or  maiden  looks  forward  to  the  ball 
and  dance.  And  although  I  have  been  a  student  all  mj  life,  aod 
have  laboured  hard  for  forty  years  to  keep  pace  with  the 
progress  of  oar  profession,  yet  have  I  never  attended  one 
of  these  meetings,  that  I  did  not  return  home  a  wiser  and  a 
bettor  man.  I  say  better,  advisedly,  for  the  more  we  increase 
in  wisdom  the  better  must  we  be ;  and  very  much  of  this  madom 
have  I  learnt  from,  to  me,  very  young  members  of  the  Profes- 
sion. But  if  the  older  members  feel  differently  from  me,  which 
I  very  much  doubt,  then  they  should  attend  these  meetingathat 
by  their  presence  they  may  give  encouragement  to  the  younger, 
members  to  persevere  in  their  work,  to  hold  fast  to  scientifia 
truths,  and  not  to  be  disheartened ;  to  tell  them  that  the  hard 
thorny  road  they  are  travelhng  has  been  trodden  by  them  sol  veB» 
and  that  if  they  had  reached  the  goal  for  which  they  had 
laboured,  it  was  by  hard  work  and  after  repeated  failures.  'I  say, 
if  for  no  other  reason  than  these,  the  older  members  of  the 
society  who  have  ao  justly  earned  their  recognised  honour^ , 
ahould  give  us,  at  least  occasionally,  the  light  of  their  counten- 
ance. Consequently  I  do  hope  and  trust  that  during  the  year 
we  have  entered  upon,  wa  shall  have  a  better  attendance  at  oi^ 
meetings  from  the  older  members  of  the  society. 

In  addressing  the  younger  members,  I  would  moat  respectfully 
suggest  that  they  should  attend  these  meetings  a  little  more 
punctually,  and  that  they  should  show  a  little  more  enthusiasm 
in  all  things  connected  with  their  profession.  The  assembling 
of  ourselves  together,  and  exchanging  our  views  on  scientific 
Bubjecte  must  be  of  great  benefit  to  us  all,  and  particularly 
BO  to  the  young  practitioners,  who  thus  learn  from  the  experience 
of  their  eldera.  Besides  they  become  not  only  better  known, 
to  one  another,  which  haa  its  advantages,  but  they  are  observed' 
by  the  older  members,  who  note  if  that  they  are  working  men, 
and  remember  it  at  a  convenient  season.  Again,  associating 
■with  men  presumably  of  more  knowledge  and  experience  than. 
ourselves,  smoothes  off  the  rough  corners  of  our  nature,  and 
makes  us  have  more  charity  and  kindly  feelings,  not  naly' 
to  one  another,  but  towards  the  whole  human  race.    Yeat'J 


PU8II>BNTIAL  ADDREBS.— BY  DB.   HOWARD.  159 

even  to  the  very  worst  samples  of  humanity.     It  also  makes 

us  humble  in  our  own  estimation,  which  is  a  great  step  towards 

acquiring  knowledge.     There  are  thousands  upon  thousands  of 

persons  who  don't  know  enough  to  know  their  pwn  ignorance. 

Had  these  persons  associated  with  men  of  intellect  and  talent, 

they  might  be  very  diflFerent  from  what  they  are,  narrow-minded 

bigots,  prejudiced  fanatics,  the  betes  noires  of  society.     You 

flee,  then,  that  we  derive  many  advantages  from  associating  with 

cne  another.     I  felt  much  disappointed  that  I  was  not  able  to 

be  present  at  our  annual  meeting,  particularly  as  I  wished  to 

hear  the  resume  of  the  procedings  of  the  past  year  from  our 

verj  able  retiring  President.     I  hope,  gentlemen,  that  during 

the  year  upon  which  we  have  entered,  we  will  make  it  a  rule 

never  to  adjourn  till  we  have  arranged  wLo  shall  read  a  paper 

on  the  ensuing  evening  of  meeting.    I  would  beg  of  the  young 

men  not  to  be  backward  in  this  particular.     A  young  man  will 

find  it  a  great  means  to  improve  himself  in  medical  science,  to 

carefully  record  his  cases,  and  prepare  from  them  a  paper  to  be 

read  before  this  society.     Another  important  subject,  indeed 

one  of  the  greatest  interest  to  us  all,  is  that  o{  pathology.     I 

have  a  very  lively  recollection  of  the  pleasure  we  received,  and 

the  instruction  derived  from  the  many  pathological  specimens 

brought  before  the  society,  at  different  times,  during  the  past 

year.     May  I  hope  that  there  will  be  no  lack  of  pathological 

specimens  during  the  present  year. 

I  wish,  gentlemen,  that  in  one  respect  I  could  inspire  you, 
and  the  whole  Medical  profession  throughout  the  world,  with  my 
conviction  that  there  is  no  profession,  no  calling  in  life,  more 
high  or  more  honourable  than  the  Medical  Profession.  What 
higher  course  can  a  man  pursue  than  the  study  of  man  ? 
To  study  him  anatomically,  physiologically  and  pathologically, 
from  the  time  of  his  conception  to  the  time  of  the  "  puling 
infant,"  and  from  that  time  through  all  the  stages  of  his 
existence  till,  in  old  age,  he  returns  to  his  second  childhood, 
and  passes  out  of  this  world  as  unconsciously  as  he  entered 
into  it ;  or,  if  conscious,  looking  back  on  his  life  as  a  dream, 
and  looking  forward  to  another  life  where  he  shall  attain  to  the 


low  CANADA    ^fEDICAL    AJfB    SOROICAL   JOCRSAL, 

happiness  ho  has  so  long  dreamt  of.  Who  can  take  so  high 
and  8ft  exalted  a  view  of  the  Creator  as  he  who  daily  studies 
the  works  of  His  hands  in  the  anatomy  and  physiology  of  man  ? 
Physicaiiy  and. mentally,  surely  to  us  of  all  others,  come  home 
the  words  of  the  Paalmist :  "  We  are  fearfully  and  wonderfully 
maiio."  And  as  we  study  the  anatomy  and  physiology  of  the 
lower  animals,  comparing  each  with  its  kind,  and  comparing  all 
with  man,  our  wonder  is  the  more  in  creased  at  the  grand  per- 
fection and  design  of  creative  power.  And  it  belongs  to  the 
medical  man,  gentlemen,  to  go  still  further— to  examine  the 
flowers  of  tho  6eld  and  all  the  fruits  of  the  earth,  and  all  the 
mbierals  contained  within  the  bowels  of  the  earth,  and  by  hia 
knowledge  to  adapt  them  for  the  use  of  man.  In  fact  the  medi- 
cal man  is  the  student  of  nature,  and  of  all  natural  laws.  How 
then  can  he  he  other  than  liberal  in  ail  his  views  ?  How  can 
.  he  help  taking  the  widest  and  most  exalted  view  of  the  great 
Creator  and  the  widest  and  most  charitable  view  of  the  creature  ? 
Wlion  the  medical  scientist  has  heard  that  a  man  has  raised  his 
hand  to  take  away  the  life  of  his  brother,  his  first  feeling  is 
regret  for  the  murdered  man,  his  second  thought  is  as  to  what 
tliero  is  peculiar  in  the  mental  organization  of  the  murderer,  that 
he  should  commit  this  crime  against  God  and  society.  He,  the 
mental  physiologist,  knows  that  there  is  something  wrong  in  the 
mental  organiaation  of  the  murflerer,  whether  he  be  the  victim 
of  hereditary  taint,  or  of  evil  associations.  And,  although  he 
does  not  deny  the  right  of  society  to  take  means  to  protect  itself, 
yet,  with  tho  knowledge  he  possesses,  he  is  compelled  to  make 
M  the  allowance  he  possibly  can  for  tho  unfurtunate  criminal. 
And  if  it  he  posaible  to  show  that  he  acted  under  an  impulse, 
tthifih  his  will  could  not  control,  whether  that  impulse  be  an 
msaoe  or  criminal  one,  and  when  he  hears  men  in  their  juat  and 
i^t«oua  indignation,  cry  out  for  the  life  of  the  criminal,  and 

nthfl  Ittw  of  Moses  T  "  WhoBO  shedeth  man's  blood,  by  man 
kte  blood  be  shed,"  he  answers,  0.\B  greater  than  Moses, 
'ikiM  H»  held  the  first  inquest  upon  the  murdered  Abel,  did 
*KI  *iik»  sway  the  life  of  the  fratricide  Cain.  Nay,  not  only  bo, 
^Mlll^  i«t  his  mark  upon  him,  that  no  man  should  dare  to  take 


PiEUtelDEKTIAL   ADDRESS. — BY  DR.   HOWARD.  161 

away  his  life.  And  again,  he  can  quote  another  greater  than 
Moses,  who  came  after  him,  the  Man-God.  His  words  were  : 
**  I  say  unto  you,  not  an  eye  for  an  eye,  and  a  tooth  for  a  tooth ; 
but  whosoever  shall  strike  you  upon  the  right  cheek,  turn  to 
him  the  other  also."  And  again  when  raised  upon  the  cross. 
His  last  appeal  to  His  Father  was :  "  Forgive  them,  for  they 
know  not  what  they  do.^'*  Surely,  gentlemen,  God  knew  what 
man  was.  He  knew  his  mental  organization.  He  knew  that 
Cain  inherited  his  mental  organization  from  his  parents,  who 
showed  they  had  in  them  the  criminal  neurosis  by  breaking 
God's  commandment.  Knowing  these  scientific  truths,  gentle- 
men, we  medical  scientists  need  not  fear  to  step  forward  boldly 
before  the  world  and  state  that  man  is  governed  hy  his  mental 
organization. 

Gentlemen,  there  is  a  certain  subject  to  which  I  wish  to  take 
this  opportunity  of  drawing  your  attention  as  medical  scientists, 
in  Hie  hope  that,  for  the  sake  of  morality,  you  may  set  your 
faces  against  it.  I  allude  to  the  public  exposure  in  the  Press  of 
those  guilty  of  breaches  of  the  moral  law ;  breaches  disgust- 
ing to  every  man,  with  even  an  ordinary  mental  organization — 
yet,  gentlemen,  breaches,  if  we  believe  history,  that  have  been 
committed  since  the  earliest  ages  of  man.  Their  exposure 
always  tends  to  evi^and  not  to  good.  Society  derives  no  benefit 
for  having  these ,  crimes  exposed,  and  besides  the  exposure  of 
them  is  a  great  breach  of  charity.  If,  gentlemen,  every  man's 
crimes  were  written  upon  his  forehead,  I  fear  there  are  but  few 
of  us  that  would  not  "  wear  our  hats  over  our  eyes."  Every 
man  knows  his  own  weak  point  morally  as  well  as  physically  ; 
and  we  should  not  expose  it  to  the  gaze  of  the  world.  It  is  not 
an  object  to  strengthen  the  mental  organization  of  the  observer, 
besides  we  know  enough  of  evil  without  telling  us  more.  But 
as  Pope  said  there  are  men,  who— 

"  Compoand  for  sins  they  are  inclined  to, 
By  cUtmning  those  they  have  no  mind  to." 

Gentlemen,  I  look  upon  the  Press  as  the  great  power  of  the 
age,  for  good  or  evil.     I  love  liberty  too  much  myself  to  ever 

NO.  LXXVI.  11 


A 


162 


CANADA   MEDICAL   AND   SPRQICAL    JOOESAL, 


even  appear  to  sanction  an;  attempt  to  gag  the  presa.  But  I 
think,  as  scientJsts,  we  have  the  right  to  respectfiiliy  point  out 
to  the  writers  on  the  preaa,  as  we  do  to  the  teachera  of  religion, 
that  for  the  sake  of  mora,litjr  there  are  some  things  better  u(A 
made  public.  Better  to  take  the  advice  of  "  Uncle  Toby," 
gravely  given  to  the  fastidious  lady,  when  she  spoke  of  h^ 
child's  possible  action  if  allowed  into  the  parlour :  "  I  wottl 
cover  it  up,  Ma'am,  and  say  nothing  about  it." 

Gentlemen,  I  owe  you  an  apology,  I  said  I  would  not  spea^ 
on  science.  Well,  gentlemen,  my  intention  was  good,  but  yon 
know  the  force  of  habit,  What  I  have  said  I  maintain,  ttiaj 
there  is  no  calling  in  life,  no  profession  more  high  or  mor< 
honourable  than  is  that  of  the  Medical  professioa  And  as  yooi 
chosen  President  and  for  the  honour  of  that  profession,  I  cal 
upon  each  and  all  of  you,  to  so  work  this  year  that  we  haT( 
entered  upon,  that  at  the  close  of  it  when  I  come  to  give  i 
resume  of  the  work  that  has  been  done,  I  can  congratulate  yoc 
and  myself  on  the  result ;  and  that  we  will  all  know  that  we  a 
wiser  and  better  men. 

Before  concluding,  I  beg  to  inform  you  that,  when  an  oppOT; 
tunity  offered,  I  did  not  forget  to  point  out  to  those  in  authori^ 
the  necessity  there  was  to  have  appointed  in  the  city  an  Inspec- 
tor of  Anatomy,  who  would  see  that  the  Anatomy  law  was 
carried  out  in  its  integrity.  I  represented  in  the  strongest  terms 
the  injustice  trom  which  the  Medical  schools  were  suffering ;  and 
I  received  the  strongest  assurance  that  care  would  be  taken,  in 
the  future,  that  the  medical  schools  should  be  justly  dealt  with. 
There  is  one  difficulty,  however,  to  overcome.  The  law,  it 
appears,  most  absurdly  provides  that  the  Inspector  of  Anatomj 
shall  be  an  employee  of  the  city  corporation.  Knowing,  howj 
ever,  that  where  there  is  a  will  there  is,  generally,  a  way,  a 
that  the  will  is  not  wanting  in  the  present  instance,  I  trust  t! 
the  Provincial  Government  will  get  over  this  difficulty,  and  fi 
the  right  man  for  the  riglit  place. 

Gentlemen,  I  congratulate  you  on  the  success  of  our  society 
up  to  the  preaent.  I  congratulate  you  that  in  the  past  such  able 
men  have  filled  the  Pre^dential.chcur ;  I  congratulate  the  old 


fiOSPITAL   REPORTS.  163 

iftfeinbers  that  they  have  added  to  their  number  so  many  young 
and  talented  men,  who  have  already  shown  that  they,  in  their 
time,  will  do  their  parts  manfully  to  maintain  the  high  position 
that  has  been  attained  by   the  Montreal   Medico-chirurgical 
Society.    I  congratulate  you  that  you  have  so  much  power  in 
your  hands,  and  that  you  will  always  use  it  for  good  — good  first 
for  society  at  large,  by  advancing  science  and  thereby  civiliza- 
tion—good, secondly,  by  elevating  the  medical  profession  to  the 
highest  intellectual  and  moral  standard.     Good,  lastly,  to  your- 
selves, by  doing  your  duty  fearlessly  and  faithfully  through  life , 
80  that  when  you  come  to  the  close  of  your  labour,  and  take  off 
your  armour,  you  may  have  that  which  no  man  can  deprive  you 
of,  a  peaceful  conscience  and  self-respect. 

Agam,  gentlemen,  I  thank  you  for  the  high  honour  you  have 
conferred  upon  me,  and,  believe  me  I  shall  do  my  best,  and  no 
man  can  do  more,  to  faithfully  discharge  the  duties  you  have  so 
kindly  imposed  upon  me.  I  thank  you  for  giving  me  such 
intelligent  and  energetic  assistants,  who,  I  feel  sure,  will  take 
pleasure  in  aiding  me,  so  that  the  society  shall  lose  nothing  by 
the  choice  you  have  made. 

S^ospital  3fleports. 

Medical  and  Surgical  Cases  Occurring  in   the  Practice  of  the 

Montreal  General  Hospital. 

ConmimUed  Fracture  of  the  Fifth  Cervical  Vertebra.  Under 
care  of  Dr.  Roddick.  Reported  by  James  Bell,  M.D., 
Assistant  House  Surgeon,  Montreal  General  Hospital. 

J.  S.,  was  brought  to  the  Hospital  on  the  27th  of  August, 
1878,  by  the  police,  having  been  picked  up  by  them  in  a  power- 
less condition,  after  falling  from  the  revetment  wall  to  the  ground 
below — a  distance  of  fifteen  feet.  He  was  quite  conscious  on 
admission,  and  could  speak  well,  but  could  not  move  hand  or 
foot.  He  admitted  being  drunk,  and  stated  that  he  was  sitting 
on  a  plank  propped  up  on  a  couple  of  stones  on  the  edge  of  the 
wall,  and  thinks  he  must  have  been  dozing  when  he  fell  back- 
wards to  the  road  below,  striking  his  head  and  infiicting  a  severe 


164 


CANADA   MEDICAL   AND    BFRalOAL    JOUBNAL. 


ao alp  wound  just  in  front  of  the  junction  of  the  corODal  and 
sagittal  sutures.  He  waa  stunned  for  a  moment,  but  recovered, 
consciousness  almost  immediately,  and  was  then  conveyed  to  the 
Hospital.  He  was  a  large,  finely-proportioned  man,  aged  40. 
He  waa  a  laborer  of  Irish  descent,  over  six  feet  high,  and 
weighing  200  ibs.  When  undressed  and  examined  there  waa 
found  to  be  complete  paralysia  of  motion  from  the  nock  down. 
The  intercostal  muscles  were  paralyzed,  and  the  breathing  purely 
abdominal.  There  was  alao  paralysis  of  the  bladder  and  sphinc- 
ter ani.  He  could  feel  the  prick  of  a  pin  over  the  shoulders 
and  on  the  front  of  the  chest  qb  low  as  the  third  rib.  Below 
this  there  was  complete  loss  of  sensation.  He  could  move  his 
hands  backwards  or  forwards,  and  from  aide  to  side,  (on  the 
axis),  and  did  not  complain  much  of  pain.  He  could  swallow 
well,  but  could  not  cough.  Aa  there  waa  paralysis  of  all  the 
nerves  arising  in  the  brochocial  plexus,  and  yet  good  diaphleg- 
matic  breathing,  the  lesion  of  the  cord  was  thought  to  be  situated 
in  the  region  of  the  fifth  cervical  vertebra.  Dr.  Roddick  en- 
deavoured to  relieve  the  Byratoms  by  stretching  the  neck  by 
means  of  Sayre's  suspensory  apparatus  and  manipulation,  but 
without  success.  The  neck  was  pretty  movable,  but  the  crepi- 
tus was  discovered.  He  was  ordered  an  ice-bag  to  the  back  of 
the  neck,  and  the  bladder  and  bowels  attended  to. 

Next  morning  the  temperature  was  100"  F.  Pulse  100.  He 
complained  of  some  pain  about  the  middle  of  the  sternum  and 
in  the  back  of  the  neck,  The  abdomen  became  distended  with 
gas,  he  could  not  cough  nor  expectorate,  and  he  gradually  sank 
and  died  on  the  morning  of  the  first  of  September,  having  lived 
about  four  days  and  a  half  after  the  accident. 

He  had  always  been  very  healthy,  but  a  notorious  drunkard. 
Family  history  good. 

Pott  mortem  32  hours  afier  death. — Body  that  i 
and  powerfully  built  man.  A  scalp  wound  is  seen  just  behind 
the  margin  of  the  hair  over  the  centre  of  the  forehead.  The 
wound  is  three  or  four  taches  long  and  encloses  a  large  triangu- 
lar portion   of  the   scalp.     "So  emaciation.      On  raising   the 


i 


HOSPITAL  REPORTS.  165 

stennim  a  traBsrerse  fracture  is  seen  separating  the  first  and 
seccfiA  portions  of  the  bone. 

Thorax  and  Ahdomen. — Position  and  appearance  of  6rgans 
nonnaL  Langs  sodden  and  filled  with  bloody  serum.  Bronchial 
tabes  filled  witii  frothy  mucus. 

Throatj  covered  with  a  thick  layer  of  fat.  The  arch  of  the 
aorta  is  dilated  into  a  large  pouch.  The  cavities  of  the  heart 
all  contain  dark  blood.  The  orifices  are  all  very  large,  but  the 
valves  and  heart  substance  are  normal.  On  opening  the  aorta 
large  patches  of  atlieroma  are  seen.  Some  of  these  are  becom- 
ing calcified,  but  most  of  them  are  quite  soft.  There  is  great 
dibtatkm  of  the  arch,  especially  the  ascending  and  transverse 
portioDS,  at  the  junction  of  which  smaller  poucbings  exist, 
where  the  coats  of  the  artery  are  so  thin  as  to  be  quite  translu* 
cent  Uver  somewhat  enlarged  and  fatty.  All  the  other  organs 
normaL  On  removing  the  cervical  portion  of  the  spinal  column 
tlie  body  of  the  fifdi  vertebra  is  found  to  be  broken  into  five  or 
six  fragments,  and  to  leave  almost  completely  severed  the  cord 
at  diig  point. 

due  of  Strangulated  Oblique  Inguinal  Hernia. —  Operation, 
Suecesrful  result. — Under  the  care  of  Dr.  Fenwick. — 
Reported  by  Mr.  Thomas  Gray. 

H.  St.  C,  aet.  27  years,  was  admitted  into  the  Montreal 
General  Hospital  on  the  26th  September,  1878,  sufiering  from 
symptoms  of  strangulated  oblique  inguinal  hernia  of  the  right 
side.  He  is  a  strong,  robust  and  muscular  man.  About  six 
years  ago  he  noticed  that  the  right  side  of  ti.e  scrotum  was 
enlarged  and  hard,  but  he  cannot  assign  any  cause  for  this  con- 
dition ;  he  is  a  fium  labourer,  but  is  not  sensible  of  ever  ha\'ing 
produced  the  hernial  {H^trusion  during  any  extra  exertion.  He 
has  been  accastoined  to  heayy  work,  and  the  swelling  of  the 
scrotom  never  gave  him  any  uneasiness  excepting  during  violent 
exertioo,  when  it  l^ecame  enlarged  and  painful,  he  also  suflered 
pain  when  exposed  to  cold.  From  the  tame  h?  first  noticed  it 
to  within  a  year  ago.  it  gradually  augmented  in  size,  when  it 
ai^ieared  to  be  statkoarj  for  a  time,  aiMl  would  frequently  go 


166  CANADA    MEDICAI.   AND   SURnlCAL    JOrBNAL. 

away,  more  especially  at  night,  and  even  in  the  daytime  when  hei 
threw  himaelf  on  hia  back,  it  would  frequently  go  in  with  a  ^rg~ 
ling  noise.  On  the  22nd  Septemher,  he  rode  on  horseback  ant 
got  cold  and  chilled  tbrougla.  On  the  evening  of  that  day,  tbei 
lump  bad  increased  in  size  and  was  painful ;  it  was  only  partially- 
reduced  during  the  night,  and  as  soon  as  he  arose  in  the  morn- 
ing it  came  out  again.  He  continued  to  work  up  to  mid-day,, 
and  on  taking  a  heavy  lift,  which  occupied  a  few  momenta,  ho' 
was  seized  with  violent  vomiting  which  has  continued  more  or- 
lesB  severe  up  to  the  present  time.  A  surgeon  was  called  and 
the  taxis  applied,  but  it  failed  to  reduce  the  hernial  protrusion  ;. 
other  means  were  also  resorted  to  but  failed  of  success,  and  aa. 
the  case  appeared  to  be  urgent,  he  was  sent  to  Montreal  for 
surgical  treatment. 

On  admission  he  looked  pale  and  distressed,  vomiting  was  per- 
aiatent.  The  vomited  matter  had  the  usual  feculent  odour,  and 
was  dark  in  colour,  hiccough  was  almost  constant,  hia  pulse  was 
full  and  bounding,  and  there  was  some  mental  disturbance,  more 
of  the  character  of  low  muttering  than  actual  delirium.  The 
eyea  were  suffused,  and  he  complamed  of  great  tenderness  in 
the  region  of  the  hernial  protrusion  near  the  neck  of  the  sac. 
The  bowcla  had  not  acted  since  the  morning  of  the  day  in  which 
these  symptoms  had  been  declared. 

At  the  hour  of  visit  on  the  day  of  his  admission  into  hospital, 
the  taxis  was  applied  hut  failed,  and  the  operation  was  at  once 
determined  on.  He  was  removed  to  the  operating  theatre, 
placed  under  other,  and  another  unsuccessful  attempt  at  reduc- 
tion was  made.  A  free  incision  was  then  made  in  the  usual 
way,  the  operator  cutting  down  carefully  until  the  sac  waa 
reached.  This  was  opened  at  its  most  dependent  part,  and  a 
quantity  of  bloody  serum  evacuated.  The  sac  waa  opened  and 
a  coil  of  email  subatance  came  into  view.  The  coats  were  found 
much  congested  and  tcdamatoua,  the  bowel  feeling  thick,  hard, 
and  brawny,  and  the  surface  waa  covered  with  a  layer  of 
lymph.  The  atricture  was  found  to  be  at  the  internal  abdominal 
ring.  This  was  incised  in  the  usual  way,  and  the  operator  then 
proceeded  to  reduce  the  protruding  bowel.     Some   difficulty 


REVIEWS  AND   NOTICES   OP  BOOKS.  l^l 

practitioner  of  medicine.  No  alteration  in  the  arrangement  of 
subjects  has  been  made  in  this  edition,  and  there  does  not  appear 
to  be  any  very  material  change  in  the  views  enunciated  in  the 
first  edition.  Additional  illustrations  are  given.  The  American 
editor  has  found  that  very  little  was  demanded  from  him  to 
render  the  work  complete  and  accurate.  The  additions  made  by 
him  are  confined  to  points  in  which  the  experience  and  practice 
of  American  obstetricians  differs  from  that  of  their  English 
brethren.  These  are  chiefly  on  the  subject  of  the  Caesarian 
section.  The  variety  of  forceps  and  the  method  of  application, 
dystochia  from  tetanoid  uterine  constriction,  and  the  intravenous 
injection  of  milk  as  a  substitute  for  transfusion  of  blood.  We 
commend  this  work  to  our  readers,  it  is  a  text-book  containing 
the  authoritative  utterances  of  a  practical  man  of  large  experi- 
ence.    It  is  to  be  had  of  Dawson  Brothers,  St.  James  Street. 

Elementary  Quantitative  Analysis. — By  Alexander  Classen, 
Professor  in  the  Royal  Polytechnic  Schofbl,  Aix  Le 
Chapelle,  translated  with  additions  by  Edgar  T.  Smith, 
A.M.,  M.D.    Philadelphia :  Henry  C.  Lea,  1878. 

This  is  a  particularly  usefnl  work  on  quantitative  analysis 
specially  adapted  to  the  beginner,  by  following  out  the  scheme 
adopted  in  this  book  the  student  is  led  from  simple  quantitative 
determinations  to  more  complex  forms  of  analysis  by  degrees, 
and  is,  in  fact,  educated  from  the  stepping  stone  to  the  complete 
quantitative  analysis  of  inorganic  structures,  to  which  is  added 
analysis  of  mineral  waters.  These  are  familiar  to  the  different 
substances  mentioned,  and  the  composition  of  many  of  the 
minerals  is  given. 

It  is  well  illustrated  with  good  practical  illustrations,  well 
drawn,  and  free  from  the  mistakes  so  common  in  such  works 
of  putting  glass  flasks  on  a  naked  metal  retort-stand.  In  the 
illustrations  in  this  book  the  metals  or  flasks  are  represented 
properly  protected. 

There  is  at  the  beginning  of  the  work  a  good  table  of  contents, 
and  at  the  end  an  excellent  table  for  calculating  analyses,  giving 


172 


MEDICAL  AND  BCEOICAL  JOCRNAL. 


md  their  com- 


the  atomic  and  muscular  weights  of  elements 
pounds,  and  the  quantities  percentically  stated. 

Thia  is  aacceeded  by  a  table  of  tension  of  a[|ueou3  vapour — 
and  for  the  calculation  of  the  hardness  of  water  by  soap  test, 
and  lastly  by  a  copious  index.  The  descriptions  are  clear,  and 
concise,  without  sacrificing  efficiency.  The  print  is  clear  and 
easily  read,  the  paper  is  good  and  strong  ;  altogether,  we  can 
highly  recommend  thia  work  to  any  one  who  is  studying  chem- 
istry practically,  especially  those  whose  occupation  will  require 
a  knowledge  of  quantitative  analysis. 

Extracts  from  ■British  and  foreign  Journals. 


Treatment  of  Ulcers  &  Varicose  Veins, 

— In  the  Lancet  for  October  12th,  a  note  on  tbe  treatment  of 
ulcers  and  varicose  veins  by  Martin's  strong  elastic  bandage, 
appears  from  the  pen  of  George  W,  Callender,  F.R.S.,  Surgeon 
to  St.  Bartholomew's  Hospital. — Having  for  some  time  used  the 
elastic  bandage  as  _  recommended  by  Dr.  Martin,  of  Boston, 
U.  S..  for  the  treatment  of  varieose  veins  and  ulcers,  it  is  right 
to  express  my  opinion  that  his  treatment  is  practically  good. 
Under  its  influence,  ulcers  not  of  a  specific  character  do  certainly 
heal,  and  quickly  ;  and  as  thus  effected  whilst  the  patient  fol- 
lows his  usual  occupation,  the  merit  of  the  treatment  is  evident. 
Although  there  has  been  scarcely  time  since  I  received  the  ban- 
dages from  America  for  use  in  St,  Bartholomew's  Hospital,  to 
test  their  efficacy  in  the  continued  treatment  of  varicose  veins, 
yet  I  have  found  that  the  application  of  the  bandage  is  at  once 
followed  by  a  sonso  of  great  relief.  A  man  of  thirty-six  years 
of  age,  who  had  suffered  for  eleven  years  from  varix  of  either 
internal  saphenous  vein,  extending  as  high  as  the  groin,  experien- 
ced at  once  and  since  greater  relief  from  the  use  of  the  bandage 
than  he  had  ever  bad  from  sillc  elastic  stockings,  although  bis 
position  was  such  as  to  allow  his  wearing  tbe  best  which  could  be 
made  for  him.  I  have  used  tbe  bandages  for  many  cases  of  ulcer 
of  the  leg,  chiefly  due  to  varicose  veins,  and  always  with  the  good 


BRITISH   AND   FOREIGN   JOURNALS,  173 

result  stated  by  Dr.  Martin,  with  whose  practical  statement  refl- 
pecting  the  treatment  of  these  ulcers  I  agree. 

There  are  some  points  named  by  Dr.  Martin  which  are  essen- 
tial if  good  results  aro  to  be  had.  The  firat  of  these  is  as  to  the 
qiiahty  of  the  bandage  itself.  It  should  be  just  as  the  author 
describes,  and  is  supplied  from  America,  li  thicker,  it  should  be 
clumsy ;  aud  if  thinner,  it  needs  to  be  more  tightJy  drawn  to  offer 
the  due  resistence,  and  the  edges  are  more  apt  to  indent  or  cut 
into  the  flesh.  If  Dr.  Martin's  treatmeat  is  to  be  tried,*  the 
bandage  is  such  as  his  experience  has  led  him  to  prefer. 

The  bandage  sbonld  be  applied  before  the  patient  rises  from 
hb  bed  in  the  morning — before,  that  ia,  the  veins  of  the  leg 
become  distended  by  the  impeded  column  of  blood  within  them. 
It  should  be  applied  with  just  snugness  enough  not  to  slip  down. 
The  moment  the  toot  is  put  to  the  ground  the  limb  is  so  increased 
in  bulk  by  the  increase  of  blood  in  the  veins  that  the  bandage 
becomes  of  precisely  the  proper  degree  of  tightness,  and  no 
matter  how  active  the  exercise  or  labour  of  the  patient,  it  will 
remain  in  position  all  day.  When  the  patient  uiidreasos  at 
night  the  bandage  is  to  be  removed,  and  the  limb  wiped  dry,  a 
piece  of  soft  old  linen  moistened  with  oil,  or  some  equally  simple 
dreswig,  laid  on  the  ulcer  and  retained  in  place  by  a  few  turns 
of  an  ordinary  roller.  The  bandage  should  be  sponged  with 
water  (cold  will  do,  but  warm  is  better),  and  hung  over  a  line 
to  dry  in  readiness  for  the  morning,  or-  it  can  be  wiped  dry  at 
once,  or  rolled  up  with  the  tapes  in  the  centre.  Such  is  the 
dressing  for  the  night ;  in  the  morning  the  leg  can  be  washed, 
but,  whether  it  is  or  not,  all  traces  of  oil  or  cerate  should  be 
carefiiUy  wiped  away,  as  contact  with  the  bandage  of  any  fatty 
matter  would  tend  gradually  to  injure  the  rubber.  This  is  the 
whole  treatment,  Rubber  bandage  all  day,  with  erect  position 
and  exercise.  The  simplest  possible  dressing  (merely  to  protect 
the  ulcer  from  injury),  with  the  horizontal  position  and  rest,  all 
night.  Any  pimples  which  may  form  are  left  to  be  treated  by 
the  rubber,  and  if  the  skin  becomes  chafed,  a  light  covering,  as 
of  bunting,  is  applied  as  a  bandage  under  the  rubber,  and  the 
same  is  recommended  to  absorb  excessive  moisture. 


Xli  CANADA  MEDICAL  AND  aDEniOAL  JOUBNAL, 

No  more  diatresaing  cases  than  of  patients  saSermg  from 
chronic  ulcers  crowd  our  hospitals,  and  I  must  aay  that  I  feel 
much  indebted  to  Dr.  Martin  for  the  suggestions  he  baa 
published,  and  which  he  has  made  practical  application  of  for 
many  years  with,  as  he  says,  great  success.  My  present  but 
recent  experience,  leads  me  to  believe  that  he  is  to  be  confirmed 
in  the  statement  he  makes,  which  any  who  like  can  read, 
as  it  ia  very  clearly  and  ably  put  in  the  Transactions  of  the 
American  Medical  Association  for  1877. 


Extrophy  of  the  Heart.— (By  Jobn  T.  Hodgen, 

M.D.)— Mrs.- ,   a   German,   at   terra,   attended   by   Dr. 

Bbrnays,  in  February,  18ti4,  gave  birth  to  a  healthy  living 
child.  The  heart  was  found  entirely  outside  of  the  cheat,  the 
vessels  passing  from  the  chest  through  an  opening  in  the  median 
line.  The  heart  was  not  covered  by  pericardium,  and  stood 
with  its  apex  pointing  forward,  downward  and  to  the  left.  The 
organ  pulsated  rapidly  but  regularly :  with  each  elongation 
of  the  organ,  the  apex  was  pushed  forward  and  swept  to  the 
left.  The  contractile  wave,  beginning  at  the  auricles,  swept 
over  the  ventricles. 

On  the  third  day  after  birth,  the  heart  had  lost  its  red  color, 
being  covered  by  a  thick  layer  of  fibrinous  matter.  This  assumed 
a  yellowish  tinge,  becoming  softened,  and  waa  detatched,  leaving 
the  muscular  tissue  of  the  heart  exposed  and  dry,  or  less  moist 
than  it  had  been. 

On  the  fourth  day,  the  auriculo-ventricular  fissure  became 
deeper,  and  presented  a  ragged-looking  groove,  which  was 
deepened  by  the  thickening  of  the  borders. 

On  the  fifth  day  the  child  died,  and  twelve  hours  after  a  post 
mortem  examination  was  made  in  the  presence  of  Drs.  Hammer 
and  Rogers. 

The  body  was  about  the  average  size,  and  perfect  except  as 
noted.     The  distance  between  the  inner  ends  of  clavicles— 
the  sterno-clavicular  articulations — was  IJ  ii"'' 
and  second  pieces  of  the  ste*"' 
Uke  the  letter  U ;  this  cl' 


I 


B&ITISH  ANI)  FOREIGN  JOUBNALS.  175 

ardculation  of  the  fourth  rib  with  the  sternum,  the  opening  being 
one  inch  in  diameter. 

As  it  approached  the  opening,  the  skin  was  continuous  with  a 
dense  fibrous  structure  which  was  found  attached  to  the  great 
vessels — (i.  6.,  the  pulmonary  artery,  the  aorta,  and  the  vena 
cava) — at  a  point  corresponding  to  that  at  which  the  pericar- 
dium is  attached.  This  connection  served  to  hold  the  vessels  in 
position  as  they  escaped  through  the  opening  in  the  more  dense 
structures.  The  heart  was  of  normal  size,  but  more  elongated 
the  apex  being  formed  by  the  right  ventricle. 

On  opening  the  chest  no  space  was  found  for  the  heart,  the 
mediastinum  being  central,  with  the  phrenic  nerves  passing 
down  in  it  near  each  other ;  the  lungs  filled  the  entire  cavity, 
and  each  lung  had  three  lobes.  The  hepatic  veins  ascended  as 
a  long  single  vessel  to  the  right  of  the  median  line,  in  the  medi' 
astinum,  to  the  opening  in  the  sternum,  and  entered  the  right 
auricle  of  the  heart  on  it&  right  side  and  behind  the  opening  for 
the  ascending  cava. 

The  ascending  cava  passed  up  the  left  side  of  the  median  line 
in  the  mediastinum,  received  the  descending  cava,  and  entered 
the  rigl^t  auricle  by  a  sinuous  passage,  at  the  first  passing  down- 
wards, then  turning  at  a  right  angle  to  the  right  entered  the 
auricle.  The  descending  cava,  half  an  inch  long,  situated  to 
left  of  median  line,  received  the  innominate  of  right  side,  which 
was  long  and  crossed  the  median  line  toward  the  left.  The  left 
innominate  vein  passed  directly  downward,  and  joined  the  right, 
on  the  left  of  die  median  line,  formed  the  descending  cava.  A 
nngle  pulmonary  vein,  formed  by  the  union  of  a  vein  fix)m  each 
ride,  entered  tiie  left  auricle.  The  pulmonary  artery,  having 
but  two  semilunar  valves  at  its  beginning,  took  ite  origin  from 
iiie  rigjht  ventricle ;  while  immediately  to  its  right,  and  from 
'  tte  ri^t  ventricle  also,  came  the  aorta.  A  free  opening  existed 
between  the  ri^t  and  left  ventricles.  No  foramen  ovale 
ewitod  between  the  right  and  left  auricles,  the  septum  being 
;  no  dustos  arteriosus. 
*  e  and  recent  adhesions,  formed  by  recently  deposited 
4  the  existence  of  peritonitis. — The  American 


176  CANADA   MEnCAt    AND    BCrBOICAl    J0T7RNAL. 

MailliillB. —  The  British  Med.  Jowrna^  remarks  ; — At  the 
meeting  of  the  British  Medical  Association  at  Bath  in  August 
last,  among  the  exhibits  of  pharmaceutical  and  medical  prepar. 
ations,  much  interest  was  ahown  in  one  called  malt.ine,  which 
may  be  described  as  a  highly  concentrated  extract  of  malted 
barley,  wheat  and  oats. 

Extracts  of  malt  (i.  e.,  malted  barley)  are  pretty  'sidely 
known,  but  this  is  the  first  example  of  a  combination  of  the  nutri- 
tious principles  of  these  three  cereils  that  we  have  seen;  and 
the  greater  value  of  this  combination  is  apparent,  as  wheat  and 
oats  are  especially  rich  in  muscular  and  fat^producing  elements. 
This  preparation  is  entirely  free  from  the  products  of  fermenta- 
tion, such  as  aicohol  and  carbonic  acid,  and  is  very  agreeable  to 
the  taste.  Ciinical  experience  enables  us  to  recommend  it  as  a  nu- 
tritive and  digestive  agent,  in  virtue  of  its  albuminoid  contents, 
and  its  richness  in  phosphates  and  hi  diastase,  likely  to  prove  an 
important  remedy  in  pulmonary  affections,  debility,  many  forma 
of  indigestion,  imperfect  nutrition,  and  deficient  lactation.  It 
will  io  many  cases  tako  the  place  of  cod-hver  oil  and  pancreatic 
emulsions,  where  these  are  not  readily  accepted  by  the  stomach, 

Tbe  agents  of  the  manufacturers,  Messrs,  J.  M.  Richards  & 
Co.,  Loudon,  issue  a  pamphlet  describing  fully  the  -process  of 
manufacture,  which  no  doubt  they  will  supply  to  any  medical 
man ;  and  we  are  disposed  to  believe  that  maltine,  which  is  less 
known  here  than  abroad,  is  well  worthy  of  practical  attention. 

Formulary.  —  (  Lalemand's  Gout  Specific).  —  A 

Western  correspondent  aends  us  the  following  formula  for  this 
preparation,  which  is  said  to  be  made  in  St.  Louis,  Mo. : 


R.     Ext.  Colchici  acet. 

"    opii  aquoB.  aA     .     . 
Potass,  iodidi.       .     .     . 

•     ■     8"-  I"- 

Aq.  destill       .... 
Vinialbi        

.    .     lUiss. 
•     •    !jv. 

Twenty  drops  three  times  a  day.- 

-QSm  Jtemedi' 

4 


BRITISH  AND  FOREIGN  JOURNALS.  177 

The  Use  of  Ergrot  in  Typhoid  Fever.— 

M.  Dubou^  of  Pan  recommends  ergot  in  typhoid  fever  for  rea- 
sons deduced  from  its  physical  action,  and  in  one  of  his  works 
cites  seven  cases  in  which  it  was  employed.  Two  were  in  the 
early  stages  and  presented  all  the  characteristic  symptoms  of 
the  malady,  but  they  got  well  so  soon  that  it  was  tiiought  that 
an  error  in  diagnods  was  possible.  In  three  others  ergot  was 
not  nsed  until  all  other  medicinal  resources  had  been  exhausted, 
and  the  patients  had  reached  an  almost  hopeless  state.  But 
they  all  recovered  after  taking  from  a  gramme  and  a  half  to 
three  grammes  of  ergot  daily  for  about  two  weeks.  Another, 
who  presented  gr^ve  ataxis  symptoms  from  the  outset,  with 
delirium,  tarismus,  carphologia,  and  intermittent  pulse,  took  ergot 
for  twelve  days,^  the  disease  assuming  a  milder  form  and  recovery 
fdlowing.  Finally,  a  patient  with  typhoid  fever,  who  was  three 
and  a  half  months  pregnant,  was  treated  with  ergot  for  fifteen 
days,  and  got  well  without  miscarriage,  although  she  took  a  daily 
dose  of  a  gramme  and  a  half  or  two  grammes  of  the  drug.— 
(^Boston  Medical  and  Surgical  Journal^  March  28,  1878.) — 
The  Practitioner. 

The  Physiologrioal   and   Therapeutic 

Action  of  JaborandL — 0.  Eahler  gives  as  the  result 
of  his  observations  in  jaborandi  that,  in  moderate  doses,  it  pro- 
duces approximation  of  the  far  point,  diminished  blood-pressure, 
as  shown  by  Marey's  sphygmograph,  with  secondary  increase  in 
the  rapidity  of  the  pulse  ;  when  given  in  large  doses  it  causes 
retardation  of  the  pulse,  with  at  first  lowering,  but  subsequently 
increase,  of  the  blood-pressure.  The  slowing  of  the  pulse 
depends  on  an  exciting  action,  opposed  to  that  of  atropine, 
exerted  upon  the  inhibitory  ganglia  in  the  heart.  (Leyden  came 
to  the,  same  conclusion  in  regard  to  pilocarpin.)  He  established 
is  antidotal  action  to  atropine,  but  found  that  it  is  much  feebler, 
than  this  poison.  As  a  general  rule  he  prefers  the  subcutaneous 
injection  of  pilocarpin  in  maximum  doses  of  0.024  of  a  gramme, 
wbmk  jaborandi  has  to  be  used  internally.  In  diabetus  mellitus 
observed  no  action  exerted  by  jaborandi  on  the  quantity  of 

12 


178  CANADA   MEDICAt   AND   SttRQIOAL    JOCRNAL. 

sugar  excreted,  providing  the  digestion  waa  not  interfered  willi. 
In  a  case  of  diabetes  insipidus,  on  the  other  band,  the  adi 
tration  of  the  drug  reduced  the  quantity  of  urine  in  three  days 
from  6-000  grammes  to  2-300 ;  the  body  weight  of  the  patienj 
did  not  undergo  any  increase,  bat  the  general  health 
*  strength  improved  materially.  In  bronchitis  acuta  and  in 
dry  catarrhs  Kayler  recommends  this  remedy  strongly,  and 
especially,  also,  in  parotitis  occurring  in  the  course  of  severe 
infectious  diseases ;  and  suggests  that  it  should  he  tried  in 
mumps.  He  considtTs  tliat  the  affections  in  which  it  is  likely  to 
prove  useful  are  rheumatic  diseases,  recent  neuralgia,  dropsy 
without  cardiac  debility,  the  existence  of  such  debility  being  ftn 
contra-indicatjon  ;  hyperaemia  and  nephritis,  uriemia,  and,  lastJ; 
chronic  metallic  poisoning. — (Prayer  wd.  WoclMiselmfl,  Nt 
33  and  34, 1877;  and  C'entralblaU  f.  d.med.  IFiss.,  April  2i 
1878.)— TXd  Practitioner. 

Stenosis   of  Pulmonary  Artery.  —  Db. 

Peacock  exhibited  a  specimen  of  Stenosis  of  the  Pulmonary 
Artery  from  disease  of  the  valves,  probably  congenital.  The 
patient  was  a  boy  thirteen  years  of  age  who  was  said  to  have 
never  been  strong,  and  to  have  always  been  livid,  but  who  was 
in  fair  health  up  to  four  months  before  his  admission  into 
hospital,  when  he  began  to  suffer  from  dyspnoea  and  increased 
lividity.  There  was  a  loud  double  murmur  over  the  pulmonary 
cartilage,  and  a  distinct  thrill.  The  patient  dying,  after  suffer- 
ing from  dropsy,  &e.,  the  heart  was  found  to  weigh  9  oz.,  the 
right  ventricle  to  be  dilated  and  hypertrophied,  and  the  orifice 
of  the  pulmonary  artery  narrowed  and  funnel-shaped,  as  from 
adhesion  of  the  valves,  the  circumference  of  the  orifice  being 
about  four-fifths  of  an  inch.  Dr.  Peacock  thought  the  disoaee 
to  be  congenital.  At  the  time  of  birth  it  must  have  been  slight, 
or  else  one  or  botli  of  the  fuetal  passages  would  have  remained 
pervious. — Dr.D.  Powell  asked  whether  the  analogous  condi- 
tion of  the  mitral  valve  was  also  congenital.  Many  cases  of 
pure  mitral  stenosis  are  met  with  in  which  no  previous  history 
of  rheumatism  is  present,  and  vbere  the  only  explanation  is  that 


!e  aays 
patieiyfl 
h  aa^H 
ihroniJB 


«y 

I 


BRITISH  AND  FOREIGN  JOURNALS.  179 

ihey  are  congenital  in  origin.  Such  patients  live  long,  there 
being  often  no  regurgitation. — Dr.  Peacock  had  long  regarded 
a  nunber  of  these  cases  as  congenital.  Bums,  of  Glasgow,  had 
pointed  this  out,  and  so  had  Farre,  and  Dr.  Peacock  himself  had 
frequently  seen  cases  of  children  who  had  been  ailing  all  their 
lives,  and  who  had  evidence  of  mitral  constriction.  He  agreed 
with  Dr.  Powell  that  very  often  cases  of  presystolic  murmur 
is  met  without  any  previous  rheumatic  history.  The  President 
said  that  a  year  ago  he  saw  a  patient,  twenty-five  years  of  age, 
wi&  presystolic  murmur,  and  who  was  known  to  have  had  it 
when  two  years  old,  and  yet  during  the  whole  time  he  had 
shown  no  symptoms  of  heart  disease. — Lancet. 

Chlorhydrate    of  Polyoarpine 
in  Ophthalmic  Practice. —Dr.  Alexandroff 

states  (Pamphlet^  Marseilles,  1877)  that  Jaborandi  for  various 
reasons  is  not  well  adapted  for  administration ;  it  has  a  dis- 
agreeable taste,  it  sits  uneasily  on  the  stomach,  causbg  nau- 
sea, vomiting,  and  sometimes  colic,  it  produces  vertigo  and 
funting,  and  lastly  it  has  the  disadvantage  of  being  inconstant 
in  its  action.  Pilocarpine,  the  active  principle  of  jaborandi 
— discovered  by  Hardy  in  1875  —is  free  from  some  of  these 
mconveniences,  and  its  action  has  been  studied  on  patients 
affected  with  rheumatism,  albuminous  nephritis,  and  pleurisy, 
but  until  his  own  observations,  no  attempts  had  been  made,  M. 
Alexandroff  states,  to  ascertain  its  physiological  value  in  (Useases 
of  tiie  eye,  except  those  of  M.  Wecker,  who  treated  a  few  cases 
by  hypodermic  injection  of  the  'chlorhydrate.  M.  Alexandroff 
determined  to  investigate  its  action,  and  tried  it  first  in  a  case 
of  rheumatismal  irido-choroiditis.  The  case  was  sufficiently 
severe  to  induce  M.  Metaxas  to  recommend  iridectomy,  to  which 
the  patient  refused  to  submit.  About  2  centigrammes  of  the 
chlorhydrate  of  pilocarpine  in  solution  in  water  was,  with  M. 
Melaxa's  permission,  injected  by  M.  Alexandroff  into  the  arm 
of  the  patient,  atropine  being  at  the  same  time  instilled  into  the 
eye.  The  patient  passed  a  better  night  and  was  free  from  pain ; 
on  the  following  day  the  injection  was  repeated,  and  again  at 


180  CANADA  MEDICAL  AND  8ITRGICAL  JOORNAL. 

intervals  on  five  occasions.  Under  this  treatment  the  media 
became  clear,  the  ulcer  which  had  been  present  healed,  and 
vision  was  completely  restored,  M,  Melaxaa  tiied  the  chlor- 
hydrate  again  in  a  second  case  of  double  rheumatic  iritis  with 
equal  success,  and  it  waa  afterwards  tried  not  only  in  many 
cases  of  rheumatic  iritis,  hut  in  retinal  hasmorrhage,  and 
in  exudative  choroiilitis.  In  all  instances  aalivatioD  and 
sweating  appear  to  have  been  produced,  diarrhoea  was  occa- 
eionally  observed.  Epiphora  was  constant.  The  pulse  and 
temperature  rose  immediately  after  the  injection.  He  thinks  it 
has  an  indisputable  action  on  the  iris,  and  finds  that  it  acts  more 
rapidly  than  escruie.  It  is  at  once  the  antagonist  and  antidote 
to  atropine.  It  occasionally  produces  praecordial  pfun  aud  feel- 
ing of  anxiety.  He  thinks  it  will  prove  valuable,  not  only  in 
cases  of  rheumatic  iritis,  but  in  all  cases  when  the  area  of  the 
pupil,  the  choroid  and  the  retina  are  the  seats  of  serous  or 
plastic  exudation  either  from  local  or  general  disease. — Prodi' 
tianer,  September,  1878, 

Iodoform   in   Glandular  S-welling^s.  — 

Dr.  MoLEScnoTT,  of  Tiirin,  writea  (  Giomale  Intemazionah 
delU  Scierne  Mediche,  Nov.  5  and  6, 1878,)  that  he  has  uaed 
iodoform  with  success  in  cases  which  have  been  usually  treated 
by  iot^e  ointment,  such  as  glandular  swellings  and  cold 
abscesses.  He  mentions  a  case  of  enlarged  spleen,  with  great 
prostration,  pallor,  obatinato  diarrhoea,  swelling  of  the  lympha- 
tic glands,  and  increase  of  the  white  blood-corpuscles  (1  to  50 
red),  in  which  very  favourable  results  followed  the  painting  of 
iodoformed  collodion  over  the  spleen  and  lymphatic  glands.  Not 
less  successful  was  its  application  in  orchitis,  and  epidydimitis, 
and  also  in  exudations  into  serous  cavities,  even  including  hydro- 
pericanlium.  lie  advises  that  iodoform  collodion  should  he  tried 
before  jiaraccntesis  whenever  removal  of  wateiy  elfuaion  is 
necessary.  He  has  cured  Gve  ca:sc3  of  acute  hydrocephalus  by 
the  application  of  this  remedy  several  times  daily  ;  calomel  and 
purgative  being,  liowovor,  given  at  tlic  same  time,  [u  cases  of 
swelling  of  the  kucfr-jmat,  wbero  sur^calinterfercncc  appeared 


BRITISH  AND  FOREIGN  JOURNALS.  181 

unavoidable,  perfect  recovery  followed  the  prolonged  application 

of  the  iodoform.    Apart  from  its  action  as  a  resolvent,  iodoform 

has  the  property  of  relieving  pain :   Dr.   Moleschott  hence 

recommends  its  use  in  painful  attacks  of  gout  and  also  in  various 

forms  of  neuralgia.     In  a  case  of  intercostal  neuralgia,  he  gave 

it  internally  in  the  form  of  pills  (three-fourths  of  a  grain  daily) 

as  well  as  externally.  In  severe  neuritis,  he  has  used  iodoformed 

collodion  successfully  after  other  treatment  had  been  tried  in 

vain.    Administered  internally,  it  will  probably  be  useful  in  the 

palpitations  of  nervous  and  hysterical  patients,  and  will  restore 

the  regularity  of  the  heart's  impulse.    Its  offensive  smell  is 

obviated  by  mixture  with  tannin. — British  Med.  Journal^  Sept. 

28, 1878. 

ntrite  of  Amyl  in  Agrue.— Dr.  W.  E.  Saun- 

DBRS,  of  Indore,  calls  attention  (^Indian  Med.  Q-azette,  No.  39.) 
to  the  value  of  mtrite  of  amyl  in  ague,  and  records  a  number  of 
cases  in  which  advantage  has  been  derived  from  its  use.  The 
drag  itself,  he  remarks,  is  inexpensive  and  goes  a  long  way.  He 
now  uses  nitrite  of  amyl  mixed  with  an  equal  part  of  oil  of  cor- 
iander, to  render  it  less  volatile,  and  at  the  same  time  to  cover 
its  odour.  He  regards  it  as  the  most  powerful  diaphoretic  he 
has  seen,  and  he  uses  it  in  all  cases  of  fever  to  produce  diapho- 
resia.  The  following  is  one  of  his  cases :  Mr.  C.  came  for  treat- 
ment about  7  P.  M,  in  the  cold  stage  of  ague.  Two  minims  of 
nitrite  of  amyl  were  administered  ;  sweating  came  on  in  seven 
minutes.  He  lay  down  for  half  an  hour  to  get  cool,  and  then 
walked  home  well.  He  next  morning  took  a  dose  of  quinine,  and 
has  had  but  one  attack  of  fever  without  the  cold  stage  since. 
Previous  to  this  he  had  fever  every  day  for  one  month,  during 
which  he  took  large  doses  of  quinine.  Dr.  Saunders  observes 
that  he  does  not  mean  to  say  that  quinine  should  not  be  used  in 
these  cases,  for  there  is  ample  proof  that  it  tends  to  check  the 
return  of  the  attacks,  and  removes  to  some  extent  the  septic 
condition  of  the  blood  induced  by  the  malarial  poison,  and  this 
more  especially  if  small  doses  of  opium  be  combined  with  it.  In 
no  case  did  the  amyl  fail  to  remove  the  attack  in  about  one- 


182 


CANADA   MEDICAL    AND    SURGICAL    JOCKNAL. 


third  the  osual  timo,  and  in  most  caaes  the  fever  did  aot  retum. 
The  method  of  adtniiiiBtration  he  adopts  is  this  :  Four  drops  of 
the  mUhire,  or  two  drops  of  amjl  are  poured  on  a  small  piece  of 
lint,  which  is  given  into  the  hands  of  the  patient,  and  he  is  told  J 
to  inhale  it  freely.  He  soon  hecomcs  flushed,  and  both  his  pulBel 
and  respiration  are  much  accelerated,  and  when  he  feels  v 
all  over  the  inhalation  is  discontinued,  as  the  symptoms  continue 
to  increase  for  some  time  afterwards.  A  profuse  respiration 
now  sets  in,  which  rapidly  ends  the  attack ;  in  some  cases,  how- 
ever, the  cold  8tar;e  merely  passed  of  without  any  hot  or  sweatva 
ing  stage — Practitioner. 

Harmlessness  of  Urea  in  the  Blood,- 

The  London  Medical  Record  mentions  exptriments  by  MM 
Feltz  and  Ritter,  to  show  that  pure  urea  never  brou;;ht  on  con- 
vulsive symptoms.  Urea  injected  into  the  blood  was  eliminated 
very  rapidly  by  the  urine,  and  when  it  existed  in  considerable 
quantities  in  the  organism  it  did  not,  as  generally  supposed,  . 
undergo  a  rapid  transformation  into  carbonate  of  ammonia.  Doge 
into  which  urea  was  injected,  after  the  renal  vessels  were  tied,! 
to  prevent  the  rapid  elimination  of  the  poison,  showed  no  mora  ' 
marked  convulsive  symptoms  than  others  in  which  the  same 
ligature  was  made  without  the  injection.  The  convulsive  symp- 
toms observed  with  urea  were  produced  by  an  impure  substance  i 
containing  ammoniacal  salts.  The  authors  summed  up  in  thai 
following  conclusions : — 1,  Pure  urea,  whether  natural  or  artifi-1 
cial  injected  iuto  the  venous  system  in  large  quantities,  rievei 
brings  on  convulsive  symptoms  ;  it  is  rapidly  eliminated  by  thefl 
aecretiona.  2.  There  are  no  ferments  in  the  normal  blood  which  1 
convert  the  urea  into  ammoniacal  salts.  The  rapidity  of 
elimination  cannot  be  regarded  as  the  cause  of  the  non-conversion, 
for,  by  the  suppression  of  the  renal  secretion  the  elimination  of 
the  urea  may  be  retarded  without  accelerating  tho  suporvention 
of  the  eclampsia.  The  urea  which  in  large  doses  brings  on  con- 
vulsions is  always  impure  urea  which  contains  ammoniacal  salts, 
which  are  easily  shown  to  be  present  by  Nessler's  reagent. — A 
Medical  and  Surg.  Reporter, 


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BRITISH  AND  FOREIGN  JOURNALS.  183 

ligature  of  the  Femoral  Artery ,— (Two 

cases  of  ligature  of  the  femoral  artery  with  carbolized  catgut, 
by  D.  Walshb,  L.R.C.P.,  Edin.,  &c.) — Now,  when  the  ments 
of  catgut  as  a  ligature  are  being  discussed,  it  would  be  well  if 
eyerj  practitioner  who  has  ligatured  an  artery  in  its  continuity 
would  publish  the  case.  Should  arteries  ha^e  been  ligatured 
by  men,  who  like  myself,  cannot  boast  much  skill  or  experience, 
the  cases  would  still  be  very  important  as  proof  of  the  success  of 
any  particular  plan  of  treatment,  or  of  the  efficiency  and  safety 
of  and  particular  kind  of  ligature.  Of  course  they  would  not  be 
so  valuable  if  advanced  as  proofs  of  the  failure  of  a  plan  of  treat- 
ment, or  of  the  inefficiency  or  danger  of  a  ligature.  The  hope 
that  the  two  following  cases  will  be  of  some  slight  use  is  the 
only  excuse  I  can  make  for  reporting  them. 

Case  L — James  R ,  thirty-two,  soldier,  was  admitted  into 

the  Chorlton  Hospital,  Withington,  Manchester,  on  October  15th, 
1873.    He  was  suffering  from  an  aneurism  of  the  left  popliteal 
artery,  about  the  size  of  a  hen's  egg.    He  had  served  in  India, 
and  had  contracted  syphilis  whilst  in  the  army.     He  had  no 
history  of  rheumatic  fever,  and  had  no  disease  of  the  heart.   He 
was  kept  in  bed,  and  had  large  doses  of  iodide  of  potassium. 
After  a  week  of  this  treatment  no  beneficial  change  was  observed 
in  the  aneurism.    I  then  applied  a  pair  of  Skey's  tourniquets 
over  the  artery  in  Scarpa's  triangle.    He  was  left  to  manage 
these  himself,  and  instructed  to  screw  them  up  alternately.  The 
aneurism,  however,  continued  to  enlarge,  and  the  pressure  of 
the  tourniquet  being  removed,  the  pulsation  returned  as  strongly 
as  when  he  was  admitted.     It  was  then  decided  to  ligature  the 
femoral  artery.    I  placed  a  ligature  on  the  artery  in  Scarpa's 
triangle  on  November  11th,  1873.    The  material  used  was  cat- 
gut, obtdned  from  Messrs.  Wood,  of  Manchester,  who  guaran- 
teed it  to  be  the  same  as  that  used  by  Professor  Lister.    It  was 
not  appUed  under  the  spray.    The  wound  was  closed  with  iron- 
wire  sutures,  and  dressed  with  carbolic  lotion.    Complete  union 
by  the  first  intention  followed,  and  the  patient  was  perfectly 
eared  on  the  tenth  day  after  operation.    Two  hours  after  the 
opafiiaoii  there  was  no  perceptible  difference  in  the  temperature 


184  CANADA  MEDICAL   AND   SUEOICAL 

of  the  sound  and  digeaaod  limbs.  He  left  the  hospital  in  Jan- 
uary, 1874  ;  but  returned  the  following  August  with  a  rupture 
of  the  rig}tt  femoral  artery.  A  large  quantity  of  blood  had 
been  effuaed,  and  he  was  in  a  very  feeble  condition.  So  weak 
was  he  that  Dr.  L:iw  (mj  colleague),  Dr.  Mallet,  and  Mr.  Jones, 
of  the  Children's  Hospital,  Manchester,  who  saw  the  case  with 
me,  advised  that  no  operation  should  be  undertaken.  The  patient, 
however,  insisted  that  something  should  be  done  for  him,  and, 
finally,  it  was  decided  that  amputation  offered  the  best  chance  of 
success.  I  amputated  in  the  middle  of  the  upper  third  of  the 
thigh  ;  but  he  survived  the  operation  only  a  few  hours.  After 
lu8  death  I  had  an  opportunity  of  examining  the  left  femoral, 
wUch  had  been  tied.  It  was  perfectly  continuous,  and  slightly 
thickened  at  the  seat  of  the  ligature,  where  it  adherod  for  about  a 
quarter  of  an  inch  to  the  sheath  on  the  outside.  The  vein  did  not 
appear  to  have  been  at  all  disturbed.  The  artery  was  completely 
occluded  both  above  and  below  the  ligature. 

Case  2nd. — Edwin  H ,  sixty-one,  joiner,  was  admitted 

into  the  same  hospital  on  August  28th,  1872,  This  patient  had 
an  enourism  of  the  lefl  popliteal,  about  the  size  of  the  closed  fiat. 
For  three  weeks  he  was  treated  by  iodide  of  potassiumand  rest — 
that  ia,  a  fortnight  longer  than  in  Case  I.  In  all  other  respects, 
however,  the  two  cases  wore  treated  exactly  alike,  the  pressure 
by  the  tourniquets  being  continued  over  the  same  space  of  time 
in  each  case.  I  mention  this  because  it  appears  to  be  the  opinion 
of  some  authors  that  uuleas  a  speedy  cure  is  effected  by  com- 
pression, it  should  not  he  continued.  The  material  used  in  this 
case  was  carbolized  catgut,  without  any  other  antiseptic  treat- 
ment. The  wound  healed  by  the  first  intention,  except  where' 
the  incision  ran  through  a  «nall  slough,  produced  by  the  tourm- 
qaets. 

Jteniarks.  —  The  ligatnres  in  these  cases  were  tied  tight 
enough  to  divide  the  inner  and  middle  coats,  and  were  secured 
by  three  knots.  Mr.  Holmes  is,  I  believe,  of  opinion  that  the 
mortality  from  ligature  after  compression  has  failed  is  10  pet 
cent  greater  than  when  the  Hunterian  operation  is  done  at 
once.   Does  it  make  any  dlSerenco  where,  and  with  what  kind  of 


I 

I 


I 


BRITISH  AND  FOREIGN  JOURNALfi.  185 

iQstniment  the  pressure  is  made  ?   In  these  cases  the  pressure 
was  made  over  that  part  of  the  artery  which  was  afterwards 
ligatured,  and  was  made  with  an  instrument  which  scarcely  a 
all  interfered  with  the  vessels  which  were  to  carry  on  the  colla- 
teral circulation.    I  learn  from  Dr.  Van  Buren's  address  to  the 
International  Medical  Congress  at  Philadelphia  that  Dr.  Todd, 
of  Dublin,  was  in  the  habit  of  preparing  his  cases  for  operation 
by  employing  compression,  '*  in  order  that  mortification  of  the 
limb  might  be  prevented  by  allowing  some  progress  to  be  made 
in  establishing  the  collateral  circulation."     The  difference  in 
temperature  between  the  sound  and  diseased  limbs,  immediately 
after  the  operation,  in  both  cases  was  remarkably  slight,  and  not 
the  least  symptom  of  gangrene  made  its  appearance  in  either 

case,  although  E.  H was  over  sixty  years  of  age.    This 

would  lead  one  to  suppose  that  the  collateral  circulation  was  to 
some  extent  established  before  the  artery  was  tied. —  The  Lancet^ 

Removal  of  the  Astragalus— for  the  relief 

of  Congenital  Talipes.)  —  In  the  British  Medical  Journal 
of  Nov.  2nd,  M.  Lund  of  Manchester  Royal  Infirmary, 
reports  a  case  of  the  removal  of  the  astragalus  in  an  adult  for 
reUef  of  congenital  taUpes.  The  patient,  a  factory  operative, 
aged  29  years,  was  the  subject  of  equino  varus  of  the  right  foot. 
No  attempt  had  been  made  in  early  life  to  remedy  the  deformity. 
Two  years  ago  the  outer  side  of  the  foot  began  to  ulcerate 
at  several  points,  and  these  had  become  so  painful  as  to  prevent 
him  following  his  work.  M.  Lund  decided  to  remove  the  astra- 
galus, which  operation  he  successfully  carried  out  under  the 
antiseptic  method.  The  tibialis  anticus  and  the  planter  fossia 
had  to  be  divided  subcutaneously,  this  being  rendered  necessary 
in  consequence  of  the  contraction  and  crumpling  up  of  the  foot. 
After  the  removal  of  the  astragalus  and  the  divisions  of  these 
contracted  bands,  the  foot  could  be  placed  at  right  angles  to  the 
leg.  The  case  progressed  favourably.  M.  Lund  exhibited  a 
cast  of  the  foot  and  leg  ;  although  not  perfectly  well,  yet  the 
patient  has  so  far  improved  as  to  be  capable  of  bringing  the  sole 
of  the  foot  to  the  ground,  which  before  the  operation  was  an 


MEDICAL    AND   smtOICAL    JOOBNAL. 

impossibility.  A  well-made  shoe  upon  Mr.  Adam's  principle 
made,  and  the  patient  was  going  about.  This  exhibited  some 
diffused  inflammation  about  the  torsaj  joints  for  which  the  patient, 
was  atill  under  treatment.  Mr,  Lund  drew  attention  to  the 
peculiar  form  of  the  astragalus  which  had  been  removed  as 
illustrated  the  observations  of  Mr.  William  Adama,  as  to  tl 
change  in  shape  of  the  astragalus  in  confirmed  congenital  taHpes 
varus. 

TVftnh w> trOm y.  —  Afler-Treatment  of  Tracheotomy 
Caaes — Dr.  Vogt  quoted  in  the  Medical  Press  and  Ciroulart 
proceeding  from  the  fact  that  with  the  present  methods  of  treating 
tracheal  croup  most  children  perish,  even  after  operation,  firom 
continued  formation  of  the  membrane,  suggests  glycerin  as  a 
means  of  hindering  the  formation.  It  is  known  that  when  tlus 
substance  is  applied  to  the  mucous  membrane  a  profuse  watery 
serous  secretion  is  excited  ;  and  this  is  relied  upon  by  Dr.  Vogt 
t«  remove  or  prevent  the  adhesion  of  the  false  membrane.  In 
the  case  of  a  little  abc  yeare  old  girl  treated  in  this  way,  a  cure 
resnlted.  Glycerin  mbted  with  an  equal  quantity  of  water  wis 
inhaled,  by  means  of  an  inhaling  apparatns  connected  with  the 
tracheal  tube,  every  half-hour.  Dr.  Vogt  has  also  used  this 
treatment  in  recent  cases  of  croup,  where  tracheotomy  has  been 
thought  unneceasary  or  unadvisable.  Disinfection  of  the  original 
patch  in  the  pharynx  by  means  of  chlorine  or  bromine  water 
preceded  the  use  of  inhalation. — Med.  and  Surgical  Reporter. 

Stryobnia  in  Nocturnal  Enuresis.— !>■ 

Kelp,  according  to  the  Medical  Tivies  and  Gaztttr,  has  obtained 
success  in  obstinate  cases  of  this  troublesome  affection  by  the 
hypodermic  injection  of  the  nitrate  of  strychnia.  lie  insei 
the  vicinity  of  the  rectum  a  single  very  small  dose  sufiioing  to 
arrest  the  malady  for  a  tamo.  When  it  returns  the  injection 
is  to  be  repeated.  His  last  case  was  a  woman,  aged  eighteen, 
previously  in  exoellont  health,  who  had  suffered  from  eneureffls 
during  several  months,  consecutive  to -scarlatina.  The  &rsi 
injection  procured  her  a  respite  foi  several  nights,  aflier  whioli 
the  treatment  was  repeated,  and  the  cure  became  complete, 
«!  and  Sttrgical  JUporUr. 


BRITISH  AND  FOREIGN  JOURNALS.  18*7 

Ballet  wound  of  the  Skull.— Mr.  Clement 

Lucas  related  this  case,  which  had  come  under  his  care  at  Guy's 

Hosptal  in  February  last.     A  solictor's  clerk,  aged  twenty-one, 

after  scmie  misunderstanding  with  his  fiancSe^  declared  that  he 

would  shoot  himself.    Two  days  subsequently  he  was  found 

drank  and  disorderly,  and  was  locked  up  by  the  police.     Soon 

afterwards  shots  were  heard,  and  he  was  found  lying  on  the 

ground  in  his  cell  in  a  pool  of  blood,  with  a  revolver  by  his  side- 

The  revolver  was  a  small  one,  which  carried  pin-fire  cartridges. 

Five  chambers  had  been  discharged,  and  one  cartridge,  carrying 

a  small  conical  bullet,  remained  unfired.  Two  bullets,  which  had 

been  fired  at  the  iron  door  of  the  cell,  were  picked  up  on  the 

floor;  two  were  afterwards  extracted  from  the  skull ;  and  one 

renuuned  unaccounted  for.     He  was  brought  to  the  hospital  in 

a  semi-conscious  state.     Almost  in  the  centre  of  the  forehead 

were  two  small  circular  holes,  with  slightly  inverted  edges. 

Except  at  the  immediate  edge  of  each  aperture,  there  was  no 

blackening  of  the  skin,  indicating  that  the  muzzle  of  the  pistol 

was  applied  directly  to  the  forehead.    The  skin  surrounding  the 

bullet-holes  was  raised  into  a  rounded  eminence.  When  seen  by 

Mr.  Lucas,  he  had  so  far  recovered  consciousness  as  to  be  able 

to  stand  without  assistance.     Some  bleeding  occurred  from  the 

nose,  and  was  takei^as  evidence  that  the  frontal  sinuses  had 

been  opened.  '   Chloroform  was  administered,  and  a  crucial 

incision  made  over  the  wounds.  On  the  flaps  being  turned  back, 

a  blackened  caviiy  was  opened  beneath  the  skin,  formed  by  the 

expansion  of  the  powder  after  it  had  penetrated  the  integument. 

At  the  bottom  of  this  cavity  a  somewhat  reniform  aperture  was 

seen  in  the  bone,  and  lying  upon  the  internal  table  were  the 

two  flattened  bullets  shown  to  the  meeting.    After  removing 

numerous  fragments    belonging    to    the  external  table   and 

diploe,  the  splintered  internal  table  was  also  removed,  in  large, 

sharp-edged,  angular  fragments.    The  dura  mater  was  then 

seen  at  the  bottom  of  the  wound,  bulging  on  either  side  of  the 

longitudinal  sinus,  and  pulsating.      At  one  spot  there  was, 

unfortunately,  a  small  aperture.     The  wound   was  dressed 

antiseptically.     On  the  following   morning,  February  3,  he 


AND   BUBQICAL   JOITBNAL. 

was  quite  conscious  ;  sensation  and  motion  perfect ;  but  he 
complained  of  great  pain  at  the  back  of  the  neck.  Hia  tem- 
perature at  11  a.m.  was  99^* ;  but  in  the  evening  it  rose  to 
9y-8'',  and  his  pulse  to  96.  He  was  confined  to  milk  as  diet, 
and  ice  was  applied  to  his  head.  On  February  4  there  was 
some  ceJema  of  the  eyelids.  The  wound  was  dressed.  His 
temperature  in  the  evening  rose  to  102'1°  ;  his  pulse  was  100, 
full  and  regular,  February  5 :  his  eyelids  were  swollen  so 
that  he  was  unable  to  open  his  eyes.  Towards  evening  he  fell 
into  a  drowsy,  semi-unconscious  state,  and  his  breathing  became 
almost  stertorous.  In  the  evening  his  temperature  was  102'2'' 
and  pulse  98  ;  his  respirationB  25  ;  and  his  general  condilion 
much  worse.  February  6 :  The  patient  was  quite  unconscious 
and  very  restless.  He  passed  urine  under  him,  and  in  the 
night  bad  slight  general  convulsions.  Hia  right  arm  was  ri^d. 
The  right  leg  was  apparently  paralysed ;  the  left  rather 
rigid.  The  wound  was  discharging  grumous  matter.  In  the 
morning  his  temperature  was  104"  ;  pulse  104  ;  and  respira- 
tions 34.  In  tho  evening  the  temperature  rose  to  104.8*  ; 
pulse  104 ;  and  respirations  34.  February  7  ;  He  remained 
unconscious,  and  passed  his  motions  and  urine  under  him. 
The  muscles  of  the  right  arm  were  very  rigid,  those  of  the  left 
paralysed.  During  the  day  the  temperature  rose  rapidly — 
at  1p.m.  it  was  104";  at  5  p.m.  105-8°  At  7.40  p.m.  he 
was  placed  in  a  bath,  the  water  being  90",  and  the  patjent'a 
temperature  lOS'G"  in  the  axilla,  and  lOH-e"  in  the  rectum. 
Tho  bath  was  cooled  by  means  of  ice  to  73°,  when  he  was 
removed,  after  having  been  immersed  twenty-seven  minutes. 
The  temperature  waa  then  found  to  be  103.4°  in  the  axilla,  and 
107*2°  in  the  rectum.  Afl:er  removal  to  bed,  he  was  thought 
to  be  improved,  his  conjunctavie  being  more  sensitive  and  his 
pulse  steadier ;  he  was  also  able  to  swallow.  The  temperature 
continued  to  fall  for  about  an  hour  after  the  bath  ;  at  9.10 
p.m.  it  was  only  100'9°,  but  it  soon  after  began  to  rise  again. 
At  10.30  it  was  1041°,  aad  at  12.15, 105°.  He  died  about 
8  a.m.  on  February  8.  At  the  post-mortem  examination,  the 
aperture  in  tho  &ontaI  bone  was  immediately  above  the  firoatal 


I 


I 


>   FOREIGN  JOOHNALB. 


189 


BB,  whicli  were  opened  by  its  lower  edge.  The  Bmall 
aperture  in  the  dura  tnater  was  coTered  with  sloughy  granu- 
lations. The  frontal  sinuses  contained  pus.  The  internal 
table  of  the  skull  W!t6  hroken  away  soma  distance  further  than 
tlte  external.  There  was  general  suppurative  meningitis 
extending  over  the  surface  of  the  right  hemiaphero  and  the 
interior  half  of  the  left,  and  under  the  haae  of  the  brain  into 
the  right  Sylvian  fissure  nearly  to  the  quadrate  space.  The 
anterior  part  of  each  orbital  lobe  was  bruised,  ecchymosed,  and 
softened  ;  elsewhere,  the  brain  was  healthy.  The  other  organs 
were  all  healthy,  except  the  lungs,  which  were  congested  and 
(edematous,  and  the  spleen,  which  was  rather  soft, 

Mr.  Hutchinson  remarked  on  the  existence  of  hemiplegia 
on  one  side  and  arachnitis  on  the  other.  He  thought  tliat  in 
these  cases  there  was  usually  some  damage  to  the  brain- 
substance  itself — encephalitis  us  well  as  arachnitis. 

Mr.  Hulke  recalled  a  case  under  the  care  of  Mr.  Lawson, 
where  the  bullet  or  leaden  plug  was  found  at  the  bottom  of  a 
large  ragged  hole  in  the  forehead,  in  a  mass  of  blood  and  brain. 
This  man  never  had  a  had  symptom.  He  thought  there  was 
damage  to  the  brain-tisasue  in  all  eases  of  hemiplegia. 

Mr.  Heath  mentioned  a  case  where  a  man  put  a  pistol  close 
to  hia  head.  He  was  not  killed,  but  was  rendered  completely 
blind.  No  bullet  could  be  found,  but  there  was  a  sbght 
prominenoe  on  the  opposite  side  of  the  head  from  the  orifice  of 
entrance.  In  this  patient  there  were  two  kinds  of  squint. 
The  man's  health  was  still  good, 

Mr.  Baker  mentioned  a  case  which  he  had  seen,  where  a 
Chassepot  bullet  had  struck  the  forehead  and  buried  itself  in 
the  brain.  After  hving  for  months  the  patient  died  conmlsed 
and  finally  comatose. 

Mr.  Hulke  said  Larry  bad  written  of  the  case  of  a  man  who 
survived  after  a  bullet  passing  clean  through  the  brmn,  so  Hiat 
8  probe  could  pass  through. 

Mr.  Howse  had  had  a  case  somewhat  similar,  only  the  result 
was  fatal.  Here  the  bullet  passed  right  through.  He  cut 
down  and  found  llie  buUet. 


190  CANADA  MEDICAL   AND   SURGICAL   JOCRNAL, 

Mr,  Hatchinaon  referreii  to  an  interesting  apecimen  in  the 
Leeda  Muaenm,  beinjf  the  skull  of  a  woman  who  was  not  known 
to  have  received  any  injury,  bnt  in  whose  sphenoidal  fissure  a 
bullet  was  found  when  she  died  of  fever. 

The  President  said  much  injury  nught  be  done  to  the  br^ 
and  yet  nothint;  particular  happen.  Injury  to  the  convolu- 
tions did  not  seem  greatly  to  matter  if  the  debris  was  carefully 
removed.  Ho  referred  to  two  cases,  one  of  which  he  promiaod 
to  bring  before  the  Society. 

Mr.  Norton  a}>oke  of  the  case  of  a  peraon,  now  alive,  on 
whom  craniotomy  had  been  performed  and  who  was  put  on 
one  aide  for  dead.  lie  was  not  more  stupid  than  the  bulk  of 
agricultural  laborers.  i 

Mr.  Lucas  said  that  in  his  case  the  paralysis  was  not  com- 
plete, but  there  waa  rigidity.  The  anterior  lobes  of  the  brMn 
nught  be  injured  without  any  marked  result  following, — 
Medical  Kraes  ^  Gazette. 

On  Ulceration  of  the  Frasnum  Lingiiie 

in  Pertussis. — (Ii  the  BrUkh  Med.  Journal  Dr.  Robt. 
Cory  remarks  on  this  subject : — Dr.  Elliott  having  lately  added 
his  experience  to  that  of  Dr.  Maccall  and  of  Dr.  Morton  with 
regard  to  the  presence  of  ulceration  on  the  frasnum  of  the 
tongue  in  cases  of  whooping-cough,  it  may,  perhaps,  be  of  some 
service  if  I  give  my  experience  obtained  from  the  children 
attending  as  out-patients  at  St.  Thomas'  Hospital. 

The  number  of  cases  of  whooping-cough  during  the  last  two   ! 
years  in  which  the  fnenum  of  the  tongue  was  examined,  amounted  | 
to  84.     Of  these  84  cases,  27  of  them  had  ulceration  of  the 
frBenum,  giving  a  percentage  of  32.14.    This,  it  will  be  observed, 
is  greater  than  that  of  Dr.  Elliott  (2i"i  per  cent.),  but  consider- 
ably less  than   that  of  Dr.  Maccall  (44  per  sent),  and  of  Dr. 
Morton  (41  per  cent).     I,  however,  agree  with  Dr.  Morton  in 
thinking  that,  if  the  casea  could  all  have  been  followed  up,  the 
ulcer  would  have  been  found  to  exist  even  in  a  greater  proporiioi 
than  41  per  cent;  and   I  therefore  look  upon  Dr.  Maccall's  ei-  ' 
perience  as  the  one  most  nearly  appn>fiehiog  the  truth.    Casea  i 


BRITISH  AND  FOREION  JOURNALS.  191 

which  only  come  once  to  the  hospital  during  the  first  week  of  the 
disease  become  classed  with  those  which  have  no  ulcer,  although 
many  of  them  no  doubt  have  it  developed  later ;  indeed,  as  a 
matter  of  fact,  the  ulcer  does  not  appear  until  the  paroxysmal 
stage  has  existed  for  some  days.  The  average  length  of  attend- 
ance at  the  hospital  of  those  having  the  ulcer  was  6.5  weeks ; 
bat,  among  those  not  having  it,  it  was  4.8  weeks. 
The  following  table  shows  the  ulcer  at  different  ages : 

No.  having  Ulcers. 

During  first  year 0  out  of  10 

<<      second  year 4      "      14 

«      third  year 7      "      16 

«      fourth  year 6      «      14 

«      fifth  year 7      «      16 

«      sixth  year 2      «        5 

'<      seventh  year 2      <<        8 

«      eighthyear 0      «       2 

Among  the  84  cases,  45  were  females  and  39  males,  and  the 
ulcer  of  the  fraenum  was  present  in  16  out  of  the  45  females, 
and  11  out  of  the  39  males. 

From  the  foregoing  table  it  would  appear,  that  the  third, 
fourth,  and  fifth  years  are  the  ones  during  which  the  ulcer  most 
frequently  occurs. 

That  the  cause  of  ulceration  is  due  entirely  to  the  friction  of 
the  soft  parts  against  the  teeth  I  have  myself  little  doubt,  and 
can  entirely  indorse  what  Dr.  Maccall  says  on  this  point.  I 
have  never  seen  the  ulcer  in  a  child  before  the  lower  incisors 
Were  cut,  and,  in  two  cases,  where  the  lower  incisors  had 
entirely  disappeared  in  children  of  three  or  four  years  respect- 
ively, the  ulcer  never  appeared,  although  repeatedly  looked  for. 

The  manner  in  which  children  cough  is  a  very  important 
p(nnt  in  the  production  of  the  ulcer.  Some  children  instinct- 
ively protrude  their  tongues  as  far  as  possible — especially  is 
this  the  case  in  those  of  three  or  four  years  old,  in  whom  the 
jdiaiynx  is  small ;  but  with  older  children  the  necesssty  for  the 
protrusion  of  the  tongue  is  not  so  urgent,  and  they  have  also,  in 
<me  sense,  a  greater  command  over  it ;  hence,  in  these  latter, 
ike  ulcer  is  not  so  frequently  formed.  The  time,  also,  at  which 
the  ulcer  usually  first  appears,  viz.,  during  the  second  and  third 


192 


CANADA  UEDtCAl,   AND   StTBOICAL    JOURNAL. 


weeks,  and  its  coincident   disappeimtnce   with   tlie  Bpasmodic 
stage,  is  exactly  what  the  mechamcal  theory  rcqiures. 

Perhaps  the  inflamed  and  swollen  orifices  of  Wharton's  ducts, 
opening  aa  they  do  on  each  aide  of  the  fnenmn  near  the  central 
line,  have  been  mistaken  for  the  commencement  of  follicular 
ulcer ;  but  this  condition,  I  take  it,  results  also  from  mechanical 
irritation.  That  the  symptom  is  an  im[K)rtant  diagnostie  one  I 
think  all  are  agreed,  and  its  simple  explanation  does  not 
detract  one  whit  from  its  value. 


^nransfiision. — At  the  meeting  of  the  Soci^t^  Biolo^e, 
Dr.  Bro.wn-Sequard  gave  an  interesting  account  of  his  experi- 
ments on  transfusion.  He  had  made  use  of  different  sorts  of 
liquid  for  transfusion,  such  as  normal  blood,  blood  without  its 
fihrinc.  and  milk.  In  such  case  he  found  the  results  to  be  the 
same,  but  in  the  case  of  the  milk  the  fiuantity  that  it  was  neces- 
sary to  inject  was  more  considerable  than  in  the  others.  Ninety- 
five  grammes  of  blood  was  drawn  from  a  dog,  and  were  replaced 
by  the  same  amount  of  milk.  Shortly  after  the  operation  (about 
forty-five  minutes)  there  was  no  trace  of  milk  globolea  to  be 
found  in  the  blood,  and  the  dog  has  cont'mned  in  excellent  health 
ever  since  the  operation,  which  took  place  more  than  five  months 
ago.  M.  Malassez  found,  upon  examining  the  blood  after  the 
transfusion,  a  greater  number  of  white  globules  than  normal. 
In  concluding  his  remarks.  Dr.  Brown-S^quard  cxpresaed  the 
o[miion  that  the  Uquid  injected  should  he  at  least  of  a  tempera- 
ture of  10°  to  12*^  C.  It  was  preferable,  he  thought,  to  chose 
the  arteries  rather  than  the  veins,  and  recommended  the  opera- 
tion to  be  done  very  slowlj,  in  order  to  allow  the  hquid  injec^on 
to  acquire  the  temperature  of  the  blood.  Transfiision  also 
succeeded  in  animals  when  the  blood  made  use  of  comes  &om  a 
species  of  animals  different  from  that  of  the  one  under  eicperi- 
ment.  It  appears  that  Dr.  Thomas,  of  New  York,  has  tried  the 
transfusion  of  milk  on  tho  Uving  subject,  and  is  convinced  thai 
it  acts  aa  well  aah](Md.— The  Lancet. 


CANADA 

Medical  &  Surgical  Journal 

DECEMBER,  1878. 

©riginal  Communications. 

PHTHISIS    AND  ITS    VARIETIES: 

A   LBOTUBl  DILIVEBED    AT   MONTBIAL, 

BY    ANDREW    CLARK,   M.D.,  F.R.C.P.,    Lond., 
Physician  to  the  London  Hospital,  &c.,  &c. 

It  was  signified  by  circular,  signed  by  Dr.  Geo.  W.  Campbell,  the  Dean 
of  the  Medical  Faculty  of  McGill  University,  and  addressed  to  the  profes- 
sion at  Montreal,  that  Dr.  Andrew  Clark,  who  had  come  to  this  country  on 
the  staff  of  H.  R.  H.  the  Princess  Louise,  would  deliver  a  lecture  on  the 
subject  of  Phthisis.  In  response  to  the  general  invitation  extended  the 
Lecture  Boom  of  the  Natural  History  Society  was  filled  with  medical  prac- 
titioners  of  both  nationalities,  as  well  as  with  the  students  of  the  three 
medical  schools  in  this  city.  A  number  of  coloured  drawings  illustrative 
of  cases  that  had  come  under  Dr.  Clark's  observation,  were  placed  on  the 
table. 

Dr.  Campbell,  in  a  few  words,  introduced  the  lecturer,  who  said : — 

When  I  desired  to  have  the  privilege  of  laymg  these  draw- 
ings of  phthisical  lungs  before  you,  and  of  setting  forth,  in  short 
and  simple  outline,  the  views  which  I  have  formed  concerning 
the  varieties  of  phthisis,  I  did  not  presume  to  think  that  in  a 
place  so  distinguished  for  its  additions  to  science  as  this  is,  and 
in  the  presence  of  persons,  many  of  whom  have  contributed  and 
are  contributing  to  that  distinction,  I  could  say  anything  which 
would  appear  new,  still,  I  desire  to  lay  these  drawings  before 
you,  and  to  set  forth  the  views  which  I  have  formed,  after  long 
study  of  the  subject  in  order  that  I  might  have  the  benefit 
of  your  friendly  criticism,  and  learn  how  far  your  own  experi- 
ence corroborated  or  confirmed  my  own  conclusions.  It  is  not 
HO.  Lxxvn.  13 


194  CANADA    MEDICAT.   AND   StrRfllCAL   JOURNAL. 

my  intention — indeed  it  would  be  out  of  place — to  enter  into 
any  critical  or  historicnl  sketch  of  the  history  of  the  various 
theories  which  have  been  promulgated  respecting  phthisia,  I 
ahtil  proceed  without  further  preface,  at  once,  to  the  heart  of 
my  subject,  and  endeavor  in  the  fewest  words  and  plainest  man- 
ner to  lay  before  you  the  conclusions  at  which  I  have  arrived 

By  phthisis  I  mean  that  assemblage  and  progression  of- 
symptoms,  due  to  suppurative  or  ulcerative  destruction,  of  more 
or  less  circumscribed  non-malignant  deposits  in  the  lung, 
shall  not  pretend  that  this  definition  is  perfect,  but  I  claim  fop 
it  that  it  ifl  a  good  working  definition,  and  has  this  enormous 
advantage,  that  it  involves  no  hypothesis,  and  whatever  our 
views  of  phthisis  may  be,  we  may  retain  the  name  whilst  the 
idea  may  change.  Tou  will  observe  in  this  definition  that  I 
have  set  entirely  on  one  side  the  disease  with  which  we  are  all 
familiar,  under  the  name  of  Acute  Tuberculosis. 

The  chief  thing  I  have  to  say  about  that  disease,  before  dis- 
missing it,  is  this : — I  think  it  has  no  special  relations  to  phthieu 
at  all.  In  its  methods  of  approach,  in  the  phenomena  which' 
attend  its  progress,  and  in  the  changes  which  we  discover 
in  them  after  death,  in  the  state  of  the  organs  during  life,  it. 
exhibits  all  the  characterietics  of  what  we  call  zymotic  disease. 
I  look  upon  acute  tuberculosis  as  a  sort  of  fever ;  which 
has  for  one  of  its  anatomical  expressions  the  little  things 
called  tubercles.  If  I  appeal  to  the  experience  of  any  one 
present  who  has  had  the  opportunity,  not  often  acquired,  of 
examining  a  number  of  cases  of  acute  tuberculosis,  I  am  s 
he  will  agree  with  me  that  acute  tuberculosis  rarely  issues  in 
what  we  call  phthisis,  or  in  any  disease  which  would  come  within 
the  terms  of  the  definition  I  have  made.  Acute  primitive- 
tuberculosis,  beginning  often,  either  in  children  or  adults,'  in 
apparently  perfect  health,  producing  fever,  with  a  sort  of  capil-' 
lary  bronchitis,  making  rapid  progress,  marked  by  irregular 
ferer,  usually  terminates  in  death  in  from  three  to  six  weeks. 

Now,  I   might  add,  that  having  been  occupied  at 
*ime  as  Villemin  in  performing  experiments  upon  inoculation, 
knd  having  aleo  tried  other  methods  of  producing  tuberculodi 


PHTHISIS  AND    ITS   VARIETIES. — BY  DR.  CLAKK. 

as  nell  k  by  inoculation,  I  have  come  to  the  concluBion  that  the 
diffiBBe  produced  by  inoculation  13  not  a  true  tuberculosia.  In 
all  my  experiinentB  on  animala,  I  found  that  with  decent  care, 
the  aocalled  tuberculoais  produced,  invariably  di8appeared, 
that  the  progress  of  the  malady,  whatever  it  was,  was  un- 
attended except  at  the  beginning  by  any  fever ;  that  in 
animala  inoculated,  a  disease  is  produced  which  does  not  appear 
10  aSect  the  general  health,  and  which  within  five  or  six  weeks 
disappears,  leaving  the  animal  as  well  as  before.  You  will  agree 
witli  me  that  this  cannot  be  called  acute  tuberculosis  in  the  same 
sense  as  that  other  malady,  which  is  sudden  in  its  commence- 
ment, rapid  in  its  progress,  profound  in  its  constitutional  effects 
and  terminates  almost  invariably  in  death.  When  we  examine 
the  lungs  of  the  bodies  of  patients  who  have  died  of  phthisis, 
we  may,  without  any  undue  refinement,  classify  these  lungs 
onder  throe  groups.  In  the  first  group,  we  shall  find  that  the 
dominant  destructive  element  is  tubercle,  and  its  secondary 
consequences.  In  the  second  group  we  have  pneumonia  as  the 
domiaant  anatomical  element.  In  the  third  group  the  dominant 
uiatomical  element  is  fibroid  tissue.  I  have  purposely  used  the 
term  "  dominant  element,"  to  protect  myself  against  any  adverse 
criticism  which  has  no  just  foundation. 

The  lung  is  a  complete  organ,  and  several  anatomic  elements 
ent«r  into  its  constitution.  When  these  are  irritated  by  any 
foreign  body,  each  comports  itself  after  the  manner  of  its  kind  ; 
so  that  with  one  irritating  agent,  you  may  have  different 
anatomical  results.  If  tubercle  is  deposited  in  the  lung  and 
die  patient  is  susceptible  of  being  irritated  by  it,  we  know 
that  two  secondary  consequences  prevail, — one,  a  form  of 
pneumonia, — the  other,  some  form  of  fibroid  change,  and  just 
as  the  one  or  other  of  these  secondary  results  prevail  in  the 
fatiire  progress  of  the  case,  rapid  and  febrile  if  the  pneumonic, 
slow  and  free  from  fever  if  the  fibroid  prevails.  So  true  is  this, 
it  baa  almost  given  rise  to  an  axiom  with  respect  to  the  chronic 
phthisis,  that  in  tubercles,  per  ge,  it  never  kills  ;  it  is  the  tubercle 
plus  the  secondary  effects  of  tho  tubercle,  which  is  fatal. 
a.  Xow,  aa  each  of  these  three  groups  has  a  distinctive  history  i 


196  CANADA   MEDICAL    AND    SttBGlCAL   JOURNAL. 

as  eacli  differs  from  the  others  in  the  mode  of  origin,  progression, 
consequences  and  issues,  I  think  it  ought  to  have  a  distinctive 
designation.  Furthermore,  that  we  may  introduce  no  new 
names  when  old  ones  will  suffice,  and  that  we  may  avoid,  in 
naming,  any  theory  about  the  thing  named,  I  shall  call  the  first 
group,  in  which  tubercle  is  the  dominant  anatomical  element, 
tubercular  plUhUin,  the  second  group  in  which  some  form  of 
pneumonic  exudation  ia  the  dominant  element,  pneumonic 
pMJtisU,  and  in  the  third  group  in  which  a  fibroid  element  is 
dominant  ^roiii  pktkim. 

b.  Now,  by  many  observers  in  Prance  and  by  some  in  England, 
it  will  be  asserted  that  this  classification  is  artilical  and  unreal ; 
that  the  histological  elements  of  tubercle  are  to  be  found  in 
caseous  pneumonia  which  is  only  a  tubercular  infiltration  ;  that 
the  fibroid  changes  are  but  transformed  tubercles;  that  the 
whole  three  are  structural  homotogues  and  but  different  expres- 
sions of  one  pathological  state  and  nature. 

Very  well,  although  I  regret  the-fe  assertions  as  incorrect,  and 
believe  that  I  could  demonstrate  their  inaccuracy  ;  yet,  for  the 
Bake  of  argument,  I  will  admit  their  force,  and  will  seek  in 
another  diraction  for  such  an  argument  as  may  he  conclurive  as 
to  the  existence  of  the  varieties  of  phthisis  which  I  have  named 
I  have  not  far  to  go  in  ray  search.  I  aver  that  the  true  criterion 
of  difference  between  patholo^cal  products  is  to  be  found  much 
more  easily  in  the  life-history  which  accompanies  their  evolution 
than  in  the  anatomical  elements  which  form  theirfinal  expression ; 
and  when  I  pass  from  the  dead-houat;  to  the  wards,  and  inquire 
if  there  is  anything  iu  the  clinical  or  life-history  of  phthisis  which 
would  justify  its  division  into  the  varieties  named,  I  discover,  as 
I  believe,  a  just  answer  in  Che  affirmative.  If  this  be  so,  can  the 
grounds  of  those  distinctions  be  so  expressed  as  to  be  capable  of 
recognition  by  ordinary  clinical  observers  ?  Within  certain 
limits  yes ! — In  the  very  advanced  stages  of  lung  disease  when 
the  symptoms  are  more  directly  due  to  mere  damage  of  function 
than  to  the  nature  of  the  damaging  agent,  recognition  b  some- 
times difficult ;  but  in  the  early  stages  with  due  care  it  is  easy. 
There  is  a  second  difficulty — partly  one  of  terminology — in 
ftirming  a  clear  conception  of  the  varieties  of  phthi^ 


PHTHISIS  AND    ITS    VARIETiKS. — BV   DB.   CLARK,  197 

When  we  speak  of  tubercular  phthisis,  there  is  no  difficulty 
ID  nnderstanding  that  we  mean  by  it,  the  assemblage  and  pro- 
gression of  symptoms  caused  by  the  ulcerative  obstruction  of 
the  lung  by  tubercle  aud  ita  secondary  effects.  But  when  we 
come  to  pneumonic  phthisis,  we  are  at  once  mot  with  a  consid- 
erable degree  of  comple.tity,  not  only  in  the  nature  of  the 
thing,  of  the  pneumonia  itself,  but  in  the  nature  of  the  ter- 
minology which  has  been  adopted.  I  will  try  to  make  it 
plain.  There  are  three  forms  of  pneumonia  which  we  will  all 
readily  recognize.  First,  there  is  the  common  inflammation 
which  attacks  the  base  of  the  lung,  which  begins  with  a  httle 
pun,  is  followed  by  crepitation,  tubular  breathing,  and,  which 
terminates  in  six  or  seven  days,  and  is  generally  removed. 
There  is  a  second  form  of  pneumonia,  altogether  different, 
which  alfects  instead  of  the  lower  part  of  the  lung,  the  upper 
part,  which  instead  of  beginning  abruptly  by  fever,  sometimes 
be^ns  insidiously  with  a  little  fever  and  continues  its  march 
&om  the  summit  of  Che  lung  downwards.  The  characteristic 
of  this  pneumonia  is  a  kind  of  cheesy  etuflT,  exactly  like  that 
we  find  in  the  ripe  scrofulous  gland. 

Between  these  two  forms  of  pneumonia  and  connecting  them, 
as  it  were,  together,  is  a  third  form,  what  is  called  catairhal 
pneumonia,  which  is  (common  in  children,  and  is  often  a  result  of 
capillary  bronchitis.  There  are  these  three  forms  of  pneumonia, 
and  every  one  of  them  with  different  degrees  of  liahihty,  is 
capable  of  developing  phthisis.  Every  one  of  these  forms  is 
capable  of  giving  rise  to  exudations  which,  when  not  absorbed, 
and  undergoing  suppurative  destruction,  come  within  the 
definition  of  phthisis.  The  common  pneumonia  may  do  this, 
aldiough  it  does  ao  very  rarely,  the  cheesy  pneumonia  does  it 
commonly,  the  catarrhal  with  an  intermediate  degree  of  fre- 
«]Uency. 

We  have  here  a  considerable  comjilexity  in  enquiring  into 
the  deBnitions  of  these  groups  of  phthisis,  I  will  not  go  too 
closely  into  it  at  present,  because  it  would  occupy  too  much 
time,  and  blur  the  outlines  of  a  picture  I  wish  to  keep  clear, 
I  will  confine  myself  to  illustrations  of  croupous  and  of  cheesy 
,  pneumonic  phthisis. 


AND  SCBOICAL   JOUBNAt. 


Are  we  justified  clinically  in  diatinguahing  these  three  groapB 
of  phthisis  ?  I  think  so.  I  will  roughly  sketch  the  diatinguiskiag 
olinioal  characteristics  of  these  groups. 

First  of  all,  there  is  the  tubercular  phthisis  produced  by  the 
destructive  agency  and  the  consequences  of  tubercle  in  the 
longs.  In  chronic  phthisis,  mere  tubercles  never  kill,  and  if 
one  could  stop  tubercles  from  producing  secondary  pneumonia, 
one  could  keep  the  patient  alive,  and  if  free  from  fever  compli- 
oations  as  well,  I  see  no  reason  why  the  patient  might  not  live 
u  long  as  any  one  else.  With  regard  to  this  first  group,  the 
mun  distinguishing  point  about  it,  clinically,  is,  as  far  as  my. 
experience  goes,  that  whilst  the  local  symptoms  are,  at  the  be-i 
ginning,  exceedingly  few,  the  constitutional  symptoms 
and  profound.  Here  is  a  case — a  ^rl  about  18  years  of  a; 
with  ahistory  of  phthisis  ici  the  family,  has  large  eyes,  is  Bushed 
easily,  and  for  some  time  has  been  getting  out  of  health,  lofflng 
strength  and  colour.  The  doctor  is  called  in  ;  he  examines  her 
and  finds  no  evidence  of  local  disease,  but  that  the  pulse  is  more 
frequent  than  natural,  temperature  higher,  and  breathing 
quicker.  He  sees  a  case  where  obviously  the  constitution  is 
gravely  distressed  and  no  local  foundation  to  cause  the  distress. 
The  patient  gets  thinner  and  weaker;  bye-and-bye  a  little 
dulneas  is  found,  and  the  chest  becomes  flattened,  then  the 
ordinary  symptoms  of  phthisis  set  In,  and  though  they  improve 
from  time  to  time,  the  main  progress  is  almost  invariably  down- 
ward, and  in  a  period  of  from  two  to  four  years,  the  case  ter- 
minates in  death.  This  is  an  ordinary  outline  of  tubercular 
phtlusis.  It  is  marked  at  the  beginning  by  the  slightness  of 
physical  and  the  prevalence  of  constitutional  symptoms.  It  is 
also,  as  I  think,  marked  by  the  want  of  response  to  almost  any 
treatment. 

Here  is  the  second  fornc,  a  case  of  pneumonic  phthisis.  This 
is  the  drawing  of  a  lung  of  a  very  well-known  case  in  the  London 
hospital,  Peter  Mackintosh.  We  examined  him  and  found  the 
usual  signs  of  pneumonia  with  these  modilications,  there  were 
diminished  tactile  vocal  fremitus ;  feeble  breath  sounds,  and 
diminished  vocal  resonance. 


] 


PHTHISIS  AM»   ITS  VARIETIES. — BV    DR,   CLARK.  199 

Many  of  these  symptoma  might  have  suggested  the  idta  of 
pleuritic  effasiou,  but  as  there  was  no  displacement  of  organs, 
no  friotion,  no  variation  of  dulness  with  variation  of  position, 
lad  45  there  was  profound  constitutional  disturbance  I  knew 
thu  I  was  dealing  with  a  case  of  pneumonia  ;  but  said  to  my 
class  that  the  exudation  would  very  probably  fail  to  be  melted 
or  absorbed. 

The  pneumonia  came  to  an  end  about  the  usual  time.  There 
was  no  absorption  of  exudation  ;  he  remained  months  under  my 
care  without  the  smallest  change  in  the  solidity  of  the  lungs. 
About  the  end  of  nine  months  he  wanted  to  go  out.  After  a 
ffhile  he  came  back  again,  having  caught  cold,  and  soon  after 
the  laog  began  to  break,  and  he  continued  with  symptoms  of 
phthisis  for  nearly  two  years  altogether  under  my  care  at  the 
London  hospital,  A  curious  compheation  occurred.  One  of  my 
big  guns  was  that,  whenever  a  pneumonic  exudation  is  unab- 
sorbed,  within  a  month  of  the  breakage  you  will  get  tubercles 
in  the  other  lung,  In  Mackintosh's  case,  within  a  month  there 
arose  symptoms  of  disease  in  the  opposite  lung,  but  on  pott 
•mrtem  examination,  I  found  a  very  beautiful  cjtample  of  lobular 
pneumonia,  and  no  tnbercles.  This  was  the  first  time  I  had  not 
found  tubercles  produced  by  the  suppuration  of  unabsorbed 
deposit;  you  will  recognize  such  caaes  of  pneumonic  phthisis 
by  the  fact  that  there  has  been  no  absorption  of  the  deposit, 
that  there  is  more  or  less  large  solidification  at  the  base  of  the 
long,  and  that  that  exudation,  instead  of  disappearing,  begins 
bye-and-bjc,  to  break  up  ^ving  rise  to  fever  and  the  other 
symptoms  of  phthisis. 

The  second  class  of  cases  of  pneumonic  phthisis  is  more  diffi- 
cult to  recognize.  There  is  no  history  in  it  of  insidiously  rapidly 
fiuhng  health. aa in  the  caseof  tuberculosis;  on  the  other  hand, 
there  is  no  history  of  acute  attack  which  may  be  considered 
u  pleurisy,  but  there  is  a  history  of  cough  creeping  on  with 
a  little  fever,  and  increasing  without  any  material  impairment 
to  the  general  health.  You  shall  see  a  fair  man  or  a  fair  woman, 
with  light  eyes,  florid  cheek,  tolerably  well  nourished  body,  few 
complaints  to  make  except  with  respect  to  cough  and  expoctora- 


200 


MEDICAL   AND    SITROICAL    JOURNAL. 


tion.  You  will  find  tha-t  whilst  contitutional  symptoms  are 
exceedingly  few,  the  physical  signs  are  very  many.  You  wiH 
find  the  middle  part  ol'  the  lung  very  solid.  Sometimea  instead 
of  being  absorbed  or  undergoing  fibroid  change,  the  lung  dian- 
tegrates,  the  clieeay  matter  breaking  down  into  smal!  cavities,' 
and  then  it  progresses  like  an  ordinaij  case  of  phthisis.  In 
speaking  of  the  clinical  character  of  these  cases  of  caseons 
pneumonic  phthisis,  they  are  not  ao  very  clearly,  expressed  aa 
either  the  tubercular  phthisis,  or  the  comtnon  pneumomc 
phthisis  ;  but  keeping  in  view  its  characterbtics,  the  considera- 
ble extent  of  uniform  consolidation  at,  say,  the  upper  part  of 
the  lung  with  the  compa.rative  slightness  of  the  constitutional 
symptoms — the  occasional  raeltiiig  and  absorption  of  the  deposit, 
or  its  conversion  into  fibroid  stuS — and  the  often  scrofulous 
history  of  the  patient,  you  will  not  fful  to  recognize  these  caseB 
during  life. 

I  must  introduce  another  element  of  complexity.  I  haTfl, 
spoken  of  cases  of  pneumonic  phthisis  aa  chronic,  but  soma 
limes  it  b  an  acute  disease.  Cases  of  this  kind  are  to  be  recog- 
nized immediately  by  the  circumstance  that  the  disease  occurs 
in  the  upper  lobe,  progresses  rapidly  from  above  dovmwards,  ib 
accompanied  by  fever,  and  either  terminates  at  the  end  of  a  fort- 
night, or  within  a  few  weeks  in  cavities.  This  form  of  case  of 
pneumonic  phthbis,  is  the  form  which  used  to  be  called  "  gallop- 
ing consumption."  I  pause  to  recur  to  the  anatomical  quesdoD. 
It  is  sometimes  said  by  French  anatomists  that  there  is  no 
distinction  in  point  of  fact  between  the  histological  record 
of  the  tubercular  and  the  caseous  deposit.  In  the  commoD 
tubercle,  you  have  the  constitutional  symptoms  being  in  a 
marked  degree  evident  at  the  beginning.  In  the  caaeoiu 
phthisis  you  have  a  very  large  amount  of  local  lesion  with  a 
small  amount  of  constitutional  disturbance.  It  must  follow 
that  tubercle  b  a  very  curious  thing,  that  for  some  reason 
not  apparent,  the  less  the  anatomical  the  more  profound 
tho  constitutional  lesion,  and  the  more  the  amount  of  phydcal 
change,  the  less  the  constitutional  effect  Thb  seems  absurd^ < 
ukd  I  know  of   no    better  argument  than  this  to    adduce 


)    IT.'    VARIETIES — BY   DR.   CLARK. 


201 


B  argument  that  they  are  identical.  I  might  adduce 
a  second,  not  so  important,  beeause  unhappily,  not  so  capable 
of  being  used,  namely,  that  I  very  much  doubt  that  grey 
tobercles  are  really  abaorbed.  I  do  not  doubt  they  may  form 
into  Gbroid  tissue,  but  that  is  a  rare  occcurrence,  after  we  have 
reoogniied  that  they  are  present  in  any  considerable  amoiint 
I  have  seen  caseooa  exudations  occur  in  the  summit  of  the  lung 
md  disappear.  Even  Laennec,  himself,  admits  that  in  certain 
circumstances,  tubercular  inliltration  disappears. 
Of  the  clinical  character  of  fibroid  phthisis,  there  can  be  no 
Babt  whatever.  It  is  marked,  as  a  rule,  by  inflammatory 
I  have  in  the  London  hospital  now,  three  cases  upon 
diicb  I  was  occupied  for  some  weeks  lecturing  before  I  came 
!  the  Atlantic.  These  will  illustrate  better  than  an  ab- 
aet  description,  one  of  the  origins  of  this  disease.  The  first 
n  had  these  symptoms — he  is  aboot  thirty-six  years  of  age — 
his  light  side  is  extremely  contracted,  the  heart  beats  under  the 
secoDd  rib,  he  ia  pretty  well  in  his  general  health,  has  no  fever, 
bat  suSers  from  a  paroxysmal  cough,  which  ends  occasionally 
m  vomiting,  by  which  act  he  ejects  a  glary  mucus,  and 
sometimes  a  foetid  pus  This  is  fibroid  phthisis,  because  on 
examining  him,  there  are  found  signs  of  two  small  cavities  near 
the  summit  of  the  lung,  not  dilated  bronchical  tubes,  and 
their  areolae  of  elastic  tissue  from  the  pulmonary  alveoli  in  the 
eixpectoratioa 

One  of  the  other  cases  has  these  characteristics.  He  is  s 
man  about  52,  has  been  eight  months  under  observation,  came 
into  the  wanls  of  the  hospital  with  a  common  right  pleurisy, 
had  a  little  effusion  at  the  base  of  the  lung.  I  said  to  my  class, 
we  will  put  him  to  bed,  and  by  rest  and  diet  the  effusion  may 
go  and  he  will  be  well.  The  effusion  went  away  and  when  I  ex- 
amined him,  I  found  a  to  and  fro  friction.  I  thought  nothing  of 
it,  bnt  a  fortnight  afterwards  this  to  and  fro  friction  was  running 
up  the  lung  and  very  soon  went  all  over  the  lung;  Notwith- 
standing all  I  could  do  with  iodide  of  potassium,  mustard 
plasters,  &c.,  it  would  not  be  influenced.  It  went  on  for 
jOQQtba  and   simultaneously  with   its    continuance  in  the  latter 


oanada  medical  and  ersoicAL  jousnax. 

stages  of  its  history,  the  lung  began  to  contract,  the  right  sida 
distiDCtly  contracted,  the  ribs  fell  in,  the  neck  began  to  swell, 
the  heart  was  drawn  down,  bye-and-bje  and  he  began  to  hava 
a  little  spinal  curvature.  In  this  state  I  left  him.  This  form 
of  fibroid  phthisis  is  to  be  recogmzed  by  its  mode  of  ori^n  :  b^ 
the  contraction  of  the  lung ;  by  the  paroxysmal  character  of 
the  cough ;  by  the  absence  of  fever ;  by  the  alow  progressloa 
of  the  disease,  and  by  the  displacement  of  the  heart  towards 
the  contracted  side. 

Here  is  an  engraving  of  a  lung  which  first  taught  me  this 
form  of  phthisis.  The  first  patient  I  had  at  the  London  Hos- 
pital was  a  man  of  lo  atone  in  weight,  a  hricidajer,  who  comr 
pifucod  of  a  cough  and  spitting  up  blood.  He  had  been  surgically 
treated  for  a  fractured  rib  some  weeks  before.  1  watched  him 
for  a  year.  Step  by  step  his  right  side  began  to  contract,  hit 
cough  became  more  and  more  paro.tysmal,  curious  changes 
appeared  in  the  state  of  the  blood  vessels,  the  right  side  of  the 
neck  became  smaller,  great  veins  traversed  the  right  side  of  the 
thorax,  and  the  right  arm  became  swelled.  In  this  state  he 
complained  of  the  right  side,  had  a  paroxysmal  cough  and  an 
occasional  fosttd  expectoration,  difficulty  in  breathing,  and  in 
ability  to  eleep.  Everybody  said  he  had  a  tumour  or  cancer. 
I  began  to  have  my  own  feuth  shaken,  and  to  believe  he  had 
Bome  sort  of  tumour,  although  I  could  not  reconcile  t^e  symp- 
toms with  any  disease  I  knew.  I  felt  satisfied  I  had  to 
do  with  a  lung  which  was  unfit  by  some  sort  of  fibroid 
ehange.  At  last  he  died  from  a  little  cold,  and  be 
willed  hia  body  to  be  esamined  by  the  doctors.  The  pleura 
was  found  an  inch  in  thickness,  in  addition  there  was  an  inch 
of  fat,  on  the  top  and  side  of  the  lung.  There  was  no  tubercle 
anywhere,  no  evidence  at  disease  anywhere  except  that  this 
right  lung  was  reduced  to  a  very  small  conoise  form  by  fibroid 
ehange,  was  coated  with  lymj^,  and  the  long  was  eaten  into 
•mall  cavities. 

This  is  a  drawing  of  the  Inng  of  a  man  called  Peak.  He  was 
brought  to  me  by  Dr  Pollock  of  Charing  Cross  Hospital.  This  is 
the  oue  of  a  lad  about  18  years  old,  who  had  recurring  bron- 


tarmaiB  and  its  varieties. — by  db.  olark. 

ohitis  and  plenn^  of  the  right  side.  The  whole  of  hJa  malady 
WM  obviously  on  the  right  side.  He  had  a  contracted  right 
ciiest,  eitreme  dntness,  feeble  breath  sounds,  and  hard  par- 
«ijmai  cough,  with  foetid  matter.  His  heart  instead  of  beat- 
ing fifth  and  sixth,  beat  a  third  from  the  right  rib.  It  was  a 
tnbercalar  case  of  fibroid  phthigia,  with  a  little  irritation  of  the 
broDohial  tubes.  It  was  exhibited  to  the  Chnical  Society ;  un- 
fortutateiy  it  was  sat  upon  by  three  gentlemen  connected  with 
the  hospital,  who  could  not  see  anything  remarkable  m  it,  said 
it  -Wis  ordinary  tobercular  phthisis  with  contraction.  Peak 
died,  and,  aft«r  some  considerable  difficulty,  Dr.  Pollock  and 
I  succeeded  in  getting  a  post-nwrtem  examination.  We 
firand  no  disease  except  in  the  right  lung.  The  lung  waa 
redoced  about  one-fourth  of  its  natural  bulk,  was  perfectly 
wlid,  permeated  by  one  or  two  dilated  bronchial  tubes.  There 
ms  nothing  which  could  be  construsd  into  tubercular  deposit. 
It  will  be  obvious  that  anatomically  there  are  these  three 
gronpa  met  with  in  lungs  of  patients  dying  of  phthisis.  I 
hope  I  have  said  enough  to  prove  that  they  are  capable  of 
recognition  during  life,  that  they  are  not  merely  pathologically 
enrions. 

If  that  be  so,  my  contention  is  that  as  these  groups  of  phthisis 
being  distinct  in  their  origin,  different  in  their  progresa,  res- 
ponding differently,  ought  to  bo  characterized  by  distinctive 
names  corresponding  to  treatment. 

One  other  point.  These  are  the  three  great  groups  of 
phthisis,  but  oorresponding  to  our  definition  there  are  other 
forms  which,  as  pathologically  and  clinically  curious  might  be 
mentioned.  There  are  on  the  table  two  drawings  taken  from 
patients  who  suffered  from  the  symptoms  of  phthisis.  In  one 
the  destructive  agents  are  syphilitic  deposits ;  in  the  other 
haemorrhagic  extravasations. 

I  cannot  hope  to  have  solved  many  of  the  difficulties  surround- 
ing Ih^  complex  subject ;  hut  if  I  have  succeeded  in  removing 
me  ohacurity  and  in  opening  fresh  paths  of  inquiry,  I  have 

lin  occupied  your  time, 
Db,  Howabd  asked :  Have  you  noticed  whether  tubercular 


204  CANADA   MEDICAL    AND   SURalCAL    JOURNAL. 

phtUiais  and  cnaeoua  pneumonic  phthisis  occur  in  children  of  the 
same  family  ?  Are  you  of  the  opinion  that  they  may  be  alter- 
native complaints  in  the  same  family?  Are  they  equally  trans- 
misaible  by  inheritance  ?  Have  you  ever  met  a  case  of  primary 
fibroid  phthisis  not  of  inflammatory  or  tubercular  origin  ? 
Are  there  means  by  which,  in  a  caae  of  pleurisy  or  pneumonia, 
one  might  early  suspect  that  this  ulterior  change  of  fibroid 
transformation  might  be  set  up  ;  if  so,  how  shall  we  recogniae,, 
at  an  early  stage,  the  future  life  history  of  the  original  disease  7 
Can  you  distinguish  those  eases  of  chronic  tubercular  phthimg 
or  caseous  pneumonic  phtliisis,  wliicb  undergo  fibroid  transfor- 
mation from  those  cases  of  fibroid  phthisis  which  begin  in  the 
pleura  or  as  a  consequence  of  pneumonia  ?  Or,  in  other  words, 
can  you  distinguish  the  fibroid  transformation  which  occasionally 
occurs  in  the  common  forms  of  pbthiais  from  the  fibroid  trans- 
formation which  follows  pleurisy,  on  the  one  hand,  or  pneumotuft 
on  the  othe  ? 

Dr.  Clark  answered : — The  first  question  is  do  I  recognise 
as  a  fact  that  tubercular  forms  of  phthisis  and  caseous  forms  of 
phthisis  alternate  in  same  family,  and  furthermore  that  people 
with  caseous  phthisis  may  beget  children  subject  to  tubercular 
phthisis  ?  I  recognize  it  fiilly.  It  is  quite  true,  and  I  do  not 
know  if  it  would  be  fair  to  assume  it  as  an  argument  againat 
the  position.  It  is  not  to  my  mind-  I  readily  admit,  that 
children  of  one  family,  I  have  seen  caseous  pneumonia  in  one 
and  evidence  of  tubercular  in  another.  I  admit  further,  as  it 
has  been  put,  that  the  of&pring  of  persons  with  caseous  phthi^a, 
may  be  tubercular.  Even  if  I  were  not  able  satisfactorily  to 
answer  that  argim^ient,  I  should  still  say  that  the  greater  proob 
of  distinction  ought  to  overrule  what  that  fact  suggests.  The 
great  facts  of  distinction  are  that  tubercular  history  is  almost 
unqualifiedly  bad ;  the  caseous  history  is  relatively  good,  and 
the  progress  appears  to  be  quite  distinct  from  that  of  the  other. 
While  the  tubercular  mischief  is  scarcely  amenable  to  treat- 
ment, the  caseous  is  amenable  to  treatment.  I  apprehend  thafc 
in  these  cases,  the  real  e-xplanation  lies  in  the  fact,  that  in  diese 
instances,  during  the  life  of  a  family,  what  is  possessed  by  each 


PHTHISIS   AND   ITS   VAKIKTrEB. — BT    DR.  CLASK.  205 

B  a  vulnerability  of  lung,  and  that  circumBtances,  dis- 
k  each  case,  determine  in  one  tubercular,  iu  anotbor 
llitiiiBiB.  Chronic  tubercular  couBumption  is  begun  in 
Hie  tJody  of  a  man  by  the  transfer  of  something  from  the  surfacea 
below  the  lung  or  in  the  body. 

The  tittle  cellular  work  is  determined  by  the  conveyance  to 
the  pulmonary  capillaries  of  something  manufactured  in  the 
blood  or  got  in  the  intestinal  service. 

The  two  diseases  from  their  very  origin,  aeem  to  be  so  distinct, 
that  I  am  disposed  to  give  them  a  distinct  name.  I  cannot 
contend  that  I  have  fully  solved  the  difficulties  of  the  subject. 
I  think  there  is  sufficient  ground,  even  on  the  anatomical  side, 
enough  on  the  clinical  side  for  recognizing  them  as  distmct  but 
names.  The  second  question  is :  Have  I  ever  met  with  cases 
of  primitive  fibroid  phthisis  ?  I  am  not  quite  sure.  In  all  the 
eases  of  which  I  have  been  able  to  keep  accurate  records,  I  am 
bound  to  say  there  is  always  some  history  or  another  of  dry 
SbrouB  pleurisy,  frequent  attacks  of  bronchitis,  ayphilis,  &c. 
Snch  a  thing  may  occur,  but  speaking  entirely  from  my  own 
observation,  I  am  not  sure  that  I  have  ever  seen  a  single  primitive 
personal  case  of  fibroid  phthisis.  The  third  question  is,  whether 
there  are  any  means  in  a  givea  ca^e  of  pneumonia  or  pleurisy 
of  determing  whether  fibroid  change  is  likely  to  occur,  I  think 
there  are.  If  I  had  a  case  of  pneumonia,  and  if  this  case  went 
on  past  the  usual  period,  and  thore  were  no  signs  of  ameliora- 
tion I  should  say  one  of  two  thiuga  now  will  occur:  Either  this 
exudation  will  break  down  and  we  shall  have  evidence  of  it  in 
the  physical  and  the  constitutional  symptoms,  or  it  wiil  wither 
back  into  a  sort  of  fibroid  mass,  and  the  evidences  of  that,  consti- 
tutionally, will  be  inactive  ;  there  will  he  that  the  patient  will  get 
greatly  better  and  declare  there  is  nothing  the  matter.  Locally, 
the  evidences  will  be  feeble  breathing,  slight  and  increasmg  con- 
traction. If  I  had  a  case  of  simple  dry  pleurisy,  and  it  went 
on,  I  should  say  if  it  receives  the  remedy  of  rest  and  restrictel 
movement,  the  chances  are  it  will  go  on  and  produce  a  fibroid 
change  in  the  lung — how  far  1  do  not  know.  If  the  man  is  a 
drankard,  it  will  go  on  to  fibroid  phthius. 


206  CANADA    MXDICAL   AND  6UB0ICAL   JOCBNAL. 

I  guarded  myself  against  the  possibility  of  im8interpretati<d( 
by  stating  that  when  these  cases  were  advanced  it  was  exceed'* 
ingly  difficult  to  diacriminate,  because  the  symptoms  offerecti 
were  much  more  referable  to  mere  destruction  of  the  orgaM' 
than  to  the  destroying  agent.  If  you  find  the  disease  begintf 
in  the  lower  part  of  the  lung  and  progresses  slowly  upward  and 
has  been  marked  by  fever  and  prostration  and  loss  of  flesh  an£ 
strength  and  colour,  if  you  find  the  summits  of  the  lung  freaj 
you  may  safely  say  you  are  deahng  with  an  ordinary  case  of 
fibroid  phthisis.  If,  on  the  other  hand,  you  find  none  of  thesft 
things,  if  you  find  the  summit  of  the  lung  affected,  I  know  of  no 
means  except  the  history  of  the  case  to  distinguish  between  theg 
two,  The  history  of  the  case,  if  it  were  one  of  sudden  origin,  a(, 
a  presumable  inflammatory  character  would  lead  to  the  concla- 
sion  that  it  was  fibroid  ;  the  insidious  origin  of  the  disease  would' 
suggest  tubercular.  Further,  if  fibroid  phthisis  is  not  alwaja. 
confined  to  one  Inng,  it  is  in  the  majority  of  cases.  I  have, 
even  in  cases  of  tubercular  phthisis,  the  appearance  of  a  second- 
ary fibroid  combination.  So  much  is  this  the  case,  that  some 
people  dealing  with  tubercular  phthisis,  recommend  their  patients 
to  become  drunkards  to  prolong  their  bves. 

Db,  Osler  asked  for  a  aketch  of  a  few  of  the  principles  of 
the  treatment  of  phthisis. 

Br.  Clark  said :  I  am  afraid  I  shall  lose  what  little  character 
I  may  possibly  have  gained.  I  pretend  to  no  special  knowledge 
of  the  treatment  of  phthisis.  Whenever  I  encounter  any 
chronic  disease,  I  deal  with  it  on  this  principle.  Every  organ- 
am  has  a  righting,  a  repturing,  and  a  resisting  power,  and  it 
exercises  these  powers  in  proportion  as  we  give  them  fair  play, 
I  proceed  always  in  a  chronic  case  to  determine  what  will  be 
f^r  play  for  tbe  organism  suffering  under  this  chronic  malady. 
Hence,  diet,  air,  attention  to  tiie  general  functions,  form  always 
the  first  points  of  treatment  in  such  case.  Whilst  we  are  ready 
enough  to  give  a  liberal  supply  of  medicines,  we  too  often  over- 
overlook  those  minute  details  of  daijj  life  which,  in  the  end, 
make  and  unmake  life.  Of  tubercular  phthisis,  I  have  very  Uttle 
to  say.  The  main  aiftur  is  the  general  health.  Lowering  the 
tendency  to  resistance  permits  the  advance  of  tbe  disease  with 


PHTHiaiB   AND   ITS    VARtBTTXS. BY   DR.   ClAKK. 


207 


h  the  patient  is  threatenect.  If  I  can  keep  him  free  from 
colds  and  consequently  pneumonias,  I  am  practically  doing  as 
much  for  my  patient  as  I  can.  There  are  no  principlea  in 
medicine ;  it  is  one  of  the  most  unprincipled  of  arte.  Every 
organism  is  somehow  or  other  different  from  every  other,  and  it 
contains  within  itself  the  laws  for  its  own  management  The 
wise  man,  he  who  has  the  gift  as  well  as  the  knowledge  of  heal- 
ing, is  he  who  with  an  instinct  is  ready  to  discover  the  laws  of  the 
organiam  with  which  he  is  dealing  and  governs  himself  accord- 
ingly. It  would  be  foolish  to  say  in  detail  how  I  should  deal 
with  a  case  of  tubercular  phthisis.  Regulated  diet,  moderate 
nae  of  alcohol,  air.  exercise,  avoiding  colds  are  the  principal 
means  to  be  used.  I  have  tried  this  medicine  and  the  other, 
bypophosphites,  arsenic,  iron,  kc,  but  I  cannot  say,  looking  at 
(he  whole  with  an  honest,  critical  eye,  I  can  lay  my  finger  on 
any  remedy  with  any  specific  influence  in  it. 

As  regards  caseous  pneumonic  phthisis,  I  believe  in  the  efficacy 
of  treatment.  In  an  acute  case,  I  have  great  faith  in  treat- 
ment,  I  put  my  patient  to  bed  and  keep  him  there  until  the 
temperature  falls  below  100°  however  long  that  may  be.  The 
second  rule  in  case  where  the  secretions  are  scanty,  the  tongue 
dry,  temperature  high,  pulse  quick,  I  satisfy  myself  with  a  free 
ase  of  salines  and  with  counter  irritation.  If  I  find  the  patient 
remaining  feverish,  I  give  up  my  citrate  of  potash,  and  put  a 
drachm  of  antimonial  wine  into  a  tnmbierfull  of  water  and 
make  him  aup  that  dunng  twenty-four  hours.  The  skin  breaks 
oat  into  perspiration,  tongue  becomes  moist,  expectoration 
usually  begins  ;  then  I  immediately  stop  and  treat  my  patiennt 
with  effervescing  alkaline  salines  with  quinine  and  citric  acid. 
I  next  feed  turn  with  milk  and  beef  tea.  We  often  forget, 
practically,  that  liquid  food  goes  quickly  to  the  lung.  In 
oases  where  exudation  is  going  on  in  the  lung,  we  minister  to  it 
by  filling  our  padenta  with  fluid  food  at  short  intervals.  In 
tajridly  extending  pneumonia,  I  have  seen  exudation  hurried  to  a 
btal  end  by  the  administration  of  fluids  every  half  hour.  Food 
should  be  ^veu  in  a  more  solid  form  and  not  oftener  than  every 
four  hours.  This  is  one  of  the  forms  in  which  I  believe  alcohol 
jo  be  extremely  useful.  In  cell  proliferation,  alcohol  ia  usefiil, 
P I  would  extend  it  to  scrofulous  diseases  generally. 


K  MEDICAL  AND  6DB0IGAL  JOUENAL. 


CASES  TREATED  BY  THE  THERMO-CAUTERE. 

By  T.  G.  Roddick,  M.D. 

Profeator  5/  Clinicai  Sargert/,  MeOill  Univtriity. 

(lUsd  before  tbe  Medico-Chirnrgical  Sooiety  or  MoDtreal.) 

I  have  now  employed  tbe  very  ingenioua  inatniment  of 
Dr.  Paquelio,  known  aa  the  Thermo-CautSre,  or  Gas  Cautery, 
in  such  a  number  and  variety  of  cases  in  both  hospital  and 
private  practice,  and  have  obtained  such  admirable  results,  that 
I  feel  bound  to  advocate  its  claims  as  a  valuable  surgical  inatru- 
meot  before  the  members  of  this  Society.  Too  great  praise, 
I  think,  cannot  be  awarded  Dr.  Paquelin  for  his  invention,  as 
now  we  are  in  a  position  to  obtam  the  excellent  results  that  no 
doubt  followed  the  employment  of  the  actual  cautery  in  the 
hands  of  the  older  surgeons,  without  the  dread  inspired  by  the 
preparation  and  general  surroundings  of  the /iw-rowye. 

The  instrument  I  show  you  is  manufactured  by  Messrs. 
Collin  &  Co.,  6  Rue  de  I'EcoIe  de  Medicine,  Paris,  and  cost 
me  there  the  sum  of  on''  hundred  and  forty  francs.  It  consists, 
as  you  see,  of  an  ordinary  spray-bellows,  a  spirit  lamp,  and  a 
flask  furnished  with  a  perforated  rubber  cork,  in  which  benzoline 
is  held.  This  is  a  hollow  handle,  insulated  with  wood  to  protect 
the  hands,  and  to  which  can  he  attached  any  of  these  platinum 
heads  corresponding  to  the  cautery  irons  found  moat  useful  in 
practice.  Each  of  these  parts  is  hollow,  and  must  be  first 
heated  to  blackness  in  the  flame  of  the  spirit  lamp,  when  with 
the  aid  of  the  bellows  a  blast  of  benzoline  vapour  is  introduced, 
which  has  tbe  remarkable  property  of  maintaining  the  platinum 
in  a  condition  of  vivid  incandescence.  This  heat  can  be  main- 
tained for  an  indefinite  time  by  a  continuous  slight  compression 
of  the  bellows.  Every  instrument  is  generally  supjilied  with 
three  platinum  heads,  namely,  a  probe  or  stylet  for  touching 
minute  points  of  ulceration,  or  for  cauterizing  sinuses,  &c.,  a 
hammer  for  coarser  work,  and  a  blunt  knife  for  cutting  purposes. 
This  form  of  knife,  with  a  sbarp  cutting  edge  at  the  point  (tbe 
gft,  by  the  way,  of  my  kind  &iend  Dr.  Ross),  is  a  more  recent 


I 


I 


p  OASES  TaEATKD   BY    THEttMO-CADTiKE — BY   DB.  RODDICK.         209 

additdon,  and  will  be  found  very  useful  for  dividing  pedicles 
or  seariag  nsevouB  growths.  Curved  knives,  scissors,  and  an 
ecraeeur  or  guillotine,  may  now  be  obtained  from  makers  in 
good  standing.  The  whole  apparatus  is  packed  in  this  neat 
box,  and  will  be  found  exceedingly  handy  and  portable. 

There  are  many  little  points  in  connection  with  the  working 
of  the  instrument,  such  as  the  amount  of  heat  required  for  a 
certain  purpose,  and  the  pressure  that  should  be  used,  which 
experience  only  can  teach.  Thus  in  order  to  divide  skin  and 
muscular  tissue,  a  red  heat  is  required  ;  while  for  the  sealing 
up  of  bleeding  vessels,  an  almost  Mack  heat  is  the  best.  It  is 
surprising  what  little  pain  is  exj>erienced  after  the  destruction 
of  even  a  large  surface  of  tissue.  In  fact,  I  believe  this  is  the 
most  painless  of  all  escharotius,  not  excepting  nitric  acid  which 
hitherto,  perhaps,  has  held  the  palm. 

The  following  cases  have  been  taken  indiscriminately  from  a 
number  of  clinical  reports  in  my  possession,  although  some  of 
them  are  the  most  important  I  have  had,  as  illustrative  of  the 
uses  to  which  this  valuable  instrument  can  be  put  in  surgery  : — 

Case  I. — Lupus — (Reported  by  Mr.  Mills.) — Moses  Fried 
maJi,  aged  about  40,  was  admitted  into  the  General  Hospital 
November  23, 1877,  under  my  care,  on  account  of  a  number 
of  lupoid  sores,  one  nearly  as  large  as  the  palm  of  the  hand, 
situated  over  the  left  back.  The  scars  of  an  extensive  ulcera- 
tion, confined  to  that  side,  were  very  marked.  There  was  no 
history  of  syphilis.  Chloroform  being  administered,  the  knife 
of  the  cautery  was  applied  in  a  cutting  manner  to  the  patches, 
and  lead  lotion,  followed  in  twenty-four  hours  by  poultices  sub- 
sequently applied.  The  sloughs  separated  in  three  or  four 
days,  and  heaUng  rapidly  went  on,  although  it  was  thought 
advisable,  in  about  ten  days,  to  reapply  the  cautery  to  some 
Bospicious  spots.  Within  three  weeks  from  the  time  of  operation 
he  was  fit  to  be  discharged. 

Case  II. — Proiapsua  Reeti. — (Reported  by  Meaara.  Gardner 
and  Smith). — Catherine  Devine,  aged  60,  was  admitted  October 
29,  1877,   Buffering   from  an  enormous  prolapse  having   the 

NO-   LXXVII.  14 


210 


CANADA    MEDICAL    AND   SUROICAI.   JOURNAI.. 


charEicter  more  of  &□  invaglDatioo  of  the  gut.  She  atCribated 
the  condition  to  obstinate  constipation,  alternating  at  timea  with 
diarrhcea.  The  bowel  protruded  fully  fonr  inches,  the  apbinoter 
being  of  necessity  very  much  distended.  Chloroform  was 
administered,  and  the  part  scarred  in  several  places  with  the 
platinum  knife  in  the  long  ajcis  of  the  tumour,  care  being  taken 
to  go  through  the  entire  thickness  of  the  mucous  membrane. 
The  protrusion  was  then  returned,  a  large  tent  of  lint  soaked 
in  carbolic  oil  was  introduced  into  the  bowel,  and  the  buttocks 
strapped  closely  together  with  adhesive  plaster  and  a  pelvic 
be!t.  A  grain  of  opium  was  given  night  and  morning.  On 
the  tenth  day  an  enema  was  administered,  and  a  copious  stool 
obtained  without  disturbance  of  the  bowel.  The  patient  was 
discharged  on  the  fifteenth  day,  with  instructions  to  attend  to 
the  condition  of  the  bowels' 

This  woman  was  sent  to  me  by  Dr.  Reddy  about  a  fortnight 
since  with  a  return  of  the  prolapse,  but  not  nearly  to  the  same 
extent  as  before.  A  few  days  ago  I  scarred  the  protruding  gut 
thoroughly,  and  then  performed  an  operation  for  narrowing  the 
anal  orifice,  which  promises  to  be  very  successful,  I  made  two 
incisions  extending  from  the  transverse  diameter  of  the  anus  to 
the  tip  of  the  coccyx,  removing  the  skin,  subcutaneous  tissue, 
and  perhaps  a  few  fibres  of  the  sphincter.  The  edges  of  the 
gaps  were  brought  together  with  wire  sutures.  Where  before 
the  entire  hand  could  be  passed  into  the  bowel  with  ease,  two 
fingers  are  now  with  difficulty  introduced,  and  when  union  is 
more  complete  the  contraction  will  still  be  greater, 

CASslli.—Sdatiaa — (Reported by  Mr,  Sutherland.)  —Mary 
Foley,  servant,  aged  20,  was  admitted  June  6th,  of  this  year, 
having  suffered  pain  for  some  weeks  in  the  course  of  the  sciaUc 
nerve.  The  ordinary  remedies  had  been  tried  with  little  benefit. 
The  cautery  was  apphed  in  lines  down  the  course  of  the  nerve 
nearly  to  the  knee.  The  pun  rapidly  disappeared,  and  she 
was  discharged  cured  on  the  seventeenth  day. 

Case  IV. — Amputation  of  tJte  Penis. — An  old  French- 
Canadian,  aged  72  years,  was  admitted  July  2d,  having  an  ex- 
tensive epithelioma  of  the  penis,  involving  the  organ  up  to  witliin 


I 


I 


CASES   TREATED   BT   THERMO- 0  A  ITT*  RE. — BY    DR.  RODDICK.         211 

three-quartere  of  an  inch  of  the  pubis.  The  patient  was  placed 
under  chloroform.  Assisted  by  Dr  Wilkins,  I  then  first  opened 
the  urethra  wih  a  scalpel  in  the  healthy  portion,  and  introduced 
a  No.  12  elastic  catheter  into  the  bladder.  Then  with  a  sawing 
movement  of  the  cautery  knife,  I  removt'd  the  entire  organ  flush 
with  the  pubis,  leaving  a  little  more  of  the  sponfty  portion  than  the 
corpora  cavervoaa.  Not  a  drop  of  blood  was  lost.  The  catheter 
was  shortened  and  secured  in  situ  by  ineBna  of  this  very  ingen- 
ious little  arrangement  devised  by  Dr.  Bel!,  the  Assistant  House 
Surgeon  of  the  Hospital,  and  which  can  he  adapted  to  any  part 
of  a  catheter,  and  to  an  instrumeDt  oi'  any  size.  The  urine  was 
carried  off  by  a  piece  of  elastic  tubing.  Putrid  infection,  so 
very  apt  to  ensue  here,  was  avoided  by  the  constant  application 
to  the  burnt  surface  of  carbolic  oil.  The  catheter  was  removed 
for  the  first  time  on  the  third  day,  and  subsequently  introduced 
for  an  hour  daily  in  order  to  prevent  undue  contiaction  of  the 
urethral  meatus.  On  the  twenty-first  day  (July  23rd)  the 
patient  was  discharged  cured,  and  has  reported  himself  in  good 
shape  on  two  or  three  occasions  since. 

Case  V. — Removal  of  Enlarged  Gland. — Thomas  Butler, 
aged  27,  was  admitted  with  a  gonorrhoea!  bubo,  which  had  been 
incised  some  time  previous.  1  enlarged  the  original  wound,  and 
found  a  gland  of  the  eiae  of  a  htm's  egg  separated  from  the 
skin  and  underlying  structures,  firm  and  apparently  having  no 
disposition  to  break  down.  The  man  stated  that  things  had 
been  in  very  much  the  same  condition  for  two  months.  I  applied 
first  chloride  of  zmc  paste,  but  finding  that  method  of  treatment 
of  little  avail,  I  dissected  out  the  entire  gland  with  the  hot  knife. 
After  the  removal  of  the  sloughjt  he  part  healed  from  the  bottom 
with  marvellous  rapidity,  and  the  man  was  discliarged  cured  on 
the  twenty-ninth  day  after  the  operation. 

Case  VI.—  Tracheotomy. — On  the  24th  of  February  last, 
Dr.  Ross  and  1  were  summonerl  to  the  Hospital  to  perform 
tracheotomy  in  a  case  of  diphtheria  under  his  care.     The  child 

^  was  in  extremis,  and  the  veins  of  the  neck  were  very  turgid. 

I  Mth  his  concurrence 'I  made  the  ordinary  incision  through  the 


212  CANADA    MEDICAL    AND   8CBGICAL    JOURNAL. 

soft  parts  with  tlie  cautery  knife,  opening  the  trachea,  however, 
with  the  scalpel.  The  operation  was  absolutely  bloodlesB,  The 
child  rallied  for  some  hours,  but  at  length  succumbed  to  blood 
contamination. 

Case  VII. — Hcemorrhoids. — Mary  Kelly,  aged  27,  came 
under  treatment  July  29,  1878,  for  several  very  large  heemor- 
rhoidal  tumours.  An  operation  for  their  removal  was  performed 
with  Mr.  Henry  Sniith's  clamp,  the  platinum  point  of  the 
thermo-cautery  being  substituted  for  his  more  cumbrous  irona. 
A  large  mass  of  thickened  tisaue  fringing  the  anus  was  removed 
witli  the  hot  knife.  The  patient  was  allowed  to  sit  up  on  the 
eighth  day  after  operation,  and  was  discharged  August  14, 

Case  VIII. — Phagedenic  Ulceration. — Philip  Gilison,  a  lad 
of  19,  having  a  distinct  history  of  chancroid,  was  admitted 
January  9  of  this  year  with  an  enormously  swollen  condition 
of  the  penis  and  a  most  offensive  discharge.  The  prepuce, 
which  was  bo  oedemaious  that  the  glans  could  not  be  exposed, 
was  slit  up  freely  along  the  dorsum,  when  a  state  of  things 
which  only  phagedenic  ulceration  can  induce,  was  brought  to 
view.  Nearly  one-half  the  glans  was  already  destroyed,  and 
not  a  little  of  the  body  of  the  penis  beyond  the  corona.  As 
soon  as  the  pressure  exerted  by  the  prepuce  was  withdrawn,  the 
bleeding  became  fm-ious,  and,  indeed,  he  had  already,  on  two 
notable  occasions,  lost  largo  ipiantities  of  blood.  I  rapidly  re- 
moved the  sloughs,  divided  any  bridges  of  tissue  that  remained,  ' 
and  applied  the  cautery  unsparingly.  An  unintermpted  con- 
valescence ensued,  and  the  patient  was  discharged  on  the  31st 
day  of  the  same  month. 

Case  IX. — iSiif>acate-Sifnoi'iti$  of  the  Knee-joint. —  (Re- 
ported by  Mr,  McArlhur.) — This  is  a  case  that  came  under 
my  care  on  the  3rd  of  the  present  month,  and  which  I  think 
worthy  of  notice  here.  From  the  notes  of  my  clinical  clerk  I 
gather  that  the  patient,  EMwani  Foley,  24  years  of  age,  has 
long  been  of  intomporato  habits,  but  never  had  any  ailment, 
with  the  single  exception  of  an  attack  of  gonorrhoea  two  months 
ago,  wliich  luted  »  very  few  days,  and  has  never  shown  aaj 


I 

I 
I 


CASES   TBEATBD   BV 


■CAUT&HB. — BT    DR.    ROnDICK.       213 


signs  of  reouirence.  The  right  knee  became  swollen  some  ten 
daya  before  admission,  and  now  measures  (I  quote  from  the 
report)  in  circumference  an  inch  and  a  half  more  than  the' 
healthy  joint.  The  patella  floats  in  the  fluid,  so  that  on  per- 
cussion it  is  heard  to  click  against  the  condyles  beneath.  There 
is  very  little  heat,  and  no  pain  elicited  excepting  when  he 
attempts  to  valk. 

October  5th. — The  joint  was  to-day  scored  on  either  side 
with  the  thenno-cantery,  ami  the  limb  was  placed  at  rest  in  a 
Macintyre  splint.  Iodide  of  potash  in  ten  groin  dosea  thrice 
daily  was  also  ordered, 

7(A. — Everything  looking  improved.  Already  on  measure- 
ment there  is  a  reduction  in  size  of  J  of  an  inch  since  the 
cauterization.     Poultices  are  made  to  replace  the  lead  lotion. 

9/A. — Knee-joint  increased  in  size  ^  of  an  inch  since  the 
operation,  on  account  of  the  cellular  infiltration  induced.  Some 
enlargement  of  the  glands  in  the  groin.     No  pain  in  the  joint. 

lith. — The  superficial  sloughing  consequent  on  the  cauteri- 
zation is  almost  gone;  circumference  diminishing  rapidly; 
joint  has  now  almost  a  normal  appearance. 

llth — Perfectly  well  ;  will  be  discharged  in  a  couple  of 
days. 

Cask  X. — Extenwive  Ulceration  following  Small-pox. — 
(Report  furnished  by  Dr.  Gardner.) — Mrs,  B.,  aged  about  30, 
at  the  eighth  and  a  half  month  pregnancy,  was  taken  with 
small-pox.  Tlic  proper  rash  of  the  disease  which  made  ite  ap- 
pearance at  the  usual  time,  was  preceded  twenty-four  hours  by 
an  erythematous  rash  on  the  abdomen,  groins,  inner  aspect  of 
thighs  and  arm-pits.  This  faded  gradually,  disappearing  in  a 
few  days.  The  patient  was  delivered  in  about  fifty-two  hours 
after  the  setting  in  of  the  initial  fever.  Six  hours  after  the 
delivery  when  I  first  saw  her,  the  temperature  was  104  °  Fah, 
The  case  throughout  was  marked  by  persistent  high  tempera- 
ture, which  however,  was  easily  reduced  temporarily,  by  quinine 
in  antipyretic  dosea.  Diarrhoea  occurred  more  than  once 
daiing  the  course  of  the  attack.  There  was  nothing  at  any  time 


214 


CANADA   MEDICAL    AND   snROICAL   JOIfRNAL. 


abaormal  in  the  lochia.  At  the  commencement  of  the  stage 
of  piistulation,  bull^  of  the  aize  of  a  ahUling,  appeared  in  con- 
siderable numbers  on  both  shins,  the  outer  surface  of  the  right 
and  the  posterior  aspect  of  the  left  thigh.  These  enlarged  and 
burst,  but  instead  of  healing,  proceeded  to  ulcerate  rapidly  by 
their  edges,  the  whole  thickness  of  the  true  skin  bemg  involved 
in  parts,  until  they  coalesced,  forming  large  painful  ulcers. 
Constitutional  symptoms  in  the  shape  of  high  fever  and  debility 
became  alarming,  rendering  it  necessary  to  act  with  decision 
and  promptitude  if  the  patient's  life  were  to  be  saved.  In  con- 
sultation with  my  friend.  Dr.  Roddick,  it  was  decided  to  apply 
the  actual  cautery  to  the  whole  of  the  now  extensive  ulcer- 
ating edge,  by  means  of  Paqueliu's  ^Thenno-Caut&re.  The 
parent  being  under  the  influence  of  ether,  this  was  accordingly 
done  most  thoroujjhly.  The  length  of  ulcerating  edge  thus 
cauterized  could  not  have  been  less  than  three  feet.  Linseed 
poultices  were  then  applied,  the  sloughs  separating  in  due  time 
displayed  healthy  granulations.  The  ulcerating  process  was 
arrested  from^he  time  of  application  of  the  cautery.  After 
the  separation  of  the  sloughs  the  sores  healed  very  'juickly ; 
this  seeming  to  be  much  hastened  by  the  little  islands  of  nn- 
destroyed  akin,  which  represented  the  centres  of  the  buUiE. 
Six  weeks  after  the  applicijtion  of  the  cautery,  (the  ulcers  bad 
been  healed  for  some  time),  the  patient  had  nearly  regained 
her  ordinary  health  and  strength,  but  suffered  on  walking  from 
a  feeling  of  heat  and  tension  in  the  cicatrices — due  doubtless  to 
their  contraction. 

I  have  been  furnished  by  Dr.  Burland  of  the  General  Hos- 
pital with  brief  reports  of  other  fifteen  eases  in  which'  the 
cautery  has  been  employed  as  a  counter  irritant  in  sciatica  and 
in  spinal  anil  joint  affections,  especially  morbus  cox£e,  where  I 
invariably  use  it ;  and  as  a  cautery  in  cases  of  lupus  and  other 
suspicious  ulceration,  and  for  the  removal  of  vegetations  and 
small  growths  of  all  kinds.  It  is  invariably  ready  at  hand  to 
assist,  if  necessary,  in  the  arrest  of  hemorrhage  during  major 
operations.     A  few  days  since  I  found  it  eminently  sernceable 


CASES  TRlATSD  BY  THERMO-OAUTiRE. — BY  DR.  RODDICK.   215 

in  arresting  the  oozing  from  the  stump  of  a  penis  amputated  in 
the  ordiiiarj  way.  In  operations  on  the  tongue,  and  for  the 
removal  of  ovarian  and  fibroid  tumours,  it  makes  a  most  excel- 
lent substitute  for  the  hot  iron.  In  one  of  the  Dispensaries  for 
Women  in  London  I  found  the  surgeon  using  the  probe  cautery 
in  preference  to  the  ordinary  escharotics,  in  cases  of  extensive 
uterine  ulceration,  and  all  polypoid  growths  were  removed  with 
the  knife  or  guillotine.  For  the  alarming  hemorrhage  of  uterine 
cancer,  nothing  could  be  more  prompt  and  effectual  than  the 
actual  cautery  applied  in  this  way. 

There  are  cases  however,  in  which  I  am  not  inclined  to  ad- 
vocate its  employment.  I  should  be  disposed,  for  instance,  in 
cases  of  malignant  disease  of  the  tongue,  and  especially  when 
the  floor  of  the  mouth  was  involved,  to  remove  the  organ  either 
with  the  knife  or  ehain  ecraseur,  trusting  to  the  cautery  to  arrest 
haemorrhage  only.  An  inordinate  amount  of  cellular  and  lym- 
phatic inflammation  is  almost  certain  to  follow  such  extensive 
burning  of  tissue  in  this  neighborhood.  In  fact  in  one  case 
already  published  by  myself — alarming  cellulitis  followed  the 
removal  with  the  hot  knife,  of  a  small  epitheliomatous  growth 
from  the  floor  of  the  mouth.  In  tracheotomy  also  when  skilled 
assistance  is  available,  I  think  it  should  be  employed  only  as 
a  styptic.  In  Dr.  Ross'  case  already  referred  to  in  which  the 
hot  knife  was  used,  1  had  great  difficulty  in  keeping  track  of 
the  anatomy  of  the  parts  on  account  of  their  charred  condition, 
and  when  reached,  the  trachea  was  with  difficulty  cleaned  up 
and  made  ready  for  opening.  I  would  perform  tracheotomy 
with  the  hot  knife,  only  in'  the  case  of  a  very  fat  child,  where 
the  venous  engorgement  was  intense,  or  where,  in  any  case,  I 
had  no  skilled  assistant. 


■:o:- 


21S  CANADA   MEOICAL   AND   STTRQICAL   JODRNAt. 

TRACHEOTOMY  IN  LAKYNGEAL  DIPHTHERIA ; 
BY  J.  W.  MACDONALD,  M.D.,  H.R.C.8.,  Eqb, 

The  operation  of  tracheotomy,  perhaps  more  than  any  other,, 
places  in  our  hands  a  meajis  oE  saving  lives  which  would  otheis 
wise  be  most  certainly  lost.  As  an  instance  of  the  value  of  tlui. 
operation,  even  in  the  most  desperate  circumstances,  I  beg  leave 
to  report  the  foilowing  caae : — During  an  epidemic  of  diphthi 

in  the  beginning  of  1877, 1  attended  R ,  a  little  girl  set.  12. 

I  first  saw  her  on  Jan.  2,  the  third  day  of  her  illness.  There 
waa  a  conaiderable  amount  of  false  membrane  about  the  ton^,, 
and  evidence  of  the  disease  having  spread  to  the  larynx.  Ab 
the  danger  to  the  respiration  did  not  seem  imminent,  I  applied 
liq,  ferri-perohloride  to  the  throat,  and  used  inanflationa  of  pow- 
dered alum,  and  prescribed  quinine  and  iron  internally.  Hok 
fomentations  were  ordered  to  be  apphed  to  the  throat,  and  steam 
inhalations  containing  permEuigaaat«  of  potass  were  to  be  freelj 
employed.     For  the  next  four  days  the  symptoms  improved. 

January  1th.  — The  laryngeal  symptoms  are  not  so  favorable. 
I  asked  the  parents  to  send  for  me  if  they  found  the  patient's 
breathing  to  become  more  obstructed.  They  were  very  much 
opposed  to  the  operation ;  and  next  day,  although  the  child  waa 
in  a  dying  state,  they  did  not  send  me  word.  Hearing  of  this 
from  another  source,  I  drove  to  the  house,  a  distance  of  four 
miles,  and  found  her  evidently  breathing  her  last.  Tbe  surfaces 
of  the  body  was  coid,  no  pulse  could  be  felt  at  the  wrist.  She 
was  totally  unconscious,  and  the  breathing  consisted  of  gasps, 
with  long  intervals  between  them.  With  all  possible  haste  I 
had  her  placed  upon  a  table  and  proceeded  to  perform  tracheo- 
tomy. By  this  time  the  breathing  had  completely  stopped.  I 
was  obliged  to  hurry  through  the  operation,  and  without  any 
(  everybody  had  fled  in  terror  from  the  room. 
Having  inserted  the  canula,  I  immediately  commenced  artificial 
respiration,  and  after  persevering  for  some  lime,  had  the  satia- 
faccion  of  seeing  the  breathing  restored.  She  now  began  to 
regiuD  consciousness,  and  by  the  motion  of  her  Ups  we  guessed 


TEACHKOTOMT   IN    DIPHTHERIA. — BY    DB.  MACDONALD.      217 

she  wanted  water,  which  was  given.     Her  thirst  was  insatiable. 

I  placed  a  piece  of  gutta-percha  tissue  between  the  guard  of  the 

canula  and  the  sliin,  and  covered  the  neclc  with  a  woolen  cloud. 

About  day-break  on  the  following  morning  a  mesenger  came  to 

me  with  the  intelligence  that  the  child  had  managed  to  pull  the 

tube  out  and  was  choking.  I  set  off  at  once,  and  with  very  little 

hope  of  finding  her  alive ;  but  the  father  had,  in  the  meantime, 

plucked  up  courage  to  insert  the  tube,  and  on  my  arrival  I  found 

her  breathing  freely. 

L      12th. — I  removed  the   canula,  and   found  that  she   could 

■breathe  perfectly  by  the  mouth.      The  wound  was   brought 

■'together   by  adhesive  plaster.     She   has  a  bad   cough,   and 

expectorates  some  blood,  with  large  ({uantities  of  mncns.     Her 

appetite  is  good  ;  pulse  90  ;  temperature  99". 

15th. — She  has  been  sitting  up  all  day ;  eats  heartily,  and 
feels  well.     The  wound  healed  very  satisfactorily  ;  by  degrees 
her  strength  returned,  and  she  has  since  been  quite  well. 
Aotigoniah,  N.S.,  Dec.  2,  1878. 

3^uiews  and  Notices  of  Boohs. 

The  Orgamc  Constituents  of  Plants  and  Vegetahle-mhslancea, 
and  their  Chemical  Analysii. — By  Dr.  G,  C,  Whtsteim, 
Authorized  Translation  from  the  German  Original.  En- 
Urged  with  numerous  additions  by  Babon  Ferd.  Von 
Mdklleb,  C.M.G.,  M.  &  Ph.  D.,  F.RS.  Melbourne: 
McCarron,  Brao  &  Co.,  37  Flinder's  Lane  West,  1878. 

