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rjSntered  a(  the  Post  Office  at  St.  Louis,  Mo.,  as  Second  Class  Mail  Matter.] 

Contents  on  Colored  Page  I. 

Vol.  XXXVIII.  Number   4 

February  20, 1880. 


The  Saint  Louis 

Medical  and  Surgical  Journal. 


SE3II-MONTHLY.  •*• 

/V 


[ESTABLISHED  1843.]  V       MM 


Thomas  F.  Bumbold,  M.  D.,  Editor  and  Proprietor. 


Terms:    $3.00  per  Annum   IN   ADVANCE.    Single   Copies,  20  Cents. 
St.  Louis:    1225  Washington  Avenue. 

Complete  Index  to  Advertisements,  on  Colored  Page  vii. 

Recent  Medical  Publications  by  Geo.  0.  Rumbold  &  Co. 

1225  Washington  Avpnue,  Saint  Louis. 


Reports  to  the  St.  Louis  Medical  Proceedings  of  the  St.  Louis  Med- 

Society  on   Yellow  Fever,  Price,  jCa|   Society,     l878-'79.     Price, 

$2,5°'  each,  $1.25. 

"  ii  has  many  admirable  features,  and  no 

doubt,  win  have  a'  marked  influence  on  the  Proceedings  of  the  Tri-State  Med- 

Bummary  of  our  knowledge. —  North  Carolina,  ical  Society.    Price,  $I.OO. 

Paresis  of  the  Sympathetic  Cen- 
"Ffcw,  If  any,  of  the  contributions' to  the  lit- 1  ters  ;   or  So-Called    Malaria.    By 
erature  of  this  mdsl  important  Subject  contain 
esfrano  importance  to  the  profes- 
sion and  public,  than  is  to  be  found  in  this  vol-  Fracture  of  the   Femur.    By  Edw. 
ume  —Maryland  Medical  Journal. 


Chas.  T.  Reber,  M.  D.    Price,  $  I 


Borck,  M.  D.    Price,  50c. 


FOR  SALE  BY  THE  PUBLISHERS  AND   BOOKSELLERS, 


To  the  Medical  Profession. 


LACTOPEPTINEJ 


The  most  important  remedial  agent  ever  presented  to  the  Profession 
for  Indigestion,  Dyspepsia,  Vomiting  in  Pregnancy,  Cholera  Infantum, 
Constipation,  and  all  diseases  arising  from  imperfect  nutrition,  contain- 
in-  the  live  active  agents  of  digestion,  viz.:  Pepsin,  Pancreatine,  Bias- 
tasc  or  Veg.  Ptyalin,  Lactic  and  Hydrochloric  Acids,  in  combination  with 
Sugar  of  MilK.  FORMULA   OF   LACTOPEPTINE. 

SiKrir  of  Milk  40ourices.    I    Veg:  Ptyalin  or  Diastase.... 4  drachms. 

Pectin  8ouuc.es        Lactic  Acid 511.    drachms. 

Pancreatine '.".]/..-.. 6ounces     |    Hydrochloric  Acid  oil.    drachms. 

IlACTOPEP-Tlira:  owes  its  great  success  solely  to  the  Medical  Profession,  and  is  sold 
almost  entirely  by  Physicians'  Prescriptions,  Its  almost  universal  adoption  by  the  profession  is 
tta  strongest  guarantee  we  can  give  that  its  therapeutic  value  has  been  most  thoroughly  estab- 

liSne<The  u„«iersigned  having  tested  LACTOPEPTINE,  recommend  it  to  the 
profession. 


ALFRED  L.  LOQMIS,  M.  D., 

Professor  of  Pathology  and  Practice  of  Medi- 
cine, University  of  the  City  of  Neiu  i'orfc. 
SAMUKLR.  PERCY,  M.  D 

Professor  Materia  Medica,  Neio  lork  Medical 
College. 
A.  Van  Deveek,  M.  D.,  Albany,  N.  Y., 
Prof,  of  the  Prin.  andPrac,  of  Surg., 
Albany  Med.   Col.;   Surg_.  Albany 
and  St.  Peter's  Hospitals. 
Julius  F.  Mixer,  M.  1).,  , 

Prof.  Special  Surgerv,  University  of 
Buffalo,  X.  Y. 
John  H.  Packakd,  M.  D.,  Phila.,  Pa., 
Prc-dent  Pa.    Co.   Obstet.   Society; 
.Surg.  Episcopal  and  Women's  Hos- 
pitals. ,        _, 
Jas.  Aitken  Meigs,  M.  1).,  Phila.,  Pa., 
Prof,  of  the  Institutes  of   Med.    and 
Med.  Juris.,  Jell".  Medical  College; 
Physician  to  Penu.  Hospital. 
W.  W.  I)A\vsox,  M.  1).,  Cincinnati,  <>., 
Prof  Prin.  and Prac.Sujrg.  Med. Col. 
of  Ohio,  Surg,  to  Good  Samaritan 
Hospital. 
Albert  P.  A.  King,  M.  D., Washington, 
I).  C, 
Prof,  of  Obstetrics,  University  of  Ver- 
mont. 


P.  LE  ROY  SATTERLEE,  M.  D.,  Pn.  D.. 

Professor  of  Chem.,  Mat.  Med.  and  Therap. 
in  the  N.  Y.  College  of  Dent ;  Prof. of  Chem. 
and  Hygiene  in  the  Am.  Vet.  College,  etc. 


1       "I  have  given  LACTOPEPTINE  a  good,  thorough 

>-  trial,  and  have  been  greatly  pleased  with  the  exeel- 

j  lent  results  that  have  followed  its  administration." 

"I  have  used  LACTOPEPTINE  in  private  practice 

n  v 

lltfi 


)  "I  have  used  L 
'•  for  the  past  two 
)  satisfactory  resul] 


•s,  in  many  cases  with  highly 
'  •  I  liavc't'ound  great  satisfaction  in  the  use  of  LAC- 


l  TOPEPTINE,  and   have  ordered    it    frequently    in 
(~  cases  of  dyspepsia,  especiallj  where  there  is  want  of 


cases  or  ayspepsia,  especi 

tone  and  defective  secretion." 


!       "1  have  used  LACTOPEPTINE  with  very 
f  effect  in  a  number  of  cases  of  dyspepsia. ' ' 


?ood 


\       "I  have  used  LACTOPEPTINE  with  greatadvan- 
'  tage  in  cases  of  feeble  digestion." 


D.  W.  Yandell,  M.  D., 

Prof,  of  the  Science  and  Art  of  Surg. 
and  clinical  Surg.,  University  of 
Louisville,  Ky. 
L.  P.  Yandi.ll,  M.  D., 

Prof.  Of  Clinical   Medicine,   D 

Of  Children  anil  Dermatology,  Uui- 
.    vcr-itv  Of  Louisville,  Ky. 
Robt.  l;  m  iky,  m.  D.,  Some,  Ga., 


")       "I have  used  LACTOPEPTINE  both  in  hospital 

f  and  private  practice,  and  have  found  ii  to  to  answer 
fully  the  Purposes  for  which  ii  is  recommended.    As 
an  immediate  aid  to  the  digestive  function,  I  know 
of  no  remedy  which  acts  more  directly.  " 
"I  have  made  much  use  of  L  \c  COPEP  CINE  and 
;  take  great  pleasure  in  stating  that  it  has  rarely  dis- 
i  >hall,  of  coarse,  continue  to  pre- 


appointed me. 
scribe  it." 

L ^CTOPEPTINE 


is    an    exceedingly    valuable 


i  preparation,  and  no  one  who  gives  it  a  fair  trial  can 
f  fail  to  be  impressed  with  its  usefulness  iu  dyspep- 


EmeritusProf  of  Obstetrics,  Atlanta    l      "  I  have  used  LAI  TOPEKTINE  in  a  case  of  dys- 
Med.  College,  and  Ex-Prea.  Med.    fpepsia,  with  satisfaction,    [think  well  of  it." 


Association  of  Ga. 
Claude  II.  Mastin,  M.  D. 


,  L.L,  D.. 

Mobile,  Ala. 


Prof.  H.  C.  Babtlett,  Ph.D.,  1     C.  S., 
London,  England. 


"\        "  I  consider  I,  ACTOTEPTINE  the  v.-i ;.   best   prep- 

!  aration  of  the  kind  which  i  have  evei  employed,  and 
f  far  patients  with  feeble  digestion,  1  know  of  nothing 
I   which  is  equal  to  it." 

■■  i  ftnd  the  preparation  of  LACTOPEPTINE  con- 
tains within  Itself  all  the  principles  required  to  pro- 
mote a  health)  digestion.'' 


PRICE  LIST. 


LACTOPEPTINE  tin 


■■      |    ■■  doz.   10  00 
in  1  2  lb  "      )  "   lb.     IS  00 


II '.■  also  prepare  the  various  Elix- 
irs and  Syrups,  in  combination  with 
■i»  ptine. 


THE  NEW  YORK  PHAEMACAL  ASSOCIATION, 
10  and  12  College  Place,  New  York. 


P.  O.  BOX    I  57A. 


Druggists'  Directory. 


DRUGGISTS'  DIRECTORY. 


MISSOURI— Continued. 

Cutler,  Geo.  L St.  Joseph 

Eaton,  T.  J.  &  Co Kansas  City 

Eilis  &  Prather Maryville 

Gittings,  M.  R.  (P.M.)...., Carrollton 

Harrison.  V.  II.  &  Co Clarkton 

Jones,  Wm.  A Warrenton 

Kearney,  Dr.  J.  R New  Point 

Kinsey,  J.  X Knob  Noster 

Layton,    Thos Perryville 

Moon,  J.  II BunVeton 

McClellan,  Dr.  J.   P Mt.m 

McMurry,  T.  W Colony 

Ream.  J.  S Green  Ridge 

Risk,  R.  C.  &Bro "Williamstown 

Scholz,  P.  C Corning 

Short,  Dr.  Jno.  L Crocker 

Waring,  A .  T 1'otosi 

Wright,  Dr.  T.J Warrensburgh 

Brown,  Jno.  T Fulton  Mo 

Stigal,  Win.  M Stewartsvillc 


MONTANA. 

Hinehman,  J.  V Virginia  City 

Reinhard ,  J M  issoul'a 


ILLINOIS— Continued. 

Hatch,  II.  Lee Jacksonville 

Hohie,  Louis Shoal  Creek 

Hood  &  Son  Litchfield 

Magee,  Dr.  Henry  Mto  Pass 

Murdick.  Dr.  Jacob Gerraantown 

Northrop,  -I     1$ Winchester 

Rogers  &  Montgomery  Quincy 

Seaman,  L.  S.  &J.  O Shell. vville 

Wheeler,  Z.  S Galatia 

TEXAS— Continued. 
Darnall,  John  H Dexter 

WYOMING. 
Addoms  &  Glover Cheyenne 

NEBRASKA— Continued . 

Brainard,  F.  A Columbus 

Dully,  L.  F. Indianola 

CALIFORNIA. 
The  San  Francisco  News  Co San  Francisco 

NEW  MEXICO. 
Fisher  &  Co Santa  Fe 


OOLVILLE  Ac  OO., 

INSURANCE  BROKERS  AND  NEWS  AGENTS. 

Agents  for  Principal  European  and  American  Newspapers. 


No.  36  Calle  de  Plateros  de  San  Pedro, 
LIMA. 


No.  46  Calle  de  la  Constitncion, 
CALLAO. 


Contents. 


ORIGINAL  CONTRIBUTIONS. 

ARTICLE.  PAGE. 

V.  The  Mastoid  Region  and  its  Diseases,  with  illustrative  Cases.  By 
Latjbence  Turn-bill.  M.  D.,  Aural  Surgeon  to  Jefferson  Medical 
College  Hospital.  Philadelphia 119 

TRANSLATIONS  FRO^I  THE  ITALIAN. 

[Translated  for  the  Journal.]    By  Dr.  A.  II.  Oiimaxx-Dumesnil,  of 

St.  Louis • 138 

TRANSLATIONS  FROM  THE   FRENCH. 
Excerpts  from  Late  French  Journals.     [Translated  for  the  Journal.] 

By  Dr.  A.  H.  Ohmann-Dumksnil,  of  St  Louis 139 


Contents. 

PROCEEDINGS  OF  MEDICAL  SOCIETIES. 

Tri-State  Medical  Society— Discussion  of  Drs.  Mumford  and  Hibberd's 
pap<  is 1*2 

Epidemic  Scarlel  fever  with  Remarks  on  its  History,  Definition,  Origin, 
Prevention,  and  Treatment.  By  J.  W.  Compton,M.  D.,  of  Evans- 
ville,  End 146 

ST.  LOUIS  MEDICAL  SOCIETY  DEPARTMENT. 

Valedictory  Address 156 

<  Janeer  of  the  Os  Uteri ' 166 

Epithelioma  of  the  lids  of  the  Right  Eye 171 

(Edema  of  the  Epiglottis 187 

Book  Reviews •. 178 

Books  and  Pamphlets  Received 180 

Meteriological   Observations 182 

Mortality  Report— City  of  St.  Louis 182 


INDEX  TO  ADVERTISEMENTS. 


Vaccine  V inis -. 5 

Druggists'  Directory 3»  *»  xxiii 

in-  Subscribers  say xxiv 

Battle  &Co,,  Bromidia facing  page  119 

John  ton's  Fluid  Beef facing  page  135 

William  li.  Warner  &Co facing    page  136 

T.   J.    EATON    &   CO.,  I.  N.  KNEELAND  &  CO., 

DRUGGISTS  and  CHEMISTS.    Proprietors  of  City  Drug  Store 

I>ealors  ill  Slirt;-i«':il  Instruments  Dealers  in  Drug  i,  Medicines,  Oils,  Qlass,  Paints,  News- 


hikI  Appliances. 


impels,  Magazines,  Stationery,  etc. 


Cor    Eighth  and  Main  Streets,  21T  Kansas  Ave-  t;ilv  Building, 

KANSAS  CITY,  MO.  TOPEKA,  KANSAS. 

ROGERS  &  MONTGOMERY,  GEORGE    L.    CUTLER, 

WHOLESALE  AND  RETAIL  DEMISTS,  Resident  BookSdltr  id  Book  Agent, 

Special  attention  given  to  Emporl  Orders. 

417  Hampshire  Street,  Art  Emporium,  -  -  -  412  Felix  Street, 

QUINCY,  ILLINOIS.  ST.  JOSEPH,  MO 


Druggists'  Directory. 


DRUGGISTS'  DIRECTORY. 


MISSOURI. 

Arthur,  Dr.  8.  F Edgar  Springs 

Baker,  l>r.  J  •  8 Bowling  Green 

Bishop,  W.  H.ftOo Cahoka 

Boyce  &  Ostrander Chillicothe 

Bradley  ftNewlee Liberty 

Brown,  Ed.  J Edina 

Bryant,  S.  II New  Market 

Butts,  II.  1!  Louisiana 

Caffee,  AmosH.&Co Carthage 

Cason,  W.  X  Montgomery 

Crawibrd,  s.  K.  &  Co Warsaw 

Cloud,  A    s Chillicothe 

Crider,  W .  II Hartville 

Crisp,  I'.  R. Monroe  City 

Crothers  ft  Deal Carthage 

Cummings,  P.  M.  ft  Co Harrisonville 

Davis  &  Bailey Greenfield 

Davis  &  Hurt Columbia 

Donaldson,  T.    W Mooresville 

Dorrell,  C.  C Osceola 

Downing,  S  Shelbina 

Dudgeon,  W.  A.  &  Co Fayette 

Ettmueller,  Dr.  Gustav Herman 

Farr,  Dr.  Jeff.  C Alauthas  Grove 

Farrar,  Dr.  Wm DeSoto 

Ferguson,  J.  G.  B Savannah 

Frazer  &  Uutton Commerce 

French,  10.  P  Martinsburg 

Haliey.  Dr.  II.  J .Blackburn 

Harding,  Dr.  D.  E Grant  City 

Herdman,  Dr.  W.  C Athens 

Hinton,  II.  C.  &  Co Allen ville 

Hogan    Dr.  C.  J Alexandria 

Hubbell,  L.  W.  ft  Co Springfield 

Hudgens  &  McMichael Rockport 

Kircliner,  Dr.  H.  A St.  Charles 

Knighteu,  .J.  A Billings 

Leach,  J.  C Memphis 

Lewis,  A.  II Bolivar 

Lindsay,  S.  P New  Loudon 

Llewellyn,  J.  S Mexico 

Mace  ft  Mitchell Stockton 

Matthews,  Dr.  J.  A Ashley 

Miller,  Dr.  R.  T Sedalia 

Pendleton,  Thos Independence 

Potter,  Dr.  Byron  B Lancaster 

Kay  ft  shoemaker Hannibal 

Richardson,  Dr.  J.  S Bloomfield 

Rucker,  Alvin Farming  ton 

Slack,  Q.  C Dexter 

Sloan,  H.  R.  &  Son Breckenridge 

Smith,  N.  M Kingston 

SnoWj  A    P California 

Stone,  Dr    A    B Millord 

>  1,  M  .  W Joplin 

Sud< lick.  Dr.  s.  T Steelville 

Thomas.  J.  P  Upha 

Townley,   K.  W Chamois 

Tuunell  .t  Adamson   i  izark 

Zellweger,  J Nevada 

Vandei'  Linde,  John Graham 

NEBRASKA. 

Ayres,  M.  o DakotaCity 

Borgquist,  C.  E Sidney 

Chase,  Dr.  < ».  (; Kearney 

Crawford,  Dr.  R.  B La  Porte 

Davis  &  Gove Oa 

Dearborn,  L.  0 Albion 

Dick,  Dr.F.  N NorthPlatte 

Doolittle,  Dr.  L.  ( St.  Paul 

Hinkle  ft  Jackson  '■■ 

Hassler  .V.  Nichols I 

Haller  &  Lane  Blair 

Magenau,  Otto Fremont 

M  mis  &  West  veer Red 

Sax  ton,  Dr.  !>    K St.  Edward 

Shurtz,  Thos.  i> Falls  i  iiy 

minima,  B.  M.  ft  Co Alma 


TEXAS. 

Atchly  &  Davis Alvorado 

Austin.  A.J.J Rio  Grande  Citv 

Baker,  C.  II Goliad 

Beall,  Dr.  E.  I Fort  Worth 

Blvthe,  VV.  II Mount  Pleasant 

Bright,  Dr.  97.  S.  &  Son Galveston 

Bussy,  J.  B Bueua  Vista 

Camp  ,W.  s Gilmer 

(  ampbell  ft  Miles Enuis 

Cannon,   Dr.  <  has Rusk 

Casimir,  J.  P  Calvert 

Cobb,  D.  A.  ft  Bro Decatur 

Co., per,  Dr.  J.  J Greenville 

(only,  J.  W Helena 

Cotter  R.  ft  Co Houston 

DeRyee  ft  Westervelt Corpus  Christi 

Eliot,   W.  II Houston 

Farmer,  X.  R Marquez 

Gilder,  Dr.  U.  M Gatesville 

Goldberg,  L.  H Clarksville 

Gregory,  Thos.  C LaGrange 

Holt,  John  B Lockhart 

Jenkins,  Y.  S Gatesville 

Johnson,  Dr.  Wm.  L Giddings 

Killebrew,  Dr.  W Marlin 

Lightfoot,  E.  W Pittsburg 

Marshall,  J.  A  ft  Co Kaufman 

McConnell,  H.  II Jackson 

Moore,  J  as.  B Cameron 

Xe ville,  Geo Paris 

Peeler,  J.   W Bonham 

Perreno,  E.  A Rockport 

Preuss,  Leo Ennis 

Ryan,  J.  E Graham 

Smith  &  Frymier Crockett 

Tieling,  Paul. ..cor.  Centre  ft  B'dy,  Galveston 

Toouev,  Dr.  F.  B Butler 

WestfaU,  Watson  ft  Co Burnet 

W  etzstein,  E.  B Castroville 

Williams  ft  Tolliver Dallas 

TLLLXOIS. 

Anderson,  A.  A Chester 

Arnold,  A  Co Cutler 

Barton,  Dr.  Ira Raymond 

Beeson,  Dr.  W.  H.  H Elm  Point 

Boi kin,  Dr.  O.  F Fidelity 

(aid  well  ft  McGregor,  booksellers Pontiac 

Douglas,  E Hillsber* 

Gilbert,  Robt Effinghas 

Gross,  Wm.  II Gillespie 

Grove  &  Sou Jit .  Carroll 

Hampton  A:  (  o Carte rville 

lrwin.  s.  Miltou Decatur 

James,  Milo Marshall 

Jones,  Dr.  H.  T Nilwood 

Kahl,  .1  alius Belleville 

Longworth  ft  Severs McLeansboro 

Mar- ha II  &  Fisher Worden 

Milligan,  .).  S Coultersville 

N'Micd,  Dr.  <:-  II Lincoln 

Peak,  Dr.  W.J Oakland 

Smith  ft  Dunbar Monmouth 

iaggart,  Bruce Summerfleld 

\\  atson  .V  McKennan New  Holland 

Webster  Bros Benton 

Whin  en,  Dr.T.  J Irving 

LOUISIANA. 

Bogel,   \uic  •) Shreveport 

s,  F.  M Baton  Rouge 

Rii  hards,  Jos  Nashville 

fceller    &  Ledbetter Summerfleld 

Sitman,  Dr.  t  .  M  Greensburg 

St.  John,  Henry     Alexandria 

Monahan  ,^  Nauman Clinton 

i'"-c  >',  W     0 .Opelousas 

Wilkinson,  M.  n  Natchitoches 

Youiij?,  M.  P.  ft  Co Vermillionville 


Druggists'  Directory. 


DRUGGISTS'  DIRECTORY. 


KANSAS. 

Barber  Bros Lawrence 

Barnes,  W.  H Stockton 

Buck  &  Co Oskaloosa 

Dalton,  J.  J Jewel  Centre 

D'Huy,  Henry  du Parsons 

Dicky,  J.  B Newton 

Green,  Dr.  L.  C Lenta 

Gordon,  J.  P.  &  Son El  Dorado 

Hooser,  II.  G Independence 

Kirby,  A.  \V. Howard 

Kneelaud,  I.  N.  &  Co Topeka 

McCoit,  Neil Marysville 

Moore,  W.J Port  Scott 

Newlon,  Dr.  >V.  S Oswego 

Not  the)  all,  J.  G Abilene 

Parker,    L.    \V LaCrosse 

1  o  tenger, .).  W Hiawatha 

Kauey,  James Fredonia 

Rush,  J.  1) Port  Scotl 

.-alii n  &  Duckworth Louisville 

Shaw,  Jas.  G Frankfort 

smith,  Eli Medicine  Lodge 

Sprague.  A.  C Phillipsburg 

Thomson,  A.  S. Lyons 

Wassam,  Dr.  A.  M Eureka 

West,  I.  P Columbus 

Weed,  Frank  S Russell 

KENTUCKY. 

Baker,  U.  G McKee 

Bass  &  Turner Bowling  Green 

Bnrnside,  W Lancaster 

Carpenter  &  Read Scott  ville 

Combs,  John  J Hazard 

Dickersou,  W,  F Mt.  Sterling 

Elliott.  Green , Barboursville 

I lackett,  Thos Brooksville 

Haunan,  Dr.  L.  F Harlan 

Higgins,  J.  T Oweusboro 

Hillyard,  J.  H Marion 

Lyon,  W.  B Russellville 

Jones,  Simon,  N  Louisville 

Maxwell,  Dr.  James  A Princeton 

McDowell,  Wni.  A LaGrange 

McKay    Dr.  C.  W Shepherdsville 

MflQmddy,  Dr.  R.  1 Lawreuceburg 

Nickels,  Wm.  II.  &  Sons Whitesburg 

Peak,  Dr.  K.I Owenton 

Pedigo  &  Williams Edmonton 

Sanders,  S.  G Boon  ville 

Sterett  &  Duncan Hawesville 

ARKANSAS. 

Atkinson,   Dr.  Jas.  A Franklin 

Briggs  .V  Heck Dan\  ille 

Byara  &  Trigg Texarkana 

Driver,  John  L.  &  Co Osceola 

Dunklin,  J.  i* Pocahontas 

Hubberl  .V;  Mount Elm  Springs 

K  irk  pal  rick.  Dr.  J  .  X Kim   Store 

Martin,  J.  il Powhattan 

M e,  J.  C Ben  I  on 

•Mo., re,  il Lewisvllle 

Wall  is,  J,  H.  P Mountain  Home 

Wright.  M    W     EveningShade 

You  mans,  Dr.  J.  V Lewisvllle 

AL\B  \.M.\. 

Andrews,  Dr.  G.  W Troy 

1  ain,  K    M  Wetumpka 

<  ioldthw  a  Hi-  &  ~-on Tn,y 

Hurd,  Jos    Pratrville 

Mu  hal  a  Belgart Haynevllle 

I'-n  i  er  a    \i  in  trong Columbiana 

Roughton,  Dr.  .) .  I-' Ureem  Ille 

Taylor,  J.  o Greem  Ille 

MINNESOT  \ 

<  rocker,  -    i.  Faribaull 
Tulborl  A  While      in.,  i  cniiai  -.,\    Minneapolis 


MISSISSIPPI. 

Benton,  I.  O Fulton 

Browne,  Dr.  J.  A Kosciusko 

Hill,  J.  W.  &Son. Senatobia 

Hunt,  E.  N. Ripley 

Price,  W.  T.  &  Co Enterprise 

TENNESSEE. 

Barlow  &  Donohoo Savannah 

Bunting  &  Pepper Bristol 

Caldwell,  S.  YV Trenton 

Cole,  F.  A  Lindeu 

Franklin,  J.  C Lynchburg 

Goodyear,  D.  F Memphis 

Hills,  J.  B Covingtou 

Lovell,  C.  II Edgefield 

McKinney,  C.  S.  &  Co Ripley 

Minor,  John  V Gainsboro 

Rawlings.  John  G Chattanooga 

Richards,  Jos  Nashville 

Scott.  W.  M.  &  Co Brownsville 

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The  Missouri  Vaccine  Farm  was  established  in  1875,  for  the  purpose 
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have  enabled  me  to  so  perfect  my  arrangements  for  producing  the  Virus 
that  I  can  supply  the  largest  demands. 

The  past  success,  the  more  general  use  of  the  Virus,  and  the  encouraging 
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me  in  continuing  the  enterprise. 

QUILLS. — Of  the  various  forms  of  Virus  supplied  physicians,  that 
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recommended. 

Five  whole  quills  are  put  up  in  an  air-tight  package  (sufficient  for  10 
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FORMULA. — Every  fluid  drachm  contains  15  grs.  each  of  pure 
Brom.-Potas.  and  purified  Chloral,  and  %  gr.  each  of  gen.  imp.  ext. 
Cannabis-Ind.  and  Hyoscyam. 

DOSE. — One-half  to  one  fluid  drachm  in  water  or  syrup  every  hour 
until  sleep  is  produced. 

Bromidia  is  the  Hypnotic  par  excellence,  it  produces  refreshing 
sleep,  and  is  exceedingly  valuable  in  Sleeplessness,  Nervousness,  Neural- 
gia, Headache,  Convulsions,  Colic,  etc..  and  will  relieve  when  opiatesfail. 
In  the  Restlessness  and  Delirium  of  Fevers,  it  is  absolutely  invaluable. 


"Bromidia  is  an  effective,  powerful  and  safe  hypnotic.  Its  effects  are 
agreeable  and  devoid  of  the  depression  of  the  heart's  action,  often  notice- 
able after  the  exhibition  of  chloral  by  itself.  Practitioners  will  tind  it 
a  very  trustzvorthy  addition  to  their  list  of  useful  remedies." 

WM.  B.  HAZARD,  M.  D., 
Prof.  Practice  of  Medicine,  St.  Louis  College  Physicians  and  Surgeons. 


"We  have  relieved  many  suffering  patients  with  Bromidia,  and 
consider  it  far  superior  to  Chloral  Hydrate  alone.  Try  the  Bromidia, 
and  you  will  rind  it  all  that  is  claimed  for  it." 

GEO.  C.  PITZER,  M.  D. 
Prof.  Practice  of  Medicine,  Amer.  Med.  College,  St.  Louis. 


"  I  have  used  Bromidia  quite  frequently.  It  is  superior  to  anything  I 
ever  used  in  alcoholism.  I  freely  recommend  it  to  the  profession  as  a 
very  superior  and  safe  anodyne.'1'1  J.  H.  LESLIE,  Al.  D. 

Cor.  6th  &  Market  Sts.,  St.  Louis. 

"I  have  used  Bromidia  icith  (treat  success,  and  am  much  pleased  with 
it."  W.  T.  GREGORY,  M.  D. 

710  Olive  Street,  St.  Louis,  Mo. 


"  Bromidia  so  far  exceeds  anything  else  as  an  anodyne,  that  I  am  never 
without  it.     It  is  the  king  of  hypnotics." 

Olney,  Mo.  ALFRED  H.  CHENOWETH,  M.  D. 

"  I  am  delighted  with  Bromidia,  and  carry  a  bottle  with  me  con- 
stantly in  case  of  an  emergency."  C.  R.  CARR,  M.  D. 
Bloomington,  Ills. 

"I  have  used  Bromidia  in  several  cases  with  success,  where  morphia  and 
other  opiates  had  faiVd.     1  regard  the  preparation  as  a  reliable  hypnotic" 
41  S.  Clark  St.,  Chicago,  Ills.  VV.  H.  HESS,  M.  D. 


"Ihave  frequently  used  Bromidia  as  an  anodyne  and  hypnotic.  It 
is  more  active  and  agreeable  than  any  other  article  I  ever  used." 