We  believe  this  ia  the  first  time  a  Canadian  Reviewer  has 
been  called  upon  to  notice  a  medical  publication  issued  from  the 
pr«s8  of  Australia.  That  far  oW  continent  has  long  been  famed 
for  its  gold  fields.  It  may  yet  be  as  well  known  for  its  literary 
possessions.  The  volume  before  us  is  certainly  evidence  that 
there  are  mines  there  which,  when  worked,  will  yield  abundance 
of  scientific  lore.  The  German  Original  of  Dr.  Wittstein  is,  in 
itself,  a  learned  production  of  high  order.  To  give  our  readers 
.  an  idea  of  its  scope,  we  may  mention  that  it  is  divided  into  two 


CASADA  UIDICAL  ADD  anBOIOAL  JotTBNAL. 

parte.  The  first  is  spread  over  three  sections,  which  an 
to  "  proximate  constituents  of  plants  and  vegetable  subatant 
as  far  as  hitherto  known ;  their  properties ;  their  mode  of  p 
paration    and   quantitative    estimation;    molecular    weight 
organic  compounds ;  synopsis  'of  those  plants  which  yield  th) 
proximate  constituents  under  the  former,  and  a  catalogue  of  th| 
vegetable  pointed  out  \a  them  with  the  order  systematical! 
arranged."     The  second  part,  likewise,  comprises  three  diy 
sions.     The  first  is  devuted  to  the  account  of  "  the  apparai 
required  for  the  phyto-chemical  analysis."  The  second  speoifiM 
the  chemicals  that  are  needed  to  perform  the  foregoing  examiit 
ations.  And  the  third  is  taken  up  with  explaining  the  "  gener 
systematic  course"  of  the  analysis  just  named.     Lastly,  thei 
are  added  "  tables  of  comparison."     Great  though  the  mass  < 
information  be  which  is  afforded  through  these  various  source 
— and  from  which  the  extensive  research  and  Chemico-Then 
peutical  culture  of  the  author  are   coaspieuoualy   apparent- 
greater  still  are  the  merits  of  the  Australian  edition.     The 
translator  and  editor,  who  has  proved  himself  well  fitted  for  the 
task  in  which  he  engaged,  tells  us  in  his  preface  that  he  has 
supplemented  "  the  original  work  with  many  additional  notes  on 
new  and  well-authenticated  data,  which  transpired  during  the 
last  few  years,  some  claiming  local  originality  here." 

The  present  treatise  purports  to  be  all  facts, — and  no 
theories.  It  is  purely  descriptive.  At  a  rough  guess  we  should 
Hay  it  touches  upon  800  different  subjects,  at  least,  if  not  many 
more.  This  is  a  formidable  array.  But,  as  the  book  will  be 
chiefly  valuable  for  reference,  this  comprehensiveness  adds 
greatly  to  its  value.  The  topics  are  of  necessity  not  dwelt 
upon  with  equal  extent.  A  judicious  measure  has  been  observed 
throughout,  and  the  largeness  or  scantiness  of  the  account  given 
of  each  article  has  been  regulated  according  to  its  degree  of 
importance  or  rarity. 

To  our  readers  who  have  not  given  attention  to  the  modem 
advances  in  the  branch  of  science  upon  which  this  new  work 
treats,  there  will  be  found  much  to  baffle  and  confound  and 
amaze.     The  very  names  of  the  objects  discussed  will  be  stun- 


RSVtEWS   AND   NOTICES    OP   BOOKS.  219 

nera,  e.  g.,  Gardenin,  Jurubebia,  Nacit,  OBtruthin,  Picroroeellin, 
Theyetoain,  &c.,  &.c.  But  with  the  DovoltieB,  the;  will  also  find 
tbe  more  familiar  aubatance,  all  in  their  place,  and  carefully 
descnbed. 

The  manner  in  which  the  painstaking  translator  haa  accom- 
plished bis  task  reQects  credit  upon  his  abilities.  He  baa  spared 
neither  time  nor  monej.  While  he  haa  devoted  much  labour  to 
the  enterprise,  —the  bringing  of  it  out  has  been  at  his  own  ex- 
pense. But  the  only  reward  to  which  ho  looks,  is — ■'  that  local 
observers  in  these  Souiliem  colonies,  as  well  as  in  other  coun- 
taiea,  teeming  with  on  almost  endless  number  of  yet  novel  objects 
for  phyto  chemic  inquiry  for  additional  resources,  may  be  armed 
with  auxiliary  means  for  extending  not  only  in  abstract  the 
science  of  Chemistry,  but  also  the  precincts  of  Therapeutics." 
And  if  this  be  the  reault,  then  oar  expectations  will  also  be 
Diade  good  of  what  may  yet  be  yielded  by  the  Australian  mines 
of  professional  lore. 

of  the  Practice  of  Medicine. — Edited  by  Dr.  H. 
VON  ZiEMSSEN.  Vol.  xvii.  Grand  anomalous  of  Nutrition 
and  Poiaona.  By  Prof.  H.  Immermann,  Prof.  R.  Boehm, 
Prof.  B.  Nacnyk,  and  Prof.  H.  vos  Boeok.  Translated 
by  W.  Bathukst  WooDMAfT,  M.D.,  and  J.  Bcrnet  Yeo, 
MD.,  of  London;  E.  S.  Wood,  M.D.,  of  Boston;  Chas. 
Emkrson,  of  Concord  ;  Portbr  Farley,  M.D.  of  Roches- 
ter, and  A.  B.  Ball,  M.  D.,  and  E.  Waller,  Ph,  D.  of 
New  York. — Albert  H,  Buck,  M.D.,  New  York,  editor 
of  American  edition.  8vo.  pp.  xiv.  968.  New  York: 
William  Wood  &  Co.,  27  Great  Jones  Street,  1878. 


I  The  first  article  from  the  pen  of  Itnmermann  forms  the  com- 
JtioD  of  the  subject  on  the  general  anamolies  of  Nutrition. 
Haemophilia,  or  what  he  terms  the  bleeder  disease,  is  the  first 
secdon  of  this  article,  from  this  we  learn  that  the  earliest 
historical  record  of  (the  hoemorrha^c  diathesis  is  found  in  the 
writings  of  an  Arabian  physician  who  died  at  Cordova  in  the 
12th  century.  Tliis  writer  had  no  knowledge  of  this  disease 
except  what  he  had  heard  from  persons  who  were  sud  to  be 
aSbcted  with  this  idiosyncracy,  nev«rtheleBs,  his  descriptions 


220  CANADA   MEDICAL   AITO   SUHOICAL   JOrfiNAL. 

are  80  vivid  aa  to  be  readily  recognized  to  correspond  with  tin.] 
same  afiection  as  occasioDatly  seen  in  tLe  preeent  day. 
giving  an  interesting  historical  record  of  this  disease  the  author- 
points  to  the  definition  of  the  disease  hsemophilia.  He  considers 
it  to  be  a  congenital  and  habitual  hccmorrhagic  diathesis,  never 
seen  except  in  yoang  persons,  at  least,  the  tendency  to  hseraor- 
rhagi'a  is  a  congenital  defect  seen  in  infancy  and  childhood,  and 
which,  as  a  rule,  continues  throughout  life.  He  remarks  "  it  is 
uncommon  for  an  individual  who  has  been  a  marked  bleeder  ia 
infancy,  and  in  whom,  therefore,  the  disposition  was  presumabl 
congenital,  to  lose  the  idiosyncracy  in  early  youth  and 
remain  thereafter  entirely  free  from  hsemorrhagic  attacks." 

The  author  then  passes  on  to  a  description  of  the  disease, 
symptomatology,  anatomical  changes,  complications,  natura, 
diagnosis,  duration,  prognosis  and  treatment.  An  allied  affec- 
tion, scurvy,  is  the  next  section  taken  up,  and  which  is  discussed 
in  the  same  systematic  manner,  after  which  we  have  a  descrip- 
tion of  the  disease  called  Morbus  Maculosiis  Werlhofii.  These 
form  the  first  article  in  the  volume,  and  it  is  apparently  full  and 
exhaustive,  occupying  some  280  pages  of  reading  matter.  The 
rest  of  this  volume  is  devoted  to  the  subject  of  poisons,  Boehm 
gives  the  first  paper  in  which  he  discusses  poisoning  by  the 
metalloids,  mineral  and  vegetable  acids,  alkaline  earths  and  their 
salts ;  poisoning  by  anieathetics  and  other  carbon  compoum 
and  poisoning  by  tainted  articles  of  food. 

Naunyn  writes  an  article  on  poisoning  by  the  heavy  mel 
and  their  salts :  in  this  article  the  author  includes  arsenic' 
phosphorus. 

Vegetable  poisons  are  next  discussed  by  von  Boeck.  In  tlua 
article  all  the  poisonous  plants  and  their  active  principles  are 
considered,  the  article  closing  with  an  account  of  poison  fun^,- 
The  edible  fungi  or  mushrooms  are  likewise  given,  as  also  the 
symptoms  induced  by  eating  decomposing  fungi,  This  volumA. 
is  a  most  important  and  useful  addition  to  the  scries  in  thV' 
cyclopedia,  and  adds  materially  to  the  general  interest  of 
work. 


18 

'P- 

!se 

lid 

lie 

im 

Jie 
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idvJ 

4 


as  VIEWS  AND    NOTICES  OF   BOOKS.,  221 

On  Megt  and  Pain. — A  course  of  lectures  on  the  influence 
of  mechanical  and  physiological  rest  in  the  treatment 
of  accidents  and  surgical  diseases. — Bj  John  Hilton, 
F.R.S-,  F.R.C.S.,  &c,,  &c.  Second  edition,  8vo.,  pp.  299. 
New  York:  William  Wood  &  Co.,  27  Great  Jones 
Street,  1879. 

These  lectures  are  too  well  known  to  demand  an  extended 
notice  at  our  hands.     They  were  first  delivered  by  Mr.  Hilton 
before  the  Royal  College  of  Surgeons  as  early  as  the  year  1860, 
and  still  they  may  be  read  with  advantage  and  instruction,  a  lot 
which  does  not  fall  to  every  work  after  a  lapse  of  eighteen 
years*     This  is  a  reprint  of  the  second  edition  of  these  lec- 
tures, which  appeared  in  London  some  two  years  ago  under  the 
editorial  guidance  of  Mr.  Jacobson,  aided  by  the  author.     It 
was  the  intention  of  Mr.  llilton  to  have  enlarged  the  work  by 
the  addition  of  material  gathered  from  other  surgical  observa- 
tions, but  all  having  the  same  end  in  view,  namely,  that  of 
iUustrating  by  clinical  records  the  advantages  to  be  gained  in  a 
practical  sense  of  the  recuperative  powers  of  Nature,  "  aided 
by  the   suggestions  of  a  thoughtful  surgeon."     Throughout 
these  lectures  the  author  emphatically  points  to  the  therapeutic 
value  of  mechanical  and  physiological  rest  in  the  treatment  of 
surgical  disease.     It  is  a  work  that  has  been  regarded  with 
general  favour.     Our  object  now  in  noticing  it  is  to  call  attention 
to  the  republication  of  this  work  as  forming  the  first  of  the 
series  of  Messrs.  Wood's  Library  of  Standard  Medical  Works. 
We  alluded  on  a  former  occasion  to  this  scheme,  but  it  may 
have  escaped  the  observation  of  our  readers,  and  we  conclude 
this  notice  with  an  extract  from  a  circular  received  from  the 
Messrs.  Wood.     It  is  understood  that  the  intention  is  to  publish 
each  year  twelve  volumes  of  standard  medical  works.     The 
publishers  look  for  the  support  of  the  profession  in  this  enter- 
prise, and  we  can  only  remark  that  if  the  series  are  brought  out 
with  the  same  care  and  style  as  this,  the  first  volume  which  is 
before  us,  that  our  medical  friends  will  have  in  the  course  of  a 
few  years  a  handsome  library  of  useful  medical  works  at  a 
nominal  price.     The  circular  concludes  as  follows ' — 


222  CANADA    MEDICAL    AND 

"  Will  you  kindly  have  this  volume  noticed  at  an  ear';/  di 
that  we  may  avail  ourselves  of  the  influence  of  your  journal 
obtaining  Bubscriptions  to  the  f 

"  To  meet  the  views  of  all  classes,  we  have  concluded  to  take' 
Bubscriptions : — IsL  The  ^12.00,  payable  on  delivery  of  the 
first  volume,  in  which  case  the  volumes  arc  all  delivered/r«e, 
by  mail,  from  New  York.  2nd.  Payable  $Q  OQ  semi-annually, 
in  January  and  July,  in  vbich  case  the  subseriber  pays  expresB 
charges  on  the  January  and  on  the  July  volumes,  the  other 
volumes  being  sent  free,  by  mail ;  and  3rd.  Payable  monthly 
at  81.25  per  volume  ;  in  this  case  the  volumes  are  each  deliv- 
ered/re«,  by  express  or  carrier,  C.  0.  D.' 

Cyclopedia  of  the  Practice  of  MecHdne. — Edited  by  Dr.  H. 
ZlEMBSEN.  Vol.  xm.  JHteages  of  the  Spinal  Cord  and 
Medulla  Oblongata — By  Prop.  W.  H.  Erb.  Translate^ 
by  E,  G.  Geoghegas,  M.D.,  of  London:  E.  W.  Schadh- 
FLER,  M.D.,  of  Kansas  City  ;  D.  F.  Lincoln,  M,D.,  <^ 
Boston;  John  A.  McCrbery,  M.D.,  of  New  Torki 
Albert  H.  Buck,  M.D.,  New  York,  Editor  of  America 
edition.  8vo,,  pp.  sii.  975.  William  Wood  &  Co.,  2 
Great  Jones  Street,  New  York,  1878. 

This  is  the  fourth  volume  on  diseases  of  the  nervous  systei 
and  is  devoted  to  affections  of  the  medulla  spinalis  and  spinal 
cord.  In  the  arrangement  the  author  deems  it  advisable  to  give, 
as  an  introduction  to  the  history  of  these  diseases,  a  brief  state' 
ment  of  the  macroscopic  and  microscopic  anatomy  of  the  cord 
and  its  membranes,  tof^other  with  its  physiology,  and  in  following 
this  arrangement  he  remarks  that  he  feels  justified  in  so  doing 
by  the  fact  that  a  knowledge  of  these  things  is  essential  to  the 
proper  understanding  of  these  diseases.  The  minutise  of  subjects 
of  this  nature  are  apt  to  escape  the  memory  of  the  busy  practi- 
tioner and  would  have  to  be  searched  for  in  test-books  not  always 
at  hand,  fiirtbermore,  when  found  the  description  ig  not  always 
given  with  due  regard  to  a  knowledge  of  or  connection  wil 
pathology. 


BKTIEWS   AND    NOTICES  OF   BOOKS.  223 

Under  the  heading  of  general  symptomatology  wo  have  the 
several  3C;;riona  of  disturbance  of  seosibility,  disturbance  of 
mobility,  disLuiLance  of  reflex  activity,  vaso  motor  diahirbance, 
trophic  disturbance,  disturbance  of  urinary  and  sexual  appar- 
stUB,  liiaturbancc  of  digestion  and  defEecation,  disturbance  of 
respiradon  and  circulation,  diaturbance  of  the  pupillary  fibres, 
cerebral  nerves  and  of  the  brain  itself. 

Of  the  causes  of  disease  of  the  spinal  cord  there  are  men- 
tioned sexual  excesses,  influence  of  age  and  sex,  disturbance  of 
nulrition,  propagation  through  morbid  processes  existing  in 
other  parts  extending  to  or  propagating  disease  in  the  spinal 
colnnm,  exposure  to  cold,  excessive  exertion  or  physical  influ- 
ences, poisoning  and  the  local  development  of  infectious  dis- 
eases, acute  disease,  and  the  irritation  depending  on  disease  of 
the  other  organs. 

The  diseases  of  the  membranes  of  the  spinal  cord  forma  the 
Bahjeet  of  the  next  article,  in  which  we  have  discussed  hyper- 
semia  of  the  membranes  of  the  cord  itself,  meningeal  hsemorr- 
hage,  inSamation  of  the  spinal  dura  mater,  inflamation  of 
the  spinal  pia  mater  the  acute  and  chronic  form,  tumours  of  the 
membranes,  and  as  an  addendum,  the  changes  met  with 
the  spinal  membrane  which  are  without  clinical  significance, 
of  the  spinal  cord  itself  is  the  next  subject  given, 
lypersemia  and  anemia  of  the  cord,  spina]  apoplexy,  wounds  of 
the  cord,  slow  compression  of  the  cord,  concussion  of  the  spine, 
spinal  irritation,  Myelitis,  Tabes  Dorsalis,  and  various  degrees 
of  paralysis.  In  the  last  section  is  considered  the  diseases  and 
injuries  of  the  medulla  oblongata,  and  tumours  of  the  medulla. 
The  work  seems  to  be  abreast  of  the  times  ;  it  is  full  without 
being  tedious,  and  the  descriptions  arc  clear  and  readable.  The 
translators  have  performed  their  task  well,  and  the  volume  is 
luced  in  the  same  excellent  style  as  those  that  precede  it. 


^^■ttnal  mem 

^^Hthe  spin! 

^^r  Diseases 

hypersemia 


(;anada  medical  anu  sukoical  journai,. 


3Extracts  from  ■British  and  IPorcigri  Journals. 


Caustic  Alcoliols. — On  the  remedial  application  of 
the  Ethylates  of  Sodium  nnd  Potassium,  or  Caustic  Alcohol. 
By  Benjamin  Ricuakdson,  M  D.,  F.R.S. — The  great  interest 
displayed  at  the  lEist  meeting  of  the  Medical  Society  of  London 
on  the  subject  of  the  ethylates  of  sodium  and  potassium,  which 
I  introduced  into  medicine  in  the  year  1870,  leads  me  to  think 
that  a  brief  description  of  these  substances  and  their  medicinEJ 
application  may  be  of  interest  to  the  wider  circle  of  medical 
praotitionerB  who  are  readers  of  The  Lancet. 

The  ethylates  Krat  came  into  my  hands  for  study  when  I  was 
conducting  a  series  of  experimental  inquiries  on  the  action  of 
the  different  alcohols.  They  are  sometimes  called  alcohola 
because  in  them  the  atom  of  hydrogen  which  in  alcohol  is,  with 
its  radical,  combined  with  oxygen,  is  replaced  by  an  atom  of 
sodium  or  potassium.  Thus,  taking  ethylic  alcohol,  which  ia 
composed  of  the  radical  ethyl  (CjH,),  hydrogen  and  oxygen, 
the  type,  the  sodium  or  potassium  replaces  the  hydrogen : — 


Ethylifl  AlDohul.         Sodium  Alfiobol.         Polauian)  AkobDl. 

H       "  Na     "  K. 


0 


The  first  object  of  research  was  to  ascertain  what  would  be  ths 
effect  of  introducing  a  new  element,  by  substitution,  into  a  aab- 
Btancc, — alcohol, — the  physiological  action  of  which  wa*  under- 
stood ;  and  the  subjoined  description  formed  part  of  my  report 
to  the  Britisn  Asaociatioa  for  the  Advancement  of  Science  in 
1870. 

Sodium  Alcohol,  01  Ethylatt  of  iSot/ium,  is  prepared  by  treati 
ing  absolute  alcohol  with  pure  metallic  sodium.  So  soon  as  the~ 
sodium  comes  in  contact  with  the  alcohol  there  is  escape  of 
hydrogen,  and  the  addition  of  sodium  has  to  be  continued  until 
action  ceases.  I  &nd  it  good  to  increase  the  temperature  gra- 
dually as  the  action  declines.     At  last  there  is  obtamed  a  thick, 


BBITISH   AND    tOREKlN 


225 


^V' 


ntarlj  white  product,  which  is  a  saturated  solution  of  sodium 
alcohol.  From  the  solution  the  ethylate  of  sodium  crjatallises 
out  ID  beaulifiil  crystals. 

When  the  ethylate  is  brought  into  contact  with  water  it  is 
decomposed,  the  sodium  becoming  oxidised  by  the  oxygen  of 
the  water  to  form  sodium  hydrate,  and  the  hydrogen  of  the 
water  going  to  reconstitute  the  ethylic  alcohol. 

The  change  of  ethylic  alcohol  into  sodium  alcohol  transforma 
it  from  an  irritant  to  a  caustic.  Laid  od  dry  parts  of  the  body 
the  sodium  alcohol  is  comparatively  inert,  creating  no  more 
change  tha.i  the  redness  and  tingling  caused  by  common  alco- 
hol ;  but  so  soon  as  the  part  to  which  the  substance  is  applied 
girea  up  a  little  water,  the  transformation  I  have  described 
above  occurs ;  caustic  soda  is  produced  in  contact  with  the  skin 
aa  water  ia  elimmated  by  the  skin,  and  there  proceeds  a  gradual 
destruction  of  tissue^  which  may  be  ao  moderated  aa  hardly  to 
be  perceptible,  or  may  be  so  intensified  as  to  act  almost  like  a 
catting  ineCrument. 

Potassium  Alcohol,  or  Potasmuirt  Ethylate^  is  made  in  a 
similar  manner  a^  sodium  ethylate — viz.,  by  bringing  pure 
potassium  into  contact  with  absolute  alcohol.  The  action  of  the 
poUkS^um  is  much  more  energetic  than  that  of  sodium  I  pre- 
fer to  immerse  the  potassium  under  the  alcohol  in  a  small  glasa 
bell,  from  which  there  is  a  tube  to  allow  of  the  escape  of  the 
liberated  hydrogen.  When  saturation  ia  complete,  a  thick  and 
almost  colourless  fluid  ia  formed,  from  which  the  ethylate  may 
be  obtained  in  a  solid  cryatalline  state.  Esposcd  to  water,  the 
potassium  ethylate  is  transformed,  as  is  the  sodium  ethylate,  into 
ethylic  alcohol  and  potassium  hydrate.  The  action  of  this  com- 
pound on  animal  tissues,  living  and  dead,  is  the  same  aa  that  of 
the  aodi am- compound,  but  is  more  energetic. 

Practical  Uses  of  Sodium  and  Potasshjm  Alcohols. 

do  not  aa  yet  see  the  means  of  applying  readily  these  two 

fire  alcohols  for  internal  administration,  but  I  can  predict  for 

them  a  very  extensive* application  for  external  purposes.     They 

are  most  potent  caustics.     In  some  cases  they  may  be  employed 

to  destroy  rapidly  such  morbid  growths  as  are  not  favourable.  . 

so.  LXXVtI.  16 


226 


CANADA   HBDICAL    AND    BrKOICAL   JOURNAL. 


for  excuioQ  by  the  knife.  In  many  cases  of  cancer  they  will 
prove  invaluable,  and  will,  I  believe,  exert  a  direct  local  curative 
influence.  Injected  into  morbid  growths,  they  would  so  qtiickl)^ 
destroy  them  that  the  action  might  have  to  be  conducted  while 
the  body  was  under  the  influence  of  an  anfesthedc. 

In  being  applied  direct  to  the  sensitive  unbroken  skin,  I  find ' 
that  their  destructive  action  is  less  painful  than  could  be  expec- 
ted. I  have  made  with  both  compounds  a  superficial  eschax  on 
my  arm  with  no  more  pain  than  a  alight  tingling  warmth.  What 
is  more,  when  pain  is  feit,  it  may  be  checked  quickly  by  drop- 
ping upon  the  part  a  drop  of  chloroform,  which  decomposes  the 
.alcohol,  converting  it  into  chloride  salt,  and  an  ether — triethylio 
— which  is  inert  locally.  Again,  I  find  that  these  alcohols  dia- 
Bolve  some  of  the  vegetable  alkaloids.  Thus  opium  may  be  ■ 
dissolved  in  them,  and  a  solution  of  opium  in  caustic  alcohol  ia 
made  directly  by  mere  addition  of  the  narcotic  Co  the  caustic 
spirit.  Practical  men  will  see  the  advantages  of  combinations 
of  these  alcohols  with  narcotics.  The  practice  opens  tlie  way 
to  one  of  the  greatest  needs  cf  medicine — a  sure,  rapid,  and: 
painless  caustic. 

The  caustic  alcohols  may  be  used  in  combination  with  local 
anaesthesia  from  cold.  A  part  rendered  quite  dead  to  pain,  by 
freezing  with  ether  spray,  could  be  directly  destroyed  by  the 
action  of  caustic  alcohol — a  practice  very  important  in  the 
treatment  of  poisoned  wounds,  such  as  the  wound  from  the  bite 
of  a  snake  or  rabid  dog.  It  ia  by  no  means  improbable  that 
some  cystic  tumours  may  bo  cured  by  the  simple  subcutaneoiiB 
injection  of  a  little  of  these  fluids  after  destruction  of  sensibii;;yi 
by  cold. 

Potassium  and  sodium  alcohol,  added  to  the  volatile  hydride 
of  amyl,  dissolve  in  the  hydride  and  produce  a  caustic  solution. 
Wheu  this  solution  is  applied  to  the  skin,  the  evaporation  of  the 
hydride  takes  place,  and  a  layer  of  the  caustic  substance  is  left 
behind.  This  application  would  prove  very  useful  to  the  sui^ 
geon  in  many  cases  of  disease. 

The  action  of  the  etliylates  on  the  blood  is  extremely  rapid 
and  marked.    The  rod  corpuscles  are  brought  by  it  into  solutiooK 


BftlTTBH  AN'n    PollEmff   J0PKNAL8, 


227 


and  there  forms  (quickly  in  some  cosea)  an  almost  instant  crys- 
tallisation of  blood ;  the  crystals  are  acicular,  and  spread  out  in 
arborescent  filaments.  The  arborescent  appearance  is  identical 
with  the  crystallization  of  the  ethylates  themselves,  but  the 
smaller  i-adiant  crystals  are  due,  I  believe,  to  the  crystallization 
of  the  crystalloidal  matter  of  the  hlood-cells.  They  are  singu- 
larly like  the  crystalline  forms  which  have  been  described,  since 
Ae  time  of  Dr  Richard  Mead,  as  occurring  in  the  blood  after 
infection  by  the  poison  of  the  viper.  One  other  peculiarity  in 
the  action  uf  the  ethylatea  on  blood  ia  worthy  of  notice  :  while 
they  seem  to  attack  and  dissolve  the  red  corpuscles  vigorously, 
they  act  with  comparative  slowness  on  the  white  corpuscles,  bo 
that  we  may  see  a  white  corpuscle  floating  uninjured  in  a  sea 
of  red  colouring  fluid  previous  to  crystallization,  and  even  adhe- 
ring to  the  crystalline  points  after  crystallization. 

The  ethylatea  possess  also  powerful  antiseptic  properties,  so 
that  even  nervous  matter,  which  of  all  animal  substance  is  most 
prone  to  decomposition,  can  be  long  kept  in  good  preservation 
in  the  presence  of  them. 

This  was  my  report  in  the  year  1876  on  these  ethylates,  and 
since  then  I  have  used  them  often  in  practice  with  much  success. 
The  ethylate  of  sodium  is  the  moat  manageable.  It  is  very 
easily  made,  and  its  caustic  property  can  be  changed  in  different 
specimens,  to  suit  different  cases,  The  solution  I  uao  is  one  of 
half  saturation,  and '  I  keep  the  solution  in  a  bottle  having  a 
glass  rod  descending  from  the  stopper,  the  end  of  the  rod  being 
somewhat  pointed.  With  thia  rod  I  lift  the  solution  from  the 
bottle  and  apply  it  from  the  point  of  the  rod.  At  one  time  I 
ased  a  glass  brush  for  the  purpose,  but  I  found  the  brush  objec- 
tionable, the  small  fibres  of  glass  being  disposed  to  break  too 
easily. 

The  first  idea  that  occurred  to  me  in  respect  to  the  applica- 
tion of  the  ethylates  was  founrjed  on  their  action  physically. 
It  seemed  to  me  T-eaaonahle  to  auppoae  that  if  the  ethylate  were 
applied  to  a  moiat  external  growth  there  would  be  produced  two 
changes:  a  caustic  action  would  be  set  up. and  at  the  same 
tnne  the  alcohol  woald  cause  instant  coagulation  of  the  fluids  of 


228 


AND   SCTBGICAL    JOtJRNAL. 


the  part,  BO  that  the  deetruction  of  structure  would  be  pure^ 
local  and  concentrated.     Id  addition  to  this  there  would  be  ths 
advantage  of  the  antiseptic  action,  which  is  so  marked.     Three 
forrae  of  dJaeaae  were,  I  thought,  amongst  the  best  for  its  usi 
cutaneous  nsavuB,  lupus,  and  malignant  ulcer. 

Treatment'  op  N*;njs  wtth  Sodium  Ethtlatk. 
In  1870  I  treated  with  the  ethylate  a  case  of  naevus  on  the 
neck  of  a  child  two  years  old.  Not  more  than  six  applicationa 
of  the  fluid  were  made  when  the  osevua  was  entirely  removed, 
and  a  sound  surface  left.  The  nsevus  in  tiia  instance  was  so 
small  I  did  not  consider  the  trial  of  sufficient  value  ;  but  soon 
afterwards  my  friend,  Mr.  Gay,  was  good  enough  to  show  me 
a  ease  of  naevus  of  the  scalp  in  a  child  under  Ids  eare  at  the 
Graat  Northern  Hospital,  The  ukvus  waa  of  the  full  size  of 
a  half-crown,  and  extremely  prominent.  It  had  been  treated 
on  various  plane — by  tying,  by  nitric  acid,  and  other  methods, 
— but  without  success,  Mr.  Gay  having  consented  to  my  rfr 
quest  that  the  ethylate  should  be  applied  in  this  case,  I  sent  a 
specimen  of  the  remedy  to  the  hospital  foi"  use  there.  Instead 
of  this  the  patient  was  sent  to  my  house  that  I  might  apply  the 
caustic  myself  I  commenced  by  covering  the  nsevus  lightly 
with  the  solution.  The  application  gave  very  httle  pain,  but 
soon  a  dark  surface  showed  that  the  caustic  had  taken  effect. 
Three  days  afterwards  a  6rm  hard  encrustation  had  formed 
where  the  caustic  had  been  applied,  which  encrustation  I  did 
not  then  remove.  A  few  days  later,  the  hard  crust  being  loose, 
I  gently  raised  it  away  to  find  the  nsevus  greatly  reduced  in 
size.  The  ethylate  was  agm  applied  to  the  surface  of  tiie 
vuB,  and  the  same  process  was  continued  until  the  nsevus 
entirely  removed,  and  a  natural  surface  was  left.  The  case 
under  my  treatment  nine  weeks  and  three  days.  Some  time 
afterwards  the  child  was  brought  to  me  ao  oomplet«lj  well  that 
it  was  not  easy  to  discover  where  the  ntevus  had  been. 

Dr,  Bnmton's  cases,  which  he  so  ably  reported  at  the  Medi- 
cal Society,  are  similar  in  kind,  and  his  results  are  equally  good^ 
I  referred  at  the  meeting  to  some  other  cases  in  which  I  had 


BOITIfiH   AND   FOREIDN  JOURNALS,  229 

Heed  the  ethjlate.  These  I  will  notice  at  length  on  some  future 
occaaion.  It  is  better  now  for  me  to  give  one  or  two  practical 
lunts  for  those  who  wish  to  use  the  ethylatos. 

Practical  Notes. 
In  makiBg  the  ethylate  of  aodium,  which  is  the  most  mana^ 
[eable,  it  is  best  not  to  make  much  at  a  time.  Put  half  a  fluid 
mce  of  rectified  alcohol  (sp.  gr.  0'975)  into  a  two-ounce  test- 
ibe,  set  the  test-tnbe  up  in  a  bath  of  cold  water,  and  add,  in 
1  piecds  at  a  time,  some  cuttings  of  pure  metalhc  sodium. 
|l  gas,  hydrogen,  will  at  once  escape.  Add  the  sodium  until 
a  gas  ceases  to  escape,  then  warm  the  water  in  the  bath  to 
100'^  F.,  and  add  a  little  more  sodium.  When  the  gas  again 
ceases  to  escape,  stop  the  putting  in  of  more  sodium ;  or,  if  crys- 
tallization takes  place,  then  stop.  Afterwards  cool  down  50" 
F.,and  add  half  a  fluid  ounce  more  of  alcohol.  This  will  give 
a  good  working  solution,  which  can  be  made  more  active  by 
adding  sodium,  or  less  active  by  adding  alcohol. 
^v  Put  the  solution  in  a  glass  stoppeired  bottle,  and  have  the  bot- 
^■e  always  well  closed. 

^K  Keep  the  bottle  always  in  a  cold  place.     Once,  a  bottle  of 
^BAyl&te,  left  during  summer  time  exposed  to  the  sun  in  my  lar 
^Hbratory,  exploded,  so  that  the  bottle  was  broken  and  the  con- 
tents spilled. 
Always  apply  the  ethylate  wiUi  a  glass  rod. 
The  ethylate  solution  must  not  be  mixed  with  other  fluids 
(ban  alcohol.     Mixed  with   chloroform,  in  quantity,  a  violent 
action  is  set  up,  and  the  ethylate  is  decomposed  into  chloride  of 
sodium  and  an  ether — triethylic. 

The  ethylate  is  not  so  manageable  for  subcutaneous  injection 
as  for  application  to  the  surface  by  the  glass  rod.  It  specially 
deserves  trial  in  lupus,  in  malignant  ulcer,  and  in  vascular  cuta- 
neoiiH  growths  and  excrescences. 
The  addition  of  an  alcoholic  solution  of  opium  lessens  the 
Q  application. 


830  CANADA   UEDIOAL   AND  SDBGICAL  jnU&NAL. 

The  Royal  Medioal  ana  Ghimrgrloal 

Society.— Tlie  fii'st  papur  read  was  that  on  a  ease  of  Thy- 
rotiimy  for  the  Rerarjvui  of  n  Membrane  completelj  Obliterating 
the  Larynx,  by  Df.  Fellx  Sbmon.  The  patient  had  attempted 
to  cnt  his  throat,  and  as  the  wound  healed  it  was  found  necessary 
to  perform  traoheotouiy.  Tbo  voice  gradually  became  dimin- 
ished, and  lai  y ngosc Dpi c ally  a  tough  dense  membrane  waa 
found  occluding  the  larynx  between  the  false  vocal  cords,  with 
evidences  of  anchylosis  of  the  left  arytenoid  cartilage.  The 
operation  was  undertalien  to  remove  this  membrane,  and 
the  third  case  on  record  in  which  thyrotoray  had  been  practised 
for  such  a  purpose.  A  modification  of  Trondlenberg's  tampoH 
was  employed  to  plug  the  trachea.  The  author  urged  great 
caution  in  the  administration  of  chloroform  througli  the  tampon- 
cannula,  the  liability  to  asphyxia  being  greater  than  when  in- 
haled in  the  ordinary  way.  In  the  operation  itself  he  had 
intended  to  only  partially  divide  the  thyroid  cartilage,  leaving 
its  upper  part  uninjured,  so  as  to  ensure  Bubseijuent  appositioD 
of  the  parts,  but  he  waa  compelled  to  fully  divide  it.  He  then 
found  that  there  was  a  second  membrane  in  the  larynx,  at  the 
level  of  the  original  suicidal  wound,  that  visible  with  the 
laryngoscope  being  probably  due  to  the  adhesion  of  the  falsa 
vocal  chords.  He  urged,  therefore,  im  similar  cases,  an 
examination  through  the  tracheotomy  wound,  to  ascertain  the 
presence  of  other  membranes.  The  lower  and  primary  mem- 
brane was  being  excised  with  a  pair  of  curved  scissors,  when 
the  patient  began  to  cough  violently.  It  was  thought  that  the 
.  tampon-cannula  did  not  sufficiently  occlude  the  larynx,  and 
that  perhaps  blood  had  entered  the  bronchi.  In  reinHatiug  the 
tampon  the  cough  was  replaced  by  an  intense  asthma  tie 
paroxysm  marked  by  e.ttreme  inspiratory  dyspnoea.  No 
obstruction  was  found  in  the  tube,  but  on  partial  evacuation  of 
the  tampon-bag  the  dyspnoea  ceased,  showing,  the  author  held, 
that  an  e.xcesa  even  of  equal  pressure  on  the  inner  walls  of  the 
trachea  sufficed  to  produce  reflex  spasm.  Tiie  sudden  cough 
was  in  corroboration  of  Stoerck's  statement  that  the  posterior 
wall  of  the   larynx,   and    especially   the   interarytenoid   fold. 


BRITISH   AND    FOHEION   JOtJKNALS. 


«3[eite  cough 


I 


231 

touched,  whilst  the  anterior  and  lateral 
"walls  of  the  larynx  are  not  ao  irritable.  The  wound  healed  by 
ynmary  uaiou,  but  in  spite  of  the  daily- repeated  and  long- 
continued  passage  of  bougies  through  the  mouth,  there  wae 
.gradual  cicatricial  atenosis  of  the  larynx,  find  a  month  after  the 
operation  no  air  passed  throu^^h  the  mouth. — The  President 
complimented  Dr.  Semon  upon  the  interest  of  his  paper,  on 
account  of  its  novelty,  and  the  candour  and  lucidity  with  which 
5t  wafi  written.  Dr.  Andrew  suggested  that  the  asthmatioal 
attack  which  occurred  during  the  operation,  characterized 
eepecially  by  marked  inspiratory  dyspnoea,  was  due  to  narrow- 
ing of  the  trachea  just  below  the  point  where  it  was  unduly 
distended  by  the  bag  of  the  tampon.  Dr.  Semon  felt  sure 
there  was  no  narrowing  of  the  trachea,  for  he  was  able  to 
explore  it  thoroughly  with  a  goose-quill,  and  although  the 
dyspnoea  was  both  expiratory  and  inspiratory,  it  was  chiefly  the 
latter ;  but  he  believed  it  produced  by  reflex  action  from 
pressure  on  the  nerves  supplying  the  mucous  membrane,  and 
thought  this  borne  out  by  some  experiments  which  had  been 
made.  Mr.  M.  Baker  suggested  that  the  elastic  bag  of  the 
tampon  may  have  been  pressed  down  and  caused  Obstruction. 
Narrowing  sufficient  to  produce  dyspncea  would  not  be  proved 
by  a  quill.  Mr.  Holmes  bad  had  but  small  experience  in 
thyrotomy,  but  he  had  seen  no  need  to  employ  sutures,  and 
criticised  the  procedure  suggested  by  Dr,  Semon,  of  not  com- 
pleting the  diviaion  of  the  cartilage,  as  diminishing  the  area  for 
manipulation,  and  preventing  the  oom]>lete  exposure  of  Che 
Tentricular  bands.  Dr.  Semou  explained  that  one  object  he 
bod  in  view  was  to  preserve  the  anterior  commissure  of  the 
vocal  cords,  and  thus  prevent  that  total  loss  of  voice  which 
Bruns  bad  shown  to  follow  after  complete  thyrotomy. — The 
Lancet. 

Treatment  of  Neuralgia  by  hypodermio 

Injections  of  Ergot. — Marino  recommends  the  injec- 
tion of  from  O'l'i  to  0-25  gr.  diiiwlvod  in  distilled  water.  This 
lOay  be  repeated  once  or  twice,  though,  perhaps  not  more  than 
Kx  times,  and  acts  well  in  certain  forms  of  neuralgic  pains, 
eepecially  in  the  douloureux.  It  appears  to  act  less  favorably 
'       ■  ■■         {Imparmah,  No.  8, 1878.) 


CANADA   MEDICAL   AND   SUKOinAI.   JOTJEKAL. 

Treatment  of  Diarrhoea  by  Oxide  of 

Zinc— Db-  Jaoqiher  has  followed  in  the  service  of  Dr. 
Boijaciy  at  Nantes,  tlie  good  effects  of  tbe  employment  of  oxide 
of  zinc  in  diarrhoea.  The  formula  which  he  has  employed  is  tbe 
foUowiug :  Oxide  of  zinc,  54  grains ;  bichromate  of  soda,  TJ 
grains  ;  in  four  packets,  one  to  be  taken  every  six  hours.  In 
all  the  cases  which  he  observed  by  Puygautier,  the  cure 
even  more  r&jiid,  since  in  only  one  case  were  ibree  doses  of  tha 
medicine  required.  The  results  are  considered  to  have  ' 
more  satisfactory,  inasmuch  as  in  several  cases  the  malady  bad 
endured  from  one  to  many  months,  and  otlier  methods  of  treat 
ment  had  not  produced  any  improvement.  Thus  he  concludes 
that,  although  by  no  means  to  be  held  as  exclusive  treatment, 
the  employment  of  oxide  of  zinc  deserves  to  be  more  generallj. 
known  as  useful  in  diarrhcea. — British  Med.  Journal,  Sept.  2S 
1878. 

A  hugre    Vesical  Calculus.-  Dr.  Shown,  of 

Barnsbury,  brought  to  the  first  meeting  of  the  Islington  Medical 
Society,  on  the  22Dd,  ultimo,  a  human  bladder  containing  thie« 
stones,  weighing  in  all  one  pound  and  a  quarter,  less  twenty 
grains  ;  the  next  half  a  pound,  less  forty  grains .  the  third  for^ 
gruns.  The  bladder  Js  thickened  and  its  mucous  coat  is  ulci 
ted.  There  had  been  indications  of  stone  for  twenty-five  years, 
and  the  patient  was  sounded  at  the  time  by  two  provincial 
surgeons.  Shortly  before  his  death  he  was  again  sounded  by  a 
London  surgeon,  who  wished  to  operate ;  hut  the  patient  woold 
not  consent,  and  soon  died.  The  suflerings  of  the  patient  were 
most  severe,  amounting  often  to  torture,  for  which  he  was  in  the 
habit  of  taking  a  mixture  of  gin  and  beer.  His  death  was  pie- 
ceded  by  a  dry  tongue,  pain  in  the  region  of  the  right  kidney, 
twitchings,  tympanites,  and  drowsiness,  which  passed  into  coma, 
Tlie  urine  during  this  period  cont^ned  large  quantities  of  blood 
and  pus.  The  stones  are  smooth  and  of  phosphatic  eompositdon. 
The  anrgeon  who  wished  to  operate  is  probably  to  be  congrata 
lated  on  the  resistance  of  the  parent.  The  specimen  will  shortly' 
be  ^ren  to  the  Royal  College  of  Surgeons, —  The  LanceL 


BRITISH  AND  TOKEION  .TOURNALS.  233 

Treatment   of  Diphtheria. — M.  Klen,  in  the 

late  epidemic  of  at  Strasburg,  has  found  that  Schaller's  method 

of  treating  diphtheria  wish  perchloride  of  iron — twenty  drops 

X  zi  twenty  drops  of  water,  in  a  teaspoonful  or  two  of  coffee  every 

fc"wo  hours — was  exceedingly  effective.    Id  some  cases,  in  which 

fclie  medicine  did  not  act  sufficiently  rapidly,  M.  Kien  has  given 

i- 31  addition  syrup  of  eucalyptus,  according  to  the  p!an  of  M, 

^joldachmidt.     If  the  patients  refused  to  take  the  perchloride 

t^  iron,  a  lotion  was  employed,  such  as  was  proposed  by  M, 

^^Mandl,  of  Paris,  for  application  in  chronic  granular  pharyngitis. 

'J' he  lotion  was  applied  by  means  of  a  brush,  as  a  wash  for  the 

^5ore  places,  two  or  three  times  a  day.     It  was  composed  of 

<::arbolic  acid,  O'lO  ;  pure  iodine,  potassium  iodide,  oa  :  0.20  ; 

^jcerine,  10-00.     Independently  of  this,  he  gives  salicylate  of 

«oda,  1-100,  if  Bymdtoms  of  fever  present  themselves ;  the  drug 

in  the  same  way  as  sulphate  of  quinine,  whilst  it  is  more 

jy  to  administer  in  a  liquid   form. — Gazette  Medicate  de 

Straibourff,  Nov.  1876.— TOf  Practitioner. 

Pilocarpln  in    Children's   Diseases.— 

Professor  Demme  of  Berne  has  recently  given  an  extended  trial 
to  pilocarpin  in  various  dropsical  affections  of  children.     The 
cases  treated  were  thirty-three  in  number,  and  the  remedy  was 
|^^_administered  subcutanoously.     Eighteen  were  cases  of  desquor 
^^Hufttive  nephritis  with  dropsy  after  scarlet  fever  ;  in  three  the 
^^Buno  affections  after  diphtheria.  In  the  romiuning  twelve  caaes 
^^^■ie  dropey  was  due  to  the  vulvular  affections  of  the  heart,  rhou- 
^^^Batism,  acute,  long  affections,  &c.     The  age  of  the  patients 
^^Hmgod  from  nine  months  to  twelve  years  ;  the  dose  varied  from 
l^^^five  milligrammes  to  two  centigrammes.     In  some  of  the  cases 
from  two  to  four  injections  of  a  centigramme  each  were  made  in 
the  twenty-four  hours.     Only  in  two  cases  were  there  any  un- 
pleasant symptoms,  such  as  vomiting,  hiccough,  paleness  of  face, 
prostration,  convulsions.     In  these  cases  the  pecuhar  effects  of 
the  remedy  were  not  obaervcd.    Professor  Demme  regards  pilo- 
carpin as  an  encellent  diaphoretic  and  siaJagoguo.     The  former 
effect  is  more  marked  in  older  children,  the  latter  in  younger 
patieiits.     Three  to  seven  minutea  usually  suffice  for  the  effect 


RANA[)A    MEDICAL  AHP 

of  tbo  drug  to  be  produced  ;  this  goes  on  increasing  for  fifteen 
intnnt«s,  aiid  remuina  at  ita  height  for  a  half  an  faoar  or  more, 
and  then  gjaduully  RubsldeB.  There  is  slight  dimiQutioa  of 
temperature.  The  pulee  iB  increased  in  volume  and  in  beqaeiu^ 
hy  &om  twenty  to  sixty  beats.  As  a  result  of  the  fiill  eSect  erf 
the  pilocarpin  there  ia  a  loss  of  weight  varj^ng  from  120  to  075 
grammes.  Diuresis  is  only  oecasionally  observed.  There  wu. 
watery  diarrhoea  in  two  cases.  Professor  Derame  thus 
marizos  his  experience  of  the  remedy  ;  1.  Pilocarpin  is  an  » 
cious  diaphoretic  and  sialogoguc  in  the  treatment  of  certain 
diseueca  of  children.  2.  In  appropriate  doses  it  is  well  borne  bj 
the  youngest  patients.  '6.  Unpleasant  aymptoms  are  of  very 
rare  occurrence,  and  can  probably  he  altogether  prevented  by 
administering  small  doses  of  brandy  before  the  injection.  4.  The 
cases  for  which  pilocarpin  is  especially  suitable  are  the  parmi- 
chymatouti  inflammations  of  the  kidney  with  dropsy  following- 
scarlatina  and  diphtheria ;  in  the  majority  of  these  cases  the 
flow  of  urine  ia  decidedly  increased,  while  the  quantity  of  blood 
and  albumen  in  the  urine  is  diminished  rather  than  augmented, 
5.  It  is  uncertain  whethor  pilocarpin  has  any  direct  inflaenoe 
upon  the  action  of  the  heart — {Medical  Examiner,  July  18, 
1818.')— The  Practitioner. 

Large  Doses  of  Belladonna  In  Intes- 
tinal Obstruction.— Dr.  Norman  Kerr  puts  on  record 
five  cases  of  intestinal  I'hatruction  which  he  has  successfully 
treated  by  the  administration  of  belladonna  in  two  graia  doses 
every  hour.  The  total  amount  of  belladonna  ^ven  ranged  from 
five  grains  the  lowest,  through  nine  and  fourteen  grains,  the 
highest.  Tlie  accessory  treatment  consisted  in  fomentations, 
warm  enomata,  gruel  and  beef-tea  per  rectum  ;  ice,  iced-milk 
and  soda  water  by  the  mouth.  Attacks  of  obstruction  occurring 
aflerwards  were  also  treated  succeseftilly  by  the  admimstratioD 
of  belladonna.  In  no  case  was  alcohol  prescribed,  but  in  one  it 
was  taken  as  two  ounces  of  port  wine  before  the  belladonna 
treatment  was  begun  In  the  after  treatment  pulvis  glycjrr- 
hixoD  composita  has  been  fnund  the  most  effectual  remedy,  as  a 
proveutative  of  obstractioii. — Sritith  AfeJicat  Eeoord- 


BRITISH  AND  FOREIGN  JOURNALH. 

Hypodermic  Injection  of  Dialyzed  Iron 

Ul  Cblorosis. — Professor  Da  Costa  reports  vast  improve- 
meiit  in  Kit:  condition  of  a  young  woman,  aged  twenty-one, 
suffering  from  ciUorosia  after  the  injection  of  dialyzed  iron  hypo- 
dennlcally  for  a  fortnight.  Hitherto  iron  has  not  been  used  in 
anbcutaoeouB  injections,  as  it  is  liable  to  cause  irritation  and 
abscesses,  even  with  the  tartrate,  which  is  one  of  the  mildest 
ioraa.  The  solution  of  dialysed  iron  was  found  to  be  from  these 
drawbacks,  even  used  undiluted,  T!ib  punctures  caused  by  the 
djringe  show  no  sign  of  inflammatory  action.  In  no  caae  was 
^re  that  oostivenesa  or  disordered  digestion  which  are  hut 
to  often  the  after-effects  of  the  use  of  iron,  Daily  injections 
of  fifteen  rainims  of  pure  dialysed  Iron  were  at  first  given,  and 
tluBWBfl  gradually  increased  to  twenty,  twenty-five,  and  thirty 
miaiins  per  day.  Under  this  treatment  the  colour  gradually 
came  back  to  the  patient's  lips,  gums  and  tongue ;  her  appetite 
"M  good  her  bowels  regular,  and  her  headache  gone.  She  was 
considered  practically  cured. — {Philadelphia  Medical  THmea.') 
•Vie  Practitioner. 

Of  the  Nature  of  Mumps.  —  M.  Fchr,  after 

observing  several  cases  of  mumps  with  the  greatest  exactness, 
decides  that  it  is  right  to  consider  the  disease  as  infectious,  and 
that,  as  was  already  noticed  by  previous  observers,  it  stands  in 
a  definite  relation  to  acute  exanthema,  particularly  to  scarlet 
fever.  The  oocaaional  swelling  occurs  in  the  neighbourhood  of 
the  glands  the'mselvcs,  whilst  tbe  surrounding  tissues  only  be- 
come infiltrated  at  a  later  period.  It  is,  to  say  tlie  least  of  it, 
inaccurate  to  describe  the  disease  as  periparititis,  as  is  usually 
done  ;  that  it  is  not  parotitis  is  shown  by  the  fact  that  in  very 
many  cases  of  mumps  it  is  the  sob-roasillary  which  is  either 
affected  alone  or  is  swollen  at  first.  The  infection  is  not  due  to 
propagation  of  intfamation  of  the  mouth  caused  by  secretions 
from  the  glands.  The  observation  that  in  most  epidemics  of 
mumps  there  is  a  period  of  incubation  lasting  several  days  with 
the  well-known  febrile  symptoms  before  the  appearance  of  the 
local  symptoms,  as  well  as  the  spread  of  disease  not  only  to  sur- 


rounding  persons,  but  also  to  the  foetuBargue  for  a  specifics 
alteration  in  the  blood.  The  swelling  of  mumps  is  not  a  catar-^ 
rhal  inflammation,  but  a  morbid  swelling  ot  the  glands  depend- — 
ing  upon  varjing  hyperseta,  which  only  occasions  coUateratf^ 
byporemia  and  inflltration  of  the  neighbouring  tissaes,wheii  there  -^ 
happens  to  be  a  stoppage  of  blood  in  the  glands. —  VbnLan-^ 
genheok'a  Arckiv.,  xx.  p.  600.  Rundnchau,  June  1878. — J 
27ie  Practitioner.  I 


Chloral  Medicated    ^rith   Caxuplior-  — 

(The  Tropical  application  of  Chloral  Jlcdicated  with  Camphor.) 
The  mixture  of  chloral  and  camphor  is  transformed  by  heat  into 
a  thick  oily  transparent  liquid,  resulting  from  the  solution  of 
the  camphor  in  the  cloral  hydrate,  which  thus  loses  ita  propor- 
tion of  water.  This  topical  application  does  mt  act  like  chloral 
by  revulsion,  for  it  docs  not  produce  the  slightest  hyperasmia  of 
the  skin.  Its  action  appears  jtherefore  to  be  due  to  its  absorp- 
tion. Dr.  Sune  who  has  made  out  these  facts,  has  seen  several 
cases  of  pwn  in  the  side  and  slight  attacks  of  neuralgia  cured  by 
this  new  medicine.     (^IiuiepeTideneia  Mediea. — Pructitioner.'y 

Iodide  of  Potassium  in  Small  Doses  in 

Persistent  Vomiting-.— Dr.  Formica  Corai  states 
that  iodide  of  potassium  given  in  small  doses  cures  obstinate 
vomiting  which  has  resisted  the  ordinary  treatment  In  a  case 
of  a  pregnant  woman  suSering  from  typhoid  fever,  Dr.  Corai 
administered  two  centigrammes  of  iodide  of  potassium  dissolved 
in  100  grammes  of  water  in  a  teaspoon  every  hour  and  a  half. 
The  vomiting,  which  had  previously  resisted  all  known  anti- 
emetic, ceased  the  following  day.  Dr.  Gin^  confirms  the  anti- 
emetic properties  of  iodide  of  pota^ium  ;  and  he  uses  the  medi- 
cine in  doses  of  one  to  five  centigrammes  daily  for  the  core  of 
constipation,  as  he  finds  that  it  acts  as  a  laxative.  (/itd<»eii- 
denda  Mediaa.) — The  Practititma: 


^;dtcal  anil  ^m%uiA  f  outnal. 


Montreal,  December,  iS 


COLONIAL  DEGREES. 


Iq  the  October  number  of  thU  periodical  we  published  an 

^^>t)cle  on  the  qnestion  of  the  recognition  of  Colonial  Degrees, 
^^'tid  in  doing  so  our  desire  was  to  endeavour  to  enlighten  our 
^2-ngKah  Brethren  aa  to  the  nature  and  character  of  our 
**utitution3.  It  appears  that  the  tone  of  this  article  has  given 
Vimbrage  to  the  Editor  of  The  Medical  Timug  and  Qazette. 
*.i  ia  lamentable  to  see  the  absurd  notions  that  are  apparently 
entertained  and  expressed  occasionally  in  the  British  Medical 
press  concerning  us  Canadians,  and  the  article  in  our  journal 
above  referred  !«,  was  one  of  a  aeries  that  have  from  time  to 
time  appeared  in  our  periodical,  for  the  the  express  purpose  of 
imparfing  some  information  to  our  fellow-countrymen  on  the 
other  aide  of  the  Atlantic  as  to  our  social  and  medico- political 
status.  But  the  article  in  question  had  a  wider  signification  as 
it  applied  in  a  degree  to  our  own  local  enactments.  We  are 
desirous  of  seeing  that  proper  understanding,  which  should 
ejtist  amongst  ns  Canadians,  but  which,  unhappily,  does  not 
exist,  of  hormoniziug  all  our  licensing  bodies  under  one  head,  so 
that  a  man  who  is  registered  in  one  section  o(  the  Dominion 
can  claim,  on  the  strength  of  that  qualification,  registration  in 
any  other  section.  Ear  be  it  from  us  to  hold  out  any  threat,  as 
ia  hinted  in  The  Medical  Times  and  Gazette  ;  such  a  line  of 
conduct  would  not  be  likely  to  attain  the  end  desired.  PerhapB 
our  contemporary  is  not  aware  that  Canada  is  a  country  sparsely 
populated,  but  coataming  an  area  of  about  aa  large  as]the  whole 


ND   StTROIOAL   JOUKMAL. 


of  Europe.  That  this  country  has  a  future  and  a  bri^t  oa& 
before  it,  few  who  are  accustomed  to  reason  od  these  aubjecta 
win  deny.  The  Canadian  faculty  are  in  no  way  anxious  thaC 
Jack's  master  should  believe  Jack  to  be  as  good  a  man  as  tiinta 
self.  Tbey  are  perfectly  willing  that  the  master  should  renuoH 
in  his  self-imposed  excluaivenees,  be  self-^tisfied  and  conriDCM 
that  he  is  far  above  other  mea,  especially  hia  man  Jack.  ^tiU 
Jack  can  go  on  in  the  old  way,  and  if  his  master  becomes  tJ 
exacting  he  can  aimply  cease  to  serve  him  or  to  recognise  hiw 
in  any  way  as  bis  superior  or  even  his  equal.  The  world  ia  all 
before  us,  and  the  Canadian  Medical  Faculty  has  yet  to  learn 
that  recognition  in  any  shape  is  essential  to  its  being.  If  the 
tone  of  our  article  was  "  not  altogether  satisfactory,"  how  can  we 
characterize  the  tone  of  the  reply  in  the  leader  of  The  Medical 
Times  and  Q-azettv  of  the  16th  November,  1878. 

The  article  in  the  Canada  Mhdioal  and  Suroical  JourhaS 
was  based  on  an  editorial  item  which  appeared  in  7%e  Londom 
Lancet  of  the  26th  of  October,  in  reply  to  a  letter  of  complaiAC 
from  a  British  graduate,  who,  we  must  confess,  was  treated  with 
apparent  injustice, — an  injustice  which,  by-the-way,  was  rectified 
bv  order  of  this  President  of  the  College  of  Physicians  and 
Surgeons  of  Ontario,  as  soon  aa  the  circumstances  became 
known  to  that  olficial.  We  are  not  so  sure  that  the  editor  of 
The  Lancet  is  correct  in  his  opinion  that  persons  registered 
under  the  imperial  law  are  entitled  to  be  registered  in  the 
Colonies,  on  payment  of  the  necessary  fee,  at  leaat,  so  far  as 
Canada  is  concerned.  According  to  the  British  North  American 
Imperial  Act,  the  various  Provincesof  this  Dominion  are  granted 
the  power  to  legislate  for  themselves.  There  is  no  saving  clause 
protecting  the  rights  of  registered  British  Medical  Practitionen. 
We  have  always  hold,  and  we  do  so  still,  that  British  practition- 
ers should  be  entitled  to  registration  on  what  their  papers  show. 
In  Canada  we  arc  general  practitioners,  and  a  man  to  registei 
with  us  must  bold  the  double  qualiticadon.  A  pure  surgeon 
would  have  to  satisfy  the  board  of  examiners,  by  examination  on 
the  subjects  in  which  his  papers  arc  deficient  of  his  fitneaa  to 
enter   the   profession  as  a  general  practitioner.     So,  again,  i 


OOLONIAl,    DEOREEH,  239 

pare  physician  would  have  to  satisfy  the  board  by  examination 
that  ho  was  proficient  in  surgery  before  he  could  obtain  hia 
license  to  practice.  Our  friends  on  the  other  side  do  not  seem 
to  la  aware  of  this  fact 

It  nonld  seem  that  the  master  inaiets  on  recognition  from  his 
man  Jack,  not  on  account  of  what  he  ia  in  verity,  but  because 
of  what  he  would  desire  to  be. 

The  Medical  Timei  and  Gazette  asBumea  that  the  grievance 
of  non-recognition  ia,  to  a  very  great  extent,  a  sensational  one. 
In  this  we  do  not  altogether  agree.  Was  it  a  sensaUonal 
griflvance  when  the  agents  in  England  of  the  Canadian  line  of 
Steamships  received  a  notice  from  the  Board  of  Trade  in 
I*ndon,  that  after  the  lat  January,  1S77,  the  steamorB  of  that 
lice  would  not  be  allowed  to  clear  at  the  Custom  Houae  in  Great 
Britdin  unless  the  Surgeon  on  board  was  provided  with  a  Diploma 
from  some  of  the  coUeges  in  Englaod,  Ireland  or  Scotland. 
Hia  action  of  the  Board  of  Trade  was  resisted  by  the  Meaars, 
Allan. 

Sir  Hugh  Allan,  the  head  of  that  firm,  who  reaidea  in  Mon- 
treal, in  a  letter  which  he  addressed  to  Dr.  G,  W  Campbell, 
the  Dean  of  the  Medical  Faculty  of  McGill  University,  and 
vbich  we  published  at  the  time,  remarks,  under  date,  January 
19, 1877  :— 

"  I  am  totally  ignorant  of  the  reason  why  this  regulation  is 
proposed,  or  of  any  good  to  be  attained  by  it. 

"  We  have  for  the  laat  twenty  years  carried  Canadian  Sur- 
geons on  board  our  steamera,  as  well  &s  Engliab  ones,  and  the 
result  of  our  experience  is,  that  the  Canadian  Surgeons  are 
quite  equal  both  in  professional  acquirements,  and  gentlemanly 
bearing, -to  those  we  receive  from  the  Colleges  in  England. 

"  I  therefore  am  not  disposed  to  aubmit  to  this  requirement, 
inasmuch  as  I  think  it  is  a  great  injustice  to  the  institutions  of 
this  country,  as  well  as  to  the  young  men  who  study  therein, 
and  in  point  of  fact  it  is  a  slight  upon  the  Dominion  itself. 

"  I  have  written  to  the  Government  urging  them  to  take  action 
in  this  matter  without  delay,  and  I  write  this  letter  to  you  with 
the  view  that  yon  should  bring  it  before  the  authorities  of  the 
University  of  McGill  College,  or  in  any  other  way  that  you 
tiiink  most  likely  to  attain  the  object  I  have  in  view,  and  that  ia 
'all  and  perfect  recognition  of  our  awn  medical  men  aa  being 
1  to  any  others," 


240  CANADA    MEDICAL  AND    EtTBOtCAL   JOtJONAL. 

We  have  reason  to  know  that  correspondence  on  thia  8ubje<^'^ 
passed  between  the  governmenta  of  the  two  countries  and  th^^ 
action  of  the  Board  of  Trade  was  for  the  time  rescinded,  bu    -* 
the  Can^Ldian  surgeons  are  not  m  a  legal  position.   Their  quali" 
fications  are  not  recognised  as  giving  them  any  status,  furiher^^ 
than  that  if  a  man  is  registered  in  his  own  colony  under  the  ^ 
I  local  enactmenta  of  his  own  country  he  is  permitted  to  serve  on 
I  British  ships.     This  is  a  state  of  things  which  is  unsatisfactory, 
more  especially  as  the  profession  of  Great  Briton  is  seeking 
for  further  legislation  as  regards  this  very  subject  of  registra- 
tion.    The  last  clause  of  the  article  in  the  Medical  Times  and'. 
Gazette  can  apply  equally  in  our  favor  as  in  theirs,  for  how  ars 
we  to  know  that  the  standard  of  their  ordinary  pass-ezamination 
is  equivalent  to  our  own.     We  take  it  for  granted  that  it  ii 
and  we  admit  men  hailing  from  their  schools  to  registrati(»>  < 
without  examination,  but  we  do  so  in  a  spirit  of  broad  liberalitf 
and  with  s  full  hope  that  an  equally  liberal  spirit  will  guide  ths 
conncils  of  those  in  authority  in  Great  Brit^ ;  not,  however, 
be  it  distinctly  understood,  because  we  are  compelled  to  do  so. 
We  possess  our  own  le^lating  bodies  in  this  country  who  can, 
if  it  seema  advisable,  exclude  every  person  front  participating 
in  our  Registration  Act  iialess  the  person  so  applying  comes 
with  a  curriculum  of  study  eqmvalent  to  our  own  and 
an  exanunatioQ  before  our  local  bo&rda. 

Dr.  Clark,  senior  phy^cian  to  the  London  Hospital,  who 
accompanied  H.  R.  H.  Princess  Louise,  and  his  Excellency  the 
Manjuis  of  Lome  on  their  coming  to  this  country,  was  enter- 
tained by  the  professioD  of  this  city  at  dinner  at  the  Windaort 
Hotel.  Some  thirty  gentlemen  sat  down.  The  Dean  of  tin 
Medical  Faculty,  McGill  Univeraty,  took  the  chair,  having  on 
bis  right  the  guest  of  the  evening. 

Dr.  J-  P.  Rott«t,  Pre^dent  of  the  College  of  Pby^cians  ai 
Surgeons,  Province  of  Quebec,  occupied  the  vice  chair.     A. 
most  enjoyable  evening  was  paased.    The  usual  loyal  and  othcr^ 
toasts  were  ^ven  and  he&rtily  responded  to. 


CANADA 


Medical  &  Surgical  Journal 


JANVART,  1879. 

Original  Communications. 

A   CLINICAL  LECTURE 

UPON   ▲  CASE   OF 

CONTfiACnON  OF  THE  EIGHT  SIDE  OF  THE  CHEST, 

AND  GREAT  ENLARGEMENT  OF  THE  SUPERIOR  HALF 

OF  THE  ABDOMEN— GIVEN  DURING  THE 

SUMMER  SESSION  OF  1878. 

By  R.  p.  Howard,  M.D.,  etc., 

^)fe8aor  of  the  Theory  and  Practice  of  Medicine,  McGill  Univeraity. 

Repobtxd  bt  Db.  Vinebibg.* 

Gbntlemen, — Owing  to  the  obliging  disposition  of  the  young 
man  who  accompanies  me  to-day,  and  who  came  from  a  distance 
for  my  opinion,  I  am  enabled  to  show  you  a  case  of  unusual 
interest.    Its  nature  has  been  the  subject  of  some  diversity  of 
opinion  amongst  the  many  physicians  who  have  examined  the 
patient ;  and  though  it  is  probably  an  example  of  a  not  uncom- 
mon pathological  combination  of  lesions,  it  must  be  admitted 
that  considerable  obscurity  and  difficulty- now  surround  it,  as 
seen  for  the  first  time  more  than  two  years  since  its  invasion. 

It  will  be  necessary  to  give  you  as  fully  as  possible  the  history 
of  the  case  as  related  by  the  patient,  who  is  a  young  man  of 
much  intelligence,  and  he  will  then  be  examined  before  you. 


*  A  few  additions  have  been  made  to  this  lecture  since  it  was  delivered. 
-R.  P.  H. 

NO.  LXXVIII.  16 


MEDICAL   AND   Sl^ajCAL  JOUKHAl.. 

W.  McD.,  ID  years  of  age,  printer,  gives  the  following  IM 
tory  from  memory : 

Had  always  enjoyed  good  health  up  to  January,  1876.  He 
then  first  experienced  ahortnesa  of  breath  when  walking,  bui 
had  not  any  cough,  and  although  looking  ill,  thought  nothing  ofl 
it.  In  the  following  May  he  had  a  alight  cough,  from  taking 
cold,  this  continued  about  three  weeks,  but  under  the  use  of 
aquilla,  prescribed  by  a  physician,  disappeared  entirely.  When 
he  first  consulted  his  medical  adviser,  great  enlargement  of  the 
epigastric  and  hypochondriac  regions  was  noticed,  but  its  nature 
was  not  made  out  and  seven  weeks  treatment  did  not  remove  it. 
During  the  succeeding  thirteen  weeks  the  swelling  remtuned 
stationary.  The  patient,  who  was  not  under  treatment,  continued 
at  his  employment,  and  on  November  lat,  the  cough  having 
returned,  he  sought  advice  from  the  brother  of  his  former  atten- 
dant, who  considered  that  he  had  tubercular  disease  of  the  right 
lung,  but  made  light  of  the  enlargement  of  the  body  above 
mentioned.  He  never  had  suffered  pain  in  his  aide,  nor,  as  far 
as  he  remembers,  did  he  experience  any  until  the  winter  set  in  ; 
but  during  that  season  he,  on  two  or  three  occasions,  experienced 
attacks  of  severe  pain  in  left  mammary  and  hypochondriac 
regions,  which  lasted  eight  or  nine  hours,  and  was  dcepseated 
and  of  a  stitch-like  character.  The  cough  lasted  all  through  the 
winter,  and  was  of  varying  intensity  ;  it  frequently  contmued 
all  night.  He  thinks  the  expectoration  was  chiefly  of  a  frothy 
mucus,  except  during  four  weoks,  when  it  was  dark-greea  and 
purulent,  and  was  always  free  from  blood. 

The  treatment  during  that  period  embraced,  amongst  other 
things,  blue  mass,  iodide  potassium,  frequent  blisters,  and  local 
apphcations  of  iodine,  and  mercurial  ointment.  In  May,  1877] 
tcdema  appeared  in  the  lower  extremities,  the  eyehda  wMI 
puffy  in  the  morning,  and  his  urine  contained  some  albumen^ 
■  but  the  dropsy  disap[)eared  in  August,  He  visited  Boston  in 
Jnly  of  that  year,  and  saw  some  of  the  most  eminent  of  the 
physicians  there :  one  of  whom  aspirated  the  right  side  of 
the  cheat  posteriorly,  but  obtained  no  fluid.  No  opmion  was 
given  him  respecting  the  nature  of  his  case,  hat  he  was  ordered 


* 


L 


A   CLINICAL    LRCTUBK. — Bf   DK.   B.    P.    HnWABl*.  243 

to  avoid  medicine  and  vrork,  and  to  live  nutritioTtsly.    He  made 

a  second  visit  to  that  citj  in  October,  when,  on  comparing  his 

person  with  a  sketch  taken  at  his  previous  viat,  no  change  could 

"«   perceived.     He  then  weighed  142  lbs.     Since  July,  1877, 

**e  tag  been  free  from  cough,  except  for  a  couple  of  days  toge- 

*'ior,  and  only  after  exposure  ;  hia  breathing  has  improved,  and 

*-*^*i«ma  of  feet  and  legs  baa  continued  stationary.     Since  the 

^-"^^i^ma  first  set  in  he  has  had  to  urinate  eight  to  t«n  times  dur- 

'*-*S  tlie  day,  and  once  during  the  night.     His  immediate  family 

■"^^sfeiy  is  as  follows :  Both  parents,  four  brothers,  and  four 

^'^ters,  are  alive,  and  with  the  exception  of  two  of  the  latter, 

^^•"^  all  healthy.     One  sister  has  been  tJie  subject  of  some  lung 

^■'S^  ction,  and  another  is  epileptic, 

■t^Mne  lltk,  ISlS.—Pregmt  ConrfiViVn.— Stature,  5  feet  9^ 
"^"'^■•^les;  weight,  150  lbs;  fair  complexion;  pale;  not  badly 
'^■^■•irished.     Taking  off  his  shirt,  wo  note  the  following : — 

-^ngpeetion  and  Measurement. — Notable  deformity  of  thorax ; 
^*^  half  larger  and  fuller  than  right,  which  is  flattened  and 
^  feracted ;  the  right  shoulder  and  nipple  on  lower  level  than  the 
^*t  ;  posterior  border  of  right  scapula  projects,  and  dorsal  spine 
l*^^sent8  a  lateral  curve,  with  the  concavity  to  the  right;  semi- 
*^*^<2-ular  measurement  a  few  inches  below  nipple — right  side, 
\-S^" :  left,  17i";  at  nipples,  right,  15  6-8" ;  left,  17" ;  axilla, 
""^elit,  15  6-8'' ;  left,  16  1-8".  Expansion  of  the  entire  right 
■^'^l*'  of  chest  very  deficient ;  that  of  left  very  marked. 

-f*erensmon  elicits  hyper-reaonance  over  entire  left  chest — 
"^^^tc-riorly,  this  note  extends  to  right  of  inesian  line  as  far  as 
"Order  of  ateniuin ;  inferiorly,  it  coasts  obliquely  along  close 
"^low  left  nipple,  into  lateral  region,  at  level  of  7th  space ; 
T'^atcriorly,  the  left  infra  acap-region,  over  about  2J  inches 
Vertically,  emits  a  flat  note.  In  the  right  infra  clavicular  and 
•■Hillary  regions  resonance  is  of  dull,  hollow,  almost  amphoric 
•V^iaJity,  but  below  the  level  of,  and  corresponding  accurately 
^fnli,  a  horizontal  line  drawn  around  the  chest  from  the  3rd 
iBtercostal  space,  the  stroke  sound  is  flat,  and  the  resistance 
pMt  over  the  rest  of  the  entire  right  chest. 
■iutcidtation. — Exaggerated  respiration  over  left  chest,  with 


244 


AND   StTROICAL   JOtTRNAL. 


comparatively  feeble  vocal  resonance  and  fremitus.     BIowiaj|| 
respiration,    increased    vocal    resonance    (pec tori ioquy)    and:l 
fremitus  exist  over  whole  right  half  of  thorax,  are  most  markejl 
above  the  level  of  third  interspace  ;  all  respiration  ceases  to  btff 
audible  below  9th  rib  posteriorly ;  a  fine,  sharp  bubbling  is  heai 
at  end  of  inspiration  in  4tli  right  interspace  from  sternum  intnfl 
axilla  and  shade  oflf  superiorly.     Heart's   impulse  and  souiidi 
more  perceptible  in  lower  sternal  region,  and  at  right  border  o 
that  region,  than  at  usual  site  inside  of  left  nipple. 

Extending  tlie  examination  to  the  abdomen,  we  are  struck 
with  the  great  enlargement  of  the  upper  zone,  the  epigastrium 
and  both  hypochondria  being  occupied  by  a  firm,  smooth,  re- 
sisting body,  which  gives  a  dull  note  on  percussion,  as  thou^ 
the  entire  liver  were  very  much  enlarged.  The  fuUnesa  i 
moat  prominent  in  the  epigastrium,  especially  over  its  left  bal 
The  dull  percussion  note  over  this  enlargement  extends  not  onlj| 
over  the  whole  upper  abdominal  zone,  but  blends  superiorlN 
with  that  present  in  the  right  mammary,  in  the  cardiac  e-iii 
lower  part  of  the  left  mammary  regions,  and  encroaches  i 
feriorly  upon  the  middle  abdominal  zone.  The  hollow  percui 
sion  resonance  of  the  stomach  is  masked  by  tlie  fiat  note  of  tl 
resisting  mass  which  seems  to  be  in  front  of  it.  A  horizontl^ 
depression  exists  around  the  abdomen,  corresponding  to  { 
lower  margin  of  tiie  dull  and  prominent  region,  and  divides  the 
belly  into  two  portions.  The  lower  portion  is  smooth,  its  walla 
tense,  and  in  the  erect  posture  fluctuation  is  perceptible  a^  high 
nearly  as  the  umbilicus.  In  the  recumbent  posture  on  the  left 
side,  sudden  palpation  appears  to  displace  fluid  and  permit  the 
enlarged  liver  to  be  felt  by  the  fingers.  Owing  to  the  teneonesB 
of  the  parietea,  the  lower  edge  of  the  liver  cannot  b» 
guiahed.  Superficial  epigastric  and  mammary  veil 
numerous  and  tolerably  enlarged ;  lower  extremities,  up  t^  bid 
tocks,  pit  upon  pressure  ;  no  oedema  of  scrotum ;  slight  puffinei 
of  eyelida.  To  the  above  physical  examination,  which  yon  liaM 
just  witnessed,  may  bo  added  the  following  facts: — Patin 
micturates  eight  or  nine  times  in  the  day,  and,  if  awake,  ont 
or  twice  during  the  night.     The  urine  is  normal  in  colour,  i 


^^  T    DR.    R.    r.    HOWARD.  245 

from  albumen,  tube  casta  and  renal  cells.  About  four  pints 
passed  daily.  His  breathing  is  short,  especially  when  exerting 
himself,  but  he  is  free  from  cough  and  expectoration.  His 
hlood  of  rich  red  color ;  red  corpuscles  coOect  into  rolls,  aro 
abundant,  of  uniform  and  fully  average  size  ;  while  they  ate 
tolerably  numerous,  but  not  excessively  so ;  small  granules 
present  in  moderate  amount. 

In  forming  an  opinion  as  to  the  nature  of  this  case,  we  will 
begin  with  the  chest,  the  right  side  of  which  is  so  much  retracted 
and  smaller  than  the  left. — What  are  the  conditions  known  to 
produce  marked  retractiou  of  one  side  of  the  thorax  with  dull 
percussion  resonance  ? 

1.  Infiltrating  carcinoma  of  the  lung;  2.  General  collapse 
**f  one  lung,  both  rare  affections ;  3.  Chronic  pleurisy,  with 
'■etraction  ;  4.  Chronic  phthisis,  both  common  affections,  and 
^-    Cirrhoab  of  one  lung,  a  comparatively  rare  affection. 

I«et  us  endeavor  to  determine  which  of  these  conditions  obtiuns 
'^   this  young  man. 

I.  Carcinoma  of  a  lung,  especially  when  diffused,  may  pro- 
••uce  retraction  of  the  side  of  the  cheat.  But  the  circumstance 
'"^t  the  patient  has  suffered  from  his  disease  for  over  two 
y©ar«,  and  that,  instead  of  losing  flesh  and  becoming  weak  and 
***^hectic,  he  is  gaining  weight  and  strength,  is  quite  incom- 
patible with  the  existence  of  infiltrating  carcinoma  of  nearly  aa 
*»tire  lung ;  adisease  which  is  uniformly  progressive  and  usually 
^*''*^^  in  from  two  to  two  and  a-half  years.  And  there  are  sev- 
***"a.l  other  facts  opposed  to  such  a  view. 

^o  mediastinal  tumour,  so  frequently  present  in  pulmonary 

'^H.pcinoma,  exists,  for  the  dull  percussion  note  does  not  extend 

**^yond  the  middle  line — rather  it  falls  short  of  it — nor  aro  the 

^Ohs  on  the  front  of  the  chest  and  shoulder,  and  at  the  root  of 

*■««  neck,  enlarged  and  varicose  ;  there  is  no  contraction  of  one 

V«pil,  no  alteration  of  the  voice,  no  ccdoma  of  the  neck  and  of 

"'e  affected  aide  of  the  chest;  in  short,  the  pressure  signs  of 

vntra-thoracic  tumour  are  wanting. 

Haamoptyais  and  red  or  black  currant  jelly-like  expectora- 
n  have  not  occurred.     There  is  no  enlargement  of  any  of  the 


24fi 


CANADA   MEDICAL   AND   SCRfflCAL    JOCRNAl. 


la  IQQ9 

rthefl 
hestq 


external  lymphatic  glands.  And,  although  there  is  enlargemonu" 
of  the  liver,  I  will  a^ign  reasons  by-and-by  agdnst  the  mali^ 
nant  nature  of  that  enlargement.  Pulmonary  carcinoma 
may  certainly  be  excluded. 

2.  Q-eneral  Collapse  of  the  Lang  may  be  excluded,  for 
is  no  evidence  of  aneurismal  or  other  tumour  in  the  chest 
compress  the  main  bronchus  which  admits  air  to  the  lung.  The 
physical  signs  are  not  those  of  mere  collapse — viz.,  feeble  respi- 
ratory murmur,  without  decided  blowing  or  hollow  quality,  mere 
diminished  percussion  resonance,  or  slight  dnlness;  absence  of 
markedly  increased  vocal  resonance  and  vibration.  On  the  con- 
trary, the  percussion  note  is  somewhat  hollow  superiorly,  ai^L 
almost  wooden  with  marked  resistance  inferiorly ;  respiratioa 
quite  blowing,  and  vocal  resonance  and  vibration  are  much 
tensified. 

3.  Chronic  Pidmonary   Comumption,  using   the   term 
Laennec'a  sense,  sometimes  develops  a  form  of  fibroid  transfi 
raation  of  the  lungs,  attended  with  contraction  of  one  side  of 
chest ;  indeed,  this  ie  the  most  frequent  origin  of  at  least  i 
form  of  pulmonary  cirrhosis.     But  not  wishing  to  assume  t 
this  form  is  identical  with  thst  which  succeeds  umple  inflanu 
tion  of  the  bronchi,  lungs,  or  pleura,  I  will  speak  of  it  by  its 
Consumption  is  but  rarely  attended  with  great  retraction  of  < 
side  of  the  chest,  and  very  seldom  with  the  degree  of  gem 
retraction  and  deformity  present  in  this  case.     Signs  of  sofl 
ing  or  excavation  will  (laually  be  present  in  the  apex  of 
affected  lung,  and  disease  will  almost  always  be  found  co-exist- 
ing in  the  apex  of  the  other  lung  when  retraction  obtains.    The 
history  will  generally  record  hiBmoptysis,  recurring  diarrhcea, 
colliquative  sweating,  unremitting  punileni  expectoration 
steadily  progressing  loss  of  strength  and  flesh.     Such 
the  clinical  features  and  history  of  our  patient,  and  chi 
phthisis  may  therefore  be  ignored. 

There  remain,  then,  hut  chronic  pleurisy  with 
cirrhosis,  or  fibroid  degeneration  of  the  lung,  and  it 
10  decide  between  Uiem. 

Fibrmd  I>eg«tttr«ltion^  or  OhtAmu  of  the  Itmg,  reeembl 
many  respects  this  caac. 


A  CLINICAL  LECTURE. — BY  DR,   R.   P.  HOWARD.  24*7 

That  disease  affects  one  lung  osaallj,  and  the  other  remains 
healthy  and  enlarges;  pain  in  the  affected  side  and  haemoptysis, 
night  sweating  amd  diarrhoea  may  be  wantmg,  and  often  are  ; 
eough  may  also  be  absent  at  first,  especially  if  it-originates  in 
pleurisy,  which  it  is  admitted  does  occur  sometimes,  and  no 
doubt  our  patient  had  pleurisy.  This  loss  of  flesh  and  strength 
ia  often  not  at  all  in  proportion  to  the  cough,  the  extent  and 
character  of  the  physical  signs,  and  the  duration  of  the  disease. 
The  previous  health  may  have  been  quite  good  up  to  the  time 
of  ihe  attack,  and  the  general  nutrition,  the  well-developed 
frame  and  muscles  may  indicate  a  healthy  and  vigorous  consti- 
tution. • 

The  retraction  of  the  side,  when  the  whole  or  the  greater 
portion  of  one  lung  is  implicated,  may  be  as  great  as  m  chronic 
pleurisy,  and  affect  the  entire  side,  although  there  is  not  usually 
(only  exceptionally)  such  marked  depression  of  the  shoulder, 
liltmg  out  of  the  inferior  angle  of  the  scapula  and  lateral  cur- 
vature of  the  spine,  as  is  seen  in  this  case. 

The  physical  signs  indicate  consolidation  of  the  lung,  and  are 
the  same  as  those  present  in  this  young  man — decided  dulness 
of  hollow  quality,  with  marked  resistance  anteriorly  and  pos- 
teriorly ;  respiration  of  blowing  quality,  pretty  generally  audible 
over  the  whole  dull  region,  although,  as  in  chronic  pleurisy 
also,  the  respiration  may,  as  in  this  case,  be  feeble  and  almost 
inaudible  at  the  base  of  the  lung,  where  a  thick  deposit  of 
exudation  matter  separates  the   pulmonary  from  the   costal 
pleura ;  and  vocal  resonance  and  fremitus  are  exaggerated  all 
.over  the  dull  region  except  at  the  extreme  base,  as  they  usually 
are  in  cirrhosis.     When  they  are  not,  it  is  probably  because 
even  the  bronchial  tubes  are  obliterated  in  the  indurated  and 
atrophied  portion   of   the  lung;   a  condition   which  will  also 
explain  the  feebleness  of  respiration  noticed  in  the  patient  in 
the  infra-scapular  region,  which,  though  very  dull  on  percussion, 
is  almost  silent  as  regards  respiratory  sound. 

Now,  while  this  case  comports  in  all  these  respects  with  ad- 
vanced cirrhosis,  the  following  circumstances  may  be  urged 
against  that  view  : — 


I 


248  CANADA  MEmcAL  AND  SCEOICAI.  JOCENAL. 

There  is  no  history  of  previoas  pneumonia,  recurring  attacks 
of  bronchitis,  chronic  tubercular  disease,  or  exposure  to  the 
inhalation  of  irritating  particles,  which  are  the  weU-ealablished 
antecedents  of  fibroid  degeneration  of  the  hings.  Even  if  it  had 
heen  satisfactorily  proved  that  that  affection  does  occasionaily 
owe  its  ori^  to  the  abuse  of  alcohol,  to  gout,  rheumatism,  or 
syphilis,  none  of  these  have  obtmed  in  the  history  of  Has 
patient. 

Fibrinous  Plenrisy  is  also  regarded  as  a.  determining  cause 
of  pulmonary  cirrhosis,  and  it  is  my  opinion  that  our  patient's 
illness  began  as  pleurisy,  but  of  that  form  which  is  accompanied 
with  eSusion,  of  which  more  hereafter. 

5.  Another  explanation  only  remsuns — J*/ej<ri«y,  followed  by 
retraction  of  the  side,  a  condition  that  sometimes  resembles,  in 
its  symptoms  and  signs,  fibroid  degeneration  or  cirrhosis  more 
than  any  other  disease  does. 

Marked  rttraction  of  the  chest,  after  pleurisy,  occurs  most 
frequently  when  the  pus  or  sero-purulent  eflusion  has  opened 
into  the  bronchial  tubes  and  been  expectorated,  or  has  perforated 
the  chest  wall  and  thus  escaped.  Sometimes,  however,  it  fol- 
lows absorption  of  the  fluid,  but  the  retraction  is  then  not  usually 
great. 

Now,  there  are  some  serious  objections  to  the  view  that  this 
case  is  one  of  pleurisy  followed  by  retraction ;  thus : — 

There  is  no  history  of  pain  in  the  right  side,  fever,  cough, 
or  illness  beyond  dyspncea,  for  the  first  four  or  five  months. 
Taking  thai  view,  we  are  obliged  to  suppose  that  the  first  phy- 
sician whom  he  consulted  (for  chronic  dyspnoea  and  a  recent 
cough),  and  who  discovered  the  great  enlargement  across  the 
epigastric  zone,  failed  to  notice  the  existence  of  pleurisy,  pro- 
bably with  more  or  less  effusion,  although  he  had  him  under 
treatment  for  seven  weeks,  and  under  observation,  in  conjunc- 
tion with  his  brother,  who  was  also  a  physician,  for  a  year  afler- 
narde. 

3Tie  dyspncea  and  great  enlargement  in  the  epigastric  zone 
continued  all  summer,  and  then  cough  set  in  agam,  but  attended 
with  expectoration,  and  still  no  mention  was  made  of  pleoiisyoz 
pleural  effusion,  but  of  phthisis. 


A  CLINIOAL   LECTURE. — BY   DR.   R.    P.   HOWARD.  249 

These  are  certsdnly  objections  to  the  theory  of  pleurisy  with 
efibsion,  but,  on  the  other  hand,  it  may  be  urged .  1st.  That  that 
<lidea8e  is  sometimes  quite  latent,  pain  being  altogether  absent, 
tilie  disease  revealing  itself  subjectively  chiefly  by  dyspnoea 
during  exertion,  and  objectively  by  its  physical  signs.  2nd.  That 
pleural  disease  may  not  have  set  in  till  the  fall ;  the  dyspnoea 
have  been  caused  by  the  large  tumour  below  the  diaphragm 
ii^^torfering  with  the  action  of  that  great  respiratory  muscle. 
That  the  doctors  may  not  have  chosen  to  inform  the  patient 
t;he  pleurisy  ;  or,  attaching  chief  importance  to  the  tumour, 
may  have  actually  overlooked  the  presence  of  effusion  in 
right  side  of  the  chest. 

lut  what  are  the  circumstances  favourable  to  the  view  that 
thoracic  affection  was  primarily  pleurisy  followed  by  retrac- 
tion ? 

1.  That  it  is  by  far  the  most  frequent  cause  of  general  retrac- 

"^oii  of  one  side  of  the  chest  ?  On  Friday  last  I  saw  an  excellent 

Example  of  it  with  Dr.  Roddick,  in  a  patient  from  whose  right 

<5lie8t  he  had  removed  80  or  90  ounces  of  serum  four  years  ago. 

The  retraction  affected  the  whole  right  side  superiorly  as  well  as 

mferiorly,  posteriorly  a^  well  as  anteriorly.     The  appearance  of 

the  entire  chest  resembled  very  closely  that  of  this  young  man. 

2.  The  existence  of  dyspnoea  from  the  beginning  of  the  year 
till  May,  without  cough,  is  reasonably  and  fairly  explicable  on 
the  supposition  of  latent  pleurisy  with  effusion. 

3.  The  enlargement  in  the  hepatic  region  noticed  in  May, 
may  have  been  due  to  the  displacement  of  that  organ  by  the 
effusion  (although  it  is  quite  possible  amyloid  degeneration  of 
the  liver  may  have  also  been  present.) 

4.  The  severe  cough  which  often  continued  throughout  the 
iii^t,  and  lasted  six  months,  may  well  have  been  due  to  the 
effiision  having  perforated  the  lung,  and  been  expectorated 
fiom  time  to  time. 

&  The  degree  of  the  retraction  being  so  considerable,  and 

*  *iig  altonded  with  depression  of  the  shoulder,  lowering  of  the 

aad  curvature  of  the  spine. — Walshe,  indeed,  says,  *'  That 


)  PANADA   MEDICAL   Ar»f>   HtmOICAt   .TOrRNAL. 

none  of  these  displacements  are  produced  by  cirrhoas  alone  :' 
and  although  this  statement  does  not  always  hold  good,  (sea 
case  by  Bastion,  in  Reynolds'  Syst.  Med.,  vol  iii,,  p.  857), ; 
it  expresses  a  good  general  rule. 

6.  While  the  physical  signs  present  may  be  equally  i 
referred  to  "  pleurisy  witli  retraction."  or  to  "  cirrhoMS,"  ^» 
absence  of  those  characterizing  dilated  bronchi  in  tbe  affected 
lung,  favour  very  decidedly,  the  existence  of  the  former 
affection. 

7.  The  absence  in  the  history  of  the  case  of  hiemoptysis,  ( 
a  peculiar  purulent  expectoration,  and  of  diarrhoea,  favoors  UsA 
view  of  pleuritic  rather  than  cirrhotic  origin. 

8.  So  does  the  cessation  of  the  cough  and  expectoration,  and 
the  steady  improvement  in  flesh,  strength  and  general  health  fof 
the  past  10  months,  Cirrhosis,  in  the  vast  proportion  of  cases^ 
progresses  from  bad  to  worse — although  it  does  so  very  slowly. 
The  congh  and  expectoration  hardly  ever  cease  for  a  long  tim^ 
for  mouths  I  mean. 

9.  Finally,  there  is  one  physical  sign  present,  which  b  almost 
a  proof  of  the  previous  existence  of  pleurisy  with  effusion,  viz.  i 
the  horizontal  line  which  the  upper  limit  of  dulness  makea 
around  the  chest,  from  the  atoroum  to  the  spine  at  the  level  o 
3rd  intercostal  space. 

Neither  tubercular  nor  malignant  disease  ;  neither  cirrho^Xf 
chronic  pneumonia,  nor  tumour  of  any  kind,  could  produce  k 
horizontal  tine  of  dulness,  unless  in  very  exceptional  cases. 

For  these  considerations,  then,  I  am  of  the  opinion  tliat  the 
affection  in  this  patient's  chest  has  been  pleurisy  with  effiisioOf 
followed  by  general  retraction  of  the  right  half  of  the  thorat 

But  a  greater  difficulty  awaits  us :  What  is  the  enlargement 
of  the  epigastric  zone  due  to  ?  The  situatiou  of  the  enlargement- 
viB. ;  in  the  epigastrium,  both  hypochondria,  more  especially  tfa 
right,  and  the  upper  part  of  the  umbilical  zone — its  percussioi 
dulness,  blending  above  with  that  of  the  liver,  spleen  and  heailj 
lad  extending  continuously  into  the  umbilical  region  below,— 
k  its  uniform,  resisting,  solid  feel — \u  auperficialncs;,  covering  ai 
it  does  the  stomach,  an  circumataocea  that  induce  me  to  regi 
it  as  aa  enlarged  liver. 


A   CLINirAL    LECTTIBE. — DT    tlR.    R.    P.    liriWABI).  251 

The  condidons,  prodnctive  of  such  great  hepatic  enlargement, 
aj~o  ehromc  mechanical  congestion,  abscess,  cancer,  fatty  degen- 
^r-ation,  both  forma  of  hypertrophic  cirrhosis,  hydatids,  and 
a.Kiiyloid  degeneration. 

Mechanical  Congestion  of  the  liver,  from  mitral  or  tricuspid 
disease  sometimes  produces  uniform  and  conaderable  enlarge- 
uaent  of  the  liver,  bat  never,  in  my  experience  to  the  extent 
piresent  in  this  young  man,  in  whom,  moreover,  no  valvular 
^flection  exists. 

Pytemic  Abscesi  of  the  liver,  consequent  upon  pleurisy  might 
■produce  enlargement  of  the  liver,  but  the  entire  absence  of  pain, 
O-iid  tenderness,  which  are  always,  and  of  jaundice,  which  is 
"OaoaHy  present  in  hepatic  abscess  ;  the  absence  of  the  general 
symptoms  of  pyasmia,  viz. :  irregularly  recurring  fever  of  inter- 
mittent type,  rigors,  profuse  sweating,  subcutaneous  and  articular 
Suppuration,  etc.,  and  the  short  duration  of  pysemic  abscess 
*kich  rarely  outlasts  three  months,  and  generally  ends  fatally, 
*ill  exclude  that  affection.     I  deem  it  unnecessary  to  discuss 
primary  abscess  of  the  liver,  the  result  of  hepatitis,  a  disease 
_         not  infrequent  in  the  tropics,  but  hardly  known  here. 
^^B      Fatty  Enlargement  of  the  liver,  bo  common  in  chronic  phthisis, 
^^Vitrare  in  other  wasting  diseases,  and  in  young  and  temperate 
^^f  persons.     It  is  not  attended  with  ascitis,  and  may  be  ignored  in 
H       this  instance.      Moreover   the   enlargement  appears   to  have 
|l  existed  before  the  protracted  cough  and  expectoration  set  in. 

Oarcinoma  of  the  liver,  which  might  well  explain  the  great 
mc  of  the  abdominal  tumour,  may  be  excluded,  owing  to  the 
absence  of  the  following  symptoms :  pain  in  and  tenderness 
nnder  pressure,  of  the  liver ;  tumour  elsewhere ;  enlarged 
gtamls,  and  that  profound  alteration  of  health  and  nutrition 
necessarily  consequent  upon  the  existence  of  a  malignant 
-.tumour  for  two  years.  Carcinoma,  steadily  pursues  the  evil 
Bnor  of  its  way  towards  cachexia,  marasmus  and  death,  and  the 

B  not  far  off  at  the  end  of  two  years. 
That  form  of  Hypertrophic  GirrJionit,  caused  through  obstruc- 
n  of  the  bile  duct  by  gall  stones,  ca.ncerous  glands,  or  pancreas, 
pc,  and  sometimes  by  malaria,  and  called  Biliary  cirrhosis  may 


253  cAMAnA  MBnrcAi.  and  acaoicAL  jotmsAL. 


be  excluded,  for  the  early  and  marked  icterus  of  that  afTectic 
has  not  existed  in  this  patient.  The  presence  of  ascites  in  thii 
case  would  also  be  opposed  tothc  idea  of  Biliary  cirrhosis,  accordi 
ing  to  Hanot,  but  other  observers  have  met  with  that  symptori 
at  least  in  the  advanced  stages.  This  young  man  has  not  reside^ 
in  a  malarial  region,  nor  had  ague. 

Simple  HypertropJac  Cirrftosis,  if  I  may  so  term  it,  to  distioi 
guish  it  from  biliary  cirrhosis,  although  not  generally  describe^ 
in  systematic  works,  is  an  affection  of  which  I  have  seen  sevend 
specimens. 

It  is  not  always  due  to  obstruction  of  the  Mle  ducts,  nor  i 
jaundice  a  necessary  symptom.  It  may  present  alt  the  cliniea 
features  of  the  ordinary  atrophic  form  of  cirrhosis,  except  that 
the  liver  is  enlarged,  sometimes  very  greatly,  instead  of  being 
reduced  in  volume.  In  an  interesting  example  which  occurred 
in  this  Hospital,  and  is  discussed  in  Dr.  Osier's  Pathological 
Report  for  1876-77,  p.  571,  the  liver  was  uniformly  enlarged, 
and  weighed  6lbs  llj  oz.  In  some  respects  our  patient's  case. 
conforms  to  cirrhosis  with  hypertrophy,  viz. :  in  the  unifoni 
enlargement  of  the  liver  ;  in  the  e.tiatence  of  ascites  and 
moderate  enlargement ;  and  visible  anastomoses  between  Hn 
epigastric  and  mammary  veins  and  the  last  two  are  amongst  Q^ 
most  reliable  evidences  of  cirrhosis. 

But  the  essence  of  gei'erat  other  features  incline  me  to  exclud 
that  affection.  Thus,  the  patient  has  not  used  either  gtrom 
alcokoUc  liqiwrB  or  ale ;  he  ia  young ;  he  has  not  had  fuEtnorkaff 
from  stomach,  bowels  or  ehewhere ;  nor  a  sub-ictcroid  colour 
skin. 

Pmally,  a  more  probable  cause  of  enlargement  of  the  Mr 
exists  to  explain  the  case. 

Two  other  causes  of  the  hepatic  enlargement  remain,  ncithfl) 
of  which  can  be  certainly  excluded,  but  I  will  take  up  the  loa^ 
probable  first.  , 

Hydatids  of  the  liver,  produce  a  alow  but  very  considerabli 
enlargement  of  the  liver,  unattended  by  pain  or  fever,  or,  ii 
many  oasca,  hyjautuiice  or  ascites,  or  enlarged  superficial  afa 
dominal  reina. 


freq 
^^^  livei 


A  OLIKICAt,    LECTURE. — BY   DH.    H.    P.   HOWARD.  253 

The  enlargement,  however,  as  a  very  general  rule,  doea  not 
involve  the  entire  liver,  but  one  or  other  part  of  it,  producing, 
in  this  way  a  tumour  not  having  the  natural  outline  of  the  liver, 
and  possessing  an  elastic  or  even  distinctly  Suctuating  foel, 
and  perhaps  presenting  one  or  more  projections  upon  its  Burface. 

The  case,  perhaps,  corresponds  in  many  respects  with  these 
characters  ;  but  the  hydatid  disease  is  so  rare  in  this  country 
that  I  have  never  met  with  an  example  of  it,  and  believe  that  the 
probabilities  are  in  favour  of  another  affection,  now  to  be 
cooBidered : 

Amyloid  degeneration  of  the  liver  resembles  in  many 
pardculrs  this  young  man's  case.  It  produces  a  glow,  and  often 
pwiless  and  uniform  enlargement  of  the  entire  organ,  usually 
without  jaundice  or  fever.  Enlargement  of  the  superficial  ab- 
dominal veins,  and  ascites  may  occur,  although  they  are  not  at  all 
constant ;  moderate  ascites  and  oedema  of  the  lower  limbs  are 
frequent.  The  spleen  is  also  frc<iuently  enlarged  as  well  as  the 
liver,  and  it  is  so  in  this  case,  I  believe  ;  although  it  is  difficult  to 
jUake  out  its  limits  accurately.  The  kidneys,  too,  are  apt  to 
amyloid  degeneration,  and  albuminuria  results. 
Our  patient's  history  corresponds  very  closely  with  this  des- 
cription, although  albumen  was  not  present  in  the  single  sample 
of  his  ume  pxamuiod  by  me  ;  but  he  says  it  was  found  when  his 
dropsy  first  appeared. 

There  is  one  important  difficulty,  however,  in  accepting  amy- 
knd  disease  as  an  explanation  of  this  case  ;  viz. :  the  fact  that 
the  enlargement  of  the  liver  was  noticed  six  months  before  the 
mnter  cough  and  expectoration  set  in — the  only  symptom  ia 
addition  to  the  enlargement  observed  by  the  patient  being 
gradually  increasing  dyspnoia. 

The  usual  came  of  amyloid  disease  is  chronic  suppuration 
from  disease  of  bone,  tuberculous  affections  of  the  lungs  and 
otter  organs,  constitutional  syphilis  and  the  like,  none  of  which 
can  be  said  to  have  preceded  tho  enlargement  of  the  liver  in  our 
patient.  The  pleural  sero- purulent,  or  purulent  effusion,  which  I 
have  inferred  to  have  obtained  at  the  beginning,  however,  may 
have  occasioned,  and  would  account  for  the  amyloid  degeneration. 


254  C&NADA  UEDICAL  AND  eilBOIOAI.  JODBIfAt. 

But,  masmuch  as  it  BOiji«tImeB  appears  to  originate  in 
of  a  scrofulous  diatheais,  ^thout  suppuration,  and  somelimes 
cannot  be  traced  to  any  c^use  whatever,  the  absence  of  a  welt 
establised  cause  in  this  case  does  not,  in  my  opinion,  justify 
saying  that  amyloid  diaea^  is  not  present — It  bett  meets  all  Vaa 
requirements  of  tfao  case. 

Yon  see,  then,  how  maaj  difficatties  surround  the  formation  of^ 
a  reUable  diagnosis  in  this  instance.  Yet,  I  venture  t«  believe 
the  moat  probable  view  b,  that  chronic  pleurisy  with  retractioB 
and  amyloid  degeneration  of  the  liver,  are  the  conditions  pre- 
sent. I  admit  the  possibility  of  some  rare  form  of  cystoma,  or 
sarcoma,  in  the  liver ;  or  of  a  tumonr  or  aneurism,  or  coUectioB 
of  pns  between  the  diaphragm  and  the  liver,  but  have  not 
to  discusa  these  clinical  curiosities,  some  of  which  are  beyond  tfafr 
power  of  diagnosis. 

^ospifat  ;^eports. 


Ca»t  of  Chirtshot  Wound  of  iJnf-  Brain. — Recovery. — Snba»^ 
qnent  Death  from  Phthisis. — Autopsy, — Under  the  caift 
of  G.   E.  Fenwick,  M.  D.     Reported  by  Mr.  H.  W^ 

Lloyd. 

C.  G,,  aged  19,  a  sickly-looking  lad,  was  admitted  into  the 
Montreal  General  Hospital  on  the  8th  day  of  March,  1878, 
suffering  from  the  effects  of  a  small  pistol  wound  situated  a  little 
above  and  in  front  of  the  right  ear.  Tliis  wound  had  been 
accidentally  received  the  day  before  his  admission  to  the  hos[u- 
tal.  The  account  he  gives  of  the  occurrence  is  as  follows  :— 
While  sitting  on  the  edge  of  his  bed,  and  examining  the  barrd 
of  a  small-sized  revolver,  which  he  did  not  suspect  to  ba  loaded, 
an  explosion  took  place,  and  the  halt  entered  the  skuU  through 
the  upper  segment  of  the  right  temporal  fossa,  piercing  the 
muscle,  bone  and  membranes,  and  passing  into  the  snhstanca 
of  the  brain.  The  barrel  of  the  revolver  was  not  more  than  > 
few  inches  from  his  head,  and  he  believed  it  to  be  almost  afe 


bOSPITAL  &£PORf  s.  255 

a  li^t  angle  to  it.    The  receipt  of  the  wound  was  followed  by 
a  sharp  pain  at  or  about  the  point  of  entrance,  accompanied  by 
airngpig  noise  in  the  ears,  slight  dizziness,  or  a  feeling  as  if  he 
was  floating  in  the  air.     Shortly  after  receiving  the  wound, 
yomitbg  set  in,  and  continued  at  intervals  for  the  ensuing  36 
lumrs.    During  the  straining  while  vomiting,  a  littie  blood 
would  ooze  from  the  wound.    There  was  no' bleeding  in  quan- 
tity from  it  at  any  time,  but  there  trickled  away  an  abundance 
tf  bloody  serosity,  in  all  likelihood  from  the  arachnoid  cavity. 
He  was  perfectly  sensible,  and  continued  so  throughout,  during 
Ms  stay  in  the  hospital    There  was  no  sign  of  paralysis.    The 
pupils  were  dilated,  but  equally  so,  and  respond  to  a  strong  light 
No  pain  complained  of;  except  in  the  vicinity  of  the  wound, 
which  was  lightly  pu%  and  red.     The  wound  itself  was  half 
an  inch  in  diameter.   The  bullet  was  lodged  in  the  substance  of 
T)rain,  possibly  in  the  anterior  lobe  of  the  cerebrum,  as  the 
P<^t  of  entrance  was  on  a  line  with,  but  above,  the  junction  of 
^6  anterior  and  middle  fossae,  close  to  the  situation  of  the 
fissure  of  Sylvius,  one  inch  and  a  half  above  the  external  audi- 
bly foramen,  and  one  inch  and  a  quarter  in  front.    Has  not 
slept  since  the  accident ;  is  silent,  perfectly  quiet ;  has  dozed, 
but  sleep  is  uneasy  and  short ;  awaking  with  a  sudden  start,  he 
&Qcies  he  hears  an  explosion,  which  arouses  him.    The  second 
day  after  his  admission  he  complained  of  frontal  pain,  not  how- 
ever severe,  his  pulse  was  60  per  minute.  There  was  no  rise  in 
temperature ;  pupils  were  still  dilated,  but  equal  in  size,  and  re- 
sponded to  light,  contracting,  however,  rather  slowly.    There  is 
no  vomiting  nor  tendency  thereto,  and  he  takes  nourishment, 
which,  however,  was  restricted  to  milk.  An  ice  cap  was  ordered 
to  the  head,  a  pledget  of  lint  wet  with  water,  and  covered  with 
oil  ffllk,  to  be  applied  over  the  wound,  and  the  following  mixture 
was  ^ven. — 

B.  Potassii  Bromd.  .  .  .  3ij, 
Ext.  Ergotae,  Fluid..  .  Iss, 
Aquae,  add  1 Ivi. 

Sg. — A  tabiespoonful  to  be  taken  every  four  hours. 


256 


CANADA   MEDICAL   AND    BDBOICAL   JODBNAL. 


From  this  time  he  progressed  favourably,  so  far  as  the  head 
Bymptoma  were  concerned,  the  brain  disturbance  gradually  sub-' 
Bided,  and  the  wound  healed.  Hia  temperature  never  was 
high ;  on  two  occasions  only,  at  night,  the  thermometer  regis- 
tered 101,  but  it  was  uaually  a  little  above  the  normal  standard. 
Pain  in  the  head  was  persistent,  confined  to  the  right  side,  and 
there  was  troublesome  constipation,  which  required  the  occa- 
sional use  of  sahnes.  On  the  iJOth  March,  the  report  states 
that  the  pain  in  his  head  is  less  severe,  he  takes  food  well,  and 
a  more  generous  diet  was  allowed,  hut  he  seems  listless,  disin- 
clined to  leave  his  bed ;  he  is  weak,  and  has  notably  emaciated, 
His  pulse  is  96,  and  his  temperature  is  normal  in  the  morning, 
with  a  slight  rise  at  night.  The  ice  cap  was  diacontbued,  as 
was  also  his  mixture ;  he  complains  of  cough,  and  expectorates 
freely  ;  has  shght  night  sweats,  but  sleeps  moderately  well. 

His  chest  was  examined,  and  there  was  found  consolidatioQ 
at  the  apices  of  both  lungs,  with  evidence  of  softening.  On  in- 
quiry, it  was  ascertained  that  some  four  years  ago  he  suffered 
from  a  severe  attack  of  pleuro-pneumonia  coming  on  after  ex- 
posure to  cold  and  a  thorough  wetting,  having  been  upset  from 
a  boat  while  fishing,  and  at  the  time  nearly  drowned.  During 
the  attack  his  life  was  despaired  of,  as  it  was  severe  and  peiv 
aatent.  There  was  no  attempt  at  resolution.  His  physician 
recommended  change  of  iur,  but  ho  remained  in  the  city 
Since  that  time  he  Lad  suflered  from  several  attacks  o£  hsemop- 
tjsis,  and  the  cough,  with  expectoration,  has  persisted  through- 
out, with  occasional  night  sweats,  general  symptoms  of  debility 
and  steady  emaciation.  There  is  no  history  of  phthisis  in  hia 
family ;  his  father  and  mother  are  still  alive  and  enjoy  good 
health,  and  all  hia  immediate  relatives  are  healthy.  A  toniO' 
was  prescribed,  good  diet  and  an  expectorant  mixture  ;  and,, 
with  a  view  of  giving  him  the  chance  of  benefit  of  change 
B3I,  as  the  spring  of  the  year  had  fiilly  set  in,  he  was  advised, 
to  go  to  the  country  and  live  as  much  in  the  open  air  aa  pos" 
sible,  partaking  of  milk  and  eggs,  with  a  moderate  allowance 
stunulants. 

He  left  the  Montreal  General  Hospital  on  the  27th  April, 
and  subsequently  entered  the  Hotel  Dieu  Hospital,  the  disease 


I 


HOBPITAI,   REPOBTS,  257 

of  tbe  lungs  progreaaed  steadily,  and  he  died  on  the  12th  August, 
following. 

Aa  an  illustration  of  the  absence  of  all  permanent  brain  dis- 
.torbance,  it  may  be  mentioned  that  two  days  before  hia  death 
he  wrote  a  letter  to  his  mother  which  waa  clear  in  diction,  well 
conipOHed  and  ho[)eful  in  character.  He  died  apparently 
syncopal,  M  lie  had  complained  of  feeling  very  weak,  was  more 
than  usually  languid,  and  passed  away  quietly  and  quite  unex- 
pectedly. Through  the  kindness  of  Dr.  Angus  C.  Maedonell, 
phyucian  to  the  Hotel  Dieu  HospitaJ,  a  post-mortem  examination 

iS  secured,  which    adds  additional  interest   to  this  unusual 

se. 

Post-mortem  examination  made  24  hmirs  after  deaHi: — 
Extensive  disease  of  both  lungs  was  found ;  the  upper  lobes 
were  riddled  with  cavities  of  various  sizes.  There  was  no 
special  examination  made  of  the  other  viscera,  as  permission 
alone  was  granted  to  examine  the  brain.  On  reflecting  the 
scalp,  an  oval-shaped  opening  through  the  cranial  wall  was 
observed.  This  opening  was  longer  vertically  than  transversely. 
It  was  situated  above  the  extremity  of  the  great  wing  of  the 
sphenoid,  and  involved  the  anterior  edge  of  the  aquamoufl 
portion  of  the  temporal  'bone,  and  also  the  anterior  inferior 
ajigle  of  the  parietal,  it  was  almost  closed  by  a  firm,  fibrous 
membrane.  On  opening  the  cranium,  the  inner  surface  of  the 
dura  mater,  on  the  right  side,  waa  of  a  deep  yellow  color.  This 
extended  to  the  right  surface  of  the  falx  cerebri,  and  also 
to  the  right  half  of  the  tentorium.  Tiie  brain  surtace  was 
likewise  stained,  but  was  not  quite  so  deep  in  color.  This 
was  evidently  due  to  effasetl  blood,  an  extensive  clot  which 
had  been  absorbed  Near  the  point  of  entrance  of  the  bullet 
tJm}ugh  the  dura  mater  were  found  several  fragments  of  the 
inner  table  attached  to  that  membrane,  A  large  fragment  of 
the  inner  table  remained  attached  firmly  to  the  posterior  margin 
of  the  opening  In  the  bone  internally,  being  slightly  tilted 
forwards,  and  had  apparently  changed  the  course  of  the  projec- 
tile.    The  bullet  entered  the  br^n  substance  at  the  posterior 

■gin  of  the  right  inferior  frontal  convolution,  just  in  front  of 
.\o.  LXVEir.  n 


268  CANADA  MKDICAL    AND   SUHOIOAL   JOCRNAI,, 

the  angle  formed  by  the  ascending  and  horizontal  branches  of 
the  fissure  of  Sylvius.  It  passed  upwards  and  forwards  and 
out  tlirough  the  inner  and  anterior  margin  of  the  middle  frontal 
convolution,  resting  between  the  brain  substance  and  the  fabc 
cerebri.  It  lay  surrounded  by  a  firm  membrane,  and  was  one 
quarter  of  an  inch  in  front  of,  and  on  a  line  with  the  anterior 
extremity  of  the  corpus  call  osum.  From  the  point  of  entrance 
through  the  trajet  of  the  bullet,  a  firm  membranous  canal  ex- 
isted, around  which,  and  for  about  three-quarters  of  an  inch  in 
extent,  the  substance  of  the  brain  was  softened. 

[We  are  indebted  to  Dr.  James  Bell,  Assistant  House  Sur- 
geon of  the  Montreal  General  Hospital,  for  the  above  carefully 
prepared  record  of  the  course  and  position  of  the  bullet  in  this 
interesting  case. — Ed.] 

afleuiews  and  Notices  of  Boolis. 

The  Principh  and  Practice  of  Surgery^  being  a  Treatise  on 
Surgical  Diseases  and  Injuries. — By  D.  Hayes  Agnew, 
M.D.,  LL.D.,  Professor  of  Surgery  in  the  Medical  De- 
partment of  the  University  of  Pennsylvania,  Profusely 
illustrated.  In  two  volumes.  Vol.  1,  royal  8vo,  pp.  x., 
1062.  Philadelphia:  J,  B.  Lippincott  k  Co.  London: 
16  Southampton  street,  Covent  Garden,  1878. 

This  volume  forms  the  first  part  of  Dr.  Agnew's  voluminous 
treatise   on  the  Principles   and    Practice  of  Surgery.     The 
author  has  expressed  his  views  freely,  based  on  his  own  experi- 
ence and  observation,  which  has  not  been  limited,  as  he  has  had 
the  advantage  during  the  past  quarter  of  a  century  of  having 
under  his  charge  surgical  diseases  and  accidents  in  the  hospittUa  1 
of  Philadelphia.     Some  of  the  enunciations  here  recorded  are 
original  in  conception.     They  differ  in  some  measure  from  the  ^ 
views  and  teaching  of  other  surreal  writers,  still  they  bear  the 
stamp  or  honest  conviction  based  on  careful  observation.     In   , 
-wounds  of  the  scalp,  sutures  are  recommended.     The  author  j 
expresses  a  doubt  concerning  theic  injurious  effect,  and  states  A 


KEVIKWS   AND    NOTICES   OP    BOOKS,  269 

that  "  the  popular  notion  that  they  tend  to  produce  erysipelas, 
is  without  foundatioL."  As  a  broad  principle  it  may  be  regarded 
as  very  questionable  advice,  but  admitting  their  usefulneas,  and 
occasional  permissibility,  the  caution  to  avoid  injury  to  the 
deep  aponeurosis,  in  their  introduction,  ought  to  be  mentioned. 
But  in  these  pages,  he  not  only  gives  his  own  views  but  those  of 
other  writers,  so  that  the  reader  may  have  an  opportunity  of 
contrastiag  different  methods  of  treatment  in  the  management 
of  their  own  cases,  and  of  judging  of  their  relative  merits. 

The  volume  begins  with  a  chapter  on  Diagnosis,  in  which  we 
loam  the  method  of  proceeding  to  arrive  at  a  correct  opinion  of 
the  nature  of  any  given  case.  This  forma  an  introduction  to  the 
rest  of  the  work,  which  is  divided  into  ten  chaptero.  In  the  first 
chipter  the  subject  of  inflammation  is  freely  discusaed,  the  varie- 
ties of  the  inflammation  such  aswhat  has  been  termed  healthy  and 
mihealthy.  The  former  term  might  he  considered  contradictory, 
but  it  is  very  generally  employed,  and  may  be  correctly  regarded 
as  indicating  thiit  condition,  in  which  the  morbid  tendency  to 
destruction  of  a  part  inflamed  is  resiated  by  a  conservative  force, 
ever  present  to  save  from  destruction  jjarts  injured  through 
accident  or  disease.  Different  degrees  of  intiammation,  causes, 
nature,  pathological  changes,  and  termination  are  all  given, 
together  with  special  methods  of  treatment.  The  next  chapter 
is  on  wounds,  their  varieties,  hasmorrhage,  nature's  method 
for  its  control,  closure  of  vessels,  formation  of  thrombus,  treat- 
ment of  liiemorrhagc  from  wounds,  the  various  methods  em- 
ployed. These  the  author  fully  discusses,  and  after  a  careful 
description  of  compreasiou,  cauterization,  torsion,  acupressure, 
and  the  use  of  the  ligature,  he  compares  the  relative  value  of 
each  method,  and  gives  a  verdict  in  favor  of  the  ligature  ;  in 
this  the  majority  of  practical  surgeons  of  any  experience  will 
agree;  still,  it  must  he  conceded  that  there  are  circumstances 
in  which  the  use  of  torsion,  or  the  needle,  will  be  advantageously 
employed.  In  con^uation  of  this  subject  of  heemorrbage  from 
wounds  transfnaion  is  mentioned  and  the  mode  of  performing  it 
described.  The  treatment  of  wounds,  with  a  description  of  the 
various  kinds  of  autures  is  next  given,  and  then  we  have  a 
description  of  the  after  treatment  of  wounds.    In  this  the  autlior 


260  CANADA    MEDICAL    AND   StmOTCAI.   JOtTHNAt. 

admits  the  advantages  to  be  gained  by  the  antiseptic  method, 
which  he  declares  he  is  satisfied  from  his  own  obsftrvatione  to  be 
superior  to  all  other  methoda  of  treatment,  The  different  kinds 
of  wounds  are  next  given  :  these  are  considered  under  the  head- 
ings of  incised  wounds,  lacerated  and  contused  wounds,  contused 
wounds  proper,  punctured  wounds,  and  poisoned  wounds ;  under 
this  heading  will  he  found  dissection  wounds,  malignant  pustale, 
foot  and  mouth  disease,  glanders  or  farcy,  hydrophobia,  bites  of 
poisonous  insects  and  veneaiDus  snakes,  and  lastly  gun-shot 
wounds.  This  is  a  moat  interesting  chapter,  especially  that 
portion  relating  to  the  poison  wounds  of  insects  and  snakes,  as 
so  little  is  to  be  found  on  this  subject  in  other  surgical  works. 

Injuries  of  the  head  form  the  subject  of  the  third  chapter,  in 
which  will  be  found  first,  a  few  general  considerations,  and 
subsequently,  a  description  of  injuries  of  the  scalp,  gun-shot 
wounds  of  the  scalp,  and  their  various  complications,  such  as 
erysipelas,  injury  to  the  cranial  hones,  and  injuries  to  the  brain 
or  its  membranes,  kc.  The  fourth  chapter  is  devoted  to 
wounds  and  injuries  of  the  chest  and  abdomen ;  in  the  fifth 
chapter  wounds  or  injuries  of  the  extremities  are  taken  up 
and  discussed.  In  chapter  six  we  have  the  diseases  of  the 
abdomen,  such  as  morbid  growths,  cysts,  fistulse,  ascites,  in 
which  the  method  of  performing  paracentesis  is  described. 
Intestinal  obstruction,  intussuseption,  organic  change  in  the 
walls  of  the  intestine,  cicatrices.  &c.,  and  in  this  connection 
is  considered  the  advisihifity  of  colotomy.  In  giving  ttie 
statistics  of  colotomy,  the  author  includes  one  case  only  of 
lumbar  colotomy,  as  having  been  performed  in  Montreal, 
whereas  there  have  been  published  five  cases  by  the  writer,  and 
one  by  Dr.  Ross.  As  to  the  results  of  these  six  cases,  the  first 
a  woman,  operated  on  hy  Dr.  Fenwick,  died  ten  months  after 
the  operation  from  a  severe  attack  of  cholera.  The  second, 
woman,  operated  on  hy  Dr.  Ross,  is,  we  believe,  still  living.  The 
third,  a  child  of  eleven  years,  operated  on  by  Dr.  Fenwick,  for 
epthelioma  extending  up  the  rectum  above  the  reach  of  the 
finger,  ia,  or  was  alive  two  noonths  ago,  November,  1878.  The 
fourth  ease  was  in  a  syphilitic  woman.    There  was  a  long  meso- 


REVIEWS  AND    NOTICES   il¥   BOOKS. 


161 


colon,  and  hence  the  peritoneal  cavity  was  opened  she  died  of 
peritonitis.  The  fifth  case,  likewise  for  Bj'phiiitio  disease  of  the 
rectum,  by  Dr.  Fenwick,  recovered  and  is  still  living;  and  the 
last  case  in  an  aged  man  for  cancer  of  the  rectum,  extending 
high  up,  also  operated  on  by  Dr.  Fenwick,  was  greatly 
relieved,  and  lived  in  comparative  comfort  for  seven  months 
after  the  operation.  We  fully  believe  in  the  advisability  of 
colotomy  in  cancer  of  the  rectum,  especially  when  the  disease 
ertenda  so  high  up  the  bowel  as  to  preclude  the  chance  of 
adopting  other  operative  measureSj  although  on  two  occaaions  we 
have  removed  the  end  of  the  bowel  alter  Lisfranc.  Here  again, 
in  speafcin;^  of  excision  of  the  rectum,  our  author  is  slightly  in 
error.  At  page  435,  he  remarks :  '■  In  this  country  ten  cases 
have  been  operated  on — 2  by  Busehe,  1  by  Mott,  1  by  Marsh,  1 
by  Bridden.  3  by  Levis,  1  by  Dr.  J .  R,  Wood  and  1  by  myself." 
Chapter  VII.  is  on  diseases  and  injuries  of  the  blood  vessels. 
In  the  next  chapter  we  have  the  ligation  of  arteries.  Chapter 
IX.  contains  a  description  of  surgical  dressings,  and  in  the  last 
chapter  there  will  be  found  a  description  of  injuries  and  dis- 
.easea  of  the  osseous  system.  The  illustrations  throughout  the 
work  are  very  clear  and  well  executed.  They  number  897. 
Many  of  them  are  familiar,  as  they  adorn  the  pages  of  other 
sorgical  works,  but  in  saying  this  we  do  not  wish  to  infer  that 
they  are  misplaced,  as  they  add  much  to  the  interest  and  use- 
of  the  work.  Whenever  an  illustration  is  borrowed,  it 
I  is  duly  accredited.  Some  of  the  wood  cuts  are  from  the  Surgi- 
i  cal  History  of  the  American  War  of  RebelUon.  These  the 
I  AutJior  acknowledges  to  have  received  through  the  kiudne^  of 
the  Surgeon-General  of  the  United  States  Army.  A  large  num- 
ber of  the  illustrations  are,  however,  from  original  drawings  by 
Mr.  Faber,  There  is  a  very  complete  index,  which  adds  to  the 
interest  of  the  volume.  The  statistical  tables  are  of  great  use, 
as  they  are  conveniently  arranged  for  reference.  We  think  a 
better  classification  might  have  beon  adopted,  as  the  number  of 
good  things  appear  pretty  well  mixed.  Nevertheless,  this  must 
be  looked  upon  as  a  valuable  addition  to  the  many  excellent 
teeatifles  on  surgery  which  have  within  the  past  few  years 
issued  from  the  press,  and  we  shall  look  forward  with  interest  to 
>  completion  of  the  work  in  the  issue  of  the  second  volume. 


262  ''ANADA   MEDICAL   AND 

Practical  Surgery;  including  Surgical  Dreitttingi,  Ban- 
daging, Ligations  and  Ampuiatione. — By  J.  Eweng 
Mbars,  M.D.,  DemoiiBtrator  of  Surgery  in  Jefferson  Medi- 
cal College,  &c.,  &c.  With  227  illustrationa.  8vo.  pp. 
279.     Philadelphia :  Lindsay  &  Blakiaton,  1878. 

This  little  book  ia  dedicated  to  Prof.  Gross,  and  is  intended 
as  a  manual  for  students,  to  whom  it  is  an  object  to  have  their 
work  presented  in  as  concise  a  form  as  possible.  We  venture  to 
say,  that  the  book,  so  far  as  it  goes,  fulfils  the  expressed  inten- 
tion of  the  author,  and  that  students  will  find  it  a  useful  work 
during  their  accademical  course,  and,  also  subsequently  in  their 
professional  career. 

In  these  days  hand-books  of  all  kinds  and  descriptions  are 
rained  upon  us.  The  student  finds  short  and  more  or  less  useful 
compendiums  on  almost  every  subject,  and  it  is  possible  that 
while  to  the  diligent  these  may  be  very  useful  as  aids  to  memory 
and  as  means  of  fixing  more  extended  reading  in  the  mind,  to 
the  indolent  or  superficial  they  may  prove  as  snares  and  pitfalls. 

The  title  of  the  present  work  might,  we  think,  be  im- 
proved, and  it  would  ^ve  a  more  exact  idea  of  its  contents. 
If  the  word  "  compiising  "  were  used  instead  of  "  including," 
for  the  book  consists  of  nothing  bat  four  parts:  one  upCHi 
Surgical  Dressings,  one  upon  Bandaging,  one  upon  ligations, 
and  a  fourth  upon  Amputations. 

These  subjects  are  well  and  concisely  treated,  and  short  as 
the  descriptions  are,  they  cannot  be  accused  of  obscurity. 

The  first  part,  upon  Surgical  Dressings,  is  good,  and  ends 
with  a  description  of  the  Antiseptic  system  of  dr«s^ng  wounds. 
The  second  part  gives  iis  a  description  of  the  various  forms  of 
bandages  and  their  modes  of  application,  and  here,  as  welt  at 
elsewhere  through  the  book,  we  recogniw?  many  fiuniliar  illustra- 
tions for  which  the  author  is  careful  to  give  his  acknowledg- 
ment in  the  preface. 

Farts  m  and  r\',  on  Ugaiions  and  Amputations,  respe«tivelv, 
are  well  written,  and  deserve  carefol  study. 

.Utogether,  this  is  a  useful  little  book,  wtucb  may  be  recom- 
mended without  hesitation. 


REVIES  AND   NOTICES   OF    BOOKS.  263 

The  Pathological  Anatomy  of  the  Ear,  —  By  Hermann 
ScHWARTZB,  M.D.,  Professor  in  the  University  of  Halle, 
pp.  174,  with  numerous  illustrations.  —  Translated  by  J. 
Orne  Grbbn,  A.M.,  M.D.,  Aural  Surgeon  to  the  Boston 
City  Hospital,  and  Clinical  Instructor  in  Otology  to  the 
Harvard  University,  Boston :  Houghton,  Osgoode  &  Co. 

This  valuable  work  is  a  translation  from  the  original  German 
of  the  sixth  part  of  Klebs'  well-known  hand-book  of  Pathological 
Anatomy,  and  constitutes  a  valuable  addition  to  the  literature 
of  Otology. 

The  difficulties  in  the  way  of  a  successful  study  of  the  patho- 
logical anatomy  of  the  ear  are  so  great  that  morbid  anatomists 
have,  almost  without  exception,  shunned  a  labour  which  promised 
80  little  return. 

Since  the  days  of  Toynbee,  however,  there  is  a  small  but 
scattered  jfraternity  of  earnest  workers,  to  whose  patient  investi- 
gations the  writer  of  this  work  is  largely  indebted  for  the  material 
it  contains.  This  may  be  said,  without  in  any  way  detracting 
from  the  merits  of  Professor  Schwartze's  own  labors,  for  he 
is  acknowledged  to  stand  among  the  foremost  in  the  field.  To 
the  otologist  the  work  is  of  extreme  interest  and  value.  The 
translation  has  been  carefully  done,  and  '*  is  issued  both  to  show 
what  has  already  been  accomplished  in  this  branch  of  otology, 
and  with  the  hope  of  directing  still  further  attention  to  patholo- 
gical anatomy,  the  only  solid  foundation  for  a  still  further 
advance  in  our  knowledge  of  disease  of  the  ear." 

All  the  morbid  conditions  to  which  the  ear  is  liable  are 
discussed  as  fully  as  the  present  state  of  knowledge  will  warrant, 
and  the  illustrations  given  are  most  interesting  and  instructive. 
There  is  certainly  no  other  work  on  the  pathology  of  the  ear  so 
complete  and  exhaustive  as  this  one. 

Essentials  of  Chemistry ^  Inorganic  and  Organic  ;  prepared 
for  the  use  of  Students  in  Medicine,  By  R.  A.  Witthans, 
A.M.,  D  D.  12mo.  pp.  257.  New  York  :  William  Wood 
&  Co.,  Great  Jones  Street,  1879. 

This  little  work  is  in  the  form  of  questions  and  answers,  by 
which  it  is  expected  that  the  student  will  be  able  to  post  himself 
in  the  necessary  minutiae  to  pass  an  examination.  It  is  a  com- 
pendium solely  intended  for  this  purpose,  and  may  be  found  of 
use  to  the  advanced  student.  We  do  not  think,  however,  that 
this  style  of  work  is  commendable,  except  for  the  purpose  for 
which  it  is  apparently  intended,  namely,  to  refresh  the  mipd 
ahready  stored  with  chemical  facts. 


AND  StIBdICAL  JOrBSAL. 


3Extracts  from  British  and  Foreign  Journals. 


THE  PAST   AND  THE  PRESENT  ; 

ob,  the  condition  of  the  wdrgical  wards  bkforb  the 

introduction  of  listee's  antiski'tic  method 

contkasted  with  theie  present  state. 

By   Prof.  Dr.  Von  Nussbal'm   op  Munich. 

TmoHlatei!  frnm  tba  GiTmaii  by  F.  Bullbk,  M.D.,  M^R.C.S.,  Eng, 
Up  to  the  year  1875, 1  employed  Lister's  method  occasioDally. 
More  often  the  ordinary  plan  of  treatment,  or  the  open  treatment 
of  wounda.  In  addition  to  this  I  often  experimented  with 
chlorine  water,  but  from  1875  on,  alt  my  patients  were 
"  Liatered."  Freah  wounds  were  "Listered"  immediately^ 
Wounda  which  were  suppurating  and  septic  on  admission,  werQ 
cleansed  with  an  8  pur  cent,  solution  of  chlor.  of  ziuc,  and  theq 
Listered.  In  this  way  a  thorouifh  and  most  satisfactory  tram 
formation  has  taken  place,  and  my  cliliique  once  of  evil,  is  am 
of  good  report. 


THE  PAST, 

An  offeuaivu  odour  of  deciimpoaiHy 
poB  pervMied  the  atmoapliure  nf  thv 
ifinls,  the  patients  were  pale,  Hat- 
low  aod  wretched,  muny  a  coud- 
tenance  wore  an  eipresBioD  of  pain 
and  diatteM.  All  tho  tempeiatnre 
chsrU  regiBtcred  such  tcmpcrittuws 
as  103,  105,  IOC,  107. 


Nearly  all  the  patiunbt  kood  a(U-r 
sdmiusiun  wi^nt  tlirougb  au  attuck 
of  «o<alled  hoHpital  fever  (Spital- 
gastriritimus),  which  oftea  reduced 
them  very  much  and  lastwl,  u  a 
rule,  two  or  three  weeks. 


THE  PRESENT. 

Ndw  Ihc  air  of  the  wards  is  frm 
and  odourl<'SB,  the  petii'nts  hare 
hi^tbf  color  and  are  fauppy ;  moai 
and  lauienlationiiaie  nuwbert: 
ble,  although  the  morphiae  I 
hoc  almost  lost  its  vncatioa. 
temperuture  uhnrta  read  98.3, 


In  many  nf  the  wards  there  a__ 
only  two  ot  threa  {ULtienlji,  whil^ 
fotmerly  thi-y  wure  occupied  by  b 
or  twelve. 

The  patients  eat  and  drink  wr 
enjoyment,   the  so-called   "  Spitab 
gaitricismuB'"  is   rarely    seen 
dently  because  tbn  air  is  fhM 
potsonons  vapours. 


"ith  H  wound  111  boDC  hei'Hitiu  n  vii:- 
lin  of  pyiemja,  eveu  flesh  wouuda 
w«N  not  eicmpt  from  the  eiuav 
«vil. 


Of 


9    tbC-T 


a  amputatioi 
were  eleven  dcatds  from  pya.! 
I>espit«  tbe  open  treatmeDt  uf 
««-oiiim1s,  or  the  treatment  hy  tontjn' 
ueol  vium  iraler  liatli8,or  bj  fetrum 
c^hjmIbuh  lioKpital  gKugrene,  with  iu 
t4;rribie  resultti.  bail  become  bu  com- 
t.  of  all 
Is  and  iilcen  were  affected  bj 


THK  PRESENT, 
Ho  pytctnia. 


Ni-  Huspitul  fiiugri'ui'. 


Of  the  DumeroUH  houd  wounds, 

tJnt  of  wliich  were  of  mudieo-le^ 

C^cesC,  Ibe  large  majority  perliibiKl 

>xai  pyaemia  if  there  hod  been  any 

'Ka«  iqjury.    liome  recovered  after 

<;rBl  atlauks  of  eryiipelnii  with 

*^'^^*^le  fsvor,  convalescence   being 

*»«i«>^br   delayed   for  many  weeks, 

**<^     u   further    period  ol    severul 

'^•^•■iitlL*  enwied,  during  which  the 

■*i.«nl»  thus  proBtratod  were  unfit 

*"««nne  their  employment. 

^E>nrlng  sevunlt-en  years   no  eaac 
**"   iKijary  lo  the  lirain  reioverud. 


'^'^-licH  Bji  CUV  kurou^u  uuriu^  u 
j'^"~»cnI  of  profiiBt-  suppnmtioD,  ar 
■J    *-»iii  pationl  escaped  with  life  tl 


,  -^vnetratlng  wouiiiIh  nf  the  thorax 
^^•fH  terminated  htally.with  pro- 
^*«  and  fCBtid  Buppm«tion,  even 
M^^ush  at  the  outset  they  seemed 
t>  promise  well. 

tunetialing  wouncU  of  the  abdii- 
"tfn,  laparotomy  and  operations  tor 
hernia  in  wbieb  Uie  puritoDeum  wiw 


Injuries  of  the  head  BerupulouKly 
Lrealed  by  the  antiaeptic  plan,  after 
the  head  has  been  sliaved  and 
(■leaned  with  ether,  the  wound  dis- 
infeitad  with  an  8  |)er t-ent solution 
of  ehluride  of  sine  and  drainage 
tiibcn  inserted  in  the  deeper  parts, 
heal  as  a  rule  by  (int  intention,  so 
that  treatment  in  hospltAl  is  much 
abridged.  This  holds  good  even 
in  coses  of  injiuy  to  the  brain. 


Cases  oftun  ret-over  witlinut  fever, 
in  which  during  the  first  two  or 
three  days  brain  •iilutanco  uscapus 
through  the  drainafi;e  tubu  and  the' 
bone  is  mneh  depressed. 

Now.  the  wonndi  of  the  ucck 
beiug  disinl'i^L'ted  wltb  chloride  of 
xtnc,  stlluhed  with  catgut  and  snil- 
iibly  provided  with  drainage  tubes 
it  seldom  happemi  a  stitch  cuts 
through.  The  suppuration  is  raroly 
profiise  and  the  healing  pro(;ess  is 
speedily  accomplished. 

Penetrating  wounds  of  l.lie  tborai 
often  htAl  rapidly  witliout  any  ele- 
vatioD  of  temperature,* 

Penetrating  wounds  of  tbe  abdo- 
men,  in  which  proper  drainage  can 
be  secured,  now  heal  without  any 
untoward  symptoms,  Wa  perform 
laparotomy  without  any  foor  of  an 
on  favorable  rueult. 


TAKADA    MEDICAL   AND   SURGICAL   JOURNAL. 


THE  PAST. 

wounded.  •]iiu>i«t  all  divd  with  the 
too  obvious  HigQE  of  septjatmik, 
Tb(-  ietcrlo  skin,  the  oCKntf  dmk 
oolotnl  ttrJDc,  the  ta'tid  btvath  aail 
high  tKmpvnttiire  weie  the  ordiDury 


THE  PRESENT, 

Opemlions   for  henJia  we    

(rider  to  l-e  devoid  of  danger,  pco- 
vfdwl  the  totestine  is  not  gangniiiA 

lu  iheBc  cBwM  t 
<rith  septicwmik. 

We  have  succeMiful  t;  performed 
the  mdica)  core  of  hernia,  by  stitcfe 
ing  the  neck  oi  the  sac  flnnlr  tv 
geUicr    with    uatgut    and    cutting 


abate 


Ovariotomj  was  followod  by  the 
HuiH  tnin  oT  HjmpUiius  and  a  liki; 

calnl  u|ter»Iiou  and  the  aberDcv  of 
symptuma  indicatiuc  peritonitis 
aertaei  to  warnuit  ■  hvumble  pro- 


In  ULses  of  ivcci'tiou  Hid  alupii- 
tation,  the  munality  bum  pyjPDUa 
vac,  ai  already  mentioned,  bkohv 
IbtDg  appalling.  Although  erery- 
dkiag  •t«iuKl  U>  lie  K"'"!'  ■">  '*" 
fhr  wveral  days,  a  sudden  and 
violeol  chill,  lutlowed  by  pertpir*- 
tion.  put  a  daapct  un  all  hope  of 
mrcoiB  I  fiK  in  the  coarse  of  a  few 
kiHUv  all  the  kcallh)  graoulalioiu 
Iwd  diB^>pe<u«il,  wtd  ia  ilw  ptetv 
fit  a  ctnunjr  pus  was  a 
kbix.  flporilic  ititi-he&  ttmnatm 
«f  t«<Eat)k.  lin-r  pnimt.  aad  awttSMg 


H-  iteel/. 

The  operation  of  ovariotomy 
three  timcFi  ae  sa«»«sliil  a>  ' 
ly.  The  bcaiiogof  Ihewoaad  i 
takes  plaue  in<|uiteadiffe[vnt  n 
art.  and  we  have  repeatedly 
sermd  cases  in  which  daring 
short  period  of  twenty  or  th 
days  coDvaleaorni 
did  not  once  exceed  1 00 ' 
patirDt  never  fell  anwelL 

CaMC  of  resection,  in  whit^  then 
ia  not  frpT  uippiustjoo  and  acptli 
>«mia  before  ihe  operatiuo  i 
bntl  fur  the  moet  part  by  Azwi 
irutioii.  If  such  caseA  are  aha 
in  a  (teptic  c«aditioa  one  or  i 
applit'stiona  of  ckluride  of  t 
often  uUKcvB  to  hiiag  akoat 
auiiiivptk  fMt«.  and  if  «c  soec 
in  tbik  lumliag  bkea  plac*  to 


watery  fortid      and  the  conttiliatt  o<  lb*  |i 


^«krtt4hi»«,4c.,*c 


BRITISH   ASh   FO&EIOS  JO^mXAL^. 


i^?; 


THE  PAST. 

I   eyen  tried  inYmction  of  ftn:>cz 

perchloride  of  mercury    m1t«.  a» 

'^^oommeiided  by  Heime.  antfl  en*:*'. 

n&ovs  olcers  and  bloody  itooU  •:<- 

f^^ited,  but  the  ilight  benefit  wcm- 

'i^S^lj  thereby  obtidned,  laAed  oiJy 

*  tcirlK>nn. 

^«  things  were  I  ■carcely  rentrnvd 
^o  make  an  incision  into  the  joints, 
^O-ci  when  impelled  thereto  by  dirr 
^^^cesdty,  death  from  pyxrmia  vss 
^Hc  Waal  resolt. 


THE  PRESEXT. 


Incision  of  joints  now  performed. 
'^vith  go  mnch  soecess.  is  the  be^t 
't««(  of  the  merits  of  the  two  methodj? 
of  treatment. 

Incision  of  jmnts  and  lapan>- 
"^omj  have  done  more  than  any  other 
surgical  procedure  towards  orer- 
coming  the  last  rival  of  the  antiwp- 
tic  method.  I  refer  to  the  ••  open 
treatment, "  for  no  surgeon  would 
now  think  of  tnisting  to  the  open 
treatment  of  incised  joints.  In  my 
bomble  opinion,  the  ineffir-ary  oi 
the  open  treatment  is  hospital  gan- 
grene snch  as  raged  in  my  wardi*. 
was  enough  to  condemn  it. 


Incision  into  joints  can.  a»  is  well, 
known,  br  made  antiseptically  with> 
out  dang»:r.  In  inflamntatonr  aifec- 
tions  the  sr<iner  this  is  done  and 
the  exudation  allowed  to  drain  off 
the  btrtter  will  W  the  r«¥ult. 

Anchylorijt  then  nerer  ensues. 
The  immediate  and  brilliant  rv$u!t 
of  incising  iuflamed  joints  in  which 
there  was  no  exudation,  «nd  thert^- 
fore  DO  nei  trssity  tor  drainage,  lias 
ofteu  astonished  me  beyond  mea- 
sure :  after  incision  the  violent  pain 
and  constitutional  disturliani^  dii^ 
appear  like  magic.  The  immediate 
relief  can.  I  think,  only  be  accounted 
for  by  the  relaxation  of  tho  ji»int 
capsule. 


Ulcerations  of  the  feet  and  legs 
necessitated  a  very  long  sojourn  in 
the  hospital,  and  were  often  com- 
plicated with  erysipelas,  hospital 
gangrene,  and  exfoliation  of  bone. 

Those  ulcers  upon  which  I  per- 
formed  my  operation  of  circumcis- 
rion,  did  not  suffer  from  relapses, 
but  this  operation  is  so  severe  a 
measuse,  that  it  is  only  justifiable  in 
very  bad  cases,  upon  the  principle 
that  the  remedy  must  never  be  more 
dangerous  than  the  disease.  The 
duration  of  treatment  in  Hospital 
was  almost  interminable. 


Ulcers  of  the  feet  and  legs  which 
formf.'rly  remained  unhealed  for  an 
indefinite  period,  and  fumishtni 
many  victims  to  erysipelas,  and  h<.»s- 
pital  gangrene,  recovered  iin<ler  the 
boracic  lint  treatment  withextnior- 
dinary  rapid'ty. 

Wet  boracic  lint,  covereii  with 
gutta-percha,  cleans  the  fimlest 
ulcers  in  live  or  six  days. 

The  ulcer  when  thoroughly  clean- 
ed and  healthy  may  be  disinfected 
with  an  8  per  cent,  solution  «)f 
chloride  of  zinc ;  the  surrounding 
skin  washed  with  a  5  per  cent,  solu- 
tion of  carbolic  acid,  and  the  heal  - 
ing  procesa  much  acctilerated  by 
Reverdin's  "  Skin  Grafting."  The 
treatment  in  Hospital  cf  wounds 


If  Kcoeeol  omiiutation  or  rcaec- 
tion  was  fortaiiBtii  eDoii)i:li  to  escapi; 
pyoemia,  it  waa  only  U>  suffer  a^cain 
and  HfiHiD  (rom  attackBof  erfKJpelru 
m  Hospit&l  fever,  or  the  wouude  be- 
euae  covered  nlth  an  unhohlthy 
exudatioa  which  had  to  be  doetioy- 
ed  b^  cauHticB  or  fiirrtim  cnndenB.  I 
often  felt  like  almndoning  hII  opura- 
tiooa  ID  desptilr,  but  there  was  no 
■jioice,  and  I  had  to  content  myself 
M  best  I  could  with  never-ending 
complainta,  And  petition  after  peti- 
tion tot  th«  eonsIruclioD  of  a  new 
HtMpital  an  tbe  only  ho|u'  of  dMS^ 
■way  with  this  lameDtablv  state  ot 
things.  Still  morv  remarkable  am 
the  mortiJity  etnlietics.  Among  an 
equal  num1>ec  oi  patlentH.  with,  the 
same  boepitai  accommodation  there 
were  eiacllj  twice  as  many  deatht^ 
and  this  is  the  most  conclutuve 
argument  that  can  be  nrged  in  fcvor 
of  the  KUtiseptic  treatment. 

Fotmerly  strong  and  healthy 
young  peoptu  itiud  (turn  the  moct 
liii-ial  wounds. 

Nuarly  at)  i-omp!ic»li.-<l  fractures. 
MnputatiutiH  null  rvsectiouH  vuv 
btal,  for  this  reason  alone  it  Foemti 
to  me  (|aite  worth  while  to  compare 
the   pictures  of  tbe   past  aud   the 


THE  PBESENT- 

and  injuries  which  remain  antisep- 
tic, is  very  much  shorter  than  it  wu 
under  the  old  system.  Nevertbelew 
it  may  appear  strange  at  first  stgU 
that  thtt  average  duration  of  days  id 
hospital  ha«  not  diminishtMl.  *" 
explanation  Is  ea«y.  Many  at 
inJDiiei!,  aitd  complicated  ftai:t 
with  purulent  periostitis,  lacenttim 
of  muscles,  kc,  which  used  to  pei^ 
ish  from  pyicmia  in  a  few  days,  noif 
escape  with  life  after  a  long  period 
of  careful  treatment.  Many  con». 
plicated  fractareu  of  the  lower  ei- 
IremitieB,  which  formerly  died  1b 
^m  8  bu  14  days,  DOW  remain  in  dM( 
hospital  from  60  to  80  days,  and  at 
length  recover  and  ore  able  I 
resume  their  employment. 

Although  the  death  rate  is  no 
just  half  what  it  mied  to  be,  it  mu; 
be  bonie  in  mind,  that  With  the  e:. 
cGption  of  the  local   treatment  o( 
surgical  tfases,  everything  elite  hi 
remained  Dnatlcred.   Of  those  wl 
die,  a  large  pmportion  are  from  tl 
nature  of  their  maladies,  lieyond  the 
reach  of  surgical  ud,  snch  a«  tuber- 
culous subjects  and  cancer  patients 
who  come  to  the  huepltal  in  the  last 
stages  of  the  disease  ;  peraons  who 
have  bct'n   fatally  stabbed  or  shot, 
suividcs,  fractures  of  the  skull,  Ac, 
*t.|  uf  M>  severe  a  kind,  that  neither 
the  antiseptic  nor  any  other  mode 
of  trcdtmenl  can  possibly  be  of  any 

The  aniiseptic  mettiod  has  not 
only  been  of  service  to  those  who 
ant  treated  by  it,  but  alj  the  other 
patientH  suffering  from  wounds  or 
injuries,  which,  from  their  nature, 
cannot  behealwlanliseptically.also 
derive  benefit,  inasmuch  aa  their 
sarronncDngs  arc  more  tavorable. 
They  remain  fme  from  pya-nia  and 
hospital  fever,  liecause  the  air  I  hey 
now  breathe  is  ra«Uy  more  nw 
from  impurities. 


Popliteal    Aneurism    treated   by   Es- 

KXiarc]l*s  Bandage. — Mr.  J.  HutchinsoD,  at  a  meeting 
of  the  Clinical   Society  of  Lrmdoa,  related  the  following  two 
cases.     The  subject  of  the  first  was  a  robust  gentleman,  aged 
2€,  who  had  never  had  syphilis.     l"he  tumour  filled  the  right 
popliteal  space,  and  pulsated  strongly.     There  bad  been  pain 
for  three  months,  but  the  pulsation  had  been  recognized  only  a 
month.     He  had  been  placed  under  Mr,  HutchicBoii'a  care  by 
Mr.  Drew.     After  three  days  rest  in  bed,  ether  was  given, 
and   Esmarch'a  banding  was  applied  to  the  entire  limb.     It 
■was  put  on  tight  below  the  knee,  very  lightly  over  the  tumour, 
and  tightly  again  on  the  thigh.     The  elastic  strap  was  applied 
as  tightly  aa  possible  in  the  upper  third,  and  after  a  little  time 
the  bandage  was  removed-     The  tumour  was  left  full  of  blood, 
which  was  completely  stagnated.     Ansesthesia  by  ether  was 
kept  up  for  an  hour,  and  at  the  end  of  that  time  the  strap  was 
removed  anc^a  horseshoe  tourniquet  substituted.    No  pulsation 
returned  in  the  tumour,  but  as  a  matter  of  precaution  the 
tourniquet  was   retained  for  a   few   hours.     The   subsequent 
recovery  was  rapid  and  complete.     The  second  case  was  leas 
speedily   successful.     Its  subject    was   a    gunnery  instructor 
from  Shoeburyness,  who  had  been  treated  by  pressure  for  an 
aneurism  in  the  calf  two  years  previously.     On  that  oceaaion, 
success  had  been  obtained  by  thirteen  days'  compression.   The 
aneurism  on  the  second  occasion  filled  the  popliteal  space,  and 
■as'  of   the  size  of  a  large   orange.      It  pul8at«d   strongly. 
Eemarch's  bandage,  under  ether,  was  used  for  one  hour  in' 
exactly  the  same  way  as  in  the   previous  case,  but  with  no 
benefit.    The  tumour  beat  as  before.    Three  days  later,  another 
trial  was  made  of  the  same  plan,  but  on  tbia  occasion  arrange- 
ments had  been  made,  by  relaya  of  students,  to  keep  up  digital 
pressure  after  removal  of  the  constricting  strap.     The  man  waa 
kept  under  ether  for  two  hours.     At  the  end  of  that  time  the 
strap  was  removed,  and  during  the  change  of  hands  it  became 
evident  that  pulsation  was  still  present,  but  it  waa  more  easily 
mtroUed  than  before.     Manual  compression  was  kept  up  for 
t  seven  hours,  at  the  end  of  which  time  pulsation  had  quite 


270  CANADA  JttmcAL  ASD  atniQlFAL  JOUttNAI,. 

ceased.     The  tumour  remained  solid,  and  rapidly  diminished 
ID  size,  and  the  man  left  the  hospital  a  few  weeks  later  quifce 
well.     It  was  thought  that  in  this  case,  although  the  Esmarct»'6 
handage  did  not  produce  consolidation,  yet  il  conduced  to  *_Tie 
cure,  and  certainly  on  neither  occasion  did  it  do  any  ha-aerffl- 
Mr.  Hutchbaon   stated  that   he  had   brought  forward  tl*-  ■«* 
cases,  in  neither  of  which  was  there  anything  original  in      ^J 
treatment,  in  oider  to  elicit  from  surgeons  statements  of  t^_>e"' 
experience  and  opinions  in  reference  to  this  novel  and  im;^E3'"' 
tant  method.     He  acknowledged  his  obligation  to  his  colle^^  ^^ 
Mr.  Warren  Tay,  Mr.  Price,  and  Mr.  Bennett,  for  their 
ance  in  carrying  out  the  details. — Mr,  I'homas  Smith,  by 
use  of  Esmarch's  bandage,  applied  as  be  had  seen  Mr.  ^^ 
applied  it  at  St.  Thomas's  Hospital,  had  cured  two  cases^ 
had  fiuled  with  two.     In  a  recent  case,  no  chloroform  was  g"»- 
and  the  bandage  was  applied  tightly  below   and  above 
tumour,  and  left  in  place.     He  considered  this  better  than 
Btrioting  the  hmb  by  the  cord — a  proceeding  which,  oi». 
continent,  had  been  followed   by   permanent   paralysis  ^» 
injury   to   nerves.     The   pressure  was  more   diffused  by 
bandage.     In  the  laat  case,  which  occurred  to  a  member  o^^ 
medical  profession,  the  bandage  was  alternated  with  pressure —     ■' 
a  tourniquet  over  the  artery,  and  the  treatment  lasted  £^5^" 
9  a.m.  to  6  p.m.,  at  which  time  great  pain  was  felt  in  the  sv^**^ 
ing,  and  coagulation  probably  took  place.     Pressure  was  1*"--^^^  ^ 
on  for  an  hour  and  a-half  after  this,  and  the  result  was  enti*""""^  ^ 
successful. — Mr,  Morrant  Baker  had  had  an  unfavourable  C^  "   ^_^ 
in  a  man  aged  forty  or  fifty,  where  some  blood  had  esca_^^-^ 
from  the  aneurism,  which  he  had  treated  successfully.     Aft^ 
preliminary  imperfect  application,  the  handage  wae  kept  on 
three-quarters   of  an   hour,  followed   by   half-an-hour's   c*-**^^ 
pression  with  the  finger,  and  was  re-applied  for  twenty  minu*^^^^* 
and   compression   again  kept  up   for  nearly  two  houre.     ^-t^'' 
anaesthetic  was  employed,  no  pain  was  complained  of ;  and  " 

the  end  of  that  time  the  aneurism  was   consolidated. \^-    ^' 

Maunder  thought  that  there  was  no  single  certiunly  succeaaf'^^ 
method  of  dealing  with  these  cases.     He  had  tried  Dr.  Rei<l  "^* 


the 

r  roR 

■^■en, 
the 


the 


for 


tetTtSH  AND    FOtlEIGN  JOURNALS.  271 

twice;   both  times  unsuccessfully.     One  was  cured  by 
digital  compression,  and  the  other  by  ligature.    In  his  opinion, 
'thie  objection  to  this   bandage   was  that  it  was  painful,  and 
x-^quired  an .  anaesthetic  with  its  attendant  risk.—  Mr.  Barwell 
Sk^greed  that  no  single  method  could  be  relied  upon,  but  that  the 
l>aindage  was  especially  unsuitable  in  fusiform  aneurisms.     He 
li.ad  tried  it  in  a  bad  case,  where  there  was  extensive  arterial 
disease,  with   fusiform   aneurisms   in  the  axilla  and  brachial 
SLTteries ;  he  made  use  of  a  sort  of  bridge  to  keep  the  bandage 
off  the  tumour,  and  applied  it  lightly  above  the  swelling,  allow- 
ing a  small  current  of  blood  to  pass.     After  an  hour  and 
st-half,  there  was  no  result ;    it  was   subsequently  re-applied 
t^ce,  but  he  was  obliged  finally  to  ligature  the  artery,  tying  it 
genUy  in  consequence  of  its  diseased  state :  the  man  was  well 
in  ten  days.     Mr.  T.  Smith  objected  that  this  method  of  apply- 
ing the  bandage,  so  as  to  allow  the  current  of  blood  to  continue- 
^as  essentially  different  from  the  plan  under  discussion. — Mr. 
£arwell  added  that  on  one  occasion  the  flow  was  arrested  for 
about  one  hour. — Mr.  Herbert  Page  had  tried  the  bandage 
^thout  success  in  a  case  apparently  well  suited  for  it,  and  in 
the  hospital  at  the  same  time  a  case  of  Mr.  Lane's  was  treated 
in  the  same  way  with  a  like  result.     The  plug  in  the  distal 
arteries,  which  had  been  thought  to  precede  clotting  in  the 
aneurism,  was,  in  his  opinion,  a  later  event,  and  followed  its 
cure.     He  alluded  to  a  case  of  Mr.  Pemberton's,  where  this 
method  of  treatment  had  been  followed  by  gangrene. — Mr. 
Bryant  related  a  case  where  the  bandage  was  used  for  one 
hour,  under  the  influence  of  morphia,  by  which  time  there  was 
much  consolidation.     In  two  or  three  days,  the  aneurism  grew 
worse ;  but  the  bandage  under  chloroform  for  three-quarters  of 
an  hour  was  followed  by  much  improvement.     It  soon  relapsed, 
and  he  then  tied  the  artery.     Gangrene  followed  in  a  few  days, 
which  required  amputation  below  the  knee.     In  his  opinion, 
the  bandage  was  responsible   for  the  gangrene  ;  and  it  con- 
stituted a  serious,  though  perhaps  not  fatal,  objection  to  its  use. 
— Dr.  Mahomed  considered  the  bandage  was  contraindicated  in 
cases  of  extensive  arterial  disease.     He  had  found  that,  when 


clot 


s  the 
bad 


272  TANADA    MSniRAL   AND   BITRQICAL   JOCaNAL. 

the  banilflge  was  placed  on  one  ann,  the  volume  of  the  oth^ 
was  much  increased,  showing  that  a  considerably  increased  d^^- 
tension  of  the  rest  of  the  vascular  system  resulted.     Wh^ssi* 
the  cerebral  arteries  were  diseased,  this  might  be  dangeroc^^s ; 
bat  this  objection  did  not  apply  to  the  ligature. — Mr.  G*-  -ul^ 
alluded  to  two  cases  of  aneurism  treated  m  this  way  wliich-     he 
had  examined.     In  both,  the  clot  in  the  aneurism  was  Io^l^s^  ■ 
that  in  the  artery,  above  and  below,  firm  and  fibrous.     He       -co*' 
flidered  that  the  coagulum  in  the  aneurism  was  secondary  -,   ^ 
he  thought  Mr.  Bryant's  case  bore  out  this  view,     Her^^^    "* 
clot,  being  soft,  was  broken  up  by  the  stream,  wbich  L^^^*^ 
thrombosis  and  gangrene  beyond.     This  difference  in  th^ 
he  attributed  to  the  imperfect  nutrition  of  the  walls  of  th  ■* 
He  still  thought  those  cases  would  be  successful  wher"~" 
opening  was  large  and  the  vessel  healthy. — Mr.  Norto*:^ 
tried  the  bandage  without  success  in  one  case.     Ther^ssi* 
extensive   vascular  disease,  with  double  aortic   murmur"  "" 
three  aneurisms.     The  treatment,  though  it  failed,  had  nc::^^*' 
the  disastrous  results  Dr.  Mahomed  predicted,  though  the 
was  just  such  a  one  as  those  referred  to  by  Dr.  Mahomed. 
considered  the  risk  due  to  distension  of  the  vessels  as  the  ^'   "        ^  _ 
of  compression  small,  indeed,  when  compared  with  the  rialie'^^ 
ligature  where  general  vascular  disease  existed. — Mr.  . 
agreed  with  Mr.  Barwell   that  a   fusiform  aneurism  wa^*- 
amenable  to  this  treatment,  and  with  Mr.  Gould  in  his  tl^  * 
of  the  action  of  this  bandage.     In  Mr.  Smith's  case,  how^^ 
the  general  state  of  the  vessels  was  very  unfavourable,  y^ 
rapid  cure  resulted.     It  was  quite  possible  that  in  Mr,  Bry^* 
the  gangrene  was  a   result  of  the  ligature,  and  not  of 
bandage.     In  a  patient  of  his  in  whom  the  bandage  had  t^ 
twice  applied,  and  in  whom  the  artery  had  been  ligatured,  C^ 
in  the  usual  way  and  once  with  antiseptic   precautions, 
result  was  of  interest :  the  patient  was  strongly  in  favou*" 
the  antiseptic  plan,  from  which  he  had  suffered  much  less  [>* 
— Mr.  Hutchinson,  in  reply  to  the  various  speakers,  sail 
thought  the  plan  of   treatment  under   discussion  a  valo^ 
addition  to  the  means  at  our  disposal.     It  seemed  impossible 


^^^  BRITISH   AND   FOBEIDN  JOURNALS. 

pTedicate  as  to  the  casos  in  which  it  ^as  most  likelj  to  Bucceed ; 

l>wt  it  seemed  to  be  a  trial  in  nearly  all.     He  could  not  admit 

^liat  Mr.  Bryant's  case  proved  that  any  ill  consequences  were 

due  to  the  bandage.     It  had  simply  not  cured.     The  gangrene 

csAme  OD  after  the  ligature,  and  should  be  attributed  to  it,  and 

not   to  the  Esmarch  bandage.     He  believed  that,  in  different 

sndividuaiB,  very  different  degrees  of  aptitude  for  coagulation 

-wwere  displayed  by  the  blood,  and  hence  chiefly  the  explanation 

■^vby  some  cases  were  cured  easily  and  others  with  difficulty. 

The  tendency  to  coagulation  might  be  helped  by  insisting  on 

abstinence  from  fluids,  as  was  done  in  both  his  cases,  and  by 

^ivtng  drugs,  such  aa  iodide  of  potassium,  lead,  and  digitalis. 

"Whilst  fully  admitting  the  great  value  of  digital  compression, 

he  still  thought  that  a  trial  should  first  be  given  to  the  bandage. 

Ee  had  had  several  very  rapid  cures  by  compression ;  but  he 

did  not  recollect  any  case  of  aneuriam  of  similar  size  in  which 

the  patient  had  suffered  less  during  the  treatment  than  the  fii-st 

of  these  which  he  had  just  related.     If  ether  were  used,  not 

chloroform,  he  believed  that  no  danger  was  encountered  ;  and 

he  felt  sure  that  the  anjesthetic  made  the  treatment  much  less 

painful.     He  would  strongly  recommend  that,  ia  all  cases  in 

which  the  bandage  was  tried,  arrangements  to  continue  digital 

compression  immediately  after  its  removal  should  be  made ; 

and  that  great  care  should  be  taken  to  prevent  the  blood  from 

passing  into  the  tumour  on  release  of  the  limb  from  the  strap 

— Britiih  Medical  Journal. 

On  tbe  Treatment  of  Diphtheria.— u  i>e 

Beodt  Hovell  observes  in  The  Lancet  the  importance  of 
giving  a  brisk  calomel  purge  at  the  outset  of  diphtheria  is,  per- 
haps, not  sufficiently  recognised  and  acted  on.  Local  applica- 
tions are  cert^nly  useful,  and  the  favourable  effects  of  tonic 
medicines  are  a  strong  contrast  to  the  very  unfavorable,  I  had 
almost  said  disastrous,  consequences  of  any  contra-stimulant 
medicine.  The  necessity  for  the  liberal  and  frequent  adminis- 
tration of  nourishment  and  stimulants  is  indicated  by  the  great 
tolerance,  or  rather  capacity,  of  the  eystem  to  receive  them ; 

_.X0.   LSZTIIL  18 


274 


CANADA  HGDIOAF.   AND   SC&QIOAL   JOtmSAL. 


e  not  secure  from 


but,  all  awd  and  done,  we  a.re  atill  fighting  an  unseen  and  trea- 
cherous enemy,  and  are  face  to  face  with  the  fact  that,  ontjl  .■ 
the  expiration  of  twelve  or  more  days,  we  n 
the  fatal  effects  of  a  fresh  deposit. 

The  late  Mr.  John  Scott  used  to  treat  severe  cases  of 
cjuanche  with  a  "  scavenger  " — viz.,  calomel,  jalap,  and  scam-, 
mony,  after  which  they  usually  got  well.  Looking  at  a  diph-. 
theritic  throat  one  day,  I  said  to  myself,  why  should  I  not  give. 
this  patient  a  scavenger '!  I  did  so,  and  remai'ked  that  the 
subsequent  course  of  the  disease  waa  certainly  cut  short. 
have  since  adopted  the  plan,  and  invariably  found  that  the 
Bame  good  results  have  followed ;  the  tendency  lo  fresh  deposit*, 
has  much  diminished,  and  in  many  cases  is  wholly  prevented, 
1  can  call  to  mind  more  than  one  case  in  which  the  attempt  at  & 
fresh  deposit  was  clear,  but  very  feeble. 

Unhappily  I  have  seen  a  good  deal  of  diphtheria  at  dififerent 
times  since  its  appearance  in  this  country  about  twenty-two 
years  ago,  and  have  treated  it,  on  the  whole,  not  unsuccessfully, 
but  it  was  only  about  a  year  ago  that  the  above  circumstances 
ahnost  accidentally  forced  the  conviction  on  my  mind  that  ellrav^ 
nation  of  the  poison  ought  to  be  the  first  object  in  treatmenlM 
How  this  elimination  takes  place  through  the  bowels,  I  JtnofF 
not,  but  diphtheria  is  a  disease  of  blood-poisonmg,  and  there  ia 
no  reason  why  the  poison  should  not  be  eliminated  through  tha 
bowels  any  less  or  more  than  in  enteric  fever — in  tliroat  fe« 
than  in  bowel  fever-  I  cannot  refuse  the  evidence  of  my  expe- 
rience that  since  I  have  adopted  the  practice  of  purging  at  the 
outset  the  course  of  the  disease  has  been  invariably  more  favou- 
rable, nor  the  testimony  of  those  who  declare  that  the  dejectioot 
thus  produced  are  abominably  offensive.  At  any  rate,  the  prac- 
tical effect  of  "  the  scavenger '"  recommends  itself  to  my  miiM 
in  a  much  higher  degree  than  the  scientific  inaction  of  tempos 
ising  and  waiting  til  the  disease  has  run  ita  course,  howevei 
masterly  such  inaction  may  appear  ;  or  than  the  inferior,  but  b* 
no  means  futile  plan,  of  trying  to  neutralise  the  effects  of  (kt 
poison.  Invaluable  as  the  scientific  knowledge  is,  it  ought  no 
to  stop  ^flhorti  nor  rest  content^  without  improvement  in  practic<e 


fiaiTISH  AND  FOBSIGN  JOURNALS.  2*75 

EUmination,  then,  (1)  through  the  bowels,  (2)  through  the 
.  kidneys.  Chlorate  of  potash  drinks  should  be  given  frequently, 
incessantly.  Where  the  nose  is  affected,  the  same  solution  or 
that  of  permanganate  of  potash  should  be  drawn  up  frequently 
through  the  nostrils,  so  as  thoroughly  to  cleanse  them.  When 
the  patient  cannot  swallow,  nutrient  enemata  should  be  given 
four  times  a  day ;  not  too  frequently  if  they  are  to  be  retained. 
For  this,  nothing  is  better  than  Dr.  Munk's  mixture,  a  tumbler- 
ful of  milk  gruel,  a  new-laid  egg,  a  teaspoonful  of  brandy.  By 
following  this  plan  a  boy  under  the  joint  care  of  my  partner, 
Dr.  C.  Eingsford,  and  myself,  twenty  years  ago,  recovered, 
although  he  swallowed  nothing  for  sixteen  days,  and  severe  para- 
lysis, or  rather  paresis,  ensued.  He  is  now  a  fine  strong  man. 
Possibly  the  adverse  effect  of  depletory  treatment  has  tended 
to  deter  firom  the  administration  of  an  asperient ;  but  in  this, 
as  in  many  other  instances,  debility  is  a  bugbear.  In  one  severe 
case  I  had  to  give  three  doses  of  calomel  and  jalapin,  and  follow 
each  dose  with  a  black  draught,  and  even  then  it  was  necessarry 
to  add  one  ounce  of  castor  oil.  The  relief  was  as  marked  as  the 
amount  of  aperients  required  to  obtain  it.  The  nourishment, 
stimulants,  and  tonics  given  subsequently  seemed  to  be  all  the 
more  thankfully  received  and  gratefully  recorded. 

The  tendency  to  rheumatism  after  even  a  slight  attack  of 
diphtheria  should  never  be  lost  sight  of.  Possibly  this  is  due  to 
excess  of  fibrin  in  the  blood ;  but  of  the  fact  I  have  certain 
experience. 

Tapping:  the  Lungrs  in    Phthisis.^-At  a 

recent  meeting  of  the  Clinical  Society  of  London,  Dr.  Theodore 
Williams  communicated  a  case  of  bronchiectasis  and  lung 
excavation,  in  which  an  attempt  was  made  to  drain  the  cavity 
by  tapping. 

The  patient,  a  man  aged  twenty-nine,  had  chronic  pneumonia 
of  both  lungs,  resulting  in  perfect  resolution  in  one,  and  an 
induration  and  dilatation  of  the  bronchi  in  the  other.  He  sub- 
sequently had  haemoptysis  to  the  amount  of  three  pints,  and  lost 
two  stone  in  weight.     When  admitted  into  the  Brompton  Hospi- 


276 


CANABA   MEniCAr.    AND    SURGICAL    JOUBNAL. 


tal,  iu  May,  1877,  the  symptoms  were  convulBive  cougb  and 
fetid  expectoration,  containing  large  quantitiea  of  lung  tiasue, 
and  so  offensive  in  character  as  to  cause  frequent  vomiting. 
There  was  also  considerable  pyrexia,  the  physical  signs  denoted 
consolidation  of  the  base  of  the  left  lung,  with  commencing 
excavation.  Daring  hia  stay  in  the  hospital  the  area  over  which 
caveroas  sounds  were  audible,  increased  considerably.  Various 
kinds  of  treatment  were  tried  to  relieve  the  cough,  and  to  facili- 
tate and  disinfect  the  expectoration,  but  all  with  only  temporarj' 
benefit ;  and  a.^  the  patient  appeared  to  be  poisoned  more  and 
more  by  the  retained  expectoration,  and  exhausted  by  the  cough, 
On  October  16th,  1877,  a  medium-sized  aspirator  needle  waa 
passed  between  the  eighth  and  ninth  ribs,  in  the  area  of  the 
cavernous  sounds,  and  appeared  to  reach  the  cavity,  but  on  ex- 
haustion only  a  few  drops  of  blood  followed  the  operation,  and 
the  puncture  was  subseiuently  closed  with  hnt.  The  patient 
afterward  suffered  pain  in  the  infra-mammary  region,  but  as  his 
symptoms  continued  to  increase,  a  fortnight  later  a  second 
attempt  was  made  to  reach  the  cavern ;  this  time  the  intercostal 
space  below  the  scene  of  the  &rst  operation  being  selected,  and  ft 
trocar  and  a  large  drainage-tube  were  introduced.  On  reacb- 
ing  the  pleura  a  pint  of  brownish,  fetid  fluid  escaped,  which 
proved  under  the  microscope  to  consist  of  broken  down  pus  cella. 
Symptoms  of  collapse  followed  the  evacuation  of  the  fluid,  and 
the  patient  was  with  difficulty  rallied  with  stimulants.  The 
abscess  was  washed  out  with  disinfectants,  but  no  improvement 
took  place,  and  the  patient  gradually  sank,  three  days  after  the 
operation. 

On  post-mortem  examination  it  was  found  that  the  lung  con- 
tained a  labyrinthine  cavity  formed  by  the  breaking  down  of  the 
walls  of  several  dilated  bronchi,  one  of  which  had  been  pene- 
trated by  the  first  operation,  Overlymg  the  cavity  was  a  hmited' 
empyema,  which  the  second  operation  had  evacuated.  The 
right  lung  was  affected  by  recent  pneumonia,  the  result  of 
infection  through  inhaled  secretion  from  the  left,  this  being  the 
imraadiate  cause  of  death. — Medical  and  Surgical  Reporter. 


BRITISH   AND   mREIGN    JOLRNALS. 


277 


■ 
t 


Iodoform  as  a  I.ocal  Anaesthetic.— In  a 

recent  article  in  the  Winer  Med.  Wochmsckrift,'QT.}>lQi\tsc\\Qit 
80J3  he  has  often  relieved  or  removed  the  most  intense  gouty 
pains  and  other  aymptoma  of  gout^  inflammation  within  twenty- 
fonr  hours,  by  painting  on  the  collodion.  In  rheumatic  yiaina  it 
18  efficacious,  but  in  the  various  neuralgies,  (intercostal,  sciatic, 
etc.,)  it  succeeds  excellently.  Unfortunately,  as  moat  people 
know,  iodoform  has  a  disagreeable  smell,  which  makes  those 
using  it  objectionable  to  others.  To  obviate  this  Moleachott 
advises  that  the  glass  vessel  containing  the  iodoform  preparation 
(collodion,  or,  what  he  also  uses,  ointment)  be  kept  outside  the 
viudow,  in  a  leaden  box  provided  with  a  well-fitting  cover,  tlie 
ODacity  of  the  box  having  the  additional  advantage  of  retarding 
the  decomposition  of  the  iodoform  by  light.  He  a!so  covers 
with  gutta  percha  tissue  the  part  anointed  with  the  collodion  ; 
and  if  possible,  only  applies  the  iodolorm  at  night,  so  that  most 
of  it  is  absorbed,  or  has  evaporated,  before  the  morning,  and 
what  remains  (if  the  ointment  is  used)  can  easily  he  removed 
with  soap  and  water.  The  use  of  iodoform  sometimes  causes 
cardiac  palpitation,  but  Dr.  Moleschott  has  also  more  than  once 
found  a  weak,  irregular  pulse  rendered  stronger  and  more 
regular  by  small  internal  doses  of  iodoform,  just  aa  by  email 
doses  of  digitalis. — Medical  find  Surgical  Reportfr. 

On  Insolation  and  Refrigeration.— Dr. 

,  KiBCHNER  has  recently  carried  out  a  series  of  experiments  on 
L  animals  with  a  view  to  gain  an  insight  into  the  pathogenesis  of 

■  the  two  allied  processes,  insolation  and  refrigeration.  He 
Ideduces  from  them  that  the  latter  may  be  characterized  as  pros- 
Etratiun  of  the  vital  forces,  and,  first  of  all,  of  reajiiration  and 

■  circulation.  The  morphotic  and  chemical  alteration  of  the  biood 
resulting  therefrom,  particularly  its  impoverishment  in  oxygen, 
e  the  immediate  cause  of  the  derangements  that  dii-ectly  threaten 

Warmth,  on  the  other  hand,  acta  as  an  irritant  on  animal 

nrganism,  and  when  in  excess  leads  to  exhaustion.    This  consti- 

Put«s  the  essence  of  insolation.  Aa  in  the  case  of  refrigeration, 

e  fbundation  of  the  symptoms  is  tlie  exhaustion  of  the  oxygen 


278  rANAPA   MEmcAL    AMD    SCROlrAI,    JOrRfJAL. 

of  the  blood,  which  here  too  is  the  consequence  of  the  failing 
respiration  and  circulatioa  The  appearance  of  rigidity  during 
exposure,  either  to  cold  or  heat,  indicates  excessive  lack  of 
oxygen  in  the  blood.  This  rigidity  is,  like  the  rigor  mortis,  an 
aniemic  muscular  tetanus.  If,  however,  we  put  coagulation,  or, 
in  other  words,  coagulation  of  the  muscles,  out  of  the  question, 
tonic  muscular  rigidity  is  not  commonly  met  with  in  cases  of 
refrigeration  or  insolation. 

The  deleterious  action  of  extreme  temperatures  on  the  organ- 
ism is  heightened  by  "other  weakening  influences  which  tend  to 
impair  the  supply  of  oxygen  and  to  exhaust  the  resisting  power 
of  the  system.     Here  must  be  mentioned,  particularly,  the  mis- 
use of  alcohol.     In  addition  to  these  acute  effects  of  the  action 
of  cold  and  heat,  there  are  analagous  chronic  conditions,  which 
must  be  ascribed  to  the  gradual  action  of  extreme  temperatures 
in  the  organism.     ITiey  are  characterized  by  manifestations  of 
anteroia  or  exhaustion,  and  in  their  higher  grades  partly  consti- 
tnte  the  basis  of  the  tropical  and  polar  cachexias.     It  is  still  an 
open  question  whether  any  other  specific  diseases  owe  their  I 
origin  to  the  influence  of  heat  and  cold.  The  fact  that  abdominal  I 
typhus  occurs  most  frequently  during  the  latter  part  of  summer  J 
and  towards  the  end  of  winter,  has  not  yet  been  satisfactorily  | 
accounted  for;  and,  as  in  many  cases,  no  external  source  of  1 
infection  can  be  discovered,  it  is,  in  fact  possible  that  the  n 
photic  and  chemical  alterations  of  the  blood  and  tissues,  wbiclifl 
have  been  proved  to  be  the  pathological  effects  of  insolation  ancl'l 
refrigeration,  play  at  least  a  subsidiary  role  in  the  production  of  J 
the  infecUon.— CA%.  Med.   Cent.  Zeit.,  No.  47,  1878).— J 
Medical  Hecord,  N.  Y. 

The   Surgical  Treatment  of  Lupus.— -J 

In  an  article  by  M.  Hillariet,  quoted  in  the   London  Medicatf 
Record,  the  writer  says  : — 

It  was  Void  who  first  introduced  acupuncture.     The  metLofl 
consists  in  pricking  tho  surface  of  the  lupw  mth  net 
in  bundles,  or  fixed  in  the  fiamc  liaodle,  hat  Bt'piira(«i)  J 
another  by  some  millimeters.    The  noctUoa,  before  I 


ttinSH  AND  FOREIGN  JOUBNALS.  279 

should  be  heated  to  a  red  colour.    This  plan,  is  however,  at  the 

present  time  much  less  employed  than  the  scraper  and  linear 

scarification.     Volkmann  invented  the  scraper,  and  published 

lis  proceeding  in  1870.   It  consists  in  scratching  the  surface  of 

tke  lupus  with  curettes  of  diJFerent  shapes,  but  generally  of 

szoall  dimensions. '  It  is  necessary,  in  order  to  aid  the  action  of 

^he  instrument,  to  raise  up  all  the  lupoid  tissue,  and  one  may  be 

satisfied  with  the  result  when  the  curette  comes  upon  more 

Insisting  parts  ;  this  is  healthy  tissue  ;  the  operator  should  then 

stop.    It  is  generally  necessary  to  repeat  the  operation  one  or 

^^Te  times  a  month  until  the  healing  of  the  lupus  is  complete. 

Volkmann  and  Hebra  both  advise  cauterization  of  the  scraped 

s^ace  with  ni^te  of  silver.    This  method  of  Volkmann's  gives 

^ery  good  results,  but  it  is  not  applicable  to  all  cases  of  lupus, 

^d  I  more  often  employ  linear  scarification.     To  practice  this, 

'^  needle,  slightly  flattened,  with  sharp  edges  may  be  used.  Or, 

lyiowing  the  example  of  Balmanno  Squire,  a  scarificator  with 

numerous  blades,  which  he  has  expressly  constructed,  may  be 

nsed.     Personally,  I  find  the  needles  most  easy  to  manage,  and 

I  make  the  linear  incisions  separated  by  a  few  millimetres.     I 

place  my  incision  in  such  a  way  that  some  are  perpendicular  to 

the  others,  and  I  repeat  the  operation  one  or  more  times  a  month 

until  the  lupus  is  well.     I  have  obtained  by  this  practice  very 

good  results,  and  I  believe  that  this  method  is  destined  to  be  of 

great  service.     It  offers  one  inconvenience,  that  is,  it  gives  rise 

to  hemorrhage,  which  may  be  very  abundant,  and  in  patients 

with  frail  constitutions  this  may  be  injurious.     I  sEould  say  a 

great  deal  of  this  loss  of  blood  may  be  avoided  by  applying  to 

the  lupoid  surfaces,  before  operating,  some  con vement  anaesthetic 

and  afterward  by  the  immediate  use  of  perchloride  of  iron  ;  this 

may  be  simply  done  by  means  of  a  piece  of  blotting  paper,  as 

recommended  by  Balmanno  Squire.    Another  recommendation 

of  Unear  scarification  is,  that  it  can  be  more  easily  and  more 

promptly  repeated  than  cauterizatioa — Med.  ^  Surg,  Reporter. 


280  TASADA   MEDICAL    ANT>   SrHOICAL   JOUR^fAL, 

Copaiba  In  Cirrhosis  and  Janndlce.— Th« 

value  of  copaiba  as  a  (iiuretic,  and  cbolngogue  is  not  sufficientlj 
appreciated,  The  following  case,  reported  in  the  British  Med. 
Journal,  by  Dr.  J.  E.  Maasiah,  illustrates  it : — . 

W.  D.,  aged  37,  a  clerk,  was  a  spirit  drblter  for  four  jeaiSf 
seven  years  ago  ;  and  during  the  last  four  years  and  a  half  hu 
had  three  prolonged  and  painful  attacks  of  jaundice,  with  aacitetf 
and  oedema  of  the  lower  limba.  On  admiaaion,  three  months 
ago,  he  was  tawny,  thin  and  rather  weak.  He  complained  c 
constant  pain  in  the  umbilical  and  lumbar  regions.  Ilia  fluctua& 
ing  abdomen  measured  thirty-four  inches  in  circumference,  and 
the  vertical  hepatic  dullness  in  the  nipple-line  was  three  inchea, 
The  urine  was  scanty,  bilious,  and  exalbuminous. 

During  the  first  month  he  took  bitartrate  of  potash  and  coi 
pound  jalap  powder ;  and  the  abdomen  increased  two  inches 
the  urine  remaining  scanty.     Then,  under  a  scruple  of  copaibt 
thrice  daily,  rose  on  aucoeasive  days,  from  one  pint  in  twenty-i 
four  hours  to  three,  four  and  five  pints  ;  while  the  ascites  begi 
to  sul'eide.     Once,  for  a  fortnight,  he  took  half  a  drachm  ) 
tincture  of  belladonna  thrice   dwly,  for  the  abdominal   pfuOj 
and  the  cjuantity  of  urine  fell  below  two  pints  daily.  The  abdo- 
men now  measures  thirty-three  inches  in  circumference,  and  h 
general  health  is  much  improved. — Med.  ^  Sitrffieal  Reporter, 

Necrosis  ^^ithout  Suppuration.— Wiiiiai 

Colics,  M.  D,,  in  the  Dublin  Journal  "f  Medical  Sciences  1 
December,  1878,  reports  the  following  case :  — 

"  F.,  aged  15,  healthy,  waa  thrown  from  a  carriage  a; 
received  some  bruises  on  the  face  ;  also  there  was  a  slight  trai 
verse  wound,  about  one  fourth  of  an  inch,  at  the  ulnar  side 
the  left  wrist  close  to  the  joint.  Through  this  opening  projei 
ted  a  small  piece  of  very  rough  bone,  which  was  considered 
be  the  lower  end  of  the  ulna  broken  off  and  projecting, 
could  not  be  restored  or  retained  in  position.  Two  days  lal 
she  was  put  under  the  influence  of  chloroform,  bnt  it  was  ij 
found  impossible  to  restjire  the  '  '  -  ..     ^   *     - 

was  therefore  delerrained 


BRITTBH   AND   FOBBIGN   JOtBNALS.  281 

With  this  view  the  piece  waa  caught  in  a  forceps,  and  a  director 
passed  behind  it.  It  was  found  that  the  latter  instrument  could 
be  easily  passed  for  a  considerable  distance  in  all  directions 
without  obstruction  from  ligamentous  or  other  attachmeota.  On 
bending  the  hand  backwards,  and  pressing  the  director  in- 
wards, there  slipped  out  a  portion  of  bone  two  inches  long.  On 
esamining  the  forearm,  the  hones  seemed  quite  naturally  in 
their  position,  but  perhaps  slightly  larger  than  those  of  the  op- 
po^te  limb.  On  examining  the  bone  extruded,  it  was  much 
smaller  than  would  be  expected  in  a  person  of  her  age  ;  it  was 
qnite  devoid  of  periosteum ;  no  cartilage  or  epiphysarj  end, 
but  a  small  rough  deposit  of  new  bone  ;  the  upper  end  irregu- 
lar, jagged,  but  in  no  part  did  it  present  any  appearance  of  its 
having  been  acted  on  by  living  parts ;  and  on  section — which 
waa  difficult,  from  the  dryness  and  friability  of  the  bone — the 
medullary  cavity  was  the  same  as  in  ordinary  section  of  bones- 

"  On  further  inquiry  it  was  found  that  about  eight  or  ten 
years  ago  the  patient  fell  and  received  what  was  called  a  sally- 
switch  fracture  of  both  bones ;  this  was  treated  by  splints  and 
rest ;  she  recovered  with  perfect  use  of  the  limb,  but  there  waa 
a  slight  thickening  of  the  bono. 

"  That  this  was  a  case  of  necrosis  there  can  he  no  doubt ; 
and  if  it  was  the  result  of  injury,  it  must  have  been  of  only  two 
days'  duration,  which  is  scarcely  possible  for  the  bone  to  die,  to 
lose  its  periosteum,  cartilage,  and  epiphyeary  end,  and  for  a  new 
case  to  be  formed  around  the  dead  bone.  Ilence  it  was  more 
probably  the  result  of  the  fracture  received  so  many  years  ago," 
—Medical  Record,  N'.T. 

Gastro-elytrotomy. — a  very  interesting  histori- 
cal account  of  this  operation,  by  Henry  J.  Garrigues.  M.D.,  has 
been  reprinted  in  pamphlet  form  from  the  New  York  Medical 
Jowmal.  It  was  first  proposed  by  Joerg  in  1806,  but  his  idea 
was  an  incision  in  the  median  line  involving  the  peritoneum.  In 
1820,  Ritgen,  profiting  by  Joerg's  suggestion,  and  improving  on 
it,  performed  t!ie  operation  by  a  lateral  incision  above  Ponpart'a 
ligament  and  elevating  the  peritoneum.     He  incised  the  vagina, 


283 


CANADA   MKDIOAL   AND   STIROICAL    JOtTBNAL. 


however,  instead  of  tearing  it,  and  the  operation  was  abandoned, 
and  a  living  child  being  delivered  by  Caesarian  section.  From 
1825  to  1844  Baudelocque,  apparently  ignorant  of  his  prede- 
cessora,  championed  this  operation  or  some  of  his  numerous 
proposed  modifications  of  it,  and  performed  it  in  two  cases  un- 
successfully. From  this  time  it  was  forgotten,  or  mentioned  only 
to  be  depreciated  by  the  authorities  on  obstetrics,  until  1870, 
when  Dr.  T.  J.  Thomas  performed  it.  and  delivered  a  living 
child.  Dr.  Thomas  has  since  operated  once,  and  Dr.  Skene,  of 
Brooklyn,  three  times,  making  in  all  five  cases ;  of  these,  three 
of  the  mothers  are  still  alive,  and  four  living  children  were 
delivered ;  the  fifth  child  was  dead  before  the  operation  was 
undertaken,  and  the  two  women  who  succumbed  were  in  artieulo 
tnortis.  The  necessity  of  tearing  the  vagina  instead  of  cutting 
it  is  strongly  insisted  upon,  as  troublesome  and  even  dangerous 
bleeding  from  the  vaginal  plexus  is  thus  avoided.  The  operation 
cannot  be  repeated  upon  the  same  side,  as  it  would  be  impossible 
to  raise  the  peritoneum  and  lift  the  vagina.  When  the  head  ia 
wedged  in  the  pelvis,  so  that  it  cannot  be  pushed  up,  the  intusion 
of  the  vagina  becomes  impossible,  and  the  operation  is  contra^ 
indicated.  The  obstruction  offered  by  the  presence  of  a  solid 
tumour  in  the  vagina  or  uterus,  or  by  atresia  or  coarctation  of 
the  vagina,  may  also  be  a  sufficient  contra-indication  Dr. 
Garrigues's  conclusions  are  ;  1.  Gastro^Iytrotomy  ought,  when 
possible,  to  be  performed  instead  of  Caesarean  section  in  all 
cases ;  and  instead  of  operations  by  which  the  fcetus  is  broken 
up  when  these  would  be  particularly  difficult,  especially  when 
the  smallest  diameter  of  the  pelvis  measures  two  inches  and  a 
half  or  less.  2.  It  does  not  require  exceptional  skill  or  rare 
instruments.  It  is,  indeed,  less  difficult  than  ovariotomy  and 
herniotomy,  3.  Five  assistants  are  desirable,  and  four  indispen- 
sable, in  order  to  carry  out  Thomas's  plan, — Medical  Record, 
Jf.Y. 


BBITIflH   Ain>  rOREION   JODHIfjlLS.  283 

Ergrottn  In  a  Case  of  Uterine  FIbroicL— 

(Note  on  the  use  of  Ergotin  in  a  case  of  Uterine  Rbroid,  by 
J-  Crawford  Rrwton,  M.B.,- Extra  Assistant  Surgeon  to  the 
Western  Infirmary,  Glasgow  : — 

Mitff  ttt  —  ToMiay  saw  Mrs.  L.,  set.  forty-five.  Patient 
complains  that  for  the  last  six  months  her  menstrual  periods, 
b&Te  been  increased  in  frequency,  and  the  discharge  doubled  in 
amount ;  for  the  past  three  months  she  has  hardly  been  free 
from  the  discharge,  and  at  times  it  has  poured  from  her,  produ- 
cing fointness.  She  also  sufiers  from  breathlessness  on  any 
exertion. 

Her  appearance  justifies  her  statement,  as  she  looks  ansemic 
^n«l  the  exertion  of  speaking  tries  her  ;  she  is  a  spare,  thin, 
*"ghtly-built  woman.  Her  previous  history  shows  that  she  has 
always  had  a  copious  discharge,  and  on  one  occasion,  after  a 
ttiiacarriftge  she  suffered  from  severe  hsemorrhage.  Her  children 
*^©  Lealthy  and  her  family  history  good. 

Examination  per  Bypogattrium.  —  On  pressure  patient 
Complains  of  alight  tenderness  in  the  left  iliac  region.  No 
***largenient  of  the  uterus  can  be  felt. 

■^er  Vaginam  —  Cervix  is  found  to  be  thrown  forward 
to^ffardfl  the  pubes,  and  posteriorly  Douglas'  space  is  filled  by  a 
l&irge  mass  of  dense  consistence,  which  is  slightly  movable  up- 
''•'a*^.  Os  closed.  Sound  passes  three  inches.  Heart  sound 
"Weak,  and  a  loud  anaemic  bruit  is  heard  over  cardiac  region. — 
No  signa  of  any  pulmonary  or  other  complication.  Urine  normal. 
SnJ. — Professor  Leishman,  to  whom  I  am  indebted  for  the 
jK^lvic  conditions,  saw  the  patient  along  with 
1  coincided  nith  me  in  recommending  rest  in  bed,  good 
.1  of  ergotin,  either  subcutaneously  or  by  suppo^- 
iggcated  in  addition  the  introduclaon  of  a  Hodge's 
e  support  and,  if  possible,  to  rwse  the  tumour 
I  forwar^ls, 
9  grains  of  ergolan  injected  subcutaneously,  but 
a  much  pun  in  her  arm  after  it  that  we  had 
Ml  four  gnuns  in  each.    At  first  she  had 


284  CANADA   MEDICAL    AND   80E(3ICAL   JOUBNAt. 

two  daily,  but  the  discharge  continued  so   profuse  that  ve 
increased  the  dose  to  four,  equal  to  16  grains. 

\2th. — After  having  the  above  four  days,  she  suffered  from 
severe  headache  and  sickness,  but  the  discharge  diminished,  and 
for  the  first  time  for  three  months  she  waa  free  from  the  drain 
on  her  system.  She  was  now  ordered  to  have  two  suppositories 
daily,  and  this  was  continued  for  a  week,  and  then  only  one  was 
nsed  until  the  26th,  when  the  discharge  commenced  again,  but 
not  in  the  severe  manner  it  had  done  formerly. 

28(A. — As  several  clots  came  away  to-day,  the  dose  was 
doubled. 

June  5th. — Discharge  quite  ceased. 

12(A, — Patient  is  steadily  improving;  she  has  been  allowed   i 
to  rise  and  rest  on  a  sofa.  A  tracing  of  her  pulse  at  this  period  I 
showed  a  very  weak  wave,  and  she  was  ordered  Fostans'  citrate 
of  iron  and  strychnine,  the  ergotine  bemg  omitted. 

16th. — Four  grains  of  ergotin  resumed  at  night. 

ZOtJi. — Discharge  commenced  and  continued  in  moderate 
degree  for  ten  days. 

She  mentioned  that  she  thought  there  was  a  difference  in  Hm 
colour  of  the  discharge,  and  she  asked  if  it  were  possible  the' 
medicine  were  coming  away  in  it. 

She  was  requested  to  omit  using  a  suppository  for  two  nights, 
and  to  send  a  specimen  of  the  menstrual  fluid,  aa  also  of  the 
urine,  for  examination.     On  being  tested  the  former  gave  with 
potash  a  distinctly  fishy  odour,  which  was  appreciated  by  other 
medical  men  who  happened  to  be  present  (odour  was  not  due  to  I 
putrefaction)  ;  it  was  again  examined  the  following  month,  and  I 
the  same  odour  felt.     The  urine  gave  no  such  reaction  with  1 
potash. 

October. — Patient  continues  to  menstruate  regularly,  and  her 
general  health  has  so  much  improved  that  she  is  able  to  attend 
to  her  household  duties  with  comfort.  She  still  uses  the  ergotm 
for  five  days  previous  to  a  period. 

We  think  we  may  fairly  ascribe  the  improvement  in  this  c 
to  the  ergotin,  and  if  further  observation  confirms  the  presence 
of  the  drug  in  the  discharge,  it  will  go  far  to  establish  its  affinity 
for  the  uterus. —  The  Practitioner. 


Igeilical  and  f  utjical  loutnal. 


■  Montreal,  January,  1879. 

THE  PRESS  AS  AN  EDUCATOR. 

We  have  been  forcibly  impressed  mth  the  influence  of  the 

f>:B:'«es  for  good  or  evi],  and  we  are  inchned  to  believe  that  in 

^«2:Ty  many  caaesitis  a  promoterof  immorality.  This,  in  a  great 

^■^  ensure,  proceeds  from  the  prurient  desire  of  the  general  public 

fc**-  scandalous  gossip.  As  a  rule  the  piiblic  taste  lies  more  in  the 

li«ie  of  what  is  horrible  and  shame-faced,  than  of  what  is  inatruo- 

tx-ve,  of  good  report,  or  of  moral  worth.  If  a  paper  were  published 

■^fcicli  excluded  everything  that  was  immoral,  or  the  recounting 

oF  the  misdeeds  of  misguided  men  and  the  punishment  for  crime. 

Xf  its  pages  contained  alone  the  fair  side  of  humanity  without 

^•Dj  of  ite  debasing  qualities,  it  would  he  regarded  as  too  tame, 

tiot  worth  reading,  and  therefore  would  have  no  circulation.  No 

I  person  would  be  bothered  with  such  literature  ;  so  that  for  the 

1  purpose  of  securing  ready  sale  and  a  large  circulation,  a  paper 

W  must  have  a  large  supply  of  the  horrible  intermingled,  with  a 

1  view  of  pointing  to  a  moral.    On  this  subject  the  Pacific  Medi- 

^^^    Baland  Surffical  Journal  remarks  as  follows: 


THE  PBESB  AS  A  PROMOTER  OF  CRIME, 


"The  Infectiougtendencjof  Tito  and  crime  iauoiverBally  acknowledged. 
Bpontdii;  cues  develop  the  epidemic  dijithcsia  in.  proportion  to  the  pub- 
mij  which  l«  given  Uiem  by  tbe  t^nguo  snd  the  press.  Suicide  ofters  % 
Uuked  illnnntion.  A  consid'-rntioD  of  tliia  vine  brings  in  rleir  the 
Influence  of  the  prees  on  tlit  momJa  of  aocicty.  Ciislom  looks  at  the  fair 
[We  md  regards  the  prese  as  a  aoiirce  of  light,  knowlodgu  and  njoiality. 
The  other  side  doea  not  appear,  for  there  la  no  mecliam  through  which  it 
'WD  appear  but  the  preaa  itaelf,  aad  the  press  will  not  publish  its  own 
tlwjne.  If  the  every-day  eipreaaions  of  individuBls  concerning  the  preaa 
cooM  be  embodied  in  one  utterance,  thunder  would  bo  gantla  music 
Mtnpsred  with  the  report.  If  the  prcas,  or  any  conRiderable  portion  of  it 
— WB  mean  Ihe  uculat  or  the  aowapftpcr  press — were  conducted  with  tho 
ootive  of  diffusing  useful  knowledge  and  cnltivating  morality,  the  cue 
-onid  U  different.  Hut  unfortunately,  tiiough  this  motive  may  enter  into 
""""'     ~~'      newspaper  is  good  for  nothing  unless  it  publiiheB  evaij- 


CAKADA  HXDrCAL   AND  SDmOIOAL   JOmNAL. 

thing,  good  or  bad  ;  and  hence  its  contents  are  gathered  promlsctiotuly 
Irom  the  public  sewer,  iind  it  becotaei  a  Tebiole,  not  for  choice  and  oMfd 
reading,  but  for  everything  tnie  aud  Mte,  clean  and  unclean.  The  que«- 
lioa  ie,  not  vbat  vill  most  benelit  the  readers,  but  what  will  most  benefit 
the  piibliahorB  and  increase  the  demand.  Deeds  of  violence  and  blood  are 
choice  materials  for  extensive  elaboration.  Sexosl  miaoonduct  and 
obacenitf  are  hunted  up  irifh  keen  reliab.  Scnndai.  slander,  rumors  of 
private  aSuira  true  or  ^ac,  advertisements  of  fortune-tellers,  quacks  and 
abortionists — such  is  the  modern  newspaper ;  the  "  palladium  of  liberty,*" 
the  messenger  of  intelligence  and  reform  1  Mtlcb  is  said  of  lute  concerning 
•civer-gss  as  a  source  of  physical  disease.  We  may  regard  the  daily  press 
with  a  few  honorable  exception,  as  a  great  moral  sewer  xteolthily  pouring 
into  our  domiciles  the  germs  of  moral  depravity — the  more  dangerotii 
because  commingled  with  the  current  news  which  is  as  necassftry  as  O^H 
daily  bread."  flH 

TROMMER  EXTRACT  OF  MALT  COMPANY.       " 

Kothiiig    can    be    more    discouraging    to    the    practising 
Physician  than  the  gradual  dechne  of  patients  from  exhausting 
disease  due  to  faulty  assimilation,  yet  hon  common  is  this  t 
case.     The  physician  exhausts  his  armamentorium  viedi 
going  through  the  whole  category  of  tonics  and  nutiienta,  a 
still  his  patient  passes  on  in  a  gradual,  some^es  rapid  cours 
from  bad  to  worse, 

We  do  not  assume  that  the  Extract  of  Malt  is  a  uniTera 
panacea,  but  that  it  is  suitable  in  the  large  proportion  of  so^ 
eases  cannot  be  denied.  The  testimony  of  physicians  in  I 
countries  is  sufficiently  pronounced  to  arrest  the  thoughtfulnol 
of  the  practitioner  and  to  induce  him  to  believe  that  there  if 
means  of  relief  ready  and  at  hand  for  these  veiy  hopeU 
cases,  in  this  malt  extract. 

Cod  liver  oil  was,  when  first  introduced,  considered  a  coi 
especially  in  debilitating  maladies,  yet  there  are  cases  in  whicf 
this  remedy,  for  it  is  a  highly  tiseful  one,  will  fail  most  sigt 
to   ^ve   even   temporary   relief.     Cod   liver   oil   comes  mai 
properly  under  the  denonoination  of  a  food,  but  there  19  suchf 
thing  as  giving  food  to  a  stomach  incapable  of  utilizing 

Malt  extract  from  its  chemical  composition  seems  suitable  to 
these  very  cases  when  through  some  want,  the  ssamiUtion  of 
ihc  food  is  not  properly  carried  on.  It  is  found  to  contain  Malt 
',  Dextrine  and  IHastase.  Dtuiiig  the  process  of  digestion 
^the.  stUKh  ■'»  &[^fjlgggg^/^§jjjlgj^#titioo  and  finally  into 
f'a  already  comcrltd 


CANADA   VINB-aaOWEEB'   ASSOCIATION,   COOKBVILLE. 


287 


'  into  dextrine  its  final  transformation  into  glucose  ia  more  readily 
efiected  than  if  presented  to  the  digestive  apparatus  as  starch. 
It  may  be  on  this  principle  that  malt  extract  owes  its  digestible 
qualities.     But  then  it  contains  that  peculiar  vegetable  principle 
•diastase,  which  is  developed  during  the  process  of  germination, 
one  part  of  which  ia  sufficient  to  changs  100  parts  of  starch  into 
gl'jcose.     It  is  declared  by  some  that  thb  principle  diastase 
poaaessea  the  property  of  augmenting  the  digea^ve  fluid  of  the 
stcniach.     The  Trommer  Extract  of  Malt  Co.  have  prepared 
^    number  of  combinations,  such  as  Extract  of  Malt  with  hops, 
■^ith   Cod   liver   oil,  with   hypophosphites,   with   pepsin,   and 
■^rith  preparations  of  iodiae,  phosphorous,  manganese,  iron  and 
•JtiJDine.     These  are  exceedingly  elegant  preparations  and  the 
'^ormulae  are  given  with  each  so  that  the  prescriber  can  without 
^^>ivich  research  know  exactly  the  dose  and  quantity  of  each 
*i«~iig  he  prescribes  for  his  patient.      We  have  no  personal 
^^^srperience  in  the  use  of  the  Ext.  of  Malt,  but  there  is  abun- 
*i«.iice  of  evidence  of   its   usefulness  to  bo  met  with  in  the 
*»»edical  literature  of  the  day.     Mr.  R.  L.  Gibson,  the  repre- 
sentative of  the  Malt  Company,  is  in  this  City  at  present  and 
_^^   iiBing  every  exertion  to  bring  this  valuable  Extact  and  its 
^^BOXnbinatioDS  prominently  before  the  public. 

^B    -We 


CANADA    VINE-GROWRES'    ASSOCIATON, 
COOKSVILLE,  ONT. 
TVe  have  received  from  Mr.  James  White  specimens  of  three 
Jidea  of  wine  manufactured  from  grape  juice  by  the  above 


"Oinpany. 

7his  is  a  new  industry  in  our  country,  and  we  understand  that 
'^xrtensive  vineyards  are  under  cultivation  which  supply  several  ■ 
^a.rietie3  of  grape  capable  of  making  an  unlimited  quantity  of 
^^uie.  The  wine  in  iome  respects  is  superior  to  that  imported, 
**>d  as  a  Canadian  enterprise  is  of  vast  importance  to  the  pros- 
l*oiity  of  our  country.  The  qualities  which  we  have  received 
*■*■«  a  white  claret  which  ia  a  full  bodied  wine,  possessing  a 
pleasant  flavour  and  is  nutritions  and  strengthening.  We 
Bnould  suppose  it  would  he  very  beneficial  to  those  recovering 
^ma  cUbilitatmg  JulmeBte  such  as  favers  o£  aU  laodaj  and  other 


2S8  CANADA  MEDICAL  AND  SITROtCAL  JOUBNAL. 

exhausting  diaeaaes.  We  do  not  believe  that  wine  or  spirit  of 
any  kind  is  an  esaential  aliment,  bnt  wo  are  fully  alive  to  tha 
benefit  to  be  derived  by  a  prudent  use  of  wine  in  those  con- 
ditions of  the  Byatem  in  which  the  assimilative  powers  E 
fault  from  deranged  function.  We  have  made  trial  of  tho 
wine  given  to  UH  by  the  Canada  Association,  and  we  believe  it 
to  be  a  pure  juice  wine  palatable  and  nutritious ;  it  contaioB 
much  grape  sugar  and  a  sufficient  quantity  of  alcohol  to  pre- 
vent fermentation  if  carefiJly  kept  from  exposure.  A  second 
kind  of  this  wine  ia  called  Madeira  and  very  closely  reaembles 
the  Madeira  produced  in  the  Island.  There  ia  a!i 
wine  which  ia  less  fiery  than  the  imported  port,  but  very  similai 
to  it  in  flavour.  These  wines  are  comparatively  cheap,  and  i 
think  they  might  with  propriety  be  introduced  into  use  in  oui 
hospitals  as  they  can  be  furnished  at  a  little  over  one-half  the 
cost  of  the  lower  grades  of  imported  wuies,  being  at  the  a 
time  to  our  taste,  quite  equal  if  not  superior  to  the  bettn 
qualitiea  of  thoaa  wines. 

Sftedical  Itemi 

Lunatic  Asylums  is  the  Provinck  op  Qdbbec. 
7*0  the  Editor  of  The  Medical  and  Sorqical  Journal. 

Deab  Sib, — Your  readers  being  very  interested  parties  a 
to  the  mode  of  procedure,  to  obtain  orders  for  the  admission  d 
patients  into  either  of  the  asylums,  I  beg  to  inform  thetOj 
that  by  virtue  of  an  order  in  council,  passed  in  the  month  d 
November,  1878,  at  the  auggestion  of  the  Hon.  Prov.  SeoretaiT^ 
Mr.  Marchand,  under  jw  circumstances  whatever,  can  any  n 
paying  patient  be  admitted  into  either  of  the  asylums  withoi 
a  government  order,  and  this  order  can  onl^  be  obtfuned  h 
making  an  application  for  it  to  the  Hon.  Pl^3vincial  Seoretarj 
Quebec.  Where  application  is  made  to  him,  the  applicant,  a 
once,  receives  all  neceasary  information. 

Truly  Yours, 
HENRY  HOWARD,  M.D. 

QoTt.  Med.  Attendant,  Luofttic  ixj\via,  J-ODgue  Poinle,  P.( 


CANADA 

Medical  &  Surgical  Journal" 

FEBRUART.  1879. 

Original  eommunications. 

"LISTERISM." 
By  Thos.  G.  Roddick,  M.D., 

ProftsBor  of  Clinical  Surgery,  McGlU  Univerailj  ;  Attending  Hurgoon 
MoDtre&l  Ocnoral  BoKpital. 

(Being  Kpftrer  read  before  iheainadB.Mediul  Anaooiatiim,  uiembled  Bt  Bimillon, 
Ontario,  Septembtr,  IgTS.) 

By  a  aomowhat  ainguiar  coincidence,  it  waa  exactly  twelve 
montha  yesterday  since  the  antiseptic  eystem  of  Liater,  or 
"  Listerism,"  aa  the  Germans  have  choaoo  to  terra  it,  was  firat 
introduced  into  the  practice  of  the  Montreal  General  Hospital, 
aad  if  I  mistake  not  (although  in  this  I  am  open  to  correction,) 
into  Canada.  During  the  year  the  method  has  been  carried 
out  in  every  operation  of  any  magnitude,  and  the  results 
obtained  have  been  on  the  whole  most  gratifying,  and  in  some 
casea  almost  unprecedented. 

As  there  are  probably  some  of  the  members  of  the  Associa- 
tion present  who  have  iievcf  seen  an  operation  performed 
antiseptically,  I  will,  without  further  prelude,  briefly  describe 
the  apparatus  at  present  employed  by  Lister,  and  then  read  tho 
notea  of  a  few  casea  in  which  the  method  has  been  employed. 

I  will  describe  briefly  tho  mode  of  procedure  adopted  in  the 
wards  under  my  caro.  A  railway  accident  is  brought  in,  let  us 
say,  in  which  amputation  is  demanded.  The  firat  duty  of  tlie 
house  surgeon  is  to  elevate  the  limb  and  apply  Eamarch'a  band, 
as  well  with  a  view  to  arrest  the  hemorrhage  aa  to  dull  the 
NO.  LXXIX,  !!• 


I  CANADA    MEDICAl,   ASK    SFRQICAL    JOOENAL. 

sensibilities  of  the  part,  for  a  tight  ligature  undoubtedly  has 
anreathotic  effect  in  such  cases.  So  convinced  am  I  of  t 
that  before  proceedini;  to  open  a  whitlow,  I  am  in  the  habit 
invariably  of  applying  a  tight  elaatic  ligature  to  the  finger  ot 
wrist,  as  the  case  may  demand,  first  emptying  the  part  of  blood 
I  presume  the  explanation  la  in  the  interference  to  tbe  nenrft 
currents,  The  extremity  is  then  enveloped  as  far  up  as  th< 
wounds  extend  in  a  towel  saturated  in  a  1  to  20  solution  0 
carbolic  acid,  the  object  being  to  imprison,  and  at  the  same  tinU 
to  destroy  any  putrefactive  elements  that  may  be  lurking  aboid 
the  lacerated  tissues.  Now  preparations  are  made  for  th 
operation.  The  eponges  are  wrung  dry  out  of  a  solution  < 
1  to  20  ;  the  instruments  are  placed  in  a  solution  of  1  to  2ft 
and  the  part  to  be  operated  on  is  thoroughly  cleansed  with  | 
solution  of  the  same  strength.  Carbolic  acid  has  a  remarkaWi 
penetrating  property,  blending  with  oily  aabstances  and  anima 
matters,  entering  the  air  folicles,  and  altogether  rendering  ti 
skin  absolutely  pure  for  surgical  purposes.  A  carbolic  solulia 
of  1  to  40  is  made  ready  to  bo  used  for  washing  sponges  durin, 
the  operation,  for  cleansing  the  hands  of  the  operator  an 
asaistanta,  and  for  moistening  the  deeper  dressings. 

Next  in  order  is  the  Spray^roducer — one  of  the  most  essai 
tial,  while  it  is  at  the  same  time  the  most  troublesome  item  i 
the  whole  proceeding.  The  instrument  I  show  you  was  recently 
purchased  from  Archibald  Young,  instrument  maker  of  Edia 
burgh,  at  a  cost  of  .£8  stg.  It  is  the  largest  size  manufacturol 
by  him,  and  is  of  the  ma,ke  recommended  by  Mr.  Lister. 
acte  on  the  principle  of  Siegle's  stoam  inhaler,  the  boiler  betiu 
filled  with  water,  and  the  bottle  with  1  to  20  carbolic  solution 
giving  an  antiseptic  atmosphere  of  1  to  40.  The  instramen 
may  either  be  placed  on  a  table  and  directed  on  the  part,  o 
better  still,  held  by  an  assistant,  who  should  be  seated.  Th( 
spray  should  always  if  possible  he  projected  towards  the  ii^l 
as  it  can  then  be  directed  with  more  exactitude.  ■ 

Carfiril'- .  r  '"'.  ■    ■  r -■  !       I'ssentials, should bi 


'  Dr.  i; 


■Ik>  wuy,  li«B  tevetitfa 
'  Aiitiwi{ilii.'  UijUigd," 
am  bn  attDngly  rucon 
I  IbitftTcDgtb  of  tbe  BritU 


"  LIBTERIBM." — BY  DR.    RODDICK. 


291 


at  hand.  This,  which,  by-the-way,  can  generally  be  obtained 
ready  for  uBe,  is  prepared  after  Lister's  directions,  in  the  fol- 
lowing way :  add  one  measure  of  water  to  ten  parts  by  weight 
of  crystalized  carbohc  acid,  mi.x  and  add  one  measure  of  the 
mixture  to  five  measures  of  olive  oil  in  a  suitable  jar  or  wide- 
mouthed  bottle ;  then  at  once  introduce  the  cat-gut,  the  hanks 
being  opened  up  to  allow  access  of  the  liquid  to  them ;  cover 
and  set  aside  in  a  cool  place.  It  is  found  that  the  small  quantity 
of  water  present  makes  all  the  difference  possible  in  the  quality 
■  of  the  ligature,  causing  the  tissue  of  which  the  gut  is  composed 
to  undergo  a  remarkable  physical  change,  which  has  never  yet 
been  satisfactorily  explained.  This  emulsion,  so  to  speak,  seems 
to  deprive  it  of  its  peculiar  slippery  nature,  and  it  is  asserted 
that  when  properly  prepared,  a  reef-knot  tied  upon  it  holds 
better  than  one  of  waxed  silk.  By  the  addition  of  chromic 
acid  to  the  oily  mixture,  the  "  staying  "  power  of  the  gut  \e 
materially  increased. 

The  Antiieptia  Gauze  cornea  up  next  for  consideration.  This, 
■which  in  the  raw  state  is  known  as  dairy  or  cheese-cloth,  is  pre- 
pared for  surgical  purposes  as  follows  :  Melt  together  in  a  water 
bath  five  parts  of  common  resin,  and  seven  parts  of  solid  paraffin, 
then  add  one  part  of  crystalized  carbolic  acid.  The  cotton-cloth, 
which  is  usually  a  yard  wide,  is  cut  into  lengths  of  six  yards, 
and  folded  to  the  dimensions  of  half  a  yard  square.  Several 
such  pieces  are  placed  in  a  dry  hot  chamber  formed  by  two  tin 
boxes  placed  one  within  the  other,  the  interval  being  occupied 
by  water,  which  is  kept  boiling  by  a  couple  of  the  gas  stoves  so 
commonly  in  use  now-a-days.  After  two  or  three  hours  the 
heated  gauze  is  removed  and  then  rapidly  replaced  layer  after 
layer,  and  sprinkled  with  the  solution  by  means  of  a  syringe 
having  a  number  of  minute  perforations  in  its  extremity,  and 
supplied  with  wooden  handles  to  protect  the  hands  of  the  work-  . 
man  A  woight  of  about  forty  pounds  in  tbe  shape  of  a  lid,  is 
put  in  the  chamber  to  compress  the  charged  cotton.  This,  also, 
should  have  been  previously  heated.  Generally  in  the  course 
of  two  or  three  hours  the  liquid  will  have  become  equally  distri- 
buted throughout  the  gauze,  and  the  material  is  fit  for  use.  The 


Ca-fAOi   KEOITAl.   J 


cant  for  nnuibctaic  in  eonateiUft  qMiitilW  (a;  1000 
7trds),iaabcwt  S}d.  perjvd.  Sofled  ^ue  may  be  recharged 
after  a  tboroa^  wadm^  and  soaking  in  rery  bot  water.     Tliat 


^me  whieli  is  to  be  apffied  direcdj  to  a  vonnd,  ia  fi 
vitk  the  1  to  20  caiboGc  solatioD,  the  reaaon  far  tin  haag.  Unit 
&e  aatiBeptie  is  ffrea  off  m  riowly,  and  in  mcfa  id  eilienHij 
■maO  amooBt,  dttt  dast,  ke.,UEBgoaitin^Biit  be  depnvad 
of  Aar  aeptie  qaaEtwa.  Hie  beftf;  dieflBinp  conaet  of  a^ 
layen  <rf'  ^me,  a  tbeet  of  impeimeable  materia],  aa  rvbber- 
dotli,  MaekinttMli,  or  gsttaperclia  tiane,  being  iuerpeacd 
between  the  serendi  and  laat  lajer.  This  is  to  prarent  the 
diachargDe  from  making  di«r  wa;  too  directlj  thnm^  the 
drean^  the  idea  being  that  tbey  ahaD  reach  the  external  air 
by  tbe  kmgcst  roate.  The  eighth  layer  of  gaoxe  is  intended  as 
a  reserre  in  the  erent  of  u>j  opemngs  in  tbe  MackinMli  bsnsg 
been  overlooked.  Tbe  gauze,  bj-tbe-waj,  is  always  osed  far 
brndagnas  weU. 

To  ensnre  dw  speedj  exit  from  woonds  of  aD  Bqnid  aecuan- 
tatioDs,  resort  is  oaoaDy  had  to  die  ordinary  eaovtcfane 
drainage  tubing.  Ttis  shoaM  vary  in sse  and proportioD  to Ibc 
qoaotity  of  discharge  anticipated,  and  the  boles  ritcwld  be  fe 
The  outer  e&d,  when  ap^^ed,  should  be  cut  flnsh  with  ibaa 
and  armed  with  a  twisted  wire  to  prevent  ita  beingpnrited  I 
the  dreasing.  The  cat -gat  drain,  so  strongly  rectanineadei  ly  1 
my  friend  Mr.  Chiene,  of  Edinbor^,  cooasta  of  a  Am  at  fima 
eight  to  aizteen  threads,  depending  oo  die  aie  and  impmlanco 
of  Che  wound.  This  form  of  drain  has  the  great  ment  of  tjmetly 
vanishing  after  its  work  is  done,  and  is  especially  suitai^  far 
minor  opertilions ;  althon^  I  hare  no  doubt,  in  tbe  baads  of 
ancfa  an  able  advocate,  it  is  deetmed  to  oectipy  a  pnyaaaeat  plaee 
in  the  apparatus  of  the  antiseptie  SMrgeoo.  Bimt  iah,  [vofieriy 
purified  by  soaking  in  l-to-SO  carfodic  aolnlaon,  also  makes  an 
excellent  drain, 

Tbe  Protective,  so-called,  is  composed  of  thin  oil  alk,  wnidted 
wi&  copal  and  then  coated  with  a  layer  of  dextrine,  whicb  tattsr 
allows  the  oil-silk  to  become  tmifacmly  wetted  by  tbe  a 
eohition.    This  is  moistened  with  the  1  to  40  and  a 


'^  LISTKUSM/' — BT  DR.   RODDICK.  293 

diately  to  the  wound  in  a  narrow  strip.  As  its  name  implies,  it 
protects  the  wound  from  the  often  too  irritating  action  of  the 
carbolic  acid  contuned  in  the  deeper  dressings.  I  never  employ 
it,  however,  in  the  first  dressings,  being,  I  think,  unnecessary  at 
this  early  stage. 

It  is  a  well  known  fact  that  the  ordinary  carbolic  solution  is 
often  too  stimulating  when  applied  to  wounds,  and  retards  the 
healing  process  in  a  marked  degree.  In  that  case  the  prepara- 
tion termed  by  Mr,  Lister,  Salicylic  Creamy  can  often  be 
substituted  in  the  later  dressings.  This  is  made  simply  by 
mixing  together  in  a  mortar  salicylic  acid  and  l-to-40  carbolic 
solution  until  the  consistence  of  thin  cream  is  obtained. 

Having  now  described  briefly  the  more  important  articles 
necessary  for  an  antiseptic  dressing,  I  will,  with  your  permision, 
proceed  to  give  you  short  reports  of  a  few  of  the  more  important 
cases  treated  by  tiiis  method  in  the  wards  of  the  Montreal 
General  Hospital,  during  the  past  twelve  months. 

As  the  three  first  cases  of  the  series  have  been  already  pub- 
lished in  The  Canada  Medical  and  Surgical  Journal,  for 
the  months  of  December,  1877,  and  February,  1878,  it  is  not 
my  intention  to  trouble  you  with  extended  reports  thereof,  but 
merely  a  brief  synopsis  for  the  benefit  of  those  who  may  not 
take  that  periodical,  and  also,  that  my  paper  may  be'  the  more 
complete. 

Case  I, — Compound  Comminuted  Fracture  of  the  Bones 
of  Tarsus^  involving  the  Ankle  Joint, — Amputation, — The 
patient,  a  laborer,  68  years  of  age,*  was  admitted  into  the 
Montreal  General  Hospital  on  the  10th  September,  1877,  a  load 
of  earth  having  fallen  on  the  left  foot  and  caused  the  injuries 
above  enumerated.  I  made  the  attempt  to  save  the  foot  by  the 
antiseptic  method,  and  although  the  most  extensive  death  of  the 
soft  parts  supervened,  I  succeeded  in  keeping  them  perfectly 
<<  sweet  '^  and  free  from  inflammatory  trouble  until  October  4tii 
(tjfenty-four  days  after  the  accident),  when  it  was  thought 
advisable  to  amputate. 

The  operation,  amputation  through  the  ankle,  was  performed 
under  the  spray,  and  with  all  the  antiseptic  precautions. 


234  CANADA   MEDICAL    AND   aUHOICAL   JOURNAL. 

Aa  the  record  of  the  case,  kept  by  my  clinical  clerk,  Mr. 
(now  Dr.)  Hutchinaon,  is  here  very  brief,  I  will  read  it : 

Oct,  bih. — Tlie  atump  was  dreaaed  to-day  anttseptically,  and 
only  a  small  quantity  of  aero-sanguineous  fluid  found  to  be  dia-. 
charged.  The  patient's  temperature  ia  found  to  be  i 
normal,  as  may  be  seen  by  reference  to  the  chart.  Pulae  weak 
and  compressible.     Appetite  poor. 

&ih. — Dressed  again  to-day, — only  a  amall  amount  of  eeruia 
on  the  draw-sheet  and  dressing.  Condition  much  aB  yesterday* 
The  wound  is  healing  in  all  parts. 

1th. — The  draw-sheet  being  slightly  stained,  the  dressing  was 
removed.  No  odour.  No  pus.  The  patient's  general  condi> 
tion  is  decidedly  improving.     Tongue  cleaning  rapidly. 

10(/t. — The  stump  has  not  been  liisturbed  for  the  past  thre« 
days.  The  edges  of  the  flaps  have  united  so  closely  that  tl« 
line  can  barely  be  discovered  ;  drainage  tubes  removed.  Th« 
sutures  were  simply  wiped  away  to-day  with  a  sponge.  Th« 
man's  general,  and  especially  hia  mental  condition,  has  womler« 
fully  improved  in  the  past  few  days. 

\Ztk, — All  dressing  removed,  and  the  patient  is  to  sit  up  i 
the  invalid  chair  this  afternoon. 

The  highest  temperature  reached  after  amputation  waa99  A 


Cane  II. — Railway  Accident  demanding  Amputation  aho% 
the  Knee-Joint,  in  a  lad  of  fifteen,  whose  left  leg  had  been  ro 
over  by  some  dozen  car  wheels.  Garden's  operation,  slight!] 
modified,  was  performed  on  the  7th  October,  1877,  my  friend 
Dr.  Rodger,  whose  case  it  was,  Msisting  me.  Throughout  i 
puB  was  noticed,  and  a  remarkable  phenomenon  occasionalh 
Been  by  the  antiseptic  surgeon  occurred  here,  namely,  tb 
absorption  of  a  narrow  strip  of  dead  tissue  noticed  for  the  fin 
three  or  four  days  to  occupy  the  edge  of  the  anterior  flap. 

To  quote  from  my  report  already  published : — When  i 
dressing  was  removed  just  one  Meek  after  the  operation,  tl 
fltump  was  found  to  be  entirely  healed,  excepting  at  the  angle 
where  the  drainage  tubes  had  been  retained.     The  latter  n 


"LI8TEBISM." — BV    DR.    RODDIC^K.  295 

remored,  and  the  knots  of  the  catrgut  sutures  picked  off  with 
the  forceps,  or  simply  brushed  away  with  the  sponge.  The 
dressing  was  re-applied  as  before,  with  thia  difference  that 
salicylic  cream  was  substituted  for  the  l-to40  solution  on  the 
protective  and  gauze,  in  order  to  prevent  too  great  irritation  of 
the  tender  cicatrix.  Dr.  Kodger  inforina  me  that  he  removed 
the  antiseptic  dressing  altogether  on  the  17th,  and  apphed  some 
red  lotion  to  the  angles  of  the  etump,  so  as  to  hasten  tlie  healing 
of  the  two  little  spots,  which  had  been  prevented  from  closing 
by  the  drainage  tubes.  The  boy  has  since  been  sitting  up  every 
day,  and  appears  in  perfect  health. 

The  temperature  throughout,  taken  night  and  morning, 
ranged  between  98  and  99'^.1,  and,  in  fact,  I  End  the  latter 
figure  was  only  reached  once  {on  the  fourth  day),  but  as  soon  as 
bis  bowels  had  been  moved  by  an  enema  it  fell  to  normal. 

Case  III.  —  .ffj-ciw'ra  of  the  Right  Elbow  for  Fibroag 
Ankyhsi»,  the  renult  of  FraHure' — The  patient,  a  man  24 
years  of  age,  was  admitted  into  my  wards  on  the  20th  Novem- 
ber, 1877.  The  injured  arm  was  painful  and  ankylosed  in  an 
awkward  position.  He  gave  a  history  of  haviDg  In  the  month 
of  June  previous  fallen  from  a  fence,  striking  his  elbow  on  a 
stone,  the  arm  being  Bexed.  Two  days  afler  admission  (22nd 
Nov.,)  excision  was  performed  antiseptically  by  the  straight 
incision. — No  splint  was  used,  the  arm  being  kept  in  position 
by  the  heavy  dressing. 

From  the  report  of  the  case  furnished  by  Mr,  Mills,  the 
present  able  House  Surgeon  of  the  Hamilton  Hospital,  I  glean 
the  following — 

Nov.  '22nd. — Wound  dressed  antiseptically ;  looking  well. 
A  slight  sero-sanguinous  discharge.  Temperature  99'1°  in  the 
morning,  101"  in  the  evening.  Piilse  98  in  the  morning,  104 
in  the  evening.     Urine  has  to  be  removed  by  catheter. 

27(A. — Wound  dressed  again.  Slight  serous  discharge. — 
Neither  pus  nor  odour. 

•l^th. — Wound  dressed  again.     Looking  well.     Temperature 

*  ClKUl*  MlUlUAL  ADD  SOBOICU.  JonKMiL,  Feb,  tSTS. 


3i»6 


CANAJtA  MIDICAI.    AWO   SUKOICAI.   JOFBNAL. 


ran  up  in  the  eremog  to  101^,  without  any  apparent  came, 
except  that  the  bowels  had  not  been  moved  for  four  days,  and 
he  was  feeling  some  discomfort  in  consequence.  I  may  here 
remark  that  in  several  of  our  cases  of  antiseptic  surgery, 
{where  the  temperature  haa  been  very  closely  watched)  sudden 
elevations  have  occurred  for  which  no  cause  could  be  assigned, 
except  a  loaded  condition  of  the  bowels,  and  that  this  was  the 
cause  seema  t«  be  established  by  the  fact  that  it  invariably  fell 
to  its  former  range  as  soon  as  the  bowels  were  relieved  by  a 
purgative  or  an  enema. 

Dec.  2.nd. — Arm  dressed  again.  Sutures  removed.  Wound 
completely  healed,  except  the  two  small  openings  from  which  the 
drainage  tubes  were  removed. 

Thus  the  wound  liad  entirely  closed  in  ten  days  after  opera- 
tion, and  the  patient  was  discharged  with  a  very  useful  arm  after 
thir^-nine  days  residence  in  hospital. 

Case  IV. — Amputation  of  the  Thigh  in  a  child  of  four 
years  for  a  railway  injury,  the  wheels  of  a  street  car  having 
passed  obliquely  over  the  foot  and  leg.  I  amputated  after 
Garden's  method.  Antiseptic  measures  were  adopted  through- 
out. Union  by  first  intention  occurred  without  a  drop  of  sup- 
puration or  trace  of  odour.  On  the  fifth  day  (third  dies^og), 
the  tubes  were  removed,  and  on  the  ninth  day,  (5th  July)  the 
stump  was  found  to  be  perfectly  healed,  and  all  dressings  were 
removed.  The  temperature  chart.  I  venture  to  say,  will  be 
found  on  examination  to  be  almost  unique  for  an  amputation  of 
the  thigh,  following  railway  injury,  as  you  see  it  never  tow 
above  99".  The  child  slept  and  ale  well  throughout,  and  as  far 
as  I  could  learn  from  the  nurse,  never  referred  to  the  wound  aa 
if  in  ptun. 

Case  V. — Excision  of  the  Elboit  for  bony  Anhiloaif. — 
This  was  a  lad  of  18  years  who  sought  advice  on  the  4th  July, 
1878,  for  ankylosis  of  the  elbow,  in  an  awkward  position,  vii : 
at  an  angle  much  greater  than  a  right  angle.  He  gave  a  history 
of  having  fallen  from  a  height  some  four  years  previous,  sus- 
taining fracture  of  the  bones  comprising  the  elbow-joint.     The 


I 


I 


—BY   DH.    RODDICK.  297 

limb  waa  treated  in  the  position  of  full  extension,  the  consequence 
being  a  perfectly  straight  arm.  Partial  excision  was  subsequently 
performed  by  Mr.  Annandale  of  Edinburgh,  resulting  in  anky- 
loos,  and  the  condition  of  things  found  on  admission. 

From  the  notes  of  my  clinical  clerk,  Mr.  Thomas  Gray,  I 
glean  the  foUoiriug  : — Hand  semi-prone — complete  loss  of  motion 
in  elbow-joint,  it  being  in  an  almost  semi-fiexed  position.  Muscles 
of  arm  and  forearm  much  wasted.  On  the  outer  side  of  the 
arm  ia  an  oblong  cicatnx  over  the  position  of  the  entemal 
condyle,  and  anotlier  on  the  inner  side  Just  behind  the  internal 
condyle.  These  correspond  to  the  incisions  of  Mr,  Annandale. 
An  irregular  bony  mass  ia  felt  corresponding  to  site  of  head  of 
radius,  and  external  side  of  humerus.  The  olecranon  is  distinct, 
but  itfl  anterior  surface  seems  firmly  adherent  to  the  humerus. 
He  complains  of  a  tingling  sensation  and  loss  of  power  in  the 
little  and  Hng  fingers,  due,  no  doubt,  to  pressure  of  the  ulnar 
nerve  between  the  inner  cicatrix  and  the  bone. 

As  the  patient  waa  not  in  very  good  health  when  admitted, 
having  recently  suffered  from  axillary  abscess,  I  deferred  opera- 
tive interference  until  the  24th  July,  on  which  day  I  proceeded 
to  excise  with  antiseptic  precautions.  I  employed  the  straight 
incision,  going  directly  through  the  periosteum,  which  I  carefully 
separated  throughout  with  the  blunt  "  elevator."  The  ulnar 
nerve  was  released  without  being  exposed-  About  two  and  a 
half  inches  of  the  ankyloaed  bone  were  removed.  (I  pass  the 
specimen  round  for  your  inspection.  You  will  find  the  bones 
comprising  the  Joint  completely  fused  together). 

I  return  to  Mr.  Gray's  notes  for  the  following  record ; 

JiUy  2oM. — Temperature  98°  ;  pulse  steady  ;  not  a  single 
symptom  has  appeared.     Some  difficulty  in  making  water, 

ich  he  says  is  always  the  case  when  obliged  to  keep  the 
intal  position.  The  arm  was  dressed  to-day,  and  looks 
"beautifu]."  No  swelling,  no  tension.  Slight  serous  discharge, 
and  the  edges  of  the  incision  are  already  meeting.  In  the 
evening  his  temperature  was  99". 

The  report  for  the  two  succeeding  days  is  most  encouraging, 
aa  the  temperature  chart  will  itself  show.     The  interesting  fact 


^_  Juli 
^^sy 

^^Tionzoi 


298  CANADA   KKOtC-U.   A!»D   SraoICAL   JOrK!«AL. 

Eoi^t  be  mentioned  here,  Uut  the  tiln&r  nerve  b  regaining  its 
proper  foDctioos,  as  the  fingers  supplied  bj  it  are  found  to  hare 
both  acri aired  &  large  share  of  their  normal  sensation  and  motion. 

iSth. — Temperatare  normal.  Poise  84.  Dressings  removed  ; 
discharge  serous  in  character  and  perfectly  "  sweet."  No  pna 
has  been  Been.  The  wound  is  united  firmlj  throoghout  with 
the  exception  of  the  angles  occupied  bj  the  dninage  tnbee, 
which,  b;  the  way,  have  been  very  much  shortened  to-day. 

Auff.  Itt. — The  antiseptic  dressings  and  dr^ni^  tnbee  were 
removed  and  the  part  dressed  simply  with  boractc  lint  and  oil  alk. 

9th. — The  angles  having  now  entirely  healed,  passive  motion 
is  begun.  It  will  be  seen  that  I  employed  no  splint  in  this  case 
the  heavy  antiseptic  dressing  being  sufficient  to  keep  the  arm 
at  any  angle  desired, 

I  beg  to  refer  you  to  the  temperatare  chart,  which  I  look 
npOQ  as  a  remarkable  one,  the  index  never  having  risen  higher 
than  99°.l,  and  that  for  two  days  only  following  the  operatiwt. 

Did  time  penmt,  I  could  give  detailed  reports  of  other  two 
cases  of  compound  fracture  ;  of  five  cases  of  Removal  of 
Breagt;  five  cases  of  Removal  of  Fatty  Tumour:  seven 
caiies  of  Amptttation  of  Finger*  and  Tots,  besides  innnmera- 
able  abscesses,  which  have  been  treated  antiaeptically  during 
the  past  twelve  months,  in  the  wards  of  the  Montreal  General 
Hospital,  and  with  the  most  gratifying  results. 

Some  of  my  colleagues  also  have  been  very  suceessful,  and  I 
have  no  doubt  they  will,  at  no  distant  date,  ^ve  the  profession 
the  benefit  of  theu'  experience. 

So  much  for  the  successes ;  now  for  the  failures,  and  here  the 
story  ia  soon  told :  We  failed  in  three  major  operations  only,  ia 
maintaiiung  the  discharges  in  an  antiseptic  condition.  These 
were  Ist.  A  Syme's  amputation ;  2nd.  Removal  of  a  laj^e 
scirrhua  breast ;  3rd.  Re-amputation  of  Leg. 

The  first  operation  waa  performed  in  a  man  about  40  years  of 
age,  on  whom  a  Chopart  had  been  done  some  months  before, 
leaving  a  painful  nicer  on  the  face  of  the  slump.  On  the  third 
day  the  protective  was  found  to  be  blackened  (a  sure  sign  of 
putrescence),  and  the  dressing  had  a  decided  odour.  Hie 
temperature  had  also  gone  up  during  the  night  to  102^  ;  pulse 


"  LISTERISM.** — BY  DR.   RODDICK.  299 

nt{Hd  and  -psin  considerable.    The  cause  of  failure  was  self; 
evident,  and  indeed  I  had  anticipated  this,  in  some   clinical 
remarks  made  after  the  operation.     I  had  just  completed  the 
flaps  and  was  about  separating  the  foot  when  the  spray-producer 
ceased  to  work,  through  some  mismanagement.    The  ''  guard  " 
was  at  once  applied,  but  the  instrument  could  not  again  be  made 
to  work,  and  the  operation  had  to  be  completed  without  the 
spray.     Notwithstanding  that  the  wound  was  thoroughly  washed 
Out  with  carbolic  lotion,  and  every  antiseptic  precaution  taken, 
the  result  was  what  I  have  stated,  some  septic  germs  having,  no 
doubt,  crept  into  the  crannies  of  the  wound  after  the  discontin- 
i:umce  of  the  spray.     This  case  illustrates  more  than  anything 
X  have  yet  seen  or  read,  the  paramount  importance  of  the  anti- 
septic spray,  and  proves  beyond  a  doubt  that  the  first  duty  of  a 
surgeon  is  to  protect  the  delicate  tissues  exposed  by  his  knife 
£Vom  contamination  by  those  organic  germs  (call  them  by  what 
xiame  you  please)  which  float  in  the  air  about  us,  and  are  un- 
doubtedly the  cause  of  putrefaction.  As  to  the  case,  I  succeeded 
after  some  trouble  in  "  sweetening  "  the  stump,  and  it  ultimately 
tiumed  out  to  be  a  very  fair  result,  although  the  man  was  two 
xnonths  in  hospital,  whereas  he  should  have  been  there  only^  two 
^eeks. 

The  second  operation  which  proved  a  failure  was  a  case  of 
simple  removal  of  breast.  Everything  went  well  until  the  fourth 
day,  when  odour  was  distinctly  perceptible,  and  the  protective 
was  blackened.  The  temperature  chart  showed  a  rise  of  nearly 
three  degrees,  and  the  pus  was  marked  in  amount.  I  could  not 
explain  it,  excepting  that  the  patient,  who  was  very  fidgety,  had 
raised  the  upper  edges  of  the  dressing  in  the  endeavor  to  loosen 
it,  and  thus  allowed  of  the  ingress  of  air.  I  have  since  discov- 
ered, however,  that  she  was  in  the  habit  secretly  of  stuffing  a 
quantity  of  cotton  wool  beneath  the  dressing  to  prevent  the 
gauze  from  irritating  the  skin.  Now,  I  think  if  germs  are  able 
to  appreciate  the  "  comforts  of  a  home,"  they  will  find  them 
among  the  delicate,  soft,  and  warm  fibres  of  the  ordinary  cotton 
wool.  I  really  think  there  is  nothing  for  which  the  antiseptic 
surgeon  should  entertain  a  greater  dread  than  this  very  material 


300 


CANADA   MEntCAt,   AND   SUBfllCAL  JOCBHAL. 


in  its  raw  state,  and  yet  vfhen  properly  prepared  there  are  fei 
forms  of  dressing  capable  of  more  universal  application. 

The  third  case  of  failure  occurred  only  the  other  day  in 
re-amputation  of  the  leg  for  painful  and  ulcerated  stump,  The^ 
case  ia  not  one  of  sufficient  interest  to  call  for  a  fall  report. 
Suffice  it  to  say  that  on  the  fifth  day  (^  third  dressing)  there  were 
evidences  of  putrescence.  I  have  yet  been  unable  to  find  a 
flufBcient  cause  for  the  failure,  unless  it  be  that  a  splint  which 
I  applied  on  the  second  day  beneath  tlie  heavy  dresBing,  had 
not  been  thoroughly  cleansed.  A  large  patch  of  cicatricial 
tissue  situated  over  the  bone  has  since  sloughed,  although  the 
case  will  ultimately  do  well. 

Thus  I  have  endeavoured  to  lay  before  you,  though,  I  must 
confess,  in  a  very  imperfect  manner,  the  result  of  one  year's 
experience  of  the  antiseptic  method  of  Lister.  The  number  of 
cases  is  certainly  small,  but  the  experience  presented  should  he 
sufficient  to  convince  the  most  sceptical  of  the  practical  efficacy 
of  the  method,  and  to  induce  tliera  at  leaat  to  give  it  a  trial. 
Our  success  in  the  Montreal  General  Hospital  has  certainly 
exceeded  our  fondest  expectations.  For  the  year  ending  yes- 
terday we  can  show  a  clean  mortality  sheet  as  far  as  the  purelj; 
antiseptic  operations  are  concerned,  while  traumatic  erysipel^ 
and  pyiemia  have  been  unknown.  Indeed,  we  may  confidentlj 
look  forward  to  the  time  when  these  surgical  plagues  will  be 
longer  dreaded,  but,  like  scurvy  in  our  day,  will  be  coomderoj 
in  the  light  of  curiosities. 

No  one,  not  even  Lister  himself,  claims  that  the  method 
faultless,  although  be  has  been  unable  to  make  any  material 
improvements  in  the  past  five  years.     Those,  besides,  who  hi 
attempted  from  time  to  time  to  modify  his  plan  of  procedura 
have,  almost  without   exception,  failed.      Thus,  Thiersch, 
Leipsic,  the  first  German  follower  of  Lister,  has  gone  back  tl 
carbolic  acid,  having  I'oand  salicylic  acid  a  sad   failure  aa 
germicide.     He  declares  that,  although  the  technical  details 
the  method  may  be  modified,    Lister's    postulate — the    tot 
exclusion  of  putrefactive  elements  from  the  woimd — will  nev 
be  lost  sight  of  by  him. 


"  LISTWaSM." — BY  DR.  RODDICK.  301 

^aasbaum,  of  Munich,   tried,  but  without  success,  eveiy 
*^cal  dressing  known,  in  his  endeavour  to  combat  hospital 
)ne  and  pysemia,  with  which  80  per  cent,  of  his  wounds 
attacked  ;  ^^  but,"  he  says,  ^^  when  we  applied  to  all  our 
I>^tdents  the  newest  antiseptic  method,  now  in  many  respects 

by  Lister,  and  did  all  operations  according  to  his 
'cctions,  we  experienced  one  surprise  after  another ;  every- 
mg  went  well ;  not  a  single  case  of  hospital  gangrene  occurred, 

pyamia  and  erysipelas  completely  disappeared." 

The  pioneer  of  "  Listerism "  on  the  contment  of  Europe, 

-^ctorph,  of  Copenhagen,  says,  ^^  he  is  sure  that  if  he  does 

carry  out  the  antiseptic  treatment  to  its  full  extent,  it  is  of 

use  whatever  to  apply  carbolic  acid  to  a  wound,  at  least  as 

^^gardft  the  dangers  that  always  accompany  putrefaction." 

Callender,  of  St.  Bartholomew's,  who  operates  without  the 

ftray,  has  certainly  had  admirable  results,  showing  a  mortality 

a  series  of  amputations  of  only  2.27  per  cent. ;  but  Volkmann, 

of  Halle,  one  of  Lister's  most  faithful  followers,  is  not  far  behind 

"vrith  a  percentage  of  2.87,  and  a  large  majority  of  his  cases 

^ere  frightful  machinery  accidents. 

Mr.  Bradley,  of  Manchester,  has  recently  published  statistics 
of  a  series  of  operations  performed  by  him  after  a  '^  modified 
method,"  shbwing  a  mortality  per  cent,  of  11.42  ;  but  one  of 
the  followers  of  Lister  in  the  Royal  Infirmary,  of  Glasgow,  has 
since  shown  his  hand,  giving  statistics  of  tlurty  of  the  most 
serious  operations  in  surgery  with  only  one  death,  or  a  mortality 
of  3.33  per  cent. 

But  antiseptic  surgeons  will  not  be  satisfied  hereafter  with 
the  bare  mortality  statistics.  They  will  demand,  and  with 
justice  too,  the  range  of  temperature  in  the  various  cases,  the 
average  number  of  days  under  treatment,  and  the  cost  of 
the  dressings.  Li  hospital  practice,  especially,  the  length  of 
time  required  for  the  cure  is  a  matter  of  the  utmost  importance. 
If,  as  our  reports  prove  we  could  have  done,  cases  of  amputa- 
tion of  the  limbs  can  be  discharged  with  safety  in  less  than 
fifteen  days,  what  a  saving  is  made,  even  though  the  cost  of  the 
dresfflng  far  exceed  in  value  any  other  that  might  be  employed 
for  the  same  length  of  time« 


302 


:.   ANDBJJBOICAl. 


ANEW  SOUND  FOR  EXiMlNING  THB  BLiDDBR 

IN  CASES  OF  SUBPECTED  STONE, 
By  G.  CtiTUBERTSON  DiiscAN,  M.D.,  L.R.C.S.,  Editi. 

The  following  deacription  of  a  new  soimd  was  sent  to  u9  last^ 
October  by  Dr.  Duncan,  just  before  he  left  Canada  for  Eng-- 
land  :  it  was  mislaid  and  overlooked,  but  we  now  publish  it  witii 
pleasure.  We  may  remark  that,  with  Dr.  Duncan,  we  tried 
the  sound  on  the  dead  aubject,  and  the  presence  of  a  minute 
fragment  of  stone  which  had  been  placed  in  the  bladder  was 
readily  made  out.  The  trial  was  ijuite  satisfactory,  and  we  are 
inclined  to  believe  that  the  iDStrument  given  us  by  Dr.  Duncan 
is  a  valuable  aid  to  diagnosis  of  stone  in  the  bladder,  more 
especially  in  those  oases  where  the  fragments  arc  small,  or  where 
symptoms  of  stone  are  persistent  and  failure  to  ascertain  its 
presence  from  some  cause  attends  the  search. — (Ed.) 

Dtfcription  of  Sound. — The  sound  is  made  of  solid  steel, 
similar,  in  most  respects,  to  the  short-beak  sound  in  ordinary  use, 
with  the  exception  of  a  modification  in  the  handle,  which  is  round, 
and  a  little  larger  than  the  rest  of  the  sound.  Situated  at  about 
two  inches  from  the  end  of  this  is  a  circular  disc  at  right  angles 
to  the  curve  of  the  beak,  to  indicate  in  what  direction  it  is  point- 
ing and  to  facilitate  its  rotary  movement  botJi  in  its  introduc- 
tion through  the  urethra  and  while  in  the  bladder.  The  whole 
nicAc^-pIated,  being  smooth,  bright,  and  not  liable  to  become 
discoloured.  The  beak  is  blackened  by  being  held  in  the  smoke 
of  an  ordinary  oil-lamp,  and  when  perfectly  cool  is  dipped  into 
It  solniaon  of  collodion,  thinned  to  a  proper  consistency  with 
ether  and  alcohol,  which,  when  dry,  forms  a  black  fihn  on  the 
sound  capable  of  being  introduced  into  the  bladder  without 
bung  injured,  but  if  brought  in  contact  with  any  hard  substance 
it  is  immediately  scratched,  and  the  bright  metallic  surface 
Uffrntn,  thus  indicating  the  presence  of  the  foreign  body. 

AJifiUUageii  Claimed. — This  method  of  preparation  does  nob 
r  the  conducting  power  of  the  sound  or  its  sensitiveness  in 
9,  as  is  the  case  with  Mr.  Napier's  leaden-pointed  iustni- 


HOSPITAL   BBP0BT8.  303 

»nt ;  also,  the  film  is  much  more  easily  scratched  than  the  lead. 

e  handle,  being  small  and  round,  is  held  between  the  index 

L^r  and  thumb  (the  most  sensitive  part  of  the  hand),  thus 

greater  facility  in  its  rotary  movements,  and  a  greater 

ice  of   detecting    the    slightest  contact    with  a  foreign 

mce. 

A  piece  of  a  calculus  weighing  about  five  grains  was  intro- 
^>iced  into  the  bladder,  and  the  sound  was  introduced  and 
^^^ihdrawn  several  times  to  shew  that  the  film  was  in  no  way 
^*\jnred,  it  was  then  made  to  sweep  the  floor  of  the  bladder  from 
^*^^e  to  side,  and  withdrawn,  when  it  shewed  evident  traces  of 
*^^vbg  come  in  contact  with  some  hard  body. 

hospital  J^eports. 

^IDICAL  AND  Surgical  Cases  Occurring  in   the  Practice  ok  the 

Montreal  General  Hospital. 

Tumour  situated  over  the  Parotid  Gland. — Removal, — By 
G.  E.  Fbnwick,  M.D.    Reported  by  Mr.  Thos.  Gray. 

A.  McL.,  a  large-framed,  robust-looking  Scotchman,  was 
admitted  into  the  Montreal  General  Hospital,  on  the  19th  Oct., 
1878,  suffering  from  a  large,  firm,  somewhat  nodular  growth, 
situated  in  the  left  parotid  region.  The  patient  states  that  he 
is  73  years  of  age,  but  he  bears  his  age  well.  The  history  he 
gives  is  as  follows :  Ten  years  ago  he  had  a  severe  cold,  and 
the  glands  of  his  neck  swelled.  There  remained  a  small,  hardly 
perceptible  growth  on  the  side  where  the  tumour  is  situated,  but 
it  never  gave  him  any  concern,  nor  any  pain.  For  the  last  three 
months  it  has  grown  rapidly,  and  for  several  weeks  past  it  has 
given  him  great  pain,  more  especially  at  night. 

The  tumour  is  situated  on  the  left  side,  over  the  parotid 
region,  the  lobule  of  the  left  ear  being  pushed  upwards,  and 
somewhat  stretched  over  the  growth.  It  is  about  the  size  of  a 
hen's  egg  ;  is  hard,  firm,  but  quite  movable,  apparently  unat- 
tached, and  has  projecting  from  its  surface  several  nodules. 
Although  to  all  appearance  free,  it  has  implicated  the  branches 
of  the  portio  dura  ;  some  of  the  muscles  of  the  left  side  of  the 
face  are  paralyzed ;  he  is  unable  to  close  the  left  eye-lid  ;  the 


ADA    KEDICAL   AUD   SUSOICAL    JOtTBNAL. 


angle  of  the  mouth  is  sligbtlj'  drawn  down  ;  he  can,  however, 
close  his  mouth,  bringing  the  lips  Rrmly  together,  bnt  he  states 
that  the  growth  baa  interfered  with  mastication.  Kis  speech  is 
a  little  thick,  but  sensation  in  the  face  is  perfect  throughoat. 
From  the  fa«t  of  the  rapid  growth  of  the  tumour,  from  its 
implicating  the  facial  nerve,  and  from  the  tumour  being  nodular, 
having  a  tendency,  apparently,  to  push  through  its  fibrous  enve- 
lope and  infiltrate  the  parta  in  the  immediate  vicinity,  it  was 
regarded  as  of  very  doubtful  character.  It  was,  however, 
perfectly  free  and  movable,  and  was  distinctly  eucapsulated. 
The  tumour  interfered  with  the  man'a  rest,  as  he  suffered 
nightly  from  neuralgic  pains  shooting  up  the  side  of  the  face 
and  scalp,  and  as  he  insisted  on  the  removal  of  the  growth  at 
all  risks,  the  operation  was  determined  on,  the  patient  being 
made  fully  aware  of  the  possible  return  of  the  tumour  before 
the  end  of  many  weeks. 

The  patient  having  been  placed  under  the  influence  of 
aulphuric  ether,  the  operation  was  commenced  by  a  straight 
incision,  made  from  above  downwards,  the  entire  length  of  the 
growth,  commencing  at  the  anterior  part  of  the  lobule,  acd 
extending  vertically  downwards  for  about  3J  inches.  The 
capsule  of  the  tumour  was  reached  and  the  soft  parts  re&di]y 
reflected.  The  growth  was  then  carefully  dissected  from  its 
bed,  one  portion  passing  behind  the  ascending  ramus  ot  the 
jaw.  In  this  dissection  the  sheath  of  the  vessels  was  laid  bare, 
but  was  not  implicated.  Several  vessels  were  tied,  and  the 
main  vessel  at  a  little  above  where  the  internal  maxillary  ia 
given  off  was  ligatured.  Th«re  was  not  much  blood  lost,  as  the 
vessels  were  secured  and  ligatured  as  the  operation  proceeded. 
Every  particle  of  the  growth  was  removed,  and  after  removal 
the  parts  did  not  look  as  if  there  .were  any  infiltrating  nodules 
in  the  tissues.  After  all  clots  were  removed,  the  edges  of  the 
wound  were  brought  together  with  fine  cat-gut  sutures,  a  piece 
of  drainage  tube  being  allovred  to  hang  out  at  the  lower  edge 
and  the  wound  was  dressed  with  dry  boracio  lint.  The  upper 
edge  of  the  wound  united  by  first  intention,  but  the  tower  part, 
which  wafi  kept  open  by  the  drfunage  tube,  filled  up  by  gr&nola- 


1 


I 


HOSPITAL   REPORTS.  305 

tion  tissue.  There  was  a  contindous  discharge  of  fluid,  like  saliva 
from  ihe  lower  edge  of  the  wound.  This,  however,  diminished, 
and  in  the  course  of  ten  days  the  man  was  able  to  leave  the 
Hospital.  There  still  continued  inability  to  close  the  upper  lid 
of  the  left  eye,  but  the  patient  stated  that  he  felt  more  move- 
ment in  the  part  than  before  ihe  operation,  and,  moreover,  that 
he  was  better  able  to  chew  his  food  on  the  left  side.  Moreover, 
his  speech  was  not  so  thick.  The  man  left  the  Hospital  and 
returned  to  his  home  on  the  twelfth  day  after  the  operation. 

Dr.  A.  F.  Ritchie,  curator  of  the  Museum  of  McGill  Univer- 
sity, ^ves  the  foUoajng  report  of  the  microscopical  appearance 
of  the  tumour : — 

The  removed  gland  is  surrounded  by  a  well-marked  fibrous 
capsule.  The  surface  is  somewhat  nodular,  but  the  general 
shape  of  the  organ  is  fairly  normal.  It  measures  2  inches  by 
1|,  with  a  thickness  of  about  an  inch.  On  section  it  presents 
a  mottled  appearance,  the  lobules  being  separated  by  dark 
trebeculae,  which  in  some  places  are  thin  and  sharply  defined  ; 
in  others,  shade  off  into  the  surrounding  tissue.  A  number  of 
reddish  patches  are  seen  pretty  uniformly  distributed  over 
the  surface  of  the  section.  They  vary  in  size  from  about  J  inch 
in  diameter  to  mere  points,  and  on  microscopic  examination 
prove  to  be  carcinomatous  nodules,  having  well  marked  loculi 
of  rather  scanty  fibrous  tissue,  filled  with  large  cells,  with  well 
defined  nuclei  and  nucleoli.  The  cancerous  growth  infiltrates 
both  the  secreting  part  of  the  gland  and  the  septa,  which  contains 
in  addition  an  excess  of  fibrous  tissue.  The  dark  colour  men- 
tioned above  is  due  to  a  large  amount  of  dark  brown  granular 
pigment  contained  pretty  uniformly  in  the  substance  of  the  cells 
and  in  the  intercellulous  tissues  of  the  affected  part. 


Note. — We  have  heard  quite  recently  from  this  patient.  He  has  much 
improved  in  health.  No  return  of  the  growth  has  occurred,  nor  are  there 
any  enlarged  glands  in  the  neighbourhood.  The  result  is  so  far  satisfac- 
tory.— Ed. 

NO.   LXXIX.  21 


300 


CANADA  IIEDICAI.  AND  SITRUICAI.  JOITRNAL. 


Case  of  Siphtheria.^Sadden  Deatkon  the  ISth  Day.—Fattj 
Degetieration  of  the  Heart  and  Cardiac  Thoiribua. — 
Under  the  care  of  Dr.  Ross,     Repotfed  by  Mr.  ImrIE. 

E.  A.,  tet.  11. — la  one  of  eeveral  children  hving  in  a  tene- 
ment above  a  room  where  a  child  died  of  diphtheria  about  two 
months  ago.  She  was  admitted  into  the  Montreal  General 
Hospital,  under  care  of  Dr.  Ross,  on  the  16th  January,  1879, 
having  byen  sick  with  sore  throat  and  severe  feverish  symptoms 
for  three  days.  The  whole  entrance  of  the  throat  was  s 
be  dusky  aud  much  congested.  Tonsils  swollen  and  covered 
with  a  pretty  thick  greyish-white  membrane,  which  also  extend- 
ed freely  upon  the  pillars  of  the  fauces  and  the  surfaces  of  the  i 
uvula.  Breath  very  offensive  ;  neck  thick-looking  and  glands  I 
moderately  enlarged;  temp,,  104°;  pulse,  120;  no  albumen  ' 
in  the  urine.  Two  days  later  (18th  January)  we  6nd  that  there 
has  been  very  tittle,  if  any,  extension  of  the  membrane  beyond 
the  parts  already  mentioned.  SwelKng  of  glands  persists  ;  also 
great  foetor  of  breath,  and  commencing  acrid  discharge  from  the 
noae.  Was  somewhat  delirious  the  past  night,  and  the  pulse  is 
_quick  (140) :  urine  contains  a  trace  of  albumen. 

January  20M. — Temperature  has  not  been  above  101"  ;  no 
more  delirium  ;  urine  moderately  albuminous — 25  ounces  in  24 
hours ;  membrane  coming  away  freely  from  the  throat ;  no  ex- 
tension ;  fetid  discharge  from  nostrils  considerable  ;  glands  still 
swollen  and  tender. 

21s(. —  Patient,  the  note  says,  seems  "  much  brighter." 

'12nd.  —There  has  been  slight  epiataxis ;  improvement  con- 
tinues ;  throat  free  from  membrane,  but  raw  aud  irritable; 
glands  less  swollen,  and  not  tender  ;  albumen  less ;  temp.,  99^  ; 
pulse,  105. 

iith. — Throat  appears  to  be  healing.  There  la  a  slight  re- 
gurgitation of  fluids  through  the  left  nostril,  and  the  voice  has  tt 
somewhat  nasal  character.     Temperature  normal. 

2.5(A, — Two  p.m. — Not  ao  well;  is  irritable  and  restless; 
complains  of  pain  and  soreness  in  the  back  and  legs.  The  akin 
of  the  le^s,  especially   the  fronts   of  the  thighs,  is  markedly 


HOSPtTAI.  REPOKTS.  AQl 

iperiBstketie.  Throat  and  glaiida  much  unproved,  but  patient 
is  aomewhat  deaf  in  both  ears.  Slight  regurgitation,  and  the 
nasal  voice  persists.  The  urine  has  been  very  scanty,  only  two 
ounces  having  been  passed  in  the  laat  24  hours  ;  contains  small 
amount  of  albumen.     Temp.,  98"  ;  pulse,  68, 

From  this  time  she  continued  rather  fretful  and  complaining 
until  5:30  p.m.,  when  alie  was  raised  by  the  nurse  upon  the  bed- 
pan, as  she  desired  to  have  her  bowels  moved.  She  had  been 
then  sitting  up  but  a  few  moments  when  she  gave  a  long  sigli, 
saying  "  Oh  dear  !"  and,  falling  back,  expired  instantly. 

At  the  autopsy,  the  following  conditions  were  found : — The 
larynx  and  trachea  were  entirely  free  from  any  exudation. 
The  heart  was  moderately  contracted.  Its  valves  were  healthy. 
The  muscular  substance  appeared  of  good  colour,  not  pale  or 
streaky-looking,  but  under  the  microscope  is  seen  to  be  in  a 
state  of  advanced  fatty  degeneration.  The  right  auricle  con- 
tained a  large  white,  pretty  firm  clot,  which  nearly  filled  its 
entire  chamber  and  extended  into  the  corresponding  ventricle. 
It  did  not  pass  into  the  pulmonary  artery.  Part  of  this,  at  any 
rate  (if  not  the  whole},  was  certainly  formed  before  death.  The 
kidneys  were  moderately  congested, 

Rcmarkg  hy  Dr.  Ros*. — Sudden  death  in  severe  cases  of 
^phtheria  is  not  altogether  unexpected.  It  also  occasionally 
occurs  during  the  course  of  a  diphtheritic  paralysis.  But  it  is 
not  often  that  sudden  death  supervenes  whilst  the  disease  itself, 
never  having  been  of  a  severe  type,  seems  to  have  given  way, 
and  convalescence  be  about  Co  begin,  The  foregoing  case,  how- 
ever, well  illuBtrates  its  pi^aibJe  occurrence.  In  all  these  cases, 
paralysis  of  the  heart,  through  the  pneumogastric,  no  doubt 
plays  the  roost  important  part ;  but,  doubtless,  fatty  degenera- 
tion of  the  heart  iqjiscle  is  a  very  common,  if  not  constant,  fore- 
.  runner  of  the  paralytic  event.  On  this  point  Oertel  says  : — 
'  When  the  ^tisease  lasts  long  and  is  very  intense,  and  espe- 
taally  in  ca^es  in  wliich  death  is  caused  suddenly  by  paraljsb 
'  die  heart,  the  muscle  appears  aoft,  pale,  friable,  broken  by 

ittvasatious  of  blood,  and  on  microscopical  examination  most 


308  CANADA    SIEDICAL    AND   SITROICAL    JOL'KNAL. 

of  its  fibres  are  fodad  in  an  advanced  stage  of  fatty  degenei 
tion,"  Now,  in  this  case,  we  found  at  the  autopsy  the  advance-  ^ 
fatty  degeneration — indeed,  hardly  a  singular  muscular  fibr* 
could  be  found  which  was  not  largely  converted  into  oil  globule*  - 
But  it  differs  from  most  others  in  the  following  respects: — Ou«" 
patient  died  on  the  thirteenth  day  of  the  disease,  and  therefore^ 
it  could  not  be  said  to  have  lasted  long.  The  attack  had  not 
been  intense,  although  it  had  been  moderately  severe.  There 
waa  no  decided  paralysis,  although  we  had  observed  a  somewhat 
paretic  condition  of  the  velum  palati.  So  that,  although  fully 
aware  of  the  occurrence  of  sudden  death  and  fatty  heart  under 
the  condition  of  an  intense  and  prolonged  attack,  especially  if 
septic  symptoms  have  been  marked,  or  in  the  debilitated  systemic 
condition  indicated  by  the  existence  of  some  kind  of  paralylie 
affection,  yet  I  waa  not  prepared  to  meet  with  instantaneous 
death  in  this  little  girl  under  the  apparently  favorable  circum- 
stances which  I  have  related-  We  learn  from  the  observations 
of  this  case  that  fatty  heart  may  exceptionally  be  fully  devel- 
oped even  after  a  short  duration  only  of  moderately  Beverc 
diphtheria — that  it  will  betray  its  pr.esence_  by  no  symptoms, 
and  may  thus  assist  in  causing  death  just  when  convalescence 
seems  about  to  begin.  I  say  "  assist  in  causing."  because  I  do 
not  think  the  fatal  event  is  to  be  entirely  attributed  to  the  mus- 
cular degeneration.  Tne  record  of  the  autopsy  shows  that 
there  was  found  in  the  right  chambers  of  the  heart  a  large  white 
fibrinous  clot.  Now,  we  should  not  have  expected  to  find  any 
such  thing  in  the  heart  of  a  person  dying  from  sudden  cessation 
of  the  heart's  action.  Dr.  Robinson  Beverly,  writing  in  the 
Lancet,  2nd  November,  1872,  has  pointed  out  that  the  forma- 
tion of  heart  clots  (cardiac  thrombosis)  is  to  be  recognized  as  a 
possible  source  of  great  danger  in  a  certain  number  of  cases  of 
diphtheria — even  in  those  apparently  progressing  very  favor- 
ably. '•  Death,"  he  says,  "  may  occur  either  suddenly  (imme- 
diately after  the  forniation  of  the  coagulum)  or  after  the  lapse 
of  a  period  of  anxiety  and  anguish,  more  or  less  prolonged. 
In  this  case  death  muat  have  occurred  immediately  after  the 
formation  of  Uie  thrombosis. 


I 


1 


i 


^  HOSPITAL    REPORTS.  309 

Caseous  Degeneration  of  a  Lung  with  Rapid  Softening. — 
J)eath  after  Hoemoptysis, — Under  the  care  of  Dr.  Ross. 
Reported  by  Mr.  W.  Sutherland. 

6.  R,  set  26,  a  negro,  was  admitted  into  the  General  Hos- 
pital, under  Dr.  Wilkins,  on  the  22nd  of  August,  1878,  com- 
plaining of  cough,  weakness  and  feverishness. 

The  only  account  of  tubercular  disease  in  his  family  is  the 
cleath  of  one  sister  at  26  from  ordinary  pulmonary  consumption. 
Sis  father  and  mother  are  both  alive  ana  well. 

He  has  always  been  a  strong  and  robust  man  until  ^the  com- 
mencement of  the  present  year,  since  when  he   has  not  been 
feeling  so  strong  and  able  to  work  as  previously.     He  has  also 
been  subject  to  coughs,  but  denies  having  had  any  persistent 
cough  until  quite  lately.     About  three  weeks  prior  to  admission 
he  got  a  severe  wetting,  and  since  that  time  has  been  feeling 
very  ill.     He  soon  beg^n  to   cough,  suffered  from  pains  in  his 
sides,  felt  feverish,  and  lost  appetite  and  strength.     No  positive 
symptoms  indicative  of  aa  attack  of  acute  pneumonia  of  ordinary 
type  can  be  found.     He  did  not  lay  up,  but  attended  as  an  out- 
patient for  two  weeks  before  coming  into  the  wards. 

During  the  month  of  September  he  had  a  persistently  high 
temperature  in  spite  of  the  administration  of  quipine  ;  coughed 
a  great  deal,  with  copious  heavy  perspiration  ;  rapidly  lost  flesh 
and  strength. 

On  the  1st  of  October  he  was  transferred  to  the  care  of  Dr. 
Ross,  and  the  following  notes  were  then  made  of  the  physical 
signs: — 

Soft  parts  of  chest  much  emaciated  and  clavicles  prominent, 
especially  the  left.  Expansion  very  deficient  on  the  left  side. 
Dullness  over  the  whole  of  the  left  lung ;  the  note  is  very  hard 
and  toneless  behind,  particularly  at  the  lower  part,  and  the 
sense  of  resistance  is  very  great — in  front  it  has  also  a  some- 
what tubular  character.  A  good  percussion  sound  upon  the 
right  side.  On  auscultation,  in  front  of  left  side,  amphoric 
breathing,  gurgling,  and  pectoriloquy — behind,  a  weak,  faintly- 
blowing  breath  sound  and  moist  rales.  On  the  right  side  rough 
breathing,  with  bubbling  rales,  is  found   beneath  the  clavicle; 


310  CANADA    MEDICAI.   ANP   StlRQICAL   JOttRNAL. 

elsewhere,  vesicular  murmur   in   unaltered.     Vocal    {remitiis 
much  increased  on  left  side. 

These  physical  signs  )>er8istGd  till  the  end  without  special 
change,  except  the  development  of  it  very  distinct  cracked  pot 
percussion  sound  beneath  the  left  clavicle. 

The  temperature  chart  shows  continuous  fluctuations  of  bod^ 
heat,  fluctuating  between  100"  P.  and  104°  F.  There 
a  daily  expectoration  of  sometimes  as  much  as  a  pint  of  heavy 
purulent  and  nummular  sputa.  The  pulse  continued  very 
rapid,  and  progressively  smaller  and  weaker.  Emaciation  and' 
prostration  i]uickly  advanced.  Ultimately,  on  the  19th  Octo- 
ber, he  was  taken  with  haemoptysis  and  died  on  the  foIlowiii|f 
morning,  without,  however,  having  spat  any  very  large  quanti^ 
of  blood. 

Autopsy. — Left  Lung — Pleura  thickened :  covered  also  ift 
places  with  flakes  o(  recent  lymph.  Entire  apex  occupied  by  A 
large  cavity,  which  contains  clots  and  dirty  reddish-yellow  pua ; 
numerous  trabcculie  cross  it.  The  lower  and  outer  portion  is 
in  a  condition  of  rough,  shaggy-looking  ulceration.  No  small 
aneurisms  are  seen.  The  rest  of  tlic  lung  is  Erm,  solid,  and, 
with  the  exception  of  a  small  margin  at  the  lower  part — airless. 
On  section,  th^  tissue  presents  a  uniform  opa<iue  white  colour, 
looking  as  if  the  whole  organ  were  in  state  of  caseous  degeucrar 
tion.  The  section  is  perfectly  dry,  and  here  and  there  a  few 
gelatinous-looking  strands  of  tissue  are  seen.  Right  Lung — 
Full  in  volume ;  crepitant,  except  part  at  the  apex  and  posterior 
part  of  the  middle  lobes.  Apex  contains  a  small  irregular 
cavity  surmounted  by  inflltrated  gelatinous-looking  tissue. 
Lower  lobe  crepitant,  contains  a  few  caseous  masses,  and  here 
and  there  are  firm  nodular  bodies  like  miliary  tubercles.  The 
bronchi  contain  small  clots  of  blood.  Bronchial  Glands. — En- 
larged, tumid,  moderately  pigmented,  not  caseous,  and  contain 
no  tuber oles. 

No  tubercular  disease  existed  elsewhere,  and  the  other  onmna 
presented  nothing  worthy  of  note. 


roBRESPOSDENCE. 


Correspondence. 


To  the  Editor  of  the  Cknutk   MiDicii,  asd  ScrOicjl  .locBll^^ : 

Edikburgb,  JaniiarT  14,  1879. 
Sir, — ^A  few  notes  from  this,  the  greatest  seat,  perhaps,  in 
itll  the  United  Kingdom  of  medical  teaching,  will  prove  interest- 
ing, I  have  no  doubt,  to  many  of  jour  numerous  readers. 
During  the  last  five  or  ai.t  years  the  changes  in  the  teaching 
statf  of  the  medical  faculty  of  this  university  have  been  very 
numerous.  After  the  loss  of  such  men  as  Bennett,  Christison, 
Lister,  Laycock,  &c.,  many  false  prophets  arose,  who  would 
fain  have  placarded  the  walls  of  their  Alma  Mater  with 
"  Ichabod  !  Ichabod !"  Ilappily,  however,  the  state  of  matters 
has  turned  out  quite  differently,  and  it  is  universally  acknow- 

t  ledged  that  the  teaching  was  never  so  thorough  and  efficient  as 
it'is  this  winter.  The  late  returns  of  the  matriculation  rolls 
show  an  attendance  of  1293  medical  students.  Of  this  number 
565  arc  from  Scotland,  445  fiom  England,  22  from  Ireland,  75 
from  India,  149  from  different  British  colonies,  and  34  from 
foreign  countries.  The  majority  of  the  colonial  students  are 
from  the  Cape  and  Australia.  There  are  also  about  150  stu- 
dents who  attend  exclusively  the  extra-mural  lectures.  Owing 
to  the  small  size  of  some  of  the  class  rooms,  a  few  of  the  lectur- 
ers have  been  compelled  to  divide  their  classes  and  lecture 
twice  daily.     This  difficulty  will,  however,  be   overcome  when 

'  the  buildings  at  present  under  construction  for  the  medical  de- 
partment of  the  university  will  bo  completed.  They  are  situated 
in  close  proximity  to  the  new  infirmary  buildings,  and  already 

,  $1,000,000  has  been  subscribed  (including  the  government 
grant  of  £80,000)  towards  the  building  fund. 

Prof.  Fraaer  has  instituted,  this  winter,  a  practical  class  in 
Materia  Medica.  It  is  very  ably  conducted,  bnt,  owing  to  the 
restrictions  of  the  late  act,  experiments  on  animals  are  not  car- 
ried out.  That  some  misguided  people  are  still  clamoring  for 
more  repressive  measures  against  experiments  on  animals,  the 

■  following  advertisement,  which  is  copied  from  to-day'e  Scottman, 

,  diows: — 

"  Anti-vivisucUoD    Prajer    Uesting    this    Dnjr,   1^30   o'clock,   S   Ijt. 
I  Atidnw'ii  Square," 


312  CANADA    MEDICAL   AND   SUBGIGAl.   JOrRNAL. 

The  followin);  case  of  a  rather  rare  disease  of  the  spina]  cord' 
is  worthy  of  menUon,  principally  oa  account  of  the  benefit  toVn 
derived  from  judicious  treatment,  and  I'rom  the  tight  it  throwt 
on  allied  spinal  affections,  which  are,  as  yet,  but,  little  under 
stood : — 

The  case,  one  of  acute  palio-myelitia,  or  the  so-called  "  infut^ 
tile  *'  paralysis  of  adults,  was  made  the  subject  of  a  clinical  lee 
tnrc  by  Prof.  Grwnger  Stewart,  the  distinguished  occupant  ol 
the  chur  of  Practice  of  Medicine.  The  patient,  who  is  18 
years  of  age,  and  a  gardener,  has  been  under  observation  sinoi 
August.  Ilia  social  and  Family  history  are  good.  He  : 
had  any  previous  illness,  nor  did  he  ever  meet  with  any  ac(» 
dent.  His  illness  began  suddenly  during  the  last  week 
July.  The  symptoms  during  the  first  week  resembled  those  Q 
an  acute  gastric  catarrh.  On  the  fifth  day  of  his  illness  ha 
noticed  that  all  his  extremities  were  weak  ;  on  tbe  seveutli  dft] 
his  right  arm  and  leg  were  completely  paralyzed,  the  left  am 
and  leg  partially  so.  The  following  was  his  condition  dorini 
the  first  week  of  November : — 

Nervoug  Sifttem. — Sensibihty  to  touch  ;  pain  and  heat  ti 
mal-  Muscular  sense  is  unimpaired.  Sight,  hearing,  taate  a 
smell  normal.  The  organic  motor  functions  of  swallowing,  mio 
tuntion  and  defcccation  are  not  interfered  with.  The  bowel 
are  slightly  costive,  but  this  is  owing  to  a  loss  of  power  in  t 
abdominal  muscles.  The  respiratory  acts,  although  ({uickenea 
are  normal  in  rhythm.  There  is  scarcely  any  lateral  expuisin 
of  the  chest  during  inspiration  :  when  he  was  admitted  then 
was  none  whatever.  Forced  expiration  is  a  very  difficult  taski 
Both  the  skin  and  t«ndon  reflex  functions  arc  entirely  abolishect 
The  arms  have  recovered  power  to  a  great  extent,  but  there  i| 
only  the  slightest  improvement  in  the  motion  of  the  lower  extre- 
Duties.  The  arms  respond  to  the  faradic  current,  but  there  i| 
no  response  to  this  form  of  current  in  the  lower  extremities 
There  is  no  exaggerated  reaction  to  the  continuous  curreoj 
showing  that  the  "  reaction  of  degeneration  is  not  prescnfe" 

There  has  been  a  great  and  rapid  wasting  of  tbe  mt 
this  case^more  than  could  be  accounted 


^  OORBESPONDENOE.  313 

a  considerable  elevation  of  temperature  at  first.  Shortly 
&£1ter  his  admission  into  the  infirmary,  he  nearly  succumbed  to 
&n  attack  of  acute  bronchitis — he  was  unable  to  expel  the  pro- 
fmise  secretion  which  collected  in  his  tubes,  owing  to  paralysis  of 
his  intercostals.  At  present  (January  6th)  this  patient  is  stea- 
dily improving ;  the  upper  extremities  have  wholly  regained 
t:beir  power,  and  the  improvement  in  the  feet  and  legs  is  very 
c^onsiderable,  but  as  yet  he  is  not  able  to  walk  unassisted. 

The  distinguishing  features  of  this  disease  are  :—  The  rapid 

ocjcurrence  of  paresis,  passing  into   palsy  of  either  whole,  or 

^^oups  of  muscles,  and  quickly  followed  by  the  rapid  wasting  of 

't^lie  muscles  involved.     There  is  loss  of  reflex  action  and  faradic 

excitability,  but  no  loss  of  sensation. 

Its  patliology  is  the  same  as  infantile  paralysis.     It  consists 

in  a  degeneration  of  the  cells  of  the  anterior  horns  of  grey  mat- 

t^r.    It  is  not  a  settled  point  whether  the  change  consists  in  a 

fDrimary  degeneration  of  the  cells,  or  whether  they  are  injured 

^nd  pressed  upon  by  the  inflammatory  products  arising  from  an 

affection  of  the  interstitial  tissues  of  the  anterior  horns  of  grey 

Tnatter.     The  latter  is,  however,  the  view   that  is  generally 

^opted. 

This  disease  throws  light  on  the  following  diseases  of  the  cord : 
L  Paralysis  of  infants.     11.  Spinal  paralysis  of  adults.     III. 
Lauder's  acute  ascending  paralysis.     IV.  Amyotrophic  lateral 
spinal  sclerosis. 

The  treatment  pursued  in  this  case  was,  in  the  early  stages, 
large  doses  of  ergot,  followed  by  iodide  of  potassium  and  the 
contmuous  current. 

Prof.  Grainger  Stewart  has  had  lately  under  his  care,  in  the 
infirmary,  a  case  of  what  Trousseau  designated  as  epileptiform 
neuralgia.  The  patient,  a  man  70  years  of  age,  has  been 
troubled  with  it  for  18  years,  and  during  that  time  he  tried  a 
great  number  of  diiferent  remedies,  but  nothing,  except  very 
laige  hypodermic  injections  of  morphia,  had  the  least  effect  in 
sr .  iWglting  the  severity  of  the  attacks,  latterly  even  the  morphia 
to  relieve  him.  The  pain,  which  came  on  in  paroxysms, 
BH  half  a  minute  to  one  and  a-half  or  two  minutes,  and 


CANADA    MF.nrcAL    ASD   SOUGICAl, 


1 


I 


was  of  the  most  agonizing  character,  started  in  the  region  ■ 
distrihution  of  the  labial  braaehes  of  the   superior  maxillar;^^^ 
nerve.     The  act  cif  cliewing  invariably  brought  on  a  paroxysm     ^ 
on  this  account  he  was  compelled  to  feed  himself  through  a  tube  —  ■m 
The  slightest  friction  over   the  area  supplied  by  the  superioc" 
maxillary  nerve  excited  an  attaiik.    As  soon  as  the  pain  started, 
the  muscles  of  the  right  side  of  the  face  began  to  twitch.     As  a 
rule,  he  had  several  attacks  daily ;  the  longest  interval  during   1 
the  18  years  that  he  was  free  from  them  was  six  months.  After   i 
his  admission  into  hospital  various  remedies  were  tried,  but  not  | 
the  slightest  benefit  was  noticeable  from  any  or  all  of  tliem. 

The  nerve,  as  it  emerges  from  the  infra-orbital  foramen,  was  I 
cut  down  upon  and  stretched.     This  procedure  was  attended,  J 
after  12  hours,  by  almost  complete  relief;  but  the  pain  recur-  i 
ring  shortly  afterwards,  the  operatien  was  attempted  to  be  re- 
peated, but  owing  to  the  nerve  being  up  in  the  newly-formed 
cicatricial  tissue,  it  could  not  be  stretched,  but  was  cut  through.   ' 
This  only  gave  partial   relief  for   a  short   time.     The    labial 
branch  of  the  nerve  was  stretched,  and  ainoe  this  has  been 
done  (seven  weeks  ago)  he  has  been  completely  free  from  pain. 
He  is  able  now  to  chew  his  food,  and  bear  his  face  to  be  roughly 
rubbed. 

Although  the  relief  which  has  followed  tliis  last  method  of 
treatment  is  complete,  it  remains  to  be  seen  whether  it  will  be 
permanent  or  not. 

The  following  case,  althongh  it  presents  notlung  unusual  in 
its  pathology  or  treatment,  is  of  very  great  interest  from  its 
frequency,  and  is  a  good  example  of  how  a  patient  with  irre- 
trievably damaged  organs  can  be  made  to  enjoy  a  comparatively 
comfortable  existence,  and  have  his  life  greatly  prolonged.  The 
patient,  a  man  (iO  years  of  age,  was  admitted  into  the  hospital  a 
year  ago  under  Prof.  McLagan's  care.  Last  May  be  was 
transferred  to  Prof,  Stewart's  wards,  and  his  condition  then 
was  as  follows : — 

He  was  suffering  from  great  dyspnoea,  aodema  of  the  ' 

extremities,  scrotum,  and  integument  of  the  lo 
back  and  abdomen.    He  hat* 


CORRVSPONBENCE.  315 

lungs,  and  double  hydrothorax.    His  heart  was  dilated  and 

Coeble,  his  mitral  valve  was  incompetent,  and  the  orifice  of  his 

aborta  was  obstructed.     He  had  a  degree  of  cirrhosis  of  the 

kidneys,  and  his  urinary  tubules  were  the  seat  of  acute  catarrh. 

He  was  drowsy  from  uraemic  poisoning.     The  pulse  was  hard 

suid  tense.     Sixty  ounces  of  serum  were  withdrawn  from  the 

:rig|ht  pleural  cavity,  although  the  dullness  did  not  reach  up  to 

t^e  inferior  angle  of  the  scapula.     Up  to  the  present  he  has 

l^een  tapped  on  ten  difierent  occasions— eight  times  from  the 

:»^ght  and  twice  from  the*  left  pleural  cavity  ;  700  ounces  in  all 

l:iaving  been  withdrawn. 

He  was  given  a  pill  containing  digitalis,  squills  and  carbonate 
of  ammonia. 

At  present  the  patient  enjoys  a  fair  degree  of  comfort,  the 
^iropsy  of  the  lower  extremities  having  almost  completely  dis- 
sppeared.  Prof.  Stewart  says  he  has  learnt  the  three  following 
lessons  from  this  case : — I.  A  bolder  use  of  the  aspirator  in 
cardiac  dropsy.  The  fluid  should  be  allowed,  however,  to  drain 
away  very  slowly,  and  the  cavity  should  not  be  completely 
emptied.  H.  A  very  large  quantity  of  fluid  may  be  present  in 
the  pleural  cavity  without  giving  rise  to  extensive  dullness. 
This  is  explained  by  the  constant  and  long-continued  pressure 
of  the  fluid,  causing  exhaustion  of  the  diaphragm.  III.  A  more 
thorough  appreciation  of  the  great  value  of  digitalis  as  a  cardiac 
tonic,  and  of  digitalis  with  squills  as  diuretics. 

The  anaemia,  which  is  an  important  factor  in  the  causation  of 
the  dropsy,  in  those  cases  is  more  certainly  relieved  by  the  use 
of  the  muriated  tinct.  than  any  of  the  other  iron  preparations, 
bat  often  it  disagrees.  Dr.  G.  Stewart  says  that  he  has  found 
that  if  the  chloride  of  ammonium  is  combined  with  the  iron 
tinct,  the  result  is  better,  and  the  former  prevents  the  irritant 
action  of  the  iron. 
Cllm  acute  lobar  pneumonia  be  aborted  ?  This  question, 
18  generally  answered  in  the  negative,  is  one  of  great 
and  is  one  which  Dr.  Geo.*  Balfour  considers  can  be 
■matively.  For  some  years  he  has  given  chloro- 
^neumonia,  and  from  a  close  observation  of  its 


CANADA   MEmCAL   AND   BTTROICAL    JOTTRNAL, 

action  he  believes  that  it  hac  a  great  influeDce  in  prerenti 
hepatization  of  the  long  structure,  or,  if  thia  atage  of  the  disei 
hafl  set  in,  in  preventing  the  spread  of  the  i;onsolidation.  Untft 
the  pathology  of  pnoumonia  is  better  understood,  it  will  not  bfll 
easy  to  give  an  explanation  of  thia  supposed  action  of  chlorofoi 
There  are  good  reasons  for  believing  that  the  term  acute  lobar, 
pneumonia  may  include  more  than  oqc  distinct  disease,  for  recei 
observations  tend  to  show  that  there  is  really  a  specific  fever» 
having  for  its  local  lesion  a  croiipal  exudation  into  the  air  cella. 

Balfour,  however,  denies  the  existence  of  a  true  speoifift 
pneumonia.  When  blood-letting  was  so  frequent  in  the  treab< 
ment  of  pneumonia,  many  cases  were  recorded  where  th« 
disease  was  seemingly  cut  short.  No  doubt  many  of  thoi 
so-called  cures  were  instances  of  the  natural  resolution  of  i 
embolic  pneumonia  ;  for  it  is  well  known  that  the  latter  form  < 
the  disease  runs  a  very  short  course.  It  seems  superfluous  i 
add  that  Dr.  Balfour,  who  has  a  very  extensive  acquaintance 
with  embolic  pneumonia,  would  not  include  it  in  those  cftses 
treated  by  chloroform. 

Dr.  Balfour  gives  the  chloroform  internally,  antl  in  small 
doses,  as  it  is  given  in  Germany. 

That  chloroform  poaaesaes  a  wonderful  influence  in  regulating 
and  controlling  the  circulation,  is  well  seen  when  it  is  given  to 
patients  almost  moribund  from  heart  disease  or  acute  peritonitis. 
Dr.  Balfour  speaks  highly  also  of  its  use  in  angina  pectoris;  it 
is  preferable  here  to  morphia,  on  account  of  the  quickness  of  its 
action,  and  to  nitrite  of  amyl  because  it  is  not  followed  by  any 
unpleasant  after  effects.  It  is  seldom  that  patients  will  take 
amyl  a  second  time,  on  account  of  the  unpleasant  fullness  of 
the  head  that  it  produces. 

The  following  is  a  well  marked  case  of  acute  miliary  tuber- 
culosis in  an  adult. 

A  female  domestic  servant,  aged  21.  was  admitted  into  the 
infirmary,  on  the  7th  January  1879,  under  Dr.  Claud  Muti 
head's  care.     Five  days  before  admiaaion  she  was  noticnl  to 
fretful  and  altered  t-  •■' '^'■■-   -.  .  !,.',,    '    '■^i,  u,];!,!. 

The  family  hisl< 


Ihoj 


OORKEdPONDENCE.  317 

as  follows ; — ^The  temperature  waa  101^,  pulse  70,  bowels 
constipated,  answers  to  questions  are  incoherent.  She  lay  in  a 
state  of  coma  vigil  during  the  first  night.  On  the  following 
day  the  pulse  was  fallen  to  HO ;  the  temperature  in  the  morning 
was  100",  in  the  evening  100.5".  The  pain  in  the  head,  which 
previously  was  confined  to  one  side,  had  now  extended  all  over 
the  vertex,  and  was  of  a  very  severe  character ;  the  pupils 
sluggish.  On  the  9th,  pulse  60,  temperature  100" ;  passed 
only  20  oz.  of  urine  during  the  last  24  houra.  During  the  next 
few  days  the  temperature  varied  from  98"  to  lOO'*,  the  pulse 
from  50  to  70.  She  has  been  either  delirious  or  in  a  semi- 
comatose state.  On  the  15th  a  double  divergent  squint  wa-s 
noticed  ;  passed  a  very  delirious  night.  On  the  morning  of  the 
16th  temperature  100".  pulse  82,  urine  10  oz.  Died  on  the 
evening  of  the  16th, 

Post-Morlem. — Brain — The  dura  mater  was  not  adherent  to 
the  bone.  The  vessels  of  the  vertex  very  full.  The  convolu- 
tions greatly  flattened.  The  lateral  ventricles  only  contained 
three  pinta  of  serum.  Pons  and  medulla  felt  hard.  The  mem- 
branes in  the  neighborhood  of  the  circle  of  Willis  thickened  and 
milky.  The  small  vessels  here  and  along  both  Sylvian  fissures 
were  covered  with  uniall  miliai-y  gelatinous  tubercles.  The 
liver,  spleen  and  kidneys  were  also  dotted  both  internally  and 
externally  with  bodies  of  the  same' size  and  consistence.  The 
same  was  applied  to  the  lungs,  but,  in  addition,  there  was  in  the 
apex  of  the  left  lung  a  caseous  mass,  one-quarter  of  an  inch  in 
diameter,  which  was  undergoing  liquefaction  in  its  centre.  The 
ori^n  of  the  infection  here  was  either  this  mass  in  the  lungs,  or 
an  enlarged  and  pigmented  caseous  bronchial  gland  which  was 
also  present.  The  morning  previous  to  death,  one-third  of  a 
grain  of  pilocarpine  was  injected  subcutanoously  :  this  produced 
great  salivation  and  sweating.  The  cause  of  the  small  quantity 
(rf  fluid  found  in  the  ventricles  was,  no  doubt,  owing  to  the  pro- 
fiiee  diaphoresis  induced  by  the  pilocarpine.  In  proof  of  this 
statement  we  have  the  flattened  condition  of  the  ventricles, 
which  shows  that  at  one  time  there  was  a  considerable  pressure 
exerted  on  them.     In  the  case  of  a  child,  seen  by  Dr.  Balfour 


31H 


CANADA   MKOICAL    AND 


L    JdURNAL. 


where  there  waa  deep  coma  in  the  laat  stage  of  tuberculous 
meningitis,  the  injection  of  pilocarpine  was  quiclily  followed  by 
the  disappearance  of  the  coma,  but  it  aoon  returned.  The 
most  remarkable  feature  in  connection  with  this  case  of  miliary 
tuberculosis  is  its  extremely  rapid  course.  She  died  within 
three  weeks  {probably  17  days)  of  the  first  appearance  of  any 
symptoms.  J.  S. 


I^ftuiiiws  arid  Botii'es  tif  3r.ooiis. 

A  Practical  Treatine  on  the  Medical  and  Surgical  uses  of 
Electricity,  ^o.,  jf-c.  By  Geo.  M.  Beard,  A.M.,  M.D.j 
and  A,  D.  Rockwell,  A.M.,  M.D.  —  Second  edition, 
revised  and  enlarged,  with  two  hundred  iUustrations, 
8vo.  pp.  794.  New  York,  William  Wood  k  Co., 
■27  Great  Jones  Street,  1878. 

The  first  edition  of  this  work  appeared  in  1S71,  and  was  very 
generally  approved  by  the  profession,  so  much  so,  indeed,  that 
it  was  translated  into  German  by  Dr.  Vater  of  Prague,  a 
gentleman  who  has  devoted  much  of  his  time  to  the  subject  of 
electrilizadon. 


Faradization  is  a  general  constitutional  tonic,  and  is  of  benefit 
in  a  number  of  affections,  as  a  therapeutic  agent  of  great  value, 
it  has  assumed  a  position  of  importance  that  can  hardly  be 
estimated.  It  is  essential  to  the  successful  use  of  electricity 
as  a  therapeutic  agent,  that  the  practitioner  should  be  familiar 
with  its  physical  relations.  It  is  in  this  knowledge  that  we 
notice  the  difference  which  results  in  the  practical  application  of 
electricity  in  disease,  by  the  blundering  charlatan  and  the 
scientific  physician ;  and  we  must  regard  the  publication  of  tfaia 
the  second  edition  of  this  work  as  a  matter  of  congratulation  to 
the  reading  professional  public,  as  its  pages  wilt  be  found  to 
contain,  as  the  author's  term  it,  a  "  thoroughly  sifted  expe- 
rience"  of  their  own,  from  the  time  they  entered  on  this  specialty 
to  the  present  period,  as  also  a  full  and  exhauative  resumi  of 
all  that  has  appeared  from  the  pen  of  other  authoritiee. 


BEVIEWS   AND    NOTIOEH   ( 

The  exptaDation  cf  the  chemistry  of  the  batterieB  is  full  in 
detail,  aod  will  be  found  in  accordance  with  the  most  recent 
chemical  knowledge  of  the  subject.  To  Ohm's  law  is  assigned 
a  epetual  chapter,  and  it  is  made  clear  in  all  its  practical 
rel&tioDs.  Electro-phyaics  is  treated  of,  and  the  most  receut 
(acts  are  given  in  a  clear  and  compact  style. 

The  chapter  on  Electro-physiology  has  received  large  addi- 
tions, which  includes  a  report  of  a  number  of  experiments  made 
by  the  antbors  during  the  past  three  years.  The  relation  of 
electro -physiology  to  electro- therapeutics  la  prominently  dealt 
with.  Since  the  publication  of  the  first  edition  of  this  work  the 
method  of  central  galvanization  has  been  reduced  to  a  system, 
and  is  here  fully  described  and  illustrated,  and  its  advantages 
over  local  galvanization  fully  discusaed.  The  various  methods 
of  using  electricity  are  also  described,  as  local  Faradization, 
local  galvanisation,  electrolysis,  and  the  uses  of  electricity  in 
surgery  as  well  as  the  galvanic  cautery,  these  are  all  described 
seriatim.  There  is  a  chapter  on  apparatus,  and  the  most  recent 
improvements  are  given.  ITie  superiority  of  the  continuous 
over  the  broken,  or  separate  coil  Faradiac  machines,  is 
likewise  discussed,  In  the  application  of  electricity  by  the 
snrgeon  the  method  of  applying  the  galvanic  cautery,  and 
ortlinary  electrolysis  is  described,  and  the  results  from  a  very 
large  experience  in  this  department  are  given,  so  that  we  may 
here  learn  what  can  be  done,  and  what  cannot  be  done  by 
electricity  in  surgical  disease.  In  the  clinical  descriptions,  the 
euccesaee  and  failures  are  fairly  represented. 

The  work  has  been  greatly  eidarged,  but  in  this  enlargement 
new  matter  is  given,  material  which  embraces  a  larger  practical 
experience  of  the  uses  of  electricity  in  disease.  Tlie  work  is 
illustrated  throughout  with  19S  engravings  on  wood,  and  to 
those  who  desire  to  employ  this  valuable  therapeutic  agent  in 
the  treatment  of  disease,  we  can  alone  observe  that  this  work 
will  be  found  indispensable. 


320  CANADA  MEDICAL   AND  8UR0I0AL   JOURNAL. 

On  Loss  of   Weight,  Blood-spitting^  and  Lung  Disease. 
By  Horace  Dobbll,M.D.,  &c.,  &c.,  Consulting  Physici 
to  the  Royal  Hospital  for  Diseases  of  the  Chest,  &c.,  &  -^ 
London :  J.  &  A.  Churchill,  1878.    8vo.  pp.  275. 

• 

Pulmonary  Consumption  being  so  frightfully  common-place  ^ 
disease  in  nearly  all  temperate  climates,  all  matters  connectecf 
with  the  elucidation  of  its  causation  and  pathology  are  of  the 
very  highest  practical  importance  to  every  zealous  physician. 
How  anxious  every  patient  is  about  what  is  to  follow  when  he 
has  had  an  attack  of  haemoptysis.  The  public  know — ^it  is 
notorious — that  this  often  seems  to  be  the  precurser  of  perma- 
nent organic  changes  in  the  lungs.  How  eagerly,  therefore, 
the  subject  of  it  seeks  the  counsel  of  his  physician  for  the 
prevention  of  the  threatened  evil,  or,  better  still,  the  consoling 
experience  that  he  has  it  not  to  dread.  The  relationship  of 
haemoptysis  to  lung  disease  has  long  been  a  debated  point  in  the 
pathogenesis  of  phthisis.  Its  exact  position  in  this  respect  is 
yet  by  no  means  settled.  Every  attempt  to  assist  in  the  solution 
of  these  problems  is  to  be  gratefully  accepted  by  the  profession. 
In  this  work  Dr.  Dobell  has  offered  to  us  a  large  amount  of 
material  of  much  interest  and  instruction  with  reference  to  the 
relations  between  loss  of  body-weight  and  blood-spitting  to  co- 
existent or  subsequent  pulmonary  disease.  Much  of  the  value 
of  the  book  is  derived  from  the  large  numbers  of  original 
observations — frequently  accompanied  by  carefuUy-taJbulated 
statements,  brought  together  and  coiApared  specially  with  the 
view  of  throwing  light  upon  the  matters  under  discussion.  All 
the  more  recent  views  of  the  principal  writers  on  Consumption 
are  also  passed  in  review,  and  looked  at  pro  and  con^  both  from 
their  own  stand-point  and  also  in  the  light  of  the  author's  own 
observations.  We  have  much  pleasure  in  bringing  to  the  notice 
of  our  readers  this  further  contribution  of  this  well-known 
writer  to  the  clinical  study  of  Consumption.  It  will  be  found 
full  of  interest,  and  a  good  guide  and  assistant  in  forming 
opinions  upon  the  important  points  set  forth  in  its  title. 


.ii^^ 


REVIEWS  AND    NOTICES   OF    BOOKS. 


321 


IH»e<i»e»  nf  ike  Bladder  and  Urethra  in  Women. — By  Albx. 
C.  Skesb,  M.D.,  Professor  of  the  Diseases  of  Women  in 
the  Long  Island  College  Hospital,  &c.,  &c.  8vo.  pp.  374. 
New  York,  William  Wood  &  Co.,  27  Great  Jouea  Street. 

This  13  a  collection  of  eight  lectttrea  which  were  prepared 
orignally  for  the  class  of  the  Long  Island  CjUege,  and  they  will 
be  fonnd  to  embrace  many  of  the  diseaaes  and  functional 
derangements  of  the  bladder  and  uretlira,  which  are  not  to  be 
found  in  any  systematic  work  in  the  English  language.  This 
worksuppUea  a  deficiency  which  has  been  felt  by  the  practitioner. 
These  maladies  may  at  first  Appear  of  no  moment,  but  experience, 
however,  will  prove  that  diseases  of  the  bladder  are  tedious  and 
perplexing,  full  of  tnisery  to  the  sufleror,  and  demnndin^  at  the 
hands  of  the  practitioner  a  large  share  of  paticTice  and  perse- 
verance. In  the  opening  lecture  the  author  gives  a  general 
outline  of  the  anatomy  of  the  bladder  and  urethra,  functions  of 
the  bladder,  its  development,  and  malformations  of  the  urethra 
and  of  the  bladder.  In  this  part  of  the  lecture  are  discussad 
the  probable  causes  of  the  congenital  malformations  which 
are  Bomeiimes  met  with.  In  the  second  lecture  the  author  dis- 
cusses functional  diseases  of  the  bladder,  irritable  bladder  due 
lo  abnormal  urine,  and  functional  derangements  due  to  disea-w 
in  other  pelvic  organs ;  the  same,  from  anomalies  in  positioa 
and  form  of  the  bladder,  and  extroversion  through  the  urethra.  * 
The  third  lecture  is  upon  organic  disease  of  the  bladder,  the 
aids  to  diagnoses  in  the  examination  of  the  uriae,  and  explora- 
tion of  the  bladder  itself.  Hyponemia  and  hremorrhage  from 
the  bladder. 

Cystitis  acute,  sub-acute,  chronic,  catarrhal,  croupous,  djph- 
^eritic  and  gonorrhceal,  form  the  aubjet-ts  discussed  in  the  fourth 
lecture.  The  treatment  of  these  affections  is  given  in  the  ne.it 
lecture,  and  in  the  sixth  lecture,  the  author  discusses  tuber- 
cular and  malignant  affections  of  the  bladder,  foreign  bodies  in 
the  bladder,  also  hypertrophy  of  the  viecus. 

The  remaining  two  lectures  are  devoted  to  affections  of  the 
female  urethra.     There  is  an  appendix  to  the  Srst  lecture,  in 

NO.    LXXIX.  22 


322  i-ANADA    MEDICAL   AND   snttfllCAL    JoraNAL. 

which  is  related  a  case  of  extroversion  of  the  bladder  by  Dr. 
Daaiel  Ajres,  which  was  auccesafally  closed  by  two  flaps  taken 
from  the  abdominiil  paricties  above.  It  appears  to  have  been  & 
characteristic  case,  but  one  greatly  benfited  by  the  operativs 
ineasuio  adopted.  This  is  a  most  uacfal  manual,  and  treats  of- 
aflectjous  which  are  not  discussed  in  works  devoted  to  the  con- 
sideration of  diseases  of  females.  We  recommend  it  to  oor 
readers  as  a  good  and  reliable  guide  in  the  treatment  of  dieeasee 
of  the  bladder  and  urethra  in  women.  The  type  is  large,  we'll 
impressed,  on  the  best  of  paper,  and  it  is  illustrated  througboat 
with  moat  artistic  wood  eDgravings. 

A  Manual  of  Phyncal  Diayrwsis.~Bj  FiiANcie  DelafielDi 
M.D-,  and  Charles  F.  Stillman,  M.D.  4to.  pp.  30, 
interleaved.  New  York :  William  Wood  k  Co.,  27  Greal 
Jones  Street,  1878. 

In  the  preface  the  author  states  that "  thia  manual  is  intendedl 
for  the  use  of  those  who  have  to  teach  and  to  learn  the  art  of 
physical  diagnosis."  and  it  is  supplied  with  blank  leaves,  so  that 
the  student  or  practitioner  may  take  it  into  the  wards  of  i 
hospital  and  use  it  as  a  note-book.  We  do  not  think  it  coul 
with  advantage  be  so  used,  but  we  have  no  doubt  that  the  woi4 
will  be  found  to  supply  a  place  which  has  until  now  r< 
unfilled.  The  work  commences  by  9  description  of  thi 
methods  of  examination,  showing  how  they  should  be  conducted 
There  is  tirst  described  the  sounds  elicited  on  percussion  'm  I 
normal  condition  of  the  chest  and  abdomen.  The  differen 
regions  being  indicated,  we  next  have  det^ed  the  sounds  elicite 
in  conditions  of  disease.  Auscultation  in  health  and  diseaa 
are  next  given,  and  then  there  is  described  the  difierencee  i| 
quality  of  the  voice  in  variable  conditions.  The  physical  sigi 
as  indicative  of  special  forms  of  disease  of  the  lungs  are  i 
^ven.  The  author  then  passes  on  in  the  same  systemalil 
manner  to  the  elucidauou  of  the  physical  signs  met  irith  in  tb 
examination  of  the  heart,  terminating  his  description  with  thofl 
indicative  of  aneurism  of  the  arch  of  the  aorta.  The  autiu 
in  the  preparation  of  this  work,  acknowledgee  tus  indebt«dQM 


REVISWB   AND   NOTFCES   OF    BO0K8.  323 

to  the  works  of  Walahe,  Flint,  and  Sibson.  There  are  two 
original  drawings  hy  Dr.  Stillmau,  one  of  ihe  anterior  regions  of 
the  chest  and  abdomen,  the  other  of  the  poaterior  regions ;  these 
are  specially  intended  to  indicate  the  relative  position  of  the 
various  organa,  and  are  of  great  practical  valae.  The  whole  ia 
most  handsomely  got  up,  and  the  plates  which  adorn  the  book, 
are  finished  in  the  highest  style  of  art.  One  is  a  dissected  plate 
and  indicates  the  position  of  the  thoracic  and  abdominal  viaccra 
witi  truthfulness  and  accuracy.  We  think  this  manual  will  bo 
foond  of  service,  more  so,  perhaps,  to  a  man  who  has  already 
become  familiar  with  physical  exploration  than  to  the  beginner. 
To  the  teacher  we  should  think  it  would  be  of  especial  use. 

A   Practical    Manual    of    tkf    Pistasen  of  Children,  with  a 

formularif,  — By    Edward   Ellis,    M.D.,  late    Senior 

Physician  to  the  Victoria  Hospital  for  Sick  Children,  &c, 

&c.     Third  Edition,  8vo.  pp.  213.    New  York  :  William 

Wood  &  Co.,  27  Great  Jones  Street,  1879. 

This  is  the  second   of  the   series   published  by  the  Messrs 

Wood  of  New  York   in   their  Library   of  Standard   Medical 

Aathors,  and  is  issued  from  the  press  in   the   same  style  of 

excellence  as  the  first  volume  formerly  noticed. 

This  is  a  very  excellent  manual  on  the  subject  of  Children's 
Diseases,  and  consists  of  ten  chapters.  The  principal  worth  of 
this  manaal  is  ihe  abundant  formulary,  the  general  therapeutic 
hiiits  and  a  description  of  suitable  diet,  which  is  more  important 
in  the  treatment  of  diseases  of  children  than  medication.  The 
last  chapter  in  this  work  is  devoted  to  this  subject.  This 
chapter  is  brief  hut  of  very  great  importance  practically. 
This  being  the  third  edition  much  fresh  material  will  be  found 
added  in  each  section,  'llie  general  description  of  diseases  is 
quite  op  U>  the  time  and  the  work  will  be  found  of  use  to  both 
practitioner  and  student ;  it  is  a  fitting  adjunct  to  the  scries 
being  published  by  the  enterprising  house  of  William  Wood 
and  Company,  in  their  Library  of  Standard  Medical  Works. 
We  trust  the  worthy  attempt  of  the  publishers  to  give  to  the 
profession  a  series  of  useful  books,  at  a  price  far  below  their 
value,  will  bo  fully  appreciated  and  liberally  supported. 


324  CA^ADA   HKDICAL    AND   SITBGICAL   JOURNAL. 

ladej:  Mediciis,  a  monthly  claasified  record  of  the  current 
Medical  Literature  of  the  world,  compiled  under  the  super- 
viaion  of  Dra.  John  S.  Billings.  Surgeon,  U.S.A.,  and 
RoBBRT  Flbtcukb,  M.R.C.S.,  Eng.  Vol,  1.  Jan.  31, 1879. 
Imp.  8vo.pp.72.  New  York:  F.  Seypolut,  37  Park  Row. 

It  is  known  to  moat  of  our  readers  that  some  years  ago  s 
library  largely  composed  of  periodical  literature  was  started 
in  connection  with  the  Surgeon-General's  department  of  the 
United  States  of  America,  at  Washington,  this  was  principally 
under  the  charge  of  Dr.  John  S.  Billings.  This  collection  has 
assumed  large  proportions,  and  contains  at  the  present  day  many 
thousand  volumes.  This,  of  itself,  is  a  most  valuable  collection 
as  in  it  are  to  be  found  Medical  periodicals  of  all  nations  and  in 
all  languages.  With  a  view  of  rendering  this  collection  of  use 
to  the  general  professiouaJ  public,  the  authors  of  the  Index 
Medicus  have  determined  to  publish  a  monthly  record  of  the 
titles  of  all  the  papers  that  appear  in  the  periodicals  which  are 
received  during  the  preceding  month. 

We  have  received  the  Srst  number  of  the  Index  published 
under  the  Editorial  management  of  Dr.  J.  S.  Billings  of  the 
Surgeon  General's  Departuient,  U.S.A.,  and  Dr.  Robt.  Fletcher. 
It  bears  evidence  of  a  vast  amount  of  labour  and  research.  It 
is  proposed  to  issue  a  monthly  index  to  contain  the  titles  of  all 
papers  that  have  appeared  in  periodicals  or  transactions  of 
societies,  new  remedies  and  the  latest  information  on  therapeu- 
tics. This  will  be  of  especial  benefit  to  authors,  as  in  these  pages 
they  will  be  able  to  discover  the  latest  views  of  writers  and 
to  ascertain  whether  the  views  which  they  themselves  hold 
have  been  anticipated  by  others.  Teachers  in  Medicine  or 
Surgery  will  be  able  to  keep,  au  oouraiit,  with  the  advance  of 
their  art,  by  noting  what  ia  being  doue  in  all  countries  ;  and 
editors  of  periodicals  will  -with  facility  be  able  to  refer  to  the 
articles  to  be  found  in  other  periodicals,  besides  the  iocalculabia 
benefit  to  be  derived  by  a  full  publicity  of  the  papers 
found  in  their  own  pages. 


BRITISH   AND   FOREIGN   JOtJBNALB. 


Kxtracts  from  British  and  JForcign  Journals. 


C3llOFa>l  Hydrate.^ (Note  on  a  method  of  adminia- 
tering  Chloral  Hydrate,  hy  E.  L.  Dixon.  M.D.,  M.R.C.P.)— 
On  the  27th  July  I  was  sent  for  some  distance  iuto  the  country 
to  see  a  farmer,  who  was  said  to  be  dying.  When  I  arrived  I 
foanil  that  he  had  been  auifering  for  the  past  twelve  hours  from 
a  aeries  of  violent  epileptic  paroxysms,  and  that  for  three  hours 
he  had  oot  been  sensible.  In  my  presence  he  had  two  attacks 
with  an  interval  of  twenty  minutes,  in  which  he  never  became 
quite  conscious,  but  continued  to  toss  about  violently.  He  had 
passed  urine  involuntarily  during  a  paroxysm ;  the  pulse  was 
quiclc  and  weak ;  the  bowels  had  been  well  acted  upon,  and  the 
temperature  was  high,  lOS^-S,  as  is  the  case  in  the  status  epil- 
epticus.  He  had  been,  it  was  said,  fairly  temperate  of  late, 
but  he  had  been  thoroughly  wet  through  two  days  before  this 
attack.  He  was  a  robust  man  of  twenty-eight  years  of  age. 
Epilepsy  had  first  shown  itself  about  two  years  before,  from 
exposure  to  the  sun  during  hay-making,  it  was  said,  and  the 
attacks  had  been  repeated  every  month  till  January  last,  when 
I  was  called  in  to  see  him  on  account  of  his  having  had  several 
in  one  day.  I  then  found  he  had  been  indulging  freely  in  alcoholic 
liquors ;  the  urine  was  free  from  albumen  and  of  fair  ap.  gr., 
but  nothing  else  was  made  out.  I  recommended  strict  teetotal- 
ism,  and  that  he  should  take  the  bromide  potassium  regularly 
for  some  time.  After  this  he  had  no  return  until  about  five 
weeks  ago,  when  he  had  two  attacks,  and  had  then  remained 
free  till  I  waa  again  sent  for 

On  this  occasion,  in  consequence  of  the  increasing  rapidity 
of  the  recurrence  of  the  fits,  I  became  alarmed  as  to  the  result, 
for  it  was  evident  that  unless  they  ceased  he  would  become 
comatose  and  die.  The  principal  indication  seemed  to  me  to 
diminish  if  possible  the  excitability  of  the  re6ex  nervous  centres. 
I  did  not  venture,  nor  did  I  think  it  desirable,  to  bleed  him.  I 
had  no  chloroform  with  me,  but  I  had  a  small  bottle  of  the 


326  RANADA   UraniCAL   AND   SITHOICAI.   JOtTBRAL. 

liquor  chloral  hydrat.  (corbyn),  of  which  each  minim  equals 
grain  of  salt.  I  tried  to  make  him  swallow  a  draught  contain- 
ing a  drachm,  diluted  with  water,  but  he  pushed  it  away  forcibly. 
I  had  no  syringe  with  which  to  administer  it  as  an  enema, 
nor  even  hypodermically.  With  the  assistance  of  a  strong  man, 
who  held  his  head  and  opened  the  jaws  with  a  piece  of  wood,  I 
emptied  a  teasDOonful  of  the  concentrated  solution  into  the  back 
of  Ilia  mouth.  He  started  Tiolently,  but  did  noteject  any  of  the 
medicine.  After  a  time  1  noticed  that  the  restlessness  dimiiw 
ished  ;  still  he  did  not  sleep.  About  half-an-bour  after  the  first 
dose  I  administered  a  second  of  about  forty  minims  in  a  similar 
manner,  when  he  gradually  sank  into  a  profound  sleep,  which 
lasted  five  or  six  hours,  and  there  was  no  return  of  the  convul-. 
sions.  Next  day  I  found  his  temperature  had  fallen  to  101°-3, 
the  pulse  was  quiet ;  the  urine,  however,  contiuned  a  small 
amountof  albumen,  and  was  of  sp.  gr,  1-014. —  The  Pract*^ 
Honer. 


Urticaria  as  a  consequence  of  the  ad- 
ministration of  Sodium  Salicylate.  —  The 

following  case  of  urticaria  came  under  the  observation  of  Prof. 
Leube's  poliklinik  last  winter.  A  man  aged  45,  who  had 
been  healthy  till  he  came  of  age,  when  he  suffered  from  a 
tedious  attack  of  rheumatism,  suffered  a  relapse  and  came  for 
advice  to  the  clinic.  The  left  elbow  and  right  knee  were 
slightly  swollen,  and  the  skin  was  somewhat  reddened,  whilst 
great  pain  was  experienced  in  the  affected  limbs.  The  heart 
was  normal.  The  clinical  appearance  of  the  disease  resembled 
the  usual  type,  but  its  course  was  protracted.  During  the  ten 
days  following  admission  0.50  of  sodium  salicylate  were  admin- 
istered every  hour,  without  any  good  effects  becoming  apparent, 
though  no  signs  of  any  change  in  the  organism  were  noticed. 
A  large  dose  of  the  substance — four  grams — was  then  given 
by  way  of  experiment.  The  same  evening  the  patient  suffered 
from  an  intolerable  itching,  which  came  on  shortly  after  injec- 
tion of  the  powder,  and  lay  rubbing  Iiimself  with  the  woollen 
I  bedclothes,  though  on  superficial  examination  nothing  was  seen 


BRITISH  AND   FOREIGN   JOURNALS.  32? 

except  that  ^e  left  half  of  the  face,  the  lower  extremities,  and 
&  part  of  the  chest  were  very  red :  on  a  closer  examination  both 
ojrelids,  the  upper  lip,  and  the  lower  extremities  as  far  as  the 
XEiiddle  of  the  lower  part  of  the  thigh,  were  slightly  oedem^tous- 
The  temperature  was  38-8^  C.  the  pulse  80.     The  urine  albu- 
zxainous.      A  physical  examination  afforded  no  results  of  impor- 
't^s^noe.     The  orginal  rheumatism,  however,  was  much  improved, 
the  patient  did  not  feel  so  much  pain  in  his  affected  joints. 
the  following  day  the  temperature  in  the  mornhig  was  37-8 
.ud  the  pulse  80  ;  in  the  evening  37-2  and  76  ;  there  was  no 
't^vace  of  redness.      Three  days  later  the  patient  was  free  from 
in  ;  but  on  the  fourth  he  suffered  so  much,  that  a  second  large 
oes  of  sodium  salicylate  was  ordered.     The  observations  were 
en  made  cautiously.      Fifteen  minutes  after  injection  of  four 
ins   of  the  powder,  a  burning  pain  was  felt  in  the  forehead, 
ve  minutes  later  great  itching  of  the  skin  over  the  right  meta- 
arpals.     There  was  slight  oedema  of  both  eyelids,  and  sur- 
^■rounding  parts  were  somewhat  reddened.     The  redness  spread 
<Dver  the  left  ear  to  the  neck,  whilst  oedema  of  the  upper  lip 
Ibecame  apparent.     Soon  afterwards  great  itching  was  felt  over 
the  epigastriiun,  and  over  the  whole  abdomen  an  eruption  of 
yale  and  sparsely  spread  vesicles  were  noticed,  situated  upon  a 
xed  ground.     Half  an  hour  afterwards  the  patient  felt   the 
itching  over  the  whole  of  his  body,  and  the  vesicles  were  appa- 
rent on  his  legs,  whilst  his  arms  were  in  a  well-marked  oedematous 
condition,  without  any  reddening  of  the  skin.      An  hour  later 
the  visicles  had  disappeared,  though  the  reddening  of  the  skin 
remained  apparent  for  two  or  three  hours.     The  urine  was  free 
from  albumen  some  hours  after  the  attack.      On  the  following 
day  nothing  could  be  seen.      Six  days  afterwards  the  experi- 
ment was  again  made  with  similar  results.     The  condition  of  the 
patient  was  always  improved,  and  he  continued  to  take  small 
closes,  which   were  without  effect  in  causing  urticaria.     After 
complete  recovery  of  the  patient  he  again  took  a  large  dose, 
followed  once  more  by  the  appearances  described.     (Dr.  Hein- 
Un,  Aertdiches  Intelligenzblatt^  1878,  No.  15,  Med^-Ohir,^ 
Bmdsehauy  Oct  1878.    The  Practitioner. 


B  CANADA   MEDICAL   AND   SCTRaiCAL    JOURNAL.        ^^^ 

Treatment  of  Sore  Nipples.— i>i"  HansmanD' 

plan  of  treating  aore  nipplea  by  the  application-  of  aolations  of 
carbolic  acid  has  recently  been  tried  in  the  Ijing-in  wards  ot 
the  Berlin  Charitil  Hospital.  Instead  however  of  applying  stripe 
of  lint  saturated  with  the  solution,  Dr.  Steiner  dii-ected  that  the 
acid  should  be  brought  into  contact  with  the  sores  by  means  of 
camel-hair  brush.  Forty  cases  have  been  thus  treated  witlt 
Batisfaetorj  results.  A  5  per  cent,  solution  seemed  to  be  most 
efficacious ;  its  application  may  be  said  to  he  painless,  as  it  causes 
only  a  very  slight  burning.  By  means  of  the  brush  the  acid 
can  be  applied  to  the  smallest  cracks,  and  two  or  three  applicar 
tions  of  this  kind  daily  are  ueimlly  sufficient.  A  shield  of 
course  must  be  nsed  when  the  child  is  put  to  the  breast.  Dr. 
Stiener  also  tried  solutioaa  of  thymol,  1  in  1,000,  for  a 
purpose,  but  found  them  to  be  far  less  efficacious  than  the  car- 
bonic acid,— (TAp  Medical  Examiner,  August  8,1878.^  PratH- 
tioner. 