9  S.  Ilalstead  St.,  Chicago,  Ills. 


J.  R.  McCULLOUGH,  M.  D. 


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Vol.  XXXVIII FEBKUAKY  20,  1880 No.  4. 


(Original  Contribution* 


Article  V. 

The  Mastoid  Eegion  and  its  Diseases,  with  Illustrative 
Cases.1  By  Laurence  Turnbull,  M.  D.,  Aural  Surgeon  to 
Jefferson  Medical  College  Hospital,  Philadelphia. 

An}T  one  avIio  has  examined  a  large  number  of  specimens  of 
the  human  crania,  will  be  struck  with  the  variety  of  forms  of 
the  mastoid  process  and  cells;  rarely  in  the  processes  of  the  same 
individual  are  they  alike.  Hyrtl2  in  an  examination  of  six 
hundred  skulls,  only  found  three  in  which  the  occipital  bone 
helped  to  form  the  mastoid  cells.  I  have  frequently  found  in 
old  persons  an  almost  complete  want  of  the  larger  cells  ami  in  a 
few  instances,  I  have  found  scared}'  any  cells  at  all. 

The  cavity  which  develops  into  the  mastoid  or  air  cells  in  re- 
cently born  children,  as  a  rule,  is  of  considerable  size,  to  which 
rule,  however,  there  are  numerous  exceptions.  In  shape  the  cav- 
ity is  a  pyramid,  one  of  whose  surfaces  is  directed  upwards 
and  is  formed  by  the  roof  of  the  tympanum.      According   to 


1.  Read  by  title  in  the  Section  of  Otology,  Congrts  PSriodique  des  Sci- 
ences Medicales,  6th  Session,  Amsterdam,  September,  1S79. 

2.  Wiener  Med.  Wochenschrift,  18G0. 


120  Original  Contributions.  [Feb.  20, 

Schwartze3  the  cavity  is  8  mm.  long,  7  mm.  high,  and  it  gradu- 
ally increases  in  size  and  changes  in  form,  becoming  larger  at 
one  end  than  at  the  other. 

Dr.  Hartmann4  has  called  attention  to  the  fact  that  in  twenty- 
one  sections  of  the  temporal  bone  in  children  he  found  the  aver- 
age thickness  of  the  bony  walls  between  the  antrum  and  the  pos- 
terior fossa  of  the  cranium  to  be  4  mm.,  while  in  twelve  tempo- 
ral bones  of  children  at  the  age  of  1  to  5  years,  the  antrum  was 
separated  from  the  posterior  fossa  of  the  cranium  by  a  bony 
wall  that  averaged  but  2  mm.  in  thickness,  and  in  five  cases  by  a 
bony  lamella  that  was  scarcely  1  mm.  thick.  From  his  opinion 
of  these  measurements  he  has  expressed  himself,  as  regards  the 
origin  of  the  cells:  "Since  the  cavity  is  again  found  smaller  in 
later  years,  this  can  only  happen  by  a  narrowing  from  the  sides, 
that  is  to  say  by  an  encroachment  of  the  partition  walls  of  the 
cells." 

Pathology. — In  very  young  children  the  inflammatory  pro- 
cess spreads  from  the  tympanum  to  the  antrum  petrosum  much 
more  quickly  than  at  a  later  period.  There  are  numerous  cases 
in  which  symptoms  of  meningitis  arise  in  a  recently  born  child 
a  few  days  after  the  appearance  of  an  "  otitis  media  purulenta." 
I  have  found  that  if  the  discharge  "otorrhoea"  is  free  and  not 
checked,  symptoms  of  meningitis  all  dissappear,  but  if  it  is  small 
in  quantity  and  thin  and  bloody,  or  if  it  is  suddenly  checked  it 
almost  always  results  in  the  death  of  the  child.  If  the  child  is 
older  there  is  less  danger  of  cerebral  affection,  as  the  intelligent 
child  is  able  to  describe  symptoms  and  the  ear  is  treated 
promptly.  In  the  infant  there  is  nothing  to  guide  us  but  the  cry 
or  the  evidence  of  pain  upon  pressure  behind  the  ear. 

The  second  stage,  i.  e.,  propagation  of  the  extra  secretion, 
particularly  when  partly  obstructed.  These  forms  in  scrufulous, 
tuberculous  and  syphilitic  children,  also  in  very  violent  purulent 
inflammation  of  the  middleear,are  the  result  of  scarlet  fever;  the 
large  collections  of  secretion  make  their  way  along  the  mastoideo- 
squamous  suture,  forming  an  abscess  behind  and  beneath  the 
auricle,  which  either  opens  spontaneously  or  is  increased  in  size 
ami  the  bone  is  necrosed,  as  in  the  following  case: 


\\.  Ueber  die  Kiinstliche  Eroffrung  des  Wurzcnfortsalzes,  Archive  fur 
Opienkeep  Band,  vii. 

4.  Ueber  die  Perforation  des  Wartzenfortsatzes ;  Langenbeck's  Archiv. 
BJ.  xxi. 


1880.]  Turnbull — Diseases  of  Mastoid  Region.  121 

Case  I.— A.  H.,  ;et.  2\  years,  a  fully  developed  child  of  a 
healthy,  strong  mother,  but  the  father  is  in  the  second  stage  of 
tuberculous  phthisis.  The  child  has  had  a  purulent  otorrhcea 
for  two  years.  There  appeared  a  large  abscess  behind  the  ear 
which  for  a  time  was  poulticed,  until  it  opened  spontaneously. 
After  some  months  the  inflammation  subsided  and  a  loosened  se- 
questrum of  bone  was  removed  by  enlarging  the  opening.  The 
child  to  all  appearances  got  well.  About  twelve  months  after- 
wards a  second  abscess  formed  in  the  same  locality  and  caused 
the  involvement  of  a  larger  quantity  of  bone.  The  head  was 
drawn  down  toward  the  neck  on  the  same  side,  and  the  upper 
part  of  the  neck  became  swollen  as  if  the  spinal  column  was  in- 
volved. The  bone,  in  the  second  attack,  did  not  come  to  the 
surface,  nor  did  the  inflammation  disappear,  but  gradually  the 
bone  was  broken  down  and  a  large  amount  of  it  was  removed 
by  discharge  of  small  particles.  Tonics,  cod  liver  oil,  iron  and 
sea  air  were  employed  to  expedite  the  slow  cure. 

Case  IT. — Henry  II.,  set.  5  years.  A  pale,  delicate,  scrofu- 
lous boy  was  brought  to  the  clinic  of  Howard  Hospital  with  a 
large  post  aural  opening,  discharging  pus.  There  were  found 
numerous  sinuses  with  rough  denuded  bone  underneath,  but  no 
loosening  or  detachment  of  bone,  nor  was  any  part  movable  by 
the  probe  or  forceps.  He  was  directed  to  use  an  antiseptic  wash 
to  the  openings.  A  few  days  afterwards  the  discharge  had 
ceased,  the  temperature  had  arisen  to  102°,  the  pulse  could  not 
be  counted  and  convulsions  and  death  soon  followed. 

In  this  case  there  was  no  doubt  in  my  mind  that  the  cere- 
brum was  affected,  for  there  was  present  persistent  pain  in  the 
head,  vomiting,  strabismus  and  convulsions  of  one  side. 

Case  III. — Mary  E.  C,  a?t.  15  years.  Her  mother,  of  decided 
tuberculous  tendency,  her  father  is  health}-.  The  girl  lias  suf- 
fered from  otitis  media  purulenta  of  two  years,  following  a  cold, 
and  this  had  gradually  improved,  with  some  loss  of  hearing.  She 
has  been  at  times  affected  with  distressing  vertigo,  so  that  if  she 
had  not  taken  hold  of  some  support  she  would  have  (alien.  Sin- 
is  deaf  in  the  left  ear,  a  rim  of  the  membrana  tympani  remaining. 
She  gradually  became  unable  to  leave  her  bed;  she  lay  with 
her  head  bent  forward  on  her  chest,  any  movement  giving  her 
pain  and  increasing  her  vertigo.     There  have  been  two  or  three 


122  Original  Contributions.  [Feb.  20, 

slight  convulsive  movements  and  internal  strabismus  was  pre- 
sent. When  the  tongue  is  protruded  there  is  a  tendency  to  the 
left  side.     She  gradually  passed  into  a  state  of  coma  and  died. 

Without  going  into  the  minute  details  of  the  post  mortem,  it 
is  sufficient  to  say  that  there  was  no  abscess  or  disease  of  the 
cerebrum.  The  cerebellum  was  softened  and  on  it  there  was 
an  abscess  containing  about  two  ounces  of  pus. 

These  three  illustrative  cases  bear  out  the  facts  first  announced 
by  Toynbee,  that  up  to  the  second  or  third  year  of  life  the  cere- 
brum is  most  frequently  affected,  corresponding  to  the  anatomical 
relations,  while  affections  of  the  cerebellum  and  the  transverse 
sinuses  appear  only  at  a  later  age. 

Our  old  method  was  the  removal  of  the  sequestra  of  bone 
with  the  knife,  probe,  elevator  and  forceps.  A  new  method  has 
been  proposed,  called  the  "Volkmann,"  in  which  a  small,  deli- 
cate, sharp,  spoon-like  knife  or  gouge  is  employed.  I  have  had 
such  an  instrument  made  and  have  operated  in  only  one  case 
with  it,  as  yet.     The  result  in  this  case  was  a  success. 

Schede,  Schwartze  and  Hartmann5  have  treated  a  large  num- 
ber of  cases  with  good  results,  and  the  following  is  Dr.  Hart- 
man's  method  of  operating : 

"An  incision  is  to  be  made  in  at  the  insertion  of  the  auricle 
and  in  such  a  way  that  the  middle  of  the  incision  lies  just  below 
the  level  of  the  opening  of  the  external  auditory  meatus.  If  a 
fistula  is  present  the  incision  either  passes  through  the  fistulous 
opening,  or  is  to  be  united  with  it  by  a  diagonal  incision.  In 
making  the  incision  through  the  soft  parts  we  must  take  care  not 
to  cut  forward,  since  the  surface  of  the  mastoid  process  passes 
over  into  the  posterior  wall  of  the  auditory  meatus,  without  any 
sharply  defined  boundaries,  and  by  passing  forward  we  run  the 
risk  of  only  loosening  the  posterior  wall  of  the  external  auditory 
meatus,  and  from  here  reaching  the  membrana  tympani.  This 
rule  seems  of  importance,  and  should  be  especially  observed 
where  the  soft  parts  are  greatly  infiltrated.  The  incision  should 
not  be  too  small,  but  fully  2  to  3  cm.  in  length.  The  edges  of  the 
wound  should  be  held  apart  with  sharp  hooks,  so  that  after  the 
bleeding  has  ceased  the  field  of  operation  can  be  thoroughly  ex- 
amined. 


5.  On  the  formation  of  sequestra  in  the  mastoid  process  of  the  child, 
by  Dr.  Arthur  Hartmann,  of  Berlin.  Translated  by  Dr.  James  A.  Spald- 
n°-,  Arch.  Otology,  vol.  viii,  No.  1,  New  York,  L879. 


1880.]  Turnbull— Diseases  of  Mastoid  Region.  123 

"In  all  the  cases  in  which  I  have  operated  either  a  fistula  was 
already  present  or  after  the  soft  parts  were  cut  through 
there  was  an  opening  in  the  bone  which  could  be  enlarged  with 
the  sharp  spoon.  In  one  case  only  did  I  have  to  employ  the 
chisel  in  order  to  enlarge  the  small  opening.  The  granulations 
Ij-ing  in  front  are  to  be  removed  with  the  sharp  spoon.  If  the 
antrum  is  opened  and  laid  bare  in  this  way  it  can  be  examined 
most  carefully  with  the  probe  or  with  the  tip  of  the  finger  intro- 
duced. If  loosened  sequestra  are  present  they  can  be  seized  with 
pincers  or  forceps  and  extracted,  or  as  proves  most  suitable,  may 
be  pried  out  Avith  the  spoon.  The  sharp  spoon  also  offers  the 
best  services  in  removing  the  bone  that  has  become  softened  by 
caries.  The  precautionary  measure  suggested  by  Schede,  to  use 
the  sharp  spoon  only  when  the  bone  is  found  to  be  softened  to  a 
certain  degree,  is  not  to  be  neglected. 

"In  my  operations  I  have  followed  the  maxim  of  confining 
myself  in  the  removal  of  the  morbid  parts  to  what  was  most 
needed — i.e.,  chiefly  the  removal  of  the  granulations  and  the  ex- 
traction of  such  sequestra  as  were  fully  loosened  and  could  easily 
be  reached.  It  seems  then  necessary  in  the  after  treatment  to  keep 
the  wound  open  by  a  thick  drainage  tube,  so  that  in  the  subse- 
quent days  we  may  have  a  full  view  into  the  depths  of  the  wound, 
from  which  now  the  sequestra  gradually  loosening  themselves 
may  be  detached  with  the  probe  and  removed.  It  seems  also 
desirable  in  the  latter  stage  (as  has  been  emphasized  especially 
by  Schwartze  and  v.  Troltsch)  to  keep  the  aperture  open  as  long 
as  possible  by  means  of  a  leaden  nail  or  a  short  leaden  tube, 
until  we  are  sure  that  the  mastoid  process  is  in  a  sound  condition. 
The  important  point  in  the  after  treatment  is  the  regular  re- 
moval of  the  accumulated  secretion,  for  which  purpose  we  prefer 
S}Tringing  at  first  with  antiseptic,  later  with  neutral,  and  lastly 
with  astringent  fluids." 

Mastoid  in  the  Adult. —  6In  the  adult  the  antrum  is  largo 
enough  to  admit  a  small-sized  pea.  There  are  small  veins 
through  the  upper  portion  of  the  process  which  form  a  medium 
of  communication  between  the  lateral  sinus  or  its  branch,  the 
superior  petrosal  sinus,  and  the  veins  on  the  outside  of  the  cra- 

6.  Transactions  of  the  Medical  Society  of  the  State  of  Pennsylvania, 
vol.  XII.  pail  1  ;  his.  of  Mastoid  Process,  with  cases,  by  Laurence  Turn- 
bull,  M.  D.,  Ph.  G. 


124  Original  Contributions.  [Feb.  20, 

nium.  By  this  communication  and  close  relation  to  the  brain,  if 
pus  be  formed  and  cannot  find  another  outlet,  death  is  apt  to  fol- 
low by  pysemic  inflammation  of  the  cerebrum  or  cerebellum.  Dis- 
ease of  the  mastoid  process  is  divisible  into  the  following  forms: 
1st,  Inflammation  of  the  external  periosteum.  2d.  Acute  inflam- 
mation of  the  lining  mucous  membrane,  followed  by  filling  up  of 
cells  with  a  reddish,  pulpy  material,  by  accumulation  of  pus  and 
with  caries.  3d,  Chronic  sub  acute  inflammation  of  the  mucous 
membrane  with  sclerosis  or  hyperostosis.  4th,  Periosteitis,  inde- 
pendent of  involvement  of  the  mastoid  cells. 

Inflammation  of  the  External  Periosteum. — In  the  course  of 
an  otitis  media  diffusa,  with  or  without  discharge,  the  mastoid 
region  begins  to  swell,  becomes  red,  and  very  painful  on  press- 
ure. If  these  symptoms  occur  in  a  healthy  individual,  the  mas- 
toid cells  are  rarely  involved.  When  this  same  swelling  takes 
place  in  a  tuberculous,  scrofulous  or  feeble  adult,  the  prognosis  is 
not  favorable.  In  the  first  class  of  cases  permanent  relief  is 
given  by  free  depletion,  or  by  an  incision  with  a  strong  scalpel 
down  through  the  periosteum  to  the  bone.  In  the  second  class 
the  disease  almost  always  involves  the  deeper  cells  of  the  bone, 
which,  becoming  filled  with  pus,  produce  caries  or  necrosis.  In 
children  such  diseased  bone  must  be  removed  when  suppuration 
brings  the  sequestrum  to  the  surface,  while  in  the  adult  an  im- 
portant operation  has  to  be  performed — i.  e.,  perforation  of  the 
bone  for  the  relief  of  the  patient.  The  second  class,  or  simple 
congestion  of  the  mucous  membrane  of  the  mastoid  cells,  which 
we  often  see  in  its  slightest  form  in  acute  inflammation  of  the 
middle  ear,  is  most  frequently  the  result  of  cold,  and  is  to  be  re- 
lieved by  cleansing  the  parts,  and  by  local  depletion  by  leeches, 
etc.  Still,  in  its  most  aggravated  form,  nothing  but  an  opera- 
tion will  relieve  it. 

Case  IV. — Illustrating  Inflammation  of  External  Periosteum, 
icith  Sudden  Stoppage  of  Discharge. — Disease  of  mastoid  process, 
with  discharge  from  external  meatus;  recovery.  Martin  F.,  set. 
7  years,  a  large  and  robust  boy,  but  of  tuberculous  family  (father 
and  four  uncles  having  died  of  phthisis),  was  convalescent  from 
scarlet  fever,  and  was  discharged  well  on  March  15.  Ten  days 
later  I  was  called  in  basic  to  sec  the  boy.  There  was  great  pain 
.and  swelling  behind  the  ear,  over  the  mastoid  process,  but  no  dis- 


1880.]  Turnbull — Diseases  of  Mastoid  Eegion.  125 

charge  from  external  meatus.  He  was  freely  leeched,  and  purg- 
atives were  administered,  and  followed  by  anodynes  to  relieve 
the  pain.  On  the  next  day  the  swelling  was  on  the  increase,  and 
had  extended  to  the  face  and  eyes,  with  fever  and  symptoms  of 
convulsions.  It  was  then  proposed  to  cut  down  to  the  hone,  di- 
viding the  periosteum,  as  the  only  means  of  relief,  to  which  pro- 
posal the  mother  consented.  An  incision  was  made  about  an 
inch  long  behind  the  ear,  and  as  nearly  as  possible  parallel  with 
the  concha,  which  at  this  time  stood  almost  horizontal.  A  pro- 
fuse gush  of  blood  followed,  mixed  with  which  was  imperfectly 
formed  pus.  The  wound  bled  and  oozed  for  three  days.  The 
pain  was  much  relieved,  and  by  the  use  of  bromide  of  potassium 
and  with  sulphate  of  morphia,  he  was  able  to  sleep,  which  lie  had 
not  done  for  two  days.  A  poultice  was  applied  on  the  third 
night,  and  by  the  fourth,  pus  flowed  freely.  This  was  encouraged, 
and  by  the  end  of  the  sixth  week  the  wound  was  disposed  to 
close;  but  this  was  prevented,  and  the  discharge  continued  for 
four  weeks  longer,  when  the  wound  was  allowed  to  close,  as  the 
roughness  of  the  bone  had  disappeared. 

.Report  several  years  afterwards:  The  young  man  is  now 
20  years  of  age,  has  enjoyed  good  health  since,  being  able  to  be 
out  in  all  weather;  is  bright  and  intelligent,  and  is  at  work  in  a 
cotton  mill.  His  hearing  in  his  left  ear  is  gone ;  right  very  good. 
Over  the  mastoid  cells  of  the  left  side  there  is  a  depression  of  a 
bluish  color  from  loss  of  bone.  Has  never  had  a  severe  attack 
since,  excepting  now  and  then  a  slight  discharge  from  the  left 
ear.     J  J  e  has  since  lost  his  mother  by  phthisis. 

Case  V. — Of  the  Same  Nature,  which  was  not  Treated.  James 
E.,  set.  5  years,  in  1862  had  a  similar  swelling  alter  an  attack  of 
scarlet  fever;  it  opened  of  itself  after  long  poulticing,  and  contin- 
ued to  discharge  from  the  back  of  the  eat-  for  twelve  months;  it 
then  ceased,  leaving  a  deep  depression  behind  the  ear,  with  loss 
of  hearing;  the  boy  is  imbecile  and  cannot  articulate. 

Case  VI. — Disease  of  the  Mastoid  Process;  Perforation  of  the 
Membrana  Tympani;  Recovery.  Mrs.  A.,  rot.  35  years,  whoso 
case  was  of  the  same  character  as  the  one  just  reported,  was 
treated  in  a  similar  manner  with  equally  :j;o<>d  results. 

Case  VII. — Abscesses  over  the  Mastoid  Process  in  Mother  and 
Child ;  similarly  treated  and  both  recovered. 


126  Original  Contributions.  [Feb.  20, 

March  25,  Thomas  N".,  set.  5  years,  applied  at  the  Howard 
Hospital  with  an  abscess  over  the  mastoid  process.  He  is  con- 
valescing from  an  attack  of  measles.  The  swelling  back  of  the 
ear  commenced  three  weeks  previously,  then  subsided,  and  again 
began  to  swell.  On  examination,  there  was,  besides  the  swel- 
ling, redness  and  slight  fluctuation.  There  was  no  discharge 
from  the  ear.  On  informing  the  mother  what  was  to  be  done, 
she  replied  :  "  Well,  do  what  you  think  is  right,  as  you  performed 
the  same  operation  upon  my  ear,  when  this  child  was  only  ten 
months  old.  I  was  at  that  time  three  months  under  your  care 
and  was  cured  and  remain  so."  I  examined  the  back  of  her  ear 
and  found  a  deep  depression,  where  there  had  been  loss  of  bone. 
Her  hearing  in  that  ear  was  not  perfect,  but  she  was  not  abso- 
lutely deaf.  The  operation  was  then  performed  on  the  boy, 
when,b}T  the  aid  of  the  probe,  the  bone  was  found  to  be  denuded 
of  its  periosteum.  Being  of  a  strumous  habit,  he  was  ordered 
syrup  of  the  iodide  of  iron,  a  small  poultice  of  ground  flax  seed, 
and  subsequently,  an  ointment  of  the  red  oxide  of  mercury,  to 
dress  the  part  and  anoint  a  tent  so  as  to  keep  it  open. 

April  1st  the  wound  suppurated  freely,  but  the  opening  was 
disposed  to  close  and  it  was  accordingly  enlarged  and  the  pre- 
vious treatment  continued,  accompanied  with  good  diet  and  ex- 
ercise in  the  open  air.  By  the  end  of  the  month  he  was  reported 
well,  wound  healed  and  all  swelling  had  disappeared. 

Case  VIII.  —  Perforation  of  the  Mastoid  Process ;  Otorrhoza ; 
Removal  of  Necrosed  Bone ;  Recovery.  Mary  R.,  set.  eight  years, 
a  robust  looking  child,  came  under  my  care  at  the  Howard  Hos- 
pital early  in  September,  1861.  It  was  reported  that  she  had 
suffered  from  scarlet  fever  of  a  most  malignant  type,  having  been 
in  a  state  of  coma  for  several  days.  This  gradually  passed  away 
when  the  throat  and  ears  became  affected,  and  a  long  period 
elapsed  before  complete  convalescence  took  place. 

Present  condition. — She  is  deaf  in  the  right  ear,  with  a  con- 
stant discharge  of  offensive  pus,  etc.  On  washing  out  the  parts,. 
the  meatus  was  found  to  have  a  white,  soft  deposit  on  its  surface 
wiih  granulations  projecting  from  the  tympanum  through  a  per- 
foration involving  the  greater  part  of  the  membrana  tympani. 

A  weak  wash  of  nitrate  of  silver  in  solution  was  to  be  used 
and  the  pails  kept  clean   by  repeated   injections  of  tepid  water. 


1880.]  Turnbull— Diseases  of  Mastoid  Region.  12*3 

Counter  irritation  was  to  be  kept  upin  front  of  the  car  and  air 
was  to  be  passed  through  the  Eustachian  tube  to  keep  it  open  and 
at  the   same  time   force  any  accumulation   of  pus    out    from  the 
middle  ear.     A  guarded  prognosis  was  given.     Having  improved 
considerably,  she  ceased  attendance,  and  the  writer  saw  nothing 
of  her  until  called  in  haste  to  see  her,  a  few  weeks  later.     The 
history  received  from  her  father,  an  intelligent  man,  was  as  fol- 
lows:    The  Sunday  previous,  being  a  very  hot  day,  when   the 
child  was  sleeping  on  a  sofa,  the  father,  to  cool  the  house,  opened 
both   the   front  and    back  doors,  and  thus    produced   a  strong 
draught  of  cool  air  which  blew  upon   the  sleeping  child.     After 
retiring  she  was  attacked  in  the  middle  of  the  night  with  intense 
pain  in°her  ear,  so  severe  as  to  cause  her  to  scream  and  at  times 
become  delirious.     The  parents  applied  a  blister  and  used  other 
means   but  the  relief  was  of  short  duration.     When  I  was  called 
to  her  she  was  suffering  intense  pain,  high  fever  alternating  with 
chills,  pulse  one  hundred  and  thirty,  and  there  was  swelling  over 
the  mastoid  region,  involving  the  side  of  the  face  and  eye. 

Treatment.— Believing  that  pus  was  formed  in  the  mastoid 
cells  and  was  endeavoring  to  make  its  way  outwards,  requiring 
onlv  an  outlet,  I  divided  the  skin,  muscle  and  periosteum  freely 
down  to  the  bone.  On  withdrawing  the  knife,  blood  mixed  with 
imperfectly  formed  pus,  flowed  very  freely.  A  hot  poultice  was 
ordered  to  be  repeated  every  few  hours.  A  saline  mixture  of 
citrate  of  potassa,  containing  sulphate  of  morphia  was  prescribed 

to  relieve  pain. 

Four  days  later,  better.  Pus  discharging  from  the  opening, 
which  not  being  quite  free  enough,  was  stimulated  by  the  appli- 
cation of  powdered  red  oxide  of  mercury. 

November— During  this  month,  visited  the  case  every  few 
days.  The  opening  being  disposed  to  close,  a  sharp,  hollow  steel 
probe  was  used  to  perforate  to  the  surface  of  the  dense  bone, 
and  the  solid  nitrate  of  silver,  which  was  applied  freely,  increased 

the  discharge. 

December.— In  the  early  part  of  this  month  the  opening  was 
again  enlarged  and  a  piece  of  bone  discharged.  On  the  19th 
carious  bone  was  found  by  the  probe  to  be  movable,  and  by  en- 
larging the  wound  a  still  larger  piece  was  removed  with  some 
difficulty,  the  bleeding  being  very  free.  A  few  days  alter  this 
operation  the  discharge  ceased  and  the  wound  healed.     There 


128  Original  Contributions.  [Feb.  20, 

was  a  deep  depression  behind  the  ear  from  loss  of  bone ;  the  per- 
foration in  the  membraita  tympani  had  closed  somewhat;  the 
child  was  deaf  in  that  ear,  but  otherwise  well,  and  continued  so 
for  several  years.  The  bone  measures  six-tenths  of  an  inch 
in  length  and  three-tenths  of  an  inch  in  width.  It  is  now  in 
the  writer's  collection,  and  has  been  examined  by  numerous 
distinguished  surgeons. 

In  the  cases  above  related,  which  number  might  have  been 
increased  by  many  others,  we  have  examples  of  three  of  the 
principal  forms  of  disease  of  the  mastoid  region,  which  will  be 
frequently  met  with  by  those  who  devote  much  attention  to  the 
ear,  and  occasionally  by  those  who  pay  no  particular  attention  to 
this  special  department. 

In  case  IV  the  simple  division  of  the  periosteum,  with  the 
subsequent  application  of  a  blister,  was  all  that  was  necessary  to 
complete  the  cure.  In  the  next  case  it  required  the  second  en- 
largement of  the  opening  and  the  breaking  down  of  the  bone  by 
the  application  of  nitrate  of  silver. 

The  third  class  of  cases  is  of  greater  danger  to  the  patient,  as 
it  involves  a  large  number  of  cells  of  the  mastoid  process.  It, 
therefore,  requires  a  free  incision  down  to  the  bone,  with  its  re- 
moval in  a  diseased  state. 

This  operation  of  perforating  the  mastoid  cells,  December, 
1861,  and  published  February,  1862,  was  the  first  of  the  kind 
that  had  been  performed  in  the  United  States  (so  far  as  the  writer 
is  aware),  and  has  been  repeated  by  him  several  times  since. 

Case  IX7 — Foreign  body,  with  middle  ear  inflammation,  involv- 
ing the  mastoid  cells — Operation  followed  by  erysipelas — Ultimate 
recovery. — W.  1L,  set.  42,  a  merchant  of  Mahanoy  City,  Pa.,  con- 
sulted me  in  1877,  bringing  a  letter  from  his  family  physician, 
Dr.  L.  M.  Thompson.  The  letter  stated:  "Patient  has  had  a 
chronic  suppurative  inflammation  of  the  left  ear  since  childhood, 
the  result  of  scarlet  fever,  accompanied  with  tinnitus  of  a  distress- 
ing character,  with  intense  pain  over  the  temporal  and  mastoid 
region, extending  also  to  the  base  of  the  brain.  The  pain  which 
is  now  almosl  constant,  is  accompanied  with  attacks  of  oppres- 
sion and  giddiness,  particularly  when  the  eyes  are  directed  up- 
wards."     While  about  his  business  he  would,  when  these  attacks 

7.  Transactions  of  .Medical  Society,  ass.  cit.,  vol.  xii,  part  1. 


•1880.]  Turnbull — Diseases  of  Mastoid  Eegion.  129 

were  coming  on,  by  pic-king,  or  rather  forcibly  scraping  or  dig- 
ging into  the  meatus  as  far  and  as  deeply  as  possible,  with  ;i  pen- 
cil, toothpick, pen-holder  or  knitting  needle,  provoke  a  discbarge 
of  pas,  which  afforded  temporary  relief.  During  one  of  these 
efforts  at  relief,  and  while  much  interested  in  his  newspaper,  he 
probed,  literally  dug,  too  deeply,  and  an  attack  of  convulsions, 
followed  by  a  partial  paralysis,  was  the  result.  Various  methods 
of  treatment  had  been  pursued,  but  the  symptoms  remained  un- 
changed. 