Fuchsin     In    Ctironlc    Nephritis    anfl 

DropyS. — Dr.  B(iuchut  communicates  the  case  of  a  boy 
six  years,  who  had  Buffered  ten  months  previously  from  scarlet; 
fever,  aud  who  was  now  ill  from  severe  albuminuria  and  dropsvii 
The  temperature  was  39"  C,  The  child  was  ordered -lO  fucnsjij 
in  two  pills  and  a  milk  diet,  aud  on  the  following  day  0-15-0-2(| 
grammes  of  the  same  drug.  The  albuminuria  and  dropsy 
completely  disappeared  after  fourteen  days  of  this  treatmenti 
whilst  no  bad  effects  were  observed.  The  author  draws  nOi 
conclusions  from  this  case,  but  bethinks,  and  no  doubt  correctly^ 
that  these  means  ought  to  be  tried  in  those  cases  of  chroiuB 
albumiouria  in  which  other  methods  of  treatment  have  heoli; 
adopted  ineffectually.— ( Cfflz-  de»  Hdpifaux,  1878,  No.  43^ 
Med.  Ckir.,  Rundschau.  Oct.  1878.)— FAe  Practitioner. 

Danger  of  Atropln.  —  M.  Galezowski  at  th«i 
stance  of  the  Society  de  Biologic  of  Paris,  stance  of  NovemlH 
16th,  1878,  showed  that  in  many  diseases  dropping  of  atropb 
intu  the  eye  was  attended  with  danger.  He  quoted  severa 
cases  of  a  adults  as  well  as  children  in  which  serious  results  hai 
followed  from  absorption  by  the  media  of  the  eye,  of  very  snm] 
doses  of  this  substance.  In  short,  Mr,  Galezowski  believM 
atropin  to  be  an  exceedingly  useful,  although  at  the  same  tiini 
very  dangerous  remedy,  which  should  be  used  with  the  great 
caution.  Duboisin  which  can  replace  atropin  is  a  less  dangflp 
ous  drug,  because  its  principle  is  less  active. — (ie  Progri 
Medietde,  November  31, 1878.)     Tke  frgcjtfjwqr^ 


CANADA 

^cdital  mi  f  ittgital  |ontnal 

Montreal,  February,  1879. 
CORONER'S    INQUESTS, 

We  insert,  bjr  request,  a  letter  from  Dr.  O'Leary,  addressed 
to  the  Editor  of  The  Montreal  Herald,  which  will  be  found  to 
be  a  running  commentary  on  the  inquest  held  on  the  body  of 
the  late  Richard  Patton,  auapected  to  have  died  by  poison,  or 
of  having  committed  suicide  by  swallowing  an  over-doae  of 
morpliine.  We  do  not  think  that  it  has  been  proved  positively 
aud  without  doubt,  that  the  deceased  actually  did  die  of  morphia 
poisoning,  but  then  it  was  not  to  be  expected  that  the. mere 
examination  of  the  stomach  and  ita  contents  would  satisfactorily 
prove  this  point. 

The  whole  affair  from  beginning  to  end  appears  to  have  been 
bungled. 

An  inquiry  touching  the  death  of  an  individual,  to  be  of  any 
service  in  the  administration  of  the  law,  ought  to  be  conducted 
on  such  principles  as  to  leave  no  loop-hole  or  asswlable  poiut 
where  a  doubt  can  be  entertained.  The  law  always  leans  to  the 
eide  of  mercy  iu  crimiaal  cases,  and  the  prisoner  ia  entitled  to 
the  benefit  of  any  doubt  which  may  arise.  Thia  is  a  well-known 
axiom,  and  since  it  is  so,  why  should  not  the  Government  guard 
against  any  such  possibility  by  the  employment  of  skilled 
evidence  where  such  is  attainable.  In  the  metiiod  of  conduct- 
ing  inquests  as  at  present  followed,  it  does  appear  to  be  a  mere 
matter  of  form,  a  disagreeable  form  which  has  to  be  gone 
through,  but  which  means  ing,  aud  practically  amounts  to 
nothing.  The  country  is  saddled  with  expense  in  conducting  a 
meaningless  inquiry,  which  in  the  end  serves  to  fill  our  evening 


papers  with  a  sensational  column,  full  of  horror  to  the  readei 
fail  of  harrowing  c ire iimata noes  to  surviving  frieDds.  whi( 
points  to  no  moral,  but  rather  pandera  to  the  prurient  cijriad 
of  a  debased  taste  of  the  public  at  large 

We  do  not  desire  to  a&y  anything  of  a  personal  nature  regai 
ing  those  engaged  in  the  special  inquest  under  cIiacu33ion>  b 
can  alone  remark,  that  whatever  the  suspicion  as  to  cause 
the  death  of  this  unfortunate  man,  we  cannot  admit  that  it  h 
been  proved  that  he  did  die  of  poison.  The  presumption  may ' 
in  favor  of  morphia  poisoning,  but  in  the  Scotch  acceptation 
the  term  it  remains  unproven.  With  respect  to  inquests  we  h« 
something  to  say. 

If  it  is  necessary  to  hold  an  inquest  at  all  we  should  apply  f 
old-fashioned  maxim,  ^'  if  it  is  worth  doing,  it  is  worth  dni 
well."     An  inquest  of  this  solemn  nature  ought  not  to  be  da 
in  a  slovenly  manner.     Any  case  that  is  Hkely  to  come  befc 
the  criminal  or  civil  courts  ought  to  be  so  conducted  as  to  leai 
no  question  of  doubt.     To  secure  this  end,  so  desirable, 
persons  employed  should  be  thoroughly  conversant  with  the 
and  in  their  several  departments  possess  the  acumen  of  experts. 
If  a  chemical  analysis  is  to  be  conducted  the  Government  ought 
to  employ  a  person,  not  second-hand,  but  direct,  who  b  known  to 
be  capable  of  carrying  out  such  analysis.     In  the  case  of  the 
late  R.  Patton,  the  contents  of  the  stomach  were  required  to  be 
analysed,  and,  strange  to  say.  to  Dr.  O'Leary,  who  we  believe 
to  be  a  very  excellent  private  practitioner,  was  allotted  the  task 
of  searching  for  the  poison.     We  were  somewhat  surprised  thai 
the  Doctor  assumed  the  task,  but  in  doing  so  he  had  to  associate 
with  himself,  or  to  secure   the  services  of  a  known  practical 
chemist,  so  tliat  the  country  is  called  upon  to  pay  for  the  services 
of  two  men,  both  we  presume,  charging  the  customary  fee.    We 
think  Dr.  O'Leary  would  have  been  more  true  to  himself  had 
he  refused  to  accept  the  responsibility  of  such  an  investigation, 
and  have  referred  the  Government  to  a  practical  chemist.    Tiiis 
is  merely  our  opinion,  and  can  go  for  all  it  is  worth. 

But  again,  in  conducting  an  enquiry,  we  think  the  Govenstaaki 
would  be  better  served  if  iiistructioua  were  g/nea  to  ti 


f 


to  employ  the  serricea  oolj  of  those  who  make  a  spemi  study 
of  sabjeets  of  tfais  description.  In  this  city  there  are  three  schools 
of  medidne,  and  in  each  school  the  subject  of  Medical  Jurispru- 
dence is  tan^t ;  who  is  bett«r  able  to  conduct  a  preliminary 
inquiry  and  perform  a  post-mortem  examination  in  cases  of 
suspected  foul  play,  than  a  man  who  makes  it  his  special  study, 
vrho  is  constantly  teaching  how  a  post-mortem  examination  ought 
^  be  conducted  in  any  special  case  where  suspicion  of  murder 
»»■  Suicide  exists.     Had  any  of  these  gentlemen  conducted  the 
e^cazniiiatioD  of  the  body  in  the  above  case,  we  hardly  think  they 
^onld  have  omitted  the  precaution  of  securing  the  contents  of 
the   Tiriiiary  bladder,  or  some  portion  of  the  liver  or  blood,  to 
I>**ove  that  the  poison,  if  any  existed  in  the  stomach  or  its  con- 
^^'^ts,  had  entered  the  system  and  was  in  process  of  elimination. 
-■-beii,  again,'we  are  not  all  chemists,     ^ie  is  a  department  of 
^^   apecial  a  nature  that  it  is  simply  absurd  to  expect  a  satisfac- 
^-^'ly  and  reasonable  report  from  any  but  a  man  who  makes  it  his 
I^^dal  study,  and  who  is  provided  with  the  necessary  apparatus 
.  *-**•    carrying  out  his  inquiry.    There  are  very  few  all-round  men 
^    'tile  profession,  though  some  may  flatter  themselves  they  can 
^**OTn  any  position  to  which  for  the  time  they  may  be  called 
^I>^in  to  occupy. 

'^  the  Editoi  of  the  Montmal  H'bald. 
,^^  ^iB, — The  Government  of  Quebec  having  honored  ma  with  an  appoint- 
I'^^Kt  in  coDQection  with  the  inqDest  case  of  the  lute  Mr.  Pattoo,  I  think 
^  l>nf  duty  to  inform  the  Qovemmentand  the  public  of  the  waj  In  which 
T^^^^naitB  Me  held  in  Montreai.  I  have  no  penonal  iotereet  wbaUoever  In 
^^*«  matter ;  but  I  will  make  a  short  review  of  it  for  the  purpose  mcntion- 
^^s  which  will  ahow  the  negligence  of  the  Coroner  in  not  aummooing  im- 
*'***tMrt  witneasea,  hfe  want  of  persoiial  dignity,  and  his  moral  inability  to 
T>»y  proper  decomm  in  hia  owe  Court,  thus  allowing  jurymen  to  make 
ta a^ainit  absent  Important  witnesxes,  just  toinfluence  their 
I  ,  and  the  indecency  of  liia  allowing  political  iqoabblet  and 
s  of  tb«  Gi>f  emment  whose  officer  he  is. 
Kr-  Fattoo,  a  rt-qwwtable  and  well-known  busineai  man,  whose  life  is 
d  fiiT  a  coQjdilenble  amoDat, — which  is  forfeited  in  case  of  suicide — 
A  tew  days  afl«r  he  suddenly  disappears.  After  five 
ttlmfoaoi  dMd,  under  the  snspicious  circumstances  com - 
I  say,  Id  a  sleigh  stored  In  a  hay-loft  of 
r  empannels  a  jury,  who  lake  the  following 


333  CANADA   UXOtOAt   AND   S4t(tTDAL    JOTTIlNAL. 

oatb,  nhicb,  tritb  oar   preM&t  Coroner,  is  gcnorall;  Cbeir  onlj  gnldr  f 
oomiDg  to  a  concloBioii : — "Toaeball  pr^ftont  no  man  for  hatred.  malicsOt 
<<  ill-wUl,  nor  spare  any  through  Tear, /avor  ur  o^ncfion;  but  a  true  renUct  ^ 
"  give  according  to  ihf  evidnHce  an<]  the  betit  of  your  Bkill  and  knowledge,  so     ' 
<'  help  foil  God."     Here  is,  in  HDbstance,  the  cvldenoe  aceordlng  to  which 
only  the  jury  was  »wom  to  bring  in  a  verdict.     Mr.  Wiiltams  merely  awesM  J 
to  the  fludiu);  of  the  body.     Ur.  Thott.  Shair  knew  deceased  for  11  yeaMV 
and  bad  noticed  for  Humu  time  past   that  bis  spirits  were  considerably  d*fH 
pressed.    Two  other  witnesBes,  Mr,  A.  C,  Hutchison  and  Mr.  H.  T.  PattOD —  ■ 
tie  latter  deceased's  tM>n—teHtifiedt«  the  same  effect.     But  Mr.  Shaw,  hav- 
ing taken  breakiast  with  decOtsed  on  the  morning  of  the  14th  Decomber. 
the  date  of  his  disappearance,  found  him  much  quieter  than  nsuai.     He 
took  very  little  breakfast,  walked  down  to   the  lane  in  rear  of  deceased'* 
residence,  which  deteased   entered  witbnot   further  remark.    This  was  a 
little  uncommon,  ae  formerly  he  naed  to  nay  that  he  was  going  no  further, 
or  something  to  that  effect.     Apart  from  the  medical  and  chemicftl  erl- 
dencD,  this  is  all  that  was  submitted.     However,  to  complete  that  part  of 
the  evidence  upon  which,  or  rather  a^iinst  wbich,  the  jurymen  mast  hare 
fbuoded  their  finding,  if  they  found  it  upon   evidence  of  any  kind.  I  will 
insert  that  part  only  of  the  medical  evidence  contained  in  the  followiDgV 
question  and  answer  •— 

Question  by  a  jurymun  to  Dr,  Beddy — If  the  circulation  of  the   t 
of  the  deceased  were  weak,  so  us  to  cause  partial  nambness  of  his  b. 
would  cieeaim  gn^  and  mental  prostraUon,  combined  with  this  weaknea 
not  Imperil  his  life  7 

Answer  by  Dr.  Beddy^It  would  not  I 

Dr,  Reddy  is  a  physician  of  great  experience  and  leaining — rsnlu 
amongst  the  iiriit  of  this  city — and  I  may  say  that  he  has  expreused  on  thai 
point  the  opinion  of  the  Faculty.  Neve  rth^lesa,  twelve  jarymen,  Bwamto 
investigate  the  cause  of  the  man's  death  according  to  the  evidence  oaly, 
retnm  the  following  verdict : — "  That  Hicbard  Patton  hod.  for  some  time 
''  prior  to  hie  death,  been  in  a  weak  condition  of  body  and  in  a  desponding 
"  state  Of  mind ;  the  jurors  are  of  opinion  that  the  death  of  the  said  K.  Patb>a 
"  was  caused  by  ezhai^Btion  arid  grief."  Now,  any  man  may  see  that — Ist. 
There  was  not  any  evidence  of  a  vieak  conciifion  (ij  l}ix  ht^y,  Znd  Nor  of  any 
sxAaiuCion  ,-  3rd.  As  for  despondency  andgrie^  Dr.  Reddy  says  emphatic«lly 
that  a  man  cannot  die  of  grief  under  such  circumstances,  of  ci 

I  wilt  nert  notice  tbe  medical  and  chemical  part  of  the  evidence,  not  M 
much  to  criticise  the  verdict  a«  to  suggest  whether  the  Qovcrument  m 
not  do  better  to  employ  the  expense  for  medical  evidence,  which  Is  o 
siderable  in  such  cases,  to  a  better  purjxjM^.  It  nti^ht  be  given,  fl 
instance,  to  educational  institutions,  tor  the  purpose  uf  ii 
dren  in  the  rudiments  of  medi-enl  juriaprtidence.  Are  twelve  mch  wea  ^ 
■re  generally  empann'-llfd  at  nf.  n — "-■*  -r  — — :■  '"■—.  -i. ..".■-.  impngtl  (1 
most  intelligent  ctsfl^c-'^.  ir  lIi<  ,  A  pbyitd 


d.Iwfll 
illowing^H 

ic   blooij^H 


coronsr'8  inquests.  333 

r,  pathology  and  medical  juriBprudencei  reasonably  to  be  expected  to 
ixiiderstand  and  jadge  of  a  poU-4nortem  examination  or  a  chemical  analysis  ? 
Xf  they  are  sensible  men  tl^ey  will  accept  the  opinion  of  experts,  but  igno- 
rance is  always  presumptuous,  and,  in  this  Patton  case,  one  juryman  went 
80  far  as  to  say  that  he  did  not  care  for  the  opinion  of  Dr.  Gird  wood  or  any 
other  M.D.    If  that  opinion  were  expressed  by  an  intelligent  man,  it  would 
<:ertainly  be  not  very  complimentary  to  the  profession ;  such  as  it  is,  it 
s^monnts  to  nothing.    This  very  omniscient  juryman  apparently  do^  not 
even  know  the  difference  between  a  fact  and  an  opinion,  for  he  asked 
"whether,  from  the  morphia  found,  we  were  prepared  to  swear  as  a/act  that 
Patton  died  of  its  effects  7    We  might  just  as  well  have  been  asked  whether 
ire  were  prepared  to  swear  as  a  /act  that  Mr.  Patton  was  dead  at  all.    Never 
having  seen  Mr.  Patton,  dead  or  alive,  the  answer  must  have  been  "  No  ;" 
bat  we  were  of  opinion  that  he  was  really  dead,  and  could  so  swear.    So 
with  our  opinion  as  to  the  cause  of  the  death ;  circumstantial  evidence,  as 
everybody  knows,  is  in  many  cases  more  reliable  than  direct  evidence.     I 
relate  this  incident  as  an  example  of  how  medical  evidence  is  appreciated 
by  incompetent  jurymen,  and  aigain  ask,  whether  Government  is  justified 
in  incorring  expense  attended  with  such  useless  results  ?    Reverting  to 
the  medical  evidence.    Dr.  Reddy  is  entrusted  with  the   « port-mortem " 
examination.    He  associates  with  him  Dr.   Osier,  a  clever  and  promising 
young  practitioner.    Dr.  Reddy  and  Dr.  Osier  report  the  perfect  healthi- 
ness of  all  the  organs  and  the  absence  of  all  natural  causes  of  death — with 
the  exception  of  the  stomach,  which  they  do  not  examine,  but  tie  up  care- 
foUy,  and  insinuate  that  there  will  probably  be  found  the  cause  of  death. 
They  also  advise  the  chemical  analysis  of  its  contents,  which  Dr.  Gird- 
wood  and  myself  proceeded  to  make.    We  invited  Dr.  Reddy  and  Dr.  Osier 
to  be  present  with  us,  in  order  to  give  them  the  opportunity  to  complete 
their  ^^post^fwrtemJ^    Dr.  Osier  being  out  of  town,  Dr.  Reddy  alone  came ; 
and  he  will  not  object,  I  am  sure,  to  my  relating  what  otherwise  he  would, 
doobtless,  iiave  said  himself  before  the  jury,  had  he  been  asked  to  attend 
at  its  subsequent  meeting.    After  giving  us,  from  memory,  a  very  graphic 
description  of  the  «  poat-mortemj'  he  observed  that : — <<  What  struck  him 
«  most  of  all  was  the  appearance  of  deceased  when  he  first  saw  him.    He 
"  looked  just  as  if  he  was  sleeping,  and,  had  he  not  known  him  dead,  his 
M  first  impulse  would  have  been  to  g^ve  him  a  good  push  in  the  ribs,  and 
,  **  would  have  expected  him  to  wake  up  suddenly  and  exclaim,  <  Hallo  ! 
<*  What's  the  matter  T    He  was  just  like  a  man  that  had  passed  from  life 
.   "  to  ^sath  in  a  sound  sleep." 

We  conclude  our  analysis,  find  morphia  in   undoubted  quantities,  and 

accordingly  to  the  jury.    The  only  question  I  am  asked  is,  whether 

died  of  the  quantity  of  morphia  found  in  the  stomach  7    I  am 

t^t  the  Coroner  should  put  such  a  question.    From  his  long 

*ia  Oozone.r  he  should  have  known  that  it  is  not  the  quantity  of 

1i^  a  man's  stomach  that  causes  death,  but  the  quantity 

I  iqritem ;  and  it  is  impossible  to  a^ertain  the  quantity 


I   334 


MEDICAL  AND  StTRSICAL  JOORNAI.. 


whioh  is  IhuB  BbwrbwJ.  Anaweriug  to  wlmt  |tho  Coroner  probably  m«fc^^"^ 
by  the  queHtion,  rather  thua  to  itH  literal  meaoing,!  eaiii  that  he  might  i^-^ 
he  might  not,  aocording  to  ciTCunutancuH, — and  tben  I  awaited  th?  dgx  '^^^ 
quBBtion  W  eiplaiu  my  npioion  of  the  caase  of  death.  This,  howevBr,  wa.  ^^ 
not  asked.  The  queBtion  that  t^honld  have  been  put  in  thia : — Froia  yoar^ 
•nalyBiB  of  the  contents  of  the  dEceased'a  stomach,  uid  from  a  careM  V" 
Biamination  of  the  posl-moHem  report,  what  ia  your  opinion  of  the  cante  ot  * 
the  late  R.  Patlon'e  death  7  Mwlioal  men  are  called  before  Corouara' 
InquflEtd  to  give  opinionn,  and  nothing  more.  If  the  opinion  i*  not  to  be 
Accepted,  il  is  no  nee  for  theni  to  be  called.  The  question  put  to  me  ii 
asked  of  Dr.  Qirdwood,  who  answers  in  the  same  fiense,  and  goes  oa  to  ex- 
plain bis  iipinion,  when  a  juror  orders  him  to  cease.  The  Doctor  CDdeaTon 
to  proceed,  when  he  is  again  interrupted,  in  grossly  uncomplimentary 
style,  by  such  expreasiona  as  -'  I  do  not  care  for  your  opinion  ;  I  care  for 
no  H.D.'s  opinion,''  and  so  on.  Nevertheless,  after  conaiderabte  iljffioul^, 
Dr.  G-irdwood  contrives  to  give  his  avidcnce,  to  the  elfcct,  that  having  ex- 
amined the  pott-morUm  report  and  other  circumstances,  he  is  of  opinion 
that  deceased  died  from  the  eEfecM  of  morphia.  To  recapitulate,  shortly — 
there  was  no  external  evidence,  except  that  of  tbii  ordinary  aoxioas  state 
of  a  man  in  buaineBs  troubles,  nor  any  natural  causti  of  deatli.  But  poison 
was  found  in  the  stomach,  and  the  medical  opirdon,  strongly  expressed, 
waK  that  thi>  death  waa  caused  by  poison,  coneistently  with  the  pott-morltm 
indicationa.  The  novel  theory  of  dying  from  grief  was  emphatically  re- 
jected by  medical  evidence.  But  verdict,  "  Died  of  Grief!"  After  making 
the  poor  raiin  die  of  grief,  thia  most  intetligeDt  jury  add  :  "  He  did  not  die 
"  of  morphial"  Bather  evident.  After  this,  surely,  they  ahould  apply  for  a 
patent.  Suppose  the  following  identical  case  :->A  disappointtd  lover  is 
found  dead  with  a  dagger  through  bis  heart.  The  "Patton  patented 
jary  "  would  ourely  return  the  following  verdict :  "  Died  of  love  and  grief — 
"  the  dagger  having  nothing  to  do  with  the  man's  death  W  I  add  a  fbiv 
remarks  ax  to  the  negligent,  irregolar  and  undecorous  manner  in  which 
this  inquest  was  conducted,  let.  The  chemical  analysis  having  been  de- 
cided on,  the  Coroner  should  bave  aubmitted  for  analysis  the  stomach,  the 
liver,  the  bladder,  with  whatever  urine  it  contained,  and  a  part  of  the 
brain,  in  au-'tight  vessels,  sealed  with  wax.  In  this  case  the  slomacb  only 
waa  submitted  in  an  unsealed  vessel.  Two  days  before  tbe  last  meeting  of 
the  jury.  Coroner  Jones  was  informed,  by  one  of  tbe  analysts,  that  morphia 
was  detected.  The  same  day  friends  of  Mr.  Fatten  were  apprised  of  the 
hct.  Hence  that  diagniceful  Bcene  in  the  jury  room  before  our  Arrival — 
when  the  correspondence  with  the  Government  was  asked  and  submitted  i 
when  attacks  against  tbe  tiovemiuent,  their  followers  and  their  nominees 
were  freely  made ;  and  when  ^bc  and  most  absurd  accusations  about  insn- 
lance  infiuences  were  uttered,  in  the  most  ungentlemanly  and  vulgar  mAa> 
ner,  in  the  presence  of  the  Coroner,  with  the  evident  intention  of  inQuHnc- 
ing  the  jury.  If  the  Coroner  had  had  a  proper  sense  of  hiaduty,  and  of  the 
importance  of  his  offioe,  he  wonld  hum  uyonmad  the  inquest  to  luiottwi 


POHnS    rilPROVED   BPHYOSinGRAPH, 


335 


I 


day,  uid  not  allow,  as  he  did,  the  jury  to  return  a  verdiot  while  laboiiog 
under  such  fHlse  itnpreHsioDB.  JerTis,iiD  "  The  OSce  and  Duty  of  Coroner,' 
sajs  ; — ^' Where  the  jury  mispect  that  undue  influence  has  been  used,  the 
''  Corooer  nay,  iti  the  exerciae  of  a,  sound  discretion,  adjourn  the  inquest 
"  to  a  future  day."  It  was  plainly  a  case  to  adjourn.  Neit,  when  Dtb. 
Keddy  and  Osier  were  asked  their  opinion  aa  to  the  catise  of  death,  at  the 
second  meeting  ol  the  jury,  they  rt-Berved  their  answer  till  the  atomach 
should  be  analysed.  Why  did  not  the  Coroner  summon  them  to  bn  preS'  - 
ent  at  the  last  tneeliag'.'  They  had  made  the  poit-niorlim,  and,  being  after- 
wards informed  of  the  results  of  the  analysis,  were  certainly  moat  Impor- 
tant witnesHeb.  They  were  not  present.  Previous  lo  the  last  meeting  it 
was  currently  reported,  and  known  to  some  of  the  jurors,  that  a  cert^n 
druggist  had  sold  potHon  to  the  late  Hr.  Patton.  Why  was  not  that 
druggist  summoned? 

I  renpect  Mr.  Jones  for  his  great  age  and  amiable  social  qualities  ;  and 
what  remarks  I  mak«  in  this  letter  concern  only  his  functions  as  a  public 
officer.  But  the  only  conelusiou  thai  could  be  arrived  at,  after  tho  con- 
eiderallon  of  the  present  case,  is,  that  Coroner  Jones  is  not  sufficiently 
qualified  to  fiiliil  the  duties  of  a  Coroner,  which,  besides,  requires  a  great 
deal  of  physical  uttiTity,  Coroner  Jones  Is  bordering  on  seventy-two 
years  of  age.  He  has  been  employed  in  the  servirt-  of  his  country  for  over 
forty  years.  He  baa,  no  doubt,  discharged  bis  duties  to  tho  best  of  hV> 
abilities.  He  should  be  allowed  to  retire  for  hie  own  good  and  that  of  the 
public,  with  a  gratuity  equal  lo  his  position  in  society.  Economy  is  very 
good,  but  should  not  interfere  with  public  interests  ;  and  a  well  qualified 
person,  welt  versed  in  medical  jurisprudence,  shoiUd  be  named  in  his 
place.  A  Qxed  salary  should  alto  be  attached  to  the  situation,  to  render 
(be  Coroner  independent,  and  not,  as  now,  dependent  on  the  number  of 
inqnests,  or  the  time  they  occupy. 

I  have  the  honor  to  be, 

P.  O'LsiBT,  M.D.,  McQIll, 

Montreal,  .lanuary  IT.  IS73. 

POND'S  IMPROVED  SPHYGMOGRAPH. 

We  have  received  one  of  these  inatrumenta  from  t!i  manufac- 
turer, and  believe  it  to  he  a  decided  improvement  on  those 
already  in  use.  It  is  welt  finished,  small,  compact,  easy  of 
application,  and  does  not  get  out  of  order  with  fair  usage.  It 
is  capable  of  heing  applied  to  any  ];art  of  the  body,  and  a  tracing 
may  he  had  from  any  artery  sufficiently  superficial  to  give 
anything  like  an  impulse.  Moreover  it  may  be  applied  over  the 
heart,  and  a  cardiagraphic  tracing  be  obtained. 

Various  modifications  of  Marcy's  instrument  have  from  time 


336  CANADA   HXDIOAL    AND   smOICAL   JOTTHIfAZi. 

to  time  been  introduced,  but  for  compactness,  wmpUoir^ 
delicateneas  and  accuracy,  we  believe  that  Pond's  insLiume;^ 
is  superior  to  them  all.  It  is  so  readily  applied  that  it  giv«^ 
no  more  trouble  in  its  use  than  does  the  clinical  thermomete- 

Another  advantage  in  this  instrument  is  its  compact  m& 
being  easily  carried  in  the   pocket,  and  always  ready  for 
A  tracing  can  be  easily  obtained  by  holding  the  instrumen* 
over  the  seat  of  the  vessel,  although  each  iastrument  is  supplte* 
with  an  adjustable  bed  on  which  to  lay  the  arm  while  takio;;  a 
tracing. 

Another  invention  of  the  Pond  Sphygmograph  Company  is 
a  method  of  reproducing  the  tracings  on  paper.  This,  of 
course,  is  applicable  to  the  tracings  taken  by  any  instrument, 
and  is  of  incalculable  benefit,  as  through  its  various  copies  of 
tracings  in  each  case  under  observation  can  be  readily  made 
and  preserved  in  a  case  book.  This  process  consists  in  prepar- 
ing a  solution  of  the  ammonto-citrate  of  iron,  and  also  a  solution 
of  the  prussiate  of  potash.  These  solutions  are  mixed  and 
kept  for  use  in  a  dark  bottle  preserved  from  the  action  of  light. 
When  desired  to  obtain  a  print  of  any  tracing,  a  slip  of  paper 
is  prepared  by  wetting  one  side  only  in  the  above  solution  and 
drying  it  in  a  dark  room.  In  printing  the  same  method  is 
adopted  as  in  printing  a  photograph,  the  mica  tracing  being  the 
negative  from  which  is  obtained  the  print.  Specific  directions 
are  given  of  the  strength  of  the  solutions,  and  of  the  method  to 
be  followed  in  obtaining  the  copy  on  pa|:ier.  We  commend 
this  instrument  to  those  of  our  readers  who  are  desirous  of 
possessing  a  sphygmograph.  It  is  without  doubt  the  moat 
compact  and  handy  instrument  of  the  kind  in  use.  On  reference 
elsewhere  the  advertisement  of  the  Pond  Sphygmograph  Com- 
pany will  be  found. 


I 

I 


CANADA 

Medical  &  Surgical  Journal 


MARCH.  1879. 


Original  Eommunicationa. 


COHNHEDI'S  THEORY  OF  TUMORS. 

Translated  and   condcoBed  from  Tol.   I.   of   hii   VorloBDn^n   Ueber 
allgemenie  Pathologio  (LwtareH  upon  General  Fathologj). 

By  Dr.  Oslkr. 

Raad  baforo  tba  Mediao-OhirurgiciU  Sosiety  of  MoDlrea]  n"  an  appondii  til  n  rocnrt 

of  two  oBica  of  rato  Kidney  Tumurs—S Wired- Muaolo  S«rotnn».wid 

Spindle-nelled  Adao(i-SBrcom&. 

The  nutrition  disturbances  which  the  organs  and  tissues  of 
the  body  oau  undergo — up  to  the  limit  of  actual  necrosis — may 
be  arranged  in  three  groups.  In  the  first  the  organ  or 
tissues  become  smaller,  but  are  othorvvise  unchanged  (simple 
atrophy).  In  the  second,  thoro  is  a  change  in  the  chomical 
constitution  of  the  part ;  fat  exists,  for  example,  where  there 
should  be  albumen  only,  lime  salts  are  in  excess,  or  substances 
may  occur  such  as  amyloid,  which  normally  are  not  found  in  the 
organism.  In  the  third,  the  physiological  proportion  of  indi- 
vidual organs  is  exceeded,  or  certain  structures  exist  which  do 
not  conform  to  the  normal  anatomy.  In  this  are  classed  tho 
pathological  regenerations,  tiie  hypertrophies,  and  the  tumours. 
la  these  processes  there  is  a  change  in  the  physiological  balance 
between  waste  and  nutrition  in  favor  of  the  latter,  by  which 
means  alone  a  definite  increase  of  tissue  could  take  place. 

NO.  LXSX.  23 


338 


C  AH  AD  A   MEDICAL   AND   SUKQIOAL   JOUBNAL. 


Naturally,  during  the  whole  period  of  physJolo^cal  growth, 
this  is  a  law  of  the  organiBm. 

The  ultimate  and  essential  cauae  of  all  growth  depends  on 
the  organization  of  the  species — hereditary,  or,  as  they  mighl 
be  called,  historical  causes,  in  conaequeaee  of  which  the  body 
and  its  organs,  in  each  individual  species,  develop  to  a  typieaJ 
form  and  ^e,  requiring  a  definite  period  of  time  for  the  whole 
body,  and  a  variable  period  for  the  different  organs,  some  of 
which  attain  their  full  development  much  earlier  than  others — 
the  thyrmus,  for  example,  at  the  second  year,  the  geuitala  at 
puberty.  In  the  history  of  these  latter  organs  the  moat  striking 
example  is  afforded  of  the  influence  of  the  original  tendency 
on  the  physiological  growth  of  the  body.  On  no  other  ground 
can  it  be  that  the  genitals  during  childhood  remain  undeveloped, 
to  begin  at  puberty  a  rapid  and  increased  growth,  which  in 
comparison  with  that  of  childhood  is  abnormal,  and  is  not 
regarded  as  such  simply  because,  according  to  the  type  of  our 
urganization,  the  child-like  growth  is  only  normal  for  a  definite 
period.  But  in  tbe  same  organs  a  much  more  marked  instance 
of  (abnormal)  growth,  dependent  on  inherent  tendency,  is 
afforded  by  the  enlargement  of  the  pregnant  uterus.  The 
cause  of  this  cannot  be  regarded  as  due  to  the  increased 
blood-flow,  for  muscle  fibres  do  not  grow  unless  they  are 
stimulated,  *',  e.,  work, — as,  for  example,  the  muscles  of  the 
stomach  or  bladder  when  there  is  any  unusual  resistance  to  be 
overcome.  The  hypertrophy  of  the  uterus  can  in  no  way  be 
compared  with  this  latter  form  of  growth,  but  only  with  the 
enlargement  which  all  parts  of  the  body  undergo  during  the 
period  of  development,  that  is  to  say,  in  consequence  of  an 
inherent  tendency  in  the  germ  of  mammalia,  the  utems,  under 
certain  conditions,  namely  impregnation,  grows  beyond  its 
normal  size. 

The  explanation  of  the  occurrence  of  monsters, ^er  excesBum, 
is  to  be  sought  for  in  some  abnormaUty  in  the  embryonal  plan. 
In  such  cases  the  abnormality  is  congenital, but  there  are  instancea 
of  abnormal  growth,  post  partum,  which  must  also  be  referred 
to  embryonic  influences.   In  the  case  of  ^ants,  some  are  bom  as 


I 


cohnhkim's  theout  of  tttmobs. — db.  osler.         339 

unusually  large  children,  others  of  ordinary  size,  the  excessive 
growth  not  beginning  unci!  months  or  years  after  birth ;  but  in 
either  case,  though  we  know  too  little  of  the  details  of  the  growth 
in  the  individual  tissues  to  say  wherein  lies  the  error  in  design, 
yet  it  must  be  in  peculiarities  of  embryonic  constitution.  I'he 
instaneee  of  excessive  development,  both  before  and  after  birth, 
of  one  or  more  extremities,  of  which  there  are  several  examples, 
must  depend  on  the  same  cause. 

Pi^bably  all  pathologists  agree  that  in  the  above-mentioned 
cases,  embryonic  tendencies  alone  afford  a  suitable  explanation. 
Prof,  Cohnheim,  however,  would  apply  this  view  over  a  much 
more  extensive,  and,  in  some  respects,  important  territory — viz., 
the  pathological  new  formations.  From  these  he  excludes  on 
the  one  hand  the  retention  tumors,  such  as  cysts,  &c.,  and  on 
the  other,  the  infeatjon  tumors,  resulting  from  syphilis,  tuber- 
culo^,  lupus,  &c.  He  adopts  Yirchow's  classiSeation  : — 
X  Tumors  constructed  on  the  type  of  the  connective  tissues,  such 
as  fibromata,  lipomata,  chondroma.ta,  angiomata,  lymphomata, 
sarcomata,  &c.  11.  Such  as  correspond  to  the  epithelial  type — 
epitheliomata,  adenomata,  carcinomas.  III.  The  type  of  muscle 
tissue — myomas,  smooth  and  striped.  IV.  The  type  of  nerve 
tissue — neuroma.  Veratoma,  in  which  entire  histological 
systems  may  be  represented,  skin,  hair,  teeth,  bone,  &c., 
as  in  the  dermoid  cysts.  In  framing  a  definition  of  a  tumor,  to 
exclude  simple  hypertrophies  of  tissues,  such  as  fatty  tissue  in 
obesi^,  or  bone  in  exostosis,  stress  must  be  laid  upon  the  fact 
that  these  do  not  conform  to  the  anatomical  type  of  the  part. 
Thus  in  a  hypertrophy  of  the  utenia  in  consequence  of  defective 
involution,  or  chronic  metritis,  the  typical  form  of  the  organ  is 
maintaiued,  but  not  so  in  the  fibro-myoma.  In  hypertrophy  of 
stratified  epithelium  the  normal  arrangement  is  maintained,  while 
the  thickness  of  the  layer  is  increased,  whereas  the  epithelial 
growth  of  a  carcinoma  is  highly  irregular.  The  atypical  nature 
is  a  significant,  nay  indispensable,  criterion  of  every  true  tumor, 
no  matter  what  its  histological  structure  may  be.  Still,  even 
this  will  not  suffice,  as  a  glance  at  the  history  of  infiammation 
1^  show,  for  what  can  be  more  atypical  than  a  fresh  bony 


340  OANADA  UKStOAL    AND    BURGIOAL   JOTIHNAL. 

calluB  after  a  fracture,  a  pleuritic  or  peritoneal  adhesion,  or  a 

fibroid  patch  in  the  heart  maacle  ? — 'all  which  are  new  forma- 
tions in  the  strictest  sense  of  the  term.  Something  more  is 
needed  to  separate  these  from  the  true  tumors,  and  that  is  to  be 
found  in  the  etiology  alone. 

Among  the  hypotheses  which  have  been  advanced  w  expl^n 
the  origin  of  tumors  that  of  mechanical  irritation,  traumatism, 
has  played  an  important  part,  and  the  number  of  cases  is  con- 
siderable in  which  a  locality,  the  seat  of  a  new  growtii,  had  been 
injured.  Biill,  in  344  eases  operated  upon  in  Langenbeck's 
Clinic,  was  able  to  trace  a  traumatic  origin  in  42,-i,  e.,  about 
12  per  cent.,  and  about  the  same  percentage  was  found  in  the 
374  cases  treated  in  the  OharitS  Clinic  during  the  past  ten 
years ;  that  is  to  say,  in  8(5  per  cent,  of  all*  cases,  in  which 
special  attention  was  directed  to  this  subject,  no  trace  of  trau- 
matic origin  could  be  ascertained  !  Cohnheim  concludes  that 
hypertrophy  and  inflammatory  products  may  follow  traumatism  ; 
true  tumors  never.  The  view  of  the  infectious  origin  by  means 
of  a  virus  has  been  supported  by  some  writers,  but  experiments 
have  shown  tbat  cancer  is  not  communicable  from  animal  to 
animal,  or  from  man  to  man. 

The  embryonic  predisposition  (or  design)  affords  by  far  the 
most  plausible  explanation,  and  has  already  been  urged  by 
certain  pathologists  iu  the  ease  of  the  dermoid  cysts,  but  not 
for  tumors  in  general.  Cohnheim  states  his  theory  in  the  follow- 
ing terms :  The  simplest  way  of  representing  the  matter  is  to 
suppose  that  at  an  early  stage  of  development  more  cells  are 
produced  than  are  necessary  for  the  construction  of  the  affected 
part,  so  that  a  cell  mass  remains  unused,  probably  of  extremely 
limited  dimensions,  but,  on  account  of  its  embryonal  nature,  of 
very  great  productive  activity.  The  period  of  this  superfluous 
production  of  cells  must  be  placed  very  early,  possibly  between 
the  diflerentiation  of  the  germinal  layers  and  the  complete 
formation  of  the  ground-work  of  the  individual  organs :  at 
least,  BO  it  seems  best  conceivable  wby  from  the  error,  not 
a  general  hypertrophy  of  a  part  takes  place,  but  only  a 
tumor — an  excessive  growth  of  one  of  the  tissues  of  the  part 


COHtniEIM'S   THEORY   OF    TDMOKS. — DR.  OSLER. 


3ii 


r 


On  account  of  our  present  very  imperfect  knowledge  of  the 
details  of  early  embryonal  growth,  we  can  only  deal  in  supposi- 
tions such  as  these.  The  main  point  is  that  the  essential  cause  of 
the  growth  of  tumors  k  an  error  or  irregularity  in  the  embryonic 
construction.  Positive  proof  of  this  is,  in  the  nature  of  things, 
not  forthcoming,  but  a  whole  series  of  facts  may  be  brought 
forward  in  its  favor.  Thus,  for  example,  the  hereditary  nature 
of  many  growths — carcinoma,  osteoma,  lipoma,  &c.,  which  have 
appeared  in  several  generations  in  the  same  family,  and  more 
frequently  inherited  from  the  mother  than  the  father.  Cases  are 
on  record  of  the  tumor  being  confined  to  one  organ — as  the 
breast — through  several  generations,  or  not  to  a  definite  locality, 
but  to  a  histological  system,  so  that  in  several  successive 
generations  one  member  of  the  family  has  had  an  enchondroma 
of  the  pelvis,  another  of  the  humerus,  a  third  of  the  femur,  &c. 
This  view  is  further  supported  by  the  congenital  appearance  of 
turaora.  The  teratoma  are  very  fretjuently  congenital,  and  other 
forms  are  by  no  means  rare,  such  as  fatty  and  fibroid  tumors, 
and  enchondromas,  carcinomas  and  adonomas  have  also  been 
met  with.  It  is  not,  however,  in  the  majority  of  cases  the  tumor 
which  is  congenital,  but  the  predisposition  thereto — i.e.,  there 
exists  a  superfluous  mass  of  cells  out  of  which  a  new  growth 
can  develop.  We  do  not  know  what  it  is  which  gives  the  impulse 
to  these  germs,  causing  them  to  increase  and  multiply ;  nor  do 
we  know  why  their  development  is  checked  or  restrained. 
Perhaps  it  is  the  resistance  of  the  normal  tissues,  and  tliis  may 
aflbrd  an  explanation  of  those  cases  in  which  a  growth  has 
followed  an  injury,  which  may  be  supposed  to  have  weakened 
the  physiological  resistance  of  the  surrounding  tissues. 

It  is  a  well  known  fact  that  certiun  epithelial  tumors,  can- 
croids and  carcinomas,  have  a  special  preference  for  the 
orifices  of  the  body,  the  lips  and  tongue,  alfe  of  nose,  eyelids, 
prepuce,  glans  and  rectum  ;  also,  very  frequently  the  external 
OS  uteri,  and  in  the  cesophagus  the  spot  corresponding  to  the 
fork  of  the  bronchi.  The  existence  of  these  predilection  spots 
has  been  urged  strongly  in  favor  of  the  part  played  by  mechan- 
ical insult  in  the  etiology  of  tumors,  but  if  this  were  the  case, 


342 


(UMADA  HZDIOAI.  AHD  BUBaiOAL  JOTTBHAL. 


how  much  more  common  should  new  formations  be  in  the  hands 
and  feet,  the  parts  above  all  others  most  subject  to  injories. 
The  reason  of  this  special  predilection  is  to  be  sought  in  quite 
another  circumatance.  All  the  above-mentioned  regions  are 
places  in  which  during  development  a  certain  complication  haa 
occurred.  At  the  various  oriSees  a  folding  in  of  the  outer 
germinal  layer,  and  a  union  of  it  with  the  internal  layer  has 
taken  place,  during  which  a  alight  irregularity  might  very  easily 
occur,  resulting  in  the  inclusion  of  a  few  superfluous  cells — the 
germs  of  a  future  tamor.  The  situation  of  oesophageal  epithelioma 
opposite  the  bifurcation  of  the  trachea  is  best  explained,  not  by 
supposing  that  here  there  is  greater  pressure  against  the  bronchi, 
but  because  this  is  the  point  where  the  original  trachea  and 
and  oesophagus  were  in  connection  with  each  other,  and  at  which 
a  developmental  complication  could  very  readily  take  place. 
In  the  rectum,  farther,  it  is  not  the  orifice,  the  anus,  where 
cancroid  develops,  as  one  might  expect  on  the  traumatic  theory, 
but  a  point  further  in,  where  the  epithelial  tube  of  the  rectum 
has  united  with  the  involution  of  the  outer  layer.  So  also  in  the 
female  generative  apparatus,  it  is  not  the  vulva  which  is  the 
chosen  seat  of  the  cancer,  hut  the  external  os,  the  very  spot  at 
which  in  an  early  period  of  development  the  squameoas  epithe- 
lium of  the  sinus  urogenitalis  haa  united  with  the  cylindrical 
epithelium  of  Miiller's  duct. 

Other  tumors  besides  cancers  have  special  localities  which 
they  afieet.  Thus  the  greater  portion  of  all  smooth  myomas 
occur  in  the  uterus.  How  is  it  that  this  rare  form  so  frequently 
develops  in  this  organ  ?  Simply  because  in  every  uterus  gertna 
exist  which  normally  grow  only  under  the  physlolo^cal  stimula- 
tion of  impregnation,  but  which,  occasionally,  under  other  than 
phy^ological  stimuli,  develop  in  an  irregular,  atypical  manner. 

So  also  with  the  myoma  or  adeno-myoma  of  the  prostate,  the 
so-called  hypertrophy,  hut  which  is  in  reality  a  true  tumor.  In 
this  organ  there  is  no  physiological  disposition  to  exceptjonal 
growth,  and  traumatism  has  probably  nothing  to  do  with  it ; 
hut  a  consideration  of  its  jcvolopmcut  points  to  the  same  caoflo 
as  noted  for  the  os  uteri — the  prostrate  develops  at  the  point 


I 


COHKHEIMS  THEORY  OP   TUMOES. — DR.   OSLER.  did 

of  junction  of  Miillers  duct,  with  tho  sinua  urogenitalis,  a  locality 
in  which  the  developmental  proceaaea  are  in  the  highest  degree 


^^^    thai 


The  heterologoua  tumor8,those  which  deviate  in  their  structure 
from  the  native  soil  in  which  they  grow,  afford  a  very  strong 
support  to  thia  theory.  Without  it  we  must  conclude  that, 
contrary  to  all  laws  of  physiological  growth,  there  may  rapidly 
develop,  out  of  gland  tissue,  cartilage  ;  out  of  connective  tissue, 
epithelium  ;  out  of  kidney  suhataoce,  striped  muscle  ;  out  of 
lung  tissue,  bone.  What  la  very  peculiar,  all  these  tumors  main- 
bun  a  remarkable  uniformity  in  relation  to  locality.  Thus  the 
enchondromas  of  bone  never  originate  in  the  cartilaginous  regions, 
but  always  out  of  the  fully  ossified  parts,  taking  their  origin 
from  tiny  embryonal  cartilaginous  remnants,  which  have  not 
been  used,  and  which  remain  within  the  bony  tiaaue.  The  germs 
of  the  enchondroma  of  the  parotid  region  represent  particles  of 
the  original  cartilage  matrix,  which  have  remained  unemployed. 
The  majority  of  dermoid  cysts  occur  either  sub-cutaoeously  in 
the  region  of  the  face  and  neck,  or  else  in  the  testicles  or 
ovaries.  Their  frequency  in  the  first  situation  may  be  explained, 
ae  suggested  by  Lilcke,  by  the  complicated  proeesaea  which  go 
on  in  the  formation  of  the  face  and  neck.  The  intimate 
relation  of  the  wolfian  body,  which  representa  the  original 
gemto-urinary  organ,  with  the  external  layer  on  the  one  hand, 
and  the  middle  layer  on  the  other,  makes  it  easy  to  understand 
how  it  is  that  in  these  organs  dermoid,  muscle  and  osseous 
tumors  80  readily  develop,  A  very  slight  error  in  the  separa- 
tion of  cells  from  the  outer  layer,  from  which  the  skin  is  formed 
would  sufiice  to  include  germs  of  a  dermoid  cyst,  and  from  the 
middle  layer,  from  which  muscle,  cartilage  and  bone  develop. 
to  furnish  germs  of  myomas,  enchondromas  and  osteomaa, 
Thia  theory  also  explains  satisfactorily  the  atypical  nature  of 
these  growths,  their  deviation  from  the  morphological  type  of 
the  locality,  for  the  germs  from  which  they  originate  being 
saperfluoua,  are  not  taken  into  account  in  the  formation  of  the 
parts,  so  that  when  they  do  develop,  it  cannot  be  in  any  other 
than  an  atypical  way.     When  the  germs  are  a  superfluous  pro- 


344 


CANADA  MEDICAL   AND  SUBOICAL   JOUKNAL. 


duct  from  the  cells  of  an  equivalent  tissue,  the  tumor  corresponds 
histologically  with  the  baae  in  which  it  grows  ;  for  example,  a 
lipoma,  which  has  resulted  from  the  growth  of  auperfluoua  germs 
affecta  cella  in  the  sub-cutaneous  tissue. 

One  of  the  most  interesting  features  in  tumors,  and  one  which 
strongly  supports  this  theory,  is  the  feet  that  certain  of  them  are 
made  up  of  tissues,  embryonal  in  character,  and  having  no 
counterpart  in  the  adult  body.  This  is  particularly  the  case  in 
myxomas  and  sarcomas.  The  former  tumors  are  composed  of  a 
gelatinous,  translucent,  mucoid  mass,  in  which  is  embedded  a 
larger  or  smaller  number  of  roimd  and  spindle-shaped  cella. 
Such  a  tissue  is  unknown  in  the  adult  body,  unless  perhaps  in 
the  vitreous  humour,  but  in  the  embryo  it  is  a  normal  precursor  of 
certain  of  the  connective  tissuea.  When  in  the  thigh  of  an  adult 
a  large  sub-cutaneous  myxoma  is  found,  shall  we  believe  that 
here  the  cells  of  the  aub-cutaneous  tissue  and  fat  have  produced 
a  tissue  of  specially  embryonal  nature,  and  from  the  material 
supplied  to  them  from  tlie  blood  have  formed,  not'  cologen  and 
fat,  as  is  their  wont,  but  mucus  ?  Or  is  it  not  more  reasonable 
to  suppose  that  the  germs  Iiiive  originated  at  such  a  period  of 
embryonal  life  when  it  is  the  physiological  function  of  the  cells 
to  produce  a  mucoid  tissue.  So  also  with  the  sarcomas,  that 
remarkable  group  of  tumors  defined  by  Virchow  as  new  growths 
of  connective  tissue  with  a  preponderance  of  cellular  elementa 
We  must  go  far  back  in  embryonic  life  to  find  tho  histological 
prototype  of  a  round  or  spindle  celled  sarcora.  Only  in  the 
very  early  stage  of  the  forma.tion  of  the  connective  tissue  organs 
do  we  find  them  composed  of  closely-packed  cells  with  but  little 
intercellular  substance.  Where  the  cells  of  a  dura  mater,  of  a 
fascia,  or  of  loose  connective  tissue  produce  a  primitive  and  in 
tho  highest  degree  embryonal  tissue,  is  it  not  again  preferable 
to  suppose  such  originates  from  superfluous,  unemployed  germs 
of  an  exceeding  early  date,  which  have  remained  included  in 
the  tissues  ? 

A  tumor,  then,  may  be  defined  to  he  an  atypical  new-formation 
of  embryonic  constitution.  Tumors  have  a  direct  relationship 
with   the  so-called  mal-fonnations,  formmg  in  reality  a  sub- 


I 


conNHEiM's  THBonr  op  tumohs. — dr.  oblek.         345 

divifflon  of  the  monsti-a  pefi-  exaessnm,  of  which  forms  the  greater 
number,  unlike  the  tumors,  arc  congeuital,  ooly  a  few  developing 
later  in  Ufe. 

Jtelaiion  of  Tumors  to  Si/pertropkies. — The  etiological  con- 
ception can  alone  afford  that  sharp  boundary  between  hypertrophy 
and  inflammation  on  the  one  hand,  and  new  growths  on  the 
other,  which  the  instinct  and  unbiasBed  judgment  of  physicians 
have  repeatedly  demanded  and  exact  research  as  often  effaced. 
How  little  in  reality  the  anatomical  stand-point  suffices  for  the 
elucidation  of  this  process  is  amply  shown  by  the  example  of  a 
well-known  and  simple  growth,  viz.,  goitre.  According  to  the 
pathologies  this  is  an  enlargement  of  the  thyroid  body  caused  by 
an  homologous  tissue  growth,  which  sometimes  involves  the  entire 
'  organ,  aometiinea  one  lobe,  or  the  part  of  a  lobe ;  in  individual 
cases  accompanied  with  exophthalmos  and  hypertrophy  of  the 
heart,  arises  epidemically  from  miasmatic  causes,and  without  such, 
sporadically,  sometimes  diminishes  spontaneously  or  with  the  use  of 
iodine.  An  entirely  different  view  ia  afforded  when  etiological  prin- 
ciples ai-e  employed.  The  thyroid  enlarges,  grows  beyond  ita 
physiological  mass,  when  the  arterial  blood  flow  is  for  a  long  time 
abnormally  increased ;  this  happens  in  Basedow's  disease,  very 
probably  on  account  of  adilator  neurosis  ;  in  other  cases  under  the 
influence  of  a  local,  and  as  yet  unlnown,  miasm.  What  occurs 
under  these  conditions  is  an  hypertrophy  of  the  thyroid,  which 
disappears  when  the  cause  is  removed.  Totally  different  from 
this  is  the  abnormal  growth  in  consequence  of  superfluous 
embryonal  germs.  What  results  in  this  case  is  also  thyroid  tissue, 
which  may  undergo  colloid  change,  like  the  hypertrophic  variety, 
but  it  presents  itself  in  the  form  uf  an  atypical  mass,  a  true 
strumous  tumor,  which  is  independent  of  locality  or  miasm, 
never  is  cured  with  iodine,  nor  accompanied  with  exophthalmos. 
In  the  former  the  whole  yland  is  a,lways  (in  Cohnheim's  experi- 
ence) involved ;  the  latter — the  true  tumors— occur  in  the  form 
of  atypical  masses,  so  that  there  is  an  anatomical  criterion  which 
renders  it  possible  to  distinguish  these  forms.  Microscopically 
I  it  wOuld  be  as  fruitless  to  attempt  to  distinguish  between  a 

matio  goitre  and  a  true  strumous  tumor  as  between  a  lipoma 

poIyBorcia. 


346 


CANADA   MEDICAL   AND   SURGICAL    JOUHNAL. 


StiU  more  iriBtructive  is  the  history  of  the  Ijmpli-glaiM^ 
hypertrophies  and  growths.  There  groups  can  be  determineCJ 
(1.)  the  aimplc  indurative  enlargement,  in  consequence  ot 
chronic  catarrhal  and  other  infiammationa ;  and  also  the  proper^ 
lymphoma,  occurring  in  the  form  of  a  more  or  leas  hard  gland3 
hypertrophy,  which  neither  suppurates  nor  becomes  caseouB, 
arising  without  previous  inflammation  in  neighbouring  mucous 
membranes,  and  situated  chiefly  in  the  neck ;  (2}  a  number  of 
forms  of  gland-hypertrophies,  more  or  leas  extensively  distributed 
over  the  lymphatic  system, — auch  are  the  leukremic,  the  scro- 
fulous, and  the  tuberculous  swellings  ;  (3)  the  lympho-earcouis. 
From  these  varieties  tho  scrofiolous  gland  hypertrophy  alone  is 
anatomically  characterized  and  distinct  from  the  others  by  the 
caseation  patho'^nomonic  of  it.  But  who,  on  account  of  the  remark- 
able similarity  of  aleuksemic  with alympho-sarcomatous  gland,  or 
a  eomnion  lymphoma,  would  identify  all  these  processes  with  each 
other,  in  spite  of  the  total  dissimilarity  in  the  constitution  of  the 
blood,  and  in  spite  of  the  varied  course.  The  etiological  con- 
ception brings  perfect  clearness  into  this  confusion.  There  can 
be  distinguished  (1)  an  inflammatory  hyperplasia — analogous  to 
a  periosteal,  peritoneal  or  pleural  thickening — the  indurative 
lymphatic  swelling ;  (2)  infectious  hyperplasias,  to  which  cer- 
tainly belong  the  scrofulous  tumors,  and  probably  also  the 
leukiemie — i.  e.,  if  leukoemia  is  an  infectious  disease,  in  any 
case,  we  have  to  deal  with  a  general  disease,  excited  by  an 
unknown  agent ;  (3)  enlargements  dependent  on  embryonic 
predisposition,  the  true  tumors  of  these  glands,  the  lympho- 
sarcomas and  the  lymphomas,  which  stand  in  the  relation  to 
each  other  of  malignant  and  benign  growths. 

The  etiology  alone  enables  us  to  make  a  scientific  separation 
of  the  true  tumors  from  inflammatory  products.  In  consequence 
of  a  periostitis  bone  may  be  formed,  Sbrous  connective  tissue 
in  consequence  of  an  inflammation,  and  alao  stratiSed  epithelium 
may  be  abundantly  produced  from  the  same  cause.  Are  we. 
therefore,  to  conclude  that  wherever  a  new  formation  of  these 
tissues  is  met  with,  there  has  been  a  previous  inflammatory 
process  ?     Far  from  it.      But  wherein  shall  one  distinguish  | 


"  CRIMB  AND  IN8ANITT." — BY  DR.  HOWARD.  34*7 

bony^  fibrous,  or  epithelial  growth  from  a  product  of  inflamma- 
tion of  the  same  histological  characters  ?  Not  by  the  atypical 
form,  for  the  most  spinous  exostosis  is  not  more  atypical  than 
the  callous  needles  which  often  form  in  the  healing  of  a  splintered 
fracture,  and  a  cutaneous  horn  is  not  more  atypical  than  a 
pointed  condyloma.  One  may  examine  the  respective  objects 
with  the  most  extreme  care,  macroscopically,  microscopically, 
and  even  chemically,  and  the  etiology  remains,  the  only  dis- 
tinguishing characteristic.  When  a  leg  becomes  enormously 
enlarged,  elephantiac,  in  consequence  of  repeated  inflammation 
of  the  skin  and  lymph  vessels,  it  remains  an  inflammatory 
product.  An  elephantiasis  of  the  scrotum  or  nympha,  on  the 
other  hand,  coming  on  without  inflammation,  either  hereditary 
or  even  congenital,  i  g.,  in  consequence  of  some  peculiarity  of 
race,  is  a  tumor.  A  true  neuroma  is  a  tumor  consisting  of  nerve 
fibres,  which  has  formed  either  singly  or  in  numbers  along  a 
nerve,  but  when  at  the  stump  of  an  amputated  nerve,  in  accord- 
ance with  the  principle  of  nerve  regeneration,  a  mass  develops 
out  of  the  old  fibres  and  forms  an  inextricable  coil,  it  is  not,  in 
spite  of  its  atypical  form,  a  true  tumor. 

{Conclusion  in  Next  Number,) 

RESPONSIBILITY  AND  IRRESPONSILITY 

IN  CRIME  AND  INSANITY ; 
A  Papbb  rkad  bbforb  the  Montreal  Medioo-Chiburgioal  Sooiety, 

BY   THE   PRESIDENT, 

HENRY  HOWARD,  M.D.,  M.R.C.S.,   Eno., 

[FEBRUARY  7tH,  1879.] 

Mr.  Chairman  and  Gentlemen, — Never  since  the  history 
of  literature,  has  there  been  so  much  written  upon  mental  science 
and  mental  diseases  as  in  the  present  day,  and  these  writings 
are  not  by  the  rank  and  file  of  the  profession,  but  by  the 
officers.  To  name  all  would  occupy  too  much  of  your  time.  I 
would,  however,  give  the  names  of  Maudsley,  Clouston,  Hach, 
Tuke,  Savage,  Bucknell,  Creichton  Browne,  Fender,  Hughlings 


\ 


348 


CANADA   MEDICAL    AND   8T7BG1CAL    JOCBNAL. 


JackBon,  Brown  Sequard,  Eulenburg,  Guttman,  W,  W.  Ireland, 
and  there  are  a  host  of  French  writers,  besides  the  men  outside 
of  the  profession,  such  as  Emel.  Du  Boia,  Reymond,  Tjndall, 
kc. ;  yet,  gentlemen,  strange  to  say,  perliapa  there  never  was 
a  time  when  mental  diseases  were  so  little  known  to,  or  studied 
by  the  medical  practitioner.  The  reason  is  obvious.  As  civili- 
zation advanced,  and  science  showed  insanity  to  bo  disease,  the 
treatment  of  the  insaae  became  more  humane,  and  instead  of  this 
class  being  allowed  to  wander  aa  outcaata  about  the  country, 
asylums  have  been  provided  for  those  suffering  from  mental  and 
neuralgic  diseases,  such  as  epilepsy,  as  well  as  for  tlie  imbecile  and 
idiot.  Ko  one  will  deny  but  this  is  as  it  should  be  ;  but  it  has 
taken  away  all  cliance  from  the  medical  student  and  medical  man 
of  clinical  3tud_,  of  the  insane,  as  well  as  the  study  of  the  patho- 
logical ravages  made  by  disease  on  man's  nervous  system. 
Generally  speaking,  for  many  very  obvious  reasons  our  insane 
asylums  are  too  far  from  our  cities  to  give  medical  students 
clinical  instruction.  Again,  our  aaylutns  are  such  that  a  crowd 
of  medical  students  would  derange  the  whole  establishment,  and 
be  injurious  to  the  patients.  Again,  the  medical  officer  of  an 
asylum — for  example,  myself,  as  at  present  situated, — would 
have  no  time  to  give  clinical  instruction.  Now,  gentlemen,  I 
have  often  thought  of  this  ajiomaious  position  o(  medical  men, 
particularly  since  the  late  Order  m  Council  in  this  Province  — 
a  very  necessary  order — compelling  medical  men,  when  giving 
certificates  of  insanity,  to  make  a  solemn  affirmation  to  their 
certificates  before  a  magistrate.  If  you  knew  as  much,  gentle- 
men, as  I  do,  you  would  see  Row  necessary  that  Order  in  Council 
was.  Well,  I  have,  as  I  have  swd,  often  thought  of  this  your 
position,  and  as  to  how  it  could  be  remedied,  so  as  that  your 
medical  students  could  get  clinical  instruction  on  mental  diseases. 
My  idea  is  that  if  you  made  arrangements  in  your  hospital,  say 
for  four  or  six  patients,  one-half  male,  the  other  half  female, 
that,  by  petition,  the  Provincial  Government  could  be  got  to 
consent  to  allow  me,  or  who  ever  takes  my  place  after  me,  to 
transfer,  from  time  to  time,  padenta  from  the  asylum,  for  clinical 
purposes,  to  your  hospital.     I  do  not  mean  to  enter  into  detiuls, 


I 


"CHIMB  AND    INSANITY.  — BY    DR.  nOWAHl>. 


349 


"bat  merely  to  point  out  to  you  that  something  might  be  done. 
If  representativeB  from  the  medical  achooU  would  wish  to  speak 
to  me  on  the  subject,  I  shall  be  most  happy  to  enter  into  further 
detiuls.  I  am  convinced,  gentlemen,  tbat  something  should  be 
done,  by  which  the  general  medical  practitioner  should  have 
more  knowledge  than  he  now  possesses  of  mental  diseases. 

Dr.  Maudsley,  speaking  of  the  duty  of  the  physician,  says ; 
"  Recognizing  the  obvious  difference  between  him  who  leiU  not 
and  him  who  cannot  fiilfil  the  claims  of  the  law,  it  is  their 
function  to  point  out  the  conditiona  of  disease  which  cons^tute 
incapacity." 

Gentlemen,  I  am  going  to  ask  you  to  join  with  me  to  do  that 
which  Dr.  Maudsley  says  it  is  our  duty  to  do,  therefore  I  will 
offer  no  apology  for  occupying  a  short  portion  of  your  time  this 
evening  in  considering  a  question  vhich  I  have  brought,  in  one 
form  or  another,  before  you  very  frequently  within  the  last  four 
years,  The  Dominion  Parliament  is  now  about  to  assemble, 
therefore  it  is  a  proper  time  for  this  representative  society  to 
express  its  views,  and  ask  for  legislation  to  define  the  responsi- 
bility or  irresponsibility  of  the  criminal ;  to  ask  the  legislature 
to  define,  on  some  scientific  ground,  where  responsibility  ende 
and  where  irreaponsibiiity  begins.  That  society  has  a  right  to 
make  laws  for  its  own  preservation,  is  a  truth  that  no  sane  man 
can  deny,  but,  that  these  laws  should  be  based  upon  justice  and 
benevolence  is  just  as  great  a  truth,  which  no  sane  man  can  deny. 
From  the  earliest  history  of  law-makers  down  to  the  present 
day,  we  find  that  as  mankind  has  progressed  in  scientific  know- 
ledge,— in  fact,  as  man's  intellectual  and  moral  faculties  have 
become  more  developed,  and  man,  in  consequence,  has  progressed 
to  a  higher  state  ef  civilization,  laws  have  been  more  generally 
based  upon  justice  and  benevolence.  But,  gentlemen,  man  is, 
aa  I  have  already  said,  a  progressive  animal ;  all  history,  and 
science  (which  is  more  trustworthy),  proves  this  fact.  When 
we  draw  the  difierence  between  the  peoples  of  the  pre-hJstoric 
age,  and  the  peoples  of  the  present  day ;  when  we  draw  the 
distinction  between  the  peoples  of  the  historic  age  and  the  pre- 
sent day  ;  or,  to  come  still  closer,  between  the  peoples  of  the 


350 


CANADA  MEDICAL  AND  SUaoiOAL  JODBJtAL. 


present  day, — for  example,  between  the  Eoropean  and  the 
African,  between  the  European  and  the  Cannibala  of  the  South 
Sea  Islands, — we  must  admit  that  man  ia  a  progreBaive  animal. 
Perhaps,  gentlemen,  in  aome  milhons  of  years  the  deacendante 
of  these  Africans  and  South  Sea  Islanders  may  become,  by  the 
natural  law  of  progress,  as  far  advanced  as  we  are  now,  and 
our  offaprmg  may  be  so  far  advanced  that  crime  and  insanity 
would  be  unknown  amongst  them.  Judging  from  the  paat,  this 
ia  but  a  natural  conclusion  to  come  to  with  regard  to  the  future. 
Not,  however,  being  a  prophet,  nor  the  son  of  a  prophet,  I  do 
not  want  to  speak  of  the  future,  but  of  the  present.  I  want  to 
speak  of  man  juat  as  we  medical  scientists  find  him  ;  and  how 
do  we  find  him  ?  We  find  him  differing  ae  much  in  his  mental 
organization — that  is,  in  hia  intellectual  and  moral  faculties, — 
as  we  find  him  differing  in  personal  appearance.  All  men 
recognize  the  fact  of  men  differing  in  their  intellectual 
facultiea  from  the  different  degrees  of  idiocy,  different  degrees 
of  imbecility,  and  different  degreea  of  intelligence  ;  and  society, 
as  a  whole,  makes  no  protest  when  science  pointe  oat  Uie 
fact  that  this  intellectual  faculty,  whether  it  be  or  be  not 
cultivated,  is  dependent  upon  a  man's  material  brain.  But 
the  moment  we  come  to  declare  the  same  of  the  other  portion 
of  a  man's  mental  organization — that  is,  of  his  moral  faculties, 
— then  all  the  teachers  of  rehgion,  and  all  those  versed  in 
law,  raise  one  universal  cry  against  us,  and  we  hear  on  all 
sides  the  terms  revolutionists  and  materialists.  Nevertheless, 
gentlemen,  it  is  as  true  of  the  moral  facultiea  as  it  is  of  the 
intellectual,  and,  as  you  know,  admits  of  as  clear  anatomical, 
phyaiological  and  pathological  proofs.  Yet,  I  admit  that  all 
scientific  truths  are  of  themaelves  revolutionary,  but  they  pro- 
duce a  revolution  very  much  to  be  desired,  a  revolution  that 
advances  civilization  ;  it  is,  in  fact,  a  daily  revolution,  going  on 
80  gradually  and  so  noiselessly  that  men  hardly  observe  it ; 
indeed,  they  do  not  observe  it  at  all  in  its  growth,  and  are  sup- 
prised  to  find  themaelves  compelled  to  admit  the  truth  of  a 
scientific  fact  that  they  had  never  dreamt  of  As  to  its  being 
maten&listic,  of  course  it  is.    The  mental  acientiBt  don't  pretend 


—BY  DR.  nowAim.  351 

io  treat  of  anything  eke  but  matter  ;  -we  see  effect  and  we  look 
for  cause  ;  we  see  that  men  differ  intellectually,  and  we  find  the 
cause  in  the  cortical  substance  of  the  frontal  portion  of  the 
hemiapheres  of  the  brain.  We  find  men  differ  morally,  and  we 
find  the  cause  in  the  cortical  substance  of  the  parietal  and 
occipital  portions  of  the  hemispheres  of  the  brain.  We  find 
that  irritation  of  the  frontal  ceils,  renders  the  moat  intellectual 
man  a  raving  maniac  ;  that  irritation  of  the  parietal  cells,  renders 
the  most  honest  man  a  pick-pocket ;  and  that  irritation  of  the 
cerebral  cells,  renders  the  most  pure  being  a  filthy,  impure 
creature.  Now,  if  tliese  be  facts,  and  facta  they  are,  we  have 
no  trouble  in  recognizing  another  fact,  and  that  is,  that  every 
man,  in  virtue  of  aome  abnormal  atate  of  his  moral  faculties, 
has  in  him  a  criminal  neurosis, — some  to  a  greater,  and  some  to_ 
a  leas  degree.  Just  as  men  differ  in  degrees  of  intelligence,  ao 
they  differ  in  degrees  of  morality.  These  are  most  reasonable, 
simple  facts,  gentlemen ;  nothing  contrary  to  our  reason,  nothing 
contrary  to  our  comprehension,  nothing  contrary  to  natural 
laws  ;  indeed,  I  conceive  one  of  the  great  difBculties  in  the  way 
of  men  receiving  these  scientific  truths  is  their  simplicity.  There 
18  something  yet  remaining  in  man  that  makes  him  lik#  the 
mysterious  and  cling  to  the  inexplicable.  Writers  of  fiction 
know  this  well,  therefore  they  always  write  so  aa  to  myatify 
their  readers.  This  abnormal  state  of  man's  moral  faculties, 
which  mental  scientists  call  a  criminal  neurosis,  and  which  we 
account  for  physically,  others  call  by  the  terms,  hia  sinful 
nature,  his  criminal  nature,  his  rebellious  nature,  &c,,  and  the 
cause  they  assign  for  it  is  the  consequence  of  original  sin.  Well, 
I  see  here  no  cause  of  quarrel  ^  all  admit  that  the  evil  ia  there, 
and  what  was  the  first  or  original  cause  of  this  unhappy  state 
of  man  is  of  but  httle  consequence  so  long  as  we  recognize  the 
fact  that  man's  criminal  neurosis,  as  he  is  to-day,  is  due  to  a 
physical  cause,  and  that  cause  is  an  abnormal  or  imperfect  state 
of  hia  moral  faculties ;  whether  hia  aoul  haa  anything  to  do  with 
the  matter  or  not  ia  of  no  conaoqueuce  to  us  so  long  as  we  treat 
the  disease  phyaically.  But,  say  our  law-makors,  our  lawyers, 
rcli^ouB  teachera,  every  man  most  be  held  respomble 


352 


CANADA   MBDIOAL   AND    SURGICAL   JOURNAL. 


for  hiB  acts.  The  scientiat  here  joins  issue  and  says  every  man 
must  be  held  responsible  to  a  degree,  hia  degree  of  responsibility 
depending  upon  his  degree  of  intellectual  and  moral  facultiea 
and  his  degree  of  controlling  aerve  power.  The  idiot,  imbecile, 
maniac,  and  morally  insane  are  not  responsible  at  all,  and  tlie 
criminal's  responsibility  must  l>e  judged  by  the  greater  or  lesser 
degree  of  hia  moral  faculties,  the  degree  of  hia  criminal  neurosis, 
and'  there  are  some  of  the  criminal  class  of  society  whose 
neurosis  is  so  exaggerated,  so  incurable,  that  they  are  not  a  bit 
more  responsible  than  are  the  morally  insane ;  the  habitual 
drunkard,  for  example.  And  here  I  consider  the  heat  time  to 
define  for  you  the  difierence  between  moral  insanity  and  what 
is  understood,  or  what  I  call  a  criminal  neurosis,  or,  if  you  will, 
moral  depravity.  I  would  define  moral  insanity  to  be  where  a 
man  has  had  a  sound  moral  organization  and  sufficient  nerve 
control  to  guide  his  moral  acta,  and  where  by  reason  of  disease 
or  some  accidental  circumstances,  either  from  reflex  action,  from 
functional  derangement,  or  leaion  of  the  parts,  or  disease  of  the 
vascular  system,  kc,  his  mental  faculties  become  altogether 
changed,  and  he  loses  power  over  his  moral  acts  from  the  loss 
of  nerve  control.  This  man's  will  may  he  to  do  right,  but  he 
has  no  nerve  controlling  power  to  resist  his  impulse  ;  and  some- 
times, to  prevent  himself  committing  a  crime,  he  will  commit 
suicide,  choosing,  as  he  conceives,  of  two  evils  the  least.  This 
is  what  I  call  moral  insanity,  and  in  such  a  case  the  intellect 
may  be  unclouded,  and  the  miserable  unfortunate  know  well 
that  he  is  no  longer  a  moral,  but  an  immoral  man;  and  he  is  & 
most  miserable  man,  always  accusing  himself,  although  he  knows 
he  cannot  help  himself.  Yet,  by  our  inhuman  and  unscientifio 
laws,  such  men  are  hanged,  that  is,  judicially  murdered ; 
and  the  righteous  man  whose  moral  faculties  are  sound,  and 
whose  moral  faculties  are  Hke  an  iceberg,  says  :  "  Serves  him 
right ;  moral  insanity,  indeed !  hang  all  such  rascals ;  these 
doctors  and  scientists,  by  and  by,  will  do  away  with  all  respon- 
sibility." 

I  will  now  define  what  I  mean  by  a  criminal  neurosis.     I  have 
said  that  every  man  has  it  more  or  lese,  but  some  have  bo  mooh 


"  CRIME  AND   INSANITY." — BY   DR.  HOWARD.  353 

of  it  that  they  are  hardly  responsible  for  their  acts.  These  are 
they  that  are  begottezi,  conceived,  born  and  brought  up  in 
crime,  generally  the  offspring  of  depraved  and  debauched 
parents.  They  differ  from  the  morally  insane,  inasmuch  as  they 
never  had  a  sound,  moral  organization  ;  their  moral  organization 
from  their  birth  has  been  deformed ;  they  never  knew  good  ;  evil 
to  them  is  good.  They  are  as  incapable  of  reasoning  as  a  wild 
horse ;  they  cannot  recognize  the  rights  of  society ;  they  are 
Ishmaelites — their  hand  is  against  every  man.  If  they  have 
controlling  nerve  power,  they  don't  know  how  to  use  it,  or  if 
they  do,  they  use  it  for  their  own  vile  ends.  These  men  never 
regret  an  evil  deed,  because  they  see  no  evil  in  their  act.  They 
are  a  law  unto  themselves.  They  are  only  in  a  very  slight  degree 
removed  from  the  lowest  brute,  either  intellectually  or  morally. 
And  these  men  we  punish  by  hanging  and  whipping,  kc.  We 
treat  them  also  as  responsible  beings,  and  still  crime  goes  on, 
and  the  criminals  still  live  in  our  midst.  Then  the  righteous 
say :  "  Well,  if  he  had  listened  to  the  voice  of  God,  if  he  had 
listened  to  the  teachings  of  religion,  if  he  had  controlled  his 
evil  desires,  his  evil  passions,  &c.,  he  would  have  been  a  different 
man."  Of  course  he  would,  but  he  didn't ;  he  had  no  desire 
to  do  so.  He  acted  exactly  in  accordance  with  his  nature ;  he 
acted  in  obedience  to  his  criminal  neurosis,  in  obedience  to  his 
abnormal  moral  faculties ;  and  for  all  the  example  it  is  to  another 
of  his  sort,  we  might  just  as  well  hang  a  dog  as  hang  such  a 
criminal.   . 

Gentlemen,  you  know,  and  I  know,  and  all  the  world-  knows, 
that  the  only  remedy  that  has  been  ever  tried  for  the  prevention 
of  crime  has  been  punishment,  and  this  punishment  has  been 
meted  out  to  all  as  if  all  were  equally  responsible  for  their  acts. 
This,  to  say  the  least,  was  unscientific,  and  consequently  unjust, 
and  punishment,  gentlemen,  has  been  proved  a  failure  for  the 
prevention  of  crime,  or  for  the  cure  of  the  criminal  class  of 
society.     Crime  continues,  and  the  criminal  classes  continue. 

There  is  no  man  recognizes  more  than  I  do,  as  I  have  already 
said,  the  right  of  society  to  enact  laws  for  its  own  preservation. 
Moreover,  I  ftilly  recognize  the  right  of  society  to  inflict  pun- 

jo.  Lxxx.  24 


354 


imcAL    AND   SUBUICAL   JOUBSAL. 


iahment,  even  capital  puniehment,  for  crimo  if  it  thinks  well  so 
to  do ;  but  I  deny  the  right  of  society  to  treat  all  criminals  as 
if  all  were  equally  responsible,  or  as  if  all  were  to  some  degree 
responsible.  If  punishment  has  to  continue,  and  I  suppose  it 
m\],  for  the  present  at  all  events,  I  would  bave  men  punished, 
not  according;  to  the  enormity  of  their  crimes,  but  in  accordance 
with  the  moral  responsibility  with  winch  they  bave  been 
endowed;  and  where  I  found  an  ir  re  claimable,  an  incurable 
criminal,  I  would  treat  bim  as  I  would  an  incurable  maniac,  and 
lock  him  up  for  life,  not  for  puniBtiment,  but  for  the  pi-otection 
of  society,  and  to  put  a  stop  to  the  procreation  of  such  animals. 
What  next  would  I  have  ?  I  would  have  the  Legislature 
recognize  the  fact  that  poverty  was  the  great  objective  caoee 
of  crime,  and  that  if  we  must  of  necessity  have  different  grades 
of  society,  if  we  must  of  necessity  have  poor,  we  must  not  of 
necessity  have  a  pauper  class,  from  which  class,  aa  a  role, 
springs  the  criminal  classea.  I  would  have  the  Legislature 
bend  their  whole  energy  to  do  away  with  pauperism,  and 
thereby  diminish  crime  and  the  criminal  clasacs.  But  you 
will  ask,  how  is  the  law  to  draw  the  distinction  between 
the  men  of  different  mental  organizations  ?  How  is  a  judge, 
before  he  passes  sentence,  to  know  a  man's  mental  callibre 
or  a  man's  moral  faculties  ?  Let  the  law  once  be  made  and  the 
medical  profession  will  soon  provide  men  capable  of  doing  that 
work.  But  we  need  not  trouble  ourselves  too  much  about  the 
question  of  criminals  at  present.  There  ia  not  much  prospect 
of  the  Legislatures  of  the  present  day  troubling  themselves 
about  the  matter.  Such  qnestiona  as  these  are  rarely  taken  up 
by  men  of  strong  party  proclivities.  Besides  we  would  have  a 
strong  power  against  us,  the  theologians  and  lawyers.  Yon 
will  naturally  ask  why,  then,  am  I  writing  so  much  upon  the 
subject  ?  I  answer,  some  men  lay  only  the  foundation ;  other 
men  build  thereon.  I  hops  that  in  time  these  other  men  will 
appear  and  build  upon  the  foundation  that  I  have  been  try- 
ing to  ky.  But  if  I  have  no  hope  to  get  legislation  upon  the 
criminal  class  of  society,  I  have  strong  hope  of  having  legisla- 
tion upon  the  question  of  inssnity,  if  for  no  other  reason  than  to 
put  a  8t«p  to  our  judges  making  themselves  ridiculous  before 


"crime   and  insanity." — BY   DR.  HOWARD.  355 

the  whole  world,  in  their  different  definitions  of  what  causes 
irresponsibility  in  the  insane.  Could  tljere  be  anything  more 
absurd  than  to  find  a  Judge  in  the  Province  of  New  Bruns- 
wick making  a  statement  the  very  contrary  of  that  made  a  few 
months  before  by  •'  the  Lord  Chief  Justice  of  England,  "  the 
Judge  instructed  the  jury  that  unless  there  was  an  entire  lack 
of  knowledge  to  distinguish  between  right  and  wrong^  they 
could  not  but  find  the  prisoner  guilty,"  the  Lord  Chief  Justice 
of  England  said  :  '*  1  coincide  most  cordially  in  the  proposed 
alteration  of  the  law,  having  been  always  strongly  of  opinion 
that,  as  the  pathology  of  insanity  abundantly  establishes,  there 
are  forms  of  mental  disease  in  which,  though  the  patient  is 
quite  aware  he  is  about  to  do  wrong ^  the  will  becomes  over- 
powered by  the  force  of  irresistible  impulse."  Here,  gentle- 
men, is  a  difierence,  but  is  the  Provincial  Judge  to  be  found 
fault  with  ?  I  certainly  think  not  ;  the  fault  lies  with  the 
Dominion  Government  for  never  having  defined  where  respon- 
sibility terminated.  I  will  now,  for  your  information,  and  in 
support  of  iKiy  views,  giveil  before  this  Society  three  years  ago, 
and  for  the  information  of  our  Legislature,  quote  the  highest 
authority  in  England,  both  legal  and  medical.  In  The 
Journal  of  Mental  Science  (edited  by  Drs.  Mandsley  and 
Clouston)  for  April,  1878,  page  22,  is  the  following  from  the 
pen  of  David  Nicolson,  M.  D.,  Deputy  Superintendent  State 
Criminal  Lunatic  Asylum,  Broadmoor,  England,  "  a  bill  intro- 
duced into  the  House  of  Commons  in  1874,  by  Mr.  Russell 
Gumey,  with  the  view  of  amending  the  Law  of  Homacide  led 
to  the  appointment  of  a  committee,  before  which  most  important 
and  hopeful  evidence  was  given.  The  following  evidence 
of  Lord  Justice  Blackburn  speaks  for  itself,  and  virtually 
displaces  the  legal  dictum  of  right  and  wrong,"  "  We  can- 
not fail  to  see  that  there  are  cases  where  the  person  is 
not  clearly  responsible,  and  yet  knows  right  from  wrong. 
I  can  give  you  an  instance.  It  was  in  the  case  of  that 
woman  of  whom  I  was  speaking,  who  was  tried  for  wounding  a 
girl  with  intent  to  murder.  The  facts  were  these :  The 
woman  had  more  than  once  been  insane,  the  insanity  being 


3S6 


CANADA   UEDICAL   AND   BD&OICAL   JOCSMATi. 


principally  brought  on  by  suckling  her  child  too  long,  which  a 
the  cause  that  had  produced  it  before.  She  was  living  wiHi. 
her  husband,  and  had  the  charge  of  this  girl,  of  about  fifteen^, 
who  lay  in  bed  all  day  ;  she  was  very  kind  to  her,  and  had 
treated  her  very  well ;  they  were  miserably  poor,  and  vei^ 
much  owing  to  that,  she  continued  to  iiurae  her  boy  tUl  h< 
nearly  two  years  old  ;  and  suddenly,  when  in  this  state,  she,  on^ 
morning,  about  eleven  o'clock,  went  to  the  child  lying  in  bei^ 
aged  fifteen,  and  deliberately  cut  her  throat ;  then  she  went 
towards  her  own  child,  a  girl  of  five  or  sLx  years  of  age,  of 
whom  she  was  exceedingly  fond,  and  the  girl  hearing  a  noise,, 
looked  up  and  said:  "  What*  are  you  doing?"  "I  hava 
"  killed  Ohvia,  and  I  am  going  to  kill  you,"  was  the  answer.  Thft 
child,  fortunately,  instead  of  screaming,  threw  her  arms  round, 
her  mother's  neck  and  said :  "  No,  I  know  you  would  not  hurt 
your  little  Mopsy."  The  woman  dropped  the  child,  went  dowHj 
and  told  a  neighbour  what  she  bad  done,  that  she  "  had  killed! 
Olivia,  and  was  going  to  kill  Mary  ;  but  when  the  darling  threw, 
its  arms  round  my  neck,  I  had  not  the  heart  to  do  it."  Shft 
clearly  knew  right  from  wrong,  and  knew  the  character  of  hej; 
act.  For  some  little  time  aHer  that  she  talked  rationally  enough^ 
but  before  night  aho  was  sent  to  a  lunatic  asylum  raving  mad» 
and  having  recovered  she  was  brought  to  be  tried  before  me  ati 
a  subsequent  Assize.  She  did  know  the  quality  of  her  act*, 
and  was  quite  aware  of  what  she  had  done,  but  I  felt  it  impos- 
sible to  say  she  should  be  punished.  If  I  had  read  the  depo^ 
tion  in  Magnantin's  case,  and  said  :  "  Do  you  bring  her  withiH' 
that  ?  "  the  jury  would  have  taken  the  hit  in  their  own  teeth, 
and  said,  "  Not  guilty  on  the  ground  of  insanity,"  and  I  thinly 
rightly.  She  ia  well  borne  out  by  the  following  extract  madft 
from  a  statement  sent  to  the  Committee  by  the  Lord  Chief 
Justice  of  England  (Sir  A.  Cockburn)  :  "  As  the  law  i 
expounded  by  the  Judges  in  the  House  of  Lnids  now  stands,  1%. 
la  only  when  mental  diseases  produce  incapacity  to  distinguish 
between  right  and  wrong  that  imraunity  from  the  penal  con- 
sequences of  crime  is  admitted.  The  present  bill  introduces  t 
new  element,  the  absence  of  power  of  self  denial.     I  concur; 


"  CRIMS  AND  INSANITY." — BY  DR.  HOWARD.  36*7 

most  cordially  in  the  proposed  alteration  of  the  law,  having 
leen  always  strongly  of  opinion  that,  as  the  pathology  of 
insanity  abundantly  establishes,  there  are  forms  of  mental 
diseaae  in  which,  though  the  patient  is  quite  aware  he  is  about 
to  do  wrong,  the  will  becomes  overpowered  by  the  force  of 
irresistible  impulse,  the  power  of  self  control  when  destroyed, 
or  suspended,  by  mental  disease  becomes,  I  think,  an  essential 
element  of  responsibility." 

In  the  July  number  of  the  same  journal  (1875),  page  258, 
is  the  following  from  the  pen  of  Dr.  Bucknill :  "  Responsibility 
depends  upon  power  and  not  upon  knowledge  and  feeling,  and 
a  man  is  responsible  to  do  that  which  he  can  do  ;  not  that 
which  he  feels,  or  knows  it  right  to  do." 

Well,  gentlemen,  no  matter  how  you,  or  others,  may  differ 
with  me  respecting  a  criminal  neurosis,  and  that  a  man's  moral 
responsibility  depends  upon  his  mental  organization,  there  are 
none  of  you,  with  such  authority  on  my  side  as  I  have  quoted 
for  you,  but  will  agree  with  me,  that  it  is  full  time  for  us  to 
have  legislation  upon  responsibility  in  the  insane.  And  that 
law  should  decide,  as  it  has  in  England,  that  a  person  may 
know  the  difference  between  right  and  wrong,  and  yet  be  irre- 
sponsible for  their  acts,  their  will  being  overpowered,  and  their 
self  control  destroyed  by  the  force  of  irrisistible  impulse.  Yes, 
it  surely  is  time  that  this  important  question  should  be  settled  ; 
it  is  time  that  the  law  should  define  where  irresponsibility  ends, 
and  responsibility  begins. 

I  have  brought,  this  evening,  before  you  three  distinct  sub- 
jects for  consideration.  The  first,  as  to  how  the  Medical  Schools 
shall  provide  means  to  give  students  clinical  instructions  upon 
mental  diseases.  Well,  gentlemen,  if  your  different  Professors 
will  come  to  some  understanding  amongst  themselves,  I  will  be 
happy  to  aid  you  in  carrying  out  your  plans.  The  second 
subject  is  with  regard  to  the  criminal  class  of  society ;  strong  as 
my  convictions  are  upon  the  unscientific  treatment  of  this  class 
of  society,  I  would  not  ask  you  to  take  any  move  in  the  matter 
it  present.  There  are  too  strong  prejudices  to  overcome ; 
better  wait  till  the  people  are  better  instructed  in  science,  press- 


358  CANADA   MEDICAL    AND    BtTBOICAL   JOIHUJAL. 

ing  the  queation  at  present  would  do  more  harm  than  good, »-' 
least  that  is  mj  opinion.     But  with  ret;ard  to  the  third  suhjecfc 
viz.,  to  urge  upon  the  Legislature  the  necessity   of  legislatini 
on  the  Buhject  of  responsibility  and  irresponsibility  in  the  insane  — 
I  ask  you  if  you  agroe  with  me,  that  we  require  such  legislalion^r 
to  prepare   petitions  to  the  Legislature  praying  for  legislation^ 
and  setting  forth  the  reasons  why  Our  prayer  should  be  acceded- 
to.     In  fact  that  the  law  should  be,  "  that  a  man  is  responsible 
for   what  he   can  do,  not   for  that   which  he  feels,  or  knows,  it 
right  to  do."     Or,  gentlemen,  if  you  see  any  more  simple  way 
to'  bring   the   matter  before  the  Legislature,  do  so ;    but  do 
something,  if  it  were  only  to  show,  as  scientists,  we  are  ative  to 
the  necessity  of  some  change  being  made  in  the  law  of  lun&cj. 


Case  of  Compound  Comminuted  Fracture  of  Leg. — Amputa- 
tion with  Antiseptic  precautions. — Recovery. — Under  the 
care  of  Db.  Roddick, 

(Keported  bj  Mr.  J.  A.  MoArthub.) 

J,  0.  M.,  laborer,  ret  22,  a  strong  healthy  young  man  of 
good  physii|ue,  was  admitted  into  the  Montreal  Gfeneral  Hos- 
pital, Oct.  8th.,  1878,  with  compound,  comminuted  fracture  of 
left  leg,  the  result  of  direct  violence.  Ilia  family  and  personal 
history  are  good. 

The  history  of  the  accident  is  briefly  as  follows :  — 

In  the  afternoon  of  above  date  the  patient,  with  others,  was 
engaged  on  ship  board,  hoisting  a  heavy  plate  from  the  hold  of 
a  steamer.  It  appears  that  when  elevated  about  ten  feet  above 
patient's  head,  the  chain  sling  attached  to  the  plate  lost  its 
catch,  the  latter  fell  suddenly  to  the  floor  before  sufficient  time 
was  given  to  get  out  of  its  way  ;  and,  from  the  nature  of  the 
accident,  probably  struck  the  limb  directly  with  its  edge. 

On  examination,  (one  hour  after  occurrence  of  accident)  the 


HOSPITAL   REP0BT8.  359 

left  leg  is  found  crushed  to  a  fearful  extent,  especially  at  a 
point  corresponding  to  the  lower  part  of  middle  third.  Here  a 
large  area  of  surface  is  broken  on  either  side,  the  soft  parts 
greatly  contused  and  lacerated,  and  the  bones  badly  com- 
minuted. Distal  part  of  limb  is  cold  and  pulseless  and  freely 
movable  in  any  direction.  Tibia  is  broken  into  five  or  six  small 
irregular  pieces  partly  or  wholly  denuded  of  periosteum.  The 
fibula  is  fractured  at  two  points,  probably  about  four  inches 
fix)m  either  extremity,  the  lower  one  being  compound,  the 
upper  one  not  so,  but  isolated,  as  it  were,  from  the  common  site 
of  injury.  He  feels  weak,  and  depressed  ;  is  slightly,  feverish  ; 
temp.  99'5^  in  axilla ;  pulse  85,  small  and  soft ;  hemorrhage 
not  over  great. 

At  5.30  P.  M..  ether  was  given,  and  Dr.  Roddick,  assisted 
by  the  house  surgeons,  proceeded  to  remove  the  limb,  Lister's 
antiseptic  method  being  carried  out  to  its  fullest  extent.  The 
site  chosen  for  amputation  was  a  point  about  six  inches  below 
the  knee,  in  close  proximity  to  the  lacerated  parts,  and  within 
half  an  inch  of  the  upper  fibular  fracture.  The  method  adopted 
was  a  modified  flap,  the  anterior  flap  made  long  by  dissection,  the 
posterior,  short,  and  by  transfixion.  Esmarch's  band  was  used 
to  control  hemorrhage.  There  was  considerable  diflSculty  in 
securing  the  vessels,  and  stopping  primary  oozing  from 
the  stump.  The  flaps  were  secured  by  catgut  sutures,  and  the 
whole  carefully  inclosed  in  the  Antiseptic  Dressing. 

9  P.  M.-^The  patient  is  weak  and  depressed.  Temp.  101®. 
Pulse,  92  ;   suffers  considerable  pain  ;    no  inclination  to  sleep. 

Oct,  9^A.,  12.30  P.  M. — Passed  a  restless  night ;  much  pain 
m  stump  ;  morning,  temp.  99°  ;  everything  looking  nicely,  and 
a  fi-esh  dressing  applied. 

10^. — Spent  a  fairly  good  night.  Not  much  pain.  Temp. 
101®.  Dressings  are  quite  sweet.  Stump  looks  well  A  little 
oozing,  chiefly  serous.  No  inflammatory  tension,  dressed  as 
before. 

Hth. — Spent  a  good  night ;  feels  comfortable,  and  is  cheer- 
ful ;  temperature  100® ;  stump  dressed  as  usual ;  looks  very 
well ;  union  seems    to  be   progressing  favorably ;   discharge 


360  CANADA   MEDIOAL    AND   BCEOlaAL    JODBNAL. 

altogether  serous ;  no  hagging  of  pu8,  or  tension  anywhere  ;  no 
signs  of  lymphatiu  trouble.  Bowels  only  moved  once  ^nce 
operation  ;  ordered  a  mild  aperient. 

Idtk. — No  serious  sjmptono  have  arisen;  temperature  ran 
ning  an  almost  uniformly  normal  course  ;  digestive  system  not 
disordered.  Stump  looks  very  well  ;  union  has  taken  place 
b(!tween  the  flaps.  Some  superficial  sloughing  of  anterior  flap, 
but  the  granulations  are  htialthy  and  vascular  ;  posterior  flap 
a  little  baggy,  but  the  droasinga  are  perfectly  sweet ;  salicylic 
cream  is  now  used, 

22nd. — No  change  worth  noting  since  last  report.  A  little 
pus  can  be  squeezed  out,  which,  however,  is  antiseptic,  as  shewn 
by  absence  of  odour,  and  by  the  microscope. 

27(/(. — Dressed  again  to-day  ;  stump  in  admirable  condition  ; 
parts  entirely  closed  throughout ;  no  signs  of  tension  or 
bagging  anywhere ;  external  surface  is  pretty  raw,  from  super- 
ficial excoriation  of  the  integument ;  temperature  varies  frohi 
98  to  QO'^.     Digestive  system  in  good  order. 

29M. — (21st  day).  Ordered  up.  Antiseptic  dressings 
discontinued  and  red  wash  applied. 

Nov.  ith. — Has  been  going  about  in  the  sick  chair;  stomp 
presents  a  fine  healthy  appearance  ;  firm  union  of  all  the  parts ; 
cicatrix  situated  well  behind.  End  of  stump  round,  uniform  and 
nicely  healed  over.     Discharged. 

Cage  of  Malignant  Epulis,  demanding  partial  removal  of  the 
Superior  Maxillart/  Bones. — Recovery. — Under  the  care 
of  Dr.  RoDDlCE. 

(BeportiHl  bj   Mr.  Thomfts  Orftj.) 

E.  Z.,  aged  52,  a  French  Canadian  laborer,  was  admitted 
into  the  Montreal  General  Hospital  in  November  of  last  year. 
He  gave  the  following  history :  In  the  June  previous  he  felt  a 
severe  pain  in  tho  second  right  molar  tooth  of  the  upper  jaw. 
A  small  tumor  soon  formed  round  the  tooth,  which  loosened  and 
it  fell  out.  The  one  next  to  this  soon  became  affected  in  the  same 
manner,  and  shared  the  same  fate.     The  tumor  continued  to 


i 


I 

I 


HOSPITAL    REPORTS.  361 

grow  uatil  it  readied  its  present  cjondition,  the  growth  being 
accompanied  by  a  good  deal  of  pain.  It  took  two  months  to 
reach  its  present  size,  and  the  patient  believeB  it  has  grown 
more  during  the  last  three  months,  being  troubtesome  only  from 
a  hot  tingling  sensation. 

He  is  a  man  of  slight  frame,  is  emaciated  and  cachetic  look- 
ing ;  says  he  has  bvcn  lusing  tiesh  for  some  months ;  general 
functions  of  body  are  fairly  performed,  excepting  the  secretion 
of  saliva,  which  haa  been  increased  since  the  onset ;  cannot  use 
aolid  food,  mastication  being  so  much  interfered  with. 

A  firm  round  movable  and  painless  tumor  is  seen  and  felt  over 
the  region  of  the  left  submaxillary  gland.  •  It  is  now  about  the 
mze  of  a  small  walnut,  but  has  never  been  painful.  A  few  of 
the  cervical  glands  on  both  sides  are  enlarged  slightly.  A  firm 
fongoid-looking  growth  occupies  the  outer  and  inner  surfaces  of 
the  alveolar  borders  of  the  supra-maxillary  bones,  extending  from 
tiie  last  molar  tooth  on  the  right  side  to  the  second  molar  on  the 
left.  It  is  also  attached  to  the  right  half  of  the  hard  palate  as  far 
back  as  the  left  molar  tooth,  the  anterior  portion  of  the  left  half 
being  also  involved.  There  is  no  attachment  to  the  mucus 
membrane  of  the  upper  lip.  The  mass  is  very  vascular  and 
bleeds  freely  at  times,  the  slightest  injury  ^ving  nse  to 
haemorrhage. 

The  removal  of  the  tumor  being  determined  on,  the  following 
operation  was  performed  on  the  2.5th  November,  1878.  The 
patient  was  put  under  tlie  influence  of  ether  and  tlien  placed 
in  a  aemi-recumbent  posture.  Dr.  Ross  asssisted.  The  head 
being  steadied,  an  incision  was  made  through  either  cheek, 
beginning  at  the  angle  of  the  mouth  and  extending  back  a  dis- 
tance of  two  inches,  and  in  a  line  corresponding  to  a  point 
midway  between  tlie  outer  canthua  and  the  external  auditory 
meatus.  The  soft  parts  were  then  carefully  dissected  back  aa 
tit  as  the  iucisions  wore  made,  and  until  the  inferior  margin  of 
the  nasal  process  of  the  superior  maxillary  bone  was  reached. 
This  flap  was  held  up  and  a  narrow  saw  was  introtluced  into 
the  nares,  and  made  to  cut  its  way  outwards  and  backwards  to 
the  angle  of  the  bone  on  each  side.  On  removal  of  this  portion 
of  bone  thus  cut  out,  formidable  toemorrhage  ensued.     This 


362  CANADA   MEDICAL    AND    GUBQICAI.   JOtJBNAL. 

was  controlled  by  the  appHeation  of  ligatures  to  the  vessels  in 
the  soft  parts,  and  the  actual  cautery  to  those  io  the  bone.  All 
oozing  being  stopped,  the  soft  parts  were  brought  in  situ,  and 
retMned  by  hare-lip  needles  and  cat-gut  snturea.  At  the  close  of 
the  operation  the  patient  was  breathing  freely  ;  pulse  88,  and 
regular,  but  small ;  was  ordered  some  brandy,  and  was  removed 
to  the  ward. 

A  microscopical  examination  of  the  tumor  was  aabsequently* 
made  hy  Dr.  Osier,  who  declared  it  to  be  epithohal  in  its 
character. 

The  patient  was  put  upon  an  exchisively  milk  diet,  with 
amall  quantities  of  stimulants.  Four  hours  after  the  operation 
he  was  very  comfortable,  with  a  temperature  of  ninety-nine 
degrees,  and  a  full  and  steady  pulse  of  72.  He  was  ordered  a 
mouth-wash  of  chlorate  of  potash,  and  the  nurse  was  instructed 
to  paint  the  glycerine  of  carbolic  acid  on  the  surface  exposed 
by  the  operation. 

From  the  notes  we  gather  that  everything  went  on  most  satis- 
factorily. 

On  the  11th  December  the  discharge  from  the  mouth  is 
reported  healthy,  and  small  in  amount ;  the  free  surface  rapidly 
heahng  over.  He  sleeps  well  and  has  an  excellent  appetite. 
Altogether  his  general  condition  is  everytliing  that  could  be 
desired.  The  incisions  through  the  cheeks  united  well  by  first 
intention,  so  that,  excepting  a  slight  faUing  in  of  the  tip,  no  dia- 
tigurment  of  any  moment,  has  resulted  from  the  operation. 

He  returned  to  his  home  within  one  month  after  the  opera- 
tion, having  gained  flesh,  and  entirely  lost  that  cachectic 
appearance  which  he  presented  on  admission. 

The  enlarged  sub-maxillary  gland  referred  to  in  the  early 
part  of  the  report  remained  in  statu  quo  and  would  have  been 
removed  hut  for  the  decided  stand  taken  hy  the  patient  against 
any  ftirther  operative  interference.  None  of  the  other  glands 
in  the  neighborhood  appeared  to  bo  seriously  involved  up  to  the 
time  of  his  discharge. 

It  is  worthy  of  mention  that  the  thormo-cautere  proved 
itself  to  bo  absolutely  indtspensible  aa  a  means  of  arresting 
hsemorrhage  during  the  operation. 


I 


HOSPITAL   BBPOKTS. 

Case  of  Compound  Fracture  of  Radius  and  Ulna,  treated 
antiaepticallg. — Unier  the  care  of  Dr.  Roddick. 
(Reported  by  W.  H.  BuRLinn,  M.D.,  Home  Hurgeoa  Mgutreal 
General  Hospilal.) 

Christina  McC,  set.  40,  a  short,  slightly  built  woman,  was 
admitted  to  th<>  Montreal  General  Hospital  on  the  24th  Decem- 
ber, 1878,  for  an  injury  ahe  had  received  to  her  right  arm, 
Iq  going  down  a  flight  or  steps  leading  to  the  yard,  ahe  sUpped 
and  fell,  striking  her  arm  against  the  edge  of  a  bucket. 
This  occurred  about  twenty  minutes  before  admission,  and  was 
followed  by  considerable  haemorrhage.  Upon  examination  it 
was  found  that  there  was  fracture  of  both  bones  of  the  right 
forearm,  about  1^  inches  above  the  wrist,  also  a  wound  through 
which  the  upper  fragment  of  the  radius  could  be  felt  and  seen, 
rendering  the  fracture  eompound.  There  was  considerable 
deformity  present  which  had  to  be  reduced,  and  as  the  case 
seemed  a  favourable  one  for  antiseptic  treatment,  it  was  dressed 
according  to  Lister's  plan,  tlie  wound  having  first  been 
sryinged  out  with  a  solution  of  carboHc  acid,  1-20.  The 
dressings  were  found  to  be  a  sufficient  support  for  the  fracture, 
and  no  splint  was  necessary.  Coaaiderable  hremorrhage  soiled 
the  dressings  for  the  first  two  days,  but  no  pus  formed,  and 
everything  remiuned  sweet.  The  dressings  were  changed  daily 
for  five  days,  then  at  longer  intervals.  The  last  one  removed 
twenty-one  days  after  the  accident,  had  been  on  for  six  days. 
Very  little  pus  formed  at  any  period  in  the  treatment,  and  the 
the  wound  was  always  perfectly  aseptic  in  character. 

2l8t  Jan. — Wound  is  quite  closed,  and  good  firm  union 
exists  between  the  bones.  Can  flex  and  extend  her  fingers 
perfectly.     No  splint,  other  than  the  heavy  dressing,  bad  been 

^H      used    throughout.       Discharged     to-day,    four    weeks    after 

^H    admissioa 


UEDICAL   AND   SUKaiCAL   JODKNAL, 

3^uiews  and  Botines  af  Boohs. 

A   Manual    of   the    Practice    of   Surgery.  —  By   THOMAft 
Bryant,    F.  R.  C.  S.,     Surgeon     to    and   Lecturer    on 
Surgery  at  Guy'a  Hospital,   &c.,  with  six  hundred  and 
seventy-two  iliustrations.      Second  American   from   the 
third  revised  and  enlarged  English  edition.     Royal,  8vo, 
pp.  xix,  045.     Philadelphia:  Hbsky  C.  Lea,  1879. 
Thia  large  volume  is  a  reprint  of  the  English  edition  (in  two 
volumes)  of  Mr.  Bryant's  excellent  Manual  of  Surgery.     It  is 
a  little  over  two  years  since  the  second  London  edition  of  this 
work  issued  from  the  press,  and  we  are  called  upon  to  notice 
this,  the  third  edition,  which  has  in  many  respects  been  improved, 
aa  extra  matter  has  been  added,  and  the  engravings  have  been 
increased  in  numljer.     Mr.  Bi'yant'a  work  is  a  fair  exponent  of 
British  surgery,  thoroughly  practical  in  its  teaching,  a  favorite 
text-hook  with  student  and  practitioner,  and  one  of  the  best  of 
its  kind.     No  material  alteration  has  been  made  in  the  arrange- 
ment of  the  subjects  under  discussion  in  this  edition,  and  Mr, 
Bryant  gives  the  results  of  his  own  experience,  which  has  been 
large,  being  that  of  one  of  the  principal  Metropolitan  Hospitals. 
But  while  taking  advantage  of  the  expeiience  gained  at  his  own 
hospital,  he  'Iocs  not  ignore  that  of  other  institutions,  and  in 
statistical  results  he  gives  the  published  records  of  other  hospi- 
tals both  English  and  Continental.     The  fact  of  this  manual 
passing  through  three  editions  in  so  short  a  time  is  an  evidence 
of  the  appreciation  of  the   work,   and  it  is  with  pleasure  we 
accord  to  it  a  full  measure  of  praise.     The  American  publisher 
has  given  us  a  handsome  volume,  printed  on  the  best  of  paper 
with  clear  and  well  impressed  type,  and  the  engravings  are  in 
the  best  style  of  art, 

The  Principfes  and  Practice  of  Surgery. — By  John  Ashcrst, 
Jr.,  M.p.,  Professor  of  Clinical  Surgery  in  the  Universily 
of  Pennsylvania,  &e.,  &c.  Second  edition ;  enlarged  and 
thoroughly  illustrated  with  five  hundred  and  forty-two 
illustrations.  Svo,,  pp.  1040,  Philadelphia:  Hknby  C, 
Lea,  1878. 
Thia  is  the  second  edition  of  Prof  Ashnrst's  Manual  of 

Principles  and  Practice  of  Surgery,  and  the  arrangement  is  the 


OF    BOOKS.  365 

same  as  that  which  he  adopted  in  the  first  issue  of  the  work. 
.Jn  the  preparation  of  this  work,  as  well  as  in  ita  revision,  the 
L  author  has  availed  himself  of  the  teaching  of  systematic  writers 
\  on  surreal  science,  and  in  special  departments  he  has  noted  the 
^ observations  of  writers  of  surgical  monographs,  and  in  making 
ie  of  the  works  of  others  due  credit  is  given.  He  has  spared 
3  labour  in  rendering  the  work  a  worthy  exponent  of  the  sub- 
K^cct  under  consideration.  Every  article  has  been  carefully 
Tevised,  and  in  making  changes  and  alterations  which  became 
necessary,  he  has  given  much  of  his  own  personal  observations 
and  experience  which  he  has  gained  as  a  clinical  teacher  and 
hospital  surgeon.  New  material  has  been  added,  but  in  so 
doing  he  has  judiciously  avoided  increasing  the  bulk  of  the 
volume  ;  the  number  of  pages  has  been  hut  slightly  added  to. 
There  is  a  most  voluminous  index  of  some  sixty  pages.  This 
19  always  to  our  tniud  an  excellent  feature  in  the  preparation  of 
medical  or  surgical  treatises,  and  is  of  the  greatest  advantage 
more  especially  in  works  of  reference  intended  for  the  use  of 
practitioners.  Altogether  the  work  before  us  will  be  found  a  safe 
guide  to  the  student  of  surgery,  and  is  also  a  handy  hook  of 
reference  for  the  busy  surgical  practitioner. 

Gmeral  Surgical  Pathology  and  TherapuHos  in   Fifty-one 

Lectures ;  a  Text  Book  for  Students. — By  Dr.  Tueodorb 

Billroth,  Professor  of  Surgery  in  Vienna,     Translated 

from  the  4th  German  edition  and  revised  from  the  8th 

edition,  by  Charles  E.  Hackley,  A  M.,  M.D.,  Physician 

*     to  the  New  York  Hospital,  &c.     8vo.,  pp.  xx.  773.     New 

York :  D.  Appleton  &  Co.,  549  and  551  Broadway, 

The  work  before  us  is  a  revised  translation  of  the  last  edition 

of  Billroth's  work  on  Surgical  Pathology.     To  Dr.  Ilackley  is 

due  the  credit  of  having  first  given  us  an  English  translation  of 

this  treatise,  which  appeared  early  in  1871.     Since  then  the 

New  Sydenham  Society  assumed  the  publication  of  the  work, 

and  now  we  are  in  receipt  of  the  very  latest,  being  a  revision 

of  the  previous  translation  by  Dr.  Uackiey  and  corresponding 

to  the  eighth  German  edition. 


lerea 
BoSV 


366  CANADA   MEDICAL    ANU   SURdTCAL   JOHKNAI.. 

The  work,  which  gives  a  general  rSunmf  of  surgical  pathology 
and  aurgical  principlea,  consists  of  twenty-one  chapters,  divided 
into  fiftjHDne  lectures.  In  the  first  chapter  are  conairlered 
simple  incised  wounds  of  the  sort  parts,  to  which  is  devoted 
lectures.  Chapter  second  consists  of  a  single  lecture  on 
peculiarities  of  punctured  wounds.  Contusions  of  the 
parts  without  wound  are  dismissed  in  the  third  chapter ;  aflet 
which  contused  and  lacerated  wounds  of  the  aofl  parts  are 
taken  up.  Simple  fractures  of  bone,  open  fractures,  and  sup- 
puration of  bone  and  injuries  of  the  joints  form  the  subjects  of 
chapters  five,  six  and  seven,  which  occupy  seven  lectures.  In 
chapters  eight  and  nine  gun-shot  wounds,  hums  and  frost-bites 
are  given.  Chapters  ton  to  nineteen,  in  which  will  be  foui 
twenty-three  lectures,  are  given  up  to  inflammation  and 
variety  of  consequences.  The  subject  of  tumours  is  discussetl' 
in  chapter  twenty,  divided  into  seven  lectures,  and  in  chapter 
twenty-one  is  a  lecture  on  amputations,  exarticulationa  and 
resections.  There  is  an  appendix  in  which  will  be  found  adi&' 
tions  from  the  eighth  German  edition-  These  are  nombei 
and  are  refori-ed  to  in  the  text  by  corresponding  numbers. 
publishers  have  done  their  part  well,  the  type  is  clear,  paper  of 
excellent  quality,  and  tho  wood-cuts  particularly  good.  In  this 
respect  we  observe  a  number  of  additions  which  did  not  appear 
in  the  former  issue.  We  commend  this  work  to  our  readei 
It  is  to  he  had  at  Dawson.  Bros.,  St.  James  street. 


4 

ter 
Old 

ereH 
TbM 
-of™ 

Ms 

ear 

1 


Kxfracta  from  -British  and  SPorcign  Journals. 


Intermeningeal  spinal  Hasmorrltag'e 

simulating  Strycbnine-Poisoning*'— S-  L. 

Dixon,  M.D.,  M.R.C.P.,  (Honorary  Medical  Officer  to  the 
Preston  and  County  of  Lancaster  Roy:il  Infirmary)  aays  : 
On  tlie  evening  of  the  12th  December,  1S76,  I  was  sent  for  in 
haste  to  see  a  grocer  who  had  been  suddenly  taken  ill.  Mj_ 
patient  was  a  tall  and  very  powerful  man  of  forty-nine  years  q" 
age,  who  for  the  previous  eight  years,  during  which  he  1 


been   under   my  observation,  had    enjoyed  remarkably  good 

health,  having  merely  Buffered  from  some  trifling  accidents,  and 
on  one  occasion  from  diarrhoea.  He  had  been  a  fanner  up  to  a 
year  ago,  when  he  had  opened  a  grocer's  shop  in  the  town ;  ho 
was  somewhat  intemperate,  and  hie  accidents  had  occurred 
when  he  was  intoxicated ;  ho  waa  of  active  habits,  and  was 
accustomed  to  lift  heavy  weights.  Oa  this  occasion  he  was  taken 
ill  at  six  in  the  evening,  soon  after  which  I  saw  him,  about  half 
an  hour  after  his  "  tea."  He  had  been  suddenly  seized  with 
violent  tetanoid  convulsions,  which  continued  to  recur  at  short 
intervals.  The  body  in  a  paroxysm  became  completely  extended, 
with  the  neck,  arms,  and  legs  stretched  out  and  stiff  for  a  short 
time  ;  comperative  tclaxation  then  took  place,  to  be  followed  in 
two  or  three  minutes  by  a  return  of  the  spasms,  during  which 
tiie  patient,  who  waa  never  unconscious,  screamed  from  the 
pain  which  he  said  he  experienced  all  over  the  body,  but 
especially  in  the  region  of  the  heart.  He  asked  not  to  be 
touched,  for  movement  in  any  way  brought  on  a  return  of  the 
paroxysm.  When  anything  was  put  into  his  mouth  with  a  spoon, 
the  jaw  contracted  forcibly  upon  it,  and  if  swallowing  was 
effected,  it  was  in  spasmodic  gulps.  The  pulse,  which  with 
difficulty  could  be  made  out  during  a  spasm,  was  in  the  inter- 

B  74,  and  of  good  volume  ;  the  pupils  during  a  paroxysm 
s  not  insensible,  but  somewhat  sluggish  and  dilated. 
IAs  he  was  lying  upon  a  stone  floor  in  aSback  room  without 
toy  accommodation,  during  a  brief  interval  from  convulsions  an 
attempt  was  made  to  remove  him  to  his  house.  He  died,  how- 
ever, before  he  could  bo  got  there.  The  whole  duration  of  hia 
illness  was  leas  than  two  hours. 

As  the  case  presented  a  very  suspicious  resserablance  to  one 
of  strychnine-poiaoning,  I  declined  ta  give  a  certiGcate  without 
a  post-mortem  examination,  although  in  the  most  careful  inves- 
tigatioii  I  could  discover  no  vestige  of  any  inducement  to 
suicide  or  murder,  nor  did  it  seem  possible  the  poison  could 
have  been  taken  accidentally,  for  his  last  meal  had  been  of  his 
customary  tea  and  bread-and-butter ;  moreover,  no  vermin  or 
other  poison  was  sold  in  the  shop. 


368  CANADA  MEDICAL  AND  8UROICAL 

With  the  assistance  of  tvfo  medical  friends  I  examined  the 
bodj  next  day,  about  eleven  houra  after  death.  But  neither  in 
the  head,  cheat,  nor  abdomen  could  we  discover  any  caiise  for 
the  sudden  death  ;  indeed,  all  the  organs  seemed  fairly  healthy. 
We.  therefore,  removed  the  stomach  with  its  contents  tied  up, 
and  also  portions  of  the  viscera.  We  then  turned  the  body  into 
the  prone  praition,  and  carefully  opened  the  spinal  canal,  when 
we  found  the  arachnoid  cavity  filled  with  black  and  coagulated 
blood  ;  there  was  no  opening  of  aortic  aneurism  into  the  canal, 
and  the  man  had  never  complained  of  pain  in  his  hack.  No 
attempt  was  made,  on  account  of  the  limited  time  at  our  disposal 
to  discover  the  vessel  or  vessels  ruptured.  We  considered  that 
the  extravasation  was  amply  sufficient  to  account  for  hiB« 
symptoms  and  death,  and  that  it  was  unnecessary  to  proceed  ti 
the  analysis  of  the  contents  of  the  stomach. 

There  are  several  points  of-ressemblance  in  this  case  to  i 
case  of  strychnia-poisoning.  1.  The  symptoms  supervened  veryj 
suddenly,  and  within  a  short  time  (half  an  hour)  after  a  i 
in  a  robust  man  apparently  in  perfect  health,     2,  The  conv\ 
sions  were  not  attended  by  loss  of  consciousness,  as  in  ordinar 
epilepsy.     3.    These  convulsions,  though  certainly  clonic,   i 
indeed  they  are  at  first  after  the  administration  of  strychnj 
were  accompanied  with  a  great  amount  of  rigidity  of  the  limbB,n 
which  remained  fi.xedly  extended  for   some  time   during   the 
height  of  each  paroaysm.  4,  There  was  praecordial  or  epigastric 
pain,  probably  depending   upon  spasm  of  the  diaphragm,  and 
also   spasmodic  trismus,  which   occurs   in   an   early   stage  oEj 
atrychninc-poisoniug.     5.  Though  in  aome  cases  of  strychoinw 
poisoning  the  patient  asks  to  bo  rubbed  in  order  that  the  c 
be  relieved,  yet  in  others  the  exalted  polarity  or  reflex  excita^ 
bility   of  the  cord  manifests   itself  in  the  production  of  thai 
paroxysm  by   the  mere  touching  of  the   body,  which   was  i 
marked  feature  in  this  case.     6.  The  rapidity  of  death,  whicbl 
occurred  within  two  hours  from  the  beginning  of  the  attack  ratHm 
■within  two  and  a  half  from  his  last  meal.     In  many  cases  ( 
poisoning  the  duration  is,  however,  much  less  than  two  hours. 

In  the  various  standard  treatises  on  medical  jurisprudence  I 


BRITISH  ANl)    PORBIGN  JOURNALS.  369 

find  no  mention  of  spinal  apoplexy  or  spinal  haemorrhage 
simulating  strychnine-poisoning.  Epilepsy,  hysteria,  myelitis, 
and  cerebro-spinal  meningitis  are  briefly  alluded  to,  but  tetanus 
is  considered  to  be  the  only  disease  with  which  the  symptoms 
produced  by  strychnine  are  at  all  likely  to  be  confounded. 
Tetanus,  however,  is  comparatively  chronic,  and  may,  as  a 
general  rule,  be  easily  discriminated  from  strychnine-poisoning 
except  in  cases  where  the  poison  has  been  administered  in 
frequently  repeated  small  doses. 

In  this  case  the  post-mortem  clearly  showed  the  cause  of 
death,  but  I  am  by  no  pfieans  convinced  that  rapidly  fatal 
illness  might  not  ^cur  without  such  marked  appearances,  and 
might  closely  resemble  a  case  of  strychnine-poisoning. — Tlie 
Lancet. 

Salicylate  of  Soda  in  Rlieuniatisin.— 

The  following  are  the  conclusions  by  Marrot — Archives  GrSnS- 
rales  de  MSdiciney  February — as  to  the  action  of  Salicylate  of 
^a  in  rheumatism  : 

1.  During  the  course  of  acute  articular  rheumatism,  there 
is  a  notable  diminution  in  the  quantity  of  urine,  the  proportion 
of  uric  acid  increasing,  and  the  increase  is  not  explained  by  the 
lessened  urine, — it  is  an  absolute  increase. 

2.  In  cases  of  acute  articular  rheumatism  left  without 
treatment,  the  cure  is  characterized  by  a  notable  increase,  dur- 
ing some  days,  of  the  quantity  of  urine,  an^by  the  return  of 
uric  acid  and  of  the  urea  to  the  normal  proportion. 

3.  Salicylate  of  soda  given  early  in  acute  articular  rheu- 
matism, in  some  way  hastens  this  natural  crisis.  One  or  two 
days  after  its  administration,  the  urine  becomes  very  abundant, 
clear  and  of  slight  density.  There  is  a  relative  polyuria  ;  the 
quantity  of  uric  acid  and  of  urea  is  much  lessened.  It  is  an 
interesting  fact  that  these  modifications  of  the  urine  occur  inde- 
pendently of  any  change  in  temperature. 

4.  In  the  cases  of  chronic  articular  rheumatism,  the  quan- 
tity of  uric  acid  and  of  urea  is  rather  diminished.  Here  the 
salicylate  of  soda  has  no  useful  result.     If  a  patient  with 

NO.  LXXX.  25 


370 


CANADA   MEDICAL   i 


chroDic  rheumatiBm  be  subjected  to  hot  hatha,  the  quantity  of 
uric  acid  contained  in  the  urine  is  notably  increased.  Hence, 
as  Professor  Lasfigue  has  shown,  auch  baths  are  exceedingly 
useful  in  chronic  rheumatism. 

6.  The  salicylate  of  soda,  as  well  as  the  hot  bath,  does  not 
increase  the  aglobulw  peculiar  to  chronic  and  acute  articular 
rheumatism, 

6.  During  the  course  of  either  acute  or  chronic  articular 
rheuraatisin,  the  quantity  of  phosphoric  acid  is  lessened  and  so 
remains  whatever  treatment  may  be  employed. — Americatt 
Practitioner. 

Notes  on  sew^er-g:as  poisoning— J.  Browh, 

L.R.C.P.  Lend.,  etc.,  (Medical  095cer  of  Health  lo  the  Bacup 
Local  Board),  says  :  In  the  Journal  for  Novemhor  16th  there 
was  an  interesting  paper,  by  Mr.  Trend,  on  sewer-gas  poisoning. 
During  the  paat  few  montha,  I  have  made  a  number  of  observa- 
tions on  the  same  subject,  as  they  conftrm  his  opinion,  and  also 
give  other  effects  of  sewer-gas  poisoning.  I  have  notes  of 
thirteen  houses,  in  which  there  were  grave  sanitary  defects.  In 
seven  houses,  the  slop-atone  pipe  was  untrapped,  and  went 
straight  into  the  drain,  and  from  which  there  arose  had  smells, 
especially  in  the  hot  weather.  In  the  rem;uning  six,  there 
were  untrapped  and  rubble  drains,  which  were  close  to  the  door 
of  the  house,  or  passed  beneath  the  floor. 

1.  Submaxillary  abscese,  and  enlarged  cervical  glands,  in 
children  aged  two  and  five  years  respectively.  There  were  on- 
trapped  slop-stone,  and  bad  smells  from  a  rubble  drain. — 2, 
Cervical  abscegg  in  a  child,  aged  nine  years,  probably  due  to 
bad  amell  from  defective  drsun. — 3.  Axillary  abscess  and 
•'  wummer-diarrhcBa."  The  child,  aged  five  years,  also  had 
other  enlarged  glands  in  the  axilla  and  elbow.  Diarrhoea  occurred 
in  a  patient  aged  six  weeks.  Another  child  had  recovered  from 
a  Buhmaxillary  abscess.  There  were  bad  smells  from  untrapped 
slop-stone  and  defective  drains. — 1.  Two  eases  of  inguinal 
abscess  and  summer-diarrhcea.  One  of  twins  died  from  exbau»- 
tdon,  due  to  inguinal  ahsceas,  and  tho  other  from  diarrhcea.  ThQ . 


I 
I 

I 


BRITISH  AND   FOREIGN  JOURNALS.  3*71 

mother  recovered  from  inguinal  abscess,  the  cause  being  an 
untrapped  slop-stone-pipe. — 5.  Facial  abscess  in  a  girl,  aged 
nine  years.     This  was  probably  due  to  sewer-gas  from  an  un- 
trapped slop -stone  pipe. — 6.  Pelvic  abscess,  and  three  cases  of 
"  summer-diarrhcea."    A  patient  had  been  confined  six  weeks. 
She  was  very  anaemic,  and  had  no  appetite.    This  was  due,  un- 
doubtedly, to  the  bad  smell  in  the  house.  She  was  taken  ill  with 
an  abscess  in  the  pelvis.  Just  at  the  same  time  there  were  three 
other  cases  of  summer-diarrhoea  in  the  house.    The  infant  died. 
For  the  sake  of  the  woman,  I  recommended  that  the  family 
should  remove  at  once,  which  they  did,  and  the  patient  made  a 
good  recovery.  The  abscess  discharged  itself  per  vaginain.  The 
cause  was  a  defective  privy,  from  which  there  was  a  continual 
leakage  of  faecal  matter  into  the  house. — 7.  Multiple  abscesses. 
A  baby,  aged  six  months,  had  twenty  abscesses,  scattered  on 
its  legs,  arms,  and  body.  This  state  was  due  to  bad  emanations 
from  a  defective  privy.     The  privy  was  at  once  altered  at  my 
suggestion,  and  the  patient  speedily  recovered. — 8.   Temporal 
abscess  in  a  patient  aged  eleven  years.     The  cause  was  foul 
emanation  from  a  defective  drain. — 9,  TypJwid  Fever ^  A  death 
from  typhoid  fever  being  reported  to  me,  I  inspected  the  house 
and  found  that  bad  smells  came  from  the  untrapped  slop-stone 
pipe. — 10.  Typhoid  Fever,    Another  death  from  typhoid  fever 
was  reported.  On  inspection,  I  found  the  slop-stone  untrapped, 
and  an  untrapped  drain  close  to  the  door. — 11.   Typhoid  Fever. 
This  was  a  case  of  typhoid  fever  in  a  gentleman  living  in  a  new, 
well-built  house.  On  inspection,  I  found  the  drains  and  slop-stone 
trapped.     ThQ  wife,  however,  complained  of  bad  smells  coming 
from  the  water-closet,  which  was  on  the  first  floor.     The  water- 
supply  in  the  summer  being  limited,  the  drain  could  not  be 
well  flushed.    The  mephitic  gases,  generated  in  large  quantities 
in  hot  weather,  would  soon  saturate  the  water  in  the  pan  of  the 
water-closet,  and  pass  into  tlie  house.     The  drain  was  long  and 
unventilated ;    and  the  sewer-gases,  being  of  lighter  specific 
gravity  than  the  air,  would  seek  an  outlet  at  the  highest  eleva- 
tion, which  would  be  the  water-closets.     The  drain  has  since 
been  veniilated.  The  patient  died. — 12.  I>iphiheria,  and  three 


372 


CANADA   MEDICAL   AND   SORGICAL   JOURNAL. 


caaes  of  Sore  throat.  A  child,  aged  three  years,  had  diphtheria, 
and  died  in  three  days.  In  the  aame  house,  there  were  three 
adults  suffering  from  sore  throats,  all  of  whom  recovered,  I 
found  that  there  was  a  had  smell  from  untrappd  slop-atflne. — 
13.  Puerperal  Septicemia.  The  third  day  after  confinement, 
the  patient  had  usual  eymptonia  of  septicsemia.  She  nearly 
succumbed  two  or  three  times.  After  about  five  weeks,  she  had 
a  relapse,  which  proved  fatal.  In  this  case  there  was  a  foul 
smell  from  an  untrappcd  drain,  within  a  few  feet  of  the  door, 
where  the  patient  was  confined. 

Remarks. — It  is  difficult  to  state  definitely  the  cause  of 
many  diseases.  In  some  of  the  caaes  given  above,  it  may  be  a 
coincidence,  and  sewer-gas  may  not  have  been  the  causa. 
Though  I  think  in  most,  if  not  in  all,  sewer-gas  was  the  chief 
factor,  I  would  not  say  positively  typhoid  fever  can  be  generated 
de  novo  from  sewer-gas ;  yet  m'j  experience  goes  to  prove  that. 
much  may  he  said  in  favour  of  it. 

Summer-diarrhcea,  especially  in  infanta  and  young  children, 
I  believe,  is  often  due  to  sewer-gas.  In  the  summer,  decompo- 
Bition  of  sewage  is  very  rapid.  Infants  who  are  nearly  all  day 
indoors  in  houses  in  which  sewer-gas  exists  (and  there  are,  un- 
fortunately, a  large  number  among  the  poor)  soon  get  diarrhceoi. 
Of  course,  there  are  other  things  to  produce  it. 

Diphtheria  and  gore  throats  are  often  duo  to  sewer-gas, 
House  No.  12  seems  to  prove  that  the  poison  which  generated 
diphtheria  in  the  child,  in  the  three  adults  caused  bad  sore 
throats.  Several  cases  of  death  from  puerperal  fever  have 
occurred,  generally  io  bous«s  which  are  subject  t©  bad  sanitary 
arrangements,  especially  as  regards  drainage  and  Ventilation. 
I  have  had  a  large  number  of  abscesses  in  children  during  the 
past  summer.  In  nearly  every  instance  there  were  strong 
reasons  to  believe  it  to  be  due  to  sewer-gae,  As  a  rule,  if  two 
or  more  persons  in  a  house  are  suffering  from  summer  diarrhoea, 
or  abscesses,  we  may  suspect  sewer-gas.  Sewcr-gas  is  especially 
dangerous  to  children.  Older  persons  may  resist  its  influence; 
bat  in  them  it  will  probably  be  the  cause  of  ansemia.  nausea, 
and  headache.  In  the  winter,  when  the  decomposition  of  sewage 


* 


ASD    FOREIGN   JOURNALS. 


373 


matter  is  far  less  active  than  in  the  Biunmer,  I  have  found  that 
infaatile  diarrh(ea  and  abscesses  are  very  few  when  compared 
with  the  nnraber  of  cases  occurring  in  the  'summer  months. — 
British  Medical  Journal. 


On  the  Treatment  of  Diseases  of  tbe 

Colon. — Di^-  Dubois  enumerates  the  diseases  of  the  colon  in 
which  the  injection  of  large  or  small  quantities  of  water  is  indi- 
cated. He  then  adds  some  practical  hints  on  the  different  ways 
of  administering  the  fluid.  There  are  two  different  kinds  of 
enemata  employed.  First,  the  simple  enemata,  which  are 
used  in  caaea  of  constipation,  when  it  is  found  necessary  to  re- 
move fsecal  masses  from  the  sigmoid  flexure,  the  caecum,  or  the 
rectum,  in  cases  where  the  mucous  membrane  of  the  rectum  is 
diseased,  and  it  is  indicated  to  bring  it  into  contact  with  water 
}  or  medicine  ;  secondly,  very  large  enemata,  which  will  be  found 
I  efficient  in  cases  where  the  water  ought  to  be  injected  liigh  up 
into  the  large  intestines,  whenever  there  exists  a  catarrhal 
affection  of  these  portions  of  the  intestines.  Some  patients  can 
bear,  without  incurring  pain  or  danger,  enemata  of  1,000  to 
1,500  cubic  centimetres  of  water,  but  in  others  such  a  large 
volume  of  fluid  would  either  prove  very  dangerous  to  the  intes- 
tines, or  could  not  be  injected  on  account  of  the  great  irritation 
of  the  intestinal  muscles.  In  such  caaes,  where  it  is  of  obvious 
necessity  to  inject  a  large  bulk  of  liquid,  the  author  advises  the 
following  method.  Tepid  water  is  injected  till  the  patient  feela 
a  violent  strain.  The  syringe  is  then  removed,  and  the  patient 
slowly  changes  under  the  bed-clothes  from  his  right  or  left  side 
to  crouching  on  his  knees  and  elbows.  After  ooq  or  two 
minutes  the  former  position  is  again  assumed  for  a  short  time, 
and  then  the  patient  lies  down  upon  his  back.  The  same  opera- 
tion and  changes  of  posture  are  then  repeated,  and  defiecation 
generally  ensues  in  about  ten  minutes  or  half  an  hour  after  the 
injection  has  been  given.  This  method  is  indicated :  a,  in  cases 
of  constipation  where  purgatives  und  the  usual  enemata  can 
either  not  be  given  or  have  proved  powerless ;  b,  in  cases  of 
coproetaais  where  fsecal  tumors,  varying  in  size,  can  be  felt  in  the 


374  CANADA   MEDICAt,   A 

caecum  or  other  parts  of  the  large  intestine,  and  have  sometimes 
been  mistaken  for  ovarian  cysts.  Here  purgatives  given  bj 
the  mouth  are  either  vomited  or  have  no  effect;  c,  it  ia  well 
known  that  inflammations  of  the  vermiform  process  are  mostly 
caused  in  healthy  individuals  by  accumulation  of  fsGCcs.  When- 
ever, therefcre,  a  slight  tenderness  and  increased  resistance  are 
felt  in  the  iliac  region,  especially  in  persons  who  have  suffered 
from  typhlitis  before,  a  bulky  injection  will  be  found  very  useful 
in  preventing  the  inflammation  and  removing  the  fiEcea.  Nar- 
cotics should  also  be  used  in  these  cases ;  d,  in  cases  of  general 
or  local  peritonitis,  when  constipation  and  accumulation  of  gases 
in  the  abdomen  have  been  produced  by  paralysis  of  the  intes- 
tinal muscles  ;  e,  in  oases  of  diarrhcea  caused  by  constipation 
or  accumulation  of  fsecea  ;  /,  in  ahaceases  of  the  intestines, 
dysentery,  etc.  (Schwe.itz&r  OorrespondtnzMatt  MtmorabiHen, 
1878,  IX.  Edt)—The  Practiliuner. 

The  patholog'y  of  rodent  ulcer.— An  in- 
teresting diacuasioo  on  the  nature  of  rodent  ulcer  took  place 
recently  in  the  London  PatLological  Society,  The  discussion 
was  raised  by  the  Drs.  Fox,  who  presented  microscopical 
specimens  to  the  meeting  and  stated  that  their  investigatJODS 
had  led  them  to  take  diffei-ent  views  concerning  rodent  ulcer 
from  those  advocated  by  other  observora.  Thiersch  distinguished 
two  kinds  of  epithelial  cancer,  the  ordinary  penetrating  epithelial 
cancer,  and  tlie  flat  epitheliaJ  cancer ;  the  latter  being  identical 
with  the  rodent  ulcer  of  English  writers.  He  was  the  first  to 
insist  on  the  epithelial  nature  of  tliis  affection.  Ke  bases  bis 
opinion  that  there  are  two  kinds  of  epithelial  cancer  of  the  skin 
mainly,  if  not  entirety,  on  the  histological  evidence,  and  con- 
siders it  probable  that  the  cell-masses  in  rodent  ulcer  take  their 
origin  in  the  sebaceous  glands,  because  the  general  shape  of  the 
masses  ressembles  that  of  the  glands,  and  because  they  are 
often  Ibund  near  a  hair.  He  does  not,  however,  find  any  direct 
evidence  of  the  origin  of  the  cell-masses  from  the  glands.  On 
the  other  hand,  Vemeuil  published  in  1848  a  case  in  which 
ulceration  of  the  face  was  produced  by  a  cell  growth,  which  lie 


BKlTrSH  AND    POREION 


375 


I 


believed  to  have  begun  in  altered  sweat-gtands,  Thiersch  and 
Tliierfelder  have  also  both'  described  undoubted  fatal  caaea  of 
adenoma  of  the  sweat-glands.  It  can  haidly  therefore  be 
doubted  that  adenoma  of  of  the  sweat-glands  constitutes  a 
variety  of  cancerous  disease.  In  four  cases  of  rodent  ulcer,  Dr. 
Thin  waa  not  able  to  trace  the  disease  directly  to  any  of  the 
epithelial  structures  of  the  skin,  but  in  two  of  hia  cases  be 
found  the  sweat  coil  the  seat  of  a  new  growth.  From  this,  and 
from  the  resemblance  of  his  cases  to  Verneuil's  case,  he  was 
led  to  infer  that  it  is  highly  probable  that  the  cell-masses  of 
rodent  ulcer  originally  begin  in  the  sweat-glands.  He  points  out 
that  the  cella  in  rodent  ulcer  differ  from  those  of  epithelial 
cancer,  strictly  so  called,  never  taking  on  the  characteristic 
changes  of  the  latter.  His  view,  that  in  rodent  ulcer  we  have  a 
true  adenoma  to  deal  with,  he  believes  to  be  strengthened  by 
the  fact  that  he  has  demonstrated  a  membrana  propria  between 
the  cell-masaea  and  the  connective  issue. 

The  Drs.  Fox,  on  the  other  hand,  aay  that  rodent  ulcer  is  an 
epithelial  growth  which  takes  its  origin  from  the  external  roof^ 
sheaths  of  the  haira,  that  ia  to  say,  from  a  purely  epidermic 
structure.  In  the  discussion  on  their  paper,  Dr.  Thin  declared 
that  the  specimens  presented  were  specimens  not  of  one  disease, 
as  the  Drs.  Fox  believed,  but  of  two  distinct  diseases,  acme  of 
them  being  preparations  of  ordinary  epithelial  cancer,  and 
others  of  rodent  ulcer.  This  wide  discrepancy  in  the  interpre- 
tation of  the  appearances  naturally  rendered  the  discussion 
unprofitable,  except  in  ao  far  aa  it  has  aroused  attention  to  the 
qnestions  whether  there  are  two  distinct  kinds  of  epithelial 
growth  producing  cancer  of  the  skin,  and  whether  it  is  possible 
to  distinguish  them  microscopically.  We  may  expect  before 
long  to  have  tliis  question  definitely  settled, — Ihe  British  Med. 
Jovmal.  Medical  Record,  N.  Y. 

The  treatment  of  Acute  Obstruction 

of  tbe  Bowels. — Writing  on  obstruction  of  the  bowels, 
,  Dr.  T-  C.  Allbutt  says,  in  the  British  Medical  Journal — Let 
»se  hastily  of  all  cases  of  essentially  chronic  obstruction. 
I  They  rarely  need  heroic  action  or  great  presence  of  mind  either 


376  CANADA   MKDICAI.    AND   SDRQICAI.   JOURNAL. 

in  physician  or  surgeon.  We  thus  clear  our  way  to  the  essen- 
tially acate  cases  ;  and  we  have  forfnd  that  in  these  inflamma- 
tion always  coiiuta  for  something,  generally  for  a  good  deal. 
Now,  whether  we  know  exactly  how  to  deal  with  the  main  cause 
or  not,  we  always  know  how  to  deal  with  the  inflammation  ;  and 
except  in  the  extremest  urgency,  our  first  duty  is  to  simplify 
our  case  by  lessening  this.  Unfortunately,  means  are  often  used 
which  tend  rather  to  aggravate  the  enteritis,  and  of  all  these, 
injections  into  the  howel  are  the  most  raiachievous.  Even  in  the 
case  of  fecal  accumulation,  it  is  not  the  fecal  mass,  but  the  in- 
flammation set  up  by  it,  to  which  the  explosion  is  due,  so  that 
even  in  these  cases  it  is  wild  practice  to  pump  into  the  inflamed 
bowel  and  to  drag  the  patient  hither  and  thither  in  bed.  Even 
for  diagnostic  purposes,  encmata  are  rated  far  too  highly,  and 
arc  rarely  of  much  service.  Clearly,  it  is  our  duty  to  reduce  our 
case  by  complete  rest,  opiates,  fermentations,  and  a  leech  or 
two  to  the  abdomen,  or  anus  until  the  enteritis  subades,  and 
then  we  can  deal  as  we  see  fit  with  its  cause.  But  if  enamata 
are  abused  in  fecal  accumulation,  wherein  they  are  chiefly 
valuable,  what  are  we  to  say  of  the  fashion  of  forcing  their  em- 
ployment in  cases  of  internal  strangulation  ?  It  is  certainly  < 
conceivable  that  an  intussusception  may  be  unfolded  by  a  i 
forcible  and  ample  injection,  or  by  the  insufflation  of  lur,  but  to 
force  air  or  water  against  a  knotted  or  snared  loop  of  intestine 
is  surely  outrageous  meddling.  And  yot  I  have  never  been 
called  into  a  case  of  such  obstruction  without  finding  that  such 
a  measure  has  been  assiduously  employed,  to  the  harassing  of 
the  patient,  to  the  aggravation  of  the  symptoms,  and  to  the  in- 
crease of  inflammation  around  the  stomach.  I  believe  no  formula 
can  be  drawn  from  our  experience  of  more  value  than  this, 
namely,  that  if  rest  in  every  way  be  sedulously  enforced,  and 
the  inflammation  which  palsies  the  bowel  be  carefully  combated 
by  the  use  of  sedatives,  such  as  opium  and  belladonna,  and 
other  means,  cases  of  obstruction  of  tlie  bowels  tend  torecoveiy. 
Medical  and  Surgical  Reporter. 


SiaTV89  AND  FO«IHeN  JOUBNALH.  377 

Jaboramdi    in     tbe    Albuminuria    of 

Preg^nancy* — T)t.  Langlet,  of  Rheims,  publishes  an 
elaborate  account  in  the  Union  Medicale  de  Nbrd-Uat  of  a  case 
of  albunnnuria  during  pregnancy  which  he  treated  success- 
fully by  the  administration  of  jaborandi.  The  patient,  three 
months  advanced  in  pregnancy,  showed  the  ordinary  symptoms 
of  albuminuria.  The  action  of  the  jaborandi  on  the  salivary 
glands  became  apparent  on  the  day  of  administration.  The 
patient  took  the  drug  continuously  for  a  period  of  sixteen  days, 
during  which  time  the  oedema  disappeared,  and  the  general 
symptoms  were  improved.  The  albumen  was  likewise  lessened 
to  such  an  extent  that  not  the  slightest  trace  could  finally  be 
detected,  and  the  lying-in  occurred  under  the  most  favorable 
circumstances. 

Dr.  Langlet  has  noticed  that  the  administration  of  jaborandi 
caused  an  increase  in  the  urinary  secretion,  and  this  coincides 
with  a  somewhat  similar  observation  of  Mr.  Render,  who  found 
that  in  a  case  of  acute  nephritis  the  drug  caused  poljpuria.  On 
the  fifteenth  day  of  the  administration  of  the  drug  haematuria 
occurred,  so  as  to  give  the  urine  a  disagreeable  odor  and  bright 
color.  This  accident,  which  did  not  retard  the  recovery,  is  to  be 
attributed  to  the  excessive  work  imposed  upon  the  kidneys  by 
the  increased  secretion,  leading  to  congestion,  and  the  conges- 
tion to  actual  hemorrhage. — Edinburgh  Medical  Journal. 

Pruritus  Vulvae. — Dr.  Mendcnhall  recommends 
(  Obstetric  Qazette,  Dec,  1878)  : 

R.     Sodae  biborat     ....     3  i 

Plumbi  acetat 3  ss. 

Tr.  opii f  3  j. 

Aquae  destil f  5  viij. 

M.  Sig. — Soak  clothes  in  the  solution  and  lay  them  upon  the 
exti^mal  parts  affected,  between  the  labia,  etc.  Keep  the 
clothes  freely  wetted.  Inject  one  ounce  of  the  solution  into 
the  vagina  several  times  a  day.  When  the  pruritus  has  been 
subdued,  apply  a  solution  of  carbolic  acid  in  glycerine  (gtt.  xx. 
to  f  5  i.)  once  or  twice  daily. 


378  CANADA  MEDICAL   AND   SPRQICAL   JOCBNAL. 

Chrysophanlc  Add.— A  writer  in  the   ChemUt 

and  Dniijgwt  says :  Chrysophanic  acid  ointment  has  been 
much  vaunted  as  a  remedy  for  psoriasis,  but  it  is  so  very 
irritating  that  it  requires  great  caution  in  its  use.  Tlie  first 
case  in  which  we  saw  its  effects  was  in  hospital  practice.  A 
woman  with  psoriasis  about  the  arm  and  shoulder  was  told  to 
apply  the  ointment,  but  returned  much  disgusted,  in  a  day  or 
two,  to  say  that  her  linen  was  spoiled,  and  it  was  found  stained 
of  a  deep,  dark  purple  color,  and,  in  addition,  there  was  severe 
erythema  extending  from  the  seat  of  disease  up  the  arm.  The 
ointment  was  discontinued,  and  the  irritation  soon  subsided.  In 
another  case  the  ointment  was  applied  to  a  patch  over  the  knee  ; 
it  caused  erythema  all  around  the  part  affected,  and  gave  rise 
to  conjunctivitis,  which  lasted  two  or  three  days,  but  in  each 
case  the  local  disease  was  removed.  It  is  also  said  to  turn  the 
hair  a  peculiar  purplish-brown  tint  and  to  stain  the  skin,  but  Dr. 
Balmanno  Squire  states  that  this  may  be  removed  by  benzol. — 
Medical  and  Svrffieal  Reporter. 

Abnormal    LoTrness    of  Temperature 

and  its  Dangrers- — Whilst  increase  of  temperature 
occuring  in  various  morbid  conditions  is  always  carefully  noted, 
deviations  in  the  opposite  direction  are  seldom  alluded  to.  In 
an  inaugural  dissertation  published  at  Eeme,  Dr.  Glaser  points 
out  that  instances  of  this  latter  phenomenon  are  more  common 
than  is  usually  supposed,  that  a  temperature  between  34*  and 
35°  C.  may  be  frequently  met  with,  and  that  a  fall  below  30°  C. 
is  not  very  rare.  Low  temperatures  are  not  indicative  of 
danger,  to  the  extent  commonly  supposed :  recovery  has  been 
known  to  take  place  after  temperature  of  24*  to  26"  C.  The 
danger  in  any  given  case  is  to  be  estimated  not  only  in  the  fall 
in  temperature,  hut  mainly  by  a  reference  to  the  causes  to  which 
it  is  duo ;  and  the  variations  in  temperature,  often  great  and 
occurring  under  norma!  conditions,  must  be  taken  into  account. 
Dr.  Glaser  also  points  out  that  Subnormal  temperatures  do  not 
always  accompany  relapse,  but  that  the  two  conditions  may 
occur  quite  independently  of  each  other — i^Med.  Examine', 
Aug.  8.  1878.)— r/(c  Pradititmer. 


I 


BRITISH  AND  FOREIGN  JOURNALS.  379 

Causation  of  Septicsemia.— M.  Colin,  of  Paris, 

read  before  the  Academy  of  Medicine  in  that  city  a  paper  on 
the  above  subject,  of  which  the  following  is  a  r^sum^  (given 
by  the  London  Medical  Record)  :  "  Putrid  material,  according 
to  its  quantity  and  degree  of  alteration,  exerts  a  variable*  action 
on  the  animal  organism.  In  a  large  dose  it  determines  a  rapid 
and  invariably  fatal  poisoning,  which  causes  no  marked  altera- 
tion in  the  blood  beyond  a  tendency  to  incoagulability,  and  is 
not  associated  with  the  reproduction  of  proto-organisms.  In 
cases  of  this  kind  the  injected  fluid  fails  to  communicate  any 
kind  of  virulent  property  either  to  the  blood  or  to  any  other 
juice  of  the  economy.  In  reduced  quantity  the  animal  fluid 
gives  rise  to  an  adynamic  febrile  condition,  which  varies  in 
intensity  according  to  the  nature  of  the  animal.  If  this  con- 
dition proves  fatal,  it  is  so  through  the  production  of  visceral 
lesions,  and  through  changes  in  the  blood.  Reproduction  of 
proto-organisms  takes  place,  at  least  in  those  parts  where  the 
putrid  agent  has  been  deposited,  and  frequently  throughout 
the  whole  mass  of  the  blood.  Certain  putrid  fluids  that  have 
not  undergone  much  alteration,  such  as  blood  mixed  with 
products  of  intestinal  transudation,  decomposing  blood  of  an 
animal  affected  with  carbon,  peritonesll  serosity  removed  some 
time  after  death,  may  alone,  when  injected  in  extremely  minute 
quantities,  determine  septicaemia  transmissible  by  inoculation, 
after  the  manner  of  the  majority  of  virulent  affections.  Here 
there  is  always  virulence  of  the  fluid  and  reproduction  of  the 
proto-organisms  introduced  from  without." — Med,  and  Surg. 
Reporter, 

Tape-Worm  in  Cucumbers.— At  a  late  meeting 

of  the  Academy  of  Sciences  of  Philadelphia,  Prof.  Dr.  Leidy 
exhibited  a  specimen  of  tape-worm  found  within  a  large  cucum- 
ber. This  specimen  was  a  true  tape-worm,  but  of  an  unknown 
species,  tlie  ovaries  being  confined  to  the  anterior  extremities. 
— Medical  Record,  N.  ¥ 


Igitdicnl  and  f  iiigical  |autnal. 

Montreal,  March,  1879. 

THE  REGISTRATION  OP  BRITISH  QUALIFICATIONS 

The  Medical  Council  of  ihe  Province  of  Ontario  lias  been 
compelled  to  recognize  a  diploma  submitted  from  the  University 
of  Edinburgh,  and  to  register  the  applicant,  Dr.  Baldwin  of 
Toronto,  on  the  payment  of  the  registration  fee,  without 
esaminatioD.  This  is  quite  in  accord  with  an  opinion  expressed 
in  this  journal  years  ago,  when  first  this  unholy  Act  wa^  hatched. 
That  it  was  an  outrage  to  the  Profession  as  a  whole  and  uncon- 
stitutional, was  an  opinion  expressed  at  the  time  by  high  judicial 
authority  in  Ontario  itself,  and  we  doubt  much  if  the  act  would 
be  ctTcctive  in  excluding  from  registration  any  graduate  holding 
a  diploma  from  a  recognised  University  possessing  a  Boyal 
charter.  We  have  all  along  been  under  the  impression  that 
our  Colonial  Universities  could  claim  registration  for  their 
Graduates,  such  institutions  at  least  that  hold  Imperial  charters, 
and  we  cannot  conceive  why  it  should  he  otherwise.  We  have 
always  opposed  the  degradation  of  our  own  universities.  If  the 
examiners  in  those  institutions  aro  untrustworthy,  or  Inclined  to 
do  their  work  in  a  slovenly  manner,  then  should  they  be 
deprived  of  their  (unction  and  replaced  by  better  men.  We 
hold  that  it  is  this  very  system  of  belittleing  our  own  institutions 
which  hns  deprived  ua  of  that  recognition  in  Great  Britain  which 
is  desirable.  It  is  not  to  be  expected  that  the  Medical  Council 
of  Great  Britain  will  recognize  a  Colonial  Difiloma  that  ia  not 
1  in  its  own  country.  The  entire  system  appears  to 
us  to  be  faulty,  and  we  must  cast  about  for  some  other  metfaod 


I 


i^GOIDlNT  TO  DR.   HENRY  HOWARD.  381 

if  we  would  obtain  from  other  countries  an  acknowledgment 
of  our  professional  status. 

With  regard  to  the  proposal  on  the  part  of  the  members  of 
the  Executive  Committee  of  the  Medical  Council  of  Ontario, 
and  their  request,  to  be  granted  the  privilege  of  exacting  a  very 
high  fee  to  check-mate  this  action  of  the  Universities,  it  is  so 
very  peculiar  that  we  have  not  been  able  to  digest  it  sufficiently 
to  make  any  remarks  thereon.  Its  modesty  is  very  refreshing. 
We  have  no  doubt  that  in  course  of  time  their  request  will  be 
granted,  and  that  the  profession  of  Ontario  itself,  with  all  its 
liberality,  will  ultimately  be  brought  to  believe  that  their  best 
interests  lie  in  littleness,  exclusiveness  and  puffed  up  self- 
importance. 

ACCIDENT  TO  DR.  HENRY  HOWARD. 

We  are  sorry  to  learn  that  our  old  and  respected  friend  Dr. 
Henry  Howard  met  with  a  serious  accident  by  which  his  left 
arm  was  broken  near  the  shoulder-joint.  In  proceeding  to  the 
Longue  Pointe  asylum,  of  which  institution  the  Doctor  has 
professional  charge,  his  sleigh  was  upset,  and  he  fell  heavily  on 
his  left  side  and  sustained  a  fracture  of  the  humerus  at  the 
surgical  neck ;  an  accident  of  this  nature  occurring  in  a  man  of 
Dr.  Howard's  age,  was  regarded  with  anxiety  by  his  friends ; 
we  are  happy  to  announce,  however,  that  the  Doctor  is  fast 
recovering,  and  that  with  his  accustomed  zeal  and  energy  he  will 
soon  be  at  his  work  again.  The  following  resolution  was  passed 
at  a  late  meeting  of  the  Medico-Chirurgical  Society,  over  which 
Dr.  Howard  presides : 

Moved  by  Dr.  Kennedy,  seconded  by  Dr.  Roddick,  and 
carried  unanimously  : 

"  That  this  Society  has  learned  with  great  regret  of  the  serious  accident 
which  has  happened  to  their  respected  President,  Dr.  Henry  Howard  ; 
That  the  Secretary  be  instructed  to  convey  to  Dr.  Howard  the  sincere 
sympathy  of  the  Society,  and  the  gratification  it  will  give  to  see  him  once 
more  in  his  accustomed  place.  That  this  Society  has  learned  with  pleasure 
of  the  action  of  the  Local  Government  authorities  in  at  once  appointing 
an  assistant  to  relieve  Pr.  Howard  from  the  anxiety  of  hjs  charge." 


CANADA    MEDICAL   ANDSHKOlCi 


AMERICAN  HEALTH  PRIMERS. 

The  well  known  publishing  house  of  Lindsay  k  Blakiaton, 
Philadelphia,  have  undertaken  the  publication  of  a  aeries  of 
works  written  in  a  popular  stylo,  for  the  purpose  of  diffusing  a 
knowledge  of  sanitary  science.  The  subjects  discussed  in  each 
volume  are  of  the  very  highest  practical  importance  to  com- 
munities, as  well  as  to  individuals,  and  we  have  no  doubt  that 
this  worthy  attempt  will  meet  with  very  general  approval.  Aa 
a  rule  in  this  country,  the  subject  of  sanitation  is  not  aa  fully 
recognized  as  its  importance  demands.  Public  health  associa- 
tions are  doing  good  work,  and  the  results  are  beginning  to  tell 
in  a  marked  improvement  in  the  comforts  of  life  and  the  les- 
sening of  disease.  Sanitary  legislation  is  as  yet  unknown  in 
this  Dominion,  nor  has  it  attelned  that  prominence  amongst  our 
neighbors  which  it  deserves.  In  the  announcement  of  these 
volumes,  by  tha  publishers,  the  hope  is  expressed  thai  "  the 
American  Health  Primers  may  assist  in  developing  a  public 
sentiment  favorable  to  proper  sanitary  laws,  especially  in  our 
large  cities."  This  sentiraont  we  fully  endorse ;  but  in  our  own 
country  we  trust  that  if  any  sanitary  laws  are  introduced  their 
application  will  be  general  and  not  restricted  to  our  large  cities. 
We  regard  all  sanitary  mattei-s  to  belong  to  the  central  govern- 
ment of  any  country,  constituted  as  ia  our  Dominion.  Local 
enactments  and  provincial  regulations  are  all  well  enough  in 
their  way,  when  they  affect  alone  the  comfort  of  local  communi- 
ties ;  but  matters  which  affect  the  sanitary  condition  of  an 
entire  nation  should  be  alone  dealt  with  by  the  parent 
government. 

The  Canadian  statesmen  who  in  the  future  will  introduce 
and  carry  throrigh  the  House  of  Commons  at  Ottawa  a  compre- 
hensive Public  Health  Act  will  be  a  groat  benefactor  to  the 
community  at  large.  It  is  true  that  several  Acts  are  on  our 
statute  books  bearing  on  sanitary  science,  so  that  we  are  gra- 
dually getting  in  the  tliin  edge  of  the  wedge,  and  probably  before 
the  termination  of  anothercentury,  when  we  may  have  men  at  the 


AMERICAN  HEALTH  PRIMERS.  383 

helm  of  state,  independent  as  to  means,  and  above  party  srtife  ; 
men  of  pure  and  unsullied  honour,  not  party  or  purity  men, 
alive  to  every  chance  of  turning  a  penny,  be  it  honestly  come  by 
or  otherwise,  then  may  we  hope  for  some  devotion  to  the  subject 
of  sanitary  science,  and  some  legislative  enactments  which  will 
reduce  very  considerably  our  present  heavy  mortality  rates. 
It  is  for  the  very  purpose  of  educating  the  masses  to  the  impor- 
tance of  these  subjects  that  the  publishers  have  undertaken  the 
issue  of  these  volumes.     We  give  below  the  scheme  proposed : 

"  Dr.  W.  W.  Keen  has  undertaken  the  supervision  of  the 
series  as  editor,  but  it  will  be  understood  that  he  is  not  respon- 
sible for  the  statements  or  opinions  of  the  individual  authors. 

The  following  volumes  are  in  press  and  will  be  issued  about 
once  a  month : 

I.  Hkarino,  and  How  to  Keep  it.    By  Charles  H.  Burnett,  M.D.,  of  Phila- 

delphia, Surgeon  in  charge  of  the  Philadelphia  Dispensary  for  Diseases 
of  the  Ear,  Aurist  to  the  Preshyterian  Hospital,  etc. 

II.  Long  Life,  and  How  to  Beach  it.     By  J.  G.  Richardson,  M.D.,  of 

Philadelphia,  Professor  of  Hygiene  in  the  University  of  Pennsylvania, 
etc. 

III.  Sea  Am  and  Sea  Bathing.  By  William  S.  Forhes,  M.D.,  of  Phila- 
delphia, Surgeon  to  the  Episcopal  Hospital,  etc. 

IV.  The  Summer  and  its  Diseases.  By  James  C.  Wilson,  M.D.,  of  Phila- 
delphia, Lecturer  on  Physical  Diagnosis  in  Jefferson  Medical  College, 
etc. 

V.  Eyesight,  and  How  to  Care  for  it.    By  George  C.  Harlan,  M.D.,  of 

Philadelphia,  Surgeon  to  the  Wills  (Eye)  Hospital. 

VI.  The  Throat  and  the  Voice.  By  J.  Solis  Cohen,  M.D.,  of  Philadelphia, 
Lecturer  on  Diseases  of  the  Throat  in  Jefferson  Medical  College. 

VII.  The  Winter  and  its  Dangers.  By  Hamilton  Osgood,  M.D.,  of  Bos- 
ton, Assistant  Editor  Boston  Medical  and  Surgical  Journal. 

VIII.  The  Mouth  and  the  Teeth.  By  J.  W.  White,  M.D.,  D.D.S.,  of 
Philadelphia,  Editor  of  the  Dental  Cosmos. 

IX.  Our  Homes.  By  Henry  Harthshorne,  M.D.,  of  Philadelphia,  Formerly 
Professor  of  Hygiene  in  the  University  of  Pennsylvania. 

X.  The  Skin  in  Health  and  Disease.     By  L.  D.  Buckley,  M.D.,  of  New 

York,  Physician  to  the  Skin  Department  of  the  Demilt  Dispensary 
and  of  the  New  York  Hospital. 

XI.  Brain  Work  and  Overwork.  By  H.  C.  Wood,  Jr.,  M.D.,  of  Philadel- 
phia, Clinical  Professor  of  Nervous  Diseases,  University  of  Penn.,  etc. 

Other  volumes  are  in  preparation,  including  the  following  subjects  :— 
«  Preventable  Diseases,"  "  Accidents  and  Emergencies,"  "  Towns  we  Live 
In,"  «  Diet  in  Health  and  Disease,"  «  The  Art  of  Nursing,"  "  School  and 
Industrial  Hygiene,"  "  Mental  Hygiene,"  etc.,  etc.  They  will  be  16mo  in 
size,  neatly  printed  on  tinted  paper,  and  bocnd  in  paper  covers.  Price  30 
cents ;  flexible  cloth,  50  cents. 


\ 


384  CANADA   MEDICAL  AMD  BDROICAL  JOUBNAL. 

MsAicnl  Items 

It  is  with  pleasure  we  ^ve  space  to  the  following  letter 
received  from  Dr.  Roddick,  to  whom,  at  least,  is  due  the  credit 
of  having  firat  iDtroduced  the  antiseptic  method  of  iJster  into 
this  city. 

Montreal,  March  9th,  1879. 

Dear  Mr.  Editor. 

In  a  paper  on  "  Ijsteriein,"  which  I 
read  at  the  last  meeting  of  Uie  Canadian  Medical  Asaociation, 
and  which  was  published  in  part  in  the  February  Dumber  of 
your  Journal,  I  make  the  statement,  open  to  correction  how- 
ever, that  the  practice  of  Lister  was  first  introduced  into 
Canada  through  the  Surgeons  of  the  Montreal  General 
Hospital.  Immediately  after  the  publication  of  the  paper,  I 
received  the  following  letter  from  my  esteemed  fiiend  Dr. 
Mack,  of  St.  Catherines,  which,  in  justice  to  him,  I  bog  you 
will  have  the  kindness  to  publish  : — 

GiKiRAL  ±wa  Habini  Hospital,       ) 
Bt  Catberines,  Ont.,  Marcb  Gth,  18T9.  / 
Mv  Dkab  Doctok. 

Tbe  antieuptic  tTcatmeot   was   first  established  Id 
this  hospital  immediately  after  tbe  details   of  tlio   process  bed  heen  pro- 
mulgated by  Dr.  LiEtcr,  and  fully  one  year  before  it  was  tried  in  Hontreftl. 
I  can  furnish  you  any  evidence  you  may  demand  of  tba  fact. 
As  t«  the  results,  they  have  been  very  satisfactory. 
Yoan  foitbfully, 

THOS,  HACK. 

I  can  only  say  1  am  delighted  the  "  System  "  has  found  such 
an  able  advocate,  and  I  trust  the  day  is  not  far  distrat  when 
the  profession  will  be  favoured  with  the  results  of  Dr.  Mack's 
experience- 
Toon  tnilj, 

,  G.  RODDICK. 


CANADA 


Medical  &  Surgical  Journal 


APRIL,  1879. 

Qriflfinal  Communications. 

VALEDICTORY    ADDRESS; 

TO  THE  GRADUATES  IN  MEDICINE  AND  SURGERY, 

MoGILL  UNIVERSITY, 

Delivered  at  the  Annual  Convocation  held  on  the  3l8t  of  March,  1879 

BY  GEORGE  E.  FENWICK,  M.D., 
Professor  of  the  Principles  and  Practice  of  Surgery. 

Gbntlbmbn  Graduates, — The  time  has  arrived  when 
the  relations  between  us  as  teacher  and  student  must  cease. 
Steady  and  persevering  industry,  which  has  marked  your 
career  throughout  your  pupilage,  has  now  been  crowned  with 
sucess,  and  you  have  been  admitted  into  the  antient  and  hon- 
ourable fraternity  of  medical  and  surgical  practitioners.  In 
offering  the  congratulations  of  this  Faculty  on  this  auspicious 
occasion,  it  becomes  a  pleasing  duty  to  add  a  few  words  of 
counsel  and  advice  touching  the  duties  you  have  assumed  as 
well  as  concerning  the  career  which  we  all  hope  you  will  follow 
with  success  in  tne  business  of  your  lives.  Ponder  well  on  the 
important  nature  of  those  duties,  for  they  are  nothing  less  than 
the  care  and  guidance  of  your  fellow-men  under  the  most  trying 
circumstances.  Duties  of  the  greatest  interest  to  the  public  as 
well  as  to  yourselves,  and  for  the  faithful  performance  of  which 
you  will  be  held  to  strict  account.  Your  career  will  be  nar- 
lowly  scrutinized,  as  to  your  keeping  is  entrusted  the  credit  and 
NO.  i#xxxi.  26 


MEDICAL    AND    SUfiOinAL   JOUBNAX.. 

reputation  of  our  Alma  Mater.     We  are  members  of  one  family, 

and  disgrace  or  discredit  falling  on  any  one  member  must  be 
felt  by  all.  There  are  a  few  auggeationa  that  may  not  be  con- 
sidered out  of  place,  and  which  will,  if  followed,  conduce  to 
your  personal  comfort  and  to  success  in  your  career.  A^nd 
strictly  to  your  own  health..  Bacon  remarks  thai  a  "  sound 
state  of  health  begets  a  natural  vigour  of  the  faculties."  No 
class  of  men  require  a  larger  share  of  bodily  vigour  than  physi- 
cians. Who  more  exposed  to  the  baneful  influence  of  malaria, 
or  the  germs  of  contagious  or  infectious  disease  than  the  physi- 
cian. In  epidemic  visitatiohs,  whilst  other  classes  of  the 
community  can  seek  protection,  by  isolation  or  abandonment  of  ( 
localities  infected,  physicians  are  called  upon  to  remain  and  risk  | 
their  lives  in  the  service  of  others.  With  the  heroism  aod 
pluck  of  the  soldier,  they  forego  all  considerations,  join  the  for- 
lorn  hope,  and  advance  to  the  breach  with  unswerving 
faithfulness. 


Tbeira  not  to  make  reply, 
Theirs  but  t< 


Need  I  refer  in  proof  of  thia  to  the  recent  scourge  of  yellow 
fever  in  the  Southern  States,  when  over  eighty  medical  men 
perished  in  giving  succor  to  their  fellow  man.     All  honour  to  ( 
their  memory.     Such  ia  the  position  that  each  one  of  us  ma 
at  any  moment  be  called  upon  to  assume,  and  as  s&nitarians  a 
know  that  strict  obedience  to  the  laws  of  health  will  aid  us 
in  resisting  the  baneful  influence  of  disease.     But  again,  your  { 
vocation  is  to  advise  and  direct  others  how  to  pi-eserve  their  I 
health,  and  in  so  domg  you  will  be  expected  to  know  how  to 
care  for  your  own. " 

I  must  caution  you  against  the  baneful  influence  of  the  cup  I 
of  bitterness.  As  physicians  Jou  are  all  fully  aware  of  the  | 
evils  of  intemperance,  how  it  beclouds  the  mind  renders  I 
helpless  the  body,  and  leads  to  disease  and  early  death.  The  J 
physician,  of  all  other  men,  should  be  at  all  times  in  fall  I 
possession  of  his  faculties,  as  at  any  hour  of  day  or  nij^t  bo  1 
may  be  called  upon  to  render  assistance,  where  the  lifu  of  a 


VALEDICTORY  ADDRESS. — BY   DR     FENWICK.  387 

fellow-man  is  at  stake.     Under  such  circumstances  the  public 
will  fully  endorse  the  sentiment  of  Hamlet : 

<<  Give  me  that  man 

That  is  not  passion's  slave,  and  I  will  wear  him 
In  my  heart's  core." 

In  this  particular  I  should  advise  you  to  adopt  the  motto  of 
Othello : 

*'  I  have  very  poor  and  unhappy  brains  for 
drinking.  I  could  well  wish  courtesy  would 
invent  some  other  custom  of  entertainment." 

Another  duty  to  yourselves  is  to  keep  pace  with  the  rapid 
advance  that  is  being  made  in  medical  and  surgical  science. 
The  practitioner  who  is  content  with  what  he  has  learnt  during 
his  pupilage,  will  soon  fall  behind,  and  rightly  earn  the  con- 
tempt of  his  fellow- man.  Idleness  should  be  no  feature  of  the 
honest  and  true  physician  ;  though  you  cease  to  be  pupils,  you 
must  still  be  students,  as  your  life  should  be  devoted  to  obser- 
vation and  reflection.  Take  stock  each  year  of  what  you  have 
acquired,  and  see  to  it  that  you,  have  added  to  your  store.  To 
your  patients  let  integrity  be  your  password,  truthfulness  your 
breastplate,  gentleness  and  sauvity,  with  forbearance  yet  firm- 
ness, your  guiding-stat".  Harshness  and  want  of  sympathy  in 
the  ills  of  others,  will  not  tend  to  elevate  you  in  the  esteem  of 
your  fellow-man.  Seek  not  success  through  any  other  channel 
than  close  attention  to  the  business  of  your  calling.  It  is  your 
privilege  to  relieve  suffering,  and,  under  heaven,  to  save  life  ; 
close  attention,  with  a  full  measure  of  judgment,  and -putting  in 
force  the  practical  knowledge  acquired  at  the  bed-side  in  the 
hospital  ward,  will  be  certain  of  success.  In  any  severe  case, 
where  you  are  in  doubt  or  perplexity,  if  you  have  any  fear  of 
the  correctness  of  your  own  judgment,  seek  the  assistance  and 
advice  of  a  brother  practitioner  of  larger  experience  than  your 
own.  Never  refuse  your  aid  because  of  the  uncertainty  of 
reoeifing  remuneration,  be  generous  to  the  poor,  remember  the 
ivords  of  our  blessed  Saviour,  **  Forasmuch  as  ye  did  it  unto  the 
vt  of  one  of  these  my  brethren,  ye  did  it  unto  me,"  and  your 
"^  will  be  dure.     The  physician  is  the  custodian  of  many 


388  CAKADA    MEDICAL   AND   SURGICAL    JOintSAL. 

family  secrets.  Ho  is  the  friend  in  adversity,  the  couoaellor  in 
time  of  need.  If  mishap  or  disgrace  invade  the  family  circle 
the  trusted  [ihjsii^ian  is  the  first  to  be  conauUed.  How  neces- 
sary then  for  the  full  exijrcise  of  discretion  and  tetinence.  How 
dangerous  is  the  babbler.  Remember  then  the  oath  you  have 
this  day  taken  ;  cautiously,  hooeatly,  with  prudence  and  chastity 
pursue  your  honorable  calling. 

I  may  here  remark  that  a  proposal  has  come  semi-officiallj 
to  the  profession  of  this  Dominion  to  join  the  ranks  of  the 
■  British  Medical  Association  by  becoming  members  of  that 
Society.  The  objects  of  that  Society  are  in  every  way  bene- 
ficial to  the  best  interests  of  the  profession,  the  advancement 
of  scientific  knowledge,  and  the  elevation  of  the  standard  of 
medical  education.  I  have  no  doubt  the  proposal  will  be 
seriously  entertained  by  the  profession  of  the  Dominion  at  the 
next  annual  meeting  of  the  Canada  Medical  Association,  to  be 
held  in  the  city  of  London,  Ontario,  in  September  next.  It 
is  very  desirable  that  the  profession  in  this  country  should 
receive  that  recognition  from,  the  institutions  of  the  Mother 
Country  which  is  its  due.  It  would  appear  as  though  the  dawn 
were  breaking  in  our  clouded  horizon,  and  although  we  may 
not  expect  to  be  placed  on  the  same  footing  as  the  older  institu- 
tions of  Great  Britain,  we  may  hope  that  we  will  not  continue  to 
occupy  the  anomalous  position  we  do  at  present.  My  chief 
object  in  referring  to  this  matter  is  to  call  your  attention  more 
especially  to  the  existence  of  this  our  national  association,  to 
which  all  members  of  the  profession  ought  to  belong.  But  more 
than  this,  it  is  much  to  be  desired  that  branch  societies  should 
be  established  in  all  the  sections  of  this  country.  We  miwt  be 
up  and  doing ;  medicine  is  a  progressive  science ;  there  is  a 
large  field  open  to  each  one  of  you  for  observation,  and  in 
observing  remember  that  you  must  not  hide  your  light  under  a 
bushel,  but  seek  to  emulate  the  work  of  those  wlio  have  enlarged 
the  boundaries  of  medicine  by  reclaiming  an  unexplored  wilder- 
ness, and  laying  bare  truths  which  have  long  lain  hid.  It 
requires  but  a  beginning,  for  you  will  find  that  the  work  wUl 
become  so  engrossing  and  eatialactory  that  you  will  bo  forced, 


CtRRHOSIS  Ol'   THE   LIVER. — BY  DR.  ROSS.  389 

from  the  very  love  of  well-doing,  to  persevere  with  all  your 
energy  to  the  end.  For  what  does  not  the  science  of  medicine 
in  some  way  bear  upon  ?  It  analyses  tha  wonderful  processes 
observed  in  all  organized  beings — generation,  development, 
growth,  nutrition,  decay,  disease  and  death.  It  solves  impor- 
tant questions  for  the  legislator,  and  discloses  mysteries  to  the 
jurist.  To  ourselves,  it  elevates  and  brings  forth  the  better 
feelings  of  our  nature,  enlarges  our  sympathy,  strengthens  our 
hope,  induces  self-denial,  and  leads  on  to  the  practice  of  the 
greatest  of  Christian  virtues — true  charity.  Follow  on,  then, 
gentlemen,  in  the  honourable  career  opening  before  you  ;  may 
you  be  worthy  sons  of  this  University,  full  of  usefulness  and  pro- 
ficiency. You  all  have  the  path  open  to  you  of  shedding  lustre 
on  Alma  Mater,  and  in  your  c^eer  may  you  be  full  of  joy  and 
peace  and  happiness  and  good  report.  Gentlemen,  farewell. 

FIVE  FATAL  CASES  OF  CIRRHOSIS  OF  THE  LIVER, 

WITH  AUTOPSIES  AND  REMARKS. 
Professor  of  Clinical  Medicine,  McGill  University. 

The  following  cases  of  cirrhosis  of  the  liver  occurred  in 
rapid  succession  in  the  practice  of  the  Montreal  Qeneral 
Hospital.  They  all  differ  much  in  their  clinical  features, 
exemplifying  several  of  the  characteristic  phases  apt  to  be 
assumed  by  this  disease.  To  some  of  these  attention  will  be 
drawn  at  the  conclusion  of  the  Reports. 

Case  No.  1. 

Intemperance — Dyspepsia — Dropsy — Paracentesis — Death 
from  Peritonitis. — T.  C,  aet.  50,  was  admitted  10th  Sept., 
1878.  Family  history  good,  never  had  syphilis.  For  twenty 
years  past  has  been  a  very  heavy  drinker  of  spirits.  For  eight 
years  has  suffered  very  frequently  from  sharp  and  stabbing 
pains  in  the  hepatic  region  and  behind  the  right  shoulder. 
Would  sometimes  be  free  from  these  for  a  week  at  a  time. 
During  last  winter  these  pains  were  much  worse.     In  May  last 


390 


CANADA  HEDIOAL  AMD   BDBGICAI,   JODBNAL. 


began  to  complain  of  various  digestive  disturbances — fulneas  " 
and  feeling  of  distress  at   the  epigastrium — loss  of  appetite, 
flatulence  and  diarrhoea — the  latter  being  rather  troublesome, 
the   evacuations   composed    principally   of    mucus   containing  ■ 
streaks  of  blood.     There  was  no  vomiting.     He  also  had  hem- 
orrhoids.    Towards  the  middle  of  June  he  noticed   his  feet  j 
swollen,  and  about  the  same  time  his  bellj  began  to  enlarge. 

On  admission  the  patient  was  found  much  emaciated,  I 
grey  and  aged-looking — a  thin  drawn  face  with  no  very  marked 
fulness  of  the  cutaneous  ca.pillaries — an:cmii!  but  not  particu- 
larly sallow.  Extensive  aacites,  with  very  great  enlargement  I 
of  the  superBcial  abdominal  veins.  No  albumen  in  the  urine  ; 
other  organs  normal.  On  the  17th  September  he  was  tapped 
by  Dr.  Fenwick  with  a  small  aspii-ator  needle,  twenty-eight 
pints  being  removeil.  This  was  followed  by  fever  and  abdominal 
tenderness  for  a  few  days,  and  rapid  re-accumulation  of  the 
dropsy.  Was  again  tapped^  seven  days  after,  in  the  same  way, 
twenty-four  pints  were  drawn  off.  During  and  after  this  period  ' 
he  was  further  treated  by  a  pill  of  digitalis  squill  and  pil 
bydrarg :  potass,  bitart,  and  an  occasional  dose  of  elaterium. 
In  spite  of  this  he  again  required  tapping  on  October  16th, 
twenty-eight  pints  being  obtained.  The  operation  was  done 
this  time  by  the  ordinary  large  trocar.  He  was  very  faint 
almost  immediately  after,  but  beyond  this  no  had  symptoms. 
Patient  continued  very  weak  from  this  time.  On  the  27th  was 
again  tapped  to  '2S  pints.  To  alleviate  the  faintness,  this  parar 
centesis  was  done  with  a  fine  trocar,  the  size  of  the  ordinary 
exploring  instrument.  It  had  been  made  expressly  for  the 
purpose,  was  provided  with  a  phlange  and  attached  to  a  rubber 
tube  to  conduct  away  the  fluid  to  a  bucket.  It  answered  per- 
fectly well,  and  the  serum  ran  slowly  off  whilst  he  lay 
quietly  in  bed.  A  few  hours  after,  however,  he  had  a  severe 
rigor,  followed  by  great  pain  in  the  abdomen,  and  constant 
vomiting.  In  spite  of  active  treatment  by  poultices,  hypodei 
mic  morphia,  and  stimulants,  lie  rapidly  sank  and  died  on 
tbo  morning  of  the  29th  Octi)ber. 

The  autopsy  revealed  nothing  beyond  advanced  cirrhosis  of 
tiie  liver  with  evident  signs  of  recent  ncrif 


cirrhosis  of  the  liver. — bt  dr.  ross.  391 

,  Case  No.  2. 

Intemperance — Rapid  Ascites — Profuse  Scematemesis  and 
Death.—  C.B.,  aet.  38,  was  admitted  12th  January,  1879.  Has 
been  a  tippler  for  several  years — has  had  delirium  tremens 
three  times.  Denies  ever  having  suflFered  from  any  symptoms 
of  gastric  disturbance.  No  morning  nausea  or  vomiting — no 
loss  of  appetite,  flatulence  or  irregularity  of  the  bowels.  Has 
been  about  and  following  his  trade  as  usual  and  did  not  think 
there  was  anything  the  matter  with  him  until  ten  days  ago. 
Then  noticed  swelling  of  his  feet  and  ankles,  and  very  soon 
after  fulness  of  the  abdomen.  On  admission  patient  found  to 
be  a  man  of  small  stature,  moderately  emaciated.  Complexion 
of  a  very  decided  dingy  or  muddy  hue,  but  no  jaundice 
—capillaries  of  cheek-prominences  much  distended  and  strik- 
ingly evident,  abdomen  greatly  swollen,  hard,  tense  and 
fluctuating — superficial  veins  much  enlarged.  Liver, — dulness 
very  much  diminished,  barely  two  inches  in  the  line  of  the 
nipple.  Urine  scanty,  of  a  remarkable  red  color;  abundant 
lithates  ;  no  albumen ;  shows  marked  reaction  for  urohaematin. 
The  feet  and  legs  are  moderately  oedematous. 

He  was  treated  by  pretty  frequent  doses  of  sulphate  ajid  car- 
bonate of  magnesia,  and  a  diuretic  mixture  of  acetate  of  potash, 
squill  and  digitalis,  with  the  effect  only  of  maintaining  the 
ascites,  without  much  increase.  No  notable  change  was 
observed  until  the  24th,  when  in  the  evening,  without  warning, 
patient  vomited  up  half  a  pint  of  dark,  somewhat  clotted  blood. 
Ice  and  tannic  acid  were  given,  but  before  morning  he  had 
brought  up  altogether  forty-six  ounces.  The  pulse  rose  to  120 
and  he  felt  weak,  but  the  bleeding  stopped,  and  for  the  next  two 
days,  whilst  the  same  treatment  was  being  followed,  did  not 
recur,  and  he  was  pretty  comfortable.  There  was  some 
diarrhoea  with  black  blood  in  the  stools.  At  10  a.m.  of  the  27th, 
and  again  at  1  p.m.  he  vomited  blood  profusely — four  and  a  half 
pints,  quite  dark  and  clotted.  Was  very  prostrate  after  this ; 
small,  rapid  pulse,  pallor  and  falntness.  Was  given  acetate  of 
lead  and  an  ice-bag  applied  over  the  epigastrium.  Without 
'  irther  bleeding  he  died  at  5  p.m. 


392  CANADA   U£D10AL    AND   SltBOtCAL    JODRNAL. 

The  liver  presented  the  most  advanced  condition  of  cirrhosii. 
it  IB  possible  to  imagine,  its  weight  being  only  thirty-twC^^ 
ounces — the  right  lobe  rounded  and  presenting  numeroi 
marked  projeetiona.  It  is  separated  from  the  left  lobe  by  a 
broad  band  of  Rbrous  tissue.  Left  lobe  is  a  thin,  flattened 
mass,  the  size  of  the  palra  of  the  hand;  entire  structure  very 
dense  and  cicatricial-looking,  mostly  blackiah-green  in  color. 
The  stomach  contained  a  quantity  of  bloody  fluid.  When  the 
mueoua  membrano  waa  carefully  cleansed  of  blood  and  adherent 
mucus  no  erosions  or  openings  into  vessels  could  anywhere  be 
seen,  and  the  membrane  looked  rather  pale.  The  small  intestine 
contained  a  (juantity  of  tarry  matters  of  black  color, 

Cask  No.  3. 

Intemperance — Ascites — Femoral  TlirombosU — Ja  undice — 
Bhod-PoiKoning  and  Death. — E.  C,  female,  house-servant, 
set.  27,  was  admitted  7th  October,  1878.  Is  a  very  impracti- 
cable kind  of  patient  as  regards  answers  to  questions.  Denies 
most  strenuously  having  ever  been  addicted  to  the  use  of  liquor 
in  excess.  Her  appearance,  however,  is  much  against  this,  for 
she  has  the  look  of  an  intemperate  and  dissolute  woman.  Ac- 
cording to  ber  account  there  were  no  symptoms  whatever  until 
three  months  ago,  when  she  noticed  a  swelling  coming  in  Uie 
lower  part  of  the  abdomen.  Subsequently  she  lost  her  appetite, 
became  weak  and  lost  fleah,  whilst  the  swelling  continued 
increasing.  Has  been  stout,  but  muscles  now  soft  and  flabby. 
Face  and  skin  generally  of  a  dirty  sallow  color.  Slight  injec- 
^on  of  the  veins  of  the  face.  Abdomen  moderately  distended 
and  giving  evidence  of  containing  a  considerable  quantity  of 
fluid.  Girth  at  umbilicus  forty  inches.  Urine  scanty,  contains 
abundant  lithates  ;  no  albumen,  and  no  bile-pigment.  By  Nov- 
ember 4th  the  umbilical  girth  reached  forty-five  and  a  half 
inches,  and  there  was  moderate  oedema  of  the  feet.  There  was 
much  distress  in  the  breathing.  She  was  tapped  with  the  smalt 
trocar  on  6tb  November,  and  nineteen  and  a  half  pints  serum 
removed.  The  livcr-dulness  was  found  diminished  to  within 
two  inches  in  the  mamillary  line.     The  dropsy  re-accumulated, 


OIBBHOSId  OF  THS  LITER. — BT  DR.  BOSS.  393 

a  second  time,  on  the  27th  November,  twenty-one  pints  were 
wn  off.     On  2nd  December  she  suflFered  rather  suddenly 
101  acute  pain  in  the  left  calf,  which  was  followed  by  rapid 
der  swelling  of  the  limb.     There  was  a  tender  spot  at  the 
er  part  of  the  popliteal  space,  none  in  the  femoral  triangle. 
0  doubt  thrombosis  of  the  popliteal  vein.)     This  gave  a  good 
3J  of  trouble.     A  week  after  there  was  plugging  of  the  right 
^Xnoral  vein  with  pain  and  swelling  in  that  limb.     About  this 
Xne  also,  10th  December,  it  was  noticed  that  she  was  becoming 
ually  but  decidedly  jaundiced.     The  urine  was.  dark,  but 
^id  not  for  some  days  give  the  reaction  of  bile-pigment,  but  sub- 
sequently the   latter  was  well  marked.     Jaundice   deepened 
'^^Mitil   quite   intense.      Symptoms  of   general  blood-poisoning 
allowed  themselves  and  the  patient  lay  for  several  days  in  a 
Restless,  half-comatose  state,  and  finally  died  insensible  on  the 
24th  December. 

Case  No.  4. 

Intemperance. — Ascites. — Paracentesis.  —  Uroemic  Symp- 
tarns. — Death. — C.  D.,  male,  aet.  34,  wat  admitted  on  the  lOlh 
Oct.,  1878.  He  is  a  horse-dealer,  and  has  been  for  the  last  four- 
teen years  addicted  to  considerable  and  constant  excess  in  the 
use  of  spirituous  liquors.  Has  never  had  any  illness  whatever, 
except  a  few  "  bilious  attacks,"  as  he  calls  them,  during  the  last 
four  years.  Whilst  thus  affected  he  lost  appetite,  felt  sick  and 
looked  yellowish  in  the  eyes — they  would  last  only  a  few  days. 
Apart  from  these  turns  he  has  felt  quite  well  until  seven  weeks 
ago,  when  he  got  diarrhoea,  which  lasted  several  days,  was  suc- 
ceeded by  constipation,  and  then  a  second  spell  of  diarrhoea. 
The  latter  condition  has  prevailed  to  a  moderate  extent  until  the 
present  time.  Vomiting  has  of  late  been  of  daily  occurrence, 
sometimes  more  frequent.  Appetite  very  uncertain — at  times 
entirely  wanting.  No  pain  about  region  of  liver.  A  little 
more  than  a  month  ago  he  observed  his  feet  and  ankles  swollen, 
and  about  the  same  time  the  abdomen  began  to  enlarge. 

Patient  is  moderately  emaciaited,  of  a  very  decided  sallow, 
dir^  hue,  but  conjunctivae  quite   clear,   not  yellow — malar 


394 


CANADA   MEDICAL   AND  BimOtCAL   JOUBHAL. 


sigmata  well  marked.  Abdomen  aymetrically  enlarged  forty- 
one  and  a  half  inches  at  umbiiicus.  Superficial  veins  considerably 
distended  and  distinct.  There  is  evident  fluctuation.  Liver- 
dubeaa  seems  not  raach  altered.  Urine  scanty  (seven  ouDcea 
last  twanty-ibur  hours,)  almost  red,  with  a  heavy  deposit  of 
lithatea,  no  albumen.  By  the  24th  October  the  girth  had 
reached  forty-three  inches,  and  he  was  tapped  with  a  fine 
trocar  to  relieve  the  distress  from  pressure  of  the  flaid  :  nearly 
twenty-sbc  pints  were  removed.  Even  at  ihia  time  and  for 
some  days  after  severe  symptoms  referable  to  the  nervous 
Byatem  were  observed.  He  was  di-owsy  and  apathetic.  Limbs 
moved  in  a  dull  and  sluggish  manner,  the  grasp  of  the  huids 
was  particularly  feeble.  Pulse  112.  The  bowels  act  freely, 
motions  light-colored,  like  putty.  On  the  28th  his  condition 
was  even  worse.  He  was  heavy  and  soporose.  On  the  30th 
quite  unconscious  and  restless,  sighs  a  great  deal.  Dingy,  sub- 
icteroid  hue  has  become  much  deejwned.  Pupils  contracted, 
and  sluggish.  Urine  escaping  in  bed.  It  is  of  a  deep  almost 
claret-red  color,  very  high  Sp.  gr.  (1032  to  1040;)  and  with 
an  equal  quantity  of  nitric  acid  becomes  almost  solid  with 
crystals  of  nitrate  of  urea.  From  this  condition  he  never 
thoroughly  rallied,  although  some  remarkable  iotermisaioaa 
occurred,  during  which  be  became  qtute  conscious  sometimes 
for  a  day  at  a  time.  Finally  with  a  dry,  brown  tongue,  sordes,  i 
and  decided  coma,  he  died  November  13th.  I 

Cask  No.  5.  1 

Si/pkilis. — Intemp&'aitei. — Dg*pep»ia.—  Dropsg — Purpura. 
— Dfoth  from  Sx^Mttian. — I.  B..  male,  xL  44.  was  admitted 
31st  Df^crmWr,  I'^IS.  He  «-a8  first  treated  for  «  short  time 
in  the  surgical  wani^  for  an  extensive  superficial  necromsof  th« 
left  titua,  accompanied  by  a  large  circular  ulcoratioa.  Hq  mi 
Uien  tnnaferred  to  Dr.  Roj^'  ward,  oa  aecoaat  of  commenCTig 
Mcttea.  B»  giv«a  an  account  of  having,  fifteen  years  ago,  had 
•  ehaiwra  foUoved  by  a  few  spots  upon  the  body.  Had  been 
very  intemp?rat«  until  thre^  ytkt9  aga,  awMe  when  he  has  tut 
drvak.  at  all.    WhiUt  drinking  was  fi«q«Mtly  tnmbM  mtfa 


CIKBHOSIS  OF  THE  LIVER. — BY  DB.  BOSS.  395 

dyspeptic  symptoms — morning  vomiting  of  glairy  mucus — 
flatulence  and  irregularity  of  the  bowels,  (alternating  constipa- 
tion and  diarrhoea,)  and  hemorhoids,  but  has  had  none  of  these 
since  renouncing  stimulants.  Has  lost  forty  pounds  weight 
within  the  last  two  years.  The  trouble  in  the  leg  began  eight 
months  ago  by  a  spontaneous  spot  of  inflammatory  swelling 
which,  after  a  slight  injury,  rapidly  ulcerated,  and  the  dead 
surface  of  the  shin-bone  was  left  exposed.  He  is  a  large  man, 
with  flabby,  flaccid  muscles,  face^ather  pale.  Malar  promin- 
ences and  eyelids  present  venous  stellate  injection.  Skin 
smooth  and  dry.  Abdomen  distended  by  moderate  ascites — 
girth  forty-one  inches.  Superficial  veins  considerably  enlarged. 
Feet,  ankles  and  scrotum  are  oedematous,  slight  nodes  on 
shins  and  some  copper-colored  scars  on  legs.  Vertical  liver- 
dullness,  three  inches.  Urine  scanty,  dark-brown,  with  abun- 
dant lithates,  no  albumen.  He  was  treated  by  diuretics  and 
occasional  purgatives,  but  little  impression  could  be  made  upon 
the  kidneys,  and  the  dropsy  of  the  abdomen  gradually  increased. 
By  the  19th  February  the  girth  reached  45  inches,  and  he  was 
tapped  with  the  small  trocar,  nearly  twenty-three  pints  of 
serum  being  removed.  Two  days  after  he  was  languid  and 
weak,  and  quite  delirious,  was  inclined  to  retch.  Tongue  red 
glazed  and  irritable.  On  3rd  March  delirium  had  disappeared, 
and  seemed  better.  Dilatation  of  left  pupil  and  slight  dropping 
of  left  eyelid  was  observed.  On  4th  March  there  was  some 
loss  of  power  in  all  the  branches  of  the  left  third  nerve.  Very 
drovifij  and  very  weak.  Pulse  has  become  morbidly  slow — 
to-day  fifty-seven.  The  foUowmg  day  there  were  patches  of 
purpuric  spots  on  the  back  of  both  hands  and  wrists,  and 
seemed  much  exhausted.  From  this  time  he  lay  in  a  very 
prostrate  condition,  and  after  having  been  insensibie  for  twelve 
hours  died  on  the  12th  March. 

The  autopsy  showed  a  rather  small,  rough,  hard  and  well 
marked  ''  drunkard's  liver,"  No  other  lesion  of  moment. 
There  was  no  sign  of  visceral  syphilis. 

Remarks  by  Dr.  Itoss. — In  the  first  case  death  occurred 
from  peritonitis,  no  doubt  induced  by  the  puncture  of  the  trocar. 


396  CANADA   MEDICAL    ANDflUROICAt    JOUHNAL. 

The  Hanger  to  be  apprehended  from  aimple  tapping  of  the  abdo- 
men with  trocar  and  canula  is  uaually  looked  upon  sa  verj 
slight,  eo  stight  indeed,  aa  hardly  to  require  being  taken  into 
consideration.  Every  precaution  waa  taken,  the  inatrument 
used  was  purposely  very  small,  and  the  fluid  was  gradually  re- 
moved, to  prevent  as  much  as  possible  the  sudden  withdrawal 
of  support  from  the  vessels  of  the  abdomen.  Probably  here 
the  patient's  age,  his  great  feebleness,  the  previous  tappinga, 
(one  of  which  had  been  followed  by  inflammation,)  all  assisted 
in  permitting  of  the  development  of  a  rapidly  spreading  and 
fatal  peritonitis.  The  knowledge  of  such  cases  (fortunately 
rare — it  is  the  first  I  remember  to  have  seen)  should  cause 
us  to  he  all  the  more  guarded  in  our  prognosis  when  performing 
paracentesis  of  the  abdomen  in  debilitated  subjects. 

The  lateucy  of  cirrhosis  of  the  liver,  and  the  rapid  manner  in 
which  ascites  may  begin  and  advance,  are  well  illustrated  by 
Case  No,  2.  This  patient,  C.  B.,  presented,  on  admission,  the 
characteristic  appearance  ot  the  subjects  of  advanced  cirrhosis. 
The  liver  was  found  very  small.  The  opinion  formed  was  that 
he  had  fully  developed  fibroid  contraction  of  that  organ,  yet  on 
the  moat  careful  questioning  no  history  pointing  towards  ante- 
cedent disturbance  of  the  digestive  system  could  be  extracted, 
and  it  was  only  ten  days  prior  to  being  first  seen  that  enlarge- 
ment of  the  helly  was  observed.  From  the  Extremely  shrunken 
state  of  the  liver  discovered  at  the  autopsy,  there  can  be  no 
doubt  that  the  disease  must  have  been  slowly  developing  for 
many  years.  Is  it  not  strange,  therefore  to  find,  as  the  final 
result  of  what  necessarily  was  an  extremely  slow  process  of 
gradual  obstruction  in  the  smaller  portal  vessels,  a  sudden  out- 
pouring of  a  large  quantity  of  serosity  into  the  peritoDeuoi  ? 
Why  should  the  ascites  not  have  appeared  sooner  ?  What  dis- 
turbed the  equilibrium  of  the  circulation  in  so  rude  and 
sudden  a  manner  ? 

I  have  several  times  seen  vomiting  of  blood  as  a  symptom  of 
cirrhosis  of  the  liver.  I  think,  however,  it  is  more  commonly 
met  with  in  the  earlier  stages,  and  it  is  well  known  that  it  may 
be  the  very  first  symptom  to  attract  attention.     In  this  case  it 


1 

I 


GIBRHOSIS  07    THE   LIVER. — BY  DR.   ROSS.  397 

was  very  profuse  and  uncontrollable.  The  autopsy  demon- 
strated the  entire  absence  of  any,  even  the  slightest,  solution- 
of  continuity  anywhere  ;  the  bleeding,  therefore,  was  from  the 
capiUaries  by  diapadesis,  showing  that  copiousness  of  haemor- 
rhage is  not,  as  sometimes  held,  a  probable  indication  of  rupture 
of  a  vessel.  I  have  seen  fatal  haemorrhage  in  typhoid  fever  simi- 
larly occur  from  a  general  exhalation  when  it  was  thought  to 
have  ori^nated  from  an  ulcerated  vessel. 

Case  No.  3  presented  another  feature,  viz.,  jaundice.  From 
the  gradual  manner  in  which  it  came  on  and  the  period  of  its 
onset  there  can  be  little  doubt  that  it  arose  from  compression 
of  some  of  the  main  biliary  outlets  by  a  portion  of  the  liver 
adjacent  which  had  been  undergoing  contraction.  The  symp- 
toms were  evidently  those  of  jaundice  from  obstruction, 
especially  the  absence  of  bile  from  the  stools,  and  cirrhosis 
alone  will  reaoh  any  degree  without  giving  evidence  of  real 
jaundice,  although  any  depth  of  the  usual  unhealthy,  dirty, 
sallow  color  may  be  seen.  No  autopsy  was  made  in  this  case, 
and  therefore  actual  demonstration  of  the  real  lesion  in  question 
is  wanting.  The  venous  thrombosis  which  was  a  diatressing 
accident  in  this  case,  and  which  occurred  in  both  lower  limbs, 
was  probably  not  directly  due  to  the  nature  of  the  pre-existing 
disease,  but  rather  only  to  the  generally  cachectic  state  of  the 
patient  and  to  the  obstructed  venous  return.  As  far  as  I  am  aware 
this  occurrence  is  bv  no  means  common  in  cases  with  abdominal 
dropsy,  but  is  oftener  seen  where  the  great  ascending  veins  are 
interfered  with  by  tumors,  such  as  ovarian  and  other  enlarge- 
ments 

In  case  No.  4  the  symptoms  of  cerebral  disturbance  were 
very  marked,  and  extended  over  a  period  of  some  weeks.  They 
consisted  in  somnolence,  great  muscular  weakness,  and  some- 
times delirium.  This  condition  resembles  very  closely  that  of 
uraemia  from  Bright's  disease,  and  it  is  probable  that  there  is  a 
strong  resemblance  in  the  state  of  the  blood  in  the  two  cases. 
At  any  rate,  the  detailed  report  of  this  case  (of  which  the  above 
is  an  extract)  shows  that,  after  this  patient  had  been  lying  in 
an  almost  completely  comatose  condition,  an  enormous  excre- 


398       CANADA  MEDICAL  AND  SURGICAL  JOURNAL. 

tion  of  urea  took  place,  and  coincidently  with  this,  intelligence 
returned.  When  this  unusual  increase  in  the  urea-elimination 
ceased,  the  same  indications  of  poisoning  of  the  nervous  system 
were  once  more  witnessed. 

The  main  point  of  interest  in  case  No.  5  was  the  matter  of 
syphilis.  There  is  no  douht  that  systemic  Lues  is  capable  of 
causing  a  disease  in  the  liver  accompanied  by  proliferation  in 
the  connective  tissue  and  thickening  of  the  capsule,  which  will, 
in  its  clinical  features,  perhaps  closely  simulate  those  of  an  alco- 
holic cirrhosis.  The  history  of  constitutional  infection  was  clear 
and  the  patient  gave  abundant  past  and  present  evidence  of 
lesions  due  to  this  cause.  'The  history  of  intemperance  was, 
however,  equally  clear.  The  question,  therefore,  arose,  what 
is  the  probable  nature  of  the  hepatic  disease  ?  The  decision  I 
arrived  at,  and  which  was  confirmed  by  the  autopsy,  was  that 
the  case  was  one  of  ordinary  cirrhosis,  from  alcoholism,  and  the 
points  depended  upon  were — the  great  frequency  of  alcohol  as 
a  cause,  and  the  rarity  of  syphilis — the  plain  account  of  the 
usual  antecedent  of  gastric  disturbances — the  absence  of  attacks 
of  severe  pain  about  the  liver,  and  therefore  the  improbability 
of  there  having  been  much,  if  any,  peri-hepatitis — the  marked 
presence  of  the  venous  stigmata  on  the  face. 

COHNHEIM'S  THEORY  OF  TUMORS. 

Translated   and  condensed    from   Vol.   I  of  his  Vorlesungen  Ueber 
allgemcnie,  Pathologie  (Lectures  upon  General  Pathology). 

By  Dr.  Osler. 

Read  before  the  Medico-Chirurgical  Society  of  Montreal  as  an  appendix  to  a  report 

of  two  coses  of  Kidney-Tumors — Striped  Muscle  Sarcoma,  and 

Spindle-celled  Adeno-Sarcoma, 

( Continued  from  page  M7. ) 

Biology  of  Tumors, — All  parts  of  the  body  have  definite 
functions  and  perform  a  certain  amount  of  work.  Tumors, 
being  atypical,  have  no  such  functions.  Myomas,  striped  or 
smooth,  are  certainly  excitable,  but  they  are  never  stimulated, 
from  the  absence  of  the  necessary  nerves.  The  adenomas  and 
gland  cancers  do  not  secrete,  partly  because  they  do  not  stand 
in  a  *'  typical  '^  relalioii  io  daots,  but  cluefly  because  the  essen- 


COHimEIM's  THEORY  OP   TUMORS. — BY  DR.  OSLER.  399 

tial  innervation  is  absent.  From  a  biological  standpoint,  the 
chief  interest  of  tumors  refers  to  the  laws  of  their  growth  and 
nutrition. 

The  embryonal  germs,  out  of  which  tumors  originate,  require 
no  other  positive  condition  for  their  development  than  a  suflScient 
blood  supply  —  qualitive  as  well  as  quantitive.  An  osteom 
can  not  arise  if  the  necessary  supply  of  lime  salts  is  not  furnished 
by  the  blood,  nor  a  lipom  develop  unless  the  needful  fat-building 
substances  are  forthcoming,  in  quantities  over  and  above  what 
is  necessary  for  the  general  nutrition. .  A  long-continued  eleva- 
tion of  the  blood-flow  serves  very  considerably  to  accelerate  and 
strengthen  the  growth  of  tumors,  as  is  commonly  seen  in  the 
increase  of  cartilaginous  and  bony  tumors  of  the  skeleton 
and  of  dermoid  cysts  at  puberty,  and  of  growths  in  the  breasts 
and  ovaries  during  pregnancy.  It  is  doubtful  whether  an 
inflammatory  hyperaemia  has  the  power  of  exciting  an  existing 
tumor-germ  to  develop,  but  there  can  be  no  doubt,  according  to 
the  statements  of  the  best  surgeons,  that  an  already  existing 
neoplasm  can  have  its  growth  rapidly  increased  by  congestive 
and  inflammatory  hyperaemias,  dependent  on  local  irritation. 
Still  these  conditions  do  not  suffice  to  explain  the  remarkable 
inequality  in  the  rate  of  growth  of  difierent  tumors.  In  this 
respect  internal  conditions,  as  yet  unknown,  must  play  a  r81e  in 
the  diverse  tumor-germs, — perhaps  the  period  of  embryonal 
life  out  of  which  the  germ  originates  may  have  an  influence  in 
this  way,  that  the  earlier  the  stage  ait  which  the  superfluous 
germs  have  been  produced,  so  much  the  greater  their  rapidity 
of  growth. 

The  nutrition  processes  in  tumors  are  simpler  than  in  any 
physiological  organ,  inasmuch  as  the  circulation  is  the  only  factor 
which  has  any  influence  on  the  tissue  changes.  Blood-vessels 
exist  in  all  new-growths,  and  they  grow  and  develop  just  as  in 
organs  and  tissues  in  physiological  growth,  with  this  difierence, 
that  the  vascularisation  of  a  tumor  is  atypical.  On  this  account, 
they  are  sometimes  poor  in  vessels,  sometimes  rich,  and  this 
difierence  is  met  with  in  similarly  constructed  myomas,  fibromas, 
myoscomas,  as  well  as  in  difierent  sorts  of  tumors,  which  at  one 


4oa 


CANADA   MEDICAL   AND   SOBOtCAI. 


time  may  be  sparsely  vascular,  at  another  nioat  abundantly  pro- 
vided with  vessels,  even  assuming  a  condition  teleangiectasy. 
Further,  the  distribution  of  the  sorts  of  vessels  in  tumors  is 
often  atypical.  Sometimes  the  capillaries  preponderate,  at 
tnother  the  veins  are  chiefly  developed,  and  again  other  tumors 
are  characterized  by  numerous  arteries,  so  that  they  pulsate  m 
masse.  All  the  various  local  disturbances  of  circulation  are  met 
with  in  tumors — anasmia,  byperajuia  (active  and  congestive), 
thrombosis,  emboUsm,  bgemorrhage  and  inflammation,  and  it 
not  iufrefjueutly  happena  that  the  whole  course  of  a  growth 
is  influenced  by  certain  of  these  disturbances.  The  various 
degeoeratioos — fatty,  calcareous  and  colloid, — are  met  with  in 
tumors.  From  these  must  be  distinguished  the  ossification  of  &6 
enchondromas,  &c,,  the  fatty  infiltration  of  cells  of  cancer  and 
adenoma  of  the  breast,  and  the  horny  transformation  of  the  celU 
of  epithelioma,  which  represent  tlie  regular  development  of  the 
respective  tumor-germs.  Necrosis  forms  the  moat  important  and 
eeriouE  nutrition  disturbance  to  which  tumors  are  subject,  and  to 
this  many  sorts  are  very  liable  on  account  of  their  atypical  and 
irregular  circulation.  When  the  entire  mass  is  involved,  it  O 
rather  a  fortunate  circumstance,  but  more  commonly,  especial!}  i 
in  tumors  which  project  upon  a  free  surface,  the  necross  is  MH 
unwelcome  and  dangerous  occurrence.  * 

What  becomes  of  a  tumor  f — This  is  the  true  cardinal  qnea- 
tion  in  the  whole  pathology  of  tumors,  for  its  solution  can  alone 
afford  an  explanation  of  the  significance  of  a  growth  to  the 
organism.  This  is  a  (luestion  easier  asled  than  answered, 
indeed,  it  can  scarcely  he  settled.  In  the  life-history  of  tumors 
there  is  indeed  but  one  universally  valid  fact,  namely,  that  i 
neoplasm  never  spontaneously  degenerates  and  disappears, 
rare  elimination  by  necrosis  cannot  be  called  a  spootani 
degeneration,  any  more  than  the  separation  of  a  ganj 
foot,  and  though  fatty  degeneration  may  diminish  the  velumei 
a  growth,  it  cannot  cause  a  spontaneous  healing.  This 
ig  readily  understood  if  the  cause  of  the  tmner  lies 
embryonic  predisposition.  Great  difierenoes,  howeTftr 
observed  in  their  life  hiatorv.     Some,  •" 


( 


COHNKEIM's   theory   of   TUMOBS. — BY  DR.  OSLER.  401 

fibromas,  lipomas,  and  exostoses,  last  the  whole  life  through,  or 
for  years  are  stationary,  without  exceeding  a  certain  size.  Others, 
again,  of  identical  structure,  grow  slowly  but  continually,  finally 
reaching  colossal  dimensions.     Further,  the  majority  of  tumors, 
be  they  large  or  small,  remain  as  local  formations,  limited 
strictly  to  the  place  and  tissue  where  they  began  to  develop ; 
still,  a  considerable  number  do  not  follow  this  local  limitation, 
but  attack  in  their  growth  the  neighbouring  tissues  and  are 
followed  by  the  production  of  numerous  similar  tumors  in  more 
or  less   distant  organs.     These   latter  peculiarities,  diffusion, 
and  metastasis,  are  the  distinguishing  characteristics  of  malig- 
nant tumors.     The  grounds  of  this  difference  in  the  growth 
of  neoplasms,  whereby  tumors  of  identical  structure  sometimes 
remain  of  limited  dimensions,  at  others  become  unlimited,  have 
not  been  sufficiently  enquired  into.     It  may  be  that  the  embry 
onic  tumor  germs  are  of  unequal  size,  and  therefore  possess 
unequal  powers  of  growth  ;  or  the  difference  may  lie  in  the 
greater  or  less  blood  supply.     One  circumstance  must  be  taken 
into  consideration  in  discussing  the  conditions  and  laws  of  the 
growth  of  tumors,  and  that  is,  the  influence  exerted  by  the 
neighbouring  tissues.     In  physiological  development,  the  size 
and  form  of  each  part  of  the  body  is  the  product  of  the  reci- 
procal action  of  all  its  growing  tissues.  How  is  it  in  this  respect 
with  the  growth  of  the  pathological  tumor  germs  ?     The  neigh- 
bouring tissues  cannot  exert  a  positive  influence  on  the  form  and 
structure  of  tumor,  simply  because  their  growth  follows  physio- 
logical laws  with  which  the  tumor  germs  have  nothing  to  do. 
It  is  another  question,  however,  whether  the  neighbouring  tissues 
cannot. influence  the  growth  of  a  tumor  by  restraining  it.    An 
inhibition,  in  a  mechanical  sense,  can  scarcely  be  spoken  of,  for 
growth  is  a  powerful  force,  and  tumors  of  various  sorts,  hard 
and  soft,  attain  colossal  dimensions  without  the  skin,  muscle,  or 
contiguous  parts,  being  able  to  hinder  their  increase  in  size. 
Batiher  more,  indeed,  are  all  tissues  pressed  aside  by  the  grow- 
ing Qpoidaam — muscle,  nerves,  blood-vessels  are  compressed, 
«»n  the  hardest  tissues,  such  as  bone,  cannot  resist  the 
'  tumors.     Though  the  mechanical  resistance  of  sur- 

2T 


402 


CANADA  HEDICAE.  AND  SUBOICAL  JOOaSAL. 


rounding  parts  has  but  little  effect  in  checking  the  growth  ( 

tumors,  it  is  otherwise  with  what  might  be  called  the  jihymojogicdl 
resistance.     This  is  no  theoretical  conception,  for  the  noftual 
history  of  development  teaches  in  a  most  emphatic  manner  that 
the  respective  tissue  boundaries  are  never  broken  through.  The 
nerves  do  not  grow  into  the  muscles  or  the  skin,  but  definite  oella 
in  the  respective  regions  of  the  body  difierentiate  into  nervcB. 
In  the  case  of  glands,  embryologists  have  long  recognized  that 
they  originate  not  by  a  growing  in  of  the  epithelial  cells  into  the 
v&acular  connective  tissue,  but  by  a  mutual  growth  of  the  one 
into  the  other.     In  the  history  of  the  development  of  tumors, 
shall  not  such  an  important  and  pervading  principle  of  growth 
hold  good  ?     In  the  great  majority  of  tumors  it  is  perfectly 
maintfuned.     They  can  grow  rapidly  whether  their  boundary  J8  J 
diffuse  or  sharply  defined.     In  the  former  case  they  push  for-  1 
vard  the  contiguous  tissue,  compressing  or  causing  it  to  atrophy, . 
but  they  always  stop  at  tho  limit  of  the  foreign  tissue  and  do  1 
not  penetrate  it.     In  a  number  of  growths,  viz.,  the  malignanl^  ] 
this  principle  is  not  followed,   the  tumors  press  regardlessly  1 
into  tho  neighbouring  tissues,  and,  moreover,  secondary  growths  I 
originate  in  different  localities  under  their  influence. 

The  malignity  of  tumors  is  to  be  attributed  to  an  absence  of  1 
the  physiological  resistance  in  the  parts  of  the  body  adjoining  I 
them,  or  at  a  distance.     It  depends  on  the   condition  of  the  I 
organism,  not    on  peculiarities  in  tho   nature   of   the   tumor  I 
itself.     The  latter  is  the  commonly  received  view,  and  in  con-  J 
sequence  great  stress  is  laid  on  the  arrangement  and  histological 
ffltuation  of  malignant  growths.     The  majority  of  such  turaore 
present  either  the  epithelial  type — cancers,  or  the  connective 
tissue  type — the  sarcomas ;  and  one  is  accustomed  to  identify  i 
malignant  growths  with  one  or  other  of  these  forms,  and  eveo-l 
in  cases  where  a  chronic  and  localized  tumor  has  assumed  M 
malignant  character,  a  carcinomatous  or  sarcomatous  degenera- 
tion is  spoken  of  in  connection  with  it.     The  weakness  of  this 
exposition  is  not  hard  to  show.     So  far  as  carcinoma  ia  concerned, 
under  this  head  are  described  tumors  composed  of  a  fibre 
I  ttroma,  in  the  meshes  of  which  epiih>  -  -      - 


COHNHEIM'S   theory  of   tumors. — BY  DR.  OSLER.  403 

A  superficial  glance  suffices  to  prove  that  this  definition  involves 
the  criterion  of  maKgnity,  for  ^ince  the  carcinomas  originate 
from  epithelial  cells,  the  existence  of  a  connective  tissue  stroma 
would  be  impossible,  did  not  the  tumor  in  its  growth  invade  a 
heterogenous  and  foreign  tissue.  But  wherein  lies  the  malignant 
nature  of  the  sarcomas  ?  In  reality,  an  exhaustive  review^ 
shows  that  malignancy  is  not  invariable.  A  very  considerable 
number  of  them  are  not  so  throughout  life.  Thus,  the  sarcoma- 
tous epulis,  which  grows  rapidly  and  recurs  after  repeated 
removals,  never  generalizes.  Also  sarcomas  of  other  bones,  of 
the  ovaries,  the  mediastinum,  and  the  fasciae,  can  remain  for 
years,  and  by  their  size  induce  the  severest  efiects,  and  yet 
neither  invade  neighbouring  tissues,  |nor  yet  become  general ; 
and  in  those  sarcomas,  whose  later  course  is  most  malignant, 
still,  as  Virchow  remarked,  a  harmless  period  always  precedes 
the  malignant  course.  Within  the  past  ten  years  many  cases 
have  been  recorded  of  tumors  which  usually  run  a  benign  course, 
becoming  very  malignant  and  generalizing.  Among  such  are 
the  cases  of  enchondroma  described  by  Virchow  and  Lucke,  of 
fibromas,  of  which  several  malignant  examples  have  been  met 
with.  Glioma  often  runs  a  most  intensely  malignant  course. 
So  also  with  certain  relatively  highly  organized  tumors — the 
smooth  and  striped  myomas,  and  a  case  is  on  record  of  metastases 
from  a  simple  tumor  (adenoma)  of  the  thyroid.  From  facts  such 
as  these,  Cohnheim  concludes  that  it  is  not  the  peculiarities  of 
the  tumor  which  determine  its  benign  or  malignant  course,  but 
the  condition  of  the  organism.  The  physiological  resistance  of 
the  neighbouring  tissues  must  be  abolished  before  a  ttimour 
ean  dififuse,  and  in  the  tissues  of  other  organs  before  it  can 
disseminate,  i.  e.,  become  infective.  There  are  several  sorts  of 
dissemination.  Of  these  the  most  frequent,  but  least  pernicious, 
18  along  the  lymphatics.  In  the  lymph  glands  next  to  the 
taDor  an  analogous  growth  arises,  then  another  gland  of  the 
group  is  affected,  then  a  third,  producing  a  whole  chain 
irons  lymph  glands,  which  may  extend  for  some  distance. 
^  fhe  lymph  vessels  themselves  remain  unaffected,  but 
uieh,  intestines,  and  lungs,  they  are  sometimes 


404 


CANADA   MEDICAL    AND    BDROICAL    JOITBNAI.. 


involved.  In  another  form  the  secondary  masses  do  not  involve 
the  lymphatics,  but  cancerous  tumors  arise  indifferently  in  organs 
which  have  neither  a  local,  histogenetic,  nor  functional  connec- 
tion with  the  locality  of  the  original  tumor.  The  organs  for 
which  metastatic  growths  have  the  most  decided  preference  are 
the  liver  and  lungs ;  and  there  is  only  one  tissue  in  which  they 
do  not  occur,  viz.,  cartilage.  In  ail  others — fat,  bone,  skin, 
muscle,  kidneys,  spleen,  teaticlea,  ovaries,  pancreas,  br^n, 
fibrous  and  serous  membranes,  heart,  uterus,  mucous  membranes, 
choroid  and  iris,  secondary  growths  aro  met  with.  There  appears 
to  be  no  rule  determining  in  which  organ  or  tissue  metastases 
shall  occur.  In  a  third  aeries  of  cases,  the  dissemination  through 
the  lymph  vessels  is  combined  with  genuine  metastasis,  the 
former  preceding  the  latter  for  a  longer  or  shorter  period. 

One  of  the  most  striking  features  in  the  dissemination  of 
tumors  is  the  fact  that  the  secondary  masses  correspond  exactly 
in  histological  and  chemical  composition  with  the  original  tumor. 
This  conformity  is  8o  complete  that  it  is  often  preferable  to 
study  the  structure  of  a  malignant  growth  in  the  metastasis  than 
the  original  mass.  There  cannot  be  the  shadow  of  a  doubt  that 
the  secondary  tumors  arise  on  account  of  the  existence  of  the 
primary  one.  From  this  conviction  the  theory  has  originated 
that  an  infectious  material  is  produced  at  the  site  of  the  original 
tumor,  which  diffusea  partly  in  the  neighbourhood,  partly  through 
the  lymph  and  blood  to  all  parts  of  the  body,  causing  the  erup- 
tion of  new  but  similar  growths.  The  virus  is  supposed  to  bo 
infectious  only  to  the  organism  in  which  it  is  produced.  The 
infecting  agent  must  be  cither  the  juice  of  the  tumor,  or  solid 
bodies,  definite  elements  of  the  mass.  Cohnbeim  inclines  to  the 
latter  view.  To  make  this  plausible  it  ia  necessary  to  show,  not 
only  that  tumor  elements  gain  access  to  the  lymph  and  blood 
channels,  but  also  that  when  transported  to  other  organs  they 
develop  and  grow.  The  investigations  of  Koater  have  satisfac- 
torily shown  this  in  the  case  of  lymphatics,  and  the  growth  of 
malignant  tumors  into  veins  is  still  more  frequent.  In  the 
majority  of  cases  of  such  tumors  in  which  a  careful  inspection 
is  made  on  this  point,  a  vein  ie  found  the  lumen  of  which  is 


I 


■  COEINSEIH'S   THEOBY  of    TUMOES. — BY    DE.    OSLEH.         40$ 

occupied  by  a  cancerous  mass,  either  attached  to  the  wall  or 
extendiag  as  a  fungoid-iike  excrescence.  How  mauy  growths 
may  penetrate  first  the  small  capillaries  and  veins  ?  The  possi- 
bility of  the  transportation  of  particles  of  a  tumor  by  means  of 
the  lymph  and  blood  streams,  is  beyond  all  question ;  indeed, 
emboli  composed  of  such  have  been  seen.  Some  believe  that 
the  cancerous  embolus  infecta  the  wall  of  the  vessel  in  which  it 
lodges,  and  its  elements  produce  the  new  growth ;  others  hold 
that  the  cells  of  the  embolus  represent  germs,  which  proceed 
in  their  development  just  as  the  original  ones  did.  Cohnheim 
and  Maas  have  shown  in  some  beautiful  experiments  that  tissue 
fragments,  separated  from  their  original  base  and  lodged  in  the 
interior  of  a  vessel,  can  grow  and  produce  a  now  tissue.  Bits 
of  fresh  periosteal  tisane  were  put  into  the  jugular  veins  of  dogs 
and  hens,  and  of  course  ultimately  reached  the  branches  of  the 
pulmonary  artery.  The  bits  became  vascular,  just  like  a 
thrombus,  vessels  passing  from  the  vasa  vasorum,  and  within 
two  weeks  were  produced  first  cartilage  and  then  actual  bone, 
and  thia  without  any  participation  of  the  vessel  wall.  This  was 
not  the  only  result.  The  newly  formed  bony  plate  not  only 
never  extended  beyond  the  wall,  but  in  the  following  weeks 
entirely  disappeared ;  by  the  fourth  -week  a  small  hard  rudiment 
only  remained,  and  by  the  fifth,  no  trace  could  be  found. 

The  same  eSect  follows  the  implanting  of  periosteal  slips 
beneath  the  skin,  and  also  the  inoculation  of  cancer,  which  at 
first  grows  forcibly.  It  would  appear  that  the  physiological 
tissues  ot  the  organism  oppose  with  an  insuperable  resistance 
the  penetration  of  heterologous  cell  matenal,  though  it  may 
possess,  as  shown  by  its  early  development,  a  power  of  active 
growth.  As  a  direct  aeiiuence  of  this  it  follows  that  the  tissue 
which  permits  of  the  penetration  of  tumor  cells  and  their 
development,  or  the  growth  of  the  pjirticles  of  a  tumor  which 
have  been  carried  to  it,  does  not  comport  itself  physiologically. 
Let  the  tissue  be  histologically  and  chemically  perfectly  natural, 
still,  there  is  absent  from  it  that  peculiarity  described  above  as 
physiological  resiatance.  This  condition  is  not  further  defined, 
but  the  circumstances  and  states  under  which  it  may  ap]>ear  are 


^06 


CANADA   MEDICAL    AND   SDKOICAL   JOURNAL. 


the  follomog:  infiammation,  old  age,  hereditary,  or,  in  some 
unknown  wny  acquired,  predispoBition. 

In  the  first  place,  Friedlander  haa  shown  that  under  the 
influence  of  inflammatoiy  hjperEemia,  new  growths  of  epitlie- 
lium  very  readily  occur,  often  penetrating  the  altered  connective 
tissue ;  thus,  to  give  an  example,  in  chronic  sub-cutaneous 
abscesses  he  has  found  the  epithelial  cells  of  the  rete  mucosum 
and  root  sheaths  of  the  hairs  of  the  skin  above  the  abscess 
penetrate  the  wall,  and  even  fcrm  an  epithelial  coating  on  the 
granulating  inner  surface  of  the  sac. 

Of  like  significance  are  the  much -discussed  cases  where,  on 
the  base  of  an  old  excoriation  or  lupoid  ulcer,  a  cutaneous  epi^e- 
lioma  has  developed.  It  has  already  been  stated  that  traumatisni 
has  no  influence  in  the  production  and  development  of  tumors, 
but  Waldeyer  has  justly  called  attention  to  the  frequency  with 
wliich  inflammatory  alterations  are  found  in  the  otherwise 
healthy  tissues  bordering  on  a  cancer.  Since  the  causes  of 
these  inflammatory  processes  may  be  very  varied,  the  possibili^ 
of  a  traumatic  influence  cannot  be  entirely  ignored,  and  it  may, 
under  certain  circumstaneea,  convert  a  benign  into  a  malignimt 
growth. 

Of  atill  greateraignificanco  in  thiarespectiaoldage,  Thirscb 
has  liud  stress  upon  this,  and  has  shown  that  the  entire  connec- 
tive tissues  of  the  body  atrophy  at  this  period,  and  are  therefore 
less  able  to  withstand  the  penetration  of  the  still  active  ejuthe- 
lial  cells.  Carcinoma  almost  always  occurs  after  the  50th  year 
that  is  to  say,  epithelial  tumors  do  not  become  malignant  before 
this  period.  The  weakness  of  the  tissues,  or  tJie  diminished 
power  of  physiological  resistance,  is  one  of  the  signs  of  general 
feebleness  and  old  age. 

There  remains,  however,  a  very  considerable  number  of 
of  malignant  growths  for  which  an  explanation  can  neither  be 
Bought  for  in  a  previous  inflammation  nor  advanced  age.  Caaea 
of  genuine  cancer  arc  not  only  met  with  in  very  young  indivi- 
duals, but  the  malignant  sarcomas  preponderate  in  childhood, 
while  the  malignant  gliomas  are  almost  peculiar  to  the  first  year 
of  life.     Upon  what  theabolitionordecreasein  the  physiological 


I 
I 

I 


COHNHSm  E   THEORY  OF   TCMOBS. — BV   DR,  OSLER. 


407 


I 


resiatance  in  these  cases  depends  is  difficult  to  say.  Posaibi; — 
even  probably — heredity  may  play  a  part,  but  in  many  cases 
we  do  not  know  the  causes  of  the  tissue-weakness  in  question. 
This  18  the  only  point  in  the  whole  of  the  pathology  of  new  growths 
Trbere  one  is  constrained  to  fall  back  upon  an  unknown  and  not 
definable  predisposition.  This  theory  no  more  recogniaes  a 
predisposition  to  a  tumor  than  it  does  a  predisposition  to  red 
hair  or  a  crooked  nose  ;  but  for  the  explanation  of  the  malignant 
course  of  certain  tumors  we  cannot  escape  from  the  admission 
of  a  predisposition.  What  makes  this  particularly  interesting, 
and  proves  at  any  rate  that  the  predisposition  is  connected  with 
the  tisauea  alone,  and  not  with  the  condition  of  the  blood  or 
nervous  system,  is  the  fact  that  it  sometimes  appears  limited  to 
certain  organs  and  tissues.  This  appears  to  be  the  simplest 
explanation  of  those  remarkable  and  not  uncommon  cases,  in 
vhich  .the  entire  metastases  are  ri^dly  confined  to  a  definite 
system,  the  skin,  the  skeleton,  (he  intestines  or  the  lymph 
glands,  the  affected  system  not  having  any  local,  or  genetic  or 
fanctdonal  relation  with  the  locality  of  the  primary  tumor. 

The  differences  in  the  course  of  diverse  malignant  growths 
are  explained  in  the  pecuharities  of  locality  and  htstologioal 
constitution  of  the  primary  tumors.  The  sarcomas  possess  an 
extraordinary  power  of  growth,  probably  on  account  of  their 
richneasincell  elements  and  the  highly  embryonic  nature  of  their 
components,  and  this  explains  the  fact  that  when  they  dissemi- 
nate, it  is  much  more  ferociously,  so  to  speak,  than  cancers,  and 
the  metastases  are  not  so  often  confined  to  the  lymph  glands. 
Sometimes  they  even  overleap  the  glands  in  the  neighbourhood, 
as  Virchow  remarked,  and  appear  in  distant  ones.  This  is  chiefly 
the  case  in  the  small-celled  sarcomas,  in  which  the  cells  might 
ilip  through  the  lymph  spaces.  The  great  frequency  with  which 
tumors  ot  the  abdominal  viscera  are  accompanied  with  met- 
astases in  the  liver,  and  nowhere  else,  speaks  in  the  most  positive 
manner  for  extension  through  the  blood-vessels.  In  such  cases 
there  are  probably  genuine  cancerous  emboli,  which  are  trans- 
ported by  the  blood  stream  until  vessels  arc  met  with  too  narrow 
to  permit  of  their  passage.     In  precisely  the  same  way,  the 


408 


lADA   MEDICAL    AND   SURGICAL   JOUUNAL. 


secondary  tumors  in  the  lungs  arise  from  malignant  growths  in 
various  regions  of  the  body,  and  it  is  a  point  worth  noting  that 
the  metastases  of  the  giant  celled  sarcoma  of  bone  are  invari- 
ably in  the  lungs.  K  the  cells  or  particles  of  tumors  gaining 
access  to  the  circulation,  are  so  small  that  they  can  pass  through 
all  blood-vessels,  then  the  laws  of  embolism  do  not  apply,  but 
they  come  under  the  same  category  as  small  particles  of  cinnober 
and  bacteria  masses.  It  may  be,  then,  a  matter  of  accident  where 
they  lodge,  or  more  probably  it  depends  on  the  rapidity  of  the 
blood  current.  The  slower  this  is  the  more  favorable  are  the 
conditions  for  lodgment  and  subsequent  growth.  On  this  ground 
it  is  that  the  boue  marrow  and  the  liver  are  the  elected  seats  of 
tumor  metastases  in  so  many  cases,  no  matter  what  the  situation 
of  the  primary  tumor  may  be.  The  lodgment  and  initial  growth 
in  the  interior  of  a  blood-vessel  does  not  necessarily  involve  the 
production  of  a  secondary  tumor.  This  depends  on  whether  the 
physiolo^cal  resistance  of  the  neighbouring  tissues  be  present, 
and  this  factor  may  be  of  influence  in  determining  the  locahsa- 
tion  of  metastases,  i.  e.,  the  seeds  of  a  tumor  may  gain  access 
in  numbers  to  the  blood,  but  only  find  in  certain  organs  or 
tissues  conditions  for  their  further  development,  these  conditions 
being  an  absence  of  the  normal  physiological  resistance. 

Note. — Space  does  not  pennit  of  the  further  consideration  of 
Prof.  Cohnheim's  views  on  epithelioma  and  rodent  ulcer,  or  the 
cancerous  cachexia.  The  above  theory  may  appear  incomplete 
in  many  points,  but  it  must  be  remembered  that  it  is  greatly 
condensed,  often,  I  am  afraid,  at  the  expense  of  clearness.  In 
the  original  it  occupies  75  pages. 

W  0. 


REVIEWS  AND   NOTIOES   OF    BOOKS.  409 

!|teuiews  and  Notices  of  JKoxx^s. 

LectureB  on  Localization  of  Diseases  of  the  Brain. — Delivered 
at  the  Faculty  de  Medicine,  Paris,  1875. — By  J.  M. 
Charcot,  Professor  in  the  Faculty  of  Medicine,  Paris ; 
Chief  of  the  Salpetridre  Hospital,  Member  of  the  Academic 
de  Medicine  :  of  the  Clinical  Society  of  London :  President 
of  the  Society  Anatomique :  former  Vice-President  of  the 
Society  de  Biologic,  &c.,  translated  by  Edward  P.  Fowler, 
M.D.    New  York :  William  Wood  &  Co.  8  vo.  pp.  133. 

The  researches  of  Heitzig,  Ferrier  and  others  have  of  late 
years  given  a  wonderful  impulse  to  the  interest  taken  in  the  study 
of  cerebral  disease.  Striking  and  remarkable  as  are  the  result 
obtained  by  experiments  upon  animals  practised  with  a  view 
of  determining  the  functions  of  different  portions  and  areas  of 
the  encophatic  mass,  yet  nothing  can  at  all  equal  in  certainty 
the  information  conveyed  by  careful  study  of  the  experiments 
performed  for  us  on  human  subjects  by  various  pathological 
conditiens ;  Charcot  strongly  urges  that  no  matter  how  plausibly 
we  may  argue  by  analogy  from  the  monkey's  brain  to  man's 
brain,  yet  nothing  can  be  QomiievQA proved  concerning  the  latter 
except  it  be  based  upon  the  undeniable  evidence  of  the  patho- 
logy on  the  human  brain  itself.  This  is  undoubtedly  the  proper 
ground  to  take,  and  everything  tending  to  increase  the  general 
knowledge  of  the  profession  concerning  these  conditions  is  a 
real  advance  in  practical  medicine.  As  the  translator  rightly 
says :  "  It  is  too  late  to  introduce  our  distinguished  author  to  the 
medical  profession,  for  wherever  medicine  is  taught  as  a  science 
his  works  are  already  known  and  prized,  and  have  been  trans- 
lated into  nearly  every  modem  language." 

In  these  lectures  will  be  found  a  short  and  concise  exposition 
of  the  main  points  which  it  is  absolutely  necessary  to  know  of 
the  normal  anatomy  of  the  various  structures  of  the  brain  as  at 
present  understood.  This  is  the  foundation  of  the  whole,  and 
in  the  condensed  form  in  which  it  appears,*  would  of  itself  be 
extremely  useful ;  but  to  this  in  a  late  chapter  is  added  the 


CANADA   HEDICAl.    AND   SURGICAL    JOITBNAL. 


410 

result  of  the  author's  own  observations,  both  clinical  and  patho- 
logical, of  the  effects  produced  hj  diseased  conditionB  of  these 
varioue  parts.  In  moat  caaes  naturally 
with  those  of  others,  but  notable  exceptions  to  these  are  found 
where  he  has  been  led  to  entertain  Tiews  opposed  to  those  of 
previbus  experimentors  and  clinical  obsorvei^.  Charoot's  great 
reputation  has  been  founded  upon  the  minute  care  with  which 
his  observations  has  always  been  made,  and  the  scrupulous 
exactness  with  which  his  results  have  been  recorded.  These 
lectures,  therefore,  which  he  presents,  as  embodying  his  deli- 
berate views  upon  this  now  absorbing  medical  topic  are  to  be 
gladly  received  in  this  eooniry,  and  must  be  entertained  as  any 
work  would  be,  commanding  such  eminent  authorship. 

As  regards  the  translation.  M.  Charcot  says  in  the  preface, 
he  considers  it  "  a  model,  both  of  scrupulous  exactitude  in  lon- 
dition  of  the  original  meaning,  and  a  clear  nnexceptjonable  s^le 
of  English." 

The  book  is  very  neatly  got  up  by  the  publishers,  and  ta 
even  profusely  illustrated  by  very  good  cuts. 

Lectures  on  BrigWs  Disease  of  the  Kidneys  ;  delivered  at 

the  School  of  Medicine  of  Paris. — By  J.  M.  Charcot, 

Professor  in  the  Faculty  of  Medicine  of  Paris :  Phyaiciao 

to  the  Salpctri^rc,  Jfec,  &c.  Collected  and  published  by  Dn. 

Jioumoville  and  Sevestre,  editors  of  the  Progrds  M^dicale, 

and  translated  with  the  permission  of  the  author  by  flsKitT 

B.  Millard,  M.D.,  A.M.  New  York:  Wiluam  Wood, 

&  Co.,  8vo.  pp.  100. 

Probably  no  disease  has  been  rendered  more  complex  and 

difficult  than  has  Bright's  Disease  by  many  authors.     This  i» 

chiefly  owing  to  the  immense  numbers  of  pathological  subdiri- 

sions  which  at  various  times  have  been  made  according  to  the 

standpoint  from  which  the  subject  has  been  viewed.  M.  Charcot 

is  not  of  those.    He  has  followed  exactly  the  opposite  plan,  and 

has  endeavoured  to  simplify  and  condense  as  much  as  such  a 

wide  range  would  permit  of ;  and  one  is  surprised  to  find  bow 

thoroughly  the  ground  has  been  covered  in  the  small  space  of 


I 


I 


REVIEWS  AND  NOTICES  OF   BOOKS.  411 

only  100  pages.  The  first  lectures  are  devoted  to  a  brief  con- 
fflderatipn  of  what  it  is  essential  to  understand  of  the  normal 
anatomy  and  physiology  of  the  kidney.  Upon  this  follows  a 
summary  of  the  views  of  Brighfs  disease.  The  whole  of  the 
forms  are  reduced  to  three :  the  large  white  kidney,  the  con- 
tracted kidney,  and  the  amyloid  kidney.  Sufficient  space  is 
devoted  to  the  discusdon  of  the  etiology,  pathology,  and  clinical 
features  of  each  of  tliese,  and  a  chapter  is  added  on  Scarlatinal 
Nephritis.  The  author  does  not  enter  upon  the  subject  of 
treatment  at  all,  but  claims,  that  a  correct  understanding  of  the 
management  of  these  formidable  cases  can  only  be  obtained  by 
close  study  and  careful  observation  of  the  diflerent  disease 
processes  which  occur  in  the  separate  forms. 

We  agree  entirely  with  iJie  Translator  in  saying  that  we 
^  know  no  work  which,  with  such  conciseness  and  precision, 
presents  tiie  various  characteristics  of  the  important  disease 
which  is  the  subject  of  these  lectures." 

It  is  a  very  neat  volume  worthy  of  being  highly  recommended 
to  the  profession.  Many  wood-cuts  assist  the  explanations  of 
the  text,  and  are  supplemented  by  two  full-page,  well-executed 
colored  lithographed  plates. 

PhymUgical  Therapeutics :  a  new  theory. — ^By  Thomas  W. 
PpOLB,  M.D.,  M.C.P.S.,  Ont.  Toronto:  The  Toronto 
News  Company.  New  York :  The  American  News  Com- 
pany. London :  The  International  News  Company,  1879. 
8vo.  pp.. 232. 

If  Therapeutics  is  to  be  advanced  it  must  be  by  such  ways 
as  the  following :  1st.  An  enlarged  knowledge  of  the  natural 
history  of  diseases,  so  that  cures  due  to  nature  may  not  be 
ascribed  to  medicines.  2nd.  A  greater  clinical  study  of  the 
actions  of  remedies  in  diseased  states,  so  that  these  actions  may 
be  discriminated  from  those  which  take  place  in  health  from  the 
same  agents  in  the  same  doses.  3rd.  Further  discoveries  as  to 
the  powers  atid  effects  of  drugs  in  various  amounts  or  modes  of 
administration.  4th.  A  more  minute  investigation  of  all  the 
results  medicines  cause,  especially  upon  the  quality  of  the 


412 


MEDICAL    AND   StTRGICAL   JOURNAL. 


i  excretions.  And  Sth-  The  finding  or  new  remedies 
I  peeseaBed  of  decided  superiority  over  the  old.  We  regret 
our  author  has  not  seen  fit  to  enter  upon  any  of  these  paths. 
Bad  he  done  so  he  might  have  conferred  a  lasting  benefit 
OD  our  science.  He  has  contented  himself  with  BimpI;  weaving 
**  a  new  theory."  His  book  is  just  such  a  one  as  might  be  spun 
by  one  who  shut  himself  up  in  his  atady  for  a  while  with  the 
works  of  others  from  which  to  cull  the  wherewithal.  As  far 
as  wu  can  sec,  he  has  not  given  the  details  of  a  single  original 
experiment  with  medicines  upon  either  animals  or  man.  He  has 
not  recorded  one  observation  of  anything  ho  has  individually 
witnessed.  And  ho  makes  no  mention  of  his  experience  firom  the 
use  of  remedies  in  practice. 

Nor  are  these  the  only  charges  we  have  agfunst  him.  We 
think  he  has  too  much  adapted  the  facts  of  others  to  He  theory 
instead  of  his  theory  to  their  facts.  Such  a  course  may  well  lead 
to  the  most  extravagant  notions.  It  has  often  done  bo  before. 
Under  it  even  such  an  absurdity  as  the  old  idea  of  "  signatures  " 
was  cast  upon  the  world.  The  eye-bright  flower  from  its  likeness 
was  then  the  allegod  cure  for  every  case  of  eore-eye.  Our 
author's  "  new  theory  "  is  bow  the  sure  explanation  of  physiolo- 
gical Therapcnttca. 

We  have  not  been  able  always  to  verify  his  references :  e,  g., 
speaking  of  Aconite  he  aays :  "  how  amid  such  general  paralysis 
as  aconite  induces,  it  could  ever  have  been  regarded  as  an 
excitor  of  any  part  of  the  nervous  system,"  and  refers  to  Ringer's 
Therapeutics,  as  if  Dr.  Ringer  regarded  it  aa  siich  an  exciter. 
In  the  edition  of  his  work  before  ua  we  find  no  allusictt  to  any- 
thing of  the  sort.  In  speaking,  too,  of  Veratrum,  our  Author 
would  have  it  underatood  that  Dr.  R.  attributes  the  muscular 
spasms  and  convulsions  produced  by  poisonous  doses  of  this 
agent  .to  heightened  reflex  function  of  the  spinal  cord.  Incare- 
fiiUy  reading  his  article,  we  find  tliat  he  attributes  them  to  ao 
entirely  diflerent  source,  he  aays  veratrum  "  kills  the  muscles," 
not  the  nerves.  He  certainly  mentions  it  was  thought  veratrum 
excited  the  nioJuUa  oblongata  and  the  spinal  cord,  but  he  takes 
care  to  state  that  tliis  was  thought  to  be  so,  not  by  himself,  bat 
b;  KoUiker. 


^ 


I 


REVIEWS  AND   NOTICES   OF   BOOKS.  '         413 

We  find,  moreover,  that  our  author  is  not  always  exact  in  his 
assertionii.  He  states,  e.  g,,  that  ^^  opium  and  morphia  diminish 
arterial  blood  supply,  and  arrest  the  secretions  everywhere.''^ 
The  italics  are  ours.)  Now  how  can  we  account  for  such  a  loose 
statement  as  this  ?  We  have  actually  found  it  contradicted  in 
another  page,  where,  quite  unconsciously,  he  mentions  the  pro- 
fuse swfeatmg  that  may  occur  after  the  use  of  opium.  How  often 
are  these  medicines  ordered  as  diaphoretics  ?  Do  they  not  in  some 
cases  of  defective  secretion  of  the  urine  increase  the  amount  ? 
Would  even  the  veriest  tyro  maintain  that  they  arrested  or 
stopped  tlie  flow  of  tears,  saliva,  gastric  juice,  or  secretions 
everywhere  V 

While,  again,  we  have  found  no  allusion  to  many  excellent 
treatises  that  have  lately  issued  from  the  press  on  his  subject, 
as  Fothergill's,  &c.,  there  are  for  us  too  many  quotations  from 
"Hughes'  Pharmacodynamics,"  a  notorious  Homoeopathic 
authority.  Why  draw  support  from  him  ?  Glonoine, — so  far 
used  only  by  infinitesimal  practitioners, — is  also  fully  treated. 

Our  readers  will  expect  the  "  new  theory  "  to  be  opposed  to 
their  old  views.  To  present  them  with  some  concefption  of  it,  we 
must  use  the  words  of  our  young  author,  "Electricity  is  not  a 
stimulus  to  nerve  or  muscle.  On  the  contray  its  action  is  that 
of  a  sedative,  anaesthetic  and  paralyzer."  "  Electricity  produces 
muscular  contractions,  *  *  by  paralyzing  the  motor  nerves." 
Ergot  of  Rye,  "  resembles  the  action  of  electricity,  and  we  see 
no  reason  to  doubt  that  its  mode  of  action  is  similar  also."  Nar- 
cotics as  well  as  Ergot  paralyse  the  nerves,  and  thereby  cause 
convulsions  and  spasms  of  muscular  fibres."  Many  other 
medicines  of  course  fall  in  with  these.  But  the  gist  of  the 
theory  is  that  all  medicines  which  cause  increased  contraction 
of  muscular  fibre  anywhere  do  so  by  withdrawing  nerve  force 
from  the  nerve  which  supplies  the  fibre. 

Our  author  heaps  together  in  support,  examples  of  paralysis, 
and  convulsions,  or  increased  contraction  after  doses  of  drugs. 
But  he  does  not  distinguish  as  he  ought  between  sensory  and 
motor  paralysis ;  nor  between  primary  convulsions  and  subsequent 
paralysis.    Besides  the  experimentum  crucis  is  wanting.    He' 


414  CANADA  MEDICAL  AND  SUKOICAI.  JOURNAL. 

might  have  cut  the  anterior  column  of  the  cord,  or  the  motor 
nerve,  anil  then  judged  whether  "  inuacular  contraclaone " 
followed.  But  he  did  not.  And  so  we  have  to  fall  back  upon  those 
who  have  done  so  before  him,  and  take  our  wisdom  from  them. 
Apart  from  the  peculiaritiea  incident  to  the  "  new  theory," 
the  reader  will  find  under  the  actions  of  the  different  medicines 
much  that  ia  worth  knowing,  compiled  from  reliable  aourocB,  and 
quite  up  to  the  present  state  of  therapeutics.  The  more  purely 
physiological  parts,  when  not  theorized,  are  sure  to  repay 
perusal.  Trusting  our  young  author  may  yet  do  much  more  to 
advance  therapeutics,  we  leave  him  in  the  hope  that  when  we 
next  meet  it  may  be  in  ways  more  practical. 

Extracts  from  British  and  Foreign  Journals. 

A  Case  of  Gangrene  of  the  "Lung  treat- 
ed by  Incision.  —  I>r.  Cayley,  (Clinical  Society  of 
London)  read  notes  of  this  case.  Thepaticnt,  aman,agod40, 
was  admitted  into  the  Middlesex  Hospital  on  December  30th, 
1878.  He  had  been  ill  five  weeks  with  cough,  spitting,  and 
pain  in  the  chesi.  During  the  last  fourteen  days,  his  breath, 
and  expectoration  bad  been  fcetid.  On  admission,  he  was  in  a 
condition  of  extreme  prostration  and  emaciation,  with  gre&t 
dyspnoea,  and  painful  cough  ;  with  much  difficult  he  expectora- 
ted small  quantities  of  horribly  offensive  brownish  mucus.  His 
breath  had  a  similar  odour.  The  physical  signs  were  those  of 
consolidation  of  the  lefl  base,  but  there  were  no  distinct  intUco- 
tions  of  a  vomica,  as  a  buhbling  crepitation  or  cavemouB  or 
aphonic  breathing.  The  absence  of  these  signs  was  probably 
duo  to  the  cavity  being  full,  and  to  its  not  communicating  freely 
with  the  bronchus.  An  exploratory  puncture  was  made  with  a 
fine  trocar  and  cannula,  and  a  few  drops  of  pus  with  the  same 
gangrenous  odour  as  the  expectoration  were  drawn  off.  The 
patient  was  now  put  under  the  infinence  of  a  mixture  of  other 
and  chloroform,  and  Mr.  Lawson  made  an  incision  in  ttie  ninth 
intercostal  space,  in  a  hne  with  the  angle  of  the  scapula,  Uiree 


I 


BRITISH  AND   FOREIGN  JOURNALS.  415 

inches  in  length,  and  continued  it  until  the  cavity  in  the  lung 
was  reached.  A  gush  of  about  five  ounces  of  horribly  foetid 
pus  then  took  place,  and  with  the  pus  several  fragments  of  gan- 
grenous lung  tissue,  the  size  of  the  end  of  a  finger,  came  through 
the  opening.  A  large-sized  drainage  tube  was  introduced,  and 
the  cavity  was  washed  out  twice  daily  with  diluted  Condy's  fluid. 
The  operation  gave  the  patient  great  relief.  He  ceased  to  cough 
and  to  expectorate  foetid  mucus,  and  his  breath  lost  that 
gangrenous  odour,  and  the  temperature,  which  before  the  opera- 
tion had  been  very  high,  fell  to  normal.  He  did  not,  however, 
rally  firom  the  state  of  prostration,  and  gradually  sank  and  died 
on  January  4th ;  the  operation  having  been  performed  on 
December  30th.  For  the  first  two  days  fragments  of  gangren- 
ous lung  were  discharged,  when  the  cavity  was  irrigated.  On 
post  mortem  examination,  the  lower  lobe  of  the  lung  was  found 
consolidated  by  pneumonia,  and  firmly  adherent  to  the  chest  wall. 
In  its  interior  was  a  targe  irregular  cavity,  with  ragged,  in  parts 
gangrenous,  walls.  Where  most  superficial  it  was  upwards  of 
an  inch  beneath  the  surface  of  the  lung.  There  was  a  small 
obsolete  tubercular  cavity,  with  some  puckered  fibrous  nodules 
in  the  apex  of  the  right  lung ;  and  the  kidneys  were  granular 
although  the  urine  had  not  contained  albumen.  In  this  case  the 
patient  was  so  much  reduced  when  he  came  under  treatment 
that  littie  hope  of  a  succesful  result  could  be  entertained.  The 
operation,  however,  which  was  unattended  either  by  danger  or 
difficulty,  gave  complete  relief  to  the  most  distressmg  symptoms, 
and  by  evacuating  a  quantity  of  putrefying  matters  which  were 
pent  up  in  the  lung,  and  causing  septicaemia,  gave  the  only 
chance  of  recovery ;  and  possibly,  if  the  operation  had  been 
performed  earlier,  the  sloughing  portions  of  lung  might  have 
become  completely  detatched,  and  the  patient  have  rallied. 

Dr.  J.  E.  Pollock  asked  how  long  Dr.  Cayley's  patient  had 
lived  after  the  operation.  [It  was  answered  that  five  days 
ebpsed  before  death  took  place.]  The  points  of  interest  in  these 
cases  were — ^First,  the  question  of  diagnosis  before  the  operation ; 
secondly,  the  eligibility  of  each  operation.  In  Dr.  Williams'  case 
the  difficulty  was  to  decide  whether  the  case  was  one  of  pneu- 


416  CANADA   MEDICAL    AND   SeRGIOAL   JOUBNAL. 

motliorax,  or  one  of  a  cavity  with  thin  walls.  This  was  always 
a  difficult  queBtion.  It  turned  out  that  the  patient  was  soffering 
from  the  former,  yet,  at  the  time  of  operation,  Mr.  Erichsen 
thought  that  he  had  passed  through  the  lung  before  reaching 
the  pua.  He  thought  that  if  the  dulness  abifted  with  the  posi- 
tion of  the  patient,  tliiB  was  a  valuable  sign  of  pneumothorax - 
He  could  not  remember  any  case  where  a  cavity  was  so  large 
that  the  physical  signs  varied  much  after  alteration  of  the 
patient's  position,  or  after  &  profuse  expectoration.  After  all, 
the  question  of  diagnosis  was,  perhaps,  not  of  vital  importance. 
He  thought  that  cavities  in  the  apex,  where  there  was  a  good 
communication  with  tho  bronchus,  wore  cort^nly  not  suitable  for 
operation ;  but  where  the  cavity  was  low  down,  with  a  small 
external  opening,  and  much  decompoaition,  they  should  be  treated 
by  inciaion  or  by  tapping.  Dr.  Cayley  was  to  be  congratulated 
on  his  boldness  in  carrying  out  the  only  method  of  treatment 
which  was  likely  to  prove  successful. — Mr.  Maunder  had 
listened  with  much  pleasure  to  the  cases  brought  forward  that 
night.  He  had  for  some  time  been  of  opinion  that,  no  matter 
what  the  exact  positition  of  these  fcetid  cavities  might  be,  they 
should  be  treated  by  incision,  just  like  abscesses  in  other  parts. 
As  soon  as  a  free  ojiening  was  established,  decomposition  was 
checked. — Dr.  Mahomed  related  a  case  of  a  child  in  Guy'a 
Hospital,  under  the  charge  of  Dr,  Fagge,  where  a  pneumonia  waa 
'thought  croupous  at  first,  did  not  clear  up,  and  gave  signs  of 
breaking  up  of  the  lung.  He  was  anxious  to  treat  the  case  by 
incision,  thinking  that  it  might  be  an  abscess  of  the  lung,  following 
extensive  catarrhal  pneumonia,  which  would,  if  left,  end  in  acute 
tuberculosis.  But  the  evidence  of  a  cavity  was  too  doubtful  to 
allow  this  course.  The  child  eventually  died  from  the  cause  he 
had  feared,  and  a  large  cavity  was  found.  He  was  anxious  to 
know  how  an  adherent  pleura  might  be  certainly  recognised. 
In  Dr.  Cayley's  case  there  seemed  to  him  to  have  been  old 
adhesions.  He  also  wished  to  ask  what  Dr.  Williams  considered 
to  be  the  nature  of  the  bilious  attacks  he  had  described.  Dr. 
Sedgwick  related  a  caae  he  had  seen  many  years  before,  whicli 
he  had  diagnosed  to  be  an  abscess  of  the  lung.     This,  having 


I 


BHFTlSn   AND    FOREIGN   JOlTRNALa.  4lt 

become  foQtid,  gavp  rise  to  great  constitutional  illness  ;  but,  after 
some  delay,  lie  thought  he  discovered  a  bulging  in  the  seventh 
intercostal  spiice,  and  here  introduced  a  trocar.  The  result  was 
very  gratifying ;  and  the  patient  (his  father)  recovered,  though 
extremely  ill  at  the  time.  In  the  following  winter  the  flame 
trouble  occurred  in  the  same  place,  and  required  the  same  treat- 
ment, by  which  life  was  prolonged  for  several  weeks. — Dr. 
DocoLAS  Powell  agreed  with  I>r.  Pollock  that  the  interest  of 
these  cases  was*  first,  as  to  the  diagnosis  ;  and,  secondly,  the 
best  treatment  for  them.  In  a  case  now  under  his  care,  he  had 
diagnosed  a  pyo-pneumothorax,  because  the  sides  were  bulged 
and  the  intercostal  space  effaced.  The  shifting  dulness  described 
by  Dr.  Pollock  he  regarded  as  a  valuable  test ;  as  also  the  altera- 
tion of  phyaieal  signs  after  profuse  expectoration.  It  had  been 
said  that  it  did  not  matter  much  which  condition  was  present ; 
bat  he  thought  that  in  empyema  it  was  better  to  make  an  incision 
in  the  lowest  available  spot,  while  a  cavity  should  be  opened  by 
a  trocar  over  its  middle.  He  would  not  touch  apex-cavities  ; 
but  in  those  at  the  base  it  was  very  different,  and  here  there 
was  risk  that  the  sputum  would  be  inhaled  into  the  other  in  the 
act  of  coughing.  lie  would  also  allude  to  an  old  way  of  treating 
profusely  secreting  apex-cavities,  which  was,  in  his  opinion,  of 
great  service  ;  namely,  by  blistering  and  the  application  of 
savinc  ointment. — Mr.  H.  Marsh  said  that  for  himself  he  always 
insisted  on  knowing  at  what  point  the  physician  wished  the  chest 
to  be  opened  ;  but  he  considered  that  it  was  generally  advisable, 
when  a  low  opening  was  needed,  to  make  a  prehminary  incision 
over  the  most  prominent  point,  and  then  make  a  counter- 
opening  below. — Mr.  Howsb  wished  to  draw  attention  to  the 
trouble  oflon  caused  by  old  adhesions  of  the  pleura  converting 
the  pleural  cavity  into  a  network  of  sinuses.  This  had  been 
frequently,  in  his  experience,  a  source  of  difficulty;  and  he 
thought  here  a  second  opening  would  often  prove  futile.  As  to 
tapping  cases  of  gangrene  of  the  lung,  he  was  not  inclined  to 
recommend  this  procedure.  He  had  seen  three  cases  lately  where 
the  gangrene  was  very  limited,  and  no  surgical  interference 
would  have  been  possible. — Dr.  Gooduart  wished  to  ask  Dr. 


418 


CANADA   MEDICAL    AND   SURorcAL    JOUHSAL. 


Cayley  what  importance  he  laid  on  the  presence  of  fcctor  as  aa 
evidence  of  gangrene.  He  had  not  understood  from  the  notes 
read  that  there  had  been  distinct  evidence  of  a  cavity.  In  two 
cases  under  his  earo  there  was  the  same  absence  of  distinct  signs 
of  cavity,  though  the  footor  was  great.  One  was,  no  doubt,  an 
old  empyema.  Was  it  not  also  true  that  these  patients  often 
went  on  a  long  time  without  getting  worse.  Mr.  G.  Bird 
always  trusted  to  a  double  opening  with  a  drainage  tuhe  between 
them,  and  insisted  on  this  as  a  point  of  importance.  If  this 
course  were  impracticable,  he  trusted  to  a  considerable  slit 
rather  than  a  single  puncture. — Mr.  Maesh  asked  how  iar  it 
was  safe  to  inject  such  cavities  with  iodine.  In  one  which  he 
had  30  treated,  and  where  there  proved  to  be  a  communication 
with  bronchus,  the  patient  nearly  died  from  asphyxia.  Dr. 
Bristowb  remarked  that  it  was  clear  there  was  great  difficulty 
in  distinguishing  between  a  cavity  and  a  pyo-pneumothorax ;  but 
he  thought  the  treatment  of  both  should  be  the  same.  With 
reference  to  the  value  of  shifting  dulnesa  that  Dr.  Pollock  had 
insisted  on,  he  mentioned  a  case  of  abscess  of  the  lung  where 
the  cavity  was  very  large,  quite  large  enough  to  have  proved 
misleading  in  this  respect.  The  recognition  of  elastic  fibres  in 
the  sputum  was  often  a  fallacious  indication,  of  which  be  related 
a  case  in  point.  For  his  part  he  trusted  greatly  in  antiseptics 
to  the  treatment  of  these  cases. — Dr.  Williams  in  his  reply, 
explained  that  in  the  recognition  of  adherent  pleura,  be  trusted 
to  the  old  rules  of  retraction  of  the  intercostal  spaces,  etc., 
and  explained  what  was  meant  by  the  bilious  attacks  in  his 
patient. — Dr.  Cailbv,  in  answer  to  Dr.  Goodhart,  said  that  he 
had  taken  the  precaution  to  puncture  with  the  aspirator  before 
tapping. — British  Medical  Journal. 

Case  of  Stricture  of  the  Kectum,  treat- 
ed by  Incision  of  Stricture.— (By  D.  Lowaos, 

M.D,) — Mrs.   S. ,  aged   thirty-four,   had   complained   for 

eight  years  of  symptoms  of  stricture  of  the  rectum  ;  and  though 
during  that  period  she  had  been  freijuently  under  medical 
treatment,  and  had  derived  considerable  relief,  yet  the  improve- 
ment lasted  only  a  short  time,  and  about  two  years  ago  she  was 


I 

I 


British  and  foeeign  journals.  419 

suffering  more  than  at  any  previous  period.  The  motions,  which 
had  been  narrowed  for  years,  had  become  much  more  difficult  to 
pass,  and  defecation  could  not  be  effected  without  severe  strain- 
ing and  considerable  pain,  and  was  often  accompanied  with  blood 
and  matter.  Hardened  masses  were  felt  along  the  whole  course 
of  the  colon  as  far  as  the  caecum,  disappearing  after  laxatives 
and  the  free  use  of  the  enema,  and  again  collecting  soon  after 
the  discontinuance  of  these  measures.  The  stricture  itself  was 
felt  about  two  inches  above  the  anus,  was  hard  and  annuls, 
and  at  some  points  ulcerated.  It  was  movable  on  the  coccyx 
behind,  as  well  as  on  the  vagina  in  front,  and  just  fitting  the 
tip  of  tiie  finger,  it  could  be  pushed  upwards  and  drawn  down- 
wards freely  within  the  surroimding  structures.  The  symptoms 
all  pointed  to  a  case  of  simple  stricture.  There  was  no  great 
irregularity  of  surface,  and  after  an  existence  of  eight  years, 
only  a  small  extent  of  bowel  was  affected.  There  was  no  excessive 
fetid  discharge  as  is  the  case  in  most  syphilitic  or  cancerous 
strictures ;  and,  in  addition,  the  patient  was  not  suffering  con- 
stitutionally, the  appetite  and  genera]  health  being  good. 

Finding  that  in  the  course  of  former  treatment  dilatation 
had  not  been  resorted  to,  and  having  first  cleared  away  the 
masses  of  scybala  filling  up  the  large  intestine,  a  process  which 
I  found  consideaably  dilated  the  stricture,  I  gradually  completed 
the  dilatation  by  bougie.  She  was  for  the  time  relieved,  but  a 
month  afterwards  I  found  the  stricture  as  before.  The  bougie 
was  again  resorted  to,  but  the  irritation  caused  by  it  became  so 
great  that  its  use  had  to  be  discontinued.  Mild  laxatives  and 
frequent  emollient  enemata  soothed  and  relieved  the  irritated 
bowel,  but  dilatation  could  not  again  be  borne,  and  the  symptom 
of  stricture  became  aggravated. 

For  twelve  months  the  patient  had  been  under  treatment 
without  any  marked  improvement  m  the  condition  of  the  stric- 
ture, and  she  now  became  very  anxious  to  have  something  done 
for  her  permanent  relief.  Dilatation  having  proved  unsuccessful, 
the  idea  of  colotomy  presented  itself,  but  imder  the  circumstances 
it  seemed  rather  an  extreme  measure  ;  and  excision  of  the  lower 
part  of  the  rectum,  although  strongly  advocated  by  high  authori- 


426 


MEDICAL    AND   SUBaiCAL   JomNAL. 


ties  for  cancer,  has  the  disadvantage  of  destroying  largely  or 
entirely  the  action  of  the  sphincters.  The  removal  of  the  stric- 
ture alone  seemed  the  most  feasible  operation,  for  by  cntUog 
out  the  narrowed  ring,  and  stitching  together  two  pieces  of 
howel  which  were  heallliy  aad  had  sustained  no  loss  of  substance 
in  their  circumference  by  the  ulcerative  process,  a  union  might 
be  expected  free  from  contraction  ;  and  approaching  the  rectum 
from  behind  by  an  incision  extending  from  a  little  behind  the 
anus  to  the  tip  of  the  coccyx,  and  by  keeping  as  near  as  possible 
the  mesial  line,  bo  as  to  run  parallel  with  the  fibres  and  divide 
into  halves  that  part  of  the  external  sphincter  which  lies  between 
the  anus  and  coccyx,  its  action  would  not  be  ultimately  interfered 
with,  and  the  internal  sphincter  would  be  preserved  entire,  Mr. 
Jessop  of  Leeds,  who  saw  and  examined  the  case  minutely, 
considered  it  a  very  favorable  one  for  operation,  as  did  also  Mr. 
Knaggs  of  Huddersfield,  Accordingly,  on  the  ith  of  December, 
1877, having  cut  down  in  tte  mesial  Ibe  in  the  interval  between 
the  coccyx  and  the  lower  end  of  the  bowel,  I  divided  the  posterior 
part  of  the  external  sphincter  as  much  as  possible  into  two 
lateral  halves,  and  turning  these  aside  with  the  intermingling 
fibres  of  the  levator  ani,  I  introduced  the  finger  inside  the 
rectum,  and  pushing  it  firmly  into  the  stricture  I  pulled  it  down 
from  its  situation  in  front  of  the  coccyx,  and  made  it  project 
backward  through  the  external  wound.  Reaching  the  wall  of 
the  rectum,  and  having  dissected  the  surrounding  stricture  from 
the  lateral  aspects  as  far  forwards  as  the  recto-vaginal  septum, 
I  cut  the  bowel  through  above  and  below  the  stricture,  dissected 
the  ring  off  the  posterior  vaginal  wall,  and  stitched  the  two 
pieces  of  bowel  together  with  catgut  sutures.  Two  small  vessels 
spouted,  but  did  not  require  ligature. 

After  the  operation  the  temperature  gradually  rose,  reaching 
its  maximum — 102" — on  the  evening  of  the  third  day,  and  falling 
again,  became  normal  two  days  after.  The  pulse  corresponded 
with  the  temperature,  being  120  the  third  day  after  the  opera- 
tion. The  catheter  had  to  be  used  for  a  fortnight.  There  waa 
never  any  abdominal  tenderness  nor  other  symptom  of  peritonitja. 
The  vaginal  pipe  of  an  onimnTr  Hisidason's  enema  was  intro- 


I 


BRITISH  AND    FOREIGN  JOURNALS.  421 

duced  into  the  rectum  on  the  conclusion  of  the  operation,  and 
the  bowels  were  kept  confined  for  five  days.  After  this,  hbwever, 
diarrhoea  came  on,  and  the  management  of  the  wound  became 
difficult.  A  small-sized  Ferguson's  speculum  was  introduced 
in  place  of  the  vaginal  pipe,  and  through  this  the  bowel  was 
cleansed.  The  stools  liow  became  liquid  and  very  irritating, 
were  mixed  with  smooth  scybaJa,  and  came  away  partly  by  the 
tube,  but  also  by  the  wound,  excoriating  the  integument  in  its 
vicinity.  Opium  had  to  be  prescribed  freely  on  account  of  the 
pain,  and  yet  the  nights  were  restless  and  the  appetite  became 
poor. 

About  three  weeks  after  the  operation  the  lower  fragment  of 
bowel  gave  way  behind,  probably  from  the  continued  pressure 
of  the  speculum,  and  immediately  all  the  symptoms  began  to 
improve.  There  was  now  no  pain  except  when  the  bowels  were 
moved  ;  there  was  considerable  retentive  power  except  when  the 
bowels  were  relaxed  ;  the  discharge  became  less  irritating  ;  the 
excoriations  healed  ;  and  the  blue  line  began  to  appear  at  the 
margin  of  the  wound. 

March  9th,  1878.— The  condition  of  Mrs.  S ,  has  greatly 

improved.  The  bowels  now  act  regularly  ;  there  is  neither  pain 
nor  straining  at  stool ;  the  motions  are  natural  in  size,  but 
flattened  ;  and  the  sphincter  is  good  except  when  the  bowels  are 
relaxed,  when  she  finds  retention  is  not  as  good  as  formerly. 

March  31st,  1879. — A  considerable  amount  of  cicatriscal 
stricture  has  formed  around  the  seat  of  the  operation,  and  some 
contraction  has  taken  place,  but  a  medium-sized  bougie  passes 
easily,  and  the  motions  without  difficulty.  The  symptom  com- 
plained of  most  is  "  painful  sitting."  To  sit  comfortable  she  is 
obliged  to  lean  well  forward,  or  inclined  to  one  side  in  a  semi- 
r6cumbent  position.  Except  during  an  attack  of  diarrhoea, 
which  she  is  sometimes  subject  to,  her  sphincter  power  is  perfect. 

The  great  difficulty  in  the  case  was  the  after-treatment.  The 
passage  of  faecal  matter  of  a  very  irritating  nature  over  the 
wound,  and  the  tendency  to  diarrhoea  common  to  most  rectal 
operations,  retarded  the  healing  process,  which  semed  also  to  be 
delayed  by  the  action  of  the  internal  sphincter,  just  as  in  the 
cases  of  fistula.  There  are  few  strictures  situated  so  low  down 
as  to  come  within  the  range  of  the  foregoing  operation ;  but  in 
cases  of  the  sort  I  think  that  it  might  be  advisable  to  perform  . 
colotomy  in  the  first  instance,  and  so  to  carry  ofi^  the  faecal  matter ' 
by  ihe  loin ;  then,  after  an  interval,  the  stricture  in  the  rectum 
sught  be  removed,  and  a  good  union  secured,  and  subsequently 
tiie  artificial  anus  closed  and  the  motions  allowed  to  pass  ofi*  by 
Imax  &rmer  channel. — The  Lancet, 


422  CANADA  MEDICAL    AND   SCRGIOAt,   JOUaNAL. 

The  influence  of  Constitutional  Syphilis 
upon  the  Course  of  Wounds-— Di-  Dlsterhokf 

states  that  tho  contiguous  forms  of  syphilis  do  not  generally 
exert  any  iiifluence  upon  the  course  of  traumatic  lemons.  A 
wound  subjected  to  constant  irritation  during  the  period  of  con- 
tagion may  become  the  seat  of  syphilitic  efliorescances,  without 
its  healing  being  sensibly  retarded.  Persistent  irritation  of  a 
wound,  bad  diet,  and  excessive  ant  Syphilitic  treatment  generally 
retard  the  cure  more  than  constitutional  syphilis  itself.  Wounds 
in  the  neighbourhood  of  a  primary  induration  may  heal  by  first 
intention.  Latent  syphilis  is  ordinarily  without  influence  upon 
tho  course  of  a  wound.  A  surgical  operation  aucoessfally 
performed  in  a  case  of  latent  syphilid  may  be  followed  after 
cicatrisation  by  syphilitic  manifestations  in  the  position  or  not  of 
the  wound.  Autoplastic  operations  performed  on  the  syphilitic 
parts  often  fail,  especially  if  an  incomplete  course  of  treatment 
adopted  shortly  before  the  operation  has  caused  the  disease  to 
become  latent.  In  this  case  syphilis  appears  spontaneously  at 
the  seat  of  the  operation.  Erery  subject  of  syphilitic  ganglia 
ought  to  be  submitted  to  a  courae  of  antisyphilitic  treatment 
before  undergoing  an  autoplastic  opei-ation.  Tertiary  syphilis 
in  a  progressive  state  renders  the  patient  an  unfavourable  subject 
for  effecting  a  cure.  This  is  not  tho  case,  however,  if  tho  patient 
is  passing  through  a  retrogresMve  stage,  or  b  entirely  cured. 
Syphilis  in  the  bones  predisposes  to  fractures  and  hinders  con- 
solidation. Treatment  by  mercury  does  not  prevent  induration, 
but  rather  assists  it.  In  cases  of  inveterate  syphilis,  more 
especially  in  syphilis  of  the  bones  wounds  are  sometimes  accom- 
panied by  a  specific  gangrene,  which  cannot  be  arrested  by  any 
antisyphilitic  treatment.  There  is  no  reason  for  supposing  that 
constitutional  syphilis  predisposes  to  haemorrhage  from  the 
wounds.  Lastly,  there  is  no  relation  between  constitutional 
syphilis  and  pysemia.  The  above  results  were  obtained  more 
especially  with  a  view  to  the  consideration  of  the  influence  of 
eonatitutional  syphilis  upon  the  course  of  wounds  received  apoa 
the  field  of  battle,  (Arch.  eU  Lange«be-:k,'BA.  xai-  b^ 
AHh.  Qen.  de  Med.,  Feb.  1879.)— 7fc» 


I 


d 


CANADA 


tAml  m&  ^mijml  f  outm^l 


Montreal,  April,  1879. 

McGILL   UNIVERSITY. 

Proceedings  of  Convocation,  M.D.,  Slat  March,  1879. 

Long  before  the  hour  fixed  for  this  ceremony  the  William 
Molson  Hall  of  the  University  was  filled  with  students  and  their 
friends.  Shortly  after  three  o'clock  tho^  members  of  Convocation 
entered  the  Hall  and  the  Chancellor  assumed  the  chair. 

The  proceedings  were  opened  with  prayer  by  Archdeacon 
Leach. 

A  large  number  of  the  Governors  and  Professors  of  the 
different  Faculties  were  present. 

Dr.  Scott,  in  the  absence  of  the  Dean  of  the  Medical 
Faculiy,  Prof.  G.  W.  Campbell,  read  the  following  report  of  the 
Medical  Faculty  for  the  first  Session, 

The  total  number  of  students  enregistered  in  this  Faculty 
during  the  past  year  was  166,  of  whom  there  were,  from 

Ontario,            87.            New  Brunswick,  7. 

Quebec,            53.            P.  E.  Island,  3. 

Nova  Scotia,      5.            Newfoundland,  1. 
United  States,        14. 

^]jjn»  following  gentlemen,  40  in  number,  have  passed  their 

" '  Examinations  on  the  following  subjects :    Anatomy, 

liateria  Medica  and  Pharmacy,  Institutes  of  Medi- 


MEDICAL    AND    aUBQICAL   JOUENAL. 

residences  are 


cme  and  Botany  and  Zoology.  Their  names, 
as  follows : 


Ajer,  H Woodhlock,  N.E. 

Brown,  T.  L Ottawa,  t>. 

Beer,  Chu.  N.,  Gbulottot«wn,  P.E.I. 

Cuneron,  P Willi amatowD,  O. 

Chwoh  F.  W Aylmer,  Q. 

OhAlan,  J Wyaudottu,  mch. 

Cowley,  D,  K Ottawa,  O. 

DIbbleu,  O .  O . .  M.  Ktepheon,  N.B  . 

Edwards,  J.  \i Londun,  O. 

Pielde,  E.  C Prescott,  O. 

Frasor,  H.  D Pembroke,  O, 

Gr«y,  W.  L Pembroke,  O. 

Heyd,  H .  B. Bmntford,  O. 

Hlgglngon,  H.  A L'Orignal,  O. 

HeuderBon,  A Montieol,  Q. 

Josephs,  Q.  E Pembroke,  O. 

LauriQ,  E.  J Montrisal,  Q. 

Lang,  W.  A St.  Marys,  O. 

MaBH,K.L Negaiinec,  Mich. 

Migiiault,  L.  D.  B.A..  .Montreal,  Q. 


McDouald,  M.  C Montroal,  Q. 

McDooald,  J.  A ... .  Panmura,  P.E.I. 

HoUonald,  R.  T MontrtAl,  Q. 

Mackenzie,  K Mulboume,  Q. 

Mapkenzle.  B.  K.,  B.  A.  .Auron,  O. 
MeLaren,  D.  C.  B.  A.  .Montreal,  Q. 

MtQunoon,  E.  A Prest-ott,  O. 

O'CalaghBii,  T.  A.  B.A.Worceettn'JI. 

Pringlo,  A.  F CornwiUI,  O, 

Puifoni,  P.  W Detroit,  Mich. 

Ross,  O.  T Montreal,  Q. 

Rosa,  J.  W Wintbrop,  O. 

RiittHQ,  A.  M Nspanee,  O. 

Riordan,  B,  L Port  Eope,  O. 

Rogers,  E.J Peterboto,  O. 

Stewart,  J St.  Anicet,  Q. 

8lervi8,F  W IroquoiB,  0. 

Smith,  E.  H Montreal,  Q. 

Snow,  WH Dunda8,0. 

Stnithera,  il,  B I'hilHpsbnr^,  O. 


W.  C.  Perks,  Port  Hope,  has  passad  the  written,  but  owing 
to  illness  was  unablo  to  present  himself  for  the  oral  e-xambation. 

The  following  gentlemen,  S7  in  number,  have  fulfilled  all  the 
rotiuirements  to  entitle  them  to  the  degree  of  M.D.,  CM.,  from 
this  University.  These  exercises  conast  in  examinations  both 
writen  and  oral  on  the  fellowing  subjects :  Principles  and 
Practice  of  Surgery,  Theory  and  Practice  of  Medicine,  Obste- 
trics and  Diseases  of  Women  and  Children,  Medical  Jurispru- 
dence and  Hygiene,  —  and  also  Clinical  Examinations  in 
Medicine  and  Surgery  conducted  at  the  bedside  in  the  Hospital . 

Lloyd,  Hoys  W Strathoiy,  O. 

Lloyd,  Chas.  C Eoscoe,  IlL 

MeArthur,  Jobn  A ..  Underwood,  O. 
McCully, Oscar  ;.  M-A. Bosses, N.B. 
McCullough,  George.  .St,  Harys^  O. 
UcGuignn,  WQlinm  J . .  Stntlbrd,  O. 

MuNee,  Stuart Perth,  O. 

Menxies,  John  B Almonte,  O. 

Kiley,  Oscar  H Fnmkllo,  Vt. 

Rutherford,  M.  C .  Washington,  N.Y. 

Scott,  John  J Ottawa,  Q 

Seymour,  Maurice  M.Cht^stervlUe,0. 

Bbaw,  William  F Ottawa,  a 

Smith,  Jobn Torbollon,  O. 

Kpencer,  Richmond.. .  .UontrsMl  O     , 
Sutherland,  William  K.N' 
Weagant,  Clareoo'  * 
WilliBlOD."   » 


Brown,  J.  L Choaterlield,  O. 

Burwash,  Henry  J.,St.  Andrew's,  Q. 

BuUer.BillaF Stirling,  O. 

Carman,  Philip  S Iroquois,  O. 

Cjwman,  John  B Iroquois,  O. 

Chiriholm,  H..Locb  Lomond,  K.  H. 

Case,  William Hamilton,  O. 

flray,  Tboioaa Braeofield,  O, 

Groves,  Georjw  H Carp,  O. 

Giird,  David  F Moatreal,  Q. 

Hart,  Geo.  C.  .Osnubrook  Centre,  O. 

Hanno,  Franklin Harlem,  O. 

HenwDod,  Alfred  J.. .  .Brantford,  O. 
Imrie,  Andrew  W.  .Spencerville,  O. 

Irwin,  J,  L Montreal,  Q. 

Jackson,  Joxepb  A. .Lawrence,  H.Y. 

Jamieson,  Chas.  J OtUwa,  O. 

Lawford,  John  B Montreal,  Q. 

Lefcbvre,  John  M TofonW.  O 


ANNUAL   CONVOCATION,   M'gILL   UNIVERSITY.  425 

Frank  Buller,  M,D.,  M.R.C.S.  Eng.,  Lecturer  on  Diseases  of 
the  Eye  and  Ear,  receives  the  degree  in  course,  with  pro-forma 
examination. 

Of  the  above  named  gentlemen,  Mr.  J.  B.  Lawford  is  under 
age.  He  has,  however,  passed  all  the  examinations  and  fulfilled 
all  the  requirements  necessary  for  graduation,  and  only  awaits 
his  majority  to  receive  his  degree. 

The  following  gentlemen  have  passed  in  Anatomy  : — 

W.  Connack,  J.  H.  Carson,  F.  Tupper, 

G.  H.  Oliver,  F.  H.  Mewbum,  W.  A.  Derby, 

W.  J.  Musgrove,  C.  M.  Gordon,  G.  C.  Wagner, 

M.  McNulty,  A.  P.  Poaps,  J.  C.  Shanks,; 

The  following  gentlemen  have  passed  in  Materia  Medica  : — 

W.  Ck>rmack,  fl.  Lunam,  B.  A.,  W.  Sbufelt, 

M.  McNalty,  W.  Moore,  J.  C.  Shanks, 

*  A.  Dunlop,  A.  McDonald.  J.  Williams, 

•  J.  J.  Hunt,  T.  W.  Beynolds,  J.  B.  Harvie, 

T.  A.  Page, 

The  foUowing  gentlemen  have  passed  in  Chemistry  :— 

A.  P.  Poaps,  A.  H.  Dunlop,  J.  B.  Harvie, 

W.  Connack,  W.  T.  Derby,  W.  A.  Sbufelt, 

A.  McDonald,  T.  W.  Reynolds,  J.  C.  Shanks. 

A.  D.  Struthers,  J.  Williams,  G.  C.  Wagner, 
J.  McKay,  J.  J.  Hunt,  F.  U.  Mewbum, 
C.  M.  Gordon,  H.  Lunam,  B.  A.  W.  Moore, 
James  Boss,  B.  A.  B.  H.  Klock,  T.  A.  Page, 

B.  Fritz.  J.  H.  Carson, 

Tho  following  gentlemen  have  passed  in  Physiology  : — 

W.  Cormack,  A.  D.  Struthers,  J.  H.  Carson, 

H.  E.  Poole,  W.  A.  Sbufelt,  E.  Fritz, 

W.  J.  Musgrove,  C.  M.  Gordon,  R.  H.  Klock, 

A.  McDonald,  G.  C.  Wagner,  A.  H.  Dunlop, 

F.  H.  Mewbum,  T.  W.  Reynolds,  W.  C.  McGiliis, 

W.  Moore,  J.  J.  Hunt, 

The  following  gentlemen  have  passed  in  Practical  Anatomy  : — 

W.  A.  Sbufelt,  F.  H.  Mewburn,  W.  A.  Derby, 

F.  Tapper,  J.  C.  Shanks,  E.  Fritz, 

#         0.  X.  Gordon,  J.  H.  Carson, 

H^^/   Students  who  have  passed  in  Botany  : — 

Class  I. 

.BJL.  (prize).  Alex.  Shaw,  T.  N.  McLean, 

1  equal.  James  A.  Trueman,        E.  J.  C.  Carter, 
'2iidpr.  Philias  Vanier,  H.  Gale, 


rANADA  MEDICAL    AND   SUEOICAL   JOUENAI,. 


Clabb  U. 
Edmand  ObrUtie, 
T.  J.  Piorce  O'Brien, 
E.  C.  BuKe, 
W.  A.  DewoltSmilh, 
J.  H.  Shaver, 

Class  III. 
N.J.Hfnkley, 
C.  R.  H.  Harvey, 
C.  H.  Ormond, 
W.  W.  Denyer, 


John  Gratuun, 
W.  H.  ShaTor, 
John  H.  Bcott, 
T,  L.  Hartin, 


B.  F.  Campbell, 
George  Shrady, 
Albert  Cuthbeii. 


MEDAL  AND  PRIZES. 

The  Medical  Faculty  Prizes  are  four  in  number  : 

lat.  The  Holmes  Gold  Medal,  awarded  to  the  student  of  the    ' 
graduating  class  who  receives  the  highest  aggregate  number  of 
marks  for  the  best  examinations,  written  and  oral,   in   both 
Primary  and  Final  branches. 

'2nd.  A  prize  in  books  awarded  for  the  best  examinataon,  ■ 
written  and  oral,  in  the  tinal  branches.  The  gold  medallist  is  ' 
not  permitted  to  complete  for  this  prize. 

3rd,  A  prize  in  books  awarded  for  the  best  examination, 
written  and  oral,  in  the  primary  branches. 

4th.  The  Sutherland  Gold  Metal  awarded  for  the  boat 
examination  in  Theoretical  and  Practical  Chemistry,  with  cre- 
ditable passing  in  the  Primary  branches. 

The  Holmes  Gold  Medal  -was  awarded  to  John  B.  Lawford, 
of  Montreal. 

The  prize  for  the  final  Examination  was  awarded  to  A.  W. 
Imrie,  Spcncerville,  Ont. 

ITic  prize  for  the  Primary  Examination  was  awarded  to  John 
Andrew  McDonald,  Panmare,  P.E.L 

The  Sutherland  Medal  was  awarded  to  W.  I.  Gray,  Pem- 
broke, Ont. 

The  following  gentlemen  arranged  in  the  order  of  merit, 
deserve   honourable    mention  :  — In   the  Final   Examlaation,    ' 
Messrs.  Shaw,  Gray,  Sutherland  and  Williston. 

In  the  Primary  Examination,  Messrs,  Josephs,  W.  L.  Gray, 
J.  W,  Rosa,  Beer,  Rogers,  Henderson,  R.  B,  Struthers  and 
Heyd. 


ANNUAL   CONVOCATION,   M'GILL    UNIVERSITY.  42*7 

Professors'  Prizes. 

Botany,      -      H.  V.  Ogden,  B.  A.  St.  Catherines,  0. 

Practical  Anatomy. — Demonstrator's  Prize,  in  the  Senior 
Class,  awarded  to  Chas.  N.  Beer,  of  Charlottetown,  P.E.I0 
Junior  Class  prize  awarded  to  James  Ross,  B.  A.  Dewitville,  Q. 

The  Sporms  Academica  was  administered  by  Prof.  Osier, 
and  the  degree  of  M.D.,  CM.,  conferred  by  the  Vice-Principal, 
J.  W.  Dawson.  The  Chancellor  then  called  on  Dr.  Oscar  J. 
McCully  to  deliver  the  valedictory  on  the  part  of  the  graduating 
class.     That  gentleman  spoke  as  follows  : — 

What  a  mysterious  double-faced  picture  this  life  of  ours  is  ? 

How  strange  it  is  that  when  we  are  the  most  elated,  when  all 

about  us  appears  bright  and  happy,  we  have  only  to  stop  and 

think  to  recollect  that  somewhere  hangs  that  hideous  skeleton. 

Again,  when  deserted  and  despondent,  when  the  world  looks 

cold  and  drear,  we  have  only  to  look  to  see  the  silvery  lining 

of  the  dark  cloud.     Often,  in  a  storm,  as  the  clouds,  gloomily 

settUng  down,  have  encircled  the  mountain-top, 

f 

<<  And  storm  rolled  in  masses  dark  and  swelling. 
As  proud  to  be  the  thunder's  dwelling," 

And  as  the  winds,  let  loose  from  their  prison-tower  have  leaped 
forth  in  nimble,  tumultuous  glee,  and  as  the  God  of  the  storm 
has  rolled  in  chariot  along  the  vault  of  heaven*  above  us,  his 
apparel  as  black  as  night.  But  above  all  this  tumult  how 
carelessly  lies  the  fleecy  cloud, "  sleeping  in  bright  tranquility," 
while  the  sunshine  reflected  from  the  sparkling  ice-capped 
peak,  dances  upon  its  snowy  bosom  in  serenity  and  peace. 

And  so  with  us  to-day  ;  our  hearts  are  sad  within  as  we  look 
at  the  dark  side  of  our  meeting  together,  cheered  as  they  look 
at  the  more  hopeful  and  pleasing  side.  True,  we  do  rejoice 
that  we  have  received,  at  the  hands  of  our  Alma  Mater,  the 
highest  honor  she  can  confer  ;  we  feel  a  certain  degree  of  self- 
satisfaction  that  we  have  at  last  accomplished  that  which  we 
have  been  striving  to  do  during  our  college  course.  But  this  is 
only  one  side  of  the  picture.  Our  college  life  is  at  an  end,  and 
as  we  who  are  met  here  to-day  as  professors  and  students  know 


428  CANADA   MEDICAL    AND   8UB0ICAL   JOURHAL. 

full  well  that  we  shall  all  never  meet  again.  And  ve  who  have 
associated  with  each  other  for  four  years,  with  our  wonted  free- 
dom from  care,  must  part  perhaps  forever.  Our  songs,  our 
merry-makings  are  at  an  end.  Friendship  made  agreeable  by 
a  community  of  interest,  cemented  by  the  fact  that  we  have  the 
same  trials,  the  same  troubles,  the  same  triumphs  most  be 
broken.  Let  us  not  sa,y  broken,  for  though  separated  far  &om 
each  other  let  friendship's  ties  still  remmn  intact.  To-day  we 
are  sent  adrift  upon  the  cold  world,  the  responsibilities  of  the 
profession  we  have  chosen  thrown  fully  upon  ua.  Now  we  must 
tight  the  battle  alone,  with  no  more  practised  hand  to  guide,  no 
sager  head  to  direct  our  steps.  If  we  had  mastered  medical 
science  in  all  its  depth  and  breadth  perhaps  we  would  be  happy 
to-day.  But  if  we  ever  thought  we  could  so  master  it  in  a 
college  course,  we  must  be  surely  undeceived  by  this  time. 
No,  we  have  simply  entered  the  vestibule,  the  mighty  structure 
with  its  airy  windings,  its  unexplored  passages,  with  all  ita. 
vastness  and  grandeur,  lies  unexplored  before  us,  and  it 
remains  for  us,  by  a  life  of  unceasing  toil  and  unremitting 
energy,  to  grope  our  way  oat,  or  be  lost  in  its  perpetual  gloom. 
We  have  looked  forward  to  this  occasion  with  the  most  pleasing 
expectation,  and  have  thought  that  when  we  attained  the  goal 
of  our  college  life,  wo  would  be  happy  indeed.  It  has  come  at 
last,  but  it  appears  to  have  lost  all  the  sweetness  in  the  posses- 
sion, and  all  the  charm  now  Ues  in  the  retrospect  We,  like 
follow- travellers,  have  been  toiling  up  a  mountain  side  and  on 
our  way  have  met  many  difficulties.  We  have  complained  of 
the  rough  boulders  over  which  we  have  had  to  climb,  of  our 
winding  path  blocked  by  the  fallen  oak,  interrupted  by  the 
rushing  stream  and  dark  ravine  that  almost  threatened  us  with 
ruin.  Then  we  could  see  nothing  of  beauty  about  us,  all  waa 
toil  and  disappointment.  But  the  summit  gained,  we  cast  our 
eyes  over  the  green  valley  below,  with  its  winding  silvery 
brooks  down  the  mountain  ade,  with  its  green  loliage,  and  ita 
rocka  standing  out  as  black  knights,  guardians  of  a  foreign  land, 
and  disdain  has  lent  "  an  enchantment  to  the  view,"  and  all  is  ~ 
beautiful.  So  with  us  in  our  college  liie,  we  have  thought  it  hard 


I 


I 


,   DNIVZESITV. 

that  we  were  compelled  to  learn  things  as  foreign  to  our  profes- 
sion as  the  hieroglyphics  of  Egypt,  forsooth  though  censured 
with  the  fact  that  was  all  for  the  attainment  of  a  good  memory 
— such  an  essential  to  a  medical  man.  We  have  thought  it 
hani  that  we  have  had  to  take  down  lectures  word  for  word, 
then  to  learn  them  by  heart  and  repeat  them  verbatim  at  our 
exanunation.  We  have  thought  it  hard  when  we  could  only 
catch  a  word  now  and  then,  and  then  be  expected  to  iill  up  the 
misaing  links  in  our  notes,  and  to  pasa  creditable  examinations 
upon  them.  Bnt  now  that  we  have  toiled  through  all  these 
troubles  they  appear  the  most  pleasant  incidents  in  our  Bojoum 
hero.  And  there  is  no  doubt  but  that  in  after  years,  amid  the 
cares  and  responsibilities  of  the  profession  we  have  chosen,  wc 
shall  look  back  upon  the  picture  of  our  life  here,  and  all  the 
defects  that  mar  its  beauty  will  be  blotted  out,  and  only  the 
beautiful  and  charming  will  stand  out  in  bold  relief,  and  no 
doubt  we  will  come  to  the  conclusion  that  our  professors  know 
far  better  what  was  good  for  us  than  we  impudent  students  did 
ourselves.  Then  we  will  wonder  we  were  so  hard  to  please, 
and  amid  our  inevitable  troubles  we  will  long  for  the  good  old 
college  days  gone  by.  We  shall  long  to  see  the  old  halla,  to  see 
the  old  college  grounds,  where  so  often  in  merry  sport  we  for- 
got the  worry  and  vexation  of  studies  to  see  the  smiling  faces  of 
our  old  companions,  to  enjoy  once  again  the  gallop  and  game  of 
college  life.  To  our  fellow-students,  whom  we  leave  behind  us, 
we  bid  an  affectionate  farewell.  It  is  not  our  place  to  offer  you 
advice,  you  need  no  defence,  for  the  position  you  occupy  as 
medical  students,  and  you  shall  be  spared  a  senseless  eulogy  at 
our  hands.  And  as  we  leave  you  we  cannot  do  better  than 
e.xpress  a  hope  which  I  know  finds  a  warm  response  in  tbe 
hearts  of  my  fellow-graduatea  and  of  every  student  connected 
with  McGill  Medical  College,  that  during  your  stay  you  may 
see  the  greatest  curse  under  our  college  labors  swept  away.  I 
need  not  name  it,  for  every  sensible  student  and  professor  must 
know  full  well  what  it  is.  Often  as  we  have  bent  over  those  ill 
constructed  forms,  and  have  attempted  to  pen  all  the  words  of 
wisdom  as  they  fell  from  some  professor,  trying  to  say  so  much 


4,10 


CANADA   MEDICAl    AND   SrSOICAI.    JOCEXAL, 


in  so  long  a  time,  and  then,  vrearietl  vritli  this  m^re  mechaaical 
act,  have  apent  our  night  trying  to  decifer  what  we  had  written, 
(at  last  having  givffli  it  up  in  despair  and  disgust}  we  have 
come  to  doubt  that  we  were  living  in  the  enlightenment  of  the 
nineteenth  century,  but  to  think  that  we  were  groping  in  the 
darkness  of  the  middle  ages,  long  before  the  printing  press  had 
been  invented.  If  ouv  notes  are  to  be  the  main  source  of  our 
knowledge  why  impose  upon  us  poor  unoffending  wretches  such 
terrible  drudgery,  and  why  rob  the  professor  of  his  time  to 
instruct  and  explaia  Why  !  and  echo,  with  a  bitter  mocking 
voice,  sends  back  the  answer,  why  !  why  !  !  We  do  not  hed- 
tate  to  venture  the  assertion  that  one-half  of  the  labor  spent  hy 
the  student  in  medicine  in  McGill  is  worse  than  wasted  in  un- 
necessary note-taking ;  and  if  that  in  our  case  had  been  spent 
in  study  upon  the  clearly  printed  page,  and  the  professors  had 
spent  time  in  demonstration  and  examination,  what  prodi^ea 
we  new-pledged  doctors  of  to-day  would  be.  Gentlemen,  in  the 
interest  of  our  Alma  Mater,  which  we  wish  well  from  the  depths 
of  our  inmost  soul,  and  against  which  we  would  shun  to  say  a 
word  which  would  detract  from  her  usefulness  or  infringe  npon 
her  dignity,  we  wish  you  this  much  needed  reform. 

To  our  professors,  who,  during  our  course,  often  at  the 
expense  of  health  and  the  duties  of  their  profession,  have  devoted 
themselves  to  the  task  of  instructing  us  in  the  profession  we 
have  chosen,  we  return  our  sincere  thanks.  We  shall  not 
dettuu  you  with  the  usual  enumeration  of  your  many  virtues 
which  falls  to  the  lot  of  the  valedictorian,  but  shall  say  that  yon 
have  ample  reward  iu  the  knowledge  of  a  noble  work  well  done. 
Your  influence  haa  not  been  confined  to  the  round  of  your  daily 
cares,  but  has  been,  aud  shall  be  felt  in  thousands  of  homea 
throughout  the  Dominion,  and  throughout  the  world;  and  yott, 
must  have  the  highest  sense  of  happiness  in  knowing  that  yoa 
have  exerted  this  mighty  inlluence  for  the  best,  and  we  have 
only  to  lament  that  we  are  not  better  exponents  of  your  teaching. 
We  may  be  pardoned  here  if  we  seek  a  personal  digression, 
There  are  departments  in  McGill  which,  under  the  able 
btration  of  those  who  have  them  in  charge,  have  been  brought) . 
within  the  last  few  years,  almost  to  perfection.     The  professors 


I 


ANNOaL   convocation,    m'oILL   DNr^-EESITY,  431 

who  have  these  in  charge  may  have  the  satisfaction  of  knowing 
that  their  eflbrta  were  appreciated  by  the  students  now  leaving 
them.  We  refer  to  the  departments  of  Hospital  Clinics  and 
Practical  Anatomy,  and  make  bold  to  aay  that  whatever  may 
be  the  faults  of  McGtll  in  other  parti  culars,  at  least  in  these  she 
can  challenge  competition  with  any  teaching  body  in  medicino 
throughout  the  world. 

To  the  ladies,  the  vision  of  whose  smile  and  genial  presence 
here  to-day  has  been  an  incentive  to  the  discharge  of  our  duty 
throughout  our  college  course,  we  return  our  sincerest  thanks 
for  the  honor  done  us  by  being  with  us  to-day.  We  make  bold 
to  address  you  as  the  major  partners  in  our  profession.  When 
those  who  boast  themselves  as  being  the  most  manly  and  strong 
fails,  woman,  with  a  heroism,  has  still  been  true  to  her  part,  as 
the  deserted  streets  of  our  pestilence-stricken  cities,  the 
bloody  field  and  the  crowded  wards  of  our  hospitals  bear  ample 
witness.  And  we  must  admit  that  her  sympathy,  her  unremit- 
ting devotion  has  done  more  in  restoring  health  than  the 
fulfilling  of  our  directions  or  the  administration  of  our  nauseoufl 
medicine. 

The  science  and  practice  of  medicine  needs  no  defence  at  our 
hands.  We  pride  ourselves  on  having  chosen  one  of  the  most 
philanthropic  of  professions.  True,  it  is.  To  stand  beside  the 
bed  of  the  aged  invalid  and  smooth  his  pillow  for  his  inevitable 
grave,  to  stay  the  hand  of  death  from  laying  his  rude  hold  upon 
the  young,  the  beautiful,  and  the  strong ;  and  to  assuage  human 
suffering  wherever  we  may  find  it,  stirs  to  life  the  noblest 
impulses  of  the  soul.  Eut  there  is  a  nobler  and  higher  aspect 
of  our  profession  than  even  this,  which  lies  in  the  power  and  duty 
of  the  medical  man — to  educate  the  people  how  to  prevent 
disease.  The  world,  with  all  its  boasted  culture  and  improve- 
ment, is  not  perfect  yet.  And  is  it  not  strange  that  to-day  we 
do  not  understand  nor  practice  sanitary  science  and  practical 
hygiene  as  well  as  did  the  ancient  Romans  and  Greeks ;  and  in 
our  chaae  after  phantoms  which  too  often  renovate  we  have 
neglected  the  cultivation  of  that,  independent  of  which  we  can- 
not be  a  great  and  happy  people.  The  masses  are  not  alive  to 
^be  mighty  preventatives,  to  discover  which  they  have  in  the 


432 


CANADA   MEDICAL    AND   StTRGirAL    JOUBNAIa 


strict  obaervaDce  of  the  laws  of  health,  and  in  the  improvement 
of  their  sanitary  Burroundings.  Let  us  then,  ae  tnie  medical 
men,  make  war  upon  the  conditions  producing  disease,  until  we 
have  &  correct  public  opinion  and  proper  legislation  upon  these 
matters  which  heretofore  have  been  shamefully  neglected.  We 
now  who  are  about  to  play  our  parts  in  the  drama  of  life,  and 
as  we  enter  upon  the  practice  of  our  profession  let  it  not  be  in 
the  narrow  spirit  of  any  one  particular  school,  although  we  may 
be  called  by  the  name  of  the  oldest  and  moat  scientific,  but  tT 
there  is  any  good  in  other  schools  let  us  not  despise  it  simply 
because  it  is  called  by  a  name  objectionable  to  us.  Let  us  seek 
faithfully  for  the  truth,  and  finding  it  where  we  may,  let  us  put 
it  into  practice.  Let  ours  be  the  broad  school  of  doing  every- 
thing we  can  to  alleviate  suffering  and  better  mankind.  Let 
us,  proud  of  a  profession  as  noble  as  it  is  responsible  ;  proud  of 
a  University  which  we  delight  to  call  our  Alma  Mater,  whose 
very  life-blood  now  pulses  in  oar  veins,  stimulating  us  to  actions 
worthy  of  her,  and  whose  honor  and  integrity  we  shall  ever 
attempt  to  maintain ;  proud  of  a  country  vast  in  its  area,  bound- 
less in  its  resources,  great  in  the  present  but  still  greater  and  ■ 
grander  in  the  glorious  future  still  lying  before  it ;  let  us  go 
forth  with  God  o'er  head  and  heart  within  to  discharge  our  duties 
to  our  fellows  f^thfully  and  manfully.  And  at  last  when  we 
have  fully  played  our  part,  though  the  voices  may  not  tremble 
to  the  death  of  one  who  has  waded  through  slaughter  to  a 
throne,  though  we  be  not  borne  in  solemn  state  through  the  long 
drawn  aisle  and  fretted  vault,  we  may  be  paid  the  humble 
thought,  no  less  en\'iable  ti-ibutc  of  the  grateful  tears  of  those 
who  will  say  that  the  world  has  been  the  better  for  us  having 
lived  in  it.  Now  we  say  to  professors,  our  fellow- students  ajid 
to  the  kind  friends  who  have  honored  us  with  their  presence, 
farewell  A  word  that  must  be  and  hath  been  ;  a  sound  which 
makes  us  linger ;  yet,  farewell.  We  cannot  do  better  as  wo 
say  those  sad  words  than  apply  to  ourselves  the  closing  lines  of 
Thanatopsis : 

"  .So  live  that  when  thy  snmmoiiR  romes  to  join 
The  innnioarabte  camvan  thftt  mores 
To  Omt  mysteriouH  realm,  where  tuch  shall  take 
HIb  chamber  in  tlie  tiilent  batli  ot  dcstb, 
Thou  ^  not  like  the  qiiariy  slave  at  nlftht 
Scourgeil  to  hia  dungeon,  bat  ■uiloined  and  «oothed 
By  an  unfaltering  tcuirt,  appronoh  thy  grave 
Like  ony  who  wraps  thedmporyofhlR  cowih 
About  him,  and  li«8  down  to  pteuant  divamn." 


I 


•.  ^ 


CANADA 


Medical  &  Surgical  Journal 


MAT,  1879. 

Qriginal  Communications. 

SOME  PRACTICAL  HINTS 

ON  THE 

GENERAL    TREATMENT    OF    THE    INSANE; 

BY  HENRY  HOWARD,  M.D.,  M.R.C.S.,  Eng., 

Attendant  Physician  to  the  Longue  Pointe  Lunatic  Asylum,  President  of 

Montreal  Medico-Chirurgical  Society. 

Mr.  Vice-President  and  GENTLEMEN,-^During  my  long, 
forced,  absence  from  you  in  consequence  of  my  broken  arm,  I 
felt,  as  soon  as  I  was  able,  I  could  not  better  employ  my  time, 
nor  could  I  in  a  more  becoming  manner  prove  to  you  my  grati 
tude  for  your  kindly  expressed  sympathy,  than  by  preparing  a 
paper  to  read  before  the  society  ;  and  as  I  had  heretofore  given 
you  so  many  papers  of  a  theoretical  character,  that  this  paper, 
at  least,  should  be  practical.  Of  course  you  will  understand 
that  being  thus  employed  was  a  pleasurable  recreation  to  me. 
No  one  recognizes  more  fully  than  I  do  the  necessity  that  there 
is  for  the  animal  man  to  have  rest  from  both  physical  and  mental 
labor,  the  former  more  particularly ;  but  when  that  rest  is  forced 
upon  us  by  having  our  bones  broken,  we  do  not  value  it  very 
highly,  perhaps  not  as  much  as  we  should.  When  we  recover  we 
may  be  led  to  see  how  good  it  was  for  us,  but  when  we  are 
suffering,  it  is  hard  to  convince  us  where  the  good  comes  b. 
As  to  mental  rest  it  is  certainly  necessary  for  us  all,  but  that  ia 

NO.  LXXXII.  29 


434  CANADA  MEDICAL   AND  StJBOICAL  JOURNAL. 

best  obtained  by  changing  our  mental  occupation,  &om  time  to 
time,  so  as  not  to  weary  our  minds  by  always  dwelling  upon  the 
one  subject.  I  know  of  nothing  more  destructive  to  the  hvdinr 
worker  than  always  poring  over  the  same  work,  never  taking 
an  hour  of  recreation,  never  condescending  to  the  wise  foUy  of 
a  good  hearty  laugh.  The  best  advice,  I  think,  we  can  gjive  to 
all  labourers,  whether  their  work  be  mental  or  physical,  is  to 
follow  the  advice  of  that  philosophical  indiddual,  Mark  Tapley, 
and  be  "jolly  "  under  any  circumstance. 

I  propose,  gentlemen,  this  evening  to  give  you  a  few  general 
remarks  on  the  treatment  of  the  insane ;  and  when  I  speak  of  the 
insane,  I  confine  my  remarks  to  those  who  having  been  sane,  have 
from  some  cause  or  other  lost  their  sanity  and  become  insane, 
and  here  I  would  at  once  state,  that,  properly-speaking,  we  neve, 
cure  these  patients  ;  they  recover  their  sanity  which  they  lost, 
and  we  aid  in  this  recovery  by  prudent  and  well  directed  treat 
ment,  as  we  retard  their  recovery  very  frequently  by  unwar- 
rantable interference  and  ill-directed  treatment.  No  matter 
from  what  exciting  cause  a  sane  person  loses  his  sanity,  if  he 
do  not  recover  his  sanity  or  die  during  the  maniac^  attack,  he 
gradually  descends  into  a  state  of  imbecility,  in  which  he  dies, 
sometimes  after  a  short,  sometimes  after  a  long  period  of  time. 

It  is  not  necessary  for  me  to  infc»rm  the  members  of  this 
society  that  there  is  no  such  thing  as  a  specific  for  the  cure  of 
insanity.  How  could  there  be  when  there  are  so  many  direct 
and  renote  exciting  causes  to  produce  it  ?  It  may  be  due  to 
some  functional  derangement,  some  reflex  action,  deranging  the 
brain  or  its  coverings ;  or  it  may  be  due  to  some  direct  irritation 
of  the  brain  or  its  meninges,  or  to  some  lesion  of  the  brain 
substance  or  its  coverings ;  it  may  be  due  to  an  increased  or 
diminished  quantity  of  blood,  it  may  be  caused  from  thrombus, 
from  aneurism,  or  congestion,  it  may  be  caused  firom  abscess,  from 
tumour,  or  from  softening  of  the  substance  of  the  brain.  Seeing 
then,  gentlemen,  that  there  are  many  remote  and  direct  causes 
which  produce  insanity,  how  can  there  possibly  be  a  specific 
for  the  cure  of  insanity  ?  Yet,  we  find,  every  day,  our  medical 
literature  and  newspapers  teeming  with  remedies  for  the  cure  of 


TREATMENT  OP   THE  INSANE. — BY  DR,   HOWAED.  435 

insanity,  because  some  one  recovered  his  sanity  while  taking  some 
particular  medicine,  which,  probably  had  no  more  to  do  with  the 
recovery  of  the  patient  than  if  he  had  taken  so  many  drops  of 
cold  water.  When  you  see  these  reported  cases,  I  beg  that  you 
may  not  let  them  produce  any  strong  impression  upon  you.  When 
you  for  a  moment  think  of  the  anatomy  of  the  brain  and  its 
appendages,  and  its  connection  with  the  whole  human  frame,  even 
to  our  most  minute  organs,  by  means  of  the  sympathetic  nerves; 
when  you  consider  the  nerves  of  sense,  the  motor  nerves, 
all  forming  one  great  arch,  and  all  connected  with  the  brain ; 
the  sensory  nerves  and  the  vaso-motor  nerves ;  when  you 
remember  that  every  nerve  has  its  own  proper  centre,  either 
in  the  brain,  the  spinal  marrow,  or  some  of  the  numerous 
ganglia  of  the  sympathetic,  and  that  the  brain,  so  to  speak,  is 
the  grand  centre  of  all,  you  are  not  surprised  to  learn  that 
many  cases  of  insanity  arise  from  some  functional  or  organic 
derangement,  of  some  of  the  many  important  organs,  whether 
it  be  the  heart,  lungs,  liver,  kidneys,  organs  of  generation, 
or  organs  of  digestion.  Aye,  I  might  even  mention  our 
members  of  locomotion,  for  I  have  seen  insanity  caused  by  the 
amputation  of  a  limb,  and  some  of  our  greatest  physiologists 
have  pointed  out  the  fact,  of  brain  and  nerve  wasting  from 
the  loss  of  an  arm.  Again,  when  you  remember  that  the 
work  of  the  brain  is  never  done,  that  it  is  never  at  rest,  you 
are  not  surprised  to  learn  of  all  the  organic  changes  that  it 
is  subject  to,  any  of  which  may  give  rise  to  insanity.  I  say 
the  brain  never  rests,  for  to  have  perfect  rest  there  must  be 
.unconsciousness,  and  there  is  no  such  thing  as  unconsciousness, 
during  life  and  health.  When  we  see  a  person  in  a  very  sound 
sleep,  we  say  he  is  unconscious ;  he  may  be  to  many  things,  but 
not  to  everything.  Make  some  unaccustomed  noise,  and  let  that 
noise  be  an  alarm  of  danger,  for  example,  and  you  will  see  how 
soon  the  person  will  wake  up ;  or  touch  him  with  your  cold 
hand,  and  see  how  quickly  he  will  start  and  open  his  eyes  ;  or 
bring  a  light  into  a  dark  room  where  a  person  is  asleep,  and  you 
will  have  the  same  result,  or  put  some  unpleasant  odour  under 
his  nose,  you  will  have  the  same  result.  I  know  a  gentleman  a  id 


436  CANADA  MEDICAL  AND   SUBGICAL  JOURNAL. 

such  is  his  abhorrence  of  the  smell  of  a  bug,  tliat  if  one  gets  into 
his  bed  and  comes  within  smelling  distance  of  his  nose,  he  will 
awake  immediately,  with  a  feeling  of  nausea,  light  his  candle, 
and  if  possible  expel  the  intruder.  So  you  see  in  the  most  deep 
healthy  sleep  the  brain  hears,  sees,  feels  and  smells  ;  so  that  it  is 
never  unconscious,  but  keeps,  as  it  were,  constant  guard  over  us. 
I  need  not  tell  you,  gentlemen,  that  all  conciousness  is  centred  in 
the  brain  ;  it  is  the  brain  that  feels,  that  hears,  that  tastes,  that 
smells,  that  suffers.  Eulenburg  and  Gutman  in  their  ^^  Phy- 
siology and  Pathology  of  the  Sympathetic  System  of  Nerves," 
speaking  of  "  Neuralgia  Mesenterica,"  say :  "  At  the  present 
day  we  need  not  (Uscuss  the  doctrine  believed  in  by  Tanqaerel 
des  Planches,  and  many  other  physiologists  of  his  time,  that  the 
sensory  and  motor  centre  for  the  intestinal  viscera  is  to  be  found 
only  in  the  ganglia  of  the  sympathetic.  We  know,  on  the  eaa- 
trary,  that  the  sensorium  commune  in  men  is  exclusively  cere- 
bral, that  is,  that  sensory  impressicms  are  felt  only  in  the  brain, 
and  that  also  the  movements  of  the  vegetative  organs  are  in 
various  waps  controlled  and  modified  by  the  cerebro-^pinal  ner- 
vous centres,  as  has  been  proved  by  numberless  experiments  and 
pathological  observations  relative  to  the  stomadi,  intestines, 
ureters,  bladder,  uterus,  vasa  deferentia,  &c.  Such  a  statement 
as  Tanquerel,  des  Planches'  would  now  be  an  anachronism.  If 
we  keep  in  view  the  neuralgic  nature  of  the  group  of  symptoms 
known  as  entetralgia  or  colic,  the  only  important  subject  for 
investigation  is  concerning  the  peripheral  course  of  the  irritating 
action  ;  whether — ^to  express  it  more  clearly — ^this  is  c(mveyed 
to  the  sensory  centre  by  sympathetic  or  excluavely  by  cerebro- 
spinal afferent  fibres.  In  the  first  case  the  sympathetic  would 
have  to  be  regarded  entirely  a  sensory  nerve,  the  analogue  of 
the  sciatic  nerve  in  sciatica,  or  of  the  trigeminus  in  prosopal^." 
This  is  an  interesting  quotation  in  many  particulars,  but  my  object 
is  to  prove  to  you,  fi-om  such  authorities,  that  sensoiy  imjH'es- 
Qons  are  felt  only  in  the  brain.  True  we  attribute  the  pain  to  the 
part  affected,  for  example,  a  Mend  of  ours  could  tell  you  of  a 
case  that  came  under  his  observation  some  few  weeks  ago,  ifhea 
at  midnight,  he  found  his  patient,  an  old  gentleman,  otting  in  a 


TREATMENT  OP   THE  INSANE.— BY  DR.   HOWARD.  437 

hip-bath,  and  suffering  most  excruciating  pain  im  the  lower  part 
of  the  rectum,  that  is  to  say  the  rectum  was  the  part  affected  ; 
but,  of  course,  it  was  the  brain  that  took  cognizance  of  it ;  this 
was  a  case,  according  to  authorities  just  quoted,  of  spasmodic 
contraction  of  the  sphincter  ani,  analogous  to  colic,  but  in  a 
different  part  of  the  intestinal  canal.  I  am  happy  to  tell  you,  that 
the  said  old  gentleman  soon  obtained  relief  from  the  treatment 
prescribed  by  his  physician.  One  point  more  with  regard  to  the 
brain,  and  that  is,  does  the  healthy  brain  ever  cease  to  think  ?  That 
is,  does  it  cease  to  think  when  we  are  asleep  ?  From  a  psycholo- 
gical and  physiological  study  of  the  question  I  do  not  think  it 
does.  What  are  our  dreams  but  thinking,  thinking  at  random, 
if  you  wiU,  but  still  thinking.  But  the  fact  is  better  established 
by  the  many  cases  on  record  of  men  working  out  difficult  prob- 
lems during  their  sleep  that  they  had  failed  to  work  out  daring 
their  waking  hours.  It  may  be  said  that  the  brain  is  perfectly 
unconscious  under  the  influence  of  chloroform  or  narcotics ;  it 
may  be  so,  though  that  requires  proof ;  but  then  the  brain  is  not 
in  a  normal  state  under  the  influence  of  narcotics  or  chloroform, 
and  I  speak  of  it  in  its  normal  state.  And  now,  gentlemen,  I  have 
given  you  a  very  meagre  outline  of  the  anatomy  and  physiology 
of  the  nervous  system,  simply  to  show  you  that  the  brain  is  the 
great  nervous  centre  in  man,  and  how  exposed  it  is  to  suffering 
from  a  thousand  physical  causes,  in  addition  to  what  it  has  to  suffer 
mentally ;  and  as  in  a  previous  paper  I  stated  to  you  that  suffer- 
ing was  the  grand  exciting  cause  of  insanity,  to  those  who  had  in 
them  an  insane  neurosis,  you  will  not  be  surprised  that  so  many 
become  insane ;  but  your  surprise  will  be  that  more  do  not  become 
insane,  again  remembering  the  physiology  of  the  nervous  system. 
You  will  see  that  where  there  are  so  many  causes,  direct  and 
indirect,  for  interfering  with  the  healthy  action  of  the  brain,  you 
will  not  be  surprised  at  what  I  have  stated,  that  I  knew  of  no 
specific  treatment  for  insanity.  Therefore,  I  can  only  give  you 
some  general  remarks.  There  is  one  symptom  always  present 
in  all  cases  of  insanity,  although  it  arises  from  different  causes, 
and  that  symptom  is  insomnia  ;  no  matter  whether  the  cause  be 
organic  or  functional ;  whether  it  be  dependent  upon  the  circu- 


438  CANADA   MEDICAL    AND    SUBQICAL   JOURNAL. 

latory  Byatem,  the  organs  of  generation,  the  urinary  organs,  or 
the  digestive  organa,  the  motor  nerves,  or  the  sensory,  the 
sympathetic  or  the  vaso-motor  nerves;  in  all  cases  of  insanity 
you  have  inaomnia,  and  your  first  care  must  he  to  procure  for 
your  patient  sleep,  and  for  this  purpose  you  have  various  hyp- 
notics, but  you  must  be  very  cautious  how  you  use  them,  for  I 
have  seen  very  great  evi!  result  from  the  use  of  this  class  of 
medicine,  one  I  would  mention  in  particular,  and  that  is  chloral. 
I  speak  of  this  from  the  dlfBculty  of  knowing  the  doae  to  pre- 
scribe in  each  particular  case,  and  from  the  fact  that  I  invaria- 
bly find  that  after  its  effects  have  passed  away  it  leaves  the 
patient  more  excited.  You  havo  also  beer,  porter,  brandy, 
whiskey,  wine,  the  different  preparations  of  opium  and  bella- 
donna, &c.  Tou  know  how  these  different  hypnotics  act  as 
well  as  I  can  tell  you,  and  you  must  be  guided  in  their  use  by 
the  cause  that  produces  the  insomnia ;  you  would  not  give  the 
same  hypnotic  for  anremia  of  the  brain  as  for  hypersemia  ;  you 
would  not  give  the  same  hypnotic  to  a  full-blooded  over-fed  man 
that  you  would  to  a  half  starred,  wretched  creature.  In  all  cases 
you  would  be  guided  by  circumstances.  All  of  these  hypnotics 
you  can  give  by  the  mouth,  some  you  can  give  hypodermieally, 
or  by  enema.  Sometimes  you  will  find  that  a  sedative,  such  as 
bromide  of  potassium,  or  digitalis,  will  be  the  best  remedy  to, 
produce  sleep,  particularly  when  the  insomnia  is  excessive,  with 
heart- palpitation,  or  due  to  the  long  continued  use  of  stimulants 
where  delirium  tremens  was  threatened,  I  have  had  patients 
recover,  and  the  only  medicine  I  gave  them  was  five  drops  of  the 
tincture  of  digitalis  three  times  a  day,  and  that  for  a  few  days 
only.  Agam,  you  will  not  press  bromide  of  potassium  if  there  is 
ansemia  of  the  brain,  whereas  you  will  give  it  freely  if  there  is 
any  irritation  of  the  organs  of  generation.  Where  the  insomnia 
is  due  to  psychosis,  you  will  give  a  stimulating  hypnotic,  these 
arc  the  cases  where  your  beer,  wine  and  brandy  come  into  use. 
I  would  speak  of  the  hot  bath  as  one  of  the  beat  of  sedatives, 
and  indirectly  a  hypnotic,  but  even  this  remedy  must  be  used 
with  caution.  In  Paris  asylums,  however,  they  are  used  to  an 
excessive  degree,  even  to  keeping  a  patient  in  them  for  twelve 


I 

■ 

I 
t 


TREATMENT  OP  THE  INSANE. — BY  DR.  HOWARD.  439 

consecutive  hours,  having  him  well  fed,  or  as  they  say  "  stuffed  " 
while  in  the  bath. 