Status  Prcesens. — Left  auricle  red  and  swollen,  meatus  exter- 
nals eczematous,  discharge  thin  and  offensive,  canal  narrowed, 
membrana  tympani  and  ossicles  gone,  promontory  glistening 
and  in  places  sclerosed.  No  other  details  of  middle  ear  to  be 
made  out  on  account  of  the  swollen  condition  of  the  mucous 
membrane  and  canal.  Eustachian  tube  pervious.  Hears  a  loud 
voice,  but  not  the  watch,  even  on  contact.  Pain,  on  pressure, 
over  mastoid  and  against  the  sides  of  the  canal.  Right  ear  nor- 
mal.  No  particular  throat  trouble.  Recommended,  on  his  re- 
turn, to  use  local  depletion  by  leeches,  followed  by  hot  fomenta- 
tions.; also,  large  doses  of  bromide  potassium,  chloral  and  mor- 
phia, with  quinine. 

These  means  afforded  but  temporary  relief  to  the  pain,  even 
after  using  half  grain  doses  of  morphia,  hypodermically,  every 
little  while,  as  well  as  successive  relays  of  leeches.  I  then  ad- 
vised a  free  post  auricular  incision  (Wilde's)  to  be  made  through 
the  integument  down  to  the  bone.  This  was  most  thoroughly 
done  by  his  physician,  who  reported  relief  obtained  for  but  a  few 
•days,  after  which  time  the  symptoms  returned  as  before.  Fi- 
nally, at  the  request  of  Dr.  Thompson,  the  patient  returned,  to 
be  under  my  immediate  care,  and  was  faithfully  attended  by  my- 
self and  son  for  several  weeks.  Meanwhile,  to  be  brief,  the  symp- 
toms varied,  at  times  better,  then  worse,  and  finally  relapsed 
into  the  old  condition.  Our  patient  and  his  friends  having 
grown  impatient,  1  told  them  there  was  but  one  course  to  pursue, 
viz.,  that  of  perforating  the  mastoid. 

The  discharge  had  ceased,  the  painfullness  and  tinnitus  had  in- 
•creased,  giddiness  and  more  or  less  delirium  were  constant,  with 
loss  of  appetite  and  symptoms  of  a  general  breakdown;  bo  that, 
rafter  due  deliberation  and  consideration  of  the  just   mentioned 


130  Original  Contributions.  [Feb.  20, 

grave  symptoms,  we  decided,  after  consulting   Drs.   Thompson,. 
Collins,  Schapringer  and  C.  S.  Tarnbull,  to  operate. 

Mr.  H.  was  admitted  October  3,  1877.  as  a  private  patient,  to 
the  Jefferson  Medical  College  Hospital,  and  I  operated  in  the 
presence  of  Drs.  S.  W.  Gross,  J.  H.  Brinton,  Collins,  Allis,  Wirg- 
man,  Poichet,  James  and  my  son.  The  po3t  auricular  incision 
previously  made  had  not  entirely  healed.  This  I  enlarged,  and 
with  a  strong  knife  extended  upwards,  scraping  as  I  went,  and. 
pushing  the  periosteum  to  either  side.  The  bone  was  not  found 
soft  or  abnormally  rough.  A  drill  was  then  applied  at  a  point 
about  a  quarter  of  an  inch  distant  from  the  auditory  canal  and 
below  the  level  of  its  upper  rim,  rotating  inward  and  slightly 
forward.  The  drill  was  withdrawn  and  carefully  cleansed  at  in- 
tervals, and  but  slight  force  used,  on  account  of  the  danger  of 
slipping  suddenly  and  breaking  down  the  delicate  cancellated 
cells  of  the  mastoid.  This  care  is  necessary  on  account  of  the 
varying  depth  of  the  cells,  which  is  apparent  even  on  opposite 
sides  of  the  same  skull. 

Upon  reaching  and  opening  the  cells,  no  pus,  but  a  dram  or  two 
of  an  aqueous  and  dark  red  colored  fluid  escaped.  The  wound 
was  cleansed  and  sprayed  with  carbolized  ether  (kept  up  during 
the  operation  as  well),  packed  with  greased  lint,  and  the  patient 
put  to  bed.  No  anodyne  was  required,  as  the  patient  was  so 
thoroughly  narcotized  with  the  amount  of  ether  which  was  used. 
The  alter  treatment  consisted  in  the  regular  administration  of 
beef  tea  and  a  nourishing  diet,  while  the  use  of  alcoholic  stimu- 
lants was  avoided.  The  wound  was  dressed  twice  in  twenty-four 
hours,  and  alter  the  third  day  a  discharge  commenced,  which  con- 
tinued while  the  opening  was  kept  plugged  with  a  linen  tent 
soaked  in  carbolized  olive  oil.  The  ear  was  thoroughly  syr- 
inged every  day.  Our  patient  never  seemed  to  rally,  although 
he  grew  no  worse,  but  at  the  end  of  the  second  week  all  hopes 
were  checked  by  the  appearance  of  an  erysipelatous  swelling  in 
the  neighborhood  of  the  wound.  This  spread  over  the  earr 
cheek  and  entire  face,  but  stopped  abruptly  before  reaching  the 
ear  of  the  other  side.  Kepeated  doses  of  the  muriated  tinct.  of 
iron,  locally,  with  good  diet  and  the  attentions  of  Dr.  Poichet,  the 
resident  physician,  and  nursing  of  a  devoted  wife,  brought  about 
a  favorable  result. 

Convalescence  soon  commenced,  particularly  after  a  copious 
discharge  of  pus  from  the  ear  and  wound,  and  just  one  month  after 


1880.]  Turnbull — Diseases  of  Mastoid  Region.  131 

the  operation  our  patient  left  for  home,  free  from  pain,  mind  quite 
clear,  slight  discharge  from  the  ear,  wound  almost  closed,  and 
general  condition  rapidly  improving.  Since  thai  time  he  has 
been  under  the  judicious  care  of  Dr.  Thompson,  through  whose 
courtesy  I  received  many  bulletins. 

A  recent  letter  from  Dr.  Thompson  says  :  "  Mr.  H.  has  never, 
since  the  operation,  had  enough  pain  to  require  even  a  mild  ano- 
dyne, and  he  requests  me  to  state  that  he  has  now  no  desire  to  dig 
in  his  ear  on  account  of  any  disagreeable  feeling;  is  able  to  sec 
company,and  he  took  dinner  with  his  family,  Thanksgiving  day, 
November  29." 

The  following  is  an  extract  from  a  letter  received  from  Dr. 
Thompson,  the  attending  physician,  which  makes  this  history 
complete:  "You  will  well  remember  with  what  tenacity  Mr.  H. 
insisted  upon  a  portion  of  a  toothpick  being  lost  in  the  ear. 
Some  weeks  ago  he  withdrew  the  cotton  from  the  ear,  when,  to 
his  great  surprise  and  delight,  he  discovered  adhering  by  dried 
blood  to  the  cotton,  a  piece  of  wood  one-half  inch  long  and  from 
one-half  to  three-fourths  of  an  inch  in  thickness.  With  its  dis- 
charge the  acute  pain  that  had  come  on  recently,  ceased.  The 
wood  must  have  passed  into  the  middle  ear,  and  the  discharge 
must  have  washed  it  out.  No  matter  what  the  cause,  or  what 
produced  the  disease,  we  were  justified  in  performing  the  opera- 
tion, as  the  man  must  have  died  had  it  not  been  done." 

We  have  repeatedly  demonstrated  upon  the  cadaver,  and  the 
following  facts  hold  good :  If  the  operation  is  made  as  usually 
directedln  most  of  the  works  upon  disease  of  the  ear,  viz.,  "On 
a  line  with  the  upper  part  of  the  auditory  canal,"  the  incision 
must  penetrate  deeply,  enter  the  horizontal  or  sigmoid  fossa  or 
sinus.  Again,  if  a  probe  be  thrust  through  such  an  opening 
made  in  the  cells,  it  is  liable,  even  when  but  slight  force  is  em- 
ployed, to  fracture  the  thin  lamella  of  bone  and  cut  the  middle 
cerebral  fossa,  which  would  likely  prove  fatal.  Therefore  the 
knife,  gouge,  drill  or  trephine,  should  he  inserted  on  a  line  with 
the  superior  edge  of  the  auditory  canal,  hut  not  at  the  upper 
edge  and  the  opening  carried  horizontally  and  a  little  forward 
and  not  upwards.  In  this  way  all  the  vital  parts  are  avoided, 
and  we  sooner  or  later  reach  the  large  cells  of  the  mastoid.  The 
after  treatment,  in  which  great  care  must  he  exercised  id  cleans- 
ing or  probing,  constitutes  a  process  which  should  be  earned  on 
every  twelve  hours. 


132  Original  Contributions.  [Feb.  20,. 

Notwithstanding  the  dangers  due  to  frequent  anatomical  de- 
viations of  the  bone,  the  operation,  when  urgent,  is  highly  to  be 
recommended,  and  has  now  become  a  standard  one. 

Case  X. — Inflammation  of  the  Subcutaneous  Tissue  of  the  Su- 
pra and  Postauricular  Region,  extending  into  the  Middle  Ear  from 
which  pus  was  discharged,  which  found  its  way  through  the  posterior 
wall  of  the  meatus,  in  which  was  a  polypoid  growth.  Operation  and 
recovery,  ivith  an  abstract  of  five  cases. 

E.  S.,  aged  forty-eight  years,  admitted  to  Jefferson  Medical 
College  Hospital  from  Chester  County,  Pennsylvania,  April  10, 
1879.  There  was  only  a  brief  history  brought  by  the  physician 
who  accompanied  him  to  the  hospital.  Exposure  to  intense  cold 
in  December,  1878,  Avas  followed  by  a  succession  of  swellings 
back  of  the  ear  and  ultimately  a  discharge  from  the  ear.  He  had 
been  leeched,  cupped,  blistered  and  iodine  was  employed  with 
other  applications  to  the  post-auricular  region,  but  the  patient^ 
had  gradually  became  worse,  was  feeble  and  now  had  a  constant' 
pain  in  his  head.  His  physician  also  stated  that  he  believed' 
there  was  inflammation  of  the  mastoid  cells,  and  that  they  re- 
quired perforation. 

On  examination  of  the  patient  in  consultation  with  Prof.  S. 
D.  Gross  and  other  members  of  the  staff  of  the  hospital,  it  was 
concluded  that  the  cells  were  not  involved.  The  following  was- 
his  condition  :  Slight  swelling  on  the  upper  part  of  the  sterno- 
cleido-mastoid  muscle,  pain  most  severe  in  the  afternoon  on  the 
upper  part  of  the  parietal  bone,  over  which  he  kept  up  a  con- 
stant rubbing  with  his  hand.  Examination  with  the  speculum 
showed  a  polypoid  growth  or  granulation  tumor  just  within  the 
meatus,  which  it  filled  up.  After  its  removal  a  probe  could  be 
passed  to  the  meatus,  showing  a  connection  between  the  poste- 
rior wall  of  the  meatus  and  the  post-auricular  region,  and  pus- 
also  issued  more  freely  when  the  post-auricular  region  was 
pressed  upon;  his  pulse  was  Sf,  temperature  100°,  and  this  con- 
tinued, varying  but  little,  until  there  was  a  more  decided  swell- 
ing, when  the  temperature  reached  110°,  i.  e.,  just  prior  to  the 
opening  of  the  abscesses 

Prof.  S.  D.  Gross  advised  blistering  behind  the  ear,  these  to> 
he  followed  by  poultices,  by  quinine  and  iron  internally,  and 
painting  the  region  with  tincture  of  iodine;,  to  relieve  the  con- 
stant  pain  chloral  hydrate  and  potassium  bromide  were  admin- 


1880.]  Turnbull— Diseases  of  Mastoid  Region.  133 

istered  through  the  day,  and  a  local  anesthetic  of  camphor  and 
chloral  to  apply  to  the  scalp,  and  a  nourishing  diet,  with  a  hypo- 
dermic injection  of  morphia  at  night.     After  the  application  of 
the  blister  there  was  a  contraction  of  the  neck,  winch  caused  the 
head  to  he  held  to  the  same  side.     The  discharge  from   his  ear 
was  thin,  light-colored  pus  with  no  odor,  the  ear  was   kept  clean 
and  Politzer's  douche  was  employed  with  hydrobromic  ether  va- 
por.    The  hearing  had  never  been  much  impared.     On  the  26th 
day   of  April,  the  patient  not  improving,  Drs.  S.  D.  and  S.  W. 
Gross  visited  the  case  in  consultation  with  me,  and  after  examin- 
ation they  both  came  to  the  conclusion  that  there  was  a  perios- 
teitis  and  there  was  pus,  and  agreed  with  me   that  a  deep  and 
long  incision  must  be  made  over  the  mastoid,  which  I  performed 
under  hydrobromic  ether,  down  to  the  bone. 

No  pus  followed  the  incision,  but  the  hemorrhage  was  very 
free.  The  bone  was  not  diseased,  nor  even  roughened  in  the  least. 
The  incision  was  kept  open  for  some  days  by  a  tent  saturated 
with  cavbolic  acid  and  olive  oil,  and  over  the  parts  a  poultice  was 
constantly  applied.  The  following  day  the  patient's  pulse  was 
80  and  temperature  99°,  pain  much  relieved,  and  he  was  directed 
to'continue  quinine  and  iron  in  pill  form  with  milk  puncii  and 

nourishing  food. 

April  28th,  pulse  and  temperature  the  same;  29th  and  oOtn, 

the  pulse  about  the  same,  was  out  in  ward,  and  even  took  a  walk 
in  the  open  air;  continued  to  do  well  until  the  5th  of  May,  when 
the  temperature  arose  1011°,  pulse  92.  The  patient  was  much 
disturbed  with  his  pain,  there  was  a  swellingon  a  line  with  the 
sterno-cleido-mastoid  muscle,  with  a  slight  chill  and  an  abscess, 
formed  near  the  point  of  incision,  and  was  freely  opened.  From 
this  time  the  pulse  was  reduced  to  80,  and  temperature  to  99  he- 
made  a  slow  but  sure  convalescence,  and  was  discharged  well  on 

May  9,  1879. 

On  carefully  studying  this  case,  wh.ch  at  first  was   very  ob- 

scure  not  having  seen  it  for  five  months  from  commencement  of 
attack,  when  he  entered  the  hospital,  and  was  placed  under  my 
care  I  felt  satisfied  that  the  mastoid  cells  were  not  involved, 
because  the  swelling  was  very  low  down  in  the  supra  and  pre- 
auricular region,  the  pain  was  never  over  the  larger  eels,  but 
high  up  near  the  top  of  the  parietal  bone,  which  latter  ind  cated 
brain  abscess,  but  without  other  symptoms  to  eonlirm  it.  1  there- 


134  Original  Contributions.  [Feb.  20, 

fore  placed  it  as  a  pain  of  a  reflex  character  from  irritation  of 
the  small  occipital  and  auriculo-temporal  nerve. 

On  reading  the  report  of  cases  by  Voltolini,8  in  which  he  di- 
rects attention  to  a  form  of  mastoid  periostitis,  as  undescribed,  by 
otological  authorities.  (I  felt  sure  that  this  was  a  similar  case, 
such  as  he  described,  although  there  was  more  disease  of  the 
external  than  of  the  middle  ear,  and  which  may  have  occurred 
from  the  use  of  irritating  applications).  The  ear,  Yoltolini  states, 
may  remain  intact,  but  may  sometimes  in  the  course  of  the  dis- 
ease participate  in  the  inflammation.  "The  disease  begins  with 
severe  tearing  pains  on  one  or  both  sides  of  the  head,  which  ex- 
tend to  the  side  of  the  face  and  teeth.  The  pain  is  sometimes 
referred  to  carious  teeth  by  the  patient,  but  later,  fever  sets  in, 
and  the  pain  becomes  localized  above  the  posterior  auricular  re- 
gion, the  mastoid  surface  becomes  swollen,  red,  tense  and  ex- 
ceedingly tender.  If  active  antiphlogistic  treatment  does  not 
relieve  these  symptoms  the  case  progresses  to  suppuration,  under 
which  circumstances  the  best  remedy  is  always  the  knife."  The 
same  rule  has  always  held  good  in  regard  to  the  early  use  of  the 
knife,  which  Wilde  recommended  where  superficial  periosteitis 
followed  an  acute  inflammation  of  the  middle  ear  with  a  sudden 
checking  of  the  discharge.  In  the  three  cases  reported  by  Vol- 
tolini all  were  the  result  of  cold  and  exposure.  In  the  first  case 
alter  the  use  of  leeches,  which  did  not  diminish  the  symptoms 
on  the  following  day,  a  long  and  deep  incision  was  made  over 
the  mastoid.  The  pain  was  almost  immediately  relieved,  the 
patient  slept  well  and  made  a  good  recovery. 

The  second  case  was  treated  by  the  family  physician  for  a 
supposed  disease  of  the  ear.  Being  called  in  consultation,  I 
found  the  following  condition:  The  region  behind  and  above 
the  ear  was  swollen,  red  and  tender;  with  the  exception  of  a 
slight  swelling  on  the  superior  posterior  wall  of  the  external 
auditory  canal,  the  outer  ear  was  normal.  The  membrana  tvm- 
pani  presented  no  special  abnormal  appearances,  nor  was  there 
any  evidence  of  more  deep-seated  trouble.  Three  days  later,  after 
application  of  poultices,  and  after  an  incision  was  made  above 
and  behind  the  ear,  with  liberation   of  considerable  saneous  pus 


8.  R.  Voltolini:  "Die  Acute  Zellhautentziindung  in  der  supra-  und 
postauricular  Gegend."  Monats,  fur  Ohrenheilkunde,  Dec.  1875,  p.  7S9. 


Font*  in  Great  Britain  and  htland,  France,  Vnited  Statu  of  Africa  ana  panada,  1876. 

JOOTSTOFS  FLUID  BEEF, 

IBS  HOST  fflffER  FOOD  TOR  INTO  EVES  HIMBDBD, 

Specially  Recommended  by  the  Medical  Faculty. 

Th.  efficacy  of  "I^.-sEx.rac,  «f  S^SS  3S3  K 

everywhere  acknowledged,  but,  outside  meuicd J  "  home-made  beef 

not  generally  known  ^*XS$*S£&  ol uWe  Silts'  of  flesh.)  and 
tea.  are  simply 'flaywof  meat,  (tectonicaiiy,ine  the  process  of 

p^JPonXs^^^ 

extracts  of  meat,  and  dg^^J^fo5f1^aJi3  be  at  once  palat- 
the  stimulative  and  nutatious ^J^Al&SoN  CLABISTO  tfEET 
able  and  easily  digestible.    THIb  Fl  £|  AitA±  searching  chemical 

THE  WANT.    It  has  been  submitted  to    ne  nius  been  adopted  in 

analysis  by  the  leading  analysts  of  Great ;  Bntag  ami  ha*  Dee  p  ^ 
their  practice  by  the  highest  medical  ™f  °nJ$  Jj.  »emf    the  notice  of 

^oSi^^ 

aie  the  flesh-forming  or  nu^Tt^Pse  shall  bfpresent  in  a  form  admitting  of  easy 
or  stimulative  qualities,  and  that  thesesjiau  ??  P*  ^    lg  the  theorv  which  1^ 

digestion  by  Jg^ooBt  «|SKWSbS»  (the  only  meat  extract  vrhich 

fulfilLPaU  ibeaco°nndUions  of  a  perfect  «>°d:  .  w     ?avs :  "  I  have  used  it  in  a  case  of  a 
Dr.  Nichols,  t 31  Spruce  street, i^2«„M  attack  of  cholera  infantum;  the  child 
child  suffering  from  extreme  debility  alter  an  a tiacK  t  find  ,,  ve].    pa  . 

blJan   o  improve  immediately and l  is  ^ taking  ttel-im^  ^  coutajued  fi„ 
Stable  and  nourishing,  easily .^f^bod'v   a*  shown  by  a  great  gain  ot  strength, 
^SSSSS^SSS^^^j^^    ..Itls  wltn  Hnnsual  pleasure 
Dr.  Malcom  Macfarlane, MM ^XdaCw  Johnston's  Fluid  Beef.    It  fa  In  the 

Llksf  ssb  sews  ffssat.  by *.  «**  **,  *~ 
sjlb^  i,uligestion  or  me     : 

Sold  by  Druggists  and  Leading  Giccc*.     rrtce 

Robert  Shoemaker  &  Co.,  Philadelphia,  General  Agents,  U.  S. 

R.CHARDSON  &  CO.,  Who.esale  Agents,  St.  Louis. 


Pills: — Physicians  practising  in  the  Southern  and  Western  States,  are 
usually  careful  to  designate  Warner  &  Co. 's  Soluble  Sugar-Coated  Pills  when 
writing  prescriptions,  as  they  have  derived  the  most  beneficial  and  uniform 
results  from  the  use  of  these  preparations.  It  would  be  well  for  physicians 
everywhere,  to  exercise  this  same  caution  when  prescribing  Pills  of  Quinia 
and  Phosphorus,  as  well  as  all  other  kinds,  to  avoid  inferior  brands  at  lower 
prices. 

Sugar-Coated  Pills  skilfully  prepared  of  pure  material,  possess  advan- 
tages over  those  coated  with  other  material.  Sugar  is  the  most  soluble, 
and,  when  necessary  is  applied  to  pills  so  soft  as  not  to  retain  their  form 
uncoated.  They  are  beautiful  in  appearance,  more  acceptable  to  the 
patient,  more  readily  swallowed  than  pills  with  sticky  coating.  Doctors  who 
had  favored  other  pills  on  account  of  their  much  vaunted  merit  for  solu- 
bility, write  us  that  their  delicate  patients  revolt  at  their  color  and  appear- 
ance. Physicians  throughout  the  country  have  it  in  their  power  to  disprove 
their  claim  for  greater  solubility,  as  samples  of  "soluble"  gelatine-coated 
pills  in  small  paper  boxes  have  been  extensively  distributed,  which  after 
being  kept  for  a  time  become  very  hard  and  brittle,  the  enclosed  mass,  as 
well  as  the  coating,  losing  its  moisture.  This  proves  that  gelatine  is  not 
nonpervious  and  is  certainly  not  the  proper  material  with  which  to  protect 
medicinal  substances,  especially  Phosphorus  in  pilular  form.  Warner  & 
Co.'s  should  be  used  and  invariably  specified  when  ordering. — W,  &  Co. 


WILLIAM  M9  WA1I11  &  ©#„ 

1228  Market  Street,        -        Philadelphia. 

MANUFACTURERS  OP 

SOLUBLE  AND  RELIABLE 


t^~PHYSICIANS'   FAVORITE    RECIPES    FOR    PILLS    MADE   TO   ORDER. 
MEDICAL   SUPPLIES   FOR 

PHYSICIANS  AND  HOSPITALS  A  SPECIALTY. 


A  HANDSOME  POCKET  CASE. 

Comprising  such  an  assortment  of  Recipes  as  may  be  desired. 


CONVENIENT  FOR  PHYSICIANS  PRESCRIBING  WARNER  &  CO.'S  SOLUBLE  SUGAR-COATED  PILLS, 
♦""COMPLETE   LISTS  SENT  TO  ANY  ADDRESS. "®ft 


1880.]  Turnbull — Diseases  of  Mastoid  Kegion.  135 

and  relief  of  pain,  which  relief  continued  to  the  termination  of 
the  case  in  recoveiy. 

The  third  case  given  did  not  end  so  fortunately ;  the  mastoid 
region  became  swollen,  and  the  proposal  for  an  incision  made  by 
the  phj-sician  called  in  attendance  being  firmly  refused,  the  in- 
flammation took  its  course.  The  application  of  poultices  finally 
induced  a  spontaneous  opening  and  discharge,  with  some  relief 
to  pain,  which  still  continued  in  a  measure.  Nine  months  after 
the  first  attack  the  patient  was  seen  accidentally,  and  he  found 
the  following  conditions  present:  The  hearing  was  but  slightly 
diminished,  as  the  patient  could  easily  hear  conversation  in  the 
ordinary  tone.  The  region  behind  and  above  both  ears  was 
much  swollen  and  relaxed,  pus  discharged  from  the  left  ear  hav- 
ing found  its  way  through  the  posterior  wall  of  the  meatus  (as  in 
the  case  No.  10);  fistulous  openings  in  the  neck  lead  upward  to 
the  original  seat  of  the  inflammatory  process,  the  pus  having 
burrowed  on  both  sides  for  a  distance  of  from  two  to  three 
inches  before  escaping. 

Free  incisions,  opening  up  the  channels  through  which  the 
pus  had  burrowed,  were  made,  but  a  careful  examination  failed 
to  detect  any  implication  of  the  bone;  this  treatment  followed  by 
poultices  seemed  of  good  effect  and  the  patient  improved  with 
nourishing  food  and  rest ;  on  the  third  day  fever  set  in  with  in- 
creased weakness,  erysipelatous  inflammation  attacked  the  edges 
of  the  cuts  and  then  extended  over  the  scalp,  and  on  the  ninth 
day  after  the  operation  the  patient  died. 

A  study  of  these  cases  (one  by  Dr.  Blake,  of  Boston,  and  one 
by  Dr.  H.  Knapp,  of  New  York9)  and  ours  reported  as  above, 
shows  the  disease  to  be  neither  one  of  the  auricle,  the  external 
auditory  canal,  the  tympanic  cavity,  nor  the  mastoid  cells,  but 
one  that  originates  without,  and  not  within  the  ear,  and  one  that 
might  progress  inward,  but  would  hardly  penetrate  deeply. 

To  Dr.  Voltolini  is  due  the  credit  of  having  given  a  clear  and 
detailed  description  of  this  affection  which  has  been  translated 
by  Dr.  C.  J.Blake,  of  Boston,  who  also  added  a  case,  the  first 
one  in  the  United  States.  It  is  not  noticed  by  Dr.  A.  H.  Buck 
in  his  paper  on  diseases  of  the  mastoid  process  in  the  Archives 
of  Ophthalmology  and  Otology  Vol.111,  No.  1,  p.  17i>,  for  in  this 


9.  Report  of  the  First  Congress  of  the  International  Otological  Society . 

D.  Appleton  &  Co.,  New  York,  1877,  p.  SO. 


136  Original  Contributions.  [Feb.  20, 

he  states  that  "the  inflammation  of  the  external  periosteum  of 
the  mastoid  process  occurs  as  a  concomitant  symptom  or  phase 
of  an  acute  inflammation  of  the  external  auditory  canal,"  nor  is 
it  mentioned  in  the  still  more  recent  works  on  otology. 

Since  the  discharge  of  patient  Case  X,  Ave  have  received 
information  that  he  exposed  himself  for  two  days  to  the  rain  and 
had  a  slight  return  of  the  swelling  and  pain,  but  the  otorrh<eal 
discharge  has  gradually  improved.  The  physician  who  has  charge 
of  the  case  was  directed  to  open  the  swelling  and  keep  it  open 
with  a  tent  saturated  with  olive  oil  and  carbolic  acid,  also  to 
wash  out  the  opening  with  a  solution  of  carbolic  acid  and  water, 
and  to  change  the  form  of  his  tonic  from  time  to  time,  as  the 
conditions  arising  might  indicate. 

APPENDIX. 

Within  the  last  week  we  have  had  a  most  interesting  case 
under  our  care,  sent  us  by  Dr.  Schott,  of  this  city.  The  brief 
history  is  as  follows : 

A  family  of  three  children,  one  girl  and  two  boys,  were  at- 
tacked with  malignant  scarlet  fever.  After  some  weeks  the  girl 
died,  and  the  other  two  children  were  so  low  as  not  to  be  ex- 
pected to  recover,  and  in  the  case  of  the  youngest,  a  boy  of  four 
years,  had  a  persistent  tonsilitis,  with  swelling  of  the  neck  up  to 
the  ears,  and  involving  the  ear  and  extending  to  the  Eustachian 
tube  and  mastoid  cells.  The  elder  bojT  had  otitis  media  puru- 
lenta  chronica,  with  perforation  of  both  membrana  tjunpana. 
After  careful  treatment  for  many  weeks  the  boys  were-  sent  to 
me.  Tin1  elder  hoy,  after  a  month's  treatment  of  the  ears,  recov- 
ered, and  is  now  able  to  be  at  school.  The  boy  of  four  had  otitis 
media  purulenta  chronica,  with  five  fistulous  openings  over  the 
mastoid  process,  two  on  the  left  and  three  on  the  right.  When 
these  openings  were  examinad  with  a  probe,  they  were  found  to 
contain  sequestra.  The  piece  of  bone  on  the  left  was  found  to 
be  movable  and  was  extracted  January  11th,  and  very  soon  one 
of  the  openings  healed  up  while  we  used  a  simple  carbolic  acid 
lotion.  The  other  remained  open  and  the  discharge  diminished, 
yet  there  was  found  on  examination  a  portion  of  roughened  bone 
which  was  scraped  by  the  sharp  steel  spoon  and  capsici  sulph.  in 
powder,  applied.  The  largest  opening  on  the  right  side  was 
filled  up  with  a  wax  sponge  tent  to  dilate  the  opening,  and  on 
.lanuarv  .".1  the  hrid<re  of  tissue  was  divided  and  the  <rranulations 


1880.]  Turnbull — Diseases  of  Mastoid  Region.  137 

trimmed  away.  By  means  of  a  strong  bone  forceps  a  large  se- 
questration was  removed  while  the  little  fellow  was  under  the 
influence  of  hydrobromic  ether.     He  is  now  doing  well. 