I  have  no  experience  of  this  treatment,  and  do  not  desire  to 
try  it,  any  more  than  I  desire  to  try  their  large  doses  of  morphia 
by  the  hypodennic  plan.  Counter  irritants  will  sometimes  prove 
the  very  best  hypnotic  that  you  can  use,  particularly  the  mustard 
poultice  over  the  abdomen.  I  have  had  patients  go  to  sleep  in 
a  few  minutes  under  the  irritation  of  a  mustard  poultice,  where 
all  other  hypnotics  have  failed  to  produce  sleep.  As  a  general 
rule,  you  will  always  find,  at  least  I  have  always  found,  that  in 
cases  of  insanity  there  is  always  excessive  constipation  ;  indeed 
I^ave  generally  found  the  large  intestine  impacted  with  faecal 
matter,  and  this  more  particularly  in  cases  of  hysterical  mania. 
Whether  this  is  cause  or  effect  it  is  very  hard  to  say.  I  am  inclined 
in  many  cases  to  look  upon  it  as  a  cause,  from  the  fact,  that 
after  a  good  purging  of  calomel  and  jalap,  I  have  frequently 
found  an  insomniac  sleep  well,  and  not  only  sleep  well,  but 
recover  without  further  treatment.  When  we  remember  the 
distribution  of  the  sympathetic  nerve  and  its  numerous  ganglia 
there  is  nothing  far-fetcljed  in  supposing,  that  such  impaction 
of  the. large  intestine,  causing  continual  pressure  upon  these 
nerves  should  act  as  an  exciting  cause  of  insanity,  more  particu- 
larly if  the  case  be  one  of  hysterical  mania.  When  we  are  sure  of 
what  is  the  cause  of  hysteria.  I  will  tell  you  the  cause  of  hyster- 
ical mania.  All  I  can  say  at  present  is  that  it  is  exaggerated 
hysteria;  and  it  appears  now  to  be  generally  admitted  that  it  is 
due  to  some  derangement  of  the  ovaries.  This  view  is 
strengthened  by  some  authors  stating  that  direct  pressure  made 
on  the  ovaries,  through  the  abdominal  parietes  will  arrest  an 
attack  of  hysteria,  I  cannot  speak  of  this  treatment  from 
observation,  for  although  there  may  be  no  great  difficulty  in 
making  pressure  with  the  hand  upon  the  ovaries,  it  would  be  a 
very  different  affair  in  a  case  of  hysterical  mania  ;  indeed  I  have 
found  that  the  less  I  touch  these  hysterical  maniacs  the  better ; 
for  even  the  feeling  of  their  pulse  will,  very  frecjuently,  excite 
them  to  a  fearful  degree,  and  much  as  I  wish  sometimes  to 
examine  their  heart  sounds  to  assist  me  in  my  diagnosis,  I 


440  CANADA  HSDIOAL  AND  SURGICAL  JOURNAL. 

abstain  from  the  exaniination  in  consequence  of  the  terrible 
excitement  I  have  seen  it  produce.  You  will  ask  what  are  the 
other  symptoms  in  hysterical  mania  necessary  to  be  known 
to  guide  our  treatment.  In  the  second  number  of  Brain  there 
is  an  article  by  Milner  Fother^ll,  M.D.,  (M.R.C.P.)  on  the 
"  Neurosal  and  Reflex  Disorders  of  the  Heart,"  in  which  he 
says :  ^^The  circulation  is  closely  linked  with  the  emotions,  not 
only  the  heart  but  the  peripheral  vessels  with  their  large  muscu- 
lar walls.  In  joyous  emotion  we  find  the  peripheral  vessels 
dilated,  the  extremities  warm,  and  the  heart  beating  vigorously. 
On  the  other  hand  dread  and  anxiety  contract  the  arterioles, 
the  face  is  pallid,  and  the  hands  are  chill,  the  blood-pressure  in 
the  arteries  heightened,  and  the  renal  secretion  is  profuse." 
Again  he  says  •  •  •  •  «  Jugt  as  there  are  persons  whose 
stomachs  are  easily  deranged,  others  where  the  liver  is  readily 
disturbed ;  so  there  are  those  whose  brains  are  quickly  upset, 
and  whose  hearts  beat  excitedly  from  very  slight  causes."  *  • 
♦  *  «  it  r£^Q  heart  was  regarded  by  the  older  physiologists 
as  the  seat  of  the  emotions,  and  it  is  certainly  in  intimate  relation 
with  the  reproductive  organs."  You  see  then  how  necessary  it 
is  to  know  the  state  of  the  heart  in  a  case  that  you  suspect  to  be 
hysterical  mania ;  you  may,  however,  be  pretty  sure  when  you 
have  the  cold  extremities,  you  have  mth  that  nervous  palpitation, 
and  you  will  at  once  perceive  that  the  treatment  in  such  cases 
must  be  both  sedative  and  tonic.  The  best  sedatives  I  have  found 
in  all  cases  of  mania,  particularly  in  the  hysterical  form,  are 
bromide  of  potass,  and  digitalis,  and  the  best  tomics  arsemc  and 
nux-vomica, — of  course,  I  speak  as  a  general  rule. 

From  time  to  dme  you  see  in  our  medical  periodicals  certain 
medicines  as  cures  for  epilepsy  and  epileptic  mania.  I  have 
tried  very  many  of  these  remedies,  and  I  have  seen  better 
results  from  the  mixture  recommended  by  Brown  S^quard  than 
firom  any  other  moiiioinos  ;  as  long^  however,  as  we  remidn  in 
ignorance  of  the  o^uso  of  e^ulepsy  we  cannot  place  much  con- 
fidence in  any  remevly.  The  following  are  the  best  remarks  on 
the  subjoct^  1  quote  a^iu  from  Eulenburg  and  Gutman : 
^*  The  relation  of  epilei^sy  to  the  sympathetic  system,  is  still 


TBBATMENT  OF  THE  INSANE.^— BY  DR.  HOWARD.  44l 

very  obscure,  on  the  whole  the  view  formerly  advanced  by  us 
appears  lately  to  have  gained  ground  :  that  many  cases,  espe- 
cially of  so-called  peripheral  epilepsy  are  of  an  angio-neurotic 
nature,  and  owe  their  origin  partly  to  a  direct,  and  partly  toa 
reflex  irritation  of  the  vaso-motor  nerves.  Benedikt  states  that 
the  epileptic  attack  is  primarily  caused  by  sudden  spasms  or  re- 
laxation of  the  vessels,  and  presents  the  most  complete  analogy 
to  neuitdgic  attacks,  only  that  here  the  irritation  afiects  chiefly 
the  vaso-motor  nerves,  and  so  leads  directly  or  indirectly  to 
anaemia  or  hyperaemia  of  the  brain.  He  also  thinks  himself 
justified  in  assuming  that  the  hippocampus  major  indicated 
by  Meynest  as  the  part  affected  in  epilepsy  is  a  vaso-motor 
centre,  irritation  of  which,  whether  from  the  cerebral  hemis- 
pheres or  by  reflex  influences  from  the  periphery,  induces  the 
phenomena  of  the  epileptic  seizure." 

Nothnagel  holds,  on  the  strength  of  his  formerly  cited  experi- 
ments, that  the  cervical  sympathetic  has  a  certain  control  over 
the  actions  of  the  pia  mater,  contraction  of  which  is  accompan- 
ied by  contraction  of  the  arteries  of  the  brain,  which  have  the 
same  origin ;  and  therefore  believes  that  the  epileptic  seizure  is 
the  result  of  the  anemia  of  the  brain  consequent  on  the  reflex 
contraction  of  its  vessels.  According  to  this  theory  the  sympa- 
thetic plays  a  most  important  part  in  bringing  on  the  epileptic 
attack,  as  most  of  the  vaso-motor  nerves  of  the  pia  mater  are 
included  either  in  the  cervical  part  of  the  sympathetic  or  in  the 
ganglion  supremum.  Other  investigators  (Schultz,  Riegel, 
Jolly,)  have  not,  however,  confirmed  the  experimental  grounds 
on  which  this  doctrine  rests. 

When,  gentlen^en,  we  see  such  different  opinions  from  the 
greatest  physiologists  and  pathologists  of  the  day,  as  to  the 
cause  of  the  epileptic  seizure,  we  must  see  how  uncertain  is  any 
mode  of  treatment.  However,  the  deadly  pallor  that  comes  over 
the  patient,  with  the  cold  extremities  and  feeble  pulse  just  before 
the  seizure,  would  lead  us  to  believe  that  the  sympathetic  and 
vaso-motor  nerves  play  an  important  part  in  the  attack.  My 
own  experience  of  epileptic  maniacs  is,  that  they  never  recover  ; 
thie,  that  they  get  over  the  maniacal  attack,  but  for  it  only  to 


442  CANADA  BIEDIOAL  AND   SURGICAL  JOTJRNAL. 

^oome  on  agam,  generally  with  more  violence.  I  am  not  even 
prepared  to  say  that  any  medical  treatment  will  shorten  these 
maniacal  attacks,  they  seem  to  get  over  them  just  as  well  without 
as  with  medicine ;  putting  them  in  the  cell  and  leaving  them 
alone  seems  to  answer  all  purposes.  But  for  the  time  b6ing 
they  are  a  most  dangerous  class  of  maniacs,  and,  as  I  stated  to 
you  in  my  paper  on  the  Medical  Jurisprudence  of  Ins'anity,  so 
impulsive  as  never  to  be  trusted.  Tou  must  not  suppose  that  all 
epileptics  are  maniacal,  many,  very  many  epileptics  pass  through 
life  most  intelligent  men,  and  live  to  a  good  age  and  never 
show  symptoms  of  insanity.  These  epileptics  rarely  apply  for 
relief  to  medical  men,  and  when  they  do  they  very  soon  get  tired 
and  give  up  treatment.  There  is  a  form  of  epilepsy,  when  not 
accompanied  by  mania,  that  you  may  keep  in  subjection  by 
medical  treatment,  that  is  by  attending  to  their  general  health, 
and  every  couple  of  months  giving  Brown  Sequard's  mixture 
for  eight  or  ten  days,  changing  it  occasionally  for  atropine.  I 
speak  of  that  form  that  the  French  designate  ^*  Petit  Mcd.^^ 
In  this  form  the  patient  never  falls  to  the  ground,  never  foams 
at  the  mouth.  They  simply  get  a  sudden  spasm  as  they  describe 
it,  of  the  heart ;  the  face  becomes  deadly  pale,  there  is  slight 
twitching  of  the  eyelids  and  corner  of  the  mouth,  the  person  is 
still  for  a  moment  of  time,  and  the  fit  passes  ofi*,  very  frequently 
in  less  than  a  minute.  I  have  a  patient,  at  present,  in  the 
asylum  who  is  an  epileptic  maniac,  and  always  knows  when  his 
severe  fits  are  coming  on  by  having  these  slight  attacks  which 
he  c&lls  *'  side  shows." 

I  do  not  propose  to  give  you  in  this  paper,  all  the  difierent 
forms  there  are  of  insanity,  and  the  symptoms  to  be  found  in  the 
difierent  forms ;  to  do  so  would  take  months  daily  lecturing. 
Ail  I  proposed  was  to  give  you  a  few  general  remarks  applicable 
to  nearly  all  cases,  and  that  you  should  be  guided  in  your  treat- 
ment by  general,  well-understood,  and  recognized,  medical  prin- 
ciples* and  that  you  should  not  be  carried  away  with  the  idea, 
that  certain  medicines  and  a  certain  mode  of  treatment  cured 
insanity  and  cured  epilepsy. 

I  wiU  now  qpedc  of  ikd  iMXtl  timtinent  applicible  as  a  general 


TREATMENT  OP  THE  INSANE. — BY  DR.  HOWARD.  443 

rule  to  all  cases  of  insanity.  A  medical  man  or  any  one  else , 
whose  duty  it  is  to  exert  a  moral  influence  over  their  insane 
patient,  must  not  think  he  can  do  so  by  looking  Btem  or  fierce  at 
them  ;  that  was  a  delusion  in  former  days,  but  it  is  long  since 
played  out.  We  must  begin  with  a  feeling  to  our  patient  of  pity 
akin  to  love,  and  the  sooner  we  come  to  love  our  patient  the 
better  for  the  patient  and  ourselves  ;  no  action  of  our  patient 
must  ever  shock  our  sensibilities,  no  matter  how  gross  or  unseemly 
that  action  may  be.  We  must  always  remember  that  their  whole 
thoughts  and  ideas  are  perverted,  and  that  in  virtue  of  their 
disease  they  are  irrtsponsible  beings,  we  must  look  upon  all  their 
acts  and  actions  with  a  feeling  as  near  as  possible  to  the  feelings 
of  a  mother  when  she  looks  upon  the  actions  of  her  baby  child. 
Whatever  chance  there  is  in  gaining  a  moral  influence  over  an 
insane  person  by  kindness,  there  is  no  chance  whatever  by 
being  cross  and  angry  with  them,  or  by  punishing  them.  These 
remarks  I  wish  to  stamp  deep  in  the  memories  of  all  those  who 
have  anything  to  do  with  the.  treatment  or  management  of  the 
insane. 

When  any  organism  is  deranged  from  any  cause,  whether  it 
be  organic  or  functional,  the  first  thing  we  must  do  is  to  try  and 
procure  rest  for  that  organ.  Therefore,  the  first  thing  we  have 
to  do  in  all  cases  of  insanity  is  to  procure  rest  for  the  brain,  and 
this  I  believe  is  best  accomplished,  as  a  general  rule,  by  remov- 
ing the  patient  as  speedily  as  possible  from  friends  and  from 
all  their  surroundings,  and  placing  them  in  a  well-directed  and 
well-managed  insane  asylum,  where  they  will  meet  with  no  con- 
tradiction to  their  insane  views ;  where  they  will  have  no  one 
to  dispute  with,  or  enter  into  discussions  to  try  and  convince 
them  that  they  are  talking  folly,  yet  where  they  will  a,t  once  feel 
that  they  are  under  both  moral  and  physical  control,  the  former 
always,  the  latter  if  necessary.  It  is  astonishmg  how  soon  an 
insane  person  yields  himself  to  the  moral  condition  that  per- 
vades a  well-managed  insane  asylum,  and  how  seldom  it  is  found 
necessary,  even  with  the  worst  cases,  to  have  resort  to  physical 
restraint.  I  would  not  have  you  to  suppose  that  I  am  opposed  to 
physical  restraint,  because  sometimes  it  is  actually  necessary, 


444  CANADA  MEDICAL   AND  SURGICAL  JOURNAL. 

not  only  for  the  safety  of  others  but  for  the  safety  of  the 
patients  themselves ;  but  I  would  have  you  to  believe  that  I 
would  have  such  restraint  the  exception,  not  the  rule.  As 
such  restraint  very  frequently,  particularly  if  long-continaed, 
only  makes  the  patient  more  excited,  the  best  restraint  to 
an  excited  patient  is  to  place  him  in  a  cell  and  leave  Um 
alone ;  understand,  I  do  not  mean  a  dark  cell,  for  darkness 
is  as  pernicious  to  the  insane  as  to  the  ^ane  brain.  In  a  paper 
I  read  at  one  time  before  this  society,  I  said  the  best  means  to 
develop  the  youthful  brain  was  by  good  feeding,  good  clothing, 
good  air,  and  healthy  exercise,  in  fact  that  you  developed  the 
brain  as  you  did  the  bone  and  muscle  of  the  body ;  now  if  this 
be  the  best  means  to  develop  the  youthful  brain,  you  can  easily 
understand  how  it  must  be  the  very  best  means  to  re-create  the 
diseased  or  disordered  brain.  Remember  that  suffering  of  one 
sort  or  other  is  the  great  exciting  cause  of  a  sane  man  becoming 
insane,  and  do  not  let  your  patient  have  any  suffering  that  you 
can  relieve  him  of.  Give  him  all  the  amusement  you  possibly 
can  to  divert  his  thoughts  from  himself;  whether  that  amuse- 
ment be  playing  cards,  or  working  in  a  garden,  but  let  there  be 
no  compulsory  labour.  With  regard  to  giving  patients  enough 
of  good  wholesome  food,  you  may  be  sure  as  long  as  an  insane 
person  does  not  put  up  flesh,  but  daily  diminishes  in  weight,  he 
is  not  improving  mentally ;  if  you  will  have  a  strong  mind 
you  must  have  a  strong  body 

I  hope,  gentlemen,  from  anything  I  have  said  you  would  not 
be  led  to  suppose  that  I  have  given  up  my  theory  of  heredity, 
on  the  contrary,  the  greater  my  experience,  and  the  more  I  study 
the  opinions  of  others,  the  more  am  I  convinced  of  the  truth  of 
this  theory,  and  in  conclusion  I  will  quote  on  this  point  some 
statements  from  very  high  authorities. 

In  the  January  number  of  the  Journal  of  Mental  Science 
(for  1879),  there  is  an  article  headed  "  Researches  in  Idiocy, 
by  J.  MiERZEJEWSKi,  Professor  in  the  Medico-Chirurgical 
Academy  of  St.  Petersburgh,  translated  by  Dr.  D.  Hack  Tukb,'* 
in  which  he  makes  the  following  statement :  "  The  study  of  the 
anatomy  of  the  brains  of  Idiots  is  a  vast  field  accessible  to 


TREAT>rENT  OP   THE  INSANE. — BY  DR.   HOWAKD.  445 

research,  which  may  serve  to  throw  light  upon  some  questions  of 
psychiatry  hitherto  obscure,  but  which  possesses  an  undeniably 
practical  value.  It  ought  to  enable  us  to  comprehend  better 
the  questions  which  relate  to  hereditary  insanity.  It  is  unde- 
niable that  the  vices  of  physical  conformation  of  ancestors  are 
transmitted  to  their  descendants,  and  that  this  phenomenon  is 
the  point  de  depart  of  pathological  varieties. 

There  are  not  only  physical  malformations,  but  also  rmral 
perversions,  which  are  subject  to  the  laws  of  hereditary  trans- 
mission. We  understand,  in  short,  that  moral  perversions  in 
the  ancestors  accompanying  malformations  of  the  brain  are 
susceptible  of  being  transmitted  from  one  generation  to  another. 
We  are  disposed  to  admit  equally  the  existence  of  anomalies  of 
the  brain  in  those  individuals  who  present  a  predisposition  to 
hereditary  insanity." 

I  should  have  told  you,  gentlemen,  that  this  is  from  the  sum- 
mary of  a  paper  read  by  the  Professor  at  the  Paris  International 
Congress  of  Mental  Medicine,  August,  1878. 

In  the  first  number  of  Brain  for  April,  1878,  there  is  a 
splendid  article  on  "  Brain  Forcing,"  by  T.  Clifford  Allbutt, 
M.A.,  M.D.,  Physician  to  the  Leeds  Infirmary.  I  wish  it  could 
be  placed  in  the  hands  of  every  school  teacher  in  the  world, 
and  indeed  in  the  hands  of  every  parent.  He  makes  the  follow- 
ing statement,  speaking  of  the  brain  ;  ''  Quality  as  I  have  said, 
cannot  be  had  for  the  asking,  it  is  fitful  in  its  growth  and  often 
born  out  of  due  time.  It  should  be  favoured  by  the  continuous 
inheritance  of  culture,  but  the  mode  of  its  epiphany  lies  in  the 
same  darkness  Ti^ith  that  developmental  nisus  which  lies  behind 
the  advance  of  life  upon  the  globe.  Inherited^  as  it  doubtless 
must  be,  yet  its  arising  cannot  be  foreseen  in  the  span  of  human 
generation."  You  see  that  I  have  not  given  you  my  belief  in 
heredity  any  more  than  I  have  my  belief  that  mind  and  body 
are  one,  on  the  contrary  I  have  shown  you  strong  reasons  why 
I  should  adhere  to  these,  which  have  been  called  by  some  of  my 
opponents,  "  Dr.  Howard's  pet  theories." 

You  will  naturally  say  what  benefit  do  you  derive  from  my 
remarks,  if  all  the  insane  are  to  be  sent  into  the  lunatic  asylums. 


446  CANADA  MEDICAL  AND  SUBQICAL  JOURNAL. 

But  I  only  made  this  the  rule,  there  are  exceptions  to  it.  There 
are  those  who  will  not  let  their  friends  be  placed  in  an  asylum, 
under  any  consideration  ;  and  there  are  those,  who,  if  placed 
in  an  asylum  would  receive  more  harm  than  good ;  when  you 
meet  with  those  cases  you  will  have  to  treat  them  in  their  own 
dwellings.  You  will  then  have  to  convert  a  part  of  the  house 
into  an  asylum,  in  so  far  that  you  must  separate  your  patient 
from  the  immediate  family,  and  provide  a  good  keeper  and 
nurse-tender  for  them  who  will  strictly  carry  out  jour  instruc- 
tions. Five  different  members  of  the  society  have  had  such 
cases,  where  I  have  been  called  in  consultation,  and  each  and 
every  case  have  recovered  their  sanity.  So  you  see  it  is  neces- 
sary that  you  should  give  some  of  your  ftttention  to  the  treat- 
ment of  insanity.  I  do  not  see  why  many  cases  of  mental 
disorders  should  not  be  treated  at  home,  and  by  any  medical 
practitioner  who  chooses  to  treat  them,particularly  cases  of  puer- 
peral mania,  when  removal  is  sometimes  attended  with  great 
danger  to  the  patient :  but  I  also  think,  as  I  have  already  said, 
that  the  necessary  physical  as  well  as  the  moral  force  should  be 
used,  and  the  treatment  that  has  proved  efficacious  in  asylums, 
should  be  applied  to  similar  cases  when  treated  outside.  But  as 
a  rule,  for  the  reasons  already  given,  I  believe  an  asylum  the 
best  place  for  the  treatment  of  the  insane. 

There  is  one  thing,  however,  you  can  all  do,  and  which  you 
are  bound  to  do,  and  that  is  to  always  remember  that  prevention 
is  better  than  cure  ;  and  it  is  for  you  to  use  your  best  efforts  to 
prevent  the  increase  of  insanity  by  opposing  with  all  your  persua- 
sive powers,  brain  forcing  in  both  the  young  and  middle-aged  ; 
by,  when  you  are  consulted  on  the  marriage  question,  honestly 
telling  those  who  seek  for  your  advice  the  danger  to  be  appre. 
bended  from  persons  marrying  where  there  is  hereditary  taint, 

by  teaching  men  to  live  sober,  chaste  and  cheerful  lives,  observ- 
ing moderation  in  all  things.  Above  all  you  must  impress  upon 
society  that  if  we  wish  to  diminish  insanity  and  its  twin  sister 
crime,  we  must  do  so  by  diminishing  poverty  and  ignorance.  It 
is  not  yet  established,  and  I  am  not  prepared  to  say  that  it  ever 
will  be,  that  all  criminals  are  insane,  yet  it  is  very  hard  to 
believe  that  a  man  can  be  very  sane  who  forces  society  to  deprive 
him  of  his  freedom  and  place  him  under  restraint 


* 


FBACTURE  OP  THE  PATELLA. — BY  DR.  RODOSR.      44*7 

FRACTURE  OF  THE  PATELLA, 

PLEURO-PNEUMONIA    DURING    CONYALESCENCE : 
THROMBOSIS  OF  PULMONARY  ARTERY. 

BY  THOS.  a.  RODGER,  M.D.,  POINT  ST.  CHARLES. 

J.  B.,  aet.  45  years,  a  tall,  powerfully-built  man,  met  with  a 
fracture  of  the  patella  on  the  morning  of  the  20th  of  December, 
1877.  Nothing  particular  (transpired  during  the  first  month,) 
more  than  is  commonly  met  with  during  attendance  upon  such 
cases,  and  at  the  end  of  that  period  I  removed  the  splint 
appliances,  and  I  put  the  knee-joint  in  a  preparation  of  plaster- 
of-paris,  which,  by-the-way,  the  patient  spoke  of  as  being  very 
comfortable.  At  this  time  union  felt  pretty  firm,  and  every- 
thing in  connection  with  the  fracture  seemed  doing  well. 

On  Monday,  the  4th  of  February,  the  seventh  week  from  the 
date  of  the  accident,  I  was  requested  to  visit  the  patient,  and 
found  that  he  had  not  been  feeling  well  for  two  or  three  days, 
yet  not  suflEiciently  ill,  as  he  thought,  to  seek  for  advice. 

I  found  his  face  very  much  flushed,  and  he  appeared  some- 
what excited  and  anxious ;  tongue  coated,  bowels  constipated. 
He  drew  my  attention  to  the  large  quantity  of  urine  he  had 
passed  during  the  last  twelve  hours :  filling  six  pickle  bottles, 
sp.  gr.,  normal,  of  good  color,  and  no  albumen.  Pulse  120  ; 
temperature,  100^,  respirations  40. 

Has  had  no  chill,  no  cough ;  there  is  no  dulness  on  percussion 
behind,  and  only  a  few  crepitant  rales  heard  during  deep  inspira- 
tion, audible  only  for  a  time,  then  disappearing.  Treatment 
B;.  Liq.  ammon,  acet.  with  tinct.  digitalis,  and  poultices  of  linseed 
meal  and  mustard  to  the  chest. 

February  5th, — Face  still  very  much  flushed,  and  breathing 
hurried.  Pulse  110 ;  temperature,  99  2-5^.  Bowels  acted 
freely  during  the  night.  Complaining  of  pain  in  the  right  side 
on  deep  inspiration.  Faint  pleuritic  friction«murmur  to4)e  heard 
at  point  referred  to  as  seat  of  pain.  Slept  very  little  all  night, 
and  required  to  occupy  a  half-sittmg  position  for  comfort,  owing 
to  dyspnoea. 


448  CANADA  MEDICAL  AND  SU|L01CAL  JOUBNAL. 

6tA. — Patient  somewhat  easier  this  morning,  and  passed  a 
better  night,  countenance  also  bearing  a  less  anxious  expresdon . 

Pleuritic  friction  still  distinct,  though  faint,  but  entire  absence 
of  cough,  a  few  crepitant  rales  to  be  heard  posteriorly  at  base 
of  the  lungs,  but  no  dullness.  Advised  change  of  posture 
to-day ;  in  fact  have  been  urging  so  for  many  days  back,  but 
patient  is  afraid  to  move  on  account  of  fracture. 

1th. — Temperature  100  3-5®.  Pulse  120,  and  he  is  restless 
and  nervous.  Complains  of  suffocation,  or  tightness  about  the 
chest.  Heart  and  lungs  both  examined,  the  former  perfectly 
healthy,  the  latter  not  presenting  anything  more  than  already 
mentioned.  Respiration  hurried,  dyspnoea  considerable.  Will 
not  allow  himself  to  be  much  disturbed,  and  has  taken  very  little 
nourishment,  but  considerable  alcoholic  stimulants. 

8tk, — Much  the  same  as  yesterday,  only  that  he  has  taken 
more  nourishment. — ^Has  been  sitting  np  for  a  short  time  on  so&. 

9tk. — Still  no  change.  Slept  well  during  early  part  of  last 
night. 

10th, — Restless  all  night.  Pulse,  120 ;  temperature  101^. 
Again  complaining  of  feeling  of  suffocation. 

I  asked  Dr.  Drake  to  see  the  case  with  me  this  morning  and 
after  examining  the  patient  thoroughly,  he  agreed  that  possibly 
the  symptoms  were  due  to  long  confinement  to  bed,  and  again 
it  was  urged  that  the  sitting  posture  be  adopted. 

Cardiac  and  alcoholic  stimulants  to  be  still  continued. 

10  p.m. — Pain  in  the  side,  very  severe,  administered  gr. 
morph.  mur.  (hypodermically).    Dyspnoea  not  so  severe. 

11^/i. — Has  had  a  pretty  good  night,  and  feels  comfortable. 
Face  still  still  slightly  flushed.  Pulse  112,  Temperature  100^. 
Pulse,  40.  He  has  been  lying  on  his  right  side  since  early 
morning,  and  says  that  he  thinks  that  he  breathes  more  freely 
in  that  position. 

12^A. — Did  not  sleep  all  night,  very  restless.  Bowels  moved 
freely  eariy  this  morning.  Temperature  102  3-5^  Pulse  128 ; 
respirations,  50.  Called  Dr.  Drake  in  consultation  again  to- 
da/.  Found  slightly  diminished  resonance  on  percussion  at  the 
lower  angle  of  both  scapulae,  but  on  auscultation  the  respiratory 


FRACTURE  OF  THE  PATELLA. — BY  DR  RODGER.      449 

murmur  is  quite  indefinite  in  character.  No  heart  murmur  can 
be  detected,  but  the  action  of  the  organ  is  somewhat  tumultuous 
in  character.  No  cough  whatever.  Had  a  slight  attack  of 
syncopy  this  afternoon  on  sitting  up  to  take  a  little  nourishment ; 
and  again  made  reference  to  the  feeling  of  suffocation,  before 
referred  to. 

lith. — ^I  was  summoned  very  early  this  morning,  the  patient 
having  been  very  restless  all  night,  complaining  of  severe  pain 
at  the  lower  end  of  the  sternum,  and  immediately  below  the 
right  nipple.  Again  administered  J  gr.  morphia  hypodermically. 
Pulse,  120 ;  temperature  100^ ;  respirations  45.  10.  p.m. 
Still  making  complaint  of  pain  at  lower  end  of  sternum,  and 
below  the  right  nipple.  Speaks  of  the  pain  as  being  constant, 
attended  with  a  feeling  of  tightness. 

Ordered  hot  poultices  of  linseed  and  mustard,  and  left  word 
with  attendants  that  if  the  pain  continued  or  became  worse  to 
send  me  word. 

At  midnight  patient  expressed  himself  as  feeling  much  easier, 
and  was  about  to  have  a  poultice  applied,  when  he  was  again 
seized  with  a  syncopal  attack,  and  before  I  reached  the  house, 
which  was  in  a  few  minutes,  expired. 

Post-mortem,  by  Dr.  Oslbr. 

Patella  is  fractured  in  transverse  direction,  segments  united 
by  fibrous  tissue.  Some  of  synovial  folds  are  injected,  in  spots 
haemorrhagic. 

Heart  of  average  size.  Clots  in  right  auricle,  and  in  the 
ventricle  there  is  a  small,  tolerably  firm,  buff-coloured  clot  closely 
interwoven  with  the  chordae  tendineae.  On  slitting  up  the  pul- 
monary artery,  a  firm  thrombus  occupies  the  trunk,  adherent  to 
the  lower  wall,  and  it  extends  into  the  right  and  left  branches, 
not  entirely  .filling  their  lumina,  but  closely  united  where  in  con- 
tact with  the  intima.  On  further  dissection  the  thrombi  can  be 
followed  into  many  ot  the  branches  of  the  3rd  and  4th  degree. 
They  are  reddish-brown  in  colour,  firm,  not  laminated,  but  of  . 
leathery  consistence  throughout. 

Nothing  of  special  note  in  left  chambers. 

In  right  pleura  half  a  pint  of  turbid  fluid  ;  upper  lobes  crepi- 
tant and  of  good  colour,  and  on  section  there  are  one  or  two 
spots  of  red  hepatization.     Pleura  over  the  part  inflamed. 

No  infarctions.  Left  lower  lobe  also  dark,  and  but  slightly 
crepitant,  but  no  hepatization.  Nothing  of  note  in  other  organs. 

NO.   LXXXTT.  30 


450  CANADA    MEDICAL   AND   SDR6ICAL    JOUBNAL. 

CASE   OF  INTUSSUSCEPTION, 

WITH  SEPARATION   AND  PASSAGE  BY  STOOL   OF    17  INCHES 

OF  INTESTINE— RECOVERY. 

By  L.  Tremain,  M.D.,  Edin.,  of  Charlottbtown,  P.  E.  I. 

Read  before  the  Medico-Chirurgical  Society  of  Montreal. 

We  are  indebted  to  Dr.  James  McLeod  of  Charlottetown, 
Prince  Edward  Island,  for  the  following  very  interesting  case 
from  notes  taken  at  the  time  by  Dr.  Tremain.  The  specimen 
was  shown  at  the  meeting  of  the  Medico-Chirurgical  Society  of 
Montreal,  held  on  the  2nd  May,  1879. — Ed. 

On  the  12th  March,  1879, 1  was  called  to^  see  Albert  Best, 
aged  14  years,  who  had  been  ill  for  some  nine  days,  suffering 
from  constipation  and  pain  in  the  abdomen.  He  had  been  under 
the  care  of  another  medical  man,  but  in  consequence  of  his 
absence  I  was  requested  to  see  the  patient.  I  found  considerable 
pain,  some  tenderness  and  tympanitic  distention  of  the  abdomen. 
There  was  no  fever,  the  surface  of  the  body  was  cool,  and  his 
pulse  not  over  80.  I  was  informed  that  he  had  had  no  passage 
from  his  bowels  since  the  2rid  March.  There  was  a  look  of 
much  anxiety,  he  had  been  vomiting  freely  during  the  day,  and 
I  was  shown  a  chamber  utensil,  which  was  half  full  of  vomited 
matter,  thin  and  feculent.  This  was  the  third  time  he  had 
vomited  a  quantity  of  matter  similar  in  quality. 

Before  I  saw  him.  I  was  informed  that  he  had  had  several 
enemata,  and  some  purgative  medicine,  but  no  result  had  followed 
except  the  discharge  of  some  hardened  masses  from  the  lower 
bowel.  Hot  fomentations  had  been  used  freely  and  constantly.  I 
ordered  immediately  large  enemata  of  warm  water,  and  repeated 
them  frequently  throughout  the  treatment,  at  the  same  time  I 
ordered  six  powders  of  calomel  and  opium,  which  were  repeated 
every  four  hours.  I  saw  him  frequently  throughout  the  three 
following  days,  during  which  time  the  treatment  consisted  in  the 
administration  of  opium,  without  the  calomel,  hot  fomentations 
over  the  abdomen,  and  enemata.  On  the  16th  his  bowels  were 
freely  moved,  which  gave  much  relief,  and  he  took  nourishnrent 


CASE   OP    INTUSSUSCEPTION. — BY.    DR   TREMAIN.  451 

which  he  retained.  During  all  this  time  there  were  no  decided 
symptoms  of  inflammation,  his  pulse  was  never  over  90,  and  the 
temperature  was  almost  normal ;  but  there  did  exist  tenderness 
on  pressure  over  the  abdomen.  On  the  16th  he  appeared  to  be 
doing  well,  and  the  following  day  he  got  up  and  dressed.  This 
indiscretion  was  followed  on  the  19th  by  a  tendency  to  diarrhoea, 
which  was,  however,  arrested  by  the  use  of  opium. 

On  Saturday,  22nd  March,  he  sufiered  from  some  discomfort 
and  pain  in  the  abdomen ;  his  bowels  had  not  moved  for  two 
days,  and  his  friends  gave  a  cathartic  pill,  and,  as  there  was 
much  pain  fomentations  were  applied  and  a  dose  of  solution 
of  morphia  given  in  the  evening.  The  following  morning, 
Sunday  the  23rd,  he  had  a  free  motion  and  passed  by  stool  a 
portion  of  intestine,  after  the  passage  of  this,  he  had  two 
more  motions,  liquid  in  consistence,  no  blood  but  feculent  in 
character,  after  which  he  was  free  from  pain,  and  slept  well 
during  the  night.  I  had  not  seen  the  patient  since  the  previous 
Wednesday,  as  at  time  he  appeared  to  be  convalescing,  and  I 
ceased  my  attendance.  On  Monday,  24th  March,  I  was  again 
requested  to  see  my  patient,  his  friends  being  anxious  about  what 
had  been  passed  by  stool.  They  kept  it  for  my  inspection  and 
at  the  visit  I  found  him  looking  much  better  and  stronger.  There 
was  some  soreness  of  the  bowels,  on  pressure  over  the  abdomen, 
but  perfect  absence  of  all  pain,  his  pulse  was  about  75,  skin 
natural,  tongue  clear,  and  he  was  taking  his  food  with  a  relish. 
He  felt  so  well  that  he  desired  to  be  up  and  dressed,  but  I  deemed 
it  more  prudent  to  keep  him  still  in  bed.  The  following  day, 
Tuesday,  he  was  much  in  the  same  condition.  Had 'a  stool  m 
the  evening  accompanied  with  some  •pain,  which  was  relieved  by 
a  draught  of  solution  of  morphia,  and  he  passed  a  comfortable 
night ;  from  this  time  he  gradually  recovered,  and  is  at  present 
in  fair  health. 

I  will  now  endeavour  to  give  a  description  of  the  portion  of 
intestine  passed :  When  laid  on  a  flat  surface  it  measured  seven- 
teen inches  in  length,  attached  to  its  outer  surface  was  a  portion 
of 'the  mesentery  about  2  J  inches  in  width ;  the  diameter  of  the 
tube  varied  from  1^  inches,  at  its  smallest  end,  to  three  inches 


452  CANADA  MEDICAL  AND  SURGICAL  JOURNAL. 

at  or  about  its  centre.  The  smallest  extremity  was  'lark  and 
easily  broke  down  when  handled  ;  it  was  considerably  fringed. 
The  cavity  can  be  filled  with  water,  when  it  presents  the  usual 
appearance  of  a  portion  of  bowel.  There  was  no  appearance  of 
exudation  of  lymph  on  the  peritoneal  covering ;  with  the  excep- 
tion of  one  extremity  the  color  was  that  of  normal  bowel,  though 
darker  than  in  the  healthy  state,  and  was  firm  in  consistence, 
the  valvulae  conniventes  being  well  seen.  The  portion  of  bowel 
I  secured  at  the  time  of  my  visit  on  Monday  the  24th,  and  after 
cleansing  it  preserved  in  a  mixture  of  carbolic  acid  and  alcohol, 
for  the  purpose  of  sending  it  to  the  museum. 

Charlottetown,  P.  E.  I.,  April  20, 1879, 

hospital  3i^eports. 

Medical  and  Surgical  Cases  Occurring  in   the  Practice  ok  the 

Montreal  General  Hospital. 

MEDICAL  CASES  UNDER  DR.  OSLER. 

I.   Miners^  Phthim. 

Reported  by  Mr.  Rankine  Dawson. 

J.  T.,  act.  60,  native  of  Cornwall,  admitted  April  16th. — 
Father,  a  miner,  died  at  the  age  of  63,  of  consumption.  Mother 
at  age  of  85.  Has  worked  in  mines  since  the  age  of  14  ;  in 
lead  and  tin  until  15  years  ago,  when  he  came  to  America,  and 
since  then  has  worked  in  copper,  zinc  and  plumbago  mines.  Has 
enjoyed  good  health  during  the  greater  part  of  his  life.  Is  a 
moderately  temperate  man.  About  three  months  ago  noticed 
a  slight  cough,  which  has  persisted  ever  since.  He  has  failed 
gradually  in  health  and  strength,  and  has  not  been  able  to  resume 
work.  On  Miarch  3rd,  came  to  Lennoxville  where  he  remaned 
twelve  weeks,  and  then  came  to  Montreal. '  Has  attended  the 
out-door  department  of  the  Hospital  for  three  weeks. 

April  ISth, — Examined  for  the  first  time. 

An  elderly,  moderately  emaciated  man ;  appears  to  prefer 
the  sitting  posture.  Face  and  hands  a  little  suffused,  as  if 
capillaries  were  over -full. 


HOSPITAL   REPORTS*  453 

CheBU — On  inspection  right  side  somewhat  sunken  in  front, 
and  does  not  expand  so  freely  as  the  left.  On  percussion,  dulness 
for  three  fingers'  breadth  below  right  clavicle,  clear  over  3rd 
and  4th  ribs,  dullness  again  below,  merging  with  that  of  the  liver. 
Clear  note  at  left  apex  in  front  and  over  both  bases  behind.  On 
auscultation,  cavernous  breathing  at  right  apex,  with  a  loud 
click  at  end  of  inspiration.  Expiration  is  prolonged  and  accom- 
panied by  whistling  r&les  at  the  left  apex  and  at  the  bases. 
Breath  sounds  are  feebler  in  left  than  in  right  scapular  region. 
Expectoration  viscid  and  glairy.  Heart's  impulse  cannot  be  felt, 
dullness  much  diminished.  Sounds  normal.  Pulse  90,  feeble  ; 
temperature  normal.    Bowels  regular ;  urine  dark-coloured. 

During  the  evening  he  sank  rapidly,  respirations  became 
shorter,  heart's  action  feeble,  and  he  died  about  midnight 

Post-mortem. — In  abdomen,  liver  depressed,  reaching  nearly 
to  the  navel.  In  thorax,  left  lung  extends  over  beyond  the 
middle  line  ;  no  adhesions  on  this  side ;  right  lung  universally 
adherent. 

Heart.  —  Right  chamber  full  of  blood  and  clots ;  20  ozs. 
escaped  on  removal  of  the  organ.  Right  auricle  large ;  tricuspid 
orifice  dilated,  measuring  over  15  Ctm.  in  circumference.  Right 
ventricle  dilated  and  hypertrophied ;  chamber  measures  from 
pulmonary  ring  to  apex  15  Ctm.,  wall,  about  middle,  7  m.  in 
thickness.  Left  ventricle  appears  of  normal  size.  Valves  healthy. 
Weight  of  organ  445  grms. 

Lungs. — Moderately  dark  in  colour.  Left  crepitant,  except 
at  one  area  behind.  Pleura  covering  the  lung  uniformly  dark, 
except  at  the  posterior  part  of  lower  lobe,  where  it  is  thickened 
and  of  an  opaque-white  colour.  Entire  upper  and  anterior  part 
of  lower  lobes  emphysematous.  A  number  of  small  firm  spots 
can  be  felt,  and  these  on  section  of  the  organ  are  seen  to  be  dense 
fibroid  areas,  excessively  pigmented.  Except  in  these  spots, 
and  about  the  vessels  and  bronchi,  the  lung  tissue  is  not  of  a 
dark,  but  rather  of  a  slate-grey  colour.  Behind  in  an  elongated 
area,  extending  through  both  lobes,  measuring  18  by  6  Ctm.  and 
4.5  Ctm.  in  depth,  the  lung  tissue  is  converted  into  a  firm  fibrous 
mass  of  inky  blackness.     On  section  it  cuts  with  resistance, 


454  CANADA  MEDICAL  AND   SURGICAL  JOURNAL. 

surface  smooth,  but  in  places  there  are  small  irregular  spaces  as 
if  the  tissue  were  breaking  down.  They  could  not  be  traced 
in  connection  with  bronchi  and  contain  dark-coloured  fluid. 

Right  lung. — Pleura  very  much  thickened  over  antero-lateraJ 
regions,  not  so  much  so  at  posterior  part  and  about  the  root. 
At  the  lower  and  front  part  there  is  an  encapsulated  pleurisy, 
about  the  size  of  the  palm  of  the  hand,  containing  5  to  6  oz.  of 
clear  fluid. 

On  section  of  the  organ  a  cavity,  the  size  of  an  orange,  half- 
filled  with  purulent  matter,  is  found  at  the  apex,  occupying 
chiefly  the  posterior  part.  It  has  very  thick  walls,  especially  in 
front,  where  the  pleura  is  greatly  developed.  Very  few  trab- 
culae  exist  on  the  walls  and  none  cross  the  cavity.  A  long 
extension  from  it  passes  downwards  and  forwards  towards  the 
middle  lobe.  The  extreme  apex  and  the  entire  anterior  margin 
are  composed  of  dense,  firm,  excessively  pigmented  fibrous  tissue, 
which  also  surrounds  the  cavity  in  its  lower  and  anterior  parts. 
Middlelobe  is  emphysematous,  lower  lobe  crepitant ;  on  section 
numerous  fibroid  and  pigmented  areas  as  in  other  lung.  At  its 
anterior  margin  it  is  compressed  by  the  encapsulated  pleurisy 
above  referred  to.  No  caseous  masses  in  either  lung.  Mucous 
membrane  of  bronchial  tubes  thickened ;  they  contain  a  good 
deal  of  secretion.  Bronchial  glands  pigmented  and  hard,  none 
caseous.    Nothing  of  special  note  in  the  other  organs. 

Remarks, — This  case  supplements  in  an  interesting  manner 
the  one  I  reported  in  this  journal  in  1876,  in  which  the  disease 
was  in  an  early  stage  ;  and  fully  sustains  the  statement  then 
made — from  an  examination  of  three  specimens — that  "  in  its 
essence  the  disease  would  appear  to  consist  of  an  overgrowth — 
a  hyperplasia — of  the  fibrous  tissue  of  the  lungs  induced  by  the 
chronic  irritation  to  which  they  are  subject  by  the  inspired  par- 
ticles of  carbon,  a  veritable  cirrhosis,  or,  as  it  might  appropriately 
be  called,  the  black  cirrhosis  of  miners."  The  detailed  histo- 
logical description  will  appear  in  the  forthcoming  Pathological 
Report  of  the  Hospital. 


HOSPITAL   REPORTS.  455 

II. — Acute  BrigMs  Disease  in  a  child.  Remarkahle  per- 
sistence of  blood-corpuscles  ,and  casts  in  the  urine  after 
disappearance  of  Albumen, 

Reported  by  Mr.  Andrew  Henderson. 

.  R.  B.,  aet.  6,  an  inmate  of  the  Ladies'  Benevolent  Home  for 
the  past  two  months  ;  previous  to  which  time  he  had  suffered 
great  privations.  Admitted  to  Hospital  April  1st,  with  dropsy. 
Had  been  ailing  for  a  few  days  before  admission,  but,  owing  to 
the  illness  of  the  Matron  of  the  institution,  no  satisfactory  account 
could  be  obtained  of  this  period  of  his  illness.  According  to  Dr. 
Wilkins  there  were  no  evidences  of  diphtheria  or  scarlet  fever. 
When  admitted  there  was  general  dropsy  ;  urine  scanty,  bloody 
and  albuminous,  specific  gravity  1040  ;  and  pain  in  lumbar 
regions.  Heart's  action  much  increased.  Temperature  101^. 
Vomited  a  good  deal. 

April  Zrd. — Urine  1^  oz.,  sp.  gr.  1030  ;  contains  blood  and 
albumen.  Temperature,  101^. 

bih. — Swelling  of  arms  and  face  almost  gone.  Urine  16  oz. 
Less  albumen.     Heart's  action  not  so  violent. 

1th, — Case  transferred  to  Dr.  Osier.  Urine  24  oz.,  clear, 
light-coloured,  no  albumen.    Temperature  99^. 

9iA. — Examined  carefully.  Skin  soft,  no  signs  of  desquama- 
tion. Throat  normal.  Dropsy  has  entirely  disappeared.  Nothing 
special  observed  in  examination  of  heart,  lungs  and  digestive 
organs.  Urine  26  ozs.  contains  no  albumen,  but  blood  corpus- 
cles and  casts  exist  in  the  sediment. 

Vlth, — 23  ozs.  of  urine  ;  no  albumen.  Fine  granular  casts, 
and  blood  corpuscles ;  latter  not  in  sufficient  numbers  to  colour 
the  urine,  four  or  five  can  be  seen  in  each  field  of  the  microscope. 

18^A. — Urine  examined  each  day.  Casts  persists  in  consider- 
able numbers.  No  albumen.  Blood  corpuscles  not  noticed 
to-day. 

23rd. — 23  oz.  of  urine  ;  no  albumen.  Sp.  grav.  1008,  very 
clear  and  watery -looking.     Blood  corpuscles  but  no  casts. 

2Uh. — 20  oz.,  dark  and  more  natural-looking  in  colour. 
Albumen  in  small  amount  for  the  first  time  since  the  6th. 

21th. — 20  oz.,  sp.  grav,  1010.  Blood  corpuscles  and  casts 
still  to  be  found.     No  albumen. 

2%th. — Still  a  few  blood  corpuscles  to  be  found  in  each  field  of 
the  microscope.     No  casts  ^ 

May  8th. — Urine  has  been  normal  during  past  week.  Patient 
removed  to  the  Home  quite  well. 


CANADA   MErrCAL    . 


;<liCAL    JOURNAL. 


3^uieius  and  Botices  of  Boohs. 


The  National  Dispensatory, — contaiuing  the  Natural  History, 
Chemiatrj,  Pharmacy,  ActiouB  and  Uses  of  Medicines, — 
including  those  recognised  in  the  Pharmacopcoias  of  the 
United  States  and  Great  Entain.— By  Alfred  Still£. 
M.D.,  LLJ>.,  Professor  of  the  Theory  and  Practice  of 
Medicine,  and  of  Clinical  Medicine  in  the  University  of 
Pennsylvania,  and  JouN  Maisch,  Ph.  D.,  Professor  of   ' 
Materia  Medica  and  Botany  in  the  Philadelphia  College  of  I 
Pharmacy,  veith  two  hundred  and  one  illusti'atione.    Royal   ' 
8vo.  pp.  1028.    Philadelphia:  Henry  C.  Lea,  1879. 

We  well  remember  when  we  were  students  the  United  Stales  1 
Dispensatory  by  Wood  and  Bache.     Irj  those  halcyon  days  it  J 
was  looked  up  to  with  great  respect  as  an  authority  upon  all  | 
matters  pharmaceutical  and  even  therapeutical.    Neglect,  how- 
ever, to  issue  it  under  successive  editions,  to  keep  it  ait  courant  I 
with  the  latest  advances  of  Medical  Science  on  the  branches  J 
within  its  domain,  has  east  it  into  comparative  unfitness  for  the 
present  times.     Its  place  is  well  taken  by  the  National  Dispen- 
satory recently  published  from  the  press  of  Lea  of  Philadelphia. 
This  last  work  is  upon  the  aame  model  as  its  predecessor.  Like   . 
it,  and  indeed  like  all  other  "  Dispensatories,"  the  alphabetical  I 
order  of  taking  up  the  description  of  the  remedies  included  is 
that  wliich  is  adopted.     This  has  the  advantage  of  facilitating  i 
reference;  and   ia  free  from  the  objections  so   easily  raised' 
against  any  system  of  classification.     Contrasted  with  the  older 
treatise,  this  one  ia  certamly  far  superior.     Without  entering 
into  minute  details,  it  may  be  safely  said  to  be  better  because  it 
is  more  comprehensive.     It  Includes,  as  the  title  states,  the 
medicines  given  not  onlyby  the  United  States'  Phannaeoposia,— 
but  also  those  contained  within  the  British  one.     The  extent  of  \ 
the  work  may  bo  inferred  from  its  containing  1G28  pages,  8vo. 
It  has  also  the  indispensable  reijuirement  in  a  standard  work  J 
of  being  modern,  that  is  to  say  presenting  the  reader  with  infor-l 
mation  upon  the  various  subjects  ijuite  up  to  the  day.     New  I 
remedies  of  any  worth,  and  the  latest  preparations  which  are  I 


EEVIEWS  AND   NOTICES  OF   BOOKS.  457 

recognised  will  be  found  in  their  respective  places,  set  forth  in 
a  clear  and  masterly  way.  As  an  example  we  may  mention 
Ferrum  Dialysatum,  or  Dialysed  Iron.  In  vain  might  the 
inquirer  turn  over  the  pages  of  other  works  on  Materia  Medica 
for  a  satisfactory  account  of  this  popular  agent.  In  the  learned 
volume,  however,  before  us,  there  is  in  two  pages  an  admirable 
digest  of  what  one  would  like  to  know  on  the  subject.  Any 
work,  pharmacological  or  medical,  in  which  Dr.  Stills  has  had  a 
hand,  would  commend  itsdf  to  the  favorable  consideration  of  all 
who  know  anything  of  his  great  abilities.  His  able  work 
"  Therapeutics  and  Materia  Medica  "  is  a  monument  of  his 
research  and  industry  and  talent.  We  know  not  what  special 
part  devolved  upon  his  associate,  nor  have  we  before  made  his 
acquaintance  ;  but,  from  the  general  goodness  of  the  articles  and 
the  apparent  equality  of  merit  in  their  treatment,  we  conclude 
that  he  is  if  not  "  a  foeman  worthy  of  his  steel," — a  collabora- 
teur  worthy  of  the  pen  of  his  senior.  We  need  hardly  say  the 
getting  up  of  the  work  is  as  excellent  as  of  others  that  have 
been  issued  by  the  same  well  known  publisher. 

Clinical  Lectures  on  Diseases  peculiar  to  Women. — By  Lombe 
Atthill,  M.D.,  Master  of  the  Rotunda,  Dublin,  &c.,  &c. 
Fifth  edition,  revised  and  enlarged,  with  illustrations,  8  vo. 
342.  Philadelphia :  Lindsay  &  Blakiston,  1879. 

This  excellent  manual  is  from  the  pen  of  a  thoroughly  practi- 
cal man  who  has  enjoyed  unusual  opportunities  as  Master  of  the 
Rotunda  Hospital,  Dublin.  The  work  has  received  universal 
commendation,  and  on  the  subjects  treated  of  in  these  pages,  it 
remains  unrivalled  as  an  instructor. 

The  work  consists  of  seventeen  lectures,  which  we  presume 
form  the  base  of  the  course  delivered  by  Dr.  Atthill  before  his 
class.  In  the  first  lecture  we  have,  after  a  few  introductory 
remarks,  some  very  excellent  hints  on  the  method  of  conducting 
an  examination  in  cases  of  diseases  of  the  uterus,  or  vagina  ; 
these  consist  essentially  of  digital  examination,  the  use  of  the 
speculum  and  the  uterine  sound.  The  author  points  out  the 
necessity  of  examination  both  by  touch  and  sight  to  facilitate  an 
accurate  diagnosis.  Leucorrhoea,  va      tis  and  vaginismus  form 

jsnui 


458  CANADA  MEDICAL  AND  SURGICAL   JOUENAL. 

the  subjects  in  the  second  lecture.  In  this  aire  given  some  prac* 
tical  suggestion  in  the  management  of  that  almost  constant 
pruritus  which  is  so  distressing  a  feature  in  these  affections.  In 
.the  ensuing  four  Lectures,  the  derangement  of  menstruation  are 
discussed,  after  which,  we  have  two  Lectures  on  uterine  polypi 
and  uterine  fibroids.  The  author  then  passes  on  to  the  considera- 
tion of  inflammation  of  the  cervix  uteri,  both  acute  and  chronic, 
endometritis  and  endocuvicitis ;  we  next  have  lectures  on  dis> 
placements  of  the  uterus,  enlargements  of  the  uterus,  the 
varieties  of  cancer  with  the  treatment. 

There  are  two  lectures  on  ovarian  disease,  cysts,  unilocular 
and  multilocular,  and  dermoid.  Ovariotomy,  is  then  discussed, 
and  the  statistics  of  the  results  of  the  operation.  He  gives  the 
wonderful  success  of  Mr.  Spencer  Wells,  showing  the  steady 
decrease  in  mortality  of  the  operation  in  the  practice  of  that 
surgeon,  who  reports  a  mortality  of  only  fourteen  per  cent,  in 
his  private  practice.  On  this  subject  the  author  remarks  :  "  I 
cannot  but  feel  that  no  small  portion  of  this  success  is  due  not 
only  to  the  dexterity  of  the  operator,  but  to  the  skill  which  he 
has  exhibited  in  selecting  suitable  and  rejecting  unsuitable 
cases,  a  dexterity  and  skill  which  all  cannot  hope  to  attain,  and  I 
fear  that  the  average  of  all  the  operations  undertaken  in  Great 
Britain,  will  still  show  a  considerably  higher  mortality  than 
that  here  recorded." 

The  remaining  two  lectures  are  devoted  to  uterine  therapeu- 
tics. These  lectures  throughout  are  written  in  a  most  pleasing 
style,  full  of  interest  and  practical  instruction,  and  we  freely 
commend  the  work  to  our  readers.  It  is  to  be  had  of  Dawson 
Brothers,  St.  James  Street. 

Medical  Chemistry^  including  the  outlines  of  Organic  and 
Pathological  Chemistry,  —  Based  in  part  on  Richd's 
Manual  de  Clinic.  By  C.  Gilbert  Wiieeleu,  Prof,  of 
Chemistry  in  the  University  of  Chicago,  &c.,  &c.  8vo.  pp. 
424.  Philadelphia :  Lindsav  &  Blakiston  ;  Chicago  : 
•     J.  S.  Wheeler,  1879. 

This  is  a  valuable  addition  the  many  works  on  Chemistry  which 
have  issued  j5x)m  the  press  during  the  past  few  years.     The 


REVIEWS  AKD   NOTICES   OP   BOOKS.  459 

author  in  publishing  it  trusts,  "  that  the  necessary  conciseness, 
"  in  method  and  form  of  expression,"  has  not  in  any  way  afifected 
the  clearness  and  comprehensiveness  of  the  arrangement.  He 
states  that  it  would  have  been  easier  to  prepare  a  larger  work, 
but  that  as  this  is  intended  for  advanced  students,  or  at  least 
for  those  who  are  familiar  with  inorganic  chemistry,  he  confined 
himself  to  what  was  essential  without  encumbering  "  the  work 
with  a  re-statement  of  that  which  appertains  to  the  theory  of 
chemistry  in  general."  , 

The  first  part  of  the  work  is  devoted  to  the  subject  of  organic 
chemistry,  and  in  the  second  part  animal  chemistry  is  discussed, 
in  which  will  be  found  the  chemistry  of  digestion,  and  of  the 
various  substances  coimected  with  that  process.  The  chemistry 
of  the  blood,  respiration,  animal  heat,  muscular  action,  and  also 
of  the  various  secretions,  as  the  urine,  sweat,  milk,  soft  tissues, 
osseous  substance,  dental  tissue,  and  also  exudations.  Tlie 
author  makes  use  throughout  of  the  metric  system,  and  the 
temperatures  indicated  by  the  centigrade  scale.  We  commend 
this  little  work  to  our  readers,  it  contains  much  material  that  is 
not  to  be  found  in  other  chemical  text-books.  It  is  very  neatly 
issued  from  the  press  on  good  heavy  toned  paper. 

Health  Primers, — No.  1.  Exercise  and  Training.  No.  2.  Al- 
cohol, its  use  and  abuse. — By  W.  S.  Greenfield,  M.D. — 
No.  3  The  House  and  its  surroundings. — No.  4.  Prema- 
ture Death,  its  Promotion  or  Prevention.  New  York : 
D.  Appleton  &  Co.,  549  and  651  Broadway,  1879. 

With  a  view  to  popularize  as  much  as  possible  the  all-impor- 
tant subjects  relating  to  health,  a  series  of  concise  primers  have 
appeared  in  England  under  the  editorial  management  of  J. 
Langdon  Down,  M.D.,  Henry  Power,  M.  B.,  J.  Mortimer 
Granville,  M.D.,  and  John  Tweedy,  F.R.C.S.  Some  fifteen 
subjects  have  been  selected  in  the  series,  and  the  contributors 
are  already  known  to  the  profession  as  writers  of  eminence. 
The  first  four  primers  of  the  series  have  appeared  on  this  side 
of  the  Atlantic,  being  republished  by  the  Messrs.  Appleton  & 
Co.     The  objects  of  the  writers  are  in  every  way  commendable, 


460  CANADA  HSDIGAL  AND  SUBGIGAL   JOUttNAL. 

as  their  efforts  will  stimulate  the  public  at  large  to  know  how  to 
avoid  disease.  What  a  vast  amount  of  misery,  disease  and  death 
might  be  saved  to  the  human  family  by  even  a  smattering  of 
knowledge  on  health  subjects.  These  health  primers  are  short, 
concise,  and  written  in  a  popular  style,  and  within  the  reach 
of  all.  We  trust  they  may  be  largely  circulated  and  largely 
read.  They  inculcate,  line  upon  line  and  precept  upon  precept, 
what  is  best  for  the  maintainance  of  the  minds  and  bodies  of 
men  in  a  perfect  condition  of  health.  These  little  books  are  full 
of  instruction,  and  should  become  generally  known.  These  little 
primers  are  to  be  had  at  a  nominal  price,  and  we  hold  that  such 
a  series  of  useful  books  will  be  of  incalculable  benefit  to  the 
public  generally,  and  that  a  careful  perusal  of  them  will  recall 
many  facts  in  regard  to  our  organization  which  ought  to  be 
widely  disseminated.  They  are  to  be  had  of  Dawson  Brothers, 
St.  James  St. 

American  Health  Primers. — Hearing  and  how  to  keep  it, — 
By  Charles  H.  Burnett,  M.D.  12mo.,  pp.  152.  Phila- 
delphia: Lindsay  &  Blakiston,  1879. 

As  we  remarked  above,  for  the  purpose  of  instructing  the 
public  generally  in  what  concerns  our  perishable  bodies,  a 
number  of  gentlemen  in  England  associated  themselves  together 
and  issued  a  series  of  health  primers.  A  somewhat  similar 
commendable  scheme  is  being  followed  on  this  side  of  the 
Atlantic.  Our  American  friends  fully  appreciate  the  value 
to  the  public  of  making  known  what  is  hurtful  to  both  body 
and  mind;  and  in  giving  to  the  American  reader  what  will 
be  found  of  great  value,  they  have  determined  to  publish  a 
series  of  popular  works  on  subjects  distinct  and  separate 
from  those  selected  by  the  English  writers.  The  first  of  the 
series  is  before  us.  It  is  divided  into  three  parts  having  several 
chapters  in  each  part.  In  part  one  we  have  described  in 
familiar  language  the  anatomy  and  physiology  of  the  ear.  In 
part  two  will  be  found  described  the  chief  diseases  and  injuries 
of  the  ear.  This  is  given  in  such  a  style  as  to  indicate  the 
avoidance  of  improper  treatment.    In  part  three  is  given  the 


REVIEWS  AND  NOTICES  OP  BOOKS.  461 

general  hygiene  of  the  ear.  This  little  work  is  written  by  a 
gentleman  who  is  aurist  to  one  of  the  hospitals  in  Philadelphia, 
and  also  consulting  aurist  to  the  Pennsylvania  institute  for  the 
Deaf  and  Dumb.  It  is  full  of  instruction,  and  will  be  found  to 
fulfil  the  object  desired  in  its  publication. 

A  Clinical  Treatise  on. Diseases  of  the  Liver. — By  Dr.  Fred. 
Theod.  Frericus,  Prof.  Clinical  Medicine  in  the  University 
of  Berlin,  &c.  In  three  volumes.  Vol.  1,  8vo.  pp.  224  ; 
Vol.  2,  pp.  228  ;  Vol.  3,  pp.  226.  Translated  by  Charles 
Murchison,  M.D  ,  F.R.C.P.,  &c.  New  Nork  ;  Wm.  Wood 
&  Co.,  27  Great  Jones  St.,  1879. 

These  three  volumes  form  a  part  of  the  Library  of  Standard 
Medical  authors  which  are  being  published  by  Messrs.  William 
Wood  &  Co.,  of  New  York.  These  volumes  will  be  regarded 
with  more  than  usual  interest  at  the  present  time,  as  both  the 
author  and  translator  have  been  removed  hy  death.  Still,  this 
work  remains  a  monument  of  accurate  observation  and  untiring 
industry,  a  reliable  book  of  reference  in  diseases  of  the  livei. 
Written  nigh  twenty  years  ago,  the  information  contained  is  as 
fresh  and  applicable  as  though  its  publication  carried  with  it  all 
the  freshness  of  a  new  work.  There  are  numerous  illustrations 
on  wood,  and  on  the  frontispage  of  each  volume  will  be  found  a 
coloured  lithograph.  Many  of  the  figures  here  portrayed  are 
copies  of  plates  which  were  issued  to  accompany  the  English 
translation  of  the  work  winch  appeared  some  years  back  in  the 
New  Sydenham  Society.  We  regret  to  observe  that  some  of 
the  wood  engravings  in  the  text  of  these  volumes  are  very 
poor,  indeed  we  think  they  mar  the  appearance  of  the  work, 
giving  to  it  an  unfinished  cast  which  is  not  in  keeping  with  the 
general  get  up  of  these  volumes.  It  is  true  that  those  volumes 
are  issued  at  a  nominal  price,  and  therefore  we  are  not  to  expect 
too  much.  This  we  admit,  but  we  should  be  far  more  contented 
to  see  the  illustrations  left  out  altogether,  than  to  have  the  entire 
volumes  spoiled  by  second  or  third-class  wood  cuts.  We  should 
be  sorry  to  damp  the  ardour  of  the  publishers  by  uncalled  for 
observations  on  this  subject.  We  make  these  observations 
believmg  as  we  do  that  kindly  criticism  is  beneficial  in  every 


462  CANADA   MEDICAL   AND   SURGICAL   JOURNAL. 

way,  and  that  it  will  in  all  likelihood  call  attention  to  what  may 
have  been  an  oversight  in  examining  the  work  done  before 
admitting  it  to  publication  :  that  is  excluding  or  refusing  to 
receive  work  of  this  nature  which  is  not  up  to  the  level  of 
a  skilled  workman.  Frerichs  on  the  liver  is  so  well  known  and 
so  generally  appreciated  by  the  profession  that  no  observations 
as  to  merits  are  demanded  at  our  hands.  We  need  only  in 
conclusion  remind  our  readers  that  three  monthly  volumes  are 
coming  to  hand  with  regularity.  We  have  before  alluded  to 
the  scheme  as  proposed  and  being  in  good  faith  carried  out  by 
the  Messrs.  Wood  of  New  York. 

An  Atlas  of  Human  Anatomy^  illustrating  most  of  the 
ordinary  Dissections^  and  many  7wt  usually  practised  by 
the  student, — By  Rickmann  John  Goodlee,  M.S.,  F.B.S. 
Quarto,  part  1st,  four  plates.  Philadelphia :  Lindsay  & 
Blakiston,  1878.  Montreal,  Dawson  Bros.,  St. 'James 
Street. 

We  have  seen  the  first  fasciculus  of  the  American  reprint  by 
Lindsay  k  Blakiston,  of  Pl^ladelphia,  of  Mr.  Groodlee's  plates, 
and  we  are  well  pleased  with  them.  The  possessor  of  a  Maclise 
or  a  Lizars  might  imagine  that  he  had  all  that  was  desired  in 
the  way  of  plates,  but  these  plates  are  entirely  different  from 
any  of  their  predecessors.  Though  artistically  not  so  fine 
as  Maclise's,  anatomically  they  are  quite  as  correct.  Their 
peculiar  utility  lies  in  the  fact  that  they  represent  dissections 
not  usually  made  by  either  teacher  or  student.  Liasmuch  as  the 
surgeon  must  be  prepared  to  cut  everywhere  and  anywhere,  it 
behoves  him  to  let  his  studies  extend  beyond  the  limits  of  dissect- 
ing-room routine. 

Tablets  af  Anatomy  and  Physioloyy.  —  By  Thomas  Cooke, 
F.R.C.S.  Second  edition.  Longmans,  Green  &  Co. — 
Tablets  of  Physiology. — By  same  author. 

These  tablets  in  book  form  are  now  making  their  debut 
amongst  the  members  of  the  profession  in  AiQcrica.  However, 
they  are  old  friends  of  ours,  and  we  know  their  usefulness.  The 
student  will  find  that  Mr.  Cooke's  teaching  is  very  exact,  very 
clear,  and  best  of  all«  very  condensed.     We  should  advise  no 


REVIEWS  AND   NOTICES  OF    BOOKS.  463 

student  to  depend  entirely  on  a  book  of  this  sort.  The  author 
does  not  wish  him  to  do  so,  but  he  should  use  his  tablets  to 
refresh  his  memory  before  presenting  himself  for  examination. 
The  physiological  tablets  we  like  very  mucL  The  student  of 
to-day  has  so  much  theory  and  conjecture  to  deal  with  that  he 
will  hail  with  delight  the  appearance  of  this  book,  which  supplies 
him  directly  with  the  acknowledged  facts  of  Physiology.  We 
recommend  students  to  provide  themselves  with  the  tablets  on 
Embryology,  for  they  will  thus  gain  great  assistance  in  master- 
ing this  difficult  subject. 

Haber short  on  the  Alimentary  Canal,  Second  American  from 
the  third  enlarged  and  revised  English  edition.  Phila- 
delphia: Henry  C.  Lea,  1879. 

We  can  do  very  little  to  add  to  the  favourable  reception  which 
has  already  been  given  by  the  Medical  press  of  the  world  to  this 
well  known  treatise.  We  however,  remind  our  readers  that  this 
is  a  new  edition  of  a  work  for  which  the  demand  was  so  great 
that  previous  editions  were  rapidly  exhausted.  The  author 
has  taken  the  opportunity  of  the  book  being  out  of  print  for 
some  years,  to  embellish  what  he  has  already  written,  and  to 
add  new  matter  of  very  considerable  importance. 

We  commend  to  all  practitioners  a  careful  perusal  of  Dr. 
Habershon's  work.  More  especially,  we  draw  attention  to  the 
number  of  cases  of  intestinal  diseases  recorded  in  its  pages, 
cases  of  extreme  interest  clinically  and  pathologically.  This 
careful  record  shows  that  this  work  is  no  complication,  but 
a  careful  exposition  of  the  author's  personal  experience. 

An  Introduction  to  Pathology  a/nd  Morbid  Anatomy, — By  T. 
Henry  Green,  M.D.,  Lend.,  &c.  Third  American  from 
the  fourth  revised  English  edition.  8vo.,  pp.  331.  Phila- 
delphia :  Henry  C.  Lea,  1878. 

This  work  has  received  an  addition  of  much  new  matter  which 
renders  it  more  complete.  All  the  chapters  have  been  carefully 
revised,  and  the  number  of  illustrations  have  increased.  We 
have  on  a  former  occasion  noticed  at  some  length  this  excellent 
treatise  which  still  retains  its  position  of  being  a  favorite  text- 
book. 


464  CANADA    lOBDICAL   AND   SURGICAL   JOURNAL. 

Extracts  from  British  and  Foreign  Journals. 

Unless  otherwise  stated  the  traiwlafions  are  made  spcdaOy  far  this  JovtnaL 

Intestinal  Obstruction    and   Deatb.— 

(Fatty  change  (and  fiulare)  of  the  muscnkr  waD  of  ttie  got,  as  a 
direct,  and  mdlrect  cause  of  intestinal  obstmction  and  deadi. 
By  FouRNKAUX  Jordan,  F.RS^  Surgeon  to  the  Queen's  Hos- 
pital, professor  of  Sorgery  at-  Qaeens's  CoQege,  Bbnmn^iam, 
Consulting  Sarge<»i  to  the  Women's  and  the  West  Bromwicfa 
Hosjutals.) — ^For  several  yeais  past,  I  have  from  time  to  time 
seen  cases  in  which,  with,  periiaps  no  premonitory  symptoms, 
continooos  vomiting  and  tympany,  lasting  one,  two,  or  more 
days,  have  been  fcAowed  by  deatL  While  these  symptoms 
appeared  in  some  cases  to  come  on  spontaneous,  in  others  and 
and  I  think,  more  &ei}aently,  diey  followed  some  abdominal  or 
pelvic  operation.  The  case,  as  a  role,  hai^ned  in  fiit  persons, 
in  perscMis  widi  large  abdomens,  in  persons  with  agns  of  d^en- 
eratkni  in  various  organs  and  with  a  history  of  habits  whidi 
lead  to  visceral  changesL  ExaminatioQ  ef  die  bodies  disclosed 
great  internal  accumuladoos  of  &l«  and  occaaooal  indicatioBS  of 
visceral  degeneradon,  but,  curioody,  no  obvious  or  recogmaed 
cause  of  intestinal  obetnictioii.  In  all  the  cases,  the  intesdnal 
canal  was  gready  k^ed  widi  Em  aoii  presented  a  striking 
yeQow  appearance :  in  some  cases,  indeed,  h  seemed  to  be 
simply  a  tube  of  hL,  In  one  c&se  the  microscope  coneh^vely 
^wed  that  die  unstr^^  muscular  fibres  of  the  bi>wel  woe 
converted  inco  &t  In  observing  and  reflecdng  on  diese  cases* 
of  some  of  wfaidi  I  ^laU  siieak  la^r,  I  hAve  arrived  at  the 
foOowrn^  conehKaoiK : 

1«  The  smoodimiKcuIar  fibres  of  ti!i»e  bowel  are  subjiect  to  Eitty 
degeneration,  which  may  become  miore  or  less  compleiae :  and 
diat,  conse«|i£endy,  diey  may,  and  <i>  in  given  cases,  wholly 
cease  »  contrac  c 

±  This  fattr  chan;y  ^  &e  easentsil  elemenc  of  die  jru^waS 
when  ic  ends  in  compleiae  cessaasm  <>f  concr&trt^ity.  causes  tleadi 
bv  intesdoal  obstmctB^n.  Facrr  t^ur«  oi  dbe  ^oescines  beinz 
in  some  cases  exfienave  in  acett  ami  r^ttchtng  ihrh  ixp  OFwards 


BRITISH   AND    FOREIGN  JOURNALS.  465 

the  stomach,  the  ensuing  obstruction  is  acute,  the  vomiting 
incessant,  and  death  early.  In  other  cases,  there  may  be  less 
complete,  or  more  limited,  or  irregulary  distributed  fatty  change  ; 
and  there  will  follow  a  slower  or  more  fitful  stream  of  symptoms 
and  a  later  death. 

3.  Fatty  transformation  in  the  gut  is  more  likely  to  appear 
(though  perhaps  not  exclusively)  in  fat,  especially  very  fat  per- 
sons ;  in  those  who  from  natural  tendency,  are  liable  to  have 
fatty  degeneration  of  other  organs,  especially  of  the  heart. 
Death  in  heart  cases  is  quick  and  direct ;  in  intestinal-cases, 
slower  and  more  indirect,  but  nevertheless  very  certain. 

4.  As  premonitory  syncope  or  exhaustion  may  happen  from 
time  to  time  before  death  from  heart-fattiness,  so  "  attacks"  of 
obstruction  may  run  before  final  obstruction  from  intestinal  fat- 
tiness. 

6.  Failure  of  the  bowel  is  helped  on  by  continued  flattulent 
distention,  bowever  it  arises  ;  the  altered  muscular  fibres  being 
so  injured,  by  overstretching  that  they  never  regain  their  func- 
tional contractility.  Herein  may  be  traced  a  likeness  to  atony 
of  the  bladder,  where,  it  is  well  known,  long-continued  distension 
is  in  certain  cases  followed  by  entire  loss  of  contractility ;  and 
it  is  not  unlikely  that  fatty  conversion  of  the  muscular  wall  of 
the  bladder  is  the  basis  of  certain  obscure  cases  of  retention  and 
cystitis  coming  on  after  middle  age.  It  is  conceivable  that  healthy 
gut  may  become  the  subject  of  fatal  atony  from  long-continued 
stretching ;  but  some,  however  slight,  fatty  change  would,  greatly 
favor  such  a  result. 

In  a  limited  number  of  cases,  death  is  due  directly  to  failure 
of  intestinal  action,  and  may  come  with  obviously  exciting  cause. 
The  muscular  fibre  is  now  no  longer  muscular.  In  a  large  number 
of  cases,  death  comes  more  indirectly  from  some  immediate 
shock  to  the  abdominal  organs.  In  strangulated  hernia,  when 
fatty  bowel  is  present,  the  blown-out  tube  never  again  contracts. 
The  vomiting  continues,  or  returns,  and  death  follows,  notwitli- 
standing  that  reduction  has  been  easy  and  complete,  and  that 
there  is  no  inflammation,  or  gangrene,  or  other  cause  of  death. 
All  injuries  and  operations  in  persons  with  failing  gut  are  liable 

NO.  LXXXTT.  31 


4G(i       CANADA  MEDICAL  AND  SURGICAL  JOURNAL. 

to  bo  followed  by  vomiting,  which  ceases  only  with  death.  Espe- 
cially is  this  so  on  operations  on  the  abdominal  or  pelvic  organs. 
Herniotomy  and  lithotomy  are  now  and  then  followed  by  fatal 
vomiting,  and  subsequent  search  brings  nothing  to  light ;  no 
injury  to  the  peritoneum,  no  haemorrhage,  to  the  inflammation, 
no  6ther  lesion  ;  nothing  but  hugely  distended  bower. 

The  case  which  led  me  to  believe  that,  in  certain  instances 
death  begins  in  the  gut  from  entire  cessation  of  action  in  the 
intestinal  muscular  fibre,  and  that  the  cessation  was  due  to  fatty 
degeneration,  I  now  briefly  cite. 

Several  years  ago,  a  lady  so  stout  that  she  had  long  been 
confined  to  her  room — the  staircase  of  her  house  was  also  narrow 
and  awkward — without  any  previous  complaint,  began  to  vomit. 
The  vomiting,  at  first  occasional,  became  incessant  and  faecal  in 
character,  and  she  sank  in  two  oi  three  days.  I  examined  the 
the  body.  The  intestinal  canal  was  from  end  to  end  enormously 
distended  with  gas,  but  there  was  nowhere  any  localized  obstruc- 
tion of  any  kind.  The  bowel  was  strikingly  yellow  in  appearance ; 
and  the  amount  of  fat,  not  only  on  the  body,  but  within  the 
abdomen,  could  only  be  described  in  words  that  would  savour  of 
carricature.  After  the  most  careful  examination,  no  other 
appearances  could  be  found  to  account  for  death. 

Another  case  which  made  a  vivid  impression  in  my  mind,  was 
that  of  an  exceedingly  stout  man.  He  got  out  of  doors  a  little 
in  a  specially  made  phaeton  with  a  bottom  so  low  that  it  just 
cleared  the  road,  and  was  reached  with  one  short  step.  Without 
injury  or  premonitory  incident  of  any  kind,  symptoms  of  intes- 
tinal obstruction  (sometimes  urgent  and  sometimes  with  intervals 
of  ease)  set  in,  and  in  a  few  days  he  died.  A  very  yellow  dis- 
tended bowel  was  seen ;  indeed,  I  remarked  in  this  case,  as  I  have 
in  others,  "  The  bowel  seems  a  tube  of  fat."  The  distension  was 
not  uniform,  but  more  in  some  coils  than  in  others.  There  was, 
however,  no  band,  or  twist,  or  stricture,  or  cause  of  obstruction 
of  any  kind.  I  had  not  yet  concluded  that  death  might  be  caused 
by  fatty  failure  of  the  gut.  I  was  more  supicious,  and  afraid 
that  it  might  be  so,  or  I  should  have  called  in  the  aid  of  the 
microscope. 


BRITISH  AND    FOREIGN  JOURNALS.  46*7 

In  a  case  of  strangulated  hernia,  in  a  very  stout  man,  the 
bowel  was  reduced  easily  and  with  marked  gurgling,  and  for  a 
few  hours  he  seemed  better,  but  vomiting  returned,  and  he  died. 
On  examination  no  inflammation,  or  gangrene,  or  aparently 
adequate  cause  for  death  was  found.  The  abdominal  organs 
were  greatly  loaded  with  fat.  The  heart  was  somewhat  softer 
than  natural.  The  extreme  yellowness  of  the  bowel  so  struck 
me,  and  my  reflections  and  fears  had  now  taken  so  clear  a  shape, 
that  I  determined  to  have  a  microscopical  examination  of  the 
muscular  fibre  of  the  bowel.  This  was  carefully  made  for  me 
by  an  experienced  microscopist,  Dr.  Wood  (one  of  our  statf),  and 
left  no  doubt  of  the  marked  fatty  change  in  the  suspected  struc- 
ture. Dr.  Wood  did  not  content  himself  with  the  appearance 
of  the  fatty  intestine  ;  he  examined  portions  of  health  intestines, 
and  found  a  striking  contrast. 

Not  long  ago  I  had  two  cases  of  lithotomy,  both  of  which  ended 
fatally  within  twenty-four  hours,  after  several  hours  of  incessant 
vomiting.  The  cases  were  singularly  alike,  a  description  of  one 
will  serve  both.  A  big  fat "  drinking  "  man  of  sixty  had  enlarged 
prostate  and  large  vesical  calculus.  There  was  no  tangible 
evidence  of  renal  or  other  visceral  disease.  There  was  no 
peculiarity  in  the  operative  st^ps  to  account  for  the  result  I 
could  not  to-day  alter  any  single  step  in  the  operation  for  the 
better.  He  was  free  from  haemorrhage  or  marked  shock,  llis 
condition  for  a  few  hours  was  quite  comfortable  ;  then  occasional 
vomiting  set  in,  and  tympany  of  the  abdomen  appeared.  The 
vomiting  became  frequent  and  was  associated  ¥nth  great 
exhaustion,  and  ended  fatally.  In  a  subsequent  examination,  a 
description  of  the  appearances  would  answer  for  both  bodies. 
The  internal  organs  were  loaded  with  fat ;  the  heart  was  some- 
what pale  and  soft ;  and  the  kidneys  were  not  healthy.  The  intes- 
tinal canal  was  singularly  and  uniformly  yellow,  and  everywhere 
enormously  distended.  There  was  no  signs  anywhere  of 
inflammation,  or  peritoneal  injury,  or  extravasation  of  blood,  or 
infiltration  of  urine. 

I  believe  the  operation  here  destroyed  the  vitality,  so  far  as 
contractility  was  concerned,  of  the  bowel.     Flatulent  distension 


CANADA   MEUICAL   t 


L.  .lonRNAI,. 


followed,  and  irratricvably  spoiled  the  gut.  This  condition,  affect- 
iDg  ail  or  a  large  portion  of  tliG  canitl,  and  affecting  it  even  to 
ihe  vicinity  of  the  stomach,  was  practically  a  condition  of  acntfi, 
high  up,  and  complete  obstruction. 

Here  the  question  naturally  arises,  what  are  the  customary 
explanations  now  and  heretofore,  of  the  causes  of  death  after 
continuous  vomiting  which  follows  the  reduction  of  strangulated 
hernia,  which  follows  also  operations  for  uncomplicated  hemise, 
which  follows  hthotomy  and  other  operations  on  the  pelvis  and 
abdoniL-n.  The  very  variety  of  the  explanations  testifies  to  their 
improbability.  One  says  shock  ;  another  says  shock  with  feeble 
heart;  another  says  ether  or  chloroform  vomiting;  another  aaya 
rapid  septic  poisoning  ;  another  saya  incipient  peritonitis.  I  am 
far  from  saying  that  these,  or  some  of  tliem,  are  inadequate 
causes  of  death  under  certain  circumstances;  but  tiiey  do  not 
satisfactory  account  for  death  in  the  cases  I  bring  forward.  In 
pure  shock,  with  or  without  cardiac  degeneration,  vomiting  is 
rare  ;  in  cases  of  say,  crushed  knee-joint,  or  amputation  at  the 
hip,  or  even  in  severe  abdominal  injury  (in  healthy  persons), 
nervous  muscular  action  dwindles  down  to  death  without  vomit- 
ing. That  ether  or  chloroform  vomiting  should  recur  after  some 
hours  of  comfort  is  at  least  hypothetical ;  hypothetical  is  also 
rapid  septic  poisoning  without  rigor  or  rise  of  tempei'ature,  and 
any  other  likeness  to  the  known  septic  state,  Pcritomtis  with- 
out the  slightest  sign  of  peritonitis  is  too  metaphysical  a  patho- 
logy to  grasp.  In  fatty  change  and  a  consequent  failure  of  the 
gut,  we  have  an  explanation  which,  is  based'  on  clinical  and 
microscopic  observation,  which  clears  up  all  difBculHes,  and  which 
is  consistent  with  known  pathological  laws. — BrU'uh  Medical 
Journal. 

Therapeutic  value  of  Croton-ChlbraU 

— In  a  very  interesting  paper  read  before  the  Ulster  Medical 
Society,  Dr.  Riddcll,  <^DiihUn  Mescal  Journal^  April,  1879), 
reports  his  experience  of  the  great  therapeutical  value  of  eroton 
(butyl)  chloral.  He  mentions  first  a  case  of  severe  paroxysmal 
headache  ineffectually  treated  for  many  yeai-s  by  all  the  great 
guns  of  the  Pharmacof)ma,  but  cured  by  five  grains  of  butyl- 


fiRITISH  AND  FOREIGN  JOITRNAtS.  469 

chloral  twice  daily  and  ten  grains  taken  at  night  dissolved  in 
spirits  of  wine  and  glycerine,  with  a  little  acid  and  syrup  of 
orange  to  cover  the  flavor.   The  patient  continues  the  five-grain 
doses  at  night,  and  now  enjoys  better  health  than  she  has  done 
for  years.     Since  that  case.  Dr.  Riddell  says  they  have  used  it 
largely — sometimes  failing,  sometimes  relieving — till,  by  keep- 
ing an  account  of  all  his  cases,  it  began  to  be  clear,  which  were 
most  benefited  by  the  drug.     Since  then,  the  number  of  cases 
relieved  (some  permanently)  has  increased.     These  cases  are  : 
headache  in  females  arising  from  mental  distress ;  those  cases 
of  headache  frequent  at  the  menopause — in  fact  all  those  called 
neuralgic,  except  a  few  arising  from  internal  mischief,  are  bene- 
fited and  in  many  instances  cured.     In  that  distressing  species 
of  neuralgia  called  tic  douloureux,  he  has  found  it  in  many  cases 
acting  like  a  charm.  Of  course,  he  doQS  not  include  any  arising 
from  cranial  or  intercranial  causes.  He  has  tried  it  in  neuralgia 
of  the  ovaries,  but  no  good  resulted.     In  insomnia,  it  is  not  so 
reliable,  as  the  hydrate ;  but  in  some  cases  where,  the  loss  of, 
or  inability  to,  sleep  is  accompanied  by  a  weak  or  fatty  heart,  it 
is  to  be  preferred,  as  it  has  no  weakening  effect  on  the  central 
organ  of  the  circulation.     In  one  case  of  delirium  tremens,  ' 
where  the  circulation  was  very  feeble,  the  combination  of  croton 
chloral  with  digitalis  had  a  wonderful  effect,  and  it  seemed  as  if 
the  drugs  could  be  given  together  in  much  smaller  doses  to 
produce  the  same  results  than  singly.  In  this,  he  pushed  it  from 
ten  to  thirty  grains  every  three  hours,  with  drachm  and  two- 
drachm  doses  of  the  infusion  of  digitalis.    In  pain  arising  from 
caries  of  teeth,  he  has  found  it  useless  in  most  cases,  and  in  all 
inferior  to  Richardson's  "  tinctura  gelsemini"  ;  but  in  one  case 
of  a  nervous  young  lady,  by  giving  her  two  ten-grain  does,  he 
was  able  to  extract  a  tooth  next  to  painlessly,  to  her  great  satis- 
faction. In  these  cases,  it  is  in  affections  of  those  parts  supplied 
by  the  fifth  pair  of  nerves  that  it  is  of  most  use  ;  but  to  be  of 
service,  the  drug  must  be  given  in  far  larger  doses  than  prescri 
bed  in  the  Pharmacopceia  for  adults,  five  grains  three  or  four 
times  daily,  gradually  increasing  if  required  ;  if  stimulants  be 
wanted,  dissolve  it  in  rectified   spirit ;  if  not,   dissolve  it  in 


470  CANADA' MEDICAL   AND   SrHOICAL   JOURNAt. 

glycerine.  In  all  cases  complicated  with  hsemorrhoids.  give 
glycerine.  If  anaemia  exist,  combine  it  with  iron,  or  what 
he  believes  better,  arsenic ;  then  gradually  lessen  the  chloral, 
in  all  cases  he  has  found  it  better  to  give  it  in  solution 
than  in  powder  or  pill.  Dr.  Riddell  mentions  also  severe  pain 
with  photophobia,  and  blepharospasm  after  injury,  in  whieh 
atropia  failed,  but  ten  grainB  of  butyl-chloral  repeated  in  an 
hour  gave  complete  relief;  and  a  case  of  acute  painful  facial 
carbuncle,  in  which  the  effect  of  ten  grain  doses  every  three 
hours  was  *' simply  marvellous,"  the  disease  going  through  its 
8Tibse(|uent  stages  almost  without  the  patient  knowing  anything 
of  the  matter  from  tlic  sense  of  feeling.  This  remedy  is  pro- 
bably less  used  in  practice  than  its  remarkable  anodyne  powers 
deserve. — Bnti»h  Medical  Journal. 

Congenital  Inguinal  Hernia.— (0|)cini ion 

for  the  radical  cure  of  congenital  inguinal  hernia  in  the 
child.  By  George  Buchanan,  M.A.,  M  D.,  Professor  of  Clinical 
Surgery  in  the  University  of  Glasgow.) — Professor  John  Wood's 
operation  for  the  radical  cure  of  inguinal  hernia  in  the  adult  Is, 
on  the  whole,  so  succoasfitl  and  so  free  from  danger,  that  I  am 
surprised  so  few  of  the  many  hundreds  affected  with  hernia  in 
every  community  seek  the  relief  it  affords.  I  presume  it  is  be- 
cause there  must  always  be  some  hesitatiwi  in  accepting  the 
present  risk,  however  small,  which  accompanies  an  opei'ation : 
and  a  hope  that  the  much  greater  danger  of  strangulation  may 
never  occur.  But  in  the  case  of  young  boys  the  risk  arisin" 
from  an  operation  is  much  less.  I  think  it  has  been  shown  that 
the  peritoneal  cavity,  especially  under  antiseptic  precautions, 
may  be  opened  with  impunity.  But  even  this  risk  is,  in  Mr. 
Wood's  plan,  not  encountered  ;  but  it  seems  to  me  strange  tliat 
boys  who  have  a  congenital  hernia  which  cannot  be  kept  perma- 
nently reduced  by  any  aparatus— a  state  of  matters  which  every 
hospital  surgeon  sees  repeatedly— should  be  allowed  to  grow  up 
with  a  deformity  which  prevents  them  from  being  useful  and 
happy  membei-s  of  society,  aod  debars  them  from  a  great  mauy 
employments. 


BRITISH  AND  PORIiiaN  JOtJRNALS.  471 

I  confess,  however,  that  I  have  been  disappointed  with  the 
results  of  my  attempts  to  cure  congenital  hernia  in  children  by 
Mr.  Wood's  operation  with  pins  used  subcutaneously.  Either 
I  did  not  succeed  in  pushing  them  through  the  anatomical 
structures  I  intended,  which  is  so  easy  to  do  in  the  adult 
with  the  strong  curved  needle,  or  I  failed  to  lock  them,  and  twist 
them  as  it  is  necessary  to  do ;  but,  from  whatever  cause,  in  the 
two  cases  on  which  I  operated  the  result  was  unsatisfactory. 
The  hernia  came  down  as  soon  as  the  pins  were  taken  out. 

I  determined,  tharefore,  to  perform  an  operation  consisting 
of  opening  the  sac  and  obliterating  the  canal  by  the  introduction 
of  strong  sutures.  The  steps  followed  will  be  best  understood 
by  the  report  of  a  case  which  formed  the  subject  of  a  clinical 
lecture, 

Robert  Inglis,^  aged  sixteen  months,  was  the  subject  of  con- 
genital inguinal  hernia,  which  was  observed  shortly  after  his 
birth.  It  was  small  when  first  noticed,  but  soon  increased  in 
size  ;  and  it  had  grown  with  his  growth.  It  was  on  January 
9th,  1879,  about  the  size  of  a  turkey's  egg,  and  distended  the 
left  side  of  the  scrotum.  It  could  be  reduced  with  ease ;  but  it 
was  easily  slipped  down,  and  no  aparatus  ot  bandage  could 
retain  it  in  its  place.  Trusses  had  been  tried  at  various  times  ; 
but  no  sooner  did  the  child  move  than  the  hernia  came  down. 
On  returning  it  into  abdomen,  the  fingers  was  rapidly  pushed 
through  the  inguinal  opening  ;  but  even  then,  unless  pushed  far 
up,  the  bowel  slipped  down  alongside  of  it. 

Before  performing  any  operation,  I  accustomed  the  little 
patient  to  the  pressure  of  a  bandage.  I  returned  the  bowel, 
and  applied  a  large  thick  pad,  which  was  bandaged  very  firmly 
with  figure-of-eight-bandage  round  the  groin.  This  retained 
the  hernia  in  its  place  for  some  hours ;  but  the  movements  of 
the  child  and  repeated  fits  of  crying  brought  it  down  usually 
within  twenty-four  hours. 

On  January  25th,  1879, 1  performed  a  radical  operation  as 
follows :  The  patient  having  been  put  under  the  influence  of 
chloroform,  the  rupture  was  returned  and  kept  up  by  the  finger 
of  an  assistant.     A  longitudinal  incision  was  made  along  the 


472 


CANADA   MEDlOAr.    AND 


I,   JOUBNAL. 


whole   length  of  the   aac,   from  opposite  the  internal  r^^ 
the  bottom  of  the  acrotom,  this  divided  all  the  texturea  down  I 
the  peritoneal  eac,  which,  aa  usual,  had  been  thickened  by  the 
preaenco   and  movements   of  the   hernia.     With  the  handle 
of  the  knife  and  a  few  touches  of  ite  point,  I  acparated  the  aac 
from  its  superEcinl  structure,  leaving  the  posterior  part  lying 
over  the  cord,  which  was  seen  behind.     I  now  divided  the  aac 
into  two  halves  by  a  trimaeverao  cut,  except  at  the  back,  where 
it  was  adhering  to  the  cord.     One  half  was  Folded  down  over 
the  teaticle,  so  as  to  form  a  sort  of  tunica  vaginalis.  The  apper 
half  was  rolled  into  a  sort  of  ball  or  plug  which  I  pushed  into 
the  internal  abdominal  ring  and  had  it  kept  there  by  the  as^atant. 
I  now  approximated  the  walla  of  the  inguinal  canal  much  in  the  • 
same  way  as  in  the  wire  operation  for  the  radical  cure  of  hernia  j 
in  the  adult    The  superficial  structures  having  been  previously  J 
pushed  aside  and  slightly  dissected  from  off  the  abdominal  apon- 
eurosis, the  relations  of  the  rings  and  the  canal  could  be  felt  and  J 
in  great  part  seen.     I  took  a  strong  nrevus-needle  and  pushed  I 
it  through  the  external  pillar  of  the  canal  at  a  spot  opposite  the  | 
internal  ring ;  then  guiding  it  with  the  point  of  my  left  fore- 
,  finger  lying  in  the  internal  ring,  I  made  it  lift  up  the  lower  j 
border  of  the  internal  oblii^ue  muscle,  and  emerge  through  tha  J 
internal  pillar  of  the  external  aponeurosis  about  half  an  inch  i 
above  its  lover  edge.     A  strong  wa.xed  silk  thread  was  i 
passed  through  the  hole  at  the  point  of   the  needle,  which 
was  then  withdrawn,  pulling  the  thread  with  it.     The  thread 
was  then  tightly  tied,  including  the  structures  through  which  the 
needle  had  been  passed,  and  so  fixing  into  the  internal  ring  the  1 
rollcd-up  bit  of  the  aac,  care  being  taken  that  the  external  raw  j 
surface  of  the  sac  should  be  turned  outwards  toward  the  integn-  [ 
ment  which  was  to  cover  it.  A  little  below  the  first  stitch,  a  second 
was  introduced  in  the  same  direction,  care  being  taken  to  avoid  I 
the  structures  of  the  cord,  which  lay  at  the  bottom  of  the  wound,  i 
The  edges  of  the  external  ring  were  now  drawn  together  tightly  J 
above  the  cord  by  a  strong  silver  wire  ;  ttiis  was  made  to  take  f 
a  very  strong  hold,  by  passing  the  needle  first  through  the  ex-  I 
terual  pillar  across  the  ring,  and  through  the  internal  pillar.  In  I 


BRITISH  AND  FOREIGN  JOURNALS.  473 

making  the  internal  puncture,  I  passed  the  point  of  the  needle 
so  far  towards  the  linea  alba  as  to  make  it  pierce  from  below  the 
tendon  of  insertion  of  the  rectus  muscle,  so  as  to  give  a  firm 
hold.  When  the  wire  was  drawn  through  with  the  needle,  it 
was  clamped,  so  as  to  squeeze  together  the  boundaries  of  the 
external  ring ;  and  it  was  retained  in  that  position  by  a  little  rod 
of  silver  with  a  hole  at  its  point,  through  which  the  two  ends  of 
the  wire  were  passed ;  and  having  been  drawn  tight,  they  were 
fixed  by  a, turn  round  the  rod.  The  silk  threads  were  clipped 
short ;  and  the  wires  with  the  little  clamping  rod,  to  which  they 
were  fixed,  were  allowed  to  hang  out  at  the  bottom  of  the  wound. 
The  edges  of  the  incision  were  now  united  with  thin  silver-wire 
sutures,  and  the  wound  dressed  with  antiseptic  precautions.  The 
child  was  placed  on  a  St.  Andrew's  cross,  the  upper  arms  of 
which  were  joined  by  a  sheet  of  calico  on  which  the  body  rested ; 
the  legs  being  securely  bandaged  with  strips  of  adhesive  plas- 
ter to  the  lower  limbs  of  the  cross.  The  pelvis  and  chest  were 
also  securely  fixed  to  the  apparatus.  In  this  way,  the  move- 
ments of  the  child  were  effectually  controlled. 

Two  days  after  the  operation,  the  scrotum  was  swollen,  as  if 
a  portion  of  hernia  had  escaped  from  beneath  the  bandages ; 
but  this  proved  to  be  only  a  soft  fluctuant  swelling,  probably  an 
effusion  of  serum  into  the  artificial  tunica  vaginalis,  which  had 
been  formed  by  the  folding  down  over  the  testicle  of  the  lower 
half  of  the  hernial  sac,  as  described  in  the  operation.  In  two 
days,  this  swelling  had  disappeared,  and  the  scrotum  was  in  its 
natural  state.  On  the  fourth  day  after  the  operation,  the 
wound  was  dressed.  It  was  found  almost  united,  except  in  the 
place  where  the  wires  were  left  hanging  out.  On  the  tenth 
day,  the  little  clamp  and  wire  were  removed,  and  the  parts 
were  found  quite  matted  together. 

It  is  unnecessary  to  detail  the  further  progress.  The  dress- 
ings were  changed  every  two  days,  and  at  the  end  of  four 
weeks  cicatrisation  was  practically  complete.  The  child  was 
then  freed  from  restraint ;  but,  for  precaution,  a  bandage  was 
still  applied  round  the  groin. 

May  1st.     At  this  date,  the  radical  cure  of  the  hernia  is 


47-t  CANADA   MEDICAL   AND   KCBOICAI.   JOC8SAL. 

perfect.  No  amount  of  exertion  either  of  the  limbs  or  on  07- 
;Qg  ha3  the  slightest  cfiect  on  the  inguinal  re^on  of  the  ftbdo- 
mina)  walie. 

The  result  has  exceeded  my  expectations,  and  I  shall  imt 
hei^iate  to  practice  the  operation  in  all  similar  cases,  and  even 
to  adopt  it  as  a  menos  of  accomplishing  a  radical  cure  in  casea 
of  strangulated  hernia  in  which  an  o]>eratioD  for  the  r«Uef  of 
strangulation  has  become  necessary. — Britiafi  Me^ealJourtui. 

<Ed^ma  of  the  feet  ocenrringr  ^  Typhoid 

rover* — ('"  ■■iniiK-f.lion  with  Alwi-wiCr-  in  tlii^li  an-l  Inralcu- 
region). — By  Dr.  Ciffkh."  Interne  dea  Hopitaax,"  (coDdease4 
from  !a  Fran-y  MriUcalr). — Abscesses  in  the  thighs,  lamhar 
and  sacral  regions  arc  freifaetitly  met  m&  as  sequels  t^  ^pboid 
'ever.  They  are  due.  no  doubt,  to  prolonged  and  enforoed 
dorsiil  decubitus.  They  are  either  superficial  or  deep,  and 
contain  pure  pus  or  a  mixture  of  pus  iaA  blood,  the  latter  tbe 
result  of  the  breaking  down  of  small  aangajneoos  tnmoars. 
As  a  rule  Ihey  arc  about  the  ^e  of  a  small  nut,  but  occasioaallj  J 
large  colleclioQS  of  pus  are  met  with  which  have  taken  ditarl 
origin  from  the  coalescence  of  smaller  ones.  "Hiese  I 
■.collecdons  are  somedmes  very  difficult  to  detect,  the  o 
^•jmptoms  of  suppuration  being  markod  by*  those  of  the  d 
Tfae  ngn  tbe  writer  draws  particular  atientinn  t 
tlie  feet,  which  always  accompanies  this  pus  formatkin,  ftad  ittl 
a  certuu  guide  to  its  detection.  It  is  enUrely  a  distinct  ttunj 
tnaa  phlcgmacia  dolens.  Be  dies  ^-om  cases  in  wfaidi  sJigfat  ' 
oederaa  of  tbe  feet  led  to  llie  absceracs  in  Qie  tbi^s  and  lumbar 


Medical  Tariff  in  Qermany.— Accord  iiu;  to 

the  AiigBbnrg  GaMtU^  liic  minster  of  puiibc  instractioB  ia 
Prussia,  has  submitted  to  the  Society  of  Medicine  at  BeriUf 
a  scheme  for  fixing  the  remmieratian  of  nedjcal  mea.  SUb  hi  <,] 
the  Tariff: 

1.  For  ^  first  visit  toapktienl2marks.<nneG«mBou 
is  oqnivalont  to  1  frunc.  2^  centimes. 1 

2.  For  every  sobsequmt  visit.  1  mark. 


BRITISH  AND   FOREIGN   JOURNALS.  475 

If  there  should  happen  to  be  more  than  one  patient  under  the 
same  roof,  the  fee  for  each  subsequent  patient  shall  be  1  mark. 

3.  For  consultation  with  one  or  several  practitioners.  For  the 
first  consultation,  5  marks,  for  each  subsequent  consultation, 
3  marks. 

4.  For  oflBce  consultations :  First  Consultation  1 J  mark, 

5.  Subsequent  consultations  f  of  a  mark. 

6.  Attendance  from  10  p.m..  to  7  a.m„  three  times  the  fee 
fixed  in  (1)  and  (2),  and  double  the  fee  in  (3)  and  (5). 

7.  For  an  examination  with  the  ophthalmoscope,  larynogos- 
cope  or  other  diagnostic  instrument,  2  marks. 

8.  For  admininistration  of  Chloroform,  for  diagnostic  pur- 
poses, 3  marks. — Le  Progres  MecUeale,  29th  March,  1879. 

Belladonna  in  the  Treatment  of  Intes- 
tinal obstruction. — Dr.  Norman  Ker  reports  five 
cases  of  intestinal  obstruction  which  have  been  cured  by  the 
administration  of  large  doses  of  belladonna.  The  treatment 
consisted  in  giving  one  or  two  grains  of  belladonna  every  hour, 
together  with  opiate  fomentation  to  the  belly  and  warm  applical 
tions.  Nearly  all  the  patients  were  in  a  dangerous  condition,  but 
were  entirely  cured,  the  remedy  taking  effect  in  six  to  nine 
hours.  One  patient  took  16  grains  of  the  extract.  The  author 
gives  no  precise  account  of  the  cause  of  the  obstruction. — 
TVie  Practitioner,  , 

Rare  Anomaly— Single  Kidney.— A  rare 

anatomical  curiosity  was  found  at  the  autopsy  of  a  patient 
who  died  of  typhoid  fever,  in  the  practice  of  Dr.  Crocq,  of 
at  St.  John's  Hospital,  Brussels.  There  was  no  right  kidney. 
The  left  kidney  was  generally  hypertrophied,  weighing  420 
grammes.  It  occupied  its  usual  place  in  the  abdomen.  A  mass 
of  connective  tissue  the  size  of  a  small  nut  represented  the  right 
kidney.  The  renal  vessels  on  the  left  side  were  large,  those  of 
the  right  merely  rudimentary. — Condensed  from  the  Presse 
Medic,  beige  of  24th  March,  1879. 


CANADA 


timl  mA  ^m%ml  |0ttviiail 


Montreal,  May,  1879. 

COLLEGE  OF  PHYSICIANS  AND  SURGEONS 

OF  ONTARIO. 

The  annual  meeting  of  the  Council  of  the  College  of  Physi- 
cians and  Surgeons  of  the  Province  of  Ontario  was  held  on 
the  13th  May  and  subsequent  days,  and  some  very  remarkable 
business  was  transacted.  It  is  reported  that  "Dr.  William 
Clarke  spoke  at  great  length  as  to  the  visit  of  the  deputation  to 
Ottawa  for  the  purpose  of  soliciting  the  repeal  of  the  British 
Regulation  Act,  which  repeal  was  earnestly  desired  by  the 
Medical  Profession  of  Canada."  Avast  there,  as  Jack  would 
say,  Dr.  William  Clarke  does  not  represent  the  Medical  Profes- 
sion of  Canada,  however  much  he  may  the  territorial  division  of 
Saugeen  and  Brock.  What  the  "  British  Regulation  Act " 
provides,  we  are  unable  to  state,  as  we  were  not  aware  of  the 
existence  of  such  an  act,  however,  we  are  led  to  infer  the  terms 
of  its  provisions,  by  the  concluding  portion  of  Dr.  William 
Clarke's  address.  Ho  stated  that  "  Sir  John  A.  Macdonald  had 
received  the  deputatation,  and  promised  to  get  the  act  repealed 
so  far  as  it  concerned  Canadian  students.  His  Excellency  the 
Governor-General  also  received  the  deputation,  and,  sympa- 
thising with  the  profession,  promised  to  make  the  necessary 
representations  to  the  Imperial  Government  to  have  the  Act 
repealed."  So  that  we  arc  thus  far  provided  with  the  fact 
that  it  is  an  Imperial  Act,  and  that  it  in  some  way  affects 
the  Canadian  student.  But  Dr.  William  Clarke  goes  a  step 
farther  and  complains  of  the  grievance  to  the  effect,  that,  unless 
repealed  Canadian  students  can  actually  go  to  Britain,  pass  the 


COLLEGE   OP   PHYSICIANS  AND   SURGEONS   OF    ONTARIO.      4*77 

examinations  and  return  and  compel  registratipn.  This,  then, 
is  the  gist  of  the  whole  matter :  a  Local  Corporation  composed 
of  probably  a  fifth  of  the  entire  Medical  Community  of  this 
Dominion,  acting  under  a  charter  granted  by  the  Local  Provin- 
cial Parliament  of  the  Province  of  Ontario,  has  the  effrontery 
to  send  a  deputation  to  the  Government  at  Ottawa,  which  depu- 
tation assumes  to  represent  the  Medical  Profession  of  Canada. 
We  have  no  doubt  that  Sir  John  A.  Macdonald  took  in  the 
position  at  a  glance,  and  to  get  rid  of  the  importunity 
promised  to  look  into  the  subject.  We  can  only  remark  that  if 
the  Right  Honourable  gentleman  does  so,  he  will,  we  have  no 
doubt,  come  to  the  conclusion  that  the  British  Regulation  Act 
had  better  be  left  as  it  is,  inasmuch  as  it  does  not  in  any  way 
affect  the  interests  of  the  Profession  of  this  Dominion  however 
much  it  may  the  self-imposed  importance  of  the  College  of 
Physicians  and  Surgeons  of  the  Province  of  Ontario. 

But  we  are  told,  moreover,  that  if  such  a  thing  were  permitted, 
that  is,  that  the  Canadian  student  should  exercise  his  right  of 
citizenship  and  go  to  Britain  for  his  education,  that  the  Medical 
profession  of  this  Dominion  would  be  endangered  thereby.  This 
is  a  most  remarkable  statement,  and  we  were  amased  to  see  it 
reported  as  coming  from  a  man  in  perfect  possession  of  his  facul- 
ties. When  we  read  this  report  in  the  Q-lobe  we  came  to  the 
conclusion  that  the  reporter  was  poking  fun  at  Dr.  William 
Clarke,  but  we  notice  that  a  literal  copy  appears  in  the  columns 
of  the  Canadian  Journal  of  Medical  Science^  so  that  we  are 
forced  to  the  conclusion  that  these  were  actually  the  utterances 
of  Dr.  William  Clarke,  late  President  of  the  College  of  Physicians 
and  Surgeons  of  the  Province  of  Ontario. 

Well,  all  we  can  say  is  that  these  views  are  crude,  and  we 
hope  that  the  good  sound  common  sense  of  thcr  profession  in 
Ontario  will  not  be  influenced  by  any  such  undigested  material. 

The  College  of  Physicians  and  Surgeons  of  Ontario  is  8imj)ly 
legislating  to  favour  the  educational  institutions  of  Ontario. 
This  would  be  well  enough,  if  it  did  not  lead  to  a  lowering  of 
the  standard  of  education  in  that  Province  ;  and  as  we  are 
all  interested  in  that  question,  we  in  this  other  province  of 


47ft  CANADA    MKDICAL    AND   SURGICAL   JOURNAL. 

the  Dominion  have  a  right  to  speak.  The  Ontario  men  can 
afford  to  learu  a  practical  lesson  from  the  Japanese.  That 
nation  lived  alone  and  avoided  the  contaminating  inflaence 
of  all  outside  barbarians,  until  they  met  with  our  neighbors 
south  of  45^,  when  they  learned  that  it  was  to  their  advantage 
to  receive  foreigners.  Our  Ontario  brethren  will  in  time 
discover  that  the  true  means  of  serving  their  own  edacational 
institutions,  is  by  affording  to  their  students  as  many  advantages 
as  they  can  get  abroad,  in  fact,  competing  honourably  and 
keenly  with  all  outsiders,  and  cease  to  try  and  build  up  a  Mae 
reputation  by  legislative  restrictions.  There  is  nothing  to  be 
apprehended  in  our  students  going  to  Britain  for  an  examina- 
tion, and  any  man  who  returns  to  this  country  ¥rith  a  British 
({ualification  ought  to  be  admitted  to  registration  at  once,  that  is 
on  what  his  papers  show  forth. 

The  profession  in  Great  Britain  is  asking  for  a  change  of  the 
Medical  Act  of  1858  under  which  it  is  governed,  and  we  have 
no  doubt,  that  of  the  many  bills  of  amendment  at  present 
before  the  Im{)erial  House  of  Commons,  bearing  on  matters 
medical,  a  useful  and  satisfactory  measure  will  come  forth.  But, 
whatever  is  obtained  from  the  Legislature,  we  do  not  think  it 
likely  that  one  of  the  prominent  features  of  the  present  act, 
that  of  securing  recognition  of  all  Registered  Practitioners  in 
any  portion  of  Her  Majesty's  Dominions  will  be  surrendered, — 
nor  indeed  is  it  necessary  that  it  should  be.  The  anomaly  of 
obliging  men  who  have  attended  a  lengthy  curriculum  of  study 
and  who  have  passed  before  any  of  the  examining  bodies  in  Great 
Britain,  to  again  submit  to  examination  in  any  of  the  Colonies  is  to 
our  mind  very  objectionable.  We  will  not  refer  to  the  personelle 
of  our  ProNnncial  Boards,  they  are  elective  bodies,  and  unfortu- 
nately the  examiners  are  occasionally  men  who  never  attended 
a  course  of  Jectures  ;  some  who  never  passed  any  examination* 
We  desire  to  see  united  action  of  the  whole  profession  in  this 
Dominion  with  a  snigle  door  of  entrance  to  the  profession.  By 
securing  such  a  measure  we  believe  the  best  interests  of  the 
profession  would  be  served,  and  then  we  might  reasonably 
expect  recognition  from  the  institutions  of  Great  Britain.     All 


A   PRIVATE  HOSPITAL.  4*79 

university  degrees  ought  to  be  honorary,  conferring  on  the 
holders  the  right  of  using  certain  distinctions  such  as  Doctors 
in  Medicine  or  Masters  in  Surgery.  But  the  possession  of 
such  a  distinction  need  not  confer  the  right  to  practice.  All 
candidates  oight  to  be  compelled  to  pass  before  a  common 
Board  of  Examiners  to  be  composed  of  the  leading  men  of  the 
Profession  and  not,  as  is  the  case  at  present,  of  men  taken  from 
the  rank  and  file,  who,  as  a  rule,  are  not  qualified  for  the  posi- 
tion they  fill.  If  such  had  been  the  case  in  Ontario  we  would 
not  have  had  at  the  last  meeting  of  the  College  the  lamentable 
spectacle  of  a  Committee  being  struck  to  enquire  into  the  truth- 
fulness of  the  allegations  of  certain  delinquencies  on  the  part 
of  the  Board  of  Examiners  which  in  the  Scotch  acceptation  of 
the  term  remained  unprt)ven. 

A  PBIVATE  HOSPITAL. 

The  following  circular  was  received  liom  Mr.  Samuel  Strong, 
late  Steward  of  the  Montreal  General  Hospital,  who  has  estab- 
lished in  the  city  a  private  hospital  for  the  better  class  of  pay 
j)atients.  Many  persons  have  an  objection  to  enter  the  wards 
of  a  pubUc  hospital ;  this  objection  is  now  removed  in  the  opening 
of  this  house. 

This  institution  is  a  comfortable  home  situated  in  a  pleasant 
locaUty,  in  the  vicinity  of  the  Windsor  Hotel,  and  on  the  main 
avenue  to  the  mountain  park.  The  house  is  large,  roomy  and 
provided  with  every  essential  for  an  institution  of  this  character. 
Mr.  Strong  is  a  middle-aged,  but  active  and  energetic  man,  and 
has  liad  a  large  experience  in  the  management  of  hospitals  both 
in  England  and  in  this  country.  The  nursing  department  is 
under  the  immediate  supervision  of  Mrs.  Strong,  who  formerly 
belonged  to  Miss  Nightingale's  establishment,  and  who  is  a 
thoroughly  competent  and  reliable  nurse.  It  is  not  the  intention 
of  the  proprietors  to  admit  infectious  diseases,  as  they  wish  to 
retain  it  exclusively  for  surgical  cases.  We  may  observe  tliat 
since  the  opening  of  the  house,  we  have  had  under  our  charge 
several  paients  who  came  to  us  from  the  country  for  surgical 


480  CANADA  MEDICAL  AND  SURGICAL  JOURNAL. 

relief,  and  they  received  every  care  and  attention,  and  to  us 
the  order  and  regularity  of  the  house  was  the  same  as  is  met 
with  in  other  well  conducted  establishments.  In  making  this 
announcement  to  our  friends  both  in  the  city  and  country  dis- 
tricts we  trust  they  will  lend  a  helping  hand  to  render  this  home 
one  of  the  aknowledged  institutions  of  this  city. 


213  Pbel  Street, 
Montreal,  26th  May,  1879. 

Dear  Sir, — I  beg  to  inform  you  I  have  taken  the  house  as 
above  for  the  reception  of  paying  patients,  to  be  attended  by 
their  own  medical  advisers,  and  I  ask  your  support. 

The  nursing  will  be  personally  superintended  by  a  well-known, 
trained  hospital  nurse. 

The  terms  will  be  $2.00  and  $1.50  per  day  according  to 
accommodation,  exclusive  of  medicines,  wines  and  spirits,  etc. 

I  remain,  Dear  Sir, 

Yours,  faithfully, 

SAMUEL  STRONG. 

Pictures  from  the  Parisian  Hospital. — Professor  (who 
has  his  class  in  the  wards)  to  patient,  '*  what  is  your  occupation  ? 
Patient  ( who  has  pulmonary  disease ),  "  Musician,  sir." 
Professor,  to  class :  "  There,  gentlemen,  at  last  I  have  the 
opportunity  of  demonstrating  what  I  have  often  told  you  in  the 
Lecture  room,  that  the  wear  and  tear  on  the  respiratory  tract 
caused  by  the  blowing  of  musical  instruments,  is  a  fertile  source 
of  just  such  difficulty  as  our  patient  here  labors  under.  To 
patient,  what  instrument  do  you  play,  sir  ?"  Patient :  "  The 
bass  drum !" 


CANADA 

Medical  &  Surgical  Journal 

JUNE,  1879. 

Qriginal  ©ommunixiatixins. 

THREE  CASES  OF  MALIGNANT  DISEASE. 

BY  RICHARD  MACDONNELL,  B.A.,  M.D.,  M.R.C.S.,  Enq. 

Assistant  Demonstrator  of  Anatomy,  McGill  University,  Montreal . 

(Read  before  the  Mcdico-Chirargical  Society  of  Montreal.) 

I  propose  to  read  to  you  this  evening  the  histories  of  three 
eases  of  scirrhus  cancer,  and  I  hope  by  them  to  illustrate  three 
points  in  the  clinical  history  of  malignant  disease. 

1.  The  insidious  progress  of  cancer  of  the  upper  part  of  the 
rectum  and  sigmoid  flexure. 

2.  The  irregular  course  of  symptoms  of  cancer  of  the  stomach. 

3.  The  rare  co-existence  of  pregnancy  and  malignant  disease 
of  the  breast. 

Case  I. — Mary  B.,  exact  age  unknown,  apparently  about  70 
years  of  age :  for  many  years  a  widow ;  of  fdr  complexion, 
thin  but  not  emaciated.  Has  been  an  inmate  of  the  Church 
Home  for  many  years. 

I  was  sent  for  on  the  28th  June,  1878,  to  visit  her.  A  slight 
cough,  to  which  she  had  been  subject  for  many  years,  was  rather 
worse  than  usual,  and  for  the  first  time  she  noticed  the  sputa 
tinged  with  blood.  She  had  a  fairly  strong  pulse  and  did  not 
feel  ill  at  all.  The  hsemoptysis  was  very  trifling.  I  prescribed 
rest,  cold  food,  and  a  mustard  poultice  to  the  chest  She  was  to 
take  a  pill  o^  acetate  of  lead  and  opium  every  four  hours  until 
I  saw  her  again. 

NO.  Lxxxni,  32 


4S2  CANADA  HEDICAL   AND   SUBQICAL   JOTTRMAL. 

The  next  day  there  was  no  return  of  the  hfemoirhage.  Tbei 

was  increase  resonance  on  percnaaion.     Large  moiflt  rales  oi 
cheat  generally.     Heart  sounds  normal. 

On  the  third  day  of  the  illDese  there  was  a  slight  return  of  the 
haemorrhage.  Altogether  she  had  taken  three  lead  and  o|num 
pills,  for  I  gave  her  ergot. 

She  complained  to  me  that  day  that  her  bovrels  were  confitu 
and  I  ordered  a  enema  of  soap  and  water. 

On  the  following  day  she  was  thought  to  be  quite  well, 
she  resumed  her  ordinary  occupation. 

Two  days  after  she  was  apparently  in  the  best  of  health, 
was  doing  her  daily  work  in  the  institution. 

Five  days  after  her  recovery  I  received  a  message  to  hurry 
to  see  Mrs.  B,  I  was  out  at  the  time  the  messenger  arrived, 
and  did  not  get  to  the  Church  Home  for  two  hours  afterwards. 
Mrs,  B.  waa  just  dying  ;  insensible  ;  extremities  cold.  She 
died  within  a  few  minutes  of  my  arrival, 

I  was  told  that  that  morning  she  had  been  uneasy  in  her 
bowels,  and  complained  of  distenBion  with  gradually  increasing 
pain,  and  that  her  abdomon  had  become  distended.  Turpentine 
stripes  had  given  momentary  relief. 

PoBt-mortem  appearanceg.  —  Abdomen  much  distended  wii 
gas.    The  colon  was  very  large,  as  large  as  a  ijuart  bottle, 
dark  in  colour  from  congestion.  Beginning  at  the  sigmoid  flexure 
and  involving  the  upper  part  of  the  rectum  was  an  indurated 
stricture  which  almost  occluded  it.     The  gut  itself  was  mueb 
thickened,  and  was  constricted  on  the  outade. 

The  colon  above  contained  a  large  quantity  of  semi-fluid  laeces. 
There  were  no  other  lesions  except  those  found  in  the  old  cases 
of  bronchitis  with  emphyBema. 

The  ate  of  the  disease  affords  a  definite  reason  for  the  absence 
of  pain.  Those  who  have  read  Mr.  Hilton's  admirable  lectures 
on  "  Rest  and  Pain,"  will  perhaps  remember  his  remarks  ob 
this  very  point. 

"  Little  sensibility  and  easy  dilatibility  are  tlie  physiolo^oat 
characteriaticB  of  the  rectum,  except  at  the  lowest  part,  whi 


num 

I 

imy« 
ved,  f 
irds. 
She 

her 
ising 
mtine 

I,  an^^^ 

re 
k1 

4 


MALIGNANT  DISEASE. — BY  DR.  MACDONNELL.'  483 

great  sensibility,  diflScult  dilatation,  and  enduring  power  of  con- 
traction are  the  normal  physiological  features." 

As  practitioners  you  have  no  doubt  noticed  the  extreme 
degree  to  which  this  part  of  the  bowel  can  be  distended  without 
even  causing  inconvenience  to  the  patient,  and  Mr.  Hilton  men- 
tions the  almost  painless  operation  of  tapping  the  bladder  through 
the  rectum,  and  of  applying  nitric  acid  to  prolapsed  gut.  It  is 
still  very  remarkable  that  this  woman  should  have  been  the 
subject  of  such  serious  disease  without  the  existence  of  pre- 
monitory symptoms. 

Case  II. — Maria  B.,  aet.  about  70.  For  many  years  a  widow. 
No  family  constitutional  disease.  One  sister  died  of  hypertro- 
phy of  heart.    Two  sisters  living. 

Always  enjoyed  excellent  health.  On  February  18th,  1878, 
she  first  came  under  my  care.  She  was  suffering  then  from 
constipation  for  which  the  usual  remedies  were  prescribed. 

On  the  18th  of  April  she  complained  of  pain  and  distension 
of  the  abdomen,  constipation  and  loss  of  appetite. 

On  that  day  I  thoroughly  examined  the  chest  and  abdomen, 
and  beyond  noticing  that  the  latter  was  slightly  tympanitic,  I 
could  find  nothing  to  account  for  the  symptoms.  She  was  greatly 
relieved  by  a  pidophyllin  pill,  and  by  the  application  of  stupes  of 
turpentine  to  the  abdomen. 

In  the  first  week  of  May  this  pain  in  the  left  hypochondrium 
was  very  troublesome.  It  was  more  a  sense  of  distension,  I 
think,  than  actual  psdn.  The  patient  could  not  localize  it;  it  was 
not  increased  by  pressure,  nor  was  it  influenced  by  posture.  It 
was  not  constant,  and  it  had  a  tendency  to  become  worse  at 
certain  hours  of  the  day.  It  was  certainly  unconnected  with  the 
taking  of  food,  or  with  its  quantity  or  quality. 

There  Were  then  only  two  symptoms,  tympanites  and  pain. 

The  general  health  was  tolerably  good.  At  this  time  I  re- 
peatedly examined  the  chest  and  abdomen.  The  urine  neither 
contained  sugar  nor  albumen.  Bowels  generally  confined.  I 
thought  then  that  the  symptoms  were  due  to  flatiUent  distension 
of  the  colon. 


484  CANADA  MSDICAL  AND  SUBQICAL  JOrSXAL. 

On  the  12th  of  May  I  had  the  benefit  of  a  consohauian  vith 
Dr,  Craik.  At  his  suggestion  salicylic  add  in  small  doses  was 
used,  with  a  view  to  assist  fennentation.  A  great  improreiDait 
in  the  symptoms  followed,  but  it  was  merely  temporaiy. 

One  day  in  the  latter  end  of  May  she  caught  cdd,  and  daring 
the  week  ending  1st  June,  1878,  she  suffered  from  hmg  symp- 
toms, which  were  thought  by  Dr.  Crsuk  and  myself  to  arise  fiom 
a  slight  pneumonia. 

After  this  attack  the  old  symptoms  returned,  and  then  I 
began  to  suspect  malignant  disease.  Id  the  middle  of  June  Dr. 
Howard  did  me  the  honour  of  examining  the  case  with  me.  We 
examined  the  chest,  abdomen,  rectum,  vagina,  and  urine,  but 
still  no  light  was  thrown  on  the  diagnosis. 

The  pain  and  typanites  continued  as  obstinate  as  ever  until 
the  14th  of  September,  when  she  went  under  homoeopathic  treat- 
ment. On  the  14th  of  October  I  resumed  charge  of  the  case 
again.  Much  emaciated.  Pulse  very  weak.  For  the  next  month 
she  improved  rapidly  and  was  soon  able  to  spend  her  day  in  a 
chsur.  The  treatment  consisted  of  anodynes,  food  and  stimulants. 
The  abdomqn  being  now  very  flaccid,  it  afibrded  us  (for  I  had 
benefit  of  frequent  consultations  with  Dr.  Howard)  abundant 
opportunities  for  careful  examination. 

We  became  day  by  day  more  convinced  that  we  had  malignant 
disease  of  the  colon,  or  of  part  of  the  intestine  to  deal  with.  For 
my  own  part,  I  did  not  even  suspect  the  stomach  until  I  had  seen, 
through  Dr.  Howard's  kindness,  the  autopsy  of  a  patient  of  his, 
whoso  symptoms  were  all  referred  to  in  the  intestines,  and  in 
whom,  after  death,  the  seat  of  the  disease  was  found  to  be  entirely 
confined  to  the  stomach,  the  fatal  event  being  caused  by  perfora- 
tion of  the  pericardium. 

The  consideration  of  this  case  prevented  me  excluding  fipom 
my  list  of  possibilities,  the  existence  of  extensive  organic  disease 
of  the  stomach. 

From  the  14th  of  October  to  the  26th  of  November,  she  was 
entirely  free  from  pain,  but  suffered  from  weakness  and  consti- 
pation.    In  fact  the  bowels  now  never  acted  spontaneously. 

On  the  28  th  of  November  she  had  a  sharp  attack  of  diarriioea, 


MALIGNANT  DISEASE. — BY  DR.  MACDONNELL.  485 

brought  on  by  an  overdose  of  mineral  water.  It  was  noticed  that 
the  stools  were  black.  They  continued  so  until  the  2nd  of 
December.  Dr.  Howard  was  of  the  opinion  that  the  dark  colour 
was  due  to  blood.  The  pulse  was  frequent,  and  she  became 
very  anaemic.  The  pain  in  the  left  hypochondrium  not  so  severe 
as  it  used  to  be,  but  more  periodic,  generally  occurring  at  4  p.m. 
Appetite  very  capricious.  Occasionally  slight  vomiting,  but 
merely  the  contents  of  the  stomach  were  ejected.  Never  vomited 
blood.  Diarrhoea  and  tenesmus  were  present  in  the  month  of 
December.  The  pulse  gradually  weakened  as  the  disease  ad- 
vanced, being  always  regular.  Tongue  is  now  dry,  brown  and 
fissured.  ^ 

On  the  26th  of  December,  Dr.  Howard  detected  in  the  left 
hypochondrium  a  small  movable  tumour  which  was  smooth  and 
rolled  under  the  fingers.  Throughout  the  whole  course  of  the 
disease  this  tumour  afibrded  us  ground  for  conjecture,  but 
from  the  fact  that  at  times  it  could  not  be  found,  we  hesitated 
at  giving  a  decided  opinion. 

At  this  time  pain  was  very  severe,  but  in  the  course  of  a 
month  or  so  it  wore  away.  She  complained  greatly  of  an  uneasy 
sinking  sensation  in  the  left  hypochondriac  region.  In  March, 
1879,  hiccough  appeared,  and  refused  to  yield  to  treatment. 

In  the  beginning  of  April  oedema,  firstly  of  the  feet,  and  sub- 
sequently of  the  hands,  set  in.  The  asthemia  became  more  and 
more  marked,  and  she  died  worn  out. 

Post-mortem  Appearances. — Extreme  emaciation,  oedema  of 
the  ankles  and  hands.  Abdomen  shrunken  and  flattened ;  no 
tumour  could  be  felt. 

On  opening  the  abdomen  the  lesser  curve  of  the  stomach 
appeared  to  be  puckered  and  red.  An  ulcer  as  large  a«,  and 
the  shape  of,  the  human  ear,  was  found  encircling  the  lesser 
curve,  about  J  an  inch  from  the  pylorus.  The  edges  of  the 
ulcer  were  raised,  thickened,  and  much  indurated.  The  centre 
of  it  was  very  thin,  so  thin  that  on  slight  manipulation  a  rent 
was  made  in  it. 

Dr.  Howard,  who  was  present  at  the  autopsy,  thought  that  it 
was  a  large  gastric  ulcer  which  had  taken  on  malignant  action. 
We  found  no  other  lesion  in  the  body  except  senile  changes. 


486 


CANADA   MEDIC4I,    ANIl    SITKOTCAL   JODRNAL. 


The  ulcer  was  examined  microscopically  by  Dr.  Ritchie,  wBl 
has  kindly  provided  us  with  the  slides  we  have  this  eve. 

The  treatment  eonsiBted  in,  at  Brst,  the  use  of  remedies  sai 
to  be  of  service  in  dyspepsia  and  constipation,  afterwards  opiate 
internally,  as  well  as  many  anodyno  applications.  Of  the  latteil 
the  best  one,  was  a  mixture  of  7  parts  of  Lin  Eellad.,  and  1 
part  of  Chloroform,  sprinkled  on  sponj^opihne.  The  last  t 
weeks  of  her  illness,  she  was  fed  almost  entirely  by  the  rectum 

A  few  remarks  on  the  diagnosis  of  this  case.  Ae  you  perceive^ 
the  early  symptoms  were  misleading.  From  their  persistence  I 
and  from  the  progressive  cachexia,  one  was  forced  into  the  coa-  1 
victioD  that  there  was  mahgnant  disease  in  some  part  of  the  I 
alimentary  canal.  But  in  what  part  'i  Exanuuing  the  symptoms  I 
one  by  one  we  shall  find  that  scarcely  any  of  them  point  to  the  I 
Btomach. 

1.  Pain  was  not  of  its  usual  character,  nor  did  it  occupy  ita  I 
usual  site.  Only  at  times  severe,  it  was  absent  during  Uw  • 
latter  part  of  the  patient's  illness. 

Habersbon  regards  pEun  in  such  cases  as  being  dae  to  exposure 
of  the  vagus  to  the  irritating  contents  of  the  stomach.  The  p 
ceases  when  the  branches  are  divided  by  the  progress  of  tl 
disease. 

2.  Vomiting,  though  occasionally  present,  was  never  urgcnl 

3.  Hajmatcracaia  was  entirely  absent. 

4.  No  tumour  could  be  felt. 

The  probabilities  of  the  disease  being  in  the  colon  were  vei 
great. 

1.  The  colon  is  a  favorite  site. 

2.  Typanites  was  an  urgent  symptom,  inclining  one  t 
that  there  was  some  obstruction  in  the  coui'se  of  the  gut 

3.  Fain  was  complained  of  in  the  left  hypochondrium,  and  ifl 
the  left  lumbar  region. 

4.  There  was  obstinate  constipation.  The  bowels  were  e 
about  every  4th  or  5th  day,  by  an  enema  of  soap  and  water<^ 
This  day  was  looked  forward  to  with  dread.  Great  relief  followi 
the  removal  of  an  accumulation  of  faeces. 


MM 


MALIGNANT   DISEASE     -BY   DR.  MACDONNELL.  487 

5.  Tenesmus  accompanied  the  diarrhoea  and  the  passage  of 
bloody  stools,  and  was  at  times  present  throughout  the  course  of 
the  disease.     She  often  strained  for  hours  without  effect. 

6.  A  small  tumour  in  the  left  hypochondrium  could  at  times 
be  felt.  This  afterwards  was  proved  to  be  faecal,  yet  at  the  time 
it  was  very  deceptive. 

7.  The  presence  of  blood  in  the  evacuations. 

Case  III. — M.  B.,  aet.  36,  came  to  the  Montreal  Dispensary 
on  the  18th  of  March,  1879.  Her  father  had  died  from  an 
unknown  cause.  Her  mother  and  several  brothers  and  sisters 
were  alive,  and  in  good  health.  Married  eleven  years.  Four 
healthy  children.  No  miscarriages.  Labours  always  uncom- 
plicated. 

From  early  girlhood  has  had  a  small  tumour  on  right  side  of 
chest.  This  commenced  as  a  little  wart,  increased  to  the  size 
of  a  wahiut,  and  gradually  acquired  a  pedicle.  It  was  never 
painful,  but  it  used  to  catch  in  her  dress  and  she  found  this 
very  inconvenient." 

In  the  beginning  of  last  autumn,  her  lefl  breast  began  to  get 
hard.  There  was  not  much  pain  in  it  at  first.  So  she  post- 
poned from  day  to  day  seeking  advice  about  it.  She  is  five 
months  pregnant.  Cannot  say  which  began  first,  the  pregnancy 
or  the  hard  breast. 

Present  Condition, — A  pendulous  lipoma  grows  from  a  thin 
pedicle  on  the  right  side  of  the  chest,  under  the  axilla  at  the 
level  of  the  eighth  rib.  Complains  of  pain  in  the  left  breast, 
which  is  uniformly  enlarged.  The  skin  is  tightly  drawn  over  it 
and  has  a  glazed  appearance.  The  nipple  is  not  retracted. 
There  is  no  puckering  of  the  mammae.  The  whole  breast  is 
extremely  hard  throughout.  On  the  surface  the  skin  a  *firmly 
adherent  to  subjacent  tissue.  There  is  no  adhesion  to  the 
ribs.  The  margins  of  the  breast  are  hard,  and  cease  abrujjtly 
in  healthy  tissue.  Two  small  glands  in  the  axilla  are  enlarged 
and  hard. 

I  cut  off  the  lipoma,  and  sent  her  up  to  Dr.  Roddick,  to  show 
to  his  class,  and  also  in  order  that  I  might  have  the  benefit  of 
his  advice. 


488  CANADA   MEDICAL    AND   EUBOICAL   jatTRNAL. 

On  the  lOtli  April  she  vias  complaining  of  pain  and  debility. 
About  four  weeks  after  that  I  went  to  see  her  but  found  that 
slic  had  moved.  I  found  a  sister  of  here,  and  &om  her  I  obtamed 
the  following  lustory.  The  debility  had  greatly  increased.  The 
axillary  glands  in  the  lelt  side  had  become  enlarged.  The  other 
breast  had  become  similarly  affected,  At  the  seventh  month 
of  pregnancy  labour  set  in.  Both  mother  and  child  died  about 
twelve  hours  afterwards. 

Cancer  of  the  breast  occurring  in  pregnancy,  is  I  think,  a 
rarity,  though  I  cannot  understand  why  such  should  be  the 
case.  Very  little  mention  of  pregnancy  ia  made  in  the  many 
work  srelating  to  disease  of  the  breast.  Mr.  Heath'  in  one  of  his 
chnical  lectures  states  that  two  conditions  are  not  incompatible, 
and  mentions  the  case  of  such  a  patient  who  went  the  foil  time 
and  gave  birth  to  a  healthy  child.  Mr.  John  Woodf  recorda  a 
case  where  scirrhus  occurring  after  pregnancy  became  compl>- 
catod  with  milk  abscess. 

Mr.  Nuun  in  his  synopsis  of  50  cases  of  cancer  of  the  breast, 
mentions  a  patient  who  in  September  noticed  her  tumour,  had  it 
removed  in  January,  and  in  the  following  April  was  delivered  of 
a  healthy  child.  The  next  June  the  right  breast  was  attacked.^ 

■  Lancel,  Vol.  i,  7!.  p.  849. 

t  Patlmlogical  Tramacliotu,  Vol.  lix. 

i  In  the  dinoiiBBioD  which  follovred  the  readiii);  of  this  |>Fkper,  Dr.  R.  P. 
Howard  and  Dr.  Hlngeton  both  mcntioDcd  cages  where  the  two  coaditionE 
co-exlated. 

l^iospital  il^ports. 


Strangulated,  oblique  Inguinal  Semia. — Congenital, — Operas  I 
tion — Death. — Under  the  care  of  G.  E.  Fenwick,  M.D.  \ 
Reported  bj  A.  W.  Imrie,  M.D.,  AHsislant  Honse  Surgeon. 
R.M.,astrongly-builtmachinist,aged  38 years, was admittetl  I 
to  the  Hospital  on  Friday  afternoon,  June  6th,  with  the  follow- 
ing symptoms  and  history : 

Sgmptoim. — Excruciating  pain,  radiating  from  an  elongated 
tense  tumour  in  the  right  inguinal  re^on — throughout  the  &b> 


f    lit  Tl- 


HOSPITAL  BEPOETS.'  489 

domen  and  down  the  thigh.  Occasional  vomiting,  unattended 
by  nausea,  and  obstinate  constipation.  Patient  felt  weak ; 
extremites  cold ;  countenance  haggard  and  inanimate.  Pulse 
regular  and  full,  at  85  to  the  minute. '  Temperatiu*e  99^. 

History, — On  the  Wednesday  evening  previous,  while  work- 
ing with  an  axe,  he  felt  his  rupture  (present  since  childhood) 
suddenly  grow  unusually  large  and  painful,  and  experiencing  a 
sensation  of  faintness,  he  took  to  his  bed,  a,nd  so  soon  as  he  felt 
somewhat  recovered  from  the  shock,  endeavoured  by  manipula- 
tion to  return  the  intestine  to  the  abdomen.  Failing  on  this  he 
soon  had  violent  pain  in  his  abdomen  and  thighs,  and  began  to 
vomit,  and  these  symptoms  (vomiting  and  pain)  he  states  per- 
sisted. On  Thursday  he  sent  for  surgical  aid,  and  /the  same 
evening  an  attempt  was  made  to  reduce  the  hernia  under  chloro- 
form. A  small  portion  of  bowel  appeared  to  slip  back  into  the 
abdomen,  and  the  tumour  grew  softer.  Patient  was  advised  to 
have  himself  removed  to  the  Hospital  where  an  operation  would 
be  done  to  reUeve  him.  This  he  obstinately  refused  to  do  until 
this  afternoon. 

Diary  and  Treatment. — On  admission  the  hernia  was  found 
to  extend  from  anterior  superior  spinous  process  of  the  right 
ilium  to  the  scrotum,  to  be  uniformly  smooth  and  tense.  But 
one  testicle  could  be  felt,  and  that  high  up  on  the  right  side.  The 
scrotum  did  not  seem  to  be  occupied  by  the  bowel.  Ice  cloths 
were  ordered  to  be  kepi  constantly  applied.  Ice  and  milk  in 
small  quantities  to  be  fed  to  the  patient,  and  grain  doses  of  opium 
administered  every  hour.  On  Saturday  pain  had  subsided. 
Tumour  felt  softer ;  vomiting  continued,  and  patient  was  some- 
what exhausted.  Hypodermic  injections  of  morphia  were 
substituted  for  the  opium.  On  Sunday,  the  pulse  (previously 
full  and  regular  at  85  or  90  to  the  minute)  had  quickened  and 
became  somewhat  easily  compressible  and  irregular.  Tempera- 
ture 100^  ;  pain  slight.  Tumour  soft.  Vonuting  and  constipa- 
tion persistent.  Extremities  blue  and  cold.  Patient,  after 
muoh  persuasion,  consented  to  submitt  to  the  operation. 

At  four  P.M.,  Dr.  Fenwick  proceeded  to  the  operation.  After 
hut  bad  been  adnunistered,  he  made  a  free  incision  cutting 


49(1  CANADA  MEDICAL   AND   SUllfllOAL   JOURNAL. 

through  the  structures,  layer  by  layer,  until  he  reached  the  sac . 
This  was  freely  opened  ;  it  cimtained  a  large  (luantitj  of  serum, 
and  nearly  two  feot  of  small  inteatine.  The  atricture  at  the 
internal  ring,  was  very  tight  and  unyielding,  and  had  to  he 
freely  incised.  A  portion  of  the  intestine  was  drawn  through 
the  stricture  and  examined,  icheu  it  was  deemed  sufficiently 
healthy  to  return  into  the  peritoneal  cavity.  This  was  done 
without  difficulty,  a  drainage  tube  was  placed  in  the  wound 
which  was  closed  with  ca^gut  sutures  and  the  patient  returned 
t(>  his  bed.  The  oiieration  was  performed  with  antisoptit:  pre- 
cautions, but  the  patient  never  rallied,  sinking  gradually  until 
seven  o'clock,  when  he  died. 

ADTOPSY   BY  Dtt.  OSLEB. 

Body,  that  of  a  tiower fully-built  man  ;  no  hair  on  the  Gice  ; 
only  a  few  bristloB  on  chin. 

On  opening  the  abdomen,  omentum  is  injected  and  is  attached 
in  right  inguinal  canal.  Lower  coils  of  intestine  injected, 
and  toward  the  ileo-cacal  valve  dark-coloured,  and  at  one  point 
there  ia  a  definite  constriction ,  immediately  above  which  is  seen 
a  tiny  orifice  through  which  the  contents  of  the  bowel  are 
eacaping.  On  removal  and  careful  inspection  of  this  part  of 
the  bowel,  it  is  seen  that  the  aipping  has  taken  place  just  three 
feet  from  the  valve ;  at  the  point  of  constriction  the  tissues 
are  aofl  and  necrotic  in  a  band  extending  round  the  gut  and 
about  three  lines  in  width.  For  eight  inches  below  this  the 
bowel  is  dark-coloured,  peritoneum  opaque,  and  intestinal  wall 
sodden,  but  scarcely  looks  gangrenous ;  the  next  twelve  inches 
are  not  bo  dark.  The  perforation  is  just  above  the  constriction 
and  is  not  much  larger  than  the  bead  of  a  pin.  The  intestine 
beyond  it  is  tolerably  natural,  walls  relaxed,  and  here  and  there 
are  a  few  cocbymoses.  A  few  ounces  of  dirty  senii-feouleat 
fluid  in  pelvic  cavity.  Very  little  lymph.  Wght  inguinal  canal 
is  large,  readily  admitting  two  fingers,  and  leads  to  a  large  I 
scrotal  sac. 

On  examination  it  was  seen  that  tbf 
subject  of  undescended  testea,  the 


HOSPITAL   REPORTS.  491 

internal  ring,  the  left  high  up  on  the  postero-lateral  wall  of  the 
pelvis.  Both  organs  are  very  small,  not  larger  than  good-sized 
almonds.  They  were  removed  with  the  vasa-deflFerentia  and 
bladder.  On  dissection  the  epidydimis  is  small  and  separated 
by  a  considerable  interval  from  the  body  of  the  testis,  the  vasa 
eflferentia  being  very  distinct.  On  section  the  substance  of  the 
organs  is  yellowish  in  colour,  and  teased  preparation  show  that 
there  is  entire  absence  of  secreting  structure,  the  seminal  tubules 
are  distinct  and  can  be  uncoiled,  but  they  are  filled  with  granu- 
lar debns  and  fatty  matter  ;  no  trace  of  either  seminal  vesicles 
or  epithelium.  Ihe  vasa  defferentia  are  small  but  patent ;  the 
vesiculse  seminales  are  of  normal  size  ;  some  of  the  tubes  contain 
fluid  resembling  semen,  but  on  examination  no  spermatozoa  are 
seen,  only  epithelial  cells.  In  the  larger  coils  there  is  a  firm, 
inspissated  matter  like  wax.  Prostate  is  normal.  The  left 
inguinal  canal  admits  the  finger,  and  leads  to  a  pouch  of  peri- 
toneum which  passes  to  the  upper  part  of  the  scrotum,  the 
middle  finger  passing  down  as  far  as  the  second  joint  from  the 
internal  ring.     Nothing  abnormal  about  the  other  organs. 

Remarks  by  Dr.  Fen  wick  : — There  are  some  points  of 
interest  in  this  case  which  demand  attention.  Although  neither 
testis  had  descended  yet  was  the  scrotum  well-formed  and 
normal  in  appearance.  The  absence  of  a  scrotum  in  similar 
cases  has  been  noticed  and  recorded  by  the  late  Mr.  Poland. 
On  both  sides,  in  this  case,  the  internal  ring  existed,  and 
a  process  of  peritoneum  passed  down,  on  the  right  side  it 
extended  into  the  right  scrotum,  and  was  filled  with  the  intes- 
tinal protrusion,  on  the  left  a  pouch  existed  quite  large  enough 
to  admit  the  passage  of  a  loop  of  intestine,  but  none  had  descend- 
ed. The  operation  for  the  relief  of  the  strangulated  gut  was 
not  urgently  necessary,  until  the  Sunday  morning,  the  day  on 
which  the  operation  was  performed.  The  man,  however,  posi- 
titisely  objected  to  submit  to  operative  measures  until  the  evening 

^llftt-day.     After  opening  the  sac  and  relieving  the  stricture 

6  was  examined  carefully ;  the  portion  which  had 

^^1  was  drawn  out  through  the  opening,  but 

k  and  congested,  it  presented  a  glistening 


4!I2 


CANADA   UBDICAL   ASIt   eunOlCAL   JOURNAL. 


appearance,  and  was  believed  to  be  sufGcientlj  healthy  to  return 
into  the  peritoneal  cavity.  The  result  in  this  case  aflords  another 
proof  of  the  danger  of  delay  in  opei-atinj;  for  the  relief  of 
Btrangulation,  and  had  the  operation  been  perfonnod  a  few 
hours  earlier  there  can  Le  httle  doubt  tho  chances  of  a  success- 
ful issue  would  have  been  much  greater. 

MEDICAL  OASES   UNDEE  DIl.  OSLEK. 
III.  Aphmia,    with   right-sided    Hemiplegia,  coming    on 
fifteen  days  after  deUrery. 

lt.-1'ortml  liy  D.  MigUHnll,  B.A. 

Philomene  A,,£et,  35,  admitted  April  15th  with  hemiplegia 
and  aphasia.  Patient  has  always  boon  a  healthy  woman. 
Married  at  23  years  of  age,  and  has  had  five  children,  the  last 
born  on  25th  of  August,  1878.  Has  never  had  a  miscarriage. 
After  the  birth  of  her  third  child  she  had  a  mammary  abseesB, 
which  continued  to  discharge  for  five  years,  and  haa  Only  healed 
BiQcc  last  confinement.  During  her  last  pregnancy  she  suffered 
fromheadache,  vertigo,  and  a  feeling  of  numbness  and  weakness 
in  the  right  side.  The  patient's  sister,  an  exceedingly  intelli- 
gent woman,  from  whom  most  of  these  facta  have  been  obtained, 
is  quite  positive  about  these  facts.  On  the  9th  of  September, 
fifteen  days  after  delivery,  sho  became  suddenly  paralysed  in 
the  right  side,  and  unconsciouB.  For  six  months  sfae  remained 
in  this  state,  never  speaking  or  appearing  to  recognize  any  of 
her  friends,  and  during  the  entire  period  passed  fiecea  and  urine 
in  bed.  At  the  latter  end  of  February  she  began  to  recognise 
her  friends,  and  soon  after  made  attempts  to  apsak,  and  began 
to  recover  the  use  of  the  right  leg. 

Present  condition. — Patient  is  well-noui'iahed,  with  a  some- 
what vacuous  expression  of  countenance,  and  langha  at  the 
slightest  provocation.  No  facial  paralysis.  She  walks  with  a 
paralytic  gait.  Right  arm  is  moderately  wasted,  and  is  kept  in 
a  aemi-flexed  position,  it  can  be  moved  from  ahouldei ,  movements 
at  elbow  less  free.  Fingers  strongly  flexed,  firm,  secondary 
contracture.     No  impairment   of   sensibility.     She  atill   com- 


HOSPITAL  REPORTS.  493 

plains  of  headache,  and  when  asked  to  point  out  the  spot  invar- 
iably places  the  hand  on  the  right  temporal  region. 

The  aphasia  still  persists,  and  presents  the  following  charac- 
teristics :  on  being  asked  her  name,  patient  cogitates  profoundly, 
and  appears  vexed  and  distressed  at  not  knowing  it,  and  finally 
shrugs  her  shoulders  in  despair.  When  told,  she  at  once  recog- 
nizes it,  and  repeats  it  quite  well,  and  can  do  so  for  two  or  three 
times,  and  then  forgets  it.  When  asked  her  husband's  name, 
she  could  not  remember  it,  but  when  a  long  string  of  names  were 
gone  over  and  the  right  one  mentioned,  she  at  once  recognized  it 
and  repeated  it  joyfully.  It  was  the  same  with  simple  objects, 
she  cannot  tell  her  age,  and  repeats  and  appears  to  consent  to 
almost  any  number  sijggested,  but  when  the  right  figure  is 
named  she  at  once  shows  by  her  expression  that  she  recognizes 
it  as  correct,  and  repeats  it  with  great  emphasis.  During  her 
short  stay  in  Hospital  she  improved  somewhat,  and  Mr.  Mignault 
got  her  to  retam  the  names  of  some  familiar  objects  from  day  to 
day. 

Heart,  lungs  and  kidneys  appear  healthy,  appetite  is  good, 
bowels  regular.  After  remaining  about  ten  days  in  hospital  her 
husband  removed  her. 

IV.  Acute  RheumatiBm  treated  with  Salicylate  of  Soda. 
Delirium  apparently  caused  by  the  remedy. 

Reported  by  B.  £.  Mackenzie,  B.A, 

Margaret  H.,  aet.  35,  admitted  April,  16th,  with  acute  rheu- 
matism. Two  years  ago,  had  a  mild  attack  of  the  same.  On  the 
evening  of  the  12th  she  was  seized  with  pain  in  the  right  knee 
and  became  feverish ;  had  been  scrubbing  during  the  day  and 
was  exposed  to  a  draught.  The  following  day  the  pain  was 
very  severe,  and  on  the  14th  and  15th  the  other  knee  and  the 
shoulders  became  affected.  On  admission  the  wrists  and  ankles 
were  also  swollen,  red  and  tender.  Temperature  100*6^. 
Ordered  salicylate  of  soda,  15  grs.  every  five  hours.  Systolic 
murmur  at  apex.  Has  a  troublesome  cough.  During  17th  and 
18th,  pain  continued.     Temperature  in  evening  reached  101^ 


494  CANADA  MEDICAL  AND  SX7BGICAL  JOURNAL. 

19^A. — Knees  better,  and  can  be  freely  moved.  Complains 
of  a  buzzing  sound  in  the  ears. 

20th, — ^Temperature  normal,  joints  much  better.  Noticed  by 
the  nurse  that  she  talks  incoherently,  and  requires  watching. 

2l8t. — Temperature  98^  ;  joints  better.  Still  rambles  and 
talks  all  sorts  of  nonsense,  is  with  difficulty  kept  in  bed. 

22nd. — Incoherence  more  marked.  Does  not  appear  to  know 
where  she  is.  Slept  badly  and  gave  great  trouble  in  the  ward. 
Systolic  murmur  distinct.  Albumen  in  urine.  Temperature, 
98^.  Pulse  108.  Salicylate  of  soda  stopped,  and  a  mixture  of 
pot.  bromide  and  chloral  ordered. 

2Srd. — Pain  has  disappeared  from  joints.  Delirium  not  so 
marked.  Slept  well.  Complaining  of  sore-throat,  and  on  examin- 
ation the  uvula  is  seen  enlarged  and  swollen,  dark  in  colour,  at 
the  tip,  and  for  a  distance  of  nearly  one  quarter  of  an  inch  it  is 
in  a  state  of  hasmorrhagic  infiltration.  The  soft  palate  is  some- 
what injected. 

2ith. — Delirium  has  disappeared.  Throat  very  sore ;  the  tip 
of  the  uvula  is  greyish-white  in  colour,  and  greatly  swollen  at 
elongated.  Palate  and  pillars  of  fauces  also  swollen.  Tempera- 
ture 99-5^. 

25th. — The  portion  of  uvula  which  was  at  first  haemorrhagic 
and  subsequently  of  a  greyish-white  colour,  appears  to  be 
separating,  a  distinct  line  can  be  seen  between  the  healthy  and 
diseased  parts.  Complains  of  pains  in  shoulders  and  knees ; 
ordered  the  salicylate  of  soda  again,  15  grains  four  times  a  day, 

26th. — Slough  has  separated  from  uvula,  leaving  a  rough 
red  base. 

SOth, — Patient  convalescent. 


PROCEEDINGS  OF  CANADA  MEDICO-CHIRUEGIOAL   SOCIETY.        495 

Jfroceedings  flf  Societies. 

MEDICO-CHIRURGICAL  SOCIETY. 

Montreal,  Mat  16, 1879. 

A  regular  meeting  of  the  above  society  was  held  this  evening, 
the  President,  Dr.  Henry  Howard,  in  the  chair. 

Dr.  Osier  exhibited  a  kidney  which  had  undergone  amyloid 
degeneration  in  a  patient  who  also  had  syphilitic  disease  of  the 
rectum.  The  patient  had  been  in  the  Montreal  General  Hospital 
under  the  care  of  Dr.  Reddy.  The  chief  symptoms  during  life 
were  albuminuria  and  profound  anaemia,  with  slight  oedema  of 
the  ankles.  On  post-mortem  examination  the  kidneys  were  found 
enlarged  and  in  a  condition  of  advanced  amyloid  degeneration. 
The  liver  was  in  a  similar  condition,  but  neither  the  liver  nor 
the  spleen  were  enlarged.  No  deposits  of  pus  were  seen  in  any 
of  these  organs.  The  uterus,  vagina,  and  bladder  were  healthy. 
The  rectum,  however,  had  the  characteristic  appearance  of 
syphilis  ;  namely,  great  thickening  of  its  lower  third,  stenosed, 
and  the  mucus  membrane  for  three  inches  above  the  anus  was 
gone,  and  replaced  by  firm,  fibroid  tissue.  Extending  from  the 
posterior  wall  were  several  sinuses  passing  into  pockets  of  pus. 
The  only  other  'evidence  of  syphilis  was  a  suspicious  ulceration 
of  the  throat.  Dr.  Osier  remarked  that  the  majority  of  these 
cases  occur  in  women. 

Dr.  A.  Lapthorn  Smith  then  read  a  paper  on  "  Chorea,"  giving 
a  detailed  account  of  several  cases  and  expressing  his  belief  that 
this  disease  is  due  to  a  defective  nutrition  of  the  motor  ganglia 
of  the  brain. 

Dr.  R  W.  Campbell  mentioned  that  he  had  three  years  ago 
a  case  of  Chorea,  so  severe  that  he  had  to  keep  the  child  for  a 
whole  week  under  the  influence  of  chloral.  The  treatment  he 
adopted  was  iron  before  meals,  and  arsenic  after. 

Dr.  Roddick  said  that  he  had  attended  a  lady  in  February  for 
pneumonia,  and  on  visiting  her  to-day  decided  choreic  move- 
ments of  the  left  side  were  noticed.  He  ordered  in  this  case 
30  min.  doses  of  dialysed  iron  three  times  a  day. 


496       OANADA  HSDIOAL  AND  SURGIOAL  JOURNAL. 

Dr.  Henry  Howard  looked  on  chorea  as  a  functional  and  not 
an  organic  disease.    His  treatment  was  arsenic  and  nux-vomica. 

A  vote  of  thanks  to  Dr.  Smith  was  moved  by  Dr.  Roddick, 
seconded  by  Dr,  Hingston,  and  carried. 

Dr.  Hingston  exhibited  to  the  society  a  pen-holder  which  he 
extracted  from  the  urethra  of  a  young  man,  it  having  uninten- 
tionally got  lodged  there.  Urethral  forceps  were  used.  They 
are  so  constructed  as  to  facilitate  the  removal  of  foreign  bodies 
from  the  urethra. 

Dr.  F.  W.  Campbell  saw  a  case  some  years  ago  in  the  General 
Hospital  under  the  care  of  the  late  Dr.  Jones,  in  which  a  pencil 
had  been  passed  into  the  urethra.  Lithotomy  was  performed 
in  order  to  extract  it.  He  also  stated  the  facts  of  a  second 
case,  where  through  envy  an  individual  was  forcibly  held  while 
two  shawl  pins  were  inserted  and  pushed  down  his  urethra. 
Finding  it  impossible  to  withdraw  them,  as  their  points  became, 
in  every  effort,  caught  in  the  urethral  walls,  the  points  were 
pressed  forward,  cut  down  on  and  extracted  through  the  wounds. 
He  was  assisted  in  this  case  by  Dr.  Drake. 

Dr.  Campbell  also  related  a  case  of  cancer  of  the  bladder. 

Dr.  Hingston  mentioned  a  case  of  atresia  of  the  vagina,  in 
which  he  had  dilated  and  subsequently  directed  a  medical  man 
to  continue  the  dilation.  At  his  next  visit,  (the  patient  residing 
out  of  town),  he  found  that  the  urethra  had  been  dilated  instead 
of  the  partially  closed  vagina 

Montreal,  May  30, 1879. 

A  regular  meeting  was  held  this  evening,  the  President  Dr. 
Henry  Howard,  in  the  chair. 

Dr.  Osier  exhibited  two  pathological  specimens.  The  first 
was  a  monstrosity.  It  was  a  foundling  brought  into  the  (Jrey 
Nunnery,  and  lived  for  thre6  days  after  admission.  It  is  devoid 
of  cerebellum  and  cerebrum.  Projecting  from  the  top  of  the 
head  are  some  peculiar  convolutions.  The  frontal  and  parietal 
bones  are  wanting ;  the  occipital  is  wanting.  The  head  is  buried 
in  the  -shoulders,  and  there  is  a  peculiar  idiotic  appearance. 
Dr.  Fenwick  asked  if  the  child  fed  and  swallowed.  Dr.  Schmidt 


CANADA   MEDICO-CHIRURGICAL    SOCIETY.  497 

replied  that  it  swallowed  very  well,  and  was  fed  from  a  spoon. 
Dr.  Smith  asked  if  the  child  could  move  its  limbs  freely.  Dr. 
Schmidt  replied  that  it  did  not  move  its  left  arm.  Dr.  Osier 
further  added :  that  an  interesting  fact  in  these  cases  is,  that 
the  cranial  nerves  are  developed  and  perfect. 

The  second  case  was  one  of  post-partum  endo-metritis,  death 
having  taken  place  on  the  9th  day  preceded  by  symptoms  of 
septic  poisoning.  There  is  a  coating  like  a  diphtheritic  membrane 
over  about  one-third  of  the  uterus.  The  uterine  veins  are  not 
filled  with  thrombi,  the  right  ovarian,  however,  is  large,  firm, 
hard  and  filled  with  a  thrombus.  This  was  traced  up  to  the 
inferior  vena  cava,  and  where  it  enters  the  cava  it  was  of  natural 
size,  and  through  this  opening  the  thrombus  extended,  and  was 
attached  to  the  wall  of  the  cava.  There  was  diphtheritic  endo- 
metritis. According  to  some  writers,  there  is  a  difference  between 
this  and  true  diphtheria.  Herschfeld  says  that  if  this  be  ino- 
culated in  the  throat  of  a  rabbit  it  will  not  induce  genuine 
diphtheria. 

Dr.  Rodger  then  read  a  paper  on  "  Softening  of  the  Brain." 
Some  discussion  followed,  and  a  vote  of  thanks  was  moved  by 
Dr.  Kennedy,  seconded  by  Dr.  Ross,  and  carried. 

Under  the  head  of  "  Cases  in  Practice  "  Dr.  Kingston  men- 
tioned that  on  Sunday  last  a  child  was  brought  to  him  suffering 
very  great  psdn  in  the  rectum.  On  passing  his  finger  into  the 
rectum,  he  found  a  needle,  which  was  removed.  The  child  had 
swallowed  it. 

Dr.  Ross  asked  what  was  the  experience  of  members  of  the 
Society  in  regard  to  Ague  occurring  within  the  city  of  Montreal, 
He  said  he  knew  of  it  occurring  in  the  neighbourhood  of  the 
city,  but  had  never  seen  a  case  originating  within  the  city.  He 
had  lately  a  case  from  Hochelaga,  and  had  seen  two  cases  in  the 
General  Hospital,  the  disease  having  attacked  the  men  while 
working  in  the  Lachine  Canal.  Dr.  Fenwick  said  he  had  seen 
cases  ori^ating  within  the  city,  especially  on  the  line  of 
Ontario  street.  Dr.  Armstrong  had  seen  one  case,  and  Dr. 
Rodger  two  at  the  Point. 

The  meeting  then  adjourned. 

0.  C.  EDWARDS, 

Secretary. 
NO.  Lxxxni.  33 


ANADA    VEIUCAL    AND   SHROICAl,    JOURSAl 


IJpuicws  and  Bolices  of  Bouhs. 

A  Practical  Treatisn  oti  Sarijiaal  Diagvattt.  Desij^iied  as  a 
Manual  for  Practitioners  and  Studenta. — By  Amkrose  L. 
Rannby,  A.m.,  M.D.,  &c.  8vo.  pp.  386.  New  York  : 
WiLUAM  Wood  &  Comiiany,  27,  Groat  Jones  Street. 

This  is  a  very  excellent  manual.  The  author  in  publishing  it 
as  a  text-book  for  students  trust*  that  it  may  be  an  aid  to  memory 
by  presenting  the  symptoms  of  any  given  diseases  in  contrast 
with  those  of  other  diseases  that  they  may  resemble,  Conaider- 
ahle  care  has  been  devoted  to  the  preparation  of  this  work. 
All  questions  of  setiology,  pathology  and  treatment  have  been 
excluded,  the  author  con6ning  himself  to  tlie  symptomatology 
of  disease,  showing  the  difTerenees  in  this  respect  between  dif- 
ferent atlections  which  often  resemble  oue  another,  and  which 
may  be  mistaken  the  one  for  the  other.  The  table  of  contents 
sets  forth  a  division  of  the  subject  into  eight  parts.  In  part  I 
Diseaee  of  the  blood-vessels  are  given.  In  the  classification  we 
have  diseases  of  the  arterial  coats,  as  atheroma  and  fatty  degen- 
eration. Disease  affecting  the  calibre  of  the  vessels,  as  aneurism, 
occlusion  of  arteries  from  pressure,  from  emboli,  from  thrombi, 
and  from  foreign  bodies.  Diseases  of  veins,  as  hypertrophy  of 
the  coats,  atrophy  of  venous  coats,  adhesive  phlebitis,  diffuse 
phlebitis,  varicose  tumours,  obstruction  from  plugging,  or  outside 
pressure,  and  parasites  of  veins. 

The  author  is  forced  to  admit  that  many  of  these  atTections  are 
obscure,  and  that  in  some  a  positive  and  decided  opinion  cannot 
be  given,  based  on  the  rational  aymptoms,  or  physical  signs 
observed. 

In  speaking  of  aneurism,  the  author  points  out  the  diihculties 
of  diagnosis,  more  especially  in  the  thoracic  and  abdominal 
varieties.  lie  enumerates  some  thirteen  other  affections  with 
which  aneurism  may  be  confounded.  The  differential  symptoms 
of  each  are  given,  side  by  side,  so  that  the  reader  is  enabled  to 
grasp  tiie  subject  more  readily. 

In  part  11.  Diaoaaes  of  joiats  are  treated  in  the  same  rnsimer. 


REVIEWS  AND   NOTICES   OP   BOOKS.  499 

These  the  author  classifies  under  the  headings,  inflammatory 
diseases,  anchylosesj  dropsy  of  joiAts,  articular  neuralgia,  loose 
cartilages,  and  congenital  and   acquired  malformations.     In 
part  III.  we  have  the  subject  of  diseases  of  bones.  Part  IV.  dislo- 
cations, and  part  V.  fractures.  Part  VI.  is  devoted  to  diseases  of 
the  male  genitals.  Part  VIL  to  diseases  of  the  abdominal  cavity, 
and  Part  VHI.  to  diseases  of  the  tissues.  In  this  last  part  will  be 
found  inflammatory  conditions  of  the  tissues,  tumefactions,  indu- 
rations,  suppurations,  gangrene,  the  formation  of  abscess,  tumors, 
both  benign  and  malignant,  and  the   differential  diagnosis, 
between  various  conditions  of  the  uterus,  uterine  fibroids,  and 
ovarian  cysts.     This  is  a  very  practical  book  and  will  be  found 
of  great  use  to  the  surgical  teacher,  more  especially  those  en- 
gaged in  bed-side  instruction.  The  arrangement  of  the  subjects 
is  concise,  and  the  difierentiation  so  placed  that  the  symptoms 
of  each  disease  can  be  reviewed  separately  by  reading  from 
above  downwards,  and  by  reading  across  the  page  the  points  of 
contrast  become  at  once  apparent,  while  at  the  foot  of  each  page 
will  be  found  an  enumeration  of  symptoms  common  to  the  disease 
under  discussion,  and  that  with  which  it  might  be  confounded. 
There  are  some  defects  which  are  of  importance,  as  for  in- 
stance, in  the  subspinous  dislocation  of  the  humerus,  it  is  stated 
that  it  is  frequent  in  all  ages.     This  is  manifestly  an.  error,  as 
this  form  of  dislocation  is  very  rare.     Frank  Hamilton  testifies 
to  the  rarity  of  this  accident.  In  the  5th  edition  of  his  valuable 
treatise  on  dislocations  and  fractures,  he  mentions  one  case  onfy 
as  having  come  under  his  observation ;  again,  in  reference  to 
this  dislocation,  the  author  states  the  reduction  is  permanent 
when  accompUshed.     This  is  certanily  not  always  the  case. 
Hamilton  mentions  the  fact  of  one  case  in  which  the  bone  would 
not  remain  in  place  when  reduced,  and  accounts  for  that  result 
from  disruption  of  the  subscapularis  muscle,  an  accident  which 
is  mentioned  as  occurring  by  Sir  Astley  Cooper.  There  are  some 
other  defects  which  in  a  careful  revision  of  the  work  will,  we 
doubt  not,  be  amended  in   a  fature  edition.    Altogether  the 
work  is  most  creditable,  and  will  be  found  of  great  use  to  both 
practitioner  and  student. 


500  OANAIJA    MElHrAF,    ANI>   HUHHICAI.    JiiURNAL. 

Moderu  Surji'ical   Thrrnprutic». — A  Compoiniiuin  of  Carrend 
Formiilaj,  appruvud.  Drosaings  iiiut  Specilic  Methods  fori 
Treatment  of  Surgical  Diseases  and  Injuries. — By  Geo.  1 
H.  Nai'Ubys,  A.M„  M.D.    Sixth  edition.    Revised  to  tlie 
moat  recent  date.     8vo.  pp.  4'20.     Philadelphia:  D,  G. 
BiUNTON,  115  South  Seventh  Street. 

This  is  an  old  friend  with  a  new  face,  another  edition  of 
very  popular  compilation  of  the  various  modes  of  treatment 
adopted  by  surgeons  in  all  parts  of  the  world,     We  are  pleased 
to  see  that  the  author  givoa  credit  to  Canada  for  some  of  the. 
]ilaDs  of  treatment  he  enumerates. 

Prof.  Fuller's  treatment  of  shock  by  opium  (^Medical  S^ecord^. 
February,  1877)  is  mentioned. 

Threo  pages  and  a  half  are  devoted  to  synopsis  of  Dr.  Rose-' 
hrugh's  (Toronto)  treatment  of  Conjunctivitis.  The  work  is  an 
exceedingly  useful  one,  and  (pute  up  to  the  practice  of  the  pre- 
sent day. 

A  Treatiff  on  (Ac  JMseasee  of  InfaTuy  and  Childhood. — 13y  J. 

Lewis  SuiTn,  M.D.,  CUnioal  Professor  of  Diseases  of 

Childreu  in  Bellevue  ilospital,  New  York,  Fourth  edition, 

thoroughly  revised,  with  illustrations.  8vo.  pp.  740.  Fhila- 

delphitt :  Hbnry  C.  Lua,  publisher,  1879. 

The  fact  that  the  author  has  been  called  upon  to  produce  & 

fourth  edition  of  this  work  demonstrates  conclusively  that  it 

supplies  a  want  keenly  felt  by  American  practitioners.     Either 

from  his  own  neglect,  in  many  more  instances  from  tlie  neglect 

of  the  authorities  of  his  coUe;^,  the  student  goes  into  practice 

knowing  little  or  nothing  about  the  diseases  of  children.  On  ths' 

day  he  graduates,  though  he  may  know  all  about  tying  the  third! 

part  of  the  subclavian,  diagnosing  spinal  sclerosis,  or  the  best 

method  of  performing  Caesarian  section,  yet  his  examiners  would 

puzzle  him  were  they  to  ask  how  an  enema  ought  to  be  given  to 

a  baby,  or  how  to  prescribe  for  a  case  of  infantile  diarrhcea. 

Many  a  young  practitioner,  aware  of  his  ignorance  in  tliis 
branch  of  medicine,  commences  his  reading  in  that  long  dreary 
period  before  the  patients  come  to  him,  by  careful  application  to 


I 


I 


REVIEWS  AND   NOTICES  OF   BOOKS.  501 

some  treatise  on  diseases  of  childhood.  Dr.  Smith's  work  would 
suit  such  readers  most  admirably. 

In  being  written  by  one  whose  experience  is  American,  it 
possesses  a  great  advantage ;  for,  as  we  all  know,  the  climate  of 
a  country  alters  in  a  great  measure  the  type  of  a  disease,  and 
many  diseases  of  childhood  are  almost  absent,  or,  at  all  events, 
not  so  prevalent  in  England  as  they  are  in  America.  The 
summer  diarrhoea  of  children  affords  an  example  of  one  of  these. 

The  earlier  chapters  are  connected  with  the  bringing  up,  the 
feeding,  the  clothing,  etc.  of  children.  Of  the  artificial  feeding 
of  infants.  Dr.  Smith's  statistics  are  alarming. 

"  Thus,  on  the  continent,  in  Lyons  and  Parthenay,  where 
foundlings  are  wet-nursed, the  deaths  are 33.7  and 35  percent. 
On  the  other  hand,  in  Paris,  Rheims,  and  Aix,  where  the  found- 
lings are  wholly  dry-nursed,  their  deaths  are  50.3,  63.9,  and  80 
per  cent.  In  this  city,  (New  York)  the  foundlings,  amounting 
to  several  hundred  a  year,  were  formerly  dry-nursed ;  and 
incredible  as  it  may  appear,  their  mortality  with  this  mode  of 
alimentation  nearly  reached  100  per  cent." 

The  subject  of  systolic  brain  murmur  in  children,  which  Pro- 
fessor Osier  brought  before  the  Medico-Chirurgical  Society  of 
Montreal  some  time  ago,  is  referred  to  by  the  author  in  connec- 
tion with  rickets.  ^'  Later  observations  have  established  the  fact, 
that  this  murmur  possesses  little  diagnostic  value.  It  is  heard  in 
healthy  as  well  as  diseased  infants.  Dr.  Wirthgen  detected  it 
22  times  in  52  children,  all  of  whom,  except  four,  were  in  good 
health.  I  have  auscultated  the  anterior  fontanelle  in  29  infants 
who  were,  with  two  exceptions,  between  the  ages  of  three  and 
thirty  months.  Most  of  them  were  well,  or  with  trivial  ailments, 
which  would  not  affect  the  cerebral  circulation.  In  most  infants 
with  a  patent  fontanelle,  a  murmur  can  be  distinctly  heard, 
synchronous  with  the  respiratory  act,  and  in  15  out  of  the  39 
cases,  no  other  bruit  could  be  detected,  while  in  the  remainder, 
namely  14,  a  bruit  synchronous  with  the  pulse  was  heard  at  the 
fontanelle." 

Dr.  Smith  ignores  the  ingenious  theory  of  Jurasz,  that  these 
brain  murmurs  are  due  to  want  of  correspondence  in  size  between 


502  CA5ADA   MEDICAL   AXD    SURGICAL   JOUItSAL. 

the  internal  carotid  artery  and  the  bony  canal  diroogh  which  h 
passes  in  the  base  of  the  skuIL  Hie  researches  of  his  own 
conntrymen,  Drs.  fisher  and  Whitney,  deseire  recognitiofi. 

In  the  treatment  of  whooptng-coo^  the  remecties  found  most 
useful  and  which  are  most  employed  in  the  New  York  insmu- 
tions,  are  belladonna,  quinine,  the  bromides,  and  the  hydrate  of 
chloral. 

^^  The  use  of  qnimne  as  a  remedy  for  pertossis^  was  fir?t 
strongly  recommended  by  Binz,  who  embraced  the  theory  of 
Letsserich,  that  this  disease  is  produced  by  a  fungus  upon  which 
the  quinine  acts  injuriously/' 

Fungus  or  no  fungus,  the  remedy  is  an  old  one.  The  use  of 
Peruvian  bark  in  whooping-cough  was  recognized  long  ago.  We 
quote  from  CuUen's  "  Rrst  lines,"  chap,  vii  paragraph 
mccccxxv : 

^^  Of  the  tonics,  I  consider  the  cup  moss  formeriy  celebrated, 
as  of  this  kind  ;  as  also  the  bark  of  the  mistletoe,  but  I  hare 
had  no  experience  of  either,  as  I  have  always  trusted  to  the 
Peruvian  bark.  I  consider  the  use  of  this  medicine  as  the  most 
certain  means  of  curing  the  disease  in  its  second  stage ;  and 
when  there  has  been  little  fever  present,  and  a  sufficient  quan- 
tity of  the  bark  has  been  given,  it  has  seldom  failed  of  soon 
putting  an  end  to  the  disease." 

The  chapters  on  ccrebro-spinal  meningitis  deserve  special 
commendation,  the  author  from  his  official  connection,  with  so 
many  institutions  for  children  in  New  York,  being  able  to  give 
valuable  information  about  this  terrible  disease. 

Apropos  of  the  relationship  between  rheumatism  and  chorea, 
which  is  thought  by  some  pathologists  to  exist,  attention  is  drawn 
to  the  somewhat  remarkble  difference  in  the  statistics  of  different 
countries. 

"  In  England  and  France,  so  large  a  proportion  of  choric 
patients  present  the  history  of  rheumatism  either  in  themselves 
or  family,  that  certain  physicians  of  these  countries  believe  that 
rheumatism  is  the  most  common  cause  of  the  disease.  In 
Germany,  on  the  other  hand,  according  to  Romberg,  in  the 
majority  of  cases  no  relation  can  be  traced  between  chorea  and 


REVIEWS   AND   NOTICES   OP   BOOKS.  503 

rheumatism,  and  the  statistics  of  this  city  (New  York),  and  I 
think  of  this  country,  correspond  with  those  in  Germany." 

The  best  part  of  the  whole  book  is  that  relating  to  the 
intestinal  catarrh  of  infancy.  Dr.  Smith  is  a  strong  believer  in 
the  benefit  of  country  air,  and  his  opinion,  will  no  doubt  be 
endorsed  by  practitioners  in  Canada.  He  thinks  the  high  tem- 
perature of  summer  is  not  directly  the  cause. 

"  But  the  state  of  the  atmosphere  which  is  most  favourable 
for  the  development  of  intestinal  catarrh,  is  found  only  in  the 
cities.  The  filthy  streets  containing  more  or  less  decaying 
animal  and  vegetable  matter,  the  crowded  and  unclean  tenement 
houses,  the  neglected  privies,  the  slaughter-houses,  pig-pens, 
bone-boiling  establishments  and  the  like,  are  so  many  sources  of 
the  most  deleterious  effluvia,  which,  inspired  by  the  infant, 
produce  diarrhoea,  and  intestinal  inflammation.  Those  squares 
of  the  city,  where  sanitary  regulations  are  most  neglected  are 
the  very  ones  where  the  mortality  from  this  cause  is  largest." 

Such  is  the  experience  of  the  profession  in  Montreal,  we  ven- 
ture to  say. 

The  perusal  of  Dr.  Smiths's  work  has  afibrded  us  much 
pleasure  and  still  more  instruction.  Its  place  is  amongst  the 
first  of  American  medical  works.  There  is  no  work  on  the 
subject  we  can  more  conscientiously  recommend  to  our  readers. 

Clinical  Diagnosis. — A  Hand-book  for  Students  and  Practi- 
tioners of  Medicine.  Edited  by  Jambs  Finlayson,  M.D., 
Physician  and  Lecturer  on  Cj^nical  Medicine  in  the  Glas- 
gow Western  Infirmary.  Examiner  in  Clinical  Medicine  to 
the  Faculty  of  Physicians  and  Surgeons,  Glasgow,^  &c.,  &c. 
with  eighty-five  illustrations.  8vo.  pp.  548.  Philadelphia : 
Henry  C.  Lea. 

There  are  a  great  many  manuals  of  Clinical  Medicine, — 
hand-books  of  physicians, — and  others  with  different  titles,  but 
a  similar  end  in  view,  already  published.  Of  course  many  of 
these  are  valuable  to  students,  and  those  beginning  the  practical 
observation  of  cases  of  diseases  at  the  bedside  of  the  sick  in  a 
hospital  ward.     One  great  fault  of  several  of  them,  it  has  ap- 


peand  ti>  as.  hts  in  die  strsr.  harsiu  lotsiuuac  lines  ufanc  ire 
dnwn  ixk  emaMwhfng  ffiferenc  «iiagnoggg  hecweqi  gomniamrg  loc 
to  resemble  caefi  odier.    lbs  ererr  exTHxiencefl  QiL^Tnsan. 
know?  tioes  zk^  exisc  in  luiciire  ami  is  is  diia^ns  3ici}rr>*ec  3i 
scm  a  stoiient  wkh  die  iiiea  diac  diou  b  wtiac  he  is  jq  fsneer  2 
fimL    Is  is  a  £ah  wfiidi  is  '{iiice  inseparable  irnnL  iie  plan  if 
emieaTorinz  go  zrre  Terr  ^tt  and  ci^neise  leeiazes  lir  die  Ss^ 
dnedre  sji^cemade  '^^gp^*^  of  most  oi  die  imporsuic  -fifleaoes. 
Tliis  pmceiiare  ii  not  feOr^weti  ac  iH  in  -iiis  lime  brnk*  insL  -m. 
die  coQtrarr.  ir  aane   ai,  ami  jociKeiis   in.  benur  ndier  an 
aonaCBU  '^  penooal  observadon.  wbiisc  u  iie  «inie  dme  x  ^^nn- 
cams  mneb  diac  is  emioenclj  iascniedT*^.  iier?  is  mori*  wiuek  i» 
Bij^izesdre.  Ic  tijes  odc  makii  anj  acsempc  a  <»ver  cie  zmimii 
of  ifia^znosa — vbieks  jo  manffesdjinip^iflsbie — bncic  fiaenaBes 
in  a  brief,  cerse  maziner.  all  die  imsonanc  srarDmms   if  eaiai 
dasB  of  tfiseaaes.  Doincinz  as  cieir  ci}nneedans  widi  •saczL  ijhse 
ami  widi  i^^ie  'Tf  idier  dasses.  acsenoim  bem;r  -nreccetl  uD  aO. 
eollaseral  <nrcTEznscances  wbzcb  aaast  in  die  t^areml  ibserTadun 
of  a  frase  as  a  viDle.  azui  in  comor^flensim  if  ^oeti  js  jre  zrnr- 
eraeii  bv  'iefiaice  uadiolDtseal  laws.     The  TnedicHi  ami  izran&r?- 
menc  is.  we  diink.  -ispe^iiailT  iiiaoiseii  5ir  "iie  -nnia  )f  Kmienis. 
ami  Tf'i  "¥01111 1  "KiTTie^idT  reiitimmeoii  ir  ji  ill  ^anii.  d)r  innscuir 
reference  ▼ttilsc  rewrdn;!  «:ases  in  die  Hbrnirai.    Ti  iive  «me 
idea  if  "aie  ^ctipe  ic  die  Trnrk:    pr^mianiT  diac  -iaoh.  ^etidun  oas 
a  Siir  amiinnc  if  ii:ai!e  iili}cseii  jo  it »  -v?  ^t^  die  Isz  )z  Mnnr:- 
bnQin  xoii  dieir  ?aDJei!T3.    Fir  1  ^netriai  iiiciri    if  diis  '3«j«)k 
is  diac  in  is  die  i* iinc  Trork  ifce7i»nl  if  die  Tjnmmenr  liiTgcim:* 
')f  Griai:  Britain — saeii  me,  is  in  die  !Tr:if  Tueoa^  if  iieuihne. 
wndniC  diaz  Dam  per'nininir  j1  die  inncii  ^idi  Toicii  ie  jimseif 

is  mf>st  inmar.     E>r.  'iir-bier  m  die  DiiT^itrnDmv  if  Diz^eafie. 

_   «      —       * 

E>r.  FmiaT^in.  L^n  Cade-riikiiiiE-  Jnii  •-'^  STmntiims  if  Etsoriers 
in  die  Vemms  Sraems.  It.  Wh.  Scapiieasuii.  L*n  die  ZTsorier? 
of  die  F-iimue  ♦V-nn.^.  E»r.  Alexamier  Ri-'bersan.  *jtl  rrmaimy 
I)r.  damson  *jemmiIL  *jxl  die  SpiiyrniigapiL  xad  L>n  die  Exam* 
inaciin  if  die  <mei<c  miL  lixiumen.  Dr.  Xjseaii  Oiais.  *Jn  die 
Examinacun  )z  die  Finees^  Lirrnx  ami  ^i&e.  mii  m  die 
Mediutt  It  P^rcudmur  Pisc-auirsm  E2aamuidjUii& 


BRITISH  AND    FOEEIGN   JOURNALS.  505 

Epitome  of  Skin  Diseases  with  Formulce. — For  Students  and 
Practitioners. — By  Tilbury  Fox,  M.D.,  F.R.C.P.,  and 
T.  C.  Fox,  M.B.,  B.A.  (Cantab).  Second  American 
edition,  enlarged  and  revised  by  the  anthers.  Philadelphia  : 
Henry  C.  Lea,  1879. 

We  have  much  pleasure  in  strongly  recommending  for  the 
careful  study  of  our  readers  this  excellent  little  took.  The  study 
of  skin  diseases  is  enveloped  in  far  too  much  mystery  in  this  age 
of  specialism.  There  is  nothing  whatever  in  the  diagnosis  and 
treatment  of  skin  diseases  which  is  outside  the  province  of  the 
general  practitionBr.  It  is  for  him  and  for  students  that  this 
little  book  is  written.  This,  the  second  American,  is  a  decided 
improvement  on  the  English  edition,  for  it  contains  an  excellent 
summary  on  the  difference  in  skin  diseases  found  in  America  and 
those  found  in  England.  The  most  useful  part  of  the  book  to 
the  every-day  practitioner  will,  doubtless,  be  the  Cutaneous 
Pharmacopeia  appended*  The  last  chapter  on  ''  Diet  in  Skin 
Diseases,"  demands  very  careful  attention. 

Extracts  from  British  and  Foreign  Journals. 

Unless  otherwise  stated  the  translations  are  made  specially  for  this  Journal. 

The  use  of  Eserine  in   Olaucoma— (By 

W.  Spenobr  Watson,  F.R.S.) — In  a  communication  to  the 
Medical  Times  and  Gazette  in  February  last,  I  remarked  that 
"  sulphate  of  eserine  in  the  form  of  coUyrium  was  said  to  be 
useful  either  when,  from  any  cause,  the  operation  is  delayed,  or 
after  the  operation  if  the  tension  returns."  Recent  experience 
has  convinced  me  that  this  reputed  power  of  eserine  is  not  a 
mere  illusion.  I  can  fully  endorse  the  views  expressed  by 
De  Wecker  in  his  recently  published  work  ("  Th^rapeutique 
Oculaire  "),  in  which  he  lays  down  as  a  rule  that  eserine  should 
always  be  employed  before  and  after  an  operation  for  glaucoma, 
whether  the  operation  chosen  be  iridectomy  or  sclerotomy.  I 
have  been  agreeably  surprised  at  the  manifest  advantages  of 
employing  it  under  these  circumstances,  and  now  find  that  oper- 
ation may  be  safely  postponed  in  certain  cases  for  a  week  or  ten 


r>nC  CANADA   MBDrCAT,    AtlD    SCKfilCAL    JOUKSAL, 

(Ifiya,  or  even  longer  when  eserine  is  ueed,  whereae  witfaoat  it 
ijelay  seemed  almost  fatal  to  the  chances  of  saving  or  restoring 
sight.  In  hospital  practice,  and  perhaps  even  more  bo  in  private, 
it  is  often  difficult  to  convince  patients  of  the  extreme  urgency 
of  the  9ympt'>m3 ;  and  even  if  convinced,  the  dread  of  the  Imife 
keeps  hack  nervous  patients  from  the  necessary  ordeal  until  it 
19  perhaps  too  late.  It  is  therefore  a  great  advantage  to  have  at 
hand  a  romcdj  the  effect  of  which  ia  to  render  delay  less  dan- 
gerouii  than  It  must  otherwise  be,  and  in  eserinc  we  possess  such 
a  remedy.  The  two  following  cases  illustrate  this  point  in  a  way 
which  to  me  ia  very  convincing : — 

Case  1 — Simple  Qlaucomn  of  both  Eijv»,  with  Excavated  Discs 
avd  Pidmtinff  Vi:»»fh — All  thf  Symj>tovi»  rcUfVi-d  by  the 
use  of  Eserine. 

Elizabeth  C,  aged  39  years,  a  amall  woman  with  dark  hair 
and  irides,  married  and  with  six  children,  came  to  the  South 
London  Ophthalmic  Hospital  on  December  ;iUth,  1878,  with  all 
the  subjective  and  objective  ayraptoma  of  simple  glaucoma. 
She  said  she  hod  been  nursing  a  sick  husband,  and  from 
various  causes  had  very  disturbed  nights,  and  yet  been  obliged 
to  work  hard  during  the  day.  For  the  last  eight  months  her 
sight  had  been  failing,  and  she  had  noticed  coloured  haloes 
round  the  candle.  She  had  never  had  any  pain  either  in  her 
eyes  or  in  the  surrounding  bones.  The  tension  was  increased 
in  both  eyes.  Vision  of  the  right  eye,  letters  of  J.  20 ;  vision 
of  left,  J.  10.  Both  pupils  fixed  and  half  dilated.  Both  anterior 
chambers  shallow,  especially  that  of  the  right,  in  which  also  the 
cornea  and  aqueous  were  very  turbid.  Both  optic  discs  were 
excavated,  that  of  the  right  eye  being  very  much  cupped  and 
pale,  as  if  from  some  degree  of  atrophic  anxmia,  while  that  of  the 
loft  eye  retained  its  normal  colour,  and  was  even  hypencmic. 
Venous  pulsation  was  seen  In  the  right  eye,  but  not  in  the  left. 
This  was  a  clear  case  for  iridectomy  or  sclerotomy.  An  opera- 
tion was  at  once  proposed,  but,  as  might  have  been  expected,  tlie 
mother  of  six  children,  with  a  sick  husband  to  nurse,  was  in 
mood  for  sudden  and  active  measures,  even  though  threatened 


1 

1 

I 
1 


BRITISH  AND   FOREIGN  JOURNALS.  507 

with  the  possibility  of  losing  her  sight.  She  was,  however,  fully 
warned  of  the  risks  she  was  running  by  refusing  operation,  and 
told  in  the  meanwhile  to  use  the  eserine  drops  twice  a  day. 

January  3rd,  1879.^Patient  declares  that  she  has  never  had 
the  coloured  haloes  before  her  eyes  since  she  used  the  drops. 
Her  vision  has  decidedly  improved  ;  right  eye,  T.  3,  V.  J.  10 ; 
left  eye,  temperature  normal,  V.  J.  8.  In  both  the  anterior 
chamber  is  clear,  and  the  plane  of  the  iris  normal. 

17th. — The  drops  have  been  continued,  and  there  is  still 
further  improvement  of  vision.  It  is  doubtful  whether  there  is 
now  any  tension,  even  of  the  worst  eye. 

An  operation  was  again  urged  upon  the  woman,  who  is,  how- 
ever, so  well  satisfied  with  the  improvement  in  her  sight  that 
she  still  declines,  and  is  therefore  directed  to  continue  the  use 
of  the  eserine  drops  and  to  take  quinine. 

The  improvement  in  this  case  followed  so  closely  upon  the 
application  of  the  eserine  and  its  known  action  upon  the  pupil, 
that  it  is  hardly  possible  to  avoid  the  conclusion  that  the  local 
application  produced  the  improvement.  As,  however,  in  simple 
glaucoma,  temporary  ameliorations  of  all  the  symptoms  are  not 
uncommon  apart  from  medical  treatment,  it  is  quite  within  the 
range  of  possibility  that  a  temporary  improvement,  due  to  natural 
causes  may  have  been  accidentally  contemporaneous  with  the 
use  of  eserine,  and  that  the  efiect  of  the  latter  was  simply  not 
detrimental^  ^ovi^  perhaps  not  actively  beneficial. 

In  the  following  case  the  symptoms  were  more  acute,  and 
though  the  influence  of  the  eserine  was  watched  for  a  short  time 
only,  there  was  good  evidence  that  during  that  period  its  effect 
was  decidedly  beneficial. 

Case  2. — Aeide  Glaucoma — Relief  of  PaiUj  but  no  Effect  on 
the  Pupil  by  the  use  of  Eserine — Iridectomy/  successful. 

Maria  D.,  aged  thirty-seven  years  had  suffered  for  five  weeks 
with  well  marked  glaucoma  of  the  right  eye.  There  were 
chromopsiae,  severe  pain,  extreme  tension  (T3),  and  great  im- 
pairment of  vision.  She  applied  on  January  20,  1879.  The 
pupil  of  the  right  eye  was  then  dilated  and  immovable,  and  the 


eomea  and  anterior  eiuunber  veiy  tnrikiL    Yishml  =  mere  per- 
eepdoa  of  G^c  at  the  outer  sde  of  the  field.     Widi  &e  ophthal- 
moscope  only  a  dullrred  redex  was  obtainable  when  examining 
the  papil.    Iridectomy  was  proposed,  bnt  the  usual  difiicalty 
about  the  eare  of  children  at  home  (one  being  «^t  months  old 
and  aneking  her  mother  3  bretist^  and  five  odiers  being  depend- 
ent on  her  care^  made  it  necessary  to  postpone  the  operation. 
Erserine  was  applied :  it  reCleTed  Ae  pdn,  bat  did  not  cause 
contraction  of  the  pnpil  nor  diminution  of  the  t»iffic«L 

On  January  24,  the  daily  use  of  eserine  hafing  no  permanent 
effect  beyond  the  s&ght  relief  of  pain,  iridectomy  upwards  was 
performed.  On  the  31st  this  patient  could  tell  the  time  by  the 
watch,  the  tension  was  normal,  and  only  a  sli^t  amount  of  pain 
was  complained  of  She  was  directed  to  continue  the  use  of 
eserine  and  to  take  quinine. 

Here  was  a  typical  instance  of  acute  glaucoma.  The  opera- 
tion was  unavoidably  postponed,  and  the  use  of  eserine  appeared 
to  delay  the  progress  of  the  glaucoma  during  the  interval  so  that 
eventually  the  operation  was  successfully  performed.  In  several 
instances  similar  good  effects  have  been  obtained.  It  is  therefore 
probable  that  in  fdture  the  use  of  eserine  in  glaucoma  will 
become  very  general  There  is  a  danger,  however,  that  its 
undoubtedly  beneficial  influence  may  be  relied  on  as  a  substitute 
for  iridectomy  or  sclerotomy.  According  to  my  experience 
hitherto,  its  action  in  the  cases  in  which  it  has  been  used  would 
not  justify  its  employment  with  this  view,  and  I  hold  that  surgi- 
cal measures  must  still  occupy  the  first  place  in  the  treatment 
of  glaucoma,  while  local  medication,  if  used,  must  take  the  place 
of  a  handmaid  or  assistant  to,  not  that  of  a  substitute  for, 
operative  treatment. — Medical  Times. 

Notes  oVi  Military  Surgrery.— (  By  Surgeon 

J.  Lbwtas,  M.B.,  LoND.,  Guides  Cavalry.) — A  few  notes  of 
some  of  the  injuries  received  in  the  cavalry  affair  near  Futeha- 
bad,  Afghanistan,  on  April  2nd,  may  perhaps  interest  some  of 
the  readers  of  The  Lancet,  The  portion  of  the  Guides  Cavalry 
present  on  that  occasion  numbered  about  two  hundred  sabres, 


BRITISH   AND    FOREIGN   JOURNALS.  509 

and  our  casualties  were  five  killed  and  twenty-eight  wounded. 

Case  1.  Penetrating  Q-un-shot  Wound  of  Frontal  Bone. — 
The  subject  of  this  injury,  a  Sikh  trooper,  was  hit  by  a  stray 
bullet  before  the  cavalry  came  into  action.  The  bullet  entered 
just  above  and  to  the  right  of  the  root  of  the  nose.  At  the  same 
time,  also,  the  right  eye-ball  projected  prominently  forwards  and 
was  painful.  He  did  not  logo  consciousness  but  complained  of 
pain  in  the  head,  and  especially  in  the  right  eye.  The  eye-ball 
was  uninjured,  but  the  conjunctiva  was  injected,  and  there  was 
a  small  quantity  of  blood  between  the  lids.  He  thought  that 
the  ball  had  passed  out  through  the  right  orbit — a  not  impossible 
hypothesis,  since  bullets  were  coming  across  from  our  left,  where 
the  enemy  was  outflanking  us.  The  subsequent  history  6f  the 
case,  too,  gave  support  for  a  while  to  his  idea,  for  it  seemed  to 
indicate  but  slight  injury  to  the  brain.  During  the  first  eleven 
days  the  only  symptoms  were  diffused  headache  and  drowsiness, 
while  there  was  dilatation  of  the  right  pupil  and  ptosis  of  the 
right  upper  eye-lid  the  two  latter  symptoms  being  not  impossible 
results  of  an  injury  to  the  orbit  only. 

Suddenly,  however,  on  the  eleventh  day  new  symptoms  develop- 
ed themselves — viz.,  epileptiform  convulsions  followed  by  coma. 
The  first  fit  occurred  about  midnight  on  April  13th.  This  passed 
off  in  half  an  hour,  leaving  a  condition  of  extreme  susceptibility 
to  muscular  spasm ;  so  much  so  that  the  attempt  to  give  him 
a  drink  brought  on  locking  of  the  jaws,  twitching  of  the  facial 
muscles  on  the  right  side,  and  spasmodic  movements  of  the  limbs. 
About  an  hour  later  he  had  a  second  fit,  and  the  convulsive 
stage  of  this  was  of  such  duration  and  attended  by  such  exhaus- 
tion— his  body  being  bathed  in  perspiration  and  his  pulse  rapid 
beyond  counting — that  I  resorted  to  chloroform-inhalation  to 
bring  on  the  stage  of  coma  at  once.  A  subcutaneous  injection 
of  one- sixth  of  grain  of  morphia  was  given  to  him  while  under 
the  influence  of  chloroform,  and  he  then  slept  for  four  or  five 
hours.  The  next  day,  April  14th,  he  had  a  third  fit,  which  was 
similarly  treated,  and  since  then  up  to  the  present  date  April 
23rd,  there  has  been  no  return.  Dilatation  of  the  right  pupil 
and  ptosis  persist.    There  is,  however,  no  squint,  nor  are  any  of 


51(1 


OAN.VDA  MEDICAL   AND    aORflrCAL   JODRKAL. 


the  movomeiits  of  the  ejebaJI  impairod.  He  is  drowsy  and 
somewhat  irritable.  There  is  also  decide  J  impnirment  of  the 
memory,  as  he  no  longer  remembers  tho  occurrences  of  that 
day,  or  even  that  he  was  wounded.  There  is  still  an  abundant 
discharge  of  yellowish-greea  pus  from  the  opening  in  the  frontal 
bone,  and  there  is  some  prominenoo  of  the  inner  angle  of  the 
roof  of  the  right  orbit. 

Remarks. — ^The  course  and  symptoms  have  not,  I  think,  con- 
firmed tbo  opinion  of  the  man  himself  that  tlie  ball  escaped  by 
way  of  the  right  orbit ;  tlio  injury  to  the  contents  of  tho  latter 
would  have  been  greater,  whereas  tho  protrusion  of  the  eyo-ball 
would  be  BufBcientiy  accounted  for  by  a  depression  of  the  roof 
of  the  orbit  caused  by  the  bullet  in  its  passage  backwards.  !n>8>% 
can,  I  think,  he  little  doubt  that  tho  hall  has  lodged  within  Ae 
skull,  but  at  what  precise  spot  it  is  impossible  to  determine. 

Cask  2.  G-mirgJiot  Fracture  of  Great  TrocfMnter  of  Femur  .- 
death  on  nhtete-entli  day. — Tho  bullet  in  this  case  entered  at  the 
outer  side  of  the  left  thigh,  about  two  inches  below  the  great 
trochanter,  passed  upwards  and  inwards,  splintering  that  projec- 
tion, and  finally  lodged  Buporficially  over  the  base  of  the  sacrum, 
where  it  pointed.  Its  position,  however,  was  not  so  superficial 
that  tho  bullet  could  be  grasped  between  the  finger  and  thumb  ; 
it  gave  rise  rather  to  a  difiuscd  swelling,  in  which  the  exact 
position  of  the  bullet  was  unccrtcun.  Hence,  I  did  not  feel  jostd- 
ficd  in  cuttmg  into  this  prominence,  and  sent  him  as  he  was  to 
the  field  hospital  at  Jelalabad,  where  a  few  days  later  the  bullet 
worked  towards  tlie  surface,  and  was  extracted.  The  discharge 
from  the  traflk  of  the  bullet  was  abundant  and  fetid ;  syrin^ng 
the  wound  twice  and  sometimes  oftener  daily  with  carboUc  lotion, 
and  a.  free  use  of  disinfecting  powder  (McDougall's)  failed  to 
keep  down  tho  fetor  He  was  further  weakened  by  obstinate 
diarrhoea,  over  which  troatment  of  various  kinds  had  httlo  effect. 
He  died  on  April  20th,mnctecndaysafterrcceiving  tho  injury. 

Remarks. — It  is  not  the  time  yet  to  gather  up  the  lessons 
upon  gun-shot  fracture  of  the  thigh  derived  from  the  war.  Kve 
cases  have  now  come  under  my  notice,  and  they  have  all  sup- 
ported the  received  canoii^  of  military  surgery  ;  especially  have  ■ 


BRITISH  AND    FOEEIQN  JOURNALS.  511 

they  shown  the  advisability  of  immediate  amputation  in  fractures 
of  even  the  upper  third  if,  as  is  invariably  the  case  in  hill  war- 
fare, the  patient  has  to  be  carried  many  miles  to  a  permanent 
hospital,  for  on  arrival  at  the  latter  he  is  so  exhausted  by  the 
journey,  and  the  limb  is  so  much  swollen,  that  an  amputation 
then  performed  has  most  unfavorable  results.  In  saying  this  I 
have  two  cases  m  particular  in  my  mind,  both  of  them  gun-shot 
fractures  of  the  upper  half  of  the  femur.  One  of  these  was 
carried  from  Ali  Musjid  to  Jumrood,  about  ten  miles,  the  other 
was  carried  for  more  than  twelve  hours  in  a  dhooly,  part  of  the 
time  ia  darkness  over  rocks  ;  and  both  of  them  died  under  the 
subsequent  operation.  The  case  of  a  man  so  injured  is  desperate, 
and  justifies  desperate  measures :  if,  under  the  conditions  sup- 
posed, his  chance  of  life  is  increased  by  immediate)  operation, 
then  the  general  rule  of  deferring  all  operations  until  arrival  at 
a  field  hospital  may  surely  be  departed  from,  and  advantage 
taken  of  the  first  halt  to  amputate  the  limb.  The  other  plan 
has  been  tried,  and  with  melancholy  results  ;  this,  of  imediate 
treatment  (under  the  circumstances  mentioned)  has  not  yet  had 
a  trial. 

Cases  3,  4,  5,  and  6  were  bayonet- wounds  —  two  of  them 
non-penetrating  of  the  walls  of  the  chest,  and  which  soon  got 
well ;  the  third  peculiar  from  its  situation — vi2.,  the  right  side 
of  the  fauces.  The  subject  of  it  was  leaning  over  in  his  saddle 
to  make  a  cut,  and  received  the  bayonet  in  his  mouth.  The 
symptoms  were  only  slight — some  pain  in  swallowing,  with  slight 
swelling  and  tenderness  of  the  neck. 

The  last  case  was  a  more  serious  one.  The  bayonet  entered 
about  two  inches  to  the  left  of  the  navel  and  penetrated  the 
peritoneum.  Acute  pain  and  collapse  followed  immediately,  and 
some  air  seemed  to  have  entered  with  the  movements  of  respira- 
tion, for  a  few  hours  later  the  abdomen  was  tympanitic.  Local- 
ised peritonitis  followed,  but  the  patient  is  now  (April  23rd,) 
convalescent. 

Case  7. — This  is  worth  mention,  as  showing  what  terrible 
injuries  a  man  will  survive  for  a  short  time.  The  skull  in  this 
case,  that  of  a  non-commissioned  officer,  was  cleft  transoversely 


513 


L    MEDICAL   AND   8UEO10AL   JO^R^AL, 


across  the  vertex,  the  sides  of  the  cloft  being  separated  in  the  I 
widest  part  by  an  eighth  of  an  inch,  and  the  cleft  extending  from  I 

ear  to  car.  In  addition  to  this  another  saber  cut  had  rdsed  tho  I 
parietal  portion  of  the  temporal  bone  from  ite  connectionB.  Yet  I 
this  man  lived  until  the  fifth  day,  and  never  lost  consciousnosa  [ 
until  shortly  before  death, — Tlie  Lancet. 

Remarkable  Operation. —M.  Pban,  the  well-| 

known  surgeon  of  St.  Louis  Hospital  has  recently  performed  a 
operation  which  has  considerably  occupied  the  minds  of  the  1 
medical  world  in  Paris.     Tho  patient  was  a  man  suRenng  from  1 
cancer  in  the  pylorus,  and  was,  at  the  time  of  the  operation,  in  j 
the  last  stage  of  cachexia,  he  not  being  able  to  retain  any  food   I 
in  his  stomach,  and  having  to  rely  almost  entirely  on  uutiitive 
enamata  for  sustenance,  which,  as  usual,  were  foun<l  to  be  insuffi- 
cient.    He  accordingly  applied  to  M.  Pi^an  to  take  some  opera- 
tive measures  to  relieve  liim,  or,  if  nothiny  could  be  done,  he  I 
was  decided,  ho  said,  to  put  an  end  to  his  life.     M.  Pfian,  rather  f 
reluctantly,  agreed  to  comply  with  the  entreaties  of  the  pationi  I 
and  his  relatives,  and  decided  to  attempt  an  operation.     An  I 
incision,  about  ten  centimetres  in  length,  was  made  on  the  left  I 
aide  of  the  umbilicus  and  parallel  to  tho  linea  alba.     When  the  f 
peritoneum  was  opened  the  stomach  was  found  to  be  considera- 
bly dilated,  extending  downwards  as  far  aa  the  pubic  arch.    Ita  ' 
walls  were  greatly  hypertrophied,  The  peritoneum  did  not  aeem 
to  be  affeoted  in  any  groat  degree.     The  pyloric  portion  of  the 
stomach  was  then  gently  drawn  forwards,  when  it  was  found 
that  tho  growth  measured  six  centimetres  transcvorsoly  and  four 
in  a  vertical  direction.     Tho  whole  of  this  mass  was  excised,  as  I 
was  also  a  portion  of  the  epiploon,  which  was  diseased.    The  tvro  I 
surfaces  of  section  were  then  drawn  into  contact  by  means  of  I 
catgut  sutures.     No  litjuid  of  any  kiud  was  allowed  to  enter  Uis  ( 
peritonal  cavity  during  the  operation.     The  abdominal  wound  | 
was  closed  in  the  ordinary  manner.     The  operation  laat«d  two  I 
hour.'i  and  a  half.     For  the  first  two  days  after  the  oporatioa  J 
the  patient  was  fed  by  the  rectum,  but  on  the  third  day  Bomo  k 
food  was  allowed  to  be  introduced  into  the  stomach.  During  tha  j 


BRITISH  AND  FOREIGN  JOURNALS.  513 

first  three  days  the  pulse  remained  alarmingly  weak,  conse- 
quently it  was  decided  to  perform  transfusion.  Fifty  grammes 
of  blood  were  introduced  into  the  midian  cephalic  vein  on  a  first ' 
occasion,  and  subsequently  eighty  more  were  injected.  Unfor- 
tunately his  condition  did  not  improve,  and  he  died  on  the  night 
of  the  fourth  day.  He  had  shown  no  signs  of  peritonitis  during 
these  four  days.  It  is  much  to  be  regretted  that  it  was  not  pos- 
sible to  obtain  permission  to  perform  a  necropsy,  as  it  would  have 
been  highly  interesting  to  see  what  had  become  of  the  catgut 
sutures,  and  to  know  whether  the  intestinal  wound  showed  any 
signs  of  uniting. —  The  Lancet. 

Intravenous  Injection  of  Ammonia.— 

Dr.  Gaspar  Griswold  in  the  New  York  Medical  Record  uses 
for  intravenous  injection  a  drachm  of  a  fluid  containing  equal* 
parts  of  ordinary  aqua  ammoniae  and  water.  The  vein  is  rapidly 
laid  bare  and  the  fluid  injected.  In  the  case  of  two  moribund 
patients,  he  succeeded  in  making  the  vital  flame  flicker  for  a  few 
hours  longer  than  it  would  naturally. 

The  most  interesting  case  he  cites  is  that  of  a  woman,  aged 
47,  who  came  into  Bellevue  Hospital  on  the  29th  April  with 
ascites,  supposed  to  be  due  to  cirrhosis  of  the  liver.  The  right 
pleural  cavity  was  full  of  fluid.  Seven  quarts  and  fifteen  pints 
were  taken  from  the  abdomen.  The  patient  was  nearly  dying 
on  the  4th  May  from  dyspnoea.  Thoracentesis  was  performed, 
and  ninety  ounces  of  clear  serum  withdrawn.  She  nearly  died 
under  the  operation,  but  was  kept  up  by  fifteen  or  twenty  half- 
drachm  doses  of  whiskey  administered  hypodermically.  Dr. 
Griswold's  colleagues  were  of  opinion  that  the  woman  was  dying, 
and  that  further  treatment  was  useless  and  even  absurd.  The 
Dr.  injected  ammonia,  and  in  fifteen  seconds  there  was  marked 
increase  in  the  force  of  pulsation. 

In  two  minutes  the  pulse  was  plainly  perceptible  at  the  wrist 9 
beating  100.  Half  an  hour  afterwards  she  was  perfectly  con- 
scious and  reported  herself  comfortable,  though  weak.  To  make 
a  long  story  short.  Dr.  Griswold  reports  that  on  the  17th  of  May 
she  sat  up  nearly  all  day,  and  was  gaining  strength. 

NO.   LXXXIII.  34 


614 


CASAHA  JtEDICAL  ANIt  filTRfirCAL  JOURNAL. 


Cases  in  Surgical  Practice.— The  followiiri 

cases  are  reported  in  The  Lancet,  taken  from  Mr.  Jonatha 
Hutchinson's  Clinical  Lectures,  they  arc  of  interest  because  d 
their  rarity : 

Paralyni  of  the  Fifth  and  Third  Nirveg  on  the  game  ^ide^ 
prohahly  from  Syphilitic  Gumma. 
The  patient,  a  pallid  man  of  middle  ago,  had  complete  ptosis,  j 
plated  pupil  and  entire  inability  to  uae  the  three  third  nerve,  i 
recti.    In  addition,  he  had  numbnesa  of  the  whole  of  the  side  of  ] 
the  face,  not,  however,  amounting  to  absolute  atijeatheaia,  with  \ 
wasting  of  the  temporal  find  masseter  muacles  and  of  the  auterior 
belly  of  the  digastric.     Thus  there  was  proof  of  implication  of  J 
the  trunk  of  the  third  ami  of  both  roots  of  the  fifth.     The  con^J 
dition  bad  been  increasing  for  some  weeks,  and  was  unattended^ 
■  by  other  indications  of  cerebral  disorder.     The  demonstration  0 
the  paralytic  atrophy  of  the  three  muacles  was  very  definite  audi 
interesting ;  not  the  slightest  action  on  the  part  of  any  of  thentl 
could  be  detected.  I  drew  attention  to  the  fact  that  the  buccinato 
bad  wholly  escaped  paralysis,  as  it  almost  always  doea  in  motor^ 
failure  of  the  fifth.    The  eye  was  not  in  the  least  congc8t£d,  and   ; 
its  being  perfectly  covered  by  the  drooping  lid  was  no  doubt  a 
valuable  protection  to  it.     Tlie  man  waa  to  be  congratulated  in 
one  respect — that,  having  paralysis  of  the  fifth,  he  had  also  par- 
alysis of  the  third.     There  was  the  history,  as  is  usual  in  these  | 
cases,  of  remote  syphilis ;  and  iodide  of  potassium,  in  fen-gi 
doaes,  was  prescribed. 

SentriicHvi-  Symmetricnl  Iritis  without  evident  cavie. 
A  very  important  example  of  this  affection  was  sent  to  me  hfm 
Mr.  Charles  Palmer,  of  Yarmouth.  The  jiatient  ia  a  singled 
young  woman  of  about  twenty-five.  No  cause — tliat  is  to  aajj  1 
neither  syphilis,  rheumatism,  gout  nor  injury — can  be  made  out,  I 
and  the  general  health  appears  to  be  good.  The  iritis  has  been  1 
most  severe,  and  has  resulted  in  blindness  with  occlusion  of  9 
pupils  and  disorganisation  of  the  iris-tissue.  It  is  remarkable  I 
that  it  has  been  almost  wholly  painless.  An  alAiost  precisely  I 
similar  case  was  that  of  a  young  man  from  Shefiield,  who  was  also  I 
under  care  at  the  same  time.  In  him  the  eyelashes  had  turnedl 
.white.     I  suspect  thac  these  cases  are  neurotic  in  ori^n. 


BRITISH  AND   I»OR«IGN   JOURNALS.  615 

Chancre  of  the  Upper  Lip. 

A  young  man  was  admitted  six  weeks  ago  with  a  large  indu- 
rated sore  on  his  lip.     Its  characters  were  most  definite,  and 
under  the  jaw  wore  a  number  of  enlarged  glands.  The  skin  was 
covered  with  a  lichenoid  and  papular  rash.     He  did  not  know 
how  he  had  caught  the  sore.     He  first  observed  a  little  crack, 
then  a  month  later  it  began  to  inflame  and  harden,  and  in  another 
month  the  rash  began  to  appear.    Having  remarked  on  the  case 
as  an  example  of  non-venereal  syphilis  (  syphilU  sine  coitu ),  or 
probably  chancre  from  kissing,  I  drew  attention  to  it  as  an  illus- 
tration of  the  early  stages  of  the  disease.  For  practical  purposes 
we  may  divide  the  early  phenomena  of  syphilis  into  three  periods 
of  one  month  each.    The  first  month  is  occupied  by  the  incuba- 
tion of  the  chancre,  and  during  it  there  is  either  no  sore  at  all, 
or  a  sore  which  is  soft,  suppurating  and  without  definite  charac- 
ter.    At  the  end  of  this  first  month  the  process  of  induration 
will  be  commenced.    Another  month  may  be  allowed  for  the 
full  development  of  the  chancre  and  for  first  appearance  of  the 
constitutional  symptoms ;  and  at  the  end  of  two  months  from 
the  contagion  the  sore  may  be  expected  to  be  very  hard,  the 
bubo  well  characterised,  and  the  skin  mottled  with  a  roseolous 
rash.     If  treatment  be  avoided,  the  rash  will  develop  further, 
during  another  month,  and  at  the  end  of  three  the  chancre  will 
V  still  be  in  full  vigour,  and  the  skin  covered  with  a  multiform 
eruption.    The  disease  will  now  be  at  its  full  height,  and  it  is  at 
this  perio'd  that  iritis  and  retinitis  are  most  likely  to  oc^ur.     In 
this  case  the  lad  has  now  been  one  month  under  treatment  by 
two-grain  doses  of  grey  powder  three  times  a  day ;  and,  without 
ptyalism,  and  without  any  interference  with  general  health, 
the  induration  has  melted  away,  and  the  rash  almost  wholly 
disappeared. 

Case  of  Rapid  Cure  of  Severe  Syphilis  by  Profuse  Ptyalism, 

In  connection  with  the  above,  in  which  syphilis  is  being  cured 
by  small  doses  of  mercury  administered  through  a  long  period, 
salivation  being  avoided  I  drew  attention  to  another,  which 
occurred  a  month  ago,  in  which  profuse  salivation  appeared  to 


516  CANADA   MBDICAL.   AND    SURGICAL  JOCENAL, 

bo  productive  of  liie  best  results.     A  married  woman  of  midiUe  I 

ago  was  admitted  with  a  moat  copious  scaly  and  papular  eruption. 
It  covered  her  lace,  trunk  and  extremities,  not  any  part  eacap- 
ing,  and  the  profuse  production  of  scale-crusts  was  a  very 
remarkable  feature.  On  the  arms  it  might  have  been  taken  for 
common  psoriasis,  but  on  the  face  there  could  be  no  doubt  as  to  | 
the  diagnosis.  Mercurial  Itaths  wercs  ordered,  hut  after  the 
third  she  became  freely  salivated.  For  a  week  or  two  she  was 
confined  to  bed,  and  in  a  very  feeble  state  from  the  profuse 
ptyaliam.  During  this  period  the  eruption  vanished  as  if  by 
magic.  No  more  mercury  was  used  in  any  form,  and  at  the  end 
of  a  mouth  the  woman  left  the  hospital  covered  with  stains, 
but  having  nothing  whatever  remaining  but  stains.  She  was 
charged  to  return  in  a  mouth,  that  we  might  know  if  any  ^elapse 
occurred. 

I  remarked  In  connection  with  this  case  that  it  was  the  moat 
rapid  cure  of  a  severe  secondary  eruption  which  I  had  ever  ■ 
known.  Although,  on  the  whole,  I  prefer  the  long-continued. 
treatment  by  small  doses,  yet  it  is  well  to  bear  in  mind  tliat  in  cer- 
tain cases  mercury  appears  to  be  far  more  efiBcient  when  pushed 
to  its  full  physiological  influence.  We  must  avoid  prejudging  tlie 
question,  and  keep  our  minds  open  for  the  reception  of  all  evi- 
dence that  may  be  fortbcoming.  In  some  acute  inflammatory 
affections,  not  syphilitic,  benefit  is  observed  immediately  that 
salivation  occurs,  whilst  none  is  witnessed  before, 

Interiiitial  KerftUtU^  with  Deafnemt. 
His  deafness  was  symmetrical.  It  had  come  on  during  the  last 
three  months,  and  it  had  progressed  to  such  an  extent  that  the 
lad  carried  in  his  band  a  slate  and  pencil  for  writing.  He  had 
not  had  any  discharge  or  pain,  but  he  complained  bitterly  of 
"  such  a  ringing  in  my  ears."  I  remarked  that  deafness  of 
this  kind  and  intensity,  and  at  this  age,  was  almost  conclusive 
in  itself  as  to  inherited  taint.  We  know  of  no  other  nflection 
which  in  young  persons  can,  without  otorrhoea  or  any  proof  of 
inflammation,  proceed  in  the  course  of  a  month  or  two  to  the 
entire  loss  of  the  function,     Such  cases  are  common  enough  in 


BRITISH  AND   FOREIGN  JOURNALS.  517 

those  who  inherit  syphilis,  and  they  occur  in  connection  with  no 
other  cause.  In  this  instance  the  lad  suffers  also  from  symme- 
trical keratitis,  and  of  this  disease  precisely  similar  statements 
are  true.  Thus,  although  his  physiognomy  is  scarcely  peculiar, 
his  teeth  are  well  formed,  and  we  know  nothing  of  his  family 
history,  yet  the  simultaneous  occurrence  of  two  maladies,  each 
of  which  is  characteristically  syphilitic,' justifies  us  in  a  confident 
diagnosis. 

Paralysis  of  both  Six  Nerves  after  Injury  to  tite  Head. 

The  man  in  whom  this  lesion  is  present  has,  in  all  probability, 
suffered  a  fracture  through  the  base  of  the  skull.  He  bled  at 
both  ears  and  from  the  nose.  His  portio  dura  is  paralysed  on 
the  right  side,  and  he  is  deaf  in  both  ears,  though  not  absolutely 
so,  and  in  the  right  he  was,  he  says,  deaf  before  his  fall.  Both 
six  nerves  are  absolutely  paralysed,  and  the  eyes  converge.  The 
man  is  quite  free  from  brain  symptoms,  and  he  is  doing  well.  In 
anticipation  of  arachnitis  he  was  put  under  the  influence  of 
mercury  during  the  first  week,  but  as  he  is  now  wholly  without 
symptoms,  excepting  the  paralysis,  it  has  been  discontinued. 

What  the  precise  lesion  may  be  which  has  caused  complete 
paralysis  of  both  abducentes  it  is  somewhat  difficult  to  conjec- 
ture. In  all  probability,  the  fracture  crosses  the  right  petrous 
bone,  and  it  may  cross  the  sella  turcica.  I  mentioned  at  the 
bedside  that  I  had  seen  several. cases  of  paralysis  of  one  sixth 
nerve  after  injury  to  the  head,  but  that  I  did  not  remember  one 
in  which  it  was  double.  During  the  same  week  I  had  seen  with 
Dr.  Macpherson  of  Midmay-park,  a  little  girl  who  had  been 
knocked  down  in  the  street  by  a  horse,  and  in  whom,  without 
any  other  cerebral  symptoms,  the  right  sixth  nerve  was  quite 
paralysed. 

Recovery  from  Paraplegia  possibly  of  Syphilitic  origin. 

We  sometimes,  in  going  over  the  past  life- histories  of  our  patients, 
come  upon  interesting  fragi^ents  of  evidence,  always,  however, 
to  be  taken  with  a  certain  amount  of  hesitation  on  account  of 
the  sources  of  fallacy.  A  gentleman  who  consulted  me  a  few 
days  ago  for  a  syphilitic  gumma  in  his  tongue,  told  me  that  he 


518  canaha  meiucm.  and  wi/boii'ai.  joursal. 

had  formerly  euHl'i'td  from  paralyBiB,  and  had  wholly  recovered.  J 
The   facts   were   these.       Fifteen  yeard    a^o  lie  had  syphtllaf 
with  eruption,  &c.,  tather  sevoroly,  and  took  mercury.    Almost  J 
ae  800U  as  his  treatment  wa*;  over,  he  began  rather  auddeuly  to  J 
louo  the  use  of  his  logs.     The  weakncas  began  at  his  heels,  and  f 
crept  upwards,  and  his  lower  extremities  wholly  failed.  lie  was  I 
on  the  couch  for  three  or  four  months      His  arms  were  weak.  I 
but  not  wholly  paralysed.     After  four  or  five  mouths'  treatment  I 
be  wholly  recovered,  and  has  never  since  had  any  reminder  of  ! 
it.     lie  was  married  at  tlio  time,  and  married  a  second  time 
some  years  afterwards.     lie  has  now  enjoyed  ten  years  of  good 
health,  and  has,  during  that   time  had  nothing  of  a  specific 
character. 

Intercarpal  Dislocation.— (Under  the  care  of  I 

Mr.   C.  E.  KiciiMu.ND,  of  the  Warrington  lufinnary  and  Die-  I 

pensary). — Dennis  S ,  aged  forty-seven,  miner,  a  muscular  i 

subject,  with  well  defined  anatomical  points,  was  admitted  March  | 
14tii,  187!).     lie  was  working  at  a  thraaliiug-machine  when  the  T 
strap  of  the  fly-wheel  caught  his  arm  and  dragged  him  up  to  the  i 
t«p  of  the  wheel  (the  height  of  which  was  stated  to  he  about 
nine  or  ten  feet),  from  whence  be  full  on  his  hand.     He  could  I 
not  state  whether  he  fell  on  the  back  or  piilm  of  the  band.  There 
were  several  skiu  lacerations  (done  by  the  strap)  midway  up  I 
the  forearm,  but  no  fracture  of  the  radiua  and  ulna  was  discover- 
able.    There  was,  however,  marked  deformity  at  the  left  wrist. ' 
The  length  of  the  hand  from  the  wrist  to  the  knuckles  was  very  I 
noticeably   shortened.      There     was    a  prominent    transverse  | 
ridge  on  the  dorsal  aspect  of  the  wrist  beneath  the  ends  uf  the  I 
radius  and  ulna ;  and  below  this  ridge   there  was  a  marked  ' 
depression.     On  the  palmar  aspect  the  base  of  tlic  hand  was 
unduly  promiment,  the  general  direction  of  the  metacarpal  bones 
being  ijiute  altered  by  their  bases  being  pushed  forward  towards 
the  palm.     The  diameter  of  the  wrist,  both  laterally  and  aulcro- 
postoriorly,  was  much  increased.     There  was  not  very  much 
bruising  or  swelling  of  the  soft  tissues  themselves,  though  the 
circumference  of  the  wrist,  takeu  round  the  extremities  of  the  i 
radius  and  ulna,  was  one  inch  and  a  quarter  more  on  the  injured  | 


BRITISH  AND   FOREIGN   JOURNALS.  519 

than  on  the  sound  hand,  and  below  this  point  the  difference  was 
even  more  marked.  He  was  unable  to  flex  or  extend  his  hand 
himself. 

On  examination  the  ends  of  the  radius  and  ulna  seemed  separar 
ted  from  each  other  somewhat.  The  transverse  dorsal  ridge 
before  mentioned  could  be  demonstrated  to  be  the  first  row  of 
carpal  bones,  with  the  semilunar  rather  unduly  prominent. 
Between  this  ridge  and  the  ends  of  the  radius  and  ulna  the 
movements  of  flexion  and  extension,  although  restricted  could  be 
obtained  with  considerable  ease  and  without  any  crepitus.  Below 
the  ridge  the  extensor  tendons  could  be  plainly  felt  stretching 
across  the  depression  to  the  fingers. 

The  articulation  between  the  thumb  and  the  trapezium  was  not 
interfered  with,  nor  had  any  of  the  articulations  between  the 
metacarpals  and  second  row  of  carpals  sustained  any  injury.  On 
the  palmar  prominence  before  mentioned  the  trapezoid  could 
be  felt  pushed  more  anteriorly  than,  and  considerably  above,  the 
level  of  the  trapezium,  and  nearer  the  ulnar  side  the  head  of  the 
OS  magnum  could  be  felt  overlapping  slightly  the  ends  of  the 
radius  and  ulna,  which  on  the  palmar  surface  were  quite 
obscured ;  and  on  flexion  and  extension  of  the  hand  the  os 
magnum  could  be  felt  to  ride  on  their  anterior  surface.  The  dis- 
placement of  the  unciform,  although  distinct,  was  much  less 
marked.  Under  no  circumstances  could  any  crepitus  (other 
than  that  attributable  to  effusion)  be  detected,  nor  was  there 
any  sign  of  fracture  whatever. 

The  result  of  examination  showed  that  the  second  row  of 
carpal  bones  was  dislocated  from  the  first  forwards  and  upwards, 
the  displacement  was  most  marked  in  the  case  of  the  trapezoid 
and  08  magnum. — The  Lancet, 

Movements  of  the  Eyelids*— A  paper  was 

read  before  the  Royal  Medical  and  Chirurgical  Society  on 
the  "  Movements  of  the  Eyelids,"  by  W.  R.  Gowers,  M.D., 
of  which  the  following  is  an  abstract :  Under  normal  conditions 
the  lids  leave  the  cornea  approximately  uncovered  in  all  posi- 
tions of  the  eye-ball  moving  with  it.     For  these  movements,  and 


520  CANADA    MKOICAL    AND   SFROICAL   JOFRNAL. 

for  tho  voluntary  closure  and  opening  of  the  lids,  there  are  0Jily3 
iwo  muscles,  the  orbicularis  and  the  levator.  These  will  not  expalnl 
all  movements,  and  it  ia  probable  that  the  eyeball  itself  □ 
the  lids,  not  by  the  conjunct!  val  connection  but  by  the  pressure  of  I 
the  convexity  of  the  sclerotic,  and  to  a  less  extent  of  the  cornea,  f 
the  ed^cs  of  the  lids  lying  in  or  near  the  sclcro-comcal  sulcus,  I 
This  eSect  is  greatest  on  the  upper  lid,  partly  because  tha  j 
tarsal  cartUages  are  attached,  at  their  cstremities  below  tho  | 
transverse  axis  of  the  eye-ball.  The  eyelids  are  moulded  o 
the  globes,  the  shape  of  tlie  palpebral  iissure  depending  on  I 
the  position  of  the  eye-ball,  and  being  curiously  altered  in  I 
some  abnormal  lateral  positions.  In  closing  the  eye-lids  gentlj  J 
the  lower  lid  is  raised  by  the  palpebral  orbicnlaris  ;  iu  rotation  I 
up  of  tho  globe  the  lower  lid  is  raised,  not  by  the  orbicularis,  , 
but  by  the  pressure  of  the  globe,  and  the  movement  is  slight  I 
if  the  globe  is  very  prominent.  Depression  of  tho  lower  | 
lid  in  looking  down  ia  by  pressure  of  the  cornea.  Tlie  upper  lid  I 
is  maint^ned  in  position  by  the  balance  of  tone  between  the  I 
levator  and  the  orbicularis.  K  the  latter  is  paralysed,  the  lid  is  J 
a  little  higher  than  normal.  The  descent  of  the  upper  lid  in  T 
looking  down  is  not  by  contraction  of  the  orbicularis  (for  it  iS'  I 
unaffected  in  facial  palsy),  but  is  by  the  prcsauro  of  the  sclerotio  I 
against  tho  tarsal  cartilage.  Tho  lid  is  raised  on  upward  rota-, 
tion  of  tho  globe  by  the  levator,  the  contraction  of  which,  if  I 
sudden,  is  oxceasivc.  With  this  is  associated  a  synergic  action  f 
of  the  frontalis;  the  latter  is  sometimes  habitual,  and  then  ul 
relaxed  with  the  levator  on  looking  down.  The  action  of  tho  I 
levator,  associated  with  that  of  the  superior  rectus,  is  beyond  I 
voluntary  control,  and,  in  the  simulated  ptosis  of  hysteria,! 
necessitates  a  strong  contraction  of  the  orbicularis  to  keep  th«  1 
lid  down,  if  the  patient  is  made  to  look  up.  The  associated  relax-f 
ation  on  looking  down  prevents  almost  all  voluntary  contractionJ 
of  the  levator  in  that  position.  Gentle  closure  of  the  lids,  as  infl 
sleep,  is  by  the  palpebral  orbicularis ;  the  levator  being  relaxed, 1 
tho  recti  passive.  Forcible  closure  is  by  the  whole  orbicularis,  1 
the  levator  being  released  and  dissociated  from  the  superior  J 
rectus,  which  contracts,  rolling  the  globe  up.     Ucnce,  probably,T 


BRITISH   AND    FOREIGN   JOURNALS.  ^  521 

the  centre  for  strong  closure  of  the  eyelid^  is  physiologically 
distinct  from  that  for  their  gentle  closure.  If  the  orbicularis  is 
paralysed  the  associated  inhibition  of  the  levator  still  occurs  on 
an  attempt  to  close  the  lids.  But,  if  the  inferior  rectus  is 
paralysed,  a  fruitless  attempt  to  rotate  the  eyeball  down  is  not 
attended  with  inhibition  of  the  levator.  This  phenomenon  (of 
which  photographs  were  shown)  is  difficult  to  explain.  Possibly 
this  relaxation  of  the  levator  is  not  the  result  of  a  central  me- 
chanism, but  is  reflex  from  the  commencing  tension  on  the  fibres, 
and  so  does  not  occur  if  the  globe  does  not  move.  If  so,  the 
fact  is  of  much  interest  in  relation  to  the  mechanism  of  other 
movements  in  the  body.  Lastly,  it  is  pointed  out  that  the  eyelids 
commonly  participate  in  the  movements  of  the  eyeballs  in 
vertical  nystagmus. 

Ophtlialiiioscopic  appearances  in  Tu- 
bercular Mening^itis. — The  following  is  an  abstract 
of  a  paper  on  the  '*  Ophthalmoscopic  Appearances  in  the 
Tubercular  Meningitis  of  Children,"  by  George  Garlick, 
M.D. : — The  ophthalmoscope  discloses  changes  in  the  optic 
discs  of  about  80  per  cent,  of  the  children  who  die  of  tubercu- 
lar meningitis.  These  changes  fall  under  one  of  two  heads — 
viz.,  optic  neuritis  or  distension  of  the  retinal  veins  alone.  As 
the  discs  vary  physiologically  in  different  individuals  and  even 
in  the  same  person,  the  two  are  often  not  alike ;  progressive 
change  is  better  evidence  than  can  be  obtained  from  a  single 
examination.  In  a  small  proportion  of  cases  the  optic  changes 
occur  very  early  in  the  course  of  the  disease,  and  enable  a 
diagnosis  to  be  made  when  the  symptoms  are  equivocal  ;  this 
is  the  case  when  the  meningitis  is  seated  chiefly  about  the 
optic  commissure.  But  the  ophthalmoscopic  changes  are  an 
important  factor  in  the  diagnosis  in  a  much  larger  number  of 
cases.  The  two  forms  of  disc  change — viz.,  optic  neuritis  and 
distension  of  the  veins — appear  related  respectively  ta  meningeal 
inflammation  and  pressure.  The  intracranial  pressure  may 
result  from  excess  of  ventricular  or  of  subarachnoid  fluid,  and 
gives  evidence  of  its  presence  in  the  anaemia  of  the  cranial 


522  CANADA    MEDICAl    AND   SDRUIOAL   .TOUBNAL. 

contents.  Tlie  palsy  of  th.e  limbs  is  mostly  found  on  the  side 
o[>i>offlto  to  that  hemisphere  of  the  brain  which  presents  that 
gi'falt'St  meningeal  affection.  No  such  definite  relation  exists 
with  regard  to  tlie  optic  discs.  In  many  cases  of  tubercular 
meningitis  which  run  an  indefinite  course,  especially  those  which 
are  secondary  to  some  other  advanced  disease,  the  optic  changes 
shai-e  the  indistinctness  of  the  other  symptoms.  The  ophthal- 
moscope CDuutenances  the  idea  that  some  cases  of  tubercular 
meningitis  recover,  and,  even  in  fatal  cases,  a  temporary 
improvement  may  occur  iii  the  discs.  Tubercles  of  the  choroid 
appear  to  be  au  uncommon  complicatioa — The  Lancet. 

Gas   in  Peritoneal  Cavity  in  Typhoid 
Fever  relieved  by  Puncture.— Mr.  Geouue 

ButnVN  read  a  paper  buforc  the  Clinical  Society  of  London  on  a 
case  as  above.  The  {>atieut,  a  young  man  aged  twenty-one,  was 
under  Mr.  Brown's  care  for  typhoid  fever  in  October  last.  T'ho 
temperature  was  high  throughout,  ranging  from  102*  to  105.2* 
during  the  height  of  the  fever.  The  case  was  complicated  with 
double  pneumonia.  In  the  thii-d  week  of  the  fever  tympanites 
developed,  which  was  at  first  localized  to  the  parts  cf  the  abdo- 
men occupied  by  the  intestines,  but  a  few  days  later  tlie  physical 
signs  indicated  that  gas  had  escaped  from  the  intestines  into  the 
peritoneal  cavity,  or  was  being  generated  in  the  cavity  itself. 
The  distension  of  the  abdominal  wall  gradually  became  more 
and  more  extreme,  the  tympanitic  note  entirely  masking  the 
hepatic  and  splenic  dulncss,  and  could  be  elicited  over  the 
sternum  as  high  as  the  articulations  of  the  fourth  costal  cartilages. 
Through  the  upward  pressure  on  the  diaphragm  there  was  urgeni 
dyspnoea,  the  respirations  reaching  as  high  as  -50  per  minute, 
and  the  heart  was  displaced  upwards  and  outwards,  so  that  the 
apex-heat  was  half  an  inch  outside  the  nipple  and  in  a  line  with 
it.  Mr.  Brown  pierced  the  abdominal  wall  with  a  small  aspira- 
tor trocar  an  inch  below  the  umbilicus,  and  on  withdrawing  the 
cannula  a  rush  of  gas  took  place  which  continued  for  si^vural 
seconds.  The  gas  was  odourless.  The  relief  was  immediate, 
the  heart  regained  its  normal  situation,  and  in  a  few  minutes  the 


I 


I 


BRITISH   AND    FOREIGN   JOURNALS.  523 

respiratious  fell  from  50  to  36  per  minute.  No  ill  effect  followed 
the  operation.  The  patient  succumbed,  however,  from  the  lung 
complications  thirty-six  hours  after.  As  to  the  source  of  the  gas, 
Mr.  Brown  dismissed  the  idea  of  perforation  of  the  intestine 
on  the  following  grounds,  viz. : — 1.  The  gradual  development 
of  the  gas  in  the  peritoneal  cavity^  2.  Absence  of  symptoms 
of  collapse  which  might  have  been  expected  had  perforation 
taken  place.  3.  The  fact  that  the  tympanitic  condition  of  the 
colon  and  small  intestines  was  unrelieved  by  the  operation.  Had 
perforation  existed,  gas  would  probably  have  continued  to  escape 
into  the  peritoneal  cavity  after  the  operation,  but  of  this  there 
was  no  evidence,  although  the  patient  lived  thirty-six  hours 
afterwards.  4.  The  fact  that  the  gas  was  odourless.  Mr.  Brown 
advanced  two  theories  as  probable  sources  of  the  gas  :  first,  the 
gas  might  have  passed  by  diffusion  through  the  intestinal  wall ; 
or  second,  the  gas  might  have  been  derived  directly  from  the 
blood  by  exosmosis  through  the  delicate  wall  of  the  peritoneal 
capillaries — and  this  was  the  more  probable,  from  the  fact  that 
several  days  previous  to  the  distension  taking  place  the  blood 
was  highly  charged  with  carbonic  acid  gas  in  consequence  of 
imperfect  aeration  in  the  lungs.  Mr.  Brown  said  he  was  unable 
to  decide  this  point,  and  preferred  to  merely  record  the  case  in 
the  hope  that  other  observers  would  be  able  to  throw  more 
light  upon  the  subject  should  similar  cases  occur  in  their 
practices. — Medical  Times. 

Amussat's  Operation  in  a  case  of  Im- 
perforate Rectum.  —  Mr.  Morrant  Baker  read 
notes  of  a  case  of  imperforate  rectum,  for  which  Amussat's 
operation  was  performed,  in  a  female  infant,  who,  when  nineteen 
days  old,  came  under  the  care  of  Mr.  Morrant  Baker  at  St. 
Bartholomew's  Hospital.  When  first  seen,  the  abdomen  was 
enormously  distended ;  there  was  frequent  vomiting,  and  the 
child  was  much  exhausted.  Chloroform  having  been  adminis- 
tered, an  attempt  was  made  to  find  the  lower  end  of  the  bowel, 
through  the  short  cul-de-sac  which  represented  the  anus.  The 
bowel,  however,  could  not  be  found,  uotwithstanding  very  free 


524 


MEtllCAl.   AND   8UR0ICAL   JOURMAl,. 


mcisions,  and  id  spite  of  the  great  dUtensioo  of  the  abdomcD, 
no  bulging  of  the  jjarts  could  be  detected,  even  dariug  the  aetion 
of  the  abdominal  muscles.  It  waa  decided,  therefore,  after  a 
consultation,  to  desist  Irom  furthar  operative  proceJurea  in  the 
neighbourhood  of  tho  anus,  and  to  perform  colotomy  by  Amus- 
sat's  operation  in  tho  left  loin.  Tliis  operation  was  accordingly 
performed.  Meconium  freely  escaped,  and  within  a  few  hours 
the  infant  waa  greatly  relieved.  An  elastic  tracheotomy-tube 
was  inserted  into  the  bowel  through  the  wound  in  the  loin,  and 
had  been  worn  continuously  ever  since.  In  this  way  all  troubles 
which  might  have  arisen  from  contraction  on  the  one  baud,  or 
prolapse  on  the  other,  were  avoided,  A  year  after  the  operation 
it  was  noted  that  tlie  child  was  well  and  wore  the  elas^c  tube  ; 
faecca  passing  only  once  or  twice  in  the  week.  The  abdomen 
was,  however,  not  <listeiided.  Two  years  after  the  ojteration  tho 
note  was  the  same,  and  the  child,  now  nearly  threo  years  old,  ' 
was  shown  to  the  Society,  perfectly  well  in  health,  and  still  wear-  I 
ing  tho  clastic  tube  in  the  loin.  Instances  of  recovery,  it  waa 
remarked,  after  the  performance  of  colotomy  for  the  relief  of 
imperforate  rectum  were  curiously  rare,  and  probably  the  case 
shown  to  the  Society  waa  the  only  one  now  in  this  country.  The 
<|uestion  as  to  tlie  best  operation  to  be  performed  in  cases  of 
imperforate  rectum,  in  which  the  bowel  could  not  be  found  at 
J;he  outlet  of  tho  pelvis,  was  discussed,  and  Mr,  Baker  thought 
that,  on  the  whole,  a  preference  should  be  given  to  Amussat's 
rather  than  to  Littrifa  method  of  colotomy. — Medical  Timei. 

WARNER'S  TILLS  OP  QUININE. 
We  have  received  from  Messrs.  Warner  &  Co,,  a  sample  of 
their  pills,  containing  gr.  ii,  of  Quinine  in  each  pill.    These  are 
thoroughly  reliable  preparations,  and  are  beautifully  put  up, 
being  coated  over  with  sugar.     The  use  of  sugar  as  a  coating  - 
for  pills  has  been  objected  to,  but  there  is  nothing  that  in  verity 
can  be  advanced  against  this  method  of  coating  these  preparor 
tions.     It  is  stated  that  in  sugar-coated  pills  the  drugs  become 
dry  and  hard  and  soon  loose  their  efficiency — not  more  so  we  ' 
should  suppose  than  in  drugs  profjared  in  the  ordinary  way. 
But  everything  in  nature  is  perishable,  and  will  ui  time  deteri- 
orate.    These  pills,  like   others  of  Messrs.  Warner   &  Go's. 
preparations,  are  made  for  use  and  not  to  be  retained  for  any  ' 
length  of  time  in  stock.     Wo  commend  them  as  being  reliable, 
and  in  being  the  most  palatable  form  of  taking  medtc'me. 


CANADA 


timl  mi  ^nxpal  ^mtn^l 


Montreal,  June,  1879. 
REGISTRATION  OF  COLONIAL  DEGREES. 

There  is  a  considerable  amount  of  egotism  in  the  sayings  of 
some  of  our  exchange  journals  of  British  heritage  concerning 
this  subject  of  the  recognition  of  Colonial  degrees.  The  Editor 
of  The  Medical  Times  and  Gazette^  in  an  article  on  "  Colonial 
Medical  Registration,"  informs  us  that  he  has  been  trying  to 
establish  reciprocity  of  Registration  between  the  colonies  and 
the  mother  country,  and  then  quotes  the  Letter  of  Dr.  Baldwin, 
a  Registered  Practitioner  of  the  United  Kingdom,  to  which  we 
have  already  referred  on  a  former  occasion. 

In  the  number  of  our  Journal  for  December,  1878,  we 
endeavoured  to  aid  the  understanding  of  our  English  contempo- 
rary touching  our  Canadian  institutions,  but  it  would  appear 
that  we  were  not  sufficiency  explicit.  We  fail  to  see  in  what 
particular  The  Medical  Times  has  in  any  way  advocated  reci- 
procity of  Registration  between  Canada  and  the  mother  country, 
and  on  referring  to  an  article  which  was  published  by  that 
periodical  on  the  16th  November,  1878,  the  directly  opposite 
inference  must  be  drawn  therefrom.  But  probably  the  Editor  of 
The  Medical  Times  and  Gf-azette  did  not  take  the  trouble  to  read 
our  article,  and  he  again  falls  into  error  as  regards  Canada  and 
our  Registration  system.  He  states  that  "  the  Privy  Council  of 
Canada  has  omitted  to  notice  that  when  the  British  Medical 
Act  of  1858  passed,  the  Ontario  College  did  not  exist,  and  that 
for  anything  that  appears,  there  may  not  have  been  at  that  date 
any  Licensing  Body  in  the  British  North  American  Provinces." 
Now  the  facts  of  the  case  are  these  :  Medical  legislation  in  this 
colony  dates  back  to  the  28th  year  of  the  reign  of  His  late 


526  CANADA  MEDICAL   AND   SURGICAL  JOURNAL. 

Majesty  King  Greorge  the  Third,  which  was  shortly  after  the 
conquest  of  the  country.  The  affairs  of  the  profession  were 
administered  under  that  Act,  which  provided  for  the  granting  of 
a  license,  to  entitle  the  holder  to  practice  physic,  surgery  and 
midwifery  in  the  then  Province  of  Canada. 

Having  enlarged  our  borders,  and  several  provinces  having 
grown  out  of  this  single  province,  it  was  found  expedient  to  seek 
for  further  legislation,  and  in  1847,  the  profession  was  incorpo- 
rated under  the  name  and  style  of  the  College  of  Physicians 
and  Surgeons  of  Lower  Canada.  One  of  the  provisions  of  this 
Act  gave  to  holders  of  its  license  the  privilege  of  legally  prac- 
tising in  any  part  of  what  at  that  day  constituted  the  Provinces 
of  Upper  and  Lower  Canada. 

By  the  provisions  of  the  Act  of  1847,  no  person  could  obtain 
the  license  unless  he  could  show  that  he  had  studied  medicine, 
surgery  and  midwifery  during  four  consecutive  years,  during 
which  time  he  was  required  to  attend  two  full  courses  of  Lec- 
tures on  the  various  branches  of  Medical  science  delivered 
at  some  university,  college  or  incorporated  school  of  medicine, 
and  produce  evidence  of  having  attended  the  regular  practice  of 
a  hospital  of  not  less  than  fifty  beds  during  a  period  of  eighteen 
months.  A  candidate  with  the  credentials  above  named  could 
obtain  his  license  by  examination.  If,  however,  he  was  the 
holder  of  a  degree  or  of  qualifications  covering  the  ground  of 
medicine,  surgery  and  midwifery  from  any  recognised  British  or 
Provincial  university  or  college,  he  was  entitled  to  receive  his 
license  on  the  payment  of  fees  without  examination.  This,  then, 
is  the  position  in  which  we  stand  at  the  present  day,  and  all 
British  Graduates  arc  admitted  to  license  on  what  their  papers 
show  forth.  We  arc  in  Canada  General  Practitioners.  If  a  pure 
surgeon  comes  to  us  for  a  license  he  can  only  obtain  such  license 
on  passing  an  examination  in  medicine  and  midwifery ;  if,  how- 
ever, these  branches  are  covered  by  other  qualifications,  he  is 
admitted  to  practise  at  once  and  the  license  issued  on  payment 
of  fees.  Tlierc  can  be  no  hardship  in  this.  We  simply  think 
it  preposterous  of  our  Britisli  friends  to  remain  in  their  pig- 
headed ignorance  and  attempt  to  write  about  our  institutions,  of 


TROMHER  EXTRACT  OF  SIALT.  527 

which  they  know  nothing.  It  is  lamentable  to  see  gaucheriea 
perpetrated  almost  in  each  issue  of  some  of  the  British  periodi- 
cals. Our  friends  on  the  other  side  of  the  Atlantic  had  better 
take  notice  and  understand  that  we  in  this  despised  colony  gave 
them  the  lead  in  medical  legislation  by  our  Act  of  1847,  and 
that  the  Ontario  Legislature  passed,  some  twelve  years  ago,  an 
act  enunciating  and  carrying  out  the  central  examining  system, 
or  the  one  door  of  entrace  into  the  profession,  a  system  that  is 
being  advocated  at  the  present  day  before  the  British  House  of 
Commons. 

EXTRACT  OF  MALT. 

There  is  probably  no  parallel,  in  the  history  of  therapeutics, 
to  the  rapidity  with  which  this  most  valuable  agent  has  forced 
its  way  into  universal  favor  with  the  profession.  Until  a  year 
or  two  ago  its  use,  in  Canada  especially,  was  of  the  most  res- 
tricted character,  now  there  are  few  practitioners  who  do  not 
occasionally  prescribe  it.  While  no  medicinal  agent  has  achieved 
such  favor,  it  may  also  be  said  there  are  few  remedies  possessing 
such  well-founded  claims  for  general  favor,  and  none  whose 
range  of  application  is  so  wide.  Its  constituents  are  malt-sugar, 
dextrine,  diastase,  phosphates,  the  importance  of  which  to  the 
digestive  process. need  not  be  discussed.  The  clinical  evidence, 
too,  which  has  sanctioned  the  physiolo^cal  claims  of  Malt  Extract 
is  most  abundant.  Authorities,  abroad  (it  is  officinal  in 
Germany)  and  at  home  emphatically  recommend  it.  Niemeyer, 
Oppolzer,  Werber,  Bock,  Hoppe-Seyler,  Heimerdinger,  Juer- 
gensen,  Schroeder  and  Ziemssen,  in  Germany ;  Trousseau, 
Gosselin,  Hardy,  Mauduit  and  Pillois  in  France  ;  Ramagalia, 
Testa  and  Tartaglia  in  Italy ;  Aitken,  Anstie,  Richardson, 
Chambers  and  Thompson,  in  England,  are  among  the  writers 
who  speak  in  favorable  terms  of  its  use.  In  America  the  tes- 
timony is  to  the  same  effect.  In  Canada,  as  we  have  said,  it  has 
been  received  by  the  profession  with  the  greatest  favor,  and  a 
large  number  of  the  profession  have  already  given  formal,  as 
well  as  practical,  endorsation  to  this  preparation. 


■«28 


CANADA  HEDICAt  ASD  SCHaiCAL  JODBHAL. 


Regarding  Malt  Extract,  Dr.  Niemcyer  says : 

"  The  class  of  diseaaes  in  vhich  the  chief,  if  indeed  not  the 
only  task  of  the  physician, is  to  maintain  or  restore  the  strengtli 
and  nutrition  of  the  jjatient,  is  very  large.  For  several  years 
past,  to  meet  those  indications,  instead  of  prescribing  cod  hver 
oil,  which  I  was  formerly  in  the  hahit  of  doing,  I  have  employed 
abnost  exclusively,  Malt  Extract,  and  with  the  very  best  eOect. 
This  substance  must  not  be  confounded  with  Hoff's  and  other 
80-called  malt  extracts,  which  are  only  a  kind  of  beer  cont^nlng 
a  large  proportion  of  carbonic  acid  and  alcohol,  which  are  often 
injurious  to  the  patient.  It  is  similar  to  othermedicinal  extraotg, 
and  consists  of  the  soluble  constituents  of  Barley  Malt." 

According  to  Professor  Douglas,  1000  parts  of  the  Trommer 
f)xtract  of  Malt  contains :  malt-sugar  46.1 ;  dextrine,  hop- 
bitter,  extractive  matter,  23.6  ;  diastase,  2.469 ;  aah-phosphates, 
1.712  :  alkalies,  .377  ;  water,  25.7.  In  comparing  this  analyaB 
with  that  of  the  Extract  of  Malt  of  the  German  Phannacopcm, 
as  ^ven  by  Hager,  he  finds  it  to  substantially  agree  with  th^,-J 
article. 

Malt  Extract,  with  its  combinations,  is  recommended  in  the 
following  diseases :  anaemia,  chlorosis,  marasmus,  dyspepsia, 
neuralgia,  insomnia,  pulmonary  and  bronchial  afTec^ons,  dysen- 
tery, constipation,  scrofula,  convalescence  from  exhausting 
diseases,  &c.  We  have  used  the  Trommer  Extract  in  some  oil 
these  affections  with  satisfactory  results,  and  have  no  hesitatioa 
in  strongly  recommending  it, 

[Mr.  R.  L.  Gibson,  agent  for  the  Trommer  Company,  is 
desirous  of  Bccuring  reports  from  physicians  of  their  experience 
in  the  use  of  Extract  of  Malt,  and  requests  us  to  say  that  Buch 
courtesy  would  be  very  highly  esteemed.  He  will  also  be  glad 
to  answer  any  enquiries,  and  to  furnish  samples  on  application. 
Address :  P.  0.  Box  724,  Montreal] . 

Siedical  Item. 

Charies  II.  Murray.  B.A.,  M.D.,  CM.,  McGill  University 
of  the  Session  of  1S76.  also  M.R.CS.,  Eng.,  passed  the  com- 
petitive cxammation  for  the  Indian  Medical  Service,  on  Febrit-  i 
ary  17th  last.  There  wer«  fourteen  vacancies  and  thirty-three  I 
candidates,  and  Dr.  Murray  stood  eighth  on  the  list  of  success 
ful  candidates.  AVe  believe  Dr.  Murray  is  at  present  serving  a 
Netley. 


I 


CANADA 


Medical  &  Sdrgical  Journal 

JULY,  1879. 

Qrifljinal  ©xxmrnunications* 


DISLOCATION   OF  THE    RIGHT   HIP   JOINT   INTO 

THE  ISCHIATIC  NOTCH ; 

OCCURRING  FROM  A  FALL,  IN  A  BOY  AGED  FOUR  YEARS. 

Reduction  by  Manipulation. 

By  George  E.  Fen  wick,  M.D., 

Prcfcssorof  Surgery,  McGill  University ;  Surgeon  to  the  Montreal  General  Hospital. 

Cases  of  dislocation  of  the  hip-joint  are  comparatively  rare 
accidents,  more  especially  amongst  children.  Having  recently 
met  with  a  case  of  dislocation  in  a  child  of  four  yeai^s,  I  deemed  it 
of  sufficient  interest  to  place  on  record.  C.  C,  a  little  boy  of  4 
years,  was  brought  by  his  mother  to  the  Montreal  General  Hos- 
pital on  the  24th  June,  1878,  with  what  was  supposed  to  be  the 
commencement  of  hip-joint  disease.  The  history,  as  given  by 
the  mother  was  that  while  running  he  slipped,  with  his  right  leg 
bent  beneath  his  body,  and  fell  on  the  side,  receiving  what  was 
supposed  to  be  an  ordinary  contusion.  The  accident  occurred 
some  ten  days  before  admission.  When  seen  he  was  lying  on 
his  back  in  bed,  the  right  knee  was  rotated  inwards  and  advanced, 
lying  upon  and  overlapping  the  left  thigh ;  it  was  slightly  flexed 
at  the  knee-joint,  and  the  mother  stated  that  he  was  unable  to 
stand  or  walk.  There  was  flattening  of  the  trochanter,  and  con- 
siderable fixity  of  the  limb.  The  examination  was  conducted  on 
a  table.  On  attempting  to  place  the  limbs  together  and  extend- 
ing them,  tlie  loins  were  arched  forwards,  a  condition  which  was 
reduced  when  the  injured  limb  was  flexed  on  the  pelvis,  but 
there  was  not  that  amount  of  fixity  which  is  usually  seen  in  these 
cases,  but  some  shortening. 

NO.    LXXXIV.  35 


530  TASAIIA    MEDICAL   AKTI 

Feeling  salisHed  that  I  had  to  deal  with  a  dislocation  ba^k-l 
warda  into  tho  ischiatic  notch,  chloroform  was  administered,  and  I 
reduction  by  manipulation  practised.     Seizing  the  ankle  in  my 
right  hand,  the  k-g  waa  flexed  on  the  thigh  at  the  knee-joint,  tlie 
thigh  flexed  on  tho  pelvis,  and  carried  first  towards  the  left  side, 
to  a  httle  marc  than  at  a  right  angle.     Abduction  and  rotation 
of  the  limb  outwards  waa  then  performed,  when  an  audible  anap 
occurred,  ami  on  extending  the  limb  it  was  found  that  the  liead 
of  the  bone  had  returned  to  its  natural  position,  the  limbs  had 
assumed  a  symmetrical  appearance,  were  of  etiual  length,  and 
the  motions  of  the  joiut  free  and  the  sensation  iptite  normal. 
The  limbs  were  then  bandaged  together,  and  the  child  returned 
to  bed.   Tho  mother  was  obliged  to  return  home,  as  she  was  from  i 
ttie  coinitry,  and  she  objected  to  leave  her  child  at  the  hospital,  I 
so  that  they  were  discharged  on  the  26th  June,  two  days  after  I 
the  reduction.     In  the  meantime  no  untoward  symptoms  had  I 
been  developed,  and  she  was  instructed  to  return,  should  any  I 
further  trouble  occur. 

The  following  table  is  taken  from  cases  reported  in  Hamilton's  I 
work  on  Fractures  and  Dislocations,  and  is  compiled  to  show  that  J 
these  injuries  may  occur  M  a  very  eai-ly  age  under  peculiar  I 
circumstances : — 

!fo.            Age.                           Silanlioa  Auiharilj/. 

1.     (i  munths Thyroid  Nottli J.  I'nwilrell,  in  Lam 

11  Oaaelle  McdimU, 
1  Dr.  Fanning.  In  Hatnlltoit,  J 
on  KfHct.  and  Digloc.  ■ 

I  Mr.  Eirbj,  in  DubUn   MedM 


D  ilii  . 


Ischiiitir  nolch, ..  \  Ih.  Buchanan't  lUagazua. 

Nut  Kt»ti!d (  Malgnigntf. 

3i  yeiitB Domum  ilii Mr.  lmiiBc,7Vop.  J/*i  JoBmaiJ 

1.     4    years Dorsum  ilii J.  N,  LilUH,Ti;\na. 

■■  '  ""• {'T.-S™.'"' }'■"■""'•■■ 

Dislocation  of  the  Inp-joint,  as  occurring  in  early  life,  is  coio- 
paratively  a  rare  accident.  We  may  account  for  this  from  the 
fact  that  young  children  are  less  exposed  to  injury,  and  that  from 
their  light  weight  are  capable  of  sustaining  injury  with  compara- 
tive immunity.  It  has  been  stated  that  dislocation  of  the  hip-joint 
never  occurs  before  the  seventh  year  of  life.     This  is  an  error; 


DISLOCATION   RIGHT   HIP  JOINT. — BY  DR.  PENWICK.         531 

there  is  one  well-authenticated  case  of  dislocation  downwards 
and  forwards  into  the  thyroid  foramen,  which  was  reduced  by 
manipulation  at  the  end  of  a  week,  the  patient  being  a  child  of 
six  mouths,  who  had  overturned  a  chair  in  which  she  was  tied. 
Reported  by  Mr.  Powdrell  in  the  Lancet  for  May  16th,  1868. 
This  will  suffice,  on  this  point.  It  is  alone  at  the  earlier  ages 
that  an  accident  of  this  nature  might  be  overlooked  by  a  sur- 
geon, until  too  late  to  remedy  it,  by  attempting  reduction. 
The  case  here  reported  ought  to  point  to  the  necessity 
of  careful  examination  of  young  children  in  cases  of  injury 
through  accident.  Very  young  children  are  incapable  of  indi- 
cating the  precise  nature  of  an  injury,  and  those  of  more  ad- 
vanced years,  may,  through  fear,  conceal  an  injury  until  it  is  too 
late  to  do  any  good  by  surgical  interference. 

CASES  OF  INTERMITTENT  FEVER. 

Treated  in  the  Montreal  General   Hospital  in  the  Months  of  May  and 

June,  1879. 

By  James  Bell,  M.D.,  House  Surgeon. 

During  the  months  of  May  and  June  of  this  year  (besides 
the  cases  treated  in  the  out  patient  department)  there  were 
four  cases  of  ague  treated  in  the  Hospital.  Two  were  under 
the  care  of  Dr.  Reddy,  and  two  were  under  Dr.  Osier's  care. 
The  following  brief  notes  of  these  cases  are  worth  recording  I 
think,  as  they  show  that  ague  does  originate  not  only  in  the 
island  of  Montreal  but  in  the  city  itself,  though  this  fact  is  often 
disputed  by  practitioners  having  large  experience  of  the 
diseases  which  occur  in  Montreal.  Three  out  of  four  of  the 
cases  reported  clearly  originated  in  the  island,  while  case  iv 
undoubtedly  originated  in  the  city  of  Montreal. 

Case  I. — A.  I.,  set.  28,  was  admitted  on  the  22nd  of  May. 
He  is  a  strong  muscular  Englishman,  but  looking  a  little 
sallow.  He  came  from  England  fifteen  years  ago,  and  went  to 
work  as  a  lumberman  on  the  Upper  Ottawa.  Five  years  ago 
he  came  to  Montreal,  and  has  not  been  further  away  from  the 
city  than  Lachine  since  that  time.  Has  never  been  in  a 
malarious  district  to  his  knowledge.     He  is  a  man  of  temperate 


532 


,   Attn  SV&aWM.  JOimNAL. 


habtte,  and  has  always  enjoyed  good  health.  In  Jiuiiiarj  last 
lie  went  to  work  on  tho  Lachino  Canal,  about  five  miles  from 
the  city.  Seven  weeks  prior  to  hie  admission  he  was  working 
on  a  derrick,  and  while  at  his  work  he  became  giddy  and  fell 
oft  Ho  had  no  chill  but  felt  very  sick,  and  could  not  retam 
to  his  work.  Three  days  later  he  had  a  severe  chill  at  11. 
p.m.,  which  lasted  about  an  hour  and  a  half,  and  was  followed 
by  three  hours  of  high  fever.  Ho  then  perspired  profusely  for 
five  or  six  hours,  and  felt  rather  better  as  the  attack  passed  off, 
but  was  not  able  to  go  to  work.  Ho  had  a  similar  attack  orory 
second  day  for  four  weeks.  For  a  couple  of  weeks  now  he  had 
tlie  chill,  etc.,  every  third  day.  when  it  again  became  tertian. 
On  admiBsion  it  became  t|uoddian  in  type,  and  was  very  severe. 
The  chill  lasted  about  an  hour  or  an  hour  and  a  half  daily,  and 
the  hot  and  sweating  stages  occupied  eight  or  ten  ho'irs.  The 
temperature  rose  to  103^  and  104°  F.  duriug  the  hot  stage. 
The  spleen  is  slightly  enlarged.  It  can  be  felt  below  the 
margin  of  the  ribs  and  ia  a  little  tender  on  pressure.  Ito 
vertical  dulncss  measures  four  inches.  All  his  other  organs 
are  healthy. 

Ho  was  kept  under  observation  three  days  before  being 
treated.  He  was  then  ordered  a  purgative  in  the  morning,  a 
twenty  grain  doso  of  quinine  at  night,  to  be  followed  by  a  ten 
grain  dose  in  the  mqrning  and  a  mixture  containing  two  grains 
of  quinine  per  dose  thi-eo  times  a  day  afterwards. 

He  had  no  more  symptoms  of  ague,  and  left  in  tiiree  daya 
feeling  quite  well. 

Cabe  n. — M.  I.,  wife  of  last  patient,  was  admitted  on  the 
26th  of  May.  Slie  is  a  tall  sallow  woman,  29  years  of  age,  of 
English  extraction,  and  reared  in  the  Province  of  Quebec. 
She  has  never  been  out  of  Canada,  nor  further  west  than 
Lachiiie.  Her  family  history  is  good.  She  is  of  temperate 
habits  and  has  never  had  any  illness,  except  an  attack  of 
pneumonia  seven  years  ago.  She  has  been  living  with  her 
husband  in  the  neighborhood  in  which  ho  was  working  (five 
miles  from  the  city),  and  they  both  attnbute  their  I 
drinking  swamp  water.     Her  illness  began  in  the  lattc 


I 


INTERMITTENT  PEVER — BY  DR.  BELL.         533 

March  last.  She  first  complained  of  pain  in  her  back  and 
stomach  and  occasional  chilly  feelings.  These  symptoms 
lasted  five  or  six  days,  and  then  she  had  her  first  regular 
paroxysm.  The  chill  lasted  about  three  quarters  of  an  hour, 
the  hot  stage  about  four  or  five  hours,  and  in  the  sweating  stage 
she  generally  fell  asleep,  and  perhaps  when  it  was  over  feeling 
pretty  well.  The  fever  in  this  case  was  of  the  tertian  type 
throughout  and  was  very  regular,  the  chill  coming  on  about  the 
same  hour  every  day  and  the  symptoms  varying  very  little 
from  day  to  day.  The  temperature  rose  in  the  hot  stage  while 
in  hospital  to  104°,  105°  and  107°  F.  She  waa  pretty  well  in 
the  intervals.  There  was  considerable  splenic  enlargement  and 
tenderness.  It  extended  well  forward  towards  the  median  line 
below  the  lower  ribs.  The  vertical  dulness  measured  seven 
inches.  With  the  exception  of  a  subinvolution  of  the  uterus  all 
her  other  organs  were  healthy.  She  was  ordered  a  quassia 
mixture  on  admission,  which  she  continued  to  take  for  eight 
days,  believing  that  she  was  taking  quinine.  She  was  then 
ordered  twenty  grains  of  quinine  at  7  a.m.  on  the  day  on  which 
she  expected  the  paroxysm.  She  had  no  symptoms  on  that 
day. 

Two  days  afterwards  she  was  given  ten  grains  of  quinine  at 
7  a.m.  She  had  a  slight  feeling  of  coldness  about  ten  o'clock, 
but  no  other  symptoms.  She  was  then  given  two  grain  doses 
three  times  a  day  with  the  tincture  of  the  perchloride  of  iron, 
and  had  no  return  of  symptoms  afterwards.  The  splenic  ten- 
derness rapidly  disappeared,  and  by  the  18th  of  June  the 
spleen  had  shrunken  to  nearly  its  natural  size.  She  was  then 
looking  well  and  feeling  much  stronger,  and  was  discharged. 

Case  HI.- — R.  E.,  a  laborer,  a  strong  healthy  looking  man, 
30  years  of  age,  was  admitted  on  the  7th  of  June.  He  is  a 
native  of  this  Ppvince  of  Quebec,  but  has  been  in  different 
parts  of  Canada  and  the  United  States,  though  never  in  any 
malarious  district  to  his  knowledge,  except  two  years  ago,  when 
he  had  a  couple  of  weeks  illness  on  the  Welland  Canal.  He  is 
positive  that  he  had  no  chill  then,  but  he  was  laid  up  for  two 
weeks.     He  was  feverish  and  "  very  sick,"  and  was  told  that 


534 


CANADA   MEDICAL   AND   StlRQICAL   JOURNAL. 


he  had  "  bilious  fever."  He  had  no  other  illness  in  his  life, 
and  was  perfectly  well  until  two  weeks  before  admisaon,  when 
he  waa  attacked  with  wellniarkod  tertian  ague.  On  the  second 
day  after  admission  he  had  a  typical  and  pretty  severe  paroxyam, 
the  temperature  ritung  to  105*  F.  There  was  no  enlargement 
of  the  spleen,  nor  any  evidence  of  disease  of  any  other  oi^an. 
On  tho  evening  fi>llowing  the  day  on  which  he  had  this  attack 
he  was  given  twenty  grains  of  (]uinine,  with  another  twenty 
grain  dose  on  the  following  morning,  and  a  >|uinine  mixture. 
He  had  no  further  symptoms  of  intermittent  fever,  and  was 
discharged  fonr  days  afterwards,  feeling  finite  well. 

Casb  IV. — W-  W.,  iBt.  lii,  a  delicate-looking  boy,  was  ad- 
mitted .June  10th,  1^79.  Patient  is  a  cab-driver,  and  for  the 
last  nine  years  has  lived  in  Griffintown,  in  the  vicinity  of  Young 
and  William  Streets.  He  has  never  been  out  of  Montreal, 
except  to  drive  out  to  Lachino  or  ronnil  the  mountain.  A 
curious  fact  in  his  family  history  is  that  his  father  contracted 
ague  in  Upper  Canada  many  years  ago,  and  had  an  attaclc 
every  Spring  and  Fall  alterwards  while  he  lived.  His  mother 
died  of  jilithisis.  He  is  of  temperate  habite,  and  never  had 
any  illness  in  his  life  before.  He  was  attacked  on  the  first  of 
June  with  typical  tertian  ague.  He  had  one  severe  attack  in 
Hospital,  during  which  the  temperature  rose  to  lO.'i''  F.  There 
was  slight  enlargement  of  his  spleen  and  some  pain  in  his  left 
side  during  the  paroxysms,  but  no  evidence  of  disease  of  any 
of  his  other  organs.  His  treatment  was  ttie  same  as  in  the 
other  cases,  and  he  had  no  return  of  any  of  the  symptoms  after 
the  first  dose  of  quinine.  He  was  discharged  on  the  18th, 
feeling  (juite  well. 


A  SIMPLE  MRTHOD    OF  PREVENTING   MAMMARY 
ABSCESS. 

BV    FRANCIS   J.    SIIBPIIKRD,  M.D.,  M.aC.8.,  ENG. 

There  is,  I  suppose,  no  accident  which  brings  more  discredit 
or  gives  more  trouble  to  the  surgeon  than  the  occurrence  in 
his  practice  of  a  "  broken  breast "  case.    Many  remedies  (such 


MAMMARY  ABSCESS — BY  DR.    SHEPHERD.  535 

as  belladonna,  hot  oil,  frictions,  &c.)  have  been  advocated  to 
prevent  this  painful  aflPection,  but  I  have  found  none  more 
efficacious  and  speedy  than  the  following  simple  plan  which  has 
been  used  for  year*  with  great  success  by  old  women  in  country 
parts  :  in  fact,  it  may  well  be  called,  what  indeed  it  is,  an  **  old 
wife's  remedy."  When  the  gland  becomes  indurated,  painful, 
and  has  a  glistening  red  look  (symptoms,  in  fact,  of  approach- 
ing suppuration),  take  a  large  piece  of  ordinary  sticking  plaster 
and  cut  it  a  circular  shape  (a  larger  or  smaller  disc,  according 
to  the  size  of  the  afflicted  breast) ;  make  a  hole  in  the  centre 
large  enough  to  allow  the  nipple  and  half  the  areola  to  be  seen, 
and  apply  this  piece  of  plaster  (after  heating  it)  so  that  it  will 
cover  the  whole  breast,  and  that  the  nipple  will  protrude  through 
the  aperture  in  the  centre.  To  make  the  plaster  fit  more  accu- 
rately, its  circumference  should  be  deeply  nicked  at  distances 
of  about  an  inch.  The  plaster  should  be  left  on  till  the  breast 
softens,  or  the  plaster  ceases  to  exercise  even  pressure.  This 
simple  method,  in  the  half  dozen  cases  I  have  seen  it  used,  has 
acted  magically,  the  breast  softening  and  the  pain  disappearing 
in  the  course  of  twenty-four  hours.  In  one  case  a  woman,  who 
had  suffered  on  several  previous  occasions  from  broken  breasts, 
came  to  the  out-door  department  of  the  General  Hospital  with 
all  the  symptoms  of  fast  approaching  suppuration  in  her  right 
breast ;  in  fact,  I  considered  that  within  twenty-four  hours  I 
should  be  obliged  to  use  the  knife.  However,  I  said  to  the 
students  that  if  there  was  anything  in  the  plaster  remedy,  this 
would  be  a  good  case  in  which  to  try  it.  I  applied  the  plaster  in 
the  way  described  above.  Two  days  after,  the  woman  returned 
and  said,  with  a  pleased  smile,  that  it  was  l;he  only  remedy  slie 
had  ever  tried  that  had  done  her  any  good  ;  that  on  previous 
occasions  every  remedy  had  failed  to  prevent  her  having  a 
"  broken  breast.*'  On  examining  the  breast,  I  found  it  quite 
soft,  painless,  and  with  only  one  small  lump  of  induration  on 
the  upper  part,  which  disappeared  m  the  course  of  a  couple  of, 
days.  In  another  case,  where  an  abscess,  due  to  depressed 
nipple,  threatened,  I  applied  the  plaster  as  before,  and  in 
twenty-four  hours  there  was  hardly  any  induration,  and  no  pain. 


536  CANADA  MEDIOAL   AND  SnROIOAL   JOUBNAL. 

In  multiparas,  where  the  breast  is  dependent,  in  addition  to  I 
covering  the  breast  with  plaster,  I  should  advise  supporting  the  T 
breast  by  a  band  of  plaster,  IJ  inclioa  broad,  passing  under 
the  breast  from  shoulder  to  shoulder.  I  may  say  that  I  have 
only  uaed  tbi?  remedy  in  cases  of  threatened  abscess,  duo  to 
distenBion  of  the  milk  ducts,  depressed  nipples,  and  obstruction 
to  a  free  flow  of  milk,  due  to  exposure  to  cold.  I  ima^ne  the 
plaster  acts  simply  by  exercising  an  even  pressure  on  the  breast 
and  giving  support  to  it.  I  hope  that  this  method  will  be  tided 
by  some  of  your  readers,  and  that  they  will  ^ve  tbe  results  of 
their  experience  of  it,  beneficial  or  otherwise. 


eorrespondence. 

Vienna,  June  20th,  1879. 

To  the  EdiloT  qf  the  Canida  HiDieiL  and  SimaiCAL  Jociinal: 

Sib, — A  few  notes  from  this  great  centre  of  medicaJ  teaching 
will,  no  doubt,  be  of  some  interest  to  many  of  your  readers. 
The  Vienna  medical  school  attracts,  without  doubt,  a  greater 
number  of  foreigners  than    any"  other   school   in  the   world. 
This  is  due  in  some  measure  to  the  eminence  of  cert^n  of  its 
professors,  but  principally  to  the  great  number  and  completeness 
of  the  special  courses.     The  following  courses  connected  with   ■ 
practical  medicine  are  conducted  in  a  manner  that  leaves  almost   ■ 
nothing  to  be  desiretl.     Laryngoscopy  and  Rhinoscopy,  by  Pro- 
fessor Schriitter  and  his  Assistant,  Dr.  Cubti ;  the  use  of  the 
opbthftlmoscope  by  Prof.  Jiieger  and  Dr.  Fuchs ;  diseases  of  the 
ear  by  Profs.  Gruher  and  Politzer ;  pathological  demonstrations 
by   Dr.    Hans  Chiari ;  auscultation  and   percussion  by  Prof. 
Schrotter  and  Dr.  Heitler ;  diseases  of  the  nervous  system  by   ' 
Prof.  Rosenthal ;  the  experimental  pliysiology  and  pathology  of 
the  central  nervous  system  by  Oborsteiner ;  experimentul  phar- 
macology, by  Profs.  S.  Von   Basch  and  Exner.     Prof.  Ebiner   < 
conducts  also  a  very  valuable  course  on  practical  physiology. 
The  clinical  courses  on  general  medicine  are  seldom  attended 
by  foreigners,  although  they  are  the  most  valuable  instruction 


CORRESPONDENCE.  537 

that  is  communicated  in  the  whole  institution.  Bamberger's 
klinik  is  especially  well  worth  attending ;  it  is  held  from  7  to  9 
a.m.,  during  which  time  two  cases  are  examined,  comments 
made  and  treatment  suggested.  The  student  who  wishes  to 
devote  the  whole  or  part  of  his  time  to  clinical  surgery  or  mid- 
wifery, will  find  a  great  number  of  special  courses  connected 
with  each  of  these  branches.  Even  those  who  are  wholly 
unacquainted  with  the  German  language  will  find  that  a 
great  amount  of  practical  knowledge  can  be  acquired  by  attend- 
ing the  practical  courses.  There  has  been  a  gradual  falling 
away  of  the  number  of  students  attending  the  medical  faculty 
for  several  years.  During  the  last  winter  session  the  number 
registered  amounted  to  864,  but  this  number  does  not  include 
the  great  majority  of  foreigners  who  are  not  required  to  register 
iHiless  they  intend  taking  the  university  degree. 

Professor  Bamberger  has  quite  lately  made  public  some  excel- 
lent observations  on  Bright's  disease.  As  this  subject  is  one  of 
great  practical  interest,  I  thought  it  would  be  of  some  value  to 
your  readers  to  give  a  rather  full  account  of  these  observations. 
The  following  is  from  notes  taken  in  the  klinik,  and  from  a  paper 
read  before  the  Royal  Imperial  Academy.  To  answer  the  ques- 
tion :  What  are  the  cause  and  efiects  of  Bright's  disease  ? 
Bamberger  examined  the  pathological  records  of  the  Vienna 
General  Hospital  during  the  last  twelve  years.  During  this 
time  19,000  post-mortems  were  performed,  and  of  this  number 
2,430  were  recorded  as  Bright's  disease.  In  addition,  during 
the  last  winter  session  all  kidneys  from  the  post-mortem  room 
were  examined  by  him.  In  conducting  the  last  investigation 
Prof.  B.  was  surprised  at  the  great  number  of  diseased  kidneys. 
He  had  to  wait  a  month  before  he  met  with  a  perfectly  healthy 
kidney.  In  many  of  his  own  cases  where  during  life  there  was 
not  the  least  suspicion  of  Bright's  disease,  after  death  it  was 
found  to  exist.  Clouding  of  the  epithelium  of  the  urinary  tubules 
is  not  included.  The  Germans  speak  of  parenchymatous  and  in- 
terstitial nephritis,  the  former  corresponds  to  the  "  large  white," 
the  latter  to  the  "  small  red  "  kidneys  of  English  authors.  In  the 
examination  of  a  fresh,  or  better,  a  hardened  specimen,  it  is  at 


538  CANADA   MEDICAL  AND   SUBU10AL   JOUBNAL. 

once  aeen  what  an  important  rolo  the  interstitial  tissues  play 
ill  all  cases  designated  as  Brighfa  disease.  A  more  or  ieaa 
considerablo  increase  in  the  corpuscular  elements  of  this  tissue 
is  nearly  always  present.  In  pronounced  cases  this  increase  is 
designated  as  small-cell  inllltratiou,  wbich  is  considered  by  some 
authorities  as  due  to  wandering  of  the  white  blootl  cells,  by 
others,  to  proliferation  of  the  normal  elements.  Bamberger  is 
of  the  opinion  that  the  latter  view  is  the  correct  one,  hut  it  is 
a  distinction,  he  says,  of  little  or  no  weight.  In  the  paren- 
chymatous form  there  is  not  only  a  considerable  celluar  increase 
in  the  interstitial  tissue,  but  the  tissue  as  a  whole  is  increased 
in  size.  In  the  vessels  and  canals  changes  are  also  regularly 
found.  This  form  passes  by  degrees  into  the  true  contracted, 
so  that  it  is  impossible  to  separate  it  frara  the  other  form  of  the 
disease.  Weigert,  assistant  to  Cohnheim,  has  quite  recen% 
published  the  results  of  his  investigations  on  this  subject.  He 
comes  to  the  same  conclusion  as  Bamberger,  viz. :  that  there 
is  no  essential  difference  between  parenchymatous  and  intersti- 
tial nephritis ;  that  disease  of  the  kidneys  is  not  limited  to  any 
one  tissue  alone,  but  affects  not  only  the  interstitial  tissue,  not 
only  tlic  cpitlieiial  cells,  but  also  the  whole  cortical  substance. 
Prof.  Bamberger  instances  two  cases  which  Uirow  a  considerable 
light  on  this  subject.  The  first  case  was  that  of  a  child  who 
died  during  the  third  week  of  scarlet  fever.  On  looking  at  a 
section  of  the  kidneys  one  sees  that  the  parenchymatous  changes 
are  predominant, — the  canals  ore  filled  with  fatty,  degenerated 
epithelium,  and  on  a  close  examination  the  interstitial  tissue  is 
found  to  be  the  seat  of  considerable  proliferation.  The  second 
ease  was  a  girl,  aged  13,  who  had  pleurisy  and  pericarditis  in 
the  third  week  of  scarlet  fever.  In  the  fourth  week  there  was 
dropsy  and  albuminuria.  Tiie  interstitial  tissue  was  found  greatly 
increased  and  tilled  with  round  cells. 

What  relations  these  individual  changes  hear  to  each  other — 
whether  the  interstitial  or  epithelial  change  is  the  primary  one — 
whether  the  last  can  be  considered  inHammatury  or  a  product 
of  retrograde  metamorphoses,  Prof.  Bamberger  says  cannot  be 
answered  at  present.  Bartels  was  the  first,  at  least  in  Germany, 


I 


CORRESPONDENCE.  539 

to  make  a  clinical  separation  between  the  parenchymatous  and 
interstitial  forms  of  the  disease.  This  separation  is  somewhat 
arbitrary.  There  are  many  exceptions  to  it.  It  is  not  uncom- 
mon to  find  cases  which  present  all  the  leading  symptoms  of 
contracted  kidney  during  life,  and  after  death  the  usual  paren- 
chymatous changes  are  predominant.  Again,  cases  frequently 
present  themselves  where  we  would  »expect  aft«i^  death  to  find 
parenchymatous  disease,  but  on  the  contrary,  we  find  the  inter- 
stitial tissue  mainly  involved. 

finally  there  are  the  mixed  cases.  Bamberger  gives  the 
following  as  an  example  of  a  contracted  kidney  being  mistaken 
(during  life)  for  a  large  white  one.  A  man,  aged  44,  fourteen 
days  after  a  severe  wetting,  came  to  the  klinik  complaining  of 
pain  in  the  region  of  the  kidneys,  haematuria  and  general  dropsy. 
The  urine  was  rich  in  albumen  and  casts.  The  dropsy  diminished 
under  hot  baths,  but  it  afterwards  returned.  Hypertrophy  of 
the  heart  set  in,  and  fifteen  months  afterwards  he  died.  The 
course  of  the  disease  throughout  corresponded  to  the  usual  paren- 
chymatous form.  On  section,  however,  the  kidneys  were  found 
to  be  typical  examples  of  granular  atrophy  of  these  organs. 

Prof.  Bamberger  asks  whether  it  is  advisable  or  not  to  retain 
the  division  of  Bright's  disease  into  parenchymatous  and  inter- 
stitial. He  is  of  the  opinion  that  the  profession  will  soon  return 
back  to  older  views  on  this  subject.  He  considers  the  division 
of  Bright's  disease  from  an  etiological  point  of  view  to  be  of 
more  importance  than  an  anatomical  one.  He  divides  it  into 
primary  and  secondary.  Of  the  2,430  cases  examined,  one-third 
were  found  to  be  primary,  the  remaining  two-thirds  secondary. 
He  considers  that  waxy  disease  of  the  kidney  is  sometimes  prim- 
ary. The  heart  was  hypertrophied  in  42.6  per  cent,  of  the  primary 
cases,  and  only  in  3.3  per  cent,  of  the  secondary  cases.  Bright's 
disease  was  secondary  to  tuberculosis  (including  scrofulosis)  in 
381  cases,  almost  16  per  cent.  Next  to  tuberculosis  stands 
valvular  defects  as  causes  of  Bright's  disease,  viz.,  9  per  cent. 
Pregnancy  comes  third,  with  6  per  cent. 

4th.  Diseases  of  the  urinary  organs  which  interfere  with  the 


540  CANADA   HEltlCAL   AND   BLlUnlrAf,   JliUUNAI,. 

free  passage  of  urine,  as  stricture,  lijpertropy  of  the  prostate, 
5.5  per  cent. 

5tli.  The  various  suppurative  processes,  as  caries,  necroms, 
purulent  inflammation  of  the  joints,  suppuration  in  internal 
organs,  chronic  purulent  skin  diseases,  ft. 2  per  cent. 

tlth.  Spirit  drinking  and  cirrhosis  of  the  liver,  4.S  per  cent. 

7th,  Carcinomatous  degeneration  of  various  organs,  4.2  por 
cent. 

8th.  Emphysema  of  the  lungs,  3.5  per  cent, 

9th.  Typhus  and  typhoid,  2.4  per  cent 

loth.  Chronic  syphilis,  2  per  cent. 

11th.  Scarlet  fever,  0.7  per  cent.  Prof.  Bamberger  explains 
the  reason  of  this  low  percentage  from  the  fact  that  the  great 
majority  of  cases  of  scarlatinal  dropsy  are  recovered  from,  and 
further  that  only  a  very  limited  number  of  children  are  admitted 
into  the  General  Hospital. 

12th.  Intermittent  fever,  5  per  cent. 

13th,  A  number  of  rarer  diseases,  aa  cholera,  variola, 
dysentery,  scurvy,  acute  yellow  atrophy  of  the  livor,  kc. 

All  these  causes  may  be  brought  together  under  three  heads. 
The  Ist  class  includes  all  those  cases  in  which  toxic  or  infectious 
substances  are   introduced  from   without,  or  originate  in  the 
organism  through  suppurative  and  putrefactive  processes.     Of 
substances  introduced  from  without,  alcohol  heads  the  list ;  sfjuills 
and  cantharidea  may  bring  about  similar  results.      Bamberger 
is  of  the  opinion  that  lead  does  not  induce  Brigbt's  disease  nearly 
so  fre(|ueiitly  as  it  is  considered  to  do.     The  2nd  class  includes   i 
those  cases  where  Bright's  disease  is  brought  about  from  the  i 
effects  of  passive  congestion,  as  valvular  disease,  emphysema   ' 
and  chronic  lung  infiltration.     The  3rd  group  comprises  those 
cases  where  the  disease  in  question  is  caused  by  retention  of 
urine.     It  has  been  experimentally  proved  that  parenchymatous 
swelling  and  interstitial  nephritis  can  be  induceil  in  animals  by 
occluding  the  urethra. 

It  is  generally  stated  that  Brigbt's  disease  is  much  more  fre- 
quent in  men  than  in  women,     Bamberger's  statistics  show  a 


CORRESPONDENCE.  541 

percentage  of  55  in  males  and  45  in  females,  but  when  it  is 
considered  that  twice  as  many  males  as  females  are  admitted 
into  hospital,  the  proportion  would  be  greater  in  females.  As 
to  the  complications,  secondary  results  and  sequelae,  it  was  found 
that  haemorrhage  into  the  brain  was  present  in  10  per  cent,  of 
the  cases,  and  croupous  pneumonia  in  22  per  cent.,  pleurisy  in 
7  per  cent.,  peritonitis  in  2  per  cent.,  intestinal  catarrh  in  13 
per  cent.,  dropsy  in  26.6  per  cent.,  fatty  degeneration  of  the 
heart  in  12  per  cent.,  pericarditis,  12  per  ceut.,  hypertrophy  and 
dilatation  of  the  heart  in  42.6  per  cent. 

The  following  case  is  one  of  great  interest  not  only  to  the 
obstetrician  but  also  to  the  medical  jurist.  It  proves  that  uterine 
muscular  action  alone  is  sufficient  to  cause  fracture  of  the  head 
of  the  foetus.  A  powerfully-built  woman,  aged  37,  was  admitted 
last  week  into  C  Braun's  wards,  in  her  ninth  pregnancy.  The 
previous  eight  labors  were  all  severe.  During  the  course  of  the 
labor  rupture  of  the  uterus  took  place,  and  a  dead  child  was 
removed  from  the  peritoneal  cavity  by  abdominal  section.  The 
mother  lived  24  hours.  On  post-mortem  the  uterus  was  found 
to  be  greatly  hyper trophied.  A  rent  15  ctm.  in  its  long  diameter 
(transverse)  was  found  in  the  cervical  region,  through  which 
intestines  protruded.  The  antero-posterior  diameter  of  the  inlet 
was  considerably  narrowed.  On  examining  the  child's  head,  the 
parietal  bones  superiorly  were  found  to  be  completely  separted, 
and  a  fracture  in  the  right  one  4  ctm.  in  length.  There  was 
effusion  of  blood  upon  the  meninges. 

Diagnosis  of  Mitral  Stenosis  ;-^It  is  a  well-known  fact  that 
the  characteristic  presystolic  murmur  of  mitral  constriction  is 
often  absent  even  when  there  is  pronounced  contraction  of  the 
bicuspid  valve.  It  may  be  present  one  day  and  absent  the  next. 
It  is  of  great  importance  then  to  be  able  to  diagnose  this  organic 
change,  irrespective  of  its  pathognomonic  murmur.  Prof,  Loebel 
considers  that  this  may  be  accomplished  by  the  observation  of 
two  physical  signs,  where  there  is  nothing  else  present  to  account 
for  their  appearance,  viz:  enlargement  of  the  liver,  and  an 
accentuated  second  pulmonary  sound.  In  two  cases  where  there 
were  no  other  physical  signs  present  but  the  above,  he  diagnosed 


tfi2  CANADA   MJLDICAL   JISTD   SCft^irCAL    JOUK^AL, 

mitral  coni^trictioD,  and  his  eoncfnons  were  prored  io  be  correct 
in  each  of  the  cases  at  the  post-^nortem. 

Dr.  I]»alfaar  of  Edinbargh  hjs  great  stress  on  the  Taloe  of  a 
^^  thiirn{iiTig  1st  sound  '^  in  the  diagnoas  ol  mitral  stenosis,  when 
the  presjrstolic  murmur  is  absent. 

Pneumonia,  during  the  months  of  February,  March  and  April, 
has  been  very  frequent  in  Vienna,  and  the  rate  of  mortality  has 
l)eeri  very  high.  I  had  occasion  to  examine  twenty-seven  cases 
(luring  ten  weeks,  and  of  this  number  seventeen  died.  The 
treatment  of  pneumonia  in  LcebeFs  wards  is  chiefly  expectant, 
occiinionally  only  is  digitalis  administered  to  counteract  heart 
f'aihire.  I^rof.  Bamberger  treats  his  sthenic  cases  with  antimo- 
nialH  in  the  early  stages.  In  the  asthenic,  and  latter  stages  of 
ail,  crises  he  gives  camphor.  Judging  from  the  results  of 
(;x[)eri mental  investigation  camphor  would  seem  to  be  peculiarly 
n<la[)te(l  for  the  treatment  of  pneumonia,  not  only  during  the 
time  that  heart  failure  threatens  to  set  in,  but  throughout  the 
whole  course  of  the  disease.  Paralysis  of  the  heart  induced  by 
the  action  of  muscarin  on  the  inhibitory  apparatus  can  be  in 
a  gn^at  part  removed  by  the  action  of  camphor,  and  what  is  of 
great  practical  value  this  recovery  can  be  brought  about  by  very 
iiioderate  doses  of  the  drug.  Camphor  also  reluces  the  tempera- 
ture of  the  body ;  this  reduction  is  more  marked  if  fever  is 
present,  and  further  it  has  the  effect  of  paralyzing  the  movements 
of  the  white  blood  corpuscles.  One  who  attends  Chiari's  patho- 
lo^^ical  demonstrations  for  sometime  will  be  surprised  at  seeing  so 
many  s|)ecimens  of  pneumonic  lungs  which  were  unrecognised 
as  such  during  life.  It  is  but  just  to  add  that  the  great  majority 
of  these  cases  come  from  the  surgical  wards.  Among  surgeons 
it  is  not  the  custom  to  make  the  physical  examination  of  the 
chest  a  matter  of  routine,  and  hence  the  reason  of  so  many  un- 
recognised secondary  pneumonias.  These  appear  to  be  especially 
frequent  after  abdominal  operations.  In  these  cases  there  is 
generally  more  or  less  extensive  peritonitis  present  also.  Both 
the  pneumonia  and  peritonitis  run  their  course  from  first  to  last 
witliout  any  marked  subjootivo  symptoms. 


CORRESPONDENCE.  543 

The  writer  has  seen  a  great  number  of  cases  of  peritonitis 
following  operations  on  the  abdomen,  not  only  in  Vienna,  but 
also  in  Edinburgh.  In  tl^e  great  majority  of  the  cases  the  peri- 
tonitis was  not  attended  dui-ing  life  by  any  noticeable  increase 
in  temperature  or  pulse.  Pain  and  tympanitis  were  absent  as 
a  rule. 

During  the  last  year  465  cases  of  pneumonia  were  treated  in 
the  general  hospital ;  of  this  number  127  died.  The  duration 
of  the  disease  in  the  fatal  cases  amounted  to  18.7  days,  in  the 
recoveries,  21.8  days.  In  the  differential  diagnoses  between 
pneumonia  and  pleurisy  great  stress  is  laid  by  many  of  the 
physicians  here  on  the  "  exquisite  tympanitic  note,"  which  is 
very  often  present  in  the  former  disease. 

Pulmonary  consumption  is  very  common  in  Vienna.  During 
the  year  1877,  1953  cases  were  admitted  into  the  hospital,  the 
mortality  amounted  to  55.6  per  cent.  Both  lungs  were  affected 
in  1335  of  the  cases,  the  right  in  371,  and  the  left  in  247. 
Haemoptysis  was  present  in  696  cases  There  was  intestinal 
tuberculosis  187  times,  but  only  three  cases  of  perforation.  In 
146  of  the  cases  there  was  a  similar  affection  of  the  larynx,  and 
27  of  the  peritoneum.  Then  followed  the  membranes  of  the 
brain  19  times,  liver  17,  spleen  16,  kidneys  14,  pleura  8, 
lymph  glands  8.  Pneumothorax  occurred  in  24  of  the  cases. 
Anal  fistula  was  only  present  in  a  single  case.  In  the  Vienna 
school  tuberculosis  is  a  general  name  for  chronic  Inng  changes. 
There  is  no  division  of  pulmonary  consumption  into  tubercular, 
catarrhal  and  fibroid  phthisis.  All  chronic  lung  changes  are 
designated  both  by  pathologists  and  physicians  as  tuberculous 
infiltration.  Pulmonary  consumption  and  pulmonary  tuberculosis 
are  synonymous  terms. 

I  have  quite  recently  seen  three  cases  of  pericarditis  caused 
by  pleurisy,  and  one  case  of  supposed  idiopathic  pericarditis 
followed  by  pleurisy  in  Prof.  Lcebel's  wards.  Dr.  Heitler  who 
had  charge  of  the  cases,  considers  that  pletirisy  is  not  an 
unfrequent  cause  of  pericarditis.  Prof.  Ducheck  goes  as  far  as 
to  say  that  pleurisy  is  a  more  frequent  cause  of  pericarditis 
than  acute  rheumatism.     The  treatment  of  pleurisy  is  purely 


544  CANADA   MBDIrAI-    ANIl   HITRIJIOAL   JODESAL. 

expectant.  Tapping  is  only  resorted  to  now  when  there  is  known 
imminent  danger  of  death  from  the  copiousness  of  the  eflhsion. 
Reat  in  hod  and  the  relief  of  pain  by  morphia  are  generally  solely 
a-licd  on. 

During  the  last  year  466  cases  of  typhoid  fover  were  treated 
in  the  hospital  with  a  mortality  of  24  per  cent.     The  duration 
of  the  disoaees  in  the  fatal  casea  was  '2ti.l  days,  in  the  rccovenes 
35.3.  Bronchitis  was  present  in  20  cases,  intestinal  h.'emorrhage   i 
ill  16,  pneumonia  in  37,  peritonitis  in  4,  iq  consequence  of  per-  i 
foration  twice,  laryngeal  ulceration  in  6  cases. 

The  treatment  of  typhoid  fever  is  also  expectant.  The  treat- 
ment by  cold  does  not  find  much  favor,  unless  hyperpyrexia 
should  set  in. 

Typhoid  fever  aud  acute  miliary  tuberculosis  arc  very  fre- 
quently mistaken  for  each  other.  In  one  ward  I  saw  three  cases  ' 
within  a  month  diagnosed  as  typhoid  fever,  and  after  death  they 
were  found  to  be   cases  of  miliary  tuberculosis.     Tubercular 
meningitis  is  often  again  mistaken  for  typhoid  fever,  septicsemia, 
&c.     ITic  following  case  which  was  under  Prof,  Bamberger's 
care,  shows  the  great  difficulty  that  attends  the  diagnosis  of  I 
those  cases.     A  young  man  with  tuberculous  inliltratioD  of  the  j 
apices  of  his  lungs  and  small  intestines,  was  admitted  under  j 
Prof.  B.'s  care.     Intestinal  perforation  occurred,  setting  up  I 
pentyphhtis,  low  nervous  symptoms  set  in,  and  a  diagnosis  gf  I 
tuberculous  memngitid  was  made.     After  death  there  was  not  a  f 
trace  of  disease  in  the  meninges,  hut  the  great  part  of  the  right  I 
lobe  of  the  liver  was  converted  into  an  abscess. 

In  former  years  Vienna  was  notorious  for  the  prevalence  of  I 
puerperal  fever.  It  is  sad  to  think  that  it  still  deserves  this  f 
fame,  especially  as  the  disease  in  iiuestion  is  due  to  easily  pre-  I 
ventable  causes.  The  post-mortems  on  puerperal  fever  cases  1 
during  the  last  four  months,  will  average  at  the  very  least  one  | 
per  day.  In  nearly  all  these  cases,  on  close  examination,  alight  I 
transverse  ruptures  of  the  vagina  could  he  found. 

Prof.  Sigmund  has  recently  given  expression  to  his  views  I 
on   the   time   when   the    treatment  of   constitutional  syphilia 
should  be   commenced.     He  says  the  proper  time  is  when  tfaa  I 


4 
I 
I 


CORRESPONDENCE.  545 

secondary  symptoms  manifest  themselves — on  the  appearance 
of  the  first  skin  symptoms,  and  even  then  there  is  no  necessity 
for  haste,  unless  several  symptoms  or  organs  are  aflTected,  or  the 
variety  of  the  disease  is  severe,  or  unless  the  general  physical 
condition  of  the  patient  has  suffered.  He  says  that  anti- 
syphilitic  general  treatment  in  the  primary  stage  exerts  no 
influence  on  its  course,  except  that  in  some  cases  the  debilitat- 
ing course  of  treatment  postpones  a  cure. 

Of  those  treated  locally  at  the  outset  40  per  cent,  pre- 
sented very  slight  secondary  symptoms,  sometimes  scarcely 
noticeable  by  the  patients  themselves.  In  the  milder  cases  of 
these  secondary  manifestations,  complete  and  permanent  cure 
very  often  followed  simple  local  means. 

Experience  has  also  shown  that  general  treatment  begun 
late  in  the  secondary  period,  is  followed  by  a  more  rapid  and 
permanent  result  than  if  undertaken  at  an  earlier  date.  Careful 
attention  should  be  paid  to  the  hygienic  and  dietetic  conditions 
and  of  prompt  treatment  of  all  complicating  constitutional  con- 
ditions. Although  trial  has  been  made  of  the  much  lauded 
Tayuga,  by  Ziessel,  but  it  cannot  compare  with  mercury  as  an 
antisyphilitic  remedy. 

The  following  case  of  removal  of  the  larynx  and  adjacent 
parts  by  Prof.  Billroth,  is  the  first  operation  of  the  kind  on 
record.  A  woman  aged  45,  was  admitted  complaining  of  almost 
total  inability  to  swallow.  Carcinoma  of  the  posterior  surface 
of  the  larynx  and  anterior  surface  of  the  pharynx  was  diagnosed. 
Tracheotomy  was  performed,  and  nine  days  later  the  parts 
implicated  in  the  disease  were  removed.  It  was  found  after  the 
operation  commenced  that  the  disease  was  more  extensive'  than 
at  first  thought.  Prof.  Billroth  found  it  necessary  to  remove  the 
whole  of  the  larynx  with  two  rings  of  the  trachea,  the  greater 
part  of  the  pharynx,  and  the  oesophagus  down  to  a  level  with  the 
manubrium,  and  finally  the  whole  of  the  thyroid  gland.  The 
patient  recovered  well  from  the  effects  of  the  operation,  and  in 
a  few  days  her  general  condition  was  much  improved.  ShQ  said 
that  she  felt  more  comfortable  than  she  had  done  for  months. 
She  was  nourished  through  an  elastic  tube  introduced  into  the 

NO.  LXXXIV.  36 


S4^  CA3SAVA  MElHTAh  AS©  SCm^SiTAl.  ^«rKXAX. 

oeeophagni  mod  f jreadM^d  dmm^  a  vAe  nitroivoad  into  liie 
tnchem.     ProC^wn-  Bifirculi  pmiosed  to  mmse  wbMt  vas  left  of 
the  phairnx  mod  <Esr/|^j^iffi.  Init  bdore  4«ikg  »[«  be  fovnd  h 
ifccccgBanr  to  dilaie  tiie  <e»:«pkmra§  W  xDemzis  <€  bospes,  m&d  sz 
veeks  after  tte  ofiendoci.  «lnle  in  liie  mcs  of  fiaoiEB^  the  eeK^ 
phijSiis.  Tiofeot  roastan^  sr:  in  SBnd  ibe  m/VFoatst^  of  die  piteiit. 
dispbeed  tiie  bo«pe  iii!o  ibe  vmvmnhM^a^  jamml.     Hob  set 
tq>  medimstkdtis  mod  mj^ivrmdre  j cnemr&k.  from  liie  efecss  <€ 
windi  dke  foiieiit  died,  tkree  dmjf  afser  ibe  mradoo.  Sbe  liFed 
«x  veeb  mod  tbree  dmjf  mfter  die  wsrwoBfL.  Prs^sassr  Bifirocb 
fams  m  remmikmUe  sfto&tssfm]  reosrd  im  liie  TcwrniH  vi  Ajnii 
^badf  fer  taB»«.  H«  itmi  bad  wifini  ni  ^oastru^r*:  smsosaelml 


To  liie  scslnit  «iK»  wiiibef  ti>  sfiadr  ^e  nerrvm  ¥vmam  mod 
K  diaemses  YievEim  ftqaaeipeg  exceflsifi  mdmcmses.  1>mhiz  ihe 


W  Brjsndal  mod  O^enaener.  tlnsre  are  &»  iBrcmres 
SafcmriiT  iq  ^  losfti^tt:*^  ff  ibe  ^eiSEil  ULiwiwifr  ^^seiB.  W 
Pnsf:  Sdrkker.  daSr  ki^^  Vr  Pn^.  M«TKrc  LcadfsaAcivi 


4e!!iii:QficraS2:fas  hl  'Sb^  smnoe  Eisassaxj  nf  laie  ^»  ■"n.  I<^;i.  3ialtz 

WfniT«iV.ra  miiiT  ir-'fcSTiPTTCL     T\t?  TttsacEii:  ^  A  '^"wa^V  mr?»i  3^  : 

Tilt  fimiTT  lEgcxT  sit£  Tr*Tii>i»  T»»^ta  wi#i«L     A  i^jsfi  afer  *k«e 
i«a»c  ae  mck^t  ^iac  sau  ismt  ii«  jmrsai  pmnni  r'pcr  im 

Tv:  v*fti5w  mit  in.  ACtEx^anL  ai;  unawt  :nac  :at»  ' 


■te  «^  9 

jefli  i3i£  It  mmsacim.  in  "aii  T^igh:  iDQ«r  m£  irv^fr 

ani  j!*x  ^^Tf  li  jiguBjOMCae.    Tin?  armmwi 

31  7*gtC  X3I:  JDK.  JC!^  UK 


CORRESPONDENCE.  54t 

The  right  extremities  reacted  normally  to  an  induced  current. 
On  the  left  side  the  electro-contractility  and  sensibility  was  in- 
creased on  the  application  of  this  form  of  electricity.  Along  the 
whole  length  of  the  spine  from  the  lumbar  region  up  to  the  naiddle 
cervical  there  is  tenderness,  especially  when  pressure  is  made 
on  the  left  side.  No  decubitus  or  bladder  complications.  This 
patient  has  gradually  been  regaining  the  loss  of  power  on  the  left 
side,  and  of  sensation  on  the  right  side,  but  the  improvement  has 
been  more  marked  in  the  motor  paralysis  than  in  the  anaesthesia. 
At  present  the  left  arm  and  leg  can  be  used  fairly  well,  but  there 
is  still  decided  loss  of  both  superficial  and  deep  sensation  in  the 
right  extremities. 

The  treatment  used  was  the  iodide  of  potassium  and  the  use 
of  the  continuous  current  to  both  the  paralysed  muscles  and 
anaesthetic  parts. 

Prof.  Bosenthal  considers  the  morbid  change  in  the  case  to  a 
sub-acute  inflammatory  action  of  the  cord  and  membranes  limited 
to  its  left  lateral  half. 

Facial  erysipelas  of  a  severe,  and  frequently  fatal,  type,  has 
been  very  prevalent  in  Vienna  during  the  last  few  months.  The 
following  is  a  good  example  of  the  great  majority  of  the  fatal 
cases.  A  stout,  and  previously  perfectly  healthy,  young  man  was 
admitted  into  the  A.  K.,  seven  days  ago  with  facial  erysipelas, 
of  four  days  standing.  The  temperature  varied  from  103*^  to 
105^..  He  complained  of  headache,  and  was  very  delirious  at 
times.  He  died  comatose  10  days  after  his  admission.  Menin- 
gitis was  diagnosed.  The  post-mortem  showed,  however,  only 
hyper'aemia  of  the  brain  and  lungs.  Meningitis  is  generally 
diagnosed  in  those  cases  having  a  similar  terminatioui  but  it  is 
never  found.  The  only  changes  in  5  cases  were  hyperaemia  of 
the  meninges,  brain  substance  and  lung, 

J.  S. 


CANADA   MZDICAL   AND  SUBOICAL  JOUUfAL. 


]|8uiews  and  Botices  oS  Soofes. 

A  Gmde  to  the  QuafUatioe  and  Quantitative  Analym*  of  tJu 
Urine ;  designed  for  Phgtieiant,  Ckemittt  and  I*harma- 
citta. — By  Dr.  C.  Nbitbackb  and  Dr.  J-  Vogel ;  revised 
bj  E.  L.  Wood,  M.D.,  Prof.  Chemiatf;  Harmd  Univer- 
wty.  8vo.  pp.  551.  New  York :  William  Wood  &  Cwn- 
panj,  1879. 

Hiis  work  is  weU-koowa  to  oor  readers,  and  it  is  sofficient  to 
aiiDoimce  a  new  editicn,  broa^t  down  to  the  present  daj,  to 
ensure  a  &ir  demand.  While  the  work  is  fvactka]  in  its  teadi- 
ing,  it  fonne  a  c«nplete  and  scientific  """"»!  open  Unnary 
Chemistry.  Chemical  analyas  <^  the  urine  is  intended  to  lead 
the  practitioner  to  infer,  &om  what  is  obeerred,  what  changes 
are  taking  place,  and  iriiat  means  sboold  be  adopted  to  avert 
mischief.  We  get  the  rvsolts  f£  actoal  chemical  dianges, 
and  are  enabled  tfaeieby  to  state  to  a  mcetj  why  theae  changes 
EJioold  be  observed.  There  t$  anodter  feature  <^  this  work 
which  addf  to  tt£  valae.  It  is  separated  into  two  parts.  Ihe 
first  (art,  wlucb  is  strictly  chenucal,  is  by  Dr,  Xeubaoer ;  the 
second  p«n.  by  Dr.  Vogel.  has  reference  to  changes  in  Ae 
nrine  from  a  medical  point,  so  that  it  adds  to  d>e  valne  <^  the 
work  as  one  of  reference  by  both  chemist  and  physician.  He 
dfst  translation  •.4'  this  w<^  was  onder  the  anspioes  ijS  die  New 
Sydenham  Society  as  eariy  as  the  year  1S63.  Snce  that  day 
many  rery  imponant  tacts  have  been  added  to  our  knoiriedge 
of  organic  and  phv^^ogical  chenumy.  lUs  editim,  the  Ttfa 
of  the  series.  ^  broo^t  down  ta.  and  cmtuns  die  most  recent 
advances  in  oriuaiy  chemical  aad  puKolngical  8cieDoe,wre  ecna- 
Bkeod  it  lo  o«r  readers.  A  word  w«  Inrv  (or  the  tvtj  ezeel- 
lent  finuh  of  the  w<»fc  ig  inniwii  ty  thn  fJiWrw,  Me—. 
Wood  h.  Ca.  of  N«^w  \\xk.  The  twlw  is  booU  m  Ml  leather, 
widi  BukM  «d2e»  ud  biads,  iW  liaAir  k  tinted  a  deep 
^  as  <^jei 


REVIEWS  AND  NOTICES  OP    BOOKS.  549 

IS  raised  by  some  against  the  use  of  the  ordinary  white  leather 
binding,  so  common  in  use  in  the  United  States,  it  is  excellently 
finished,  and  forms  a  handsome  library  edition. 

A  G-uide  to  Therapeuzics  and  Materia  Medica, — By  Robert 
Farquharson,  M.D.,  Edin.,  F.R.C.P.,  Lond.  Lecturer  on 
Materia  Medica,  at  St.  Mary's  Hospital  Medical  School, 
&c.  Second  American  edition,  revised  by  the  author, 
enlarged  and  adapted  to  the  U.  S.  Pharmacopoeia,  by 
Frank«  Woodbury,  M.D.,  Physician  to  the  German  Hospital. 
8vo.  pp.  498.     Philadelphia:  Henry  C.  Lea.    1879. 

The  mer«  fact  of  a  second  edition  of  this  book  having  been 
already  called  for  shows  of  itself  that  it  has  proved  a  welcome 
addition  to  medical  literature.  The  plan  adopted  in  treating  of 
the  various  subjects  is  very  different  from  most  text-booksof  this 
kind.  Since  the  principal  object  on  hand  is  to  present  the 
reader  with  a  concise  view  of  the  main  physical  and  therapeutical 
action  of  various  drugs,  the  more  the  corelative  of  these  are 
prominently  exhibited  the  better.  Thus  the  pages  are  mostly 
divided  longitudinally  in  the  centre,  containing  on  the  one  hand 
the  known  and  demonstrated  physiological  action  of  the  medi- 
cine under  consideration,  and  on  the  other  the  diseased  condition 
in  which,  owing  to  such  physiolo^cal  properties,  it  either  has 
been  used  with  satisfaction  or  might  probably  be  successfully 
employed.  This  method  of  presentment  is  doubtless  very  effec- 
tive, as  especially  with  students,  it  is  calculated  to  leave  a  strong 
impression  for  the  reasons  of  the  uses  of  various  drugs.  All 
ttie  important  additions  to  the  materia  medica  of  late  years  are 
discussed,  and  the  reader  is  put  in  possession  of  all  the  well- 
established  facts  concerning  them  up  to  the  present  time.  Books 
such  as  these  do  a  great  deal  to  remove  the  empiricism  still 
mmaining  amongst  us,  and  to  lead  to  our  practice  being  based 
lljiA  omoh  better  and  surer  foundation.    As  a  text-book  for  the 

and  equally  as  much  as  book  of  reference  for  the  prac- 
i'Dr.  Farquharson's  volume  will  be  found  one  of  the 

Hslly  useful  and  reliable  yet  published. 


550 


CANADA   USDICAL    AND   BUBOTCAL   JOURNAX, 


A  Pradieai  Mtmual  of  the  Diteatea  of  Children,  vnth  a  For^  I 
iKulaTy. — By  Edwird  Ellis,  M.D.    Third  Edition.     8ro. 
pp.  213.     New  York:   William  Wood  &  Co.,  27   Great 
Jouea  street. 

The  first  edition  of  thia  work  appeared  in  1867,  and  it  waa 
theD  favorably  received.  Siiice  then  it  has  passed  through  a 
second  ei^tion,  and  noft  (1878)  it  has  obtiuned  a  third.  The 
present  volume  is  an  American  reprint  from  the  third  English 
edition,  and  is  one  of  the  books  which  Messrs.  Woods  are  now 
issuing  as  a  library  set.  The  first  chapter  is  taken  up  with  the 
general  points  to  be  noted  in  an  examination  of  an  infant  or 
young  child;  the  ^neral  management  during  the  first  year  of 
life,  and  a  diet  table  for  children  of  one  year  and  upwards. 
Chapter  II.  treats  of  general  diseases,  Scrofciosia,  Tuberculosis, 
Ricketa.  Syphilis  and  Acute  Rheumatism,  Skin  diseases  are 
treated  of  in  Chapter  III.,  and  a  good  resume  is  ^ven  of  their 
symptoms  and  treatment.  In  the  succeeding  chapters  we  find 
Congenital  Affections  and  Diseases  of  the  New-born,  Fevers, 
Diseases  of  the  Brain  and  Nervous  System,  Diseases  of  the 
Air-passages  and  Thoracic  Organs,  and  Diseases  of  the  Food- 
passages  and  Abdominal  Organs.  Under  the  head  of  Fevers, 
there  are  some  good  observations  regardmg  the  use  of  cold 
baths,  and  a  warning-note  sounded  regarding  their  too 
general  use.  The  section  devoted  to  Diphtheria  is  carefully 
written,  and  will  repay  peruaal.  In  the  Chapter  on  Diseases  of 
the  Abdominal  Organs,  we  find  no  notice  of  Intus-eusception, 
which  ought  to  find  a  place  even  in  a  work  devoted  as  this  isi, 
solely  to  the  medical  diseasea  of  infancy  and  childhood. 

Chapter  IX.  contains  a  few  general  therapeutic  hints  and  a 
formulary.  The  formulary  is  very  full,  and  will  be  found  useful. 
The  book  ends  with  a  Dietary,  which  is  also  very  complete. 
We  think  that  the  book  at  present  under  consideration  will  be 
found  useful,  especially  by  students  and  young  practitioners. 
It  is  arranged  conveniently  for  reference,  and  the  tlieiapeutjcs 
are  safe.  There  is  probably  more  really  useful  information  pre- 
sented in  it  than  in  some  more  pretentious  volumes  on  the  sab- 


BRITISH  AND   FOaEIQN  JOURNALS.  551 

ject,  and  without  any  special  claim  to  originality,  the  author  may 
rest  assured  that  he  has  produced  a  work  which  will  be  widely 
appreciated. 


^Extracts  from  British  and  Foreign  Journals. 

Unless  otherwise  stated  the  traoslations  are  made  specially  for  this  Journal. 

Action  of  Iodoform.— -HoGYES  (Archiv  far  Experi- 
ment. Pharmakologie^  x.  3  and  4)  endeavours  to  arrive  at  a 
permanent  settlement  of  the  discrepancies  between  the  state- 
ments made  by  previous  enquirers  concerning  the  toxic  and 
narcotic  properties  of  the  compound  in  question ;  further  to 
test  the  statements  recently  made  by  Binz  with  regard  to  its 
mode  of  operation.  The  following  is  a  summary  of  the  chief 
results  of  his  enquiry  ;  1.  Iodoform  in  adequate  doses,  is  fatal 
to  dogs,  cats,  and  rabbits.  Death  is  caused  by  a  rapid  paralysis 
of  the  circulation  and  respiration ;  it  is  preceded  by  wasting 
of  the  body,  but  not  by  convulsions.  2.  After,  death  we  find 
fatty  changes  in  the  liver,  kidney  heart  and  voluntary  muscles. 
One  or  two  haemorrhagic  extravasations  are  almost  always 
present  in  the  lower  lobes  of  the  lungs.  3.  Large  doses  cause 
marked  drowsiness  in  the  dog  and  cat ;  no  such  effect  is  wit- 
nessed in  the  rabbit  even  aft;er  a  lethal  dose.  During  the  period 
of  somnolence,  reflex  irritability  does  not  appear  to  be  much 
interfered  with.  4.  What  changes  does  iodoform  undergo  before 
its  absorption  ?  If  it  is  introduced  in  an  undissolved  condition, 
the  first  step  is  its  solution  in  whatever  fatty  matter  may  be  at 
hand  (in  the  intestines,  the  oily  ingredients  of  the  chyme  ;  in 
the  subcutaneous  tissue  and  the  serous  cavities,  the  oily  consti- 
tuents of  the  tissue-juices  and  serous  liquids).  The  oily  solution 
of  iodoform  next  gives  up  its  iodine  to  any  albuminous  principles 
that  may  be  present ;  the  iodide  of  albumen  thus  produced  is 
speedily  taken  up  into  the  blood,  while  a  few  minute  coagula 
and  colourless  oil-globules  are  left  behiild.  5.  Precisely  the 
same  series  of  changes  occur  when  a  solution  of  iodine  in  oil  is 
injected  under  the  skin  or  into  a  serous  sac.     6.  An  iodide  of 


552 


CANADA   MEDICAL    AH!}   SURtllCAL   JOrRNAL. 


albumen  prepared  by  mixing  white  of  egg  with  a  solution  of 
iodine  in  sodium  iodide,  produces  narcotic  effects  in  the  cat  and 
dog,  just  lifce  iodoform ;  like  this,  moreover,  it  fails  to  produce 
them  in  the  rabbit,  Wliether  we  administer  iodoform,  iodine 
dissolved  in  oil,  or  iodide  of  albumen,  the  iodine  is  gradnallj 
eliminated  from  the  system  in  combination  with  the  alk.ili-metals. 
Broadly,  we  may  regard  the  action  of  iodoform,  locally  applied, 
aa  equivalent  to  the  prolonged  and  gradual  influence  of  iodine. 
Its  action  on  the  system  after  absorption,  is  likewise  in  the  main, 
that  of  iodine, but  with  some  hitherto  unexplained  peculiarities, 
— London  Med.  Record,  May  15,  1879. 