In  this  connection  we  would  most  highly  recommend  this 
new  anaesthetic  to  the  surgical  profession,  and  indeed  to  all  who 
operate.  We  introduced  the  hydrobromic  ether  in  this  country 
in  the  summer  of  1877  10  and  have  employed  it  in  over  one  hun- 
dred cases  which  were  reported  at  the  International  Congress  at 
Amsterdam,  in  1879.  We  also  brought  it  before  the  Section  of 
Otology  at  the  meeting  of  the  British  Medical  Association,  at 
Cork.  In  June,  1879,  we  administered  it  in  the  public  clinic  be- 
fore a  class  of  two  hundred  students,  at  Jefferson  College  Hos- 
pital, and  Dr.  Samuel  W.  Gross  removed  a  cyst  in  front  of  the 
hyoid  bone  in  a  young  girl,  Dr.  Levis  having  charge  of  the  pulse, 
which  he  found  but  little  atfected.  It  has  been  employed  now 
in  all  classes  of  operations,  and  its  advantages  are  as  follows: 

First.  It  is  perfectly  safe  as  an  anaesthetic,  and  free  from 
many  of  the  objections  to  chloroform  or  ether. 

Second.  It  is  almost  as  rapid  in  its  anaesthetic  effects'as  chlo- 
roform and  is  more  rapidly  eliminated  by  the  lungs. 

Third.  It  is  more  agreeable  in  its  odor  than  ordinary  ether, 
is  not  inflammable,  and  therefore  can  be  employed  at  night  in 
using  the  actual  cautery,  or  in  a  private  office  or  a  lady's  cham- 
ber without  being  offensive  or  dangerous. 

Fourth.  The  cost  is  now  about  thirty-five  cents  per  ounce, 
yet  it  requires  only  two  drams  to  produce  its  anaesthetic  influ- 
ence, and  two  more  to  keep  it  up. 

Filth.  Vomiting  is  very  rare,  unless  the  stomach  has  been 
recently  filled  with  solid  food. 

Sixth.  The  pulse  is  increased  in  force  and  volume,  respiration 
not  much  over  the  normal,  and  the  pupil  at  times  slightly  di- 
lated, with  free  action  on  the  skin. 


10.  See  The  Advantages  and  Accidents  of  Artificial  Anaesthetics,  first 
edition;  also  2d  edition,  pp.  67,  80,  294,  with  a  fullaccounl  of  its  proper- 

ties  and  the  best  method  of  preparing  it.  etc. 


138 


Translations  from  the  Italian. 


[Feb.  20, 


Crnnslntions. 


FROM   THE   ITALIAN. 

Dr.  A.  H.  Ohmann-Dumesnil,  Translator.     [For  the  Journal.] 

Albuminuria  in  BriCxHt's  Disease. — Prof.  Semmola,  of  Na- 
ples, read  a  note  on  Bright's  disease  before  the  International  Con- 
gress at  Amsterdam.  In  this  note  he  gave  the  following,  con- 
nected with  albuminuria: 


r     By  the    presence  in,     Novmal     kidn  ey  f    ^dividual    mi 

the  blood  ot  au  excess)  r^h-irBinlne-inal   e\i>pii-«' mu  m    0t    ulea' 

of  albuminoids  derivedi  SS'^T"  1  Plates  and  phosp] 


l'rom  food. 


Dyscrasic 
albuminuria. 

Chemical    ^ 
conditions  of 

the  blood. 


ment  easily  made) . 


Uu  the  urine. 


m  a  x  l  - 
sul- 
phates 


By  an   excess  of  al- 
b  u  minoi  da  i  n    the 

blood,  that  is  due  to  a 
fault  in  the  combus- 
tion. 


f    Irritative  hyperemia  ( 
!  — more  or  less  intense,  j 

according  to  the  organ 
|  or  apparatus   whose) 
|  function  has  been  dis-  \ 
turned  (cutaneous  sur- 
face, lung  disease, 
Letc) 


Progressive  diminu- 
tion of  urea  in  the 
urine  without  accumu- 
lation in  the  blood  ; 
delect  in  production. 


By  an  alteration'  in 
the  chemical  constitu- 
tion of  the  circulating 
albuminoids,  w  b  i  c  h-! 
renders  them  unassim- 
ilable,  very  diffusable, 
v.etc;   (cachexias). 


Fatty  degeneration 
Amyloid    degenera— < 
tion. 


The  same  as  above 
in  regard  to  the  grav- 
ity of  the  cause  which 
produces  the  cachexia 


Mechanical 
albuminuria. 

Degree  of 
pressure  of 

he    blood 
curt  i-iit , 


(    Urea  almost  normal 
Renal  stasis  more  or  ;  and  within  the  limits 
mole  Influences  on  the^  less  temporary.  )  of  physioiogicai  oscil- 

vaso- motor  system.       L  (Jations. 

I  The  same  as  above, 
bul  frequently  the  sta- 
sis becomes  permanent  |  Urea  according  to 
on  account  of  general)  the  pregnancy  or  to  the 
conditions  of  the  body  \  organic  causes  produc- 
er by  organic  causes  j  ing  the  compression, 
which   produce  the 


Different   neuropath-  | 
ics  having  direct  or  re-  J 


Pregnancy  an  d    in 
general    al  1     pressure  ! 
exercised  on  the  vena-( 
cava  inferior  or  on  the 

renal  veins,  etc. 


Heart  diseases  which 

have  arrived  al  their 
non- apensating  pe- 
riod— that  is  to  -a\  .  lu  ' 
i he  i n\ ersion  of    the 
arterial  and  v  e  n  o  u  e  I 
tensions. 


pressure. 


Persistent  stasis. 
Cyanosed  kidney. 
Cardiac  kidney. 


I 


Diminished  urea  ac- 
-'  cording  to  the   heart 
disease. 


1880.] 


Trantlations  from  the  French. 


139 


f 

All   irritative    pro 
cesses  of  the  kidney 
!  in  their  different  stages 


Irritative 
albuminuria. 


ch 


I  (     Normal  urea  or  aug- 

I     All  t  h  e  anatomical  J  mented  insensibly,  ac- 
I  consequences    "i    in- {cording  to  the  fever 
flammation,  from  the  t.  (acute  stage) . 

up  to  complete  n^frI-i^l™Plet?Sbfd8*aJfand.    I4.  .    ,      , 

1  degeneration ol  theva-  (     Diminished  urea 

■ious    epitheliums   to)  without   accumulation 

iclerosis  and  atrophy-c  in  the  blood, according 


The  albuminous 
nitration   i>  more 


uiii.ttiou   is  more  or        ,         .' -■-■-  —     ..........   ... . 

Hi«i«in<rt™iSless  considerable   inJ  sclerosis  and  atrophy^  totheblood.according 
Histological     ,„.,...,...,;,,„  ,,,  ,,,„  ,,.,,.,    ot  the  kidney,  accord-    to  general  troubles   in 

-h:,'"-Tei"  the    payed  ■     1   o    hV  i,       in?  ' e  BPecial  hi"  '  combnstion. 

elements  in  the  mech-  aammatorJ  process  i  Diminished  urea 
anismof urinary  Ultra-  and  °*  "»•  ■1Paolal  »"  ''  .accumulation  in 
tion                      •  cause   which  lias   pro-<  the  blood  as  a  conse- 

I  duced  it.  |  quence  of  Fault]  flltra- 

: I  (.don. 


— [Giornale  Inter  nazionale  dell  a  Scienze  Mediche. 


FROM    THE    FRENCH. 

Excerpts  from  Late  French  Journals.     [Translated  for  the 
Journal.]     By  Dr.  A.  H.  Ohmann-Dumesnil,  of  St.  Louis. 

Fungating  Excrescences  of  the  L'mbilicus  in  Infants. — At 
the  Anatomical  Society,  M.  Ch.  Fere  called  attention  to  the  fact 
that  these  tumors  are  not  very  rare  but  still  have  not  been 
studied  much  in  certain  directions.  These  little  tumors  gener- 
ally show  themselves  four  or  five  days  after  the  cord  has  dropped 
off,  and  develop  rapidly.  They  assume  various  forms:  cylin- 
drical, pedunculated,  sessile,  etc.  Their  volume  is  generally 
that  of  a  pea  although  the}-  occasionally  attain  the  size  of  a 
cherry.  They  have  no  tendency  to  cure  spontaneously.  The 
cylindrical  vegetations  may  be  destroyed  by  ligating  or  cutting, 
and  the  sessile  forms  by  cauterization.  The  histological  struc- 
ture is  divided:  some  are  granulomas  (of  Virchow)  and  the 
most  common;  others  vascular  fungus,  rare 5  and  the  rest  ade- 
nomas. The  author's  examinations  showed  them  to  be  sar- 
comatous (with  small  cells)  and  a  tendency  to  form  connec- 
tive tissue. — Progris  Medical,  Dec.  20,  1879. 

New  Method  for  the  Post-Mortem  Study  of  (;.\sTiur  Les- 
ions:— M.  Damoschino  detailed,  to  the  Biological  Society,  a 
method  to  preserve  the  stomach  in  its  true  state  after  death.  It 
is  impossible  almost  to  make  an  autopsy  inside  of  24  hours  after 
death  and  during  that  time  the  stomach  undergoes  changes  due 


140  Translations  from  the  French.  [Feb.  20, 

to  the  action  of  the  gastric  juice  and  to  the  decomposition  of 
food.  He  thinks  that  this  can  be  obviated  by  filling  the 
stomach  with  86  per  cent  alcohol,  one  or  two  hours  after  death. 
Besides  its  antiseptic  properties  the  alcohol  hardens  the  tissues 
and  renders  them  much  more  advantageous  for  microscopic 
investigations.  The  color  of  the  mucous  membrane  is  reduced  a 
trifle  paler.  -Ibid,  Dec.  27,  1879. 

Traumatic  Atrophy  of  the  Papilla  of  the  Optic  Nerve. — 
M.  Gralezowski  recognizes  three  varieties  :  1st.  Where  it  is  the  re- 
sult of  meningo-cephalitis  and  is  only  observed  when  the  mem- 
branes of  the  brain  had  been  wounded.  It  is  characterized  by 
greyish  circumpapillar  exudates  which  are  ineffaceable.  2d.  The 
result  of  a  direct  wound  of  the  optic  nerve,  in  its  orbital  part, 
by  means  of  thrusts  from  weapons  or  by  fractures  into  the  optic 
foramen.  3d.  Loss  of  sight  is  immediate  in  one  eye  in  certain 
fractures  of  the  skull  and  the  atrophy  of  the  optic  nerves  becomes 
progressive  as  in  locomotor  ataxy.  These  are  very  interesting 
phases  whose  pathology  is  not  as  yet  very  clear. — Gazette  des 
Hopitaux,  Dec.  18,  1879. 

Pathology  and  Treatment  of  Rabies. — Dr.  Brochin,  in  a 
review  of  a  work  by  Dr.  Dubone,  gives  the  following  as  the  au- 
thor's conclusions  : 

The  morbific  agent  progresses  slowly  in  a  centripetal  direction, 
from  the  site  of  the  wound  to  the  spinal  center  and  backwards 
very  rapidly  in  a  centrifugal  direction. 

The  effects  of  rabies  commence  as  soon  as  the  virus  attains 
the  spinal  center  and  are  recognized  by  the  radiating  pains. 

The  period  of  incubation  is,  in  general,  proportioned  to  the 
distance  the  virus  must  travel.  Whence  it  follows  that  it  is 
shorter  in  children  than  in  adults,  in  wounds  of  the  face,  etc. 

The  morbid  phenomena  which  characterize  the  period  of  in- 
vasion are  directed  to  the  general  and  sensorial  sensibility,  which 
at  first  becomes  more  acute  but  finally  disappeai*s  and  paralysis 
results. 

The  lesions  of  rabies  are  of  two  kinds  :  those  which  are  prox- 
imate, visible  only  with  the  aid  of  the  microscope,  and  consisting 
in  an  increased  opacity  of  the  nerve  cells,  together  with  a  granular 
state  of  a  number  of  afferent  and  efferent  fibers;  the  other  lesions 
visible  to  the  naked  eye,  are  marked  congestion  of  various  or- 
gans ami  viscera. 


1880.]  Translations  from  the  French  141 

Rabies  belongs  to  a  grand  class  of  morbid  affections  of  a  pe- 
ripheric origin,  like  certain  eruptive  levers  and  neuroses. 

The  transmission  of  the  virus  along  the  course  of  nerves  fur- 
nishes the  following  therapeutic  indications :  1st,  to  destroy  the 
virus  in  situ;  2d,  to  prevent  its  passage  to  the  spinal  cord,  in 
case  it  cannot  be  destroyed  j  3d,  to  dull  the  sensibility  of  the 
spinal  center  during  the  whole  period  of  incubation,  in  case  the 
means  given  above  are  not  feasible;  4th,  to  constantly  acton 
the  centers  of  the  cords  by  intra-venous  injections,  to  combat 
the  ordinarily  rapid  progress  of  asphyxia. 

The  reviewer  states  that  the  unilateral  character  of  rabies  is 
notan  observed  fact  and  that  experiments  (of  which  a  resumt  was 
given  in  a  former  number  of  the  Journal)  have  been  made  with 
rabbits  which  tends  to  prove  it  bilateral, — Ibid,  Dec.  23,  1879. 

Eserine. — Dr.  A.  Dehenne  says  that  eserine  has  certain  indi- 
cations for  its  use  and  that  it  is  a  mistake  to  employ  it  as  a  substi- 
tute for  atropine,  in  all  cases.  Not  only  this,  but  it  frequently 
becomes  a  source  of  danger.  It  is  not  necessary  to  mention  the 
antiglaucomatous  properties  of  eserine;  but  besides  this  its  use 
ought  to  be  limited  to  abscess  and  simple  ulceration  of  the  cornea, 
.  with  a  limited  use  in  inflammatory  or  traumatic  perforations  ac- 
companied by  herniairids,  hypopia,  etc.  He  relates  the  cases  of 
a  number  of  patients,  whom  he  treated  for  iritis  with  synechia 
caused  by  eserine,  and  which  promptly  yielded  to  the  use  of 
atropine. — France  Medicale,  Dec.  27,  1879. 


142  Proceedings  of  Medical  Societies.  [Feb.  20r 


Jprocecfctngs  of  iSlctiical  Societies 


TRI-STATE  MEDICAL  SOCIETY. 


[Reported  for  the  Jour  sal.] 
Fifth  Anunal  Session-  held  at  Evansville,  Ind.,  Nov.  -1th.  5th,  and  6th,  1879. 
DISCUSSION  OF  DRS.  MUM  FORD  AxVD  HIBBERD'S  PAPERS. 

Dr.  J.  M.  Holloway,  Louisville,Ky  —  I  desire  to  express  my 
great  pleasure  at  hearing  these  papers,  and  move  their  reference 
to  the  proper  committee.     This  motion  was  seconded  and  carried. 

Dr.  T.  M.  Stevens,  Indianapolis,  Ind. — These  are  valuable 
papers.  They  recall  several  facts.  In  the  first  paper  it  was 
truly  stated  that  a  great  many  cases  are  taken  for  consumption 
or  tuberculosis  that  are  not  such.  As  far  as  Dr.  Hibberd's  paper 
is  concerned,  it  amounted  to  about  this,  viz  :  That  consumption 
cannot  be  cured  by  drugs.  Civilization  is  a  failure  in  many 
points.  If  it  would  build  up  the  physical  health  of  men  it  would 
be  no  failure,  but  civilization  does  not  build  up  physical  health; 
nor  do  drugs.  Barbarous  nations  are  far  healthier  than  we 
are. 

Dr.  F.  M.  Beard,  Vincennes,  Ind. — Some  gentlemen  who  were 
present  at  Springfield,  111.,  last  year  will  recall  Dr.  Hibberd's 
remarks  on  the  use  of  quinine,  and  of  his  having  criticized  the 
speakers  on  that  occasion  pretty  freely.  I  am  happy  to  see  that 
Dr.  Hibberd  had  been  converted.  He  has  found  another  disease 
that^quinine  cures,  viz.,  consumption. 

Dr.  J.  M.  Holloway — It  seems  to  me  these  papers  will 
have  a  wide  influence  on  the  profession.  Coming  from  men  of 
experience,  they  will  teach  younger  men  not  to  rely  so  much  upon 
the  use  of  drugs  in  the  treatment  of  this  most  intractable  disease, 
which  we  call  consumption.  The  papers  are  suggestive  of  that 
point. 

I  would  have  been  glad  if  Dr.  Hibberd  and  Dr.  Mumford  had 
alluded  to  another  important  point  which  is  not  controlled  by 
the  profession,  but  might  be  influenced  by  them  very  greatly; 
that  is  the  hygienic  management  of  those  we  call  consumptives; 


1880.]  Tri-State  Medical  Society.  143 

trying  to  exert  all  the  influence  possible  in  the  direction  of  the 
prevention  of  the  disease,  particularly  in  the  line  of  hereditary 
transmission.  I  know  it  is  a  delicate  subject,  and  often  where 
the  professional  attendant  interferes  he  injures  himself.  Some- 
times the  healthy  one  of  the  pair  so  impresses  the  germ  that, 
together  with  proper  hygienic  surroundings,  disease  in  the  off- 
spring is  prevented,  but  we  are  tar  from  certain  that  even  a 
healthy  individual  can  have  healthy  offspring  by  a  consumptive 
or  even  one  who  is  in  the  line  of  hereditary  consumption.  I  am 
gratified  at  another  point  these  papers  suggest,  namely,  the  ten- 
dency to  go  around  in  a  circle  and  come  back  to  the  old  point, at 
least  a  point  reached  by  some  of  our  profession  long  ago.  The 
profession  is  not  altogether  responsible  for  this  drifting  ten- 
dency, while  so  great  a  power  as  the  press  is  constantly  forcing 
on  the  people  remedies  for  the  profession  to  use. 

Excellent  doctors  are  swayed  and  captured,  not  only  by  pub- 
lications but  by  commercial  travellers  who  distribute  the  publi- 
cations, calling  attention  to  the  value  of  special  remedies  in  the 
management  of  this  disease,  and  setting  forth  the  plausible  idea 
that  they  are  remedies  to  build  up  the  system. 

I  did  not  intend  to  drift  into  these  remarks.  I  rise  mainly 
to  put  on  record  a  fact  which  will  be  interesting  to  the  younger 
members  of  the  profession,  and  which  is  familiar  to  the  older 
members  living  in  and  around  Evansville. 

Many  years  ago — about  the  year  1837 — a  very  interesting 
work  was  published  Louisville,  by  a  doctor  who  lived  in 
Louisville,  on  the  curability  of  consumption.  This  author 
adopted  the  pathology  of  the  disease  which  was  considered  the 
best  at  the  time;  he  was  too  modest  to  discuss  the  subject  of  the 
pathological  changes  in  the  lungs  on  the  limited  knowledge 
he  had.  He  (then  living  in  Virginia)  and  his  room-mate  were 
obliged  to  differ  with  an  eminent  doctor,  with  whom  they 
were  studying  medicine,  as  regards  the  use  of  depletion,  anti- 
mony and  diuretics  that  were  used  by  the  profession  at  the 
time  as  pleasant(?)  remedies  to  cure  this  terrible  disease.  These 
room-mates  parted,  one  for  Tennessee,  one  for  Kentucky.  Be- 
fore leaving  they  agreed,  that  as  they  themselves  were  -ul.jeets 
of  phthisis,  they  would  strive  to  adopl  a  directly  opposite  treat- 
ment to  that  suggested  by  their  distinguished  tutor,  upon  their 
own  persons,  ami  if  they  found  the  treatment  beneficial,  they 
would  use  it  on  their  patients.      The  writer  of  this  hook   in    his 


i 


144  Proceedings  or  Medical  Societies.         [Feb.  20, 

preface,  says  that  his  friend  and  class-mate  did  an  active  prac- 
tice on  horseback  in  that  lovely  countiy.  He  accomplished  a 
cure  in  his  case  by  producing  what  he  termed  the  antijjodes  of 
consumption — that  was  gout.  In  fifteen  or  sixteen  years  he  died 
of  gout,  while  the  other,  who  had  lived  on  frog  legs  and  eschewed 
medicine,  but  still  being  careless  about  himself,  and  being  too 
much  of  a  student,  spending  too  little  time  in  the  open  air,  had* 
not  improved  so  much  as  to  die  of  gout,  or  produce  gout.  He 
felt  he  had  improved  his  condition  by  the  treatment,  now 
spoken  of  so  frequently,  as  the  "building  up  treatment"  and 
the  avoidance  of  specific  medication.  He  lived  to  quite  a  con- 
siderable old  age.  After  he  had  written  this  book,  I  had  the 
pleasure  of  knowing  him  and  catching  frogs  for  him.  While  I 
lived  in  Louisville  this  thoughtful  and  honest  man  was  hounded 
out  of  the  city  of  Louisville.  He  was  doing  a  successful  prac- 
tice, but  so  great  was  the  opposition  to  his  building  up  method 
of  curing  consumption,  that  the  tutors  of  the  great  University  of 
Louisville  and  their  followers  hounded  him  from  his  home,  by 
bringing  him  into  such  derision  that  he  was  eventually  deprived 
of  practice  and  compelled  to  leave  Louisville.  He  found  an  asy- 
lum just  below  the  creek  not  far  from  this  house,  here  in  Evans- 
ville.  This  man  wrote  his  convictions,  which  have  proven  to  be 
true,  but  truly  did  he  suffer  for  it.  He  reared  children  and 
finally  he  died  at  a  ripe  old  age.  Perhaps  he  died  of  consump- 
tion ;  I  do  not  know.  The  elder  members  of  the  profession  may 
have  seen  this  book.  I,  perhaps,  possess  to  day  the  only  copy 
in  the  state  of  Kentucky. 

I  allude  to  the  work  of  Dr.  William  A.  McDowell,  a  cousin 
of  the  distinguished  Dr.  Ephraim  McDowell,  and  quite  a  near 
relative  of  Dr.  J.  N.  McDowell,  the  great  and  eccentric  surgeon 
of  St.  Louis.  I  rise  as  I  said,  to  have  itplaced  on  record  that  these 
men — Drs.  Mumford  and  Hibherd — have  come  to  the  same  con- 
clusion  that  Dr.  McDowell  did  in  the  year  1837. 

Dr.  (i.  P.  Senter,  Evansville,  Ind.— Dr.  Payne,  of  Illinois,  had 
been  afflicted  with  consumption  ;  he  went  to  Darwin,  111.;  he  re- 
lied on  quinine  and  whisky,  and  died  at  an  old  age.  At  his 
death  he  had  but  a  part  of  one  lung  and  he  died  from  another 
disease.  In  regard  to  the  treatment  suggested  by  the  papers  I 
think  that  it  is  proper;  I  like  the  effects  of  opium;  I  give  a 
doseof  it  at  night  if  necessary.     Another  remedy  I  often  give,  is 


1880.]  Tri-State  Medical  Society.  1  15 

quinine;  it  stops  the  lover,  and  stops  the  tendency  to, so-called 
galloping  consumption.  It  should  be  remembered  that  lever  is 
produced,  in   these  cases,  by  disintegration  of  the  tissue,  and  this 

is  intensified  where  we  have  local  irritation  and  congestion.  The 
quinine  has  the  effect  of  re-establishing  the  circulation  of  these 
local  congestions  as  well  as  Of  the  general  system.  The  other 
treatment  suggested  I  think  is  eminently  proper;  milk  I  used 
in  place  of  cod  liver  oil.  I  let  the  patient  drink  it  ad  libitum. 
The  rule  I  follow  is,  never  to  let  a  consumptive  patient  go  to 
bed  hungry. 

Dr.  Williams,  Cincinnati,  O—  I  am  reminded  of  my  expe- 
rience when  I  was  a  medical  student.  1  went  to  hear  Velpeau. 
He  brought  before  his  students  a  man  who  had  erysipelas.  He 
says  :  "  One  of  the  first  things  you  have  to  learn,  is  to  respect  the 
authorities  in  the  curability  of  disease.  I  will  enumerate  a  num- 
ber of  well  anthenticated  remedies  for  erysipelas."  He  went 
over  all  of  them,  and  when  he  was  through,  he  asked  his  students 
what  they  thought  of  the  curability  of  eiwsipelas.  They  replied 
that  he  should  answer  for  them.  He  said  that  erysipelas  was  a 
self  limiting  disease,  and  that  there  were  too  many  remedies  for 
it  and  none  were  of  specific  value.  It  was  one  of  those  diseases 
that  need  to  be  managed  throughout  its  course,  and  conducted 
safely  to  its  end. 

The  drift  of  this  discussion  seems  to  bring  out,  in  my  opin- 
ion, that  treatment  of  consumption  is  not  derived  from  direct 
experience  but  from  the  observation  of  others.  I  can  perhaps 
illustrate  it  best  by  a  story  of  one  of  our  old  Cincinnati  physi- 
cians. He  was  fond  of  technical  and  stilted  languages.  A  Span- 
ish family  came  to  the  city;  one  of  its  members  was  taken  sick. 
They  understood  a  little  English  and  called  this  doctor,  lie 
gave  them  a  prescription  for  pills  and  he  wrote  the  direction  : 
"One  pill  to  be  taken  three  times  a  day  in  any  convenient 
vehicle."  The  family  looked  in  the  dictionary  to  get  at  the  mean- 
ing of  the  prescription.  They  got  on  well  until  they  got  to 
the  word  vehicle.  They  found  "  cart,  wagon,  carriage,  buggy, 
wheelbarrow."  They  saw  anything  but  the  technical  meaning 
of  the  word  they  were  looking  for.  After  grave  consideration 
they  came  to  the  conclusion  that  the  doctor  meant  he  should  ride 
out,  and  while  in  the  vehicle  he  should  take  the  pill.  I  think 
that  consumption  is  oftener  cured  by  riding  out  than  by  any 
kind  of  medicine. 


146  Proceedings  of  Medical  Societies.  [Feb.  20, 


Epidemic  Scarlet  fever  with  Eemarks  on  its  History,  Defini- 
tion, Origin,  Prevention,  and  Treatment.  By  J.  W.  Comp- 
ton,  M.  D.,  of  Evansville,  Ind. 

The  epidemic  of  scarlet  fever  which  prevailed  in  the  city  of 
Evansville  and  vicinity  from  January,  1879,  to  November  of  the 
same  year,  was  characterized  more  for  its  long  continuance  and 
its  invasion  of  every  portion  of  the  city  and  adjacent  country, 
than  for  its  malignancy  or  mortality.  Its  approach  was  so  insid- 
ious and  so  gradual  that  it  had  almost  reached  its  climax  before 
attracting  much  attention  from  the  profession  or  the  citizens. 

In  the  month  of  January  there  were  15  cases ;  in  Feb.  6;  March, 
6  ;  April,  65  ;  May,  349 ;  June,  75  j  July,  41 ;  Aug.,  49 ;  Sept.,  20  ; 
October,  22  ;  total ;  638.  The  respective  ages  at  which  persons 
were  attacked  have  been  summed  up  as  follows:  under  one  year, 
50  ;  from  one  to  three  years,  120 ;  from  three  to  6  years,  159  ;  from 
six  to  ten  years,  152;  from  ten  to  twenty,  113;  from  twenty  to 
thirty,  16  ;  from  thirty  to  forty,  20 ;  from  forty  to  fifty,  5 ;  from  fifty 
to  sixty,  2  ;  and  from  sixty  to  seventy,  1 ;  total,  638.  The  deaths 
from  scarlet  fever  during  January  were  3;  Feb.,  1,;  March,  1; 
April,  15  ;  May,  65;  June,  27  ;  July,  9  ;  Aug.,  7  ;  Sept.,  6 ;  Oct., 
3;  total,  137.  Showing  a  death  rate  of  a  fraction  less  than  1  in 
5,  a  mortality  approaching  even  that  of  the  much  dreaded  yellow 
fever. 