Use   of  Pilocarpinum   Muriaticum  in 
Children's  Diseases.—  Weiss  (  Pint.  Med.  Cfiir. 

Pri'gxi',  187tl,  2)hiiahad  the  opportunity  of  observing  the  effects 
of  pilocarpine  in  fourteen  cases  where  the  patients  were  suffer- 
ing from  nejihritis,  complicated  with  general  dropsy,  following 
scarlatina.     In  four  cases  there  existed  extensive  bronchitis,  in 
two  diphtheria,  and  in  one  pneumonia  of  the  left  side  of  Qie  lung. 
In  each  of  these  cases  the  results  produced  by  pilocarpine  were 
most  favorable,  and  the  patients  could  all  be  dismissed  as  cured. 
One  of  the  most  important  properties  of  pilocarpine  is  that  it 
prevents  the  dropsy  from  increasing,  keeping  it  stationary  with- 
out implicating  the  kidneys,  till  the  latter  have  recovered  their 
power  of  secreting  urine  more  abundantly.  Two  different  kinds 
of  solutions  were  used  for  the  hypodermic  injections ;  a  1  per 
cent,  solution  for  children  under  four  years,  and  a  2  per  cent 
one  for  children  above  four  years.     In  such  young  patients,   I 
where  collapse  seemetl  to  threaten  from  prolonged  illness  and 
great  weakness,  4  or  5  drops  of  ether  were  added  to  the  solnUon   ] 
of  pilocarpine  in  the  syringe.  The  author  observed,  that  v^hen- 
ever  he  used  this  mixture,  the  young  patients  did  not  present   : 
the  phenomena  which  generally  followed  the  injection  of  a  Bo!a-  I 
tion  of  pure  pilocarpine,  viz.,  vomiting,  nausea,  hiccough,  pallor,   i 
and  feeble  pulse.     The  injections  were  made  once  daily  into  the   I 
upper  arm,  beginning  with  half  a  syringeful,  and  rising  to  a 
whole  one.     The  eDects  of  pilocarpine  generally  appeared  after 


• 


BRITISH  AND   FOREIGN   JOURNALS.  553 

a  few  minutes,  beginniDg  with  a  slight  flush  on  the  face,  which, 
however,  gradually  increased,  and  only  disappeared  when  the 
perspiration  had  ceased.  The  latter  set  in  after  three  or  five 
minutes,  beginning  on  the  forehead  and  face,  and  gradually 
spreading  over  the  rest  of  the  body.  The  duration  of  the  per- 
spiration was  different ;  in  one  case  it  lasted  for  1^  hours,  in 
another  3^  hours,  in  a  third  case,  of  very  considerable  universal, 
dropsy,  where  the  amount  of  urine  passed  in  the  24  hours  was 
only  150  c.c.m.,  the  secretion  lasted  for  16  hours,  after  which, 
the  oedematous  infiltration  decreased  considerably.  The  quantity 
of  fluid  secreted  in  the  saliva  and  the  perspiration  were  in  direct 
proportion  to  the  amount  of  pilocarpine  which  had  been  injected, 
and  to  the  strength  of  the  solution.  Thus,  a  2  per  cent,  solution 
always  called  forth  a  more  considerable  secretion  of  perspiration 
and  saliva  than  a  1  per  cent,  solution.  Two  out  of  the  fourteen 
patients  complained  of  pains  in  the  abdomen  after  the  injection, 
and  four  of  headache.  In  eight  cases,  the  pupil  was  seen  to 
contract ;  the  contraction  began  at  the  same  time  at  which 
perspiration  set  in,  and  lasted  from  30  to  45  minutes.  The 
temperature  was  taken  in  every  case  both  before  and  after  the 
injection,  and  in  several  of  them  was  observed  to  fall  rapidly  after 
the  injection  ;  the  decrease,  however,  never  lasted  longer  than 
from  half  an  hour  to  three  hours,  after  which  time  the  normal 
temperature  was  again  reached.  Only  in  one  case,  where  the 
perspiration  had  lasted  for  16  hours,  the  temperature,  which  had 
been  40.4  deg.  Cent,  before  the  injection,  fell  to  86.6  35  seconds 
after  it,  and  did  not  rise  again.  The  pulsations  of  the  radial 
artery  increased  in  a  minute  from  12  to  30  ;  the  pulse  was  full 
and  jerking ;  this  accelleration  lasted  from  15  to  30  minutes, 
after  whicn  time  the  pulse  regained  its  previous  character.  In 
four  cases,  the  patients  vomited.  The  vomited  matter  consisted 
mostly  of  mucus.  After  the  injection,  almost  all  the  children 
coughed  very  much ;  in  four  cases  where  there  was  extensive 
bronchitiSj  and  in  a  fifth,  which  had  been  showing  symptoms  of 
oedema  of  the  lungs  and  uraemia,  the  lungs  were  entirely  cleared 
from  the  secretion  which  had  accumulated  in  them  by  the 
frequent  coughing  within  48  hours.      In  nine  cases,  there  was 


6S4  CAKAbA  UBDICAL   Ain)   SimaiCAL   JO0STTAL. 

a  strong  desire  to  micturate  immediately  atler  the  injectioa; 
and,  in  three  to  evacuate  the  bowels.  The  motions  were  thin 
and  very  offensive,  and  were  passed  in  great  quantity,  ■  In  a 
case  of  constipation  which  had  lasted  four  days,  the  bowels  were 
moved  copiously  immediately  after  the  injection. 

There  was  uo  notable  increase  in  the  quantity  of  mine  passed 
after  pilocarpine  had  been  injected  ;  it  was  of  a  much  higher 
colour  than  before.     The  following  are  the  autlior's  conclusions  : 
1.  Pilocarpine  has  proved  to  be  a  very  successful  remedy  for 
children  who  suffer  from  nephritis  and  scarlatina  ;  2.  In  giving 
it  to  children,  care  should  be  taken  to  begin  at  lirst  with  small  i 
doses,  which  may  later  on  bo  gradually  increased;  3-   If  the  | 
little  patients  are  very  weak  and  arc  likely  to  collapse  after  the 
injection,  a  few  drops  of  ether  should  be  added  to  the  pilocarpine 
solution.     4.  The  drug  produces  a  very  copious  and  lasting  I 
secretion  of  sweat,  such  as  no  ether  drug  ever  has  been  known  J 
to  call  forth — It  acts  quickly ;  5,  In  cases  of  bronchitis,  com- 
plicated by  dropsy,  which  often  produces  dyspnoea  in  children, 
the  affection  of  the  bronchi  vanishes  very  soon  after  the  remedy  .1 
has  been  administered. — London  Med.  Record,  May  15, 1879- 

PreTention    of   Relapses  in    Typhoid 

Fever. — Immehmann  is  of  opinion  (^CentTalll.,  No.  I.  1879) 
that  relapses  in  cases  of  typhoid  fever  are  due  to  the  presence 
of  the  typhoid  poison  in  the  system,  except  in  instances  where 
the  patient  has  committed  some  error  in  diet.  The  latter  occur- 
rence can  of  course  be  prevented  by  watching  the  patient  care- 
fully, and  the  author  has  endeavoured  to  prevent  the  former  by 
putting  the  convalascent  through  a  systematic  process  of  disin-  I 
fection.  The  process  consisted  in  giving  the  patients  daily  from  ] 
4  to  0  grammes  of  salicylate  of  soda  for  ten  or  twelve  days, 
beginning  from  the  first  day  the  temperature  aasumes  its  normal 
state.  Fifty-one  patients  were  treated  in  this  way,  and  only  two 
sufiered  from  relapses ;  one  owing  to  something  she  had  eat«n 
in  secret,  and  the  other  because,  owing  to  a  mistake,  the  dmg 
had  not  been  given  to  him  immediately  after  the  fever  had  iefl 
him.     Fifteen  out  of  faxty-seven  patients  who  had  not  been 


I 


BRITTSH   AND   FOREItSN  JOORNALS.  55B 

treated  with  salicylate  of  aoda  had  relapses.  The  author  con- 
cludes from  these  observations,  that  salicylate  of  soda  is  not  only 
a  powerful  preventive  of  relapses  in  cases  of  typhoid  fever,  but 
that  it  also  would  prove  very  useful  in  procuring  immunity  from 
the  disease  for  the  nurses  and  attendants. 

Imraermann  has  also  observed  that  patients  who  had  been 
treated  exclusively  with  cold  water  showed  a  greater  tendency  to 
relapse  than  others  who  had  undergone  a  combined  water  and 
quinine,  or  salicylate  of  soda  treatment.  —  London  Medical 
Record,  May  15,  1879. 

Treatment  of  Impenuable  Stricture 

of  the  Urethra.— At  a  moetinj!  of  the  Clinical  Society 
of  London  (_L<incet,  May  10, 1S7£*),  Mr.  Hulkb  read  notes  (jf 
a  case  of  Retention  of  Urine,  caused  by  Impermeable  Urethral 
Stricture,  treated  by  tapping  the  bladder  above  the  pubes.  and 
later  by  external  section  of  the  stricture,  a  catheter  passed 
through  the  bladder  and  a  staff  per  penem,  as  far  as  the 
obstruction,  being  used  as  guides.  The  patient,  40  years  of 
age,  was  admitted  into  tlie  Middlesex  Hospital  on  November 
29tb,  with  retention  of  twelve  blurs'  standing,  the  bladder 
being  distended  to  the  umbilicus-  He  had  been  treated  for 
stricture  twelve  years  previously.  It  being  found  impossible 
to  paaa  a  catheter,  Mr.  Hulke  emptied  the  bladder  by 
aspiration  above  the  piibes.  Twonty-seven  hours  later,  no 
urine  having  been  passed,  a  trocar  was  passed  into  the  bladder 
above  the  pubes,  and  a  canuJa  left  in  situ  ;  and  on  the  third 
day  this  was  substituted  For  a  gum-elastic  catheter.  During 
the  next  few  weeks  the  patient  had  two  attacks  of  pleurisy. 
Several  unsuccessful  attempts  were  made  to  pass  a  catheter  per 
penem,  and  on  January  3d,  Mr.  Iluike  divided  the  stricture 
from  the  perineum,  a  staff  pased  throngh  the  urethra  up  to 
the  stricture,  and  a  catheter  through  the  prostatic  urethra 
from  the  bladder  down  to  it  being  used  as  guides.  The  tough 
fibrous  tissue  was  divided,  and  the  cathether  being  withdrawn, 
.the  stafT  was  guided  into  the  bladder,  and,  lastly,  another 
I  catheter  passed  over  the  staff  mto  tlie  viscus.     The  suprapubic 


• 


666  OANADA  MEDICAL   AND    SUBQICAL   JOURNAL. 

aperture  was  allowed  to  close,  and  the    case   did  well.     Mr. 
Hulko  remarked  that  the  suprapubic  tapping  was  selected  in 
preference  to  Hunter's  and  Cock's  method,  because    of   the 
deviation  of  the  urethra  to  the  left.     Not   that  this  operation 
(first  suggested  by  Hunter,  and  then  practiced  by  Dittel)  was 
intended  to  supersede  puncture  through  the  rectum,  but  it  was 
suitable  for  exceptional  cases,  such  as  this.     It  was  not  more 
liabl^  to  be  followed  by  urinary  extravasation,  wluch  did  not 
occur  in  any  of  Dittel's  cases,  nor  had  Mr.  Hulke  found  it  to  take 
place :  whilst  a  provincial  surgeon  had  made  the  same  satement, 
based  on   an   experience  of   seventeen  cases.      It    admitted 
further  of  antiseptic  precautions,  and  had  the  advantage  of 
allowing  the   course   of  the   urethra  before  and  behind  the 
stricture  to  be  made  out  if  division  6t>m  the  perineum  became 
necessary.     Me  had  scmie  Utile  difficulty  in  fin^Bng  ttie  orifice 
of  thd  prostatic  urethnu     The  SQ^estkm  to  use  a  catheter 
pois^  through  the  e3ctemal  wound  as  a  guide   to  perineal 
section  is  made  in  a  fool  note  appended  to  tlie  remarks  made 
by  Hunter  in  the  collected  edition  of  his  writings. 

Mr.  Mak.'^h  said  that  in  The  Lancet  for  1SS8,  Mr.  Hurdey 
re<N>rils  a  c^^j^o  of  im}"«erroe4ivle  scricture^  where  he  perftHined 
^^uj-^myAiibic  ta^^pang.  arnl  pas^an^  an  instroment  downwards 
thro-Uizh  t}>e  stricture^  tnaz^apcd  by  its  means  to  draw  upwards 
into  t}>e  KUdiicr  a  catheter  yias$«ed  per  yeuem,  Mr,  Hulke^s 
paper  wa:?  very  rahxa  We  a?  afTor^M  ai»od)eT  means  for  trealing 
a  verr  difBcult  cJas?  ci  ca5»«L 


of  Fiathtsis.  —  K^^^^^^hi^t  i^R^-rw  M^dumh  Jit  FE^^ 
Ja3r.i«iTx  1.x  iSTi^  •  rr^jar^t  tJie  ni^t  ^ipeaiang  of  j&ddais  as 
eTitar^Jr  >inV«r.iiTiai!e^  T/^  the  TxreTia^  die  Tmriable  coarse  acnd 

<4ort  of  Tu^T^tTT  t^  Tti/^Ta))e  aPA^  T^^dtice  die  {eSirile  iiiOT'«3^^ 
a  dm^T^oro)  i^  t}>e  ^qr^&m^.    He  aibo  mwaUHM^t  daft  iC  wkeu 

mmal  p(«rsf«r«Miiu  ^«^  $A  n  imaaofc  ^wmafc  &e 


BRITISH   AND    FOREIGN   JOURNALS.  551 

curious  alternation  of  these  two  phenomena,  one  appearing  when 
the  other  disappears,  and  vice  versd.  Hence,  he  concludes,  that 
it  is  not  always  right  to  check  the  sweatings,  especially  when 
they  come  on  at  the  commencement  of  phthisis,  and  ac- 
company a  rapid  evolution  of  the  pulmonary  tuberculization 
with  high  fever  and  active  pulmonary  congestion.  That  in 
such  case,  to  attack  the  perspiration  is  to  attack  the  efiect  not 
the  cause,  and  it  is  not  likely,  therefore,  to  be  attained  with 
success.  But  when  abundant  sweatirfgs  occur  together,  with 
a  normal  flow  of  urine  and  frequent  diarrhoea,  then  it  is  neces- 
sary to  direct  our  therapeutic  eflForts  to  arrest  the  excessive 
drain  on  the  system. — London  Med.  Record^  May  15, 1879. 

Cystitis  by  Contagrion. — Bemarks  on  the  Pro- 
duction of  Cystitis  by  Contagion  through  the  use  of  Instruments. 
— Sir  Henry  Thompson,  in  a  recent  communication  to  the 
British  Medical  Journal  (May  10,  1879),  says:  I  have  long 
suspected  that  cystitis  is  capable  of  being  propa^^ated  by  the 
direct  transference  of  inflammatory  products  from  the  bladder 
of  one  patient  to  that  of  another.  All  are  sujfificiently  familiar 
with  the  fact  that  purulent  matter  from  the  vagina,  and  probably 
from  the  uterus  also,  produces  inflammation  of  the  male  urethra, 
and  that  conjunctivitis  may  be  caused  by  contact  with  pus  &om 
either  source  ;  and  I  believe  it  is  quite  unnecessary  to  imagine 
that  any  specific  quality  attaches  to  purulent  matter  produced 
in  these  localities,  rendering  it  more  than  ordinarily  virulent 
and  contagious.  Certainly  no  proof  can  be  adduced  that  such 
quality  exists  ;  a  decision  on  this  point,  however,  does  not  neces- 
sarily affect  the  question  whether  cystitis  may  be  originated  or 
not  by  contagion. 

Every  one  knows  that  the  operation  of  sounding  the  bladder — 
it  may  be  for  stone  or  for  tumor,  etc. — ^is  sometimes,  although 
rarely,  followed  by  an  attack  of  inflammation  more  or  less  severe. 
Such  an  occurrence  is,  in  some  circumstances,  not  unnatural. 
A  delicate  organ  is  mechanically  disturbed,  and,  if  force  be 
employed  in  the  process,  some  inflammation  of  the  mucous  mem- 
brane 18  not  an  improbable  result.  Hence  the  extreme  importance 


,  558  (lAMADA  MXIIICAL  AND  HliaOirAL  JOURNAL. 

of  adopting  a  method  and  instruments  which  shall  accomplish 
the  object  in  view  with  the  smallest  degree  of  distension  and 
movement  ■  and  also  of  forbearing  to  make  such  an  ejtploratioa, 
except  in  circumstances  which  manifestly  indicate  its  necesBity. 
In  my  experience  of  such  cases  of  this  kind  aa  have  fallen  nnder 
my  observation  duiing  many  years,  I  have  remarked  that  the 
inflammatory  attacks  which  follow  sounding  occur  in  two  modes, 
distinct  from  each  other.     Thus,  in  some  instances,  the  patieot 
has  a  shiver,  occurring  within  three  to  four  hours  of  the  time 
of  the  examination ;  soon  afterwards,  the  urine  is  poised  too 
frequently  and  with  pfun,  becomes  cloudy,  and  some  general  4 
fever  sets  in.      In  such,  the  cause  of  inflammation  is  clearly  a -4 
mechanical  cue,  and,  if  the  patient  be  healthy,  it  soon  subsides  I 
with  rest  and  treatment.     But,  in  a  few  other  instances,  no  <^  I 
turbancc  occurs  until  the  lapse  of  forty  t«  fifty  hours,  or  there*  I 
about,  after  the  sounding.     The  subject  of  the  examination  has  ] 
been  in  all  respects  well  since  the  sounding  took  place,  and  felt, 
if  anything,  only  slight  soreness  during  the  first  few  hours  fol- 
lowing the  operation.     Aft«r  the  interval  named,  he  experiences  I 
a  little  undue  frequency  of  micturition,  loses  appetite,  is  chilly  1 
or  has  a  shiver ;  and  by  degrees  symptoms  of  cystitis  appear, 
and  continue  a  marked  course  for  a  few  days,  with  varying  per- 
sistence aceoi-ding  to  circumstances.    Usually,  the  patient  attri- 
butes his  condition  "  to  some  cold  he  must  have  caught  the  day 
after  the  examination,"  and  by  no  means  attributes  his  troubles 
to  the  instrument,  as  he  infallibly  does  in  the  circumstances  first 
described. 

Why,  in  certain  circumstances,  these  phenomena  should  occur 
80  long  after  the  provocation  which  must  have  ^ven  rise  to  them, 
has,  aa  I  have  already  intimated,  fro<[ucntly  afibrded  me  an 
interesting  subject  of  speculation.  But  a  case  has  recently 
occurred,  which  I  have  been  enabled  to  watch  closely,  and 
which  seems  to  throw  light  on  the  nature  of  these  examples  of  _ 
the  second  kind.     I  shall  give  the  chief  particulars  in  detail. 

A  medical  man,  under  sixty  years  of  age,  having  had  occasion^  I 
as  he  thought,  to  pass  for  himself  a  silver  catheter  (No.  10)  ' 
daily,  had  a  new  one  made ;  there  was  a  peculiarity  in  its  con- 


BRITISH   AND    FOREIGN   JOURNALS.  559 

struction,  the  lower  or  curved  portion,  about  two  inches  and  a 
hajf  in  length,  being  separate  and  attached  by  a  screw  to  the 
shaft.  Such  catheters  were  frequently  made  formerly  for  the 
purpose  of  packing  in  a  surgical  pocket-case.  He  passed  this 
daily  with  great  ease  during  some  weeks,  on  no  occasion  pro- 
ducing irritation.  One  day,  and  this  was  the  only  occasion  on 
which  he  used  the  catheter  for  another  person,  he  introduced  it 
into  the  bladder  of  a  patient  whose  urine  was  highly  muco- 
purulent, and  who  was  indeed  sufiering  with  severe  cystitis. 
He  believes  that,  immediately  after  using  the  catheter,  he  washed 
it  in  the  ordinary  way.  Subsequently,  on  that  day,  he  employed 
it  as  usual  for  himself;  and  it  is  somewhat  curious  that  he  did 
not  use  it  the  next  day — not  because  he  felt  any  irritation,  but, 
oh  the  contrary,  because  he  was  arriving  at  the  conclusion  that 
the  instrument  was  no  longer  necessary.  The  next  day  but  one 
after  his  last  employment  of  the  catheter,  about  forty-four  hours 
after,  he  felt  chilly,  and  micturition  was  slightly  painful.  Next 
day  he  had  some  fever,  no  rigor,  but  increase  of  temperature ; 
his  urine  was  cloudy  and  passed  frequently.  The  day  after, 
he  was  confined  to  bed ;  the  temperature  varied  between  102^ 
and  103^  for  a  few  days,  and  the  urine  was  loaded  with  muco- 
purulent jelly-like  deposit  during  one  or  two  days.  After  more 
than  a  week's  confinement  to  his  room,  he  gradually  improved 
and  soon  perfectly  recovered,  having  in  his  urine  now  no  trace 
of  the  attack  ;  he  empties  his  bladder  perfectly,  and,  in  relation 
to  the  urinary  system,  has  nothing  whatever  to  complain  of. 

The  circumstances  of  this  case  will  go  far,  I  think,  to  suggest 
the  strong  probability  that  this  attack  of  cystitis  was  caused  by 
the  transference  of  infectious  matter,  by  means  of  the  catheter, 
from  the  patient  for  whom  it  was  once  used  to  the  subject  of 
our  case.  I  can  scarcely  doubt  that  the  exceptional  formation 
of  the  instrument,  the  screw-attachments  which  on  examination, 
moreover,  appeared  to  be  a  little  loose,  offered  a  chink,  in  which 
matter  lodged,  especially  as  this  lower  part  was  not  detached 
for  cleaning — the  eyes  of  the  catheter  serving  that  purpose,  as 
in  the  ordinary  instrument. 

It  may  very  naturally  be  urged :  if  inflammation  be  so  easily 


560        CANADA  MEDICAL  AND  SURGICAL  JOUKKAI.. 

produced  through  contagion  by  pasring  instmiiieiiiB  not 
lously  rendered  clean,  so  numerous  and  varied  as  these  are^  and 
so  fre(i[uentlj  used,  how  is  it  that  cystitis  is  doI  a  Terj  frequei^ 
result — for  this  it  certainly  is  not— of  ordinary  cadietenam  ? 

I  think  the  reason  is  not  far   distant^  and   that  it  may  be 

found  in  the  action  of  the  catheter  itself.     The  moment  Ae 

instrument  reaches  the  bladder,  the  urine  rushes  throogii  Ae 

orifice,  and  carries  off   in    its  current   any   miniito  partides 

which  may  be  adherent  to  its  extremity.     In  bov^iea,  dd 

opening  for   the   lodgement    of   advendtioas  matters    existSy 

and  any  risk  of  contgaion  by  their  use  must  be  considerably 

less.      Besides,  the  action   of  the   urethra  itself,  clinging  to 

the  instrument  and  sweeping  off,  almost  at  the  external  meataay 

as  it  does  by  that  action,  most  of  the  lubricating  material^  is  a 

sort  of  defence  to  the  internal  passages  firom  danger.     On  the 

other  hand,  in  examining  a  bladder,  the  sound  is  rarely  used  as 

a  catheter,  and  although  it  often  has  an  eye  in  its  extremity^  tiie 

handle  is   closed,  and  urine  seldom  passes  throogii  it.      Tlie 

various  movements  of  a  sound  in  searching  the  Madder  are 

calculated  to  detach,  within  its  carity,  foreign  pardeks^  if  any 

such  exist,  in  or  about  the  eye. 

The  practical  (question,  how  to  prevent  any  tranrference  of 
matter  to  the  bladder  and  urethra,  in  employing  instmmenis^ 
of  any  and  every  kind,  presses  for  solution.  It  is  one  of 
extreme  importance  to  all  concerned,  and  the  occur- 
rance  of  an  accident  of  the  kind  described,  however  rare 
it  may  be,  \i  one  the  bare  possibiflity  of  whkh  cannot  be 
contemplated  frithout  extreme  repu^^nance. 

After  some  ct>nsideratioQ  and  3<:)me  expenmental  trials*  I 
think  the  foflowing  reo>mmendacion3  will  render  contagion  by 
iDstniments  imptDSsible. 

First!  v:  All  metal  instruments — caAefcers,  soonds,  and 
lithotries — after  use,  at  any  rate  in  cases  *y(  iDnei>paniient 
urine,  should  be  plunged  for  a  minute  or  two  infio  boiling  water, 
to  which  either  a  little  c>m«)n  3«>la  or  a  little  cari>>Gc  add 
has  been  addetl.  If  the  b«>iiin^  p>int  of  water  be  noc  coor- 
»dered  absolutely  sufficient,  a  strong  aoluoon  ci  cyocide  rf 


BRITISH  AND   POtlEIGN  JOURNALS.  56l 

!zinc  in  water  may  be  used.  At  the  strength  of  twelve  per 
cent,  solution,  the  boiling  point  is  22^  Fahr.,  or  eight  above 
that  of  boiling  water.  For  some  years  past,  as  advised  in  the 
last  edition  of  my  lectures,  I  have  always  placed  all  gum  and 
other  catheters  and  bougies  in  a  bath  of  weak  carbolic  acid 
immediately  after  use. 

Secondly  :  I  have  more  recently — that  is,  since  the  occur- 
rance  described — added  a  solution  of  carbolic  acid  to  the  oil 
used  for  lubrication  of  instruments.  Oil  being  the  remedial 
agent  for  the  caustic  effects  of  carbolic  acid,  there  is  no 
danger  in  applying  to  the  urethra  a  comparatively  strong 
solution  of  the  acid  in  oil,  since  no  irritating  effect  whatever  is 
produced,  and  the  disinfectant  influence  is  unimpaired. 

For  the  last  two  months,  I  have  used  the  following  formula, 
and  can,  therefore,  guarantee  that  it  is  absolutely  unirritating  ; 
R  Acidi  carbolici  med.  gr.  xii ;  olei  olivae  li. 

A  free  use  of  this  as  a  lubricant  to  all  instruments  before 
using  will,  I  believe  insure,  at  all  events  in  combination  with 
the  modes  of  cleaning  just  described,  safety  from  the  occurrence 
of  any  contagion  by  means  of  instrumental  treatment. 

Traumatic  TBtBJlUS— Case  of  Traumatic  Tetanus, 
treated  mth  the  hypodermic  injection  of  Atropia  ;  amputation 
of  great    toe;   recovery — By   Surgbon  D.   H.    Cullimore, 

P.R.C.S.I.,     &C.,     BX-RESIDBNCY     SURGBON     AT      THE     COURT 

OF  THE  KING  OF  BURMAH. — In  April,  1876,  when  the  highest 
temperature  in  the  shade  was  98^  F.,  with  a  great  diurnal 
variation,  the  rainy  season  having  just  set  in,  a  Lascar,  a  camp 
follower,  was  admitted  into  the  hospital  for  details  at  Rangoon, 
Burmah,  suffering  from  a  lacerated  contused  wound  of  the 
great  toe,  inflicted  some  three  days  previously  by  the  tread  of 
a  horse.  The  patient  (a  powerful  muscular  man,  aged  twenty- 
eight  years)  was  confined  to  bed,  and  a  rice  poultice,  medi- 
cated with  laudanum,  applied  for  two  days,  when,  no  improve- 
ment taking  place,  and  the  condition  and  seat  of  the  injury 
being  such  as  is  frequently  followed  by  tetanus,  the  toe  was 
amputated,  with  the  object  of  removing  what  I  was  afraid 
might  become  the  exciting  cause  of  that  decease,  when,  some- 

NO.  LXXXIV.  31 


1    SU  ltd  If  A  I.    JOURNAL. 


what  to  my  surprise,  in  about  fifty  iiours  after  the  perfoi 
of  the  operation,  the  symptoms  of  tetanus  became  manifest 
— first,  by  yawning  and  liatlessneas  ;  secondly,  by  stiffiiess  of 
the  muscles  of  the  neck  and  the  abdomen,  accompanied  by  the 
usual  exprcasion  of  face ;  and,  lastly,  and  later  on,  by 
spasmodic  contraction  of  the  abdominal  muscles  and  opistho- 
tonos, which  latter  continued  for  about  six  hours  on  the  fourth 
day  from  the  inception  of  the  disease. 

As  this  was  the  fourth  case  that  came  under  my  notice  in 
the  space  of  six  months,  one  of  which  was  treated  with  chloral, 
and  the  others  with  hypodermic  injection  of  atrupia  in  combin- 
ation with  morphia,  and  as  all  three  terminated  fatally  between 
the  ninth  and  the  twelfth  day,  I  felc  convinced  that  chloral 
would  prove  a  failure,  and  judging  from  tlie  physiological 
effect  of  morphia  and  atropia,  which  is  the  reverse  of  each 
other,  at  least  in  so  far  as  their  action  on  the  pu[iil  is  observed, 
I  determined  to  try  atropia  alone,  more  with  the  object  of 
noting  its  action  than  with  any  but  a  vague  hope  that  it  ought 
be  the  means  of  preventing  a  fatal  issue.  On  the  first 
appearance  of  the  symptoms  one-sixtieth  of  a  grtun  of  atropia 
was  injected  hypodermically  over  the  dorsal  spinal  region,  and 
was  repeated  three  times  daily.  On  the  morning  of  the  second 
day  one-fortieth  of  a  grain  was  injected  every  four  hours,  and 
continued  for  six  successive  days,  till  the  spasms  had  entirely 
ceased,  and  the  stifihess  disappeared  from  all  but  the  muscloH 
of  the  neck  and  face,  which,  as  they  were  the  first  to  become 
affected,  continued  longest  under  the  influence  of  the  disease. 
On  the  eighth  and  ninth  days  the  dose  was  reduced  to  one- 
sixtieth  of  a  grain  twice  a  day,  and  subsetjuently  reduced  to 
one-abttieth  of  a  grain  at  night  for  a  further  period  of  two  days, 
ending  on  the  evening  of  the  eleventh  day  from  the  com- 
mencement of  the  disease,  when  the  patient,  though  not  yet' 
cured,  was  well  out  of  danger,  and  in  a  fair  way  lo  recovery. 

I  should  hare  mentioned  that  the  bowels  were  constipated 
throughout,  and  were  acted  upon  by  four  grains  of  calomel 
with  forty  grains  of  compound  jalap  powder,  administered 
every  other  day,  and  that  after  each  evacuation  the  patient 
invariably  expressed  himself  "  much  lighter  "  and  relieved. 


1 


BRITISH   AND   POREIQN   JOURNALS.  563 

Under  the  influence  of  tonics  and  nourishing  diet,  with  an 
occasional  purgative,  such  progress  was  made  that  on  the 
twenty-sixth  day  from  his  admission  into  hospital,  and  on 
the  twenty-first  from  the  manifestation  of  tetanic  symptoms,  the 
man  was  discharged.  During  his  stay  in  hospital,  and  within 
the  space  of  nine  days,  two  grains  of  atropia  were  introduced 
into  his  system,  which  caused  neither  dilatation  of  the  pupil 
nor  any  continued  increase  of  temperature  ;  in  fact  there  was 
no  ascertainable  physiological  action,  with,  perhaps,  the  excep- 
tion of  drowsiness  and  slight  occasional  hyperaesthesia  of  the 
surface  which  I  am  now  more  inclined  to  connect  with  the 
disease  than  the  remedy. 

Though  this  case  occurred  so  long  ago,  the  facts  may  be  relied 
upon,  as  the  notes  were  taken  at  the  time,  but  not  published 
for  want  of  leisure. 

Memarks. — The  points  illustrated  by  this  case  are  : — 

1.  That  tetanus — i.  e.,  a  series  of  reflex  phenomena  depend, 
ing  upon  an  over-excited  or  congested  state  of  the  brain,  the 
spinal  cord,  and  their  membranes — is  capable  of  being  relieved, 
or  even  cured,  by  atropia,  when  administered  in  comparatively 
small  doses,  extended  over  a  certain  period  of  time  according 
to  the  severity  of  the  symptoms ;  though  we  know  from  the 
experience  and  experiments  of  Drs.  Harley,  Fraser,  and  others, 
that  when  given  to  its  full  physiological  efiect  it  produces  ex- 
citement and  congestion  of  the  cord,  followed  by  the  usual 
reflex  results,  as  jactitation,  muscular  spasm,  and  convulsive 
fits. 

2.  That  the  administration  of  the  medicine  was  not  followed 
by  any  of  the  easily  recognizable  symptoms  of  the  drug  (two 
grains  of  which  has  caused  the  death  of  a  healthy  adult  when 
given  in  one  dose),  proving  both  the  tolerance  induced  by  the 
disease,  and,  perhaps,  also  illustrating  the  homoeophatic  theory 
or  formula,  sine  the  infinitesimal  system  of  dosage, 

3.  That  amputation  of  the  injured  part,  strongly  recommended 
by  Larrey  and  others,  even  after  the  supervention  of  tetanus, 
though  it  may  perhaps  help  to  lessen  the  severity  of  the  disease, 


5C4  CANADA   MEUICAT,    AND    SrRGICAL    JorRNAI.. 

does  not  act  as  a  prophylactic,  and  should,  I  think,  nerer  Le  had 
recourae  to  after  tlie  symptoma  have  declared  themselvoa.  It 
wouUl  then  be  injurious,  for  the  peripheral  irritation  would  have 
become  central,  and  indejtendently  dynamic.  For  the  same 
reason,  tlic  division  of  nerves  should  not  be  resorted  to.  In 
two  cases  where  I  examined  the  nerven  after  death  I  f^led  to 
perceive  that  they  differed  in  any  way  from  those  of  the  opposite 
side.  In  one  of  these  there  was  slight  congestion  of  the  mem- 
branes and  softening  of  the  cor<i  in  the  lumbar  region,  and  in 
the  other  a  peculiar  cloudiness  of  the  cord,  which  may,  how- 
ever, have  been  due  to  post-mortem  changes.  Yet  it  is  certain 
that  there  is  some  lesion,  though  in  every  case  we  may  not  be 
able  to  perceive  it.  This  lesion  should  be  looked  for  in  that 
portion  of  the  sjiinal  cord  with  which  the  nerves  from  the  affect- 
ed part  first  communicate. 

4.  If  the  line  of  treatment  adopted  in  tliis  ca^  should  be 
found  beneficial  in  others  of  the  same  disease,  I  would  suggest  ( 
that  it  might  be  extended,  with  such  modifieatiouB  as  may  be 
necessary,  to  the  treatment  of  such  allied  diseases  as  epilepsy, 
puerperal  convulsions,  and  hydrophobia. —  Thfi-  Liumet. 

"Wlien  shall  the  Lying-in  Woman  get 

up? — 0.  KosTNER  took  occasion  in  the  obstetrical  clinic  at 
Ilalle  to  tost  the  value  of  Goodell's  suggestion  relative  to  the 
getting  up  period  after  labor,  in  the  first  days  after  delivery. 
He  experimented  with  sixteen  women  whom  he  allowed  to  get 
up  whenever  they  felt  like  it.  Four  got  up  on  the  first  day, 
two  on  the  second,  three  on  the  third,  and  seven  on  the  fourth 
day.  They  remained  up  according  to  pleasure,  Evacuation 
of  the  bowels  was  essentially  better,  the  secretion  of  urine  was 
not  lessened,  and  of  sweat  but  little  lessened ;  the  appetite  was 
good.  The  loss  of  weight  in  these  cases  was  not  abnormal, 
although  the  lochia  were  more  free.  Involution  of  the  uterua  ] 
took  place  en  regie.  But  as  three  of  the  cases  showed  fever, 
which  the  author  thought  due  to  maltreatment  by  exercise  of 
the  physiological  wounds  of  the  genital  organs,  and  as  this 


BRITISH  AND    FOREIGN   JOURNALS.  565 

danger  is  always  imminent,  Kiistner  advises  that  lying-in  women 
remain  in  bed  about  one  week.  In  private  practice  the  physician 
will  be  chiefly  guided  by  the  condition  of  the  discharges,  and 
will  demand  that  patients  remain  in  bed  until  all  bloody  dis- 
charges, or  coloration  of  discharge,  shall  have  ceased. — Berlin 
Klin.      Wochenschrift,     The  Am,  Med.  Bi-  Weekly. 

Cllloral  Hydraite. — Antagonistic  and  Antidotal 
Powers  of  Chloral  Hydrate. — Dr.  Husemann  found  that  in 
rabbits  chloral  hydrate  acted  as  an  antidote  to  strychnine,  to 
the  combination  of  strychnos  bases  known  in  commerce  by  the 
name  of  leucine,  and  to  thebaine,  which  produces  tetanic 
symptoms,  and  af  the  same  time  diminished  sensibility ;  the 
chloral  controlled  the  spasms,  and,  within  certain  limits,  warded 
off  death.  On  the  other  hand,  when  non-lethal  doses  of  chloral 
hydrate  were  administered  to  rabbits  poisoned  with  ammonium 
chloride,  the  fatal  termination  resulted  more  rapidly  than  when 
lethal  doses  of  either  ammonium  chloride  alone  or  of  chloral 
alone  were  employed,  probably  because  of  the  combination  of 
the  paralyzing  effects  of  both  drugs  on  the  respiratory  centre. 
The  spasms  excited  by  the  ammonium  chloride  were,  it  is  true, 
relieved  or  even  entirely  controlled  by  non-lethal  doses  of 
chloral  hydrate,  but  still  death  ensued. 

Dr.  Husemann  found  the  antidotal  power  of  chloral  hydrate 
to  be  much  less  against  codeine  than  against  picrotoxin.  The 
chloral  controlled  the  spasms  and  saved  life  when  only  the 
minimum  fatal  dose,  or  the  minimum  dose  increased  by  one- 
half  of  codeine  was  administered,  but  it  was  unable  to  do  so 
when  double  the  minimum  dose  was  given.  On  the  other  hand, 
the  life  of  the  rabbit  could  be  saved  by  chloral  when  even  five 
times  the  minimum  lethal  dose  of  picrotoxin  had  been  adminis- 
tered. Hence  it  would  be  incorrect  to  assume  that  because 
chloral  is  a  powerful  antidote  to  picrotoxin,  it  is  equally  so  to 
the  other  so-called  cerebral  irritants. 

Against  calabarine  the  action  of  chloral  is  the  same  as 
codeine  ;  in  poisoning  by  baryta,  however,  it  is  not  even  able  to 
relieve  the  symptoms,  far  less  to  save  life.     In  poisoning  by 


KIiirAI,    AND    f 


CM.    .IOUR\AL. 


carbolic  acid  it  does  not  completely  control  the  spasmodic 
muscular  movements,  nor  is  it  able  to  ward  off  death,  even  when 
only  the  minimum  lethal  dose  of  the  acid  has  been  admiuiatered. 
On  the  other  hand  a  combination  of  lethal  or  of  non-lethal 
doses  of  carbolic  acid  and  chloral  hydrate  causes  a  more  excessive 
depression  of  temperature  than  is  observed  in  afliite  poisoning 
by  carbolic  acid,  or  by  chloral  alone. — Med.  Record,  N.Y. 

Deaf-Mutism.  —  Case   of  mppoged  Deaf-MiitUm  ; 

Eustachian  Closure  ;  Moist  Catarrh  of  Ti/mpanum  ;  recovery. 
By  T.  Wemyss  Bohr,  m.b.,  m.r.c.p.  Lond- — In  August  last, 
at  the  Christ  Church  Infant  Nursery,  in  this  town,  my  attention 
was  directed  to  an  older  child,  who  was  stated  to  be  an  intnate 
because  of  being  deaf  and  dumb.  Never  having  inspected  the 
ears  of  a  deaf-mute,  I  asked  |>crmission  to  examine  here,  and 
on  doing  so  a  few  days  later  I  learned  tliat  the  deaf-matism 
was  not  absolute,  and  obtained  the  following  history. 

Jemima  B ,  aged  live  years  ;  had  two  maternal  uncles 

who  became  stono  deaf ;  bad  scarlet  fever  at  eleven  months  ;  no 
otorrhoea,  no  convulsions,  but  has  been  deaf  over  since.  Was 
unable  to  go  to  school,  or  hear  passing  vehicles. 

August  13th,  1878. — Child  hears  when  spoken  to  in  a  loud 
voice ;  puts  a  natch  to  her  cars ;  smiles  when  a  tuning-fork 
is  placed  at  her  right  ear.  Tries  to  imitate  some  sounds,  and 
can  say  imperfectly  about  twenty  words — viz.,  Freddy,  Johnny, 
dada,  mamma,  Bob,  get  away,  leave  off,  one,  two,  three,  four, 
five.  Cannot  ask  for  anything  by  name;  palate  not  cleft. 
Right  membrana  tympani  entire, rather  opaque;  cone  of  li^t 
visible.  Left  membrana  the  same,  partly  hidden  by  wax.  On 
learning  these  facta,  I  concluded  that  treatment  with  Allen's 
nasal  bag  would  cither  relieve  or  cure  her  deafness,  and 
applied  it  to  her  nostrils  several  times  every  day,  or  cverjr 
other  day,  from  August  14  th  to  Sept.  13th,  afterwards  less 
frequently.  After  the  first  application  she  appeared  to  hear 
my  voice  better.  * 

16th. — Her  mother  says  she  certainly  hears  better.  Syringed 
left   ear  and  removed  a  considerable  quantity  of  bard  wax. 


I 


BRITISH  AND  FOREIGN  JOURNALS.  561 

Several  enlarged  vessels  seen  on  malleus ;  moist  sound  in  ear 
heard  on  using  Allen's  nasal  bag.  She  heard  the  nurse  speak 
to  her  this  morning. 

17th. — While  lying  in  bed  this  morning,  lifted  up  her  finger 
as  a  sign  to  listen  while  a  cart  was  passing. 

21st.4— Seems  to  hear  better  when  spoken  to  ;  the  voice  has 
not  to  be  much  raised.  Has  tried  to  imitate  the  voices  of  the 
children  singing,  but  can  only  attempt  to  utter  "  Oh,  I  say." 
Tried  to  say  "  lady  "  when  a  visitor  came. 

23rd. — Hears  the  knocks  at  the  door.  Air  enters  tympanic 
cavity  with  a  drier  sound ;  left  membrana  tympanic  fibrous- 
looking  ;  a  bloodvessel  crosses  it  midway  down  behind  maunbri- 
um ;  cone  of  light  imperfect. 

24th. — Drier  sound  with  nasal  bag.  She  pointed  up  to  the 
sky  when  it  was  thundering  to-day ;  had  never  noticed  it  before. 

25th. — Tried  to  say  "  flower  "  when  the  word  was  loudly 
uttered  to  her. 

28th. — Hears  them  speak  in  low  tone,  and  hears  light  knocks 
at  the  door. 

31st. — Heard  thunder  again,  though  it  was  not  so  loud  ; 
frequently  hears  passing  vehicles  ;  tries  to  say  "  Put  that  down" 
when  the  words  are  spoken  to  her  with  moderate  loudness. ' 

Sept.  3rd. — Can  hear  if  called  when  she  is  out  of  the  room  ; 
says  "  ake  "  when  I  ^say  "  cake  "  ;  hears  her  playmates  cry, 
running  and  taking  them  toys  to  soothe  them.  Right  membrana 
tympani  wrinkled  as  if  sodden  ;  tympanic  plexus  visible  ;  left 
membrana  tympani  smooth  in  most  parts,  opaque  behind  malleus  ; 
no  plexus  visible. 

5th. — Has  been  busy  making  the  children  in  the  creche 
say  "  Poor  Bob  "  after  her  and,  shaking  them  well  if  they 
failed.     Heard  street  music  to-day  for  the  first  time. 

13th. — Tries  to  say  "  sugar,"  "  butter."  Has  tried  to 
repeat  the  names  of  the  things  in  the  ante-room,  and  to  call  the 
children  by  their  names. 

•  25th. — Tries  to  pronounce  the  names  of  the  things  on  the 
alphabet  blocks  when  they  are  repeated  to  her ;  much  diflBculty 
with  *'  viper." 


568 


'ANADA   ME  Die  A I 


)   StiKOICAl.    JOURNAL. 


e,     pretty 
wtich  she 


Oct,  Sth. — Can  say  " spoon,"  "apple,"  "no 
clearly.  Went  into  a  aliop  and  aaked  for  "  appli 
bought. 

11th. — \Vben  standing  with  her  back  lo  the  fire  she  heard  a 
cinder  I'aJI  out  of  the  grate. 

14th. — Tries  to  repeat  words  she  hears  others  mcDtioD  in 
conversation.  Was  taught  the  word  "  moon  "  a  few  days  ago, 
and  repeated  it  on  seeing  the  moon  to-day, 

Nov.  9th. — Talks  better  ;  saya  "  Pick  that  i\\i "  distinctly- 

30th. ^Notices  the  railway  whistle-  Repeated  the  words 
"  Jack  Frost '"  after  her  mother.  Calls  her  doll  "Judy,"  and 
says  "  No,  yon,"  on  hearing  the  words  uttered. 

After  this  date  I  saw  no  more  of  the  child,  as  her  parents 
removed  to  Freshwater  in  thp  Isle  of  Wight ;  but,  writing  oh 
April  16lh  last,  her  mother  says:  "  I  fee!  very  much  pleasure 
in  informing  you  that  my  little  girl  has  very  much  improved  in 
her  hearing,  and  wonderfidly  in  her  talking.  She  can  say  dis- 
tinctly all  her  alphabet,  and  count  hor  figures  up  to  10.  She 
will  say, '  Dadu  made  that,' '  Mamma  gone  out,'  *  Tea  please, 
mamma,"  but  she  cannot  manage  more  words  in  one  sentence." 

From  Aug.  "2t)t!i  to  Sept.  13th  both  Allen's  and  Politzer's  nasal 
bags  were  employed,  but  subsefiuently  Allen's  alone,  in  con- 
sequence of  the  child's  resistance  to  Politzcr's.  The  only 
additional  local  remedy  was  an  iodine  embrocation  applied,  hut 
irregidarly,  behind  tlie  ears.  The  treatment  was  obvious 
enough.  She  was  unsuccessfully  treated  a  year  or  two  pre- 
viously, but  only  during  a  short  period,  I  believe ;  and  a  firiend 
of  her  mother's  informed  me  that  she  had  on  former  occasions 
attempted  to  teach  lier  various  words,  but  being  iraperfectJy 
heard  they  were  speedily  forgotten.  From  the  above  report,  in 
which  only  new  manifestations  of  speech  and  hearing  are  detiut- 
ed,  it  appears  probable  that  had  treatment  been  delayed  much 
longer  the  child  would  have  become  permanently  deaf  and  dumb. 
This  case  also  shows  the  desirability  of  watehing  patients  afWr 
scarlet  fever,  to  note  if  their  hearing  is  impaired,  before  ceasing 
to  attend  them. 

The  pathology  was  evidently  moist  catarrh  of  the  middle  ear, 


I 


BRITISH   AND    FOREIGN   JOURNALS.  569 

with  occlusion  of  the  Eustachian  tube  ;  and  when  the  latter  was 
kept  permanently  open  by  means  of  the  nasal  bag,  the  fluid 
gradually  escaped,  and  the  structures  regained  their  normal 
state,  though  probably  some  thickening  remained.  The  progress 
was  therefore  rapid  until  the  fluid  was  removed,  evidenced  by 
the  sound  becoming  dry  on  the  use  of  the  nasal  bag ;  after- 
wards the  remaining  congestion  subsided  only  slowly,  though 
steadily,  the  order  in  which  sounds  became  audible  being  ap- 
parently, first,  grave  tones,  like  thunder  and  the  rumbling  of 
vehicles,  then  sharper  ones  by  degrees,  ending  with  the  railway 
whistle. 

The  child  suffered  from  gastro-enteric  catarrh,  due  to  im- 
proper food,  but  was  well  in  other  respects,  and  appeared  very 
quick  and  intelligent. — The  Lancet. 

Cysticeroi  in  the  Brain  diagrnosticated 

during^  liife. — A  case  of  this  character  is  recored  by 

Dr.  Joseph  PoUak  m  the  Wiener  Med.  Fresse^  No.  47, 1878. 

The  patient  was  a  boy  eight  years  of  age.     Examination  of  the 

pulse,  temperature,  thoracic  and  abdominal  viscera  failed  to 

reveal  anything  abnormal.   The  boy  complained  of  excruciating 

headache,  and  his  piercing  cries  were  loud  enough  to  be  heard 

at  quite  a  distance.     Very  shortly  after   his   first  visit  the 

attendant  was  recalled,  when  he  found  the  pupils  dilated,  the 

urine  and  fseces  passed  involuntarily,  the  abdomen  distended ; 

headache  was  still  severe.     Every  few  hours,  attacks  of  an 

epileptiform  nature  recurred,  iffhile  in  the  intervals  there  was  a 

remarkable  absence  of  all  these  symptoms.   At  one  of  his  visits 

just  after  prescribing  a  cathartic,  he  had  occasion  to  examine 

the  stools,  where  he  found  portions  of  a  taenia.      The  presence 

of  this,  in  connection  with  the  other  symptoms,  at  once  aroused 

the  suspicion  that  he  had  here  a  case  of  entozoal  origin.  At 
his  next  visit  he  found  the  patient  comatose,  and  on  examination 
of  his  pupils  found,  to»  his  surprise,  what  proved  on  a  closer 
examination  to  be  a  cysticercus  in  the  anterior  chamber.  He 
at  once  pronounced  the  case  one  of  cysticercus  of  the  brain. 
The  patient  died  shortly  afterward,  and  the  diagnosis  was  fully 
verified. — Atlanta  Med.  and  Surg.  Journal. 


^eiital  and  f  utjical  |(rm:«al. 


:al,  July,  1879. 


AIT  ACT  TO    FirRTHBR  AMEND   AND   CONSOLIBATB  TUB  ACTS  RB- 

LATING   TO  TUB   PROFESSION   OF  MEDICINE  AND  StlKQEBT 

IN    THE    PROVINCE    OP    QCEBEC, 

We  were  somewhat  aiirpTiBed  to  receive  a  bill  to  further 
amend  the  act  uoder  which  the  profession  in  this  Province  is 
governed,  and  on  looking  it  over  we  observe  that  it  is  a  literal 
tranacnpt  of  the  present  act,  with  a  fen  alterations  and  additions, 
but  whether  this  is  an  improvement  on  the  present  act  is  a  ques- 
tion which  we  shall  leiivo  open  for  further  comment.  It  is  pas- 
sing strange  and  somewhat  suggestive,  that  this  bill  should  be 
submitted  to  the  Legislature  on  the  eve  of  the  {Ussolution  of  the 
present  Board.  The  present  act  was  assented  to  on  the  28th  De- 
cember, 1876.  It  became  lawjust  before' the  triennial  meeting  of 
the  profession  for  the  election  of  a  board  of  Governors,  which 
would  have  taken  place  under  the  old  Act,  and  although  many 
important  vested  rights  were  surrendered  for  the  general  good, 
yet  it  would  seem  that  th'3  same  restless  spirit  is  abroad,  and 
with  an  apparent  view  of  opening  again  the  doors  of  the  College 
to  defaulters  and  all  comers,  a  newbill  is  inaugurated  just  before 
the  cominggeneral  election,  which  is  to  tako  place  in  Julj,1880. 
Wo  should  be  sorry  to  suppose  that  the  promoters  of  this 
bill  of  amendment  have  any  ulterior  object  in  view.  Never- 
theless we  must  gay  that  it  is  hardly  decent  for  a  few  mem- 
bers of  the  profession,  forty  in  number,  if  all  are  agreed 
to  these  changes,  to  submit  a  bill,  and  endeavour  to  hnrr^ 
it  through  the  Legislature,  without  first  obtaining  an  expresdon 
of  opinion  from  the  profession  at  large. 


i 


I 


EDITORIAL.  571 

We  learn  by  the  daily  papers  that  a  committee  of  the  House 
has  been  struck,  presided  over  by  the  Honorable  Dr.  Church, 
and  that  it  has  adjourned  until  Tuesday  next,  29th  July,  so  as 
to  give  the  profession  an  opportunity  of  expressing  an  opinion 
as  to  the  desirability  of  the  changes  demanded.  Through  the 
courtesy  of  the  Hon.  Dr.  Church  we  received  a  copy  of  this  bill, 
but  we  would  ask.  Can  an  expression  of.  opinion  from  the  profes- 
sion at  large  be  obtained  in  the  time  allotted,  seven  clear  days  ? 
If  alterations  of  a  technical  character  are  demanded  to  make  the 
present  act  a  legal  one,  no  dissenting  voice  could  in  reason  be 
raised  ;  but  to  do  away  with  the'present  act,jto  begin  anew,  seems 
to  us  a  very  objectionable  feature.  It  cannot  be  urged  that 
we  are  without  legislative  protection.  We  are  all  interested  in 
seeing  the  best  interests  of  the  profession  and  of  the  public 
protected.  There  are  some  clauses  in  the  present  act  which 
might  with  advantage  be  amended.  The  method  of  election 
of  Governors,  as  at  present  Qonducted,  is  not  calculated  to 
yield  an  independent  selection  of  representative  men.  If  it 
be  desirable  that  the  profession,  as  a  whole,  should  take  an 
interest  in  the  management  of  the  College,  the  entire  Province 
should  be  divided  into  territorial  electoral  districts,  and  each 
territorial  electoral  district  should  have  the  right  of  electing 
its  own  representative.  At  present  the  election  is  conducted 
by  the  profession  generally  at  a  mass  meeting,  hence  any  man 
who  attends  the  meeting,  and  has  a  large  number  of  friends  in 
the  cities,  can  carry  a  vote,  although  probably,  had  he  been  left 
to  his  own  territorial  electors,  his  name  never  would  have  come 
up  for  election.  This  is  a  subject  of  very  great  importance  to 
the  profession  as  a  whole.  For  instance,  in  outlying  districts, 
who  better  able  to  select  a  delegate  than  the  men  resident  in 
that  district  ?  By  adopting  this  method,  we  think  a  better  and 
more  independent  expression  of  opinion  would  be  obtained,  and 
each  and  every  member  of  the  profession  would  take  an  interest 
in  the  affairs  of  the  College.  But  we  may,  with  advantage,  in- 
quire into  some  of  the  changes  that  are  asked  for  in  this  bill.  The 
very  first  clause  repeals  all  acts  having  reference  to  the  study 
or  practice  of  medicine,  surgery  or  midwifery  in  this  Province 


CANADA   MEDICAL   AND   SritOICAl,   JOttBNAI.. 

of  Quebec,  as  well  as  specially  naming  the  aut  which  was  passed  ] 
in  1876 — "  as  well  as  the  Act  40  Vict,  chap.  26,  intituled,"  &c.  I 

According  to  the  second  sectiun, '*  All  pemone  rcaident  i 
the  Province  of  Quebec,  and  licensed  to  practice  and  acttialljJ 
practicirij^     •     at  the  tiraa  of  the  [lassing  of  this  Act 
shall  be  and  are  hereby  coQstituted  a  body  jwlitic,"  &«.,  kc,- 
Bo  that  this  bill  is  intended  to  be  a  fresh  start,  to  taJce  in  allfl 
persons  whether  they  have  complied  with  the  present  law  or  not,,  f 
whether  they  have  contributed  to  the  funds  of  the  College  or  not,  J 

In  section  IV.  a  change  might  with  advantage  be  made.     Aa  iJ 
at  present,  it. reads,  *'  provided  always  that  not  less  than  twft  j 
members  out  of  the  city  mombers  shall  be  delegates  from  oachJ 
of  the  Universities,  &c.     Now  we  hold  that  the  'TJniversitiea  I 
should,  without  doubt  have  representation,  but  that  two  mem<-l 
hers  from  each  University  is  sufficient.     The  clause  reads  that  * 
"  not  less  than  two  out  of  thfc  city  members,"  &c,,  but  it  doea 
not  limit  the  number  to  two  ;  had  it  done  so,  we  would  not  tor 
day  have  on  the  Board  of  Governors,  four  raerabera  as  repre- 
senting one  school,  to  the  exclusion  of  two  men  from  the  outside 
profession.     Again,  it  is  stated  in  the  bill  of  amendment  that 
the  delegates,  before  taking  their  seats,  must  have  their  appoint- 
ments ratified  by  the  College  of  Physicians  and  Surgeons  of  the 
Province  of  Quebec.     Now  this  will  lead  to  endless  trouble  and 
obstruction  to  the  proceedings  of  the  College.     The  Board  of 
Governors  is  not  complete,  unless  the  whole  number,  40  Gov- 
ernors, has  been  elected.     Let  us  for  the  sake  of  argument, 
suppose  that  the  Board  of  Goverpors  did  not  ratify  the  appoint- 
ment of  the  nominee  of  any  University,  they  could  not  work. 
Forty  must  be  their  number;  if  they  lack  the  number,  40,  they 
are,  by  the  act,  no  College;  how,  then,  can  they  ratily  the 
nomination  of  the  Universities.    This  clause  is  an  anomaly— we 
do  not  quite  understand  it.     It  appears  to  as  that  the  legal  consti- 
tution of  the  College  consists  in  the  election  of  forty  Governors, 
but  in  no  placo  aro  we  informed  that  32  elected  Governors  can 
ratify  the  appointment  of  the  eight  nominees  of  the  schools. 

In  this  matter  wo  think  that  the  schools  should  possess  inde- 
pendent action,   and  have   the  right   to   nominate  their  own 


EDITORIAL.  673 

delegates,  who,  by  virtue  of  such  selection,  should  become 
Governors  of  the  College  ;  but  that  power  should  be  limited  to 
two  representatives  only  for  each  University  or  incorporated 
school. 

Again,  in  clause  3,  section  4,  a  change  might  with  advantage 
be  made,  as  at  present,  and  in  the  amended  bill,  in  case  of  any 
death  vacancy  or  resignation,  the  Board  of  Governors  are  given 
the  privilege  to  "  fill  up  such  vacancy  from  amongst  the  eligible 
"  members  of  the  College  in  the  city  or  district  where  such 
"  vacancy  shall  have  occurred,"  This  is  a  very  summary  way 
of  proceeding,  and  would  have  to  be  altered,  provided  the  sys- 
tem of  each  district  sending  its  own  representative  be  adopted. 
Now  let  us  remark  on  this  point  that  the  profession  is  being 
taxed  every  year  to  contribute  to  the  funds  of  the  College,  and 
as  tax-payera  they  ought  not  to  be  disfranchised,  but  should  be 
given  the  right  of  electing  their  own  delegate  and  of  sending 
him  to  their  medical  parliament.  How  would  it  be,  in  case 
of  a  death  vacancy,  or  of  a  resignation  of  any  member  of  the 
House  of  Commons,  or  even  of  the  Local  Legislature,  if  the 
members  of  the  House  should  proceed  to  elect  a  resident  frcto  the 
city  or  district  where  "  such  vacancy  shall  have  occurred  "  ! ! ! 
What  a  howl  of  indignation  would  there  be  throughout  the 
country,  and  how  it  would  strike  at  the  principle  of  the  inde- 
pendence of  Parliament. 

In  section  VII  we  read,"  provided  that  such  diploma  shall  have 
"  only  been  given  after  four  consecutive  years  of  study  of  the 
*^  medical  profession,  or  after  four  terms  of  consecutive  lectures 
"  from  the  date  of  his  admission  to  study,  and  according  to  the 
"  requirements  of  the  existing  law."  Now  we  may  remark 
that  some  Universities  divide  their  courses  of  lectures  into 
terms,  and  that  during  a  six  months  course  there  may  be 
three  terms,  so  that  we  think  this  clause  ought  to  be  a  little 
more  explicit. 

Section  XI  is  a  new  clause  ;  it  provides  for  the  examination 
of  persons  coming  from  recognized  Colleges  outside  of  Her 


574 


NADA   MEDICAL   AND 


JOURNAL. 


MaJeBtjy'a  domiDions,  a  power  which  was  not  before  beld,  and  it 
not  in  any  way  objectionable. 

At  section  XII,  clause  2,  wo  read  that  the  Board  of  Gover- 
nora  shall  have  power  "  to  examine  all  credentials,  certifies! 
"  of  admiBsion  to  study  or  of  attendance  at  lectures,  and  aU 
"  other  documents  purporting  to  entitle  the  bearer  to  a  licei 
'*  to  practice,  and  all  diplomas  sought  to  be  registered  in  this 
"  Province,  and  to  oblige  the  bearer  of  such  credentiala, 
"  diplomas  or  other  documents  to  attest  on  oath  (^to  be  admin- 
"  istered  by  the  Chairman  for  the  time  being)  that  he,  &c." 

Now  either  this  is  a  Registration  Act  or  it  ia  not.  If  it  is, 
then  should  the  rejj^ter  be  open  at  all  times,  and  the  Registrar 
should  have  the  power,  with  the  consent  of  the  officer?  of  the 
College,  to  enter  the  name  of  any  applicant  who  holds  docu- 
ments that  legally  entitle  him  to  the  certificate  of  re^stration. 
Wo  do  think  it  unwise  to  throw  open  the  door  of  the  College  to 
all  applicants  at  all  times  when  most  convenient  to  themselves, 
hut  occasion  may  arise  when  not  to  register  a  name  because 
the  Board  is  not  in  session  would  be  to  do  a  man  entitled  to  it 
positive  injustice,  and  a  certain  discretionary  power  should  be 
granted  to  the  oflicers  of  the  College,  which,  for  good  and  justi- 
fiable cause,  they  should  be  permitted  to  exercise. 

Wo  have  made  these  few  remarks  with  a  view  to  drawing: 
attention  to  this  Bill,  and  to  give  our  readers  an  opportunity  tO' 
judge  of  the  nature  of  the  changes  which  are  asked.  We  hope- 
tJtat  there  will  be  no  hasty  legislation  on  theso  points.  We 
have  an  act  which  is  sufficiently  effective — it  may  not  be  perfecb! 
in  all  its  parts,  but  it  is  good  enough  for  the  purpose  intended, 
and  under  it  we  can  work  with  safety  for  years  to  come.  We 
can  agitate  amendments,  and  have  them  fairly  discussed  by  the 
profession.  Wo  invite  discussion,  and  throw  open  the  columoa 
of  this  Journal  for  the  purpose.  If  we  look  abroad  we 
observe  that  the  profession  in  Great  Britain  has  been  knocking 
at  the  door  of  Parliament  for  several  sessions,  and  yet  no  agree- 
ment has  been  arrived  at,  nor  is  it  nearer  a  solution  of  its 
difficulties  to-day  than  it  was  m  1874,  when   the  first  demand 


I 


I 


MEDtCAI,   ASSOCIATION.  5t5 

for"  medical  reform  was  made.  The  interests  involved  are 
numerous,  and  by  hastily  carrying  an  ill-advised  measure  no 
satisfaction  will  be  given  to  any  peraon,  and  changes  will  have 
to  be  asked  for  at  each  session  of  Parliament,  which  will  lead 
expense  and  probably  endless  difficulties. 


CANADA  MEDICAL  ASSOCIATION. 


The  Annual  Meeting  of  this  Association  will  take  place  at 
London,  Ont.,  on  Wednesday,  10th  September  next,  when  it  is 
hoped  there  will  be  a  full  representation  of  the  jirofeasiou  both 
east  and  west.  We  understand  that  several  very  important 
papers  will  come  up  for  discussion,  as  also  a  proposal  on  the 
part  of  the  British  Medical  Association  to  in  some  way  become 
connected  with  it.  We  are  unable  to  state  whether  any  definite 
proposal  has  been  mado,   coming   officially  from   the   parent 

r-Society,  but  we  are  aware  that  it  is  at  least  considered  desirable 

H>j  leading  members  of  tlie  profession  in  Great  Britain  that 

mething  more   than  fratomal  intercourse  should   unite  our 

■Associations.      We  give  below  a  circular  received  from  the 

■Secretary,  which  apeaka  for  itself: — 


UANADA  MEDICAL  ASSOCIATION, 

MuNTRKAU,  23rd  July,  1ST9. 

DiAH  SiEi,,— I  beg  to  inform  you,  by  direction  of  tlie  Preaidout,  Dr.  J.  D. 
Placdonnld.  Ibat  iu  cousequeuci:  uf  tliu  openlug  of  tile  Provinulul  Exbibi- 
ironti),  on  the  ;ird  SeptembA'  by  their  ExcelleDL'iea  tbo  Oovemor- 
ncral  and  H.R.U.  Uie  PrincHKe  Loniie,  he  boE,  at  the  ruqueitt  of  tievanU 
sabers  of  the  Asanciatiou,  decmoil  it  advigablc  tu  /mtf^xirw  the  Aaniial 
EUeuting  until  Wednesday,  the  lOtb  ol  Septiiinber  next,  ut  place  of  appoint- 
Ktaent,  Lunduu,  Ont. 
■  A.  H,  DAVID,  M,D., 

Omeral  Secretary,  Canada  Midieal  AuociaUon. 


A  Pen  wobth  Becommendino. — We  have  been  favored  with 
samples  of  the  celebrated  Spencerian  Double  Elastic  Steel  Pens, 
and  after  trying  them  feel  justified  in  highly  commending  them 


&?6 


CANADA   MSnrcAL   AND   SUKGICAL   JOPRSAL. 


to  our  readers.     They  are  made  of  the  best  steel,  and  by  t) 
most  expert  workmeD  in  England,  and  have  a  national  repiitatio| 
for  certiun  deaii-able  qualities  which  no  other  pens  seem  to  ban 
attained  in  so  great  perfection,  among  which  are  uniform  even 
nesa  of  point,  durabiUty,  flexibihty,  and  quill  actioa     It  is  Utq 
quite  natural  that  the  Spencerian  should  be  preferred  And  u 
hy  professional  penmen,  in  business  colleges,  counting-n 
Govermnent  offices,  public  schools,  and  largely  throughout  t 
country.     Indeed  so  popular  have  they  become,  that  of  t 
"  Number  One "  alone,  as  many  as  eight  millions  are  sotj 
annually  in  the  United  States.      ITie  Spencerian  Pens  may  b 
had,  as  a  rule,  from  any  dealer ;  but  when  not  thus  obtaiDabl^ 
the  agents,  Messrs.  Ale:cander  Buntin   &  Co,,  345  St.  Pa^ 
Street,  Montreal,  will   send  for  trial  samples  of  each  of  t 
twenty  numbers  on  receipt  of  twenty  centa. 


Jftedical  Jtems. 

The  Bummer  course  of  lectures  at  McGill  University  wfJ 
largely  attended,  and  closed  on  the  11th  July  instant, 

A  number  of  medical  gentlemen  proceeded  to  Quebec  on  tl 
28th   instant,   to   confer  with   the   Committee  of  the  House  fl 
Assembly  touching  the  new  Medical  Bill.      It  is  strange  thej| 
were  all  University  Professors ;  there  was  not  a  single 
vidual  representing  the  outside  profession. 

John  B.  Lawford,  M.D.,  CM.,  McGill  University,  18tJ 
passed  his  primary  professional  examination  before  the  Roy^ 
College  of  Surgeons,  of  England,  for  the  diploma  as  membf 
OD  the  9th  inst. 

David  F.  Gurd,   M.D.,   CM.,  McGill    University,   187^ 
passed  before  the  Royal  College  of  Physicians,  of  London,  i 
received  the  License  of  the  College  on  the  9th  instu 


-«t^^«v»^^«  *--  - 


WHOLE  No.  LSSXrV. 


JITLT,  1879. 


I 


CANADA 

EDICAL  AND  SURGICAL 


(Conttnta. 


'piM.. 


SSI 


i,..,™..-Uj  W-3. 
-iiiuti,l^ni.,iLl^..il.ll.C.S.,Et>g.  534 

ftUttor,  .I.S 636 

jva  HoTicie  or  B»nKs. 
lu   Ibe  (JualltHtlvo   unil 
jQAntitntlrc  JUialrBin   uf  the 
KUiiiit;-— By   Dr.  C.  Scubttu-r 

rl  Dr.  J,  Vofcel S48 

'  :•  Thcrnpeuticg  nnd  M*> 
Lteria  M^kn— fiy  Iki<>t.  Fur- 

^pbonon,  M,D 049 

jOIIcb]  MuiUBl  of  tliiT  Olncwcs 
If  Children.— By  Kditd.  Elllx, 


.  nsa 


At-'tioii  iif  lodofotm. i 

V^'f  ril   rllMitrplnam  Mnrintlcam 

in  Chililr«n'4  Illimui^ S 

["Kivriitlon  of  llelapsei  ro  t^pTioid 


KevKi 


TTi'.itmpnt  of  Iinpirminhlo  fltrle- 

turc  ot  the  UrsUini 5 

Scatu   Ptvutjarltixii  In   the   niglit 

Swi:uts  nf  PhtbisiB S 

CjstSliii  li;  CiiritMgloij f> 

TrBiimnU>:  TrWuun 6 

Wlien  HhKll  the  Ljrlng-in  Wama 


R«t" 


t'bloTHl  Hydrnlc B 

Deaf- Mult  mi ( 

C}'BU<.'prt.'i  iij  til"  Brilii  <1UgnoMU 
(mtcil  during  llfi; 5 


iiimendlng 5Ta 


nunuiilcAtioriH,  Kiehnugt*,  nnd  Booha  for  Review,  mutt  be  nddrcsfed  to 

^^EdltoTjOio.  K.  Fw<wicE,M.O.,  Dnwor  3Se,  Pu«t  office,  Montn«l     Oom- 

iBtUoicailtina  r«r  inMrtioa  must  be  reoelved  licfocR  the  I5lh  ol  tfca  month. 

I  cummuiticBlions,   subseriptloiis    und   wiv«n.lMmntt  chould  he 

FiddnrtMd  to  Iltv  pabliaberi. 


[nuXTED  AXl)  I'l'IlUSUEti  BV  TUE  liAIETTE  I'BINTISO  CiMP-VM-. 


"^ar 


a^^ffa^Tgr-rfiirgfei 


J 


SAVORY  &  MOORI 

PANCREATIC  EMULSION, 

THE  MEDICINAX  FOOD,  FOR  USE 

IN  CONSUMPTION  AND  OTHER  WASTING  DISEASES. 
PANCEEATIC  EMULSION.wh....  th.-rougiiiy  known,  u, ; 

tnUc'  )irc-tr.'dL-iR'i-  ••!  iJi>il.iLfnr  Oil,  lnrrB»«<m 'iflU  inltiidiiddL' 
Si'Iiii  t'liti  i;]|.p  iliu  ej'ilfiii  insinn<li>i  f.hn  BVWiMPWil  fliti J  ' 
Ho  Oilv  Emulsions  of  uny  kind,  nor  oven  Cnd-ln. 
ftan  •npplr  tne  ..  '--r  i.niinii  nnii  vigorou- 

In  tddUinn  to  1 1  lonx  ara  llabln  tn  !.v, 

looiit  <>r  ihem  1^1' 


l!<.n  ■ 


I  ultim 


.  -irt  by  Iht 


PANCEEATIC  EMULSION  (rn-j)^ 


■Hyfto-(^allc<i),bUir  n 
inoit  relialile  furm  nf  mi: 
I  ■  I.  i  •! -..ii'  tip  PhTtbimij  nrothBr  wafttioK  Iv 
<-  I  i^-t>'.i:~  I'ur.  in  uxHunllnlly  Ihe  ■■mx^nditi'iii 
-i>r()ti<iii  n-<  in  a  Tignrous  hamnn  Tramn.  and  ilii! 
cbmige  in  Lhe  untnrnl  ^ncretlcm  of  Ihc  Pnucrut 

PAKCEEATI3ED  (DiRestive)  COD-UVBE  OIL.    By  . 

bining  tbp  rdHfreslTo  .Iiiiee  with  the  Oil  tho  dij^e.Dua  .if  lb*  If 
ca>ilv  Jinil  rapiJlr  ..■fl«Glnd,  [itiuaeu  U  jiri^veiit.'d.  nnii  thd  bei 
pniiiprtu',-  of  Ibp  Oil  urn  Jncri:flBBd. 

PEPTODTN,  for  INDIGESTION,  is  a  combination  of  t. 
whole  of  the  digestive  secretions— Pepsi ae,  P^ 
creatine,  Diastase,  or  Ptyalin,  &o ,   rurmifig  f 

iLivaliiiiblP  r.iiiiwiU  in  \b<!  tr"«itneut  -f  nil  I'-iron  ol  DyspeiiMk,  a-  "" 


PAWCEEATINE  WINE.  Th.,  Wino  i.  a.i  oxix-llool 
-. -■Iiii.leliiv  tiikiniiL'ijil.hrarOil.  oudpiomotioit  Ibe  digei' 


PEP8INE  PORCI.  I 
PEP8INE  WINE. ) 


SnldU 

Sm«m  Bo' 

MMl 
nnluMr' 

Inbi 


IhesB  well-known  BttnsiliMfor  loiM- 
pestion  rnurflaenta  tbo  digBstiTC 
principle  of  lh(!  Gastrio  Ji ' 

THE  BEST  FOOD  FOR  INFANTS. 

As  supplied  to  the  Eoyal  Families  of  ' 
ENGLAND  AND  EUSSIA.  

TUE  UIOEST  AMOUNT  OF  NoUUll^UUKST  IX  1 

MOST  DHjBSTaBLE  iKD  COKVEKIBNT  POKl 

J(,-f.:mbh-£M,:fh<r:i^i!k  more  dos--l!/ than  an>/ other  A 

FOR  ASTHMA  and  CHRONIC  BRONGHIl 

DATURA  PATULA,  a  i^nwortiil  11T..I 
liemedy. 
"  By  iuitredialL-  ooatact  with  »ic  oelli)  Uid  piuisagea.  laslant  relisf  is  ffin 
Db.  Latham,  fhnticiaa  to  the  §u(en. 

"  A  iBmedf  ut  greal  power  add  u-ielQliiMa  111  A.«thmB,  Obronlc  Ilroaoultiy 
Dr.  W.  I'ABGtii. 

''  The  Kiuoke  cauie^  uu  nanaan.    1  bave  never  kauwu  an  iostsnoe  in  ^ 
leliof  WSE  not  obtained.— GnKBKAL  .\LeZAtiDEB. 

lu  Tins,  fur  ose  by  inoaad  uf  a  pipe.  Cigars  and  CigaroiiDS,  onA  PbAHh 
Inhalatiuu.  4 

143  N£W  BOND  STREET.  LONDON.  W..  &SD  ALL  CHEMIST 
THaOUQHOUT  THE  WORLD. 


^^1 


OMMER'S  EXTRACT  OF  MALT. 


The  rapidly  increasiaft  demand  for  onr  Impritbi'  Extract  of  Malt,  during 
the  four  years  ibat  it  hu  been  manofRctureit  .lod  ullcred  to  the  medical  priifeesiun 
in  AmerioB,  judtiSes  tbe  belief  Ibuc  lu  its  production  here  we  are  ineetiog  a 
geaeratlj  felt  want 

hoof[  eiperii'iicL'  in  raanDJactaring  Mnlt  Extract  has  enabled  ns  tu  ccimpletely 
overcome  ihe  muDj  difficalties  attendinf:  il«  maaufocture  in  large  qnactitf  :  and 
ve  positively  assnre  tbe  proreasiiin  that  oar  Extract  of  Malt  in  not  only  porTeotly 
pore  and  reliable,  bat  that  it  will  keep  for  rearf ,  in  any  climate,  wltl  out  ferment- 
ing or  molding,  and  that  itii  flavor  actually  improvBH  b;  age.  Onr  Extract  ig 
guaranteed  to  eqaal,  in  every  reapect.  the  best  German  make,  n'bile,  by  avoiding 
the  expenses  of  importation,  it  ik  afforded  at  lean  than  half  tbe  price  of  the  foreign 
article. 

The  Mait  from  which  it  is  made  is  obtaineil  by  carefully  malting  the  very  best 
nality  of  selected  Ton)nto  (Canada)  Burley.  The  extract  is  prepared  by  an 
improifecl  firocrstt,  which  pvevenls  injury  to  its  properties  or  flavor  bv  aicesg  of 
beat.  It  representB  tUe  soluble  coustitQentB  of  Halt  aiid  Hops, 
Tie,,  Malt  Sugab,  IJextrinb,  OiAflTASE,  Kbhik  and  Bitter  of  Hops.  Phospbatbh 
OF  LiUB  and  Magnf-sia,  and  Alkaline  Saitb. 

Attention  is  invited  to  the  followitig  acalyBis  of  thia  Extract,  aa  given  by  S.  H. 
Douglas,  Professor  ol  Cbemiatry,  Dniversity  of  Miobigan,  Ann  Arbor ; — 

TROUMEB  EXTRACT  OF  MALT  CO.— I  encloie  herewith  my  analyeiB  0 
year  Extract  of  Malt: 

Malt  SngM,  45'1 :  Dextrine,  Hop-bitter.  Extr<ictivB  Matter.  3-3'G;  Atbaminons 
Matter  (Diantaw),  2'469.  Aah— Phoanhatts.  1712:  Albalien,  -377.  Water,23'7. 
Total.  9a-958. 

In  comparing  the  above  analyiia  with  that  nf  tbe  Extract  ol  Malt  of  the 
GermBQ  PbarmacopcBa,  ak  given  liy  Hager,  that  baa  been  generally  received  by  the 
profession,  I  find  it  to  sabstantially  Bjcree  with  thi«  article. 

fours  truly,        SILAS  H.  DODGLAS, 

Prot.  of  Analytical  and  Applied  CheroiBtry. 

This  invaluable  preparation  is  highly  recommended  by  the  medical  profession, 
aa  a  most  effective  therapeutic  agent,  for  tb«  restoration  of  delicate  and  exhausted 
eonatitatioas.  It  is  \erj  nutrttiau^1,  being  rich  in  both  mn«cle  anil  fat-producing 
materials. 

The  very  large  proportion  of  Dia4to»e  renders  it  most  effective  in  those  forma 
of  diseaBe  oriplnBtiDg  in  iiuperfeet  digestion  of  the  starelis  elejiwnts  uf  laoa, 

A  ningie  dose  of  tbe  Improved  Trommer's  Extract  of  Malt  contains  a  larger 
quantity  of  the  active  properties  of  Malt  than  apint  of  the  best  ale  or  porter;  and 
Dot  having  undergone  fermentation,  id  abBvlutely  liee  from  alcohol  aud  carbonic 

The  dose  for  odultn  is  from  a  dessert  to  a  tablespoonfnl  three  times  daily.  It 
IB  best  taken  afl«r  meals,  pore,  or  mixed  with  a  glass  of  miU.  or  in  water,  wine, 
or  any  kind  of  spiritnous  liquor.     Each  bottle  con  tains  li  lbs.  of  the  Extract. 

Our  preparations  of  3lult  are  for  sa!e  by  druggisls  generallfj  througliou/  the 
United  States  and  Canadas.  al  the  fittoicing  prices  :— 

JlxTHACTOP  Malt,  iTith  Bops  (Plain),        -       -       .       -       -       -       $1  00 
"       "      Pyrophosphate  of  iron  (Ferrated),     ■       -       -       -      1  00 

"        "       Cod  Liver  Oil, 1  00 

"       "      Cod  lAtier  Oil  and  Iodide  of  Iron,       -       -       -       -     1  00 
Cod  Liver  Oil  and  Phoi^horus,         .        -        -        ,  1  OO 

Hupophosphiles, ]50 

'■       "      Iodides, 1  50 

■'       Jltei-aiives. I  50 

"      Citrate  of  Iron  and  Quinia,     -       -               -       -         150 
Pepsin, 15'' 


TROMMER  EXTRACT  OF  MALT  CO, 


SALICYLICA 

The  Celebrated  European  Salicylic  Treatment. 
NO   MORE   RHEUMATISM    OR   O-OUT. 

ACUTE  OE  CHRONIC. 


SALICVLICA.  SUltE  CURE. 

MANUFACTURED  BY   THE 

European    Salicylic   Uedicine    CompanyJ 

F&aiS  AND  LEIPZIG, 

IMMEDIATE 

N™  Bidusi.-.. ,  ... . 

SUplB.  Humlew  and  Keliable  KetoBdr  ua  LotbouDtiDeDtB'    Tbe  ULgbent  Mediaal  Aauisnl 

III  ParurapoTU  'jS  onres  outuf  liH)  coaeii.  within  throe  dnye.    Ssorol— Tbe  only  digaolTorS 

■    and  (}outT  P«tier-      °  — 


ity  uteri, 

Htitbiu  throe  <: 

THESE   ARE    ITS    CARDINAL   VIBTUBS 


SALICYLICA." 


4ih.  It  is  a  diaaiilTer  lud  oliminator  at  oalr  1 
irioue  depoeita  in  ttie  haman  body. 
5th.  Iliatheonly  KMMINiToaof  thoUWO 
nin  in  the  blood  whioh  Ib  tho  prims  OMua  dI 

thlB  polBon'oiu  ooid  off  ^rou^  the 
uriuary  ahaimeL 


Rsmedj  BtBiDds  far  aborBallotben,  ottiHgui  mtk  il 

remodrBhouliihavBthBpnfefenee  to  the  eufunsn  q/' oil  oi W«i 

cambined  advanlMrea  (A— 

ai  iriiU  as  Dhronic  Rhennu- 
<f  tha  worit  kind  and  loDcBn 

SpeciSc  of  Rheumatism  kdiI  Oout,  cither  acute  ot-| 

Eubdueil  almost  immediiitelj  after  ewallowing;  ^4 

irritating  Bctioa  on  the  Btomachv 


EUROPEAN  SALICYLIC  MEDICAL  COMPANY, 

PARIS    AND   LEIFZIQ. 

Please  ueud  for  Pam]ihlets  mid  Price-List.    AddUreas — 

WASHBURNE   &  CO.,    Sole  Agents, 

Only  Importers'  D$pot,  212  BROADWAY,  NEW  YORK, 
Jbr  sale  by  LYMAN,  SONS  &  CO.,  and  H.  HASWELL   &  CO-, 


DR.  L.  D.  MCINTOSH'S 


Electric  or  Galfailc  Belt. 


iribi 

pcrfaction  tliBtiwsinKil  iB  coarlncinv  proof  of  its  (r«al 
twknovlBiUe,  alinoat  uniTansUr.  fUeairo-TbeTapaaCici. 

Tbla  oombiiuitiaii  is  dompOBed  of  ilxteen  oatls,  |iliio«d  Id  poolcsti  on  a  bolt.  Each  mil  u 
nude  of  hard  rulcuiiied  rohber,  liaed  with  a  copper  cell,  nhioh  conEtUute  ihe  nagaiivo  Plata. 
ThantbherooallnKperfeatljiDBalataaeBahcslI.  The  poeitive  plstwi  are  <if  line.  irrHpiifldm 
■  porous  material  lo  abioib  the  eidting  fluid,  aad  pTerent  cantaet  with  the  ooppet,  ami  pec- 
nut  Che  oarrent  to  put  from  the  sapper  to  the  line. 

Thus  the  eelli  are  abaned  without  wetting  the  belt,  and  the  dlHOmfbrt  roIlawiiiK  to  tbe 

,  patient.    A  wiie  it  soldered  to  aaah  linc  platei  vhlcb  coaneats  nith  the  copper  aell  b;aDtar- 

ioB  a  tabe  on  its  aide,  thus  Feiiduciiis  tbe  belt  pliable. 

The  HalntoihElBOtrioBeltisauperior  tnall  at  hoi 

It  is  Qomposed  of  sfileen  cells— Ihua  giving  a  potri. _ 

■tranged  that  one  ax  more  cellii  eao  he  mod  nt  pleaiun.    There  ii  not  anrthinf  initating 

Teak  aoids  and  plnised  next  toths  tktti.    The  eleetrodet  are  pieoea  uf  metsl  covered  aimilar 

amngement.  a  current  from  the  belt  can  be  epplied  to  produce  a  general  orloual  eifwl., 

the  DrDfeBiioD. 

Oar  pamphlet  ud  Medical  Electricity  5ent  free  on  applicati'iu.    Address 


MclNTOSH  GALVANIC  BELT  AND  BATTER*  CO., 

lg2andI94JackpoiiSt..  CHICAGO.  ILL. 

Dr.  Wadsworth's  Uterine  Elevator. 

The  most  simple  and  practical  of  any  Stem 
i'Pessary  ever  invented  ;  made  of  India  liubber 
vnthout  lead,  unirritating,  of  easy  application, 
and  imfailingly  keeps  the  womb  in  its  natnta 
position.  The  first-class  physicians  in  Providence,  and  emi- 
nent practitioners  in  almost  every  State,  highly  recommend 
it. 

A  pamphlet  describing  it,  and  testimonials  of  distinguish- 
ed Physicians,  also  Price  List,  sent  on  application. 

H,  H.  BURRINOTON,  Sole  Proprietor, 

PROVIDENCE.  B.  I. 

8^  Also    for  sale   by  dealers    in  Surgical   Instruments 

generally, 

I  have  used  aliout  thirty  ounces  of  Cincho-Quinine  iu  my  practice, 
and  like  it  very  much.  It  can  be  made  into  a  syrup  for  children,  and 
ID  this  form  I  employ  it  largely, 

U.  N.  Mellktte,  M,D.,  WiUiam&hu.rq^  In-d. 


mportmit    remedial    agent    ever    presented    to    the   Profeenon   | 
Indittestion,  Dyspepsia,  Vomitine  in  Pregnancy.  Chnlera  lufaninni,  CunBtipatio 
and  all  di9eaf;es  arising  from  imperfect  nniritinn.  cimuiiiirp  tbe  fiva  sotivB"" 
agents  of  digestion,   vie  :     Pepsin,  Pancreatine.  Diastase  or  Ve|r.  PtvaJin, 
Lactic  aoil   Hjdrnchlciric   Acida,  in   combinstion   with  Sugar  of  Milli. 

FORMULA    OF    LACTOPEPTINE. 

Sugar  of  Milk 40  onnoBB  I  Vpp.  Piyalin  or  bia9ta»e-4  draobmB.  M 

Pepsin a      "         Lactic  Acid 5  fl    "  ^M 

Pancreatine ^      "       I  Uj-drocbloric  Acid. 5fi     "  ^M 

LACTOPEPTINE  uwe^  ita  wtea-t  sncetsi  solely  to  tbe  Medical  Profruian, and  ii  ««3 

■ImOBC  enlirelAy  Physioiaiw'  PrMoriptmnc,  lu  nlmoBl  unitfrpnl  adopiido  by  thci  profeuim 

The  ondendgned  luTlng  leitsd  LAOTOPEPTDIE,  KoooniMd  it  W  the  pra&uioa. 
ALTRSD  L.  WOMIS.M.  D..  .  F.  LE  RoT  SATTERLEE,  M.  D.,  Pa.  D. 

fivfeKorof  Paihtil'^  ond  Praelirtiif  MrA-t        ••''"•  ■        ■  — 

ion,  Ottirtrnia  of  the  City  q/  If*"  "  "' 
LEWIS  L  SAYRE.  M..p.j 


/'™/..rf 


A.ViB  DiTMfcMD..  , 

Alban)'.N.Y..Jiine8lh.lSTB. 
/W.  </  tie  Prin  'inrf  I'ne-  if  Sniv- , 
AlUmvMiii.  Col.  !  Sun>.  Albany  4 
St.  Pcltr'n  HolifnU, 
JOBN  H.  Packard,  M.D. 

PbiUdelpllia,Pa.,Miiy3(Hb.l87S. 
Pnt'lPa-  Co.  Oitiri.  Snriaiy:  STtrntm 
Efinfopaland  Womrn'i  Bofiilalt. 
IM.  AiTEiv  MirsB,  H-D., 

Phil>dali£l*,  JuD*  20tli,  IBTS. 
Fnf.'ufllie  Int.  </ JAd.  «*«i  J»™., 
Jiff.  Utd.   Col.:  Phv-  I"  ft«'i.  Bo: 
W.  W.  Diiraan,  MJ).. 

Cincinnali.O  . June2let,187B, 
/W.  Prill,  i:  /Vqc,  Snrp.  Mrd.  Col.  <4 
GKio;  Surv.toOoad&imarilaiiBo; 

AlbrriF.  a.  KiKOpM.D. 

Waahin^-  "  ^    '— 
Fn/.iif 

D.  W.  TakmUbM.Dj 

i^y.  Iff  till 


W.  ./  CMrm.,  Mat.  Med.  and  TAtroB.  in 
lAf  .V.  y.  CWif-iM-Aiu.;  /W.qf  cEn.. 

IVm.  R.  PERCY.  M.  D.,       ^^' 
V.  Mai.  MhI.  ,  ScK  rork  Mtd.  CoUi 

"I  bave  riTM  LACTOPEPTINB  a  gi 
thoroogli  trial,  and  Iutb  besn  cmtljr  pl«ai 
witbclie  escellfDl  r»ulu  that  hare  fvAowed 


June  19lh.  1878. 


•'Ihaveosed  LACTOPEPTINB  both  in„„ 
and  private  imc lice,  and  hai-e  foandil  toai 
folly  the  parDoaei  for  wbioh  It  !■  no 

As  an  immediate  aid  tu  tin  dicaatire 

know  ot  QU  remedy  which  aota  more  dlreottv-" 

"  I  have  made  macb  an  .vf  LACIOPEPXDIE, 

_ fehaJI,  of oounB?(!ont 

Uooe  to  iirencribe  i^  " 


,  Ky.,  kareh  Ttb>  1878.      I  and  lake  greai 
iritnct  A  An  Svrg-.nnd  I  rarely  disappoi 
VnivertUj/  c/  LimimUe.  J  tiaire  to  prescH 
BoiT.  BimtT,  MJ>.  1 

"---  "-     ' — -lb.  1878.      I       -'I  have  nfied  LACrOPEPTIXE  ii 
•,  Ailnnla  t  DyipepBia,  with  gatiifacliuD.   1  think 


,-    'dlMetr 


CUUP! 


■i.i.M.D.,LL.D. 


MobilB,  Ala.,  Juu 


Prof.  H.  C.  BiRii-Err,  Ph.  D. ,  F-C.8 
London,  England. 

Febnury  SAlh,  1 87 
PRICE  LIST. 

LACTOPEPTL>IE  lin  <,t.  bollluf), . , . 


1  preparation  of  . 
i  ployed,  and  for 
J  know  of  nothini 


troi.|1.0 
■  dot  liui 
•t  lb.  K.0 


mole  a  healthy  digMtion." 
I  We  also  pr^are  the  viiritms 
Elixirs  and  Symps  in  combir^ 
I  ation  with  Lactopeptine.  ' 


THE  SEW  VORK  PHARMACEUTICAL  ASSOClATtOSj 


TrHypodermic  Syringes 

'-^^  B-mr^ 

TlirHP^'iiK  (I»<i-iliinl-  iLiL'  oftii^  Bicu)  n-iiri'ti'nt  a  duk  lEyiHtdcrmlnSyrinEQ  of  niir  iiii.ii- 
urarlTim.  WilMlii  <>.' i>li«ii  of  [he  needles,  it  is  uf  Ijirmnn  SILtci— auutorial  choWD  u 
piiKi.i'~^iriv.  iM'tt  ri>  -rr  .<[.  ihv  BTOitMt  rigidity  uid  dambililv,  while  Tree  t'ruin  liability  to 

o^viLpjI '1^11'  ^.11  u' I  I-  hinneii  by  jl  prooen  peouliar  to  oniwlyos,  RecnriDc  anifonnl&pt 

™\\hr,-  "III -.,1,1 1  i.iiiii  or  Biaa.    It  U  iilsUd  initide  aiui  outside  with  Diokel.    Tha 

l»funi  I-  I  Ml  kv'l  111  ii|.'  .{<.iilili>  psnobute  form,  with  leather  prep&rsd  oipreealj' Ibr  tfaepar- 

wf,:     li  mil  I...  Ti i  III  taUiin  ill  BJMtiDity.  to  QpenUe  imaothl)'-  to  reaiatui  teDdeDoy  of 

fluid  III  rill-"  hIiovimu  nl'  Kirhelowit.  A  ninely  nnienTBd  ihIb  upon  the  piBlon  n>d  iadioates 
iniiiiiii!'.  Ill  11-1 V  beiuii  the  o»piioitj' of  thesyrincai 

S>  riiLL'i-  \iw.  2,3  and  4  have  aIh)  a  roieir  thread  upon  the  piiton-rod,  soda  trarem) 
Tiui.  ihiTi'liv  liivoriDK  the  Dtmcxl  nicety  in  the  (raduatlon  of  dosei. 

No. :',  ''iiiiinitEt.  Iiaa  halUnr  piaten-rod  to  reoeireana  ooedlBi  aim  a  pruteotiog  vovur  and 
Kiiiil  ri'iHiiiir:  it  niay  bv  lurrii-d  in  thu  Pookel  iDstranienE  or  Vial  Oaae,  ur  without  lUiyoaae. 

N-    I.  I", I'll. I'  I.  i-  !i],i'  \<i.    ;.  I'iil)  the  addition  of  HiSMOcd  needle,  uBTriod  nrnn  the 

^   -   I  II  ■■  -■  I.-  !■  .1   ill- .11  iiiTin'i'iioiiroreiliiMe.  with  vial. 

I" ill      II'   I  mill- i  >viih  eM^h  inBtniniBnt,NoB.1.2andt:  one  only  with 

''I.         I    '  '    II'    .1  i.  :  I  .  I  'i.'i  I.  I  iniNJly  leiauered,  tuid  thuroughly  pUdid  with  (old:  thay 

,    ieiuiircwi.i'iii'i,  iij'j>i>ni.,imi.mM.''Hiiil  ihural'ore  «au»e  leait  pain,    jtt  the  point  ol' union  with 
the  flouket  llxiy  iltl'  reiut'urmid  willi  an  ontsr  covariiig  ol'  llernuui  Silnr.  tliBrabr  oiereominK 
I         tbe  lendeany  lo  beoDOie  brukea  M  thin  pUoa.    Thoy  uta  eonneutnl  vtitli  the  harrelji  by  ■ 
■eren  thread. 

PriMW  :    No.  1.  M.aO.  No.  Z.  M.OO.  P(ulj.«o.  .(B. 

^^^  "        No.  3,    a.ae.        Nu.  4.    s-so.  .oa 

Tbp^i-  .Syrlmnw  nro  sn  Ihnriuighl)'  and  utroniily  niado  sj>  In  bo  Treo  frnin  IfiP  nnnoying 
bitl'y.iiiiil  iii';Dly  orviiiintnioliaii.  they  haro  noauporlor. 

OtheF    Hypodevmic    Sypinses. 

N'i>.  T.    ;  I      'i.  I  ■  ■  I  "11  bmTol,  witli  acrow-nnt  im  ointpn.  niokel-plJilPd 

1.  ..in  ueatflSHi »».CM».  poaliiHu.  .02 

N,i.  >  iiibored  on  nistaD-rod,«itb  (iprow-nnl.twu  b«sttitue 

HI II  ■ ■   I' ■■■■ »S.0O.  ikwUko. -OZ 

No.  :,.!  ■.'    .i.i!ii.,...-;ll.  ,i:,ii.,L..aii,,;,ll.:^,  either a.«o,       -         .02 

(Jo.  111.  dm,.-.  I.ii..|'3  IKrpm:li)  icr>i.luiiti<m  lu  No.  »,  oni,  ^obl  iw.-itl,.  iiiiil  r..,.  f(,.i.l  notdlii^,  ail- 
No.  ll.Kbis.1  uylinUon  foneatratod,  niokcl-plalBd  nieiiil  iilinir.  loin-ir.ii:.!  tu  shuw  tjjo 

liriuhiiifionp  forminlma.  The  innntment  may  ntiuliK-  Ik-  tulirii  uNiir  I'nr  .-IpjininK-  iinil- 
for  thoBo  whii  iitefarglasa,  ia  recommondedfocitiinoii-iijiliiliij  i,i  lirii.ikiii:i..     I'ripp,  with  two 

beat  >te?i«ilt  needle*,  in  II  neat  ewe 83..1U.  ]>oBtaita  .IS. 

jpy     Any  qf  (Ae  about  viUi  In  tent  hg  rftirm  mnil  on  rtctipt  qf  price  and  juMage. 
Bypodermle  Syringes  af  all  Undi  promptly  Tspalred, 

Our  now  ILl.USTIlATBri  I.HTAI/VIOE  OF  flURIlIf.tT.  INRTRH.MRNTS.  iilao  a  now 

Eln-'h.'  ll.-,  .'r-l.^i-'M.  ii'  U-- N-'iii.".  'li'.'m'i  I  "Ml'.';,      'ii  'ii";'  i'       '.^i^i.-l-/'iyiibiilmo- 

Aiii'iiiriiii-;  '\-.',. .' \'n'!.-"i'iMi'i.'.'ih'i'nvn  -i.i'i.'i,"-  '   \".  h  ii'iMi'i   ii'i-ir.ii'i '- ;'   Wiildonbu'l^'a 


CODMAN    &    SHURTLEFF, 

Makers  1  Importers  of  Superior  Surgical  Instruments 


I 


1    CATHARTICS  and  LAXATIVES. 

GRANULES.           ^^| 

udanlrihsbF<tiaM<r[>li>nen)pli>Tw1.  V.luva 

Aloes  and  Ujrrh. 

iloin,                                                                   1  P-. 

Aloio,                                              1-10  HCKl  iSP 

ArseiuoBB  Add,  1-60.  i-4'i,  1-30  and  MOjfc. 

UelladoQiu  Extract,                                 1-4  p. 

CslDSMl.                           1-2,  I,  3,  3  and  6  gn. 

Su  u>u  oa  Mid  X.u»u.  ouoBMiiiv  p*9B 

CodeU,                                      l-IGaDd  1-d  n. 

Hydramia.                                                 I-J  gr. 

Uercury,  Bb-Iodide.            1-25  ood  I-lKjp-. 

Msreury.  Proto- Iodide,        1-5.  1-4  and  l-J  Rf. 

Dinner,  L»dy  WolwlPr'B. 

Hooper's,                                       a  i-a  nr!*. 

our  ana    libinWry  six]  benw  Qur  uUli  va  bik* 
■olaUa  wd  eObMIn  [bu  Uia  ImparML 

Maroiir;,  Ijyanide,                                      1-80  p. 

Vodophyllin.                      1-fi,  !■*,  1-3  and  1  ^r. 

Uorpliifl,  Ai-etalo,                      1-8  ami  1-*  «, 

PodoplijIllQ  and  Blue 

Uorphiu,  Muriate,                                    1-8  n; 

Podoptijllin  and  Leptandrin. 

Morphia,  Sulphata,  Mfl,  MO,  l-S,  1-6, 1-4 gr. 

rodopliyllin,  CapBiCHni  and  BeUiirfoDu« 

Marp'hia.ValeriaDBie,                               I-g  ^. 

Podopliylliij,                              i-s  and  1-1  gr. 

Poke  Kool  CoaipQund. 

Strychnia,          1.100,  1.60,  1-lOaad  1-30  p. 

Rhubarb,  U.  S. 

Sulphur.  Iodide,                     1-15  Hud  MO  gr. 

Tllmbarb  Compound,  U.  S. 

Tartar  Emetic,               t-IOO,  1-20  and  l-t  p. 

Ziuf,  Phoapbide,                l-fi."  1-4  aad  l-J  ft. 

IMPORTANT  FORMULAS  OF  GELATD^B-COATED  PlUA 

>a  and  Iron,  3  gra-  |'    Ceriiini,  Oxalate,  1  and  >  nt, 

H  a  TTiiwIr  Id  the  rick.  Btomjufa  oTpiHnMl'i 
(s  WON  H  In  rtaiaUlI.  Uyaterii,  PrntSat 
Djipejiiia. 

and  Oleo-Roaia  Cubeb, 
tbEH  InirKtlmi 


Animomum.  Talerianali 

Anli-BUioUB. 
Anti-Dyspeptic. 

Aasafislida, 
AsaaftBlidn  and  Aloes. 
Assaftelldo  Compound. 
AsaarcBtiftaand  Nui  Vi 

Uada  of  porinod 
OiBmuth,  Subuidate, 
Ulue  rill, 

Tbii  miHi  li  frvpurtA  no 
rhamuoopreU. 
CaUeia,  Citrate, 

Id  f^a  doBBs  ereiy  haur, 
IWDIj-un,  It  bu  been  tecommi 
pntenUia  Id  •Irk  beaduhc, 
psrladld. 

Calcium,  Sulphide, 

_Thl»  artiole  wu  mrj-  ilgl 


•od  Bgll, 


rr3,"'°v!r;sr; 


ffl»aer,la  fimL'i 
dud  Ibe  pun  of  1-1 
[ibjildu.  who  ta 


ibrniuy.  IST*.    Wi 
irfl*.  irlandulv  VDlArgemanta. 


Onlomei  Goia pound. 

Calomel  and  Opium, 

Camphor  and  llenbiuie. 

Coiocyuth,  Ipecac,  and  Blue. 

Camphor,  Mono- B ram ated,  2  e 

Uiod  In  tnutiDfaC  vf  SmnnunrfaiD 
nwommHided  In  cum  of  U<nb«l-An> 
■ansHitullyln  InBuilllo  Convolitoiu  IW 
IljrBIerla.  l[«HliurbD  tntm  nvet  itndy  or  m 
■md  NruipboDumU.  la  iba  latter  cuo  Ibsj 
glren  uadi  a  decMed  etttci  IJ  ftrodnccd  or 


trigpa- 

- -J  (!»fi* 

..y  *]lirliCdaeiiiibeM 

that  tlid  larger  jmipunkfn  la  j>awditndi;uE»ebBeiTtaL 
Hypoplioaphites  Compound. 

A  oonvenleaC  tbnn  of  AdmlnlitnUoB. 
Iodide  of  Iron  (Ulaneard'o),  I  ff. 

Freehlj  pn|iar«d;  eDperior  w  the  liDpvtIAd. 
Iron,  Diulysed,  3  m. 

Utde  of  Merak'e  sulee  and  (haul  twiinl;r  OaB 
UuitreagihcirUieeoluiVinBlB  uuirkct. 
Lithium,  Bromide,  i  V*- 

A  hetler  hypnolie  thui  Bivin.  Poiuh,  ud  doe* 
not  dcno^  toe  elouiach- 
Piperin  Compouod. 

PotaSBiura,  Bromide,  2  and  S  gn. 

Salicin,  2  1-2  and  i  gr* 

In  Acute  Bheui 


It  hu  boen  cUmeil 
CoraiUdfl  (eapparftUr 

Salicylic  Acid, 

Salicylic  Acid  and  : 
Roeommanded  la 
Chronlp. 

Zinc,  Phoaphide, 

nu  been  very  >u 
mnnd,  Koulh.  ud  c 


lai  ui  -The  Uniwt."  out  laM 
tn  bu  u  abiolaia  ii|wda>  la 
i  1-!  and  S  gn. 


■cRtlHilM  ft  HUHIUNS'  BEUnHE-CDI 


SOLID  EXTKACT8  IN  FUL  FOBH. 

Kon.— Tlwu  plUi  on  nuidv  from  Solid  Eilriru  of  ourom  mainfacturr;  lycahl]-  iirepired  b;t  Uie  tnoni 
npnfTid  motliuiU  tur proHrvlDE  'iM  Ihe  icUvt  iirlndplai  of  Iha  drug.  Tbie  li  a  duldr  urfnal  ImpUTUmw  lo  Lhi- 
nuta^oo,  ma  iuuny  cd  the  tolhT^xmcU  fuaua  La  trdrlut  km  k&owD  tu  wy  gnatJy  from  the  eumdiird  au^d^, 
wbUu  AOED^  an  aliDOflL  or  quLt«  li^nrl.  pLtbttr  from  aitA  Gpr<«t«ltf«B  mvii]b?4Dr«-  Tbit  Ia  e«[irriiii]y  Uie  dUd  wlIJi 
.Kr^A,  tAbiuble  JodJcJk  itflHodgDii^  H«nlAD«,  l.;oai  and  oUitirA,  whm,  If  oin  la  not  luwd  Id  liw  hIkiIod  of  tba 
flroaa  drug^  Uia  exUKCt  la  alioast  vaLucLau, 


Belladonna  Kxtrsct,  \-t  and  1-2  gr. 

Alao  granules  of  l-GOgr,  AOTpplJL 

Caniiuljiii  liidioi  Kxlrnul.  1<3  and  1  gr, 

Thaaa  |Xll3.  wbtn  wl,  axhlblt,  iu  a  markad  Diauior. 

t)ia  dlailncIlKi  oilur,  tuU  and  odur  at  lbs  Itoably 

made  eitnet.  V  e  tony  trum  ttie  V-  S.  Olap,  the  (bl- 

kiwtag:  "In  murbld  autea  of  Ihs  ajatem.  Ii  (Kit. 

lay  (jiuiDt.  la  cnmiiaH  Mrvous  iDqulMuda  nBd  lo 
niltv*  pila :  It  diasn  trom  a|iiumlD  ant  dlmliliMng 
Uia  ajiiwUla,  cbacklur  tlu  aecmlon^  «  runatlpjulii^ 
thv  twwota.  It  Liaa  bficb  Bpvdally  ncoismvDdDd  In 
ii*anlel«.  goul.  rbsuniaUaiD,  Isuuiaa.  euDiulilona. 
briMna.  ia«Dl*l  depr»«lgii  and  duUilDm  mmDaB." 

Oht  BDlId  EiDHt  la  mode  from  IreHBIj  Import*! 

>  imMiatlan  ot  IfaU  bjuun  la  Dmsiiiunn  ID  enable  Uw 
Pbyalclnn  Iii]udi{BDt>rr«ol]]ruriU«  vMus  oftblarom- 
•df.    Uocs  hj-yiAnu^kin  l>  ■  Soulb  JmeHcwi  plant. 

buMc  tiaiblib and (qilnm  ofolbn-CDnatilra.  [tim- 
parta  ttor  to  Ibo  -     -  ' " 

OslocyniK  l^oiiipi 
Of  Iho  V.  B.  I*h 

OMolaiia  Kx tract, 


i.  Krifol.)  3  KTS. 

ir  EiKuUn  wllb  gnat  tan  fMHB 

k  ijuiuitj  Mv  livah.  nIaclHl  £^1.  and  It  COD- 

if  Ergut  of  liyi^.    The  valne  of  Ereoilp.  In 

id  It  li  »)  V  larfnly  ad  ml 


andln^ro) 


......     ItlB 

at  or  Naui 


nf  our  tu«t  RllaUe  iHHtlllonera,  and 
Mf  of  ailendi'd  8ip«rU«i«  lo  Gyim- 
Dology,  avH-rl  tbnt  Ibuy  bsva  nerrr  Ibund  a  imuan- 
IkH  orErniViD  wbli^h  ibry  MtaamuulieaBadatico 
ulB  UaEuMn  ti  KobbUia*  KisoUn  PIU*. 
OuraalH  taavs  l«m  yny  largo. 
Fncus  VeaioHioBua  iixtrnti.  3  gn. 

^tbnughlbl>iii[Li.t»ii»<m.ltt,-<{  tMi.  IL.'  DnbUn 

MlanMlnlr  I'lilci.  -  V -    .  I  -  .:;i      II  BJipmrB 


Gelsemium  Kitract,  I  gr. 

Grindelin  Robiixta  Kitmct.  3  me. 

TUi  Solid  Eitraci  la  Ub  Um«n  tbe  ilrenglb  uf  tbr 
Harb.  Tbouwof  thlarainody  In  Hay  foTBr.ajid  all 
Aatbinalle  dllHraltlu.  bu  iDcnaaed  largely  In  lb> 
EuUrb  »UI»i  ami  Kodips.  and  Iu  ibanprndn  vilm 


adaaglb  of  the  d 

Ftlltw1tbiniindni»lnihtlrl>clngtbeiDuata 

mode  of  pri^aenUng  Uila  widvly  aaed  ud  uincb  Bn- 
prociatfd  renwdy,  aa  tb«  drug  vartoa  so  moch  In 
BtreBgtfa;  eoino  nrnpaiaOoBt  In  ibe  ninikot  >■■•*  MeB 
IbuiHrtoconBUtMrgdIfof  hnpurllloa.  Wdur«fq]tf 
eianilnii  mcb  ^iBmtiit.  and  aolKt  lb*  beat  iilcnii  tor 

gupariorandiuilfanniindlt)'.  ThgTalacoTOn 
la  many  pbaaea  of  alrk,  norvoua  and  aun  "-- 
K  ireir  na  In  NannlglD.  and  In  InttUkna 
rona  DieuibnnB.  bas  beooaiB  woll  kBowa  toprwtl- 
tJoDOTB,  And  Its  happy  aJTvola  in  IIUiTlKea,  1>yeealfry 
and  Undrcd  dlteasH.  ha*o  boon  atlwtsd  In  nilmwini 

HeobaDO  Kitraot,  I  gr. 

AleopUla  of  llyoaoramliie  ^raalnDldl  1-4  grain. 
Indiau  Uemp  Ritraol  and  PboaplioruB. 

A  good  naroodc.  wban  Uorplila  abould  not  bo  ad- 
in1bldUn3d.  and  nHsmmondiAl  aa  an  aphrodlBlao  lii 
tbaplaoe  ofNnr"— -      " —     -■" 


li  Kll 


Tboao  paia  pnwmt  ■  mr  amaptablo  fonn  uf  ad 
mlnUlarla^  tbU  powernd  DIaphnnille  and  rllnlBgognft 
Nui  Vomica  Eitract,  l-l  and  1-2  jrr 

Nui  Vomica  Extract  i,  Phfwpbonia. 
Opium  Hninicl,  1-4,  1-3  and  1  ftr- 

'  Mado  of  tbs  aqowui  aitnct,  wblch  1>  fonnit  lo  ba 


■nil  2  ^n. 

.,  .Mill  ulallng 

'ed  lo  bv  injKrttnr  Iu  tw 


StiDdal  Wood  Kitract, 

Tb>-ser>llla  contain  both  tbr 

In  Sandiif  Wood,  nnd 

oil  alond.  whilo  nioiia 
Suotbiil  Kxtnict. 


-vhen  usniiatlda  nil  benrtolbn  bwo  mneb  used, 
Tnlerian  EitraoC,  3  gra. 


(OiUUiiNATlONS  OP  IRON  IN  PILL  FORM. 


Iron  and  Aiwa, 

Iron.  Phoeplialo  and  Strj^hnine. 

Iron  and  lodororn, 

2gn. 

Iron,  Phosplinlea,  Quinine  aud  Sliychnino. 

Iron  Bud  I'liosphoruB, 

Iron,  PhnHplionis  aud  Aloes. 

Ima  and  Fotau*  (Blaud'a), 

:i  aiMl  B  Br,. 

Tron,  Phoaphorua  and  Nui  Vomfca, 

Sgrs. 

Iron,  Pliopphorus  and  Quinine. 

,  1  and  3  KfB. 

Iron,  Phosphoriia,  Qiiinine,  and  Sax  Vomica. 

Iron,  Carb-  and  Bui,  QuiniuP. 

Sirni, 

Iron,  Phoaphorua,  Quinine,  and  Strfdinine. 

Iron,  Citralo  and  Qniniue, 

1  and  3  grit. 

Iron,  Proto-Carb.,  (Vallet's).         3  and  6  gn. 

Iron,  Citmte  snil  Sirvohnino- 

Iron,  Quinine  and  Areenic. 

IroD,  DLa]7«ed, 

Iron,  Quinine  and  Nni  Vomica, 

Iron,  Ferrocjanide, 

-Igre. 

Irou,  Iodide, 

Igf. 

Iron,  Iodide  nnd  Sul.  (jiilnino. 

Iron,  Kedacturo  and  Su!.  Quinine,           2  grs. 

Iron,  Laclale, 

"r- 

Iran,  Vslerianato,                                       l  gr. 

roriHU  Booi,  Mmttiilgg  GOEflDtt  Uit 


ipeolfy  ■■  McKsaaon  A,  Itobblni  tl,  C,  llllj  "  on  their  pra- 

ESNO^  *  KOSBI.\S.  ei  FDlton  Klrrtt.  y,„  Ynrb. 

ud  hll  iMai,  htiUUl  i;cg  if^luUo.  | 


Rr  iT  if  V»Lt  r  ^*z  C'Tir^inTJi  Ak;Bii 


X-T 


ii  ■-•     -ir*cis  ■' 


»  TT 


*   •        .1 


.  ^    ..di 


•  -—I.. 


•    .  i.*_ 


-»••       .     ■       t        --.   .^-. r  ;.     ^3^ 

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rr -UC"                ."^   --^-    :.  -  .      -I.     -.,.,►    J.. 

"'t^" 

-iwiL    -             •-    — i-         4.    -  — «:.i-    -  .      —     - 

. 

••■-;       J— .:.    .      -             :.■.".■ 

- 

.iin*rrr     -      '  -       -     —               — .       -^     Zj..  - 

»••«• 

■•■  ■'     "*•      •-    •           .■".'..  -,.»..  ■    ...     »— 

^ 

tat^       .--£-         t--                .-       r— r       -w^,      ;_                 --I.-  ..  1.- 

k 

»    '■'.*    •   I                 ..u.    «!•    ~»     r"M  ^  --.    x"" 

—  ..*-. 

ATI — t*"^'  •■.     -cf.—  ■■■ 

■  .-    :.—    *-j,-.  _     -sv    ,-»■--     ,»— r     v-^^,   ^1 

-*■ 

**>■>■  "i    t.i        I  -    -.         ..-•"  ..:                r"    ■'._: 

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r.n 


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•.  ^ 


t.  -.'..-i.  » 


M--— ...— I  »*-' 


3Ull#f3l^    RiL 


:     ti.  :    *^ 


1 


«r 


Ol. 


:^  2UJIM 


-    «. 


LaaiT.  2!ii  2-Ijiet.  Innnre  -'Is. 


IS. 


jjon,  iilTCncmaia  -*is. 


.aion.  .Jinnna 


tttoi^iaic    -TijL-sa  -« 


i!W.'0.-.1'"~'i         — »^-VT.-. 


L  Hypodermic  Syringes 


0)0')-  ThB  buTBl  u  fonuod  by  h  pruaem  iwanDu'  lo  ooiDallea,  woariug  uuifuriDiti 
liintbont>(ild«red  Joiat  or  ivkitu  It  Is  plulml  inude  and  nnUtdewtlh  uiFk«l.  1 
Jin  pMkad  in  tbo  double  paraohuto  torn,  vith  leulhei-  prspand  axpreisly  fur  iho  i 
^Jt  trill  ba  foand  to  reMn  iM  alntticUy.  to  i>p«ra(e  imoothVi  lo  resiil.  vN  inndpTH! 


Ikbwabii'B 


below...    _ 

iin«  the  esutoiUr  uf  Ihi 
dThe—  -'-- 


HI  tiia  sitioa  rod  indioi 


riBawJHoe.  £.3  and  (here  itlBo  n  Hraw  throiid  upmi  the  pIsEon-rod,  ends  tniveno 
•nbv  IkTarina  the  ntmaat  nicety  in  Ibe  artduation  of  doseii. 
.3,CMn^ot,Eaa  hDllowputon-nid  In  reuBiTBono  noedls-  »lau  n  prvloDtiiiK  Dcivor  uid 
IbutMTi  It  nnuibe  aarrieil  in  the  PuaketliwtriunBiiCDrViBlOiue.  or  without  any  saae. 


„  ..  ...-, .«  like  No.  3,  with  the  iiddlliini  oS  ■  aeuoud  neodle,  cuiriod  apo.. . 

t*  in  tlM  uauai  ploeei  protected  by  H  mctai  ibield. 

'     '       '  2  are  pat  up  id  neat  momica  oorered  eatfn  with  viftl. 

>r  rteedlea  are  f^nuHbod  with  eaeh  tnatrameDtT  Ni».1.3and  4;  one  only  vr 
'  refined  ateol.  carefully  teiduered-  and  (boronghly  plated  Willi  KUld:  II 
ter  and  large  relative  calibre,  sbarpoaed  tn  Bii«h  an  anftlo  m  trill  ol 

.enotmlion.  and  theroforB  oamo  lc«»t  pain.    At  the  point  of  union  w 

•ket  tbty  are  reinfnraed  with  ao  outer  ooveriud  of  HBrman  Sil™r,  theruh*  nvercunii 
Mndeiwy  to  become  broken  ul  this  plaoc.    Tfany  are  ciiunacleil  wilh  the  barrek  b; 

Friees:    Nii.1.  aa^O.  Na.2.«4.0l>.  Poftage,  .01 

"  No.  3,      0.30.  No.  1,     S.JO>  "        .02 


lalf  di 


Stber    Hypo  dermic    Syrinees. 


■fit  DaelnuA!  I 
HfcTiirO."iUif 


ItX.OO.  pnr<hi«! 


H«.10,gl«M.  Luei'nlFrm.'hlBrii.iujit.oii.i-  \..  ■-   ..i  .■  .  ,■■ i: ■■....  ,,.  i  -,..; 

TflrmODiitinn.nDatTelvot-lincd  ni<ir —  ■-r?.>i(i.  . 

Ita.  Ill  ^MB  Byluulori  feneitistod,  aick'l  i  i 

■naaMian* Tor miuime.    Tbo  imlniiiiM. 

for  (h0B«  Who  prefer  itlBM.isreiJoninionili'il  |.  i  i.  n-. i i.  i.      .  i  i  ■ 

tH»t  (levl  Kilt  needles,  in  a  neat  oaee —                                                        ">'  p"    ■ 

J^^  Any  of  the  about  will  be  tnt  by  return              n          f    <J  f  and  fi 

HTpadermlc  STrlagsB  of  all  Undi  promptlf  lep^nd. 

Ournew  ILUISTRATEDCATAIflUUEOPSim    ILAI  I^PTR    MHN  ■«       «> 
pAinpbltr  "n  Inbuliktionof  Atomiied  Lliinidii,  by  diat.  up      hed  mnl  b  n       w 

valuable  fiinutilas.  will  be  [brwarded  pnf>t)uud  on  appl  oat  on. 

ATOMI/KRS.uid  aitieles  tat  Antiieptio  SorMnr.  Aau  ra  i 
Gliutiii  II'HK.',  Eleetrieal  InatmniBntii.  Invalid!'  ArtTdem  Um  I 
moi-h:  Ilr.  I'aiioaiin'B  !nionB<>-CautOTy :  F  "  " 


Apim 


KB  from  oi 


CODMAN    &    SHURTLEFF, 

Makers  1  Importers  of  Superior  Surgical  Instruments 


,,tl  15  Ti-i: 

Hpuudiug  with  advciUlui  i^Uumo  lu 


OPBICE  OP 

TROMMREXRTACTOFMALTCO. 

FREMONT,    OHIO. 

Fremont,  Ohio,  Aprils  1878. 

DHAB  SIR  h 

It  is  now  five  years  since  we  first  introduced  and 
began  the  manufacture  of  Extract  op  Malt  in  the  United  States. 
)  t  has  been  our  aim  to  famish  the  medical  profession  in  America  with 
a  malt  extract  equal  to  the  best  German  make,  and  (by  saving  the 
expenses  of  importation),  much  cheaper  than  the  foreign  article  can 
be  afiorded.  For  the  manner  in  which  our  efforts  have  been  appre 
eiated  by  the  medical  profession,  we  desire  to  express  our  warmest 
thanks. 

The  difficulties  attending  the  manufacture  of  Extract  of  Malt  in 
large  quantities  can  be  overcome  only  by  that  kind  of  skill  which  is 
acquired  by  experience.  Its  constituents  must  receive  no  injury  by 
the  process,  and  good  flavor  and  keeping  quality,  adapting  it  to  all 
climates,  must  characterize  the  product.  All  are  familiar  with  the 
striking  difference  between  certain  celebrated  brands  of  ale  and 
porter — and  yet  the  poorest  as  well  as  the  best,  is  or  should  be 
produced  from  barley  malt  and  hops.  Success  greatly  depends,  of 
course,  upon  the  employment  of  none  but  the  best  material ;  but  it  is 
hy  the  use  of  specific  and  long-tried  procedures  that  results  are 
obtained  which  are  so  difficult  to  rival. 

We  do  ourselves  but  simple  justice  in  stating  that  our  entire 
attention  is,  and  for  many  years  has  been,  exclunvely  devoted  to  the 
manufacture  of  the  Extract  of  Malt  for  medicinal  purposes,  and  that 
we  give  our  undivided  personal  attention  to  each  step  in  the  delicate 
process  by  which  Extract  of  Malt  of  excellent  quality  can  alone  be 
made. 

Under  these  circumstances,  it  is  unreasonable  to  suppose  that  the 
various  manufacturers  of  fluid  extracts,  elixirs,  pill^,  &c.,  who 
(attracted  by  the  high  reputation  of  our  Extract  of  Malt),  have 
recently,  in  various  sections  of  the  country,  undertaken  the  manufac- 
ture of  a  similar  article,  should  generally  succeed  in  producing  it  of  a 
quality  according  with  the  fulsome  praise  with  which  their  advertise- 
ments are  filled.  While  being  perfectly  willing  to  let  the  reputation 
(of  our  Extract  of  Malt)  rest  upon  its  real  merits,  we  owe  it  to  the 
medical  profession,  as  well  as  to  ourselves,  to  gjve  warning  against 
imposition. 

It  has  come  to  our  knowledge  that  certain  articles  extensively 
advertised  as  *'pure  "  and  "  genuine  exlT«LcV.oi  xaaXXi^  ^^t^  ^^\sss^^^ 


tihiefljr  of  the  substance  called  Grape  Suoab  or  Malttne.  wluch. 
as  is  well  known,  ia  the  product  of  the  action  of  sulphuric  acid  upon 
starch  subjected  to  a  high  temperature.  This  artificial  grape  eagar 
or  glucose  which  is  extensively  manufactured  from  corn  starch,  is  now 
heing  used  in  immense  ([uantitics.  instead  of  ordinary  cane  sugar,  in 
the*  sophistication  of  confectionary,  sugar-house  syrup,  "  strained 
honey,"  uative  wines,  and  canned  fruits,  and  bj  some  brewerif  in  dte 
manufacture  of  beer  and  ale.  The  cheapness  of  this  artificial  prudocl 
of  Indian  com,  constitutes  the  chief  Inducement  for  this  epccics  of 
substitution  for  barley  malt  and  cane  sugar. 

Again,  an  extract  of  malted  grain  is  manufactured  for  the  purpose 
of  obttuning  diaxtane,  which,  (simple  and  variously  combined)  ia 
much  used  in  medicine.  The  appearance  of  the  extract  is  hut 
.shghtly  changed  by  being  deprived  of  this  important  constituent, 
although,  it  is  unnecessary  to  add  that  its  valne  as  a  medicinal  agent 
is  thereby  greatly  impaired.  Nevertheless,  this  very  substance,  which 
ia,littlo  more  than  refuse  material,  in  the  manufacture  of  diastase,  is 
now  being  offered  lor  pure  malt  extract. 

It  ia  tiiaU  extract  prepared  from  Barley  malt  combined  with  the 
proper  proportion  ol  IIo]is,  that  has  lieen  for  many  years  the  standard 
medicinal-nutritive  employed  hy  the  medical  faculty  of  Europe,  and 
especially  of  Germany.  Its  value  has  been  established  by  experience. 
and  its  use  in  the  treatment  of  all  forms  of  disease  of  nutnCion 
is  constantly  extending.  We  shall  continue  to  devote  the  most  scru- 
pulous attention  to  the  maintenance  of  the  reputation  of  our  malt 
extract,  by  the  careful  selection  of  material,  and  by  unwearied 
personal  attention  to  manufacturing  delails. 

Attention  is  respectfully  directed  to  the  accompanying  extract  from 
Ziemmson,  and  also  to  our  circular  and  testimonials  elsewhere  printed. 

Very  respectfully, 

TROMMMEH  EXTRACT  OF  MALT  CO. 

B'roh  Ziem^sra's  Cyclopsma    of   the    Practice   of   MEinciXK. 
Vol.  XVI.  paoe  474. 

"  The  Malt  Extract  prepared  from  Trommer's  receipt  is  designed 
to  fulfil  much  the  same  purpoae  as  Cod-liver  oil,  carbo-hydrates,  (maJt 
sugar,  dextrin,  taking  the  place  of  fatty  matter.  The  simple  (much 
or  little  lioped)  and  the  Chalybeate  form  of  Malt  Extract  are  coming 
more  and  more  into  favor  as  substitutes  for  the  oil ;  they  are  more 
palateable  and  more  easily  digested,  and  should  therefore  be  preferred 
in  the  dyspejrtic  forms  of  anaemia.  During  the  last  few  yeai^  Malt 
Extract,  has  almost  entirely  taken  the  place  of  Cod  Liver  Oil  in  the 
treatmentof  Phthisis,  and  other  wasting  diseases  at  the  Basle  hospital, 
and  wo  have  as  yet  found  no  reason  for  returning  to  the  use  of  the 
latter  remedy.  The  extract  may  be  ^ven  from  one  to  three  limes  a 
day  in  doaes  varyhig  from  a  tcaspoonhl  to  a  tablespoonfiil  in  milk, 
broth,  beer,  or  wine." 


IMPROVED  SPHYGMOGRAPH ! 

The  practical  use  and  advantages  of  the  Sphygmographic  trace  to  the 
physiciui  over  the  old  and  inaccorate  custom  of  feeling  the  pulse  is  every  day 
acknowledged. 

Eminent  physicians  have  demonstrated  by  the  use  of  the  SPHYGMOGRAPH 
that  Tarlous  organic  affections  of  the  heart  and  other  important  organs  can  be 
detected,  which,  without  it  would  escape  observation,  and  this  by  so  simple  a 
process  with  this  Sphygmograph,  that  in  the  hands  of  any  physician  the  same 
result  can  be  obtained. 

Dr.  Mahombd  of  London,  says  :  « In  the  acute  cases,  Scarlet  Fever,  Measles, 
£!rysipelas,  Pregnancy,  &c.,  when  there  is  tendency  to  Bright's  Disease,  there  is 
nothing  which  so  clearly  shows  this  danger  in  advance  as  the  Sphygmograph." 

Eminent  physicians  urge  the  daily  use  of  the  Sphygmograph  by  practicing 
physicians. 

The  more  one  uses  the  Sphygmograph  the  more  he  sees  that  the  day  of  touch- 
ing the  pulse  for  information  is  passed. 

It  takes  too  long  to  acquire  the  difficult  tact  of  feeling  the  pulse  with  the 
fingers  ;  besides,  there  is  no  means  of  comparison  from  day  to  day. 

A  student  can  learn  more  of  the  pulse  with  a  teacher  and  Sphygmograph  in 
one  week,  than  he  could  learn  in  ten  years'  practical  observation  without  the 
instrument. 

Yoi;  can  tell,  as  to  prognosis,  ten,  twelve  or  twenty-four  hours  in  advance  in 
acute  cases,  of  what  you  would  be  able  to  do  without  the  Sphygmograph. 

It  shows  tendency  to  death  in  typhoid  fever  from  paralysis  of  the  heart. 

Gives  warning  of  danger  from  sinking  before  it  can  be  detected  in  any 
other  way* 

Of  the  greatest  help  in  detecting  aneurism  and  organic  disease  of  the  heart. 

Tells  exactly  when  and  how  to  stimulate. 

Should  always  be  used  when  administering  ether  or  chloroform. 

It  shows  the  exact  condition  of  the  arteries  and  heart,  and  is  invaluable  to 
every  physician  in  his  daily  practice. 

It  is  perfectly  practical  and  easily  and  quickly  applied  to  almost  every 
artery,  requiring  no  longer  time  than  to  feel  the  pulse  in  the  ordinary  manner. 

No  physician  can  use  this  instrument  and  carefully  observe  his  cases 
without  being  able  to  communicate   valuable   information  in  aid  of   medical 

science. 

Physicians  by  exchanging  traces  would  soon  familiarize  themselves  with  all 
the  various  kinds  of  important  tracings. 

Dr.  Edgar  Holden  says  : — ''  I  concide  to  it  the  preference  not  only  over  my 

own  but  Marcy  &  Keyt's,  and  every  other  I  have  seen." 

Dr.  E.  G.  Janeway  says  : — "  I  use  it  with  a  great  deal  of  satisfaction,  and 
believe  that  it  will  prove  especially  serviceable  to  those  who  desire  to  record  the 

nature  of  the  pulse." 

Dr.  Wm.  Pepper  says : — '*  I  use  your  Sphygmograph  constantly  and  it  works 
admirably.     I  consider  it  the  most  desirable  Sphygmograph  in  the  market." 

Dr.  J.  M.  DaCosta  says  : — "  It  is  a  v^ry  delicate  and  excellent  Instrument, 
and  is  used  by  us  with  much  satisfaction." 

Price    -    -    -    -    $35.00 

Will  be  sent  to  any  address  upon  receipt  of  price,  or  by  express,  C.  O.  D. 
Send  for  Pamphlet,  showing  yon  what  the  traces  mean  and  how  to  interpret  them. 

Addresih-  POND'S  SPHTaMOG&APH  CO., 

[79]  '^\re\»iasi^'^   . 


B HI  list!  A.ND  COSTINKNTAL  BOOKS  &  PEHIOIUCAl^ 
^i|>(jiiv>i.      L'ht!  ili^'uuiit  atlowetl  off  the   Pohliabers  fiviees  of 
Uit^h<  '^iw.ii  Money  OnliT  (.>r  Draft  is  remitted  more  than  conn 
i^u  iw  Caiukta  »ii-i  the  United  States. 

L  LONDON  UVNCEHT,  posttnl  on  the  day  of  pnVEcatiaa  fa 
I  receipt  of  X  I.  14.  S, 

HENRY    KIMPTON. 

Medic«l  Bookseller.  >^-  High  Holbom,  London.  EogUiuL 
^trouiaed  by  Ute  Profeiaaors  of  McGill  CiuTersity. 


I 


^rfl 


..ULSION 

IVER  OIL 

■r  LIME  AND   SOD 

NT,     FAL4TABLE. 


I 


^sCBRpecirutljaakUiu  Medical  Prufeseiuu  to  give  tbe  above  preparation  a  tnsl.knoxriBg: 
VUI  And  itjunt  thti  tbinfiloDcileHlred,  and  nbUin  npkmlid  resnlts  in  llie  wutiug  ili«)B»iw  tn 
ted  b J  mal^nntrition  nod  a-tHimilatiiin.  Tbe perfeel  unA permanfnt  aaioa  of  tb^Cod  Lini 
^th  the  Hjrpciphnxphiten.  and  tbe  thoronj;]i  maoneT  in  wbich  Uie  nauReoos  taste  U  dii^ 
KO'^era  it  k  palatesble  that  the  motit  delieate  Htnmacli  can  retun  iu  The  nntnble  sdvaiitw 
P"*^itHea  over  all  otbsr  preparatioDH,  i*  it«  pemiADenoj  tm  an  emnlsioD.  remainiiiK  fiw  od  •! 
>u>Uniited  time  without  tbe  )<lighte8t  eeparatioa  or  change,  wbicb  enable*  the  Phyeioian  tlw^ 
praicnbe  It  in  its  proper  prnportiona.  The  nil  ia  prepared  eipreMly  for  na,  andgonr&nteedBU 
pure.  Wo  will  glodfy  famish,  oiprei^H  paiil  a  4  oi.  8am)ile  to  an;  J'hyidoian  In  the  cutmtiy 
»»  not  been  Ftapplied. 

B'ORMtiLA.— fiO  per  oent.  of  para  Cod  Uver  Oil,  6  f^ain^  of  the  HopophcnphiteK  of  time 
3  graiuB  of  Cbo  Hypophosphite  of  Soda  to  a  Said  ounce. 

MeKsrc.  Scott  &  Bowhr:  Genta— I  hare  psescribed  Scott's  Emnlsion  of  Cod  Liver  OH 
Hypophonpliites  in  both  private  and  hunpital  practice,  and  cont^idor  it  a  valuable  prnparatNi 
renioina  oh  a  pennooent  emnUioo  even  in  e:itFeDiely  bnt  wisatber  nnJ  Ik  mare  pnlat«nblo  thai 
olber  prepanttioD  of  nil  that   I  have  axed. 

New  York,  Sept,-!.  ISTf-.  Tours,  raspectfollv.    ROBERT  WATTS,  M,D., 

Pres.  Med.  Board  Chanty  Hiwjutal 

We  bIko  rafer  by  peroiiKsiim  tn  tbc  fiillowing  PhyiticiaaH.  who  aae  it  and  recommeoit 
the  profession ,—(■.  C.  Sbattnck,  M.D..  18  Stamford  street  (late  Viaitinp  PhyHician  Uass.  6» 
BoBpitftl);  J.  Ayer,  M.D..  Nn.  G  Hancock  street.  Bostun  ;  0.  TT.  Gay,  M,D..ii7,'i  Tramnnti 
(Viaitinn  Snrtceon.  Boston  City  Hoapital) ;  t\  B.  Bnndy,  M.D.,  99  Walthaoi  street,  Bm 
TT.  B.  Uackie,  M.D.,  (iT6  Tremout  .-troet,  B<i9t.)n. 

SCOTT  &  BOWNE.  Manufacturing  Chemiits,  126  Hudson  St..  N.Y. 


■^^•^iJi 


^^E 


HOSPITAL    MEDICAL     COLLEGE. 

TORK 

OF  THE  AHEBICAN  UEDICAL  COLLEGE  ASSOCIATION. 

SESSIONS    OF    1  879-' SO. 

TOE  COLLEGIATE  YEAR  in  this  lustltulion  embncuapreliminu;  A 
the  KegnUr  WintorfJaiuion,  and  a  EJpring  Seseion. 

TDK   PRKLIMINARY  AUTITHNAL  TERM  for  Ig^i-'SO  oiU    bairi' 

SeiitODilMr  ITlh.  l»7!l,  and  continue  until  "  ' " 

term,  inHruMion,  oonuitiDg  of  didutiu  iodluku  .. 
leoturar.  will  be  given,  u  haralorore,  br  the  entire  Ki 
B«  diinne  lbs  BsBulftrSaiBiui      "■    ■     ■  ■• 

mended  to  attend  the  Prelin 

TPB  RBOULAR  BBBSION  wiU  berio  on  Wedn. 
litofMueh.  18S0.    Daring  this  Seuion. '       '"" 
iay  except  Sstardu.  two  ur  three  houn 

Tii«  SPRIN0SBS8I0N  i       ' 
beflnB  nn  the  lilt  at  March  x-B 


If  acuity. 

ISSAC  E.  TAYLOIl,  M.  B., 
rofonmt  uf  Obaletrios  luid  UieeuBB  of  Women,  and  Preoident  ol  I 


AUSTIN  FLINT,  M.  D.. 

Professor  nf  lbs  Princi|>lce  and  Practice  of 

Modieine  and  Clinioiii  Medicine. 

W.  H.  VAN  BDBEN,  M.  D., 

Frefeiunrnr  Principle*  and  Pniolieeoftiurgen' 

DiWiuMWOf  Gonito-tlrinsiy  Sysleln. 

and  Clinioal  Bonrerr. 

LBH'IS  A.  8AVKK,  M.  D.. 

of  Ortbonodic  Sorger 


Hp»' 


i.  M.U.. 


UlaenDUon, 


B  Annual  ISnular  anil  Catalogue 
I,  »ildnm  frot  AcBitnEtiiiT,  Jr., 


ALE.'CANpBK  B.  MOTT,  M.  D, 
TraCusMr  of  Cliaital  and  Operative  Surgery, 

WILLIAM  T.  LUBK.  M.D., 

PloTenar  of  Obntelriee  &  UiBBaaoe  of  Worn' 

■nd  Children  nod  Clinloli  Midnitbir. 

EDWARD  O.  JANKWAY,  M.  H,, 
I        Professor  of  Piilhologiottl  Annlomy  and  IliBlolocri  Diseases  hi 
Ciinical  Medieiiio. 

PB0FES80BS  OF  SPECIAL  DEPAHTMEHTS,  Etc. 


llENltV  U.  NOV. 
bswr  <i(  Oplhitlmulogy  and  Olulogr. 
J.  LEWIS  ^MITO,  M.D„ 
OUnioal  Prafosnr  of  DieeiuDB  of  Ohildren. 

BDWAPJ)  L.  KEYBS.  IU.D., 
PtoTeuor  oI  UBrmatologr,  and  adjnnot 
IThair  of  Prinoiples  of  bntgery, 
JOHN  P.  ORAY,  M.U.,  LL.U. 
Professor  of  Psj-cholopoal  Med i nine 
Modieat  JunspnidenoD 
ERSKINE  MASON,  M.D., 
Clinical  Professor  of  SurgoDT. 
LEROV  MILTON  YALE,  M.I). 
Lecturer  Adj and  ujion  Ortbupodic  Bui 

FEES  FOR  THE  REQULAR  SESSION. 

fees  for  tiolietsto  all  tbo  Iwturos  during  the  Preliminary  I 

and  Regular  Term  including  Clinical  Locturen ( 

U.,.4-.,1..(inTi  Vftk. ..... 

alforDiMeedoni. 


TILDEXS  ERGOT. 

TORMTXA  OF  1^^4^- 

posm  VE  rxiFOKMm'  w  steex^.tb  k  action  EXSrRED 

BV  THE  METHOD  OF  PREPAKATIOX. 


Tine  ttSifrthj  ^  (.cvwdirir  ^vidf  W  aasi  ^rvc^Bdei^  «$  fntm  i«iidiiig  sampls 
«#  m  FLCID  EXTfiA^LT  OF  EEi>«>r.  asi£  v<^  zut  dM!f«fc«fit  call  attentioBto 
^hik^  jub4  »4k  T'/Q  to  pPM-ure  h  tto^i^^  T««zr  irx£jpsi  cr  desilcr  in  roar  Tidnitjr. 


We  hftT«  'imdcd  t/>  plaeer  h  viti^zzi  the  m^^  c^  ercrr  pisracian  br  amngbig 
tbe  prk«  <^  /Vy«r  ovik'^.  Ei^kt  <fmm4x  am^i  ^*Ttte»  'immce  PackA^res  on  a  scale  that 
prei  it  u>  v</a  io  aixhur  f<*nD  at  the  same  pdce  p«r  paai>d.  and  joa  will  thus  te 
able  to  '/rd^fT  it  in  either  Mze,  in  orijonal  puckafRs.  aad  to  secure  an  article,  widek 
h*f  n^A  failed  t^#  pre  eatire  «au>£Ktioo  Then  obtained  a«  it  leaves  our 
Laborat//rr. 

CAUTION." ^<^  have  infonoation  from  fCTeral  qaaner^  that  FLUID 
KK^/OT  tii  ptMtr  qaalitjr  ix  Ijeing  i^nb^titnted  for  onns  br  bein^  put  np  in  our 
bottleK.  tbuK  diMpenjfed  from  <iar  bottler,  and  pat  np  and  labeled  promioently 
*'  F  irmulft  of  If^iJ^  14:yMcianj$  will  pleaee  be  on  their  gnard,  and  report  t» 
OM  any  drcuDD^taoee  that  indicates  this  firand  upon  them. 


PUERPURAL   ANTISEPTIC  I 

Bromo-Ohloralum. 

NON-POISONOUS !    ODORLESS  ! 

Ih  a  concentrated  Holution  of  Bromide  and  Chloride  of  Alnmninm.  It  operates 
>y  decompoHJng  noxiouB  gases  and  thas  removing  them,  and  not  by  causing  an 
odor  greater  than  the  one  sought  to  be  removed. 

In  the  lying-in-room  the  ph^^sician  should  always  prepare  a  bowl  of  one  ounce 
of  Bromo-Ohloraluni  to  ten  ounces  of  soft  water,  and  moisten  towels  to  place 
under  the  patient  to  receive  all  dejections,  and  also  to  apply  to  vulva.  He  should 
wet  his  hands  with  the  same  before  examination,  and  after  conclusion  of  labor, 
or  as  often  as  ho  pleases  during  the  progress  of  the  labor.  He  will  find  the  odor 
which  frequently  persistently  attaches  to  the  hands  to  be  removed  at  once ;  be- 
sides it  is  of  inestimable  value  in  protecting  any  abrasion  from  being  affected 
by  contact  with  acrid  secretions. 

After  confinement  the  vagina  should  bo  thoroughly  cleansed  by  injecting  the 
same  dilution,  and  continued  night  and  morning  by  the  nurse  till  convalesence. 

or  No  case  of  PUEKPERAL  PliJVER  has  occurred  where  BKOMO  was  used 
at  oouliuement— and  during  oouvaloscouco.  It  should  bo  used  on  every  such 
occasion.    Send  for  Pamphlet  on  Puerperal  Fever. 


riLDBN  &  CO..  IJeYf  ^  '      '^  wA\'\^^-^YMs^SJut^vi\,^'««  x.«tk. 


IIVERSITY  OF  THE  CITY  OF  NEW  YORK 

MEDICAL     DEPARTMENT. 

410  East  Twenty-Sixth  Street,  opposite  Bellevue  Hospital,  New  York. 
THIRV-NINTU  SESSION,  1S79-80. 


^ROWARO  CROSBY,  M.D..  LL.  D.. 
rSoncellar  oflhe  UDi.er.ftv, 
«ED  C  POST.  M.D.,  LL.  D.,  Et 


FACULTY  OF  MEDICINE. 

WILLIAM  H.  THOMPSON.  M.D.,  Profcj- 


of  Dl: 

TI^^ARBV,  M.D.,  Eiwckui  PiofHsor 

KAPER,  M.D.,  LL.  D.,  Prgl^iuc 

'r^OMIS,  M.D.,  Profmor  of 
iatj  luxl  Pnttice  ol  Msdidiie. 
Hr  DARLING,  A.M.,  M.D.,  F.R. 


gClwr 


a  Uidici 


M.D., 


and  'rhcri 


-f  Phj- 


J.  WfLLisrON'wKK'HT,  M.D.,  Profcuor 

Wm!  mIToIIk,  M.D.,  Pjof=i«>rorObjlelfia 

and  DiieiHiDrWamiD  andChildicD. 
FANEUEL  D,  WBJSSE,  M.D.,  ProroBor  af 


A.  L.  RAN.VEV.  M.D.,  Ad]iii.a  Pr 
JOSEPHE.  WINTERS,  M.D„  Den 


:  A.  HAMMUND,  M  D,. 
BitciKi  afibe  Mind  and  Nei 
^UEN  SMITH,  M.D.,  Pr 

fcOUlfl?,'  M.D.,  Prol 
aaflheGcnilo-UriDaiTS. 


POST-CRADUATE  FACULTY. 

MONTROSE  A.  PALLEN,   M.D.,  Prerui 

ofCvn.iculogjr. 
11ENR?G.  PfiTARD,  M.D.,  Profeuor 

A.    E.   MACDCINALD,   M.D.,    Profcjioi 

Midie»l  Juriipnidciice, 
JAMES    L.    LITTLE,    M.  D.,    Ptoruior 

Clioiul  SuTEerr. 


...,«  Smt 


E  COLLESIATB  VGAK  b  diridsd  ii 
■  Winior  Suaaioo,aDd  a  Spring  Sasaioa 
E  PREUMINARY  SBaSlON  will  c" 
B  opSQing  of  the  Regular  Wistcr  Sbu 

E  REGULAR  WINTER  SESSION  nil 

■  ■■     '    M. 

egc  sdifice  beioe 


J  tlirea  ^eseioan— a  Frelimiairy  SeeBiun,  ■ 

UDDFC  Septombflr  17. 1879,  and  niti  Mntinua 
1.    It  will  ba  oonnaalfld  OD  the  rlnn  ol  that 

ant  of  Dctobur,  1S79,  sad 

isdititelj  opptHite  Ihi  (Inle  of  BoUavna 


^tal,  and  a  fon  dUpa  (una  the  furry  to  Gbaritv  EMi,iIal,  KluikHeirs  Islanil,  Cha 
Ints  t>f  tbe  Uniiaraitj  Madical  CollugB  uro  ooablod  to.enjoy  tbe  sdruitaKas  nfforded  br 
KHDspiI.ilii,  witbthelaulpoaiiblolouartima,  The  PrufoBBurn  of  the  pnatiaal  Cbain 
^msDied  wltb  the  HaapiUlB.uidtbatliiiverBit)' Students  ure  admitted  to  alltht  Clinia 


Bight  Clinial  each  week  in  the  Oollo» 

isivea  dailT  ia  the  CnliuEe  Biiildini,  und  Itioiilna 

iduBlad  by  the  Proftssors  uf  Chamiitry,  Praotioe,  Aunlomy,  Malflriit 

PhysiolOE;,  SurEory,  and  ObiletriBi,  upon  (ha  aubjacti  of  their  leiMDreB. 
THB  SPRINa  SESSION  embcuieB  s  Dcriod  of  iweWe  weeki,  begin nlnt  in  the  Gntnoek 
if  Hueh  and  andioE  tfaa  Inst  waek  of  May.    The  dully  ClinioB,  KecitatinDB,  and  Special 
•     -    ■-  1.  .     ..  ■    -.    ™.  .      .-..,_=._   .._1.^ ^U  bo  LeoturaB  on 


>  SESSION  embcuieB  s  period 
lioE  tfaa  Inst  week  of  May.  'j 
will  be  tbe  BBme  OB  in  the  W 


ForCouiieotLeotur 

MatrieulatioD 

Demonalmtor'a  Feo  (inoludloK  umtorial  for  diss 


of  Mm . 

Piaotiul  Connoe  will  be  tbe  BBme  at  in  the  Winlcr  SuiBi„_.  _ 
UpaoW  SobjecU  by  the  membon  of  the  PoBt-Graduaie  Fiiaalty. 

THE  DIB8BCTI0K  ROOM  ia  ouan  thronghout  the  entire  Calloilate  rear.  Material  is 
■bnodiLnl,  uid  it  is  furuiihed  (roe  uT  uberie. 

Stadeati  who  hare  studied  two  ^eors,  and  who  have  attended  two  fall  oonrasaof  lee- 
tares,  nuj  be  admiltad  to  aiauiuatiou  in  ChumiHirr,  Auatoniy.  and  Pbyiioloiyj  and,  if 
luooeBsfal,  will  be  examined  at  tho  eipinillonnf  their  full  oourse  uf  study  on  Praotioo, 
Materia  Med ioa I  and  Tborcapeulio*,  Bttrsery  and  Obatetrlua  ;  but  thoae  wlio  prefer  it  nuty 
bare  nil  their  eiHmioation.i  at  the  close  uftaeir  full  ternu. 

F  £!  E  9. 

iiw.wi 

"".  lo.uo 

Umdustion  Fee - 31. W 

Pust-draduate  Certifioato KI.UO 

For  rarthsrpartioulatsand  oireulon  addrota  tho  Oeani 

Prof.  CMAKLEB  INSLEE  FAtQBB,  M.D.. 
Unicftitu  Molical  CuUrft,  UU  Scul  rucaln-JKHA  Stmt,  StK  Ytirk. 


COLLEGE  OF  PHYSICIANS  &  SURGEONS, 

(Mfdical  Dcpitrtment  of  Columbin  <'olU'je,) 

Corner  of  Fourth  Avenue  and  Twenty-Third  Street,  New  York. 


SEVENTr-TUlRD  SESSIOX,  1S79-1 


FACULTY  OF  MEDICINE. 


ALONZO  CLARK,  M.D.,  Prcnideni  and  Pro- 

rcBior  of  PiihdlDEr  lod  Pnciicil  Msdicioe. 

WILLAtiO_  PARKER,  M.D.,  PiB(a«n  oC 

JOHn"!^  DAlfruN,  M.D.,  Pfoftswr  of  Phy- 

•iolDgy  and  aygieoe. 
THOMAS  M.  UAKKOK,  U.D.,  Profeiwror 

Ihi  PriBciplEiuf^urgnir. 
T.  GAILLAKD  THUaAi,  M.D.,  Prafciior 

orCrnJBcoluiiy. 
JOHNT.  MBI'CaLFE,  M.D.,  Eioeiilml'FO- 

laiororClliiicil  UediciiK. 
HENKV  B.SAHDi,  SI.D„  Froreoor  of  Ihe 

PmciicgrSuipny. 
JAMES  IV.  McLANE 


EDWARD  CURIIS.M. 

wtii  MEdkaind  nicrapeunci. 
FRANCIS  DELAFIKLD  M.D.,Adiuncl  Pro- 


JOHSG.  CURTIS.  M.O.,  Adinnct  Piotan 
orPhyiiolfl^uiii  Hygiene,  Srcretary  of  Af' 


DSTM< 

ofMUka 
WILLIAM 

COKNELIUS  R.  AGNKW,  M.C  CUai 

Proreiidr  of  UiKUei  af  the  Eyeud  Ed 

ABRAHAM  JACUBL  U.D„  Qiniol  Pid 

FESSCNDEN  N.  UTIS,  M.b.,  CUnal  !> 

EDWARD  C  SEGUIN.  M.U.,  Clinhal  t 
tasor  ofDiuua  of  the  Mind  and  Hm 
SysioiB. 

GEO.  M.  LEFFERTS,  M.D.,  CHniol  Pni 

Threat. 
CHAS.  McBURNEY,  U.D.,  Demoumla 


K'ni'b..  c 


WM.  T.  1 


iJLL,  M.D.,  Asistanl 


Tndl-^ 

FRANCIS  DELAFIELI 
lot  of  the  PilhaloBiul  L^ibunLiaiy  o 


FACULTY  OF  THE  SPRING  SESSION. 

JAMES  L.  LITTLE,  M.D..  Lecturer  on  Oper-    i  H.  KNAPP,  M.D.,  Lectotec  oi 

alive  Surgery  aod  Surgical  DreuLon.  the  Eye  and  Kv- 

GEORGE  G.  WHEELDCK,  U.D.,  Lectunt       T.  A.  McURIUE,  M.D.,  Lcnnrc 

OD  Physical  Dicwnoiia.  malutosy. 

RUBKKT  F.  WJ^lCt,  M.D.,  Leclorer  on  Dia-       CHAS.  UcllURNEV,  U.D.,  Lecluref 

euu  of  ihcGEDilo-Urinaty  Ui^ni.  |         Analauiy  of  ihe  Ncrrei, 

Tha  CULLB^IIATE  YEAR  ombnou  n  gpueUI  Sfi'i'-v  nnd  ■  tognlar  WiiUrr  Se 
MtaniluDae  ut  iliQ  Uiltr  onlr  being  required  for  the  jErMastinE  oouna.  Tbe  Snrina  S 
baiiDiiaMiLrcb.iindouBtiaaastiLl  jDDe  IbL  The  Aspubir  Waiter  Sr^ioa  for  im^ 
Oolabsr  let.  imd  cudUduh  till  ISiweb. 

TDIIIOX  iB  by  the  following  motboda  :— 

r.  DimCTici  LKLTDEia.— Durini;  the  Wintrr  Stinou  from  fiyatifri'  1.citi»~.  -u 
daily  by  the  Foaulty.    Aituudauaa  ablitriLtory.    Darinc  the  apriaii 
Knsn  diiily  by  Ibj  Fiioulty  of  the  Spring  Seaaion.    AttenOiiiiaB  upm 

It.  Olinic.il  Tkacuuo.— Tod  CliaicH,  cnveriiiji  nil  .Icnartmuntii  of  medicine  uid  lamfh 

alt  bold  neekly  tbiuugbout  the  eiitir»y<  ir '  .:l.  ^.   :.  uMIni.-.  In  adililioD,  tb«  FtMRP 

lurgor  CUy  II  .    iriL-s  (fUuU   lu   the  Ballntar 

."^-iii'l  l!(irIu6ru.Br»,*«j3 


DisaM*/ 

in  SyntW' 


>  held  d< 


,-C»»D»  .11  •ID.M,,r.  ar.' 

iHhvif.   Ofih'kamaipsvt  (Jtotoffif^  LnrimjtHopa,  umi  in 
Attandince  optional,  eicepl  upon  ProDtienl  Aimtuuiy. 

EipBHSRS— Tha  nrrcwiru  exponlfls  ureayearlyiu 
lesiatH  yesil.  the  fees  for  tbo  laoturoi  of  the  Wliitoc 
branch,  or  *l*l  fur  tha  anlire  cumouluEO).    The  J'ra 


chart*.  Pawj^ 
fnrmP 


isssriU 


HUNYADI  JANOS  MINERAL  WATER. 

THE  BEST  NATURAL  APERIENT. 


_  .1  D».  yuul'VCK  IsAKKHI.   i'mTTMion        .  ...    __ _,^ 


■  Ii«.  I.  A.  ^AVRK.  Pk(i 


A.  ^AVRK.  Pkoh 


a  iiK.  t(««  III  1,11   Piuvfiwi 


■.UV.l«l,H  ilKMtU 


M«y  bo  ordCTSd  ol  all  Ch«imstM  and  Miaeral  Waier  Dealer*. 
"HUNYADI    JANOS    MINERAL   WATER." 


butht 


31,    33    &.    li£4. 

ibuthampton  Bow,  Rusaeli  Square,  W.  C 


WORKS 

HORNSET  ROAD,   N..   aud  SDMMERFIEIJ)  WORKS. 

HOMLBTON.   N.  &.,   LONDON. 


PREPARATIONS  OF  PEPSIiE, 


ure  Ciietnicais  and  all  New  Medicines. 


SPECIA-LITIES  : 


Orson's  I'epsine  (Tbe  original  English  Mauaf'acturers) 
Morsou's  Pepsine  Porci  Pur*?. 
Morson's  Pepsine  Powder  or  Poudre  Nutritive. 
Morson's  Pepsine  Wine. 
Morson's  Popsine  Lozenges. 
^^Morsou's  Pepsine  Globulfs. 
^^■^rsoQ's  Pancreatine  Powder. 
^^pEorson's  Pancreatic  Emulsion, 
^^iloreon'e  Pancreatized  Cod  Liver  Oil. 
Morson's  Saccharated  Wh'-at  Phosphatide, 
)Iorson  s  Creasotc  (I'rom  Wood  Tar)  the  only  Eugtish  makei-s 
N.B. — Test  of  purity,  insoluble  in  Pricesglycerine 
lorson's  Grelatiue   (The    most    economical    substitute    lor 

Isinglass.) 
iOrson's  Chlorodyne. 

lorson's  Kfferv(?hdng  Citrate  of  Magnesia. 
Arson's  Arliiiciiil  Essem>?B  for  Eavoriug. 

jld  Wholesale  and  Retail  by  all  Cbemiats  and  Draggiati  throughoot 
tbe  World.