Prof.  Chandler,  of  the  New  York  Board  of  Health,  is  credited 
with  saying  that  "  the  scarlet  fever  caused  more  deaths  in  New 
York  last  year  than  the  yellow  fever  did  in  the  South  and  yet  failed 
to  excite  public  apprehension  or  make  people  ordinarily  careful  to 
prevent  infection."  The  citizens  here  in  many  instances  continued 
to  visit  families  infected  with  scarlet  fever,  permitted  their  chil- 
dren to  visit  and  to  remain  in  the  room  with  the  sick,  and  even 
brought  their  children  from  considerable  distances  in  the  country 
so  thai  they  contracted  the  disease  and  spread  it  through  their 
neighborhood.  In  the  south-west  part  of  the  city  in  Union  town- 
ship, five  children  died  in  one  neighborhood  eight  and  ten  miles 
from  the  city  and  tho  contagion  was  traced  to  contact  with  the 
sick  in  tins  city.  So  strongly  was  I  impressed  with  the  danger- 
ously   infectious  and   contagious   character  of  the    disease,   and 


1880.]  Tei-State  Medical  Society.  147 

being  urged  to  the  task  by  the  peculiarly  Btrange  and  character- 
istic action  of  one  of  my  patrons,  that  I  wrote  the  following  com- 
munication, which  was  published  on  the  13th  of  March,  79,  In  the 

daily  Courier  of  this  city,  hoping  thai  it  might  prove  a  warning 
and  result  in  benefit-to  some  persons  at  least.  This  letter  re- 
ceived the  following  head  lines  from  the  editor  :  "  Scarlet  fever. 
Timely  advice  to  mothers,  and  how  they  may  prevent  the  spread- 
ing of  this  insidious  disease."  And  roads:  "In  view  of  the 
epidemic  and  contagious  character  of  scarlet  fevor,  desolating 
so  many  fair  homes  by  the  merciless  slaughter,  many  times, 
of  all  the  innocent  children  of  the  household,  creating  in  once 
happy  families  painful  vacancies  only  to  be  filled  by  the  bleeding 
memories  and  blasted  hopes  of  fond  but  stricken  parents,  is  it  not 
strange  that  the  physician  should  be  so  frequently  asked,  Is 
scarlet  fever  contagious?  and  when  answered  yes,  exceedingly 
so,  and  another  question  follows  when  one  child  has  been 
stricken  by  the  disease,  is  there  any  way  to  prevent  the  other 
children  from  taking  it?  when  answered,  yes,  separate  them 
constantly  from  the  sick  one,  is  it  not  doubly  strange  that  except 
in  very  few  instances  the  advice  of  the  physician  is  practically  dis- 
regarded ?  Nevertheless,  strange  as  it  may  appear,  in  many  in- 
stances, it  may  be  from  a  multiplicity  of  cares  or  from  want  of 
full  confidence  in  the  contagiousness  of  the  disease,  the  whole- 
some council  of  the  physician  is  only  followed  by  efforts  spas- 
modic at  first  and  wholly  abandoned  in  a  day  or  two.  " 

One  representative  case  will  serve  to  illustrate  very  many  of 
a  similar  character  :  The  oldest  of  a  family  of  children  nurses  the 
sick  child  of  a  visitor  who  has  just  come  from  an  infected  district. 
The  sick  child  has  a  fever  and  sore  throat.  The  parents  become 
alarmed  about  it  and  take  it  home.  In  a  few  days  the  one  who 
nursed  upon  its  lap  a  pestilential  disease-  unawares,  is  attacked 
with  fever  and  sore  throat;  the  mother  wraps  up  the  throat  and 
uses  some  domestic  gargle,  but  in  spite  of  her  care  the  fever  in- 
creases in  intensity,  swallowing  becomes  difficult, and  after  a  day 
or  two  the  Doctor  is  sent  for.  He  discovers  intense  redness  of 
the  throat,  a  bright  eruption  on  the  skin,  fever  of  high  grade  and 
rapid  pulse,  and  in  response  to  the  anxious  inquiries  of  the 
mother  as  to  what  the  disease  is,  is  compelled  to  answer,  "your 
child  has  scarlet  fever,  madam.  "  The  mother  freely  -led-,  tears 
of  anxiety  and  alarm,  saying  what  shall  I  do?  Sere  are  tin- 
smaller  children,  some  of  them  delicate.     La  there  any   way  to 


148  Proceedings  op  Medical  Societies.         [Feb.  20^ 

keep  them  from  having  the  disease?  Yes,  keep  the  other  chil- 
dren out  of  and  away  from  the  room  of  the  sick  one  j  they  will  very 
likely  not  have  it.  The  mother  quickly  cries  out,  "  Here,  Susan 
Jane,  take  these  children  to  another  part  of  the  house  and  do 
not  let  them  come  near  this  room  again.  "  The  doctor  sees  the 
children  hurried  out  of  the  room  and  so  far  the  prospect  of  con- 
fining the  disease  to  the  single  case  seems  excellent.  On  his 
visit  to  his  patient  the  succeeding  day,  the  children  observe  him 
as  he  goes  to  the  sick  chamber ;  curiosity  takes  possession  of 
them  and  they  follow.  The  patient  is  examined  and  appears  to 
be  doing  well,  but  hearing  the  door  open  and  looking  around 
discovers  the  children  so  hurriedly  sent  away  the  day  before, 
standing  directly  in  the  doorway,  inhaling  the  poisonous  air  as 
it  rushes  out  through  the  open  door  to  give  place  to  the  pure  air 
that  enters.  The  mother,  intent  on  telling  how  much  medicine 
and  what  kind  of  nourishment  the  sick  one  has  taken,  sees  her 
precious  darlings  standing  in  the  most  dangerous  position  possi- 
ble, and  mildly  says,  without  moving  from  her  seat  or  manifest- 
ing any  of  the  alarm  of  the  previous  day,  "  Sadie,  dear,  go  away  ; 
Benny,  son,  go  along  and  shut  the  door.  "  But  Sadie  and  Benny 
do  not  move  and  so  they  remain  until  their  inclinations  attract 
them  in  some  other  direction.  On  his  visit  the  following  day, 
the  doctor  finds  all  of  the  smaller  children  comfortably  seated 
in  the  sick  chamber  busily  engaged  with  their  playthings,  look- 
ing very  much  as  if  they  had  come  to  stay  all  day.  The  precau- 
tions of  the  family  to  limit  the  disease  to  one  case,  accidentally, 
I  might  say  unavoidably  exposed,  have  had  their  fitful  existence 
and  the  universal  laws  governing  disease  germs  will  have  re- 
ceived no  infringement  when  four  or  five  little  coffins  with  their 
precious  contents  have  been  carefully  removed  and  the  loved, 
ones  with  their  parents'  blighted  hopes  find  a  quiet  resting  place 
in  the  cemetery. 

This  is  not  the  time  to  enter  into  an  examination  as  to 
whether  scarlet  fever  is  a  contagious  or  infectious  disease,  or  the 
period  during  the  course  of  the  disease  when  it  is  more  intensely 
one  or  the  other,  but  to  impress  in  plain  language  the  necessity 
of  and  the  means  by  which  the  disease  may  be  limited  to  a 
single  member  of  the  household  provided  parents  and  citizens 
generally  will,  in  good  faith,  aid  the  physician  in  his  efforts  by 
faithfully  ami  persistently  following  his  instructions.  In  doing 
this   they  must  abandon    all  preconceived    opinions  that  the  dis- 


1880.]  Tri-Statb  Medical  Society.  149- 

ease  is  not  contagious,  or  if  so  at  all,  only  contagious  during  the 
fever  or  at  certain  other  stages  which  mark  the  course  of  the 
malady.  If  the  people  can  only  be  educated  t<>  know  the  con- 
tagious character  of  scarlet  fever  at  all  stages  as  the  physician 
knows  it,  there  would  not  be  so  much  trouble  in  securing  their 
cooperation  in  efforts  to  prevent  the  spread  of  the  disease  as 
soon  as  discovered. 

A  case  reported  by  Dr.  J.  R.  Black",  of  Ohio,  will  fully  illus- 
trate the  necessity  of  thus  educating  the  people,  so  that  they 
may  the  more  intelligently  aid  the   profession   in   arresting  the 
spread  of  the   disease:      "In    the   spring  of  1876,  while  scarlet 
fever  was  prevailing  as  an  epidemic,  J  was  called  to  see  the  eldest 
child  of  Mr.  F.     He  had  three  other  children,  all  of  whom  were 
delicate  and  prone  to  attacks  of  angina.     The  entire  surfaceof 
the  boy,  who  was  eight  years  old,  had   the  characteristic  exan- 
them  with  high  fever,  sore  throat  and  rapid  pulse.     The  parents 
were  intensely  alarmed  as  with  three  younger  and  more  delicate 
children  they  might  well  be,  at  the  thought  that  all  ot  them  must 
now  suffer  by  the  dreadful  malady.     'Is  there  any  way  of  pre- 
venting the   other  children   having  the  disease,  was  the  earnest 
inquiry.    'Certainly,'  was  my  reply,  'If  you  will  faithfully  fol- 
low  my  directions.'     'That    we   will    do;    hut  Doctor,    the   Other 
children    have  all    been    with   the  sick   one   while  the   fever  was 
on  him,  and  some 'doctors  say  that  it  is   more  catching  then  than 
at  any  other  time.'     'Nevermind  what  others  say.     Some  think 
it  is  not  contagious,  not   infectious,jus1  as  some  think  to  this  day 
that  the  world  does  not  turn  around.'   Mr.  F.  had  a  large  two  story 
house;   the  limitation  of  the  disease  appeared  perfectly    feasible. 
The   chamber  selected  for  the  sick  hoy  was  up  stairs,  and  in  a 
room  apart,   as  much  as  practicable,    from    the  others,  with  an 
open  fire-place,  which,  with   the  windows  dropped  from  the    top, 
afforded  ample  means  for  ventilation.     The  transom  was  closed 
and  the  door  ordered  not  to  be  opened  except  for  entrance  and 
exit  for  the  nurse.     To    her  was  given  the  following  directions  : 
to  wear  in  the  sick  room  a  loose  gown  which  must  be  thrown  off 
before  leaving  the  sick  room,  and  if  the  patient  had  hen  bandied 
to  wash  the  hands  in  water  into  which  a  little  carbolic  acid  had 
been  dropped  ;  not  a  handkerchief,  napkin  or  piece  of  bed  linen 
must  be  taken  out  of  the  room  dry  bul  must    be  plunged  into 
water.     During  cutaneous  exfoliation  the  scurf  must  be  carefully 
collected  from  the   sheets  (which  in  this   instance   amounted  to  a 


150  Proceedings  of  Medical  Societies.  [Feb.  20, 

teaspoonfnl)  and  thrown  into  the  fire;  especial  care  must  be 
taken  that  none  falls  upon  the  carpet.  The  isolation  of  the 
patient  must  be  continued  for  at  least  ten  days  after  desquamation 
has  been  completed,  and  the  week  prior  to  leaving  the  room, 
carbolic  acid  baths  must  be  given  once  daily-.  This  should  be  of 
tepid  water,  into  which  an  ounce  of  the  solution  must  be  mixed. 
Every  inch  of  the  surface  must  be  carefully  disinfected,  especially 
around  the  hair  of  the  head.  Many  precautions  have  been  ren- 
dered wholly  nugatory  by  neglect  of  this  point.  The  patient,  it 
is  said,  has  been  carefully  disinfected  and  yet  the  disease  has 
spread.  The  mystery  would  be  explained  by  an  increase  of  ves- 
ual  power.  The  minute  scales  abounding  in  infection,  linger  in 
the  head  longer  than  any  where  on  the  person.  A  boy  has  been 
well  of  the  fever  say  for  a  month.  He  goes  upon  the  street,  into 
the  school  room,  sitting  or  standing  with  two  or  three  others 
around  him.  He  scratches  his  head,  and  it  is  only  needful  to 
place  him  where  a  few  sunbeams  ai*e  allowed  to  fall  upon  his  head 
to  be  aware  that  a  little  cloud  of  infectious  particles  is  diffused 
around  him.  Some  of  it  is  inhaled  by  his  companions  ;  it  adheres 
to  their  throats,  to  the  bronchia  and  bronchioles  and  so  enters 
the  blood.  Mysteriously  these  companions  are  taken  down  with 
scarlet  fever  and  yet  parents  are  most  confident  that  their  children 
have  not  been  any  where  near  the  infection.  The  patient's  time 
of  seclusion  having  elapsed  and  all  the  infected  clothing  as  care- 
fully disinfected  as  his  person,  he  may  then  mix  in  safety  with 
his  fellows.  Attention  should  then  be  turned  to  the  bed-room 
and  its  furniture.  No  child  should  be  allowed  to  enter  the  apart- 
ment until  it  is  thoroughly  disinfected.  This  may  be  done  by  clos- 
ing the  room  tightly,  windows,  flue  and  doors,  and  then  burn- 
ing sulphur  in  it  until  the  fumes  prevade  every  part,  allowing  it 
to  be  thus  tightly  closed  and  fumigated  for  several  hours.  After 
this  all  windows  should  be  thrown  as  wide  open  as  possible,  day 
and  night  for  a  week.  The  room  will  then,  after  cleaning  in  the 
ordinary  way,  be  ready  for  occupancy.  I  believe  the  stamping 
out  of  scarlet  fever  and  diphtheria  in  any  particular  locality  to 
be  practicable,  if  the  populace  were  only  educated  up  to  its  en- 
tire feasibility,  and  to  render  intelligent  co-operation." 

Definition  and  Pathology. — Aitken  defines  scarlet  fever 
as  "  A  febrile  disease,  the  product  of  specific  poison,  which  is  re- 
produced during  the  progress  of  the  affection.     On  the  second 


1880.]  Tri-State  Medical  Society.  1M 

day  of  the  illness,  or  sometimes  later,  a  scarlel  efflorescence  gen- 
erally appears  on  the  fauces  and  pharynx,  and  on  the  face  and 
neck,  which  spreads  over  the  whole  body  and  commonly  termi- 
nates in  desquamation  from  the  fifth  to  the  seventh  day.  The 
fever  is  accompanied  with  an  affection  of  the  kidneys,  often  with 
severe  disease  of  the  throat,  or  of  some  internal  organ,  and  is 
sometimes  followed  hydropsy.  The  disease  runs  a  definite  course, 
and  as  a  rule  occurs  only  once  in  life."  Tain  not  inclined  to 
take  issue  with  this  definition.  Nor  with  bis  pathology,  which 
says  that  "After  a  definite  period  of  latency,  the  peculiar  poison 
of  scarlet  fever  induces  a  disorder  of  the  blood,  which  is  in  the 
first  instance  made  manifest  by  a  febrile  state  and  a  disturbed 
condition  of  the  great  nervous  centers."  "That  fever  precedes 
the  distinct  actions  of  the  skin  in  this  disease  is  so  general  a  rule 
that  it  has  few  exceptions;  and  the  pyrexia  has  been  occasionally 
so  severe  as  to  destroy  the  patients  before  the  more  specific  les- 
ions of  the  disease  have  been  set  up."  As  regards  the  disordered 
condition  of  the  blood  in  scarlet  fever,  numerous  and  frequent 
experiments  have  settled  the  question  beyond  the  reasonable  pos- 
sibility of  a  doubt. 

Coze  and  Feltz  experimented  upon  sixty-six  rabbits,  b}- intro- 
ducing the  scarlatinous  blood  under  the  skin.  Of  these  sixty-six 
rabbits,  sixty-two  died  between  eighteen  hours  and  fourteen  days. 
having  had  high  temperatures  with  diarrhoea  and  emaciation. 
An  examination  of  the  blood  after  death  revealed  the  presence 
of  bacteria  and  bacteridia  the  same  as  was  found  in  the  blood  of 
the  scarlatinous  patients  themselves.  Under  the  magnifying 
power  of  five-hundred  diameters,  Hies  examined  the  blood  of  a 
patient  dying  with  scarlet  fever,  and  found  an  infinite  number 
of  small  dark  bodies  in  the  serum  between  the  groups  of  blood 
corpuscles.  He  injected  a  few  drops  under  the  skin  of  the  back 
of  a  rabbit  and  the  animal  died  in  twenty-four  hours.  Upon  ex- 
amination of  the  blood  it  was  found  to  be  similar  to  that  pre- 
viously  injected.      These  and  other  experiments  prove   clearly 

that  the  poisonons  principle  enters  the  bl 1  at  the  time  of  the 

inception  of  the  disease  and  further  that  this  poisonous  principle 
must  be  dependent  upon  the  disease  germs,  the  very  bacteria  or 
micrococi    found    in  the    blood.      These   organisms    being   capable 

of  reproducing  themselves  during  the  progress  of  the  disease,  we 
may  readily  account  for  the  contagiousness  of  the  disease,  for  the 
exhalations  from  the  skin,  the  lungs  and  the  secretions  generalh 


152  Proceedings  of  Medical  Societies.  [Feb.  20, 

which  are  all  organs  of  elimination  and  eliminator  of  the  blood 
and  the  blood  contains  the  contagious  principle  upon  which  the 
infection  is  dependent. 

A  striking  illustration  of  the  contagious  character  of  scarlet 
fever  is  afforded  us  in  the  experiments  of  inoculation,  and  it  is 
further  proven  that  the  disease  is  developed  in  the  inoculated 
form  with  quite  as  much  intensity  as  it  existed  in  the  person 
from  whom  the  matter  was  taken.  This  experiment  was  per- 
formed by  Williams  and  seeing  the  result  it  was  never  afterward 
repeated.  The  usual  mode  of  the  introduction  into  the  sj'stem 
of  scarlatinous  infection  is  through  absorption  by  the  mucous 
membranes,  of  the  poison,  generated  by  a  patient  suffering  with 
the  disease.  This  absorption  may  take  place  by  a  healthy  per- 
son breathing  an  atmosphere  contaminated  by  the  exhalation 
from  the  sick  or  it  may  be  directly  by  receiving  upon  the  mucous 
membranes  the  flying  particles  of  exfoliated  dust,  from  carpets 
or  infected  clothing. 

Origin — Referring  to  the  origin  of  scarlet  fever,  I  assume 
that  there  can  be  no  case  of  this  disease  without  the  presence  of 
the  seed  germ  ;  as  soon  may  we  expect  that  there  can  be  a  stalk 
of  wheat  without  there  having  been  a  grain  of  wheat  to  originate 
it.  We  admit  no  other  origin  and  we  know  that  the  grain  of  wheat 
from  which  the  wheat  stalk  is  growing,  tame  from  a  parent 
grain  of  wheat.  The  same  principle  applies  to  this  specific  dis- 
ease. Prof.  Tyndall  has  px*oved  the  doctrine  of  spontaneous 
generation  to  be  without  foundation  and  has  shown  clearly  that 
no  life  exists  without  antecedent  life.  I  am  aware  that  Ocrtel, 
in  discussing  infectious  diseases,  sa}Ts  that  u  A  spontaneous  out- 
break of  the  disease  may  frequently  be  observed,  especially  in 
cities  where  it  has  already  appeared  epidemically,  and  it  is  then 
to  he  explained  only  by  the  theory  that  the  disease  has  been 
produced  by  some  miasm,  some  noxious  agent,  at  certain  times 
widespread,  but  the  nature  of  which  is  yet  unknown."  If  the 
disease  has  been  epidemic  in  a  city  or  other  place  it  is  a  reason- 
ahle  assumption  that  the  germs,  the  seeds  of  the  disease,  have 
survived  in  some  way  all  the  elements  of  destruct:on,  and  find- 
ing a  proper  lodgment  or  proper  soil  have  been  warmed  and 
nurtured  into  life,  and  it  is  no  more  a  spontaneous  outbreak  than 
it  would  he  tor  a  stalk  of  wheat  to  lie  found  in  some  out  of  the 
way  place.  The  seed  was  there,  no  difference  how  it  got  there, 
and  reproduce! I  its  kind. 


1880.]  Tri-State  Medical  Society.  153 

Liebermeister  says,  in  reference  to  the  infectious  diseases,  that 
"through  the  long  series  of  generations,  diseases  preserve  their 

specifie  character  with   the  utmosl    pertinacity;  and  if  at   ti a 

some  of  these  characteristics  arc  not  brought  into  complete  ma- 
turity, owing  to  an  unfavorable  field  for  their  development, yel 
they  assume  them  again  so  soon  as  they  are  planted  in  a  favora- 
ble soil.  In  fine  it  may  be  said  that  no  external  influence  ever 
decides  the  nature  of  the  affection,  and  one  infectious  disease 
never  under  such  conditions,  changed  into  another. "  The  reason 
of  this  I  will  state  is  the  fact  that  they  cadi  have  only  one  spe- 
cific cause.  In  support  of  this  doctrine  of  the  unity  of  the  ori- 
gin of  scarlet  fever.  Prof.  Jos.  (i.  Richardson  say- :  "This  bri 
me  to  a  notice  of  one  of  the  most  mischevious  popular  errors 
which  a  general  acceptance  of  the  germ  theory  would  necessarily 
subvert,  namely,  the  belief  that  small-pox  and  other  contagious 
maladies  often  arise  without  previous  exposure  to  the  seeds  of 
the  disease.  This  doctrine  is  frequently  advanced  in  private  life 
as  an  excuse  for  neglect  of  proper  care  and  caution  in  regard  to 
children,  etc.,  and  occasionally  sustained  by  public  authorities  as 
an  apology  for  violation  of  quarantine  and  other  sanitary  regu- 
lations, and  our  utmost  gratitude  would  be  due  to  the  germ 
theory  of  disease,  even  should  its  establishment  render  no  other 
service  to  humanity  than  the  explosion  of  this  fallacy."  He 
further  remarks  that,  "  putting  aside  the  primary  origin  of  dis- 
ease, which,  with  one  or  two  exceptions  is  a  question  of  pic- 
historic  times,  the  germ  theory  teaches  us  that  every  new  case  of 
the  contagious  maladies,  already  enumerated,  is  the  immediate 
offsprings  of  a  preceding  case,  and  the  direct  exposure  of  an 
unprotected  human  being  to  the  chance  of  having  the  spores  or 
seeds  of  disease  implanted  in  his  system.  "  The  germs  of  purely 
miasmatic  diseases  should  not  be  confounded  with  those  germs 
producing  diseases  which  are  purely  contagious  ;  indeed,  a  \r\-\ 
marked  distinction,  and  the  strong  line  of  domarkation  which 
their  dissimilarity  entitle-  them  to,  should  be  drawn  between 
them.  Liebermeister,  in  speaking  of  this  distinction,  uses  the  fol- 
lowing language:  "  It  is  usual  now  to  Bpeak  of  contagium  a-  a 
specifTc  excitant  of  disease  which  originates  i ganisms  suffer- 
ing from  the.specific  diseases;  while  miasm,  on  the  other  hand. 
is  used  a-  a  specific  excitant  of  a  disease,  which  propagates  itself 
outside  of  and  disconnected  from  a  previously  diseased  organism. 
Coma.-ion  can  he  conveyed    by  contact  from  a  diseased  person 


154  Proceedings  of  Medical  Societies.         [Feb.  20, 

to  a  sound  one,  producing  the  same  disease  in  him,  and  then  re- 
producing itself.  Miasm  originates  from  without  j  taken  up  into 
the  bod}7  it  can  call  a  specfic  disease  into  action,  but  it  cannot 
spread  the  disease  any  further  by  conveying  it  from  a  diseased  to 
a  sound  person.  There  are  diseases  which  are  purely  contagious 
and  diseases  which  are  purely  miasmatic.  Measles,  scarlet  fever, 
variola,  vaccina,  typhus,  diphtheria,  malignant  pustule,  rabies, 
virulent  ulcers,  blenorrhoeaSjSj-philis,  pyremiaand  puerperal  fever 
are  purely  contagious.  In  all  of  these  diseases  thepoison  can  be 
conveyed  from  one  individual  to  another  by  contact."  The 
malarial  diseases  are  purely  miasmatic  and  are  not  conveyed 
from  one  individual  to  another. 

Prevention — In  addition  to  what  has  already  been  said  in  re- 
gard to  isolation  and  disinfection  as  safeguards  against  the  spread 
of  this  disease,  I  will  quote  from  Aitken's  Science  and  Practice  of 
Medicine,  vol.  1,  page  320  : 

''This  disease  being  established,  the  patient  generates  a  poi- 
son which  maybe  communicated  directly,  or  which  may  contam- 
inate the  atmosphere.  The  disease  is  so  eminently  communi- 
cable, that  no  susceptible  person  can  remain  in  the  same  room, 
and  hardly  in  the  same  house,  without  contracting  it.  The  in- 
fecting distance  is  consequently  much  greater  than  in  t}"phus. 
Indeed,  it  is  necessary  to  break  up  every  academic  establish- 
ment in  which  scarlatina  prevails;  for  it  is  hardly  possible  to 
isolate  children  in  the  same  house  or  school,  however  large,  so 
as  to  prevent  the  disease  from  spreading.  " 

No  such  precautions  were  taken  by  our  authorities  during 
the  progress  of  the  epidemics  of  1879.  Our  public  and  other 
schools  containing  nine  thousand  children  of  the  city  and  vicin- 
ity, and  which  I  believe  excited  greater  influence  than  any  other 
one  cause  in  disseminating  the  widespread  prevalence  of  this  epi- 
demic, continued  to  hold  their  daily  sessions  regardless  of  the 
number  of  interested  parents  who  desired  them  closed,  but  who 
feared  to  take  their  children  out  of  school  because  their  absence 
would  reduce  their  per  centage  in  examinations  and  their  pros- 
pects for  promotion.  One  member  of  the  school  board  and  the 
superintendent  of  the  public  schools  took  their  children  out  of 
school,  and  a  number  of  school  patrons  did  the  same,  until,  by  the 
number  thus  taken  out  and  those  out  by  reason  of  their  having 
the  fever,  the  schools  were  so  much  reduced  in  attendance  that  they 


1880.]  Tri-  State  Medical  Society.  155 

were  compelled  to  close  before  the  completion  of  the  school 
year. 

In  regard  to  the  treatment,  I  discovered  perhaps  the  greatest 
unanimity  among  the  profession  here  in  the  practice  of  freely 

oiling  the  entire  surface  with  some  bland  oil  to  allay  the  itching 
so  constant  and  an  accompaniment  of  the  eruptive  stage  of  scarlet 

fever.  There  is  also  much  unanimity  in  the  effort  to  eliminate 
the  poison  from  the  system  through  the  emunctorios,  the  skin 
and  kidneys.  For  the  accomplishment  of  this  purpose  various 
diuretics  and  diaphoretics  have  been  prescribed.  One  that  ap- 
peared to  have  given  general  satisfaction  to  those  who  gave  it 
a  trial,  was  jaborandi.  It  produced  copious  diaphoresis  with 
reduction  of  febrile  symptoms,  heat  of  skin  and  temperature. 
Some  used  sponging  the  surface  with  cold  water  to  reduce  the 
heat  of  skin  and  temperature  and  speak  well  of  the  results.  In 
my  own  practice  I  can  strongly  recommend  two  remedies  that 
I  relied  upon  and  from  which  entire  satisfaction  was  received. 
Quinine,  as  an  antipyretic,  exhibited  the  most  satisfactory  results, 
producing  copious  diaphoresis  and  reducing  more  permanently 
the  fever  heat  of  skin  and  temperature,  ameliorating  all  the 
symptoms  of  high  fever,  depression  of  the  nerve  centers  and 
delirium.  Its  well  known  properties  of  being  destructive  to  low 
forms  of  organisms  to  be  found  in  the  fermentative  stage  of  ma- 
larial  fevers  and  complications  of  this  condition  with  scarlet 
fever,  and  there  is  every  reason  to  believe  that  it  also  acts  as  an 
agent  destructive  to  the  germs  of  scarlet  fever.  To  a  child  four 
years  old  with  intense  high  grade  of  fever,  delirium  and  stupor 
bordering  at  times  on  coma,  I  gave  twenty  -rains  of  quinine  in 
twelve  hours,  unmistakably  reducing  the  temperature,  inducing 
copious  sweating  and  restoring  the  child  to  comfort  and  ration- 
ality to  the  extent  that  it  eagerly  BOUghl  its  playthings  which 
were  placed  on  the  bed.  Twenty  grains  were  repeated  each  day 
for  three  successive  days,  when  the  fever  was  quite  subdued  and 
a  good  recovery  was  made.  As  an  eliminator  of  Bcarlet  fever 
poison   it  is  entitled  to  be  placed  at  tin-  head  of  the  list. 

The  other  remedy  which  gave  me  universal  satisfaction  was 
themuriated  tincture  of  iron  in  solution  of  chlorate  of  potassa. 
In  addition  to  the  other  medical  properties  which  I  shall  mention 
hereafter  this  combination  supercedes  the  disagreeable  ami  an- 
noying mopping  of  the  throat, which  so  much  excites  children 
and  against  which  they  often  struggle  until  greatly  irritated  and 


156  Proceedings  of  Medical  Societies.  [Feb.  20, 

exhausted.  Where  it  can  be  used  as  a  gargle  I  have  the  throat 
cleaned  out  by  the  remedy  and  after  this  the  patient  is  directed 
to  swallow  a  suitable  portion.  This  plan  of  treatment,  which  is 
based  upon  the  conviction  that  the  fever  is  a  distinct  form  of 
blood  poison,  caused  by  living  organisms,  capable  of  multiplica- 
tion in  the  human  system,  has  yielded  excellent  results;  and 
in  it  is  contained  one  great  hope  of  the  future  in  controlling  this 
incorrigible  disease.  That  there  is  in  this  fever  a  condition  of 
toxaemia  in  which  poisoned  blood  depraves  the  nervous  and  cir- 
culating systems  as  to  produce  that  train  of  symptoms  so  char- 
acteristic of  this  fever,  scarcely  admits  of  a  doubt.  It  then  fol- 
lows that  the  remedy  best  calculated  in  its  known  action,  in  de- 
stroying low  forms  of  organisms,  should  be  employed  to  neutralize 
and  destroy  the  germs  which  produce  the  fever.  This  remedy 
contains  chlorine  in  acid  combination,  prevents  the  tendenc}T  to 
putridity  in  the  contents  of  the  stomach,  and  by  entering  the 
blood  by  absorption  comes  in  contact  with  the  poison  in  that 
fluid,  and  by  its  well-known  antiseptic  properties  acts  as  an  anti- 
dote in  the  blood,  destroying  the  poison  it  overtakes  in  that 
fluid. 


ST.  LOUIS  MEDICAL  SOCIETY. 

Valedictory  Address.    Delivered  January  10,  1S80,  by  Charles  W. 
Stevens,  M.  I>„  President  of  the  Society  for  the  year  1879. 

[Reported  for  the  Journal.] 

Among  the  number  now  constituting  the  roll  of  membership 
of  this  Society,  or  forming  the  body  known  as  the  medical  pro- 
fession of  this  city,  but  few  arc  here  to-night;  in  fact,  but  few 
are  now  living,  who  can  in  memory  call  up  the  forms,  the  fea- 
tures, the  moral,  intellectual  or  social  qualities  of  our  predecess- 
ors in  the  profession  of  thirty  or  forty  years  ago;  but  few  are 
able  to  detail  or  recount  the  events,  professional  or  otherwise,  in 
which  tlu^y  were  aetoi's.  Thirty  years  is  regarded  by  statisti- 
cs, ns  as  a  generation  of  man;  this  is  the  average  of  human  life. 
What,  then,  would  be  the  average  of  our  professional  lite,  which 
begins,  we  will  say,  as  a  rule,  when  we  have  passed  twenty-five 
years  of  our  allotted  time?      It  would  doubtless  fall  much  lower 


1880.]  St.  Louis  Medical  Society.  157 

in  the  scale,  and  perhaps  wo  would  be  justified  In  sayingthal  the 
average  of  the  physician's  professional  life  is  twenty  years.  If 
by  favorable  surroundings,  or  by  the  kindness  of  our  mother 
nature,  a  few  of  us  have  over-lived  our  time,  it  offers  no  war- 
rantor guaranty  to  the  rising  generation  thai  they  will  be  thus 
favored.     This  may  look  Bomewhat  discouraging  to  the  young  or 

the  novices  now  before  me, but  the  consideratio appreciation 

of  this  startling  truth  should  demonstrate  to  them  as  well  as  oth- 
ers the  necessity  of  energizing  all  their  powers  and  facull 
Only  twenty  years  for  the  long  anticipated  joys  of  pro 
sional  life;  only  twenty  years  in  which  to  make  a  fortune;  only 
twenty  years  in  which  to  make  a  name,  a  reputation  ;  only  twenty 
years  to  be  a  benefactor,  to  make  the  world  the  better  for  my 
having  lived  in  it.  Yes,  these  are  pertinent  reflections,  and  I  in- 
dulge them  with  a  degree  of  timidity,  but  at  the  same  time  I 
know,  notwithstanding  all  that  may  he  said,  each  one  before  me 
will  take  a  hopeful  view  of  his  own  condition  and  prospects,  and 
will  flatter  himself  that  he  will  be  fortune's  favorite.  -  Sope 
springs  eternal  in  the  human  breast." 

But  just  here,  while  indulging  in  these  rather  solemn  reflec- 
tions myself,  may  I  not  be  mistaken  as  to  the  train  of  thoughts 
that  have  arisen  in  your  minds?  Perhaps  some  of  you,  in  cogi- 
tating upon  my  calculation,  are  saying  mentally  that  these  old 
fellows,  these  ancient  individuals,  who  have  outlived  their  dou- 
ble ten  years,  ought  to  be  out  of  our  way;  you  ought  to  have 
stepped  down  and  out  long  ago.  Well,  then,  it'  my  genealogical 
proposition  has  had  only  tin's  effect,  we  had  better  consider  an- 
other matter;  perhaps  some  rambling  thoughts  about  this  Soci- 
ety, or  some  observations  upon  men  and  events.  This  Society, 
as  I  am  informed,  was  organized  aboul  forty-five  years  ago. 
Coming  to  St.  Louis  in  1840,  it  was  mj  privilege  to  know  ami 
to  become  acquainted  with  the  men  who  had  founded  it.  In 
memory  I  now  picture  them,  much  as  they  appeared  to  rnj 
youthful  eyes.  Several  of  them  were,  even  at  that  lime,  old  in 
service, and  had  been  the  pioneers  in  the  profession.  Beaumont, 
Sykes,  McCabe,  Eardage  bane,  Wm.  Carr  bane,  Farrar,  Merry, 
Adreon,  Pultae,  Tiffin,  White,  Tone  survives,  ami  I  feel  honored 
that  he  is  now  before  me  —  Dr.  Meredith  .Martin,  the  President), 
areas  vividly  before  my  mind'-  eye  a-  though  I  had  seen  them 
but  yesterday,  and  I  believe  any  who  remember  them  will  bear 
testimony  with  me  to  their  worth. 


158  Proceedings  of  Medical  Societies.  [Feb.  20, 

From  that  time  to  the  present  I  am  confident  they  have  not 
been  surpassed  in  the  elements  of  character  or  the  qualities  that 
serve  to  make  the  true  man,  the  polished  gentleman,  and  the  useful 
and  accomplished  physician.  I  have  often  thought  it  would  be 
exceedingly  interesting  and  instructive  to  have  at  hand  a  truth- 
ful and  impartial  biography  of  those  men.  I  cannot,  however, 
let  the  opportunity  pass  without  a  few  words  in  regard  to  one  or 
two  of  our  associates,  though  no  word  of  eulogy  from  me  is  nec- 
essary or  called  for.  The  name  and  fame  of  Beaumont  should 
be  kept  in  mind  by  the  members  of  this  Society.  His  reputation 
was  world  wide,  and  even  now  the  reports  of  his  experiments, 
observations  and  conclusions  are  found  in  every  work  on  physi- 
ology. In  1850,  in  the  City  of  Paris,  I  was  introduced  to  the 
then  greatest  of  living  surgeons,  Velpeau.  Immediately  upon 
learning  that  I  hailed  from  St.  Louis,  he  said  :  "Ah!  you  have 
there  Dr.  Beaumont."  I  well  remember  the  enthusiasm  with 
which  he  spoke  of  him  and  of  his  discoveries.  For  many  years 
he  was  the  leading  surgeon  of  our  city,  and  stood  high  in  medi- 
cal and  practical  competency.  He  is  now  most  affectionately  re- 
membered by  the  older  families  of  our  town,  not  alone  profes- 
sionally, but  for  his  amiable  and  manly  social  qualities. 

It  was  our  fortune  also  to  have  as  an  associate  one  whose 
memory  should  be  cherished  by  all  who  are  capable  of  appre- 
ciating the  doctrines,  or  rather  the  great  fundamental  principles 
of  physiology,  which  he  formulated.  I  allude  to  Prof.  John 
Waters.  The  grand  idea  that  in  tissue  disintegration,  retrograde 
metamorphosis,  we  have  the  life  force,  was  first  definitely  or  dis- 
tinctly elaborated,  and  given  form,  and  made  practical  by  him. 
In  failing  to  place  upon  record  the  debates  upon  this  question,  in 
which  Hammer  and  Pallen  (who  have  departed)  and  others  now 
living  participated,  a  great  loss  to  our  literature  has  been  sus- 
tained. Many  of  you  remember  the  sharp  contests  upon  this 
principle,  as  its  application  to  physiological  and  pathological 
processes,  which  were  then  discussed,  and  the  clear,  methodical, 
and  convincing  manner  in  which  Waters  presented  and  demon- 
strated his  theory.  He  died  comparatively  a  young  man.  It  has 
been  said,  "  Whom  the  gods  love  die  young."  He  was  not,  how- 
ever, without  faults.  A  hint  is  sufficient,  and  this  only  as  a 
warning:  He  was  his  own  and  his  only  enemy.  Dr.  Workman 
jsn  vs,  "  That  to  say  a  man  was  faultless,  would  be  to  libel  humanity, 


1880.]  St.  Louis  Medical  Society.  159 

for  lifeless  are  the  faultless;  but  let  us,  as  in   the  words  of  the 

sweet  poet,  guard  thus  his  memory  : 

"  When  cold  in  the  earth  lies  tin'  friend  thou  hasl  loved, 
Be  his  faults  and  his  follies  forgot  by  thee  then; 
Or  if  from  their  slumbers  the  veil  be  removed, 
Weep  o'er  them  in  silence,  and  close  ii  again." 

I  might  with  propriety  remind  you  of  many  others  lull  as 
worthy  of  mention  ;  many  of  them  have  passed  away  so  recently 
that  we  almost  fancy,  at  times,  uc  see  their  forms  and  hear  their 
voices.  Who  could  desire  a  more  honorable  professional  ances- 
try? In  the  genealogy  of  families  the  reputation  of  an  honora- 
ble ancestry  is  ever  a  matter  of  pride,  and  is  a  stimulus  and  an 
incentive  to  those  in  whose  keeping  the  good  name  rests  to  trans- 
mit the  boon,  unsullied,  to  those  that  come  after,  .lust  in  that 
light  do  I  look  upon  our  professional  lineage,  and  just  so  do  1  re- 
gard it  as  our  duty  to  guard  and  sustain  it  as  a  Bacred   trust. 

How,  then,  do  we  stand  to-day?  My  answer  will  he  brief.  I 
think  lam  justified  in  the  belief  that  at  this  time  our  institu- 
tion  manifests  greater  vitality  than  at  any  former  period,  not- 
withstanding the  predictions  of  a  few  who  have  become  luke- 
warm in  its  support.  Prophets  of  evil  always  abound;  such  in- 
dividuals but  little  know  the  strength  of  this  stalwart  corpora- 
tion. I  have  heard  this  cry  again  and  again,  and  I  believe  I  un- 
derstand its  import — its  echoes  soon  die  away  ;  but  we  have  had 
civil  wars  and  other  perils,  and  some  of  them  certainly  should 
never  be  forgotten.  1  have  only  time  to  notice  one  of  them,  and 
nobody  will  be  hurt  by  a  reference  to  its  history.  Do  any  of  you 
remember  the  Mary  Dugan  war?  It  was  almost  equal  to  the 
famed  wars  of  the  Koses,  though  the  odors  might  not  be  very 
sweet.  Most  of  you  were  born  too  late;  it  is  only  your  misfor- 
tune that  you  were  not  permitted  to  enjoy  that  superlative  farce, 
in  which  there  was  about  as  much  of  serio-comic  acting  as  any 
reasonable  man  could  wish  to  see  in  a  lifetime.  I  cannot,  on  this 
occasion,  give  you  by  any  means  a  lull  history  of  the  affair. 

This  Mary  Dugan  had  a  tumor  in  her  groin,  which  was  mis- 
taken for  a  something  which  it  was  not.  This  tumor  was  cut, 
and  what  Mrs.  Dugan  had  eaten  lor  hn-aklaM  came  out  through 
the  opening,  and  for  four  years  the  half-and-half  substance,  di- 
gested ami  undigested  pulp, persisted  in  flowing  from  this  unnat- 
ural or  preternatural  fissure;   thus  leaving  nearly  one  half  of  her 


160  Proceedings  of  Medical  Societies.  [Feb.  20, 

alimentary  tube  a  useless  cavity.  At  last,  alas!  poor  Mary  died. 
While  she  lived  she  was  regarded  as  an  object  of  wonderful  in- 
terest and  attraction,  not  only  by  the  faculty,  but  b}^  the  commu- 
nity, for  the  matter  took  the  wings  of  the  wind.  Pity  and  sym- 
pathy for  her  forlorn  condition  moved  the  hearts  of  the  charita- 
bly disposed,  and  everything  possible  was  done  for  her  bodily 
comfort;  but  the  battles  among  the  doctors  eclipsed  all  other  con- 
siderations. One  party  maintained,  and  by  speeches  and  learned 
essays  proved  incontestably,  that  this  was  an  undoubted  case 
of  the  then  almost  unknown  disease,  typhlo- enteritis.  Another 
party  as  stoutly  argued  that  it  was  only  an  ordinary  case  of  fem- 
oral hernia.  For  four  years  the  contest  raged,  and  pamphlets 
with  supplements  and  appendices  were  scattered  about  like  fall- 
ing leaves.  For  four  years  the  air  was  filled  with  threats  of  per- 
sonal chastisement,  and  often  a  rumor  of  pistols  for  two  was  pro- 
claimed as  part  of  the  programme.  It  seemed  somehow  unac- 
countably strange  that  men  thirsting  for  each  other's  blood  could 
not  in  this  long  time  find  the  victims  they  were  so  eager  to 
slaughter,  but  so  it  was. 

Mary,  in  the  meantime,  manifested  an  enterprising  spirit.  It 
occurred  to  her,  or  more  likely  was  whispered  in  her  ear,  that 
she  might  fill  her  pockets,  just  in  proportion  to  the  vacuum  made 
in  her  bowels.  She  brought  suit  for  $5,000  damages.  She  went 
up  town  and  down  town,  and  showed  her  typhlo  to  every  doctor 
and  to  anybody  who  wished  to  see  it.  This  was  Mary's  little 
lamb,  but — 

''Its  fleece  was  not  as  white  as  snow, 
But  everywhere  that  Mary  went,  the  lamb  was  sure  to  go." 

(I  hope  the  children  will  pardon  me  for  making  this  use  of  their 
beautiful  poem.)  The  doctors  talked  typhlo- enteritis,  and  so  did 
all  the  old  women.  In  the  legal  investigation  at  least  two 
dozen  doctors  were  on  the  stand;  in  fact,  but  few  other  wit- 
nesses were  needed.  About  one-half  were  for  typhlo,  and  the 
others  favored  the  hernia  theory;  but  the  jury,  in  their  wisdom, 
or  rather  in  their  confusion,  decided  against  the  unfortunate 
plaintiff;  so  she  Jailed  to  fleece  the  doctors,  as  she  anticipated. 

As  before  stated,  Mary  died,  and  wisely  willed  her  bod}'  to 
the  party  who  had  befriended  her,  and  quickly  did  he  avail  him- 
self of  his  opportunity.  "Eureka!"  shouted  Dr.  W.,  and  "I 
told  you  so!"  exclaimed   forty  doctors  at   once;  "femoral  her- 


1880.]  St.  Louis  Medical  Society.  161 

ilia,  and  nothing  else  '.  "  What  a  victory  for  one  Bide,  and  what 
a  crushing  defeat  for  the  other!  All  the  actors  in  this  drama 
have  gone  down,  and  their  souls,  we  trust,  have  lc ' 1 1 1 •  up;  and  it 
is  to  be  hoped  that  they  have  long  sine'  arranged  all  matters  with 
Mrs.  Dngan;  and  that  she  is  receiving  compensation  for  all  she 
suffered  here. 

As  a  climax  to  this  affair  there  appeared  in  one  of  our  dailies 
a  large  wood-cut,  showing  a  balloon,  surmounted  by  a  woman's 
head;  the  basket  below  contained  three  well-known  doctors,  and 
clinging  to  the  ropes  below  were  four  others,  trying  to  prevent 
the  ascension.  Beneath  the  cut  was  a  short  poem,  headed: 
"Grand  Medical  Ascension!  The  Celebrated  Balloon,  Typhlo- 
Enteritis!"  Far  off  in  the  clouds  was  the  temple  of  lame.  Eere 
is  the  poem : 

"Come  all  ye  mystic  medicos, 

And  stand  up  in  a  row . 
Who.  seizing  Mary's  petticoats, 

Aloft  to  tame  would  go; 
And  you  ye  grudging  grumblers,  who 

Would  strive  to  keep 'em  down, 
Let  go  your  strings  and  borrow  wings, 

To  soar  to  like  renown. 

••Entire  obliterations  oft 

A  second  time  will  show, 
And  '•  Inguinal"  and  "  Femoral  " 

Are  different,  we  know. 
Notes.  "Supplements,"  "Appendixes," 

Of  course  are  understood : 
The  case,  Still   pretty  much  a  case, 

The  quarrel,  clear  a-  mud. 

"Now,  whether  in   the  ■•crural   arch" 

The  scalpel  in  was  sent, 
Or  under  Poupart's  ligament 

With  sad  effect  it  went— 
Enlighten,  Lord,  tie-  Faculty, 

Who  only  are  in  doubt, 
WhateVr  tiie  case,  'tis  they,  alaa  ! 

Have  let  their  humors  out."' 

Well,  so  much  for  this  remarkable  quarrel.  Others  equally 
interesting  or  farcical,  and  some  almost  tragical,  could  he  detailed, 
but  we  forbear.  In  view,  then,  of  the  past  and  the  present,  I  am 
inclined  to  predict  for  our  Society  a  perpetuity,  a  continued  ex- 
istence, a  Wight  future  ;  that  it  will  not  cease  to  he  what  it  is  now. 


162  Proceedings  of  Medical  Societies.  [Feb.  20, 

the  center  of  attraction  for  those  of  our  profession  who  appre- 
ciate the  grand  truths  of  science,  or  who  are  inspired  by  the 
spirit  of  progress.  It  has  for  a  long  time  been  apparent  to  me, 
and  I  do  not  believe  I  am  mistaken,  that  those  who  have  availed 
themselves  of  the  advantages  of  this  Society,  are  in  consequence 
more  useful,  more  practical,  and  in  every  way  better  qualified 
for  the  duties  they  are  required  to  perform  than  others.  This 
thought  was  often  expressed  by  our  late  colleague,  Prof.  Linton, 
and  he  often  denounced  in  strong  terms  those,  especially  young 
men,  who  failed  to  appreciate  such  advantages. 

The  benefits  derived  and  conferred  by  a  free  interchange  of 
sentiments  and  experiences  are  of  almost  incalculable  value  and 
importance,  and  should  be  properly  estimated  by  all,  and  espe- 
cially those  who  are  ambitious  to  stand  in  the  front  rank  of  pro- 
fessional service  or  who  desire  to  be  esteemed  and  respected  by 
the  community.  The  merchant  or  tradesman  who  never  goes  on 
'Change,  whose  associates  are  only  those  with  whom  his  pecuni- 
ary interest  brings  him  in  contact,  who  day  after  day  and  year 
by  year  confines  his  thoughts  to  buying  and  selling  his  goods  or 
his  wares,  his  mind  all  the  time  upon  percentages,  is  a  very  differ- 
ent being  from  one  who  associates  largely  with  others  of  his  call- 
ing. There  is  a  marked  difference  in  the  looks  and  actions,  in 
the  modes  of  expression,  in  the  address,  in  the  social  qualities, 
in  fact  the  whole  bearing  of  these  individuals.  The  questions 
■and  discussions  which  arise  in  the  assembly  serve  to  sharpen  the 
faculties,  to  animate  and  develop  all  the  powers  of  the  mind,  to 
make  the  man  a  better  citizen  and  better  in  all  the  relations  of 
•life. 

As  a  notable  example  of  grand  results  accomplished  by  con- 
cert of  action,  I  desire  to  refer  to  the  organization  known  as  the 
Teachers'  Association,  connected  with  the  Public  Schools  of  our 
city.  At  the  suggestion  of  one  of  our  sagacious  Superintend- 
ents, the  lamented  Divol,  this  society  was  formed  many  years 
ago.  It  numbers  now  some  six  hundred  members;  attendance 
and  membership  are  made  compulsory;  everything  relating  to 
principles  and  practice  in  the  art  of  teaching  is  substantially  im- 
pressed upon  the  minds  of  all,  and  those  who  by  want  of  capac- 
ity or  other  circumstances,  fall  short  of  an  established  grade  of 
•competency  are  dropped  from  the  lists.  To  the  practical  work- 
ings of  this  society  we  ma}r  attribute,  in  great  part,  the  excel- 
lence and  efficiency  of  these  schools.     A  few  years  since,  when 


1880.]  St.  Louis  Medical  Society.  1(''" 

Bancroft,  the  historian,  and  one  of  our  mosl  ardenl  educatore,had 

made  a  thorough  inspection,  I  heard  him  remark,  "  Boston  must 
look  out  for  her  laurels." 

If,  then,  in  associations  such  as  I  have  mentioned  these  ad- 
vantages are  realized,  what  may  we  look  for  in  a  profession 
which  deals  with  human  health  and  human  lite,  and  whose  min- 
istrations reach  and  compass  very  many  of  the  interests  and 
principles  of  social  economy?  I  assume  thai  as  a  consequei 
of,  or  immediatel}-  growing  out  of  associated  labor,  in  personal 
influence,  in  the  contact  of  mind  with  mind,  in  exchange  and 
discussions  of  views,  sentiments  and  doctrines,  there  is  a  power 
exerted — educational,  may  we  not  regard  it ?— preparing  us  for 
our  duties  and  responsibilities,  that  can  come  from  no  other 
source;  and,  more  than  this,  there  is  a  cultivation  of  the  kindly 
and  sympathetic  qualities  of  our  nature  that  cannot  be  too  highly 
estimated.  In  the  presence  of  each  other,  generous  and  honora- 
ble impulses  flow  and  overflow  and  find  expression.  One  may 
entertain  high  personal  esteem,  reverence  and  regard  for  tl 
of  his  grade  or  class,  even  without  intimate  relations  or  acquaint- 
ance, but  when  these  sentiments  find  actual  expression,  known 
to  come  from  the  heart,  how  salutary  is  the  effect.  We  need  al- 
ways demonstrations  of  friendship  or  affection  to  make  us  feel 
their  full  force. 

In  considering  this  subject  there  is  another  point  that  appears 
to  me  of  great  importance.  Specialism  is  now  the  order  of  the 
day,  and  has  produced  a  remarkable  change,  or  we  might  say  a 
revolution  in  the  old  and  long  established  order  of  things.  A 
very  large  proportion  of  the  physicians  of  our  city  are  now  prac- 
ticing specialties,  and  the  indications  are  that  the  time  will  soon 
come  when  the  general  practitioner  will  1'*'  left  behind,  a  thing 
of  the  past,  an  old  fogy.  A  great  danger  is  that  the  specialist 
will  neglect  general  culture  and  become  a  man  of  one  idea.  U 
this  is  true,  how  manifest  is  it  that  in  the  Society  is  found  tin- 
greatest  safeguard;  it  is  the  only  place  where  the  specialist  met. 
under  the  fairest  circumstances  and  conditions,  not  <>nly  those  of 
his  own  class,  hut  those  engaged  in  other  departments,  as  well  as 
those  who  still  pursue  the  beaten  track.  Eere  all  meel  as  equals, 
on  common  ground,  for  free  inquiry,  discussion  or  criticism,  and 
each  and  all  are  incalculably  benefited.  The  acquired  knowl- 
edge of  each  becomes  commen  property,  and  here,  too,  there  is 
no  restraint  or  embarrassment  tending  to  make  us  fed  ashamed 


164  Proceedings  of  Medical  Societies.  [Feb.  20, 

of  an  honest  difference  of  opinion  or  antagonism  of  practical 
judgment.  The  case  is  widely  different  where  our  judgments  or 
sentiments  are  subjected  to  the  tribunal  which  a  censorious  pub- 
lic always  exercises,  or  where  our  declarations  and  professions 
must  be  made  to  accord  with  our  financial  interests  or  reputation. 
And  now,  having  said  so  much  upon  the  subject  of  specialties, 
may  I  ask  your  indulgence  in  a  declaration  of  my  private  opin- 
ion in  reference  to  this  innovation.  I  do  this  certainly  with  a 
degree  of  timidity;  I  am  free  to  confess  that  I  entertain  the  con- 
viction that  this  departure  from  the  long  tried  and  established 
usages  is,  to  say  the  least,  fraught  with  many  dangers.  Special- 
ism in  medicine  is  not  an  unmixed  good,  and  it  is  not  an  unmiti- 
gated evil.  It  is  a  remarkable  compound  of  good  and  evil.  In 
the  main,  viewing  it  in  the  abstract,  it  is  inherently  and  intrins- 
ically good;  it  is  made  an  evil  by  extrinsic  influences;  and  these 
are  numerous  and  varied,  and  are  of  such  a  character  as  to  lie 
almost  beyond  the  reach  of  corrective  measures.  Perhaps  some 
may  say  that  whatever  is  wrong  in  the  system,  will  cure  itself; 
but  do  we  not  know  from  long  observation  and  experience  that 
reformation  is  very  slow  in  all  cases  where  the  self-interest,  the 
condition,  the  circumstances  of  a  large  and  influential  class  are 
at  stake  ?  I  am  then  constrained  to  say,  taking  the  whole  field 
into  view,  that  I  believe  the  introduction  of  specialism  into  the 
profession  has  produced  more  of  harm  than  good,  as  far  as  the 
welfare  or  interests  of  the  people  are  concerned;  and  in  forming 
this  opinion,  I  have  done  so  after  a  long  and  close  observation  of 
its  practical  working ;  and  here  is,  or  should  be,  the  grand  test 
in  all  matters  that  concern  the  well-being  of  the  community, 
whether  it  be  in  medicine,  religion,  politics,  social  economy,  or  any- 
thing else.  I  believe  a  sentiment  against  this  order  of  things  is 
growing,  and  will  ere  long  manifest  its  strength.  I  have  indi- 
cated one  of  the  sources  from  which  a  great  danger  to  the  inter- 
ests of  the  people  comes,  and  for  fear  you  may  think  me  bold 
and  presumptuous  in  my  expressions  concerning  the  motives  that 
actuate  men,  I  quote  the  language  of  one  of  the  clearest  minds  of 
the  time,  Henry  Maudslcy : 

"The  practical  religion  of  the  day,  the  real  guiding  gospel  of 
life,  is  money  getting;  the  professed  religion  is  Christianity. 
Now,  without  asserting  that  riches  are  not  to  be  gotten  by  hon- 
est industry,  it  may  be  maintained  that  the  eager  passion  to  get 
rich— honestly,  it  may  be,  but  if  not,  still  to  get  rich — is  often 


1880.]  St.  Louis  Medical  Society.  165 

inconsistent  with  the  spirit  of  the  gospel  professed.  The  too 
frequent  consequence  is,  that  life  becomes  a  systematic  inconsist- 
ency, or  an  organized  hypocrisy.  With  a  profession  of  faith  that 
angels  might  adopt,  there  is  too  often  a  rule  of  practice  which 
devils  mJght  not  disdain." 

It  is   this    religion    of    money  getting   that    overrides   and 
stamps  out  much  of  the  good  thai  otherwise  might  result  from  ;i 
well  regulated  and  systematized  division  of  labor.     How  true  is 
the  saying  that  "The  love  of  money  is  the   rool  of  all   evik" 
Specialism  has  not  yet  got  its  growth,  and  we  have  yel  to  - 
what  fruit  it  will  hear  in  its  maturity.     It  has  grown  rapidly, too 
rapidly,  as  we  think,  to  make  a  tree  thai   "shall  be  for  the  heal- 
ing of  the  nations."     The  --rand  oaks  are  always  of  slow  growth. 
At  the  present  time  a  very  large  proportion  of  those  who  are 
full}'  committed  to  specialism  are  men  who   have  tor  years   had 
large  experience  in  general  practice.      But  it  will  not  he  so  much 
longer.     Of  the  thousands   now  in  our  medical   colleges,  I  have 
no  doubt  more  than  one-half  are  directing  all  their  efforts  to  pre- 
paring themselves  for  some  one  of  the  subdivisions  of  practice ; 
and  why  not,  when  they  know  that  the  specialist  can  get  rich    in 
one-half  the  time  and  with  one  quarter  of  the  labor  they  would 
otherwise  have  to  perform?     Our  schools  and  college-  are  over- 
crowded, and  there  is,  as  stated  by  a  sagacious  writer,  "in  this 
country  a  plethora  of  education   that  is  squeezing  out  the   life- 
blood  of  the  nation."     The  time  was,  and   that  only  a  few  short 
years  ago,  when  we  entirely  discountenanced  and  almost    perse- 
cuted  specialists.     Now  we  not   only  recognize  them,  but  in  ev- 
ery way  treat  them  as   physicians,  and  with  honor  and   affection. 
This  is  all  right  in  principle,  but  should  not  there  be  a  limit  some- 
where, and  should  not  that   limit   be  one  of  education   and  pro- 
fessional qualification  in  the  broadesl  and  most  comprehensive 
signification  of  those  terms?     This  is  not  the  time  to  elaborate 
these  questions,  hut  it  is  well  to  look  forward  and  see  whither  we 

are  drifting. 

In  my  view,  no  man  can  be,  in  the  true  sense,a  physician  un- 
less he  is  trustworthy  in  the  treatment  of  the  whole  range  of  dis- 
eases that  alllict  the  human  body.  Collea  wrote  his  book  to 
tablish  thedoetrine  of  the  constitutional  origin  of  local  diseases. 
Has  this  doctrine  turned  a  backward  Bomorsault,  aid  are  constitu- 
tional diseases  of  local  origin  ?  Ci  ia  a  consoling  reflection  thai 
at  the  present  time,  and  in  this  Society,  our  specialists  arc,  with- 


166  Proceedings  of  Medical  Societies.  [Feb.  20, 

out  exception,  men  true  to  the  profession  ;  and  I  am  confident 
they  will  join  heart  and  hand  in  all  measures  in  which  truth,  sci- 
ence and  philanthropy  are  the  guiding  principles.  Let  me  be 
fully  and  fairly  understood.  I  stand  committed  to  the  idea  that 
there  is  a  vast  amount  of  good  in  the  system  of  specialism  as  it 
now  exists,  but  that  it  is  high  time  that  the  medical  profession, 
medical  societies  and  medical  colleges  work  in  concert,  that  they 
may  utilize  all  there  is  that  is  valuable,  and  at  the  same  time 
counteract  all  that  tends  to  revolution  and  anarchy. 

I  think  well  of  the  gentleman  you  have  elected  as  my  suc- 
cessor. I  ought  to  think  well  of  him,  for  I  taught  him  anatomy, 
and  I  believe  I  did  it  well  and  thoroughly,  and  I  desire  to  share 
a  part  of  the  honor  of  making  him  a  good  and  useful  man  in  the 
profession.  But  how  strangely  matters  and  things  turn  about! 
I  now  sit  and  listen  to  him  on  this  floor,  and  feel  as  the  Apostle 
did  at  the  feet  of  Gamaliel.  Well,  this  verifies  what  Dr.  Watts 
says  in  one  of  his  hymns.  He  predicts  a  good  time  coming, 
"  when  men  shall  grow  wiser  than  their  teachers  are,  and  better 
know  the  Lord." 

And  now,  gentlemen,  fondly  trusting  that  I  have  not  unduly 
trespassed  on  your  valuable  time,  permit  me  to  tender  you  my 
grateful  thanks  for  the  kindness  and  consideration  you  have 
uniformly  manifested  towards  me  during  the  period  in  which  I 
have  had  the  honor  of  presiding  over  your  deliberations. 


Saturday,  January  24,  1880. 

Cancer  of  the  Os  Uteri. 

Dr.  E.  H.  Gregory —  1  will  report  a  case  that  happened  to- 
day. I  was  consulted  in  a  case  of  cancer  of  the  os  uteri.  There 
was  apparently  a  distinct  belt  between  the  morbid  growth  and 
the  insertion  of  the  vagina,  and  it  was  thought  a  proper  case  for 
extirpation.  I  succeeded  in  placing  the  chain  of  an  ecraseur  be- 
tween the  insertion  of  the  vagina  and  the  disease,  and  removed 
it.  Now  somebody  here  may  think  I  am  implicating  myself  in 
some  bad  surgery,  but  I  think  these  cases  had  just  as  well  be  re- 
ported.    I  succeeded  in  removing  the  mass,  and  I  thought  very 


1880.]  St.  Louis  Medical  Society.  107 

properly,  but  on  examination  I  found  that  aboul  two  thirds  of 
the  vagina  was  separated  from  the  uterus,  and  I  could  pat  my 
fingers  into  the  abdominal  cavity. 

Dr.  W.  Coles  (Sotto  voce) —  It  is  not  the  first  time. 

Dr.  Gregory  —  The  Doctor  says  it  is  not  the  first  time.  No, 
it  is  the  second  time.  He  was  present  when  the  same  acci- 
dent happened  once  before.  The  point  is  this:  Here  is  a  space 
into  which  we  can  place  a  chain  safely  and  divide  the  structures. 
I  am  sure  the  chain  was  placed  in  the  groove  indicated,  not  above 
it;  simply  above  or  beyond  the  disease.  T  don't  think  it  was  two 
lines  beyond  the  disease,  and  yet  this  happened.  The  Doctor 
says  it  is  not  the  first  time.  Perhaps  it  is  well  that  I  should  re- 
port the  other  case  also.  The  former  case  was  one  in  which  a 
tumor  was  removed.  The  patient  lived  a  year  or  two,  and  died 
of  phthisis.  In  the  case  to-day  I  succeeded  in  stitching  the  va- 
gina and  the  uterus  very  satisfactorily,  and  late  this  evening  the 
patient  seemed  to  be  in  a  very  fair  condition.  Now,  I  have  per- 
formed this  operation  a  number  of  times.  You  must  not  suppose 
I  always  open  the  peritoneum;  I  have  opened  it  twice,  but  to-day 
I  am  satisfied  it  was  detached  two-thirds  of  the  circumference  of 
the  uterus.  If  I  had  used  the  scissors,  as  we  ordinarily  do,  I 
should  have  cut  away  as  with  the  ecraseur.  The  ecraseur 
draws  the  tissue  in,  and  perhaps  sacrifices  more  than  the  knife 
and  scissors.  1  suppose  that  I  should  have  opened  the  peritoneal 
sac  with  the  scissors  if  I  had  attempted  the  removal  of  the  tumor 
with  that  instrument.  So  there  must  be  cases  in  which  the  va- 
ginal portion  of  the  neck  is  very  short,  and  where  the  peritoneum 
reaches  down,  close  around  the  lips  of  the  OS. 

Da.  F.  J.  Lutz  —  Do  we  understand  you  to  have  removed 
the   uterus? 

Dr.  Gregory  —  No,  but  I  could  have  removed  it  without  any 
trouble.  But  the  removal  of  the  uterus  is  a  very  serious  opera- 
tion, and  certainly  a  great  shock  to  the  system,  and  I  do  not  think 
that  organ  should  be  removed  because  the  neck  is  involved  in 
disease,  for  it  is  within  reach,  should  the  disease  reappear. 

Dr.  W.  Johnston  —  Have  you  kept  a  record  of  how  many  of 
those  upon  whom  you  have  operated,  live,  and  how  many  are 
dead  ?     How  long  did  they  live,  and  what  proportion  died  '( 


168  Proceedings  of  Medical  Societies.  [Feb.  20, 

Dr.  Gregory  —  I  have  no  written  record  of  the  cases;  I  can 
remember  two  or  three  cases  where,  two  years  ago,  I  performed 
this  operation,  and  the  patients  are  still  living.  I  make  it  a  rule 
to  make  these  patients  visit  me  once  or  twice  every  two  or  three 
months.  A  lady  from  Illinois  came  once  in  six  weeks;  there  is 
n.o  sign  of  a  return.  The  case  reported  to-day  is  no  more  uu- 
favorable  than  that  one. 

Dr.  Johnston  —  How  many  are  dead? 

Dr.  Gregory  —  I  cannot  say;  I  acknowledge  most  of  them 
are  dead.  I  will  mention  another  case  or  two,  in  removing  these 
cancers.  I  remember  removing  a  breast  for  cancer.  The  woman 
lived  five  years,  and  then  died  with  brain  symptoms. 

The  President  —  The  same  accident  which  happened  to  you 
happened  to  Dr.  A.  J.  Simm. 

Dr.  Gregory  —  I  think  it  is  only  a  matter  of  the  number  of 
cases  that  a  man  has.  I  am  surprised  so  little  is  said  of  it  in  the 
books.  If  a  man  cuts  off  enough  of  them,  he  will  meet  with  cases 
now  and  then  where  he  will  have  accidents  like  the  one  that  hap- 
pened to  me  to-day. 

,  Dr.  Coles  —  I  have  some  curiosity  to  hear  what  explanation 
Dr.  Gregory  has  of  the  anatomical  condition  of  things  that 
contributed  to  this  accident.  I  am  inclined  to  think  that  the 
disease  itself  had  a  good  deal  to  do  with  the  drawing  of  the  per- 
itoneum into  close  proximity  to  the  os.  I  am  watching  a  case  in 
conjunction  with  a  ph}-sician  from  Illinois  where  this  condition 
is  well  marked.  It  would  be  a  great  risk  to  amputate  the  cervix 
in  this  case  with  the  ecraseur.  Another  point  is,  that  in  a  large 
majority  of  cases  of  cancer  of  the  uterus  there  is  a  tendency  to 
flexion  of  the  uterus  in  women  who  have  borne  a  number  of 
children. 

Dr.  Gregory  —  It  has  occurred  to  me  that  the  portion  of  the 
vagina  inserted  in  the  neck  was  made  friable  by  the  disease;  it  is 
barely  possible  the  vagina,  at  its  insertion  in  the  neck,  may  have 
been  softened  by  cancerous  infiltration.  I  have  seen  a  number 
of  cancerous  breasts  smaller  than  healthy  ones.  A  great  patho- 
logical feature  of  cancer  is  stroma.  After  it  is  formed  it  con- 
tracts, and  it  draws  the  tissue  not  implicated.  The  contraction 
-characteristic  of  stroma  is  one  of  the  most  interesting  features 
to  the  conservative  surgeon,  because  it  is  supposed  the  contrac- 


I88O.3  St.  Louis  Medical  Shhi.iv. 


169 


tion  in  this  stroma  tends  to  Btraqgulate  the  vessels.  The  cica- 
tricial contraction  tends  to  cut  off  the  flow  of  blood  to  the  epi- 
thelial material.  I  have  declined  to  operate  where  the  contrac- 
tion was  a  marked  feature,  and  the  party  has  readied  a  fair  old 
age.  I  declined  because  I  felt  thai  the  Btroina  was  controlling 
the  circulation  of  the  cancer— that  there  could  be  very  little  mul- 
tiplication in  the  new  material  thai  formed  the  new  cancerous  era, 
as  the  marked  growth  of  cancer  depended  on  the  multiplication 
of  the  cell  structures.  The  contraction  placed  in  abeyance  this 
multiplication,  and  consequently  this  increased  growth  is  pre- 
vented. 

Dr.  A.C.  Bernays —  Some  time  since  Dr.  Saunders  informed 
the  Society  that  in  Vienna  the    peritoneum   had   been   opened 

thirty  times  in  succession  while  amputating  the  vaginal  portion 
of  the  womb,  and  that  all  these  cases  recovered.  While  I  was 
there  I  heard  persons  speak  of  such  cases,  and  the  Professor  of 
Gynsecologj*,  Henry  Braun,  thought  it  was  not  wrong  or  danger- 
ous to  open  the  peritoneum. 

Dr.  Johnston  —  I  have  no  doubt  that  Dr.  Gregory  performed 
the  operation  with  all  the  skill  it  is  admitted  he  possesses.  I 
have  no  doubt  that  my  young  friend,  who  has  been  in  Vienna, 
did  not  remain  long  enough  to  see  whether  they  recovered  or 
whether  the  grave  covered  them.  Dr.  Gregory  acknowledges 
that  the  grave  covered  many  of  his  cases.  Some  of  the  profes- 
sion are  indoctrinated  in  the  German  pathology,  as  taught  by 
Virchow,  that  disease  has  itsorigin  in  a  local  cell,  is  that  a  tint  ''. 
John  Simon  has  demonstrated  that  the  trouble  lay  in  the  previ- 
ous condition  of  the  system. 

Dr.  Gregory  —  I  wish  to  call  attention  to  the  fact  thai  in  the 

two  cases  reported  the  patients  are  yet   living,  and  the  resull  has 

justified  the  operation. 

Dr.  G.  Hurt —  I  take  issue  with  Dr.  Johnston  in  regard  to  the 
origin  of  cancerous  and  other  malignant  growths.  There  is  a 
great  difference  between  a  predisposition  to  a  disease  and  the  dis- 
ease itself.  The  diathesis  is  not  the  disease  at  all ;  the  microscope 
does  not  show,  neither  does  pathology  --how  it.  There  is  no  poi- 
son in  the  system  to  constitute  that  predisposition,  and  the  erup- 
tion of  the  disease  itself  at  its  firsl  appearance  may  be  due.  es- 
pecially in  the  case  of  cancer,  to  local  irritation  ;  it  may  also  be 


170  Proceedings  of  Medical  Societies.         [Feb.  20, 

due  to  mal-nutrition,  and  the  mal-nutrition  may  stand  just  be- 
hind the  local  irritation,  which  may  fall  upon  some  particular  or- 
gan or  tissue. 

Dr.  J.  S.  Moore  —  I  am  of  the  opinion  that  cancer  is  always 
dependent  on  a  constitutional  diathesis;  it  requires  constitutional 
treatment.  I  understand  also  that  the  cancerous  diathesis  and 
the  tuberculous  diathesis  exist  in  different  individuals  in  differ- 
ent degrees  of  strength.  A  person  may  be  born  with  a  tubercu- 
lous or  cancerous  diathesis  and  yet  never  have  tuberculosis  or 
cancer.  Sometimes  the  diathesis  is  aided  by  some  local  cause.  A 
woman  may  have  the  cancerous  diathesis  very  weak,  and  she 
may  accidentally  receive  a  bruise.  If  the  injury  is  operated  on 
before  the  cancerous  matter  is  absorbed  into  the  system  she  may 
be  permanently  cured,  but  if  it  be  neglected,  the  cancerous  juice 
will  be  absorbed  and  developed  locally. 

Dr.  Hurt — I  agree  with  the  last  speaker,  that  a  certain  dia- 
thesis is  required  for  cancer.  I  will  go  further,  however,  and  say 
it  is  not  of  necessity  absolutely  hereditarj^.  I  am  almost  disposed 
to  assert  the  transmutability  of  one  predisposition  into  the  dia- 
thesis of  another  predisposition. 

Dr.  Coles  —  The  practical  question  comes  up  as  to  the  course 
we  would  pursue  in  such  cases.  I  know  of  two  or  three  cases  in 
which  I  am  satisfied  the  lives  of  the  patients  were  saved  by  the 
means  of  an  operation. 

Dr.  Prewitt —  This  is  a  constantly  recurring  question — the 
constitutional  or  local  origin  of  cancer.  It  involves  a  practical 
question.  As  one  of  the  speakers  stated,  there  is  a  diathesis  that 
produces  cancer.  Sometimes  the  cancer  returns  after  an  opera- 
tion, because  of  the  infiltration  of  the  tissues.  Many  cancers 
have  been  removed  and  never  returned,  because  the  local  mani- 
festation has  been  got  rid  of. 

Dr.  BtRNAYS  described  at  some  length  the  course  through 
which  a  cancerous  disease  usually  runs  before  it  ends  in  death, 
and  advised  the  early  removal  of  cancerous  growths  before  the 
system  has  become  infected  from  the  local  disease. 


1880.]  St.  Louis  Medical  Society.  171 


Saturday,  January  31,  1880. 

Epithelioma   of    the   lids   of    the    Itixht    Eye. 

Dr.  A.  D.  Williams — Twelve  months  ago  !  cured  a  case  of  epi- 
thelioma of  both  lids  of  the  right  eye  by  electricity,  or  what  is 
called  the  lectrolytic  action  of  electricity.  As  no  one  in  the  dis- 
cussion daring  the  last  evening  alluded  to  that  method  of  treat- 
ment of  cancer,  I  thought  I  would  report  this  case  this  evening 
and  have  it  go  on  record  on  the  heels  of  that  discussion. 

An  old  gentleman,  from  Southern  Kansas,  about  twelve 
months  ago  came  to  me  for  an  affection  of  the  right  eve,  which 
he  had  had  for  some  considerable  time.  I  found  an  epithelioma 
of  both  lids.  The  lids  had  about  one-half  sloughed  away  by  the 
cancerous  ulceration;  it  had  attacked  apparently  the  edges  of  the 
lid  about  the  middle  and  had  extended  upward  ami  on  either  side, 
so  that  about  one-halt' of  the  surface  of  both  lids  were  destroyed 
by  the  disease.  The  extreme  corners  of  both  lids  were  intact; 
the  ulcer  extended  into  the  substance  of  the  lids  in  a  semi  lunar 
form  along  their  central  portion,  it  being  deepest  at  the  mid- 
dle of  both  lids.  The  tarsal  cartilages  were  nearly  destroyed. 
The  cancer  had  extended  along  the  palpebral  conjunctiva,  until 
it  had  passed  across  the  cul-de-sac,  and  reached  the  surface  of  the 
eyeball,  so  that  the  ocular  conjunctiva,  also,  was  involved  in  the 
process.  The  cul-de-sac  was  obliterated  by  the  contraction,  so 
that  when  the  remnants  of  the  upper  lid  were  pulled  away  from 
the  ball,  a  band  of  the  conjunctiva,  infiltrated  with  cancerous 
material,  could  be  seen  stretched  across  to  the  eyeball,  showing 
the  cancerous  process  had  actually  reached  the  eyeball  through 
the    conjunctiva. 

The  cornea  had  sloughed  sometime  previous  to  his  visit  to 
me ;  the  eyeball  being  partially  exposed  by  the  extensive  des- 
truction of  the  eye  lids,  the  atmosphere  had  caused  the  sloughing 
of  the  cornea,  which  of  course  made  him  completely  blind  in  that 
eye.      The  ulceration  was  still  going  on  quite  rapidly  when   1  saw 

him.     I  asked  my  friend  Dr.  Dickinson  to  see  the  case  with  me, 

.U1,|    he    on    examination    concurred  with    me    in      the    diagnosis, 

namely,  that   it  was  an  epithelioma.     The  eyeball  was  removed 
while  he   was  under  the    influence   of  chloroform.       This    was 


172  Proceedings  or  Medical  Societies.  [Feb.  20, 

done  to  save  him  from  intense  suffering,  and  in  order  to  be  able 
to  treat  the  cancerous  trouble  more  perfectly.  After  I  removed 
the  eyeball,  I  applied  various  escarotics,  such  as  chloride  of  zinc, 
chromic  and  carbolic  acids  to  the  cancerous  gi'anulations,  with 
the  effect,  apparently,  of  increasing  or  stimulating  the  trouble.  I 
concluded  that  as  nothing  was  to  be  gained  by  their  use,  I  would 
try  the  effect  of  electricity.  I  devised  an  electrode.  It  consisted  of 
four  ordinary  sewing  needles  stuck  through  a  cork,  so  that  they 
were  parallel  to  each  other,  and  their  points  were  on  a  level.  Be- 
tween the  blunt  ends  of  the  needles,  thus  fastened  in  the  cork,  I 
passed  the  end  of  the  negative  wire  from  the  battery,  and  wrapped 
silk  thread  around  the  whole,  so  as  to  bring  all  the  needles  in  con- 
tact with  the  wire,  and  at  the  same  time  to  insulate  them,  so  as  to 
enable  me  to  handle  the  electrode  thus  made  without  receiving 
the  electrical  charge.  I  inserted  the  points  of  these  four  needles 
into  the  cancerous  granulations  deep  enough  to  reach  what  I 
supposed  would  be  healthy  flesh.  I  completed  the  circuit  by  hav- 
ing the  patient  hold  in  his  hand  the  wet  sponge  of  the  pos- 
itive pole.  I  used  an  eight-cell  galvanic  battery.  After  closing 
the  circuit,  I  allowed  the  current  to  run  for  a  few  moments  dur- 
ing each  insertion  of  the  needles,  say  from  one  to  three  minutes. 
The  electrolytic  process  went  on  during  the  time  the  circuit  was 
closed.  I  continued  the  needles  in  one  place  until  the  cancerous 
granulations  seemed  to  be  cooked,  or  changed  completely,  and 
then  I  removed  them  to  another  point,  and  so  on  until  I  treated 
the  whole  granulated  surface.  I  was  careful  to  appl}*  them  to 
every  point  where  I  could  see  cancerous  granulations.  During 
the  time  that  the  needles  were  in  contact  with  the  flesh  and  the 
current  was  allowed  to  run,  a  white  foam  would  come  up  around 
the  needles.  This  gas  was  of  conrse  hydrogen  escaping  from 
the  decomposition  of  the  watery  portion  of  the  flesh. 

I  treated  the  case  in  this  way  for  several  days  in  succession. 
Each  time  I  was  careful  to  treat  all  the  cancerous  granulations 
I  could  see,  always  letting  the  current  continue  with  each  succes- 
sive insertion  of  the  needles,  until  all  the  granulations  were  ap- 
parently cooked.  On  the  tenth  day,  after  I  began  this  treat- 
ment, the  old  gentleman  was  compelled  to  return  home.  Before 
he  left,  the  granulations  had  mostly  disappeared.  After  he  re- 
turned lo  Southern  Kansas  he  had  no  further  trouble  from  his 
eye.  Suppuration  from  the  conjunctiva,  and  from  the  edges  of 
the  lids  ceased  in   a  short  time,  and  the  ulcerated  surface  con- 


1880.]  St.  Louis  Medical  Society.  173 

tracted  and  cicatrized,  so  that  he  had  no  further  annoyance 
from  it. 

About  six  months  after  the  above  treatment,  I  was  in  South- 
ern Kansas,  ami  I  purposely  called   to  Bee  him.     I   found  him 

suffering  with  a  low  form  of  typhoid  fever.  Thai  was  about  the 
first  of  last  August.  It  was  a  mild  attach  which  he  had  bad 
several  weeks  before  I  saw  him.  At  that  time  there  was  no 
trace  of  epithelioma  on  the  lids,  or  on  the  conjunctiva,  or  any 
where  else.  The  lids  had  contracted  and  cicatrized,  bo  there  was 
not  a  trace  of  the  cancerous  process  visible.  That  was  the  first 
case  that  I  have  treated  with  electricity,  and  1  think  the  result 
was  quite  flattering.  I  do  not  propose  it  as  a  universal  remedy 
for  epithelioma,  but  it  certainly  did  well  in  that  particular  ih- 
stance. 

Dr.  Prewitt  —  Did  you  apply  it  only  to  the  granulated  sur- 
face? 

Dr.  Williams  —  Only  to  the  cancerous  granulations.  I  stuck 
the  needles  down,  say  a  quarter  of  an  inch,  into  them,  and  al- 
lowed the  current  to  run  one  to  three  minute-,  until  the  granula- 
tions at  that  point  were  apparently  cooked;  then  I  moved  the 
needles  to  other  points,  and  so  on,  till  I  made  the  application  to 
all  the  cancerous  surface. 

President  Maughs  —  Do  you  know  of  any  other  cases  that 
have  been  treated  that  way? 

Dr.  Williams  —  I  got  the  idea  from  Alliums*  work  on  the 
use  of  electricity  in  affections  of  that  kind,  hut  I  do  not  remem- 
ber that  he  reports  a  case  of  epithelioma  cured  in  that  way. 

President  Maughs  —  Inquired  if  Dr.  Gregory  had  had  any 
experience  in  that  way. 

Dr.  Gregory  —  I  have  no  experience  in  the  use  of  electric- 
ity in  such  cases.  I  reported  a  case  here  last  Saturday  upon 
which  I  believe  I  performed  an  operation,  and  I  am  glad  !■>  say 
that  the  woman  has  recovered.  There  were  no  bad  symptoms, 
In  this  case  1  used  ether  instead  of  chloroform,  because  il  is  gen- 
erally considered  to  be  a  safer  remedy  than  chloroform j  this  is 
the  popularand  professional  belief,  and  I  used  it  for  that  reason.,  I 
prefer  chloroform.  I  have  used  chloroform  twenty  live  years,  and 
I  have  had  but  om-  mishap.     I  mention  it  for  the  reason  that  the 


174  Proceedings  of  Medical  Societies.  [Feb.  20, 

patient  was  a  colored  person.  I  have  read  that  colored  people 
were  more  frequently  the  victims  of  chloroform  than  the  white 
race.     Whether  that  is  true  or  not,  I  am  not  prepared  to  say. 

Dr.  Williams  —  The  professional  pendulum  has  now  com- 
menced to  go  in  the  opposite  direction  in  regard  to  the  compar- 
ative safety  of  ether  and  chloroform.  It  strikes  me  that  physi- 
cians now  think  there  is  as  much  danger  from  ether  as  chloro- 
form. In  sympathy  with  the  professional  feeling  I  began  the 
use  of  ether.  I  disliked  its  effects,  and  now  give  chloroform  reg- 
ularly. I  think  my  patient  is  about  as  safe  as  when  I  use  ether, 
and  history  will  show  as  many  accidents  happening  from  ether 
as  from  chloroform. 

Dr.  Gregory  —  I  sympathize  with  Dr.  Williams,  and  hope  I 
will  be  permitted  to  use  chloroform;  I  certainly  prefer  it  as  an 
anaesthetic. 

Dr.  Prewitt  —  As  to  the  case  reported,  by  Dr.  Williams,  if 
his  diagnosis  is  correct — and  I  would  not  call  it  in  question — it 
would  certainly  be  a  remarkable  effect  from  the  action  of  the  bat- 
teiy.  I  understand  him  to  say  he  applied  the  needles  only  to  the 
ulcerated  surface,  and  to  a  moderate  depth.  Unless  the  electric 
action  passed  all  through  the  growth,  it  could  not  be  expected 
that  the  action  on  the  ulcerated  surface  would  cure  epithelioma. 
In  these  cases  the  difficulty  is  in  getting  rid  of  the  infiltrated  tis- 
sue about  the  tumor.  When  we  cut  it  out,  we  often  find  that 
there  is  infiltration  beyond  the  line  of  incision.  If  electric  ac- 
tion on  the  surface  is  to  cure  these  things,  the  effect  must  extend 
far  beyond  the  surface  acted  upon  by  the  means.  We  would 
hardly  expect  that  to  be  the  case  with  the  action  of  the  battery 
as  he  details  its  use.  In  this  case  it  is  said  to  have  been  sufficient, 
not  only  to  have  destroyed  the  epitheliomatous  growth,  but  it 
should  have  acted  on  the  cells  for  some  distance  beyond.  It 
eeems  remarkable  such  results  should  follow.  I  doubt  exceed- 
ingly whether  we  should  have  any  such  results  in  other  cases. 

Dr.  Williams  —  I  will  say  that  in  pressing  the  needles  into 
the  granulations,  my  object  was  to  pass  them  through  the  granu- 
lated tissue,  and  deep  enough  to  have  them  reach  what  I  sup- 
posed to  be  healthy  tissue.  There  was  no  tumor;  it  was  an  open, 
sloughing  sore.     Of  course  I  did  not  expect  such  a  result.     I  ex- 


1880.]  Sr.  Louis  Medical  Society.  175 

pected  he  would  have  trouble  when  he  got  home,  but  he  did  not 
When  I  saw  him  it  had  healed  nicely.  So  far  as  the  diagnosis  is 
■concerned,  I  believe  it  to  be  a  case  of  epithelioma,  and  Dr.  Dick- 
inson concurred  in  this  opinion. 

Dr.  U.  H.  Hughes  —  In  the  Alienist  and  Neurologist  for  Jan- 
uary may  be  found  an  explanation  as  to  the  method  of  the  action 
of  electricity  in  reducing  morbid  growths.  It  is  a  translation 
from  the  Gazette  Hebdomdiaire  on  "the  Effects  of  Cephalic  Elec- 
trization," by  Dr.  (Jh.  Letournian.  Doctor  Laborde  assisted  him 
in  the  experiment  on  a  kitten  a  month  old,  in  which  the  cranial 
wall  was  still  very  thin,  and  was  quite  easy  to  cut;  a  considera- 
ble portion  of  cranium  was  cut  out  on  the  left  side.  The  dura 
mater  being  so  exposed  it  was  wvy  easy  to  see  with  the  naked 
eye,  and  still  better  with  a  magnifying  glass,  the  arterial  and 
venous  branches  which  ramify  upon  the  surface.  They  proceeded 
then  to  the  electrization,  making  use  of  the  small  portable  pile 
for  continuous  current  of  MM.  Onimus  and  Brown.  This  pile 
contains  eighteen  elements,  and  they  took  care,  by  the  aid  of  a 
galvanometer,  introduced  into  the  circuit,  to  assure  themselves 
that  the  passage  of  the  current  was  effected  regularly.  During 
all  the  duration  of  the  experiment,  the  positive  pole  was  placed 
behind  the  right  ascending  ramus  of  the  inferior  maxilla,  and  the 
negative  pole  upon  the  anterior  cranial  region  above  the  eyes. 

"Ten  or  fifteen  seconds  after  the  closing  of  the  circuit,  the  tine 
arterial  branchings  of  the  dura  mater  became  less  and  les.s  visi- 
ble, and  a  little  later  the  venous  branches  themselves  became 
pale.  At  each  interruption  of  the  current  the  anaemia  increased 
for  an  instant,  then  the  vessels  resumed,  little  by  little,  a  little 
larger  caliber. 

"The  experiment  repeated  a  number  of  times  gave  always 
the  same  results,  determined  successively  by  Doctors  Duval,  La- 
borde, Condereau  and  themselves.  The  dura  mater  of  the  right 
side  having  been  denuded  in  its  turn,  the  experiment  was  re- 
peated, which,  on  this  side,  again  gave  the  Bame  results.  They 
pursued  the  experiment,  cutting  out  on  the  left  side  a  portion  of 
the  dura  mater.  Tne  pia  mater  being  thus  exposed,  and  its  vas- 
cular branches,  arterial  and  venous,  being  very  visible  upon  the 
gray  ground  of  the  cerebral  substance,  the  same  observations 
were  made  upon  it.  There,  also,  we  could  obtain  at  will,  con- 
traction of  the  vessels. 


176  Proceedings  of  Medical  Societies.  [Feb.  20, 

"The  experiments  just  related,"  they  go  on  to  state,  "added  to 
facts  cited  in  the  commencement  of  this  paper,  put  it  beyond  doubt 
that  it  is  possible,  even  easy,  to  produce  in  man  a  temporary  anannia 
of  the  brain,  by  means  of  suitable  electrization ;  but  the  therapeu- 
tical bearing  of  this  fact  should  not  escape  the  physician.  For 
this  temporary  ancemia  can,  without  the  least  inconvenience,  be  re- 
newed a  great  number  of  times  daily  if  one  wishes ;  and  our  per- 
sonal experience  permits  us  to  affirm  that,  with  a  little  persist- 
ence, one  may  triumph  so  over  various  congestive  states  of  the 
brain,  manifesting  themselves  either  by  the  simple  depression  of 
the  intellectual  faculties  or  by  psychical  disorders  of  varied 
nature." 

In  support  of  the  preceding  statement  they  cite  a  typical  case 
of  chronic  congestion  of  the  brain,  which  yielded  to  electrization 
repeated  persistently,  but  which  we  omit.  I  have  been  in  the 
habit  for  several  years  of  using  electrization  for  the  purpose  of 
arresting  cerebral  hyperemia. 

Dr.  Dickinson  —  How  do  you  apply  the  galvanism? 

Dr.  Hughes  —  In  various  ways,  the  positive  pole  to  the  left 
temple  and  the  negative  to  the  right  occipito-vertebral  junction, 
and  vice  versa;  sometimes  pass  it  transversely  through  the  tem- 
ples, though  generally  from  the  seventh  cervical  vertebra  follow- 
ing the  cervical  sympathetic  in  the  brain.  The  opening  and  clos- 
ing of  the  circuit  so  acts  on  the  vaso-moter  system  as  to  contract 
the  vessels  and  diminish  the  morbid  activity  resulting  from  cere- 
bral hyperemia.  If  you  can  arrest  morbid  growth  by  strangu- 
lating it  with  a  ligature,  you  can  arrest  it  by  the  use  of 
electricity. 

Dr.  W.  Dickinson  —  I  had  the  pleasure  of  seeing  the  case  re- 
ported by  Dr.  Williams,  and  I  have  no  doubt  myself  of  the 
character  of  the  disease.  The  result  certainly  exceeded  my  ex- 
pectations. I  have  had  three  cases  of  epithelioma,  located  on  the 
globe.  The  first  case  was  six  or  seven  years  ago  ;  it  was  limited 
to  a  small  space,  and  it  disappeared.  In  the  second  case  I  re- 
moved the  diseased  part  with  a  knife;  what  remained  I  cauter- 
ized. The  patient  left  the  city,  and  at  the  expiration  of  a  year, 
returned.  It  had  re-formed  a  little,  but  not  so  much  as  at  first. 
I  pursued  the  same  course,  and  I  have  written  to  him  to  know 
the   result.     There    is   no   regeneration  of  the  mass.     The  third 


1880.]  St.  Louis  Medical  Societv.  177 

case  was  one  I  treated  in  a  Bimilar  manner,  removing  whal  I  could  ; 
by  that  process  it  was  diminished  one-third.  It  returned  on  ac- 
count of  its  regeneration,  and  on  this  occasion  I  had  the  pleasure 
of  being  assisted  by  my  friend,  Dr.  Gregory.  The  remedy 
adopted  was  excision  and  the  patient  recovered. 

(Edema  of  th<»  Epiglottis. 

Dr.  "Wesseler  —  Presented  a  pathological  specimen,  and  said  : 
I  have  a  case  to  present  of  oedema  of  the  epiglottis.  The  man 
was  set.  34  years,  German,  unmarried,  and  of  very  spare  build. 
He  had  been  in  the  Alexian  Brothers'  Hospital  previously.  At 
the  time  he  was  admitted  he  was  very  much  emaciated.  He  was, 
as  a  rule,  unable  to  retain  food,  and  when  his  stomach  did  retain 
anything  it  was  quickly  passed  away  by  the  bowels,  undigested. 
He  was  discharged  in  September,  and  came  to  my  office  about 
New  Years,  asking  to  be  readmitted.  He  had  been  unable  to  do 
labor,  and  had  a  cough  and  sore  throat.  He  had  been  a  member 
of  a  singing  society,  and  lost  Ids  position  on  account  of  inability 
to  sing,  suffering  from  laryngitis.  There  was  considerable  trou- 
ble in  his  laiynx.  Last  Sunday  ho  was  about.  On  Monday 
morning,  on  visiting  the  hospital,  I  found  him  in  a  dying  condi- 
tion. He  was  suffering  very  much  as  a  child  dying  from  croup  ; 
had  all  the  symptoms,  and  had  the  distress  that  children  have 
when  they  die  of  croup.  Next  morning  he  was  dead.  I  have 
looked  through  various  works  on  practice, and  have  read  that  the 
case  is  fatal  in  almost  every  instance,  and  Niemeyer  Bays  thai 
blood-letting,  blistering,  purging  and  fomentations,  applied  as 
they  generally  are,  are  of  no  avail.  Although  tracheotomy 
might  be  performed,  there  is  little  to  be  hoped  from  it.  In 
these  cases  the  constitutional  disturbance  is  such  that  the  patient 
usually  will  not  recover. 

[A  recess  was  here  taken,  and  the  members  of  the  Society  ex- 
amined the  specimen  under  consideration.] 

President  Maughs  requested  Dr.  Lutz  to  Btate  what  was  In- 
experience in  the  case. 

Dr.  Lutz  —  My  experience  in  this  case  was  at  the  post  mor- 
tem. The  infiltration  of  tin-  epiglottis  is  due  to  the  inflammation 
of  the  larynx.  As  you  have  sen,  two  large  ulcers  are  situated 
on  both  sides,  above  the  vocal  cords.  The  trachea  is  not  in- 
volved.   As  a  palliative   measure,  perhaps   tracheotomy   could 


178  Book  Eeviews.  [Feb.  20, 

have  been  performed.  The  man  suffei-ed  from  tuberculosisr  and 
had  cavities  in  both  lungs,  and  his  hours  were  numbered.  Only 
as  a  palliative  measure  would  an  operation  have  been  justifiable. 


6  o  o  \\   U  c  u  i  e  m  s . 


The  Cell  Doctrine:  Its  History  and  Present  State.  By 
James  Lyons,  M.  D.,  Prof,  of  General  Pathology  and  Morbid 
Anatomy  in  the  University  of  Penn.,  etc.,  etc.,  2d  Ed.  Lind- 
say &  Blakiston  publisher,  Phila.,  p.  199.    1879. 

This  is  a  very  interesting  and  readable  book,  in  which  we 
have  presented  a  very  clear  statement  of  the  views  of  many  mi- 
croscopists  and  pathologists  in  regard  to  the  origin,  position  and 
function  of  the  cell  in  living  organisms.  The  general  reader 
will  find  here  all  that  has  been  written  on  the  subject,  which  it  is 
important  for  him  to  know,  and  after  he  has  bestowed  as  much 
study  on  these  pages  as  they  deserve,  he  will  find  himself  much 
more  familiar  with  the  subject  than  when  he  began  it.  We  feel 
that  we  cannot  too  highl}^  commend  the  work  to  those  who  de- 
sire to  know  a  good  deal  about  the  cell. 

The  cell  is  now  known  to  play  a  most  important  part  in  liv- 
ing organisms;  and  what  we  have  in  Prof.  Lyon's  work  will 
serve  as  a  solid  basis  on  which  to  stand  to  take  a  further  and 
wider  view  of  the  Cell  Doctrine.  The  cell  is  certainly  the  basis 
of  a  rational  view  of  Histology;  and  it  is  now  an  almost  self- 
evident  truth  that  the  origin,  structure  and  function  of  the  tissues 
cannot  be  well  understood  without  a  clear  view  of  their  relation 
to  cell-organism.  The  tissues  are  certainly  the  result  of  the  def- 
ferentiation  of  cells;  but  just  how  this  defferentiation  takes  place, 
or  on  what  ground  it  is  to  be  accounted  tor,  has  not  been  ex- 
plained by  any  of  the  writers  quoted  in  this  work.  It  is  certainlj?- 
true  that  all  the  different  tissues  were  potentially  present  in  the 
fecundated  germ-cell ;  but  what  is  the  cause  of  the  defferentia- 
tion observed,  the  author  has  not  explained,  nor,  indeed,  suggested 
any  rational  view.  This  may  not  have  been  within  the  purpose 
of  the  work,  yet  the  subject  is  one  of  such  importance  as  to  merit 
some  consideration.  The  work  should  be  in  the  hands  of  every 
physician. 

H.  Christopher. 


1880.]  Book  Reviews.  179 

Higiene  de  la  Vista.  Por  el  Doctor  D.  J.  Santos  Fernandez. 
Obro  prennada  por  la  Real  Academie  de  Cienciaa  de  la  Ila- 
bana,  en  1875;  aumentada,  reformada  v  publicada  baja  la  di- 
receion  del  antor  por  1).  Elisdora  Arias  Gago,  Medico  Kilitar. 
[Habana:  Le  Propaganda  Literaria,  O'Eeilly, num. 54,  1979. 
16  mo. ;  pp.  272.] 

Hygiene  of  the  Eyesight.    By  Dr.  D.  J.  Santos   Fernandez. 

Prize  Essay,  presented  to  the    Royal   Academy  of   Medical 
Sciences  of  Havana,  in  1875;  enlarged,  revised,  and  published 
under  the  direction  of  the  author,  by  D.  Elisdoro  Arias  Grago, 
Military   Surgeon.     [Havana:     The    Propaganda    Literaria 
print,  No.  54  O'Reilly  street,  1879;  16mo.;  pp.  272.] 
This  little  work,  written  by  the  editor  of  the  Gronica  Medico 
Quirurgica  de  la  Habana,  is  one  which  ought  to  be  translated  into 
our  tongue,  as  it  would  certainly  find  a  large  number  of  readers. 
It  is  terse  and  clear,  and  embraces  a  large  and  varied  number  of 
subjects  connected  with  the  care  and   preservation   of  the  eye- 
sight.    Beginning  with  the  eyesight  in  childhood,  be  passes  all 
the  different  phases  undergone  till  glasses  are  used.     The  rela- 
tions of  trades  are  discussed,  as  also  the  effects  of  food,  drink, 
and  the  passions.     The   chapters   on    spectacles   and    spectacle 
frames  are  interesting,  as  well  as  that  on  opera  glasses.     The  pre- 
cautions to  be  used  by  those  employing  artificial  eyes  is  the  last 
and  not  least  useful  chapter.     This  is  followed  by  a  bibliography 
of  the  subject.  Dr.  A.  H.  Ohmann-Dumesnil. 

Proceedings  of  the  Association  of  Medical  Officers  of  Amer- 
ican Institutions  for  Idiotic  and  Feeble  Minded  Persons. 
Sessions:    Syracuse,  June    8-12,  1878;  Lincoln,  Mav   27-30 
1879. 

These  proceedings  make  a  good  showing  and  indicate  progress. 
At  the  two  sessions  a  number  of  excellent  and  instructive  sub- 
jects were  presented.  Dr.  Shuttleworth  discoursed  on  the  sub- 
ject of  intemperance  as  a  cause  of  idiocy;  Dr.  Fletcher  Beach, 
on  temporary  loss  of  speech  from  shock'  ;  Mrs.  (\W.  Brown,  on  the 
offspring  of  first  cousins;  Dr.  Seguin,  on  recent  progress  in  the 
training  of  idiots;  Dr.  C.  T.  Wilbur,  on  the  relation  of  speech  or 
language  to  idiocy;  Dr.  H.  M.  Knight,  on  internal  hydroceph- 
alus, and  Dr.  Isaac  N.  Kerlin,  on  juvenile  insanity.  Alter 
which  follows  "statistics  of  the  work  before  the  people  and  leg- 
islatures," showing  altogether,  very  satisfactory  progress. 

The  proceedings  were  throughout  interesting,  and  all  tho 
papers  creditable. 

It  is  gratifying  to  see  the  feeble-minded  in  tin-  care  of  such 
able-minded  men. 

The  superintendents  of  the  institutions  of  the  idiotic  and 
feebleminded  possess  a  love  for  psychical  investigation,  coupled 
with  an  earnest  philanthropic  spirit. 

C.  11.   Bdohes. 


180  Book  and  Pamphlets  Keceived.         [Feb.  20, 


Sooks  unti  |Jnmpl)lcts  Ucceiueti. 


Transactions  of  the  American  Otological  Society.  Twelfth 
Annual  Meeting,  Newnort,  E.  I.,  Julv  23,  1879.  Vol.  II,  part  3. 
[Boston,  1879.] 

Hints  on  the  Antiseptic  Management  of  Wounds.  By  Fran- 
cis M.  Caird,  M.  B.     [Edinburgh,  1880.] 

Treatment  of  Diphtheria.  By  Ira  E.  Oatman,  M.  D.,  of  Sac- 
ramento, Cal. 

The  Answer  of  the  New  York  Neurological  Society  to  the 
Document  known  as  the  Report  of  the  Committee  on  Public 
Health  Relative  to  Lunate  Asylums.     [New  York,  1880.] 

On  the  Medical  Uses  of  Electricity.  By  George  W.  Balfour, 
M.  D.,  F.  R.  S.  E.  London  Eng. 

The  Regulation  of  Medical  Practice  by  State  Boards  of 
Health,  as  Exemplified  by  the  Executive  of  the  Law  in  Illinois. 
By  H.  A.  Johnson,  M.  D.,  Chicago  111. 

Paquelin's  Thermo-Cautery,  with  Wilson's  Arithmetic  Shield, 
in  Epithelioma  of  the  Cervex  Uteri.  By  H.  P.  C.  Wilson,  M.  D., 
Baltimore,  Md. 

A  Copy  of  a  Circular  Address  to  the  Legislature  of  the  State 
of  New  York.  The  Petition  of  the  Undersigned  Plvysicians, 
Lawyers  and  other  Citizens  of  the  State  of  New  York. 

A  Protest  Against  Meddlesome  Midwifery.  By  H.  Gibbons, 
Sr.,  M.  D.  [Read  before  the  San  Francisco  County  Medical  So- 
ciety.] 

Report  of  the  Special  Committee  on  Medical  Education  be- 
fore the  Illinois  State  Medical  Society,  at  its  Twenty-ninth  Anni- 
versary Meeting,  held  at  Lincoln,  May,  1879.  E.  Ingalls,  M.  D., 
Chairman  Committee.     [Chicago,  1879.] 

A  Clinical  Lecture  upon  the  Operation  for  Inversion  of  the 
Lower  Eyelid.     By  F.  C.  Holtz,  M.  D.     Reprinted  from  the  Chi- 


1880.]  Books  and  Pamphlets  Received.  181 

cago  Medical  Journal  and  Examiner  for  January,  1880.     ("Chi- 
cago, 1880.] 

The  Student's  Guide  to  Diseases  of  the  Eye.  By  Edward 
Nettleship,  F.  R.  C.  S.  With  eighty-nine  illustrations.  Forsale 
by  the  Hugh  R.  Eildreth  Printing  Company,  St.  Louis  ;  pp.  369; 
large  16mo.     [Philadelphia:     Eenry  C.  Lea,  1880.J 

Clinical  Lectures  on  the  Diseases  of  Women,  delivered  in  St. 
Bartholomew's  Hospital.  By  J.Matthews  Duncan,  .M.  D.,  LL.  D., 
etc.;  8vo.;  pp.175.  Forsale  bythe  Eugh  R.Hildreth  Printing 
Company,  St.  Louis.     [Philadelphia:     Eenry  C.  Lea,  1880.] 

Pharmacographia.  A  Eistoryofthe  Principal  Drugs  of  "Veg- 
etable Origin  met  with  in  Great  Britain  and  British  India.  By 
Friedrich  A.  Fliiehiger,  Phil.  Dr.,  and  Daniel  Bambury,  F.  R.S. 

Second  edition;  8vo. ;  pp.  80S.      For  sale  by  the   Eugh  II.  Eil- 
dreth Printing  Company,  St.  Louis.    [London  :  Macmillan  &  I  !o 
1879,] 

On  Loss  of  Weight,  Blood-spitting  and  Lung  Diseases.     By 
Horace    Dobell,  M.  D.     Second    edition;   revised,  enlarged    and 
annotated;  to  which  is  now  added  Part  VI,  on  the  Functions  ami 
Disorders  of  the   Liver;    8vo. ;    pp.   306.     [London:     J.   &   A 
Churchill,  1880.] 

The  Sanitation  of  Small  Cities  ;  Soil,  Drainage.  Sewerage, and 
the  Disposal  of  Sewage.  By  David  Prince,  M.  D.  [From  the 
Transactions  of  the  Illinois  State  .Medical  Society   for  1879.] 

Biennial  Eeport  of  the  Missouri  Eye  and  Far  [nfirmary,  1304 
Chestnut  street.  From  June  26,  1877,  to  .Line  26,  1879 fact  of 
incorporation.     [St.  Louis,  1879.] 

Valedictory  Address  to  the  Graduating  Class  of  the  Medical 
Department  of  the  University  of  California,  By  W.  '•'.  McNutt 
M.  D.,  L.  R.  C.  P.,  Ed.,  etc.  '[Reprinted  from  the  Western  Lan- 
cet, December,  1879.] 

The  Second  Annual  Report  of  i lie  Presbyterian  Bye  and  Ear 
Charity  Hospital,  No.  77  Fast  Baltimore  street,  Baltimore,  Md. 
For  the  year  ending  December  1,1879.    [Baltimore:  [nnesA  Co.] 


182 


Meteorological  Observations. 


[Feb.  20, 


METEOROLOGICAL  OBSERVATIONS. 

By  A.  Wislizenus,  M.  D. 

The  following  observations  of  daily  temperature  in  St.  Louis  are  made  with  a 
maximum  and  minimum  thermometer  (of  Green,  N.  Y.) .  The  daily  minimum  occurs 
generally  in  night,  the  maximum  at  p.  m.  The  monthly  mean  of  the  daily  minima 
and  maxima  ad  led  and  divided  by  two,  gives  quite  a  reliable  mean  of  the  monthly 
temperature. 

1      THERMOMETER,  FAHRENHEIT— JANUARY,  1879. 


Day  of 
Month. 

Minimum. 

Maximum. 

Day  of 

Month 

Minimum. 

Maximum. 

1     .... 

.    .    29.0     .... 

....     39.0 

18     .... 

....    39.0 

63.5 

2 

19     .... 

....     485 

59.0 

3     .... 

....    49.0    .... 

....     64.5 

20     .... 

.    ..     42.5 

45.0 

....       1.0 

21     .... 

36.5 

51 .5 

5     .... 

....     51.0     .... 

....     64.0 

22     .... 

....     34.0 

36.0 

6     .... 

...    54.0     .... 

....     610 

23 

.     29  5 

43.0 

7     .... 

....    51  0     

....     61.0 

24     .... 

....     32.0 

48.5 

8     .... 

...     48  0     .... 

....    54.0 

25     

..    .     37.0 

56.5 

9     ... 

....     52.5     .... 

....     62.0 

26     .... 

....     38.5 

58.5 

27     .... 

. .    .     39.0 

62.5 

11     .... 

....     45  0     .... 

...66.5 

28     .... 

.      .     34.0 

38.0 

12     .... 

....     34.0     .... 

...     41.0 

29     

32 .0 

4  .0 

13      . . . 

...     29.5     .... 

....     42.5 

30     .... 

..       35.0 

55.5 

14    ... 

....     32.0     .... 
...     28.5     .... 

48.5 
....     43.5 

31     .... 

....  25.0 

39.5 

16    .... 

...     35 .0     .... 

....     68.5 

39  0 

17     .... 

.     41.5     .... 

....     55.0 

M  mrhly 

Mean. .  .45.8 

Quantity  of  rainfall,  3.71  incites. 


MORTALITY  REPORT.-CITY  OF  ST.  LOUIS. 


FROM  JANUARY  11,  1880,  TO  FEBRUARY  7,  1880,  INCLUSIVE. 


Diabetes 1 

Measles 4 

Syphilis 0 

S':ai  laiina.        .   . .  3 
Pyaemia  &  Septicae  :; 

Erysipelas 3 

Diphtheria ....       17 
Membran's  Croup.  10 
Whooping  Cough.  2 
Diabete-  .Mod  ins.  4 
Posl  I'art.  Ilem'ge  1 
Tjphoid  Fever       .10 
Cerebro  Spinal  Fe.  0 
Remiitent,     Inter- 
mittent,   Typho- 
Malarial,     Con- 
gest ive  &  simple 
ContinM  fevers,  9 
Puerperal  Fevers.     9 
Diarrhoea!  Disea'sll 


Exhaust.  I'm  Lab.  4 
Inanition,  Want  01 
Breast  Milk, etc.  4 

Alcoholism 4 

Itheumat'm  &Gout  l 
Cancer  and  .Malig- 
nant Tumor 9 

Phthisis  &  Tuber- 
culosis, l'ulmon.68 

Bronchitis. 9 

senility    28 

Pneumonia 32 

Heart  Diseases   . .  21 
other  Diseases  of 
Respir'y  organs  17 

Osteomyelitis 0 

.Marasmus —  1  abes 
Meseuterica  and 

Scrofula 18 

Aneurism    0 


Convulsions  &  Tris- 
mus Neonatornml9 

Hydrocephalus  an<t 
Tub.  Meningitis.  4 

Meningitis   &    hn 
cephaliti 


Other  Diseases  of 
the  Brain  and 
Nervous    System  7 

Cirrhosis  of  Liver 
ami   Hepatitis. ..  7 

Enteritis,  Gastro- 
Ententis,  Peri- 
tonitis, and  Gas- 
tritis   11 

Blight's  Disease 
and  Nephritis.       2 

Other  Diseases  of 
Urinary  organs. 

Atheroma  Arta.   . .  1 


Apoplexy 6 

Cyanosis  and  At- 
electasis  

Premature  &  Pre- 
ternatural Birth 
Death-,  by  Suicide  1 
Dea.ns  hv  Vcciil't  9 
D'ths  by  Homicide  3 
Congen  Delor'ly. .  18 
Total  Deaths  from 

all  Causes 368 

Total  Zymotic  Dis- 
eases   89 

Total  Constitution- 
al Diseases 104 

Total    Local     Dis- 
eases     136 

Total     Develop'tal 

Diseases         ....  26 
Deaths  by  Viol'ce  13 


CHAS.  W.  FRANCIS,  Health  Commissioner. 


1843.        jphemiijmss        1880. 


FOR   THE 

ST,  LOUIS  MEDICAL  AND  SURGICAL  JOURNAL 

FOR  1880. 

Those  who  are  acquainted  with  medical  periodicals  will  ^ee  at  once  that  the  St. 
Louis i  Medical  and  Surgical  Journal  is  the  largest  publication  fortlie  price  in  the 
United  States  or  even  in  the' world.  For  this  reason  it.seems  superfluous  to  offer  jpre- 
miurtis  in  its  subscribers.  In  facl  the  instruments  and  books  are  offered  more  as  a  con- 
venience to  the  profession  than  as  inducements.  v>  the  numberof  instruments  to  be 
given  a.-  premiums  will  be  quite  large,  I  have  been  enabled  to  make  such  arrange- 
ments with  Messrs.  Alex.  Heburn  &  Co..  of  i his  city,  thai  1  can  offer  them  to  sub- 
scribers at  a  reduction  fr  m  catalogue  juice-,     [f  the  reduction  is  nol  great  il  i-  l » 

both  the  instruments  and  the  Journal  arc  first-cla8s.  i  li  ise  taking  them  are  bure 
t0  .,..  their  money's  worth.  Upon  the  receipt  of  the  snms  set  opposite  the  various  offers 
mentioned  below" I  will  send  the  Journal  ami  Premiums  paid  for. 

Keports  ou  Yellow  Fever  to  St.  Louis  Medical  Society,  328 

pages,  82.50,  and  the  Journal,  for         ...         -  §4.00 

Proceedings  of  St.  Lou:s  Medical  Society  for  1878,  81.50, 

and  the  Journal,  for 3.75 

Reber  on  Paresis  of  the  Sympathetic  Centers,  $'.00,  and 

the  Journal,  for 3.50 

Borck  on  Fracture  of  the  Femur,  50c,  and  the  Journal,  for     3.00 

With 
Price.  Journal. 

Wilde's  Ear  Speculum,  Set  of  three **•«  *'";'' 

Lorribee's  Ear  Speculum,  Set  of  three ;;-.-  »•*» 

Frankel's  Nasal  Speculum ■ , ". 

Probang  (bristle)  for  removing  foreign  bodiesfrom  the  throat *•&" 

Sims'  Speculum,  Nickel  Plated • -  *  t~ 

Sims' Improved' Speculum   Nickel  Plated j-W  6.50 

N,,u'a  Trivah  e  Speculum,  Nickel  Plated »-«j  _'•  j*j 

Kectal  Speculum 2  00  4^50 

Powder lnsuflatdr "  "; ',„, 

Vulcellum  F« nee] is 4  75 

Uterine  Dressing  Forceps  '*"  :,  -0  4  --t 

g&fiS  %Z&£?32&. Ca&  Graduated ion  Bowl «Plito.":::::;:  Jg  ■    J.gj 

Double  Bladed  Knife. .,  ,l(l  r,  (ll| 

Goulay's Catheter •"      :;  (ll)  5  00 

Four  Jaques'<  all, ether ..  ll(|  -,  ,,, 

5S&  ;^;^,;V;::;;i:,'cr;.-;^ ,  v^in.gua^i. 

KSSxtiUo^^  |.j 

Mar  in'-  Klas  ic  Bandage.   - ..  -  .  -  -- 

Esmarch's  Tourniquet  for  151 Uess  Operations    ;  •; 

sit  orEishtRumbold's  Spray  Tubes,  each  111  a  box  4.00  6.00 

One  Double  Bulb  for  Atonafcing. 7  ,„,  8  7=, 

One  Pair  Hodge's  Obstetrical  Forceps,  Nickel  1  fated ^ 

Haie's  ..  ..  ..  ..  9.00         10.26 

Sawyer's  __  ..  ..  .,-,,,  }i  ,M) 

Elliott's  "  '  ;;    0  6  50 

Attir's  Dilator ,,  ,„,         1 

Ellinger's  Dilator 

Loamir.s  Placenta  Forceps g 

Placenta    Forceps  4  -„  ,-.  :,  > 

S5.SLE  ;'\11na,;;r;,i1b.a1b,,cr.:an;--:::::::::::::::: 

Catheter  Nasal  Douche ,.  (l0 

Tom  ,  •     1  1.25 

Modiiiciilion  of  Lucas's  tar  ft     '  

Anvoftheabovi  their  eqnivn  »  ""* 

be  higher  priced.     All  of  the  above  named  G 


New  Remedies 


FLUIB  EXTRACTS. 

m    i      fj_  „1_        From  Bolivia.    Almost  a  specific  in  acute  and  chronic  diarrhoea,  cholera, 
UOtO  JJctrii. ""cholera  morbus,   etc 

n- «*-«.-    CU  ,*«•»»  J «        (Rhamnus  Purshiana  )    From  the  Pacific  Slope.    A  certain 
U2lSC3«r2»  wa&TcLClcl. — remedy  lor  habitual  constipation:  and  very  useful  in  all  cases 

where  a  laxative  or  cathartic  is  indicated.    Beware  of  the  fluid  extracts  of  spurious 

varieties  of  this  bark. 
T\    V*»    fl/tw^Vm        From  Brazil.     A  powerful  alterative,  which  exerts  a  marked  curative 
£  Ollcl  WO.ro  D3B." "action  in  syphilis,  scrofula  and  kindred  disorders. 
"D  It      c    A  T/vm  a  +  Im         A  ™medy  iu  diabetes,  and  other  diseases  of  the  genito-urinary 

T\     «^;«s-«         (Turnera  Aphrodisiaca.)    From  Mexico.    The  best  known  aphrodisiac.    Of 
UamiclUcl. "great  value  iu  impotence,  spermatorrhoea,  and  loss  of  sexual  appetite. 
"Drtl^A         (Peumus  Boldo.)     From  Chili.     Thenew  tonic.     Very  useful  in  dyspepsia,  hepatic 
JjOl&f*  ""torpor,  yellow  fever,  etc. 

■n^-T-     .:«     A««;fAlMiwi        From  California.    Has  marked  alterative  and  tonic pow- 
JjGr  DtfllS  21Q  uliQIiUIIl.~"ers)  and  has  been  used  with  extraordinary  success  in  salt 

rheum.,  psoriasis,  eczema,  scrofula  and  syphilis. 
T31«/->1t  TTottt        (Viburnum  Prunifolium.)    From  the  United  Stacks.    Employed  to  pre- 
JjlclCK  llci  vv  ■  ""vent  abortion  and  miscarriage. 

uTlHCL6ll2L  luODUStcL."  diseases  of  the  air  passages. 

n«:«JAi;«    C*ni«*,«n«        From    California.      Anti-maian 

(jrillClGllcL  wQ  U.2.rOScL. — spleen  and  other  malarial  diseases 

r<«««„«   T5«««1««/3;;         (CereusGrandflorusandCereusMcDonaldii.)    FromMEXico. 

UGrGUS  JjOHpi3.IiQ.ll. ""Heart  sedatives.    Very  useful  iu  controlling  functional  and 

organic  disturbances  of  the  heart 

|        (Dyospyros  Kaki.)     From  Jj 

L.— in  mucous  dyspepsia,  typhoid  fever,  etc 

PoTriC!  Ps  Y1  9  rl  OY1  Cl  C       Indigenous.    A  positive  remedy  in  chronic  diarrhoea,  dysentery 

Jaboramli,  (diaphoretic).      Guatana,  (sick  headache) .      Fucus  Vesicnlosus,  anti-fat. 
Iicarsfoot,  (enlarged  spleen) .  Coca,  (nervous  stimulants.)  Mava  Kava,  (Gonorrhoea) . 
Eucalyptus  Globulus,  [anti-septic  and  anti-malarial.]      Yerba  Santa,  (coughs]. 
Yerba  Keuma,  (catarrh) .        Wood  lie  tony,  [dyspepsia] .  Cstilag©  Maidis,  [oxytocic] . 
Penthoruni  Sedoides,  [catarrh].  Soap  Tree  Bark,  [tooth  wash]. 


From  California.    A  valuable  curative  agent  in  asthmaand 
liseases  of  the  air  passages. 
From    California.      Anti-malarial.      Used    "In  enlarged 


■JT-I-Z       (Dyospyros  Kaki.)     From  Japan.    Peculiar  action  on  the  mucous  surfaces.     Useful 


CRUDE  DRUGS. 

Goa  Powder,  [ringworm  and  diseases  of  the  skin]. 

Gurjuu  Balsam,  [a  substitute  for  Copaiba]. 

Alstonia  Constricta,  [a  substitute  for  Calisaya) 


SUGAR  COATED  GRANULES. 

Calcium  Sulphide,  1-10  g-r,  [for  the  cure  of  boils  and  carbuncles.] 
Our  limited  space  prevents  our  describing  in  detail  the  history  and  application  of  each  remedy 
but  to  those  interested  in  New  Remedies,  we  will  say,  that  we  can  furnish 
inferesting  information  relative  to  the  above  new  drugs. 

PARKE,  DATIS    &z   OO., 
DETROIT,     -       -      MICHIGAN. 

If  you  desire  to  pri  cure  any  of  i  lie  id  Now  Remedies,  send  for  same  to  Kichardson  A-  Co., 
Meyer  Bros.  A-  <'<►..  A.  A'.  Mellier,  Jacob  S.  M  err  ell,  and  ii.  K.  Hopkins  A:  Co., 
si.  Louis;  Arthur  Peter  A  <'<»..  It.  A.Robinson  A  Co..  Louisville;  Win.  i,ii- 
terer  A  «'<>..  Nashville;  it.  Macready  A  Co.,  Hale,  Justis  &Co„  Kauelil'uss, 
Eager  A  <'«>.,  <'.  A.  \nis<n  A  <'«.,  and  «'.  10.  Potts  a  Co.,  Cincinnati;  Miller  A 
Pleree,  Richmond;  specifying  "P.,  I>.  A-  Co.'s"  in  all  cases;  by  so  doing  you 
ensure  reliable  preparations  ol  the  true  drugs.